ABSTRACT - 202307-202402 Flashcards
Lane - 2024 - JAVMA - Synthesis of surgeon and rehabilitation therapist treatment methods of bicipital tenosynovitis in dogs allows development of an initial consensus therapeutic protocol
Objective: To compare the therapeutic approach of surgical specialists, sports medicine and rehabilitation specialists, and veterinarians with rehabilitation certification when treating bicipital tendon disease or tenosynovitis in dogs and to combine this information with existing research to develop a treatment algorithm that provides a framework for treating bicipital tenosynovitis.
Sample: 223 respondents to an internet survey of board-certified veterinary surgeons, board-certified sports medicine and rehabilitation therapists, and veterinarians with rehabilitation certification.
Methods: The survey was promoted via multiple listservs, specialist college newsletters, and private relevant social media sites. Answers were compiled and submitted for statistical analysis.
Results: Compared to rehabilitation therapists (RTh), surgeons placed less value on the stabilizing function of the biceps tendon and its role in preventing other shoulder morbidities. Similarly, compared to RTh, surgeons were more inclined to select surgery as the primary therapeutic approach and attributed a less optimistic prognosis to conservative therapy outcomes. There were multiple differences between surgeons and RTh in executing a conservative therapy program, with RTh more likely to recommend therapeutic exercise, extracorporeal shockwave, regenerative medicine, therapeutic ultrasound, exercise restriction, photobiomodulation, and pulsed electromagnetic field therapy. RTh were less likely to prescribe NSAIDS or inject corticosteroids. Despite the above noted differences, there were also multiple areas of agreement.
Clinical relevance: Consensus agreement, combined with existing research, was used to create a treatment algorithm suggesting how to best address multiple manifestations of bicipital tendinopathy. Such guidelines can be considered to direct therapeutic strategies for this common condition.
Sevy - 2024 - JAVMA - Abdominal computed tomography and exploratory laparotomy have high agreement in dogs with surgical disease
Objective: To compare the results of abdominal CT with exploratory laparotomy in the dog.
Animals: 100 client-owned dogs from 1 academic institution.
Methods: Medical records were searched for dogs that had undergone a preoperative abdominal CT scan read by a board-certified veterinary radiologist followed by an exploratory laparotomy. CT and surgical reports were compared.
Results: The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97%. Overall, there was no evidence that proportion agreement differed on the basis of body condition score, time interval between CT and surgery, or oncologic versus nononcologic disease.
Clinical relevance: Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. When performing a specific abdominal surgery, it is acceptable for the surgeon to fully explore the abdomen or forego it for a smaller approach to the organ of interest if an abdominal CT was performed prior.
Hixon - 2024 - JAVMA - Bupivacaine liposomal injectable suspension does not provide improved pain control in dogs undergoing abdominal surgery
Objective: To evaluate the difference in postoperative pain scores of dogs undergoing abdominal surgery receiving surgical incision infiltration of saline or bupivacaine liposomal injectable suspension (BLIS).
Animals: 40 dogs undergoing exploratory laparotomy.
Methods: Dogs were prospectively enrolled and randomized to receive either BLIS or saline surgical incision infiltration. All dogs received 5.3 mg of BLIS/kg or an equal volume of saline infiltrated in the muscle/fascia, subcutaneous tissue, and intradermal layer during closure. All dogs received a standardized postoperative pain management protocol. Pain assessment was performed at select time points postoperatively by blinded observers with an electronic algometer, short version of the Glasgow Composite Measure Pain Scale (GCMPS), and indirect measures of pain, including systolic blood pressure, heart rate, and serum cortisol levels.
Results: At day 0, blood pressure was higher in the saline group (149.6 vs 125.8 mm Hg; P = .006). At day 3, GCMPS was lower in the BLIS group (BLIS = 1, saline = 2, P = .027), though both average GCMPS scores were low and only 10 dogs were available for day 3 assessments (6 BLIS and 4 saline). No other differences in algometer readings, GCMPS scores, other measured parameters, or need for rescue analgesia were present between BLIS and saline groups at any time point. There was no difference in postoperative incisional infection rate or complications.
Clinical relevance: Use of BLIS for exploratory laparotomy did not provide improved pain control over postoperative opioid administration alone. Patients that received BLIS had no increase in short-term complications.
Velay - 2024 - JAVMA - Safe gastric wall closure in dogs using a single-layer full-thickness simple continuous suture pattern
Objective: To evaluate different suture patterns for gastrostomy closure, with a focus on major complications and survival time. We hypothesized that using a full-thickness single-layer simple continuous pattern would be as safe as the traditional double-layer pattern and would not be associated with more major complications. To our knowledge, this is the first study to compare the suture patterns used for gastric closure in clinical situations.
Animals: 60 dogs that underwent gastrostomy for foreign body removal, with 20 dogs in each group.
Methods: Dogs treated with gastrotomy from January 1, 2018, to January 1, 2023, were randomly assigned to groups based on the suture pattern used at the gastrotomy site. Gastrotomies were closed with a double-layer inverting continuous pattern (DLI) in the DLI group. Gastrotomies were closed using a double-layer simple continuous pattern (DLS) in the DLS group. Gastrotomies were closed with a full-thickness single-layer simple continuous pattern (SLS) in the SLS group.
Results: All dogs were discharged from hospitalization. The survival rate did not differ among the 3 groups 1 month postoperatively, and major complications were not observed.
Clinical relevance: Using a full-thickness single-layer pattern is a safe alternative for gastrotomy closure.
Manchester - 2024 - JAVMA - Difficult catheterization and previous urethral obstruction are associated with lower urinary tract tears in cats with urethral obstruction
Objective: To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO).
Animals: 15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO.
Methods: University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated.
Results: The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats.
Clinical relevance: Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.
Makar - 2024 - JFMS - Feline radial and ulnar diaphyseal fractures - A retrospective study of 49 cases comparing single bone fixation and dual bone fixation
Objectives: The objectives of this study were to report the complications in radial and ulnar diaphyseal fractures in cats and to compare the differences in outcome between single and dual bone internal fixation.
Methods: Medical records between 2004 and 2022 were searched retrospectively for cats with antebrachial diaphyseal fractures treated with internal bone-plate fixation. In total, 49 cases were included from six referral hospitals, including one teaching hospital. Patient information was collated, including fracture configuration, location, repair method and clinical outcome as assessed by veterinary physical examination, radiography and owner questionnaire.
Results: A total of 47 cats (mean age 4.2 years) were included. Fractures were located distally (24/49, 49%), proximally (13/49, 26.5%) and mid-diaphyseally (12/49, 24.5%). Dual bone fixation was used in 13/49 (26.5%) cases, with only 1/13 (7.7%) having major complications. By comparison, 4/36 (11.1%) of single plated fractures had major complications. Single bone fixation was 14.25 times more likely (95% confidence interval [CI] 2.07-97.99) to have a successful outcome (veterinarian-assigned score of 0) compared with dual bone fixation (P = 0.007). When evaluating owner-assessed outcomes, single bone fixation was 9.4 times more likely (95% CI 1.4-61.96) to have a successful outcome (owner score of 0) compared with dual bone fixation (P = 0.019).
Conclusions and relevance: Fractures that were repaired with single bone fixation had a greater chance of a better outcome. Although the difference was not significant, there was a higher major complication rate and a lower minor complication rate for cases treated with single bone fixation compared with dual bone fixation. The majority of fractures were located in the distal diaphysis. Comminution of the fracture and concurrent orthopaedic issues did not significantly affect the outcome. Further prospective studies with standardised follow-up, radiographic assessment, surgeon and implants are required to truly assess the difference between dual and single bone fixation.
Masuyama - 2024 - JSAP - Atypical azygos continuation of the caudal vena cava in a dog
XX
Pye - 2024 - JSAP - Determining predictive metabolomic biomarkers of meniscal injury in dogs with cranial cruciate ligament rupture
Objectives: This study used hydrogen nuclear magnetic resonance spectroscopy for the first time to examine differences in the metabolomic profile of stifle joint synovial fluid from dogs with cranial cruciate ligament rupture with and without meniscal injuries, in order to identify biomarkers of meniscal injury. Identifying a biomarker of meniscal injury could then ultimately be used to design a minimally invasive diagnostic test for meniscal injuries in dogs.
Materials and methods: Stifle joint synovial fluid was collected from dogs undergoing stifle joint surgery or arthrocentesis for lameness investigations. We used multi-variate statistical analysis using principal component analysis and univariate statistical analysis using one-way analysis of variance and analysis of co-variance to identify differences in the metabolomic profile between dogs with cranial cruciate ligament rupture and meniscal injury, cranial cruciate ligament rupture without meniscal injury, and neither cranial cruciate ligament rupture nor meniscal injury, taking into consideration clinical variables.
Results: A total of 154 samples of canine synovial fluid were included in the study. Sixty-four metabolites were annotated to the hydrogen nuclear magnetic resonance spectroscopy spectra. Six spectral regions were found to be significantly altered (false discovery rate adjusted P-value <0.05) between groups with cranial cruciate ligament rupture with and without meniscal injury, including three attributed to nuclear magnetic resonance mobile lipids [mobile lipid -CH3 (P=0.016), mobile lipid -n(CH3 )3 (P=0.017), mobile unsaturated lipid (P=0.031)].
Clinical significance: We identified an increase in nuclear magnetic resonance mobile lipids in the synovial fluid of dogs with meniscal injury which are of interest as potential biomarkers of meniscal injury.
Horikirizono - 2024 - JSAP - Intraoperative hypertensive crisis in a dog with functional paraganglioma of the gall bladder
A 15-year-old spayed female mongrel presented with anorexia and an abdominal mass. The mass originated from the gall bladder and was surgically resected along with divisionectomy of the central hepatic division. Paroxysmal hypertension and tachycardia were noted during manipulation of the mass. Following resection, arterial blood pressure decreased significantly. Histopathological analysis confirmed a diagnosis of neuroendocrine neoplasm. Immunohistochemical staining for synaptophysin and chromogranin A yielded diffuse and strong positive results, while gastrin was positive in only 10% of the cells. The preoperative elevated concentrations of catecholamine in the urinalysis showed a marked decrease after surgery. Based on these findings, the tumour was diagnosed as a functional paraganglioma of the gall bladder. The patient has undergone regular thoracic radiographs and ultrasound examinations and, until 431 days after surgery, has shown no signs of metastases or recurrences. Based on our literature search, we report the first case of functional paraganglioma of the gall bladder in a dog.
Sabetti - 2024 - JSAP - Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation
Objectives: Proximal duodenal ulceration is often characterised by continuous bleeding, and treatment is challenging. The aims of this study were to investigate the role of vascularisation in proximal duodenal ulceration and describe clinical aspects, endoscopic features and treatment in dogs.
Material and methods: Polyurethane foam casts of gastroduodenal vessels were obtained from five dogs which had died from disorders unrelated to the digestive system. In addition, 12 dogs having proximal duodenal ulcers diagnosed by endoscopic examination were enrolled in a treatment trial. After the endoscopic diagnosis of a duodenal ulcer, all the dogs were treated medically and, in the absence of resolution, were subsequently treated by endoscopic electrocauterisation or by surgery.
Results: A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum. In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall. The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection of the proximal duodenal portion. All the dogs survived until discharge, and the median survival time following discharge was 107.5 days.
Clinical significance: Based on the anatomical details highlighted in this study, the continuous bleeding observed in our patients may have been due to the prominent venous plexus evidenced at the level of the proximal duodenum. Surgical and endoscopic treatments in six patients resolved the ulcer bleeding with no recurrences noted during follow-up.
Camilletti - 2024 - JSAP - Long-term outcomes of atrophic/oligotrophic non-unions in dogs and cats treated with autologous iliac corticocancellous bone graft and circular external skeletal fixation - 19 cases (2014-2021)
Objectives: To determine the short- and long-term outcomes and complications in dogs and cats undergoing surgical treatment for viable oligotrophic and nonviable atrophic non-unions using circular external skeletal fixation and autologous corticocancellous bone graft.
Materials and methods: In this case series, the medical records and radiographs of all dogs and cats with radius/ulna and tibia/fibula viable oligotrophic and nonviable atrophic non-unions treated with corticocancellous bone graft and circular external skeletal fixation at two referral veterinary hospitals between 2014 and 2021 were retrospectively reviewed. The long-term follow-up was 1 year or greater.
