Experimental and clinical evaluation of transperitoneal laparoscopic ureteronephrectomy in dogs.

OBJECTIVE: To report a surgical technique for transperitoneal laparoscopic ureteronephrectomy (TLU) in dogs and describe complications and outcome in a cohort of dogs. STUDY DESIGN: Experimental study and case series. ANIMALS: Purpose-bred research dogs (n = 3) and canine clinical cases (9). METHODS: In 11 of 12 dogs, a 3 port laparoscopic approach was used and in 1 dog a 4-port approach was used. Incision through the retroperitoneal space was followed by early dissection of the ureter to aid retraction and elevation of the renal hilus. Dissection was performed principally by use of a vessel-sealing device. Ligation of the renal hilar vessels was accomplished using laparoscopic hemoclips. Experimental dogs were euthanatized and necropsied. RESULTS: In 3 experimental dogs, no intraoperative complications occurred and conversion to an open approach was unnecessary. Of 9 clinical cases, conversion to an open approach was required in 2 dogs, because of severe hydroureter obscuring observation in 1, and uncontrollable retroperitoneal hemorrhage in the other dog. In 1 dog hemorrhage from the renal capsule and renal vein was controlled laparoscopically. No other major complications occurred. All dogs were discharged. CONCLUSIONS: Transperitoneal laparoscopic ureteronephrectomy is feasible in dogs although conversion to an open approach should be considered when uncontrollable hemorrhage is encountered or the view is obscured by anatomic alteration.

Evaluation of bacterial contamination on surgical drapes following use of the Bair Hugger(®) forced air warming system.

This pilot study determined the rate of bacterial contamination on surgical drapes of small animal patients warmed intra-operatively with the Bair Hugger(®) forced air warming system compared to a control method. Surgical drapes of 100 patients undergoing clean surgical procedures were swabbed with aerobic culturettes at the beginning and end of surgery. Samples were cultured on Trypticase soy agar. Contamination of the surgical drapes was identified in 6/98 cases (6.1%). There was no significant difference in the number of contaminated surgical drapes between the Bair Hugger(®) and control groups (P = 0.47).

Évaluation de la contamination bactérienne des champs opératoires après l'utilisation du système de chauffage à air pulsé Bair HuggerMD . Cette étude pilote a déterminé le taux de contamination bactérienne des champs opératoires de patients petits animaux réchauffés lors du processus peropératoire à l'aide du système de chauffage à air pulsé Bair HuggerMD comparativement à une méthode témoin. Les champs opératoires de 100 patients subissant des interventions chirurgicales propres ont été écouvillonnés avec des Culturettes aérobies au début et à la fin de la chirurgie. Les échantillons ont été cultivés sur gélose Trypticase soja. La contamination des champs opératoires a été identifiée dans 6/98 cas (6,1 %). Il n'y avait aucune différence significative dans le nombre de champs opératoires contaminés entre le groupe Bair HuggerMD et le groupe témoin (P = 0,47).(Traduit par Isabelle Vallières).

Use of a balloon-expandable metallic stent to relieve malignant urethral obstruction in a cat.

CASE DESCRIPTION: A 19-year-old neutered male domestic shorthair cat was evaluated because of signs of urinary tract obstruction. CLINICAL FINDINGS: Physical examination findings were consistent with urethral obstruction, and a mass could be palpated in the region of the bladder neck. Abdominal ultrasonography and thoracic radiography revealed a mass in the trigone of the urinary bladder and a solitary mass in the left caudal lung lobe. Cytologic examination of the urine sediment, samples obtained by means of traumatic urethral catheterization, and fine-needle aspirates of the bladder mass did not result in a diagnosis. TREATMENT AND OUTCOME: A balloon-expandable metallic stent was placed in the proximal portion of the urethra to relieve the malignant obstruction. After stent placement, the cat had signs of urinary incontinence and detrusor atony, both of which resolved with medical treatment. The cat was euthanized 1 month after stent placement because of progressive azotemia. Histologic examination of necropsy samples revealed grade III urothelial carcinoma and papillary pulmonary adenocarcinoma. CLINICAL RELEVANCE: Findings suggested that stent placement may be a viable palliative treatment in cats with malignant urinary obstruction.

Renal cystadenoma in a domestic shorthair.

An 11-year-old domestic shorthair was examined after an enlarged left kidney was palpated by the referring veterinarian. No abnormalities were noted on complete blood count, serum biochemical profile and total thyroxine concentration, and the urine specific gravity was 1.039. An abdominal ultrasound identified the presence of a large cystic structure on the caudal pole of the left kidney. No abnormalities of the right kidney were seen. A left ureteronephrectomy was performed, and the cat recovered uneventfully from the procedure and was discharged from the hospital 5 days after surgery. The cat remains clinically normal 16 months postoperatively. Histopathology of the removed kidney demonstrated the presence of a renal cystadenoma. This report describes the successful surgical treatment of a renal cystadenoma. Renal cystadenoma should be considered as a differential diagnosis when renomegaly is noted. To the author's knowledge, a renal cystadenoma has not been previously reported in a cat.

