Evaluation of factors associated with retained surgical sponges in veterinary patients: a survey of veterinary practitioners.

OBJECTIVES: To evaluate factors that could be associated with retained surgical sponges in veterinary patients. MATERIALS AND METHODS: A survey was distributed to 322 veterinarians attending a national veterinary conference in the UK. The survey included questions about the staff, scheduling, type of surgical procedure, surgical sponges, methods to track surgical sponges and details of clinical cases with retained surgical sponges. RESULTS: The response rate was 64 of 322 (19%). Lack of designated scheduled time for surgical procedures was reported by 30% of respondents and was variable for 31%. More than half of respondents (66%) had two people involved in each surgical procedure. The majority of respondents sterilised their own surgical sponges (91%) and used non-radiopaque surgical sponges (56%). Sponges were not counted by 27% of respondents and only occasionally by 20%. Sponge count was not recorded by 70% of respondents. The majority (66%) did not use or have a surgical checklist. Lack of awareness of gossypibomas was reported by 11% of respondents. In all, 27% of respondents were aware of at least one case of retained surgical sponge. Of the 17 cases reported, 14 were small animals. The abdomen was the most common anatomical location for retained surgical sponges and followed elective neutering. CLINICAL SIGNIFICANCE: Despite the low-response rate, our results suggest that methods of surveillance might reduce the incidence of retained surgical sponges. Lack of specifically scheduled time for surgery, few theatre staff and lack of sponge counting and documentation may have contributed to the 17 retained surgical sponge cases reported.

Tension pneumothorax secondary to nasojejunal feeding tube misplacement in a mechanically ventilated dog.

CASE REPORT: An 11-year-old female terrier-cross underwent general anaesthesia and mechanical ventilation for insulinoma resection. Following tumour removal, three consecutive but unsuccessful attempts were made to place a wire-guided nasojejunal feeding tube (NJFT), using both nostrils, with one tube eventually left in situ in the right nostril. A final successful attempt using a smaller NJFT was made via the left nostril. On withdrawal of the previously, unsuccessfully placed NJFT, the dog developed an acute tension pneumothorax. Severe cardiorespiratory dysfunction ensued, including decreasing arterial haemoglobin O2 saturation, increasing end-tidal CO2, hypotension and tachycardia. Immediate thoracocentesis with air evacuation from the pleural cavity followed by continuous air drainage through bilateral thoracostomy tubes produced marked improvement of cardiorespiratory function. During exploratory thoracotomy performed 1 day later, two lung lesions were identified and over sewn, one in the right middle lobe and the other in the accessory lobe. CONCLUSIONS: This is the first case report to describe in an anaesthetised and mechanically ventilated dog the occurrence and management of a tension pneumothorax as a life-threatening complication secondary to parenchymal injury after NJFT misplacement into the tracheobronchial tree. It illustrates that presence of a cuffed endotracheal tube does not protect against passing a NJFT into the bronchial system.

High-level gentamicin-resistant and vancomycin-resistant Enterococcus faecium isolated from a wound in a dog.

This report describes the first clinical case, in Europe, of a high-level gentamicin-resistant and vancomycin-resistant Enterococcus faecium infection in a dog. The aim of this report is to alert the veterinary profession to high-level gentamicin-resistant and vancomycin-resistant Enterococcus faecium in companion animal patients. Multi-drug resistant strains of this pathogen are the cause of considerable problems in human hospitals and for community healthcare professionals worldwide. The potential for a similar impact within veterinary medicine is discussed.

Clinically overt infections with methicillin-resistant Staphylococcus aureus in animals in New Zealand: a pilot study.

