Long-Term Survival in 241 Cases of Intussusception in Cattle and Factors Associated with Mortality.

Intussusception is a frequent cause of mechanical ileus in cattle. Long-term survival has never been described and risk factors for mortality are scarcely documented. A retrospective cohort study on 241 cattle was conducted to determine survival of intussusception and identify risk factors for mortality. Clinical records were matched with the national cattle identification database. Information on possible predictors including clinical examination, ultrasonography, blood-gas analysis and surgery were collected. Survival analysis and decision tree analysis were used. Overall survival was 44.8% until discharge. Of all animals, 39.0% could complete their life cycle and were eligible for slaughter. Male animals and cattle < 226 days old experienced a significantly higher mortality risk (hazard ratio [HR] = 2.1; 95% confidence interval [CI] = 1.4-3.0 and HR = 2.4; 95% CI = 1.7-3.4, respectively). The final model consisted of heart rate (>95 beats per minute) and packed cell volume (<36.5%) with sensitivity and specificity of 60.4% and 49.4%, respectively. A second model consisted of sex (male) and time to referral (>4.5 days) with sensitivity and specificity of 88.0% and 65.6%, respectively. The long-term prognosis for intussusception in cattle appears to be fair. Factors identified in this study may aid in the decision-making process in cases with presumed intussusception to perform the surgery or opt for euthanasia.

Equine Suture Exostosis: A Review of Cases from a Multicenter Retrospective Study.

Suture exostosis is an intriguing and not uncommon pathology that has to be included in the differential diagnosis for horses with swelling of the head. Although several singular case reports have been published, no large case series is available. The aim of this study is to report a multicentric retrospective collection of suture exostosis cases. Data concerning horses with suture exostosis in the facial region were collected retrospectively. Information regarding breed, age, gender, history, imaging findings, initiated treatment, response to treatment and follow up was recorded. One hundred and five cases of various breeds were reported. Analysis revealed the cases could be grouped into four entities: 45 developed following sino-nasal surgery, 23 following trauma, seven with underlying sinus pathology and 25 idiopathic. Treatment consisted of sequestra removal, plate fixation, antimicrobial and anti-inflammatory drugs or no treatment. Whereas initial localized pain fades within few days or weeks, resolution or reduction of the swelling was obtained in most cases after 3 months to 1.5 years. The etiopathogenesis of suture exostosis seems to consist of different entities. Identification of an underlying cause, particularly the presence of a bone sequester and infection is important to speed up resolution and before concluding an idiopathic case. When performing sinusotomies, it is important to provide as little trauma as possible to the surgical site in order to prevent suture exostosis as a complication.

Diagnosis and Surgical Treatment of Idiopathic Primary Sino-Nasal Obstruction in Miniature Horse Breeds: Long-Term Follow-Up of Seven Cases.

Idiopathic sino-nasal obstruction resulting in retention of large amounts of liquid in the paranasal sinus compartments was diagnosed in seven young (2. 2 ± 0.7 years) miniature-breed horses based on clinical, endoscopic, radiographic, and CT scan examinations. The most prevalent clinical signs included decreased or no airflow from the nostril(s) (7/7) and nasal discharge (6/7). The problem presented bilaterally in six of seven cases. An alternative sino-nasal communication was created through bone flap osteotomy surgery and perforation of the ventromedial floor of the dorsal conchae in all cases, followed by fixation of silicone irrigation tubes/Foley catheters in six of seven cases to keep the newly created ostium patent. This resulted in long-term resolution of the problem with good cosmetic appearance in all animals following a median period of 19 months. Premature loss of fixed tubes was reported in three cases.

Clinical applicability of detomidine and methadone constant rate infusions for surgery in standing horses.

