Staff attitudes to and compliance with the use of a surgical safety checklist.

OBJECTIVES: To investigate staff attitudes to the use of a surgical safety checklist in a small animal operating room and to gain insight into barriers to use. MATERIALS AND METHODS: A questionnaire was designed and used to assess attitudes of 36 operating room personnel to the checklist. The checklist was retrospectively audited on 984 patients over an 8-month period to investigate compliance. RESULTS: Responses were obtained from 100% of operating room personnel. Attitudes to the checklist were positive, with 83.4% agreeing that it improved teamwork and 100% agreed that the checklist improved patient safety, reduced error and was best practice. Most personnel (94%) believed that a completed checklist was used for every procedure. Several barriers were highlighted, including issues of hierarchy and team-working and lack of training. 984 checklists were used during the study period with 83 (8.4%) being fully completed. CLINICAL SIGNIFICANCE: Surgical safety checklists have potential to improve patient safety in veterinary operating rooms. However, appropriate design and implementation are critical and surgeons should endeavour to support checklist use.

Infiltrative laryngeal disease in dogs.

OBJECTIVES: To describe the clinical features and outcome of neoplastic and inflammatory infiltrative laryngeal disease in dogs. MATERIALS AND METHODS: Medical records at a single referral centre were retrospectively reviewed for dogs diagnosed with infiltrative laryngeal disease by CT or laryngoscopy. RESULTS: Fifteen dogs were included, with a median age of 6 years (range 1-14 years). Thirteen dogs were diagnosed with inflammatory disease including granulation tissue (n = 4) and neutrophilic (n = 2), septic neutrophilic (n = 2), eosinophilic (n = 1) lymphocytic/plasmacytic (n = 1) and mixed/unclassified (n = 3) inflammation. One dog was diagnosed with large cell lymphoma and one dog was diagnosed with mast cell tumour. Twelve dogs survived to discharge. Follow-up was available for 10 dogs diagnosed with inflammatory disease. Four had fully recovered (7, 10, 23 and 32 months) and one dog developed acute leukaemia and was euthanased at 2 months. Five dogs had recurrence of clinical signs at 1, 1, 5, 17 and 26 months. The dog with lymphoma was euthanased at 8 months and the dog with mast cell tumour died at 5 months. CLINICAL SIGNIFICANCE: In this cohort, infiltrative inflammatory lesions of the larynx were more common than neoplastic infiltration. For dogs that survived to discharge, outcome was fair although relapse was common.

Serological markers of gluten sensitivity in Border terriers with gall bladder mucocoeles.

OBJECTIVES: To evaluate serological markers of gluten sensitivity in conjunction with cholecystokinin measurement in Border terriers with gall bladder mucocoeles. MATERIALS AND METHODS: Medical records from two referral hospitals were obtained between 2011 and 2019 to identify Border terriers with gall bladder mucocoeles, non-Border terriers with gall bladder mucocoeles and control Border terriers with non-biliary diseases. Enzyme-linked immunosorbent assays were performed on stored fasted serum samples for anti-gliadin IgG, anti-canine transglutaminase-2-IgA autoantibodies and cholecystokinin. Statistical analysis was performed using the Kruskall-Wallis test to identify differences between the groups. RESULTS: Fifteen Border terriers with gall bladder mucocoeles, 17 non-Border terriers with gall bladder mucocoeles and 14 control Border terriers with non-biliary diseases were recruited. Median transglutaminase-2-IgA autoantibodies in Border terriers with gall bladder mucocoeles was 0.73 (range: 0.18 to 1.67), which was significantly greater than in control Border terriers at 0.41 (0.07 to 1.14). Median cholecystokinin concentration in Border terriers with gall bladder mucocoeles was 13 pg/mL (6 to 45 pg/mL), which was significantly lower than in control Border terriers at 103 pg/mL (9 to 397 pg/mL). There was no difference in the anti-gliadin IgG between these groups. There was no difference observed in the non-Border terriers with gall bladder mucocoeles with either of the other groups. CLINICAL SIGNIFICANCE: Reduced cholecystokinin and increased transglutaminase-2-IgA autoantibodies was detected in Border terriers with gall bladder mucocoeles; which is in part homologous to gall bladder disease identified in human coeliac disease. The results suggest an immunological disease with impaired cholecystokinin release may be affecting gall bladder motility and possibly contributing to mucocoele formation in Border terriers.

