Arthritis Australia

By G. Hector. Swarthmore College.

In severe disease the ngers lose pulp substance generic 50mg losartan visa, ulcerate or Cryopathies Cryoglobulinaemia Cryobrinogenaemia become gangrenous (Fig order losartan 50 mg otc. However, Neurological disease Peripheral neuropathy some patients with what seems to be Raynaud s Syringomyelia disease will later develop a connective tissue disease, Toxins Ergot usually scleroderma. The blood pressure should be monitored before effective agents although they work best in patients each incremental increase in the dosage. Patients should be (30 60 mg three times daily) is less effective than warned about dizziness caused by postural hypoten- nifedipine but has fewer side-effects. Initially it is worth giving nifedipine as a 5-mg ators such as naftidrofuryl oxalate, nicotinic acid and test dose with monitoring of the blood pressure in the thymoxamine (moxisylyte) are also worth trying. If this is tolerated satisfactorily the starting Glycerol trinitrate ointment, applied once daily may dosage should be 5 mg daily, increasing by 5 mg every reduce the severity and frequency of attacks and may allow reduction in the dosage of calcium channel blockers and vasodilators. Infusions with reserpine or prostacyclin help some severe cases although occasionally sympathectomy is needed. Temporal arteritis Here the brunt is borne by the larger vessels of the head and neck. The condition affects elderly people and may be associated with polymyalgia rheum- Fig. Blindness may follow if the ophthalmic arteries are involved, and to reduce this risk systemic steroids should be given as soon as the diagnosis has been made. Atherosclerosis This occlusive disease, most common in developed countries, will not be discussed in detail here, but involvement of the large arteries of the legs is of concern to dermatologists. These may develop slowly over the years, or within minutes if a thrombus forms on an atheromatous plaque. The feet are cold and pale, the skin is often atrophic, with little hair, and peripheral pulses are diminished or absent. Fasting plasma lipids (cholesterol, triglycerides and lipoproteins) should be checked in Cause the young, especially if there is a family history of vascular disease. Doppler ultrasound measurements The main factors responsible for pressure sores are as help to distinguish atherosclerotic from venous leg follows. Arterial emboli 4 Malnutrition, severe systemic disease and general Emboli may lodge in arteries supplying the skin and debility. Causes include Clinical features dislodged thrombi (usually from areas of atheroscle- rosis), fat emboli (after major trauma), infected emboli The sore begins as an area of erythema which pro- (e. The skin overlying the sacrum, greater Sustained or repeated pressure on skin over bony trochanter, ischial tuberosity, the heel and the lateral prominences can cause ischaemia and pressure sores. These are common in patients over 70 years old who are conned to hospital, especially those with a frac- Management tured neck of femur. Regular cleansing with normal saline Treatment is anticoagulation with heparin and or 0. Appropriate operation is less frequent now, with early postoperat- systemic antibiotic if an infection is spreading. If the affected vein is varicose or supercial it will be red and feel Deep vein thrombosis like a tender cord. The leg becomes suspicion of an underlying malignancy or pancreatic swollen and cyanotic distal to the thrombus. Abnormalities of the vein wall Trauma (operations and injuries) Chemicals (intravenous infusions) Neighbouring infection (e. Femoral vein This persisting venous hypertension enlarges the cap- illary bed; white cells accumulate here and are then activated (by hypoxic endothelial cells), releasing Popliteal vein oxygen free radicals and other toxic products which cause local tissue destruction and ulceration. The increased venous pressure also forces brinogen and 2-macroglobulin out through the capillary walls; these Long macromolecules trap growth and repair factors so that saphenous vein Short minor traumatic wounds cannot be repaired and an saphenous vein ulcer develops. Patients with these changes develop lipodermatosclerosis (see below) and have a high serum brinogen and reduced blood brinolytic activity. Communicating veins Clinical features Medial Venous hypertension is heralded by a feeling of heavi- malleolus ness in the legs and by pitting oedema. Other signs include: 1 red or bluish discoloration; 2 loss of hair; 3 brown pigmentation (mainly haemosiderin from Fig. Cause Incompetent perforating branches (blowouts) between Satisfactory venous drainage of the leg requires the supercial and deep veins are best felt with the three sets of veins: deep veins surrounded by muscles; patient standing. Under favourable conditions the supercial veins; and the veins connecting these exudative phase gives way to a granulating and togetherathe perforating or communicating veins healing phase, signalled by a blurring of the ulcer mar- (Fig. When the muscles relax, with the help of gravity, the leg the look of an inverted champagne bottle. If an ulcer has a hyper- plastic base or a rolled edge, biopsy may be needed to rule out a squamous cell carcinoma (Fig. The most important differences between venous and other leg ulcers are the following.

