Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis.

REASONS FOR PERFORMING STUDY: Horses requiring different methods of intestinal anastomosis during equine colic surgery may have differences in mortality and morbidity. HYPOTHESES: Horses requiring side-to-side jejunocaecal anastomosis have a higher mortality and morbidity rate than those requiring end-to-end jejunojejunal anastomosis. Morbidity and mortality of handsewn vs. stapled side-to-side jejunocaecal anastomoses are not significantly different. METHODS: A prospective, nonrandomised, observational study was conducted. Clinical and surgical details were recorded during hospitalisation and survival data acquired by periodic telephone questionnaire. Differences in mortality and morbidity rate were evaluated by survival analysis. RESULTS: A total of 184 horses underwent end-to-end jejunojejunal anastomosis and 178 underwent side-to-side jejunocaecal anastomosis. Horses with a jejunocaecal anastomosis had a significantly higher mortality rate. The incidence of post operative colic in horses requiring side-to-side jejunocaecal anastomoses was greater than those requiring end-to-end jejunojejunal anastomoses. Within the group undergoing side-to-side jejunocaecal anastomosis there was no evidence of differential survival between horses with handsewn vs. stapled anastomoses. CONCLUSIONS: Mortality rate is higher in horses that have required side-to-side jejunocaecal anastomosis than in those that needed end-to-end jejunojejunal anastomosis; and post operative colic is more common after side-to-side jejunocaecal anastomosis. No difference in mortality was found between horses with handsewn and stapled side-to-side jejunocaecal anastomoses. POTENTIAL RELEVANCE: Surgeons should be aware of the increased mortality and morbidity in horses requiring side-to-side jejunocaecal anastomosis. Our finding of no difference in mortality between handsewn and stapled side-to-side jejunocaecal anastomoses justifies surgeons exercising personal preference in their selection of anastomosis method.

Do subcutaneous sutures increase risk of laparotomy wound suppuration?

REASONS FOR PERFORMING STUDY: Incisional drainage and suppuration occurs commonly following exploratory laparotomy; any technique with the potential to reduce the incidence of this complication warrants investigation. OBJECTIVES: To determine if abandoning the use of subcutaneous sutures in laparotomy wound closure is safe and whether it reduces the risk of suppuration. METHODS: A randomised controlled study was carried out at 2 referral hospitals in the UK, involving 309 horses undergoing exploratory laparotomy; 150 horses underwent '2-layer' closure without a subcutaneous suture, while 159 underwent conventional '3-layer' closure. Information regarding degree of oedema and gross types of discharge was recorded daily; suppuration was defined as discharge of pus. Telephone follow-up was carried out 30 days after hospital discharge to identify those complications occurring after that date and, thereafter, every 3 months. The influence of closure method on risk of wound suppuration was assessed by Chi-squared analysis and by logistic regression. Time to suppuration was modelled using a Cox proportional hazards model. RESULTS: No catastrophic failures of 2-layer closures were recorded. Prevalence of suppuration was not significantly different, being 18.7% and 23.9% for 2- and 3-layer closures, respectively (OR = 1.37, 0.79-2.37, P = 0.263). CONCLUSIONS AND POTENTIAL RELEVANCE: This study found no significant difference in prevalence or rate of wound suppuration in 2-layer closures compared to conventional 3-layer closure. Two-layer closure is recommended as a safe alternative means of achieving ventral midline abdominal closure in horses.

Pre-operative and anaesthesia-related risk factors for mortality in equine colic cases.

Mortality rates for horses that have undergone emergency abdominal surgery are higher than for other procedures. Here, multivariable modelling of data from 774 surgical colic cases is used to identify pre-operative and anaesthesia-related variables associated with intra- and post-operative mortality. Intra-operative mortality was significantly (P<0.05), and positively associated with heart rate and packed cell volume (PCV) at admission, and negatively associated with the severity of pain. Post-operative mortality increased with increasing age and PCV at admission. Draught horses, Thoroughbreds and Thoroughbred-cross horses carried a significantly worse prognosis. We detected a small but significant variability in the risk of intra-operative death amongst referring veterinary surgeons. Different anaesthetic induction agents, inhalation maintenance agents and the use, or not, of intermittent positive pressure ventilation had no significant effect on risk of death. We conclude that cardiovascular compromise, level of pain, age, and breed are all associated with the risk of mortality in equine surgical colic cases.

