Effects of parenteral fish oil on plasma nonesterified fatty acids and systemic inflammatory mediators in dogs following ovariohysterectomy.

OBJECTIVE: To evaluate the effects of intravenous (IV) infusion of fish oil (FO) emulsion following ovariohysterectomy (OVH) on inflammatory mediators and plasma omega-3 nonesterified fatty acids (NEFA) concentrations in dogs. DESIGN: Prospective clinical study. SETTING: University teaching hospital. ANIMALS: Twenty-nine privately owned dogs undergoing routine OVH. INTERVENTIONS: Postoperative 3-hour IV infusion of saline (n = 9), FO (Omegaven, n = 10), or soybean oil (SO, intralipid, n = 10) emulsion and blood collected before, 5 and 24 hours following OVH for plasma NEFA and RBC membrane fatty acids (FAs) concentrations, leukocyte cytokine production capacity, and C-reactive protein (CRP) measurement. MEASUREMENTS AND MAIN RESULTS: Plasma omega-3 NEFA, eicosapentaenoic acid, docosahexaenoic acid, and total long-chain omega-3 FA significantly increased shortly after FO infusion (8.8 ± 3.3 µM, 13.6 ± 5.6 µM, and 25.1 ± 9.6 µM, respectively) compared to SO (0.7 ± 0.9, 2.3 ± 1.8, and 4.2 ± 3.0 µM, respectively) and saline infusion (1.6 ± 2.5, 2.6 ± 3.1, and 5.9 ± 6.4 µM, respectively). Plasma CRP concentration significantly increased after OVH, but with no significant group differences. A weak negative correlation occurred between post-OVH CRP and postinfusion total long-chain omega-3 FA concentrations (r2 = 0.21, P = 0.014). Stimulated leukocyte interleukin (IL) 6 production capacity increased (P = 0.001) after OVH in all groups; SO infusion resulted in reduced leukocyte IL-6 production capacity (1048.1 ± 277.7 pg/mL) compared to FO (1299.9 ± 302.1 pg/mL, P = 0.048) and saline infusions (1499.0 ± 363.1 pg/mL, P = 0.01). No significant group difference was observed in leukocyte IL-10 and tumor necrosis factor α production capacities. CONCLUSIONS: Postoperative administration of FO emulsion increases plasma omega-3 NEFA concentrations promptly, but does not significantly attenuate CRP production or leukocyte cytokine production capacity. FO infusion at the dosage used in the present study can be safely used in dogs, but it was not clearly beneficial in decreasing post-OVH indices of inflammation.

Comparison of two portable lactate meters in dogs.

The objective of this study was to compare two portable lactate analyzers for testing canine patients in a clinical setting with a previously accepted methodology for measuring plasma lactate. Between Jan 1, 2005 and Jun 1, 2006, all samples were analyzed using two different portable analyzers (devices A and B), and 86 of those samples were also analyzed by a reference laboratory (REF). The concordance correlation coefficient (CCC) for device A and the REF was 0.949 (95% confidence interval [95% CI], 0.923-0.966). For device B and REF, the CCC was 0.990 (95% CI, 0.985-0.993). Only 8 of 85 samples (9.4%) exceeded a relative difference of 20% for device B (note that 1 of the 86 samples was not included because the lactate level fell below the detectable limit of device B), but 48 of 85 samples (56.5%) exceeded a relative difference of 20% for device A. Both portable lactate analyzers appeared to be effective in detecting clinically significant elevations in plasma lactate compared with the REF but device B had better agreement. A positive correlation among all three analyzers existed; however, the analyzers do not yield directly interchangeable results.

Radiology-Pathology Conference: 18F FDG PET-CT imaging of solitary fibrous tumor of the pleura.

Solitary fibrous tumors of the pleura (SFTPs) are mesenchymal neoplasms that arise from the pleura. SFTPs can grow slowly and may become big masses with malignant behaviors and metastases. The ratio of benign to malignant is 7:1, and pathology is necessary to differentiate between benign and malignant. We present a case of a 37-year-old man with a presumptive diagnosis of benign SFTP by 18F-fluorodeoxyglucose positron emission tomography/computed tomography, which was confirmed by pathology.

Chest radiographic evolution in fat embolism syndrome.

