Thoracoscopic Thoracic Duct Ligation and Thoracoscopic Pericardectomy for Treatment of Chylothorax in Dogs

Objective— To report the use of thoracoscopic thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax.
Study Design— Case series.
Animals— Dogs with chylothorax (n=12).
Methods— Dogs with secondary or idiopathic chylothorax had thoracoscopy performed in sternal recumbency through 3 portals in the caudal right hemithorax for TDL and were then repositioned in dorsal recumbency for pericardectomy. Portals were placed in the 5th and 7th intercostal spaces of the right hemithorax with 1 transdiaphragmatic portal in the right paraxiphoid position. Follow-up was performed by recheck examination or telephone interview to determine outcome.
Results— Seven dogs (58%) had idiopathic chylothorax; 6 dogs (85.7%) had complete resolution of their effusion, whereas only 2 of the 5 nonidiopathic dogs (40%) had complete resolution.
Conclusions— Thoracoscopy is minimally invasive, provides excellent observation, and allows for ligation of the thoracic duct in the caudal thorax. Patients with idiopathic chylothorax may have a better prognosis after TDL and pericardectomy than dogs with nonidiopathic chylothorax.
Clinical Relevance— Thoracoscopy for ligation of the thoracic duct and pericardectomy is an acceptable surgical technique for treatment of chylothorax.     

Pericardial free patch grafting as a rescue technique in surgical management of right atrial HSA

A 7 yr old, neutered female vizsla underwent an exploratory thoracotomy after diagnosis of recurrent hemorrhagic pericardial effusion and a right auricular mass. Staging tests were negative for metastasis. The patient underwent a right, fourth intercostal thoracotomy, subtotal pericardectomy, right auricular mass excision, and pericardial free patch graft. The patient experienced blood loss during surgery, which required a packed red blood cell transfusion. The patient experienced transient arrhythmias postoperatively, but was discharged from the hospital 48 hr later. Histopathologic diagnosis of the mass was hemangiosarcoma. The patient was treated with carboplatin single-agent chemotherapy and palliative radiation therapy. The patient died at home, presumably from metastatic disease 260 days postoperatively. Surgical mass removal or debulking along with pericardial free patch grafting may be considered as palliative treatment options for dogs diagnosed with right auricular masses. In this case report, other techniques failed to repair the defect in the heart and a free patch graft offered a good rescue procedure with a favorable outcome without the need for inflow and outflow occlusion when used in conjunction with adjunctive therapies.     

Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog

Objective – To describe and report successful surgical management of pericardial effusion and cardiac tamponade in a dog caused by intrapericardial granulation tissue.
Case Summary – An 8-month-old, intact male, Greater Swiss Mountain Dog was referred for cardiac evaluation following 2 weeks of progressive lethargy, abdominal distention, and difficulty breathing. On the day of presentation, the dog had an episode of acute collapse. A 14-cm multilocular pericardial cystic lesion causing collapse of the right atrial free wall and resulting in pericardial tamponade was observed on echocardiogram. After the dog subsequently experienced two acute episodes of pericardial effusion, a subtotal pericardectomy was performed and clinical signs resolved. The histopathologic diagnosis of the mass was inflammation and granulation tissue, likely caused by a resolving hematoma or abscess.
New or Unique Information Provided – This is the first report of intrapericardial granulation tissue as the cause of pericardial effusion and cardiac tamponade.     

Computed Tomographic Lymphography of the Thoracic Duct by Mesenteric Lymph Node Injection

Objective— To document a novel technique to image the thoracic duct and its tributaries by contrast enhanced computed tomography (CT) lymphography.
Study Design— Clinical report.
Animals— Dogs (n=6) idiopathic chylothorax.
Methods— Ultrasonography was used to guide percutaneous injection of intestinal lymph nodes with nonionic iodinated contrast medium for preoperative CT lymphography of the thoracic duct in 6 dogs with chylothorax. Thoracic CT images were acquired immediately after contrast medium injection. All dogs had subtotal pericardectomy and thoracic duct ligation. Postoperative thoracic duct lymphography was performed in 3 dogs. Superficial cervical lymph node lymphography was performed in 2 dogs to determine cervical lymphatic contribution to thoracic effusions.
Results— Preoperative thoracic duct lymphography using this technique was successful in delineating the cisterna chyli, thoracic duct, and associated lymphatic vessels in all dogs. Immediate postoperative lymphography performed in 2 dogs revealed successful duct ligation in 1 dog and persistent lymphatic leakage in the other. A 1-month postoperative thoracic duct lymphogram performed in 1 dog revealed unsuccessful ligation or recannulation of 1 of 3 redundant vessels seen preoperatively.
Conclusion— Percutaneous CT lymphography results in excellent detection of the thoracic duct and abnormal thoracic duct drainage patterns both pre- and postoperatively. The contribution of superficial cervical lymph node drainage to reoccurrence of effusions can be evaluated.
Clinical Relevance— Percutaneous CT lymphography using ultrasound-guided contrast medium injection should be considered as an alternative to conventional open abdominal approaches to radiographic or CT lymphography.     

