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- Author or Editor: Victoria J. Lipscomb x
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A 14-year-old neutered female Border Collie with a 3-week history of collapse during exercise was evaluated because of recumbency, tachycardia, and hypotension.
Results of biochemical testing indicated the presence of a pheochromocytoma, and CT revealed an enlarged right adrenal gland mass that extended down the right phrenicoabdominal vein into the posthepatic thoracic portion of the caudal vena cava.
TREATMENT AND OUTCOME
A midline celiotomy and median sternotomy were performed to allow en bloc removal of the right adrenal gland tumor and its tumor thrombus extension within the caudal vena cava. Temporary occlusion of the thoracic and abdominal portions of the caudal vena cava and both renal veins and the dual inflow to the liver (Pringle maneuver) were required. The venotomy and tumor and thrombus extractions required a 25-minute period of vascular occlusion. The dog had no major postsurgical complications. Histologic findings indicated that direct adrenal tumor invasion into the caudal vena cava wall had occurred along the established route of tumor extension down the phrenicoabdominal vein.
For the dog of this report, an adrenal tumor thrombus that extended into the thoracic portion of the caudal vena cava was surgically managed with a combined median sternotomy and midline celiotomy approach and temporary occlusion of the hepatic artery, portal vein, and abdominal and thoracic portions of the caudal vena cava. This facilitated successful manual manipulation of the tumor and enabled venotomy of sufficient size for tumor thrombus extraction.
To describe indications, complications, and outcomes associated with subdermal plexus skin flap (SPSF) procedures in dogs and cats.
53 dogs and 20 cats that received SPSFs for reconstruction of skin defects from 2000 to 2017.
Medical record data were collected and summarized regarding patient signalment, indication for the SPSF procedure, type and location of SPSF, complications, and outcome.
92 SPSF procedures (64 in dogs and 28 in cats) were included. Indications for the procedures included tumor excision (n = 37 [40%]), acute wound (14 [15%]) or chronic wound (28 [30%]) reconstruction, surgical scar revision (7 [8%]), and other reasons (6 [7%]). Types of SPSFs included advancement (31 [34%]), axillary fold (20 [22%]), inguinal fold (20 [22%]), rotation (16 [17%]), transposition (3 [3%]), and distant direct (2 [2%]). Complications were noted for 47 (51%) procedures at a mean ± SD of 6.9 ± 4.0 days after surgery and were classified as minor (34 [37%]) or major (13 [14%]). Outcome was considered excellent for 44 (48%) procedures, good for 33 (36%), fair for 13 (14%), and poor for 2 (2%).
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that approximately half of SPSF procedures in dogs and cats can be expected to be followed by a complication, occurring at a mean of 1 week after surgery, and yet with appropriate management of these complications, a good to excellent outcome was possible. Owners should be counseled about the likely need for additional visits and costs associated with treatment of postoperative complications.
Objective—To determine whether hepatic portal vascularity assessed via intraoperative mesenteric portovenography (IMP) is related to outcome in cats undergoing surgical attenuation of a congenital portosystemic shunt (CPSS).
Design—Retrospective case series.
Animals—25 cats, each with 1 CPSS, in which IMP was performed before and after temporary complete occlusion of the shunting vessel to provide complete (n = 9) or partial (16) shunt attenuation.
Procedures—Medical records were reviewed for signalment, clinical history, postoperative complications, clinical outcome, and results of bile acids stimulation testing. Portovenograms obtained before and after shunt occlusion were graded to determine whether degree of intrahepatic portal branching was correlated with degree of shunt attenuation, clinical or biochemical factors, postoperative complications, or outcome. In 12 of the 16 cats that had partial CPSS attenuation, procedures were later repeated to achieve complete (n = 9) and additional partial (1) CPSS attenuation.
Results—Degree of opacification of the intrahepatic portal vessels increased significantly (higher portovenogram grade) after CPSS attenuation. The median portovenogram grade assigned after temporary shunt occlusion at the first surgery was significantly higher in cats that did not have postattenuation neurologic complications or neurologic signs at follow-up than in cats that did. It was also higher in cats that had a better clinical response to surgery versus those that had a poor response and in cats with reduced preprandial and postprandial serum bile acids concentrations at follow-up versus those that did not.
