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OBJECTIVE: To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Large breed (25-40 kg) cadaver dogs (n = 10). METHODS: Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS: Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS: Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE: Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
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Cadáver , Excisão de Linfonodo , Mediastinoscopia , Mediastino , Animais , Cães , Mediastinoscopia/veterinária , Mediastinoscopia/métodos , Excisão de Linfonodo/veterinária , Excisão de Linfonodo/métodos , Mediastino/cirurgia , Linfonodos/cirurgia , Linfonodos/anatomia & histologiaRESUMO
Determining the risk of pathologic fracture in dogs with a primary bone tumor would aid in case selection for in-situ treatment options. Prior research found strong relationships between in vitro strength of canine antebrachii with primary bone tumors and CT-derived metrics. This study assesses the prognosis for pathologic fracture in dogs with distal radial bone tumors using CT-derived structural analysis metrics. CT images of the antebrachium in dogs with aggressive osseous lesions of the radius were used to calculate structural rigidity and failure forces, including axial rigidity (AR), craniocaudal bending rigidity (BR), torsional rigidity (TR), and failure forces for a slightly-curved/asymmetric beam (Fs) or a curved beam (Fc). Metrics were compared with the clinical outcome of radial fracture. Eight of 19 dogs with CT-derived metrics developed a radial fracture. The prognostic potential of the metrics to discriminate fractured and nonfractured bones was analyzed using receiver operating characteristic curves (area under the curve), stepwise logistic regression, and classification regression (CART) analyses. Fc was the most sensitive and specific metric for prognosing fracture occurrence (AUC = 0.864). When dog body weight (BW) was included, all five metrics had AUC > 0.705. Fc was the best predictor of fracture using stepwise logistic regression and CART analysis, followed by BR. An indication of fracture probability can be determined by normalizing Fc or BR with dog BW or by using the logistic regression equation of either metric with dog BW. Results warrant further analysis of a larger cohort to evaluate fracture likelihood in dogs with antebrachial bone neoplasia.
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OBJECTIVE: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN: Narrative review. METHODS: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.
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Privação do Sono , Cirurgia Veterinária , Desempenho Profissional , Humanos , Fadiga , Narração , Gestão de Riscos , Privação do Sono/psicologia , Cirurgia Veterinária/organização & administração , Desempenho Profissional/estatística & dados numéricos , Tolerância ao Trabalho Programado , Carga de TrabalhoRESUMO
Background: Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor. Objectives and procedures: This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors. Results: Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians. Conclusion and clinical relevance: Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.
Un examen narratif des horaires de travail qui ont un impact sur la fatigue et la récupération en rapport avec le bien-être des vétérinaires. Mise en contexte: L'insuffisance de sommeil est une affection mondiale avec de graves implications pour la santé mentale et physique. Les facteurs liés à l'emploi jouent un rôle important dans la détermination des habitudes de sommeil. Les travailleurs de la santé sont particulièrement sensibles à l'insuffisance de sommeil liée au travail et au repos inadéquat en général. Il y a peu de publications sur les pratiques de sommeil chez les vétérinaires, et la reconnaissance globale des impacts d'un repos inadéquat au sein de la profession vétérinaire est faible. Objectifs et procédures: Cette revue décrit les facteurs professionnels affectant la quantité suffisante de repos et de la récupération, passe en revue la littérature spécifique aux vétérinaires ainsi que celle adjacente pertinente concernant les habitudes de sommeil, et discute des solutions potentielles pour traiter les horaires professionnels contribuant à l'insuffisance de sommeil et au repos inadéquat. Des bases de données en ligne ont été consultées pour extraire la littérature contemporaine relative au sommeil, au repos insuffisant et aux facteurs liés à l'emploi, en mettant l'accent sur la médecine vétérinaire et d'autres secteurs de la santé. Résultats: Les facteurs liés à l'emploi entraînant un repos insuffisant chez les travailleurs de la santé comprennent les charges de travail excessives, les journées de travail prolongées, les jours cumulés d'heures de travail pénibles et les gardes après les heures normales de travail. Ces facteurs sont répandus au sein de la profession vétérinaire et peuvent contribuer à un repos insuffisant généralisé et aux impacts négatifs qui en résultent sur la santé et le bien-être des vétérinaires. Conclusion et pertinence clinique: Une quantité et une qualité de sommeil suffisantes sont essentielles à la santé physique et mentale et sont négativement affectées par de nombreux aspects de la profession vétérinaire. L'examen critique des stratégies actuelles utilisées dans la pratique clinique est essentiel pour promouvoir l'épanouissement professionnel, la santé et le bien-être des vétérinaires.(Traduit par Dr Serge Messier).
