Using Artificial Intelligence to Predict Survivability Likelihood and Need for Surgery in Horses Presented With Acute Abdomen (Colic).

Artificial intelligence and machine learning have promising applications in several medical fields of diagnosis, imaging, and laboratory testing procedures. However, the use of this technology in the veterinary medicine field is lagging behind, and there are many areas where it could be used with potentially successful outcomes and results. In this study, two critical predictions were explored in horses presented with acute abdomen (colic) using this technology. Those were the need for surgical intervention and survivability likelihood of affected horses based on clinical data (history, clinical examination findings, and diagnostic procedures). The two prediction parameters were explored using the application of Decision Trees, Multilayer Perceptron, Bayes Network, and Naïve Bayes. The machine learning algorithms were able to predict the need for surgery and survivability likelihood of horses presented with acute abdomen (colic) with 76% and 85% accuracy, respectively. The application of this technology in the different clinical fields of veterinary medicine appears to be of a value and warrants further investigation and testing.

Primary gastric rupture in 20 horses from Midwestern Brazil: case report / Ruptura gástrica primária em 20 equinos no Centro-Oeste do Brasil: relato de caso

An 11-year (2007-2018) survey of epidemiological, clinical and pathological findings of horses with primary gastric rupture (PGR) was conducted. Twenty horses presented PGR, nine (45%) horses were clinically evaluated, eleven (55%) were sent dead, and all animals were necropsied. PGR contributed to a prevalence of 0.31% (9/2,868) of all equid attendances, 1.83% (9/491) of colic cases, and 4.1% (20/487) of all equid necropsies. Highly fermentable feed (n=7), gastric impaction (n=4), and perforating gastric ulcer (n=1) were the main causes of PGR; whilst eight horses presented idiopathic gastric rupture. Clinically evaluated horses were tachycardic, tachypneic, febrile, dehydrated, with increased abdominal tension, abnormal mucous membranes and reduced to absent intestinal borborygmi. Improper dietary management, such as the ingestion of low-quality roughage and highly fermentable feedstuffs were detected as the main factors associated with PGR in Midwestern Brazil. It is important to raise awareness in horse owners about proper feed management to minimize PGR.(AU)

Foi realizado um levantamento de 11 anos (2007-2018) dos achados epidemiológicos, clínicos e patológicos de equinos com ruptura gástrica primária (RGP). Vinte equinos apresentaram RGP, dos quais nove (45%) foram avaliados clinicamente e 11 (55%) foram enviados mortos, sendo todos os animais necropsiados. A RGP contribuiu com prevalência de 0,31% de todos os atendimentos de equídeos (9/2.868), 1,83% (9/491) dos casos de cólica, e 4,1% (20/487) das necropsias em equídeos. Alimentos altamente fermentáveis (n=7), compactação gástrica (n=4) e perfuração de úlcera gástrica (n=1) foram as principais causas de RGP, enquanto oito equinos tiveram ruptura gástrica idiopática. Os equinos avaliados clinicamente apresentaram-se taquicárdicos, taquipneicos, febris, desidratados, com mucosas anormais, aumento da tensão abdominal e motilidade intestinal reduzida. O manejo inadequado da dieta, como a ingestão de forragens de baixa qualidade e alimentos altamente fermentáveis, foi o principal fator de risco associado à RGP no Centro-Oeste do Brasil. É importante aumentar a conscientização dos proprietários de equinos sobre o manejo alimentar adequado para minimizar a RGP.(AU)

Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies.

In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.

Exploratory Celiotomy in the Horse Secondary to Acute Colic: A Review of Indications and Success Rates.

To review indications and risk factors for exploratory celiotomy secondary to acute colic in the horse; decision making for and during surgery; and prognosis for return to function after exploratory celiotomy for the practicing veterinarian. Data sources included scientific reviews and original research publications from veterinary sources, as well as clinical data specifically in regard to underlying disease and survival rates from a tertiary referral hospital where exploratory celiotomy is commonly performed. There is a high positive predictive value of specific clinical preoperative parameters of the equine acute abdomen, many of which rely on techniques available to field practitioners, relative to the need for surgical intervention. Decision making regarding surgical procedure or even intraoperative euthanasia depends on owner expectations. Survival rates following exploratory celiotomy range from fair to excellent (60%-100%) depending on underlying lesion and return to athleticism following celiotomy is good to excellent (76%-90%). A knowledge base of indications for and rates of survival from colic requiring exploratory celiotomy in the horse is of paramount importance to the equine practitioner. Preconceived notions of poor survival rates are rampant among horse owners, and owners rely on their primary veterinarian's advice for continuation to referral center and in further treatment including exploratory celiotomy.

