Ultrasound-guided biopsy of the cricoarytenoideus lateralis muscle: technique and safety in horses.

REASONS FOR PERFORMING STUDY: Current diagnosis of recurrent laryngeal neuropathy (RLN) depends upon disease recognition in the clinically affected horse. Biopsy of the intrinsic laryngeal muscles may provide a method to identify the changes in fibre-type composition that occur in RLN before clinical signs become apparent. OBJECTIVE: To develop an ultrasound-guided biopsy technique of the left cricoarytenoideus lateralis muscle (CALM) and evaluate its efficacy and safety in vivo. STUDY DESIGN: A longitudinal descriptive study. METHODS: Six standing horses underwent ultrasound-guided biopsy of the left CALM. Frozen muscle cores were obtained with a breast biopsy tool. Serial endoscopic, ultrasonographic and physical examinations before and for 8 weeks after the biopsy were assessed for iatrogenic trauma. Histologies of representative muscle core cross-sections were analysed for the total number of muscle fibres obtained with each biopsy. RESULTS: There were no immediate complications of the procedure and the left CALM was harvested in all instances. Biopsy samples had an average weight of 0.043 g (range = 0.023-0.077 g) and contained 3418 fibres in cross-section (range = 711-7143). Laryngeal endoscopic grade did not change significantly between prebiopsy and the end of the 8 week follow-up. The left CALM had significantly greater echogenicity than the right throughout the study (P<0.001), but there was no difference between the prebiopsy CALM echogenicity and that at completion of the study. CONCLUSIONS: Ultrasound-guided biopsy of the left CALM is safe and well tolerated, providing a minimally invasive method to obtain muscle from healthy horses. This new technique may be applicable in research and clinical settings.

Owner assessment in judging the efficacy of airway disease treatment.

REASONS FOR PERFORMING STUDY: Efficacy of medications for recurrent airway obstruction is typically tested using clinical, cytological and lung function examinations of severely affected animals. These trials are technically challenging and may not adequately reflect the spectrum of disease and owner complaints encountered in clinical practice. OBJECTIVE: To determine if owners of horses with chronic airway disease are better able to detect drug efficacy than a veterinarian who clinically examines horses infrequently. METHOD: In a double-blinded randomised controlled trial, owners and a veterinarian compared the efficacy of dexamethasone (0.1 mg/kg bwt per os, q. 24 h, for 3 weeks; n = 9) to placebo (n = 8) in horses with chronic airway disease. Before and after treatment, owners scored performance, breathing effort, coughing and nasal discharge using a visual analogue scale (VAS). The clinician recorded vital parameters, respiratory distress, auscultation findings, cough and nasal discharge, airway mucus score, bronchoalveolar lavage fluid (BALF) cytology and arterial blood gases. RESULTS: The VAS score improved significantly in dexamethasone- but not placebo-treated horses. In contrast, the clinician failed to differentiate between dexamethasone- and placebo-treated animals based on clinical observations, BALF cytology or endoscopic mucus score. Respiratory rate (RR) and arterial oxygen pressure (PaO(2)) improved with dexamethasone but not placebo. CONCLUSIONS AND CLINICAL RELEVANCE: In the design of clinical trials of airway disease treatments, more emphasis should be placed on owner-assessed VAS than on clinical, cytological and endoscopic observations made during brief examinations by a veterinarian. Quantifiable indicators reflecting lung function such as RR and PaO(2) provide a good assessment of drug efficacy.

Effect of magnitude and direction of force on laryngeal abduction: implications for the nerve-muscle pedicle graft technique.

