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Biomedical subjects

D E Freeman

Publications and source records attributed to D E Freeman.

At least 73 records · Page 4Linked to original sources

Measurement of portal and hepatic blood flows using a modified method for surgical placement of catheters in the major splanchnic vessels of sheep.

A modified catheterization and para-aminohippurate dye dilution technique was used to measure portal and hepatic blood flows in sheep. Blood flows (mean +/- 1SD) for 7 healthy sheep were 1.54 +/- 0.71 L/min and 1.98 +/- 0.75 L/min for portal and hepatic flows, respectively. Blood flow measurement was facilitated when dye injection rates produced blood para-aminohippurate acid concentrations greater than 15 mg/L. Uniform mixing of dye with blood was confirmed in 1 sheep with 2 portal vein catheters. Surgery to place the catheters was facilitated by using a ventral para-costal approach. Blood gas analysis was useful in confirming the placement of the catheters. Useful catheter life in this experiment was 41 days, which was longer than in previous reports. Treating the catheters with an organo-silane preparation, protecting the catheters against dislodgement, and use of a belly bandage to minimize damage to the external parts of the catheter may have prolonged catheter life in this experiment.

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Hepatic and extrahepatic lactate metabolism in sheep: effects of lactate loading and pH.

Hepatic lactate metabolism was studied in five sheep receiving infusions of either lactic acid or sodium lactate using an arteriovenous difference technique. Hepatic uptake of lactate was a saturable process with second order (Michaelis-Menten) kinetics. Although lactic acid infusion decreased blood pH, hepatic saturation of lactate uptake occurred before changes in pH could influence hepatic lactate metabolism. The Vmax for hepatic lactate metabolism is 5.72 mmol X kg-0.75 X h-1 and the Km 3.06 mmol/l. These findings have therapeutic relevance. In acidosis, the hepatic response to therapeutic administration of sodium lactate during fluid therapy will be variable. If plasma lactate is low, lactated fluids may increase hepatic uptake and produce an alkalizing effect. If plasma lactate is already high, hepatic lactate metabolism is nearly saturated, and additional lactate will not produce a hepatic alkalizing response. Extrahepatic tissues switch from lactate production to lactate utilization under conditions of lactate loading. They remove more lactate than liver at high plasma lactate concentrations. Muscle may be important in lactate removal in certain types of exercise.

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Volatile fatty acids and the role of the large intestine in the control of feed intake in ponies.

The roles of volatile fatty acids (VFA) and of the large intestine in the control of feeding in ponies were investigated. Ponies with cecal fistulas were adapted to ad libitum access to pelleted feed. Treatment solutions were given as a bolus 15 min before the animals were allowed free access to feed after a 4-h fast. Each dose of VFA solution was tested in a crossover design with a water control. When the ponies were permitted to eat after the treatments, the latency to eat, first meal size, and duration and first intermeal interval were recorded. Feed intakes were measured at 3 and 18 h after the treatments were given. Intracecal infusions of .4 mmol propionate (Prop)/kg body weight (BW) increased (P less than .05) total feed intake 7.5% relative to control values. Higher doses of Prop (.75 mmol/kg BW) and acetate (1.00 and 1.25 mmol/kg BW) reduced (P less than .05) feed intake by prolonging the first intermeal interval 143% (Prop) and 71 to 74% (acetate), although 24-h intakes did not differ from controls. The highest dose of Prop tested (1.00 mmol/kg BW) reduced first meal size 22% (P less than .01) without affecting subsequent feeding behaviors. The results indicate that changes in cecal VFA concentration can generate cues that may contribute to the control of meal size and frequency in ponies.

Acetates↗

Occlusion of internal carotid artery in the horse by means of a balloon-tipped catheter: evaluation of a method designed to prevent epistaxis caused by guttural pouch mycosis.

A procedure developed to occlude the internal carotid artery of horses with guttural pouch mycosis was modified was modified and evaluated in nine clinically normal horses. The left internal carotid artery was ligated at its origin and occluded distally with an intraluminal balloon catheter. In four horses, the balloon-tipped catheters were left in place until these horses were euthanatized at 4 to 244 days after surgery. In the remaining horses, the catheters were removed after 10 to 14 days by a cutdown procedure, and these horses were euthanatized 1 to 60 days after catheter removal. In both groups, gross and histologic examinations revealed that occlusive thrombosis had developed in sections of artery distal to the balloon. Postoperative complications were not encountered.