Utility of two-view vs. three-view abdominal radiography in canines presenting with acute abdominal signs.

There are clear differences in the normal radiographic appearance of the abdominal organs between a left lateral vs. a right lateral view. While a few veterinary academic institutions have transitioned to a three-view abdominal radiographic study protocol, obtaining only two views of the canine abdomen remains the current standard in veterinary medicine. In this combined retrospective and prospective, case-controlled study, 48 canine patients presenting with signs of acute abdomen were recruited. Four board-certified veterinary radiologists and four general practice veterinarians with greater than 3 years of experience in small animal practice were asked to determine if 10 predetermined findings were present within the set of images and if surgery was recommended based on those findings. Image readers were unaware of the clinical history. Three-view studies did not yield statistically significantly greater accuracy than two-view studies when evaluating all readers together. No statistically significant associations between the availability of the third view and increased accuracy or confidence were found in evaluations of general practitioners specifically. Evaluation of three-view radiographic examination, as compared to two-view examination, did not have perceived or statistically significantly increased diagnostic utility. Based on our findings, there is no statistically increased utility to justify a standard three-view abdominal radiographic examination over a two-view study for canines presenting with signs of acute abdomen.

Use of a Boari flap and renal descensus as treatment for proximal ureteral rupture in a cat.

CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Lethargy, mydriasis, bradycardia, abdominal distension, and signs of pain on abdominal palpation were observed. Abdominal ultrasonography revealed moderate urinary bladder distension without evidence of free abdominal fluid; hematologic evaluation revealed leukocytosis with high BUN and serum creatinine concentrations. TREATMENT AND OUTCOME The patient was hospitalized, medical stabilization was attempted, and an indwelling urinary catheter was placed. Urinary output was < 1 mL/kg/h (< 0.45 mL/lb/h), and signs of abdominal pain persisted despite treatment. The next day, ultrasonographic examination revealed fluid in the retroperitoneal space, and ureteral rupture was suspected. Exploratory laparotomy confirmed retroperitoneal fluid accumulation; a large hematoma surrounded the right kidney and perirenal structures. An abdominal drain was placed to aid patient stabilization. Three days later, IV pyelography revealed rupture of the proximal part of the right ureter. Ureteroneocystostomy was performed with elongated cystoplasty through a Boari flap and caudal transposition of the right kidney (renal descensus). On follow-up examination 18 months after treatment, the cat was free of clinical signs, and results of ultrasonography, CBC, and serum biochemical analysis were unremarkable. CLINICAL RELEVANCE Results suggested that a Boari flap procedure with renal descensus could be a feasible alternative in the management of proximal ureteral rupture in cats, but research is needed in this area.

[Comparison of the findings of rectal examination and ultrasonographic findings in horses with colic]. / Vergleich rektaler und sonographischer Untersuchungsbefunde bei der Kolik des Pferdes.

OBJECTIVE: The examination of patients suffering from an acute abdomen routinely comprises both clinical and rectal examinations, and is ever more frequently accompanied by an ultrasonographic abdominal examination. The aim of the study was to compare the findings as defined through rectal examination with the results of the ultrasonographic examination for different forms of colic. MATERIAL AND METHODS: In a retrospective study, the patient records of the Large Animal Clinic of the University of Leipzig from 2012 and 2013 were analysed, and those of horses suffering from colic were included. Diagnoses made through rectal and ultrasonographic examination were grouped and compared with the diagnoses made during colic surgery or pathologic examination, which served as the gold standard. Horses that underwent conservative treatment had a definitive diagnosis assigned only in cases where a pathognostic rectal finding defined the diagnosis. Based on these data, sensitivity, specificity and positive and negative predictive values were calculated for both techniques. RESULTS: Ultrasonography was more sensitive than rectal examination in cases of small intestinal occlusion (97.1% vs. 50.7%), torsion of the large colon in the long axis (63.2% vs. 26.3%) and dislocation of the large colon into the nephrosplenic space (90.9% vs. 72.7%). Rectal examination was more sensitive than ultrasonographic examination in cases of other types of dislocation of the large colon (96.5% vs. 8.8%) and of constipations of the large colon (93.6% vs. 29.8%). CONCLUSION AND CLINICAL RELEVANCE: In cases of severe diseases, including small intestinal occlusions and torsions of the large colon, ultrasonography helps to better identify and more precisely diagnose conditions that in most cases require abdominal surgery than rectal examination. Therefore, under hospital conditions, it is highly advisable to include ultrasonography in the routine examination of the equine acute abdomen. However, this technique does not replace the traditional rectal examination, which is superior in the diagnosis of dislocations and constipations of the large colon as well as diseases of the caecum.

