To compare the hypoglycaemic effects of this plant wiht that of the standard drug order nizagara 25 mg visa, hypoglycaemic effect of glibenclamide (4mg/kg) was also investigated 25mg nizagara for sale. The phytochemical studies of the crude powder and 80% ethanolic exteact of this plant showed that both contained alkaloid 50mg nizagara fast delivery, flavonoid, glycoside, steroid, saponin, tanin and amino acid. In acute toxicity atudy in mice, it was observed that the crude powder of rhizomes of this plant was not toxic up to the maximal feasible dose of (5g/kg). The results showed that the 80% ethanolic extract of the rhizomes of this plant at the dose level of (1. But, the crude powder of the rhizomes of this plant at the dose level of (3g/kg) showed no significant hypoglycaemic effect. It was observed that the hypoglycaemic effect of 80% ethanolic extract of this plant was inferior to that of the standard drug, glibenclamide. A clinical trial to determine the hypoglycemic potential of popular Myanmar medicinal plant Orthosiphon aristatus Bl. A significant blood sugar lowering effect was observed 1hr after administration of 175ml of plant decoction extracted from 25g leaves on glucose- loaded (75g glucose) model when compared to glucose loaded control group. There was no effect on liver function tests, kidney function tests blood urea and electrolyte, serum creatinine and serum cholesterol level. First group of 10 patients received 75g of glucose together with 175ml plant decoction at the same time (group A). A second group of 10 patients, 175ml of plant decoction was given first; 75g glucose load was given 2hrs later (group B). The effect of 500mg of glucophage together with 75g glucose was also determined on the same group of patients for positive control. Significant blood sugar lowering effects were observed in both group A and group B 3 hours after administration of plant decoction. There was statistical significant reduction of blood sugar level in both group A and group B patients when compared to the control group (p<0. There was more reduction of blood sugar level in both receiving See-cho-pin (group A and group B) when compared to patients receiving glucophage 500mg. Khin Chit; Ohnmar May Tin Hlaing; Phyu Phyu Aung; Tin Tin Aung; Win Win Myint; Khine Khine Lwin; Aye Than; Phyu Phyu Win; San San Win. A clinical trial to determine the hypoglycemic effect of Orthosiphon aristatus (Bl. Individual diet instruction as prescribed by dietitian of Nutrition Research Division was distributed to each patient. After the control study, the patient was given 8gm of dried leaf in 250ml boiled water for 30mins, 3 times per day for 28 days. The effect of gliclazide 80mg for a period of 28 days was also studied on the positive control group of six patients. There was a statistically significant reduction of blood sugar level in patients receiving See-cho-pin plain tea (p<0. A significant blood sugar lowering effect was also observed in patients receiving gliclazide (p<0. There was no significant difference in the blood sugar lowering effect among the group receiving gliclazide and the group receiving See-cho-pin plain tea after a complete wash out period. No significant side effect of See-cho-pin plain tea was observed clinically during the study. Hypoglycemic effect of “Paya-say”, prepared from traditional method, on rabbit model. The aim of this study is to determine acute toxicity and the hypoglycaemic effect of “Paya-say”, prepared from traditional method. The “Paya-say”, was not toxic up to the maximum feasible dose level of 53ml/kg body weight. It was found that “Paya-say”, 15ml/kg body weight showed not significantly lowered the blood glucose levels at 1hr, 2hr, 3hr and 4hr respectively. May Aye Than; Mu Mu Sein Myint; Aye Than; Khin Tar Yar Myint; San San Myint; Mya Thet Lwin; Nu Nu Win. The purpose of this study is to determine phytochemical constituents, acute toxicity and hypoglycemic effect of (ovJoD;) Punica granatum Linn. Flavonoids, terpene, reducing sugar, tannins, glycosides, saponin, amino-acid and vitamin C were present in the fresh and concentrated juice. Acute toxicity study of the fresh juice with seeds, concentrated juice without seeds and 70% ethanol extract of seeds were evaluated in mice. Evaluation of hypoglycemic effect of the fresh juices with seeds (40ml), the concentrated juice without seeds (6g/kg), 70% ethanol extract (3g/kg) and glibenclamide 4mg/kg body weight were carried out on adrenaline-induced hyperglycemic rabbits model. It was found that 70% ethanol extract of seeds and glibenclamide 4mg/kg showed significant lowered the blood glucose levels at 2hr and 3hr (p<0. The percent inhihition of blood glucose levels of ethanol extract and glibenclamide were 38. Using adrenaline-induced diabetic rabbits, both aqueous and ethanolic extracts of the whole plant of Scoparia dulcis Linn. Dried crude powder sample and aqueous extract contained glycosides, steroids, polyphenol, tannin, carbohydrates and reducing sugar whereas