AIM: To describe clinically overt infections with methicillin resistant Staphylococcus aureus (MRSA) in animals in New Zealand, characterise clinical isolates, and track their sources. METHODS: MRSA isolates identified in 2005 and 2006 by a veterinary diagnostic laboratory were referred to Massey University for confirmation and characterisation. Clinical information was extracted from the laboratory records or obtained from referring clinicians. RESULTS: Seven MRSA isolates from animals and contact persons were characterised. All the isolates belonged to the British epidemic MRSA 15 strain (EMRSA-15). Three EMRSA-15 were isolated from post-operative infections in two dogs. An EMRSA-15 indistinguishable from the isolate recovered from one dog was isolated from the anterior nares of a healthy hospital staff member involved in the care of the animal, suggesting nosocomial transmission. Other EMRSA-15 isolates of uncertain clinical significance were isolated from the femoral head of a cat, and from a sample of cow's milk. AlleMRSA-15 isolates were resistant to ciprofloxacin, and four were resistant to erythromycin; the latter four isolates also exhibited inducible resistance to clindamycin. CONCLUSIONS: MRSA can cause clinically overt and difficult-to-treat infections in animals in New Zealand. The rapid emergence of EMRSA-15 as the dominant MRSA strain in humans has resulted in infection spill over to animals. CLINICAL RELEVANCE: Little is known about the incidence of clinically overt infections with MRSA in animals. The cases described here illustrate the complexities involved in the pharmacological management of EMRSA-15 infections, which is compounded by the universal resistance to beta-lactams, and by the strain's fluoroquinolone resistance and frequent inducible resistance to clindamycin. Such complexities indicate there is a need to develop specific empirical antimicrobial treatment strategies and antibiotic susceptibility testing protocols in countries where EMRSA-15 is dominant.

PCR screening reveals unexpected antibiotic biosynthetic potential in Amycolatopsis sp. strain UM16.

AIMS: To assess the antibiotic biosynthetic potential of Amycolatopsis sp. strain UM16 and eight other Amycolatopsis species. METHODS AND RESULTS: Amycolatopsis genomic DNA was screened by PCR for the glycopeptide, Type-II (aromatic) polyketide and ansamycin biosynthetic gene clusters. Amycolatopsis sp. strain UM16, which exhibits weak antitubercular activity, was shown to have the glycopeptide oxyB gene and the Type-II (aromatic) polyketide-synthase KSalpha-KSbeta tandem gene pair, but not the AHBA synthase gene. The ristocetin (glycopeptide) producer, Amycolatopsis lurida NRRL 2430(T), was shown to have the oxyB gene and the Type-II polyketide-synthase KSalpha-KSbeta tandem gene pair. Amycolatopsis alba NRRL 18532(T) was shown to have the glycopeptide oxyB gene and the AHBA synthase gene. Phylogenetic analyses using Amycolatopsis oxyB and KSalpha-KSbeta gene sequences were conducted. CONCLUSIONS: Amycolatopsis sp. strain UM16 appears to have the biosynthetic potential to produce glycopeptide and Type-II polyketide antibiotics, but not ansamycins. The potential to synthesize aromatic polyketides may be more widely distributed in Amycolatopsis than is currently recognized. SIGNIFICANCE AND IMPACT OF THE STUDY: PCR screening is a very useful tool for rapidly identifying the biosynthetic potential of an antibiotic-producing actinomycete isolate. Advanced knowledge of the type of antibiotic(s) produced will allow appropriate methods to be selected for antibiotic purification.

Canine cardiac mesothelioma with granular cell morphology.

Cardiac mesothelioma with granular cell features was diagnosed in a 10-year-old Golden Retriever presenting with pericardial and abdominal effusions. The diagnosis was based on gross, morphologic, and immunohistochemical features. The immunohistochemical profile of the neoplasm was pancytokeratin positive, vimentin positive, and S-100 negative; most gross and morphologic features were consistent with both mesothelioma and granular cell tumor. To the authors' knowledge, the prognosis for either primary cardiac mesothelioma or granular cell tumor in the dog is unknown. At 4 months after thoracotomy, pericardectomy, and mass excision, this dog was alive and without clinical evidence of pericardial or abdominal effusions. We describe a granular morphologic variant of cardiac mesothelioma in a dog.

Septic peritonitis secondary to unilateral pyometra and ovarian bursal abscessation in a dog.

A seven-year-old, female entire Labrador retriever was presented for acute-onset vomiting and lethargy, associated with weakness and generalised tremors. The clinical, radiographic, ultrasonographic and histopathological findings revealed septic peritonitis which occurred secondarily to unilateral pyometra and ovarian bursal abscessation. However, in this case, the initial clinical findings, blood parameters, radiographic and ultrasonographic findings did not allow a specific diagnosis. Repeat monitoring was required, and abdominocentesis proved to be the most useful diagnostic test, allowing a definitive diagnosis and the decision to be made as to whether or not to carry out exploratory surgery.

Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland.

