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Objective: The aim of the study was to evaluate the strength and size of the double forwarder (DF) knot in 2 and 3 USP polyglactin 910 when used to form a ligature and to compare the knot holding capacity (KHC), size and weight of the DF knot to surgeon's (SU) and square (SQ) knots with varying numbers of throws., Study Design: Laboratory study., Study Population: Knotted suture., Methods: Knots were tied using 2 and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and (KHC) were recorded. Knot volume and weight were determined by digital micrometer and balance. KHC, size, and weight between knot type, number of throws, and suture type and size were compared using ANOVA testing, with p < .05 as significant., Results: In both suture types, DF knots had a higher KHC than SQ/SU knots (p < .004), with the exception of SU knots with 6-8 throws in 3 USP polyglactin 910 (p > .42). All DF knots failed by suture breakage at the knot, as did all SQ/SU knots with >6 throws. DF knots in 2 and 3 USP polyglactin 910 were larger and heavier than SQ and SU knots when the same number of throws was applied (p < .003)., Conclusion: Self-locking DF knots provided increased strength compared to SU/SQ in large gauge suture but only when fewer than six throws are applied to SU/SQ knots., Clinical Relevance: The new DF knot could be an alternative for a secure ligature., (© 2023 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Objective: To determine the effect of concurrent versus delayed treatment with corticosteroid on equine articular tissues also treated with local anesthetic in vitro in the presence of inflammatory mediators., Study Design: Controlled laboratory study., Animals: Five geldings, one mare (aged 3-18 years)., Methods: From each horse, 24 synovial and 12 osteochondral explants were cultured in a 12-well plate (2 wells/group, 2 synovial and 1 osteochondral explant/well, total 216 explants in the study). Explants were stimulated in culture medium with 10 μg/ml recombinant equine interleukin-1β and 10 μg/ml tumor necrosis factor-α for 48 hours, then randomly assigned to six treatments: unstimulated control, stimulated control, triamcinolone acetonide (TA, 10 -6  M), mepivacaine hydrochloride (MH, 4.4 mg/ml), MH + TA (concurrent) and MH + TA (delayed). The delayed group was treated with MH and, 6 days later, treated with TA. Every 3 days for 9 days total, medium levels of lactate dehydrogenase (LDH), prostaglandin E 2 (PGE 2 ), matrix metalloproteinase 13 (MMP-13) and glycosaminoglycan (GAG) were quantified via ELISA. Data were analyzed with mixed-effects models with Tukey's multiple comparisons., Results: Stimulation increased medium PGE 2 and MMP-13 and had no effect on LDH or GAG. Treatment with MH increased LDH and decreased PGE 2 and MMP-13. Treatment with TA decreased PGE 2 and MMP-13., Conclusion: There were no differences in cytotoxicity, inflammation or matrix degradation for delayed or concurrent MH and TA treatment groups up to 9 days in culture., Clinical Significance: The lack of an effect of concurrent versus delayed treatment might indicate that concurrent therapy is acceptable., (© 2022 American College of Veterinary Surgeons.)

Objectives: To combine laparoscopic techniques with natural orifice transluminal endoscopic surgery (hybrid NOTES) to minimize number and enlargement of paralumbar laparoscopic portals for bilateral ovariectomy in standing, sedated mares., Study Design: Case series., Animals: Six horses., Materials and Methods: Six mares with palpably normal ovaries were restrained in stocks, sedated, and had caudal epidural anesthesia performed. A 7.5 MHz ultrasound probe was used transvaginally to select placement of vaginotomy. An attempt was made to remove both ovaries with 70 cm esophageal forceps through the vaginotomy, while visualized and transected via ipsilateral paralumbar fossa laparoscopic portals. Surgical time, intraoperative, and postoperative complications were recorded. Vaginoscopy was performed at days 0, 3, 7, and 14 postoperatively. After 14 days, mares were euthanized and necropsied., Results: Hybrid NOTES allowed successful bilateral ovariectomy in all six mares, with a mean surgical time of 70 ± 25 min. In two mares, one ovary was dislodged from the forceps during vaginotomy extraction. Abdominal retrieval of the ovary was successful with reapplication of forceps or a surgeon's hand via vaginotomy. At necropsy, five mares had no adhesions within the abdominal cavity or at the vaginotomy site. One mare in which hand retrieval of the ovary was necessary, developed an adhesion between the bladder and the vaginotomy., Conclusions: This technique appears to offer a safe alternative for bilateral ovariectomy with minimal postoperative complications., Clinical Significance: Decreased number and size of paralumbar laparoscopic incisions could decrease complications associated with exteriorization of ovaries through the flank., (© 2021 American College of Veterinary Surgeons.)

Impairment of oxygen uptake can occur during general anesthesia in horses resulting in hypoxemia. Multiple treatments have been investigated for correction of hypoxemia with varying levels of success. In clinical trials, albuterol, a short-acting β 2 adrenergic agonist, improved arterial oxygen partial pressure (PaO 2 ) in anesthetized horses unresponsive to adjustments in mechanical ventilation and administration of positive inotropic drugs. However, controlled studies comparing the magnitude of change and duration of effect of albuterol on PaO 2 in healthy, nonhypoxemic anesthetized horses are lacking. In a prospective study, 14 horses were anesthetized and received a FiO 2 of 0.5 (n = 7) or > 0.95 (n = 7). Horses were maintained on isoflurane and mechanically ventilated. After 15 minutes, baseline PaO 2 was determined. Within each FiO 2 group, five horses were administered inhaled albuterol (2 µg/kg) and two horses received no treatment. At 10, 20, 30, and 40 minutes after baseline, PaO 2 was measured. Data for horses that received albuterol were analyzed with repeated measures analysis of variance with significance at P < .05. Horses that received albuterol had an increase in PaO 2 for at least 40 minutes after baseline. Albuterol administered via inhalation, was associated with an increased PaO 2 of at least 40 minutes compared to baseline in healthy, nonhypoxemic horses undergoing anesthesia at similar depth, using a FiO 2 of 0.5 and > 0.95. Side effects were mild and consisted of increased heart rate and sweating. Albuterol administered at 2 μg/kg via inhalation may be useful for increasing PaO 2 in anesthetized horses., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To compare a 2% lidocaine solution containing 5 μg/ml (1:200 000) epinephrine with 2% mepivacaine for reducing lameness in horses after use in proximal nerve blocks., Study Design: Experimental randomized crossover., Animals: Six adult horses with naturally occurring forelimb lameness., Methods: Horses were evaluated using an inertial gait sensor system. Lameness was measured as a vector sum (VS). Following baseline lameness examination, median and ulnar nerve blocks were performed with lidocaine/epinephrine (0.5 mg epinephrine added to 50 ml of 2% lidocaine immediately prior to administration) or an equal volume of 2% mepivacaine. Horses were trotted at 5 min and then at 30 min intervals for 150 min. After 24 h, nerve blocks were repeated using the other local anesthetic. Data were evaluated using linear models., Results: The reduction in the VS did not differ after nerve blocks with lidocaine/epinephrine or mepivacaine (P = .791). Mean time to VS <8.5 mm (n = 5) was 5 and 9.6 min for lidocaine/epinephrine and mepivacaine, respectively. For one horse, VS was not reduced to <8.5 mm with either treatment (this horse had the highest VS before treatments were administered). The decrease in VS to <8.5 mm lasted for 150 min in both treatment groups., Conclusion: The outcomes of the median and ulnar nerve blocks performed with 2% lidocaine with epinephrine did not differ from blocks performed with 2% mepivacaine., Clinical Relevance: Two percent lidocaine with epinephrine may serve as an adequate replacement for proximal nerve blocks when mepivacaine is unavailable., (© 2021 American College of Veterinary Surgeons.)

