Surgical Treatment of Gastric Outflow Obstruction in 40 Foals

Objective— To report short- and long-term survival and factors affecting outcome of foals after surgical correction of gastric outflow obstruction.
Study Design— Case series.
Animals— Foals (n=40) aged 5–180 days.
Methods— Clinical signs, laboratory data, diagnostic imaging, surgical findings, surgical procedures, medical treatment, and necropsy findings were retrieved from medical records. Outcome was obtained by reviewing performance, sales, and produce records or by telephone conversations with the owners.
Results— Gastric outflow obstruction was treated by gastroduodenostomy or by gastrojejunostomy with or without jejunojejunostomy. Long-term follow-up was available for 36 of 39 foals that survived to hospital discharge; 25 (69%) survived >2 years. All 8 foals with pyloric obstruction survived >2 years, whereas only 11 of 21 (52%) foals with duodenal obstruction survived >2 years. Six of 8 foals with obstruction of the duodenum and pylorus survived >2 years. Obstruction of the duodenum, adhesions to the duodenum, and postoperative ileus were significantly associated with decreased long-term survival.
Conclusions— Long-term outcome after gastric bypass procedures was substantially improved compared with previous reports. Factors that may have contributed to improved survival include better case selection and performing the gastrojejunostomy with the jejunum aligned from left to right.
Clinical Relevance— The prognosis for long-term survival after surgical bypass of pyloric obstruction is excellent. The overall prognosis for long-term survival after surgical bypass of duodenal obstruction is fair but should be considered guarded in those with pre-existing duodenal adhesions.     

Endoscopic appearance of gastric lesions in foals: 94 cases (1987-1988)

Of 183 foals examined by use of gastroendoscopy during 1987 and 1988, 94 had gastric lesions. Sixty-eight of 120 foals in the 1- to 85-day-old age range had endoscopically confirmed gastric lesions, and 26 of 63 foals in the 90- to 310-day-old age range had gastric lesions. Lesions were observed most frequently in the stratified squamous mucosal epithelium, particularly adjacent to the margo plicatus. Lesions were observed in the gastric glandular mucosa in 26 of the 94 foals with gastric lesions, and with a greater frequency in foals with a clinical disorder than in foals with no disorder (27% vs 3%). In young foals, lesions were consistently observed in the stratified squamous mucosal epithelium adjacent to the margo plicatus along the greater curvature of the stomach at 2 specific sites. These lesions were frequently associated with desquamation of the stratified squamous mucosal epithelium, which was observed in 69 of the 82 foals less than or equal to 30 days old and in 13 of the 101 foals greater than 30 days old. Lesions in the stratified squamous mucosal epithelium adjacent to the margo plicatus were associated with concurrent clinical disorders in foals greater than 90 days old, but developed with identical frequency in foals less than 90 days old with or without a clinical disorder. Lesions in the stratified squamous mucosal epithelium along the lesser curvature of the stomach were observed only in foals with concurrent clinical disorder, and with a higher frequency in foals greater than 90 days old than in younger foals (24% vs 3%).     

Absorption of bovine colostral immunoglobulins G and M in newborn foals

The uptake of colostral IgG and IgM, their serum half-lives, and the rates of endogenous synthesis of IgG and IgM were evaluated in 6 newborn foals fed bovine colostrum (principals) and 6 foals allowed to suckle their dams (controls). The principal foals were fed 400 ml of bovine colostrum (IgG, 10,000 mg/dl and IgM, 200 mg/dl) at 2-hour intervals, from 2 to 20 hours after foaling (total dose, 4 L). Serum IgG and IgM concentrations were determined by single radial immunodiffusion from birth to 98 days of age. At foaling, principal foals had no detectable serum equine IgG, but 1 control foal had serum equine IgG of 185 mg/dl. After ingestion of colostrum, there was no significant difference in the maximal serum bovine IgG concentration (range, 1,350 to 3,300 mg/dl) in the principal foals, and maximal serum equine IgG concentration in the control foals (range, 500 to 6,000 mg/dl). The calculated biological bovine and equine IgG half-life in the principal and control groups was 9.4 and 26 days, respectively. Endogenous IgG synthesis was first detected in 1 principal foal at 3 days of age, but was detected first between 28 and 42 days in the other principal foals. Starting on day 56 there was no significant difference in serum equine IgG concentration between groups. At foaling, foals in both groups had low equine IgM concentrations. In the control foals, there was marked individual variation in the increases in equine IgM concentration (range, 5 to 73 mg/dl) after ingestion of colostrum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bronchointerstitial Pneumonia and Respiratory Distress in Young Horses: Clinical, Clinicopathologic, Radiographic, and Pathological Findings in 23 Cases (1984–1989)

