Interpreting abdominal fluid in colic horses: Understanding and applying peritoneal fluid evidence.

BACKGROUND: Interpreting changes in peritoneal fluid helps clinicians manage colic and other diseases in horses. During abdominal problems in the horse, abdominal fluid characteristics such as color, turbidity, total nucleated and red blood cell counts, cytology, total protein, and l-lactate change in predictable ways, helping the clinician characterize the disease. DESCRIPTION: Normal abdominal fluid in horses is odorless, clear to light yellow in color, and transparent. Peritoneal fluid becomes more turbid with increasing levels of protein, number of WBCs or RBCs, or with gross contamination following intestinal rupture. The color of abdominal fluid will also change with the type and quantity of cells or other elements present. The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions. Serosanguinous defines fluid that is both turbid and orange to bloody because of increased total protein, WBCs, and RBCs, and is considered classic for diseases characterized by intestinal ischemia. Peritoneal fluid may also be red or blood-colored because of a hemoperitoneum, or secondary to blood contamination during sample collection. l-Lactate measurement in the abdominal fluid has proven invaluable for the identification of strangulating intestinal injury. Cytology acts as an important supplement to cell counts in peritoneal fluid, and the normal ratio of non-degenerate neutrophils:mononuclear cells of 2:1 changes during various gastrointestinal diseases. Culture of peritoneal fluid samples should be performed when septic peritonitis is suspected. SUMMARY: Abdominal fluid is a sensitive indicator of intestinal injury and a useful tool to direct treatment. Peritoneal fluid evaluation includes gross visual and olfactory examination, nucleated cell count, total protein, RBC count, lactate levels, cytology, and culture. The changes noted in such variables are related to the type and duration of the abdominal problem. KEY POINTS:  Abdominal fluid interpretation has become central to the triage and management of challenging equine colic patients.  The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions.  Contamination with RBCs at various concentrations may be secondary to vascular (eg, abdominal wall or mesenteric vessels) or splenic trauma during abdominal fluid collection; however, this must be distinguished from orange to red fluid associated with intestinal strangulating obstruction or hemoabdomen  Peritoneal fluid analysis reveals abdominal pathology by recognizing specific changes that occur with disease processes affecting the tissues and organs within this cavity.  Abdominal fluid examination should be used as a tool to direct treatment rather than the definitive test for diagnosis of the acute abdomen  Septic peritonitis in horses most commonly originates secondary to intestinal compromise or accidents (vascular damage, perforation, or surgical manipulation), leading to bacterial translocation into the abdomen.

Abdominocentesis techniques in horses.

BACKGROUND: Abdominocentesis is commonly used to evaluate the abdominal cavity of the horse. This technique provides valuable diagnostic information as well as the means to monitor patients with abdominal diseases being managed medically and to determine their need for surgical management. Complications are uncommon and include trauma to the gastrointestinal tract or spleen, septic peritonitis, or abdominal wall infection. PROCEDURES: This review describes the indications, utility, patient preparation, and instructions for performing abdominocentesis as well as possible complications reported in horses. Step-by-step instructions are provided for the two most commonly used abdominocentesis techniques in horses, which include the use of a needle (18 Ga, 3.8 cm [1.5 in]) and a teat cannula (9.5 cm [3.75 in]). SUMMARY: Peritoneal fluid collection and fluid analysis can be used to confirm diagnosis of intraabdominal pathology including inflammatory, infectious, neoplastic, obstructive, and bowel strangulation, leading to additional diagnostic and therapeutic plans. KEY POINTS: Abdominocentesis is useful as a diagnostic procedure in horses suffering from colic, diarrhea, weight loss, or other conditions involving the abdominal cavity and is an integral component of diagnostic testing for colic at referral institutions or in the field. Abdominal fluid collection using an 18-Ga, 3.8-cm (1.5-in) needle is recommended for adult horses because the needle is long enough to penetrate the peritoneal cavity. The teat cannula technique is recommended for use in adult horses, foals, and miniature horses to reduce the risk of enterocentesis, even though this procedure is more traumatic than using an 18-Ga, 3.8-cm needle. Ultrasonography of the abdomen is a valuable tool in the assessment of any horse with signs of colic, but it is not essential for performing an abdominocentesis successfully.

