Milan Milovancev

Long-term outcome after surgical ameroid ring constrictor placement for treatment of single extrahepatic portosystemic shunts in dogs

OBJECTIVE To report long-term clinical outcome in dogs treated for single congenital extrahepatic portosystemic shunt (CEHPSS) with a ameroid ring constrictor (ARC) and to identify perioperative variables associated with outcome. STUDY DESIGN Retrospective, multi-institutional study. ANIMALS Dogs (n = 206) with CEHPSS. METHODS Medical records of dogs with CEHPSS treated by ARC were reviewed for perioperative and short-term (<1 month) data. Long-term follow-up information was obtained by telephone interview with referring veterinarians and/or owners. Kaplan-Meier analysis was used to estimate median survival time. Factors associated with short-term survival, outcome grade, and total survival time were identified. RESULTS Fifteen dogs died <1 month after ARC placement. Follow-up data were obtained for 112 of 191 dogs that survived >1 month; median follow was 54 months (range, 1-175 months) and 103 (92%) dogs had no clinical signs. Estimated median survival time was 152 months. Variables significantly associated with short-term survival included being intact and a low total white blood cell (WBC) count. Variables significantly associated with a successful outcome included having surgery later in the study period and negative postoperative nuclear scintigraphy. In the long-term survival analyses, intact dogs and those with higher WBC counts and occlusion pressures and lower bile acid concentrations were more likely to survive. CONCLUSIONS Dogs with CEHPSS treated by ARC generally have a good prognosis and prolonged postoperative survival.

Comparative pathology of canine soft tissue sarcomas: possible models of human non-rhabdomyosarcoma soft tissue sarcomas.

Comparative analyses of canine and human soft tissue sarcomas (STSs) are lacking. This study compared the histological and immunohistochemical (labelling for desmin, smooth muscle actin [SMA], CD31, pancytokeratin, S100 and CD34) appearance of 32 archived, formalin-fixed, paraffin wax-embedded canine STS tumour specimens by board-certified veterinary and medical pathologists, both blinded to the others interpretations. Comparison between the veterinary and human diagnoses revealed a generally consistent pattern of interpretation with few notable variations. Most tumours (13/32) were judged to display similar histomorphological appearance to human low-grade spindle cell sarcomas, appearing non-distinctive and morphologically of a fibroblastic/myofibroblastic type. Five canine cases resembled human liposarcoma, but with atypical desmin-positive epithelioid cells present. Five canine cases resembled human spindle cell sarcoma with myxoid features and two additional cases resembled human myxofibrosarcoma. Seven canine cases were noted to resemble human undifferentiated sarcoma. Findings in the present study demonstrate that canine STSs display histological and immunohistochemical features similar to their human equivalents. Because of these cross-species similarities, a particular opportunity exists to understand the biology and treatment of human STS by potentially including dogs as clinical models.

Preoperative factors associated with postoperative hypocalcemia in dogs with primary hyperparathyroidism that underwent parathyroidectomy: 62 cases (2004–2009)

OBJECTIVE To identify preoperative variables associated with postoperative hypocalcemia in dogs with primary hyperparathyroidism undergoing parathyroidectomy. DESIGN Retrospective case series. ANIMALS 62 dogs. PROCEDURES Medical records of dogs undergoing parathyroidectomy for treatment of primary hyperparathyroidism between January 2004 and January 2009 at 4 institutions were reviewed; data regarding various preoperative variables and postoperative serum total and ionized calcium concentrations were recorded. Preoperative ultrasonographic and surgical findings were compared regarding laterality (right, left, or bilateral) of parathyroid gland lesions. Data were analyzed via ANOVA, simple linear regression, and multiple linear regression to identify associations between preoperative variables and postoperative serum total and ionized calcium nadir concentrations. RESULTS Preoperative variables significantly associated with low postoperative serum total calcium nadir concentrations included old age, history of weakness, lack of gastrointestinal tract signs, high serum parathyroid hormone concentration, and low serum calcium-phosphorus concentration product value. Preoperative variables significantly associated with low postoperative serum ionized calcium nadir concentrations included sexually intact status, low body weight, high serum urea nitrogen concentration, and lack of polyuria and polydipsia in the history. Age, body weight, serum calcium-phosphorus concentration product, and serum concentrations of parathyroid hormone and urea nitrogen were included in the final multiple linear regression model for prediction of postoperative serum calcium concentrations. Ultrasonography was performed in 58 dogs; results for 44 (75.9%) dogs agreed with surgical findings regarding laterality of parathyroid gland lesions. CONCLUSIONS AND CLINICAL RELEVANCE Prediction of postoperative hypocalcemia in dogs in this study with primary hyperparathyroidism that underwent parathyroidectomy was difficult and depended on multiple (history, physical examination, and clinicopathologic) factors.