Cisterna chyli ablation with thoracic duct ligation for chylothorax: results in eight dogs

OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.     

Pericardial effusion and cardiac tamponade in a cat with extranodal lymphoma

A five-year-old domestic longhaired cat was evaluated for a seven-day history of worsening respiratory distress. Serum analysis for feline leukaemia virus antigen was positive. Pleural effusion was detected on thoracic radiographs and echocardiography revealed a pericardial effusion and cardiac tamponade. Cytological evaluation of the pleural and pericardial effusions showed lymphoblastic cells indicative of disseminated lymphoma. Following thoracocentesis and pericardiocentesis, the cat was treated for lymphoma using the University of Wisconsin-Madison chemotherapy protocol. The cat was sent home after three days and, at the time of writing (six months after initial presentation), was still symptom free. To the authors' knowledge, this is the first report confirming pericardial effusion and cardiac tamponade in the cat as a direct result of an extranodal lymphoma with cytological evidence of neoplastic cells in the pericardial fluid.     

Surgical Treatment of Gastric Outflow Obstruction in 40 Foals

Objective— To report short- and long-term survival and factors affecting outcome of foals after surgical correction of gastric outflow obstruction.
Study Design— Case series.
Animals— Foals (n=40) aged 5–180 days.
Methods— Clinical signs, laboratory data, diagnostic imaging, surgical findings, surgical procedures, medical treatment, and necropsy findings were retrieved from medical records. Outcome was obtained by reviewing performance, sales, and produce records or by telephone conversations with the owners.
Results— Gastric outflow obstruction was treated by gastroduodenostomy or by gastrojejunostomy with or without jejunojejunostomy. Long-term follow-up was available for 36 of 39 foals that survived to hospital discharge; 25 (69%) survived >2 years. All 8 foals with pyloric obstruction survived >2 years, whereas only 11 of 21 (52%) foals with duodenal obstruction survived >2 years. Six of 8 foals with obstruction of the duodenum and pylorus survived >2 years. Obstruction of the duodenum, adhesions to the duodenum, and postoperative ileus were significantly associated with decreased long-term survival.
Conclusions— Long-term outcome after gastric bypass procedures was substantially improved compared with previous reports. Factors that may have contributed to improved survival include better case selection and performing the gastrojejunostomy with the jejunum aligned from left to right.
Clinical Relevance— The prognosis for long-term survival after surgical bypass of pyloric obstruction is excellent. The overall prognosis for long-term survival after surgical bypass of duodenal obstruction is fair but should be considered guarded in those with pre-existing duodenal adhesions.     

Pull-through technique for palmar digital neurectomy: forty-one horses (1998-2004)

Objectives— To report outcome of horses treated for navicular syndrome using a pull-through (PT) technique for palmar digital neurectomy (PDN).
Design— Retrospective study.
Animals— Horses (n=41) with navicular syndrome (NS).
Methods— Medical records (1998–2002) for horses that had NS and failed to respond to conservative management that had unilateral or bilateral forelimb, biaxial PDN were reviewed. Outcome for up to 6 years was obtained by telephone questionnaire or lameness examination. Survival analysis was used to assess time to recurrence of lameness.
Results— One year after PDN, 36 horses (88%) were free of lameness. Mean survival with no lameness after surgery was estimated at 4.14±0.33 years (median, 5 years).
Conclusions— PT–PDN technique resulted in soundness for 88% of horses for at least 1 year. PT–PDN was easily and quickly performed without specialized equipment, and had a low incidence of complications.
Clinical Relevance— The PT technique is an effective and viable alternative surgical method for PDN.     

