Radiotherapy for the treatment of periocular tumours in the horse

Periocular tumours are a relatively common problem in the horse, and present some unique challenges. Radiotherapy has long been considered the ‘gold standard’ for the treatment of periocular tumours in the horse, and there are various techniques of delivering this treatment. Although teletherapy and plesiotherapy are occasionally used, the most commonly used technique is interstitial brachytherapy. Low-dose rate interstitial brachytherapy has reported success rates of between 74 and 100% for the treatment of periocular sarcoids, and other tumours can also be successfully treated using this technique. There are significant disadvantages to the low-dose rate brachytherapy approach, and recently, a technique using high-dose rate brachytherapy has been described with a reported success rate of 100% for periocular sarcoid treatment. Electronic brachytherapy is a technique which may provide an alternative to high-dose rate brachytherapy, but its use for the treatment of periocular tumours has not been reported, and the requirement for general anaesthesia is a significant disadvantage.     

Lawsonia intracellularis proliferative enteropathy in a 3.5‐year‐old miniature horse

A 3.5‐year‐old miniature horse gelding was evaluated for signs of colic and decreased faecal production. Initial clinical pathology showed severe hypoproteinaemia with an albumin concentration <10 g/l. Abdominal ultrasound identified multiple loops of small intestine with significantly increased wall thickness. Diagnosis of equine proliferative enteropathy was based on clinical and laboratory findings, as well as a positive faecal polymerase chain reaction and positive antibody titre (>1:240) to Lawsonia intracellularis. Treatment with intravenous oxytetracylcine and additional supportive care gradually resolved the clinical and laboratory abnormalities.     

Equine herpesvirus 1‐associated ulcerative dermatitis in a horse

This case report describes the clinical and histopathological findings of an infection caused by equine herpesvirus‐1 (EHV‐1) in a horse showing respiratory signs and a papular, crusted and ulcerative dermatitis involving mucosae. This diagnosis was supported by real‐time PCR positive for EHV‐1 on nasal swabs and tissues.     

Plasma concentration‐dependent suppression of endogenous hydrocortisone in the horse after intramuscular administration of dexamethasone‐21‐isonicotinate

Detection times and screening limits (SL) are methods used to ensure that the performance of horses in equestrian sports is not altered by drugs. Drug concentration–response relationship and knowledge of concentration–time profiles in both plasma and urine are required. In this study, dexamethasone plasma and urine concentration–time profiles were investigated. Endogenous hydrocortisone plasma concentrations and their relationship to dexamethasone plasma concentrations were also explored. A single dose of dexamethasone‐21‐isonicotinate suspension (0.03 mg/kg) was administered intramuscularly to six horses. Plasma was analysed for dexamethasone and hydrocortisone and urine for dexamethasone, using UPLC‐MS/MS. Dexamethasone was quantifiable in plasma for 8.3 ± 2.9 days (LLOQ: 0.025 μg/L) and in urine for 9.8 ± 3.1 days (LLOQ: 0.15 μg/L). Maximum observed dexamethasone concentration in plasma was 0.61 ± 0.12 μg/L and in urine 4.2 ± 0.9 μg/L. Terminal plasma half‐life was 38.7 ± 19 h. Hydrocortisone was significantly suppressed for 140 h. The plasma half‐life of hydrocortisone was 2.7 ± 1.3 h. Dexamethasone potency, efficacy and sigmoidicity factor for hydrocortisone suppression were 0.06 ± 0.04 μg/L, 0.95 ± 0.04 and 6.2 ± 4.6, respectively. Hydrocortisone suppression relates to the plasma concentration of dexamethasone. Thus, determination of irrelevant plasma concentrations and SL is possible. Future research will determine whether hydrocortisone suppression can be used as a biomarker of the clinical effect of dexamethasone.     

Laparoscopic‐assisted splenectomy in a horse with splenomegaly

This reports describes the surgical management of a horse evaluated for recurrent colic. These frequent colic episodes were attributed by exclusion to an abnormally enlarged spleen (idiopathic splenomegaly). Splenectomy was elected and performed with a laparoscopic assisted technique. The advantages observed by using this surgical approach were a clear view of the visceral aspect of the spleen and consequently an accurate dissection of the hilus of the spleen and associated vasculature. Ultimately the laparoscopic technique allowed the surgeons to reduce the size of the laparotomy incision required to remove the spleen and the overall invasiveness of the procedure. The horse recovered well from the procedure and ultimately returned to the previous level of competitiveness.     

Surgical treatment of a rostral mandibular complex odontoma in a 3‐year‐old horse

Complex odontomas are rare odontogenic tumours in horses comprised of a combination of mesenchymal and epithelial tissues. Examination, radiographic and histopathological findings in this patient all represent the typical behaviour of a complex odontoma. Oral tumours in horses may have treatment limitations due to tumour size and location. Similar to treatment in other species, surgical enucleation was curative for this type of tumour.     

