The Fourth Sir Frederick Hobday Memorial Lecture. Back problems in the horse--a look at past, present and future progress.
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Biomedical subjects
Publications and source records attributed to L B Jeffcott.
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The synthetic prostaglandin (PG) analogue fluprostenol was used to induce parturition in mares and its mode of action was investigated by measuring endocrine changes before and during the induction period. Progestagens and unconjugated oestrogens showed little change during the induction period, but two different patterns in plasma PGFM levels were observed. The first was seen when foaling occurred within 90 min of injection; PGFM levels rose soon after injection and peaked during the maximum expulsive stage of labour, thus resembling events during natural foaling. The second occurred when foaling took longer than 90 min, and in these mares PGFM levels rose at various times after injection and peaked well before the onset of the expulsive stage of labour. It is suggested that these differences reflect the hormonal readiness of the mares to foal. Other procedures, such as rupture of the allantochorion, and dilatation of the cervix and injection of fluprostenol into the allantois, produced no uterine activity and did not stimulate labour or PGFM release.
The position, posture and presentation of the fetus were studied by serial radiography of the abdomen in 18 crossbred Pony mares near term and during first- and second-stage labour. In 3 mares the fetal position was assessed before and after induction of parturition with the synthetic prostaglandin, fluprostenol. In late gestation and up to the time of first-stage labour the fetus lay in ventral position with the forelimbs and poll flexed or partly flexed. At this time fetal movements were confined to flexion and extension of neck and forelimbs, but at parturition the head and limbs gradually extended the the forelimbs, head and neck rotated so that dorsal position and cranial extension were achieved. From this position, with the forelimbs and muzzle engaged in the cervical canal, delivery was quickly effected. The trunk and hindlimbs came into dorsal position during second-stage labour. The mechanics of these fetal movements and their relation to causes of dystocia are discussed.
Post-partum placentae and uterine biopsy samples from mares after normal and abnormal foalings are described. After normal delivery there is little damage to fetal or maternal tissues. The villous epitheliochorial palcenta separates cleanly at the maternal-fetal interface and the afterbirth consists almost exclusively of fetal tissue. Uterine involution is well advanced by the 3rd and 4th days post partum and the changes are usually complete by the oestrus 7--10 days after parturition. Placental separation and involution of the uterus appear to proceed normally in malpresented foals and in otherwise viable foals with musculoskeletal defects. In aborted, stillborn or dysmature foals there are obvious signs of damage to both fetal and maternal tissues. It is generally accepted that the growth and development of the fetus is dependent upon a placenta of adequate functional capabilities. The observations suggest that the placenta is similarly dependent upon its association with a normal healthy fetus.
Clinical features of haemolytic disease of the newborn foal (HDNF) are reviewed. The state of knowledge concerning the serological factors associated with isoimmunisation of mares and as assessment of the methods available for screening potential "haemolytic mares" are presented. The treatment of severely affected foals has principally involved exchange transfusion but more recently a simple transfusion of mare's packed erythrocytes has proved more successful.
The concentrations of 13, 14-dihydro-15-oxo-prostaglandin F(PGFM), the stable metabolite of prostaglandin F, were measured in the plasma of catheterized mares and foetuses and non-catheterized thoroughbred mares and ponies during the last months of gestation. The plasma concentration of PGFM increased gradually towards term in all groups of animals. During the operation for insertion of catheters, maternal and foetal concentrations of PGFM were high, but the values fell to basal levels 24--48 h after the operation. It was found the preoperative starvation (24 h) led to a rise in the concentration of PGFM in the maternal plasma. The raised concentrations of PGFM during the operation were associated with low progestogen and high oestrogen concentrations in umbilical venous plasma. The subsequent survival period of the catheterized foal was inversely related to the maximum concentration of PGFM were studied during normal parturition in thoroughbred mares, during oxytocin-induced delivery in non-catheterized ponies and during premature delivery or abortion in the catheterized animals. The greatest increase in the concentration of PGFM was seen in the thoroughbred animals during second-stage labour; oxytocin also resulted in a very rapid rise in the level of PGFM, which remained high until delivery. In the catheterized animals, the birth of live foetuses was associated with a rise in the concentration of PGFM in both foetal and maternal plasma during the last 2 h before delivery. Less consistent changes were found during abortion.
Much has been written on laminitis and its treatment over the past 200 years. This article makes a brief review of the practical essentials of the disease and considers some of the recent trends in therapy. Knowledge of the pathogenesis and aetiology of equine laminitis is still very incomplete but recent work in the United States by Coffman and his colleagues has been particularly productive.
The clinical uses and side-effects of phenylbutazone in man, horses, and other animals are reviewed. The blood dyscrasias commonly described in man have not been reported in the horse, although several of the more minor side-effects have occasionally been seen (e.g. water retention, depression, transient staggering and phlebitis). Despite the lack of documented evidence, the toxicity of phenylbutazone in the horse is considered to be lower than that in man. This may be associated with the lower dose rates normally used, the more rapid plasma clearance rate and the comparatively younger age of most horses under treatment. The following guidelines for the use of phenylbutazone in practice are put toward. It should only be used under strict veterinary control and then only if there are clear clinical indications. It should not be given if there are signs of gastro-intestinal ulceration, clotting defects or any cardiac, renal or hepatic dysfunction. Dose rates should be kept to a minimum and the drug withdrawn immediately if any side-effects occur or if there is no clinical response within 4 days. If prolonged therapy is necessary, periodic haematological analyses should be carried out.