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Occlusion of internal carotid artery in the horse by means of a balloon-tipped catheter: clinical use of a method to prevent epistaxis caused by guttural pouch mycosis.

An intravascular procedure was used to occlude the internal carotid artery of two horses with epistaxis caused by guttural pouch mycosis. In each horse, the affected internal carotid artery was ligated close to its origin. A balloon-tipped catheter was introduced into the artery distal to the ligature, and its tip was advanced beyond the site of infection. The balloon was then inflated so that the infected segment of artery was isolated from the cerebral vascular system. The catheters were removed at 14 and 51 days, and both horses were returned to training and racing. Neither horse had further episodes of epistaxis.

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Mesodiverticular bands as a cause of small intestinal strangulation and volvulus in the horse.

Volvulus of the jejunum and ileum in three horses was associated with intestinal strangulation in a mesenteric rent. The rent was in the jejunal mesentery at its point of attachment with an anomaly that was classified as a mesodiverticular band. The band also was attached to the dorsolateral surface of the jejunum, thus forming one side of a triangular hernial sac that was completed on the other side by the adjacent jejunal mesentery. Incarceration of a loop of small intestine in the hernial sac preceded rupture of the jejunal mesentery and subsequent intestinal strangulation. Surgical correction was successful in two horses and involved resection of the gangrenous intestine, then jejunocecal anastomosis. The third horse was euthanatized when intestinal rupture and peritonitis were found on exploratory laparotomy. Two mesodiverticular bands attached to the distal jejunum were incidental necropsy findings in a fourth horse.

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Cervical esophagostomy to permit extraoral feeding of the horse.

An indwelling stomach tube was placed through a cervical esophagostomy in 5 clinically normal horses and in 3 horses requiring artificial alimentation. In all but one case, surgery was performed on conscious horses following tranquilization and infiltration of the surgical sites with a local anesthetic. Six horses were fed liquid rations through the indwelling tubes, which were left in place from 3 to 26 days. After the tubes were removed, the stomas healed rapidly and with minimal complications. Cervical esophagostomy proved to be a safe, easy, and effective method for the provision of extraoral feeding of the horse.

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Evaluation of a technique to occlude the internal carotid artery of horses.

OBJECTIVE: To evaluate an occlusion technique for the internal carotid artery of horses using an intravascular, detachable, self-sealing, latex balloon distally and ligatures proximally. STUDY DESIGN: Experimental study. ANIMALS: Six healthy adult horses. METHODS: In each horse, the left internal carotid artery was occluded by placement of an intravascular, detachable, self-sealing, latex balloon distally and two ligatures proximally. Radiographs were taken on days 2, 5, 10, and 30 after surgery to evaluate balloon inflation and position. Endoscopic examination of the left guttural pouch was performed 10 days after surgery to evaluate the integrity of the internal carotid artery and surrounding tissues. At 30 days, the left and right, common, internal, and external carotid arteries were examined grossly and then processed for histologic evaluation. RESULTS: Immediate and long-term occlusion of the left internal carotid artery was achieved in all horses. The surgical procedure was technically straightforward and no intraoperative or postoperative complications were encountered. The balloons remained inflated and in their original position throughout the study. Maturing to mature, organized thrombi were present in the left internal carotid artery in all horses at 30 days. The cerebral arterial circle and common carotid artery were patent at their junctions with the internal carotid artery in all horses. CONCLUSIONS: Use of an intravascular, detachable, self-sealing, latex balloon distally and ligatures proximally is an effective technique for occluding the internal carotid artery of horses. CLINICAL RELEVANCE: This technique may be useful for prevention of fatal hemorrhage in horses with lesions of the internal carotid artery.

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Effect of venous strangulation obstruction on length of equine jejunum and relevance to small-intestinal resection.

