Objective
To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism.
Study design
Surgical technique description and clinical case report.
...Animals
Five canine cadavers and 5 client‐owned dogs with primary hyperparathyroidism.
Methods
A surgical technique for minimally invasive video‐assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases.
Results
A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space.
Conclusion
Minimally invasive video‐assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases.
Clinical significance
Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs.
Abstract
OBJECTIVE
To characterize the association between peritoneopericardial diaphragmatic hernia (PPDH) or congenital central diaphragmatic hernia (CCDH) and ductal plate malformations (DPMs) in ...dogs and cats.
ANIMALS
18 dogs and 18 cats with PPDH or CCDH and 19 dogs and 18 cats without PPDH or CCDH.
PROCEDURES
Evaluation of clinical details verified PPDH or CCDH and survival times. Histologic features of nonherniated liver samples were used to categorize DPM. Immunohistochemical staining for cytokeratin-19 distinguished bile duct profiles per portal tract and for Ki-67–assessed cholangiocyte proliferation. Histologic features of herniated liver samples from PPDH or CCDH were compared with those of pathological controls (traumatic diaphragmatic hernia, n = 6; liver lobe torsion, 6; ischemic hepatopathy, 2).
RESULTS
DPM occurred in 13 of 18 dogs with the proliferative-like phenotype predominating and in 15 of 18 cats with evenly distributed proliferative-like and Caroli phenotypes. Congenital hepatic fibrosis DPM was noted in 3 dogs and 2 cats and renal DPM in 3 dogs and 3 cats. No signalment, clinical signs, or clinicopathologic features discriminated DPM. Kaplan Meier survival curves were similar in dogs and cats. Bile duct profiles per portal tract in dogs (median, 5.0; range, 1.4 to 100.8) and cats (6.6; 1.9 to 11.0) with congenital diaphragmatic hernias significantly exceeded those in healthy dogs (1.4; 1.2 to 1.6) and cats (2.3; 1.7 to 2.6). Animals with DPM lacked active cholangiocyte proliferation. Histologic features characterizing malformative bile duct profiles yet without biliary proliferation were preserved in herniated liver lobes in animals with DPM.
CONCLUSIONS AND CLINICAL RELEVANCE
DPM was strongly associated with PPDH and CCDH. Because DPM can impact health, awareness of its coexistence with PPDH or CCDH should prompt biopsy of nonherniated liver tissue during surgical correction of PPDH and CCDH.
Abstract
Background
Canine intrarenal cystic lesions (ICLs) are infrequently reported in the veterinary literature. Several treatment options have been described including cyst fenestration (partial ...nephrectomy/deroofing) +/− omentalization, sclerotherapy using alcohol as a sclerosing agent, percutaneous cyst drainage (PCD), and ureteronephrectomy. Information regarding presenting clinical signs, physical examination findings, histologic diagnosis and outcomes of dogs with ICLs treated by different methods is limited. Medical records of 11 institutions were retrospectively reviewed to identify dogs that underwent PCD, sclerotherapy, surgical deroofing +/− omentalization, or ureteronephrectomy for management of ICLs from 2004 to 2021. Six weeks postoperative/post-procedural follow-up was required. Cases suspected to represent malignancy on preoperative imaging were excluded. The study objective was to provide information regarding perioperative characteristics, complications, and outcomes of dogs undergoing treatment of ICLs.
Results
Eighteen dogs were included, with 24 ICLs treated. Ten had bilateral. There were 15 males and 3 females, with crossbreeds predominating. PCD, sclerotherapy, deroofing and ureteronephrectomy were performed in 5 (5 ICLs treated), 7 (11 ICLs), 6 (6), and 7 (7) dogs, respectively, with 5 dogs undergoing > 1 treatment. Seven dogs experienced 8 complications, with requirement for additional intervention commonest. PCD, sclerotherapy and deroofing resulted in ICL resolution in 0/5, 3/11 and 3/6 treated ICLs, respectively. Histopathology identified renal cysts (RCs) in 7/13 dogs with histopathology available and neoplasia in 6/13 (4 malignant, 2 benign). Of 5 dogs diagnosed histopathologically with neoplasia, cytology of cystic fluid failed to identify neoplastic cells. Among 7 dogs with histologically confirmed RCs, 4 had concurrent ICLs in ipsilateral/contralateral kidney, compared with 2/6 dogs with histologically confirmed neoplasia.