Does a fabella-tibial suture alter the outcome for dogs with cranial cruciate ligament insufficiency undergoing arthrotomy and caudal pole medial meniscectomy?

OBJECTIVES: The objective of this study was to evaluate the effects of fabella-tibial suture (FTS) on long-term outcome in dogs with cranial cruciate ligament (CCL) insufficiency and concurrent medial meniscal tear (MMT) that were managed by an open, caudal pole medial meniscectomy (CPMM). METHODS: A retrospective review was performed of the clinical records of dogs treated for CCL insufficiency with concurrent MMT by open CPMM, with or without the non-random addition of a nylon FTS according to surgeon preference, during the period of 2001 to 2004. The Bristol Osteoarthritis in Dogs questionnaire was modified for owner assessment of outcome using a visual analogue scale based on several criteria: level of activity, disability, severity of lameness and frequency of lameness before and after surgery. RESULTS: Completed questionnaires from 31 dog owners were received. A FTS was used after CPMM in 22 dogs (FTS group), but in nine dogs (control group) only a CPMM was performed. The median time to follow up was longer in the FTS group (25 months) than the control group (16 months) (P=0.03). There were not any significant differences between the two groups before and after surgery for the following: disability, activity, frequency of lameness, severity of lameness, ability to climb stairs and ability to sit down. CLINICAL SIGNIFICANCE: The placement of a FTS following stifle joint arthrotomy and CPMM in dogs with CCL deficiency and concurrent MMT may not be a significant factor affecting the ultimate surgical outcome, although our study is limited by the non-randomised study design.

Arteriovenous haemangioma in two dogs and a cat.

Haemangiomas are benign vascular tumours and several types can be distinguished based on microscopical features. Capillary and cavernous haemangiomas are most commonly reported in man and domestic animals. Arteriovenous haemangiomas are rare variants in man and herein we describe this subtype in two dogs and one cat. One dog and the cat presented with a cutaneous vascular lesion, the other dog with a bleeding mass in the tongue. Surgically excised masses comprised non-encapsulated proliferations of variably sized arterial- and venous-like vessels, accompanied by clusters of capillaries and immature vascular structures in the feline cutaneous tumour and the canine lingual neoplasm. All vasoformative elements had von Willebrand factor-positive endothelia enclosed by a smooth muscle actin-positive tunica media or by pericytes. The results of this study expand the range of differential diagnoses for vascular neoplasms in the dog and cat.

Intrahepatic congenital portosystemic shunts in dogs: short- and long-term outcome of suture attenuation.

OBJECTIVES: To report the short- and long-term outcomes of one- or two-staged suture attenuation for complete closure of intrahepatic congenital portosystemic shunts in dogs. MATERIALS AND METHODS: Retrospective cohort study of dogs surgically treated for intrahepatic congenital portosystemic shunts between February 2000 and March 2015. Long-term follow-up was conducted by telephone conversations with the referring veterinary surgeon, owner, or both. RESULTS: In total, 55 dogs had suture attenuation of their intrahepatic congenital portosystemic shunt; 10 dogs (18·2%) tolerated complete attenuation, whilst 45 dogs (81·8%) tolerated partial attenuation. Postoperative complications occurred in 24 dogs (43·6%), and six dogs (10·9%) died. Repeat surgery was performed in 33 of 39 dogs (84·6%) that had previously undergone partial attenuation, and 27 of these (84·9%) ultimately achieved complete shunt attenuation. One dog (3·0%) died following second surgery, resulting in an overall postoperative mortality of seven of 55 (12·7%). Detailed follow-up was available for 22 dogs that were still alive at a median of 29 months after surgery (7·4 to 103·1) with a subjectively good quality of life. Of 17 dogs (82·4%), 14 with complete attenuation in one or two surgeries had an excellent outcome compared with one of five dogs (20%) with persistent shunting. CLINICAL SIGNIFICANCE: Staged suture ligation resulted in a high proportion of complete attenuation and reduced persistent shunting compared with a single surgery. Repeat surgery was associated with fewer complications than the first surgery. The proportion of dogs with an excellent outcome was greater for those that had complete attenuation in one or two surgeries compared with those with persistent shunting.

Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review.

