Prevalence and risk factors for cardiac diseases in a hospital-based population of 3,434 horses (1994-2011).

BACKGROUND: Risk factors for cardiac diseases in horses have not been explored in a large population of animals. OBJECTIVES: To describe risk factors for various cardiac diseases in a hospital-based population of horses. ANIMALS: Files of 3,434 horses admitted at the Internal Medicine Department of the Liege Equine Teaching Hospital between 1994 and 2011 were reviewed and of those, 284 were categorized as having moderate-to-severe cardiac disease. METHODS: Observational study. After calculating prevalence for each cardiac disease, we tested whether breed (chi-square test) or sex, age, body weight (BW), and other cardiac diseases (logistic regressions) were risk factors (p < .05 significant). RESULTS: Mitral regurgitation (MR, 4.4%), atrial fibrillation (AF, 2.3%), aortic regurgitation (AR, 2.1%), and tricuspid regurgitation (TR, 1.7%) were the most common cardiac abnormalities detected. Determinants were male sex and increasing age for AR (OR = 2.03, CI = 1.07-4.94), racehorses breed and middle-age for TR (OR = 4.36; CI = 1.10-17.24), and high BW for AF (OR = 3.54; CI = 1.67-7.49). MR was the most common valvular disease associated with AF, clinically important ventricular arrhythmia, pulmonary regurgitation (PR), and congestive heart failure (CHF). TR was also associated with AF, PR, and CHF; AR was not associated with CHF. CONCLUSIONS AND CLINICAL IMPORTANCE: Several previously suspected risk factors for a variety of equine cardiac diseases are statistically confirmed and other risk factors are highlighted in the studied hospital-based population. These observations should be taken into account in health and sport's monitoring of horses presenting predisposing factors.

Effect of breed, sex, age and body weight on echocardiographic measurements in the equine species.

Little is known about the effect of various animal's signalment variables on echocardiographic reference values in the equine species. This study was performed to evaluate the effect of sex, breed, age and body weight (BW) on echocardiographic measurements in the equine species. Echocardiography was performed on 212 ponies or horses of various breeds, aged from 1 day to 37 years old (mean±SD: 7.8 ± 5.8 years), BW 38-890 kg (mean ± SD: 421 ± 133 kg), and free of cardiac disease. Fifty of those animals aged from 2 months to 35 years old (mean ± SD: 11.6 ± 6.4 years old); BW 77-662 kg (mean ± SD: 436 ± 135 kg) were also examined using the pulsed-wave Doppler mode. Standard two-dimensional and M-mode echocardiography were performed on all animals. Standard pulsed-wave Doppler examination of each cardiac valve was performed on the 50 first examined animals. Data were analysed using a general linear model including the effect of sex, age, breed and BW after logarithmic transformation of the data. Therefore, the same analysis was performed separately on animals aged ≤ 2 years-old and on older animals. All dimensional echocardiographic measurements were significantly affected by BW and most of them were significantly affected by breed, but not by sex. Only the aortic and the pulmonary artery internal diameter were significantly affected by age. None of the Doppler measurements were significantly affected by the tested variables. In conclusion, in the equine species, dimensional echocardiographic reference values should be established using regression equations as a function of BW, which could increase the diagnostic value of this leading technique in equine cardiology. Breed could also have an effect on those measurements.

Successful treatment of equine sarcoids with cisplatin electrochemotherapy: a retrospective study of 48 cases.

REASONS FOR PERFORMING STUDY: Sarcoids are the commonest form of equine skin tumour. Several therapeutic measures have been described but none is considered to be universally effective. Electrochemotherapy (ECT) is a new anticancer therapy that utilises electrical field pulses to induce increased cell membrane permeability to antitumour hydrophilic drugs, such as cisplatin. The increased intracellular concentration of the drugs has a significant therapeutic benefit. The procedure has not been previously reported in a large number of horses. OBJECTIVE: To validate ECT as a novel alternative treatment for equine sarcoids. METHODS: A retrospective study evaluating the efficacy of cisplatin ECT in the treatment of equine sarcoids was performed. Electrochemotherapy treatments were applied under general anaesthesia at 2 week intervals with or without prior excision or debulking. Electric pulses were directly applied to the lesions following intra-tumoural injections of an aqueous solution of cisplatin. RESULTS: One-hundred-and-ninety-four sarcoids on 34 horses, 2 ponies, 11 donkeys and one mule were treated with ECT. The 4 year nonrecurrence rate was 97.9% for animals (47/48) and 99.5% (193/194) for tumours. When ECT was used as a single treatment, a significant influence of tumour size (ρ= 0.55) on the number of treatments required for cure was shown. When prior surgery was performed, there was a significant influence (P<0.001) of the excision quality (complete or incomplete) and the healing mode (closed or open wound) on the number of treatments. The most common adverse effect was a slight oedematous reaction for lesions located on thin skin regions. CONCLUSION AND CLINICAL RELEVANCE: Results demonstrate that ECT, with or without concurrent tumour debulking, is an effective alternative for treatment of equine sarcoids.

