Anastomosis of the caudal thoracic duct and intercostal vein using a microvascular anastomotic coupler device: Experimental study in six dogs.

OBJECTIVE: To describe the technique for anastomosis of the caudal thoracic duct (TD) to the 10th or 11th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) device in dogs and assess patency of the anastomosis on days 0 and 30. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Six adult Beagle dogs. METHODS: Under general anesthesia, fluoroscopic popliteal lymphangiography was performed and the TD identified. A right ninth or 10th intercostal thoracotomy was performed. Using an operating microscope, the TD and the 10th or 11th ICV were isolated, ligated, and anastomosed using a 1.5 or 2.0 mm MAC. Fluoroscopic popliteal lymphangiography was repeated immediately after surgery and on day 30. RESULTS: The anastomosis was successful and lymphangiography documented flow into the azygos vein in all six dogs immediately after surgery. At day 30, the anastomosis was patent in four of six dogs. In two dogs, flow through the anastomosis was obstructed due to kinking of the ICV just cranial to the MAC. CONCLUSION: Anastomosis of the TD and ICV using a MAC was feasible and was shown to maintain patency up to 30 days. When performing the anastomosis, care should be taken to ensure the ICV is not kinked by the MAC. CLINICAL SIGNIFICANCE: Direct anastomosis of the TD and ICV may have application for treatment of idiopathic chylothorax in dogs by maintaining flow from the abdominal lymphatics to the central venous circulation and thereby preventing the stimulus for collateral circulation and persistent chylous effusion. Further investigation is warranted to assess the efficacy of this technique in dogs affected with idiopathic chylothorax.

Lymphaticovenous anastomosis of the caudal thoracic duct to the azygous vein: A feline cadaver study.

OBJECTIVE: The aim of this study was to describe a technique for anastomosis of the thoracic duct (TD) to the azygos vein (AV) using a microvascular anastomotic coupler (MAC) device in feline cadavers. Our hypothesis was that a TD-AV lymphaticovenous anastomosis would be feasible in feline cadavers. STUDY DESIGN: Cadaveric study. ANIMALS: Eight domestic shorthair feline cadavers. METHODS: A left paracostal laparotomy and 9th or 10th intercostal thoracotomy was performed. Contrast media was injected into a mesenteric lymph node and lymphography was used to identify the TD and its branches. The TD and AV were isolated, ligated, and divided with the aid of a surgical microscope. The TD and AV were anastomosed end-to-end using a 1.5 or 2.0 mm MAC. Intraoperative patency was assessed by manipulation of chyle and venous blood across the anastomosis. Mesenteric lymphography was repeated to confirm postoperative anastomotic patency. RESULTS: The TD was identified via lymphography in seven of eight cats. The anastomosis was successful and patency was confirmed via intraoperative assessment and postoperative lymphography in all cats. The median (range) duration for the dissection and anastomosis portions of the procedure was 122 (80-150) min. CONCLUSION: End-to-end anastomosis of the TD to the AV using a MAC was feasible in the feline cadaver without major intraoperative technical challenges. CLINICAL SIGNIFICANCE: Anastomosis of the TD and AV may have application as an alternative treatment for idiopathic chylothorax in cats. By directly connecting the abdominal lymphatics to the central venous system, the stimulus for collateral vessel development around the site of TD ligation may be minimized, which may prevent leakage of chyle through the more cranial lymphatics.

Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Computed tomographic findings in a canine ovarian teratoma.

A 2-year-old, intact female, Labrador Retriever was referred for progressive abdominal distension, assessed by emergency clinicians as being extrauterine in origin on AFAST. Abdominal radiographs and ultrasound identified a large, lobulated, partially mineralized, soft tissue, mid-abdominal mass and gravid uterus. Contrast-enhanced CT identified a mixed fat to soft tissue attenuating mass with a complex internal mineralized matrix, heterogeneous contrast enhancement, receiving blood from the left ovarian artery. Histology confirmed a left ovarian teratoma, diffuse endometrial hyperplasia, and fetal implantation. The patient had a good post-operative outcome for 2 years, but was later diagnosed with primary cranial mediastinal neuroendocrine carcinoma.

