Carbon dioxide laser ablation for treatment of limbal squamous cell carcinoma in horses

Limbal squamous cell carcinoma in 4 horses was treated successfully, using carbon dioxide laser ablation. Tumors were removed, with minimal to no postoperative inflammation or discomfort to the horses. Carbon dioxide laser ablation represents a promising new option in the treatment of limbal squamous cell carcinoma in horses.     

Carbon dioxide laser resection of a distal carpal pilomatricoma and wound closure using swine intestinal submucosa in a dog

A carbon dioxide laser was used to incise around, dissect, and remove a 2-cm intradermal mass from the left carpus of an 8-year-old, spayed female wheaten terrier. The wound was partially closed, resulting in a 3-cm diameter circular defect with extensor tendons exposed. A swine intestinal submucosa graft was utilized to cover the remaining defect. The graft was removed 5 days later, revealing a healthy granulation tissue bed covering previously exposed tendons with minimal wound margin retraction. The remaining wound was allowed to heal by contraction and epithelialization that was complete by 5 weeks postoperatively. The mass, a pilomatricoma, had not recurred at the last follow-up contact 18 months after surgery. Pilomatricoma, laser application, swine intestinal submucosa grafting, and postoperative wound management are discussed.     

Standing laser surgery of the head and neck.

The use of carbon dioxide and Nd:YAG lasers has expanded the capabilities of equine surgeons. These lasers are used to incise, vaporize, and coagulate tissue with minimal hemorrhage and reduced morbidity to the patient. In this article, practical fundamentals of laser surgery are briefly reviewed, and selected standing laser procedures of the head and neck are discussed.     

Observations on some cardiopulmonary effects of midazolam, xylazine and a midazolam/ketamine combination in the goat

Xylazine, midazolam and a midazolam/ketamine combination were administered to 6 goats in a randomised 3-way block design. All goats received all treatments with at least a 7-day interval between treatments. Statistically significant (P < 0.05) changes were observed in some of the measured cardiopulmonary variables for xylazine and midazolam/ ketamine. Xylazine administration resulted in statistically significant decreases in minute volume, arterial partial pressure of oxygen, heart rate and mean arterial blood pressure. The increase in arterial partial pressure of carbon dioxide was not statistically significant. For the midazolam/ketamine combination, the decrease in tidal volume was statistically significant, but not the decrease in minute volume and increase in arterial partial pressure of carbon dioxide. The decrease in the arterial partial pressure of oxygen was also statistically significant. The mean arterial blood pressure for the combination was statistically significantly higher compared to xylazine. The changes in cardiopulmonary variables after midazolam administration were not statistically significant, such as tidal and minute volume, arterial partial pressure of oxygen and carbon dioxide. However, clinically significant effects such as hypoventilation and hypoxia were observed after its administration. The change in mean arterial blood pressure was minimal.     

Use of a carbon dioxide laser for surgical management of cutaneous masses in horses: 32 cases (1993-2000)

OBJECTIVE: To determine outcome of horses in which cutaneous masses were removed with a carbon dioxide laser. DESIGN: Retrospective study. ANIMALS: 32 horses. PROCEDURE: Medical records of horses with 1 or more cutaneous masses treated with a carbon dioxide laser were examined. Follow-up information was obtained through telephone interviews with owners and referring veterinarians. RESULTS: Cutaneous masses were classified as sarcoids (15 horses), neoplastic masses other than sarcoids (squamous cell carcinoma [91; fibroma [1]; and melanoma [1]), and nonneoplastic masses (6). Minimum follow-up time was 6 months. Five sarcoids and 2 squamous cell carcinomas recurred. Seven (21%) horses had complications associated with dehiscence of wounds that had been closed primarily or failure of wound healing because of recurrence of the mass. Twenty-six (81%) owners were satisfied with the cosmetic appearance following surgery. CONCLUSION AND CLINICAL RELEVANCE: Results suggest that a carbon dioxide laser may be effective for treatment of cutaneous masses in horses.     

