Incidence and characterization of aerophagia in dogs using videofluoroscopic swallow studies.

BACKGROUND: Aerophagia (ingestion of air), is a functional aerodigestive disorder in people. Criteria for diagnosis of aerophagia in dogs are >1/3 of bolus volume containing air or ingested air resulting in gastric distention (>1/3 of end gastric volume). Aerophagia is highlighted during eating and drinking. Videofluoroscopic swallow studies (VFSS) document aerophagia in dogs, but the incidence, clinical signs (CS), and associated disorders are unknown. OBJECTIVES: Identify the incidence of aerophagia, compare CS between dogs with and without aerophagia, and identify associated and predisposing disorders using VFSS. ANIMALS: A total of 120 client-owned dogs. METHODS: Sequential VFSS and associated medical records from dogs presenting to veterinary teaching hospitals at Auburn University and the University of Missouri were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney and chi-squared tests, odds ratios (OR), and multiple logistic regression (P < .05). RESULTS: The incidence (95% confidence interval [CI]) of aerophagia was 40% (31.7-48.9). Dogs with mixed CS (gastrointestinal [GI] and respiratory; P < .001, 58.3%) were more likely to have aerophagia than dogs with exclusively respiratory CS (25%). Aerophagia was significantly more common in brachycephalic dogs (P = .01; 45.8% vs 13.8%), dogs with nonbrachycephalic upper airway obstruction (P < .001; 33.3% vs 4.1%), pathologic penetration and aspiration (P-A) scores (P = .04; 41.6% vs 23.6%), and gagging (P < .001; 25% vs 11.7%). Mixed CS (P = .01), brachycephaly (P < .001), and upper airway obstruction (P < .001) were independent predictors of aerophagia. CONCLUSIONS AND CLINICAL IMPORTANCE: Aerophagia was common, particularly in dogs with mixed CS. Brachycephalic dogs and dogs with upper airway obstruction are predisposed. Aspiration risk was high, emphasizing overlapping upper aerodigestive pathways.

Fluoroscopically measured bronchial collapse in healthy dogs during cough exceeds 25%, and a cutoff of 60% bronchial collapse can be used to distinguish healthy from chronically coughing dogs.

Bronchomalacia, the weakening of bronchial cartilage, is a common cause of cough in dogs. The gold standard for diagnosis of bronchomalacia is bronchoscopy; however, fluoroscopy is often used as a preliminary diagnostic test due to its noninvasiveness. The normal amount of bronchial collapse in healthy dogs using fluoroscopy has not been previously established, with some authors citing <25%. The aims of this prospective and retrospective analytical observational study were to determine the normal amount of airway collapse in healthy animals, the amount of airway collapse in dogs with chronic cough and presumed bronchomalacia, and cut-off values of airway collapse during expiration and cough to distinguish between the two groups. Thoracic fluoroscopy was performed in right and left lateral recumbency during inspiration, expiration, and cough to evaluate the percentage collapse of the trachea and lobar bronchi in 45 healthy and 76 chronically coughing dogs. The bronchi of chronically coughing dogs exhibited a significantly greater amount of collapse during both expiration and cough compared with healthy dogs. Chronically coughing dogs exhibited up to 31.7 ± 26.6% collapse in expiration and 87.5 ± 23.7% collapse during cough, whereas healthy dogs exhibited 14.9 ± 6.1% collapse in expiration and 35.0 ± 13.7% collapse during cough. Based on ROC curves, the authors suggest using cut-off values of 30% during expiration and 60% during cough to distinguish between healthy dogs and those with presumed bronchomalacia. Findings suggest that though healthy dogs can exhibit a greater degree of airway collapse than previously thought, fluoroscopy can be used to distinguish between healthy and presumed bronchomalacic dogs.

Fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac luxations in cats using 2.4 mm headless cannulated compression screws: Description, evaluation and clinical outcome.

