Sara Nannarone

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.

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.

The Use of Alpha-2 Agonists in the Equine Practice: Comparison between Three Molecules

Nannarone, S., Gialletti, R., Veschini, I., Bufalari, A. and Moriconi, F., 2007. The use of alpha-2 agonists in the equine practice: comparison between three molecules. Veterinary Research Communications, 31(Suppl. 1), 309–312

Fentanyl or sufentanil continuous infusion during isoflurane anaesthesia in dogs: clinical experiences.

Bufalari, A., Di Meo, A., Nannarone, S., Padua, S. and Adami, C., 2007. Fentanyl or sufetanil continuous infusion during isoflurane anaesthesia in dogs: Clinical experiences. Veterinary Research Communications,31(Suppl. 1), 277–280

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.

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.

Serum Amyloid A, Fibrinogen, and Haptoglobin as Inflammation Markers in the Horse: Preliminary Results

The early detection and monitoring of inflammation is a primary challenge in veterinary medicine. The circulating concentrations of acute-phase proteins may provide an objective measure of both the severity of insult and the intensity of inflammatory responses in the horse. A clinical study on the possible role of serum amyloid A (SAA), fibrinogen, and haptoglobin as inflammation markers in the horse was conducted in 40 horses, with a significant correlation emerging between the patterns of SAA concentrations and clinical assessments of the patients being monitored during their hospitalization. The results of this preliminary study support the use of SAA as an important parameter at diagnostic, prognostic, and therapeutic stages. The sequential levels of SAA appear to be particularly useful in the postintervention monitoring of surgical patients.

A survey of ocular ultrasound abnormalities in horse: 145 cases

PurposeTo describe the association of clinical and ultrasonographic (US) findings in horses affected by visual impairments, to estimate the most frequent ultrasonographic alteration as well importance and limits of US as a part of ophthalmic evaluation in equine patients.MethodsOne-hundred-forty-five horses referred to the Veterinary Teaching Hospitals of the University of Perugia and Camerino for ocular problems were submitted to ophthalmic examination and ocular ultrasound. The following group of abnormalities was established: corneal alteration, cataract, synechiae, iris prolapse, anterior chamber alterations, vitreous opacities, globe reduction, globe enlargement, retinal detachment, lens subluxation/luxation, lens rupture, intraocular masses, retrobulbar masses. Specificity, sensitivity, positive and negative predictive value and related 95% confidence interval were calculated. Kappa value was estimated for concordance evaluation.ResultsA total of 384 clinical alterations were observed during ophthalmological examination, while 357 were found by ultrasound investigation. A very good agreement was found for lens subluxation/luxation, intraocular masses, iris prolapse, globe enlargement, lens rupture, vitreous opacities and cataract. Moderate agreement was found for retinal detachment, anterior chamber alterations and synechiae. Corneal alteration and globe reduction resulted in a fair and poor agreement, respectively.ConclusionsUltrasonography affords the benefit of providing a complete cross-sectional view of the eyeball, facilitating the identification of ocular diseases in cases of loss of transparency of ocular media. It also represents an indispensable aid whenever anterior opacification precludes the use of ophthalmoscopic or biomicroscopic examination techniques.SommarioObiettiviDescrivere l’associazione tra reperti clinici ed ultrasonografici in cavalli affetti da alterazioni della visione, valutare i più frequenti reperti ultrasonografici e l’importanza ed i limiti dell’ultrasonografia come parte della valutazione oftalmologica nel cavallo.MetodiCentoquarantacinque cavalli riferiti all’ospedale Veterinario Didattico dell’Università di Perugia e di Camerino per patologie oculari sono stati sottoposti a valutazione clinica e a ultrasonografia oculare. Le alterazioni sono state suddivise nelle seguenti categorie: lesioni corneali, cataratta, sinechie, prolasso dell’iride, alterazioni della camera anteriore, opacità vitreali, riduzione dimensioni globo, aumento dimensioni globo, distacco retinico, lussazione/sublussazione del cristallino, rottura della lente, masse intraoculari, masse retrobulbari. Sono stati calcolati specificità, sensibilità, valore predittivo positivo (VPP) e negativo (VPN) con i relativi intervalli di confidenza (95%). La concordanza è stata valutata per mezzo del k-value.RisultatiSono state riscontrate un totale di 384 lesioni all’esame clinico e 357 a quello ultrasonografico. Concordanza eccellente è stata riscontrata per lussazione/sublussazione del cristallino, masse intraoculari, prolasso dell’iride, aumento di volume del globo, rottura della lente, opacità vitreali e cataratta. Concordanza moderata per distacco retinico, alterazioni della camera anteriore e sinechie. Le alterazioni corneali e la riduzione delle dimensioni del globo avevano concordanza rispettivamente pari a modesta e scarsa.ConclusioniL’ultrasonografia ha il vantaggio di fornire una visione completa della sezione dell’occhio facilitando l’identificazione di patologie causanti perdita di trasparenza delle strutture oculari. Rappresenta quindi un ausilio indispensabile nel caso di opacizzazione delle strutture anteriori che impediscono l’esecuzione di un corretto esame oftalmoscopico o biomicroscopico.

Influence of neck position on commonly performed radiographic measurements of the cervical vertebral region in horses

OBJECTIVE To determine the influence of various neck positions on cervical vertebral radiographic measurements in horses. ANIMALS 18 client-owned horses examined for lameness but free of cervical disease. PROCEDURES Laterolateral radiographs of the cervical vertebrae from C1 through T1 were acquired for each horse in 3 neck positions (low, neutral, and high). Minimum sagittal diameter, intravertebral sagittal diameter (intra-VSD) ratio, inter-VSD ratio, length of the articular processes joint ratio, vertebral alignment angle, and vertebral fossa angle were measured at each segment in each neck position. Values for the high and low positions were compared with those for the neutral position. RESULTS No significant differences from neutral position values were identified for minimum sagittal diameter, intra-VSD ratio, and vertebral fossa angle as measured in low and high neck positions. Compared with results in the neutral position, the high position resulted in a greater vertebral alignment angle at C3-4 and inter-VSD ratio at C4-5 and a lower length of the articular processes joint ratio at C2-3, C3-4, and C4-5; the low position resulted in a lower vertebral alignment angle at C4-5. However, all observed differences were small. CONCLUSIONS AND CLINICAL RELEVANCE Neck position influenced some radiographic measurements of the cervical vertebrae in horses free of cervical disease. However, because several of these measurements were not or were only minimally affected by neck position, some latitude in neck position may be possible without concern about substantially affecting radiographic measurements in this region.