Complications and outcome of cats with congenital extrahepatic portosystemic shunts treated with thin film: Thirty-four cases (2008-2017).

BACKGROUND: Congenital extrahepatic portosystemic shunts (CEHPSS) are rare in cats. Outcome after attenuation of CEHPSS with thin film has been described in a small number of cases. OBJECTIVES: To describe the clinical presentation, postoperative complications, and outcome of cats treated with thin film to attenuate CEHPSS. ANIMALS: Thirty-four cats with CEHPSS were identified from the database of 3 institutions over 9 years. METHODS: Retrospective study. Medical records were reviewed to identify cats with a diagnosis of a CEHPSS that underwent surgical attenuation. Congenital extrahepatic portosystemic shunts were suspected from clinical signs, clinicopathologic findings, and diagnostic imaging, and confirmed at exploratory laparotomy. Cats treated with thin film band attenuation were included. Postoperative complications and follow-up were recorded. RESULTS: Complications were recorded in 11 of 34 cats. Deaths related to CEHPSS occurred in 6 of 34; 4 cats did not survive to discharge. Persistent seizures were the cause of death in 4 cats. Seizures were recorded in 8 of 34 cats after surgery; all these cats received preoperative antiepileptic drugs. Serum bile acid concentrations normalized in 25 of 28 of the cats for which data was available. Three cats had persistently increased serum bile acid concentrations and underwent a second exploratory laparotomy. One had a patent shunt, the other 2 had multiple acquired portosystemic shunts. Median follow-up was 8 months (0.5-84 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Congenital extrahepatic portosystemic shunts attenuation using thin film in cats carries a good short- and mid-term prognosis if they survive the postoperative period. Seizures were the most common cause of death.

Dermoid sinus in the perirectal fossa of a Siamese cat with involvement of the vaginal wall.

A 2.5-year-old spayed female Siamese cat was presented with a recurrent exudative wound in the right perirectal fossa. Clinical examination at presentation revealed a 1 cm long open wound with purulent discharge in the right perirectal fossa but was otherwise unremarkable. A computed tomography contrast-enhanced study showed a tracking sinus which could be traced from the right dorsolateral perianal region right up to the level of the vagina. Surgical exploration was performed from the perirectal region. The intermuscular sinus tract, which formed a cystic structure and connected to the vaginal wall, was en bloc excised. Histopathological examination confirmed the diagnosis of a dermoid sinus in the perirectal fossa with vaginal infiltration. To the authors' knowledge, this is the first case report in the veterinary literature of the successful surgical management of a dermoid sinus in the perianal region connected to the vaginal wall in a cat.

Outcome of two variations of a surgical technique performed for canine unilateral arytenoid lateralisation.

Background The purpose of this study is to compare the rate of aspiration pneumonia and survival time of dogs undergoing two unilateral arytenoid lateralisation (UAL) techniques.Methods Eighty dogs diagnosed with laryngeal paralysis were treated by one of two UAL techniques: (1) a standard technique (ST) and (2) an anatomic preservation technique (APT). Outcome was assessed by in clinic re-examination and an owner follow-up questionnaire.Results Minor complications were reported for 22 per cent of dogs undergoing ST and 26 per cent for APT. Major complications were 7 per cent for ST versus 23 per cent for APT. Postoperative aspiration pneumonia was reported for 7 per cent of cases in ST and 17 per cent in APT. The median survival time for ST was 636 days and was 1067 days for APT. Cause of death was related to the laryngeal paralysis in 22 per cent, neurological deterioration in 16 per cent and for non-associated reasons in 59 per cent of cases. There was no statistically significant difference in the rate of aspiration pneumonia or survival time among the treatment groups. Owners reported that their dogs improved after both surgical procedures, with 90 per cent of the owners satisfied with the surgical outcome. Eighteen per cent of the dogs suffered recurrence of clinical signs.Conclusions In this study, there was no significant difference in risk of aspiration pneumonia or survival time following arytenoid lateralisation by either an ST or an APT.

Retrobulbar steatitis and meningitis/empyema secondary to right otitis media, right otitis interna and an inflammatory polyp in a cat.

