Case report: Abdominal hernia repair using a surgical wire and an autologous omental graft in a Japanese Black calf.

Background: Hernia formation is a well-known abdominal wall disorder in calves and most often occurs in the umbilical region. In addition, it occurs in the abdominal wall outside the umbilical region. It has been reported to involve acquired factors, such as external force to the lower or lateral abdominal wall, trauma, muscle weakness, and, although rare, congenital or hereditary factors. Although there have been reports on the repair of abdominal wall hernias caused by abnormal muscle formation, there have been no reports on the treatment of abdominal wall hernias caused by abnormal vertebral and rib formation in cattle or other ruminants. In this study, for the first time, we describe a case of successful closure of a hernia in the left flank caused by malformation of the vertebrae and ribs. The repair was performed by narrowing the ribs using a surgical wire and covering the defect with a free omental graft. Case presentation: A male Japanese Black calf showed a mild bulge of the left abdominal wall and abnormal morphology of the left ribs immediately after birth. At 3 months of age, computed tomography revealed fusion of the 9th, 10th, and 11th thoracic vertebrae and missing formation of the 10th and 11th left ribs at the thoracic vertebral fusion site. Additionally, a 15.2 × 24.4 cm abdominal hernia had formed in the abdominal wall. During surgery, the ribs forming the hernia were narrowed with a surgical wire, and the hernia was covered with a large autologous free omental graft to prevent intra-abdominal organ prolapse. At the monthly follow-up (11 months after surgery), the calf had developed similarly to other calves of the same age on the farm, and no complications were noted. Conclusions: The current case shows that a combination of rib correction using a surgical wire combined with transplantation of a free autologous greater omentum graft was shown to be a possible treatment option for surgical repair of large abdominal wall hernias caused by rib malformation.

Differential calcium handling in two canine models of right ventricular pressure overload.

BACKGROUND: The purpose of this investigation was to characterize differential right atrial (RA) and ventricular (RV) molecular changes in Ca(2+)-handling proteins consequent to RV pressure overload and hypertrophy in two common, yet distinct models of pulmonary hypertension: dehydromonocrotaline (DMCT) toxicity and pulmonary artery (PA) banding. METHODS: A total of 18 dogs underwent sternotomy in four groups: (1) DMCT toxicity (n = 5), (2) mild PA banding over 10 wk to match the RV pressure rise with DMCT (n = 5); (3) progressive PA banding to generate severe RV overload (n = 4); and (4) sternotomy only (n = 4). RESULTS: In the right ventricle, with DMCT, there was no change in sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) or phospholamban (PLB), but we saw a trend toward down-regulation of phosphorylated PLB at serine-16 (p[Ser-16]PLB) (P = 0.07). Similarly, with mild PA banding, there was no change in SERCA or PLB, but p(Ser-16)PLB was down-regulated by 74% (P < 0.001). With severe PA banding, there was no change in PLB, but SERCA fell by 57% and p(Ser-16)PLB fell by 67% (P < 0.001). In the right atrium, with DMCT, there were no significant changes. With both mild and severe PA banding, p(Ser-16)PLB fell (P < 0.001), but SERCA and PLB did not change. CONCLUSIONS: Perturbations in Ca(2+)-handling proteins depend on the degree of RV pressure overload and the model used to mimic the RV effects of pulmonary hypertension. They are similar, but blunted, in the atrium compared with the ventricle.

Surgical Treatment of a Retropharyngeal Abscess in a Japanese Black Cow.

A 17-month-old Japanese Black cow presented with inappetence, wheezing, dysphagia, and drooling. Radiography and ultrasonography revealed an oval, dorsal, pharyngeal mass, with an internal horizontal line demarcating the radiolucent area from the radio-opaque area. Upper airway endoscopy revealed pus-like deposits in the dorsal nasal passage, hyperemia, and edema in the dorsal pharynx, leading to swelling and airway obstruction. Manual palpation, after sedation, revealed a thickened mass surface, which was difficult to rupture with manual pressure. After inserting a linear sonographic probe through the mouth to establish the vascularity surrounding the mass and to identify a relatively thin-walled area, a trocar was pierced into the mass under endoscopic guidance, and the opening was enlarged manually. The mass was filled with stale pus-like material, which was removed manually. The abscess cavity was washed using saline and povidone-iodine. Day 1 post-surgery, dysphagia and wheezing disappeared. Day 16 post-surgery, endoscopy showed significant improvement in the airway patency. One year postoperatively, the owner reported that the cow had an uneventful recovery. For deep abscesses, such as bovine pharyngeal abscesses, it is important to perform a preoperative transoral Doppler ultrasonography to assess the vascularity and thickness of the abscess wall for safe trocar insertion and abscess drainage.

