Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.

The advent of EC/IC Bypass surgery has focused attention on selected patients who might benefit from this innovative procedure. There is a poverty of natural history data pertaining to all such lesions. Two centres (Memphis, Tennessee and London, Ontario) pooled their resources to carry out a retrospective review of 58 patients with angiographically-proven intracranial internal carotid artery steno-sis. Only 33% of the patients were alive and free from subsequent cerebral vascular events at the end of the mean follow-up of 30 months. Forty-three percent of the patients died during follow-up: 36% due to stroke and 44% because of cardiac disease. Forty-three percent of the patients suffered cerebral vascular events during the follow-up period: there were 17 strokes (29%) including 9 fatal strokes. The incidence of ipsilateral stroke was 19%; 65% of the strokes were appropriate to the stenotic intracranial carotid lesion under study. The annual ipsilateral stroke rate for patients with this lesion was 7.6% per year. This lesion detected on angiography is indicative of severe atheroma, and carries a serious risk of death due to ischemic heart disease or stroke. Stroke Vol 13, No 6, 1982 ATHEROSCLEROTIC STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) is a common lesion, most frequently found in the cervical portion of the internal carotid artery just beyond its origin. Carotid endarterectomy is often performed in the management of patients with atheromatous irregularity, ulcerative disease and stenosis of this portion of the artery. Severe intracranial ICA stenosis is not as common and is usually found in the surgically inaccessible part of the artery between the carotid canal and the origin of the ophthalmic artery.' The advent of extracranial to intra-cranial (EC/IC) bypass surgery has focused attention on this lesion as one that might benefit from the innovative procedure. Review of this literature reveals a poverty of data on the natural history of such lesions. The natural history of 21 patients with symptomatic intracranial ICA stenosis from London, Ontario was reviewed and reported in an earlier communication. 2 Subsequently resources were pooled with Memphis, Tennessee to carry out a retrospective review and analysis of this lesion. Patients and Methods Patients were seen at University Hospital, London, Ontario between 1972 and 1980 and at the VA Hospital , Memphis, Tennessee between 1975 and 1981. Seventy-four patients formed the initial data base as judged by angiographic findings. Patients were included who had a stenosis reducing the arterial lumen by at least one-third of its diameter in one or both intracra-nial portions of the internal carotid arteries. Asympto-matic as well as symptomatic lesions were studied. Several patients had an ipsilateral lesion in the extra-cranial part of the artery (tandem lesion) and these were included. Also included were patients who had a cervical carotid endarterectomy. Patients were not included in this natural history review for the following From reasons: an EC/IC bypa...

Major complications after TTA are uncommon, even in dogs with concurrent patellar luxation or bilateral simultaneous procedures. In spite of its morbidity, medial meniscal release may prevent postliminary meniscal tears.

Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction.