Biomechanical comparison of canine median sternotomy closure using suture tape and orthopedic wire cerclage.

OBJECTIVE: To compare the mechanical properties of suture tape and orthopedic wire cerclage in an ex vivo canine median sternotomy model. STUDY DESIGN: Ex vivo. ANIMALS: Twelve large-breed canine cadaveric sternums. METHODS: Median sternotomies were performed, leaving the manubrium intact. The specimens were randomly assigned to group W (20-gauge stainless steel orthopedic wire cerclage in a figure-of-eight pattern) or group ST (suture tape in a figure-of-eight pattern). Each specimen was laterally distracted until failure using an electrodynamic materials-testing system. RESULTS: No differences were observed for displacement, yield load, maximum load, implant failure between the groups. The orthopedic wire construct was stiffer than the suture tape construct. CONCLUSION: Suture tape was biomechanically similar to orthopedic wire cerclage for sternotomy closure in dogs, although wire constructs were stiffer. CLINICAL SIGNIFICANCE: Suture tape may represent an alternative to cerclage wire for sternotomy closure in dogs. Additional studies evaluating its clinical use are needed.

Complications associated with iliosacral lymphadenectomy in dogs with metastatic apocrine gland anal sac adenocarcinoma.

Objective: To report intraoperative and immediate postoperative complications associated with removal of metastatic iliosacral lymph nodes in dogs with apocrine gland anal sac adenocarcinoma. Animals: There were 136 client-owned dogs in the study. Procedure: Retrospective multi-institutional study. The database of collaborating institutions was searched for dogs with metastatic apocrine gland anal sac adenocarcinoma that underwent lymphadenectomy for removal of one or more iliosacral lymph nodes. Information of signalment, hematological abnormalities, abdominal computed tomography or ultrasound findings, number and size of enlarged lymph nodes, intraoperative and postoperative complications, treatment and outcome were collected. Results: The overall complication rate associated with metastatic iliosacral lymphadenectomy was 26.1%. The only intraoperative complication recorded was hemorrhage and was reported in 24 (17.6%) surgeries, 11 (45.8%) of which received a blood transfusion. Postoperative complications were reported in 10.4% of surgeries, and included edema formation (n = 4, 2.6%), unilateral or bilateral paraparesis (n = 4, 2.6%), hypotension (n = 3, 2.0%), surgical site infection (n = 2, 1.3%), abdominal incision dehiscence (n = 1, 0.6%), urinary incontinence (n = 1, 0.6%), and death (n = 1, 0.6%). The size of the iliosacral lymph nodes was significantly associated with a greater risk of complications, hemorrhage, and the need of transfusion during lymphadenectomy for metastatic apocrine gland anal sac adenocarcinoma. Conclusion: Complications associated with iliosacral lymphadenectomy for metastatic apocrine gland anal sac adenocarcinoma are relatively common and mostly relate to hemorrhage. These complications are significantly associated with the size of the extirpated metastatic lymph nodes. Clinical relevance: This retrospective study provides information for the clinician regarding the potential surgical complications for extirpation of metastatic iliosacral lymph nodes. These complications, although not common, can be severe and should be discussed with owners before surgery.

