Veterinary Surgery最新文献

Objective: To report outcomes and complications of proximal tibial detorsional osteotomy (PTDO) in dogs with patellar luxation (PL).

Study design: Multicenter retrospective observational case series.

Animals: A total of 53 stifles in 50 client-owned dogs.

Methods: Medical records (2013-2023) were reviewed. Preoperative tibial torsion was assessed by computed tomography (CT; tibial torsion angle [TTA]) or by standardized caudocranial radiographs (tibial tuberosity alignment). Concurrent procedures and implants were recorded. Postoperative radiographs were evaluated for patellar position, tibial alignment, bone healing, and implant position. Final limb function was categorized as full, acceptable, or unacceptable based on lameness, patellar tracking, complications, and radiographic outcomes.

Results: Medial PL was present in 52/53 (98%) cases. Preoperative medial displacement of the tibial tuberosity was diagnosed in 52/53 (98%) limbs. Mean preoperative TTA was 8.8° ± 4.7 (external torsion). Normal patellar tracking was restored in 51/53 (96%) cases. Final limb function was full in 38/53 (72%) and acceptable in 13/53 (24%) cases. Mean radiographic follow-up was 3.0 ± 0.9 months (short-term). Mean time to radiographic union was 2.7 ± 0.5 months. Overall complications occurred in 18/53 (33%: 11% major; 22% minor); most major events were implant-related and managed successfully with revision.

Conclusion: PTDO effectively corrected abnormal tibial torsion, resulting in restoration of zormal patellar tracking in 96% of stifles. A 11% major complication rate was observed.

Clinical relevance: PTDO is a reliable surgical technique to treat abnormal tibial torsion in dogs with PL.

Objective: To determine whether perioperative management guided by conditional computed tomography-myelography (C-CTM) is non-inferior to magnetic resonance imaging (MRI) regarding functional outcome for acute thoracolumbar intervertebral disc extrusion (IVDE) in non-ambulatory chondrodystrophic dogs.

Study design: Quasi-randomized natural experiment utilizing unscheduled MRI downtime as an exogenous instrument.

Sample population: A total of 560 client-owned dogs (MRI, 518 dogs; C-CTM, 42 dogs).

Methods: A retrospective cohort study was conducted. The primary outcome was recovery of ambulation, analyzed with intention-to-treat (ITT) and per-protocol (PP) principles with a prespecified non-inferiority margin of -12%. Secondary outcomes included safety events (postoperative neurologic deterioration, progressive myelomalacia, major complications) and time-adjusted treatment costs.

Results: C-CTM was non-inferior to MRI for recovery of ambulation in both ITT (risk difference + 6.5%, 95% CI: -2.7%-15.7%, one-sided p < .001) and PP analyses (risk difference + 2.5%, 95% CI: -7.3%-12.2%, one-sided p < .001). There was no difference in rates of postoperative neurologic deterioration, progressive myelomalacia, or major complications. Total treatment costs and imaging costs were significantly lower for C-CTM (p < .01). There was no difference in non-imaging costs between groups.

Conclusion: In non-ambulatory chondrodystrophic dogs with acute thoracolumbar IVDE, C-CTM is non-inferior to MRI for recovery of ambulation with a similar safety profile, at significantly lower cost.

Clinical significance: In dogs with a high pretest probability of acute thoracolumbar IVDE, routine use of MRI may not be justified given the comparable clinical outcomes and lower treatment costs achieved with C-CTM.

Objective: To provide a step-by-step description of canine lip/alveolar cleft repair, describe intra- and postoperative complications, and report mid-term clinical, functional and cosmetic outcomes.

Study design: Prospective study.

Animals: A total of 10 client-owned puppies with unilateral or bilateral lip/alveolar clefts.

Methods: Detailed clinical and historical data were recorded. The lip/alveolar clefts were repaired using a surgical technique adapted from human medicine including: (1) alveolar cleft and labial vestibulum repair, (2) cheilorhinoplasty and (3) palatal cleft repair when indicated. Intra- and postoperative complications, as well as clinical, functional and cosmetic outcomes, were recorded at 7 and 14 days and at a minimum of 3 months postoperatively. Cosmetic outcomes were evaluated using postoperative CT measurements.

Results: A total of 10 puppies (4 males, 6 females) were included. Of these, six presented with unilateral lip/alveolar clefts (2 right-sided and 4 left-sided) and four presented with bilateral clefts. A total of 14 lip/alveolar clefts were repaired. Four dogs had a complete secondary palate cleft. No intraoperative surgical complications were reported. Three cases of minor dehiscence of the cheilorhinoplasty suture line were observed, all healed by second intention within 14 days postoperatively. One case of oronasal communication on the hard palate was successfully treated with minor revision surgery. Successful clinical and functional outcomes were reported for all dogs at the 3-month postoperative evaluation. Overall cosmetic outcomes were rated as good to excellent.

