Blood glucose in horses with acute abdominal disease

BACKGROUND: Hyperglycemia in critically ill humans is associated with increased glucose production and insulin resistance and is associated with death. This might also be true in horses presenting with acute abdominal disease. HYPOTHESIS: Throughout hospitalization, hyperglycemia will be common in adult horses presenting with acute abdominal disease. Hyperglycemia will be associated with a worse prognosis for survival to hospital discharge. ANIMALS: Two hundred sixty-nine adult horses with acute abdominal disease. METHODS: Observational retrospective study. Records were reviewed for 269 horses that had glucose data analysed and recorded at the time of hospital admission: 154 horses had a first sample after admission; 110 horses at 24 hours after admission; 74 horses at 36 hours after admission; and 49 horses at 48 hours after admission. Logistic regression analyses were performed to investigate the association of glucose concentrations with survival, in addition to the association of glucose concentrations with surgical, small intestinal, strangulating lesions, and lesions requiring a resection. RESULTS: Of 269 horses presenting with acute abdominal disease, 50.2% had blood glucose concentrations greater than the reference range (75.6-131.4 mg/dL); 0.4%, below the reference range; and 49.4%, within the reference range at admission. Of 269 horses, 2.3% had blood glucose concentrations below the reference range at some point during the first 48 hours of hospitalization, all of which had strangulating intestinal lesions. Horses that did not survive to hospital discharge had a higher mean blood glucose concentration at admission; at the first sample after admission; at 24, 36, and 48 hours after admission; and higher maximum and minimum blood glucose concentrations in the first 24 hours after admission. CONCLUSIONS AND CLINICAL IMPORTANCE: Derangements of blood glucose concentration are common in horses with acute abdominal disease. Hyperglycemia is much more common than hypoglycemia in these animals. Hyperglycemia in the first 48 hours of hospitalization is associated with a worse prognosis for survival to hospital discharge.     

Detection of fibrin deposits in tissues from horses with severe gastrointestinal disorders

BACKGROUND: In humans and experimental animals, disseminated intravascular coagulation (DIC) causes fibrin deposition in several organs, which eventually leads to ischemia and multiorgan failure. HYPOTHESIS: Horses who died or were euthanized for severe gastrointestinal disorders could have fibrin deposits in different tissues. ANIMALS: Tissue-organ samples collected during postmortem examinations on 66 colic horses with poor prognoses (eg, severe intestinal ischemia, enteritis, peritonitis), from 11 colic horses with good prognoses (eg, large-colon obstruction or displacement), and from 16 slaughter horses. METHODS: Tissue samples (kidney, lung, liver) were stained with hematoxylin and eosin, and phosphotungstic acid hematoxylin for a blinded histologic examination. A fibrin score (grades 0 to 4) was established for each tissue sample and for each horse. RESULTS: Fibrin deposits were found in tissue specimens of 11 of 27 of horses (40.7%) in the ischemic group, 8 of 21 in the enteritis group (38.1%), and 7 of 18 in the peritonitis group (39.0%), whereas none of the horses in the obstructive group (n = 11) and only 1 horse in the slaughter group (n = 16) had fibrin deposits in their tissues. In addition, the mean fibrin score values for the ischemic, enteritis, and peritonitis groups (1.3 +/- 1.7, 1.1 +/- 1.6, and 0.9 +/- 1.3, respectively) were statistically higher than those for the obstructive and slaughter groups (0.0 +/- 0.0 and 0.1 +/- 0.5, respectively). The largest fibrin deposits were found in the lungs. Conclusions and Clinical Importance: Horses with severe gastrointestinal disorders have fibrin deposits that are consistent with capillary microthrombosis, multiorgan failure, and DIC.     

