Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horses.

REASONS FOR PERFORMING STUDY: The success rate of prosthetic laryngoplasty is limited and may be associated with significant sequelae. Nerve muscle pedicle transplantation has been attempted but requires a year before function is restored. OBJECTIVE: To determine the optimal parameters for functional electrical stimulation of the recurrent laryngeal nerve in horses. METHODS: An experimental in vivo study was performed on 7 mature horses (2-21 years). A nerve cuff was placed on the distal end of the common trunk of the recurrent laryngeal nerve (RLN). In 6 horses the ipsilateral adductor branch of RLN was also transected. The electrodes were connected to programmable internal stimulator. Stimulation was performed using cathodic phase and then biphasic pulses at 24 Hz with a 0.427 ms pulse duration. Stimulation-response experiments were performed at monthly intervals, from one week following implantation. The study continued until unit failure or the end of project (12 months). Two of the horses were stimulated continuously for 60 min to assess onset of fatigue. RESULTS: Excellent arytenoid cartilage abduction (mean arytenoid angle of 52.7 degrees, range 48.5-56.2 degrees) was obtained in 6 horses (laryngeal grades I or II (n = 3) and III (n = 2). Poor abduction was obtained in grade IV horses (n = 2). Arytenoid abduction was maintained for up to a year in one horse. Technical implant failure resulted in loss of abduction in 6 horses at one week to 11 months post operatively. Mean tissue impedance was 1.06 kOhm (range 0.64-1.67 kOhm) at one week, twice this value at 2 months (mean 2.32, range 1.11-3.75 kOhm) and was stable thereafter. Maximal abduction was achieved at a stimulation range of 0.65-7.2 mA. No electrical leakage was observed. Constant stimulation of the recurrent laryngeal nerve for 60 min led to full abduction without evidence of muscle fatigue. CONCLUSIONS: Functional electrical stimulation of the recurrent laryngeal nerve leading to full arytenoid abduction can be achieved. The minimal stimulation amplitude for maximal abduction angle is slightly higher than those for man and dogs. CLINICAL RELEVANCE: This treatment modality could eventually be applicable to horses with recurrent laryngeal neuropathy.

Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997-2007).

REASONS FOR PERFORMING STUDY: The success of combined prosthetic laryngoplasty with ipsilateral ventriculocordectomy (LPVC) has not been compared to that of partial arytenoidectomy (PA) in a clinical population. HYPOTHESES: In Thoroughbred (TB) racehorses: (1) earnings after LPVC are unaffected by the severity of recurrent laryngeal neuropathy (RLN) (laryngeal grade III vs. grade IV); (2) LPVC and PA yield similar results in the treatment of grade III RLN; (3) performance outcome following PA is independent of diagnosis (RLN vs. unilateral arytenoid chondritis [UAC]); and (4) neither LPVC nor PA returns horses to the level of performance of controls. METHODS: Medical and racing records of 135 TB racehorses undergoing LPVC or PA for the treatment of grade III or IV RLN or UAC were reviewed. Racing records of age and sex matched controls were also reviewed. RESULTS: After LPVC, horses with grade III RLN performed better compared to those with grade IV RLN. Furthermore, horses treated for grade III RLN by LPVC showed post operative earnings comparable to controls. Rate of return to racing were similar for PA and LPVC, although LPVC resulted in higher post operative earnings. Performance after PA was similar regardless of diagnosis (UAC or RLN). Finally, neither LPVC when performed for grade IV RLN, nor PA performed for either diagnosis restored post operative earnings to control levels. CONCLUSIONS: Thoroughbred racehorses treated by LPVC for grade III RLN show significantly better post operative earnings compared to horses treated for grade IV disease. In grade III RLN, LPVC returns earning potential to control levels. PA and LPVC lead to similar success in terms of rate of return to racing, but PA leads to inferior earnings after surgery. POTENTIAL RELEVANCE: Laryngoplasty should be recommended for all TB racehorses with grade III RLN to maximise return to racing at a high level. This contradicts the common approach of waiting for complete paralysis.

Equus caballus papillomavirus 8 (EcPV8) associated with multiple viral plaques, viral papillomas, and squamous cell carcinoma in a horse.

