Evaluating the cost of robotic-assisted total and unicompartmental knee arthroplasty.

As uptake of robotic-assisted arthroplasty increases there is a need for economic evaluation of the implementation and ongoing costs associated with robotic surgery. The aims of this study were to describe the in-hospital cost of robotic-assisted total knee arthroplasty (RA-TKA) and robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and determine the influence of patient characteristics and surgical outcomes on cost. This prospective cohort study included adult patients (≥ 18 years) undergoing primary unilateral RA-TKA and RA-UKA, at a tertiary hospital in Sydney between April 2017 and June 2021. Patient characteristics, surgical outcomes, and in-hospital cost variables were extracted from hospital medical records. Differences between outcomes for RA-TKA and RA-UKA were compared using independent sample t-tests. Logistic regression was performed to determine drivers of cost. Of the 308 robotic-assisted procedures, 247 were RA-TKA and 61 were RA-UKA. Surgical time, time in the operating room, and length of stay were significantly shorter in RA-UKA (p < 0.001); whereas RA-TKA patients were older (p = 0.002) and more likely to be discharged to in-patient rehabilitation (p = 0.009). Total in-hospital cost was significantly higher for RA-TKA cases (AU$18580.02 vs $13275.38; p < 0.001). Robotic system and maintenance cost per case was AU$3867.00 for TKA and AU$5008.77 for UKA. Patients born overseas and lower volume robotic surgeons were significantly associated with higher total cost of RA-UKA. Increasing age and male gender were significantly associated with higher total cost of RA-TKA. Total cost was significantly higher for RA-TKA than RA-UKA. Robotic system costs for RA-UKA are inflated by the software cost relative to the volume of cases compared with RA-TKA. Cost is an important consideration when evaluating long term benefits of robotic-assisted knee arthroplasty in future studies to provide evidence for the economic sustainability of this practice.

Patient-Reported Outcomes and Range of Motion Following Knee Arthroplasty Using a Megaprosthesis in Non-Oncological Patients: A Systematic Review.

BACKGROUND: This review aimed to determine outcomes following megaprostheses in non-oncological indications for knee arthroplasty, including range of motion (ROM) and patient-reported outcome measures (PROMs) of function, pain, and quality of life (QoL). METHODS: A search of MEDLINE, Embase, and Cochrane via Ovid, and PubMed between January 2003 and June 2023 was conducted. Studies reporting function, pain, ROM, and/or QoL in non-oncological patients who have received knee megaprostheses were included. Studies with sample sizes (n ≤ 5) were excluded. The risk of bias was assessed using the Downs and Black Quality Checklist for Health Care Intervention Studies. Central tendency measures (mean or median) were reported at each time point, and dispersion measures were extracted and reported whenever data were available. RESULTS: A total of 30 studies (involving 1,294 megaprostheses) were included. Of which, 14 of 30 studies reviewed patients who had mixed indications, 14 of 30 looked at fracture only; 1 of 30 focused on distal femur nonunion; and 1 of 30 focused on patients who had periprosthetic infections. The average patient follow-up time was 40.1 months (range, 1.0-93.5). Most studies presented a high risk of bias (27 of 30), while a few (3 of 30) presented a low risk of bias. Improvements from preoperative baseline were observed in 85.7% of studies that reported baseline and follow-up data for function (12 of 14), 100.0% pain (4 of 4), 90.9% ROM (10 of 11), and 66.6% QoL (2 of 3). CONCLUSION: Favorable function, pain, ROM, and QoL outcomes following knee megaprostheses in non-oncological patients were observed. Heterogeneity in outcome measures and follow-up periods prevented the pooling of data. Future comparative studies are warranted to enhance the body of evidence relating to knee megaprostheses in non-oncological patients.

Impact of Preoperative Mental Health on Surgical Outcomes Following Robotic-assisted Radical Prostatectomy.

