In vitro evaluation of an inverted end-to-end equine jejunojejunal anastomosis using skin staples

OBJECTIVE: To compare functional indices of end-to-end (EEA) jejunojejunal anastomosis using skin staples in horses with a 2-layer inverting hand-sewn technique. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Jejunal segments from 8 fresh equine cadavers. METHODS: For each bowel segment, 2 EEA anastomoses were created: one 2-layer hand-sewn and one 1-layer using skin staples. Time for anastomosis creation was recorded and compared. Lumen diameter of each anastomosis was measured on digital radiographs after intraluminal instillation of contrast medium and inflation of the jejunal segments to 14 mm Hg. Anastomotic indices (a compensated measure of stoma diameter) and bursting pressure were determined. RESULTS: EEA jejunal anastomosis using skin staples was significantly faster than use of a 2-layer hand-sewn technique. Anastomotic index, a measure of lumen size, was significantly larger with the skin-staple technique; however, the bursting pressure of stapled anastomoses was significantly less than for the hand-sewn technique, but the values were well above those reported for other anastomotic techniques. CONCLUSIONS: An anastomotic technique using skin staples was easy to learn and perform, effective and faster, and mechanically comparable with a hand-sewn 2-layer technique. CLINICAL RELEVANCE: The staple technique could be beneficial in equine gastrointestinal surgery by reducing anastomosis time, although further in vivo studies are needed to establish clinical safety.     

Comparison of one-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end anastomosis in equine jejunum

OBJECTIVE: To evaluate single and double layer end-to-end anastomosis in equine jejunum. STUDY DESIGN: Experimental in vitro study. ANIMALS: Mid-jejunal sections from 12 adult horses without gastrointestinal disease. METHODS: Jejunal end-to-end anastomoses were performed by a continuous Lembert pattern or a simple continuous pattern oversewn with a Cushing pattern. Jejunal segments were distended with fluid at 1 L/min, and intraluminal pressure at failure, and mode of failure were recorded. Bursting pressure and bursting wall tension were calculated. Anastomosis construction time and degree of luminal reduction were recorded. Results- Single layer anastomoses were constructed in less time than 2-layer anastomoses. Both anastomotic techniques resulted in luminal reduction compared with control tissue; however, the reduction was smaller with a 1-layer continuous Lembert anastomosis. No differences were noted in bursting pressure or bursting wall tension between groups. CONCLUSIONS: Anastomosis using a 1-layer continuous Lembert pattern resulted in a larger stoma, was faster to perform, and as strong as a 2-layer anastomosis. CLINICAL RELEVANCE: Use of a 1-layer continuous Lembert pattern for jejunojejunosotomy may be beneficial by decreasing anastomosis time and produce a larger stoma than a 2-layer anastomosis.     

A comparison of three methods of end-to-end anastomosis in the equine small colon

Six animals were used to compare simple interrupted, simple continuous, and stapled techniques for end-to-end rotated small colon anastomoses. Three ponies were evaluated three days after surgery for adhesion formation and luminal diameter at each anastomosis site. Two ponies and one horse were evaluated 14 days after surgery for adhesion formation. All anastomosis sites were examined histologically for alignment of tissue planes, and evidence of inflammation. No single technique was superior in all areas examined. While only three of the nine anastomoses had mild fibrinous adhesions at three days after surgery, all anastomoses had varying degrees of well-organized adhesions by 14 days after surgery. Three days after surgery luminal diameter was most comprised by the simple continuous technique. Although the simple interrupted technique was most consistent in its alignment of tissue planes, it was only slightly better than the simple continuous pattern. Stapled anastomoses were inverted or everted at all sites examined. Adhesion formation was less extensive, and histologic evidence of inflammation was less severe, in stapled anastomoses. The average times required to complete the simple interrupted, simple continuous, and stapled anastomoses were 22, 14, and 8 minutes, respectively.     

