Multiligament stifle injury, a multicenter retrospective study in 26 dogs.

OBJECTIVES: To describe multiligament stifle injury in dogs and report complications and long-term outcomes. METHODS: Medical records of dogs surgically treated for multiligament stifle injury were reviewed from six veterinary hospitals. Long-term follow-up was collected from referring veterinarians. RESULTS: Twenty-six client-owned dogs and 26 stifles were included. Road traffic accidents and limb entrapment were the most common causes of injury. Cranial cruciate and lateral collateral ligament rupture was the most common combination of injury (10 cases). The caudal cruciate ligament was damaged in 12/23 cases but was surgically addressed in only 2 cases. Cranial cruciate ligament rupture was present in all cases and was managed using TPLO (6 cases), extracapsular suture (15 cases) and TTA (2 cases). Postoperative immobilisation with a transarticular external skeletal fixator was used in 4/26 cases. Intraoperative complications were reported in 2/23 cases, short-term complications in 17/25 cases, of which eight were major, and long-term complications in 7/18, of which two were major. Patella luxation was seen in one case and is a previously unreported complication. The overall outcome was excellent in 9/24 cases, good in 5/24 cases, fair in 7/24 cases and poor in 3/24 cases. Follow-up time ranged from 1.5 months to 9 years with the median (IQR) of 9.5 (4.0 to 28.5) months. CONCLUSIONS: Multiligament stifle injury in dogs is associated with a high rate of major complications. The overall outcome was good to excellent in just over half of the dogs.

Traumatic pulmonary pseudocysts in nine dogs and two cats.

OBJECTIVE: To describe the clinical presentation, imaging findings, treatment, and outcome in dogs and cats with traumatic pulmonary pseudocysts (TPP). STUDY DESIGN: Retrospective observational study. ANIMALS: Nine client-owned dogs and two cats. METHODS: The hospital database of Anderson Moores Veterinary Specialists was reviewed for cases with a diagnosis of TPP based on computed tomography (CT). Clinical presentation, additional injuries, treatment, and outcome were recorded. RESULTS: Eleven patients with TPP were identified. The ratio of TPP detected by radiographs when compared to CT was 7:11 (64%). Seven cases were managed conservatively, and three underwent lung lobectomy. One cat was euthanized due to the severity of concomitant injuries. The decision to perform thoracic surgery was due to refractory pneumothorax (2) or very large TPP (1). Ten patients survived to discharge. No patients died as a result of the TPP. CONCLUSION: Radiographic lesions were identified in about two-thirds of cases diagnosed by CT. TPPs were not fatal in our population but were commonly associated with severe concomitant injuries. Conservative treatment led to the resolution of smaller TPPs. CLINICAL SIGNIFICANCE: Conservative management of TPP is appropriate in most cases, although selected cases may benefit from surgical treatment.

Surgical findings and outcomes after unilateral adrenalectomy for primary hyperaldosteronism in cats: a multi-institutional retrospective study.

CASE SERIES SUMMARY: Twenty-nine cats from different institutions with confirmed or highly suspected primary hyperaldosteronism treated by unilateral adrenalectomy were retrospectively included in this study. The most frequent clinical signs were lethargy (n = 20; 69%) and neck ventroflexion (n = 17; 59%). Hypokalaemia was present in all cats, creatinine kinase was elevated in 15 and hyperaldosteronism was documented in 24. Hypertension was frequently encountered (n = 24; 89%). Preoperative treatment included potassium supplementation (n = 19; 66%), spironolactone (n = 16; 55%) and amlodipine (n = 11; 38%). There were 13 adrenal masses on the right side, 15 on the left and, in one cat, no side was reported. The median adrenal mass size was 2 × 1.5 cm (range 1-4.6 × 0.4-3.8); vascular invasion was present in five cats, involving the caudal vena cava in four cats and the renal vein in one. Median duration of surgery was 57 mins. One major intraoperative complication (3%) was reported and consisted of haemorrhage during the removal of a neoplastic thrombus from the caudal vena cava. In 4/29 cats (14%), minor postoperative complications occurred and were treated medically. One fatal complication (3%) was observed, likely due to disseminated intravascular coagulation. The median duration of hospitalisation was 4 days; 97% of cats survived to discharge. The potassium level normalised in 24 cats within 3 months of surgery; hypertension resolved in 21/23 cats. Follow-up was available for 25 cats with a median survival of 1082 days. Death in the long-term follow-up was mainly related to worsening of comorbidities. RELEVANCE AND NOVEL INFORMATION: Adrenalectomy appears to be a safe and effective treatment with a high rate of survival and a low rate of major complications. Long-term medical treatment was not required.

