Standing flank laparotomy for colic: 37 cases.

BACKGROUND: Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy. OBJECTIVE: To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy. STUDY DESIGN: Retrospective case series. METHODS: Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis was performed. RESULTS: Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey (euthanised) were subjected to standing flank laparotomy via the left flank (n = 31), right flank (n = 2) or both flanks (n = 4). The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived). Enterotomy was performed in four animals (all survived). Partial typhlectomy was performed in one horse (euthanised). Resection-anastomosis of the SI or LC was performed in three animals (one survived). Three animals had intraoperative complications that negatively affected the outcome: Two ponies had intolerance to abdominopelvic exploration; one mare had spontaneous exteriorisation of a long segment of the SI leading to a large tear in the mesentery. In seven cases, severe/extensive lesions found during standing flank laparotomy warranted immediate euthanasia. The survival rate was 54%. All owners were satisfied with the decision to perform standing flank laparotomy. MAIN LIMITATIONS: The retrospective design, lack of a control group, small number of cases and lack of standardised protocols between hospitals. CONCLUSIONS: Although ventral midline laparotomy is the standard of care for horses with colic, standing flank laparotomy is a viable approach for some types of colic. Systemic administration of analgesics may not produce sufficient peritoneal analgesia, which can lead to intolerance to abdominopelvic exploration during standing flank laparotomy in horses with colic and may negatively affect the outcome.

Effects of xylazine, romifidine, or detomidine on hematology, biochemistry, and splenic thickness in healthy horses.

Alpha-2 agonist-induced changes in packed cell volume (PCV), total solids (TS), selected biochemical parameters, and splenic thickness were investigated in horses. Four healthy mares were treated in a blinded, randomized, cross-over design with a dose of xylazine (0.5 mg/kg), romifidine (0.04 mg/kg), or detomidine (0.01 mg/kg) IV, and detomidine (0.02 mg/kg) IM. Hematology, TS, colloid osmotic pressure (COP), plasma osmolality; glucose, lactate, urea (BUN) and electrolyte concentrations; venous blood pH and ultrasonographic splenic thickness were evaluated at intervals for 300 min. Repeated measures analysis of variance (ANOVA) were performed with P < 0.05. There was a significant change over time in PCV and TS following each treatment (P < 0.001), with median (range) reductions of 20.9% (12.9% to 27.3%) and 5.8% (3.0% to 10.3%), respectively. Red blood cell count, BUN, and COP decreased while osmolality, glucose, Na(+), and splenic thickness increased. Treatments induced clinically significant transient changes in PCV, TS, and other biochemical parameters, which should be considered when assessing horses that received these drugs.

Effets de la xylazine, de la romifidine ou de la détomidine sur l'hématologie, la biochimie et l'épaisseur splénique chez des chevaux en santé. Des changements induits à l'aide d'alpha-2 agonistes au niveau de la valeur d'hématocrite (VH), des solides totaux (ST), de paramètres biochimiques choisis et de l'épaisseur splénique ont été étudiés chez les chevaux. Quatre juments en santé ont été traitées dans une étude à l'aveugle, randomisée et croisée avec une dose de xylazine (0,5 mg/kg), de romifidine (0,04 mg/kg) ou de détomidine (0,01 mg/kg) IV et de détomidine (0,02 mg/kg) IM. L'hématologie, les ST, la pression osmotique colloïdale (POC), l'osmolalité plasmatique, le glucose, le lactate, l'urée (l'azote uréique du sang) et les concentrations d'électrolytes, le pH du sang veineux et l'épaisseur splénique échographique ont été évalués à des intervalles de 300 minutes. L'analyse de la variance des mesures répétées a été réalisée avec P < 0,05. Il y avait des changements significatifs dans le temps de VH et des ST après chaque traitement (P < 0,001), avec des réductions moyennes (écart) de 20,9 % (de 12,9 % à 27,3 %) et de 5,8 % (de 3,0 % à 10,3 %), respectivement. Le nombre de globules rouges, l'azote uréique du sang et la POC ont diminué tandis que l'osmolalité, le glucose, Na+ et l'épaisseur splénique ont augmenté. Les traitements ont induit des changements transitoires significatifs sur le plan clinique dans la VH, les ST et les autres paramètres biochimiques qui devraient être considérés lors de l'évaluation des chevaux qui ont reçu ces médicaments.(Traduit par Isabelle Vallières).

