Internal bleeding and mucosal bleeding in hollow organs are uncommon conditions in equine medicine and endoscopy. Most of the times, they respond to treatment of the underlying primary condition. However, there are cases in which a rapid and effective control of blood loss is required and the animal is not suited for surgery or general anaesthesia. We report two cases referred to our Veterinary Teaching Hospital with signs of urinary disease and bladder haemorrhage identified by cystoscopy which were successfully managed with topical application of a haemostatic carboxymethyl-starch powder. The product was applied directly on the bleeding mucosa after bladder emptying either under endoscopic guidance or blindly, through a urinary catheter. The application of the haemostatic powder appears to be easy to perform, safe, and helpful in controlling mucosal bleeding in hollow organs in the short time, with no adverse reactions noticed. This approach should be considered in cases where mucosal bleeding can be identified by endoscopy and a prompt control of blood loss is required, also in the field.

Background: A reduction in the Egg Reappearance Period (ERP) has been suggested to be an early indication of emerging anthelmintic resistance in strongyles. Objective:To measure the strongyle ERP following moxidectin treatment of horses in the southeast of England. Study Design: Prospective study. Methods: Horses with a faecal egg count (FEC) of > 400 strongyle eggs per gram (EPG) in a routine screening sample were enrolled into the study. Moxidectin (400 mcg/kg) was administered per os and FEC tests repeated every 2 weeks for 16 weeks. Results: Forty-eight horses completed the study. The mean EPG prior to treatment was 1047 (range 375 – 2137 EPG). In all but two horses, FEC was 0 EPG 2 weeks after moxidectin administration. In the remaining two, the FECs were 12.5 EPG (97.8-98.3% reductions compared to pre-treatment FEC). At 4 weeks post-treatment, 6 horses had positive FECs (96.6-99.2% reductions). At 6 weeks, 11 horses had positive FECs (83.8% reduction in one horse; >90% reduction in 10). At 8 weeks, 21 horses exhibited positive FECs (<90% reduction in 2). At 10 weeks, 27 horses had positive FECs (<90% in 6). At 12 weeks, 31 horses had positive FECs (<90% reduction in 11). At 14 weeks, 34 horses had positive FECs (<90% reduction in 13). At 16 weeks, 38 horses had positive FECs (<90% reduction in 17). Limitations: Weights of some horses were estimated using weigh tapes rather than a weighbridge. Dosing of the horses with moxidectin was carried out by owners. Conclusions: The results indicated acceptable efficacy of moxidectin at 14 days after treatment; however, the ERP pattern measured across the group suggest that this anthelmintic has a considerably shorter suppressive effect on strongyle egg shedding than measured when it was first introduced ( >13 weeks and up to 24 weeks).

Sinoscopy consists on direct visualization of the paranasal sinuses and was first conceived for diagnostic purposes using an endoscope through a skull trephination. Since then, the use and approaches to perform it have evolved thanks to current advancements in knowledge (sinus anatomy and pathology) and technology. The aim of this study is to review the techniques reported to perform traditional and minimally invasive sinoscopy and to review the current use of sinoscopy to treat paranasal sinus disease. The history of sinoscopy, as we know it today, is relatively recent but its use among clinicians is not necessarily widespread due to the invasiveness of the traditional technique when compared to imaging techniques. This limitation could be bypassed using the newer intranasal or extranasal minimally invasive sinoscopic approaches. These techniques allowed sinoscopic visualization through natural orifices or minimally invasively created openings. Despite the potential of these techniques, case selection is still crucial as visualization can be limited in selected pathologies (i.e: sinus cyst), some sinuses (i.e: rostral maxillary with intranasal approaches) and if haemorraghe or severe exudate accumulation is found. Nevertheless, sinoscopy offers a diagnostic rate superior to traditional imaging and it is an alternative diagnostic tool when advanced imaging techniques, such as CT, are not available. In recent years, sinoscopic treatment is progressively replacing the use of sinusotomies to treat most sinus pathologies. Sinoscopic treatment yields a high resolution rate while complications are kept low. Familiarization with sinoscopic techniques and in-depth anatomic sinus knowledge will likely make sinoscopy the gold standard technique to treat sinus disease in the short future.