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Privação do Sono , Médicos Veterinários , Humanos , Fadiga/veterinária , Saúde Mental , Privação do Sono/veterináriaRESUMO
Background: Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue. Objectives and procedures: This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years. Results: The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health. Conclusion and clinical relevance: Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health.
Un examen narratif de la physiopathologie et des impacts d'un sommeil insuffisant et perturbé. Contexte: Malgré les ramifications importantes d'un manque de sommeil sur la santé mentale et physique et le bien-être général, de nombreuses personnes ignorent ce qui constitue un sommeil suffisant ou l'étendue à court et à long terme des effets du manque de sommeil, y compris ceux qui peuvent ne pas être perçus comme de la fatigue. Objectifs et procédures: Cette revue décrit la physiologie du sommeil, définit des normes de santé, passe en revue la physiopathologie et les risques pour la santé de l'insuffisance de sommeil aiguë et chronique et propose des concepts pour améliorer l'hygiène individuelle du sommeil. Des bases de données en ligne ont été consultées pour extraire la littérature relative au sommeil, à l'insuffisance de sommeil, à la fatigue et à la santé, en mettant l'accent sur la littérature publiée au cours des 5 années précédentes. Résultats: Les effets néfastes de la perte de sommeil aiguë et chronique varient dans leur portée et leur impact. Les individus obtiennent souvent une quantité de sommeil inférieure aux normes, un problème mal reconnu par les individus et la société. Ce manque de reconnaissance perpétue une culture dans laquelle l'insuffisance de sommeil est acceptée, entraînant des impacts négatifs graves et substantiels sur la santé mentale et physique. Conclusion et pertinence clinique: La gestion du sommeil est l'un des aspects les plus fondamentaux et les plus imprévisibles de la santé personnelle. Améliorer la prise de conscience des rôles physiologiques importants du sommeil, des habitudes de sommeil saines et des conséquences d'un sommeil insuffisant est essentiel pour promouvoir le bien-être général et la santé mentale et physique.(Traduit par Dr Serge Messier).
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Nível de Saúde , Privação do Sono , Animais , Privação do Sono/veterinária , Fadiga/veterinária , SonoRESUMO
OBJECTIVE: To describe and compare onset and intensity of thoracic duct (TD) coloration in healthy dogs after intrahepatic injection of either indocyanine green (ICG) visualized by intraoperative near-infrared fluorescence lymphography (NIRFL) or direct thoracoscopic visualization of methylene blue dye (MB). STUDY DESIGN: Prospective study. ANIMALS: Healthy adult Beagle dogs (n = 5). METHODS: All dogs had biochemical panels and complete blood counts preoperatively. Computed tomography lymphography (CTL) was performed prior to a standard 3-port thoracoscopic approach. A mixture of MB and ICG was injected by ultrasound-guided percutaneous injection into right or left-sided hepatic lobes. Data collected included dose of contrast agent (MB vs. ICG), injection site, timing, and quality of operative TD identification. Potential hepatic injury was assessed by repeat laboratory evaluation and abdominal ultrasound 14 days postoperatively. RESULTS: Preoperative CTL provided a diagnostic study in 5/5 dogs. After intrahepatic injection of combined dyes, NIRFL allowed visualization of TDs in 5/5 dogs, but MB did not result in visible TD coloration in any dog. Intrahepatic injection of ICG achieved successful NIRFL in a median time of 6 minutes and persisted for the 20 minute observation period in all five dogs. All dogs recovered without complication and were subsequently adopted. CONCLUSION: NIRFL of the TD can be achieved with intraoperative hepatic injection of ICG. Intrahepatic injection of MB did not result in visible TD coloration. CLINICAL SIGNIFICANCE: Hepatic intra-parenchymal injection is a reliable alternative portal into the TD system for intraoperative visualization of TD anatomy using ICG in dogs.
