Daniel D. Smeak

Plasma and ear tissue concentrations of enrofloxacin and its metabolite ciprofloxacin in dogs with chronic end‐stage otitis externa after intravenous administration of enrofloxacin

The purpose of this study was to measure the concentrations of enrofloxacin and its metabolite ciprofloxacin following intravenous administration of enrofloxacin in the plasma and ear tissue of dogs with chronic end-stage otitis undergoing a total ear canal ablation and lateral bulla osteotomy. The goals were to determine the relationship between the dose of enrofloxacin and the concentrations of enrofloxacin and ciprofloxacin, and determine appropriate doses of enrofloxacin for treatment of chronic otitis externa and media. Thirty dogs were randomized to an enrofloxacin-treatment group (5, 10, 15 or 20 mg kg(-1)) or control group (no enrofloxacin). After surgical removal, ear tissue samples (skin, vertical ear canal, horizontal ear canal, middle ear) and a blood sample were collected. Concentrations of enrofloxacin and ciprofloxacin in the plasma and ear tissue were measured by high performance liquid chromatography. Repeated measures models were applied to log-transformed data to assess dosing trends and Pearson correlations were calculated to assess concentration associations. Ear tissue concentrations of enrofloxacin and ciprofloxacin were significantly (P < 0.05) higher than plasma concentrations. Each 5 mg kg(-1 )increase in the dose of enrofloxacin resulted in a 72% and 37% increase in enrofloxacin and ciprofloxacin concentrations, respectively. For bacteria with an minimal inhibitory concentration of 0.12-0.15 or less, 0.19-0.24, 0.31-0.39 and 0.51-0.64 microg mL(-1), enrofloxacin should be dosed at 5, 10, 15 and 20 mg kg(-1), respectively. Treatment with enrofloxacin would not be recommended for a bacterial organism intermediate or resistant in susceptibility to enrofloxacin since appropriate levels of enrofloxacin would not be attained.

Expected Frequency of Use and Proficiency of Core Surgical Skills in Entry‐Level Veterinary Practice: 2009 ACVS Core Surgical Skills Diplomate Survey Results

Objectives ACVS Diplomates were surveyed to identify a complete list of core surgical skills, determine the expected frequency of use of these skills, and ascertain the level of skills proficiency expected of entry-level practicing veterinarians. Study Design Internet-based survey. Sample Population Randomly chosen ACVS Diplomates (n = 750). Methods Rating scale items were used to construct the main portion of the survey with 26 skills that were scored by participants based on rankings of proficiency expected of entry-level veterinarians, as well as expected frequency of use of these skills. Additional demographic questions were included to gather information regarding gender, practice type, year of veterinary school, year of ACVS membership, job description, primary surgical discipline, practice location, average number of procedures performed on a weekly basis, and number of new graduates mentored in the last 5 years. Results Of 337 Diplomates (44.9%) who responded to the survey, >60% expected entry-level graduates to have good skills with minimal supervision or complete skills for 21 of the 26 skills categories listed. More than 60% of respondents ranked 7 skills with a lower frequency score (seldom or occasionally use). Orthopedic instrument handling and fixation skills as well as electrosurgical and laser skills received some of the lowest expected proficiency and frequency rankings. No additional skills categories were identified in the open-ended survey questions. Conclusions A complete list of core surgical skills was identified. There was broad consensus between boarded surgeons irrespective of their practice type, experience, or discipline for ranked proficiency and frequency scores among the core surgical skills expected of entry-level veterinarians.OBJECTIVES ACVS Diplomates were surveyed to identify a complete list of core surgical skills, determine the expected frequency of use of these skills, and ascertain the level of skills proficiency expected of entry-level practicing veterinarians. STUDY DESIGN Internet-based survey. SAMPLE POPULATION Randomly chosen ACVS Diplomates (n = 750). METHODS Rating scale items were used to construct the main portion of the survey with 26 skills that were scored by participants based on rankings of proficiency expected of entry-level veterinarians, as well as expected frequency of use of these skills. Additional demographic questions were included to gather information regarding gender, practice type, year of veterinary school, year of ACVS membership, job description, primary surgical discipline, practice location, average number of procedures performed on a weekly basis, and number of new graduates mentored in the last 5 years. RESULTS Of 337 Diplomates (44.9%) who responded to the survey, >60% expected entry-level graduates to have good skills with minimal supervision or complete skills for 21 of the 26 skills categories listed. More than 60% of respondents ranked 7 skills with a lower frequency score (seldom or occasionally use). Orthopedic instrument handling and fixation skills as well as electrosurgical and laser skills received some of the lowest expected proficiency and frequency rankings. No additional skills categories were identified in the open-ended survey questions. CONCLUSIONS A complete list of core surgical skills was identified. There was broad consensus between boarded surgeons irrespective of their practice type, experience, or discipline for ranked proficiency and frequency scores among the core surgical skills expected of entry-level veterinarians.