Objectif: Rapporter les complications peropératoires et postopératoires immédiates associées à l'ablation des ganglions lymphatiques ilio-sacrés métastatiques chez les chiens atteints d'un adénocarcinome des glandes apocrines des sacs anaux. Animaux: Il y avait 136 chiens appartenant à des clients dans l'étude. Procédure: Étude multi-institutionnelle rétrospective. La base de données des institutions collaboratrices a été recherchée pour les chiens atteints d'un adénocarcinome métastatique des glandes apocrines des sacs anaux qui ont subi une lymphadénectomie pour l'ablation d'un ou plusieurs ganglions lymphatiques ilio-sacrés. Des informations sur le signalement, les anomalies hématologiques, les résultats de la tomodensitométrie abdominale ou de l'échographie, le nombre et la taille des ganglions élargis, les complications peropératoires et postopératoires, le traitement et les résultats ont été recueillis. Résultats: Le taux global de complications associées à la lymphadénectomie ilio-sacrée métastatique était de 26,1 %. La seule complication peropératoire enregistrée était une hémorragie et a été rapportée dans 24 (17,6 %) chirurgies, dont 11 (45,8 %) ont reçu une transfusion sanguine. Des complications postopératoires ont été signalées dans 10,4 % des interventions chirurgicales et comprenaient la formation d'oedème (n = 4, 2,6 %), la paraparésie unilatérale ou bilatérale (n = 4, 2,6 %), l'hypotension (n = 3, 2,0 %), l'infection du site opératoire (n = 2, 1,3 %), la déhiscence de l'incision abdominale (n = 1, 0,6 %), l'incontinence urinaire (n = 1, 0,6 %) et le décès (n = 1, 0,6 %). La taille des ganglions ilio-sacrés était significativement associée à un risque accru de complications, d'hémorragie et à la nécessité d'une transfusion lors d'une lymphadénectomie pour un adénocarcinome métastatique des glandes apocrines des sacs anaux. Conclusion: Les complications associées à la lymphadénectomie ilio-sacrée pour l'adénocarcinome métastatique des glandes apocrines des sacs anaux sont relativement fréquentes et concernent principalement l'hémorragie. Ces complications sont significativement associées à la taille des ganglions lymphatiques métastatiques retirés. Pertinence clinique: Cette étude rétrospective fournit des informations au clinicien concernant les complications chirurgicales potentielles pour le retrait des ganglions lymphatiques ilio-sacrés métastatiques. Ces complications, bien que rares, peuvent être graves et doivent être discutées avec les propriétaires avant la chirurgie.(Traduit par Dr Serge Messier).

Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: A retrospective study by the Society of Veterinary Soft Tissue Surgery.

OBJECTIVE: To evaluate gastrointestinal injury and outcomes between dogs treated with immediate surgical intervention vs those treated with delayed surgical intervention for gastrointestinal foreign body obstruction (GIFBO). STUDY DESIGN: Retrospective cohort study. SAMPLE POPULATION: Client-owned dogs (n = 855) from five referral hospitals. METHODS: Medical records of dogs in which GIFBO had been diagnosed between 2007 and 2017 were reviewed for preoperative management, timing of surgery, intraoperative findings, postoperative management, outcome, and survival. Surgical intervention was classified as immediate when it occurred within 6 hours of presentation and delayed when it occurred >6 hours after presentation. RESULTS: Outcomes did not differ between dogs treated immediately (n = 584) or over 6 hours after presentation (n = 210). Intestinal necrosis and perforations were more common when surgery was delayed (P = .008; P = .019) but became nonsignificant after controlling for preoperative differences. Risk factors for necrosis and perforations included duration of clinical signs, increased lactate, linear foreign material, and timing of surgery. Enterectomies (P = .004) as well as the duration of surgery (P = .004) and anesthesia (P = .001) were increased when surgery was delayed. Immediate surgery was associated with earlier return to feeding (P = .004) and discharge from the hospital (P < .001); (5%) dogs in each group (n = 33 immediate; n = 11 delayed) either had a negative explore or the foreign body was milked aborally into the colon at the time of surgery. CONCLUSION: Although outcomes were not associated with surgical timing, the unadjusted prevalence of gastrointestinal injury and, thus, the requirement for complex surgical procedures was higher in the delayed group. CLINICAL SIGNIFICANCE: Earlier surgical treatment of stabilized dogs with GIFBO may involve fewer complex procedures and accelerate recovery.

Collaborative Care Improves Treatment Outcomes for Dogs with Chronic Otitis Externa: A Collaborative Care Coalition Study.

The purpose of this retrospective study was to compare outcome measures in dogs treated by a primary care veterinarian (pcDVM) before referral and after seeking collaboration with a board-certified veterinary dermatologist (BCVD) for cases of severe recurrent chronic otitis externa. Medical records of 65 client-owned dogs were retrospectively reviewed, and data were obtained regarding treatment history, referral timeframe, recurrence rate, clinical signs, and resolution of signs. The median number of otitis recurrences while under the care of the pcDVM was 4 (range 1-40) versus collaborative BCVD care of 2 (P < .01). There was a longer median time to otitis recurrence with collaborative care (171 days) compared with dogs managed by the pcDVM before referral (21 days; P > .01). Proliferative changes in the ear canals improved in 41/45 (91%) of cases under BCVD care compared with 6/45 (13%) under care by the pcDVM (P < .01). Dogs with chronic otitis had better long-term outcomes when collaboration with a BCVD was pursued within 6 mo of treatment. Referral or consultation with a BCVD should be considered for cases of chronic canine otitis that are persistent or quickly recurrent (20-30 days) over a 6 mo period.