glycosides, steroids, polyphenol and tannin were present in ethanolic extract. Extracts of the following Myanmar medicinal plants were tested for their hypoglycemic effects on glucose-loaded and diabetic rabbit models. Fresh leaves juices of Cassia glauca and Aegle marmelos and fresh fruit juice of Morinda angustifolia were also investigated. The ethanolic extract had more hypoglycemic effect than watery extract of Orthosiphon aristatus. Extracts of other selected plants produced no hypoglycaemic effects on the glucose loaded hyperglycaemia rabbit model. Probable, structural features of the compounds are being speculated on the light of the present data. A clinical trial to determine the hypoglycemic potential of locally grown Momordica charantia Linn. Fruit powder was carried out on 26 non-insulin dependent diabetes mellitus patients for a period of 28 days during which their diet, exercise, smoking and all medications except anti-hypertensives were restricted. It was found that the fruit powder had highly significant effect on the glucose tolerance patterns in 92. Clinically evident side effects were not detected and it had no effect on liver function test, blood urea and cholesterol levels. The reputed hypolipidiemic effect of locally grown saffron Carthamus tinctorius L. The 80% ethanolic extract of saffron leaves and stem (2g/Kg) and Standard drug lovastatin (500mg/Kg) intraperitoneally. The mean blood total cholesterol levels of the saffron leaves and stem treated group were82. Both saffron leaves and stem treated rat showed not significant lowering the total cholesterol but the standard lovastatin treated rat showed significant lowering the total cholesterol (p<0. Hypolipidiemic effect of (ovJoD;) seed on triton induced hyperlipidiemic rat model. The 70% ethanolic extract of (ovJoD;) seed (2g/Kg) and Standard drug Lovastatin (500mg/Kg) intraperitoneally. The 70% ethanolic extract of (ovJoD;) seed treated rat showed not significant lowering the total cholesterol but the standard lovastatin treated rat showed significant lowering the total cholesterol(p<0. Khin Kyi Kyi; Mya Bwin; Sein Gwan; Chit Maung; Aye Than; Mya Tu, M; Tha, Saw Johnson. Early trials with the water-alcohol soluble extract in a dose of 125mg/kg given intravenously were found to produce a fall in arterial blood pressure of 20-40mmHg. Further fractionation of the extract was carried out and screened for hypotensive activity. The fraction designated F-7 produced a fall in the arterial blood pressure which was sustained up to 1 hour. An indigenous medicinal plant growing in Myeik, Tanintharyi Division whose bitter fruit commonly known as Yardan-zeet is very similar to the vernacular name of the Chinese drug "Yardan-zeet" the ripe bitter fruit of Brucea javanica (L. Due to the similarity in the common names, the specific name of Yardan-zeet plant obtained from Myeik was identified taxonomically.
Information cannot be determined accurately by conventional angiographic approaches 100 mg nizagara mastercard. The critical factor in whether a patient needs coronary artery bypass surgery or angioplasty is how well the left ventricular pump is working generic nizagara 100 mg with visa, not the degree of blockage or the number of arteries affected purchase 25mg nizagara free shipping. The left ventricle (chamber) of the heart is responsible for pumping oxygenated blood through the aorta (the large artery emanating from the heart) to the rest of the body. Bypass surgery is helpful only when the ejection fraction, the amount of blood pumped by the left ventricle, is less than 40% of capacity. The results from large studies with these procedures, including the use of stents that release drugs to prevent blockage (drug-eluting stents), show the same lack of beneﬁt as bypass operations. Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difﬁcult procedures in modern medicine. Considering the cost of the procedure, the lack of long-term survival beneﬁt, and the high level of complications, it appears that electing to have this surgery is unwise for the majority of patients. This is particularly true in light of the availability of effective natural alternatives to coronary bypass surgery. Numerous studies have shown that dietary and lifestyle changes can signiﬁcantly reduce the risk of heart attack and other causes of death due to atherosclerosis (see the chapter “Heart and Cardiovascular Health”). Simple dietary changes—decreasing the amount of saturated fat and cholesterol in the diet; increasing the consumption of dietary ﬁber, complex carbohydrates, ﬁsh oils, and magnesium; eliminating alcohol consumption and cigarette smoking; and reducing high blood pressure—would greatly reduce the number of coronary bypass operations performed in westernized countries. In addition, clinical studies have shown that several nutritional supplements and botanical medicines improve heart function in even the most severe angina cases. Although this therapy is controversial, considerable clinical research has