A Review of Management of Congenital Sublobar Hyperinflation at a Single Institution.

There has been an increased recognition of a subset of congenital lobar emphysema (CLE), termed congenital sublobar hyperinflation (CSLH), which may affect only a segment of lung as opposed to an entire lobe. This is an uncommon variant for which there is a paucity of information in published literature. The majority of CLE are managed surgically. Current literature suggests non-operative management for CSLH. However, there has been slow adoption of non-operative management and there is not a well-established observation pathway. A retrospective review of all pediatric patients diagnosed with CSLH at a single institution was performed from 2017 to 2023 to determine if this variant may be safely managed with observation. A total of 10 patients were identified. Of these, three patients had consolidation on cross-sectional imaging; therefore, operative intervention was undertaken given diagnostic uncertainty. All patients managed observationally remained asymptomatic. This case series validates non-operative management for patients with asymptomatic CSLH.

Intra-abdominal complications following intestinal anastomoses by suture and staple techniques in dogs.

OBJECTIVE To compare the incidence of intra-abdominal complications in dogs following resection and functional end-to-end stapled anastomosis (FEESA) versus anastomosis with an end-to-end sutured technique for treatment of enteric lesions. DESIGN Multicenter, retrospective descriptive cohort study. ANIMALS 180 dogs. PROCEDURES Medical records of dogs undergoing intestinal resection and anastomosis at 3 nonaffiliated private practice specialty centers were retrospectively reviewed. Preoperative clinical variables, indication for surgery, surgical technique (sutured end-to-end anastomosis vs FEESA), and evidence of postoperative anastomosis site leakage (dehiscence) were recorded. Variables of interest were analyzed for associations with dehiscence. RESULTS Dehiscence rates of sutured and stapled anastomoses were 12 of 93 (13%) and 4 of 87 (5%), respectively; odds of postoperative dehiscence were significantly lower for dogs with FEESAs than for dogs with sutured anastomoses (OR, 0.28; 95% confidence interval, 0.09 to 0.94). Among dogs that underwent surgery for treatment of intestinal dehiscence after surgery at another facility, subsequent dehiscence developed in 3 of 5 with sutured anastomoses and 0 of 11 with stapled anastomoses. Dehiscence rates varied significantly among clinics. No other variable was associated with risk of dehiscence. Eleven of 16 dogs with dehiscence were euthanized without additional surgery. Impaction at the anastomosis site was identified months or years after surgery in 3 dogs (4 anastomosis sites) that had FEESAs. CONCLUSIONS AND CLINICAL RELEVANCE Odds for dehiscence were significantly greater for sutured end-to-end anastomoses than FEESAs, and dogs undergoing surgery for previous dehiscence were significantly more likely to experience a subsequent dehiscence with a sutured anastomosis. However, variability of procedure types and dehiscence rates among clinics suggested further research is needed to confirm these findings. Obstruction at the anastomosis site was identified as a potential long-term complication of FEESA.

Video-assisted thoracoscopic surgery as a primary intervention in pediatric parapneumonic effusion and empyema.

The use and effectiveness of video-assisted thoracoscopic surgery (VATS) for the treatment of empyema and complex parapneumonic collections in pediatric patients is well documented. Timing of this intervention still remains controversial. We reviewed our experience with VATS to determine if it should be used as the initial procedure in children with pleural collections. We reviewed all pediatric (age younger than 17 years) patients with a diagnosis of pneumonia admitted between July 1998 and June 2008. Demographics, comorbidities, laboratory data, and hospital length of stay (LOS) were evaluated. Patients were divided into groups: those who only had thoracentesis or thoracostomy (Group A), those who underwent a procedure and then required VATS (Group B), and those who went directly to VATS (Group C). We identified 382 patients admitted with pneumonia. Of these, 79 (21%) required a thoracic drainage procedure. Overall, 49 (67%) of patients with a thoracic fluid collection underwent VATS at some point. With regard to type of intervention, there was no statistical difference noted in clinical variables. Thirty (38%) patients were in Group A, 18 (22%) in Group B, and 31 (39%) in Group C. LOS for Group C (10.5 days) was significantly (P < 0.05) shorter than for both Group A (14.8 days) and Group B (15 days). Only two (6%) patients required conversion to open thoracotomy. A high percentage of children initially treated by tube thoracostomy eventually require additional interventions, leading to increased LOS. As a result of its simplicity, safety, and efficacy, VATS pleural evacuation can be recommended as the initial intervention in pediatric parapneumonic effusions and empyema in patients who do not require emergent drainage.

