Incidence of residual biologic debris and contamination of reused bipolar vessel sealing devices after ethylene oxide sterilization following splenectomy.

OBJECTIVE: The aim of the present study was to quantify the amount of biologic debris present within disposable bipolar vessel sealing devices after each use for canine splenectomies and determine the aerobic bacterial load of the debris following instrument resterilization with ethylene oxide. STUDY DESIGN: Prospective observational clinical study. STUDY POPULATION: Client-owned dogs (n = 40) presenting to a single specialty hospital for open, routine, or emergency splenectomies. METHODS: A total of 16 bipolar vessel sealing devices were randomly assigned to undergo one, two, three, or four splenectomies, manual hand cleanings, and ethylene oxide sterilizations before being dismantled. After final use and sterilization, each handset was agitated in phosphate-buffered saline before disassembly, which was submitted for aerobic culture. Following aseptic disassembly, all biological residue was photo-documented, collected, quantified using a subjective scoring system, and submitted for culture. RESULTS: Biologic debris was present within the inner mechanics of all devices, specifically under the blade used for vessel transection. A linear increase in debris was not appreciated amongst devices used once versus devices used multiple times. None of the devices nor any of the biologic debris cultured positive following sterilization with ethylene oxide. CONCLUSION: The presence of biologic debris was documented after the initial use of disposable bipolar vessel sealing devices, but no devices or debris yielded positive culture results following ethylene oxide sterilization after splenectomies. CLINICAL SIGNIFICANCE: Increased risk of iatrogenic surgical site contamination from reused vessel sealing devices is unlikely when they have been cleaned and sterilized with ethylene oxide after up to four splenectomy surgeries.

Effect of continuous positive airway pressure helmet on respiratory function following surgical procedures in brachycephalic dogs: A randomized controlled trial.

OBJECTIVE: To evaluate the effect of continuous positive airway pressure (CPAP) on respiratory function in the early postoperative period of brachycephalic dogs. STUDY DESIGN: Prospective, randomized clinical trial. ANIMALS: A total of 32 dogs. METHODS: Dogs were assigned to recover with or without CPAP (control) and assessed at specific time points over 1 h. Treatment was discontinued for dogs with a CPAP tolerance score of 3 or more (from a range of 0-4). The primary outcome was pulse oximetry (SpO2). Secondary outcomes were arterial O2 pressure (PaO2)/FiO2 ratio (PaO2/FiO2), arterial CO2 pressure (PaCO2), and rectal temperature. For dogs that reached a CPAP tolerance score of 3 or more, only the data collected up to the time point before discontinuation were included in the analysis. The treatment effect (ß) was analyzed using random effects models and the results were reported with 95% confidence intervals. RESULTS: Dogs were assigned randomly to each protocol. Baseline characteristics in both groups were comparable. Arterial blood gases were obtained in seven control group dogs and nine CPAP group dogs. Treatment did not affect SpO2 (ß = -0.1, -2.1 to 2.0) but affected the PaO2/FiO2 ratio (ß = 58.1, 2.6 to 113.6), with no effects on PaCO2 (ß = -4.3, -10.5 to 1.9) or temperature (ß = 0.4, -0.8 to 1.6). CONCLUSION: In postoperative brachycephalic dogs, CPAP had no effect on SpO2 but improved the PaO2/FiO2 ratio in brachycephalic dogs postoperatively. CLINICAL SIGNIFICANCE: Continuous positive airway pressure offers a valuable solution to improve gas exchange efficiency, a prevalent concern in postoperative brachycephalic dogs, with the potential to enhance overall outcomes.

Effect of surgical simulator training on student and live animal outcomes in a feline ovariohysterectomy teaching laboratory.