Twenty-three foals, between 1 and 7 months old, with signs of acute respiratory distress, were examined at the Veterinary Medical Teaching Hospital (VMTH), University of California, Davis, between 1984 and 1989. Characteristic features included sudden onset of severe respiratory distress and tachypnea, cyanosis unresponsive to nasal oxygen, pyrexia, hypoxemia, hypercapneic respiratory acidosis, poor response to treatment, and histopathologic lesions of bronchiolitis and bronchointerstitial pneumonia. Seven of the 23 foals were normal before the onset of respiratory distress, 3 foals were found dead, aqd 13 foals were being treated for respiratory tract infections at the time of presentation. Laboratory data obtained for 13 horses showed increased plasma fibrinogen concentration (630.7 ±193 mg/dL), leukocy-tosis (18,607 ± 7,784/μL), and neutrophilia (13,737 ± 8,211/μL). Thoracic radiographs showed a diffuse increase in interstitial and bronchointerstitial pulmonary opacity and, in 5 foals, an alveolar pulmonary pattern of increased density was also seen. In 3 foals heavy interstitial infiltration proceeded to a coalescing nodular radiographic appearance. Microbiological culture of tracheobronchial aspirates (TBA) from 9 foals yielded bacterial growth, but no one bacterial species was consistently isolated. Microbiological culture of postmortem specimens of the lung from 6 foals yielded growth of bacteria that included Escherichia coli, Enterobacter spp., Proteus mirabilis, Klebsiella pneumonias, Rhodococcus equi, or β-hemolytic Streptococcus spp. Tracheobronchial aspirates from 4 foals and lung samples collected from a further 4 foals at necropsy yielded no bacterial growth. Cultures were not taken from two foals premortem or postmortem. Virologic examination of TBA, lung tissue, or pooled organ tissue from 12 foals was negative. Viral culture of TBA from 1 foal showed cytopathic effects and positive immunoflu-orescence for equine herpes virus type II (EHV-II). In addition to the 3 foals that were found dead, 11 foals died or were euthanatized. Pathologic lesions were limited to the lungs in 50% of the foals; the remainder also had bowel lesions suggestive of hypoxic injury. The predominant histopathologic pulmonary lesions included bronchiolitis, bronchiolar and alveolar epithelial hyperplasia, and necrosis. Many bronchioles were filled with mucoid and fibrinocellular exudate. The peribronchiolar interstitium and adjacent alveolar spaces were also infiltrated with inflammatory cells and contained proteinaceous edema fluid. Type II cell hyperplasia and hyaline membrane formation were observed in the majority of foals and in 2 foals alveolar multinucleate giant cells were also present. Nine of 13 foals (69%) on which treatment was attempted at the VMTH survived after aggressive medical care that included external thermoregulatory control, oxygen by nasal insufflation, antimicrobial drugs, bronchodilating agents, nonsteroidal anti-inflammatory drugs, and corticosteroids. Persistent radiographic evidence of increased interstitial density was noted up to 24 months after initial presentation, and one horse remained exercise intolerant for at least 15 months after discharge. The exact etiopathogenesis of this disorder and long-term sequalae in the survivors have yet to be fully determined. However, it is likely that a number of different insults rather than a single agent may initiate the pulmonary damage that leads to severe interstitial pneumonia and subsequent acute respiratory distress or apparent sudden death in foals. (Journal of Veterinary Internal Medicine 1993; 7:277–288. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Pathogenicity of equine herpesvirus 1 subtype 2 for foals and adult pony mares

Three pony mares and 4 pony foals were inoculated with a subtype 2 strain of equine herpesvirus 1. Foals had periods of fever 12 h and 2.5 days after inoculation and leukopenia, involving both neutrophils and lymphocytes, followed by leukocytosis. Mares had transient fever and leukopenia 24 hours after inoculation that were less severe than in foals. An increase in circulating virus-neutralizing antibody was seen in 2 of 3 inoculated mares, but not in foals. Attempts to isolate virus from blood were unsuccessful. These studies show that equine herpesvirus 1 subtype 2 is a mild pathogen for ponies and infection may result in inapparent clinical disease.     

