Postoperative integrity of veterinary surgical gloves

A multicenter, prospective study was performed to document the incidence of defective gloves postoperatively in veterinary surgery and to correlate defects with a variety of influencing factors. Gloves were collected after surgical procedures performed by the small animal clinical services at two veterinary teaching hospitals and one institution's student surgery laboratories. Gloves were evaluated for defects using electrical resistance testing. The overall incidence of glove defects was 23.3%. Significantly more defects occurred in gloves used for nonsoft-tissue procedures and in gloves worn on the nondominant hand. Eighty-four percent of all defects occurred in procedures lasting >60 minutes. No differences were detected in the brands of gloves used nor among surgeons of different experience levels. The individuals performing the surgery were not able to accurately predict the presence of a defect in their gloves. Surgeons should remain alert for possible glove defects and consider measures such as changing gloves every 60 minutes or double-gloving to minimize potential complications.     

Bacterial contamination of gloves worn by small animal surgeons in a veterinary teaching hospital

This prospective study investigated bacterial contamination of surgical gloves during small animal surgical procedures and factors associated with glove contamination. The outer surface of surgical gloves was sampled and cultured after completion of surgical procedures. Bacterial presence and numbers were recorded. Of 78 gloves sampled from 39 surgical procedures, bacterial contamination was noted in 16/78 (21%) gloves from 12/39 (31%) procedures. There was no difference in contamination of left or right hand glove [7/39 (18%) versus 9/39 (23%)], respectively (P = 0.78). There was no impact of glove type of left hand (P = 0.41), right hand (P = 0.44) or either hand (P = 0.26) contamination, or of surgical time (P = 0.71), dominant hand (P > 0.13), surgery type (orthopedic versus soft tissue versus neurological) (P > 0.42) or surgical wound classification (P > 0.11) on the incidence of contamination.     

Effect of latex and vinyl examination gloves on canine spermatozoal motility

Two experiments were conducted to determine whether contact with latex or vinyl examination gloves affects canine spermatozoal motility. In experiment 1, semen was collected by digital manipulation from each of 5 dogs, and initial spermatozoal motility was assessed. The ejaculate was divided into 5 equal subsamples of 2 ml each, then randomly assigned to a control group, or treated with a 0.5-cm2 piece of latex or vinyl glove with or without talcum powder. After such exposure, spermatozoal motility was assessed at 1 and 5 minutes. Talcum powder within latex or vinyl glove treatments had no significant effect on spermatozoal motility at either period. Spermatozoal motility in samples did not differ between the control and vinyl glove groups; however, latex glove-treated samples were found to have a significant (P less than 0.05) decrease in spermatozoal motility at 1 and 5 minutes. In experiment 2, the effects of latex and vinyl gloves on canine spermatozoal motility during a sham laboratory manipulation was performed. Three ejaculates of approximately 10 ml were collected from each of 5 dogs and randomly assigned, within each dog, to be either a control (no glove exposure) or allowed to briefly contact either a latex or vinyl glove during sample manipulation. Spermatozoal motility was assessed for each sample immediately prior to and at 1 minute after manipulation. Exposure of semen to latex gloves significantly (P less than 0.05) decreased sample spermatozoal motility, whereas vinyl glove exposure had a minimal (P greater than 0.05) effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Objective

To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs.

Study Design

Prospective clinical study.

Sample Population

Client‐owned dogs undergoing stifle surgery (n = 100).

Methods

IO cultures were taken in each case from surgical foot wrap, peri‐incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI.

Results

Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%.

Conclusion

Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR.     

Entrapment of the small intestine in the epiploic foramen in horses: a retrospective analysis of 71 cases recorded between 1991 and 2001

The clinical features of 71 cases in 70 horses in which part of the small intestine became entrapped in the epiploic foramen are described. The horses' sex, age and breed, the month during which they were affected, and whether they exhibited stereotypic behaviour were compared with the same variables in 1279 horses which suffered other types of surgical colic during the same period. Thoroughbred and thoroughbred cross horses were over-represented among the 70 affected horses. There was no age or sex predilection. Fifty-five (77.5 per cent) of the cases occurred between October and March and 15 (21.1 per cent) occurred in January. The cases were significantly more likely to have a history of crib-biting/windsucking than the control group (odds ratio 7.9, 95 per cent confidence interval 4.1 to 15.3). The condition had recurred in two of the horses. Fifty-eight (81.7 per cent) recovered from surgery and 49 (69 per cent) survived until they were discharged from hospital. The median survival time of 31 of the affected horses discharged from the hospital was 700 days, whereas 417 horses with other types of surgical colic had a median survival time in excess of 1931 days.     

