Reengineering the clinical laboratory.
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Laboratories, Hospital↗
Biomedical subjects
J R Snyder
Publications and source records attributed to J R Snyder.
Jejunal microvasculature of the llama and alpaca.
The vasculature of the jejunum was studied in 6 llamas and 1 alpaca, using a combination of microangiography, standard light microscopy, and vascular cast imaging. The casts were examined by use of scanning electron microscopy and low-power dissecting microscopy. After administration of 40,000 IU of heparin, all animals were euthanatized by administration of an overdose of sodium pentobarbital. Three sections of jejunum and their respective arcuate vessels were isolated from each animal. One section was immediately placed in formalin for later H&E staining. The second and third sections were placed in warm saline solution, and the vasculature was flushed free of all blood by repeated infusions of the solution. Once flushed of all blood, one section was infused with a radio-opaque medium and subsequently evaluated by microangiography, and the remaining section was perfused with a methylmethacrylate polymer for creation of vascular casts. The arcuate vessels branched into extensive primary and secondary arcades prior to giving rise to the marginal rete. Muscular arteries and small veins left the marginal rete and penetrated the tunica serosa and tunica muscularis to provide nutrients or drain the mesenteric angle, respectively, or entered into the circumferential submucosal network. The primary penetrating vessels in the submucosa formed an extensive submucosal plexus that supplied the tunica serosa, tunica muscularis, and tunica mucosa. The primary penetrating vessels anastomosed with vessels from oral and aboral sections and with their counterparts from the opposite side at the antimesenteric border.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Microvascular permeability and endothelial cell morphology associated with low-flow ischemia/reperfusion injury in the equine jejunum.
Microvascular permeability of the jejunum of clinically normal equids and microvascular permeability associated with 60 minutes of ischemia (25% baseline blood flow) and subsequent reperfusion were investigated. Eight adult horses were randomly allotted to 2 equal groups: normal and ischemic/reperfusion injury. Lymphatic flow rates, mesenteric blood flow, and lymph and plasma protein concentrations were determined at 15-minute intervals throughout the study. Microvascular permeability was determined by estimates of the osmotic reflection coefficient, which was determined when the ratio of lymphatic protein to plasma protein concentration reached a constant minimal value as lymph flow rate increased (filtration-independent lymph flow rate), which occurred at venous pressure of 30 mm of Hg. Full-thickness jejunal biopsy specimens were obtained at the beginning and end of each experiment, and were prepared for light microscopy to estimate tissue volume (edema) and for transmission electron microscopy to evaluate capillary endothelial cell morphology. The osmotic reflection coefficient for normal equine jejunum was 0.19 +/- 0.06, and increased significantly (P < or = 0.0001) to 0.48 +/- 0.05 after the ischemia/reperfusion period. Microscopic evaluation revealed a significant increase (P < or = 0.0001) in submucosal and serosal volume and capillary endothelial cell damage in horses that underwent ischemia/reperfusion injury. Results indicate that ischemia/reperfusion of the equine jejunum caused a significant increase in microvascular permeability.
Analysis of Variance↗
Laparoscopic anatomy of the equine abdomen.
Laparoscopy was performed on 6 horses (2 mares, 2 geldings, 2 stallions) to determine the normal laparoscopic anatomy of the equine abdomen. After withholding feed for 36 hours, horses were examined from the left and right paralumbar fossae, and the visceral anatomic structures were recorded by videotape and photography. One mare developed emphysema located subcutaneously at the primary laparoscopic portal; otherwise, there were no complications. The anatomic structures of diagnostic importance that were observed in the left half of the abdomen were the hepatic duct; left lateral and quadrate lobes of the liver; stomach; spleen; left kidney with the associated nephrosplenic ligament; segments of jejunum, descending colon, and ascending colon; left side of the male and female reproductive tracts; urinary bladder; vaginal ring; and mesorchium. Important structures observed in the right side of the abdomen were portions of the common hepatic duct; left lateral, quadrate, and right lobes of the liver; caudate process of the liver; stomach; duodenum; right dorsal colon, epiploic foramen; omental bursa; right kidney; base of the cecum; segments of jejunum, descending colon, and ascending colon; urinary bladder; right half of the male and female reproductive tracts; and rectum.
