Biology Reference
In-Depth Information
and physitis, both of which led to unfortunate outcomes. The highest SAA concentra-
tion upon admission was found in a mare affected by bacterial hepatitis (546.58 mg/l).
Fibrinogen concentrations upon admission were abnormal in 16 horses, though levels
were only mildly elevated in four horses. Haptoglobin levels were measured in 19
horses, and only three neonatal foals had levels higher than the physiological limit.
Clinical monitoring through sequential blood sampling was implemented for
24 horses. Patients that underwent urgent laparotomy for noninflammatory
pathologies featured low SAA concentrations upon admission, with one exception.
SAA concentrations peaked 48 h after surgery and descended until they were
normalized within 7 days. With the exception of a horse with a SAA peak of
41.39 mg/l, all other uncomplicated cases featured 48-h postsurgery SAA peaks
between 234.18 and 463.72 mg/l. Horses with postsurgical complications showed
either further elevation of SAA values with peaks higher that 600 mg/l (824.23 mg/l in
one patient) or a concentration plateau beyond 400 mg/l. Horses that were admitted for
elective surgery with less invasive procedures than laparotomy featured a similar SAA
surgery response curve though with a lower 48-h peak (61.11mg/l for arthroscopy and
177.59 mg/l for laryngoplasty and ventriculectomy). In all these patients, SAA
concentrations returned to normal levels within 4 days after surgery.
21.4 Discussion
The main element of clinical interest is the significant correlation between SAA
concentrations and the clinical assessments of the horses that were monitored
during hospitalization. Therefore, the SAA surgery response scheme could provide,
both for elective and urgent procedures, a useful clinical tool for postsurgical
evaluation and early detection of complications, with special reference to septic
cases. All uncomplicated cases featured a 48-h postsurgery SAA peak that promptly
receded in the following days. A postpeak SAA plateau or further increases in SAA
were always associated with the emergence of postsurgical complications. Hence, it
would be appropriate to introduce the SAA sequential measurement in postsurgery
monitoring protocols for both intensive-care patients and elective procedures. It is
also interesting to note that, despite the limited sample size, the postsurgery peak
was proportional to the severity of the surgical insult and the invasiveness of the
procedure: minimal peaks following arthroscopy, medium peaks following
laryngoplasty and ventriculectomy, and maximal peaks following laparotomy.
Laparotomy wound infections that affected many patients did not alter the
postsurgery SAA response curve, possibly because of its exclusive localization to
the external suture planes and the limited systemic influence.
Postsurgery monitoring of fibrinogen and haptoglobin concentrations was not
equally rewarding. While fibrinogen concentrations were often found beyond the
normal range, no clear correlation was identified with the clinical assessment of the
respective patients. Two main hypotheses were formulated to justify this evidence.
First, fibrinogen concentrations can be altered by changes in hematocrit values and
