Efficacy of the positioning system when measuring canine intraocular pressures with the Reichert® Tono-Vera® Vet rebound tonometer.

OBJECTIVE: To compare intraocular pressure (IOP) measurements in dogs taken with the Reichert® Tono-Vera® Vet rebound tonometer with and without the automatic positioning system. ANIMALS STUDIED: Measurements were taken on 49 eyes from 26 Beagle-derived dogs with variable genetics-four non-glaucomatous and 22 ADAMTS10-mutant dogs affected with different stages of open-angle glaucoma. Seventeen of the 26 dogs were measured 2-4 times on different days with variable intervals since IOP-lowering medications were administered. PROCEDURES: In each dog, tonometry was performed with the Tono-Vera® Vet using three different methods in a randomized order: (Method 1) Average of three readings with an automatic positioning system; (Method 2) one reading with an automatic positioning system; and (Method 3) average of three readings obtained without the automatic positioning system. Statistical analyses included one-way ANOVA, Tukey pairwise comparisons, and Bland-Altman plots (MiniTab®). RESULTS: With each of the three tonometry methods, 116 measurements were taken, resulting in 348 total IOP measurements with a range of 12.8-49.9 mmHg. The means and standard deviations for each method were 25.4 ± 6.9 mmHg (Method 1), 26.0 ± 7.2 mmHg (Method 2), and 26.9 ± 7.7 mmHg (Method 3), with no significant differences (p = .27). Mean IOP variances were also not significantly different between tonometry methods (p = .24 to .78). CONCLUSIONS: Because mean IOPs and their standard deviations were not statistically different between the three tonometry methods, we conclude that Tono-Vera® Vet measurements conducted without the aid of the positioning system still provide reliable results.

Comparison of three methods of tonometry in horses presented for ophthalmic disease.

OBJECTIVE: To compare the measurement of intraocular pressure in horses with clinical ocular disease using three tonometry devices. ANIMALS STUDIED: A total of fifty horses were presented to the New Bolton Center Ophthalmology Service. PROCEDURE: Intraocular pressure was taken on 50 client-owned horses (100 eyes) using the TonoVet, TonoVet Plus and Tono-Pen Avia tonometers. Clinical equine patients included were presented to New Bolton Center for ophthalmic examination. Auriculopalpebral blocks were performed but horses were unsedated. RESULTS: All three tonometers were found to have strong agreement among them. The strongest agreement was between the TonoVet and the TonoVet Plus with the TonoVet on average 1.330 mmHg less than the TonoVet Plus (standard deviation 4.388 mmHg). This was followed by the TonoVet and the Tono-Pen Avia Vet with the TonoVet on average 2.531 mmHg greater than the Tono-Pen Avia Vet (standard deviation 4.124 mmHg). The weakest agreement was between the TonoVet Plus and the Tono-Pen Avia with the TonoVet Plus on average 3.854 mmHg greater than the Tono-Pen Avia (standard deviation 4.724 mmHg). CONCLUSIONS: All three tonometers showed strong agreement, however, the TonoVet and the TonoVet Plus carried the strongest agreement with the TonoVet Plus having slightly higher measurements overall compared with the TonoVet. Due to small variations between devices, it is recommended that the same device be used for serial measurements of intraocular pressure. However, all three devices are appropriate to use in horses presented for ophthalmic evaluation.

Comparison of three rebound tonometers in normal and glaucomatous dogs.