OBJECTIVES: To explore the association between preoperative mental health status and surgical outcomes following robotic-assisted radical prostatectomy (RARP). METHODS: This cohort study included consecutive patients undergoing RARP surgery for prostate cancer between October 2016 and May 2022 at a major public hospital in Sydney, Australia. The primary outcome was preoperative self-reported mental health status measured using the mental component score from the Short Form 36 survey. Other variables included patients' characteristics, surgical outcomes, postoperative quality of life, pain and decision regret. Data were analysed using linear regression analysis. RESULTS: A total of 266 men underwent RARP during the studied period. Of these, 242 patients (91%) completed the preoperative survey and were analyzed. Poorer preoperative mental health had significant univariate associations with younger age (P = .025), reduced access to economic resources (P = .043), diagnosis of a mental illness (P = .033), poorer mental health at 6 weeks and 6 months postoperatively (both P <.001), greater pain (P = .001), and higher decision regret (P = .001) 6 weeks following surgery. In the multivariate analysis, poorer preoperative mental health status was associated with younger age (P = .028) and poorer mental health at 6 weeks (P <.001) and 6 months (P = .025) postoperatively. CONCLUSION: For patients undergoing RARP, poor preoperative mental health status was associated with younger age and poorer postoperative mental health. Future studies should investigate if targeted preoperative psychological interventions would improve postoperative mental health outcomes, specifically in younger men undergoing RARP.

Live zoster vaccination in an immunocompromised patient leading to death secondary to disseminated varicella zoster virus infection.

In 2016, the live attenuated zoster vaccine (Zostavax, Merck and Co, USA) was introduced into the Australian National Immunisation Program for people aged 70 years who are not significantly immunocompromised. We report the administration of Zostavax in an immunocompromised patient with chronic lymphocytic leukaemia and no evidence of primary varicella zoster virus (VZV) infection. The patient presented with a bilateral vesicular facial rash 22 days after receiving Zostavax and was initially managed as an outpatient with oral acyclovir. He re-presented three days later and was diagnosed with disseminated VZV infection complicated by meningoencephalitis. The patient died following cardiac arrest on day 10 of hospitalisation. This unfortunate case highlights the challenge of safely implementing a high titre live vaccine in a population where contraindications are prevalent. The non-live recombinant herpes zoster subunit vaccine (Shingrix, GSK) may provide a safe and effective option to protect immunocompromised patients from shingles and post-herpetic neuralgia.

Comparison of lidocaine and lidocaine-epinephrine for the paravertebral brachial plexus block in dogs.

OBJECTIVE: To compare the motor and sensory block efficacy and duration of a modified paravertebral brachial plexus block (PBPB) after administration of lidocaine alone (LI) or combined with epinephrine (LE). STUDY DESIGN: Prospective, randomized, blinded, crossover study. ANIMALS: A total of eight healthy female Beagle dogs. METHODS: Under general anesthesia, modified PBPB was performed on the left thoracic limb using neurostimulation and/or ultrasound guidance to administer lidocaine (2 mg kg-1; 0.2 mL kg-1) either alone (treatment LI, n = 10) or with epinephrine (1:100,000; treatment LE, n = 9). Sensory block was evaluated through reaction to a painful mechanical stimulus applied at five sites on the limb. Motor block effect was evaluated according to visual gait assessments and thoracic limb vertical force measurements under dynamic and static conditions. Data were analyzed using repeated-measures generalized estimating equations. All statistical tests were performed two-sided at the α = 0.05 significance threshold. RESULTS: The duration of sensory block did not differ significantly between treatments. Visible gait impairment was more persistent in LE than in LI (118 ± 63 minutes for LI and 163 ± 23 minutes for LE; mean ± standard deviation) (p = 0.027). At nadir value, dynamic peak vertical force was lower in LE than in LI (p = 0.007). For both dynamic and static evaluations, the nadir and the return to baseline force were delayed in LE (return to normal at 180-200 minutes) when compared with LI (130-140 minutes) (p < 0.005). CONCLUSIONS AND CLINICAL RELEVANCE: The addition of epinephrine to lidocaine prolonged the duration and increased the intensity of the regional block, as verified by visual gait assessment and kinetic analysis. No significant difference was noted between treatments regarding sensory blockade. Kinetic analysis could be useful to evaluate regional anesthetic effect in dogs.

