MSPCA-Angell

To evaluate survival outcomes, complication rates, and prognostic factors for dogs and cats with urothelial carcinoma (UC) treated with partial cystectomy. Medical records of client-owned dogs and cats with UC treated with partial cystectomy between January 2010 and December 2024 were retrospectively reviewed. Data regarding signalment, tumor and surgical characteristics, adjuvant therapy, and outcomes were collected. Disease-free interval and median survival time (MST) were estimated via the Kaplan-Meier method. Prognostic factors were identified with log-rank tests and Cox proportional hazards modeling. 30 animals were included (20 dogs, 10 cats). Overall MST for 27 patients was 512 days and disease-free interval was 255 days. Mean survival time was 498 days for dogs and 730 days for cats. Complete surgical margins were associated with longer MST on univariate analysis. On multivariate analysis, complete surgical margins (hazard ratio, 0.27) and adjuvant chemotherapy (hazard ratio, 0.24) were independent positive prognostic factors. Postoperative complications occurred in 16 of 30 patients (53%). Local recurrence was documented in 12 patients (40%) and distant metastasis in 5 patients (17%). Partial cystectomy, as part of a multimodal treatment plan including adjuvant medical therapy, can be associated with prolonged survival in select dogs and cats with nontrigonal UC. The achievement of complete surgical margins is a critical predictor of outcome. The procedure carries a substantial risk of complications and eventual disease progression, underscoring the importance of careful case selection and comprehensive client counseling regarding the palliative intent of therapy.

There are numerous surgical procedures employed to remove damaged and diseased segments of the upper and lower eyelid in humans. A number of articles and ophthalmology textbooks discuss these procedures. The techniques available for extensive loss of this structure are more limited. With defects limited to the external cutaneous surface of the eyelids, reconstruction can be performed with the adjacent skin by simple undermining and advancement, transposition flaps, or single pedicle advancement flaps. Lesions involving the eyelids may be excised and closed directly when less than one-third of the eyelid margin is involved. The lateral canthal ligament can be divided to relieve eyelid tension during direct closure, if necessary. Cryosurgery and thermal destruction of eyelid tumors have been used with variable success in place of surgical excision. For major full-thickness eyelid reconstruction, four specialized reconstructive surgical techniques that can be useful for major eyelid reconstruction, include: the mucocutaneous subdermal plexus flap (lip-to-lid procedure), a combined mucosal graft/transposition skin flap technique, eyelid tarrsomarginal graft replacement of major upper eyelid defects (Hubner's Technique), and a third eyelid–skin flap technique.

It is the author's experience that reviewing multiple clinical cases enhances the ability of surgeons to better understand how to properly execute surgical procedures. This is particularly true when the veterinarian is trying to translate a particular closure technique to various body regions. This chapter contains additional representative clinical cases from the author's archived collection of surgical cases photographs, many of which are used in educational programs. The surgical cases include the use of skin flaps and other wound closure options discussed in the previous chapters.

To conduct a retrospective multi-institutional study reporting short- and long-term outcomes of adrenalectomy in patients presenting with acute hemorrhage secondary to spontaneous adrenal rupture. 59 dogs and 3 cats. Medical records of dogs and cats undergoing adrenalectomy between 2000 and 2021 for ruptured adrenal masses were reviewed. Data collected included clinical presentation, preoperative diagnostics, surgical report, anesthesia and hospitalization findings, histopathology, adjuvant treatments, and long-term outcome (recurrence, metastasis, and survival). Median time from hospital admission to surgery was 3 days, with 34% of surgeries being performed emergently (within 1 day of presentation). Need for intraoperative blood transfusion was significantly associated with emergent surgery and presence of active intraoperative hemorrhage. The short-term (≤ 14 days) complication and mortality rates were 42% and 21%, respectively. Negative prognostic factors for short-term survival included emergent surgery, intraoperative hypotension, and performing additional surgical procedures. Diagnoses included adrenocortical neoplasia (malignant [41%], benign [12%], and undetermined [5%]), pheochromocytoma (38%), a single case of adrenal fibrosis and hemorrhage (2%), and a single case of hemangiosarcoma (2%). Local recurrence and metastasis of adrenocortical carcinoma were confirmed in 1 and 3 cases, respectively. Overall median survival time was 574 days and 900 days when short-term mortality was censored. No significant relationship was found between histopathological diagnosis and survival. Adrenalectomy for ruptured adrenal gland masses was associated with similar short- and long-term outcomes as compared with previously reported nonruptured cases. If hemodynamic stability can be achieved, delaying surgery and limiting additional procedures appear indicated to optimize short-term survival.