Conclusion: The described step-by-step surgical technique resulted in good to excellent clinical, functional, and cosmetic outcomes.

Impact: This technique offers a new surgical treatment with a low complication rate.

Objective: To determine the caudalmost extent of diffusion of contrast media administered through a cervical epidural catheter (CEC) and to describe pathologic changes associated with maintaining an indwelling CEC for up to 17 days.

Study design: Pilot study.

Animals: Two mature horses.

Methods: CECs were placed under ultrasound guidance in two horses. Both horses were injected with 5 mL 50% Iohexol contrast solution, followed by radiographs of catheter insertion site to confirm placement. A total volume of 15 mL contrast solution was injected in 5 mL aliquots up to 25 min post-initial injection. Laterolateral radiographs were taken every 5 min post-initial 5 mL injection in the caudal cervical region. Horses were euthanized 16 or 17 days after placement of an indwelling CEC and the area surrounding the catheter was examined using gross necropsy.

Results: In one horse, cranial C6 was reached at 25 min following 15 mL of contrast solution. In the other horse, cranial C6 was reached at 1 min following 5 mL of contrast solution. The caudalmost extent of contrast solution was reached after 15 mL and 20-25 min. Grossly, areas of mild inflammation and fibrosis were identified in the epidural space surrounding the catheters at 16-17 days post-catheter placement.

Conclusion: These results indicate that a 10-15 mL volume of contrast solution can reach the cranial extent of the brachial plexus. Indwelling CECs at days 16 and 17 displayed similar findings on gross necropsy to those previously described for sacrococcygeal and lumbosacral epidural catheters.

Clinical significance: Further studies are warranted to assess the effect of the medical treatment of lesions in the caudal cervical vertebrae of horses through administration via cervical epidural catheters.

Objective: To investigate the effect of surgical delay on radiographic and patient outcomes following canine humeral condylar fracture stabilization.

Study design: Retrospective observational cohort study.

Sample population: A total of 211humeral condylar fractures (204 dogs).

Methods: Time to surgery and clinical data were collected from the medical record. Immediate postoperative radiographs were reviewed for an intracondylar gap or articular step defect. Postoperative complications and short-term outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis modeled radiographic and patient outcomes.

Results: Fracture events occurring on Friday or Saturday were systematically associated with longer delays to surgery (p < .001). Increasing delays to surgery were associated with an increased risk of an intracondylar gap or articular step defect on immediate postoperative radiographs (adjusted OR = 3.86 per additional day, 95% CI: 2.04-7.29, p < .001). Presence of an intracondylar gap or articular step defect was associated with an increased risk of postoperative complications (adjusted OR = 5.92, 95% CI: 1.44-24.36, p = .01). Presence of an intracondylar gap or articular step defect was associated with an increased risk of a poorer short-term outcome (adjusted OR = 0.13, 95% CI: 0.04-0.42, p = .001). The presence of postoperative complications increased the risk of a poorer short-term outcome (adjusted OR = 0.38, 95% CI: 0.17-0.87, p = .02).

Conclusion: Delays to surgery are an important system-level factor influencing the accuracy of fracture reduction, postoperative complications, and short-term outcomes in canine humeral condylar fracture repair.

Clinical significance: System-level optimization may be an avenue for quality improvement in this patient population.

Objective: To assess the effects of clinically relevant doses of commonly employed intra-articular corticosteroids-specifically, triamcinolone acetonide (TCA), methylprednisolone acetate (MPA), and combination of betamethasone acetate and betamethasone sodium phosphate (BM)-on equine osteoclasts.

Study design: In vitro controlled laboratory study.

Sample population: Three donor mares (13-19 years).

Methods: Following differentiation from bone marrow aspirates, osteoclasts were cultured alone (pure osteoclast cultures; n = 18 wells per group) or on equine bone slices (osteoclast-bone cultures; n = 6 wells per group) and treated with TCA (36 μg/mL), MPA (48 μg/mL), or BM (4 μg/mL). Untreated wells were controls. Outcome parameters included number of osteoclasts, bone resorption area and media biomarker concentrations, specifically tartrate-resistant acid phosphatase isoform-5b (TRACP-5b) and C-terminal telopeptide of type I collagen (CTX-I), measured using enzyme-linked immunosorbent assay (ELISA).