REASONS FOR PERFORMING STUDY: The nerve-muscle pedicle graft technique is a treatment for recurrent laryngeal neuropathy (RLN), but the optimal placement of the pedicles within the cricoarytenoideus dorsalis (CAD) muscle is unknown. HYPOTHESIS: The magnitude and direction of force placed on the muscular process of the left arytenoid cartilage affects the magnitude of laryngeal abduction. METHODS: Five larynges were harvested from cadavers. Using increments of 0.98 N, a dead-weight force generator applied a force of 0-14.7 N for 1 min each to the left muscular process at 0, 10, 20, 30, 40, 50, 60 and 70 degrees angles. The rima glottis was photographed digitally 1 min after each force had been applied. Distances between biomarkers (Lines 1-4) and right to left angle quotient (RLQ) were used to assess the degree of left arytenoid abduction. RESULTS: Increasing force from 0-14.7 N progressively and significantly increased the length of all lines and RLQ, indicating abduction. Furthermore, there was a significant interaction between force and angles. Applying forces of 7.84 N or greater (Lines 2-4 and RLQ) or 11.76 N or greater (Line 1) at angles 0, 10, 20 and 30 degrees resulted in significantly greater abduction than applying the same forces at 40, 50, 60 and 70 degrees. Angles of 0-30 degrees correspond with the direction of pull exerted by the lateral compartment of the CAD muscle. CONCLUSION: In RLN, nerve-muscle pedicle grafts should be placed preferentially in the lateral rather than in the medial compartment of the CAD muscle. POTENTIAL RELEVANCE: The information presented can be used to assist surgeons in the planning and application of the nerve-muscle pedicle graft procedure.

Effect of ventriculectomy versus ventriculocordectomy on upper airway noise in draught horses with recurrent laryngeal neuropathy.

REASONS FOR PERFORMING STUDY: Little is known about the efficacy of bilateral ventriculectomy (VE) or bilateral ventriculocordectomy (VCE) in draught horses. OBJECTIVES: To compare the effect of VE and VCE on upper airway noise in draught horses with recurrent laryngeal neuropathy (RLN) by use of quantitative sound analysis techniques. HYPOTHESIS: In competitive draught horses with grade 4 RLN, VE and VCE reduce upper airway noise during exercise, but VCE is more effective. METHODS: Thirty competitive hitch or pulling draught horses with grade 4 RLN were evaluated for upper airway sound during exercise. Respiratory rate (RR), inspiratory (Ti) and expiratory time (Te), the ratio between Ti and Te (Ti/Te), inspiratory (Sli) and expiratory sound levels (Sle), the ratio between Sli and Sle (Sli/Sle), and peak sound intensity of the second formant (F2) were calculated. Eleven horses were treated with VE and 19 with VCE. After 90 days of voice and physical rest and 30 days of work, the horses returned for post operative upper airway sound evaluation and resting videoendoscopy. RESULTS: VE significantly reduced Ti/Te, Sli, Sli/Sle and the sound intensity of F2. Respiratory rate, Ti, Te and Sle were unaffected by VE. VCE significantly reduced Ti/Te, Ti, Te, Sli, Sli/Sle and the sound intensity of F2, while RR and Sle were unaffected. The reduction in sound intensity of F2 following VCE was significantly greater than following VE. After VE and VCE, 7/11 (64%) and 15/18 (83%) owners, respectively, concluded that the surgery improved upper airway sound in their horses sufficiently for successful competition. CONCLUSIONS: VE and VCE significantly reduce upper airway noise and indices of airway obstruction in draught horses with RLN, but VCE is more effective than VE. The procedures have few post operative complications. POTENTIAL RELEVANCE: VCE is recommended as the preferred treatment for RLN in draught horses. Further studies are required to evaluate the longevity of the procedure's results.

Histological evaluation of the equine larynx after unilateral laser-assisted ventriculocordectomy.