OBJECTIVE: The objectives of the study were to compare intraocular pressure (IOP) readings across a wide range and obtained via three rebound tonometers in ADAMTS10-mutant Beagle-derived dogs with different stages of open-angle glaucoma (OAG) and normal control dogs and to investigate the effect of central corneal thickness (CCT). ANIMALS STUDIED: Measurements were performed on 99 eyes from 50 Beagle-derived dogs with variable genetics-16 non-glaucomatous and 34 with ADAMTS10-OAG. Seventeen OAG eyes were measured twice-with and without the use of IOP-lowering medications. PROCEDURES: IOP was measured in each eye using three tonometers with their "dog" setting-ICare® Tonovet (TV), ICare® Tonovet Plus® (TVP), and the novel Reichert® Tono-Vera® Vet (TVA)-in randomized order. CCT was measured with the Accutome® PachPen. Statistical analyses included one-way ANOVA, Tukey pairwise comparisons, and regression analyses of tonometer readings and pairwise IOP-CCT Pearson correlations (MiniTab®). RESULTS: A total of 116 IOP measurements were taken with each of the three tonometers. When comparing readings over a range of ~7-77 mmHg, mean IOPs from the TV were significantly lower compared with TVP (-4.6 mmHg, p < .001) and TVA (-3.7 mmHg, p = .001). We found no significant differences between TVA and TVP measurements (p = .695). There was a moderate positive correlation between CCT and IOP for TVA (r = 0.53, p < .001), TVP (r = 0.48, p < .001), and TV (r = 0.47, p < .001). CONCLUSIONS: Our data demonstrate strong agreement between TVP and TVA, suggesting that the TVA may similarly reflect true IOP values in canines. CCT influenced IOP measurements of all three tonometers.

Intraocular pressure estimates using rebound tonometry in juvenile northern bobwhite quails (Colinus virginianus).

OBJECTIVE: To determine intraocular pressure (IOP) estimates using rebound tonometry in juvenile northern bobwhite quails. ANIMALS STUDIED: Eighteen, 28-day-old, wild caught, captive raised, northern bobwhite quails. PROCEDURES: Birds were manually restrained in sternal recumbency with two fingers placed below the head, applying minimal pressure. Following detailed ophthalmic examination by a board-certified veterinary ophthalmologist, IOP was obtained via rebound tonometry using the Tonovet "P" setting for undefined species in animals without obvious ocular pathology. IOPs were estimated three times on each eye. The mean result of the three estimates was recorded for further analysis. Only readings with low or no reported error were recorded. RESULTS: No difference was detected between the eyes; therefore, a reference interval was calculated using both eyes. The overall IOP (n = 36 eyes) was 5.6 ± 1.2 mmHg (mean ± SD), the median was 6 mmHg, and the range was 2-7 mmHg. The 95% reference interval was 2.2-7.6 mmHg. All quails were ultimately released with no clinically appreciable abnormalities. CONCLUSIONS: This study provides information on normal IOP values for juvenile northern bobwhite quails, which can be used to evaluate the ocular health of this species. Future studies with a larger number of animals are needed, as well as validation of the rebound tonometry method using direct manometry.

Single instead of triplicate intraocular pressure measurements in dogs do not substantially lower accuracy and precision but do slightly reduce statistical power.

OBJECTIVE: To compare single and triplicate applanation tonometry values across previous intraocular pressure (IOP) studies in dogs. ANIMALS: 116 ophthalmologically normal dogs. PROCEDURES: Triplicate IOP readings (n = 1432) from studies evaluating effect of anesthetic protocols were analyzed to estimate a range of probable differences between averaged triplicate and first, averaged and lowest, and first and lowest IOPs. The decrease in variability with triplicate measurements and the magnitude of effects on statistical power were quantified. RESULTS: The 2.5th to 97.5th interpercentile range for differences of averaged triplicate values minus first IOP readings was -3 to 2.7 mm Hg; for averaged minus lowest: 0 to 3.7 mm Hg; for first minus lowest: 0 to 5 mm Hg. The 95% prediction interval for differences in study group means (n = 160 groups, n = 5 to 11 eyes per group) based on averaged minus first measurements was -1.0 to 0.9 mm Hg with associated SDs reduced by 4% on average. Analysis of previous studies using averaged instead of first IOP values resulted in minimal decreases in SEs of 3-9% (0.03 to 0.09 mm Hg). Of 11 comparisons found significant with averaged data, 2 (18%) were found nonsignificant with first measurements. Of 96 comparisons found nonsignificant with averaged data, 3 (3%) were found significant with first measurements. CLINICAL RELEVANCE: With applanation tonometry in ophthalmologically normal dogs, no clinically meaningful difference was found between the first, lowest, or averaged triplicate IOP measurements, but the first reading has a larger variance and hence will result in lower statistical power.

