Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine Emergencies

Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate.
Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC].
Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement.
Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]Δ T ) was calculated from changes in [LAC] between sampling points.
Results: Median [LAC] was significantly ( P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60–18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30–13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17–1.43) at admission to 49.90 (6.47–384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]Δ T was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24–72 hours (− 0.47, P = .001) and 48–72 hours (− 0.07, P = .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors.
Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]Δ T can be a useful prognostic indicator in horses.     

Strangulating volvulus of the ascending colon in horses

Of 57 horses with strangulating volvulus of the ascending colon, 42 were mares (including 21 postparturient mares), 8 were stallions, and 7 were geldings. Volvulus occurred most frequently in the summer (n = 24) and spring (n = 17). Pain was evaluated as severe in 41 horses, moderate in 9, and mild in 4. The abdominal fluid from 30 horses varied from clear yellow in 19 horses, to cloudy yellow in 3 horses, and serosanguineous in 8 horses. Protein content and nucleated cell count in the abdominal fluid were 2.5 +/- 1 g/dl and 1,000 +/- 900 microliters, respectively. Fifty horses had greater than or equal to 360 degrees volvulus and 7 had a 270 degrees volvulus, with 49 occurring in a counterclockwise direction. The site of volvulus in all horses was at the mesenteric attachment of the colon, except for a 360 degrees volvulus at the sternal and diaphragmatic flexures in 1 horse. Survival rates for horses with a greater than or equal to 360 degrees and a 270 degrees volvulus were 36% and 71%, respectively. The difference in survival rates reflected the severe vascular occlusion in the colon of horses with greater than or equal to 360 degrees volvulus. In nonsurvivors, hemorrhage in the submucosa and lamina propria (P less than 0.005) and edema in the submucosa (P less than 0.01) were greater than those in survivors. In nonsurvivors, greater than 97% of the superficial epithelium was lost. In horses that survived, only 60% of the cells were lost or degenerated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of and Risk Factors for Postoperative Ileus after Small Intestinal Surgery in Two Hundred and Thirty-Three Horses

Objectives— To determine the incidence of postoperative ileus (POI) in a population of horses after small intestinal surgery and the effect of multiple variables on development of POI.
Study Design— Case series.
Animals— Horses (n=233) aged ≥1 year that had exploratory celiotomy for small intestinal disease that recovered from surgery from 1995 to 2005.
Methods— Sixty-eight variables were collected from medical records (1995–2005) for each horse. POI was defined as nasogastric reflux volume >20 L over 24 hours or >8 L at any single time after surgery.
Results— Twenty-seven percent (64/233) of horses developed POI; 29 of 64 (46%) horses with POI had duodenitis proximal jejunitis (DPJ). When no intestinal resection was required at surgery, excluding horses with DPJ, 15% of horses had POI; 30% horses had POI after intestinal resection. Ten percent of horses had POI for >24 hours. When horses with DPJ were excluded, factors associated with increased risk of POI included high packed cell volume at hospital admission ( P =.024), increasing age ( P =.0004), and length of intestinal resection ( P =.05).
Conclusions— Risk factors for POI in this study were nonspecific although horses with intestinal resection are at higher risk compared with horses without intestinal resection.
Clinical Relevance— Predicting with certainty which cases will develop POI remains elusive.     

Colonic Luminal Pressure in Horses With Strangulating and Nonstrangulating Obstruction of the Large Colon

Colonic luminal pressure (median, range) measured during ventral midline celiotomy in 69 horses with strangulating obstruction (SO) of the large colon (SO; ≥ 270° large colon volvulus; 27 cm H₂O: 2 to 80 cm H₂O) was greater ( P =.0023) than that measured in 37 horses with nonstrangulating obstruction (NSO) of the large colon (NSO; ≤ 180° volvulus or a nonstrangulating displacement; 18 cm H₂O; 6 to 46 cm H₂O). Sixty-five percent (45 of 69) of horses with SO and all horses with NSO survived. Survival analysis was restricted to 59 horses with large-colon SO that survived to hospital discharge or met the criteria specified for classification as nonsurvivors. Colonic luminal pressure in nonsurvivors (48.5 cm H₂O; 34 to 80 cm H₂O) was higher ( P =.0001) than that measured in survivors (18 cm H₂O; 2 to 50 cm H₂O) of SO. From response operating characteristic curves, a luminal pressure of 38 cm H₂O optimized the distribution of horses with SO into survivor and nonsurvivor groups. Sensitivity, specificity, and positive and negative predictive values for a colonic luminal pressure greater than 38 cm H₂O in predicting nonsurvival were 0.89, 0.91, 0.72 and 0.97, respectively. Measurement of colonic luminal pressure may be useful for predicting survival in horses with colonic volvulus.     