REASONS FOR PERFORMING STUDY: Trans-endoscopic laser surgery, such as unilateral laser-assisted ventriculocordectomy (LVC), has gained popularity in the treatment of RLN because a laryngotomy incision or general anaesthesia are not required. However, removal of the vocal fold and ventricle takes considerable laser energy and could cause collateral tissue damage, including injury to the adjacent laryngeal cartilages. OBJECTIVES: To document the histological effects of laser surgery on laryngeal tissues in horses that have undergone LVC for the treatment of laryngeal hemiplegia (LH). METHODS: Six horses were used: 4 with experimentally induced LH that had subsequently undergone LVC 6 months prior to euthanasia; and, 2 horses were used as controls. One of the control horses with naturally occurring LH was used to study the effect of neuropathy alone, whereas the other was subjected to euthanasia immediately following LVC to evaluate the acute effect of laser surgery. Using a band saw, each larynx was sectioned transversely at 5 mm intervals and evaluated histologically. RESULTS: Acutely, LVC caused thermal damage to adjacent soft tissues but did not affect the histology of the laryngeal cartilages. Six months after LVC, laryngeal cartilages were histologically normal and there was squamous metaplasia of the repaired laryngeal mucosa, resulting in restitution of the mucosal integrity. CONCLUSIONS: Using a diode laser in contact fashion at 20 W, LVC can be used to remove the laryngeal vocal fold and ventricle without causing laryngeal cartilage damage. POTENTIAL RELEVANCE: Laryngeal chondritis is an unlikely consequence of LVC.

Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Recent studies have evaluated surgical techniques aimed at reducing noise and improving airway function in horses with recurrent laryngeal neuropathy (RLN). These techniques require general anaesthesia and are invasive. A minimally invasive transnasal surgical technique for treatment of RLN that may be employed in the standing, sedated horse would be advantageous. OBJECTIVE: To determine whether unilateral laser-assisted ventriculocordectomy (LVC) improves upper airway function and reduces noise during inhalation in exercising horses with laryngeal hemiplegia (LH). METHODS: Six Standardbred horses were used; respiratory sound and inspiratory transupper airway pressure (Pui) measured before and after induction of LH, and 60, 90 and 120 days after LVC. Inspiratory sound level (SL) and the sound intensities of formants 1, 2 and 3 (Fl, F2 and F3, respectively), were measured using computer-based sound analysis programmes. In addition, upper airway endoscopy was performed at each time interval, at rest and during treadmill exercise. RESULTS: In LH-affected horses, Pui, SL and the sound intensity of F2 and F3 were increased significantly from baseline values. At 60 days after LVC, Pui and SL had returned to baseline, and F2 and F3 values had improved partially compared to LH values. At 90 and 120 days, however, SL increased again to LH levels. CONCLUSIONS: LVC decreases LH-associated airway obstruction by 60 days after surgery, and reduces inspiratory noise but not as effectively as bilateral ventriculocordectomy. POTENTIAL RELEVANCE: LVC may be recommended as a treatment of LH, where reduction of upper airway obstruction and respiratory noise is desired and the owner wishes to avoid risks associated with a laryngotomy incision or general anaesthesia.

