Heterogeneity of intrapleural pressures during exercise.

We determined whether the caudodorsal region of the intrapleural space in exercising horses experiences larger pressure fluctuations than other regions and whether systematic phase-shifting of peak intrapleural pressures along the length of the thorax suggests the existence of locomotor-induced intrapleural pressure waves. We utilised percutaneous introducers and solid-state pressure-tip transducers implanted along the dorsal aspect of the thorax, mid-thorax or oesophagus to measure regional intrapleural pressures while 3 horses galloped on a flat treadmill at 13-14 m/s, then recorded pressures from the same catheters when horses exercised intensely (heart rate 170-190 beats/min) while swimming with no ground concussion. Pressure excursions in the caudodorsal region did not vary systematically from other regions during galloping or swimming, nor more than a few torr between different locations. During swimming, peak expiratory pressures were higher than during galloping (68-79 vs. 26-32 torr), and horses breathed explosively at frequencies 5 times slower than while galloping (28 vs. 120/min). During galloping, individual catheter locations registered locomotor concussion; however, this was variable and did not indicate a systematic pressure wave passing through the lung or intrapleural space.

Use of sevoflurane for anesthetic management of horses during thoracotomy.

OBJECTIVE: To evaluate sevoflurane as an inhalation anesthetic for thoracotomy in horses. ANIMALS: 18 horses between 2 and 15 years old. PROCEDURE: 4 horses were used to develop surgical techniques and were euthanatized at the end of the procedure. The remaining 14 horses were selected, because they had an episode of bleeding from their lungs during strenuous exercise. General anesthesia was induced with xylazine (1.0 mg/kg of body weight, IV) followed by ketamine (2.0 mg/kg, IV). Anesthesia was maintained with sevoflurane in oxygen delivered via a circle anesthetic breathing circuit. Ventilation was controlled to maintain PaCO2 at approximately 45 mm Hg. Neuromuscular blocking drugs (succinylcholine or atracurium) were administered to eliminate spontaneous breathing efforts and to facilitate surgery. Cardiovascular performance was monitored and supported as indicated. RESULTS: 2 of the 14 horses not euthanatized died as a result of ventricular fibrillation. Mean (+/- SD) duration of anesthesia was 304.9 +/- 64.1 minutes for horses that survived and 216.7 +/- 85.5 minutes for horses that were euthanatized or died. Our subjective opinion was that sevoflurane afforded good control of anesthetic depth during induction, maintenance, and recovery. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of sevoflurane together with neuromuscular blocking drugs provides stable and easily controllable anesthetic management of horses for elective thoracotomy and cardiac manipulation.

Use of pelvic flexure biopsies to predict survival after large colon torsion in horses.

OBJECTIVE: To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict outcome in horses with large colon torsion. STUDY DESIGN: Clinical study. ANIMALS: Fifty-four horses with large colon torsion. METHODS: A full-thickness biopsy was collected from the pelvic flexure of the ascending colon after correction of naturally occurring colonic torsion. Morphologic changes were evaluated and graded for interstitial tissue to crypt ratio (I:C ratio), percentage loss of superficial and glandular epithelium, and the degree of hemorrhage and edema. These variables were then used to predict survival. RESULTS: Morphologic variables could be used to correctly predict survival or death in 51 horses (P < .0001). This corresponded to a sensitivity of 95.1% (82.2%-99.2%; 95% CI) and a specificity of 92.3% (62.0%-99.6%; 95% CI). Of 6 horses that had colonic resection, 5 survived; an accurate prediction of outcome based on morphologic criteria was made for each horse. CONCLUSIONS: Interpretation of changes in colonic morphology can be used to accurately predict postoperative survival in horses with large colon torsion. CLINICAL RELEVANCE: Use of frozen colonic tissue sections is a rapid, reliable, and relatively inexpensive method for assessing morphologic damage associated with large colon torsion during surgery. Intraoperative evaluation of pelvic flexure biopsies can aid in the prediction of survival and guide surgical judgment as to the need for colonic resection.

