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your treatment records. From the lawyer's point of view, if there is something that comes to your attention which has been left out of your records, add it to the file by a separate memo. If the claim is large enough to exceed your insurance coverage or if you feel that your insurance carrier is not a d e q u a t e l y p r o t e c t i n g your interests, you should hire your own counsel. There are inevitable conflicts between your interests and your insurance carrier's interests, particularly if the amount of the claim exceeds your potential insurance coverage. In our rather jaded view, it is unwise to depend on the insurance company when its interests may be inconsistent with yours. Hiring individual counsel creates the uncomfortable situation in which you are paying for an attorney to help you on a claim that you thought was going to be handled by the insurance carrier. "Take heart, he said, "unless your insurance carrier is refusing to defend you, the insurance lawyer will continue to represent you and do most of the heavy lifting. The purpose of hiring your own lawyer is to watch the insurance company."

6TH EQUINE COLIC RESEARCH SYMPOSIUM

The 6th Equine Colic Research Symposium was held November 8-11, 1998 at Athens, Georgia. Many research reports were given on a variety of topics related to colic. Colic associated with internal parasites and gastric ulcers are summarized here. Internal parasites Twenty horses with colic referred to the Liverpool University Equine Hospital since 1992 were found at laparotomy to have obstruction of the colon associated with a mural lesion located in all cases in the left dorsal colon. All cases had severe submucosal edema with focal to diffuse eosino-philic inflammation. The cause of the colonic lesion was not seen in any of the resected tissue, although the nature of the inflammatory reaction suggests the possibility of parasitic infection. -G. B. Edwards, et al. Investigation of the role of the tapeworm Anoplocephala perf oliata in colic has been hampered by difficulties of diagnosis. The development of a serodiagnostic ELISA, utilizing the

host's IgG(T) response to a 12/13kDa protein secreted by the parasite, was described. Validation of the assay demonstrated good correlation of ELISA optical density with tapeworm infection intensity (r = 0.63). The assay was used to evaluate t a p e w o r m infection as a risk factor for ileal impaction colic (as diagnosed at laparotomy) and spasmodic colic, in a matched case-control study. Univariate analysis demonstrated odds ratios of 44 (95% C.I. 7.4) and 3 (1.3, 7.5) for the risk of ileal impaction colic and spasmodic colic respectively, in the presence of tapeworm infection. C o n d i t i o n a l logistic r e g r e s s i o n analysis, using ELISA O.D. as an indicator of infection intensity, demonstrated a linear relationship between infection intensity and the log-odds of disease. It was concluded that tapeworms are a significant risk factor for both types of colic investigated and that serodiagnosis of t a p e w o r m infection is a useful epidemiological tool. -Christopher J. Proudman and Sandy J. Trees. Type 2 cytokine responses, particularly that of IL-4, are associated with protective immunity to GI nematode infections in murine systems. The

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dominance of Type 1 or Type 2 responses in this regard were examined in the equine using Strongylus vulgaris infections in immune and nonimmune ponies as a model. Gene expression of IL- 2, I L - 4 , I L - 5 , I L - 1 0 a n d IFN-gamma was quantitatively measured by a RT-QPCR method following challenge infection of vaccinated and naive ponies. R N A for this purpose was collected from peripheral blood mononuclear cells (PBMC) and colonic lymph node cells (CLNC) prior to and during the early course o f infection. RNA was collected from cells immediately after removal and following in vitro stimulation with antigen. CLNC were collected by sequential surgeries at days 4 and 9 post infection. Necropsies were performed on day 14. Prior to challenge vaccinates produced more IL-4 and IL-5 than naive ponies. Both CLNC and PBMC exhibited a Type 2 cytokine response following

challenge infection in both vaccinates and naive ponies. However, this response appeared earlier in vaccinates than in naive animals. This response was also seen first in the CLNC. These cytokine data support previous observations suggesting that type 2 cytokines are responsible driving the protective immune response to these nematodes. -T. R. Klei, et al. The purpose of one study was to evaluate the effect o f infection with Strongylus vulgaris on clinical signs, hematologic variables, cytokines, and plasma nitric oxide (NO) concentration in parasite-free ponies. It was found that acute infection with S. vulgaris in parasite-free ponies induces an inflammatory response that does not appear to involve serum cytokines, however, a potential role of NO exists.

