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Determining the risk of pathologic fracture in dogs with a primary bone tumor would aid in case selection for in-situ treatment options. Prior research found strong relationships between in vitro strength of canine antebrachii with primary bone tumors and CT-derived metrics. This study assesses the prognosis for pathologic fracture in dogs with distal radial bone tumors using CT-derived structural analysis metrics. CT images of the antebrachium in dogs with aggressive osseous lesions of the radius were used to calculate structural rigidity and failure forces, including axial rigidity (AR), craniocaudal bending rigidity (BR), torsional rigidity (TR), and failure forces for a slightly-curved/asymmetric beam (Fs) or a curved beam (Fc). Metrics were compared with the clinical outcome of radial fracture. Eight of 19 dogs with CT-derived metrics developed a radial fracture. The prognostic potential of the metrics to discriminate fractured and nonfractured bones was analyzed using receiver operating characteristic curves (area under the curve), stepwise logistic regression, and classification regression (CART) analyses. Fc was the most sensitive and specific metric for prognosing fracture occurrence (AUC = 0.864). When dog body weight (BW) was included, all five metrics had AUC > 0.705. Fc was the best predictor of fracture using stepwise logistic regression and CART analysis, followed by BR. An indication of fracture probability can be determined by normalizing Fc or BR with dog BW or by using the logistic regression equation of either metric with dog BW. Results warrant further analysis of a larger cohort to evaluate fracture likelihood in dogs with antebrachial bone neoplasia.
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OBJECTIVE: To report the complications and outcomes associated with thoracoscopic cranial mediastinal mass resection in dogs. ANIMALS: 49 client-owned dogs that underwent thoracoscopic cranial mediastinal mass removal. METHODS: This was a retrospective cohort study (January 1, 2014, to July 31, 2023), and the medical records of 49 client-owned dogs that underwent thoracoscopic cranial mediastinal mass removal were reviewed. The signalment, history, clinicopathologic features, perioperative complications, and long-term outcome were recorded. RESULTS: Preoperative myasthenia gravis (MG) and megaesophagus (ME) were identified in 17 of 49 (35%) dogs and 11 of 49 (22%) dogs, respectively. The median maximal tumor diameter on CT images was 4.7 cm (range, 2.7 to 8.5 cm). Nonemergent conversion to an open procedure was necessary in 4 of 49 (8%) dogs, and dogs with conversion to an open procedure had a significantly larger median maximal CT tumor diameter than dogs without conversion (P = .03). The most common tumor type was thymoma (37/49 [76%]). The overall median survival time for dogs with thymoma was 1,102 days (95% CI, 482 to upper bound not reached). The median survival time for dogs with thymoma and concurrent presurgical MG was 182 days (95% CI, 14 to upper bound not reached). Presurgical diagnosis of MG (P = .44) or ME (P = .69) was not associated with survival time. CLINICAL RELEVANCE: Thoracoscopic removal of cranial mediastinal masses was associated with low conversion and complication rates. Long-term survival is possible, and thoracoscopic removal should be considered for select cases.
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OBJECTIVE: To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Large breed (25-40 kg) cadaver dogs (n = 10). METHODS: Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS: Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS: Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE: Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
Subject(s)
Cadaver , Lymph Node Excision , Mediastinoscopy , Mediastinum , Animals , Dogs , Mediastinoscopy/veterinary , Mediastinoscopy/methods , Lymph Node Excision/veterinary , Lymph Node Excision/methods , Mediastinum/surgery , Lymph Nodes/surgery , Lymph Nodes/anatomy & histologyABSTRACT
OBJECTIVE: To report the clinical characteristics, treatments, and outcomes in a cohort of dogs with histologically confirmed retroperitoneal sarcoma (RPS) and to identify potential variables of prognostic significance. ANIMALS: 46 client-owned dogs from 10 clinics with histopathologic diagnosis of a sarcoma originating from the retroperitoneal space. METHODS: Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed to report descriptive data for all cases and overall survival time. Multivariate analysis was utilized to evaluate prognostic factors for overall survival. RESULTS: Hemangiosarcoma was the most common histologic subtype diagnosed (76.1%). Cytoreductive and curative intent surgical excision of the RPS was attempted in 12 and 22 dogs, respectively; 12 dogs underwent no surgery or had an exploratory laparotomy with incisional biopsy only. Nineteen dogs received adjuvant chemotherapy, either injectable or metronomic, and 1 dog received adjuvant radiation therapy. Fourteen of the 34 (41.2%) surgically treated dogs developed evidence of local recurrence, but there was no difference in local recurrence when comparing dogs categorized as curative intent versus cytoreductive surgery. The median overall survival time was 238 days. On multivariable analysis, treatment approach was associated with survival with surgical excision (vs palliative treatment) and adjuvant chemotherapy following surgery being protective against death. A diagnosis of hemangiosarcoma was associated with a greater hazard of death. CLINICAL RELEVANCE: This study demonstrates a substantially greater survival time than previously published and suggests a survival benefit from surgical excision and adjuvant chemotherapy.