Conclusions
Benign and neoplastic ICLs were approximately equally common and cystic fluid cytology failed to differentiate the 2. Among renal-sparing treatments, deroofing most commonly resulted in ICL resolution. Presence of concurrent ICLs in ipsilateral/contralateral kidney does not appear reliable in differentiating benign from malignant ICLs.
An 8-year-old castrated male mixed-breed dog (dog 1) and a 13-year-old spayed female mixed-breed dog (dog 2) were evaluated because of spontaneous pneumothorax.
Both dogs had decreased ...bronchovesicular sounds with coughing, tachypnea, cyanosis, lethargy, or a combination of these clinical signs. Radiographic examination revealed pneumothorax in both dogs and consolidation of a lung lobe in dog 2. Pneumothorax was alleviated following thoracocentesis in both dogs but recurred.
Dog 1 was initially treated by placement of a thoracostomy tube but underwent thoracotomy when pneumothorax recurred after tube removal; left caudal lung lobectomy was performed because a ruptured bulla was suspected, and a pulmonary bulla was histologically confirmed. Dog 2 underwent thoracotomy with left caudal lung lobectomy and partial removal of the left cranial lung lobe; diffuse pulmonary emphysema was diagnosed. This dog underwent a second surgery for right caudal lung lobectomy because of torsion. When pneumothorax recurred and additional surgery was not considered feasible, pleural access ports were placed in both dogs for repeated removal of air from the thoracic cavity. Ports were used clinically for 17 days in dog 1 and 14 days in dog 2. Dog 1 successfully underwent another surgery when pneumothorax recurred 18 days after port placement but was euthanized 17 months later when dyspnea and tachypnea recurred. Pneumothorax had not recurred further in dog 2 twenty-three months after port placement.
Findings suggested that pleural access ports may have a role in the management of spontaneous pneumothorax in dogs.
The mediastinal serous cavity is a normal anatomic space in the caudal mediastinum. Aims of this anatomic and case series study were to describe the signs of pathologic expansion of the mediastinal ...serous cavity observed during computed tomography (CT), review the underlying anatomy, perform a literature review, and evaluate the medical records of several dogs with mediastinal serous cavity empyema (paraesophageal empyema). The mesothelial lined mediastinal serous cavity is a cranial extension of the omental bursa, separated from the peritoneal cavity by the diaphragm, in the dorsal part of the caudal mediastinum, to the right of the esophagus, between the heart base and diaphragm. In five adult, large‐breed dogs with surgically and histologically confirmed paraesophageal empyema, macroscopic plant material was found at surgery in two dogs, adherence to adjacent lung was present in three different dogs, accessory lobectomy was performed in two dogs with subacute‐chronic pyogranulomatous pneumonia, and one dog had concurrent pyothorax and mediastinitis, but none had esophageal abnormalities. This study expands our understanding of the pathogenesis and basis for the imaging appearance of paraesophageal empyema in dogs by clarifying the underlying anatomic structures that direct development of this condition. The term empyema accurately describes this condition because the purulent material accumulates within an existing body cavity. The study also provides initial evidence that the development of paraesophageal empyema might be due to local extension of lung disease, such as foreign body migration or pneumonia. Computed tomography was helpful for diagnosis, assessing size, and determining the spread of disease.
Objective
To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats.
Study design
Single‐center, randomized, blinded, controlled ...trial conducted in a veterinary teaching hospital.
Animals
Two hundred ninety‐seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17).
Methods
Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting Q group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow‐up was obtained at 10 and 30 days postoperatively.
Results
Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28‐0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 interquartile range (IQR), 0.2‐2.6 N, NC = 0.83 IQR, 0‐1.87 N, P = .04) on the day after surgery.
Conclusion
Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy.
Clinical significance
Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low‐cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.
Objective
To report the clinical characteristics, types of vascular ring anomalies (VRA), operative findings, complications, and survival after surgical treatment of cats with VRA.
