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Abstract

OBJECTIVE To determine the most common types of injuries in cats surgically treated for thoracic trauma, complications associated with surgical treatment, and factors associated with mortality rate and evaluate the effectiveness of the animal trauma triage (ATT) scoring system for predicting outcome.

DESIGN Retrospective case series with nested observational study.

ANIMALS 23 client-owned cats surgically treated for thoracic trauma at 7 veterinary teaching hospitals between 1990 and 2014.

PROCEDURES Medical records were reviewed to collect data on signalment, medical history, clinical signs and physical examination findings at initial evaluation, clinicopathologic findings, initial emergency treatments and diagnostic tests performed, type of trauma sustained, imaging findings, surgery details, postoperative complications, duration of hospitalization, and cause of death, if applicable. All variables were evaluated for associations with survival to hospital discharge.

RESULTS Types of trauma that cats had sustained included dog bite or attack (n = 8 [35%]), motor vehicle accident (6 [26%]), other animal attack (2 [9%]), impalement injury or fall (2 [9%]), projectile penetrating trauma (1 [4%]), or unknown origin (4 [17%]). Intrathoracic surgery was required for 65% (15/23) of cats. The overall perioperative mortality rate was 13% (3/23). Mean ± SD ATT scores for surviving and nonsurviving cats were 6.4 ± 2.2 and 10.0 ± 1.7, respectively. Nineteen of 20 cats with no cardiopulmonary arrest survived to discharge, compared with 1 of 3 cats with cardiopulmonary arrest. Only these 2 variables were significantly associated with outcome.

CONCLUSIONS AND CLINICAL RELEVANCE The perioperative mortality rate was low in this series of cats with thoracic trauma; however, those with cardiopulmonary arrest were less likely to survive to hospital discharge than other cats. Cats with a low ATT score were more likely to survive than cats with a high ATT score.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To determine perioperative mortality rate and identify risk factors associated with outcome in dogs with thoracic trauma that underwent surgical procedures and to evaluate the utility of the animal trauma triage (ATT) score in predicting outcome.

DESIGN Retrospective case series.

ANIMALS 157 client-owned dogs.

PROCEDURES Medical records databases of 7 veterinary teaching hospitals were reviewed. Dogs were included if trauma to the thorax was documented and the patient underwent a surgical procedure. History, signalment, results of physical examination and preoperative laboratory tests, surgical procedure, perioperative complications, duration of hospital stay, and details of follow-up were recorded. Descriptive statistics and ATT scores were calculated, and logistic regression analysis was performed.

RESULTS 123 of 157 (78%) patients underwent thoracic surgery, and 134 of 157 (85.4%) survived to discharge. Mean ± SD ATT score for nonsurvivors was 8 ± 2.4. In the multivariable model, female dogs and dogs that did not experience cardiac arrest as a postoperative complication had odds of survival 6 times and 102 times, respectively, those of male dogs and dogs that did experience cardiac arrest as a postoperative complication. Additionally, patients with a mean ATT score < 7 had odds of survival 5 times those of patients with an ATT score ≥ 7.

CONCLUSIONS AND CLINICAL RELEVANCE The overall perioperative mortality rate was low for patients with thoracic trauma undergoing surgery in this study. However, male dogs and dogs that experienced cardiac arrest had a lower likelihood of survival to discharge. The ATT score may be a useful adjunct to assist clinical decision-making in veterinary patients with thoracic trauma.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To document outcomes of thoracoscopic treatment of idiopathic chylothorax (IC) in dogs with and without constrictive pericardial physiology (CPP) and evaluate patterns of chyle flow redistribution after thoracic duct ligation (TDL).

ANIMALS

26 client-owned dogs.

PROCEDURES

In this prospective cohort study, echocardiography and cardiac catheterization were performed to document CPP in dogs with IC. Thoracoscopic TDL with pericardiectomy was performed if CPP was present (TDL/P group). Dogs without evidence of CPP underwent thoracoscopic TDL alone (TDL group). Dogs underwent preoperative, immediate postoperative, and 3-month postoperative CT lymphangiography studies when possible. Perioperative morbidity, resolution and late recurrence rates, and long-term outcome were recorded.