Abdomen↗
Stringhalt secondary to trauma to the dorsoproximal region of the metatarsus in horses: 10 cases (1986-1991).
A review of medical records was used to identify 10 horses in which stringhalt developed subsequent to trauma to the dorsal metatarsus. Six horses developed stringhalt within 3 months after injury, 3 horses developed stringhalt > 3 months after injury, and time from injury to stringhalt was unknown for 1 horse. Horses were treated with exercise, including daily hand-walking with pasture turnout, followed by lunging; or surgically, using lateral digital extensor myotenectomy. Of the horses treated with exercise, 1 had resolution of stringhalt, 2 improved but had residual stringhalt, and 1 had no change. Two of the horses having lateral digital extensor myotenectomy had resolution of stringhalt. Two of the remaining 3 horses treated surgically had varying degrees of improvement, and in 1 horse there was no change. Stringhalt is a potential complication following trauma to the dorsal metatarsal region. Potential causes include tendon adhesions enhancing tarsocrural joint flexion or abnormalities in the myotatic reflex caused by tendon injury that result in abnormal flexion of the tarsocrural joint.
Animals↗
Abdominal radiography for diagnosis of enterolithiasis in horses: 141 cases (1990-1992).
Medical records of 245 horses that had been evaluated by use of abdominal radiography between January 1990 and December 1992 were reviewed. One hundred forty-one horses subsequently had a postmortem examination or surgical exploration performed for definitive lesion diagnosis. The signalment, diagnosis, site, and number of enteroliths were obtained from the medical records. Radiographs were evaluated individually by 3 reviewers for the presence of enteroliths, preferred diagnostic view, evidence of large colon tympany, and film quality. Of the 141 cases reviewed, 66.7% (94/141) had confirmed enterolithiasis. Enteroliths were identified in the right dorsal colon of 59 horses, in the transverse colon of 28, in the small colon of 24, and in the ventral colon of 1 (enteroliths were detected in multiple sites in 12 horses). For the 3 reviewers, mean sensitivity was 76.9% and specificity was 94.4%. Mean positive-predictive value was 96.4%, and negative-predictive value was 67.5%. Cases involving only large colon enteroliths were correctly diagnosed 83.2% of the time, compared with 41.6% of the time for cases involving small colon enteroliths. Enteroliths were evident in 54.8% of the horses with radiographic signs of large colon distention. Fifteen horses had enteroliths in the small colon, 4 in the transverse colon, and 4 in the dorsal colon. Radiographic quality was evaluated and scored as adequate (0), underexposed (-1), overexposed (1), or incomplete. Mean score was -0.5, and there were 21 (14.9%) incomplete studies.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Transnasal incision of restrictive nasopharyngeal cicatrix in three horses.
Three horses were found to have an extensive nasopharyngeal cicatrix that was responsible for respiratory impairment. The cicatrization was diagnosed by use of endoscopy during evaluations of the horses for inspiratory stridor. All 3 horses were treated by endoscope-guided transnasal incision of the cicatrix and were able to resume their previous activities.
Animals↗
Surface oximetry for intraoperative assessment of colonic viability in horses.
