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.     

Periocular sarcoid in a horse

A periocular nodular sarcoid of the right upper and lower eyelids was diagnosed in an 11-year-old Thoroughbred mare. Computed tomography scan revealed the extent of the tumor. The mass was surgically debulked under general anesthesia, and the affected periocular region was injected intralesionally with Bacillus of Calmette and Guerin (BCG). An emulsion of cell wall fractions was used, which has been modified to reduce the toxic and allergic effect, but retain the antitumor activity. In total, five injections were performed at 2-week intervals. At follow-up 7 months after the last BCG injection, the tumor was completely resolved. Two years after the last treatment, the horse remains tumor-free.     

Successful removal of a guidewire from the jugular vein of a mature horse

This case report describes the removal of a metal guidewire that was lost accidentally in the jugular vein during the placement of an indwelling catheter. The proximal end of the guidewire was identified in the distal third of the cervical region by radiography and ultrasonography. The retained wire was removed successfully by percutaneous fluoroscopically assisted endovascular retrieval with a 4 pronged retrieval catheter.     

The diagnosis and treatment of periorbital sarcoid in the horse: 445 cases from 1974 to 1999

OBJECTIVE: Diagnosis and management of periorbital sarcoids in horses is a significant clinical challenge for the practicing veterinary surgeon and pathologist. The purpose of this study was to investigate the response of various types of sarcoids to different therapeutic methods. Animals studied Medical records of 445 clinical patients. Procedures This paper retrospectively examines the clinical and histological features of periorbital sarcoids and the treatment of 445 cases. Treatment by surgical excision, cryosurgery, Bacillus-Calmette-Gaérin (BCG) immunomodulation, topical cytotoxic applications, and radiation are described. RESULTS: Six types of sarcoid can be found in the immediate periorbital region and each has some characteristics of other disorders of the skin with which they can be confused. The diagnosis of sarcoids is, however, relatively simple in most cases. The lesions are not necessarily restricted to the dermis and epidermis, but commonly invade into the subcutis and the deeper muscular structures around the eye. Treatment with radiation is expensive and difficult to manage but resulted in the best outcome with almost 100% resolution in 66 cases. By contrast, surgical excision has serious potential complications that arise primarily as a result of the infiltrative nature of periorbital sarcoids. The value of BCG immunomodulation therapy for fibroblastic and nodular lesions described by previous workers is confirmed in this paper, with a good overall response (69%), provided that the material was injected intralesionally. Perilesional injection did not appear to carry a significant benefit. However, treatment of verrucose or occult lesions by this method gave generally poor results. The results of intralesional injection of cisplatin emulsions suggest that this may be an effective method of treatment in cases where other modalities are not feasible. In common with previous reports, failure to resolve the lesions frequently resulted in regrowth of the tumor, and in most cases this recurrence appeared to be more aggressive, with extensive local infiltration and faster growth. Conclusion The periorbital tissues are less tolerant of damage than those at many other sites and therefore certain treatment methods may be contraindicated. This suggests that it is important to select the best possible treatment at the first opportunity. It is a wise precaution to warn owners of horses with periorbital sarcoids of the dangers of leaving them and the particular risks associated with the currently available treatments.     

The clinical presentation and surgical treatment of verrucous dermatitis lesions in a draught horse

Verrucous pastern dermatitis is a progressive inflammatory skin disease commonly involving the palmar or plantar aspects of the pasterns of horses. There are no reports of successful surgical treatment for multifocal circumscribed verrucous masses in the chronic stages of verrucous pastern dermatitis. A combination of sharp dissection and electrocautery was used to resect numerous multifocal circumscribed verrucous masses from the distal hindlimb of an 11-year-old gelding draught horse. There was no evidence of significant regrowth or complications at a 24 month postoperative examination.     

Surgical repair of a full-thickness ear pinna defect in a horse

A 5-year-old gelding used for showing was presented for surgical repair of a full-thickness 15 mm diameter defect in the right pinna, which had occurred as a delayed complication following laser excision of a sarcoid. The defect had resulted in progressive deformity of the ear, and the horse was considered at risk of further injury if the defect became entrapped on a fixed object. Two artificial dermis meshes were inserted to encourage the formation of granulation tissue across the defect, and a commercially available skin expander was implanted adjacent to the site. Eighteen days later, a second surgery was performed to remove the skin expander and to mobilise a local rotational skin flap to close the defect. Both surgeries were performed under standing sedation and local anaesthesia. The site healed well, avoiding further potential trauma to the ear and deformity due to tissue contracture at the site, although some deformation of the lateral aspect of the cartilage remained.     

