Case report: Chylopericardium secondary to dialysis catheter related jugular venous thrombosis in two dogs receiving long-term hemodialysis.

Chylopericardium is a rare entity in veterinary medicine. In this report we document the development of chylopericardium in two dogs undergoing chronic hemodialysis. An 11-year-old female spayed Labrador retriever (Case 1) presented with acute coughing and lethargy 2 months following initial dialysis catheter placement and initiation of dialysis therapy for severe azotemia. Echocardiography demonstrated severe pericardial effusion and cardiac tamponade. Pericardial fluid analysis was consistent with chylous effusion. The dog underwent a subtotal pericardiectomy with thoracic duct ligation, and a PleuralPort™ was placed. The patient continued to receive outpatient hemodialysis therapy after pericardiectomy for several months until she died acutely at home. A 4-year-old male neutered Doberman (Case 2) was being treated for 2 months with outpatient hemodialysis for management of chronic kidney disease. On presentation for the 17th hemodialysis treatment, the patient had increased respiratory rate. Echocardiography demonstrated pleural and pericardial effusions, and fluid analysis in both cavities was consistent with chylous effusion. Use of tissue plasminogen activator (TPA), clot removal and replacement of the catheter was attempted; however pleural and pericardial effusion continued. The patient was euthanized after 25 hemodialysis sessions as owners elected not to pursue more procedures. In both cases, the cause of the chylopericardium was suspected to be secondary to catheter-associated thrombosis and/or stenosis based on multiple imaging modalities. Despite use of rivaroxaban and clopidogrel concurrently in each case, the chylous effusion persisted. This case report describes clinical details of a rare complication of long-term indwelling dialysis catheters in two dogs.

Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

BACKGROUND: Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. HYPOTHESIS/OBJECTIVES: Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). ANIMALS: Eight client-owned dogs with UD treated with an AUS. METHODS: Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. INCLUSION CRITERIA:  diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. RESULTS: Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). CONCLUSION: Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Canine Prostate Cancer: Current Treatments and the Role of Interventional Oncology.

Prostate carcinoma is one of the most common cancers worldwide in men, with over 3 million men currently living with prostate carcinoma. In men, routine screening and successful treatment schemes, including radiation, prostatectomy, or hormone therapy, have allowed for high survivability. Dogs are recognized as one of the only mammals to spontaneously develop prostate neoplasia and are an important translational model. Within veterinary medicine, treatment options have historically been limited in efficacy or paired with high morbidity. Recently, less invasive treatment modalities have been investigated in dogs and people and demonstrated promise. Below, current treatment options available in dogs and people are reviewed, as well as a discussion of current and future trends within interventional treatment for canine PC.

Changing the Culture: Increasing and Sustaining Anesthesiology Resident Physician Publication Rates.

Background: Academic inquiry is foundational to the advancement of medicine and resident training and must be demonstrated to the Accreditation Council for Graduate Medical Education. Past attempts at increasing publication rates have failed to identify educational best practice models. Our aim was to increase resident publication rates via culture and value changes that are universally implementable, affordable, effective, and sustainable. Methods: In 2018, a multifaceted initiative was implemented to shift departmental values and foster a culture of academic productivity. This culture change stressed the value of scientific publication through frequent, consistent messaging from department leaders. In addition, residents were provided the freedom to choose their scholarly activities. In this retrospective cohort innovation, resident authors were identified for 4 academic years before and after the intervention and publication rates were determined (2014-2018 vs 2018-2022). Resident authors and publications per resident per year were compared using descriptive statistics and Student t test. Results: The pre- and postintervention groups included 38 and 37 residents, respectively. Resident-authored publications increased from 7 preintervention to 24 postintervention, representing 343% of baseline. Mean ± SD publications per resident per year similarly increased 357% from 0.183 ± 0.16 to 0.654 ± 0.11 postintervention. Unpaired t test analysis demonstrated a significant difference in total publications per year (P = .002) and authorship rate (P = .003). Conclusions: A multifaceted academic initiative resulted in a threefold increase in resident publication rates. This initiative demonstrates that local advocacy by leaders, freedom of choice for authors, and supportive departmental culture are driving factors in publication rates.

Thoracoscopic resection of lung masses is associated with excellent survival to discharge and good long-term outcomes.

