Retrospective evaluation of a hand-sewn side-to-side intestinal anastomosis technique in dogs and cats.

Background: Hand-sewn intestinal resection and anastomosis are commonly performed in veterinary medicine. The outcome of the hand-sewn side-to-side anastomosis (SSA) technique has never been described and compared to other techniques in dogs and cats. Aim: The study aims to describe the side-to-side hand-sewn anastomosis technique in small animals and to compare it with the end-to-end technique. Methods: A retrospective evaluation of the clinical records of dogs and cats that underwent enterectomy between 2000 and 2020 and were treated with side-to-side or end-to-end anastomosis (EEA) was performed. Results: Of the 52 dogs and 16 cats included in the study, 19 dogs and 6 cats received an SSA, and the remaining received an EEA. No intraoperative complication was reported. However, short-term complication rates were comparable, and mortality rates in the EEA group were higher. At the same time, stenosis was a frequent complication of SSA and was never reported following EEA. Conclusion: End-to-end technique remains the gold standard for hand-sewn intestinal anastomosis in small animals. However, SSA can be considered for selected cases with acceptable morbidity and mortality rates.

Perforated duodenal ulcer in a dog with gallbladder agenesis.

Background: Duodenal ulceration (DU) in dogs derives from different causes but has never previously been related to gallbladder agenesis (GA). GA is a rare congenital disorder in dogs and is considered a predisposing factor for DU in humans. Case Description: A 5-month-old intact female Maltese was presented for acute vomiting and diarrhea. Abdominal ultrasound suggested duodenal perforation and absence of the gallbladder. Exploratory laparotomy was performed to treat the perforation and confirmed GA. Hepatic ductal plate malformation (DPM) was histologically diagnosed in liver biopsy, but no signs of liver dysfunction were detected by blood work at first admission. Two months later, the dog developed signs of portal hypertension and medical treatment was started. However, the clinical condition gradually worsened until liver failure and the dog was euthanized 8 months after surgery. Necropsy confirmed hepatic abnormalities. Conclusion: This report describes a case of DU associated with GA and DPM in a dog. As in humans, GA may represent a hepatobiliary disease predisposing to gastroduodenal ulcerations.

Automated Wound Image Segmentation: Transfer Learning from Human to Pet via Active Semi-Supervised Learning.

Wound management is a fundamental task in standard clinical practice. Automated solutions already exist for humans, but there is a lack of applications regarding wound management for pets. Precise and efficient wound assessment is helpful to improve diagnosis and to increase the effectiveness of treatment plans for chronic wounds. In this work, we introduced a novel pipeline for the segmentation of pet wound images. Starting from a model pre-trained on human-based wound images, we applied a combination of transfer learning (TL) and active semi-supervised learning (ASSL) to automatically label a large dataset. Additionally, we provided a guideline for future applications of TL+ASSL training strategy on image datasets. We compared the effectiveness of the proposed training strategy, monitoring the performance of an EfficientNet-b3 U-Net model against the lighter solution provided by a MobileNet-v2 U-Net model. We obtained 80% of correctly segmented images after five rounds of ASSL training. The EfficientNet-b3 U-Net model significantly outperformed the MobileNet-v2 one. We proved that the number of available samples is a key factor for the correct usage of ASSL training. The proposed approach is a viable solution to reduce the time required for the generation of a segmentation dataset.

Patterns of nodal metastases, biological behaviour and prognosis of canine mast cell tumours of the pinna: A multi-institutional retrospective study.

Canine cutaneous mast cell tumours (cMCTs) of the pinna have been associated with an aggressive biological behaviour, although data remain scarce. The knowledge acquired over the past years on histologic gradings, and the value of lymph node (LN) staging, may help in better characterizing this anatomical presentation. The first aim was to describe the frequency, location, and histologic appearance of LN metastases in cMCT of the pinna. A second aim was to evaluate prognosis. Medical records of dogs with cMCT of the pinna, that underwent tumour and sentinel (SLN) or regional LN (RLN) excision, were reviewed. The influence of potential prognostic variables on time to progression (TTP) and tumour-specific survival (TSS) was investigated. Thirty-nine dogs were included: 19 (48.7%) had Kiupel high-grade (K-HG) and 20 (51.3%) had low-grade (K-LG) MCTs. Eighteen (46.1%) dogs underwent SLN mapping: the superficial cervical LN was at least one of SLN in 17 (94.4%) cases. Twenty-two (56.4%) dogs had LN metastases; the superficial cervical LN was always involved. On multivariable analysis, only K-HG was associated with increased risk of progression (p = .043) and tumour-related death (p = .021). Median TTP and TSS were 270 and 370 days in K-HG, respectively; these were not reached in dogs with K-LG tumours (p < .01). cMCTs of the pinna are often K-HG and are also associated with a higher frequency of LN metastasis; however, we confirmed the independent prognostic value of histologic grading. A multimodal treatment may lead to favourable long-term outcome. Moreover, the superficial cervical LN is most often the SLN.