OBJECTIVE: To describe fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac-luxation (SIL) in cats and report radiographic results and long-term functional outcomes. STUDY DESIGN: Retrospective clinical study. ANIMALS: Eleven cats. METHODS: Percutaneous fixation of 17 SILs in 11 cats was performed with 2.4 mm headless cannulated compression screws under fluoroscopic guidance. Luxation-reduction, screw placement and purchase within the sacral body, pelvic canal diameter ratio (PCDR) and hemipelvic canal width ratio (HCWR) were assessed on pre- and postoperative radiographs. Radiographic follow-up was performed to assess the same parameters when available. Long-term clinical outcome was evaluated with an owner questionnaire. Wilcoxon paired-test was performed for comparison. RESULTS: Mean age and bodyweight of the cats were 3.3 ± 2.6 years and 4.0 ± 0.82 kg, respectively. Nine cats presented with concurrent pelvic injuries. Median luxation-reduction was 94.1% (IQR = 13.9) and median screw-purchase within the sacral body was 73.3% (IQR = 17.0) immediately postoperatively. One screw exited the sacral body caudally. Upon 7-week radiographic follow-up, luxation-reduction (88.3%, IQR = 20.1) and screw-purchase (70.7%, IQR = 12.8) had decreased compared to immediately postoperatively (p = .008 and p = .013 respectively). Screw migration was not observed. PCDR and HCWR measured on postoperative radiographs indicated successful restoration of the pelvic canal width. Owners reported an excellent long-term functional outcome (mean postoperative time: 19 ± 5 months). CONCLUSION: Fluoroscopically-assisted closed reduction and fixation of feline SIL using 2.4 mm headless cannulated compression screws allowed good reduction and optimal screw purchase within the sacral body. An excellent functional outcome was reported. CLINICAL SIGNIFICANCE: Minimally invasive reduction and fixation with headless compression screws should be considered in cats with SIL.

Reliability of fluoroscopic examination of nasopharyngeal dorsoventral dimension change in pugs and French bulldogs.

OBJECTIVE: To compare intra- and interobserver agreements in two-dimensional measurements of changes in nasopharyngeal dimensions during breathing in pugs and French bulldogs. STUDY DESIGN: Experimental randomized study. ANIMALS: A total of 20 French bulldogs and 16 pugs. METHODS: Four observers with different levels of experience measured the dorsoventral dimensions of the nasopharynx during inspiration and expiration on fluoroscopy videos. Measurements were performed at the maximal narrowing of the nasopharynx for the functional method and at the level of the tip of the epiglottis for the anatomically adjusted method. The intra- and interobserver agreements of the measurements, ratio of the dynamic nasopharyngeal change (ΔL), and grade of nasopharyngeal (NP) collapse (no, partial or complete) were evaluated. RESULTS: The functional method resulted in intraobserver correlation coefficients of 0.532 (p < .01) and 0.751 (p < .01) and interobserver correlation coefficients of 0.378 (p < .01) and 0.621 (p < .01) for NP collapse grade and ΔL, respectively. The anatomically adjusted method, 0.491 (p < .01) and 0.576 (p < .01) and 0.495 (p < .01) and 0.729 (p < .01) for NP collapse grade and ΔL, respectively, were being used. One observer (radiologist) achieved intraobserver correlation coefficients >0.9 for both methods. CONCLUSION: Fair interobserver agreement was found for NP collapse grade (functional method), moderate intra- and interobserver agreements were found for NP collapse grade and ΔL (both methods) while intraobserver agreement for ΔL was good (functional method). CLINICAL SIGNIFICANCE: Both methods seem repeatable and reproducible but only for experienced radiologists. The use of ΔL may offer higher repeatability and reproducibility than grade of NP collapse regardless of the method used.

Computed tomography and fluoroscopy versus radiographic guidance for internal fixation of simulated dorsomedial-plantarolateral central tarsal bone fractures in nonracehorses.