Acquired pulmonary artery stenosis in four dogs.

CASE DESCRIPTION 4 dogs with acquired pulmonary artery stenosis (PAS) were examined for various clinical signs. One was a mixed-breed dog with congenital valvular PAS that subsequently developed peripheral PAS, one was a Golden Retriever with pulmonary valve fibrosarcoma, one was a Pembroke Welsh Corgi in which the left pulmonary artery had inadvertently been ligated during surgery for correction of patent ductus arteriosus, and one was a Boston Terrier with a heart-base mass compressing the pulmonary arteries. CLINICAL FINDINGS All 4 dogs were evaluated with 2-dimensional and Doppler echocardiography to characterize the nature and severity of the stenoses; other diagnostic tests were also performed. TREATMENT AND OUTCOME The mixed-breed dog with valvular and peripheral PAS was euthanized, surgical resection of the pulmonic valve mass was performed in the Golden Retriever, corrective surgery was performed on the Pembroke Welsh Corgi with left pulmonary artery ligation, and the Boston Terrier with the heart-base mass was managed medically. CLINICAL RELEVANCE Acquired PAS in dogs may manifest as a clinically silent heart murmur, syncope, or right-sided heart failure. The diagnosis is made on the basis of imaging findings, particularly results of 2-dimensional and Doppler echocardiography. Treatment may include surgical, interventional, or medical modalities and is targeted at resolving the inciting cause.

Management of Complications Associated with Total Ear Canal Ablation and Bulla Osteotomy in Dogs and Cats

Total ear canal ablation combined with bulla osteotomy is a salvage procedure recommended primarily for end-stage inflammatory ear canal disease but also for neoplasia and severe traumatic injuries. Due to the complexity of the procedure and the poor exposure associated with the surgical approach, there is significant risk for a variety of complications. This review discusses intraoperative, early postoperative, and late postoperative complications reported in large retrospective studies, the causes for these complications, and recommendations about how to prevent them.

Risk Factors for Dehiscence of Stapled Functional End-to-End Intestinal Anastomoses in Dogs: 53 Cases (2001-2012).

OBJECTIVE To identify risk factors for dehiscence in stapled functional end-to-end anastomoses (SFEEA) in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 53) requiring an enterectomy. METHODS Medical records from a single institution for all dogs undergoing an enterectomy (2001-2012) were reviewed. Surgeries were included when gastrointestinal (GIA) and thoracoabdominal (TA) stapling equipment was used to create a functional end-to-end anastomosis between segments of small intestine or small and large intestine in dogs. Information regarding preoperative, surgical, and postoperative factors was recorded. RESULTS Anastomotic dehiscence was noted in 6 of 53 cases (11%), with a mortality rate of 83%. The only preoperative factor significantly associated with dehiscence was the presence of inflammatory bowel disease (IBD). Surgical factors significantly associated with dehiscence included the presence, duration, and number of intraoperative hypotensive periods, and location of anastomosis, with greater odds of dehiscence in anastomoses involving the large intestine. CONCLUSION IBD, location of anastomosis, and intraoperative hypotension are risk factors for intestinal anastomotic dehiscence after SFEEA in dogs. Previously suggested risk factors (low serum albumin concentration, preoperative septic peritonitis, and intestinal foreign body) were not confirmed in this study.

Complication Rates After Bilateral versus Unilateral Total Ear Canal Ablation with Lateral Bulla Osteotomy for End‐Stage Inflammatory Ear Disease in Dogs: 79 Ears

OBJECTIVE To determine whether perioperative complication rates are different between unilateral (ULS) versus single-stage bilateral (BLSS) total ear canal ablation-lateral bulla osteotomy (TECA-LBO) surgeries. STUDY DESIGN Retrospective case series. ANIMALS Fifity-seven dogs (79 ears) undergoing TECA-LBO at a single institution over 14 years. METHODS Medical records of dogs undergoing TECA-LBO for end-stage inflammatory non-neoplastic ear disease from March 1999 to September 2013 at the Colorado State University Veterinary Teaching Hospital were evaluated for intraoperative and early postoperative complications associated with the procedure. Inclusion criteria were clinical and/or histopathologic diagnosis of chronic otitis externa, surgical treatment by TECA-LBO, and a minimum of 2 week follow-up data. RESULTS Twenty dogs (40 ears) underwent BLSS and 37 dogs (39 ears) had ULS. Complications were recorded for 29 of 40 ears (72.5%) in the BLSS group (40.0% facial nerve, 15.0% ocular, and 32.5% minor incisional complications) and 25 of 39 ears (64.1%) in the ULS group (33.3% facial nerve, 12.8% ocular, and 23.1% minor incisional complications). Dogs undergoing BLSS did not have a significantly higher total complication rate, or higher neurologic, ocular, or incisional complication rates, than the ULS procedure. No major anesthetic complications affecting outcome were recorded for either group. CONCLUSION Anesthetic and early surgical complication rates after ULS and BLSS were not significantly different in our study. Offering single-stage bilateral TECA-LBO procedures for otherwise healthy dogs with end-stage inflammatory otitis externa is a viable treatment option without additional risk for complication.

