Discovery proteomics for the detection of putative markers for eradication of infection in an experimental model of equine septic arthritis using LC-MS/MS.

Septic arthritis (SA) is a life-threatening condition in horses, and identifying eradication of infection in equine SA is challenging. This study explored the discovery of putative biomarkers for the eradication of joint infection in horses. We performed proteomics analysis of synovial fluid (SF) and plasma from horses with experimental SA, non-septic lipopolysaccharide-induced arthritis, and controls. The point of eradication of infection in horses with SA was determined previously. We compared spectral intensities between groups as well as before and after the eradication of infection. Twenty-six differentially abundant proteins were identified, which were upregulated in SF of horses with SA compared to the other groups, as well as compared to the same horses post-eradication of infection. In plasma, we did not identify differentially abundant proteins. Differentially abundant proteins in SF were of cellular origin and their biological functions included ubiquitination, signal transduction, apoptosis etc. The difference in their relative abundance between experimental groups was ≥10-fold compared to the abundance expected based on the difference in cell count alone (2-fold). Since most of cells in joints with bacterial infection are neutrophils, we suggest that the variable abundance of neutrophil- and cell-associated proteins represent potential biomarkers of eradication of infection in equine SA. SIGNIFICANCE: Septic arthritis is an important condition in horses, which can be life-threatening. At present, identifying eradication of infection in cases of equine septic arthritis is challenging. In this study, we performed a global proteomics analysis of synovial fluid and plasma in horses with experimental septic arthritis and identified 26 differentially abundant proteins compared to non-septic arthritis and post eradication of infection. The results of this study provide the basis for further characterization of the differentially abundant proteins and identification of clinically relevant biomarkers of septic arthritis in horses.

Use of serum amyloid A in serum and synovial fluid to detect eradication of infection in experimental septic arthritis in horses.

While serum amyloid A (SAA) has been investigated as a potential marker for septic arthritis in horses, no study has reported on whether SAA can be used to detect eradication of joint infection. Therefore, the objective of this study was to investigate whether the eradication of joint infection in experimentally induced septic arthritis in horses can be detected using serum and synovial fluid SAA. A total of 17 horses were randomly assigned to 3 groups. A middle carpal joint of each horse was injected with saline (control group, n = 3), lipopolysaccharide (LPS) (nonseptic synovitis group, n = 6), or Escherichia coli (septic arthritis group, n = 8) on day 0. Starting on day 1, horses underwent treatment for septic arthritis. Sequential samples of serum and synovial fluid were collected, and quantification of SAA was carried out. Concentrations of serum and synovial fluid SAA were compared among groups and time points. A concurrent study was conducted and determined that infection was eradicated on day 4 in this experimental model of septic arthritis. Concentrations of serum and synovial fluid SAA rapidly increased after inoculation of E. coli and were highest on day 3 and day 4, respectively. Thereafter, both serum and synovial fluid SAA decreased with eradication of joint infection, although they remained significantly increased from baseline until day 9 and day 10, respectively. Serum and synovial fluid SAA did not increase in the control or nonseptic synovitis group. These findings suggest that serial measurements rather than a single measurement of SAA are required to determine eradication of infection from septic arthritis in horses.

Bien que l'amyloïde sérique (SAA) fut étudiée comme marqueur potentiel pour l'arthrite septique chez les chevaux, aucune étude n'a rapporté si SAA peut être utilisée pour détecter l'élimination d'une infection articulaire. Ainsi, l'objectif de la présente étude était d'examiner si l'élimination d'une infection articulaire lors d'arthrite septique induite expérimentalement chez les chevaux peut être détectée en utilisant la SAA du sérum et du liquide synovial. Un total de 17 chevaux fut réparti de manière aléatoire en trois groupes. Une articulation carpienne médiale de chaque cheval fut injectée avec de la saline (groupe témoin, n = 3), du lipopolysaccharide (LPS) (groupe synovite non-septique, n = 6) ou Escherichia coli (groupe arthrite septique, n = 8) au jour 0. En débutant au jour 1, les chevaux furent soumis à un traitement pour arthrite septique. Des échantillons séquentiels de sérum et de liquide synovial furent prélevés et la quantification de SAA effectuée. Les concentrations de SAA dans le sérum et le liquide synovial furent comparées parmi les groupes et à différents temps. Une étude concomitante était menée et a déterminé que l'infection était éliminée au jour 4 dans ce modèle expérimental d'arthrite septique. Les concentrations de SAA dans le sérum et le liquide synovial ont rapidement augmenté après l'inoculation d'E. coli et étaient maximales au jour 3 et au jour 4, respectivement. Par la suite, les concentrations de SAA du sérum et du liquide synovial ont diminué avec l'élimination de l'infection articulaire, bien qu'elles soient demeurées augmentées significativement par rapport au seuil de base jusqu'au jour 9 et jour 10, respectivement. Les concentrations de SAA du sérum et du liquide synovial n'ont pas augmenté dans les groupes témoin et synovite non-septique. Ces résultats suggèrent que des mesures en série plutôt qu'une mesure unique de SAA sont requises pour déterminer l'élimination de l'infection lors d'arthrite septique chez les chevaux.(Traduit par Docteur Serge Messier).