Modulation of simultaneously collected hemodynamic and electrophysiological functional connectivity by ketamine and midazolam.

The pharmacological modulation of functional connectivity in the brain may underlie therapeutic efficacy for several neurological and psychiatric disorders. Functional magnetic resonance imaging (fMRI) provides a noninvasive method of assessing this modulation, however, the indirect nature of the blood-oxygen level dependent signal restricts the discrimination of neural from physiological contributions. Here we followed two approaches to assess the validity of fMRI functional connectivity in developing drug biomarkers, using simultaneous electroencephalography (EEG)/fMRI in a placebo-controlled, three-way crossover design with ketamine and midazolam. First, we compared seven different preprocessing pipelines to determine their impact on the connectivity of common resting-state networks. Independent components analysis (ICA)-denoising resulted in stronger reductions in connectivity after ketamine, and weaker increases after midazolam, than pipelines employing physiological noise modelling or averaged signals from cerebrospinal fluid or white matter. This suggests that pipeline decisions should reflect a drug's unique noise structure, and if this is unknown then accepting possible signal loss when choosing extensive ICA denoising pipelines could engender more confidence in the remaining results. We then compared the temporal correlation structure of fMRI to that derived from two connectivity metrics of EEG, which provides a direct measure of neural activity. While electrophysiological estimates based on the power envelope were more closely aligned to BOLD signal connectivity than those based on phase consistency, no significant relationship between the change in electrophysiological and hemodynamic correlation structures was found, implying caution should be used when making cross-modal comparisons of pharmacologically-modulated functional connectivity.

Pharmacokinetics and Safety of Mitragynine in Beagle Dogs.

Mitragynine is the most abundant psychoactive alkaloid derived from the leaves of Mitragyna speciosa (kratom), a tropical plant indigenous to regions of Southeast Asia. Mitragynine displays a moderate affinity to opioid receptors, and kratom is often self-prescribed to treat pain and/or opioid addiction. The purpose of this study was to investigate the safety and pharmacokinetic properties of mitragynine in the dog. Single dose oral (5 mg/kg) and intravenous (0.1 mg/kg) pharmacokinetic studies of mitragynine were performed in female beagle dogs. The plasma concentrations of mitragynine were measured using ultra-performance liquid chromatography coupled with a tandem mass spectrometer, and the pharmacokinetic properties were analyzed using non-compartmental analysis. Following intravenous administration, mitragynine showed a large volume of distribution (Vd, 6.3 ± 0.6 L/kg) and high clearance (Cl, 1.8 ± 0.4 L/h/kg). Following oral mitragynine dosing, first peak plasma (Cmax, 278.0 ± 47.4 ng/mL) concentrations were observed within 0.5 h. A potent mu-opioid receptor agonist and active metabolite of mitragynine, 7-hydroxymitragynine, was also observed with a Cmax of 31.5 ± 3.3 ng/mL and a Tmax of 1.7 ± 0.6 h in orally dosed dogs while its plasma concentrations were below the lower limit of quantification (1 ng/mL) for the intravenous study. The absolute oral bioavailability of mitragynine was 69.6%. Administration of mitragynine was well tolerated, although mild sedation and anxiolytic effects were observed. These results provide the first detailed pharmacokinetic information for mitragynine in a non-rodent species (the dog) and therefore also provide significant information for allometric scaling and dose predictions when designing clinical studies.

Pharmacokinetics of platinum and safety evaluation of carboplatin-impregnated calcium sulfate hemihydrate beads after implantation in healthy cats.

OBJECTIVE: To evaluate the pharmacokinetics (PK) of platinum (Pt) and safety of carboplatin-impregnated calcium sulfate hemihydrate (C-I CSH) beads after implantation in healthy cats. STUDY DESIGN: In vivo experimental study. ANIMALS: Six healthy adult cats. METHODS: Three C-I CSH beads were implanted in muscle pockets over the right and left hemithoraces of each cat (~3.9 mg/kg of Pt; 60.4 mg/m2 of calculated carboplatin). Hematology and blood chemistry were tested at baseline and 3, 7, 14, and 21 days postimplantation. Serum was analyzed for Pt at specific times from 1 hour to 21 days. Tissue was obtained for histopathology and analysis of Pt at 3, 7, 14, and 21 days at standardized distances from implantation sites. RESULTS: Platinum was detected in tissues at all times and distances (range, 0.1-4.19 µg/g). Serum Pt increased up to 2.6 hours (3.25 µg/mL) then decreased sharply. Samples containing muscle had higher Pt compared with samples without muscle (P = .004). Mild hypercalcemia was noted in four cats, and mild inflammatory reaction was noted on histopathology of all samples. CONCLUSION: Platinum was released from C-I CSH beads differentially into surrounding tissues over 21 days. Systemic absorption of Pt was minimal, but mild hypercalcemia occurred. CLINICAL SIGNIFICANCE: Implantation was well tolerated by healthy adult cats. Securing beads within muscle may limit Pt diffusion to targeted tissue. Although Pt concentrations did not achieve levels reported to be cytotoxic for feline sarcoma cells in culture, results provide evidence to support evaluation of efficacy in the tumor microenvironment of cats with locally invasive cancers.

Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease.

OBJECTIVES: Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD), yet the effectiveness of oral iron supplementation is limited. Intravenous iron sucrose is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of iron sucrose in pediatric IBD subjects with IDA and determine the clinical response as measured by improvement in hemoglobin concentration. The secondary aim was to describe adverse events associated with iron sucrose use in this cohort. METHODS: A retrospective chart review was performed of all pediatric patients with IBD receiving iron sucrose infusions for IDA at a single tertiary care center between 2011 and 2015. RESULTS: Seventy-two subjects (53 with Crohn disease, 11 with ulcerative colitis, and 8 with IBD-unclassified) received a total of 273 iron sucrose infusions. Forty-three subjects qualified for the efficacy analysis. There was a significant increase in hemoglobin over the treatment course, with mean (±SD) hemoglobin increasing from 9.6 ±â€Š1.2 g/dL at baseline to 12.1 ±â€Š1.3 g/dL after iron sucrose treatment (P < 0.001). Eighteen adverse events were reported in 13 subjects (18.1% of subjects and 6.6% of infusions). No anaphylaxis reactions occurred and none of the adverse events were, however, life-threatening or required hospitalization. CONCLUSIONS: Intravenous iron sucrose is a safe and potentially efficacious treatment choice for IDA in pediatric IBD.

In vitro chemosensitivity of feline injection site-associated sarcoma cell lines to carboplatin.

OBJECTIVE: To determine the in vitro chemosensitivity of feline injection site-associated sarcoma (FISAS) cells to carboplatin concentrations generated by elution of carboplatin-impregnated calcium sulfate hemihydrate (CI-CSH) beads. STUDY DESIGN: In vitro study. SAMPLE: Five immortalized cell lines from histologically confirmed, primary FISASs. METHODS: For each cell line, one 96-well microplate was used for each time point (24, 48, 72 hours). In each microplate, 3 wells were seeded with ∼7.5 × 103 cells per well for every carboplatin treatment added, ranging from 5 to 450 µM. Microculture plates were incubated for 24, 48, or 72 hours. Drug efficacy was assessed via a bioreductive fluorometric assay. For apoptosis analysis, 3 wells were seeded with ∼5 × 104 cells per well for every carboplatin treatment added, ranging from 5 to 450 µM. Flow cytometry was performed and the relative percentages of viable, apoptotic, and late apoptotic/necrotic cells were reported. All experiments were run in triplicates. RESULTS: Carboplatin exerted dose-dependent and time-dependent effects on FISAS cell viability. The IC50 values were within the range of carboplatin concentrations eluted from CI-CSH beads. CONCLUSION: Elution of carboplatin from CI-CSH beads generate concentrations sufficient to result in 50% growth inhibition of FISAS cells in vitro. Local tumor control might be achieved by implantation of CI-CSH beads immediately following radical or marginal excision of the primary tumor or by implantation without tumor resection.

Diverting Ileostomy for the Treatment of Severe, Refractory, Pediatric Inflammatory Bowel Disease.

