Evaluation of a laryngotomy approach for near-total resection of the nasal septum in the horse.

OBJECTIVE: To report a laryngotomy approach for the removal of the nasal septum in adult horses. STUDY DESIGN: Descriptive study. ANIMALS: Horses (n = 10). METHODS: Near-total resection of the nasal septum was made using a modification of a previously reported 3-wire technique using a trephination approach and a 2-wire technique using a laryngotomy approach. Surgical time, ease of technique, complications, and outcome were recorded. At 45 days, horses were euthanatized and septal measurements made. RESULTS: Near-total resection of the nasal septum was accomplished with both techniques without complications. Incisional complications occurred in the trephination group and transient granulation tissue formation near the rostral stump occurred in the laryngotomy group. The laryngotomy technique was technically easier and resulted in a more cosmetic outcome. CONCLUSIONS: A laryngotomy approach is safe and expedient for near-total resection of the nasal septum with minimal complications.

Resection and anastomosis of the descending colon in 43 horses.

OBJECTIVES: To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. STUDY DESIGN: Multicentered case series. ANIMALS: Horses (n=43) that had descending colon resection and anastomosis. METHODS: Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short-term survival (hospital discharge). Long-term survival was defined as survival > or =6 months after hospital discharge. RESULTS: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty-eight of 30 horses with follow-up information survived > or =6 months. No significant associations between perioperative factors and short-term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). CONCLUSIONS: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival > or =6 months. The most common cause of small colon incarceration was strangulating lipoma. CLINICAL RELEVANCE: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.

Indications for and short- and long-term outcome of permanent tracheostomy performed in standing horses: 82 cases (1995-2005).

OBJECTIVE: To identify indications for and short- and long-term outcome of permanent tracheostomy performed in standing horses. DESIGN: Retrospective case series. ANIMALS: 82 horses undergoing permanent tracheostomy. PROCEDURES: Data obtained from medical records included signalment, diagnosis, surgical technique, complications, use of the horse before and after surgery, and owner satisfaction. Follow-up information was obtained through a telephone questionnaire administered to owners. RESULTS: Indications for permanent tracheostomy included nasopharyngeal cicatrix (n = 59), arytenoid chondropathy (55), and laryngeal hemiplegia (20); 54 horses had multiple indications for tracheostomy. Complications identified prior to discharge included partial dehiscence (n = 8), transient fever (10), and excessive swelling (13). Complications identified after discharge included partial dehiscence (n = 3), inversion of skin (2), and stenosis of the tracheostomy requiring repair (1). Long-term follow-up information was available for 64 horses. Fifty-seven of the 64 (89%) horses returned to their previous use, and owners of 63 (98%) horses reported being very satisfied with the results. The owner of 1 (2%) horse was unsatisfied with the results. The 1-year survival rate was 97% (95% confidence interval, 95% to 100%). Mean estimated truncated survival time (ie, failure-free period) was 9.7 years (95% confidence interval, 9.3 to 10.1 years). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that permanent tracheostomy can be safely performed in standing horses and was a viable treatment for horses with obstructive disease of the upper respiratory tract that was unresponsive to medical treatment or other surgical treatments.

Outcome of medical and surgical treatment of cecal impaction in horses: 114 cases (1994-2004).

OBJECTIVE: To determine short- and long-term outcomes, including recurrence rates, for horses with cecal impaction treated medically or surgically. DESIGN: Retrospective case series. ANIMALS: 114 horses. PROCEDURES: Medical records were reviewed for information on signalment, history, clinical findings, treatment (medical vs surgical), and short-term outcome. Information on longterm outcome was obtained through a mail survey and telephone interview with owners. RESULTS: 54 horses were treated medically, 49 horses were treated surgically, and 11 horses were euthanized after initial examination without further treatment. Horses treated surgically were significantly more likely to have signs of moderate or severe pain than were horses treated medically. Forty-four of the 54 (81%) horses treated medically were discharged from the hospital. Twelve of the 49 horses treated surgically were euthanized at surgery because of cecal rupture. Thirty-five of the 37 (95%) horses that were allowed to recover from surgery were discharged from the hospital. In 34 horses treated surgically, typhlotomy without a bypass procedure was performed. Long-term (>or= 1 year) follow-up information was available for 19 horses treated medically and 28 horses treated surgically. Eighteen (95%) and 25 (89%) of the horses, respectively, were alive at least 1 year after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that medical and surgical treatment were both associated with favorable outcomes in horses with cecal impactions. In this population, typhlotomy alone without cecal bypass was associated with a low recurrence rate. The long-term prognosis for horses that were discharged from the hospital was good.

Dietary risk factors and colonic pH and mineral concentrations in horses with enterolithiasis.

