Acid base imbalances in ill neonatal foals and their association with survival.

REASONS FOR PERFORMING STUDY: Acid-base imbalances observed in human paediatric patients are associated with outcome. Likewise, neonatal foals may have different acid-base imbalances associated with diagnosis or prognosis. OBJECTIVES: To determine acid-base imbalances by the quantitative method in ill neonatal foals and assess their association with diagnosis and prognosis. STUDY DESIGN: Observational prospective clinical study. METHODS: This study included 65 ill neonatal foals (32 septic, 33 nonseptic) admitted to an equine referral hospital from 2005 to 2011with acid-base parameters determined on admission and a control group of 33 healthy neonatal foals. Blood pH, pCO2 , sodium, potassium, chloride, L-lactate, albumin and phosphate concentrations were determined. Bicarbonate, globulin, measured strong ion difference (SIDm ), nonvolatile weak buffer concentrations (Atot ), base excess and its components were calculated. Analysis of covariance (ANCOVA) and multiple linear regression statistical analyses were performed. Results are summarised as mean ± s.d. for normally distributed variables and median [25-75th percentiles] for non-normally distributed ones. RESULTS: A total of 63% of ill foals had respiratory alkalosis and 58.5% had SIDm acidosis. The combination of both alterations was detected in 21 of 65 ill foals and abnormal pH was found in 24 of 65. Compared with healthy foals, ill foals had significantly lower SIDm (nonseptic 31.6 ± 6.3 [P<0.01] and septic 32.0 ± 6.4 [P<0.01] vs. control 40.3 ± 3.1 mmol/l), potassium (nonseptic 3.5 [3.3-3.8; P<0.01] and septic 3.6 [3.2-4.3; P = 0.01] vs. control 4.2 [3.8-4.5] mEq/l) and higher L-lactate (nonseptic 5.1 ± 4.2 [P = 0.01] and septic 5.0 ± 3.7 [P = 0.03] vs. control 2.5 ± 1.3 mmol/l). Significantly higher L-lactate and venous pCO2 were found in nonsurviving (6.4 ± 3.5 mmol/l [P = 0.04] and 51 ± 13 mmHg [P<0.01]) compared with surviving foals. CONCLUSIONS: The most common acid-base imbalances observed in ill foals were respiratory alkalosis, SIDm acidosis or mixed respiratory alkalosis with strong ion acidosis. Increased venous pCO2 and blood L-lactate concentration were associated with poor outcome.

Association Between Necropsy Evidence of Disseminated Intravascular Coagulation and Hemostatic Variables Before Death in Horses With Colic.

BACKGROUND: Disseminated intravascular coagulation (DIC) is frequent in horses with severe gastrointestinal disorders. Postmortem studies have found fibrin microthrombi in tissues of these horses, but studies relating these histopathological findings with antemortem hemostatic data are lacking. HYPOTHESIS: Antemortem classification of coagulopathy is related to the presence and severity of fibrin deposits observed postmortem in horses with severe gastrointestinal disorders. ANIMALS: Antemortem hemostatic profile data and postmortem tissue samples (kidney, lung, liver) from 48 horses with colic. METHODS: Tissue samples were stained with phosphotungstic acid hematoxylin and immunohistochemical methods for histological examination. A fibrin score (grades 0-4) was assigned for each technique, tissue and horse, as well as the presence or absence of DIC at postmortem examination. D-dimer concentration, prothrombin time (PT), activated partial thromboplastin time (aPTT), and antithrombin (AT) activity, as well as the clinicopathological evidence of coagulopathy, were determined from plasma samples collected 0-24 hours before death or euthanasia. Histologic and clinicopathologic data from the same horses were compared retrospectively. RESULTS: No association was found between antemortem classification of coagulopathy and postmortem diagnosis of DIC based on tissue fibrin deposition. None of the hemostatic parameters was significantly different between horses with or without postmortem diagnosis of DIC. There was no association between horses with fibrin in tissues or different cut-offs for D-dimer concentration and postmortem evidence of DIC. CONCLUSIONS AND CLINICAL IMPORTANCE: Abnormalities of the routine clotting profile, including D-dimer concentration, were not useful in predicting histologic evidence of DIC at necropsy in horses with severe gastrointestinal disorders.

