Factors associated with survival to hospital discharge for cats treated surgically for thoracic trauma.

OBJECTIVE To determine the most common types of injuries in cats surgically treated for thoracic trauma, complications associated with surgical treatment, and factors associated with mortality rate and evaluate the effectiveness of the animal trauma triage (ATT) scoring system for predicting outcome. DESIGN Retrospective case series with nested observational study. ANIMALS 23 client-owned cats surgically treated for thoracic trauma at 7 veterinary teaching hospitals between 1990 and 2014. PROCEDURES Medical records were reviewed to collect data on signalment, medical history, clinical signs and physical examination findings at initial evaluation, clinicopathologic findings, initial emergency treatments and diagnostic tests performed, type of trauma sustained, imaging findings, surgery details, postoperative complications, duration of hospitalization, and cause of death, if applicable. All variables were evaluated for associations with survival to hospital discharge. RESULTS Types of trauma that cats had sustained included dog bite or attack (n = 8 [35%]), motor vehicle accident (6 [26%]), other animal attack (2 [9%]), impalement injury or fall (2 [9%]), projectile penetrating trauma (1 [4%]), or unknown origin (4 [17%]). Intrathoracic surgery was required for 65% (15/23) of cats. The overall perioperative mortality rate was 13% (3/23). Mean ± SD ATT scores for surviving and nonsurviving cats were 6.4 ± 2.2 and 10.0 ± 1.7, respectively. Nineteen of 20 cats with no cardiopulmonary arrest survived to discharge, compared with 1 of 3 cats with cardiopulmonary arrest. Only these 2 variables were significantly associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE The perioperative mortality rate was low in this series of cats with thoracic trauma; however, those with cardiopulmonary arrest were less likely to survive to hospital discharge than other cats. Cats with a low ATT score were more likely to survive than cats with a high ATT score.

Perioperative mortality rate and risk factors for death in dogs undergoing surgery for treatment of thoracic trauma: 157 cases (1990-2014).

OBJECTIVE To determine perioperative mortality rate and identify risk factors associated with outcome in dogs with thoracic trauma that underwent surgical procedures and to evaluate the utility of the animal trauma triage (ATT) score in predicting outcome. DESIGN Retrospective case series. ANIMALS 157 client-owned dogs. PROCEDURES Medical records databases of 7 veterinary teaching hospitals were reviewed. Dogs were included if trauma to the thorax was documented and the patient underwent a surgical procedure. History, signalment, results of physical examination and preoperative laboratory tests, surgical procedure, perioperative complications, duration of hospital stay, and details of follow-up were recorded. Descriptive statistics and ATT scores were calculated, and logistic regression analysis was performed. RESULTS 123 of 157 (78%) patients underwent thoracic surgery, and 134 of 157 (85.4%) survived to discharge. Mean ± SD ATT score for nonsurvivors was 8 ± 2.4. In the multivariable model, female dogs and dogs that did not experience cardiac arrest as a postoperative complication had odds of survival 6 times and 102 times, respectively, those of male dogs and dogs that did experience cardiac arrest as a postoperative complication. Additionally, patients with a mean ATT score < 7 had odds of survival 5 times those of patients with an ATT score ≥ 7. CONCLUSIONS AND CLINICAL RELEVANCE The overall perioperative mortality rate was low for patients with thoracic trauma undergoing surgery in this study. However, male dogs and dogs that experienced cardiac arrest had a lower likelihood of survival to discharge. The ATT score may be a useful adjunct to assist clinical decision-making in veterinary patients with thoracic trauma.

Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy.

OBJECTIVE To compare analgesic and gastrointestinal effects of lidocaine and buprenorphine administered to rabbits undergoing ovariohysterectomy. ANIMALS Fourteen 12-month-old female New Zealand White rabbits. PROCEDURES Rabbits were assigned to 2 treatment groups (7 rabbits/group). One group received buprenorphine (0.06 mg/kg, IV, q 8 h for 2 days), and the other received lidocaine (continuous rate infusion [CRI] at 100 µg/kg/min for 2 days). Variables, including food and water consumption, fecal output, glucose and cortisol concentrations, and behaviors while in exercise pens, were recorded. RESULTS Rabbits receiving a lidocaine CRI had significantly higher gastrointestinal motility, food intake, and fecal output and significantly lower glucose concentrations, compared with results for rabbits receiving buprenorphine. Rabbits receiving lidocaine also had a higher number of normal behaviors (eg, sprawling, traveling, and frolicking) after surgery, compared with behaviors such as crouching and sitting that were seen more commonly in rabbits receiving buprenorphine. Both groups had significant weight loss after surgery. Pain scores did not differ significantly between treatment groups. Significant decreases in heart rate and respiratory rate were observed on the day of surgery, compared with values before and after surgery. Rabbits in the lidocaine group had significantly overall lower heart rates than did rabbits in the buprenorphine group. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of lidocaine to rabbits provided better postoperative outcomes with respect to fecal output, food intake, and glucose concentrations. Thus, lidocaine appeared to be a suitable alternative to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.

Cranioplasty Using Titanium Mesh After Skull Tumor Resection in Five Dogs.

