Type 2 diabetes mellitus with pancreatic β cell dysfunction in 3 horses confirmed with minimal model analysis

Reasons for performing study: Type 2 diabetes mellitus (T2DM) is diagnosed rarely in equine practice although it may be under‐recognised. A greater awareness of the condition and therapeutic considerations would be to the benefit of such cases presenting in practice. More investigation into the pharmacological management of these cases is needed. Objectives: Three cases of diabetes mellitus were investigated using a specific test for insulin sensitivity and pancreatic β cell function in order to define accurately and characterise the existence of T2DM in all 3 subjects. Methods: The insulin‐modified frequently sampled i.v. glucose tolerance test was performed in each case and the data so obtained were subject to minimal model analysis of insulin‐glucose dynamics. Cases were then monitored following treatment using a combination of dietary modification, metformin, glibenclamide and pergolide. Results: Marked insulin resistance was identified in each case and, furthermore, severe pancreatic β cell dysfunction was present therefore classifying each case as end stage T2DM. Treatment was nevertheless associated with restoration of normoglycaemia in all cases. Conclusions: T2DM in horses may be more common than generally considered. In some cases individuals may respond to therapy aimed at restoring insulin sensitivity and pancreatic function. Drugs used in other species for the treatment of T2DM have not yet been adequately tested in horses. Potential relevance: T2DM should be considered as an important differential diagnosis in mature to elderly horses and ponies suffering from weight loss, polydipsia and polyuria. Clinicians should be encouraged to offer treatment and management advice when such cases are encountered.     

Effect of Tibial Plateau Leveling Osteotomy on Femorotibial Contact Mechanics and Stifle Kinematics

Objective— To evaluate the effects of tibial plateau leveling osteotomy (TPLO) on femorotibial contact mechanics and 3-dimensional (3D) kinematics in cranial cruciate ligament (CrCL)-deficient stifles of dogs.
Study Design— In vitro biomechanical study.
Animals— Unpaired pelvic limbs from 8 dogs, weighing 28–35 kg.
Methods— Digital pressure sensors placed subjacent to the menisci were used to measure femorotibial contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. Three-dimensional static poses of the stifle were obtained using a Microscribe digitizing arm. Each specimen was tested under normal, CrCL-deficient, and TPLO-treated conditions. Repeated measures analysis of variance with a Tukey post hoc test ( P <.05) was used for statistical comparison.
Results— Significant disturbances to all measured contact mechanical variables were evident after CrCL transection, which corresponded to marked cranial tibial subluxation and increased internal tibial rotation in the CrCL-deficient stifle. No significant differences in 3D femorotibial alignment were observed between normal and TPLO-treated stifles; however, femorotibial contact area remained significantly smaller and peak contact pressures in both medial and lateral stifle compartments were positioned more caudally on the tibial plateau, when compared with normal.
Conclusion— Whereas TPLO eliminates craniocaudal stifle instability during simulated weight bearing, the procedure fails to concurrently restore femorotibial contact mechanics to normal.
Clinical Relevance— Progression of stifle osteoarthritis in dogs treated with TPLO may be partly the result of abnormal stifle contact mechanics induced by altering the orientation of the proximal tibial articulating surface.     

Influence of Cholinergic Blockade on the Development of Epinephrine-Induced Ventricular Arrhythmias in Halothane- and Isoflurane-Anesthetized Dogs

The arrhythmogenic effects of anesthetic drugs are assessed using the arrhythmogenic dose of epinephrine (ADE) model. The purpose of this study was to determine the influence of cholinergic blockade (CB) produced by glycopyrrolate (G) on ADE in 1.5 minimum alveolar concentration (MAC) halothane (H)- and isoflurane (I)-anesthetized dogs. Eight dogs (weighing between 12.5 and 21.5 kg) were randomly assigned to four treatment groups (H, HG, I, and IG) and each treatment was replicated three times. Anesthesia was induced and maintained with H (1.31%, end-tidal [ET]) or I (1.95%, ET) in oxygen. Ventilation was controlled (carbon dioxide [PCO₂] 35 to 40 mmHg, ET). G was administered 10 minutes before ADE determination at a dose of 22 μg/kg (11 μg/kg, intravenous [IV] and 11 μg/kg, intramuscular [IM]). The ADE was determined by IV infusion of epinephrine at sequentially increasing rates of 1.0, 2.5, and 5.0 μg/kg/min; and defined as the total dose of epinephrine producing at least four ectopic ventricular contractions (EVCs) within 15 seconds during a 3-minute infusion and up to 1 minute after the end of the infusion. Total dose was calculated as the product of infusion rate and time to arrhythmia. Data were analyzed using a randomized complete block analysis of variance. When significant (P < .05) F values were found a least significant difference test was used to compare group means. Values are reported as means ± standard error. The ADE (μg/kg) for H, HG, I, and IG were 1.53 ± 0.08, 3.37 ± 0.46, 1.61 ± 0.21, and > 15.00, respectively. Heart rates (HRs) (beats/min) and systolic pressures (mmHg) at the time of arrhythmia formation for H, HG, I, and IG were (60.3 ±4.0 and 142.0 ± 7.6), (213.0 ± 13.1 and 239.2 ± 7.1), (62.9 ± 4.5 and 151.9 ± 6.3), and (226.3 ± 6.1 and 323.5 ± 3.4), respectively. The H and I ADE were not different. The HG ADE was significantly less than the IG ADE. The H and I ADE were significantly less than the HG and IG ADE. We conclude the following from the results of this study of epinephrine infusion in halothane- and isoflurane-anesthetized dogs: (1) two distinct mechanisms are responsible for the development of arrhythmias, (2) CB produced by G significantly increases ADE but is associated with higher rate pressure products (RPP) and myocardial work, and (3) ADE methodology could be improved by determining ADE with and without CB.     