Objective: To determine the compressive effect of abdominal bandages after ventral midline celiotomy closure in horses., Study Design: Ex vivo, experimental study., Animals: Equine cadavers (n = 18), six per group., Methods: A 20-cm ventral midline celiotomy was created in each of 18 equine cadavers. A 200-L inflatable bladder was placed in the abdomen, and the linea alba was apposed. Horses were randomly assigned to no bandage (C), elastic (E), or Velcro inelastic (I) bandage groups for testing. Circumferential bandages were placed with a subbandage pressure monitoring system over the incision. The bladder was insufflated until construct failure, which was determined by a decrease in pressure reading. Bursting pressure, location of body wall or bandage failure, and subbandage pressures were recorded., Results: Maximum bursting pressure was different between groups E and C (P = .004), with no difference between groups E and I (P = .146) or I and C (P = .085). Group I achieved higher subbandage pressure compared with group E (P = .036). Abdominal compliance was not different between groups (P = .099). Location of failure differed between groups (P = .011), with failure at the diaphragm more common in group I (6/6, 100%) compared with groups E (3/6 [50%]) and C (1/6 [16.7%])., Conclusion: Elastic abdominal bandages had higher abdominal bursting pressures compared with unbandaged incisions., (© 2021 The American College of Veterinary Surgeons.)

Objective: To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots., Study Design: In vitro mechanical study., Study Population: Knotted suture., Methods: Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P < .05 considered significant., Results: In all suture types and number of throws, FE knot KHC/RKS was 28% to 66.99% (1.2-1.6 fold) stronger compared with SQ/SU knots (P < .001). For 2 USP polydioxanone, FE knots had 10% (1.1 fold) higher KHC/RKS compared with AB knots (P < .042). However, in 2 and 3 USP polyglactin 910, FE knot KHC/RKS values were not different from those of AB knots (P > .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2-1.4 fold) smaller compared with SQ/SU knots (P < .028). Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4-2.0 fold) larger compared with AB knots (P < .001)., Conclusion: Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots., Clinical Relevance: Forwarder end knots should be considered for closures when suture is placed under tension., (© 2020 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

Objective: To compare the biomechanical properties and healing of ventral midline celiotomies (VMC) closed with a self-locking knot combination and forwarder start and Aberdeen end (F-A) vs a traditional knot combination and surgeon's start and end (S-S)., Study Design: In vivo, experimental., Animals: Twenty-one horses., Methods: Fourteen horses underwent VMC, which was closed with either an F-A (n = 7) or an S-S (n = 7) knot combination. Incisions were subjectively graded by masked evaluators for dehiscence, edema, and drainage. Biomechanical testing was performed on three abdominal segments, and histology was performed on one segment from each animal after humane euthanasia 10 days post-VMC. The abdominal wall of control horses (n = 7, no celiotomy) was collected for biomechanical testing., Results: Forwarder start and Aberdeen end and S-S horses had less tensile strength compared with control horses (P ≤ .001). No differences were detected between treatment groups for any variable evaluated, including tensile strength (P = .975), location of failure (P = .240), and histologic healing at the knot (P = .600)., Conclusion: Closure of VMC with self-locking knots resulted in biomechanical and healing features similar to those with a traditional closure technique, with neither restoring the tensile strength of the linea alba., Clinical Significance: Results of this study provide evidence to support a clinical trial to evaluate long-term performance of the F-A self-locking knot closure in horses., (© 2020 American College of Veterinary Surgeons.)

Objective: To evaluate the effect of changes in intraabdominal pressure (IAP) on central venous pressure (CVP) in normal horses., Design: Experimental, in vivo study., Setting: University Teaching Hospital., Animals: Convenience sample of 7 mixed breed horses-5 geldings and 2 mares., Interventions: Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intraabdominal hypertension. CVP was obtained from the cranial vena cava, concurrent with pressure obtained from the peritoneal cavity., Measurements and Main Results: CVP increased as IAP increased up to 12 mm Hg, and declined as IAP increased further. The changes in CVP over time were significantly different (P < 0.03). Repeated measures correlation was positive, and highest, for mean CVP as IAP increased from 0 to 12 mm Hg (r = .70; 95% CI, .43-.85; P < 0.0001). Correlation of mean CVP with insufflation pressure became negative as IAP increased further from 15 to 20 mm Hg (r = -.47; 95% CI, -.66 to -.21; P = 0.0006)., Conclusions: This report provides preliminary data demonstrating a biphasic trend in equine CVP caused by changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this trend and to confirm these results in clinical patients., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To evaluate the effect of changes in intra-abdominal pressure (IAP) on medial saphenous venous pressure (MSVP) and hemodynamics in normal horses., Design: Experimental, in-vivo study., Setting: University Teaching Hospital., Animals: Convenience sample of 7 mixed breed horses; 5 geldings, and 2 mares., Interventions: Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intra-abdominal hypertension. The MSVP and vital parameters were recorded, along with direct arterial blood pressure from the transverse facial artery., Measurements and Main Results: As IAP increased, MSVP increased in a stepwise manner, in concert with changes in IAP. The consistency in measurement between MSVP and IAP was high (intraclass correlation coefficient = 0.92; P < 0.001) and repeated measures correlation was excellent (r = 0.98; P < 0.001). Heart rate was unchanged over the course of the experiment (P = 0.09), however, respiratory rate increased with increasing IAP (P < 0.001). Arterial blood pressure also increased with insufflation (P < 0.001), with a significant difference at an IAP of 15 mm Hg (P = 0.04)., Conclusions: This report provides preliminary data demonstrating a strong correlation between equine MSVP and changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this relationship, and to confirm these results in clinical patients., (© Veterinary Emergency and Critical Care Society 2020.)

Fresh and frozen cartilage samples of the fetlock, carpus, and stifle were collected from 12 deceased horses. Half were measured immediately following extraction, and half were frozen for seven days and then measured. Seven indentations (various normalized displacements) were implemented with an indention rate of 0.1 mm/s. Solid phase aggregate modulus (Es), hyperelastic material constant (α), and fluid load fraction (F') of equine articular cartilage were assessed using the Ogden hyperelastic model. The properties were statistically compared in various joints (fetlock, carpus, and stifle), and between fresh and frozen samples using various statistical models. There was no statistical difference between the fetlock and carpus in the aggregate modulus (p = 0.5084), while both were significantly different from the stifle (fetlock: p = 0.0017 and carpus: p = 0.0406). For the hyperelastic material constant, no statistical differences between joints were observed (p = 0.3310). For the fluid load fraction, the fetlock and stifle comparison showed a difference (p = 0.0333), while the carpus was not different from the fetlock (p = 0.1563) or stifle (p = 0.3862). Comparison between the fresh and frozen articular cartilage demonstrated no significant difference among the joints in the three material properties: p = 0.9418, p = 0.7031, and p = 0.9313 for the aggregate modulus, the hyperelastic material constant, and the fluid load fraction, respectively., (Copyright © 2020 by ASME.)