Results: Thirteen dogs and six cats with 19 non-union fractures met the inclusion criteria for the study. Eighteen non-union fractures (94.7%) healed and one did not. Five patients (26%) had minor perioperative period complications (<3 months). The patient that did not achieve bone union underwent revision surgery with internal fixation (plate and screws) and autologous cancellous bone graft. Fifteen (78.9%) cases returned to full function and three (15.8%) cases returned to acceptable function in the long-term follow-up period.
Clinical significance: The use of circular external skeletal fixation associated with autologous corticocancellous bone graft for the treatment of radius/ulna and tibia/fibula atrophic/oligotrophic non-union fractures in dogs and cats was considered successful in the majority of patients and was free of major or catastrophic complications.
Davini - 2024 - JSAP - Radiographic and MRI findings of a complex cervical vertebral malformation in a French bulldog
XX
Townsend - 2024 - VETSURG - Comparison of three-dimensional printed patient-specific guides versus freehand approach for radial osteotomies in normal dogs - Ex vivo model
Objective: To compare the accuracy of three-dimensional (3D) printed patient-specific guide (PSG) with a freehand (FH) approach for radial osteotomies in ex vivo normal dogs.
Study design: Experimental study.
Animals: Twenty four ex vivo thoracic limb pairs from normal beagle dogs.
Methods: Computed tomography (CT) images were collected preoperatively and postoperatively. Three osteotomies tested (n = 8/group) were: (1) uniplanar 30° frontal plane wedge ostectomy, (2) oblique plane (30° frontal, 15° sagittal) wedge ostectomy, and (3) single oblique plane osteotomy (SOO, 30° frontal, 15° sagittal, and 30° external). Limb pairs were randomized to a 3D PSG or FH approach. The resultant osteotomies were compared with virtual target osteotomies by surface shape-matching postoperative to the preoperative radii.
Results: The mean ± standard deviation osteotomy angle deviation for all 3D PSG osteotomies (2.8 ± 2.8°, range 0.11-14.1°) was less than for the FH osteotomies (6.4 ± 6.0°, range 0.03-29.7°). No differences were found for osteotomy location in any group. In total, 84% of 3D PSG osteotomies were within 5° deviance from the target compared to 50% of freehand osteotomies.
Conclusion: Three-dimensional PSG improved FH accuracy of osteotomy angle in select planes and the most complex osteotomy orientation in a normal ex vivo radial model.
Clinical significance: Three-dimensional PSGs provided more consistent accuracy, which was most notable in complex radial osteotomies. Future work is needed to investigate guided osteotomies in dogs with antebrachial bone deformities.
Danielski - 2024 - VETSURG - Influence of oblique proximal ulnar osteotomy on humeral intracondylar fissures in 35 spaniel breed dogs
Objective: To investigate the effects of oblique proximal ulnar osteotomy (PUO) on the healing of humeral intracondylar fissure (HIF) in spaniel breed dogs.
Study design: Clinical retrospective study.
Sample population: A total of 51 elbows from 35 spaniel dogs.
Methods: An oblique PUO was performed in dogs diagnosed with HIF. The degree of healing of HIF was subjectively and objectively assessed on preoperative and long-term follow-up CT imaging. Objective assessment was performed by measuring the bone density in Hounsfield units (HU) of a rectangular region of interest (ROI) encompassing the entire hypoattenuated humeral fissure. Major and minor complications were recorded.
Results: A total of 24 partial and 27 complete HIFs were diagnosed. The follow-up CT scan was performed at a median 18.5 months (range 10-49 months). Subjective assessment confirmed partial or complete healing of the HIF in 41 elbows (80.3%). Objective assessment confirmed a difference in mean HU of the HIF’s ROI between preoperative (HU 640) and last follow-up CT images (HU 835) (p = .001). Young dogs (<14 months) had the highest increase in HU of the HIF’s ROI. Major complications occurred in five dogs (6 limbs) of which four were related to the lack of healing of the fissure (7.8%).
Conclusion: Oblique PUO resulted in partial or complete healing of HIF and pain resolution in the majority of dogs.
Clinical significance: This study introduces an innovative approach to achieve healing of the HIF in the dog, which may help reduce the high complication rate traditionally associated with the use of transcondylar screws.
Carwardine - 2024 - VETSURG - Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures - A randomized clinical trial
Objective: To determine the influence of screw direction on complications following transcondylar screw placement for the treatment of canine humeral intracondylar fissures (HIFs).
Study design: Equivalence, parallel group, randomized clinical trial.
Sample population: Fifty-two client owned dogs (73 elbows).
Methods: Transcondylar screw placement was randomized to either a medial or lateral approach. The primary outcome was the incidence of postoperative complications.
Results: There were 37 cases in the lateral approach group and 36 cases in the medial approach group. There was a significantly greater proportion of postoperative complications following placement of transcondylar screws from a lateral to medial direction (p = .001). There were seven cases with complications (19%) in the medial approach group versus 23 cases with complications (62%) in the lateral approach group. The majority of complications were seromas (n = 13) and surgical site infections (n = 16) with 4 complications requiring further surgery. Implant area moment of inertia (AMI), normalized to bodyweight, was lower in dogs with a major complication (p = .037).
Conclusion: Transcondylar screws placed from lateral to medial for canine HIFs had a greater proportion of postoperative complications in this randomized clinical trial design. Implants with a lower AMI, relative to bodyweight, were more likely to lead to major complications.
Clinical significance: We recommend placing transcondylar screws from medial to lateral for canine HIFs to reduce the risk of postoperative complications. Relatively small diameter implants had an increased risk of major complications.
Guevara - 2024 - VETSURG - Ex vivo comparison of pin placement with patient-specific drill guides or freehand technique in canine cadaveric spines
Objective: To compare vertebral implant placement in the canine thoracolumbar spine between 3D-printed patient-specific drill guides (3DPG) and the conventional freehand technique (FH).
Study design: Ex vivo study.
Animals: Cadaveric canine spines (n = 24).
Methods: Implant trajectories were established for the left and right sides of the T10 through L6 vertebrae based on computed tomography (CT) imaging. Customized drill guides were created for each vertebra of interest. Each cadaver was randomly assigned to one of six veterinarians with varying levels of experience placing vertebral implants. Vertebrae were randomly assigned a surgical order and technique (3DPG or FH) for both sides. Postoperative CT images were acquired. A single, blinded observer assessed pin placement using a modified Zdichavsky classification.
Results: A total of 480 implants were placed in 240 vertebrae. Three sites were excluded from the analysis; therefore, a total of 238 implants were evaluated using the FH technique and 239 implants using 3DPG. When evaluating implant placement, 152/239 (63.6%) of 3DPG implants were considered to have an acceptable placement in comparison with 115/248 (48.32%) with FH. Overall, pin placement using 3DPG was more likely to provide acceptable pin placement (p < .001) in comparison with the FH technique for surgeons at all levels of experience.
Conclusion: The use of 3DPG was shown to be better than the conventional freehand technique regarding acceptable placement of implants in the thoracolumbar spine of canine cadavers.
Clinical significance: Utilizing 3DPG can be considered better than the traditional FH technique when placing implants in the canine thoracolumbar spine.
Jones - 2024 - VETSURG - Evaluation of subchondral bone cysts in canine elbows with radiographic osteoarthritis secondary to elbow dysplasia
Objective: To investigate whether subchondral bone cysts (SBCs) were present in dogs with radiographic elbow osteoarthritis (OA) and to investigate their relationship with radiographic OA severity.
Study design: Retrospective cross-sectional study.
Sample population: Thirty-eight Labrador retrievers (total of 76 elbows).
Methods: Elbow computed tomography (CT) images of 18 young (≤2 years old) and 20 old (>2 years old) Labrador retrievers, which presented for elbow-associated lameness, were reviewed. Radiographic elbow OA was graded into four groups based on the largest osteophyte size on CT. The presence, number, and maximum diameter of SBCs were determined.
Results: Subchondral bone cysts were only identified in elbows with osteophytic new bone formation. The number and size of SBCs were associated with radiographic OA severity (p < .001 and p = .041 respectively). Specifically, the rate at which SBCs were present increased for both moderate and severe OA in comparison with the mild OA (moderate OA RR = 2.46, 95% CI 2.08-2.92, p < .001; severe OA RR = 5.60, 95% CI 4.79-6.55, p < .001). For dogs with severe OA, there was an increased likelihood that their SBCs were larger than SBCs from dogs with mild OA (OR = 1.056, 95% CI 1.012-1.101, p = .012). No SBCs were observed in elbows without radiographic evidence of OA.
Conclusion: Subchondral bone cysts were identified as a feature of radiographic elbow osteoarthritis in Labrador retrievers, and their number and size were indicative of the presence and severity of radiographic elbow OA.
Clinical significance: Subchondral bone cysts are a potential imaging biomarker for quantitative assessment for canine OA.
Case - 2024 - VETSURG - Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats
Objective: To describe a laparoscopic technique and outcome for partial pancreatectomy in cats.
Study design: Prospective cohort study.
Animals: Nine cats.
Methods: Laparoscopic pancreatectomy was performed using a single incision laparoscopic surgery port and an additional 5.5 mm port. The left pancreatic limb was dissected, sealed and divided at the level of the splenic vein insertion to the portal vein using a harmonic device. Surgical time and complications were recorded. The weight and length of the resected pancreatic limb was recorded. Pre- and postoperative trypsin-like immunoreactivity (TLI), pancreatic lipase immunoreactivity (PLI), and hemoglobin A1C were documented.
Results: Laparoscopic partial pancreatectomy was performed successfully in all cats. One grade 1 intraoperative complication occurred (1/9; 11%) resulting in minor hemorrhage from a caudal splenic vein branch. A grade 2 postoperative complication occurred within 3 days after surgery in one cat (1/9; 11%), involving localized, sterile peritonitis in the region of the pancreatic angle. Signs resolved with conservative management. No cats exhibited signs of pancreatitis postoperatively. Long-term, mean TLI decreased by 37% ± 38% (p = .03) following partial pancreatectomy, while PLI and A1C were unchanged. All cats were alive and clinically well at last follow-up 250 to 446 days following surgery.
Conclusions: Laparoscopic partial pancreatectomy using a harmonic device is effective in cats, and offers a minimally-invasive alternative to open surgical pancreatectomy techniques. Laparoscopic pancreatectomy of the left limb results in adequate exocrine and endocrine function in the long-term.
Sanders - 2024 - VETSURG - Gastrointestinal thickness, duration, and leak pressure of five intestinal anastomosis techniques in cats
Objective: To compare time to construct completion and resistance to leakage for five intestinal anastomosis techniques in cats and to report normal feline gastrointestinal thickness.
Study design: Experimental study.
Sample population: Grossly normal intestinal segments (n = 120) from 10 fresh cat cadavers.
Methods: A total of 8 cm segments of fresh feline cadaveric intestine were collected, and mural thickness was recorded. Segments were randomly allocated between a control group (n = 20 segments) and five treatment groups (20 segments/group with 2 segments/construct = 10 constructs per group): (1) hand-sewn anastomosis - simple interrupted (HSA-SI), (2) hand-sewn anastomosis - simple continuous (HSA-SC), (3) functional end-to-end stapled anastomosis (FEESA), (4) functional end-to-end stapled anastomosis with oversew (FEESA-O), (5) skin stapled anastomosis (SS). Time to construct completion, leakage location, initial leak pressure (ILP), and maximum intraluminal pressure (MIP) were compared.
Results: Mean mural thickness ± SD (mm) for the stomach, duodenum, jejunum, and ileum were 1.66 ± 0.28, 2.05 ± 0.18, 2.28 ± 0.30, and 2.11 ± 0.39, respectively. ILPs (mean ± SD) for HSA-SI (165 ± 122 mmHg), HSA-SC (149 ± 83), FEESA-O (63 ± 25, FEESA (84 ± 59), SS (77 ± 56), and control segments (>500) were compared. There was no statistically significant difference in ILP (p > .08) or MIP (p > .084) between any treatment groups. Nonoversewn FEESAs were 2.4 times faster to perform compared to oversewn FEESA and SS groups, and 4.7 times faster than HSA (p < .001).
Conclusion: All anastomosis techniques provide resistance to leakage that is supraphysiological to that of the normal maximum intraluminal pressure. HSA take longer to complete than stapled anastomoses.
Clinical significance: All anastomotic techniques may be appropriate in cats. Hand-sewn anastomoses result in a longer surgical time.
Thompson - 2024 - VETSURG - Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies
Objective: To compare the intraluminal initial and maximal pressures of enterotomies closed using three different techniques (single-layer appositional continuous closure; closure with cyanoacrylate; a single-layer appositional closure augmented with cyanoacrylate) in a cooled canine cadaveric jejunal model and to report the initial leak location in all samples.