Atypical presentation of ovarian remnant syndrome in a dog.

A 2 yr old spayed female dog presented for evaluation of abdominal pain, decreased appetite, dysuria, and frantic licking of her vulva. A midventral, soft, fluctuant mass was detected on abdominal palpation. Diagnostic testing and exploratory celiotomy revealed remnant ovarian tissue and a cystic uterine remnant. The ovary and cystic uterine remnant were removed and submitted for histopathological evaluation. Ovarian remnant syndrome (ORS) is an infrequently encountered condition of dogs. This dog had none of the classic signs of estrus associated with ORS but instead presented for sharp, intermittent, abdominal pain that is similar to women with ORS.

Ultrasonographic examination in non-human primates with acute abdomen signs.

BACKGROUND: The acute abdomen is any abdominal disorder resulting in pain, shock, or sepsis. Although it has a multifactorial etiology, the primary cause is gastrointestinal tract pathology. The aim of this study was to assess the contribution of abdominal ultrasound as a complementary diagnostic tool in non-human primates with an acute abdomen. METHODS: Three different non-human primates with clinical signs of acute abdomen were evaluated as follows: a chimpanzee (Pan troglodytes), a tufted capuchin (Cebus apella), and a black-tufted marmoset (Callithrix penicillata). RESULTS: Ultrasonographic examination assisted in the identification of a variety of differential diagnoses and was used in decision-making for exploratory laparotomy, which was performed in two animals. Ultrasound examination confirmed the source of the acute abdomen as the gastrointestinal tract in the three animals studied. CONCLUSIONS: Abdominal ultrasound is a useful technique for the investigation of signs of acute abdomen in non-human primates.

Comparison between survey radiography, B-mode ultrasonography, contrast-enhanced ultrasonography and contrast-enhanced multi-detector computed tomography findings in dogs with acute abdominal signs.

Contrast-enhanced multi-detector computed tomography (CE-MDCT) is used routinely in evaluating human patients with acute abdominal symptoms. Contrast-enhanced ultrasound (CEUS) continues to be in its infancy as it relates to evaluation of the acute abdomen. The purpose of this study was to compare survey radiography, B-mode ultrasound, CEUS, and CE-MDCT findings in canine patients presenting with acute abdominal signs; with a focus on the ability to differentiate surgical from non-surgical conditions. Nineteen dogs were prospectively enrolled. Inclusion required a clinical diagnosis of acute abdominal signs and confirmed surgical or non-surgical causes for the clinical signs. Agreement for the majority of recorded imaging features was at least moderate. There was poor agreement in the identification of pneumoperitoneum and in the comparison of pancreatic lesion dimensions for B-mode vs. CEUS. The CT feature of fat stranding was detected in cases including, but not limited to, gastric neoplasia with perforation, pancreatitis, and small intestinal foreign body. Ultrasound underestimated the size and number of specific lesions when compared with CE-MDCT. Contrast-enhanced ultrasound was successful in detecting bowel and pancreatic perfusion deficits that CE-MDCT failed to identify. Accuracy for differentiation of surgical vs. non-surgical conditions was high for all modalities; 100%, 94%, and 94% for CE-MDCT, ultrasonography and survey radiography respectively. Findings indicated that CE-MDCT is an accurate screening test for differentiating surgical from non-surgical acute abdominal conditions in dogs. Focused CEUS following CE-MDCT or B-mode ultrasonography may be beneficial for identifying potentially significant hypoperfused lesions.

