A long-term study of apicoectomy and endodontic treatment of apically infected cheek teeth in 12 horses

The aim of this study was to evaluate the long-term results of apicoectomy and retrograde endodontic treatment in 12 horses with apical cheek teeth infections. The affected apices were removed using a diamond bur mounted on a dental drill, and after pulp removal the root canals were filed with Hedstrøm files and then alternately flushed with sodium hypochlorite, hydrogen peroxide and alcohol. The pulp canals were dried and filled with endodontic cement and gutta-percha points. An undercut was made in the apical aspect of the root canals that were then sealed with self-curing glass ionomer cement.Follow up information was obtained 38–67 months following treatment and indicated that the treatment had been successful in 7/12 horses (58%), partially successful in 2 horses (17%) and unsuccessful in 3 (25%). With good case selection, apicoectomy can preserve a proportion of apically infected cheek teeth. The use of advanced imaging techniques and improved surgical techniques could increase the success rate.     

Recovery of horses from general anesthesia in a darkened or illuminated recovery stall

ObjectiveTo assess whether recovery from general anesthesia, in an illuminated or a darkened stall, has an effect on time to first movement, time to standing, and recovery score.Study designProspective randomized clinical study.AnimalsTwenty-nine healthy, 2- to 5-year-old horses undergoing surgical correction of dorsal displacement of the soft palate.MethodsEach horse was assigned randomly to recover in either an illuminated (n = 15) or a darkened stall (n = 14). For pre-anesthetic medication, all horses received intravenous (IV) xylazine (0.4 mg kg⁻¹) and butorphanol (0.02 mg kg⁻¹). Anesthesia was induced with midazolam (0.1 mg kg⁻¹) and ketamine (2.2 mg kg⁻¹) IV and maintained on isoflurane in oxygen. Vital parameters, end-tidal CO₂ and isoflurane were recorded at 5-minute intervals. At the conclusion of anesthesia, horses were placed in either an illuminated or a darkened stall and xylazine (0.2 mg kg⁻¹) IV was administered at extubation. Video cameras were used to record the horses while they were allowed to recover undisturbed. Video recordings were later viewed and recoveries were evaluated on a 100-point scale by three graders.ResultsHorses in illuminated and darkened recovery stalls were evaluated on total anesthesia time, minimum alveolar concentration hours of isoflurane, time to first movement, time to standing, and total recovery score. There were no significant differences between the two groups in any of the measured parameters.ConclusionRecovering horses in a darkened versus an illuminated recovery stall may provide no benefit.Clinical relevanceDarkening the recovery stalls for horses recovering from general anesthesia may be unnecessary.     

Use of the advanced micro-osmometer model 3300 for determination of a normal osmolality and evaluation of different formulas for calculated osmolarity and osmole gap in adult dogs

Objective: To determine a reference interval of whole blood and plasma osmolalities for dogs using the Advanced Micro Osmometer Model 3300, to compare calculated osmolarity to measured osmolality, to determine a reference osmole gap, and to determine the best formula for calculated osmolaity. Design: Prospective, observational. Setting: Tertiary referral and teaching hospital. Animals: One hundred healthy adult dogs. Interventions: None. Measurements: Serum and whole blood biochemistry and osmolality assessments. Results: The mean and median of the measured whole blood osmolality were 323 and 320 mOsm/kg, respectively, with a standard deviation of 13.2 mOsm/kg. The mean and median of the measured plasma osmolality were 313 and 310 mOsm/kg, respectively, with a standard deviation of 13.2 mOsm/kg. The formula that was closest to predicting the measured whole blood and plasma osmolality was ((1.86(Na+K))+(BUN/2.8)+(Glucose/18))/0.93 followed closely by the traditional formula of (2(Na+K))+(BUN/2.8)+(Glucose/18). The mean calculated osmolarities using these formulas were 314.1 and 313.25 mOsm/L, respectively. The mean osmole gap using these formulas was 3.49 and 4.41 mOsm, respectively, for whole blood and ?2.01 and ?1.1 mOsm, respectively, for plasma. Conclusion: The Advanced Micro Osmometer Model 3300 was successful in measuring the osmolality in relative agreement with the current published reference intervals for osmolality. Measured osmolality correlated well with traditional calculated osmolarity.     