This case represents the first reported case of Bipolaris hawaiiensis infection in an equid, and its aggressive clinical course. This case provides important descriptive and prognostic information for horses diagnosed with phaeohyphomycotic rhinitis. A 19-year-old American Quarter Horse mare was presented for second opinion of stertor and exercise intolerance of four-month duration. Endoscopy revealed generalized, proximal nasal edema, and computed tomography identified a soft tissue mass eroded through the rostral nasal bone. Biopsy of the mass was identified as a fungal granuloma caused by B. hawaiiensis resulting in chronic invasive fungal rhinitis. Treatment options were limited because of invasive infection, financial constraints, fungal sensitivity results, and published accounts of in vivo behavior of the organism. The infection progressed, resulting in euthanasia. In this case of equine phaeohyphomycosis, B. hawaiiensis was likely traumatically introduced into the patient's nasal cavity. Its aggressive nature in an apparently immunocompetent patient is noteworthy, in the face of surgical debridement and attempted medical therapy. Therapeutic decisions were challenging in this case based on limited in vivo efficacy data in equids, pharmacokinetic challenges with available antifungal agents, and client-driven limitations regarding management of airway restriction., (Published by Elsevier Inc.)

Objective: To evaluate the effect of exposure to a balanced electrolyte solution (BES), or equine abdominal fat on the knot-holding capacity (KHC), relative knot security (RKS), weight, and volume of forwarder knots versus surgeon's knots., Sample: 315 knots tied and tested in vitro., Procedures: United States Pharmacopeia size-3 polyglactin 910 suture exposed to air (dry [control]), equine abdominal fat (fat-exposed), or BES (BES-exposed) was used to tie forwarder knots with 2, 3, and 4 throws and surgeon's knots with 5, 6, 7, and 8 throws. A universal materials testing machine was used to test the tensile strength of suture and knots to failure, and the KHC, RKS, weight, and volume of knots were determined., Results: Forwarder knots had significantly higher KHC and RKS and lower volume, compared with surgeons' knots. Forwarder knots tied with fat-exposed suture had greater weight, but not volume, than did forwarder knots tied with dry or BES-exposed suture with the same number of throws., Conclusions and Clinical Relevance: Results indicated that forwarder knots were superior to surgeon's knots when configured as start knots intended for continuous lines of suture. Exposure to media did not negatively affect mechanical or physical properties of forwarder knots and may improve specific biomechanical functions, including KHC and RKS.

Suitable use of prophylactic antimicrobial drugs for wounds depends on the accurate selection of appropriate antibiotics, dosing regimen, and duration of use. Regional intravenous delivery and intraosseous infusion of antibiotics are pivotal to a successful outcome for deep-rooted infections, inadequately perfused tissue, and infected wounds containing biofilm. Antibiotic-impregnated polymethylmethacrylate beads are predominantly helpful for wounds that have a poor blood supply and for those containing surgical implants that must remain in place., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To compare the bursting strength and failure mode of ventral midline celiotomy closed with a simple continuous suture pattern with 1 of 2 knot combinations, a novel self-locking knot combination of a forwarder start with an Aberdeen end knot (F-A) and a traditional combination of a surgeon's start with a surgeon's end knot (S-S)., Study Design: Ex vivo experimental., Sample Population: Equine cadavers (n = 14)., Methods: A 20-cm ventral midline celiotomy was created in 14 equine cadavers. Horses were assigned to celiotomy closure with an F-A or S-S knot combination. Prior to closure, a 200-L inflatable bladder was placed in the abdomen and then insufflated until failure of the celiotomy closure. The horses' signalment, weight, breed, and age, as well as knot combination type, mode of failure, closure time, and bursting strength (mm Hg) were recorded., Results: The median bursting strength was significantly greater when incisions were closed with the F-A knot combination (388 mm Hg) compared with the S-S knot combination (290 mm Hg) (P = .035). Most incisions failed along the fascia when closed with F-A combinations and at the knot when closed with S-S combinations., Conclusion: The bursting strength of ventral midline incisions in equine cadavers was increased by an average of 25% when closed with the self-locking F-A knot combination., Clinical Significance: Closing ventral midline celiotomies with an F-A knot combination may provide a more secure closure than the traditional S-S knot combination. Additional in vivo investigation is required prior to recommending this closure in clinical cases., (© 2018 The American College of Veterinary Surgeons.)

Objective: To investigate the knot holding capacity (KHC) of pattern-ending square, surgeon's and Aberdeen knots each tied in 4 throw combinations using large gauge suture after exposure to media commonly found in equine abdominal surgery., Study Design: In vitro mechanical study., Sample Population: Knotted suture strands (n = 10/group)., Methods: Strands of 2 polydioxanone or 3 polyglactin 910 were exposed to 1 of 4 media for 15 minutes. Control suture strands remained dry. Media used included balanced electrolyte solution, 1% sodium carboxymethylcellulose, equine serum, or equine fat. Pattern-ending knots for the 3 knot configurations were loaded to failure in a linear fashion on a materials testing machine to determine KHC., Results: Surgeon's knots tied using media-exposed 3 polyglactin 910 had a significantly higher KHC than the same dry knots with 5 and 6 throws. Square knots tied using media-exposed to 3 polyglactin 910 had a significantly higher KHC than the same dry knots at 5 throws. Aberdeen knots tied with either media-exposed 2 polydioxanone or 3 polyglactin 910 had a significantly higher KHC than their equivalent dry knots. Aberdeen knots had a superior KHC, while requiring less suture than both surgeon's and square knots., Conclusion: Media exposure either had no effect on KHC or significantly improved the KHC of all knots investigated. Based on KHC and knot volume, Aberdeen knots tied using media-exposed 3 polyglactin 910 with 3 throws and 1 turn are recommended to end a continuous suture pattern., (© 2017 The American College of Veterinary Surgeons.)

Objective: To investigate the strength and size of surgeon's and square knots for starting and ending continuous suture lines using large gauge suture., Study Design: In vitro mechanical study., Study Population: Knotted suture., Methods: Surgeon's and square knots were tested using 2 and 3 USP polyglactin 910 and 2 USP polydioxanone under linear tension on a universal testing machine. Failure mode and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated as a percentage of KHC. Comparisons were made between number of throws, suture size, suture type, and knot types. Knot volume and weight were assessed by a digital micrometer and balance, respectively., Results: There were no significant differences in KHC (P = .295), RKS (P = .307), volume (P = .128), or weight (P = .310) between square and surgeon's knots at the start or end of suture lines with the same number of throws and suture type. A minimum of 6 throws were required for start knots and 7 throws at end knots to prevent unraveling. Knots tied with 3 polyglactin 910 were strongest (P < .001) and 2 polyglactin 910 produced knots with higher KHC and RKS than 2 polydioxanone (P < .001)., Conclusion: No consistent differences were detected between knots types tied with the same suture material; however, number of throws affected KHC and RKS up to 6 throws in start or 7 throws in end knots. The configuration of square and surgeon's knots performed at the end of a continuous line alters their KHC, supporting the use of additional throws for knot security., (© 2017 The American College of Veterinary Surgeons.)