Study design
...Retrospective, multi‐institutional case series.
Animals
Client‐ or shelter‐owned cats presenting to academic, referral veterinary institutions.
Methods
Medical records of cats with VRA that underwent surgical treatment were reviewed. Signalment, relevant medical history, clinical signs, diagnostic imaging, surgical findings, complications, and survival were recorded.
Results
Twenty cats with VRA were included. Vascular ring anomalies were most commonly (75% 15/20) diagnosed in cats less than 1 year old, with no breed or sex predilection. Regurgitation was the most common clinical sign, present in 18 of 20 (90%) cats. A persistent right aortic arch was diagnosed in 17 of 20 (85%) cats, with concurrent aberrant left subclavian artery in four of the cats. Surgical treatment was associated with survival to discharge in 18 of 20 (90%) cats. Persistent clinical signs were reported in nine of 13 (69%) cats, and radiographic evidence of megaesophagus persisted in four of 13 (31%) cats, with a median follow‐up of 275 days after discharge.
Conclusion
Persistent right aortic arch was the most commonly diagnosed VRA in cats in this series, although multiple anomalies were observed. Surgical treatment of VRA in cats was associated with a high survival to discharge, although persistence of clinical signs and megaesophagus was noted in 69% and 31% of the cats, respectively.
Clinical significance
Surgical treatment of VRA in cats is associated with a high survival rate; however, persistence of clinical signs is an expected outcome.
Objective
To determine the influence of a quilting suture pattern tacking the subcutaneous tissues to the deep fascia on complications after midline celiotomy in dogs.
Study design
Single‐center, ...randomized, blinded, controlled trial conducted in a veterinary teaching hospital.
Animals
Four hundred thirty‐two dogs undergoing midline celiotomy for ovariohysterectomy (n = 249) or other abdominal procedures (n = 183).
Methods
Dogs were randomly assigned to (1) a quilting group, subcutaneous tissue with apposition plus tacking to the rectus fascia or (2) a nonquilting group, with apposition of subcutaneous tissue without tacking. Randomization was stratified on hospital admitting service. Primary outcome was the incidence of incisional seroma. Secondary outcomes included postoperative pain the day after surgery and surgical site infection (SSI). Outcomes were assessed during the first 30 postoperative days.
Results
No differences were detected between the quilting group (n = 183) and the nonquilting group (n = 175) in terms of illness severity, surgical procedure performed, surgeon's experience, duration of surgery, intraoperative complications, or methods of surgical closure other than the intervention under study. In an intent‐to‐treat analysis, the incidence of incisional seroma was lower in the quilting group (odds ratio = 0.30, 95% CI = 0.13‐0.67, P = .004). Pain assessed 24 hours postoperatively was lower in the quilting group (P = .03). The incidence of SSI did not differ between groups.
Conclusion
Tacking the subcutaneous tissues to the deep fascia is indicated to reduce seroma during celiotomy closure.
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.
The use of mesenchymal stem cells (MSCs) for tissue regeneration is often hampered by modest engraftment in host tissue. This study was designed to quantitatively compare MSCs engraftment rates after ...delivery using a polysaccharide-based porous scaffold or endocardial (EC) injection in a rat myocardial infarction model. Cellular engraftment was measured by quantitative reverse transcription-polymerase chain reaction using MSCs previously transduced with a lentiviral vector that expresses green fluorescent protein (GFP). The use of a scaffold promoted local cellular engraftment and survival. The number of residual GFP(+) cells was greater with the scaffold than after EC injection (9.7% vs. 5.1% at 1 month and 16.3% vs. 6.1% at 2 months, respectively n=5). This concurred with a significant increase in mRNA vascular endothelial growth factor level in the scaffold group (p<0.05). Clusters of GFP+ cells were detected in the peri-infarct area, mainly phenotypically consistent with immature MSCs. Functional assessment by echocardiography at 2 months postinfarct also showed a trend toward a lower left ventricular dilatation and a reduced fibrosis in the scaffold group in comparison to direct injection group (n=10). These findings demonstrate that using a porous biodegradable scaffold is a promising method to improve cell delivery and engraftment into damaged myocardium.
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