Fifty cases (36 dogs and 14 cats) with a confirmed diagnosis of pyothorax were evaluated from five referral institutions in the UK and Ireland. Aetiology, clinical presentation, diagnosis, treatment and outcome of all cases were examined. The underlying cause of pyothorax was determined in 18 per cent of cases. Positive bacteriological cultures of the pleural fluid were obtained in 68.7 per cent of the animals. Treatment modalities included surgery and medical management, involving thoracostomy tube placement, thoracic aspiration, thoracic lavage and antimicrobial therapy. A successful outcome was achieved in 86 per cent of patients.

High rise syndrome with impalement in three cats.

Three cats were presented for management of impalement injuries sustained following falls from second storey windows onto spiked metal railings. Two cats presented with penetrating thoracic wounds and extensive pulmonary parenchymal trauma, while one presented with abdominal impalement and splenic rupture. Following stabilisation, all three cats underwent exploratory surgery. A good outcome was achieved in two of the cats: one with thoracic and one with abdominal penetration. Impalement injury secondary to free fallis a previously unreported variation of 'high rise syndrome' in cats.

Neurological dysfunction in three dogs and one cat following attenuation of intrahepatic portosystemic shunts.

Neurological dysfunction is an uncommon complication following extrahepatic portosystemic shunt ligation. Three dogs and one cat are described that developed neurological signs within 21 to 42 hours of attenuation of intrahepatic portosystemic shunts. None of these cases had biochemical evidence of hepatic encephalopathy postoperatively. Two dogs died during management of status epilepticus following aspiration of food. One dog died six months postoperatively. The cat had persistent neurological dysfunction at discharge, but was alive and had recovered most of its neurological function at the time of writing, 37 months after surgery. This report demonstrates the potential for animals with intrahepatic portosystemic shunts to develop postoperative neurological signs and highlights the difficulty of managing such cases. Two dogs had both intrahepatic and extrahepatic portosystemic shunts. Large intestinal malrotation (partial situs inversus) may have been linked to the development of a portosystemic shunt in the remaining dog.

Association between anal furunculosis and colitis in the dog: preliminary observations.

Treatment of anal furunculosis in dogs is often unsatisfactory and may be associated with significant recurrence and complications. This may be compounded by the simultaneous presence of colitis in affected animals. Clinical signs associated with colitis and anal furunculosis may be similar, including faecal tenesmus, dyschezia and haematochezia. To examine the incidence of concurrent anal furunculosis and colitis, colonic biopsies were collected from 18 dogs referred for treatment of anal furunculosis. Nine dogs (50 per cent) had a histopathological diagnosis of colitis. Clinical signs more indicative of colitis than anal furunculosis (increased frequency of defecation, mucus in faeces and diarrhoea) were not observed more frequently in dogs with confirmed colitis compared with those with furunculosis alone. Therefore, while an association between colitis and anal furunculosis may exist, clinical signs alone cannot be used as an indicator of the presence of colitis in cases of anal furunculosis. The authors recommend that colonic biopsies should be undertaken in all dogs presented with anal furunculosis. Whether specific treatment of colitis in dogs with histopathological evidence of colitis improves the outcome of treatment for anal furunculosis awaits further study.

Decrease in beta-cell mass leads to impaired pulsatile insulin secretion, reduced postprandial hepatic insulin clearance, and relative hyperglucagonemia in the minipig.

Most insulin is secreted in discrete pulses at an interval of approximately 6 min. Increased insulin secretion after meal ingestion is achieved through the mechanism of amplification of the burst mass. Conversely, in type 2 diabetes, insulin secretion is impaired as a consequence of decreased insulin pulse mass. beta-cell mass is reported to be deficient in type 2 diabetes. We tested the hypothesis that decreased beta-cell mass leads to decreased insulin pulse mass. Insulin secretion was examined before and after an approximately 60% decrease in beta-cell mass achieved by a single injection of alloxan in a porcine model. Alloxan injection resulted in stable diabetes (fasting plasma glucose 7.4 +/- 1.1 vs. 4.4 +/- 0.1 mmol/l; P < 0.01) with impaired insulin secretion in the fasting and fed states and during a hyperglycemic clamp (decreased by 54, 80, and 90%, respectively). Deconvolution analysis revealed a selective decrease in insulin pulse mass (by 54, 60, and 90%) with no change in pulse frequency. Rhythm analysis revealed no change in the periodicity of regular oscillations after alloxan administration in the fasting state but was unable to detect stable rhythms reliably after enteric or intravenous glucose stimulation. After alloxan administration, insulin secretion and insulin pulse mass (but not insulin pulse interval) decreased in relation to beta-cell mass. However, the decreased pulse mass (and pulse amplitude delivered to the liver) was associated with a decrease in hepatic insulin clearance, which partially offset the decreased insulin secretion. Despite hyperglycemia, postprandial glucagon concentrations were increased after alloxan administration (103.4 +/- 6.3 vs. 92.2 +/- 2.5 pg/ml; P < 0.01). We conclude that an alloxan-induced selective decrease in beta-cell mass leads to deficient insulin secretion by attenuating insulin pulse mass, and that the latter is associated with decreased hepatic insulin clearance and relative hyperglucagonemia, thereby emulating the pattern of islet dysfunction observed in type 2 diabetes.