Effect of laryngoplasty on respiratory noise reduction in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Laryngoplasty is the technique of choice for treatment of laryngeal hemiplegia, with the aim of improving airway function and/or eliminating respiratory noise. However, there are no quantitative data in the literature describing the effect of laryngoplasty on upper airway noise or its relationship to upper airway mechanics in horses with laryngeal hemiplegia. OBJECTIVES: To determine whether laryngoplasty reduces respiratory noise in exercising horses with laryngeal hemiplegia; and to establish whether the degree of upper airway obstruction can be predicted by upper airway noise, or the degree of arytenoid abduction correlated with airway obstruction and noise production. METHODS: Six Standardbred horses with normal upper airways during maximal exercise were used. Respiratory sounds and inspiratory transupper airway pressure (Pui) were measured in all horses before and after induction of laryngeal hemiplegia and 30, 60 and 90 days after laryngoplasty. Inspiratory sound level (SL) and the sound intensity of the 3 inspiratory formants (F1, F2 and F3, respectively) were measured using a computer-based sound analysis programme. The degree of abduction was graded by endoscopic visualisation 1, 30, 60 and 90 days post operatively. Linear regression analysis was used to determine correlations between Pui, sound indices and grades of arytenoid abduction. RESULTS: In laryngeal hemiplegia-affected horses, Pui, inspiratory SL and the sound intensity of F1, F2 and F3 were significantly increased. At 30 days following laryngoplasty, the sound intensity of F1 and Pui returned to baseline values. The sound intensities of F2, F3 and SL were significantly improved from laryngeal hemiplegia values at 30 days post operatively, but did not return to baseline at any measurement period. Sound level, F2 and F3 were significantly correlated with Pui (P<0.05), but the correlations were weak (r2 = 0.26, 035 and 0.40, respectively). Grade of abduction and F2 were positively and significantly correlated (P<0.006, r2 = 0.76). Grade of arytenoid abduction and Pui were not correlated (P = 0.12). CONCLUSIONS: Laryngoplasty reduced inspiratory noise in laryngeal hemiplegia-affected horses by 30 days following surgery, but did not return it to baseline values. While upper airway noise and Pui were correlated, this relationship was insufficiently strong to predict Pui from noise in individual animals. The degree of arytenoid abduction was not correlated with Pui, but was positively correlated with noise production. POTENTIAL RELEVANCE: Laryngoplasty reduces upper airway noise in horses with laryngeal hemiplegia, but is not as effective as bilateral ventriculocordectomy in this regard, although respiratory noise reduction occurs more rapidly than with bilateral ventriculocordectomy. Residual noise during exercise cannot be used as a predictor of improvement in upper airway function in individual horses following laryngoplasty. The degree of arytenoid abduction obtained following surgery does not affect upper airway flow mechanics. Interestingly, we found that the greater the arytenoid abduction, the louder the respiratory noise.

Airway mucus in recurrent airway obstruction--short-term response to environmental challenge.

Mucus accumulation and neutrophilic inflammation in the airways are hallmarks of heaves. Endoscopically visible mucus accumulations, however, have not been studied during exposure to dusty hay and allergens (ie, environmental challenge). We hypothesized that (1) heaves-affected horses have increased mucus accumulation compared with controls, (2) mucus accumulations increase in heaves-affected horses during environmental challenge, and (3) environmental challenge also induces neutrophilic inflammation and mucus accumulation in control horses. Mucus accumulation was graded endoscopically (mucus grades [MGs] 1-5), and airway inflammation was evaluated by bronchoalveolar lavage fluid (BALF) cytology before (0 hours) and during (6, 24, 48 hours) environmental challenge. Large amounts of mucus (MG 4-5) were specific for heaves-affected horses in this study. Variation among controls was considerable, however, and intermediate grades (MG 2-3) were nonspecific, showing complete overlap between the 2 groups. Median mucus accumulations (25th, 75th percentiles) increased in heaves-affected horses from MG 2.5 (1.5, 3.5) at baseline to MG 3.5 (2.0, 4.0), 4.0 (3.0, 4.0), and 4.0 (4.0, 4.0) at 6, 24, and 48 hours, respectively. MG values did not increase in controls--overall MG 1.0 (1.0, 2.0)--even though controls also showed a moderate increase of BALF neutrophils. Mucus accumulations before and especially after exposure to dust and allergens are increased in heaves-affected horses compared with controls. Healthy controls show considerable variability in mucus accumulation but, despite an influx of neutrophils into the airways, no increase of mucus accumulation after exposure to hay dust.

