Shoulder pain following tetraplegia: a follow-up study 2-4 years after injury.

OBJECTIVES: To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life. DESIGN: Longitudinal study. SETTING: Spinal Injuries Unit, Australia. METHODS: Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life. RESULTS: Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants. CONCLUSION: Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.

Surgical management of true patent urachus in a cat.

A five-week-old kitten presented with clinical signs consistent with a patent urachus. The urachal anomaly was revealed by exploratory celiotomy and surgically excised without complications. Follow-up radiographic evaluation confirmed the complete removal of the urachal anomaly. Twenty-five months after surgery the cat remained healthy and without problems.

Pancreatic pseudocyst associated with chronic-active necrotizing pancreatitis in a cat.

A 13-year-old, neutered female domestic shorthair was referred for evaluation of chronic, intermittent vomiting of approximately two years' duration. On physical examination, a fluctuant mass was palpated in the left cranial abdominal quadrant. Significant laboratory findings included neutrophilia, hyperglycemia, hyperlipasemia, and proteinuria. A distinct mass within the left cranial quadrant was noted on abdominal radiographs. Ultrasonographically, the pancreas appeared slightly hyperechoic with a hypoechoic mass arising from its left lobe. A cystic mass in the left lobe of the pancreas was identified during an exploratory celiotomy. The mass and affected areas of the pancreas and a portion of the spleen were resected. The cat recovered completely. Cytological, histological, and laboratory evaluations of the mass were consistent with pancreatic pseudocyst formation, which has been reported in dogs and humans but has not yet been reported in cats.

Intestine submucosa and polypropylene mesh for abdominal wall repair in dogs.

Continuing investigations of abdominal body wall reconstruction materials suggest that unacceptable implant complications continue and that the ideal material has not yet been found. This pilot study compared xenogeneic (porcine) small intestine submucosa (SIS) with polypropylene mesh (PPM) for repair of created partial-thickness (six dogs) and full-thickness (six dogs) abdominal wall defects. Postoperative clinical evaluation of all dogs showed no evidence of implant failure. Dogs were euthanized at 1, 2, and 4 months after surgery. The SIS implants were completely replaced by host tissue at 4 months as determined by immunohistochemistry. The resultant repair was well-organized, smooth, dense collagenous connective tissue that was well incorporated into the adjacent fascia and skeletal muscle fiber bundles. In the full-thickness defect dogs, omentum covered a significantly larger portion of PPM (P = 0.001) and was more firmly attached to PPM (P = 0.0001) compared to SIS/connective tissue repair. We conclude that xenogeneic SIS can be used as an abdominal body wall repair material in the dog and warrants further investigations.

Total laryngectomy and permanent tracheostomy for treatment of laryngeal rhabdomyosarcoma in a dog.

An extensive, laryngeal tumor was identified in a nine-year-old, spayed female, mixed-breed dog. Clinical staging of the tumor included computed tomography. Six days prior to surgery, a percutaneous gastrostomy tube was placed under endoscopic guidance. Surgical treatment included total laryngectomy and permanent tracheostomy. The histologic diagnosis of the tumor was rhabdomyosarcoma. There were no major postoperative complications, and there have been no signs of local recurrence, metastatic disease, or long-term complications associated with the surgical procedure during an 18-month follow-up period.

Distant abdominal and thoracic pedicle skin flaps for treatment of distal limb skin defects.

The treatment of large skin defects of the distal limbs of dogs and cats can be difficult due to the lack of skin available for primary wound closure or the creation of local skin flaps. Distant pedicle skin flaps provide an acceptable alternative for wound closure with full thickness skin and provide a cosmetic result. Fourteen animals (10 dogs and four cats) that had distant pedicle skin flaps are reviewed. The technique allowed 100 per cent wound coverage in 10 of 14 animals and greater than 95 per cent skin flap survival occurred in 12 to 14 animals. complications associated with the procedure were most commonly wound infection and partial suture line dehiscence, however these did not detract from the final outcome. Flap release was in one or two stages, however the outcomes did not appear to be affected by the release protocol.

Gastroduodenal ulceration associated with flunixin meglumine administration in three dogs .

In 3 clinically ill dogs, signs of gastroduodenal ulceration were first noticed within 7 days of beginning flunixin meglumine administration and included pyrexia, anorexia, weight loss, vomiting, melena, pain on abdominal palpation, and abdominal distention. One dog was euthanatized and 2 dogs recovered after surgical repair of the perforated ulcers and treatment of peritonitis. Prolonged administration of flunixin meglumine should be avoided, especially in debilitated dogs or when concurrently administering other nonsteroidal anti-inflammatory drugs or corticosteroids.

Effects of flunixin meglumine on dogs with experimental gastric dilatation-volvulus.

