Center of rotation of angulation-based leveling osteotomy for stifle stabilization in skeletally immature dogs.

OBJECTIVE: To describe short-term outcomes of center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) in skeletally immature dogs with cranial cruciate ligament (CrCL) injury. STUDY DESIGN: Retrospective case series. ANIMALS: Fifteen skeletally immature dogs (16 stifles). METHODS: Medical records of dogs with CrCL injury and radiographically documented open proximal tibial physis and tibial tuberosity apophysis managed with CBLO were reviewed. Clinical assessment, radiographic assessment, and complications were reviewed. RESULTS: Fifteen dogs (16 stifles) with radiographically documented open proximal tibial physis and tibial tuberosity apophysis and CrCL injury underwent a CBLO. Mean tibial plateau angle (TPA) was 26° preoperatively, 9° postoperatively, and 9° at final recheck. One dog developed 10° recurvatum of the proximal tibia secondary to inadvertent over rotation of the tibial plateau (TPA 3°) to protect primary repair of an insertional CrCL avulsion. Correction of the recurvatum was declined as the dog had full limb function. Two dogs developed a valgus deformity secondary to a plate screw engaging the distolateral aspect of the proximal tibial physis. Owners of these dogs reported normal function but requested surgical revision to prevent long-term problems secondary to abnormal weight bearing. Both dogs regained full function following recovery from revision surgery. At a mean time of 23 months following surgery, all dogs continued to have full function as per phone conversation with owners. CONCLUSION: With proper preoperative planning, CBLO is an option for skeletally immature dogs with CrCL injury.

Timing of and risk factors for deep surgical site infection requiring implant removal following canine tibial plateau leveling osteotomy.

OBJECTIVE: To identify demographic risk factors for deep surgical site infection (SSI) requiring tibial plateau leveling osteotomy (TPLO) implant removal and time to implant removal. ANIMALS: Four hundred and thirty-three dogs that underwent a TPLO (144 that developed a deep SSI and required implant removal, 289 that did not). STUDY DESIGN: Retrospective case-control study. METHODS: Records of dogs undergoing implant removal due to a deep SSI after TPLO between 2006 and 2018 at two referral centers were reviewed. These records were frequency-matched by date to dogs undergoing TPLO that did not require implant removal. Multivariable analyses tested associations between demographics and implant removal as well as timing of implant removal. RESULTS: Deep SSI and implant removal occurred in 144 of 4813 (3.0%; 95% CI: 2.5, 3.5) dogs treated with TPLO. Implant removal was performed at a median of 279 days (range 49-2394 days) postoperatively. Male dogs (OR 1.8; 95% CI: 1.2, 2.7) and German Shepherd dogs (GSDs) (OR 7.4; 95% CI: 2.6, 20.5) were associated with plate removal. Earlier TPLO plate removal was associated with GSDs only (HR 2.4; 95% CI: 1.4, 4.1). CONCLUSION: Implant removal due to SSI after TPLO was uncommon, although male dogs and GSDs seemed predisposed to this complication. SIGNIFICANCE: These demographic risk factors can be used to educate owners regarding perioperative management.

Comparison of carbon dioxide laser versus bipolar vessel device for staphylectomy for the treatment of brachycephalic obstructive airway syndrome.

Carbon dioxide (CO2) laser and bipolar vessel sealing device (BSD) are industry standards for soft palate resection. No studies exist to directly compare these 2 techniques in a clinical setting. The purpose of this study was to describe and compare clinical outcomes for dogs that underwent CO2 laser versus BSD staphylectomy. Medical records of brachycephalic dogs that underwent CO2 laser (Group-L) or BSD staphylectomies (Group-B) between September 2013 and September 2017 were reviewed retrospectively. Of 60 dogs that met the inclusion criteria, 26 dogs (43%) were designated Group-L and 34 (57%) Group-B. Techniques did not differ in procedure or anesthetic time (P = 0.52 and P = 0.19, respectively) or major complication rates [intraoperative (P = 1.00), post-operative (P = 0.72), short-term (P = 1.00), and long-term (P = 0.68)]. This study suggests that patient outcomes are similar for dogs undergoing staphylectomy performed by CO2 laser and BSD.