The Effects of Ischemia and Reperfusion on Mucosal Respiratory Function, Adenosine Triphosphate, Electrolyte, and Water Content in the Ascending Colon of Ponies

Objective- The purpose of this study was to examine the effects of ischemia and reperfusion on the biochemical integrity of equine colonic mucosa to assess the relative roles of ischemic- and reperfusion-induced damage.
Study Design- Two hours of no-flow ischemia experimentally induced by 720° counterclockwise ascending colon volvulus followed by 2 hours reperfusion after derotation.
Animals- Ten ponies.
Methods- Ascending colon biopsies were obtained every hour for measurement of mucosal adenosine triphosphate (ATP), water, sodium, and potassium content. Additional samples were homogenized for assay of mitochondrial respiratory function.
Results- ATP content diminished 92% after ischemia and recovered to only 44% of control levels ( P <.001 versus controls) after 2 hours reperfusion. Reperfusion increased mucosal water and decreased sodium and potassium content for the duration of the experiment. Both NADH- (pyruvate) and FADH-linked (succinate) respiration decreased after ischemia and did not recover during reperfusion indicating electron transport chain dysfunction.
Conclusions- Two hours ischemia induced severe metabolic dysfunction in equine colon mucosa which persisted throughout reperfusion. Unequivocal evidence of injury specific to reperfusion was not observed in this study suggesting that much of the damage observed during reperfusion may be a continuation of injury induced during the ischemic period and not specific to reperfusion per se.
Clinical Relevance- This study suggests that greater efforts to metabolically support ischemically injured mucosa may be an important aspect of obtaining improved survival of horses affected by ascending colon volvulus (ACV).     

Pulmonary gas exchange and plasma lactate in horses with gastrointestinal disease undergoing emergency exploratory laparotomy: a comparison with an elective surgery horse population

Objective: To characterize pulmonary gas exchange and arterial lactate in horses with gastrointestinal disease undergoing anesthesia, compared with elective surgical horses, and to correlate these variables with postoperative complications and mortality. Study Design: Prospective clinical study. Animals: Horses undergoing emergency laparotomy for acute intestinal disease (n=50) and healthy horses undergoing elective surgery in dorsal recumbency (n=20). Methods: Arterial blood gas analysis was performed at predetermined intervals on horses undergoing a standardized anesthetic protocol. Alveolar–arterial oxygen gradient was calculated. Predictive factors for postoperative complications and death in colic horses were determined. Results: Arterial oxygen tension (P_aO₂) varied widely among horses in both groups. P_aO₂ significantly increased in the colic group after exteriorization of the ascending colon. P_aO₂ and alveolar–arterial oxygen gradient were not significantly different between groups, and neither were correlated with horse outcome. Arterial lactate in recovery ≥5 mmol/L was associated with a 2.25 times greater relative risk of complications and lactate ≥7 mmol/L was associated with a 10.5 times higher relative risk of death. Conclusion: Colic horses in this population were not more likely to be hypoxemic than elective horses, nor was gas exchange impaired to a greater degree in colic horses relative to controls. Arterial lactate sampled immediately after anesthetic recovery was predictive for postoperative complications and death.     

Effect of specimen collection and storage on blood glucose and lactate concentrations in healthy,hyperthyroid and diabetic cats

