Francesca Beccati

Is there a statistical correlation between ultrasonographic findings and definitive diagnosis in horses with acute abdominal pain

REASON FOR PERFORMING STUDY Abdominal ultrasonography has become a part of the diagnostic investigation for the acute abdomen in many equine clinics. There is limited information on the correlation between abnormalities detected on abdominal ultrasonography and the specific category of small intestine (SI) and large intestine (LI) diseases. OBJECTIVES To investigate the relationship between abdominal ultrasonographic findings and disease categories that cause abdominal pain requiring surgery. METHODS Medical records were reviewed for horses undergoing surgery or post mortem examination for colic. The ultrasound examination was performed to assess free peritoneal fluid, the left kidney, stomach, appearance and motility of the duodenum, identification, appearance, motility and thickness of small intestine loops, and the appearance and motility of the colon. Logistic regression analysis was used to identify associations between disease categories and ultrasonographic findings; a Chi-squared test was used to test for associations between each variable and disease categories. RESULTS The study included 158 horses. Distended and nonmotile SI loops were associated with strangulated obstruction (n = 45); increased free peritoneal fluid, completely distended SI loops with abnormal motility and thickened loops were associated with definitive diagnosis involving SI (n = 58). Failure to visualise the left kidney was associated with renosplenic entrapment (n = 16); thickened large colon (LC) was associated with LC strangulating volvulus (n = 9). CONCLUSION The use of abdominal ultrasonography can be used for the accurate definitive diagnosis involving SI and LI diseases. POTENTIAL RELEVANCE This retrospective study may be used as a basis for prospective studies to assess the ultrasonographic findings in horses with medical colic and to compare these with surgical findings.

Gambling on putative biomarkers of osteoarthritis and osteochondrosis by equine synovial fluid proteomics.

Osteoarthritis (OA) and osteochondrosis (OC) are two of the main challenges in orthopedics, whose definitive diagnosis is usually based on radiographic/arthroscopic evidences. Their early diagnosis should allow preventive or timely therapeutic actions, which are generally precluded from the poor relationships occurring between symptomatologic and radiographic evidences. These limitations should be overcome by improving the knowledge on articular tissue metabolism and on molecular factors regulating its normal homeostasis, also identifying novel OA and OC biomarkers suitable for their earlier diagnoses, whenever clinical/pathological inflammatory scenarios between these joint diseases seem somewhat related. To identify proteins involved in their aetiology and progression, we undertook a differential proteomic analysis of equine synovial fluid (SF), which compared the protein pattern of OA or OC patients with that of healthy individuals. Deregulated proteins in OA and OC included components related to inflammatory state, coagulation pathways, oxidative stress and matrix damage, which were suggestive of pathological alterations in articular homeostasis, plasma-SF exchange, joint nutritional status and vessel permeability. Some proteins seemed commonly deregulated in both pathologies indicating that, regardless of the stimulus, common pathways are affected and/or the animal joint uses the same molecular mechanisms to restore its homeostasis. On the other hand, the increased number of deregulated proteins observed in OA with respect to OC, together with their nature, confirmed the high inflammatory character of this disease. Some deregulated proteins in OA found a verification by analyzing the SF of injured arthritic joints following autologous conditioned serum treatment, an emergent therapy that provides positive results for both human and equine OA. Being the horse involved in occupational/sporting activities and considered as an excellent animal model for human joint diseases, our data provide suggestive information for tentative biomedical extrapolations, allowing to overcome the limitations in joint size and workload that are typical of other small animal models.

Ultrasonographic findings in 38 horses with septic arthritis/tenosynovitis.

Septic arthritis/tenosynovitis in the horse can have life-threatening consequences. The purpose of this cross-sectional retrospective study was to describe ultrasound characteristics of septic arthritis/tenosynovitis in a group of horses. Diagnosis of septic arthritis/tenosynovitis was based on historical and clinical findings as well as the results of the synovial fluid analysis and/or positive synovial culture. Ultrasonographic findings recorded were degree of joint/sheath effusion, degree of synovial membrane thickening, echogenicity of the synovial fluid, and presence of hyperechogenic spots and fibrinous loculations. Ultrasonographic findings were tested for dependence on the cause of sepsis, time between admission and beginning of clinical signs, and the white blood cell counts in the synovial fluid. Thirty-eight horses with confirmed septic arthritis/tenosynovitis of 43 joints/sheaths were included. Degree of effusion was marked in 81.4% of cases, mild in 16.3%, and absent in 2.3%. Synovial thickening was mild in 30.9% of cases and moderate/severe in 69.1%. Synovial fluid was anechogenic in 45.2% of cases and echogenic in 54.8%. Hyperechogenic spots were identified in 32.5% of structures and fibrinous loculations in 64.3%. Relationships between the degree of synovial effusion, degree of the synovial thickening, presence of fibrinous loculations, and the time between admission and beginning of clinical signs were identified, as well as between the presence of fibrinous loculations and the cause of sepsis (P ≤ 0.05). Findings indicated that ultrasonographic findings of septic arthritis/tenosynovitis may vary in horses, and may be influenced by time between admission and beginning of clinical signs.