Laparoscopic cholecystectomy for management of uncomplicated gall bladder mucocele in six dogs.

OBJECTIVES: To describe a technique for, and outcome after, laparoscopic cholecystectomy (LC) for management of uncomplicated gall bladder mucocele (GBM) in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n=6) with uncomplicated GBM. METHODS: Dogs with ultrasonographic evidence of GBM but without imaging or laboratory signs of gall bladder rupture, peritonitis, or extra-hepatic biliary tract rupture that had LC were included. A 4 portal technique was used. A fan retractor was used to retract the gall bladder to allow dissection around the cystic duct with 5 or 10 mm right-angle dissecting forceps. The cystic duct was ligated using extracorporeally tied ligatures supplemented sometimes with hemostatic clips. A harmonic scalpel was used to dissect the gall bladder from its fossa. The gall bladder was placed into a specimen retrieval bag and after bile aspiration the bag was withdrawn through the 11 mm portal incision. RESULTS: Five dogs had mild intermittent clinical signs including vomiting, inappetence, and lethargy. All dogs had successful LC without conversion to an open approach. All dogs with clinical signs had improvement or resolution of signs postoperatively. No important perioperative complications occurred and all dogs were alive at a median of 8 months postoperatively (range, 3-14 months). CONCLUSIONS: LC can be accomplished safely and effectively in dogs with uncomplicated GBM. CLINICAL RELEVANCE: A minimally invasive approach for cholecystectomy can be used for the treatment of GBM in dogs.

Clinical and immunohistochemical differentiation of gastrointestinal stromal tumors from leiomyosarcomas in dogs: 42 cases (1990-2003).

OBJECTIVE: To reexamine (via immunohistochemical techniques) canine tissue samples that had been previously classified as gastrointestinal leiomyosarcomas (GILMSs), identify and differentiate gastrointestinal stromal tumors (GISTs) from GILMSs, and compare the biological behavior and clinical course of GISTs and GILMSs in dogs. DESIGN: Retrospective case series. ANIMALS: 42 dogs. PROCEDURES: Medical records of 42 dogs for which a histologic diagnosis of GILMS was confirmed were reviewed for signalment, clinical signs, physical examination findings, results of initial diagnostic tests, surgical findings, adjunctive treatment, location of the tumor, completeness of resection, and outcome after surgery. Archived tumor tissue specimens from each dog were restained via immunohistochemical techniques to differentiate tumor types. Long-term follow-up information was obtained from the medical record or through telephone interviews with owners and referring veterinarians. RESULTS: On the basis of immunohistochemical findings, 28 of 42 tumors were reclassified as GISTs and 4 were reclassified as undifferentiated sarcomas; 10 tumors were GILMSs. In dogs, GISTs developed more frequently in the cecum and large intestine and GILMSs developed more frequently in the stomach and small intestine. Median survival times for dogs with GISTs and GILMSs were 11.6 and 7.8 months, respectively; if only dogs surviving the perioperative period were considered, median survival times were 37.4 and 7.8 months, respectively. These differences, however, were not significant. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, many previously diagnosed GILMSs should be reclassified as GISTs on the basis of results of immunohistochemical staining. The biological behavior of these tumors appears to be different.

Choledochal tube stenting for decompression of the extrahepatic portion of the biliary tract in dogs: 13 cases (2002-2005).

OBJECTIVE: To determine clinicopathologic features, surgical management, complications, and long-term outcome associated with diseases of the extrahepatic portion of the biliary tract treated via choledochal stent placement in dogs. DESIGN: Retrospective case series. ANIMALS: 13 dogs. PROCEDURE: Data were obtained from medical records, and follow-up information was obtained via reexamination or telephone interview with owners or referring veterinarians. RESULTS: 10 dogs had extrahepatic biliary obstruction (EHBO), 6 as a result of pancreatitis. Two dogs had rupture of the common bile duct associated with cholelithiasis. In 1 dog, a stent was placed prophylactically after gastroduodenostomy was performed for a perforated duodenal ulcer. Nine of 13 dogs survived the perioperative period and were discharged. No recurrence of EHBO or other complications developed in the discharged dogs while the stents were in place. Median follow-up period from surgery to last owner contact was 13.3 months. In 1 dog, the stent was removed endoscopically 10 months after surgery and EHBO recurred 9 months after stent removal because of cholangitis. In 4 of 5 dogs that were discharged from the hospital, in which the fate of the stent could be confirmed and the stent was secured to the duodenal wall with absorbable suture materials, the stents were passed in the feces 1 to 11 months after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Choledochal tube stenting is an effective method of decompression of the extrahepatic portion of the biliary tract in dogs and provides a less complex alternative to traditional cholecystoenterostomy techniques in select cases.