Isolation of calves to a separate In pure Mycoplasma pneumonia discount losartan 25mg on line, fatalities are rare order losartan 25 mg amex, but farm following immediate removal from their dams may typical Mycoplasma pneumonia gross lesions appear as be the only solution. These vention of Mycoplasma infection in calves include avoid- areas resemble atelectatic areas but are rm, and pus ing feeding Mycoplasma bovis infected milk, using sepa- may be expressed from the airways within these rm rate feed buckets and bottles for every calf, and preventing areas on a cut section. In most instances in which Mycoplasma is merely one Viral Diseases of the Respiratory Tract component of infection, gross necropsy lesions are typi- cal of the other pathogens usually anterior ventral con- Infectious Bovine Rhinotracheitis solidating bronchopneumonia typical of Mannheimia, Etiology and Signs. Treatment for Mycoplasma pneumonia reproductive tract, infectious balanoposthitis of the male may be unnecessary in some pure Mycoplasma infections external genitalia, endemic abortions, and the neonatal because the cattle do not appear extremely ill. In pure septicemic form characterized by encephalitis and focal infections, oxytetracycline hydrochloride (11 mg/kg plaque necrosis of the tongue. Abor- lones are reported to be the most effective antibiotic tions may occur in association with any of the forms of against Mycoplasma, but these are not approved for use the disease, either during the acute disease or in the en- in dairy cattle in the United States. Each infected herd animals usually continue to eat, chlortetracycline or seems to have one predominant clinical form of the dis- oxytetracycline (Terramycin, Pzer) added to the feed in ease, but occasional animals may also show signs of therapeutic levels may provide effective therapy for other forms during an endemic. If the Pasteurella or Histophilus isolate is recrudescence when previously infected cattle harboring sensitive to tetracycline or erythromycin, choosing one of latent virus infection are stressed by infectious diseases, these drugs may provide efcacy against both the bacteria shipment, or corticosteroids. Fortunately, if treatment is directed fection or vaccination is short lived and probably does against the bacterial pathogens and ventilation or man- not exceed 6 to 12 months. These problems have been very (These viruses are discussed further in this section. Therefore these herds, but calf hutches do seem to prevent bacterial combination infections may result in high mortality be- infection in the calves. Although fetal mortality Although bronchitis and bronchiolitis occasionally have can occur at any stage of gestation, most abortions oc- been observed, most cases do not have pulmonary pa- cur in cows in the second or third trimester of preg- thology unless secondary bacterial bronchopneumonia nancy. Devastating mortality may occur in stressed, conjunctiva and serous ocular discharge that becomes recently transported or purchased animals that develop mucopurulent within 2 to 4 days. In addition, viral isolation is possible dur- and a penlight is present in the right lower corner of the ing this time. The virus certainly may have been present for much longer, but new diag- nostic procedures, increased technology in virology, and recognition of the virus and its pathophysiology have heightened awareness of this disease. One word of caution, however throughout the United States in the 1980s in endemic individual sick cows with septic mastitis, septic metritis, form in beef and dairy cattle. The virus