A preliminary study on the use and effect of hand antiseptics in veterinary practice.

OBJECTIVES: To assess use and effect of hand antiseptics in veterinary clinical practice. MATERIALS AND METHODS: Veterinary practice nurses were questioned concerning their use of hand antiseptics, in particular waterless hand rubs. Subsequent clinical trials assessed the effect of single applications of alcohol-based and quaternary ammonium compound-based hand rubs at reducing bacterial counts on the hands of theatre nurses in a neutering clinic. RESULTS: The majority of responding practices used waterless hand rubs (alcohol-based, 67.5% and quaternary ammonium compound-based, 9.5%) as their primary hand hygiene agent and believed them to be effective. 23% of practices favoured an antiseptic hand-wash. In clinical trials, alcohol-based rubs were potentially more effective at reducing bacterial counts than quaternary ammonium compound-based rubs especially in the period immediately after application. However, over 3 hours there was no significant change between these and a control group. There were more adverse skin effects in the group using alcohol-based than in the quaternary ammonium compound-based and control groups. The bacterial counts after application were unaffected by variables such as the number of animals contacted. CLINICAL SIGNIFICANCE: The studies provide useful baseline data for evaluation of efficacy of more frequent applications of the most common antiseptic hand rubs used in veterinary practice.

The efficacy of chlorhexidine gluconate in canine skin preparation - practice survey and clinical trials.

OBJECTIVES: To determine the use in practice and efficacy of different concentrations of chlorhexidine gluconate for canine pre-operative skin preparation. METHODS: Questionnaires were used to establish which antiseptics and techniques were used for patients undergoing elective neutering. In a clinical study, five different concentrations of chlorhexidine gluconate - 0 per cent (tap water, as a control) 1, 2, 3 and 4 per cent - were tested on 50 dogs undergoing elective ovariohysterectomies and orchidectomies. RESULTS: A variety of preparation practices occurred but only 21 per cent of the veterinary nurses surveyed were aware of the concentration and contact time they used whilst preparing animals. The clinical study revealed there was a significant difference (P<0.001) between the different concentrations used. All concentrations of chlorhexidine were significantly more effective than the control tap water. There was a tendency towards increasing efficacy as concentration increased from 1 to 4 per cent but this was not statistically significant. CLINICAL SIGNIFICANCE: The lack of significant differences in efficacy between the different concentrations of chlorhexidine gluconate means that current practices may be adequate, although if the chlorhexidine gluconate concentrations and contact times used are unknown, they may be lower than those tested here and, possibly, ineffective, especially if contact times are short.

Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting.

BACKGROUND: Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings. OBJECTIVES: To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting. METHODS: We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy. RESULTS: We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15.6 [95% confidence interval (CI) 2.9-83.7, P = 0.016]; removal of two outlier studies changed this to 9.0 (95% CI 1.5-54.6, P = 0.03). CONCLUSIONS: Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.

Recovery characteristics following maintenance of anaesthesia with sevoflurane or isoflurane in dogs premedicated with acepromazine.

A standard anaesthetic protocol was used to anaesthetise 40 dogs for intravenous urography and a retrograde urethrogram or vaginourethrogram. The dogs were allocated by blocked randomisation to receive either isoflurane or sevoflurane for maintenance of anaesthesia after they had been premedicated with acepromazine and pethidine, and anaesthesia induced with propofol. An observer who was unaware of which agent had been used assessed ataxia 30 and 60 minutes after discontinuation of administration of the anaesthetic and assigned an overall recovery score. No complications occurred during anaesthesia of either group of dogs. The scores for ataxia were significantly lower after 60 minutes than after 30 minutes, but there was no significant difference between the groups. The quality of recovery was significantly better in the dogs that received sevoflurane than in those that received isoflurane, but the recovery times were similar.

Factors affecting bacterial counts during preparation of the hands for aseptic surgery.

