Retention Curves for Pediatric and Neonatal Intubation Skills After Simulation-Based Training.

OBJECTIVES: We evaluated the retention of pediatric and neonatal intubation performance abilities of clinicians trained on a simulated or live tissue model at 3 intervals after initial training to assess competency degradation related to either training modality or retention interval. METHODS: We implemented a quasi-experimental design with purposive sampling to assess performance differences between 171 subjects randomly assigned to 1 of 3 intervals after initial training: 6 weeks, 18 weeks, or 52 weeks. Training followed the American Heart Association Pediatric Advanced Life Support and Neonatal Resuscitation Program protocols with hands-on practice using 1 of 2 models (live feline or simulated feline). Assessment data were captured using validated instruments and analyzed using analysis of variance with repeated measures (statistical significance set at P < 0.05). RESULTS: Cognitive retention scores decreased significantly (P = 0.000) from posttraining cognitive scores. There were no significant differences between posttraining and retention scores for pediatric and neonatal performances. Both affect and self-efficacy retention scores decreased significantly (P = 0.000) from posttraining scores at 18 and 52 weeks, but remained constant at 6 weeks. Retention scores for all dimensions showed a significant difference between subjects with varying amounts of experience performing pediatric and neonatal intubation, such that those with more experience scored higher those with less (P < 0.003). CONCLUSIONS: Retention performance outcomes decreased sufficiently from posttraining scores to suggest that training refreshment could serve to maintain posttraining competency in the ability to perform pediatric and neonatal intubation. Retraining intervals may be best aligned with provider experience levels. Future research focusing on the effect of variable interval refresher training on retention in pediatric and neonatal intubation is merited.

Performance-based comparison of neonatal intubation training outcomes: simulator and live animal.

The purpose of this article was to establish psychometric validity evidence for competency assessment instruments and to evaluate the impact of 2 forms of training on the abilities of clinicians to perform neonatal intubation. To inform the development of assessment instruments, we conducted comprehensive task analyses including each performance domain associated with neonatal intubation. Expert review confirmed content validity. Construct validity was established using the instruments to differentiate between the intubation performance abilities of practitioners (N = 294) with variable experience (novice through expert). Training outcomes were evaluated using a quasi-experimental design to evaluate performance differences between 294 subjects randomly assigned to 1 of 2 training groups. The training intervention followed American Heart Association Pediatric Advanced Life Support and Neonatal Resuscitation Program protocols with hands-on practice using either (1) live feline or (2) simulated feline models. Performance assessment data were captured before and directly following the training. All data were analyzed using analysis of variance with repeated measures and statistical significance set at P < .05. Content validity, reliability, and consistency evidence were established for each assessment instrument. Construct validity for each assessment instrument was supported by significantly higher scores for subjects with greater levels of experience, as compared with those with less experience (P = .000). Overall, subjects performed significantly better in each assessment domain, following the training intervention (P = .000). After controlling for experience level, there were no significant differences among the cognitive, performance, and self-efficacy outcomes between clinicians trained with live animal model or simulator model. Analysis of retention scores showed that simulator trained subjects had significantly higher performance scores after 18 weeks (P = .01) and 52 weeks (P = .001) and cognitive scores after 52 weeks (P = .001). The results of this study demonstrate the feasibility of using valid, reliable assessment instruments to assess clinician competency and self-efficacy in the performance of neonatal intubation. We demonstrated the relative equivalency of live animal and simulation-based models as tools to support acquisition of neonatal intubation skills. Retention of performance abilities was greater for subjects trained using the simulator, likely because it afforded greater opportunity for repeated practice. Outcomes in each assessment area were influenced by the previous intubation experience of participants. This suggests that neonatal intubation training programs could be tailored to the level of provider experience to make efficient use of time and educational resources. Future research focusing on the uses of assessment in the applied clinical environment, as well as identification of optimal training cycles for performance retention, is merited.

The Effect of Low-Level Laser Therapy on the Healing of Open Wounds in Dogs.