Confirmed and presumptive cervical vertebral compressive myelopathy in older horses: a retrospective study (1992-2004)

BACKGROUND: Cervical vertebral compressive myelopathy (CVCM) is a common cause of myelopathy in horses aged 6 months to 4 years. Little information is available regarding the types of lesions, treatment, and outcomes in horses with CVCM that are > or =4 years old. ANIMALS: Twenty-two affected horses (10 with a confirmed diagnosis of CVCM and 12 presumptive cases) and 210 contemporaneous control horses. METHODS: Horses > or =4 years old that were diagnosed with CVCM between January 1992 and January 2004 were identified from medical records at Texas A&M University and the University of Florida. Data analyzed included history, signalment, neurologic examination findings, lesion location, treatment, and outcome. Signalment was also recorded in a population of contemporaneous controls. RESULTS: Horses identified had a median age of 8.4 years, and there was a greater percentage of male horses among the cases than among the controls. The most common breeds represented were warmblood (n=6) and quarter horse (n=5) types; warmbloods were significantly (P < .05) overrepresented relative to control horses. The caudal cervical vertebral column was the most common site of CVCM lesions, and the C5-C6 (4/9) and C6-C7 (3/9) articulations were most often identified as abnormal via myelography. The most common lesions seen with radiography and myelography were articular process osteophytes. Of the 22 affected horses, 8 were euthanized and a diagnosis of CVCM was confirmed by necropsy for all; 5 of 8 of these horses had spinal cord compression caused, entirely or in part, by articular process osteophytes. Medical management was the therapy chosen in all horses, and administration of corticosteroids and nonsteroidal anti-inflammatory drugs resulted in improvement in the greatest number of horses. CONCLUSIONS AND CLINICAL IMPORTANCE: CVCM should be a differential diagnosis in older horses with cervical myelopathy. Articular process osteophytes are the most frequently identified cause of spinal cord compression in this group. Male horses and horses of warmblood or Tennessee Walking Horse breeds may be predisposed to this condition.     

Superficial necrolytic dermatitis in 11 dogs with a history of phenobarbital administration (1995-2002)

The clinical records of 11 dogs with histologically confirmed superficial necrolytic dermatitis (SND) and a history of phenobarbital (PB) administration (SND/PB) were evaluated retrospectively (1995-2002). Historical, clinical, clinicopathologic, ultrasonographic, and pathologic findings were compared with those in dogs with SND without prior PB exposure (SND/No PB; n = 9) and with those dogs with PB-associated hepatotoxicity without skin disease (PB/hepatotoxicity). Dogs in the SND/PB group accounted for 44% of all histologically confirmed cases of SND that were evaluated at The Ohio State University Veterinary Teaching Hospital between 1995 and 2002. Median age of dogs in the SND/PB group was 10 years, and median duration of PB therapy was 6 years. Mean alanine aminotransferase (ALT) activity was 239 U/L, and median duration of abnormally high ALT activity was 6.25 months before SND diagnosis. Plasma amino acid concentrations measured in 1 dog were severely decreased. Ultrasonographic findings of hypoechoic nodules with hyperechoic borders corresponded to pathologic findings of nodular areas of normal hepatic tissue surrounded by zones of collapsed parenchyma with vacuolated hepatocytes. Clinical, clinicopathologic, ultrasonographic, and pathologic features of SND/PB and SND/No PB were similar. PB-associated cirrhosis and overt hepatic failure were not features of SND/PB. Different pathogenic mechanisms might induce SND in dogs. Chronic administration of PB requires further examination as a potential risk factor for the development of SND.     

Investigation of the prevalence of neurologic equine herpes virus type 1 (EHV-1) in a 23-year retrospective analysis (1984–2007)

A single nucleotide polymorphism in the equine herpesvirus 1 (EHV-1) DNA polymerase gene (ORF30 A₂₂₅₄ to G) has been associated with clinical signs of equine herpes myeloencephalopathy (EHM). The purpose of our study was to determine the odds ratio for this genetic marker and EHM using a panel of field isolates from North America collected over the past twenty-three years. EHV-1 isolates cultured at the Cornell University Animal Health Diagnostic Laboratory from 1984 to 2007 were retrieved along with their clinical histories. DNA was extracted from these EHV-1 cultures and allelic discrimination was performed using real-time PCR. The results were confirmed by sequencing of the target region in ORF30. PCR and sequencing were in 100% agreement and showed that 19 out of the 176 isolates had the ORF30 G₂₂₅₄ allele (11%), of which16 were EHM cases and 3 respiratory or abortion cases. The odds of having neurologic disease with the ORF30 G₂₂₅₄ genotype were computed as 162 times greater than those with the opposite allele ORF30 A₂₂₅₄ (95% confidence interval: 35–742). Despite this strong statistical significance, 24% (5/21) of horses with neurologic disease in our study population harbored the “non-neurologic” form of the allele (ORF30 A₂₂₅₄), suggesting that other factors may also contribute to the onset of EHM.     

