Surgical management of superficial digital flexor tendon luxation in dogs: 48 cases (2005-2020).

OBJECTIVES: To report the outcome, frequency of complications and potential prognostic factors associated with surgical repair of superficial digital flexor tendon (SDFT) luxation in dogs. MATERIALS AND METHODS: Medical records from 10 referral hospitals were reviewed retrospectively for cases of SDFT luxation in dogs that underwent surgical stabilisation. Signalment, clinical presentation, diagnostic imaging, surgical method, type and length of post-operative limb immobilisation, nature of and length of exercise restriction, presence of post-operative complications and outcomes were recorded. Data were summarised descriptively and prognostic risk factors assessed for association with surgical outcome using risk ratios. RESULTS: Forty-eight cases were included. A successful surgical outcome was recorded in 35 of 48 (73%) cases. Re-luxation of the SDFT occurred in seven of 48 (15%). Six out of 48 (13%) had a persistent lameness despite a stable non-luxating SDFT. A high frequency of post-operative complications occurred (71%), with the majority resolved medically. The risk of surgical failure was 60% higher (risk ratio 1.6, 95% confidence interval 1.1 to 2.4) where absorbable suture material was used compared to non-absorbable suture material. Surgical failure was more common in cases managed with non-rigid immobilisation post-operatively (57% failure) compared to cases managed with rigid immobilisation (19% failure), although this result was not statistically significant. Limb immobilisation of 6 weeks or longer did not significantly affect surgical outcome, compared to shorter periods of exercise restriction or limb immobilisation. CLINICAL SIGNIFICANCE: A good outcome can be expected following surgical stabilisation of SDFT luxation. The use of non-absorbable suture was associated with a more successful surgical outcome.

Outcome following surgery to treat septic peritonitis in 95 cats in the United Kingdom.

OBJECTIVES: To review the cause, management and outcome in cats with septic peritonitis within the United Kingdom (2008 to 2018) and to identify if previously identified prognostic factors were associated with survival in this population. MATERIALS AND METHODS: Clinical records from 10 referral hospitals in United Kingdom were reviewed. Data collected included signalment, clinicopathological data and management techniques. Serum albumin, glucose, lactate and ionised calcium concentration; presence of intraoperative hypotension and correct empirical antibiosis were analysed via logistic regression for association with survival. RESULTS: Ninety-five cats were included. The overall survival rate was 66%. Lethargy (89%) and anorexia (75%) were the most common clinical signs, with abdominal pain and vomiting in 44% and 27% of cases, respectively. Gastro-intestinal leakage was the most common source of contamination. The presence of an abdominal mass on clinical examination was not strongly predictive of the presence of neoplasia on histology and did not confer a worse prognosis. Cats presenting with dehiscence of a previous enterotomy/enterectomy did not have a worse prognosis than those presenting with other aetologies. Intraoperative hypotension (adjusted odds ratio 0.173, 95% confidence intervals 0.034 to 0.866, P=0.033) was associated with non-survival. Cats that survived beyond 1 day postoperatively had an improved likelihood of survival (87.5%). All cats that survived beyond 6 days were successfully discharged. CLINICAL SIGNIFICANCE: This study describes the largest group of cats with septic peritonitis with an overall survival rate of 66%. The presence of an abdominal mass on clinical examination or having dehiscence of a previous gastrointestinal surgery did not confer a worse prognosis.

Management of incontinence following pre-pubic urethrostomy in a cat using an artificial urethral sphincter.

A 14-year-old male neutered domestic shorthair cat presented with a 4-year history of urinary incontinence following prepubic urethrostomy. Physical examination confirmed peristomal dermatitis, urine scalding and constant urine leakage. Haematology, serum biochemistry and urinalysis were unremarkable. Ultrasonography revealed a non-distended urinary bladder. An artificial urethral sphincter mechanism, with subsequent incremental inflation of the cuff 6 weeks later, resulted in complete resolution of clinical signs, return to normal urinary function and excellent quality of life. The cat was still continent at 5-year follow-up. Further studies including additional cases are required to highlight effectiveness and harms of the procedure.

Simultaneous AFM and fluorescence imaging: A method for aligning an AFM-tip with an excitation beam using a 2D galvanometer.