Gastric dilatation-volvulus (GDV) was created experimentally and maintained for 90 minutes in 16 anesthetized, mixed-breed dogs. After the GDV was corrected, normal saline solution (0.044 mL/kg intravenously [IV]) was administered to eight dogs (controls), and flunixin meglumine (2.2 mg/kg IV) was administered to eight dogs. Microspheres labeled with radioactive cobalt, scandium, tin, or niobium were injected intravenously at baseline (before GDV) and minutes 90, 100, and 270, respectively, to determine tissue blood flows. Plasma endotoxin and prostacyclin were measured at the same intervals. Electrocardiogram, mean arterial pressure, portal pressure, and cardiac output were recorded continuously. Dogs were euthanatized at minute 270 and necropsied. There was no significant difference between treatment groups for any measured variable at any time. Endotoxin levels increased significantly during GDV. Prostacyclin levels were lower in dogs treated with flunixin meglumine than in controls at minutes 210 and 270. Histopathologic findings were similar for all dogs and consistent with those associated with endotoxemia. Flunixin meglumine treatment did not alter cardiac indices or tissue blood flows significantly. However, elevation of prostacyclin was inhibited by flunixin meglumine, which suggested that continued effects of endotoxic damage might be attenuated or inhibited.

Effects of dietary fiber supplementation on glycemic control in dogs with alloxan-induced diabetes mellitus.

The effect of a high insoluble-fiber (IF) diet containing 15% cellulose in dry matter, high soluble-fiber (SF) diet containing 15% pectin in dry matter, and low-fiber (LF) diet on glycemic control in 6 dogs with alloxan-induced insulin-dependent diabetes mellitus was evaluated. Each diet contained greater than 50% digestible carbohydrate in dry matter. A crossover study was used with each dog randomly assigned to a predetermined diet sequence. Each dog was fed each diet for 56 days. Caloric intake was adjusted weekly as needed to maintain each dog within 1.5 kg of its body weight measured prior to induction of diabetes mellitus. All dogs were given pork lente insulin and half of their daily caloric intake at 12-hour intervals. Mean (+/- SEM) daily caloric intake was significantly (P less than 0.05) less when dogs consumed the IF diet vs the SF and LF diets (66 +/- 3 kcal/kg, 81 +/- 5 kcal/kg, and 79 +/- 4 kcal/kg, respectively). Serum alkaline phosphatase activity was significantly (P less than 0.05) higher when dogs consumed the LF diet vs the IF and SF diets (182 +/- 37 IU/L, 131 +/- 24 IU/L, and 143 +/- 24 IU/L, respectively). Mean postprandial plasma glucose concentration measured every 2 hours for 24 hours, beginning at the time of the morning insulin injection, was significantly (P less than 0.05) lower at most blood sampling times in dogs fed IF and SF diets, compared with dogs fed the LF diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Problems and complications associated with maxillectomy, mandibulectomy, and oronasal fistula repair.

Many oral tumors can be effectively treated by partial maxillectomy or mandibulectomy. These techniques involve excision of the tumor as well as the underlying bone. These procedures are described here and emphasis placed on the management of potential complications. Useful techniques for repairing oronasal fistulas are also described.

Comparison of survey radiography with ultrasonography and x-ray computed tomography for clinical staging of subcutaneous neoplasms in dogs.

A study of 26 dogs (examined consecutively) with infiltrative subcutaneous neoplasms (mastocytoma, n = 11; soft tissue sarcoma, n = 13; and adenocarcinoma, n = 2) was conducted. Dogs were evaluated by physical examination, survey radiography, ultrasonography (US), and x-ray computed tomography (CT) prior to surgical excision of the tumor. The purpose of the evaluation was to accurately define gross neoplastic margins before surgical excision and to determine whether a difference could be observed between routine clinical staging (physical examination and survey radiography) and more detailed clinical staging (US and CT imaging). The clinical stage of 5 of 26 neoplasms assessed by US and of 17 of 26 neoplasms assessed by CT was determined to be more advanced because of previously undetected neoplasia, greater neoplastic size, or greater tissue invasiveness. Preoperative imaging of infiltrative subcutaneous neoplasms, using US and CT, is highly recommended to accurately determine gross neoplastic margins.

Peritracheal abscess associated with tracheal collapse and bilateral laryngeal paralysis in a dog.

Tracheal collapse and bilateral laryngeal paralysis were diagnosed in an 8-month-old Cocker Spaniel that had acute onset of dyspnea and cyanosis. Surgical exploration of the mediastinum revealed an abscess involving the ventral wall of the trachea immediately caudal to the thoracic inlet. Both recurrent laryngeal nerves were entrapped in fibrous tissue surrounding the abscess. The dog recovered after tracheal resection and anastomosis and freeing of the entrapped nerves. The peritracheal abscess was suspected to have been the result of esophageal perforation secondary to foreign body penetration.

Surgical excision of ectopic thyroid carcinoma involving the base of the tongue in dogs: three cases (1980-1987).

