Treatment of ischaemic jejunum with topical and intraluminal Carolina Rinse

Carolina Rinse Solution (CRS) was applied topically and intraluminally to ischaemic (Group 1; n = 5) and distended equine jejunum (Group 2; n = 5). Mesenteric blood flow, ORC (osmotic reflection coefficient), wet weight to dry weight ratios (WW/DW), serosal thickness, and neutrophil accumulation in the serosa were measured. After 60 min ischaemia followed by reperfusion (Group 1), mesenteric blood flow remained greater than baseline values. The mean ORC was similar to that previously reported in normal bowel or ischaemic intestine treated with CRS by arterial perfusion. The ORC after distention and decompression (Group 2) increased and was similar to that previously reported in a comparable untreated experimental model. The WW/DW after both ischaemia and distention increased compared to specimens collected from noninstrumented jejunum proximal to the experimental segments in the same horses. There was no difference in neutrophil numbers in the serosa of either ischaemic or distended intestine compared to the noninstrumented proximal jejunum. CRS-treated ischaemic intestine maintained microvascular permeability similar to that reported for normal intestine whereas treated distended intestine did not. Combined topical and intraluminal application of CRS to ischaemic intestine may reduce complications due to acute inflammation during reperfusion.     

Use of an extracorporeal circuit to evaluate effects of intraluminal distention and decompression on the equine jejunum

OBJECTIVE: To use an extracorporeal circuit to evaluate effects of intraluminal distention on the jejunum of healthy horses. SAMPLE POPULATION: 2 jejunal segments from each of 5 horses. PROCEDURE: Jejunal segments were harvested and maintained in an extracorporeal circuit. One segment was subjected to distention (intraluminal pressure, 25 cm H2O) followed by decompression, and 1 segment was maintained without distention. The influence of distention-decompression on vascular resistance was calculated. Mucosal permeability was evaluated by measuring the clearance of albumin from blood to lumen. After distention and decompression, tissue specimens were collected for histomorphologic evaluation. In addition, the contractile response of the circular smooth muscle layer was determined following incubation with 3 prokinetic agents. RESULTS: Intestinal vascular resistance increased during intraluminal distention and returned to baseline values after decompression. Albumin clearance rate increased after distention, compared with baseline and control values. Histologic examination of the distended segments revealed grade-1 and -2 lesions of the mucosal villus. Edema and hemorrhage were evident in the submucosa and muscular layers. Mesothelial cell loss, edema, and hemorrhage were also evident in the serosa. Mucosal surface area and villus tip height decreased and submucosal volume increased in the distended tissue. Compared with responses in control specimens, distention decreased the contractile response induced by cisapride, erythromycin, and metoclopramide. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention of the jejunum followed by decompression increased mucosal permeability and injury and decreased responses to prokinetic agents. Horses with intraluminal intestinal distention may have a decreased response to prokinetic agents.     

Effects of intraluminal distention and decompression on microvascular permeability and hemodynamics of the equine jejunum

OBJECTIVE: To determine whether intraluminal distention and subsequent decompression of the equine jejunum affects intestinal blood flow, hemodynamics, and microvascular permeability. ANIMALS: 5 healthy adu t horses. PROCEDURES: Horses were anesthestized and underwent exploratory laparotomy. Two jejunal segments were identified as sham-operated or instrumented segments. After baseline values were obtained, intraluminal distention was created in the experimental segment to induce an ntraluminal pressure of 18 cm H2O. After 120 minutes of distention, the intestine was decompressed for 120 minutes. Mesenteric blood flow, oxygen delivery, oxygen consumption, microvascular permeability, wet weight-to-dry weight ratio, neutrophil infiltration, and vascular resistance were determined and comparisons made among control, sham-operated, and experimental segments. RESULTS: Mean jejunal blood flow was 21.4 ml/min per kg. There was a significant decrease in mesenteric bood flow to the distended intestine (13.4 ml/min per kg). Blood flow increased significantly during the decompression period (340% of baseline blood flow). Intraluminal distention and subsequent decompression resulted in a significant increase in microvascular permeability, as determined by the osmotic reflection coefficient. Oxygen delivery and oxygen content decreased significantly during the distention period and increased during decompression. Morphologic evaluation revealed a significant increase in edema and neutrophil infiltration after distention and decompression, compared with results for the sham-operated or control segments. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention and decompression of the equine jejunum results in low-flow ischemia and edema, which may contribute to adhesions and ileus in the postoperative period after surgery for obstructions of the small intestines.     