Intra-abdominal mass containing controlled internal drug release (CIDR) devices detected by CT in a Japanese Black cow.

This report describes an intra-abdominal mass caused by progesterone-containing controlled internal drug release (CIDR) devices in the abdominal cavity of a 28-month-old Japanese Black heifer presenting with infertility. Rectal examination revealed a mass containing a cartilage-like object in the pelvic cavity. Computed tomography revealed a mass containing two T-shaped foreign bodies. Laparotomy was performed to remove the mass containing the foreign bodies. The heifer was healthy at discharge seven days post-surgery. This case adds CIDR device as a new etiology for intra-abdominal masses. Furthermore, it highlights the usefulness of CT in diagnosing deep abdominal lesions.

Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device.

Obtaining endolumenal closure of hollow visceral defects may complement conventional, incision-based, surgical alternatives and benefit the experimental field of natural orifice translumenal endoscopic surgery (NOTES). Endoscopic tissue plicating devices (TPD) represent a promising closure technology; however, the long-term integrity of resultant closures is uncertain. Swine (n=10) underwent survival transgastric NOTES peritoneoscopy procedures with TPD gastrotomy closure while device performance and closure integrity were evaluated. Following uncomplicated procedures, no animals revealed leakage on upper gastrointestinal contrast fluoroscopy immediately following closure and on postoperative days 2 and 7. Necropsy performed on the 14th postoperative day revealed a subclinical colonic injury for one animal; the remaining nine animals had no complications. Gastric burst testing revealed the strength of closure was comparable to that of nonsurgical control stomachs (85.1 vs. 85.3 mm Hg, p=0.98). For six of nine (66%) TPD animals, bursting occurred remote to the closure site in nonsurgical tissue, indicating that closure strength equaled that of native tissue. Endoscopic TPD closure of standardized NOTES gastric defects results in strong, leak-proof closure; however, injuries can occur. These findings support evaluation of TPD closure in human trials involving noncontrolled gastric defects.

Tugging force: A new objective index for evaluating acute changes in neuromuscular function in mice.

INTRODUCTION: Many agents, including muscle relaxants, influence neuromuscular function. Although in vitro and in situ measurement systems of skeletal muscular contractility have been developed and in use for years, no convenient device and parameter are available to examine the time course of the acute effects of such agents on neuromuscular function in conscious mice. METHODS: We created a two-compartment device consisting of a transparent, wide, acrylic chamber with a foot shock grid, and an attached, opaque narrow tunnel to measure neuromuscular performance. A mouse placed into the wide chamber, quickly enters the narrow tunnel. We attached a string to the tail of the mouse to measure the developed tugging force when the mouse entered the narrow tunnel. RESULTS: After administering the muscle relaxants suxamethonium, vecuronium, and pancuronium, the peak tugging force decreased maximally at 3 or 5 min after administration, and recovered within 20 min. These responses to the muscle relaxants were dose-dependent. DISCUSSION: Tugging force is an objective and reproducible parameter for examining the time course of an acute change in neuromuscular function.

Concomitant tricuspid valve surgery during implantation of continuous-flow left ventricular assist devices: a Society of Thoracic Surgeons database analysis.

BACKGROUND: Performing concomitant tricuspid valve procedures (TVPs) in left ventricular assist device (LVAD) patients with significant pre-operative tricuspid regurgitation (TR) is controversial, and no studies have been large enough to definitively guide therapy. METHODS: Between January 2006 and September 2012, 2,196 patients with moderate to severe pre-operative TR from 115 institutions underwent implantation of a continuous-flow left ventricular assist device (LVAD) as reported by The Society of Thoracic Surgeons National Database. Of these, 588 (27%) underwent a concomitant TVP. Inverse probability weighting based on propensity score was used to adjust for differences between the LVAD alone and LVAD+TVP groups, and outcomes were compared. RESULTS: Most patients in the LVAD+TVP group underwent an annuloplasty alone (81.1%). Concomitant TVP did not affect risk of post-operative right VAD insertion (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.49-1.36; p = 0.4310) or death (RR, 0.95; 95% CI, 0.68-1.33; p = 0.7658). However, TVP was associated with an increased risk for post-operative renal failure (RR, 1.53; 95% CI, 1.13-2.08; p = 0.0061), dialysis (RR, 1.49; 95% CI, 1.03-2.15; p = 0.0339), reoperation (RR, 1.24; 95% CI, 1.07-1.45; p = 0.0056), greater total transfusion requirement (RR, 1.03; 95% CI, 1.01-1.05; p = 0.0013), and hospital length of stay > 21 days (RR, 1.29; 95% CI, 1.16-1.43; p < 0.0001). Time on the ventilator and intensive care unit length of stay were also significantly prolonged for the LVAD+TVP group. CONCLUSIONS: Performing a concomitant TVP for continuous-flow LVAD patients with moderate to severe TR did not reduce early death or right VAD requirement and was associated with worse early post-operative outcomes. These data caution against routine concomitant TVP based solely on degree of pre-operative TR and suggest that additional selection criteria are needed to identify those patients in whom concomitant TVP may prevent post-operative right ventricular failure.

