Video and review of the surgical management of recurrent urethral diverticulum.

INTRODUCTION: Recurrent urethral diverticulum has been reported in 23% of cases after primary repair and can be difficult to manage. The aim of this video is to demonstrate a surgical technique of repairing a recurrent diverticulum in a woman who had two previous procedures, one with a Martius labial fat pad graft. METHODS: A 40-year-old woman presented with a symptomatic recurrent urethral diverticulum after two previous repairs. She underwent surgery with excision of the diverticular mucosa and multilayer urethral closure using the diverticulum wall after mobilization and then repositioning of the Martius labial fat pad interposition. RESULTS: There were no surgical complications intra- or postoperatively, and the patient had improvement of her symptoms postoperatively with resolution of the diverticulum on ultrasound. CONCLUSIONS: Mobilizing and repositioning a Martius labial fat pad is a feasible technique for complex recurrent urethral diverticulum repairs. The graft alone without meticulous urethral repair will not prevent diverticulum recurrence, fistula formation or stress urinary incontinence. This procedure requires experienced surgeons to minimize surgical complications and optimize outcome.

Computed tomographic appearance of choanal atresia in an alpaca cria.

A 6-hour-old alpaca cria was admitted for evaluation of respiratory distress since birth. Contrast radiography confirmed the presence of bilateral choanal atresia, and computed tomography (CT) evaluation was planned to aid in the surgical treatment. Due to deterioration in the cria's condition, euthanasia was performed prior to the CT examination. Postmortem CT examination was performed to determine the appearance of choanal atresia. The embryology and CT appearance of choanal atresia is discussed.

Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal displacement of the soft palate in horses.

REASONS FOR PERFORMING STUDY: Contributes to the understanding of the pathogenesis of dorsal displacement of the soft palate during exercise so that management of this condition could be enhanced. HYPOTHESIS: That the thyrohyoid muscles play an important role in the stability of the laryngo-palatal relationship and that dysfunction of these muscles leads to dorsal displacement of the soft palate (DDSP) during exercise. METHODS: Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control conditions (n = 10), after resection of thyrohyoid muscles (TH, n = 10), after sham-treatment (n = 5), or after restoration of function of the thyrohyoid muscles with surgical sutures (prosthesis-treatment, n = 6). During trials, the following determinations were made: videoendoscopy of the upper airway, gait frequency and pharyngeal and tracheal static pressures. RESULTS: None of the 10 horses developed DDSP during 2 separate treadmill-exercise trials under the control conditions. Seven of the 10 horses developed DDSP after resection of the TH muscles, 4 of 5 of these horses still experienced DDSP after sham-treatment, but 5 of 6 horses no longer experienced DDSP at exercise after the prosthesis-treatment. There were significant anomalies in airway pressures, respiratory frequency, and occurrence of DDSP in both the TH resection and sham-treatment conditions compared to control conditions. In contrast, no statistical differences were noted in any of the parameters measured between the prosthesis-treatment and control conditions. CONCLUSIONS: That the function of the TH muscles is important to the stability of the laryngo-palatal relationship and plays a role in the pathophysiology of exercise-induced DDSP. POTENTIAL RELEVANCE: Management of horses with DDSP could be enhanced by restoring the function of the TH muscles.

Persistent post-laparoscopy pneumoperitoneum.

