Evaluation of risk factors for mortality in dogs with lung lobe torsion: A retrospective study of 66 dogs (2000-2015).

The objectives of this retrospective case series study were to describe a group of 66 dogs with lung lobe torsion (LLT) and to investigate the incidence of complications and risk factors for mortality and overall outcome in this population. Sixty-six dogs with LLT from 3 independent academic institutions were investigated. Information on signalment, history, clinical findings, and interventions was obtained. Associations with mortality outcome were examined via logistic regression. Dogs with a depressed mentation at presentation were 21 times more likely to die than dogs with normal mentation [P = 0.008, 95% confidence interval (CI) = 1.949 to 579.904]. The overall odds of mortality were increased by 18% for each unit change in Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) score (P = 0.04, 95% CI = 0.998 to 1.44). No other clinical abnormalities correlated with outcome.

Évaluation des facteurs de risque pour la mortalité chez les chiens souffrant d'une torsion du lobe pulmonaire : étude rétrospective de 66 chiens (2000­2015). Les objectifs de cette étude rétrospective d'une série de cas consistaient à décrire un groupe de 66 chiens ayant une torsion du lobe pulmonaire (TLP) et d'investiguer l'incidence de complications et les facteurs de risque pour la mortalité et les résultats généraux chez cette population. Soixante-six chiens atteints de TLP provenant de trois établissements universitaires indépendants ont été étudiés. Des données ont été obtenues sur le signalement, les résultats cliniques et les interventions. Les associations avec les résultats de mortalité ont été examinées via la régression logistique. Il était 21 fois plus probable que les chiens ayant un état mental déprimé à la présentation meurent que les chiens ayant un état mental normal (P = 0,008, intervalle de confiance [IC] de 95 % = de 1,949 à 579,904). Les probabilités globales de mortalité augmentaient de 18 % pour chaque unité de changement selon la note Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) (P = 0,04, IC de 95 % = de 0,998 à 1,44). Aucune autre anomalie clinique n'offrait de corrélation avec les résultats.(Traduit par Isabelle Vallières).

Predictors of survival in lung torsion: A systematic review and pooled analysis.

OBJECTIVE: Lung torsion (LT) is a rare but life-threatening event. The objective of this study was to systematically review the natural history and clinical outcome of LT in published studies. METHODS: A review of publications on LT from January 1950 to December 2014 was performed using 3 databases (PubMed, EMBASE, and Web of Science). The primary efficacy outcome was LT-related mortality. Intervention was classified as direct resection (resection without detorsion), indirect resection (resection after detorsion), and reposition. Univariate comparisons of survival were performed using a logistic regression model. RESULTS: There were 109 patients from 91 studies identified in this analysis. LT was frequently reported after upper lobectomy (74.4%) and the middle lobe was the most vulnerable lesion (29.4%). The main clinical presentations were dyspnea (38.4%), fever (23.3%), and chest pain (17.4%). Radiologic findings suggestive of LT included worsening consolidation and abrupt truncation/tapering of the pulmonary artery. The overall mortality was 8.3%. Univariate analysis showed that the extent of torsion (whole LT vs lobar torsion) was significantly associated with survival (odds ratio, 5.867; P = .017). No significant difference was found between patients receiving direct resection and those receiving reposition; a trend was observed for worsening outcomes in patients treated with indirect resection (odds ratio, 5.300; P = .060). CONCLUSIONS: The systematic review reveals the prevalence, key diagnostic tests, and optimal treatment methods for lung torsion. Whole LT is associated with higher mortality rates than lobar torsion. If the tortuous part is viable, reposition and direct resection have similar survival rates; otherwise, direct resection should be performed.

Primary splenic torsion in dogs: 102 cases (1992-2014).

OBJECTIVE: To determine the percentage of dogs surviving to hospital discharge and identify factors associated with death prior to hospital discharge among dogs undergoing surgery because of primary splenic torsion (PST). DESIGN: Retrospective case series. ANIMALS: 102 client-owned dogs. PROCEDURES: Medical records of dogs with a confirmed diagnosis of PST that underwent surgery between August 1992 and May 2014 were reviewed. History, signalment, results of physical examination and preoperative bloodwork, method of splenectomy, concurrent surgical procedures, perioperative complications, duration of hospital stay, splenic histopathologic findings, and details of follow-up were recorded. Best-fit multivariate logistic regression was performed to identify perioperative factors associated with survival to hospital discharge. RESULTS: 93 of the 102 (91.2%) dogs survived to hospital discharge. German Shepherd Dogs (24/102 [23.5%]), Great Danes (15/102 [14.7%]), and English Bulldogs (12/102 [11.8%]) accounted for 50% of cases. Risk factors significantly associated with death prior to hospital discharge included septic peritonitis at initial examination (OR, 32.4; 95% confidence interval [CI], 2.1 to 502.0), intraoperative hemorrhage (OR, 22.6; 95% CI, 1.8 to 289.8), and postoperative development of respiratory distress (OR, 35.7; 95% CI, 2.7 to 466.0). Histopathologic evidence of splenic neoplasia was not found in any case. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the prognosis for dogs undergoing splenectomy because of PST was favorable. Several risk factors for death prior to discharge were identified, including preexisting septic peritonitis, intraoperative hemorrhage, and postoperative development of respiratory distress.