A study of bovine and equine immunoglobulin levels in pony foals fed bovine colostrum

As part of a project to raise specific pathogen free (SPF) Welsh Mountain Pony foals, free from exposure to Equid herpesvirus type 1, foals were removed from their dams at birth and fed bovine colostrum. This study characterises the uptake of bovine colostral immunoglobulin and production of endogenous immunoglobulin, in 10 SPF foals. An enzyme-linked immunoadsorbent assay was developed to measure serum concentrations of bovine IgG1 (boIgG1) to assess the efficiency of transfer, and rate of elimination of boIgG1 by the foal. The endogenous production of equine IgG was studied using a single radial immunodiffusion test. Foals were given 1.2 to 2 litres of bovine colostrum achieving peak serum boIgG1 concentrations of 18.9 to 34.2 g/litre (mean 28.0). The mean half-life of boIgG1 in the foals was 7.4 days. Endogenous immunoglobulin production resulted in equine IgG concentrations greater than 2 g/litre in six of 10 foals by 14 to 19 days of age, and greater than 7 g/litre in eight of 10 foals by 37 to 50 days of age. All foals had equine IgG serum concentrations greater than 10 g/litre by 102 to 135 days of age.     

A Necropsy Survey of Neurologic Diseases in 4,319 Horses Examined in Normandy (France) from 1986 to 2006

The frequencies of neurologic diseases and various corresponding causes were analyzed in 4,319 Norman horses examined by autopsy between 1986 and 2006. Five hundred forty-three cases of nervous system disorders were detected, or a total prevalence of 12.6%. One hundred eighty-seven of the 543 horses (34.4%) exhibited lesions of a traumatic origin affecting the skull or the vertebral column at different levels. Their frequency was less in foals younger than 1 month of age and higher in horses aged 6 months to 2 years. Eighty-three cases of cervical vertebral compressive myelopathy (CVCM) (15.3%) were identified. Males and geldings were more often affected than females. CVCM was diagnosed mostly in animals aged 6 months to 2 years. Horses affected with lesions in the mid-cervical region (region C3–C5) were significantly younger than those exhibiting more caudal lesions (region C5–C7). Neonatal maladjustment syndrome was diagnosed in 62 foals younger than 3.5 days (4.8% of the causes of death between birth and 1 month) by using clinical or lesional criteria. The prevalence was higher in Thoroughbreds as well as in the miscellaneous breed category and less in French Standardbreds. Bacterial meningoencephalomyelitis and meningitis represented 9.6% of nervous system disorders (52 cases) and most often affected foals aged 1 to 6 months. The main bacteria identified were beta-hemolytic Streptococci , Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, and Actinobacillus sp. The other causes diagnosed were, in decreasing order of frequency: grass sickness or equine dysautonomia (6.3% of neurologic diseases), hepatic encephalopathy syndrome (5.2%), septic vertebral arthritis or osteitis mainly caused by Rhodococcus equi (2.6%), congenital defects of the nervous system (2.4%), equine herpesvirus 1 myeloencephalopathy (2.2%), botulism (2.2%), malformations of the vertebral column other than CVCM (2%), and neighboring polyneuritis associated with guttural pouch mycosis (1.5%).     

