Recurrent Perineal Hernia in a Female Cat Diagnosed by Positive-Contrast Vaginourethrocystogram.

A 9 yr old female spayed domestic shorthair was presented with a 12-day history of stranguria. Six years previously, the cat had a bilateral perineal herniorrhaphy with cystopexy and pubic osteotomy. At presentation, survey radiographs and a positive-contrast vaginourethrocystogram were performed, which revealed cystolithiasis and recurrent bilateral perineal hernias with bladder retroflexion. A cystopexy was repeated, followed by bilateral perineal repairs using the internal obturator muscle flap transposition. To the authors' knowledge, this is the first reported case of a perineal hernia with recurrent bladder retroflexion after cystopexy diagnosed with positive-contrast vaginourethrocystogram in a female cat.

Surgical management of dystocia in a colobus monkey (Colobus guereza).

A 14-year-old female black and white colobus monkey (Colobus guereza) presented in labor with fetal arms visible protruding from the vulva. Manual manipulation for assisted delivery of the fetus was unsuccessful. Radiographs identified a large fetal skull and hysterotomy was required with ovariohysterectomy elected to follow. The fetus was confirmed to be deceased during hysterotomy, but the dam recovered from the procedure uneventfully. The detailed description of the anesthesia and surgical procedure in this case may aid other clinicians when presented with similar dystocia cases in this species.

Long-acting injectable methadone (methadone-fluconazole) provides safe and effective postoperative analgesia in a randomized clinical trial for dogs undergoing soft tissue surgery.

OBJECTIVE: To assess the pharmacokinetics, clinical efficacy, and adverse effects of injectable methadone with the pharmacokinetic enhancer fluconazole (methadone-fluconazole), compared with the standard formulation of injectable methadone, in dogs after ovariohysterectomy. We hypothesized that 2 doses of methadone-fluconazole would provide 24 hours of postoperative analgesia. ANIMALS: 3 purpose-bred dogs (pharmacokinetic preliminary study) and 42 female dogs from local shelters (clinical trial) were included. PROCEDURES: Pharmacokinetics were preliminarily determined. Clinical trial client-owned dogs were blocked by body weight into treatment groups: standard methadone group (methadone standard formulation, 0.5 mg/kg, SC, q 4 h; n = 20) or methadone-fluconazole group (0.5 mg/kg methadone with 2.5 mg/kg fluconazole, SC, repeated once at 6 h; n = 22). All dogs also received acepromazine, propofol, and isoflurane. Surgeries were performed by experienced surgeons, and dogs were monitored perioperatively using the Glasgow Composite Measure Pain Scale-Short Form (CMPS-SF) and sedation scales. Evaluators were masked to treatment. RESULTS: Findings from pharmacokinetic preliminary studies supported that 2 doses of methadone-fluconazole provide 24 hours of drug exposure. The clinical trial had no significant differences in treatment failures or postoperative CMPS-SF scores between treatments. One dog (methadone-fluconazole group) had CMPS-SF > 6 and received rescue analgesia. All dogs had moderate sedation or less by 1 hour (methadone-fluconazole group) or 4 hours (standard methadone group) postoperatively. Sedation was completely resolved in all dogs the day after surgery. CLINICAL RELEVANCE: Methadone-fluconazole with twice-daily administration was well tolerated and provided effective postoperative analgesia for dogs undergoing ovariohysterectomy. Clinical compliance and postoperative pain control may improve with an effective twice-daily formulation.

Laryngeal function in normal dogs administered isoflurane following partial clearance of alfaxalone or propofol.

