Peritoneal bile acids concentration in adult horses with hepatic and gastrointestinal disorders.

BACKGROUND: Peritoneal bile acids concentration (PBAC) has not been previously reported in horses. A case of liver lobe torsion in which increased PBAC was detected prompted us to study PBAC in horses. OBJECTIVES: (a) To determine a reference range of PBAC in horses; (b) to compare PBAC from horses with either hepatic or gastrointestinal disease and healthy horses and (c) to assess the prognostic and diagnostic values of PBAC. STUDY DESIGN: Prospective case-control. METHODS: Prospective observational clinical study. Bile acids concentrations were measured in both plasma and peritoneal fluid in selected clinical patients with hepatic or gastrointestinal disease (n = 108) and healthy horses (n = 11). Sixty-eight of 108 patients survived to hospital discharge, and the remaining 40 were nonsurvivors. Additionally, other haematological and biochemistry analyses were performed. RESULTS: Sick horses were classified according to diagnosis into hepatic (n = 13), gastrointestinal (GI) obstructive (n = 48) and GI ischaemic-inflammatory (n = 47) groups. The hepatic group had significantly higher PBAC (6.8 [2.3-9.4]; median [IQR]) than the control (1.0 [0.6-1.5]) and GI obstructive groups (1.2 [0.8-1.7] µmol/L; P < .001). Moreover, the GI ischaemic-inflammatory group (3.3 [1.4-5.5]) also had significantly higher values than the control and GI obstructive groups (P < .001). Regarding outcome, the nonsurvivor group (n = 40) had significantly higher median PBAC value than the survivor group (n = 68, 4.1 [1.6-6.5] vs 1.3 [0.8-3]; P < .001). MAIN LIMITATIONS: A higher number of horses with abdominal disease is required to confirm the clinical significance of these findings. CONCLUSIONS: PBAC may have a role in the diagnosis of hepatic and gastrointestinal disease and as a prognostic tool in horses with abdominal pain.

Plasma iron concentrations and systemic inflammatory response syndrome in neonatal foals.

BACKGROUND: Sparse information regarding plasma iron concentration in neonatal foals and its utility as an inflammatory marker in this population has been published. OBJECTIVES: To determine the physiologic plasma iron concentration in neonatal foals. To assess its utility as an inflammatory marker to predict systemic inflammatory response syndrome (SIRS) and as a prognostic marker. ANIMALS: Forty-seven ill neonatal foals admitted to a referral equine hospital were divided in 2 groups based on the SIRS criteria (24 SIRS and 23 non-SIRS). Two control groups of 43 hospital and 135 stud farm healthy neonatal foals were also included. METHODS: Observational prospective study. Data were summarized by mean and its 95% confidence interval and absolute frequency and percentage for quantitative andqualitative variables. One-way ANOVA, ANCOVA (group and age effects) and Dunnett as posthoc analysis were used to compare plasma iron concentration among groups. RESULTS: Neonatal foals with SIRS did not have had any statistically significant different plasma iron concentrations compared to non-SIRS (P = .56) and stud farm control group (P = .99), 172.8 µg/dL (95% CI; 126.0-219.6), 193.1 µg/dL (139.1-247.2), and 181.8 µg/dL (171.3-192.4), respectively. Plasma iron concentration had a large variability in healthy neonatal foals, and was negatively correlated with age in hospital controls (rho = -0.387) and sick neonatal foals (rho = -0.598) (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Plasma iron was not a useful marker of SIRS in neonatal foals and was not associated with outcome.

Prognostic value of measuring heart rate variability at the time of hospital admission in horses with colic.