Sinocutaneous fistula repair with a masseter muscle transposition flap combined with wound matrix and cancellous bone graft in a horse: A new technique.

OBJECTIVE: To describe a new technique to repair a sinocutaneous fistula with a masseter muscle transposition flap. STUDY DESIGN: Case report. ANIMAL: One 13-year-old thoroughbred stallion. METHODS: One 13-year-old stallion with a 3.5 × 6-cm sinocutaneous fistula over the right caudal maxillary sinus was treated with a transpositional masseter muscle flap. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material; a cancellous bone graft collected from the right tuber coxa placed on the dressing; and a portion of the superficial layer of the masseter muscle, with its pedicle at the facial crest, transposed dorsally over the bone graft, followed by a rotational skin flap with skin rostral to the fistula to close the defect. RESULTS: Seroma formation and dehiscence of the skin flap occurred, but the transposed muscle flap survived, and the technique resulted in successful closure of the sinocutaneous fistula with excellent cosmetic and functional outcome. CONCLUSION: A chronic maxillary sinocutaneous fistula was successfully treated by using a transposition flap of the masseter muscle and a rotational skin flap with minor complications. CLINICAL IMPACT: Transposition of the superficial layer of the masseter muscle should be considered for a repair of large maxillary sinocutaneous fistulas in horses.

Total intravenous anesthesia with alfaxalone, dexmedetomidine and remifentanil in healthy foals undergoing abdominal surgery.

OBJECTIVE: To evaluate effects of anesthesia induced with alfaxalone and maintained with alfaxalone, dexmedetomidine and remifentanil infusions in foals. STUDY DESIGN: Prospective, experimental study. ANIMALS: A group of six healthy foals [median (range) 11 (8-33) days] undergoing abdominal surgery. METHODS: Intravenous (IV) dexmedetomidine (3-7µgkg-1) provided sedation for insertion of a pulmonary artery catheter. IV anesthesia was induced with alfaxalone (2mgkg-1) and maintained with alfaxalone (6mgkg-1hour-1), dexmedetomidine (1µgkg-1hour-1) and remifentanil (3µgkg-1hour-1). Foals were endotracheally intubated and lungs were mechanically ventilated with oxygen. Cardiac output (thermodilution), heart rate and systemic arterial pressure were measured. Arterial and mixed venous blood was analyzed for PO2 and PCO2, and glucose, lactate and electrolyte concentrations. Anesthetic depth was subjectively assessed. Systemic vascular resistance (SVR), oxygen utilization and intrapulmonary shunt were calculated. Preinduction (PB) or 10 minutes postinduction (+10B) data were used as baselines with one-way analysis of variance for repeated measures. Data are mean ± standard deviation; significance was p ≤ 0.05. RESULTS: Duration of anesthesia was 129 ± 22minutes. One foal was administered additional alfaxalone (0.5mgkg-1) following induction. Cardiac index decreased to 107 ± 31 and 87 ± 21mLkg-1minute-1 at 60 and 80minutes, respectively, compared with PB (157 ± 33mLkg-1minute-1). SVR increased to 1223 ± 166dynessecond-1cm-5 at 80minutes compared with +10B (704 ± 247dynessecond-1cm-5). Mean arterial pressures were 63-128mmHg. Time from stopping infusions to standing was 46-106minutes. All foals were hypothermic (<36°C) and three foals were administered atipamezole (0.05mgkg-1) intramuscularly during recovery. CONCLUSION: and clinical relevance Combined alfaxalone-dexmedetomidine-remifentanil provided suitable anesthesia to permit laparotomy in foals. At the doses evaluated, prolonged recovery may occur.

Use of standard diagnostic techniques to determine eradication of infection in experimental equine septic arthritis.

