Minimally Invasive Beaded Electrosurgical Dissectors, Basic Science, and Pilot Studies.

Background: Minimally invasive beaded electrosurgical dissectors ("BEED devices") provide simultaneous sharp dissection, blunt dissection, and electrosurgical coagulation while performing 100 cm2 porcine tissue plane dissections in 0.8 to 3 min with minimal bleeding and no perforations. Objectives: The aim of the study was to report the basic science and potential clinical applications and to video document the speed and quality of planar dissections in in vivo and ex vivo porcine models with thermal damage quantified by thermal and histopathologic measurements. Additionally, in vivo porcine specimens were followed for 90 days to show whether adverse events occurred on a gross or macroscopic basis, as evidenced by photography, videography, physical examination, and dual ultrasonography. Methods: Ex vivo porcine models were subjected to 20, 30, and 50 W in single-stroke passages with BEED dissectors (granted FDA 510(k) clearance (K233002)) with multichannel thermocouple, 3 s delay recordation combined with matching hematoxylin and eosin (H&E) histopathology. In vivo porcine models were subjected to eight 10 × 10 cm dissections in each of 2 subjects at 20, 30, and 50 W and evaluated periodically until 90 days, wherein histopathology for H&E, collagen, and elastin was taken plus standard and Doppler ultrasounds prior to euthanasia. Results: Five to 8 mm width dissectors were passed at 1 to 2 cm/s in ex vivo models (1-10 cm/s in vivo models) with an average temperature rise of 5°C at 50 W. Clinically evidenced seromas occurred in the undressed, unprotected wounds, and resolved well prior to 90 days, as documented by ultrasounds and histopathology. Conclusions: In vivo and ex vivo models demonstrated thermal values that were below levels known to damage subcutaneous adipose tissue or skin. Tissue histopathology confirmed healing parameters while Doppler ultrasound demonstrated normal blood flow in posttreatment tissues.

Assessment of a standing position during abdominal point-of-care ultrasound on abdominal fluid score in dogs.

OBJECTIVE: To assess the use of a standing position during abdominal point-of-care ultrasound (POCUS) examination when evaluating dogs for peritoneal effusion. DESIGN: Randomized prospective study over 17 months. SETTING: Single-center, university veterinary teaching hospital. ANIMALS: Thirty dogs presenting for acute abdominal disease. Eligibility included suspicion for free peritoneal effusion and the ability to stand. INTERVENTIONS: Dogs underwent standing abdominal POCUS, right lateral abdominal POCUS, and a full abdominal ultrasound. We originally had nothing listed. It now includes all three ultrasound evaluations that were performed for each patient. MEASUREMENTS AND MAIN RESULTS: Patients underwent both a right lateral and standing abdominal POCUS via a previously described abdominal focused assessment with sonography for trauma (A-FASTrl and A-FASTs, respectively) technique in a randomized and sequential order followed by a full abdominal ultrasound (AUS-full). The A-FASTs examination included a right flank location in addition to the following standard views: subxiphoid, left flank, urinary bladder, and umbilicus. Five-second cine loops were obtained at each location for each examination and reviewed in the order they were obtained. Locations for both A-FAST exams were interrogated in the same order every time. The cine loops were scored for the degree of peritoneal effusion based on a previously published abdominal fluid scoring system by a board-certified radiologist, radiology resident, and radiology intern. The overall abdominal fluid score (AFS) was compared to a subjective full abdominal ultrasound score given by a board-certified radiologist. Six dogs had no peritoneal effusion, 13 had a small volume (AFS 1 or 2), and 11 had a moderate to large volume (AFS 3 or 4). Excellent agreement (intraclass correlation coefficient) was found between the A-FASTs and A-FASTrl techniques (0.95, 0.93, 0.94), good agreement between A-FASTs and AUS-full (0.80, 0.77, 0.82), and good agreement between A-FASTrl and AUS-full (0.80, 0.82, 0.84). The interobserver agreement was good (0.87) for the A-FASTs technique and excellent (0.91) for the A-FASTrl technique. Mean observer agreement score was excellent (0.94) when evaluating A-FASTrl to A-FASTs, good (0.86) when evaluating A-FASTs to AUS-full, and good (0.87) when evaluating A-FASTrl to AUS-full. CONCLUSION: Performing a standing abdominal POCUS examination may be a valid option for identifying and quantifying peritoneal effusion in situations when a more traditional right lateral approach cannot be performed.

Evaluation of Clinicopathological Data, the Specific Feline Pancreatic Lipase Assay, and Abdominal Ultrasound as Severity Determinants in Cats with Pancreatitis.

