Surgical management of urinary incontinence.

Urethral sphincter mechanism incompetence and ureteral ectopia are the two most common causes of urinary incontinence in dogs and cats. Surgical treatments for both disorders have been described.Once a diagnosis is made, surgical intervention may lead to improved outcomes with resolution of incontinence in many patients. Proper case selection and surgical technique are critical in achieving clinical success when managing these difficult cases.     

Surgical procedures for glaucoma: what the general practitioner needs to know

Glaucoma can be treated by medical and surgical options. Most ophthalmologists believe that patients with glaucoma are best treated with surgery. Early recognition of clinical signs and selection of the most effective type of surgery depending on the stage of glaucoma and the underlying cause are important factors in glaucoma surgery. Several surgical procedures exist for dogs with primary glaucoma, which may include a cyclodestructive technique or an aqueous outflow bypass procedure or a combination of both procedures. Salvage procedures such as enucleation, evisceration with an intrascleral prosthesis, or chemical intravitreal injection may be advised for chronically blind eyes with no hope of vision. Client compliance and expectations, therapeutic goals, status of vision (visual versus blind), financial constraints, surgical expertise, and underlying systemic disorders should be considered in the selection of the most appropriate surgical option for each patient.     

Diseases of the nictitating membrane of the dog

The clinical signs and treatment of the following conditions of the nictitating membrane are described–prominence of the nictitating membrane due to various causes, injuries and foreign bodies, conjunctivitis, plasma cell infiltration, disorders of the nictitans gland, neoplasia, and deformity of the cartilage. The surgical removal of the third eyelid is also discussed.     

Surgical Management of Adrenal Tumors and Insulinomas in Ferrets

Domestic ferrets are popular pets and comprise a significant percentage of the caseload in many veterinary practices. This article describes the diagnosis and surgical techniques for treatment of 2 common endocrine disorders affecting ferrets, adrenal gland disease and pancreatic beta cell neoplasms. Although medical treatment options are used to reduce the severity of clinical signs associated with adrenal hyperplasia or neoplasia, surgical removal of the adrenal gland(s) is the treatment of choice. Clinical disease associated with pancreatic beta cell tumors includes hypoglycemia, and in many cases the tumor will metastasize early in the course of the disease. Although achieving a complete resolution of pancreatic beta cell neoplasia is unlikely, surgical removal of insulin-secreting tumors is recommended to temporarily alleviate the clinical syndrome and confirm the diagnosis.     

Decision making in bovine abdominal surgery

This article describes the signs, hematologic alterations, and methods of diagnosis of digestive disorders that may be treated surgically. The necessity for surgical intervention is analyzed, based on clinical experience and current knowledge. The prognosis for surgical correction of common digestive problems and prognostic indicators for abomasal volvulus are described. Decision analysis for digestive surgery is reviewed, with examples for abomasal displacement and volvulus. Preoperative preparation for abdominal surgery--including facilities, equipment, supportive therapy, and distinction between elective and emergency surgery--is discussed briefly. The four most common surgical approaches for abdominal surgery are reviewed, and their indications noted.     

Surgery of the bovine abomasum

Intensive management of cattle has resulted in an increased incidence of abomasal disorders. Many of these disorders require surgical intervention for the best outcome. This article reviews the anatomy and physiology of the abomasum, abomasal disorders that may be treated by surgery, and the advantages and disadvantages of various surgical approaches to those disorders.     

Disorders of Serum Potassium, Sodium, Magnesium and Chloride

Fluid and electrolyte imbalances are frequently encountered in a variety of medical and surgical disorders therefore requiring the clinician's astute evaluation of his/her patient's fluid and electrolyte status. Disorders involving the gastrointestinal tract, kidneys, and endocrine organs will frequently cause abnormalities in sodium, potassium, magnesium, and chloride balance. An accurate initial assessment of serum electrolyte concentrations and monitoring during the treatment is essential in order to maintain electrolyte homeostasis. Failure to do so can lead to severe clinical consequences for the patient and change a diagnostic triumph into a therapeutic failure. This presentation provides an overview of the etiologies, clinical signs, and therapeutic approaches to electrolyte disorders in the critically ill animal. (Vet. Emerg. & Crit. Care, 9:209–217, 1999)     