Septic arthritis is an important disease in horses, necessitating aggressive and prolonged therapy. In order to guide therapy, reliable methods of detecting the eradication of infection are needed. Therefore, the objective of this study was to investigate detection of eradication of infection in an experimental model of equine septic arthritis using standard diagnostic techniques. For this purpose, 17 adult horses were assigned to 3 experimental groups. The middle carpal joint of each horse was injected with Escherichia coli (Septic group, n = 8), lipopolysaccharide (LPS) (LPS group, n = 6), or sterile saline (Control group, n = 3) at day 0. Contralateral joints were not injected. Standard therapy was applied to all joints except non-injected joints in the Control group at day 1. Sequential samples of synovial fluid (SF) were collected for bacterial culture using 3 culture media [Columbia blood agar (CBA), brain heart infusion broth (BHI), and Signal blood culture medium] and for cytological evaluation [percentage neutrophils (PN), total nucleated cell count (TNCC), and total protein (TP)]. Escherichia coli-specific polymerase chain reaction (PCR) was carried out to detect E. coli DNA in synovial fluid. Culture and PCR were positive for E. coli in all joints injected with E. coli at day 1 and 1 joint was positive on BHI at day 4. Based on the results of bacterial culture, PCR, and TNCC, the elimination of infection in our experimental model occurred by day 4 post-infection in 6 out of 7 cases. Total protein (TP) and PN remained elevated at clinical threshold used for diagnosis of septic arthritis until day 14. In our experimental model of E. coli-induced arthritis, we conclude that TP and PN may not be good indicators for detecting the eradication of bacterial infection caused by E. coli from infected and subsequently treated joints.

L'arthrite septique est une pathologie importante chez les chevaux, nécessitant une thérapie agressive et prolongée. Afin de guider la thérapie, des méthodes fiables pour détecter l'éradication de l'infection sont requises. Ainsi, l'objectif de la présente étude était d'examiner la détection de l'éradication de l'infection dans un modèle expérimental d'arthrite septique équine en utilisant des techniques diagnostiques standards. À cet effet, 17 chevaux adultes ont été assignés à trois groupes expérimentaux. L'articulation carpienne moyenne de chaque cheval a été injectée avec Escherichia coli (groupe septique, n = 8), du lipopolysaccharide (LPS) (groupe LPS, n = 6), ou de la saline stérile (groupe témoin, n = 3) au jour 0. Les articulations contra-latérales n'ont pas été injectées. Au jour 1, une thérapie standard fut appliquée à toutes les articulations sauf les articulations non-injectées dans le groupe témoin. De manière séquentielle des échantillons de liquide synovial (LS) furent prélevés pour culture bactérienne en utilisant trois milieux de culture [gélose au sang Columbia (CBA), bouillon coeur-cerveau (BHI), et hémoculture Signal] et pour évaluation cytologique [pourcentage de neutrophiles (PN), dénombrement total de cellules nucléées (DTCN), et la quantité de protéines totales (PT)]. Une réaction d'amplification en chaîne par la polymérase (ACP) spécifique à E. coli a été réalisée afin de détecter l'ADN d'E. coli dans le LS. La culture et l'ACP étaient positives pour E. coli dans toutes les articulations injectées avec E. coli au jour 1 et une articulation était positive avec le BHI au jour 4. Sur la base des résultats des cultures bactériennes, de l'ACP, et du DTCN, l'élimination de l'infection dans notre modèle expérimental est survenue au jour 4 post-infection dans 6 des 7 cas. Les valeurs de PT et de PN sont demeurées élevées au seuil clinique utilisé pour diagnostiquer une arthrite septique jusqu'au jour 14. Dans notre modèle expérimental d'arthrite induite par E. coli, nous concluons que les valeurs de PT et de PN ne seraient pas de bons indicateurs pour détecter l'éradication de l'infection bactérienne causée par E. coli dans des articulations infectées et subséquemment traitées.(Traduit par Docteur Serge Messier).

Comparison of hand-sewn and oversewn stapled jejunojejunal anastomoses in horses.

The objective of this study was to compare the biomechanical properties of hand-sewn jejunojejunal anastomoses to those of oversewn stapled jejunojejunal anastomoses. Jejunojejunal anastomoses were constructed from harvested jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique oversewn with Cushing pattern (SS), and closed 1-stage stapled functional end-to-end technique oversewn with Cushing pattern (FEE). Anastomosed segments were distended with fluid until the point of biomechanical failure. The 2HS had the longest construction time of all anastomoses. Bursting pressures were significantly higher for hand-sewn jejunojejunostomies than those for oversewn stapled jejunojejunostomies. No significant differences were found in bursting pressures between 1HS and 2HS or between SS and FEE. Hand-sewn jejunojejunostomies proved to be biomechanically stronger than oversewn stapled jejunojejunostomies when initially constructed. However, all anastomotic types would be secure techniques to be used clinically based on the supraphysiological pressures they are capable of withstanding.

