Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: tarsus and stifle

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the hindlimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the tarsometatarsal, centrodistal and tarsocrural joints, and the 3 synovial compartments of the stifle in 33 fresh equine cadavers. The tarsometatarsal joint and one synovial compartment of the stifle in the left limb and the centrodistal joint and a different synovial compartment of the stifle in the right limbs were injected with mepivacaine. Following flexion and extension of the limb, synovial fluid was aspirated from the noninjected centrodistal and tarsometatarsal joints and the tarsocrural joints of the hock and the noninjected compartments of the stifle. Concentrations of mepivacaine in these samples were assayed using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid the concentration of mepivacaine was determined by comparing the concentration of urea in the diluted synovial fluid and the concentrations of the serum urea. Mepivacaine was detected in 25/25 (100%) adjacent tarsometatarsal and centrodistal joints after diffusion in both directions, in 23/25 (92%) of tarsocrural joints after diffusion from tarsometatarsal joints and in 22/25 (88%) tarsocrural joints after diffusion from centrodistal joints in the hocks. Diffusion from the femoropatellar to medial and lateral femorotibial joints and between the medial and lateral femorotibial joints in both directions were 20/20 (100%). Diffusion from the lateral femorotibial to the femoropatellar joint was 18/20 (90%) and from the medial femorotibial to femoropatellar joints 17/20 (85%). Mepivacaine was detected at concentrations >0.3 mg/l in a proportion of samples ranging from 15/25 (60%) in the tarsocrural joint following tarsometatarsal joint injection to 18/20 (90%) in the lateral femorotibial joint after femoropatellar joint injection. At mepivacaine concentrations >100 mg/l, detection ranged from 3/20 (15%) in the lateral femorotibial joint from the medial femorotibial joint to 19/25 (76%) in the centrodistal joint from the tarsometatarsal joint. At mepivacaine concentrations >300 mg/l, detection ranged from 1/25 (4%) in the tarsocrural joint from the tarsometatarsal joint to 16/25 (64%) in the from centrodistal joint the tarsometatarsal joint. The results show greater diffusion of mepivacaine between these adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. Therefore, commonly performed intrasynovial local analgesic techniques in the hindlimb of the horse are not as specific as first thought.     

1H NMR investigation of normal and osteo-arthritic synovial fluid in the horse.

Proton magnetic resonance spectroscopy (1H NMR) has been successfully used in the study of many biological fluids. The data presented here report on the metabolic profiles of normal equine synovial fluids compared with osteoarthritic (OA) fluids. Twenty-five OA synovial fluid samples and eight normal ones were collected from the forelimb fetlock joint in 22 horses, aged between five and 24 years. 1H NMR spectroscopy was carried out with a Bruker Avance DRX 500 equiped with a cryo-magnet working at 11 Tesla, and 'Mestre-C 4.9.9.6' software was used to analyze the spectra. The study assessed the increase of lactate, alanine, acetate, N-acetylglucosamine, pyruvate, citrate, creatine/creatinine, glycerol, HDL choline, and a-glucose in OA synovial fluid. The variations observed in samples from horses with OA compared to those in the control group, and similar data found in other studies, confirm that this technique may be useful in the study of joint metabolism. Its practical application may be in the evaluation of the treatment of OA in athletic horses.     

Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 1: Navicular bone and related structures

REASONS FOR PERFORMING STUDY: Causes of palmar foot pain and the aetiopathogenesis of navicular disease remain poorly understood, despite the high incidence of foot-related lameness. HYPOTHESES: Abnormalities of the collateral sesamoidean ligaments (CSLs), distal sesamoidean impar ligament (DSIL), deep digital flexor tendon (DDFT), navicular bone, navicular bursa, distal interphalangeal (DIP) joint or collateral ligaments (CLs) of the DIP joint may contribute to palmar foot pain. METHODS: Feet were selected from horses with a history of unilateral or bilateral forelimb lameness of at least 2 months' duration that was improved by perineural analgesia of the palmar digital nerves, immediately proximal to the cartilages of the foot (Group 1, n = 32); or from age-matched control horses (Group 2, n = 19) that were humanely destroyed for other reasons and had no history of forelimb foot pain. Eight units of tissue were collected for histology: the palmar half of the articular surface of the distal phalanx, including the insertions of the DDFT and DSIL; navicular bone and insertion of the CSLs; DDFT from the level of the proximal interphalangeal (PIP) joint to 5 mm proximal to its insertion; synovial membrane from the palmar pouch of the DIP joint and the navicular bursa; CLs of the DIP joint and DSIL. The severity of histological lesions for each site were graded. Results were compared between Groups 1 and 2. RESULTS: There was no relationship between age and grade of histological abnormality. There were significant histological differences between groups for lesions of the flexor aspect, proximal and distal borders, and medulla of the navicular bone; the DSIL and its insertion and the navicular bursa; but not for lesions of the CSLs, the dorsal aspect of the navicular bone, distal phalanx and articular cartilage, synovium or CLs of the DIP joint. CONCLUSIONS: Pathological abnormalities in lame horses often involved not only the navicular bone, but also the DSIL and navicular bursa. Abnormalities of the navicular bone medulla were generally only seen dorsal to lesions of the FFC. POTENTIAL RELEVANCE: Adaptive and reactive change may be occurring in the navicular apparatus in all horses to variable degrees and determination of the pathogenesis of lesions that lead to pain and biomechanical dysfunction should assist specific preventative or treatment protocols.     