Calculating and selecting fluid therapy and blood product replacements for horses with acute hemorrhage.

BACKGROUND: Blood products, crystalloids, and colloid fluids are used in the medical treatment of severe hemorrhage in horses with a goal of providing sufficient blood flow and oxygen delivery to vital organs. The fluid treatments for hemorrhage will vary depending upon severity and duration and whether hemorrhage is controlled or uncontrolled. DESCRIPTION: With acute and severe controlled hemorrhage, treatment is focused on rapidly increasing perfusion pressure and blood flow to vital organs. This can most easily be accomplished in field cases by the administration of hypertonic saline. If isotonic crystalloids are used for resuscitation, the volume administered should be at least as great as the estimated blood loss. Following crystalloid resuscitation, clinical signs, HCT, and laboratory evidence of tissue hypoxia may help determine the need for a whole blood transfusion. In uncontrolled hemorrhage, crystalloid resuscitation is often more conservative and is referred to as "permissive hypotension." The goal of "permissive hypotension" would be to provide enough perfusion pressure to vital organs such that function is maintained while keeping blood pressure below the normal range in the hope that clot formation will not be disrupted. Whole blood and fresh frozen plasma in addition to aminocaproic acid are indicated in most horses with severe uncontrolled hemorrhage. SUMMARY: Blood transfusion is a life-saving treatment for severe hemorrhage in horses. No precise HCT serves as a transfusion trigger; however, an HCT < 15%, lack of appropriate clinical response, or significant improvement in plasma lactate following crystalloid resuscitation and loss of 25% or more of blood volume is suggestive of the need for whole blood transfusion. Mathematical formulas may be used to estimate the amount of blood required for transfusion following severe but controlled hemorrhage, but these are not very accurate and, in practice, transfusion volume should be approximately 40% of estimated blood loss. KEY POINTS: Modest hemorrhage, <15% of blood volume (<12 mL/kg), can be fully compensated by physiological mechanisms and generally does not require fluid or blood product therapy. More severe hemorrhage, >25% of blood volume (> 20 mL/kg), often requires crystalloid or blood product replacement, while acute loss of greater than 30% (>24 mL/kg) of blood volume may result in hemorrhagic shock requiring resuscitation treatments Uncontrolled hemorrhage is a common occurrence in equine practice, and is most commonly associated with abdominal bleeding (eg, uterine artery rupture in mares). If the hemorrhage can be controlled such as by ligation of a bleeding vessel, then initial efforts to resuscitate the horse should focus on increasing perfusion pressure and blood flow to organs as quickly as possible with crystalloids or colloids while assessing need for whole blood transfusion. While fluid therapy is being administered every effort to physically control hemorrhage should be made using ligatures, application of compression, surgical methods, and local hemostatic agents like collagen-, gelatin-, and cellulose-based products, fibrin, yunnan baiyao (YB), and synthetic glues Although some synthetic colloids have been shown to be associated with acute kidney injury in people receiving resuscitation therapy,20 this undesirable effect in horses has not been reported.

Collection and administration of blood products in horses: Transfusion indications, materials, methods, complications, donor selection, and blood testing.