Results: In pure osteoclast cultures (n = 16 wells in control and BM groups; n = 17 wells in TCA and MPA groups), mature osteoclast numbers were lower following corticosteroid addition compared with controls (MPA, p < .001; TCA, p = .009; BM, p = .002), and lower in the MPA group than the TCA group (p = .015). There was no difference in TRACP-5b between groups. In osteoclast-bone cultures (n = 5 in control group; n = 6 wells in TCA, MPA and BM groups), CTX-I decreased with MPA treatment compared with controls (p = .001), TCA (p = .006), and BM (p = .007) groups. TRACP-5b decreased with TCA compared with controls (p = .001). No differences in bone resorption area were measured.

Conclusion: Clinically relevant doses of commonly employed intra-articular corticosteroids-TCA, MPA, and BM-impacted equine osteoclast activity in vitro.

Clinical significance: Understanding that intra-articular corticosteroids may influence osteoclast activity, potentially affecting subchondral bone remodeling and repair, is important for guiding judicious use in equine joint management.

Objective: To describe the perioperative and long-term outcomes of dogs with massive hepatocellular carcinoma (HCC) in the right hepatic division causing compression or involvement of the caudal vena cava (CVC) treated with right divisional hepatectomy using temporary caval occlusion (TCO).

Study design: Retrospective case series.

Animals: Nineteen client-owned dogs.

Methods: Medical records were reviewed. Data collected included signalment, preoperative imaging findings, operative details, adjunct procedures, transfusion requirements, histopathological diagnosis and surgical margin status, perioperative complications, and survival to discharge. Long-term outcome information was obtained from recheck examinations when available and from telephone interviews with referring veterinarians and/or owners.

Results: Right divisional hepatectomy with TCO was completed in all dogs; a Pringle maneuver was used in two of 19 dogs. Median TCO duration was 17.6 min (range, 7.0-25.7) and median operative time was 82 min (range, 69-127). Primary suture repair of the CVC was required in six of 19 dogs. R0 resection was achieved in 14 of 19 dogs. One dog died on postoperative day 2; 18/19 dogs were discharged. Of these dogs, seven were alive without reported recurrence or intrahepatic metastasis at the last follow up, 95-1355 days after surgery, whereas 11 had died at a median of postoperative day 729 (range, 204-1154). Postoperative intrahepatic metastasis was suspected in two dogs.

Conclusion: Temporary caval occlusion-assisted right divisional hepatectomy provided venous control in selected dogs with massive right-sided HCC and compression or involvement of the CVC, with no intraoperative mortality, one in-hospital death, and postoperative complications in six of the 18 discharged dogs.

Clinical significance: Temporary caval occlusion facilitates controlled dissection of the right hepatic veins and repair of small caval defects when present.

Objective: To evaluate short- and long-term outcomes and health-related quality of life (Hr-QoL) in dogs with congenital intrahepatic portosystemic shunts (cIHPSS) treated using percutaneous transcatheter embolization (PTCE).

Study design: Single center retrospective and prospective study.

Animals: Sixty-one client-owned dogs.

Methods: Medical records were reviewed, and owners completed validated Hr-QoL and congenital portosystemic shunt scoring (Hr-CPSS) questionnaires. Hr-QoL scores ranged from 0 (worst) to 100 (best), and Hr-CPSS from 0 (best) to 100 (worst). Survival was assessed using Kaplan-Meier analysis. Medical or dietary management at final follow-up were recorded.

Results: Median follow-up time was 769 days (interquartile range [IQR]: 297-1865). Median survival time was 1496 days. At last follow-up, 33 of 59 dogs remained on medical management and/or a specialized diet. Median Hr-CPSS significantly decreased from prediagnosis (25 [IQR: 18-51.3]) to post-PTCE (5 [IQR: 3-11]; p < .001), but not between post-medical and post-PTCE (p = .68). Median Hr-QoL scores improved post-PTCE (100 [IQR: 80-100]) compared to prediagnosis (35 [IQR: 10-50], p < .0001), and post-medical (75 [IQR: 40-90], p = .005) as well as between prediagnosis and post-medical (p = .038). One-, two-, and five-year survival rates were 83%, 66%, and 54%, respectively.

Conclusion: Treatment of cIHPSS with PTCE in dogs was associated with a good long-term survival and significant improvement in QoL and clinical signs.

Impact: The combination of PTCE and targeted medical management provides an effective minimally invasive treatment option for dogs with cIHPSS, supporting improved longevity and quality of life.