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Verde de Indocianina , Ducto Torácico , Animais , Corantes , Cães , Azul de Metileno , Estudos Prospectivos , Ducto Torácico/cirurgia , Ultrassonografia de Intervenção/veterináriaRESUMO
OBJECTIVE: To describe academic rank, gender, surgical career length, and publication record of academic veterinary surgeons and to estimate the association between gender and higher academic rank. STUDY DESIGN: Cross-sectional study. SAMPLE: Residency-trained surgeons at US veterinary schools in 2019. METHODS: Surgeons were identified via institutional websites. Data including surgeon gender, academic title, and year of board certification were collected from public resources. Publication record was measured by using author h-indices obtained from Scopus. Data were analyzed with descriptive and inferential statistics. RESULTS: Three hundred eighteen surgeons were identified from 30 institutions, including 162 (51%) women and 156 (49%) men. Women represented 66% of instructors and assistant professors, and men represented 60% of associate and full professors. This distribution differed significantly (P < .001). Author h-index was associated with career length but not gender. Men were 2.5 times more likely than women to be associate or full professors (odds ratio 2.52, 95% CI 1.03-6.14, P = .042) after adjustment for career length and h-index. CONCLUSION: Female surgery faculty at US veterinary schools in 2019 were concentrated in lower academic ranks and were less likely than male surgery faculty to be associate or full professors after adjustment for career length and publication record. IMPACT: A gender gap exists in academic veterinary surgery in the United States. It is critical to recognize that women's increasing participation in veterinary medicine has not been matched by equal representation in all areas. Additional efforts are warranted to identify contributing factors and implement strategies to improve gender inclusion.
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Desempenho Acadêmico , Docentes de Medicina/estatística & dados numéricos , Faculdades de Medicina Veterinária/estatística & dados numéricos , Fatores Sexuais , Cirurgiões/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Estados UnidosRESUMO
OBJECTIVE: To evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats. STUDY DESIGN: Systematic literature review. SAMPLE: English-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016. METHODS: CAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations. RESULTS: One hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions. CONCLUSION: Definitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies. CLINICAL SIGNIFICANCE: Lack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results.
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Doenças do Gato/cirurgia , Doenças do Cão/cirurgia , Neoplasias/veterinária , Complicações Pós-Operatórias/veterinária , Sistemas de Notificação de Reações Adversas a Medicamentos , Animais , Gatos , Cães , Neoplasias/cirurgia , Projetos de Pesquisa , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the effects of intrathoracic insufflation on cardiorespiratory variables and working space in cats undergoing video-assisted thoracic surgery. STUDY DESIGN: Prospective randomized study. ANIMALS: Six healthy cats. METHODS: Cats were anesthetized using a standardized protocol. A Swan-Ganz catheter was positioned in the pulmonary artery under fluoroscopic guidance for measurement of cardiac output. Intrathoracic pressures (ITP) of 0 (baseline), 3, and 5 mm Hg were induced with CO2 and maintained for 30 minutes. Statistical comparison of cardiorespiratory variables was performed. After the procedures, all cats were recovered from anesthesia. Videos of thoracic working space at each ITP level were scored in a blinded fashion by 3 board-certified surgeons using a numerical scale from 0-10. RESULTS: All cats tolerated insufflation with 3 and 5 mm Hg for 30 minutes without oxygen desaturation, although ventilatory levels had to be increased substantially to maintain eucapnia and oxygenation. Cardiac index was not significantly different from baseline after 30 minutes at 3 mm Hg but was significantly lower after 30 minutes at 5 mm Hg compared with 3 mm Hg. Oxygen delivery was unaffected by 3 or 5 mm Hg compared with baseline. Scores for working space increased between baseline and 3 and 5 mm Hg but were not different between 3 and 5 mm Hg. CONCLUSION: CO2 insufflation to 5 mm Hg seems well tolerated in healthy cats, provided ventilatory settings are substantially increased as ITP increases. CLINICAL SIGNIFICANCE: Thoracic CO2 insufflation of 3 mm Hg in cats during video-assisted thoracic surgery is associated with less hemodynamic perturbation than 5 mm Hg insufflation and may provide the benefit of improved working space compared with baseline.