OBJECTIVE: To report and evaluate risk factors for conversion and perioperative and long-term outcomes in dogs undergoing thoracoscopic lung lobectomy for resection of lung masses. ANIMALS: 61 client-owned dogs. METHODS: This retrospective cohort study (June 11, 2008, to February 14, 2020) of data collected from medical records included signalment, results of diagnostic imaging, surgical technique, surgical and anesthesia time, mass location and size, hospitalization time, histopathologic findings, and long-term outcome. Follow-up was obtained from medical records and telephone contact with owners or referring veterinarians. RESULTS: Histopathology results were available for 60 of 61 tumors. Fifty-seven (95%) were considered primary lung tumors, of which 46 (81%) were carcinomas. Clean surgical margins were achieved in 46 of 52 (88%) dogs. Conversion from thoracoscopy to thoracoscopic-assisted or open surgery occurred in 16 of 61 (26%) dogs. Larger tumor diameter (≥ 5 cm) and lymphadenopathy detected by preoperative CT scan were significantly associated with increased risk of conversion. There was no association between conversion and patient weight, body condition score, and tumor location. All 61 dogs survived to discharge, and 56 of 57 were alive 1 month postoperatively. Median overall survival time was 311 days (95% CI, 224 to 570 days). Tracheobronchial lymphadenopathy on preoperative CT scans was associated with shorter postoperative survival (P < .001). Patient age, tumor diameter, adjuvant chemotherapy following surgery, and incomplete margins were not associated with survival time. CLINICAL RELEVANCE: Dogs had high survival to discharge and good long-term prognosis following thoracoscopic lung lobectomy. However, larger tumor size and tracheobronchial lymphadenopathy may increase the likelihood of conversion.

Treatment of retroperitoneal sarcoma results in improved outcomes.

OBJECTIVE: To report the clinical characteristics, treatments, and outcomes in a cohort of dogs with histologically confirmed retroperitoneal sarcoma (RPS) and to identify potential variables of prognostic significance. ANIMALS: 46 client-owned dogs from 10 clinics with histopathologic diagnosis of a sarcoma originating from the retroperitoneal space. METHODS: Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed to report descriptive data for all cases and overall survival time. Multivariate analysis was utilized to evaluate prognostic factors for overall survival. RESULTS: Hemangiosarcoma was the most common histologic subtype diagnosed (76.1%). Cytoreductive and curative intent surgical excision of the RPS was attempted in 12 and 22 dogs, respectively; 12 dogs underwent no surgery or had an exploratory laparotomy with incisional biopsy only. Nineteen dogs received adjuvant chemotherapy, either injectable or metronomic, and 1 dog received adjuvant radiation therapy. Fourteen of the 34 (41.2%) surgically treated dogs developed evidence of local recurrence, but there was no difference in local recurrence when comparing dogs categorized as curative intent versus cytoreductive surgery. The median overall survival time was 238 days. On multivariable analysis, treatment approach was associated with survival with surgical excision (vs palliative treatment) and adjuvant chemotherapy following surgery being protective against death. A diagnosis of hemangiosarcoma was associated with a greater hazard of death. CLINICAL RELEVANCE: This study demonstrates a substantially greater survival time than previously published and suggests a survival benefit from surgical excision and adjuvant chemotherapy.

Minimally invasive splenectomy is associated with a low perioperative complication rate and short operative time in cats.

OBJECTIVE: To report the perioperative outcome and complications in cats undergoing minimally invasive splenectomy. ANIMALS: 17 client-owned cats. METHODS: Perioperative data were collected from cats undergoing minimally invasive splenectomy from September 2010 to June 2023. Data included history, signalment, preoperative examination and diagnostic testing results, operative technique and time, perioperative outcomes, complications, hospitalization duration, histopathological diagnosis, and outcome. RESULTS: 13 spayed females and 4 neutered males were included, with a median age of 144 months (48 to 196 months). Seven cats underwent total laparoscopic splenectomy (TLS), with 1 cat requiring conversion from TLS to laparoscopic-assisted splenectomy (LAS) due to splenomegaly and an additional cat requiring conversion from TLS to open splenectomy due to uncontrollable splenic capsular hemorrhage. Ten cats underwent LAS, with 1 cat requiring conversion to open splenectomy due to splenomegaly. Additional procedures were performed in 13 cats, with the most common being liver biopsy in 10 cats. Median operative times were 50 minutes (45 to 90 minutes) for TLS and 35 minutes (25 to 80 minutes) for LAS. An intraoperative complication occurred in 1 cat. All but 1 cat survived to discharge. Median follow-up time was 234 days (18 to 1,761 days), with 15 of 16 cats confirmed alive at 30 days and 9 of 16 cats alive at 180 days postoperatively. CLINICAL RELEVANCE: Minimally invasive splenectomy in this cohort of cats was associated with short operative times and a low perioperative complication rate. Veterinary surgeons may consider minimally invasive splenectomy as an efficient and feasible technique in the treatment of splenomegaly or modestly sized splenic masses for diagnostic and therapeutic purposes in cats.

