Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions

Objective —To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.
Study Design —Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.
Animals or Sample Population—12 horses.
Methods —Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.
Results —All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less ( P <.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.
Conclusions —Peritoneal lavage reduced the frequency of intraabdominal adhesions.
Clinical Relevance —When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.     

Peritoneal Lavage and Drainage with Fenestrated Balloon Catheters in Standing Horses: A Comparative Study

This experimental study compares the efficiency of two fenestrated balloon catheters in allowing drainage of fluid during abdominal lavage in 12 healthy horses. Catheter A (with multiple side holes) or catheter B (with a single side hole) was placed in the ventral abdominal wall. Lactated Ringer's solution was instilled through a catheter in each paralumbar fossa of the standing horse. Drainage was performed through two catheters A in group 1, one catheter A in group 2, and one catheter B in group 3. Drainage was not significantly faster when using two, as compared with one, catheters A (P = 1). Amount of fluids recovered was greater using catheter A compared with catheter B (P = .004). Abdominal fluid analysis on day 30 was significantly higher (P = .008) for total protein in individuals with catheter B compared with catheter A. Use of one multiple fenestrated balloon catheter may be justified in clinical cases that need abdominal lavage and drainage.     

奶牛严重舌损伤治愈一例

奶牛舌损伤在临床上不多见。由于其解剖部位的特殊性,临床上容易错过最佳治疗时期,或由于护理不当造成感染引起舌坏死最终引起淘汰。2004年8月笔者成功治愈一例因风扇扇叶造成严重舌损伤的病例。1病例8月9日晚,9921号奶牛上班饲喂时未见异常,后进挤奶间挤奶,从挤奶间出来发现满嘴流血,后证实由于奶牛的好奇,在候挤厅将舌头伸入一个风扇网罩变形的风扇内,造成损伤。2症状病牛满嘴流血,不停作嘴咬动作,透过空隙看到舌尖有2~3cm的损伤,损伤部分游离。为进一步探明伤情,试拉出舌头,由于舌损伤疼痛,病牛极力反抗,均失败后,采用舌根传导麻醉,约10…     

Cytological Analysis of Bronchoalveolar Lavage Fluid in the Diagnosis of Spontaneous Respiratory Tract Disease in Dogs: A Retrospective Study

Results of cytological analysis of bronchoalveolar lavage (BAD fluid were compared with clinical diagnoses in dogs that presented with signs of respiratory disease to referral hospitals. Of 68 dogs in which a clinical diagnosis was possible, BAL cytological findings were considered definitive for the diagnosis in 17 cases (25%), supportive of the diagnosis in 34 cases (50%), and not helpful in 17 cases (25%). Findings were most often considered supportive of or definitive for the clinical diagnosis in dogs with alveolar or bronchial radiographic patterns, or the presence of pulmonary masses. BAL results among lung lobes differed in 23 of 63 dogs (37%) with diffuse radiographic patterns. Tracheal wash cytology differed from BAL fluid cytology in 45 of 66 dogs (68%). Bronchoalveolar lavage was a clinically useful procedure for the diagnostic evaluation of dogs with signs of respiratory disease.     

Diagnostic Accuracy of D‐Dimer and Other Peritoneal Fluid Analysis Measurements in Dairy Cows with Peritonitis

Background: Peritoneal fluid analysis in cattle traditionally includes the classic parameters despite the fact that they have only moderate diagnostic accuracy and often fail to identify the pathogenesis or etiological factors. Therefore additional parameters recently have been established to improve diagnostic precision. In a recent study, reference ranges for several of these parameters have been proposed in dairy cows. Hypothesis/Objectives: The aim of this observational study was to assess the diagnostic value of D‐Dimer and other measurements of peritoneal fluid analysis in dairy cows with peritonitis. Animals: The study included 110 Holstein‐Friesian cows grouped into cows with peritonitis (n = 47) and cows without peritonitis (n = 63). Methods: Peritoneal fluid was obtained by abdominocentesis. Total protein, albumin, glucose, cholesterol, fibrinogen, l ‐lactate, D‐Dimer, lactate dehydrogenase (LDH), alkaline phosphatase, creatine phosphokinase, white blood cell, and red blood cell were determined in peritoneal fluid and venous blood. Serum‐ascites albumin gradient (SAAG) and ratios of peritoneal fluid‐venous blood were calculated. Sensitivity (SN) and specificity (SP) were calculated and receiver operating characteristic curve analysis performed. Results: Peritoneal fluid D‐Dimer was most accurate in diagnosing peritonitis in cows (SN and SP>95.0%). Total protein concentration, LDH and LDH ratio, and SAAG had sensitivities between 49.0 and 67.1%, and specificities between 88.4 and 95.5%. A low‐peritoneal fluid glucose concentration was found to be highly indicative of septic peritonitis. Conclusions and Clinical Importance: Measurement of the recently introduced parameters may increase the diagnostic value of peritoneal fluid analysis and provide additional specific information. Therefore these measurements should be included in the routine procedure.     