Comparaison du laser au gaz carbonique par rapport au dispositif de coagulation bipolaire lors de la staphylectomie pour le traitement du syndrome de brachycéphalie d'obstruction des voies respiratoires. Le laser au gaz carbonique (CO2) et le dispositif de coagulation bipolaire sont des normes de l'industrie pour la résection du palais mou. Aucune étude n'existe afin de comparer ces deux techniques dans un milieu clinique. Le but de cette étude consistait à décrire et à comparer les résultats cliniques pour les chiens qui ont subi une opération au laser CO2 par rapport à une staphylectomie à l'aide d'un dispositif de coagulation bipolaire. Les dossiers médicaux de chiens brachycéphales qui ont subi des staphylectomies au laser CO2 (Groupe-L) ou à l'aide d'un dispositif de coagulation bipolaire (Groupe-B) entre septembre 2013 et septembre 2017 ont été examinés rétrospectivement. Parmi les 60 chiens qui satisfaisaient aux critères d'inclusion, 26 chiens (43 %) ont été désignés dans le Groupe-L et 34 (57 %) dans le Groupe-B. Les techniques n'ont pas différé pour la durée de l'intervention ou de l'anesthésie (P = 0,52 et P = 0,19, respectivement) ou les taux de complications majeures [intra-opératoires (P = 1,00), postopératoires (P = 0,72), à court terme (P = 1,00) et à long terme (P = 0,68)]. Cette étude suggère que les résultats des patients sont semblables pour les chiens subissant une staphylectomie réalisée par laser au CO2 et à l'aide d'un dispositif de coagulation bipolaire.(Traduit par Isabelle Vallières).

Short-, intermediate-, and long-term results for endoluminal stent placement in dogs with tracheal collapse.

OBJECTIVE To evaluate outcomes following endoluminal stent placement for treatment of tracheal collapse (TC) in dogs. DESIGN Retrospective case series with nested observational study. ANIMALS 75 dogs that underwent endoluminal placement of a self-expanding metallic stent to treat TC between September 2009 and August 2015. PROCEDURES Medical records were reviewed to collect data on dog characteristics, clinical signs, TC type, diagnostic test results, peri- and postoperative complications, and outcomes. Complication rates and survival times and rates were compared between various groups. RESULTS The 75 dogs received 119 stents (56% [42/75] received 1 stent and 44% [33/75] received ≥ 2 stents). Thirty-eight (51%) dogs had a malformation type of TC, and 37 (49%) had the traditional type. Ninety-three percent (70/75) of dogs survived to hospital discharge. Median survival time was 1,005 days. Improvement in goose-honking or raspy breathing (89% [42/47]) and dyspnea (84% [43/51]) was reported at final follow-up examination. Major complications requiring additional stent placement procedures occurred in 47% (33/70) of dogs over the follow-up period; stent fracture and tissue ingrowth were the most common types. Male dogs and younger dogs had a significantly longer survival time than other dogs. Mainstem bronchial collapse at the time of stent placement had no significant association with outcome. CONCLUSIONS AND CLINICAL RELEVANCE Endoluminal stent placement provided a high survival rate for dogs with TC, even those with severe clinical signs. This information, as well as the information on potential complications, should be useful for advising owners of affected dogs.

An Exploration of Patient Navigation and Community Health Worker Activities Across National Comprehensive Cancer Control Programs.

Purpose: Health disparities persist across the cancer care continuum. Patient navigator (PN) and community health worker (CHW) interventions are designed to increase health equity. National Comprehensive Cancer Control Program (NCCCP) awardees develop and implement plans to coordinate cancer prevention and control activities, including supporting PN and CHW interventions. This content analysis examined NCCCP action plans to assess the extent to which jurisdictions report engaging in PN and/or CHW activities. Methods: We abstracted PN and CHW content from NCCCP action plans and coded content according to specific areas of PN and/or CHW intervention (e.g., screening, survivorship, and cancer type), used descriptive statistics to characterize overall results, and calculated chi-squares to determine whether programs engaged PNs and CHWs differently. Results: Eighty-two percent (n=53) of 65 NCCCP action plans had content related to PN and/or CHW activities, with more PN language (83%) than CHW (58%). These action plans described engaging PNs and CHWs in activities across the cancer continuum, but particularly for screening (60%) and survivorship (55%). Eighty-one percent of these plans described activities related to workforce development, such as training and standardizing roles and competencies. Programs engaged CHWs more often than PNs for outreach and in community settings. Conclusion: The majority of NCCCP awardees reported engaging in PN and/or CHW activities. Understanding how NCCCP awardees engage PNs and CHWs, including awardees' needs for workforce development in this area, can help Centers for Disease Control and Prevention provide more focused technical assistance as programs increase engagement of PNs and CHWs to improve health equity.