Surface oximetry was used to evaluate viability of the ascending colon in 60 horses with naturally occurring colonic volvulus or displacement. Tissue surface oxygen tension (PsO2) was measured on the serosal surface of the pelvic flexure after anatomic correction of the colonic obstruction. Horses with PsO2 > 20 mm of Hg were predicted to have viable colon; whereas, horses with PsO2 < or = 20 mm of Hg were predicted to have nonviable colon. Results of surface oximetry were compared with final outcome. For surface oximetry, sensitivity (ability to accurately identify colon that was nonviable) was 53%, but specificity (ability to accurately identify bowel that was viable) was 100%. Negative predictive value (probability that a horse with PsO2 < or = 20 mm of Hg truly had nonviable bowel) was 87%, and positive predictive value (probability that a horse with PsO2 < or = 20 mm of Hg truly had nonviable bowel) was 100%. The overall accuracy was 88%. Of the 45 horses that had a colonic PsO2 > 20 mm of Hg and survived, 7 had been given, on the basis of subjective assessment of visual criteria, a good prognosis, 28 had been given a guarded prognosis, and 10 had been given a poor prognosis. Of the horses that had a colonic PsO2 > 20 mm of Hg but died after surgery because of further colonic infarction, confirmed at necropsy, 4 had been given a poor prognosis, and 3 had been given a guarded prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Renal dysplasia and benign ureteropelvic polyps associated with hydronephrosis in a foal.
A 4-month-old male Trakehner foal with a history of hematuria, poor growth, and abnormal hair was found to have unilateral hydronephrosis and hydroureter, as determined by ultrasonography and surgical exploration. Nephrectomy and ureterectomy were performed as treatment. Gross examination of the ureter and kidney revealed renal pelvic and ureteral polyps causing obstruction and subsequent hydronephrosis. The histologic features were consistent with renal dysplasia. The polyps and renal dysplasia were likely to be congenital, but the etiopathogenesis is not known. The finding that urinary outflow obstruction can disrupt nephrogenesis and lead to renal dysplasia supports the view that the polyps developed, blocked urine flow, and caused the hydronephrosis and renal dysplasia in the foal.
Animals↗
Evaluation of myeloperoxidase concentrations in experimentally induced equine colonic ischaemia and reperfusion.
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Animals↗
Effects of the 21-aminosteroid U-74389G on ischemia and reperfusion injury of the ascending colon in horses.
Sixteen horses were allotted at random to 3 groups: vehicle only; low dosage (vehicle and 3 mg of U-74389G/kg of body weight); high dosage (vehicle and 10 mg of U-74389G/kg). These solutions were given prior to reperfusion. The ascending colon was subjected to 2 hours of ischemia followed by 2 hours of reperfusion. Before, during, and after ischemia, full-thickness colonic tissue biopsy specimens were obtained for measurement of malondealdehyde (MDA) concentration and myeloperoxidase activity and for morphologic evaluation. Although increases were not significant, MDA concentration and myeloperoxidase activity increased during ischemia and reperfusion. Administration of U-74389G did not have significant effects on MDA concentration and myeloperoxidase activity. However, the lower dosage tended (P = 0.08) to reduce myeloperoxidase activity at 30 and 60 minutes of reperfusion. In horses of the vehicle-only group, ischemia induced a decrease in mucosal surface area that was continued into the reperfusion period (P < or = 0.05). Administration of U-74389G at both dosages (3 and 10 mg/kg) prevented the reperfusion-induced reduction in mucosal surface area, which was significant at 60 minutes (high dosage; P = 0.05) and 90 minutes (low and high dosages; P = 0.02). After initial reduction in horses of all groups, mucosal volume increased for the initial 60 minutes of reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
Evaluation of the microcirculation of the equine small intestine after intraluminal distention and subsequent decompression.
Effects of intraluminal distention (25 cm of H2O, 120 minutes) and subsequent decompression (60 minutes) on intramural vascular patterns of the small intestine was evaluated in 7 anesthetized horses. Intraluminal distention (25 cm of H2O, 120 minutes) was created in 2 jejunal segments in each horse. Experimental and control segments were removed either immediately after the experimental period or after 60 minutes of decompression. The vascular system of experimental and control jejunal segments was lavaged with NaCl, then was injected with a blue-colored radiopaque medium for microangiography or with a diluted methyl methacrylate for scanning electron microscopy of microcorrosion vascular casts. After angiographic evaluation, tissue sections were prepared for light microscopic evaluation to assess vascular filling and tissue morphology. The distended segments had short villi, which were separated by expanded crypts, and had mesothelial cell loss, neutrophil infiltration, and edema in the seromuscular layer. The number of perfused vessels was significantly (P < 0.05) decreased in the seromuscular layer and, to a lesser extent, in the mucosal layer of the distended segments, compared with controls. After decompression, the morphologic lesions progressed in mucosal and serosal layers and the number of observed vessels increased in all intramural layers; however, vascular density did not return to the predistention state. These results identify altered intramural vascular patterns in the equine jejunum during luminal distention and subsequent decompression.