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Dióxido de Carbono/administração & dosagem , Débito Cardíaco/efeitos dos fármacos , Doenças do Gato/cirurgia , Frequência Cardíaca/efeitos dos fármacos , Insuflação/veterinária , Cirurgia Torácica Vídeoassistida/veterinária , Animais , Gatos , Hemodinâmica/efeitos dos fármacos , Laparoscopia/métodos , Oxigênio , Pressão , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida/métodosRESUMO
OBJECTIVE: To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-seven client-owned dogs. METHODS: Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. RESULTS: At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty-six dogs had one or more lung lobes surgically removed. Thirty-seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty-five of 37 (94.6%) dogs survived to discharge. CONCLUSION: Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short- and long-term survival was excellent in this cohort. CLINICAL SIGNIFICANCE: Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.
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Doenças do Cão/cirurgia , Corpos Estranhos/veterinária , Migração de Corpo Estranho/veterinária , Pneumopatias/veterinária , Animais , Broncoscopia , Cães , Empiema Pleural/cirurgia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pneumotórax/veterinária , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/veterinária , Resultado do TratamentoRESUMO
OBJECTIVE: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Fifty dogs treated with 78 procedures. METHODS: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. RESULTS: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. CONCLUSION: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. CLINICAL SIGNIFICANCE: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved.
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Doenças do Cão/cirurgia , Complicações Intraoperatórias/veterinária , Doenças da Laringe/veterinária , Complicações Pós-Operatórias/veterinária , Animais , Cães , Epiglote , Feminino , Doenças da Laringe/cirurgia , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To report the morbidity and mortality associated with adrenalectomy with cavotomy for resection of invasive adrenal neoplasms in dogs and evaluate risk factors for perioperative outcomes. STUDY DESIGN: Retrospective study. ANIMALS: Forty-five client-owned dogs. METHODS: Dogs that underwent open adrenalectomy with cavotomy for resection of adrenal masses with tumor thrombus extending into the vena cava were included. Clinicopathologic data were harvested from medical records. Selected clinical, imaging, and operative variables were statistically evaluated as risk factors for packed red blood cell transfusion, nephrectomy, perioperative death, and overall survival. RESULTS: Thirty-six of 45 masses were pheochromocytomas, 7 were adrenocortical carcinomas, and 2 were unknown type. Caval thrombus terminated prehepatically in 21 of 45 dogs and extended beyond the porta hepatis but terminated prediaphragmatically (intrahepatic prediaphragmatic location) in 15 dogs and thrombi extended postdiaphragmatically in 5 dogs. Thirty-four (76%) dogs were discharged from the hospital, and 11 (24%) dogs died or were euthanized prior to discharge. Median overall survival time for all 45 dogs was 547 days (95%CI 146-710). Bodyweight, tumor type, and size and extent of caval thrombus did not affect survival to discharge, but postdiaphragmatic (rather than prediaphragmatic) thrombus termination was associated with a greater risk of death. CONCLUSION: Long-term survival was common in dogs that survived the perioperative period. Postdiaphragmatic thrombus extension affected the prognosis for overall survival. CLINICAL SIGNIFICANCE: Findings of this study help to stratify operative risk in dogs with adrenal neoplasia and caval invasion.
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Neoplasias das Glândulas Suprarrenais/veterinária , Adrenalectomia/veterinária , Carcinoma Adrenocortical/veterinária , Doenças do Cão/cirurgia , Feocromocitoma/veterinária , Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Adrenocortical/cirurgia , Animais , Cães , Feminino , Humanos , Neoplasias Renais/cirurgia , Neoplasias Renais/veterinária , Masculino , Nefrectomia/métodos , Nefrectomia/veterinária , Complicações Pós-Operatórias/veterinária , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To describe and assess techniques of intraoperative near-infrared fluorescence lymphography (NIRFL) using indocyanine green (ICG) for lymphatic duct identification during thoracoscopic thoracic duct (TD) ligation in dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 15) with naturally occurring chylothorax that underwent TD ligation. METHODS: Medical records of dogs treated with thoracoscopic TD ligation in which NIRFL was utilized for intraoperative TD identification were reviewed. Data retrieved included CT lymphography (CTL) and surgical data, fluorophore dose and injection site, and timing and quality of operative TD identification. RESULTS: Preoperative CTL was successful in 13/15 dogs and operative NIRFL was successful in 15/15 dogs. Popliteal lymph node injection achieved successful NIRFL within ≤10 minutes in 7/11 in which it was attempted. TDs identified by NIRFL imaging correlated with TDs identified by preoperative CTL in 12/13 cases in which CTL was achieved. In 1/13 cases, NIRFL identified small lymphatics not visible on CTL. In 5/9 cases in which methylene blue (MB) and ICG were combined for operative lymphography, no ducts or fewer ducts were recorded as identifiable by visible MB than by NIRFL or CTL. The median dose of ICG to achieve NIRFL imaging was 0.05 mg/kg. Thoracoscopic TD ligation was successfully achieved in all patients. CONCLUSION: NIRFL is a viable technique to aid in TD identification during thoracoscopy. High contrast NIRF illumination of the TD can be achieved with successful intraparenchymal injection of ICG into the popliteal lymph node.
