Standing laparoscopic abdominal lavage using a suction-irrigation device in 2 horses with primary suppurative peritonitis.

The use of a laparoscopic suction-irrigation device in 2 standing horses for lavage of the abdomen for the treatment of primary suppurative peritonitis is reported. Two horses were presented with a 1- to 2-week history of weight loss. Abdominocentesis revealed highly elevated total nucleated cell count. Peritoneal lavage systems were placed in both horses, but complications prevented adequate lavage. Both horses underwent standing laparoscopy; the dorsal abdomen was explored and the abdomen was profusely lavaged, using a suction-irrigation device. The procedure was efficient and allowed adequate visualization of the dorsal abdomen and lavage. A successful outcome was achieved in both cases. Key clinical message: Lavage of the abdomen of horses with peritonitis can be achieved under standing sedation, using a laparoscopic technique. In appropriately selected cases, this allows for adequate visualization of the dorsal abdomen and efficacious abdominal lavage.

Lavage abdominal laparoscopique debout à l'aide d'un dispositif d'irrigation par aspiration chez deux chevaux atteints de péritonite suppurée primaire. L'utilisation d'un dispositif laparoscopique d'irrigation par aspiration pour le lavage de l'abdomen pour le traitement d'une péritonite suppurée primaire chez deux chevaux debout est rapportée. Deux chevaux ont été présentés avec une histoire de 1 à 2 semaines de perte de poids. L'abdominocentèse a révélé un nombre total de cellules nucléées très élevé. Des systèmes de lavage péritonéal ont été placés chez les deux chevaux, mais des complications ont empêché un lavage adéquat. Les deux chevaux ont subi une laparoscopie debout; l'abdomen dorsal a été exploré, et l'abdomen a été abondamment lavé à l'aide d'un dispositif d'irrigation par aspiration. La procédure était efficace et permettait une visualisation adéquate de l'abdomen dorsal et un lavage. Une résolution positive a été obtenue dans les deux cas.Message clinique clé:Le lavage de l'abdomen de chevaux atteints de péritonite peut être réalisé sous sédation debout, en utilisant une technique laparoscopique. Dans des cas bien choisis, cela permet une visualisation adéquate de l'abdomen dorsal et un lavage abdominal efficace.(Traduit par Dr Serge Messier).

Effectiveness of a paraverterbral nerve block versus local portal blocks for laparoscopic closure of the nephrosplenic space: A pilot study.

OBJECTIVE: To compare the effectiveness of a paravertebral nerve block vs local portal blocks for laparoscopic closure of the nephrosplenic space in standing sedated research horses. STUDY DESIGN: Randomized clinical trial. ANIMALS: Twelve horses were randomly allocated to two groups (n = 6 per group), paravertebral block of nerves T18 , L1 , and L2 or local blocks of the three laparoscopic portals. METHODS: Horses were sedated with dexmedetomidine (4 µg/kg IV and constant rate infusion [CRI] of 2.5 µg/kg/h) and morphine (50 µg/kg IV and CRI of 30 µg/kg/h). According to group allocation, 20 mL of either lidocaine or saline was injected into each paravertebral nerve site or into each local portal site to facilitate laparoscopy for closure of the nephrosplenic space. The overall quality of sedation, analgesia, behavior exhibited during surgery, and ease to perform the surgery were blindly scored by using a visual analog scale (VAS). RESULTS: Time to complete local anesthesia was similar for both blocks, and there was no difference in VAS scores between groups. Total duration of surgery was also similar between the paravertebral (79 ± 16 min) and local portal blocks (85 ± 25 min) groups. CONCLUSION: The paravertebral nerve block and the local portal blocks provided similar conditions during surgery and can be used interchangeably for closure of the nephrosplenic space. CLINICAL SIGNIFICANCE: The paravertebral nerve block can be readily performed and may be useful in surgical procedures.

Techniques and Accuracy of Abdominal Ultrasound in Gastrointestinal Diseases of Horses and Foals.

Diagnostic ultrasonography has been used as a test to determine the presence or absence of gastrointestinal disease in horses and foals. General techniques and anatomic landmarks are reviewed. Many clinical reports that have included diagnostic ultrasound as part of their diagnostic process and accuracy studies are necessary to determine the usefulness of diagnostic ultrasound in clinical practice.

Clinical indications, complications, and long-term outcome of esophageal surgeries in 27 horses.