RESULTS

17 dogs underwent TDL, and 9 underwent TDL/P. Twenty-five of 26 (96%) survived the perioperative period. One dog died from ventricular fibrillation during pericardiectomy. Resolution rates for TDL and TDL/P were 94% and 88%, respectively (P = .55), with 1 late recurrence occurring in the TDL group in a median follow-up of 25 months (range, 4 to 60 months). On 3-month postoperative CT lymphangiography studies, ongoing chyle flow past the ligation site was demonstrated in 5 of 17 dogs, of which 1 dog developed recurrence at 13 months postoperatively. In 15 of 17 dogs, chylous redistribution after TDL was principally by retrograde flow to the lumbar lymphatic plexus.

CLINICAL RELEVANCE

In dogs without evidence of CPP, TDL alone was associated with a very good prognosis for treatment of IC. In the absence of CPP, the additional benefit of pericardiectomy in the treatment of IC is questionable.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To evaluate colonoscopic and histologic features of rectal masses in dogs.

DESIGN Retrospective case series.

ANIMALS 82 client-owned dogs with rectal masses that underwent colonoscopy.

PROCEDURES Medical records of dogs with rectal masses that underwent colonoscopy were reviewed. History, signalment, clinical signs, results of physical examination, diagnostic imaging findings, and results of colonoscopy (including complications) were recorded. When available, tissue samples obtained during colonoscopy and by means of surgical biopsy were reviewed by a single board-certified pathologist. Histologic features and tumor grade (when applicable) of tissue samples obtained during colonoscopy versus surgical biopsy were compared.

RESULTS Multiple rectal masses were observed during colonoscopy in 6 of the 82 dogs, but no lesions were visualized orad to the colorectal junction. Results of histologic evaluation of surgical biopsy specimens were consistent with a diagnosis of epithelial neoplasia in 58 of 64 dogs, of which 71% were classified as benign adenoma or polyp and 29% were classified as adenocarcinoma in situ or adenocarcinoma. Complications of colonoscopy occurred in 3 of 82 dogs but were considered minor. A discrepancy in diagnosis occurred in 5 of 16 dogs for which both colonoscopic and surgical biopsy samples were available for histologic review.

CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that multiple rectal masses are uncommon in dogs, and secondary lesions orad to the colorectal junction were not found in this study. Colonoscopy was associated with few complications, but the need for colonoscopic assessment of the entire colon in this patient population may merit reevaluation.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To describe surgical technique, biopsy sample quality, and short-term outcome of minimally invasive small intestinal exploration and targeted abdominal organ biopsy (MISIETB) with use of a wound retraction device (WRD) in dogs.

ANIMALS

27 client-owned dogs that underwent MISIETB with a WRD at 1 of 4 academic veterinary hospitals between January 1, 2010, and May 1, 2017.

PROCEDURES

Medical records were retrospectively reviewed, and data collected included signalment; medical history; findings from physical, ultrasonographic, laparoscopic, cytologic, and histologic evaluations; surgical indications, procedures, duration, and complications; and short-term (14-day) outcomes. The Shapiro-Wilk test was used to evaluate the normality of continuous variables, and descriptive statistics were calculated for numeric variables.

RESULTS

Laparoscopic exploration was performed through a multicannulated single port (n = 18), multiple ports (5), or a single 6-mm cannula (4). Median length of the incision for WRD placement was 4 cm (interquartile [25th to 75th percentile] range, 3 to 6 cm). All biopsy samples obtained had sufficient diagnostic quality. The 2 most common histologic diagnoses were lymphoplasmacytic enteritis (n = 14) and intestinal lymphoma (5). Twenty-five of 27 (93%) dogs survived to hospital discharge, and 3 (12%) dogs had postsurgical abnormalities unrelated to surgical technique.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that MISIETB with WRD was an effective method for obtaining diagnostic biopsy samples of the stomach, small intestine, pancreas, liver, and mesenteric lymph nodes in dogs. Prospective comparison between MISIETB with WRD and traditional laparotomy for abdominal organ biopsy in dogs is warranted.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the percentage of dogs surviving to hospital discharge and identify factors associated with death prior to hospital discharge among dogs undergoing surgery because of primary splenic torsion (PST).