Surgical findings and outcomes after unilateral adrenalectomy for primary hyperaldosteronism in cats: a multi-institutional retrospective study.

CASE SERIES SUMMARY: Twenty-nine cats from different institutions with confirmed or highly suspected primary hyperaldosteronism treated by unilateral adrenalectomy were retrospectively included in this study. The most frequent clinical signs were lethargy (n = 20; 69%) and neck ventroflexion (n = 17; 59%). Hypokalaemia was present in all cats, creatinine kinase was elevated in 15 and hyperaldosteronism was documented in 24. Hypertension was frequently encountered (n = 24; 89%). Preoperative treatment included potassium supplementation (n = 19; 66%), spironolactone (n = 16; 55%) and amlodipine (n = 11; 38%). There were 13 adrenal masses on the right side, 15 on the left and, in one cat, no side was reported. The median adrenal mass size was 2 × 1.5 cm (range 1-4.6 × 0.4-3.8); vascular invasion was present in five cats, involving the caudal vena cava in four cats and the renal vein in one. Median duration of surgery was 57 mins. One major intraoperative complication (3%) was reported and consisted of haemorrhage during the removal of a neoplastic thrombus from the caudal vena cava. In 4/29 cats (14%), minor postoperative complications occurred and were treated medically. One fatal complication (3%) was observed, likely due to disseminated intravascular coagulation. The median duration of hospitalisation was 4 days; 97% of cats survived to discharge. The potassium level normalised in 24 cats within 3 months of surgery; hypertension resolved in 21/23 cats. Follow-up was available for 25 cats with a median survival of 1082 days. Death in the long-term follow-up was mainly related to worsening of comorbidities. RELEVANCE AND NOVEL INFORMATION: Adrenalectomy appears to be a safe and effective treatment with a high rate of survival and a low rate of major complications. Long-term medical treatment was not required.

Congenital Lobar Emphysema in a Kitten with Concomitant Hiatal Hernia and Nutritional Secondary Hyperparathyroidism.

A 2 mo old domestic shorthair kitten was presented for acute respiratory distress and severe ambulatory difficulties. Thoracic radiography revealed hyperinflation of the left cranial lung lobe and a mass with soft-tissue/gas opacity in the caudal mediastinum, leading to the suspicion of congenital lung lobe emphysema and hiatal hernia. Decreased bone radiopacity and suspected pathological fractures were also present. Complete clinicopathological analyses showed significant ionized hypocalcemia and suspicion of secondary hyperparathyroidism related to an inadequate diet. Lung lobectomy and reduction of the hiatal hernia following a median sternotomy and a cranial laparotomy were performed. IV and oral supplementation of calcium led to a full recovery and improvement in the kitten's walking. A histopathological analysis revealed pulmonary emphysema associated with hypoplastic and irregular bronchial cartilage. Congenital lobar emphysema is a rare disease in both humans and animals. This is the first veterinary report describing a kitten affected by congenital lobar emphysema combined with a hiatal hernia and additionally complicated by secondary nutritional hyperparathyroidism with a good long-term outcome.

Histologic grade has a higher-weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumours and overtly metastatic sentinel lymph nodes.

In canine cutaneous mast cell tumours (cMCTs), histologic grade and clinical stage are the most important prognostic factors, with high-grade tumours and metastatic lymph nodes (LNs) significantly influencing the evolution of disease. However, it is uncertain whether histologic grade and clinical stage should be given equal weighting value in patient prognostication and management. Dogs with low- and high-grade cMCTs and at least one overtly metastatic sentinel LN undergoing standardized treatment, consisting of surgical excision of the cMCT, lymphadenectomy and chemotherapy, were retrospectively included. The aim was to determine whether, at the same clinical stage, histologic grade retained prognostic relevance. Sixty dogs were included: 26 had a high-grade cMCT tumour and 34 had a low-grade cMCT. Median follow-up was 367 days (range, 187-748) in the high-grade group, and 1208 days (range, 180-2576) in the low-grade group. Median time to progression was significantly shorter in the high-grade group than in the low-grade group (214 days versus not reached; p < .001), as well as tumour-specific survival (545 days versus not reached; p < .001). On multivariable analysis, a high histologic grade and incomplete margins retained prognostic significance for both tumour progression and tumour-specific death. In dogs with cMCT and at least one overtly metastatic LN undergoing multimodal treatment, histologic grade significantly correlated with outcome. Overall prognosis was not unfavourable, even in the high-grade group, further supporting that a multimodal therapeutic approach, addressing primary tumour and sentinel LN, should be offered. Whether chemotherapy should be incorporated in the therapeutic planning of low-grade cMCTs remains to be defined.