Effect of intraluminal distention on microvascular perfusion in the equine small colon

OBJECTIVE: To determine the effect of experimental intraluminal distention on microvascular perfusion of the small colon in horses. ANIMALS: 6 mixed-breed healthy horses (mean age [+/- SDI, 9.1 +/- 2 years). PROCEDURE: Under general anesthesia, the small colon was exposed by celiotomy and 3 segments were demarcated. In 1 of these segments, intraluminal obstruction was created by placement of a latex balloon inflated to a pressure of 40 mm Hg (obstructed segment). The other segments were the sham-operated segment and the control segment. Microvascular perfusion was evaluated in the mucosal, submucosal, muscular, and serosal layers by injection of 15 microm-diameter colored microspheres into branches of the caudal mesenteric artery. Recovery of microspheres was performed by tissue digestion, washing, and centrifugation. Distribution of microspheres in the intestinal layers was evaluated by direct observation of stained frozen sections by light microscopy. RESULTS: A significant reduction was observed in total microvascular perfusion of obstructed segments, which was 26.4% of that of control segments. This reduction was not evident in the mucosal layer. CONCLUSIONS AND CLINICAL RELEVANCE: Intraluminal distention of the equine small colon wall can promote ischemia by a reduction in microvascular perfusion in the intestinal wall. Intestinal layers do not seem to be affected to the same extent, because the absolute value for mucosal perfusion did not decrease in the obstructed segment.     

Evaluation of sodium carboxymethylcellulose for prevention of experimentally induced abdominal adhesions in ponies

Twelve ponies were used to evaluate the reliability of an abdominal adhesion model and the efficacy of intraperitoneal infusion of sodium carboxymethylcellulose in preventing abdominal adhesions. A celiotomy was performed on each of the 12 ponies and the serosa of the distal portion of the jejunum was abraded with a dry gauze sponge at 5 locations. In addition to the serosal damage, a single 2-0 chromic gut suture was placed through the seromuscular layer of the jejunum in the center of the abraded area. After closure of the celiotomy, a 1% solution of sodium carboxymethylcellulose (7 ml/kg of body weight) was infused into the peritoneal cavity of 6 ponies. The other ponies served as untreated controls. All ponies were euthanatized 14 days after surgery. All ponies in the control group had abdominal adhesions at the time of necropsy. Four of the 6 ponies in the treatment group were free of adhesions. There was a significant (P less than 0.0001) difference in the total number of adhesions between the 2 groups.     

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).     

Local and remote lesions in horses subjected to small colon distension and decompression

The purpose of this study was to observe and characterize colonic and lung lesions in horses subjected to experimental distension and decompression of the small colon. Sixteen healthy adult horses were divided into 2 groups: 9 horses that were subjected to distension of the small colon by means of a latex balloon surgically implanted in the lumen and inflated to a pressure of 40 mm Hg for 4 h, and 7 horses in which the balloon was implanted but not inflated. Colonic biopsy specimens were collected before balloon implantation, at the end of the period of obstruction, and 1.5 and 12 h after decompression and were examined for hemorrhage, edema, and neutrophil infiltration; myeloperoxidase (MPO) activity and hemoglobin concentration were measured as well. At the end of the experiment, lung samples were also collected and examined for neutrophil accumulation and MPO activity. The mucosa was not affected by luminal distension; lesions were restricted to the seromuscular layer. Neutrophil accumulation and edema were observed in the samples from both groups of horses but were greater in those from the distension group, in which there was also hemorrhage, fibrin deposition, and increased MPO activity in the seromuscular layer. Similarly, there was greater accumulation of neutrophils in the lung samples from the distension group than in those from the sham-operated group, as determined by histologic evaluation and MPO assay. These findings provide new evidence of reperfusion injury and a systemic inflammatory response, followed by remote lesions, in horses with intestinal obstruction.     