Subject(s)
Dog Diseases , Retroperitoneal Neoplasms , Sarcoma , Animals , Dogs , Dog Diseases/therapy , Dog Diseases/mortality , Dog Diseases/surgery , Dog Diseases/pathology , Sarcoma/veterinary , Sarcoma/therapy , Sarcoma/mortality , Sarcoma/surgery , Retroperitoneal Neoplasms/veterinary , Retroperitoneal Neoplasms/mortality , Retroperitoneal Neoplasms/surgery , Retroperitoneal Neoplasms/therapy , Retroperitoneal Neoplasms/pathology , Male , Female , Retrospective Studies , Treatment Outcome , Survival Analysis , Cohort Studies , Hemangiosarcoma/veterinary , Hemangiosarcoma/mortality , Hemangiosarcoma/therapy , Hemangiosarcoma/surgery , Hemangiosarcoma/pathologyABSTRACT
OBJECTIVE: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity. ANIMALS: 255 client-owned dogs. METHODS: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time. RESULTS: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence. CLINICAL RELEVANCE: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.
Subject(s)
Adrenal Gland Neoplasms , Dog Diseases , Laparoscopy , Humans , Dogs , Animals , Adrenalectomy/veterinary , Laparoscopy/veterinary , Retrospective Studies , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/veterinary , Adrenal Gland Neoplasms/surgery , Adrenal Gland Neoplasms/veterinary , Adrenal Gland Neoplasms/pathology , Dog Diseases/surgeryABSTRACT
Background: Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor. Objectives and procedures: This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors. Results: Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians. Conclusion and clinical relevance: Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.
Un examen narratif des horaires de travail qui ont un impact sur la fatigue et la récupération en rapport avec le bien-être des vétérinaires. Mise en contexte: L'insuffisance de sommeil est une affection mondiale avec de graves implications pour la santé mentale et physique. Les facteurs liés à l'emploi jouent un rôle important dans la détermination des habitudes de sommeil. Les travailleurs de la santé sont particulièrement sensibles à l'insuffisance de sommeil liée au travail et au repos inadéquat en général. Il y a peu de publications sur les pratiques de sommeil chez les vétérinaires, et la reconnaissance globale des impacts d'un repos inadéquat au sein de la profession vétérinaire est faible. Objectifs et procédures: Cette revue décrit les facteurs professionnels affectant la quantité suffisante de repos et de la récupération, passe en revue la littérature spécifique aux vétérinaires ainsi que celle adjacente pertinente concernant les habitudes de sommeil, et discute des solutions potentielles pour traiter les horaires professionnels contribuant à l'insuffisance de sommeil et au repos inadéquat. Des bases de données en ligne ont été consultées pour extraire la littérature contemporaine relative au sommeil, au repos insuffisant et aux facteurs liés à l'emploi, en mettant l'accent sur la médecine vétérinaire et d'autres secteurs de la santé. Résultats: Les facteurs liés à l'emploi entraînant un repos insuffisant chez les travailleurs de la santé comprennent les charges de travail excessives, les journées de travail prolongées, les jours cumulés d'heures de travail pénibles et les gardes après les heures normales de travail. Ces facteurs sont répandus au sein de la profession vétérinaire et peuvent contribuer à un repos insuffisant généralisé et aux impacts négatifs qui en résultent sur la santé et le bien-être des vétérinaires. Conclusion et pertinence clinique: Une quantité et une qualité de sommeil suffisantes sont essentielles à la santé physique et mentale et sont négativement affectées par de nombreux aspects de la profession vétérinaire. L'examen critique des stratégies actuelles utilisées dans la pratique clinique est essentiel pour promouvoir l'épanouissement professionnel, la santé et le bien-être des vétérinaires.(Traduit par Dr Serge Messier).