Comparaison des anastomoses jéjuno-jéjunales cousues à la main et agrafées et cousues chez les chevaux. Cette étude avait pour objectif de comparer les propriétés biomécaniques des anastomoses jéjuno-jéjunales cousues à la main et celles des anastomoses jéjuno-jéjunales agrafées et cousues. Des anastomoses jéjuno-jéjunales ont été construites à partir de segments jéjunaux prélevés en utilisant la technique Lembert à couche unique (1HS), la technique Cushing à double couche simple continue (2HS), la technique agrafée côte à côte selon la méthode Cushing (SS) et la technique fonctionnelle de bout en bout fermée en 1 étape avec couture selon la méthode Cushing (FEE). Des segments anastomosés ont été dilatés avec du liquide jusqu'au point de défaillance biomécanique. La technique 2HS présentait le temps de construction le plus long de toutes les anastomoses. Les pressions de rupture étaient significativement supérieures pour les jéjuno-jéjunostomies cousues par rapport aux jéjuno-jéjunostomies agrafées et cousues. Aucune différence significative n'a été constatée au niveau des pressions de rupture entre 1HS et 2HS ou entre SS et FEE. Les jéjuno-jéjunostomies cousues à la main se sont avérées plus fortes sur le plan mécanique que les jéjuno-jéjunostomies agrafées et cousues lors de la construction initiale. Cependant, tous les types anastomotiques seraient des techniques sûres pour utilisation clinique en se basant sur les pressions supra-physiologiques qu'elles sont capables de supporter.(Traduit par Isabelle Vallières).

Is there an application for wireless capsule endoscopy in horses?

This pilot study assessed wireless capsule endoscopy in horses. Image transmission was achieved with good image quality. Time to exit the stomach was variable and identified as one limitation, together with gaps in image transmission, capsule tumbling, and inability to accurately locate the capsule. Findings demonstrate usefulness and current limitations.

Existe-t-il une application pour l'endoscopie par capsule sans fil chez les chevaux? Cette étude pilote a évalué l'endoscopie par capsule chez les chevaux. La transmission d'images a permis d'obtenir une bonne qualité d'image. Le temps jusqu'à la sortie de l'estomac était variable et identifié comme une limitation, de même que les lacunes dans la transmission de l'image, le culbutage de la capsule et l'incapacité de situer l'emplacement exact de la capsule. Les résultats démontrent l'utilité et les limitations actuelles.(Traduit par Isabelle Vallières).

Laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses: 43 cases.

OBJECTIVE: To document laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses. STUDY DESIGN: Retrospective study. ANIMALS: Forty-three male horses. METHODS: Food was withheld for 36 hours before horses were placed under general anesthesia and positioned in dorsal recumbency. One laparoscopic portal and 2 instrument portals were placed for the laparoscopic procedure. A third instrument portal was created in bilateral cryptorchid horses. A vessel-sealing device was used for hemostasis and transection of retained testes. Descended testes were removed via closed castration with primary closure of the scrotal incision. Time required for removal of the retained testis and perioperative complications were recorded. Short-term (14, 30, 60 days) and long-term follow-up (>1.5 years) consisted of telephone interview with owners and referring veterinarians. RESULTS: Forty-three male horses underwent laparoscopic cryptorchidectomy. Thirteen horses were bilateral cryptorchids, 19 were unilateral cryptorchids with a descended testis, and 11 were unilateral cryptorchids with 1 testis previously removed. Inguinal testes, identified in 5 horses, were pulled into the abdomen prior to excision. The vaginal ring was apposed with endoscopic staples in 3 of 5 horses. Mean surgery time was 31.34 ± 7.41 minutes. No intraoperative or immediate postoperative complications were encountered. No short-term or long-term complications were reported. CONCLUSION: Laparoscopic cryptorchidectomy can be safely performed with a vessel sealing-device in dorsal recumbent horses. This method was effective and did not result in any complication in our case series.

A pilot study evaluating laparoscopic closure of the nephrosplenic space using an endoscopic suturing device in standing horses.

This study evaluated the use of an articulating automated suturing device for laparoscopic closure of the nephrosplenic space in standing horses. Closure of the nephrosplenic space was performed in 4 horses using an automated suturing device. Second-look laparoscopy was performed at 5 weeks. A smooth fibrous adhesion formed between the spleen, the perirenal fascia, and the nephrosplenic ligament in 3 of the 4 horses in which the nephrosplenic space was closed using the automated suturing device. In 1 horse, closure of the nephrosplenic space was not possible due to constant breakage of the endoscopic needle. Intra-operative complications encountered with the automated suturing device were tearing of the perirenal fascia, nephrosplenic ligament, and dorsal splenic capsule along with breakage of the needle. The automated suturing device used in this study for laparoscopic closure of the nephrosplenic space resulted in longer surgery times, suffered instrument failures and delivered inadequate suture.