Characterization, treatment, and outcome of bacterial cholecystitis and bactibilia in dogs

Objective-To characterize historical, clinicopathologic, ultrasonographic, microbiological, surgical, and histopathologic features of bacterial cholecystitis and bactibilia in dogs and evaluate response to treatment and outcomes in these patients. Design-Retrospective case-control study. Animals-40 client-owned dogs (10 with bacterial cholecystitis on histologic analysis or bactibilia on cytologic examination [case dogs] and 30 without bactibilia [controls]) evaluated at a veterinary teaching hospital between 2010 and 2014. Procedures-Signalment, history, clinicopathologic findings, ultrasonographic features, microbiological results, surgical findings, histopathologic changes, treatments, and outcomes of case dogs were derived from medical records and summarized. Demographic and clinicopathologic data and ultrasonographic findings were compared between case and control dogs. Relationships among prior antimicrobial treatment, sediment formation in the gallbladder, presence of immobile biliary sludge, and presence of bactibilia or bacterial cholecystitis were assessed. Results-No finding was pathognomonic for bactibilia or bacterial cholecystitis in dogs. Case dogs were significantly more likely to have immobile biliary sludge and had a greater degree of biliary sediment formation than did control dogs. All case dogs for which gallbladders were examined histologically (6/6) had bacterial cholecystitis. Five of 10 case dogs were Dachshunds. Medical or surgical treatment resulted in good outcomes. Conclusions and Clinical Relevance-Bactibilia and bacterial cholecystitis were important differential diagnoses in dogs with signs referable to biliary tract disease. Dachshunds were overrepresented, which may suggest a breed predisposition. Cytologic evaluation of bile should be considered in the routine assessment of dogs with hepatobiliary disease if immobile biliary sludge is present. (J Am Vet Med Assoc 2015;246:982-989).

A comparison of microscopic ink characteristics of 35 commercially available surgical margin inks.

OBJECTIVE To compare microscopic characteristics of commercially available surgical margin inks used for surgical pathology specimens. STUDY DESIGN Prospective in vitro study. SAMPLE POPULATION Thirty-five different surgical margin inks (black, blue, green, orange, red, violet, and yellow from 5 different manufacturers). METHODS Inks were applied to uniform, single-source, canine cadaveric full-thickness ventral abdominal tissue blocks. Tissue blocks and ink manufacturers were randomly paired and each color was applied to a length of the cut tissue margin. After drying, tissues were fixed in formalin, and 3 radial slices were obtained from each color section and processed for routine histologic evaluation, yielding 105 randomly numbered slides with each manufacturers color represented in triplicate. Slides were evaluated by 5 blinded, board-certified veterinary anatomic pathologists using a standardized scoring scheme. Statistical analyses were performed to evaluate for ink manufacturer effects on scores, correlation among different subjective variables, and pathologist agreement. RESULTS Black and blue had the most consistently high scores whereas red and violet had the most consistently low overall scores, across all manufacturers. All colors tested, except yellow, had statistically significant differences in overall scores among individual manufacturers. Overall score was significantly correlated to all other subjective microscopic scores evaluated. The average Spearman correlation coefficient among the 10 pairwise pathologists overall ink scores was 0.60. CONCLUSIONS There are statistically significant differences in microscopic ink characteristics among manufacturers, with a notable degree of inter-pathologist agreement.Objective To compare microscopic characteristics of commercially available surgical margin inks used for surgical pathology specimens. Study Design Prospective in vitro study. Sample Population Thirty-five different surgical margin inks (black, blue, green, orange, red, violet, and yellow from 5 different manufacturers). Methods Inks were applied to uniform, single-source, canine cadaveric full-thickness ventral abdominal tissue blocks. Tissue blocks and ink manufacturers were randomly paired and each color was applied to a length of the cut tissue margin. After drying, tissues were fixed in formalin, and 3 radial slices were obtained from each color section and processed for routine histologic evaluation, yielding 105 randomly numbered slides with each manufacturers color represented in triplicate. Slides were evaluated by 5 blinded, board-certified veterinary anatomic pathologists using a standardized scoring scheme. Statistical analyses were performed to evaluate for ink manufacturer effects on scores, correlation among different subjective variables, and pathologist agreement. Results Black and blue had the most consistently high scores whereas red and violet had the most consistently low overall scores, across all manufacturers. All colors tested, except yellow, had statistically significant differences in overall scores among individual manufacturers. Overall score was significantly correlated to all other subjective microscopic scores evaluated. The average Spearman correlation coefficient among the 10 pairwise pathologists overall ink scores was 0.60. Conclusions There are statistically significant differences in microscopic ink characteristics among manufacturers, with a notable degree of inter-pathologist agreement.