A prospective, randomized, double blind, placebo-controlled evaluation of the effects of eicosapentaenoic acid and docosahexaenoic acid on the clinical signs and erythrocyte membrane polyunsaturated fatty acid concentrations in dogs with osteoarthritis.

BACKGROUND: Osteoarthritis (OA) in dogs is a prevalent and serious condition. The most common treatment for the clinical signs of OA in dogs is the administration of nonsteroidal antiiflammatory pharmaceuticals. Omega-3 (n-3) fatty acids have been shown to reduce the clinical signs of osteoarthritis in dogs. OBJECTIVE: The primary goals of this study were 1) to determine the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the clinical signs of OA in dogs, 2) to evaluate the effects of supplementation on the arachadonic acid (ARA)/ (EPA+DHA) algorithm and 3) to correlate alterations in the ARA/(EPA+DHA) with changes in the clinical signs of canine OA. METHODS: Seventy-eight client owned dogs were enrolled in a prospective, randomized, double-blind, placebo controlled clinical trial. Dogs were randomized to placebo oil or triglyceride n-3 oil (providing an average dose of 69mg EPA+DHA/kg/day). Orthopedic examinations and blood analyses were performed at baseline, day 42, and day 84. A single investigator confirmed a diagnosis of OA of the coxofemoral joints and/or stifle joints in all dogs. RESULTS: Seventy-four dogs completed the trial. All clinical outcomes for measuring discomfort, lameness, and joint severity at day 84 and all blood metrics at day 42 and day 84 significantly (p<0.05) improved compared with placebo. No major side effects were observed. CONCLUSION AND CLINICAL RELEVANCE: This study demonstrated that the daily supplementation of a dogs diet with EPA and DHA shifts the blood fatty acid concentrations correlating to relief of clinical signs associated with OA in dogs.

Development and characterization of a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.

OBJECTIVE: To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog. DESIGN: Prospective technique development study. SETTING: University teaching hospital. ANIMALS: Six healthy adult male Beagles. INTERVENTIONS: Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of the body wall using an 18F peel-away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16-18). MEASUREMENTS AND MAIN RESULTS: Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9-93 minutes). Median total procedure time was 53 minutes (range, 49-113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs. CONCLUSIONS: PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression.

Fracture of an endoluminal nitinol stent used in the treatment of tracheal collapse in a dog.

A 5-year-old castrated male Pomeranian was evaluated because of severe dyspnea and coughing, and a diagnosis of complete, static collapse of the trachea at the thoracic inlet was made. After failure to improve with medical management alone, an endoluminal tracheal stent was placed, which resulted in resolution of signs. Ten weeks after stent placement, the dog underwent tracheal resection and anastomosis because the stent had fractured at the level of the thoracic inlet. One year after surgery, the dog was doing well and required treatment with hydrocodone infrequently. Compared with other surgical treatment options, placement of an endoluminal tracheal stent is a relatively noninvasive intervention that can provide effective relief from the clinical signs associated with tracheal collapse in dogs. Implantation of endoluminal tracheal stents may be associated with complications; therefore, the procedure may best be regarded as a salvage procedure for dogs with end-stage disease that are refractory to appropriate medical management, have extensive collapse of the intrathoracic portion of the trachea, or are poor candidates for surgery.

Oral, dental, and beak disorders of reptiles.

Each species of reptile has evolved unique characteristics that are associated with their oral cavity, dentition, tongue, glands, and methods of mastication. These developments have provided each with an opportunity to interact with their surroundings. In captivity, the developmental relationship is often severed by the introduction of artificial surroundings and inappropriate husbandry. These changes predispose the animals to many stresses and disorders. Disorders of the oral cavity are often a representation of what is occurring systemically. Bacterial, viral, fungal, parasitic, neoplastic, and nutritional causes of disorders of the oral cavity in reptilian species are probably underestimated and likely cause a higher incidence of morbidity and mortality than has been reported. The misinformation that clients receive regarding husbandry may directly correlate with the frequency of oral diseases seen in a clinical setting. Prevention of disease of the oral cavity is primarily through providing appropriate environmental conditions and diet.

Surgical oncology of exotic animals.

This article reviews the initial management of exotic patients with amass. The important principles of the initial workup, including how to get a definitive diagnosis and how to stage the extent of the disease are covered. There are many biopsy instruments currently available, and the advantages and disadvantages of these are presented. Principles of tumor excision and marking the tissue sampled are also discussed. It is important to submit all of the tissue excised and evaluate the surgical margins for the presence of neoplastic cells, even if the tumor seems too small to put in the sample vial. Follow-up for patients that have had cancer surgery is also reviewed, along with the effects of adjunct therapies on wound healing.