A demographic survey of unwanted horses in Ireland 2005-2010

Background

The Irish Horse Industry expanded during the Celtic Tiger boom years, then contracted in the current economic recession. High value horses were traditionally controlled through sale at public auction, private sales and sales to dealers; these are now also being reduced by decreases in production (> 40%), and increases in retirement, re-homing, euthanasia and disposal through Category 2 plants and abattoirs. The absence or banning of horse abattoirs has been shown to have very significant welfare social and economic consequences in the USA. This study described the currently available data on the demographics of unwanted horses in Ireland from 2005 to 2010.

Results

The majority of horses euthanised by practicing veterinarians are destroyed on medical grounds but the number euthanised at the request of welfare groups and the state, as well as welfare related calls and the number of horses involved in these calls and subsequent visits is increasing reflecting the increasing involvement of the veterinary profession in equine welfare. Welfare groups have limited resources and do not have a tradition of recording data, but they too have reported increasing calls, visits and numbers of horses per visit. Welfare groups provide significant service to equine welfare and the community. Local Authorities report similar trends. Over 300 horses were found dead or required immediate or subsequent euthanasia following welfare group and local authority visits in 2010, which is of national concern. The majority of local authority interfaces with unwanted horses are with urban (60%) rather than rural (40%) horses. Mortality figures are poor indicators of non-fatal neglect. More horses were admitted into the care of local authorities than welfare groups, reflecting significant state and taxpayer investment in the control of low value horses. Category 2 plants and abattoirs represent a significant state investment in licensing and control in the national interest. Abattoirs provide an increasingly important and essential service for the disposal of unwanted horses. Despite the increase in unwanted horses, Ireland is a minority contributor to the EU slaughter total.

Conclusions

There is a need for annual demographic data compilation and review of the numbers of unwanted horses and ponies within the horse industry to assist policy makers and legislators.     

A comparison of traditional and quantitative analysis of acid-base and electrolyte imbalances in horses with gastrointestinal disorders

The purpose of this study was to compare traditional and quantitative approaches in analysis of the acid-base and electrolyte imbalances in horses with acute gastrointestinal disorders. Venous blood samples were collected from 115 colic horses, and from 45 control animals. Horses with colic were grouped according to the clinical diagnosis into 4 categories: obstructive, ischemic, inflammatory, and diarrheic problems. Plasma electrolytes, total protein, albumin, pH, pCO2, tCO2, HCO3-, base excess, anion gap, measured strong ion difference (SIDm), nonvolatile weak buffers (A(tot)), and strong ion gap were determined in all samples. All colic horses revealed a mild but statistically significant decrease in iCa2+ concentration. Potassium levels were mildly but significantly decreased in horses with colic, except in those within the inflammatory group. Additionally, the diarrheic group revealed a mild but significant decrease in Na+, tCa, tMg, total protein, albumin, SIDm, and A(tot). Although pH was not severely altered in any colic group, 26% of the horses in the obstructive group, 74% in the ischemic group, 87% in the inflammatory group, and 22% in the diarrheic group had a metabolic imbalance. In contrast, when using the quantitative approach, 78% of the diarrheic horses revealed a metabolic imbalance consisting mainly of a strong ion acidosis and nonvolatile buffer ion alkalosis. In conclusion, mild acid-base and electrolyte disturbances were observed in horses with gastrointestinal disorders. However, the quantitative approach should be used in these animals, especially when strong ion imbalances and hypoproteinemia are detected, so that abnormalities in acid-base status are evident.     