Localized thyroid carcinoma involving the base of the tongue was diagnosed in 3 dogs examined because of a midline cervical mass rostroventral to the larynx. These masses had been present for 4 to 12 months and were firm, nonsensitive, and fixed in position. One dog had progressive dysphagia and dyspnea. Masses were surgically excised together with the base of the tongue and portions of the hyoid apparatus. Severe dyspnea that developed immediately after surgery in 1 dog was managed by tracheostomy intubation for 4 days. Transient dysphagia developed in all dogs. Hydration was maintained by IV fluid administration until water and food of gruel consistency could be swallowed 1 to 6 days after surgery. Consistency of food was gradually thickened to normal, as swallowing improved 6 days to 2 months after surgery. One dog developed aspiration pneumonia that resolved after antimicrobial administration and improved swallowing that prevented further aspiration. After 9 months, 3 years, and 6 years, the dogs were clinically normal.

Intraperitoneal circulation and drainage in the dog.

The patterns of dispersion and drainage of a low viscosity, oil-based contrast medium within the peritoneal cavity were examined in 12 normal dogs. Intraperitoneal injection of contrast medium was cranial or caudal and drainage was by the sump-Penrose or open peritoneal method. Radiographs were made over a 96 hour period, before and after peritoneal drainage was established. Each dog was euthanatized and necropsied. The contrast medium was dispersed throughout the peritoneal cavity 15 to 30 minutes after cranial injection and 1 to 2 hours after caudal injection. Most of the contrast medium drained within 6 hours after open peritoneal drainage and within 24 to 48 hours after sump-Penrose drainage. At necropsy, there was complete encasement of all sump-Penrose drains and partial occlusion of all open peritoneal incisions by omentum adhered to the abdominal wound edges. Peritonitis was not grossly evident, but all dogs showed histologic evidence of an acute inflammatory reaction associated with the drain or wound edge.

Management of the patient with generalized peritonitis.

Peritonitis is a serious disease requiring aggressive therapy in the hope of effecting a cure. Stabilization of the patient's condition is important; immediate fluid therapy and systemic antibiotics are essential. Surgery is indicated, not only to locate and correct the causative lesion, but to mechanically cleanse the peritoneal cavity by debridement and copious irrigation. Establishment of drainage is also necessary. The drainage method chosen is dictated by the source and the extent of peritoneal contamination, the patient's condition, and the experience of the surgeon.

Pathophysiology and pathogenesis of generalized peritonitis.

Peritonitis is a complex disease state that results in many pathophysiologic alterations that affect multiple organs. The clinician must possess a thorough understanding of the pathophysiology and pathogenesis of the disease so that effective treatment can be instituted. Treatment should be directed at eliminating the cause of peritonitis and preventing or reversing the resulting pathophysiologic alterations.

Conservative management of fractures of the mandibular condyloid process in three cats and one dog.

Three cats and 1 dog with fracture of the mandibular condyloid process and concomitant fracture(s) of the rostral portion of the mandible were treated successfully by wire fixation of the rostral mandibular fracture(s) and by conservative management of the mandibular condylar fracture. All animals regained satisfactory dental occlusion and normal, pain-free motion of the jaw. Fracture of the mandibular condyloid process is an infrequently diagnosed injury that usually occurs with other mandibular fractures. If satisfactory dental occlusion can be achieved by surgical stabilization of the noncondylar fractures, surgical repair of the mandibular condyloid fracture may not be necessary.

Generalized peritonitis in dogs: 50 cases (1975-1986).

Medical records of 50 dogs with generalized peritonitis and examined between 1975 and 1986 were reviewed. In these dogs, the gastrointestinal tract was the most common source of peritoneal cavity contamination (30 dogs). The most common cause of contamination was surgical wound dehiscence (14 dogs). Overall mortality of the 50 dogs was 68%.

Pancreatic abscess in dogs: six cases (1978-1986).

Pancreatic abscess was diagnosed by exploratory celiotomy in 6 dogs. The most common clinical signs included acute onset of lethargy (n = 5), anorexia (n = 6), vomiting (n = 5), and diarrhea (n = 2). Physical examination revealed pain response to abdominal palpation (n = 5), depression (n = 5), icterus (n = 3), fever (n = 3), and cranial abdominal mass (n = 2). Consistent preoperative clinicopathologic abnormalities included leukocytosis with left shift, observance of toxic neutrophils on the blood smear, hyperlipasemia, hyperamylasemia, hyperbilirubinemia, and increased serum alkaline phosphatase activity. In 5 of 6 dogs, abdominal radiography revealed increased soft tissue density in the cranial portion of the abdomen. Ultrasonography performed on 4 dogs confirmed pancreatic mass. In all dogs, exploratory celiotomy revealed a cavitary pancreatic mass that contained sterile, mucopurulent material. Histopathologic diagnoses included acute necrotizing or chronic-active pancreatitis and steatitis. Two dogs were euthanatized at the time of diagnosis, and the remaining 4 were treated by use of pancreatic debridement(s), open abdominal drainage, and intensive administration of fluids and antibiotics. One dog was euthanatized 4 days after surgery, because of progressive pancreatic abscessation. Three dogs recovered and were discharged.