The use of inhaled nitric oxide as adjuvant therapy in patients with burn injuries and respiratory failure.

Inhaled nitric oxide (NO) is a relatively new modality in the management of acute respiratory distress syndrome. The purpose of this study was to examine our experience with inhaled NO in 10 adult patients with burn injuries and acute respiratory distress syndrome-related oxygenation failure. The patients had a mean age of 50 +/- 19 years and a mean burn size of 41% +/- 20% of the total body surface area. Seven patients died and 3 survived. The survivors and nonsurvivors did not differ with respect to age, burn size, pre-NO ventilator settings, or indices of oxygenation including PaO2, oxygen saturation in arterial blood, PaO2/fraction of inspired oxygen (FIO2) ratio, and alveolar-arterial oxygen tension difference. The concentration of NO administered ranged between 5 ppm and 30 ppm. PaO2, oxygen saturation in arterial blood, and the PaO2/FIO2 ratio increased in all patients. Although it was not statistically significant, survivors tended to have a more vigorous and sustained response than non-survivors; this was best exemplified by the change in PFR. During the first hour of therapy, the PaO2/FIO2 ratio increased from 64.3 +/- 12.7 to 231.8 +/- 154.5 in survivors and from 93.9 +/- 44.0 to 161.5 +/- 81.8 in the nonsurvivors. After 12 hours of therapy, the PaO2/FIO2 ratio was 306.2 +/- 333.7 in the survivors and 178.9 +/- 69.9 in the nonsurvivors. There were no complications associated with the use of inhaled NO. Although a stronger early response to NO seems to occur in survivors, we cannot definitely conclude that the early response pattern is predictive of recovery. Nonetheless, we believe that inhaled NO has a useful role in the treatment of patients with burn injuries and severe acute respiratory distress syndrome-related oxygenation failure.

Cardiovascular effects of 1.0, 1.5, and 2.0 minimum alveolar concentrations of isoflurane in experimentally induced hypothyroidism in dogs.

This study was performed to determine the cardiovascular responses to isoflurane in euthyroid and hypothyroid dogs. Four healthy mixed-breed dogs were studied prior to thyroidectomy (PRE), 6 months after thyroidectomy (HYP), and after 2 months of oral supplementation with 1-thyroxine (SUP). Heart rate (HR), cardiac output (Q), stroke volume (SV), systolic, diastolic, mean arterial blood pressure (SAP, DAP, MAP), and total peripheral resistance (TPR) were determined in awake dogs and in the same dogs when end-tidal isoflurane concentration were 1.28%, 1.92%, and 2.56%. Ventilation was controlled in anesthetized dogs and PACO2 maintained between 38 to 42 mm Hg. Isoflurane caused significant (P < .05) dose-dependent reduction in Q, SV, SAP, DAP, and MAP in the PRE, HYP, and SUP dogs. Cardiac output was lower in the HYP dogs than in the PRE or SUP dogs during awake measurement. TPR was increased in the awake HYP dogs compared with the PRE or SUP dogs. During anesthesia, HYP dogs tended to have lower Q, SV, SAP, and MAP PRE or SUP groups, but the only significant reduction was SAP during 1.5 MAC. The cardiovascular responses to isoflurane in hypothyroid dogs are similar to euthyroid animals with a dose-dependent depression in Q, SV, and arterial pressure.

A comparison of simple continuous versus simple interrupted suture patterns for tracheal anastomosis after large-segment tracheal resection in dogs.

Two suture techniques for tracheal anastomosis after large-segment tracheal resection were compared. Eight cartilages were resected from the trachea of each of 12 dogs; anastomoses with 4-0 polydioxanone suture were created using a simple continuous suture technique in six dogs and a simple interrupted suture technique in six dogs. Surgical time was shorter but apposition of tracheal segments at the time of surgery was less precise with the simple continuous suture technique. The dogs were evaluated for 150 days after surgery. Clinical abnormalities after tracheal resection and anastomosis were not observed. Percent dorsoventral luminal stenosis was calculated by measuring the tracheal lumen diameter on lateral cervical radiographs. Percent luminal stenosis was calculated planimetrically using a computerized digitizing tablet. Anastomotic stenosis was mild in all dogs; however, the mean percent.luminal stenosis determined planimetrically was significantly greater for dogs that had the simple continuous suture technique. Planimetric measurements of cross-sectional area made before and after formalin fixation were not significantly different. Radiographic determination of percent dorsoventral luminal stenosis was a poor predictor of diminution of cross-sectional area determined planimetrically.

Comparison of stainless steel fascial staples and polypropylene suture material for closure of the linea alba in dogs.