Ultrasonographic Findings in 41 Dogs Treated with Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for a Supraspinatus Tendinopathy: A Retrospective Study.

OBJECTIVE: To report sonographic findings for dogs with a supraspinatus tendinopathy (ST) treated with an ultrasound-guided intratendinous injection of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP). METHODS: Medical records for dogs diagnosed with an ST and treated with a BMAC-PRP injection were reviewed. Data collected included patient signalment, radiographic findings at the time of initial evaluation, and sonographic findings, including cross-sectional area (CSA), fiber pattern, and echogenicity. RESULTS: Of 70 records reviewed, 41 met the inclusion criteria. Mean CSA of the supraspinatus tendon decreased by 0.06 cm2 between baseline and 45 days post-treatment (p = 0.0025), and 0.09 cm2 between baseline and 90 days post-treatment (p < 0.0001). Analysis of CSA in dogs with a unilateral ST at baseline revealed a difference of 0.08 cm2 between the affected and unaffected tendon at baseline, with the affected tendon measuring larger than the contralateral tendon (p < 0.0001). This difference became statistically insignificant by 45 days after treatment (u1-u0 = 0.04 cm2, p = 0.2855) and remained so 90 days post-treatment (u1-u0 = 0.03 cm2, p = 0.1910). In most cases (90.6%), the fiber pattern and echogenicity was considered improved 90 days post treatment. In a minority of these cases (13.8%) the fiber pattern and echogenicity abnormalities were considered resolved. CONCLUSIONS: Using qualitative and quantitative sonographic measures, BMAC-PRP was associated with an improvement in supraspinatus tendon size, fiber pattern, and echogenicity. Given the protracted nature of tendon healing, long-term evaluation may reveal continued improvements in chronic structural changes not captured during the current study. Functional studies are required to evaluate the clinical benefits of BMAC-PRP in the treatment of STs in dogs. CLINICAL SIGNIFICANCE: An ST is a common contributor to forelimb lameness in dogs and remains notoriously difficult to treat. Previous studies have been associated with inconsistent treatment outcomes. In the current study, BMAC-PRP is investigated as a minimally invasive treatment option, revealing positive sonographic results.

Immediate, short-, and long-term changes in tracheal stent diameter, length, and positioning after placement in dogs with tracheal collapse syndrome.

BACKGROUND: Intraluminal tracheal stenting is a minimally invasive procedure shown to have variable degrees of success in managing clinical signs associated with tracheal collapse syndrome (CTCS) in dogs. OBJECTIVES: Identify immediate post-stent changes in tracheal diameter, determine the extent of stent migration, and stent shortening after stent placement in the immediate-, short-, and long-term periods, and evaluate inter-observer reliability of radiographic measurements. ANIMALS: Fifty client-owned dogs. METHODS: Retrospective study in which medical records were reviewed in dogs with CTCS treated with an intraluminal tracheal stent. Data collected included signalment, location, and type of collapse, stent diameter and length, and post-stent placement radiographic follow-up times. Radiographs were used to obtain pre-stent tracheal measurements and post-stent placement measurements. RESULTS: Immediate mean percentage change was 5.14%, 5.49%, and 21.64% for cervical, thoracic inlet, and intra-thoracic tracheal diameters, respectively. Ultimate mean follow-up time was 446 days, with mean percentage change of 2.55%, 15.09%, and 8.65% for cervical, thoracic inlet, and intra-thoracic tracheal diameters, respectively. Initial mean stent length was 26.72% higher than nominal length and ultimate long-term tracheal mean stent shortening was only 9.90%. No significant stent migration was identified in the immediate, short-, or long-term periods. Good inter-observer agreement of radiographic measurements was found among observers of variable experience level. CONCLUSIONS AND CLINICAL IMPORTANCE: Use of an intraluminal tracheal stent for CTCS is associated with minimal stent shortening with no clinically relevant stent migration after fluoroscopic placement. Precise stent sizing and placement techniques likely play important roles in avoiding these reported complications.