Variables affecting surgeons' use of, and preferences for, instrumentation in veterinary laparoscopy.

OBJECTIVE: To investigate the impact of variables on use and preference of common laparoscopic instruments. STUDY DESIGN: Online survey. SAMPLE POPULATION: Surgeons (n = 140) with 3 years or more laparoscopic experience. METHODS: Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression. RESULTS: Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%). CONCLUSION: Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use. CLINICAL SIGNIFICANCE: When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures.

Variables associated with the prevalence of self-reported work-related musculoskeletal disorders in veterinary laparoscopic surgeons.

OBJECTIVE: To investigate the relationship between physical attributes and difficulty performing laparoscopic maneuvers with the prevalence of self-reported musculoskeletal injury. STUDY DESIGN: Online survey. SAMPLE POPULATION: Surgeons (n = 140) with 3 or more years of laparoscopic experience. METHODS: Electronic survey distributed via LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, presence of musculoskeletal injuries, and surgical practice data. Statistical analysis was performed using the Shapiro-Wilk test, linear regression, logistic regression, and Wilcoxon rank sum tests. RESULTS: A total of 52 of the 140 respondents reported a musculoskeletal injury with 38 specifying at least one injury (72%). Neck strain was the most prevalent reported musculoskeletal injury (18/52, 34.6%), followed by shoulder tendinopathies (16/52, 30.8%), arm/hand tendonitis (8/52, 15.4%), carpal tunnel (7/52, 13.5%), back pain (4/52, 7.7%) and arm/hand arthritis (1/52, 1.9%). Women were significantly more likely to report a musculoskeletal problem than men (p = .011) with the odds of women reporting a musculoskeletal injury 2.59 times greater than men. Women and surgeons with smaller glove sizes were significantly more likely to report shoulder tendonitis (p = .034, p = .1) and neck strain (p = .009, p = .001). Respondents with a musculoskeletal problem experienced significantly more difficulty using rotating cup biopsy forceps (p < .001) and perceived this as difficult a greater amount of time (p = .006). CONCLUSION: Female surgeons report more musculoskeletal injuries than their male counterparts. Surgeons with musculoskeletal injuries experience more difficulty performing particular laparoscopic maneuvers. CLINICAL SIGNIFICANCE: Improving ergonomics for women and surgeons with smaller glove sizes must be prioritized to improve surgeon health and laparoscopic instrument use.

Minimally invasive video-assisted parathyroidectomy in dogs: Technique description and feasibility study.

OBJECTIVE: To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism. STUDY DESIGN: Surgical technique description and clinical case report. ANIMALS: Five canine cadavers and 5 client-owned dogs with primary hyperparathyroidism. METHODS: A surgical technique for minimally invasive video-assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases. RESULTS: A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space. CONCLUSION: Minimally invasive video-assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases. CLINICAL SIGNIFICANCE: Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs.

Ambidirectional cohort study on the agreement of ultrasonography and surgery in the identification of parathyroid pathology, and predictors of postoperative hypocalcemia in 47 dogs undergoing parathyroidectomy due to primary hyperparathyroidism.