The Serosal Patch Clinical Use in 12 Animals

Hollow viscus perforation and leakage were treated successfully in eight dogs by suturing the surface of a loop of healthy bowel over the leaking areas, forming a serosal patch. The technique also was employed in three dogs and one cat to reinforce areas of potential leakage in the urinary bladder, small intestine, and colon.
Healthy bowel serosa was used to seal perforations in both clean-contaminated and grossly infected visceral wounds. The serosal patch, with its muscular and submucosal reinforcing layers, resisted intraluminal pressure and proved successful in some animals where omental patching or wrapping had failed.     

Evaluation of Carolina Rinse solution as a treatment for ischaemia reperfusion of the equine jejunum

REASONS FOR PERFORMING STUDY: Ileus and peritoneal adhesions are the most common complications following surgery for small intestinal obstruction. Carolina Rinse (CR) has been shown to decrease reperfusion injury in intestine and other organs. HYPOTHESIS: CR decreases intestinal inflammation and subsequent scarring associated with reperfusion injury. METHODS: CR was infused intra-arterially and applied topically just prior to reperfusion in jejunum exposed to experimental ischemia. Vascular permeability, neutrophil accumulation and serosal scarring were compared in treated and untreated intestine. RESULTS: CR maintained a normal osmotic reflection coefficient and decreased migration of neutrophils into the serosa during reperfusion. After 10 days, treated intestine was normal in appearance with a trend toward less serosal scarring and fibroblast proliferation. There was a significant decrease in fibroplasia at biopsy sites in treated intestine. CONCLUSIONS: Arterial perfusion combined with topical application of CR during jejunal ischaemia decreases immediate reperfusion injury and limits post operative scarring. POTENTIAL RELEVANCE: CR should be used as a local perfusate rather than a systemic treatment; it may best be applied topically and intraluminally to avoid damaging mesenteric arteries. CR should be considered an adjunct treatment as part of overall surgical management and post operative care.     

EVALUATION OF THE GASTROINTESTINAL TRACT IN DOGS USING COMPUTED TOMOGRAPHY

Abdominal computed tomography (CT) studies of 19 dogs with no history or clinical signs of gastrointestinal disease, and two dogs with a histological diagnosis of gastrointestinal neoplasia were examined retrospectively. Gastrointestinal segments were evaluated subjectively for conspicuity, contrast enhancement, and wall layering after contrast medium administration. In dogs without gastrointestinal disease, there were 62.8% of gastrointestinal segments (serosa to serosa) and 77.7% of gastrointestinal walls (serosa to mucosa) visualized. Wall layering on postcontrast images was seen in 21.8% of gastrointestinal segments. There was significant association between gastrointestinal diameter and wall thickness. There was significant association between weight and gastrointestinal wall thickness in the following regions: gastric fundus, gastric body, gastric pylorus, gastric pyloric antrum, duodenal cranial flexure, jejunum and ascending colon, and between patient weight and gastrointestinal diameter in cranial duodenal flexure, descending duodenum, transverse duodenum, ascending duodenum, and jejunum. Measurements acquired from CT studies correlated well with previously published normal reference ranges for radiographic and ultrasonographic studies. Gastrointestinal neoplasia, diagnosed in two dogs, had a gastrointestinal wall thickness greater than the range of the dogs without gastrointestinal disease. Computed tomography offers identification of the gastrointestinal tract segments in dogs, allows for evaluation of gastrointestinal diameter and aids in investigation of gastrointestinal wall thickness.     