Subject(s)
Sleep Deprivation , Veterinarians , Humans , Fatigue/veterinary , Mental Health , Sleep Deprivation/veterinaryABSTRACT
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.
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Background: Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue. Objectives and procedures: This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years. Results: The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health. Conclusion and clinical relevance: Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health.
Un examen narratif de la physiopathologie et des impacts d'un sommeil insuffisant et perturbé. Contexte: Malgré les ramifications importantes d'un manque de sommeil sur la santé mentale et physique et le bien-être général, de nombreuses personnes ignorent ce qui constitue un sommeil suffisant ou l'étendue à court et à long terme des effets du manque de sommeil, y compris ceux qui peuvent ne pas être perçus comme de la fatigue. Objectifs et procédures: Cette revue décrit la physiologie du sommeil, définit des normes de santé, passe en revue la physiopathologie et les risques pour la santé de l'insuffisance de sommeil aiguë et chronique et propose des concepts pour améliorer l'hygiène individuelle du sommeil. Des bases de données en ligne ont été consultées pour extraire la littérature relative au sommeil, à l'insuffisance de sommeil, à la fatigue et à la santé, en mettant l'accent sur la littérature publiée au cours des 5 années précédentes. Résultats: Les effets néfastes de la perte de sommeil aiguë et chronique varient dans leur portée et leur impact. Les individus obtiennent souvent une quantité de sommeil inférieure aux normes, un problème mal reconnu par les individus et la société. Ce manque de reconnaissance perpétue une culture dans laquelle l'insuffisance de sommeil est acceptée, entraînant des impacts négatifs graves et substantiels sur la santé mentale et physique. Conclusion et pertinence clinique: La gestion du sommeil est l'un des aspects les plus fondamentaux et les plus imprévisibles de la santé personnelle. Améliorer la prise de conscience des rôles physiologiques importants du sommeil, des habitudes de sommeil saines et des conséquences d'un sommeil insuffisant est essentiel pour promouvoir le bien-être général et la santé mentale et physique.(Traduit par Dr Serge Messier).
Subject(s)
Health Status , Sleep Deprivation , Animals , Sleep Deprivation/veterinary , Fatigue/veterinary , SleepABSTRACT
OBJECTIVE: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN: Narrative review. METHODS: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.
Subject(s)
Sleep Deprivation , Surgery, Veterinary , Work Performance , Humans , Fatigue , Narration , Risk Management , Sleep Deprivation/psychology , Surgery, Veterinary/organization & administration , Work Performance/statistics & numerical data , Work Schedule Tolerance , WorkloadABSTRACT
Objectives: To describe the diagnostic techniques, surgical treatments, and outcomes of two cats with recurrent pleural transudate caused by urinary ultrafiltrate. Animals: Two cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts that were evaluated and treated for recurrent pleural transudate caused by urinary ultrafiltrate. Study design: Short case series. Methods: Multiphase contrast CT scan revealed leakage of contrast media from the kidneys bilaterally into the retroperitoneal spaces in both cats. Renal scintigraphy performed in one cat revealed progressive accumulation of 99mTc diethylenetriamine penta-acetic acid (Tc-DTPA) in the pleural space. Exploratory laparotomy localized the leakage of fluid to renal capsular defects bilaterally in both cats. The retroperitoneum was incised bilaterally to promote fluid drainage into the peritoneum, and nephropexies were performed. Results: One cat had long-term survival with recurrent, though decreasing volumes of, pleural effusion. The second cat was euthanized 16 days postoperatively for progressive renal disease. Conclusion: The diagnosis of spontaneous urinary ultrafiltrate accumulation in the pleural space of cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts has not previously been reported. The surgical correction described reduced but did not completely eliminate the rate of pleural effusion accumulation.
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Sex steroids regulate bone metabolism directly and indirectly through receptors on bone. Estrogen receptors (ER-â, ER-ß), progesterone receptor (PR), and androgen receptor (AR), have been previously identified on human osteosarcoma (OSA) cells, and are considered to influence tumor growth, but their expression and role in canine OSA is unknown. The aim of this study was to characterize sex hormone receptor expression levels in naturally occurring OSA tissue and in three canine OSA cell lines. The expression of ER-α, ER-ß, PR, and AR was investigated using RT-PCR. PR expression levels were also quantified in OSA cells cultured under hypoxic conditions or in the presence of estradiol. The effects of progesterone on cell proliferation were quantified. Results demonstrated varying expression levels of these receptors in five OSA subtypes. OSA cell lines demonstrated high gene expression levels of PR and low gene expression levels of ER-α and ER-ß and no gene expression of AR. PR expression was increased in OSA cells cultured under hypoxic conditions in a HIF-â independent manner. Interestingly, one cell line expressed very high levels of PR, expression of which decreased in response to estradiol. In addition, progesterone decreased OSA cell proliferation in this particular cell line. Further investigation of the role of sex steroids, particularly PR and its ligands, in regulation of canine OSA is recommended.
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OBJECTIVE: To describe and compare onset and intensity of thoracic duct (TD) coloration in healthy dogs after intrahepatic injection of either indocyanine green (ICG) visualized by intraoperative near-infrared fluorescence lymphography (NIRFL) or direct thoracoscopic visualization of methylene blue dye (MB). STUDY DESIGN: Prospective study. ANIMALS: Healthy adult Beagle dogs (n = 5). METHODS: All dogs had biochemical panels and complete blood counts preoperatively. Computed tomography lymphography (CTL) was performed prior to a standard 3-port thoracoscopic approach. A mixture of MB and ICG was injected by ultrasound-guided percutaneous injection into right or left-sided hepatic lobes. Data collected included dose of contrast agent (MB vs. ICG), injection site, timing, and quality of operative TD identification. Potential hepatic injury was assessed by repeat laboratory evaluation and abdominal ultrasound 14 days postoperatively. RESULTS: Preoperative CTL provided a diagnostic study in 5/5 dogs. After intrahepatic injection of combined dyes, NIRFL allowed visualization of TDs in 5/5 dogs, but MB did not result in visible TD coloration in any dog. Intrahepatic injection of ICG achieved successful NIRFL in a median time of 6 minutes and persisted for the 20 minute observation period in all five dogs. All dogs recovered without complication and were subsequently adopted. CONCLUSION: NIRFL of the TD can be achieved with intraoperative hepatic injection of ICG. Intrahepatic injection of MB did not result in visible TD coloration. CLINICAL SIGNIFICANCE: Hepatic intra-parenchymal injection is a reliable alternative portal into the TD system for intraoperative visualization of TD anatomy using ICG in dogs.
Subject(s)
Indocyanine Green , Thoracic Duct , Animals , Coloring Agents , Dogs , Methylene Blue , Prospective Studies , Thoracic Duct/surgery , Ultrasonography, Interventional/veterinaryABSTRACT
BACKGROUND: Limited information currently exists regarding the clinical progression and outcomes of cats that undergo choledochal stenting as a treatment for extrahepatic biliary obstruction (EHBO). HYPOTHESIS/OBJECTIVES: Describe clinical characteristics, indications for choledochal stent placement, procedure, and outcomes in a cohort of cats undergoing choledochal stenting and evaluate risk factors associated with survival as well as recurrence of EHBO in affected cats. ANIMALS: Twenty-three client-owned cats undergoing choledochal stent placement. METHODS: Retrospective study. Medical records from 6 academic institutions were reviewed, and data were extracted and analyzed statistically. RESULTS: Median age of cats was 10.1 years (range, 2-16), and all cats had at least 2 clinical signs. Most common clinical signs were vomiting in 20/22 (90.9%), inappetence in 19/22 (86.4%), and lethargy in 19/23 (82.6%). Procedural complications were uncommon and rarely related to the stenting procedure. Clinical signs improved postoperatively in 15/20 (75.0%) cats and serum total bilirubin concentration decreased postoperatively in 13/19 (68.4%) cats. Eighteen (78.3%) cats survived to discharge. Recurrence of EHBO was documented in 7/18 (38.9%) cats that survived to discharge. Cholelithiasis was associated with recurrence of EHBO. Median survival time for cats that survived to discharge was 931 days (range, 19-3034). Absence of peritoneal effusion was associated with survival to discharge. CONCLUSIONS AND CLINICAL IMPORTANCE: Choledochal stenting was an effective treatment modality in cats with EHBO with few procedural complications and potential for prolonged survival, but substantial risk for recurrence of EHBO was identified.