Peritoneal lavage in the horse.

Eight horses ranging in age from 4 days to 9 years were treated for peritonitis. Escherichia coli was isolated in four cases and Nocardia sp in one case. In each case, a catheter placed in the peritoneal cavity allowed drainage of a large amount of purulent fluid. Retrograde peritoneal lavage was performed through a Foley catheter or medical tubing, using Ringer's lactate solution containing kanamycin, povidone iodine, or nitrofurazone. All except two horses responded well to repeated lavage.     

Bronchoalveolar Lavage in the Evaluation of Pulmonary Disease in the Dog and Cat

Bronchoalveolar lavage is a diagnostic procedure used to obtain specimens representative of disease processes involving the deep lung. Saline is instilled into an airway in sufficient volumes to bathe the alveoli dependent on that airway. The saline is retrieved by suction along with cellular and acellular material lining the epithelial surfaces of the lung. Cytologic and microbiologic evaluation of the fluid can be used to characterize pulmonary diseases in the dog and cat.     

Development of the Genital Peritoneal Folds in Sheep

Development of the genital peritoneum in the sheep was studied in embryos/fetuses that were 27-69 days old. The plica mesonephrica was the first visible fold of the urogenital organs of the embryos and was the origin of the proximal mesorchium or mesovarium. The plica suspensoria gonadalis fixed the gonad to the mesonephros and held the cranial genital ligament and the cranial part of the gubernaculum. The distal mesorchium or mesovarium evolved from this fold. The inguinal fold fixed the caudal part of the gubernaculum. The suspensory fold of the gonad and plica inguinalis formed a system of serosal folds called the Plica gonadoinguinalis. The fold of the genital ducts had two parts, divided by the crossing with the gubernaculum. The mesepididymis or mesosalpinx evolved from the cranial part of the fold, while the caudal part was the origin of the mesoductus deferens or mesometrium. The caudal part of the right and left folds contributed to defining another system of peritoneal folds, the Plica genitalis. A rearrangement of some accepted terms in the nomenclature is proposed, as are some new terms. An analysis of the meaning of some terms, especially those applied to systems of peritoneal folds, is given to aid in their interpretation.     

Comparison of Clinical Signs,Endometrial Culture,Endometrial Cytology,Uterine Low-Volume Lavage,and Uterine Biopsy and Combinations in the Diagnosis of Equine Endometritis

Endometritis is the most common cause of infertility in mares; however, many mares fail to be diagnosed despite availability of many diagnostic tests. Our objective was to compare different diagnostic methods and establish a cutoff value for the number of polymorphonuclear cells in cytology samples. Fifty-four mares were classified positive for endometritis based on endometrial biopsy (“gold standard”), and in a later analysis, the mare was reclassified as positive for endometritis if two or more of the following five criteria on a checklist were present (“new gold standard” [NGS]): (1) abnormal clinical findings, (2) abnormal gross character of low-volume lavage (LVL) fluid, (3) positive endometrial cytology, (4) bacterial growth on culture of the LVL pellet, and (5) histologic evidence of inflammation on endometrial biopsy. Kappa (κ) coefficient and percentages were calculated for sensitivity and positive predictive value (PPV) using SAS 9.3 software. Endometritis was diagnosed in 35/44 (79.5%) mares by biopsy. Based on the endometritis checklist, 33/51 (64.7%) mares were positive for endometritis. The character of LVL was 45% sensitive, whereas culture was 22% sensitive, when compared with endometrial biopsy. One percent of neutrophil-to-epithelial cell ratio was the most sensitive cutoff value (93.3%) when using a guarded swab (κ = 0.64). Endometrial biopsy was the most sensitive diagnostic method when compared against the NGS (sensitivity = 86%). Abnormal clinical findings and positive cytology showed moderate agreement with the NGS (κ = 0.41 and κ = 0.38, respectively). These studies demonstrate the importance of combining clinical findings and laboratory data when evaluating mares for endometritis.     