Electromyographic, myomechanical, and intraluminal pressure changes associated with acute extraluminal obstruction of the jejunum in conscious ponies

Bipolar electrodes, strain gauge force transducers, intraluminal pressure recording catheters, and extraluminal intestinal obstructors were surgically implanted in 4 ponies to record myoelectrical and mechanical activity of the distal portion of the jejunum and ileum. After determining normal intestinal activity and pressures, the distal portion of the jejunum was obstructed with an extraluminal obstructor. Myoelectrical and mechanical activity recorded from jejunal segments proximal to the obstruction increased significantly (P less than 0.01), whereas activity distal to the obstruction remained unchanged. Intraluminal pressure increases were recorded during periods of intestinal spasm. Obstruction pressures remained unchanged from preobstruction pressures.     

Use of an isolated intestinal circuit to evaluate the effect of ischemia and reperfusion on mucosal permeability of the equine jejunum

OBJECTIVES: To evaluate the efficacy of an isolated perfusion circuit and the effect of ischemia-reperfusion on mucosal permeability of the jejunum. STUDY DESIGN: In vitro study of intestinal mucosal permeability. ANIMALS: Twelve healthy adult horses. METHODS: A control segment of jejunum was placed in an isolated perfusion circuit for 240 minutes and mucosal permeability was measured. After detecting no deleterious effects of the isolated system on the control intestine, low flow ischemia was created in experimental segments for 20, 40, 60 and 90 minutes followed by 60 minutes of reperfusion and mucosal permeability was evaluated. At the completion of the studies, histologic evaluation was used to determine mucosal grades, surface area, and volume. RESULTS: Control tissue was maintained in the isolated circuit for 240 minutes without effect on mucosal grade, surface area, or volume relative to intact tissue. After ischemia-reperfusion, mucosal grade increased, and volume and surface area decreased progressively with longer periods of ischemia. Mucosal clearance of albumin remained constant during 240 minutes of perfusion in control tissue and was elevated after ischemia-reperfusion. CONCLUSIONS: No deleterious changes were noted in jejunum perfused with this isolated circuit, whereas alterations in mucosal permeability were present after ischemia-reperfusion. CLINICAL RELEVANCE: The isolated perfusion circuit successfully maintained an isolated segment of jejunum within physiologic limits, and can be used to evaluate the effects of injury and the efficacy of pharmaceuticals to attenuate these changes.     

Effects of Carolina rinse solution, dimethyl sulfoxide, and the 21-aminosteroid, U-74389G, on microvascular permeability and morphology of the equine jejunum after low-flow ischemia and reperfusion

OBJECTIVE: To evaluate effects of Carolina rinse solution, dimethyl sulfoxide (DMSO), and 21-aminosteroid, U-74389G, on microvascular permeability and morphology of the equine jejunum after low-flow ischemia and reperfusion. ANIMALS: 20 healthy adult horses. PROCEDURE: Under anesthesia, full-thickness biopsy specimens of a distal portion of the jejunum were obtained for baseline measurements. In addition to a control segment, 2 jejunal segments were identified as sham-operated or experimental segments. Experimental segments underwent 60 minutes of low-flow ischemia and 3.5 hours of reperfusion. Treatments were as follows: U-74389G (3 mg/kg, IV; 6 horses), DMSO (20 mg/kg, IV; 6) diluted in 1 L of saline (0.9% NaCl) solution, local perfusion (via jejunal artery) of Carolina rinse solution (0.5 mL/kg; 4), and local perfusion of lactated Ringer's solution (0.5 mL/kg; 4). RESULTS: Jejunal microvascular permeability was significantly lower after treatment with Carolina rinse solution or DMSO, compared with U-74389G or lactated Ringer's solution treatments. After DMSO treatment, serosal- and submucosal-layer edema was significantly increased in experimental segments, compared with control or sham-operated segments; however, edema increases were significantly less than for lactated Ringer's solution or U-74389G treatments. Significant decreases in intestinal wet weight-to-dry weight ratio were found following Carolina rinse solution or DMSO treatments, compared with lactated Ringer's solution or U-74389G treatments. Edema formation and leukocyte infiltration in jejunal segments of horses treated with lactated Ringer's solution or U-74389G were increased, compared with Carolina rinse solution or DMSO treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Carolina rinse solution and DMSO may be protective against ischemia-reperfusion injury in the equine jejunum.     

