Treatment of shoulder joint luxation with glenoid ostectomy in a miniature donkey.

CASE DESCRIPTION: A 13-year-old 128-kg miniature donkey gelding was evaluated for right forelimb lameness of 7 weeks' duration. CLINICAL FINDINGS: Muscular atrophy of the infraspinatus and supraspinatus muscles over the right scapula with a palpable bony prominence over the point of the shoulder was evident. At the walk, the cranial phase of the stride was reduced with adduction of the distal aspect of the limb, dragging of the toe, and lameness (grade, 4/5). Lateral and craniocaudal radiographs of the right shoulder joint revealed lateral luxation of the humerus in relation to the scapula with bony proliferation and remodeling of the humeral head. TREATMENT AND OUTCOME: Glenoid ostectomy was performed. Immediately after surgery, the donkey was able to intermittently stand squarely on the limb but maintained a reduced cranial phase of the stride at the walk. The donkey had no short-term complications and was discharged from the hospital 11 days after surgery. Following discharge, the donkey was confined to a box stall for 60 days, followed by a gradual increase in movement to full pasture turnout. The lameness continued to improve, and at 15 months after surgery the donkey was turned out in pasture and had mild lameness (grade, 3/5) at the trot. Mild muscular atrophy of the supraspinatus and infraspinatus muscles was present with no signs of pain on palpation or manipulation of the limb. Shoulder joint radiography at 15 months after surgery revealed remodeling of the glenoid cavity of the scapula and humeral head with formation of a pseudoarthrosis. CLINICAL RELEVANCE: Glenoid ostectomy should be considered as an alternative to shoulder joint arthrodesis in small equids with shoulder joint luxation. Other indications for this procedure could include chronic osteoarthritis or fractures affecting the shoulder joint.

Evidence of acrolein in synovial fluid of dogs with osteoarthritis as a potential inflammatory biomarker.

BACKGROUND: Acrolein is a known pro-inflammatory toxic aldehyde, propagating cellular damage and tissue inflammation in humans and animal models of various diseases. Osteoarthritis (OA) has a significant inflammatory component; however, presence of acrolein in synovial fluid of joints with OA has not been previously reported. The first aim of this study was to evaluate evidence of acrolein in the synovial fluid of dogs with OA as well as in Control joints. The second aim was to determine if evidence of acrolein can be detected in synovial fluid samples that have been in a frozen state for long periods of time. METHODS: In this pilot clinical study, synovial fluid samples were prospectively collected (i.e., New samples) from a single joint of both clinically healthy (New Control, n = 5) and dogs with OA (New OA, n = 16) and frozen until the time of analysis. Additionally, frozen synovial fluid samples from a biobank (i.e., Old samples) were used to evaluate ability to detect evidence of acrolein in long-term stored samples (median of 4.89 years) in Old Control (n = 5) and Old OA (n = 5) samples. Measurements of acrolein in all synovial fluid samples was based on detection of its major protein adduct, N ε - (3-formyl-3, 4-dehydropiperidino)lysine (FDP-lysine), using the western blot method. Synovial fluid matrix metalloproteinase 2 (MMP2) was measured in all samples using the western blot method as a positive control of OA inflammation. RESULTS: Acrolein-lysine adduct was detected in both Control (n = 10) and OA (n = 21) groups in both Old and New samples. Acrolein-lysine adduct and MMP2 were detectable at a lower level in the Old compared to New synovial fluid samples; however, the differences were not statistically significant (p > 0.1). The measured MMP2 levels were significantly higher in the OA compared to Control group samples (p = 0.033), but not for acrolein-lysine adduct (p = 0.30). CONCLUSIONS: This study confirmed evidence of acrolein in canine synovial fluid of both OA and Control groups. Freezing of synovial fluid for up to 5 years does not appear to significantly affect the ability to detect acrolein-lysine adduct and MMP2 in these samples.

Evaluation of serum MMP-2 and MMP-3, synovial fluid IL-8, MCP-1, and KC concentrations as biomarkers of stifle osteoarthritis associated with naturally occurring cranial cruciate ligament rupture in dogs.