Abdômen agudo em equídeos no semiárido da região nordeste do Brasil / Acute abdomen in equidae in the semiarid of the Brazilian Northeast

Foram revisados os casos de abdômen agudo de origem gastrintestinal em equídeos atendidos no Hospital Veterinário da Universidade Federal de Campina Grande, em Patos, Paraíba. No período de janeiro de 2001 a dezembro de 2010. Setenta (4,5%) do total de 1542 equídeos atendidos no período apresentaram quadro clínico de cólica, sendo 60 equinos, cinco muares e cinco asininos. A compactação de cólon maior foi a causa mais frequente de cólica, diagnosticada em 37,14% dos casos, seguida por compactação de cólon menor (10%) e corpo estranho de cólon menor (7,14%). Em quatro casos as cólicas foram causadas pela presença de fitobezoares no intestino grosso, sendo dois deles associados ao consumo de vagens de Prosopis juliflora. Em cinco casos foi observada a presença de corpos estranhos no cólon menor e em um caso os corposestranhos foram encontrados no cólon maior, sendo principalmente sacos plásticos. As lesões estrangulantes do intestino delgado foram observadas em quatro casos. Outras causas foram cólica espasmódica (dois casos por parasitose e dois por ingestão de resíduos domiciliares), sobrecarga gástrica (três casos) e deslocamento de cólon maior que foi diagnosticado em dois animais. Laceração de cólon menor, torção de ceco, compactação de ceco e timpanismo por consumo de Manihot esculenta foram diagnosticados em uma única ocasião. O principal fator de risco para o desenvolvimento de cólicas foi o consumo de Pennisetum purpureum, Brachiaria decumbens, Sorghum spp. ou Echinochloa polystachya picados manualmente ou em picotadeira ou triturados em forrageira (OR=4,03; P=0,007). Como resultado da baixa qualidade dos alimentos ingeridos, a frequência dos atendimentos de equídeos portadores de cólica foi significativamente maior no segundo semestre (época da seca na região estudada) (OR=2,61; P<0,01). Concluiu-se que a oferta de volumoso de baixa qualidade na seca contribui para a alta frequência de casos de cólica e que o manejo alimentar tem um papel importante na ocorrência da doença e, por isso, a sua melhoria pode influenciar positivamente na redução do número de casos de cólica em equídeos no semiárido nordestino.

The cases of equidae acute abdomen diagnosed in the Veterinary Hospital of the Federal University of Campina Grande, in the semiarid of the Brazilian Northeast were reviewed. From January 2001 to December 2011, 70 (4.5%) equidae out of 1542 were affected by colic, including 60 horses, 4 mules, and 6 donkeys. Large colon impaction diagnosed in 37.14% of the cases was the most frequent cause of colic, followed by small colon impaction (10%) and foreign body in the small colon (7.14%). In four cases, colics were caused by phytobezoars in the large gut, two of which were associated with the ingestion of large amounts of fresh Prosopis juliflora pods. Six cases of colic by foreign bodies, mainly plastic bags, were observed, five located in the small colon and one in the large colon. Strangulating small intestinal lesions were observed in four cases. Other causes of colic were spasmodic colic (two cases due to gastrointestinal parasites and two due to consumption of home residues), and gastric impaction (three cases). Large colon displacement was diagnosed twice. Laceration of the small colon, cecal torsion, and bloat by ingestion of Manihot esculenta were diagnosed once. The main risk factor for the occurrence of colic was the ingestion of choped Pennisetum purpureum, Brachiaria spp., Sorghum spp. or Echinochloa polystachya (OR=4.03; P=0.007). As a result of the low quality of the foods the frequency of colic was significantly higher during the dry season (second semester) (OR=2.61; P<0.01). It is concluded that feeding with low quality forages during the dry season contributes with the high frequency of cases of colic in the Brazilian semiarid, and that is necessary to improve food quality and food management to try to decrease the frequency of this syndrome in the region.

Alterações clínicas e laboratoriais em equinos adaptadosa dieta com nível elevado de concentrado e submetidos àsobrecarga dietética com amido / Clinical and laboratorial changes in horses adapted to diet with high levels of concentratedand submitted to dietetic starch overload

