Comparison of mortality of brachycephalic dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide laser, or bipolar vessel sealing device.

OBJECTIVE: To compare mortality of dogs undergoing partial staphylectomy using conventional incisional, carbon dioxide (CO2 ) laser, and bipolar vessel sealing device (BVSD) techniques for the treatment of brachycephalic obstructive airway syndrome (BOAS). STUDY DESIGN: Retrospective multicenter cohort study. ANIMALS: A total of 606 client-owned English bulldogs, French bulldogs, and pugs. METHODS: Medical records from 2011 to 2021 were reviewed for signalment, history, surgical technique, length of hospitalization, and complications. Multivariate statistical analysis was performed to compare odds of mortality between the three techniques of staphylectomy. RESULTS: The overall mortality rate was 24/606 (4.0%). Of those 24 dogs, staphylectomy was performed with BVSD technique in 13 cases, with CO2 laser in nine, and using conventional incisional technique in two. Nine dogs were graded II or III laryngeal collapse, 14 were graded I, and one was unknown. BVSD technique was associated with mortality prior to discharge compared to the other two techniques (OR = 6.0, 95% CI: 1.3-28.4, p = .023). No differences were detected between conventional incisional and CO2 laser techniques. Concurrent higher grade (stage II or III) laryngeal collapse was independently associated with mortality prior to discharge (OR = 4.6, 95% CI: 1.8-11.8, p = .002). CONCLUSION: The use of BVSD and grade of laryngeal collapse were associated with a higher risk of perioperative mortality. CLINICAL SIGNIFICANCE: Clinical studies using a randomized trial design should be conducted to further determine the putative influence of surgical instrumentation in the perioperative mortality rate following multilevel surgery in dogs with BOAS.

Prospective measurement of outcomes and complications of tibial tuberosity advancement using novel mini plates in small breed dogs.

Cranial cruciate ligament (CrCL) disease is a common orthopedic disease in canine patients. Tibial osteotomy procedures for the treatment of cranial cruciate ligament disease in small breed dogs (<15 kg) have previously been limited. A total of 22 client-owned dogs, 26 stifles, with cranial cruciate ligament disease were treated with novel mini-tibial tuberosity advancement plates. The most common intraoperative complications included the need for plate-cage overlap in 7 stifles (26.92%) and screw head fracture in 1 (3.85%). Post-operative complications included tibial tuberosity fracture (3.85%), post-operative medial patella luxation (7.69%), and persistent lameness (7.69%). Of the 26 stifles evaluated in the medium term (>6-12 months) post-operatively, 92.3% had no lameness, with the remaining 7.7% having Grade 1 lameness. A good to excellent clinical outcome was noted in all 26 stifles that underwent TTA with novel mini plates.

Stormwater management in nutrient-sensitive watersheds: a case study investigating impervious cover limits and pollutant-load regulations.

The objective of this research project was to compare two stormwater management strategies within a nutrient-sensitive watershed: impervious cover limits versus pollutant-load regulations. A case study was conducted in the nutrient-sensitive Falls Lake watershed in North Carolina, USA, where a commercial fitness complex was constructed in a zone previously restricted to low-density housing. The Falls Lake watershed has a stormwater regulation that limits total nitrogen and total phosphorus export loads to 2.47 kg/ha/yr and 0.37 kg/ha/yr, respectively. Hydrology and water quality were monitored pre- and post-development to quantify changes to stormwater volumes, pollutant concentrations, and annual export loading rates. On-site stormwater control measures (SCMs) reduced nutrient export loading rates below the regulatory standard. However, increased stormwater volumes and nutrient export loading rates were observed from pervious surfaces that were disturbed during construction (total nitrogen increased from 2.06 to 4.24 kg/ha/yr, total phosphorus increased from 0.41 to 0.73 kg/ha/yr). Results from this case study suggest that (1) impervious cover limits do not adequately account for a parcel's nutrient export loads and (2) SCMs that reduce volume and treat pollutants can reduce nutrient export loads below regulatory levels in the Falls Lake watershed.