Mixed micelle formation with hydrophobic and hydrophilic Pluronic block copolymers: implications for controlled and targeted drug delivery.

Pluronic block copolymers offer affluent phase behavioral characteristics and are extensively investigated for drug delivery applications. Hydrophobic Pluronics produce larger aggregates whereas hydrophilic Pluronics often generate small-sized micelles in aqueous milieu. To overcome the limitations and combine the advantages of different kinds of Pluronics the mixing of such two types of Pluronics is studied here, especially for hydrophobic Pluronic L81 and relatively hydrophilic Pluronic P123. Critical micelle concentration (CMC) of the developed binary mixtures was 0.032 mg/ml as evidenced from pyrene fluorescence spectroscopy and is located in between that of the individual Pluronics. Dynamic light scattering (DLS) showed very small particle sizes (∼20 nm) and low polydispersity indices for most of the mixed micelles. Transmission electron microscopy (TEM) demonstrated spherical shape of micelles. Based upon the ratio of hydrophobic and hydrophilic Pluronics, dispersions of varied stability were obtained. With 0.1/1.0 wt.% and 0.5/3.0 wt.% of Pluronic L81/P123, stable dispersions were obtained. Stability was assessed from turbidity measurement, size analysis and clarity of dispersion on standing. Micelles were also found to be stable in bovine serum albumin (BSA) solution. Mixed micelles showed fairly high entrapment efficiency, loading capacity and sustained release profile for aceclofenac (Acl), a model hydrophobe. Presence of salt lowered Acl solubilization in micelles. Thermodynamic parameters for Acl solubilization in mixed micelles revealed high partition coefficient values and spontaneity of drug solubilization. Thus, the developed novel mixed micelles hold promise in controlled and targeted drug delivery owing to their very small size, high entrapment efficiency and stability.

[Problems posed by secondary peritoneal carcinosis of digestive origin]. / Problèmes posés par les carcinoses péritonéales secondaires d'origine digestive.

Secondary peritoneal carcinoma occurs in cases of malignant bowel disease after the initial curative operation or rarely after palliative surgery. The main problems are frequent overshoot in the diagnosis and correct management. Based on our experience with 101 patients with secondary peritoneal carcinoma treated over the last 10 years, we determined the therapeutic possibilities. In 23% of the cases no surgery was possible and in only 4% underwent a second palliative operation. Survival was basically dependent on the initial malignant disease. More aggressive therapeutic methods are currently under study.

[Textiloma. Apropos of 25 cases and review of the literature]. / Textilomes. A propos de 25 cas et revue de la littérature.

It is exceptional to "forget" a compress in a operative wound, but the consequence are important. We report 25 cases of textilomes operated over a period of 18 years. There were 18 cases involving visceral surgery and 7 involving bone surgery. Sixty percent of the patients were women and 82% were adults. Emergency surgery was required in 70% of the bone operations and in only 33% of the visceral indications. Twelve percent of the cases were discovered fortuitously and 40% led to pain or occlusion, 24% leading to a digestive tract fistula and 24% to an inflammatory tumour formation. Standard X-rays and echography were sufficient for diagnosis in the abdominal cases. CT scan or MRI may be useful. Ablation of the abdominal foreign body was the followed by complications in two-thirds of the cases with a mortality of 25%. No deaths were observed in the other localizations but the functional result was impaired. We reviewed the literature reporting 117 such cases.

[Lumbar hernias in adults. Apropos of 4 cases and review of the literature]. / Les hernies lombaires de l'adulte. Rapport de 4 observations et revue de la littérature.