Abstract: The objective of this study was to compare and investigate differences in glucose and lactate concentrations in sodium fluoride/potassium oxalate (NaF/Ox) plasma and serum in healthy cats and cats with metabolic disease. Glucose and lactate concentrations were determined in routinely processed serum and NaF/Ox plasma obtained from healthy (n = 30), hyperthyroid (n = 27) and diabetic (n = 30) cats, and in samples from 6 healthy cats stored at 25°C or 4°C for 0,1, 2, 4, or 8 hours. The packed cell volume (PCV) of blood collected in NaF/Ox was compared with that of blood collected in EDTA. Mean glucose concentration was significantly (P < .05) lower in NaF/Ox plasma than in serum in all groups of cats, by 0.7–2.5 mmol/L (11–45 mg/dL); the difference was greater in cats with hyperglycemia. Mean lactate concentration was significantly higher in serum than in NaF/Ox plasma in all groups of cats, by 0.4–1.2 mmol/L (3.6–10.8 mg/dL); the difference was greater in hyperthyroid and diabetic cats. In vitro, only serum stored on the clot for ≥ 1hour at 25°C had significantly lower glucose and higher lactate concentrations. The PCV of NaF/Ox-anticoagulated blood was lower than that of EDTA-anticoagulated blood, by 7.0%± 1.4% (P<.01). In conclusion, collection of feline blood in NaF/Ox was necessary to prevent in vitro increases in lactate concentration; however, NaF/Ox artifactually decreased plasma glucose concentration because of RBC shrinkage. The PCV should not be determined on blood collected in NaF/Ox.     

Survival and Complications After Large Colon Resection and End‐to‐End Anastomosis for Strangulating Large Colon Volvulus in Seventy‐Three Horses

Objective— To report complications and survival after large colon resection and end‐to‐end anastomosis in horses with strangulating large colon volvulus. Study Design— Retrospective case series. Animals— Horses (n=73) with strangulating large colon volvulus. Methods— Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow‐up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. Results— The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short‐term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long‐term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. Conclusion— None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self‐limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. Clinical Relevance— Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long‐term survival with minimal negative impact on quality of life and use.     

Blood Lactate Concentrations in Anesthetized Dogs with Intracranial Disease

Background: The importance of blood lactate concentrations in dogs with intracranial disease has not been established, despite frequently observed hyperlactatemia in dogs undergoing general anesthesia for advanced imaging, surgery, or both.
Hypothesis: Blood lactate concentrations are elevated in anesthetized dogs with intracranial disease, compared with dogs with intervertebral disc disease (IVDD).
Animals: Eighty-five hospitalized dogs undergoing advanced imaging, surgery, or both for primary neurologic disease; 30 with intracranial disease; 55 with IVDD.
Methods: Retrospective study. Age, breed, neurologic diagnosis, time from anesthesia induction to measurement of blood lactate, blood lactate concentration under anesthesia, and concurrently measured heart rate, mean arterial pressure, PCV, arterial hemoglobin oxygen saturation, and arterial partial pressure of oxygen were included in a multivariable linear regression analysis.
Results: Dogs with meningioma (adjusted mean lactate 2.99 mmol/L, 95% CL 2.21–4.05, P < 0.0001) and hydrocephalus (adjusted mean lactate 1.5 mmol/L, 95% CL 0.99–2.27, P = 0.003) had higher blood lactate concentrations compared with dogs with IVDD (adjusted mean lactate 0.79 mmol/L, 95% CL 0.6–1.04). Only dogs with meningioma had clinically important hyperlactatemia (>2.5 mmol/L).
Conclusions: Prospective studies are warranted to determine the degree and clinical importance of high blood lactate concentrations in dogs with intracranial disease.     

Ultrasonographic visualization of colonic mesenteric vasculature as an indicator of large colon right dorsal displacement or 180�� volvulus (or both) in horses

Visualization of colonic mesenteric vasculature during transabdominal ultrasonographic examination of horses with colic can be a predictor of right dorsal displacement of the large colon or 180° large colon volvulus, or both. Medical records of 82 horses having had surgical treatment of colic and having received a transabdominal ultrasonographic examination on admission were reviewed. Colonic mesenteric vessels were sonographically identified coursing laterally on the right side of the abdomen in 24 of the 82 cases. Horses with colonic vessels identified on ultrasound were 32.5 times more likely to be diagnosed at surgery with either large colon right dorsal displacement or 180° large colon volvulus than those in which vessels were not seen (P < 0.001). Visualization of colonic mesenteric vessels on ultrasound provided a sensitivity of 67.7%, specificity of 97.9%, positive predictive value of 95.8%, and negative predictive value of 81% for large colon right dorsal displacement or 180° large colon volvulus, or both.     