Comparison of intraocular pressures estimated by rebound and applanation tonometry in dogs with lens instability: 66 cases (2012-2018).

OBJECTIVE: To compare intraocular pressures (IOPs) estimated by rebound and applanation tonometry for dogs with lens instability. ANIMALS: 66 dogs. PROCEDURES: Medical records of dogs examined between September 2012 and July 2018 were reviewed for diagnoses of anterior (ALL) or posterior (PLL) lens luxation or lens subluxation. RESULTS: Estimates of IOP obtained with rebound and applanation tonometry significantly differed from each other for all types of lens instability considered collectively (mean ± SE difference between tonometric readings, 8.1 ± 1.3 mm Hg) and specific types of lens instability considered individually (mean ± SE difference between tonometric readings: ALL, 12.8 ± 2.5 mm Hg; PLL, 5.9 ± 1.7 mm Hg; subluxation, 2.8 ± 0.8 mm Hg). Median (range) differences between rebound and applanation tonometer readings for dogs with ALL was 5 mm Hg (-9 to 76 mm Hg), with PLL was 3 mm Hg (-1 to 19 mm Hg), and with lens subluxation was 3 mm Hg (-9 to 18 mm Hg). In eyes with ALL, rebound tonometer readings exceeded applanation tonometer readings on 44 of 60 (73%) occasions. CONCLUSIONS AND CLINICAL RELEVANCE: Rebound tonometry yielded higher estimates of IOP than did applanation tonometry in eyes with ALL and with all types of lens luxation considered collectively. Estimates of IOP in eyes with lens instability should ideally be obtained with both rebound and applanation tonometers. Veterinarians with only one type of tonometer should interpret results for dogs with lens instability concurrent with physical examination findings.

Evaluation of the effect of disposable tonometer cover brand on performance of Tono-Pen Vet in canine eyes.

PRIMARY OBJECTIVE: To evaluate the effect of latex tip cover manufacturer on accuracy and repeatability of Tono-Pen Vet™ in canine eyes. ANIMAL STUDIED: Twelve enucleated globes from six dogs. PROCEDURES: The anterior chamber was cannulated and connected to a calibrated manometer. Intraocular pressure (IOP) measurements were obtained using the Tono-Pen Vet and TONOVET Plus at manometric IOP ranging from 5 to 80 mmHg. At each IOP, the Tono-Pen Vet was used with a new Ocu-Film™ latex tip cover (the only manufacturer-approved brand of cover) followed by a new Softips™ latex tip cover. For comparison, the TONOVET Plus was also used at each IOP with a new disposable rebound probe. Measured IOP values were analyzed by linear regression and intraclass correlation coefficient (ICC). RESULTS: Tono-Pen Vet accuracy was unaffected by tip cover manufacturer or by frequent change in cover. Using ICC analysis, repeatability of measurements using either tonometer was good to excellent at physiologic IOP levels but variably decreased with both devices at supraphysiologic IOP. CONCLUSIONS: Neither tip cover manufacturer nor frequent changes in tip cover adversely affect Tono-Pen Vet accuracy. Measurement repeatability with Tono-Pen Vet and TONOVET Plus is widely variable at supraphysiologic IOP. Therefore, minor changes in IOP >25 mmHg should not be used to make clinical decisions without considering this variability.

MEASUREMENT OF INTRAOCULAR PRESSURE USING REBOUND TONOMETRY IN ANESTHETIZED PERUVIAN FUR SEALS (ARCTOCEPHALUS AUSTRALIS) FROM PUNTA SAN JUAN, PERU.