Association of hyperlactatemia with age,diagnosis, and survival in equine neonates

Objective – To investigate the association between blood lactate concentration, measured at admission and following 12–36 hours of treatment, and age, diagnosis, and survival in neonatal foals. Design – Retrospective, observational study. Setting – Two equine referral hospitals. Animals – One hundred and twelve foals ≤96 hours of age were included. Interventions – Arterial or venous blood samples were obtained from all foals at admission and surviving foals at 12–36 hours. Measurements – The lactate concentration (LAC) was recorded at 2 time points: admission (LAC‐Admission) and 12–36 hours following treatment (LAC‐24 hours). Main Results – LAC decreased by 0.05 mmol/L for each increased hour of age at presentation. Premature/dysmature foals demonstrated increased odds of nonsurvival of 55% for each 1 mmol/L increase in LAC‐Admission while foals with major diagnoses of neonatal encephalopathy (NE), enteritis and ‘Other’ had increased odds of nonsurvival of 52%, 113%, and 247%, respectively, for each 1.0 mmol/L increase in LAC. Blood‐culture positive foals had significantly lower LAC than blood culture negative foals. LAC‐Admission and LAC‐24 hours were significantly larger in nonsurviving foals. LAC‐Admission of >6.9 mmol/L and LAC‐24 hours >3.2 mmol/L, respectively, correctly classified 85.6% and 94.1% of cases as survivors or nonsurvivors. No differences were found when the 24‐hour change in LAC was investigated in terms of outcome, age at admission, or major diagnosis; however, LAC‐24 hours remained significantly associated with survival. Conclusions – Admission or persistent hyperlactatemia is associated with a nonsurvival. Younger foals, premature/dysmature foals, and foals with neonatal encephalopathy had the largest LAC.     

Cardiac troponins

Objective: To review the use of cardiac troponins as biomarkers for myocardial injury in human and veterinary medicine. Data sources: Data sources included scientific reviews and original research publications. Human data synthesis: Cardiac troponins have been extensively studied in human medicine. Finding an elevated cardiac troponin level carries important diagnostic and prognostic information for humans with cardiovascular disease. Troponin assays are used primarily to diagnose acute myocardial infarction in patients with ischemic symptoms such as chest pain. However, elevated blood levels may be found with any cause of myocardial injury. Veterinary data synthesis: Several studies have shown that cardiac troponins are sensitive and specific for myocardial damage in veterinary patients and may have utility in diagnosis and prognosis for certain disease states. Human assays may be used in most animals due to significant homology in the troponin proteins between species. Conclusions: Cardiac troponins are sensitive and specific markers of myocardial injury although they do not give any information regarding the mechanism of injury. They have redefined how acute myocardial infarction is diagnosed in humans. Their use in the clinical management of veterinary patients is limited at this time. Further prospective studies are warranted.     

Intestinal surgery in small animals: historical foundations,current thinking,and future horizons

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra‐abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.     

Evaluating the public health response to a mass bat exposure—Wyoming, 2017

Mass bat exposures (MBEs) occur when multiple people are exposed to a bat or a bat colony, often over an extended period. In August 2017, a public health investigation was started in response to an MBE that occurred during May–August 2017 at a national park research station in Wyoming. We identified 176 people who had slept primarily in two lodges (Lodges A and B) at the research station, and successfully contacted 165 (93.8%) of these individuals. Risk assessments (RAs) were administered to all 165 individuals to determine degree and type of exposures to bats (e.g., biting or scratching). Exposure status for research station guests was classified as “non‐exposed,” “low risk” or “high risk,” and counselling was provided to guide post‐exposure prophylaxis (PEP) recommendations. Prior to public health notification and intervention, 19 persons made the decision to pursue PEP. The healthcare‐seeking behaviours of this group were taken to represent outcomes in the absence of public health intervention. (These persons received a RA, and their risk classification was retrospectively assigned.) Approximately 1–2 weeks after conducting the RAs, we conducted a follow‐up survey to determine whether recommendations regarding PEP were ultimately followed. The proportion of individuals that unnecessarily pursued PEP was higher among the 19 individuals that sought health care prior to receiving the RA (p < 0.00001). Among those receiving the RA first, all persons classified as high risk followed public health guidance to seek PEP treatment. Despite this, upon re‐interview, only 21/79 (26.6%) of guests could accurately recall their risk classification, with most people (55.7%) overestimating their risk. Study findings demonstrate that early public health interventions such as RAs can reduce unnecessary use of PEP and that messaging used during rabies counselling should be clear.