Julie E. Dechant

Prevalence of gastric ulcers in Thoroughbred broodmares in pasture: A preliminary report

Gastroscopic examinations were performed in 62 Thoroughbred broodmares (33 pregnant, 29 non-pregnant) at one breeding farm to investigate the prevalence of gastric ulceration. Age, pregnancy status, race earnings, last race start, herd size, medical history, number of live foals, breeding years, feed type and number of feedings were recorded, plus coat condition and body condition score were determined. Twenty-one mares were re-evaluated after foaling, and the foaling date, foal weight at birth and placenta weight were recorded. The overall prevalence of gastric ulcers was 70.9%, with a median ulcer score of 3.0 (range: 2-5). Most ulcers were present on the squamous portion of the stomach, while two mares had glandular ulcers. There were no differences in the presence, location and severity of gastric ulcers between pregnant and non-pregnant mares. Furthermore, there were no significant associations between the variables measured and the presence of gastric ulceration. The prevalence of gastric ulceration in this specific population of horses was higher than expected and further investigation is warranted to determine the factors that contributed to this finding.

Peritoneal and plasma D-lactate concentrations in horses with colic.

OBJECTIVE To evaluate the association between peritoneal fluid and plasma d-lactate concentration with variables used in the diagnosis and prognosis of horses with colic. ANIMALS Clinically healthy horses (n=6) and 90 horses with colic. STUDY DESIGN Prospective cross-sectional study. METHODS D-lactate concentration was determined in peritoneal fluid and plasma of all horses. Information on other blood and peritoneal fluid variables, signalment, results from the physical examination, outcome, need for surgery, lesion location, and type was retrieved from medical records. RESULTS Peritoneal D-lactate concentration was strongly correlated with plasma D-lactate concentration (r=0.71; P<.001). Peritoneal and plasma D-lactate concentrations were positively correlated with peritoneal (r=0.8; P<.001) and plasma L-lactate (r=0.33; P=.001) concentrations, respectively. Peritoneal D-lactate concentration was negatively correlated with survival to discharge (U=430.5; P<.001). Median peritoneal D-lactate concentration of horses with septic peritonitis (455.2 μmol/L) and horses with gastrointestinal rupture (599.5 μmol/L) were higher compared with horses with nonstrangulating obstructions (77.7 μmol/L). A cut-off concentration of peritoneal D-lactate of 116.6 μmol/L had a sensitivity of 0.813 and a specificity of 0.651 to differentiate between nonstrangulating and strangulating obstructions. CONCLUSIONS Peritoneal D-lactate concentration may be more useful for identifying horses with strangulating obstructions (high sensitivity, low probability of a false negative) than to ruling out strangulating obstruction (moderate specificity, high probability of a false positive).

Resection and Anastomosis of the Descending Colon in 43 Horses

Objectives: To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Study Design: Multicentered case series. Animals: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995–June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short-term survival (hospital discharge). Long-term survival was defined as survival ≥6 months after hospital discharge. Results: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty-eight of 30 horses with follow-up information survived ≥6 months. No significant associations between perioperative factors and short-term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). Conclusions: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival ≥6 months. The most common cause of small colon incarceration was strangulating lipoma. Clinical Relevance: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.OBJECTIVES To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. STUDY DESIGN Multicentered case series. ANIMALS Horses (n=43) that had descending colon resection and anastomosis. METHODS Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short-term survival (hospital discharge). Long-term survival was defined as survival > or =6 months after hospital discharge. RESULTS Of 43 horses, 36 (84%) were discharged from the hospital. Twenty-eight of 30 horses with follow-up information survived > or =6 months. No significant associations between perioperative factors and short-term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). CONCLUSIONS Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival > or =6 months. The most common cause of small colon incarceration was strangulating lipoma. CLINICAL RELEVANCE Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.