OBJECTIVE: To investigate (1a) agreement of ultrasonographic, surgical, and histopathologic findings in the diagnosis of a neoplastic etiology underlying primary hyperparathyroidism (PHPT), (1b) the ability of ultrasonographically determined parathyroid gland size to distinguish between malignant (carcinoma) and non-malignant (hyperplasia, adenoma) pathology, and (2) variables associated with postoperative hypocalcemia in dogs undergoing surgical treatment of PHPT. STUDY DESIGN: Ambidirectional cohort study. ANIMALS: Forty-seven client owned dogs with PHPT (34 retrospective; 13 prospective). METHODS: Data were extracted from medical records. Method agreements were explored using Cohen's Kappa statistic. A receiver operating characteristic curve (ROC) was used to determine a cut-off separating parathyroid pathologies. Univariable and multivariable models assessed associations between postoperative hypocalcemia and potential risk factors. RESULTS: Agreement of ultrasound and surgery for number and side of affected glands was 31/47 (65.9%) and 34/47 (72.3%), respectively. In 37/47 (78.7%) cases, parathyroid tissue was correctly assessed as pathologic by the surgeon. An ultrasonographic cut-off of ≥8.0 mm (ROC AUC = 0.82) best distinguished malignant from benign pathologies. Dogs with a preoperative serum ionized calcium (iCa) concentration ≥1.75 mEq/L had 7.5 times greater odds of becoming hypocalcemic postoperatively. CONCLUSION: A fair agreement existed between ultrasonographic and surgical findings in dogs with PHPT. A parathyroid mass ≥8.0 mm on ultrasonographic examination was suggestive of malignancy, while dogs with a preoperative serum iCa concentration ≥1.75 mEq/L were at increased risk for postoperative hypocalcemia in this study. CLINICAL SIGNIFICANCE: This study supports the use of bilateral cervical surgical exploration to identify abnormal parathyroid glands for the treatment of PHPT.

Influence of locoregional lymph node aspiration cytology vs sentinel lymph node mapping and biopsy on disease stage assignment in dogs with integumentary mast cell tumors.

OBJECTIVE: To compare the effect of sentinel lymph node (SLN) histology vs locoregional lymph node (LRLN) fine needle aspiration (FNA) cytology on assigned disease stage and adjunctive treatment recommendations and describe the incidence of anatomic disparity between the LRLN and SLN. STUDY DESIGN: A pre-post study refers to a study design type in which subjects are compared pre and post the intervention of interest. ANIMALS: Seventeen dogs undergoing primary excision of 20 cutaneous and subcutaneous mast cell tumors (MCT). METHODS: Client-owned dogs presenting to the Cornell University Hospital for Animals for surgical removal of a cytologically confirmed cutaneous or subcutaneous MCT >1 cm in diameter were enrolled. Cytological examination of FNA from the LRLN was compared with histology of the SLN. The SLN was identified by indirect computed tomographic lymphangiography (ICTL) after peritumoral injection of iopamidol and scanning at 1, 3, 5, 10, and 15 minutes. Histopathologic node score > 1 was considered metastatic. After case review by an oncologist, LRLN FNA cytology was compared with SLN histology for effect on changes in stage assignment and adjunctive treatment recommendations. RESULTS: Mast cell tumors were graded as 2 low (n = 11), 2 high (n = 2), and subcutaneous (n = 7). Optimal scan timing was 10 minutes after injection of iopamidol. Sentinel lymph node differed anatomically from LRLN in 5 of 18 scans. Metastases were detected by histology in 9 of 20 SLN compared with in 1 of 20 FNA of LRLN (P = .001), changing stage and adjunctive treatment recommendations 8 of 20 tumors. Only 6 of 19 LRLN FNA samples were diagnostic. CONCLUSION: Sentinel lymph nodes were consistently identified with ICTL and differed from LRLN in one-quarter of tumors. Histopathological examination of SLN altered recommendations in half of the dogs compared with the previous standard of care. CLINICAL SIGNIFICANCE: Indirect computed tomographic lymphangiography and SLN excision should be considered as a new standard for dogs with MCT.

Fatal Complications of Nasogastric Tube Misplacement in Two Dogs.

Provision of enteral nutrition via the use of nasoenteric feeding tubes is a commonly used method in both veterinary and human medicine. Although case reports in human medicine have identified fatalities due to misplacement of nasogastric (NG) tubes into the tracheobronchial tree and subsequent pneumothorax, there are no case reports, to our knowledge, of fatalities in veterinary patients. This case report describes two fatalities caused by misplaced NG tubes in intubated patients (one intraoperative, one postoperative). This report highlights risk factors for feeding tube complications and methods to prevent future fatalities such as two-view radiography, two-step insertion, capnography, laryngoscopic-assisted placement, and palpation of the NG tube in the stomach. The recent fatalities discussed within this case series demonstrate that deaths as a result of NG tubes misplaced into the tracheobronchial tree occur in veterinary patients, and measures should be taken to prevent this complication.