Minimally invasive abdominal and thoracic surgery: principles and instrumentation.

Minimally invasive surgery, including laparoscopy, thoracoscopy, and endoscopic-assisted procedures, is becoming more common in veterinary medicine. The basic principles of laparoscopy and thoracoscopy involve gaining access to a cavity through small incisions, creating a workspace, and maneuvering extracorporeally activated instruments within that workspace.

Minimally invasive abdominal and thoracic surgery: techniques.

Laparoscopy, thoracoscopy, and other endoscopic-assisted procedures have many uses in veterinary medicine. Diagnosis and biopsy are currently the most common uses of minimally invasive techniques, but popularity for procedures such as ovariectomy, cancer staging, lung lobectomy, and pericardectomy is rising. This article touches on basic surgical procedures and describes some more advanced techniques.

Complications of the extrahepatic biliary surgery in companion animals.

Surgery of the biliary tract is demanding and is associated with several potentially life-threatening complications. Veterinarians face challenges in obtaining accurate diagnosis of biliary disease, surgical decision-making, surgical hemostasis and bile peritonitis. Intensive perioperative monitoring is required to achieve early recognition of common postoperative complications. Proper treatment and ideally, avoidance of surgical complications can be achieved by gaining a clear understanding physiology, anatomy, and the indications for hepatobiliary surgery.

Complications of hepatic surgery in companion animals.

The most common hepatic procedures performed in companion animals are liver biopsies and partial or complete liver lobectomies. Although these procedures are relatively simple to perform in healthy animals, surgery in clinical patients with liver disease is often complicated by the presence of significant systemic illness or by the technical challenges associated with removing massive hepatic tumors. An in-depth understanding of the possible complications that can occur with hepatic surgery helps to provide the best possible outcome for the patient by allowing the surgeon to not only take precautions to try to prevent complications but allows one to monitor for them postoperatively and treat them early if noted.

Social work with a pet loss support group in a university veterinary hospital.

This article describes the development of a bereavement support group for pet owners in a university veterinary hospital. The group is predicated on the understanding that a human-animal relationship can be strong and the loss of that bond, through the animal's death, can produce a grief reaction, though this problem is often overlooked. The description of the support group is presented in detail so that it may be replicated. Included are: the history of the group, the procedure for making clients aware of the group, the program, the demographics, and problems brought to the group. The discussion and conclusion support the development of interdisciplinary collaborations among veterinarians, owners and social workers in other veterinary hospitals.

Variables associated with outcome in dogs undergoing extrahepatic biliary surgery: 60 cases (1988-2002).

OBJECTIVE: To report clinical findings and define clinical variables associated with outcome in dogs undergoing extrahepatic biliary surgery. STUDY DESIGN: Retrospective study. ANIMALS: Sixty dogs that had extrahepatic biliary tract surgery. RESULTS: Primary diagnoses included necrotizing cholecystitis (36 dogs, 60%), pancreatitis (12 dogs, 20%), neoplasia (5 dogs, 8%), trauma (4 dogs, 7%), and gallbladder rupture from cholelithiasis without necrotizing cholecystitis (3 dogs, 5%). Bile peritonitis occurred in 19 (53%) dogs with necrotizing cholecystitis, 4 dogs with trauma, and 3 dogs with cholelithiasis without evidence of necrotizing cholecystitis. Cholecystectomy (37 dogs, 62%) and cholecystoduodenostomy (14 dogs, 23%) were the 2 most commonly performed procedures. Median hospitalization for survivors was 5 days (range, 1-15 days). There were 43 surviving dogs (72%) and 17 nonsurvivors (28%, 4 died, 13 euthanatized). Presence of septic bile peritonitis (P=.038), elevation in serum creatinine concentration (P=.003), prolonged partial thromboplastin times (PTTs; P=.003), and lower postoperative mean arterial pressures (P=.0001) were significantly associated with mortality. CONCLUSIONS: Extrahepatic biliary surgery is associated with high mortality and a relatively long hospitalization time for survivors. Cholecystectomy and cholecystoduodenostomy were the most common surgical procedures to treat the 4 major biliary problems (necrotizing cholecystitis, pancreatitis, neoplasia, and trauma) observed in this cohort of dogs. The relatively high mortality rate likely reflects the underlying diseases and their effects on the animal (septic bile peritonitis, higher serum creatinine, prolonged PTT, and lower postoperative mean arterial pressure) rather than complications of surgery. CLINICAL RELEVANCE: Septic bile peritonitis, preoperative elevated creatinine concentration, and immediate postoperative hypotension in dogs undergoing extrahepatic biliary tract surgery are associated with a poor clinical outcome. Adequate supportive care and monitoring in the perioperative period is critical to improve survival of dogs with extrahepatic biliary disease.