First description of the female of the jumping spider Balmaceda nigrosecta Mello-Leitão (Salticidae, Dendryphantini, Marpissina).

The female of Balmaceda nigrosecta Mello-Leitão, 1945 is described and illustrated for the first time. In addition, this paper further illustrates the male, and provides the first known observations on the natural history of this species, including habitat, cohabitation, and prey capturedata.

Factors affecting long-term survival of horses recovering from surgery of the small intestine.

REASONS FOR PERFORMING STUDY: Epiploic foramen entrapment (EFE) has been associated with a particularly poor post operative prognosis for equine colic cases, but the reasons for this are unknown. OBJECTIVES: To identify variables associated with post operative survival following surgery for small intestinal disease; develop a model describing long-term post operative survival; and identify reasons for the poor prognosis associated with EFE. METHODS: Data from 382 horses undergoing surgery were used to identify variables associated with survival. A multivariable Cox proportional hazards model for post operative survival was developed and model fit evaluated. RESULTS: The final model included the variables total plasma protein (TP) and packed cell volume (PCV) at admission, duration of surgery and the dichotomous variable relaparotomy (yes/no). Risk of death was positively associated with increasing PCV, but negatively associated with increasing TP (which decreased the probability of death). In a univariable model, EFE cases had a significantly higher death rate than other types of small intestinal disease (hazard ratio = 1.7, P = 0.035). Multivariable modelling indicated that some of the increased risk associated with EFE cases was due to lower TP values and longer duration of surgery. CONCLUSIONS: Preoperative TP is associated negatively with the risk of post operative death in horses recovering from small intestinal surgery. Other variables associated with the probability of survival are preoperative PCV, duration of surgery and relaparotomy. The increased post operative death rate of EFE cases can be explained in part by lower TP and longer surgery times of these cases. POTENTIAL RELEVANCE: Total plasma protein may be not simply a measure of hydration status in small intestinal colic cases, but an important determinant of survival. Further investigation of this relationship is warranted. Our model for post operative survival highlights the importance of preoperative TP, PCV and duration of surgery as prognostic indicators. This information should allow a more accurate post operative prognosis following small intestinal surgery.

Modelling long-term survival of horses following surgery for large intestinal disease.

REASONS FOR PERFORMING STUDY: Large intestinal diseases are an important cause of equine colic that require surgical management, but there is little published information about long-term survival of such cases. OBJECTIVES: To identify variables associated with post operative mortality and to develop a model for post operative survival following surgery for large intestinal disease. METHODS: Clinical data and long-term follow-up information from 275 horses undergoing surgery for large intestinal disease were used. A multivariable, Cox proportional hazards model for post operative death was developed and the fit of the model evaluated. RESULTS: The continuous variables age, heart rate and packed cell volume (PCV) were associated positively with the risk of post operative death, as were the categorical variables resection (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-5.1) and relaparotomy (OR 3.5, 95% CI 1.4-8.4). CONCLUSIONS: In the population studied, the probability of post operative survival following surgery for large intestinal disease was associated with the cardiovascular parameters heart rate and PCV on admission, age of the horse and whether it underwent resection or relaparotomy. POTENTIAL RELEVANCE: The prognosis for post operative survival for horses with large intestinal disease may be improved by early surgery, prior to the development of cardiovascular compromise. Surgeons should be aware that increasing age, resection of large colon and relaparotomy are all associated with a worsening prognosis for survival.

Evaluation of the clinical efficacy of prokinetic drugs in the management of post-operative ileus: can retrospective data help us?

