The effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium in a simulated tumor model.

OBJECTIVE: To determine the effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium. STUDY DESIGN: Experimental study. ANIMALS: Eight healthy research beagles. METHODS: A predefined area of skin measuring 2 × 1.5 cm in dimension was designated on either the right or left brachium. Preoperative lymphoscintigraphy was performed with technetium sulfur colloid injected into the subcutaneous tissues around the predefined anatomic location in a four-quadrant technique. Dogs underwent surgery for excision of the predefined area of skin, subcutis, and fascia of the lateral head of the triceps muscle with 1-cm margins. Eighteen days after surgery, lymphoscintigraphy was again performed with technetium sulfur colloid injected into the subcutaneous tissues around the surgical scar in a four-quadrant technique. RESULTS: Sentinel lymph nodes were identified in eight of eight dogs preoperatively and in eight of eight dogs postoperatively. Agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was identified as complete in four of eight dogs and partial in four of eight dogs. Sentinel lymph node identification occurred immediately in three of eight dogs preoperatively and in eight of eight dogs postoperatively. CONCLUSION: Sentinel lymph node identification occurred faster postoperatively. Agreement or partial agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was observed in eight of eight dogs. CLINICAL SIGNIFICANCE: Surgery appears to have an effect on lymphoscintigraphy drainage patterns. Additional studies are required to compare preoperative and postoperative sentinel lymph node mapping patterns in tumor-bearing dogs. However, this study provides preliminary information regarding the effect of surgery on sentinel lymph node identification.

Sentinel lymph node detection differs when comparing lymphoscintigraphy to lymphography using water soluble iodinated contrast medium and digital radiography in dogs.

Sentinel lymph node (SLN) mapping by various means has become standard of care in certain types of human cancers and is receiving more attention in veterinary oncology. Current SLN mapping techniques can be costly and often require advanced imaging equipment. The objective of this prospective, method comparison study was to compare an SLN mapping protocol of lymphoscintigraphy to lymphography using water soluble iodinated contrast medium (WIC) and digital radiography for identification of an SLN. Lymphoscintigraphy and lymphography were performed on eight healthy purpose-bred dogs using technetium-99m sulfur colloid and WIC injected into the subcutaneous tissues in a four-quadrant technique around a predefined area of skin on the brachium. Images were obtained using a gamma camera and digital radiography at different time points post-injection. Image sequences were evaluated by one of two American College of Veterinary Radiology board-certified veterinary radiologists. Data obtained were compared between methods using descriptive statistics. An SLN was identified in all dogs with lymphoscintigraphy and seven of eight dogs with lymphography. Agreement between results of the lymphoscintigraphy and lymphography studies was a complete match in three dogs, a partial match in four dogs, and no match in one dog. The SLN detected differed based on the imaging modality used.

Sentinel lymph node mapping of the canine anal sac using lymphoscintigraphy: A pilot study.

Sentinel lymph node mapping and biopsy are important parts of oncologic staging in human medicine. Sentinel lymph node mapping enables identification of the first lymph node to receive lymphatic drainage while avoiding unnecessary lymph node dissection. Anal sac adenocarcinoma is the most common malignant neoplasm of the canine perineal area. For dogs with anal sac adenocarcinoma, lympadenectomy and metastasis to the iliosacral lymphocentrum are negative prognostics indicators. The objectives of this prospective, two by two, crossover pilot study were to establish the feasibility of lymphoscintigraphy using Technetium-99 sulfur colloid of the canine anal sac of healthy dogs, compare two injection techniques, and the time for identification of sentinel lymph nodes using each technique. We hypothesized that both intramural and perimural injections of the canine anal sac would identify similar sentinel lymph node drainage. The sentinel lymph node was identified in all dogs using either technique. Intramural injection of the canine anal sac showed radiopharmaceutical uptake faster than perimural injection technique (P = 0.040). There was concordance between intramual and perimural techniques for the sentinel lymph node identified in 50% of cases. A sacral lymph node was identified as sentinel in three of eight dogs (37.5%). Lymphoscintigraphy of the canine anal sac is safe and feasible in normal dogs; however, the method of injection technique seems to have a significant effect on the sentinel lymph node identified.