Este trabalho teve como objetivo avaliar o efeito da sobrecarga dietética com amido em equinos adaptados a dieta comnível elevado de concentrado. Seis equinos adultos foram previamente adaptados à dieta composta por feno de coastcross e concentrado na proporção de 60:40 e, posteriormente submetidos à infusão gástrica de 17,6 g amido/kg de pesocorporal. Os equinos foram avaliados por meio de exames clínicos e laboratoriais até 36 horas após a sobrecarga. Umequino veio a óbito 32 horas após a sobrecarga, apresentando quadro clínico de endotoxemia e laminite. Não houvediferença ( P > 0,05) nas frequências cardíaca e respiratória, temperatura retal, tempo de preenchimento capilar etemperatura superficial dos cascos dos equinos durante o experimento. Houve tendência ao aumento na motilidadeintestinal, seguido de aumento na fluidez das fezes. O volume globular e a concentração de proteína plasmática totalaumentaram ( P < 0,05) 24 horas após a sobrecarga quando comparados aos valores basais, de 26,7 a 32,0% e de 7,1e 8,1 g/dL, respectivamente. Os neutrófilos bastonetes aumentaram ( P < 0,05) durante o período de avaliação, comvalores variando de 0,1 a 0,7 x 103/μL antes da sobrecarga e 24 horas após, respectivamente, enquanto os eosinófilosapresentaram redução. A concentração plasmática de lactato teve aumento discreto com diferença ( P < 0,05) antes, 20 e28 horas após a sobrecarga, com valores de 0,7, 1,0 e 1,2 mmol/L, respectivamente. Conclui-se que equinos consumindodieta com elevado nível de concentrado e submetidos à sobrecarga dietética com amido apresentam alterações clínicas elaboratoriais moderadas, porém, casos graves, seguidos do óbito, podem ocorrer devido à variação individual.

This work was carried out to evaluate the effect of dietetic starch overload in horses adapted to diets with high levelof concentrated. Six crossbreed mature horses were previously adapted to diet composed by coast cross hay andconcentrate in a 60:40 proportion and later submitted to gastric infusion of 17.6 g starch/kg body weight. The horseswere evaluated by clinical and laboratorial examination until 36-hour after overload. One horse died 32 hours afteroverload, presenting clinical signs of endotoxemia and laminitis.No differences ( P > 0.05) were observed in heartand respiratory rate, rectal temperature, capillary refill time and hoof temperature of horses. There was a tendency toincrease intestinal mobility following by fluidity of faeces. Increase ( P < 0.05) in packed cell volume and total plasmaprotein were observed 24 hours after overload when compared to baseline, from 26.7 to 32.0% and 7.1 to 8.1 g/dL,respectively. Neutrophils increased ( P < 0.05) during the evaluation period, with values varying of 0.1 to 0.7 x 103/μLbefore overload and 24 hours after, respectively, while the eosinophils decreased. The plasma lactate concentration wasslight increased with difference (p < 0.05) before, 20 and 28 hours after overload, with values of 0.7, 1.0 and 1.2 mmol/L,respectively. It was concluded that horses consuming diets with high levels of concentrated and submitted to dieteticstarch overload had clinical and laboratory changes moderate, however, severe cases, followed by death may occur dueto individual variation.

Perfil e distribuição da síndrome cólica em eqüinos em três unidades militares do Estado do Rio de Janeiro, Brasil / Profile and distribution of equine colic syndrome in three military units in Rio de Janeiro, Brazil

Este estudo teve como objetivo avaliar o perfil e a distribuição da síndrome cólica em equinos de três unidades militares no Estado do Rio de Janeiro, o Regimento Escola de Cavalaria (REsC), a Academia Militar das Agulhas Negras(AMAN) e o Esquadrão Escola de Cavalaria (EEC). No período entre 2003 e 2004, 770 equinos foram acompanhados para a ocorrência de casos clínicos de cólica. Realizou-se análise descritiva dos dados, e foram calculadas a taxa de incidência de cólica e a proporção de equinos acometidos. O teste do χ2 foi utilizado para avaliar a associação entre síndrome cólica evariáveis relativas às características dos equinos e do manejo. A incidência variou entre as unidades militares, 0,12 na AMAN, 0,21 no EEC e 0,95 casos/equino-ano no REsC, sendo acometidos 15% dos equinos da AMAN, 30% do EEC e 69% do REsC. A maior incidência foi de episódios de origem gástrica, 76,5%. Casos de reincidência foram elevados, sendo 62,5% no REsC, 36,7% na AMAN e 29,0% no EEC. A síndrome cólica estava significativamente associada às variáveis unidade militar, sistema de criação, quantidade de grãos ingerido esuplemento mineral-vitamínico. As altas incidências, reincidências e proporção de animais acometidos observadas ocorreram de forma diferenciada nas três unidades, indicando que, apesar de possuírem como característica comumpertencerem a unidades militares, os equinos formam um grupo heterogêneo no que diz respeito à ocorrência de síndrome cólica, provavelmente devido às diferentes condições de manejo.