Basilar skull fracture in a Thoroughbred colt: radiography or computed tomography?

A two-year-old Thoroughbred colt was presented to the Equine Clinic, Onderstepoort Veterinary Academic Hospital for head trauma after rearing and falling backwards, hitting his head on the ground. Following medical therapy for acute onset neurological impairment secondary to a suspected basilar skull fracture, the horse was anaesthetised and computed tomography of the skull was performed. A diagnosis of a comminuted basilar skull fracture was made and skull radiographs were taken for comparison. The horse was subsequently euthanased owing to the poor prognosis; necropsy findings were compatible with imaging findings. The value and limitation of computed tomography versus radiography for the diagnosis of basilar skull fracture are discussed in this report.

Cytokine mRNA expressions after racing at a high altitude and at sea level in horses with exercise-induced pulmonary hemorrhage.

OBJECTIVE: To determine concentrations of cytokine mRNA in horses with exercise-induced pulmonary hemorrhage (EIPH) after racing. ANIMALS: 97 Thoroughbreds. PROCEDURES: Following tracheobronchoscopy, the severity of EIPH was graded (scale of 0 to 4), and venous blood samples were collected from 10 horses in each grade. After RNA isolation and cDNA synthesis, real-time PCR assay was conducted to detect cytokinespecific mRNA for interleukin (IL)-1, IL-6, and IL-10; interferon (INF)-gamma; and tumor necrosis factor (TNF)-alpha. RESULTS: Neither location nor grade of EIPH affected the expression of IL-1 and INF-gamma. There was significantly greater overall expression of IL-6 mRNA at sea level, with significantly more IL-6 expressed in horses with grade 4 EIPH than in horses with grade 0, 1, or 2 EIPH. At a high altitude, no difference was detected for IL-6 expression among the various EIPH grades. There was significantly greater overall expression of TNF-alpha mRNA at a high altitude; however, there was no difference within the various grades of EIPH. Expression of IL-10 was significantly affected by grade of EIPH because horses with grade 3 EIPH expressed significantly more IL-10 mRNA than did horses with grade 0 or 2 EIPH; this expression was not affected by location. CONCLUSIONS AND CLINICAL RELEVANCE: At sea level, increased IL-6 expression was associated with more severe EIPH, and altitude may affect gene expressions of the proinflammatory cytokine TNF-alpha and anti-inflammatory cytokine IL-6. Studies on protein concentrations of cytokine expression are needed. The pathophysiologic importance of these findings remains to be explained.

Radiographic quantification of tracheal dimensions of the normal Thoroughbred horse.

Radiographic measurement of tracheal dimensions in the horse may be useful in evaluating upper and lower respiratory tract conditions due to the gradient of pressure changes between these areas. Lateral radiographs of the trachea of 15 normal sedated Thoroughbred horses were made at inspiration and expiration and magnification-corrected mean airway heights measured were, respectively: larynx: 5.89 and 5.86 cm; trachea at the third cervical vertebra (C3): 4.17 and 4.04cm; at the fifth cervical vertebra (C5): 3.62 and 3.59 cm; at the first thoracic vertebra (T1): 3.4 and 3.23cm; and carina: 3.85 and 4.12 cm. The ratio of airway height to nearby vertebral body lengths, at inspiration and expiration were, respectively: laryngeal height at C3: 0.56 and 0.56; tracheal height at C3: 0.4 and 0.39; at C5: 0.37 and 0.37; at T1: 0.59 and 0.59; and carina height: 0.91 and 0.94. The ratio of tracheal height to the thoracic inlet at inspiration and expiration was, respectively, 0.15 and 0.15. There was not a statistically significant association between airway diameter and phase of respiration. No association was found between tracheal height and body mass or height at the withers. Radiographic tracheal height can be measured independent of respiratory phase in sedated horses. It is suggested that the ratio of tracheal height to an adjacent bony landmark is more reliable for comparison between horses and tracheal height measurement should be made at C5, due to a lower standard deviation. If only thoracic radiographs are made, measurements of tracheal height at the thoracic inlet may be valuable.