Use of an extracorporeal circuit to evaluate effects of intraluminal distention and decompression on the equine jejunum

OBJECTIVE: To use an extracorporeal circuit to evaluate effects of intraluminal distention on the jejunum of healthy horses. SAMPLE POPULATION: 2 jejunal segments from each of 5 horses. PROCEDURE: Jejunal segments were harvested and maintained in an extracorporeal circuit. One segment was subjected to distention (intraluminal pressure, 25 cm H2O) followed by decompression, and 1 segment was maintained without distention. The influence of distention-decompression on vascular resistance was calculated. Mucosal permeability was evaluated by measuring the clearance of albumin from blood to lumen. After distention and decompression, tissue specimens were collected for histomorphologic evaluation. In addition, the contractile response of the circular smooth muscle layer was determined following incubation with 3 prokinetic agents. RESULTS: Intestinal vascular resistance increased during intraluminal distention and returned to baseline values after decompression. Albumin clearance rate increased after distention, compared with baseline and control values. Histologic examination of the distended segments revealed grade-1 and -2 lesions of the mucosal villus. Edema and hemorrhage were evident in the submucosa and muscular layers. Mesothelial cell loss, edema, and hemorrhage were also evident in the serosa. Mucosal surface area and villus tip height decreased and submucosal volume increased in the distended tissue. Compared with responses in control specimens, distention decreased the contractile response induced by cisapride, erythromycin, and metoclopramide. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention of the jejunum followed by decompression increased mucosal permeability and injury and decreased responses to prokinetic agents. Horses with intraluminal intestinal distention may have a decreased response to prokinetic agents.     

Use of an isolated intestinal circuit to evaluate the effect of ischemia and reperfusion on mucosal permeability of the equine jejunum

OBJECTIVES: To evaluate the efficacy of an isolated perfusion circuit and the effect of ischemia-reperfusion on mucosal permeability of the jejunum. STUDY DESIGN: In vitro study of intestinal mucosal permeability. ANIMALS: Twelve healthy adult horses. METHODS: A control segment of jejunum was placed in an isolated perfusion circuit for 240 minutes and mucosal permeability was measured. After detecting no deleterious effects of the isolated system on the control intestine, low flow ischemia was created in experimental segments for 20, 40, 60 and 90 minutes followed by 60 minutes of reperfusion and mucosal permeability was evaluated. At the completion of the studies, histologic evaluation was used to determine mucosal grades, surface area, and volume. RESULTS: Control tissue was maintained in the isolated circuit for 240 minutes without effect on mucosal grade, surface area, or volume relative to intact tissue. After ischemia-reperfusion, mucosal grade increased, and volume and surface area decreased progressively with longer periods of ischemia. Mucosal clearance of albumin remained constant during 240 minutes of perfusion in control tissue and was elevated after ischemia-reperfusion. CONCLUSIONS: No deleterious changes were noted in jejunum perfused with this isolated circuit, whereas alterations in mucosal permeability were present after ischemia-reperfusion. CLINICAL RELEVANCE: The isolated perfusion circuit successfully maintained an isolated segment of jejunum within physiologic limits, and can be used to evaluate the effects of injury and the efficacy of pharmaceuticals to attenuate these changes.     

Use of an intravitreal sustained-release cyclosporine delivery device for treatment of equine recurrent uveitis.

OBJECTIVE: To evaluate the use of an intravitreal sustained-release cyclosporine (CsA) delivery device for treatment of horses with naturally occurring recurrent uveitis. ANIMALS: 16 horses with recurrent uveitis. PROCEDURES: Horses with frequent recurrent episodes of uveitis or with disease that was progressing despite appropriate medication were selected for this study. Additional inclusion criteria included adequate retinal function as determined by use of electroretinography, lack of severe cataract formation, and no vision-threatening ocular complications (eg, retinal detachment, severe retinal degeneration, and posterior synechia). Sustained-release CsA delivery devices (4 microg of CsA/d) were implanted into the vitreous through a sclerotomy at the pars plana. Reexaminations were performed 1, 3, 6, and 12 months after implantation, then continued annually. Ophthalmic changes, number of recurrent episodes of uveitis, and vision were recorded. RESULTS: The rate of recurrent episodes after device implantation (0.36 episodes/y) was less than prior to surgery (75 episodes/y). In addition, only 3 horses developed episodes of recurrent uveitis after surgery. Vision was detected in 14 of 16 affected eyes at a mean follow-up time of 13.8 months (range, 6 to 24 months). CONCLUSIONS AND CLINICAL RELEVANCE: This intravitreal sustained-release CsA delivery device may be a safe and important tool for long-term treatment of horses with chronic recurrent uveitis.     