OBJECTIVE: To evaluate the effects of low-level laser therapy (LLLT) on acute, full-thickness wound healing in dogs. STUDY DESIGN: Randomized block (dog); historical control. ANIMALS: Adult male Beagles (n = 10). METHODS: Two 2 × 2 cm(2) wounds were surgically created bilaterally on the trunk of each dog. Each side was randomized to receive LLLT (laser, LAS) or standard-of-care management (control, CON), 3 times weekly for 32 days. The LLLT consisted of a dual diode laser (7.5 mW/diode) at 635 nm and total energy density of 1.125 J/cm(2). Wound planimetry was performed on the caudal wounds, from which percent contraction and percent epithelialization were calculated. Histologic features were evaluated at 7 time points from cranial wound biopsies. Experimental data were also compared to wounds from a historical female control cohort (historical control, HCON). RESULTS: There was no difference between LAS and CON wounds for all parameters, including histology. The HCON wounds had significantly greater contraction and epithelialization compared to LAS and CON wounds. The LAS and CON wounds had significantly less inflammation than HCON wounds early in wound healing, but inflammation was significantly greater in LAS and CON wounds by day 21. Fibroblast infiltration and collagen deposition were significantly less in LAS and CON wounds than HCON wounds. CONCLUSION: There are no apparent beneficial effects of LLLT on the healing of acute wounds in healthy dogs using this LLLT protocol. Gender may influence wound healing in intact dogs.

Benefits of pre- and intraoperative planning for tibial plateau leveling osteotomy.

OBJECTIVE: To determine (1) if preoperative and intraoperative osteotomy planning increases the likelihood that a surgeon will achieve a centered osteotomy during tibial plateau leveling osteotomy (TPLO) and (2) if that centered osteotomy reduces the risk of tibial tuberosity (TT) fractures. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 406) with cranial cruciate ligament that had TPLO (n = 468). METHODS: Medical records (2007-2010) and radiographs of dogs that had TPLO were reviewed. Osteotomies from Group A (pre and intra-operative planning) were compared to Group B (free-hand osteotomy only) investigating the influence of osteotomy planning as well as 21 other variables, looking for any other confounding variables that may also contribute to TT fractures. Data were analyzed with logistic regression and χ(2) analysis. RESULTS: Actual osteotomies were closer to the centered-osteotomy position in Group A than in Group B (P ≤ .01). TT fractures occurred in 20 cases (4.3% overall). Group A had 0 fractures out of 172 surgeries and Group B had 20 fractures out of 296 surgeries (6.8%). Five variables were found to increase the risk of TT fractures: lack of osteotomy planning, bilateral same-session surgeries, osteotomy gap, anti-rotational pin location, and decreased tibial crest width at the insertion of the patellar ligament (P ≤ .05). CONCLUSIONS: Dogs that had osteotomy planning had a more centered osteotomy position and a reduced risk of developing TT factures.

Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999-2009): a multicenter study.

OBJECTIVE: To determine the incidence of canine post-anesthetic aspiration pneumonia (AP) and to identify anesthetic agents, procedures and management factors associated with the development of AP. STUDY DESIGN: Multicenter, randomized, case-controlled retrospective study. ANIMALS: Two hundred and forty dogs affected with AP and 488 unaffected control dogs. METHODS: Electronic medical record databases at six Veterinary colleges were searched for dogs, coded for anesthesia or sedation and pneumonia from January 1999 to December 2009. The resultant 2158 records were hand-searched to determine eligibility for inclusion. Diagnosis of AP was made radiographically. Two unaffected control dogs were randomly selected for each affected dog, from a list of dogs that underwent sedation or anesthesia in the same time period and did not develop aspiration pneumonia. Fifty-seven factors were then evaluated for association with aspiration pneumonia. Data analysis was performed using univariate Chi-square or student t-tests, then multivariate logistic regression. RESULTS: Incidence of post-anesthetic AP was 0.17%, from 140,711 cases anesthetized or sedated over the 10 year period. Two anesthesia-related events were significantly associated with development of AP: regurgitation and administration of hydromorphone at induction. Administration of anticholinergics was not associated with AP. Procedures associated with increased odds of aspiration pneumonia included laparotomy, upper airway surgery, neurosurgery, thoracotomy and endoscopy. Orthopedic surgery, ophthalmologic surgery, dental procedures, MRI, CT, bronchoscopy, cystoscopy, tracheoscopy and neutering were not associated with development of AP. Three patient factors were associated with the development of AP: megaesophagus, and a history of pre-existing respiratory or neurologic disease. Sixty-nine% of dogs with two or more of the above independent predictive variables developed AP. CONCLUSION AND CLINICAL RELEVANCE: Most anesthetic agents and procedures were not associated with the development of AP. We need to devise and evaluate strategies to protect at risk patients.