OBJECTIVE: To assess laryngeal function in normal dogs administered isoflurane following partial clearance of alfaxalone or propofol. STUDY DESIGN: Randomized experimental crossover study. ANIMALS: A group of 12 purpose-bred, male Beagle dogs. METHODS: Dogs were randomly assigned to one of two treatments: alfaxalone-isoflurane (ALF-ISO) or propofol-isoflurane (PRO-ISO) and anesthetized for three video laryngoscopy examinations. The alternate treatment occurred after ≥ 14 days interval. Examinations were performed after induction of anesthesia (LS-A), after 20 minutes of breathing isoflurane via a facemask (LS-B) and after a further 20 minutes of isoflurane (LS-C). Parameters of objective laryngeal function included inspiratory rima glottidis surface area (RGSA-I), expiratory rima glottidis surface area (RGSA-E) and % RGSA increase, calculated from three consecutive respiratory cycles in the final 15 seconds of each video laryngoscopy examination. The % RGSA increase was calculated using [(RGSA-I - RGSA-E)/RGSA-E] × 100. Subjective laryngeal function was evaluated independently by two experienced surgeons blinded to treatment. RESULTS: The % RGSA increase within each treatment was greater for LS-B and LS-C than for LS-A (ALF-ISO: p = 0.03, PRO-ISO: p = < 0.001). There was no difference within each treatment from LS-B compared with LS-C. RGSA-I increased within each treatment from LS-A to both LS-B and LS-C (ALF-ISO: p = 0.002) and to LS-C (PRO-ISO: p = 0.006). Subjective laryngeal function scores improved from LS-A to LS-C. CONCLUSIONS AND CLINICAL RELEVANCE: Laryngeal function improved from postinduction examination following either 20 or 40 minutes of anesthesia with isoflurane via facemask. This study demonstrates that isoflurane may have a lesser effect on arytenoid abduction activity compared with more commonly used intravenous induction anesthetics (alfaxalone and propofol).

Perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine ovariohysterectomy.

OBJECTIVE: To determine perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine ovariohysterectomy. ANIMALS: 43 healthy female dogs. PROCEDURES: Dogs were randomly assigned to receive the methadone-fluconazole-naltrexone formulation at 1 of 2 dosages (0.5 mg/kg, 2.5 mg/kg, and 0.125 mg/kg, respectively, or 1.0 mg/kg, 5.0 mg/kg, and 0.25 mg/kg, respectively, PO, q 12 h, starting the evening before surgery; n = 15 each) or methadone alone (0.5 mg/kg, SC, q 4 h starting the morning of surgery; 13). Dogs were sedated with acepromazine, and anesthesia was induced with propofol and maintained with isoflurane. A standard ovariohysterectomy was performed by experienced surgeons. Sedation and pain severity (determined with the Glasgow Composite Pain Scale-short form [GCPS-SF]) were scored for 48 hours after surgery. Rescue analgesia was to be provided if the GCPS-SF score was > 6. Dogs also received carprofen starting the day after surgery. RESULTS: None of the dogs required rescue analgesia. The highest recorded GCPS-SF score was 4. A significant difference in GCPS-SF score among groups was identified at 6:30 am the day after surgery, but not at any other time. The most common adverse effect was perioperative vomiting, which occurred in 11 of the 43 dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Oral administration of a methadone-fluconazole-naltrexone formulation at either of 2 dosages every 12 hours (3 total doses) was as effective as SC administration of methadone alone every 4 hours (4 total doses) in dogs undergoing routine ovariohysterectomy. Incorporation of naltrexone in the novel formulation may provide a deterrent to human opioid abuse or misuse.

Amount of skin shrinkage affecting tumor versus grossly normal marginal skin of dogs for cutaneous mast cell tumors excised with curative intent.

OBJECTIVE To assess differences in skin shrinkage between grossly visible tumor and grossly normal marginal skin of dogs for cutaneous mast cell tumors (MCTs) excised with curative intent and to determine an equation to estimate postexcisional gross tumor margins from preexcisional measurements and vice versa. SAMPLE 19 cytologically confirmed and surgically excised cutaneous MCTs obtained from dogs. PROCEDURES Tumors were measured in craniocaudal and dorsoventral directions before excision, immediately after excision, and after fixation in formalin. Both grossly visible tumor and surrounding grossly normal skin that comprised the surgical margin were measured at each time point. Percentage of shrinkage was compared among time points and between the tumor and surrounding grossly normal skin. Patient and histopathologic variables were correlated to skin shrinkage. RESULTS Overall shrinkage was 17.70%. The amount of shrinkage within the grossly visible tumor (4.45%) was less than that within the surrounding grossly normal skin (24.42%). Most of the shrinkage occurred immediately after excision. There was no effect of age, sex, completeness of excision, or degree of edema. Accuracy of an equation to estimate postexcisional margins from preexcisional measurements was only 18.4%. CONCLUSIONS AND CLINICAL RELEVANCE Grossly evident MCTs of dogs shrunk less than did the grossly normal surrounding skin. Although an equation to estimate postexcisional margins from preexcisional measurements could be derived, it likely would need to contain additional variables not included in the study reported here. Until such an equation exists, care must be used when extrapolating surgical margins from histologic margins and vice versa.