A prospective, unmatched case control study was performed to identify dietary and environmental risk factors for enterolithiasis in horses in California and to determine whether colonic ingesta analyses differed between horses with and without enteroliths. Forty-three horses with enterolithiasis were compared with 19 horses with surgical colic attributable to nonstrangulating obstruction of the colon without enteroliths. Colonic ingesta samples were collected at surgery from horses with enteroliths and control horses. Colonic pH and colonic concentrations of magnesium, phosphorus, sulfur, sodium, calcium, potassium, and nitrogen were measured. Questionnaires were distributed to owners to determine diet and management practices. Student's t-test and Mann-Whitney tests were used to evaluate differences in pH, dry matter content, percent nitrogen, and mineral content. Associations between dietary and management risk factors and enterolith occurrence were quantified by odds ratios. Mean pH of colonic contents from horses with enterolithiasis was significantly higher than for control horses. Horses with enterolithiasis had significantly lower percent dry matter in colonic fecal samples and higher mean mineral concentrations than controls. On the basis of reported feeding and management practices, horses with enterolithiasis were fed a significantly higher proportion of alfalfa in their diet and were less likely to have daily access to pasture grass than horses without enteroliths. Results suggest that decreasing alfalfa consumption and allowing daily access to pasture grazing might reduce the risk of enterolithiasis. Dietary modifications promoting acidification of colonic contents and dilution of minerals might be beneficial as preventive measures for enterolithiasis in horses.

Expression of the ether-a-go-go (ERG) potassium channel in smooth muscle of the equine gastrointestinal tract and influence on activity of jejunal smooth muscle.

OBJECTIVE: To determine whether ether-a-go-go (ERG) potassium channels are expressed in equine gastrointestinal smooth muscle, whether ERG channel antagonists affect jejunal muscle contraction in vitro, and whether plasma cisapride concentrations in horses administered treatment for postoperative ileus (POI) are consistent with ERG channels as drug targets. SAMPLE POPULATION: Samples of intestinal smooth muscle obtained from 8 horses free of gastrointestinal tract disease and plasma samples obtained from 3 horses administered cisapride for treatment of POI. PROCEDURE: Membranes were prepared from the seromuscular layer of the duodenum, jejunum, ileum, cecum, large colon, and small colon. Immunoblotting was used to identify the ERG channel protein. Isolated jejunal muscle strips were used for isometric stress response to ERG channel blockers that included E-4031, MK-499, clofilium, and cisapride. Plasma concentrations of cisapride were determined in 3 horses administered cisapride for treatment of POI after small intestinal surgery. RESULTS: Immunoblotting identified ERG protein in all analyzed segments of the intestinal tract in all horses. The selective ERG antagonist E-4031 caused a concentration-dependent increase in jejunal contraction. Clofilium, MK-499, and cisapride also increased jejunal contraction at concentrations consistent with ERG channel block; effects of E-4031 and cisapride were not additive. Peak plasma cisapride concentrations in treated horses were consistent with ERG block as a mechanism of drug action. CONCLUSIONS AND CLINICAL RELEVANCE: The ERG potassium channels modulate motility of intestinal muscles in horses and may be a target for drugs. This finding may influence development of new prokinetic agents and impact treatment of horses with POI.

Comparison of insertion time and pullout strength between self-tapping and non-self-tapping AO 4.5-mm cortical bone screws in adult equine third metacarpal bone.

OBJECTIVE: To compare screw insertion characteristics and pullout mechanical properties between self-tapping (ST) and non-self-tapping (NST) AO 4.5-mm cortical bone screws in adult equine third metacarpal bone (MC3). STUDY DESIGN: In vitro biomechanical experiment. ANIMALS OR SAMPLE POPULATION: Seven pairs of adult equine MC3. METHODS: Bicortical holes were drilled transversely in proximal metaphyseal, diaphyseal, and distal metaphyseal locations of paired MC3. NST screws were inserted in pre-tapped holes in 3 sites of one bone pair, and ST screws were inserted in non-tapped holes of contralateral MC3. Tapping and screw insertion times and maximum torques were measured. Screw pullout mechanical properties were determined. RESULTS: Screw insertion time was longer for ST screws. Total time for tapping and insertion (total insertion time) was over twice as long for NST screws. Statistically significant differences were not observed between screws for any pullout mechanical property. From pullout tests, diaphyseal locations had significantly stiffer and stronger structure than metaphyseal locations. Pullout failure more commonly occurred because of screw breakage than bone failure. Bone failure and bone comminution were more commonly associated with ST screws. Bone failure sites had pullout failure loads that were 90% of screw failure sites. CONCLUSIONS: NST and ST 4.5-mm-diameter cortical bone screws have similar pullout mechanical properties from adult equine MC3. ST screws require less than half the total insertion time of NST screws. CLINICAL RELEVANCE: Use of ST 4.5-mm-diameter cortical bone screws should be considered for repair of adult equine MC3 fractures; however, bone failures at screw sites should be monitored.