Retropharyngeal lymph node infection in horses: 46 cases (1977–1992)

SUMMARY A retrospective study of 46 horses with retropharyngeal lymph node (RPLN) infection presented to the Rural Veterinary Centre between 1977 and 1992 was undertaken. Horses aged less than one year were most commonly represented (46%). Thirty-nine percent of cases had been exposed to horses with confirmed or suspected strangles (Streptococcus equi subsp equi infection) within the previous 8 weeks. Most frequent signs were unilateral or bilateral swelling of the throat region (65%), respiratory stertor/dyspnoea (35%), purulent nasal discharge (20%), inappetence and signs of depression (15%), and dysphagia (9%). All horses had a soft tissue density in the retropharyngeal region on radiographs. Rhinopharyngoscopy, ultrasonography, haematology as well as cytological and microbial analysis of material aspirated from the soft tissue swelling facilitated diagnosis in some horses. Fifteen horses (33%) were treated with procaine penicillin intramuscularly for 4 to 7 days followed by oral trimethoprim-sulphadimidine for 7 to 14 days. Non-steroidal anti-inflammatory drugs were administered to 6 horses. Four required tracheostomy for severe respiratory distress. The 15 horses treated medically responded to treatment and were discharged from hospital. Three horses (6%) with mild signs received no treatment and recovered uneventfully. Twenty-eight horses (61%) underwent general anaesthesia and surgical drainage of a RPLN abscess. Nineteen received procaine penicillin G for 4 to 7 days. Four of the nine horses that did not receive antibiotic treatment after surgery required further surgical drainage 10 days to 7 weeks after the initial surgery . Limited follow-up information was available for 37 horses. Thirty-two horses were considered to have made complete recovery, 3 horses had died through misadventure and 2 had been euthanased because of chronic ill-thrift .     

Jejunoileal anastomosis following small intestinal resection in horses: seven cases (1999-2001)

OBJECTIVE: To report the postoperative outcome in horses undergoing jejunoileal anastomosis performed with a 2-layer simple continuous technique. DESIGN: Retrospective study. ANIMALS: 7 horses. PROCEDURE: Information regarding signalment, clinical signs, findings at surgery, and postoperative complications was obtained from medical records of horses that underwent exploratory ventral midline celiotomy, small intestinal resection, and jejunoileal anastomosis to correct various small intestinal strangulating lesions. Follow-up information was obtained via telephone conversations with owners or trainers. RESULTS: Six males and 1 female of various breeds aged 10 months to 27 years and weighing 312 to 785 kg (686.4 to 1,727 lb) were included. The most common complications were mild to moderate tachycardia and mild to moderate signs of abdominal pain. Two horses developed incisional infections and soft, fluctuant swelling at the incision site following resolution of the infection. Follow-up time ranged from 7 to 17 months after surgery. Owners reported no further colic episodes and no diet change necessary following surgery. All horses had returned to their intended level of use. CONCLUSIONS AND CLINICAL RELEVANCE: Advantages to the jejunoileal technique include maintaining the normal ileocecal valve and a postoperative recovery period similar to that described following other small intestinal anastomoses. Jejunoileal anastomosis is a viable alternative to ileal bypass. This technique appears to result in a postoperative complication rate similar to that reported following jejunojejunostomy procedures.     

Diaphragmatic hernia in horses: 44 cases (1986–2006)

Objectives – To present a case series of horses diagnosed with diaphragmatic hernia, and to determine the significance of (1) historical information, examination findings, and laboratory data; and (2) exploratory laparotomy or necropsy findings on short- and long-term outcome.
Setting – University Referral Hospital.
Design – Retrospective study.
Animals – Forty-four horses/foals admitted between 1986 and 2006 with a diagnosis of diaphragmatic hernia made either at exploratory laparotomy or necropsy.
Interventions – None.
Measurements and Main Results – Information from the medical records included history, clinical examination findings at presentation, and findings of exploratory laparotomy or necropsy. Logistic regression or the Fisher exact test was used to determine factors associated with survival. Outcome was defined as survival to discharge (short-term survival), and long-term survival was defined as horses alive at least 1-year post surgery. Of the 44 horses, 18 died or were euthanized before surgery. Twenty-six were taken to surgery, 17 were euthanized. Nine horses recovered from anesthesia, 7 of which survived to hospital discharge. Of these, 5 were alive at long-term follow-up. Survival was significantly associated with the age of the horse (≤2 y old) at presentation, presence of normal peritoneal fluid at presentation, amount of compromised viscera at surgery (<50% small intestine), and the size (<10 cm) and location (ventral) of the diaphragmatic tear.
Conclusion – This study confirms that size and location of the lesion do play a significant role in prognosis. And, although the prognosis for horses with diaphragmatic hernia is poor, if horses have operable lesions there is a fair prognosis for long-term survival.     