Metabolic and endocrine profiles in sick neonatal foals are related to survival.

BACKGROUND: Sick neonatal foals suffer from a variety of endocrine and metabolic derangements that may be related to outcome. There are several hepatic and lipid metabolism blood markers that have never been assessed in neonatal foals. OBJECTIVES: Assess panel of endocrine and metabolic variables in group of sick and healthy neonatal foals in order to describe their relationship with diagnosis and survival. ANIMALS: All neonatal foals referred to Unitat Equina-Fundació Hospital Clínic Veterinari during 3 consecutive foaling seasons and a group of healthy foals. METHODS: Observational prospective study. Blood samples were obtained on admission and, when possible, after 24-48 h of hospitalization and immediately before discharge or death. Measured variables were triglycerides, nonsterified fatty acids, glucose, creatinine, urea, γ-glutamyltransferase, glutamate dehydrogenase (GLDH), insulin, cortisol, bile acids, and adrenocorticotropic hormone (ACTH). ACTH/cortisol and glucose/insulin ratios were calculated. RESULTS: Urea, creatinine, and cortisol had median concentrations in septic and nonseptic foals 2- to 8-fold higher than in the control group (P < .001). Median ACTH concentration in the septic group was approximately 4 times higher than in nonseptic and control foals (P < .001). ACTH/cortisol ratio was significantly lower in sick foals compared to control foals (P < .001). A score was designed including creatinine, GLDH, and cortisol. When ≥ 2 of these variables were altered (P < .001), the foal had 32 times more risk of dying (OR, 31.7; 95% CI, 7.7-130.3). CONCLUSIONS AND CLINICAL IMPORTANCE: Plasma creatinine, GLDH, and cortisol should be determined in sick newborn foals on admission because of their association with survival.

Energy expenditure of critically ill neonatal foals.

REASONS FOR PERFORMING STUDY: Nutritional support in critically ill neonatal foals is of great importance given their high metabolic rate and minimal stores of energy and protein. Nutrient requirements of healthy growing foals have been estimated based on daily milk intake; however, little is known about the resting energy expenditure (REE) of sick foals. OBJECTIVES: To determine REE in critically ill neonatal foals (sepsis and/or hypoxic-ischaemic encephalopathy [HIE] and compare this with REE in control foals. METHODS: Critically ill newborn foals admitted to the Fundació Hospital Clinic Veterinari, Universitat Autònoma de Barcelona, Spain from March 2009 to February 2011 were included in this study. Healthy neonatal foals and foals with nonsystemic conditions were used as controls. Oxygen consumption and CO2 production were measured with a respiratory monitor connected to a tight fitting facemask and REE (kcal/kg bwt/day) was calculated with the abbreviated Weir formula. Measurements were performed within 24 h of admission and repeatedly during hospitalisation. RESULTS: Twenty-seven foals were included (16 critically ill foals and 11 controls) and a total of 47 measurements were performed. In the critically ill, REE was reduced (mean +/- s.e. 49.5 +/- 2.1 kcal/kg bwt/day) on admission relative to the controls. In surviving foals (n = 5), REE before hospital discharge was not different (68.4 +/- 7.0 kcal/kg bwt/day) from control foals (64.8 +/- 2.7 kcal/kg bwt/day). CONCLUSIONS: REE was lower in critically ill foals upon admission (40-50 kcal/kg bwt/day) and normalised before hospital discharge (60-80 kcal/kg bwt/day). POTENTIAL RELEVANCE: Critically ill neonatal foals tolerating enteral feeding would receive approximately their REE when given 10% of their bodyweight in mare's milk daily. For sick neonates unable to tolerate enteral nutrition, provision of 50 kcal/kg bwt/day would be a reasonable goal for parenteral nutrition.

Clinical findings in 10 foals with bacterial meningoencephalitis.