Objective: To investigate the strength, size, and holding capacity of the self-locking forwarder knot compared to surgeon's and square knots using large gauge suture., Study Design: In vitro mechanical study., Study Population: Knotted suture., Methods: Forwarder, surgeon's, and square knots were tested on a universal testing machine under linear tension using 2 and 3 USP polyglactin 910 and 2 USP polydioxanone. Knot holding capacity (KHC) and mode of failure were recorded and relative knot security (RKS) was calculated as a percentage of KHC. Knot volume and weight were assessed by digital micrometer and balance, respectively. ANOVA and post hoc testing were used tocompare strength between number of throws, suture, suture size, and knot type. P<.05 was considered significant., Results: Forwarder knots had a higher KHC and RKS than surgeon's or square knots for all suture types and number of throws. No forwarder knots unraveled, but a proportion of square and surgeon's knots with <6 throws did unravel. Forwarder knots had a smaller volume and weight than surgeon's and square knots with equal number of throws. The forwarder knot of 4 throws using 3 USP polyglactin 910 had the highest KHC, RKS, and the smallest size and weight., Conclusion: Forwarder knots may be an alternative for commencing continuous patterns in large gauge suture, without sacrificing knot integrity, but further in vivo and ex vivo testing is required to assess the effects of this sliding knot on tissue perfusion before clinical application., (© Copyright 2016 by The American College of Veterinary Surgeons.)

Objective: To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space., Study Design: Experimental in vivo study., Animals: Normal horses without previous history of abdominal surgery (n=8)., Methods: The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by necropsy in 6 horses. The length of closure was measured and nature of the healed tissue was evaluate grossly., Results: Total surgery time was 65-167 minutes (mean ± SD, 89.6 ± 22.6). Suturing time was 30-65 minutes (40.4 ± 16.3). Second laparoscopy in 2 horses was performed at days 198 and 227. Necropsy was performed at day 69-229 postoperatively (132.7 ± 63.0) in 6 horses. The closure measured 12-14 cm in length (13 ± 1) and consisted of mature fibrous tissue bridging the splenic capsule and the nephrosplenic ligament. No residual suture material was identified grossly in any horses. The procedure was easily performed; extracorporeal suture management to hold it taut was unnecessary since the barbs had excellent purchase in the apposed tissues, and intracorporeal knot tying was not required., Conclusion: The barbed knotless suture appears to be a valid alternative to facilitate laparoscopic closure of the nephrosplenic space in normal horses; however, further work is necessary to investigate its suitability in clinically affected horses., (© Copyright 2016 by The American College of Veterinary Surgeons.)

Objective: To compare the load to ultimate failure, load to a 2 mm gap, mode of failure, and gap at failure (mm) of the Teno Fix(®) (TF) to the 3-loop pulley (3LP) for repair of equine tendon lacerations. The use of 4TF devices versus 5TF devices on load to ultimate failure and load to a 2 mm gap was also compared., Study Design: Ex vivo biomechanical study; unbalanced incomplete block (horse) design., Samples: Cadaveric equine forelimb superficial digital flexor tendon (n = 20 paired tendons)., Methods: Ten tendon pairs were selected randomly and repaired with a 3LP and 4TF pattern, and 10 tendon pairs repaired with a 3LP and 5TF pattern. Load to ultimate failure, load to a 2 mm gap, mode of failure, and gap at failure were obtained using materials testing., Results: The 3LP had a significantly greater ultimate load to failure (P < .001, respectively) and a significantly higher load to a 2 mm gap than both TF repairs (P < .001, respectively). The most frequent mode of failure was suture pull-out for the 3LP and anchor pull-out for the TF. Gap at failure was significantly larger in the 3LP than both TF repairs (P < .001). The ultimate load to failure was significantly higher for the 5TF than the 4TF (P = .004) but there was no significant difference in load to a 2 mm gap, or gap at failure between both TF repairs (P = .11, P = .15, respectively)., Conclusions: Neither TF repair was stronger than the 3LP in load to ultimate failure and load to a 2 mm gap. Addition of a fifth TF device significantly increased the load to ultimate failure but did effect the load to a 2 mm gap over the 4TF., (© Copyright 2015 by The American College of Veterinary Surgeons.)

Purpose: Thicknesses of fresh equine articular cartilage surfaces from the fetlock, carpal and stifle joints were measured employing a needle probe test., Materials and Methods: Eighty-seven samples used in measurement were cultivated from fetlock, carpal and stifle joints of 12 deceased within 4 h of death. After approximately three minutes of exposure to air during dissection, all cartilage samples were preserved in a saline solution to keep the articular cartilage hydrated for testing. The thickness was measured on five different spots on the same sample. The thicknesses of the fetlock, carpus and stifle were compared., Results: The articular cartilage of the stifle was thicker than the fetlock and carpus, while the fetlock and the carpus had similar thickness values. The average thickness of the fetlock, carpal and stifle joint are 0.86, 0.87 and 2.1 mm, respectively. They were statistically compared using the Student t-test. The differences on the articular cartilage thicknesses between the fetlock and stifle, and carpus and stifle were "very highly significant" (p < 0.001). This indicates that the articular cartilage thickness of the stifle is significantly different from that of the fetlock and carpus. Four different surfaces in the fetlock and four in the carpal joint were also compared. Significant differences between each set of the four surfaces were not observed. In the carpus, the difference in thickness between the distal radius and proximal third carpal bone articular cartilage surfaces as well as the proximal radial carpal bone and distal radial carpal bone articular cartilage surfaces were statistically significant.

Bullet wounds in horses can cause a wide array of injuries, determined by the type of projectile, the energy of the bullet on entry, and the type of tissue the bullet encounters. Treatment includes identification of all structures involved, debridement of the permanent cavity, and establishing adequate drainage. Bullet wounds should be treated as contaminated, and broad-spectrum antibiotics, including those with an anaerobic spectrum, are indicated. Although musculoskeletal injuries resulting from gunshots are most common in horses, they carry a good prognosis for survival and return to function., (Published by Elsevier Inc.)

Objective: To compare in vitro strength and failure characteristics of a tendon implant against a 3 loop pulley suture pattern for equine superficial digital flexor tendon (SDFT) laceration repair., Study Design: Experimental., Study Population: Cadaveric equine forelimb SDFT (n = 16)., Methods: One tendon of each of 8 pair of SDFT was randomly selected for repair with either the 3-loop pulley (3LP) suture pattern using 2 polydioxanone or with 4 stainless steel suture and anchor implants (SA). Ultimate load to failure, mode of failure, gap at failure, and load to 2 mm gap were obtained using a materials testing system synchronized with a high-speed camera. Statistical evaluation was made using Student's t-test; significance was set at P ≤ .05., Results: The 3LP failed at a significantly (P = .0001) greater load (363.5 ± 83.7 N) than SA (132.4 ± 26.8 N), but the load to a 2 mm gap (3LP = 164.9 ± 67.7 N, SA = 114.5 ± 21.5 N) was not significantly different (P = .09). Failure mode was by suture pull out and anchor pull out respectively. The gap at failure was significantly larger in the 3LP than in SA repair (P = .000005)., Conclusions: Both the SA repair and the 3LP resisted similar tension to 2 mm gap. However, the ultimate load to failure of the SA repair was only 36% that of the 3LP repair., (© Copyright 2014 by The American College of Veterinary Surgeons.)

Cartilage is a unique material in part because of it biphasic properties. The structure of cartilage is a porous matrix of collagen fibers, permeated with synovial fluid which creates a gliding and near frictionless motion in articulating joints. However, during in vitro testing or surgery, there exists potential for cartilage to dehydrate, or dry out. The effects of this drying can influence experimental results. It is likely that drying also changes joint performance in vivo. In in vitro testing of equine cartilage explants exposed to open air, the average roughness of cartilage changes from 1.85 ± 0.78 to 3.66 ± 1.41 µm SD in a 5-h period. Significant changes in roughness in individual samples are seen within 10 min of exposure to open air. However, the multi-scale nature of cartilage, characterized by the fractal dimension, does not significantly change during the same period. The current study attempts to quantify the magnitude of error that is introduced when cartilage is removed from its native environment., (© 2013 Wiley Periodicals, Inc.)