Partial splenectomy for incidentally detected non-ruptured splenic lesions in dogs: 18 cases (2004-2018).

The objective of this retrospective study was to describe the outcome and incidence of splenic malignancy in 18 dogs undergoing partial splenectomy for incidentally detected, non-ruptured splenic lesions. Incidence of splenic malignancy in the present study was 5.6% [95% confidence interval (CI): 0.14% to 27.65%]. Median diameter of splenic nodules was 2 cm (range: 1.5 to 4 cm). Splenic hemangiosarcoma was diagnosed in 1 dog, while the remaining 17 dogs had benign splenic lesions. There was a higher incidence of non-splenic malignancy (50%) than splenic malignancy (5.6%) in the study population. Overall median survival time after surgery was 300 days (range: 4 to 1332 days). Median survival time in dogs with malignant disease (splenic and non-splenic) was 67 days (range: 4 to 425 days) and for non-malignant disease was 727 days (range: 8 to 1332 days). In conclusion, partial splenectomy may be appropriate for small, incidental non-ruptured splenic lesions in dogs.

Splénectomie partielle pour des lésions spléniques non-rupturées détectées de manière fortuite chez des chiens : 18 cas (2004­2018). L'objectif de cette étude rétrospective était de décrire l'issue et la fréquence de malignité splénique chez 18 chiens soumis à une splénectomie partielle pour des lésions spléniques non-rupturées détectées de manière fortuite. La fréquence de malignité splénique dans la présente étude était de 5,6 % [intervalle de confiance de 95 % (CI) : 0,14 % à 27,65 %]. Le diamètre médian des nodules spléniques était de 2 cm (écart : 1,5 à 4 cm). Un hémangiosarcome splénique fut diagnostiqué chez un chien, alors que les 17 autres chiens avaient des lésions spléniques bénignes. Il y avait une plus grande fréquence de malignité non-splénique (50 %) que de malignité splénique (5,6 %) dans la population étudiée. Globalement, le temps de survie médian après la chirurgie était de 300 jours (écart : 4 à 1332 jours). Le temps de survie médian chez les chiens avec une condition maligne (splénique et non-splénique) était de 67 jours (écart : 4 à 425 jours) et pour ceux avec une condition non-maligne il était de 727 jours (écart : 8 à 1332 jours). En conclusion, une splénectomie partielle peut être appropriée pour des petites lésions spléniques secondaires non-rupturées.(Traduit par Dr Serge Messier).

A comparison of microRNA expression profiles from splenic hemangiosarcoma, splenic nodular hyperplasia, and normal spleens of dogs.

BACKGROUND: Splenic masses are common in older dogs; yet diagnosis preceding splenectomy and histopathology remains elusive. MicroRNAs (miRNAs) are short, non-coding RNAs that play a role in post-transcriptional regulation, and differential expression of miRNAs between normal and tumor tissue has been used to diagnose neoplastic diseases. The objective of this study was to determine differential expression of miRNAs by use of RNA-sequencing in canine spleens that were histologically confirmed as hemangiosarcoma, nodular hyperplasia, or normal. RESULTS: Twenty-two miRNAs were found to be differentially expressed in hemangiosarcoma samples (4 between hemangiosarcoma and both nodular hyperplasia and normal spleen and 18 between hemangiosarcoma and normal spleen only). In particular, mir-26a, mir-126, mir-139, mir-140, mir-150, mir-203, mir-424, mir-503, mir-505, mir-542, mir-30e, mir-33b, mir-365, mir-758, mir-22, and mir-452 are of interest in the pathogenesis of hemangiosarcoma. CONCLUSIONS: Findings of this study confirm the hypothesis that miRNA expression profiles are different between canine splenic hemangiosarcoma, nodular hyperplasia, and normal spleens. A large portion of the differentially expressed miRNAs have roles in angiogenesis, with an additional group of miRNAs being dysregulated in vascular disease processes. Two other miRNAs have been implicated in cancer pathways such as PTEN and cell cycle checkpoints. The finding of multiple miRNAs with roles in angiogenesis and vascular disease is important, as hemangiosarcoma is a tumor of endothelial cells, which are driven by angiogenic stimuli. This study shows that miRNA dysregulation is a potential player in the pathogenesis of canine splenic hemangiosarcoma.