REASONS FOR PERFORMING THE STUDY: Bacterial meningoencephalitis is a severe complication in septic foals and there is scarce and often unclear information in the equine literature. OBJECTIVES: To report the most frequent clinical signs, clinicopathological findings, causative agents, treatments given and outcome of a group of foals with confirmed bacterial meningoencephalitis. METHODS: Foals aged < 6 months of age admitted to the Universitat Autonoma de Barcelona (2004-2009) with confirmed bacterial meningoencephalitis were retrospectively included in the study Diagnosis of bacterial meningoencephalitis was made by cerebrospinal fluid (CSF) culture, CSF analysis consistent with bacterial infection, observation of bacteria in CSF cytology or postmortem confirmation. RESULTS: Nine neonates and one 5-month-old foal were included. The most frequently observed clinical signs were alterations in mental status (10/10), recumbency (8/10), weakness (8/10), abnormal pupillary light reflexes (6/10), decreased suckling-reflex (6/9), seizures and/or nystagmus (4/10). Common clinicopathological alterations included hyperfibrinogenaemia (8/9), hyperlactataemia (7/7), and neutropenia (5/10) or neutrophilia (5/10). Most neonates (8/9) developed bacterial meningoencephalitis despite having a sepsis score near the cut-off value (median = 12). On CSF analysis, pleocytosis (9/9), increased total protein concentration (5/6) and intracellular bacteria (6/9) were detected. The most frequently isolated bacterium was Escherichia coil. Once bacterial meningoencephalitis was diagnosed, antimicrobial therapy was switched to third and fourth generation cephalosporins. CONCLUSIONS: The diagnosis of bacterial meningoencephalitis is established based on CSF analysis and culture. Clinical recognition of bacterial meningoencephalitis is difficult and can be easily overlooked. Moreover, severe sepsis is not necessary to develop bacterial meningoencephalitis. POTENTIAL RELEVANCE: CSF analysis should be considered more often in sick newborn foals with signs indicative of central nervous system (CNS) involvement. Cerebrospinal fluid (CSF) cytology and culture would help to confirm or rule out unnoticed bacterial meningoencephalitis, and to choose appropriate antimicrobial therapy

Bronchoalveolar lavage fluid cytology and cytokine messenger ribonucleic Acid expression of racehorses with exercise intolerance and lower airway inflammation.

BACKGROUND: There is limited information relating bronchoalveolar lavage (BAL) cytology and cytokine messenger ribonucleic acid (mRNA) expression in racehorses with inflammatory airway disease (IAD). HYPOTHESIS AND OBJECTIVE: We hypothesize that cytokine expression in BAL cells would correlate with cytology. Thus, we evaluated the mRNA expression of selected cytokines in BAL cells in racehorses with exercise intolerance and lower airway inflammation. ANIMALS: Thirty-one client-owned Standardbred racehorses with exercise intolerance. METHODS: Prospective, observational study. Cells were obtained by BAL, and mRNA expression of interleukin (IL)-1ß, IL-4, IL-8, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ was determined by reverse transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS: Nine horses had normal BAL cell differential cytology (Controls), while 22 horses had evidence of IAD based on BAL fluid cytology. Relative expressions of TNF-α/glyceraldehyde 3-phosphate dehydrogenase (GAPDH; 0.0092 ± 0.010 versus 0.0045 ± 0.005, P= .034), IL-4/GAPDH (0.001 ± 0.002 versus 0.0003 ± 0.0003, P= .029), and IFN-γ/GAPDH (0.0027 ± 0.003 versus 0.0009 ± 0.001, P= .028) were greater in horses with IAD compared with controls. Furthermore, IL-4/GAPDH (0.001 ± 0.002 versus 0.0002 ± 0.0003, P < .0001) and IFN-γ/GAPDH (0.003 ± 0.003 versus 0.001 ± 0.001, P= .002) mRNA expression was increased in horses with increased metachromatic cell counts compared with horses with normal metachromatic cell counts. Only the mRNA expression of IL-1ß/GAPDH (1.1 ± 0.7 versus 0.3 ± 0.3, P= .045) was increased with airway neutrophilia. CONCLUSIONS AND CLINICAL IMPORTANCE: Differences in gene expression were associated with the presence of IAD and with specific cell types present in airway secretions of Standardbred racehorses with poor performance. These findings suggest that different pathophysiological pathways are implicated in IAD.

Acid-base imbalances during a 120 km endurance race compared by traditional and simplified strong ion difference methods.