Microdeletions of chromosomal region 2q23.1 that disrupt MBD5 (methyl-CpG-binding domain protein 5) contribute to a spectrum of neurodevelopmental phenotypes; however, the impact of this locus on human psychopathology has not been fully explored. To characterize the structural variation landscape of MBD5 disruptions and the associated human psychopathology, 22 individuals with genomic disruption of MBD5 (translocation, point mutation and deletion) were identified through whole-genome sequencing or cytogenomic microarray at 11 molecular diagnostic centers. The genomic impact ranged from a single base pair to 5.4 Mb. Parents were available for 11 cases, all of which confirmed that the rearrangement arose de novo. Phenotypes were largely indistinguishable between patients with full-segment 2q23.1 deletions and those with intragenic MBD5 rearrangements, including alterations confined entirely to the 5'-untranslated region, confirming the critical impact of non-coding sequence at this locus. We identified heterogeneous, multisystem pathogenic effects of MBD5 disruption and characterized the associated spectrum of psychopathology, including the novel finding of anxiety and bipolar disorder in multiple patients. Importantly, one of the unique features of the oldest known patient was behavioral regression. Analyses also revealed phenotypes that distinguish MBD5 disruptions from seven well-established syndromes with significant diagnostic overlap. This study demonstrates that haploinsufficiency of MBD5 causes diverse phenotypes, yields insight into the spectrum of resulting neurodevelopmental and behavioral psychopathology and provides clinical context for interpretation of MBD5 structural variations. Empirical evidence also indicates that disruption of non-coding MBD5 regulatory regions is sufficient for clinical manifestation, highlighting the limitations of exon-focused assessments. These results suggest an ongoing perturbation of neurological function throughout the lifespan, including risks for neurobehavioral regression.

Objective: To describe a laparoscopic technique for, and short-term outcome after, closure of the epiploic foramen (EF) in horses., Study Design: Descriptive, experimental study., Animals: Healthy, adult horses (n = 6)., Methods: Laparoscopic portals to approach the EF were identified in standing horses. Under laparoscopic observation, the gastropancreatic fold and right lobe of the pancreas were grasped with Babcock forceps and secured to the caudate hepatic lobe using helical titanium coils to obliterate the EF. Surgical procedure time and intra- and postoperative complications were recorded. Serial analysis of select serum enzymes was used as an indication of involvement of the pancreas and liver. Closure was reevaluated at 4 weeks using repeat laparoscopy, and necropsy was performed immediately after., Results: At initial surgery, EF closure was successful in all 6 horses; median surgical time was 40.5 minutes (range, 22-110 minutes). Serum gamma-glutamyl transferase (GGT) and sorbitol dehydrogenase (SDH) were not significantly altered by the surgical procedure; however, aspartate aminotransferase (AST) and amylase (AMY) were transiently increased. At repeat laparoscopic reevaluation, closure was complete in 5 horses, with partial closure of the EF observed in 1 horse. No complications related to the procedure were noted during or after surgery in any horse., Conclusions: EF closure in the standing horse can be accomplished without complications to the surrounding organs and vessels., (© Copyright 2013 by The American College of Veterinary Surgeons.)

Objective: To measure intra-abdominal pressure (IAP) in horses that crib and compare it with IAP in horses that do not have this vice., Study Design: Cohort study., Animals: Healthy cribbing horses (cribbing cohort, n = 8) and 8 healthy noncribbing horses (noncribbing cohort)., Methods: A microsensor catheter was introduced into the peritoneal cavity through the right paralumbar fossa, using local anesthesia, for measurement of IAP. These pressures were recorded in 1-minute intervals for 2 hours, while the horses were standing tied in a stall. IAPs of cribbing horses were compared to the noncribbing cohort., Results: Baseline IAPs were not significantly different between cribbing and noncribbing cohorts (P = .076); however, IAPs in the cribbing cohort were significantly increased when compared with the noncribbing cohort, during active cribbing behavior (P = .0016). Frequency of cribbing was not associated with increased IAP (P = .35). IAPs in the cribbing cohort remained significantly elevated compared with the noncribbing cohort, even after the behavior had ceased (P = .0002)., Conclusion: Cribbing is associated with increased IAP in the horse, both during and after the behavior., (© Copyright 2013 by The American College of Veterinary Surgeons.)

Objective: To determine the effect of gastric distension on intraabdominal pressures (IAP) measured directly from the intraperitoneal space., Design: Prospective, experimental study., Setting: A university-based equine research facility., Animals: Ten healthy adult horses, 5 males and 5 females., Interventions: Intraabdominal pressures were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder at 6 time points: at rest, after placement of a nasogastric tube, and after instillation of each 5 L increment up to a total of 20 L of water. Simultaneously, mean arterial pressures (MAP) were obtained using a tail cuff, and abdominal perfusion pressures (APP) were calculated using the measured IAP minus the measured MAP., Measurements and Main Results: Baseline direct IAP measurements were subatmospheric (-4.5 ± 3.0 cm H2 O). IAPs were not significantly affected by placement of a nasogastric tube (-2.69, 95% CI [-3.24, -2.14], P = 0.4195), but were significantly increased after placement of 5 L (-1.73, 95% CI [-2.28, -1.18], P = 0.0015), 10 L (-0.54, 95% CI [-1.09,0.01], P = 0.0001), 15 L (0.89, 95% CI [0.34, 1.44], P = 0.0001), or 20 L (3.08, 95% CI [2.53, 3.63], P = 0.0001) of water into the stomach. APPs were not significantly different for any volume of fluid infused into the stomach (P = 0.05 for all comparisons)., Conclusion: IAPs were significantly increased when > 5 L of water was infused into the stomach. These results indicate the need for further research in clinical cases to determine the relationship between gastric pressures and the development of intraabdominal hypertension in horses., (© Veterinary Emergency and Critical Care Society 2013.)

Objective: To determine the effect of an abdominal support wrap and transrectal abdominal palpation on intra-abdominal pressures (IAPs) measured directly from the peritoneal space., Design: Prospective, experimental study., Setting: A university-based equine research facility., Animals: Ten healthy adult horses, 5 males and 5 females., Interventions: IAPs were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder. Triplicate measurements were obtained at rest, during transrectal palpation, after placement of an abdominal support wrap, and during transrectal palpation with the support wrap still in place. Simultaneous mean arterial pressures were obtained using a tail cuff and abdominal perfusion pressures were calculated using the measured IAP minus the measured mean arterial pressures., Measurements and Main Results: Baseline direct pressure measurements were subatmospheric (-4.5 ± 3.0 cm H(2) O). IAPs were not significantly affected by transrectal palpation, but were significantly increased after placement of an abdominal support wrap (-1.19 ± 3.01 cm H(2) O; P = 0.01). Abdominal perfusion pressures were not significantly affected by either transrectal palpation or application of the support wrap., Conclusion: IAPs were significantly increased after application of an abdominal support wrap commonly used after exploratory laparotomy. Further investigations are warranted to determine the clinical implications of abdominal bandaging on IAP and its implications on postoperative complications including intra-abdominal hypertension. However, transrectal abdominal palpation likely does not contribute to abdominal hypertension in normal horses., (© Veterinary Emergency and Critical Care Society 2012.)

