Dynamic respiratory endoscopy in 67 Thoroughbred racehorses training under normal ridden exercise conditions

Reasons for performing study: There are potential advantages to imaging the upper portion of the respiratory tract (URT) of horses during ridden exercise. With the advent of a wireless endoscope, this is now possible. However, there has been no detailed validation of the technique and findings have not been compared to ridden speed. Objectives: To assess the combined use of a Dynamic Respiratory Scope (DRS) and global positioning system (GPS) receiver for examining the URT of a group of Thoroughbred racehorses randomly selected from a single flat racehorse training establishment. Methods: Horses were selected randomly from a population of Thoroughbred horses in training at the same training yard. Endoscopic images of the URT were recorded during a ridden exercise test on an ‘all‐weather‐gallop’ and were reviewed post testing. Speed was measured using a wrist mounted GPS receiver. Results: A total of 67 (34%) of the 195 horses in training were examined. Endoscopic findings included: normal URT function (44 cases); dorsal displacement of the soft palate (DDSP) (13 cases); laryngeal asymmetry (4 cases); and axial deviation of the aryepiglottic folds (3 cases). Maximum speed obtained by individual horses ranged from 41.8–56.3 km/h. Ridden speed was variably affected by DDSP. Conclusions: The DRS provides a safe effective system for imaging the equine URT during ridden exercise at speed. The abnormalities of the URT identified were similar to those observed during treadmill endoscopy studies reported in the literature. The effect of URT abnormalities on ridden speed requires further investigation. Potential relevance: This technique can be used to diagnose common causes of URT associated with poor performance in horses during normal training. This has substantial implications for future clinical diagnosis and treatment of URT pathology.     

Clinical trials using a telemetric endoscope for use during over‐ground exercise: A preliminary study

Dynamic collapse of the upper respiratory tract (URT) is a common cause of poor performance in horses. These conditions occur predominantly during strenuous exercise when the URT is unable to maintain dilation in the face of high inspiratory pressures. In most cases, these disorders cannot be accurately diagnosed during a resting endoscopic examination. To date, a definitive diagnosis of dynamic URT obstructions has been possible only by performing an endoscopic examination during high‐speed treadmill exercise. However, recent technological advances now enable URT endoscopy to be performed while the horse is exercising in its normal environment.     

Correlation of resting and exercising endoscopic findings for horses with dynamic laryngeal collapse and palatal dysfunction

Reasons for performing study: To correlate resting and exercising endoscopic grades of laryngeal function in horses undergoing high‐speed treadmill endoscopy (HSTE) using the Havemeyer grading system. To correlate dorsal displacement of the soft palate (DDSP) seen at rest with palatal function during exercise. Methods: Records of horses that underwent HSTE examination (1999–2009) were reviewed. Resting laryngeal function score and other abnormalities noted on resting endoscopy were recorded as were results of HSTE. Results of resting and exercising endoscopic findings were correlated. Results: 281 horses underwent HSTE. There was significant correlation between grade of laryngeal function at rest (grades 1–4) and exercise (ρ= 0.53, P<0.001) and between resting subgrades 3.1, 3.2 and 3.3 and exercising grades of laryngeal function (ρ= 0.43, P = 0.0017). DDSP was observed at rest significantly more often in horses that developed DDSP during HSTE than those without DDSP during HSTE (RR = 4.1, P<0.001). The sensitivity and specificity of DDSP seen during resting endoscopy as a test for DDSP occurring during exercise were 25.5 and 95.1% respectively (positive predictive value 0.57, negative predictive value 0.83). Conclusions and potential relevance: The results of the current study support the use of the Havemeyer system for grading laryngeal function in the resting horse, and corroborate findings of previous studies correlating resting and exercising palatal abnormalities. Studies that use the presence of spontaneous DDSP during resting endoscopic examination as an inclusion criterion for investigating efficacy of treatments for DDSP are likely to have a low proportion of horses with false positive diagnoses.     