Hemoperitoneum in horses: 67 cases (1989-2004)

OBJECTIVE: To evaluate clinical findings, underlying causes, and short-term outcome associated with hemoperitoneum in horses. DESIGN: Retrospective case series. ANIMALS: 67 horses with hemoperitoneum. PROCEDURES: Medical records of horses with hemo-peritoneum (excluding postoperative abdominal hemorrhage) from 1989 through 2004 were analyzed. Information obtained included history, signalment, physical examination findings, diagnostic test results, and short-term outcome. RESULTS: Breed distribution was 28 Thoroughbreds, 13 Arabians, 10 Quarter Horses, 5 Warmbloods, 3 Appaloosas, and 1 each of 8 other breeds. There were 40 mares, 23 geldings, and 4 stallions. Median age was 12 years (range, 1 month to 40 years). Signs of abdominal discomfort were the primary complaint in 79% of horses. Clinical findings included shock (60%) and pale mucous membranes (60%). Median heart rate was 76 beats/min (range, 30 to 216 beats/min), median respiratory rate was 30 breaths/min (range, 8 to 92 breaths/min), median Hct was 31% (range, 10.5% to 73.0%), and total protein concentration was 5.8 g/dL (range, 3.3 to 8.7 g/dL). Cause of hemoperitoneum was attributed to trauma (25.4%), neoplasia (17.9%), uterine artery rupture (13.4%), mesenteric injury (11.9%), disseminated intravascular coagulopathy (6.0%), other causes (3.0%), and idiopathic causes (22.4%). Fifty-one percent of horses survived to hospital discharge, 37% were euthanized, and 12% died. Poor short-term outcome was significantly associated with high respiratory rate and certain underlying causes. CONCLUSIONS AND CLINICAL RELEVANCE: Hemoperitoneum is an infrequent but important cause of abdominal discomfort in horses. Predominant underlying causes were trauma, neoplasia, and idiopathic causes. Identification of underlying cause is important because of its association with outcome.     

Acute febrile diarrhoea in horses: 86 cases (1986–1991)

SUMMARY: Eighty-six horses presented for examination at the Rural Veterinary Centre between January 1986 to December 1991 with acute diarrhoea. The average age of affected horses was 3.2 ± 0.2 years (mean ± SE), with 69% three years or younger. Sixty-one horses were male (36 stallions, 25 geldings) and 83 horses were Thoroughbreds (47) or Standardbreds (36). Sixty-six horses were undergoing routine training at the time of onset of diarrhoea. Eight horses were afflicted with a non-specific illness within one to five days before the onset of diarrhoea, whereas eight horses developed diarrhoea during or within 48 h of discontinuation of antimicrobial therapy. Three horses developed the diarrhoea within 24 h of road transportation. Clinically, the disorder was characterised by a fever, sudden onset of profuse diarrhoea, clinical evidence of dehydration (estimated to be 5 to 12% of body weight at the time of admission) and shock. Degenerative leucopaenia, hyponatraemia, hypochloraemia, hyperkalaemia, hyperglycaemia and azotaemia were characteristic laboratory findings. Laminitis was a sequel in about 30% of cases. The cause of diarrhoea remained undetermined in most cases. Salmonellas were isolated from faecal or tissue samples in only two cases. Similarly, there was no evidence of seroconversion to Erhlichia risticii in 17 cases. Sixty-two of the horses survived the acute phase of the disease in response to supportive care. In horses that did not survive, necropsies were performed and revealed sanguineous or turbid peritoneal fluid. The colonic and caecal walls were oedematous and thickened with serosal congestion and discolouration of these organs evident grossly. Histopathological examination of the caecum and colon revealed diffuse congestion, oedema, inflammatory reactions and submucosal vascular thrombosis with varying degrees of mucosal devitalisation. Most cases presented in this series represent a distinct syndrome of diarrhoea characterised by acute diarrhoea predominantly affecting young horses in training with concomitant signs of fever and toxaemia.     