Fibrinolytic Responses of the Equine Peritoneum to Abdominal Surgery,Surgical Trauma,and Intraperitoneal Sodium Hyaluronate

Postoperative abdominal adhesions are known to present clinical challenges to the surgeon. Adhesion formation is a balance modulated by the fibrinolytic system. The key components involved are the tissue plasminogen activators (tPAs) and plasminogen activator inhibitors (PAI-1 and PAI-2). Sodium hyaluronate (HA) has been shown to reduce the incidence and severity of adhesions in horses. The objectives of this study were to measure tPA and PAI-1 activity in equine peritoneum and evaluate the effect of 0.4% HA solution on local tPA and PAI-1 activity. An exploratory laparotomy was performed and local serosal trauma was induced by using an established abrasion model. Our study involved two groups: in the first group (n = 6) 0.4% HA was used in all intestinal manipulations, whereas in the second group (n = 6) sterile saline was used. Parietal peritoneum, jejunal seromuscular biopsies at abraded sites (AJ) and nonabraded sites, and peritoneal fluid samples were taken at time 0- and at 30-minute intervals up to 120 minutes. Peritoneum tPA activity was significantly decreased at 60 and 90 minutes. Interestingly, AJ contained significantly higher tPA activity than nonabraded sites at 30-, 60-, 90-, and 120-minute intervals in control horses. The increase in tPA activity with AJ in treated (HA) horses was significantly attenuated as compared with the control (saline). Detectable levels of PAI-1 activity could not be identified in our samples. The results of our study indicate that exploratory celiotomy in horses is associated with a significant decrease in peritoneal tPA activity, and HA significantly decreases the fibrinolytic response of the jejunum to surgical trauma. Further characterization of these responses will hopefully lead to new pharmacologic strategies for adhesion prevention.     

Expression of the ether-a-go-go (ERG) potassium channel in smooth muscle of the equine gastrointestinal tract and influence on activity of jejunal smooth muscle

OBJECTIVE: To determine whether ether-a-go-go (ERG) potassium channels are expressed in equine gastrointestinal smooth muscle, whether ERG channel antagonists affect jejunal muscle contraction in vitro, and whether plasma cisapride concentrations in horses administered treatment for postoperative ileus (POI) are consistent with ERG channels as drug targets. SAMPLE POPULATION: Samples of intestinal smooth muscle obtained from 8 horses free of gastrointestinal tract disease and plasma samples obtained from 3 horses administered cisapride for treatment of POI. PROCEDURE: Membranes were prepared from the seromuscular layer of the duodenum, jejunum, ileum, cecum, large colon, and small colon. Immunoblotting was used to identify the ERG channel protein. Isolated jejunal muscle strips were used for isometric stress response to ERG channel blockers that included E-4031, MK-499, clofilium, and cisapride. Plasma concentrations of cisapride were determined in 3 horses administered cisapride for treatment of POI after small intestinal surgery. RESULTS: Immunoblotting identified ERG protein in all analyzed segments of the intestinal tract in all horses. The selective ERG antagonist E-4031 caused a concentration-dependent increase in jejunal contraction. Clofilium, MK-499, and cisapride also increased jejunal contraction at concentrations consistent with ERG channel block; effects of E-4031 and cisapride were not additive. Peak plasma cisapride concentrations in treated horses were consistent with ERG block as a mechanism of drug action. CONCLUSIONS AND CLINICAL RELEVANCE: The ERG potassium channels modulate motility of intestinal muscles in horses and may be a target for drugs. This finding may influence development of new prokinetic agents and impact treatment of horses with POI.     