Comparison of complications following tibial tuberosity advancement and tibial plateau levelling osteotomy in very large and giant dogs 50 kg or more in body weight.

OBJECTIVES: To analyse and compare major complications in dogs ≥50 kg undergoing tibial tuberosity advancement (TTA) or tibial plateau levelling osteotomy (TPLO) for treatment of cranial cruciate ligament disease. METHODS: Medical records and radiographs of client-owned dogs (≥50 kg) treated for cranial cruciate ligament disease with either TTA or TPLO between January 2011 and November 2015 were reviewed. Ninety-one TTA cases and 54 TPLO cases met the study inclusion criteria. All complications within one year of surgery were recorded. Major complications were those requiring surgical revision or intervening medical therapy to resolve. Logistic regression analysis evaluated for associations with major complication occurrence. Major complications were statistically compared between TTA and TPLO treatment groups. RESULTS: Incidence of major complications following TTA and TPLO surgery were 19.8% and 27.8%, respectively. Surgical site infection (SSI) was the single most common major complication following both TTA (15.4%) and TPLO (25.9%) surgery. There were no significant differences between TTA and TPLO treatment regarding the rate of SSI, surgical revision, or overall occurrence of major complications. Postoperative antibiotic therapy significantly reduced the risk of a major complication in all dogs ≥50 kg (p = 0.015; OR: 0.201: 95%CI: 0.055-0.737). CLINICAL SIGNIFICANCE: Major complications occurred frequently following TTA and TPLO treatment of cranial cruciate ligament disease in dogs ≥50 kg. The increased chance for SSI should be considered and postoperative antibiotic therapy is recommended.

Nest thermoregulation of the paper wasp Polistes dominula.

Wasps of the genus Polistes build combs without any cover and hence are insufficiently protected against temperature fluctuations. Due to this fact, different types of thermoregulation of Polistes dominula nests were investigated using the modern method of thermography. The study of active mechanisms for nest thermoregulation revealed no brood incubation or clustering behaviour of P. dominula. Furthermore, we found out that wing fanning for cooling the nest was almost undetectable (4 documented cases). However, we could convincingly record that water evaporation is most effective for nest cooling. By the direct comparison of active (with brood and adults) and non-active (without brood and adults) nests, the start of cooling by water evaporation was detected above maximum outside temperatures of 25°C or at nest temperatures above 35°C. The powerful role of water in nest cooling was manifested by an average decrease of temperature of single cells of about 8°C and a mean duration of 7min until the cells reached again their initial temperature. The investigation of passive thermoregulatory mechanisms revealed that the architecture of the nest plays an important role. Based on the presented results, it can be assumed that the vertical orientation of cells helps maintaining the warmth of nests during the night, whereas the pedicel assists in cooling the nest during the day. Therefore, our study of nest thermoregulation has revealed that P. dominula wasps regulate the temperature of their nest actively by evaporative cooling and passively by a careful site selection and the architecture of their nests.

Short-Term Radiographic Complications and Healing Assessment of Single-Session Bilateral Tibial Tuberosity Advancements.

The objective of this study is to report on the short-term radiographic complications and bone healing associated with single-session bilateral tibial tuberosity advancements (TTAs). This retrospective study consists of 74 client-owned dogs with bilateral cranial cruciate ligament rupture that underwent consecutive single-session bilateral TTAs. Radiographs from 74 dogs (148 stifles) were evaluated for evidence of postoperative complications. One hundred forty-three of 148 stifles were scored for radiographic healing using a previously described scoring system. Variables evaluated for a relationship with radiographic complications and healing scores were: breed, age, body weight, sex, and TTA plate type. The overall radiographic complication rate was 17.6% (13/74). Twelve of the 13 radiographic complications were considered to be minor and one was major. Increasing body weight and use of a fork implant were statistically significant factors associated with an increased risk of complication. One hundred forty-three stifle radiographs met the inclusion criteria to be assessed for healing. The mean score was 2.96 out of 4.0. The overall radiographic complication rate and healing scores associated with single-session bilateral TTAs were found to be similar to those described for unilateral TTA.