OBJECTIVE: The aim of this study was to assess screw placement in simulated dorsomedial-plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques - computed tomography (CT) with fluoroscopy compared to digital radiography alone (DR). STUDY DESIGN: Experimental study. SAMPLE POPULATION: Equine cadaver hindlimbs (n = 10 pairs). METHODS: One tarsus per pair was randomly assigned to have a 4.5 mm cortical screw placed across the CTB using CT and fluoroscopy (CT/F group) or digital radiography alone (DR group). Postoperative CT was performed on all limbs. Variables related to marker placement, procedure time, and screw positioning were recorded and compared using a paired t-test for dependent means (p < .05). RESULTS: Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12). CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning. Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%-91.2%) versus CT/F (78.4%-84.0%). CONCLUSION: Internal fixation of CTB fractures can be successfully performed using either technique for imaging guidance. CT and fluoroscopy did not result in faster or more accurate screw placement compared to radiographs alone, except in determining screw length. CLINICAL SIGNIFICANCE: Mild adjustments in fluoroscopic or radiographic angle appeared to be a point of variability in the perception of screw placement. While CT is recommended for improved understanding of fracture configuration and surgical planning, radiographic guidance may be a suitable alternative for internal fixation of dorsomedial-plantarolateral fractures.

Radiation exposure to the orthopedic surgeon-a dosimetric comparison of two mini C-arm fluoroscopy models: a pilot study.

OBJECTIVE: Perform a cadaveric experimental pilot study to measure and compare potential radiation exposure to an orthopedic surgeon from 2 different-generation mini C-arm models during a simulated orthopedic surgery. SAMPLE: 16 radiation dosimeters. METHODS: Mock surgery setups were constructed with a canine cadaver thoracic limb and 2 different-generation mini C-arm models. Four radiation dosimeters were placed near the mini C-arm to mimic common locations of radiation exposure during image acquisition. One mini C-arm was placed in auto technique mode, and 100 static images were acquired. The dosimeters were replaced, and a 5-minute-long dynamic image was acquired. The same protocols were repeated for the second mini C-arm. The dosimetry badges were then submitted for radiation exposure quantification. RESULTS: All but 1 dosimeter had radiation exposure levels below the detectable limits of the dosimeter. The dosimeter closest to the primary x-ray beam of 1 mini C-arm during dynamic image acquisition had a reading of 1 mrem. CLINICAL RELEVANCE: Intraoperative radiation exposure from the mini C-arm is low, specifically to areas not protected by lead and in close proximity to the primary x-ray beam. That being said, surgeons should always practice the principles of ALARA (ie, as low as reasonably achievable) to minimize radiation exposure in the workplace.

Fluoroscopy-guided fine-needle aspiration of deep-seated pulmonary masses in dogs and cats appears safe and accurate.

OBJECTIVE: Deep-seated pulmonary lesions can be difficult to sample safely. The objective of this study was to determine the relative safety and accuracy of fluoroscopy-guided fine-needle aspiration of deep-seated pulmonary lesions regardless of their size and depth. ANIMALS: Client-owned animals; 5 dogs and 5 cats. CLINICAL PRESENTATION: Pulmonary lesion locations were determined on dorsoventral and lateral views using fluoroscopy. The lateral thoracic wall was aseptically scrubbed, and an indelible marker was used to mark the point of entry of the needle for sampling. The path of a 22-gauge needle attached to a syringe was followed using fluoroscopic guidance. Mass volume (Vma) and distance from skin and pleura to lesion (DSK-L and DPL-L) were recorded. RESULTS: In dogs, mean Vma was 137.2 cm3 (range, 6.3 to 426.2 cm3). Mean DSK-L was 71 mm (range, 37 to 101 mm) and DPL-L was 33 mm (range, 16 to 71 mm). Exfoliative cytology results were consistent with carcinoma in 4 dogs and lymphoma in 1 dog. A minor postprocedural complication was noted in 1 dog. In cats, the mean Vma was 2.4 cm3 (range, 1.6 to 3.7 cm3). Mean DSK-L was 42 mm (range, 20 to 75 mm) and DPL-L was 21 mm (range, 12 to 32 mm). Cytology results were consistent with pulmonary carcinoma in 2 cats, inflammation in 2 cats, and necrotic debris in 1 cat. CLINICAL RELEVANCE: Fluoroscopy-guided fine-needle aspiration of pulmonary masses is a safe and accurate technique to obtain cytologic samples irrespective of the size and depth of the lesions.

Evaluation of a 3-D printed drill guide to facilitate fluoroscopic-assisted Kirschner wire placement for minimally invasive iliosacral screw placement in dog cadavers.