The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthalmic and neurological examinations, haematology and biochemistry, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and aerobic, anaerobic bacterial and fungal culture of material from the middle ear. A 6-year-old female neutered domestic-short-haired cat presented with right-sided exophthalmos and resistance to retropulsion. Anisocoria, reduced corneal sensation and oculocephalic movements and low Schirmer tear test (STT1) were found. An MRI revealed the right external ear canal and tympanic bulla to be fluid filled with presence of a thickened contrast-enhancing mucosa. Contrast enhancement extended into the calvarium, as marked thickening and contrast enhancement of the pachymeninges, and further rostrally through the right orbital fissure into the orbit. The retrobulbar tissues were swollen, resulting in mild exophthalmos. Enrichment culture of material from the middle ear revealed Klebsiella pneumonia susceptible to marbofloxacin. The cat underwent a total ear canal ablation with removal of the cartilaginous cuff at the external auditory meatus and local debridement and curettage. A polypoid structure was removed from the middle ear. No bulla osteotomy was performed. Horner's syndrome was present immediately following surgery. The cat received a course of systemic dexamethasone (1mg/cat SID/3 weeks) tapered off and marbofloxacin (2mg/kg SID/2 weeks). Follow up at 120 days showed no recurrence of the symptoms. The Horner's syndrome and low STT1 had resolved and returned to normal values respectively. This case highlights the importance of MRI in the investigation of retrobulbar diseases. MRI is a useful tool for the evaluation of the extent of the lesion and the appearance of adjacent structures in which additional potentially life-threatening abnormalities, such as meningitis, can be seen.

Outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs: 52 cases (2005-2012).

OBJECTIVE: To describe the outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs and identify factors associated with outcome. DESIGN: Retrospective case series. ANIMALS: 20 cats and 32 dogs with a skin defect involving the distal aspect of a limb that received 58 full-thickness skin grafts between 2005 and 2012. PROCEDURES: Data regarding patient signalment, location and cause of the skin defect, surgical and anesthetic duration, and postoperative bandaging protocol were obtained from the medical records. Graft outcome was assessed by interpreting descriptions in the records; skin viability over ≥ 75% of the graft area between 7 and 14 days after surgery was considered a successful outcome. RESULTS: For 4 of the 58 grafts, graft outcome could not be determined from the medical record. For the remaining grafts, success rate was significantly higher for grafts placed in cats (17/22 [77%]) than in dogs (12/32 [38%]). The overall complication rate was 50%; complications included skin graft failure, donor site dehiscence, and bandage-induced sloughing of skin adjacent to the graft recipient site. In addition to species, anatomic location of the skin defect was identified as a prognostic indicator of graft outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Full-thickness skin grafting had a higher success rate in cats than in dogs. Skin grafts applied to the antebrachium, compared with other locations on the distal aspects of the limbs, were associated with a poorer prognosis.

The outcome of combined urethropexy and colposuspension for management of bitches with urinary incontinence associated with urethral sphincter mechanism incompetence.

OBJECTIVE: To report 1) a combined technique of urethropexy and colposuspension; 2) intra- and postoperative complications; and 3) medium term outcome. STUDY DESIGN: Retrospective case series. ANIMALS: Female dogs (n = 30) with urinary incontinence associated with urethral sphincter mechanism incompetence (USMI) unresponsive to medical management. METHODS: Through a ventral median celiotomy, the bladder was positioned abdominally to permit the urethra to be anchored with single interrupted polypropylene sutures to the prepubic tendon and linea alba. The vagina was freed from the vesicovaginal and rectovaginal attachments and advanced cranially by traction before attachment to the prepubic tendon with polypropylene mattress sutures. Bitches were re-examined 2 weeks postoperatively; medium term outcome (>6 months) was evaluated by telephone interview of owners. RESULTS: At a median follow up of 39.5 months, 21 bitches (70%) were considered to have an "excellent" medium term outcome with complete resolution of their urinary signs; 8 (26.6%) had a "good" outcome, and 3 (10%) had mild transient dysuria postoperatively. CONCLUSION: Combined urethropexy and colposuspension resulted in complete resolution of urinary incontinence in 70% of bitches with USMI and was not associated with major complications.

Effect of three anesthetic induction protocols on laryngeal motion during laryngoscopy in normal cats.