Using Artificial Intelligence to Predict Survivability Likelihood and Need for Surgery in Horses Presented With Acute Abdomen (Colic)

Artificial intelligence and machine learning have promising applications in several medical fields of diagnosis, imaging, and laboratory testing procedures. However, the use of this technology in the veterinary medicine field is lagging behind, and there are many areas where it could be used with potentially successful outcomes and results. In this study, two critical predictions were explored in horses presented with acute abdomen (colic) using this technology. Those were the need for surgical intervention and survivability likelihood of affected horses based on clinical data (history, clinical examination findings, and diagnostic procedures). The two prediction parameters were explored using the application of Decision Trees, Multilayer Perceptron, Bayes Network, and Naïve Bayes. The machine learning algorithms were able to predict the need for surgery and survivability likelihood of horses presented with acute abdomen (colic) with 76% and 85% accuracy, respectively. The application of this technology in the different clinical fields of veterinary medicine appears to be of a value and warrants further investigation and testing.     

Pelvic fractures in horses: 19 cases (1974-1984)

The clinical features of 19 horses with pelvic fractures were reviewed. The most common problem was a grade III or IV unilateral hind limb lameness. The prevalence of fractures was greater in females and horses less than 4 years old. All horses were treated with a combination of analgesic administration and stall rest for 2 to 6 months. Seven of 11 horses (64%) available for long-term follow-up evaluation recovered and 4 of 11 (36%) had no lameness when being ridden. Five of seven (71%) horses with fractures that involved the acetabulum recovered, and 4 (57%) had complete resolution of lameness. No correlation was found between the long-term outcome of the horses and the bone fractured, age of horse, or duration of injury before admission.     

Clinical use of metronidazole in horses: 200 cases (1984-1989)

Case records of 200 horses treated with metronidazole were reviewed. Horses were treated for respiratory tract infections (90 cases), peritonitis or abdominal abscess (39 cases), celiotomy (49 cases), orthopedic infections (6 cases), and miscellaneous soft tissue infections (16 cases). Bacteria of the genus Bacteroides were most prevalent (55 of 167 anaerobic isolates). Metronidazole was always used in combination with other antimicrobial drugs. Only 4 of the 200 horses had signs of adverse effects associated with metronidazole treatment. Those 4 horses had poor appetite that resolved when metronidazole treatment was discontinued.     

Management and outcome of cats with ureteral calculi: 153 cases (1984-2002)

OBJECTIVE: To determine outcome of medical and surgical treatment in cats with ureteral calculi. DESIGN: Retrospective study. ANIMALS: 153 cats. PROCEDURE: Medical records were reviewed. Owners and referring veterinarians were contacted for follow-up information. RESULTS: All cats were initially treated medically before a decision was made to perform surgery. Medical treatment included parenteral administration of fluids and diuretics to promote urine production and passage of the ureteral calculus and supportive treatment for renal failure. Ureteral calculi in the proximal portion of the ureter were typically removed by ureterotomy, whereas ureteral calculi in the distal portion of the ureter were more likely to be removed by partial ureterectomy and ureteroneocystostomy. Ureterotomy could be performed without placement of a nephrostomy tube for postoperative urine diversion. Postoperative complication rate and perioperative mortality rate were 31% and 18%, respectively. The most common postoperative complications were urine leakage and persistent ureteral obstruction after surgery. Chronic renal failure was common at the time of diagnosis and continued after treatment, with serum creatinine concentration remaining greater than the upper reference limit in approximately half the cats. Twelve-month survival rates after medical and surgical treatment were 66% and 91%, respectively, with a number of cats dying of causes related to urinary tract disorders, including ureteral calculus recurrence and worsening of chronic renal failure. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that medical and surgical management of ureteral calculi in cats are associated with high morbidity and mortality rates. Treatment can stabilize renal function, although many surviving cats will continue to have impaired renal function.     

Endoscopic findings of the gastric antrum and pylorus in horses: 162 cases (1996-2000)