Intra-abdominal versus intramuscular application of two ampicillin preparations in cows

Plasma ampicillin concentrations were determined in a cross-over trial involving five cows after single intramuscular or intra-abdominal administration of sodium ampicillin (10 mg/kg) and ampicillin anhydrate (40 mg/kg). After injection of sodium-ampicillin, high plasma concentrations were reached within 10 min; Cmax following intramuscular injection was 9.1 micrograms/ml and after intra-abdominal injection 7.5 micrograms/ml. Urine concentrations of ampicillin were low after 24 h (1-1.5 micrograms/ml). No significant changes in blood leucocyte numbers, plasma zinc, iron or fibrinogen levels occurred. After injection of ampicillin anhydrate 1 h elapsed before maximum plasma levels were obtained; Cmax was 5.4 micrograms/ml after intramuscular and 6.7 micrograms/ml after intra-abdominal administration. Urine concentrations were very high (238-303 micrograms/ml) after 24 h and stayed above 1 microgram/ml for 6 days. After administration of ampicillin anhydrate a significant increase in blood neutrophils (P less than 0.01) and a significant increase in plasma fibrinogen was measured after intramuscular and intra-abdominal injection (P less than 0.05). A significant decrease in plasma zinc concentration after intra-abdominal injection occurred (P less than 0.05). In abdominal surgery in cows in which contamination cannot be prevented, and practical objections inhibit preoperative administration, intramuscular or intra-abdominal administration during surgery of sodium ampicillin seems justified. Ampicillin anhydrate should not be used intra-abdominally.     

Clinical Determination of Preoperative and Postoperative Intra-abdominal Pressures in Dogs

Intra-abdominal pressure (IAP) was indirectly measured, using a transurethral catheterization technique, in 20 client-owned dogs before and after elective ovariohysterectomy. Mean preoperative IAP was 4.50 ± 0.44 cm H₂O. Elective abdominal surgery caused significant elevations in mean postoperative IAP (mean 7.50 ± 0.45 cm H₂O, range 0 to 15 cm H₂O) that persisted for at least 24 hours. However, the increase in IAP caused no clinically evident complications; thus, after elective abdominal surgery an elevation in IAP up to 15 cm H₂O is to be expected. Intra-abdominal pressure was also measured in 20 consecutive clinical cases with gross abdominal distension, before or after laparotomy, or both. Included in this group were dogs with gastric dilation and volvulus, closed pyometra, hemoperitoneum, acute ascites, and diaphragmatic hernias. All dogs with gross abdominal distension had an elevated IAP (> 16 cm H₂O) either before or after surgery. Severe elevations of IAP were associated with anuria in two dogs, necessitating surgical decompression; one with hemoperitoneum (47 cm H₂O) and one after repair of a chronic diaphragmatic hernia (30 cm H₂O).     

Alternative Intrabladder Manometry Technique for the Indirect Measurement of Intra-abdominal Pressure in Horses

Although indirect methods for estimating intra-abdominal pressure (IAP) have been extensively studied in humans, mainly for identification of IAP increments in critical care unit patients (life-threatening condition), little work has been performed in veterinary medicine, especially in horses. The standard method of acquisition of intrabladder pressure (IBP) in human subjects (fluid-filled system with no balloon distention) has been previously evaluated in horses with an unfavorable outcome. Therefore, we reexamined the previously performed method of IBP investigation in horses by using an air-filled intrabladder manometry system in female horses. Intrabladder pressure was estimated by air-filled balloon manometry in seven healthy adult mares. The results were compared with two sets of directly acquired IAP values obtained by right paralumbar puncture using an 8-G needle in seven horses. Direct IAP values were obtained at times unrelated to IBP measurement acquisitions, and three of the seven horses used (for direct IAP measurement) were different animals from the mares used for assessment of IBP. Both sets of IAP measurements yielded subatmospheric values (IAP₁ = −10.5 ± 2.2 mm Hg; IAP₂ = −11.6 ± 2.0 mm Hg). Slightly subatmospheric IBP values were also recorded in some mares, but the mean (±SD) IBP was 1.4 ± 2.0 mm Hg. There was no correlation between IBP and IAP. These results suggest that this indirect (IBP) method for estimating IAP is not applicable for female horses.     

Comparison of 4 Giardia Diagnostic Tests in Diagnosis of Naturally Acquired Canine Chronic Subclinical Giardiasis