Clinical evaluation of a closed,one-stage,stapled, functional,end-to-end jejuno-ileal anastomosis in 5 horses

This study describes the outcome and complications in horses that had a closed, one-stage, stapled, functional, end-to-end (COSFE) jejuno-ileal anastomosis (JIA) following resection of compromised small intestine. Medical records were reviewed to identify all horses that had a COSFE JIA performed during exploratory laparotomy and to determine post-operative complications and final outcome. All 5 horses that were identified had successful COSFE JIA with resection of various amounts of distal jejunum and proximal ileum. Post-operative ileus occurred in 1 of the 5 horses. All horses survived at least 1 year after surgery. The survival times and incidence of post-operative ileus compared favorably with published results for other types of small intestinal resection and anastomoses. A COSFE JIA is a viable surgical procedure to correct lesions of the distal jejunum and proximal ileum.     

Mucosal permeability of water-soluble drugs in the equine jejunum: a preliminary investigation

Ussing chambers have been used to study the mucosal permeability of drugs in humans, rats and other species. This data can then be used to develop in vitro/in vivo correlations (IVIVC) for drugs based on the Biopharmaceutics Classification System (BCS). Due to the poor oral bioavailability of many drugs in the horse, this method may be useful for screening drugs before development to determine if they warrant further study. Cephalexin (CPX), marbofloxacin (MAR), metronidazole (MTZ) and fluconazole (FCZ) were chosen for this study based on the wide range of physicochemical properties and bioavailability in the horse. Permeability was ranked as follows: MTZ > FCZ > MAR > CPX. This correlated with the bioavailability (R(2) = 0.633447), the Log P (R(2) = 0.648517), as well as the molecular weight (R(2) = 0.851208) of the drugs. Metronidazole induced a decrease in the tissue transepithelial resistance, suggestive of the possibility of tissue toxicity, which may have falsely increased its permeability. The low permeability of cephalexin across the tissue may indicate a lack of active transporters that are found in other species. From this study, we can conclude that the Ussing chamber is a promising method for determining mucosal permeability in the horse.     

Effect of a leukocyte-depleting filter in an extracorporeal circuit used for low-flow ischemia and reperfusion of equine jejunum

OBJECTIVE: To determine effect of leukocyte depletion on hematologic, morphologic, and metabolic variables of equine jejunum after induction of arterial low-flow ischemia and reperfusion by use of an extracorporeal circuit. ANIMALS: 14 healthy adult horses. PROCEDURE: A segment of jejunum was surgically removed and maintained in an isolated circuit for 3 hours (control group), arterial flow was reduced to 20% of baseline for 40 minutes followed by 1 hour of reperfusion (low-flow group), or leukocyte depletion was filter-induced, and low-flow ischemia and reperfusion were conducted as in the low-flow control group (filter-treated group). Various metabolic, hemodynamic, and histomorphologic variables were evaluated, including effects of electrical field stimulation and L-N-nitro-arginine-methyl-ester (L-NAME) on contractile activity. RESULTS: The extracorporeal circuit appeared to maintain the jejunum within physiologic limits for an extended period. Low-flow ischemia with reperfusion induced significant differences in various measurements, compared with control specimens. Significant differences were not detected between the low-flow and filter-treated groups. Myeloperoxidase activity was greater in the low-flow group than the control group, whereas a difference was not detected between control and filter-treated groups. CONCLUSIONS AND CLINICAL RELEVANCE: The extracorporeal circuit maintained intestine for 3 hours in a physiologic state and may be used for simulation of tissue injury. Leukocyte depletion generally did not attenuate the effects of low-flow ischemia and reperfusion on equine small intestine.     