Facilitation of Asian elephant (Elephas maximus) standing immobilization and anesthesia with a sling.

An Asian elephant (Elephas maximus) required general anesthesia for orthopedic foot surgery. The elephant was unable to lie down, so it was placed in a custom-made sling, administered i.m. etorphine hydrochloride in the standing position, and lowered to lateral recumbency. General anesthesia was maintained with isoflurane administered through an endotracheal tube. After surgery, the isoflurane anesthesia was terminated, with immobilization maintained with additional i.v. etorphine. The elephant was lifted to the vertical position, and the immobilizing effects of etorphine were reversed with naltrexone. The suspension system and hoist for the sling were designed specifically for the elephant house.

Evaluation of uniformity of morphological injury of the large colon following severe colonic torsion.

This report describes the evaluation of uniformity of morphological injury of the large colon following severe colonic torsion in 17 horses presented to the Veterinary Medical Teaching Hospital. In 16 horses, twist occurred at the colonic base and in 1 at the sternal and diaphragmatic flexure. Eleven of the 17 horses were subjected to euthanasia at surgery and 6 of 17 following surgical correction within 4 days postoperatively. The objective of this study was to determine if the degree of histological changes present at the pelvic flexure were uniformly distributed throughout the regions of the colon involved in cases of severe colonic torsion.

Hepatic sarcocystosis in a horse.

Hepatic sarcocystosis was diagnosed in a horse in association with refractory bacterial osteomyelitis and plasma cell tumor of the maxilla and hepatic salmonellosis. Gross lesions included pleural, pericardial, and peritoneal effusions, hepatomegaly, gastric ulceration, colonic edema, and proliferative tissues filling 2 maxillary dental alveoli. Histologically, liver was characterized by severe suppurative, necrotizing, periportal hepatitis, and severe periacinar necrosis. Hepatocytes frequently contained protozoal schizonts in various stages of development. In mature schizonts, merozoites were often arranged radially around a central residual body, consistent with asexual division by endopolygeny. Ultrastructural features of merozoites included an apical conoid and polar ring, anterior micronemes, central nuclei, and absence of rhoptries. These protozoa did not react to antisera raised against Neospora caninum, Sarcocystis neurona, Toxoplasma gondii, or Hammondia hammondi. The microscopic and ultrastructural characteristics and immunoreactivity of this organism are consistent with a Sarcocystis sp. other than S. neurona. This is the first report of Sarcocystis-associated hepatitis in a horse. The life cycle of this organism and source of infection are unknown.

Evaluation of iodophor skin preparation techniques and factors influencing drainage from ventral midline incisions in horses.

OBJECTIVE: To document natural bacterial flora on the ventral aspect of the equine abdomen, to compare 2 preparation techniques, and to identify potential risk factors that may contribute to incisional drainage. DESIGN: Prospective study. ANIMALS: 53 horses undergoing exploratory celiotomy. PROCEDURE: Group-1 horses (n = 26) were prepared with povidone-iodine and alcohol. Group-2 horses (27) were prepared with a film-forming iodophor complex. Numbers of bacterial colony-forming units (CFU) were measured before and after surgical scrub, following skin closure, and after recovery from general anesthesia. Swab specimens to identify normal skin bacterial flora and potential pathogens were obtained by swabbing a 4 x 4-cm area. Variables that might affect incisional drainage were also investigated. RESULTS: For both techniques, there was a significant reduction in bacterial numbers after skin preparation. Incisional drainage was observed in 14 (26%) horses (8 group-1 and 6 group-2 horses). Preexisting dermatitis, poor intraoperative drape adherence, high number of bacterial CFU obtained after recovery from anesthesia, and high number of CFU obtained from the surgery room environment were the main risk factors associated with subsequent incisional drainage. Bacillus spp, nonhemolytic Staphylococcus spp, Micrococcus spp, Corynebacterium spp, Streptomyces spp, other nonenteric genera, and nonhemolytic Streptococcus spp were the most common isolates obtained before surgical scrub. CONCLUSIONS AND CLINICAL RELEVANCE: Both skin preparation techniques were equally effective in reducing numbers of bacterial CFU by 99%, and a significant difference was not found in incisional drainage rate between groups. Protection of the wound during recovery from anesthesia and the immediate postoperative period may reduce incisional drainage after abdominal surgery in horses.