Correlative fluorescence and atomic force microscopy (AFM) imaging is a highly attractive technique for use in biological imaging, enabling force and mechanical measurements of particular structures whose locations are known due to the specificity of fluorescence imaging. The ability to perform these two measurements simultaneously (rather than consecutively with post-processing correlation) is highly valuable because it would allow the mechanical properties of a structure to be tracked over time as changes in the sample occur. We present an instrument which allows simultaneous AFM and fluorescence imaging by aligning an incident fluorescence excitation beam with an AFM-tip. Alignment was performed by calibrating a 2D galvanometer present in the excitation beam path and using it to reposition the incident beam. Two programs were developed (one manual and one automated) which correlate sample features between the AFM and fluorescence images, calculating the distance required to translate the incident beam towards the AFM-tip. Using this method, we were able to obtain beam-tip alignment (and therefore field-of-view alignment) from an offset of >15 µm to within one micron in two iterations of the program. With the program running alongside data acquisition for real-time feedback between AFM and optical images, this offset was maintained over a time period of several hours. Not only does this eliminate the need to image large areas with both techniques to ensure that fields-of-view overlap, but it also raises the possibility of using this instrument for tip-enhanced fluorescence applications, a technique in which super-resolution images have previously been achieved.

Surgical management of impalement injuries to the trunk of dogs: a multicentre retrospective study.

OBJECTIVES: To review a large series of dogs referred for treatment of traumatic impalement injuries to the thorax and/or abdomen and to report aetiologies, injury characteristics, management and long-term outcomes. MATERIALS AND METHODS: Previously collected data on dogs that were surgically treated for impalement injuries to the trunk at six veterinary specialist referral institutions in the UK over an 11-year period were reviewed. Data included patient signalment, physiological variables, injury-specific variables, diagnostic imaging reports, surgical procedures undertaken, duration of hospitalisation, antibiotic use, complications and outcomes. Data were reported with summary statistics. RESULTS: Fifty-four dogs were included. Impalement occurred most frequently on wooden objects (n=34), and the thoracic cavity was most commonly penetrated (n=37). Computed tomography was sensitive and specific to identifying wooden material in 64% and 88% of cases (n=11), respectively. Thoracotomy was performed in 56%, coeliotomy in 20% and a foreign body or its fragments were retrieved during surgery in 37% of the cases. Complications occurred in 19 dogs (35%), and of these, 68% were minor and 32% major. The survival rate for thoracotomy cases was 93% (n=30). Overall long-term survival was 90%. CLINICAL SIGNIFICANCE: Despite the often dramatic presentation of impalement injuries, the majority of patients treated in the specialist referral setting can achieve excellent outcomes. These injuries require thorough diagnostic imaging and interpretation before adequate surgical exploration and management, augmented by anaesthesia and critical care during the peri- and postoperative periods; therefore stable patients should be referred to centres able to provide this type of care.

The natural history of humeral intracondylar fissure: an observational study of 30 dogs.

OBJECTIVES: To determine the risk of condylar fracture, or of needing to have a transcondylar screw placed, and to identify risk factors in a cohort of dogs with humeral intracondylar fissure (also known as incomplete ossification of the humeral condyle) that was initially managed non-surgically. METHODS: A retrospective owner survey of dogs diagnosed with humeral intracondylar fissure as an incidental finding and managed non-surgically with a minimum of two years follow-up. Body weight, age, estimated fissure size, gender and contralateral fracture at the time of diagnosis were evaluated as potential risk factors for the development of a humeral condylar fracture or for having a transcondylar screw placed. RESULTS: Data were available for 30 dogs (34 elbows). Six humeral condyles with a mean fissure size of 50% fractured at a mean of 14 months after diagnosis. A transcondylar screw was placed across two humeral condyles with fissure sizes of 60 and 100% at 11 and 17 months. No risk factors were identified for fracture/screw placement. For those cases that did not fracture or have a screw placed mean fissure size was 52% and mean follow-up time was 56 months (range 29 to 79 months). CLINICAL SIGNIFICANCE: Eighteen percent of cases progressed to fracture and 24% in total required surgery. This information allows clinicians and owners to make an informed decision regarding surgery when faced with a dog with humeral intracondylar fissure identified as an incidental finding.

Treatment of tibial diaphyseal fractures following plateless tibial tuberosity advancement to manage cranial cruciate disease.