OBJECTIVE: To evaluate the ease and accuracy of using a 3-D printed (3-DP) drill guide to insert Kirschner wires through the ilium and into the sacral body in preparation for minimally invasive iliosacral screw placement in dog cadavers. ANIMALS: 10 dog cadavers weighing 20 to 30 kg (mean ± SD, 24.5 ± 5 kg). METHODS: Kirschner wires were placed using a limited approach to the lateral ilium. Fluoroscopy was used in freehand and 3-DP drill guide application groups to facilitate the placement of a 1.0-mm Kirschner wire that was over-drilled using a 2.5-mm cannulated drill bit. Kirschner wires were placed using a 3-DP drill guide on 1 hemipelvis and freehand wire placement was done on the contralateral hemipelvis. Postprocedural CTs were obtained, and 2-D and 3-D analyses were performed. The Student t-test and Wilcoxon rank sum test were used to compare groups. A Pearson correlation coefficient was performed to evaluate the in-group correlation. RESULTS: Likert scores that assessed the ease of the procedure were significantly greater (P = .04) and the incision length was significantly shorter (P = .016) in the 3-DP drill guide group compared with the freehand group. The time of the procedure, the number of attempts to obtain accurate Kirschner wire placement, and fluoroscopy images did not differ (P > .05) between application groups. Drill tracks were primarily confined to the sacral body, with minor projected screw thread cortical breeches occurred in 1 cadaver in the freehand group and 2 cadavers in the 3-DP drill guide group. CLINICAL RELEVANCE: The 3-DP drill guide simplified appropriate iliosacral Kirschner wire placement through a smaller incision compared with freehand drilling and would appear to be an efficient, practical instrument to facilitate accurate fluoroscopic-assisted screw placement when stabilizing sacroiliac luxations in dogs.

Fluoroscopy-Guided Surgical Removal of a Microchip from the Spinal Canal of Two Cats.

Two cats were presented with acute left-sided paresis after implantation of a microchip at the referring veterinary clinic. Neurological examinations were consistent with left-sided lesions between spinal cord segments C1 and C5. Orthogonal radiographs of the cervical spine showed a microchip dorsoventrally oriented, partially embedded in the cervical vertebral canal. Fluoroscopy was used to localize and retrieve the foreign body from the cervical spinal cord in each case. Improvement in clinical condition and return to ambulation was observed in both cats within 48 hr of surgical removal of the implant. No significant perioperative adverse events were noted during the surgical retrieval of the microchip. Two previously reported cases of intraspinal canal microchip placement had been treated surgically by hemilaminectomy. This approach carries a risk of complications, including hemorrhage from the venous sinus, iatrogenic damage to the spinal cord, and improper identification of the surgical site, requires advanced surgical training, and typically has an extended surgical time. The use of fluoroscopy to assist intraoperative localization of a spinal canal foreign body may lessen the requirement for more invasive surgical procedures.

Radiation dose during interventional cardiology procedures: portable C-arm vs. a new generation fluoroscopy system.

INTRODUCTION: Occupational exposure to ionizing radiation poses health risks for veterinary interventionalists. There are limited veterinary studies evaluating radiation dose in the cardiac catheterization laboratory. The purpose of this study was to report direct radiation dose exposure to patients during common interventional cardiology procedures and compare these doses between two fluoroscopy units. ANIMALS: One hundred and fifty-four client-owned dogs. MATERIALS AND METHODS: Patient dose during procedures using a portable C-arm were retrospectively analyzed and compared to those performed in a contemporary interventional suite. Fluoroscopy equipment, procedure type, operator, patient weight, fluoroscopy time, dose area product, and air kerma were recorded and statistically modeled using univariable and multivariable linear regression to evaluate the effect of each factor. RESULTS: Patient dose population (154 dogs), comprised 61 patent ductus arteriosus occlusions, 60 balloon pulmonary valvuloplasties, and 33 pacemaker implantations. Patient dose was significantly lower in the group utilizing a newer generation fluoroscopy unit vs. the group utilizing an older portable C-arm, positively correlated with patient weight, and highest during balloon pulmonary valvuloplasties compared to patent ductus arteriosus occlusions or pacemaker implantations (all P<0.010). DISCUSSION: Newer fluoroscopy systems can be equipped with technologies that improve image quality while reducing patient dose and radiation exposure to interventional personnel. CONCLUSIONS: We documented a significant reduction in patient radiation dose using a newer fluoroscopy system as compared to an older portable C-arm for interventional cardiology procedures in animals. Improved knowledge of patient radiation dose factors may promote better radiation safety protocols in veterinary interventional cardiology.