Comparison of pH, Lactate, and Glucose Analysis of Equine Synovial Fluid using a Portable Clinical Analyzer with a Bench-Top Blood Gas Analyzer

OBJECTIVE To compare agreement between a portable clinical analyzer and laboratory-based bench-top analyzer for analysis of pH, lactate, and glucose concentrations in synovial fluid. STUDY DESIGN Prospective experimental study. ANIMALS Clinically normal horses (n=8); 6 horses euthanatized for reasons unrelated to the study; 11 horses that had synoviocentesis for reasons other than sepsis; 7 horses that had synoviocentesis for evaluation of sepsis; and 2 horses without recorded clinical data. Median age of horses was 8 years (range, 1 day to 24 years). METHODS Supernatant from each synovial fluid sample was analyzed for pH, lactate, and glucose concentrations using an ABL 705 laboratory-based bench-top analyzer and i-STAT portable clinical analyzer. Bland-Altman plots were constructed and concordance analysis performed to determine bias and agreement between the 2 analyzers. RESULTS There was acceptable agreement between analyzers for lactate and glucose concentrations, with biases of 0.198 mmol/L and 9 mg/dL and concordance correlation coefficients of 0.97 and 0.96 for lactate and glucose, respectively. The agreement between analyzers for pH was not acceptable, with a bias of -0.057 and concordance correlation coefficient of 0.89. CONCLUSIONS This study found that the portable clinical analyzer performed similarly to the bench-top blood gas analyzer for evaluation of lactate and glucose concentrations, but not pH, in synovial fluid.Objective To compare agreement between a portable clinical analyzer and laboratory-based bench-top analyzer for analysis of pH, lactate, and glucose concentrations in synovial fluid. Study Design Prospective experimental study. Animals Clinically normal horses (n=8); 6 horses euthanatized for reasons unrelated to the study; 11 horses that had synoviocentesis for reasons other than sepsis; 7 horses that had synoviocentesis for evaluation of sepsis; and 2 horses without recorded clinical data. Median age of horses was 8 years (range, 1 day to 24 years). Methods Supernatant from each synovial fluid sample was analyzed for pH, lactate, and glucose concentrations using an ABL 705 laboratory-based bench-top analyzer and i-STAT portable clinical analyzer. Bland–Altman plots were constructed and concordance analysis performed to determine bias and agreement between the 2 analyzers. Results There was acceptable agreement between analyzers for lactate and glucose concentrations, with biases of 0.198 mmol/L and 9 mg/dL and concordance correlation coefficients of 0.97 and 0.96 for lactate and glucose, respectively. The agreement between analyzers for pH was not acceptable, with a bias of −0.057 and concordance correlation coefficient of 0.89. Conclusions This study found that the portable clinical analyzer performed similarly to the bench-top blood gas analyzer for evaluation of lactate and glucose concentrations, but not pH, in synovial fluid.

Evaluation of 3 handheld portable analyzers for measurement of L-lactate concentrations in blood and peritoneal fluid of horses with colic.