racing was suffering an abnormally high incidence of colic, including several ileal impaction colics that required surgery. It was concluded that tapeworms were an important risk factor for colic in this population and that serodiagnosis of tapeworm infection can be a useful clinical tool. -Christo-

pher J. Proudman.
F e e d i n g of the n e m a t o p h a g o u s fungi Duddingtonia flagrans spores has been demonstrated to effectively reduce burdens of equine strongyle L3 in cold temperate climates. The objective of the current investigation was to determine the effectiveness of this procedure in the subtropical climate of s o u t h e r n L o u i s i a n a . Duddingtonia flagrans effectively reduced the L3 larval burdens during all seasons of the year. -M.A. Baudena, et al.

-Jeremy D. Hubert, et al.

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Continued on page 62

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Volume 19, Number 1, 1999

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Continued from page 27 Gastric ulcers Short chain fatty acids (SCFAs) may cause acid injury and stomach ulceration in horses. Gastric juice SCFAs, pH, and number and severity of gastric lesions were evaluated in six seven-year-old horses with gastric canhulas fed different diets. Horses were randomly assigned a bromegrass hay diet or an alfalfa hay/grain diet in a two period crossover design. Horses were fed for two weeks. Gastric juice was collected immediately postfeeding and 1-8, 10, 12 and 24 hours after feeding, while the horses fasted. Horses underwent gastroscopy before beginning each diet and after the 24-hour fast on day 15. Gastric juice pH was measured using a pH electrode. Concentrations of SCFAs (acetic, propionic, and isovaleric acids) were measured using gas chromatography. Number and severity of gastric lesions were scored by gastroscopic examination. The pH of the gastric contents was variable throughout the 24-hour collection period. The alfalfa hay/grain diet produced significantly higher pH, acetic, propionic and isovaleric acid concentrations when compared to the bromegrass hay diet. Non-glandular gastric lesion number and severity scores were lower in horses fed the alfalfa hay/grain diet when c o m p a r e d to the horses fed the bromegrass hay diet. Alfalfa hay, due to its high protein and calcium concentrations, may act as a dietary antacid. Alfalfa hay may have a protective effect on the non-glandular gastric mucosa in horses. -J.A. Nadeau, et al. To determine its effect on 24-hour basal and pentagastrin-stimulated (PGS) gastric acid secretion, omeprazole (Ome, 0.25 and 1.0 mg/kg, IM) or saline was administered Once to five adult horses with chronic gastric cannulas in a three-period crossover design. Gastric juice was collected from the cannula every 15 minutes during

the following four periods, 45 minutes before and continuing for two hours after Ome administration and 5-7, 10-12 and 22-24 hours after Ome administration. Basal secretion was determined during the first hour of collection and PGS (8 gg/kg/h, IV, continuous infusion) secretion was determined during the second hour. Gastric juice pH and total acid output (TAG) were determined in each 15 min sample. Mean basal gastric juice pH increased from 3.1 in saline treated horses to 4.1 after 0.25 mg/kg and to 6.2 after 1.0 mg/kg of Ome. Mean PGS gastric juice pH increased from 3.0 in saline treated horses to 3.8 and 6.5 in horses treated with 0.25 mg/kg and 1.0 mg/kg, respectively. Mean stimulated TAO was inhibited (p<0.01) by 62 and 92%, 24 hours after Ome administration at 0.25 mg/kg and 1.0 mg/kg, respectively. Ome significantly and in a dose dependent manner decreases TAO and increases the gastric pH for 24 hours after a single IM dose. The IM route may be a practical way of administering Ome for treatment of gastric ulcer disease in horses. -A. Sandin, et al. Peptic ulcer disease is an important clinical entity in foals. The widespread use of acid-suppressing agents in the face of limited experimental data was the stimulus for the current study. The aims included 1) characterization of i n t r a g a s t r i c pH p r o f i l e s and response to ranitidine (2 mg/kg, IV or 6.6 mg/kg, PO) in normal neonatal foals; and 2) contrasting these profiles to those in age-matched sick foals. Intragastric pH was measured in all animals using a disposable antimony electrode and portable monitor. In six normal foals the mean hourly pH ranged from 3.2 to 3.7 for baseline hours and was significantly raised for hours 1-5 (IV) and 2-8 (oral) after treatment (JAVMA 212:1407, 1998). Milk intake had a marked, but transient alkalinizing effect on pH. The pH in sick foals (11=14) varied widely and