Current British veterinary attitudes to the use of perioperative antimicrobials in small animal surgery

A questionnaire was sent to 2951 mixed and small animal veterinary practices to examine the use of perioperative antimicrobials in cats and dogs in the UK. The percentage of respondents who always used antimicrobials in two surgical procedures classified according to NRC criteria as 'clean' was 25.3 per cent for removal of a 1 cm cutaneous mass and 32.1 per cent for routine prescrotal castration. Factors considered important in decision-making about when to use antimicrobial agents included immunosuppression, presence of a drain, degree of wound contamination, potential for spillage of visceral contents and implantation of prosthesis. The most common antimicrobial agents mentioned were potentiated amoxicillin (98.0 per cent), amoxicillin (60.5 per cent), clindamycin (21.8 per cent), enrofloxacin (21.7 per cent), cephalexin (18.6 per cent) and metronidazole (12.7 per cent). Forty-three per cent of all responding veterinarians listed a long-acting preparation for perioperative use. The routes used were subcutaneous (76.1 per cent), intravenous (25.8 per cent), intramuscular (19.8 per cent), oral (13.5 per cent) and topical (7.7 per cent). Antimicrobials were given before surgery (66.6 per cent), during surgery (30.2 per cent), immediately after surgery (12.0 per cent) and after surgery (6.3 per cent). This survey has identified the suboptimal use of perioperative antimicrobials in small animal surgery with improvements needed with respect to timing, duration, choice of antimicrobial and a more prudent selection of surgical cases requiring prophylaxis.     

Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases

O bjectives : To establish predilection sites of obstruction and to investigate clinical factors associated with a poor outcome.
M ethods : A retrospective study of 208 consecutive cases over a 48-month period from first-opinion practice.
R esults : Overall, 91 per cent of cases recovered with higher survival rates from discrete foreign bodies (94 per cent in dogs and 100 per cent in cats) as opposed to linear foreign bodies (80 per cent in dogs and 63 per cent in cats). English bull terriers, springer spaniels, Staffordshire bull terriers, Border collies and Jack Russell terriers were over-represented. In dogs, 63 per cent of obstructions occurred in the jejunum but foreign objects were encountered at all points along the gastrointestinal tract. A longer duration of clinical signs, the presence of a linear foreign body and multiple intestinal procedures were associated with significantly increased mortality. Neither the degree of obstruction (partial or complete) nor the location of the foreign body was shown to have a significant influence on survival.
C linical S ignificance : Prompt presentation, diagnosis and surgical intervention improve the outcome of gastrointestinal obstruction by foreign bodies. At surgery, the minimal number of intestinal procedures should be performed to restore the integrity of the alimentary tract.     

Total ear canal ablation in the cat: indications, morbidity and long-term survival

Fifty-two total ear canal ablation (TECA) procedures in 44 cats were reviewed. The indication for surgery was neoplasia in 41 per cent of the cats, 86 per cent of which had ceruminous gland adenocarcinoma. Chronic inflammatory or polypoid disease accounted for 50 per cent of surgical procedures. Postoperative complications included Horner's syndrome (42 per cent) and facial paralysis (56 per cent) and these were permanent in 14 per cent and 28 per cent of cases, respectively, with the rest resolving in the ensuing weeks or months. The higher incidence of Horner's syndrome and facial paralysis in the cat, compared to the dog, was attributed to greater fragility of the feline tympanic plexus and facial nerve. The median survival time of cats with ceruminous gland adenocarcinoma was 50-3 months, and did not differ significantly from that for inflammatory or polypoid disease. A potential prognostic indicator for this tumour was the mitotic index (MI): cases with MI < or = 2 survived significantly longer than those with MI > or = 3.     