DIAGNOSTIC SENSITIVITY AND INTEROBSERVER AGREEMENT OF RADIOGRAPHY AND ULTRASONOGRAPHY FOR DETECTING TROCHLEAR RIDGE OSTEOCHONDROSIS LESIONS IN THE EQUINE STIFLE

Osteochondrosis lesions commonly occur on the femoral trochlear ridges in horses and radiography and ultrasonography are routinely used to diagnose these lesions. However, poor correlation has been found between radiographic and arthroscopic findings of affected trochlear ridges. Interobserver agreement for ultrasonographic diagnoses and correlation between ultrasonographic and arthroscopic findings have not been previously described. Objectives of this study were to describe diagnostic sensitivity and interobserver agreement of radiography and ultrasonography for detecting and grading osteochondrosis lesions of the equine trochlear ridges, using arthroscopy as the reference standard. Twenty-two horses were sampled. Two observers independently recorded radiographic and ultrasonographic findings without knowledge of arthroscopic findings. Imaging findings were compared between observers and with arthroscopic findings. Agreement between observers was moderate to excellent (κ 0.48-0.86) for detecting lesions using radiography and good to excellent (κ 0.74-0.87) for grading lesions using radiography. Agreement between observers was good to excellent (κ 0.78-0.94) for detecting lesions using ultrasonography and very good to excellent (κ 0.86-0.93) for grading lesions using ultrasonography. Diagnostic sensitivity was 84-88% for radiography and 100% for ultrasonography. Diagnostic specificity was 89-100% for radiography and 60-82% for ultrasonography. Agreement between radiography and arthroscopy was good (κ 0.64-0.78). Agreement between ultrasonography and arthroscopy was very good to excellent (κ 0.81-0.87). Findings from this study support ultrasound as a preferred method for predicting presence and severity of osteochondrosis lesions involving the femoral trochlear ridges in horses.

Arthroscopic anatomy of the equine cervical articular process joints

REASON FOR PERFORMING STUDY Although arthropathy of the cervical articular process joints (APJs) is common, descriptions of the arthroscopic technique of the cervical APJ have not been reported previously. OBJECTIVES To develop an arthroscopic approach to the APJ and to describe the arthroscopic anatomy of the APJ. STUDY DESIGN Descriptive cadaver study and clinical case report. METHODS The regional anatomy was reviewed and the technique developed on fresh cadaver necks. A series of cadaveric APJ arthroscopies from C2-C3 to C6-C7 were performed to evaluate the procedure, which was then used in 3 clinical cases. A description of the procedure and the potential complications encountered were recorded. RESULTS The equine APJ consists of cranioventral and caudodorsal recesses; a single entry point at one of these recesses enables almost complete evaluation of cartilage surfaces and the synovial membrane and its villi. Successful entry into both APJ recesses was achieved in 22 cadaveric APJs and 5 APJs in the 3 clinical cases operated upon. An instrument portal was created to assess the feasibility of surgical arthroscopy. Complications were minor, and dissection of the APJs following the arthroscopic exploration revealed that the cartilage and periarticular neurovascular structures were not damaged during the procedure. CONCLUSIONS This study shows that arthroscopic examination of the APJs of equine cervical vertebra is feasible and can be performed in mature horses. Arthroscopy of the APJs may provide additional diagnostic information compared to conventional diagnostic techniques.

Radiographic evaluation of changes in the proximal phalanx of Thoroughbreds in race training

OBJECTIVE To evaluate changes in the cortical bone of the proximal phalanx of the fore-limbs of Thoroughbreds in response to training. ANIMALS Twenty-seven 2-year-old Thoroughbreds (20 females, 2 males, and 5 geldings). PROCEDURES Horses were principally in training for races in a straight line and in a clockwise direction. Lateromedial and dorsopalmar radiographic views of each metacarpophalangeal joint were obtained before the horses started training and 1 year after starting exercise and racing. Width of the dorsal, palmar, lateral, and medial cortex and the width and thickness of the medulla were measured. Ratios (rather than absolute values) were used to remove the effect of differences in bone size among horses. RESULTS 10 horses were lost from the study. Radiographs were obtained for 17 horses 1 year after starting training (9 horses raced in a clockwise direction, and 8 raced in clockwise and counterclockwise directions). There was no difference between the cortical bone in the right and left forelimbs at the start of the study. After training for 1 year, the palmar cortex in the right forelimb was significantly thicker than that in the left forelimb. CONCLUSIONS AND CLINICAL RELEVANCE The strain patterns, biomechanics of rapid exercise, and type of training most probably determined differences in the adaptive responses of the proximal phalanx. The data reported here can be used in the evaluation of weight-bearing distribution along the proximal phalanx and evaluation of the relationship between exercise and bone remodelling of the proximal phalanx.

