Thoracic bite trauma in dogs and cats: a retrospective study of 65 cases.

OBJECTIVES: To report a case series of thoracic bite trauma in dogs and cats and to evaluate risk factors for mortality. METHODS: A retrospective study concerning thoracic bite wounds in dogs and cats was performed. Lesions were categorized by depth of penetration: no wound, superficial, deep or penetrating. Thoracic radiographic reports were reviewed. Lesion management was classified as non-surgical, wound exploration, or explorative thoracotomy. RESULTS: Sixty-five cases were collected. Twenty-two percent of patients with normal respiratory patterns showed thoracic radiographic lesions. Respiratory distress was not correlated with mortality. Twenty-eight patients were presented with superficial wounds and 13 with deep wounds. Eight patients exhibited penetrating wounds. Radiographic lesions were observed in 77% of dogs and 100% of cats. Explorative thoracotomy was performed in 28% of patients, and surgical wound exploration in 17.2%. With the exception of skin wounds, thoracic wall discontinuity was the most frequent lesion. Thoracotomy was associated with increased length of hospitalisation but was not correlated with mortality. The mortality rate was 15.4%. No studied factor correlated with mortality, and the long-term outcomes were excellent. CLINICAL SIGNIFICANCE: A penetrating injury, more than three radiographic lesions, or both together seemed to be indicative of the need for a thoracotomy. In the absence of these criteria, systematic bite wound explorative surgery is recommended, with extension to thoracotomy if thoracic body wall disruption is observed.

Swift recovery of severe hypoxemic pneumonia upon morbid obesity.

A morbidly obese (body mass index = 55.5) female patient presented with severe hypoxemic community acquired pneumonia [PaO2/FiO2 (P/F) = 57] with primarily right basal atelectasis, but without bilateral opacities in the upper lobes on the chest X-ray. Major O2 desaturations led the nurses to object to moving the patient to the prone position: muscle relaxation combined to prone position was impossible. Therefore, stringent 60 degrees reverse Trendelenburg legs down position was constantly maintained during mechanical ventilation through the endotracheal tube, using low pressure support (pressure support = 5-10 cmH2O) and high positive end-expiratory pressure (PEEP). PEEP was progressively increased to 20 cmH2O, and little or no sedation was used. A P/F improvement from 57 to 200 over three days allowed removing the tracheal tube. The patient was discharged 13 days after admission. In this paper, the use of high PEEP in the context of morbid obesity, and low pressure support are discussed.

Comparison of radiographic measurements of the patellar tendon-tibial plateau angle with anatomical measurements in dogs. Validity of the common tangent and tibial plateau methods.

OBJECTIVE: To evaluate the validity of the common tangent and conventional tibial plateau angle methods for measuring the patellar tendon angle (PTA) in dogs. METHODS: Radiographs of cadaveric stifles (n = 20) placed at 135° in true lateral position were obtained to measure the PTA with both methods. A Kirschner wire was inserted perpendicularly to the patellar tendon at its insertion on the tibia and the stifle was dissected. Two Kirschner wires were then used to identify the anatomical landmarks of the tibial plateau. A digital image was obtained of the proximal tibia in true lateral position. Six blinded observers measured each PTA digitally while the anatomical PTA was determined by an independent blinded observer from the angle between the line representing the tibial plateau and the Kirschner wire representing the perpendicular to the patellar tendon. The agreement between the methods was determined statistically from an intraclass correlation coefficient (ICC). RESULTS: The global ICC for the common tangent method (0.44) and for the conventional method (0.4) indicated that their overall validity is poor. The measurements obtained by common tangentmethod and conventional method were respectively below and above the anatomical measurements. The reproducibility of the PTA measurements based on images of the dissected stifles was very good. CLINICAL SIGNIFICANCE: Both the common tangent and conventional methods show poor concordance with the anatomical measurement of PTA. Further studies are needed to determine if errors in measurements affect the clinical outcome.