Use of Isobutyl-Cyanoacrylate Adhesive in Osteosynthesis A Preliminary Study

Isobutyl 2-cyanoacrylate was used to reattach partial-thickness cortical bone fragments from the femur in rabbits. Stability, apposition, callus formation, and inflammation around the fragments were evaluated at 2, 4, 8, and 12 weeks.
All glued bone fragments were stable, compared with 85% of controls. Good apposition was achieved in 95% of the glued bone fragments, compared with 19% of the controls. Analysis of the mean scores for callus formation revealed a significant difference only in the 8 week survival group.
Bony union was noted in 20 of 21 of the glued fragments. No evidence of inflammation was seen around the glue, and viable bone was seen adjacent to the adhesive in many sections. In control legs, 13 fragments had healed by osseous union, two by fibrous union, and in six the chip had resorbed.     

Effects of Halothane, Enflurane, and Isoflurane on Supraventricular and Ventricular Rate in Dogs With Complete Atrioventricular Block

Complete atrioventricular (AV) block was produced in 32 chloralose-anesthetized autonomically intact dogs to determine the effects of halothane, enflurane, and isoflurane on supraventricular and ventricular rate. Halothane (n = 17), enflurane (n = 6), and isoflurane (n = 9) were administered in three separate experiments in sequential minimum alveolar concentration (MAC) multiples of 0.5, 1.0, 1.5, 2.0, 1.5, and 1.0. Supraventricular rate, ventricular rate, and mean arterial blood pressure (MAP) were measured and recorded at baseline and after a 20-minute equilibration period of each inhalation anesthetic at each MAC multiple. Increasing concentrations of enflurane and isoflurane significantly decreased supraventricular rate ( P < .05). Ventricular rate was not significantly changed by sequential MAC multiples of halothane, enflurane, and isoflurane. Increasing concentrations of halothane, enflurane, and isoflurane significantly decreased MAP with enflurane producing the most significant decrease ( P < .05). Ventricular arrhythmias occurred in 5 of 17 dogs anesthetized with halothane and 1 of 9 dogs anesthetized with isoflurane. Inhalation anesthesia can significantly decrease supraventricular rate and MAP, does not alter ventricular rate, and can produce ventricular arrhythmias in dogs with complete AV block.     

Penetration of the small intestine by an unusual foreign body resulting in colic in a horse: A case report

A nine-year-old Arabian gelding was evaluated for acute abdominal pain. Based on clinical signs and the results of the diagnostic work-up, surgical exploration of the abdominal cavity was performed. An adhesion was found involving a section of jejunum, its mesentery, and the omentum. Passage of gas and/or ingesta was obstructed at that point. On closer examination of the involved bowel, a porcupine quill which had perforated throught the intestinal wall from the lumen was identified. This was believed to have been the inciting cause for the formation of the adhesion and subsequent intestinal obstruction.     

Comminuted First Phalanx Fractures in 30 Horses: Surgical vs. Nonsurgical Treatments

Comminuted first phalanx fractures were diagnosed in 30 horses. One leg was involved in each horse. Five horses were presented with open fractures. Nine horses had a portion of intact cortex (strut) extending from the proximal to distal joint. Ten horses were euthanized, including one with an open fracture, without treatment. The remaining 20 horses were treated by open reduction with a neutralization plate (8 horses, including one with an open fracture), open reduction with lag screw fixation (3 horses), lag screw fixation through stab incisions (2 horses), external coaptation with a cast (3 horses), and external skeletal fixation using a weight supporting shoe (4 horses, including 3 with open fractures).
Thirteen horses were euthanized following treatment because of persistent infection (9), chronic lameness (2), and third metacarpal bone fractures (2). Seven horses survived longer than 1 year after treatment. Six were lame and used as breeding animals, and one horse went on to race successfully. All four horses with open fractures that were treated were subsequently euthanized.
Significantly more horses with an intact strut of bone survived after treatment (4 of 7 [57%]) when compared to horses without an intact strut of bone that were treated (3 of 13 [23%]) (p < 0.05).
Invasive surgical approaches used for the repair of comminuted first phalanx fractures in this study were associated with an unacceptable infection rate (55%). Techniques involving less trauma to the compromised soft tissue around the fracture should afford a better chance for a successful outcome.