OBJECTIVE: To report diaphyseal fractures of the proximal tibia following tibial tuberosity advancement without plate stabilisation for the management of cranial cruciate ligament rupture in dogs. METHODS: Members of the British Veterinary Orthopaedic Association's online discussion forum were invited to submit revision cases of tibial diaphyseal fracture following tibial tuberosity advancement without plate fixation. Data collected included signalment, surgical revision technique, pre- and postoperative revision radiographic findings, complications and veterinary assessment. Owners were invited to complete the Liverpool Osteoarthritis in Dogs questionnaire. RESULTS: A total of 17 dogs were included in the study. Eleven dogs had OrthoFoam-wedge modified Maquet procedures and six had the tibial tuberosity advancement rapid procedure. Tibial tuberosity advancement was maintained in 14/17 cases. Postrevision surgery complications occurred in eight cases: minor complications in 3/17 dogs; major in 5/17 and no catastrophic complications. Surgical site infection was the most common complication (4/8). Final clinical outcome found 8/17 of dogs to have excellent, 8/17 satisfactory and 1/17 poor clinical outcome. The median Liverpool Osteoarthritis in Dogs score was 12/52 (range 2 to 28). Final outcome was 6/13 owners that were very satisfied, 2/13 owners indifferent and 5/13 owners very disappointed. CLINICAL SIGNIFICANCE: This is the first case series reporting tibial diaphyseal fractures following tibial tuberosity advancement without plate stabilisation. The authors report here a wide spectrum of potential fixation strategies should one of these fractures occur.

Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases.

The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty-three cases were identified; 26 were traumatic in origin; almost one-third were iatrogenic, of which over three-quarters occurred as a complication following surgical stabilisation of patellar luxation. Treatment involved primary reapposition of the ligament (36 cases). The repair was protected by circumpatellar and/or transpatellar loop(s) of orthopaedic wire, nylon, polypropylene or polydioxanone suture (34 cases). Wire loops were more likely to require surgical removal compared with loops of other materials (P=0.0014). The stifle joint was immobilised postoperatively by the applications of a transarticular external skeletal fixator (taESF) in 17 cases and by external coaptation (EC) in 8 cases; in 18 cases, no postoperative joint immobilisation was provided. Complications specific to the method of immobilisation occurred in seven of the cases with taESF and six of the cases with EC. Revision surgery to address failure of repair was required in five cases. Outcome was classified as acceptable or good in over three-quarters of the cases (31/40) and poor in less than a quarter (9/40). These data highlight patellar ligament rupture as a complication of surgical stabilisation of patellar luxation.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs.

OBJECTIVE: To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications. METHODS: Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination. RESULTS: Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow-up (median of 106 weeks, range 26-227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen. CLINICAL SIGNIFICANCE: The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

Designing Endocrine Disruption Out of the Next Generation of Chemicals.

A central goal of green chemistry is to avoid hazard in the design of new chemicals. This objective is best achieved when information about a chemical's potential hazardous effects is obtained as early in the design process as feasible. Endocrine disruption is a type of hazard that to date has been inadequately addressed by both industrial and regulatory science. To aid chemists in avoiding this hazard, we propose an endocrine disruption testing protocol for use by chemists in the design of new chemicals. The Tiered Protocol for Endocrine Disruption (TiPED) has been created under the oversight of a scientific advisory committee composed of leading representatives from both green chemistry and the environmental health sciences. TiPED is conceived as a tool for new chemical design, thus it starts with a chemist theoretically at "the drawing board." It consists of five testing tiers ranging from broad in silico evaluation up through specific cell- and whole organism-based assays. To be effective at detecting endocrine disruption, a testing protocol must be able to measure potential hormone-like or hormone-inhibiting effects of chemicals, as well as the many possible interactions and signaling sequellae such chemicals may have with cell-based receptors. Accordingly, we have designed this protocol to broadly interrogate the endocrine system. The proposed protocol will not detect all possible mechanisms of endocrine disruption, because scientific understanding of these phenomena is advancing rapidly. To ensure that the protocol remains current, we have established a plan for incorporating new assays into the protocol as the science advances. In this paper we present the principles that should guide the science of testing new chemicals for endocrine disruption, as well as principles by which to evaluate individual assays for applicability, and laboratories for reliability. In a 'proof-of-principle' test, we ran 6 endocrine disrupting chemicals (EDCs) that act via different endocrinological mechanisms through the protocol using published literature. Each was identified as endocrine active by one or more tiers. We believe that this voluntary testing protocol will be a dynamic tool to facilitate efficient and early identification of potentially problematic chemicals, while ultimately reducing the risks to public health.

Post-operative respiratory distress following primary cleft palate repair.

