Richard P. Hackett

Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal displacement of the soft palate in horses

REASONS FOR PERFORMING STUDY Contributes to the understanding of the pathogenesis of dorsal displacement of the soft palate during exercise so that management of this condition could be enhanced. HYPOTHESIS That the thyrohyoid muscles play an important role in the stability of the laryngo-palatal relationship and that dysfunction of these muscles leads to dorsal displacement of the soft palate (DDSP) during exercise. METHODS Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control conditions (n = 10), after resection of thyrohyoid muscles (TH, n = 10), after sham-treatment (n = 5), or after restoration of function of the thyrohyoid muscles with surgical sutures (prosthesis-treatment, n = 6). During trials, the following determinations were made: videoendoscopy of the upper airway, gait frequency and pharyngeal and tracheal static pressures. RESULTS None of the 10 horses developed DDSP during 2 separate treadmill-exercise trials under the control conditions. Seven of the 10 horses developed DDSP after resection of the TH muscles, 4 of 5 of these horses still experienced DDSP after sham-treatment, but 5 of 6 horses no longer experienced DDSP at exercise after the prosthesis-treatment. There were significant anomalies in airway pressures, respiratory frequency, and occurrence of DDSP in both the TH resection and sham-treatment conditions compared to control conditions. In contrast, no statistical differences were noted in any of the parameters measured between the prosthesis-treatment and control conditions. CONCLUSIONS That the function of the TH muscles is important to the stability of the laryngo-palatal relationship and plays a role in the pathophysiology of exercise-induced DDSP. POTENTIAL RELEVANCE Management of horses with DDSP could be enhanced by restoring the function of the TH muscles.

Racing performance after combined prosthetic laryngoplasty and ipsilateral ventriculocordectomy or partial arytenoidectomy: 135 Thoroughbred racehorses competing at less than 2400 m (1997-2007)

REASONS FOR PERFORMING STUDY The success of combined prosthetic laryngoplasty with ipsilateral ventriculocordectomy (LPVC) has not been compared to that of partial arytenoidectomy (PA) in a clinical population. HYPOTHESES In Thoroughbred (TB) racehorses: (1) earnings after LPVC are unaffected by the severity of recurrent laryngeal neuropathy (RLN) (laryngeal grade III vs. grade IV); (2) LPVC and PA yield similar results in the treatment of grade III RLN; (3) performance outcome following PA is independent of diagnosis (RLN vs. unilateral arytenoid chondritis [UAC]); and (4) neither LPVC nor PA returns horses to the level of performance of controls. METHODS Medical and racing records of 135 TB racehorses undergoing LPVC or PA for the treatment of grade III or IV RLN or UAC were reviewed. Racing records of age and sex matched controls were also reviewed. RESULTS After LPVC, horses with grade III RLN performed better compared to those with grade IV RLN. Furthermore, horses treated for grade III RLN by LPVC showed post operative earnings comparable to controls. Rate of return to racing were similar for PA and LPVC, although LPVC resulted in higher post operative earnings. Performance after PA was similar regardless of diagnosis (UAC or RLN). Finally, neither LPVC when performed for grade IV RLN, nor PA performed for either diagnosis restored post operative earnings to control levels. CONCLUSIONS Thoroughbred racehorses treated by LPVC for grade III RLN show significantly better post operative earnings compared to horses treated for grade IV disease. In grade III RLN, LPVC returns earning potential to control levels. PA and LPVC lead to similar success in terms of rate of return to racing, but PA leads to inferior earnings after surgery. POTENTIAL RELEVANCE Laryngoplasty should be recommended for all TB racehorses with grade III RLN to maximise return to racing at a high level. This contradicts the common approach of waiting for complete paralysis.

Effect of a tart cherry juice blend on exercise-induced muscle damage in horses.

OBJECTIVE To evaluate whether administering a tart cherry juice blend (TCJB) prior to exercise would reduce skeletal and cardiac muscle damage by decreasing the inflammatory and oxidative stress response to exercise in horses. ANIMALS 6 horses. PROCEDURES Horses were randomly allocated into 2 groups in a crossover study with a 2-week washout period and orally administered either TCJB or a placebo solution (1.42 L, twice daily) in a double-masked protocol for 2 weeks prior to a stepwise incremental exercise protocol. Horses were tested for serum activities of creatine kinase and aspartate aminotransferase (AST) and concentrations of cardiac troponin I (cTnI), thiobarbituric acid reactive substances (TBARS; an indicator of oxidative stress), and serum amyloid A (SAA; an indicator of inflammation). To ensure that treatment would not result in positive results of an equine drug-screening protocol, serum samples obtained from each horse prior to and after 2 weeks of administration of TCJB or the placebo solution were tested. RESULTS All horses had negative results of drug screening at both sample times. The exercise protocol resulted in a significant increase in TBARS concentration, SAA concentration, and serum AST activity in all horses. Administration of TCJB or placebo solution was not associated with an effect on malondialdehyde or SAA concentrations. However, administration of TCJB was associated with less serum activity of AST, compared with administration of placebo solution. CONCLUSIONS AND CLINICAL RELEVANCE Administration of TCJB may diminish muscle damage induced by exercise.