National Trends in the Surgical Treatment of Ovarian Torsion in Children: An Analysis of 2041 Pediatric Patients Utilizing the Nationwide Inpatient Sample.

The aim of this study was to evaluate the national trends in surgical management of ovarian torsion (OT) in children. The Nationwide Inpatient Sample was queried from 1998 to 2011 for females less than 18 years of age with OT. Patients were stratified into three treatment groups: oophorectomy (OO), oophoropexy, or release of torsion (RT) alone. There were 2041 patients with OT, of which 1598 (78%) underwent OO, 126 (6%) oophoropexy, and 317 (15%) RT. RT significantly increased from 1998 to 2011 (9% vs 25%; P < 0.05). At nonteaching hospitals, there were higher rates of OO (89.3% vs 79.5%; P < 0.05) and lower rates of RT (10.7% vs 20.5%; P < 0.05) compared with teaching hospitals. RT was performed at a higher rate in Northeast United States compared with the South (22.7% vs 14.2%; P < 0.05). Girls presenting at nonteaching hospitals and the South had increased odds of undergoing OO compared with those presenting at teaching hospitals and the Northeast (P < 0.05). Although ovarian conservation for OT in children is more often performed in the Northeast United States and at teaching hospitals, this large population-based study demonstrates OO remains the most common surgical management for OT in the United States.

Increased risk of complications in acute onset intestinal malrotation.

INTRODUCTION: Intestinal malrotation is a potentially life-threatening illness which presents in many different ways and the symptoms span from acute to chronic. The purpose of this study was to determine the clinical presentation of intestinal malrotation at all ages. MATERIAL AND METHODS: This was a retrospective study of all patients operated for intestinal malrotation at Odense University Hospital in the period from 1/1/1990 to 1/4/2012. The following information was recorded in the hospital records: demographics, presentation, duration of symptoms, diagnostic imaging and outcome. Patients were classified into two age groups: children (0-15 years) and adults (over 15 years). RESULTS: A total of 54 patients were identified - 47 children and seven adults. Children frequently presented with acute symptoms, while adults mostly had chronic symptoms. The mortality rate was 6% and 14% for children and adults, respectively (p = 0.44). Deaths were due to volvulus. CONCLUSION: Intestinal malrotation may have an acute and a chronic form in both children and adults. Complications and death only occurred in patients with an acute onset. Proper knowledge about symptoms is important for a good outcome. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Liver torsion leading to death in a 16-month-old infant treated neonatally for an omphalocele]. / Volvulus du foie d'évolution fatale 16 mois après la cure d'une omphalocèle géante.

We report the case of an infant who underwent surgery on the first day of life for a giant omphalocele. At the age of 16 months, he presented an acute abdominal syndrome and died a few hours later. Autopsy revealed a twisted left liver lobe (LL) including a suprahepatic vein. To our knowledge, this is the first case of giant omphalocele complicated by twisted liver lobe and fatal outcome.

Adnexal torsion leading to death of an infant.

BACKGROUND: Torsion of the uterine adnexa is an uncommon occurrence in infants, but when it does occur, the consequences may be catastrophic. CASE: A 4-month-old female presented with sudden cardiac and respiratory arrest. There were no prior signs of illness. The infant was resuscitated and survived for one day after the event. Autopsy revealed a left ovarian cyst with torsion. Necrosis of the transverse colon was also seen. Other organs revealed signs of shock. The cause of death was felt to be related to the torsion. SUMMARY AND CONCLUSION: Torsion of the uterine adnexa is rare in infants. In the few reported cases, antecedent symptoms were present. Clinicians should be aware of this possibility and include it in the differential diagnosis of death in infancy.

Surgical treatment of uterine torsion using a ventral midline laparotomy in 19 mares.

OBJECTIVE: To report on the outcome of surgical treatment of uterine torsion in preterm mares. DESIGN: Retrospective case series of pregnant mares with uterine torsion presented to the Clinic for Obstetrics, Gynaecology and Andrology of Large and Small Animals. METHODS: Hospital records of all pregnant mares that underwent ventral midline laparotomy for uterine torsion between 1998 and 2004 were reviewed. The signalment, history, clinical signs, results of diagnostic procedures, direction and degree of the uterine twist, treatment and outcome were retrieved from each case record. RESULTS: This study comprised 19 mares between months 5 and 11 of pregnancy (8.7 +/- 1.9) and suffering from uterine torsion. In all cases ventromedian laparotomy was carried out under general anaesthesia. Gastrointestinal disorders were also present in 52.6% of horses. Postoperative complications included subcutaneous seromas (five mares), peritonitis (one mare) and abortion (two mares). In four mares (21%) the operation was unsuccessful (i.e. these mares had to be euthanased intra- or postoperatively). Of the surviving 15 mares, 13 (86.6%) gave birth to viable foals at full term. The foals developed normally. Only two mares aborted. CONCLUSIONS: Because of its versatility the ventral midline approach should be considered for correction of uterine torsion. The approach has many advantages, including rapid and clear access to the abdominal cavity, safety, visual assessment of uterine wall viability, correction of concomitant gastrointestinal tract problems, and performance of hysterotomy or hysterectomy, if indicated. In this study, managing uterine torsion in this way resulted in a high percentage of cases (86.6%) in which pregnancy was maintained, with the birth of a viable, mature foal.