Long-term outcome of permanent tracheostomies in dogs: 21 cases (2000-2012).

This retrospective study reports long-term outcome, survival, and complications in dogs which received a permanent tracheostomy due to upper airway obstruction. Data were collected from medical records (n = 21) in 2 institutions over a 12-year period. Patients were followed until death, complications, causes of death, and survival times are reported. Major complications were reported in 50% of patients with 20% of patients receiving revision surgery. The most common complications were aspiration pneumonia and need for revision surgery. Median survival time was 328 days with 25% of patients surviving 1321 days or longer. Some (26%) patients died acutely at home at various times after surgery. Permanent tracheostomy is a viable procedure for patients with end stage upper airway obstruction; however, a subpopulation of patients suffers acute death at various times after surgery, which is thought to be due to airway obstruction.

Résultat à long terme des trachéostomies chez les chiens : 21 cas (2000­2012). Cette étude rétrospective présente les résultats, la survie et les complications à long terme chez les chiens qui ont subi une trachéostomie permanente en raison d'une obstruction des voies respiratoires supérieures. Les données ont été recueillies dans les dossiers médicaux (n = 21) de 2 institutions sur une période de 12 ans. Les patients ont été suivis jusqu'à la mort à la suite de complications; les causes de décès et les temps de survie sont signalés. Des complications majeures ont été signalées chez 50 % des patients et 20 % des patients ont subi une reprise chirurgicale. Les complications les plus fréquentes étaient la pneumonie de déglutition et le besoin de reprise chirurgicale. Le temps de survie moyen était de 328 jours avec 25 % des patients qui ont survécu 1321 jours ou plus. Certains patients (26 %) sont morts de façon aiguë à la maison à divers moments après la chirurgie. Une trachéostomie permanente est une intervention viable pour les patients ayant une obstruction des voies respiratoires de stade final. Cependant, une sous-population de patients sont décédés de façon aiguë à divers moments après la chirurgie, que l'on croit attribuable à l'obstruction des voies respiratoires.(Traduit par Isabelle Vallières).

Reproducibility of an objective four-choice canine vision testing technique that assesses vision at differing light intensities.

OBJECTIVE: The increasing importance of canine retinal dystrophy models means accurate vision testing is needed. This study was performed to evaluate a four-choice vision testing technique for any difference in outcome measures with repeated evaluations of the same dogs. ANIMALS STUDIED: Four 11-month-old RPE65-deficient dogs. PROCEDURES: Vision was evaluated using a previously described four-choice vision testing device. Four evaluations were performed at 2-week intervals. Vision was assessed at six different white light intensities (bright through dim), and each eye was evaluated separately. The ability to select the one of the four exit tunnels that was open at the far end was assessed ('choice of exit') and recorded as correct or incorrect first tunnel choice. 'Time to exit' the device was also recorded. Both outcomes were analyzed for significance using anova. We hypothesized that performance would improve with repeated testing (more correct choices and more rapid time to exit). RESULTS: 'Choice of exit' did not vary significantly between each evaluation (P = 0.12), in contrast 'time to exit' increased significantly (P = 0.012), and showed greater variability in dim light conditions. CONCLUSIONS: We found no evidence to support the hypothesis that either measure of outcome worsened with repeated testing; in fact, the 'time to exit' outcome worsened rather than improved. The 'choice of exit' gave consistent results between trials. These outcome data indicate the importance of including a choice-based assessment of vision in addition to measurement of device transit time.