Background: Neonatal foals are born essentially agammaglobulinemic and therefore must ingest colostrum or receive immunoglobulins to maintain health. Failure of passive transfer treatment involves administration of equine colostrum, plasma or commercial powdered colostrum (CPC). Anecdotal reports suggest a risk of anaphylaxis associated with plasma transfusion in neonates that received CPC prior to gut closure. Bovine serum albumin (BSA) in CPC may serve as a target for BSA-specific immunoglobulin E (IgE) in donor equine plasma. Objectives: To determine presence of BSA-specific IgE in samples collected post-routine vaccination in healthy horses, horses experiencing adverse vaccine reactions and commercial equine plasma. Study Design: Prospective Observational Methods: Serum was collected from 65 healthy horses at day 0, 14, 28, 90, 180, 270 and 365 post-vaccination, 26 horses after vaccine reaction at day 1, 180 or 270 post-vaccination, 4 horses not vaccinated and 10 horses from a commercial plasma donor herd. BSA-specific IgE was determined using enzyme-linked immunosorbent assay (ELISA). Results: BSA-specific IgE was not detected in non-vaccinated horses and was identified in all vaccinated horses. Younger horses demonstrated higher fold changes in post-vaccination BSA-specific IgE expression compared to older horses. No significant difference in BSA-specific IgE levels between commercial plasma donors and healthy horses was identified. No significant difference in post-vaccination anti-BSA IgE levels between reactor and healthy horses at day 180 and 270 post-vaccination were identified. Main Limitations: Small number of reactor horses at day 180 and 270 post-vaccination with most samples being collected 24 hours. There were no healthy horse samples for 24 hours post-vaccination; therefore, it was not possible to compare the two groups at this timepoint. Conclusions: Horses may express BSA specific IgE following vaccination. There may be risk of hypersensitivity type reaction when veterinarians administer commercial plasma to neonatal foals that have consumed CPC prior to gut closure.

A one-year-old Belgian warmblood with a previously known history of successfully repaired temporal and parietal bone fracture sustained at 14 days of age was presented for investigation of a recent, acute, and progressive four limbs ataxia. The owner reported a lack of coordination and difficulty getting up with progressing paresis two weeks prior to the presentation. Neurological examination revealed pronounced hypermetria/dysmetria in walk and trot in all four limbs. No evidence of cranial nerve deficit was observed. The horse was in good general condition with unremarkable clinical parameters. Survey lateral radiographs of the cervical spine showed moderate to severe signs of cervical malformation of the vertebral canal and articular process joints, indicating cervical stenotic myelopathy. Cervical computed tomographic (CT) myelography revealed the presence of a dorsal subarachnoid diverticulum causing significant spinal cord compression at multiple locations, with associated osteoarthrosis of the cervical articular process joints. Due to a poor prognosis and warranted surgical outcome, the owner declined further treatment, and the horse was discharged with conservative corticosteroid treatment. The patient was euthanised shortly after the initial presentation due to progressive worsening. To the author’s knowledge, CT myelography findings in a yearling with cervical subarachnoid diverticulum have not been previously published. This case illustrates the usefulness of advanced imaging techniques, such as CT myelography, in combination with static and dynamic radiography to provide a better and more accurate diagnosis.

A 2-year-old racing Thoroughbred gelding in training was presented with moderate (6/10) right hindlimb lameness unresponsive to regional anaesthesia of the right hind limb. Gamma scintigraphic examination revealed severe, focal, increased radio-pharmaceutical uptake over the dorsal aspect of the right 18th rib, which had an abnormal contour. Ultrasonographic examination of this area confirmed the presence of a complete, displaced fracture of the proximal aspect of the right 18th rib. Local infiltration with local anaesthetic around the 18th right rib (10ml cranial and 10ml caudal to the fracture site) abolished the right hindlimb lameness. A diagnosis of rib fracture causing moderate ipsilateral hindlimb lameness was made. The horse returned to walking exercise after 12 weeks of rest and was reported to be sound on the same limb 12 months after presentation. Caudal rib fractures should be considered as possible cause of hind limb lameness. Local diagnostic anaesthesia around the fracture site can aid localise the origin of lameness.

Background: Analgesic protocols related to orchiectomy or castration of young horses vary widely depending on geographic location, educational background of the veterinarian, and other demographic factors. Specific practices of equine veterinarians in the United States (US) have not been reported. Objectives: To determine perioperative pain management practices of equine veterinarians in the US as they relate to castration of young male horses. Study Design: Cross-sectional survey Methods: An internet-based questionnaire included items related to analgesic drugs used in association with castration of healthy yearling colts. Demographic and educational factors associated with routine recommendation of analgesic medications after castration were analyzed using logistic regression. Results: Responses from 146 equine veterinarians in the US revealed that 112/146 (76.7%) administered a nonsteroidal anti-inflammatory drug (NSAID) at the time of castration. Routine recommendation of post-castration analgesia was associated with veterinarians who were employed in a multi-veterinarian practice, completed their veterinary education after 2000, and provided a higher pain severity score for horses at 24 hours after a routine castration. Main Limitations: Possible distribution, self-selection, response, and recall biases as a result of convenience sampling methodology. Conclusions: Perioperative pain management practices vary widely among US veterinarians but the majority of veterinarians, especially more recent graduates, recommend administration of an NSAID.