OBJECTIVE: To characterize the temporal chest radiographic findings of fat embolism syndrome. MATERIAL AND METHOD: Twenty-nine patients with clinically diagnosed fat embolism syndrome between 1988-1999 were retrospectively identified from the Trauma Registry of Haborview Medical Center, University of Washington. In twenty-two patients, complete medical records and serial chest radiographs were available. All images were reviewed by a dedicated thoracic radiologist. RESULTS: Two of 22 patients had normal radiographs throughout hospitalization, while 20/22 developed abnormal chest radiographs. The radiographic findings were consistent with non-specific diffuse pulmonary edema in all abnormal cases. The time to appearance of evident radiographic lung injury was < 24 hours of initial trauma in 10/20 (50%), between 24-48 hours in 4/20 (20%), between 48-72 hours in 5/20 (25%), and 1 patient (1/20, 5%) developed an abnormal chest radiograph after 72 hours. Ten of 20 patients (50%) with abnormal radiographs had complete resolution of the edema pattern within 1 week of development of opacities, 3/20 (15%) cases showed complete radiographic resolution between 1-2 weeks, 2/20 (10%) cases showed complete radiographic resolution between 2-3 weeks, 1/20 (5%) showed complete radiographic resolution between 3-4 weeks, and 4/20 (20%) died without resolution of the radiographic finding. CONCLUSION: The chest radiographic appearance of fat embolism syndrome is non-specific. Normal radiographs can also be seen. Most patients presenting with a normal initial radiograph develop radiographic evident abnormalities within 72 hours of injury and most cases showed radiographic resolution within 2 weeks of hospitalization. Although chest imaging play a little role in the clinical management of fat embolism syndrome, understanding of temporal presentation and evolution of the otherwise non-specific pulmonary opacities may help to avoid unnecessary evaluation in selected patients.

The misdiagnosis of acute cervical spine injuries and fractures in infants and children: the 12-year experience of a level I pediatric and adult trauma center.

OBJECTIVE: The objective was to determine the frequency of acute cervical spine injuries and fractures that were misdiagnosed in infants and children (< or =14 years) initially evaluated at a pediatric and adult urban level I trauma center. METHODS AND RESULTS: This was a retrospective, single-institution, case series of pediatric cervical spine injuries and fractures that were misdiagnosed during initial emergency room imaging evaluation. "Misdiagnosed" cases were those cases whose imaging studies initially obtained in the emergency room were misinterpreted based on reevaluation by a senior trauma radiologist blinded to the initial results. Nineteen percent (7 out of 37) were misdiagnosed on initial emergency room imaging evaluation. Five percent were true "missed" fractures, and 14% were "normal and/or developmental variants" read as fractures or dislocation. CONCLUSIONS: The error rate for infants and children < or =8 years was 24%, and for children > or =9 years was 15%. The occiput to C2 region was the most common site of diagnostic error. The most common factors predisposing to misdiagnosis were unfamiliarity with pediatric cervical spine anatomy, failure to recognize normal variants seen during growth and development, and suboptimal conventional film techniques.

Major glossectomy in dogs: a case series and proposed classification system.

Major resections of the tongue have not been commonly performed in animals because of concerns about the unfavorable postoperative effects of diminished lingual function. Five dogs were retrospectively reviewed to determine prehensile function and quality of life after glossectomies. Examinations were performed 1 week to 8 years after glossectomy, and owner interviews were conducted 10 months to 8 years after the surgery. All five dogs had acceptable and functional outcomes. Based on these five cases, glossectomy was well tolerated by dogs and may be a viable treatment option for aggressive tongue tumors and other conditions that render the tongue unsalvageable.

Use of helical computed tomography for imaging the pediatric cervical spine.

OBJECTIVE: To determine the differences in resource utilization and radiation exposure between conventional radiography (ConvRad) and helical computed tomography (HCT) when used to survey the pediatric cervical spine (CSp). METHODS: Patients aged 0-14 years who required CSp radiographic evaluation in addition to cranial CT were prospectively enrolled and assigned to undergo either HCT or ConvRad with adjunctive linear tomography. Outcomes of medication usage, emergency department (ED) length of stay (LOS), cervical spine radiation exposure, and imaging resource use (relative value unit [RVU]) were compared between the two groups. Data were analyzed by regression analysis with adjustment for confounders. RESULTS: Of 136 patients, 64 and 72 patients were assigned to the ConvRad group and HCT group, respectively. At the discretion of the trauma team, 34% of the patients enrolled crossed between the two study arms. Odds ratio (OR), based on original assignment, was 0.8 (95% CI = 0.4 to 1.8) for difference in medication usage between the two groups. Mean LOSs were 259 minutes (95% CI = 124 to 394) and 183 (95% CI = 166 to 200) minutes for HCT and ConvRad, respectively. CSp imaging RVUs were 5.5 (95% CI = 5.1 to 5.8) for HCT and 4.0 (95% CI = 3.3 to 4.6) for ConvRad. Mean CSp radiation doses were 389 mRem (95% CI = 346 to 432) for HCT and 294 mRem (95% CI = 245 to 343) for ConvRad. Adjustment for confounders did not change the direction of the results. CONCLUSIONS: As a modality to screen the pediatric CSp for blunt-force trauma, HCT results in increased radiation exposure and radiology resource use without a reduction in sedation usage or time in the ED.