Ventriculocordectomy reduces respiratory noise in horses with laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: Show and performance horse with laryngeal hemiplegia (LH) often present for excessive respiratory noise rather than significant exercise intolerance. Therefore, the goal of surgery in these horses is to reduce respiratory noise but there are no quantitative studies evaluating the effect of any upper-airway surgery in LH-affected horses. OBJECTIVE: To determine whether bilateral ventriculocordectomy (VC) reduces respiratory noise in exercising horses with laryngeal hemiplegia. METHODS: Six Standardbred horses with normal upper airways were used in this study. Respiratory sounds and inspiratory trans-upper airway pressure (Pui) were measured in all horses before and after induction of LH, and 30, 90 and 120 days after VC. In horses with LH, spectrogram analysis revealed 3 inspiratory sound formants centred at approximately 400, 1700 and 3700 Hz. Inspiratory sound levels (SL) and the sound intensity of the 3 inspiratory formants (F1, F2, F3 respectively) were measured using a computer-based sound analysis programme. RESULTS: In LH-affected horses, Pui, inspiratory SL and the sound intensity of F2 and F3 were significantly increased compared to baseline values. At 90 and 120 days after VC the sound intensities of F2 and F3 returned to baseline values. The Pui and SL, were significantly decreased compared to LH values, but remained different from baseline. CONCLUSIONS: VC effectively reduces inspiratory noise in LH-affected horses by 90 days following surgery. Inspiratory trans-upper airway pressures are improved 30 days following VC, but do not return to baseline values. POTENTIAL RELEVANCE: VC can be recommended as a surgical treatment of LH-affected horses if reduction of respiratory noise is the primary objective of surgery. Further studies are required to determine if variations of the surgical technique used in this study will have similar results.

Equine thoracoscopy: normal anatomy and surgical technique.

Six normal, healthy horses age 3-10 years underwent left and right thoracoscopic examination using a rigid telescope. A minimum of 30 days was allowed between procedures. Horses were restrained in stocks and sedated with a continuous detomidine infusion. After surgical preparation of the hemithorax elected for surgery, and administration of local or regional anaesthesia of the surgery sites, thoracoscopy was completed during two 15 min pneumothorax periods. During the procedures, the thoracic structures were viewed using a 57 cm, 10 mm diameter, 30 degrees rigid telescope connected to a digital camcorder to allow computer capture of digital images. The telescope was inserted into the thoracic cavity via 3 different intercostal spaces. The 8th, 10th and 12th intercostal spaces were randomly selected and used among horses. The exploration of each hemithorax started from the dorsal-caudal quadrant continued toward the cranial thorax and was completed by observing the diaphragmatic and caudal pulmonary region. Collapsed lung, aorta, oesophagus and diaphragm were viewed readily in either hemithorax. On exploration of the right hemithorax, the azygos vein, thoracic duct and pulmonary veins were also identified. Horses tolerated thoracoscopy well. Signs of discomfort, such as increased respiratory rate, coughing and decreased level of sedation, were associated with lung collapse in one horse, with pneumothorax on 2 occasions, and when the thorax was approached through the 8th intercostal space. Surgery performed via the 8th intercostal space was hindered by the rigidity of the 8th and 9th ribs, and by the presence of a greater musculature, which did not allow easy cranial and caudal movements of the telescope.

Stabling is associated with airway inflammation in young Arabian horses.

We examined the effect of stabling on upper and lower airway inflammation in 14 yearling Arabian horses that had been at pasture since birth. Horses were divided into 2 groups of 7. One group was stabled for 3 months and the other remained at pasture. The groups were then switched over for another 3 months. The nasopharynx, guttural pouches and trachea were examined endoscopically and bronchoalveolar lavage performed every month. An upper airway inflammation score was devised based on the magnitude of pharyngeal lymphoid hyperplasia and guttural pouch inflammation. During stabling this score remained constant, whereas it decreased during the 3 months at pasture. Stabling was also associated with a higher number and percentage of neutrophils in bronchoalveolar lavage fluid and with a smaller percentage of lymphocytes. There was no correlation between upper airway inflammation score and bronchoalveolar lavage cytology. During a nasal occlusion test, dorsal displacement of the soft palate occurred more times in stabled than in pastured horses, but this was heavily biased by the results from one animal. We conclude that stabling is associated with inflammation of both the upper and lower airway of young horses.