Ocular disease in pinnipeds under human care is well described, and intraocular pressure (IOP) can be impacted by a variety of ophthalmic conditions. Species-specific reference parameters from clinically normal animals are instrumental for understanding how ophthalmic diseases may impact ocular pressures. IOP measurements were obtained using rebound tonometry from free-ranging Peruvian fur seals (Arctocephalus australis unnamed subspecies) at Punta San Juan, Peru, over a 6-yr period (2010-2016). Retrospective data obtained from 108 (81 adults and 27 neonates comprising 69 females and 39 males) anesthetized fur seals with normal anterior segment ophthalmic examinations was included in the analysis. Differences in IOP from each eye were compared to categorical variables (age, year, sex, restraint) using an independent-samples t test. All univariate results with a significance of P < 0.05 were included in multivariate analysis. Of the 13 general linear models evaluated, the top two for both the right and the left eye included age class when all variables were evaluated simultaneously. Neonates had significantly lower IOP values than adults in both the right eye (17.5 mm Hg; 95% confidence interval [CI]: 14.0-21.1 mm Hg compared to 33.5 mm Hg; 95% CI: 31.0-36.1 mm Hg, respectively) and the left eye (18.4 mm Hg; 95% CI: 14.4-22.5 mm Hg compared to 32.3 mm Hg; 95% CI: 29.3-35.3 mm Hg, respectively). Anesthesia method was not statistically significant (P > 0.05). This is the first report of normal IOP measurements for any fur seal species. Described data can be used to improve diagnosis and management of ocular alterations in pinnipeds.

Comparison of right lateral versus left lateral versus sternal recumbence intra-abdominal pressure measurements in normal dogs.

OBJECTIVE: To determine if there is a difference in intra-abdominal pressure (IAP) among 3 anatomic body positions (right lateral, left lateral, and sternal recumbence) in apparently healthy dogs. DESIGN: Prospective, observational study. SETTING: University Veterinary Medical Teaching Hospital. ANIMALS: Fourteen apparently healthy male dogs. MEASUREMENTS AND MAIN RESULTS: After mild sedation with dexmedetomidine, a water manometer attached to a Foley urinary catheter was used to measure IAP in 3 different body positions in each dog. There was no significant difference in IAP between right lateral (3.87± 3.16 cm H2 O), left lateral (4.45 ± 3.22 cm H2 O), and sternal recumbence (4.04 ± 3.57 cm H2 O). CONCLUSIONS: Based on data from these 14 apparently healthy dogs, these 3 body positions can be used interchangeably for monitoring an individual dog. However, more research in dogs is needed to see if this conclusion holds true when IAP is abnormal.

Use of testicular tone and echogenicity in identifying boars with low sperm quality / Uso de tônus e ecogenicidade testiculares na identificação de reprodutores suínos com baixa qualidade espermática

This study aimed to evaluate the use of some testicular traits to identify boars with low sperm morphological quality. The consistency (scores from 1 to 5), tone with tonometry (mm), parenchyma echogenicity and heterogeneity with ultrasound (pixel) were assessed in 402 mature boars (18.5 months on average). Sperm abnormality thresholds (≤ 25% of total sperm abnormalities, ≤ 5% of heads, acrosome, neck or midpiece defects, ≤ 10% tail defects, and 15% cytoplasmic droplets) were used to classify boars as approved or disapproved. Three classes of testicular traits were formed (extremely low and high values, approximately 15% each, were kept in separated classes). When the traits were individually evaluated, fewer boars were approved if the echogenicity or heterogeneity were high, or if the tone was rigid. When evaluated in combination, the interaction between heterogeneity and tone, and between heterogeneity and echogenicity were significant. The high heterogeneity combined with soft tone or with hypo-echogenicity resulted in lower approval of boars. Tonometry and ultrasonography have a moderate potential to be included in breeding soundness examination of boars. When combined, they provide more reliable information about the impact of testicular parenchymal alterations on morphology of sperm cells.(AU)