OBJECTIVE: To evaluate the effect of training with a high-fidelity surgical simulator on outcomes of live animals and students participating in a feline ovariohysterectomy teaching laboratory. STUDY DESIGN: Nonrandomized controlled trial. SAMPLE POPULATION: Cats (n = 186) and students (n = 146). METHODS: Live animals were paired with student surgeons. Outcomes for animals and students were evaluated over two consecutive years before (year 1: NO SIM) and after (year 2: SIM) the introduction of a graded student teaching laboratory conducted on a high fidelity surgical simulator. Live animal surgical times and postoperative pain scores using the Glasgow Composite Measure Pain Scale - Feline acute pain scale as well as self-declared student confidence were assessed and the scores of the two groups were compared. RESULTS: The duration of the live animal surgical procedure was on average 6 min shorter in the SIM group (p = .04). A pain score triggering intervention (> = 5/20) occurred less frequently in the SIM group (n = 1/82) than in the NO-SIM (n = 16/104) group (p < .01). Similarly, rescue analgesia was administered less frequently (4/82 vs 16/104, p = .03) in the SIM group. Student confidence prior to the live animal procedure was higher (median = 7/10 [IQR = 6-8]) in the SIM group than in the NO-SIM group (median = 6/10 [IQR = 4-7]) (p < .01). CONCLUSION: Surgical simulator training prior to live animal procedures improves live animal outcomes and student confidence. CLINICAL SIGNIFICANCE: Surgical simulator competency should be considered a prerequisite to participation in live animal teaching laboratories. This would improve both animal welfare and the student experience.

Surgical and oncologic outcomes in dogs with malignant peripheral nerve sheath tumours arising from the brachial or lumbosacral plexus.

Malignant peripheral nerve sheath tumours (MPNST) of a plexus nerve or nerve root cause significant morbidity and present a treatment challenge. The surgical approach can be complex and information is lacking on outcomes. The objective of this study was to describe surgical complication rates and oncologic outcomes for canine MPNST of the brachial or lumbosacral plexus. Dogs treated for a naïve MPNST with amputation/hemipelvectomy with or without a laminectomy were retrospectively analysed. Oncologic outcomes were disease free interval (DFI), overall survival (OS), and 1- and 2-year survival rates. Thirty dogs were included. The surgery performed was amputation alone in 17 cases (57%), and amputation/hemipelvectomy with laminectomy in 13 cases (43%). Four dogs (13%) had an intraoperative complication, while 11 dogs (37%) had postoperative complications. Histologic margins were reported as R0 in 12 dogs (40%), R1 in 12 dogs (40%), and R2 in five dogs (17%). No association was found between histologic grade and margin nor extent of surgical approach and margin. Thirteen dogs (46%) had recurrence. The median DFI was 511 days (95% CI: 140-882 days). The median disease specific OST was 570 days (95% CI: 467-673 days) with 1- and 2-year survival rates of 82% and 22% respectively. No variables were significantly associated with recurrence, DFI, or disease specific OST. These data show surgical treatment of plexus MPNST was associated with a high intra- and postoperative complication rate but relatively good disease outcomes. This information can guide clinicians in surgical risk management and owner communication regarding realistic outcomes and complications.

Development of a minimally invasive endoscopic technique for excisional biopsy of the axillary lymph nodes in dogs.

OBJECTIVE: To develop and describe a minimally invasive technique for excisional biopsy of the axillary lymph nodes in dogs. STUDY DESIGN: Descriptive cadaver and clinical case series. ANIMALS: Four canine cadavers and three clinical patients. METHODS: A 3D computed tomographic reconstruction of the canine axilla was used to identify an optimal avenue of approach to the lymph nodes. This approach was refined using endoscopic techniques in four cadavers (six procedures) and potential surgical hazards, landmarks, and the surgical time required for excisional biopsy of the nodes was recorded. The procedure was then performed in three clinical cases. RESULTS: Axillary lymph node removal was achieved using an endoscopic technique with surgical times of 58 and 35 minutes in two of three clinical cases. The third case required conversion to an open approach after endoscopic identification of the node. No major complications were encountered. CONCLUSION: Excisional biopsy of the axillary lymph nodes can be performed successfully using a minimally invasive technique in the dog. Further investigation in clinical cases is needed to determine the risks and complications of this procedure. CLINICAL SIGNIFICANCE: Minimally invasive excisional biopsy of the axillary lymph nodes in dogs can be performed and may have a role in assisting with staging and local disease control in oncologic cases.

Update on Adrenalectomy.