Performance of a novel bipolar/monopolar radiofrequency ablation device on the beating heart in an acute porcine model.

OBJECTIVE: Although the advent of ablation technology has simplified and shortened surgery for atrial fibrillation, only bipolar clamps have reliably been able to create transmural lesions on the beating heart. Currently, there are no devices capable of reproducibly creating the long linear lesions in the right and left atria needed to perform a Cox-Maze procedure. This study evaluated the performance of a novel suction-assisted radiofrequency device that uses both bipolar and monopolar energy to create lesions from an epicardial approach on the beating heart. METHODS: Six domestic pigs underwent median sternotomy. A dual bipolar/monopolar radiofrequency ablation device was used to create epicardial linear lesions on the superior and inferior vena cavae, the right and left atrial free walls, and the right and left atrial appendages. The heart was stained with 2,3,5-triphenyl-tetrazolium chloride, and each lesion was cross-sectioned at 5-mm intervals. Lesion depth and transmurality were determined. RESULTS: Transmurality was documented in 94% of all cross sections, and 68% of all ablation lines were transmural along their entire length. Tissue thickness was not different between the transmural and nontransmural cross sections (3.1 ± 1.3 and 3.4 ± 2.1, P = 0.57, respectively), nor was the anatomic location on the heart (P = 0.45 for the distribution). Of the cross sections located at the end of the ablation line, 11% (8/75) were found to be nontransmural, whereas only 4% (8/195) of the cross sections located within the line of ablation were found to be nontransmural (P = 0.04). Logistic regression analysis demonstrated that failure of the device to create transmural lesions was associated with low body temperature (P = 0.006) but not with cardiac output (P = 0.54). CONCLUSIONS: This novel device was able to consistently create transmural epicardial lesions on the beating heart, regardless of anatomic location, cardiac output, or tissue thickness. The performance of this device was improved over most devices previously tested but still falls short of ideal clinical performance. Transmurality was lower at the end of the lesions, highlighting the importance of overlapping lines of ablation in the clinical setting.

The impact of previous catheter-based ablation on the efficacy of the Cox-maze IV procedure.

BACKGROUND: Failed catheter-based ablation for the treatment of atrial fibrillation is an indication for the Cox-maze procedure. Many patients are referred for the Cox-maze IV procedure with recurrent atrial fibrillation after a previous catheter-based ablation, but the efficacy and safety of surgical management in these patients remains unclear. METHODS: Data were collected prospectively on 129 consecutive patients who underwent a stand-alone Cox-maze IV procedure. Patients were grouped by the presence (n=61; 47%) or absence (n=68; 53%) of previous catheter ablation history. Follow-up was conducted at 3, 6, and 12 months (94% complete, mean 15.1±15.6 months) with electrocardiograms and 24-hour Holter monitoring. RESULTS: In patients with no ablation history compared with those with, freedom from atrial tachyarrhythmias and antiarrhythmic drugs were similar at 3 months (73% versus 67%), 6 months (85% versus 83%), and 12 months (81% versus 87%; p<0.05 for all). Those who had failed previous catheter ablation had significantly smaller left atria and longer durations of atrial fibrillation, and were more likely to have persistent atrial fibrillation compared with the group without prior ablation history. All analyzed baseline patient characteristics and comorbidities were similar between the groups. No differences were found in complication rates or surrogate measures of operative difficulty. CONCLUSIONS: The Cox-maze IV procedure is safe and effective in treating recurrent atrial fibrillation regardless of previous catheter ablation history. Surgical management should be considered in patients who have failed catheter ablation for the treatment of their atrial fibrillation.