Orbital apex syndrome secondary to an orbital sarcoma in a dog.

A 12-year-old castrated male cocker spaniel dog was presented with a 4-week history of left episcleral injection and pawing at the face. Clinical examination findings included left internal and external ophthalmoplegia, left dorsal strabismus, pain opening the mouth, and intermittent amaurosis. Imaging studies revealed a left orbital apex mass with adjacent sphenoid bone lysis and extension into the cranial cavity. A left exenteration was performed and histopathology confirmed an orbital soft tissue sarcoma. Key clinical message: This report describes an orbital tumor causing orbital apex syndrome. This condition should be differentiated from cavernous sinus syndrome as the latter does not course with optic neuropathy.

Syndrome de l'apex orbitaire secondaire à un sarcome orbitaire chez un chien. Un épagneul mâle castré âgé de 12 ans fut présenté avec une histoire d'injection épisclérale gauche et frottage de la face d'une durée de 4 semaines. Les trouvailles de l'examen clinique incluaient une ophtalmoplégie interne et externe à gauche, un strabisme dorsal à gauche, de la douleur lors de l'ouverture de la gueule et une amaurose intermittente. Les examens par imagerie ont révélé une masse dans l'apex orbitaire gauche avec lyse de l'os sphénoïde adjacent et extension dans la cavité crânienne. Une exentération gauche fut effectuée et l'histopathologie confirma un sarcome des tissus mous orbitaires.Message clinique clé:Ce rapport décrit une tumeur orbitaire causant un syndrome de l'apex orbitaire. Cette condition devrait être distinguée du syndrome du sinus caverneux étant donné que ce dernier n'évolue pas avec une neuropathie optique.(Traduit par Dr Serge Messier).

Transorbital postcaruncular endoscopic surgery as an alternative to orbital exploratory surgery: A cadaveric study and case report in a dog with an orbital sarcoma.

OBJECTIVE: To describe a postcaruncular approach for transorbital endoscopy as an alternative, minimally invasive technique to access the orbital apex. STUDY DESIGN: Ex vivo and prospective clinical case report. ANIMALS: A 12-year-old male castrated cocker spaniel and three cadaver heads (one large breed dolichocephalic, one medium-sized breed mesocephalic, and one small breed brachycephalic). METHODS: Transorbital endoscopy was performed to obtain biopsies of an orbital apex mass by using a postcaruncular approach. A 2.7-mm 30° rigid endoscope fitted with a cystoscope working sheath was used with the aid of a blunt suction-dissector and fluid ingress. This procedure was first performed on three cadavers to assess feasibility and later performed in a clinical case. RESULTS: By using a transorbital postcaruncular approach, it was possible to visualize and obtain biopsies from structures within the orbital apex with minimal perioperative morbidity. Dissection and expansion of the working space was facilitated with the aid of fluid ingress; however, judicious use of fluids is recommended because secondary orbital edema and chemosis can occur. CONCLUSION: Transorbital endoscopy via a postcaruncular approach is feasible. CLINICAL SIGNIFICANCE: This technique should be considered in cases in which a histological diagnosis is required prior to definitive treatment as a method to obtain biopsy samples of the orbital apex region without major surgical dissection.

Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial.

OBJECTIVE: To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats. STUDY DESIGN: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. ANIMALS: Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17). METHODS: Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively. RESULTS: Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery. CONCLUSION: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy. CLINICAL SIGNIFICANCE: Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.

Influence of speaker's gender on speaker introductions at the 2018 ACVS Surgical Summit.