Background: The performance of Giardia diagnostic tests that detect either cysts or fecal antigens has not been thoroughly examined. Hypothesis/Objectives: We examined the concordance and agreement among 4 Giardia diagnostic tests (2 cyst and 2 coproantigen detection methods) in a colony of dogs chronically and subclinically infected with Giardia. Animals: Twenty dogs with chronic, subclinical Giardia infection. Methods: Giardia diagnostic tests were performed repeatedly on each dog over 120 days. Fecal cyst detection methods (ZnSO₄ flotation and fluorescent antibody [FAB] coproscopy) were performed 3 times per week. Coproantigen methods (Giardia SNAP test and quantitative ELISA) were performed weekly. Results were analyzed and compared among methods. Results: When compared with FAB coproscopy, all of the in‐house diagnostic tests had excellent positive predictive values (PPVs, 95–99%) at the study prevalence (89%). At lower prevalence rates, ZnSO₄, SNAP, and ELISA tests all had good negative predictive values (NPVs), but poor PPVs. There was poor to good agreement among tests by κ analysis. Conclusion and Clinical Relevance: Our findings show that most commonly used in‐house Giardia diagnostic tests have poor agreement with the gold standard method (FAB coproscopy). The in‐house tests have good NPVs, but poor PPVs, at prevalence rates common in most clinical settings.     

Effects of Castration on Peritoneal Fluid in the Horse

Twenty-four clinically normal horses were castrated by routine methods. Peritoneal fluid was collected prior to castration and at 1, 3, 5, and 7 days postcastration. Peritoneal fluid was collected on days 9 and 11 if nucleated cell (NC) counts were still markedly elevated on day 7. Peritonitis, defined as NC counts greater than 10,000/microliters, was evident in 15 horses following castration. Mean NC counts peaked on day 5 but were less than 10,000/microliters for 74% of the horses by day 7, and 90% of the horses by day 9. One horse had a NC count greater than 60,000/microliters on day 11 when sampling ended. Postcastration peritoneal fluid was obviously blood-tinged in 21 horses. Peak RBC counts occurred on day 3 but markedly decreased by day 5. Elevated peritoneal RBC counts correlated well with elevated NC counts (P less than 0.001). Horses with peritonitis tended to have fever (P less than 0.05). Other clinical signs of peritonitis were not apparent.     

Failure of Calcium Channel Blockade to Prevent Intra-abdominal Adhesions in Ponies

Intra-abdominal adhesions were created by localized serosal trauma in 11 adult ponies at three locations on the small intestine. Six ponies received verapamil hydrochloride (0.2 mg/ kg) subcutaneously every eight hours for three days, and five ponies received an equal volume of saline solution at the same intervals. The investigators were not informed which treatments the ponies received. Systolic, diastolic, and mean carotid arterial pressures and heart rates were measured six hours before surgery, and then 0.5, 1, 1.5, and 8 hours after the first treatment on each day for three days. One pony was euthanatized on day 13 because of colic, and the other 10 ponies were euthanatized 14 days after surgery. Scoring methods were used to assess the severity of adhesion formation and to grade the histologic appearance of the abraded sites. No significant differences were found for rectal temperature, packed cell volume, total plasma proteins, heart rate, and systolic, diastolic, or mean arterial pressures between control and verapamil-treated ponies. No significant differences were detected between the treatment groups for adhesion scores per abraded site, total adhesion scores per pony, the total number of adhesions per pony, or in the histologic scores.     

Diagnostic and Predictive Capability of Routine Laboratory Tests for the Diagnosis and Staging of Equine Inflammatory Disease

Background

A wide spectrum of laboratory tests is available to aid diagnosis and classification of equine inflammatory disease.

Objectives

To compare diagnostic efficacy and combined predictive capability of the myeloperoxidase index (MPXI), and plasma fibrinogen, iron and serum amyloid A (SAA) concentrations for the diagnosis of inflammation.

Animals

Twenty‐six hospitalized horses with systemic inflammation (SI), 114 with local inflammation (LI) and 61 healthy horses or those with noninflammatory disease (NI) were included.

Methods

A retrospective study was performed; clinicopathologic data from horses were compared between groups. Receiver‐operator characteristic (ROC) curves were used to evaluate diagnostic efficacy; classification and regression tree analysis (CART) and logistic regression analysis were used to generate diagnostic algorithms.

Results

Horses with SI had significantly higher SAA than horses with LI (P = .007) and NI (P < .001) and lower iron concentrations than horses with LI (P < .001) and NI (P < .001). Fibrinogen concentration was higher in horses with inflammation than in those without inflammation (P = .002). There was no difference between the SI and LI groups. White blood cell count, neutrophil count and MPXI were similar between groups. SAA had the highest accuracy for diagnosing inflammation (area under ROC curve [AUC], 0.83 ± 0.06) and iron and SAA concentration had the highest accuracy for differentiating SI from LI (AUC, 0.80 ± 0.09 and 0.73 ± 0.10 respectively). Predictive modeling failed to generate useful algorithms and classification of cases was moderate.

Conclusions and Clinical Importance

Very high SAA and low iron concentrations may reflect SI, but diagnostic guidelines based on quantitative results of inflammatory markers could not be formulated.