BACKGROUND: Equus caballus papillomavirus 8, a recently discovered virus, has been reported to cause generalised papillomavirus in horses. OBJECTIVES: To describe a case in which multiple viral plaques, viral papillomas, squamous cell carcinoma (SCC) in situ and invasive squamous cell carcinoma (ISCC) were associated with EcPV8 in a horse. STUDY DESIGN: Case report. METHODS: A 16-year-old mixed breed horse presented with dozens of raised crusted papular to nodular lesions over a course of 4 years. Masses had been surgically excised four times and cisplatin beads and emulsion were implanted on three different occasions; however new masses continue to develop in sites of previous masses as well as new sites. RESULTS: Multiple viral plaques, viral papillomas, SCC in situ and ISCC, localised to the inguinal region, were diagnosed via histopathology. EcPV8 DNA was detected via PCR. MAIN LIMITATIONS: Since only a few cases have been reported, we do not know the incidence of EcPV8 nor how often it may be associated with SCC in situ or ISCC without further study. CONCLUSIONS: This is the fourth reported case of viral papillomatosis in the context of an EcPV8 infection in a horse. This is the first case in which SCC has been associated with EcPV8.

Surgical advancement of the larynx (laryngeal tie-forward) as a treatment for dorsal displacement of the soft palate in horses: a prospective study 2001-2004.

REASONS FOR PERFORMING STUDY: Correct placement of sutures ('laryngeal tie-forward') in experimentally created dorsal displacement of the soft palate (DDSP) has been observed to replace the function of the thyrohyoideus muscles and prevent DDSP. HYPOTHESIS: The 'laryngeal tie-forward' procedure would prevent or delay the occurrence of DDSP during exercise in horses with naturally occurring DDSP and therefore improve performance. METHODS: A clinical population (n = 116), mainly of racehorses was presented for treatment of naturally occurring exercise-induced DDSP. All horses underwent the 'laryngeal tie-forward' procedure. The relative position of the thyroid and cricoid cartilage in relation to the caudal aspect of the basihyoid bone was recorded; follow-up was obtained by telephone communication with trainers, owners and/or referring veterinarians. In addition, a performance index and earnings were determined using race records. RESULTS: Preoperatively, the median distance between the caudal aspect of the basihyoid bone and rostral aspect of the thyroid cartilage was 3.5 cm. Post operatively, the thyroid cartilage was moved a median distance of 4 cm rostrally and the larynx was shown to be in a position more rostral and dorsal than in preoperative radiographs. Of 98 horses for which follow-up was available, the performance of 87% was classified as improved, 12% as unchanged and 2% as worse. In 20 horses in which the diagnosis had been confirmed by treadmill videoendoscopy, 80% had a significantly increased performance index and earnings (P = 0.007). For the entire population, there was a significant improvement in performance index and earnings after surgery (82%) (P = 0.0001). CONCLUSIONS: Placing the larynx in a more rostral and dorsal position may have improved the performance in 80-82% of the horses affected with naturally-occurring DDSP. POTENTIAL RELEVANCE: 'Laryngeal tie-forward' is a surgical technique that has a measurable effect on the position of the larynx and offers an alternative therapy for treating horses affected with DDSP. More experience may be needed with this technique prior to its widespread use in horses with a clinical diagnosis of DDSP.

Can an external device prevent dorsal displacement of the soft palate during strenuous exercise?