Disseminated aspergillosis in a German shepherd mixed breed dog with unusual initial localization to the iliac wing.

A female, 1.5 years old, mixed­breed dog, was presented for left hind limb lameness. Radiographs revealed an irregular periosteal proliferation on the left iliac wing. The clinical condition worsened with generalised enlargement of the lymph nodes, azotaemia, and pyelonephritis. The magnetic resonance imaging of the pelvis and a surgical biopsy diagnosed a mycotic myositis and osteomyelitis of the iliac wing and gluteal muscles. Aspergillus terreus was isolated from culture of urine and lymph nodes aspirates. The antifungal susceptibility test showed moderate sensitivity to Itraconazole. After one month of therapy with itraconazole, the dog presented discospondylitis of L1­L2 and partial ureteral obstruction due to mycotic bezoar that was resolved with medical treatment and itraconazole dose elevation. After twelve months, itraconazole was suspended; a severe osteomyelitis of the left femur developed, and the dog was euthanised. The necropsy confirmed the presence of mycotic osteomyelitis of the iliac wing and femur, discospondylitis, lymphadenitis and severe granulomatous pyelonephritis. Systemic aspergillosis has rarely been reported in the literature, especially in Italy. The pelvic bone involvement is rare both in dogs and humans. Although itraconazole treatment allowed remission of the clinical signs for one year, it was not able to cure the dog.

Sleeping Beauty: Anesthesia May Promote Relapse in Dogs With Diffuse Large B-Cell Lymphoma in Complete Remission After Chemo-Immunotherapy.

Surgery-induced stress and anesthesia-related immunosuppression are believed to play a critical role in human oncology patients. Studies have hypothesized that anesthesia influences patients' outcome, promoting tumor recurrence and metastasis. Aim of the study was to investigate whether anesthesia promoted relapse in dogs with diffuse large B-cell lymphoma (DLBCL). Medical records were searched for dogs with DLBCL, that were in complete remission (CR) after the same chemo-immunotherapy protocol. Dogs receiving anesthesia were included if the procedure was performed while in CR. Time to relapse (TTR) was obtained via Kaplan-Meier method. Association between anesthesia and relapse was assessed using a nested case-control design and estimated using conditional logistic regression. Sixty-one dogs with DLBCL were included. Overall median TTR was 329 days (95% CI, 281-377). Forty-eight (79%) dogs relapsed during the study period, while 13 (21%) were still in CR at data analysis closure. Eighteen (30%) dogs received anesthesia with opioids, propofol, and isoflurane or sevoflurane. The relative risk of lymphoma relapse for dogs undergoing anesthesia was significantly higher compared with dogs not undergoing anesthesia, with an odds ratio of 3.09 (P = 0.019) on multivariable analysis. Anesthesia may promote relapse in dogs with DLBCL treated with chemo-immunotherapy, although a role of perioperative stress cannot be ultimately excluded. Considering the high frequency of anesthetic procedures required for diagnostic and therapeutic protocols among oncology patients, it is of utmost interest to characterize the effects of single anesthetic agents on the immune system. Further prospective studies are needed to better define the impact of anesthesia on patients' outcome.

The use of small-bore wire-guided chest drains for the management of feline pyothorax: A retrospective case series.

Background: Pyothorax in cats is routinely managed, at least initially, with thoracic tube placement associated with systemic antimicrobial administration. Traditionally, large-bore trocar-type thoracostomy tubes have preferentially been used for the drainage of thick material from the pleural space. In recent years, the use of small-bore wire-guided thoracic drains has increased in both small animals and in humans. Few studies have highlighted the efficacy of small-bore wire-guided thoracostomy tubes. Aim: The purpose of this study was to describe the use of small-bore wire-guided thoracostomy tubes in feline pyothorax in terms of efficacy, safety, and outcome. Methods: Cats with pyothorax managed with small-bore thoracostomy tubes (SBTTs) (2015-2018) were retrospectively studied. The number of drains inserted, the need for anesthesia and analgesia for chest tube placement and maintenance, and related major and minor complications were reviewed. Clinical data, diagnostic results, treatment, and outcome were recorded. Results: Ten cats were enrolled. Thoracostomy tube placement was unilateral in 7/10 cats, despite the presence of bilateral effusion in 9/10 cats, and required sedation (8/10) or anesthesia (2/10). Three cats experienced minor complications during the chest tube insertion, including self-limiting pneumothorax (1/3) and malpositioning (2/3). One cat had a major complication (non-functional malposition) requiring reposition of the drain. Pain management was adequately achieved using opioids (8/10) or opioids plus nonsteroidal anti-inflammatory drugs (2/10). Partial chest tube occlusion occurred in three cases and it was resolved with lavage. In one case, the occlusion was complete, requiring drain removal. Three out of 10 cats were treated medically, combining thoracostomy tubes and antibiotics, while 7/10 cats underwent surgery. All the cats survived. Conclusion: SBTTs represent a safe and effective option for the initial management of feline pyothorax. In fact, mainly minor complications were reported during insertion and usage. The SBTTs were well tolerated by the cats with a satisfactory performance in terms of exudate drainage in most cases. The combined use of a small-bore thoracostomy drain together with the common practice of surgical treatment might have resulted in the successful management of the cases presented.

