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differentiation and matrix synthesis. These factors can affect chondrocyte metabolism, chondrogenesis, and improve cartilage healing in vivo. Several human studies show favorable clinical outcomes as compared to intra-articular injection of hyaluronic acid (HA). There is substantial variation in the preparation and formulation of autologous PRP, but affordable point of care preparation is certainly feasible.
Mechanical therapiesfor OA include pulsed ultrasound and shockwave. There is some evidence for the efficacy of shockwave therapy in the management
of osteoarthritis. There is a need for more controlled studies in the canine to determine the efficacy relative to the current standard of care and recommended therapy protocols.
Surgical treatment, often required for effective management of OA, may involve joint stabilization, removal of cartilage/bony chips, or joint replacement. The relative importance and timing of surgery is variable depending upon the condition underlying the osteoarthritis. Typically, early intervention is indicated to maximize the surgical efficacy with regard to preservation of joint health.
A. Boswood1
1Royal Veterinary College, Clinical Science and Services, London, United Kingdom
Congestive heart failure is present when a patient is showing clinical signs as a consequence of retention of an excessive volume of fluid secondary to the presence of heart disease. Heart disease leads to an “underfilling” of the arterial circulation which initiates a cascade of nervous and endocrine compensatory responses. Chronic stimulation of these pathways results in retention of excessive sodium chloride and water leading to an expansion of the circulating fluid volume. This additional volume is primarily retained in the venous vasculature leading to elevated venous and capillary pressures. Ultimately venous and capillary pressures become so elevated that fluid can no longer be retained within the vasculature. This fluid leaks out into tissues in the form
of oedema, or into body cavities in the form of effusions such as a pleural effusion or ascites. When a patient
is demonstrating clinical signs as a consequence of
this excessive retention of fluid they can be said to be showing signs of congestive heart failure.
Some patients with congestive heart failure are concurrently showing signs of inadequate cardiac output. These signs will be apparent as signs of poor perfusion such as pallor, cold extremities, weakness and lethargy. These patients may be found to be hypotensive if blood pressure is measured. The presence of concurrent signs of poor output complicates the treatment of congestive heart failure.
When treating patients with signs of heart disease and heart failure, clinicians should ideally practice “evidence based medicine”. There is good evidence to support the use of some agents in the treatment of patients with chronic congestive heart failure; particularly those with common underlying diseases such as degenerative mitral valve disease (DMVD) and dilated cardiomyopathy (DCM). Few if any clinical trials have evaluated the effectiveness of different agents in the setting of acute heart failure management. The most effective treatment of patients presenting acutely with signs of congestive heart failure therefore depends upon an understanding of what can be achieved with the different agents available.
There are a few key questions that clinicians need to
ask themselves when managing these patients and the management process will be explained by going through these questions and possible responses.
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