The purpose of this study was to evaluate matrix metalloproteinases (MMP) -2 and MMP-3 in serum, and keratinocyte-derived chemoattractant (KC), interleukin 8 (IL-8) and monocyte chemoattractant 1 (MCP-1) in synovial fluid (SF) as stifle osteoarthritis (OA) biomarkers in dogs. Dogs with naturally occurring cranial cruciate ligament (CrCL) rupture (OA group) and healthy controls were recruited. Stifles with CrCL deficiency were surgically stabilized. Serum, SF, and synovial biopsy samples were collected from the OA group preoperatively, whereas samples were collected once from control dogs. A blinded veterinary pathologist graded synovial biopsies. Serum and SF analyses were performed using xMAP technology. General linear regression was used for statistical comparisons of serum biomarkers, and mixed linear regression for SF biomarkers and temporal concentration changes. The overall discriminative ability was quantified using area under curve (AUC). Spearman's correlation coefficient was used to assess correlations between synovial histology grades and the biomarkers. Samples from 62 dogs in the OA group and 50 controls were included. The MMP-2 and MMP-3 concentrations between the OA and control groups were not significantly different, and both with an AUC indicating a poor discriminative ability. All three SF biomarker concentrations were significantly different between the OA group and controls (P <0.05). The MCP-1 was the only biomarker showing an acceptable discriminative performance with an AUC of 0.91 (95% confidence interval: 0.83-0.98). The sum of the inflammatory infiltrate score was significantly correlated with all three SF biomarkers (P <0.01). Summed synovial stroma, and all scores combined were significantly correlated with IL-8 and MCP-1 concentrations (P <0.003), and the summed synoviocyte scores were significantly correlated with MCP-1 concentrations (P <0.001). Correlations between MCP-1 concentrations and synovial histopathologic grading and its discriminative ability suggest its potential as a synovitis biomarker in canine stifle OA associated with CrCL rupture.

Total hip replacement in dogs with contralateral pelvic limb amputation: A retrospective evaluation of 13 cases.

OBJECTIVE: To report the clinical characteristics, surgical management, and medium-term outcomes of total hip replacement (THR) performed in dogs with previous contralateral pelvic limb amputation. ANIMALS: Thirteen client-owned dogs. STUDY DESIGN: Multi-institutional retrospective clinical study. METHODS: Data recorded from medical records included signalment, indication for amputation and THR, and surgical complications. Implant positioning and complications were assessed on radiographs. Clinical outcomes were evaluated during follow-up examinations by one of the authors and through a mobility- and lifestyle-based questionnaire completed by owners. RESULTS: All 13 dogs had satisfactory clinical results at follow-up a median of 3 months (range, 2-36) after THR. No postoperative luxation was recorded. Four dogs had minor complications that did not require additional treatment. The only major complication was one failure of osseointegration of a cementless acetabular cup, and it was successfully revised. CONCLUSION: Total hip replacement resulted in satisfactory clinical results and acceptable morbidity in this population. CLINICAL SIGNIFICANCE: Total hip replacement should be considered in dogs with severe coxofemoral joint disease and contralateral pelvic limb amputation.

Infrared spectroscopy of synovial fluid as a potential screening approach for the diagnosis of naturally occurring canine osteoarthritis associated with cranial cruciate ligament rupture.