The efficacy and safety of oxytocin, dexamethasone and prostaglandin, used alone or in combination as inducing agents, are discussed. It is contended that insufficient evidence exists to support the routine application of any of these methods in practice. Oxytocin has been the most widely used and it is claimed by some to be free from side effects. However, the synthetic prostaglandin analogue, fluprostenol, seems to pose the least risk to the foetus and dexamethasone appears to be either ineffective, or too dangerous to use at all. The main indications for induced foaling are managerial convenience or for research and teaching purposes. There are few clinical indications, although ventral rupture and cases of prolonged gestation have been mentioned by various workers. It is considered that foetal maturity is the pre-requisite before a decision to induce should be made in practice, and 3 criteria are essential: 1) a gestational length of greater than 320 days, 2) substantial mammary development, 3) the presence of colostrum in the mammae.
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The current knowledge of the clinical signs, epidemiology and pathogenesis of abortion due to the equid herpesvirus (EHV 1) is reviewed. The relationship between the respiratory and abortigenic forms of the disease is discussed as well as the low incidence of virus abortion in the UK compared to some other parts of the world. Some practical aspects of the disease as they affect stud management are considered including methods of diagnosis, prophylaxis and the necessary action to be taken to prevent spread of infection.
This short review article describes the various techniques currently available for artificial insemination in the horse. The collection and use of raw and extended semen is discussed together with the more recent developments in freezing semen. The expected conception rates with both fresh and frozen semen are quoted. The possible benefits in disease control and stud management are discussed, as well as the difficulties in controlling the use of A.I. from the Breed Registration Authorities point of view.
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A description of some of the clinical features of low back pain in the horse has been given and a number of methods for assisting diagnosis considered. As well as a complete clinical examination both at rest and during exercise, a useful diagnostic aid in some chronic cases was the injection of local anaesthetic into the interspinous spaces. A laboratory examination, including haematological and biochemical profiles, was undertaken in all cases. The serum enzymes GOT and CPK were particularly valuable as an aid to diagnosis in atypical tying-up. A technique for radiography of the vertebral column of the mid back in the standing position and of the pelvic and sacroiliac regions of the anaesthetised horse was described using a Siemens Triplex Optimatic 1023 machine. Some of the radiological features of the vertebral column were considered and a breakdown of the diagnosis of 110 referred back cases. The most important conditions included muscle strain, crowding and overriding of the dorsal spinous processes in the mid back, spondylosis, undue curvature of the spine and vertebral fractures.
This paper describes the surgical treatment of 14 horses exhibiting chronic back pain attributed to impaction and overriding of the dorsal spines in the thoracolumbar region. The technique involved the resection of the summits of one or more dorsal spines following midline division of the supraspinous ligament. All the horses returned to full work after a convalescent period of at least four months, and 12 of them showed considerable improvement in their form and performance. A post-surgical complication encountered in one case was the development of new bone on the edge of a resected spine. This lesion, which pressed on the dorsal spine immediately caudal to it, was removed subsequently at a second operation and no further sequelae occurred.
The mechanism of transfer of maternal immunity to the foal is reviewed. Maximal efficiency of macromolecular absorption by specialized cells of the small intestine exists soon after birth. The absorptive cells are progressively replaced by more mature-looking cells incapable of taking up large molecules and the rate of absorption is reduced in a linear decline and ceases completely within 24 hr. Passive antibody levels fall rapidly in the first 4 weeks of life to less than half their original values and have usually completely disappeared by 6 months of age. The foal shows immunological competence soon after birth although appreciable levels of autogenous immunoglobulins are not usually attained until 2 to 3 months of age.
Of 211 consecutive thoroughbred foalings, 145 satisfied a set of criteria for normal parturition and foal viability. The fetal membranes from these and from 10 pony foalings have been systematically examined morphologically and quantitatively and the findings compared to those of other authors. Five sites on the allantochorion were consistently devoid of villi. Expulsion usually occurred with the non-villous side outermost. In 24 per cent of allantochorions the non-pregant horn was of equal length or longer than the pregnant horn. These placentae tended to be shed with the villous side outermost. All membranes contained a hippomane in the allantoic cavity. Remnants of the yolk sac placenta and extra-embryonic coelom were always present. Large vestigeal yolk sacs have previously been confused with anomalous twins. In most cases the endometrial cup sites were site recognisable, usually arranged around the umbilical cord attachment. This attachment was found on the dorsal aspect of the uterine cavity either at the junction of the horns or within the pregnant hor; rarely, it was in the non-pregnant horn. A degree of twistng of the umbilical cord is normal. In 6.2 per cent of cords small urachal dilatations were noted, resulting from flight stenosis of the urachal luman at the site of a twist. Ninety-five per cent of cords measured between 36 and 83 cm.