Exercising Blood Gas Analysis, Dynamic Upper Respiratory Tract Obstruction, and Postexercising Bronchoalveolar Lavage Cytology—A Comparative Study in Poor Performing Horses

Respiratory abnormalities are common causes of decreased performance in horses presumably because of impaired pulmonary gas exchange. The objectives of the present study were to describe respiratory abnormalities in poorly performing horses and to investigate the relationships between dynamic upper respiratory tract (URT) videoendoscopy, postexercising bronchoalveolar lavage (BAL) cytology, and exercising arterial blood gas analysis. Medical records of 93 horses with exercise intolerance, which presented for treadmill evaluation, were reviewed. Relationships between horse demographics, treadmill endoscopic findings, exercising blood gas values, and BAL cytology results were examined. A total of 25 (27%) horses had a URT obstruction and 91 (98%) horses had abnormal BAL cytology; 73 (78%) had evidence of inflammatory airway disease (IAD) and 83 (89%) had exercise-induced pulmonary hemorrhage (EIPH). In all, 39 (42%) horses had abnormal blood gas values. Dynamic URT obstruction was significantly associated with exercising hypoxemia (P = .036). There were no significant relationships between gas exchange and IAD or between EIPH. Out of 24 (26%) horses with combined URT obstruction and abnormal BAL, horses with URT obstruction and EIPH were more likely to be hypoxic during exercise (P = .037). It was concluded that horses with dynamic URT abnormalities are likely to have exercising hypoxemia. Although IAD and EIPH were commonly indentified in poor performers, they were not significantly associated with abnormal exercising blood gas analysis.     

Exercising upper respiratory videoendoscopic evaluation of 100 nonracing performance horses with abnormal respiratory noise and/or poor performance

Reasons for performing study: Although well documented in racehorses, there is paucity in the literature regarding the prevalence of dynamic upper airway abnormalities in nonracing performance horses. Objective: To describe upper airway function of nonracing performance horses with abnormal respiratory noise and/or poor performance via exercising upper airway videoendoscopy. Methods: Medical records of nonracing performance horses admitted for exercising evaluation with a chief complaint of abnormal respiratory noise and/or poor performance were reviewed. All horses had video recordings of resting and exercising upper airway endoscopy. Relationships between horse demographics, resting endoscopic findings, treadmill intensity and implementation of head and neck flexion during exercise with exercising endoscopic findings were examined. Results: Dynamic upper airway obstructions were observed in 72% of examinations. Head and neck flexion was necessary to obtain a diagnosis in 21 horses. Pharyngeal wall collapse was the most prevalent upper airway abnormality, observed in 31% of the examinations. Complex abnormalities were noted in 27% of the examinations. Resting laryngeal dysfunction was significantly associated with dynamic arytenoid collapse and the odds of detecting intermittent dorsal displacement of the soft palate (DDSP) during exercise in horses with resting DDSP was only 7.7%. Exercising endoscopic observations were different from the resting observations in 54% of examinations. Conclusions: Dynamic upper airway obstructions were common in nonracing performance horses with respiratory noise and/or poor performance. Resting endoscopy was only helpful in determining exercising abnormalities with recurrent laryngeal neuropathy. Potential relevance: This study emphasises the importance of exercising endoscopic evaluation in nonracing performance horses with abnormal respiratory noise and/or poor performance for accurate assessment of dynamic upper airway function.     

Dynamic respiratory endoscopy without a treadmill: Initial experiences

There are potential advantages to imaging the upper portion of the respiratory tract (URT) of horses during ridden exercise within their normal environment. With the advent of a wireless endoscope, this is now possible. The following article describes initial experiences using the dynamic respiratory endoscope (DRS) on horses presented for the investigation of poor performance or abnormal respiratory noise and suggests that this technique can be used to diagnose common causes of URT associated with poor performance in horses during normal training. This has substantial implications for future clinical diagnosis, treatment of URT pathology and equine welfare.     