OBJECTIVE: To determine the required rate of a detomidine infusion (loading dose 5 µg kg-1; initial rate 12.5 µg kg-1 hour-1) added to a constant infusion of methadone (0.2 mg kg-1; 0.05 mg kg-1 hour-1) for sedation in standing horses and ponies undergoing elective surgeries with appropriate local anaesthetic techniques. STUDY DESIGN: Prospective, clinical study. ANIMALS: Adult, healthy, client-owned, non-food-producing horses or ponies sedated for elective standing surgeries longer than 45 minutes. METHODS: At baseline (in the stables before administration of sedative agents), at 10 minutes after sedation and every 5 minutes thereafter, ataxia, sedation and surgical condition were evaluated; each scored 0-3. These scores were used to adjust the detomidine administration rate using the Ghent Sedation Algorithm. A 10 cm visual analogue scale (VAS) was used by the main surgeon at the end of the procedure to evaluate the surgical conditions. Heart rate, systolic arterial pressure and respiratory frequency were also recorded at each time point. For statistical analysis, anova for normal, Kruskal-Wallis H-test for non-normal variables, and Mann-Whitney U test for VAS were used. RESULTS: From the 42 horses/ponies included in this study, 28 underwent dental procedures and 14 other types of procedures. Overall, dental procedures required higher mean detomidine rates compared with other types of surgeries (16.9 ± 4.5 versus 9.0 ± 1.9 µg kg-1 hour-1) (p < 0.001). Dental procedures were assigned similar VAS scores, median (range), of 7.8 (5.8-10) with other procedures, 8.7 (2.8-10). Cardiovascular changes were not clinically significant. No signs or behavioural changes of abdominal pain were observed postoperatively. CONCLUSIONS AND CLINICAL RELEVANCE: Satisfactory surgical conditions were achieved using a combination of detomidine and methadone infusions with locoregional anaesthesia, with no adverse effects. Dental procedures required higher detomidine dose rates compared with other surgeries.

Anatomy of the vestibulum esophagi and surgical implications during prosthetic laryngoplasty in horses.

OBJECTIVE: To describe the anatomy of the entry to the equine esophagus (vestibulum esophagi) and to assess the risk of penetrating its adventitia and/or lumen during laryngoplasty. STUDY DESIGN: Ex vivo cadaveric study. SAMPLE POPULATION: Five isolated equine larynges and 39 equine head and neck specimens. METHODS: The anatomy of the vestibulum esophagi was studied by dissection of 5 cadaver specimens. Then, a bilateral laryngoplasty was performed, including 5 suture placements through the muscular processes, caudal, rostral, and sagittal, with straight and curved needles. Two of the 3 surgeons performing the implantations were unaware of the goals of the study. Suture positions and iatrogenic trauma to the lumen and/or adventitia of the vestibulum esophagi were identified during dissection of the specimens. Risk factors for penetrating the adventitia were evaluated with a multivariate regression model. RESULTS: The vestibulum esophagi spans between both wings of the thyroid cartilage over the entire width of the larynx, covering the rostral spine (arcuate crest) of the arytenoid cartilages. It is covered by the thyropharyngeus and cricopharyngeus muscles. Masked surgeons were associated with a significantly higher number of adventitia penetrations (72%) compared to the nonmasked surgeon (9%). The lumen of the vestibulum esophagi was penetrated in 4.6% of suture placements and only by the 2 masked surgeons. CONCLUSION: Penetration of the adventitia was more common when surgeons were unaware of the anatomical extent of the vestibulum esophagi. CLINICAL SIGNIFICANCE: Anatomical knowledge of the extent of the vestibulum esophagi reduces the risk of penetrating its lumen or adventitia during suture placement on the muscular process of the arytenoid cartilage.

Use of a national identification database to determine the lifetime prognosis in cattle with necrotic laryngitis and the predictive value of venous pCO2.