Submucosal resection via a transanal approach for treatment of epithelial rectal tumors - a multicenter study.

OBJECTIVE: To report complications and long-term outcomes after submucosal resections of benign and malignant epithelial rectal masses. STUDY DESIGN: Retrospective multicentric study. SAMPLE POPULATION: Medical records of 93 dogs at 7 referral hospitals. METHODS: Records were reviewed for surgical time, diagnosis, margins, complications, and recurrences. Survival of dogs was evaluated based on tumor types, categorized as benign, carcinoma in situ, and carcinoma. The Kaplan-Meier survival curve and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and survival time. RESULTS: Duration of follow up was 708 days (range, 25-4383). Twenty-seven dogs (29%) developed complications. Recurrence was identified in 20/93 (21%), with 12/20 recurrent masses treated with repeat submucosal resection. Median survival was not reached in any group. The 1-,2-, 5-year survival rates for carcinomas were 95%, 89%, and 73% respectively. However, overall survival was longer for benign tumors than carcinomas (P = .001). Recurrence was more likely when complications (P = .032) or incomplete margins (P = .023) were present. Recurrence was associated with an increased risk of death (P = .046). CONCLUSION: Submucosal resection of both benign and malignant rectal masses was associated with a low rate of severe complications and prolonged survival in the 93 dogs described here. CLINICAL SIGNIFICANCE: Submucosal resection is a suitable technique for resection of selected rectal masses.

Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000-2021).

CASE SERIES SUMMARY: Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. RELEVANCE AND NOVEL INFORMATION: Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

Traumatic stifle injury in 72 cats: a multicentre retrospective study.

OBJECTIVES: The aim of the study was to describe traumatic stifle injury in cats and report complications and long-term outcome. METHODS: The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. RESULTS: Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5-204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. CONCLUSIONS AND RELEVANCE: Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although long-term outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.

Feline sialocoele: clinical presentation, treatment and outcome in 19 cases.

OBJECTIVES: The aim of this retrospective observational study was to describe the clinical presentation, treatment and outcome of cats with sialocoele. METHODS: Clinical records from seven referral hospitals were retrospectively searched to identify cats with sialocoele between 2007 and 2021. RESULTS: Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia. Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2), cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular-sublingual (n = 15), mandibular-sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11 cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2) and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15-1460). Postoperative seroma was the only complication observed in one cat. No recurrence was reported. CONCLUSIONS AND RELEVANCE: Feline salivary sialocoele are relatively rare and have a good prognosis. They can be managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate case selection.

Complications between ventral and lateral approach for mandibular and sublingual sialoadenectomy in dogs with sialocele.