INTRODUCTION: Infants are obligate nasal breathers. Cleft palate closure may result in upper airway compromise. We describe children undergoing corrective palatal surgery who required unplanned airway support. SETTING: Tertiary referral unit. METHOD: Retrospective study (2007-2009) of 157 cleft palate procedures (70 primary procedures) in 43 patients. Exclusion criteria comprised combined cleft lip and palate, secondary palate procedure, and pre-existing airway support. RESULTS: The children's mean age was 7.5 months and their mean weight 7.72 kg. Eight children were syndromic, and eight underwent pre-operative sleep studies (five positive, three negative). Post-operatively, five developed respiratory distress and four required oxygen, both events significantly associated with pre-operative obstructive sleep apnoea (p = 0.001 and 0.015, respectively). Four desaturated within 24 hours. Five required a nasopharyngeal airway. Hospital stay (mean, 4 days) was significantly associated with obstructive sleep apnoea (p = 0.002) and nasopharyngeal airway insertion (p = 0.017). DISCUSSION: Pre-operative obstructive sleep apnoea correlated significantly with post-operative respiratory distress, supplementary oxygen requirement, nasopharyngeal airway insertion and hospital stay. We recommend pre-operative sleep investigations for all children undergoing cleft palate repair, to enable appropriate timing of the procedure.

Inter- and intra-operator variability associated with extracapsular suture tensioning: an ex vivo study.

OBJECTIVES: To determine inter- and intra- operator variability associated with extracapsular suture tensioning as performed during lateral fabello-tibial suture placement. STUDY DESIGN: Ex vivo study. METHODS: Fifteen Greyhound cadaveric pelvic limbs were prepared by cutting the cranial cruciate ligament and placing an extracapsular fabello-tibial suture. On two occasions, three surgeons tensioned the extracapsular suture of each stifle. Stifles were returned to 135 degrees of flexion and the suture tension was measured using a commercially available suture tensioner with inbuilt tensiometer. STATISTICAL ANALYSIS: Intra-operator and inter-operator agreement were assessed using the limits of agreement method. A linear mixed effects model was specified to assess the effect of operator, repeated estimates and stifle order on tension applied. RESULTS: The mean difference within the three operators ranged from 0 to 14.7N. With 95% limits of agreement, on most occasions for all three operators, the difference was between -31.7 and 41.0 N. The mean difference between the three operators ranged from 6.0 to 30.7 N. With 95% limits of agreement, on most occasions the difference between operators was between -25.6 and 62.5 N. CLINICAL SIGNIFICANCE: Marked variation exists in the tension applied during fabello-tibial suture application, both within and between surgeons. This variation may lead to inconsistent clinical outcomes. Further studies are required to determine the clinical consequences of this marked variation in extracapsular suture tensioning.

Wilson disease: Canadian perspectives on presentation and outcomes from an adult ambulatory setting.

BACKGROUND: Wilson disease (WD) is a rare disorder of copper metabolism. OBJECTIVE: To describe the authors' clinical experience with a cohort of 48 adult patients followed in an ambulatory setting. METHODS: A retrospective chart review of patients with a diagnosis of WD was performed. RESULTS: Fifty-nine charts were identified and 11 were excluded on further review. At diagnosis, 14 patients were asymptomatic, with 13 hepatic, 15 neurological and six mixed hepatic/neurological presentations. Ceruloplasmin levels were low (<0.20 g/L) in 94%, and 24 h urinary copper levels high (>0.60 µmol/L) in 95% of cases. D-penicillamine was the most common initial therapy (48%), with zinc the most common at review (65%). Overall, biopsy and ultrasound reports documented cirrhosis in 53%. Portal hypertension, defined as splenomegaly (>12.0 cm), reversed portal venous flow on ultrasound or varices/gastropathy on endoscopy was seen in 63%. At last review, 39% had elevated aspartate aminotransferase (>34 U/L) and/or alanine aminotransferase levels (>40 U/L). One death and one transplant occurred, while three patients had encephalopathy, two became jaundiced, two developed ascites and one experienced variceal bleed. Of 21 neurological presenting patients, 14 improved compared with baseline, with four making almost complete recovery. Eleven patients experienced documented episodes of neurological decline, including four with non-neurological presentation. Diagnostic magnetic resonance imaging showed basal ganglia (64%), brainstem (64%) abnormalities and atrophy (36%); follow-up showed basal ganglia lesions (50%) and atrophy (55%). CONCLUSION: WD is a diverse chronic disease with generally favourable outcomes for patients who respond to initial therapy, which can be managed predominantly in an ambulatory setting.

Toggle rod stabilisation of coxofemoral luxation in 14 cats.