Changes in left ventricular dynamics during graded exercise.

Three mature Thoroughbred horses were prepared surgically with ultrasonic sonomicrometer crystals affixed to their ventricular pericardia. Signals from crystals recorded dimensions of axes across the left ventricle. Cubic algorithms were fitted to dimensional data to generate volume estimates that matched stroke volumes simultaneously measured using the Fick principle. As horses stood at rest or exercised at various intensities (approx 7, 12, 24, 47 and 100% maximal rate of O2 consumption VO2max[), left ventricular dimensions were recorded and 20 consecutive diastolic and systolic volumes calculated. Although Fick estimates detected no difference in stroke volume at different exercise intensities, sonomicrometer measurements of stroke volume were significantly lower at rest and higher at VO2max. These differences mirrored changes in end-diastolic volume, although end-systolic volume did not change. At all exercise intensities, stroke volume was most variable and end-diastolic volume the least. The pattern conforms to the Frank-Starling mechanism, and indicates that at high exercise intensities ventricular myocytes generate high pressures with higher myocardial wall stress due to the increased size of the chamber.

Cardiac output measurements using sonomicrometer crystals on the left ventricle at rest and exercise.

Eight horses were fitted surgically with 8 ultrasonic sonomicrometer crystals each attached to their left ventricular pericardia and a left atrial catheter. Three horses returned to treadmill performance with a maximum rate of oxygen consumption similar to their presurgical values. These horses were evaluated to determine how well sonomicrometer estimates of cardiac output agreed with those obtained by a steady-state method, the Fick principle. Variance between the 2 was similar to the coefficient of variation (approximately 12.5%) of the Fick estimates. We conclude that left ventricular sonomicrometer measurements in horses appear to give a reasonable estimate of ventricular dimensions and can, therefore, be used potentially to evaluate such variables as diastolic flow.

Comparison of perioperative versus postoperative intratumoral administration of cisplatin for treatment of cutaneous sarcoids and squamous cell carcinomas in horses.

OBJECTIVE: To determine the benefits of reducing the interval between surgical cytoreduction and intratumoral administration of cisplatin. DESIGN: Randomized clinical study. ANIMALS: 70 horses with 89 incompletely resected T2- and T3-stage sarcoids (n = 64) and squamous cell carcinomas (25). PROCEDURE: Horses were given 4 intratumoral treatments of cisplatin at 2-week intervals. The first treatment was given at the time of, or immediately after, surgical resection for horses treated in accordance with the perioperative protocol (group 1). Horses in group 2 were treated with cisplatin after the skin healed following surgical resection in accordance with the postoperative protocol. RESULTS: A difference was not found in duration of overall local tumor control between the 2 groups. Patterns of treatment failures and interval to failure differed between the 2 groups. Length of the surgical scar was the only factor that affected prognosis; an increase in length was associated with a poorer prognosis. A detrimental effect of postoperative treatment was only found in tumors with a high tumor proliferative fraction. Local reactions were similar for the 2 treatment groups, and chronic reactions were not observed. CONCLUSIONS AND CLINICAL RELEVANCE: Intratumoral administration of cisplatin is beneficial for treatment of cutaneous tumors in horses. Tumor repopulation during the interval between surgery and intratumoral administration of cisplatin decreases treatment efficacy. These results provide evidence of rapid tumor repopulation following surgical resection without a lag period for tumors with a high proliferation index. When tumor proliferation index is not known, it may be prudent to use the perioperative protocol.

Surgical removal of infected phalanges from an Asian elephant (Elephas maximus).