The naturally occurring structure of articular cartilage has proven to be an effective means for the facilitation of motion and load support in equine and other animal joints. For this reason, cartilage has been extensively studied for many years. Although the roughness of cartilage has been determined from atomic force microscopy (AFM) and other methods in multiple studies, a comparison of roughness to joint function has not be completed. It is hypothesized that various joint types with different motions and regimes of lubrication have altered demands on the articular surface that may affect cartilage surface properties. Micro- and nanoscale stylus profilometry was performed on the carpal cartilage harvested from 16 equine forelimbs. Eighty cartilage surface samples taken from three different functioning joint types (radiocarpal, midcarpal, and carpometacarpal) were measured by a Veeco Dektak 150 Stylus Surface Profilometer. The average surface roughness measurements were statistically different for each joint. This indicates that the structure of cartilage is adapted to, or worn by, its operating environment. Knowledge of cartilage micro- and nanoscale roughness will assist the future development and design of treatments for intra- articular substances or surfaces to preserve joint integrity and reduce limitations or loss of joint performance.

Objective: To determine the lowest ACTH dose that would induce a maximum increase in serum cortisol concentration in healthy adult horses and identify the time to peak cortisol concentration., Design: Evaluation study., Animals: 8 healthy adult horses., Procedures: Saline (0.9% NaCl) solution or 1 of 4 doses (0.02, 0.1, 0.25, and 0.5 μg/kg [0.009, 0.045, 0.114, and 0.227 μg/lb]) of cosyntropin (synthetic ACTH) were administered IV (5 treatments/horse). Serum cortisol concentrations were measured before and 30, 60, 90, 120, 180, and 240 minutes after injection of cosyntropin or saline solution; CBCs were performed before and 30, 60, 120, and 240 minutes after injection., Results: For all 4 doses, serum cortisol concentration was significantly increased, compared with the baseline value, by 30 minutes after administration of cosyntropin; no significant differences were detected among maximum serum cortisol concentrations obtained in response to administration of doses of 0.1, 0.25, and 0.5 μg/kg. Serum cortisol concentration peaked 30 minutes after administration of cosyntropin at a dose of 0.02 or 0.1 μg/kg, with peak concentrations 1.5 and 1.9 times, respectively, the baseline concentration. Serum cortisol concentration peaked 90 minutes after administration of cosyntropin at a dose of 0.25 or 0.5 μg/kg, with peak concentrations 2.0 and 2.3 times, respectively, the baseline concentration. Cosyntropin administration significantly affected WBC, neutrophil, and eosinophil counts and the neutrophil-to-lymphocyte ratio., Conclusions and Clinical Relevance: Results suggested that in healthy horses, administration of cosyntropin at a dose of 0.1 μg/kg resulted in maximum adrenal stimulation, with peak cortisol concentration 30 minutes after cosyntropin administration.

Objective: To develop an indirect method for measurement of intraabdominal pressures in the standing horse using measurement of gastric pressures as a less invasive technique, and to compare this method with direct intraabdominal pressures obtained from the peritoneal cavity., Design: Prospective, experimental study., Setting: University-based equine research facility., Animals: Ten healthy adult horses, 7 geldings and 3 mares., Interventions: Gastric pressures were measured using a nasogastric tube with a U-tube manometry technique, while intraperitoneal pressures were measured with a peritoneal cannula. Measurements of intraabdominal pressure were obtained by both methods, simultaneously, and were evaluated using 5 increasing volumes of fluid infused into the stomach (0, 400, 1,000, 2,000, and 3,000 mL). Bias and agreement between the 2 methods were determined using Bland-Altman analysis and Lin's concordance correlation coefficients., Measurements and Main Results: Mean gastric pressure was 14.44 ± 4.69 cm H(2)O and ranged from 0 to 25.8 cm H(2)O. Intraperitoneal pressure measurements were generally subatmospheric, and ranged from -6.6 to 3.1 cm H(2) O (mean ± SD, -1.59 ± 2.09 cm H(2)O). Measurements of intraperitoneal pressures were repeatable; however, intra- and interindividual variance was significantly larger for measurements of gastric pressures. The mean and relative bias for comparison between the 2 techniques was 15.9 ± 5.3 cm H(2)O and 244.3 ± 199.2%, respectively. The Lin's concordance correlation coefficient between gastric and intraperitoneal pressures was -0.003 but this was not statistically significant (P=0.75)., Conclusions: There was no statistical concordance between measurements of intraabdominal pressure using gastric and intraperitoneal pressure measurement, indicating that gastric pressures cannot be substituted for intraperitoneal pressure measurement. Direct measurement of intraperitoneal pressures may be a more consistent method for comparison of intraabdominal pressures between horses, due to less variability within and between individuals., (© Veterinary Emergency and Critical Care Society 2011.)

Navicular syndrome is a chronic, progressive condition affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. The treatment options for navicular syndrome are as varied as the proposed causes of the condition. The severity of clinical signs, intended use and workload of the horse, and owner compliance with therapy are important considerations in developing a treatment plan. Nonsurgical treatment of navicular syndrome consists of rest, hoof balance and corrective trimming/shoeing, and medical therapy, including administration of systemic antiinflammatories, hemorheologic medications, and intraarticular medications. While surgical therapy can include desmotomy of the collateral (suspensory) ligaments of the navicular bone, palmar digital neurectomy is more commonly performed when medical therapy is ineffective. Recently, adjunct therapies, such as acupuncture and extracorporeal shock wave therapy, have also been used to treat horses with navicular syndrome. Because of the wide range of pathologic changes and the lack of a definitive cure associated with navicular syndrome, treatment is directed toward the individual horse, focusing on the management of clinical signs to alleviate stress and retard degenerative changes of the navicular bursal and navicular regions.

Navicular syndrome is a chronic and often progressive disease affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. This syndrome has long been considered one of the most common causes of forelimb lameness in horses. Diagnosis of navicular syndrome is based on history, physical examination, lameness examination, and peripheral and/or intraarticular diagnostic anesthesia. Several imaging techniques (e.g., radiography, ultrasonography, nuclear scintigraphy, thermography, computed tomography [CT], magnetic resonance imaging [MRI]) are used to identify pathologic alterations associated with navicular syndrome. Radiographic changes of the navicular bone are not pathognomonic for navicular syndrome. Additionally, not all horses with clinical signs of navicular syndrome have radiographic changes associated with the navicular bone. Therefore, newer imaging modalities, including CT and especially MRI, can play an important role in identifying lesions that were not observed on radiographs. Navicular bursoscopy may be necessary if the clinical findings suggest that lameness originates from the navicular region of the foot and if other imaging modalities are nondiagnostic. With new diagnostic imaging techniques, clinicians are learning that anatomic structures other than the navicular bursa, navicular bone, and DDFT may play an important role in navicular syndrome.