BACKGROUND: Necrotic laryngitis, caused by Fusobacterium necrophorum, frequently requires surgical intervention (laryngostomy) in the chronic stage. HYPOTHESIS/OBJECTIVES: To determine survival until slaughter of cattle surgically treated for necrotic laryngitis and to identify predictors of mortality. ANIMALS: A total of 221 cattle diagnosed with necrotic laryngitis by laryngoscopy and surgically treated METHODS: Retrospective cohort study. Clinical records were matched with the national cattle identification, registration, and movement database. Information on possible predictors including clinical examination, biochemistry, and surgery was collected. A multivariable Cox proportional hazard model was used to identify predictors of mortality. RESULTS: The overall survival rate was 65.2% and 58.6% of the animals with a completed life cycle could be slaughtered. Animals <6 months old experienced significantly higher mortality risk (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.5). The venous partial pressure of carbon dioxide (pCO2 ; HR, 2.4; 95% CI, 1.4-4.2) at a 64.5 mm Hg cut-off was most significantly associated with mortality. Sensitivity and specificity of the final model consisting of age and pCO2 were 49.1 and 86.4%, respectively. Instead of pCO2 , total carbon dioxide (TCO2 ) could also be used, with similar diagnostic accuracy. CONCLUSIONS AND CLINICAL RELEVANCE: The lifetime prognosis for chronic necrotic laryngitis in cattle with surgical intervention appears fair. Age, venous pCO2 and TCO2 are easily accessible predictors of survival to support owners and veterinarians in their decision process of whether or not to operate and to identify high risk animals that require more intensive follow-up.

Topical use of 5% acyclovir cream for the treatment of occult and verrucous equine sarcoids: a double-blinded placebo-controlled study.

BACKGROUND: Previous studies mention the use of topical acyclovir for the treatment of equine sarcoids. Success rates vary and since the bovine papillomavirus (BPV) lacks the presence of a kinase necessary to activate acyclovir, there is no proof of its activity against equine sarcoids. RESULTS: Twenty-four equine sarcoids were topically treated with acyclovir cream and 25 with a placebo. Both creams were applied twice daily during 6 months. Before the start of the treatment and further on a monthly basis, photographs and swabs were obtained. On the photographs, sarcoid diameter and surface area were measured and verrucosity of the tumours was quantified using a visual analog scale (VAS). The swabs were analysed by PCR for the presence of BPV DNA and positivity rates were calculated as the number of positive swabs divided by the total number of swabs for each treatment group at each time point. Success rates were not significantly different between both treatment groups. There was also no significant effect of treatment on sarcoid diameter, surface area or VAS score. For the swabs, a significantly higher BPV positivity rate was found for acyclovir treated tumours compared to placebo treated sarcoids only after 1 month of treatment and not at other time points. CONCLUSIONS: None of the results indicate that treatment with acyclovir yields any better results compared to placebo treatment.

Treatment of sarcoids in equids: 230 cases (2008-2013).

OBJECTIVE To evaluate outcomes following treatment of sarcoids in equids and to identify risk factors for treatment failure in these patients. DESIGN Retrospective case series. ANIMALS 230 equids with 614 sarcoids. PROCEDURES Records were searched to identify equids treated for ≥ 1 sarcoid between 2008 and 2013. A standardized protocol was used to determine treatment choice (electrosurgery, electrosurgery with intralesional placement of cisplatin-containing beads, topical administration of imiquimod or acyclovir, cryosurgery, bacillus Calmette-Guerin vaccine injection, or intralesional injection of platinum-containing drugs). Data regarding animal, tumor, treatment, and outcome variables were collected. Complete tumor regression without recurrence for ≥ 6 months was considered a successful outcome. Success rates were calculated; binary logistic regression analysis was used to identify risk factors for treatment failure and to compare effects of the 2 topical treatments. A χ(2) test was used to compare effects of the number of Bacillus Calmette-Guerin vaccine or cisplatin-containing drug injections on outcome. RESULTS The overall success rate was 460 of 614 (74.9%). Electrosurgical excision resulted in the highest treatment success rate (277/319 [86.8%]); odds of treatment failure were significantly greater for intralesional injection of platinum-containing drugs, cryosurgery, and topical acyclovir treatment. Odds of treatment failure were also significantly greater for sarcoids on equids with multiple tumors than for solitary lesions, and significantly lower for sarcoids on equids that received concurrent immunostimulating treatment for another sarcoid than for those on patients that did not receive such treatment. CONCLUSIONS AND CLINICAL RELEVANCE Selection bias for treatments was inherent to the study design; however, results may assist clinicians in selecting treatments and in determining prognosis for equids with sarcoids treated according to the described methods.

Long Term Outcome of Conservative Management or Surgical Treatment of Bovine Spastic Paresis: 79 Cases.