Effects of a cross-linked hyaluronic acid based gel on the healing of open wounds in dogs.

OBJECTIVE: To compare effects of a cross-linked hyaluronic acid (HA) based gel (CMHA-S) to a standard wound management protocol on the healing of acute, full-thickness wounds in dogs. STUDY DESIGN: A prospective, controlled, experimental study. ANIMALS: Purpose-bred, adult, female beagles (n = 10). METHODS: Two 2 × 2 cm wounds were surgically created bilaterally on the trunk of each dog and each side randomized to treatment (CMHA-S) or control (CON) groups. Total and open wound areas were measured with digital image planimetry at 15 time points. From these data, percent contraction and percent epithelialization were calculated. Tissue biopsies were obtained at 6 time points and histologic features were scored. RESULTS: Total wound area was significantly larger and percent contraction was significantly less in CMHA-S compared to CON wounds at all data points between days 9 and 18. At day 25, and for the remainder of the study, CMHA-S wounds were smaller and contracted more than CON wounds, reaching significance at day 32. Percent epithelialization was significantly less in CMHA-S compared to CON wounds at all data points after day 11. Histologically, fibroblastic cellular infiltration was significantly higher in CMHA-S wounds at day 21. CONCLUSIONS: CMHA-S wounds healed more slowly than CON wounds. This HA-based gel is not indicated in acute, full-thickness skin wounds in dogs as administered in this study. However, treatment may be beneficial in the mid-to-late repair stage of healing, or if scar minimization is desired. Further studies to evaluate the effects of the CMHA-S gel on canine wounds are indicated.

Effects of negative pressure wound therapy on healing of free full-thickness skin grafts in dogs.

OBJECTIVE: To compare healing of free, full-thickness, meshed skin grafts under negative pressure wound therapy (NPWT) with bolster dressings in dogs. STUDY DESIGN: Randomized, controlled experimental study, paired design. ANIMALS: Dogs (n = 5) METHODS: Full-thickness skin wounds (4 cm × 1.5 cm) were created bilaterally on the antebrachia of 5 dogs (n = 10). Excised skin was grafted to the contralateral limb. Grafts were randomized to NPWT or bolster dressings (control; CON). NPWT was applied continuously for 7 days. Grafts were evaluated on Days 2, 4, 7, 10, 14, and 17, biopsied on days 0, 4, 7, and 14, and had microbial culture on Day 7. Outcome variables were: time to first appearance of granulation tissue, percent graft necrosis, and percent open mesh. Significance was set at P < .05. Histologic findings, culture results, and graft appearance were reported. RESULTS: Granulation tissue appeared earlier in the NPWT grafts compared with CON grafts. Percent graft necrosis and remaining open mesh area were both greater in CON grafts compared with NPWT grafts at most time points. Histologic results showed no significant difference in all variables measured, and all cultures were negative. CONCLUSIONS: Variables of graft acceptance were superior when NPWT was used in the first week post-grafting. Fibroplasia was enhanced, open meshes closed more rapidly and less graft necrosis occurred with NPWT application. More preclinical studies are required to evaluate histologic differences.

Evaluation of bacterial contamination on surgical drapes following use of the Bair Hugger(®) forced air warming system.

This pilot study determined the rate of bacterial contamination on surgical drapes of small animal patients warmed intra-operatively with the Bair Hugger(®) forced air warming system compared to a control method. Surgical drapes of 100 patients undergoing clean surgical procedures were swabbed with aerobic culturettes at the beginning and end of surgery. Samples were cultured on Trypticase soy agar. Contamination of the surgical drapes was identified in 6/98 cases (6.1%). There was no significant difference in the number of contaminated surgical drapes between the Bair Hugger(®) and control groups (P = 0.47).