The main objective of this retrospective study was to describe clinical findings, management, and short- and long-term outcome in 27 horses that underwent various surgical techniques for esophageal disease. Surgical techniques (sometimes concurrently) performed were: esophagostomy (n = 14), esophagotomy with primary closure (n = 6), esophagomyotomy (n = 3), and esophagoplasty (n = 2). Esophageal perforation in 5 horses was treated by ventral drainage; 3 horses had the esophageal defect sutured (n = 3). Feeding tubes were placed in 15 horses. Postoperative complications occurred in 52% (14/27) with a median of 3 complications/horse (range: 1 to 7). Significantly more complications occurred in horses with a perforated esophagus. Eighteen horses (18/27; 67%) were discharged. Most horses (8/9; 89%) with a lesion located in the proximal esophagus were discharged. Horses with a higher number of postoperative complications, particularly postoperative infection, were more likely to be euthanized. One year after surgery, 41% of the horses were alive and free of complications.

Indications cliniques, complications et résultat à long terme de chirurgies œsophagiennes chez 27 chevaux. L'objectif principal de cette étude rétrospective a été de décrire les résultats cliniques, la gestion et les résultats à court et à long terme chez 27 chevaux qui ont subi diverses techniques de chirurgie pour le traitement de la maladie œsophagienne. Les techniques chirurgicales réalisées (parfois de manière concomitante) étaient : l'œsophagostomie (n = 14), l'œsophagotomie avec fermeture primaire (n = 6), l'œsophagomyotomie (n = 3) et l'œsophagoplastie (n = 2). La perforation œsophagienne chez 5 chevaux a été traitée par drainage ventral; 3 chevaux ont subi une suture du défaut œsophagien (n = 3). Des sondes d'alimentation ont été placées chez 15 chevaux. Les complications postopératoires se sont produites chez 52 % des chevaux (14/27) avec une médiane de 3 complications/cheval (fourchette : 1 à 7). Un nombre significativement supérieur de complications se sont produits chez les chevaux ayant une perforation de l'œsophage. Dix-huit chevaux (18/27; 67 %) ont reçu leur congé. La plupart des chevaux (8/9; 89 %) ayant une lésion situé dans l'œsophage proximal ont reçu leur congé. Il était plus probable que les chevaux avec un nombre supérieur de complications postopératoires, particulièrement une infection postopératoire, soient euthanasiés. Un an après la chirurgie, 41 % des chevaux étaient vivants et libres de complications.(Traduit par Isabelle Vallières).

Endoscopic removal of esophageal and ruminal foreign bodies in 5 Holstein calves.

Endoscopic removal of esophageal and ruminal foreign bodies was successfully performed in 5 Holstein-Friesian calves under sedation or general anesthesia by using an electrocautery snare or a wire-guided Dormi basket. This report describes the endoscopic manipulations, treatment, and outcomes of esophageal foreign body removal in these calves.

Trans-oral endoscopie pour retirer un corps étranger oesophagien ou ruminal chez 5 veaux Holstein. L'extraction d'un corps étranger oesophagien ou ruminale a été effectuée par endoscopie à l'aide d'un lassot ou d'un panier endoscopique (Dormi) avec succès chez cinq veaux de race Holstein, sous sédation ou anesthésie générale. Ce rapport de cas décrit les manipulations endoscopiques, les traitements et le pronostic suite à l'extraction endoscopique du corps étranger chez ces veaux.(Traduit par les auteurs).

Assessment of unassisted recovery from repeated general isoflurane anesthesia in horses following post-anesthetic administration of xylazine or acepromazine or a combination of xylazine and ketamine.

OBJECTIVES: To compare the effects of sedative doses of acepromazine, xylazine or xylazine/ketamine administered to horses after isoflurane anesthesia on the quality of recovery and anesthesia recovery times. To determine if recovery scores improve after repeated consecutive anesthetic episodes. STUDY DESIGN: Prospective, randomized, crossover study. ANIMALS: Fifteen adult research horses, 6.5±3.4 years old and weighing 499±40 kg. METHODS: Horses undergoing three anesthetic episodes with isoflurane for magnetic resonance of the forelimbs were administered acepromazine (0.02 mg kg(-1) i.v.) or xylazine (0.3 mg kg(-1) i.v.) or xylazine (0.15 mg kg(-1) i.v.) combined with ketamine (0.3 mg kg(-1) i.v.) in random order upon arrival in recovery. The quality of recovery was compared between the three treatments using a composite numerical rating and a general descriptive scoring system. RESULTS: Horses administered xylazine had better recovery scores than horses administered xylazine/ketamine, associated with better scores during their move to sternal, strength and number of attempts to standing. Horses administered acepromazine had similar recovery scores to horses administered xylazine and to horses administered xylazine/ketamine. Time to sternal recumbency and time to extubation were statistically longer for the xylazine treatment. Time to standing was similar between treatments. Horses had better recovery scores during the third anesthetic episode, regardless of the sedative drug administered, associated with better scores for strength and number of attempts to standing. CONCLUSIONS: Xylazine administration was superior to xylazine/ketamine but similar to acepromazine. This study also indicates that horses improve the quality of recovery during consecutive anesthetics associated with longer time to sternal and to standing, regardless of the sedative used. CLINICAL RELEVANCE: All treatments provided good quality recoveries. The experience of the individual horse gained during recent previous anesthetic episodes may have a positive effect in facilitating a better recovery.