Antimicrobial associated diarrhoea in the horse. Part 1: Overview,pathogenesis and risk factors

Antimicrobial associated diarrhoea (AAD) is the most commonly recognised adverse effect of antimicrobial treatment in horses, although its incidence is probably low given the frequency of antimicrobial administration. Clinical signs vary from transient self‐limiting diarrhoea to rapidly fatal toxic enterocolitis. AAD prolongs the duration of hospitalisation, increases diagnostic and therapeutic costs, and was associated with a lower case survival rate than other types of acute diarrhoea in one study. Virtually all antimicrobials have been implicated in AAD, but some pose a greater risk than others.     

Plasma mepivacaine concentrations after caudal epidural and subarachnoid injection in the horse: comparative study

The venous plasma concentrations of mepivacaine were determined in 7 adult mares (420 +/- 17.1 kg) given an injection of a 2% solution of the hydrochloride at either the sacral (S2-3 to S5-C1) epidural space or the midsacral (S2-3) subarachnoid space. An average dose of 91.4 +/- 15.7 mg (4.6 +/- 0.8 ml) was needed to produce caudal epidural analgesia (CEA) and 26.7 +/- 5.4 mg (1.3 +/- 0.3 ml) to produce caudal subarachnoid analgesia (CSA). Maximal caudal analgesia extended from spinal cord segments S-1 to coccyx during CEA and CSA. The onset of analgesia as measured by response to superficial and deep muscular pinprick stimulations was significantly (P less than 0.05) faster in mares with CSA than with CEA (8.3 +/- 2.4 minutes vs 21.4 +/- 3.8 minutes). The period of analgesia was significantly (P less than 0.05) longer in mares with CEA than with CSA (80.0 +/- 11.5 minutes vs 67.4 +/- 26.3 minutes). The rate of vascular absorption of mepivacaine from the epidural space was significantly (P less than 0.05) faster than from the subarachnoid space. Maximum venous plasma concentrations of mepivacaine were similar (P greater than 0.05) after epidural and subarachnoid injections (0.05 +/- 0.03 micrograms/ml and 0.05 +/- 0.03 micrograms/ml) at the same times after mepivacaine administration (51.4 +/- 33.4 minutes and 53.6 +/- 24.3 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)     

Computerized detection of supporting forelimb lameness in the horse using an artificial neural network.

The purpose of this study was to investigate whether artificial neural networks could be used to determine equine lameness by computational means only. The integral parts of our approach were the combination of automated signal tracking of horses on a treadmill and the computational power of artificial neural networks (ANN). The motion of 175 horses trotting on a treadmill was recorded using the SELSPOT II system for motion analysis. Two cameras traced infrared (IR) markers on the head and on the left forehoof. The motion of the head was Fourier-transformed and further processed by a multilayer feedforward ANN, which was trained to distinguish healthy from pathological gaits and to quantify the lameness. The classification was correct in 78.6% of cases. In 12% of cases the network gave contradictory results, in 5.9% the network found no answers, and in 3.5% the answers were wrong. However after proper training, it is proposed that neural networks are potentially capable of making a non-human diagnosis of equine lameness.     

Malignant melanoma in the foot of a horse

A 24-year-old horse had a malignant melanoma of the right forefoot. Because surgical excision of the melanoma was incomplete, as determined by histologic examination of the excised tissue margins, the tumor margins were injected with a matrix therapeutic implant containing cis-diamminedichloroplatinum, epinephrine, and purified bovine collagen matrix. The foot healed and the horse remained clinically free of disease for 26 months before recurrence of malignant melanoma. Surgical exploration of the digit revealed extensive involvement of the foot, and the horse was euthanatized.     