Évaluation de la contamination bactérienne des champs opératoires après l'utilisation du système de chauffage à air pulsé Bair HuggerMD . Cette étude pilote a déterminé le taux de contamination bactérienne des champs opératoires de patients petits animaux réchauffés lors du processus peropératoire à l'aide du système de chauffage à air pulsé Bair HuggerMD comparativement à une méthode témoin. Les champs opératoires de 100 patients subissant des interventions chirurgicales propres ont été écouvillonnés avec des Culturettes aérobies au début et à la fin de la chirurgie. Les échantillons ont été cultivés sur gélose Trypticase soja. La contamination des champs opératoires a été identifiée dans 6/98 cas (6,1 %). Il n'y avait aucune différence significative dans le nombre de champs opératoires contaminés entre le groupe Bair HuggerMD et le groupe témoin (P = 0,47).(Traduit par Isabelle Vallières).

Effects of a curricular revision on learner outcomes in veterinary clinical pathology.

A mixed-methods evaluation was conducted to study learner attitudes and knowledge about clinical pathology across a curricular change that instituted a stand-alone clinical pathology course in place of content within a previously integrated pathology course structure. Groups of pre- and post-change students were assessed three times across the two semesters leading up to graduation. At each time, rank-ordered and open-ended response items probed attitudes, and multiple-choice items assessed knowledge. Data about student clinical pathology performance were also collected from clinical pathology instructors and supervising clinicians. Student rank-ordered items were evaluated by factor analysis; resulting factor-scale scores, multiple-choice scores, and rank responses from study cohorts were statistically assessed between groups and within each group over time. Intraclass correlations were calculated for the coding of student open-ended responses, and all coded responses were compared among groups. Analysis revealed that students in the revised curriculum had greater satisfaction with their training and greater confidence in data interpretation compared to students without exposure to an independent clinical pathology course. Although differences in knowledge of clinical pathology were not detected, it was also apparent that the independent clinical pathology course filled a student-perceived curricular need without raising criticisms related to diminished integration with anatomic pathology. Secondary study outcomes included formative feedback for course improvement, evidence of clerkship efficacy, and baseline data for further studies.

Survival after surgery for tracheal collapse and the effect of intrathoracic collapse on survival.

OBJECTIVES: To determine (1) long-term survival of dogs with tracheal collapse (TC) receiving cervical extraluminal prosthetic rings (ELR) and (2) whether intrathoracic collapse effects long-term survival of dogs receiving ELR. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 33) with TC that had ELR. METHODS: Medical records (July 2002-July 2008) were searched for TC dogs treated with ELR. Age, breed, gender, location of TC, and age at follow-up (death or censor) were recorded. Kaplan-Meier survival curves were generated. RESULTS: Of 114 TC dogs, 33 had ELR. Breeds and gender were consistent with previous reports; mean (±SD) age at presentation was 6.3±2.6 years. TC was categorized as cervical or cervical and intrathoracic. All dogs had cervical TC and 15 had concurrent intrathoracic collapse; 8 of these had collapse of mainstem bronchi. Median survival time was >2500 days (median not reached) for cervical TC alone and 1500 days for cervical and intrathoracic TC with no difference in median survival time between groups (P = .26). CONCLUSION: Dogs with TC have a median survival time of 1680 days (4.6 years) after ELR and no differences were seen when dogs had intrathoracic collapse. Intrathoracic collapse does not exclude a dog from receiving ELR.

Effects of negative pressure wound therapy on healing of open wounds in dogs.

