Augmenting Laparoscopic Surgery with Fluorescence Imaging.

Minimally invasive endoscopic surgery is growing in veterinary medicine, in large part, due to the advantages associated with reduced pain, potential for decreased complications, and increased visualization of structures through magnification and illumination. With advancing technologies, we can now improve upon natural "white light" endoscopy with fluorescence-guided imaging. Near-infrared (NIR) cameras allow for real-time, high-definition visualization of vessels, anatomic structures, and perfusion. New uses of NIR technologies during laparoscopy are continuing to grow for vascular, lymphatic, and oncologic-related techniques. Limitations exist, and future efforts need to determine optimal dosing, tissue-specific fluorophores, and veterinary-specific techniques.

Near-infrared-guided Thoracoscopic Surgery and Future Near-infrared Targets.

Intraoperative near-infrared fluorescence imaging allows for real time, noninvasive visualization of anatomic structures (blood vessels, lymphatic vessels) or diseased states (cancer, inflammation). This technique is easily adapted to thoracoscopy and has allowed for improved detection of lung tumors and other various cancers, thoracic lymphatics, and cardiothoracic vasculature.

Surgical management and outcome of dogs with primary spontaneous pneumothorax: 110 cases (2009-2019).

OBJECTIVE: To describe surgical management and associated outcomes for dogs with primary spontaneous pneumothorax. ANIMALS: 110 client-owned dogs with primary spontaneous pneumothorax that underwent surgical management. PROCEDURES: Medical records at 7 veterinary teaching hospitals were reviewed. Data collected included signalment, history, clinical signs, radiographic and CT findings, surgical methods, intraoperative and postoperative complications, outcomes, and histopathologic findings. Follow-up information was obtained by contacting the referring veterinarian or owner. RESULTS: 110 dogs were included, with a median follow-up time of 508 days (range, 3 to 2,377 days). Ninety-nine (90%) dogs underwent median sternotomy, 9 (8%) underwent intercostal thoracotomy, and 2 (2%) underwent thoracoscopy as the sole intervention. Bullous lesions were most commonly found in the left cranial lung lobe (51/156 [33%] lesions) and right cranial lung lobe (37/156 [24%] lesions). Of the 100 dogs followed up for > 30 days, 13 (13%) had a recurrence of pneumothorax, with median time between surgery and recurrence of 9 days. Recurrence was significantly more likely to occur ≤ 30 days after surgery, compared with > 30 days after surgery. Recurrence > 30 days after surgery was rare (3 [3%]). No risk factors for recurrence were identified. CONCLUSIONS AND CLINICAL RELEVANCE: Lung lobectomy via median sternotomy resulted in resolution of pneumothorax in most dogs with primary spontaneous pneumothorax. Recurrence of pneumothorax was most common in the immediate postoperative period, which may have reflected failure to identify lesions during the initial thoracic exploration, rather than development of additional bullae.

Comparison of visual metric and planimetry methods for brain tumor measurement in dogs.

OBJECTIVE To compare the orthogonal diameter (visual metric) method against a manual perimeter tracing (planimetry) method to measure volume of brain tumors in dogs by use of MRI scans. SAMPLE 22 sets of MRI brain scans pertaining to 22 client-owned dogs with histologically confirmed glioma. PROCEDURES MRI scans were reviewed by 2 operators, and scans revealing tumors with a degree of gadolinium enhancement that allowed discrimination between tumor tissue and healthy parenchyma were used. Each operator calculated tumor volume for each set of scans twice by use of visual metric and planimetry methods. Inter- and intraoperator variability were assessed by calculation of an agreement index (AI). RESULTS Mean ± SD intraoperator AIs were 0.79 ± 0.24 for the visual metric method and 0.89 ± 0.17 for the planimetry method. Intraoperator variability for both operators was significantly less when the planimetry method was used than when the visual metric method was used. No significant differences were identified in mean interoperator AI between visual metric (0.68 ± 0.28) and planimetry (0.67 ± 0.31) methods. CONCLUSIONS AND CLINICAL RELEVANCE The lower intraoperator variability achieved with the planimetry versus visual metric method should result in more precise volume assessments when the same operator performs multiple volume measurements of brain tumors in dogs. Equivocal results for interoperator variability may have been due to method variance or inadequate preliminary training. Additional studies are needed to evaluate the suitability of planimetry for assessing response to treatment.

Mapping continuous potentials to discrete forms.

The optimal conversion of a continuous inter-particle potential to a discrete equivalent is considered here. Existing and novel algorithms are evaluated to determine the best technique for creating accurate discrete forms using the minimum number of discontinuities. This allows the event-driven molecular dynamics technique to be efficiently applied to the wide range of continuous force models available in the literature, and facilitates a direct comparison of event-driven and time-driven molecular dynamics. The performance of the proposed conversion techniques are evaluated through application to the Lennard-Jones model. A surprising linear dependence of the computational cost on the number of discontinuities is found, allowing accuracy to be traded for speed in a controlled manner. Excellent agreement is found for static and dynamic properties using a relatively low number of discontinuities. For the Lennard-Jones potential, the optimized discrete form outperforms the original continuous form at gas densities but is significantly slower at higher densities.

Free flap coverage of pyoderma gangrenosum leg ulcers.

BACKGROUND: Pyoderma gangrenosum is a necrotizing skin disorder of unknown cause. Treatment of pyoderma gangrenosum usually entails medical treatments. Surgical treatment is generally not successful. OBJECTIVE: Two patients with pyoderma gangrenosum of their lower extremities are presented. The application and utility of microvascular free flap coverage of their ulcers is discussed. RESULTS: Both patients achieved successful healing with microvascular free flaps. CONCLUSION: Microvascular free flap coverage may be a surgical treatment option for selected patients with pyoderma gangrenosum.