proved its efficacy. When an Angiogram Is Unavoidable When an angiogram or angioplasty is deemed necessary, the goal is then to prevent the damaging effects produced by this procedure. This can be accomplished with a high-potency multiple vitamin and mineral formula, along with additional vitamin C (minimum 500 mg three times per day) and CoQ10 (300 mg per day two weeks prior to surgery and for three months afterward). Vitamin C supplementation is rarely employed in hospitals, despite the fact that it may provide signiﬁcant beneﬁts; low vitamin C status is quite common in hospitalized patients. In a study analyzing the vitamin C status of patients undergoing coronary artery bypass, the plasma concentration of vitamin C was shown to plummet by 70% in the 24 hours after coronary artery bypass surgery; this level persisted in most patients for up to two weeks after surgery. Given the importance of vitamin C, this serious depletion may deteriorate defense mechanisms against free radicals, infection, and wound repair in these patients. Supplementation appears to be essential in patients recovering from heart surgery, or any surgery, for that matter. Return of blood flow (reperfusion) after coronary artery bypass surgery results in oxidative damage to the vascular endothelium and myocardium and thus greatly increases the risk of subsequent coronary artery disease. Coenzyme Q10 is recommended in an attempt to prevent such oxidative damage after bypass surgery or angioplasty. In one study, 40 patients undergoing elective surgery either served in the control group or received 150 mg CoQ10 each day for seven days before the surgery. The treatment group also showed a statistically signiﬁcant lower incidence of ventricular arrhythmias during the recovery period. These results clearly demonstrate that pretreatment with CoQ10 can play a protective role during routine bypass surgery by reducing oxidative damage. Therapeutic Considerations Nutritional Supplements From a natural perspective, there are two primary therapeutic goals in the treatment of angina: improving energy metabolism within the heart and improving blood supply to the heart. These goals are interrelated, as an increased blood ﬂow means improved energy metabolism and vice versa. It converts free fatty acids to energy in much the same way as an automobile uses gasoline. Defects in the utilization of fats by the heart greatly increase the risk of atherosclerosis, heart attack, and angina pain. Speciﬁcally, impaired utilization of fatty acids by the heart results in accumulation of high concentrations of fatty acids within the heart muscle. This makes the heart extremely susceptible to cellular damage, which ultimately leads to a heart attack. Carnitine, pantethine, and coenzyme Q10 are essential compounds in normal fat and energy metabolism and are of extreme beneﬁt to sufferers of angina. These nutrients prevent the accumulation of fatty acids within the heart muscle by improving the conversion of fatty acids and other compounds into energy. Antioxidants Using antioxidant supplementation is important for patients with angina. In an analysis of normal controls and patients with either stable or unstable angina, the plasma level of antioxidants has been shown to be a more sensitive predictor of unstable angina than the severity of atherosclerosis. Oral nitroglycerin is widely used in the conventional treatment of angina, but its continuous use can result in the development of tolerance (loss of effectiveness). Experimental ﬁndings indicate that tolerance is associated with increased vascular production of superoxide, a free radical form of oxygen. The superoxide molecules generated quickly degrade the nitric oxide formed from the administration of nitroglycerin and result in lower levels of intracellular regulators that promote relaxation of the coronary arteries. Because vitamin C is the main aqueous (water) phase antioxidant and free radical scavenger of superoxide and vitamin E is the main lipid (fat) phase antioxidant, their importance is obvious. Clinical trials have upheld this connection, showing that high-dose vitamin C and E supplementation can prevent the development of tolerance. A deﬁciency in carnitine results in a decrease in fatty acid concentrations in the mitochondria and reduced energy production. Normal heart function is critically dependent on adequate concentrations of carnitine. Although the normal heart stores more carnitine than it needs, if the heart does not have a good supply of oxygen, carnitine levels become depleted. This leads to decreased energy production in the heart and increased risk for angina and heart disease. Since angina patients have a decreased supply of oxygen, carnitine supplementation makes good sense. Several clinical trials have demonstrated that carnitine improves angina and heart disease. The results indicate that carnitine is an effective alternative to drugs in cases of angina. In one study of patients with stable angina, oral administration of 900 