Equine intervertebral disc disease with dorsal protrusion and spinal cord compression: A computed tomography, myelography, MRI, and histopathologic case study.

A 3-year-old American Saddlebred gelding presented for progressive tetraparesis, ataxia, and cervical hyperaesthesia. Radiographic myelography identified spinal cord compression at C6-7 in neutral, extended, and flexed positions and at C4-5 in the flexed position. CT myelography and postmortem MRI identified severe vertebral canal stenosis/compression at C6-7. MRI further identified severe intervertebral disc herniation at C6-7 with intramedullary changes. Disc protrusion was confirmed macroscopically at postmortem. Lesions consistent with compressive myelopathy were confirmed microscopically at C6-7. This is the first report of equine disc protrusion and myelocompression confirmed by multiple advanced imaging modalities and postmortem examination.

Special Diagnostic Techniques in Equine Neurology (Radiography, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging).

Diagnostic imaging is often an important part of the diagnostic approach to neurologic disease. Advanced imaging techniques such as myelography, computed tomography (CT), and magnetic resonance imaging (MRI) provide more information than radiography and ultrasonography but are more limited in their availability. The clinician should be cognizant of the findings of the clinical examination when interpreting diagnostic imaging findings.

When radiography and ultrasonography are not enough: the use of computed tomography and magnetic resonance imaging for equine lameness cases.

MRI and CT have enhanced our diagnostic abilities for equine lameness beyond what is available using radiography and ultrasonography. This has allowed veterinarians to better prognosticate and treat lameness conditions, improving patient outcomes. This article discusses the basic principles behind MRI and CT, their advantages and disadvantages, the different types of equipment available for clinical use in horses, the typical diagnostic workup prior to pursuing advanced imaging, and common regions where MRI and CT are used clinically. The companion Currents in One Health by Spriet, AJVR, July 2022, discusses even more advanced equine imaging in the form of positron emission tomography. Combined, these future directions of MRI, CT, and positron emission tomography may include improved ability to image standing horses or screen for injury prevention.

Preoperative computed tomographic evaluation of neonatal foals with rib fractures.

OBJECTIVE: To compare ultrasonographic and computed tomographic findings in neonatal foals prior to surgical repair of rib fractures as well as postoperative outcomes in foals with and without preoperative thoracic computed tomography (CT). Study design Retrospective cohort study. Sample population 43 neonatal foals undergoing surgical treatment of rib fractures between 2013 and 2021. METHODS: Medical records were reviewed for age, sex, delivery method, comorbidities, presurgical anesthetic time, surgical time, number and location of fractured ribs identified with ultrasound and CT, number and location of ribs surgically repaired, survival to discharge, and post-mortem findings. Statistical analyses were performed using chi-square, Fisher's exact, and t-tests. RESULTS: Twenty-two foals underwent surgical repair of rib fractures after preoperative CT from 2019-2021 (median: 4/18/20) and 21 foals were anesthetized (20 underwent repair) for surgical repair of rib fractures without preoperative CT from 2013-2020 (median: 4/9/15). Ultrasound and CT findings differed in number and location of fractured ribs in 13/17 (76%) foals (p = .049). More cranially positioned ribs were identified as fractured with CT than with ultrasonography (p = .035). Survival to discharge was improved when foals underwent CT (20/22, 91%) than when they did not (12/20, 60%, p = .019). CONCLUSION: Ultrasound findings differed from CT findings in most foals. Foals evaluated with CT were more likely to survive to hospital discharge. CLINICAL SIGNIFICANCE: When available, CT is recommended prior to surgical repair of rib fractures in neonatal foals.

Effect of Intramedullary Nailing Patterns on Interfragmentary Strain in a Mouse Femur Fracture: A Parametric Finite Element Analysis.

