Risk factors for intraoperative hemorrhage and perioperative complications and short- and long-term outcomes during surgical patent ductus arteriosus ligation in 417 dogs.

OBJECTIVE: To evaluate the short- and long-term outcomes of dogs undergoing surgical ligation for a left-to-right shunting patent ductus arteriosus (PDA), identify risk factors for intraoperative hemorrhage and intra- and postoperative complications, and report overall mortality rates. ANIMALS: 417 client-owned dogs undergoing surgical ligation for a left-to-right shunting PDA between January 2010 and January 2020. PROCEDURES: Data recorded included patient signalment, echocardiogram findings, intraoperative complications and mortality, postoperative complications, and short- and long-term outcomes. RESULTS: There was no association between age and risk of intraoperative hemorrhage (P = .7), weight and intraoperative hemorrhage (P = .96), or increasing left atrium-to-aortic (LA:Ao) ratio and intraoperative hemorrhage (P = .08). Intraoperative hemorrhage occurred in 10.8% of patients. Intraoperative mortality was 2%. Ninety-five percent of dogs experiencing intraoperative hemorrhage survived to discharge. Survival to discharge was 97%. One- and 5-year survival rates were 96.4% and 87%, respectively. CLINICAL RELEVANCE: Surgical ligation for a left-to-right shunting PDA is recommended due to the good long-term prognosis. Certain preoperative factors such as age, weight, and the presence and degree of mitral valve regurgitation had no detectable association with risks of intraoperative hemorrhage and, therefore, should not preclude surgical treatment for a left-to-right shunting PDA. Future studies are needed to further assess the association between increasing LA:Ao ratio and risk of intraoperative hemorrhage.

Negative impact of chronic pain: The role of locus of control and perceived family validation of chronic pain.

The present study investigates how participants' locus of control and their family and friends' validation of their pain influences participants' chronic pain experiences. Four thousand, 25 adults were recruited through the Chronic Pain In America survey. Results show that individuals who endorse an internal locus of control and experience family and friends' validation of their chronic pain reported better chronic pain outcomes and less negative life impact due to chronic pain. The current results indicate the locus of control and family and friends' validation of chronic pain experience plays an important role in chronic pain and the impact of chronic pain across the life course.

Comparison of surgeon experience using simple interrupted and simple continuous suture patterns in intestinal resection and anastomosis.

This experimental study compared leak pressures and completion time of intestinal anastomoses performed by novice veterinarians and a Board-certified surgeon using simple interrupted and simple continuous suture patterns. Grossly normal jejunal segments (n = 108) from 6 fresh canine cadavers were used to harvest 8-cm cooled canine cadaveric jejunal segments that were randomly assigned to a control group (12 segments) and 4 treatment groups (24 segments/group, 12 constructs/group): i) simple interrupted anastomoses performed by a Board-certified surgeon (BSI); ii) simple continuous anastomoses performed by a Board-certified surgeon (BSC); iii) simple interrupted anastomoses performed by novice veterinarians (NSI); and iv) simple continuous anastomoses performed by novice veterinarians (NSC). Median (range) initial leak pressure (ILP) for control was 400.2 mmHg (226.0 to 500.0 mmHg), BSI 37.4 (14.4 to 124.0), BSC 32.5 (13.4 to 91.0), NSI 36.5 (22.9 to 62.0), and NSC 47.5 (8.9 to 120.0). No difference was noted between experience (P = 0.73, P = 0.53), suture technique (P = 0.07, P = 0.38), or across treatment groups (P = 0.17, P = 0.94), for ILP or MIP (maximum intraluminal pressure), respectively. Time to construct completion differed based on suture technique (P < 0.0001) and experience (P < 0.0001). The median and mean ILP of all anastomoses exceeded physiologic intraluminal peristaltic pressures. Simple continuous anastomoses were faster to complete overall. Both handsewn anastomosis techniques are appropriate for intestinal anastomoses.

Cette étude expérimentale a comparé les pressions de fuite et le temps de complétion d'anastomoses intestinales réalisées par des vétérinaires novices et un chirurgien certifié comme spécialiste en utilisant des schémas de suture simples interrompus et continus simples. Des segments jéjunaux grossièrement normaux (n = 108) de six cadavres canins frais ont été utilisés pour prélever des segments jéjunaux cadavériques canins refroidis de 8 cm qui ont été assignés au hasard à un groupe témoin (12 segments) et à quatre groupes de traitement (24 segments/groupe, 12 constructions/groupe) : i) anastomoses simples interrompues réalisées par un chirurgien agréé par le Board (BSI); ii) des anastomoses continues simples réalisées par un chirurgien certifié par le Board (BSC); iii) les anastomoses simples interrompues réalisées par des vétérinaires novices (NSI); et iv) des anastomoses continues simples réalisées par des vétérinaires novices (NSC). La pression de fuite initiale médiane (plage) pour le témoin était de 400,2 mmHg (226,0 à 500,0 mmHg), BSI 37,4 (14,4 à 124,0), BSC 32,5 (13,4 à 91,0), NSI 36,5 (22,9 à 62,0) et NSC 47,5 (8,9 à 120,0). Aucune différence n'a été notée entre l'expérience (P = 0,73, P = 0,53), la technique de suture (P = 0,07, P = 0,38) ou entre les groupes de traitement (P = 0,17, P = 0,94), pour l'ILP ou la MIP (pression intraluminale maximale), respectivement. Le temps de complétion de l'assemblage différait en fonction de la technique de suture (P < 0,0001) et de l'expérience (P < 0,0001). L'ILP médian et moyen de toutes les anastomoses dépassait les pressions péristaltiques intraluminales physiologiques. Les anastomoses continues simples étaient globalement plus rapides à réaliser. Les deux techniques d'anastomose cousues à la main conviennent aux anastomoses intestinales.(Traduit par Docteur Serge Messier).

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers.

OBJECTIVE: To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS. STUDY DESIGN: Canine cadaveric model. ANIMALS: Fifteen medium- to large-breed canine cadavers. METHODS: Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA. RESULTS: The mean baseline RGA was 0.52 ± 0.28 cm3 and mean post-TEA RGA was 0.78 ± 0.37 cm3 (p-value < .0001). The LEGS remained intact post-TEA in all cadavers. CONCLUSIONS: The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS. CLINICAL SIGNIFICANCE: The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.