Glomerular filtration rate determination by computed tomography in two pet rabbits with renal disease.

CASE DESCRIPTION A 3-year-old and a 7-year-old spayed female rabbit (Oryctolagus cuniculus) were evaluated because of digestive stasis associated with renal asymmetry. CLINICAL FINDINGS Neoplasia of the right kidney was diagnosed via cytologic analysis in the 3-year-old rabbit. Ureterolithiasis of the left kidney was diagnosed via abdominal ultrasonography in the 7-year-old rabbit. To evaluate whether unilateral nephrectomy was indicated, evaluation of glomerular filtration rate by dynamic CT (CT-GFR) was performed on both rabbits. On the basis of the functional and morphological CT-GFR results, radical nephrectomy was recommended for the rabbit with renal neoplasia whereas a more conservative approach was recommended for the other rabbit. TREATMENT AND OUTCOME The rabbit with renal neoplasia underwent radical nephrectomy without complication. The rabbit with ureterolithiasis underwent ureteral stent placement, and the renal pelvic dilatation resolved. Both rabbits maintained unremarkable serum urea and creatinine concentrations after surgery. CLINICAL RELEVANCE GFR is a highly useful and reliable variable for the evaluation of renal function but is difficult to assess with routine clinical laboratory tests. The CT-GFR technique described here was quickly performed, was technically suitable for rabbits, and provided clinically relevant information. Studies are required to establish reference values for CT-GFR in rabbits.

Evaluation for association between urolithiasis and chronic kidney disease in cats.

OBJECTIVE To determine whether urolithiasis is associated with chronic kidney disease (CKD) in cats. DESIGN Retrospective case-control study. ANIMALS 126 cats (59 and 67 with and without urolithiasis, respectively). PROCEDURES Medical records from June 2006 to July 2013 were searched to identify cats that underwent abdominal or focal urinary tract ultrasonography and for which serum creatinine concentration and urine specific gravity data were obtained ≤ 14 days before or after the examination. In cats with (urolithiasis group) and without (control group) urolithiasis, the presence of CKD was determined according to International Renal Interest Society guidelines. Information recorded included signalment, body weight, serum creatinine concentration, and urine specific gravity; when present, the location and number of uroliths were noted. Differences between groups and associations between group and categorical variables were analyzed statistically. RESULTS Age, weight, sex, and breed did not differ between groups. The prevalence of CKD was significantly higher in cats with urolithiasis than in the control group. Among cats with urolithiasis, there was a negative association between CKD and presence of cystoliths. There was no association between urolithiasis and the stage of CKD or between presence of CKD and location of nephroliths in the kidney. CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed a positive association between urolithiasis and CKD in the feline population studied and suggested that cats with urolithiasis should be evaluated for CKD. Further research is warranted to assess the nature of the relationship between CKD and urolithiasis in cats.

COMPARISONS AMONG RADIOGRAPHY, ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE.

A better understanding of imaging characteristics of equine stifle osteoarthritis (OA) may allow earlier detection and improve prognosis. Objectives of this ex vivo, prospective, methods comparison study were to (1) describe the location and severity of naturally acquired OA lesions in the equine stifle using ultrasound (US), radiography (XR), computed tomography (CT), and macroscopic evaluation (ME); (2) compare the diagnostic performance of each imaging modality with ME; and (3) describe subchondral bone mineral density (BMD) in equine stifle joints with OA using CT. Radiographic, CT, and US evaluations were performed on 23 equine cadaver stifles and compared with ME. Significant associations were found between osteophyte global scores for all imaging modalities (CT, P ˂ 0.0001; XR, P = 0.005; US, P = 0.04) vs. ME osteophyte global scores. Osteophytes were detected most frequently in the medial femorotibial (MFT) joint. A specific pattern of osteophytes was observed, with a long ridge of new bone at the insertion of the MFT joint capsule cranially on the medial femoral condyle. A novel caudo-10°proximo-5°lateral-cranio-disto-medial oblique radiographic projection was helpful for detection of intercondylar osteophytes. Multiplanar CT reformatted images were helpful for characterizing all osteophytes. Osteophyte grades at most sites did not differ among modalities. Low sensitivity/specificity for subchondral bone sclerosis and flattening of femoral condyles suggested that these signs may not be reliable radiographic and CT indicators of equine stifle OA. Equine stifle OA was associated with a decrease in BMD and specific sites of focal subchondral bone resorption/cyst formation were found in some specimens.

