Intravenous loss of over-the-wire catheter guidewires in 13 horses.

BACKGROUND: Over-the-wire (OTW) catheter placement is performed frequently in horses. Intravascular loss of a guidewire has been anecdotally reported, but there is limited information regarding the treatment and outcome of horses that have experienced this complication of OTW catheter placement. OBJECTIVES: Describe the clinical and diagnostic features, treatment, and outcome of horses experiencing IV guidewire loss at the time of OTW catheter placement. ANIMALS: Thirteen horses. METHODS: Multicenter retrospective study to identify horses with IV guidewire loss. Horses of all ages were considered for inclusion. Horses were excluded from the study if complete medical records of signalment, indication, and outcome were not available. Intravenous guidewire loss was defined as the guidewire being lost IV at the time of OTW catheter placement. RESULTS: No horses in this study experienced adverse clinical signs associated with the loss of a guidewire. Eight horses had the guidewire removed and the guidewire was left in situ in 5 horses. None of the horses with the guidewire in situ had experienced long-term effects. CONCLUSIONS AND CLINICAL IMPORTANCE: Intravenous guidewire loss seems to have a good long-term prognosis even in horses in which removal of the guidewire was not possible. Thus, in horses where guidewire removal is not feasible, guidewires that remain in situ may have limited to no adverse effects.

Comparison of the effects of normothermic machine perfusion and cold storage preservation on porcine intestinal allograft regenerative potential and viability.

Intestinal transplantation (IT) is the final treatment option for intestinal failure. Static cold storage (CS) is the standard preservation method used for intestinal allografts. However, CS and subsequent transplantation induce ischemia-reperfusion injury (IRI). Severe IRI impairs epithelial barrier function, including loss of intestinal stem cells (ISC), critical to epithelial regeneration. Normothermic machine perfusion (NMP) preservation of kidney and liver allografts minimizes CS-associated IRI; however, it has not been used clinically for IT. We hypothesized that intestine NMP would induce less epithelial injury and better protect the intestine's regenerative ability when compared with CS. Full-length porcine jejunum and ileum were procured, stored at 4 °C, or perfused at 34 °C for 6 hours (T6), and transplanted. Histology was assessed following procurement (T0), T6, and 1 hour after reperfusion. Real-time quantitative reverse transcription polymerase chain reaction, immunofluorescence, and crypt culture measured ISC viability and proliferative potential. A greater number of NMP-preserved intestine recipients survived posttransplant, which correlated with significantly decreased tissue injury following 1-hour reperfusion in NMP compared with CS samples. Additionally, ISC gene expression, spheroid area, and cellular proliferation were significantly increased in NMP-T6 compared with CS-T6 intestine. NMP appears to reduce IRI and improve graft regeneration with improved ISC viability and proliferation.

Bilateral patellar aplasia in a foal.

A 2-day-old Cleveland Bay colt was referred to the Equine Emergency Service of the Farm Animal and Equine Veterinary Medical Center at North Carolina State University's College of Veterinary Medicine for evaluation of decreased nursing behaviour and right hindlimb lameness of 2 days' duration. When assisted to stand, the foal was unable to extend either hindlimb or bear weight on the hindlimbs, the right patella was luxated laterally and unable to be reduced, and the foal assumed a crouched position. Stifle radiographs revealed minimal, heterogeneous, ill-defined ossification of both patellae. Due to the severity of the musculoskeletal defects, humane euthanasia was elected. Post-mortem examination identified a congenital malformation of both patella bones with failure of ossification and cardiac changes suggestive of right atrioventricular valve dysplasia. Histology of the patellae showed no evidence of osteoid deposition or ossification. To our knowledge, bilateral congenital patellar aplasia has not been previously described in foals.

Biomarkers of Intestinal Injury in Colic.

Biomarkers are typically proteins, enzymes, or other molecular changes that are elevated or decreased in body fluids during the course of inflammation or disease. Biomarkers pose an extremely attractive tool for establishing diagnoses and prognoses of equine gastrointestinal colic, one of the most prevalent causes of morbidity and mortality in horses. This topic has received increasing attention because early diagnosis of some forms of severe colic, such as intestinal ischemia, would create opportunities for rapid interventions that would likely improve case outcomes. This review explores biomarkers currently used in equine medicine for colic, including acute phase proteins, proinflammatory cytokines, markers of endotoxemia, and tissue injury metabolites. To date, no single biomarker has been identified that is perfectly sensitive and specific for intestinal ischemia; however, L-lactate has been proven to be a very functional and highly utilized diagnostic tool. However, further exploration of other biomarkers discussed in this review may provide the key to accelerated identification, intervention, and better outcomes for horses suffering from severe colic.