Clinical effects of betamethasone and hyaluronan,and of defocalized carbon dioxide laser treatment on traumatic arthritis in the fetlock joints of horses

The clinical effects of intra-articular betamethasone together with hyaluronan (betaM/HA) and treatment with a defocalized carbon dioxide laser on acute traumatic arthritis of the fetlock joint were assessed. The horses in these studies were selected using a thorough lameness examination, including intra-articular anaesthesia abolishing the lameness. This investigation comprised an observer-blind study, including 10 sport horses (10 joints), and a prospective study, including 180 sport horses (333 joints). In both studies, the material was divided into two groups treated with either betaM/HA or a carbon dioxide laser. The treatment doses were 12 mg of betaM, 20 mg of HA or 60 J/cm2 of treated area. Convalescence before training was 21 days for both groups in the observer-blind study. In the prospective study, convalescence in the betaM/HA group was 21 days but was only 7 days for the laser-treated group. In the observer-blind study, three of five treated joints recovered in both cohorts. In the prospective study, the groups had significantly different recovery rates--68% of the betaM/HA-treated joints and 80% of the carbon dioxide laser-treated joints. These results indicate that the defocalized carbon dioxide laser should be an applicable mode of treatment of acute traumatic synovitis in horses. However, the biochemical functions related to carbon dioxide laser treatment require further elucidation.     

Use of the carbon dioxide laser for perianal and rectal surgery.

The skin of the perianal region is very thin and sensitive. The carbon dioxide laser is a very effective tool for removing tumors and treating conditions of this area. It offers a "no touch" method of treatment for conditions of the perianal region. There is less bleeding, less pain, less swelling with the use of the carbon dioxide laser. The carbon dioxide laser is an effective tool for excising perianal tumors, rectal tumors, performing anal sacculectomies and treating perianal fistulas.     

A histopathological comparison of two techniques for soft palate resection in normal dogs

Eighteen dogs were used to compare histopathological findings following excision of the soft palate using either a bipolar sealing device or a carbon dioxide laser. Histopathological comparisons were done at 48 and 96 hours after soft palate resection. Mean depths of tissue injury at 96 hours were 3.5 and 3.33 mm for bipolar sealing device and carbon dioxide laser, respectively. Control of hemorrhage was excellent in all dogs, and none of the dogs developed signs of respiratory compromise after soft palate resection. Using the bipolar sealing device for soft palate resection was significantly faster than using the carbon dioxide laser, although both techniques were fast.     

Pulsed Carbon Dioxide Laser for Cartilage Vaporization and Subchondral Bone Perforation in Horses Part I: Technique and Clinical Results

A carbon dioxide laser, used in a rapidly pulsed mode, was evaluated for intra-articular use in horses. Under arthroscopic guidance, a lensed 5 mm laser probe attached directly to a hand-held carbon dioxide laser was inserted into one intercarpal joint of eight horses. In four horses, a cartilage crater 1 cm in diameter was created to the level of the subchondral bone of the articular surface of the third carpal bone. In four horses, the laser was directed perpendicular to the articular surface of the third carpal bone and activated to penetrate the cartilage and subchondral bone. The intercarpal joint of the opposite carpus in each horse was subjected to arthroscopic examination and insertion of the laser probe for an equivalent time. The laser was not activated and these joints served as sham operated controls. The horses were evaluated clinically for 8 weeks, then euthanatized, and the joints were examined radiographically, grossly, and histologically. Pulsed carbon dioxide laser vaporized cartilage readily but penetrated bone poorly. Cartilage vaporization resulted in no greater swelling, heat, pain on flexion, lameness, or synovial fluid reaction than the sham procedure. Laser drilling resulted in a shallow, charred hole with a tenacious carbon residue, and in combination with the thermal damage to deeper bone, resulted in increased swelling, mild lameness and a low-grade, but persistent synovitis. The carbon dioxide laser is a useful intra-articular instrument for removal of cartilage and has potential application in inaccessible regions of diarthrodial joints. It does not penetrate bone sufficiently to have application in subchondral drilling.     

Evaluation of excision, cryosurgery and local BCG vaccination for the treatment of equine sarcoids.

Ninety-five horses with sarcoids were subjected to three types of treatment: surgical excision (conventional or carbon dioxide laser), cryotherapy or local BCG vaccination. The type of treatment was selected on the basis of the size, location and clinical appearance of the tumours. The choice between conventional and laser excision was empirical. A successful outcome was obtained in 11 of 14 (79 per cent) of the horses treated by cryosurgery, 18 of 27 (67 per cent) treated by BCG vaccination, 18 of 22 (82 per cent) treated by conventional excision, and 20 of 28 (71 per cent) treated with a carbon dioxide laser. For both excision methods, rigorous measures were taken to avoid autoinoculation and to ensure a wide margin of normal skin. The probability of local recurrence after excision was significantly higher for large sarcoids and sarcoids which had previously failed to respond to treatment. In 10 of the 31 horses with remaining sarcoids, some or all of the untreated sarcoids were observed to regress spontaneously.     

Soft tissue application of lasers.