Étude pilote pour évaluer la fermeture par laparoscopie de l'espace néphrosplénique à l'aide d'un appareil de suture endoscopique chez des chevaux debout. Cette étude a évalué l'utilisation d'un appareil articulé et automatisé de suture pour la fermeture laparascopique de l'espace néhrosplénique chez les chevaux debout. La fermeture de l'espace néphrosplénique a été réalisée chez 4 chevaux à l'aide d'un appareil de suture automatisé. Une laparascopie de second regard a été réalisée à 5 semaines. Une adhésion fibreuse lisse s'était formée entre la rate, le fascia périrénal et le ligament néphrosplénique chez 3 des 4 chevaux pour lesquels l'espace néphrosplénique avait été fermé à l'aide de l'appareil de suture automatisé. Chez un cheval, la fermeture de l'espace néphrosplénique n'avait pas été possible en raison de bris constant de l'aiguille endoscopique. Des complications peropératoires avec l'appareil de suture automatisé déchiraient le fascia périrénal, le ligament néphrosplénique et la capsule splénique dorsale et l'aiguille se brisait. L'appareil de suture automatisé utilisé dans cette étude pour la fermeture laparascopique de l'espace néphrosplénique a donné lieu à des temps de chirurgie plus longs, à des défaillances de l'instrument et à des sutures inadéquates.(Traduit par Isabelle Vallières).

Quality of Adhesions After Sutured Paramedian vs. Laparoscopic Toggle Abomasopexy in an Ovine Model.

OBJECTIVE: To evaluate adhesions created by abomasopexies using either chromic gut or polydioxanone suture through a right paramedian approach and determine whether a laparoscopic toggle technique is an acceptable alternative to open abomasopexy using an ovine model. STUDY DESIGN: Experimental study. ANIMALS: Mature ewes (n=30). METHODS: Ewes received 1 of 3 abomasopexy techniques (n=10): right paramedian approach using chromic gut or polydioxanone, or a laparoscopic toggle technique. After euthanasia 8 weeks postoperatively, adhesions were removed en bloc and adhesion cross-sectional area (width × length) and depth (distance from abdominal wall to abomasum) were measured and given a grade of 0-3 based on the quality of adhesion. Surgical time was recorded and compared for each technique. Significance was set at P≤.05. RESULTS: Abomasopexies performed with either suture material resulted in a significantly larger mean cross-sectional area and higher adhesion grades compared to those performed using the toggle. Width and length of adhesions formed using chromic gut or polydioxanone were not significantly different; however, both were significantly wider and longer than those formed using the toggle. The laparoscopic toggle technique required significantly less surgical time than the sutured techniques. CONCLUSION: Polydioxanone is as effective as chromic gut suture material in inducing abomasal adhesion formation in our sheep model. The clinical significance of the size and grade of adhesions formed is unknown and requires further investigation before the laparoscopic toggle technique can be recommended as a replacement for paramedian abomasopexy in cattle for the treatment of displaced abomasum.

Effect of Arthroscopic Lavage on Systemic and Synovial Fluid Serum Amyloid A in Healthy Horses.

OBJECTIVE: To evaluate the effect of arthroscopic lavage on systemic serum amyloid A (SAA) and SAA, total protein, nucleated cell count, and percentage of neutrophils in synovial fluid in healthy horses. STUDY DESIGN: Prospective experimental study. ANIMALS: Healthy adult horses (n = 6). METHODS: Middle carpal joints were randomly assigned to 1 of 2 treatments: arthrocentesis (controls) or arthroscopic lavage, with 30 day washout period between treatments. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96, and 120 hours. Measurements included systemic and synovial fluid SAA, as well as total protein, nucleated cell count, and percentages of neutrophils in synovial fluid. Data were analyzed by median quantile regression and Wilcoxon signed-rank test and significance level set at P < .05. RESULTS: Systemic and synovial fluid SAA did not increase from baseline (except systemic SAA at 24 hours for both treatments) and were not significantly different between treatments. Total protein values were significantly increased after arthroscopic lavage (except at 96 hours) but not in controls at all time points. With both treatments, nucleated cell counts significantly increased from baseline values at all time points. Percentages of neutrophils were significantly increased after arthroscopic lavage at all time points, but only at 24 hours in controls. CONCLUSION: Total protein, nucleated cell count, and percentage of neutrophils in synovial fluid were significantly increased after arthroscopic lavage; however, synovial fluid SAA was not affected by this procedure. Further research is warranted to validate synovial fluid SAA as a monitoring tool during treatment of septic arthritis.

Transthecal Arthroscopy of the Palmar Distal Interphalangeal Joint in the Horse: A Cadaver Study.