Veterinary Interventional Oncology.

Interventional oncology (IO) is a rapidly growing field in veterinary medicine and has been accepted as a fourth pillar of treatment of neoplastic disease with other modalities including surgery, chemotherapy, and radiation therapy. The major categories of IO therapies in companion animals are focused on the use of locoregional therapies and stenting of malignant obstructions. Although significant assessment of veterinary IO techniques is still necessary, early evaluation of these varying techniques is demonstrating promising results.

Pharyngeal oxygen delivery device sustains manikin lung oxygenation longer than high-flow nasal cannula.

Purpose: Hypoxemia during a failed airway scenario is life threatening. A dual-lumen pharyngeal oxygen delivery device (PODD) was developed to fit inside a traditional oropharyngeal airway for undisrupted supraglottic oxygenation and gas analysis during laryngoscopy and intubation. We hypothesized that the PODD would provide oxygen as effectively as high-flow nasal cannula (HFNC) while using lower oxygen flow rates. Methods: We compared oxygen delivery of the PODD to HFNC in a preoxygenated, apneic manikin lung that approximated an adult functional residual capacity. Four arms were studied: HFNC at 20 and 60 liters per minute (LPM) oxygen, PODD at 10 LPM oxygen, and a control arm with no oxygen flow after initial preoxygenation. Five randomized 20-minute trials were performed for each arm (20 trials total). Descriptive statistics and analysis of variance were used with statistical significance of P < 0.05. Results: Mean oxygen concentrations were statistically different and decreased from 97% as follows: 41 ± 0% for the control, 90 ± 1% for HFNC at 20 LPM, 88 ± 2% for HFNC at 60 LPM, and 97 ± 1% (no change) for the PODD at 10 LPM. Conclusion: Oxygen delivery with the PODD maintained oxygen concentration longer than HFNC in this manikin model at lower flow rates than HFNC.

Adrenal tumors treated by adrenalectomy following spontaneous rupture carry an overall favorable prognosis: retrospective evaluation of outcomes in 59 dogs and 3 cats (2000-2021).

OBJECTIVE: To conduct a retrospective multi-institutional study reporting short- and long-term outcomes of adrenalectomy in patients presenting with acute hemorrhage secondary to spontaneous adrenal rupture. ANIMALS: 59 dogs and 3 cats. METHODS: Medical records of dogs and cats undergoing adrenalectomy between 2000 and 2021 for ruptured adrenal masses were reviewed. Data collected included clinical presentation, preoperative diagnostics, surgical report, anesthesia and hospitalization findings, histopathology, adjuvant treatments, and long-term outcome (recurrence, metastasis, and survival). RESULTS: Median time from hospital admission to surgery was 3 days, with 34% of surgeries being performed emergently (within 1 day of presentation). Need for intraoperative blood transfusion was significantly associated with emergent surgery and presence of active intraoperative hemorrhage. The short-term (≤ 14 days) complication and mortality rates were 42% and 21%, respectively. Negative prognostic factors for short-term survival included emergent surgery, intraoperative hypotension, and performing additional surgical procedures. Diagnoses included adrenocortical neoplasia (malignant [41%], benign [12%], and undetermined [5%]), pheochromocytoma (38%), a single case of adrenal fibrosis and hemorrhage (2%), and a single case of hemangiosarcoma (2%). Local recurrence and metastasis of adrenocortical carcinoma were confirmed in 1 and 3 cases, respectively. Overall median survival time was 574 days and 900 days when short-term mortality was censored. No significant relationship was found between histopathological diagnosis and survival. CLINICAL RELEVANCE: Adrenalectomy for ruptured adrenal gland masses was associated with similar short- and long-term outcomes as compared with previously reported nonruptured cases. If hemodynamic stability can be achieved, delaying surgery and limiting additional procedures appear indicated to optimize short-term survival.