OBJECTIVES: Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population. METHODS: Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD. Clinical variables were compared in the 1 year before ileostomy and 1 year after diversion. Surgical and disease outcomes including changes in diagnosis were reviewed through 2015. RESULTS: Twenty-four patients underwent diverting ileostomy for refractory colonic disease. Initial diagnoses were Crohn disease in 10 (42%), ulcerative colitis in 1 (4%), and IBD-unclassified in 13 patients (54%). Comparing data before and after surgery, there were statistically significant improvements in height and weight velocities, height velocity z score, blood transfusion requirement, hemoglobin, and hospitalization rates. Chronic steroid use decreased from 71% to 22%. At the conclusion of the study, 10 patients had undergone subsequent colectomy, 7 had successful bowel reanastomosis, and 7 remain diverted. Seven patients (29%) had a change in diagnosis. There were 13 surgical complications in 7 subjects, including prolapse reduction, stoma revision, and resection of ischemic bowel. CONCLUSIONS: In pediatric patients with refractory colonic IBD, diverting ileostomy can be a successful intervention to induce clinical stability. Importantly, diversion is a steroid-sparing therapy and allows additional time to clarify the diagnosis.

Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome.

PURPOSE OF REVIEW: Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS. RECENT FINDINGS: The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers. SUMMARY: More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.

Endoscopic application of fibrin glue may be a feasible method of treatment for postintubation tracheal lacerations in cats.

OBJECTIVE: To determine the feasibility of endoscopic application of fibrin glue for the treatment of experimentally induced postintubation tracheal laceration (PITL) in feline cadavers. The secondary objective was to determine the optimal technique for application of the fibrin glue. ANIMALS: 20 feline cadavers (n = 10 fresh and 10 frozen). PROCEDURES: An experimentally induced tracheal rupture was created via overinflation of an endotracheal tube cuff. After endoscopic identification of the tracheal tear, fibrin glue was instilled into the tracheal defect in either a bridging or filling fashion. Following the procedure, the airway of each cat was examined and leak tested. Length of tear, volume of glue applied, procedural time, and glue efficacy were recorded. RESULTS: Experimentally induced tracheal lacerations were full thickness with a mean length of 3.27 ± 0.96 cm. A complete seal was attained in 6 of the 9 fresh cadavers when filling the defect with fibrin glue. In the remaining 3 fresh cadavers, air leakage was restricted to the dorsal mediastinum. Bridging the defect with fibrin glue did not attain a seal in fresh or frozen cadavers. The median volume of glue used to fill defects in fresh cadavers was 0.5 mL (range, 0.4 to 2 mL). Procedural time for the application of fibrin glue was 10.5 ± 4.1 minutes for bridging the defect and 7.8 ± 1.5 minutes for filling the defect. CLINICAL RELEVANCE: Endoscopic application of fibrin glue may be a feasible method of treatment for PITL in cats.

Evaluation of automated staple sizes on gastric layer incorporation and intraluminal pressure for partial gastrectomy closure in an ex vivo canine model.

OBJECTIVE: To evaluate the performance of automated staple sizes on a cadaveric canine partial gastrectomy model. METHODS: Stomachs were transected through the gastric body axis and randomly allocated to two closure groups: Group B, thoracoabdominal (TA) stapler 3.5 mm staple cartridge (blue); Group G, TA stapler 4.8 mm staple cartridge (green). After construct completion, leak testing was performed for both groups and compared. Initial leakage pressure (ILP), maximal leakage pressure (MLP) and leakage location were recorded. Staple lines were evaluated by direct observation and fluoroscopy to assess sub-mucosal layer incorporation and staple conformation. Staple shape was classified as optimal or suboptimal. Significance was set at p less than 0.5. RESULTS: Following gastrectomy, the mean double gastric wall thickness was 7.82 ± 2.05 mm at the gastric body. Mean ILP was significantly lower in groups G (17.13 ± 1.19 mmHg) compared to group B (50.46 ± 6.03 mmHg, p = 0.0013). Similarly, mean MLP was significantly lower in group G (21.41 ± 1.39 mmHg) compared to group B (64.61 ± 10.21 mmHg, p < 0.0001). Although group G had higher percentage of B-shaped staple formation compared to group B, this was not significant (group G; 92.38%, group B; 54.56%; p = 0.054). CONCLUSION: The 3.5 mm TA staple cartridge (blue) achieved superior bursting pressures compared with the 4.8 mm TA staple cartridge (blue) for the closure of a canine partial gastrectomy model. Both staple sizes incorporated all gastric layers. No differences were noticed in optimal staple conformation between groups. In vivo investigation is warranted to evaluate the use of different staple sizes on gastric tissue perfusion, successful healing and post-operative stasis and dehiscence.

A narrative review on the role of carbon nanoparticles in oncology.