Cholangiopancreatography in cats: a post-mortem comparison of MRI with fluoroscopy, corrosion casting and histopathology.

In human medicine, magnetic resonance cholangiopancreatography (MRCP) is a valuable diagnostic tool for hepatobiliary and pancreatic diseases. In veterinary medicine, however, data evaluating the diagnostic value of MRCP are limited. The primary objectives of this prospective, observational, analytical investigation were to assess whether MRCP reliably visualizes the biliary tract and pancreatic ducts in cats without and with related disorders, and whether MRCP images and measurements of the ducts agree with those of fluoroscopic retrograde cholangiopancreatography (FRCP), corrosion casting and histopathology. A secondary objective was to provide MRCP reference diameters for bile ducts, GB, and pancreatic ducts. Donated bodies of 12 euthanized adult cats underwent MRCP, FRCP, and autopsy with corrosion casting of the biliary tract and pancreatic ducts using vinyl polysiloxane. Diameters of the biliary ducts, gallbladder (GB), and pancreatic ducts were measured using MRCP, FRCP, corrosion casts and histopathologic slides. There was an agreement between MRCP and FRCP in measuring diameters of the GB body, GB neck, cystic duct, and common bile duct (CBD) at papilla. Strong positive correlations existed between MRCP and corrosion casting for measuring GB body and neck, cystic duct, and CBD at the extrahepatic ducts' junction. In contrast to the reference methods, post-mortem MRCP did not visualize right and left extrahepatic ducts, and pancreatic ducts in most cats. Based on this study, MRCP with 1.5 Tesla can be regarded as a contributory method to improve the assessment of feline biliary tract and pancreatic ducts when their diameter is >1 mm.

The effect of an aiming device on the accuracy of humeral transcondylar screw placement.

OBJECTIVES: (1) To evaluate the accuracy of an aiming device on placement of humeral transcondylar screws compared to fluoroscopic methods. (2) To compare experience level on outcome. STUDY DESIGN: Randomized, match pair, prospective ex-vivo study. SAMPLE POPULATION: A total of 68 dogs. METHODS: Canine cadaveric forelimbs were randomly assigned to either aiming device or fluoroscopic-guided groups, and to diplomate or resident. Digital radiography was used to evaluate screw trajectory deviation and eccentricity on the humeral condyle. Procedure time, outcome based on experience, and complications were recorded. RESULTS: The aiming device screw trajectory angle was decreased in the right limb (1.9 ± 1.1°) compared with the left (3.6 ± 1.1°, p = .0178), and compared to fluoroscopy (3.4 ± 1.1° p = .0128). There was no difference between leg laterality with fluoroscopy (p = .9979). Trajectory angle was increased with resident versus diplomate (3.4 ± 1.1° and 2.5 ± 1.1° respectively, p = .0366). Eccentricity deviation was decreased using fluoroscopy versus aiming device (3.1 ± 0.36 mm, 4.2 ± 0.36 mm, respectively, p = .0017). The risk of joint involvement was 8 times greater in aiming device groups, though not significant (p = .0575). Significant complications included increased drill attempts in fluoroscopic groups (p = .0237). CONCLUSION: The aiming device provided accurate placement of transcondylar screws, in terms of both position on the condyle and trajectory angle. Results were similar to fluoroscopic-guided method. CLINICAL SIGNIFICANCE: An aiming device is an acceptable means of placing humeral transcondylar screws. The use of the aiming device had an eight times increased risk of joint involvement compared to fluoroscopy.

Videofluoroscopic swallow study abnormalities identify aerodigestive disorders in dogs with respiratory disease versus healthy controls.