Cryptococcal nasopharyngeal polypoid mass in a cat.

CASE SUMMARY: An indoor 9-year-old castrated male domestic cat was referred with a 4 month history of increased upper airway noise. Computed tomography revealed a nasopharyngeal polypoid mass, which was removed endoscopically with basket forceps. Histopathology was compatible with a polypoid granulomatous pharyngitis with Cryptococcus-like organisms. This was supported by a positive serum latex cryptococcal antigen agglutination test (LCAT). Minimal inflammation of the nasal tissue was noted on histopathology, with no evidence of fungus. Following endoscopic removal of the mass, the patient was treated with systemic antifungal medication (itraconazole). One year after diagnosis, the LCAT titer was negative and the cat remained free of clinical signs. RELEVANCE AND NOVEL INFORMATION: This case report emphasizes the importance of considering Cryptococcus species as a potential etiology in cats presented with signs of nasopharyngeal obstruction with an isolated nasopharyngeal polypoid mass, even if kept indoors.

A comparison of computed tomography, computed radiography, and film-screen radiography for the detection of canine pulmonary nodules.

Computed tomography (CT) has become more widely available and computed radiography (CR) has replaced film-screen radiography for canine thoracic imaging in many veterinary practices. There are limited data comparing these modalities in a veterinary clinical setting to detect pulmonary nodules. We compared CT, CR, and film-screen radiography for detecting the presence, number, and characteristics of pulmonary nodules in dogs. Observer performance for a variety of experience levels was also evaluated. Twenty-one client-owned dogs with a primary neoplastic process underwent CT and CR; nine also received film-screen radiographs. Positive/negative classification by consensus agreed between the three modalities in 8/9 dogs and between CR and CT in the remaining 12. CT detected the greatest (P = 0.002) total number of nodules and no difference was seen between CR and films. The greatest number of nodules was seen in the right middle and both caudal regions, but only using CT (P < 0.0001). Significantly smaller nodules were detected with CT (P = 0.0007) and no difference in minimum size was detected between CR and films. Observer accuracy was high for all modalities; particularly for CT (90.5-100%) and for the senior radiologist (90.5-100%). CT was also characterized by the least interobserver variability. Although CT, CR, and film-screen performed similarly in determining the presence or absence of pulmonary nodules, a greater number of smaller nodules was detected with CT, and CT was associated with greater diagnostic confidence and observer accuracy and agreement.

Use of magnetic resonance imaging and histopathologic findings for diagnosis of an aneurysmal bone cyst in the scapula of a cat.

CASE DESCRIPTION: An 18-month-old spayed female domestic shorthair cat was evaluated because of left thoracic limb lameness. CLINICAL FINDINGS: A firm mass was palpable in the left scapular region. On the basis of clinical signs; results of radiographic, ultrasonographic, and cytologic evaluations; and findings on magnetic resonance imaging, an aneurysmal bone cyst (ABC) of the scapula was strongly suspected. TREATMENT AND OUTCOME: Considering the large size of the mass and the poor prognosis for return to function of the left thoracic limb, amputation was elected. Histologic evaluation ruled out a malignant process and was diagnostic for ABC originating from the left scapula. The patient recovered well and was ambulatory the day after surgery. Three years after surgery, the cat was healthy. CLINICAL RELEVANCE: The combination of radiography, regional ultrasonography, and magnetic resonance imaging enabled lesion structure and cavity content evaluation. However, final diagnosis was confirmed by histologic evaluation. To our knowledge, this is the first veterinary report of the use of magnetic resonance imaging in the characterization and diagnosis of an ABC.

Comparison of sonographic features of benign and neoplastic deep lymph nodes in dogs.