Association of treadmill upper airway endoscopic evaluation with results of ultrasonography and resting upper airway endoscopic evaluation

Reasons for performing study: Assessment of arytenoid movement has traditionally been performed using upper airway (UA) endoscopy. However, recent work suggests that laryngeal ultrasonography may provide additional complementary information. Objective: To determine the value of laryngeal ultrasonography for the diagnosis of recurrent laryngeal neuropathy in the horse. Hypotheses: Horses with abnormal arytenoid movement (AM) during treadmill UA endoscopy would have increased echogenicity of the left cricoarytenoideus lateralis muscle (CALM) and smaller left CALM and vocalis size while horses with normal AM during treadmill UA endoscopy would have normal echogenicity of the left CALM and similar left and right CALM and vocalis muscle size. Laryngeal ultrasonography would be more accurate than resting endoscopy at predicting abnormal AM. Methods: Medical records were examined to identify Thoroughbred racehorses aged ≥2 years that had undergone resting and treadmill UA endoscopy and laryngeal ultrasonography. Resting and treadmill AM was graded using accepted scales. The treadmill examination was used as the criterion standard for AM. Laryngeal ultrasonography was performed and the relative echogenicity of the left and right CALM and the cross‐sectional area (CSA) of the CALM and vocalis muscle determined. Data analysis included Chi‐squared tests, paired t tests and one‐way ANOVA. Results: The presence of abnormal AM was associated with relative hyperechogenicity of the CALM while normal AM was not. Laryngeal ultrasonography had a sensitivity of 90% and specificity of 98% and resting UA endoscopy had a sensitivity of 80% and specificity of 81% for diagnosis of abnormal AM. CSA of the left CALM and vocalis muscle was not different between groups. Conclusions: Laryngeal ultrasonography has high accuracy for diagnosing abnormal AM. Potential relevance: Ultrasonography is a valuable addition to the diagnostic evaluation of the equine UA.     

Relative prevalence of upper respiratory tract obstructive disorders in two breeds of harness racehorses (185 cases: 1998-2006)

Reasons for performing study: Two genetically and phenotypically distinct horse breeds are used for harness racing in Scandinavia: the Standardbred (SB) and Coldblooded Trotter. These racehorses have identical environmental, management and racing conditions. Therefore, this study was undertaken to identify and compare the relative prevalence of upper respiratory tract (URT) obstructive disorders in these 2 breeds. Objectives: To determine whether these 2 phenotypically different breeds of harness racehorses have different predispositions for URT disorders. Methods: Retrospective study of 88 Norwegian Coldblooded Trotters (NCT) and 97 SBs referred to this hospital for URT evaluation between 1998 and 2006. Case records of all horses diagnosed with an URT disorder during resting endoscopy, and all horses undergoing high‐speed treadmill videoendoscopy (HSTV) with one or more periods of induced poll flexion were evaluated. The relative prevalence of URT disorders between the 2 breeds was analysed using a Fisher's exact test. Results: There was a significant (P<0.05) breed predisposition regarding 6 URT disorders. Bilateral dynamic laryngeal collapse associated with poll flexion and flaccid epiglottis was significantly more frequent in the NCT. Alar fold collapse and nasopharyngeal collapse were significantly more frequent in SBs. Epiglottic entrapment and nasal flutter were only diagnosed in the SBs. Dynamic disorders were more common than resting disorders in both breeds. Conclusion: URT obstructive disorders (dynamic laryngeal collapse associated with poll flexion, flaccid epiglottis, pharyngeal collapse, alar fold collapse, nasal flutter and epiglottic entrapment) are breed related, indicating an anatomic or functional cause. Periods of induced poll flexion during HSTV was essential to declare harness racehorses free of URT disorders. Potential relevance: Further anatomic or physiological studies comparing these breeds could potentially provide insight into the pathogenesis of certain URT obstructive disorders. Induced poll flexion should be included in routine HSTV examinations of all harness racehorses.     

Dynamic respiratory endoscopy of Standardbred racehorses during qualifying races

Reason for performing study: Examination of the equine upper airway during racing has not previously been documented. Objective: To describe the feasibility and appearance of the upper airways by overground respiratory endoscopic examination during racing conditions. Methods: Overground videoendoscopic examinations were performed on 46 Standardbred racehorses during qualifying races. Examined horses' speeds were recorded throughout the race with a portable GPS device. Results: The procedure did not interfere with performance as there were no significant differences in race times between races in which horses were examined with the endoscope in place and prior unexamined races. Airway obstructions during or after the race were documented in 21 horses. Most previously reported causes of upper airway obstruction were observed; surprisingly bilateral ventro‐medial arytenoid displacement (VMAD; n = 5) was seen during exercise as frequently as dorsal displacement of the soft palate (DDSP). Although DDSP (n = 10) was the most common diagnosis made, many displacements (n = 5) occurred after the race. Horses that demonstrated DDSP after the race had slower speeds than unaffected horses during the race. Conclusions: Racing endoscopy permits the diagnosis of upper airway obstructions without affecting performance. The occurrence of DDSP immediately after exercise may be clinically relevant. During racing VMAD may be an important anomaly. Potential relevance: Racing endoscopy could be used to correlate the sensitivity of diagnostic endoscopy during race‐training or treadmill examination. The pathogenesis and significance of VMAD deserves further investigation.     