OBJECTIVE: To evaluate whether formality of introduction differed between male vs female speakers at the 2018 American College of Veterinary Surgeons (ACVS) scientific meeting and identify other variables that predisposed introducers or chairs to informal introduction. STUDY DESIGN: Observational study. SAMPLE POPULATION: Thirteen session chairs introducing 68 lectures (41 by females, 27 by males) by 63 speakers. METHODS: Observers recorded the session introducer, speaker, and whether speakers were introduced with a formal or informal title. Information evaluated included type of oral presentation; introducer gender, year, and country of graduation from veterinary school; speaker gender; whether the speaker was a resident; and speaker's year of graduation. RESULTS: Female speakers were introduced by their first name in 9 of 41 introductions compared to in 1 of 27 introductions for male speakers. This difference reached statistical significance when data independence was assumed (P = .043); however, this significance was narrowly lost when data clustering on session introducer was controlled for (P = .067). CONCLUSION: In this study, female speakers were more likely than male speakers to be introduced by their first and last names rather than with their professional title at a recent ACVS scientific meeting. IMPACT: Additional research is required to determine the effect of this type of subordinate language and gender bias in veterinary surgery.

Decreased incidence of perioperative inadvertent hypothermia and faster anesthesia recovery with increased environmental temperature: A nonrandomized controlled study.

OBJECTIVE: To determine perioperative inadvertent hypothermia (PIH) incidence, risk factors, prevention methods, and effect of PIH prevention on anesthesia recovery times. STUDY DESIGN: Nonrandomized controlled before-and-after trial. ANIMALS: Dogs (n = 277) and cats (n = 20) undergoing open surgery. METHODS: Incidence and risk factors for PIH (core temperature <96.8°F), existing thermal care practices, and recovery times were documented at baseline. For group 1, a thermal care bundle consisting of protocol-driven active warming combined with raised environmental temperatures (75°F) in induction rooms (IR) and operating rooms (OR) was implemented. Perioperative inadvertent hypothermia incidence and recovery times were recorded. For group 2, baseline active warming practices were resumed while environmental temperatures remained elevated. RESULTS: Perioperative inadvertent hypothermia was associated with preoperative imaging (P = .039) and percentage clip area (P = .037). Perioperative inadvertent hypothermia decreased in group 1 (13.5%, n = 96, P < .001) and group 2 (13.0%, n = 100, P < .001) compared with baseline (35.6%, n = 101). Median time from anesthesia withdrawal to extubation decreased in group 1 (5 minutes, P = .028) and group 2 (5 minutes, P = .018) compared with baseline (7 minutes). Median time from anesthesia recovery to spontaneous food intake decreased in group 1 (6 hours, n = 92, P = .016) but not in group 2 (6.0 hours, n = 88, P = .060) compared with baseline (n = 94, 6.7 hours). No group differences in PIH risk factors were identified. CONCLUSION: Perioperative inadvertent hypothermia incidence was high but reducible by raising environmental temperatures alone or in combination with increased focus on active warming. Reductions in PIH shortened recovery times. CLINICAL SIGNIFICANCE: Maintaining IR and OR temperatures at the standard-of-care for human pediatric surgery reduces PIH and may improve outcomes.

Clinical hypocalcemia following surgical resection of apocrine gland anal- sac adenocarcinomas in 3 dogs.

Three canine patients were presented with marked hypercalcemia secondary to an apocrine gland anal sac adenocarcinoma (AGASCA). Two of the patients underwent treatment for hypercalcemia before surgical resection of their tumors, including diuresis and the administration of bisphosphonates. All dogs developed clinically symptomatic hypocalcemia 2 to 4 days following surgery. Clinical signs included facial rubbing, muscle fasciculations, lameness, and collapse. The dogs each required calcium supplementation and close monitoring of serum ionized calcium, as inpatients and continuing after discharge. Hypocalcemia and associated clinical signs resolved with treatment in all cases.