Animals↗
Evaluation of the microcirculation of the equine jejunum and ascending colon after ischemia and reperfusion.
Intramural vascular patterns of the jejunum and colon were evaluated during ischemic strangulation obstruction (ISO, 70 minutes) and subsequent reperfusion (60 minutes) in 7 adult anesthetized horses. Microvasculature of experimental and control segments was described by comparison of results from microangiography, light microscopy, and scanning electron microscopy of vascular replicas. Experimental and control segments with isolated vascular arcades were removed either immediately after the experimental period or after 60 minutes of reperfusion. Blood was flushed from the vascular system by use of isotonic NaCl, and the segments were divided. Half of each segment was perfused with a modified radiopaque medium for microangiographic evaluation, and half was perfused with dilute methyl-methacrylate to create a vascular replica to be studied by scanning electron microscopy. Microangiographic section also were evaluated for histologic changes. Microvasculature of jejunal control segments and all colon segments was similar to described normal microvasculature of the equine jejunum and ascending colon. In jejunal ISO segments, intramural perfusion was redistributed away from the mucosa. In the villi, the central arteriole was short and convoluted and the subepithelial capillaries were not filled. The submucosal vessels and crypt capillaries were congested, compared with those of controls, and the serosal vessels were not filled in the ischemic segments. Histologic grade II-III mucosal lesion was seen in jejunal ISO segments. Reperfused jejunal segments had a transmural hyperemic response, and previously unfilled capillaries were observed in all intestinal layers. After reperfusion, the mucosal lesion progressed to grade III-IV and a cellular infiltrate and edema formation were observed in the serosa. The intramural vasculature of the ischemic and reperfused colon remain unchanged. Minimal histologic damage was observed in the colon after 70 minutes of ISO or after 60 minutes of reperfusion.
Animals↗
Microvascular permeability changes in ischemia/reperfusion injury in the ascending colon of horses.
The normal microvascular permeability of the ascending colon in horses and the microvascular permeability of that segment after ischemia and reperfusion were investigated. Microvascular permeability was estimated by the ratio of lymphatic protein to plasma protein concentration (Cl/Cp) at high lymph flow rates in 8 adult horses in 2 equal groups: normal and ischemic (2-hour period). Lymphatic flow rates and lymph and plasma protein concentrations were determined. Intestinal biopsy specimens were obtained at the end of each experiment. Flow independent values were selected and compared by one-way ANOVA, and the mean and SEM of these values were determined. The mean Cl/Cp ratios for the flow independent part of each data set were as follows: normal = 0.36 +/- 0.08; ischemic = 0.70 +/- 0.08. These groups were significantly different (P < or = 0.0001). Microscopic evaluation revealed mild congestion and edema in the normal group. The ischemic group had mild to moderate mucosal degeneration, with moderate to severe congestion and edema. We concluded that ischemia of the ascending colon, when followed by reperfusion, results in a significant increase in microvascular permeability.
Animals↗
Ionized calcium concentration in horses with surgically managed gastrointestinal disease: 147 cases (1988-1990).