Cervical vertebral canal endoscopy in the horse: intra- and post operative observations

Reasons for performing study: Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. Objective: To determine the feasibility and safety of CVCE in healthy mature horses. Methods: Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto‐occipital space into the epidural space (epiduroscopy, Horses 1–3) or the subarachnoid space (myeloscopy, Horses 4–6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. Results: All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. Conclusions: Endoscopic examination of the epidural and subarachnoid space from the atlanto‐occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. Potential relevance: Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.     

Assessment of dynamic upper respiratory tract function in the equine athlete

Dynamic upper respiratory tract (URT) obstructions occur commonly in the equine athlete. During the past 25 years, veterinary diagnostic capabilities have improved greatly with the ability to perform endoscopy during exercise and thus to visualise upper airway function during various types of exercise. After correctly reproducing and diagnosing an URT obstruction, the veterinary surgeon must consider the functional significance of the endoscopic findings for that individual athlete. This is the third paper in this series and focuses on the diagnosis of URT obstructions, their relationship to the exercise test and their functional significance.     

Oral endoscopy as an aid to diagnosis of equine cheek tooth infections in the absence of gross oral pathological changes: 17 cases

Reasons for performing study: Removal of cheek teeth in all but the aged horse or pony is a serious undertaking with potentially deleterious sequellae. Rigid endoscopy permits detailed examination of the oral cavity and erupted dental tissues and has the potential to assist in the correct identification of the diseased tooth. Objectives: To document oral endoscopic findings associated with infected equine cheek teeth in cases without gross oral pathological changes and thereby determine the usefulness of rigid oral endoscopy as an aid to diagnosis of such infections. Methods: Records of all cases of equine cheek tooth removal attempted under standing sedation over a 38 month period were examined. Cases were excluded from the study if apical infection was associated with gross dental fracture, malalignment, diastema/periodontal pocketing or supernumerary teeth. Endoscopic and radiographic findings were analysed and correlated to diseased tooth location. Results: Seventeen cases of apical dental infection fitting the inclusion criteria (nonresponsive to antibiotics and with no gross oral abnormality of the affected arcade) were identified in which oral endoscopy was used as an aid to diagnosis. In 15 (88%) of the 17 cases, oral endoscopy revealed abnormalities specific to the infected tooth. Focal gingival recession (10/17 cases) was the most common visible abnormality associated with infected teeth. Conclusions: In the majority of cases of apical infection of equine cheek teeth there is visible intraoral evidence implicating the affected tooth. Potential relevance: Oral endoscopy facilitates detailed examination of the mouth and should be considered along with radiography as an important aid to diagnosis in cases of equine dental infection.     

Pharmacokinetics of detomidine administered to horses at rest and after maximal exercise

Reason for performing study: Increased doses of detomidine are required to produce sedation in horses after maximal exercise compared to calm or resting horses. Objectives: To determine if the pharmacokinetics of detomidine in Thoroughbred horses are different when the drug is given during recuperation from a brief period of maximal exercise compared to administration at rest. Methods: Six Thoroughbred horses were preconditioned by exercising them on a treadmill. Each horse ran a simulated race at a treadmill speed that caused it to exercise at 120% of its maximal oxygen consumption. One minute after the end of exercise, horses were treated with detomidine. Each horse was treated with the same dose of detomidine on a second occasion a minimum of 14 days later while standing in a stocks. Samples of heparinised blood were obtained at various time points on both occasions. Plasma detomidine concentrations were determined by liquid chromatographymass spectrometry. The plasma concentration vs. time data were analysed by nonlinear regression analysis. Results: Median back‐extrapolated time zero plasma concentration was significantly lower and median plasma half‐life and median mean residence time were significantly longer when detomidine was administered after exercise compared to administration at rest. Median volume of distribution was significantly higher after exercise but median plasma clearance was not different between the 2 administrations. Conclusions and potential relevance: Detomidine i.v. is more widely distributed when administered to horses immediately after exercise compared to administration at rest resulting in lower peak plasma concentrations and a slower rate of elimination. The dose requirement to produce an equivalent effect may be higher in horses after exercise than in resting horses and less frequent subsequent doses may be required to produce a sustained effect.     