DESIGN

Retrospective case series.

ANIMALS

102 client-owned dogs.

PROCEDURES

Medical records of dogs with a confirmed diagnosis of PST that underwent surgery between August 1992 and May 2014 were reviewed. History, signalment, results of physical examination and preoperative bloodwork, method of splenectomy, concurrent surgical procedures, perioperative complications, duration of hospital stay, splenic histopathologic findings, and details of follow-up were recorded. Best-fit multivariate logistic regression was performed to identify perioperative factors associated with survival to hospital discharge.

RESULTS

93 of the 102 (91.2%) dogs survived to hospital discharge. German Shepherd Dogs (24/102 [23.5%]), Great Danes (15/102 [14.7%]), and English Bulldogs (12/102 [11.8%]) accounted for 50% of cases. Risk factors significantly associated with death prior to hospital discharge included septic peritonitis at initial examination (OR, 32.4; 95% confidence interval [CI], 2.1 to 502.0), intraoperative hemorrhage (OR, 22.6; 95% CI, 1.8 to 289.8), and postoperative development of respiratory distress (OR, 35.7; 95% CI, 2.7 to 466.0). Histopathologic evidence of splenic neoplasia was not found in any case.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that the prognosis for dogs undergoing splenectomy because of PST was favorable. Several risk factors for death prior to discharge were identified, including preexisting septic peritonitis, intraoperative hemorrhage, and postoperative development of respiratory distress.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To report and evaluate risk factors for conversion and perioperative and long-term outcomes in dogs undergoing thoracoscopic lung lobectomy for resection of lung masses.

ANIMALS

61 client-owned dogs.

METHODS

This retrospective cohort study (June 11, 2008, to February 14, 2020) of data collected from medical records included signalment, results of diagnostic imaging, surgical technique, surgical and anesthesia time, mass location and size, hospitalization time, histopathologic findings, and long-term outcome. Follow-up was obtained from medical records and telephone contact with owners or referring veterinarians.

RESULTS

Histopathology results were available for 60 of 61 tumors. Fifty-seven (95%) were considered primary lung tumors, of which 46 (81%) were carcinomas. Clean surgical margins were achieved in 46 of 52 (88%) dogs. Conversion from thoracoscopy to thoracoscopic-assisted or open surgery occurred in 16 of 61 (26%) dogs. Larger tumor diameter (≥ 5 cm) and lymphadenopathy detected by preoperative CT scan were significantly associated with increased risk of conversion. There was no association between conversion and patient weight, body condition score, and tumor location. All 61 dogs survived to discharge, and 56 of 57 were alive 1 month postoperatively. Median overall survival time was 311 days (95% CI, 224 to 570 days). Tracheobronchial lymphadenopathy on preoperative CT scans was associated with shorter postoperative survival (P < .001). Patient age, tumor diameter, adjuvant chemotherapy following surgery, and incomplete margins were not associated with survival time.

CLINICAL RELEVANCE

Dogs had high survival to discharge and good long-term prognosis following thoracoscopic lung lobectomy. However, larger tumor size and tracheobronchial lymphadenopathy may increase the likelihood of conversion.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the clinical characteristics, treatments, outcomes, and factors associated with survival time in a cohort of dogs with lingual neoplasia that underwent surgical excision.

Design—Retrospective case series.

Animals—97 client-owned dogs.

Procedures—Medical records of dogs with a lingual tumor examined between 1995 and 2008 were reviewed. Records were included if a lingual tumor was confirmed by histologic examination and surgical excision of the mass was attempted. Data were recorded and analyzed to identify prognostic factors.