OBJECTIVE: To report the long term clinical outcome of calves treated surgically or managed conservatively for bovine spastic paresis of the gastrocnemius (BSP-G), quadriceps femoris muscle (BSP-Q), or mixed muscle involvement (BSP-M). STUDY DESIGN: Retrospective case study. ANIMALS: Calves (n = 79) with bovine spastic paresis. METHODS: Medical records of calves treated by partial tibial neurectomy or managed conservatively for bovine spastic paresis were analyzed for sex, breed, lineage history, and the onset, duration, and severity of clinical signs. Cases were classified as unilateral or bilateral BSP-G, BSP-Q, or BSP-M. Long term follow-up information was obtained by telephone questionnaire. RESULTS: The study group included 26 BSP-G (33%), 16 BSP-Q (20%), and 37 BSP-M (47%) calves. BSP-M and BSP-Q calves were significantly more bilaterally affected compared to BSP-G calves. Twenty-five of 26 BSP-G calves were treated surgically; 86% had complete resolution of clinical signs. Twenty-nine of 37 BSP-M calves were treated surgically; 81.5% improved, but none completely recovered. In all of the conservatively managed BSP-M calves, clinical signs gradually worsened. None of the BSP-Q calves were treated surgically; in 66.7%, clinical signs gradually worsened and 33.3% of calves spontaneously improved. CONCLUSION: Partial tibial neurectomy is advocated for the treatment of BSP-G and in selected cases of BSP-M. However, only partial resolution of clinical signs should be expected for BSP-M. No surgical treatment exists for BSP-Q calves, although spontaneous improvement is possible.

Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?

OBJECTIVE: To assess risk factors for celiotomy incisional infection in horses, especially the use of staples for skin closure. STUDY DESIGN: Case series. ANIMALS: Horses (n=356) that had 1 exploratory celiotomy for colic and survived >2 weeks after surgery between March 1, 2004 and December 31, 2007. METHODS: Incisions were classified as "normal" (no complication, only edema, serous drainage lasting <24 hours) or as "surgical site infection (SSI)" (persistent serosanguinous drainage or purulent drainage with or without positive bacterial culture). All possible risk factors, including method of skin closure (monofilament sutures or staples), were statistically analyzed using univariate and multivariate logistic regression. RESULTS: Of 356 horses, 303 (85%) had normal wound healing and 53 (15%) developed a SSI (purulent: 48 [14%]; persistent serosanguinous: 5 [1%]). Bacterial cultures were positive in 33 of 40 cases. Factors significantly associated with SSI in the multivariate analysis were: use of staples for skin closure (odds ratio [OR] 3.85, P<.001) and surgical site closure by a 1st or 2nd year resident (OR 2.20, P=.016). Lavage of the linea alba with sterile saline solution after closure was a protective factor (OR 0.38, P=.004). CONCLUSION: Use of staples for skin closure and less experienced surgeons closing the abdomen are risk factors for incisional infection. Incisional lavage after linea alba closure was a protective factor. CLINICAL RELEVANCE: Despite their ease and speed of application, skin staples can lead to an increase in celiotomy wound complications in horses.

Evaluation of bone regeneration with an injectable, in situ polymerizable Pluronic F127 hydrogel derivative combined with autologous mesenchymal stem cells in a goat tibia defect model.

In situ forming bone substitute materials are attractive candidates for filling irregularly shaped defects. In this study, a chemically modified form of the Pluronic F127 hydrogel was used. Similar to the parent form, this derivative underwent a sol-gel transition in the body and additional radical curing resulted in a stable three-dimensional network gel with a controllable degradation rate. An extra cell source of autologous bone marrow-derived mesenchymal stem cells was mixed with the hydrogel to increase the ossification process, when implanted in noncritical size unicortical tibia defects. These cells were cultured and predifferentiated on two types of cell carrier systems, that is, gelatin CultiSpher-S microcarriers and hydroxyapatite tubular carriers. Radiographic and histological evaluation revealed that bone regeneration was comparable in the defects with the bone substitute compositions and the untreated control defects at 2 and 4 weeks postimplantation and that newly formed bone originated from the cells on the CultiSpher-S carriers. This resulted, 6 and 8 weeks postimplantation, in faster bone repair in the defects filled with the hydrogel plus CultiSpher-S carriers in comparison to the control defects. Surprisingly, there was no formation of new bone originating from the hydroxyapatite carriers. The hydrogel by itself seemed to stimulate the natural repair process.