OBJECTIVE: To determine if venous strangulation obstruction (VSO) of the distal half of the equine small intestine would increase length of that segment. STUDY DESIGN: Halothane-anesthetized horses were assigned randomly to 3 groups of 5 horses: Group 1 (controls)--the entire small intestine was measured and rubber-shod clamps were applied to mark each end of the most distal 50% of the small intestine; Group 2--same procedure, except that VSO was induced in the distal 50% of the small intestine for 180 minutes; and Group 3--same initial procedure, except that VSO was induced for 90 minutes and followed by reperfusion for 90 minutes. ANIMALS OR SAMPLE POPULATION: Fifteen horses. METHODS: The proximal and distal halves of the small intestine were measured before and at 180 minutes after clamps and ligatures were applied. At the end of the study, biopsies were taken to assess mucosal epithelial damage by light microscopy, and horses were euthanatized while under general anesthesia. RESULTS: Intestine subjected to VSO and VSO and reperfusion had marked hemorrhagic changes and thickening in the intestinal wall. Both groups had incurred a grade 2.8 of 5 mucosal injury by 180 minutes. Total length of small intestine and length of the distal 50% did not change in the control group, but intestine subjected to VSO only and VSO and reperfusion had increased in length by 29% (P <.05) and 36% (P <.05), respectively. CONCLUSIONS: Small intestine of horses subjected to VSO can increase in length, and this change could cause an overestimate of the amount of intestine involved in an extensive strangulating lesion. CLINICAL RELEVANCE: An overestimate of the amount of intestine involved in an extensive strangulating lesion could lead to an overly pessimistic assessment of a horse's risk for postresection malabsorption and maldigestion. Therefore, estimates of the proportion of small intestine that is strangulated should be corrected for this potential error and the risk of malabsorption determined accordingly.

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Occlusion of the external carotid and maxillary arteries in the horse to prevent hemorrhage from guttural pouch mycosis.

Balloon-tipped catheters were used to occlude the external carotid artery and its branches in nine horses with hemorrhage caused by guttural pouch mycosis. The internal carotid artery on the affected side was occluded simultaneously in four horses and had been occluded previously in two others. In three horses, a single balloon-tipped catheter was inserted in the external carotid artery beneath the floor of the guttural pouch and its tip was advanced blindly into distal branches. In one horse, the superficial temporal artery was occluded briefly during surgery by a balloon-tipped catheter so a catheter inserted into the external carotid artery could be diverted into the maxillary artery. In the other five horses, the external carotid artery was occluded proximally and the maxillary artery was occluded immediately caudal to the alar canal by a balloon-tipped catheter inserted into the major palatine artery. Serious postoperative hemorrhage did not occur in eight horses, but one horse that had a single balloon-tipped catheter inserted into the external carotid artery had profuse hemorrhage 11 days after surgery and was euthanatized. One horse was euthanatized because of persistent dysphagia. The only complication related to use of balloon catheters was a mild incisional infection in one horse. It was concluded that the external carotid and maxillary arteries must be occluded on both sides of the eroded segment to prevent hemorrhage from normograde and retrograde flow.

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A large frontonasal bone flap for sinus surgery in the horse.

A large frontonasal bone flap was created to treat diseases of the paranasal sinuses in 14 horses. The bone flap was made as wide as possible within the confines of the nasolacrimal duct so the floor of the frontal sinus and the dorsal and ventral conchae could be opened. These openings exposed the nasal passages, maxillary sinuses, and ventral conchal sinus thereby facilitating removal of diffuse and localized lesions from these sites. Diseases treated were ethmoid hematomas (4 horses), sinus cysts (5 horses), cryptococcal granuloma, osteoma, hemangiosarcoma, pus in the ventral conchal sinus, and periapical infection of a second molar. Four horses were euthanatized during or after surgery, one because of postsurgical pleuritis and pneumonia (horse with osteoma) and three because of their primary problems (cryptococcal granuloma, hemangiosarcoma, pus in the ventral conchal sinus). Skin suture abscesses that responded to treatment developed in four horses. Ten horses returned to their intended uses, the sinus flaps healed without blemish, and the original problems did not recur. The frontonasal flap technique provided greater access to all paranasal sinuses than methods described previously.

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Endoscopic examination of normal paranasal sinuses in horses.