OBJECTIVE: To describe a transthecal approach to the palmar pouch of the distal interphalangeal joint (DIPJ) in horses and compare it with the conventional blind arthroscopic technique. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Cadaver forelimbs (n = 26 pairs) from mature horses. METHODS: One limb from each pair was randomly assigned to each arthroscopic approach (conventional or transthecal). The conventional arthroscopic approach was performed as previously described and the transthecal approach was performed through sharp dissection of the distal reflection of the digital flexor tendon sheath (DFTS). The proportion (0-100%) of the navicular bone, palmar aspect of the condyles of the 2nd phalanx, collateral sesamoidean ligaments, and palmar synovial pouches of the DIPJ visualized by each approach was estimated. Limbs were dissected and iatrogenic damage of relevant structures was assessed. Nondirectional Mann-Whitney U-test was used to compare groups. Significance was set at P < .05. RESULTS: The transthecal approach provided greater visualization of the navicular bone (P < .001), palmar aspect of the 2nd phalanx (P < .001), and palmar synovial pouches of the DIPJ (P < .001) than the conventional approach. There were no significant differences in iatrogenic damage between approaches. CONCLUSION: The transthecal approach provides improved visualization of the palmar aspect of the DIPJ compared to the conventional blind approach and may be useful in nonseptic conditions of the DIPJ. However, because of the creation of communication with the DFTS, use of the transthecal approach for suspected synovial sepsis of the DIPJ may be contraindicated.

Occurrence of Incisional Complications After Closure of Equine Celiotomies With USP 7 Polydioxanone.

OBJECTIVES: To report the occurrence of, and risk factors associated with, incisional complications of equine ventral median celiotomies closed with USP 7 polydioxanone (7PD). STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Horses (n = 73; 75 celiotomies). METHODS: Medical records (2000-2010) were retrieved and reviewed for horses that had a ventral celiotomy closed with 7PD and survived ≥14 days. Follow-up (>1 year) was obtained from the medical record, owner, or referring veterinarian. Independent variables were selected based on risk factors identified in previous studies, perceived clinical relevance, and if there were adequate data recorded in the medical record. Statistical analysis, including multivariable logistic regression with a forward-building model process, was performed to evaluate variables associated with incisional complications. RESULTS: One or more incisional complication(s) occurred in 19 celiotomies (25.3%) during hospitalization or after discharge including: drainage (25.3%), infection (12.0%), and partial dehiscence (5.3%). Two of 63 horses (3.2%) available for follow-up developed an incisional hernia. Variables associated with incisional complications after multivariate analysis included: number of days hospitalized, surgery time, postoperative colic, and postoperative fever. CONCLUSION: Overall occurrence of incisional herniation after closure of ventral celiotomies with 7PD was low.

Ex vivo evaluation of 7 polydioxanone for closure of equine ventral midline celiotomies.

The objective of this study was to compare the bursting strength (BS) and mode of failure (MF) of ventral midline (VM) celiotomies closed with USP 7 polydioxanone (7PD) in 1 or 2 simple continuous sections. A bursting strength model, consisting of inserting and inflating a 200-L polyurethane bladder through a 25-cm VM celiotomy, was used on 15 fresh equine cadavers. Celiotomies were closed using 7PD in 2 separate sections (4 knots), 2 continuous sections (3 knots), or a single section (2 knots) using a simple continuous pattern. The horses' signalment, body weight, number of total knots, MF, and BS were recorded and analyzed statistically for interactions. No difference was found between the BS of VM celiotomies closure types (P = 0.4). All celiotomy/ suture constructs failed at the abdominal wall. The celiotomy closure types evaluated in this study provided a secure method of closure in VM celiotomies in vivo.

L'objectif de la présente étude était de comparer la force d'éclatement (BS) et le mode d'échec (MF) de laparotomies par la ligne ventrale médiale (VM) refermées avec du 7 polydioxanone USP (7PD) en une ou 2 sections continues. Un modèle de force d'éclatement, consistant en l'insertion et le gonflement une vessie de 200 L en polyuréthane via une laparotomie de 25 cm fut utilisé sur 15 cadavres frais de cheval. Les laparotomies étaient refermées en utilisant le 7PD en deux sections séparées (4 nœuds), 2 sections continues (3 nœuds), ou une section simple (2 nœuds) au moyen d'un patron simple continu. L'historique des chevaux, leur poids corporel, le nombre total de nœuds, MF, et BS ont été enregistrés et analysés statistiquement pour les interactions. Aucune différence ne fut trouvée entre les BS et les types de fermetures de VM des laparotomies (P = 0,4). Toutes les laparotomies/modes de suture ont lâché au niveau de la paroi abdominale. Les types de fermeture des laparotomies évalués dans ce projet ont fourni une méthode sécuritaire de fermeture par la VM de laparotomies in vivo.(Traduit par Docteur Serge Messier).

Ex vivo comparison of the biomechanical properties of hand-sewn and stapled jejunoileal anastomoses in horses.