Five centimeter segments of the linea alba in mature, female, mixed breed dogs were incised and then approximated with either stainless steel fascial staples or size 0 polypropylene suture material. Breaking strength of the linea alba closures was determined at 0 (Phase I, 18 dogs) and at 7, 14, and 31 days (Phase II, 18 dogs). Histology and videointeractive planar morphometry were used to evaluate healing of the linea alba. Breaking strength and histologic and morphometric variables were analyzed statistically using analysis of variance in a split plot design. In a clinical trial, 20 cm linea alba incisions were approximated with stainless steel fascial staples after elective ovariohysterectomy in mature, female, mixed breed dogs (Phase III, eight dogs). The dogs were evaluated at 1, 2, 7, 14, 31, 90, and 180 days. Linea alba incisions approximated with polypropylene suture material were significantly stronger than linea alba incisions approximated with stainless steel fascial staples on day 0. There was no significant difference between breaking strength values, histologic, and morphometric appearance of linea alba incisions closed with stainless steel fascial staples or polypropylene suture material when compared 7, 14, and 31 days after surgery. All of the dogs in the clinical trial appeared to be normal at all evaluation times. Approximation of linea alba incisions with stainless steel fascial staples compares favorably to closure with a simple continuous pattern of polypropylene suture material with regard to breaking strength, clinical, histologic, and morphometric appearance.

Clinical and pathologic effects of a modified technique for application of spiral prostheses to the cervical trachea of dogs.

A modified surgical technique for application of extraluminal polypropylene spiral prostheses (PSP) to the trachea was developed. A portion of the segmental blood supply to the collapsed segment of trachea was maintained by fenestrating rather than completely dissecting the right lateral pedicle. Polypropylene spiral prostheses were applied to the cervical trachea of 12 dogs (group I) via the modified technique and to 12 dogs (group II) with the identical surgical dissection but without PSP applied. Clinical abnormalities included mild coughing in group I dogs and swelling of the incisions in both groups. Limited necrosis and moderate degeneration and inflammation were observed histologically in both groups. Pathologic changes were worse in the caudal cervical segment of the trachea. Mucosal regeneration was present on day 10 in both groups. Transmural tracheal necrosis was not observed. The modified technique for application of PSP is recommended by the authors because it provides adequate surgical exposure and the blood supply preserved by segmentally dissecting the right lateral pedicle is adequate to maintain tracheal viability.

Cholelithiasis in dogs: 29 cases (1980-1990).

Medical records of 29 dogs with cholelithiasis were reviewed. Aged female small-breed dogs were overrepresented. Mean age was 9.5 years, and mean weight was 12 kg. Vomiting, anorexia, weakness, polyuria/polydipsia, weight loss, icterus, fever, and signs of abdominal pain were the most common clinical signs. Leukocytosis, neutrophilia with left shift, monocytosis, high activity of serum hepatic enzymes, hypoalbuminemia, and high concentrations of serum total bilirubin were common. Radiopaque choleliths were evident on abdominal radiography of 13 of 27 dogs. Microbial culturing of bile isolated organisms in 15 of 20 dogs. Gram-negative bacteria were most common. Surgery was performed in 22 dogs. Four dogs were treated medically, and 3 dogs were euthanatized without treatment. Surgical treatment consisted of cholecystectomy in 11 dogs, choledochotomy in 5 dogs, cholecystotomy in 4 dogs, and cholecystojejunostomy in 1 dog. Sphincter of Oddiotomy was performed in 1 dog. Five dogs had concurrent generalized peritonitis attributable to bile. Multiple choleliths were detected in most of the dogs. Choleliths were located in the gallbladder in 20 dogs and in the bile ducts in 14 dogs. The most common abnormalities of the gallbladder, identified histologically, were chronic cholecystitis, mucosal hyperplasia, and pericholecystic inflammation. The most common abnormalities of the liver were cholestasis, hepatocellular degeneration, and periportal fibrosis. Survival rate of dogs that underwent cholecystectomy tended to be higher (86%) than that of dogs treated via cholecystotomy (50%) or cholecystectomy in combination with choledochotomy (33%). Dogs that underwent medical treatment, abdominal exploratory, cholecystojenunostomy, choledochotomy, and sphincter of Oddiotomy died or were euthanatized because of redevelopment of clinical signs associated with cholelithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric perforation associated with administration of ibuprofen in a dog.

A 3-year-old Chow Chow was examined because of a 2-week history of vomiting and anorexia after administration of 200 mg of ibuprofen. Peritoneal effusion and free gas within the peritoneal cavity were observed on radiography of the abdomen. A full-thickness perforation of the pyloric antrum and pylorus were detected during exploratory laparotomy, and a Billroth-I gastroduodenostomy was performed successfully.

Hypoplasia of the trachea in dogs: 103 cases (1974-1990).