Cementless Total Hip Replacement in an Alpaca

Objective— To report management of a chronic slipped capital femoral epiphysis (SCFE) in an alpaca using cementless total hip replacement (THR).
Study Design— Case report.
Animal— An 18-month-old, 47 kg alpaca male.
Methods— Cementless THR was performed in an alpaca with a chronic, right SCFE, and secondary osteoarthritis. Force plate gait analysis was performed before and 8 weeks after surgery. Outcome was determined through clinical evaluation, radiography, and force plate gait analysis.
Results— Cementless THR resulted in marked improvement in the alpaca's comfort level, degree of lameness, and range of motion. On preoperative force plate gait analysis there was decreased contact time ( P =.01) and vertical impulse ( P <.01) of the affected limb, whereas at 8 weeks postoperatively significant differences in gait analysis between pelvic limbs were not apparent.
Conclusion— THR using a BioMedtrix^® canine cementless modular prosthesis restored hip function in an alpaca with coxofemoral osteoarthritis from chronic SCFE.
Clinical Relevance— THR may be an appropriate treatment for selected traumatic and degenerative conditions of the coxofemoral joint in alpacas.     

Use of Buccal Mucosal Flaps for the Correction of Congenital Soft Palate Defects in Three Dogs

Objective —To present an alternative surgical technique for the repair of soft palate defects in dogs.
Animal Population —Three Foxhound cross dogs.
Methods —Bilateral buccal mucosal flaps, based at the palatoglossal arches, were raised. One flap was rotated so that the mucosal side created the floor of the nasopharynx. The second flap was rotated so that the mucosal side formed the roof of the oropharynx. The mucosa of the remnant of the soft palate and the pharyngeal walls was incised and the flaps sutured to these free mucosal edges. The caudal ends of the two flaps were sutured to each other.
Results —Complete closure of the soft palate defect was obtained in all three dogs. The dogs were monitored for between 1.5 and 3 years postoperatively, and no long-term problems were encountered.
Conclusions —This surgical technique resulted in an excellent functional separation of the oropharynx and nasopharynx and allowed reconstruction of a large bilateral soft palate defect.
Clinical Relevance —By using the buccal mucosal flaps, as described in this report, a tension-free closure of large soft palate defects can be obtained, thereby eliminating a major cause of failure of this type of reconstructive surgery.     

Fluorescence In Situ Hybridization Confirms Clearance of Visible Helicobacter spp. Associated with Gastritis in Dogs and Cats

Background: The results of studies examining the role of Helicobacter spp. in the pathogenesis of canine and feline gastritis are inconclusive. Furthermore, data evaluating the effectiveness of medical therapy for eradication of Helicobacter infection are limited.
Aim: To detect Helicobacter spp. in mucosal biopsies of dogs and cats diagnosed with gastritis, with fluorescence in situ hybridization (FISH).
Animals: Three dogs and 2 cats with signs of chronic gastrointestinal disease.
Methods: Dogs and cats infected with Helicobacter spp. were treated with triple antimicrobial therapy and fed an elimination diet for 21 days. Helicobacter spp. status in endoscopic (3 dogs, 1 cat) or surgical biopsies (1 cat) of gastric mucosa was compared pre- and posttreatment in each animal by histology, FISH analysis, and polymerase chain reaction (PCR).
Results: Gastritis of varying severity with intraglandular spiral bacteria was observed in all animals. Pretreatment diagnostic tests confirmed the presence of mucosal Helicobacter spp. in all animals by FISH and histopathology and in 4/5 animals by PCR. Rapid resolution of vomiting episodes was observed in all animals. Gastric biopsies performed after triple therapy revealed clearance of visible Helicobacter spp. by histopathology and negative FISH analysis, as well as PCR in all animals.
Conclusions and Clinical Importance: Application of FISH to routine biopsy specimens enabled rapid and specific identification of Helicobacter spp. within the gastric mucosa of dogs and cats. Although medical therapy was useful in resolution of clinical signs and clearance of visible Helicobacter spp. in gastric biopsies, gastric inflammation persisted.     

Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax

Chylothorax is a devastating disease, and the success rates from either medical or surgical management are less than satisfactory. In some animals with chylothorax, a thickening of the pericardium occurs that is associated with chronic irritation induced by chyle. We hypothesized that pericardial thickening would lead to increased right-sided venous pressures and that abnormal venous pressures would act to impede the drainage of chyle via lymphaticovenous communications after thoracic duct (TD) ligation. We also hypothesized that serosanguineous effusions that occurred after TD ligation could effectively be treated or prevented by pericardectomy in affected animals. TD ligation plus pericardectomy was performed in 17 animals, and pericardectomy alone was performed in an additional 3 animals that presented during a 5.5-year period to the Texas A&M University (College Station, TX). Nineteen animals presented for an evaluation of idiopathic chylothorax (9 dogs and 10 cats), and 1 dog presented for serosanguineous pleural fluid after TD ligation that had been performed elsewhere. Echocardiography was normal in all animals, except for a subjectively thickened pericardium in 7 cats and 6 dogs. Clinical signs of pleural fluid accumulation resolved in 10 of 10 dogs and in 8 of 10 cats after surgery. The overall success rate for the surgical treatment of chylothorax (ie, the resolution of pleural fluid accumulation) in this study was 90% (100% in dogs and 80% in cats). These data suggest that TD ligation in conjunction with pericardectomy has a favorable outcome in animals with idiopathic chylothorax.     

Magnetic Resonance Imaging of Right Ventricular Morphology and Function in Boxer Dogs with Arrhythmogenic Right Ventricular Cardiomyopathy

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a myocardial disease characterized by fibrofatty replacement of the right ventricle and ventricular tachyarrhythmias, reported most commonly in the Boxer dog. Although ARVC is characterized as a myocardial disease, the impact of the disease on the function of the right ventricle has not been well studied.
Objective: To noninvasively evaluate the function and anatomy of the right ventricle in Boxer dogs with ARVC.
Animals: Five adult Boxer dogs with ARVC and 5 healthy size-matched hound dogs.
Methods: Magnetic resonance imaging was performed on an ECG-gated conventional 1.5-T scanner using dark blood imaging and cine acquisitions. Images were evaluated by delineation of endocardial right and left ventricular contours in the end-diastolic and end-systolic phases of each slice. Right and left end-systolic and end-diastolic volumes were generated using Simpson's rule and ejection fraction was calculated. Images were evaluated for right ventricular (RV) aneurysms and wall motion abnormalities. Spin echo images were reviewed for the presence of RV myocardial fatty replacement or scar.
Results: RV ejection fraction was significantly lower in Boxers with ARVC compared with the controls (ARVC 34%± 11 control 53%± 10, P < .01). There was an RV aneurysm in 1 dog with ARVC but not in any of the controls. RV myocardial gross fatty changes were not observed in dogs of either group.
Conclusions and Clinical Importance: These findings could be interpreted to suggest that arrhythmias and myocardial dysfunction precede the development of morphological abnormalities in dogs with ARVC.     

Iatrogenic sciatic nerve injury in eighteen dogs and nine cats (1997-2006)

Objective— To report clinical features associated with iatrogenic peripheral nerve injury in dogs and cats admitted (1997–2006) to a referral teaching hospital.
Study Design— Retrospective study.
Animals— Dogs (n=18), 9 cats.
Methods— Patients had acute signs of monoparesis attributable to sciatic nerve dysfunction that developed after treatment. Neurologic examination and electrodiagnostic testing were performed. Surgical therapy was used for nerve entrapment and delayed reconstructive surgery used in other cases.
Results— Of 27 nerve injuries, 25 resulted from surgery (18 with treatment of pelvic injuries). Iliosacral luxation repair resulted in tibial (4 cats) and peroneal (3 dogs) nerve dysfunction. Other causes were intramedullary pinning of femoral fractures (3), other orthopedic surgery (cemented hip prosthesis [2] and tibial plateau-leveling osteotomy [1]), and perineal herniorrhaphy [1]. Nerve injury occurred after intramuscular injection (1 cat, 1 dog). Immediate surgical treatment was removal of intramedullary nails, extruded cement, or entrapping suture. Delayed nerve transplantation was performed in 2 dogs. Within 1 year, 13 patients recovered completely, clinical improvement occurred in 7, and there was no improvement in 7. Five of the 7 dogs that did not recover had acetabular or ilium fracture.
Conclusion— Iatrogenic sciatic nerve injury occurred most commonly during treatment of pelvic orthopedic diseases and had a poor prognosis. Clinical variation in sciatic nerve dysfunction in dogs and cats can be explained by species anatomic differences.
Clinical Relevance— Iatrogenic sciatic nerve injury leads to severely debilitating locomotor dysfunction with an uncertain prognosis for full-functional recovery.     