REASONS FOR PERFORMING STUDY: Acid-base disturbances are traditionally assessed using the Henderson-Hasselbach equation. The simplified strong ion approach describes more accurately the complex acid-base and electrolyte abnormalities present in endurance horses. OBJECTIVE: To describe acid-base and electrolytes changes in fit horses competing in a FEI*** 120 km endurance race and to compare the traditional vs. strong ion approaches. METHODS: Thirty horses were initially enrolled in the study. Venous blood samples were obtained before the race (n = 25), at the second (n = 29; 65.4 km) and third vet-gates (n = 23, 97.4 km) and upon race completion (n = 17). Blood gas analysis was performed to determine pH, PCO(2), PO(2), Na(+), K(+) and iCa(++), and calculate HCO(3)(-), base excess and tCO(2). Packed cell volume and total protein, globulin, albumin, lactate, phosphate, glucose and creatinine concentrations, as well as muscle enzymes activities, were also determined. Calculated variables included strong ion difference (SIDm), strong ion gap (SIG) and nonvolatile buffer concentration (A(tot)). A longitudinal linear model using the general estimating equation methodology was used for statistical analysis. RESULTS: Mild but significant increases in PCO(2), SIDm, lactate, plasma protein, globulins and A(tot), as well as a decrease in potassium concentrations were observed from the second vet-gate to race finish when compared to prerace values (P < 0.05). Using the strong ion approach, 67% samples showed acid-base disturbances vs. 70% when using the traditional method, but their interpretations only matched in 24% of measurements. CONCLUSIONS: A complex acid-base imbalance characterised by a mild strong ion alkalosis (hypochloraemia attenuated by hyperlactataemia), nonvolatile buffer acidosis and compensatory mild respiratory acidosis were present in most horses, although pH did not significantly change during a 120 km endurance race. The strong ion approach to interpretation of acid-base balance should be favoured over the traditional approach in endurance horses, given the frequent and complex alterations in PCO(2), SIDm and A(tot) during a race.

Association of admission plasma D-dimer concentration with diagnosis and outcome in horses with colic.

BACKGROUND: Coagulopathies detected in horses with gastrointestinal problems seem to be associated with poor outcome. Plasma D-Dimer concentration is a sensitive test for assessing coagulopathies. HYPOTHESIS: Plasma D-Dimer concentration tested on admission is related to diagnosis and outcome in horses with colic. ANIMALS: Four hundred and ninety three horses referred for evaluation of abdominal pain. METHODS: Prospective observational clinical study. Horses were grouped according to diagnosis (medical and surgical intestinal obstructions, ischemic disorders with and without intestinal resection, enteritis, peritonitis), outcome (survivors, nonsurvivors), and number of coagulopathies (normal profile, 1 or 2 coagulopathies, subclinical disseminated intravascular coagulation [DIC]). Blood samples were collected on admission and plasma D-Dimer concentration, clotting times (PT and aPTT), and antithrombin activity were determined. Positive likelihood ratios (LR+) were calculated for evaluation of D-Dimer cut-off values, which were later tested in a logistic regression model. RESULTS: Horses with enteritis or peritonitis had significantly (P<.001) higher plasma D-Dimer concentrations and more severe coagulopathies on admission than horses with other diagnoses. Nonsurvivors also had significantly (P<.001) higher plasma D-Dimer concentrations at presentation than did survivors, and those horses with subclinical DIC on presentation had an odds ratio (OR) 8.6 (95% confidence interval [CI], 3.3-22.5, P<.001) for nonsurvival. Finally, D-Dimer concentrations>4,000 ng/mL had a LR+ of 5.9 and an OR 8.8 (95% CI, 4.5-17.1, P<.001) for nonsurvival. CONCLUSION AND CLINICAL IMPORTANCE: Plasma D-Dimer concentration measured on admission can be used to facilitate diagnosis and outcome prediction in horses with colic. A potential cut-off value for nonsurvival was found at approximately 4,000 ng/mL.

Low-molecular-weight heparin dosage in newborn foals.