Delayed long bone fracture healing and nonunion continue to be a significant socioeconomic burden. While mechanical stimulation is known to be an important determinant of the bone repair process, understanding how the magnitude, mode, and commencement of interfragmentary strain (IFS) affect fracture healing can guide new therapeutic strategies to prevent delayed healing or nonunion. Mouse models provide a means to investigate the molecular and cellular aspects of fracture repair, yet there is only one commercially available, clinically-relevant, locking intramedullary nail (IMN) currently available for studying long bone fractures in rodents. Having access to alternative IMNs would allow a variety of mechanical environments at the fracture site to be evaluated, and the purpose of this proof-of-concept finite element analysis study is to identify which IMN design parameters have the largest impact on IFS in a murine transverse femoral osteotomy model. Using the dimensions of the clinically relevant IMN as a guide, the nail material, distance between interlocking screws, and clearance between the nail and endosteal surface were varied between simulations. Of these parameters, changing the nail material from stainless steel (SS) to polyetheretherketone (PEEK) had the largest impact on IFS. Reducing the distance between the proximal and distal interlocking screws substantially affected IFS only when nail modulus was low. Therefore, IMNs with low modulus (e.g., PEEK) can be used alongside commercially available SS nails to investigate the effect of initial IFS or stability on fracture healing with respect to different biological conditions of repair in rodents.

Fluoroquinolone exposure in utero did not affect articular cartilage of resulting foals.

BACKGROUND: Recent studies have shown that fluoroquinolones, specifically, enrofloxacin and its active metabolite (ciprofloxacin), cross the equine placenta without causing gross or histological lesions in the first and third trimester fetuses or resulting foal. However, it is possible that in utero exposure to fluoroquinolones may cause subtle lesions not detectable by standard means; thus, a more in-depth assessment of potential toxicity is warranted. OBJECTIVES: To use quantitative magnetic resonance imaging (qMRI), biomechanical testing, and chondrocyte gene expression to evaluate the limbs of foals exposed to enrofloxacin during the third trimester of pregnancy. STUDY DESIGN: In vivo and control terminal experiment. METHODS: Healthy mares at 280 days gestation were assigned into three groups: untreated (n = 5), recommended therapeutic (7.5 mg/kg enrofloxacin, PO, SID, n = 6) or supratherapeutic (15 mg/kg, PO, SID, n = 6) doses for 14 days. Mares carried and delivered to term and nursed their foals for ~30 days. Two additional healthy foals born from untreated mares were treated post-natally with enrofloxacin (10 mg/kg PO, SID, for 5 days). By 30 days, foal stifles, hocks, elbows, and shoulders were radiographed, foals were subjected to euthanasia, and foal limbs were analysed by quantitative MRI, structural MRI, biomechanical testing and chondrocyte gene expression. RESULTS: Osteochondral lesions were detected with both radiography and structural MRI in foals from both enrofloxacin-treated and untreated mares. Severe cartilage erosions, synovitis and joint capsular thickening were identified in foals treated with enrofloxacin post-natally. Median cartilage T2 relaxation times differed between joints but did not differ between treatment groups. MAIN LIMITATIONS: A small sample size was assessed and there was no long-term follow-up. CONCLUSION: While further research is needed to address long-term foal outcomes, no differences were seen in advanced imaging, biomechanical testing or gene expression by 30 days of age, suggesting that enrofloxacin may be a safe and useful antibiotic for select bacterial infections in pregnant mares.

Common lesions of the distal end of the third metacarpal/metatarsal bone in racehorse catastrophic breakdown injuries.

Equine catastrophic skeletal breakdown injury is a serious issue within the racing industry, given the impact on equine and human health. The metacarpo- and metatarso-phalangeal (fetlock) joints are common sites of catastrophic injury. However, lesions involving articular cartilage, subchondral bone, and synovium are commonly identified within the fetlock of the contralateral limb; hence, it is imperative that lesions in both limbs are evaluated and characterized during postmortem examination. Bone and articular cartilage changes typically occur in specific locations, related to cyclic fetlock load and overextension during high-speed exercise. Associations between preexisting degenerative fetlock lesions and catastrophic injury are a focus of continued research. These lesions often occur because of adaptive failure related to cumulative damage. Further investigation of these lesions is imperative to determine their impact on equine performance or injury. Ultimately, consistent documentation of catastrophic versus non-catastrophic osteochondral lesions provided by pathologists, in the context of training history, diagnostic imaging, and the presence or absence of catastrophic injury, will contribute to further understanding of skeletal responses associated with catastrophic failure.

