Partial resection of the plica salpingopharyngeus for the treatment of three foals with bilateral tympany of the auditory tube diverticulum (guttural pouch).

CASE DESCRIPTION: 3 foals were referred for treatment of tympany of the auditory tube diverticulum (guttural pouch). CLINICAL FINDINGS: Bilateral guttural pouch tympany was diagnosed in all 3 foals on the basis of clinical signs and results of radiographic and endoscopic evaluations and gutturocentesis. In each foal, previous medical or surgical interventions or both had failed to correct the problem. TREATMENT AND OUTCOME: Bilateral surgical resection of the plica salpingopharyngeus was performed. Follow-up telephone interviews with owners 8 months to 3 years after surgery revealed that long-term resolution of the tympany had been achieved in each foal, with few to no postsurgical complications. CLINICAL RELEVANCE: Surgical correction of refractory bilateral guttural pouch tympany can be accomplished by resection of the plica salpingopharyngeus within the pharyngeal opening of the Eustachian tube. In the foals of this report, permanent resolution of tympany was apparently achieved without interfering with upper airway function, providing support for the use of surgical resection of the plica salpingopharyngeus in the treatment of bilateral guttural pouch tympany.

Safety and efficacy of a technique for thoracoscopically guided pulmonary wedge resection in horses.

OBJECTIVE: To evaluate the safety and efficacy of thoracoscopically guided pulmonary wedge resection in horses. ANIMALS: 10 horses (5 control horses and 5 horses affected with recurrent airway obstruction [ie, heaves]). PROCEDURE: Each horse underwent a thoracoscopically guided pulmonary wedge resection. Before, during, and after surgery, heart rate, respiratory rate, arterial blood gases, and systemic and pulmonary arterial pressures were measured. Physical examination, CBC, and thoracic radiography and ultrasonography were performed 24 hours before and 2 and 48 hours after surgery. Pulmonary specimens were assessed by histologic examination. A second thoracoscopic procedure 14 days later was used to evaluate the resection site. RESULTS: The technique provided excellent specimens for histologic evaluation of the lung. Heart and respiratory rates decreased significantly after horses were administered sedatives. A significant transient decrease in Pao2 was detected immediately after pulmonary wedge resection, but we did not detect significant effects on arterial pH, Paco2, or mean arterial and pulmonary arterial pressures. All horses except 1 were clinically normal after thoracoscopic surgery; that horse developed hemothorax attributable to iatrogenic injury to the diaphragm. The second thoracoscopy revealed minimal inflammation, and there were no adhesions. CONCLUSIONS AND CLINICAL RELEVANCE: Thoracoscopically guided pulmonary wedge resection provides a minimally invasive method for use in obtaining specimens of lung tissues from healthy horses and those with lung disease. This technique may be useful for the diagnosis of diseases of the lungs and thoracic cavity.

In vitro effects of oxytetracycline on matrix metalloproteinase-1 mRNA expression and on collagen gel contraction by cultured myofibroblasts obtained from the accessory ligament of foals.

OBJECTIVE: To determine the effects of oxytetracycline on matrix metalloproteinase-1 (MMP-1) mRNA expression and collagen gel contraction by equine myofibroblasts in an effort to explain the mechanistic basis for the pharmacologic treatment of flexural deformities in foals. SAMPLE POPULATION: Cultured myofibroblasts from the accessory ligament (distal check ligament) of 6 foals. PROCEDURE: Collagen gel scaffolds seeded with equine myofibroblasts were cultured in individual culture dishes containing complete media (Dulbecco's modified Eagle medium with 10% fetal bovine serum) and oxytetracycline (0, 12.5, 25, or 75 microg/mL) for 48 hours. After 24 hours, the gels were released from the bottom of the culture plate and allowed to contract. Photographs were taken at 0, 1, 2, 4, 6, 8, and 24 hours after release to assess the degree of collagen gel contraction. Additional gels were harvested at 2 hours after release for RNA isolation and reverse transcriptase-polymerase chain reaction assessment of the degree of MMP-1 mRNA expression. RESULTS: Oxytetracycline induced a dose-dependent inhibition of collagen gel contraction by equine myofibroblasts. Oxytetracycline also induced a dose-dependent decrease in MMP-1 mRNA expression by equine myofibroblasts. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicate that oxytetracycline inhibits tractional structuring of collagen fibrils by equine myofibroblasts through an MMP-1 mediated mechanism. In young foals, oxytetracycline administration may make the developing ligaments and tendons more susceptible to elongation during normal weight-bearing. Inhibition of normal collagen organization may provide the mechanistic explanation for the results seen following the pharmacologic treatment of flexural deformities in foals by oxytetracycline administration.