OBJECTIVE: To compare bursting strength, construction time, and anastomotic dimensions of 4 jejunoileal anastomotic techniques. STUDY DESIGN: Experimental ex vivo study. ANIMALS: Adult horses (n = 12). METHODS: Jejunoileal anastomoses were constructed from harvested ileal and distal jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique (SS), or stapled functional end-to-end technique (FEE). Anastomotic construction time was recorded. Bursting pressures (BP), bursting wall tension (BWT), percentage of mean anastomotic luminal diameter reduction, percentage of luminal diameter reduction relative to adjacent ileal and jejunal diameters and stomal length, were calculated. RESULTS: FEE had the shortest construction time. BP of 1HS and 2HS was significantly higher than FEE and SS (P < .001), which were not different from each other (P = .67). There were no significant differences in BP (P = .25) and BWT (P = .21) between 1HS and 2HS. Mean luminal diameter reduction was less for 1HS (25.1%) than for 2HS (34.8%), however, not statistically different (P = .12). Luminal diameter reduction relative to ileal diameter was significantly less for 1HS (15.2%) than for 2HS (28.47%; P = .012). Luminal diameter reduction relative to jejunal diameter was less for 1HS (32.4%) than 2HS (44.6%) but not statistically different; P = .07). Stomal length was significantly larger for SS (9.93 cm) than FEE (7.32 cm; P = .0002). CONCLUSION: 1HS and 2HS jejunoileal anastomosis are equal in strength; however, 1HS results in less relative luminal diameter reduction. SS and FEE have comparable strength but fail at significantly lower BPs than hand-sewn jejunoileal anastomoses.

Cardiopulmonary effects of an infusion of remifentanil or morphine in horses anesthetized with isoflurane and dexmedetomidine.

OBJECTIVE: To examine the cardiopulmonary effects of infusions of remifentanil or morphine, and their influence on recovery of horses anesthetized with isoflurane and dexmedetomidine. STUDY DESIGN: Randomized crossover study with 7-day rest periods. ANIMALS: Six adult horses (507 ± 61 kg). METHODS: After the horses were sedated with xylazine, anaesthesia was induced with ketamine and diazepam, and maintained with isoflurane. After approximately 60 minutes, a dexmedetomidine infusion was started (0.25 µg kg(-1) then 1.0 µg(-1) kg(-1) hour(-1) ) in combination with either saline (group S), morphine (0.15 mg kg(-1) then 0.1 mg kg(-1) hour(-1) ; group M), or remifentanil (6.0 µg kg(-1) hour(-1) ; group R) for 60 minutes. Mean arterial pressure, heart rate, end-tidal carbon dioxide tension, and end-tidal isoflurane concentration were recorded every 5 minutes. Core body temperature, cardiac output, right ventricular and arterial blood-gas values were measured every 15 minutes. Cardiac index, systemic vascular resistance (SVR), intrapulmonary shunt fraction, alveolar dead space, oxygen delivery and extraction ratio were calculated. Recoveries were videotaped and scored by two observers blinded to the treatment. Data were analyzed using repeated measures anova followed by Dunnett's or Bonferroni's significant difference test. Recovery scores were analyzed using a Kruskal-Wallis test. RESULTS: No significant differences were found among groups. Compared to baseline, heart rate decreased and SVR increased significantly in all groups, and cardiac index significantly decreased in groups S and M. Hemoglobin concentration, oxygen content and oxygen delivery significantly decreased in all groups. The oxygen extraction ratio significantly increased in groups M and R. Lactate concentration significantly increased in group S. Recovery scores were similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Dexmedetomidine alone or in combination with remifentanil or morphine infusions was infused for 60 minutes without adverse effects in the 6 healthy isoflurane-anesthetized horses in this study.

Ex vivo comparison of 7 polydioxanone, 2 polyglactin 910 for closure of ventral median celiotomy in horses.

OBJECTIVE: To compare bursting strength and failure mode between ventral median celiotomies closed with USP 7 braided polydioxanone (7PD) or USP 2 polyglactin 910 (2PG). STUDY DESIGN: Ex vivo experimental. ANIMALS: Equine cadavers (n = 10). METHODS: A 25 cm ventral median celiotomy was created in fresh equine cadavers. A 200 L polyurethane bladder was inserted into the abdomen. Celiotomies were closed in a simple continuous pattern with 2 sections of 7PD or 2PG. The bladder was inflated with compressed air until construct failure. The horses' signalment, body weight, suture type, failure mode (suture or abdominal wall), and bursting strength (mmHg) were recorded. Interactions between independent and dependent variables were assessed with statistical tests including linear regression. RESULTS: Failure mode was significantly different by suture type (P = .01). Four of 5 celiotomies closed with 2PG failed at the suture; whereas, 0 celiotomies closed with 7PD failed at the suture. In celiotomies closed with 7PD, increasing age was highly and negatively correlated with bursting strength (r = -0.99). When the effect of age was controlled, 7PD had a significantly higher bursting strength than 2PG (P = .024). CONCLUSION: 7PD has a higher bursting strength compared with 2PG. Suture failure was the main failure mode for 2PG; whereas, all celiotomies closed with 7PD failed at the abdominal wall.