Effect of Transvenous Electrical Cardioversion on Plasma Cardiac Troponin I Concentrations in Horses with Atrial Fibrillation

Background: Whether electrical cardioversion of cardiac arrhythmias results in cardiomyocyte damage is unknown.
Objective: To describe effect of transvenous electrical cardioversion (TVEC) on plasma cardiac troponin I (cTnI) concentration in horses.
Animals: All horses presented to the Cornell University Hospital for Animals for cardioversion of atrial fibrillation between May 2006 and October 2008 were eligible for inclusion in the study. Owners of 14 horses elected for TVEC and each horse was then enrolled (16 procedures).
Methods: Prospective observational study measuring concentrations of plasma cTnI before and after TVEC.
Results: Median cTnI concentration increased from 0.045 ng/mL at baseline (range 0.0–0.20 ng/mL) to 0.11 ng/mL after TVEC (range 0.0–3.73 ng/mL) ( P = .036). This increase was not associated with the number of shocks delivered, maximal energy delivered, cumulative energy delivered, chronicity of atrial fibrillation before cardioversion, or positioning of the pulmonary artery catheter.
Conclusions: The increase in cTnI is unlikely to be clinically important. The increase might be correlated with persistent atrial dysfunction after TVEC, suggesting that a longer convalescent period after the procedure could be warranted.     

Physiological responses of mature Quarter Horses to reining training when fed conventional and fat-supplemented diets

An initial experiment (Experiment I) was conducted utilizing five mature Quarter Horses to establish baseline physiological responses to typical reining training. In an initial standardized exercise test (SET) which simulated reining horse maneuvers, heart rate and plasma lactate concentration indicated that galloping circles, spinning and stopping were anaerobic maneuvers (203 beats/min and 8.86 mmol/L, respectively). However, lactate concentrations declined before the end of the SET. The values were used to modify the SET to a degree of difficulty that would elicit significant anaerobiosis, thus maintaining elevated lactate concentrations throughout the SET.In a subsequent experiment (Experiment II), ten mature Quarter Horses were exercised by reining horse training in a crossover experiment. Horses were fed a control (C) and a 10% fat-supplemented (F) concentrate with bermuda grass hay in a 65:35 ratio. Heart rate (HR), respiration rate (RR), rectal temperature (RT) and venous blood samples were taken prior to, during and following recovery from a modified SET which simulated reining horse maneuvers but was more demanding than the previous SET. Heart rates and plasma lactate concentrations indicated that all maneuvers, except loping circles elicited anaerobiosis (208 beats/min and 11.8 mmol/L, respectively; peak values on d 0). Plasma glucose concentration fell while loping circles from resting concentrations of 104.3 mg/dl to 79.2 mg/dl increased throughout the remainder of the SET to 89.7 mg/dl and returned to resting concentrations by 30 min of recovery. Respiration rate, packed cell volume (PCV), rectal temperature and total serum non-esterified fatty acid concentration (NEFA) increased throughout the SET and peaked between the end of exercise and after 10 min of recovery (128 breaths/min; 51%; 39.9°C and .871 mEq/L, respectively).Diet composition had no consistent effects on physiological responses, but there were training effects. Heart rate and plasma lactate were lower on day 28 than on day 0 (P<.05) while plasma glucose, NEFA and PCV were not affected by training. Respiration rate and rectal temperature reflected ambient conditions.     

Plasma Adrenocorticotropin Concentration in Healthy Horses and in Horses With Clinical Signs of Hyperadrenocorticism

Pituitary adenomas are commonly reported in older horses. The typical clinical signs associated with this condition, also known as equine Cushing's disease (ECD), are related to increased adrenocorticotropin (ACTH) production resulting in hyperadrenocorticism. The primary purpose of this study was to determine whether plasma ACTH concentrations differed between cushingoid and healthy horses. The second objective was to determine the effects of blood sample handling techniques on ACTH concentrations. A commercial human ACTH radioimmunoassay (RIA) was used to quantify equine plasma ACTH. Intra-assay and interassay variations, as well as dilutional parallelism were determined during the RIA validation. Plasma ACTH concentrations were evaluated in a group of healthy equids composed of 18 horses and 9 ponies, and in 22 equids with a clinical diagnosis of hyper adrenocorticism (11 horses and 11 ponies). The mean plasma ACTH concentrations in healthy horses and ponies, (18.68 ± 6.79 pg/mL (mean ± SD) and 8.35 ± 2.92 pg/mL, respectively), were significantly different (P = .009). The mean plasma ACTH concentration in horses and ponies with ECD, (199.18 ± 182.82 pglmL and 206.21 ± 319.56 pg/mL, respectively), were significantly higher than the mean ACTH concentration in the control animals (P < .001). Plasma ACTH concentrations appeared to be a sensitive and specific indicator of ECD in horses and ponies. ACTH concentrations measured in plasma samples kept at room temperature (19°C) as long as 3 hours after blood collection were not statistically different from those of samples kept at 1°C. J Vet Intern Med 1996;10:1–6. Copyright 1996 by the American College of Veterinary Internal Medicine .     