Effect of vascular seal configuration using the LigaSure on arterial challenge pressure, time for seal creation, and histologic features.

OBJECTIVE: To determine the effectiveness of a vascular sealing technology on canine carotid arteries using various seal configurations to achieve maximal vessel security. STUDY DESIGN: Ex-vivo study. ANIMALS: Dogs (n = 20). METHODS: Carotid arteries (n = 40) were removed from the mid-cervical region of recently euthanatized dogs. Harvested vessels were closed with 2 circumferential ligatures (Group 1) or a vascular sealing device using 1 of 4 seal configurations of 1 or 2 seals combined with 1 or 2 machine activations/seal. The artery was instrumented to measure intraluminal pressure to evaluate the security of each seal during saline infusion. Maximum intraluminal pressure was recorded for each group, and time for application of each sealing protocol was compared using 1-way ANOVA and Tukey's test for multiple comparisons. Histologic features of the sealing protocols were evaluated. RESULTS: Arterial closures for each group were effective in preventing leakage up to 300 mmHg. There was no significant difference in maximum intraluminal pressure between any group. A significant difference (P ≤ .001) was observed for time to seal creation between the groups using 1 and 2 seals. Histologic evaluation showed no differences between the different sealing protocols. CONCLUSION: Vessel sealing using a single seal created with a single activation cycle was adequate for sealing canine carotid arteries. Histologic examination did not demonstrate any disadvantages to multiple seals or multiple cycle activations.

Effect of enteric biopsy closure orientation on enteric circumference and volume of saline needed for leak testing.

This study describes the effect of enteric biopsy closure orientation on circumference and volume of saline needed for leak testing. There were significant differences in circumference measurements at baseline, central circumference of longitudinally closed sites, and volume of saline for leak testing.

Effet de l'orientation de la fermeture de la biopsie entérique sur la circonférence entérique et le volume de solution saline requis pour l'essai d'étanchéité. Cette étude décrit l'effet de l'orientation de la fermeture de la biopsie entérique sur la circonférence et le volume de solution saline requis pour l'essai d'étanchéité. Il y avait des différences importantes dans les mesures de la circonférence pour les données de référence, la circonférence centrale des sites fermés longitudinalement et le volume de solution saline pour l'essai d'étanchéité.(Traduit par Isabelle Vallières).

Evaluation of outcomes in dogs treated for pyothorax: 46 cases (1983-2001).

OBJECTIVE-To determine the effect of treatment approach on outcome and the appropriateness of initial empirical antimicrobial treatment in dogs with pyothorax. DESIGN-Retrospective case series. ANIMALS-46 dogs with pyothorax confirmed by either (n = 15) or both (31) of the following: intracellular bacteria in pleural fluid or tissue (41) and bacteria recovered via culture of pleural fluid (36). PROCEDURES-Medical records of dogs treated for pyothorax from 1983 through 2001 were reviewed. Data on signalment, history, clinical signs, and treatment and results of diagnostic imaging and cytologic and microbiological evaluations were obtained. Follow-up was performed via reexamination (n = 15) and contact with referring veterinarians (26) and owners (24). RESULTS-46 dogs were treated with at least 1 antimicrobial and thoracocentesis (n = 7; noninvasive group), a thoracostomy tube (26; invasive group) with or without pleural lavage and heparin, or a thoracotomy (13; surgical group) and thoracostomy tube with or without pleural lavage and heparin. Pyothorax recurred in 7 dogs, and 5 of the 7 died or were euthanatized. In the respective groups, the short-term survival rate was 29%, 77%, and 92% and the long-term survival rate was 29%, 71%, and 70%. Pleural lavage and heparin treatment increased the likelihood of short- and long-term survival. Results of antimicrobial susceptibility testing suggested empirical antimicrobial selection was associated with a 35% risk of inefficacy. CONCLUSIONS AND CLINICAL RELEVANCE-In the dogs with pyothorax in this study, favorable treatment effects were achieved with surgery (for short-term survival) and pleural lavage and heparin treatment (for short- and long-term survival). Findings failed to support the hypothesis that invasive (surgical) versus noninvasive treatment of pyothorax in dogs leads to a better long-term outcome.