Packed cell volume, total plasma protein, serum sodium, potassium, and ionized Ca2+ concentrations, and blood pH were determined at the time of admission and following surgery in 147 horses with acute abdominal crisis. Horses were allotted to 3 categories on the basis of the surgical lesion: (1) nonstrangulating obstruction of the ascending or descending colon (category A, n = 76), (2) strangulating and nonstrangulating infarction of the cecum or ascending colon (category B, n = 37), and (3) strangulating and nonstrangulating infarction of the small intestine (category C, n = 25). Horses with low serum ionized Ca2+ concentration following surgery were given 23% calcium gluconate (100 to 300 ml) IV to effect, and ionized Ca2+ concentration was determined following treatment. The serum ionized Ca2+ concentrations of horses in categories A, B, and C before and after surgery were lower than our normal laboratory reference range. Prior to surgery, serum ionized Ca2+ concentration measured from horses in category B and C was lower than that in horses in category A. There was no difference in ionized Ca2+ concentration in serum samples obtained before surgery in horses from category B and C, and in serum samples obtained following surgery. There was a decrease in ionized Ca2+ concentration during surgery in horses in category A. There was no change between preoperative and postoperative ionized Ca2+ concentration in the samples obtained from horses in category B and C. After calcium gluconate administration, all horses with low serum ionized Ca2+ after surgery had concentrations within our normal range. Measurement of serum ionized Ca2+ in horses with an acute abdominal crisis is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen, Acute↗
Prepurchase evaluation of horses: 134 cases (1988-1990).
To quantify some components of prepurchase evaluations in horses, records from 134 evaluations performed during a 2-year period were reviewed and the outcome was determined via telephone follow-up interview. Sixty-two percent of the prepurchase evaluations had been performed at the clinic and 38% had been performed in the field by the ambulatory service. All evaluations included physical and lameness examinations, whereas radiography (49%), endoscopy (15%), nerve blocking (5%), transrectal palpation (3%), hematologic analysis (2%), electrocardiography (2%), drug testing for analgesic agents (2%), and ultrasonography of the flexor tendons (1%) were not always performed. Fifty-nine percent of horses evaluated at the clinic were radiographed, compared with 33% of horses evaluated in the field (P less than 0.05). Thirty-seven percent of horses evaluated were judged serviceable for their intended use. Thirty-five percent of horses evaluated at the clinic were assessed to be serviceable, compared with 41% of those evaluated in the field (P less than 0.05). Horses used for pleasure riding (48%) tended to be considered serviceable more often than horses used for more athletic endeavors (3-day eventing, 33%; hunter/jumper, 24%; show, 31%; dressage, 30%). The most common basis for finding a horse unserviceable was lameness (88%).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Surgical treatment of colic in American miniature horses: 15 cases (1980-1987).
A study of 15 American miniature horses (AMH) that underwent surgical treatment for colic was performed. Information obtained from the medical records included signalment, clinical signs, type and location of gastrointestinal lesion, and postoperative complications. All 15 AMH had intraluminal obstructions, attributable to feed impactions (11 horses), enteroliths (2), and sand (2). The most common location of obstruction was the small colon, which was involved in 9 of the 15 cases. All 15 AMH survived and were discharged from the hospital. Six of the 15 AMH underwent subsequent surgical treatment for abdominal disorders. Elapsed time between the first and second operations ranged from 1 month to 5 years. Intestinal adhesions were observed in all AMH that were surgically treated twice. Thus, despite the fact that most of the AMH had a simple intraluminal obstruction, 40% (n = 6) developed adhesions that required or complicated a second surgery. Of the 15 AMH, 87% (n = 13) survived at least 12 months after the initial exploratory celiotomy. These findings suggest that most surgical abdominal conditions in AMH can be corrected; however, precautions should be taken to avoid or minimize adhesion formation.
Animals↗
Repair of a supraglenoid tuberosity fracture in a horse.
A 14-month-old Arabian colt was admitted for treatment of an articular fracture of the supraglenoid tubercle of the right forelimb. Successful repair was achieved by use of three 5.5-mm cortical screws placed in lag fashion across the fracture line. In other reports of supraglenoid tubercle fractures in horses, investigators have preferred conservative management or surgical removal of the fragment, because of limited success with internal fixation. Use of three 5.5-mm screws placed in lag fashion may offer an alternative method of treatment in selected cases of supraglenoid tubercle fractures.
Animals↗