Factors associated with mortality and morbidity in small intestinal volvulus in horses

OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.). STUDY DESIGN: Retrospective study. ANIMALS: Client-owned horses (115), aged 1 month to 21 years. Methods: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction. RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery. CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors. CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.     

Initial investigation of mortality rates and prognostic indicators in horses with colic in Israel: A retrospective study

Reasons for performing study: Initial assessment of the mortality rates and prognostic indicators in horses with colic presented to a referral hospital in Israel. Objectives: To determine mortality rates and to identify potential prognostic indicators in horses undergoing treatment for colic. Methods: The medical records of 208 colic cases were reviewed and mortality rates calculated including 95% confidence intervals. Mortality rates in surgical cases were calculated separately for strangulating and nonstrangulating lesions as well as for lesions of the large and small intestines. Potential prognostic indicators were identified and evaluated by Student's t test or X² test, where appropriate. Those found to be significant (P<0.05) were evaluated in 2 logistic regression models; one including all horses with colic and one for surgical cases only. Results: The overall mortality rate was 51/208 (25%); 5/72 (7%) in medically treated cases, 46/136 (34%) in surgical cases, 30/50 (60%) in strangulating lesions and 15/85 (18%) in nonstrangulating lesions, 17/27 (63%) in cases involving small intestinal lesions and 28/108 (26%) in cases with large intestinal lesions. Clinical parameters found to be significantly associated with death by univariate analysis were medical/surgical treatment, location of lesion, severity of lesion, mucous membrane colour (MM), capillary refill time (CRT) and heart rate. Using a multivariate logistic regression model, including all cases, medical/surgical treatment, CRT and MM were found to be prognostic indicators and when using the surgical cases alone, only CRT and lesion severity remained related to mortality. Conclusions: Mortality rates were similar or better than those previously reported in most cases, however, studies from the USA and the UK published better success rates for small intestinal surgeries. Cultural attitudes toward euthanasia may be associated with mortality rates. Potential relevance: These results assist clinicians in providing an immediate prognosis based on clinical findings at presentation and contribute to an international database that may aid future research in improving treatment of colic.     

Plasma trypsin level in horses suffering from acute intestinal obstruction

Gastrointestinal disorders in horses leading to endotoxic shock could have further consequences on other splanchnic organs such as the pancreas, as can be seen in humans suffering from septic shock. In this study, the range of enzymatically active trypsin (EAT) in healthy horses was established and is similar to the range observed in healthy humans. EAT values were determined in horses with acute abdominal crises on admission as well as during anaesthesia and in the postoperative phase. A significant increase in plasma EAT was found in 59% of the horses with surgical colic when compared to our established reference range. Significantly higher values were found in severe shock cases. When separated in groups according to the duration of colic before referral, significantly higher EAT values were observed in the non-survivor group compared to the survivor group of colics of short duration. EAT plasma values increased significantly during the postoperative phase, and were significantly higher in small intestine obstructions than in large bowel disorders. In human medicine, hypovolaemic or septic shock patients show an increase in pancreatic proteases. Splanchnic hypoperfusion during shock could lead to pancreatic damage resulting in trypsin liberation into the peritoneal space and an increase in plasma levels. Trypsin is able to activate inflammatory cascades and leucocytes and could play a role in multiple organ failure. Further studies are needed to evaluate the implications of changes in plasma trypsin in the disease process of equine acute abdomen and to demonstrate possible pancreatic damage.     

Cutaneous T-cell lymphoma in a heifer with increased serum lactate dehydrogenase activity

A 1-year-old heifer from an enzootic bovine leukemia virus (BLV)-free breeding herd was examined for numerous cutaneous plaques on the neck, shoulder, back, perineum, and tail. Impression smears of the skin lesions contained a large population of neoplastic lymphoblastic cells. Hematologic findings included mild anemia, neutrophilia, and lymphocytosis. The serum activity of lactate dehydrogenase (LDH) was moderately increased at admission (4712 U/L), and remained increased despite normal to minimally increased activities of liver- and muscle-specific enzymes. The heifer was serologically negative for BLV. Because of declining condition and poor prognosis, the heifer was euthanized on day 37 after presentation. At necropsy and on histologic examination, epitheliotropic and folliculotropic cutaneous lymphoma, with generalized involvement of lymph nodes and spleen and infiltration of liver and kidney, was diagnosed. Immunophenotyping results (CD79-, CD3+) were consistent with a lymphoma of T-cell origin. We concluded that cutaneous T-cell lymphoma had spread to the other internal organs, and that the neoplasm likely contributed to increased serum LDH activity.     