Transcutaneous ultrasonographic evaluation of the air-filled equine stomach and duodenum following gastroscopy.

Gastroscopy with air insufflation was performed in 10 ponies, after which a transcutaneous ultrasound examination of the stomach and duodenum was performed immediately and at 1, 2, and 4 h postgastroscopy, and 24 h after feeding. Stomach measurements included the dorsoventral and craniocaudal dimensions, as well as the stomach depth from the skin surface and stomach wall thickness at the different time periods. Gastric wall folding was observed in one pony, becoming most distinct 2-4 h postgastroscopy. An undulating stomach wall was noted in eight other ponies postgastroscopy. These observations appeared to be a response to the deflation of the stomach as the insufflated air was released gradually. Gas was detected in the duodenum after the gastroscopy. The parameters measured were noted to be useful to evaluate the extent of stomach distension due to air or feed. The ultrasonographic appearance of the stomach can, therefore, be altered by gastroscopy and this should be borne in mind when examining horses with suspected gastric disease.

Eimeria macusaniensis infection in 15 llamas and 34 alpacas.

CASE DESCRIPTION: 15 llamas and 34 alpacas between 3 weeks and 18 years old with fecal oocysts or intestinal coccidial stages morphologically consistent with Eimeria macusaniensis were examined. Nineteen of the camelids were admitted dead, and 30 were admitted alive. Camelids admitted alive accounted for 5.5% of all camelid admissions during this period. CLINICAL FINDINGS: Many severely affected camelids had signs of lethargy, weight loss, decreased appetite, and diarrhea. Camelids with clinical infection also commonly had evidence of circulatory shock, fat mobilization, and protein loss. Nonsurviving camelids also had evidence of shock, edema, bile stasis, renal insufficiency, hepatic lipidosis, muscle damage, relative hemoconcentration, and sepsis. Postmortem examination frequently revealed complete, segmental replacement of the mucosa of the distal portion of the jejunum with coccidial meronts and gamonts. For 17 of 42 camelids, results of initial fecal examinations for E macusaniensis were negative. TREATMENT AND OUTCOME: Most camelids admitted alive were treated with amprolium hydrochloride, plasma, and various supportive treatments. Fifteen of the 30 treated camelids died or were euthanized. CLINICAL RELEVANCE: Findings suggest that E macusaniensis may be an important gastrointestinal tract pathogen in camelids of all ages. Clinical signs were frequently nonspecific and were often evident before results of fecal examinations for the parasite were positive. As with other coccidia, severity of disease was probably related to ingested dose, host immunity, and other factors. The clinical and herd relevance of positive fecal examination results must be determined.

Compressive myelopathy due to intervertebral disk extrusion in a llama (Lama glama).

A 12-year-old intact female llama was euthanized following acute onset of spastic tetraparesis and recumbency with inability to rise. Postmortem examination revealed caudal cervical spinal cord compression due to a mass within the ventral spinal canal arising from the C6-C7 intervertebral disk space and attached to an irregularly thickened annulus fibrosis. On histopathologic examination, the mass was composed of amorphous acellular basophilic to amphophilic material admixed with irregularly arranged collagen bundles. The amorphous material was metachromatic and contained multiple small foci of markedly vacuolated round cells, characteristic of origin from the nucleus pulposus. Severe necrosis of all white matter tracts with astrocytic reaction was present in the overlying spinal cord segment. Ascending and descending Wallerian degeneration and dissecting interstitial astrogliosis were present within white matter tracts above and below the lesion, respectively. The diagnosis was compressive myelopathy due to chronic extrusion of the nucleus pulposus of the C6-C7 intervertebral disk. To the authors' knowledge, this is the first report of intervertebral disk disease in a camelid.

Encrusted cystitis secondary to Corynebacterium matruchotii infection in a horse.