Study design: Experimental, ex-vivo study.
Sample population: Grossly normal chilled small intestine segments from three canine cadavers.
Methods: A total of 45 chilled jejunal segments (n = 15 segments/group) were assigned to a handsewn group (HSE), a cyanoacrylate only group (CE) and a handsewn and cyanoacrylate group (HS + CE). A 2 cm antimesenteric enterotomy was performed and closure with one of the above techniques. Initial leakage pressures (ILP), maximal intraluminal pressures (MIP) and initial leakage location were recorded by a single observer.
Results: Handsewn enterotomies leaked at higher ILP when augmented with cyanoacrylate (83.3 ± 4.6 mmHg, p < .001) compared to both the HSE group (43.8 ± 5.3 mmHg) and the CE group (18.6 ± 3.5 mmHg). Those sealed with cyanoacrylate only leaked at a lower MIP compared with the other groups (p < .001). Maximal intraluminal pressures did not differ between handsewn enterotomies, whether augmented or not (p = .19).
Conclusion: Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum.
Clinical significance: The increased leakage pressures achieved by reinforcing enterotomies with cyanoacrylate could consequently reduce the incidence of postoperative intestinal leakage following an enterotomy and may result in reduced patient morbidity or mortality.
Bergen - 2024 - VETSURG - Clinical use of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs - 11 cases (2012-2022)
Objective: To describe the application of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary obstructions (EHBOs) and the outcomes for dogs and cats treated for EHBO with this technique.
Study design: Retrospective single institutional study.
Animals: Eight dogs and three cats treated at the Veterinary Specialty Hospital of San Diego for EHBO between January 2012 and February 2022.
Methods: Data collected from the medical records included signalment, presenting complaint, laboratory and imaging findings, surgical findings, hospitalization time, complications, and follow-up information.
Results: Median duration of short-term follow up was 16 days (6-45 days). Improved biochemical abnormalities and resolution of clinical signs were recorded in 10/11 cases. Two dogs died within 2 weeks of surgery. One dog developed systemic inflammatory response syndrome 5 days postoperatively and was euthanized; the cause of death in the second case was unknown. Long-term follow up was available in seven cases, with a median duration of 307.5 days (62-2268 days). Bile-duct patency was maintained for at least 356-622 days (median: 446 days) in three cats and 62-2268 days (median: 650.5 days) in four dogs with long-term follow up available. One cat had recurrent obstruction with choledocholiths 446 days postoperatively. One stent was removed 614 days postoperatively due to recurrent cholangiohepatitis.
Conclusion: Uncovered balloon-expandable metallic biliary stents were placed successfully and relieved EHBO in all cases that survived to discharge.
Clinical significance: Use of uncovered balloon-expandable metallic biliary stents should be considered as an alternative to temporary choledochal luminal stenting or cholecystoenterostomy to manage EHBO.
Spies - 2024 - VETSURG - Clinical presentation and short-term outcomes of dogs > 15 kg with extrahepatic portosystemic shunts
Objective: To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery.
Study design: Multicenter retrospective (10 university hospitals, one private referral institution).
Animals: Dogs ≥15 kg (n = 63).
Methods: Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed.
Results: Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens.
Conclusions: Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs.
Clinical significance: Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.
Janas - 2024 - VETSURG - Clinical outcomes for 20 cats with congenital extrahepatic portosystemic shunts treated with ameroid constrictor ring attenuation (2002-2020)
Objective: To report the clinical perioperative, short-term, and long-term outcomes for cats undergoing ameroid ring constrictor (ARC) attenuation of a congenital extrahepatic portosystemic shunt (EHPSS).
Study design: Retrospective case series from a single veterinary teaching hospital (2002-2020).
Animals: Twenty client-owned cats with EHPSS.
Methods: Data collected from medical records included signalment, history, physical examination, clinicopathologic testing, medications, diagnostic imaging, intraoperative findings, perioperative complications, and postoperative clinical outcomes. Long-term clinical outcome was obtained from a standardized owner interview or medical records.
Results: Perioperative complications were reported in five cats out of 20, including blindness (two cats), ascites (one cat), head pressing (one cat), and seizures and death (one cat). Short-term clinical outcome was excellent in 14/18 cats, good in 2/18 cats, and poor in 2/18 cats that were available for follow up, and long term clinical outcome was excellent in 15/18, good in 1/18 cats, and poor in 2/18 cats that were available for follow up.
Conclusion: Long-term clinical outcome was good or excellent in 16/18 of cats available for follow up. Perioperative complications were reported in five cats.
Clinical significance: Surgical attenuation of EHPSS with an ARC can result in resolution of clinical signs and biochemical abnormalities in the majority of cats. The perioperative complication rate for feline patients with EHPSS attenuated with an ARC was lower than reported historically. Seizures may persist in the long term despite normal bile acid stimulation test results, complete blood count, and biochemistry analysis.
Dobberstein - 2024 - VETSURG - Comparison of the diagnostic yield of 3 and 5 mm laparoscopic liver biopsy forceps in cats
Objective: To determine whether 3 and 5 mm laparoscopic cup biopsy forceps provide samples of equivalent diagnostic quality in cats.
Study design: Experimental study.
Animals: Twelve colony cats undergoing a concurrent nutrition study.
Methods: Two biopsy forceps (3 and 5 mm) and three biopsy techniques (twist, pull, and twist + pull) were used to collect 68 laparoscopic liver samples. Biopsies were performed consecutively with the 3 and 5 mm biopsy sites adjacent to each other. Data analyzed included the number of portal triads and hepatic lobules, tissue crush and fragmentation, overall sample area (mm2 ), sample weight, and agreement regarding morphologic diagnosis.
Results: The 5 mm forceps provided more hepatic lobules, portal triads, and a larger tissue weight and histologic area (mm2 ) (p < .01). The twist and pull techniques provide more hepatic lobules and portal triads compared to the twist + pull technique while the twist + pull technique resulted in greater tissue crush compared to the twist technique (p = .0097). There was good agreement for morphological diagnosis between the 3 and 5 mm samples using the twist + pull technique but not for the twist or pull techniques.
Conclusion: Liver samples can be safely collected with 3 or 5 mm laparoscopic biopsy forceps and provide sufficient tissue for histopathology analysis in cats, with minimal artifact. The diagnostic accuracy of 3 mm samples remains unknown.
Clinical significance: Although 3 mm laparoscopic cup biopsy forceps provided samples of sufficient diagnostic quality for histopathologic interpretation in cats, further studies are required to assess their diagnostic accuracy.
Quinn - 2024 - VETSURG - Adjunctive fixation of the humeral epicondyle in a lateral condylar fracture model - Ex vivo comparison of pins and plates with a novel composite (AdhFix)
Abstract
Objective: To compare the biomechanical properties of using a novel composite construct (AdhFix) to an interfragmentary Kirschner wire or a reconstruction plate as adjunctive epicondylar stabilization in simulated lateral unicondylar humeral fractures.
Study design: Cadaveric biomechanical assessment.
Sample population: Paired humeri harvested from skeletally mature dogs (14-41 kg), nine cadavers per group.
Methods: Simulated lateral unicondylar humeral fractures were stabilized with a transcondylar 4.5 mm cortical screw placed in lag fashion. Adjunct fixations consisting of a novel composite incorporating 2.7 mm cortical screws on one side, and either a 2.7 mm reconstruction plate or a 1.6 mm Kirschner wire on the contralateral side, were tested within paired humeri. Repaired humeri were axially loaded to failure and construct stiffness, yield load, and ultimate load were obtained from the load-deformation curves.
Results: In pairwise comparison, yield load was significantly higher for AdhFix group compared to the pin group, p = .016. No statistical significance was seen in the comparison between AdhFix group and the plate group, p = .25.
Conclusion: Adhfix was mechanically superior to K-wires, and comparable to plate fixation, for adjunctive fixation in a lateral humeral condylar model. Our results support further investigation of the novel composite for adjunct fracture fixation in lateral humeral condylar fractures.
Clinical significance: The novel composite tested may be a viable alternative for adjunct fixation of humeral condylar fractures, a technique that circumvents plate contouring.
Singh - 2024 - JAVMA - Laparoscopic surgical treatment for sliding hiatal hernia is associated with an owner-perceived improvement in clinical outcome in dogs
Abstract
Objective: To report perioperative complications and client-perceived outcome following laparoscopic surgical treatment for sliding hiatal hernia (SHH) in dogs.
Animals: Client-owned dogs (n = 9).
Methods: Medical records were reviewed and perioperative data collected including preoperative diagnostic imaging, operative details, complications, and need for conversion to open celiotomy. A single-incision, multicannulated port was inserted in the subumbilical region followed by placement of an additional 2 or 3 instrument portals. Hiatal plication, esophagopexy, and left-sided gastropexy were performed laparoscopically. Follow-up information was collected with telephone interview with the owners and/or referring veterinarian. A standardized questionnaire was completed by dog owners postoperatively.
Results: Intraoperative pneumothorax occurred in 5 of 9 (55.6%) dogs and resulted in conversion to open celiotomy in 2 (22.2%) dogs. In 4 dogs, pneumothorax was suspected to be the result of progressive leakage of capnoperitoneum through the suture bite holes of the esophageal hiatal plication sutures. Hiatal plication was performed using intracorporeal simple interrupted sutures (n = 4) or a simple continuous pattern with barbed suture (4). Esophagopexy was performed using barbed suture in all dogs. Gastropexy was performed using a total laparoscopic technique (n = 4) or laparoscopic-assisted technique (3). Using a standardized questionnaire, dog owners perceived a postoperative improvement in regurgitation after eating and regurgitation after excitement/increased activity.
Clinical relevance: Laparoscopic treatment of SHH resulted in owner-perceived improvement in clinical signs. Intraoperative pneumothorax occurred in a high proportion of dogs but did not result in long-term sequelae.
Castejon - 2024 - JAVMA - Use of a barrier membrane to repair congenital hard palate defects and to close oronasal fistulae remaining after cleft palate repair - Seven dogs (2019-2022)
Objective: To describe the use of a barrier membrane in dogs for repair of congenital hard palate defects and closure of oronasal fistulae (ONF) remaining after previous cleft palate (CFP) repair.
Animals: 7 client-owned dogs.
Methods: The hard palate defect was closed with medially positioned flaps (Von Langenbeck technique) or pedicle flaps (2-flap palatoplasty) and a membrane composed of autologous auricular cartilage from the pinna or allogenous fascia lata underlying the mucoperiosteal flaps.
Results: All palate defects were considered to have a high risk of dehiscence based on their type and size and the characteristics of the surrounding tissue. The barrier membrane was used in 5 dogs for repair of congenital hard palate defects and in 2 dogs for closure of ONF remaining after previous CFP repair. Resolution of clinical signs occurred in all cases. Complete success (ie, complete closure of the palate defect and absence of clinical signs) was achieved in 5 dogs (4 with congenital hard palate defects and 1 with an ONF remaining after previous CFP repair). The persistent ONF in 1 dog with functional success (incomplete closure, but no clinical signs) was smaller than prior to surgery.
Clinical relevance: Barrier membranes underlying mucoperiosteal flaps may constitute an alternative technique in dogs for repair of congenital hard palate defects and closure of ONF remaining after previous CFP repair.
Andrews - 2024 - JAVMA - Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections
Objective: To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated.
Animals: Client-owned dogs (n = 211) and cats (78).
Methods: Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated.
Results: 7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4).
Clinical relevance: Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.
Tichenor - 2024 - JAVMA - Characteristics and outcomes for 61 cats that underwent either surgery or stereotactic radiotherapy as treatment for intracranial meningioma (2005-2017)
Objective: To report clinical features and outcomes of cats undergoing either stereotactic radiotherapy (SRT) or surgical excision for the treatment of intracranial meningioma.
Animals: 61 client-owned cats.
Methods: Medical records were retrospectively reviewed of cats with intracranial meningiomas that were treated with surgical removal and/or SRT between 2005 and 2017. Signalment, clinical signs, duration of clinical signs, diagnostic imaging reports, histopathology reports, treatment protocol, complications, recurrence or progression, and survival time were obtained from the medical record and through follow-up phone calls.
Results: Of the 61 patients, 46 had surgery, 14 had SRT, and 1 had surgery followed by SRT for initial treatment. Significantly more cats that underwent surgery had peritreatment complications compared to the SRT group (P < .0001). Cats that received surgery initially had a significantly longer median survival time (MST) of 1,345 days compared to the MST of 339 days for the SRT cats (P = .002). Fourteen (30%) cats in the surgery group and 4 cats in the SRT group (28%) had MRI- or CT-confirmed tumor regrowth or new tumor growth (P = 1.00). Five cases that had SRT for subsequent recurrence had an MST of 700 days (range, 335 to 1,460 days) after the last treatment.
