Influence of orthopedic reinforced gloves versus double standard gloves on contamination events during small animal orthopedic surgery.

OBJECTIVE: To determine the influence of orthopedic reinforced gloves on contamination events during small animal orthopedic surgery. STUDY DESIGN: Prospective randomized controlled trial SAMPLE POPULATION: Two hundred and thirty-seven pairs of orthopedic gloves (474 gloves) and 203 pairs of double standard gloves (812 gloves) worn during 193 orthopedic procedures. METHODS: Primary and assistant surgeons were randomized to wear either orthopedic reinforced gloves or double gloves. Gloves were leak tested to identify perforations at the end of procedures. Perforations detected intraoperatively or postoperatively were recorded. A contamination event was defined as at least one perforation on either hand for orthopedic reinforced gloves, or a perforation of both the inner and outer glove on the same hand for double gloves. RESULTS: Baseline characteristics between the 2 intervention groups were similar. There was no difference in contamination events between the double-gloved and orthopedic gloved groups (OR = 0.95, 95% CI = 0.49-1.87, P = .89). The same percentage of contamination events (8% glove pairs used) occurred in the double gloved group (17 contamination events) and in the orthopedic gloved group (19 contamination events). The odds of a contamination event increased by 1.02 (95% CI 1.01-1.03, P < .001) with each additional minute of surgery. CONCLUSION: Orthopedic reinforced gloves and double standard gloving were equally effective at preventing contamination events in small animal orthopedic procedures. CLINICAL RELEVANCE: Surgeons reluctant to double glove due to perceptions of decreased dexterity and discomfort may safely opt for wearing orthopedic gloves, which may improve their compliance.

Internal hemipelvectomy for treatment of obstipation secondary to pelvic malunion in 3 cats.

Pelvic fractures are a common injury in cats, and both surgical and conservative management approaches have been described. One of the major complications of pelvic fractures managed conservatively is narrowing of the pelvic canal. Severe pelvic canal narrowing can result in constipation and subsequent megacolon. The purpose of this case series is to describe the long-term outcome for 3 cats with obstipation treated with internal hemipelvectomy because of megacolon secondary to pelvic canal narrowing after conservative management. All cats had a good functional outcome of the affected limb. Two cats required ongoing medical management for recurrent constipation. Overall, internal hemipelvectomy offers good long-term limb function; however, its success in relieving clinical signs of constipation requires additional research.

Hémipelvectomie interne pour le traitement de la constipation opiniâtre secondaire à un cal vicieux pelvien chez 3 chats. Les fractures pelviennes sont une blessure commune chez les chats et les approches chirurgicales et prudentes ont toutes deux été décrites. L'une des complications majeures des fractures pelviennes gérées de manière prudente consiste à raccourcir le canal pelvien. Un rétrécissement sévère du canal pelvien peut se traduire par la constipation et un mégacôlon subséquent. Le but de cette série de cas consiste à décrire le résultat à long terme pour 3 chats souffrant de constipation opiniâtre traitée par une hémipelvectomie interne en raison d'un mégacôlon secondaire au rétrécissement du canal pelvien après une gestion prudente. Tous les chats ont obtenu de bons résultats fonctionnels du membre affecté. Deux chats ont nécessité une gestion médicale permanente pour une constipation opiniâtre. En général, l'hémipelvectomie interne offre une bonne fonction du membre, mais son succès dans le soulagement des signes cliniques de la constipation exige de la recherche additionnelle.(Traduit par Isabelle Vallières).

Association between methicillin-resistant Staphylococcus pseudintermedius carriage and the development of surgical site infections following tibial plateau leveling osteotomy in dogs.

