Laparoscopic Removal of a Large Abdominal Testicular Teratoma in a Standing Horse

Objective— To describe laparoscopic removal of a large testicular teratoma in a standing horse.
Study Design— Clinical report.
Animals— Thoroughbred horse (11 months) with a testicular teratoma.
Methods— A unilateral cryptorchid testicle could not be removed by an inguinal approach under general anesthesia because of it s large size. After recovery from general anesthesia, ultrasound evaluation revealed a 24 × 19 cm fluid-filled testicular mass. The mass was removed by paralumbar fossa laparoscopy with the horse in a standing position. After fluid aspiration of the mass, the mesorchium and ductus deferens were ligated with extracorporeal knots and the mass retrieved inside a laparoscopic specimen pouch. Morphologic features were consistent with a teratoma.
Results— Laparoscopic-guided aspiration of fluid from the teratoma decreased mass size and increased ease of manipulation and retrieval. Retrieval of the teratoma in a laparoscopic specimen pouch prevented loss of abdominal insufflation, helped reduce fluid leakage, and potential seeding of neoplastic cells.
Conclusion— Use of laparoscopy for removal of neoplastic cryptorchid testicles offers many advantages including minimal invasiveness and increased safety associated with good visibility of structures.
Clinical Relevance— Standing laparoscopic surgery should be considered for removal of testicular neoplasms in horses.     

Creation of a Urethral Conduit from a Preputial Indirect Flap in a Dog with Perineal Hypospadias

Objective— To report a surgical technique for creation of a urethral conduit using a preputial indirect flap.
Study Design— Case report.
Animals— Male Doberman Pinscher (6 weeks old).
Methods— A urethral conduit was constructed using a multistage preputial indirect flap in a dog with severe perineal hypospadias.
Results— Successful transfer of a perineal located urethral meatus to a more anatomically normal inguinal location was achieved with a preputial flap. The procedure was performed to aid control of recurrent urinary tract infections after anal and urethral separation in a dog with imperforate anus, urethrorectal fistula, and proximal perineal hypospadias.
Conclusions— Creation of a urethral conduit from a tubed bipedicle flap using redundant preputial tissue eliminated fecal contamination of the urethral meatus, aiding control of urinary tract infection. A good functional and cosmetic outcome was achieved.
Clinical Relevance— This technique should be considered in aiding control and prevention of urinary tract infections in dogs with proximal perineal hypospadias where a preputial remnant exists.     

Retrospective Study: The association of blood lactate concentration with outcome in dogs with idiopathic immune‐mediated hemolytic anemia: 173 cases (2003–2006)

Objective – To determine the association of blood lactate with outcome and response to transfusion therapy in dogs with idiopathic immune‐mediated hemolytic anemia (IMHA). Design – Retrospective study. Setting – Urban veterinary small animal emergency hospital. Animals – One hundred and seventy‐three client‐owned dogs with IMHA. Interventions – None. Measurements and Main Results – Serial blood lactate concentration, therapeutic interventions, and outcome were recorded. Nonsurvivors were defined as those that died or were euthanized. One hundred and thirty‐three dogs (77%) survived, 35 (20%) were euthanized, and 5 (3%) died. One hundred forty‐five dogs (84%; 145/173) had a lactate concentration above the laboratory reference interval [0.46–2.31 mmol/L] on presentation. Blood lactate at presentation was higher in the nonsurvivors (median 4.8 mmol/L; 0.5–13.6) compared with survivors (median 2.9 mmol/L; 0.3–13.2) (P<0.01). All dogs presenting with hyperlactatemia that normalized (<2.0 mmol/L) within 6 hours of admission survived, whereas, 71% of dogs that had a persistent hyperlactatemia at 6 hours survived (P=0.034). Lactate was positively correlated with age, BUN, and alkaline phosphatase, and inversely correlated with PCV. Receiver operating curve analysis for lactate concentration at admission as a test for outcome had an area under the curve of 0.69 with an optimal lactate cutoff concentration of 4.4 mmol/L correctly predicting outcome 73% of the time (sensitivity 60%, specificity 77%). Conclusions – Lactate concentration at presentation was significantly higher in nonsurvivors than survivors. Lactate was significantly correlated with previously reported outcome variables but lactate concentration at admission, as a predictor for outcome was less than optimal. However, serial lactate concentration measurements may be more predictive as patients with persistent hyperlactatemia 6 hours after admission were less likely to survive. Prospective studies evaluating serial lactate concentration while controlling for other variables may provide further insight into lactate measurement as a prognostic indicator in animals with IMHA.     