The objectives of the study were to determine whether retrospective data can be used to answer questions about the efficacy of prokinetic agents when used to treat horses with post-operative ileus (POI). We describe prevalence and mortality of POI with reference to treatment with four prokinetic agents. By combining data from two Hospitals a study population of 55 horses with POI following pedunculated lipoma obstruction (PLO) was established. Univariable and multivariable associations were determined between short term survival and potential explanatory variables. With death as outcome in multivariable models, breed and hospital were significantly associated with outcome but the use of prokinetic agents was not (P=0.15). However, sample size estimates indicate the low power of this study to detect differences in outcome. It was not possible definitively to evaluate the efficacy of prokinetics as treatment for POI following PLO using retrospective data. The data were suggestive of limited efficacy of prokinetics as treatment for POI. It is postulated that the identified association between hospital and survival reflects differences in clinician decision making. The study highlights the need for further prospective studies using randomised clinical trials to evaluate accurately the efficacy of prokinetic agents. This report illustrates difficulties with performing retrospective analysis of clinical data to determine the efficacy of treatment regimes.

Suspected venous air embolism in a horse.

A horse which had had a caecal impaction for 10 days was treated by means of an ileocolostomy [corrected] but failed to respond satisfactorily. Before a second laparotomy was performed it was observed to have dislodged the extension set from a jugular catheter and air was heard being sucked into the vein. It became very agitated but was anaesthetised again and the impaction was removed through an incision in the apex of the colon [corrected] After recovering from the anaesthesia it developed severe signs of pruritus which subsided only after 12 hours. These signs were considered most likely to have resulted from a venous air embolism.

Freyinae, a major new subfamily of Neotropical jumping spiders (Araneae: Salticidae).