OBJECTIVE: To evaluate the association between preoperative carriage of methicillin-resistant Staphylococcus pseudintermedius (MRSP) and the development of surgical site infections (SSIs) following tibial plateau leveling osteotomy (TPLO) in dogs. DESIGN: Prospective multicenter study. ANIMALS: 549 dogs. PROCEDURES: At 7 veterinary hospitals, swab specimens were obtained from the pharynx, nares, rectum, and skin of dogs admitted for TPLO. Specimens were submitted for culture of MRSP. For each dog, information regarding preoperative and postoperative antimicrobial administration, comorbidities, contact with other dogs, and whether the dog developed an SSI was obtained. Univariable and multivariable analyses were performed to identify variables associated with preoperative and postoperative MRSP colonization and the development of an SSI. RESULTS: Of the 549 study dogs, 24 (4.4%) were identified as MRSP carriers before TPLO and 37 (6.7%) developed an SSI after TPLO. Bacteriologic culture was performed on specimens obtained from 32 of the 37 SSIs, and MRSP was isolated from 11 (34%). Carriers of MRSP (OR, 6.72; 95% confidence interval [CI], 2.12 to 21.4) and Bulldogs (OR, 11.1; 95% CI, 2.07 to 59.3) were at risk for development of an SSI after TPLO, whereas postoperative administration of antimicrobials (OR, 0.36; 95% CI, 0.15 to 0.91) appeared to protect against development of an SSI. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that carriage of MRSP were a risk factor for development of an SSI after TPLO and measures to rapidly identify and treat MRSP carriers are warranted. Postoperative administration of antimicrobials protected against development of an SSI after TPLO.

SUCCESSFUL DIAGNOSIS AND TREATMENT OF BILATERAL PERINEAL HERNIAS IN A SKUNK (MEPHITIS MEPHITIS).

This brief communication describes the diagnosis and surgical treatment of bilateral perineal hernias in a 1-yr-old, intact female, striped skunk (Mephitis mephitis) that was evaluated for chronic intermittent constipation, following early age, bilateral anal sacculectomy for descenting. Complete blood count and biochemistry results were within the reference ranges. Diagnosis was based on history, physical exam, clinical signs, and diagnostic imaging. A two-stage surgical approach for treatment was performed. First, colopexy and cystopexy were performed via celiotomy, which was followed by unilateral perineal herniorrhaphy by using an internal obturator muscle flap augmented with porcine small intestinal submucosa biomaterial. Long-term resolution of clinical signs was achieved without evidence of recurrence. This is the first description of bilateral perineal hernia in a skunk following routine anal sacculectomy for descenting.

Combined use of intravesicular ureteroneocystostomy techniques to correct ureteral ectopia in a male cat.

A 2 yr old castrated male Himalayan presented for evaluation and treatment of persistent urinary incontinence that had been present since birth. Ultrasonographic evaluation of the urinary tract revealed suspected bilateral, extramural, ureteral ectopia that was confirmed at the time of surgical exploration. Marked left hydroureter and a normal right ureter were found entering the urethra ∼ 2 cm caudal to the bladder neck. An intravesicular mucosal apposition (modified Leadbetter-Politano) and "drop-in" ureteroneocystostomy techniques were used for reimplantation of the left and right ureter, respectively. Postoperatively, the cat gained urinary continence and remained continent and clinically normal 6 mo following surgery.

Delayed urethral obstruction after uterine torsion in a pregnant dog.

A 4 yr old pregnant female shih tzu was presented with abdominal discomfort and bloody vulvar discharge. The nongravid uterine horn was reflected caudally over the trigone, obstructing urine outflow. A cesarian section and ovariohysterectomy were performed. Postoperatively, the hematuria and pollakiuria resolved. Seventeen days later, the pelvic urethra was completely obstructed by a soft tissue mass that was identified by rectal palpation, blocked catheterization attempts, contrast radiography, ultrasonography, and surgery. Management included temporary cystostomy tube and definitive prepubic urethrostomy. Histologic diagnosis was severe, multifocal, necrosuppurative urethritis with fibroplasia, fibrosis, and cellulitis, apparently secondary to ischemia. Delayed urethral obstruction is a potential complication of canine uterine torsion.

Con: current laboratory benchmarking options are not good enough.

In an ideal world, benchmarking performance in the clinical laboratory would improve performance, quality, and overall patient satisfaction. However, there is a reason why laboratory managers continue to be on the lookout for the perfect benchmarking product--it doesn't exist. As a result, benchmarking performance in the laboratory is inherently flawed. Here is why.