Prevalence of gastric lesions in foals without signs of gastric disease: an endoscopic survey

Gastroendoscopic examinations were conducted on 75 Thoroughbred foals aged two to 85 days on seven breeding farms in England and Ireland. The foals showed no signs of gastric disease. There was no significant difference between lesion prevalence in foals in England (16 of 28 foals; 57 per cent) or Ireland (22 of 47 foals; 47 per cent). Neither was there any sex predilection (18 of 36 males; 20 of 39 females). Lesions were most prevalent in foals under 10 days old (8 of 9) and least prevalent in foals older than 70 days (3 of 10). Lesions occurred most frequently in the squamous mucosa immediately adjacent to the margo plicatus along the greater curvature (34 foals), whereas lesions in the squamous fundus, the glandular fundus, and the lesser curvature were observed in 11, six and three foals, respectively. Lesions were not observed in the squamous mucosa surrounding the cardia. Gastric lesions were more prevalent in foals with a previous disorder than in those without (68 vs 43 per cent) and particularly with a history of recent or concurrent diarrhoea (9 of 14).     

Evaluation of equine immunoglobulin specific for Rhodococcus equi virulence-associated proteins A and C for use in protecting foals against Rhodococcus equi-induced pneumonia

OBJECTIVE: To determine whether purified equine immunoglobulin specific for Rhodococcus equi virulence-associated proteins A and C (VapA and VapC) can confer passive protection against R. equi-induced pneumonia in foals. ANIMALS: Twenty-eight 3-week-old mixed-breed pony foals. PROCEDURE: 7 foals received IV injections of equine hyperimmune plasma (HIP) against whole-cell R. equi, and 7 received purified equine immunoglobulin specific for VapA and VapC 1 day prior to intrabronchial infection with R. equi strain 103+. Eleven foals were not treated prior to infection, and 3 control foals were neither treated nor infected. Heart rate, respiratory rate, and rectal temperature were recorded twice daily, and serum fibrinogen concentration and WBC count were determined every other day following infection. Foals were euthanatized 14 days following infection, and lung lesions and concentration of R. equi in lungs were assessed. RESULTS: The onset of clinical signs of pneumonia was significantly delayed in the HIP- and immunoglobulin-treated groups, compared with the untreated infected group. Moreover, pulmonary lesions were less severe in the treated groups, and significantly fewer R. equi organisms were cultured from the lungs of treated foals. CONCLUSIONS AND CLINICAL RELEVANCE: Degree of protection against R. equi-induced pneumonia provided by purified immunoglobulin specific for VapA and VapC was similar to that provided by commercially available HIP. Results not only suggest that immunoglobulin is the primary component of HIP that confers protection against R. equi-induced pneumonia in foals but also indicate that antibodies against R. equi VapA and VapC are protective.     

Effects of repeated Strongylus vulgaris inoculations and concurrent ivermectin treatments on mesenteric arterial lesions in pony foals

Eight of 10 pony foals reared under helminth-free conditions were inoculated PO with 50 Strongylus vulgaris infective larvae/week for 4 weeks, at which time 1 foal died of acute verminous arteritis. Inoculation of 7 remaining foals continued at 2-week intervals for 20 weeks. Of the 7 foals, 3 were treated with ivermectin (0.2 mg/kg of body weight) in an oral paste formulation at experiment weeks 8, 16, 24; 4 foals were not treated. Two foals were not inoculated or treated and served as controls. After the first ivermectin treatment, ivermectin-treated foals had fewer days (12 +/- 2.9) with rectal temperatures greater than 38.6 C than did nontreated foals (23.3 +/- 3.8). Mean baseline rectal temperatures were 38 +/- 0.2 C. Adverse clinical reactions to ivermectin treatment were not observed in foals. Foals were euthanatized and necropsied 3 weeks after the last ivermectin treatment (week 24). Ivermectin was effective in reducing S vulgaris arterial larval and intestinal adult parasite numbers by 100% in 3 treated foals. Strongylus vulgaris arterial larvae and/or adults were recovered from all 4 nontreated inoculated foals. One nontreated inoculated foal lacked arterial larvae or active arterial lesions, indicating that protective resistance had developed in this individual. Marked gross and histopathologic lesions typical of chronic S vulgaris infection were observed in the 3 nontreated inoculated foals with arterial larvae. Repeated killing of intra-arterial S vulgaris fourth-stage larvae in ivermectin-treated foals did not exacerbate lesions associated with verminous arteritis or induce unique lesions associated with repeated destruction of arterial larvae.(ABSTRACT TRUNCATED AT 250 WORDS)     