mg carnitine increased average exercise time and the time necessary for abnormalities to occur on a stress test (6. Carnitine, by improving fatty acid utilization and energy production in the heart muscle, may also prevent the production of toxic fatty acid metabolites. These compounds are extremely damaging, as they activate various inﬂammatory enzymes and disrupt cellular membrane structures. The changes in the properties of cardiac cell membranes induced by fatty acid metabolites are thought to contribute to impaired heart muscle contractility, increased susceptibility to irregular beats, and eventual death of heart tissue. Supplemental carnitine increases heart carnitine levels and prevents the production of toxic fatty acid metabolites. This has been demonstrated clinically: the early administration of carnitine (40 mg/kg per day) in patients having heart attacks was found to considerably reduce heart damage. CoA is involved in the transport of fatty acids to and from cells, as well as to the mitochondria. The synthetic pathway from pantethine to CoA is much shorter than that of pantothenic acid, making pantetheine the preferred therapeutic substance. In addition, pantetheine has signiﬁcant lipid-lowering activity, while pantothenic acid has very little (if any) effect in lowering cholesterol and triglyceride levels. Its mechanism of action is due to inhibiting cholesterol synthesis and accelerating fatty acid breakdown in the mitochondria. Like carnitine levels, heart pantethine levels decrease during times of reduced oxygen supply. Demonstrated effects in animals indicate that pantethine would greatly benefit individuals with angina. Deﬁciency can be a result of impaired CoQ10 synthesis due to nutritional deﬁciencies, a genetic or acquired defect in CoQ10 synthesis (e.
The Importance of Soluble Fiber in Lowering Cholesterol It is well established that the soluble ﬁber found in legumes purchase nizagara 100 mg on-line, fruit order nizagara 50 mg visa, and vegetables is effective in lowering cholesterol levels cheap nizagara 100 mg on-line. In individuals with high cholesterol levels (above 200 mg/dl), the daily consumption of the equivalent of 3 g soluble oat ﬁber typically lowers total cholesterol by 8 to 23%. This is highly signiﬁcant, as with each 1% drop in serum cholesterol level there is a 2% decrease in the risk of developing heart disease. Although oatmeal’s ﬁber content (7%) is less than that of oat bran (15 to 26%), it has been determined that oatmeal’s polyunsaturated fatty acids contribute as much to its cholesterol-lowering effects as its fiber content does. To help lower cholesterol, try to eat 35 g ﬁber per day from ﬁber-rich foods (a full listing can be found in Appendix B). Achieving higher ﬁber intake is associated not only with lower cholesterol levels but also with lower levels of inflammatory mediators such as C-reactive protein. Fish oils work to lower triglyceride levels by reducing the formation of triglycerides while increasing their breakdown into energy. Fortunately, several natural compounds can lower cholesterol levels and other signiﬁcant risk factors for cardiovascular disease. In fact, when cost, safety, and effectiveness are all considered, the natural alternatives presented here may offer signiﬁcant advantages over standard drug therapy, especially when used together rather than as isolated therapies. Niacin Since the 1950s niacin (vitamin B3) has been known to be effective in lowering blood cholesterol levels. In the 1970s the famous Coronary Drug Project demonstrated that niacin was the only cholesterol-lowering agent to actually reduce overall mortality. Despite the fact that niacin has demonstrated better overall results in reducing risk factors for coronary heart disease compared with other cholesterol- lowering agents, physicians are often reluctant to prescribe it. The reason is a widespread perception that niacin is difﬁcult to work with because of the bothersome ﬂushing of the skin. In addition, because niacin is a widely available generic agent, it does not offer the drug companies the huge proﬁts that the other lipid-lowering agents have enjoyed. As a result, niacin does not beneﬁt from the intensive research and advertising that focus on the statin drugs. Despite the advantages of niacin over other lipid-lowering drugs, it accounts for less than 10% of all cholesterol-lowering prescriptions. Niaspan, a prescription niacin product, accounted for 952,000 prescriptions in 2002, translating to sales of $145. By 2010, sales had reached over $927 million, with approximately 100,000 prescriptions per week. The increasing sales of niacin reflect physicians’ growing awareness of the advantages of niacin over statin drugs. In the ﬁrst published clinical study, niacin was compared with lovastatin directly in 136 subjects. In the two patient groups, 66% of those treated with lovastatin and 54% of those treated with niacin reached the maximum dose. Although niacin produced a 35% reduction in Lp(a) levels, lovastatin