BACKGROUND: Heparin is used in humans as prophylaxis of hypercoagulable states and disseminated intravascular coagulation (DIC). However, babies need a higher heparin dose than do adults. Septic neonate foals are at high risk of hypercoagulable state and DIC, and there is limited objective information about heparin dose for equine neonates. OBJECTIVE: To assess whether neonate foals require higher dosages of low-molecular-weight heparin (LMWH) than adults. ANIMALS: Eighteen healthy and 11 septic neonate foals. METHODS: Experimental and clinical studies. Firstly, healthy foals were randomly distributed in 2 groups, 1 receiving 50 IU/kg SC of dalteparin and the 2nd group receiving 100 IU/kg SC of dalteparin, once daily for 3 days. Blood samples were collected before and 3, 6, 27, and 51 hours after the 1st LMWH administration. Plasma antifactor-Xa activity was measured, together with hemostatic and hematologic parameters used to assess the risk of bleeding. Subsequently, septic foals were treated blindly either with placebo (saline) or 100 IU/kg of dalteparin for 3 days. Plasma antifactor-Xa activity and other hemostatic parameters were determined before and after treatment. RESULTS: Plasma antifactor-Xa activity in healthy foals was below prophylactic activity when using the adult dosage (50 IU/kg), whereas prophylactic activities were achieved when using the double dosage (100 IU/kg). No hemorrhagic events and erythrocyte-related complications were observed with either dosage. In the clinical study, only 4/6 septic foals had plasma antifactor-Xa activity adequate for prophylaxis. CONCLUSIONS AND CLINICAL IMPORTANCE: Equine neonates require higher dosages of LMWH compared with adults to reach prophylactic heparinemia.

Enteral fluid therapy in 108 horses with large colon impactions and dorsal displacements.

To assess the effect of enteral fluid therapy (EFT) in horses with colic, 78 adult horses with colon impactions and 30 with left dorsal colon displacements received an isotonic electrolyte solution via a nasogastric tube at a rate of 8 to 10 l every two hours until resolution of clinical signs. Clinical progression was monitored closely, and plasma biochemistry was evaluated before, during and after treatment. Volume of fluids, time to resolution, and outcome were also recorded. EFT was well tolerated by 102 of 108 horses and was an effective method to resolve 99 per cent of colon impactions and 83 per cent of displacements. For both groups, the mean (sd) time to resolution was 20.2 (5.2) hours and the volume of fluid administered was 118.6 (34.5) l. No relevant abnormalities were observed in most plasma biochemistry parameters during treatment, except for a mild haemodilution effect in 63 per cent of horses.

Uveal inflammation in septic newborn foals.

BACKGROUND: Septicemia in humans is described as a leading cause of uveitis, which eventually can induce blindness. HYPOTHESIS/OBJECTIVES: Uveal inflammatory findings could be related to sepsis severity in newborn foals and might be used as an indirect indicator for survival. ANIMALS: Seventy-four septic foals, 54 nonseptic foals, and 42 healthy foals. METHODS: Prospective observational clinical study. A detailed blinded, ophthalmic examination was performed by boarded ophthalmologists on all admitted newborn foals. Foals were grouped as septic (when blood culture resulted positive or the sepsis score was > or =14), nonseptic, and controls. Based on blood culture results, the septic group was subdivided into bacteremic and nonbacteremic foals. RESULTS: Blood culture was performed in 62/74 septic foals, from which 35 (56%) were bacteremic and 27 (44%) were non-bacteremic. Anterior uveitis was diagnosed in a significantly (P < .005) higher number of septic/bacteremic foals (14/35, 40%) than in septic/nonbacteremic foals (5/27, 19%), nonseptic foals (4/54, 7%), and control foals (0%). Anterior chamber fibrin was only observed in 4/14 (29%) septic/bacteremic foals with anterior uveitis. Anterior uveitis was also associated with posterior uveitis in 6/35 (19%) septic/bacteremic foals. The diagnosis of uveitis was related to nonsurvival (P = .001, odds ratio = 6.2, 95% confidence interval = 2.1-18.2). CONCLUSIONS AND CLINICAL IMPORTANCE: Anterior uveitis is highly prevalent in septic newborn foals, especially in those with a positive blood culture, and it should be considered as a survival prognostic factor.

Theophylline does not potentiate the effects of a low dose of dexamethasone in horses with recurrent airway obstruction.