Pleuropulmonary and cardiovascular consequences of thoracoscopy performed in healthy standing horses.

Six healthy, awake, and pharmacologically restrained mature horses were studied in order to define the changes in cardiopulmonary function during and after exploratory thoracoscopy and to determine the presence of postoperative complications occurring 48 hours after thoracoscopy. In a randomised 3 x 3 latin square design with 2 replications, 18 procedures were performed: 6 right (RTH) and 6 left thoracoscopies (LTH) and 6 sham procedures (STH). Prior to each procedure a physical examination and a bronchoalveolar lavage fluid analysis were performed. During thoracoscopy and sham protocols, horses were sedated with a continual drip of detomidine HCl and data were collected at 6 time intervals: T1 (baseline), T2 (10 min detomidine administration), T3 (first 15 min pneumothorax), T4 (5 min recovery from pneumothorax), T5 (second 15 min pneumothorax), and T6 (10 min recovery from the second pneumothorax and detomidine). An endoscopic thoracic examination was conducted during the 2 pneumothorax periods. An identical protocol was followed for sham procedures without surgery or pneumothorax. Data were analysed by ANOVA with time and surgical procedure as main factors. Physical examinations, thoracic radiography and ultrasound, CBC and bronchoalveolar lavage fluid analysis were performed 48 h after thoracoscopy. Heart rate, respiratory rate, and cardiac output decreased following detomidine administration. There was a trend for cardiac output to be lower during thoracoscopy. Mild systemic hypertension was associated with thoracoscopy although there was no effect on pulmonary arterial pressure. Total and pulmonary vascular resistances were increased following detomidine administration. Thoracoscopy caused a further increase in systemic and pulmonary vascular resistances especially during the second pneumothorax. Arterial O2 tension decreased following detomidine administration and was further decreased during the second pneumothorax period. PaO2 values were lower when thoracoscopy was performed on the left rather than the right hemithorax. No significant complications were found during the 48 h follow-up evaluation. A subclinical postoperative pneumothorax occurred in 2 horses, one of which had sustained a lung laceration by the trocar. Thoracoscopy performed in healthy, awake, and pharmacologically restrained horses did not have detrimental cardiopulmonary effects and did not cause postoperative complications within the first 48 h period.

Role of cAMP and neuronal K+ channels on alpha 2-AR-induced inhibition of ACh release in equine trachea.

To investigate the effects of changes in intracellular cAMP on alpha 2-adrenoceptor (AR)-induced inhibition of airway acetylcholine (ACh) release, we examined the effects of the alpha 2-AR agonist clonidine on electrical field stimulation-evoked ACh release from equine tracheal parasympathetic nerves before and after treatment with 8-bromo-cAMP or forskolin. We also tested whether charybdotoxin (ChTX)- or iberiotoxin (IBTX)-sensitive Ca(2+)-activated K+ channels mediate alpha 2-AR-induced inhibition by examining the effect of clonidine in the absence and presence of ChTX or IBTX on ACh release. The amount of released ACh was measured by HPLC coupled with electrochemical detection. Clonidine (10(-7) to 10(-5) M) dose dependently inhibited ACh release before and after treatment with 8-bromo-cAMP (10(-3) M) or forskolin (3 x 10(-5) M). ChTX and IBTX, both at the concentration of 5 x 10(-7) M, significantly increased ACh release; however, they did not alter the magnitude of clonidine-induced inhibition. These results indicated that in equine tracheal parasympathetic nerves, alpha 2-AR-induced inhibition of ACh release is via an intracellular cAMP-independent pathway. Activation of both ChTX- and IBTX-sensitive Ca(2+)-activated K+ channels inhibits the electrical field stimulation-evoked ACh release, but these channels are not involved in the alpha 2-AR-induced inhibition of ACh release.

Mechanism of capsaicin-induced relaxation in equine tracheal smooth muscle.