Variability of resting endoscopic grading for assessment of recurrent laryngeal neuropathy in horses

Reasons for performing study: The extent to which variability affects endoscopic grading of arytenoid cartilage movement is uncertain. Objective: To determine the observer and within horse variability of grading arytenoid cartilage movement in horses during resting endoscopic examination, using a 7‐grade system. Methods: Endoscopic recordings of the upper respiratory tract made at rest in 270 draught horses were reviewed independently by 2 veterinarians to assess interobserver variability when scoring horses' laryngeal function with a 7‐grade system. Grading was repeated by both examiners in 80 randomly selected recordings in order to assess intraobserver variability. In 120 horses, endoscopy was repeated after 24–48 h, with videos graded by both veterinarians to assess intrahorse variability. Results: The mean weighted κ statistic for concordance within examiners was 0.867, with a mean intraobserver agreement of 76.3%. The weighted κ statistic for concordance between the 2 examiners was 0.765, with an interobserver agreement of 63.1%. Of the horses receiving 2 endoscopic examinations, the same grade was assigned to 57.1% of horses at the second examination, when effects resulting from interobserver variability were removed. The mean weighted κ statistic for concordance between the grade assigned at first vs. second examinations was 0.588, indicating only moderate agreement. Conclusions and potential relevance: Intra‐ and interobserver reliability of resting endoscopic grading of arytenoid cartilage movement using a 7‐grade system was high when examinations were conducted by experienced veterinarians. However, there was moderate daily intrahorse variability, suggesting that results of resting endoscopic examinations performed on a single day should be interpreted with caution.     

Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study

Reason for performing study: Localisation of spinal cord compression in horses with cervical vertebral stenotic myelopathy is inexact. Vertebral canal endoscopy has been used in man to localise spinal cord lesions and has the potential to become a useful diagnostic technique in horses. Objective: To establish a surgical approach via the atlanto‐occipital space to the cervical vertebral canal in equine cadavers and describe the endoscopic anatomy of the cervical epidural and subarachnoid spaces. Methods: The cadavers of 25 mature horses were used to assess 3 surgical methods to approach the cervical vertebral canal, including 2 minimally invasive and one open technique. Once the approach had been made, a flexible videoendoscope was inserted into the epidural space (epiduroscopy) or the subarachnoid space (myeloscopy) and advanced caudally until the intervertebral space between C7 and T1 was reached. Results: The epidural and subarachnoid spaces could not be accessed reliably using the minimally invasive techniques. Furthermore, damage to the nervous tissues was a frequent complication with these procedures. The open approach allowed successful insertion of the videoendoscope into the epidural and subarachnoid spaces in all horses and no inadvertent damage was observed. Anatomical structures that could be seen in the epidural space included the dura mater, nerve roots, fat and the ventral internal vertebral venous plexus. In the subarachnoid space, the spinal cord, nerve roots, blood vessels, denticulate ligaments and external branch of the accessory nerve were seen. Conclusions: Using the open approach, epiduroscopy and myeloscopy over the entire length of the cervical vertebral canal are possible in the mature horse. Potential relevance: Cervical vertebral canal endoscopy may become a valuable tool to localise the site of spinal cord injury in horses with cervical vertebral stenotic myelopathy and could aid in the diagnosis of other diseases of the cervical spinal cord.     

