Use of intralesional cisplatin to successfully treat distal limb haemangiosarcoma in a foal.

A 4-month old, 200 kg, grey warmblood colt presented for a firm, non painful mass on the distal medial aspect of the left third metatarsus. Excisional biopsy revealed a diagnosis of haemangiosarcoma. Equine haemangiosarcoma is uncommon and only limited reports of successful treatment are available. The prognosis for survival is therefore considered to be poor. After two separate incidences of recurrence with incomplete excision of the tumour, intralesional treatment with cisplatin without excision or debulking was performed on three separate occasions. Intralesional cisplatin injection was performed at monthly intervals for three treatments. Four years post treatment with cisplatin, the horse remained in remission. This case report describes the diagnostic and treatment challenges for successful treatment of a primary haemangiosarcoma on the distal limb of a warmblood foal using intralesional cisplatin chemotherapy.

Autologous bone marrow aspirate for treatment of superficial digital flexor tendonitis in 105 racehorses.

To evaluate a treatment protocol whereby superficial digital flexor (SDF) tendonitis in Thoroughbred and Standardbred racehorses was treated with autologous bone marrow aspirate (ABMA) obtained from the sternebrae. This treatment was combined with desmotomy of the accessory ligament of the SDF tendon (DAL-SDFT) in selected cases. Medical records of 105 horses treated using the reported protocol were reviewed. Signalment, history and details of treatment were recorded. Racing records were reviewed and performance recorded. Of Thoroughbreds, 82 per cent had one or more starts within the follow-up period and 59 per cent had five or more starts. Of Standardbreds, 76 per cent had one or more starts and 62 per cent had five or more starts. A statistically significant difference was found when comparing race starts between sexes, with females having less starts than males (≥1start P=0.017 and ≥5 starts P=0.008, respectively). The proportions of horses having one or more starts and five or more starts did not differ significantly if a DAL-SDFT was performed or not (P=0.31 and 0.63, respectively). Horses with a core lesion in the body of the SDFT have a good prognosis for return to racing following intralesional ABMA injection. Addition of DAL-SDFT to the treatment regimen did not significantly influence outcome.

Use of ultrasound-guided autologous bone marrow transfer for treatment of suspensory ligament desmitis in 30 race horses (2003-2010).

OBJECTIVE: To evaluate the racing performance of horses that underwent ultrasound-guided intralesional injection of autologous bone marrow aspirate for treatment of selected forelimb suspensory ligament (body or branch) core lesions. DESIGN: Retrospective cohort study of 13 Standardbred and 17 Thoroughbred race horses. METHODS: Autologous bone marrow aspirated from the sternebrae was injected, under ultrasound guidance, into suspensory ligament core lesions (body or branch). Racing records were reviewed for a comparison of performance before and after surgery. RESULTS: Of the 13 Standardbreds, 9 (69%) had one or more starts within the follow-up period and 9 (69%) had five or more starts. Of the 17 Thoroughbreds, 15 (88%) had one or more starts within the follow-up period and 12 (71%) had five or more starts. Eight Standardbred horses had at least one start both before and after surgery. Earnings per start did not differ significantly between the three starts immediately after surgery compared with the three starts immediately prior to surgery. Thirteen Thoroughbred horses had at least one start both before and after surgery. Earnings per start were less for the three starts immediately after surgery compared with the three starts immediately prior to surgery. CONCLUSIONS AND CLINICAL RELEVANCE: A horse with a core lesion in the branch or body of the suspensory ligament has a good prognosis for return to racing after treatment with intralesional injection of bone marrow aspirate.

Transection of the lateral and long digital extensor tendons in racehorses.

OBJECTIVE: To report on the outcome of wounds to the hindlimb of racehorses, and horses with the intended use of racing, where both the long digital extensor (LoDE) and lateral digital extensor (LaDE) tendons had been completely transected. DESIGN: Retrospective case series. METHODS: Records of all horses admitted with hindlimb lacerations between 2002 and 2009 were examined for cases where both the LoDE and LaDE tendons in the hindlimb had been severed, and specifically in horses intended to be used for racing. Outcome was assessed via retrieval of race records and via telephone questioning of the owners. RESULTS: In total, 589 records were retrieved and 34 horses met the inclusion criteria: 26 horses (76%) had proximal wounds that severed both the LoDE and LaDE tendons and 8 (24%) had more distal wounds, where the tendons were severed below the point at which they join; 14 horses (41%) were euthanased prior to discharge. Of the 20 horses discharged, 6 (30%) raced and 12 (60%) did not; 2 (10%) of the treated horses, both Thoroughbred colts, were in race training and showing no signs of lameness at the time of the study. Of the 34 horses presented for treatment, 18% went on to race. CONCLUSIONS: The prognosis for racing after transection of both hindlimb extensor tendons is poor. Clinicians may wish to consider these findings when formulating advice for clients regarding this injury in racehorses.