The effects of capsaicin and neuropeptides were examined in equine tracheal smooth muscle (TSM). Neither capsaicin nor substance P (SP) contracted TSM. Capsaicin (100 microM) elicited relaxation in TSM contracted with methacholine. This relaxation was not mimicked by SP or calcitonin gene-related peptide (CGRP). Relaxation was not attenuated by removal of the epithelium or by pretreatment of tissue with meclofenamate or the nitric oxide (NO) synthase inhibitor NG-nitro-L-arginine. Previous exposure of TSM to capsaicin did not eliminate the relaxation responses to subsequent capsaicin. Although vasoactive intestinal peptide (VIP) elicited marked relaxation that was attenuated by alpha-chymotrypsin, alpha-chymotrypsin did not affect the capsaicin-induced relaxation. Capsaicin-induced relaxation was abolished by charybdotoxin, a blocker of large-conductance Ca(2+)-activated K+ channels. These results indicate that capsaicin-induced equine TSM relaxation is not mediated either by neuropeptides such as SP or CGRP released from capsaicin-sensitive sensory nerves or by prostanoids, NO, or VIP. Relaxation is due to the effect of capsaicin on large-conductance Ca(2+)-activated K+ channels. The peptidergic nerves play no important role in the regulation of TSM tone in horse airways.

Effect of bilateral tenectomy of the tensor veli palatini muscle on soft palate function in horses.

OBJECTIVE: To determine the effect of bilateral tenectomy of the tensor veli palatini muscle on soft palate and nasopharyngeal function in exercising horses. ANIMALS: 5 Standardbreds. PROCEDURE: Treadmill videoendoscopy was performed on 5 Standardbreds exercising at 50, 75, and 100% of the speed that produced maximum heart rate; tracheal and pharyngeal pressures were measured before and after surgery. Tenectomy of the tensor veli palatini muscle was performed bilaterally on each horse while under general anesthesia, using a transoral approach. RESULTS: Peak inspiratory tracheal pressures were significantly (P = 0.016) more negative and there was a trend (P = 0.06) for peak pharyngeal inspiratory pressure to be less negative following bilateral tenectomy of the tensor veli palatini muscle, compared with preoperative values. The rostral half of the soft palate was unstable and collapsed dorsally into the nasopharynx during inspiration, causing partial obstruction of the nasopharynx. The caudal free margin of the soft palate remained ventral to the epiglottis, and dorsal displacement of the soft palate did not occur in any horse. CONCLUSIONS: Bilateral tenectomy of the tensor veli palatini muscle did not cause dorsal displacement of the soft palate in horses while exercising at maximum heart rate, but resulted in collapse of the nasopharynx during inspiration. CLINICAL RELEVANCE: Results of our study indicate that the tensor veli palatini muscle functions to support and dilate the nasopharynx during intense inspiratory efforts in horses by tensing the palatine aponeurosis.

Efficacy of prosthetic laryngoplasty with and without bilateral ventriculocordectomy as treatments for laryngeal hemiplegia in horses.