A Systematic Review of Canine Cystectomy: Indications, Techniques, and Outcomes.

This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes.

Laparoscopic adrenalectomy for resection of unilateral noninvasive adrenal masses in dogs is associated with excellent outcomes in experienced centers.

OBJECTIVE: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity. ANIMALS: 255 client-owned dogs. METHODS: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time. RESULTS: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence. CLINICAL RELEVANCE: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.

Bilateral external jugular vein anomalies preventing hemodialysis catheter placement in a cat with anuria secondary to Lilium species intoxication.

Case series summary: A 2-year-old female spayed Abyssinian cat was evaluated for lethargy and inappetence that first occurred approximately 4 days prior. In addition, urination had not been observed by the owner for 5 days. A Lilium species plant had been brought into the house approximately 5 days before initial evaluation, and intoxication was therefore suspected. Bloodwork revealed anemia, severe azotemia and hyperkalemia. As the cat was anuric with severe azotemia, hyperkalemia and fluid overload, intermittent hemodialysis was recommended. Attempts were made to place a hemodialysis catheter into the external jugular veins bilaterally, but after initial successful venipuncture, the instrumentation would not pass into either vein. During fluoroscopic angiography, no internal jugular veins or external jugular veins caudal to the thoracic inlet were visualized and venous drainage from the head occurred via the vertebral veins. Owing to the anomalous anatomy in the cervical region, a hemodialysis catheter could not be placed into either jugular vein. Alternative sites for the placement of an extracorporeal catheter were discussed with the owner, but humane euthanasia was elected. Relevance and novel information: To the authors' knowledge, this is the first report of a cat with bilateral external jugular vein anomalies resulting in blind endings that did not communicate with the vena cava. This was discovered during attempts to place a hemodialysis catheter for the management of anuric renal failure secondary to Lilium species intoxication. While this anatomical variation is likely uncommon, it is an important differential to consider when faced with challenging external jugular vein catheterizations in feline patients.

A 20-year scoping review of the veterinary interventional radiology and interventional endoscopy literature (2000-2019).

BACKGROUND: Interventional radiology (IR) and interventional endoscopy (IE) have broad potential for minimally invasive therapy in veterinary patients, but the scope of original peer-reviewed veterinary IR/IE research publications has not been described. OBJECTIVES: Catalogue published applications and indications for noncardiac therapeutic IR/IE in animals and describe type and quality of veterinary IR/IE research over 20 years. METHODS: Highly-cited veterinary journals were searched to identify articles published 2000 to 2019 involving therapeutic IR/IE applications for clinical veterinary patients. Articles were assigned a level of evidence (LOE) according to published standards. Authorship, animal data, study design, and interventions were described. Change in publication rate, study size, and LOE of IR/IE articles over time was analyzed. RESULTS: One hundred fifty-nine of 15 512 (1%) articles were eligible, including 2972 animals. All studies were low LOE and 43% were case reports with ≤5 animals. Number of IR/IE articles per year (P < .001), proportion of journals' articles pertaining to IR/IE (P = .02), and study size (P = .04) all increased over time, but LOE (P = .07) did not. Common target body systems were urinary (40%), digestive (23%) respiratory (20%), and vascular (13%). Common indications were nonvascular luminal obstructions (47%), object retrieval (14%), and congenital anomalies (13%). Most procedures involved indwelling medical devices or embolic agents, whereas tissue resection and other procedures were less common. Procedures utilized fluoroscopy (43%), endoscopy (33%), ultrasound (8%), digital radiography (1%), or fluoroscopy in combination with other modalities (16%). CONCLUSIONS: Treatments involving IR/IE have wide applicability in veterinary medicine but large, rigorous, and comparative studies describing these procedures are lacking.

Short- and long-term outcomes associated with anal sacculectomy in dogs with massive apocrine gland anal sac adenocarcinoma.

