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- Author or Editor: Nicole J. Buote x
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Abstract
Case Description—3 kittens were examined because of a malformation affecting the hind limbs, resulting in an inability to bear weight or ambulate normally.
Clinical Findings—2 kittens were younger than 6 weeks of age, and 1 was 4 months of age at the time of initial examination. The congenital abnormality was characterized by severe tarsal hyperextension in which weight was borne on the cranial aspect of the tarsus, and the plantar surface of the metatarsus faced dorsally. In 2 kittens, the condition affected both hind limbs, and in the older kitten, the condition was unilateral. In the 2 kittens in which radiographs were obtained, no bone abnormalities were detected. Full-cylinder fiberglass casts were applied and changed weekly to accommodate growth. Owners administered physical therapy after final cast removal.
Treatment and Outcome—Conservative management involving external coaptation and physical therapy led to favorable results in all 3 cats.
Clinical Relevance—Although further studies are needed to determine the etiology of the disorder, affected kittens may be successfully treated with conservative management. Owners should be committed to the necessity for returning cats for serial cast changes, care for pressure sores, and administration of physical therapy after cast removal.
Abstract
Objective—To determine whether epidural administration of opioids was associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures.
Design—Retrospective cohort study.
Animals—179 client-owned dogs undergoing elective surgery for cranial cruciate ligament rupture.
Procedures—Medical records of 179 dogs that underwent surgical correction for cranial cruciate rupture between January 2009 and October 2012 were reviewed; 120 received epidural administration of opioids and 59 did not. Signalment, type of procedure, administration of epidural analgesia, time to first postanesthetic urination, and number of urinations during the first 24 hours were evaluated and compared between groups.
Results—Administration of preservative-free morphine into the epidural space was not significantly associated with time to first urination following anesthetic recovery or the total number of urinations within the first 24 hours of anesthetic recovery. Administration of a hydromorphone bolus IV following surgery was significantly associated with urinary retention, compared with administration of either morphine boluses or fentanyl constant rate infusions following surgery. No other variables were significantly associated with urinary retention.
Conclusions and Clinical Relevance—Administration of preservative-free morphine into the epidural space was not associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Systemic administration of opioids may be associated with urinary retention.
Abstract
OBJECTIVE
To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs.
ANIMALS
170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016.
PROCEDURES
Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors.
RESULTS
Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.
CONCLUSIONS AND CLINICAL RELEVANCE
These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.
Abstract
OBJECTIVE
To determine the difference in histologic artifacts and morphologic diagnosis among 3 laparoscopic cup biopsy forceps techniques and wedge hepatic samples.
ANIMALS
Cadavers of 20 client-owned dogs following euthanasia for unrelated reasons between January 3 and July 29, 2021.
PROCEDURES
Four biopsy techniques were performed from the margin of 3 liver lobes/dog. Laparoscopic techniques used 5-mm cup biopsy forceps to obtain biopsy samples by pulling the forceps forcefully caudally to free a sample (the PULL technique), rotating the forceps 360° in 1 direction until freed (the TWST technique), or pulling the forceps through a 5-mm cannula to remove the sample (the CAN technique); wedge biopsy samples served as the control (CON). Data collected included sample weight, histologic features, diagnosis, and artifact characterization. Gwet AC1 or intraclass correlation coefficients (ICCs) were calculated to detect agreement among techniques.
RESULTS
Sample weights for CON and TWST were significantly larger (P < .001 and P = .035, respectively) than for PULL and CAN. There was excellent agreement among all techniques for most diagnostic features (Gwet AC1, 0.93 to 1). The TWST technique resulted in the best overall artifact profile for laparoscopic techniques, with 90% of samples (54/60) having crisp edges and 65% of samples (39/60) having no or mild tearing. The agreement was moderate to good (ICC, 0.73 for edges and 0.76 for tearing) among all cup biopsy forceps techniques.
CLINICAL RELEVANCE
The TWST technique resulted in the largest sample and had the fewest artifacts, supporting its continued use during laparoscopic procedures.
Abstract
Objective—To identify factors associated with outcome in cats with extrahepatic biliary tract obstruction (EHBTO) that undergo biliary diversion surgery.
Design—Retrospective case series.
Animals—22 cats.
Procedures—Medical records of cats with surgically confirmed EHBTO that underwent cholecystoenterostomy were reviewed.