Evaluation of two nephrocystostomy techniques for ureteral bypass in cats.

OBJECTIVE: To describe two techniques for nephrocystostomy (NCT) in cats. STUDY DESIGN: Experimental study. ANIMALS: Twelve, adult, purpose-bred, cats. METHODS: A simple NCT (n = 3) or bladder cuff NCT (n = 9) was performed in the right or left kidneys. For simple NCT, an 8F catheter was placed through the caudal pole into the renal pelvis and the bladder was sutured around the catheter. For bladder cuff NCT, a 6 mm defect was removed from the caudal pole and a cuff of bladder mucosa was advanced and sutured into the renal pelvis. A 10F catheter was placed through the defect into the renal pelvis and the bladder wall was sutured around the catheter. Catheters were removed 41-118 days post-surgery. Computed tomography (CT) was performed 25 days after catheter removal for the simple NCT and 30 (n = 6) and 90 (n = 3) days after catheter removal for bladder cuff NCT. Histological evaluation of the nephrocystostomy site was performed. RESULTS: All simple NCTs became obstructed after catheter removal. All bladder cuff NCTs were patent, and CT revealed contrast flow into the bladder. Hematuria, clot-associated urethral obstruction, catheter dislodgement, and bladder infection occurred variably after surgery. Histological findings consisted of smooth epithelialization of the NCT and degenerative changes in the caudal pole of the kidney. CONCLUSION: Bladder cuff NCT was feasible in normal cats and remained patent for 90 days. Methods to limit nephrostomy track hemorrhage should be investigated. Degenerative changes may be related to vascular impairment from the bladder cuff sutures. CLINICAL SIGNIFICANCE: Complete ureteral bypass was possible in cats using only native tissues.

Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone.

OBJECTIVE: To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only. ANIMALS: 351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age. PROCEDURES: Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time. RESULTS: 351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%. CLINICAL RELEVANCE: Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats.

OBJECTIVES: The aim of this report was to describe the clinical signs, diagnostic imaging findings, surgical management, histopathological findings, outcome and possible risk factors for cats that developed retroperitoneal fibrosis (RPF) following renal transplantation. METHODS: Medical records of cats that underwent renal transplantation and developed clinically significant RPF between 1995 and 2019 were reviewed. RESULTS: Eighty-one cats underwent 83 renal transplantations. Of these 81 cats, six developed clinically significant RPF. For all six cats, renal transplantation was performed using cold organ preservation solution and ureteral papilla implantation. Immunosuppression protocol included ciclosporin and prednisolone. All cats had at least one subtherapeutic trough ciclosporin level (<250 ng/ml) in the postoperative period. Cats presented with moderate-to-severe azotemia 39-210 days following renal transplantation. Abdominal ultrasonography and contrast pyelography revealed various degrees of hydroureter and hydronephrosis of the transplanted kidney. Surgical examination revealed a layer of dense fibrous tissue surrounding the transplanted kidney, ureter and bladder resulting in ureteral obstruction. Ureteral obstruction was managed by reimplantation of the proximal ureter or renal pelvis to the bladder. Histopathologic examination of the fibrous tissue and affected portion of the distal ureter revealed fibrous connective tissue with lymphoplasmacytic infiltration and perivascular inflammation suggestive of an autoimmune type reaction. Of the six cats, two died within 5 days after revision surgery, two developed signs consistent with recurrent partial ureteral obstruction (40 and 41 days after revision), one was euthanized 6 years later for an unrelated disease and one was lost to follow-up. CONCLUSIONS AND RELEVANCE: The incidence of RPF in this population of cats was relatively low (7%), but still represents a significant cause of morbidity and mortality. The cause of RPF remains unknown, although investigation into suboptimal immunosuppression as a potential cause for local rejection reaction is warranted.