Linac‐based stereotactic radiation therapy for canine non‐lymphomatous nasal tumours: 29 cases (2013‐2016)

Twenty‐nine dogs were treated with linac‐based stereotactic radiation therapy (SRT) for non‐lymphomatous nasal tumours. Only dogs with a follow‐up time >365 days were included in this retrospective analysis. No dogs had evidence of distant metastasis at diagnosis. Treatment was planned and a total of 30 Gy in 3 daily 10 Gy fractions was delivered using intensity‐modulation, cone‐beam CT‐based image guidance and a robotic treatment couch. Clinical signs improved in all cases. Nineteen dogs had CT scans 3‐4 months post‐SRT and all had partial or complete tumour response. Minimal acute toxicities were detected. Clinically significant late toxicities included oronasal or nasocutaneous fistulas (N = 3) and biopsy‐confirmed fungal rhinitis with no evidence of tumour progression (N = 2). The median progression‐free survival (PFS) was 354 days, with 49% and 39% progression‐free at 1 and 2 years post‐SRT, respectively. The median survival time (ST) was 586 days, with 69% and 22% alive 1 and 2 years post‐SRT, respectively. Neither the clinical parameters evaluated (modified Adams’ stage, histopathology, presence of intracranial extension of the tumour) nor dosimetric data were predictive for PFS or ST. This SRT protocol appears to be well tolerated, and PFI and ST are comparable or superior to those reported in other definitive‐intent radiotherapy protocols.     

Long‐term outcomes with conventional fractionated and stereotactic radiotherapy for suspected heart‐base tumours in dogs

Published radiotherapy results for suspected heart‐based tumours in dogs are limited. In this retrospective longitudinal study (3/2014‐2019), eight dogs with either clinical signs attributable to a heart‐base mass (6), or asymptomatic with a progressively larger mass on echocardiogram (2), received conventional fractionated radiotherapy (CFRT) or stereotactic body radiotherapy (SBRT). Clinical findings in symptomatic cases included one or more of the following: retching/coughing (4), exercise intolerance (2), collapse (1), pericardial effusion (2), rare ventricular premature contractions (2), abdominal effusion (1), or respiratory distress due to chylothorax (1). CFRT cases received 50 Gray (Gy) in 20 fractions and SBRT cases received 30 Gy in 5 or 24 Gy in three fractions. Two dogs received chemotherapy post‐radiation. At analysis, 7/8 dogs were deceased and one was alive 684 days post‐treatment. The estimated median overall survival (MOS) from first treatment was 785 days (95% CI 114‐868 days, [range 114‐1492 days]). Five dogs received CFRT (MOS 817 days; (95% CI 155 days‐not reached [range 155‐1492 days])). Three dogs received SBRT with one alive at analysis (MOS 414 days, (95% CI, 114 days‐not reached [range 114‐414 days])). No statistically significant difference was found between survival for CFRT and SBRT. Of the symptomatic patients, 5/6 showed improvement. Mass size reduced in 4/5 cases receiving follow‐up ultrasounds. Possible complications included asymptomatic radiation pneumonitis (4), atrial tachycardia/premature beats (4) and pericardial effusion with heart failure coincident with tumour progression (1). This study provides preliminary evidence that radiotherapy may impact clinically relevant or progressively enlarging heart‐base masses.     

True cementomas (cementoblastomas) associated with a nonvital left maxillary second premolar in an 11‐year‐old miniature horse

An 11‐year‐old miniature horse gelding presented for a left maxillary facial swelling and surgical removal of 2 ovoid mineralised masses located near the tooth roots of the left maxillary second and third premolars. Preoperative radiographs were performed to triangulate the location of the calcified masses for removal, and an oral examination revealed that the left maxillary second premolar was nonvital with multiple feed‐packed pulp exposures. Both the radiographs and oral examination indicated that the mineralised masses were associated with the nonvital second premolar. Therefore, the tooth was extracted intraorally, and the masses were removed via a maxillary trephine dorsal to the extracted tooth. Both masses were submitted for histopathology, which diagnosed the masses as true cementomas (cementoblastomas) with adenomatous hyperplasia of the surrounding nasal glandular tissue.     

Use of a chronic soft tissue expansion device to facilitate blepharoplasty in a horse with lower‐lid cicatricial ectropion with a 14‐year follow‐up

A 3‐year‐old Thoroughbred filly presented to a referral equine hospital for surgical correction of a severe cicatricial lateral lower eyelid ectropion OD, with secondary exposure keratitis. The severity of the ectropion deemed that conventional ectropion repairs would be unsuccessful. Therefore, a soft tissue expansion device was used to create sufficient local tissue for a rotational graft with tension‐relieving horizontal incisions to be performed to facilitate closure and acceptable eyelid apposition. The keratitis had resolved by two months postoperatively. There were no long‐term complications and only mild recurrence of the keratitis observed 14‐years postoperatively.     

Ultrasound‐guided lipoaspiration for mesenchymal stromal cell harvest in the horse

Mesenchymal stromal cells (MSC) are being used to treat a variety of conditions in the horse. Traditional lipectomy and bone marrow aspiration for MSC harvest have disadvantages including cosmetic issues with lipectomy and extensive time for cell expansion after bone marrow harvests. This article describes a new technique of adipose harvest in the horse, utilising ultrasound and liposuction that can be safely and effectively performed in an ambulatory environment. Ultrasound‐guided lipoaspiration offers a minimally invasive technique using small portals and a diffuse area of collection significantly improving aesthetic outcome and increasing the likelihood of treating within a matter of days vs. a matter of weeks.