BACKGROUND: Persistent pneumoperitoneum after a laparoscopic operation can represent either residual postoperative pneumoperitoneum or free intraperitoneal gas released from the gastrointestinal tract. This animal study was conducted to better characterize the extent and duration of postoperative pneumoperitoneum as detected by computed tomography (CT). METHODS: Five pigs underwent cholecystectomy, four laparoscopically and one open. All pigs were followed serially with upright chest radiographs and abdominal CT scans beginning immediately postoperatively and continuing daily until resolution of pneumoperitoneum as detected by both imaging modalities. All radiographs and CT scans were reviewed by dedicated radiologists who reported the extent and duration of pneumoperitoneum in a blinded fashion. RESULTS: Pneumoperitoneum resolved on upright chest radiographs in all five pigs by or on postoperative day 1. Serial CT scans demonstrated that the laparoscopic group had either resolution of pneumoperitoneum or minimal persistence of free intraperitoneal gas by postoperative day 2. In contrast, the single pig in the open group had CT evidence of persistent pneumoperitoneum through postoperative day 6. CONCLUSIONS: In the pig model, small pockets of free intraperitoneal gas detected by CT scanning are expected to resolve by postoperative day 2 following laparoscopic surgery. Persistence of pneumoperitoneum beyond this interval is abnormal and may represent a perforated viscus. Whereas a prospective CT imaging study in humans is not ethically feasible, we believe that parallel conclusions between the pig and human may be drawn.

Repeatability of dorsolateral subluxation scores in dogs and correlation with macroscopic appearance of hip osteoarthritis.

OBJECTIVE: To determine whether dorsolateral subluxation (DLS) scores in young dogs could be used to reliably predict which dogs would develop evidence of hip osteoarthritis and whether DLS scores measured at various ages correlated with each other. ANIMALS: 129 Labrador Retrievers, Greyhounds, and Labrador Retriever-Greyhound crossbreds. PROCEDURES: DLS scores were measured on radiographs taken at 4, 8, and 12 months of age and at necropsy (8 to 36 months of age). At necropsy, the hip joints were examined macroscopically and a score assigned for degree of cartilage degeneration. RESULTS: DLS scores at 4 (n = 35, r(s) = -0.62), 8 (n = 106, r(s) = -0.54), and 12 (n = 15, r(s) = -0.87) months of age were significantly correlated with cartilage degeneration scores, and DLS scores at 8 months of age were significantly correlated with scores obtained at the time of necropsy (n = 39, r(s) = 0.87). The DLS scores at 4 months of age were significantly different from scores at 8 months of age, but scores did not differ significantly thereafter. Likelihood ratios for cartilage lesions for low (< 45%), intermediate (> or = 45 but < or = 55%), and high (> 55%) DLS scores at 8 months of age were 8.0, 2.6, and 0.2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that DLS score at 8 months of age was a reasonable, albeit imperfect, predictor of the condition of the hip joint cartilage at necropsy. Thus, the DLS method might be useful for early identification of dogs with hip dysplasia.

Comparison of three radiographic methods for diagnosis of hip dysplasia in eight-month-old dogs.

OBJECTIVE: To compare the accuracy of the extended-hip radiographic (EHR) score, the distraction index (DI), and the dorsolateral subluxation (DLS) score for identifying hip dysplasia in dogs at 8 months of age. DESIGN: Cohort study ANIMALS: 129 Labrador Retrievers, Greyhounds, and Labrador Retriever-Greyhound crossbreds. PROCEDURE: Radiography was performed when dogs were 8 months of age. Dogs were euthanatized at 8 to 36 months of age; hip dysplasia was diagnosed at the time of necropsy on the basis of results of a gross examination of the articular cartilage of the hip joints for signs of osteoarthritis. RESULTS: The EHR score, DI, and DLS score at 8 months of age were all significantly correlated with degree of cartilage degeneration at necropsy. Sensitivity and specificity of using EHR score at 8 months of age to diagnose hip dysplasia (scores > 3 were considered abnormal) were 38 and 96%, respectively; sensitivity and specificity of using DI (values > 0.7 were considered abnormal) were 50 and 89%; and sensitivity and specificity of using DLS score (scores < 55% were considered abnormal) were 83 and 84%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that specificities of the 3 methods for diagnosing hip dysplasia in dogs at 8 months of age were similar. However, the DLS score had higher sensitivity, indicating that there were fewer false-negative results.

Influence of patient positioning on sensitivity of mesenteric portography for detecting an anomalous portosystemic blood vessel in dogs: 34 cases (1997-2000).