The sacroiliac joints: evaluation using nuclear scintigraphy. Part 1: The normal horse

REASONS FOR PERFORMING STUDY: Sacroiliac (SI) disease is recognised as a cause of poor hindlimb action but differential diagnosis is often difficult. HYPOTHESES: That in clinically normal horses there would be a significant difference in the ratio of radiopharmaceutical uptake (RU) between the fifth lumbar vertebra (L5) and each tuber sacrale (TS) and between L5 and each SI joint; and that these ratios would alter with age, but ratios would be bilaterally symmetrical. METHODS: Dorsal scintigraphic images of the SI region of 15 horses, selected randomly from the clinic database, were analysed by 2 of the authors, comparing noncorrected and motion-corrected images. To determine scintigraphic anatomy, the scintigraphic images of 10 Thoroughbred horses were superimposed over a ventrodorsal radiographic image of an isolated pelvis. Dorsal scintigraphic images of 40 clinically normal horses age 3-16 years were evaluated using subjective examination, profile analysis and quantification using regions of interest. RESULTS: The tubera sacrale were seen as 2 well-defined oval regions immediately to the left and right of the midline, abaxial to which were larger, approximately oval areas with less RU, representing uptake in the SI joints. The definition between the SI region and the TS was more obvious in younger horses. Nonmotion-corrected images were often not of diagnostic quality or could be misinterpreted as abnormal. There were significant differences in RU between the TS and SI joints compared to L5, and decreased RU in the tubera sacrale with increasing age, but no change of uptake in the SI joint region and no effect of gender on RU. There was a high degree of left-right symmetry of the TS and SI joint regions. CONCLUSIONS AND POTENTIAL RELEVANCE: The scintigraphic images of horses with suspected sacroiliac joint disease should be compared with images of normal horses of comparable age. In normal horses, there was a high degree of symmetry; therefore, marked left-right asymmetry is likely to be abnormal.     

Pathology of gastritis and gastric ulceration in the horse. Part 1: Range of lesions present in 21 mature individuals

Reasons for performing study: Gastric ulceration is now widely recognised as an important disease in high performance horses. Little is known about gastric histopathology in healthy or diseased animals; a comprehensive assessment would enhance interpretation of gross findings through assessment of their accuracy and allow for identification of lesion variety and pathogenesis in different anatomical regions of the stomach. Objectives: To investigate the true extent and variety of gastric lesions in a mixed population of mature horses at post mortem. Methods: Stomachs were removed from a mixed population of 21 horses at post mortem. Mucosal abnormalities were recorded in photographic and written form. Representative samples from all gross lesions were taken for histopathology and processed routinely. Special stains including Gram, PAS and Warthin Starry, were used when appropriate. Pathological classification of lesion type using both gross and histological appearances was performed. Results: Classification of lesions within the squamous region included hyperkeratosis, punctate scars, diffuse erosions/ulcerations and margo injuria; and within the glandular region, hyperaemia, focal erosions and ulcerations. Glandular metaplasia was recognised for the first time in the equine stomach. No Helicobacter‐like organisms were detected in association with lesion development. Conclusions and potential relevance: This study used gross and histological examination to highlight the large variety of naturally occurring gastric lesions in a mixed population of horses. Analysis of the pathogenesis of lesion development is now possible. Further research regarding the range of pathology in larger, more diverse groups of horses is required.     

Correlation between radiographie and arthroscopic findings in the equine carpus

The radiographic and arthroscopic findings in 150 carpal joints in 114 lame horses were compared. Chip, slab, or sagittal fractures were identified in 130 (87%) joints. In 101 (78%) of these there was good agreement between radiographic and arthroscopic findings on the number and position of fractures. In 23 (18%) joints, chip fractures additional to those seen radiographically were found arthroscopically. In one joint a large chip fracture from the craniolateral aspect of the distal radius was identified only by arthroscopy, while in 6 joints fractures were identified only by radiography. Observed causes of lameness, other than intra-articular fractures, included degenerative joint disease, synovitis, ruptured intra-carpal ligaments, and haemarthrosis. Correlation between the radiographic and arthroscopic assessment of degenerative joint disease was poor. It was concluded that both radiography and arthroscopy should be used to obtain the most accurate assessment of the equine carpus.     

Pathological changes in the navicular bone and associated structures of the horse.

Navicular bones from 74 horses were examined at necropsy. Animals ranged in age from eight months to 30 years. Eight horses had a clinical history of navicular disease. Degenerative lesions in the fibrocartilaginous surface of the navicular bone and of the surface of the deep flexor tendons were age related changes not necessarily related to lameness. These lesions were more extensive in horses with a history of navicular disease, and were often accompanied by adhesions and subchondral cavitation of the fibrocartilaginous surface of the navicular bone. Osteophytes, present in 12 of the 74 horses, appeared to be age-related and were uncommon in horses with a history of navicular disease. Nutrient foramina on the distal border of the navicular bone were highly variable in size and shape; in horses with a history of navicular disease they often had a small external opening that became larger as it penetrated the bone. Occlusive vascular disease (arteriosclerosis) was found in sound horses and in horses with a history of navicular disease. Thrombosis of arteries or ischemic necrosis of bone was not identified in any case.