To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. A 10-month-old spayed female ferret. The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.

IntroductionThe purpose of this study is to determine the rate of implant removal after partial carpal arthrodesis and to investigate factors associated with implant removal.MethodsCase records of 22 dogs that underwent partial carpal arthrodesis at two private veterinary referral hospitals were reviewed. Details retrieved were body weight at time of surgery, sex, neuter status, breed, age, cause of carpal hyperextension injury, joint(s) involved in carpal hyperextension injury, laterality, type of implant, administration of post-operative antibiotics, post-operative outcome and indication for implant removal. Association between these factors and implant removal was evaluated.ResultsOf 22 partial carpal arthrodesis, 12 (55%) had implant removal due to persistent lameness and 9/12 (75%) returned to full and acceptable function after implant removal. Indications for implant removal were implant interference (8), infection (4), and migration (1). When comparing type of implant, there was a significant difference when observing implant removal rates (p = 0.04). All 5 dogs with pins and wires (100%) required implant removal. Of 17 dogs with a plate, 7 (41.2%) required implant removal. Implant removal was performed on average 114 days post-operative.DiscussionImplant removal after partial carpal arthrodesis was frequent and was commonly indicated due to pin and wire fixation or plate implant interference. This study may impact how we prepare clients for potential post-operative complications and implant removal when recommending partial carpal arthrodesis.

To describe the author's surgical guidelines for the effective use of a modified von Langenbeck technique, utilizing bilateral bipedicle mucoperiosteal flaps in the dog. 12 client-owned dogs with cleft palate defects of the hard and soft palates. 12 dogs with cleft palate were presented to the Angell Animal Medical Center from May 20, 2015, to March 24, 2022. The patient's ages ranged from 5 months to 3 years. All 12 dogs had closure of the hard palate clefts by use of modifications of the original von Langenbeck technique in this prospective study. Successful closure of the cleft (hard and soft) palate defects was achieved in all 12 dogs in a single surgical procedure. A small residual opening was noted at the level of the incisive papilla in each dog; this was of no clinical consequence in this report. The von Langenbeck technique, using the simple closure modifications reported, was effective in closing both narrow and wide defects. Successful execution requires the complete elevation of each flap, which facilitates their tension-free advancement over the palatal cleft. Vertical mattress sutures evert the flap margins, allowing for direct collagen surface contact for proper healing. Placement of sutures in the rugal folds increases the tissue purchase to reduce the risk of suture cut-out. Fine interrupted sutures, placed between the vertical mattress sutures, maintains the proper alignment of the incisional margins. The author waits a minimum of 5 months before closing cleft palate defects, enabling the donor areas time to mature and improving their ability to retain sutures more effectively.

To investigate associations among care errors, staffing, and workload in small animal ICUs. Multicenter observational cohort study conducted between January 2017 and September 2018. Three small animal teaching hospital ICUs. None. None. Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1-18). Median patient illness severity was 15.1 (4.7-27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR]=1.11; 95% confidence interval [CI],1.02-1.20; P= 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI,1.84-3.54; P< 0.001) for patient:technician ratios of>4.0 compared with≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR=1.005; 95% CI, 1.002-1.007; P< 0.001). The major error incident rate ratio was 1.71 (95% CI,1.30-2.25; P< 0.001) for APPLEfast :technician ratios of>73 compared with≤73. The odds of a major error decreased by 2% (OR=0.98; 95% CI,0.97-0.99; P= 0.01) for each year increase in total technician years of ICU work experience. Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.