The pathophysiology of intestinal damage: effects of luminal distention and ischemia

Intestinal edema, luminal distention, and ischemia are common pathologic processes involved in producing the intestinal damage found during surgical exploration for acute abdominal disorders in the horse. The severity of intestinal edema depends on the degree of altered intravascular forces and changes in capillary permeability. Capillary hydrostatic pressure rises as the less pliable venules and veins become occluded during intestinal obstruction. Concurrently, the production of various endogenous products that damage the vascular wall leads to increases in capillary permeability and protein exudation, causing fluid movement into the interstitium and consequent tissue edema. The information presently available indicates that luminal distention does not produce the morphologic damage observed during natural conditions. However, slight intestinal edema was observed with experimental distention of the equine small intestine. Although the effects of increased luminal pressure appear minor, in the overall scheme of intestine damage, many processes are occurring together, and the luminal distention may be additive in the production of intestinal damage. The intestinal damage occurring during natural obstructions is most likely related to both the severity of the ischemia and the subsequent reperfusion injury. Experimentally, an ischemic insult produces a consistent sequence of mucosal alterations to both the equine small and large intestine. Severity of ischemia may be the limiting factor in determining the clinical outcome in cases in which the ischemic insult is irreversible; however, if the intestinal tissue survives the ischemia, the reperfusion injury may substantially increase the damage, producing an irreversible injury. The proposed mechanisms responsible for the reperfusion injury include the presence of highly reactive cytotoxic oxygen radicals. The intestinal epithelium and vascular endothelium are both capable of producing these unstable compounds. Secondly, the influx and activation of neutrophils may also release oxygen radicals. During experimental ischemia, neutrophils gradually move to the affected area; however, during reperfusion their numbers dramatically increase and may play a significant role in producing intestinal damage. Therapy for intestinal damage involves first determining the viability of the affected intestine. All nonviable bowel should be resected and viable intestine anastomosed. The care and maintenance of intestine of questionable viability are presently based on therapy in humans and experimental information concerning the pathophysiologic mechanisms of intestinal ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)     

Effect of a leukocyte-depleting filter in an extracorporeal circuit used for low-flow ischemia and reperfusion of equine jejunum

OBJECTIVE: To determine effect of leukocyte depletion on hematologic, morphologic, and metabolic variables of equine jejunum after induction of arterial low-flow ischemia and reperfusion by use of an extracorporeal circuit. ANIMALS: 14 healthy adult horses. PROCEDURE: A segment of jejunum was surgically removed and maintained in an isolated circuit for 3 hours (control group), arterial flow was reduced to 20% of baseline for 40 minutes followed by 1 hour of reperfusion (low-flow group), or leukocyte depletion was filter-induced, and low-flow ischemia and reperfusion were conducted as in the low-flow control group (filter-treated group). Various metabolic, hemodynamic, and histomorphologic variables were evaluated, including effects of electrical field stimulation and L-N-nitro-arginine-methyl-ester (L-NAME) on contractile activity. RESULTS: The extracorporeal circuit appeared to maintain the jejunum within physiologic limits for an extended period. Low-flow ischemia with reperfusion induced significant differences in various measurements, compared with control specimens. Significant differences were not detected between the low-flow and filter-treated groups. Myeloperoxidase activity was greater in the low-flow group than the control group, whereas a difference was not detected between control and filter-treated groups. CONCLUSIONS AND CLINICAL RELEVANCE: The extracorporeal circuit maintained intestine for 3 hours in a physiologic state and may be used for simulation of tissue injury. Leukocyte depletion generally did not attenuate the effects of low-flow ischemia and reperfusion on equine small intestine.     

Post operative neutrophilic inflammation in equine small intestine after manipulation and ischaemia