BACKGROUND: Blood transfusion is a lifesaving treatment for horses with acute hemorrhage and other causes of anemia. Transfusions improve oxygen delivery to the tissues via increased blood volume and hemoglobin concentration. Certain aspects of equine blood transfusion are challenging, especially in the field situation, and practitioners may be unfamiliar or feel overwhelmed with the process. An understanding of the indications, materials, methods, and techniques as well as donor selection and possible complications will help practitioners successfully implement blood transfusion in clinical practice. PROCEDURES: Blood transfusion involves several steps including appropriate donor selection, cross-matching, blood collection, and administration, as well as monitoring and handling of transfusion reactions. Guidance for each of these steps are detailed in this review. SUMMARY: Blood transfusion is an effective and often lifesaving treatment for managing diseases of blood loss, hemolysis, and decreased RBC production. Equine practitioners require a thorough understanding of the indications for blood transfusion, the immunological principles behind compatibility testing and transfusion reactions, and the technical skills to aseptically collect and administer blood products KEY POINTS: Equine practitioners require a thorough understanding of the indications for blood transfusion, the immunological principles behind compatibility testing and transfusion reactions, and the technical skills to aseptically collect and administer blood products. Because there are over 400,000 possible equine RBC phenotypes, no universal donor exists, and some blood type incompatibilities are likely between any donor and recipient. Therefore, prior to any blood transfusion, donor and recipient blood should be cross-matched Inadequate delivery of oxygen (Do2 ) to the tissues, resulting from low hemoglobin (Hb) concentration, is the most important indication for blood transfusion Neonatal isoerythrolysis most commonly occurs following an anamnestic response in late gestation; it rarely occurs following a primary exposure because the immune response is not strong enough to produce clinically significant alloantibody titers.

The pathophysiology of uncontrolled hemorrhage in horses.

BACKGROUND: Hemorrhagic shock in horses may be classified in several ways. Hemorrhage may be considered internal versus external, controlled or uncontrolled, or described based on the severity of hypovolemic shock the patient is experiencing. Regardless of the cause, as the severity of hemorrhage worsens, homeostatic responses are stimulated to ameliorate the systemic and local effects of an oxygen debt. In mild to moderate cases of hemorrhage (<15% blood volume loss), physiological adaptations in the patient may not be clinically apparent. As hemorrhage worsens, often in the uncontrolled situation such as a vascular breach internally, the pathophysiological consequences are numerous. The patient mobilizes fluid and reserve blood volume, notably splenic stored and peripherally circulating erythrocytes, to preferentially supply oxygen to sensitive organs such as the brain and heart. When the global and local delivery of oxygen is insufficient to meet the metabolic needs of the tissues, a cascade of cellular, tissue, and organ dysfunction occurs. If left untreated, the patient dies of hemorrhagic anemic shock. CLINICAL IMPORTANCE: An understanding of the pathophysiological consequences of hemorrhagic shock in horses and their clinical manifestations may help the practitioner understand the severity of blood volume loss, the need for referral, the need for transfusion, and potential outcome. In cases of severe acute uncontrolled hemorrhage, it is essential to recognize the clinical manifestations quickly to best treat the patient, which may include humane euthanasia. KEY POINTS: Uncontrolled hemorrhage may be defined as the development of a vascular breach and hemorrhage that cannot be controlled by interventional hemostasis methods such as external pressure, tourniquet, or ligation. Causes of uncontrolled hemorrhage in horses may be due to non-surgical trauma, surgical trauma, invasive diagnostic procedures including percutaneous organ biopsy, coagulopathy, hypertension, cardiovascular anomaly, vascular damage, neoplasia such as hemangiosarcoma, toxicity, or idiopathic in nature. When a critical volume of blood is lost, the respondent changes in heart rate, splenic blood mobilization, and microcirculatory control can no longer compensate for decreasing oxygen delivery to the tissues In spite of organ-specific microvascular responses (eg, myogenic responses, local mediator modulation of microvasculature, etc), all organs experience decreases in blood flow during severe hypovolemia Acute, fatal hemorrhagic shock is characterized by progressive metabolic acidosis, coagulopathy, and hypothermia, often termed the "triad of death," followed by circulatory collapse.

Agreement of Bioreactance Cardiac Output Monitoring With Thermodilution in Healthy Standing Horses.