OBJECTIVE: To compare the effect of negative pressure wound therapy (NPWT) with standard-of-care management on healing of acute open wounds in dogs. STUDY DESIGN: Prospective, controlled, experimental study. ANIMALS: Adult dogs (n=10). METHODS: Full-thickness 4 m × 2 m wounds were surgically created on each antebrachium and in each dog were randomized to receive either NPWT or standard wound dressings (CON) for 21 days. Dressing changes and wound evaluations were made at 8 time points. First appearance of granulation tissue, smoothness of granulation tissue, exuberance, percent epithelialization, and percent contraction were compared. Biopsies for histopathology were taken, and histologic scores determined, at 5 time points, and aerobic bacterial wound cultures performed at 2 time points. RESULTS: Granulation tissue appeared significantly earlier, and was smoother and less exuberant in NPWT wounds compared with CON wounds. Percent contraction in NPWT wounds was less than CON wounds after Day 7. Percent epithelialization in NPWT wounds was less than CON wounds on Days 11, 16, 18, and 21. Histologic scores for acute inflammation were higher in NPWT on Day 3, and lower on Day 7, than CON wounds. Bacterial load was higher in NPWT on Day 7. CONCLUSION: NPWT accelerated appearance of smooth, nonexuberant granulation tissue; however, prolonged use of NPWT impaired wound contraction and epithelialization.

In vitro comparison of plain radiography, double-contrast cystography, ultrasonography, and computed tomography for estimation of cystolith size.

OBJECTIVE: To compare accuracy of estimates of cystolith size obtained by means of plain radiography, double-contrast cystography, ultrasonography, and computed tomography. SAMPLE POPULATION: 30 canine cystoliths ranging from 1 to 11 mm in diameter with various mineral compositions. PROCEDURES: A bladder phantom model was created by filling a rubber balloon with saline (1% NaCl) solution and positioning it on top of a 2% gelatin cushion at the bottom of a water-filled 4-quart container. Cystoliths were individually placed in the bladder phantom and imaged by each of the 4 techniques. For each image, cystolith size was measured by 2 radiologists with computerized calipers, and size estimates were compared with actual cystolith size. RESULTS: Mean cystolith size estimates obtained by means of radiography, cystography, and computed tomography did not differ significantly from each other. However, for ultrasonographic images, mean +/- SD difference between actual and estimated cystolith size (2.95 +/- 0.73 mm) was significantly higher than mean difference for radiographic, cystographic, and computed tomographic images. For ultrasonography, mean +/- SD percentage overestimation in cystolith size was 68.4 +/- 51.5%. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that measurements of cystolith size obtained by means of ultrasonography may overestimate the true size. This suggests that cystolith size estimates obtained by means of ultrasonography should be interpreted with caution whenever cystolith size may influence patient management.

Esophageal dysfunction in dogs with idiopathic laryngeal paralysis: a controlled cohort study.

OBJECTIVES: To compare esophageal function in dogs with idiopathic laryngeal paralysis (ILP) to age and breed matched controls; to determine if dysfunction is associated with aspiration pneumonia over 1 year; and to compare clinical neurologic examination of dogs with ILP at enrollment and at 1 year. STUDY DESIGN: Prospective controlled cohort study. ANIMALS: Dogs with ILP (n=32) and 34 age and breed matched healthy dogs. METHODS: Mean esophageal score was determined for each phase of 3 phase esophagrams, analyzed blindly. After unilateral cricoarytenoid laryngoplasty, dogs with ILP were reexamined (including thoracic radiography) at 1, 3, 6, and 12 months. Neurologic status was recorded at enrollment, 6 and 12 months. RESULTS: Esophagram scores in dogs with ILP were significantly higher in each phase compared with controls, most notably with liquid (P<.0001). Dysfunction was more pronounced in the cervical and cranial thoracic esophagus. Five dogs that had aspiration pneumonia during the study had significantly higher esophagram scores than dogs that did not develop aspiration pneumonia (P<.02). Ten (31%) ILP dogs had generalized neurologic signs on enrollment and all ILP dogs developed neurologic signs by 1 year (P<.0001). Conclusions- Dogs with ILP also have esophageal dysfunction. Postoperative aspiration pneumonia is more likely in dogs with higher esophagram scores. Dogs with ILP will most likely develop generalized neuropathy over the course of 1 year. CLINICAL RELEVANCE: Esophagrams and neurologic examinations should be performed on all dogs with ILP.

Resection and anastomosis of the descending colon in 43 horses.