This research aimed to verify the profile and distribution of colic syndrome in horses of three military units in Rio de Janeiro, Brazil, which were Regimento Escola de Cavalaria (REsC), Academia Militar das Agulhas Negras (AMAN), and Esquadrão Escola de Cavalaria (EEC). From 2003 to 2004, 770 horses were followed up for the incidence of colic cases. A descriptive analysis of clinical data, incidence of colic cases and rate of horses affected was established. Chisquared test was used to evaluate the association among colic syndrome and variables related to horses characteristics and management. Colic syndrome incidence varied among military units as follows: 0.12 cases/horse-year at AMAN, 0.21 at EECand 0.95 at REsC, affecting 15% of horses in AMAN, 30% in EEC and 69% in REsC. The highest incidence was of gastric episodes (76.5%). Recurrence cases were 62.5% in REsC, 36.7% in AMAN and 29.0% in EEC. Colic syndrome occurred associated with variables: military unit, management, amount of intake grains and supplemented mineral-vitamin. Highincidence, recurrence and horses rate with colic were differentiated among the three units. Although the horses of military units had common characteristic , they formed a heterogeneous group in respect to colic syndrome occurrence, probably due to different management conditions.

Obstrucción estrangulante del intestino grueso en equinos: evaluación clínica y tratamiento quirúrgico en dos casos / Strangulation obstructions of large intestine in horses: clinical evaluation and surgical treatment in two cases

La obstrucción estrangulante es la combinación de obstrucción simple del tracto gastrointestinal del equino acompañado de bloqueo del abastecimiento circulatorio, lo cual causa severa enfermedad intestinal. Esta afección es comúnmente conocida como Síndrome Abdominal Agudo o Cólico. La incidencia de esta afección es considerada baja con una mortalidad alta dependiendo del segmento anatómico involucrado y del tiempo con que se intervenga quirúrgicamente el paciente. En el presente trabajo se reportan los hallazgos clínicos e histopatológicos, el tratamiento quirúrgico, la evolución clínica y el manejo medico post-quirúrgico de dos casos de obstrucciones estrangulantes del colon mayor en equinos referidos a la Clínica Veterinaria Dr. “Luis Medina”. La historia, sintomatología clínica y pruebas de laboratorio orientaron el diagnóstico, el cual fue confirmado a través de laparotomía exploratoria, la resolución de cada caso fue acompañada con un estudio histológico del segmento intestinal afectado. La resolución en el caso número uno fue por enterotomía de vaciado, mientras que el caso dos fue tratado con reseción del colon mayor con entero anastomosis latero-lateral. Ambos casos sobrevivieron, observándose mejor progreso clínico post-quirúrgico en el caso número dos.

Strangulation obstructions are external vascular constriction with simultaneous blockage of intestinal lumen. It has also been referred cause severe intestinal disease in the horses and commonly related colic. The incidence of this lesion is low with high fatality influenced by anatomic segment involved and rapid surgical intervention at the horse. This paper report the history, clinical signs, histopathologic findings, surgical ma- nagement, clinical progress and post-surgical treatment in two case of strangulation of the large colon in horses sent to the veterinary clinic “Dr. Luis Medina”. History, physical examination, laboratory test and exploratory laparatomy were used for diagnostic purpose. The resolution of each case has been completed with a histopatlogic study of the anatomic segment involved. The resolution in the case number one was for pelvic flexure enterotomy to decompress the colon torsion. The case number two was threatened with large colon resection and sideto-side anastomosis of left dorsal and ventral colons. Both cases survived however the case two have better clinical progress post-surgical.

Ramos colaterais parietais e terminais da aorta abdominal em Myocastor coypus (nutria) / Terminal and parietal colateral branches of the abdominal aorta in Myocastor coypus (nutria)

