persistierte die Urachusfistel und es traten lokale Entzündungen auf, die zum Abbruch der konservativen Therapie und zur chirurgischen Versorgung des Nabels führten.Während die Lotagen ® -Behandlung bereits nach zwei Tagen bei 84 % der Fohlen zu einer lokal umschriebenen Entzündung führte, die sich bei vier Fohlen (50 %) bis auf den Blasenpol ausgedehnt hatte, zeigte die Kryochirurgie eine Omphaloarterourachitis bei 2 Tieren (16 %) erst am 11 respektive 17 Tag der Therapie. Im Rahmen der Nabelresektion der therapieresistenten Patienten war es auffällig, dass intra operationem bei allen mit Lotagen ® behandelten Fohlen nicht nur der Urachus und die Harnblasenwand in unterschiedlichen Ausmaß entzündlich verändert waren, sondern auch eine lokale Peritonitis im Bereich dieser umbilikalen Struktur bestand. Hingegen trat nur bei 33 % der operierten Fohlen aus der Kryochirurgiegruppe eine Omphaloarterourachitis auf. Eine konservative Therapie ist nur erfolgreich, wenn der Diameter des Urachuslumens ≤ 6 mm ist und keine umbilikalen Inflammationen vorliegen. Die kryochirurgische Versorgung der Urachusfistel ist der Verödung mit Metakresol (Lotagen ® ) vorzuziehen, da nur selten und erst nach langer Therapiedauer geringgradige Entzündungsreaktionen der umbilikalen Strukturen auftreten. Eine Verödung von Urachusfisteln kann wegen der hochgradigen Entzündungsreaktionen nicht empfohlen werden.Schlüsselwörter: Fohlen, Urachusfistel, Kryochirurgie, Verödung mit Metakresol, Komplikationen Conservative therapy of the patent urachus in foals: Cryosurgery versus obliteration with metacresoleThe patent urachus is one of the most common complications in immunsuppressed foals. The persistent urachus is a primary portal of entry for bacteria leading to complications such as ascending navel infection, septicaemia and subsequent joint diseases. An early and effective occlusion of the urachus is therefore essential. Conservative treatment regimens for sealing the lumen of the fistula by chemical cauterization (silver nitrate, Lugol's iodine, phenol, 5% formalin, PVP-iodide or metacresole), cauterization or cryosurgery are recommended in the absence of infections of the umbilical structures. This study compares the effectiveness of cryosurgery and obliteration with metacresole (Lotagen ® ) concerning treatment success and side effects. In total, 20 foals of various breeds, aged between 2 and 15 days and presenting an patent urachus without inflammation of the umbilical structures were included in this study. A clinically segmental examination including a profound navel check was performed first. Thereafter, the navel was examined by ultrasound comprising the dimensional measurement of the navel structures. The obliteration with metacresole (Lotagen ® ) was applied in 8 foals. Twelve horses were treated cryosurgically. The treatment success was assessed by clinical and ultrasound follow-up findings. The conservative treatment was successful in 40% of all foals irrespective of the applied treatment. Comparing the crure rate, use of cryosurg...

ObjectiveEpidural venous varicosity (congestion of the epidural vein) is rarely introduced as an influential factor of clinical symptoms. However, there are several studies suggesting that epidural venous varicosity results in neurologic symptoms. We would like to highlight evidence that epidural venous varicosity results in neurologic symptoms and the relation between epidural venous varicosity and neural structure observed during the surgery. Based on our experiences, we also propose a new classification of epidural venous varicosity.Methods29 patients with symptomatic lumbar stenosis received microsurgical decompression via partial hemilaminectomy. The authors retrospectively reviewed all recorded intraoperative pictures and categorized patterns of venous varicosities with relationship to neural structures.ResultsType A is conditions in which epidural veins are dilated but located parallel to the nerve root on the lateral side of the nerve root and thus do not compress the nerve root. Type B is conditions in which varices are located on the anterior lateral side of the nerve root to compress the nerve root. Type C is conditions in which varices are encircled around the nerve root and compressing the nerve root.ConclusionEpidural venous varicosity is observed in most lumbar stenosis patients with clinical symptoms. Of the types, the types of epidural venous varicosity compressing nerve structures were Type B and Type C. All epidural venous varicosities were removed regardless of classification during operations. Most patients showed relief in clinical symptoms after the operation. We thought to epidural venous varicosity as a factor that causes clinical symptoms of lumbar stenosis.

While extruded disc fragments are known to migrate anteriorly, posteriorly, or laterally to the theca sac, posterior migration of the fragments is relatively rare and sudden onset of cauda equina syndrome (CES) caused by the migration is extremely rare. The authors experienced a case of CES that was manifested abruptly with sudden paraplegia caused by posterior migration of the lumbar intervertebral disc. A 74-year old man, who had no prior significant neurologic signs or trauma history, visited our emergency center with paraplegia of both lower extremities occurring suddenly when awakened. On magnetic resonance image (MRI) findings, we could detect ruptured disc herniation with severe lumbar stenosis at the L2-3 level. We performed an emergent decompression, and the right posterior migrated disc fragments at L2-3 were intraoperatively observed. The patient was fully recovered himself on the follow up after 3 months of the operation. In conclusion, early operation can result in better outcome in acute paraplegia caused by the posterior migrated disc fragments.

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