A multi-institutional retrospective study of 103 dogs in which hypoplasia of the trachea was diagnosed was conducted. Bulldogs (55%) and Boston Terriers (15%) were most commonly affected. Age at diagnosis ranged from 2 days to 12 years, with a median of 5 months. Hypoplasia of the trachea was diagnosed more frequently in males (66%) than females (34%). Congenital anomalies in dogs with hypoplasia of the trachea included elongated soft palate (n = 44), stenotic nares (n = 23), cardiac defects (n = 12), and megaesophagus (n = 10). Ratios between tracheal lumen diameter and depth of the thoracic inlet or width of the third rib did not correlate with dyspnea. Of 42 dogs reexamined greater than 6 months after diagnosis, 25 (60%) were clinically normal. The remaining 17 were dyspneic and 15 (88%) had concurrent respiratory or cardiovascular disease that could account for their clinical signs. Hypoplasia of the trachea appears to be tolerated well in the absence of concurrent respiratory or cardiovascular disease.

Cutaneous actinomycosis and nocardiosis in dogs: 48 cases (1980-1990).

Medical records of 48 dogs with cutaneous actinomycosis or nocardiosis were reviewed. Male, large-breed dogs kept outdoors were overrepresented. The mean age at admission was 3.6 years. Cutaneous swelling (68%), abscesses (65%), draining tracts (48%), fever (36%), and signs of pain (13%) were the most common clinical findings. The cervicofacial area was affected in 48% of the dogs. Abdominal and thoracic wall involvement was less common. Leukocytosis, neutrophilia with left shift, monocytosis, and hyperglobulinemia were common. The diagnosis was confirmed by cytologic examination, bacteriologic culture, or histologic examination. Gram-positive filamentous bacteria were seen in 69% of the fine needle aspirates and in 50% of the biopsy specimens. Actinomyces spp were isolated from cutaneous lesions in 27 (60%) dogs. Nocardia asteroides was isolated from 1 dog. Treatment consisted of surgical debridement, drainage, and administration of antibiotics in 29 dogs (group A) and antibiotics alone in 13 dogs (group B). The infection redeveloped in 10 (42%) group-A dogs and 6 (60%) group-B dogs. Of the 10 group-A dogs with recurrent infection, 6 had resolution after a second surgery and 4 were euthanatized. Of the 6 group-B dogs, 1 had resolution after surgery, 4 were euthanatized or died because of persistent disease, and 1 had an unresolved infection. The combination of surgery and antibiotic treatment appeared to be superior to antibiotic treatment alone in resolving cutaneous Actinomyces and Nocardia infections.

The etiology and surgical management of tracheal collapse in calves.

The mean ages of 10 calves with tracheal collapse were 2.7 weeks at onset of clinical signs and 9.4 weeks at presentation for treatment. Inspiratory and expiratory dyspnea and stunted growth were the most common clinical signs. There were abnormalities of the cranial ribs consistent with healing fractures with redundant callus in eight lateral thoracic radiographs. Tracheal collapse in calves may result from cranial thoracic trauma during or soon after birth. Short polypropylene ring prostheses made from 60 ml syringe barrels were placed on the tracheas of four calves with cervical tracheal collapse. There were cranial rib masses in all calves and resection of the right first and second ribs was necessary in one calf to allow placement of prostheses. Dyspnea was relieved in all calves. One calf died of unrelated causes in year 3, and one calf had recurrence of clinical signs at month 5 and was euthanatized. In both calves, tracheal stenosis resulted from continued growth and infolding of the trachea within the constraints of the prostheses. One calf was alive at month 11, and one calf died of acute bronchopneumonia on day 2. Removal of tracheal prostheses in calves is recommended after 2 to 3 months if clinical signs recur.

Results of ligation of patent ductus arteriosus in dogs: 201 cases (1969-1988).

Surgical treatment of 201 dogs with patent ductus arteriosus at the College of Veterinary Medicine, The Ohio State University was evaluated retrospectively to determine risk factors for development of surgical complications. During surgery, 15 dogs (7%) died because of hemorrhage associated with ductus dissection (n = 8), pulmonary edema (n = 4), ventricular fibrillation (n = 1), hemorrhage not associated with ductus dissection (n = 1), and cardiac arrest immediately after ductus ligation (n = 1). An additional 8 dogs (4%) died less than 1 month after surgery (total mortality before, during, and immediately after surgery, 11%). Nineteen dogs (9.5%) developed hemorrhage during surgery. Sixteen dogs developed complications other than hemorrhage (pulmonary edema [n = 4], cardiac arrest [n = 4], iatrogenic lung trauma [n = 3], ventricular fibrillation [n = 2], septicemia [n = 2], and recanalized ductus [n = 2]). Correlation was not found between age, sex, body weight, surgical technique (Jackson method vs standard method of dissection), or surgeon level of training and development of hemorrhage during surgery, other complications, or survival less than 5 days. Positive correlation (P less than 0.05) was found between hemorrhage and death within 5 days after surgery. Positive correlation (P less than 0.05) was also found between other complications and death within 5 days after surgery. Nineteen dogs survived surgery, but later died of unrelated causes (mean life span, 57 months); 63 of the dogs were still alive and doing well as of January 1990 (mean life span, 47 months after surgery). Contrary to previous reports, age, body weight, and surgical technique did not affect results.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and pathologic effects of spiral and total ring prostheses applied to the cervical and thoracic portions of the trachea of dogs.

