Risk factors associated with development of postoperative ileus in horses.

OBJECTIVE: To determine risk factors associated with development of postoperative ileus in horses undergoing surgery for colic. DESIGN: Case-control study. ANIMALS: 69 horses that developed ileus after surgery for colic and 307 horses that did not develop postoperative ileus. PROCEDURE: Signalment, history, clinicopathologic data, treatment, lesions, and outcome were obtained from medical records. RESULTS: Variables associated with increased risk of postoperative ileus included age > 10 years, Arabian breed, PCV > or = 45%, high serum concentrations of protein and albumin, anesthesia > 2.5 hours' duration, surgery > 2 hours' duration, resection and anastomosis, and lesions in the small intestine. Enterotomy reduced the risk of postoperative ileus. After multivariate logistic regression, the final model included the variables Arabian breed, PCV > or = 45%, lesion type, duration of surgery (> 2 hours vs < or = 2 hours), and pelvic flexure enterotomy. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that by evaluating certain factors, horses at increased risk of postoperative ileus may be recognized before the condition develops. Preventative treatment and early intervention may be instituted in these horses. Shortening surgery time and performing an enterotomy may decrease the probability of horses developing postoperative ileus.     

Evaluation of risk factors associated with development of postoperative ileus in horses

OBJECTIVE: To determine factors associated with development of postoperative ileus (POI) in horses undergoing surgery for colic. DESIGN: Prospective case-control study. ANIMALS: 251 horses undergoing colic surgery, of which 47 developed POI. PROCEDURE: Signalment, history, clinicopathologic data, pre- and postoperative treatments, lesions, complications, costs, and outcome were recorded for all horses during hospitalization. RESULTS: Variables associated with increased odds of POI included small intestinal lesion, high PCV, and increased duration of anesthesia. There was modest evidence that pelvic flexure enterotomy and intraoperative administration of lidocaine may have reduced the odds of developing POI. CONCLUSIONS AND CLINICAL RELEVANCE: Findings during the preoperative and intraoperative periods can be used to identify horses at increased risk of POI. Reducing surgical and anesthetic duration should decrease the incidence of POI.     

Surgical treatment of mammary carcinomas in dogs with or without postoperative chemotherapy

This retrospective study identified prognostic factors associated with survival; and compared survival data in 94 canine mammary carcinoma (MCA) dogs treated with surgery (n = 58), or surgery and adjunct chemotherapy (n = 36), and a subset of dogs with poor prognostic factors. On multivariate analysis independent predictors of median survival time (MST) were clinical stage, lymphatic invasion (LI; present 179 days; none 1098 days), ulceration (present 118 days; none 443 days) and surgical margins (incomplete 70 days; complete 872 days). Complete surgical margins were associated with MST in dogs with stages 1–3 MCA (incomplete 68 days; complete 1098 days) and dogs with LI (incomplete 70 days; complete 347 days). There was no statistically significant improvement in MST in dogs with advanced disease (stage 4 or LI) treated with adjunctive chemotherapy (chemotherapy 228 days; none 194 days); although five dogs with complete surgical margins that received mitoxantrone and carboplatin had a mean survival of 1139 days.     

Placebo-controlled blinded study of postoperative pain therapy with carprofen and levomethadone in dogs with fractures

It was the aim of this placebo-controlled study to evaluate the analgesic efficacy of the NASAID carprofen and the pure m-agonist levomthadone over a five-day postoperative evaluation period in dogs with fractures of the humerus or the femur (n = 30). Pain and sedation evaluation was carried out with a visual analogues system (VAS) and with the aid of a numerical estimation scale(NRS). The degree of lameness, the pain treshhold, the glucose and cortisol concentration curves as well as the respiration and heart rate and the systolic blood pressure were used as further pain indicators and to identify drug side effects. The levomethadon group displayed the lowest degree of pain on postoperative examination on the first day. On days 2 to 5, the carprofen group showed the lowest degree of pain in comparison to the placebo group. The levomethadon- and the carprofen group showed no statistically proven differences from day 2 on. Due to great variations in the pain scores and comparatively high median pain score especially on the first day of this study, the efficacy of all analgesics evaluated here must be regarded as insufficient in many cases. Only the parameter nociceptive pain treshhold showed a little, the degree of lameness, the glucose and cortisol levels showed no close correlation to the VAS and NRS pain scores and were therefore of little usefulness as postoperative pain indicators. No relevant clinical side effects caused by the used analgesics were detected in the kidney, the liver, the gastrointestinal tract and the circulatory system in this study. Rather, traumatically induced elevation of enzyme levels improves or normalised until the 5th day of the study. In addition, no negative effect on wound healing was noted, especially for carprofen. Therefore, the evaluated analgesics seems to be adequate for postoperative pain therapy also in fracture patients (trauma patients). However, the efficacy of all analgesics evaluated here must be regarded as insufficient in many cases.     

Fetotomy in cattle with special reference to postoperative complications--an evaluation of 131 cases

In the course of this retrospective study on fetotomy of cattle 131 operations were evaluated. The case studies put the cattle 2 to 96 hours into labour (average 13 hours). The cows that exhibited post-operative complications were on average 19.2 hours into labour prior to the operation. Those which had a normal puerperium however were only 8.4 hours, on average, in labour. 79% of the animals showed depressed general health on admission, 8% of which were unable to stand. The main cause of the dystocia was the incorrect position/orientation of the dead foetus (38.9%) as well as relative or absolutely too large calves (25.2%). In 14.5% of the cases the offspring were malformed causing the dystocia. 28 of the protracted births were due to both maternal as well as foetal causes. Mortality of the cows lay by 6.9%, irregularities in the puerperal period ran at 67.2%. The age of the mother did not seem to influence the post operative events. The most common complication was retained placenta (n = 49; 37.4%) followed by lochiometra (n = 21; 16%), vaginal wounds and pelvic phlegmons (each n = 16; 12.2%) and neurotripsy (n = 6; 12.2%). Of these puerperal complications the pelvic phlegmon required the longest post-operative care (14.3 days, retention secundinarum was cured in 13 days, lochiometra in 8.8, cows without complaint were treated for 3.8 days after the operation). The most important factors for the post-operative prognosis are the time in labour and any trauma of the soft birth canal which influence the forming of pelvic phlegmons.     