Transpalatal reconstruction and stenting for treatment of choanal atresia and nasopharyngeal stenosis in a dog.

CASE DESCRIPTION: A 3-year-old 17.5-kg (38.5-lb) mixed-breed dog was referred for evaluation because of nasal discharge, sneezing, and signs of nasal congestion of approximately 9 months' duration. A diagnosis of nasopharyngeal stenosis (NPS) was made prior to referral. CLINICAL FINDINGS: Sneezing, bilateral mucopurulent nasal discharge, reduced nasal airflow, stertor, and increased inspiratory effort were noted on physical examination. Results of serum biochemical analysis were within respective reference ranges. Review of CT images of the skull revealed findings consistent with severe bilateral partial osseous choanal atresia and NPS. Retrograde rhinoscopy confirmed membranous NPS. TREATMENT AND OUTCOME: A ventral rhinotomy was performed; communication between the pharynx and nasal passageway was reestablished by surgical debridement of the caudal border of the palatine bone and vomerine crest and groove, followed by dissection of the membranous NPS and reconstruction of the caudal part of the nasopharynx. A covered nasopharyngeal stent was placed in the newly established nasopharynx. The dog recovered uneventfully but was presented 3 weeks later with recurrent signs; diagnostic findings were consistent with stenosis rostral to the stent. The stenosis was treated with balloon dilation, and a second covered stent was placed rostral to and overlapping the first stent, spanning the stenotic region. Eleven months after this procedure, the dog was doing well. CLINICAL RELEVANCE: Results for this patient suggested that ventral rhinotomy and covered nasopharyngeal stent placement can be used successfully for the management of osseous choanal atresia in dogs; however, careful attention to preoperative planning and potential complications is necessary.

Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: A canine cadaver study.

OBJECTIVE: To describe a technique for anastomosis of the thoracic duct (TD) to the 11th or 12th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) in the dog. STUDY DESIGN: Cadaveric study. ANIMALS: Eight beagles. METHODS: A right paracostal laparotomy and 10th intercostal thoracotomy were performed in each dog. Mesenteric contrast lymphography was used to identify the TD and its branches on fluoroscopy. The TD and adjacent 11th or 12th ICV were isolated, double ligated, and divided using a surgical microscope. The caudal TD and proximal ICV were anastomosed in an end-to-end fashion using a 1.5 mm or 2 mm MAC. Mesenteric lymphography was repeated to document patency of the anastomosis. RESULTS: The TD was identified via lymphography in all dogs; five dogs had a single duct, and three dogs had additional branches. The anastomosis was successful in all eight dogs, and flow into the azygos vein without leakage was confirmed via lymphography. CONCLUSION: End-to-end anastomosis of the TD to an ICV using a MAC was technically feasible in the canine cadaver. CLINICAL SIGNIFICANCE: Lymphaticovenous anastomosis combined with TD ligation may have application as a treatment for idiopathic chylothorax. By maintaining the flow of chyle from the abdominal lymphatics to the systemic circulation, this procedure may reduce the stimulus for collateral circulation and persistent flow to the cranial mediastinal lymphatics.

Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation.