Surgical removal is the standard of care for adrenal tumors greater than 2.0 cm diameter. For tumors smaller than 2.0 cm, imaging techniques evaluating patterns of contrast washout may offer a promising avenue for early identification of adrenal malignancy. Pretreatment of pheochromocytoma with phenoxybenzamine is associated with reduced surgical mortality risk. Surgical technique can be laparoscopic or open, depending on tumor anatomy and the experience of the surgeon. Vascular invasion is a contraindication for a laparoscopic technique. This review provides a summary of minimally invasive and open adrenalectomy techniques, including a discussion of management of vascular invasion and partial cavectomy.

Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score.

OBJECTIVES: The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score. METHODS: Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures. RESULTS: There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group (P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3-74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group (P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872-1021) vs US$623 (IQR US$595-679) in the open group (P <0.01). CONCLUSIONS AND RELEVANCE: In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

Laparoscopic inguinal herniorrhaphy with barbed suture in a ram.

A 7-month-old Hampshire ram, with no history of trauma or breeding, was referred for treatment of acute, unilateral scrotal swelling. Physical examination revealed a moderately sized, soft, left-sided, non-reducible swelling of the proximal scrotum and mild swelling of the scrotal neck. Ultrasound evaluation of the scrotum revealed morphologically normal testicles and a mild accumulation of free fluid in the left vaginal tunic. Unilateral, laparoscopic inguinal herniorrhaphy under general anesthesia was performed. The herniated omentum was reduced and barbed suture was used to imbricate the internal inguinal ring and the vaginal ring. No recurrence of herniation was reported 5 months after surgery. Key clinical message: Laparoscopic inguinal herniorrhaphy with barbed suture can be a safe and effective means of scrotal hernia resolution in a ram. When performed by a competent surgeon experienced in laparoscopy, this treatment for inguinal and scrotal herniation may minimize post-operative pain, provide a rapid return to function, and preserve normal testicular and scrotal anatomy.

Herniorraphie inguinale laparoscopique avec suture barbelée chez un bélier. Un bélier Hampshire âgé de 7 mois, sans antécédent de traumatisme ou de reproduction, a été vu pour traitement d'un gonflement unilatéral aigu du scrotum. L'examen physique a révélé une tuméfaction modérée, molle, du côté gauche, non réductible du scrotum proximal et une légère tuméfaction du col scrotal. L'examen échographique du scrotum a révélé des testicules morphologiquement normaux et une légère accumulation de liquide libre dans la tunique vaginale gauche. Une herniorraphie inguinale unilatérale laparoscopique sous anesthésie générale a été réalisée. L'épiploon hernié a été réduit et une suture barbelée a été utilisée pour imbriquer l'anneau inguinal interne et l'anneau vaginal. Aucune récidive de hernie n'a été rapportée 5 mois après la chirurgie.Message clinique clé:La herniorraphie inguinale laparoscopique avec suture barbelée peut être un moyen sûr et efficace de résolution de la hernie scrotale chez un bélier. Lorsqu'il est effectué par un chirurgien compétent et expérimenté en laparoscopie, ce traitement des hernies inguinales et scrotales peut minimiser la douleur postopératoire, permettre un retour rapide à la fonction et préserver l'anatomie testiculaire et scrotale normale.(Traduit par Dr Serge Messier).

Real-time analysis of intraoperative delays and variations in intraoperative workflow with level of experience of the primary surgeon in small animal surgery.