1例猫特发性乳糜胸胸腔镜手术治疗与保守疗法的效果比较

旨在对比猫特发性乳糜胸胸腔镜下手术治疗和保守疗法的效果.将患有特发性乳糜胸的猫采取两种方式治疗.保守治疗采用安置胸导管每日抽吸胸腔积液,同时服用芦丁药物,并采取低脂饮食的方法.手术治疗采用胸腔镜下的胸导管结扎术和心包切除术.通过检查患猫体格状况、血液检查、细胞学检查、影像学检查来判断患猫的恢复程度.结果表明:保守治疗7...     

Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat.

A 6-year-old, spayed female Himalayan cat with idiopathic chylothorax, which failed to respond to medical management, was successfully treated by advancement of the omentum into the thorax. Exploratory thoracotomy revealed severe, constrictive pleuritis as a sequela to chylothorax. Because of the poor prognosis for recovery from chylothorax in cats with thoracic duct ligation alone, and the lack of success in performing thoracic duct ligation in this cat, the omentum was advanced into the thorax through a hole created in the diaphragm and sutured within the thoracic cavity. The cat recovered from surgery and is clinically normal 13 months postoperatively. Omental advancement may be an effective surgical management technique for this challenging disease in cats.     

Multiple Rib Fracture Repair in a Neonatal Holstein Calf

Objectives— To report rib fracture repair in a neonatal calf using the Securos^® Cranial Cruciate Ligament Repair System (SCCLRS).
Study Design— Case report.
Animals— A 2-day-old female Holstein calf with fracture of right ribs 4–10.
Methods— On the day of admission the calf was anesthetized and rib fractures were repaired using open reduction and the SCCLRS.
Results— Rib fractures were successfully stabilized and the calf discharged from the hospital 8 days postoperatively.
Conclusions— Modification of previously reported use of the SCCLRS to repair rib fractures in foals was required because of the different anatomy in the calf. This new technique was rapidly and easily performed for a large number of fractured ribs in this case.
Clinical Relevance— Effective rib fracture repair in calves can be readily performed using the SCCLRS with modification of the technique reported in foals.     

Laparoscopic Adhesiolysis in a Horse

Objective —The purpose of this report was to describe the use of laparoscopy as a method of treatment for abdominal adhesions in the horse.
Clinical Report —Unilateral ovariectomy for removal of a granulosa cell tumor was performed through a diagonal paramedian approach in a 14-year-old Arabian mare. Progressive incisional swelling and hemorrhage culminated in acute incisional dehiscence with herniation of ileum on the sixth postoperative day. Septic peritonitis that responded to parenteral antibiotic therapy was identified 7 days after hernia repair. Seven days later, the mare had signs of abdominal pain, and adhesions of small intestine to the paramedian incision were identified on rectal palpation. Transrectally assisted laparoscopic adhesiolysis was performed. No further complications occurred.
Clinical Relevance —Laparoscopic adhesiolysis may provide better observation of adhesions and reduced postoperative morbidity compared with laparotomy.     

Acute Phase Response to Surgery of Varying Intensity in Horses: A Preliminary Study

Objective— To evaluate the postoperative inflammatory response of horses to elective surgery of varying intensity.
Study Design— Prospective longitudinal study.
Animals— Horses referred to 2 hospitals for either arthroscopic removal of a unilateral osteochondritic lesion in the tibiotarsal joint (minimal surgical trauma, n=11), correction of recurrent laryngeal neuropathy by laryngoplasty and ventriculectomy (intermediate surgical trauma, n=10) or removal of an ovarian tumor by laparotomy (major surgical trauma, n=5).
Methods— Horses had a thorough clinical examination every day. White blood cell (WBC) counts and concentrations of serum amyloid A (SAA), fibrinogen, and iron were assessed in blood samples obtained before, and 1–3, 5, 7, 9, and 11 days after surgery. Differences in levels of the inflammatory markers between the 3 surgical groups were analyzed using repeated measures ANOVA.
Results— Postoperative concentrations of SAA and fibrinogen were significantly higher in horses that had laparotomy and ovariectomy than in horses that had laryngoplasty and ventriculectomy, or arthroscopy. Iron concentrations decreased to lower levels after intermediate and major surgical trauma than after small surgical trauma. WBC count did not differ between the 3 groups.
Conclusions— Levels of SAA, fibrinogen, and iron reflected the intensity of the surgical trauma, whereas WBC count did not.
Clinical Relevance— Postoperative measurements of SAA, fibrinogen, and iron may be useful for comparing surgical trauma associated with new and established surgical techniques. Moreover, knowledge of the normal postoperative acute phase response is essential, if acute phase reactants are to be used for monitoring occurrence of postoperative infections.