Objectives: To develop a direct method for measuring intra-abdominal pressures in the standing horse, identify a reference interval for direct intra-abdominal pressures, compare these pressures to indirect intra-abdominal pressures measured from the bladder, and determine the optimal bladder infusion volume for indirect pressure measurement., Design: Prospective, experimental study., Setting: A university-based equine research facility., Animals: Ten healthy adult horses, 5 males and 5 females., Interventions: Direct intra-abdominal pressures were measured through an intraperitoneal cannula and zeroed at the height midway between the height of the tuber ishii and point of the shoulder. Indirect measurements of intra-abdominal pressure were performed by measuring intravesicular pressures through a transurethral catheter zeroed at the tuber ishii., Measurements and Main Results: Direct pressure measurements obtained in the standing horse were subatmospheric (mean, -1.80 cm H(2)O; SD, 1.61 cm H(2)O; 95% CI, -2.80 to -0.80) and were shown to decrease as the horse's weight increased (Pearson's r=-0.67, P=0.04), with no effect of head position (P=0.15). Mean baseline indirect pressure measurements (mean, -8.63 cm H(2)O; SD, 4.37 cm H(2)O; 95% CI, -13.05 to -4.21) were significantly different from the pressures measured directly from the abdomen (P<0.001). Indirect pressure measurements were noted to increase with increasing volumes infused into the bladder, and were statistically different at a volume of 100 mL (P=0.004). There was low to moderate correlation between direct and indirect pressure measurements of intra-abdominal pressure over a range of fluid volumes infused into the bladder (Pearson's correlation range -0.38 to 0.58)., Conclusion: Pressures measured directly in the standing horse were subatmospheric, and increased as the horse's weight increased. Indirect pressures measured were altered by increasing volumes infused in the bladder. There was no significant correlation between the 2 methods of intra-abdominal pressure measurement.

Case Description: A 7-year-old 509-kg (1,120-lb) Tennessee Walking Horse mare was evaluated because of bilateral mucosanguinous nasal discharge, intermittent right-sided epistaxis, and worsening dyspnea of 9 months' duration., Clinical Findings: Multiple masses in the nasopharynx were detected via endoscopic and radiographic examinations. Cytologic and histologic examinations of biopsy specimens of 1 mass revealed round yeasts with thick nonstaining capsules and occasional narrow-based budding that resembled cryptococcal organisms., Treatment and Outcome: Oral administration of fluconazole and organic ethylenediamine dihydriodide and intermittent intralesional injections with fluconazole, amphotericin B, and formalin resulted in resolution of lesions for a period of 2.5 years. The horse then developed exophthalmos, recurring clinical signs, and extensive nasopharyngeal masses. The masses were surgically debulked via a large frontonasal bone flap, and the horse was treated with IV injections of amphotericin B and long-term oral administration of fluconazole. Clinical signs did not recur in the following 2-year period. A presumptive diagnosis of cryptococcosis was made following cytologic and histologic evaluations of the masses; results of serologic analysis and fungal culture confirmed infection with Cryptococcus neoformans., Clinical Relevance: Cryptococcal infection of the upper respiratory tract in horses has previously been described as a uniformly fatal disease. As this case report illustrates, medical and surgical treatment of sinonasal cryptococcal granulomas in horses may be successful, but the importance of long-term follow-up and the potential for disease recrudescence should be considered. As efficacious antifungal agents become less expensive, their increased use will likely decrease mortality rates in horses with fungal infections.

Complications of wounds and cosmetic surgery can be accurately managed with a combination of timely surgical and medical intervention to ensure the best possible outcome. The lack of soft tissue protection and a large quantity of susceptible synovial, tendon, ligament, and neurovascular structures make early and meticulous evaluation of limb wounds critical. Skin grafting is usually used following a period of open wound management and after healthy granulation tissue formation. Penetrating wounds of the abdomen or thorax have a guarded prognosis resulting from the ensuing potential for infection and pneumothorax. Gunshot wounds limited to the skeletal muscles have a good prognosis, whereas injuries that involve vital organs decreased survivability.

Objective: To evaluate the pharmacokinetic-pharmacodynamic parameters of enrofloxacin and a low dose of amikacin administered via regional IV limb perfusion (RILP) in standing horses., Animals: 14 adult horses., Procedures: Standing horses (7 horses/group) received either enrofloxacin (1.5 mg/kg) or amikacin (250 mg) via RILP (involving tourniquet application) in 1 forelimb. Samples of interstitial fluid (collected via implanted capillary ultrafiltration devices) from the bone marrow (BMIF) of the third metacarpal bone and overlying subcutaneous tissues (STIF), blood, and synovial fluid of the radiocarpal joint were collected prior to (time 0) and at intervals after tourniquet release for determination of drug concentrations. For pharmacokinetic-pharmacodynamic analyses, minimum inhibitory concentrations (MICs) of 16 microg/mL (amikacin) and 0.5 microg/mL (enrofloxacin) were applied., Results: After RILP with enrofloxacin, 3 horses developed vasculitis. The highest synovial fluid concentrations of enrofloxacin and amikacin were detected at time 0; median values (range) were 13.22 microg/mL (0.254 to 167.9 microg/mL) and 26.2 microg/mL (5.78 to 50.0 microg/mL), respectively. Enrofloxacin concentrations exceeded MIC for approximately 24 hours in STIF and synovial fluid and for 36 hours in BMIF. After perfusion of amikacin, concentrations greater than the MIC were not detected in any samples. Effective therapeutic concentrations of enrofloxacin were attained in all samples., Conclusions and Clinical Relevance: In horses with orthopedic infections, RILP of enrofloxacin (1.5 mg/kg) should be considered as a treatment option. However, care must be taken during administration. A dose of amikacin > 250 mg is recommended to attain effective tissue concentrations via RILP in standing horses.

Objective: To evaluate the value of microarthroscopy in the equine midcarpal joint using the vital stains methylene blue, trypan blue, neutral red, and Janus green B to observe components of the synovial lamina propria, vascular architecture, and synoviocytes., Study Design: Experimental., Animals: Ten horses., Methods: Microarthroscopy of left and right midcarpal joints was performed with and without vital staining of the synovium. Four vital stains (methylene blue, trypan blue, neutral red, and Janus green B) were evaluated, with each stain used in 5 joints. Synovial biopsy specimens were collected from the dorsomedial and dorsolateral aspects of the joint., Results: All dyes were biocompatible. At x 60 without vital staining, synovial surface topography, vascular network, and translucency were observed. Intra-articular vital dyes improved evaluation of synovial surface topography. At x 150 with vital staining, individual synoviocytes were clearly identified with all dyes, except neutral red. Although methylene blue provided the best in vivo microscopic differentiation of the structure of the intima, trypan blue had superior retention in conventionally processed synovial biopsies., Conclusions: Methylene blue, trypan blue, neutral red, and Janus green B stains can be used safely for microarthroscopy. Good visualization of cells and vascular network can be obtained by microarthroscopy, and microarthroscopic evaluation of the synovium compares favorably with conventional histologic evaluation of biopsy specimens., Clinical Relevance: Microarthroscopy may be beneficial in both research and clinical diagnosis of equine articular diseases.

Extensive thermal injuries in horses can be difficult to manage. The large surface of the burn dramatically increases the potential for loss of fluids,electrolytes, and calories. Burns are classified by the depth of injury: first-degree burns involve only the most superficial layers of the epidermis;second-degree burns involve the entire epidermis and can be superficial or deep; third-degree burns are characterized by loss of the epidermal and dermal components; and fourth-degree burns involve all the skin and underlying muscle, bone, and ligaments. Burns cause local and systemic effects. Routine use of systemic antibiotics is not recommended in burn patients. Topical medications should be water based, be easily applied and removed, not interfere with wound healing, and be readily excreted or metabolized. Weight loss of 10% to 15% during the course of illness is indicative of inadequate nutritional intake. Gradually increasing the grain,adding fat in the form of vegetable oil, and offering free-choice alfalfa hay increase caloric intake.

The use and aims of various wound dressings are discussed. Application and indications in the horse vary according to the type and location of the wound as well as the nature and availability of the dressing material. Coaptation and immobilization are essential to promote healing in certain locations. Techniques used for bandage application in horses are described, with special emphasis on problem areas.