Evaluation of an injectable, photopolymerizable, and three-dimensional scaffold based on methacrylate-endcapped poly(D,L-lactide-co-epsilon-caprolactone) combined with autologous mesenchymal stem cells in a goat tibial unicortical defect model.

An in situ crosslinkable, biodegradable, methacrylate-endcapped poly(D,L-lactide-co-epsilon-caprolactone) in which crosslinkage is achieved by photoinitiators was developed for bone tissue regeneration. Different combinations of the polymer with bone marrow-derived mesenchymal stem cells (BMSCs) and alpha-tricalcium phosphate (alpha-TCP) were tested in a unicortical tibial defect model in eight goats. The polymers were randomly applied in one of three defects (6.0 mm diameter) using a fourth unfilled defect as control. Biocompatibility and bone-healing characteristics were evaluated by serial radiographies, histology, histomorphometry, and immunohistochemistry. The results demonstrated cell survival and proliferation in the polymer-substituted bone defects. The addition of alpha-TCP was associated with less expansion and growth of the BMSCs than other polymer composites.

Immediate postextraction implant placement in sheep's mandibles: a pilot study.

PURPOSE: In this study, sheep were examined as a potential animal model for immediate implant placement in fresh extraction sockets using experimental photopolymerisable bioabsorbable polymers. MATERIALS: A total of 22 cylindrical implants were placed in fresh mandibular premolar extraction sockets of 7 sheep. Residual bone-implant voids were filled with a biocompatible composite of poly-methyl-methacrylate and poly-hydroxyl-ethyl-methacrylate (Bioplant 24). Photopolymerisation of a viscose mixture of experimental prepolymers and Bioplant 24 applied to the neck of the implants provided additional support before gingival closure. Clinical and radiographic controls were performed 30, 90, and 180 days after surgery. At 180 days postoperatively, the sheep were sacrificed and the mandibular segments were isolated for histological processing. RESULTS: High cumulative implant failure rates of 45.5%, 63.6%, and 77.3% at respectively 30, 90 and 180 days were recorded. Significantly more implants were lost when the position of the neck was located above the level of the alveolar crest (P < 0.05). Clinical and histological observations demonstrated poor implant osseointegration characterized by ingrowth of soft tissue into the extraction sockets. Bone substitutes were lost in all cases. DISCUSSION AND CONCLUSION: Sheep have many practical advantages compared with other animal models. However, their specific oral biomechanics inherent to their constant ruminant activity accounted for a high degree of the reported implant failures. Important adaptations to the implantation technique and postoperative management will be necessary to use sheep as an animal model for future oral implant related experiments.

Computed tomography-guided brain biopsy for in vivo diagnosis of a cholesterinic granuloma in a horse.

CASE DESCRIPTION: An 8-year-old warmblood mare was evaluated following an acute onset of neurologic abnormalities. CLINICAL FINDINGS: Computed tomography of the head revealed large masses in both lateral ventricles, and a presumptive diagnosis of cholesterinic granuloma was made. TREATMENT AND OUTCOME: Freehand biopsy of the intracranial masses was performed under computed tomographic guidance, and histologic examination of biopsy specimens confirmed the diagnosis. No adverse effects associated with the brain biopsy procedure were encountered. Clinical signs resolved, and long-term follow-up did not reveal any recurrence of neurologic deficits. The horse was able to return to its previous level of training. CLINICAL RELEVANCE: Findings suggested that computed tomographic-guided brain biopsy is feasible in horses and can be used to establish a diagnosis in horses with intracranial masses.

Histologic and micro-computed tomographic evaluation of the osseointegration of a nonresorbable bone substitute in alveoli of ponies after tooth extraction.