Lumbar hernias are rare (2% of abdominal wall hernias). Symptomatology consists frequently only of an arch formation seen best with the patient sitting and when coughing. In adults it is twice as frequent in women and on the left side. Acute events, dominated by incarceration of a digestive segment, particularly colic, often suggest the diagnosis (10% of cases). Diagnosis is simple when confronted with a large hernia, but difficulties arise with those less than 5 cm in diameter, often diagnosed as a lipoma or parietal tumor. Conventional radiographs and ultrasound images are usually sufficient to establish the correct diagnosis and to determine the content of the hernial sac, but computed tomography scans can provide data on the exact limits of the defect and allow evaluation of possible problems during surgical repair. Rarely congenital (10%), these hernias occur either secondary to a violent lumbo-abdomino-pelvic injury (25%) or following surgical intervention to the lumbar region (50% of cases). Small hernias can be repaired using the direct approach but larger deficits require the insertion of a reinforcing non absorbable prosthesis. Long term results, both for the 4 cases reported and those published in the literature, were assessed as satisfactory.

[Management of patients over 75 years of age with digestive or abdominal disease. A series of 660 cases]. / Prise en charge des patients âgés de plus de 75 ans présentant une pathologie digestive ou abdominale. A propos de 660 observations.

Over a period of 3 years, the authors cared for 660 patients over 75 years of age with diseases of the digestive tract. In 180 cases, the initial hospitalization had been previously planned and in 480 (72.7%) emergency admission was necessary. The diagnosis had not been confirmed in 90% of the emergency admissions. Half of the patients suffered from major illness (ASA III, IV). Planned hospitalization in a surgical unit involved cancer in 60% of the cases among which about one-half were colorectal cancers. In this latter group, mean hospitalization was 12 days and hospital mortality was 9.7%. For the patients with emergency admissions, diagnosis was only established after exploratory examinations (echography 296, endoscopy 205, opacification of the digestive tract 157...). No diagnosis could be established in 1.6% of the patients. Four types of emergency patients could be identified: occlusions 39.6%, painful abdomen 37%, haemorrhage 13.9% and jaundice 7.7%. In these groups, surgery was required in 64.7%, 69.1%, 72% and 40.5%, and mortality was 21.9%, 20.3%, 21.6% and 8.1% respectively. Duration of hospitalization was however similar (12 days). The overall mortality in this series was 14% (5.7% in non-operated patients and 16.7% in operated patients with a distinction between planned operations, 9.7%, and emergency operations, 20.3%). The two main risk factors were underlying disease and the need for emergency surgery. Age over 90 was also aggravated prognosis.

[Severe hemorrhage from gastroduodenal ulcer. Apropos of 100 cases]. / Hémorragies graves des ulcères gastro-duodénaux. A propos de 100 cas.

Over a period of 7 years, 100 patients (70 males and 30 females; mean age 66 years) were operated for digestive tract haemorrhage originating in an ulcer. There was a past history of ulcer in 21% and 29% had been taking drugs known to have a toxic effect on the stomach. Patent bleeding was observed by endoscopy in 32% with clear arterial flow, or a visible vessel in 10. In 20 patients a fresh clot was observed. Surgery had been indicated for massive haemorrhage in 25 cases, for persistent bleeding in 27, for recurrent bleeding in 37 and due to a visible vessel in 11. Conservative treatment was possible in three-fourths of the cases. Gastrectomy was performed in 26. Follow-up was uneventful in 55. There were 18 cases with complications and 27 deaths factors leading to fatal outcome and the data reported in the literature were analyzed.

[Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases]. / Le dogme de la laparotomie exploratrice doit-il être maintenu en présence d'une plaie de l'abdomen? Discussion à propos de 176 observations.