Despite increasing numbers of veterinarians incorporating lasers into their clinical practices, little information has been published about laser clinical applications in soft tissue surgery. This article reviews soft tissue interaction, describes laser equipment and accessories commonly marketed to veterinarians, and discusses clinical applications of the carbon dioxide laser in a systems-based approach. A table of recommended laser tips and settings based on the authors' experiences using a carbon dioxide laser (AccuVet Novapulse LX-20SP, Bothell, WA) is provided.     

Respiratory responses of the domestic fowl to low level carbon dioxide exposure

Respiratory function in the restrained, conscious domestic fowl was measured using a non-invasive technique and computer aided analysis to examine respiratory flow, and in-dwelling arterial catheters to monitor blood carbon dioxide levels. The effects of two low ranges of inspiratory carbon dioxide (0.2 to 1.0 per cent and 0.25 to 2.25 per cent) were studied, simulating levels of carbon dioxide that may occur in commercial poultry units and representing a mild environmental stress for the birds. A linear increase in minute volume with inspiratory carbon dioxide was observed, due primarily to increases in tidal volume. Arterial carbon dioxide (PaCO2) tension also rose as the inspiratory carbon dioxide concentration was raised, but higher inspiratory carbon dioxide levels were required to affect significantly blood carbon dioxide concentration than to modify respiratory parameters. Variation was observed in the individual bird's response to carbon dioxide (bird X carbon dioxide interaction), suggesting that resting values of the respiratory parameters measured were important in determining the bird's ventilatory response to carbon dioxide.     

Carbon dioxide laser as a surgical instrument for sarcoid therapy--a retrospective study on 60 cases.

The objective of this retrospective clinical study was to evaluate the carbon dioxide laser in the treatment of single and multiple sarcoids in 60 animals (44 horses, 13 donkeys, 2 mules, and 1 pony). Only animals that had been operated on 6 mo or more ago were included. Recurrence, new manifestation rate, and cosmetic outcome were determined. Recurrence was observed in 23 (38%) individuals. Animals with new sarcoid manifestation with or without recurrence of a sarcoid were observed in 35 cases (58%). Cases of scar tissue formation and, rarely, leukotrichia were observed. Animals presented with multiple sarcoids were more predisposed to recurrence. Donkeys showed a significantly lower recurrence rate than horses.     

Use of a carbon dioxide laser to treat ceruminous gland hyperplasia in a cat

This case report describes the skin condition ceruminous gland hyperplasia of the ears of a cat. The diagnosis was made through histopathology. Treatment consisted of carbon dioxide laser ablation of the cystic structures and postoperative care associated with the surgery, as well as a hydrolyzed protein diet, weekly ear cleaning and intermittent topical corticosteroid drops in the ears to minimize the reoccurrence of the cysts.     

Evaluation of carbon dioxide laser ablation combined with mitoxantrone and piroxicam treatment in dogs with transitional cell carcinoma

CASE DESCRIPTION: 8 dogs that underwent carbon dioxide (CO2) laser ablation of transitional cell carcinoma in the bladder trigone and proximal portion of the urethra and were also treated with mitotranxone and piroxicam. CLINICAL FINDINGS: Transitional cell carcinoma of the bladder frequently involves the trigone and urethra and can be difficult to manage surgically. Dogs underwent laser ablation of the primary tumor and were treated with mitoxantrone at a dosage of 5 mg/m2)every 3 weeks for 4 treatments. Piroxicam was given at a dosage of 0.3 mg/kg (0.14 mg/lb) once daily for the remaining life of the dog. TREATMENT AND OUTCOME: Median and mean disease-free intervals were 200 and 280 days, respectively. Median and mean survival times were 299 and 411 days, respectively. Adverse treatment effects were observed in 2 dogs; signs included mild, self-limiting inappetance and lethargy. The procedure appeared to be well tolerated; all treated dogs had rapid resolution of clinical signs of disease of the lower portion of the urinary tract. CLINICAL RELEVANCE: Although survival times achieved with CO2 laser ablation and treatment with mitoxantrone and piroxicam were similar to survival times associated with chemotherapy alone, resolution of clinical signs was better with the combined treatment.     

Thermal injury by in vitro incision of equine skin with electrosurgery, radiosurgery, and a carbon dioxide laser.

Freshly harvested equine skin incised with an electrosurgical unit, a radiosurgical device, or a carbon dioxide (CO2) laser was examined by light microscopy to determine the extent of thermal injury caused by each instrument. There was no significant difference between the thermal injury caused by the electrosurgical unit in the pure-cut mode and the CO2 laser in the superpulse mode, or between the electrosurgical unit and the radiosurgical device in the fully filtered cut mode. However, thermal injury caused by the CO2 laser was significantly less than that caused by the radiosurgical device. The amount of thermal injury in this in vitro study was similar to that found in vivo with other species.     