Surgical margins in the veterinary cancer patient

In veterinary oncologic specimens, histopathology is the gold standard for determining adequacy of excision. Despite limitations of this technique, the pathologists interpretation of margin status significantly impacts patient management, including indications for adjuvant therapy. This article aims to summarize peer-reviewed literature as it relates to histologic margin evaluation in veterinary cancer patients. The value of histologic tumour-free margins and technical factors influencing histopathologic margin outcomes are also discussed. We review alternative strategies for determining excisional status, and discuss how an evolving understanding of tumour biology might inform clinical and research perspectives on surgical margins. In doing so, we aim to provide context and a stimulus for future investigations into this important yet incompletely understood topic.

A multiplex biomarker approach for the diagnosis of transitional cell carcinoma from canine urine

Transitional cell carcinoma (TCC), the most common cancer of the urinary bladder in dogs, is usually diagnosed at an advanced disease stage with limited response to chemotherapy. Commercial screening tests lack specificity and current diagnostic procedures are invasive. A proof of concept pilot project for analyzing the canine urinary proteome as a noninvasive diagnostic tool for TCC identification was conducted. Urine was collected from 12 dogs in three cohorts (healthy, urinary tract infection, TCC) and analyzed using liquid chromatography tandem mass spectrometry. The presence of four proteins (macrophage capping protein, peroxiredoxin 5, heterogeneous nuclear ribonucleoproteins A2/B, and apolipoprotein A1) was confirmed via immunoblot. Of the total 379 proteins identified, 96 were unique to the TCC group. A statistical model, designed to evaluate the accuracy of this multiplex biomarker approach for diagnosis of TCC, predicted the presence of disease with 90% accuracy.

Current Concepts in Minimally Invasive Surgery of the Abdomen

Minimally invasive surgery of the abdomen constitutes an increasingly common and developed set of surgical options in small animal veterinary patients. In addition to established procedures, such as laparoscopic gonadectomy and biopsies, more advanced procedures, such as adrenalectomy, cholecystectomy, cisterna chyli ablation, and lymph node extirpation, are described. Some laparoscopic procedures have been reported using different techniques or approaches, reflecting the fields progression beyond its infancy. Advances in equipment and experience among an ever-growing group of veterinary surgeons are expected to result in progressively more widespread adoption of minimally invasive procedures.

In vitro evaluation of a novel fiducial marker for computed tomography and magnetic resonance imaging of soft tissues in small animals

OBJECTIVE To construct and optimize a fiducial marker suitable for both CT and MRI. SAMPLE Fiducial markers containing serial dilutions of iopamidol mixed with water. PROCEDURES IV tubing sets were infused with serial dilutions (0% to 100%; increments of 10%) of iopamidol. Tubing ends were sealed; additional seals were added to create an equilateral triangle. A reference point was created by placing a crimp in 1 side. Markers were fixed to a gelatin soft tissue-attenuating phantom and evaluated by use of CT and MRI. For CT, simple linear regression analysis was used to assess the relationship between the percentage of marker contrast medium and quantitative variables, including marker attenuation, attenuation changes in the phantom, and beam-hardening artifact length. A subjective grading scheme for artifact creation on CT images and marker visibility on MRI images was used. Measurements were obtained by investigators who were unaware of the contents of each marker. RESULTS Percentage of contrast medium in each marker was strongly correlated with marker attenuation (r(2) = 0.96), artifact length (r(2) = 0.765), and mean attenuation changes within the phantom (r(2) = 0.826) for CT. Subjective CT scores indicated that concentrations of contrast medium > 50% resulted in excessive artifacts. Markers with concentrations of iopamidol > 50% had poor subjective MRI visibility scores. No artifacts were seen on MRI. CONCLUSIONS AND CLINICAL RELEVANCE A marker containing a 10% solution of iodinated contrast medium mixed with water provided ideal contrast for both CT and MRI.

Histopathologic Evidence of Capecitabine Corneal Toxicity in Dogs

In an experimental model of transplant rejection, renal transplants were performed on 6 mixed-breed dogs. Capecitabine (CPC) was administered as an oral immunosuppressive agent. All recipients received systemic CPC, cyclosporine (CSA), prednisolone, and famotidine throughout the study. Two dogs developed superficial keratitis, which was characterized by multifocal geographic erosions, superficial corneal epithelial pigmentation, and corneal neovascularization. These clinical signs correlated with the dose of CPC given, whereas other drug doses remained unchanged. After euthanasia, routine histologic sections were stained with hematoxylin and eosin and with alcian blue periodic acid— Schiff for light microscopic evaluation. Ocular histopathologic abnormalities were limited to neovascularization and inflammatory infiltrate of the anterior corneal stroma and abnormal basal cell morphology, disorganization, thinning, and pigmentation of the corneal epithelium. The purpose of this communication is to describe the clinical and histopathologic evidence of CPC corneal toxicity in dogs.