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Quilotórax/veterinária , Doenças do Cão/cirurgia , Ducto Torácico/diagnóstico por imagem , Animais , Quilotórax/cirurgia , Cães , Feminino , Corantes Fluorescentes , Verde de Indocianina , Ligadura/veterinária , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfografia/veterinária , Masculino , Estudos Retrospectivos , Ducto Torácico/patologia , Ducto Torácico/cirurgia , Toracoscopia/veterináriaRESUMO
OBJECTIVE: To describe a technique for video-assisted thoracoscopic (VATS) thoracic duct ligation (TDL) in normal cats with a bipolar vessel-sealing device and to assess durability of the seal. STUDY DESIGN: Prospective case series. ANIMALS: Six healthy research cats. METHODS: Cats were placed under anesthesia for computed tomography lymphangiography (CTLA) to identify thoracic duct anatomy. On the basis of CTLA findings, cats were positioned in either right or left lateral recumbency for a 3-port VATS TDL. Thoracic duct branches were dissected from the aorta after subcutaneous indirect near-infrared fluorescence (NIRF) lymphography with indocyanine green was performed to optimize detection. A vessel-sealing device was used to seal each thoracic duct in 1 or more locations. Postattenuation, indirect NIRF lymphography was repeated to confirm complete occlusion of thoracic duct flow. CTLA was repeated in all cats 3 months postoperatively. RESULTS: The thoracic duct was surgically approached from the right in 3 cats and from the left in 3 cats. A median of 2.5 (range 1-6) TDL seal sites were applied. In 2 cats, leakage of chyle was detected during dissection. At 3 months postoperatively, CTLA confirmed reestablished chylous flow in 5 of 6 cats, appearing to occur through recanalization of previously sealed sites rather than through development of de novo lymphatic vessels. CONCLUSION: VATS TDL is feasible in cats, although the variable and delicate nature of feline thoracic duct anatomy should be considered preoperatively. CLINICAL SIGNIFICANCE: Bipolar vessel-sealing devices are not a durable modality for thoracic duct sealing in healthy cats in a seal only fashion.
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Gatos/cirurgia , Ducto Torácico/cirurgia , Cirurgia Torácica Vídeoassistida/veterinária , Toracoscopia/veterinária , Animais , Feminino , Ligadura/veterinária , Linfografia , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/instrumentação , Toracoscopia/métodosRESUMO
OBJECTIVE: To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. METHODS: Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. RESULTS: All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P = .001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P = .029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. CONCLUSION: PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.
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Cateterismo Venoso Central/veterinária , Doenças do Cão/terapia , Embolização Terapêutica/veterinária , Veia Porta/anormalidades , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Sistema Porta/cirurgia , Veia Porta/patologia , Veia Porta/cirurgia , Derivação Portossistêmica Cirúrgica , Estudos Prospectivos , Cintilografia , Stents , UltrassonografiaRESUMO
OBJECTIVE: To compare anatomic sources and underlying etiology of hemorrhage in small vs large dogs with spontaneous hemoperitoneum (SH). STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Client-owned dogs with SH at 2 academic institutions. METHODS: Medical records were reviewed for age, breed, sex, weight, and results of imaging, surgery, necropsy, cytology, and histopathology. Dogs were divided according to body weight (≤ 20 kg = small, > 20 kg = large). Confidence intervals were calculated to estimate rates of splenic and hepatic hemorrhage in small and large dog SH populations. Multivariable regression was used to compare prevalence of anatomic sources of hemorrhage and etiology in small vs large dogs. RESULTS: We identified 742 dogs with SH, including 637 in which the anatomic site of hemorrhage was investigated. Splenic hemorrhage was diagnosed in 43.2% (95% CI, 34.3-52.4) of small dogs and 61.3% (95% CI, 57.0-65.6) of large dogs. Small dogs had lower prevalence of splenic hemorrhage (prevalence ratio, 0.70; 95% CI, 0.58-0.87; P < .001) and higher prevalence of hemorrhage from liver (prevalence ratio, 1.72; 95% CI, 1.20-2.47; P = .003) or from another location such as retroperitoneal mass, kidney, or adrenal (prevalence ratio, 2.73; 95% CI, 1.66-4.47; P < .001) vs large dogs. Hemangiosarcoma was associated with splenic hemorrhage and occurred more frequently in large vs small dogs (P = .011). CONCLUSION: Small dogs had a lower rate of splenic hemorrhage and higher rates of hemorrhage from liver and other sites compared to large dogs. Etiologies other than splenic hemangiosarcoma were common, particularly among dogs weighing ≤ 20 kg. CLINICAL SIGNIFICANCE: Clinicians should perform diagnostics and consider body size before making presumptive diagnoses in dogs with SH.