Kidney-Sparing Surgery for Renal Subcapsular Abscess Caused by Staphylococcus pseudintermedius in a Dog.

An 11 yr old male Drahthaar dog was presented for dysuria, pollakiuria, and history of uroliths. Abdominal ultrasound revealed a subcapsular fluid-filled lesion of the left kidney, suspected cholecystitis, and a splenic infarct. The renal lesion was fully drained and cytology of the renal subcapsular and perirenal fluids revealed septic exudate. Bacterial culture of the urine, bile, and perirenal and subcapsular fluids were all positive for Staphylococcus pseudintermedius. Antimicrobial therapy was instituted based on culture sensitivity. After 7 days the dog re-presented for vomiting and abdominal pain, and a focal intestinal injury was suspected based on abdominal ultrasound. Enterectomy of an ischemic jejunal loop, a partial splenectomy, and excision of the left renal subcapsular abscess were performed. The renal parenchyma was left intact. Histopathology confirmed the diagnosis of a renal subcapsular abscess, intestinal infarction, and focal pyogranulomatous splenitis. Cholecystitis was confirmed by bile cytology and culture. No major complications and no recurrences were encountered at 1 yr follow-up. This is the first report of a renal subcapsular abscess in the dog, with septic complications, and treated with a kidney-sparing surgery.

Deep Vegetal Foreign Bodies in Cats: A Retrospective Study of 10 Cases.

The aim of this study was to describe the anatomic locations and treatments available for deeply located vegetal foreign bodies in cats. Ten cases of migrating vegetal foreign bodies (vFBs) requiring surgical removal are reported. The diagnoses of vFBs in the thoracic cavity (4/10), retroperitoneal space (2/10), and paratracheal region (1/10) were obtained by ultrasound examination; however, in the perineum or penile urethra (2/10) and peritoneum (1/10), the vFBs were found during surgery. Intraoperative ultrasound guidance helped remove vFBs from the retroperitoneal space and paratracheal tissues. Clinical signs resolved in 8 out of 10 cases, 1 out of 10 cases had recurrent draining fistula, and 1 out of 10 was euthanized for ethical reasons. The intrathoracic was the most common location in the present study, followed by retroperitoneal space and urethra/perineum. Ultrasound guidance was essential for the diagnosis and/or treatment of vFBs located in the thoracic, retroperitoneal, and cervical regions.

Prognostic value of canine pancreatic lipase immunoreactivity and lipase activity in dogs with gastric dilatation-volvulus.

This study evaluated the association between a selection of candidate predictor variables, including the elevation of specific pancreatic enzymes, and outcome in dogs with gastric dilatation-volvulus (GDV). Twenty-two dogs with gastric dilatation-volvulus were included, being classified as survivors or non-survivors based on the final outcome. Dogs with intestinal obstruction (n = 16) were selected for comparison. Blood samples were collected upon admission (T0) and after 24 hours (T1). Serum lipase activity, canine pancreatic lipase immunoreactivity (cPLI) and other variables (plasma lactate concentration and C- reactive protein -CRP- in particular) were evaluated as predictive variables. T0 cPLI and serum lipase activity were not found to differ significantly between dogs with gastric dilatation-volvulus or intestinal obstruction. Canine pancreatic lipase immunoreactivity values above 400 µg/L were detected in 6/22 dogs with gastric dilatation-volvulus and 4/16 with intestinal obstruction. However, lactate concentration was significantly higher and CRP significantly lower in GDV as compared to IO dogs, and in the GDV group, lipase, cPLI and CRP measured upon admission were significantly associated with a negative outcome. No differences in lipase activity and canine pancreatic lipase immunoreactivity values were detected between T0 and T1. Presurgical cPLI and lipase activity were frequently increased during gastric dilatation-volvulus and were suggestive of the presence of pancreatic damage; while more extensive studies are required, based on this pilot analysis, cPLI has the potential to be a useful predictive variable for outcome in GDV. Further to this, serum CRP was able to predict outcome in this population of dogs with GDV, while blood lactate was not.