Spinal accessory nerve biopsy as an ante mortem diagnostic test for equine motor neuron disease

The effectiveness of spinal accessory nerve branch biopsy evaluation as a means to confirm the diagnosis of equine motor neuron disease (EMND) was investigated. Sixteen horses with histories and clinical signs suggestive of EMND and 16 control horses with neither histories nor clinical signs of any neurological disorder, were subjects of the study. Biopsy samples of the ventral branch of the spinal accessory nerve were obtained either surgically, under general anaesthesia or post mortem immediately after euthanasia. Evaluation was done on the spinal cord of all horses to serve as the definitive diagnostic indicator of EMND. Results indicate that biopsy of the ventral branch of the spinal accessory nerve is a reliable ante mortem diagnostic test for EMND. Histological evidence of the degeneration of myelinated axons is present in both acute and arrested cases. The ventral branch of the spinal accessory nerve is easy to approach surgically and biopsy of the nerve causes no disfigurement of the sternocephalicus muscle. The use of semi-thin Epon sections is an excellent method of sample preparation. Formalin fixation and routine paraffin embedment may prove more accessible and provide good quality preparations for reliable interpretation. In the hands of an experienced pathologist, the sensitivity and specificity reliability coefficients for spinal accessory nerve branch biopsy are 94%, making this technique an extremely valuable diagnostic tool for the ante mortem diagnosis of EMND.

The effect of exercise on diaphragmatic activation in horses

Horses chronically-instrumented with costal diaphragmatic electromyographic electrodes were studied during exercise while unencumbered by a breathing mask. Exercise-associated changes in esophageal (Pes), gastric (Pga) and transdiaphragmatic (Pdi) pressures were measured and related to diaphragmatic electromyographic activity (CS EMG) and to left forelimb impact. In all breaths examined, CS EMG always coincided with decrements in Pes. For all exercise trials, linear increases in CS EMG, Pga and Pdi and linear decreases in Pes, as a function of exercise intensity, always occurred. During all gaits, breathing frequency (fR) was entrained with stride frequency (fS) one for one. However, a constant phase-coupling relationship between fR and fS, observed when horses cantered and galloped, was absent when horses walked or trotted. We conclude that biomechanical forces contribute minimally to ventilation in exercising horses, that the diaphragm is always phasically active during each breath and its total electrical activity and mechanical output are proportional to the exercise hyperpnea.

Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horses.

REASONS FOR PERFORMING STUDY The success rate of prosthetic laryngoplasty is limited and may be associated with significant sequelae. Nerve muscle pedicle transplantation has been attempted but requires a year before function is restored. OBJECTIVE To determine the optimal parameters for functional electrical stimulation of the recurrent laryngeal nerve in horses. METHODS An experimental in vivo study was performed on 7 mature horses (2-21 years). A nerve cuff was placed on the distal end of the common trunk of the recurrent laryngeal nerve (RLN). In 6 horses the ipsilateral adductor branch of RLN was also transected. The electrodes were connected to programmable internal stimulator. Stimulation was performed using cathodic phase and then biphasic pulses at 24 Hz with a 0.427 ms pulse duration. Stimulation-response experiments were performed at monthly intervals, from one week following implantation. The study continued until unit failure or the end of project (12 months). Two of the horses were stimulated continuously for 60 min to assess onset of fatigue. RESULTS Excellent arytenoid cartilage abduction (mean arytenoid angle of 52.7 degrees, range 48.5-56.2 degrees) was obtained in 6 horses (laryngeal grades I or II (n = 3) and III (n = 2). Poor abduction was obtained in grade IV horses (n = 2). Arytenoid abduction was maintained for up to a year in one horse. Technical implant failure resulted in loss of abduction in 6 horses at one week to 11 months post operatively. Mean tissue impedance was 1.06 kOhm (range 0.64-1.67 kOhm) at one week, twice this value at 2 months (mean 2.32, range 1.11-3.75 kOhm) and was stable thereafter. Maximal abduction was achieved at a stimulation range of 0.65-7.2 mA. No electrical leakage was observed. Constant stimulation of the recurrent laryngeal nerve for 60 min led to full abduction without evidence of muscle fatigue. CONCLUSIONS Functional electrical stimulation of the recurrent laryngeal nerve leading to full arytenoid abduction can be achieved. The minimal stimulation amplitude for maximal abduction angle is slightly higher than those for man and dogs. CLINICAL RELEVANCE This treatment modality could eventually be applicable to horses with recurrent laryngeal neuropathy.