Bilateral flank ovariectomy in the dog -surgical technique and sequelae in 72 animals

Seventy-two dogs of 27 breeds were ovariec-tomised and followed for six years minimum. Trie technique used was a bilateral surgical flank approach, removing the ovaries and leaving the uterus in situ. The main technical advantages of the technique are the better ovarian exposure, the possible deep placement of the ligatures and the small incisions. The disadvantages are the need to turn the animal, to redrape it and the difficulty in finding the ovarian bursa in some animals as well as the difficulty of removing the uterus when necessary. Post surgical complications were minimal and consisted mainly of seroma formation in 16 dogs (26 per cent) for a maximum of two weeks. In the long term the major complications were weight gain (60 per cent), excessive hair shedding (26 per cent), aggressiveness towards other dogs (22 per cent), sedentary behaviour (29 per cent) and urinary incontinence (18 per cent). The latter started approximately 1–5 years after surgery and occurred periodically in one half and continuously in the other half of the dogs. Over the mean 10 years follow-up period no cases of pyometra occurred.     

Retrospective study of bacterial infective arthritis in 31 dogs

OBJECTIVES: To characterise the presenting signs and pathological changes of canine bacterial infective arthritis in 31 dogs, and to document the response to different treatment regimens. Risk factors that may predispose joints to bacterial infective arthritis and influence the success of treatment were also investigated. METHODS: A retrospective review of cases of bacterial infective arthritis that were presented to three university veterinary referral hospitals over a five-year period (January 1997 to January 2002) was performed. RESULTS: The elbow joint (38 per cent) and stifle joint (44 per cent) were most commonly affected. Radiographic changes consistent with pre-existing osteoarthritis were identified in 14 joints, which had no history of previous surgery (articular or periarticular) or penetrating wound. No significant difference (P = 0.78) was identified between the outcome of combined surgical and medical management, and medical management alone. There were trends for poorer outcomes with increased bodyweight of the dog, longer duration of lameness and a higher nucleated cell count of the affected joint fluid at presentation. The overall infection rate for articular surgical procedures at one institution was 1-3 per cent. CLINICAL SIGNIFICANCE: Medical and/or surgical management were usually successful in resolving infection (94 per cent). However, they were frequently unsuccessful in restoring full joint function; this may in part have been due to the nature of the underlying joint     

Detomidine-butorphanol sedation in equine clinical practice

Combinations of detomidine (mean dose rate 13 micrograms/kg) and butorphanol (mean dose rate 26 micrograms/kg) were used to sedate 61 horses for a variety of surgical or diagnostic procedures in general equine practice. Three horses were sedated on more than one occasion. The degree of sedation was graded from 3 to 0 (deep sedation to no effect) and any side effects were recorded. Forty-three per cent of the horses were graded 3, 46 per cent were graded 2, 8 per cent were graded 1 and 3 per cent were graded 0. Bradycardia and ataxia were the major side effects. The combination was judged to be effective and safe for use in general practice. In 56 horses (92 per cent) the necessary procedure was carried out under excellent conditions and in only one horse was the degree of sedation considered to be totally unsatisfactory.     

Review of left-to-right shunting patent ductus arteriosus and short term outcome in 98 dogs

The case records of 98 dogs with a left-to-right shunting patent ductus arteriosus (PDA) were reviewed. There were 35 breeds represented, with a female to male ratio of 3:1. Forty per cent of the dogs were older than one year at initial presentation and 31 per cent had clinical signs attributable to PDA. A left heart base continuous murmur of grade IV/VI or higher was noted in 90 per cent of the dogs. On electrocardiography, the most common abnormalities were tall R waves (63 per cent) and deep QII waves (62 per cent). The radiographic triad of dilation of the descending aorta with enlargement of the main pulmonary artery segment and left atrium, typical of PDA, was noted in only 26 per cent of cases. Two-dimensional (2D) and M-mode echocardiography detected left atrial enlargement (35 per cent) and an increased left ventricular diameter in diastole (82 per cent) and systole (84 per cent) as the most common abnormalities. Doppler echocardiography demonstrated increased aortic outflow velocities in 66 per cent of cases. The overall short-term successful outcome in this study was 95 per cent. There was no significant difference between surgical ductal ligation using a standard technique or the Jackson-Henderson technique in terms of survival, occurrence of haemorrhage or residual shunting. The number of interventional procedures used in this study was too low for statistical comparison, but there appeared to be a trend towards a higher rate of residual shunting and a lower fatality rate using a coil occlusion technique.     