OBJECTIVE: To describe the technique and determine the feasibility of an end-to-side (ETS) anastomosis of the renal vein to vena cava and renal artery to aorta using a microvascular anastomotic coupler (MAC) for feline renal transplantation. STUDY DESIGN: In vivo experimental study. ANIMALS: Six purpose-bred domestic shorthair cats. METHODS: The left kidney was autotransplanted using a MAC for ETS vascular anastomosis. Outcomes included intraoperative hemorrhage from the anastomosis sites, duration of anastomoses, surgical complications, postoperative renal perfusion (including resistive index (RI)) measured by Doppler ultrasonography and computed tomography angiography, and histopathological examination of the left kidney and anastomosis sites (30 days). RESULTS: Anastomosis was successful in all cats, and intraoperative hemorrhage was negligible. Intraoperative renal perfusion was considered excellent. Venous and arterial anastomoses were completed in 11 minutes 20 seconds (range, 6:38-13:27) and 21 minutes 50 seconds (range, 11:05-30:24), respectively. Vascular occlusion time was 32 minutes (17:43-42:03). One cat was euthanized 5 hours postoperatively because of bleeding from a muscular arterial branch of the dorsal aorta causing hemoabdomen. Renal perfusion and RI of the remaining five cats were within normal range (<0.8) and similar to the contralateral kidney at all time points. Endothelialization of the anastomosis was complete with mild-to-moderate fibrosis surrounding the MAC in all cats. CONCLUSION: End-to-side anastomosis of the renal vein and artery to the vena cava and aorta, respectively, was consistently achieved in all six cats with the MAC. CLINICAL SIGNIFICANCE: The use of the MAC may be considered as an alternative to hand suturing for ETS anastomoses for feline renal transplantation.

Late-onset laryngeal paralysis: Owner perception of quality of life and cause of death.

BACKGROUND: Late-onset laryngeal paralysis (LoLP) is an idiopathic disease of older dogs, and is common in the Labrador Retriever. Owner perspective of how LoLP affects their pet's quality of life (QOL), the degree to which LoLP is perceived to be a life-limiting disease, and how a glottic opening procedure affects these perceptions is not known. OBJECTIVES: (a) To determine owner's perception of late-onset laryngeal paralysis (LoLP) with respect to their dog's QOL; (b) To determine whether LoLP is considered by owners to be a life-limiting disease; (c) To evaluate whether a glottic opening procedure altered QOL and perceived cause of death in affected dogs. METHODS: Owners of Labrador Retrievers with LoLP completed a questionnaire. Questions were asked pertaining to a dog's LoLP, including clinical progression and perception of cause of death, and whether a glottic opening procedure was undertaken. Owners also completed a pet-owner administered QOL survey. RESULTS: Seventy-six owners participated. Overall, 94% of owners felt their dog's LoLP affected QOL, and 47% of owners felt LoLP was a large contributing factor in their dog's death. Dogs that underwent a glottic opening procedure were reported to have a better QOL, and the contribution of LoLP towards their death was less than dogs that did not have surgery. CONCLUSION: Owners of Labrador Retrievers with LoLP perceive LoLP to be a life-limiting disease that negatively impacts their dog's QOL. Arytenoid lateralization surgery had a positive impact on QOL in affected dogs.

Temporary abdominal packing for management of persistent hemorrhage after liver lobectomy in three dogs with hepatic neoplasia.

OBJECTIVE: To describe the technique and outcome of temporary abdominal packing for control of persistent hemorrhage from liver lobectomy sites in 3 dogs with hepatic neoplasia. SERIES SUMMARY: Three dogs were treated with massive transfusion for hemoperitoneum secondary to bleeding hepatic tumors. Surgical resection of the affected liver lobe(s) was performed but hemostasis could not be achieved through conventional methods. All 3 dogs demonstrated acidosis, hypothermia, and coagulopathy. Temporary abdominal packing of liver lobectomy sites was performed and hemostasis was achieved in all dogs. One dog died prior to removal of the packing. The other 2 dogs had the packing removed with no evidence of rebleeding. One dog was euthanized after removal of the packing due to acute kidney injury and the remaining dog survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: Temporary abdominal packing combined with medical management was successful in achieving hemostasis in all 3 dogs, however, 2 dogs died of complications related to multiple organ dysfunction syndrome. Temporary abdominal packing may be considered when definitive surgical hemostasis cannot be achieved or in unstable patients not able to tolerate prolonged surgical times. Further research is needed to better define efficacy, optimal patient selection, packing technique, timing of removal, and complications associated with temporary abdominal packing.