Prognostic value of surgical and postoperative findings in cattle with abomasal volvulus.

A prospective study evaluating the prognostic value of surgical and postoperative findings in 80 cattle with abomasal volvulus was performed. Surgical correction of abomasal volvulus was performed in all animals. After surgery, cattle were categorized into 3 groups: productive (acceptable milk production or appetite, n = 59), salvaged (poor milk production or appetite, n = 10), and nonsurvivors (n = 11). Cattle with omasal-abomasal volvulus had a significantly (P less than 0.005) worse prognosis than cattle without omasal involvement. Large abomasal fluid volume, venous thrombosis, and blue or black abomasal color before decompression were all indicative of a poor prognosis. Most cattle had poor or fair appetites the first day after surgery; productive animals had marked improvement in appetite over the next 3 days. All cattle observed to have a good appetite within 3 days after surgery were later determined to be productive animals. The heart rate decreased in all groups after surgery; however, tachycardia (heart rate greater than 80 beats/min) was sustained in cattle that were later salvaged for slaughter. Diarrhea was observed after surgery in 54% of cattle. The duration of diarrhea was significantly shorter (P = 0.009) in productive cattle than in salvaged and nonsurviving cattle. The presence or absence of diarrhea was only of predictive value when considered in conjunction with the estimated abomasal fluid volume.     

病犬术后护理的几个注意点

病犬术后护理是犬病治疗过程中的一个重要环节。对采取手术治疗的病犬,手术完成后,不等于手术治疗全部任务的完成,必须对犬精心护理,才能保证手术治疗成功。所谓"三分治疗,七分护理",其含义就在于     

Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation

OBJECTIVE: To quantify, using radiographic and computed tomographic (CT) techniques, the effects of surgical procedures most commonly combined to treat dogs with medial patellar luxation (MPL). STUDY DESIGN: Prospective study. METHODS: Six dogs with 8 MPL were studied. Radiographs and CT of the pelvic limbs were obtained before and immediately after soft-tissue reconstruction, trochlear wedge recession, and tibial crest transposition. Radiographic measurements included angle of inclination, Norberg angle, quadriceps angle (QA), anteversion angle, ratio of the length of the patellar tendon (PT) to the length of the patella, and change in patella tendon angle. CT measurements included angle of inclination, Norberg angle, QA, anteversion angle, depth of the femoral trochlear groove, ratio of the middle femoral trochlear groove depth to the patella thickness, and tibial crest alignment. RESULTS: Conformation of the coxofemoral joint was not affected by surgery. Surgical treatment corrected the QA by 33-58%. Trochlear wedge recession was most effective in deepening the proximal trochlea by 103.5%. The ratio of the middle femoral trochlear groove depth to the thickness of the patella postoperatively resulted in 50% coverage of the patella. Tibial crest transposition resulted in caudalization of the PT by 8.5+/-3.0 degrees, with lateralization of the tibial tuberosity of 11.3 degrees. CONCLUSION: The effects of surgery for MPL can be quantified with radiographic and CT measurements. Surgical correction restored the alignment of the quadriceps and adequately deepened the femoral trochlear groove. Tibial crest transposition resulted in caudalization of the patella tendon and lateralization of the tibial tuberosity. CLINICAL RELEVANCE: These pilot data quantified the effects of surgical procedures most commonly combined to treat MPL. We hope to use these measurements to correlate surgical treatment with functional outcome and postoperative occurrence of luxation.     

Factor VIII inhibitors complicating treatment of postoperative bleeding in a dog with hemophilia A

Objective – To describe the clinical course of a dog with hemophilia A and circulating factor VIII inhibitors complicating the treatment of postoperative hemorrhage.
Case Summary – A 7-year-old castrated male Japanese Chin with hemophilia A, weighing 6 kg, was presented for dental cleaning, polishing, and extractions. Despite presurgical administration of cryoprecipitate, continuous oral bleeding occurred. Circulating factor VIII inhibitors were detected, and the postoperative hemorrhage was subsequently managed with extensive and prolonged blood component transfusion. The dog was discharged after a full clinical recovery.
New or Unique Information Provided – This case report describes the clinical consequences and successful treatment of postoperative hemorrhage in a dog with hemophilia A and circulating factor VIII inhibitors. A relevant discussion of the management of human patients with circulating factor VIII inhibitors is included.     

Salmonella typhimurium abscess as a postoperative complication in a horse with colic.

An 11-year-old, 430-kg fox-trotter stallion was referred for evaluation of colic. A right-sided inguinal hernia was diagnosed. At exploratory laparotomy, the ileum was found to be herniated through the right inguinal canal. Compromised small intestine was resected, jejunocecal anastomosis was performed, and the horse was castrated. Three days after surgery, the stallion would not bear weight on the left hind limb. The musculature of the left thigh region became swollen. Aspiration of the left thigh region yielded serosanguineous fluid from which Salmonella typhimurium was isolated. Ultrasonography of the left thigh revealed multiple hypoechoic areas suggestive of abscess. The left medial thigh region was surgically incised, and a large abscess was drained. Bacteriologic culture of feces yielded S typhimurium. The owner elected to have the horse euthanatized.