OBJECTIVE: To evaluate short- and long-term outcomes for dogs undergoing anal sacculectomy for massive (> 5 cm) apocrine gland anal sac adenocarcinoma (AGASACA). ANIMALS: 28 client-owned dogs with massive AGASACA. PROCEDURES: A retrospective multi-institutional study was performed. Pre-, intra-, and post-operative data was collected, and variables were statistically analyzed for associations with progression-free interval (PFI) and overall survival (OS). RESULTS: At the time of anal sacculectomy, 19 (68%) dogs underwent concurrent iliosacral lymph node extirpation, including 17 of 18 (94%) dogs with suspected nodal metastasis preoperatively. Five (18%) dogs experienced grade 2 intraoperative complications. Ten (36%) dogs experienced postoperative complications, including 1 grade 3 and 1 grade 4 complication. No dogs had permanent fecal incontinence, tenesmus, or anal stenosis. Nineteen dogs received adjuvant chemotherapy, radiation, or both. Local recurrence occurred in 37% of dogs. Dogs with lymph node metastasis at surgery were more likely than dogs without metastasis to develop new/progressive lymph node metastasis (10/17 [59%] vs 0/10 [0%]; P = .003) and distant metastasis (7/17 [41%] vs 0/10 [0%]; P = .026). Median PFI was 204 days (95% CI, 145 to 392). Median OS was 671 days (95% CI, 225 to upper limit not reached). Nodal metastasis at the time of surgery was associated with shorter PFI (P = .017) but not OS (P = .26). Adjuvant therapy was not associated with outcome. CLINICAL RELEVANCE: Dogs with massive AGASACA experienced prolonged survival following anal sacculectomy despite a high incidence of local recurrence and metastasis. Lymph node metastasis at the time of surgery was a negative prognostic indicator for PFI but not OS.

Modified hemipelvectomy techniques in dogs and cats appear well tolerated with good functional outcomes.

OBJECTIVE: To describe the clinical characteristics, procedural techniques, complications, and outcomes of dogs and cats undergoing any of the following modified hemipelvectomy techniques: concurrent partial sacrectomy and/or partial vertebrectomy, osseous excision crossing midline, and reconstruction without the use of local musculature. ANIMALS: 23 client-owned animals (20 dogs and 3 cats) that underwent modified hemipelvectomy techniques. Animals that underwent traditional (nonmodified) hemipelvectomy techniques were excluded. PROCEDURES: The medical records of 3 academic institutions were reviewed, and data were recorded and analyzed. RESULTS: Modified hemipelvectomy was performed with partial sacrectomy and/or vertebrectomy in 11 dogs, excision crossing pelvic midline with concurrent limb amputation in 5 dogs and 2 cats, and closure without use of native muscle or mesh in 4 dogs and 1 cat. Surgery was performed for tumor excision in all cases. Excision was reported as complete in 16 of 23, incomplete in 6 of 23, and not recorded in 1 of 23 animals. All animals survived to discharge. Only animals undergoing partial sacrectomy/vertebrectomy (4/11) experienced postoperative mobility concerns. Major intra- or post-operative complications (grades 3 and 4) occurred in 2 dogs that underwent partial sacrectomy/vertebrectomy, and 1 of these animals experienced a complication that resulted in death. The median time to death or last follow-up was 251 days (range, 3 to 1,642). CLINICAL RELEVANCE: The modified hemipelvectomy techniques reported in this cohort were overall well tolerated with good functional outcomes. These findings support the use of these modified hemipelvectomy techniques in dogs and cats, and previous notions regarding tolerable hemipelvectomy procedures should be reconsidered. However, additional studies with larger numbers of patients undergoing modified hemipelvectomy techniques are needed to gain more information.

Arterial Cannulation Near-Miss During Jugular Venous Catheterization With Carotid Artery Aneurysm: A Case Report.

Central venous catheterization is a common procedure that may lead to inadvertent arterial cannulation, potentially causing bleeding, hematoma, stroke or rarely, death. In this near-miss case presentation, an aneurysmal carotid artery was misidentified with ultrasound by a junior resident, nearly leading to placement of a sheath into the artery. This case highlights arterial punctures that still occur even with ultrasound guidance. Further, training inadequacies as well as anatomic, cultural, and production pressure factors led to this potentially highly morbid near-miss. Physician teachers should critically evaluate teaching methods to confirm that trainees are learning skills as intended. (A&A Practice. 2023;17:e01661.).