was influenced by disease type, ability to ambulate, and milk intake. Foals that were chronically recumbent frequently maintained a high pH, possibly due to ileus and enterogastric reflux. In contrast, foals that could stand and walk without assistance had pH profiles before and after ranitidine (2 mg/kg, IV, Q 8 h) that mimicked that of healthy cohorts. (Supported in part by Merial, Inc.) -L. C. Sanchez, et al. Thoroughbred racehorses selected at random were examined for gastric ulcers by endoscopy on one to six occasions. The mucosa of the stomach of each horse was scored for ulcers on a scale from 0 (no ulcers; normal mucosa) to 4 (severe ulceration, with at least 5 deep lesions). At their first exam, Thoroughbred horses in race training had an average ulcer score of 1.1. Twenty-one of the 53 horses had completely normal mucosa. Males (including male castrates) had slightly higher average ulcer scores (1.2) than females (1.0), and two-year-old horses had lower scores (0.7) than older horses (1.4). Each of these average scores was significantly (p<0.05) greater than zero; there was no significant difference between males and females, or between age groups. For the horses examined two or more times, the average exam score on all subsequent exams was higher than the first exam score overall, for each sex, and for each age group. The average change from previous exam (of the same horse) was significantly greater than zero, representing a worsening of ulcer scores, overall (p<0.05) and for males (p<0:10) and three-year-old horses (p<0.05). -James A. Orsini. O m e p r a z o l e (1.0 m g / k g ) , as " d e l a y e d - r e l e a s e " enteric coated granules in capsules, was administered to 5 horses with gastric cannulas to determine its effect on gastric acid output (mmol H+), pH, and volume. Omeprazole granules were mixed with corn syrup (12 ml) and administered

62

JOURNAL OF EQUINE VETERINARY SCIENCE

]oraily by dosing syringe once daily for ] five days. Gastric secretion tests were done on the 1st and 5th day of dosing. Gastric juice samples were collected every 15 minutes from the cannula starting five hours after administration of omeprazole. Basal secretion was determined in the first hour of collection followed by a two-hour determination of pentagastrin (6gg/kg/hr) stimulated secretion. Placebo studies were carried out in the same horses for comparison. I Mean basal and stimulated gastric acid output were inhibited by 80% after the fifth daily dose of omeprazole. Mean [ basal and stimulated gastric juice pH was greater than 4.5 by the fifth day of omeprazole treatment. Gastric juice Volume was not significantly effected ] by omeprazole treatment. Omeprazole, as "delayed-release" enteric coated granules in capsules, given orally in corn syrup significantly inhibited basal

and stimulated gastric acid secretion and increased gastric juice pH in horses by the 5th day of administration. The current "delayed-release" granule preparation of omeprazole (Prilosectin) is not inactivated when given orally to horses and can be used in the treatment of gastric ulcer syndrome. - F r a n k
Andrews, et al.

This dose titration study was designed to determine an effective dose of oral omeprazole for the treatment of experimentally-induced gastric ulcers. The gastric mucosa was examined by video endoscopy in weanling horses under xylazine/ketamine anesthesia. An endoscopic scoring system was utilized to score both number and severity of gastric ulcers in the glandular and n o n g l a n d u l a r mucosa. Flunixin meglumine was then administered at 1.0 mg/kg IV, TID for 10 days and gastric scoring repeated. After flunixin

administration, 92 horses with gastric ulceration were divided into groups of four with similar gastric scores. Each horse in the group of four was then randomly assigned to receive either placebo, 1.0, 2.0, or 4.0 mg/kg omeprazole PO once daily for 28 days. Omeprazole was administered as an oral gel preparation. Gastric scoring was repeated at days 14 and 28 of omeprazole treatment. After two weeks of treatment only the 4.0 mg/kg group had significantly more horses with complete gastric healing than the placebo group. At four weeks of treatment there was significantly greater healing in all three omeprazole treated groups. Lesions in the glandular portion of the stomach healed rapidly in all groups. Healing with omeprazole appeared to be time and dose dependent.
-C.G. MacAllister, et al.

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