Outcome and prognostic indicators in 20 cats with surgically treated primary lung tumors.

The purpose of this retrospective study of 20 client-owned cats was to describe the clinical signs, surgical interventions, histological features, stage and treatments of primary lung tumors removed by surgical excision, and to determine which factors significantly influence survival. Any cat that underwent surgical resection of a primary lung tumor between 2000 and 2007 was included in the study. Patient records were reviewed and signalment, clinical signs, preoperative diagnostics, surgical findings and histopathological results recorded. Histological reports were reviewed and scored using World Health Organization criteria. The Kaplan-Meier test was used to evaluate each potential prognostic factor with survival. Twenty cats met the inclusion criteria. The presence of clinical signs (such as dyspnea) at the time of diagnosis (P = 0.032), pleural effusion (P = 0.046), stage M1 (P = 0.015), and moderately and poorly differentiated tumors on histopathology (P = 0.011) were factors that were significantly correlated with reduced survival times. The median survival time of the 20 cats was 11 days. Cats presenting with no clinical signs had a median survival time of 578 days post-surgery vs 4 days post-surgery when presented with clinical signs. Cats staged T1N0M0 lived longer than cats at other stages (P = 0.044). Of the cats that survived to the time of suture removal, median survival time was 64 days. The results indicate that the presence of clinical signs, pleural effusion, moderately and poorly differentiated tumors on histopathology, evidence of metastasis and any stage beyond T1N0M0 are negative prognostic indicators for cats with primary lung tumors. The findings demonstrate that cats that presented with clinical signs, pleural effusion, any stage other than T1N0M0, or moderately and poorly differentiated tumors on histopathology had a poor prognosis. Therefore, extensive preoperative diagnostics, including computed tomography scans, should be performed before considering surgical intervention in these cats. These findings may be used to guide therapeutic decision-making in cats diagnosed with primary lung tumors.

Fracture repair using a polyaxial locking plate system (PAX).

OBJECTIVES: To report outcomes and complications of dog and cat fractures treated with the polyaxial locking plate system (PAX). STUDY DESIGN: Case series. ANIMALS: Dogs (n = 60) and 2 cats. METHODS: Medical records (December 2009-March 2011) of dogs and cats with fractures treated with the PAX system were reviewed. Cases with adequate follow-up to document a functional union, had surgery performed by an author, had no prior treatment of the fracture(s), and with complete operative records were included. Signalment, body weight, bone(s) fractured, area of bone fractured, fracture classification, concurrent orthopedic injuries, complications, time to functional union, if minimally invasive plate osteosynthesis (MIPO) techniques were used, plate size, number of plates, bone graft use, and ancillary methods of fixation were recorded. Additionally, fracture segment: plate length, screw, number of plate holes, number of empty screw holes overlying/adjacent to the fractures, number of cortices engaged above/below the fracture was evaluated. Variables were evaluated statistically for effect on complications and functional union. RESULTS: Sixty-two animals were included. Mean time to functional union was 7.1 weeks. Complications occurred in 12 animals (19%) and plate failure occurred in 3 (5%). Statistically significant factors that affected time to functional union were the presence of multiple injuries and age. Those associated with complications were double plates and number of cortices engaged above and below fractures. CONCLUSIONS: The PAX system allows for multidirectional screw insertion with an overall complication rate and time to functional union similar to other fracture repair implant systems.

Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the Longitudinal Assessment of Manic Symptoms study.