O estudo objetivou avaliar o uso de características testiculares para identificar reprodutores com baixa qualidade de morfologia espermática. A consistência (escore de 1 a 5), o tônus por tonometria (mm), a ecogenicidade e a heterogeneidade do parênquima testicular por ultrassonografia (pixel) foram avaliados em 402 machos suínos maduros (18,5 meses, em média). Limiares máximos de anormalidades espermáticas (≤ 25% de defeitos totais, ≤ 5% de defeitos de cabeça, acrossoma, colo e peça intermediária, ≤ 10% de defeitos de cauda e 15% de gota citoplasmática) foram utilizados para classificar os machos como aprovados ou reprovados. Três classes de características testiculares foram formadas (valores extremamente baixos e altos, aproximadamente 15% em cada, foram mantidos em classes separadas). Quando as características testiculares foram avaliadas individualmente, menos machos foram aprovados se a ecogenicidade ou a heterogeneidade foram altas, ou se o tônus era rígido. Quando avaliadas em combinação, a interação entre heterogeneidade e tônus e a interação entre heterogeneidade e ecogenicidade foram significativas. A alta heterogeneidade combinada com testículos flácidos ou com testículos hipoecogênicos resultou em menor aprovação de cachaços. A tonometria e a ultrassonografia possuem potencial moderado para serem incluídas no exame andrológico de cachaços. Quando combinadas, as técnicas fornecem uma informação mais consistente do impacto das alterações do parênquima testicular na morfologia das células espermáticas.(AU)

Evaluation of gastric and bladder tonometry as indicators of tissue perfusion in induced hypotension in dogs.

OBJECTIVE: To evaluate the use of gastric (PgCO2 ) and bladder (PbCO2 ) tonometry for assessing tissue hypoperfusion in dogs during sevoflurane-induced hypotension, and to compare these measurements with delivery of oxygen, arterial oxygen content, and plasma lactate concentration. DESIGN: Prospective experimental trial. SETTING: University veterinary teaching hospital. ANIMALS: Fourteen adult Beagle dogs. INTERVENTIONS: Anesthetic induction was performed by mask with sevoflurane and oxygen. Heart rate, direct arterial pressures, respiratory rate, and end-tidal carbon dioxide were recorded; arterial blood samples were taken to measure blood gases, and venous samples were sampled to measure plasma lactate. A tonometric catheter was introduced into the stomach to measure PgCO2 . Samples of saline from the balloon of a Foley catheter placed in the bladder were collected every 10 minutes and used to measure PbCO2 by gas analysis. Tonometry measurements, plasma lactate, and oxygen delivery and consumption were compared at 3 time points: at baseline, during hypotension, and during treatment periods. A hypotensive period (mean arterial pressure (MAP) < 60 mm Hg) of 15 minutes was induced by an overdose of sevoflurane, whereas during the treatment period, a constant-rate infusion of dopamine (10 µg/kg/min) was administered intravenously for 40 minutes. MEASUREMENTS AND MAIN RESULTS: Values for PgCO2 and PbCO2 increased significantly during the hypotensive period, and correlations were found between these values and the delivery of oxygen. Gastric tonometry values had stronger correlations compared with bladder tonometry values. CONCLUSIONS: Gastric and bladder tonometry can be used to detect hypoperfusion. Further studies are warranted to determine the potential use of gastric and bladder tonometry in assessing dogs in clinical situations.

Evaluation of three hand-held tonometers in normal canine eyes.

Tonometry, an indirect measurement of intraocular pressure (IOP), is important for the diagnosis and management of glaucoma and uveitis. The aim of this study was to compare the performance of three hand-held tonometers in normal canine eyes. Eyes from cadavers of dogs without observable ocular disease were used to compare tonometric measurements with direct manometry over a range of 7.4-65mmHg. In vivo measurements using the three tonometers in both eyes of 12 healthy dogs were compared. All tonometers significantly underestimated manometric values both ex vivo and in vivo. One tonometer showed a small fixed bias over the range of IOP, whilst the other two tonometers had a negative proportional bias. The results of this study show that differences exist between handheld tonometers across the clinically relevant range of IOP, and that all underestimate manometric measurements.