A computer-derived protocol to aid in selecting medical versus surgical treatment of horses with abdominal pain

In order to determine which variables are useful in identifying horses with abdominal pain requiring surgery, data were analysed from 219 horses presented at one veterinary teaching hospital. Using multiple stepwise discriminant analysis with a recursive partitioning algorithm, we obtained a decision tree that identifies surgical and non-surgical patients. The prevalence of surgical patients was 79 per cent in this population. The sensitivity, specificity, and positive and negative predictive values of this decision tree were 99 per cent, 55 per cent, 90 per cent and 99 per cent respectively. Compared to the clinical decision, this decision tree yielded more false positives (11 per cent) but almost eliminated false negatives (1 per cent). This decision tree was validated by the jack-knife method and also by evaluation using a new sample in a second veterinary teaching hospital in which the prevalence of surgical patients was 55 per cent. This led to sensitivity, specificity and positive and negative predictive values of 93 per cent, 73 per cent, 81 per cent and 89 per cent respectively.     

Antithrombin III activity in horses with colic: an analysis of 46 cases

Antithrombin-III (AT-III) activity was measured at the time of admission in 46 horses referred with colic. Differences in AT-III activities between animals treated medically or surgically and survivors or non-survivors were compared. The mean AT-III values for the horses treated medically (76.2 per cent), surgical survivors (69.5 per cent) and surgical non-survivors (55.9 per cent) were significantly different from the reference value for healthy adults (92 to 108 per cent). The mean AT-III activity of the survivors was significantly (P less than 0.01) greater than that of the nonsurvivors. The majority of the survivors (11 to 13 horses) had AT-III activities exceeding 60 per cent of normal, whereas that of 10 of the 14 non-survivors was less than 60 per cent of normal. There was an apparent distinction between the survivors and non-survivors at approximately 60 per cent of normal AT-III activity.     

Plasma endotoxin levels in horses subjected to carbohydrate induced laminitis

Thirteen (65 per cent) of 20 horses subjected to carbohydrate overload developed Obel Grade 3 lameness within 56 h. Increases in plasma endotoxin from control levels of less than 0.1 ng/litre to values ranging from 2.4 to 81.53 ng/litre were measured in 11 (85 per cent) of 13 horses during the onset of Obel Grade 3 lameness. Obel Grade 3 lameness was associated with rises in plasma Gram-negative endotoxin levels in 11 (92 per cent) of 12 horses. Two peak increases separated by 16 h were verified in five (45 per cent) of 11 horses that exhibited both endotoxaemia and Obel Grade 3 lameness. The first peak occurred, on average, at 32 h and the second peak at 48 h post overload when only one peak was measured, this occurred in four horses at the average time of 24 h whereas in another three horses only a 48 h or 56 h peak was detected after carbohydrate overload.     

Effects of a mastitis control programme on the incidence of clinical mastitis

Summary

The results of a mastitis control field experiment in Utrecht over three and a half years, including sevens herds with a total of 225 lactating cows are presented. Every case of clinical mastitis was examined bacteriologically. Quarter samples were taken routinely at an average interval of five weeks.

The incidence of clinical mastitis in each herd at the start of the experiment varied from 10 to 104 quarter cases per 100 cows per year. The majority of cases of clinical mastitis (33.1 per cent) occurred during the first month of lactation.

In 74.4 per cent of the lactations marked by clinical mastitis only a single case was observed during that lactation period. If the animals were on pasture during the first month of lactation, the incidence of clinical mastitis was significantly lower during this month, compared with the first month when they were housed. Str. dysgalactiae was the most common isolate from clinical cases (21.5 per cent). A total proportion of 40.3 per cent of the clinical cases were caused by cocci, 20.3 per cent by Gram‐negative bacteria and 16.0 per cent were bacteriologically negative. Of the clinical cases caused by streptococci and staphylococci, 33.3 per cent were preceded by subclinical infection, compared with 11.8 per cent of the clinical cases due to E. coli. The overall incidence of clinical mastitis in this experiment decreased from 47 to 31 per 100 cows per year.     