Results—Clinical signs and physical examination findings included vomiting, anorexia, icterus, lethargy, weakness, and weight loss. Common clinicopathologic abnormalities included high serum hepatic enzyme activities and serum bilirubin concentration. Abdominal ultrasonography was performed in 21 cats, and all 21 had findings consistent with EHBTO. Eleven of 15 cats in which blood pressure was monitored had intraoperative hypotension. Eighteen cats had anemia following surgery, and 14 cats had persistent hypotension. Extrahepatic biliary tract obstruction was a result of neoplasia in 9 cats and chronic inflammatory disease in 13. Fourteen cats survived long enough to be discharged from the hospital, but only 6 survived > 6 months after surgery, all of which had chronic inflammatory disease. Median survival time for cats with neoplasia (14 days) was significantly shorter than that for cats with inflammatory disease (255 days). No other variable was associated with outcome.
Conclusions and Clinical Relevance—Results suggest that cats with EHBTO secondary to neoplasia have a poorer prognosis than cats with EHBTO secondary to chronic inflammatory disease. However, the overall prognosis for cats with EHBTO undergoing cholecystoenterostomy must be considered guarded to poor, and the incidence of perioperative complications is high.
Abstract
Objective—To evaluate the effect of preoperative antimicrobial administration on culture results in dogs undergoing cystotomy as a treatment for urolithiasis.
Design—Prospective controlled study.
Animals—41 dogs undergoing cystotomy for cystic calculi removal.
Procedures—Urine samples were collected at time of anesthetic induction and during surgery prior to cystotomy, and a mucosal biopsy and culturette swab was collected during surgery from a control group, which received antimicrobials only after surgical culture sample collection, and from an experimental group, which received antimicrobials at the time of anesthetic induction.
Results—17 of 41 patients had positive culture results at anesthetic induction. Twenty of 41 patients had positive results of cultures for the surgical sample. No dogs that had positive results before antimicrobial administration had negative results after antimicrobial administration. There were no significant changes to urinalysis results regardless of group. Calcium monohydrate uroliths were the most common stone removed (24/41), followed by magnesium ammonium phosphate uroliths (11/41).
Conclusions and Clinical Relevance—There was no difference in culture results (positivity and bacterial type) when antimicrobials were given at anesthetic induction versus after surgical culture sample collection for dogs undergoing cystotomy for cystic calculi removal.
Abstract
OBJECTIVE
To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations.
ANIMALS
14 dogs and 4 cats that underwent double limb amputations.
PROCEDURES
Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected.
RESULTS
The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days).
CLINICAL RELEVANCE
Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.
Abstract
OBJECTIVE
To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS).
ANIMALS
136 client-owned dogs.
PROCEDURES
Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group – Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines.
RESULTS
LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus.
CLINICAL RELEVANCE
In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.
Abstract
OBJECTIVE
To evaluate outcomes in cats undergoing subtotal colectomy for the treatment of idiopathic megacolon and to determine whether removal versus nonremoval of the ileocecocolic junction (ICJ) was associated with differences in outcome.
ANIMALS
166 client-owned cats.
PROCEDURES
For this retrospective cohort study, medical records databases of 18 participating veterinary hospitals were searched to identify records of cats with idiopathic megacolon treated by subtotal colectomy from January 2000 to December 2018. Data collection included perioperative and surgical variables, complications, outcome, and owner perception of the procedure. Data were analyzed for associations with outcomes of interest, and Kaplan-Meier survival time analysis was performed.
RESULTS
Major perioperative complications occurred in 9.9% (15/151) of cats, and 14% (12/87) of cats died as a direct result of treatment or complications of megacolon. The median survival time was not reached. Cats with (vs without) a body condition score < 4/9 (hazard ratio [HR], 5.97), preexisting heart disease (HR, 3.21), major perioperative complications (HR, 27.8), or long-term postoperative liquid feces (HR, 10.4) had greater hazard of shorter survival time. Constipation recurrence occurred in 32% (24/74) of cats at a median time of 344 days and was not associated with retention versus removal of the ICJ; however, ICJ removal was associated with long-term liquid feces (OR, 3.45), and a fair or poor outcome on owner assessment (OR, 3.6).
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that subtotal colectomy was associated with long survival times and a high rate of owner satisfaction. Removal of the ICJ was associated with less favorable outcomes in cats of the present study.