Carbon dioxide laser ablation combined with doxorubicin hydrochloride treatment for vaginal fibrosarcoma in a dog.

The combined use of CO2 laser ablation and doxorubicin hydrochloride (30 mg/m2) administered twice, 4 weeks apart, resulted in complete remission of vaginal fibrosarcoma in a 10-year-old Miniature Poodle. The tumor had redeveloped when only CO2 ablation was used for treatment and doxorubicin hydrochloride alone has had marginal influence on fibrosarcomas; however, use of both treatments in this dog resulted in a 20-month, disease-free period. This treatment combination was minimally traumatic to the dog, easily accomplished, and effective, and it allowed retention of the normal anatomy and function of the urogenital tract.     

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.     

Use of a neodymium:yttrium-aluminum-garnet laser to remove exuberant granulation tissue from the esophagus of a horse

Use of a neodymium:yttrium-aluminum-garnet laser to remove exuberant granulation tissue from the esophagus of a horse A 4-year-old Quarter Horse mare was evaluated because of recurrent esophageal obstruction. Endoscopic examination revealed a proliferative mass in the esophagus approximately 55 cm aborad to the nares. Histologic examination of biopsy specimens revealed diffuse suppurative esophagitis and granulation tissue with no evidence of neoplasia. The mass was excisedand ablated transendoscopically with a neodymium:yttrium-aluminum-garnet laser. During a follow-up examination 2 weeks after the final laser procedure, the mass was no longer apparent, and the esophagus appeared healed. Six months after the final examination, there had been no recurrence of the mass. In this horse, transendoscopic laser excision was efficacious and avoided problems associated with an esophagotomy.     

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.     

Resection of a ceruminous adenocarcinoma in a horse by a modified vertical ear canal ablation

A 13‐year‐old Swedish Warmblood mare was presented for evaluation of a mass on the medial aspect of the left vertical ear canal. The mass was initially resected using monopolar loop diathermy. Histopathological diagnosis of the excisional biopsy was a low‐grade malignant ceruminous adenocarcinoma. The clinical and histopathological features of this previously unreported neoplasm in the horse are described. A modified vertical ear canal ablation was performed in order to remove the base of the neoplasm with adequate free margins. The surgical technique is described. No recurrence was noted 2 years after surgery and the appearance and function of the pinna were retained.     

Standing surgical removal of a progressive ethmoidal haematoma invading the sphenopalatine sinuses in a horse

Progressive ethmoidal haematomas (PEH) have been described as encapsulated, gradually expanding masses, which typically develop from the ethmoidal turbinates. Plain skull radiographs have been shown to be useful in determining the extent of the soft tissue mass if it invades the paranasal sinuses; however, where it is available, computed tomography (CT) offers substantial advantages in the evaluation of the full extent of a PEH. This Case Report describes a PEH invading into the sphenopalatine sinus, and the use of CT in accurately identifying the extent of the lesion.     

Surgical correction of ear curling caused by scar tissue formation in a horse

An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses.     

Standing removal of the proximal aspect of an olecranon fracture in a mature horse

A 12‐year‐old 450 kg Argentine polo mare presented with a dropped elbow and an unwillingness to bear weight after being kicked by another horse on the lateral aspect of the upper left forelimb. The mare was subsequently diagnosed with a displaced olecranon fracture that did not readily conform to the standard classification systems. Referral for surgical treatment involving open reduction and internal fixation was declined due to financial constraints. Due to the mare being unsuitable for breeding, and conservative treatment of displaced olecranon fractures being deemed to have an overall poor prognosis for return to full athletic performance, another treatment option was sought. Given the fracture configuration, standing surgical removal of the large proximal fragment was performed. The mare returned to full athletic performance 12 months post operatively without lameness. This case report describes an alternative treatment option for selected olecranon fractures.     

Carbon dioxide (CO2) laser treatment of cutaneous papillomas in a common snapping turtle, Chelydra serpentina

Carbon dioxide (CO2) laser was used to treat multiple cutaneous papillomas on an adult female common snapping turtle, Chelydra serpentina serpentina. A combination of excisional and ablative techniques provided excellent intraoperative visibility and postoperative results due to the laser's unique ability to incise and vaporize soft tissue.