This study was designed to compare the efficacy of four hand preparation techniques in removing bacteria from the hands preoperatively. The effect of bacteriological swabbing itself on bacterial counts was also investigated. The numbers of bacteria obtained from the dominant and non-dominant hands were also determined. The techniques all used 4 per cent chlorhexidine gluconate, and consisted of rubbing for five minutes with one application of antiseptic; rubbing for five minutes with five applications of antiseptic; rubbing for one minute with one application of antiseptic; and scrubbing with a brush for five minutes with one application of antiseptic. The results showed that the four techniques were equally effective at removing bacteria. There was no significant difference in the bacterial counts obtained from the dominant and non-dominant hands. The wearing of gloves for up to 30 minutes after scrubbing had no effect on the bacterial counts. Swabbing itself significantly reduced the number of bacteria cultured from the hands.

Evaluation of transanal endoscopic treatment of benign canine rectal neoplasia.

OBJECTIVES: To evaluate transanal endoscopic treatment in the management of benign canine rectal neoplasia. METHODS: A retrospective study was carried out to evaluate the response to transanal endoscopic treatment in 13 dogs with extensive rectal neoplasia that was considered inoperable by conventional surgical techniques but was indicated as benign by previous biopsy. RESULTS: Tumours affected the lengths of rectal mucosa varying from 2 to 13 cm. Between 25 and 100 per cent of the rectal circumference was affected in each case. Transanal endoscopic treatment of canine rectal neoplasia was curative in five dogs, palliative in three and associated with a poor result in the remaining five. Complications of the technique included rectal perforation, leading to peritonitis and death. CLINICAL SIGNIFICANCE: Transanal endoscopic treatment can be recommended as an alternative to radical, full-thickness rectal excision for the management of extensive but benign canine rectal neoplasia. Owners should be informed that the treatment may be palliative rather than curative and that complications, if they occur, can be fatal. Dogs should be hospitalised for at least five days after treatment and observed for signs of potentially fatal complications such as rectal perforation.

Estimation of the volume of the gall bladder of 32 dogs from linear ultrasonographic measurements.

The maximum length and depth of the longitudinal section, and the maximum width and depth of the transverse section of the gall bladders of 32 dog cadavers were measured ultrasonographically; the contents of the gall bladder were then aspirated and its actual volume measured. The volume of the gall bladder was estimated from the ultrasonographic measurements by using formulae suggested for assessment of the volumes of the urinary bladder in human beings and the gall bladder of dogs, and these formulae were compared with a formula derived from the measurements made in this study. In 21 of the dogs, the measurements were repeated twice so that their reproducibility could be evaluated. All the formulae gave good estimations of the volume of the dogs' gall bladders, but the formula for the human urinary bladder volume was better than the other two. The actual volume of the gall bladder was related to the dogs' bodyweight. There were no significant differences between the repeated measurements of the maximum length and depth of the longitudinal section or the width of the transverse section of the gall bladder, but there were significant variations in the depth of the transverse section.

Methods used in veterinary practice to maintain the temperature of intravenous fluids.

To determine the methods used in veterinary practice to maintain the temperature of intravenous fluids, and the users' impression of their efficacy, data were collected from a survey of 150 veterinary practices. Of the 99 per cent of the practices that warmed intravenous fluids, the use of a heat retention bag cover was most popular and was considered most effective. In a laboratory experiment, four methods of maintaining the temperature of intravenous fluids were compared. The results showed that there was a significant loss of heat through the giving set. A heat retention cover was an effective device for maintaining the temperature of the prewarmed fluid in its bag. The use of ;hot hands' (a sealed surgical glove containing warmed water) was most effective in reducing heat loss from the delivered fluid, and was aided by prewarming the giving set.

Comparison of flank and midline approaches to the ovariohysterectomy of cats.

