The effect of experience, simulator-training and biometric feedback on manual ventilation technique.

OBJECTIVE: To determine the frequency of provision and main providers (veterinary surgeons, nurses or trainees) of manual ventilation in UK veterinary practices. Furthermore, to determine the variation in peak inspiratory (inflation) pressure (PIP), applied to a lung model during manual ventilation, by three different groups of operators (inexperienced, experienced and specialist), before and after training. STUDY DESIGN: Questionnaire survey, lung model simulator development and prospective testing. METHODS: Postal questionnaires were sent to 100 randomly selected veterinary practices. The lung model simulator was manually ventilated in a staged process over 3 weeks, with and without real-time biometric feedback (PIP display), by three groups of volunteer operators: inexperienced, experienced and specialist. RESULTS: The questionnaires determined that veterinary nurses were responsible for providing the majority of manual ventilation in veterinary practices, mainly drawing on theoretical knowledge rather than any specific training. Thoracic surgery and apnoea were the main reasons for provision of manual ventilation. Specialists performed well when manually ventilating the lung model, regardless of feedback training. Both inexperienced and experienced operators showed significant improvement in technique when using the feedback training tool: variation in PIP decreased significantly until operators provided manual ventilation at PIPs within the defined optimum range. Preferences for different forms of feedback (graphical, numerical or scale display), revealed that the operators' choice was not always the method which gave least variation in PIP. CONCLUSIONS AND CLINICAL RELEVANCE: This study highlighted a need for training in manual ventilation at an early stage in veterinary and veterinary nursing careers and demonstrated how feedback is important in the process of experiential learning. A manometer device which can provide immediate feedback during training, or indeed in a real clinical setting, should improve patient safety.

Trephination of the frontal sinuses and instillation of clotrimazole cream: a computed tomographic study in canine cadavers.

OBJECTIVE: To use computed tomography (CT) to assess the distribution of surgically administered clotrimazole cream and associated filling of the frontal sinuses and caudal aspect of the nasal cavities in canine cadavers. STUDY DESIGN: Observational study. ANIMALS: Small (n = 1) and medium-large (n = 11) breed canine cadavers. METHODS: CT scans of 12 cadaveric canine heads were used to confirm absence of sinonasal disease. Then after creating an opening into the left and right frontal sinuses with a 3.2 mm Steinmann pin at standardized landmarks, clotrimazole cream (20 g) was instilled into each side. Postoperative CT scans of the heads was used to assess the distribution and degree of filling of the sinonasal cavities with clotrimazole cream, and to identify any damage to local structures. RESULTS: Filling was excellent in 22 sinuses, very poor in 2, and excellent in all caudal nasal cavities. Two cadavers had damage: unilateral penetration of the cranium (2) and unilateral penetration of the lateral sinus wall (1). CONCLUSION: Excellent filling of most of the frontal sinuses and caudal nasal cavity of cadavers with clotrimazole cream is achieved when administered by this technique. Damage to local structures may occur intraoperatively using this technique.

Incidence of alimentary and respiratory disease in brachycephalic dogs presenting to primary care veterinary practices participating in the SAVSNET project.

BACKGROUND: Brachycephalic dogs clinically affected by brachycephalic obstructive airway syndrome have been shown to have a high incidence of gastrointestinal disease, with French Bulldogs (FBD) identified as a particularly affected breed. METHODS: Clinical records of 750 brachycephalic dogs attending over 500 practices participating in the small animal veterinary surveillance network (SAVSNET) project were analysed in this cohort study to determine the incidence of alimentary and respiratory disease within FBD, Bulldogs (BD) and Pugs attending primary care veterinary practice. Electronic clinical records were studied for treatment or acknowledgement of specific clinical signs that could be attributed to different anatomical locations. Disease of the different anatomical locations was marked as either being present or not present which allowed for statistical analysis. RESULTS: Significant differences in the incidence of oesophageal (p = 0.006), gastric (p = 0.001) and intestinal (p = 0.001) diseases were present among the breeds studied. FBD had significantly increased odds ratios of having oesophageal (2.0, 2.2), gastric (2.4, 1.5) and intestinal (1.7, 1.5) diseases relative to Pugs and BD, respectively. Pugs had significantly increased odds ratios of having upper respiratory tract disease relative to BD (1.9). CONCLUSION: The results show the incidence of gastrointestinal disease and upper respiratory tract disease is significantly different between the brachycephalic breeds studied. Furthermore, the general population of FBD has the highest incidence of gastrointestinal disease.

Canine anal sac gland carcinoma with regional lymph node metastases treated with sacculectomy and lymphadenectomy: Outcome and possible prognostic factors.