Hypocalcémie clinique après la résection chirurgicale d'adénocarcinomes du sac de glandes anales aprocrines chez trois chiens. Trois patients canins ont été présentés avec une hypercalcémie marquée secondaire à un adénocarcinome du sac des glandes anales apocrines (ASGAA). Deux des patients ont subi un traitement pour l'hypercalcémie avant la résection chirurgicale de leurs tumeurs, y compris la diurèse et l'administration de bisphosphonates. Tous les chiens ont développé une hypocalcémie cliniquement symptomatique de 2 à 4 jours après la chirurgie. Les signes cliniques incluaient le frottement de la face, des fasciculations des muscles, la boiterie et le collapsus. Les chiens ont tous exigé de la supplémentation au calcium et une étroite surveillance du calcium ionisé sérique, comme patients à l'interne et après le congé. L'hypocalcémie et les signes cliniques connexes se sont résorbés avec le traitement dans tous les cas.(Traduit par Isabelle Vallières).

Sex-hormone producing adrenal tumors causing behavioral changes as the sole clinical sign in 3 cats.

Three neutered cats with adrenocortical tumors that were presented with behavioral changes but no evidence of hyperaldosteronism or hypercortisolism are described. All 3 cats had resolution of their clinical signs following adrenalectomy. For neutered cats presenting with behavior changes, a sex-hormone secreting adrenal tumor should be considered as a differential diagnosis.

Tumeurs surrénaliennes produisant des hormones sexuelles causant des changements de comportement comme seul signe clinique chez 3 chats. Les cas de trois chats stérilisés ayant des tumeurs surrénaliennes qui ont été présentés avec des changements comportementaux mais aucun signe d'hyperaldostéronisme ou hypercortisolisme sont décrits. Les trois chats ont eu une résorption de leurs signes cliniques après une surrénalectomie. Pour les chats stérilisés présentant des changements comportementaux, une tumeur surrénalienne sécrétant des hormones sexuelles devrait être considérée comme un diagnostic différentiel.(Traduit par Isabelle Vallières).

A quilting subcutaneous suture pattern to reduce seroma formation and pain 24 hours after midline celiotomy in dogs: A randomized controlled trial.

OBJECTIVE: To determine the influence of a quilting suture pattern tacking the subcutaneous tissues to the deep fascia on complications after midline celiotomy in dogs. STUDY DESIGN: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. ANIMALS: Four hundred thirty-two dogs undergoing midline celiotomy for ovariohysterectomy (n = 249) or other abdominal procedures (n = 183). METHODS: Dogs were randomly assigned to (1) a quilting group, subcutaneous tissue with apposition plus tacking to the rectus fascia or (2) a nonquilting group, with apposition of subcutaneous tissue without tacking. Randomization was stratified on hospital admitting service. Primary outcome was the incidence of incisional seroma. Secondary outcomes included postoperative pain the day after surgery and surgical site infection (SSI). Outcomes were assessed during the first 30 postoperative days. RESULTS: No differences were detected between the quilting group (n = 183) and the nonquilting group (n = 175) in terms of illness severity, surgical procedure performed, surgeon's experience, duration of surgery, intraoperative complications, or methods of surgical closure other than the intervention under study. In an intent-to-treat analysis, the incidence of incisional seroma was lower in the quilting group (odds ratio = 0.30, 95% CI = 0.13-0.67, P = .004). Pain assessed 24 hours postoperatively was lower in the quilting group (P = .03). The incidence of SSI did not differ between groups. CONCLUSION: Tacking the subcutaneous tissues to the deep fascia is indicated to reduce seroma during celiotomy closure.

Dorsal skin necrosis secondary to a solar-induced thermal burn in a brown-coated dachshund.

A 5-year-old neutered male brown dachshund dog was presented for a large dorsal cutaneous burn that occurred following direct sunlight exposure outdoors in high ambient temperatures. Although burns are quite common in dogs, full-thickness solar-induced radiation burns are less common and have not been previously reported in animals without a black hair coat.