Anatomical variation of the spinous and transverse processes in the caudal cervical vertebrae and the first thoracic vertebra in horses

REASONS FOR PERFORMING STUDY There are scant data on the incidence of different anatomical variants of the equine caudal cervical spine, despite interest in cervical pathology. OBJECTIVES To identify morphological radiographic variation in the 6th and 7th cervical vertebrae and the first thoracic vertebra in horses of different breeds and to determine whether there are breed- and sex-related differences. STUDY DESIGN Retrospective descriptive study. METHODS Radiographs of the cervical spine of 270 horses were assessed retrospectively. The Chi-square test, or Fishers exact test when appropriate, was used to test for associations between radiographic findings and sex or breed, and residual analysis was performed to localise differences. Chi-square tests and calculation of phi coefficient (φ) were used to test for associations between different types of radiological variation. RESULTS Three variants were identified in the spinous process of the 7th cervical vertebra, and 2 variants were identified in the spinous process of the first thoracic vertebra. The presence of the spinous process of the 7th cervical vertebra was associated with breed, and transposition of the ventral process of the 6th cervical vertebra onto the ventral aspect of the 7th cervical vertebra was associated with sex. The shape of the spinous process of first thoracic vertebra was associated with the shape of the spinous process of the 7th cervical vertebra and with the presence of transposition of the ventral process of the 6th cervical vertebra onto the ventral aspect of the 7th. CONCLUSIONS A large number of anatomical variants can be detected radiographically in the caudal cervical area; some of these have a higher frequency, depending on sex and breed. Knowledge of the different shapes is very important in avoiding misdiagnosis of periarticular new bone formation. The spinous process of the first thoracic vertebra has 2 morphological variants.

IMAGING DIAGNOSIS - USE OF MULTIPHASE COMPUTED TOMOGRAPHIC UROGRAPHY IN THE DIAGNOSIS OF URETERAL TEAR IN A 6-DAY-OLD FOAL.

A 6-day-old foal was evaluated for depression and inappetence. After initial stabilization, the filly developed a hypochloremic metabolic alkalosis and persistent hypercreatinemia. Abdominal ultrasound revealed fluid accumulation around the left kidney and a well-defined rounded fluid filled structure dorsal to the urinary bladder. Computed tomography revealed a partial tear of the left ureter with distension of the retroperitoneal membrane. Exploratory celiotomy was performed to allow left kidney nephrectomy. At 6 months follow-up, the filly was growing normally without complications. Ultrasound and CT imaging in this case provided an accurate diagnosis and a presurgical aid to select the appropriate therapeutic approach.

Evaluation of transabdominal ultrasound as a tool for predicting the success of abdominocentesis in horses

The aim of this study was to evaluate the transabdominal ultrasonography as a tool for predicting the success of abdominocentesis in horses. Patients were included in the study if a complete transabdominal ultrasonography examination and abdominocentesis were performed as part of the clinical work-up. Ultrasonographically, the amount of peritoneal fluid was assessed using a 4-point grading system, as well as the amount of peritoneal fluid collected. A χ2 or Fischer exact test was performed to test for an association between the ultrasonography findings and fluid retrieved, and between the two grading scales. Interobserver and intraobserver agreement values were calculated using k statistics. Values of P<0.05 were considered significant; 109 horses met the inclusion criteria. Peritoneal fluid was identified ultrasonographically in 72 per cent of horses, and it was collected from 93 per cent of these cases. In horses with no peritoneal fluid identified at ultrasonography (28 per cent), fluid was collected in 70 per cent of cases. There is a significant association between transabdominal ultrasonography detection of peritoneal fluid and the likelihood to obtain a diagnostic amount of peritoneal fluid at abdominocentesis; however, even when peritoneal fluid is not detected during abdominal ultrasonography examination, an amount of peritoneal fluid useful for gross, clinicopathological and cytological evaluation can frequently be obtained.

Umbilical infections in foals: microbiological investigation and management

This study aims to investigate the bacteria involved in equine omphalitis and their susceptibility to antimicrobial drugs, and consequently to provide guidelines concerning the most suitable treatment protocol in accordance with the clinical, ultrasound and laboratory findings. Forty foals aged between one and 30 days were evaluated in the course of this investigation. An ultrasound examination of all umbilical remnants was carried out carefully in all foals; umbilical swabs were collected for bacteriological examination, and blood samples were collected for blood culture from 19 foals with fever and abnormal blood values. Bacterial omphalitis was observed in 95 per cent of foals and bacterial septicaemia was diagnosed in 11 cases. Enterobacteria and coccoid Gram-positive bacteria were isolated more frequently than Serratia marcescens, Pantoea agglomerans and Trueperella pyogenes. Omphalectomy was performed in 77.5 per cent of the foals examined; the remainder were treated only medically with antimicrobial drugs as recommended by antibiotic susceptibility testing performed for all bacteria isolated. Antibiotic therapy was successful in all foals that only received medical treatment; nevertheless, omphalectomy was performed in most cases particularly in situations of clinical decline despite antibiotic therapy and when involvement of umbilical vein, fever and joint disorders were observed.