Objective: To evaluate infrared (IR) spectroscopy of synovial fluid (SF) as tool to differentiate between knees of dogs with naturally occurring OA associated with cranial cruciate ligament rupture (CrCLR) and controls. Method: 104 adult dogs with CrCLR (affected group) and 50 adult control dogs were recruited in a prospective observational study. Synovial fluid (SF) samples were collected preoperatively from dogs with CrCLR and from a subset of these at 4-, and 12-week post-surgery. Knee samples were collected bilaterally once from control dogs. Dried synovial fluid films were made, and IR absorbance spectra acquired. After preprocessing, partial least squares discriminant analysis (PLS-DA) and ANOVA-simultaneous component analysis (ASCA) were used to evaluate group and temporal differences, and to develop predictive models. Results: There were statistically significant spectral differences between the SF of OA affected and control dogs at all three time-points (P < 0.001). Pairwise comparison of spectral SF of knees with CrCLR over time showed statistically significant differences amongst all three time-points (P < 0.001). The predictive model for identifying the affected group from control had sensitivity, specificity and overall accuracy of 97.6%, 99.7% and 98.6%, respectively. Conclusions: The findings demonstrate the ability of FTIR-spectroscopy of synovial fluid combined with chemometric methods to accurately differentiate dogs with OA secondary to CrCLR from controls. The role of this IR-based screening test as a diagnostic and monitoring biomarker for OA specific to the joint being sampled warrants further investigation.

Surgical correction of bilateral metacarpophalangeal valgus with curved osteotomies and type II external skeletal fixation in a seven-month-old alpaca.

OBJECTIVE: To report the successful surgical correction of severe bilateral metacarpophalangeal valgus angular limb deformities in a seven-month-old intact male alpaca cria using curved osteotomies stabilized with type II external skeletal fixation. METHODS: Using a 21 mm crescentic shaped oscillating saw blade, bilateral osteotomies were performed in the distal metaphyses of the fused third and fourth metacarpal bones to correct valgus angular limb deformity of the metacarpophalangeal joints. Axial alignment of each limb was achieved by medially rotating the distal metacarpus in the frontal plane along the curved osteotomies. The osteotomies were stabilized using type II external skeletal fixators. RESULTS: The alpaca was immediately weight-bearing following the surgical procedure and no to minimal lameness was observed during healing of the osteotomies. Evaluation at five and 10 months following the surgery demonstrated acceptable axial alignment in the left forelimb while moderate to severe varus deformity (overcorrection) was observed in the right. CLINICAL SIGNIFICANCE: Curved osteotomy of the distal metacarpus stabilized with type II external skeletal fixation can provide a favourable outcome in older alpaca crias affected with metacarpophalangeal angular limb deformities. Placement of the distal transfixation pins relative to the metacarpal physes should be carefully evaluated as overcorrection is possible, especially if growthpotential remains in only one physis of the fused third and fourth metacarpal bones.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

OBJECTIVE: To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. STUDY DESIGN: Historical cohort study. SAMPLE POPULATION: Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. METHODS: Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. RESULTS: Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). CONCLUSION: No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure.

An Unusual Case of Metastatic Seminoma in a Dog.

An 8 yr old, reportedly castrated male Boston terrier presented with a history of generalized hyperesthesia and intermittent shifting leg lameness. Physical examination revealed a caudal abdominal mass and bilateral shoulder pain. A complete blood count, serum biochemistry panel, and urinalysis were unremarkable. Thoracic radiographs demonstrated bony proliferation and lysis of the third sternebra, an expansile lesion of the left tenth rib, and lucency in both proximal humeral metaphyses. Abdominal radiographs and ultrasound revealed a soft tissue mass within the caudoventral right abdomen. Ultrasonography also revealed an enlarged lymph node within the right retroperitoneal space. Exploratory laparotomy identified the mass as a retained testicle. A cryptorchidectomy, lymph node biopsy, and bilateral percutaneous core biopsies of the proximal humeri were performed. Histopathologic examination revealed malignant seminoma of the testicle with metastasis to lymph node and bone. Adjuvant chemotherapy was recommended, but it was declined by the owner. All follow-up was lost. This case highlights a unique case for causative hyperesthesia secondary to a novel site of metastasis from malignant seminoma. Metastasis to bone has not been reported in humans or dogs and represents a very unusual and aberrant variant of the normally relatively benign biological behavior of seminoma in the dog.

Biomechanical evaluation of finger trap suture variants for securing catheters.