THE ACUTE ABDOMEN IN THE HORSE EPIDEMIOLOGIC CONSIDERATIONS

A retrospective case history study of acute gastro-intestinal disease in the horse was undertaken to determine: 1) if a statistically significant age, sex, or breed distribution existed; 2) if a correlation existed between duration of clinical signs and surgical complications; and, 3) if the lesions causing the signs significantly altered surgical prognosis. Significant age, sex and breed distributions existed. Duration of clinical signs ranged to 5 days with a definitive time trend existing for surgical correction of strangulating colics. Surgical correction was successful only within 24 hours of the appearance of clinical signs. Surgical prognosis for specific intraabdominal lesions ranged from 20% survival with strangulation obstructions to 84% with impaction. Differential diagnosis in horses with signs of acute abdominal pain is difficult, and techniques available for this purpose are limited. ^3,7,8 Differentiation of specific lesions is necessary because the prognosis varies greatly with each, and the choice of treatment used depends on the nature of the lesion.¹ Knowledge of significant age, sex, or breed related distributions would aid differential diagnosis. There are few epidemiologic reports available for use in the clinical management of these cases.⁴ A recent report has dealt with the relative incidence of various types of intestinal obstructive diseases in the horse.⁷ The purpose of this retrospective case history study of gastrointestinal disorders in the horse was to determine: 1. If a statistically significant age, sex or breed distribution existed for all or specific lesions; 2. If a correlation existed between duration of clinical signs and surgical survival; and 3. If the lesions causing the clinical signs significantly altered surgical prognosis.     

Metabolic acid-base disorders in the critical care unit.

The recognition and management of acid-base disorders is a commonplace activity in the critical care unit, and the role of weak and strong acids in the genesis of metabolic acid-base disorders is reviewed. The clinical approach to patients with metabolic alkalosis and metabolic acidosis is discussed in this article.     

Long-term results of upper respiratory syndrome surgery and gastrointestinal tract medical treatment in 51 brachycephalic dogs

OBJECTIVES: After a first clinical study showing a high prevalence of gastrointestinal tract diseases in brachycephalic dogs presented for upper respiratory syndrome, a prospective study was performed to determine the influence of medical treatment for gastrointestinal tract disorders associated with upper respiratory syndrome surgery. METHODS: The gastrointestinal tract and respiratory disorders of 61 brachycephalic dogs presented for upper respiratory syndrome were evaluated. Together with surgery of the upper respiratory tract, a specific gastrointestinal medical treatment was administered. A minimal follow-up of six months was required for inclusion. RESULTS: Palatoplasty with rhinoplasty was the most common surgical correction (88.5 per cent). The mortality rate in the perioperative period was 3.3 per cent. Minor complications accounted for 26.2 per cent of cases. No aspiration pneumonia was encountered. A sufficient follow-up was obtained in 51 dogs. The improvement was judged by the owners as excellent or good in 88.3 per cent of the respiratory disorders and in 91.4 per cent of the gastrointestinal disorders. Clinically, a statistically significant improvement was obtained for both respiratory and gastrointestinal disorders. CLINICAL SIGNIFICANCE: In comparison with other studies, digestive tract medical treatment combined with upper respiratory surgery seems to decrease the complication rate and improve the prognosis of dogs presented for upper respiratory syndrome.     

Urodynamic testing in the diagnosis of small animal micturition disorders

Urodynamic testing provides a quantitative assessment of the function of the small animal lower urinary tract. Most commonly these techniques are utilized to assess urethral tone (urethral pressure profile or UPP) and bladder detrusor muscle function (cystometrogram or CMG). A UPP may be indicated in cases of canine and feline micturition disorders. Examples include suspected primary sphincter mechanism incontinence (PSMI), ureteral ectopia, other congenital abnormalities, suspected neurological disorders, and mechanical or functional urethral obstruction. A UPP can be performed effectively utilizing human dedicated equipment. A CMG may be indicated to assess detrusor function in all of the above cases as well as cases of suspected atonic or infiltrated urinary bladder. This procedure can also be performed using the same human equipment. These tests are useful not only in providing an accurate diagnosis, but also in providing a sensitive prognostic indicator for clinical outcome of micturition disorders with and without pharmacological or surgical therapy. A leak pressure point may also be established in dogs with urinary incontinence, and may be even more sensitive than a UPP to predict clinical incontinence in some cases.     