Neste estudo, utilizaram-se 30 nutrias, 15 fêmeas e 15 machos, com o sistema arterial aórtico-abdominal preenchido com látex 603, pigmentado em vermelho, e fixado em uma solução aquosa de formaldeído a 20 por cento. A aorta abdominal emitiu de sua superfície dorsal de 6 a 8 artérias lombares únicas. Das artérias renais, direita e esquerda, originaram-se as artérias frênico-abdominal para irrigar parte do diafragma e da parede abdominal lateral cranial. A aorta abdominal lançou dorsalmente, a artéria sacral mediana, cranialmente a sua bifurcação em artérias ilíacas comuns. As artérias ilíacas comuns, ramos terminais da aorta abdominal, originaram as artérias ilíacas interna e externa. A artéria ilíaca interna distribuiu-se nas vísceras da cavidade pélvica. A artéria ilíaca externa emitiu uma artéria umbilical e, antes de alcançar o anel femoral, lançou a artéria circunflexa ilíaca profunda para a parede abdominal lateral, em seus dois terços caudais. A artéria ilíaca externa lançou o tronco pudendo-epigástrico, que originou a artéria epigástrica caudal, para a parede abdominal ventral e a artéria pudenda externa, que saiu pelo canal inguinal, para irrigar a genitália externa. Os ramos parietais diretos da aorta abdominal foram as artérias lombares e a artéria sacral mediana, enquanto as artérias frênico-abdominal, circunflexa ilíaca profunda e epigástrica caudal, foram ramos colaterais parietais indiretos. Os ramos terminais da artéria aorta abdominal foram as artérias ilíacas comuns com seus ramos, as artérias ilíacas interna e externa.

For this study it was used 30 nutria, 15 females and 15 males, with its abdominal aorta system full filled with latex 603, stained in red, and fixed in an aqueous solution of formaldehyde 20 percent. The abdominal aorta emitted from its dorsal surface 6 to 8 single lumbar arteries. From the renal arteries, left and right, it has been originated the phrenicoabdominal arteries, in order to irrigate part of the diaphragm and the cranial lateral abdominal walls. The abdominal aorta emitted, dorsally, the median sacral artery, cranially to its bifurcation into the common iliac arteries. These common iliac arteries, terminal branches of the aorta, originate the internal and external iliac arteries. The internal iliac artery was distributed along the pelvic cavity viscera. The external iliac artery emitted an umbilical artery and, before reaching the inguinal ring, emitted the deep circunflex iliac artery to 2/3 of the caudal lateral abdominal wall. The external iliac artery emitted the pudendoepigastric trunk, wich has originated the caudal epigastric artery, to the ventral abdominal wall, and the external pudendal artery, wich passed through the inguinal ring to irrigate the external genital. The direct parietal branches of the abdominal aorta were the lumbar arteries and the median sacral artery, while the phrenicoabdominal arteries, deep circunflex iliac and the caudal epigastric artery were indirect colateral parietal branches. The terminal branches of the abdominal aorta were the common iliac arteries with its branches, the internal and external iliac arteries.

Equilíbrio ácido-base e hidroeletrolítico em eqüinos com cólica / Acid-base and hidroelectrolytic balance in colic horses

Foram utilizados setenta eqüinos distribuídos em três grupos experimentais, G1 (vinte eqüinos hígidos), G2 (vinte e cinco eqüinos com cólica, os quais passaram por tratamento clínico ou cirúrgico e sobreviveram) e G3 (vinte e cinco eqüinos com cólica, os quais passaram por tratamento clínico ou cirúrgico e foram a óbito ou foram sacrificados). Amostras de sangue foram obtidas em dez diferentes momentos, mediante punção da jugular, para estudo do equilíbrio ácido-base e hidroeletrolítico. Os eqüinos com cólica apresentaram diminuição (P<0,05) nos valores do pH(v), principalmente os animais do G3, a qual, associada com a diminuição da pCO2(v), cBase(v) e cHCO-3(vP), confirmou a acidose metabólica, que teve como origem a produção aumentada de lactato durante a glicólise anaeróbica decorrente da hipovolemia. Adicionalmente apresentaram hiponatremia, hipocalemia e hipercloremia. A presença e a magnitude dos desequilíbrios contribuíram substancialmente com o prognóstico dos animais com cólica.

Seventy horses were distributed into three experimental groups ad follows: G1, twenty healthy animals; G2, twenty-five colic horses that survived after clinical or surgical treatment; and G3, twenty-five colic horses that were sacrificed or died after clinical or surgical treatment. Blood samples were taken from the jugular vein to assess acid-base balance and water-electrolyte balance. Colic horses had lower pH(v) (P<0.05), mainly G3 animals. Acidosis was confirmed by the lower pH(v) associated with decreased pCO2(v), cBase(v) and cHCO-3(vP), which was probably due to an increased production of lactate during anaerobic glycolysis as a result from hypovolemia. Furthermore, hyponatremia, hypokalemia and hyperchloremia were detected. The presence and the extent of the imbalances contributed substantially to the prognosis of colic horses.