REASONS FOR PERFORMING STUDY: Theophylline has been shown to have corticosteroid-sparing effects for the treatment of human asthma. A similar effect, if present in horses, would allow diminishing the dose of corticosteroids administered to equine patients with inflammatory airway diseases. OBJECTIVES: To evaluate whether theophylline potentiates the effects of a low dose of dexamethasone when treating horses with recurrent airway obstruction (RAO). HYPOTHESIS: Theophylline has steroid-sparing effects in horses with RAO. METHODS: Ten mature mixed breed horses in clinical exacerbation of RAO were studied. Using an incomplete crossover design and 3 experimental periods of 7 days duration, horses were distributed randomly in 5 treatment groups; and administered dexamethasone s.i.d., at either 0.05 mg/kg bwt i.v. or per os, or 0.02 mg/kg bwt alone or combined with theophylline at 5 mg/kg bwt per os b.i.d. A fifth group was treated with theophylline alone at the above dosage. Lung function was evaluated prior to drug administration and then 3 and 7 days later. RESULTS: Oral administration of dexamethasone alone or combined with theophylline failed to improve lung function significantly in RAO affected horses. Theophylline alone also failed to improve lung function in all treated horses. Conversely, dexamethasone administration at 0.05 mg/kg bwt i.v. resulted in a significant improvement in lung function starting on Day 3. CONCLUSIONS AND POTENTIAL RELEVANCE: Oral theophylline for 7 days did not improve the effects of a low dose of dexamethasone for the treatment of horses with RAO.

New insights from age determination on toxic element accumulation in striped and bottlenose dolphins from Atlantic and Mediterranean waters.

This study aimed at comparing toxic element (Hg, Cd) bioaccumulation in relation to age for bottlenose (Tursiops truncatus) and striped dolphins (Stenella coeruleoalba) from Mediterranean and Atlantic waters. Metal concentrations were also measured in selected prey to infer metal exposure through the diet. As expected, Mediterranean prey exhibited the highest Hg levels, probably as a consequence of the Hg enrichment of the Mediterranean Sea. Comparing the predators from each area and taking age into account, Mediterranean bottlenose dolphins displayed higher Hg levels than Atlantic dolphins (p = 0.032), whereas Mediterranean striped dolphins did not (p = 0.691). The consumption of Myctophid fish, which showed the highest Hg levels (105+/-80 ngg(-1) w.wt.) among Atlantic prey, may explain the high Hg levels in the liver of the Atlantic striped dolphins and suggested a preferential offshore feeding behaviour in this area. Concerning Cd, no clear differences were found between geographical areas.

[Problems in emergency visceral reconstruction in colorectal pathology]. / Problematiche della ricostruzione viscerale in urgenza nella patologia colo-rettale.

A diagnostic-therapeutic protocol for colorectal haemorrhage is suggested. The Authors underline the need to remove inflammatory foci when a perforation of the colon occurs; furthermore, in the acute obstruction due to colorectal carcinoma a resection followed, when possible, by an immediate anastomosis is recommended.

[Chronic splenic tuberculosis. Description of a case]. / La tubercolosi splenica cronica. Descrizione di un caso.

The authors report a case of chronic splenic tuberculosis. They underline the diagnostic difficulties, notwithstanding the remarkable progresses in radiological technics, essentially related to the rarity of this tubercular site and they outlined the exact surgical indication to the splenectomy.

[Indications for and comparisons between transduodenal papillostomy and choledochoduodenostomy]. / Indicazioni e confronti tra papillostomia transduodenale e coledocoduodenostomia.

Biliary lithiasis is still a subject of great interest. The aim of surgical treatment is removing common bile duct stones and assuring a good biliary outflow. In this study the authors report their experience in the surgical treatment of common bile duct stones and the indications for transduodenal papillostomy (PST) and latero-lateral choledochoduodenostomy (CDA). The results are similar to those in the international literature and are surely good for both the procedures. Papillostomy is the procedure of choice, unless there are specific contraindications, in the treatment of common bile duct lithiasis for the following reasons: good immediate and long-term results, low incidence of postoperative complications, prevention of recurrent lithiasis. Choledochoduodenostomy, when clearly indicated, offers good results and, when the anastomosis is large enough, also has a low incidence of postoperative complications. Finally PST and CDA are not alternative procedures but present precise indications. The authors stress the possibility of combining these two techniques, in selected cases, with good results.