Changes in equine intestinal stem/progenitor cell number at resection margins in cases of small intestinal strangulation.

BACKGROUND: Intestinal epithelial stem cells (ISC) are responsible for epithelial regeneration and are critical to the intestine's ability to regain barrier function following injury. Evaluating ISC biomarker expression in cases of small intestinal strangulation (SIS) may provide insight into clinical progression. OBJECTIVES: Intestinal resection margins from cases of SIS were evaluated to determine if (1) evidence of injury could be identified using histomorphometry, (2) ISC biomarker expression was decreased in the proximal resection margin compared to control and distal resection margin, and (3) the ISC biomarker expression was associated with the number of preoperative risk factors negatively related to outcome, post-operative complications, or case outcome. STUDY DESIGN: Retrospective cohort study. METHODS: Intestinal samples were obtained intraoperatively from resection margins of adult horses with SIS and horses euthanised for reasons unrelated to colic. Preoperative risk factors negatively related to outcome, post-operative complications, and case outcome were obtained from medical records. Horses were grouped as euthanised intraoperatively, postoperatively, or survived to discharge. Histomorphometry and immunofluorescence were performed to evaluate tissue architecture and ISC and progenitor cell number. Groups were compared using one-way ANOVA. Associations between biomarker expression and the number of preoperative risk factors and post-operative complications negatively related to outcome were determined using linear regression modelling. RESULTS: Thirty-six cases of SIS were evaluated. Ki67+ cell counts were decreased in the proximal (mean = 15.45 cells; 95% CI = 10.27-20.63; SD = 4.17; p = 0.02) and distal resection margins (mean = 15.05; 95% CI = 8.46-21.64; SD = 4.141; p = 0.03) in horses euthanised postoperatively compared to control (mean = 23.62 cells; 95% CI = 19.42-27.83; SD = 5.883). In the distal resection margin, an increase in SOX9+ Ki67+ cells were associated with a decrease in the total number of preoperative risk factors negatively related to outcome (95% CI = 0.236-1.123; p = 0.008, SE = 0.1393). MAIN LIMITATIONS: Small population size. CONCLUSIONS: Proliferating cell and ISC numbers may be associated with case outcome.

Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion.

Successful intestinal transplantation is currently hindered by graft injury that occurs during procurement and storage, which contributes to postoperative sepsis and allograft rejection. Improved graft preservation may expand transplantable graft numbers and enhance posttransplant outcomes. Superior transplant outcomes have recently been demonstrated in clinical trials using machine perfusion to preserve the liver. We hypothesized that machine perfusion preservation of intestinal allografts could be achieved and allow for transplantation in a porcine model. Methods: Using a translational porcine model, we developed a device for intestinal perfusion. Intestinal samples were collected at the time of organ procurement, and after 6 h of machine perfusion for gross and histologic evaluation, hourly chemistry panels were performed on the perfusate and were used for protocol optimization. Following transplantation, porcine recipient physical activity, systemic blood parameters, and vital signs were monitored for 2 d before sacrifice. Results: In initial protocol development (generation 1, n = 8 grafts), multiple metabolic, electrolyte, and acid-base derangements were measured. These factors coincided with graft and mesenteric edema and luminal hemorrhage and were addressed with the addition of dialysis. In the subsequent protocol (generation 2, n = 9 grafts), differential jejunum and ileum perfusion were observed resulting in gross evidence of ileal ischemia. Modifications in vasodilating medications enhanced ileal perfusion (generation 3, n = 4 grafts). We report successful transplantation of 2 porcine intestinal allografts after machine perfusion with postoperative clinical and gross evidence of normal gut function. Conclusions: This study reports development and optimization of machine perfusion preservation of small intestine and successful transplantation of intestinal allografts in a porcine model.

Equine Wounds over Synovial Structures.

Equine septic synovitis commonly occurs secondary to traumatic wounds. The distal limbs of horses have minimal soft tissue protection, thus wounds in these areas are more likely to involve adjacent synovial structures. Synovial sepsis can be debilitating due to difficulties clearing established infections and the degenerative changes that result from ongoing inflammation. Prompt diagnosis allows for immediate treatment, improving the prognosis. Goals for successful treatment of infected synovial structures due to wounds include early and accurate recognition of the condition, rapid resolution of pain and inflammation, complete elimination of microorganisms, appropriate wound healing, and a timely return to function.

Evaluation of the reasons for and outcomes of gastrointestinal tract surgery in pet pigs: 11 cases (2004-2015).