REASONS FOR PERFORMING STUDY: Dorsal displacement of the soft palate (DDSP) is a common condition in racehorses for which various surgical treatments are often performed. In light of recent findings that suggested the position of the larynx may influence the occurrence of DDSP, we investigated whether a noninvasive mean of affecting the position of the larynx could be effective in the management of DDSP. HYPOTHESIS: An external device (laryngohyoid support; LHS) positioning the larynx in a more rostral and dorsal location and preventing caudal displacement of the basihyoid bone would be effective in preventing DDSP during strenuous exercise. METHODS: Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control (n = 10); control with external device (n = 10); after bilateral resection of thyrohyoid (TH) muscles (n = 7); and after bilateral resection of TH muscles with external device (n = 7). Two trials were performed randomly for each of the 4 conditions. In Trial 1, videoendoscopic images of the upper airway, pharyngeal and tracheal static pressures, and arterial blood gases were collected. In Trial 2, airflow measurement combined with mask and tracheal static pressure was obtained, and upper airway impedance calculated. The trials allowed calculation of airway impedance and respiratory frequency, and assessment of ventilation using arterial PO2 and PCO2. RESULTS: Under control conditions, none of the 10 horses developed DDSP. There was no statistically significant effect from the LHS on airway impedance or respiratory frequency, nor on arterial PO2 and PCO2. Seven of the 10 horses developed DDSP during exercise after resection of the TH muscles. None of these 7 horses continued to experience DDSP during exercise with the external device. In the latter group and condition, the LHS significantly improved inspiratory and expiratory flow and impedance. CONCLUSIONS: The LHS helped prevent experimentally induced DDSP at exercise, probably by statically positioning the larynx in a more rostral and dorsal position. POTENTIAL RELEVANCE: Field studies are required to investigate whether the LHS can successfully prevent DDSP in horses with naturally occurring disease.

Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal displacement of the soft palate in horses.

REASONS FOR PERFORMING STUDY: Contributes to the understanding of the pathogenesis of dorsal displacement of the soft palate during exercise so that management of this condition could be enhanced. HYPOTHESIS: That the thyrohyoid muscles play an important role in the stability of the laryngo-palatal relationship and that dysfunction of these muscles leads to dorsal displacement of the soft palate (DDSP) during exercise. METHODS: Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control conditions (n = 10), after resection of thyrohyoid muscles (TH, n = 10), after sham-treatment (n = 5), or after restoration of function of the thyrohyoid muscles with surgical sutures (prosthesis-treatment, n = 6). During trials, the following determinations were made: videoendoscopy of the upper airway, gait frequency and pharyngeal and tracheal static pressures. RESULTS: None of the 10 horses developed DDSP during 2 separate treadmill-exercise trials under the control conditions. Seven of the 10 horses developed DDSP after resection of the TH muscles, 4 of 5 of these horses still experienced DDSP after sham-treatment, but 5 of 6 horses no longer experienced DDSP at exercise after the prosthesis-treatment. There were significant anomalies in airway pressures, respiratory frequency, and occurrence of DDSP in both the TH resection and sham-treatment conditions compared to control conditions. In contrast, no statistical differences were noted in any of the parameters measured between the prosthesis-treatment and control conditions. CONCLUSIONS: That the function of the TH muscles is important to the stability of the laryngo-palatal relationship and plays a role in the pathophysiology of exercise-induced DDSP. POTENTIAL RELEVANCE: Management of horses with DDSP could be enhanced by restoring the function of the TH muscles.

Do Thoroughbred and Standardbred horses have similar increases in pulmonary vascular pressures during exertion?

To test the hypothesis that the pulmonary vascular pressures of Thoroughbred and Standardbred horses behave similarly during exertion. Measurements were made on 5 Thoroughbred and 5 Standardbred horses on a treadmill at rest and during 3-minute exercise intervals at speeds predicted to produce 75%, 90%, and 100% maximal heart rate. Left forelimb acceleration, heart rate, esophageal pressure, and pulmonary artery pressure were measured continuously. Pulmonary capillary and wedge pressures were measured during intermittent occlusion of the pulmonary artery. Breathing rate and gait frequency were the fundamental frequencies of the esophageal pressure and limb acceleration signals respectively. The ratio of speed:gait frequency gave stride length. The effects of exertion and breed were evaluated using two-way analysis of variance. Exertion produced significant increases in pulmonary artery (P = 0.001), capillary (P = 0.002), and wedge (P = 0.005) pressures. No significant effect of breed was detected on pulmonary artery pressure, but at exertion pulmonary capillary and wedge pressures were 15% (P = 0.03) and 23% (P = 0.04) greater in Thoroughbreds, respectively. Treadmill speed was approximately 12% greater (P = 0.04), stride length was approximately 25% greater (P = 0.0003), gait frequency was approximately 10% less (P = 0.006), breathing rate was approximately 10% less (P = 0.001), and heart rate was approximately 6% less (P = 0.06) for Thoroughbreds. There was no effect of breed on inspiratory or expiratory esophageal pressure although mean esophageal pressure was approximately 2 mmHg greater (P = 0.03) in exercising Standardbreds. In conclusion, pulmonary capillary and wedge pressures are greater in Thoroughbreds than in Standardbreds at similar fractions of maximal heart rate. This is compatible with the higher incidence of exercise-induced pulmonary hemorrhage observed in Thoroughbreds.