Subject(s)
Cat Diseases , Cholestasis, Extrahepatic , Animals , Cat Diseases/surgery , Cats , Cholestasis, Extrahepatic/surgery , Cholestasis, Extrahepatic/veterinary , Retrospective Studies , Stents/veterinary , Treatment OutcomeABSTRACT
CASE SUMMARY: An 8-year-old neutered male indoor cat was presented for evaluation of a year-long history of swelling over the bridge of the nose that extended from the subcutaneous tissue of the right upper eyelid to the dorsum of the skull. Intermittent regression of the mass lesion was reported with antibiotic or corticosteroid therapy; however, progressive swelling, malaise and hiding behavior persisted. CT revealed an aggressive osteolytic mass lesion in the right and left nasal cavities and extending into the frontal sinuses. Rhinoscopy using a 2.8 mm rigid telescope revealed somewhat normal-appearing turbinates rostrally and ventrally on the left side, with turbinate destruction on the right. After obtaining a biopsy from the right side of the nasal cavity, thick material filling the entire nasal cavity was visible caudally and was extracted endoscopically from a rostral approach. Surgical biopsy of the dorsal nasal bridge resulted in protrusion of inspissated material from the incision site. Rhinoscopic exploration revealed that the material extended into both frontal sinuses. Following extensive debridement and medical therapy, marked resolution of facial asymmetry was achieved. RELEVANCE AND NOVEL INFORMATION: Facial distortion is often considered suggestive of a neoplastic process; however, it can also be seen with fungal and mycobacterial infections, and, in this case, an inflammatory condition of unknown etiology. In this cat, aggressive intervention and debridement of necrotic debris resulted in substantial bony remodeling of the skull and return to normal activity levels.
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OBJECTIVE: To describe academic rank, gender, surgical career length, and publication record of academic veterinary surgeons and to estimate the association between gender and higher academic rank. STUDY DESIGN: Cross-sectional study. SAMPLE: Residency-trained surgeons at US veterinary schools in 2019. METHODS: Surgeons were identified via institutional websites. Data including surgeon gender, academic title, and year of board certification were collected from public resources. Publication record was measured by using author h-indices obtained from Scopus. Data were analyzed with descriptive and inferential statistics. RESULTS: Three hundred eighteen surgeons were identified from 30 institutions, including 162 (51%) women and 156 (49%) men. Women represented 66% of instructors and assistant professors, and men represented 60% of associate and full professors. This distribution differed significantly (P < .001). Author h-index was associated with career length but not gender. Men were 2.5 times more likely than women to be associate or full professors (odds ratio 2.52, 95% CI 1.03-6.14, P = .042) after adjustment for career length and h-index. CONCLUSION: Female surgery faculty at US veterinary schools in 2019 were concentrated in lower academic ranks and were less likely than male surgery faculty to be associate or full professors after adjustment for career length and publication record. IMPACT: A gender gap exists in academic veterinary surgery in the United States. It is critical to recognize that women's increasing participation in veterinary medicine has not been matched by equal representation in all areas. Additional efforts are warranted to identify contributing factors and implement strategies to improve gender inclusion.
Subject(s)
Academic Performance , Faculty, Medical/statistics & numerical data , Schools, Veterinary/statistics & numerical data , Sex Factors , Surgeons/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , United StatesABSTRACT
BACKGROUND: Lower urinary tract transitional cell carcinoma (TCC) is an important but rarely described disease of cats. OBJECTIVES: To report the clinical characteristics, treatments, and outcomes in a cohort of cats with lower urinary tract TCC and to test identified variables for prognostic relevance. ANIMALS: One-hundred eighteen client-owned cats with lower urinary tract carcinoma. METHODS: Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed statistically. RESULTS: Median age of affected cats was 15 years (range, 5.0-20.8 years) and median duration of clinical signs was 30 days (range, 0-730 days). The trigone was the most common tumor location (32/118; 27.1%) as assessed by ultrasound examination, cystoscopy, or both. Treatment was carried out in 73 of 118 (61.9%) cats. Metastatic disease was documented in 25 of 118 (21.2%) cats. Median progression-free survival and survival time for all cats were 113 days (95% confidence interval [CI], 69-153) and 155 days (95% CI, 110-222), respectively. Survival increased significantly (P < .001) when comparing cats across the ordered treatment groups: no treatment, treatment without partial cystectomy, and treatment with partial cystectomy. Partial cystectomy (hazard ratio [HR], 0.31; 95% CI, 0.17-0.87) and treatment with nonsteroidal anti-inflammatory drugs (HR, 0.55; 95% CI, 0.33-0.93) were significantly associated with longer survival times. CONCLUSIONS AND CLINICAL IMPORTANCE: The results support treatment using partial cystectomy and NSAIDs in cats with TCC.