OBJECTIVE: To evaluate the efficacy of prosthetic laryngoplasty with and without bilateral ventriculocordectomy for treatment of experimentally induced left laryngeal hemiplegia (LLH). ANIMALS: 15 adult Standardbreds. PROCEDURE: Horses were allotted to 3 equal groups. Sham operation (group 1), prosthetic laryngoplasty (group 2), or prosthetic laryngoplasty with bilateral ventriculocordectomy (group 3) was performed after induction of LLH. Upper airway function testing was performed prior to left recurrent laryngeal neurectomy (LRLN), 14 days after LRLN, and 60 and 180 days after surgical treatment. Measurements were obtained at rest and at treadmill speeds corresponding to 75 and 100% of maximal heart rate. Videoendoscopy was performed at rest and during exercise in all horses prior to LRLN and 60 and 180 days after surgical treatment. Upper airway endoscopy was performed immediately after LRLN to document induction of grade-IV LLH. Also, horses in group 3 were endoscopically examined at 7, 14, 21, 28, and 120 days after surgical treatment to evaluate healing of the ventriculocordectomy sites. RESULTS: When horses were at rest, significant differences were not apparent between groups at any period or between periods for any measured variable. LRLN induced airway obstruction in all horses during exercise. In sham-operated horses, this obstruction was unaffected by time. In contrast, 60 and 180 days after surgical treatment, inspiratory flow limitations induced by LRLN were reversed in horses of groups 2 and 3. There were no significant differences between the 2 treatment groups. Endoscopy revealed the left arytenoid cartilage abducted beyond the intermediate position, but not touching the pharyngeal wall in all horses with a laryngeal prosthesis. After surgical treatment, 4 group-2 horses had filling of both ventricles with air during exercise. There was moderate to marked swelling of the ventriculocordectomy sites immediately after surgery, and this swelling resolved by 7 days after surgery. The ventriculocordectomy sites looked best at 14 and 180 days. CONCLUSIONS: 60 and 180 days after prosthetic laryngoplasty, upper airway function returned to pre-LRLN values in horses with experimentally induced LLH exercising at 100% of maximal heart rate. Combining ventriculocordectomy with prosthetic laryngoplasty does not further improve upper airway function in these horses.

Potentiation of acetylcholine release from tracheal parasympathetic nerves by cAMP.

We tested the hypothesis that increasing intracellular levels of adenosine 3', 5'-cyclic monophosphate (cAMP) increases acetylcholine (ACh) release from airway parasympathetic nerves. Muscle strips from equine trachea were preincubated for 60 min with 10(-7)M atropine, 10(-6)M neostigmine, and 10(-5) M guanethidine. The ACh release was evoked by electrical field stimulation (EFS, 20 V, 0.5 ms, 0.5 Hz) and measured by high-performance liquid chromatography with electrochemical detection. Agents known to increase cAMP, i.e., forskolin (10(-6) - 10(-4) M), 8-bromoadenosine 3', 5'-cyclic monophosphate (8-BrcAMP; 10(-5)-10(-3) M), and 3-isobutyl-1-methylxanthine (IBMX ; 10(-5)-10(-3)M) was potentiated by IBMX but not mimicked by 1,9 dideoxyforskolin. To determine if the augmentation of Ach release facilitated EFS-induced ACh release in a concentration-dependent manner. Forskolin-induced augmentation of ACh release induced by activation of beta 2-adrenoceptors is mediated via cAMP-dependent pathways, we also examined the additive effects of 8-BrcAMP, forskolin, and IBMX with 10(-6)M isoproterenol (ISO), the concentration that maximally augments ACh release. Neither forskolin nor 8-BrcAMP potentiated the maximal augmentation produced by ISO, but inhibition of phosphodiesterase with IBMX (10(-4) and 10(-3)M) augmented the maximal effect of ISO. These observations indicate that neuronal cAMP is a physiological modulator of ACh release from airway parasympathetic nerves and mediates ISO-induced augmentation of ACh release. Bronchodilators that increase cAMP may therefore paradoxically augment ACh release while relaxing smooth muscle.

The role of emergency surgery in malignant spinal extradural compression: assessment of functional outcome.

The role of emergency surgery for spinal cord or cauda equina compression secondary to extradural metastases is assessed in terms of functional outcome in 84 cases. The records of patients with proven malignant extradural spinal compression were reviewed retrospectively to determine the influence of emergency versus elective decompressive surgery on functional outcome. A greater proportion undergoing emergency surgery, rather than electively (within 24 h) on the next list showed functional improvement, with recovered mobility (61.5% vs 25%). Overall, 70% of patients were mobile postoperatively. The findings suggest that despite initial delays in referral, and even if the patient is incontinent and immobile, emergency spinal decompression is justified.