Serum concentration of surfactant protein D in horses with lower airway inflammation

Reasons for performing study: Surfactant protein D (SP‐D), mainly synthesised by alveolar type II cells and nonciliated bronchiolar cells, is one important component of innate pulmonary immunity. In man, circulating concentrations of SP‐D are routinely used as biomarkers for pulmonary injury. To date, serum SP‐D levels have only been investigated in horses in an experimental model of bacterial airway infection. Objectives: To compare serum SP‐D concentrations at rest and after exercise in horses with and without inflammatory airway disease (IAD). Methods: Venous blood samples were collected from 42 Standardbred racehorses at rest and 60 min after performing a standardised treadmill exercise test. Tracheal wash and bronchoalveolar lavage fluid (BALF) samples were collected after exercise. Based on BALF cytology, 22 horses were defined as IAD‐affected and 20 classified as controls. Serum SP‐D concentrations were assessed using a commercially available ELISA kit and statistically compared between groups of horses and sampling times. Results: Serum concentrations of SP‐D in IAD‐affected horses were significantly higher than those of control horses, both at rest and after exercise. Within the IAD‐affected group, no significant correlation was found between serum SP‐D concentrations and BALF cytology. Within each group of horses (IAD and control), no significant influence of exercise was found on serum SP‐D levels. Conclusions: This is the first study determining serum SP‐D concentrations in a noninfectious, naturally occurring form of lower airway inflammation in horses. The results highlight that IAD is associated with a detectable, though moderate, increase of circulating SP‐D levels. Potential relevance: Serum concentration of surfactant protein D could represent a potentially valuable and readily accessible blood biomarker of equine lower airway inflammation.     

Dynamic obstructions of the equine upper respiratory tract. Part 2: comparison of endoscopic findings at rest and during high-speed treadmill exercise of 600 Thoroughbred racehorses

REASONS FOR PERFORMING STUDY: The reliability of diagnoses of obstructive conditions of the upper respiratory tract (URT) based on examinations performed at rest vs. at exercise is controversial. OBJECTIVE: To compare diagnosis of URT by endoscopy at rest with that achieved during high-speed treadmill exercise (HSTE). HYPOTHESIS: Endoscopy of URT at rest, when performed in isolation from other simpler techniques is unreliable in the prediction of dynamic respiratory obstructions. METHODS: Endoscopic findings of 600 Thoroughbred racehorses during quiet breathing were compared with findings during high-speed treadmill exercise. Other parameters were also assessed for their specificity in diagnosis. RESULTS: Endoscopy of the resting horse showed low sensitivity (0.15) in the diagnosis of dorsal displacement of the soft palate (DDSP) and palatal instability (PI). When endoscopy and reported noises were taken together there was still a 35% misdiagnosis rate. Although there was significant association between resting laryngeal function score (LFS) and dynamic vocal cord and/or arytenoid cartilage collapse at exercise, 19% of horses with a grade 4/5 LFS were able to attain and maintain full abduction during exercise and 7% of those with 'normal' grades 1 or 2 LFS at rest showed dynamic laryngeal collapse when exerted. Sensitivity of the diagnostic model was greatly increased (80%) when a history of inspiratory noise and palpable intrinsic muscle atrophy were included. CONCLUSIONS AND POTENTIAL RELEVANCE: Endoscopy of the upper respiratory tract of static horses is unreliable in the diagnosis of dynamic obstructions of the URT and should not be used in isolation in surgical decision-making or in the assessment of horses at the time of sale.     

Exercising videoendoscopic evaluation of 45 horses with respiratory noise and/or poor performance after laryngoplasty

Objective: To (1) assess upper airway function by videoendoscopy in horses performing poorly after laryngoplasty and (2) establish whether dynamic collapse of the left arytenoid can be predicted by the degree of resting postsurgical abduction. Study Design: Case series. Animals: Horses that had left laryngoplasty (n=45). Methods: Medical records (June 1993–December 2007) of horses evaluated for abnormal respiratory noise and/or poor performance after laryngoplasty were reviewed. Horses with video recordings of resting and exercising upper airway endoscopy were included and postsurgical abduction categorized. Horses with immediate postoperative endoscopy recordings were also evaluated and postsurgical abduction categorized. Relationships between resting postsurgical abduction and historical information with exercising endoscopic findings were examined. Results: Dynamic collapse of the left arytenoid cartilage was probable in horses with no postsurgical abduction and could not be predicted in horses with grade 3 or 4 postsurgical abduction. Respiratory noise was associated with upper airway obstruction but was not specific for arytenoid collapse. Most horses with a left vocal fold had billowing of the fold during exercise. Other forms of dynamic collapse involved the right vocal fold, aryepiglottic folds, corniculate process of left arytenoid cartilage, dorsal displacement of soft palate, and pharyngeal collapse. Complex obstructions were observed in most examinations and in all horses with exercising collapse of the left arytenoid cartilage. Conclusions: There was no relationship between exercising collapse of the left arytenoid cartilage and grade 3 or 4 postsurgical abduction but was likely in horses with no abduction.     