Limited data exist to predict the severity of pancreatitis in cats. In this retrospective case series, we reviewed the medical records of 45 cats with SP from June 2014 to June 2019. Case definition was based on an internist's review of clinopathologic data, Spec fPL concentration, and AUS findings. Information extracted from the medical records included signalment, history, physical examination findings, selected clinicopathological data (total bilirubin, glucose, ALP, ALT, and total calcium), Spec fPL concentration, AUS images/clips, length of hospitalization, and survival data. Hazard ratios were used to evaluate the association between clinicopathological data, the Spec fPL assay, AUS findings, and the length of hospitalization. Clinicopathological abnormalities, the Spec fPL, and AUS abnormalities were not statistically associated with the length of hospitalization. Despite a lack of statistical significance, the hazard ratios suggest the potential that an elevated total bilirubin (hazard ratio (HR): 1.19), hypocalcemia (HR: 1.49), and an elevated Spec fPL concentration (HR: 1.54) could be associated with prolonged hospitalization, although additional studies would be needed to verify this. Additionally, hazard ratios suggest that AUS evidence of concurrent gallbladder (HR: 1.61) and gastric abnormalities (HR: 1.36) could be associated with prolonged hospitalization.

Description of normal pulmonary radiographic findings in 55 apparently healthy juvenile Kemp's ridley sea turtles (Lepidochelys kempii).

A total of 55 digital radiographic studies from 53 individual juvenile Kemp's ridley sea turtles (Lepidochelys kempii) were retrospectively used to determine the normal radiographic anatomy of the lower respiratory tract in sea turtles that had been stranded due to hook-and-line injury and were otherwise clinically healthy. There were three or four projections available for each study: dorsoventral (DV), rostrocaudal (RoCd), and left and/or right lateral. The DV and RoCd were most conducive for assessing global lung volume and symmetry of lung volume. The DV and lateral views were most helpful for evaluating the main bronchus and its branching channels and for assessing lung margination. The RoCd view was most useful for assessing the symmetry of the lung opacity. The lateral views were most helpful for assessing the ventral margin of each lung lobe. On the lateral view, the main bronchus lay ventrally and coursed horizontally through the lung from cranial to caudal. On the DV view, the bronchus lay medially and was observed to be curvilinear coursing caudomedially. On the RoCd view, the main bronchus was located ventromedially. The RoCd view demonstrated the channels and niches end-on resulting in a reticulated or honeycomb appearance. The channels were seen as uniform striations coursing perpendicular to the main bronchus on the lateral views (vertical striations coursing dorsal to ventral) and DV views (horizontal striations coursing medially to laterally).

Multisystemic eosinophilic epitheliotropic disease in three donkeys.

Multisystemic eosinophilic epitheliotropic disease (MEED) is a rare condition of equids characterized by eosinophilic infiltration of multiple organs. Clinical signs are variable depending on the affected organs. The most common clinical signs include chronic weight loss, diarrhoea and exfoliative dermatitis. Respiratory distress and raised liver enzymes are less frequently seen. The cause is unknown and the pathogenesis is poorly understood. There are less than 50 reported cases of horses with MEED. We now document the lesions in three donkeys with fluctuating or chronic loss of weight, lethargy, exfoliative dermatitis and peripheral eosinophilia. All three animals were euthanized due to poor prognosis and welfare concerns. Post-mortem examination revealed multiple white to tan, irregular masses composed of eosinophilic infiltrates, including eosinophilic granulomas in several organs, confirming the presence of MEED. To the best of our knowledge, MEED has not previously been reported in donkeys.

Sildenafil does not have a significant effect on the portal vein velocity, cross-sectional area, and congestion index in the dog.

In veterinary medicine, sildenafil is most frequently used to treat pulmonary hypertension, but has also been investigated and used as a treatment for congenital megaesophagus and ischemic infarcts. With the increasing use, the effects of sildenafil on the portal vasculature in the dog have not been previously evaluated. The purpose of this study was to evaluate the effects sildenafil has on the portal vasculature, which anecdotally may have caused decreased portal vein pressure in an adult dog. The ultrasound cross-sectional area of the aorta, cross-sectional area of the portal vein, and portal vein blood flow velocity were acquired in dogs prior to administration, and 45, 90, and 120 min after oral administration of sildenafil for the treatment of pulmonary hypertension. Thirteen dogs were enrolled in the study. No statistically significant difference was detected between all measured values and the congestion index at all time points. A trend was identified that demonstrated progressively lower portal vein velocity with each evaluation, but this was not significant. Although this study had a small sample size, sildenafil was not shown to have a significant effect on the size or blood flow velocity of the portal vasculature. The hepatic buffer system, designed to maintain a constant blood flow to the liver, may be a contributing factor, but further studies with a larger sample size will be required for further evaluation.

American Canine Hepatozoonosis Causes Multifocal Periosteal Proliferation on CT: A Case Report of 4 Dogs.