Comparison of acute hemodynamic effects of lidocaine and procainamide for postoperative ventricular arrhythmias in dogs.

Heart rate and systolic, diastolic, and mean pressures were measured in two groups of dogs during treatment of postoperative ventricular arrhythmias either with intravenous (IV) 2% lidocaine hydrochloride or procainamide hydrochloride. Hemodynamic parameters were not significantly changed after IV administration of either drug. Additionally, changes in hemodynamic parameters for dogs treated with 2% lidocaine were not significantly different from those of dogs treated with procainamide. When dosed appropriately in the clinical setting, one bolus of IV procainamide was safe for the treatment of postoperative ventricular arrhythmias.

Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog.

A 2-year-old female Siberian Husky was referred for evaluation of a rectocutaneous fistula of unknown etiology. On evaluation, a rectal tear and an associated perivulvar abscess and draining tract were identified. Several attempts were made to repair the rectocutaneous fistula and associated rectal tear. Primary repair and fascia lata graft repair failed. Successful management was achieved via a laparoscopic-assisted end-on jejunostomy for fecal diversion, and the wound healed readily by second intention. During the period of hospitalization, the dog lost a considerable amount of weight. Particular care should be taken regarding fluid therapy, administration of antimicrobials, and adequate nutrition in patients with rectocutaneous fistulas. Overall, the use of laparoscopic-assisted end-on jejunostomy for fecal diversion in the management of rectocutaneous fistulas in dogs appears to be feasible; end-on or loop jejunostomy may also be an option for the treatment of other diseases of the distal portion of the gastrointestinal tract.

The neonate with an abdominal mass.

Abdominal masses in neonates reflect a wide spectrum of diseases,from lesions that can cause significant morbidity and mortality,to conditions readily corrected surgically, to entities which maybe safely observed. It is incumbent upon the infant's physician to determine the nature of the mass in a timely, safe, and cost-effective manner.

Management of typical and atypical intestinal malrotation.

BACKGROUND: "Atypical Malrotation" has been increasingly diagnosed at the authors' institution. METHODS: The authors reviewed retrospectively 201 consecutive operations for malrotation over 5 years to anatomically classify, and describe results of operation for, atypical malrotation. The ligament of Treitz (LOT) was classified as high if left of midline and above the 12th thoracic vertebra, low if left of midline and below the 12th thoracic vertebra, and typical if absent or right of midline. RESULTS: A total of 201 patients underwent operation for malrotation, in 176 there were adequate radiologic studies to allow classification of the LOT. Typical malrotation was present in 75 patients, low LOT in 56, and a high LOT in 45. Volvulus was more common in the Typical group compared with the other 2 groups (12 of 75 v 1 of 56 low; 1 of 45 high; P <.05) as were internal hernias (18 of 75 v 6 of 56 low, 1 of 45 high; P <.05). Complications occurred in 13% of typical versus 22% low and 21% of high patients (P =.10). Low and high LOT patients had 13% and 11% incidence of persistent symptoms postoperatively versus 0% of typical patients. CONCLUSION: Atypical malrotation patients are at significantly lower risk of volvulus and internal hernia compared with typical malrotation patients, and operation appears to come with increased morbidity.

Mycoplasmal respiratory infections in small animals: 17 cases (1988-1999).

Seventeen cases (i.e., 14 dogs and three cats) were identified as having Mycoplasma spp. as the sole bacterial isolate cultured from airway washings in 224 cases evaluated for lower respiratory disease that was present in each case. Primary diagnoses included pneumonia (35.3%), airway collapse (35.3%), and bronchitis (29.4%). Fourteen cases had follow-up information available. Of these cases, eight showed resolution or improvement with antimycoplasmal drugs. Mycoplasma spp. is recognized as a primary cause of respiratory disease in several species, including humans. The relationship between Mycoplasma spp. and respiratory disease detected in some of these cases suggests some Mycoplasma spp. may act as primary pathogens in dogs and cats.

Feline orthopedics.

Although many aspects of canine care do cross over to the feline patient, the adage "cats are not small dogs" holds more true today than ever. The area of feline orthopedics is no different. The purpose of this article is to familiarize the reader with the more common feline orthopedic problems. Although many nonsurgical aspects are covered, the majority of text discusses surgical orthopedic problems. In addition, situations considered unique to the feline patient are addressed, including preoperative, perioperative, and postoperative concerns. Diagnostics and implant systems are also covered.