The aim of this study was to establish the evidence base for the treatment of intrahepatic congenital portosystemic shunts in dogs through a systematic review of the pertinent literature. Studies were filtered for evidence to answer the question "Which of the treatment options for intrahepatic CPSS in dogs offers the best short- and long-term outcome?" Studies were assigned a level of evidence based on a system published by the Oxford Centre for Evidence-Based Medicine. Thirty-two studies were included in the review. Twenty-six provided level 4 evidence and six provided level 5 evidence. There were no level 1, 2 or 3 studies. One study compared surgical treatment with medical management and one study compared suture ligation with ameroid constrictor placement. The remaining studies were case series describing the outcome for one treatment method alone. Methods and timings of assessments of short- and long-term outcomes were highly varied, making direct comparisons challenging. The evidence regarding the treatment of intrahepatic congenital portosystemic shunts in dogs is weak, with only two studies directly comparing treatments. There is a lack of evidence regarding short- and long-term outcomes on which to base clinical decisions.

The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

OBJECTIVES: The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. METHODS: Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. RESULTS: Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. CLINICAL SIGNIFICANCE: Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.

Comparison of flank and midline approaches to the ovariohysterectomy of cats.

In a survey of uk veterinary practitioners, 96 per cent indicated that they performed ovariohysterectomy on cats via flank laparatomy rather than a midline coeliotomy. At a veterinary teaching hospital 32 cats were spayed by the midline approach and 34 by the flank approach, by undergraduate students under the continuous supervision of a veterinary surgeon. The duration of each part of the procedures was recorded and information was obtained from the students, the supervisors and the owners of the cats by means of questionnaires. The total duration of the surgery and the students' assessment of the difficulty of the surgery were not significantly different between the two groups. The time taken from the skin incision to entering the peritoneum was significantly longer with the flank approach, but finding the uterus took significantly longer with the midline approach. There was a high incidence of wound complications, in the form of swelling, redness or discharges, but the only statistically significant difference between the groups was a greater incidence of discharges in the cats spayed via the flank (five cases) than in the cats spayed via the midline (one case).

Tracheal foreign bodies in the cat and the use of fluoroscopy for removal: 12 cases.

OBJECTIVES: To gather information to support the use of fluoroscopically guided removal of tracheal foreign bodies in cats. It was also the intent to produce a case series and look at the long-term outcome following tracheal foreign body removal. METHODS: A retrospective study was performed. This looked at cases of tracheal foreign bodies in cats seen at the University of Bristol veterinary school at Langford over an eight-year period. Outcome was assessed via telephone conversations with the owners. RESULTS: Twelve cats were presented with tracheal foreign bodies during this time. Ten of these foreign bodies were successfully removed using fluoroscopy and two using bronchoscopy. All cats survived. Follow-up was available for nine cats and showed no long-term complications. CLINICAL SIGNIFICANCE: Forceps removal under fluoroscopic guidance is a rapid, safe, and effective method for removal of tracheal foreign bodies in cats. It should be considered as an alternative to bronchoscopy for removal of tracheal foreign bodies in cats. Indeed, in cases where bronchoscopy has failed, it can be attempted to avoid thoracotomy. Successful removal of tracheal foreign bodies in cats is associated with a good long-term outcome.

Questionnaire study of canine neutering techniques taught in UK veterinary schools and those used in practice.

OBJECTIVES: To gather information about the different techniques employed in general practice and to compare this with current undergraduate teaching. This would provide an insight into any areas of discrepancy and influences on technique in practice. METHODS: A questionnaire was composed and distributed to 407 practices throughout the UK, using a commercial mailing list. Fifty further questionnaires were distributed by final-year students to their foster practices and five were sent to practices on request. A second questionnaire was composed and sent to the members of staff responsible for teaching surgical neutering techniques at each of the UK veterinary schools. RESULTS: Completed questionnaires were received from 183 respondents. These were compared with seven questionnaires from university teachers. Only areas in which the teachers reached a consensus of opinion were directly compared. CLINICAL SIGNIFICANCE: Several areas of discrepancy between current teaching and techniques in practice were identified. A study of complications compared with technique would provide further information. There is a lack of published material or an evidence base in many aspects of surgical neutering to support one technique over another.

Lipopolysaccharide and toll-like receptor 4 in dogs with congenital portosystemic shunts.