Plasma serotonin in horses undergoing surgery for small intestinal colic

This study compared serotonin concentrations in platelet poor plasma (PPP) from healthy horses and horses with surgical small intestinal (SI) colic, and evaluated their association with postoperative ileus, strangulation and non-survival. Plasma samples (with EDTA) from 33 horses with surgical SI colic were collected at several pre- and post-operative time points. Serotonin concentrations were determined using liquid-chromatography tandem mass spectrometry. Results were compared with those for 24 healthy control animals. The serotonin concentrations in PPP were significantly lower (P < 0.01) in pre- and post-operative samples from surgical SI colic horses compared to controls. However, no association with postoperative ileus or non-survival could be demonstrated at any time point. In this clinical study, plasma serotonin was not a suitable prognostic factor in horses with SI surgical colic.     

Cecocolic intussusception in horses: 11 cases (1979-1989)

Over a 10-year period, cecocolic intussusception was diagnosed in 11 of 842 horses undergoing surgical treatment for colic at the New York State College of Veterinary Medicine. Eight horses died or were euthanatized because of poor prognosis determined at surgery or because of postoperative complications. Three horses recovered without complication after manual reduction of the intussusception and partial typhlectomy, using an intestinal stapling device.     

Survival rates for horses undergoing stapled small intestinal anastomosis: 84 cases (1988-1997)

OBJECTIVE: To determine whether location and type of small intestinal anastomosis and other variables were associated with short- and long-term survival rates in horses undergoing stapled small intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 84 horses that underwent small intestinal anastomosis. PROCEDURE: Medical records from 1988 to 1997 were examined for horses that underwent stapled small intestinal anastomosis. Horses were allotted into 4 groups: jejunojejunostomy (n = 27), jejunoileostomy (11), jejunoileocecostomy with small intestinal resection (20), and jejunoileocecostomy without small intestinal resection (26). Survival rates and other variables were determined. RESULTS: Horses that underwent jejunoileocecostomy without resection had a significantly higher survival rate at all intervals than did horses in the other 3 groups. At 180 and 365 days after surgery, horses that underwent jejunojejunostomy had a significantly lower survival rate than those that underwent jejunoileocecostomy with intestinal resection. Horses that underwent jejunoileocecostomy with intestinal resection had a significantly higher survival rate at 1 year, compared with the combined jejunojejunostomy and jejunoileostomy groups. Preoperative heart rate was inversely associated with survival rate. Overall survival rates at discharge and 1 year were 81 and 56%, respectively. For horses that underwent small intestinal resection, survival rates at discharge and 1 year were 65 and 47%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that underwent anastomosis of the small intestine to the cecum without resection had the highest survival rate, compared with horses that required intestinal resection. In some instances, resection and anastomosis involving the cecum had better prognosis than resections involving 2 segments of the small intestine.     

Surgical and postoperative factors influencing short-term survival of horses following small intestinal resection: 92 cases (1994-2001)

Although short-term survival rates following small intestinal resection reportedly range from 48-88%, there is little information on predicting which horse may or may not survive small intestinal (SI) resection and anastomosis. The aim of this study was to identify factors that contribute to nonsurvival in horses following small intestinal resection. Medical records of horses which recovered from anaesthesia following SI resection were reviewed. Clinical and surgical variables were evaluated for their association with short-term survival using logistic regression and were reported as odds ratios (OR), including the 95% confidence interval (CI), indicating the likelihood of horses not surviving to hospital discharge. Ninety-two records met the criteria for inclusion. Thirty-six (81.8%) of the horses that underwent jejunojejunostomy (JJ) and 34 (70.8%) of the horses that underwent jejunocaecostomy (JC) survived to discharge. Multiple logistic analysis indicated that postoperative ileus (OR = 29.7; 95% CI 2.5-354.6), repeat celiotomy (OR = 18; CI 1.7-187.6), and an elevated heart rate of > or = 60 beats/min (OR = 5.6; CI 1.5-20.6) were the principal factors associated with nonsurvival. A low total plasma protein of <55 g/l (OR = 1.8; CI 0.-7.6) was incorporated in the final model because its inclusion improved the overall validity of the model, Clinicians should be aware of the factors associated with the greatest likelihood of nonsurvival following small intestinal resection, so that they can institute aggressive treatment and accurately inform owners on the likelihood of survival.     