REASONS FOR PERFORMING STUDY: Post operative ileus (POI) remains an important cause of post operative morbidity and mortality in the horse. However, clinical progression of naturally occurring cases of POI in both horse and man does not entirely support the 'neurogenic' hypothesis as the sole mechanism of POI; and the hypothesis that inflammation plays a major role at 12-24 h after surgery requires validation. HYPOTHESIS: An inflammatory infiltrate in the muscularis externa and myenteric plexus of equine jejunum is present 18 h following a period of ischaemia. METHODS: Samples of normal jejunum, jejunum from the proximal resection margins of clinical cases and jejunum obtained 18 h after 1 or 2 h ischaemia or manipulation alone were evaluated for neutrophil infiltration. Samples obtained 18 h after surgery were additionally evaluated for leucocyte activation using calprotectin immunohistochemistry. Results were evaluated by ANOVA and P < 0.05 was considered significant. RESULTS: Significant neutrophilic inflammation was identified in the samples from the proximal resection margins of clinical cases compared to uninjured jejunum. In experimental cases, neutrophilic inflammation appeared to be increased further by 18 h and was identified through all intestinal layers, particularly in the serosa, fascial planes around circular and longitudinal muscle fibres, and myenteric plexus. This elevated level of neutrophilic inflammation was mirrored by an increased number of calprotectin-positive cells in these intestinal layers, indicating leucocyte activation. CONCLUSIONS: Significant neutrophilic inflammation occurs in equine jejunal myenteric layers 18 h after surgery. POTENTIAL RELEVANCE: This neutrophilic inflammation coincides with the clinical time point at which POI is identified and may indicate that inflammatory pathways, rather than solely neurogenic pathways, are responsible for POI in the horse.     

Crystalloids versus colloids: implications in fluid therapy of dogs with intestinal obstruction

Responses of jejunal transcapillary and transmucosal fluid fluxes to IV infusion of crystalloid or colloid solutions were evaluated in 12 dogs. One isolated intestinal segment in each dog was used as the control segment, and 2 segments were distended to a intraluminal hydrostatic pressure of 10 cm of H2O. The artery supplying 1 of the 2 distended (autoperfused) segments was cannulated and perfused with blood from the femoral artery. One of the 2 distended segments was autoperfused from the femoral artery. Intraluminal pressure was increased in the autoperfused segment and in 1 other segment for three, 20-minute periods after administration of the crystalloid or colloid solution. Net transmucosal fluid flux was estimated, using a volume recovery method. In each autoperfused segment, blood flow, capillary pressure, lymph flow, and plasma protein and lymph protein concentrations were measured during each 20-minute distention period. Systemic arterial pressure was monitored throughout the procedure. Plasma and tissue oncotic pressures were calculated from the plasma protein and lymph protein concentrations. Total vascular resistance and precapillary and postcapillary resistances were determined. Capillary pressure increased after infusion with colloids and crystalloids, with the effects being more prolonged in the colloid group. Plasma oncotic pressure transiently increased after infusion with colloids and decreased after infusion with crystalloids. Lymph flow increased only in crystalloid-treated dogs. Due to alterations in transcapillary fluid filtration, crystalloids induced a net loss of fluid into the intestinal lumen, whereas the fluid absorptive capacity of the jejunum was unaltered by colloid treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

In vitro evaluation of a customized solution for use in attenuating effects of ischemia and reperfusion in the equine small intestine.

OBJECTIVE: To determine whether a customized solution could attenuate the effects of low-flow ischemia and reperfusion injury of the equine jejunum. SAMPLE POPULATION: A segment of jejunum obtained from 21 healthy adult horses. PROCEDURE: A segment of jejunum was maintained in an isolated extracorporeal circuit, and arterial flow was reduced to 20% of baseline for 40 minutes (ischemia) followed by 60 minutes of reperfusion. In 1 group, a customized solution was infused at a rate of 1 ml/min during low-flow ischemia and 3 ml/min during reperfusion. In a second group, the solution was infused at the same rate during low-flow ischemia, but it was infused at a rate of 7 ml/min during reperfusion. Control groups received lactated Ringer's solution administered at the same rates as for the customized solution. Various metabolic, hemodynamic, histologic, and permeability variables were recorded. RESULTS: A lower flow rate during reperfusion (3 ml/min) had a beneficial effect, compared with lactated Ringer's solution or the higher flow rate (7 ml/min). Use of the solution at this rate resulted in less histomorphologic injury and reduced mucosal permeability to albumin. CONCLUSIONS AND CLINICAL RELEVANCE: Use of a customized solution at a lower flow rate during repurfusion appeared to have a protective effect on equine jejunum when administered IV during low-flow ischemia and reperfusion.