Removal of a nasogastric tube fragment from the stomach of a standing horse.

An 82-cm fragment of nasogastric tube was removed from the stomach of an adult horse under standing sedation by use of an endoscope and electrocautery snare. This is the first report of successful non-surgical removal of a nasogastric tube fragment from the stomach of a horse.

Laparoscopic removal of a large abdominal testicular teratoma in a standing horse.

OBJECTIVE: To describe laparoscopic removal of a large testicular teratoma in a standing horse. STUDY DESIGN: Clinical report. ANIMALS: Thoroughbred horse (11 months) with a testicular teratoma. METHODS: A unilateral cryptorchid testicle could not be removed by an inguinal approach under general anesthesia because of it s large size. After recovery from general anesthesia, ultrasound evaluation revealed a 24 x 19 cm fluid-filled testicular mass. The mass was removed by paralumbar fossa laparoscopy with the horse in a standing position. After fluid aspiration of the mass, the mesorchium and ductus deferens were ligated with extracorporeal knots and the mass retrieved inside a laparoscopic specimen pouch. Morphologic features were consistent with a teratoma. RESULTS: Laparoscopic-guided aspiration of fluid from the teratoma decreased mass size and increased ease of manipulation and retrieval. Retrieval of the teratoma in a laparoscopic specimen pouch prevented loss of abdominal insufflation, helped reduce fluid leakage, and potential seeding of neoplastic cells. CONCLUSION: Use of laparoscopy for removal of neoplastic cryptorchid testicles offers many advantages including minimal invasiveness and increased safety associated with good visibility of structures. CLINICAL RELEVANCE: Standing laparoscopic surgery should be considered for removal of testicular neoplasms in horses.

In vitro and in vivo evaluation of ferric-hyaluronate implants for delivery of amikacin sulfate to the tarsocrural joint of horses.

OBJECTIVE: To assess the antimicrobial elution characteristics, toxicity, and antimicrobial activity of amikacin-impregnated ferric-hyaluronate implants (AI-FeHAI) for amikacin delivery to the tarsocrural joint of horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: AI-FeHAI implants, equine cartilage, and synovium, and horses (n=6). METHODS: In vitro study: Five AI-FeHAI were placed in saline solution with daily replacement until implant degradation. Eluent was tested for amikacin concentration and bioactivity. Synovial and cartilage explants were incubated in the presence or absence of AI-FeHAI for 72 hours and subsequently assessed for morphology, viability, and composition. Synovial explants were incubated with Staphylococcus aureus in the presence or absence of AI-FeHAI. Spent medium was cultured daily and explants were assessed for morphology and viability after 96 hours. In vivo study: AI-FeHAI were placed in 6 tarsocrural joints. Standard cytologic analysis and amikacin concentration (SFAC) were determined in synovia obtained regularly for 28 days thereafter. Similar analyses were conducted after a single intra-articular injection of amikacin 6 months later. RESULTS: In vitro study: Amikacin concentrations exceeded 16 microg/mL and inhibited S. aureus growth for 8 days. AI-FeHAI had no effect on cartilage explants. AI-FeHAI eliminated bacteria from synovial explants. In vitro study: After AI-FeHAI placement, SFAC was highest (140.78+63.81 microg/mL) at first sampling time. By 24 hours SFAC was <16 microg/mL. After intra-articular injection, SFAC was the highest (377.91 +/- 40.15 microg/mL) at first sampling time. By 48 hours SFAC was <16 microg/mL. CONCLUSIONS: A single intra-articular amikacin injection demonstrated superior pharmacokinetics than AI-FeHAI prepared as described. CLINICAL RELEVANCE: AI-FeHAI cannot be recommended for clinical use.

Comparison of laparoscopic versus conventional open cryptorchidectomies on intraoperative and postoperative complications and duration of surgery, anesthesia, and hospital stay in horses.