Surgical attenuation of a congenital portosystemic shunt (CPSS) results in increased portal vein perfusion, liver growth and clinical improvement. Portal lipopolysaccharide (LPS) is implicated in liver regeneration via toll-like receptor (TLR) 4 mediated cytokine activation. The aim of this study was to investigate factors associated with LPS in dogs with CPSS. Plasma LPS concentrations were measured in the peripheral and portal blood using a limulus amoebocyte lysate (LAL) assay. LPS concentration was significantly greater in the portal blood compared to peripheral blood in dogs with CPSS (P = 0.046) and control dogs (P = 0.002). LPS concentrations in the peripheral (P = 0.012) and portal (P = 0.005) blood of dogs with CPSS were significantly greater than those of control dogs. The relative mRNA expression of cytokines and TLRs was measured in liver biopsies from dogs with CPSS using quantitative PCR. TLR4 expression significantly increased following partial CPSS attenuation (P = 0.020). TLR4 expression was significantly greater in dogs that tolerated complete CPSS attenuation (P = 0.011) and those with good portal blood flow on pre-attenuation (P = 0.004) and post-attenuation (P = 0.015) portovenography. Serum interleukin (IL)-6 concentration was measured using a canine specific ELISA and significantly increased 24 h following CPSS attenuation (P < 0.001). Portal LPS was increased in dogs with CPSS, consistent with decreased hepatic clearance. TLR4 mRNA expression was significantly associated with portal blood flow and increased following surgery. These findings support the concept that portal LPS delivery is important in the hepatic response to surgical attenuation. Serum IL-6 significantly increased following surgery, consistent with LPS stimulation via TLR4, although this increase might be non-specific.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs.

OBJECTIVE: To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications. METHODS: Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination. RESULTS: Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow-up (median of 106 weeks, range 26-227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen. CLINICAL SIGNIFICANCE: The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

Magnetic resonance imaging for detection of late meniscal tears in dogs following tibial tuberosity advancement for treatment of cranial cruciate ligament injury.

OBJECTIVES: To document the use of and to estimate the accuracy of magnetic resonance (MR) imaging for detection of late meniscal tears in dogs with cranial cruciate ligament injury treated with tibial tuberosity advancement (TTA). METHODS: Medical records of dogs that had TTA followed by stifle MR imaging for suspected meniscal tear and subsequent arthrotomy were reviewed retrospectively. Magnetic resonance images were reviewed independently by an observer blinded to clinical information who classified menisci as torn, abnormal but intact, or normal. Magnetic resonance and surgical findings were compared. RESULTS: Eight stifles from large breed dogs were included. Six stifles had a medial meniscal tear identified in MR images and later confirmed surgically. In the remaining two stifles, the menisci appeared intact in MR images and no tear was identified at subsequent arthrotomy. Lateral menisci in all stifles appeared intact in MR images and were considered normal at surgery. Susceptibility artefacts associated with TTA implants were present in all images but did not adversely affect interpretation of intra-articular structures. CLINICAL SIGNIFICANCE: Magnetic resonance imaging appears to be accurate for diagnosis of late meniscal tears. Artefacts associated with TTA implants did not prevent evaluation of critical intra-articular structures. Further investigation with MR imaging should be considered when late meniscal tear is suspected following TTA.

Hepatic hepcidin gene expression in dogs with a congenital portosystemic shunt.

BACKGROUND: Microcytic anemia is common in dogs with a congenital portosystemic shunt (cPSS) and typically resolves after surgical attenuation of the anomalous vessel. However, the pathophysiology of the microcytic anemia remains poorly understood. Hepcidin has been a key role in controlling iron transport in both humans and animals and in mediating anemia of inflammatory disease in humans. The role of hepcidin in the development of microcytic anemia in dogs with a cPSS has not been examined. HYPOTHESIS: To determine whether hepatic hepcidin mRNA expression decreases, while red blood cell count (RBC) and mean corpuscular volume (MCV) increase in dogs after surgical attenuation of a cPSS. ANIMALS: Eighteen client-owned dogs with confirmed cPSS undergoing surgical attenuation. METHOD: Prospective study. Red blood cell count (RBC) and mean corpuscular volume (MCV), together with hepatic gene expression of hepcidin, were measured in dogs before and after partial attenuation of a cPSS. RESULTS: There was a significant increase in both RBC (median pre 6.17 × 10(12) /L, median post 7.08 × 10(12) /L, P < .001) and MCV (median pre 61.5fl, median post 65.5fl, P = .006) after partial surgical attenuation of the cPSS. Despite the increase in both measured red blood cell parameters, hepatic gene expression of hepcidin remained unchanged. CONCLUSIONS AND CLINICAL IMPORTANCE: This study found no evidence that dysregulated production of hepcidin was associated with anemia in dogs with a cPSS.

Markers of angiogenesis associated with surgical attenuation of congenital portosystemic shunts in dogs.