OBJECTIVE To evaluate the reasons for and outcomes of gastrointestinal tract surgery in pet pigs. DESIGN Retrospective case series. ANIMALS 11 pigs. PROCEDURES The medical record database of a teaching hospital was searched to identify pet pigs that underwent at least 1 celiotomy because of a possible gastrointestinal tract obstruction between 2004 and 2015. For each pig, information extracted from the medical record included history; signalment; clinical signs; physical examination, diagnostic imaging, and diagnostic test results; perioperative management; surgical diagnosis, duration, and procedures performed; postoperative complications; and outcome. Descriptive data were generated. RESULTS 11 pet pigs underwent 12 celiotomies during the study period. Five pigs with intestinal obstructions caused by foreign bodies survived to hospital discharge. Four pigs were euthanized during surgery: 2 because of extensive adhesions that prevented correction of an intestinal obstruction, 1 because of a perforated spiral colon, and 1 because of neoplasia. One pig with a fecal impaction in the spiral colon died during anesthetic recovery. A diagnosis was not achieved for 1 pig, which was euthanized after surgery because of a deteriorating clinical condition. For the pig that underwent 2 celiotomies, the first procedure was an enterotomy for removal of a foreign body, and the second was an intestinal bypass of a stricture caused by adhesions at the previous enterotomy site. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated prognosis was good for pet pigs following surgical removal of gastrointestinal foreign bodies; however, the presence or development of intra-abdominal adhesions appeared to adversely affect prognosis.

Femoral head ostectomy and medial patellar ligament desmotomy to treat a pregnant miniature horse with coxofemoral joint luxation and upward fixation of the patella.

A 2-year-old, 8-weeks pregnant, non-weight bearing miniature horse mare was treated for a 6-day-old left coxofemoral joint luxation with a femoral head ostectomy. The procedure had no negative effects on pregnancy or parturition and 23 months following surgery the horse had minimal lameness.

Ostectomie de la tête fémorale et desmotomie du ligament patellaire médial pour traiter une jument miniature gravide atteinte d'une luxation de l'articulation coxofémorale et d'une fixation supérieure de la rotule. Une jument miniature non portante gravide de 8 semaines et âgée de 2 ans a été traitée pour une luxation de l'articulation coxofémorale gauche datant de 6 jours à l'aide d'une ostectomie de la tête fémorale. L'intervention n'a pas eu d'effets négatifs sur la gestation ou la parturition et 23 mois après la chirurgie, la jument présentait une boiterie minime.(Traduit par Isabelle Vallières).

Frontal and caudal maxillary sinus lipoma in a horse.

An adult horse was diagnosed with a frontal and caudal maxillary sinus lipoma, which was surgically removed. This is the first known report of a sinus lipoma in a horse. Lipomas should be considered in the differential diagnoses of equine sinus masses; complete surgical excision appears to be curative.

Lipome du sinus maxillaire frontal et caudal chez un cheval. Un cheval adulte a été diagnostiqué avec un lipome du sinus maxillaire frontal et caudal qui a été enlevé par chirurgie. Il s'agit du premier rapport d'un lipome de sinus chez un cheval. Les lipomes devraient être considérés dans les diagnostics différentiels des masses des sinus chez les équidés; l'excision chirurgicale complète semble être curative.(Traduit par Isabelle Vallières).

Serum and Synovial Fluid Serum Amyloid A Response in Equine Models of Synovitis and Septic Arthritis.

OBJECTIVE: To investigate the serum and synovial fluid serum amyloid A (SAA) response in equine models of synovitis and septic arthritis and to compare handheld and validated immunoturbidometric assays for SAA quantification. STUDY DESIGN: Controlled, experimental study. ANIMALS: Healthy adult horses (n = 9). METHODS: Synovitis (n = 4) and septic arthritis (n = 5) were induced using lipopolysaccharide and Staphylococcus aureus, respectively, and serial serum and synovial fluid samples were collected. Serial synovial fluid cytology was performed for both models and synovial fluid from the septic arthritis model was submitted for bacterial culture. Serum and synovial fluid SAA were quantified by handheld test and immunoturbidometric assay. Cytologic and SAA data were compared within and between models (mixed model ANOVA) and results of SAA assays were compared using category-by-category analysis (weighted kappa coefficient). RESULTS: Synovial fluid total nucleated cell counts and total protein increased significantly following induction of both models. Serum and synovial fluid SAA remained normal in synovitis horses and increased significantly in septic arthritis horses. Serum SAA increased more rapidly than synovial fluid SAA. Agreement was 98% when SAA concentrations were low (<50 µg/mL) but the assays diverged when concentrations were greater than ∼100 µg/mL. Overall, there was good category-by-category agreement between SAA assays (weighted kappa = 0.824). CONCLUSION: Serum and synovial fluid SAA may be useful adjuncts in diagnosing septic arthritis in horses. SAA concentrations for the assays diverged and examination using a larger sample size is needed before direct numeric comparisons between the assays can be made.