Comparison of two postoperative complication grading systems after treatment of stifle and shoulder instability in 68 dogs.

OBJECTIVE: (1) To adapt and apply the Clavien-Dindo (aCD) postoperative complication grading system to dogs experiencing complications following a single orthopedic procedure. (2) To compare the reliability of the Clavien-Dindo system to the Cook complication grading system. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Sixty-eight client-owned dogs. METHODS: Scenarios derived from complications following TightRope stabilization of the stifle and shoulder were graded by four ACVS-boarded surgeons using two systems; the Cook 3-point scale and the aCD 5-point scale. Because the aCD system distinguishes complications from outcomes ("sequelae" or "failure to cure"), two data sets were created: one with (n = 76) and without (n = 67) inclusion of "sequelae" and "failure to cure" cases. Interobserver reliability was evaluated using intraclass correlation coefficient (ICC) calculations. RESULTS: Seventy-six scenarios from 68 records were evaluated. The ICC of the aCD system was 0.620 consistent with moderate reliability. The reliability of the Cook system was good, with an ICC of 0.848. Exclusion of cases with "sequelae" or "failure to cure" resulted in excellent reliability of the aCD system (ICC = 0.975) and good reliability of the Cook systems (ICC = 0.857). CONCLUSION: The aCD grading system was less reliable than the Cook system when evaluating all cases but more reliable when evaluating cases of complications excluding "sequelae" and "failures to cure". CLINICAL SIGNIFICANCE: The Cook grading system is reliably good in grading postoperative complications in dogs. The aCD system can also be used to assess postoperative complications with excellent reliability but is less reliable when distinguishing complications from other postoperative outcomes.

Axillary lymphadenectomy in dogs: A description of surgical technique.

The axillary lymph center drains a large area; however, axillary lymphadenectomy is rarely reported in series detailing lymph node extirpation in dogs. No surgical technique has yet been described for axillary and superficial axillary lymphadenectomy. This study describes a technique for excision of nodes in the axillary lymph center of the dog. Two male neutered and two male intact cadavers weighing between 6.3 and 36.1 kg were used. With cadavers in dorsal recumbency and the shoulder extended, an incision was made in the caudal axillary region. Blunt dissection was used to separate the pectoralis profundus and latissimus dorsi muscles and loose connective tissue was dissected until the axillary lymph node was identified caudal to the brachial vein. The axillary lymphatic trunk was followed caudad from the axillary lymph node to identify the accessory axillary lymph node, deep to the lateral border of the pectoralis profundus muscle, for subsequent extirpation. Axillary lymph nodes were successfully removed in all axillae, and accessory axillary lymph nodes were located in 6/7 axillae and could not be visualized within the axillary lymphatic trunk in the remaining axilla. The described surgical technique allowed consistent identification of the axillary lymph node and the lymphatic trunk associated with the accessory axillary lymph node. This technique description provides a guide for surgeons to facilitate axillary and accessory axillary lymphadenectomy in the dog. While anatomic variation must be considered, the use of the axillary lymphatic trunk as a landmark may simplify identification of the small and inconsistent accessory axillary lymph node.

A Pilot Study of Cancer-Induced Bone Pain Using Validated Owner Questionnaires, Serum N-Telopeptide Concentration, Kinetic Analysis, and PET/CT.

Cancer-induced bone pain, despite its frequency and severity, is a poorly understood phenomenon in people and animals. Despite excitement regarding translational osteosarcoma studies, there is a lack of attention toward examining cancer pain in dogs. In this pilot study, we used a multimodal pain assessment methodology to evaluate pain relief after therapeutic intervention in dogs with primary bone cancer. We hypothesized that intervention would cause objective evidence of pain relief. Evaluations of 8 dogs with primary bone cancer included 18F-FDG PET/CT scans, kinetic analysis, validated owner questionnaires (Canine Brief Pain Inventory, canine BPI), and serum N-telopeptide (NTx) concentration. Dogs were routinely staged and had 18F-FDG PET/CT scans prior to treatment with day 0, 7, 14, and 28 canine BPI, serum NTx, orthopedic exam, and kinetic analysis. Dogs treated with zoledronate and radiation underwent day 28 18F-FDG PET scans. All clinical trial work was approved by the University of Missouri IACUC. Four dogs underwent amputation (AMP) for their appendicular bone tumors; four received neoadjuvant zoledronate and hypofractionated radiation therapy (ZOL+RT). Canine BPI revealed significant improvements in pain severity and pain interference scores compared to baseline for all dogs. Positive changes in peak vertical force (+16.7%) and vertical impulse (+29.1%) were noted at day 28 in ZOL+RT dogs. Dogs receiving ZOL+RT had a significant (at least 30%) reduction in serum NTx from baseline compared to amputated dogs (p = 0.029). SUVmax (p = 0.11) and intensity (p = 0.013) values from PET scans decreased while tumor uniformity (p = 0.017) significantly increased in ZOL+RT-treated tumors; gross tumor volume did not change (p = 0.78). Owner questionnaires, kinetic analysis, and 18F-FDG PET/CT scans showed improved pain relief in dogs receiving ZOL+RT. Serum NTx levels likely do not directly measure pain, but rather the degree of systemic osteoclastic activity. Larger, prospective studies are warranted to identify the ideal objective indicator of pain relief; however, use of multiple assessors is presumably best. With improved assessment of pain severity and relief in dogs with cancer, we can better evaluate the efficacy of our interventions. This could directly benefit people with cancer pain, potentially decreasing the amount of subtherapeutic novel drugs entering human clinical trials.

Radiographic determination of normal canine femoral alignment in the sagittal plane: A cadaveric pilot study.

OBJECTIVE: To establish a reliable methodology for radiographic determination of alignment of the normal canine femur in the sagittal plane. STUDY DESIGN: Cadaveric pilot study. SAMPLE POPULATION: Twenty-nine cadaveric canine femurs. METHODS: Femoral specimens were collected from the University of Missouri veterinary anatomy laboratory, and standardized sagittal plane radiographs were obtained. The anatomic and mechanical axes, joint orientation, lines and joint orientation angles were determined in the sagittal plane by using the center of rotation of angulation methodology. Landmarks were clearly described to allow repeatability and reliability of measurements. Three observers with various degrees of experience measured two centers of rotation of normal angulation, the anatomic caudoproximal femoral angle, and the mechanical caudodistal femoral angle for all femurs on three separate days. Interobserver and intraobserver reliability were measured by using two-way mixed intraclass correlation coefficients (ICC) with associated 95% CI. RESULTS: Twenty-nine medium to large breed canine femora were measured. A high degree of correlation was present both among and between observers for all measurements performed, as defined by an ICC >0.8 for each. CONCLUSION: The described methodology was reliable and repeatable for measurement of angulation of grossly normal canine femora in the sagittal plane when performed by observers with varying degrees of clinical experience, as evidenced by a high degree of correlation for all values measured. CLINICAL SIGNIFICANCE: This methodology may be used for standardized evaluation of alignment of canine femora in the sagittal plane.