Unlabelled: Published reports have indicated that after callosotomy half or more of all patients will experience a 50% or greater reduction in seizure frequency. Those callosotomy patients whose seizures produce falls appear to have the best results. We studied the value of ictal EEG in 41 patients 18 years or older who had undergone either a total or partial callosotomy at our program. Ictal EEG's were separated into two categories: Type I: generalized slow spike wave, electrodecrement, non-evolving low amplitude fast activity; Type II: all other patterns. Types I and II were then compared to a defined one-year outcome for the targeted seizure type using Chi-square or Fishers Exact Test. Previously identified predictors of good or worthwhile outcome as defined by the literature were also evaluated., Results: A significant association was noted for presence of specifically defined EEG patterns and a 90% reduction in seizure frequency but not for other factors analyzed., Conclusion: The ictal EEG but not other factors is able to identify a group of patients who have a better than 90% chance for total or nearly total resolution of seizures causing sudden falls.

This study aimed to identify blood serum lidocaine concentrations in the horse which resulted in clinical signs of intoxication, and to document the effects of toxic levels on the cardiovascular and cardiopulmonary systems. Nineteen clinically normal mature horses of mixed breed, age and sex were observed. Lidocaine administration was initiated in each subject with an i.v. loading dose of 1.5 mg/kg bwt and followed by continuous infusion of 0.3 mg/kg bwt/min until clinical signs of intoxication were observed. Intoxication was defined as the development of skeletal muscle tremors. Prior to administration of lidocaine, blood samples for lidocaine analysis, heart rate, mean arterial blood pressure, systolic blood pressure, diastolic blood pressure, respiratory rate and electrocardiographic (ECG) data were collected. After recording baseline data, repeat data were collected at 5 min intervals until signs of intoxication were observed. The range of serum lidocaine concentrations at which the clinical signs of intoxication were observed was 1.85-4.53 microg/ml (mean +/- s.d. 3.24 +/- 0.74 microg/ml). Statistically significant changes in P wave duration, P-R interval, R-R interval and Q-T interval were observed in comparison to control values, as a result of lidocaine administration. These changes in ECG values did not fall outside published normal values and were not clinically significant. Heart rate, blood pressures and respiratory rates were unchanged from control values. This study establishes toxic serum lidocaine levels in the horse, and demonstrates that there were no clinically significant cardiovascular effects with serum lidocaine concentrations less than those required to produce signs of toxicity.

Fourteen horses with a progressive forelimb lameness of 3 to 12 months' duration, diagnosed as navicular syndrome, were selected from clinical cases admitted to Auburn University Equine Hospital for evaluation of the efficacy of an orally administered nutraceutical (Cosequin, Nutramax Laboratories, Inc., Edgewood, MD) for ameliorating clinical signs associated with naturally occurring navicular syndrome. Horses were randomly allocated to treatment with the nutraceutical or a placebo. Treatment was five scoops (16.5 g) of powder twice daily in the feed. The test group (n = 8) received a patented nutraceutical consisting of 9 g of FCHG49 (a highly purified glucosamine HCl), 3 g of TRH122 (a specific purified low-molecular-weight sodium chondroitin sulfate), and 600 mg of manganese ascorbate. The placebo group (n = 6) received an indistinguishable oral powder containing only excipients. Owners and the investigator were unaware of group assignments. The same investigator assessed lameness and overall clinical condition at enrollment and after 4 and 8 weeks of treatment. Lameness was assessed by an algofunctional lameness index, comprising a combined sum score of standing posture, hoof tester examination, and lameness scores at various levels of work. Overall clinical efficacy was rated on a visual analogue scale. Owners assessed lameness via a preassigned questionnaire, incorporating an algofunctional lameness index and overall clinical condition at weekly intervals. Radiographic examinations of the navicular bones were performed at enrollment and after 8 weeks of treatment. The median algofunctional lameness index and overall clinical condition scores assigned the investigator were significantly improved (P = .05) for horses treated with the nutraceutical compared with placebo-treated horses. The degree of improvement in algofunctional lameness index assigned by owners after 8 weeks was also significant (P = .045) between the treatment groups. Radiographic scores after treatment were not significantly different between the groups (P > .05).

An 18-year-old 454-kg (1,000-lb) American Quarter Horse gelding was evaluated because of chronic intermittent malodorous right-sided nasal discharge. Endoscopy revealed a mycotic plaque in the nasal cavity adjacent to the nasomaxillary opening of the right caudal maxillary sinus. The nasomaxillary opening appeared to be larger than normal. Fungal culture of specimens of the mycotic plaque yielded Pseudallescheria boydii. The horse was treated with 2% miconazole intranasally, sodium iodide i.v., and potassium iodide p.o. Thirty and 60 days after treatment was initiated, the nasal cavity was found to be free of infection.

Suture ligature failure is a potential complication during laparoscopic ovariectomy techniques utilizing ligatures as a means of hemostasis. This complication in the standing mare and the successful use of laparoscopic electrosurgical instrumentation as the sole means of providing hemostasis to the mesovarium of a mare are described.

The objective of this study was to define the normal gross anatomic appearance of the adult equine tarsus on a low-field magnetic resonance (MR) image. Six radiographically normal, adult, equine tarsal cadavers were utilized. Using a scanner with a 0.064 Tesla magnet, images were acquired in the sagittal, transverse and dorsal planes for T1-weighted and the sagittal plane for T2-weighted imaging sequences. Anatomic structures on the MR images were identified and compared with cryosections of the imaged limbs. Optimal image planes were identified for the evaluation of articular cartilage, subchondral bone, flexor and extensor tendons, tarsal ligaments, and synovial structures. MR images provide a thorough evaluation of the anatomic relationships of the structures of the equine tarsus.

Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares.

Objective: To evaluate the seasonal influence, signalment, type of hay consumed, clinical examination findings, and outcome after surgery for horses with ileal impaction., Study Design: A retrospective study., Results: Between 1988 and 1993, 28 horses had surgical correction of ileal impaction. There was a significantly higher rate of ileal impaction during the Fall (September-November, P = .0041 ). Mean duration of clinical signs of abdominal pain before referral was 15 hours. Transrectal palpation was used to localize the impaction in 11 horses. The ileal impaction was reduced by extraluminal massage aided by admixing of intestinal fluid oral to the impaction or injection of fluids intraluminally and then movement of the ingesta into the cecum alone in 24 horses. A total of 26 horses recovered from surgery; 24 horses were discharged from the hospital and eventually returned to previous use. Two horses had fatal postoperative complications: jejunocecostomy dehiscence and development of extensive small intestine adhesions after manual reduction of the impaction. One horse initially treated by manual reduction required jejunocecostomy twice for management of recurrent ileal impaction. Follow-up information was obtained for 21 horses, of which 20 were alive 1 year or longer after surgery. A total of 27 of 28 horses were fed Coastal Bermudagrass hay as the primary type of hay consumed. A total of 9 horses continued to be fed Coastal Bermudagrass hay as the only roughage source, whereas 6 horses were fed Coastal Bermudagrass with at least 50% other hay, and in 6 horses, Coastal Bermudagrass hay was entirely eliminated from the diet., Conclusion and Clinical Relevance: Ileal impactions can be successfully reduced by celiotomy and extraluminal massage and injection techniques to soften the ingesta for passage into the cecum without enterotomy or bypass techniques in most horses. Changes in weather and feeding practices in the Fall may account for an increased risk of ileal impaction in horses in the southeastern United States at that time of year.