Objective To compare 3 portable handheld analyzers with a bench top blood gas analyzer for measurement of blood and peritoneal fluid L-lactate concentrations in horses admitted with signs of colic. Study Design Prospective clinical study. Sample Population Blood and peritoneal fluid from horses with colic. Methods L-lactate concentrations in heparinized blood and peritoneal fluid were measured serially on 10 occasions to evaluate repeatability of the portable analyzers. Blood and peritoneal fluid L-lactate concentrations were simultaneously evaluated by a bench top and 3 portable analyzers and the results compared by intraclass correlation coefficients and Bland Altman plots. L-Lactate concentrations in a subgroup of peritoneal fluid samples were evaluated by a chromogenic laboratory assay and compared with the bench top and the handheld analyzers. Results Portable lactate analyzers had good intra-analyzer reliability for peritoneal fluid. Two portable analyzers had poor intra-analyzer reliability for mid concentrations of L-lactate in blood. L-lactate measurements from portable analyzers were closer to the bench top analyzer at low concentrations of L-lactate than at higher concentrations. Compared with the bench top analyzer, the Lactate Pro and Lactate Plus have the highest intraclass correlation coefficient and the smallest bias for peritoneal fluid and blood L-lactate, respectively. The bench top analyzer and the Lactate Pro had the highest level of agreement for peritoneal fluid compared with the chromogenic assay. Conclusions Although portable analyzers are alternatives for the measurement of L-lactate concentration in field situations, clinicians need to be aware of the variable results between analyzers, especially when extrapolating means or cutoff values from studies using different lactate analyzers.OBJECTIVE To compare 3 portable handheld analyzers with a bench top blood gas analyzer for measurement of blood and peritoneal fluid L-lactate concentrations in horses admitted with signs of colic. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Blood and peritoneal fluid from horses with colic. METHODS L-lactate concentrations in heparinized blood and peritoneal fluid were measured serially on 10 occasions to evaluate repeatability of the portable analyzers. Blood and peritoneal fluid L-lactate concentrations were simultaneously evaluated by a bench top and 3 portable analyzers and the results compared by intraclass correlation coefficients and Bland Altman plots. L-Lactate concentrations in a subgroup of peritoneal fluid samples were evaluated by a chromogenic laboratory assay and compared with the bench top and the handheld analyzers. RESULTS Portable lactate analyzers had good intra-analyzer reliability for peritoneal fluid. Two portable analyzers had poor intra-analyzer reliability for mid concentrations of L-lactate in blood. L-lactate measurements from portable analyzers were closer to the bench top analyzer at low concentrations of L-lactate than at higher concentrations. Compared with the bench top analyzer, the Lactate Pro and Lactate Plus have the highest intraclass correlation coefficient and the smallest bias for peritoneal fluid and blood L-lactate, respectively. The bench top analyzer and the Lactate Pro had the highest level of agreement for peritoneal fluid compared with the chromogenic assay. CONCLUSIONS Although portable analyzers are alternatives for the measurement of L-lactate concentration in field situations, clinicians need to be aware of the variable results between analyzers, especially when extrapolating means or cutoff values from studies using different lactate analyzers.

Comparison of two tourniquet application times for regional intravenous limb perfusions with amikacin in sedated or anesthetized horses.

Regional limb perfusion (RLP) in horses has proven to be a simple and effective technique for the treatment of synovial and musculoskeletal infections in the distal portion of the limbs. The ideal tourniquet time needed to achieve therapeutic synovial concentrations remains unknown. The pharmacokinetic effects of general anesthesia (GA) versus standing sedation (SS) RLP on synovial amikacin concentrations are not completely understood. This study investigated the pharmacokinetic effects of RLP under general anesthesia (GA) versus standing sedation (SS) on synovial amikacin concentration following 20 or 30 min tourniquet time. Using 1 g of amikacin RLP was performed in two groups of six horses (GA and SS). A pneumatic tourniquet was applied proximal to the carpus and maintained for 20 or 30 min. Two weeks later, the opposite treatment (20 or 30 min) was randomly performed in the opposite limb of horses in each group (GA and SS). Synovial fluid samples were collected from the metacarpophalangeal (MCP) and radiocarpal (RC) joints. Amikacin was quantified by a fluorescence polarization immunoassay. Regardless of the group, no significant difference in the synovial amikacin concentrations was noted between 20 and 30 min RLP. Mean synovial concentrations of amikacin in the standing sedated horses were significantly higher in the MCP joint at 30 min (P = 0.003) compared to horses under general anesthesia. No significant difference was noted for the RC joint.

Penetrating injuries to the frog (cuneus ungulae) and collateral sulci of the foot in equids: 63 cases (1998-2008)

Objective-To determine the outcome of penetrating injuries to the central region of the foot in equids and identify factors that may affect treatment and outcome. Design-Retrospective case series. Animals-63 equids (61 horses, 1 pony, and 1 mule). Procedures-Records of equids incurring puncture wounds through the frog (cuneus ungulae) or collateral sulci of the foot between 1998 and 2008 were reviewed. Evaluated factors that were hypothesized to affect outcome included signalment, degree of lameness, foot affected, duration between injury and admission, and treatment. Injuries were graded from 1 (< 1 inch; involving superficial corium only) to 4 (involving a synovial structure) on the basis of severity of penetration as determined by radiographic evidence or findings on synoviocentesis at the time of admission. Results-Overall, 60% (38/63) of equids returned to soundness. Thirteen equids were euthanized on the basis of synovial structure involvement and financial constraints. Of 35 equids that were treated conservatively, which may have included undergoing a surgical procedure with the horse standing, 32 (91.4%) returned to their previous level of soundness. Fifteen equids underwent surgical treatment under general anesthesia, of which 6 (40%) became sound for intended use. Ten of 34 (29%) equids with synovial structure involvement regained soundness. Equids treated earlier after injury had a better prognosis. Equids with a hind foot injury had a more favorable outcome than those with a forefoot injury. Conclusions and Clinical Relevance-Results suggested that penetrating injuries located centrally in the foot of equids without involvement of a synovial structure have a favorable prognosis, especially if managed early. Penetration of a synovial structure provided a poor prognosis.