A 40-yr-old female Asian elephant (Elephas maximus) developed cellulitis and became lame in her left front leg. A draining tract behind the lateral nail of her left front foot was discovered. This lesion was treated by aggressive irrigation using a variety of disinfectant solutions. Radiographically, there was degeneration and fragmentation of the distal phalanx of the fifth digit and patterns suggestive of osteomyelitis of the second (middle) phalanx. The fragments of the distal phalanx and the affected portion of the second phalanx were removed surgically. Six months after surgery the incision had healed but a fistulous tract remained on the palmar surface of the foot. The tract extended to the second phalanx, and there was radiographic evidence of osteomyelitis in the second phalanx and the distal portion of the proximal phalanx. The remainder of the second phalanx and the distal portion of the proximal phalanx were surgically removed. Aggressive aftercare allowed complete wound closure by second intention.

Comparison of intratumoral administration of cisplatin versus bleomycin for treatment of periocular squamous cell carcinomas in horses.

OBJECTIVE: To compare therapeutic benefits of intratumoral administration of cisplatin and bleomycin for squamous cell carcinoma of the eyelids in horses. ANIMALS: 25 horses with 27 T2-stage periocular squamous cell carcinomas. PROCEDURE: Horses were treated 4 times at 2-week intervals with a slow-release formulation of cisplatin (1 mg/cm3 of tissue) or bleomycin (1 IU/cm3 of tissue). A two-stage design was used to minimize the sample size in each treatment arm. RESULTS: The local control rate at 1 year for lesions treated with cisplatin was 93 +/- 6%, and with bleomycin was 78 +/- 10%. Difference in local control duration between the 2 treatment groups was not significantly different. A high tumor proliferative fraction index value was associated with a higher local (infield) control rate, but also with a higher risk of marginal and regional recurrences. Tumors with a low proliferative fraction index value (< 28%) had 9.5-times higher (P = 0.0411) risk of recurrence than those with a high index value. Local acute reactions were similar in the 2 treatment groups, and chronic reactions were not observed. CONCLUSIONS: Cisplatin and bleomycin were effective anticancer agents for carcinoma of the eyelid in horses. Based on therapeutic benefit and treatment cost, cisplatin was found to be a better choice for intratumoral chemotherapy of eyelid carcinomas. CLINICAL RELEVANCE: Results of this study confirm the value of intratumoral chemotherapy, using cisplatin, for treatment of cutaneous squamous cell carcinomas in horses.

The effect of doxapram-induced hyperventilation on respiratory mechanics in horses.

To investigate the influence of increased respiratory frequency on respiratory mechanics in the horse, measurements were made in two groups of seven tracheostomized horses before and after the administration of doxapram. The horses in group I had normal base line values for respiratory mechanics, whereas the horses in group II had significantly lower values of dynamic compliance (Cdyn), higher respiratory resistance (R), and a higher total change in pleural pressure (delta P). The administration of 0.3 mg kg-1 doxapram intravenously resulted in a significant increase in respiratory frequency (fR), R, delta P, tidal volume (VT), and peak to peak respiratory flow (V), and a decrease in Cdyn in both groups of horses. The group II horses had significantly greater increases in R and delta P than the horses in group I.

Efficacy of metoclopramide for treatment of ileus in horses following small intestinal surgery: 70 cases (1989-1992).