apparently does not infect alveolar macrophages but may damage physi- cal defense mechanisms of the lower airway, such as mucociliary transport, and may lead to antigen-antibody complexes that subsequently engage complement and result in damage to the lower airway. In any and rales (usually as a result of secondary bacterial bron- event, interstitial pneumonia, secondary bacterial pneu- chopneumonia) have been described. However, the relative de- agement and have not purchased new cattle, shipped cit of airway sounds ts the existing pathology because and returned existing cattle, or stressed animals in any pneumothorax and/or diffuse interstitial edema and em- apparent way. Where did the infection come from in physema compress the small airways and cause the lungs these herds? This is the same phenomenon that occurs thought to be the reservoir, but it has not yet been in proliferative pneumonia in which the alveoli and shown how or why the virus activates, replicates, and small airways are obliterated or reduced in size. Dyspnea will be severe in such cases, and virus, or serologic conrmation when acute epidemics affected animals usually show open mouth breathing of respiratory disease occur in cattle. Despite the high high morbidity in the affected group within several days fevers and respiratory distress, affected cattle frequently to 1 week. The rst stage or phase of the disease is ple increased respiratory rate (40 to 100 breaths/min) characterized by mild or more serious signs as described to open mouth breathing; and in all but the most mild above. Because these animals initially appeared cultation of the lungs in acute cases may reveal a wide to have mild disease and responded to treatment, this range of sounds. These signs are rarely seen in calves younger than 6 weeks, but calves aged 2 to 6 months seem to be most commonly affected. Auscultation of the lungs in acute cases may be helpful if the lungs sound diffusely quiet despite obvious severe dyspnea. Any se- vere pneumonia (especially other interstitial pneumo- nias or severe consolidating bronchopneumonia) can also cause subcutaneous emphysema because the only C remaining normal lung tissue (dorsal or caudal lung elds) is overworked to the point at which emphysema and interstitial edema are likely. Baker and Frey emphasize that antibody titers show reasonable patience when requesting conrmation may increase early after acute infection and often peak of viral diseases. Therefore collection of se- the laboratory, explain the seriousness of the outbreak, rum on day 1 and day 14 is very important when evaluat- provide appropriate samples, and ascertain the appro- ing seroconversion. Necropsy otics are indicated to counteract or discourage bacterial specimens may be very helpful in establishing a diagno- bronchopneumonia and should be initiated following sis. This is especially true if death has been acute and collection of tracheal wash samples from acutely in- secondary bacterial pneumonia has not yet developed to fected calves or cattle. In addition, focal rm bacterial therapy may be instituted if bacterial patho- areas of pneumonia will be palpable throughout the en- gens are isolated. Subsequent laboratory procedures may identify the ity reaction, should receive antiinammatory medication causative virus, but viral cultures often lag behind bacte- in addition to broad-spectrum antibiotics. Despite the clinical frustra- onset and extreme dyspnea exhibited by these animals is tions and economic consequences, the veterinarian must usually fatal; therefore heroic therapeutic measures are indicated.