OBJECTIVES: To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. STUDY DESIGN: Multicentered case series. ANIMALS: Horses (n=43) that had descending colon resection and anastomosis. METHODS: Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short-term survival (hospital discharge). Long-term survival was defined as survival > or =6 months after hospital discharge. RESULTS: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty-eight of 30 horses with follow-up information survived > or =6 months. No significant associations between perioperative factors and short-term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). CONCLUSIONS: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival > or =6 months. The most common cause of small colon incarceration was strangulating lipoma. CLINICAL RELEVANCE: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.

Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs.

OBJECTIVE: To evaluate effectiveness of a combination of topically applied tacrolimus, orally administered prednisone, and a novel-protein diet for treatment of perianal sinuses in dogs and to monitor clinical progress and owner management of the condition for 2 years. DESIGN: Noncontrolled clinical trial. Animals-19 dogs with perianal sinuses. Procedures-Perianal sinuses were diagnosed during physical examination, and dogs were placed on a 16-week treatment protocol consisting of topically applied 0.1% tacrolimus ointment, orally administered prednisone (tapering dose), and a novel-protein diet. Metronidazole was orally administered for the first 2 weeks. Anal sacculectomy was recommended whenever anal sacs were involved. Dogs were evaluated every month for the first 4 months and then every 6 to 12 weeks for 2 years. RESULTS: Perianal sinuses resolved completely in 15 of 19 dogs during the 16 weeks. In the remaining 4 dogs, the lesions markedly improved but failed to completely resolve. Three of these had anal sac involvement, and the owner of 1 dog had complied poorly with treatment instructions. During the 2 years following treatment, all dogs were maintained on intermittently applied tacrolimus ointment, 4 dogs also received prednisone every other day, and 11 dogs remained on the novel-protein diet. At the conclusion of the study, 13 of the 15 dogs that survived to that point were free of perianal disease. CONCLUSIONS AND CLINICAL RELEVANCE: The described protocol was effective and economical for resolving perianal sinuses. Dogs maintained on intermittent medications were unlikely to redevelop lesions. When the anal sacs were involved, anal sacculectomy appeared to improve the outcome.

Prevalence of and risk factors for postoperative ileus after small intestinal surgery in two hundred and thirty-three horses.

OBJECTIVES: To determine the incidence of postoperative ileus (POI) in a population of horses after small intestinal surgery and the effect of multiple variables on development of POI. STUDY DESIGN: Case series. ANIMALS: Horses (n=233) aged > or =1 year that had exploratory celiotomy for small intestinal disease that recovered from surgery from 1995 to 2005. METHODS: Sixty-eight variables were collected from medical records (1995-2005) for each horse. POI was defined as nasogastric reflux volume >20 L over 24 hours or >8 L at any single time after surgery. RESULTS: Twenty-seven percent (64/233) of horses developed POI; 29 of 64 (46%) horses with POI had duodenitis proximal jejunitis (DPJ). When no intestinal resection was required at surgery, excluding horses with DPJ, 15% of horses had POI; 30% horses had POI after intestinal resection. Ten percent of horses had POI for >24 hours. When horses with DPJ were excluded, factors associated with increased risk of POI included high packed cell volume at hospital admission (P=.024), increasing age (P=.0004), and length of intestinal resection (P=.05). CONCLUSIONS: Risk factors for POI in this study were nonspecific although horses with intestinal resection are at higher risk compared with horses without intestinal resection. CLINICAL RELEVANCE: Predicting with certainty which cases will develop POI remains elusive.

Phimosis in cats: 10 cases (2000-2008).

Medical records of 10 cats diagnosed with phimosis were reviewed. The most common clinical signs exhibited were stranguria and pollakiuria, which occurred in eight out of 10 cats. The diagnosis of phimosis was made from physical examination alone in all cats. Eight of the 10 cats had surgical widening of the preputial orifice. Seven of these eight cats had follow-up of > or = 1 month, consisting of communications with the owner or referring veterinarian, who revealed resolution of preoperative clinical signs that were attributed to phimosis.