OBJECTIVES: To describe the surgical technique and to report outcomes in cats with coxofemoral luxation treated with open reduction and toggle rod stabilisation. METHODS: Retrospective study of cats with coxofemoral luxation stabilised via the toggle rod method. Short-term follow-up included clinical examination and radiographs. Long-term follow-up was via owner questionnaire. RESULTS: Fourteen cats were included. All of the cats had reported unilateral craniodorsal hip luxation. Nine cats (64·3%) had additional orthopaedic injuries. Luxations were stabilised with a 3·2-mm toggle rod (2·7-mm toggle rod in one cat) and two loops of four-metric polydioxanone (five-metric polydioxanone in one cat and three loops of four-metric polydioxanone in two cats). Success rate, in terms of maintenance of reduction, was 86%. Reluxation occurred in two cats (14%), both of which had multiple limb injuries. Eleven owner questionnaires (mean follow-up time 15·5 months) reported a functional outcome of "very good" to "excellent". Although the diameter of the pelvic canal was reduced by the presence of the toggle rod (mean narrowing 16.2%), none of the cats had defaecatory issues. CLINICAL SIGNIFICANCE: Toggle rod stabilisation is an effective method for the treatment of coxofemoral luxation in cats. Injuries to multiple limbs may be a risk factor for reluxation.

Post-trauma inguinal seroma formation in the cat.

Seven cats presented with large caudoventral abdominal or inguinal swellings following road traffic accidents. No case had evidence of disruption to the body wall or inguinal ring and the inguinal swellings may have been the result of either shear or compressive injury to soft tissues of the inguinum or disruption of the regional lymphatics. Six cases resolved completely following strict rest or simple Penrose drain placement with no recurrence reported. Recurrence of seroma was seen in one case but which then fully resolved following omentalisation of the inguinum.

The use of haemostatic gelatin sponges in veterinary surgery.

OBJECTIVES: To describe the use of absorbable gelatin sponges as haemostatic implants in clinical veterinary surgical cases and to document any related postoperative complications. METHODS: Practice databases were searched for the product names "Gelfoam" and "Spongostan". Patient records were retrieved and data regarding patient signalment, surgical procedure, National Resource Council (NRC) wound classification, source of haemorrhage, pre- and postoperative body temperature, postoperative complications, time to discharge and details of any postoperative imaging were recorded and reviewed. Follow-up information was obtained by repeat clinical examination or telephone interview with either the owner or referring veterinary surgeon. Cases with incomplete surgical records or those which were not recovered from anaesthesia were excluded from the analysis. RESULTS: Fifty cases (44 dogs and 6 cats) satisfied the inclusion criteria. Satisfactory haemostasis was achieved in 49 cases with one case requiring reoperation during which a second gelatin sponge was used. There were no detected hypersensitivity responses or confirmed postoperative complications relating to the use of gelatin sponges during the follow-up period (median 13 months). CLINICAL SIGNIFICANCE: This is the first review of the use of gelatin sponges in clinical veterinary surgery and suggests that gelatin sponges are safe to use in cats and dogs.

Prevalence of incomplete ossification of the humeral condyle and other abnormalities of the elbow in English Springer Spaniels.

OBJECTIVES: To determine the prevalence of incomplete ossification of the humeral condyle (IOHC) and other osseous abnormalities of the elbow in English Springer Spaniels with no history of lameness. METHODS: Prospective observational study of English Springer Spaniels with no recent history of lameness. Computed tomography scans of both elbows were obtained from dogs older than six months of age which were anaesthetized or sedated for reasons unrelated to this study. Computed tomography scans were reviewed for the presence of IOHC and other abnormalities of the elbow. Radioulnar incongruity (RUI) measurements from normal elbows were compared to elbows with IOHC and elbows with medial coronoid process (MCP) abnormalities. RESULTS: Computed tomography scans from 50 dogs (100 elbows) were reviewed. The prevalence of IOHC was 14% (8 elbows in 7 dogs). All condylar fissures were incomplete with a mean length of 2.6 mm. Fifty percent of the dogs (44% of elbows) had abnormalities of the medial coronoid process and 60% of the elbows had periarticular osteophytes. Group RUI meansurements for IOHC and MCP were not significantly different from normal elbows. CLINICAL SIGNIFICANCE: Small IOHC fissures, periarticular osteophytes and MCP abnormalities may be identified in English Springer Spaniels without forelimb lameness. Abnormalities of the MCP are more common than IOHC.

The use of a stifle flexion device to manage avulsion of the lateral head of the gastrocnemius muscle in a cat.

This report describes the diagnosis and treatment of a traumatic avulsion of the lateral head of the gastrocnemius muscle in a three-and-a-half-year-old male neutered Domestic Shorthaired cat. Surgical repair was achieved using a modified three-loop pulley suture pattern passed through a suture anchor inserted at the point of origin of the tendon and around the fabella. A stifle flexion device was utilised during the postoperative period to protect the repair. Follow-up at five months showed a return to normal function. This is the first report of avulsion of the lateral head of the gastrocnemius in a cat.