Rib osteomyelitis in three foals.

Three foals aged between 21 and 44 days were presented for evaluation of pyrexia and lameness. Each had subcutaneous abscessation associated with osteomyelitis of a rib at the costochondral junction and pathological fracture of the affected rib; one foal had more than one rib affected. Other localised sites of infection included other sites of osteomyelitis, omphalophlebitis, uveitis, enterocolitis, and calcaneal bursitis. The subcutaneous abscessation and rib osteomyelitis was treated surgically in two foals. Salmonella typhimurium was isolated from the subcutaneous abscess in one foal and from the faeces of another. Two of the three foals were euthanased. Ultrasonography was a more useful modality than radiography for establishing the diagnosis of costal osteomyelitis.

Surgical treatment of carpal flexural deformity in 72 horses.

UNLABELLED: Carpal flexural deformities (CFD) are frequently encountered in the horse, with both congenital and acquired forms described. The success of surgical correction of CFD, both in terms of the ability to achieve a straight palmar carpal angle and the impact on future athletic performance, requires further investigation. OBJECTIVE: To report the surgical management and outcome of treatment of flexural deformity of the carpus in 72 horses up to 12 months of age. METHOD: Information was obtained from the medical records of horses surgically treated for CFD and through follow-up contact with owners. At the time of examination each case was graded on the severity of the flexural deformity as grade 1, 2, or 3, in order of ascending severity. Surgical treatment consisted of tenotomy of the ulnaris lateralis and flexor carpi ulnaris muscles. Re-assessment of the palmar carpal angle was made in the immediate postoperative period and again from at least 8 months after surgery via telephone contact with owners and/or breeders. A successful outcome was defined as achievement of a straight palmar carpal angle. Long term outcome was assessed in terms of fullfilment of intended use for horses reaching 3 years of age at the time of the study. RESULTS: A total of 135 surgical procedures were performed on 72 horses. A successful outcome was recorded in 111 limbs (82%). Excluding cases lost to follow-up, surgical correction was more successful in restoring a straight palmar carpal angle in grade 1 limbs (25/25, 100%) compared to grade 2 limbs (78/87, 89%) and grade 3 limbs (8/14, 57%). For those horses that had reached 3 years of age, 26 of 36 Thoroughbreds started in a race (72%) and 12 of 14 non-Thoroughbreds fulfilled their intended use (86%). CONCLUSION: Tenotomy of the ulnaris lateralis and flexor carpi ulnaris tendons for treatment of grade 1 and 2 CFD's has an excellent prognosis for restoration of a straight palmar carpal angle and for intended athletic pursuit of the horse. In cases of grade 3 CFD, the prognosis following surgery is guarded, especially in neonates. Horses treated in this study were up to 12 months of age, indicating that this deformity may not always be self-limiting as previously thought, and treatment may be required for successful resolution of flexural deformity of the carpus in older animals. The results of this study will help veterinarians to make recommendations regarding the surgical treatment of CFDs.

Repair of sinocutaneous fistulae in two horses.

Chronic facial defects extending into the sinuses of two mares were repaired using periosteal flaps. Partial osseous bridging was established over the defects following repair. Previous attempts to close the defects with skin alone had failed. A periosteal flap is a simple surgical technique that provides the foundations for successful repair, despite the chronicity of some fistulae.

Polymerase chain reaction tests for the identification of Ross River, Kunjin and Murray Valley encephalitis virus infections in horses.