MANAGEMENT OF ENDOMETRIOSIS IN TWO CAPTIVE MANDRILLS (MANDRILLUS SPHINX).

Endometriosis has been reported in humans, great apes, and Old World monkeys. Although cases are noted anecdotally in Mandrillus spp., and a previously reported case was noted on postmortem examination, to the authors' knowledge, no previous reports of case management have been published in the peer-reviewed literature. This paper describes the medical and surgical management of endometriosis in two mandrills (Mandrillus sphinx).

Occurrence and Clinicopathologic Features of Splenic Neoplasia Based on Body Weight: 325 Dogs (2003-2013).

Medical records of 396 dogs undergoing splenectomy for treatment of a splenic mass or nodular disease were reviewed retrospectively. Overall distribution of histopathologic diagnosis and clinicopathologic features were evaluated for 325 dogs that met inclusion criteria. Dogs were dichotomized into two groups based on weight, with the statistically derived cutoff identified as 27.8 kg. Malignancy was diagnosed in 58% of dogs, with no difference between small (55%) and large (61%) dogs (P = .291). Overall, 32% of splenic masses were hemangiosarcoma (HSA), which comprised 25 and 39% of all masses in small and large dogs, respectively. The diagnosis of HSA, non-HSA malignancy, or benign splenic disease was significantly different between the groups (P = .019). Of malignant diagnoses, HSA comprised 46 and 65% of small and large dog splenic neoplasms, respectively (P = .009). In both groups, dogs with HSA were significantly more likely to have preoperative anemia, hemoabdomen, thrombocytopenia, and a blood transfusion, as compared to dogs with non-HSA malignancy or benign lesions. Overall, dogs had similar odds of having a malignant splenic lesion regardless of weight, but dogs ≤27.8 kg were significantly less likely to be diagnosed with HSA.

Chronic splenic torsion in two dogs.

A 5 yr old spayed female poodle (case 1) was presented with a 4 mo history of lethargy, inappetence, and nonregenerative anemia. A 5 yr old castrated male French bulldog (case 2) was presented with a 2 wk history of mild abdominal pain, dyschezia, and intermittent anorexia. Both dogs were diagnosed with chronic splenic torsion based on changes in splenic position, echogenicity, and/or echotexture identified on B-mode abdominal ultrasonography, as well as either decreased or absent splenic blood flow on color-flow Doppler ultrasonography. Both dogs underwent splenectomy and had full resolution of clinical signs. Presentation of chronic splenic torsion is variable, and clinical signs can be nonspecific. Abdominal ultrasound with Doppler evaluation is an important diagnostic step that can lead to appropriate surgical intervention and good long-term prognosis.

Nephrectomy in an Asian small-clawed otter (Amblonyx cinereus) with pyelonephritis and hydronephrosis secondary to ureteral obstruction.

A 10-yr-old, captive, intact male Asian small-clawed otter (Amblonyx cinereus) with a history of bilateral nephrolithiasis was presented for acute-onset lethargy and inappetance of 5 days duration. On physical examination, the otter was about 8% dehydrated and a palpable fluid wave was present in the abdomen. An abdominal ultrasound revealed hydronephrosis of the left kidney and a hyperechoic structure present within the lumen of the left ureter, causing an obstruction. A urinalysis revealed struvite crystalluria, bacteriuria, and an elevated pH. Following 4 days of antibiotic therapy, a left ureteronephrectomy was performed. Upon opening the kidney to retrieve calculi, a large amount of purulent material was noted within the renal pelvis. To the authors' knowledge, this is the first documented case of a nephrectomy in an Asian small-clawed otter. Nephrectomy should be considered as a viable option for treatment of ureteral obstruction, hydronephrosis, or severe pyelonephritis.