Can an external device prevent dorsal displacement of the soft palate during strenuous exercise

REASONS FOR PERFORMING STUDY Dorsal displacement of the soft palate (DDSP) is a common condition in racehorses for which various surgical treatments are often performed. In light of recent findings that suggested the position of the larynx may influence the occurrence of DDSP, we investigated whether a noninvasive mean of affecting the position of the larynx could be effective in the management of DDSP. HYPOTHESIS An external device (laryngohyoid support; LHS) positioning the larynx in a more rostral and dorsal location and preventing caudal displacement of the basihyoid bone would be effective in preventing DDSP during strenuous exercise. METHODS Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control (n = 10); control with external device (n = 10); after bilateral resection of thyrohyoid (TH) muscles (n = 7); and after bilateral resection of TH muscles with external device (n = 7). Two trials were performed randomly for each of the 4 conditions. In Trial 1, videoendoscopic images of the upper airway, pharyngeal and tracheal static pressures, and arterial blood gases were collected. In Trial 2, airflow measurement combined with mask and tracheal static pressure was obtained, and upper airway impedance calculated. The trials allowed calculation of airway impedance and respiratory frequency, and assessment of ventilation using arterial PO2 and PCO2. RESULTS Under control conditions, none of the 10 horses developed DDSP. There was no statistically significant effect from the LHS on airway impedance or respiratory frequency, nor on arterial PO2 and PCO2. Seven of the 10 horses developed DDSP during exercise after resection of the TH muscles. None of these 7 horses continued to experience DDSP during exercise with the external device. In the latter group and condition, the LHS significantly improved inspiratory and expiratory flow and impedance. CONCLUSIONS The LHS helped prevent experimentally induced DDSP at exercise, probably by statically positioning the larynx in a more rostral and dorsal position. POTENTIAL RELEVANCE Field studies are required to investigate whether the LHS can successfully prevent DDSP in horses with naturally occurring disease.

Activity of selected rostral and caudal hyoid muscles in clinically normal horses during strenuous exercise

OBJECTIVE To determine the phase and quantitate the electromyographic (EMG) activity of the genioglossus, geniohyoideus, hyoepiglotticus, omohyoideus, sternohyoideus, sternothyroideus, and thyrohyoideus muscles of clinically normal horses during strenuous exercise. ANIMALS 7 clinically normal adult horses (2 Thoroughbreds and 5 Standardbreds). PROCEDURES Bipolar electrodes were surgically implanted in the aforementioned muscles, and horses were subjected to an incremental exercise test on a high-speed treadmill. The EMG, heart rate, respiratory rate, and static pharyngeal airway pressures were measured during exercise. The EMG was measured as mean electrical activity (MEA). The MEA values for maximal exercise intensity (13 or 14 m/s) were expressed as a percentage of the MEA measured at an exercise intensity of 6 m/s. RESULTS MEA was detected during expiration in the genioglossus, geniohyoideus, sternohyoideus, and thyrohyoideus muscles and during inspiration in the hyoepiglotticus and sternothyroideus muscles. Intensity of the MEA increased significantly with exercise intensity in the genioglossus, geniohyoideus, and hyoepiglotticus muscles. Intensity of the MEA increased significantly in relation to expiratory pharyngeal pressure in the geniohyoideus and hyoepiglotticus muscles. CONCLUSIONS AND CLINICAL RELEVANCE Once exercise intensity reached 6 m/s, no quantifiable additional increase in muscular activity was detected in the omohyoideus, sternohyoideus, sternothyroideus, and thyrohyoideus muscles. However, muscles that may affect the diameter of the oropharynx (genioglossus and geniohyoideus muscles) or rima glottis (hyoepiglotticus muscle) had activity correlated with the intensity of exercise or expiratory pharyngeal pressures. Activity of the muscles affecting the geometry of the oropharynx may be important in the pathophysiologic processes associated with nasopharyngeal patency.

UMBILICAL HERNIORRHAPHY IN A JUVENILE ASIAN ELEPHANT (ELEPHAS MAXIMUS)

Abstract An umbilical hernia was diagnosed in a 2-wk-old Asian elephant (Elephas maximus) by physical and ultrasonographic examinations. Umbilical herniorrhaphy was elected because the defect was large (approximately 7 cm long and 10 cm deep) and could potentially lead to incarceration of an intestinal loop. General anesthesia was induced with a combination of ketamine, xylazine, and diazepam and maintained with isoflurane in oxygen. The hernial sac was explored and contained fibrous tissue, fat, and an intestinal loop but no adhesions. The hernial sac was resected and the body wall closed using the technique of simple apposition. Following a superficial wound infection, the surgical site healed with no further complications.

Comparison of endoscopic tracheal washing, bronchoalveolar lavage and visual detection of blood following instillation of blood into the airways of horses

Summary In an experimental study of endoscopic tracheal washings and bronchoalvveolar lavage specimens collected prior to and following instillation of 0,250, 500 or 1000 ml of autologous citrated blood into the airways of nonexercising, adult horses, there was no apparent correlation between the amount of blood or exudate seen endoscopically, the volume of washing fluid recovered, or the cytologic evaluation of numbers of erythrophages or siderophages. Tracheal washing and bronchoalveolar lavage specimens appear to be complementary for detection of erythrophages or siderophages in cytologic specimens since these cell types may be present in one, or the other, or both types of specimens. There may be an advantage to collecting two BAL specimens since more erythrophages or siderophages were seen in the second BAL in some horses. Further studies of experimentally-instilled blood and spontaneouslyoccurring exercise-induced pulmonary hemorrhage are needed to further characterize the mechanisms by which pulmonary hemorrhage is resolved and/or characterize the cytologic methods best suited for detection and/or quantitation of pulmonary hemorrhage.