A 17-year-old gelding was evaluated because of dysuria, inappetence, and weight loss. Cystoscopy revealed severe mucosal ecchymoses with luminal hemorrhage and accumulations of crystalloid sludge. Analysis of a urine sample revealed isosthenuria, an alkaline pH, pyuria, hematuria, bacteriuria, and numerous calcium carbonate crystals. Histologic examination of bladder mucosa biopsy specimens revealed severe neutrophilic infiltration with mineralization. A diagnosis of encrusted cystitis exacerbated by sabulous urolithiasis was made. A Corynebacterium sp susceptible to penicillin, sulfonamide, and enrofloxacin was cultured from the urine and the bladder mucosa biopsy specimens. The horse was treated with penicillin G potassium, IV, for 5 days, followed by trimethoprim-sulfamethoxazole for 4 weeks. Bladder lavage was performed daily for the first 3 days with a balanced electrolyte solution and dimethyl sulfoxide in an attempt to aid expulsion of necrotic debris and crystalline sludge from the bladder. Molecular phylogenetic analysis based on the 16S rDNA gene sequence was used to identify the isolate and determine its phylogenetic position. Results indicated that the isolate was closely related to Corynebacterium matruchotii. To our knowledge, encrusted cystitis secondary to C matruchotii has not been previously identified in a horse.

The diagnostic and prognostic value of alkaline phosphatase activity in serum and peritoneal fluid from horses with acute colic.

Alkaline phosphatase (ALP) is an enzyme present in intestinal mucosa, bile, bone, and renal tubule cells. We sought to assess the diagnostic and prognostic relationships of total ALP (ALPt) activity and that of intestine-derived ALP (ALPi) in serum and peritoneal fluid of 126 horses with colic. ALPt and ALPi activities were measured in both serum and peritoneal fluid by using both standard and L-phenylalanine-based buffers, respectively. Neither ALPt nor ALPi activity were useful in classifying type or severity of intestinal damage. ALPt and ALPi activities in peritoneal fluid were lowest in horses suffering from simple medical colic (39 international units [U]/L [19-60 U/L]; versus 31 U/L [16-44 U/L], median [interquartile range], P < .001) and nonstrangulated surgical lesions (45 U/L [30-62 U/L] versus 36 U/L [23-54 U/L], P < .001), and highest in surgical cases with suspected ulceration (109 U/L [60-1,113 U/L] versus 83 U/L [52-970 U/L], P < .001), strangulation (114 U/L [69-240 U/L] versus 94 U/L [56-191 U/L], P < .001), peritonitis (313 U/L [110-2,227 U/L] versus 283 U/L [91-1,800 U/L], P < .001) or intestinal rupture (687 U/L [205-852 U/L] versus 564 U/L [166-732 U/L], P < .001). Higher ALPt and ALPi activities in peritoneal fluid were associated with greater intestinal damage, increased probability of surgery, and a worse prognosis. The use of L-phenylalanine buffer in both serum and peritoneal fluid did not improve the sensitivity of the test. Based on these results, total ALP activity in peritoneal fluid may help in identifying ischemic or inflammatory bowel lesions in horses with acute colic.

Necrotizing hepatitis associated with enteric salmonellosis in an alpaca.

Salmonella typhimurium was isolated from the feces of an alpaca suffering anorexia and weight loss. Multifocal necrotizing and suppurative hepatitis consistent with bacterial infection was found in the liver biopsies. Enteric salmonellosis may be associated with milder physical and clinicopathological changes in camelids than in other large animal species.

Use of chemotherapy for treatment of a mixed-cell thoracic lymphoma in a horse.

A 4-year-old Oldenburg mare was evaluated because of signs of lower airway disease and subsequently developed bilateral pleural effusion. Neoplastic cells were not identified in the fluid sample obtained via the initial thoracocentesis. A thoracic mass was detected radiographically, but its location prevented collection of a tissue sample. A diagnosis of lymphoma was made on the basis of results of immunophenotyping of pleural fluid specimens. Treatment of thoracic lymphoma in horses has been attempted, but there are limited data regarding chemotherapeutic-induced remission. In this horse, remission was achieved by use of a chemotherapeutic protocol consisting of administration of cytarabine, cyclophosphamide, and prednisolone. No adverse drug reactions were encountered during treatment. Immunophenotyping of cells in specimens of pleural fluid could be used to determine lymphocyte lineage and may be a useful alternative diagnostic modality when morphologic and cytologic examination of tissue specimens obtained via invasive techniques is not feasible.