Abstract Background No study has described the computed tomographic (CT) sinonasal findings in a large cohort of referred sinonasal disease cases. Objectives To report the CT imaging findings in equine sinonasal disease and examine associations between case outcome and CT findings. Study Design Retrospective case series. Methods Data were collected from medical records from 19 equine hospitals on sinonasal disease cases which had undergone CT imaging. Case outcome was obtained from clinical records, and/or by contacting clients and referring veterinarians. Multivariable logistic regression analysis was used to examine variables at presentation associated with case outcome. Results The 1600 cases of sinonasal disease had unilateral sinusitis in 1457 and bilateral sinus disease in 143. The rostral maxillary sinuses (86.1% affected) and ventral conchal sinuses (74.8% affected) were most commonly involved. Fluid attenuation or distortion of the ventral nasal conchal bullae (NCB) was present in 21.3% and 39.3% of cases, respectively, and of the dorsal NCB, in 16.5% and 28.4% of cases, respectively. Hyperostosis (inflammatory thickening) of sinus‐related bones was mild in 35.5%, moderate in 19.8%, severe in 8.7%, and absent in 36.1% of cases. A total of 659 non‐fractured and 200 fractured apically infected teeth were found. The normal contralateral sinuses in 100 horses showed CT evidence of endodontic/apical infection in 114 cheek teeth. The multivariable model was built with data from 674 cases. Cases with apically infected non‐fractured (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.41–3.29) or fractured teeth (OR 2.03, 95% CI 1.08–3.81) (i.e., dental sinusitis) had a higher likelihood of cure than those that did not. Cases with caudal group sinusitis (OR 0.48, 95% CI 0.29–0.80) or moderate or severe bone hyperostosis (OR 0.53, 95% CI 0.36–0.78) had a lower likelihood of cure than those without. Main Limitations Retrospective study with incomplete data available for some cases. Conclusions Maxillary cheek teeth endodontic/apical infection does not always cause sinusitis. Sinus bone hyperostosis and caudal group sinusitis are associated with a lower likelihood of cure, whereas apical infections are associated with a higher likelihood of cure.
Abstract Background No large study has described the signalment, pre‐referral management or clinical and nasal endoscopic findings in equine sinonasal disease. Objectives To explore associations between case outcome and signalment, pre‐referral treatments, clinical and nasal endoscopic variables in sinonasal disease. Study Design Retrospective case series. Methods Data were collected from medical records of 19 equine hospitals on sinonasal disease cases they had examined and which had undergone computed tomographic (CT) imaging. Case outcome was obtained from clinical records and/or by contacting clients and referring veterinarians. Multivariable logistic regression analysis was used to examine variables at presentation associated with case outcome. Results One thousand six hundred cases met inclusion requirements, including 1457 cases of unilateral and 143 cases of bilateral sinonasal disease. Most were chronic disorders (median duration 17.9 weeks). The most common antimicrobials administered pre‐referral were potentiated sulphonamides, doxycycline and procaine penicillin. Pre‐referral surgical treatments included maxillary cheek tooth extraction ( n = 234 teeth) in 201 horses (12.6%), sinoscopy (11.8%), nasofrontal sinus osteotomy (5.2%) and maxillary sinus osteotomy (3.6%). Nasal airflow was obstructed in 14.9%, and facial swelling was present in 26.9% of cases. Nasal endoscopy showed exudate at the sinonasal ostium in 65.8% of cases, and middle meatus abnormalities, including inspissated exudate, sequestra and sinonasal fistulae, were present in 44.6%. A multivariable model was built with data from 650 cases. Age at presentation greater than 12 years (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36–0.79), sinonasal disease of over 8 weeks duration (OR 0.63, 95% CI 0.42–0.94), nasofrontal sinusotomy prior to referral (OR 0.36, 95% CI 0.16–0.81) and presence of facial swelling or bilateral nasal discharge at presentation to a referral centre (OR 0.33, 95% CI 0.18–0.62) were significantly associated with a decreased chance of complete cure. Main Limitations This was a retrospective study with incomplete data for some cases. Conclusions Equine sinonasal disease cases aged over 12 years old, with disease of over 8 weeks duration or having had nasofrontal sinusotomy prior to referral had a decreased chance of complete cure following referral.