OBJECTIVE: To compare complications of dogs treated with mandibular and sublingual sialoadenectomy for sialocele using a lateral (LAT) or ventral paramedian (VPM) approach. STUDY DESIGN: Retrospective multicenter study. ANIMALS: Dogs (140) with mandibular and sublingual sialocele. METHODS: Medical records of dogs that underwent mandibular and sublingual sialoadenectomy through a LAT or VPM approach from 2004 to 2020 were reviewed. Clinical and histopathological findings were analyzed to compare the groups. RESULTS: Seventy dogs were included in each group. The most represented breed was crossbreed (26%), and males (99/140 [71%], intact/neutered) were overrepresented. Dogs in the VPM approach group were more likely to undergo digastricus tunnelization and placement of a drain or a bandage. Dogs in the LAT approach group were heavier and more likely to undergo excision of an inflammatory pseudocapsule. No difference was detected in complication rates between groups (LAT [20%], VPM [31%], P = .116). Recurrences were more likely after LAT approach (5/70 vs 0/70, respectively; P = .029), whereas wound-related complications were more likely after VPM approach (20/70 vs 9/70, respectively; P = .018). Prolonged duration of surgery was associated with an increased risk of recurrence, and none of the other variables affected the complication rate. CONCLUSION: Ventral paramedian approach for mandibular and sublingual sialoadenectomy was associated with a lower risk of recurrence but a higher risk of wound-related complications compared with LAT approach. CLINICAL SIGNIFICANCE: Ventral paramedian approach for mandibular and sublingual sialoadenectomy may be preferred to reduce recurrence in dogs with sialoceles, but wound-related complications are common.

Esophageal feeding tube placement and the associated complications in 248 cats.

BACKGROUND: Esophageal feeding tubes are commonly used to provide enteral nutrition to cats, but their use is associated with adverse effects. OBJECTIVES: To evaluate the complications associated with e-tube placement in cats and to identify factors predisposing to these complications. ANIMALS: Cats that had an esophageal feeding tube placed (n = 248). METHODS: This was a retrospective case review in which clinical records were interrogated across 2 referral centers to identify records of cats that had esophageal tubes placed. Clinical data were collected for signalment, clinical indication, method of placement, time of removal, and any complications. Logistic regression was then employed to assess the odds of an increase in complications, including infection and death. RESULTS: For those cats that survived to discharge, tubes were in place for a median of 11 days, ranging from 1 to 93 days. Complications occurred in 35.8% of the cats, with the most common being tube dislodgement (14.5%), followed by stoma site infections (12.1%). Cats receiving glucocorticoids or oncolytic agents (OR = 3.91; 95% CI, 1.14-13.44) and with discharge at the stoma site (OR = 159.8; CI, 18.9-1351) were at an increased odds of developing a stoma site infection, whereas those with a lower weight (OR = 1.33; 95% CI, 1.02-1.75) or (pancreatic [OR = 4.33; 95% CI, 1.02-18.47], neoplastic [OR = 15.44; 95% CI, 3.67-65.07], respiratory [OR = 19.66; 95% CI, 2.81-137.48], urogenital [OR = 5.78; 95% CI, 1.15-28.99], and infectious diseases [OR = 11.57; 95% CI, 2.27-58.94]) had an increased odds of death. The duration of time in place and the cat being discharged with the tube in place were not associated with an increased risk of infection or death. CONCLUSIONS AND CLINICAL IMPORTANCE: Owners should be made aware of the potential risks involved and their predisposing factors.

Long-term outcome of permanent tracheostomy in 15 dogs with severe laryngeal collapse secondary to brachycephalic airway obstructive syndrome.

OBJECTIVE: To report the long-term outcome of permanent tracheostomy for the management of severe laryngeal collapse secondary to brachycephalic airway obstructive syndrome. STUDY DESIGN: Retrospective case series. ANIMALS: Fifteen brachycephalic dogs with severe laryngeal collapse treated with permanent tracheostomy. METHODS: Follow-up data were obtained from medical records or via telephone conversation with the owners. The Kaplan-Meier estimator was used to calculate median survival time. Death was classified as related or unrelated to tracheostomy surgery. Complications were classified as major when they were life-threatening or required revision surgery. Owners were asked to classify the postoperative quality of life as improved, unchanged, or worse and the management of the stoma as simple or demanding. RESULTS: The median survival time was 100 days. Major complications were diagnosed in 12 of 15 (80%) dogs, resulting in death in 8 (median survival time 15 days) and revision surgery in 4 dogs. Seven of 15 (47%) dogs died of unrelated causes or were alive at the end of the study (median survival time 1982 days). The postoperative quality of life of 9 dogs was judged as markedly improved. Stoma management was defined as simple in 8 dogs and demanding in 4. CONCLUSION: Permanent tracheostomy was associated with a high risk of complications and postoperative death in brachycephalic dogs. However, long-term survival (exceeding 5 years) with a good quality of life was documented in 5 of 15 dogs. CLINICAL SIGNIFICANCE: Permanent tracheostomy is a suitable salvage option in brachycephalic dogs with severe laryngeal collapse that did not improve following more conservative surgeries.