Failure of the dermal papilla to reach the hair follicle bulge during catagen stage will lead to cessation of follicular cycling as seen in patients with congenital papular atrichia buy 50mg losartan with visa. These patients carry a mutation in the hairless gene or vitamin D receptor gene cheap losartan 25mg without prescription, resulting in permanent disconnection of the der- mal papilla from the hair bulge, leading to hair loss (25). In horizontal sections, the catagen hair is generally round or oval and is surrounded by a thickened hyaline membrane, often concertinaed by compression from the ascending hair bulb. The catagen hair usually contains apoptotic cells, which stain reddish with hematoxylin and eosin. The level of this section shows only a shrinking outer root sheath (trichilemma) which is surrounded by a thickened hyaline membrane, indicating catagen (hematoxylin and eosin stain, original magnication 200x). Terminal Telogen Hair After catagen, the hair follicle enters telogen, where the hair follicle matures into a club hair. The hair follicle retracts to the level of the bulge at the site of insertion of the arector pili mus- cle into the follicle (Fig. Here the resting hair comprises a telogen germinal unit situated below the telogen club. The telogen germinal unit consists of trichilemma, which is somewhat convoluted and surrounded by palisading basaloid cells. The telogen germinal unit has a char- acteristic appearance and shows no obvious apoptosis (Fig. A telogen club comprises a central mass of trichilemmal keratin, star-shaped in horizontal section, surrounded by trichil- emmal and brous sheaths, connecting telogen germinal units and hair shafts (Fig. After 2 to 4 months of telogen, the telogen germinal cells envelops the dermal papilla and grows down the existing follicular tract or stela to form an anagen hair (Fig. Subsequent hair cycling will continue throughout life for as long as the hair follicle is viable. A certain proportion of the hair follicles undergo growth, regression, and rest, continuously and independently. This process involves orchestration of a complex yet delicate interplay of molecular signals. A thorough knowledge of the gross and microscopic follicular anatomy in vertical and horizontal sections is essential for the accurate interpretation of the biopsy, leading to the successful evaluation of the patient with hair disorder. Note that total brosis without a vascular supply indicates cicatricial alopecia and a lack of ability for further cycling. The Structure of the Human Hair Follicle: Light Microscopy of Vertical and Horizontal Sections of Scalp Biopsies. Transverse microscopic anatomy of the human scalp: a basis for morphometric approach to disorders of the hair follicle. Label-retaining cells reside in the bulge area of pilosebaceous unit: implications for follicular stem cells, hair cycle and skin carcinogenesis. A comparison of vertical versus transverse sections in the evaluation of alopecia biopsy specimens. Vertical and Transverse sections of alopecia biopsy specimens: Combining the two to maximize diagnostic yield. Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. Morphology and properties of Asian and Caucasian hair J Cosm Sic 2006; 57:327 338. Difference is hair follicle dermal papilla volume are due to extracellular matrix volume and cell number: implications for the control of hair follicle size and androgen responses. Atrichia caused by mutations in the Vitamin D receptor gene is a phenocopy of generalized atrichia caused by mutations in the hairless gene. Hair cosmetics can be helpful in camouaging hair loss by optimizing the appearance of exist- ing hair; however, hair cosmetics may also be the cause of hair loss when improperly used or used to excess. The primary goal of this chapter is to help the reader understand how shampoos and conditioners can be incorporated into a treatment algorithm for patients undergoing hair disease treatment. The secondary goal of this chapter is to understand hair loss precipitated by hair coloring, permanent waving, and hair straightening. While these procedures can beautify the hair or appeal to fashion concerns, they can also permanently damage the hair protein and produce premature hair breakage and loss. Haircare is important because damage to the non- living ber is permanent until replaced by new growth, which is a time-consuming activity. Cleansing the hair is actually a complex task, since the average woman has 4 to 8 square meters of hair surface area to clean (2). Thus, the goal of a shampoo is to maintain scalp hygiene while beautify- ing the hair. A shampoo that has high detergent properties can remove the outer cuticle of the hair shaft rendering it frizzy and dull, while a well-designed conditioning shampoo can impart shine and improve manageability.