OBJECTIVE: To evaluate the prognostic value of measuring heart rate variability (HRV) in horses with colic at the time of admission to a referral hospital. ANIMALS: 51 horses > 1 year of age with colic (41 that survived [survivors] and 10 that died or were euthanized [nonsurvivors]). PROCEDURES: HRV was recorded within 1 hour after admission by use of heart rate sensors with horses restrained in stocks. A 5-minute recording period was analyzed to obtain HRV measurements (eg, SD of R-R intervals [SDRR], root mean square of successive differences between R-R intervals [RMSSD], and geometric SDs determined from Poincaré plots [SD1 and SD2]). Variables associated with outcome (survival vs nonsurvival) were identified. Measurements were compared among diagnostic categories for colic (obstructive, inflammatory, or ischemic). RESULTS: SDRR and RMSSD were significantly higher in survivors (median [25th to 75th percentile], 91.0 milliseconds [78.9 to 114.6 milliseconds] and 64.8 milliseconds [40.9 to 78.4 milliseconds], respectively) than in nonsurvivors (50.7 milliseconds [29.1 to 69.2 milliseconds] and 33.4 milliseconds [12.6 to 47.9 milliseconds], respectively). Similarly, SD1 and SD2 were significantly higher in survivors (48.3 milliseconds [28.9 to 60.9 milliseconds] and 111.3 milliseconds [93.0 to 146.6 milliseconds], respectively) than in nonsurvivors (23.7 milliseconds [8.9 to 33.9 milliseconds] and 65.1 milliseconds [33.7 to 91.9 milliseconds], respectively). The SDRR and SD2 were significantly higher for horses with obstructive colic than for horses with ischemic colic. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of HRV in horses with colic may provide information on the underlying cause and be helpful in identifying horses less likely to survive.

Investigation of ventricular pre-excitation electrocardiographic pattern in two horses: clinical presentation and potential causes.

Two horses referred to the Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, for unrelated clinical problems, and with no previous history of cardiac disease exhibited an intermittent ventricular pre-excitation electrocardiographic pattern during hospitalization. Both animals showed decreased plasma total and ionized magnesium concentrations, but no other relevant electrolyte disturbances were detected. Altered interventricular septal motion associated with ventricular pre-excitation beats (VPBs) was detected on M-mode echocardiography in both horses. The likely localization of an accessory pathway (AP) was identified in case 2 using pulsed-wave tissue Doppler imaging in the left anterior paraseptal location. Decreased frequency of the VPB was observed with long-term magnesium supplementation and restoration of plasma magnesium concentrations. The presence of ventricular pre-excitation electrocardiographic pattern was attributed to higher sensitivity of the AP to hypomagnesemia in both cases.

Myelographic and low-field magnetic resonance imaging findings in dogs with presumptive acute hydrated non-compressive nucleus pulposus extrusion.

MRI is considered gold standard for the diagnosis of presumptive acute hydrated non-compressive nucleus pulposus extrusions (AHNCNPE). This retrospective study describes the myelographic findings in dogs with AHNCNPE diagnosed by low-field MRI and their association with neurological grade, need of surgical decompression and outcome. Forty-two myelographies (21 dogs with presumptive AHNCNPE, 21 dogs with Hansen type I disc disease herniation) were blindly evaluated. Site of herniation, compression pattern, ratio of length of the lesion to length of the second lumbar vertebra (LL:L2) and degree of spinal cord compression (SCC) were measured on the myelographies of dogs with presumptive AHNCNPE and were compared with the corresponding MRI features. Percentage of extruded volume of nucleus pulposus (VNP) was calculated on MR images. Myelographic interobserver agreement for presumptive diagnosis of AHNCNPE was almost perfect (κ=0.8). Accuracy of myelography to detect site of herniation was 80.9 per cent and to identify extradural compression was 57.1 per cent. Mean SCC was 5.8±2.6 per cent for myelography and 6.6±3 per cent for MRI. Mean LL:L2 ratio was 1.7±0.9 for myelography and 1.2±0.8 for MRI. Mean percentage of extruded VNP was 40±14 per cent, and it was positively associated with neurological grade.

Evaluation of an oral direct factor Xa inhibitor anticoagulant in healthy adult horses.