Estudo retrospectivo dos casos de enterolitíase e corpo estranho em intestino grosso de eqüinos, no período de janeiro de 1993 a janeiro de 2003 / Retrospective study of enterolithiasis and foreign bodies found in the large intestine of horses (january 1993 to january 2003)

No período de janeiro de 1993 a janeiro de 2003, foram realizados 195 procedimentos cirúrgicos de abdômen agudo em eqüinos, no Serviço de Cirurgia de Grandes Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. Dentre eles, foram diagnosticados 30 casos de enterolitíase e sete casos de corpo estranho, localizados em intestino grosso. Das 37 laparotomias, 35 foram realizadas em decúbito dorsal com acesso pela linha média e duas em estação com acesso pelo flanco. Os animais apresentaram idade variando de um a dezoito anos com média de oito anos, sendo 25 machos e 13 fêmeas. As formações e corpos estranhos apresentaram a seguinte localização: 13 (35,14%) em cólon maior, 19 (51,35%) em cólon menor, 03 (8,10%) em cólon transverso e 02 (5,41 %) em cólon transverso e menor. Em relação à evolução, 23 (62,16%) receberam alta e 14 (37,84%) evoluíram para óbito (6) ou foram submetidos à eutanásia (8). Seis procedimentos de eutanásia, foram realizados no período trans-operatório e dois no período pós-operatório. Dentre os animais que apresentaram evolução satisfatória, destacam-se um caso em que foram retirados sete enterólitos e outro em que a ponta de um prego que era o núcleo do enterólito se mantinha proeminente e em contato com a mucosa intestinal. Comparativamente às demais afecções do intestino grosso dos eqüinos e pela análise dos resultados obtidos neste estudo, conclui-se que os processos obstrutivos causados por enterólitos ou corpos estranhos apresentam prognóstico favorável.

In the period from January 1993 to January 2003, 195 surgical procedures of equine acute abdomen were performed at the Service of Large Animal Surgery of the Veterinary Hospital of the School of Veterinary Medicine and Zootechnics of the University of São Paulo. From these 195 cases there were 30 enterolithiasis and seven foreign bodies located in the colono Thirty-five out of 37 laparotomies were performed in dorsal recumbency, with access through the ventral midline and two were performed through the flank, with the animal in standing position. Of the 37 animals, 25 were male and 12 were females. Age varied from one to 18 years old with any average of eight years of age. Location of enteroliths and foreign bodies was as follows: 13 (35.14%) in large colon, 19 (51.35%) in small colon, 03 (8.10%) in transverse colon and 02 (5.41 %) in both transverse and small colon. In regards to the clinical evolution, six were humenely eutmanized killed during surgery. From the 31 remaining, 23 (74,19%) were discharged,6 (19,36%) died and 2 (6,45%) were killed eutmanized during the post-operative period. Among those animals with satisfactory evolution two animals stand out. One of them had seven enteroliths and in the other, the nucleus of the mass was the tip of a nail, which protruded from the mass and was in constant contact with the intestinal mucosa. In spite of the large incidence of obstruction caused by enteroliths or foreign bodies in comparison of other studies, the prognosis of post-operative recovery is favourable.

Surgical abdomen of the calf.

Although underrepresented compared with infectious diseases, calves' surgical abdomen diseases and abdominal surgery are a part of daily veterinary practice. Clinical presentations may differ from adult cattle and change rapidly. The decision whether to perform abdominal surgery or refer the animal has to take into consideration the condition and its prognosis for the calf. This article discusses clinical presentation of calves and focuses on specific situations with a detailed description of the surgical techniques, atresia coli, and umbilical remnants infection.

Modulation of the cytokine responses in equine macrophages following TACE-inhibition.

The detrimental effects of the pro-inflammatory cytokine TNF-alpha during equine acute abdominal disease are well known. Its pivotal role in many human diseases has led to various in-depth studies regarding its release mechanism, in particular by TNF-alpha converting enzyme (TACE). In this study we investigated the inhibitory effect of a TACE-inhibitor on cytokine release (TNF-alpha, IL-1alpha and IL-6) in three different cell models, including U937 cells, a recently established equine macrophage cell line, known as eCAS, and primary equine PBMC. The aim was to show the similarity of TNF-alpha release through the TACE mechanism in human and equine cells after stimulation with LPS. Results indicate that, by using a TACE-inhibitor, TNF-alpha, IL-1alpha and IL-6 release can be reduced in both equine cell models and achieved comparable results in the human U937 cells. These results suggest that equine TNF-alpha, like its human homologue, is released from its membrane-bound position by TACE.