OBJECTIVE: To evaluate the biological behavior of a nonresorbable bone substitute (NRBS) in the alveoli of ponies, compared with tissue quality in naturally healing alveoli, after cheek tooth extraction. ANIMALS: 5 clinically normal ponies. PROCEDURES: In each pony, both maxillary fourth premolars (Triadan 108/208) were repulsed bilaterally during anesthesia. One randomly chosen alveolus was filled with NRBS and isolated from the oral cavity by use of dental impression material and a spring-wire retention device. The other alveolus was occluded in its occlusal third portion with dental impression material. One year after surgery, cylindrical lateromedial biopsy specimens were collected from the apical, middle, and occlusal level of each alveolus. Biopsy samples were evaluated for bone mineral density and bone volume via micro-computed tomography; qualitative histologic characteristics were evaluated via light microscopy. RESULTS: Bone mineral density and bone volume were greater in control alveoli, compared with NRBS-treated alveoli. Control alveoli were characterized by the presence of few mature bone trabeculae and wide spaces containing fat tissue and mesenchymal stroma. In treated alveoli, biocompatibility and osteoconductive properties of the NRBS were excellent; continuous bone formation and bone remodeling were also evident. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the NRBS was integrated well in calcified alveolar tissues in ponies 1 year after maxillary cheek tooth extraction. Further research is necessary to establish the benefits of this NRBS in the development of a dental implant surgical technique in equids.

Evaluation of periodontal changes following intra-alveolar prosthesis for maxillary cheek tooth extraction in ponies.

This study investigated the placement of an intra-alveolar prosthesis of bone substitute on gingival/periodontal health in 5 ponies following repulsion of cheek teeth 108 and 208. In each pony, one randomly chosen alveolus was allowed to heal by second intention while the other was filled with a non-resorbable, biocompatible bone substitute. At 6, 12 and 24-months after surgery, both maxillary arches were evaluated for wear abnormalities and for gingival health using a periodontal scoring system. Recorded changes included development of overgrowths on mandibular cheek teeth, widening of maxillary interproximal spaces due to tooth drift with subsequent food accumulation, gingivitis, and subgingival pocket formation. Diastema formation initially occurred between the maxillary 06 and 07s but resolved after 24-months, whereas the diastemata that developed between the maxillary 09 and 10s remained. It was concluded that maxillary cheek teeth extraction induced progressive changes in the position of adjacent teeth that caused periodontitis. The use of a bone substitute prosthesis in the alveolus did not prevent the development of periodontal disease.

Use of a synthetic bone substitute to retard molariform tooth drift after maxillary tooth loss in ponies.

OBJECTIVE: To evaluate the effect of alveolar bone substitute on post-extraction drift of maxillary cheek teeth in ponies. STUDY DESIGN: In vivo longitudinal experimental study. ANIMALS: Five ponies (5-7 years) with a healthy dentition. METHODS: Both maxillary 4th premolar teeth (Triadan 08) were surgically removed. One alveolus was filled with a biocompatible non-resorbable bone substitute (Bioplant 24), whereas the other healed by second intention. A polyvinylsiloxane plug and spring wire isolated the bone substitute from the oral environment. Pathologic changes to dentition and adjacent soft tissue were recorded. Tooth drift was calculated after 1 and 2 years. RESULTS: At 1 month, bone substitute material was incorporated into healthy tissue. Tooth drift was observed but differed significantly between control and treated sides at 2 years (P<.01). For both techniques, tooth drift differed significantly between years 1 and 2 (P<.001). Total drift in control arcades for year 1 was 10.69+/-2.12 mm and for year 2 was 9.08+/-0.87 mm, whereas for bone substitute arcades it was 9.90+/-1.60 mm for year 1 and 5.60+/-1.78 mm for year 2. CONCLUSIONS: Partial tooth replacement therapy after maxillary P4 extraction provided good healing in the immediate post-surgical phase. Alveolar filling with bone substitute material significantly slowed post-extraction tooth drift but did not stop it completely. Clinical Relevance- Important changes occur in equine dentition after maxillary cheek teeth removal. Further longer term observations are needed to fully validate study findings.

Surgical correction of ear curling caused by scar tissue formation in a horse.

An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses.