Evaluating preoperative coagulation panels in dogs undergoing liver lobectomy for primary liver tumors: A multi-institutional retrospective study.

BACKGROUND: The objectives of this study were to: (i) Determine whether operable primary liver tumors were associated with prolongations in prothrombin time (PT) and activated partial thromboplastin time (aPTT) and (ii) determine if these secondary hemostatic abnormalities were more prevalent with specific liver tumors. STUDY DESIGN: Multi-institutional retrospective study. ANIMAL POPULATION: Dogs (n = 359) undergoing liver lobectomy for a primary liver tumor with a preoperative coagulation panel. METHODS: Data was identified via electronic medical record review at eight veterinary teaching hospitals. Baseline dog characteristics, coagulation panel values, platelet count, emergency versus non-emergency procedure, whether the dogs received transfusion(s) of a blood product, liver lobe removed, and histopathological diagnosis were extracted from the medical record. Chi-square analysis was used to compare categorical variables between groups. Continuous variables were assessed for normality using the Shapiro-Wilk test. RESULTS: A total of 74 of 359 dogs (20.6%) had a prolongation in either PT or aPTT preoperatively. A total of 20 of 359 dogs (5.6%) were found to have prolongation of both PT and aPTT. Hemangiosarcoma was the only histopathological diagnosis associated with concurrent prolongations of both PT and aPTT (p < .001) in 6/16 (37.5%) dogs. CONCLUSION: Coagulation panels including PT and aPTT are unlikely to detect substantial deficiencies in secondary hemostasis in most dogs with primary liver tumors except in dogs with a histopathological diagnosis of hemangiosarcoma. CLINICAL SIGNIFICANCE: PT and aPTT testing is low yield as an elective preoperative screening test in dogs with primary liver tumors except in dogs where there is a hemoabdomen or high suspicion for hepatic hemangiosarcoma.

Effect of hydrocolloid-nitric oxide wound dressings on wound healing in dogs.

OBJECTIVE: To determine the rates of wound healing in surgically created wounds between nitric oxide releasing wound dressings and control wound dressings. STUDY DESIGN: Prospective, controlled, randomized experimental study. ANIMALS: Purpose-bred, adult, male Beagles (n = 6). METHODS: Four 2 × 2 cm wounds were surgically created on the trunk of each dog with each wound randomized to treatment with a nitric oxide wound pad (NP), nitric oxide wound gel (NG), plain hydrocolloid wound dressing (HC), or Telfa pad (T). Wound images were taken daily for 8 days then every other day until day 21 with images masked and randomized for evaluation. Total wound area, contraction percentage, and days until granulation were calculated. RESULTS: Time to first appearance of granulation tissue was significantly shorter for NP (3.2 days) than for NG (4 days; p = .023), HC (4.5 days; p = .001), and T (5.2 days; p < .0001). There were significant differences in total wound area and contraction percentage between sites and treatments (p < .001). Total wound area for NG was lower than treatment T (0.7 ± 0.1 cm3; p < .001), HC (0.9 ± 0.1 cm3, p < .001), and NP (0.6 ± 0.1 cm3, p < .001). CONCLUSION: Use of a nitric oxide wound dressing resulted in faster wound healing as evidenced by lower total wound area and higher contraction in the NG group and faster time to granulation tissue development in the NP group. CLINICAL SIGNIFICANCE: Nitric oxide wound dressings are innovative and inexpensive products that can significantly decrease the amount of time and cost necessary for open or second intention wound resolution in dogs.

Anatomical classification of canine congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 1082 dogs.

Canine congenital extrahepatic portosystemic shunt (EHPSS) morphologies have not been fully elucidated. The goal of this retrospective, multi-institutional study was to use CT angiography to create an anatomical-based nomenclature system for canine congenital EHPSS. These shunt morphologies were then evaluated to identify any significant association with patient age, sex, breed, weight, or subjective portal perfusion score. Data collected respectively from the SVSTS and VIRIES list-serves included patient DOB, sex, breed, weight, CT date, and reported diagnosis. A single author (C.W.) viewed all CT scans and classified shunts based on the shunt portal vessel(s) of origin, the shunt systemic vessel(s) of insertion, and any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between one (poor/none) and five (good/normal) based on the caliber of the intrahepatic portal veins. A total of 1182 CT scans were submitted from 13 different institutions. Due to exclusion criteria, 100 (8.5%) were removed, leaving 1082 CT scans to be included. Forty-five different EHPSS anatomies were identified with five classifications accounting for 85% of all shunts (left gastric-phrenic [27%], left gastric-azygos [19%], left gastric-caval [15%], aberrant left gastric-caval with right gastric vein [12%], and aberrant left gastric-caval with right gastric vein and short gastric vein [11%]). Shunt origin involved the left gastric vein in 95% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of the CT scan (P < .001), sex (P = .009), breed (P < .001), weight (P < .001), and subjective portal perfusion score (P < .001). An anatomical classification system for canine EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for these patients.

Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes.

Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.

Evaluation of coagulation and platelet activation state and function in heartworm-infected dogs.

BACKGROUND: Enhanced platelet responses have been demonstrated in heartworm-infected (HWI) dogs; however, the cause and clinical implications of altered platelet function have not been fully elucidated. OBJECTIVE: This study evaluated platelet function in HWI dogs. METHODS: Anticoagulated whole blood collected from eight HWI and eight uninfected dogs was evaluated using turbidometric platelet aggregometry, a platelet function analyzer (PFA-100), a total thrombus analysis system (T-TAS), tissue factor-activated and tissue plasminogen activator modified thromboelastography (TF- and tPA-TEG), CBC, von Willebrand Factor activity, and fibrinogen concentrations. Platelet activation state and the presence of reticulated platelets were assessed via flow cytometric expression of P-selection (CD-62P) and thiazole orange staining. RESULTS: Platelet aggregation responses to adenosine diphosphate (ADP, 10 µM) or collagen (20 µg/mL), PFA-100 closure times, and T-TAS occlusion times did not differ between groups. TEG values TF-R, tPA-R, TF-K, and TF-LY60 were decreased (P = .025, P = .047, P = .038, P = .025) and TF-MA, tPA-MA, TF-G, tPA-G and TF-alpha angle were increased (P < .04) in HWI dogs. HWI dogs had higher fibrinogen concentrations (465.6 ± 161 mg/dL vs 284.5 ± 38 mg/dL, P = .008) and eosinophil counts (0.686 ± 0.27 × 103/µL vs 0.267 ± 0.20 × 103/µL, P = .003). There was no difference in hematocrit, activation state, or percent of reticulated platelets. Non-activated reticulated platelets exhibited higher CD62P expression compared with mature platelets. CONCLUSIONS: Chronic canine heartworm disease was accompanied by hypercoagulability, hyperfibrinogenemia, and decreased fibrinolysis. Enhanced platelet activation was not identified in this group of HWI dogs.

Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Improved predictability is needed for calculators used to preoperatively determine the etiology of splenic masses in dogs: an external validation study of the HeLP score and T-STAT.

OBJECTIVE: To assess the predictability of the hemangiosarcoma likelihood prediction (HeLP) score and the Tufts Splenic Tumor Assessment Tool (T-STAT) for hemangiosarcoma and malignancy, respectively. ANIMALS: 261 dogs undergoing splenectomy for a splenic mass. METHODS: Medical records were retrospectively reviewed; variables for the HeLP score and T-STAT were collected, and scores were assigned. Area under the curve (AUC) was calculated for each score. RESULTS: The HeLP score included 141 dogs; hemangiosarcoma was diagnosed in 87 (61.7%) dogs. The median cumulative HeLP score was 51 (range, 17 to 82; IQR, 39 to 58) for dogs with hemangiosarcoma and 28 (range, 0 to 70; IQR, 17 to 41) for dogs without hemangiosarcoma. The categorical HeLP score was low (28; 32.2%), medium (31; 35.6%), and high (28; 32.2%) for dogs with hemangiosarcoma and was low (41; 75.9%), medium (9; 16.7%), and high (4; 7.4%) for dogs without hemangiosarcoma. The AUC of the cumulative and categorical HeLP scores for diagnosis of hemangiosarcoma were 0.79 (95% CI, 0.71 to 0.86) and 0.73 (95% CI, 0.65 to 0.82), respectively. The T-STAT included 181 dogs. Lesions were benign in 95 (52.5%) and malignant in 86 (47.5%) dogs. The median T-STAT score was 62% (range, 5% to 98%; IQR, 36% to 77%) for dogs with malignant lesions and 38% (range, 5% to 91%; IQR, 24% to 59%) for dogs with benign lesions. The T-STAT had an AUC of 0.68 (0.60 to 0.76) for diagnosis of malignancy. CLINICAL RELEVANCE: The HeLP score had acceptable performance, and the T-STAT had poor performance for diagnosis prediction. A tool with excellent or outstanding discrimination is needed to more reliably predict the presence of hemangiosarcoma or a malignant lesion preoperatively.

Treatment of retroperitoneal sarcoma results in improved outcomes.

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.

Bupivacaine liposomal injectable suspension does not provide improved pain control in dogs undergoing abdominal surgery.

OBJECTIVE: To evaluate the difference in postoperative pain scores of dogs undergoing abdominal surgery receiving surgical incision infiltration of saline or bupivacaine liposomal injectable suspension (BLIS). ANIMALS: 40 dogs undergoing exploratory laparotomy. METHODS: Dogs were prospectively enrolled and randomized to receive either BLIS or saline surgical incision infiltration. All dogs received 5.3 mg of BLIS/kg or an equal volume of saline infiltrated in the muscle/fascia, subcutaneous tissue, and intradermal layer during closure. All dogs received a standardized postoperative pain management protocol. Pain assessment was performed at select time points postoperatively by blinded observers with an electronic algometer, short version of the Glasgow Composite Measure Pain Scale (GCMPS), and indirect measures of pain, including systolic blood pressure, heart rate, and serum cortisol levels. RESULTS: At day 0, blood pressure was higher in the saline group (149.6 vs 125.8 mm Hg; P = .006). At day 3, GCMPS was lower in the BLIS group (BLIS = 1, saline = 2, P = .027), though both average GCMPS scores were low and only 10 dogs were available for day 3 assessments (6 BLIS and 4 saline). No other differences in algometer readings, GCMPS scores, other measured parameters, or need for rescue analgesia were present between BLIS and saline groups at any time point. There was no difference in postoperative incisional infection rate or complications. CLINICAL RELEVANCE: Use of BLIS for exploratory laparotomy did not provide improved pain control over postoperative opioid administration alone. Patients that received BLIS had no increase in short-term complications.

Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts.

OBJECTIVE: To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery. STUDY DESIGN: Multicenter retrospective (10 university hospitals, one private referral institution). ANIMALS: Dogs ≥15 kg (n = 63). METHODS: Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed. RESULTS: Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens. CONCLUSIONS: Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs. CLINICAL SIGNIFICANCE: Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.

Accuracy, precision, and interobserver and intraobserver agreements related to pressure-measurement devices.

OBJECTIVE: To evaluate the accuracy, precision, and observer agreement of three pressure measurement devices. STUDY DESIGN: In vitro model study. SAMPLE POPULATION: Water manometer with built-in gauge (WMg), arterial pressure transducer (APT), and Compass CT (CCT). METHODS: The model was set to five predetermined pressures (4, 8, 13, 17, and 24 cm H2 O) using a water manometer with a ruler (WMr) as the gold standard. Each device was tested at each pressure in a randomized order by three investigators. Bland-Altman plots were used to assess agreement between devices. Intraclass correlation coefficients (ICC) were calculated for interobserver and intraobserver agreements. RESULTS: The mean differences (cm H2 O) ± SEM in comparison with the set pressure were -0.020 ± 0.010 (WMg), -0.390 ± 0.077 (APT), and -1.267 ± 0.213 (CCT). Pressures measured by WMg did not differ from those measured by WMr. Pressures measured by all devices did not differ from each other (p > .062 for all comparisons). Interobserver agreement was excellent (1.000), and intraobserver agreement was excellent (0.985, 0.990, 0.998 for each observer). CONCLUSION: Compared to the WMr, the WMg was the most accurate and precise, followed by the APT; the CCT was the least accurate and precise. Interobserver and intraobserver agreements for all three devices were excellent. CLINICAL SIGNIFICANCE: The largest mean difference of all devices was within 1.3 cm H2 O of the set pressure, indicating possible clinical utility of any of the devices. However, WMr or WMg should be considered first due to their high precision and accuracy.

Perioperative ventricular arrhythmias are increased with hemoperitoneum and are associated with increased mortality in dogs undergoing splenectomy for splenic masses.

OBJECTIVE: To identify risk factors for intra- and postoperative ventricular arrhythmias (VAs) and in-hospital mortality in dogs undergoing splenectomy for splenic masses. ANIMALS: 308 dogs. METHODS: Records from 2010 through 2018 were reviewed for dogs undergoing splenectomy for a splenic mass. Clinical and laboratory findings on admission, diagnostic imaging, anesthesia, surgery and pathology reports, treatment records, and in-hospital mortality were evaluated with logistic regression. RESULTS: VAs occurred in 138 (44.8%) dogs (126/308 [40.9%] postoperative, 51/308 [16.6%] intraoperative, 26/308 [8.4%] preoperative), with 50/308 (16.2%) dogs having more than one type of VA. Increasing heart rate and body weight, decreasing PCV and platelet count, hemoperitoneum, receipt of a transfusion, and diagnosis of hemangiosarcoma were associated with the presence of intra- and postoperative VAs on univariable analysis (all P < .001). On multivariable analysis, hemoperitoneum (P < .001 , < .001), increasing body weight (P = .026, < .001), and increasing heart rate (P = .028, < .001) were significant for intra- and postoperative VAs, respectively. Twenty dogs died (20/308 [6.5%]; 14/138 [10.1%] with VAs, 6/170 [3.5%] without VAs). Intra- and postoperative VAs were associated with in-hospital mortality (P = .009, .025, respectively). CLINICAL RELEVANCE: Perioperative VAs were common and odds of VAs were increased with hemoperitoneum, increasing heart rate, and increasing body weight. Presence of VAs increased the odds of in-hospital mortality. Despite this, the overall in-hospital mortality rate was low (6.5%), indicating a good prognosis for survival of surgery in dogs with splenic masses, regardless of the presence of VAs or hemoperitoneum.

Acute kidney injury is common in dogs with septic peritonitis and is associated with increased mortality.

OBJECTIVE: To identify the frequency of and risk factors for acute kidney injury (AKI) in dogs undergoing abdominal surgery for septic peritonitis, and to evaluate outcome and kidney-related risk factors for survival to discharge in those dogs. ANIMALS: 77 dogs that underwent abdominal surgery for septic peritonitis. METHODS: Medical records of dogs that underwent surgery for septic peritonitis from 2012 through 2022 were reviewed. Data regarding signalment, clinical and biochemical findings at presentation, blood creatinine concentration throughout hospitalization, surgery characteristics, postoperative monitoring, and outcome were collected. Dogs were classified based on occurrence of AKI and whether they presented with or developed AKI in-hospital. Perioperative risk factors were evaluated, and outcomes were compared with univariable logistic regression. RESULTS: 31 dogs (40.3%) had AKI diagnosed; 18/77 (23.4%) dogs presented with AKI, 11 (61.1%) of which had it postoperatively, and 13/77 (16.9%) dogs developed AKI postoperatively. Significant factors for presenting with AKI included increasing baseline respiratory rate (OR 2.5 for every 10 beats per minute higher), decreasing systolic blood pressure (OR 0.8 for every 10 mm Hg higher), and increasing body condition score (OR 2.2 for every score greater). No significant factors for developing AKI postoperatively were identified after multiple comparisons adjustment. Sixteen dogs (20.8%) did not survive to discharge; 12 (75.0%) had AKI and 4 (25.0%) did not. Dogs with AKI had decreased odds of survival to discharge (OR 0.2). CLINICAL RELEVANCE: AKI was common in dogs with septic peritonitis and was a significant risk factor for survival to discharge. Clinical surveillance of AKI is critical in this population.

Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009-2021.

OBJECTIVES: Gastrointestinal foreign bodies (FBs) are an important cause of emergency surgical intervention in cats, but little information exists in the literature evaluating the risks and outcomes in this species. The study purpose was to describe cases of feline FBs and compare perioperative factors and outcomes between linear foreign body (LFB) and discrete foreign body (DFB) surgery in cats. METHODS: The medical records from the University of Georgia Veterinary Teaching Hospital were searched for cats that had undergone surgery for FB removal between August 2009 and August 2021. Perioperative data were collected and described. Data were compared between cats with an LFB and cats with a DFB. A binomial probability series was used to estimate the likelihood of postoperative septic peritonitis or mortality in an additional cat in the series. RESULTS: A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB. Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017). CONCLUSIONS AND RELEVANCE: Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

Risk factors for intraoperative hemorrhage and perioperative complications and short- and long-term outcomes during surgical patent ductus arteriosus ligation in 417 dogs.

OBJECTIVE: To evaluate the short- and long-term outcomes of dogs undergoing surgical ligation for a left-to-right shunting patent ductus arteriosus (PDA), identify risk factors for intraoperative hemorrhage and intra- and postoperative complications, and report overall mortality rates. ANIMALS: 417 client-owned dogs undergoing surgical ligation for a left-to-right shunting PDA between January 2010 and January 2020. PROCEDURES: Data recorded included patient signalment, echocardiogram findings, intraoperative complications and mortality, postoperative complications, and short- and long-term outcomes. RESULTS: There was no association between age and risk of intraoperative hemorrhage (P = .7), weight and intraoperative hemorrhage (P = .96), or increasing left atrium-to-aortic (LA:Ao) ratio and intraoperative hemorrhage (P = .08). Intraoperative hemorrhage occurred in 10.8% of patients. Intraoperative mortality was 2%. Ninety-five percent of dogs experiencing intraoperative hemorrhage survived to discharge. Survival to discharge was 97%. One- and 5-year survival rates were 96.4% and 87%, respectively. CLINICAL RELEVANCE: Surgical ligation for a left-to-right shunting PDA is recommended due to the good long-term prognosis. Certain preoperative factors such as age, weight, and the presence and degree of mitral valve regurgitation had no detectable association with risks of intraoperative hemorrhage and, therefore, should not preclude surgical treatment for a left-to-right shunting PDA. Future studies are needed to further assess the association between increasing LA:Ao ratio and risk of intraoperative hemorrhage.

Scar revision for incompletely or narrowly excised soft tissue sarcomas in dogs.

Objective: Describe clinical features of dogs undergoing scar revision for incompletely or narrowly excised soft tissue sarcomas (STSs) in the absence of gross disease and to determine local recurrence rates following scar revision. Animals: Thirty-three dogs with 33 scars. Procedures: Medical records were reviewed to collect data on signalment, tumor details, pre-surgical diagnostic tests, surgical and pathologic findings for both the initial and revision surgeries, and clinical outcomes. Descriptive statistics were generated. Results: For the initial excision, cytology was performed before surgery in 45.5% (15/33) of dogs, and information on surgical margins was rarely reported [4.0% (1/25) of circumferential and 12.0% (3/25) of deep margins]. Microscopic evidence of residual STS was identified in 18.2% of scars. Recurrence occurred in 3.0% (1/33) of dogs [median follow-up of 1127 d (1 to 3192 d)]; this dog had had no evidence of residual tumor in the scar revision pathology. Conclusions: Despite the low identification rate of residual tumor, the local tumor recurrence rate was 3.0%, which is lower than what is historically reported for incompletely or narrowly excised STSs. Clinical relevance: Scar revision for incompletely or narrowly excised STSs resulted in durable tumor remission in the dogs of this study. Pre-surgical diagnostic tests were not often performed in this study; these may be considered before the first excision to plan surgical margins for potentially reducing the incidence of incomplete or narrow excision. Surgical reports should include details on circumferential and deep margins to guide pathologic interpretation and future scar revision, if required.

Révision des cicatrice pour les sarcomes des tissus mous incomplètement ou étroitement excisés chez le chien. Objectif: Décrire les caractéristiques cliniques des chiens subissant une révision de cicatrice pour des sarcomes des tissus mous (STSs) incomplètement ou étroitement excisés en l'absence de maladie macroscopique et pour déterminer les taux de récidive locale après la révision de cicatrice. Animaux: Trente-trois chiens avec 33 cicatrices. Procédures: Les dossiers médicaux ont été examinés pour recueillir des données sur le signalement, les détails de la tumeur, les tests de diagnostic pré-chirurgicaux, les résultats chirurgicaux et pathologiques pour les chirurgies initiales et de révision, et les résultats cliniques. Des statistiques descriptives ont été générées. Résultats: Pour l'excision initiale, une cytologie a été réalisée avant la chirurgie chez 45,5 % (15/33) des chiens, et les informations sur les marges chirurgicales ont été rarement rapportées [4,0 % (1/25) des marges circonférentielles et 12,0 % (3/25) des marges profondes]. Des preuves microscopiques de STS résiduel ont été identifiées dans 18,2 % des cicatrices. Une récidive est survenue chez 3,0 % (1/33) des chiens [suivi médian de 1127 jours (1 à 3192 jours)]; ce chien n'avait eu aucun signe de tumeur résiduelle dans la pathologie de révision de la cicatrice. Conclusions: Malgré le faible taux d'identification de tumeur résiduelle, le taux de récidive tumorale locale était de 3,0 %, ce qui est inférieur à ce qui est historiquement rapporté pour les STS incomplètement ou étroitement excisés. Pertinence clinique: La révision des cicatrices pour les STS incomplètement ou étroitement excisés a entraîné une rémission tumorale durable chez les chiens de cette étude. Les tests diagnostiques pré-chirurgicaux n'ont pas souvent été effectués dans cette étude; ceux-ci peuvent être envisagés avant la première excision pour planifier les marges chirurgicales afin de réduire potentiellement l'incidence de l'excision incomplète ou étroite. Les rapports chirurgicaux doivent inclure des détails sur les marges circonférentielles et profondes pour guider l'interprétation pathologique et la révision future de la cicatrice, si nécessaire.(Traduit par Dr Serge Messier).

Scar revision for incompletely or narrowly excised cutaneous mast cell tumors in dogs.

Objective: Describe clinical features and outcomes of dogs undergoing scar revision for incompletely or narrowly excised cutaneous mast cell tumors without gross disease. Animals: 52 dogs undergoing 54 scar revisions. Procedures: Retrospective record review with information collected on signalment, tumor type/location, pre-surgical diagnostics, surgical and pathologic findings for the first excision and scar revision surgeries, and follow-up. Descriptive statistics were generated. Results: Prior to initial excision, cytology was performed on 38.9% (21/54) of tumors and the initial surgery report rarely described surgical resection margins [14.6% (7/48) of surgeries]. Residual tumor was identified pathologically in 29.6% (16/54) of scars. Local recurrence following scar revision occurred in 3.7% (2/54) of all scars [median follow-up 881.5 d (range: 0 to 3317 d)]; both scars had either complete excision of residual mast cell tumor or no evidence of mast cell tumor on scar revision and neither dog received radiation therapy. Conclusions: Identification of residual disease was uncommon, and local recurrence was less common than previously reported for incomplete/narrow mast cell tumor excision. Clinical relevance: Scar revision of unplanned primary excisions appears to yield a high likelihood of durable tumor remission in patients. First opinion practitioners are encouraged to avoid unplanned excisions by informing the surgical plan with cytology of the primary tumor and detailing surgical margin excision which may facilitate revision, if necessary.

Révision des cicatrices pour des mastocytes cutanés incomplètement ou étroitement excisés chez le chien. Objectif: Décrire les caractéristiques cliniques et les résultats des chiens subissant une révision de cicatrice pour des tumeurs mastocytaires incomplètement ou étroitement excisées sans maladie grave. Animaux: Cinquante-deux chiens soumis à 54 révisions de cicatrice. Procédures: Examen rétrospectif des dossiers avec des informations recueillies sur le signalement, le type/l'emplacement de la tumeur, les diagnostics pré-chirurgicaux, les résultats chirurgicaux et pathologiques pour les premières chirurgies d'excision et de révision de cicatrice, et le suivi. Des statistiques descriptives ont été générées. Résultats: Avant l'excision initiale, une cytologie a été réalisée sur 38,9 % (21/54) des tumeurs et le rapport chirurgical initial décrivait rarement les marges de résection chirurgicale [14,6 % (7/48) des chirurgies]. Une tumeur résiduelle a été identifiée pathologiquement dans 29,6 % (16/54) des cicatrices. Une récidive locale après révision des cicatrices s'est produite dans 3,7 % (2/54) de toutes les cicatrices [suivi médian de 881,5 jours (intervalle : 0 à 3317 jours)] les deux cicatrices présentaient soit une excision complète du tumeur mastocytaire résiduel, soit aucun signe de tumeur mastocytaire lors de la révision de la cicatrice et aucun chien n'a reçu de radiothérapie. Conclusions: L'identification de la maladie résiduelle était rare et la récidive locale était moins fréquente que précédemment rapportée pour l'excision incomplète/étroite du tumeur mastocytaire. Pertinence clinique: La révision de la cicatrice des excisions primaires non planifiées semble donner une forte probabilité de rémission tumorale durable chez les patients. Les praticiens de première opinion sont encouragés à éviter les excisions non planifiées en informant le plan chirurgical avec la cytologie de la tumeur primaire et en détaillant les marges de l'excision chirurgicale ce qui peut faciliter la révision, si nécessaire.(Traduit par Dr Serge Messier).

Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs.

OBJECTIVE: To describe complications and outcomes of dogs undergoing thoracoscopic-assisted (TA) lung lobectomy. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: Client-owned dogs (n = 30). METHODS: Medical records of dogs that underwent TA lung lobectomy were reviewed. Signalment, bodyweight, clinical signs, imaging findings, surgical variables, complications, and short-term/long-term outcome were assessed. Thoracoscopic-assisted lung lobectomy was performed with a mini-thoracotomy. RESULTS: Twelve intraoperative complications were recorded in 11 dogs, 6 requiring conversion to open thoracotomy. Reasons for conversion were reported in 5/6 dogs and included adhesions (2), difficultly manipulating the lesion through the mini-thoracotomy (2), and acute oxygen desaturation (1). One lung ventilation was successful in 4 of the 7 dogs in which this was attempted. A linear stapling device (DST series Medtronic, Minneapolis, Minnesota) was used for lung lobe ligation in 14 dogs. Twenty-three dogs underwent surgery for a neoplastic lesion, with 19 of these being carcinoma. The median lesion size was 4.3 cm (range 1-10 cm); margins were clean, except in 1 dog. Complications were documented in 8 dogs prior to discharge, 5 of these being classified as mild. Twenty-nine dogs were discharged at a median of 47 h postoperatively (range 24-120 h). Death was reported in 9 dogs, with a median survival time of 168 days (range 70-868 days). CONCLUSION: Thoracoscopic-assisted lung lobectomy was achieved with few major complications in the population reported here. Dogs were able to be discharged from hospital quickly, with most surviving beyond the follow-up period. CLINICAL SIGNIFICANCE: Thoracoscopic-assisted lung lobectomy may be considered to facilitate the excision of larger pulmonary lesions or to treat smaller dogs, in which a thoracoscopic excision may be technically more challenging.