Gender, race and diet affect platelet function tests in normal subjects, contributing to a high rate of abnormal results.

To assess sources of variability in platelet function tests in normal subjects, 64 healthy young adults were tested on 2-6 occasions at 2 week intervals using four methods: platelet aggregation (AGG) in platelet-rich plasma (PRP) in the Bio/Data PAP-4 Aggregometer (BD) and Chrono-Log Lumi-Aggregometer (CL); and AGG in whole blood (WB) in the CL and Multiplate Platelet Function Analyser (MP), with ATP release (REL) in CL-PRP and CL-WB. Food and medication exposures were recorded prospectively for 2 weeks prior to each blood draw. At least one AGG abnormality was seen in 21% of 81 drug-free specimens with CL-PRP, 15% with CL-WB, 13% with BD-PRP and 6% with MP-WB, increasing with inclusion of REL to 28% for CL-PRP and 30% for CL-WB. Epinephrine AGG and REL were significantly reduced in males (P < 0·0001). Ristocetin AGG and collagen and thrombin REL were significantly reduced in Blacks (P < 0·0001). One-third of specimens drawn following flavonoid-rich food exposures had aberrant results, compared to 8·5% of specimens without such exposures (P = 0·0035). PRP tests had less intra-individual variation than WB tests. Gender, race, diet and test system affected results of platelet function testing in healthy subjects, suggesting caution when interpreting the results of platelet function testing in patients.

Injection of platelet- and leukocyte-rich plasma at the junction of the proximal sesamoid bone and the suspensory ligament branch for treatment of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated suspensory ligament branch desmitis.

OBJECTIVE: To determine the effects of treatment with platelet- and leukocyte-rich plasma (PRP) on future 2-, 3-, and 4-year-old racing performance of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated suspensory ligament branch (SLB) desmitis. DESIGN: Randomized clinical trial. ANIMALS: 39 yearling Thoroughbreds. PROCEDURES: Yearling Thoroughbreds with radiographic evidence of performance-limiting proximal sesamoid bone inflammation and ultrasonographic evidence of associated SLB desmitis were identified and randomly assigned to undergo PRP (treatment group) or saline (0.9% NaCl) solution (control group) injection at the affected SLB-proximal sesamoid bone junction. Race records of horses for the 2-, 3-, and 4-year-old racing years were obtained. Data regarding amount of money earned and number of races started were used as outcome measures, and results for groups were compared. RESULTS: Horses treated with PRP were significantly more likely to start at least 1 race during the 2-year-old racing year than were horses treated with saline solution; no significant differences were detected between groups regarding that variable for the 3- and 4-year-old racing years. No significant differences between groups were detected regarding earnings for any racing year. CONCLUSIONS AND CLINICAL RELEVANCE: Although PRP-treated horses were more likely to start a race during the 2-year-old racing year versus control group horses, results for horses in each group were not significantly different for the 3- and 4-year-old racing years. Therefore, the PRP treatment protocol evaluated in this study did not seem to improve future racing performance of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated SLB desmitis, compared with injection of saline solution.

Magnetic resonance imaging findings in horses with septic arthritis.

Fourteen horses with septic arthritis underwent high-field (1.5 T) magnetic resonance imaging (MRI). Septic arthritis was diagnosed based on results from historical and clinical findings, synovial fluid analyses and culture, and radiographic, ultrasonographic, arthroscopic, and histopathologic findings. MR findings included diffuse hyperintensity within bone and extracapsular tissue on fat-suppressed images in 14/14 horses (100%), joint effusion, synovial proliferation, and capsular thickening in 13/14 horses (93%), bone sclerosis in 11/14 horses (79%), and evidence of cartilage and subchondral bone damage in 8/14 horses (57%). Intravenous gadolinium was administered to five of the 14 horses and fibrin deposition was noted in all horses. Other findings after gadolinium administration included synovial enhancement in 4/5 (80%) horses, and bone enhancement in 1/5 (20%) horses. The MR findings of septic arthritis in horses were consistent with those reported in people. MRI may allow earlier and more accurate diagnosis of septic arthritis in horses as compared with other imaging modalities, especially when the clinical diagnosis is challenging. It also provides additional information not afforded by other methods that may influence and enhance treatment.