did not produce any effect. Niacin’s effect on Lp(a) in this study conﬁrmed a previous study that showed niacin (4 g per day) reduced Lp(a) levels by 38%, and a subsequent study that showed similar reductions in Lp(a) in patients with diabetes. In the second phase, 37 patients agreed to take niacin; 27 patients ﬁnished this phase at a dose of 4. Niacin has been shown to address all of these areas much more signiﬁcantly than the statins or other lipid- lowering drugs. Speciﬁcally, in patients with coronary artery disease niacin produces beneﬁcial changes in lipid particle distribution that are not well reﬂected in typical lipoprotein analysis. No signiﬁcant changes from baseline were seen in any tested variable in subjects who received a placebo. These results indicate that the addition of niacin to existing medical regimens for patients with coronary artery disease and already well-controlled lipid levels favorably improves the distribution of lipoprotein particle sizes and inﬂammatory markers in a manner expected to improve cardiovascular protection. While niacin exerts signiﬁcant beneﬁt on its own, it does not appear to enhance the beneﬁts of statins in patients whose lipid levels are well controlled. The study ended 18 months early because there was no additional cardiovascular beneﬁt in those taking niacin. The most common and bothersome side effect is the skin ﬂushing that typically occurs 20 to 30 minutes after the niacin is taken. Other occasional side effects of niacin include gastric irritation, nausea, and liver damage. In an attempt to combat the acute skin ﬂushing, several manufacturers began marketing sustained-release, timed-release, or slow- release niacin products. These formulations allow the niacin to be absorbed gradually, thereby reducing the ﬂushing reaction. However, although these forms of niacin reduce skin ﬂushing, early versions of timed-release preparations were proved to be more toxic to the liver than regular niacin. In one analysis 52% of the patients taking an early sustained-release niacin preparation developed liver toxicity, while none of the patients taking immediate-release niacin developed liver toxicity. This form of niacin has long been used in Europe to lower cholesterol levels and also to improve blood ﬂow in intermittent claudication. It yields slightly better clinical results than standard niacin and is much better tolerated, in terms of both flushing and, more important, long-term side effects. Niacin should not be used by anyone with pre-existing liver disease or elevation in liver enzymes. For best results niacin should be taken at night, as most cholesterol synthesis occurs during sleep. If pure crystalline niacin is being used, begin with a dose of 100 mg a day and increase carefully over four to six weeks to the full therapeutic dose of 1. If you use an intermediate-release product (do not use any other form of time-release niacin) or inositol hexaniacinate, a 500-mg dosage should be taken at night and increased to 1,500 mg after two weeks. Plant Sterols and Stanols Phytosterols and phytostanols are structurally similar to cholesterol and can act in the intestine to lower cholesterol absorption by displacing cholesterol from intestinal micelles (an aggregate of water- insoluble molecules, such as cholesterol, surrounded by water-soluble molecules that facilitate absorption into the body). Because phytosterols and phytostanols are poorly absorbed themselves, blood cholesterol levels will drop, owing to increased excretion. Phytosterols and phytostanols can be used in addition to diet or drug interventions, as they provide additional beneﬁts. The individuals most likely to respond are those who have been identiﬁed as having high cholesterol absorption and low cholesterol biosynthesis. Phytosterols and phytostanols have also shown antiplatelet and antioxidant effects. Pantothenic acid is the most important component of coenzyme A, which is involved in the transport of fats to and from cells as well as to the energy-producing compartments within the cell. Pantethine has signiﬁcant lipid-lowering activity, while pantothenic acid has little if any effect in lowering cholesterol and triglyceride levels. Garlic Garlic (Allium sativum) appears to be an important protective factor against heart disease and stroke for many reasons. Garlic has been shown to lower blood cholesterol levels even in apparently healthy individuals. However, most trials not using products that can deliver this dosage of allicin fail to produce a lipid-lowering effect. However, the others do have a place in the clinical management of high cholesterol and triglycerides. In particular, the beneﬁts of ﬁsh oils extend far beyond their effect on blood lipids. Typically, along with dietary and lifestyle recommendations, niacin (1,000 mg to 3,000 mg at night) reduces total cholesterol by 50 to 75 mg/dl in patients with initial total cholesterol levels above 250 mg/dl within the ﬁrst two months. In patients with initial cholesterol levels above 300 mg/dl, it may take four to six months before cholesterol levels begin to reach recommended levels. Once cholesterol levels are below 200 mg/dl for two successive blood measurements at least two months apart, the dosage can be reduced to 500 mg three times per day for two months. If the cholesterol levels creep up above 200 mg/dl, then the dosage of niacin should be raised back up to previous levels. If the cholesterol level remains below 200 mg/dl, then the niacin can be withdrawn completely and the cholesterol levels rechecked in two months, with niacin therapy reinstituted if levels have exceeded 200 mg/dl.