Clinical relevance: SRT proved to be a safe, alternative treatment option for feline patients with intracranial meningiomas; however, the survival times with surgery alone were significantly longer. SRT for the treatment of recurrence following initial surgery may show promising results.
Martin - 2024 - JAVMA - Computed tomography and magnetic resonance imaging are potential noninvasive methods for evaluating the cisterna chyli in cats
Objective: There is limited information on the normal appearance of the cisterna chyli (CC) in cats on CT and MRI. The aim of this retrospective study was to describe the CT and MRI characteristics of the CC in a group of cats without lymphatic system pathology.
Sample: A total of 31 CT and 63 MRI images were obtained of client-owned cats between January 2017 and March 2022.
Methods: The presence, location, shape, maximum width, MRI-signal intensity, mean attenuation, and contrast enhancement of the CC were recorded from CT and MRI scans.
Results: The CC was identified in all the CT scans and in 60 MRI studies. The CC was located level with the cranial mesenteric artery in 56 of 91 cases. It was crescent shaped in 34 of 54 cases. On precontrast CT images, the mean attenuation of the CC was 17 HU, and the mean postcontrast attenuation was 28 HU. On T2-weighted sequences, the CC was isointense to CSF and hyperintense to the muscles, while on T1-weighted images, it was isointense to the muscles. Contrast enhancement was variable in both techniques.
Clinical relevance: CT and MRI have the potential for noninvasive evaluation of CC in cats.
Russell - 2024 - JAVMA - Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection
Objective: To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU).
Animals: 41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled.
Methods: Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence.
Results: Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence. Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048).
Clinical relevance: Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.
Pierrot - 2024 - JAVMA - Presumed concurrent medial coronoid process fracture is a frequent radiographic finding in dogs and cats with humeral condylar fractures
Objective: To report the prevalence of presumed concurrent medial coronoid process fractures in a series of cases of humeral condylar fractures and evaluate factors influencing the presence of a suspected fracture of the medial coronoid process.
Animals: 48 dogs and 7 cats, with a total of 57 humeral fractures.
Methods: Medical records of dogs and cats diagnosed with a humeral condylar fracture with radiographs were reviewed between October 2013 and March 2022. Species, sex, neutered status, age, weight, and the nature of the trauma were noted. Radiographs were assessed for the configuration of humeral condylar fracture, the presence of a suspected fractured medial coronoid process (MCP), number of MCP fragments, nature of fracture, degree of radioulnar incongruity, soft tissue swelling, and elbow luxation/subluxation.
Results: A presumed fracture of the MCP was seen in 26 of 57 cases. Comminution of the condylar fracture was the only parameter that had a positive effect on the presence of a possible fractured MCP. Body weight was significantly associated with size of the suspected fractured MCP. The presence of this fracture was not associated with the type of humeral condylar fracture. The size of the presumed fractured MCP fragment was positively correlated with body weight.
Clinical relevance: There was a high prevalence of presumed fractured MCPs in dogs with humeral condylar fractures (almost 50%) and even more so in animals with comminuted fractures. The consequences of suspected fractured MCP associated with humeral condylar fractures and whether dogs and cats would benefit from removal of the fragment remain unknown.
Bellamy - 2024 - JFMS - Feline ventral abdominal wall angiosarcoma - Haemangiosarcoma or lymphangiosarcoma - Clinical and pathological characteristics in nine cases
Objectives: Angiosarcomas are rare malignant mesenchymal neoplasms of endothelial cell origin with a predilection to the ventral abdominal wall in cats. Larger case series describing this entity are lacking.
Methods: Two referral centre laboratory databases were searched for angiosarcoma of the ventral abdominal wall. Nine cases with a histological diagnosis were included. Immunohistochemistry (factor VIII and PROX-1 antibodies) was used to phenotype them as haemangiosarcoma or lymphangiosarcoma.
Results: All cats presented with a ventral abdominal mass, five of which were producing a serosanguinous discharge. Eight underwent tumour staging and pulmonary metastases were suspected in one cat (but not histologically confirmed). With histopathology alone, a diagnosis of angiosarcoma and lymphangiosarcoma was made in four and five cases, respectively. After immunohistochemistry, five cases had a haemangiosarcoma phenotype and four had a lymphangiosarcoma phenotype, including two cases of lymphangiosarcoma that were reclassified as hemangiosarcoma. Eight cats received treatment (either surgery with or without adjuvant therapies or medical management alone). Six cats were euthanased due to local disease progression. The median survival time for haemangiosarcoma was 166 days (range 137-381), and for lymphangiosarcoma it was 197 days (range 67-208). Two cats with haemangiosarcoma remained alive for a follow-up period of 329 and 580 days, respectively.
Conclusions and relevance: Feline ventral abdominal angiosarcomas are rare locally aggressive neoplasms. While histology often provides a diagnosis of angiosarcoma, immunohistochemistry is ultimately required to differentiate between haemangiosarcoma and lymphangiosarcoma phenotypes. Further studies are required to evaluate whether the different phenotypes have an impact on treatment response and outcome.
Trivino - 2024 - JSAP - Objective comparison of a sit to stand test to the walk test for the identification of unilateral lameness caused by cranial cruciate ligament disease in dogs
Objective: The purpose of this study was to evaluate a sit to stand test with the walk test for the identification of unilateral cranial cruciate ligament rupture in dogs.
Materials and methods: Peak vertical force and vertical impulse were measured on a pressure-sensitive walkway, during a sit to stand test and walk test, and in 10 dogs with unilateral cranial cruciate ligament rupture and 18 non-lame dogs. Data collected were used to calculate symmetry indices (SI) of ipsilateral and contralateral hindlimbs (HL), diagonal limb pairs (DLP) and ipsilateral limb pairs (ILP).
Results: The symmetry indices of peak vertical force of HL during the walk test and sit to stand test were 100% and 90% sensitive for discriminating lame and non-lame dogs respectively. The symmetry indices of vertical impulse of HLs during the walk test and sit to stand test were 100% and 50% sensitive for discriminating lame and non-lame dogs respectively. Analysis of ipsilateral and diagonal limb pairs did not improve the discrimination in either test. The time taken to collect data from the sit to stand test data was shorter than for the walk test.
Clinical significance: Whilst the sit to stand test required a shorter time for collection of data than the walk test, it did not accurately identify all dogs with lameness associated with CCLR, and thus has relatively limited clinical utility in its tested form.
Pye - 2024 - JSAP - Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis
Osteoarthritis is a progressive degenerative disease process that affects a significant proportion of the canine population, impacting these animals’ quality of life. Currently, there is no cure and treatment consists of managing the clinical signs of pain and reduced mobility. There are many treatments for canine osteoarthritis and in this review we discuss the evidence base behind non-pharmaceutical, non-surgical treatments of this disease. These treatments include weight management, nutraceuticals, acupuncture, physiotherapies such as therapeutic exercise, hydrotherapy as well as other therapeutic modalities including photobiomodulation therapy, electromagnetic field therapy and others.
Stavroulaki - 2024 - JSAP - Trends in urolith composition and factors associated with different urolith types in dogs from the Republic of Ireland and Northern Ireland between 2010 and 2020
Objectives: The purpose of this study was to determine changes in urolith trends and factors associated with different urolith types in dogs from the Republic of Ireland and Northern Ireland between 2010 and 2020.
Materials and methods: A laboratory database was searched for canine urolith submissions between 2010 and 2020. Trends in urolith composition between 2014 and 2020, and associations between patient characteristics with each urolith type were evaluated.
Results: A total of 1162 submissions were included. Struvite (39.0%), calcium oxalate (27.8%) and compound (10.2%) were the most prevalent uroliths. Calcium oxalate urolith (CaOx) incidence significantly increased from 27.8% to 31.2% and that of struvite significantly decreased from 41.7% to 33.0% between 2014 and 2020. Struvite uroliths were overrepresented among females compared to males (odds ratio 8.7, 95% confidence interval 6.6 to 11.5). Males (odds ratio 9.6, 95% confidence interval 6.9 to 13.3) and dogs >7 years of age (odds ratio 4.1, 95%, confidence interval 3.0 to 5.4) were more likely to have CaOx while males (odds ratio 9.6, 95% confidence interval 5.3 to 17.8) and dogs ≤7 year of age, purine uroliths (odds ratio 3.0, 95% confidence interval 1.8 to 5.0). Incidence was higher in bichon frise (odds ratio 1.7, 95% confidence interval 1.3 to 2.4) and Yorkshire terrier (odds ratio 2.8, 95% confidence interval 1.9 to 4.1) for CaOx and higher in shih-tzu for compound uroliths (odds ratio 1.7, 95% confidence interval 1.1 to 2.7) compared to the remaining reported breeds.
Clinical significance: Factors associated with different uroliths were similar to the ones previously reported. Proportion of CaOx submissions increased and that of struvite decreased over the study period which was in agreement with the changes identified in other European countries.
Marks - 2024 - JSAP - Prognostic factors and outcome in cats with thymic epithelial tumours - 64 cases (1999-2021)
Objectives: To describe the clinical presentation, treatment and outcomes of cats diagnosed with thymic epithelial tumours and to determine prognostic factors for survival and recurrence.
Materials and methods: Clinical records of cats diagnosed with a thymic epithelial tumour between 1999 and 2021 at three referral institutions were retrospectively reviewed.
Results: Sixty-four cats were included. Paraneoplastic syndromes were present in nine cats and metastatic disease was seen in two cats, one at diagnosis and one at the time of recurrence. Median tumour diameter was 6 cm (range, 2 to 15) and a cystic appearance was described on imaging in 25 cats. Surgical excision was attempted in 54 cats with a perioperative mortality rate of 11%. Median survival time for cats surviving to hospital discharge was 897 days (range, 21 to 3322). The 1-, 2- and 5-year survival rates for surgically treated thymic epithelial tumour were 86%, 70% and 66%, respectively. Survival was longer for cats with Masaoka-Koga stage I and II tumours compared to stages III and IV (1366 days versus 454 days; P=0.002). Masaoka-Koga stage was the only significant prognostic factor detected on multi-variable analysis, with stage III and IV tumours associated with increased risk of death (hazard ratio: 5.67, 95% confidence interval: 1.29 to 24.91, P=.021). Tumour recurrence occurred in 11 cats at a median of 564 days (range, 93 to 1095); no significant prognostic factors for recurrence were identified.
Clinical significance: Cats with thymic epithelial tumours had a good long-term prognosis following surgery. Tumour recurrence can occur late in the disease course and ongoing monitoring should therefore be considered. Masaoka-Koga stage may influence survival time and could be used to predict outcome.
Liatis - 2024 - JSAP - Head tilt as a clinical sign of cervical spinal or paraspinal disease in 15 dogs (2000-2021)
Objectives: To characterise head tilt as a rare clinical sign of cervical spinal or paraspinal disease in dogs.
Materials and methods: Retrospective single-centre case-series study of dogs with head tilt and cervical spinal or paraspinal disease in the absence of intracranial abnormalities. Descriptive statistics were used.
Results: Fifteen dogs met the inclusion criteria of this study. Median age at onset was 6 years (range 2.5 to 12 years). Onset of neurological signs was mainly chronic (9/15, 60%). Most common presenting complaints included head tilt (9/15, 60%) and cervical hyperaesthesia (8/15, 53%). Most common neurological findings included head tilt (15/15, 100%), generalised proprioceptive ataxia and tetraparesis (6/15, 40%) and cervical hyperaesthesia (8/15, 53%). Diagnoses included post-operative complication of C2 spinal nerve root mass removal (2/15, 13%), C3-C4 intervertebral disc extrusion (2/15, 13%), cervical paraspinal myositis (2/15, 13%) and one of each: C2 vertebral malformation, C2 spinal nerve root mass, C1-C2 meningioma, C2 vertebral fracture, C4-C5 intervertebral disc extrusion, C4 vertebral body mass, C5-C7 osseous-associated cervical spondylomyelopathy, and concurrent C5-C6 and C6-C7 intervertebral disc protrusions. Two dogs were euthanased shortly after diagnosis and two of 15 were dogs lost to follow-up. No post-mortem examination was performed for these cases. For the 11 of 15 remaining dogs, head tilt resolved in eight of 15 (53%) dogs after treatment of the underlying condition and in three of 15 (20%) dogs, it remained static.