A 19-year-old Cob mare with atrial fibrillation (AF) presented for transvenous electric cardioversion (TVEC). Under general anaesthesia, three successive incremental electric shocks were given (total 750 Joules) and sinus rhythm was temporarily restored. After 13 seconds, AF recurred so a fourth shock (300 Joules) was given and intravenous (IV) amiodarone started. Shortly after, capnography revealed an acute drop in the end-tidal carbon dioxide, which was followed by agonal gasping. Echocardiography showed severe cardiac dysfunction. Successful cardiac resuscitation consisted, amongst others, of cessation of amiodarone, and administration of dobutamine and adrenaline. This case report highlights the importance of capnography as a non-invasive means of cardiac output monitoring in equine anaesthesia which definitely contributed to a positive outcome. It also emphasises the critical importance of early recognition and communication of complications within anaesthetic and cardiology teams.

This case report describes the clinical and diagnostic imaging findings, treatment, and outcome of a three-month-old Thoroughbred foal referred for the evaluation of severe left forelimb lameness and presents the acquisition of a novel radiographic projection of the scapula used to achieve the diagnosis. No abnormalities were found with the standard radiographic examination of the left shoulder. Ultrasound and a dorsal 45° lateral‐ventral lateral oblique radiographic view were performed to evaluate the body of the left scapula. A longitudinal, minimally displaced fracture of the infraspinous fossa was diagnosed with this projection that was not detected in the routine projections. Ultrasound was used in conjunction to confirm the diagnosis, assess the displacement of the fracture in the frontal plane, and evaluate soft tissue damage. The foal was treated conservatively with anti-inflammatory drugs and stall rest. A radiographic follow-up and clinical reassessment were performed, and the horse appeared sound, no atrophy of the region was appreciated, and no radiographic abnormalities were found.

Thoracic hemivertebra is one of the rare congenital vertebral anomalies in horses resulting in vertebral column deformity with or without neurological signs. A nine-month-old Racking filly was presented with a distinct bump over the back region. This bump was apparent at birth and has been increasing in size. Clinical examination revealed a painless kyphoscoliosis over the thoracic vertebrae with mild ataxia and abnormal gait of hindlimbs. In plain lateral radiographs of thoracic vertebrae, hemivertebrae were seen in the 13th-15th thoracic vertebrae. At myelography performed under general anaesthesia, the ventral and dorsal aspects of the contrast medium column were narrowing at the level of the 13th-14th thoracic vertebrae, and no sign of contrast medium after the 14th thoracic vertebra that represents spinal cord compression. Little information about hemivertebra in horses exists and a better understanding of hemivertebra etiology is required.

A two-day-old female Warmblood foal (70 kg) presented with a closed, displaced Salter-Harris type-II fracture of the proximal physis of the left hind first phalanx. For fracture repair four 4.5 mm cortical screws and wire in a figure-of-8 pattern were applied on the lateral and medial aspect of the phalanx, respectively. A 4.5 mm cortical screw was additionally inserted in lag-fashion to engage the lateral metaphyseal spike. Three days postoperatively, medial axis deviation and implant infection were noted and revision surgery was performed. Previous implants were removed and two 4.5 mm transphyseal cortical lag-screws were placed in proximolateral-distomedial and dorsoproximal-plantarodistal direction. Postoperatively, the fracture healed rapidly and the implants were removed 6 weeks later. Nineteen months after implant removal the horse did not show any sign of lameness, despite a shortening of the proximal phalanx compared to the contralateral limb. In cases of postoperative implant instability and infection, implant removal often becomes necessary. However, new implants cannot be placed safely in the previous location. To avoid this problem, this report describes an alternative approach for screw positioning in case of previous implant infection in a Salter-Harris type-II fracture of the proximal physis of the first phalanx.

Septicemia can be a tragic illness in neonatal and young foals. Sick foals may manifest a variety of clinical symptoms all related to a common infection and its systemic effects. While the pathogenesis of this disease is the same as for adult equids, the clinical signs seen can be very different. The rapid changes seen in foal are reflective of their low endogenous reserves of glucose and innate immune mediators as well as the poor ability to self-regulate their metabolism. The neonatal immune system is reliant on maternal antibodies at birth and development of the foal's own system takes a significant amount of time. This non-competent immune system changes how the foal responds to infection when compared to the adult. Clinical signs in septic foals include tachycardia, tachypnea, depression, anorexia, colitis, and fever. Less commonly, foals may show petechiation, swollen joints, anterior uveitis, and coma. This article is the first of a two part series on neonatal sepsis and will present a review on the neonatal immune system, the pathophysiology of sepsis, and the range of clinical signs seen in foals.