Idiopathic eosinophilic meningoencephalitis in Rottweiler dogs: three cases (1992–1997)

We report three cases of eosinophilic meningitis in young male Rottweiler type dogs in New Zealand. No cause for the disease was identified. There were variable clinical signs referable to central nervous system dysfunction, and a variable response to treatment.     

Extrapyramidal side effects following subcutaneous metoclopramide injection for the treatment of post operative ileus

Metoclopramide is used for the management of post operative ileus in horses for its gastrointestinal prokinetic effects. Adverse extrapyramidal signs have been reported following its use in horses as well as in man. This report describes the clinical signs exhibited during an adverse reaction suspected to be associated with subcutaneous administration of 0.25 mg/kg bwt metoclopramide at 6 h intervals.     

Use of phacofragmentation for cataract removal in horses: 12 cases (1985-1989)

The medical records of 12 horses that had cataracts removed by use of phacofragmentation were reviewed. Cataracts were removed from 16 eyes in horses ranging in age from 2 months to 15 years. Complications after surgery included corneal ulcers in 13 eyes, diffuse corneal edema in 5 eyes, and uncontrollable uveitis in 3 eyes. Follow-up information was obtained in all horses from 1 month to 3.5 years after surgery. Visual results were judged good by owners or veterinarians in 10 of the horses.     

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.     

Modelling long-term survival of horses following surgery for large intestinal disease

REASONS FOR PERFORMING STUDY: Large intestinal diseases are an important cause of equine colic that require surgical management, but there is little published information about long-term survival of such cases. OBJECTIVES: To identify variables associated with post operative mortality and to develop a model for post operative survival following surgery for large intestinal disease. METHODS: Clinical data and long-term follow-up information from 275 horses undergoing surgery for large intestinal disease were used. A multivariable, Cox proportional hazards model for post operative death was developed and the fit of the model evaluated. RESULTS: The continuous variables age, heart rate and packed cell volume (PCV) were associated positively with the risk of post operative death, as were the categorical variables resection (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-5.1) and relaparotomy (OR 3.5, 95% CI 1.4-8.4). CONCLUSIONS: In the population studied, the probability of post operative survival following surgery for large intestinal disease was associated with the cardiovascular parameters heart rate and PCV on admission, age of the horse and whether it underwent resection or relaparotomy. POTENTIAL RELEVANCE: The prognosis for post operative survival for horses with large intestinal disease may be improved by early surgery, prior to the development of cardiovascular compromise. Surgeons should be aware that increasing age, resection of large colon and relaparotomy are all associated with a worsening prognosis for survival.     

Brachygnathia in horses: 20 cases (1979-1989).

The medical records of 20 horses admitted to the veterinary medical center with a diagnosis of brachygnathia over a 10-year period (1979 to 1989) were reviewed. The study included 18 foals and 2 adult horses. Males were affected 5.7 times more frequently than females. The amount of disparity between the mandible and premaxilla varied between 0.75 and 3 cm. Sixteen foals were treated surgically with the temporary application of premaxillary tension band devices. Thirteen of the 16 surgical cases were available for follow-up evaluation. All of the surgically treated animals had improved incisive occlusion, and 6 foals had complete resolution of the deformity with corrections ranging from 0.75 to 2.5 cm. Complete correction of the malocclusion was more likely to occur if foals were treated when they were less than or equal to 6 months old. The average amount of correction achieved in foals treated when they were less than or equal to 6 months old was 1.5 cm. (range, 0.75 to 2.5 cm). Foals treated, when they were 7 to 12 months old, had an average of 0.6 cm of reduction in the malocclusion (range, 0.25 to 1 cm). Implant failure was the most common complication and occurred in 9 of the 13 foals treated surgically.     