Background: The Wellness Ready Test (WRT) 1 is a stable-side lateral-flow test for measuring blood insulin concentrations in equids. The assay has been validated and compared with a radioimmunoassay used commercially in the USA. A method comparison with insulin assays commonly used in the UK has not been reported and would facilitate clinical application of the WRT. Objectives: To compare the results of WRT insulin analysis with the Immulite chemiluminescent immunoassay (ICLIA) 2 and the Tosoh immunofluorescent assay (TIFA) 3 . Study Design: Method comparison. Methods: Basal insulin concentrations were analysed from clinical cases for routine diagnosis (ICLIA). Residual blood was used for comparative analysis using the WRT and TIFA. To account for the WRT’s restricted range (20 – 99.9 µIU/mL), data were reformatted, with ICLIA and TIFA values restricted to the same range. Continuous data were analysed using Lin’s concordance correlation coefficients (CCC) and Pearson’s r values. Clinically relevant WRT cut-offs for laminitis risk were derived by ROC analysis compared with the reference method (TIFA). Continuous insulin data were categorised using method-specific laminitis risk cut-offs. Cohen’s kappa coefficient is reported for the inter-method agreement of categorical insulin data. Results: 59 samples were analysed. Concordance between testing methods was strong; WRT/TIFA CCC 0.90 (95% CI 0.86-0.95), Pearson’s r 0.93, p<0.001, WRT/ICLIA CCC 0.84 (95% CI 0.76-0.91), Pearson’s r 0.85, p<0.001. Derived cut-offs for WRT basal insulin values were low risk < 22.2µIU/ml, high risk > 48.3µIU/ml. Cohen’s kappa coefficient for laminitis risk categories for WRT and TIFA was substantial at 0.79 (p<0.001), but moderate for WRT and ICLIA at 0.67 (p<0.001). Main limitations: Limited data from a single hospital and a restricted readable range on the WRT. Conclusions: The WRT shows substantial agreement with established laboratory-based insulin assays in the UK. Results support the stable-side use of the WRT in UK equine practice.
Equine squamous cell carcinomas (eSCCs) are common, and a proportion are likely induced by Equus caballus papillomavirus 2 (EcPV-2). Accurate prediction of clinical outcomes is challenging with no recognized prognostic criteria or consistent histopathological classification scheme for eSCC. The aims of this study were to histopathologically subtype a large case series of eSCCs (genital and ocular) and correlate them with p16 and HER-2 expression, equine papillomavirus infection status, and various clinical and histopathological parameters to predict tumour behavior and prognosis. One hundred and eighty-five samples were examined and subtyped histologically. HER-2 and p16 immunohistochemistry (IHC) and in situ hybridization (ISH) for the EcPV-2 E6/E7 oncogenes were performed on a subset of cases, and follow-up survival data were analyzed. The results were compared and correlated with published guidelines on the categorization of human SCC. Six histopathological subtypes of SCC, according to the WHO, were identified for the first time in horses: usual/invasive (most common), verrucous, pseudoglandular, papillary, warty, and basaloid, with different histological subtypes demonstrating prognostic significance. HER-2 and EcPV-2 statuses were not associated with prognosis in horses with SCC. p16 expression is not associated with EcPV-2 status but could be a potential prognostic factor. ISH demonstrated EcPV-2 genetic material in the majority of eSCCs, except for the papillary subtype, which includes mature, not just pre-cancerous, eSCCs. Widespread HER-2 expression in eSCCs could suggest a role for this cell receptor as a potential therapeutic target.
BACKGROUND:The diagnosis of equine sinonasal disorders has been greatly enhanced by using computed tomographic (CT) imaging. OBJECTIVES:To explore associations between specific diagnoses and clinical and CT findings and between specific diagnoses and case outcome in equine sinonasal disease. STUDY DESIGN:Retrospective case series. METHODS:Data were collected from medical records from 19 equine hospitals on cases of sinonasal disease, all of which underwent CT imaging. Case outcome was obtained from clinical records, and/or by contacting clients and referring veterinarians. Logistic regression analysis was used to examine associations between specific diagnoses and clinical and CT variables and examine associations between specific diagnoses and case outcome. RESULTS:Dental sinusitis due to apical infection was the most common cause of sinusitis (n = 693; 43.3% of cases). Other causes were primary sinusitis (n = 329; 20.6%), sinus cyst (n = 178; 11.1%), progressive ethmoid haematoma (PEH) (n = 100; 6.3%), traumatic sinonasal disease (n = 90; 5.6%), sinonasal neoplasia or suspect neoplasia (n = 86; 5.4%), other non-neoplastic sinonasal growths (n = 11; 0.6%), mycotic infection (n = 65; 4.1%), sinus pneumocele (n = 5; 0.3%), oro-nasal fistulae-related sinusitis (n = 4; 0.25%), sinus mucocele (n = 2; 0.13%) and facial suture infection (n = 1; 0.06%) cases. Facial swelling was more common with sinonasal cysts, tumours, trauma and mycosis than other diagnoses. Nasal malodour was most common with dental sinusitis. Nasal airflow obstruction was most common with sinonasal cysts, PEH and tumours. Empyema of the nasal conchal bullae was least common with sinus cysts, PEH, trauma and tumours (less purulent types of sinusitis). More severe grades of hyperostosis were associated with sinus cysts and tumours. Sinonasal tumours (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.01-0.07) and PEH (OR 0.23, 95% CI 0.12-0.43) had a significantly lower likelihood of cure than primary sinusitis. MAIN LIMITATIONS:This was a retrospective study, and histology was not performed in some cases. CONCLUSIONS:Equine sinonasal disease has a range of underlying causes which impacts the clinical presentation and outcome.