The differentiation of benign vs. neoplastic lymph nodes impacts patient management. Specific sonographic features are typically considered when assessing lymph nodes in dogs. However, the usefulness of these criteria in distinguishing benign vs. malignant lymph nodes remains largely unknown, especially for deep lymph nodes. Our aim was to compare sonographic features in benign and neoplastic deep lymph nodes with the hope of identifying predictive criteria. Thirty-one deep lymph nodes (16 mesenteric, 10 medial iliac, three hepatic, one sternal, and one cranial mediastinal) in 31 dogs were examined prospectively with B-mode and Color flow Doppler. Lymph nodes were aspirated using ultrasound-guidance and final diagnosis were established based on cytologic and/or histopathologic interpretation. Prevalence of each sonographic feature and combinations of two features was calculated for each group and compared using a χ(2) -test or Student's t-test for unequal variances. Ten lymph nodes were benign (hyperplastic and/or inflammatory) and 21 were neoplastic. All were hypoechoic, except for one neoplastic lymph node. Maximal short-axis diameter (P=0.0006) and long-axis diameter (P=0.01), and SA/LA ratio (P=0.008) were increased significantly for neoplastic (2.8, 5.5 cm, and 0.50, respectively) vs. benign (1.2, 3.8 cm, and 0.34, respectively) lymph nodes. The prevalence of other features was similar between groups. Doppler evaluation was possible in 77% of lymph nodes, but there was no significant difference between groups. When any two ultrasound features were combined, the only difference between benign and neoplastic lymph nodes was for the combination of contour regularity and appearance of the perinodal fat (P=0.03).

Thoracoscopic lung biopsies in heaves-affected horses using a bipolar tissue sealing system.

OBJECTIVE: To validate the use of the LigaSure™ Vessel Sealing System (LVSS) to perform thoracoscopic lung tissue biopsies in heaves-affected horses. STUDY DESIGN: Prospective clinical study. ANIMALS: Heaves-affected horses (n=12). METHODS: Lung biopsies (n=34) were collected with the LVSS (2-4 biopsies/horse) in horses with and without clinical signs of heaves. Thoracoscope (13th intercostal space [ICS]) and 2 instruments (between the 12-15th ICS) portals were used. Selected clinical and arterial blood gas variables were monitored. Postoperative pneumothorax was evaluated. Depth of thermal injury to the surrounding tissue and representativeness of the biopsies were determined. RESULTS: Mean surgical time was 22.9±8.0 minutes. The complication rate was 5.6%, and primarily related to a focal inadequate sealing of the biopsy margin. Five horses in exacerbation required intraoperative intranasal O(2) . Mean PaO(2) was significantly lower in heaves-affected horses with clinical signs compared with those without clinical signs. Postoperative pneumothorax was detected radiographically after 20 of the 34 procedures. One horse with clinical signs of heaves developed a fatal tension pneumothorax 5 days postoperatively despite close radiographic monitoring. CONCLUSION: Thoracoscopic lung biopsy using LVSS is a rapid and effective technique to harvest peripheral lung tissues from heaves-affected horses. Although the complication rate was tolerable, tension pneumothorax was a potential life-threatening complication because of incomplete lung sealing. CLINICAL RELEVANCE: LVSS can be used with relative safety to perform thoracoscopic lung biopsy, but close postoperative monitoring is necessary to avoid tension pneumothorax.

Multiple follicular cysts of the ear canal in a dog.

An 11-year-old, 18-kg, neutered male standard schnauzer was presented for evaluation of recurrent otitis externa with para-aural swelling and fistulation of the right external ear canal of 6 months' duration. Otoscopic examination was impossible because of the severe stenosis of the ear canal. Right para-aural ultrasound examination and ultrasound-guided fine-needle aspiration of a mass-like lesion were performed. Cytology was suggestive of a follicular cyst. Magnetic resonance imaging revealed severe ear canal stenosis with a heterogeneous mass in the horizontal portion of the ear canal and associated otitis media. Total ear canal ablation with lateral bulla osteotomy was performed. Histopathological diagnosis was chronic otitis externa associated with multiple follicular cysts confined to the ear canal. Surgical treatment proved curative. This is the first report of multiple follicular cysts originating from the ear canal in a dog.