The intraosseous placement of a needle provides ac- Following the osteotomy purchase 25mg nizagara with visa, the muscles are sutured cess to the vascular space for administration of fluids over the end of the bone to provide padding buy discount nizagara 100 mg on-line. Hemostatic agents should be Vascular access devices are subcutaneously im- avoided generic nizagara 25 mg amex. This skin pattern will provide adequate tissue for closure over the distal end of the bone. The plantar skin is somewhat stronger than the dorsal skin, providing additional protection over the end of the bone. Because the metaphysis and epiphysis of the phalanges are larger than the diaphysis, it may be beneficial to remove the exposed joint surface with rongeurs prior to skin closure. Risk of sepsis and recumbency, and the area over the right jugular vein thrombosis is minimized because the catheter is not is prepared for surgery. These have been main- there is no need to remove feathers because there is tained in humans for years and in birds for up to 12 an apterium in this location. The jugular vein is identified and isolated for a dis- tance of approximately 15 mm. Dissection must pro- The material, construction, surface finish and tip ceed cautiously as the vein is very fragile. Two liga- configuration influence the thrombogenicity of the tures are placed around the vein, one at the cranial catheter. Silicone and hydromer-coated polyurethane extent and the other at the caudal extent of the are considered the least thrombogenic materials cur- isolated area. The jugular vein will distend and vein, artery or other hollow organ and connected to the cranial suture is then tied off permanently oc- the reservoir. Using fine iris scissors and mag- daily or several times daily, there is no need for nification, a transverse venotomy is created in the heparin locks, which eliminates the potential for distended portion of the vein. However, there is a higher transect the vein but will allow the catheter to be potential for thrombus formation with small gauge inserted. After the blood from the distended segment catheters, and a heparin lock may still be necessary. The tension on the caudal ligature Removal of the device requires a surgical approach to will have to be loosened to allow the catheter to pass, the vein and the reservoir. The sutures holding the but enough tension should be maintained to prevent reservoir are removed as is the suture holding the reflux hemorrhage. The ligature is catheter is advanced to the right atrium and secured tightened to prevent reflux of blood. Closure of the in place by suturing above and below the retention skin and subcutaneous tissues is routine. Perinatal Surgery A Huber needle attached to a three-way stopcock and Many aviculturists do not seek veterinary assistance a saline-filled syringe is used to test the ease of with embryonal and neonatal matters, attempting to injection and withdrawal of a sample. Rarely are these at- the catheter tip should be evaluated using contrast tempts successful. Compared with adult tissues, they have a those that are radiolucent, the position can be evalu- high moisture content, making them very friable, ated by injecting a vascular contrast medium. With practice and management, fine suture (8-0 to 10-0) and an atrau- A subcutaneous pocket is created dorsal to the jugu- matic needle can be used for closure of the umbilicus. A 2 to 4 cm loop Featherless neonates are highly prone to developing of catheter is left to allow for neck movements. During re- less than 15 minutes, and the operating room tem- covery, feathers over the reservoir should be removed perature should be elevated to 75 to 85°F. Only non- out the procedure, and supplemental glucose should coring needles should be used with these devices. Because of their small blood volume, perinatal pa- The skin area above the port must be aseptically tients are more likely to require transfusion if major prepared before each use. Chlorhexidine has been blood loss occurs or if the hematocrit is below 20 to shown to be three to four times more effective at 25%. Respiratory movements may be difficult to ob- preventing bacterial colonization of the catheter than serve in perinatal patients, making the use of clear povidone iodine. The non-coring needle is inserted into ally full, increasing the risk of regurgitation and the reservoir until it