unilateral sixth nerve palsies as early presenting signs of metastatic prostatic carcinoma AbstractPurpose To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma. Methods The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed. Results Diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition.Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage. Conclusion Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed.In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology. Keywords: cranial nerve palsies; base of the skull metastases; prostatic carcinoma; bilateral third nerve palsies; radiotherapy; prostate specific antigen Base of the skull metastases are a rare but documented late complication of metastatic prostatic carcinoma, which can give rise to cranial nerve palsies. 1 We report four cases, which were unusual in that the nerve palsy was the presenting feature of the disease in two cases and a recent diagnosis of prostatic carcinoma had been made in the other two. Case reports Case 1A 66-year-old male presented with facial tingling, which resolved and was followed by the onset of diplopia.Extraocular movements revealed limitation of upgaze, adduction and depression in both eyes with full abduction. Slight bilateral ptosis was noted. The right pupil was dilated and unreactive to light and accommodation but the left pupil was normal. The remainder of the physical and neurological examinations were unremarkable. Investigations (blood
This publication is a compilation of all Research Abstracts presented at the Ninth International Conference on Equine Exercise Physiology. Unlike previous ICEEP conferences there will not be a conference proceedings of full length manuscripts. These abstracts succinctly summarise a wide array of investigations relevant to the equine athlete, and will be useful to veterinarians and others involved in management of horses used for sport, work and competition. The abstracts encompass the topics of Applied PhysiologyIntroduction: The ability to accurately assess equine oxygen consumption (VO2) under field conditions has been limited by the need for unrestricted gas exchange.Methods: Two variations of a mask and an associated electronics control module (ECM) were designed to enable breath-by-breath measurement of airflows with two 8.0 cm diameter pneumotachometers located 7.5 cm in front of each narus and connected to differential pressure transducers mounted on the outside of the mask. The ECM was comprised of electronics for signal filtering to the flow transducers, an oxygen sensing cell, and an analog-to-digital converter all powered by a lithium-ion battery. The battery also powered a pump connected to gas sampling ports between the nares and pneumotachometers. Airflow and oxygen content of inspired and expired gases were recorded through the ECM and electronically transferred to a notebook. VO2 was determined from these recordings by an operator using a customized software analysis program. One mask encased the lower head (E). The other left the jaw free so horse could wear a bit and be ridden (R). Multiple treadmill exercise tests were undertaken by 6 horses to measure VO2max and blood gases. Each mask was worn twice and results compared to those from an open flow-through system (O) by 2-way RMANOVA (P<0.05). Utility of the system was evaluated using the intraclass correlation coefficient of 4 independent raters.Results: Blood gases and VO2max (152.0 ± 4.0 (mean ± SEM; O), 147.7 ± 4.3 (E), 150.7 ± 3.3 (R) ml/(kg.min) were not different between masks. VO2 measures were reproducible for each mask. Agreement between the 4 raters was excellent (intraclass correlation coefficient = 0.99).Conclusions: Masks capable of measuring VO2 during field exercise were developed, tested and found accurate by multiple users.Ethical Animal Research: Studies performed were approved by the Institution's Animal Care and Use Committee (protocol #3807). Sources of funding: Institutional sources. Competing interests: Washington State University has filed notice of its intent to apply for a patent for facemask used in this study.Introduction: Exertional myopathies are a common cause of exercise intolerance in the equine athlete, and Polysaccharide Storage Myopathy (PSSM) is a widely described muscular disease. It is characterized by an accumulation of abnormal glycogen in myofibers due to a genetic defect in the skeletal muscle glycogen synthase (GYS1) enzyme. We hypothesized that energy production through oxidative phosphorylation (OXP...
Aims This study describes the distal limb kinematics including intra‐horse and inter‐horse variability, and variability between gaits in sound horses using high‐speed fluoroscopy which allows cineradiographic examination at speed. Methods Distal limb kinematics were collected at walk and trot from 6 sound horses using a high‐speed fluoroscopy system set over a force plate. The dorsal proximal interphalangeal joint (PIPJ) angle and the dorsal distal interphalangeal joint (DIPJ) angle were repeatedly measured at toe‐on, 25, 50 and 75% stance. Results The PIPJ and DIPJ showed overall extension through stance. The mean (± s.d.) range of motion (ROM) during stance of the PIPJ was 10 ± 3° (walk) and 9 ± 3° (trot) and for the DIPJ was 29 ± 5° (walk) and 27 ± 6° (trot) showing significant differences between strides, gaits and horses (P<0.001). Conclusions High‐speed fluoroscopy allows for kinematic assessment of the distal limb. The ROM of the PIPJ observed was similar to the literature whilst the ROM for DIPJ was less than previously reported. Practical significance Kinematic analysis allows investigation of forces acting on bones, joints, ligaments and tendons. This is of special interest in the foot as the most common site of forelimb lameness in the horse; however, kinematic analysis of the foot has to date been a challenge due to the presence of the hoof capsule. The described method allows reliable assessment of foot kinematics at different gaits and speeds, which can be used for future studies to assess the effectiveness of treatment and monitor disease progression. Ethical animal research Ethical approval was granted by the Royal Veterinary College Ethics Committee. Sources of funding: The Royal Veterinary College. Competing interests: None.
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