Case Description—An 11-year-old castrated male mixed-breed dog was examined for a 3-month history of hematochezia and tenesmus. Abdominal ultrasonography and rectal examination prior to referral had revealed a colorectal polyp, diagnosed as a benign colorectal polypoid adenoma after histologic examination of tissue samples. The patient was referred for treatment.
Clinical Findings—A 2-cm-diameter sessile polypoid mass was located approximately 6 cm orad to the anus in the right dorsolateral region of the descending colon just caudal to the pubis. There was no evidence of metastasis on thoracic radiography or abdominal ultrasonography. Results of a CBC and serum biochemical analysis were within reference limits.
Treatment and Outcome—Endoscopic mucosal resection (EMR) and snare electrocautery were used to resect the mass and a definitive histopathologic diagnosis of a sessile colorectal polypoid adenoma was made. A 9.9-mm gastroduodenoscope was used during colonoscopy to inspect the mass. To aid in EMR, a 25-gauge endoscopic injection needle was used to infuse sterile saline (0.9% NaCl) solution under the base of the polyp, into the submucosa to elevate the mucosa from the muscularis layer beneath the polyp prior to polypectomy. This was necessary because of the sessile, rather than pedunculated, base of the mass. The entire polyp was successfully removed with endoscopic guidance. The clinical signs of hematochezia and tenesmus resolved immediately, and serial rectal examinations were performed over the following 36 months with no palpable evidence of recurrence.
Clinical Relevance—The patient described in the present report underwent successful colonic EMR and snare polypectomy with no known evidence of mass recurrence during the following 36 months, suggesting that this minimally invasive procedure may be a valuable treatment option for sessile polyps. The advantage of this technique was that elevation of the mucosa via injection of saline solution improved visibility of the polyp and helped to separate the polyp base from the deeper submucosal colorectal tissue, making complete resection possible.
Objective—To compare volumes of square knots and Aberdeen knots in vitro and evaluate security of these knot types when used as buried terminal knots for continuous intradermal wound closures in canine cadavers.
Sample—24 surgically closed, full-thickness, 4-cm, epidermal wounds in 4 canine cadavers and 80 knots tied in vitro.
Procedures—Continuous intradermal closures were performed with 4–0 polyglyconate and completed with a buried knot technique. Surgeon (intern or experienced surgeon) and termination knot type (4-throw square knot or 2 + 1 Aberdeen knot; 12 each) were randomly assigned. Closed wounds were excised, and a servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, and mode of construct failure were recorded. Volumes of 2 + 1 Aberdeen (n = 40) and 4-throw square knots (40) tied on a suture board were measured on the basis of a cylindrical model.
Results—Aberdeen knots had a mean smaller volume (0.00045 mm3) than did square knots (0.003838 mm3). Maximum load and displacement did not differ between construct types. Mean stiffness of Aberdeen knot constructs was greater than that of square knots.
Conclusions and Clinical Relevance—The 2 + 1 Aberdeen knot had a smaller volume than the 4-throw square knot and was as secure. Although both knots may be reliably used in a clinical setting as the termination knot at the end of a continuous intradermal line, the authors advocate use of the Aberdeen terminal knot on the basis of ease of burying the smaller knot. (J Am Vet Med Assoc 2015;247:260–266)
A 9-year-old spayed female Golden Retriever was referred for evaluation of right forelimb lameness of 5 months' duration. Initial treatment by the referring veterinarian included oral administration of prednisone (20 mg q 12 h for 1 week, 20 mg q 24 h for 1 week, and 20 mg every other day for 1 week), which resulted in clinical improvement. Three months later, the lameness returned, but it did not diminish after the same treatment regimen, so the dog was referred for evaluation.
On physical examination, the dog had a severe to moderate weight-bearing lameness of the right forelimb with
To determine the effectiveness of a digital interactive multimedia tutorial (DIMT) for preparing veterinary students to perform ultrasonography in horses.
42 third-year veterinary students.
Students were randomly assigned to 3 instructional methods: independent study (ie, 45 minutes to read a highlighted textbook chapter), lecture (ie, 45-minute lecture by a faculty member), or digital interactive multimedia tutorial (DIMT; ie, 45-minute narrated, interactive module). Written and practical tests were administered after each instruction session. For the practical test, each student was required to obtain a series of ultrasound images of a live horse, and images were later scored for quality by an individual unaware of the instructional method used.
Higher-quality ultrasound images were obtained by veterinary students who had reviewed the DIMT rather than the analogous information in textbook chapters. No difference in scores was identified between students in the lecture group and those in the DIMT group. Students’ perceptions suggested that practical instruction facilitated by clinicians was a key component of learning how to perform ultrasonography in horses.
CONCLUSIONS AND CLINICAL RELEVANCE
Results supported the use of DIMTs in preparing veterinary students to perform ultrasonography in horses.