Potential Iatrogenic Medial Meniscal Damage During Tibial Plateau Leveling Osteotomy

Objective— To evaluate potential iatrogenic medial meniscal (MM) damage during tibial plateau leveling osteotomy (TPLO) and to establish a safe zone (SZ) for hypodermic needle (HN) identification of the medial aspect of the stifle joint.
Study Design— Prospective cohort.
Animals— Cadaveric canine stifles (n=40).
Methods— HN (20 or 25 G) were inserted through the medial collateral ligament (MCL) of the femorotibial joint and through the SZ insertion points. The medial meniscus was inspected for iatrogenic damage. Statistical comparison of MM damage caused by different needle sizes and insertion sites was performed using Fisher's exact test with significance at P <.05.
Results— Twenty-gauge group: 65% of stifles had minor MM damage with MCL insertion compared with 35% of stifles with SZ insertion ( P =.0049). Severe MM damage occurred in 25% of stifles with MCL insertion compared with 0% of stifles with SZ insertion ( P =.0014). Twenty-five-gauge group: 85% of stifles had minor MM damage with MCL insertion compared with 30% after SZ insertion ( P =.0011); however, no severe MM injury was noted.
Conclusions— HN insertion though the MCL can produce iatrogenic damage to the MM. Use of a 25 G HN and SZ site for insertion reduced the frequency and severity of MM damage.
Clinical Relevance— HN insertion into the medial aspect of the femorotibial joint during TPLO can cause gross iatrogenic MM damage, which may contribute to the incidence and misdiagnosis of latent MM injuries after TPLO.     

Evaluation of an indirect oscillometric blood pressure monitor in normotensive and hypotensive anesthetized dogs

Objective – To determine the accuracy and precision of an oscillometric noninvasive blood pressure device as a predictor of invasive direct blood pressure in healthy anesthetized hypotensive and normotensive dogs. Design – Prospective observational study. Setting – University teaching hospital. Animals – Eight crossbred adult dogs. Interventions – Anesthesia was induced with propofol and maintained with isoflurane. A catheter was placed in the dorsal pedal artery to record systolic, mean, and diastolic arterial blood pressures (aSAP, aMAP, and aDAP, respectively). The noninvasive blood pressure device cuff was placed around the contralateral front limb to record noninvasive systolic, mean, and diastolic blood pressure (nSAP, nMAP, and nDAP). Two states of blood pressure (BP) were studied: baseline state was established by keeping end‐tidal isoflurane concentration at 1.2±0.1%. The hypotensive state was achieved by maintaining the same isoflurane concentration while withdrawing approximately 40% of the animal's blood volume until aMAP was stable at approximately 40 mm Hg. At the end of the study, blood was returned to the animal and it was allowed to recover from anesthesia. Measurements and Main Results – Agreement between the direct and indirect BP measurements was determined by the Bland‐Altman method. The SAP and MAP but not DAP bias varied significantly between each BP state. Normotensive absolute biases (mean [SD]) for SAP, MAP, and DAP were ?14.7 mm Hg (15.5 mm Hg), ?16.4 mm Hg (12.1 mm Hg), and ?14.1 mm Hg (15.8 mm Hg), respectively. Absolute biases during the hypotensive state for SAP, MAP, and DAP were ?32 mm Hg (22.6 mm Hg), ?24.2 mm Hg (19.5 mm Hg), and ?16.8 mm Hg (17.2 mm Hg), respectively. Conclusion – The oscillometric device was not reliably predictive of intra‐arterial BP during hypotension associated with acute hemorrhage.     

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation‐volvulus: 84 dogs (2003–2007)

Objective – To test whether an initial plasma lactate≥6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation‐volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. Design – Retrospective study over a 5‐year period (2003–2007). Setting – Urban private referral small animal teaching hospital. Animals – Eighty‐four client‐owned dogs with a diagnosis of GDV and plasma lactate measurements. Interventions – None. Measurements and Main Results – There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate≥6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by≥50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by≥50% from the initial blood lactate. Conclusion – The results of this study indicate that an initial presenting plasma lactate concentration≥6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations≥50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.     

动物肥厚性心肌病--人类疾病理想模型

动物肥厚性心肌病的临床所见、心脏超声波图、肉眼组织病理、冠状小动脉变化、胶原纤维组织变化等 ,与人类肥厚性心肌病非常相似 ;遗传学分析 ,人类及猫肥厚性心肌病均为家族性常染色体显性遗传类型。动物肥厚性心肌病可为理想模型来研究人类疾病 ,而且动物肥厚性心肌病小冠状动脉病变与人类冠状动脉粥样化血管切除或皮下血管内腔扩张术后小冠状动脉再阻塞相同 ,可为人类疾病之模型。尤其猪心脏血行、生理及形态均与人类心脏相似 ,故猪肥厚性心肌病实为人类肥厚性心肌病研究之理想动物模型。