The staging system commonly used in canine anal sac gland carcinoma (ASGC) is a revised Tumour-Node-Metastasis (TNM) system published in 2007. This staging system consists in four stages and, for dogs with nodal metastases, the size of the metastatic lymph node (mLN) defines the N stage. However, we hypothesise that (1) the mLN size has no prognostic significance when the mLN can be excised, (2) a high number of mLNs is associated with poorer prognosis and (3) the measurement of the mLN on imaging is not reproducible. To investigate these hypotheses, medical records and diagnostic images of dogs with ASGC and mLN, treated with sacculectomy and lymphadenectomy, with or without chemotherapy, were reviewed. Interobserver variability for mLN measurement was assessed. Prognostic factors including mLN size and number were investigated. Time to documented progression (TDP) and disease-specific survival (DSS) were evaluated. Progression-free interval (PFI) was analysed with interval-censored data analysis. Fifty-seven dogs were included. The median PFI, TDP and DSS were 110 (95%CI 61.5-185.5), 196 (95%CI 162-283) and 340 days (95%CI 321-471), respectively. For measurement of the largest mLN, interobserver agreement was excellent but limits of agreement reached 39.7%. Neither the size of the largest mLN nor the use of adjuvant chemotherapy were associated with outcome. The number of mLNs was associated with outcome and having more than four mLNs was associated with shorter PFI (p < .001), TDP (p = .004) and DSS (p < .001). While mLN size measurement was not consistently reproducible and did not influence outcome in our cohort, number of mLNs did. Further studies are required for development of a revised staging system.

Evaluation of transdermal fentanyl patch attachment in dogs and analysis of residual fentanyl content following removal.

OBJECTIVE: To investigate whether the method used to attach matrix-type fentanyl patches influences the degree of skin attachment and the amount of active drug remaining in patches after use. STUDY DESIGN: Prospective, randomised clinical study. STUDY POPULATION: Fifteen adult dogs of mixed breeds. METHODS: Two equally sized matrix-type fentanyl patches were attached to the dorsal third of the lateral thorax of fifteen dogs for 72 hours. The two patches were attached using different techniques: Method AD used an adhesive dressing in combination with a transparent film. Method TG used tissue adhesive applied to the edges of the patch. After 72 hours the patches were removed and the proportion of the patch attached at this time calculated. The residual content of the patches was analysed using a validated gas chromatography-mass spectrometery (GC-MS) analysis technique. RESULTS: After 72 hours of continuous attachment, the mean proportion of drug uptake for method AD was 17.2 (SD ± 11.1)% and for method TG this was 16.9 (SD ± 7.3)%. The median proportion of attachment for method AD was 100% and for method TG was 95.6%. CONCLUSIONS: The method of attachment did not significantly influence the uptake of fentanyl from matrix-type patches. The method of attachment resulted in a significant difference in the proportion of the patch attached 72 hours after placement, with method AD resulting in a greater median proportion of attachment than TG. CLINICAL RELEVANCE: The method used to attach matrix-type fentanyl patches to dogs should not interfere with drug uptake. The residual fentanyl content remaining in these patches after 72 hours of continuous application is significant and could lead to intoxication if ingested by humans.

Ultrasound-guided placement of an anchor wire or injection of methylene blue to aid in the intraoperative localization and excision of peripheral lymph nodes in dogs and cats.

OBJECTIVE: To evaluate ultrasound-guided placement of an anchor wire (AW) or injection of methylene blue (MB) to aid in the intraoperative localization of peripheral lymph nodes in dogs and cats. ANIMALS: 125 dogs and 10 cats with a total of 171 lymphadenectomies. PROCEDURES: Medical records of dogs and cats that underwent peripheral lymphadenectomies with or without (N) the AW or MB localization technique were reviewed. Data retrieved included clinical, surgical, and histologic findings. The proportions of successful lymphadenectomies, lymph node characteristics, and complications among the 3 groups were analyzed. RESULTS: 143 (84%) lymph nodes were successfully excised. Lymphadenectomy success was significantly affected by the localization technique, with 94% for group AW, 87% for group MB, and 72% for group N. Lymph node size was smaller in groups AW and MB, compared with group N. Duration of lymphadenectomy was shorter in group AW, compared with groups MB and N, and in group MB, compared with group N. Intra- (7%) and postoperative (10%) complications and final diagnosis did not significantly differ among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Both lymph node localization techniques were highly successful and reduced surgery time, compared with unassisted lymphadenectomy. Specifically, these techniques were effective for localization of normal-sized and nonpalpable lymph nodes and were efficient and practical options for peripheral lymphadenectomies, particularly for those that were small or nonpalpable.

CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure.

CASE SUMMARY: A 3-year-old male neutered domestic shorthair cat was presented with a 1-week progressive and rapidly deteriorating history of lethargy and abnormal behaviour. Neurolocalisation indicated multifocal intracranial lesions (right oculomotor nerve, brainstem [obtundation, non-ambulatory tetraparesis, vestibular dysfunction and intermittent decerebrate rigidity] and possibly the thalamus [left-sided pleurothotonus]), or more likely a single brainstem lesion with mass effect. MRI of the brain demonstrated a brainstem abscess causing severe dorsal displacement particularly affecting the pons and the medulla oblongata causing cerebellar vermis herniation through the foramen magnum. CT-guided free-hand technique drainage of the brain abscess was performed and broad spectrum antibiotics were started based on sensitivity results. The cat recovered uneventfully from anaesthesia displaying marked improvement immediately after the procedure. Antibiotics were continued for 8 months; repeat imaging prior to withdrawal found complete resolution of the brainstem abscess. RELEVANCE AND NOVEL INFORMATION: Free-hand CT-guided drainage of a brainstem abscess is not without risk; however, in this case it led to significant clinical improvement and stabilisation likely owing to reduced intracranial pressure. It also provided a diagnostic sample that allowed successful medical treatment planning and outcome. To our knowledge, this is the first report describing the successful management of a brainstem abscess by CT-guided drainage in the veterinary literature. It suggests that stereotactic drainage followed by medical therapy can be considered a successful therapeutic alternative to brain surgery or medical treatment alone, providing an emergency treatment in cases of acute brainstem dysfunction.

Efficacy of en bloc ligation of the thoracic duct: descriptive study in 14 dogs.

OBJECTIVE: To assess whether en bloc ligation of all caudal mediastinal tissue between the aorta and thoracic vertebrae will occlude all branches of the thoracic duct. STUDY DESIGN: Descriptive study. ANIMALS: Canine cadavers (n=15). METHODS: The cisterna chyli was approached through a right paralumbar abdominal incision and cannulated. A right 10th intercostal thoracotomy was performed and the tissue of the caudal mediastinum dorsal to the aorta and ventral to the thoracic vertebrae was ligated. Radio-opaque contrast material was injected into the cisterna chyli during fluoroscopic imaging of the thorax and cranial abdomen. Still images were obtained before and after contrast injection and a subtraction image produced. Gray values were measured from these images, cranial and caudal to the ligature site. RESULTS: Cannulation of the cisterna chyli in 1 cadaver was impossible and it was, therefore, excluded. In 13 (93%) cadavers contrast material did not pass cranial to the ligature site. In 1 cadaver, an intact thoracic duct was identified on lymphangiography outside the en bloc ligation. CONCLUSION: En bloc ligation of the caudal mediastinal tissue dorsal to the aorta was successful in preventing opacification with contrast material of all branches of the thoracic duct in 93% of cadavers. CLINICAL RELEVANCE: En bloc ligation is successful in 93% of cadavers and reduces the operative time compared with techniques requiring some type of mesenteric lymphangiography to aid identification of the thoracic duct.

Use of recombinant human interferon alpha-2a in the management of a dog with epitheliotropic lymphoma.

An 8-year-old, mixed-breed dog with preputial epitheliotropic lymphoma was initially treated with cyclophosphamide, vincristine, and prednisolone. A short-term partial response was followed by disease progression after 4 weeks. Recombinant human interferon alpha-2a was administered starting at week 7. The interferon therapy resulted in rapid resolution of clinical signs and a 10-week disease-free interval. The lymphoma recurred at 17 weeks and did not respond to rescue chemotherapy. Additional oral lesions were treated with localized radiotherapy followed by increased dosages of interferon. This additional interferon treatment resulted in another 12 weeks of stable disease.

Prevalence of feline chronic gingivo-stomatitis in first opinion veterinary practice.

Feline chronic gingivo-stomatitis (FCGS) is a syndrome characterised by persistent, often severe, inflammation of the oral mucosa. In the absence of similar studies, our objective was to estimate the prevalence of FCGS in a convenience based sample of cats visiting first opinion small animal veterinary practices. Twelve practices took part, providing a sample population of 4858 cats. Veterinary surgeons identified cases of FCGS according to our case definition over a 12-week sampling period; age, sex and breed information was determined for all cats, plus brief descriptive data for FCGS cases. The prevalence of FCGS was 0.7% (34 cases, 95% confidence intervals: 0.5-1.0%). Of the 34 cases of FCGS, 44% (15 cats) were new cases and 56% (19 cats) were ongoing cases. No statistically significant difference (P>0.353) was found when the age, sex and breed of cats with FCGS were compared to data from cats without the condition.