Results of non-selective adrenocorticolysis by o,p'-DDD in 129 dogs with pituitary-dependent hyperadrenocorticism

One hundred and twenty-nine dogs with pituitary-dependent hyperadrenocorticism were treated according to a protocol aimed at the complete destruction of the adrenal cortices by the administration of o,p'-DDD (mitotane) at a daily dose of 50 to 75 mg/kg bodyweight for 25 days. On the third day, glucocorticoid and mineralocorticoid supplementation was begun for the induced adrenocortical insufficiency. The first followup examination after completion of the 25-day course and the subsequent twice-yearly follow-up examinations included physical examination and measurements of plasma concentrations of sodium and potassium to optimise substitution therapy. In 19 dogs the full course of 25 days treatment could not be completed. Of the 110 dogs which received the full course of treatment, the administration had to be stopped temporarily in 32 because of side-effects, such as anorexia and vomiting. The actual dose of o,p'-DDD administered was not significantly different in the dogs with and without these side-effects. Clinical remission occurred in 111 dogs (86 per cent), of which 43 (39 per cent) had a relapse. The estimated one-year disease-free fraction was 77 per cent (95 per cent confidence interval [CI]: 67 to 85 per cent). The estimated one-year survival fraction was 80 per cent (95 per cent CI: 71 to 87 per cent), the two-year survival was 69 per cent (95 per cent CI: 59 to 78 per cent), and the three-year survival was 61 per cent (95 per cent CI: 49 to 71 per cent). The bodyweight and age of the dog, and vomiting occurring during the period of treatment, were positively correlated with the length of the disease-free period, whereas weakness during the treatment and resistance to dexamethasone suppression of the urinary corticoid/creatinine ratios at the start of the treatment were associated with a relatively short survival time.     

Prevalence of wet litter and the associated risk factors in broiler flocks in the United Kingdom

A postal questionnaire was sent to the managers of 857 broiler farms in the UK to determine the prevalence and risk factors for wet litter. The response rate was 75 per cent. Wet litter was reported by 75 per cent (95 per cent confidence interval [CI] 71.3 to 78.3) of the respondents in at least one flock during the year 2001 and 56.1 per cent (95 per cent CI 52.0 to 60.0) of them reported that they had an outbreak of wet litter in their most recently reared flock. Wet litter occurred more often during the winter months and farms using side ventilation systems were at an increased risk (odds ratio 1.74; 95 per cent CI 1.09 to 2.76). A multivariable analysis was carried out using two different definitions of wet litter as outcome variables - all cases of wet litter, and cases of wet litter associated with disease. Consistent risk factors for both outcomes were coccidiosis, feed equipment failures and the availability of separate farm clothing for each house. Cases of wet litter associated with disease were reported by 33.7 per cent (95 per cent CI 28.8 to 39.1) of the managers in their last flock and were associated with the use of hand sanitisers and broiler houses with walls made of concrete.     

Clinical and laboratory findings in cases of toxic mastitis in cows in Northern Ireland

This paper describes the clinical and laboratory findings from 264 cases of toxic mastitis in cows in Northern Ireland between October 1995 and May 1997. Nearly all the cases occurred during the winter housing period, with 84 per cent occurring between November and March inclusive, and 30 per cent in March. Sixty per cent of the cases occurred within one month of calving, and 29 per cent within four days of calving. The most common clinical signs were lethargy (92 per cent), discoloured milk (90 per cent), anorexia (72 per cent), tachypnoea (23 per cent), diarrhoea (23 per cent), recumbency (18 per cent) and staggering (15 per cent). Severe pyrexia (18 per cent) and clinical dehydration (44 per cent) were relatively common findings. Pure growths of Escherichia coli were isolated from 50 per cent of the milk samples, but 11 per cent yielded no bacterial growth. In vitro sensitivity tests indicated that enrofloxacin was effective against 98 per cent of the bacteria isolated, and framycetin and amoxycillin/clavulanic acid against 91 per cent. Abnormally high blood urea levels were observed in 31 per cent of cases, high blood creatinine levels in 42 per cent, and severe leucopenia in 56 per cent. Of the cases which were followed up, 14 per cent died, 21 per cent were culled early and a further 22 per cent lost milk production from the affected quarter.