Hyperkalemic periodic paralysis, plasma lactate and exercise tolerance

The purpose of this, trial was to determine the effect of hyperkalemic periodic paralysis (HYPP) on exercise tolerance in Quarter Horses. Five HYPP affected and five nonaffected horses were matched for age, size, gender and reproductive status. HYPP status was diagnosed by DNA analysis and potassium chloride challenge testing. Plasma lactate concentration and heart rate were used as indicators of work intensity. Serum potassium concentrations were also monitored. Two exercise experiments were conducted, the first being forty-five minutes of slow, aerobic exercise (hacking) and the other being moderate, partially anaerobic exercise (galloping). Post-exercise the horses were cooled out by randomly assigning them to either forty minutes, of standing still or forty minutes of walking. Heart rates of HYPP affected and unaffected horses were not significantly different during exercise or recovery. Plasma lactate concentrations changed slightly following slow exercise and were significantly higher for HYPP affected horses (P=0.01).At the end of exercise, values were 1.4±0.2 mmol/L and 1.0±0.1 mmol/L for HYPP affected and unaffected horses, respectively. Following moderate exercise, plasma lactate concentrations were much greater, and the difference (P<0.001) between affected and unaffected horses was more marked: immediately following exercise concentrations were 10.6±1.8 and 6.2±1.0 mmol/L in affected and unaffected horses, respectively. The higher post-exercise plasma lactate concentrations in affected horses indicates increased anaerobic muscle metabolism. Serum potassium concentrations rose following exercise and significantly higher values were seen in horses that were walked rather than stood still post-exercise.Hyperkalemic periodic paralysis (HYPP) is a dominant autosomal genetic defect occurring in American Quarter Horses and related breeds. ^1–5 The condition is widely geographically distributed and has been estimated to affect 0.4% of all Quarter Horses.⁶ Signs include sporadic attacks of muscle fasciculation, muscle spasm, sweating and weakness. Oral administration of potassium chloride produces a more severe hyperkalemia in HYPP affected horses and induces clinical attacks.¹ Electromyography reveals widespread continuous, spontaneous, muscle contraction.² Some people believe that HYPP affected horses are suitable for riding⁷; others have expressed doubts about the safety of this practice and the exercise tolerance of affected horses. HYPP affected horses have an unstable muscle membrane potential causing random muscle fiber contractions,^2,8 which could antagonize purposeful movement. This, in combination with increases in extracellular potassium concentration occurring during exercise,^9–11 may cause affected horses to stumble or collapse while being ridden, posing a danger to both horse and rider. In HYPP affected people, potassium concentration rises approximately one to two hours after exercise during which time HYPP attacks can occur.^9,10 For these reasons, the exercise tolerance of HYPP affected horses and the effects of exercise on spontaneous HYPP attacks deserves investigation.We standardized the exercise test and chose heart rate and plasma lactate concentrations as indicatoors, of exercise tolerance and energy metabolism.¹² Heart rate is the major determinant of oxygen delivery to muscle and the rate rises with exercise intensity until it reaches a plateau at high velocities.^13,14 Several lines of investigation indicate that plasma lactate concentrations reflect muscle work. Lactate release from resting muscle is minimal but large amounts are released during strenuous exercise.^15–17 Lactate release increases with increasing muscle work.^16,18 During exercise, muscle oxygen consumption increases until eventually a plateau is reached after which no further increase in oxygen consumption in response to increased work loads is possible.¹⁸ At this point the mitochondrial electron chain transport system is operating at its maximal possible rate, energy production can only be supplemented by the use of inefficient anerobic glycolytic metabolism and the muscle starts to release lactate. If the concentrations of plasma lactate are high, the muscles are depending on anaerobic metabolism and are working closer to exhaustion^16,18–21The objectives of this experiment were twofold. One was to determine if HYPP adversely affects exercise performance. The second was to study the effects of cooling out, by either standing still or walking, on serum potassium and plasma lactate concentrations.     