Ex vivo comparison of bursting strength of ventral median and right ventral paramedian celiotomies in horses.

OBJECTIVE: To compare bursting strength and failure mode between ventral median (VM) and right ventral paramedian (RVP) celiotomies closed with 1 section of USP 7 braided polydioxanone (7PD). STUDY DESIGN: Ex vivo experimental. ANIMALS: Equine cadavers (n = 12). METHODS: A 25 cm VM or RVP (positioned 5 cm lateral to the linea alba) celiotomy was created in fresh equine cadavers. A 200 L polyurethane bladder was inserted into the abdomen. Celiotomies were closed in a simple continuous pattern with 1 section of 7PD. The bladder was inflated with compressed air until construct failure. Horse signalment, body weight, celiotomy type, failure mode (suture or abdominal wall), failure location (adjacent or remote from the celiotomy), and bursting strength (mmHg) were recorded. Interactions between independent and dependent variables were assessed with statistical tests including linear regression. RESULTS: Increasing age (P = .002) and Quarter horse-type breed (P = .01) had a negative effect on bursting strength. When age and breed were controlled, RVP celiotomies had a lower bursting strength compared with VM celiotomies (P = .039). None of the celiotomies failed at the suture. CONCLUSION: VM celiotomies have a greater bursting strength than RVP celiotomies when age and breed are controlled. Celiotomy bursting strength decreases with increasing age and is lower in Quarter horse-type breeds compared with non-Quarter horse-type breeds.

Alcohol-facilitated ankylosis of the distal intertarsal and tarsometatarsal joints in horses with osteoarthritis.

OBJECTIVE: To assess the safety and efficacy of alcohol-facilitated ankylosis of the distal intertarsal (DIT) and tarsometatarsal (TMT) joints in horses with osteoarthritis (bone spavin). DESIGN: Prospective clinical trial. ANIMALS: 21 horses with DIT or TMT joint-associated hind limb lameness and 5 nonlame horses. PROCEDURES: 11 horses (group 1) underwent lameness, force-plate, and radiographic examinations; following intra-articular analgesia, lameness and force-plate examinations were repeated. Nonlame horses were used for force-plate data acquisition only. Following localization of lameness to the DIT and TMT joints, contrast arthrographic evaluation was performed; when communication with the tibiotarsal joint was not evident or suspected, 70% ethyl alcohol (3 mL) was injected. Group 1 horses underwent lameness, force-plate, and radiographic examinations every 3 months for 1 year. Ten other horses (group 2) underwent lameness and radiographic examinations followed by joint injection with alcohol; follow-up information was obtained from owners or via clinical examination. RESULTS: Significant postinjection reduction in lameness (after 3 days to 3 months) was evident for all treated horses. Twelve months after injection, 10 of 11 group 1 horses were not lame; lameness grade was 0.5 in 1 horse. Follow-up information was available for 9 of 10 group 2 horses; 7 were not lame, and 2 remained mildly lame (1 had a concurrent problem in the injected limb, and the other had DIT joint collapse that precluded needle entry). CONCLUSIONS AND CLINICAL RELEVANCE: Intra-articular alcohol injection in horses with bone spavin resulted in a rapid (usually within 3 months) reduction in lameness and joint space collapse.

Evaluation of a laparoscopic technique for collection of serial full-thickness small intestinal biopsy specimens in standing sedated horses.

OBJECTIVE: To assess a technique for laparoscopic collection of serial full-thickness small intestinal biopsy specimens in horses. ANIMALS: 13 healthy adult horses. PROCEDURES: In the ex vivo portion of the study, sections of duodenum and jejunum obtained from 6 horses immediately after euthanasia were divided into 3 segments. Each segment was randomly assigned to the control group, the double-layer hand-sewn closure group, or the endoscopic linear stapler (ELS) group. Bursting strength and bursting wall tension were measured and compared among groups; luminal diameter reduction at the biopsy site was compared between the biopsy groups. In the in vivo portion of the study, serial full-thickness small intestinal biopsy specimens were laparoscopically collected with an ELS from the descending duodenum and distal portion of the jejunum at monthly intervals in 7 sedated, standing horses. Biopsy specimens were evaluated for suitability for histologic examination. RESULTS: Mean bursting strength and bursting wall tension were significantly lower in the ELS group than in the hand-sewn and control groups in both the duodenal and jejunal segments. Use of the hand-sewn closure technique at the biopsy site reduced luminal diameter significantly more than use of the stapling technique. In the in vivo part of the study, all 52 biopsy specimens collected during 26 laparoscopic procedures were suitable for histologic examination and no clinically important perioperative complications developed. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic collection of serial full-thickness small intestinal biopsy specimens with a 45-mm ELS may be an effective and safe technique for use in healthy adult experimental horses.