Effect of furosemide on physiologic variables in exercising horses.

Twelve horses (6 Standardbreds and 6 Thoroughbreds) received IM injections of furosemide (250 mg) or physiologic saline solution and performed standard exercise tests, to assess the effects of furosemide and breed on blood gas values, PCV, plasma lactate concentration, and heart rate during exercise. After furosemide administration, arterial and venous blood pH values were significantly (P < 0.05) increased. Partial pressures of O2 and CO2 in arterial blood and of CO2 in venous blood (PaO2, PaCO2, and PVCO2, respectively) were unaffected by furosemide treatment, whereas venous partial pressures of O2 (PVO2) were significantly (P < 0.05) less during exercise after furosemide treatment, suggesting an increase in oxygen uptake by the exercising muscles or a change in cardiac output. A significant (P < 0.05) difference was found between Thoroughbred and Standardbred values for arterial and venous pH, PaO2, PaCO2, plasma lactate concentration, and heart rate, suggesting that Standardbreds exercised at a relatively higher work rate than did Thoroughbreds.

Measurement of upper airway pressures in exercising horses with dorsal displacement of the soft palate.

To determine whether abnormal airway pressures have a role in development of dorsal displacement of the soft palate (DDSP), measurements of tracheal and pharyngeal pressures were correlated with nasopharyngeal morphology in exercising horses. Exercising videoendoscopy and measurement of tracheal and pharyngeal pressures were used in 14 clinically normal horses and 19 horses with intermittent DDSP. The pressure signals were superimposed on the videoendoscope image, and both images were saved simultaneously on a videocassette for slow motion analysis to determine the instant displacement occurred in the respiratory cycle. Horses were submitted to an escalating 8-minute high-speed test with a maximal speed of 14 m/s. Compared with clinically normal horses, horses with intermittent DDSP did not have excessively negative inspiratory pressures during exercise. Eight horses displaced the soft palate during inspiration, 4 horses displaced it during expiration, and 7 displaced it by swallowing. Some horses displaced the soft palate at the beginning of the exercise trial, before reaching maximal speed, some horses displaced it at the peak speed, and some horses displaced it when slowing down. Epiglottic size in horses with DDSP was within normal limits, ruling out epiglottic hypoplasia as a cause of DDSP during exercise. Airway pressures were significantly (P < 0.002) altered after DDSP. Pharyngeal and tracheal inspiratory pressures were less negative, whereas pharyngeal expiratory pressure became less positive and tracheal expiratory pressure became more positive after displacement, suggesting a decrease in airflow and an increase in expiratory resistance in the upper airway.

Regulation of respiratory muscle activities during chemoreceptor stimulation in adult horses.

We examined the electromyographic activity of the costal portion of the diaphragm and the transverse abdominal and external oblique muscles in 6 chronically instrumented awake adult horses during eupneic breathing, during 2 levels of hypercapnia (fractional concentration of inspired CO2; FICO2 = 0.4 and 0.6), and during 2 levels of hypocapnic hypoxia (FIO2 = 0.15 and 0.12). Using the inert gas technique, we also measured the end-expiratory lung volumes of the 6 horses during eupnea, 6% CO2 challenge, and 12% O2 breathing. During eupneic breathing, phasic electrical activity of these 3 muscles was always present and was preceded by the onset of mechanical flow. At progressive levels of hypercapnia, the magnitude of inspiratory and expiratory electrical activity increased, and for the expiratory muscles, this recruitment coincided with significant (P < 0.05) increases in peak expiratory gastric pressure. However, during hypocapnic hypoxia, differential recruitment patterns of the respiratory muscles were found. The electrical activity of the diaphragm increased in magnitude and occurred sooner relative to the onset of mechanical flow. The magnitude and onset of abdominal expiratory activity failed to increase significantly during these episodes of hyperpnea and this pattern of activity coincided with decrements in peak expiratory gastric pressure. Despite alterations in muscle recruitment patterns during these hyperpneic episodes, end-expiratory lung volume remained unchanged. Thus, we conclude that adult horses respond similarly to awake dogs during peripheral and central chemoreceptor stimulation.