Bioreactance is the continuous analysis of transthoracic voltage variation in response to an applied high frequency transthoracic current and was recently introduced for non-invasive cardiac output measurement (NICOM). We evaluated NICOM compared to thermodilution (TD) in adult horses. Six healthy horses were used for this prospective, blinded, experimental study. Cardiac output (CO) measurements were performed simultaneously using TD and the bioreactance method. Different cardiac output scenarios were established using xylazine (0.5 mg/kg IV) and dobutamine (1.5-3 mcg/kg/min). Statistical analysis was performed by calculating the concordance rate, performing a regression analysis, Pearson correlation, and Bland Altman. The TD-based CO and NICOM values were highly correlated for low, normal and high CO values with an overall correlation coefficient. A 4-quadrant plot showed an 89% rate of concordance. The linear regression calculated a relationship between NICOM and TDCO of Y = 0.4874 · X + 0.5936. For the corrected Bland Altman agreement, the mean bias and lower/upper limits of agreement were -0.26 and -3.88 to 3.41 L/min, respectively. Compared to TD, bioreactance- based NICOM showed good accuracy at induced low, normal, and high CO states in normal horses. Future studies performed under more clinical conditions will show if this monitor can help to assess hemodynamic status and guide therapy in horses in ICU settings and under general anesthesia.

Clinical Assessment of an Ipsilateral Cervical Spinal Nerve Block for Prosthetic Laryngoplasty in Anesthetized Horses.

The nociceptive blockade of locoregional anesthesia prior to surgical stimulation can decrease anesthetic agent requirement and thereby potential dose-dependent side effects. The use of an ipsilateral second and third cervical spinal nerve locoregional anesthetic block for prosthetic laryngoplasty in the anesthetized horses has yet to be described. Anesthetic records of 20 horses receiving locoregional anesthesia prior to laryngoplasty were reviewed and compared to 20 horses of a similar patient cohort not receiving locoregional anesthesia. Non-blocked horses were 11 times more likely to require adjunct anesthetic treatment during surgical stimulation (P = 0.03) and were 7.4 times more likely to receive partial intravenous anesthesia in addition to inhalant anesthesia (P = 0.01). No horse in the blocked group received additional sedation/analgesia compared to the majority of non-blocked horses (75%) based on the anesthetist's perception of anesthetic quality and early recovery movement. No difference in recovery quality was observed between groups (P > 0.99). Cervical spinal nerve locoregional anesthesia appears well-tolerated and useful in reducing cumulative anesthetic agent requirement and may decrease the need for additional sedation/analgesia in horses undergoing anesthetized prosthetic laryngoplasty.

Clinical Pathology of the Racehorse.

The assessment of blood analytes in racehorses can provide useful data on performance and health. The horses' adaptive responses to training that occur to optimize performance should be considered when interpreting alterations seen on laboratory results. Similarly, the alterations observed in laboratory test results can identify subclinical and clinical disease and be helpful for identifying organ dysfunction and, in many cases, monitoring progress and response to treatment. This article discusses hematologic and biochemical tests that are important in the evaluation of performance and health in racehorses.

Sudden death of a horse with supraventricular tachycardia following oral administration of flecainide acetate.

OBJECTIVE: To describe a case of supraventricular tachycardia and sudden death in a horse following administration of flecainide acetate. CASE SUMMARY: An 8-year-old Hanoverian warmblood gelding was treated for chronic, naturally occurring, supraventricular tachycardia with digoxin, procainamide hydrochloride, quinidine sulfate, and flecainide acetate. After oral administration of flecainide, polymorphic ventricular tachycardia (torsades de pointes) and ventricular fibrillation developed, leading to cardiovascular collapse and death. NEW OR UNIQUE INFORMATION PROVIDED: Atrial fibrillation is the most commonly diagnosed dysrhythmia associated with poor performance in horses, while atrial tachycardia is rarely documented. Here, we describe a case of sudden death in a horse with atrial tachycardia following the oral administration of flecainide acetate, after the lack of response to other antiarrhythmic drugs. Information provided in this case report is new and will make clinicians aware of the potential complications of flecainide alone or in combination with other drugs, in horses with cardiac dysrhythmias.