OBJECTIVE: To determine whether sensitivity of detecting an anomalous portosystemic blood vessel during operative mesenteric portography varied with patient positioning. DESIGN: Retrospective study. ANIMALS: 34 dogs with a portosystemic shunt diagnosed via scintigraphy or surgery. PROCEDURE: Portograms were evaluated for a portosystemic blood vessel. Sensitivity was calculated from results obtained with dogs in left lateral, right lateral, and dorsal recumbency and from results obtained with dogs in 2 or 3 positions. Differences in sensitivity among positions and between 2 examiners were evaluated. RESULTS: Sensitivity was 85, 91, and 100% in dorsal, right lateral, and left lateral recumbency, respectively. Sensitivity was lower in dorsal recumbency than in left lateral recumbency, although differences were not significant. There was no significant difference between sensitivity of results obtained in dorsal and right lateral recumbency or right lateral and left lateral recumbency. Sensitivity for combined right lateral and dorsal positions was 97%, which was better than that in dorsal recumbency alone, although the difference was not significant. Because sensitivity in left lateral recumbency was 100%, there was no need to evaluate the improvement obtained by combining the result of this position with the results of other positions. CONCLUSION AND CLINICAL RELEVANCE: Results of mesenteric portography varied with patient positioning. The optimal position varied among patients but left lateral recumbency may be better and dorsal recumbency worse. Sensitivity may be improved by performing the test with the patient in orthogonal recumbent positions.

The diagnosis and treatment of a thoracic abscess in an alpaca.

A 6-month-old alpaca presented for lethargy, failure to thrive and leucocytosis. Diagnostic procedures, including thoracic ultrasound, radiographs and a computed tomography scan, were used to document a thoracic mass. Based on appearance and ultrasound-guided aspiration of purulent material, the mass was determined to be a large abscess. The abscess was treated with surgical drainage and long-term antibiotic therapy. The origin of this thoracic abscess was felt to be the caudal mediastinum, secondary to bacterial seeding of the caudal mediastinal lymph nodes. Although an aetiological agent was not definitively determined, the most likely was Actinomyces spp or Arcanobacterium pyogenes. The alpaca made a complete recovery following treatment.

Glomerular filtration rate and renal volume in dogs with congenital portosystemic vascular anomalies before and after surgical ligation.

Glomerular filtration rate (GFR) and renal volume were evaluated in dogs with confirmed portosystemic vascular anomalies (PSVA) before and after surgical ligation of their PSVA. Pre- and postligation CBC, serum biochemistry, urinalysis, abdominal ultrasonography with measurement of renal volume, and per rectal scintigraphy were performed to document resolution of abnormalities consistent with portosystemic shunting. GFR was estimated by plasma 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) clearance before (n = 21) and after (n = 12) surgical correction of PSVA. Preligation 99mTc-DTPA GFR was increased (median, 5.64 mL/minute/kg; range, 3.53-8.49 mL/minute/kg; reference range, 2.83-4.47 mL/minute/kg) in 81% (17/21) of dogs. Postligation 99mTc-DTPA GFR decreased in all 12 evaluated dogs (median change = -42%; P < .001). Preligation renal volume was above the reference range for the left and right kidneys in 71% (10/14) and 69% (11/16) of dogs evaluated, respectively. Right renal volume decreased significantly (n = 5; median change, -45%; P = .03) after surgical ligation of PSVA. These findings document increased GFR and renal volume in dogs with PSVA, which may explain in part the low blood urea nitrogen and serum creatinine concentrations encountered in these dogs. Knowledge of changes in GFR associated with PSVA ligation may prove helpful in the anesthetic, drug, and dietary management of affected dogs.

Intestinal haemorrhage associated with colonic vascular ectasia (angiodysplasia) in a dog.