Freyinae, new subfamily, is described for a group of genera of Neotropical jumping spiders that can be distinguished from other non-ant mimic salticoid Neotropical salticids by having the following three morphological features: a slightly more elongate carapace, a distinctive prolateral tibial macrosetae arrangement (medially placed subdistal and subproximal macrosetae, with a subdorsal medial macroseta in some males), and an unusual dorsoventrally thick tegulum basal division (although one or two of these features are sometimes lost). It includes 20 genera previously considered valid, of which 19 are retained: Akela Peckham & Peckham, 1896, Aphirape C.L. Koch, 1850, Asaracus C.L. Koch, 1846, Capidava Simon, 1902, Chira Peckham & Peckham, 1896, Edilemma Ruiz & Brescovit, 2006, Eustiromastix Simon, 1902, Freya C.L. Koch, 1850, Frigga C.L. Koch, 1850, Kalcerrytus Galiano, 2000, Nycerella Galiano, 1982, Onofre Ruiz & Brescovit, 2007, Pachomius Peckham & Peckham, 1896, Phiale C.L. Koch, 1846, Rishaschia Makhan, 2006, Sumampattus Galiano, 1983, Trydarssus Galiano, 1995, Tullgrenella Mello­Leitão, 1941, and Wedoquella Galiano, 1984. Romitia Caporiacco, 1947 (and its synonym Uspachus Galiano, 1995) is synonymized with Pachomius, new synonymy. New genera described in the subfamily are: Drizztius, Leptofreya, Megafreya, Philira, Tarkas, Triggella, and Xanthofreya. The following nomenclatorial changes are made: New synonyms: Freya demarcata Chamberlin & Ivie, 1936 = Freya (sub Cyrene) albosignata (F.O.P.-Cambridge, 1901); Freya (sub Cyrene) grisea (F.O.P.-Cambridge, 1901) = Freya (sub Cyrene) infuscata (F.O.P.-Cambridge, 1901); Freya (sub Cyrene) emarginata (F.O.P.-Cambridge, 1901) and Nycerella (sub Heraclea) sanguinea paradoxa (Peckham & Peckham, 1896) = Nycerella (sub Heraclea) sanguinea (Peckham & Peckham, 1896); Pachomius (sub Phiale) maculosus (Chickering, 1946) = Phiale (sub Cyrene) bilobata (F.O.P.-Cambridge, 1901); Phiale (sub Cyrene) mediocava (F.O.P.-Cambridge, 1901) = Freya (sub Cyrene) maculatipes (F.O.P.-Cambridge, 1901); Phiale (sub Cyrene) simplicicava (F.O.P.-Cambridge, 1901) = Freya (sub Cyrene) bifurcata (F.O.P.-Cambridge, 1901). New combinations: Capidava rufithorax Simon, 1902 = Drizztius rufithorax; Freya frontalis Banks, 1929 = Eustiromastix frontalis; Chira (sub Attus) spinipes (Taczanowski, 1872) = Eustiromastix spinipes; Freya (sub Euophrys) ambigua (C.L. Koch, 1846) = Leptofreya ambigua; Freya (sub Cyrene) bifurcata (F.O.P.-Cambridge, 1901) = Leptofreya bifurcata; Freya (sub Cyrene) laticava (F.O.P.-Cambridge, 1901) = Leptofreya laticava; Freya (sub Cyrene) longispina (F.O.P.-Cambridge, 1901) = Leptofreya longispina; Phiale (sub Cyrene) bilobata (F.O.P.-Cambridge, 1901) = Pachomius bilo-batus; Phiale (sub Cyrene) hieroglyphica (F.O.P.-Cambridge, 1901) = Pachomius hieroglyphicus; Phiale (sub Cyrene) niveoguttata (F.O.P.-Cambridge, 1901) = Pachomius niveoguttatus; Romitia (sub Euophrys) albipalpis (Taczanowski, 1878) = Pachomius albipalpis; Romitia (sub Euophrys) andina (Taczanowski, 1878) = Pachomius andinus; Romitia (sub Uspachus) bahiensis (Galiano, 1995) = Pachomius bahiensis; Romitia (sub Uspachus) columbiana (Galiano, 1995) = Pachomius columbianus; Romitia (sub Uspachus) juquiaensis (Galiano, 1995) = Pachomius juquiaensis; Romitia (sub Phiale) ministerialis (C.L. Koch, 1846) = Pachomius ministerialis; Romitia (sub Uspachus) misionensis (Galiano, 1995) = Pachomius misionensis; Romitia nigra Caporiacco, 1947 = Pachomius nigrus; Romitia (sub Uspachus) patellaris (Galiano, 1995) = Pachomius patellaris; Chira (sub Diagondas) micans (Simon, 1902) = Philira micans; Chira superba Caporiacco, 1947 = Philira superba; Freya (sub Cyrene) maculatipes (F.O.P.-Cambridge, 1901) = Tarkas maculatipes; Freya (sub Cyrene) bifida (F.O.P.-Cambridge, 1901) = Triggella bifida; Freya infuscata (F.O.P.-Cambridge, 1901) = Triggella infuscata; Freya (sub Cyrene) minuta (F.O.P.-Cambridge, 1901) = Triggella minuta; Freya (sub Cyrene) albosignata (F.O.P.-Cambridge, 1901) = Xanthofreya albosignata; Freya arraijanica Chickering, 1946 = Xanthofreya arraijanica; Phiale (sub Cyrene) bicuspidata (F.O.P.-Cambridge, 1901) = Xantho-freya bicuspidata; Freya chionopogon Simon, 1902 = Xanthofreya chionopogon; Freya (sub Heraclea) rustica (Peckham & Peckham, 1896) = Xanthofreya rustica. Combinations restored: Phiale (sub Pachomius) flavescens (Peckham & Peckham, 1896) = Pachomius flavescens; Phiale (sub Pachomius) similis (Peckham & Peckham, 1896) = Pachomius similis. Invalid name: Freya dyali Roewer 1951 is an invalid replacement name for Euophrys trifasciata "Dyal 1935", which was a redescription of Euophrys trifasciata C.L. Koch, 1846, not a homonym. New species: Drizztius geminensis. First female descriptions and transfers of mismatched females: First descriptions for Asaracus megacephalus C.L. Koch, 1846, Capidava biuncata Simon, 1902, and Phiale formosa (Banks, 1909); the true female of Eustiromastix spinipes is described, and its mismatched female is identified as the female of Eustiromastix falcatus Galiano, 1981; the mismatched female of Freya (sub Cyrene) prominens (F.O.P.-Cambridge, 1901) is identified as the female of Xanthofreya rustica; the misidentified female of X. rustica is identified as the female of Leptofreya bifurcata. Lectotypes: designated for Cyrene bifida F.O.P.-Cambridge, 1901 and Cyrene formosa Banks, 1909. New synapomorphy: a constricted proximal end of the cymbium of the male palp is an apparent new synapomorphy for Salticoida.