In this retrospective study, postoperative ileus was studied in horses having resection of the small intestine followed by a jejunojejunal (n = 35) or a jejunocaecal (n = 35) anastomosis. Twenty-six horses received no metoclopramide, 27 received metoclopramide as an intermittent intravenous infusion and 17 horses received metoclopramide as a continuous intravenous infusion (0.04 mg/kg/hour). Horses receiving a continuous infusion of metoclopramide had a reduced total volume (P < 0.001), shorter duration (P < 0.001), and a slower rate (P < 0.001) of postoperative gastric reflux, and a shorter postoperative hospital stay (P < 0.01) when compared to horses receiving no metoclopramide and horses receiving metoclopramide as an intermittent infusion. Horses having jejunocaecostomy performed had a larger volume (P < 0.05), longer duration (P < 0.05), and a greater rate (P < 0.05) of postoperative gastric reflux, and a longer postoperative hospital stay (P < 0.001) than horses undergoing jejunojejunostomy. Horses that had an abdominal drain placed during surgery had a longer length of intestine resected (P < 0.05) and a longer postoperative hospital stay (P < 0.05) than horses without an abdominal drain. Horses that died or were euthanased during the postoperative period had a greater total volume (P < 0.05), longer duration (P < 0.05), and greater rate of postoperative gastric reflux (P < 0.01), a longer length of small intestine resected (P < 0.01), and a shorter postoperative hospital stay (P < 0.05) than horses that survived until discharge from the hospital. In a multivariate regression analysis the continuous infusion of metoclopramide was the only variable that contributed significantly to predicting the total volume (P < 0.001; r2 = 0.24), duration (P < 0.001; r2 = 0.24) and rate (P < 0.001; r2 = 0.25) of postoperative gastric reflux. We concluded that metoclopramide given as a continuous intravenous infusion decreased the incidence and severity of ileus following small intestinal resection and anastomosis in horses.

Laparoscopic anatomy of the abdomen in dorsally recumbent horses.

OBJECTIVES: To provide an accurate and detailed description of the laparoscopic anatomy of the abdomen of horses positioned in dorsal recumbency and to compare those observations with laparoscopic anatomy of standing horses. The effects of laparoscopy and positional changes on arterial blood pressure and blood gas values also were investigated. DESIGN: Descriptive anatomic study. SAMPLE POPULATION: Laparoscopy was performed on 6 horses (2 mares, 2 geldings, and 2 stallions) to record the normal laparoscopic anatomy of the abdomen in dorsal recumbency. PROCEDURE: Feed was withheld from all horses for 36 hours. Horses, under general anesthesia, were examined in horizontal and inclined positions (head-up and head-down). Intermittent positive-pressure ventilation was used, arterial blood pressure was continuously monitored, and samples for arterial blood gas measurements were taken at intervals. RESULTS: The main structures of diagnostic relevance observed in the caudal region of the abdomen were the urinary bladder, mesorchium and ductus deferens (left and right), left and right vaginal rings, insertion of the pre-pubic tendon, random segments of jejunum and descending colon, pelvic flexure of the ascending colon, body of the cecum, and cecocolic fold. The main structures observed in the cranial region of the abdomen were ventral surface of the diaphragm, falciform ligament and round ligaments of the liver, ventral portion of the left lateral, left medial, quadrate, and right lateral lobes of the liver, spleen, right and left ventral colons, sternal flexure of the ascending colon, apex of the cecum, and stomach. CONCLUSIONS: Alterations in cardiovascular and respiratory function in response to pneumoperitoneum and various positional changes indicated the need for continuous and thorough anesthetic monitoring and support. Comparison of anatomic observations made in dorsally recumbent, inclined horses with those reported for standing horses should enable practitioners to make patient positioning decisions that best suit access to specific visceral structures. Development of special instrumentation for manipulation of the viscera in horses, particularly the intestinal tract, would increase the diagnostic and therapeutic capabilities of laparoscopy during dorsal recumbency.

Infection of the intertubercular bursa in horses: four cases (1978-1991).

OBJECTIVE: To determine the clinical outcome of horses treated for infection of the intertubuercular bursa (infectious bicipital bursitis). DESIGN: Retrospective analysis of case records. ANIMALS: Four horses referred for treatment of infectious bicipital bursitis. PROCEDURE: Medical records of horses that were severely lame on admission were reviewed. RESULTS: In 3 horses, palpation over the bicipital bursa as well as flexion and extension of the scapulohumeral joint were resented. Ultrasonography performed in 1 horse revealed that the bicipital bursa was large and that excessive amounts of fluid containing hyperechoic material were evident within the bicipital bursa. Two horses were treated by the administration of antimicrobial and nonsteroidal antiinflammatory drugs. Both remained lame and failed to resume their former activity. Two horses additionally were treated surgically by means of a partial synovectomy. Both resumed their former activity although a subtle lameness remained in 1 horse. CLINICAL IMPLICATIONS: Partial synovectomy may be useful in the treatment of horses with infectious bicipital bursitis.