Assuntos
Doenças do Cão/epidemiologia , Hemoperitônio/veterinária , Registros , Esplenopatias/veterinária , Medicina Veterinária , Animais , California/epidemiologia , Estudos Transversais , Doenças do Cão/etiologia , Doenças do Cão/patologia , Cães , Feminino , Hemoperitônio/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Esplenopatias/epidemiologiaRESUMO
OBJECTIVE: To improve the prediction of fractures in dogs with bone tumors of the distal radius by identifying computed tomography (CT) indices that correlate with antebrachial bone strength and fracture location. STUDY DESIGN: Prospective experimental study. ANIMALS: Dogs with antebrachial osteosarcoma (n = 10), and normal cadaver bones (n=9). METHODS: Antebrachia were imaged with quantitative CT prior to biomechanical testing to failure. CT indices of structural properties were compared to yield force and maximum force using Pearson correlation tests. RESULTS: Straight beam failure (Fs), axial rigidity, curved beam failure (Fc), and craniocaudal bending moment of inertia (MOICrCd) CT indices most highly correlated (0.77 > R > 0.57) with yield and maximum forces when iOSA-affected and control bones were included in the analysis. Considering only OSA-affected bones, Fs, Fc, and axial rigidity correlated highly (0.85 > R > 0.80) with maximum force. In affected bones, the location of minimum axial rigidity and maximum MOICrCd correlated highly (R > 0.85) with the actual fracture location. CONCLUSIONS: CT-derived axial rigidity, Fs, and MOICrCd have strong linear relationships with yield and maximum force. These indices should be further evaluated prospectively in OSA-affected dogs that do, and do not, experience pathologic fracture.
Assuntos
Doenças do Cão/etiologia , Fraturas Ósseas/veterinária , Fraturas Espontâneas/veterinária , Osteossarcoma/veterinária , Tomografia Computadorizada por Raios X/veterinária , Animais , Fenômenos Biomecânicos , Cadáver , Doenças do Cão/patologia , Cães , Fraturas Ósseas/patologia , Humanos , Osteossarcoma/complicações , Osteossarcoma/patologia , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To determine the influence of neoplasia on the biomechanical properties of canine antebrachia. STUDY DESIGN: Ex vivo biomechanical study. SAMPLE POPULATION: Osteosarcoma (OSA)-affected canine antebrachia (n = 12) and unaffected canine antebrachia (n = 9). METHODS: Antebrachia were compressed in axial loading until failure. A load-deformation curve was used to acquire the structural mechanical properties of neoplastic and unaffected specimens. Structural properties and properties normalized by body weight (BW) and radius length were compared using analysis of variance (ANOVA). Modes of failure were compared descriptively. RESULTS: Neoplastic antebrachia fractured at, or adjacent to, the OSA in the distal radial diaphysis. Unaffected antebrachia failed via mid-diaphyseal radial fractures with a transverse cranial component and an oblique caudal component. Structural mechanical properties were more variable in neoplastic antebrachia than unaffected antebrachia, which was partially attributable to differences in bone geometry related to dog size. When normalized by dog BW and radial length, strength, stiffness, and energy to yield and failure, were lower in neoplastic antebrachia than in unaffected antebrachia. CONCLUSIONS: OSA of the distal radial metaphysis in dogs presented for limb amputation markedly compromises the structural integrity of affected antebrachia. However, biomechanical properties of affected bones was sufficient for weight-bearing, as none of the neoplastic antebrachia fractured before amputation. The behavior of tumor invaded bone under cyclic loading warrants further investigations to evaluate the viability of in situ therapies for bone tumors in dogs.
