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Calcium Dobesilate - A New Therapeutic Agent for Treatment of Navicular Disease in Horses
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Magnetic Resonance Imaging (MRI) has improved the diagnosis of foot pain in horses originating from the area of the navicular bone because this imaging technique enables the clinician to differentiate soft tissue from bony lesions. Pathological lesions of the navicular bone can be identified in absence of radiographic changes and with no detectable abnormalities of the flexor fibrocartilage or cortex, but with diffuse abnormalities of the medulla charaterised by increased signal in fat suppressed images. This may reflect a variety of pathological processes including fibrosis, necrosis, bone oedema or abnormal trabecular modelling.
It has been hypothesised that impaired venous drainage causes venous hypertension in the navicular bone marrow resulting in intraosseous hypertension and bone edema (Pleasant et al. 1993; Svalastoga and Smith 1983). Alternatively, the accumulation of osmotically active proteins in the subchondral tissue cause leads to a compartment syndrome within the navicular bone, which is characterised by increased tissue pressure, acidosis, pain and a vicious cycle of progressive pathological changes. The degenerative processes within the compartment are triggered by a switch from aerobic to anaerobic metabolism locally. Surgical procedures have been explored to decompress the medullary cavity of the navicular bone in sound horses (Jenner and Kirker-Head 2011). An experimental study revealed that drilling the bone reduced excessive intraosseous hydrostatic pressure due to lowered perfusion resistance and improved local blood circulation. However the direct decompression effects are shortlived due to the rapid healing of the drill channels. [...]
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