急性甲胺磷中毒家兔血清酶水平动态监测

给家兔灌服不同剂量甲胺磷造成急性中毒,分时间(1 h、6 h、12 h、24 h、48 h)采血,观察血清中胆碱酯酶(CHE)、超氧化物歧化酶(SOD)、丙二醛(MDA)、乳酸脱氢酶(LDH)及碱性磷酸酶(AKP)水平变化。结果:与灌药前相比,①试验组CHE明显受抑制(P<0.01),且在对应各时间相,中剂量(5.0 mg·kg-1)组抑制程度明显高于低剂量(2.5 mg·kg-1)组(P<0.01),但CHE抑制呈现先抑制后逐渐恢复的变化趋势;②试验组SOD呈下降趋势(P<0.05),MDA在血液中的堆积逐渐增加(P<0.05),LDH和AKP均呈逐渐升高趋势(P<0.05);在对应各时间相,中低剂量组之间差异显著(P<0.05)。     

Effect of temperature,storage time,and sample type on sorbitol dehydrogenase activity in llama serum and plasma

Abstract: Serum and heparinized plasma samples were collected from 11 adult, clinically healthy llamas. Aliquots were assayed for sorbitol dehydrogenase (SDH) activity after storage at room temperature (20°C), 4°C, or −20°C for defined time intervals up to 1 week postcollection. Sorbitol dehydrogenase activity in all samples was within reference intervals for our laboratory. No difference was found between serum and plasma SDH activity when measured immediately (within 1 hour) after collection. Sorbitol dehydrogenase activity decreased to 79% of initial activity by 24 hours in serum stored at room temperature; plasma had 94% of initial SDH activity under the same conditions. Sorbitol dehydrogenase activity was stable in both plasma and serum stored for up to 1 week at 4°C or −20°C. With the exception of serum stored at 20°C for > 8 hours, in vitro stability of llama SDH was adequate for its use in diagnostic testing.     

The usability of peritoneal lactate concentration as a prognostic marker in horses with severe colic admitted to a veterinary teaching hospital

Colic can be a life‐threatening condition in horses and there is a need for parameters that can help determine the prognosis and need for surgery. The aim of the study was to investigate whether peritoneal fluid (PF) lactate concentration is useful for this purpose in horses with severe colic presented to a veterinary hospital. During a 16 month period, the peritoneal fluid (PF) lactate concentration was measured in 74 of 760 colic horses admitted to the Utrecht University equine clinic using a portable analyser. When comparing survivors and nonsurvivors, heart rate, PF and blood lactate concentrations and blood glucose concentration were significantly higher in horses that did not survive. No horse with a PF lactate concentration >9.4 mmol/l survived. The presence of a strangulating lesion was also significantly associated with nonsurvival, as was PF colour: no horse with red PF survived in the present series. In horses with yellow PF, the blood glucose concentration was correlated with the presence of a strangulating intestinal lesion. Peritoneal lactate concentrations can be easily and rapidly measured using a portable analyser and may be useful in assessing the prognosis and/or need for surgery in equine colic cases.     

Cardiovascular effects of acute pulmonary obstruction in horses with recurrent airway obstruction

BACKGROUND: Recurrent airway obstruction (RAO) is common in horses. Although pulmonary artery (PA) pressure increases during RAO, cardiac function in horses with RAO has received limited attention. HYPOTHESIS: The purpose of this study was to noninvasively determine the cardiovascular effects of acute pulmonary obstruction (APO) in horses with RAO and their reversibility. ANIMALS: Five geldings with RAO, inducible by exposure to moldy hay, were studied. METHODS: Pulmonary mechanics, echocardiography, serum troponin I concentrations, arterial blood gases, and hematocrit were obtained before and after 7 days of APO. Heart rate, PA diameter and flow characteristics, right and left ventricular luminal dimensions and wall thicknesses, global cardiac performance, and evidence of myocardial damage were evaluated. Pulmonary mechanics and echocardiography were reevaluated during remission. RRESULTS: Severe, transient APO did not induce chronic cor pulmonale in horses, because cardiac anatomy and function were normal between episodes. An acute episode of APO produced anatomical and functional cardiac changes in both the right and left heart (including increased PA diameter, abnormal septal motion, and decreased left ventricular diameter and estimated stroke volume), possibly because of the development of pulmonary hypertension, without apparent myocardial damage. The decrease in stroke volume was offset by the increase in heart rate. CONCLUSIONS AND CLINICAL IMPORTANCE: With APO of 7 days' duration, cardiovascular abnormalities and the functional airway changes that produce them are reversible when the offending allergens are removed.