Comparison of Veterinary Student Understanding of Extrahepatic Portosystemic Shunts when Given a Pre-Lecture Activity of a Text-Only Narrative versus an Interactive Electronic Book.

Complex vascular anomalies are often difficult concepts for veterinary medical students to comprehend, as knowledge of normal anatomy, visualization of the abnormal anatomy, and understanding of the physiologic implications of that abnormality are all required to appreciate the clinical impacts of the anomaly. Access to interactive three-dimensional models of both the normal and abnormal vasculatures may improve student comprehension. In this study, third-year veterinary medical students in a core small animal digestive diseases course completed a pre-lecture assignment consisting of a text-only narrative (n = 100) or an interactive electronic book (e-book; n = 102) focused on extrahepatic portosystemic shunts, followed by two generative learning activities in which they described portal anatomy and extrahepatic portosystemic shunts. An optional, anonymous post-lecture learning assessment was given to both groups. Although no difference in post-lecture assessment scores was identified between the groups, students using the interactive e-book spent significantly longer on the pre-lecture assignment and activities than students in the text-only narrative group. Students in the text-only narrative group were more likely to use spatial visualization strategies during the generative learning activities than students in the e-book group. There was no correlation between time spent on the pre-lecture tasks and learning assessment score. Interactive e-books and generative learning activities may be useful adjunct pre-lecture learning tools for teaching of complex vascular anomalies to veterinary medical students.

Surgical treatment of deep neck infections in 19 dogs.

OBJECTIVE: Describe clinical features, treatment, and outcomes in dogs with deep neck infections. ANIMALS: 19 dogs undergoing surgical treatment of deep neck infections from January 1, 2015, through December 31, 2020. PROCEDURES: Retrospective record review was conducted, with data collected including clinical signs; neutrophil-to-lymphocyte ratio (NLR); diagnostic imaging, surgical, and histopathologic findings; and follow-up. Spearman correlation and Wilcoxon rank sum were used to compare variables to NLR. RESULTS: All dogs had cervical swelling, and 9 were febrile. On CT, a distinct mass or abscess (7/13) or abscessed lymph node (4/13) was common, with contrast enhancement (10/13), fluid tracking (8/13), and displacement of the trachea, pharynx, or larynx (6/13) also frequently seen. Foreign material was suspected on CT for 4 dogs and was identified at surgery or histopathology for 4 dogs, only 1 of which was suspected on CT. Histopathology most commonly revealed pyogranulomatous inflammation (14/15). Increasing NLR was moderately correlated to a decreased duration of clinical signs before presentation (ρ = -0.548; P = .035) and an increased length of hospitalization (ρ = 0.645; P = .009). Bacterial culture was submitted for all dogs, and polymicrobial infections were common (8/19). Broad-spectrum empirical antimicrobials were commonly prescribed. Change in antimicrobial treatment based on culture was uncommon (3/19). All dogs survived to hospital discharge; 18 dogs with long-term follow-up had complete resolution of clinical signs. CLINICAL RELEVANCE: CT was useful to plan for surgery, and surgical treatment resulted in resolution of clinical signs in all dogs with long-term follow-up available. Empirical antimicrobial treatment, such as amoxicillin-clavulanic acid or ampicillin-sulbactam, should be considered.