Ultrasound biomicroscopy and tonometry in ophthalmologically normal pigeon eyes.

OBJECTIVE: To evaluate the feasibility of ultrasound biomicroscopy (UBM) and tonometry in pigeons and to provide biometric reference ranges for normal pigeon eyes. ANIMALS STUDIED: Ten pigeons (Columba livia var. domestica) with ophthalmologically normal eyes. PROCEDURES: Ophthalmic examinations, including slit-lamp biomicroscopy and tonometry, were performed to confirm that the eyes were normal. UBM was then performed on the left eye. On each obtained image, the ciliary cleft (CC) length, CC width, and CC area, and iridocorneal angle (ICA) were measured. RESULTS: Richly vascularized iris was observed in all pigeon eyes. Mean intraocular pressure was 11.7 ± 1.6 mmHg, without any statistical difference between the left and right eyes. The UBM scanning procedure was well tolerated in all pigeons. Mean values of CC length, CC width, CC area, and ICA were 1.55 ± 0.17 mm, 0.36 ± 0.05 mm, 0.39 ± 0.04 mm2 , and 15.17 ± 1.06°, respectively. CONCLUSIONS: Ultrasound biomicroscopy could be a useful diagnostic tool to evaluate anterior ocular segment of pigeons.

High-resolution manometric evaluation of the effects of cisapride on the esophagus during administration of solid and liquid boluses in awake healthy dogs.

OBJECTIVE To validate the use of high-resolution manometry (HRM) in awake, healthy dogs and compare the effects of bolus type (liquid vs solid) and drug treatment (saline [0.9% NaCl] solution [SS] vs cisapride) on esophageal pressure profiles. ANIMALS 8 healthy dogs. PROCEDURES In a crossover study, each dog received SS (10 mL) IV, and HRM was performed during oral administration of 10 boluses (5 mL each) of water or 10 boluses (5 g each) of canned food. Cisapride (1 mg/kg in 60 mL of SS) was subsequently administered IV to 7 dogs; HRM and bolus administration procedures were repeated. Two to 4 weeks later, HRM was repeated following administration of SS and water and food boluses in 4 dogs. Pressure profile data were obtained for all swallows, and 11 outcome variables were statistically analyzed. RESULTS After SS administration, predicted means for the esophageal contractile integral were 850.4 cm/mm Hg/s for food boluses and 660.3 cm/mm Hg/s for water boluses. Predicted means for esophageal contraction front velocity were 6.2 cm/s for water boluses and 5.6 cm/s for food boluses after SS administration. Predicted means for residual LES pressure were significantly higher following cisapride administration. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that HRM was feasible and repeatable in awake healthy dogs of various breeds and sizes. Stronger esophageal contractions and faster esophageal contraction velocity occurred during solid bolus and liquid bolus swallows, respectively. Lower esophageal sphincter pressure increased significantly following cisapride administration. Esophageal contractions and bolus transit latency should be further evaluated by HRM in clinically dysphagic dogs.

MEASUREMENT OF INTRAOCULAR PRESSURE USING TONOVET® IN EUROPEAN POND TURTLE (EMYS ORBICULARIS).

Twenty-two captive adult European pond turtles (12 males and 10 females) were unrestrained without sedation while intraocular pressure (IOP) was measured by means of a Tonovet®. Mean±SD IOP values between 8 and 10 am for all turtles were 5.42±0.96 mm Hg (range, 3-9 mm Hg). IOP between the right and left eye and between males and females was not significantly different. There was no correlation between IOP and body weight or body length of animals.

Determination and validation of volume to be instilled for standardized intra-abdominal pressure measurement in dogs.