Mares admitted to a referral hospital for postpartum emergencies: 163 cases (1992–2002)

Objective: To identify and describe the physical, historical, and clinicopathologic characteristics of diseases requiring emergency treatment in postpartum mares, and to evaluate the utility of these characteristics in making an accurate diagnosis in these mares. Design: Retrospective study. Setting: University large animal hospital. Animals: One hundred and sixty‐three mares admitted for emergency treatment within 30 days following parturition between the years 1992 and 2002. Interventions: None. Measurements and main results: Information obtained from the medical records included age, breed, date of admission, sex of the foal from this parturition, time from parturition to admission, duration of clinical signs prior to admission, and any report of dystocia or normal attended delivery, physical examination and clinicopathologic findings and diagnosis. Urogenital hemorrhage and large colon volvulus were the most common diagnoses, comprising 16.6% and 15.9% of total cases, respectively. Older mares were more likely to have a diagnosis of urogenital hemorrhage than younger mares. Mares with urogenital hemorrhage had a median age of 13 years and were admitted to the hospital significantly closer to parturition than mares with other diagnoses. Anemia, hypoproteinemia, and hypofibrinogenemia were significantly associated with a diagnosis of urogenital hemorrhage and occurred in 32%, 36%, and 26% of the mares with urogenital hemorrhage, respectively. Dystocia was more commonly reported (70%) in mares with metritis. Leukopenia was more common (88%) in mares with uterine tears. Conclusions: Careful evaluation of clinicopathologic data can aid the emergency clinician in making a correct diagnosis in postpartum mares with emergent problems.     

Tenoscopic-assisted treatment of open digital flexor tendon sheath injuries in horses: 20 cases (1992-2001)

OBJECTIVE: To determine history, physical and diagnostic examination findings, medical treatment, and outcome of horses with open injuries to the digital flexor tendon sheath treated with the assistance of tenoscopy. DESIGN: Betrospective study. ANIMALS: 20 horses. PROCEDURE: Medical records of 20 horses with open injuries to the digital flexor tendon sheath were reviewed. Signalment, history, physical and diagnostic examination results, bacteriologic culture and susceptibility testing results, surgical and medical treatments, and follow-up examination results were determined. Outcome was determined by use of telephone interview or physical examination. RESULTS: All horses were treated with tenoscopic-assisted lavage and debridement. Eighteen horses survived, and 2 were euthanatized during treatment. All horses were either grade-4 or grade-5 lame before treatment. Ten horses returned to previous use. Four horses were considered mildly lame and in athletic use. Three horses were considered mechanically lame and are in use with reduced expectations. One horse was lost to follow-up after being sold. One horse was euthanatized for financial reasons and 1 because of complications from regional sepsis. CONCLUSIONS AND CLINICAL RELEVANCE: Tenoscopy appears to be a useful modality in the treatment of open injury to the digital flexor tendon sheath in horses. Direct viewing, guided debridement, and targeted large-volume lavage are advantages obtained with intrathecal arthroscopy. Tenoscopy, when combined with antimicrobial and anti-inflammatory treatment, appears to offer a good chance of survival for affected horses.     

Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990-1997)

OBJECTIVE: To describe the clinical findings in horses with small intestinal strangulation through mesenteric rents, and to determine the recurrence and survival rates after surgery. DESIGN: Retrospective study. ANIMALS: 15 horses with small intestinal obstruction via a mesenteric rent. PROCEDURE: Medical records of horses with obstruction of the small intestine via a mesenteric rent between January 1990 and December 1997 were reviewed. The signalment, history, initial physical examination findings, results of abdominocentesis, and clinical laboratory values were recorded. Surgical findings, including location of the mesenteric rent and surgical procedure performed, were recorded. Short- and long-term survival rates were calculated. RESULTS: Most mesenteric rents were located in the mesentery of the small intestine (13 horses). Two horses had multiple mesenteric defects. Seven horses were euthanatized at surgery because of an inability to reduce the entrapped intestine (3 horses), uncontrollable hemorrhage (2), inability to close the rent (1), and the amount of compromised intestine involved (1). Seven horses required intestinal resection and anastomosis. The median length of intestine resected was 2.6 m (range, 0.6 to 4.5 m). The mesenteric rents created during resection were not closed in 2 horses. One of these 2 horses subsequently developed a strangulating obstruction through the open rent. Seven of 15 horses in our study were discharged from the hospital (i.e., short-term survival rate of 47% [7/15]). Long-term follow-up information was available for 5 of the 7 horses (follow-up duration of 5 months to 9 years), of which 2 died as a result of colic, and 1 horse was euthanatized because of severe arthritis (i.e., long-term survival rate of 40% [2/5]). CONCLUSIONS AND CLINICAL RELEVANCE: Inability to reduce the intestinal obstruction, severe hemorrhage from the mesentery, and the length of intestine involved are the main factors that decrease survival rates in horses with small intestinal strangulation caused by mesenteric rents.