BACKGROUND: Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration. OBJECTIVES/HYPOTHESIS: We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease. ANIMALS: Client-owned dogs: RESP (n = 45) and CON (n = 15) groups. METHODS: Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS. RESULTS: Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P = .01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P = .03). The RESP dogs with airway disease had higher PAS than CON dogs (P = .01) but not RESP dogs with parenchymal disease (P = .25). CONCLUSIONS: Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.

Fluoroscopic Categorization of Cementless Acetabular Component Positioning.

OBJECTIVES: The purpose of this study was to evaluate a fluoroscopic method of angle of lateral opening (ALO) categorization based on identification of the visible portion of a pre-existing, circular recess within the metal shell of the BioMedtrix BFX acetabular component, which projects as an ellipse at clinically relevant ALO values. Our hypothesis was that there will be an association between the actual ALO and the categorization of ALO based on identification of the visible portion of the elliptical recess on a lateral fluoroscopic image at clinically relevant values. STUDY DESIGN: A custom plexiglass jig was fitted with a two-axis inclinometer and a 24 mm BFX acetabular component attached to its tabletop. Fluoroscopic reference images were obtained with the cup positioned at an ALO of 35, 45 and 55 degrees with a fixed 10 degrees of retroversion. Thirty study fluoroscopic images (10 images at each ALO) were obtained based on randomization at an ALO of 35, 45 and 55 degrees (±0.5 degrees) with 10 degrees of retroversion. The order of the study images was randomized, and a single, blinded observer categorized the 30 study images as representing an ALO of 35, 45 or 55 degrees by comparison to the reference images. RESULTS: Analysis showed perfect (30/30) agreement with a weighted kappa coefficient of 1 (95% confidence interval: -0.717 to 1). CLINICAL RELEVANCE: The results demonstrate that accurate categorization of ALO can be achieved using this fluoroscopic method. This method may prove to be a simple but effective method of estimating intraoperative ALO.

Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs.

OBJECTIVES: To report the short-term clinical outcome and complications in dogs that underwent surgical repair of femoral capital physeal or neck fractures via fluoroscopic-guided percutaneous pinning (FGPP). STUDY DESIGN: Retrospective case series. ANIMALS: Client owned dogs (n = 11) with femoral capital physeal or neck fractures (n = 13). METHODS: Records (July 2018-July 2021) of dogs that underwent surgery for femoral capital physeal or neck fracture repair with FGPP from two hospitals were reviewed. Data collected included signalment, age, weight, preoperative lameness severity, fracture factors (etiology, Salter-Harris classification, time from injury to surgery, radiographic displacement), surgical factors (surgery time, number/size of implants, reduction quality) and outcome (follow-up examination findings, radiographic findings, complications). RESULTS: Most fractures (11/13) occurred secondary to trauma. The median time from injury to surgery was 5.5 days. There was mild radiographic displacement preoperatively in 10/13 fractures. Satisfactory fracture healing and limb function was achieved in 10/13 femurs. Complications occurred in 5/11 cases and included intra-articular implants, implant failure/nonunion, implant migration (2), and malunion. Of these five complications, two resolved with implant removal, and a salvage procedure was recommended in the remaining cases. Of the three cases requiring salvage procedures, two originally presented with radiographic evidence of fracture chronicity. CONCLUSIONS: FGPP can be used to successfully treat femoral head and neck fractures with appropriate case selection and precise surgical technique.

Incidence, clinical signs, and videofluoroscopic swallow study abnormalities associated with airway penetration and aspiration in 100 dogs.