Can sonographic findings predict the results of liver aspirates in dogs with suspected liver disease?

While abdominal ultrasound and ultrasound-guided fine-needle aspiration cytology are often combined to help determine the type of liver disease in dogs, little is known about the relationship that may exist between the results of these tests. We hypothesized that specific sonographic findings, or combinations of findings, may predict results of liver ultrasound-guided fine-needle aspiration cytology. Hepatic and extrahepatic sonographic findings were recorded prospectively using a standardized form in 70 dogs with clinically suspected liver disease and in which liver ultrasound-guided fine-needle aspiration cytology was performed. The predictive value of sonographic findings in regard to the category of cytology results was assessed with stepwise logistic regression analysis. Sonographic detection of a hepatic mass (> or = 3cm; risk ratio [RR] 3.83, 95% Wald confidence intervals [95% CI] 2.42-3.93, P = 0.0036), ascites (RR 3.82, 95% CI 1.94-4.28, P = 0.0044), abnormal hepatic lymph node(s) (RR 3.01, 95% CI 1.22-4.88, P= 0.0262), and abnormal spleen (RR 3.26, 95% CI 1.20-3.85, P = 0.0274) were the most predictive of liver neoplasia on cytology. Conversely, sonographic detection of hepatic nodules (< 3cm; RR 1.97, 95% CI 0.95-2.96, P = 0.0666) was most predictive of vacuolar hepatopathy on cytology. In dogs with suspected liver disease, several sonographic findings, alone or combined, are thus predictive of liver ultrasound-guided fine-needle aspiration cytology results. In the light of the fact that ultrasound-guided fine-needle aspiration cytology of the liver has limitations, these predictabilities could influence the selection of diagnostic tests to reach a reliable diagnosis.

Comparison of single-slice computed tomography protocols for detection of pulmonary nodules in dogs.

Two dogs (4 and 38 kg) with radiographic evidence of pulmonary nodules were evaluated using single-slice, helical computed tomography (CT). Each thorax was scanned using 12 combinations of examination parameters that included slice collimation width (3 and 5mm for the small dog and 5 and 7mm for the large dog), pitch (1, 1.5, and 2), and reconstruction interval (0.5 and 1). Sensitivity, specificity, and accuracy for nodule detection were evaluated for each protocol by three different observers, their results being compared with a consensus evaluation of images acquired with the protocol providing the best theoretic resolution (narrow collimation, pitch of 1, reconstruction interval of 0.5). For all observers, sensitivity and accuracy were significantly increased when using a protocol with narrow collimation (P < 0.0001-0.005 and P = 0.0003-0.005, respectively). Pitch and reconstruction interval did not significantly influence the accuracy, sensitivity, or specificity for at least two of the observers. Additionally, nodule size (< 3mm vs. > 3mm) did not significantly affect nodule detection. Interobserver repeatability was variable among protocols (K = 0.32-0.78), highlighting the fact that nodule detection may be more dependent on the observer than on the choice of the CT protocol. For single-slice CT, the results of this study suggest that narrow collimation (3-5 mm, depending on the animal's size), a pitch of 2 and a reconstruction interval of 1 should be used in dogs for the detection of pulmonary nodules.

Evaluation of a thoracoscopic technique using ligating loops to obtain large lung biopsies in standing healthy and heaves-affected horses.