In a survey of uk veterinary practitioners, 96 per cent indicated that they performed ovariohysterectomy on cats via flank laparatomy rather than a midline coeliotomy. At a veterinary teaching hospital 32 cats were spayed by the midline approach and 34 by the flank approach, by undergraduate students under the continuous supervision of a veterinary surgeon. The duration of each part of the procedures was recorded and information was obtained from the students, the supervisors and the owners of the cats by means of questionnaires. The total duration of the surgery and the students' assessment of the difficulty of the surgery were not significantly different between the two groups. The time taken from the skin incision to entering the peritoneum was significantly longer with the flank approach, but finding the uterus took significantly longer with the midline approach. There was a high incidence of wound complications, in the form of swelling, redness or discharges, but the only statistically significant difference between the groups was a greater incidence of discharges in the cats spayed via the flank (five cases) than in the cats spayed via the midline (one case).

Vaginoperitoneal fistula after ovariohysterectomy in three bitches.

Vaginoperitoneal fistulation was detected in three neutered bitches undergoing retrograde positive contrast vaginourethrography. This is a rarely detected complication of ovariohysterectomy and appears to result in no clinical signs.

Prostatopexy as a treatment for urethral sphincter mechanism incompetence in male dogs.

OBJECTIVES: The incidence of urinary incontinence due to urethral sphincter mechanism incompetence (USMI) in male dogs is relatively rare compared with the incidence in bitches, but the medical management of USMI in male dogs is less rewarding than in bitches. Attempts have been made to manage this condition surgically using either urethral bulking agents such as Teflon or by relocating the intrapelvic bladder neck to an intra-abdominal position by vas deferentopexy. This paper reports the response to prostatopexy in male dogs with USMI. METHODS: The response to prostatopexy was determined in nine severely incontinent male dogs with USMI that were followed up for periods ranging from 10 months to five years (mean 2.3 years). RESULTS: One dog was cured, four were improved, and no improvement in the frequency or degree of urinary incontinence occurred in the remaining four animals. No complications were seen in any of the dogs. CLINICAL SIGNIFICANCE: Prostatopexy may provide a further method of treating male dogs with USMI that do not respond to medical therapy.

Frequency of urination and ultrasonographic estimation of residual urine in normal and dysuric dogs.

The aim of this study was to determine residual urine and frequency of urination in normal male and female dogs and to compare these with dogs with neurogenic and obstructive dysuria. The bladder volume before urination was estimated ultrasonographically in 99 dogs (48 normal and 51 abnormal dogs). Each animal was then taken outdoors and walked on grass for 10 minutes. The number of attempts to urinate (successful or not) was recorded. Bladder urine volume after urination was then calculated. Normal females made only one or two (100 per cent successful) attempts to urinate while males a mean of 6.9 attempts (mean 75.4 per cent successful) within 10 minutes. The residual urine per kg body weight of normal dogs varied from 0.1 to 3.4 ml kg(-1)(median 0.2 ml kg(-1)). The residual urine volumes of normal dogs were significantly less (P<0.0001) than those of dogs with neurological disorders or obstructive disease. Ultrasonographic estimation of residual urine volumes could be valuable in diagnosing suspected neurological or obstructive bladder disease and in monitoring the response to treatment.

Suitability of the cranial portion of the vagina as a site for measurement of intra-abdominal pressure variations in dogs.

OBJECTIVE: To determine whether the cranial portion of the vagina of dogs is a suitable site for measuring intra-abdominal pressure during cystometry. ANIMALS: 16 bitches (8 sexually intact and 8 spayed). PROCEDURE: 2 types of vaginal catheters were used to measure intra-abdominal pressure changes in anesthetized dogs. Catheters were inserted in the rectum and cranial portion of the vagina. RESULTS: Intra-abdominal pressure variations were detected with greater magnitude in the rectum than the cranial portion of the vagina, regardless of type of catheter used and reproductive status (sexually intact vs spayed) of the dogs. CONCLUSIONS AND CLINICAL RELEVANCE: The rectum was the better site for measuring intra-abdominal pressure changes in female dogs. Measurement of intra-abdominal pressure with concomitant measurement of intravesical pressure to determine detrusor pressure during cystometry in female dogs is more reliably detected from the rectum than the cranial portion of the vagina.

Transanal endoscopic treatment of benign canine rectal tumours: preliminary results in six cases (1992 to 1996).