Biodegradable Drug Delivery Systems for Gentamicin Release and Treatment of Synovial Membrane Infection

OBJECTIVE: This study investigated two biodegradable drug delivery systems (BDDS) for elution of gentamicin and elimination of synovial membrane infection. STUDY DESIGN: The effect of BDDS on control and infected synovial explants was determined. ANIMALS OR SAMPLE POPULATION: Synovial explants from four adult equine cadavers. METHODS: First, BDDS were placed in phosphate buffered saline for 14 days. Eluent was tested for gentamicin concentration (G) and bioactivity. Second, synovial explants were divided into four groups (n = 14/group): Group 1 (control); Group 2 (infected control) 405 cfu Staphylococcus aureus added at 6 hours; Group 3 (antibiotic BDDS [Ab-BDDS]) Ab-BDDS added at 24 hours; Group 4 (infected Ab-BDDS) 405 cfu S. aureus added at 6 hours, Ab-BDDS added at 24 hours. Both types of Ab-BDDS were used (n = 7/type/group). Explants were incubated in standard medium for 4 days. Medium was cultured and analyzed for (G) and hyaluronic acid concentration (HA). Explants were analyzed for viability and morphologic changes. RESULTS: The Ab-BDDS released >500 microg/mL of active gentamicin for 10 days. In Group 3, infection was eliminated within 24 hours, but histologic scores did not return to normal. Viability was significantly reduced by infection, but if eliminated, viability tended to return to normal. In Group 3, the Ab-BDDS had no significant effect on viability or (HA). Histopathologic scores were significantly higher for infected synovium. Infection, even if treated, significantly reduced (HA). CONCLUSIONS: Both Ab-BDDS eliminated infection within 24 hours. However, synovial morphology, viability and function did not return to normal. CLINICAL RELEVANCE: The Ab-BDDS may be useful for treatment of synovial membrane infection.     

ULTRASONOGRAPHIC DIAGNOSIS OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RESULTS OF A PROSPECTIVE STUDY

The aims of this study were to determine if accurate diagnosis of congenital portosystemic shunt was possible using two dimensional, grey-scale ultrasonography, duplex-Doppler, and color-flow Doppler ultrasonography in combination, and to determine if dogs with congenital portosystemic shunts have increased or variable mean portal blood flow velocity. Eighty-two dogs with clinical and/or clinicopathologic signs compatible with portosystemic shunting were examined prospectively. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 38 of these dogs using operative mesenteric portography: 14(37%) dogs had an intrahepatic shunt and 24(63%) had an extrahepatic shunt. Ultrasonography had a sensitivity of 95%, specificity of 98%, and accuracy of 94%. Ultrasonographic signs in dogs with congenital portosystemic shunts included small liver, reduced visibility of intrahepatic portal vessels, and anomalous blood vessel draining into the caudal vena cava. Correct determination of intra - versus extrahepatic shunt was made ultrasonographically in 35/38 (92%) dogs. Increased and/or variable portal blood flow velocity was present in 21/30 (70%) dogs with congenital portosystemic shunts. In one dog with an intrahepatic shunt the ultrasonographic diagnosis was based partly on finding increased mean portal blood flow velocity because the shunting vessel was not visible. Detection of the shunting vessel and placement of duplex-Doppler sample volumes were facilitated by use of color-flow Doppler. Two-dimensional, grey-scale ultrasonography alone is sufficient to detect most intrahepatic and extrahepatic shunts; sensitivity is increased by additional use of duplex-Doppler and color-flow Doppler. Increased and/or variable portal blood flow velocity occurs in the majority of dogs with congenital portosystemic shunts.