BACKGROUND: Dogs with congenital portosystemic shunts (CPSS) have hypoplasia of the intrahepatic portal veins. Surgical CPSS attenuation results in the development of the intrahepatic portal vasculature, the precise mechanism for which is unknown, although new vessel formation by angiogenesis is suspected. HYPOTHESIS: That the degree of portal vascular development and the increase in portal vascularization after CPSS attenuation is significantly associated with hepatic vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR2) gene expression and serum VEGF concentration. ANIMALS: Client-owned dogs with CPSS undergoing surgical treatment. Forty-nine dogs were included in the gene expression data and 35 in the serum VEGF data. MATERIALS AND METHODS: Dogs surgically treated by partial or complete CPSS attenuation were prospectively recruited. Relative gene expression of VEGF and VEGFR2 was measured in liver biopsy samples taken at initial and follow-up surgery using quantitative polymerase chain reaction. Serum VEGF concentration was measured before and after CPSS attenuation using a canine specific ELISA. Statistical significance was set at the 5% level (P ≤ .05). RESULTS: There was a significant increase in the mRNA expression of VEGFR2 after partial attenuation (P = .006). Dogs that could tolerate complete attenuation had significantly greater VEGFR2 mRNA expression than those that only tolerated partial attenuation (P = .037). Serum VEGF concentration was significantly increased at 24 (P < .001) and 48 (P = .003) hours after attenuation. CONCLUSIONS AND CLINICAL IMPORTANCE: These findings suggest that intrahepatic angiogenesis is likely to occur after the surgical attenuation of CPSS in dogs, and contributes to the development of the intrahepatic vasculature postoperatively.

Airway injury associated with cervical bite wounds in dogs and cats: 56 cases.

OBJECTIVE: To investigate the frequency of airway injury and damage to other vital structures associated with cervical bite wounds in dogs and cats and the implications for management and outcome. METHODS: A retrospective search of electronic patient records was used to identify dogs and cats suffering cervical bite wounds that were presented to a large multidisciplinary veterinary hospital over a four year period. RESULTS: Complete records were available for 55 animals, with one animal suffering two separate injuries. Fourteen animals (25%) had injuries to vital structures, including airway injury in nine (17%) which was surgically confirmed and treated in six (11%). Airway injuries were associated with either subcutaneous or mediastinal emphysema in all affected animals. Other structures injured included the jugular vein, pharynx, oesophagus and spine. Airway injuries were treated with primary repair in five animals and a fasciomuscular patch in one. Temporary tracheostomy was performed in three animals. Median duration of hospitalisation was one day (0-19) with 53 animals (54 cases) (96%) surviving to discharge. Long-term follow-up (16-114 months) revealed that 43 of 49 animals were alive with six that died due to unrelated reasons. CLINICAL SIGNIFICANCE: Cervical bite wounds are associated with significant injury to vital structures. Up to 17% of animals may have injury to their airway. Identification and treatment of airway injury is vital and was associated with an excellent outcome in six animals.

Histopathological findings in the livers of cats with a congenital portosystemic shunt before and after surgical attenuation.

Histopathological changes are reported in the livers of cats with congenital portosystemic shunts (CPSS) before and after surgical attenuation. Medical records, portovenograms and liver biopsies from cats treated surgically for CPSS were reviewed. Biopsies were graded for histopathological features characteristic of CPSS. Of 40 cats with CPSS included in the study, all had portal vein hypoplasia and arteriolar hyperplasia at initial surgery, 20 (50 per cent) had hepatocyte swelling with microvesicular vacuolar change, 17 (42.5 per cent) had fibrosis, 12 (30 per cent) had hepatocyte swelling with macrovesicular vacuolar change, 8 (20 per cent) had biliary hyperplasia and 2 (5 per cent) had haemosiderin within Küpffer cells. Cats with macrovesicular vacuolar change were significantly older than cats without (P = 0.001), with median ages of 18.5 months and 8.5 months, respectively. Twenty-five cats had partial attenuation of the CPSS at initial surgery, and 16 of these had follow-up biopsy samples. There were no significant differences in the histopathological features of biopsies before and after partial attenuation. From first to second surgery, there was a significant improvement in intrahepatic vasculature on portovenography both before (P = 0.001) and after (P = 0.039) temporary complete attenuation. Following partial CPSS attenuation, there was no significant change in histopathological features despite an improvement in intrahepatic vasculature on portovenography.