Evaluation of a cranial arthroscopic approach to the stifle joint for the treatment of femorotibial joint disease in horses: 23 cases (1998-1999).

OBJECTIVE: To describe a single-portal cranial arthroscopic approach to the stifle joint in horses and to determine the clinical outcome in horses with femorotibial joint disease in which this approach was used. DESIGN: Retrospective study. ANIMALS: 23 adult horses. PROCEDURE: Medical records were reviewed to obtain information on clinical outcome in horses in which the single-portal cranial arthroscopic approach was used. RESULTS: Twenty-nine stifle joints of 23 horses were examined arthroscopically, using the described approach. Subchondral bone cysts were treated in 19 medial femoral condyles of 12 horses. Unilateral cruciate ligament desmitis (4 horses), meniscal tearing (3), or both (2) were identified in 9 horses. Evidence of degenerative joint disease without cystic lesions or soft tissue trauma was found in 2 horses. Information on clinical outcome was obtained for 21 of 23 horses. A successful outcome was obtained in 15 of 21 horses and was defined as return to sound performance at a degree equal to or better than that prior to injury and lameness. Eight of 12 horses treated for medial femoral condylar cysts had a successful outcome. Four show horses treated for cruciate ligament lesions alone successfully returned to showing activity. None of the 3 horses with meniscal tearing were able to perform successfully. CONCLUSIONS AND CLINICAL RELEVANCE: The femorotibial joint was evaluated through a single-portal cranial arthroscopic approach, using the femoropatellar joint as the point of access. This approach was easy to perform, allowed controlled access to the femorotibial joint, avoided accidental damage to articular structures, and required fewer access portals.

Use of a condylar screw plate for repair of a Salter-Harris type-III fracture of the femur in a 2-year-old horse.

A 2-year-old sexually intact male Paint horse weighing 427 kg (940 lb) was admitted for examination and treatment of intermittent non-weight-bearing lameness of the right hind limb of 1 week's duration. Radiography revealed a displaced Salter-Harris type-III fracture of the right femoral condyle with the sagittal component of the fracture line located in the intercondylar space and the transverse component exiting on the medial aspect of the femur. The fracture was repaired with a condylar screw plate designed for repair of femoral condylar fractures in humans. The owner reported by telephone 9 months after surgery that the horse was sound. To our knowledge, use of this particular implant system for fixation of a Salter-Harris type-III fracture on the medial side of the femur in a horse has not been described. Results in this horse suggest that this implant can be successfully used for repair of femoral condylar fractures in selected adult horses.

Microvasculature of the suspensory ligament of the forelimb of horses.

OBJECTIVE: To determine the microvascular anatomy of the suspensory ligament of the forelimb of horses. SAMPLE: 17 cadaveric forelimbs from 9 adult horses with no known history of forelimb lameness. PROCEDURES: The median artery of the forelimb was cannulated proximal to the antebrachiocarpal joint and injected with contrast medium for CT evaluation of the gross vasculature (n = 2) or India ink to evaluate the microvasculature (12). Routine histologic evaluation was performed on an additional 3 forelimbs to confirm the microvascular anatomy. RESULTS: The vascular supply of the suspensory ligament of the forelimb originated from branches of the medial and lateral palmar and palmar metacarpal vessels as well as the proximal and distal deep palmar arches. An abundant, longitudinally oriented microvascular supply was evident throughout the length of the suspensory ligament without distinct variation among the proximal, midbody, and distal regions. The intraligamentous blood supply originated from a periligamentous vascular plexus that surrounded the suspensory ligament throughout its length. Histologic findings indicated the presence of a periligamentous connective tissue plexus, which contained vessels that penetrated and anastomosed with an extensive network of intraligamentous vessels throughout the length of the suspensory ligament. CONCLUSIONS AND CLINICAL RELEVANCE: The suspensory ligament of the equine forelimb had an abundant intraligamentous microvascular supply throughout its entire length. The absence of an obvious hypovascular area suggested that regional variations in healing rates of the suspensory ligament are not associated with the microvascular anatomy.