Complex dynamic upper airway collapse: associations between abnormalities in 99 harness racehorses with one or more dynamic disorders

Reasons for performing study: Many horses demonstrate dynamic collapse of more than one upper respiratory tract (URT) structure during high‐speed treadmill videoendoscopy (HSTV). Objectives: To report the frequency of complex dynamic URT collapse in harness racehorses and determine if an association exists between occurrence of certain disorders. Methods: Retrospective study of 99 Standardbreds and Coldblooded trotters that had one or more dynamic URT disorders identified during HSTV between 1998 and 2006. The horses underwent HSTV using a protocol that included periods of free head carriage and poll flexion until fully fatigued. Dynamic abnormalities were classified as: dynamic laryngeal collapse (DLC) associated with poll flexion; axial deviation of the aryepiglottic folds (ADAF); dynamically flaccid epiglottis (FE); caudal palatal instability (PI); intermittent dorsal displacement of the soft palate (iDDSP); pharyngeal collapse (PC); alar fold collapse (AFC) and nasal flutter (NF). Cluster analysis and Fisher's exact test was performed between groups. Significance was set at P<0.05. Results: The overall incidence of complex dynamic URT collapse was 69.7%. Axial deviation of the aryepiglottic folds was significantly associated with PI (P<0.0001) and FE (P<0.0001); iDDSP was significantly associated with PI (P = 0.004) only. Dynamic laryngeal collapse associated with poll flexion was significantly associated with FE (P = 0.002). Cluster analysis confirmed strong associations between the above diagnosis groups and weaker associations between others. Conclusion: Caudal PI seems to result in 2 diagnosis groupings: one that leads to ADAF and the other to iDDSP. Dynamic collapse of the margins of the epiglottis was a common finding in this study strongly associated with DLC, PI and ADAF. Potential clinical relevance: The associations between certain dynamic diagnoses identified in this study seems best explained as due to local anatomic and functional weaknesses that influence other structures through the Bernouilli principle, rather than being due to a generalised neurological disorder.     

Cartilage-derived retinoic acid-sensitive protein in equine synovial fluid from healthy and diseased joints

Reasons for performing study: More sensitive and specific diagnostic methods for early detection of changes in the joint cartilage are needed. Cartilage‐derived retinoic acid‐sensitive protein (CD‐RAP) is a potential marker of cartilage synthesis and regeneration. This is the first study on equine CD‐RAP. Objectives: To evaluate the ability of a commercially available human sandwich ELISA assay to detect equine CD‐RAP in synovial fluid from healthy and diseased joints. Methods: Synovial fluid was collected from 28 horses with no signs of joint disease and from 5 with induced inflammatory arthritis. CD‐RAP concentrations were measured using a human CD‐RAP ELISA. Intra‐ and interassay imprecision of the assay were evaluated by multiple measurements on pools of equine synovial fluid. Assay inaccuracy was determined by linearity under dilution. Results: The assay showed moderate to large intra‐ and interassay variation when applied to equine synovial fluid. Equine CD‐RAP was detected in synovial fluid from healthy horses ranged at 8.2–52 ng/ml. Repeated arthrocentesis (after injection of isotonic saline), age, joint or gender did not significantly affect CD‐RAP concentrations. Twelve hours after intra‐articular injection of lipopolysaccharide, concentrations of CD‐RAP were significantly lower than after injection of isotonic saline and remained significantly lower until the end of the study at 144 h. Conclusion and potential relevance: The assay is suitable for longitudinal monitoring of CD‐RAP concentration in individual horses. Disease significantly influenced CD‐RAP levels. Similar to previous results obtained in man, CD‐RAP seems to be a marker of cartilage synthesis and/or regeneration in horses.