Equine intradermal test threshold concentrations for house dust mite and storage mite allergens and identification of stable acari fauna.

BACKGROUND: House dust mite (HDM) and storage mite (SM) stable fauna and their associated equine intradermal test (IDT) threshold concentrations (TCs) for the midwestern region of the USA are unknown. HYPOTHESIS/OBJECTIVES: To determine IDT TCs and serum IgE concentrations for two HDM and three SM species in clinically normal horses over two seasons, and to identify the mite taxa and habitats in a stable. ANIMALS: Thirty-eight clinically normal horses. METHODS: Threshold concentrations for HDMs and SMs were determined using IDT subjective measurements and a statistical model. An enzyme-linked immunosorbent assay was used to quantify serum IgE concentrations for the same mite species. A modified flotation method was used to identify morphologically HDMs and SMs. RESULTS: Subjective IDT TCs were as follows: 1:80,000 w/v for Dermatophagoides farinae in both seasons; 1:80,000 w/v in spring and 1:160,000 w/v in late summer for Dermatophagoides pteronyssinus; 1:40,000 w/v in spring and 1:20,000 w/v in late summer for Acarus siro; 1:20,000 w/v for Lepidoglyphus destructor in both seasons; and 1:20,000 w/v in spring and 1:10,000 w/v in late summer for Tyrophagus putrescentiae. Statistically significant associations for increased serum IgE and a positive IDT reaction were evident for D. farinae in the spring and D. pteronyssinus in both seasons. One mite from all four genera specific to this study was identified; however,two HDM and A. siro species were not detected.Conclusions and clinical importance ­ This study established HDM and SM IDT dilution concentrations for the horses in this region. Exposure to diverse acaridae fauna may contribute to the pathogenesis of equine allergic disease.

An ex vivo model to evaluate the effect of cyclical adductory forces on maintenance of arytenoid abduction after prosthetic laryngoplasty performed with and without mechanical arytenoid abduction.

OBJECTIVES: To (1) develop a model of cyclical adduction force on an abducted left arytenoid cartilage that mimics swallowing or coughing; (2) determine if arytenoid abduction by a clamp before knot tying will improve the maintenance of abduction under cyclical adduction testing. STUDY DESIGN: Experimental. SAMPLE POPULATION: Cadaveric equine larynges (n = 14). METHODS: Left laryngoplasty performed using a single suture of #5 Ethibond with (n = 7) and without (n = 7) abducting the arytenoid with a clamp before knot tying. Each laryngoplasty was loaded cyclically from 2 to 26 N at 0.5 Hz for 5000 cycles in a servohydraulic test frame. Arytenoid displacement data were collected at 1 Hz intervals and median percent loss of abduction compared between groups. Significance was set at P < .05. RESULTS: Median left arytenoid abduction distance was 16.9 mm (range, 9.8-19.8 mm). One larynx in each group failed at <1000 cycles. Loss of abduction was determined by progressive displacement of the testing actuator and confirmed by measurement. There was no difference in loss of abduction between clamped and non-clamped larynges after 5000 cycles. This model of cyclical adduction resulted in arytenoid displacements similar to those seen in the 1st week postoperatively. CONCLUSIONS: Ex vivo cyclical adductory forces produced a significant loss of laryngoplasty abduction. The use of a clamp to abduct the arytenoid cartilage before knot tying did not reduce the loss of abduction.

Serum protein concentrations as predictors of serum immunoglobulin G concentration in neonatal foals.