Factors influencing wound healing complications after wide excision of injection site sarcomas of the trunk of cats.

OBJECTIVE: Wide surgery is the mainstay of the multimodal treatment of injection site sarcomas (ISS) in cats. The aim of the study was to analyze potential factors influencing the development of wound healing complications (WHC) in cats undergoing wide excision of ISS. STUDY DESIGN: Retrospective case series. ANIMALS: Forty-nine cats with ISS located on the trunk underwent wide excision after contrast-enhanced computed tomography planning. METHODS: The prognostic effect of covariates (sex, age, weight, body condition score (BCS), site, clinical dimension (CD), computed tomographic dimension (CTD), histotype, duration of surgery, surgical margin status, local anesthesia) on total, major and minor WHC was evaluated by univariate and bivariate analysis. Cox model was used for total WHC and Fine and Gray model was used for major and minor WHC. The relationship between duration of surgery and clinical and imaging variables was evaluated. RESULTS: The main factor associated to the risk of total and major WHC was surgical time. Based on univariate analysis, pattern of reconstruction, CDT, CD, weight, and BCS were significant prognostic factors for major WHC, but this was not confirmed when adjusted for other clinical variables in bivariate analysis. The duration of surgery was influenced by excision pattern and tumor CTD width. CONCLUSIONS: An increased duration of surgery as the consequence of complex surgical procedures represented the best predictor for the development of WHC.

Glottic and skull indices in canine brachycephalic airway obstructive syndrome.

BACKGROUND: Forty dogs presented for brachycephalic airway obstructive syndrome with laryngeal collapse not over 1st degree (saccule eversion) underwent glottis endoscopic and radiographic skull measurements before surgery. Fifteen Pugs, fifteen French and ten English Bulldogs were included. The goals were prospectively to compare three common brachycephalic breeds for anatomical differences regarding glottis and skull measurements, and to assess if any correlation between glottis and skull measurements was present. Linear measurements were used to obtain glottis and skull indices. Correlations between glottis and skull indices and glottic measurements were evaluated. Finally, glottis indices were compared among the three breeds. RESULTS: No correlation was found for glottis and skull indices. The glottic index differed among the three breeds (smaller in Pugs and higher in English Bulldogs), ultimately representing a morphologic indicator of the different larynx shape in the three breeds (more rounded in English Bulldogs, more elliptical in Pugs and in-between in French Bulldogs). CONCLUSIONS: The lack of correlation between skull/glottic indices does not support skull morphology as predictor of glottic morphology. As Pugs had the lowest glottic index, it may be speculated that Pugs' original narrow glottic width may predispose to further progressive respiratory deterioration more easily than in the other two breeds.

Feline injection-site sarcoma: recurrence, tumour grading and surgical margin status evaluated using the three-dimensional histological technique.

The three-dimensional histology technique is used in human medicine for the evaluation of complete lateral and deep surgical margins. In this study, the technique was applied to 48 excised feline injection-site sarcoma specimens. The predictive value of the histological margin status and tumour grading on local recurrence was investigated. In 32/48 cases, the margins were non-infiltrated, whilst in the remaining 16 cases, they were infiltrated. Overall, 6/32 (19%) tumours with non-infiltrated margins and 11/16 (69%) with infiltrated margins recurred. Tumours with infiltrated margins recurred about 10 times more frequently compared to tumours with non-infiltrated margins (P=0.0011). No statistically significant correlation was observed between grading and recurrence. The assessment of margin status using the 3D histology technique showed a good predictivity for post-surgical tumour recurrence. Extensive application of the 3D histology technique is recommended to standardise the evaluation of histological margins and to allow comparison between results from different laboratories.