Repair of osteochondral defects with allogeneic tissue engineered cartilage implants.

The objective of this study was to evaluate the effect of allogeneic tissue engineered cartilage implants on healing of osteochondral defects. Rabbit chondrocytes were cultured in monolayer, then seeded onto biodegradable, three-dimensional polyglycolic acid meshes. Cartilage constructs were cultured hydrodynamically to yield tissue with relatively more (mature) or less (immature) hyalinelike cartilage, as compared with adult rabbit articular cartilage. Osteochondral defects in the patellar grooves of both stifle joints either were left untreated or implanted with allogeneic tissue engineered cartilage. Histologic samples from in and around the defect sites were examined 3, 6, 9, and 12, and 24 months after surgery. By 9 months after surgery, defects sites treated with cartilage implants contained significantly greater amounts of hyalinelike cartilage with high levels of proteoglycan, and had a smooth, nonfibrillated articular surface as compared to untreated defects. In contrast, the repair tissue formed in untreated defects had fibrillated articular surfaces, significant amounts of fibrocartilage, and negligible proteoglycan. These differences between treated and untreated defects persisted through 24 months after surgery. The results of this study suggest that the treatment of osteochondral lesions with allogenic tissue engineered cartilage implants may lead to superior repair tissue than that found in untreated osteochondral lesions.

Osteomyelitis of the atlanto-occipital region as a sequela to a pharyngeal stick injury.

An eight-year-old female Belgian shepherd dog was referred for investigation of chronic neck pain. The dog had sustained a pharyngeal injury 12 weeks previously while catching a stick. Radiographs of the cervical spine revealed signs consistent with a septic arthritis of the atlanto-occipital joint and osteomyelitis of both occipital condyles and the atlas. A foreign body was identified ultrasonographically in the retropharyngeal soft tissues, and a stick was surgically removed from a site ventral to the right side of the atlanto-occipital joint. The signs of neck pain started to resolve within a week of surgery.

Obstructive inflammatory laryngeal disease in three cats.

Three cats with upper respiratory tract obstruction due to laryngeal inflammation are presented. Cervical radiography showed the presence of a soft tissue mass in the laryngeal region in all cases, and laryngoscopy allowed direct visualization of a mass associated with the larynx. Laryngeal samples were obtained by a combination of fine needle aspiration, cutting biopsy forceps, by ventral laryngotomy, and at post-mortem. Histopathology of the laryngeal samples showed the presence of a predominantly granulomatous inflammation, with macrophage and lymphocyte infiltration. One case was euthanased due to severe dyspnoea. The remaining two cases underwent combined medical (corticosteroid and antibiotic) and surgical (permanent tracheostomy or excision of laryngeal tissue by ventral laryngotomy) treatment. One case died of an undetermined cause 15 weeks after surgery while the other case remains clinically well 20 months after diagnosis. Recognition of the existence of granulomatous laryngitis is important as clinical signs and radiographic findings are indistinguishable from laryngeal neoplasia.

Client counseling in orthopedic emergencies.

Important client communication issues associated with most orthopedic emergencies are addressed. Information on client communication and support, providing a prognosis, discussing economic concerns, discharge planning, euthanasia, and client grief is presented. The issue of animal abuse as a cause of orthopedic emergencies also is examined.

Spinal fracture/luxation.

Clinical management of the spinal fracture/luxation patient requires prompt and accurate diagnosis of the extent of injury coupled with intensive medical or surgical intervention. Convalescent patient care is often physically challenging and labor intensive.