Clinical Features and Outcome of Dogs with Epiglottic Retroversion With or Without Surgical Treatment: 24 Cases

Background

Published information describing the clinical features and outcome for dogs with epiglottic retroversion (ER) is limited.

Hypothesis/Objectives

To describe clinical features, comorbidities, outcome of surgical versus medical treatment and long‐term follow‐up for dogs with ER. We hypothesized that dogs with ER would have upper airway comorbidities and that surgical management (epiglottopexy or subtotal epiglottectomy) would improve long‐term outcome compared to medical management alone.

Animals

Twenty‐four client‐owned dogs.

Methods

Retrospective review of medical records to identify dogs with ER that underwent surgical or medical management of ER.

Results

Dogs with ER commonly were middle‐aged to older, small breed, spayed females with body condition score (BCS) ≥6/9. Stridor and dyspnea were the most common presenting signs. Concurrent or historical upper airway disorders were documented in 79.1% of cases. At last evaluation, 52.6% of dogs that underwent surgical management, and 60% of dogs that received medical management alone, had decreased severity of presenting clinical signs. In dogs that underwent surgical management for ER, the incidence of respiratory crisis decreased from 62.5% before surgery to 25% after surgical treatment. The overall calculated Kaplan–Meier median survival time was 875 days.

Conclusion and clinical importance

Our study indicated that a long‐term survival of at least 2 years can be expected in dogs diagnosed with epiglottic retroversion. The necessity of surgical management cannot be determined based on this data, but dogs with no concurrent upper airway disorders may benefit from a permanent epiglottopexy to alleviate negative inspiratory pressures.     

Surgery of the trachea.

As our knowledge of the disease conditions affecting the airways increases, the opportunity and need to surgically invade these structures will increase accordingly. The importance of a carefully planned and excuted anesthetic protocol cannot be overemphasized; a well trained and experienced individual must monitor patients throughout the procedure and manipulate the anesthesia as required. With the use of current anesthetic equipment and techniques, the surgical correction of tracheal disorders can be accomplished safely.     

Diaphragmatic dysfunction in dogs with cervical spinal disorders before and after surgery using fluoroscopy,motion‐mode ultrasound and radiography was not different than a group of control dogs

Cervical spinal disorders can lead to life‐threatening respiratory complications. Diaphragmatic dysfunction is attributed to spinal cord morbidity secondary to cervical myelopathy or decompressive surgical intervention. The purpose of this observational case‐control study was to determine the frequency of diaphragmatic dysfunction in dogs with cervical spinal disorders and a control group, the strength of association between cervical myelopathies and decompressive surgery with diaphragm paresis, and the agreement between and clinical usefulness of fluoroscopy, motion‐mode ultrasonography, and radiography for diagnosing diaphragmatic dysfunction. Thirty‐five client‐owned dogs were recruited with 14 control dogs and 21 test dogs. Dogs were evaluated for the presence of diaphragmatic dysfunction using radiography, M‐mode ultrasonography, and fluoroscopy before and after an anesthetic or surgical event. Diaphragmatic dysfunction was observed more frequently in dogs with cervical spinal disease prior to surgery (8/21; 38.1%) compared to control dogs (3/14; 21.4%) but was not statistically significant (P = .30). The occurrence of diaphragmatic dysfunction did not significantly increase following surgical decompression in either group. There was no to slight agreement between all imaging modalities. Most dogs with diaphragmatic dysfunction were asymptomatic. Diaphragmatic dysfunction was not statistically associated with cervical myelopathy or decompressive surgery. Ultrasonography and radiography were not useful diagnostic tests for determining diaphragmatic dysfunction in asymptomatic dogs when compared to fluoroscopy.     