OBJECTIVE: To describe the causes of intraoperative delays and the changes in delays and surgical workflow with the level of training of the primary surgeon. STUDY DESIGN: Prospective observational study. SAMPLE POPULATION: Seventy-three small animal surgical procedures performed at an academic teaching institution between January 17, 2018 and April 10, 2018. METHODS: Procedures (trainee = 37, faculty = 36) totaling 103.2 h were observed and video recorded. Operative time was allocated to the surgical approach, exploration, exposure, intervention, and closure phases. Suballocations were made to specific tasks within these categories (such as cutting or hemostasis). Intraoperative delays and reasons were recorded. Differences in use of time between trainee and faculty surgeons were analyzed. RESULTS: Delays constituted 9.2% (±4.4) of the operative time, of which 6.5%(±3.6) were surgeon controlled and 2.6% (±2.7) were non-surgeon controlled. Surgeons preparing instrumentation outside of the operative field and retrieval of equipment from supply areas were the greatest contributors to delays. Intraoperative delays did not increase when the trainee was placed in the primary surgeon role (P = .78). During the approach faculty surgeons spent proportionally less time on hemostasis (P = .02), and during closure they spent less time suturing (P = .03) than trainees. CONCLUSION: Trainee surgeons did not have greater intraoperative delays. Delays were created when surgeons prepared their own instrumentation. Workflow differed between experts and trainees. CLINICAL SIGNIFICANCE: Advancing a trainee surgeon into the primary role is unlikely to increase intraoperative delays, which can be reduced by the inclusion of trained scrub technicians. A focus on efficient hemostasis and fluidity when suturing may improve operative efficiency for surgical trainees.

The Canine Postamputation Pain (CAMPPAIN) initiative: a retrospective study and development of a diagnostic scale.

OBJECTIVE: To develop a scale to diagnose and assess the severity of postamputation pain (PAP) in dogs. STUDY DESIGN: Single-center retrospective study. ANIMALS: A total of 66 dogs that underwent thoracic or pelvic limb amputation and 139 dogs that underwent tibial plateau leveling osteotomy (TPLO) at a veterinary teaching hospital. METHODS: An online survey regarding postoperative behavioral changes was sent to owners. Categorical, multiple-choice responses were entered into a univariable logistic regression model and tested for association with amputation using the Wald test. If p < 0.2, variables were forwarded to a multivariable logistic regression model for manual build. Model simplicity and predictive ability were optimized using the area under the receiver operating curve (AUROC) characteristic, and model calibration was assessed using the Hosmer-Lemeshow test. The selected model was converted to an integer scale (0-10), the Canine Postamputation Pain (CAMPPAIN) scale. Univariable logistic regression related each dog's calculated score to the probability of PAP. RESULTS: Multivariable logistic regression identified four independent predictors of PAP (p < 0.05): 1) restlessness or difficulty sleeping, 2) episodes of panic or anxiety, 3) sudden vocalization, and 4) compulsive grooming of the residual limb. Score AUROC was 0.70 (95% confidence interval = 0.63-0.78) with good calibration (Hosmer-Lemeshow statistic p = 0.82). A score of 2 corresponded to a risk probability of 0.5. Taking a score ≥ 2 to indicate PAP, score specificity and sensitivity were 92.1% and 36.4%, respectively. When this score was used to diagnose PAP, prevalence was 36.4% (24/66) and 7.9% (11/139) in the amputation and TPLO groups, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Postamputation pain is characterized by specific postoperative behaviors and appears to affect approximately one-third of canine amputees. The CAMPPAIN scale generated from these data could facilitate diagnosis, treatment and further study of PAP but requires external validation.

Development of a veterinary trauma score (VetCOT) in canine trauma patients with performance evaluation and comparison to the animal trauma triage score: A VetCOT registry study.

OBJECTIVE: To develop a population-derived, parsimonious, and objective risk stratification model for dogs following trauma and compare its predictive performance to the animal trauma triage (ATT) score. DESIGN: Observational cohort study using data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) trauma registry acquired between September 2013 and October 2017. SETTING: Nine Level I and Level II veterinary trauma centers. ANIMALS: Nine hundred eighty-four dogs assessed within 24 h of traumatic injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient mortality was 10.8%. The VetCOT model was constructed based on 4 variables: plasma lactate and ionized calcium obtained within 6 h of admission, and presence or absence of clinical signs consistent with either head or spinal trauma. The VetCOT score had good discriminatory performance (AUROC = 0.87, 95% CI = 0.83-0.91) comparable to that of the 6 variable ATT score for the same population (area under the receiver operator characteristic [AUROC] = 0.87; 95% CI, 0.84-0.90). No statistical difference in discriminatory performance between the 2 scores was identified (P = 0.98). The VetCOT score showed good calibration on this population (Hosmer-Lemeshow test P = 0.93), whereas the ATT score failed to calibrate (P = 0.02) due to overprediction of mortality at low scores. Sensitivity and specificity for outcome of the VetCOT score at a risk probability cutoff of 0.5 for this population were 28.97% and 97.95%, respectively. CONCLUSIONS: The VetCOT score is a more parsimonious model with comparable discriminatory performance and superior calibration to the ATT score for risk stratification in dogs following trauma. Further prospective validation studies are required to confirm the discriminatory performance of the VetCOT score.

Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi-institutional retrospective study.

OBJECTIVE: To determine whether catheterization of the common bile duct (CBD) is associated with outcome in dogs undergoing cholecystectomy for gallbladder mucocele and to determine whether this association is modified by the catheterization method. STUDY DESIGN: Multi-institutional retrospective cohort study. ANIMALS: Dogs (n = 252) that underwent cholecystectomy for gallbladder mucocele. METHODS: Dogs were identified via electronic medical record review at four veterinary teaching hospitals. Baseline dog characteristics, surgical findings, and methods including normograde vs retrograde CBD catheterization, intraoperative outcomes, and postoperative outcomes and complications were recorded. Variables were compared between dogs with and without catheterization. RESULTS: Catheterized dogs had higher American Society of Anesthesiologists scores (P = .04), higher total bilirubin (P = .01), and were more likely to have dilated CBD at the time of surgery (P < .01). Incidence of major and minor intraoperative complications was similar between the two groups. Surgical time was longer for the catheterized group (P = .01). The overall incidence of postoperative complications was similar between the groups; however, postoperative pancreatitis was associated with performing CBD catheterization (P = .01). This association was retained as an independent association in a multivariable model that addressed baseline group differences (P = .04). Likelihood of developing postoperative pancreatitis was not different between normograde and retrograde catheterization (P = .57). CONCLUSION: Catheterization of the CBD was associated with development of postoperative pancreatitis. This was not influenced by the method of catheterization. CLINICAL SIGNIFICANCE: The requirement for catheterization of the CBD during open cholecystectomy in dogs should be carefully considered, particularly in dogs without evidence of biliary obstruction because the procedure may induce postoperative pancreatitis.

Influence of locoregional lymph node aspiration cytology vs sentinel lymph node mapping and biopsy on disease stage assignment in dogs with integumentary mast cell tumors.

OBJECTIVE: To compare the effect of sentinel lymph node (SLN) histology vs locoregional lymph node (LRLN) fine needle aspiration (FNA) cytology on assigned disease stage and adjunctive treatment recommendations and describe the incidence of anatomic disparity between the LRLN and SLN. STUDY DESIGN: A pre-post study refers to a study design type in which subjects are compared pre and post the intervention of interest. ANIMALS: Seventeen dogs undergoing primary excision of 20 cutaneous and subcutaneous mast cell tumors (MCT). METHODS: Client-owned dogs presenting to the Cornell University Hospital for Animals for surgical removal of a cytologically confirmed cutaneous or subcutaneous MCT >1 cm in diameter were enrolled. Cytological examination of FNA from the LRLN was compared with histology of the SLN. The SLN was identified by indirect computed tomographic lymphangiography (ICTL) after peritumoral injection of iopamidol and scanning at 1, 3, 5, 10, and 15 minutes. Histopathologic node score > 1 was considered metastatic. After case review by an oncologist, LRLN FNA cytology was compared with SLN histology for effect on changes in stage assignment and adjunctive treatment recommendations. RESULTS: Mast cell tumors were graded as 2 low (n = 11), 2 high (n = 2), and subcutaneous (n = 7). Optimal scan timing was 10 minutes after injection of iopamidol. Sentinel lymph node differed anatomically from LRLN in 5 of 18 scans. Metastases were detected by histology in 9 of 20 SLN compared with in 1 of 20 FNA of LRLN (P = .001), changing stage and adjunctive treatment recommendations 8 of 20 tumors. Only 6 of 19 LRLN FNA samples were diagnostic. CONCLUSION: Sentinel lymph nodes were consistently identified with ICTL and differed from LRLN in one-quarter of tumors. Histopathological examination of SLN altered recommendations in half of the dogs compared with the previous standard of care. CLINICAL SIGNIFICANCE: Indirect computed tomographic lymphangiography and SLN excision should be considered as a new standard for dogs with MCT.