The lymphatic system is the first site of metastasis for most tumors and is a common reason for the failure of cancer therapy. The lymphatic system's anatomical properties make it difficult to deliver chemotherapy agents at therapeutic concentrations while avoiding systemic toxicity. Carbon nanoparticles offer a promising alternative for identifying and transporting therapeutic molecules. The larger diameter of lymphatic vessels compared to the diameter of blood vessels, allows carbon nanoparticles to selectively enter the lymphatic system once administered subcutaneously. Carbon nanoparticles stain tumor-draining lymph nodes black following intratumoral injection, making them useful in sentinel lymph node mapping. Drug-loaded carbon nanoparticles allow higher concentrations of chemotherapeutics to accumulate in regional lymph nodes while decreasing plasma drug accumulation. The use of carbon nanoparticles for chemotherapy delivery has been associated with lower mortality, fewer histopathology changes in vital organs, and lower serum concentrations of hepatocellular enzymes. This review will focus on the ability of carbon nanoparticles to target the lymphatics as well as their current and potential applications in sentinel lymph node mapping and oncology treatment regimens. This article is categorized under: Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery.

Acellular fish skin may be used to facilitate wound healing following wide surgical tumor excision in dogs: a prospective case series.

OBJECTIVE: To prospectively evaluate clinical outcomes using acellular fish skin grafts (FSGs) for the management of complete wound healing by secondary intention after wide surgical excision of skin tumors in dogs. ANIMALS: 5 dogs undergoing wide surgical excision of skin tumors on the distal extremity. CLINICAL PRESENTATION AND PROCEDURES: FSGs were applied to surgical wound beds following wide excision of the tumor. Bandages were changed weekly and additional grafts placed when integration of the previous graft was complete. The wounds were assessed for the following: dimensions, tissue health (color), time to complete epithelialization, complications, and tumor recurrence. RESULTS: All masses were excised with 2-cm lateral margins and 1 fascial plane deep to the tumor. Tumor diagnoses included 3 mast cell tumors and 2 soft tissue sarcomas. Surgical wounds had a median area of 27.6 cm2 (range, 17.6 to 58.7 cm2). The median number of FSG applications was 5 (range, 4 to 9 applications). Complete epithelialization occurred within 7 to 9 weeks for uncomplicated wounds (3 of 5) and 12 to 15 weeks for complicated wounds (2 of 5) that sustained self-trauma. There were no adverse events related to the use of FSGs. Local recurrence was not seen over a follow-up period ranging from 239 to 856 days. CLINICAL RELEVANCE: Wide surgical excision of distal extremity skin tumors, followed by repeated application of acellular FSGs, resulted in complete healing of all wounds with no adverse events. This treatment method does not require advanced reconstructive surgical skills and may be useful for the management of skin tumors on the distal extremities.

Client perceptions improve with collaborative care when managing dogs with cancer: a Collaborative Care Coalition study.

OBJECTIVE: Collaboration between primary care veterinarians (pcVets) and veterinary oncologists is common for dogs diagnosed with cancer, but no data exist that explore dog owner utilization and perceptions of collaborative care. The objectives were to describe dog owner perceptions of the value of collaborative veterinary cancer care and identify drivers of a positive collaborative care experience between the pcVet and oncologic specialists. SAMPLE: 890 US dog owners who had pets diagnosed with cancer in the past 3 years. PROCEDURES: Online contextual survey. Data were analyzed using group comparisons and multiple regression analysis. Significance was set at P < .05. RESULTS: 76% of clients sought specialty care following cancer diagnosis in their dog. Seventy percent of owners across all income brackets indicated that referral to a specialist was a very good value based on money spent and outcomes. Delayed referral resulted in lower client satisfaction scores for pcVets. Top predictors of client satisfaction with pcVets were as follows: responsiveness to questions, staying involved with their dog's care, and willingness to work with other veterinarians and specialists. For specialists, top predictors were as follows: providing accurate cost estimates, cancer knowledge, and effectiveness of care. Client perceptions of pcVets were 6 times more likely to improve following referral to a specialist. All were significant predictors of owner advocacy (P < .0001). CLINICAL RELEVANCE: Dog owners perceived early collaboration between pcVets and specialists favorably, fostering client satisfaction and positive perceptions of the value for service provided for dogs diagnosed with cancer.

Laparoscopic ultrasonography of the liver is feasible and safe in dogs.