OBJECTIVE: To develop and validate specific, sensitive and rapid diagnostic tests using RT-PCR for the detection of Ross River virus (RRV), Kunjin virus (KV) and Murray Valley encephalitis virus (MVEV) infections in horses. METHODS: Primer sets based on nucleotide sequence encoding the envelope glycoprotein E2 of RRV and on the nonstructural protein 5 (NS5) of KV and MVEV were designed and used in single round PCRs to test for the respective viruses in infected cell cultures and, in the case of RRV, in samples of horse blood and synovial fluid. RESULTS: The primer pairs designed for each of the three viruses amplified a product of expected size from prototype viruses that were grown in cell culture. The identity of each of the products was confirmed by nucleotide sequencing indicating that in the context used the RT-PCRs were specific. RRV was detected in serums from 8 horses for which there were clinical signs consistent with RRV infection such that an acute-phase serum sample was taken and submitted for RRV serology testing. The RRV RT-PCR was analytically sensitive in that it was estimated to detect as little as 50 TCID50 of RRV per mL of serum and was specific in that the primer pairs did not amplify other products from the 8 serum samples. The RRV primers also detected virus in three independent mosquito pools known to contain RRV by virus isolation in cell culture. Samples from horses suspected to be infected with KV and MVEV were not available. CONCLUSION: Despite much anecdotal and serological evidence for infection of horses with RRV actual infection and associated clinical disease are infrequently confirmed. The availability of a specific and analytically sensitive RT-PCR for the detection of RRV provides additional opportunities to confirm the presence of this virus in clinical samples. The RT-PCR primers for the diagnosis of KV and MVEV infections were shown to be specific for cell culture grown viruses but the further validation of these tests requires the availability of appropriate clinical samples from infected horses.

Surgical cleft soft palate repair in a foal.

An Anglo-Arab foal with bilateral postprandial nasal discharge was diagnosed as having a full-length defect of the soft palate. Surgical repair was attempted using a combination of two surgical approaches. Initially a mandibular symphysiotomy approach was used. The posterior portion of the defect did not heal adequately, so a ventral laryngotomy, bisecting the body of the thyroid cartilage and extending to a pharyngotomy approach, was performed 5 months later. The foal has since matured fully despite a slight unilateral nasal discharge. This case report demonstrates that these two surgical approaches used simultaneously provide surgical access that is superior to either approach used individually.

Incarceration of the small intestine by the epiploic foramen in fifteen horses.

In 15 horses with acute abdominal disease, a diagnosis of incarceration of small intestine through the epiploic foramen was made, either at the time of exploratory celiotomy or at necropsy.The horses exhibited signs of moderate to severe abdominal pain and were suffering from hypovolaemic and/or endotoxic shock. Nasogastric intubation produced either gas or fluid, the pH of which was in the range of 5 to 7.2, indicating reflux of small intestinal content into the stomach. Consistent physical findings included absence of gut sounds on auscultation, dilated small intestine palpable on rectal examination, and serosanguineous or xanthochromic fluid from abdominal paracentesis.A ventral midline laparotomy was performed on 11 horses. The incarcerated bowel, which involved the distal jejunum and ileum in 14 horses and jejunum in one horse, varied in length from 26 cm to 13 meters. Reduction of the incarceration was accomplished by gentle traction of the efferent and/or afferent intestine. Infarcted segments of the small intestine were exteriorized, resected, and an end-to-end jejunal anastomosis or an end-to-side jejunocecal anastomosis was performed. A successful postoperative recovery was achieved in three horses.

Elective inversion of the distal ileal stump into the caecum of the horse.

The distal 30 to 40 cm of the ileum cannot be exteriorized through a midline laparotomy incision because of its close anatomical association with the base of the caecum. A method was developed to deal with those cases where this segment of small intestine was involved in an avascular, necrotic process and therefore required resection. The technique involves inverting the distal stump of ileum into the lumen of the caecum and then performing a routine ileocaecal or jejunocaecal anastomosis. This avoids the risk of peritonitis if a Parker-Kerr oversew of the necrotic ileal stump should dehisce. The technique was performed on five clinically normal horses and on four horses in which the terminal 30 to 40 cm of the ileum was necrotic. The postoperative clinical findings and autopsy results of these horses are discussed.

Ethmoid hematoma of the equine.

Two cases of ethmoid hematoma of the equine are reported. Clinically both horses had intermittent unilateral epistaxis unassociated with exercise. In one horse, diagnosis was based on the use of an endoscope for visualization and for biopsy of a mass associated with the ethmoid turbinates. In the other horse, exploratory trephination of the posterior maxillary sinus was necessary to obtain a diagnostic biopsy specimen. Radiography was helpful in the diagnosis of one case. Surgical removal of the mass was attempted in one case. Histological examination of the biopsies was the single most definitive diagnostic technique in both cases.