Clinical and clinicopathologic abnormalities in young dogs with acquired and congenital portosystemic shunts: 93 cases (2003-2008).

OBJECTIVE: To determine whether clinical and clinicopathologic data could assist differentiation of congenital portosystemic shunts (CPSSs) from acquired portosystemic shunts (APSSs) in young dogs. DESIGN: Retrospective case series. ANIMALS: Dogs < 30 months of age with CPSSs (n = 62) or APSSs (31). PROCEDURES: Medical records from 3 referral centers identified 31 dogs with APSSs and 62 dogs with CPSSs diagnosed from July 2003 to July 2008. Signalment, clinical signs, physical examination, and clinicopathological data were recorded, and statistical analyses were performed to determine differences between groups. RESULTS: Univariable analysis showed APSS patients were older, heavier, and in poorer body condition, compared with CPSS patients. In CPSS patients, diarrhea was less prevalent, and neurologic signs were more prevalent. Ascites was more prevalent in APSS (Fisher exact test; OR, 50.2; 95% confidence interval [CI], 6.2 to 409.7), with no significant difference in albumin concentration between groups. The logistic regression model used to assess clinicopathological parameters showed lower Hct (OR, 1.42 × 10(-12); 95% CI, 1.42 × 10(-17) to 4.0 × 10(-6)), higher mean corpuscular volume (OR, 1.27; 95% CI, 1.08 to 1.50), and higher alanine aminotransferase concentrations (OR, 1.005; 95% CI, 1.001 to 1.009) were more likely in APSS patients. CONCLUSIONS AND CLINICAL RELEVANCE: Several clinicopathologic differences between dogs with congenital and acquired shunts were identified; however, assessed alone, these would be unlikely to enable differentiation between the 2 conditions. Awareness of the rarity of ascites in CPSS cases should prompt recognition of a likely diagnosis of APSS, allowing the veterinarian to target further diagnostics and counsel the owner appropriately.

Biliothorax in a Siamese cat.

A 2-year-old male neutered cat presented for further investigation of biliothorax. The cat was initially treated for pyothorax, including bilateral chest drains for lavage of the pleural space. Five days later, the pleural effusion turned clear-yellow and had a bilirubin concentration of 427 µmol/l compared to the serum bilirubin concentration of 15 µmol/l. Exploratory surgery revealed a 2mm tear in the diaphragm, with a corresponding 2mm defect in the diaphragmatic surface of the gall bladder, creating a fistula between the gall bladder and the pleural cavity. The defects were repaired routinely and the cat made a full recovery. It was suspected that the tears had been created at the time of the thoracostomy tube placement. Biliothorax has not been described before in a cat, and appears to be a rare complication following thoracostomy tube placement.

Underlying diseases in dogs referred to a veterinary teaching hospital because of dyspnea: 229 cases (2003-2007).

OBJECTIVE: To identify the most frequent underlying diseases in dogs examined because of dyspnea and determine whether signalment, clinical signs, and duration of clinical signs might help guide assessment of the underlying condition and prognosis. DESIGN: Retrospective case series. ANIMALS: 229 dogs with dyspnea. PROCEDURES: Case records of dogs referred for dyspnea were reviewed and grouped according to location or etiology (upper airway, lower respiratory tract, pleural space, cardiac diseases, or obesity and stress). Signalment, clinical signs at initial examination, treatment, and survival time were analyzed. RESULTS: Upper airway (n = 74 [32%]) and lower respiratory tract (76 [33%]) disease were the most common diagnoses, followed by pleural space (44 [19%]) and cardiac (27 [12%]) diseases. Dogs with upper airway and pleural space disease were significantly younger than dogs with lower respiratory tract and cardiac diseases. Dogs with lower respiratory tract and associated systemic diseases were significantly less likely to be discharged from the hospital. Dogs with diseases that were treated surgically had a significantly better outcome than did medically treated patients, which were significantly more likely to be examined on an emergency basis with short duration of clinical signs. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs examined because of dyspnea, young dogs may be examined more frequently with breed-associated upper respiratory tract obstruction or pleural space disease after trauma, whereas older dogs may be seen more commonly with progressive lower respiratory tract or acquired cardiac diseases. Nontraumatic acute onset dyspnea is often associated with a poor prognosis, but stabilization, especially in patients with cardiac disease, is possible. Obesity can be an important contributing or exacerbating factor in dyspneic dogs.