Spontaneous resolution of postoperative chylothorax following surgery for persistent right aortic arch in two dogs.

Two young dogs underwent surgical management of a persistent right aortic arch (PRAA) and developed chylothorax postoperatively. In both cases, the surgical procedure and anesthetic recovery were uncomplicated and routine. Following surgery, both patients appeared bright, alert, responsive, and previous signs of regurgitation had resolved. Dyspnea and tachypnea developed 1-2 days postoperatively in each patient, and chylous effusion was detected on thoracocentesis. For each case, a diagnosis of chylothorax was based on cytology and triglyceride concentrations of the aspirated pleural fluid. Similar protocols for monitoring were used in the treatment of each patient's chylothorax. The duration and volume of chylous effusion production were closely monitored via routine thoracostomy tube aspiration. Both dogs rapidly progressed to recovery with no additional complications. With diligent monitoring, chylothorax secondary to surgical trauma can resolve in a rapid, uncomplicated manner.

Investigation into the impact of audience response devices on short- and long-term content retention.

Audience Response Systems (ARSs) may enhance short-term knowledge retention. Long-term knowledge retention is more difficult to demonstrate. According to previous studies, ARS questions requiring application of knowledge or peer interaction are more effective in maintaining student attention. The purpose of this study was to determine if peer discussion or individual-knowledge questions enhance short- and/or long-term knowledge retention. Third-year veterinary students responded to ARS questions posed in individual knowledge (n=3 questions) and peer discussion (n=3 questions) format from six different instructors. To test short-term memory, the same questions were delivered during the course examination (within 21 days). To test long-term retention, these questions were posed during a retention exercise (four months later). On the course examination, students had a higher (p<.01) probability (±SE) of correctly answering ARS individual-knowledge questions (93.8 ± 1.8%) compared to novel (previously unseen, non-ARS control) course examination questions (87.5 ± 3.1%), but the probability of correctly answering examination questions previously posed using ARS peer discussion format (89.5 ± 3.0%) did not differ from individual knowledge or novel examination questions. The positive impact of ARS-knowledge questions was not maintained through the retention exercise. Neither individual knowledge (70.5 ± 6.4%) nor peer-discussion questions (67.5 ± 6.9%) performed better on the retention exercise than the questions that appeared only on the course examination (68.6 ± 6.1%). Curricular strategies that emphasize content review may be more powerful than strategies that strengthen initial learning for long-term content retention.

Web-based documentation of clinical skills to assess the competency of veterinary students.

Kansas State University implemented a Web-based program to assess students' competency to perform technical skills during clinical rotations throughout the fourth year of the veterinary curriculum. The classes of 2009 and 2010 recorded a minimum number of procedures (104 and 103, respectively) from a menu of more than 220 recommended procedures. Procedures were categorized by species (small animal, equine, food animal) and disciplines (imaging, anesthesia, diagnostic medicine/necropsy). Ophthalmology was added as a fourth discipline for the class of 2010. Students recorded procedures into the Web-based system, including information about the patient, procedure performed, supervisor, and a self-assessment of performance. Faculty, staff, and house officers evaluated the procedures electronically by confirming that they witnessed the procedure and providing qualitative and written feedback. The class of 2009 recorded 18,492 procedures (M=171/student) and the class of 2010 recorded 16,935 procedures (M=158/student). Two students from each class (2009 and 2010) did not complete the minimum required skills during clinical rotations and returned to perform procedures immediately before (n=3) or immediately after (n=1) graduation to receive their diploma. The Web-based system captured a large number of assessments of technical competency performed in the clinical setting. The system provided students with formative feedback throughout the clinical year, ensured equitable distribution of procedural opportunities across the student body, and required minimal additional resources.