Saline volume necessary to achieve predetermined intraluminal pressures during leak testing of small intestinal biopsy sites in the dog.

OBJECTIVE: To determine the volume of saline needed to achieve targeted intraluminal pressures during leak testing of closed jejunal biopsy sites in the dog. STUDY DESIGN: Experimental. ANIMALS: Dogs (n=38). METHODS: Jejunal biopsies in dogs were performed and closed using 3-4 full thickness simple interrupted sutures. Saline volumes needed to achieve 2 predetermined intraluminal pressures (20 and 34 cm water [15 and 25 mmHg]) in a 10 cm canine jejunal segment containing a closed biopsy site using 2 methods of luminal occlusion were recorded. RESULTS: The 95% confidence intervals for the volume of saline needed to achieve 20 and 34 cm water intraluminal pressure were 10.9-13.6 and 16.3-19.0 mL, respectively with digital occlusion and 8.5-11.1 and 12.1-14.8 mL, respectively with Doyen occlusion. Correlation between volume of saline instilled and the pressure achieved was 0.76 for digital occlusion and 0.86 for Doyen occlusion. CONCLUSION: Correlation between volume of saline instilled and pressure achieved was greater with Doyen than digital occlusion. CLINICAL RELEVANCE: For canine jejunum, saline volumes of 16.3-19 mL (digital occlusion) and 12.1-14.8 mL (Doyen occlusion) can be used to achieve intraluminal pressures of 34 cm water during leak testing of a 10 cm segment containing a closed biopsy site.

In vitro elution of amikacin and vancomycin from impregnated plaster of Paris beads.

OBJECTIVE: To describe in vitro elution characteristics of amikacin and vancomycin from calcium sulfate hemihydrate 98% (plaster of Paris, POP) beads and characterize eluent inhibition of Staphylococcus spp. STUDY DESIGN: Experimental study. METHODS: POP beads were impregnated with amikacin or vancomycin alone or in combination and then incubated alone or in combination for 84 days at 37 degrees C in plastic tubes containing sterile phosphate-buffered saline (PBS). Beads containing no antimicrobial served as negative control. Beads were intermittently moved to a new tube containing drug-free PBS. Antimicrobial was measured in the eluent using a polarized fluorescent immunoassay. Eluent inhibition of Staphylococcus spp. was determined at each time point. RESULTS: Antimicrobial release from beads was characterized by an initial rapid phase then a slower phase. Although antimicrobial release from beads occurred throughout the 84 days, most was in the first 24 hours, except for vancomycin alone. Duration of eluent inhibition of Staphylococcus spp. growth ranged from 0.5 (amikacin alone) to 56 days (vancomycin alone). Control eluent did not inhibit bacterial growth. CONCLUSIONS: Amikacin elution from POP beads was rapid, inhibiting growth for <24 hours with or without vancomycin. Vancomycin elution was slower and inhibited growth for 56 days alone or for 5 days with amikacin. CLINICAL RELEVANCE: Vancomycin-impregnated beads appear to be reasonable as a therapeutic option whereas amikacin-impregnated POP beads and amikacin and vancomycin combinations may require further study before considering as a therapeutic option.

