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Compendium May 2007 (Vol 29, No 5)

Abstract Thoughts—Biliary Surgery In Dogs

by Joseph Harari, MS, DVM, DACVS

    Amsellem PM, Seim HB, MacPhail CM, et al: Long-term survival and risk factors with biliary surgery in dogs: 34 cases (1994-2004). JAVMA 229:1451-1458, 2006.

    Abstract: In this retrospective case series from a university teaching hospital and private referral practice, the factors associated with long-term (years) survival were determined for 34 dogs that underwent biliary surgery. Data extracted from the record included various clinical, laboratory, and histologic parameters, and follow-up was based on medical records or phone conversations with owners and referring veterinarians.

    The most common breeds represented were mixed breeds (eight dogs) and cocker spaniels (five). Anorexia and vomiting were the most common (25 dogs) clinical signs. Abdominal ultrasonography was frequently (26 dogs) used as a diagnostic tool. The most common diseases identified in all patients were gallbladder mucocele (20 dogs), inflammatory biliary disease (four), and pancreatitis (four). Eleven dogs died or were euthanized for reasons related to biliary disease or surgery; nine died within 3 weeks after surgery. Nine dogs died from unrelated causes. One- to 2-year survival rates were both 66%. Increasing age, g-glutamyltransferase activity, and preanesthetic heart rate as well as blood urea nitrogen, phosphorus, and bilirubin concentrations were risk factors for death. Biliary diversion procedures were also risk factors for death; pancreatitis was associated with poor long-term survival. The authors concluded that dogs that survived the early postoperative period had a good long-term prognosis if biliary diversion or pancreatitis was not a factor.

    Commentary: With the increasing use of abdominal ultrasonography and perioperative critical care monitoring, biliary surgery is being performed more frequently. Traditionally, this surgery has been associated with high morbidity and mortality rates in dogs and cats. Although limited in scope by the retrospective, nonstandardized nature of the study and the loss of five dogs to follow-up, the data on these surgical patients from two clinical sources are useful. It appears that gallbladder mucocele is a common and benign disorder, whereas primary and secondary (pancreas) neoplastic or inflammatory conditions, especially those requiring biliary diversion, are not. Furthermore, the prognosis for 1- to 2-year survival rates is enhanced if dogs survive the immediate postoperative period. It is worthwhile to note that, based on this review, focal, nonseptic bile peritonitis associated with gallbladder mucocele did not have a poor prognosis and may not constitute a surgical emergency.

    Relaxin In Pelvic Diaphragm Musculature Of Dogs

    Merchav R, Feuermann Y, Shamay A, et al: Expression of relaxin receptor LRG7, canine relaxin, and relaxin-like factor in the pelvic diaphragm musculature of dogs with and without perineal hernia. Vet Surg 34:476-481, 2005.

    This investigation of the pathogenesis of perineal hernia (PH)-specifically, the possible role for relaxin as a cause of PH-evaluated expression of relaxin, relaxin-like factor (RLF), and relaxin receptor LRG7 obtained from muscles of the pelvic diaphragm of 15 intact male dogs (older than 7 years) with PH and four mature, intact male dogs without PH (controls). RNA isolated from biopsy specimens of levator ani, coccygeus, and internal obturator muscle was reverse transcribed and used for real-time polymerase chain reaction (rt-PCR) testing. rt-PCR products, separated by electrophoresis and stained with ethidium bromide, were analyzed via statistical methods.

    Quantified products showed significantly higher expression levels of relaxin receptor LRG7 (which is more responsive to relaxin than LRG8, the other known relaxin receptor) in dogs with PH versus controls. However, no significant differences were found for relaxin or RLF, perhaps because pros­tatic tissue itself was not examined. Excess relaxin secretion (by prostatic and paraprostatic tissue) and up-regulation of relaxin receptors could act together in the pathogenesis of PH.

    Key Finding:

    • Relaxin receptor LRG7 up-regulation occurred in muscles in the pelvic area of dogs with PH, suggesting that atrophy of these muscles, which predisposes patients to PH, may be caused by increased relaxin activity.

    Excision Of Grades I And Ii Cutaneous Mast Cell Tumors In Dogs: Surgical Margin

    Fulcher RP, Ludwig LL, Bergman PJ, et al: Evaluation of a two-centimeter lateral surgical margin for excision of grade I and grade II cutaneous mast cell tumors in dogs. JAVMA 228:210-215, 2006.

    To evaluate the need for a 3-cm lateral margin, which causes large tissue defects, for excision of grade I or II cutaneous mast cell tumors (MCTs), results were obtained for a 2-cm lateral margin. Potential prognostic indicators such as signalment; tumor grade, stage, size, and location; treatments; recurrence; de novo MCTs; disease-free interval; and survival time were also analyzed.

    A 2-cm lateral margin and a deep margin of one fascial plane were used for 16 dogs with one or more MCTs (six dogs had multiple MCTs). Of 23 MCTs on the trunk, hindlimb, forelimb, or head and neck, four were grade I and 19 were grade II. All grade I MCTs were completely resected at 1- and 2-cm margins, and 17 of 19 grade II tumors (two incomplete resections) had no mast cells at the 2-cm margin. All MCTs were completely resected at the deep margin. Numbers of local recurrences (zero) and de novo tumors (three) compared well with prior reports.

    Key Findings:

    • Excision with a 2-cm margin may achieve clinical outcomes similar to those for a 3-cm margin and minimize complications.
    • A lack of grade III MCTs and of MCTs in other locations precludes general application of the results. No prognostic variables were identified.

    Repair Of Urethral Defects With Fascia Lata Autografts In Dogs

    Atalan G, Cihan M, Sozmen M, Ozaydin I: Repair of urethral defects using fascia lata autografts in dogs. Vet Surg 34:514- 518, 2005.

    Because complications associated with grafting have stimulated a search for alternative tissues for use as urethral substitutes, this experimental study evaluated the feasibility of urethroplasty with a free fascia lata graft in 14 mixed-breed male dogs. A hemicircumferential, longitudinal (~1.5 cm-long) urethral defect was grafted with autogenous fascia lata tissue (~2 x 2 cm), using 3-0 polyglactin 910 continuous sutures. Positive-contrast urethrograms were obtained on day 60 and again after 6 months; gross and histologic examinations and monitoring for complications were also conducted.

    No degenerative or reparative changes, stricture, or fistula formation occurred in eight dogs by 2 months and in six dogs by 6 months after grafting. Urethrograms indicated normal anatomy, although a slightly irregular contour was seen in four dogs. All dogs had unobstructed urine outflow and normal urination frequency; new urethral tissue was histologically and functionally similar to native tissue. For 2 to 3 days, four dogs had postoperative voiding difficulty and painful urination that resolved.

    Key Findings:

    • Clinical, radiologic, and histopathologic exami­nations confirmed repair of a 50% circumferential urethral defect via a fascia lata graft with good graft survival and minimal postoperative complications.
    • Fascia lata grafts should be considered for the repair of urethral defects in dogs.
    NEXT: Editorial: "World Veterinary Day and a World-Class Veterinarian"

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