RADIOGRAPHIC DIAGNOSIS OF GASTROINTESTINAL DISORDERS IN THE FOAL

Abdominal discomfort in the foal presents a diagnostic challenge, because the small size of the foal precludes rectal palpation. Standing lateral horizontal beam abdominal radiographs using conventional techniques were evaluated as a diagnostic aid to identify the presence and location of gastrointestinal disorders in foals presented with colic. Forty foals were radiographed prior to surgery (20 foals), necropsy (7 foals), or clinical diagnosis (13 foals). Clinical, surgical, or necropsy findings were then correlated to radiographic findings. Gastrointestinal disease was accurately identified on radiographs as the source of colic in 25 of 26 foals that had surgical or postmortem confirmation. The site of disease, whether gastric, small intestinal, large intestinal, or a combination, was accurately determined from radiographs. Standing lateral abdominal radiographs were determined to be a valuable diagnostic aid in the foal presented with colic.     

Evaluation of heparin for prophylaxis of equine laminitis: 71 cases (1980-1986)

The records of 71 horses with small intestinal disorders requiring surgical correction were disorders requiring surgical correction were reviewed to compare the prevalence of laminitis in those horses treated prophylactically with heparin and the prevalence of horses not treated with heparin. The prevalence of laminitis was 13% (9/71), and there was no significant difference (P less than 0.05) in the prevalence of laminitis between the 2 groups. The lack of significant benefit after treatment with heparin indicates that further work needs to be done on the equine coagulation system before heparin can be advocated for prevention of laminitis.     

Degenerative lumbosacral stenosis in the dog: A review of 30 cases

Lumbosacral disorders were diagnosed in 43 dogs over a five-year period. Degenerative lumbosacral stenosis was found to be the cause in 30 dogs. The clinical, radiographic and myelographic findings in these dogs are reviewed and the results of conservative and surgical treatment presented. Low back pain was found to be the most important presenting sign. Only seven dogs (23 per cent) presented with a significant neurological abnormality and 15 dogs (50 per cent) showed no detectable neurological deficit. The problems associated with the definitive diagnosis of this disorder and its significance as a cause of pain and lameness in the hindquarters of large dogs are discussed.     

Massive pulmonary thromboembolism in six horses

This report involves 6 cases in which medical records and post mortem findings were reviewed leading to the diagnosis of massive pulmonary thromboembolism (MPTE). All horses were mature and MPTE has not been recognised previously as a sequel to generalised systemic illness in mature horses. The clinical data and pathological findings of the cases are reported and the authors conclude that MPTE is an uncommon but important complication of medical and surgical disorders in mature horses. In 3 of the cases, the condition was nonfatal suggesting that some horses having developed PTE survive and the condition may not be recognised in such cases. The incidence of the condition might be higher than supposed.     

A prospective study of postoperative surgical site infections in dogs and cats

OBJECTIVE: To assess postoperative surgical site infection (SSI) rate and to identify associated predictive factors. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs and cats that had surgery (1010 interventions) during 58 weeks from April 1999 to June 2000. METHODS: Data sheets were completed by clinicians. Patients were controlled for clinical evidence of SSI at suture removal. Two definitions of SSI ("infection" and "infection/inflammation") were developed specifically for this study and used for statistical analysis. Logistic regression models were built in order to identify significant predictive factors for SSI. RESULTS: Wounds with "infection/inflammation" occurred in 5.8% and "infected" wounds in 3% of patients. The outcome "infection" was associated with 3 major risk factors (duration of surgery, increasing number of persons in the operating room, dirty surgical site) and 1 protective factor (antimicrobial prophylaxis). The outcome "infection/inflammation" was associated with 6 significant factors (duration of anesthesia, duration of postoperative intensive care unit stay, wound drainage, increasing patient weight, dirty surgical site, and antimicrobial prophylaxis). CONCLUSIONS: SSI frequency in companion animals is comparable with the frequency observed in human surgical patients. Several significant predictive factors for SSI in small animals surgery were identified. CLINICAL RELEVANCE: Baseline information for SSI surveillance in our hospital and for comparison with other studies was defined. The factors identified may help to predict infections in surgical patients and to take adequate preventive measures for patients at risk.