OBJECTIVE: To evaluate use of pre-tied ligating loop to perform thoracoscopic, large lung biopsy in normal and heaves-affected horses. STUDY DESIGN: Prospective clinical study. ANIMALS: Normal (n=5) and heaves-affected (n=6) horses. METHODS: Lung biopsies, 1 from each hemithorax, were collected thoracoscopically using a pre-tied ligating loop. Horses were either normal (C) or heaves-affected with the latter being in remission (Ha) for the initial biopsy and in exacerbation (Hs) for the 2nd biopsy. Clinical variables, PaO(2), and PaCO(2) were used to determine the effect of surgical biopsy. Postoperative pneumothorax was monitored by serial thoracic radiographic examinations. RESULTS: Thoracoscopic lung biopsy (n=29, 22 procedures) was well tolerated by all horses. Complication rate was 31%, including 8 ligature slippage and 1 pulmonary hemorrhage. Intranasal oxygen was administered intraoperatively to 6 horses (2 C, 1 Ha, 3 Hs) with severe hypoxemia or labored breathing. There was a significant decrease in PaO(2) during surgery in horses not supplemented with oxygen. Postoperative pneumothorax (21/22 procedures) detected radiographically resolved within 3 weeks. CONCLUSION: Thoracoscopic lung biopsy using pre-tied ligating loops was minimally invasive, relatively inexpensive, and fairly efficient. Heaves-affected horses tolerated the surgery well, even when in exacerbation; however, the technique was associated with non life-threatening complications in 31% of the biopsies, most of which required correction with additional ligating loops or more sophisticated instrumentation. CLINICAL RELEVANCE: Using laparoscopic pre-tied ligating loop for thoracoscopically-assisted lung biopsy can be considered in horses with normal and impaired lung function but alternative instrumentation and access to intranasal oxygen must be available to the surgeon in case of complications.

Magnetic resonance imaging and marsupialization of a hemorrhagic intramedullary vascular anomaly in the cervical portion of the spinal cord of a dog.

CASE DESCRIPTION: A 1-year-old female spayed Labrador Retriever was admitted for evaluation of a progressive gait disturbance characterized by tetraparesis and general proprioceptive ataxia in all limbs. CLINICAL FINDINGS: Neurologic examination suggested a dysfunction of the C6-T2 spinal cord segments, which was slightly worse on the right side. Discomfort was suspected upon lateral flexion of the neck. Two magnetic resonance imaging (MRI) examinations at a 3-week interval revealed an intramedullary fluid-filled cavitary lesion adjacent to C7, containing a blood clot. TREATMENT AND OUTCOME: Following unsuccessful initial conservative management, surgical marsupialization of the lesion was performed through a dorsal laminectomy, durotomy, and myelotomy at C6 and C7. Histologic evaluation including immunohistochemistry was diagnostic for a vascular anomaly. Initially, the dog was nonambulatory with tetraparesis and became tetraplegic after surgery; movement was regained 6 days later. Four weeks after the procedure, the dog was able to walk unassisted. One year after surgery, the dog was actively running and jumping, with mild residual ataxia in the pelvic limbs. CLINICAL RELEVANCE: The intramedullary vascular anomaly in this dog was successfully treated with a surgical marsupialization technique. The combination of MRI, histologic evaluation, and immunohistochemistry enabled lesion localization, evaluation of cavity content, and final diagnosis.

Congenital branchial apparatus malformation in a Haflinger colt.

OBJECTIVE: To report the diagnosis and treatment of a branchial apparatus anomaly (BAA) associated with a mandibular malformation in a foal. DESIGN: Clinical report. ANIMAL: Haflinger foal. METHODS: A 6-day-old foal had a fluctuating cystic mass in the pharyngeal (throatlatch) region, which changed in appearance after ingestion of milk. Upper airway endoscopy and diagnostic imaging (ultrasonography, radiography, computed tomography) permitted identification of the anatomic location of a communicating tract between the lumen of the cystic mass and the pharynx. The mass was surgically removed and communication with the pharynx ligated. Histologic appearance of this mass was consistent with a branchial cyst or sinus. The mandibular malformation was managed conservatively. RESULTS: Surgical resection of a third branchial sinus resulted in an excellent functional and cosmetic outcome. There was no evidence of any mandibular deformity 2 years later. CONCLUSION: BAA may induce secondary mandibular deformation in utero and may cause respiratory compromise postpartum. Careful surgical dissection and removal of BAA resulted in an excellent outcome. CLINICAL RELEVANCE: BAAs should be included in the differential diagnosis of a throatlatch region mass in equine neonates. Complete surgical excision is recommended and full recovery of any associated mandibular deformity may be anticipated without additional treatment in very young patients.