Operation-management factors associated with early-postnatal mortality of US foals

Of 7320 equine foals reported born alive during 1997 on 1043 operations that had equids on 1 January 1997, and that participated in the United States National Animal Health Monitoring System (NAHMS) Equine 1998 Study, 120 foals were reported to have died (by either euthanasia or natural causes) within the first 2 days of a live birth. The weighted estimate was 1.7% mortality (standard error=0.5) within the first 2 days of live birth for all foals born on operations in the 28 states included in the study.A multivariable logistic-regression model revealed that foals born in the southern region were more likely to have been reported to have died within the first 2 days of live birth than in the western region. In addition, the following operation-level factors were associated with increased odds of a foal dying within the first 2 days of live birth: not routinely testing newborn foals for adequate absorption of colostral immunoglobulins during the first 2 days of life; adding new resident equids to the operation during 1997; having non-resident equids stay on the operation for 1-30 days during 1997; never requiring an official health certificate (for operations that had non-resident equids stay on the operation for 1-30 days); using something other than straw or hay as the predominant bedding type; and feeding equids a vitamin-mineral supplement/premix with forage and/or grain.     

Endoscopic evaluation of changes in gastric lesions of Thoroughbred foals

Gastroendoscopic examinations were conducted on thirty-two 2- to 60-day-old Thoroughbred foals on 5 breeding farms. Repeat gastroendoscopic examinations were performed 35 to 135 days after the initial examination, with the age of foals ranging from 39 to 190 days. On initial endoscopic examination, lesions consisting of ulcers and/or erosions were most prevalent in the stratified squamous epithelial mucosa adjacent to the margo plicatus along the greater curvature of the stomach (15 of 32 foals), and were observed much less frequently at other sites within the stomach. In addition to ulcers and erosions, squamous epithelial desquamation at the margo plicatus was observed in 16 of 19 foals less than 30 days old and in 3 of 13 foals 30 to 60 days old, and was not seen in any foal on repeat endoscopy. At the time of repeat endoscopic examination, the frequency of ulcers and erosions at the margo plicatus was significantly (P less than 0.01) less than at initial examination (4 of 32 foals vs 15 of 32 foals). Lesions had healed in 14 of the 15 foals with lesions at the margo plicatus on the initial examination. Lesions were observed in the glandular mucosa of the fundus in 3 of 32 foals on initial examination and in 6 of 32 foals reexamined. Lesions in the glandular fundus observed on initial examination had healed in 2 of 3 foals, and of the 6 foals with glandular mucosal lesions on reexamination, 5 had developed lesions since the initial examination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Equine proliferative enteropathy: a cause of weight loss, colic, diarrhoea and hypoproteinaemia in foals on three breeding farms in Canada

Proliferative enteropathy (PE) is a transmissible enteric disease caused by Lawsonia intracellularis. An outbreak of equine PE was diagnosed in foals from 3 breeding farms. Most foals had been weaned prior to the appearance of clinical signs, which included depression, rapid and marked weight loss, subcutaneous oedema, diarrhoea and colic. Poor body condition with a rough haircoat and a potbellied appearance were common findings in affected foals. Respiratory tract infection, dermatitis and intestinal parasitism were also found in some foals. Haematological and plasma biochemical abnormalities included hypoproteinaemia, transient leucocytosis, anaemia and increased serum creatinine kinase concentration. Postmortem diagnosis of PE was confirmed on 4 foals based on the presence of characteristic intracellular bacteria within the apical cytoplasm of proliferating crypt epithelial cells of the intestinal mucosa, using silver stains, and by results of PCR analysis and immunohistochemistry. Antemortem diagnosis of equine PE was based on the clinical signs, hypoproteinaemia and the exclusion of common enteric infections. Faecal PCR analysis was positive for the presence of L. intracellularis in 6 of 18 foals tested while the serum of all 7 foals with PE serologically evaluated had antibodies against L. intracellularis. Most foals were treated with erythromycin estolate alone or combined with rifampin for a minimum of 21 days. Additional symptomatic treatments were administered when indicated. All but one foal treated with erythromycin survived the infection. This study indicates that equine PE should be included in the differential diagnosis of outbreaks of rapid weight loss, diarrhoea, colic and hypoproteinaemia in weanling foals.     