Penetrating wounds of the thorax in 15 horses.

Clinical features, treatment and outcome of 15 horses with penetrating thoracic wounds are described. The most common cause of trauma was collision with an object (10 horses). Concurrent clinical findings included subcutaneous emphysema (12 horses), pneumothorax (12 horses), haemothorax (5 horses) and pneumomediastinum (6 horses). Axillary wounds were present in 5 horses. Foreign bodies were identified and removed from 2 horses. Wounds were sutured (6 horses) or packed (7 horses). Air was evacuated from the pleural cavities of 11 horses. Eleven horses (73%) were discharged from the hospital. All horses subjected to euthanasia had severe trauma to structures outside the thoracic cavity including perforation of the colon (2 horses), renal trauma (1 horse) and a luxated thoracolumbar vertebra (1 horse). From this study, it can be concluded that 1) the prognosis for horses with penetrating thoracic wounds, without extrathoracic injury, is favourable; 2) a thorough evaluation including the abdominal cavity should be performed and 3) horses with axillary wounds should be monitored closely for respiratory distress until the wound has completely healed.

Resolution of a left ureteral stone using electrohydraulic lithotripsy in a thoroughbred colt.

A 3-year-old Thoroughbred colt was presented for evaluation of azotemia and anorexia. Physical examination revealed a ureterolith in the left ureter, approximately 10 cm from the bladder, which was thought to obstruct urine flow by approximately 90% when viewed cystoscopically. Ultrasonographic examination of both kidneys revealed indistinct corticomedullary junctions, and the right kidney was more hyperechoic. A percutaneous biopsy of the right kidney revealed chronic interstitial nephritis with marked interstitial medullary fibrosis. Medical therapy consisting of IV fluids, sodium chloride PO, and ammonium chloride PO was initiated. Ureteroscopic electrohydraulic lithotripsy via a perineal urethrostomy was used to successfully remove the stone. Klebsiella oxytoca, which responded to oral enrofloxacin therapy, was cultured from the urine after surgery. Azotemia resolved and the horse resumed training.

Partitioning of total pulmonary resistance in horses.

The partitioning of total pulmonary resistance (RL) into upper airway resistance and lower airway resistance (RI) was studied in 8 Thoroughbred geldings. In addition, the phase shift and amplitude distortion of 3 catheters used for pressure measurements in this study were evaluated under static and dynamic conditions. Flow rate was obtained from a heated pneumotachograph attached to a tight-fitting mask placed over the nose. Electronic integration of the flow signal gave tidal volume. Transpulmonary pressure (PL) was obtained from calculation of the difference between the esophageal balloon catheter pressure and mask pressure. Lateral tracheal pressure was measured from a polyethylene catheter placed percutaneously in the middle portion of the trachea. Lower airway pressure (PI) was calculated as the difference between esophageal pressure and lateral tracheal pressure. Similarly, upper airway pressure was defined as the difference between lateral tracheal pressure and mask pressure. Pressures are reported as the difference between the maximal and the minimal pressures recorded during a respiratory cycle. Airway resistance was calculated, using the isovolume method, at 50% of tidal volume. There were individual and group variations in Pi and Pl/PL, although Pi accounted for more than 60% of PL in all horses. In 6 horses, Rl was more than 50% of RL whereas in 2 horses, Rl was only 30 and 34% of RL. Amplitude distortion was minimal for the 3 catheters under static conditions in the in vitro study. Under dynamic conditions, amplitude distortion varied according to the catheter studied, the frequency, and the resistance of the system.(ABSTRACT TRUNCATED AT 250 WORDS)