OBJECTIVES: The objectives of this study were to determine (1) most appropriate volume of saline to be infused into the bladder prior to intra-abdominal pressure (IAP) measurement, (2) to determine if a difference exists between IAP measurements before and after abdominal surgery, and (3) to assess the variability in IAP measurements associated with different saline volumes. DESIGN: Prospective study. SETTING: University teaching hospital. ANIMALS: Fifteen female research dogs, 7 undergoing ovariohysterectomy (OHE), and 8 undergoing laparoscopy. INTERVENTIONS: All dogs had urinary catheters placed and 4 consecutive IAP measurements measured using a different volume of instilled saline (0.25, 0.5, 1, and 2 mL/kg) at baseline. Measurements were repeated intraoperatively in laparoscopy dogs and postoperatively in OHE dogs. MEASUREMENTS AND MAIN RESULTS: For both groups of dogs, the volume infused into the bladder significantly affected IAP measurement. An instilled volume of 1 mL/kg of saline produced the best correlation (R(2) = 0.44, P = 0.04) between IAP measurement and laparoscopic insufflator pressure. The mean (±SD) preoperative IAP (cmH2 O) using 1 mL/kg instilled saline was 7.9 ± 1.4 and 9.6 ±1.9 for laparoscopy and OHE dogs, respectively. There was no difference in IAP before and after surgery in the dogs undergoing an OHE (P = 0.58). The volume of saline instilled into the bladder significantly affected the IAP (P = 0.0028). CONCLUSIONS: One milliliter per kilogram instilled saline is recommended for standardized IAP pressure measurement in dogs. IAP in clinically normal dogs was not affected by abdominal surgery.

High-resolution manometric evaluation of the effects of cisapride and metoclopramide hydrochloride administered orally on lower esophageal sphincter pressure in awake dogs.

OBJECTIVE: To evaluate the effects of cisapride and metoclopramide hydrochloride administered orally on the lower esophageal sphincter (LES) resting pressure in awake healthy dogs. ANIMALS: 6 adult Beagles. PROCEDURES: Each dog was evaluated after administration of a single dose of cisapride (0.5 mg/kg), metoclopramide (0.5 mg/kg), or placebo (empty gelatin-free capsule) in 3 experiments performed at 3-week intervals. To measure LES pressure, a high-resolution manometry catheter equipped with 40 pressure sensors spaced 10 mm apart was used. For each experiment, LES pressure was recorded during a 20-minute period with a virtual electronic sleeve emulation before treatment (baseline) and at 1, 4, and 7 hours after drug or placebo administration. A linear mixed-effects model was used to test whether the 3 treatments affected LES pressure differently. RESULTS: In the cisapride, metoclopramide, and placebo experiments, median baseline LES pressures were 29.1, 30.5, and 29.0 mm Hg, respectively. For the cisapride, metoclopramide, and placebo treatments, median LES pressures at 1 hour after administration were 44.4, 37.8, and 36.6 mm Hg, respectively; median LES pressures at 4 hours after administration were 50.7, 30.6, and 31.1 mm Hg, respectively; and median LES pressures at 7 hours after administration were 44.3, 28.5, and 33.3 mm Hg, respectively. The LES pressures differed significantly only between the placebo and cisapride treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that orally administered cisapride may be of benefit in canine patients for which an increase in LES pressure is desirable, whereas orally administered metoclopramide did not affect LES resting pressures in dogs.

Dextranomer hyaluronic acid copolymer effects on gastroesophageal junction.

OBJECTIVE: The outcomes of fundoplication for gastroesophageal reflux disease are suboptimal in many children, and alternatives are clearly needed. Dextranomer hyaluronic acid (DxHA) copolymer, an agent with proven efficacy in vesicoureteral reflux, was studied with respect to its effects on the gastroesophageal junction (GEJ). METHODS: Twelve New Zealand white rabbits underwent measurement of lower esophageal sphincter pressure followed by laparotomy and injection into the muscular layer of the GEJ (controls, 1.0 mL saline; low-dose DxHA [0.5 mL]; high-dose DxHA [1.0 mL]). After a 12-week survival period, the animals underwent manometry, sacrifice, and necropsy. Organs were examined histologically by pathologists blinded to the injection delivered. RESULTS: All animals survived. Weight gain was equal in the 3 groups. There was no significant difference in mean lower esophageal sphincter pressure from baseline in any group (control 2.3 mmHg [95% confidence interval, CI -3.3 to 7.9]; low-dose group 3.2 mmHg [95% CI -0.8 to 7.2]; high-dose group -4.0 mmHg [95% CI -18.95 to 10.95]). Histologically, DxHA injection produced an intramural implant, with a foreign body giant cell reaction, and fibroblastic infiltration with collagen deposition. High-dose injection did not consistently result in a qualitative increase in the magnitude of the reaction. There was no mucosal injury or luminal stenosis. CONCLUSIONS: In this first study evaluating the effects of DxHA injection at the GEJ, a histologic bulking effect was observed without obvious functional complications. The agent may have a role in the treatment of gastroesophageal reflux disease.