Evaluation of Carolina Rinse solution as a treatment for ischaemia reperfusion of the equine jejunum

REASONS FOR PERFORMING STUDY: Ileus and peritoneal adhesions are the most common complications following surgery for small intestinal obstruction. Carolina Rinse (CR) has been shown to decrease reperfusion injury in intestine and other organs. HYPOTHESIS: CR decreases intestinal inflammation and subsequent scarring associated with reperfusion injury. METHODS: CR was infused intra-arterially and applied topically just prior to reperfusion in jejunum exposed to experimental ischemia. Vascular permeability, neutrophil accumulation and serosal scarring were compared in treated and untreated intestine. RESULTS: CR maintained a normal osmotic reflection coefficient and decreased migration of neutrophils into the serosa during reperfusion. After 10 days, treated intestine was normal in appearance with a trend toward less serosal scarring and fibroblast proliferation. There was a significant decrease in fibroplasia at biopsy sites in treated intestine. CONCLUSIONS: Arterial perfusion combined with topical application of CR during jejunal ischaemia decreases immediate reperfusion injury and limits post operative scarring. POTENTIAL RELEVANCE: CR should be used as a local perfusate rather than a systemic treatment; it may best be applied topically and intraluminally to avoid damaging mesenteric arteries. CR should be considered an adjunct treatment as part of overall surgical management and post operative care.     

Use of an ELISA test in the eradication of an equine infectious anaemia focus

Summary An enzyme linked immunosorbent assay (ELISA) test and the classic agar gel immunodiffusion (AGID) test were used as diagnostic methods in the eradication of a focus of equine infectious anaemia from a herd of 86 horses. The ELISA test proved to be more sensitive, detecting positive animals earlier than the AGID test. A group of 16 animals positive only by ELISA also became positive to the AGID when retested one month later, except for 2 animals which showed clinical signs of the disease and died before retesting.

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El Uso De Una Prueba Elisa En La Erradicacion De Un Foco De Anemia Infecciosa Equina

Resumen La prubla ELISA (Enzyme Linked Immunosorbent Assay) y la pruebla clásico de imunodifusión en gel agar (IDGA) fueron utilizados como métodos de diagnóstico para eliminar un foco de Anemia Infecciosa Equina. La pruebla de ELISA fue más sensible, detectando los animales positivos antes que la pruebla de IDGA. Un grupo de animales positivos, que fueron detectados solamente por la pruebla de ELISA, fueron también detectados por la pruebla de IDGA en el reteste después de treinta dias. De los 16 animales de ese grupo, solamente 2 mostrarom signos clinicos de la enfermedad y murieron antes de la realización del reteste.

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L'utilisation Du Test Elisa Dans L'eradication D'un Foyer D'anemie Infectieuse Equine

Résumé Un test d'ELISA (Enzyme Linked Immunosorbent Assay) et un test cassique d'immunodiffusion en gel d'agar (IDGA) ont été utilisés comme méthodes de diagnostic de l'erradication d'un foyer d'Anémie Infectiuse Equine. Le test d'ELISA a été le plus sensible detectant animaux positifs plus tot que le test d'IDGA. Un groupe d'animaux positifs qui ont été detectés seulement par le test d'ELISA ont aussi été detectés par le test d'IDGA lors d'un nouveau test après trente jours. De ce groupe constituté par seize animaux, seulement deux ont montré des signes cliniques de la maladie et sort morts avant la réalisation du nouveau test.

     

Use of stapling instruments to aid in the removal of ovarian tumours in mares

Ovarian granulosa theca cell tumours were removed surgically in 10 mares. Stapling instruments were used to facilitate haemostasis of the ovarian pedicle in five out of 10 cases and as a sole method of haemostasis in the remaining five cases. Postoperative haemorrhage from the ovarian pedicle was suspected in only one case. All cases survived long term follow-up from six months to four years. Results from this series of cases indicate that stapling instruments provide a rapid, easy and efficient means of ligating ovarian pedicles when performing ovariectomy in the mare.     

Use of an extracorporeal circuit to evaluate effects of ischemia and reperfusion of the equine large colon