Intraoperative and major postoperative complications and survival of dogs undergoing surgical management of epiglottic retroversion: 50 dogs (2003-2017).

OBJECTIVE: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Fifty dogs treated with 78 procedures. METHODS: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. RESULTS: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. CONCLUSION: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. CLINICAL SIGNIFICANCE: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved.

Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat.

CASE SUMMARY: A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well. RELEVANCE AND NOVEL INFORMATION: To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.

An Interdisciplinary Approach to Surgical Skills Training Decreases Programmatic Costs.

BACKGROUND: Surgical resident duty hour limitations have necessitated operative skill training outside of the operating room. Although wet-lab skills training is ideal, materials and human resource requirements make wet labs-utilizing biologic samples cost prohibitive for many residency programs. To resolve this problem, our general surgery residency program collaborated with the Institution's School of Veterinary Medicine Surgery Residency program to pilot a cost-effective interdisciplinary surgical skills curriculum. MATERIALS AND METHODS: The general surgery residency program manager and program director initiated a collaboration with the Veterinary Surgery Residency. Postgraduate year (PGY) 2 general surgery residents and PGY 1-3 veterinary surgery residents participated in monthly joint surgical skills practice sessions. A novel interdisciplinary surgical skills curriculum was implemented that incorporated skills beneficial to both sets of trainees utilizing donated canine cadavers. RESULTS: A total of nine joint skills sessions were conducted for nine general surgery residents and five veterinary surgery residents. A cost analysis was conducted for a surgical skills curriculum servicing both programs independently and compared to the actual costs of the collaborative curriculum. The cost analysis estimated total savings generated by the collaborative to be $27,323.79. Review of initial feedback from trainees suggest that skill sessions reinforce knowledge, and that the collaborative skills sessions were an enjoyable and valuable learning activity. CONCLUSIONS: The skills curriculum collaborative has proven to be a cost-effective and high quality interdisciplinary pedagogic tool. The partnership allowed for mutually beneficial resource sharing and allowed for the initiation of a surgical skills wet lab that had previously been unavailable to both groups.

Comparison of the effects of alfaxalone and propofol with acepromazine, butorphanol and/or doxapram on laryngeal motion and quality of examination in dogs.

OBJECTIVE: To compare the effects of alfaxalone and propofol, with and without acepromazine and butorphanol followed by doxapram, on laryngeal motion and quality of laryngeal examination in dogs. STUDY DESIGN: Randomized, crossover, blinded study. ANIMALS: Ten female Beagle dogs, aged 11-13 months and weighing 7.2-8.6 kg. METHODS: The dogs were administered four intravenous (IV) treatments: alfaxalone (ALF), alfaxalone+acepromazine and butorphanol (ALF-AB), propofol (PRO) and propofol+AB (PRO-AB). AB doses were standardized. Dogs were anesthetized 5 minutes later by administration of alfaxalone or propofol IV to effect. Arytenoid motion during maximal inspiration and expiration was captured on video before and after IV doxapram (0.25 mg kg-1). The change in rima glottidis surface area (RGSA) was calculated to measure arytenoid motion. An investigator blinded to the treatment scored laryngeal examination quality. RESULTS: A 20% increase in RGSA was the minimal arytenoid motion that was detectable. RGSA was significantly less in ALF before doxapram compared with all other treatments. A <20% increase in RGSA was measured in eight of 10 dogs in PRO and in all dogs in ALF before doxapram. After doxapram, RGSA was significantly increased for PRO and ALF; however, 20% of dogs in PRO and 50% of dogs in ALF still had <20% increase in RGSA. A <20% increase in RGSA was measured in five of 10 dogs in PRO-AB and ALF-AB before doxapram. All dogs in PRO-AB and ALF-AB with <20% increase in RGSA before doxapram had ≥20% increase in RGSA after doxapram. Examination quality was significantly better in PRO-AB and ALF-AB. CONCLUSIONS AND CLINICAL RELEVANCE: The use of acepromazine and butorphanol improved the quality of laryngeal examination. Any negative impact on arytenoid motion caused by these premedications was overcome with doxapram. Using either propofol or alfaxalone alone is not recommended for the evaluation of arytenoid motion.