OBJECTIVES: To objectively measure and subjectively score the effect of 3 anesthetic induction protocols on arytenoid cartilage motion in normal cats. STUDY DESIGN: Randomized prospective clinical study. ANIMALS: Cats (n = 35) without previous history of respiratory dysfunction. METHODS: Cats were randomly assigned to administration of alfaxalone, propofol, or midazolam and ketamine to induce anesthesia after premedication with methadone. Videolaryngoscopy was performed. Still images at maximum inspiration and expiration were used to measure the area and height of the rima glottidis. Change in rima glottidis area and of normalized glottal gap area (NGGA = area/height(2) ) was calculated. Subjective scores for arytenoid movement were obtained. Kruskal-Wallis test was performed on change of NGGA and rima glottidis area. RESULTS: No statistically significant difference was found between groups for age, sex, body weight, and body condition score. Percentage increase of rima glottidis area and change in NGGA were similar for all groups (P = .33 and P = .29). No significant differences were found for subjective scores between groups (P = .54). Arytenoid movement was not detected during videolaryngoscopy and subjective scoring in 3 cats anesthetized with propofol and in 3 cats anesthetized with midazolam and ketamine, despite presence of respiratory movements. CONCLUSIONS: No difference in laryngeal motion was observed between the 3 protocols used to induce anesthesia in cats premedicated with methadone.

Subtotal vaginectomy for management of extensive vaginal disease in 11 dogs.

OBJECTIVE: To report (1) a surgical technique for subtotal vaginectomy using a combined abdominal and vestibular approach; (2) intra- and postoperative complications; and (3) long-term outcome. STUDY DESIGN: Retrospective case series. ANIMALS: Female dogs (n = 11) with extensive intramural vaginal disease. METHODS: Through a ventral median celiotomy, the cranial aspect of the vagina was freed and ovariohysterectomy (OVH) was performed in intact females. After episiotomy, the vaginal wall was incised at the vestibulovaginal junction cranial to the urethral orifice, and the vagina freed from any remaining pelvic attachments. Dogs were reexamined at 4 weeks and 6 months. Long-term outcome was evaluated by contacting the primary veterinarian by phone. RESULTS: Five dogs had benign vaginal disease and 6 had malignant vaginal neoplasia. A combined abdominal and vestibular approach permitted subtotal vaginectomy in all dogs; 6 dogs also had OVH. No major complications occurred and clinical signs had resolved by 4 weeks. One dog with malignant neoplasia was euthanatized 3 months later for metastatic disease and 1 dog developed postoperative urinary incontinence. Local recurrence or metastases were not identified in the other dogs. CONCLUSION: Combined abdominal and vestibular approach for subtotal vaginectomy allowed complete resection of extensive vaginal lesions, was not associated with major complications, and outcome was favorable.

Arytenoid lateralization for management of combined laryngeal paralysis and laryngeal collapse in small dogs.

OBJECTIVE: To identify combined laryngeal paralysis and collapse in small dogs and describe postoperative outcome after arytenoid lateralization. STUDY DESIGN: Case series. ANIMALS: Small nonbrachycephalic breed dogs with laryngeal paralysis and collapse (n = 6). METHODS: Medical records of small breed dogs with airway problems and undergoing laryngeal surgery (January-December 2008) were reviewed. Dogs with combined laryngeal paralysis and laryngeal collapse (LPLC) had arytenoid lateralization. The immediate, 4 week and 6 month postoperative outcomes were described. RESULTS: Direct visual laryngeal exam under a light plane of anesthesia revealed bilateral failure of arytenoid and vocal fold movement and concurrent bilateral medial folding with contact of the cuneiform processes in all dogs. None of the dogs had intra- or immediate postoperative complications after arytenoid lateralization. Two dogs required a 2nd contralateral procedure. Follow-up after 6 months revealed marked improvement in clinical signs related to upper airway obstruction, but all dogs continued to have mild respiratory noise. CONCLUSION: Concurrent laryngeal paralysis and collapse should be considered as part of the differential diagnosis for small, nonbrachycephalic dogs with upper airway disease. Arytenoid lateralization resulted in improvement of clinical signs related to obstructive airway disease.