OBJECTIVE: To biomechanically evaluate various finger trap patterns and suture materials for securing 5F polyvinylchloride and polypropylene catheters. DESIGN: In vitro prospective study. SAMPLE: 132 finger trap constructs. PROCEDURES: Each group of constructs comprised 6 to 10 replicates each of 3 finger trap patterns tied with 2-0 glycolide-lactide copolymer (GLC), braided nylon, and monofilament polypropylene suture on 5F polypropylene and polyvinylchloride catheters. The 3 finger trap variants were of similar lengths but differed in the number of surgeon's throws included in the pattern. Constructs were tested with a universal materials testing machine to the point of failure or a maximum of 100 mm of distraction. Force and distraction data were evaluated for significance with a competing risks model. RESULTS: There was no difference in performance (as measured by the proportion of test failures, median distraction distance, or median force at failure or end of testing) attributable to the finger trap pattern variants. Sixteen of 66 constructs with polyvinylchloride catheter material failed at ≤ 100 mm distraction, whereas all polypropylene constructs failed during testing. For polypropylene catheters, braided nylon or GLC suture withstood greater distraction distance and force, respectively. For polyvinylchloride catheters, differences among suture types were nonsignificant. CONCLUSIONS AND CLINICAL RELEVANCE: Data suggested that, for the material combinations evaluated, a finger trap suture pattern with fewer knots may provide catheter security similar to that for patterns tied with a more traditional pattern. These results should not be extrapolated to catheters of different diameters or materials, patterns tied with different suture sizes, or clinical performance in vivo without further testing.

Nephroureterectomy and ureteroneocystostomy in an alpaca with bilateral ectopic ureters diagnosed by computed tomographic excretory urography.

OBJECTIVE: To report diagnosis and treatment of urinary incontinence in a female Huacaya alpaca. STUDY DESIGN: Clinical case report. ANIMALS: Female intact Huacaya alpaca (n = 1) METHODS: Computed tomographic (CT) excretory urography and vaginourethrography were performed to diagnose the cause of urinary incontinence. RESULTS: Bilateral ectopic ureters and left hydronephrosis and hydroureter were diagnosed. Left nephroureterectomy and right ureteroneocystostomy were performed with subsequent resolution of clinical signs. Pyelonephritis was identified by culture of the resected left kidney. CONCLUSIONS: CT excretory urography was helpful in the diagnosis of bilateral ectopic ureters in an alpaca and provided information for surgical planning. Surgical repair by ureteroneocystostomy and unilateral nephroureterectomy was successful in resolving clinical signs.

Spontaneous cholecystocutaneous fistula in a dog.

The purpose of this case report was to describe the surgical correction of a cholecystocutaneous fistula in a dog. A 6 yr old Vizsla presented with a 2 mo history of a chronic draining wound on the right ventral thorax. Diagnostics revealed numerous fistulous tracts opening at a single site on the right ventrolateral chest wall, extending caudodorsally through the chest wall and diaphragm to the region of the right medial liver lobe. Exploratory laparotomy revealed the apex of the gallbladder adhered to the diaphragm with a tract of fibrous tissue extending along the diaphragm laterally to the right thoracic wall. Cholecystectomy was performed. The fistulous tract was incised to expose the lumen of the fistula, and the fistula was omentalized. Twenty-eight months after surgery, the dog had had no recurrence of the fistulous tract. Exploratory laparotomy allowed excellent visualization of the intra-abdominal path of the fistula and facilitated the ease of resection of the source. Cholecystectomy resulted in rapid and complete resolution of the fistula without the need for excision of the fistula. Although rare, gallbladder disease should be a differential for chronic fistulous tracts.

Comparison of three intraoperative patient warming systems.