OBJECTIVE: To assess whether an oral direct factor Xa inhibitor (DiXaI) anticoagulant drug used at the low end of the recommended dose in people achieves presumed prophylactic plasma concentrations and does not induce bleeding in horses. DESIGN: Experimental study. SETTING: Field study. ANIMALS: Ten healthy adult horses. INTERVENTIONS: A DiXaI was administered at a dose of 0.125 mg/kg every 24 h orally for 4 days. Following a wash-out period of 2 weeks, 8 of 10 horses received daily subcutaneous doses of a low molecular weight heparin (dalteparin) for 4 consecutive days at 50 IU/kg. In both trials, antifactor Xa activity was measured at baseline time and 3 hours after each dose administration. Activated partial thromboplastin time, prothrombin time, hematocrit, erythrocyte agglutination, and platelet aggregation were monitored throughout the study. In addition, an in vitro spiking experiment was performed to demonstrate anticoagulant activity of this DiXaI in horse plasma. MAIN RESULTS: When treated with the DiXaI, this group of horses did not achieve the suggested thromboprophylactic plasma range of antifactor Xa activity (0.1-0.2 IU/mL), except for 1 horse after the first administration of the drug. In contrast, median values of plasma antifactor Xa activity 3 hours after receiving dalteparin were within the prophylactic range (0.16 IU/mL). No hemorrhagic events or erythrocyte agglutination were observed. In vitro addition of this DiXaI caused a concentration-dependent effect in antifactor Xa activity. CONCLUSIONS: At the low end of the recommended dose in people this oral formulation of DiXaI did not reach prophylactic plasma antifactor Xa activity in this group of healthy adult horses. Further studies are warranted in order to establish the prophylactic dose for horses.

Simplified strong ion difference approach to acid-base balance in healthy foals.

OBJECTIVE: To determine the strong ion difference (SIDa ) and total nonvolatile weak buffers (ATOT ) in healthy foals during the first year of life and to compare reference biochemistry laboratory with analyzers available during emergency hours. DESIGN: Prospective study performed over 2 years. SETTING: University teaching hospital. ANIMALS: Two hundred thirty-six healthy foals distributed in 6 groups: A (21 days-2 months), B (2-3 months), C (3-6 months), D (6-9 months), E (9-12 months), and 33 neonatal foals (< 21 days old). INTERVENTIONS: Blood samples were obtained to determine L-lactate, sodium, potassium, chloride, and total plasma protein concentrations. In neonatal foals, samples were analyzed using 4 different devices. Reference intervals of SIDa and ATOT for each of the analyzers under comparison were established using mean ± 2 standard deviations. Age effect was evaluated using one-way ANOVA analysis. Linear regression in neonatal foals was employed to obtain a new equation to estimate ATOT from total plasma protein concentration. MEASUREMENTS AND MAIN RESULTS: A significant age effect was observed for ATOT and SIDa . In all foals younger than 6 months, ATOT values were lower than in older foals (P < 0.003). A clinically and statistically significant difference in SIDa was detected only in the neonatal period (P < 0.001). The equation to estimate ATOT from total plasma protein adjusted for neonatal foals is ATOT = 2.5 × total plasma protein concentration. CONCLUSIONS: Reference intervals of ATOT should be considered different from adults during the first 6 months of life in horses. Regarding SIDa , values should be considered different only during first 21 days of life.

Canine intracranial meningiomas: Immunohistochemical evaluation of tissue factor, fibrin/fibrinogen and D-dimers.

The haemostatic system influences angiogenesis, cell growth and metastasis in solid tumours. The aim of this study was to investigate tissue factor (TF) expression, fibrin/fibrinogen and D-dimer deposition, as well as the occurrence of intravascular thrombosis (IVT) in canine intracranial meningiomas using immunohistochemistry. All but three (26/29) meningiomas expressed TF. TF immunolabelling was significantly higher in high-grade (grades II and III) than in low-grade (grade I) meningiomas. Fibrin/fibrinogen and D-dimer deposits were detected in all meningiomas and staining scores were statistically different between different meningioma grades. IVT was detected in 19/29 specimens, but no statistical differences were observed between different malignancy grades. In conclusion, the haemostatic system may be involved in meningioma pathobiology and may be a potential therapeutic target for canine meningiomas, as also suggested for human meningiomas.