American canine hepatozoonosis (ACH) represents an important but relatively uncommon differential diagnosis in a dog with fever, muscle wasting, profound leukocytosis, and/or musculoskeletal pain. Despite this, obtaining a definitive diagnosis can prove difficult. Peripheral blood smears and whole-blood polymerase chain reaction (PCR) rely on rare parasitemia, and the gold standard diagnostic test (skeletal muscle biopsy) is uncommonly pursued due to its invasive and costly nature. Demonstration of characteristic periosteal proliferative lesions aids diagnosis. The lesions typically involve the more proximal long bones of the appendicular skeleton. The periosteal proliferation is of currently unknown pathogenesis, but its distribution is characteristic of this disease with few differential diagnoses. This case series describes the findings on computed tomography (CT) in 4 dogs with PCR- or cytologically-confirmed Hepatozoon americanum. All dogs had multifocal, bilaterally asymmetric, irregularly marginated, non-destructive, non-articular, periosteal proliferative lesions. Recognition of this unusual CT finding and awareness of this disease could assist in the diagnosis and subsequent treatment of dogs with ACH and may offer an additional indication for CT in cases of fever, muscle wasting, and myalgia.

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

Intraoperative Ultrasound Applications in Intracranial Surgery.

The methods and use of intraoperative ultrasound in 33 canine and five feline patients and its ability to localize and identify anatomical structures and pathological lesions in canines and felines undergoing intracranial surgery are described from a case series. All were client-owned referral patients admitted for neurologic evaluation, with an advanced imaging diagnosis of an intracranial lesion, and underwent surgical biopsy or surgical removal of the lesion. Medical records, retrieval and review of imaging reports, and characterization of findings for all canine and feline patients show that intraoperative ultrasound guidance was used in intracranial procedures during the period of 2012 and 2019. Twenty-nine of the canine patients had intracranial tumors. The remainder had various other conditions requiring intracranial intervention. Three of the feline patients had meningiomas, one had a depressed skull fracture, and one had an epidural hematoma. The tumors appeared hyperechoic on intraoperative ultrasound with the exception of cystic portions of the masses and correlated with the size and location seen on advanced imaging. Statistical comparison of the size of images seen on ultrasound and on MRI for 20 of the canine tumors revealed no statistical differences. Neuroanatomical structures, including vascular components, were easily identified, and tumor images correlated well with preoperative advanced imaging. The authors conclude that intraoperative ultrasound is a valuable asset in intracranial mass removals and can augment surgical guidance in a variety of intracranial disorders that require surgery. This is the first known publication in veterinary surgery of using intraoperative ultrasound as a tool in the operating theater to identify, localize, and monitor the removal/biopsy of intracranial lesions in small animals undergoing craniotomy/craniectomy.

Sedation with dexmedetomidine is associated with transient gallbladder wall thickening and peritoneal effusion in some dogs undergoing abdominal ultrasonography.

BACKGROUND: Dexmedetomidine often is used for sedation before or during abdominal ultrasonography. The effect of dexmedetomidine on gallbladder wall thickness is unknown. HYPOTHESIS/OBJECTIVES: To investigate the relationship between dexmedetomidine administration and gallbladder wall thickening in dogs. The hypothesis was that sedation with dexmedetomidine will cause transient gallbladder wall thickening. Gallbladder wall thickness will be associated with duration of sedation and recumbency position. ANIMALS: Seventy-nine client owned dogs and 10 healthy research dogs. METHODS: A prospective observational study (n = 79) was used to establish the prevalence of gallbladder wall thickening (> 2.0 mm) after sedation with dexmedetomidine. A randomized, crossover study (n = 10) was used to evaluate the effect of time and recumbency position on the development of gallbladder wall thickening. Linear mixed models were used. RESULTS: The proportion of client-owned dogs that developed gallbladder wall thickening was 24.05% (19/79; 95% confidence interval [CI], 15.1%-35.0%) with a median dose of dexmedetomidine of 5.0 µg/kg (range, 2.0-12.5 µg/kg). After sedation, the proportion of research dogs that developed gallbladder wall thickening in left lateral (5/10, 50%; 95% CI, 18.7%-81.3%) and dorsal (7/10, 70%; 95% CI, 34.8%-93.3%) recumbency did not differ significantly (P = .45). Gallbladder wall thickening developed within 20 to 40 minutes. Duration of sedation was significantly associated with thickening of the gallbladder wall (P < .001). Five dogs developed 9 instances of peritoneal effusion in both lateral (5) and dorsal (4) recumbency. CONCLUSIONS AND CLINICAL IMPORTANCE: Sedation with dexmedetomidine is associated with gallbladder wall thickening (> 2.0 mm) and peritoneal effusion that could be confused with pathologic etiologies.