hits the base plate and the aspiration. Elevating the head and packing These devices can be maintained for extended peri- 17 the thoracic esophagus with moist cotton will also ods of time but require some maintenance. In Yolk Sac Removal geese, the catheters were flushed every four days The yolk sac is a diverticulum from the small intes- with 1. Yolk sac removal is most effective if performed the endodermal cells of the yolk sac and, at least in before the chick becomes dyspneic. Percutaneous as- chickens, nutrients are absorbed through a duct that piration of the yolk should not be attempted as the connects the yolk stalk to the intestines. Yolk pro- yolk sac is very thin and will leak yolk into the vides nourishment, minerals, fat-soluble vitamins coelomic cavity resulting in peritonitis. Injecting an- and maternal antibodies to the developing embryo tibiotics directly into the yolk sac carries the same and the neonatal bird. Products Mentioned in the Text A procedure for removal of unabsorbed yolk sacs has a. Avian cause death of cannon-netted wild for removal of multiple foreign bodies Anatomy. Typically, these techniques have been C H A P T E R N adapted from those used for small mam- mals and humans. Regardless of the specific tech- niques employed in fracture repair, it is important to: Treat contaminated and infected wounds. Maintain range of motion in all joints affected by the fracture or fixation technique. Subcutaneous emphysema may be noted in birds with ruptured air sacs or with fractures of the humerus, thoracic girdle or some ribs (the pneumatic bones). In many cases, birds may require several Howard Martin days of stabilization with fluids, steroids, antibiotics or supportive alimentation before anesthesia and Branson W. Minimal soft tissue damage Fracture stabilization techniques used in free-rang- Maintenance of length, rotation, angular orientation ing birds must be designed to increase the likelihood Anatomic alignment that a rehabilitated bird can be released. Repair of a Rigid stabilization wing fracture, particularly near a joint, must be Minimal disturbance of callus formation nearly perfect with no ankylosis and minimal soft Neutralization of forces: tissue damage to ensure return to full flight. For – Rotation, bending (transverse fractures) these avian patients, maintenance and protection of – Shear, rotation, bending (oblique or spinal fractures) soft tissues is the single most important aspect of – Compression, shear, rotation, bending (comminuted fractures) successful surgery. The degree and type of soft tissue damage may be more critical in determining the potential for postsurgical return to function than specific osseous injuries. Native avifauna with inju- Developing a Surgical Plan ries that will prevent their release must be repaired to a functional level that allows them to adapt to a The method of fixation selected should suit the pa- zoo, breeding program or educational facility. Injured tient’s injury, natural behavior, activity levels and native birds that cannot be repaired to sufficiently future needs (Tables 42. Bipolar radio- breeding facilities must have adequate postoperative surgery is necessary to control blood loss and allow use of a fractured limb to allow them to function thorough visualization of a relatively small surgical effectively in their respective environments. It is best to cover the medullary canal of the proximal fragment of a humeral fracture before irrigating the surgical site. Fluids or necrotic debris that are flushed into the pneumatic bones may cause Therapeutic Strategies asphyxiation, air sacculitis or pneumonia. The distal legs and wings of birds have relatively little soft tissue (ie, tendons, ligaments, skin and The fracture should be classified as to anatomy, muscles). Bone in these areas are, therefore, particu- shape, whether it is open or closed and its chronicity. Aggressive tissue manipulation can specific therapy and stabilization procedures that are cause increased damage of already compromised used. Patient preparation for surgery, preparing the blood supply and soft tissues, which increases the surgical site and draping are discussed in Chapter 40. Closed reduction involves the manipulation of the fracture through application of traction and counter- traction to stretch the soft tissues and appose and align the bone fragments. It is difficult to achieve adequate alignment and reduction of fractures with closed reduction techniques without causing signifi- cant soft tissue trauma, except in those fractures that are minimally displaced. The advantages of open reduction include reduced soft tissue trauma (as traction is applied directly to the bones), visualization of the fracture site (and therefore the ability to attain optimal reduction as well as cleansing of the fracture site) and removal from the fracture site of interposed soft tissues, con- taminated or infected debris and necrotic or devital- ized bone.
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