Description of a novel technique for surgical placement of gastrostomy tubes in dogs.

BACKGROUND: Early enteral nutrition in dogs with critical illnesses, including septic peritonitis, has been shown to have a positive influence on patient outcome. Surgical placement of a gastrostomy tube (GT) is one option for providing early enteral nutrition. Complications, including premature tube removal or separation of the stomach from the body wall, can result in leakage of gastric contents into the abdominal cavity and subsequent peritonitis. A safe and reliable technique for the placement of a GT is desirable to minimize such complications. KEY CONCEPTS: A modified method for surgical placement of a GT is described. A thoracic trocar catheter (TTC) with an attached Pezzer tube is inserted through a gastrotomy incision and exited through the left gastric body and body wall. A left-sided tube gastropexy is performed using an interlocking box (ILB) pattern. SIGNIFICANCE: GT placement using a TTC is efficient, requiring minimal additional anesthesia time. The gastric defect created by the TTC conforms well with the Pezzer tube. As such, placement and utilization of the ILB suture pattern enables removal of the GT in the early postoperative period, if appropriate.

Pharmacokinetics and pharmacodynamics of oral pradofloxacin administration in dogs.

OBJECTIVE To determine whether target values for pharmacokinetic-pharmacodynamic (PK-PD) indices against selected canine pathogens were achievable for pradofloxacin in various canine fluids and leukocytes. ANIMALS 8 healthy adult hounds (experiments 1 and 2) and 6 healthy adult dogs (experiment 3). PROCEDURES In 3 experiments, pradofloxacin (3, 6, or 12 mg/kg) and enrofloxacin (5 or 10 mg/kg) were orally administered once a day for 5 days, and blood, interstitial fluid (ISF), and other fluid samples were collected at various points. Sample drug concentrations were measured, and noncompartmental pharmacokinetic analysis was performed; then, PK-PD indices (ratios between maximum observed concentration [Cmax] and minimum inhibitory or mutant prevention concentrations) were determined for 7 bacterial species. RESULTS PK-PD values for pradofloxacin at 3 mg/kg were approximately 5 times as high in leukocyte versus plasma and were lowest in CSF, synovial fluid, and aqueous humor. No significant differences were noted between serum and ISF. Value ratios for serum versus other body fluids were numerically higher for pradofloxacin (vs enrofloxacin) for all fluid types except CSF and aqueous humor. Target PK-PD values were exceeded for pradofloxacin against all 7 bacterial species in leukocytes and against all species except Bacteroides spp in serum and ISF. Enrofloxacin achieved the target Cmax-to-minimum inhibitory concentration ratio against Pasteurella multocida in serum, ISF, and leukocytes and for Staphylococcus pseudintermedius in serum and leukocytes. A Cmax-to-mutant prevention concentration ratio ≥ 1 against Eschericha coli was achieved for pradofloxacin at 6 mg/kg. CONCLUSIONS AND CLINICAL RELEVANCE These findings supported once-daily oral administration of pradofloxacin to dogs at the currently recommended dose (7.5 mg/kg).

Biomechanical comparison of two ostectomy configurations for partial mandibulectomy.

OBJECTIVE: To determine the stiffness and load to failure of two different ostectomy configurations using canine mandibles. STUDY DESIGN: Cadaveric biomechanical assessment. ANIMALS: Paired mandibles (n = 30). METHODS: Standardized partial ostectomies were created on the alveolar surface of 30 mandibles. Samples were randomly assigned to right-angled (n = 15) or crescentic ostectomy (n = 15). Excision spanned the mesial aspect of the fourth premolar tooth to the distal aspect of first molar tooth. Mandibles were loaded to failure in three-point bending. The stiffness, displacement at maximum load, and load to failure were measured. RESULTS: There was no significant difference in stiffness (p = 0.59), displacement at maximum load (p = 0.16) and load to failure (p = 0.76) between right-angled or crescentic ostectomy. Right-angled and crescentic ostectomy failed mostly by fracture through an empty alveolus (11/15 and 13/15, respectively). CLINICAL RELEVANCE: No significant differences in load to failure or stiffness between ostectomy techniques were observed. Crescentic ostectomy did not improve the acute load to failure for partial mandibulectomy. The empty alveolus served as a focal stress concentration point eliminating the potential mechanical advantage of a crescentic ostectomy.