Repeatability and normal values for measurement of pharyngeal and tracheal pressures in exercising horses.

Repeatability of measurements of peak and mean tracheal and pharyngeal pressures in exercising horses was determined. Five athletically fit horses were subjected to repeated (n = 5) standardized exercise trials. Static pressures in the trachea, nasopharynx, and mask were determined. At least 96% of all mean pressure measurements were within 5 cm of H2O of the mean value for any horse. Peak pressure measurements were less repeatable, but at least 96% of all measurements were within 10 cm of H2O of the mean peak measurements for any horse. In 10 horses galloping at 14 m/s, the 95% confidence interval for peak tracheal and pharyngeal inspiratory pressures ranged from -40 to -50 cm of H2O and -20 to -26 cm of H2O, respectively. During expiration, the 95% confidence interval for peak tracheal and pharyngeal pressure at the same speed ranged from 15 to 28 cm of H2O and 10 to 24 cm of H2O respectively. During inspiration, horses with induced laryngeal hemiplegia had static pressure measurements generally outside that range. We conclude that determination of tracheal and pharyngeal pressures is a potentially useful adjunct for assessment of the proximal portion of the respiratory tract.

Effects of extrathoracic airway obstruction on intrathoracic pressure and pulmonary artery pressure in exercising horses.

OBJECTIVE: To determine whether dorsal displacement of the soft palate (DDSP) results in pulmonary artery hypertension and leads to increases in transmural pulmonary artery pressure (TPAP); to determine whether pulmonary hypertension can be prevented by prior administration of furosemide; and to determine whether tracheostomy reduces pulmonary hypertension. ANIMALS: 7 healthy horses. PROCEDURE: Horses were subjected to 3 conditions (control conditions, conditions after induction of DDSP, and conditions after tracheostomy). Horses were evaluated during exercise after being given saline (0.9% NaCl) solution or furosemide. RESULTS: Controlling for drug, horse, and speed of treadmill, DDSP-induced increase in intrathoracic pressure was associated with a significant increase in minimum (36 mm Hg), mean (82 mm Hg), and maximum (141 mm Hg) pulmonary artery pressure, compared with values for control horses (30, 75, and 132 mm Hg, respectively). Increases in pulmonary artery pressure did not induce concomitant increases in TPAP. Tracheostomy led to a significant reduction of minimum (53 mm Hg), and mean (79 mm Hg) TPAP pressure, compared with values for control horses (56 and 83 mm Hg, respectively). When adjusted for horse, speed of treadmill, and type of obstruction, all aspects of the pulmonary artery and TPAP curves were significantly decreased after administration of furosemide, compared with those for horses given saline (0.9% NaCl) solution. CONCLUSIONS: DDSP was associated with increases in pulmonary artery pressure but not with increases in TPAP. CLINICAL RELEVANCE: Expiratory obstructions such as DDSP are likely to result in pulmonary hypertension during strenuous exercise, but may not have a role in the pathogenesis of exercise-induced pulmonary hemorrhage.

Effects of airway obstruction on transmural pulmonary artery pressure in exercising horses.

OBJECTIVE: To determine whether laryngeal hemiplegia would increase transmural pulmonary artery pressure (TPAP). ANIMALS: 6 horses. DESIGN: Horses were studied under 5 conditions: control conditions, after induction of left laryngeal hemiplegia, during obstruction of the left nostril, after placement of an instrumented tracheostomy, and after placement of an open tracheostomy. Horses were evaluated after being given saline solution and after being given furosemide. PROCEDURES: Horses were exercised on a high speed treadmill, using a maximum speed of 13 m/s. During each exercise, airway pressures, airflow, esophageal and pulmonary artery pressures, and blood gas partial pressures were measured. RESULTS: When adjusted for horse, speed, and obstruction condition, mean TPAP (pulmonary artery pressure-esophageal pressure) and minimum TPAP were significantly lower after administration of furosemide than after administration of saline solution. In horses given saline solution, respiratory obstruction that increased intrapleural pressure significantly increased mean TPAP, and respiratory obstruction that decreased intrapleural pressure significantly decreased minimum TPAP. CONCLUSIONS: Changes in intrapleural pressure appear to play an important role in pulmonary artery pressure and TPAP. CLINICAL RELEVANCE: Because induction of laryngeal hemiplegia did not increase TPAP, laryngeal hemiplegia is unlikely to contribute to development of exercise-induced pulmonary hemorrhage.