Subject(s)
Carcinoma, Transitional Cell/veterinary , Cat Diseases/pathology , Cystectomy/veterinary , Urinary Bladder Neoplasms/veterinary , Animals , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Carcinoma, Transitional Cell/therapy , Cat Diseases/therapy , Cats , Cohort Studies , Retrospective Studies , Treatment Outcome , Urinary Bladder Neoplasms/therapyABSTRACT
OBJECTIVE: To evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats. STUDY DESIGN: Systematic literature review. SAMPLE: English-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016. METHODS: CAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations. RESULTS: One hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions. CONCLUSION: Definitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies. CLINICAL SIGNIFICANCE: Lack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results.
Subject(s)
Cat Diseases/surgery , Dog Diseases/surgery , Neoplasms/veterinary , Postoperative Complications/veterinary , Adverse Drug Reaction Reporting Systems , Animals , Cats , Dogs , Neoplasms/surgery , Research Design , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-seven client-owned dogs. METHODS: Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. RESULTS: At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty-six dogs had one or more lung lobes surgically removed. Thirty-seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty-five of 37 (94.6%) dogs survived to discharge. CONCLUSION: Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short- and long-term survival was excellent in this cohort. CLINICAL SIGNIFICANCE: Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.
Subject(s)
Dog Diseases/surgery , Foreign Bodies/veterinary , Foreign-Body Migration/veterinary , Lung Diseases/veterinary , Animals , Bronchoscopy , Dogs , Empyema, Pleural/surgery , Female , Foreign Bodies/complications , Foreign Bodies/surgery , Foreign-Body Migration/surgery , Lung Diseases/complications , Lung Diseases/surgery , Male , Pneumothorax/veterinary , Retrospective Studies , Tomography, X-Ray Computed/veterinary , Treatment OutcomeABSTRACT
OBJECTIVE: To describe surgical technique, biopsy sample quality, and short-term outcome of minimally invasive small intestinal exploration and targeted abdominal organ biopsy (MISIETB) with use of a wound retraction device (WRD) in dogs. ANIMALS: 27 client-owned dogs that underwent MISIETB with a WRD at 1 of 4 academic veterinary hospitals between January 1, 2010, and May 1, 2017. PROCEDURES: Medical records were retrospectively reviewed, and data collected included signalment; medical history; findings from physical, ultrasonographic, laparoscopic, cytologic, and histologic evaluations; surgical indications, procedures, duration, and complications; and short-term (14-day) outcomes. The Shapiro-Wilk test was used to evaluate the normality of continuous variables, and descriptive statistics were calculated for numeric variables. RESULTS: Laparoscopic exploration was performed through a multicannulated single port (n = 18), multiple ports (5), or a single 6-mm cannula (4). Median length of the incision for WRD placement was 4 cm (interquartile [25th to 75th percentile] range, 3 to 6 cm). All biopsy samples obtained had sufficient diagnostic quality. The 2 most common histologic diagnoses were lymphoplasmacytic enteritis (n = 14) and intestinal lymphoma (5). Twenty-five of 27 (93%) dogs survived to hospital discharge, and 3 (12%) dogs had postsurgical abnormalities unrelated to surgical technique. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that MISIETB with WRD was an effective method for obtaining diagnostic biopsy samples of the stomach, small intestine, pancreas, liver, and mesenteric lymph nodes in dogs. Prospective comparison between MISIETB with WRD and traditional laparotomy for abdominal organ biopsy in dogs is warranted.