This study compared the short-term clinical and pathologic effects of spiral and total ring prostheses, applied to the cervical and thoracic portions of the trachea of dogs via a combined intercostal thoracotomy and ventral cervical midline approach. The effect of intraluminal placement of synthetic monofilament nonabsorbable suture also was evaluated. Eleven small-breed dogs were randomly allotted to 3 groups. Group 1 (n = 3) were controls that had been treated by sham operation, group 2 (n = 4) had polypropylene spiral prostheses applied to the cervical and thoracic portions of the trachea, and group 3 (n = 3) had total ring prostheses applied to the cervical and thoracic portions of the trachea. All dogs were euthanatized and necropsied 8 weeks after surgery. Clinical complications were minimal and limited to mild, short-term lameness and coughing. Three and 6 weeks after surgery, radiographs were within normal limits in all dogs. Tracheoscopy confirmed maintenance of tracheal lumen diameter and integrity of the mucosal epithelium in all dogs. Gross and microscopic postmortem findings were similar in groups 2 and 3. Mild adhesions were present between prostheses and adjacent structures. Similar adhesions were present where prostheses had been applied and subsequently removed in group-1 dogs. Histopathologic abnormalities included mild to moderate adventitial and periprosthetic fibrosis and mild advential inflammation associated with polypropylene spiral prostheses and total ring prostheses. The majority (70%) of intratracheal sutures evaluated were covered by microscopically normal ciliated mucosal epithelium by 8 weeks after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysmal bone cyst in a rib of a cat.

An aneurysmal bone cyst was identified in the rib of a 3 1/2-year-old domestic shorthair cat. Surgical excision of the cyst, with reconstruction of the thoracic wall, was performed. Though aneurysmal bone cyst is a benign neoplastic condition that may be associated with locally aggressive growth, it does not metastasize. The condition is rare in any species other than human beings, but has been reported in cats, dogs, and horses.

Chylothorax associated with congestive cardiomyopathy in a cat.

Chylothorax associated with congestive cardiomypathy was diagnosed in a 10-year-old male castrated domestic shorthair cat via analysis of pleural fluid. The triglyceride concentration in the pleural fluid was high (579 mg/dl), compared with that in serum (87 mg/dl), and the fluid cleared with ether. Evidence of atrial and left ventricular enlargement was found via electrocardiography and thoracic radiography. Left-sided cardiac dilatation and reduced systolic motion of the left ventricle were revealed by echocardiography. The cat was treated with digoxin, furosemide, and aspirin. Two months after initiation of treatment, fluid (265 ml) was aspirated from the pleural cavity. Two months after this procedure, the cat was doing well, with minimal pleural fluid production.

Pulmonic stenosis in the dog: 29 cases (1975-1984).

In a retrospective study of 29 dogs with congenital pulmonic stenosis, we evaluated the clinical, radiographic, angiocardiographic, and cardiac catheterization data. Eighteen dogs had no clinical signs of disease and were referred for evaluation of a previously detected cardiac murmur, 5 dogs had congestive right-sided heart failure, and 5 dogs were examined for exercise intolerance or syncope. Dogs with heart failure tended to be older than dogs without clinical signs of heart failure (19.3 months vs 12 months). All dogs had radiographic or electrocardiographic evidence of right ventricular enlargement. Poststenotic dilatation of the main pulmonary artery and apparent pulmonary undercirculation were observed frequently on survey radiographs. Isolated pulmonic valve dysplasia, representing a range of angiographic pulmonic valve abnormalities, was evident in 88% of the available 26 angiographic studies, whereas subvalvular stenosis was uncommon and observed in only 2 dogs. Muscular hypertrophy of the right ventricular infundibulum and supraventricular crest were observed in 96% and 25% of the angiocardiograms, respectively. Poststenotic dilatation of the main pulmonary artery was observed in every dog. A ratio between the width of the main pulmonary artery and the valve annulus was useful in identifying pulmonic stenosis and distinguishing this anomaly from other congenital malformations. The degree of poststenotic dilatation did not appear to be related to the severity of the systolic pressure gradient, which ranged from 20 to 228 mm of Hg (mean, 93 mm of Hg).(ABSTRACT TRUNCATED AT 250 WORDS)