Transanal endoscopic resection and cautery of benign rectal tumours was performed in six dogs with extensive and/or inaccessible rectal neoplasia. The results were encouraging, with three dogs cured and the quality of life of a further two improved for a significant time. The remaining dog died as a result of rectal perforation. Transanal endoscopic treatment of extensive and/or inaccessible benign canine rectal tumours offers an alternative to more radical techniques such as pull-through surgery.

Comparison of ultrasonographic and radiographic measurements of canine prostate dimensions.

The purposes of this study were to: 1) compare prostatic dimensions measured on radiographic and ultrasonographic images and 2) compare a subjective radiographic assessment of prostate size with a previously-described objective method. Thirty-four male dogs undergoing investigation of prostatic disorders were used. Prostate length and depth were measured from ultrasonographic and radiographic images. A subjective assessment of prostate size ('small', 'normal', or 'enlarged') was made in 29 animals by one of the authors who was unaware of radiographic or ultrasonographic measurements. In addition, the distance from sacral promontory to the pubic brim was also measured. A prostate length or depth of >70% of this distance was defined as 'enlarged' and <70% as 'normal'. After the effects of magnification on radiographic measurements were eliminated, there were no significant differences between prostatic length measured by the two methods. However, a significant difference was obtained between prostatic depth measurements. The subjective assessment agreed with a previously described objective assessment of prostatic size in 21/29 dogs for prostate length but in only 12/29 for depth. Prostatic length varied from 46.6 to 116.4% (mean 75.7%) of the distance from the pubic brim to the sacral promontory. Prostatic depth varied from 33.0% to 94.6% (mean 59.7%) of the same distance. It is recommended that prostate length, rather than depth, be used when evaluating prostate size from lateral abdominal radiographs.

Ultrasonographic estimation of prostatic size in canine cadavers.

The purpose of this study was to determine the accuracy of transabdominal ultrasound in estimating the volume and weight of the canine prostate gland, to derive a simple formula from actual and ultrasonographic prostate measurements for estimating prostate volume and weight, and to evaluate the reproducibility of ultrasonographic measurements of linear prostate dimensions. The prostate volume and weight were measured and also calculated in 77 male canine cadavers (60 entire and 17 neutered) with the aid of statistical computer programmes using actual linear dimensions of the prostate ('actual') and those measured ultrasonographically before ('in vivo') and after ('in vitro') removal of the prostate gland. Therefore, 'in vivo', 'in vitro' and 'actual' estimations of prostate size were obtained and compared with prostatic volume and weight. The evaluation of the reproducibility of the ultrasonographic measurements made was performed in 59 of the dogs in which the prostate was imaged three times in longitudinal and three times in transverse sections. This study demonstrated that prostatic weight and volume are related to body weight and age in entire dogs but not in neutered dogs. Formulae were derived to estimate prostate weight and volume from physical and ultrasonographic measurements. There were good correlations between the ultrasonographic and physical measurements and prostate size derived from these measurements provided a good estimate of actual prostate size. 'Best subsets' analyses indicated that prostate width and length (measured physically or ultrasonographically) were the best predictors of prostatic volume and weight, both when all dogs were considered together and in entire dogs only. Statistical analyses indicated that there were no significant differences between the repeated measurements of length and depth (P>0.05). However, there was a significant difference between repeated measurements of width (P= 0.0357).

Effect of body position on ultrasonographic estimations of bladder volume.

A study was undertaken to determine the effect of body position on ultrasonographic bladder measurements and volume estimations. Of the 42 dogs studied, 15 were fresh canine cadavers without urological disease and the remaining 27 were undergoing investigations for disorders of the lower urinary tract. Bladder volume was estimated using a formula described previously. Irrespective of whether all dogs were considered together or only live animals were included, measurements made in dorsal recumbency tended to underestimate bladder volume while those made in right lateral recumbency resulted in overestimation. This was due to significant differences in all linear measurements, apart from width, between body positions. Measurements in right lateral recumbency were higher than those in dorsal recumbency. In all animals and in living dogs alone, bladder measurements in dorsal recumbency appeared to give a more accurate estimation of actual bladder volume.