OBJECTIVE: To determine the predictive value of serum concentrations of total protein (sTP), albumin (sAlb), and globulin (sGlob) measured by automated calorimetric assays to estimate serum immunoglobulin G (sIgG) concentrations in neonatal foals and identify failure of transfer of passive immunity when compared to turbidoimmunometric assay determinations of sIgG. DESIGN: Retrospective and prospective analysis of laboratory data. SETTING: University tertiary care facility. ANIMALS: Group 1 (retrospective): foals (n = 45) ≤7 days of age in which sIgG, sGlob, sAlb, and sTP concentrations were measured on an automated chemistry analyzer. Group 2 (prospective): foals (n = 31) ≤7 days of age with same laboratory data collected used to validate equations generated from group 1 foals. INTERVENTIONS: Spearman rank correlations between measured sIgG and serum protein concentrations were performed. When significant correlation was found, sIgG was estimated using an sGlob simple linear regression and estimated using a sGlob, sTP, and sAlb multiple linear regression. Comparisons between estimated and measured sIgG was performed using Kruskal-Wallis testing. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to identify foals with sIgG < 8.0 g/L [<800 mg/dL]. MEASUREMENTS AND MAIN RESULTS: sIgG was correlated with sGlob, sTP, and sAlb (ρ = 0.8, 0.6, and -0.3, respectively; P < 0.05). Estimated sIgG and measured sIgG were not different (P > 0.9). In group 1 foals, the sensitivity, specificity, positive predictive value, and negative predictive value were 73%, 76%, 73%, and 83%, respectively, for sGlob, and 90%, 76%, 75%, and 90%, respectively, for multiple proteins estimated sIgG identification of failure of transfer of passive immunity. Test qualities were improved in group 2 foals. CONCLUSIONS: Serum protein concentrations may be used to estimate sIgG concentrations in newborn foals. Further investigation using a larger sample size is needed to validate this methodology of assessing humoral immunity in neonatal foals.

Direct intra-abdominal pressures and abdominal perfusion pressures in unsedated normal horses.

OBJECTIVES: To determine whether direct intra-abdominal pressures (IAP) and calculated direct abdominal perfusion pressures (APP) are location dependent within the abdomen of standing horses. We hypothesize that IAP will be increased and calculated APP will be decreased at a ventral abdominal location (V) when compared to values obtained from the left (LFl) or right flank (RFl). DESIGN: Prospective experimental design. SETTING: University-based equine research facility. ANIMALS: Seven healthy adult horses, 4 geldings and 3 mares. INTERVENTIONS: Measurements of direct IAP obtained from the RFl, LFl, and V locations via abdominal cannulation and direct arterial blood pressures obtained via catheterization of the transverse facial artery were obtained in fasted, standing, unsedated horses. APP was calculated for each location by the subtraction of IAP from the mean arterial pressure. Differences between sites of measurement for IAP, APP, and their gradients were calculated and compared by ANOVA and t-tests. MEASUREMENTS AND MAIN RESULTS: Mean flank IAP measurements were subatmospheric and negative compared to ventral IAP values (LFl = -3 mm Hg, RFl = -5 mm Hg, V = 25 mm Hg; P < 0.001 between each flank and the ventral location). Ventrum APP was lower than flank APP (V = 82 mm Hg; LFl = 106 mm Hg; RFl = 108 mm Hg; P = 0.029 between each flank and the ventral location). Gradient calculations between sites showed the IAP increased and APP decreased from dorsal to ventral (P < 0.05) and from right to left (P = 0.004) within the abdomen. CONCLUSIONS: IAP and calculated APP are location dependent. These data provide new information regarding abdominal pressure profiles in standing healthy adult horses.

Hypothalamic-pituitary gland axis function and dysfunction in horses.

Hypothalamic-pituitary (HP) dysfunction has been documented in a limited capacity in horses and foals associated with critical illness, stress, and pain. This article reviews species-specific details of anatomy, function, hormones, receptors, and testing of the HP axis in the horse. A discussion of critical care medicine relevant to HP dysfunction in the horse with some reference to current understanding in human medicine is made, focusing primarily on current and relevant literature. A brief mention of other conditions described in human and veterinary medicine is also provided for reference only, such as syndrome of inappropriate antidiuretic hormone secretion and other conditions.

Multicentric mast cell tumors in a horse.