Conclusions and Clinical Relevance—IMP may be used to help predict complications and outcome following surgical treatment of CPSS in cats.
Objective—To determine whether hepatic portal vascularity, as assessed by intraoperative mesenteric portovenography (IMP), is related to outcome in dogs undergoing attenuation of single congenital portosystemic shunts (CPSSs).
Design—Retrospective case series.
Animals—45 dogs, each with a single CPSS, in which IMP was performed before and after temporary complete occlusion of the shunting vessel and that underwent complete (17 dogs) or partial (28 dogs) CPSS attenuation (surgery 1).
Procedures—Medical records were reviewed for signalment, clinical history, and bile acids stimulation test results. Intrahepatic portal vessel (IPV) opacification in pre- and postocclusion portovenograms was graded to determine whether the degree of opacification was correlated with the degree of shunt attenuation, clinical or biochemical factors, or long-term clinical outcome. In 17 of 28 dogs that had partial CPSS attenuation, these procedures were subsequently repeated (surgery 2) to achieve complete (14 dogs) or further partial (3 dogs) CPSS attenuation.
Results—Compared with preattenuation findings, IPV opacification increased significantly after partial or complete CPSS attenuation. The degree of IPV opacification before and after CPSS occlusion (surgery 1) was greater in dogs that tolerated complete versus partial CPSS attenuation and was correlated positively with age. The degree of IPV opacification following CPSS occlusion (surgery 1) was maximal in all dogs without encephalopathy and was correlated negatively with follow-up preprandial serum bile acids concentrations and positively with clinical improvement.
Conclusions and Clinical Relevance—Data suggest that IMP can be used to assess changes in IPV blood flow and help predict outcome following attenuation of single CPSSs in dogs.
Objective—To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted.
Design—Retrospective case series.
Animals—37 dogs and 39 cats.
Procedures—Information was obtained from medical records.Long-term follow-up information was obtained by use of a client questionnaire.
Results—Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease.Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with blad-der dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction.Thirty-seven (49%) animals had tube complications.Development of complica tions was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use.In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place.
Conclusions and Clinical Relevance—Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow.Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.
Objective—To review hepatic histopathologic lesions in dogs undergoing surgical attenuation of a congenital portosystemic shunt (CPSS) in relation to clinical findings and tolerance of complete surgical attenuation.
Design—Retrospective case series.
Animals—38 dogs that underwent surgical attenuation of a CPSS.
Procedures—Hepatic histologic examination findings and medical records of dogs undergoing surgical attenuation of a single CPSS between August 2000 and July 2004 were reviewed. Liver biopsy specimens were obtained from 38 dogs during surgery prior to complete (n = 16) or partial (22) attenuation of a CPSS and from 13 of the same dogs a median of 3 months following surgical attenuation.
Results—Portal tracts were inadequate for interpretation in 2 liver biopsy specimens. Liver biopsy specimens obtained prior to surgical attenuation of a CPSS had a lack of identifiable portal veins (13/36 dogs), hepatic arteriolar proliferation (25/36), ductular reaction (5/36), steatosis (16/38), and iron accumulation (32/38). Lack of identifiable portal veins on histologic examination was associated with increased hepatic arteriolar proliferation, decreased tolerance to complete surgical CPSS attenuation, and decreased opacification of intrahepatic portal vessels on portovenography. Ductular reaction was always associated with failure to tolerate complete surgical attenuation of a CPSS. Surgical CPSS attenuation resulted in significant clinical, serum biochemical, and portovenographic changes indicative of improved liver function, but only subtle changes in hepatic histologic examination findings.
Conclusions and Clinical Relevance—Dogs without identifiable intrahepatic portal veins that had a ductular reaction on hepatic histologic examination were less likely to tolerate complete attenuation of a CPSS.
To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur.
50 client-owned dogs.
Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog’s quality of life.
Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog’s long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved.
Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.