OBJECTIVE: To determine efficacy of an extracorporeal circuit to maintain a segment of equine large colon for 3.5 hours and to evaluate the effect of low arterial flow on histologic and metabolic variables. SAMPLE POPULATION: Segments of large colon from 15 healthy adult horses. PROCEDURE: The pelvic flexure was surgically removed and maintained in an isolated circuit. In the control group, tissue was evaluated for 3.5 hours, whereas in the low-flow group, arterial flow was reduced to 20% of baseline for 40 minutes followed by 2 hours of reperfusion. Various metabolic and hemodynamic variables were evaluated at 30-minute intervals. Effects of nitric oxide (NO) and L-N-nitro-arginine-methyl-ester (L-NAME) on contractile activity were determined, and histomorphologic evaluation was performed at the completion of the study. RESULTS: Low-flow ischemia with reperfusion caused significant histomorphologic differences, compared with the control group. In the low-flow group, significant differences included reduction in PaCO2, reduction in bicarbonate concentrations, increase in PaO2, and an increase in base deficit in arterial and venous blood samples. Other significant differences included increases in PCV, protein concentration, total WBC count, and albumin clearance for the low-flow group. Differences were not detected in inhibitory activity of the low-flow group relative to the control tissue with or without addition of NO and L-NAME. CONCLUSION: The extracorporeal circuit maintained a segment of equine intestine for 3.5 hours and can be used to simulate ischemic injury. The extracorporeal circuit provides the potential to investigate pharmaceutic agents that can minimize intestinal injury.     

Use of a fetlock support brace to manage lacerations of equine flexor tendons

A retrospective analysis of 15 cases of flexor tendon lacerations managed with a fetlock support brace between 2004 and 2008 was performed. Information was gathered concerning exact nature of the injury, treatment details and outcome. Limbs involved included 2 forelimbs and 13 hindlimbs. Eight of fifteen horses (53%) presented with a dropped fetlock, elevated toe or both when bearing weight on the affected limb. General anaesthesia was performed on 7/15 cases to further evaluate and treat the wound, 8/15 cases were managed with local anaesthesia and/or sedation only. The brace was applied within 14 days of presentation and maintained for a mean of 106 days. Sixty percent of cases were sound and used as intended and an additional 20% were sound but at a lesser level of work. Horses with flexor tendon lacerations can be managed with a fetlock support brace alone and have a similar outcome with shorter hospitalisation than horses managed by other methods.     

Attempts to restore abduction of the paralyzed equine arytenoid cartilage. III. Nerve anastomosis.

The purpose of this project was to attempt restoration of abduction of a recently denervated left dorsal cricoarytenoid muscle in the horse by anastomosing the first cervical nerve to the abductor branch of the left recurrent laryngeal nerve. Ten horses were used in the study. In six horses the left recurrent laryngeal nerve was transected and ligated while the ventral branch of the left first cervical nerve was anastomosed to the abductor branch of the left recurrent laryngeal nerve. The remaining four horses also had the left recurrent laryngeal nerve transected and ligated but had no nerve anastomosis performed. Each horse was evaluated preoperatively, and at one week, three and six months after surgery, by endoscopy and determination of upper airway resistance. The endoscopy was performed with the horses breathing room air and while breathing 10% carbon dioxide. All ten horses showed endoscopic signs of complete laryngeal hemiplegia immediately postoperatively. Starting at three months postoperatively clonic movements of the left arytenoid cartilage were observed in four of the six reinnervated horses but not in the sham operated horses. At the sixth postoperative month five reinnervated horses had clonic movements of the left arytenoid cartilage. The comparison of upper airway resistance measurements before surgery and at one week, three and six months after surgery showed no significant differences in either control or experimental horses. Following euthanasia at six months postoperatively, the left and right dorsal crioarytenoid muscles were compared for evidence of reinnervation. No significant difference in weight was noted in the reinnervated horses but the left dorsal cricoarytenoid muscle weighed less than the control horses.     

Use of immunohistochemical marker calretinin in the diagnosis of a diffuse malignant metastatic mesothelioma in an equine.

Mesotheliomas are rarely reported in animal species. In this report, the occurrence of a diffuse, metastatic mesothelioma in a 6-year-old gray Arabian mare is described. The mare was presented on clinical examination with ascites, bilateral pleural effusion, and pleural roughening. Necropsy revealed abundant fluid in the abdominal and thoracic cavities. The surface of all organs was thick and fibrosed with multiple raised nodules and hemorrhages. Histology was characteristic of a generalized, biphasic mesothelioma with vascular and lymph nodes metastases. It is believed that the primary tumor developed in the pericardium and spread through lymphatics. In this report, calretinin was used as an immunohistochemical marker in the diagnosis of mesothelioma in an equine species for the first time.