Results—Clinical signs were mostly related to the oral cavity. For 93 dogs, marginal excision, subtotal glossectomy, and near-total glossectomy were performed in 35 (38%), 55 (59%), and 3 (3%), respectively. Surgery-related complications were rare, but 27 (28%) dogs had tumor recurrence. The most common histopathologic diagnoses for the 97 dogs were squamous cell carcinoma (31 [32%]) and malignant melanoma (29 [30%]). Eighteen (19%) dogs developed metastatic disease, and the overall median survival time was 483 days. Median survival time was 216 days for dogs with squamous cell carcinoma and 241 days for dogs with malignant melanoma. Dogs with lingual tumors ≥ 2 cm in diameter at diagnosis had a significantly shorter survival time than did dogs with tumors < 2 cm.

Conclusions and Clinical Relevance—Similar to previous studies, results indicated that lingual tumors are most commonly malignant, and squamous cell carcinoma and malignant melanoma predominate. A thorough physical examination to identify lingual tumors at an early stage and surgical treatment after tumor identification are recommended because tumor size significantly affected survival time.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To evaluate potential associations between surgical approach and complication rate, progression-free survival time, and disease-specific survival time in cats with mammary adenocarcinoma.

DESIGN Retrospective case series.

ANIMALS 107 client-owned cats.

PROCEDURES Medical records of cats that underwent surgical excision of mammary adenocarcinoma by means of a unilateral or bilateral (staged or single-session) mastectomy at 9 hospitals between 1991 and 2014 were reviewed. Relevant clinicopathologic data and details of surgical and adjuvant treatments were recorded. Outcome data were obtained, including postoperative complications, progression-free survival time, and disease-specific survival time.

RESULTS Complications occurred in 12 of 61 (19.7%) cats treated with unilateral mastectomy, 5 of 14 (35.7%) cats treated with staged bilateral mastectomy, and 13 of 32 (40.6%) cats treated with single-session bilateral mastectomy. Complications were significantly more likely to occur in cats undergoing bilateral versus unilateral mastectomy. Median progression-free survival time was longer for cats treated with bilateral mastectomy (542 days) than for cats treated with unilateral mastectomy (289 days). Significant risk factors for disease progression included unilateral mastectomy, tumor ulceration, lymph node metastasis, and tumors arising in the fourth mammary gland. Significant risk factors for disease-specific death included lymph node metastasis and development of regional or distant metastasis. Among cats that did not develop metastasis, unilateral mastectomy was a significant risk factor for disease-specific death. Treatment with chemotherapy was associated with a significantly decreased risk of disease-specific death.

CONCLUSIONS AND CLINICAL RELEVANCE Results supported bilateral mastectomy for the treatment of mammary adenocarcinoma in cats to improve progression-free and disease-specific survival time. Performing bilateral mastectomy in a staged fashion may help to decrease the complication rate.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To evaluate perioperative morbidity and outcome in dogs and cats undergoing esophageal surgery.

DESIGN Retrospective case series.

ANIMALS 63 client-owned dogs and 9 client-owned cats.

PROCEDURES Medical records of dogs and cats that underwent esophageal surgery were reviewed for information on signalment, history, results of preoperative diagnostic testing, condition treated, details of surgery, intraoperative complications, and postoperative complications. Long-term follow-up data were obtained via veterinarian and client telephone conversations. The relationship between complications and survival to hospital discharge was evaluated by means of regression analysis.

RESULTS The most common indication for surgical intervention was an esophageal foreign body in dogs (50/63 [79%]) and esophageal stricture in cats (3/9). Complications were documented in 54% (34/63) of dogs and 3 of 9 cats. The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat). Partial esophagectomy and resection with anastomosis were significantly associated with the development of immediate postoperative complications in dogs. The most common delayed postoperative complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat). For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed postoperative complications. Six dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were negative prognostic factors for dogs being discharged from the hospital.

CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that the short-term prognosis for dogs and cats that survive surgery for treatment of esophageal lesions is favorable, with 90% of patients discharged from the hospital (57/63 dogs; 8/9 cats). However, dogs treated for more extensive esophageal lesions as well as those undergoing esophagectomy or resection and anastomosis were more likely to develop postoperative complications.

Full access
in Journal of the American Veterinary Medical Association