An eight-year-old, sexually intact, male, 37 kg crossbred dog was referred for investigation of two acute episodes of intestinal bleeding and severe anaemia within a five-month period. There was no evidence of coagulopathy or underlying systemic disease. Technetium-labelled red blood cell scintigraphy suggested the colon as the site of bleeding. Colonoscopy identified a focal area of dilated and tortuous mucosal blood vessels. Histopathology of the resected colon revealed vascular ectasia (angiodysplasia). At nine months post-resection, the dog remained healthy and free of any overt intestinal haemorrhage.

An outcrossed canine pedigree for linkage analysis of hip dysplasia.

Canine hip dysplasia (CHD) is a prevalent, debilitating, polygenic disease characterized by hip subluxation and laxity which results in osteoarthritis. We are developing an informative pedigree for linkage analysis of CHD. The seven greyhound founders had excellent hip conformation with high dorsolateral subluxation scores (percentage of femoral head covered by the dorsal acetabulum in a weight-bearing position) of 66 +/- 4% (mean +/- SD averaged over both hips) and low hip distraction (laxity) indices of 0.14 +/- 0.08. Nine greyhounds bred on site had radiographic evidence of ossification in the capital femoral chondroepiphysis at 7.7 +/- 0.9 days of age. At 8 months of age they had a mean distraction index of 0.24 +/- 0.08 and dorsolateral subluxation score of 76 +/- 1%. Of the four dysplastic Labrador retriever founders, three had mean age at onset of capital femoral chondroeplphyseal ossification of 20 +/- 7 days of age n = 3) and a mean distraction index of 0.46 +/- 0.1 accompanied by hip osteoarthritis. Thirty-four F1s had mean onset of capital femoral ossification (10.7 +/- 4.0 days of age) and mean dorsolateral subluxation scores (61 +/- 12%) similar to the greyhound founders, but distraction indices (0.42 +/- 0.2) more similar to the Labrador retriever founders. One F1 had CHD radiographically but none of 20 F1s had osteoarthritis at necropsy at 10 months of age. These data suggested that maximum passive laxity (as measured by the distraction index) and normal osseous conformation (as indicated by a high dorsolateral subluxation score) were both dominant traits and were controlled by separate quantitative trait loci (QTL). Forty-three back-crosses between F1s with the highest hip laxity and greyhound founders had mean onset of capital femoral ossification at 9.9 +/- 2.6 days of age. Of 10 dogs in the backcross generation that have reached 8 months of age, 2 had palpable subluxation without marked CHD radiographically. The mean distraction index of these dogs was 0.36 +/- 0.16 and the dorsolateral subluxation score was 65 +/- 5%. Although dogs in the backcross generation that were three-quarter greyhound had a broad range of hip laxity, a protective effect of the greyhound QTLs for good osseous conformation has mitigated thus far against subluxation and CHD.

Comparison of measurements of dorsolateral subluxation of the femoral head and maximal passive laxity for evaluation of the coxofemoral joint in dogs.

OBJECTIVE: To determine whether dorsolateral subluxation (DLS) of the femoral head reflects osseous conformation of the coxofemoral (hip) joint and represents a property distinct from maximum passive laxity of the hip joint in dogs. ANIMALS: 14 Labrador Retrievers, 16 Greyhounds, 58 Greyhound-Labrador Retriever mixed-breed dogs, and 1 Rottweiler. PROCEDURES: DLS of the femoral head (DLS score) and passive laxity of the hip joint (distraction index) were determined radiographically in 3 groups of dogs: not treated (167 joints of 84 dogs); before and after injecting 2 ml of hyaluronan into 25 hip joints of 13 dogs; and before and after unilateral triple pelvic osteotomy in 5 dogs. Results of the 2 methods were compared for each group. RESULTS: In untreated dogs, the correlation coefficient (r) of DLS score versus distraction index was -0.73 and -0.69 for 84 left and 83 right hip joints, respectively. Mean coefficient of determination (r2) for both hips was 0.5. Mean DLS score did not differ before and after intra-articular injection of hyaluronan into either hip joint, whereas mean distraction index increased significantly after intra-articular injection. Unilateral triple pelvic osteotomy resulted in a significant increase in DLS score, compared with values obtained before surgery. However, distraction index before and after surgery did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE: The DLS test assesses the congruity of the acetabulum and the femoral head in a canine hip joint and thus represents a characteristic distinct from maximum passive laxity. The DLS score and the distraction index evaluate different components of hip joint stability.