Medical records and endoscopy images were examined for 209 horses that had gastroscopic examinations performed with a 2.5- or 3-m-long endoscope by one of the authors (MJM) during a 4-year period (1996-2000). The antrum and pylorus were viewed in 162 horses, and the duodenum was viewed in 94 horses. Of these 162 horses, the gastric squamous mucosa was seen in 157 horses and 50% or more of the glandular mucosa of the body of the stomach was seen in 156 horses. Erosions or ulcers were seen in the gastric squamous mucosa in 91 (58%) horses. Erosions or ulcers were seen in the glandular mucosa of the body of the stomach in only 8% of the horses. Lesions consisting of erosion or ulceration were seen in the antrum or pylorus in 94 (58%) horses. Lesions consisting of hyperemia and a rough or "bumpy" appearance were seen in the mucosa of the duodenum of 16 horses. An association between the presence of lesions in the squamous mucosa and the presence of lesions in the mucosa of the antrum/pylorus was examined by Fisher's exact test, and the linear association of lesion severity scores between the squamous mucosa and the mucosa of the antrum/pylorus was tested using a Monte Carlo estimate for linear-by-linear association. There was no association (P = .88) between these sites for presence of lesions or lesion severity scores. Similarly, there was no association between scores for the glandular mucosa in the gastric body and those in the antrum/pylorus. Because of the high prevalence of lesions in the antrum and pylorus of the stomachs of adult horses examined in a hospital setting, the entire stomach should be viewed during a gastroscopic examination.     

A retrospective analysis of left dorsal displacement of the large colon treated with phenylephrine hydrochloride and exercise in 12 horses (1996-98)

AIM: To review the outcome of cases of left dorsal displacement of the large colon (LDDLC) treated with phenylephrine HCl and mild exercise. METHODS: Physical parameters, laboratory data, ultrasonographic findings and outcome were analysed in a retrospective study of 12 horses with a confirmed diagnosis of LDDLC which were treated with phenylephrine HCl and mild exercise. RESULTS: Administration of phenylephrine HCl and mild exercise resulted in the resolution of LDDLC in 11 of 12 treated horses. One horse failed to resolve the entrapment and required surgical correction. CONCLUSION: Administration of phenylephrine HCl appears to be an effective treatment for horses with confirmed diagnosis of LDDLC presented with mild to moderate colonic distention.     

CCNU (lomustine) toxicity in dogs: a retrospective study (2002-07)

Objective To describe the incidence of haematological, renal, hepatic and gastrointestinal toxicities in tumour‐bearing dogs receiving 1‐(2‐chloroethyl)‐3‐cyclohexyl‐1‐nitrosourea (CCNU). Design The medical records of 206 dogs that were treated with CCNU at the Melbourne Veterinary Specialist Centre between February 2002 and December 2007 were retrospectively evaluated. Results Of the 206 dogs treated with CCNU, 185 met the inclusion criteria for at least one class of toxicity. CCNU was used most commonly in the treatment of lymphoma, mast cell tumour, brain tumour, histiocytic tumours and epitheliotropic lymphoma. Throughout treatment, 56.9% of dogs experienced neutropenia, 34.2% experienced anaemia and 14.2% experienced thrombocytopenia. Gastrointestinal toxicosis was detected in 37.8% of dogs, the most common sign of which was vomiting (24.3%). Potential renal toxicity and elevated alanine transaminase (ALT) concentration were reported in 12.2% and 48.8% of dogs, respectively. The incidence of hepatic failure was 1.2%. Conclusions CCNU‐associated toxicity in dogs is common, but is usually not life threatening.     

Collateral desmitis of the distal interphalangeal joint in 18 horses (2001-2002)