Objective-To compare surgical preparation time, surgery and anesthesia times, hospitalization duration, and intra- and postoperative complications between laparoscopic and conventional open cryptorchidectomy in horses. Design-Retrospective cohort study. Animals-60 horses that underwent cryptorchidectomy. Procedures-Medical records were reviewed to identify horses that had undergone cryptorchidectomy from 1991 to 2012. Thirty horses that underwent laparoscopic cryptorchidectomy (case horses) were matched with 30 control horses that had undergone open cryptorchidectomy (ie, inguinal and parainguinal surgical approaches). Horses were matched according to history of previous surgery, testicle location, and type of closure following removal of an undescended unilateral testicle. Duration of surgery, surgical preparation and anesthesia times, hospitalization duration, and number of intra- and postoperative complications were compared between horses that underwent laparoscopic cryptorchidectomy versus open cryptorchidectomy. Comparisons were also made between horses in terms of whether there was a history of previous failed cryptorchidectomy or unknown location of testicle prior to surgery. Results-Horses that underwent laparoscopic cryptorchidectomy had significantly longer surgery and anesthesia times overall, compared with horses that underwent open cryptorchidectomy. No difference in surgery time was found between case and control horses that had a previous surgical attempt to remove an undescended testicle or in which the testicle location was unknown prior to surgery. Overall, horses undergoing laparoscopy had a nonsignificant increase in intraoperative complications, compared with control horses, and had significantly more postoperative complications. Conclusions and Clinical Relevance-Horses undergoing laparoscopic cryptorchidectomy had increased surgical preparation time, increased surgery and anesthesia times, and more postoperative complications, compared with horses undergoing open cryptorchictomy. Laparoscopy may be advantageous for a second attempt at cryptorchidectomy or if the testicle location is unknown prior to surgery.

Evaluation of a broad range real-time polymerase chain reaction (RT-PCR) assay for the diagnosis of septic synovitis in horses.

Septic synovitis is a potentially debilitating and life-threatening disorder in horses. We hypothesized that a universal bacterial real-time PCR (RT-PCR) assay would have improved sensitivity and decreased turn-around time for detection of bacteria in synovial fluid (SF) samples. Forty-eight SF samples were collected from 36 horses that presented to two referral institutions with suspected septic synovitis. Universal RT-PCR, bacterial culture and SF analysis were performed on all samples, and an interpretation on the sample being septic or not was derived by three board certified specialists from the history, clinical assessment and SF characteristics. RT-PCR results were compared to a composite standard comprised of positive culture and interpretation by all three specialists of samples as "septic". For 41 of 48 samples (85%), culture and RT-PCR results were concordant. Compared to the composite standard, 83% of samples were correctly classified by RT-PCR (turn-around time of approximately 4 hours). Relative sensitivity and specificity of RT-PCR were 87% and 72% respectively, and 56% and 86% for culture. Hence, universal RT-PCR was a rapid and highly sensitive test, which may accelerate diagnosis and improve outcome for horses with septic synovitis.

La synovite septique est une condition potentiellement débilitante et mortelle chez les chevaux. Nous avons émis l'hypothèse qu'une épreuve universelle d'amplification en chaîne par la polymérase en temps réel (RT-PCR) pourrait avoir une sensibilité augmentée et une diminution du délai d'obtention des résultats pour la détection de bactérie dans des échantillons de liquide synovial (SF). Quarante-huit échantillons de SF ont été prélevés à partir de 36 chevaux présentés à deux centres de référence avec une synovite septique suspectée. L'épreuve RT-PCR universelle, la culture bactérienne et l'analyse du SF ont été effectuées sur tous les échantillons et une interprétation à savoir si l'échantillon était septique ou non était obtenue de trois spécialistes certifiés à partir de l'histoire du cas, de l'évaluation clinique et des caractéristiques du SF. Les résultats du RT-PCR ont été comparés à un composite standard consistant en une culture et une interprétation positives par les trois spécialistes d'échantillons comme étant «septique¼. Pour 41 des 48 échantillons (85 %), les résultats de la culture et du RT-PCR concordaient. Comparativement au composite standard, 83 % des échantillons ont été classés correctement par le RT-PCR (délai d'obtention des résultats approximatif de 4 heures). La sensibilité et la spécificité relatives du RT-PCR étaient de 87 % et 72 %, respectivement, 56 % et 86 % pour la culture. Ainsi, l'épreuve RT-PCR universelle était un test rapide et hautement sensible, ce qui pourrait accélérer le diagnostic et améliorer le sort des chevaux avec une synovite septique.(Traduit par Docteur Serge Messier).