OBJECTIVE: To describe the clinical details, surgery, postoperative imaging, and short to mid-term outcome after cranioplasty with titanium mesh in dogs with large skull tumors. STUDY DESIGN: Case series. ANIMALS: Client-owned dogs with skull tumors (n=5). METHODS: All tumors were removed via craniectomy and a sheet of titanium mesh was contoured to reconstruct the calvarial defect and sutured to surrounding musculature. RESULTS: Four dogs had multilobular tumors of bone and 1 dog had a soft tissue sarcoma invading the cranial vault. Neurologic examination was unchanged or improved postoperative, a good cosmetic appearance was achieved, and no complications were noted at 2 weeks postoperative. Late postoperative computed tomography (CT) in 2 dogs and magnetic resonance (MR) imaging in 1 dog confirmed the presence of the titanium mesh without migration. There was no interference of the mesh with image interpretation and definitive radiation therapy was pursued in 1 dog without complication. Late follow-up reported 2 dogs euthanatized; at 44 weeks postoperative due to tumor re-growth; at 12 weeks postoperative for hemoabdomen, respectively. One dog drowned at 40 weeks postoperative, 1 dog was lost to follow-up, and 1 dog is alive at 83 weeks postoperative free of clinical signs. CONCLUSIONS: Titanium mesh is suitable for cranioplasty based on its strength, biocompatibility, and excellent handling characteristics. It does not interfere with acquisition or interpretation of CT or MR images, thereby allowing postoperative imaging for ongoing assessment.

Efficacy of allogeneic mesenchymal stem cell administration in a model of acute ischemic kidney injury in cats.

OBJECTIVE: To evaluate the effects of allogeneic mesenchymal stem cells (MSCs) in a model of ischemic acute kidney injury (AKI). STUDY DESIGN: Randomized controlled trial. ANIMALS: Adult, purpose-bred research cats (n=15) and a historical reference group (n=3). METHODS: Cats underwent unilateral, in vivo, warm renal ischemia, then intravenous administration of 4 million adipose-derived MSCs, bone marrow-derived MSCs, or fibroblasts (n=5/treatment) 1h after reperfusion. Serum creatinine and blood urea nitrogen concentrations were measured at baseline and days 1 and 6. Urine specific gravity, urine protein to urine creatinine ratio, and glomerular filtration rate were measured at baseline and day 6. Both kidneys were harvested on day 6; histopathology was described and scored and smooth muscle actin was quantified with histomorphometry. A 2-way ANOVA was used to compare time and treatment. Chi square analysis was used to determine the % of cats with at least International Renal Interest Society (IRIS) Grade 1 AKI. RESULTS: Time, but not treatment, had a significant effect on renal function. No difference was noted in % of cats with IRIS AKI. Significantly fewer mitotic figures were observed in ischemic kidneys that received bone-marrow derived MSCs vs. fibroblasts. No differences in smooth muscle actin staining were noted. CONCLUSIONS: This study did not support the use of allogeneic MSCs in AKI in the regimen described here. Type of renal injury, MSC dose, allogenicity, duration, and route or timing of administration could influence the efficacy MSCs.

Efficacy of a topical bovine-derived thrombin solution as a hemostatic agent in a rodent model of hepatic injury.

Hemorrhage is a major concern in patients undergoing hepatic surgery or in those with hepatic trauma. In these cases, employing traditional hemostatic strategies can be problematic due to the diffuse nature of hepatic hemorrhage and limited opportunities for direct hemostasis. This study assessed the efficacy of a bovine-derived thrombin solution, (BT), as a topical liquid agent to augment hemostasis and survival following severe hepatic hemorrhage in a rat model. Heart rate (HR), arterial blood pressure (ABP), packed cell volume (PCV), and overall survival were evaluated in 54 rats randomly assigned to receive topical application of BT, saline, or suture ligation applied immediately to a liver lobe following controlled laceration. Six additional rats received liver laceration with no applied treatment. Intravenous fluid resuscitation was initiated and HR and ABP were recorded for 60 min, after which survivors were recovered from anesthesia. Rats were then monitored for 72 h, after which survivors were euthanized. There was no significant difference in survival time, percentage survival, intra-operative ABP or HR, or post-operative PCV between treatment groups. There is insufficient evidence to recommend BT as the sole therapy using this delivery method for mitigating severe hemorrhage from liver injury.

Une hémorragie est une préoccupation importante chez les patients soumis à une chirurgie hépatique ou chez ceux avec un trauma hépatique. Lors de ces cas, l'utilisation des méthodes traditionnelles d'hémostase peut être problématique étant donné la nature diffuse de l'hémorragie hépatique et les opportunités limitées d'hémostase directe. La présente étude évalue l'efficacité d'une solution de thrombine d'origine bovine (BT) comme agent liquide topique pour augmenter l'hémostase et la survie suite à une hémorragie hépatique sévère dans un modèle chez le rat. Le rythme cardiaque (RC), la pression sanguine artérielle (PSA), l'hématocrite, et la survie globale ont été évalués chez 54 rats répartis de manière aléatoire pour recevoir une application topique de BT, de saline, ou de ligature appliquée directement à un lobe hépatique suite à une lacération contrôlée. Six rats supplémentaires ont subi une lacération hépatique sans recevoir de traitement. L'administration de fluide intraveineux fut débutée et le RC et la PSA enregistrés pendant 60 min, après quoi l'anesthésie fut cessée chez les survivants. Les rats ont été surveillés pendant 72 h et les survivants euthanasiés. Il n'y avait aucune différence significative entre les groupes dans le temps de survie, le pourcentage de survivants, la PSA ou le RC pendant la chirurgie, ou l'hématocrite post-chirurgie. Il n'y a pas suffisamment de preuves pour recommander l'utilisation de BT comme traitement unique avec la méthode employée pour mitiger une hémorragie sévère suite à une blessure hépatique.(Traduit par Docteur Serge Messier).