Clinical significance: Head tilt can be a rare clinical sign of cervical spinal or paraspinal disease in dogs.
Kang - 2024 - VCOT - Biomechanical Comparison of Double 2.3-mm Headless Cannulated Self-Compression Screws and Single 3.5-mm Cortical Screw in Lag Fashion in a Canine Sacroiliac Luxation Model - A Small Dog Cadaveric Study
Objective: The aim of this study was to evaluate the feasibility of safe positioning of double 2.3-mm headless cannulated self-compression screws (HCS) in a small dog cadaveric sacroiliac luxation model and to compare the static rotational biomechanical properties of fixation repaired using two different screw systems with a minimally invasive osteosynthesis technique: double 2.3-mm HCS and a single 3.5-mm standard cortical screw placed in a lag fashion.
Study design: A unilateral small dog sacroiliac luxation model was stabilized using double 2.3-mm HCS (n = 11) or a single 3.5-mm cortical screw (n = 11). Radiographic and computed tomography (CT) imaging analyses and biomechanical testing of rotational force on the sacroiliac joint of both fixations were performed. The maximum load at failure and failure modes of each fixation were recorded and compared.
Results: Fluoroscopically guided percutaneous application of double HCS was safe in a unilateral sacroiliac luxation model in small dogs without violation of the vertebral and ventral sacral foramen. Furthermore, resistance to rotational force applied on fixation of the sacroiliac joint repaired with double 2.3-mm HCS estimated by maximum failure load was significantly higher than that of a single 3.5-mm cortical screw (p < 0.001).
Conclusion: Although this was an experimental cadaveric study, based on our results, the use of smaller double HCS may be beneficial as an alternative to the conventional single lag screw for stabilization of sacroiliac luxation in small dogs.
Evans - 2024 - VCOT - Effect of Plate-Bone Distance and Working Length on 2.0-mm Locking Construct Stiffness and Plate Strain in a Diaphyseal Fracture Gap Model - A Biomechanical Study
Objective: The aim of this study was to determine the effect of plate-bone distance (PBD) and working length on 2.0-mm locking compression plate (LCP) stiffness and strain in four-point bending and torsion in a diaphyseal fracture gap model.
Study design: A total of 54 LCP with three screws per fragment were assigned to one of nine combinations of working length (WL; short, medium, and long), and PBD (1, 1.5, and 3 mm) for a sample size of six per construct configuration. Stiffness was measured under quasistatic, nondestructive four-point compression bending and torsion. Plate surface strain was recorded using three-dimensional (3D) digital image correlation during four-point compression bending.
Results: WL had a significant effect on overall construct stiffness in both compression bending and in torsion, with shorter WL constructs having higher stiffness (p < 0.0001). PBD had no effect on construct stiffness in compression bending; however, a significant reduction in stiffness was noted in torsion (p = 0.047) as PBD incrementally increased. WL had a significant effect on plate strain in compression bending, with shorter WL constructs having lower plate strain (p < 0.0001). PBD had no effect on plate strain in compression bending except for lower plate strain recorded in long WL constructs with 1-mm PBD, compared with 1.5- and 3-mm PBD constructs (p < 0.0001).
Conclusion: Longer WL constructs, regardless of PBD, had lower stiffness in compression bending, while in torsion, some modulation of this effect was noted with incremental decreases in PBD. Longer WL resulted in high plate strain, regardless of PBD.
Murphy - 2024 - VCOT - The Prevalence and Risk Factors of Contralateral Cranial Cruciate Ligament Rupture in Medium-to-Large (≥15kg) Breed Dogs 8 Years of Age or Older
Objective: The aim of this study was to determine the prevalence of contralateral cranial cruciate ligament rupture (CCLR) in dogs 8 years of age or older, weighing more than or equal to 15 kg at the time of first-side CCLR and to assess associated risks.
Study design: It is a cross-sectional retrospective study of 831 client-owned dogs METHODS: Medical records of dogs weighing more than or equal to 15 kgs that were more than or equal to 8 years of age at the time of first CCLR diagnosis were reviewed. Data collected included weight, sex, pre-operative tibial plateau angle, co-morbidities, time between diagnosis of first CCLR and diagnosis of contralateral CCLR. Multivariate logistic regression analysis was used to estimate odds ratio. A median follow-up period of over 112.7 months (25th/75th quartiles 75.4/157.7 months) from first CCLR diagnosis was allotted.
Results: Eight-hundred thirty-one dogs were identified and included. About 19.1% (159/831 dogs, 95% confidence interval: 16.6-22.0%) of dogs that experience a first-side CCLR at 8 years of age or older will rupture the contralateral side, a median of 12.9 months (25th/75th quartiles 6.5/24.3 months) later. Age (p = 0.003) and breed, Golden Retrievers (p = 0.028) and Labrador Retrievers (p = 0.007), were factors significantly associated with contralateral CCLR.
Clinical relevance: The prevalence of contralateral CCLR in medium-to-large breed dogs more than or equal to 8 years of age old is less than previously reported and the risk decreases as they age. This important information will help guide owners when deciding to pursue surgical stifle stabilization following CCLR in older dogs.
Emilian - 2024 - VCOT - Use of Locking Plates Fixed with Cortical Screws for Pelvic Fracture Repair in 20 Cats
Objective: The aim of this study is to describe the use of String of Pearls (SOP) plates for the surgical management of feline pelvic fractures, including surgical technique, proposed indications, complications, and outcomes in a cohort of cats.
Study design: This study is a single-center retrospective clinical case series.
Methods: Medical records (2015-2019) of cats presenting for pelvic fractures (n = 33) were reviewed. Type of fracture, preoperative and postoperative imaging, and complications were retrospectively retrieved. Owners were contacted via questionnaire for medium- and long-term follow-up.
Results: A total of 20 cats met the inclusion criteria. Minor intraoperative complications were encountered in three patients. One patient suffered a major intraoperative complication. Five major complications were encountered postoperatively. These included two greater trochanter osteotomy fixation implant removal and three SOP plate removal. Full function was recovered in all patients according to the owners’ assessment.
Clinical significance: The use of SOP plates in feline pelvic fractures appears to yield a consistently good outcome with a very low incidence of canal narrowing and screw loosening. SOP plates are easy to contour and to apply along the entire pelvic length.
Redolfi - 2024 - VCOT - Complications and Long-Term Outcomes after Combined TPLO and TTT for Treatment of Concurrent Cranial Cruciate Ligament Rupture and Grade III or IV Medial Patellar Luxation
Objectives: This study aims to report complications and long-term outcomes of combined tibial plateau leveling osteotomy and tibial tuberosity transposition (TPLO-TTT) for treatment of concurrent cranial cruciate ligament rupture and medial patellar luxation (MPL).
Study design: This is a retrospective study. Dogs that underwent TPLO-TTT for treatment of combined cranial cruciate ligament rupture and grade III or IV MPL were included. Signalment, fixation method, and complications were recorded. Long-term outcome assessment (minimum 1 year postoperatively) was performed through clinical and radiographic reexamination at the authors’ institution.
Results: Twenty-four stifles (22 dogs) were included. Twenty-one stifles had a grade III MPL, and 3 stifles had grade IV MPL. Four major complications consisting of surgical site infection (n = 3) and recurrent grade II MPL (n = 1) were observed. Dogs with surgical site infections were successfully treated with implant removal and oral antibiotics. No additional surgery was performed for the patient with recurrent MPL as no signs of lameness were observed. Minor complications occurred in five cases. At long-term evaluation (median: 27 months; range: 12-67 months), 21/22 dogs were clinically sound and 23/24 stifles had a complete resolution of MPL.
Conclusion: TPLO-TTT can be considered as an effective surgical option to treat patients with concurrent cranial cruciate ligament rupture and MPL with a relatively low major complication rate. Owners should be warned of the potential need for implant removal.
Klever - 2024 - VCOT - Influence of Femoral Position and Pelvic Projection on Norberg Angle Measurements
Objective: Canine hip dysplasia is a common orthopaedic disease in dogs. The Norberg angle value is a measure of hip joint laxity. The aim of this study was to quantify the degree of rotation necessary to consider the radiograph as inadequately positioned and to determine the influence of rotation on the Norberg angle.
Study design: Three sets of radiographs with different positioning and projections were acquired using 10 canine cadavers. Rotation of the pelvis was simulated by rotating the X-ray tube without changing the position of the patient.
Results: In dorsoventral projections, the Norberg angle value is increased by 3.2 to 5.8%. Due to rotation along the long axis, the Norberg angle increases on one side and decreases on the contralateral side by approximately the same value. Rotation of greater than 2 degrees in a lateral direction is visually perceived by the observer as tilted. Rotation of the projection in the caudoventral to craniodorsal direction causes mild increase of the Norberg angle (≤1%), while rotation of the projection in a cranioventral to caudodorsal direction causes moderate (≤2%) decrease of the Norberg angle. Rotation of less than -10 degrees (caudoventral to craniodorsal) or greater than 10 degrees (cranioventral to caudodorsal) is visually perceived as tilted.
Conclusion: Tilted images that are subjectively perceived evaluable have only little effect on the Norberg angle and are therefore probably acceptable. Dorsoventral projections can be recognized based on the proximal position of the patella and should be excluded from evaluation, as the Norberg angle value can be falsely increased.
Vandekerckhove - 2024 - VCOT - Quantifying the Stress in Stress Radiographs to Determine Sufficient Laxity of the Coxofemoral Joint - A Canine Hip Dysplasia Cadaveric Study
Objective: While it has been known for a long time that laxity in the hip joint is the primary cause of degenerative changes later on in canine hip dysplasia, limited data are available on the fundamental characteristics that define the procedure used to quantify this. The aim of this study was to evaluate the force-laxity relation to assess the repeatability of repeated cycles of stress on the hip joint and determine the force necessary tomeasure a sufficient proportion of laxity present in hip joints.
Materials and methods: Thirty-four canine cadavers underwent a radiographic protocol including stress radiographs with increasing force using the Vezzoni modified Badertscher distension measuring device (VMBDmD). Three dogs underwent five repeat examinations. The laxity index (LI) and osteoarthritis were scored.
Results and conclusion: The curves and the maximal LI (LImax) were not significantly influenced by osteoarthritis, weight, gender, and side. The position of the VMBDmD influenced the curve but not the LImax. The force-laxity curve itself and the LImax were repeatable, which indicated that it did not cause permanent damage to the joint and also confirmed the practicability of the procedure. Ninety percent of hip joints reached sufficient laxity at a force of 95.32 N, which is realistically achievable. Further studies are necessary before extrapolating these results to patients and to further enlighten the biomechanics of stress radiographs.
Holman - 2024 - VCOT - Quantification of the Field of View for Standard Lateral Arthroscopy of the Canine Shoulder
Objective: The aim of this study was to define the extent of the biceps tendon, subscapularis tendon, and cranial border of the medial glenohumeral ligament within the field of view during standard lateral shoulder arthroscopy in the dog. We also examine the effect of joint flexion on the field of view of the biceps tendon.
Study design: This was a cadaveric study using 21 shoulders of large breed dogs. Each shoulder was explored with a 30-degree arthroscope using standard lateral ports. For each supporting structure, the margins within the arthroscopic field of view were marked with ink. In 11 shoulders, the distal margin of the biceps tendon was identified and marked first with the limb at a standing angle and then in flexion. The margins of the cranial border of the medial glenohumeral ligament were marked at the standing angle. In 10 additional shoulders, the margins of the subscapularis tendon were evaluated. Each joint was fully dissected and the portion of each stabilizing structure within the field of view was quantified.
Results: Fifty-eight percent of the cranial border of the medial glenohumeral ligament was within the arthroscopic view. At a standing angle, 48% of the intra-articular length of the biceps tendon was within the arthroscopic view, compared to 63% with the limb flexed. Twenty percent of the subscapularis tendon was within the arthroscopic view.
Conclusion: A significant portion of the biceps tendon and medial stabilizing structures of the canine shoulder are outside the field of view of arthroscopy through a standard lateral approach. The limitations of the arthroscopic field of view should be appreciated when evaluating the shoulder.
Miller - 2024 - VETSURG - Complications and outcome following staphylectomy and folded flap palatoplasty in dogs with brachycephalic obstructive airway syndrome
Objective: To compare the prevalence of pre-, intra-, and postoperative variables and complications associated with staphylectomy (S) and folded flap palatoplasty (FFP).
Study design: Retrospective study.
Sample population: Client-owned dogs (n = 124).