Vascular Injury Associated with Naturally Occurring Strangulating Obstructions of the Equine Large Colon

Ten horses were euthanatized before, during, or after surgery to correct severe volvulus of the large colon. At surgery, the colonic serosa changed from blue-gray, blue or purple toward a more normal pink in seven horses after the volvulus was corrected. The mucosa consistently remained black or dark red. Results of postmortem colonic microangiography revealed perfusion of the serosa and the circular and longitudinal muscle layers, but mucosal perfusion was limited by thrombosis in the muscularis mucosae and submucosa. There was evidence of thrombosis of the mesenteric colic vessels in six horses. Damage to the colonic vascular system, especially thromboembolism in the submucosa, may be an important limitation to colonic viability after surgical correction of volvulus of the large colon.     

A Lateral Approach for Screw Repair in Lag Fashion of Spiral Third Metacarpal and Metatarsal Medial Condylar Fractures in Horses

Objective— To describe a lateral approach for screw fixation in lag fashion of simple spiral medial condylar fractures of the third metacarpus/metatarsus (MC3/MT3).
Study Design— Case series.
Animals— Thoroughbred racehorses (n=9).
Methods— Nondisplaced medial MC3/MT3 condylar fractures (3 thoracic, 6 pelvic limbs), with mean length 126 mm (range, 91–151 mm) were repaired by internal fixation, under general anesthesia, using multiple 4.5 mm cortical screws inserted in lag fashion from the lateral aspect of the limb, using radiographic or fluoroscopic guidance. Horses were recovered from anesthesia in half-limb casts; 7 unassisted and 2 using a rope-recovery system. Horses had 2 months box rest, 1 month in-hand walking, and follow-up radiographic examination at 3 months.
Results— Horses recovered uneventfully from anesthesia. Five horses raced; 1 returned to training, was persistently lame, and was retired to stud; 2 were retired directly to stud; and 1 horse was lost to follow-up.
Conclusions— MC3/MT3 medial condylar fractures were successfully repaired by screws inserted n lag fashion form the lateral aspect.
Clinical Relevance— Use of a lateral approach to medial condylar MC3/MT3 fractures allows screw insertion perpendicular to the fracture plane without interference with palmar/plantar soft tissue structures or from the splint bones. Although repair was performed under general anesthesia, the technique should be adaptable to application in standing horses.     

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.     

Ionized calcium concentration in horses with surgically managed gastrointestinal disease: 147 cases (1988-1990).

Packed cell volume, total plasma protein, serum sodium, potassium, and ionized Ca2+ concentrations, and blood pH were determined at the time of admission and following surgery in 147 horses with acute abdominal crisis. Horses were allotted to 3 categories on the basis of the surgical lesion: (1) nonstrangulating obstruction of the ascending or descending colon (category A, n = 76), (2) strangulating and nonstrangulating infarction of the cecum or ascending colon (category B, n = 37), and (3) strangulating and nonstrangulating infarction of the small intestine (category C, n = 25). Horses with low serum ionized Ca2+ concentration following surgery were given 23% calcium gluconate (100 to 300 ml) IV to effect, and ionized Ca2+ concentration was determined following treatment. The serum ionized Ca2+ concentrations of horses in categories A, B, and C before and after surgery were lower than our normal laboratory reference range. Prior to surgery, serum ionized Ca2+ concentration measured from horses in category B and C was lower than that in horses in category A. There was no difference in ionized Ca2+ concentration in serum samples obtained before surgery in horses from category B and C, and in serum samples obtained following surgery. There was a decrease in ionized Ca2+ concentration during surgery in horses in category A. There was no change between preoperative and postoperative ionized Ca2+ concentration in the samples obtained from horses in category B and C. After calcium gluconate administration, all horses with low serum ionized Ca2+ after surgery had concentrations within our normal range. Measurement of serum ionized Ca2+ in horses with an acute abdominal crisis is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation‐volvulus: 84 dogs (2003–2007)

Objective – To test whether an initial plasma lactate≥6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation‐volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. Design – Retrospective study over a 5‐year period (2003–2007). Setting – Urban private referral small animal teaching hospital. Animals – Eighty‐four client‐owned dogs with a diagnosis of GDV and plasma lactate measurements. Interventions – None. Measurements and Main Results – There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate≥6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by≥50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by≥50% from the initial blood lactate. Conclusion – The results of this study indicate that an initial presenting plasma lactate concentration≥6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations≥50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.