Antimicrobial use in the surgical patient.

Antimicrobials are often used in the surgical patient in an effort to prevent infection (prophylactic) or to treat established infection (therapeutic). To be effective, prophylactic antimicrobials at appropriate concentrations must be present in tissues at the surgical site at the time of contamination to prevent bacterial growth and subsequent infection. Therapeutic antimicrobials are used to treat established localized or systemic infection. Selection of antimicrobial agents for prophylactic or therapeutic use should be based on knowledge of expected flora, ability of the antimicrobial to reach the target tissue at appropriate concentrations, bacterial resistance patterns, drug pharmacokinetics, and culture and susceptibility testing results (therapeutic use). Failure of antimicrobial therapy to prevent or treat infection in the surgical patient may result from poor antimicrobial selection, inappropriate dosage or frequency, or inappropriate duration of therapy.

Topical and systemic medications for wounds.

There are a plethora of topical and systemic medications available to the veterinary practitioner today that aid the wound healing process. Some of these help to maintain a moist environment. Others increase growth factors, provide local energy sources, control infection, provide for debridement, increase wound blood flow and temperature, or reduce wound edema. Modern wound care requires that the proper products(s)be used, depending on the condition of the wound and the phase of wound healing. This article discusses various wound care products and provides guidelines on their use.

Evaluation of the concentration of marbofloxacin in alveolar macrophages and pulmonary epithelial lining fluid after administration in dogs.

OBJECTIVE: To determine concentrations of marbofloxacin in alveolar macrophages (AMs) and epithelial lining fluid (ELF) and compare those concentrations with plasma concentrations in healthy dogs. ANIMALS: 12 adult mixed-breed and purebred hounds. PROCEDURE: 10 dogs received orally administered marbofloxacin at a dosage of 2.75 mg/kg every 24 hours for 5 days. Two dogs served as nontreated controls. Fiberoptic bronchoscopy and bronchoalveolar lavage procedures were performed while dogs were anesthetized with propofol, approximately 6 hours after the fifth dose. The concentrations of marbofloxacin in plasma and bronchoalveolar fluid (cell and supernatant fractions) were determined by use of high-performance liquid chromatography with detection of fluorescence. RESULTS: Mean +/- SD plasma marbofloxacin concentrations 2 and 6 hours after the fifth dose were 2.36 +/- 0.52 microg/mL and 1.81 +/- 0.21 microg/mL, respectively. Mean +/- SD marbofloxacin concentration 6 hours after the fifth dose in AMs (37.43 +/- 24.61 microg/mL) was significantly greater than that in plasma (1.81 +/- 0.21 microg/mL) and ELF (0.82 +/- 0.34 microg/mL), resulting in a mean AM concentration-to-plasma concentration ratio of 20.4, a mean AM:ELF ratio of 60.8, and a mean ELF-to-plasma ratio of 0.46. Marbofloxacin was not detected in any samples from control dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Marbofloxacin concentrations in AMs were greater than the mean inhibitory concentrations of major bacterial pathogens in dogs. Results indicated that marbofloxacin accumulates in AMs at concentrations exceeding those reached in plasma and ELF The accumulation of marbofloxacin in AMs may facilitate treatment for susceptible intracellular pathogens or infections associated with pulmonary macrophage infiltration.

Effect of tympanic cavity evacuation and flushing on microbial isolates during total ear canal ablation with lateral bulla osteotomy in dogs.