Nonstrangulated colonic displacement in horses.

Nonstrangulated colonic displacement was diagnosed by exploratory celiotomy in 32 horses with acute abdominal pain. Clinical signs progressed slowly and included evidence of mild to moderate abdominal pain, good cardiovascular status, reduced intestinal sounds, and normal peritoneal fluid, and resembled those of colonic impaction. In most horses, rectal palpation supported a diagnosis of colonic obstruction but not a diagnosis of colonic impaction.

Cecocolic intussusception in horses: 11 cases (1979-1989).

Over a 10-year period, cecocolic intussusception was diagnosed in 11 of 842 horses undergoing surgical treatment for colic at the New York State College of Veterinary Medicine. Eight horses died or were euthanatized because of poor prognosis determined at surgery or because of postoperative complications. Three horses recovered without complication after manual reduction of the intussusception and partial typhlectomy, using an intestinal stapling device.

Neoplasia of the equine urinary bladder as a cause of hematuria.

In 6 horses with urinary bladder neoplasms, common clinical findings included a palpable mass in the bladder, anemia, hematuria, and/or proteinuria. Squamous cell carcinoma was found in 4 horses and appears to be the most common bladder tumor in the horse. Single cases of transitional cell carcinoma and fibromatous polyp also were identified. All horses except one were over 10 years of age. In one mare, treatment with 5-fluorouracil intracystically resulted in decreased bleeding from the bladder mass and apparent stabilization of the mass size. The mare ultimately died because of abdominal metastasis. Although rare, neoplasia of the urinary bladder should be considered when evaluating horses with hematuria.

Avulsion fractures of the origin of the suspensory ligament of the horse.

Five horses with avulsion fractures of the proximal origin of the suspensory ligament were examined for lameness. The horses in the series each had lameness of acute onset; four were severely lame, and one was moderately lame. The condition was difficult to diagnose because commonly used local anesthetic blocks did not result in improvement during the routine examination. Local infiltration of the area with local anesthetic returned the horses to soundness. After a period of rest, varying from a few weeks in the acute injury to 6 months in the chronic injuries, the horses were returned to racing without lameness.

Tracheal rupture in two horses.

Two horses were admitted for evaluation of diffuse SC emphysema. Diagnosis of ruptured trachea was made by tracheoscopy and radiography. The tracheal cartilages were not involved in either case. One of the defects was small and responded to medical management. The other defect was large and was apposed surgically. Both horses recovered without complications.

Nasal obstruction caused by cystic nasal conchae in cattle.

Four Holstein heifers were found to have partial nasal obstruction caused by bilateral cystic conchae. Three of the heifers (age range, 4 to 6 months) had a history of progressive nasal obstruction since near birth, were affected severely, and required surgical management. Each of 2 surgical procedures, a bilateral dorsolateral nasal flap approach and a dorsal nasal flap approach, was used successfully. The fourth heifer, which was 15 months old, had signs of nasal obstruction since shortly after birth, but was affected only mildly and was not treated. Follow-up information obtained 10 to 37 months later revealed that all cattle were considered normal and had no signs of nasal obstruction. In each case, a developmental problem or malformation of the ventral nasal concha resulting in cystic enlargement was suspected. The onset of clinical signs early in life and the bilateral nature suggested that the defect was of congenital origin.

Metabolic abnormalities associated with rupture of the urinary bladder in neonatal foals.

Rupture of the urinary bladder was diagnosed in 4 neonatal male foals. Marked hyponatremia, hypochloremia, and hyperkalemia developed in all 4 cases, and the electrolyte abnormalities were considered to be of potential diagnostic value. Blood urea nitrogen concentration was normal or only slightly higher than normal in 3 of 4 cases and therefore was not a reliable diagnostic test.