Identification, Management and Outcome of Postoperative Hemoperitoneum in 23 Horses After Emergency Exploratory Celiotomy for Gastrointestinal Disease

OBJECTIVE To investigate postoperative hemoperitoneum in a population of horses that had surgery for colic. STUDY DESIGN Retrospective case series. ANIMALS Horses (n = 23). METHODS Preoperative, intraoperative, and postoperative information was obtained from medical records (1985-2012) of horses with postoperative hemoperitoneum after emergency exploratory celiotomy. Pre-existing hemoperitoneum during surgery and nonsurgical hemoperitoneum were excluded. RESULTS Of 4520 horses that had emergency exploratory celiotomy for gastrointestinal disease, 23 horses met inclusion criteria; an incidence of 0.5%. Horse signalment approximated the colic population, although Thoroughbreds were significantly overrepresented. Hemoperitoneum was significantly associated with intestinal resection. Postoperative hemoperitoneum was recognized a mean (± SD) of 1.0 ± 0.7 days after surgery and associated with tachycardia, decreasing hematocrit, incisional drainage, or ultrasonographic identification of swirling, echogenic abdominal fluid. Primary treatments included intravenous fluid therapy (n = 23), colloid support (20), blood transfusion (13), and antifibrinolytic agents (11). Fifteen horses (65%) survived to discharge, which was associated with admission lactate and days of hospitalization. CONCLUSIONS Postoperative hemoperitoneum is a rare complication of exploratory celiotomy in horses that should be considered when there are signs of abdominal discomfort and declining hematocrit in the early postoperative period. Prognosis is guarded because of potential sequelae of septic peritonitis and adhesion formation.

A Preliminary Study of Silver Sodium Zirconium Phosphate Polyurethane Foam Wound Dressing on Wounds of the Distal Aspect of the Forelimb in Horses

OBJECTIVE To determine if application of silver sodium zirconium phosphate polyurethane semi-occlusive foam (SPF) dressing would improve measures of wound healing and decrease bacterial contamination compared with a non-adherent, absorbent dressing applied to wounds created on the distal aspect of the equine limb. STUDY DESIGN Controlled randomized experimental study. ANIMALS Adult Quarter Horse and Thoroughbred horses (n = 5). METHODS One 6.25 cm(2) wound was created on the dorsomedial aspect of the proximal metacarpus on each forelimb. A SPF dressing was applied to 1 randomly assigned limb as a treatment and a non-adherent, absorbent dressing was applied to the opposite limb as control. Bandages were changed every 3 days for 60 days. Granulation tissue was scored every 3 days, wound area measured every 6 days, and wound bed was cultured every 12 days. RESULTS SPF-treatment wounds had significantly decreased wound area and decreased granulation tissue scores when evaluated <30 days and over the 60 day study, although complete wound healing times were not significantly different. Bacteria were cultured from all wounds at varying times throughout the study. CONCLUSIONS The SPF wound dressing improved some measures of wound healing compared with the control dressing, most significantly during the first 30 days. This suggests that the SPF wound dressing may be useful in the early management of wounds on the equine lower limb. Further studies using the SPF dressing are needed to characterize the temporal and cellular effects on wound healing and evaluate this dressing in a clinical environment.Objective To determine if application of silver sodium zirconium phosphate polyurethane semi-occlusive foam (SPF) dressing would improve measures of wound healing and decrease bacterial contamination compared with a non-adherent, absorbent dressing applied to wounds created on the distal aspect of the equine limb. Study Design Controlled randomized experimental study. Animals Adult Quarter Horse and Thoroughbred horses (n = 5). Methods One 6.25 cm2 wound was created on the dorsomedial aspect of the proximal metacarpus on each forelimb. A SPF dressing was applied to 1 randomly assigned limb as a treatment and a non-adherent, absorbent dressing was applied to the opposite limb as control. Bandages were changed every 3 days for 60 days. Granulation tissue was scored every 3 days, wound area measured every 6 days, and wound bed was cultured every 12 days. Results SPF-treatment wounds had significantly decreased wound area and decreased granulation tissue scores when evaluated <30 days and over the 60 day study, although complete wound healing times were not significantly different. Bacteria were cultured from all wounds at varying times throughout the study. Conclusions The SPF wound dressing improved some measures of wound healing compared with the control dressing, most significantly during the first 30 days. This suggests that the SPF wound dressing may be useful in the early management of wounds on the equine lower limb. Further studies using the SPF dressing are needed to characterize the temporal and cellular effects on wound healing and evaluate this dressing in a clinical environment.