OBJECTIVE: To describe the feasibility and technique for performing laparoscopic ultrasound (LUS) of the liver in dogs. ANIMALS: 12 client-owned dogs presenting for elective laparoscopic surgery from January 1, 2022, to October 31, 2022. METHODS: Laparoscopic exploration and LUS of the liver were performed in all dogs. Dogs were positioned in reverse Trendelenburg and laterally rotated to facilitate access to all liver lobes. Time to perform laparoscopic exploration and LUS, ability to visualize and access each liver lobe entirely, and any complications were recorded. Each dog underwent an elective laparoscopic procedure. The surgeon completed a National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire after surgery. RESULTS: Mean body weight was 25.9 kg (SD, ± 4.1 kg; range, 5.7 to 62 kg). All liver lobes were scanned to the level of the hilus in 10/12 dogs. In 2 dogs, the caudate lobe could not be completely imaged. Median time to perform LUS was 9 minutes (IQR, 5 to 16.5 minutes), and median NASA-TLX score was 9/100 (IQR, 6.3 to 20). There was a significantly strong negative correlation between time to perform LUS (r = -0.77; P = .0037) and NASA-TLX score (r = -0.84; P = .0006) with trial number. Minor complications occurred in 2 dogs during laparoscopic exploration. No complications occurred during LUS. CLINICAL RELEVANCE: LUS was feasible and safe in all dogs. The right lateral and caudate lobes were occasionally challenging to access. Technical demand and time to perform LUS improved with experience, suggesting a learning curve. Evaluation of LUS in dogs with clinical disease is warranted.

Multiple biliary duct hamartomas in a cat resulting in a hepatic mass: A case report.

A 13-year-old, male neutered domestic short-haired cat was diagnosed with multiple biliary duct hamartomas after liver lobectomy for a suspected malignant hepatic mass. Distinguishing ultrasonographic findings included a lobular, mostly well-defined, heterogeneous, predominantly hyperechoic, left hepatic mass. Computed tomography (CT) confirmed the presence of a lobular, well-defined, fluid to soft tissue attenuating, heterogeneously hypoenhancing left divisional hepatic mass. Grossly, a large left sided multilobular pale pink gelatinous hepatic mass was surgically excised. Histopathologically, the mass was composed of irregular cystic spaces lined by cuboidal epithelium and separated by mature regular fibrous tissue. Three months following surgery there was no evidence of recurrence or progression of disease on repeat abdominal ultrasound (AUS).

Superficial anatomic landmarks can be used to triangulate the location of canine peripheral lymphocentrums: superficial cervical, axillary, and superficial inguinal.

OBJECTIVE: To utilize the geometry of superficial anatomic landmarks to guide incisional location and orientation for peripheral lymphadenectomy, document deep anatomic landmarks for lymphocentrum identification, and develop novel surgical approaches to the superficial cervical, axillary, and superficial inguinal lymphocentrums in dogs. ANIMALS: 12 canine cadavers. PROCEDURES: 2 cadavers were used for a pilot investigation to determine optimal body positioning, select superficial anatomic landmarks for lymphocentrum identification, and evaluate novel surgical approaches to the 3 lymphocentrums. These lymphocentrums were then dissected in 10 additional cadavers using these novel surgical approaches. Measurements of the distances from lymphocentrum to landmark and between landmarks were obtained for each lymphocentrum. Deep anatomic landmarks were recorded for each dissection. The mean and SD were calculated for each measurement and used to develop geometric guidelines for estimating the location of each lymphocentrum for these surgical approaches. RESULTS: Each peripheral lymphocentrum was found in the same location relative to the respective, predetermined, superficial, anatomic boundaries in all cadavers. Briefly, the superficial landmarks to each lymphocentrum were as follows: (1) superficial cervical: wing of atlas, acromion process of scapula, greater tubercle of humerus; (2) axillary: caudal border of transverse head of superficial pectoral muscle, caudal triceps muscle, ventral midline; and (3) superficial inguinal: origin of pectineus muscle, ipsilateral inguinal mammary gland, ventral midline. The proposed superficial and deep surgical landmarks were identified within every cadaver. The previously undescribed surgical approaches were effective for lymphocentrum identification. CLINICAL RELEVANCE: Anatomic landmarks provided in this study may help reduce surgical time and tissue trauma during peripheral lymphadenectomy in dogs. This study was also the first to describe a surgical approach to the superficial inguinal lymphocentrum and ventral approaches to the superficial cervical and axillary lymphocentrums and provided previously unpublished anatomic landmarks for a lateral approach to the superficial cervical lymphocentrum.