The calf also had Congenital nystagmus has been observed in several congenital absence of the tail and a ventricular septal breeds and is common in Holsteins cheap 25 mg losartan with amex. It persists throughout the animal s life and does not seem to interfere signicantly with vision generic losartan 25mg with visa. The temporal bulbar conjunctiva has become pigmented as a result of chronic exposure. Enucleation has been successful in these cases, and the relatively rare incidence rules against inheritance. Microphthalmic globes usually are not treated, but if no other anomalies exist, the owner may elect to raise a calf with unilateral microphthalmos. Chronic conjunctivitis occurs in some microphthalmic patients and, if persistent and severe, may dictate enucleation to stop chronic discharge and y irritation, thereby aiding patient comfort. Acquired Diseases Acquired megaglobus may follow severe intraocular in- ammation of exogenous or endogenous cause. Endophthalmitis and pan- ophthalmitis secondary to septic uveitis or ocular perfo- ration may also cause megaglobus. If megaglobus is se- vere enough to cause exposure keratitis, the affected globe should be enucleated to prevent eventual perfora- tion or panophthalmitis. Neurologic Diseases Unilateral facial nerve palsy causing ptosis and exposure keratitis is common in calves affected with otitis media/ interna and adults affected with listeriosis. Trauma may cause facial nerve injuries resulting in neuroparalytic keratitis in bovine patients of any age. The most com- mon cause of bilateral eyelid paralysis in cattle is stan- chion trauma wherein a cow pulls back against a stan- chion until her head is trapped along the temporal ridge between the ears and orbit. Signs of neuroparalytic keratitis include lacrimation, ptosis, absence of palpebral response, and progressive corneal exposure damage. Treatment requires therapy for primary diseases and protection of the cornea with frequent application of antibiotic ointments or tarsor- rhaphy. Cattle with facial nerve paralysis appear to be much less likely to develop corneal ulcers than in many other species. Treatment of stanchion paralysis requires warm compresses, systemic antiinammatories, and pro- tection of the cornea with ocular lubricants or broad- spectrum antibiotic ointment if indicated. Tetany of the retractor oculi muscles pulls the improvement in appetite and production as a result of resolution of pain and irritation caused by the enlarged globe caudally in the orbit, allowing passive prolapse of globe. Inammatory Diseases Less frequently, megaglobus follows intraocular neo- plasia or granulomatous infections of the uveal tract. The eyelids can perforations, chronic uveal inammation, and severe be severely swollen as a result of hemorrhage or inam- pinkeye complications such as corneal perforation and mation because cattle have abundant eyelid skin with a iris prolapse. However, if chronic conjunctivitis, surgeon a great deal of tissue to work with if surgical or facial dermatitis from discharges, and y irritation affect plastic repair is necessary. Cellulitis of the eyelids and secondary orbital cellulitis are possi- ble in neglected or dirty wounds. Less common causes of lid inammation include Congenital Diseases actinobacillosis granulomas appearing at the site of pre- Ancillary or supernumerary nasolacrimal duct open- vious eyelid injury and demodectic mite infestation. Lacerations of the eyelid may be closed using a two-layer technique with absorbable sutures (2-0) in the lid stroma and nonab- sorbable sutures (2-0 or 3-0) in the skin. Atypical large bropapilloma growing from the upper Actinobacillosis granulomas should be debulked, eyelid of a Holstein heifer. This tu- mor requires aggressive early therapy to prevent pro- gression, or the cow will be lost. In tion of early tumor formation when the mass is less most instances, the tumors are raised, rm masses with than 2. These large tumors also are are mostly white or have nonpigmented lid margins or more likely to invade adjacent adnexal tissue, orbital nictitans are at risk. Tumors at most bovine patients with squamous cell carcinoma the medial canthus are extremely dangerous because ( cancer eye ) are Holsteins. True Treatment options include: squamous cell carcinoma of the eyelid usually is pre- 1. Sharp surgery: This is best performed on lesions ceded by precursor lesions that are epitheliomas or a smaller than 1. Fibropapillomas normally are self-limiting within 4 to This method also is indicated for squamous cell car- 6 months and do not require treatment. Cryosurgery: This is perhaps the best therapy for small to moderate lesions because the freeze can be adjusted to the size of the tumor and cosmetic results at the lid margin tend to be good, thereby preventing subsequent exposure keratitis from loss of lid margin. The cow is sedated, restrained, and the tumor site blocked by regional anesthesia. Tissue peripheral to the lesion is shielded with petroleum jelly, and a Styrofoam wedge can be applied to the cornea to act as a protective contact lens if the lid margin area must be frozen.