Nécrose de la peau dorsale secondaire à une brûlure thermique induite par l'exposition au soleil chez un Dachsund à pelage brun. Un chien Dachsund brun stérilisé âgé de 5 ans a été présenté pour une grande brûlure cutanée dorsale qui s'était produite après une exposition directe au soleil à l'extérieur durant des températures élevées. Même si les brûlures sont assez courantes chez les chiens, les brûlures du troisième degré causées par l'exposition au soleil sont moins communes et n'ont pas déjà été signalées chez des animaux sans un pelage à poil noir.(Traduit par Isabelle Vallières).

Outcomes in dogs with congenital extrahepatic portosystemic shunts treated with surgical ligation or medical management.

OBJECTIVE: The objective of this study was to evaluate differences in outcomes in dogs treated for extrahepatic portosystemic shunts (EHPSS) by either complete suture ligation, partial suture ligation or medical management. STUDY DESIGN: This wasa retrospective, single institutional study. SAMPLE POPULATION: Dogs (n = 152) with EHPSS treated with suture ligation (n = 62), surgery with no ligation (n = 2), or medical management (n = 88). METHODS: Medical records were reviewed for data on signalment, treatment variables, complications, and outcome. Kaplan-Meier plots were generated to assess survival across groups. Cox's proportional hazard models were used to assess the relationship between survival times and multiple predictor variables. For outcomes of interest, backwards, stepwise regression was performed (p < 0.05). RESULTS: Complete suture ligation was possible in 46/64 (71.9%) of dogs where surgical attenuation was attempted. One dog was euthanized following partial suture ligation due to suspected portal hypertension. Dogs with complete suture ligation of the EHPSS had a significantly longer median survival time (MST) compared to the medical management group (MST not reached vs. 1730 days [p < 0.001]). Complete resolution of clinical signs (without the need for further medical treatment or dietary changes) was achieved in 16/20 (80.0%) dogs with complete suture ligation and 4/10 (40.0%) dogs with partial suture ligation of their EHPSS. CONCLUSION: Suture ligation (complete or partial) for the treatment of EHPSS, where clinically possible, yielded the best clinical outcome and increased longevity compared to medical management in this study. CLINICAL SIGNIFICANCE: While medical management for the treatment of EHPSS in dogs is a valid treatment option, better clinical outcomes are achieved with surgical intervention.

Evaluation of submucosally injected polyethylene glycol-based hydrogel and bovine cross-linked collagen in the canine urethra using cystoscopy, magnetic resonance imaging and histopathology.

OBJECTIVE: To (1) investigate the tissue response to a novel urethral bulking agent, polyethylene glycol carboxymethyl cellulose hydrogel (PEG-CMC) injected submucosally in the canine urethra and (2) compare PEG-CMC with bovine collagen (BC), the current standard for urethral bulking. STUDY DESIGN: Experimental study. ANIMALS: Purpose-bred female hound dogs (n = 8). METHODS: Standardized submucosal urethral injections of BC and PEG-CMC were performed in 8 female dogs. Injection sites were evaluated by cystoscopy on days 0 (n = 8), 30 (n = 4), and 90 (n = 4), magnetic resonance imaging on days 0 (n = 8), 30 (n = 8), and 90 (n = 4) and by histopathology on days 30 (n = 4) and 90 (n = 4). RESULTS: Both PEG-CMC and BC were detectable on MRI as hyperintense foci on T2-weighted images. Grossly, PEG-CMC formed more prominent blebs than BC. On follow-up cystoscopic examination, 6/8 PEG-CMC injection needle tracts were visible, and 3 of these sites had mucosal erosions. Histopathologic scores for foreign body reaction and inflammation were significantly higher for PEG-CMC compared with BC (P < 0.005). BC elicited a lymphoplasmacytic reaction whereas PEG-CMC incited a granulomatous response. CONCLUSIONS: The overall physical characteristics and histologic response associated with PEG-CMC support its use as a urethral bulking agent; however, the current formulation needs to be adjusted for clinical use.