Equine primary hyperparathyroidism is rare compared with the condition in human medicine where it is often encountered and represents the most common explanation for hypercalcemia in the outpatient setting. Primary hyperparathyroidism results from a hyperfunctioning parathyroid gland and surgical treatment (parathyroidectomy) is typically curative. Successful surgical removal of a diseased parathyroid gland can be challenging in horses as both normal and hyperfunctioning glands are difficult to localize. Identification of surgical targets using ultrasonography and/or Technetium-99m sestimibi scintigraphy are useful for this purpose in both the human and equine contexts. However, these localization approaches are not aways effective. Moreover, not all patients are candidates for general anesthesia and surgery and the costs associated with diagnostic localization and parathyroidectomy may be prohibitive for some owners. This commentary presents information about primary hyperparathyroidism in the event that it is not treated and strives to review aspects of the disease when left untreated from the human medical context.

Streptococcus equi subspecies equi (S. equi) is the causative organism of the upper respiratory disease of equids, strangles, characterised by pyrexia, lymphadenopathy, and mucopurulent nasal discharge. Strangles was first reported over 750 years ago and continues to be of significance in equine populations across the globe. This review discusses how S. equi has adapted, the clinical manifestation of strangles, and how clinicians and caregivers can tackle the disease in the future. S. equi evolved from the commensal, and occasionally opportunistic pathogen, Streptococcus equi subspecies zooepidemicus refining its capabilities as it became host restricted. The success of S. equi can be attributed to its ability to cause both acute and persistent infection, the latter occurring in about 10% of those infected. In this carrier state, S. equi persists in the guttural pouch without causing clinical signs, intermittently shedding into the environment, and encountering naïve animals. Insight into the S. equi genome and lifestyle has led to advances in diagnostic assays and the development of a safe and efficacious recombinant-fusion vaccine, giving clinicians and caregivers the tools to better combat this infection. Alongside rigorous biosecurity protocols and pragmatic control measures such as screening new arrivals for exposure and carrier status, these new technologies demonstrate that strangles can be an increasingly preventable infection.

Bladder prolapse is a rare condition in mares and may occur as a result of excessive straining during the parturition or in the postpartum period. We report a case of dystocia associated prolapse and incarceration of the small colon through the external urethral opening into a prolapsed urinary bladder. No previous reports of this condition were found. An 11-year-old Thoroughbred mare was presented to The Equine Hospital at the Jockey Club of Saudi Arabia for evaluation and treatment of dystocia. Prolapse of the urinary bladder was concomitantly diagnosed. Initial assessment deemed replacement of the urinary bladder in the normal position and vaginal delivery not possible. The mare was immediately prepared for caesarean section. The foal was successfully delivered and resuscitated. Detailed assessment of the bladder during the surgery revealed that the small colon had prolapsed through the external urethral opening and was inside the bladder. The urinary bladder was opened. The small colon was replaced into the abdominal cavity; a first surgeon gently replaced the small colon through the external urethral sphincter and a second surgeon retrieved the small colon by gentle traction. The mare recovered uneventfully from general anaesthesia. The mare and the foal were discharged from the hospital seventeen days post-operatively.

Urethral diverticula have been described in other species. Congenital anomalies of the urinary tract in horses are rare. A 26-year-old gelding presented with complaints of abdominal discomfort and dysuria. Urine dribbling was reported since several years. General clinical examination was within normal limits. Rectal palpation showed a distended bladder, which was emptied spontaneously after manipulation. Urine cytology showed an increased white blood cell count and presence of bacteria. Bacterial culture however remained sterile. Cystoscopy identified two symmetrical urethral diverticula dorsal to the entrance of the bladder, lined with normal epithelium. Mucosa of the bladder, urethra and two diverticula were hyperemic with evidence of urine accumulation in both diverticula. Ultrasound, abdominal and transrectal, did not identify the diverticula. Treatment included trimethoprim-sulfamides and meloxicam. After 2 weeks, the owner reported resolution of clinical signs. It is unclear if the diverticula in this case were congenital or acquired. In humans it is described that urethral diverticula can be asymptomatic and incidental findings. Surgical intervention has been described in small animal and human medicine with complete resolution of clinical signs, however in this case was not possible due to financial restraints.

Due to the length of the reserve crown and roots of equine cheek teeth, especially in younger horses, their extraction (exodontia) can be a challenging procedure with the potential for many types of post-extraction complications to develop. The prevalence of post-extraction complications is greatly influenced by the exodontia technique used, with unacceptably high levels of complications with the traditional repulsion technique and conversely, low levels of complications with oral extraction performed by skilled operators. Recent objective studies on post-exodontia problems in horses have also highlighted some risk factors for the development of post-extraction problems including exodontia of rostral mandibular teeth in young horses, and exodontia of teeth with apical infections The recent recognition that some non-healing post-extraction equine alveoli suffer from a disorder very similar to dry socket in humans, may help clinicians to recognise, treat and possibly help prevent this disorder.

A document by Callum Haseler. Click on the document to view its contents.