Methods: Medical records of S and FFP dogs from a veterinary teaching hospital were reviewed between July 2012 and December 2019. Signalment, clinical pre-, intra-, and postoperative data were collected and reviewed. Median (interquartile range) was reported.
Results: A total of 124 dogs among 14 breeds underwent surgical treatment for an elongated soft palate with either a S (n = 64) or FFP (60). FFP dogs without concurrent non-airway procedures were associated with longer duration of surgery (p = .02; n = 63; S, median = 51 min [34-85]; FFP, median = 75 min [56.25-94.5]) and anesthesia (p = .02; n = 63; S, median = 80 min [66-125]; FFP, median = 111 min [91-140.8]). Neither soft palate surgery was associated with the occurrence of anesthetic complications (p = .30; 99/120; S, 49; FFP, 50), postoperative regurgitation (p = .18; 27/124; S, 17; FFP, 10), or with hospitalization duration (p = .94; n = 124; S, median = 1 day [1]; FFP, median = 1 [1]). Postoperative aspiration pneumonia (9/124; S, 4; FFP, 5) and major complications were rare (5/124; S, 3; FFP, 2).
Conclusion: S and FFP had similar anesthetic and perioperative complications, although FFP dogs had longer anesthetic and operative times.
Clinical significance: Although FFP took longer, no other clinically significant differences were appreciated between S and FFP procedures. Because of limitations inherent in study design, surgeons should continue to use clinical judgment when deciding on a procedure.
Story - 2024 - VETSURG - Morphologic impact of four surgical techniques to correct excessive tibial plateau angle in dogs - A theoretical radiographic analysis
Objective: To determine morphologic differences between four tibial osteotomy techniques used to correct excessive tibial plateau angle (eTPA).
Study design: Retrospective radiographic analysis.
Sample population: Sixteen dogs (27 tibias) with eTPA.
Methods: Virtual corrections of eTPA were performed on sagittal plane radiographs of canine tibia using four tibial osteotomy techniques and categorized into respective groups. Group A represented the center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) and coplanar cranial closing wedge ostectomy (CCWO), Group B the tibial plateau leveling osteotomy (TPLO) and CCWO, Group C the modified CCWO (mCCWO), and Group D the proximal tibial neutral wedge osteotomy (PTNWO). Pre- and post-correction TPA, tibial length and mechanical cranial distal tibial angle (mCrDTA) were measured and compared.
Results: Mean TPA prior to correction was 42.67 ± 6.1°. Post-correction mean TPAs were 10.47 ± 2.1°, 6.77 ± 1.6°, 4.76 ± 1.5°, and 7.09 ± 1.3° for Groups A, B, C, and D, respectively. TPA correction accuracy in Groups A and D varied least from target TPAs. Tibial shortening was documented in Group B in contrast to other groups. The greatest mechanical axis shift was identified in Group A.
Conclusion: Each technique achieved TPA < 14° despite having different effects on tibial morphology including alteration of tibial length, mechanical axis shift and variation in correctional accuracy.
Clinical significance: Despite all methods being able to correct eTPA, the choice of technique will affect morphology in unique ways and should be considered prior to surgery to consider the implications in a given patient.
Sanders - 2024 - VETSURG - Influence of antiseptic lavage during tibial plateau leveling osteotomies on surgical site infection in 1422 dogs
Objective: To determine the influence of preclosure antiseptic versus saline lavage on surgical site infections (SSI) in dogs following tibial plateau leveling osteotomy (TPLO).
Study design: A multicenter retrospective study.
Sample population: Dogs treated with TPLO (n = 1422) between December 2019 and October 2021.
Methods: The medical records of dogs treated with TPLO were reviewed for preclosure antiseptic lavage or saline irrigation. Additional collected data included signalment, unilateral or bilateral TPLO, postoperative administration of antimicrobial medications, antibiotic agent, surgeon, and development of SSI within 90 postoperative days. Eleven factors were analyzed for association with SSI using univariate and multivariate analysis.
Results: Data were collected from the records of 519 dogs treated with antiseptic lavage and 903 dogs treated with saline lavage during TPLO. Surgical site infections were diagnosed more frequently in dogs that received preclosure antiseptic lavage (77/519, 14.84%) than those with saline irrigation (80/903, 8.86%) (p = .001). Single session bilateral TPLO increased the odds of SSI by 2.5x (p = .004). The odds of SSI increased by 11% (p = .001) for every 5 kg increase in bodyweight. Postoperative administration of antimicrobials decreased the risk of SSI (p = .008).
Conclusion: The preclosure antiseptic lavage tested here did not decrease the incidence of SSI after TPLO.
Clinical significance: The results of this study do not provide evidence to support preclosure antiseptic lavage during TPLOs.
Banks - 2024 - VETSURG - A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery - An in silico and clinical evaluation of 100 cases
Objective: (1) To determine whether Oxley’s modified cranial closing wedge osteotomy (CCWO) results in a tibial plateau angle (TPA) of 5° in silico, (2) compare in silico to clinical postoperative TPA and (3) determine the impact of ostectomy distalization in silico.
Study design: Cross-sectional retrospective radiographic in silico study.
Sample population: A total of 100 stifle radiographs; 90 dogs (small ≤25 kg = 84; large >25 kg = 16).
Methods: Tibial plateau angles were measured preoperatively (TPAPre ), after in silico planning (TPAPlan ), and postoperatively (TPAPost ). Virtual ostectomies were evaluated for plate fit. Postoperative ostectomy position was measured. Virtual ostectomies were performed 5/7.5/10/15 mm from the patellar tendon insertion in 10 dogs from each preoperative TPA category (≤20°/21-25°/ 26-30°/31-35°/>35°). Comparisons for TPAPre , TPAPost , and TPAPlan were made between small and large dogs, and the outcome to the target 5° between TPA categories and ostectomy positions.
Results: Mean ± SD TPAPre was 28.6 ± 6.2° and higher in small than large dogs. Mean TPAPlan was 7.6 ± 2.7°. Plate fit was appropriate in all. In silico, TPAs were greater than 5° except for cases with TPAPre > 35°. Median TPAPost was 5.5° (-4-21) and was higher in small (7°) than large (4.5°) dogs. Postoperative ostectomy position was more distal than Oxley’s guidelines. When distalized >7.5 mm in silico, the magnitude of under-correction increased.
Conclusions: Oxley’s modified CCWO did not result in TPA of 5° in most cases. Ostectomy distalization exacerbated under-correction.
Clinical impact: Current guidelines should be modified to achieve 5° TPA postoperatively.
Vodnarek - 2024 - VETSURG - Reliability of fluoroscopic examination of nasopharyngeal dorsoventral dimension change in pugs and French bulldogs
Objective: To compare intra- and interobserver agreements in two-dimensional measurements of changes in nasopharyngeal dimensions during breathing in pugs and French bulldogs.
Study design: Experimental randomized study.
Animals: A total of 20 French bulldogs and 16 pugs.
Methods: Four observers with different levels of experience measured the dorsoventral dimensions of the nasopharynx during inspiration and expiration on fluoroscopy videos. Measurements were performed at the maximal narrowing of the nasopharynx for the functional method and at the level of the tip of the epiglottis for the anatomically adjusted method. The intra- and interobserver agreements of the measurements, ratio of the dynamic nasopharyngeal change (ΔL), and grade of nasopharyngeal (NP) collapse (no, partial or complete) were evaluated.
Results: The functional method resulted in intraobserver correlation coefficients of 0.532 (p < .01) and 0.751 (p < .01) and interobserver correlation coefficients of 0.378 (p < .01) and 0.621 (p < .01) for NP collapse grade and ΔL, respectively. The anatomically adjusted method, 0.491 (p < .01) and 0.576 (p < .01) and 0.495 (p < .01) and 0.729 (p < .01) for NP collapse grade and ΔL, respectively, were being used. One observer (radiologist) achieved intraobserver correlation coefficients >0.9 for both methods.
Conclusion: Fair interobserver agreement was found for NP collapse grade (functional method), moderate intra- and interobserver agreements were found for NP collapse grade and ΔL (both methods) while intraobserver agreement for ΔL was good (functional method).
Clinical significance: Both methods seem repeatable and reproducible but only for experienced radiologists. The use of ΔL may offer higher repeatability and reproducibility than grade of NP collapse regardless of the method used.
Knudsen - 2024 - VETSURG - Diagnosis of medial meniscal lesions in the canine stifle using multidetector computed tomographic positive-contrast arthrography
Objective: To assess diagnostic value and clinical utility of multidetector computed tomographic positive contrast arthrography (CTA) for meniscal lesions in dogs.
Study design: Prospective case series.
Study population: Client-owned dogs (n = 55) with cranial cruciate ligament injuries.
Methods: Sedated dogs underwent CTA using a 16-slice scanner, and subsequently received mini-medial arthrotomy for meniscal assessment. Scans were anonymized, randomized, and reviewed twice for meniscal lesions by three independent observers with varying experience. Results were compared with surgical findings. Reproducibility and repeatability were assessed with kappa statistics, intraobserver changes in diagnosis by McNemar’s test, and interobserver differences using Cochran’s Q test. Test performance was calculated using sensitivity, specificity, proportion correctly identified, and positive and negative predictive values and likelihood ratios.
Results: Analysis was based on 52 scans from 44 dogs. Sensitivity for identifying meniscal lesions was 0.62-1.00 and specificity was 0.70-0.96. Intraobserver agreement was 0.50-0.78, and interobserver agreement was 0.47-0.83. There was a significant change between readings one and two for the least experienced observers (p < .05). The sum of sensitivity and specificity exceeded 1.5 for both readings and all observers.
Conclusion: Diagnostic performance was suitable for identifying meniscal lesions. An effect of experience and learning was seen in this study.
Moreira - 2024 - VETSURG - Predicting tibial plateau angles following four different types of cranial closing wedge ostectomy
Objective: To investigate how tibial long axis (TLA) shift affects the postoperative tibial plateau angle (TPA) in four cranial closing wedge ostectomy (CCWO) techniques.
Study design: In silico study.
Sample population: A total of 15 client-owned dogs.
Methods: Computed tomography (CT) scans of 15 client-owned dogs were reviewed using an open-source 3D computer graphics editor. Each computer-generated 3D tibia model underwent a CCWO, with cranial cortex alignment, in 10° increments up to 70° using each of the four previously described techniques. The TLA shift, TPA and mechanical tibial length (mTL) were calculated, using trigonometry, for each model. Equations for predicting final TPA were generated with linear regression.
Results: A total of 433 3D computer generated tibial models were analyzed. With each technique, the TPA varied in a linear fashion within the studied range of wedge angles. The TLA shift and tibial shortening magnitude varied between the four different CCWO techniques, with maximum mTL reduction of ranging from 7.5% to 40.9%. All predicted TPAs using the generated equations were within the target range of 4-6°.
Conclusion: A linear relationship between ostectomy wedge angle and TPA correction was observed in this study, which allowed for generation of accurate corrective equations.
Clinical significance: These results allow extrapolation of the wedge angle required to reach a postoperative TPA of 5°, by considering the TLA shift. The use of the generated corrective equations may thus increase CCWO planning precision.
Glenn - 2024 - VETSURG - Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system
Abstract
Objective: To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection.
Study design: Prospective, cohort study.
Animals: Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital.
Methods: Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians.
Results: Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined “SSI” or “No SSI” from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. “No SSI” was diagnosed in responses not meeting criterion 1, and “SSI” in responses meeting criteria 1 and 2. “Inconclusive” responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only.
Conclusion: Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection.
Clinical significance: Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.
Franklin - 2024 - VETSURG - Comparison of the effectiveness of three different rhinoplasty techniques to correct stenotic nostrils using silicone models - A case study
Objective: To compare the effects of three different rhinoplasty techniques on the postoperative cross-sectional areas (CSAs) of the nares and nasal vestibuli.
Study design: Experimental study.
Sample population: Ninety-nine 3D-printed, remolded silicone models of a single French bulldog’s rostral nose.
Methods: Models were fabricated based on a computed tomographic (CT) scan of the nose of a French bulldog with moderately stenotic nares. Each model underwent either vertical wedge resection (VW), modified horizontal wedge resection (MHW), or ala-vestibuloplasty (AVP) performed by a single surgeon (n = 33 per group). Preoperative and postoperative CT scans of the models were performed, and CSAs of the airway from the nares to the caudal end of the nasal vestibules were calculated.