A 6-year-old female Rocky Mountain horse was presented for evaluation of draining tracts and distal limb subcutaneous edema on the left front and left hind limbs that had been present for 2 weeks. Direct smears of fluid collected by fine-needle aspiration of subcutaneous fluid from both limbs were highly cellular with a predominance of eosinophils accompanied by numerous, moderately atypical, variably granulated mast cells. The cytologic diagnosis was mast cell tumor (MCT) with prominent eosinophilic infiltration with a differential diagnosis of eosinophilic granuloma. Histologic evaluation of surgical biopsies of lesions from both limbs was performed on sections stained with H&E, toluidine blue, and Luna stains. The histologic diagnosis was MCT, and staining with toluidine blue and Luna stains confirmed the presence of mast cells and eosinophils, respectively. In addition, the mast cells strongly expressed CD117. This is the first reported case of cutaneous mast cell neoplasia in a horse in which primary presenting complaints were draining tracts and distal limb subcutaneous edema involving multiple limbs. This case illustrates the utility of staining for CD117 expression in combination with traditional stains, such as toluidine blue and Luna, in differentiating MCTs from other eosinophilic lesions in horses.

Isolation of Campylobacter fetus subspecies fetus in a two-year-old quarterhorse with chronic diarrhea of an undetermined etiology.

A 2-year-old quarterhorse was evaluated for chronic diarrhea and weight loss of 5 weeks duration after numerous diagnostic tests failed to identify an underlying cause. Historically, the horse was housed at pasture where human household waste vehicles were routinely cleaned and the effluent could run onto the field. Physical examination revealed poor body condition and frequent high-volume diarrhea. Diagnostic testing for Salmonella spp., endoparasites, Cryptosporidium spp., Clostridium spp., and diffuse infiltrative bowel disease were negative. Rectal tissue histopathology failed to identify Mycobacterium spp., spirochetal organisms, or submucosal infiltration with cells. Rectal tissue biopsy and a fresh fecal sample identified numerous Campylobacter organisms with microaerobic culture. Molecular testing revealed the species as Campylobacter fetus subsp. fetus as a possible organism associated with large bowel disease in this filly. The organism was sensitive to fluoroquinolone antimicrobials in vitro. The filly responded transiently to therapy, forming discrete fecal balls after 72 hr of treatment. At 5 months follow-up, the horse had gained weight, was alert and responsive, but reverted back to having soft "cow-pie" feces. Reculture of the feces at 9 months failed to identify any Campylobacter organisms. To the authors' knowledge, this is the first report to identify C. fetus subsp. fetus from feces and tissue of a horse with the use of molecular methods. This organism could play a role in the etiology of chronic diarrhea in horses.

Poorly differentiated leiomyosarcoma of the urogenital tract in a horse.

CASE DESCRIPTION: A 2-year-old Thoroughbred filly was evaluated because of hemorrhage from the vulva and suspected hematuria of 5 days' duration. CLINICAL FINDINGS: A primary coagulopathy was ruled out on the basis of results of hematologic testing. Vaginoscopy and cystoscopy revealed a large bleeding mass in the bladder that extended into the vagina, causing marked obliteration of normal urogenital structures and difficulty in urination. Histologic examination of endoscopic and surgical biopsy specimens revealed a poorly differentiated neoplasia likely of mesenchymal origin. Chronic suppurative cystitis caused by Streptococcus zooepidemicus was also diagnosed. TREATMENT AND OUTCOME: The tumor continued to grow despite treatment with doxorubicin and, within 45 days, was causing substantial discomfort and stranguria. Given the grave prognosis, the horse was euthanized. At necropsy, the tumor was found to have caused widespread destruction of the urinary bladder and to have invaded the broad ligament of the uterus. The mass was identified as a poorly differentiated leiomyosarcoma on the basis of results of histologic examination and immunohistochemical staining for alpha-actin. CLINICAL RELEVANCE: Findings suggested that leiomyosarcoma should be considered in the differential diagnosis when examining horses with urogenital bleeding.