Cullen's sign and haemoglobinuria as presenting signs of retroperitoneal haemorrhage in a dog.

Haemoglobinuria and periumbilical discoloration (also known as Cullen's sign) are clinical signs uncommonly reported in veterinary patients. This report describes a case of retroperitoneal haemorrhage in a dog, associated with haemoglobinuria and Cullen's sign. To the authors' knowledge, these clinical signs have not previously been reported singularly or in combination with retroperitoneal haemorrhage in dogs. A neutered male Shetland sheepdog, which was presented for haematuria, also had an abdominal mass, abdominal pain and a large area of periumbilical discoloration. Laboratory studies determined that haemoglobinuria was the cause of the red-coloured urine. Abdominal radiographs suggested a splenic mass and a coeliotomy was performed. During the induction and throughout the anaesthetic period the dog was hypertensive and a large haematoma originating from the right retroperitoneal space was identified at surgery. The cause of the haemorrhage was uncertain but a ruptured phaeochromocytoma was thought possible on the basis of the persistent hypertension and the location of the haemorrhage.

Dorsolateral subluxation of hip joints in dogs measured in a weight-bearing position with radiography and computed tomography.

OBJECTIVE: develop a radiographic procedure to measure dorsolateral subluxation (DLS) of the femoral head in canine coxofemoral (hip) joints in a weight-bearing position. STUDY DESIGN: DLS measured on a radiographic projection was compared with DLS measured on computed tomography (CT) images of hip joints in a weight-bearing position. ANIMALS: A total of 24 dogs of varying ages were examined including Labrador retrievers, greyhounds, and Labrador-greyhound crossbreeds. METHODS: Anesthetized dogs were placed in sternal recumbency in a kneeling position in a foam rubber mold. The stifles were flexed and adducted with the femora perpendicular to, and in contact with, the table. To test for DLS, dogs were imaged in this weight-bearing position (DLS test) with routine radiography and CT. For each hip, the DLS score was determined by measuring the percentage of the femoral head medial to the lateralmost point of the cranial acetabular rim on the dorsoventral radiographic projection and the lateralmost point of the central, dorsal acetabular rim on the CT image. Higher DLS scores indicated better coverage of the femoral head by the acetabulum. DLS scores were compared with the distraction index (DI) by grouping joints according to their probability of developing osteoarthritis (OA) as predicted by the DI. RESULTS: The DLS score in the new position ranged from 29% to 71% for radiography and 15% to 59% for CT. Joints classified as OA unsusceptible had a mean score of 64% +/- 1.5% for radiography and 55% +/- 0.8% for CT (n = 10); hip joints having a high probability of developing OA had a score of 39% +/- 2.6% for radiography and 26% +/- 1.9% for CT (n = 8). When the DLS test was repeated on the same dogs at a different time, the intraclass correlation coefficient for the DLS score on the radiographs was 0.85 (left hip) and 0.89 (right hip). There was a strong correlation (r = .89 for both hips) between the DLS score measured on the weight-bearing radiograph and the CT image. A strong correlation also was observed between the DLS score and the DI (r = -.87). The DLS scores for OA unsusceptible joints and joints with a high probability of developing OA were significantly different (P < .05). CONCLUSIONS AND CLINICAL RELEVANCE: The DLS test can be performed with CT or routine radiography to measure variable amounts of DLS in weight-bearing hip joints oriented similarly to those of a standing dog. After additional long-term follow-up studies evaluating the development of OA and breed effects are performed, the DLS method may prove useful in studies of normal and abnormal hip joint development related to canine hip dysplasia.