Reports of envenomation by brown recluse spiders (Araneae: Sicariidae) outnumber verifications of Loxosceles spiders in Florida.

Bites attributed to the brown recluse spider, Loxosceles reclusa Gertsch & Mulaik, are frequently reported by medical personnel throughout Florida, whereas the extensive arachnological evidence contradicts the alleged widespread occurrence of Loxosceles spiders in the state. We compared reports of brown recluse spider bites made by medical personnel from a 6-yr Florida poison control center database to the known verifications of Loxosceles spiders from 100 yr of Florida arachnological data. Medical personnel diagnosed 124 brown recluse spider bites from 31 of Florida's 67 counties in 6 yr. In contrast, only 11 finds of approximately 70 Loxosceles spiders have been made in 10 Florida counties in 100 yr. Florida does not have sufficient widespread populations of Loxosceles spiders to warrant consideration of brown recluse spider envenomation as a probable etiology of dermonecrosis. Florida health care would improve if medical personnel would consider the multitude of other etiologies that manifest in dermonecrosis.

Pilot study: validating staff nurses' observations of sleep and wake states among critically ill patients, using polysomnography.

BACKGROUND: Effective management of sleep pattern disturbance begins with accurate assessment of the patient's sleep and wake states. OBJECTIVE: The purpose of this study was to validate staff nurses' observations of sleep and wake states among critically ill adult patients, using polysomnography. SAMPLE AND SETTING: The sample consisted of 21 adult patients with multisystem diagnoses in a 10-bed medical intensive care unit in a 540-bed acute care teaching hospital. METHOD: Each staff nurse caregiver observed a single patient for the entire data collection period of 4 hours, with a total of 15 nurses participating in the study. A total of 340 observations were made, with the possibility of 17 observations per patient. Nursing observations were made every 15 minutes on each patient and compared to the actual patient state as measured by polysomnography. RESULTS: Nurses' assessments were correct 81.9% of the time. CONCLUSIONS: There is some basis for using staff nurses as observers of sleep and wake states. Increased credence can be placed on nursing assessments and diagnosis of sleep pattern disturbance, resulting in more timely and effective management of the problem.

Equine adenovirus 1 isolated from cauda equina neuritis.

Equine adenovirus 1 was recovered after four to six passages from two out of three cases of cauda equina neuritis (CEN) using kidney monolayers. Similar treatment of lumbo-sacral spinal cord from six normal horses did not yield adenovirus. All three cases of CEN had antibodies to the neuritogenic myelin protein P2 while immunofluorescence demonstrated that autologous IgG bound to the myelin of affected nerves. Adenovirus was not detected in neural tissue by immunofluorescence.

Cytokine mRNA expression pattern in horses with large intestinal disease.

The aim of this study was to investigate cytokine expression patterns in the large intestinal mucosa of horses, particularly in diseases associated with inflammation. Many cases of equine colitis remain without a definitive diagnosis and survival rates are poor. In humans, colitis is associated with increased expression of pro-inflammatory cytokines. To examine if similar responses occur in horses, we investigated il -2, il -4, il -5, il -10, tnfalpha, ifngamma and tgfbeta messenger rna expression in large intestinal mucosa. Samples were obtained from animals with large intestinal disease (n=15) or from horses which had different levels of cyathostomin infection (n=9) and analysed by reverse transcription-polymerase chain reaction. il -2 was detected at all sites, whilst il -4 was detected at all but one site. The presence of il -10, il -5, ifngamma and tgfbeta varied with no significant differences amongst groups (P>0.4). Detection of tnfalpha was significantly different between the group of horses that had infiltrative inflammatory bowel disease and those with larval cyathostominosis (P=0.028) and those that were helminth negative (P=0.014). These results indicate a possible role for tnfalpha in the pathogenesis of equine infiltrative inflammatory bowel disease.