Effects of gastric distension on intraabdominal pressures in horses.

OBJECTIVE: To determine the effect of gastric distension on intraabdominal pressures (IAP) measured directly from the intraperitoneal space. DESIGN: Prospective, experimental study. SETTING: A university-based equine research facility. ANIMALS: Ten healthy adult horses, 5 males and 5 females. INTERVENTIONS: Intraabdominal pressures were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder at 6 time points: at rest, after placement of a nasogastric tube, and after instillation of each 5 L increment up to a total of 20 L of water. Simultaneously, mean arterial pressures (MAP) were obtained using a tail cuff, and abdominal perfusion pressures (APP) were calculated using the measured IAP minus the measured MAP. MEASUREMENTS AND MAIN RESULTS: Baseline direct IAP measurements were subatmospheric (-4.5 ± 3.0 cm H2 O). IAPs were not significantly affected by placement of a nasogastric tube (-2.69, 95% CI [-3.24, -2.14], P = 0.4195), but were significantly increased after placement of 5 L (-1.73, 95% CI [-2.28, -1.18], P = 0.0015), 10 L (-0.54, 95% CI [-1.09,0.01], P = 0.0001), 15 L (0.89, 95% CI [0.34, 1.44], P = 0.0001), or 20 L (3.08, 95% CI [2.53, 3.63], P = 0.0001) of water into the stomach. APPs were not significantly different for any volume of fluid infused into the stomach (P = 0.05 for all comparisons). CONCLUSION: IAPs were significantly increased when > 5 L of water was infused into the stomach. These results indicate the need for further research in clinical cases to determine the relationship between gastric pressures and the development of intraabdominal hypertension in horses.

Evaluation of esophageal high-resolution manometry in awake and sedated dogs.

OBJECTIVE: To evaluate the use of high-resolution manometry (HRM) in awake and sedated dogs and to assess potential effects of a standard sedation protocol. ANIMALS: 22 Beagles. PROCEDURES: An HRM catheter with 36 pressure sensors was inserted intranasally in each dog. After an adaption period of 5 minutes, each set of measurements included 5 swallows of a liquid and 5 swallows of a solid bolus. Measurements were repeated 30 minutes after IM administration of buprenorphine and acepromazine. RESULTS: HRM was successfully performed in 14 dogs. Data sets of 8 dogs were adequate for analysis. For the upper esophageal sphincter, median values of baseline pressure, residual pressure, relaxation time to nadir, and relaxation duration were determined for awake and sedated dogs for liquid and solid swallows. For the tubular portion of the esophagus, median values of peristaltic contractile integral, bolus transit time, and contractile front velocity were determined for awake and sedated dogs for liquid and solid swallows. For the lower esophageal sphincter, median values of baseline pressure and residual pressure were determined for awake and sedated dogs for liquid and solid swallows. Significant differences (awake vs sedated) were found for the upper esophageal sphincter residual pressure (liquid swallows), relaxation time to nadir (liquid swallows), bolus transit time (solid swallows), and contractile front velocity (solid swallows). CONCLUSIONS AND CLINICAL RELEVANCE: HRM was feasible for evaluation of esophageal function in most awake dogs. Although sedation in uncooperative patients may minimally influence results of some variables, an overall assessment of swallowing should be possible.