A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units.

OBJECTIVE: To investigate associations among care errors, staffing, and workload in small animal ICUs. DESIGN: Multicenter observational cohort study conducted between January 2017 and September 2018. SETTING: Three small animal teaching hospital ICUs. ANIMALS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1-18). Median patient illness severity was 15.1 (4.7-27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02-1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84-3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002-1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30-2.25; P < 0.001) for APPLEfast :technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97-0.99; P = 0.01) for each year increase in total technician years of ICU work experience. CONCLUSIONS: Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.

Auriculectomy for spontaneous thrombosis of the left auricle in a domestic shorthair cat.

A 3-year-old castrated male domestic shorthair cat was presented for evaluation of acute onset tachypnea, dyspnea, and restlessness. Blood analysis revealed markedly elevated creatinine kinase, troponin, and D-dimers, together with azotemia and an inflammatory leukogram. Ultrasonography identified cardiomegaly with pericardial and pleural effusion. Thoracocentesis identified a high protein transudate. Cardiac computed tomographic angiography (CTA) identified an enlarged left auricle containing a non-contrast enhancing mass measuring 1.6 × 1.2 × 1.2 cm subsequently confirmed to be a thrombus. The cat underwent a left cardiac auriculectomy and was discharged on clopidogrel. Post-operative complications, including late-onset hemothorax and dyspnea, were managed to resolution. Key clinical message: A cardiac auriculectomy was effective in management of thromboembolic disease in a domestic cat.

Auriculectomie pour une thrombose spontanée de l'oreillette gauche chez un chat domestique à poils courts. Un chat domestique à poils courts castré âgé de 3ans fut présenté pour évaluation suite à l'apparition soudaine de tachypnée, dyspnée et agitation. L'analyse sanguine révéla une augmentation marquée de la créatine kinase, de la troponine, des dimères-D avec également une azotémie et un leucogramme inflammatoire. L'échographie révéla une cardiomégalie avec effusions péricardique et pleurale. Une thoracocentèse identifia un transsudat élevé en protéine. Une angiographie par tomodensitométrie (CTA) identifia une oreillette gauche augmentée de volume contenant une masse non-contrastante mesurant 1,6 × 1,2 × 1,2 cm qui fut subséquemment confirmée être un thrombus. Le chat subit une auriculectomie cardiaque gauche et obtint son congé avec du clopidogrel. Des complications post-opératoires, incluant un hémothorax qui apparut tardivement et de la dyspnée, furent gérées jusqu'à leur résolution.Message clinique clé :Une auriculectomie cardiaque fut efficace pour gérer un problème thrombo-embolique chez un chat domestique.(Traduit par Dr Serge Messier).

Influence of speaker's gender on speaker introductions at the 2018 ACVS Surgical Summit.

OBJECTIVE: To evaluate whether formality of introduction differed between male vs female speakers at the 2018 American College of Veterinary Surgeons (ACVS) scientific meeting and identify other variables that predisposed introducers or chairs to informal introduction. STUDY DESIGN: Observational study. SAMPLE POPULATION: Thirteen session chairs introducing 68 lectures (41 by females, 27 by males) by 63 speakers. METHODS: Observers recorded the session introducer, speaker, and whether speakers were introduced with a formal or informal title. Information evaluated included type of oral presentation; introducer gender, year, and country of graduation from veterinary school; speaker gender; whether the speaker was a resident; and speaker's year of graduation. RESULTS: Female speakers were introduced by their first name in 9 of 41 introductions compared to in 1 of 27 introductions for male speakers. This difference reached statistical significance when data independence was assumed (P = .043); however, this significance was narrowly lost when data clustering on session introducer was controlled for (P = .067). CONCLUSION: In this study, female speakers were more likely than male speakers to be introduced by their first and last names rather than with their professional title at a recent ACVS scientific meeting. IMPACT: Additional research is required to determine the effect of this type of subordinate language and gender bias in veterinary surgery.

Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions.