The purpose of this randomized clinical trial was to compare the efficacy of three patient warming devices (i.e., circulating water blanket, forced-air, and warming panels) used either alone or in combination on patients undergoing surgeries lasting >60 min. In total, 238 dogs were included and divided into either the celiotomy or nonceliotomy group. Dogs in each group were further divided into one of three subgroups. Dogs in subgroup 1 (n=39) were placed on a circulating water blanket with a forced-air warming blanket placed over the trunk. Subgroup 2 dogs (n=40) were placed on a forced-air warming blanket only. Subgroup 3 dogs (n=40) were placed on warming panels. Significant temperature drops occurred from time of induction (38.1°C±0.64°C) to the start of surgical procedures (36.7°C±0.95°C). Although body temperature was maintained once the warming units were started in all groups, there were significant differences in temperatures for the type of surgical procedures (i.e., celiotomies versus nonceliotomies) performed over time except for subgroup 3. The warming panels and forced-air devices were equally effective in preserving body temperature in anesthetized patients.

Surgical removal of a Cuterebra larva from the cervical trachea of a cat.

A case of cervical intratracheal cuterebriasis is reported. The cat was presented with intermittent dyspnea of 3 days' duration. The larva was located during tracheoscopy but was not retrievable. Surgical exploration of the cervical region was performed, and the larva was removed. All clinical signs resolved upon recovery from surgery. The larva was identified as a second instar Cuterebra sp.

Acquired umbilical hernias in four captive polar bears (Ursus maritimus).

Umbilical hernias are a common occurrence in domestic animals and humans but have not been well documented in polar bears. Surgical reduction and herniorrhaphies were performed to correct acquired hernias in the region of the umbilicus in four adult captive polar bears (Ursus maritimus) housed in North American zoos. Two of the four bears were clinically unaffected by their hernias prior to surgery. One bear showed signs of severe discomfort following acute enlargement of the hernia. In another bear, re-herniation led to acute abdominal pain due to gastric entrapment and strangulation. The hernias in three bears were surgically repaired by debridement of the hernia ring and direct apposition of the abdominal wall, while the large defect in the most severely affected bear was closed using polypropylene mesh to prevent excessive tension. The cases in this series demonstrate that while small hernias may remain clinically inconsequential for long periods of time, enlargement or recurrence of the defect can lead to incarceration and acute abdominal crisis. Umbilical herniation has not been reported in free-ranging polar bears, and it is suspected that factors such as body condition, limited exercise, or enclosure design potentially contribute to the development of umbilical hernias in captive polar bears.

Hypertrophic osteodystrophy of the proximal humerus in two dogs.

Two dogs, 3 and 6 months of age, were presented with painful, swollen shoulder and carpal joints; reluctance to stand; and pyrexia. Radiographs in both cases revealed an irregular lucent zone in the metaphysis of the proximal humerus, parallel and adjacent to the physis. The same lucent zone was also evident in the physes of the distal radial and ulnar metaphyses. Clinical signs and radiographs were consistent with hypertrophic osteodystrophy. Clinical signs resolved in both dogs with administration of carprofen, tramadol, and intravenous fluids. No signs of recurrence were reported at 3-month follow-ups.

A review of lameness attributable to the shoulder in the dog: part two.

The scapulohumeral joint is a common site of forelimb lameness in the dog. Establishing a definitive diagnosis may be difficult because of the limitations of orthopedic examination and radiographs and the inherent elusiveness of the associated conditions. The intent of this review is to present, in a single reference, the pathophysiology, diagnosis, and treatment of reported causes of lameness intrinsically associated with the shoulder. Part One of this series discusses conditions associated with cartilage and bone maturation disorders and joint instability, while Part Two reviews tendon diseases, muscle disorders, synovial diseases, and soft-tissue mineralization disorders.

A review of lameness attributable to the shoulder in the dog: part one.

The scapulohumeral joint is a common site of forelimb lameness in the dog. Establishing a definitive diagnosis may be difficult because of the limitations of orthopedic examination and radiographs and the inherent elusiveness of the associated conditions. The intent of this review is to present, in a single reference, the pathophysiology, diagnosis, and treatment of reported causes of lameness intrinsically associated with the shoulder. Part One of this series discusses conditions associated with cartilage and bone maturation disorders and joint instability, while Part Two reviews tendon diseases, muscle disorders, synovial diseases, and soft-tissue mineralization disorders.