Soft tissue application of lasers.

Despite increasing numbers of veterinarians incorporating lasers into their clinical practices, little information has been published about laser clinical applications in soft tissue surgery. This article reviews soft tissue interaction, describes laser equipment and accessories commonly marketed to veterinarians, and discusses clinical applications of the carbon dioxide laser in a systems-based approach. A table of recommended laser tips and settings based on the authors' experiences using a carbon dioxide laser (AccuVet Novapulse LX-20SP, Bothell, WA) is provided.

A Calf Model for Left Ventricular Centrifugal Mechanical Assist.

The increased use of centrifugal mechanical assist (CMA) for treatment of refractory postcardiotomy cardiogenic shock highlights the need for experimental testing to improve clinical results. This report describes the preoperative conditioning, anesthetic and surgical technique, and postoperative management of a reliable calf model refined in this laboratory for in vivo sub-chronic (96 h) testing of CMA. Holstein bull calves (2 to 3 months old; mean body weight, 78 kg; n = 35) were instrumented for left ventricular CMA; 4 of these calves were sham-operated controls. Anesthetic recovery and postoperative restraint were accomplished in a specially designed crate to which each calf was preconditioned extensively. Younger calves were more readily conditioned and more tolerant of postoperative restraint than older calves. One calf died of ventricular fibrillation in-traoperatively. One calf that had been heparinized developed uncontrollable hemothorax and died 12 h postoperatively. One calf prematurely dislodged his aortic cannula 15 h postoperatively and exsanguinated. Six calves developed pelvic limb paresis or paralysis because of lumbar spinal cord thromboembolism by 36 h postoperatively, and 3 of these calves were sacrificed by 42 h postoperatively. Fifteen calves required sedation in the first 12 h after the operation. Tachycardia associated with bottle feeding occurred in 15 calves. Second-degree atrioventricular block was noted frequently during deep relaxation. Postmortem examination demonstrated the absence of surgical wound and distant infection, security of cannulae in all but the calf that prematurely dislodged the aortic cannula, absence of thrombus formation at cannu-lation sites, and presence of thromboembolism in 51% of the calves. The incidence of thromboembolic lesions was not influenced by the need for chemical restraint, by the occurrence of feeding-associated tachycardia, or by the presence of atrioventricular block. There were no thromboembolic lesions in any of the sham-operated controls.

Subchronic Centrifugal Mechanical Assist in an Unheparinized Calf Model.

The purpose of this study was to determine whether the major centrifugal pumps currently in use in the United States (Medtronic, BioMedicus BioPump and Carmeda-coated BioPump, Sams 3M centrifugal pump, and St. Jude Medical Lifestream) could function as left mechanical assist devices in the subchronic (72 h) unheparinized calf model. Calves were instrumented for left atrial to aorta ex vivo assist, and the pump flow was set at 3.5 ± 0.4 L/min. Two calves (Sarns 3M and St. Jude) survived 72 h of pumping without clinical complications. The other 2 calves died at 62 and 66 h (Medtronic Bio-Pump and Carmeda-coated BioPump, respectively); both had pelvic limb paralysis. The seal of the Sarns 3M pump head ruptured after approximately 36 h of pumping and required replacement. On postmortem examination, pump-associated thromboembolic lesions were detected in 3 of the 4 calves in one or more of the following organs: kidney, pancreas, abomasum, duodenum, ileum, spleen, and lumbar spinal cord. The calf with the Sarns 3M pump had no discernable lesions. Because of the clinical abnormalities and postmortem lesions in the unheparinized calf model, it was suggested that anticoagulation is necessary for conducting centrifugal mechanical assist studies in calves using presently available technology.