Imaging diagnosis--nasal septal and laryngeal cyst-like malformationsin a Thoroughbred weanling colt diagnosed using ultrasonography and magnetic resonance imaging.

A foal was examined for abnormal upper airway noise. Endoscopically, there were narrowed nasal passages and an extralumenal mass of the cranial trachea. Using ultrasonography and magnetic resonance (MR) imaging of the larynx and cranial cervical trachea, irregular margins of the laryngeal cartilages and first tracheal ring containing areas consistent with fluid were identified. In MR images, a widened nasal septum was seen that contained material consistent with fluid. Postmortem examination confirmed the diagnosis of nasal septal, laryngeal, and cranial cervical tracheal cyst-like lesions. This is a unique congenital condition, in which premortem imaging was instrumental in defining the abnormalities.

Endoscopic evaluation of arytenoid function and epiglottic structure in Thoroughbred yearlings and association with racing performance at two to four years of age: 2,954 cases (1998-2001).

OBJECTIVE-To determine the association between results of endoscopic evaluation of arytenoid function (AF) and epiglottic structure (ES) in Thoroughbred yearlings and racing performance at 2 to 4 years of age. DESIGN-Retrospective case series. ANIMALS-2,954 Thoroughbred yearlings. Procedures-Records of yearlings that had endoscopic evaluation of the larynx between 1998 and 2001 were obtained, and results were graded by use of standardized scales. A modified Havemeyer scale (grade I, II.1, II.2, III, or IV) was used to evaluate AF; ES was graded on a scale of 0 to IV. Records were annotated if the epiglottis was subjectively short or narrow. Racing performance data were obtained from an online database. RESULTS-Horses with grade II.2 AF had significantly less earnings at 4 years of age, compared with earnings of horses with AF grades < II.2. Grade III AF was associated with fewer starts and less earnings at 3 and 4 years of age. No horses met the criteria for grade IV AF. Horses with ES grades > II had less earnings at 2 and 4 years of age, compared with earnings of horses with ES grades < II. A short epiglottis was associated with less earnings at 2 and 3 years of age. CONCLUSIONS AND CLINICAL RELEVANCE-Analysis suggested that yearlings with grade III AF had a decrease in athletic potential. Yearlings with grade II.2 AF, an ES grade > II, or a short epiglottis typically had decreases in racing performance. These factors should be evaluated carefully when developing purchase recommendations.

The transition from veterinary school to equine practice.

The transition from veterinary school to equine practice can be challenging. This article provides suggestions and advice for new graduates in areas that include internships, associate positions, financial considerations, balancing personal and professional responsibilities, mentorship, continuing education, and professionalism.

The effect of a bioresorbable matrix barrier in endodontic surgery on the rate of periapical healing: an in vivo study.

The purpose of this prospective clinical study was to assess the rate of healing of periapical bony defects created at the time of endodontic periapical surgery by measuring the densitometric ratio change in periapical osseous tissues, after periapical endodontic surgery was performed, by using or not using Guidor bioresorbable membrane material. Periapical surgeries were performed on 25 patients where nonsurgical root canal therapy had failed and a periapical lesion was present. For inclusion in the study, the osseous defect to be analyzed had to be confined to the apical area, with bone covering the entire root surface coronally, and an intact lingual cortical plate had to be present. A series of radiographs at the 3-, 6-, and 12-month recalls were compared with the radiograph taken immediately after surgery by using digital imaging and a densitometric ratio that gave a numerical estimation of osseous healing. Using repeated-measure ANOVA, it was shown that there was no statistical difference between the rate of healing in those cases where a Guidor resorbable membrane was used and those cases where no membrane was used. The results suggest that placement of a guided tissue membrane over the bony opening created during an endodontic periapical surgical procedure has no beneficial effect on the rate of healing and the added expense to the patient would not be warranted in these cases.