OBJECTIVE: To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: One hundred fifty-three client-owned dogs with intestinal intussusception. METHODS: Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1-4). Follow-up was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow-up after discharge was 334 days (interquartile range, 15-990; range, 1-3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen-day postoperative mortality rate was 6%. CONCLUSION: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications. CLINICAL SIGNIFICANCE: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.

Comparison of lateral surgical margins of up to two centimeters with margins of three centimeters for achieving tumor-free histologic margins following excision of grade I or II cutaneous mast cell tumors in dogs.

OBJECTIVE: To determine whether conservative lateral surgical margins (equal to tumor diameter for tumors < 2 cm in diameter or 2 cm for larger tumors) were noninferior to wide (3-cm) lateral surgical margins for achieving tumor-free histologic margins following excision of grade I and II cutaneous mast cell tumors (MCTs) in dogs. ANIMALS: 83 grade I and II MCTs excised with a deep surgical fascial margin and requisite lateral surgical margins from 68 dogs from 2007 to 2017. Tumors representing scar revision or local recurrence were excluded. PROCEDURES: A pathology department database was searched to identify qualifying MCTs, and medical records were cross-referenced to obtain data regarding patients and tumors. Outcome (complete vs incomplete excision as histologically determined) was compared between conservative- and wide-margin groups. A noninferiority margin of ≥ 0.9 was used for the risk ratio (probability of complete excision for the conservative- vs wide-margin group), implying that noninferiority would be established if the data indicated that the true risk of complete excision with the conservative-margin approach was at worst 90% of that for the wide-margin approach. RESULTS: The proportion of excised MCTs with tumor-free histologic margins was similar between the conservative- (43/46 [93%]) and wide- (34/37 [92%]) margin groups. There were no differences in tumor diameter or location between treatment groups. The risk ratio (1.02; 95% confidence interval, 0.89 to 1.19) met the criterion for noninferiority. CONCLUSIONS AND CLINICAL RELEVANCE: The conservative-margin approach appeared to be noninferior to the wide-margin approach for achieving tumor-free histologic margins in the dogs of this study, and its use could potentially reduce the risk of postoperative complications. (J Am Vet Med Assoc 2020;256:567-572.

Higher body mass index may increase the risk for the development of incisional complications in horses following emergency ventral midline celiotomy.

BACKGROUND: Obesity is common in the equine population and it has been associated with increased surgical morbidity and mortality in humans. The effect of increased body mass index (BMI) on the incidence of surgical site infections has not been investigated in horses. OBJECTIVES: To determine whether horses with increased body fat, as estimated by BMI, are more likely to develop post-operative complications, particularly incisional complications, following emergency ventral midline celiotomy. STUDY DESIGN: Retrospective, multi-institutional clinical study. METHODS: Medical records of horses >2 years old presenting with colic that underwent ventral midline celiotomy between January 2010 and September 2018 with follow-up of a minimum of 30 post-operative days were reviewed. Extracted data included signalment, operative details and outcome. BMI was calculated by dividing the patient's weight (kg) by the withers height squared (m2 ). RESULTS: In all, 287 horses fit inclusion criteria. Incisional complication prevalence was 23.7%. Horses with incisional complications had a higher BMI (median 203.6 kg/m2 , IQR = 191.5-217.4) compared with those without (median 199.1 kg/m2 , IQR = 184.7-210.2) (P = .03). Multi-variable analysis of the effects of age, sex, breed and presence of metabolic disease on the association between BMI and risk of incisional complications, identified a tendency towards increased risk with a higher BMI, but statistical significance decreased to P = .07. Breed had an association with BMI (P < .01), but not with incisional complication risk. MAIN LIMITATIONS: BMI as an estimate of body fat has limitations. Retrospective studies with reliance on owners reporting data and complete medical records is imperfect. When the data were subjected to multi-variable analysis, the trend towards an increased incidence of incisional complications in horses with higher BMI persisted but it was not statistically significant. CONCLUSION: Higher BMI may increase the risk for the development of incisional complications in horses following emergency ventral midline celiotomy.

Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial.

OBJECTIVE: To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats. STUDY DESIGN: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. ANIMALS: Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17). METHODS: Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively. RESULTS: Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery. CONCLUSION: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy. CLINICAL SIGNIFICANCE: Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.