OBJECTIVE: To examine the proposed disruptive mood dysregulation disorder (DMDD) diagnosis in a child psychiatric outpatient population. Evaluation of DMDD included 4 domains: clinical phenomenology, delimitation from other diagnoses, longitudinal stability, and association with parental psychiatric disorders. METHOD: Data were obtained from 706 children aged 6-12 years who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study (sample was accrued from November 2005 to November 2008). DSM-IV criteria were used, and assessments, which included diagnostic, symptomatic, and functional measures, were performed at intake and at 12 and 24 months of follow-up. For the current post hoc analyses, a retrospective diagnosis of DMDD was constructed using items from the K-SADS-PL-W, a version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which resulted in criteria closely matching the proposed DSM-5 criteria for DMDD. RESULTS: At intake, 26% of participants met the operational DMDD criteria. DMDD+ vs DMDD- participants had higher rates of oppositional defiant disorder (relative risk [RR] = 3.9, P < .0001) and conduct disorder (RR = 4.5, P < .0001). On multivariate analysis, DMDD+ participants had higher rates of and more severe symptoms of oppositional defiant disorder (rate and symptom severity P values < .0001) and conduct disorder (rate, P < .0001; symptom severity, P = .01), but did not differ in the rates of mood, anxiety, or attention-deficit/hyperactivity disorders or in severity of inattentive, hyperactive, manic, depressive, or anxiety symptoms. Most of the participants with oppositional defiant disorder (58%) or conduct disorder (61%) met DMDD criteria, but those who were DMDD+ vs DMDD- did not differ in diagnostic comorbidity, symptom severity, or functional impairment. Over 2-year follow-up, 40% of the LAMS sample met DMDD criteria at least once, but 52% of these participants met criteria at only 1 assessment. DMDD was not associated with new onset of mood or anxiety disorders or with parental psychiatric history. CONCLUSIONS: In this clinical sample, DMDD could not be delimited from oppositional defiant disorder and conduct disorder, had limited diagnostic stability, and was not associated with current, future-onset, or parental history of mood or anxiety disorders. These findings raise concerns about the diagnostic utility of DMDD in clinical populations.

Elective and emergency surgical management of adrenal gland tumors: 60 cases (1999-2006).

Sixty-one adrenal gland tumors were surgically removed from 60 dogs. Fifty-two dogs underwent elective adrenalectomy and 8 dogs underwent emergency adrenalectomy for acute adrenal hemorrhage. Size of adrenal tumors ranged from 10 mm to 80 mm. Histopathology confirmed a diagnosis of adrenocortical tumor in 47 dogs, 26 of which were malignant. Pheochromocytoma was diagnosed in 11 dogs. Six dogs had tumor invasion of the caudal vena cava. Of the seven dogs that did not survive the perioperative period, four underwent emergency adrenalectomy. No dogs with tumor invasion of the caudal vena cava died perioperatively. Perioperative morality rates were 5.7% for dogs that underwent elective adrenalectomy and 50% for dogs that underwent emergency adrenalectomy for acute adrenal hemorrhage. Median survival time was 492 days for the 53 dogs that survived the perioperative period. Of the factors analyzed, only adrenal tumor size and the presence of acute adrenal hemorrhage had predictive values for perioperative mortality. Those dogs that survived the perioperative period had extended survival times of up to 1,590 days. The mortality rate associated with elective adrenalectomy in dogs may be lower than previously reported. Dogs with very large tumors or acute adrenal hemorrhage may have a more guarded prognosis.

The effect of cancellous autograft and novel plate design on radiographic healing and postoperative complications in tibial tuberosity advancement for cranial cruciate-deficient canine stifles.

OBJECTIVE: To assess the effect of autogenous cancellous bone graft (autograft) and novel plate use on radiographic healing and complications in tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Consecutive dogs (n=125) with unilateral CrCL-deficient stifles. METHODS: Four treatment groups: CPG, conventional plate with autograft; CPNG, conventional plate without autograft; NPG, novel plate with autograft; NPNG, novel plate without autograft were studied. Radiographs from 60 dogs were scored for healing at 6 and 10 weeks postoperatively; all 125 dogs were assessed for radiographic complications. Variables evaluated for relationship with healing scores and radiographic complications were age, weight, sex, cage and plate size, implant type, and graft use. RESULTS: Dogs with autograft had overall higher healing scores at 6 and 10 weeks. Radiographic complications occurred in 13 dogs (12 minor, 1 major), and were not influenced by graft or novel plate use. CONCLUSION: Autograft increases healing scores, but was not found to have a significant impact on the rate of complications in TTA. The novel plate was not found to have healing scores or radiographic complication rates significantly different from the conventional plate design.