Intraoperative contrast-enhanced ultrasonography of normal canine jejunum.

Nine normal juvenile dogs were evaluated with direct jejunal contrast-enhanced ultrasonography via midline celiotomy. Three different doses of ultrasound contrast medium (Definity®) were injected through a peripheral venous catheter. Time-intensity curves were used to calculate baseline, time to initial rise, inflow slope, time-to-peak, peak intensity (PI), and outflow slope for each administered dose. PI was directly proportional to dose. Outflow slope was similar for all patients, independent of dose. The most favorable images were acquired with a dose of 0.030 ml/kg given as a rapid intravenous manual bolus. The technique and normal jejunal perfusion pattern described herein may provide useful data for evaluation of intestinal vascular, inflammatory, and neoplastic disease in the dog.

Ultrasonographic and magnetic resonance imaging diagnosis of an oropharyngeal wood penetrating injury in a dog.

A 5 yr old female intact English setter with a 17 day history of a penetrating oropharyngeal wound was referred for cervical swelling and pain. Physical examination revealed swelling at the left lateral aspect of the cranial cervical region. Pain was elicited upon flexion, extension, and leftward movement of the neck. Neurologic deficits were not identified. Cervical ultrasonography showed a 0.4 cm × 2.3 cm linear, hyperechoic structure in the soft tissues ventrolateral to the first (C1) and second (C2) cervical vertebrae. MRI demonstrated a linear structure 2 cm in length adjacent to the cranial aspect of C2. The foreign material was isointense to hyperintense on precontrast T1-weighted images, isointense on postcontrast T1-weighted images, and hypointense on T2-weighted images relative to adjacent muscle. Abnormalities within the spinal canal were not identified. Upon surgical exploration, a reed foreign body was identified deep to the serratus ventralis muscle. The patient was normal on follow-up evaluations 4 wk postsurgically.

Fournier's gangrene syndrome in a chimpanzee (Pan troglodytes).

A 37-yr-old male chimpanzee (Pan troglodytes) was evaluated for intermittent diarrhea, scrotal swelling, and lethargy of 2 days duration. Physical examination revealed marked swelling of the scrotum and perineal tissues with mild pitting edema and crepitus. Computed tomography revealed a mixed gas and soft-tissue density extending from the caudal ventral subcutaneous tissues caudally to the scrotum and perineal tissues. Surgical exploration and castration were performed to establish drainage, and culture revealed a polymicrobial infection. A diagnosis of scrotal and fascial plane abscessation consistent with Fournier's gangrene was made. Although castration with open drainage was performed, the animal died 36 hr after surgery. Postmortem examination and histopathology revealed necrotizing fasciitis of the penis, vaginal tunic, and subcutaneous perineal and perianal tissues.

Evaluation of a real-time, continuous monitor of glucose concentration in healthy dogs during anesthesia.

OBJECTIVE: To evaluate the accuracy of a real-time, continuous glucose monitoring system (CGMS) in healthy dogs undergoing anesthesia for elective ovariohysterectomy or orchiectomy. ANIMALS: 10 healthy dogs undergoing routine elective surgery. PROCEDURES: A CGMS was placed and used to obtain calculated glucose measurements before, during, and after anesthesia in each dog. Periodically, CGMS measurements were compared with concurrent measurements of glucose concentration in peripheral venous blood obtained with a portable chemistry analyzer (PCA). RESULTS: CGMS-calculated glucose measurements were significantly different from PCA blood glucose measurements during most of the anesthetic period. The CGMS values differed from PCA values by > 20% in 54 of 126 (42.9%) paired measurements obtained during the anesthetic period. Hypoglycemia was evident in CGMS measurements 25 of 126 (19.8%) times during anesthesia. By comparison, only 1 incident of hypoglycemia was detected with the PCA during the same period. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the CGMS for routine monitoring of interstitial glucose concentration as an indicator of blood glucose concentration during anesthesia cannot be recommended. Additional investigation is necessary to elucidate the cause of discrepancy between CGMS results and PCA data during anesthesia.