REASONS FOR PERFORMING STUDY: There have been no previously published case series of horses examined using either scintigraphy or MRI to diagnose collateral ligament injuries not detectable using ultrasonography or radiography, nor have other concurrent soft tissue lesions been described. OBJECTIVES: To describe the clinical features of horses with desmitis of the collateral ligaments of the distal interphalangeal (DIP) joint and to evaluate the results of radiographic, ultrasonographic, scintigraphic and magnetic resonance imaging (MRI) examinations. METHODS: Horses were examined between January 2001 and January 2003 and were selected for inclusion in the study if there was unequivocal evidence of collateral desmitis of the DIP joint based on ultrasonography or MRI. Subject details, case history, results of clinical examination and responses to local analgesic techniques were reviewed. The results of radiographic, ultrasonographic, scintigraphic and MRI examinations were assessed. RESULTS: Eighteen horses were identified with desmitis of a collateral ligament of the DIP joint, 3 horses (Group 1) based on ultrasonography alone, 7 (Group II) with positive ultrasonographic and magnetic resonance images and 8 (Group III) with no lesion detectable using ultrasonography, but lesions identified using MRI. Seventeen horses had forelimb injuries and one a hindlimb injury. The medial collateral ligament was injured most frequently (13 horses). In the majority of horses, no localising clinical signs were seen. Lameness was invariably worse in circles compared with straight lines. Lameness was improved by palmar digital analgesia in 16 horses (87%), but only 6 were nonlame. Intra-articular analgesia of the DIP joint produced improvement in lameness in 6/15 horses (40%). In 16 horses, no radiographic abnormality related to the DIP joint or collateral ligament attachments was identified. Eight of 14 horses (57%) had focal, moderately or intensely increased radiopharmaceutical uptake (IRU) at the site of insertion of the injured collateral ligament on the distal phalanx. Alteration in size and signal in the injured collateral ligament was identified using MRI. In addition, 5 horses had abnormal mineralisation and fluid in the distal phalanx at the insertion of the ligament. Eleven horses had concurrent soft tissue injuries involving the deep digital flexor tendon, distal sesamoidean impar ligament, navicular bursa or collateral ligament of the navicular bone. CONCLUSIONS AND POTENTIAL RELEVANCE: Collateral desmitis of the DIP joint should be considered as a cause of foot lameness. Although some injuries are detectable ultrasonographically, false negative results occur. Focal IRU at the ligament insertion on the distal phalanx may be indicative of injury in some horses. MRI is useful for both characterisation of the injury and identification of any concurrent injuries. Further follow-up information is required to determine factors influencing prognosis.     

Renosplenic entrapment of the large colon in horses: 33 cases (1984-1989)

Between 1984 and 1989, 33 horses were diagnosed with renosplenic entrapment of the large colon. Duration of colic, signalment, physical findings, and laboratory values were determined, and treatment methods were evaluated. Nonsurgical correction was attempted in 22 of the horses with suspected renosplenic entrapment of the large colon and was successful in 11 cases. Survival and complication rates also were determined. Nonsurgical correction is a viable alternative to immediate surgery for renosplenic entrapment of the large colon, if cases are selected properly.     

Hepatic disease in Alberta horses: A retrospective study of 'alsike clover poisoning' (1973-1988)

Over sixteen years, 49 horses were diagnosed by Alberta Agriculture Animal Health laboratories as having “alsike clover poisoning”. There was a distinct northwestern distribution of cases, the majority coming from the Peace River district. This distribution is opposite to that of the Alberta horse population, but coincides with areas of alsike clover cultivation. Cases could be divided into chronic or nervous clinical presentations, as described by Schofield. Tissues from 45 animals were retrieved and examined microscopically. Significant histological lesions were confined to the liver and consisted of biliary fibrosis and epithelial proliferation.

I conclude that alsike clover poisoning is a specific disease entity, likely due to exposure to an exogenous toxin. The evidence is not strong enough to incriminate alsike clover as the etiology.

     

Arthroscopic removal of fracture fragments involving a portion of the base of the proximal sesamoid bone in horses: 26 cases (1984-1997)

OBJECTIVE: To determine the outcome of horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone was removed arthroscopically and to determine whether fragment size was associated with outcome. DESIGN: Retrospective study. ANIMALS: 26 horses. PROCEDURE: Dorsopalmar and axial-abaxial lengths of the fracture fragment were measured on the dorsopalmar and mediolateral radiographic views, respectively, and percentage of the base of the sesamoid bone involved was estimated. Fractures were classified as grade 1 (< or = 25% of the base involved) or grade 2 (> 25% but < 100% of the base involved). Outcome was classified as successful if the horse started at least 2 races or unsuccessful if the horse started only 1 race or failed to return to racing. RESULTS: There were 24 racehorses and 2 nonracehorses. Twelve (50%) of the racehorses returned to racing and started at least 2 races. Eight of 14 horses with grade-1 fractures and 4 of 10 horses with grade-2 fractures had a successful outcome. Ten of 16 horses without associated articular disease had successful outcomes, compared with 2 of 8 horses with associated articular disease. However, fragment size and presence of associated articular disease were not significantly associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone is removed arthroscopically have a fair prognosis for return to racing.