OBJECTIVE: To evaluate differences in bacterial numbers, identity, and susceptibility in samples obtained from the tympanic cavity on entry (preflush) and after evacuation and lavage (postflush) and assess perioperative and empiric antimicrobial selection in dogs that underwent total ear canal ablation (TECA) with lateral bulla osteotomy (LBO) or reoperation LBO. DESIGN: Prospective clinical study. ANIMALS: 34 dogs. PROCEDURE: TECA with LBO or reoperation LBO was performed on 47 ears. Pre- and postflush aerobic and anaerobic samples were obtained from the tympanic cavity. Isolates and antimicrobial susceptibility patterns were compared. RESULTS: Different isolates (31/44 [70%] ears) and susceptibility patterns of isolate pairs (6/44 [14%] ears) were detected in pre- and postflush samples from 84% of ears. Evacuation and lavage of the tympanic cavity decreased the number of bacterial isolates by 33%. In 26% of ears, bacteria were isolated from post-flush samples but not preflush samples. Only 26% of isolates tested were susceptible to cefazolin. At least 1 isolate from 53% of dogs that received empirically chosen antimicrobials postoperatively was resistant to the selected drugs. Anaerobic bacteria were recovered from 6 ears. CONCLUSIONS AND CLINICAL RELEVANCE: Accurate microbiologic assessment of the tympanic cavity should be the basis for selection of antimicrobials in dogs undergoing TECA with LBO. Bacteria remain in the tympanic cavity after evacuation and lavage. Cefazolin was a poor choice for dogs that underwent TECA with LBO, as judged on the basis of culture and susceptibility testing results.

Student assessment of the educational benefits of using a CD-ROM for instruction of basic surgical skills.

RATIONALE FOR STUDY: At Texas A&M University, introductory-level surgical lecture and laboratory notes were converted to a CD-ROM format that included illustrative photographs as well as instructional videos demonstrating the basic surgical skills that all students were required to master. The CD-ROM was distributed to all students in place of traditional paper notes in the second-year surgical class in the professional veterinary curriculum. The study reported here was designed to evaluate the educational benefits of the use of the CD-ROM in place of traditional paper notes by examining the attitudes and practices of students before and after exposure to the CD-ROM format. METHODOLOGY: An anonymous survey was distributed to students in the second-year introductory surgery course on the first day of class and again on the last day of class. Responses to questions were tabulated, response frequencies determined, and Chi-square analysis performed to determine differences between initial and final responses. RESULTS: On the final survey, 89 per cent of students responded that the instructional videos definitely helped them prepare for the laboratory, and 77 per cent responded that they were more likely to practice techniques learned from the CD-ROM videos than those learned from traditional study materials. The majority of students believed that the CD-ROM improved both the course (60 per cent) and their learning experience (62 per cent) as compared to traditional paper notes. CONCLUSIONS: Including instructional videos on the CD-ROM enhanced the educational experience of the students by promoting preparedness for laboratories and promoting practice of techniques learned from the videos outside of the laboratory.

Current concepts in hepatobiliary surgery.

The most common hepatic procedures performed in companion animals are liver biopsies and partial hepatectomies. Surgery of the biliary tract most often involves the gallbladder, although surgical intervention of the bile duct may also be performed. Hepatobiliary surgery is often challenging, being performed in patients with significant systemic illness and associated with potentially life-threatening complications. An in-depth understanding of the regional anatomy, use of a team concept for patient management, particularly for patients undergoing partial hepatectomy surgery, and provision of intensive perioperative monitoring and support helps minimize complications and maximize outcome.

Antimicrobial considerations in the perioperative patient.

Surgical site infections are among the complications that can be reduced with the timely implementation of appropriate antimicrobial therapy. A 3-D approach to judicious antimicrobial use focuses on the de-escalation of systemic antimicrobial therapy, design of dosing regimens, and decontamination of the surgeon, patient, and environment. De-escalation can be accomplished in part through proper antimicrobial prophylaxis. Dosing regimens should be designed to maximize efficacy and minimize resistance. Decontamination includes disinfection of inanimate surfaces and timely application of appropriate antiseptics at concentrations that maximize efficacy.