Modified ear canal ablation and lateral bulla osteotomy for management of otitis media in an alpaca.

OBJECTIVE: To report surgical treatment of severe otitis media in an alpaca by a modification of a subtotal ear canal ablation and lateral bulla osteotomy technique used in dogs. STUDY DESIGN: Case report. ANIMALS: An 11-week-old female alpaca cria. METHODS: The cria had a 2-week history of right otitis media, nonresponsive to medical treatment, as well as right facial nerve paralysis, and a melting corneal ulcer of the right eye. Otitis media was confirmed by computed tomography. Right subtotal ear canal ablation and lateral bulla osteotomy were performed using a modification of a technique reported in dogs. RESULTS: There were no surgical complications and the alpaca was discharged from the hospital 5 days later. At 10 months, moderate motor function had been restored to the pinna with the ear standing partially erect. The otitis had resolved, and the alpaca was reportedly well integrated into the herd. CONCLUSION: Subtotal ear canal ablation and lateral bulla osteotomy, a technique modified from that performed in dogs, were successful in providing complete clinical resolution of otitis media in an alpaca.

Development of Sciatic Neuropraxia following Abdominal Surgery in 3 Giant Breed Dogs.

This report describes the clinical course of three giant breed dogs (2 Great Danes and 1 Saint Bernard) that developed sciatic neuropraxia following successful surgical management of gastric dilatation and volvulus (GDV). All three patients received physical rehabilitation with varying degrees of success. Two patients died of unrelated causes within a year of their initial presentation. The third case recovered nerve function and is alive with minimal neurologic deficits at the time of publication. This paper is aimed at positing potential causes for this complication and highlighting the importance of proper management of giant-breed dogs during hospitalization. Special attention should be given in regards to intraoperative positioning and postoperative care including frequent walks or changes in positioning, deep kennel bedding, and physical therapy.

Factors associated with survival in dogs with a histopathological diagnosis of hepatocellular carcinoma: 94 cases (2007-2018).

Background: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer in dogs. Despite this, relatively few reports of this disease exist pertaining to prognostic factors and outcome. Aim: To evaluate factors associated with survival in dogs with all subtypes of HCC diagnosed on histopathology. Methods: A retrospective single institutional study was carried out on 94 client-owned dogs with a histopathologic diagnosis of HCC between 2007 and 2018 obtained by biopsy (21/94) or attempted definitive resection (73/94). Signalment, preoperative features, surgical findings, and postoperative outcomes were recorded. Associations between survival to discharge data were collected and univariable logistical regression was carried out. Kaplan-Meier survival analysis was carried out to identify negative risk factors for long-term prognosis. Results: The median survival time (MST) for all patients was 707 days (95% CI = 551-842). MST was not significantly different (p > 0.05) between patients who had suspected versus incidentally diagnosed HCC (695 vs. 775 days), between complete versus incomplete surgical margins (668 vs. 834 days), or between patients with massive subtype versus nodular/diffuse subtype (707 vs. 747 days). Logistical regression identified an association with the excision of the right medial lobe and risk of perioperative death (OR = 9.2, CI 1.5-55.9, p = 0.016). An American Society of Anesthesiologists score ≥4, disease present within the quadrate lobe, and elevated blood urea nitrogen, potassium or gamma-glutamyltransferase were identified as negative prognosticators during multivariable Cox regression. Preoperative imaging (ultrasound or CT) agreed with the surgical location in 91% of the cases. Preoperative cytology was consistent with a diagnosis of HCC in 15/32 (46.9%) cases. Conclusion: Type of diagnosis (incidental vs presumed), completeness of excision, and subtype were not associated with MST in this study. Preoperative identification of tumors within the central division may be related to a less favorable outcome. Results of preoperative cytology were not highly sensitive for identifying a malignancy.