Characteristics of children with elevated symptoms of mania: the Longitudinal Assessment of Manic Symptoms (LAMS) study.

OBJECTIVE: The aim of the Longitudinal Assessment of Manic Symptoms (LAMS) study is to examine differences in psychiatric symptomatology, diagnoses, demographics, functioning, and psychotropic medication exposure in children with elevated symptoms of mania (ESM) compared to youth without ESM. This article describes the initial demographic information, diagnostic and symptom prevalence, and medication exposure for the LAMS cohort that will be followed longitudinally. METHOD: Guardians of consecutively ascertained new outpatients 6 to 12 years of age presenting for treatment at one of 10 university-affiliated mental health centers were asked to complete the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M). Patients with scores ≥ 12 on the PGBI-10M (ESM+) and a matched sample of patients who screened negative (ESM-) were invited to participate. Patients were enrolled from December 13, 2005, to December 18, 2008. RESULTS: 707 children (621 ESM+, 86 ESM-; mean [SD] age = 9.4 [2.0] years) were evaluated. The ESM+ group, compared to the ESM- group, more frequently met DSM-IV criteria for a mood disorder (P < .001), bipolar spectrum disorders (BPSD; P < .001), and disruptive behavior disorders (P < .01). Furthermore, they showed poorer overall functioning and more severe manic, depressive, attention-deficit/hyperactivity, disruptive behavioral, and anxiety symptoms. Nevertheless, rates of BPSD were relatively low in the ESM+ group (25%), with almost half of these BPSD patients (12.1% of ESM+ patients) meeting DSM-IV criteria for bipolar disorder not otherwise specified. ESM+ children with BPSD had significantly more of the following: current prescriptions for antipsychotics, mood stabilizers, and anticonvulsants (P < .001 for each); psychiatric hospitalizations (P < .001); and biological parents with elevated mood (P = .001 for mothers, P < .013 for fathers). ESM+ children with BPSD were also lower functioning compared to ESM+ children without BPSD. CONCLUSIONS: Although ESM+ was associated with higher rates of BPSD than ESM-, 75% of ESM+ children did not meet criteria for BPSD. Results suggest that longitudinal assessment is needed to examine which factors are associated with diagnostic evolution to BPSD in children with elevated symptoms of mania.

A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs.

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis.

The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain on endodontic access. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The X-tip injection site was 3- to 7-mm apical to the mucogingival junction of the affected tooth. Success of the X-tip intraosseous injection was defined as none or mild pain on endodontic access or initial instrumentation. The results of this study demonstrated that 6 of 33 (18%) X-tip injections resulted in backflow of anesthetic solution into the oral cavity; none were successful in obtaining anesthesia. Twenty-seven of the remaining 33 X-tip injections (82%) were successful. We conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the X-tip system, when used in an apical location and when there was no backflow of the anesthetic solution into the oral cavity, was successful in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis.

The purpose of this prospective, randomized, blinded study was to compare the anesthetic efficacy of the conventional inferior alveolar nerve block, administered with the needle bevel oriented away from the mandibular ramus, to the bidirectional-needle-rotation technique, administered using the computer-assisted Wand II anesthesia system, in patients diagnosed with irreversible pulpitis. Sixty-four emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a blinded manner, 2.8 ml of 2% lidocaine with 1:100,000 epinephrine using either a conventional inferior alveolar nerve block or a bidirectional-needle-rotational technique using the Wand II injection system. The conventional inferior alveolar nerve block was administered with the needle bevel oriented away from the mandibular ramus so the needle would deflect inward toward the mandibular foramen. The bidirectional-needle-rotation technique was administered by rotating the Wand handpiece assembly in a clockwise-counterclockwise movement (like an endodontic hand file) to minimize needle deflection. Endodontic access was begun 17 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (VAS recordings) on endodontic access or initial instrumentation. The results of this study showed no significant differences (p > 0.05) between the success rates of the two techniques. The conventional inferior alveolar nerve block, with the needle bevel oriented away from the mandibular ramus, had a 50% success rate. The bidirectional-needle-rotation technique with the Wand II had a 56% success rate. Neither technique resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.