Idiopathic Hypocalcemia in Foals

Five thoroughbred foals (4 fillies and 1 colt), all in good to excellent body condition, ranging in age from 4 days to 5 weeks at the time of onset of signs, were presented to 2 Kentucky equine hospitals from 1992 through 1996. All 5 foals presented with tachycardia, hyperhidrosis, diarrhea or a recent history of diarrhea, and muscle rigidity or stiff gait. Four of the 5 foals presented for recumbency, seizure-like activity with opisthotonos, or pronounced extensor muscle rigidity. All 5 foals were hypocalcemic. All foals either died or had euthanasia performed. None responded to oral calcium supplementation. The cause of the hypocalcemia was unknown. Different idiopathic hypocalcemia syndromes may exist in foals.     

Isolation, characterization, and quantitative analysis of ceruloplasmin from horses.

Ceruloplasmin (Cp) was isolated from fresh equine plasma by precipitation, cellulose chromatography, and improved ion-exchange chromatography. Purified equine Cp is a glycoprotein having a molecular weight of approximately 115,000. In electrophoresis, equine Cp migrated to the alpha 1-globulin region, its isoelectric point was about 4.15 and consisted of about 890 amino acid residues. Serum Cp concentration was measured by use of the single radial immunodiffusion method. In clinically normal horses, the mean (+/- SD) serum Cp concentration of newborn foals was 2.87 +/- 0.40 mg/ml and that of 3-month-old foals was 5.02 +/- 0.92 mg/ml, which was similar to the adult value. It reached a peak of 6.06 +/- 0.74 mg/ml in 2-year-old horses. The Cp concentration in mares was not statistically different for the perinatal period, but it decreased immediately before and after delivery. Concentration of Cp increased at 6 days after IM administration of turpentine oil, castration, or jejunojejunostomy in adult horses, and increased to peak values twice as high as baseline values at 7 to 14 days, returning to baseline values at 28 days after treatment. We concluded that equine serum Cp is an acute-phase reactive protein increased in the intermediary or later phase of acute inflammation.     

Epizootiological and virological studies of foal diarrhea associated with serotype 3 rotavirus

Epizootiological and virological studies were conducted on foal diarrhea occurring in 3 foal-raising locations in a light horse farm from March to July, 1987. At the first location, although 27 (75%) of 36 foals had developed diarrhea, the isolation rate of rotavirus (RV) was low (5/14 feces, 36%). Many of the foals had the disease as early as 23 days after birth. At the second and third locations, 21 (27%) of 78 foals and 41 (76%) of 54 foals were affected with diarrhea. Isolation rates of RV were 90% (20/22 feces) and 100% (26/26 feces), respectively. The diseased cases were observed throughout the short period from June to early July and on foals aged from 63 to 65 days. These findings suggested the importance of RV as a causal agent of foal diarrhea at the latter location, RV and/or other agents at the former location. All the 3 strains of RV represented from each location were identified as serotype 3 by plaque reduction neutralization test against the antiserums of serotypes 1 to 6 of RV. However, the 3 strains showed low cross-reactivity with antiserum of the serotype 3 of the equine RV.     

Vascular characteristics of the cartilage and subchondral bone of the distal radial epiphysis of the young foal

The vascular features of the distal epiphysis of the radius of 27 foals aged from 3 weeks premature to 120 days postpartum were determined. The limbs were perfused with barium, and the distal radius was sawn into sagittal slabs which were decalcified, cut into thin slices and radiographed. More arteries approached areas of thick cartilage than thin cartilage. In thick cartilage, vessels in a lattice network were observed, and adjacent to these vessels was sinusoidal filling in the epiphyseal subchondral bone, which had a similar pattern to sinusoidal filling in the metaphysis. The sinusoidal filling adjacent to thick cartilage was at the predisposition site for epiphyseal osteomyelitis lesions in foals. This particular type of bone infection occurs commonly in the foal, but much less commonly in other species. The vascular features of the immature epiphysis may account for the predominance of epiphyseal osteomyelitis in the foal.