BACKGROUND: Videofluoroscopic swallow studies (VFSS) utilizing penetration-aspiration (P-A) scoring assesses airway protection in people. On VFSS, penetration (ingesta or secretions immediately cranial to the vocal folds) and aspiration (material caudal to the vocal folds) are associated with increased risk of lung injury in people. Penetration-aspiration (P-A) scoring has been validated in animal models, but the incidence of P-A, clinical signs (CS), and dysphagic disorders associated with P-A in dogs are unknown. OBJECTIVES: Using VFSS, identify the incidence of P-A, compare CS between dogs with and without P-A, and identify predisposing dysphagic abnormalities for P-A. ANIMALS: One hundred client-owned dogs. METHODS: Sequential VFSS and associated medical records from dogs presenting to the veterinary teaching hospitals at Auburn University (n = 53) and the University of Missouri (n = 47) were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney tests, one-way analysis of variance (ANOVA) on ranks, multiple linear regression, and Spearman rank order correlation (P < .05). RESULTS: On VFSS, the incidence of pathologic P-A was 39%. No significant differences in CS were found between dogs with or without P-A (P > .05), with 14/39 dogs with P-A presenting without respiratory CS. Pharyngeal (P < .001) and esophageal (P = .009), but not oral-preparatory (P = .2) dysphagia was more common with P-A. Pharyngeal weakness (P < .001) and esophago-oropharyngeal reflux (EOR; P = .05) were independent predictors of P-A and were moderately and weakly positively correlated with P-A score respectively (P < .001, r = 0.489; P = .04, r = 0.201). CONCLUSIONS: Penetration-aspiration occurs in dogs in the absence of respiratory CS (i.e., occult P-A). Dogs with pharyngeal weakness and EOR should be considered at risk for P-A.

Feasibility and safety of three-dimensional electroanatomical cardiac mapping, mapping-guided biopsy and transseptal puncture in dogs.

Three-dimensional electroanatomical mapping (3D EAM) has expanded radiofrequency catheter ablation applications in humans to almost all complex arrhythmias and has drastically reduced fluoroscopy use, yet its potential in dogs is poorly investigated. The objectives of the current study were to assess the feasibility and safety of 3D EAM of all four heart chambers, 3D EAM-guided biopsies and transseptal puncture in dogs. Eight healthy purpose-bred Beagle dogs. Electroanatomical mapping was performed under general anaesthesia during sinus rhythm using a 22-electrode mapping catheter. Left heart catheterisation was achieved by either retrograde transaortic access (n = 4) or transseptal puncture (n = 4). Successful 3D EAM of the right atrium and ventricle was achieved in all dogs at a median time of 33 (13-40) min and 17 (3-52) min, respectively. Left atrial and ventricular 3D EAM was successful in six and seven dogs, at a median time of 17 (4-27) min and 8 min (4-19 min), respectively. Complications requiring intervention occurred in one dog only and were a transient third degree atrioventricular block and pericardial effusion following transseptal puncture, which was treated by pericardiocentesis. All dogs recovered uneventfully. Fluoroscopy time was limited to a median of 7 min (0-45 min) and almost exclusively associated with transseptal puncture. Three-dimensional EAM of all cardiac chambers, including mapping-guided biopsy and transseptal puncture is feasible in small dogs. Complications are similar to those reported in human patients. This suggests a potential added value of 3D EAM to conventional electrophysiology in dogs with arrhythmias.

Specialists' approach to tracheal collapse: survey-based opinions on diagnostics, medical management, and comorbid diseases.

OBJECTIVE: To describe the current standard of care among specialists for the routine diagnostic evaluation and medical management of stable tracheal collapse in dogs, identifying gaps between practice and scientific evidence to facilitate the development of future prospective studies. A secondary objective was to describe the perceived incidence of selected comorbid disorders in dogs with tracheal collapse and the diagnostic tests performed to evaluate for those disorders. SAMPLE: 180 veterinary specialists in 22 countries. PROCEDURES: An electronic survey was sent to 4 specialty listservs to target diplomates. Respondents completed multiple-choice and free-response questions related to the diagnostic evaluation and treatment of a theoretical stable dog with suspected tracheal collapse. RESULTS: Most respondents routinely utilized radiography, tracheobronchoscopy, and fluoroscopy to diagnose tracheal collapse and performed airway sampling, sedated airway examination, and echocardiograms to rule out comorbidities. The most frequently perceived comorbid disorders included chronic bronchitis, bronchomalacia, and myxomatous mitral valve disease. Respondents most often prescribed opioid antitussives, glucocorticoids, anxiolytics, and antibiotics as treatments. Less frequently, they utilized bronchodilators and nonopioid medications for cough. CLINICAL RELEVANCE: Despite a lack of published guidelines, specialists have similar approaches in their diagnostic and therapeutic approach to a stable dog with suspected tracheal collapse and believe evaluating for comorbid disorders is important. A description of a typical diagnostic approach and knowledge of realistic treatment goals will assist the general practitioner managing dogs with stable tracheal collapse. Additionally, gaps between current practices established via this survey and data supporting those practices exist, specifically concerning the use of antibiotics and nonopioid medications for cough, representing areas for further study.