Use of CO2 laser as an adjunctive treatment for caudal stomatitis in a cat

Lasers have become a popular tool in veterinary practice, particularly the carbon dioxide (CO2) laser. In humans, the CO2 laser is used most commonly in oral and maxillofacial soft tissue surgery due to its favorable interactions with oral soft tissues. Other types of lasers are better suited for use on hard tissues such as enamel and dentin. This article reviews the history of laser use, physics of laser-tissue interaction, delivery systems, and laser types used in dentistry and oral surgery. This is followed by a case report describing the use of CO2 laser as an adjunctive treatment for therapy of refractory caudal stomatitis in a cat.     

Pulsed Carbon Dioxide Laser for Cartilage Vaporization and Subchondral Bone Perforation in Horses Part II: Morphologic and Histochemical Reactions

A pulsed carbon dioxide laser was used to vaporize articular cartilage in four horses, and perforate the cartilage and subchondral bone in four horses. Both intercarpal joints were examined arthroscopically and either a 1 cm cartilage crater or a series of holes was created in the third carpal bone of one joint. The contralateral carpus served as a control. After euthanasia at week 8, the treated and control joints were examined for gross changes, and samples of cartilage and subchondral bone, synovial membrane, and peripheral lymph nodes were examined histologically. Depletion of cartilage matrix glycosaminoglycan was assessed by safranin-O histochemical staining of the laser site and adjacent cartilage. Cartilage removal by laser vaporization resulted in rapid regrowth, with fibrous and fibrovascular tissue and occasional regions of fibrocartilage at week 8. The subchondral bone, synovial membrane, and draining lymph nodes appeared essentially unaffected by the laser cartilage vaporization procedure. Conversely, carbon dioxide laser drilling of subchondral bone resulted in poor penetration, extensive areas of thermal necrosis of bone, and significant secondary damage to the apposing articular surface of the radial carpal bone.     

Monitoring of the ventilatory status of anesthetized birds of prey by using end-tidal carbon dioxide measured with a microstream capnometer.

The relationship between end-tidal partial pressure of carbon dioxide (PETCO2), arterial partial pressure of carbon dioxide (PaCO2), and blood pH in isoflurane-anesthetized raptors was evaluated. PaCO2 and pH were determined in serial arterial samples from isoflurane anesthetized birds and compared with concurrent end-tidal partial pressure of carbon dioxide measured with a Microstream sidestream capnograph. Forty-eight paired samples, taken from 11 birds of prey (weighing 416-2,062 g), were used to determine correlations coefficients between PaCO2 and PETCO2, and between PETCO2 and pH. Limits of agreement between PaCO2 and PETCO2 also were calculated. Strong correlations were observed between PaCO2 and PETCO2 (r = 0.94; P < 0.0001) as well as between PETCO2 and pH (r = -0.90; P < 0.0001). However, the level of agreement between PaCO2 and PETCO2 varied considerably. Low values of PETCO2, ranging from 18 to 29 mm Hg, exceeded the concomitantly measured values of PaCO2 by an average of 6.0 mm Hg (6.0 +/- 1.9 mm Hg; mean +/- SD). Conversely, high values of PETCO2, ranging from 50 to 63 mm Hg, were on average 7.6 mm Hg (7.6 +/- 9.8 mm Hg) lower than values of PaCO2. In the 30 to 49 mm Hg range for PETCO2, the difference between PETCO2 and PaCO2 was on average 1.0 mm Hg (1.0 +/- 8.5 mm Hg). These results suggest that the capnograph used provided a sufficiently accurate estimation of arterial partial pressure of carbon dioxide for birds weighing > 400 g and receiving manual positive ventilation with a Bain system. In our study, the linear relationship observed between the pH and the end-tidal partial pressure of carbon dioxide suggested that the monitoring of end-tidal partial pressure of carbon dioxide also can be useful to prevent respiratory acidosis.     

Evaluation of a technique using the carbon dioxide laser for the treatment of aural hematomas

A new technique using the carbon dioxide (CO2) laser for the treatment of aural hematomas is described. The laser is used to make an incision into the hematoma to allow for evacuation of the blood, and then multiple, small incisions are made over the surface of the hematoma to stimulate adhesions between the tissue layers. The CO2 laser was used in this fashion to treat 10 aural hematomas in eight dogs. Follow-up ranged from 1 to 23 months. Owners evaluated the cosmetic results following CO2 laser surgery as excellent in three ears, good in five ears, and fair in two ears. Hematomas were resolved in all 10 cases, although two cases developed serosanguineous fluid accumulation that required percutaneous drainage in one case and a second laser procedure in the other case.