Management of abdominal wounds is presently the subject of discussion between the partisans of routine laparotomy and those preferring "armed" surveillance. Results of study of a series of 176 abdominal wounds subjected to surgical dogma showed: that the diagnosis of non penetrating wounds (17.6%) was not always evident, due either to their anatomical localization (frontier region wounds) or to insufficient local exploration in urgent cases (6.6% of false-negatives), that the existence of serious clinical signs (50 cases) was always associated with one or more visceral lesions, requiring urgent laparotomy with a morbidity of 20% and a mortality of 8% (4 cases), that in the case of asymptomatic penetrating wounds (96 cases), routine laparotomy did nevertheless allow the diagnosis of visceral lesions in 50 cases (including 23 major lesions) but was of no utility in 46 cases (31.5% of blind laparotomies for the total series). The elevated proportion of useless laparotomies (30% in the literature), the result of a dogmatic attitude, or the risk of a delayed intervention (5 to 8%) in the series practising the selective method, led to a modification in the authors' attitude. The existence of serious signs should obviously result in a laparotomy. In their absence, and when confronted with a penetrating or doubtful (frontier region) wound, an exploratory celioscopy is proposed to ensure complete abdominal exploration, to confirm the presence or absence of penetration, to treat minimal lesions and to perform a classical laparotomy in case of evident necessity.

[Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment]. / L'empierrement du cholédoque, une forme grave de lithiase biliaire. Quel traitement choisir?

Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks.

[What is the role of elective surgery in diverticular sigmoiditis?]. / Quelle place pour la chirurgie "à froid" dans les sigmoïdites diverticulaires?

From 1981 to 1991 inclusive, 188 operations were carried out for diverticular sigmoiditis. One hundred and thirty-nine patients were operated in emergency for acute complications (123) or fistulae (16), and another 49 had surgery scheduled outside acute crisis periods. Mortality and morbidity respectively are 16.5 and 31% in the first group, against 0 and 12% in the second one. Similarly, the stay in hospital varies from 13 days for scheduled surgery to 23 days for emergent surgery, the latter also requiring to account for risks and for the duration of a second operation that is far from exceptional (40%). Considering the severity of some evolutive complications, the authors advocate early radical surgery for symptomatic diverticular sigmoiditis, after the second crisis or as soon as the first one if it has been severe, and in young subjects and patients at risks.

[Intestinal obstruction after Nissen's fundo-plication]. / Les occlusions intestinales après fundoplicature de Nissen.

Nissen's fundal plication is acknowledged as the most effective procedure to suppress gastroesophageal reflux. It entails some morbidity (dysphagia, gas bloat syndrome), in which obstruction is the least frequently evoked but most severe risk. We report about 6 cases (4 children and 2 adults). The 4 children had been operated 3 times during the first few months of life, and their reflux was secondary to the cure of atresia of the esophagus in 2 cases, and caused severe apneas in 1 case, a former premature infant. In three cases, the obstruction was complicated within a few hours by intestinal ischemia causing death. In one case, the emergent insertion of a gastric tube allowed the decompression of the digestive tract and second surgery; the obstruction recurred 2 months later, with no postoperative complications. Two adults (aged 64 and 66) presented with gastric perforation 7 days and 9 months after fundal pliction; one of them died. These cases show how serious these obstructions are (4 deaths/6 cases). The emergent measure in such cases consists of inserting a gastric tube, although which may be impossible (1 case). The patients and their parents must be informed of this risk of complication and of its expressions. Prevention is based on a strictly submesocolic surgical approach, without any exposure of the small bowel.

[Incidentally discovered adrenal tumors. Apropos of 20 cases]. / Les incidentalomes surrénaliens. A propos de 20 cas.

According to Glazer, the term of incidentaloma describes an adrenal tumor discovered incidentally during acomputed tomographyscan and by extension to all masses discovered whatever the imaging process. Twenty patients have been operated during the last 10 years. The discovering circumstances are not specific, except the ecography and CT Scan. Complementary examinations include biological tests aiming at showing a possible hormonal secretion and more specific examinations MIBG scintygraphy and magnetic resonance imaging. The tumors often large (80% more than 5 cm long) and solid (75%) have all been removed by transperitoneal approach (13) or lombotomy. Post operative course was approach unevertful. The histological study showed 6 metastasis, 5 benign kystic lesions, 3 hematomas, 3 adenomas, 2 adrenalcortical carcinoma and 1 ganglioneuroma. A review of the literature series leads us to evaluate the frequency and risk of incidentalomas and to consider the necessary examination and the strategy to be adopted in front of such lesions. The evaluation of hormone status, the recourse to specific imaging seems necessary whereas the guided needle biopsy does not present any risk and should be reserved for very special cases. A decisional scheme is proposed, which ains at removing all voluminous and/or secreting tumors. Small lesions behind 35 mm will have to be examined closely and will be removed if they grow larger or persist.