Evaluation of a Fluoroscopic Angiography Protocol in Hispaniolan Amazon Parrots (Amazona ventralis).

Fluoroscopic angiography evaluates the heart and vascular tree in real time and can be recorded for further diagnostic analysis and measurements. Although reports have been published of the use of fluoroscopic angiography in birds, this technique has not been evaluated in any avian species. The purpose of this study was to evaluate a fluoroscopic angiography protocol in 12 adult Hispaniolan Amazon parrots (Amazona ventralis). Under general anesthesia, the birds were positioned in right lateral (LAT) recumbency on a fluoroscopy table. A bolus of nonionic iodinated contrast agent was injected through a catheter inserted into the basilic or medial metatarsal vein during video acquisition. The same bolus was repeated to obtain the ventrodorsal (VD) view with the bird placed in dorsal recumbency. Eleven studies were performed. A total of 19 (10 VD, 9 LAT) continuous, real-time, fluoroscopic angiograms were successfully captured. The brachiocephalic trunk, aorta, pulmonary arteries, pulmonary veins, and caudal vena cava were visualized, and selected intraluminal measurements collected. The intraobserver and interobserver variability for 3 observers was calculated. Intraobserver agreement was found to be near perfect (intraclass correlation coefficient ≥0.95), whereas interobserver agreement was moderate to substantial (intraclass correlation coefficient ≥0.52). Coefficients of variation were excellent (VD 0.99, LAT 0.99) for intraobserver assessments and moderate (VD 0.72, LAT 0.52) for interobserver assessments. For the interobserver assessments, the VD projection measurements performed better than the LAT measurements. These results suggest that although there was some variation between different observers, relatively consistent vascular measurements could be obtained. The described fluoroscopic angiography protocol is a repeatable and reliable technique that could be useful for the diagnosis and monitoring of cardiovascular diseases in birds.

Use of a videofluoroscopic feeding evaluation to guide management of dogs with congenital idiopathic megaoesophagus.

BACKGROUND: Evidence-based guidelines for determining dietary management in dogs with megaoesophagus are lacking. OBJECTIVES: This study looked to compare oesophageal clearance times (ECT) of liquid and two food consistencies using a contrast videofluoroscopy feeding evaluation, and to assess if recommendations made based on findings could improve regurgitation and quality of life in dogs with congenital megaoesophagus. METHODS: Twenty-one dogs with congenital megaoesophagus and nine healthy dogs received liquid, slurry, and meatball diets containing barium while in an upright position. Follow-up was performed to determine response to recommendations. RESULTS: Healthy dogs had significantly shorter median ECT for all consistencies (p < 0.001). In the megaoesophagus group, ECT varied by consistency and individual. The number of dogs in the megaoesophagus group with complete clearance was four (median ECT 10 min) for liquid, five (median ECT 5 min) for slurry, and two (median ECT 5 and 30 min, respectively) for meatballs. Partial clearance was seen in 11 dogs (median clearance 25%) with liquid, seven with slurry (median clearance 50%), and five with meatballs (median clearance 60%). Recommendations included altering current medications (13/21 dogs), diet consistency (6/21), time upright (12/21), water delivery (21/21), and adding activity (7/21). Regurgitation episodes/week decreased significantly from 5.5 to 2.5 (p < 0.001) at follow-up 3-5 weeks post-evaluation, with 95% of owners reporting improvement in quality of life. Seventy percent were alive 46-777 days after last recheck. Three dogs died from megaoesophagus associated complications (median survival 461 days after diagnosis). CONCLUSIONS: The findings of this study suggest that a videofluoroscopic feeding evaluation may help guide management of dogs with congenital megaoesophagus.