Laparoscopic Gastropexy Using Knotless Unidirectional Suture and an Articulated Endoscopic Suturing Device: Seven Cases.

OBJECTIVE To describe a technique for laparoscopic incisional gastropexy using an articulated endoscopic suturing device with knotless unidirectional barbed suture in healthy large breed dogs. STUDY DESIGN Prospective case series. ANIMALS Healthy client-owned dogs presented for prophylactic gastropexy and weighing >20 kg (n=7). METHODS Incisional gastropexy was performed using a single port access system with an articulated endoscopic suturing device. An additional 5 mm cannula was placed in the right caudal abdomen. A 2-0 knotless unidirectional barbed suture was used to complete the gastropexy with 2 separate simple continuous suture lines. All dogs underwent a focal abdominal ultrasound to evaluate the gastropexy site 3-12 months postoperatively. RESULTS Median weight of the dogs was 33.5 kg (range, 20-51 kg) and the median age was 2 years (range, 0.6-8.5 years). Median surgical time was 60 minutes (range, 39-88). The articulated suturing device malfunctioned twice. On abdominal ultrasound between 3 and 12 months, all gastropexy sites were intact. No motion was detected between the stomach and body wall during distal antral contractions or respiratory motion and a focal thickening of the gastric wall was present in dog. No complications were reported in the postoperative periods as of the 2 week suture removal visit or as of the time of their ultrasound appointment. CONCLUSION This technique using an endoscopic articulated suturing device with a knotless unidirectional barbed suture provides a feasible technique to perform laparoscopic gastropexy.

Intramural Abscess Causing Obstruction at a Previous Jejunal Enterotomy Site in a Dog

This case report documents a novel late surgical complication in a 2 yr old dog following an enterotomy to remove a jejunal foreign body. Twenty-six days following the original surgery, the dog was re-presented with signs consistent with an intestinal obstruction. A mural intestinal abscess was found as the cause of the obstruction during exploratory surgery, and the site was successfully removed with a resection and anastomosis. Histopathology showed multifocal abscessation with cyst-like structures partially lined with mucosa. The dog recovered without complication and remains healthy 4 mo later. The exact cause of the lesion is not known; however, local contamination through a focal mucosal defect or complications related to the use of barbed suture in the original enterotomy repair may have contributed.

Video-assisted extirpation of cranial mediastinal masses in dogs: 18 cases (2009–2014)

OBJECTIVE To characterize clinical findings, surgical procedures, complications, and outcomes in dogs undergoing extirpation of masses from the cranial mediastinum via video-assisted thoracic surgery (VATS) and establish preliminary guidelines for case selection when considering VATS for thymectomy in dogs. DESIGN Retrospective case series. ANIMALS 18 client-owned dogs that underwent extirpation of a cranial mediastinal mass by means of VATS at 5 academic referral hospitals from 2009 through 2014. PROCEDURES Medical records were reviewed and data extracted regarding signalment, clinical signs, physical examination findings, diagnostic imaging results, surgical approach and duration, cytologic and histologic examination results, complications, outcome, and cause of death, when applicable. RESULTS 16 dogs had a thymoma, 1 had thymic anaplastic carcinoma, and 1 had hemangiosarcoma. Seven had both megaesophagus and myasthenia gravis. Median approximate tumor volume was 113.1 cm3 (interquartile range, 33.5 to 313.3 cm3). Median duration of VATS was 117.5 minutes (interquartile range, 91.5 to 136.3 minutes). Conversion to an open thoracic surgical procedure was required for 2 dogs, 1 of which died during surgery. Median survival time following VATS for dogs with thymoma and concurrent myasthenia gravis and megaesophagus was 20 days. Dogs with thymoma without paraneoplastic syndrome survived for ≥ 60 days, and none of these dogs died of disease-related causes. CONCLUSIONS AND CLINICAL RELEVANCE VATS appeared to be an acceptable approach for extirpation of masses from the cranial mediastinum in dogs under certain conditions. Dogs with myasthenia gravis and megaesophagus had a poor postoperative outcome.

Treatment of Persistent Deep Infection After Total Ear Canal Ablation and Lateral Bulla Osteotomy

Persistent deep infection originating from remnants of an incompletely excised ear canal, or epithelium and debris left in the osseous ear canal or tympanic cavity after surgery total ear canal ablation and lateral bulla osteotomy can be debilitating. Clinical signs including pain elicited on deep palpation over the affected bulla or when opening the mouth, or draining sinuses may be delayed months to years. Localization of the nidus via CT imaging is important for surgical planning. Although antibiotic therapy usually reduces or eliminates the clinical signs of deep infection, relapses are common. Surgery more consistently results in permanent resolution.