Evaluation of Translaryngeal Percutaneous Arytenoid Lateralization (TPAL) in dogs with experimentally created laryngeal paralysis.

The aim of this experimental study was to evaluate the effect of Translaryngeal Percutaneous Arytenoid Lateralization (TPAL) in dogs with experimentally created laryngeal paralysis. All dogs (n=5) underwent bilateral recurrent laryngeal neurectomy before TPAL. Two TPAL suture techniques were evaluated. TPAL-CranialCaudal (TPAL-CC) was performed first, followed 11 to 14days later by TPAL-DorsalVentral (TPAL-DV). For both techniques, a mattress suture was placed through the arytenoid cartilage via an oral approach. Laryngeal examination was performed before, immediately after, and on days 1, 3 and 7 for both TPAL techniques. Ipsilateral hemiglottic surface area and the degree of laryngeal swelling or reaction to the suture were recorded. Laryngeal tissue was evaluated by histopathology at the end of the study. For both TPAL techniques, hemiglottic surface area was increased immediately after suture placement (P<0.05). At all other times, hemiglottic area was not statistically different from preoperative value (P>0.05). TPAL-DV resulted in less laryngeal swelling compared to TPAL-CC. Histopathology of the arytenoid cartilage surrounding the mattress suture revealed mucosal ulceration and inflammation consistent with the presence of the suture material. Both TPAL techniques were effective at lateralizing the arytenoid cartilage and significantly increasing hemiglottic surface area immediately after suture placement. However, mucosal swelling and loss of tension on the mattress suture lead to a decrease in glottic area within 24h. Further refinements in suture placement technique are warranted to minimize swelling and improve the duration of arytenoid lateralization prior to clinical application.

Diagnosis and management of inflammatory bowel disease in a harpy eagle (Harpia harpyja) with suspected fenbendazole toxicosis.

CASE DESCRIPTION A 14-year-old 4.1-kg (9.02-lb) male harpy eagle (Harpia harpyja) was evaluated because of vomiting, anorexia, lethargy, and weight loss (decrease of 0.35 kg [0.77 lb]) of 4 weeks' duration. The bird had previously been treated orally with fenbendazole after the initial onset of clinical signs. CLINICAL FINDINGS An initial CBC revealed marked heteropenia and anemia, but whole-body contrast-enhanced CT images and other diagnostic test findings were unremarkable. Clinical signs persisted, and additional diagnostic testing failed to reveal the cause. During celiotomy, a biopsy specimen of the duodenum was obtained for histologic examination, which revealed lymphoplasmacytic inflammation, consistent with inflammatory bowel disease (IBD). TREATMENT AND OUTCOME Prior to histopathologic diagnosis of IBD, barium sulfate administered via gavage resulted in a temporary improvement of clinical signs. Following diagnosis of IBD, corticosteroid administration was initiated in conjunction with antifungal prophylaxis. Cessation of vomiting and a return to normal appetite occurred within 3 days. Fifteen months after cessation of corticosteroid treatment, the eagle continued to do well. CLINICAL RELEVANCE To our knowledge, this was the first report of diagnosis and management of IBD in an avian species. For the eagle of the present report, results of several diagnostic tests increased clinical suspicion of IBD, but histologic examination of an intestinal biopsy specimen was required for definitive diagnosis. Although successful in this case, steroid administration in avian species must be carefully considered. Conclusive evidence of fenbendazole toxicosis was not obtained, although it was highly suspected in this bird.