Clinical findings and management of 153 horses with large colon sand accumulations

Objective To determine the influence of radiographic quantification of sand accumulation on the medical versus surgical management of large colon sand accumulations. To compare short- and long-term outcomes and complications associated with medical and surgical management of these horses. Study design Retrospective. Sample population A total of 153 horses. Methods Medical records and abdominal radiographs of horses presented for colic between 2004 and 2014 were reviewed. Severity of sand accumulation was quantified by tracing and measuring a region of interest with a commercial software program. Breed, weight, amount of sand, presence of diarrhea at presentation, treatment, and the development of complications were recorded. Results Records from 153 horses were reviewed. The mean cross-sectional area of sand accumulation was 692.9 cm2 (median = 658.7 cm2, 84.6-1780.7 cm2). Increased accumulation of gas on radiographs and abnormal transrectal examination findings were associated with an increased likelihood of surgery. The most common complication was the development of diarrhea (20.3%) with only 4 (2.6%) horses positive for Salmonella spp. Horses had a favorable prognosis, with 94.8% of horses treated medically and 94.7% of those treated surgically surviving to discharge. Conclusion Increased accumulation of gas on radiographs and transrectal palpation of impaction or intestinal gas distension increase the likelihood of surgery. Both medical and surgical treatments carry a good prognosis. Clinical relevance The sheer quantity of sand is not a factor when determining surgical intervention. Attention should be paid to the presence of increased gas accumulation on rectal or radiographic examination.OBJECTIVE To determine the influence of radiographic quantification of sand accumulation on the medical versus surgical management of large colon sand accumulations. To compare short- and long-term outcomes and complications associated with medical and surgical management of these horses. STUDY DESIGN Retrospective. SAMPLE POPULATION A total of 153 horses. METHODS Medical records and abdominal radiographs of horses presented for colic between 2004 and 2014 were reviewed. Severity of sand accumulation was quantified by tracing and measuring a region of interest with a commercial software program. Breed, weight, amount of sand, presence of diarrhea at presentation, treatment, and the development of complications were recorded. RESULTS Records from 153 horses were reviewed. The mean cross-sectional area of sand accumulation was 692.9 cm2 (median = 658.7 cm2 , 84.6-1780.7 cm2 ). Increased accumulation of gas on radiographs and abnormal transrectal examination findings were associated with an increased likelihood of surgery. The most common complication was the development of diarrhea (20.3%) with only 4 (2.6%) horses positive for Salmonella spp. Horses had a favorable prognosis, with 94.8% of horses treated medically and 94.7% of those treated surgically surviving to discharge. CONCLUSION Increased accumulation of gas on radiographs and transrectal palpation of impaction or intestinal gas distension increase the likelihood of surgery. Both medical and surgical treatments carry a good prognosis. CLINICAL RELEVANCE The sheer quantity of sand is not a factor when determining surgical intervention. Attention should be paid to the presence of increased gas accumulation on rectal or radiographic examination.