Results: All three rhinoplasty techniques increased CSAs (adjusted p values <.001) but to different levels caudally within the nasal vestibule. Vertical wedge resection achieved this up to the start of the alar fold, MHW up to halfway between the nares and the alar fold and AVP up to the caudal nasal vestibule. Average percentage increases in CSA were 26%, 15% and 74%, respectively. Ala-vestibuloplasty led to larger CSAs than VW and MHW from the nares to the caudal nasal vestibule (adjusted p values <.05). The proportional difference within each technique was <7%.
Conclusion: Ala-vestibuloplasty resulted in a larger increase in the airway CSA of silicone modeled nares and nasal vestibules of a single French bulldog in comparison with VW and MHW.
Clinical significance: Ala-vestibuloplasty can be considered for French bulldogs with moderately stenotic nares and evidence of nasal vestibular stenosis.
Larose - 2024 - VETSURG - Near-infrared fluorescence cholangiography in dogs - A pilot study
Objective: To determine the effect of indocyanine green (ICG) dose and timing of administration on near-infrared fluorescence (NIRF) imaging of the normal canine biliary tree.
Study design: Preclinical prospective study.
Animals: Eight purpose-bred beagles.
Methods: The dogs were randomized to receive two of four intravenous ICG dose (low [L]:0.05 mg/kg or high [H]:0.25 mg/kg)/time (0 and 3 h prior to NIRF) combinations. NIRF images were collected every 10 min for 120 min. Target (cystic duct)-to-background (liver) ratios were calculated for all timepoints and compared.
Results: ICG cholangiography was successful in all dogs. The contrast ratio was above 1 in the L0 group by 20 min and reached its peak at 100 min. In the H0 group, the ratio was above 1 by 60 min and reached its peak at 90 min. Contrast ratios above 2 (fluorescence twice as bright in the cystic duct compared to the liver) were maintained from 180 to 300 min for L3 and H3 and was achieved after 80 min for L0.
Conclusion: Low dose ICG provided better ratios early after injection compared to the high dose which remained highly concentrated in the liver tissue after injection. Both doses provided excellent visualization of the biliary tree at 3 h post injection, low dose ICG provided better ratios from 3 to 5 h post injection. Based on these results, 0.05 mg/kg of ICG administered at anesthetic premedication, or as early as 3 h prior to laparoscopic surgery should yield optimal fluorescence images.
Clinical significance: This study provides guidelines for NIRF cholangiography in clinically normal dogs.
Williams - 2024 - VETSURG - Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome - A prospective, randomized study
Objective: To assess the use of adrenaline (0.00198%) in a bilateral maxillary nerve block to reduce intraoperative hemorrhage in dogs undergoing staphylectomy for the treatment of brachycephalic obstructive airway syndrome (BOAS).
Study design: Prospective, randomized, double-blinded controlled study.
Sample population: A total of 32 client owned, clinically affected dogs undergoing a cut and sew sharp staphylectomy for treatment of BOAS. A total of 16 dogs randomly assigned to adrenaline (A) group and 16 to no-adrenaline (NA) group.
Methods: A bilateral maxillary nerve block was performed in all dogs prior to staphylectomy using lidocaine alone (group NA) or a combination of lidocaine and adrenaline (group A). Total hemorrhage was measured by weighing cotton-tipped applicators and swabs used on precision scales. In addition, a semi-quantitative hemorrhage score (1-5) was determined. Dogs were monitored for intraoperative hemodynamic stability during the procedure.
Results: Total hemorrhage was significantly (p = .013) lower in group A compared with group NA. The median semi-quantitative hemorrhage score was significantly lower for group A (p = .029) compared with group NA. No significant adverse effects were noted due to adrenaline usage.
Conclusion: This study demonstrated that the use of adrenaline in a bilateral maxillary nerve block results in significantly lower intraoperative hemorrhage during cut and sew sharp staphylectomy and appeared safe to use.
Clinical significance: Potential clinical advantages include improved visualization, prevention of unnecessary blood loss and reduction in risk of blood aspiration.
Jones - 2024 - VETSURG - Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device
Objective: To compare mortality of dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide (CO2 ) laser, and bipolar vessel sealing device (BVSD) techniques for the treatment of brachycephalic obstructive airway syndrome (BOAS).
Study design: Retrospective multicenter cohort study.
Animals: A total of 606 client-owned English bulldogs, French bulldogs, and pugs.
Methods: Medical records from 2011 to 2021 were reviewed for signalment, history, surgical technique, length of hospitalization, and complications. Multivariate statistical analysis was performed to compare odds of mortality between the three techniques of staphylectomy.
Results: The overall mortality rate was 24/606 (4.0%). Of those 24 dogs, staphylectomy was performed with BVSD technique in 13 cases, with CO2 laser in nine, and using conventional incisional technique in two. Nine dogs were graded II or III laryngeal collapse, 14 were graded I, and one was unknown. BVSD technique was associated with mortality prior to discharge compared to the other two techniques (OR = 6.0, 95% CI: 1.3-28.4, p = .023). No differences were detected between conventional incisional and CO2 laser techniques. Concurrent higher grade (stage II or III) laryngeal collapse was independently associated with mortality prior to discharge (OR = 4.6, 95% CI: 1.8-11.8, p = .002).
Conclusion: The use of BVSD and grade of laryngeal collapse were associated with a higher risk of perioperative mortality.
Clinical significance: Clinical studies using a randomized trial design should be conducted to further determine the putative influence of surgical instrumentation in the perioperative mortality rate following multilevel surgery in dogs with BOAS.
Nash - 2024 - VETSURG - Esophageal pH-monitoring in nonbrachycephalic dogs - A reference
Objective: To establish parameters that describe acidic gastroesophageal reflux (GER) events in nonbrachycephalic, hospitalized dogs without gastrointestinal disease following short total intravenous anesthesia, to establish upper reference limits for parameters that describe GER.
Study design: Clinical prospective study.
Animals: Healthy, client-owned dogs presenting for elective orthopedic surgery.
Methods: Dogs were sedated with IM methadone (0.2 mg/kg) and medetomidine (5 ug/kg), followed by alfaxalone total intravenous anesthesia. The Digitrapper esophageal dual pH monitoring probe was placed transnasally into the esophagus. Dogs were unsedated during the subsequent recording period. A GER event was defined as esophageal pH less than 4.0. Parameters that described GER were: (1) number of GER events per hour, and (2) cumulative esophageal acid exposure (percentage of recording duration) at each sensor. Upper reference limits were calculated for each parameter.
Results: Thirty-five dogs were included (median age 7 years, range 1-12). The median recording duration was 21.1 h (range 13.6-29.3). Productive regurgitation was not noted in any dog. The median number of distal and proximal GER events per hour was 0.3 (range 0-4.3) and 0 (range 0-1), respectively. The median cumulative distal and proximal esophageal acid exposure was 0.2% (range 0.3-9%) and 0% (range 0%-1%), respectively.
Conclusion: Upper reference limits for distal and proximal GER per hour was 2.4 and 0.4, respectively, and, for cumulative distal and proximal esophageal acid exposure, 2.3% and 0%, respectively.
Clinical significance: Dogs undergoing esophageal pH monitoring in a similar hospital setting with parameters above these upper reference limits have excessive GER.
Thibault - 2023 - JSAP - Osteochondritis dissecans of the vertebral endplate of C5 with concomitant C4-C5 disc protrusion in a French Bulldog
A 4-year-old French bulldog was presented with neck pain and left forelimb lameness. CT scan revealed a bony defect in the craniodorsal rim of the endplate of C5 with a concomitant disc protrusion leading to ventral spinal cord compression. Ventral slot at C4-C5 was performed to remove the protruding material and the fragment. Based on CT and histological findings, this bone defect was consistent with osteochondritis dissecans. Neck pain was absent immediately after the operation and the dog recovered without complication. Only a slight proprioceptive deficit of the left forelimb persisted during the 6-month of follow-up. Based on our search of the veterinary literature, this is the first published report of an osteochondritis dissecans of cervical endplate treated surgically.
Michael - 2023 - JAVMA - Perioperative ventricular arrhythmias are increased with hemoperitoneum and are associated with increased mortality in dogs undergoing splenectomy for splenic masses
Abstract
Objective: To identify risk factors for intra- and postoperative ventricular arrhythmias (VAs) and in-hospital mortality in dogs undergoing splenectomy for splenic masses.
Animals: 308 dogs.
Methods: Records from 2010 through 2018 were reviewed for dogs undergoing splenectomy for a splenic mass. Clinical and laboratory findings on admission, diagnostic imaging, anesthesia, surgery and pathology reports, treatment records, and in-hospital mortality were evaluated with logistic regression.
Results: VAs occurred in 138 (44.8%) dogs (126/308 [40.9%] postoperative, 51/308 [16.6%] intraoperative, 26/308 [8.4%] preoperative), with 50/308 (16.2%) dogs having more than one type of VA. Increasing heart rate and body weight, decreasing PCV and platelet count, hemoperitoneum, receipt of a transfusion, and diagnosis of hemangiosarcoma were associated with the presence of intra- and postoperative VAs on univariable analysis (all P < .001). On multivariable analysis, hemoperitoneum (P < .001 , < .001), increasing body weight (P = .026, < .001), and increasing heart rate (P = .028, < .001) were significant for intra- and postoperative VAs, respectively. Twenty dogs died (20/308 [6.5%]; 14/138 [10.1%] with VAs, 6/170 [3.5%] without VAs). Intra- and postoperative VAs were associated with in-hospital mortality (P = .009, .025, respectively).
Clinical relevance: Perioperative VAs were common and odds of VAs were increased with hemoperitoneum, increasing heart rate, and increasing body weight. Presence of VAs increased the odds of in-hospital mortality. Despite this, the overall in-hospital mortality rate was low (6.5%), indicating a good prognosis for survival of surgery in dogs with splenic masses, regardless of the presence of VAs or hemoperitoneum.
Crofts - 2023 - JAVMA - Increased incidence and shift in the location of gunshot wound injuries in dogs and cats during the COVID-19 pandemic
Objective: To investigate the incidence and patterns of gunshot wound trauma in patients that were presented to an urban level 1 veterinary trauma center before and after the start of the coronavirus disease of 2019 (COVID-19) pandemic.
Animals: 24 dogs and 1 cat.
Methods: Medical records were retrospectively reviewed for patients presenting with gunshot wound injuries between March 2018 and February 2020 (prepandemic) and March 2020 and February 2022 (pandemic). The total number of patients presented to the hospital during those same time periods was also obtained. Patient data were collected including species, breed, age, sex, location of injury, trauma score (if available), surgical procedures performed, length of hospitalization, and case outcome.
Results: In the prepandemic period, 9 patients were presented for gunshot wound injuries, whereas there were 16 patients evaluated for gunshot wound injuries during the pandemic period. The total number of gunshot wound cases increased by 77.8% in the pandemic period. The total number of hospital patient visits, however, decreased by 12.2% in the pandemic period as compared to the prepandemic period: 65,168 versus 74,262 patients, respectively. Injuries were predominantly localized to the extremities (55%) in the prepandemic period versus maxillofacial (56%) in the pandemic period.
Clinical relevance: There was an increased number of gunshot wound injuries in companion animals presenting to an urban level 1 veterinary trauma center during the COVID-19 pandemic. A shift in the predominant location of injury was also identified during the pandemic period. This study highlights the ramifications that societal dynamics can have on animal health and welfare.
Forster - 2023 - JAVMA - Bilateral pubic and ischial osteotomy in cats offers good exposure for resection of large vaginal masses with minimal postoperative complications
Objective: To describe the clinical presentation, diagnostic imaging findings, surgical technique, histopathological diagnosis, and postoperative outcome in 3 cats with extensive vaginal masses.
Animals: Medical records of cats diagnosed with vaginal masses that had a bilateral pubic and ischial osteotomy and vaginectomy between 2004 and 2022 were retrospectively reviewed. Three cats met the inclusion criteria.
Clinical presentation: Histopathological diagnosis included T-cell-rich B-cell lymphoma (n = 1), mycetoma (1), and vaginal polyp (1). Diagnostic imaging included CT (n = 2) and MRI (1), and tumor length/width/height percentages in relation to the pelvic dimensions were 53% X 62% X 63% (case 1), 50% X 100% X 60% (case 2), and 150% X 120% X 120% (case 3). A bilateral pubic and ischial osteotomy was performed in all 3 cases.
Results: All 3 cases developed mild pelvic-limb splaying postoperatively; all resolved within 8 weeks, and 2 cases fully resolved within 14 days. Two of the 3 cases presented with mild stranguria postoperatively, which resolved fully in both cases.
