Sebastiaan A. van Nimwegen

Laparoscopic ovariectomy in cats: Comparison of laser and bipolar electrocoagulation

Fourteen mixed-breed domestic cats underwent laparoscopic ovariectomy (lapOVE) using paediatric equipment, an Nd:YAG laser and a bipolar electrocoagulation forceps. Cats were placed in 10° Trendelenburg position (head down) and insufflation pressure was kept at 4 mmHg, while surgery was performed through three midline portals. Randomly-assigned unilateral laser resection of one ovary (laserOVE) and bipolar electrocoagulation (BECOVE) of the contralateral ovary were performed. Duration of predetermined surgery intervals was recorded, as well as occurrence of intra- and postoperative complications. Both methods were successful and without complications. Duration of laserOVE was significantly increased compared to BECOVE. The right ovary was more difficult to access; however, both ovaries were easy to manipulate because of the relatively long suspensory ligament. The ovarian ligaments contained minimal amounts of fat and obesity did not influence surgery duration. Convalescence period was short (0.9±0.4 days) and owner satisfaction high.

Utility of contrast-enhanced computed tomography in the evaluation of canine insulinoma location

Abstract Objectives: To determine 1) the sensitivity of contrast-enhanced CT (CECT) for detection of primary canine insulinomas and metastases 2) the sensitivity of CECT to locate canine insulinomas within the pancreas and 3) the CECT attenuation pattern of canine insulinomas and post-contrast phase in which insulinomas have the best visibility. Methods: A retrospective review was performed of the medical records of 27 canine insulinoma patients. Simultaneous occurrence of blood glucose < 3.5 mmol/L (reference interval: 4.2–5.8 mmol/L) and plasma insulin > 10 mIU/L (reference interval: 1.4–24.5 mIU/L) were considered diagnostic for insulinoma. The dogs had a mean age of 9.0 ± 1.7 (SD) years and comprised 11 males and 17 females. Results: Using CECT-scans, 26/27 insulinomas were successfully detected. However, CECT-scans predicted the correct location of insulinomas within the pancreas in only 14/27 dogs. In 9/13 inaccurately located insulinoma cases, the location error was major. There was no significant difference between triple, double and single-phase CECT-scans with location accuracies of 54%, 50% and 50%, respectively. Also, there was no specific post-contrast phase in which insulinomas could be visualised best. Detection of lymph node metastases with CECT-scans had a sensitivity of 67% (10/15 lymph node metastases). Detection of liver metastases had a sensitivity of 75% (6/8 liver metastases). This study highlights that major location errors mainly occurred if single- or double-phase CECT-scans were used (6/9 cases). Conclusion: It is suggested that triple-phase CECT-scans have superior outcome over single- or double-phase CECT-scans in pre-operative imaging of canine insulinomas.

Intratumoral injection of radioactive holmium-166 microspheres in recurrent head and neck squamous cell carcinoma : preliminary results of first use

Background Limited treatment options exist for patients with locoregional recurrences of head and neck squamous cell carcinoma (HNSCC). In the palliative setting, a single session, minimally invasive, and relatively safe therapy is desirable. This case series illustrates the feasibility of a direct intratumoral injection of radioactive holmium-166 microspheres (166HoMS) in patients as a palliative treatment for recurrent HNSCC. Patients and methods In this retrospective analysis, patients with already reirradiated irresectable recurrent HNSCC, for whom palliative chemotherapy was unsuccessful or impossible, were offered microbrachytherapy with 166HoMS. The intratumoral injection was administered manually under ultrasound guidance. Parameters scored were technical feasibility (i.e. administration, leakage, and distribution), clinical response (response evaluation criteria in solid tumors 1.1), and complications (Common Terminology Criteria for Adverse Events 4.3). Results From 2015 to 2017, three patients were treated. None of the patients experienced adverse events; however, therapeutic effects were minimal. Technical difficulties, including precipitating of microspheres and high intratumoral pressure, resulted in suboptimal distribution of the microspheres. Conclusion Intratumoral injections with 166HoMS are minimally invasive and relatively safe in palliation of HNSCC patients. Careful patient selection and improved administration techniques are required to provide a more effective treatment. Further investigation of this novel treatment modality should be carried out because of the absence of side effects and lack of other treatment options.

Negative pressure therapy versus passive open abdominal drainage for the treatment of septic peritonitis in dogs: A randomized, prospective study

OBJECTIVE To compare passive open abdominal drainage (POAD) and negative-pressure abdominal drainage (NPAD) using the ABThera™ system in the treatment of septic peritonitis. STUDY DESIGN Randomized prospective clinical trial. ANIMALS Dogs (n = 16) with septic peritonitis. METHODS Dogs with septic peritonitis were randomly assigned to one of two treatment protocols: NPAD versus POAD. Anesthesia time, operating time, duration of drainage, costs, survival, and complications were compared between techniques. Hematological and biochemical parameters in blood and abdominal fluid, and histopathological findings of omentum and abdominal wall tissue samples were compared between NPAD and POAD at time of initial surgery and at time of closure. RESULTS Overall survival was 81%. Treatment costs, anesthesia and operating time, drainage time, survival, and postoperative complications were similar between techniques. Loss of total plasma protein and decreased inflammation-related factors in abdominal fluid at time of closure were noted in all patients. Neutrophilic inflammation was greater in abdominal wall samples after NPAD. POAD patients showed discomfort during bandage changes and had frequent leakage of abdominal fluid outside of the bandage. CONCLUSION NPAD is an effective alternative to POAD for treatment of septic peritonitis, based on costs and survival. NPAD resulted in less abdominal fluid leakage, and evidence of superior healing on histological evaluation of abdominal tissues.