Effects of exercise on markers of venous remodeling in lungs of horses.

OBJECTIVE: To determine the effects of 2 weeks of intense exercise on expression of markers of pulmonary venous remodeling in the caudodorsal and cranioventral regions of the lungs of horses. ANIMALS: 6 horses. PROCEDURES: Tissue samples of the caudodorsal and cranioventral regions of lungs were obtained before and after conditioning and 2 weeks of intense exercise. Pulmonary veins were isolated, and a quantitative real-time PCR assay was used to determine mRNA expression of matrix metalloproteinase-2 and -9, tissue inhibitor of metalloproteinase-1 and -2, collagen type I, tenascin-C, endothelin-1, platelet-derived growth factor, transforming growth factor (TGF)-ß, and vascular endothelial growth factor (VEGF). Protein expression of collagen (via morphometric analysis) and tenascin-C, TGF-ß, and VEGF (via immunohistochemistry) was determined. RESULTS: Exercise-induced pulmonary hemorrhage was detected in 2 horses after exercise. The mRNA expression of matrix metalloproteinase-2 and -9, tissue inhibitor of metalloproteinase-2, TGF-ß, and VEGF was significantly lower in pulmonary veins obtained after exercise versus those obtained before exercise for both the caudodorsal and cranioventral regions of the lungs. Collagen content was significantly higher in tissue samples obtained from the caudodorsal regions of the lungs versus content in samples obtained from the cranioventral regions of the lungs both before and after exercise. Exercise did not alter protein expression of tenascin-C, TGF-ß, or VEGF. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicated 2 weeks of intense exercise did not alter expression of marker genes in a manner expected to favor venous remodeling. Pulmonary venous remodeling is complex, and > 2 weeks of intense exercise may be required to induce such remodeling.

Laser vocal cordectomy fails to effectively reduce respiratory noise in horses with laryngeal hemiplegia.

OBJECTIVE: To report the effect of unilateral laser vocal cordectomy on respiratory noise and airway function in horses with experimentally induced laryngeal hemiplegia (LH). STUDY DESIGN: Experimental study. ANIMALS: Six Standardbred horses without upper airway abnormalities at rest or during high-speed treadmill exercise. METHODS: Respiratory sounds and inspiratory trans-upper airway pressure (P(Ui)) were measured before (baseline) and 14 days after induction of LH by left recurrent laryngeal neurectomy, and again 30, 60, 90, and 120 days after endoscopically assisted laser cordectomy of the left vocal cord. Data were collected with the horses exercising on a treadmill at a speed producing maximum heart rate (HR(max)). RESULTS: In horses exercising at HR(max), induction of LH caused a significant increase in P(Ui), sound level (SL), and the sound intensity of formant 2 (F(2)) and 3 (F(3)). The sound intensity of formant 1 (F(1)) was unaffected by induction of LH. Laser vocal cordectomy had no effect on SL, or on the sound intensity of F(1) and F(3). At 30, 60, 90, and 120 days after surgery, P(Ui) and the sound intensity of F(2) were significantly reduced, but these variables remained significantly different from baseline values. CONCLUSIONS: Unilateral laser vocal cordectomy did not effectively improve upper airway noise in horses with LH. The procedure decreased upper airway obstruction to the same degree as bilateral ventriculocordectomy. CLINICAL RELEVANCE: Currently, laser vocal cordectomy cannot be recommended for the treatment of upper airway noise in horses with LH.

Laryngeal reinnervation in the horse.

Left laryngeal hemiplegia is a frustrating condition for the equine athlete and equine veterinarian. Treatment for the past 30 years has centered on the prosthetic laryngoplasty ("tie-back") with or without ventriculectomy. Laryngeal reinnervation has been used successfully in people and has been shown experimentally to benefit affected horses. This article reviews equine laryngeal reinnervation using the nerve muscle pedicle graft and describes the surgical technique, its complications, and the follow-up in 146 cases treated over the past 10 years. Also discussed is ongoing research into stimulation studies to improve the success of equine laryngeal reinnervation.