Parallel testing of plasma iron and fibrinogen concentrations to detect systemic inflammation in hospitalized horses.

OBJECTIVES: To determine if plasma iron concentration is different between horses with and without systemic inflammation (SI) and to assess the accuracy for the detection of SI by assaying plasma iron and fibrinogen concentrations, individually or combined. To assess the prognostic value of plasma iron concentration and to describe the progression of plasma iron and fibrinogen concentrations during hospital follow-up, and its relation to SI and survival. DESIGN: Prospective observational study evaluating plasma iron and fibrinogen. SETTING: University veterinary teaching hospital. ANIMALS: Equine patients greater than 30 days of age. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Plasma iron and fibrinogen concentration was prospectively determined in hospitalized horses. Horses were classified into 2 groups: SI and non-SI. Horses were also classified according to clinical outcome. A group of control healthy horses was also included. A total of 135 horses were included in the study. Plasma iron concentration was significantly lower and fibrinogen concentration was higher in the SI group. Nonsurvivors had a mean plasma fibrinogen concentration significantly higher than survivors. The combination of plasma iron and fibrinogen has a high degree of specificity, sensitivity, and accuracy for the detection of SI in horses. Follow-up measurements were obtained in 48 horses. Surviving horses normalized plasma iron concentration during follow-up examination whereas nonsurviving horses had persistently low plasma iron concentrations. CONCLUSIONS: Plasma iron concentration alone is an accurate marker of SI in hospitalized horses. Alteration of both plasma iron and fibrinogen concentrations improves the specificity and positive predictive value for diagnosis of SI. Alteration of either one of both increases sensitivity and negative predictive value. Surviving horses normalized plasma iron concentrations during follow-up period. The combination of plasma iron and fibrinogen concentrations may help in the detection of SI. Follow-up of plasma iron concentrations may provide useful prognostic information.

Immunohistochemical evaluation of tissue factor, fibrin/fibrinogen and D-dimers in canine gliomas.

In human gliomas, tissue factor (TF) is overexpressed, associated with the grade of malignancy and influences tumour biology. Intra-tumoural fibrin/fibrinogen deposition and activation of the fibrinolytic system also play a role in tumour cell proliferation and angiogenesis. The first aim of the present study was to investigate TF expression and the presence of fibrin/fibrinogen and D-dimers in canine glioma biopsies, graded according to the World Health Organization (WHO) classification of tumours of the central nervous system. The second aim was to investigate the occurrence of intravascular thrombosis (IVT) in canine gliomas, as a potential histological marker of glioma type or grade of malignancy. An immunohistochemical study using antibodies against TF, fibrin/fibrinogen and D-dimers was performed with 24 glioma samples, including 15 oligodendrogliomas, 6 astrocytomas and 3 mixed gliomas. Immunohistochemical data were statistically analysed to determine whether there was any relationship between glioma type and grade of malignancy. All gliomas were moderate to strongly positive for TF and the staining score was significantly higher (P = 0.04) in high-grade (III or IV) than in low-grade (II) gliomas. Intra-tumoural fibrin/fibrinogen deposition was detected in all tumour biopsies assessed, and D-dimers were detected in 17/24 gliomas. IVT was a frequent finding, but was not linked to a specific glioma type or malignancy grade. TF expression, fibrin/fibrinogen deposition, extravascular fibrinolytic system activation and IVT occur in canine gliomas. Canine glioma might be a suitable model for studying coagulation and fibrinolysis as potential therapeutic targets for human gliomas.