Assuntos
Doenças do Cão/patologia , Membro Anterior/patologia , Osteossarcoma/veterinária , Animais , Fenômenos Biomecânicos , Cadáver , Cães , Osteossarcoma/patologia , Pressão , Suporte de CargaRESUMO
Sentinel lymph node mapping can help to direct surgical oncologic staging and metastatic disease detection in patients with complex lymphatic pathways. We hypothesized that indirect computed tomographic lymphography (ICTL) with a water-soluble iodinated contrast agent would successfully map lymphatic pathways of the iliosacral lymphatic center in dogs with anal sac gland carcinoma, providing a potential preoperative method for iliosacral sentinel lymph node identification in dogs. Thirteen adult dogs diagnosed with anal sac gland carcinoma were enrolled in this prospective, pilot study, and ICTL was performed via peritumoral contrast injection with serial caudal abdominal computed tomography scans for iliosacral sentinel lymph node identification. Technical and descriptive details for ICTL were recorded, including patient positioning, total contrast injection volume, timing of contrast visualization, and sentinel lymph nodes and lymphatic pathways identified. Indirect CT lymphography identified lymphatic pathways and sentinel lymph nodes in 12/13 cases (92%). Identified sentinel lymph nodes were ipsilateral to the anal sac gland carcinoma in 8/12 and contralateral to the anal sac gland carcinoma in 4/12 cases. Sacral, internal iliac, and medial iliac lymph nodes were identified as sentinel lymph nodes, and patterns were widely variable. Patient positioning and timing of imaging may impact successful sentinel lymph node identification. Positioning in supported sternal recumbency is recommended. Results indicate that ICTL may be a feasible technique for sentinel lymph node identification in dogs with anal sac gland carcinoma and offer preliminary data to drive further investigation of iliosacral lymphatic metastatic patterns using ICTL and sentinel lymph node biopsy.
Assuntos
Adenocarcinoma/veterinária , Neoplasias das Glândulas Anais/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Linfografia/veterinária , Linfonodo Sentinela/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Adenocarcinoma/diagnóstico por imagem , Sacos Anais/diagnóstico por imagem , Sacos Anais/patologia , Animais , Cães , Feminino , Metástase Linfática/diagnóstico por imagem , Linfografia/métodos , Masculino , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To report the diagnosis, treatment, and short-term outcome in dogs with suspected persistent right aortic arch (PRAA) undergoing thoracoscopy with concurrent esophagoscopy. STUDY DESIGN: Multi-institutional retrospective case series. ANIMALS: Dogs with suspected PRAA (n=9). METHODS: Medical records were reviewed from 2012 to 2016. Dogs undergoing thoracoscopy for PRAA at 3 referral hospitals were included. Signalment, clinical signs, diagnostic imaging, anesthesia protocol (including the use of one-lung ventilation), surgical approach, complications, and short-term outcome were recorded. Dogs underwent a left-sided intercostal thoracoscopic approach with concurrent intraoperative esophagoscopy. The ligamentum arteriosum (LA) and constricting fibers were divided using a vessel-sealing device using a 3 or 4 port thoracoscopy technique. Visualization and dissection of the LA was aided by transesophageal illumination by esophagoscopy. RESULTS: Thoracoscopy confirmed PRAA in 9 dogs, with an aberrant left subclavian artery (LS) identified in 5 dogs. Major complications occurred in 2 dogs: postoperative hemorrhage from the LS and esophageal perforation, which resulted in euthanasia. Median follow-up was 250 days (range, 56-1,595). Regurgitation resolved in 4 of 8 surviving dogs. One dog had recurrence of regurgitation 1,450 days postoperatively, esophageal compression by the LS was identified, and regurgitation resolved following LS transection. CONCLUSION: Esophagoscopy aided identification and dissection of the LA in all cases. Due to the potential for the LS to cause clinical esophageal constriction postoperatively, a recommendation for LS transection may be warranted. Vascular clips can also be considered as an alternative for vessel ligation to avoid complications associated with vessel-sealing device use.