Cartilage breakdown in equine osteoarthritis: measurement of keratan sulphate by an ELISA system.

Degradation of cartilage in osteoarthritis of man results in the release of sulphated glycosaminoglycans, particularly keratan sulphate, into tissue fluids. A study was made to evaluate these markers for osteoarthritis in the horse. Synovial fluid and serum levels of keratan sulphate, measured by an ELISA-inhibition technique, and sulphated glycosaminoglycans measured by specific dye binding assay, were found to be significantly increased (P less than 0.001) in joints from horses with osteoarthritis, compared with normal joints. Synovial fluids from joints with infective arthritis also showed high keratan sulphate levels, but statistically were not significantly different from osteoarthritis. Measurement of serum/synovial fluid levels of proteoglycan may enable cartilage degeneration to be detected and monitored and help more effective treatments to be developed in the equine species.

Interleukin-1-like activity in synovial fluids and sera of horses with arthritis.

Synovial fluid samples of horses with osteoarthritis were investigated to detect interleukin-1 (IL-1) activity which could contribute to the disease pathogenesis. Of the 32 samples tested, 12 (37.5 per cent) showed an augmented phytohaemagglutinin induced proliferation of C3H/HeJ mouse thymocytes. Positive results were also seen in horses with infected arthritis, osteochondritis, traumatic arthritis and undefined synovial effusions. Normal synovial fluid and sera from all groups failed to show any detectable IL-1 activity. Fractionation of synovial fluid showed that the IL-1 activity was in the 15 to 20 Kd fractions. In the absence of mitogen, synovial fluid failed to stimulate thymocytes and did not stimulate the growth of an interleukin-2 (IL-2) dependent CTLL cell line, but synovial fluid stimulated IL-2 release by mouse spleen cells incubated with suboptimal doses of lectin. Evidence of an IL-1 inhibitor in synovial fluid from osteoarthritic horses was provided by ultrafiltration experiments and by the inhibitory activity of synovial fluid at particular dilutions in the thymocyte assay. The presence of IL-1-like activity could be relevant in the pathogenesis of arthritis in horses.

Changes in the sustentaculum tali associated with distension of the tarsal sheath (thoroughpin).

Results of the clinical and radiographic examination of 8 lame horses with tarsal sheath distension are described. In chronic cases pathological exostoses were identified radiographically in the sustentaculum tali and were demonstrated at post mortem in 4 of the horses which were destroyed. The prognosis and the feasibility of treatment are discussed in the light of these changes and the associated damage found at post mortem in the deep flexor tendon and its sheath. Trauma to the hock was known to have occurred in half the cases and was suspected in the others.

Surgical arthrodesis for the treatment of bone spavin in 20 horses.

During a 3 year period 20 horses with bone spavin were treated by surgical arthrodesis of the affected joints. The horses chosen for surgery were those with osteoarthritis, but with little or no evidence of periostitis. Whenever possible they were examined periodically during the postoperative period to evaluate the lameness and to assess the progress of ankylosis by radiography. Three of the horses were still lame 12 months later. The remainder returned to normal work, although one subsequently developed spavin in the other hock and was destroyed. The earliest return to soundness was 3 1/2 months, the longest 10 months (average 5 1/2 months).

Surgical management of intussusception in the horse.

During a 14 year period, 27 of 310 horses undergoing laparotomy because of abdominal pain were found to have an intussusception involving the small intestine (16 cases) or caecum (11 cases). The clinical signs, operative findings and techniques adopted to overcome the obstruction are described. An evaluation of possible predisposing factors provided further evidence of the important role of the tapeworm Anoplocephala perfoliata in initiating intussusception involving the ileum and caecum.

Resection and anastomosis of small intestine: current methods applicable to the horse.

Intraoperative techniques for assessing the viability of ischaemic bowel are discussed. Intravenous administration of sodium fluorescein appears useful but further investigation of the method is required. Methods of resection and anastomosis of small intestine are described and illustrated, including the use of automatic stapling instruments.