Clinical relevance: Vaginal neoplasia, either malignant or benign, is infrequently reported in cats in the veterinary literature. Bilateral pubic and ischial osteotomy for resection of vaginal masses in cats is a successful surgical approach, offering good exposure for resection of large vaginal masses, with minimal postoperative complications.
Traverson - 2023 - JAVMA - Adrenal tumors treated by adrenalectomy following spontaneous rupture carry an overall favorable prognosis - Retrospective evaluation of outcomes in 59 dogs and 3 cats (2000-2021)
Objective: To conduct a retrospective multi-institutional study reporting short- and long-term outcomes of adrenalectomy in patients presenting with acute hemorrhage secondary to spontaneous adrenal rupture.
Animals: 59 dogs and 3 cats.
Methods: Medical records of dogs and cats undergoing adrenalectomy between 2000 and 2021 for ruptured adrenal masses were reviewed. Data collected included clinical presentation, preoperative diagnostics, surgical report, anesthesia and hospitalization findings, histopathology, adjuvant treatments, and long-term outcome (recurrence, metastasis, and survival).
Results: Median time from hospital admission to surgery was 3 days, with 34% of surgeries being performed emergently (within 1 day of presentation). Need for intraoperative blood transfusion was significantly associated with emergent surgery and presence of active intraoperative hemorrhage. The short-term (≤ 14 days) complication and mortality rates were 42% and 21%, respectively. Negative prognostic factors for short-term survival included emergent surgery, intraoperative hypotension, and performing additional surgical procedures. Diagnoses included adrenocortical neoplasia (malignant [41%], benign [12%], and undetermined [5%]), pheochromocytoma (38%), a single case of adrenal fibrosis and hemorrhage (2%), and a single case of hemangiosarcoma (2%). Local recurrence and metastasis of adrenocortical carcinoma were confirmed in 1 and 3 cases, respectively. Overall median survival time was 574 days and 900 days when short-term mortality was censored. No significant relationship was found between histopathological diagnosis and survival.
Clinical relevance: Adrenalectomy for ruptured adrenal gland masses was associated with similar short- and long-term outcomes as compared with previously reported nonruptured cases. If hemodynamic stability can be achieved, delaying surgery and limiting additional procedures appear indicated to optimize short-term survival.
MacCormick - 2023 - JAVMA - Use of a jumbo plate in dogs greater than 50 kg following tibial plateau leveling osteotomy does not prevent increase in tibial plateau angle through convalescence
Objective: To investigate the use of a locking 3.5/4.0-mm jumbo tibial plateau leveling osteotomy (TPLO) plate in maintaining the postoperative tibial plateau angle (TPA) in giant-breed dogs weighing > 50 kg and to report the associated complications.
Animals: Canine patients weighing > 50 kg that underwent TPLO stabilized with a locking 3.5/4.0-mm jumbo TPLO plate between January 2017 and May 2022.
Methods: Retrospective case series retrieving postoperative outcomes from the medical records. Healing scores and TPAs were calculated using postoperative and recheck radiographs. Owner-perceived outcomes were obtained via questionnaire.
Results: 24 stifles in 22 dogs were included. Postoperative complications were recorded in 11 of 24 cases (45.8%) inclusive of 1 minor, 1 catastrophic, and 9 major complications. A statistically significant increase in TPA over the convalescent period was found. Grade 4 healing was present in 18 of 24 (75%) stifles, while the remainder were scored as grade 3.
Clinical relevance: The use of a locking 3.5/4.0-mm jumbo TPLO plate did not prevent a statistically significant increase in TPA through convalescence. This procedure displayed an unacceptably high complication rate when compared with contemporary literature of TPLO. Despite a high complication rate in this patient population, most complications were successfully managed with medical and/or surgical treatment, and high mean and median healing scores were achieved at the radiographic recheck. Additionally, owner-perceived long-term outcomes were excellent.
Mayhew - 2023 - JAVMA - Laparoscopic adrenalectomy for resection of unilateral noninvasive adrenal masses in dogs is associated with excellent outcomes in experienced centers
Objective: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity.
Animals: 255 client-owned dogs.
Methods: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time.
Results: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence.
Clinical relevance: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.
Ullal - 2023 - JAVMA - Increasing age and severe intraoperative hypotension associated with nonsurvival in dogs with gallbladder mucocele undergoing cholecystectomy
Objective: To identify prognostic indicators and inflammatory markers associated with nonsurvival in dogs with gallbladder mucoceles (GBMs) following cholecystectomy and to evaluate C-reactive protein (CRP) and haptoglobin concentrations in dogs with GBMs compared to healthy controls.
Animals: 25 dogs that underwent cholecystectomy for removal of GBM and 20 healthy control dogs.
Methods: A prospective, multicenter cohort study. Survival outcomes to hospital discharge and 2 weeks postdischarge were recorded from medical records. Laboratory variables, inflammatory markers (CRP and haptoglobin), and 25-hydroxyvitamin(OH) D (25[OH]D) concentrations were measured preoperatively. Associations between signalment, clinicopathologic variables, acute patient physiologic and laboratory evaluation (APPLEFAST) scores, inflammatory markers, 25(OH)D concentration, and survival were analyzed using logistic regression.
Results: 76% (19/25) and 68% (17/25) of dogs survived to hospital discharge and 2 weeks postdischarge, respectively. For each additional year of age, the odds of nonsurvival in hospital and 2 weeks postdischarge increased by 2.2 (P = .01; 95% CI, 1.2 to 5.0) and 1.7 (P = .04; 95% CI, 1.0 to 3.2), respectively. Intraoperative systolic blood pressure ≤ 65 mm Hg increased the probability of nonsurvival in hospital (P < .04). Gallbladder perforation, APPLEFAST scores, and preoperative serum concentrations of CRP, haptoglobin, and 25(OH)D were not associated with survival. Serum CRP and haptoglobin concentrations were greater in dogs with GBM compared to controls (P < .001).
Clinical relevance: Increasing age and intraoperative systolic blood pressure ≤ 65 mm Hg were associated with nonsurvival in dogs with GBM undergoing cholecystectomy. Serum CRP, haptoglobin, and 25(OH)D were not associated with nonsurvival postcholecystectomy in this sample population.
Nash - 2023 - JAVMA - Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment - 61 dogs (2018-2022)
Objective: To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management.
Animals: 61 dogs.
Clinical presentation: Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment.
Results: 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27).
Clinical relevance: Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.
Sartore - 2023 - JFMS - Osteochondrodysplasia and the c.1024G>T variant of <em>TRPV4</em> gene in Scottish Fold cats - Genetic and radiographic evaluation
Objectives: The objectives of this study were to investigate the c.1024G>T SNP in the TRPV4 gene in Scottish Straight and Fold cats, and to evaluate the pattern of skeletal phenotype and the evolution of radiological signs of Scottish Fold osteochondrodysplasia (SFOCD) over time in heterozygous subjects.
Methods: DNA was obtained from blood samples of 17 cats (Scottish Fold: n = 12; Scottish Straight: n = 5) and subsequently genotyped by sequencing in a 249 bp region of the TRPV4 gene (exon 6), including the known c.1024G>T causative mutation for osteochondrodysplasia. Orthopaedic and radiographic analyses were performed on animals carrying the mutant allele.
Results: Genotyping by sequencing confirmed that all and only the Scottish Fold cats carried the mutant allele in a heterozygous asset. Furthermore, two other exon variants, already described in the literature as silent variants, were found in some of the sampled cats. Comparative orthogonal radiographic views of the shoulder, elbow, carpus, hip, stifle and tarsus were obtained. A mediolateral projection of the thoracic and lumbar column was also performed. Three out of four cats were clinically and radiographically examined again 1.5 years later.
Conclusions and relevance: Although the presence of the mutant allele in all the tested Scottish Fold cats was confirmed, only 1/12 showed clinical signs of SFOCD. Furthermore, no cats in the 1.5-year follow-up showed skeletal changes. Although significant, the c.1024G>T mutation in the TRPV4 gene, supposedly, is not the only cause or risk of developing SFOCD.
Clark - 2023 - JSAP - A composite occipito-atlanto-axial joint cavity cyst in a cat
XX
Danielski - 2023 - JAVMA - Lower body weight and increasing age are significant risk factors for complications following bi-oblique proximal ulnar osteotomy in dogs
Objective: To report and evaluate the risk factors for complications following bi-oblique proximal ulnar osteotomy (PUO) in dogs.
Animals: 82 client-owned dogs (93 limbs).
Methods: Clinical records of dogs treated with bi-oblique PUO over a 5-year period were reviewed. Postoperative radiographs were analyzed, and osteotomy location and angles were recorded; follow-up radiographs were reviewed to assess the degree of osteotomy healing. Complications were classified as minor, major, and catastrophic. Logistic regression analysis was performed to investigate possible associations between the predictor variables and occurrence of complications.
Results: 82 dogs (93 limbs) were included. Postoperative complications were documented in 39 limbs (13 major and 26 minor). The most common major complication was osteotomy nonunion (8 limbs), while the most common minor complication was delayed union (21 limbs). Statistical analysis revealed that lower body weight (P = .01) and older age (P = .04) were significantly associated with the development of postoperative complications.
Clinical relevance: In this study, lighter and older dogs were more likely to develop complications following bi-oblique proximal ulnar osteotomy. We did not identify an association between osteotomy angle and location on complication rate. Careful patient selection is therefore required to reduce the incidence of postoperative complications after bi-oblique PUO.
Fontes - 2023 - JAVMA - Long-term outcomes associated with a modified versus traditional closed anal sacculectomy for treatment of canine anal sac neoplasia
Objective: To report the short-term and long-term outcomes of dogs that underwent the modified closed and traditional closed anal sacculectomy procedures for the treatment of anal sac neoplasia.
Animals: 90 client-owned dogs.
Methods: The medical records of 2 tertiary referral hospitals were reviewed to identify dogs that underwent anal sacculectomy for treatment of anal sac neoplasia between January 2016 and December 2020. Data collected included signalment and preoperative diagnostic findings. The occurrence of intraoperative and postoperative complications, short-term outcomes, and long-term outcomes were also collected. Descriptive statistics were calculated to summarize dog signalment information, and recurrence, metastasis, and survival proportions were compared between techniques using Fisher exact tests.
Results: 35 and 55 dogs, respectively, underwent the modified or traditional closed anal sacculectomy procedure. Minor postoperative complications that resolved with minimal intervention occurred in 5 of 35 (14.3%) modified approach dogs and 12 of 55 (21.8%) traditional approach dogs. Tumor recurrence was confirmed in 8 of 35 (22.9%) modified and 8 of 55 (26.4%) traditional approach dogs and was suspected in 3 of 35 (8.6%) and 6 of 55 (13.2%; P = .68), respectively. Confirmed metastatic disease was identified in 8 of 35 (22.9%) and 14 of 53 (26.4%) modified and traditional approach dogs, respectively, and was suspected in 4 of 35 (11.4%) and 7 of 53 (13.2%). Sixty-three (70%) dogs survived to study conclusion.
Clinical relevance: No benefits in complication rate or local recurrence were identified in dogs following the modified approach as opposed to the traditional closed anal sacculectomy technique.
Hynes - 2023 - JAVMA - Cranial cruciate ligament disease is perceived to be prevalent and is misunderstood in field trial sport
Objective: Cranial cruciate ligament disease (CCLD) is the most prevalent orthopedic problem in canines, affecting 3% to 5% of dogs, causing stifle instability, mobility dysfunction, and pain. The objective of this study was to evaluate the American Kennel Club field trial community’s knowledge of CCLD and estimate its perceived prevalence within this population.
Sample: 401 field trial participants responded, with 701 field trial canines reported.
Methods: A survey instrument was emailed to a population of Retriever field trial participants to collect information on perceptions and experience with CCLD and current canine participants. Analyses included descriptive statistics, multiple logistic regression, and χ2 tests (significant at P < .05).
Results: The majority of respondents appropriately identified the connection between genetics and CCLD (69%). There was under-recognition (6%) of the degenerative nature of the disease, with 61% inappropriately identifying trauma as the major cause. Respondents also indicated that a CCLD diagnosis in a dog’s sibling or offspring affected their breeding decisions less than a diagnosis in their parents, indicating a misunderstanding of genetics. More than half of respondents indicated prior experiences with CCLD. The reported occurrence of CCLD was found to be 12% (72/610) in field trial Labrador Retrievers.
Clinical relevance: There is a lack of knowledge in the field trial community regarding CCLD. This population showed a higher owner-perceived occurrence of CCLD compared to data collected from medical records. Further investigation is warranted to validate the true prevalence of CCLD in field trial Retrievers.