The frontal, caudal maxillary, and rostral maxillary sinuses of 10 equine cadavers were examined endoscopically, and the findings were confirmed by sinusotomy. Similar endoscopic examinations were performed in five conscious, adult horses by using sedation and local anesthesia. Useful portals of entry for the arthroscope in adult horses were: for the frontal sinus, 60% of the distance in a lateral direction from midline to the medial canthus and 0.5 cm caudal to the medial canthus; for the caudal maxillary sinus, 2 cm rostral and 2 cm ventral to the medial canthus; and for the rostral maxillary sinus, 50% of the distance from the rostral end of the facial crest to the level of the medial canthus and 1 cm ventral to a line joining the infraorbital foramen and the medial canthus. The frontal sinus portal was most useful for examination of the frontal and caudal maxillary sinuses. The caudal maxillary sinus portal was most useful for examining the sphenopalatine sinus. Structures in the frontal and caudal maxillary sinuses could be approached surgically by viewing them through the frontal sinus portal and guiding an instrument to them through the caudal maxillary sinus portal. Tooth root identification was reliable for the second and third upper molars in animals older than 5 years, but was more difficult for the rostral teeth and in younger animals. Endoscopy was not difficult to perform and was well tolerated in standing, sedated horses. The only complication of this procedure was mild, local subcutaneous emphysema that resolved spontaneously within 14 days.

Anesthesia, Local↗

Endoscopic examination and treatment of paranasal sinus disease in 16 horses.

Sixteen horses with suspected paranasal sinus disease had endoscopic examination of the paranasal sinuses with a 4.0 mm arthroscope either while standing and sedated (14 horses) or under general anesthesia (two horses). Endoscopic diagnosis included sinusitis (four horses), sinus cyst (three horses), hemorrhage (three horses), neoplasia (three horses), and tooth root abnormalities (two horses). No abnormalities were detected in one horse. Endoscopic findings concurred with the radiographic findings in 13 horses (81%). Samples of sinus contents for bacteriologic (eight horses) and histologic examinations (five horses) were obtained using sinus endoscopy. Diagnostic sinus endoscopy was combined with debridement, lavage, and suction as a therapeutic technique in 10 horses. In three horses, sinus exploration was performed after diagnostic endoscopy confirmed sinus disease, whereas in three horses, further therapy was not recommended after sinus endoscopy. Clinical signs of sinus disease resolved in 11 horses (69%) overall and in eight of 10 horses (80%) with sinusitis, cyst formation, or hemorrhage using endoscopic techniques alone. Mild, local subcutaneous emphysema occurred at the portal sites in all horses, but healing occurred without additional complications. Iatrogenic damage to sinus structures occurred in one horse. Sinus endoscopy was useful in the diagnosis and management of paranasal sinus disease and avoided the need for exploratory sinusotomy in some horses.

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Unusual internal carotid artery branching that prevented arterial occlusion with a balloon-tipped catheter in a horse.

A mare with hemorrhage caused by guttural pouch mycosis was treated by insertion of a balloon-tipped catheter into the left internal carotid artery. During recovery from general anesthesia, the mare had profuse epistaxis, and was anesthetized again to determine the site of hemorrhage. The affected guttural pouch was opened to confirm that hemorrhage was from the left internal carotid artery. The mare was euthanatized, and, at necropsy, the balloon catheter was found in an aberrant branch that arose from the internal carotid artery and joined the basilar artery. The mycotic plaque was on the left internal carotid artery, distal to the origin of the aberrant branch, so that the balloon did not obstruct retrograde flow through the infected segment. Additional dissection of the internal carotid artery before insertion of a balloon catheter is recommended to identify any aberrant branches. Ligation of aberrant branches at their bifurcation with the internal carotid artery is recommended to prevent both inadvertent catheterization and retrograde flow from the cerebral arterial circle.

Anesthesia, General↗

Effect of ligation on internal carotid artery blood pressure in horses.

The effect of a single ligature on back pressure in the internal carotid artery was studied in nine horses. In six anesthetized horses, one internal carotid artery was catheterized 2 cm from its origin and blood pressure was recorded continuously. Then the artery was ligated, pressure was recorded again, and the horses were euthanatized. In another three anesthetized horses, indwelling catheters were placed in both internal carotid arteries and a loose ligature was placed proximal to one catheter. After horses recovered from anesthesia, the ligature was tied and blood pressure was recorded in both arteries on that day and 3 days later, then these horses were euthanatized. The anatomy of the cerebral arteries was examined in all nine horses. Blood pressure in the internal carotid arteries did not change after ligation. Subjectively, collateral channels considered most likely to maintain blood pressure in the ligated internal carotid artery were the caudal intercarotid artery and the cerebral arterial circle. We concluded that ligation of the internal carotid artery would not prevent severe hemorrhage from the internal carotid artery in horses with guttural pouch mycosis until the ligated artery thrombosed to the level of the lesion.

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