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OBJECTIVE: The after-hours effect on postoperative complications has been poorly studied in the neurosurgical literature. A recent retrospective analysis showed that patients with a surgical start time (SST) between 09:01 PM and 0...
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OBJECTIVE: The after-hours effect on postoperative complications has been poorly studied in the neurosurgical literature. A recent retrospective analysis showed that patients with a surgical start time (SST) between 09:01 PM and 07:00 AM had a greater risk of complications. This study used a prospective registry to examine the relationship between SST and postoperative complications in a large neurosurgical population.
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Objective-To determine the effectiveness of cystotomy for complete removal of urocystoliths and urethroliths in dogs, the types and frequency of diagnostic imaging performed to verify complete urolith removal, the complications th...
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Objective-To determine the effectiveness of cystotomy for complete removal of urocystoliths and urethroliths in dogs, the types and frequency of diagnostic imaging performed to verify complete urolith removal, the complications that develop as a result of cystotomy, and predictors of each of these variables.Design-Retrospective case series.Animals-128 dogs that underwent a cystotomy for removal of urocystoliths, urethroliths, or both from 1994 through 2006.Procedures-The following data were obtained from medical records: sex, body weight, number and locations of lower urinary tract uroliths identified in preoperative and postoperative imaging reports, types of imaging used for urolith detection, number of uroliths recovered during cystotomy, quantitative urolith composition, and major complications attributable to cystotomy. Objective criteria were applied to determine whether a cystotomy failed or succeeded and whether appropriate imaging was performed. Associations between potential prognostic factors and outcomes were statistically assessed.Results-Effectiveness of cystotomy could be determined in 44 (34%) dogs, of which 9 (20%) had incomplete removal of uroliths. Appropriate postoperative imaging was performed for only 19 (15%) dogs, of which 8 had incomplete removal. Dogs with both urethroliths and urocystoliths were more likely to have a failed cystotomy than dogs with only urethroliths or urocystoliths. Complications developed in 5 (4%) dogs.Conclusions and Clinical Relevance-Cystotomy was a safe and effective surgical procedure for removal of lower urinary tract uroliths in most dogs. Failure to remove all uroliths occurred in a substantial percentage of patients. (J Am Vet Med Assoc 2010;236:763-766)
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Surgical procedures of the lower urinary tract are commonly performed in small animal practice. Cystotomy for removal of uroliths and urethrostomy diverting urine outflow due to urethral obstruction are the most commonly performed...
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Surgical procedures of the lower urinary tract are commonly performed in small animal practice. Cystotomy for removal of uroliths and urethrostomy diverting urine outflow due to urethral obstruction are the most commonly performed surgical procedures of the bladder and urethra respectively. Surgical procedures of the lower urinary tract are typically associated with few complications, including leakage of urine, loss of luminal diameter (stricture or stenosis), urine outflow obstruction, tissue devitalization, denervation, urinary incontinence, urinary tract infection, and death. Complications can result from inappropriate or inadequate diagnosis, localization, and surgical planning; failure to respect regional anatomy, and other causes.
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Due to the negative effects of urine on wound healing, the high rate of complications associated with surgical incisions in the ureter and a desire to avoid large open approaches to the abdomen, there is a strong trend in human me...
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Due to the negative effects of urine on wound healing, the high rate of complications associated with surgical incisions in the ureter and a desire to avoid large open approaches to the abdomen, there is a strong trend in human medicine toward the use of endoscopic methods in the treatment of upper urinary tract disease. However, the small size of urogenital structures in companion animals has prevented the widespread application of endoscopy of the upper urinary tract and surgery continues to be the mainstay of treatment. Through careful decision making, veterinary surgeons now use microsurgical technique and interventional radiology to provide a high success rate. The current review will discuss complications pertaining to surgery of the kidney and ureter in companion animals, using experimental and clinical data to guide the detection and avoidance of these complications.
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Minimally invasive surgery (MIS) has become increasingly popular in recent years for diagnosis and treatment of an ever-expanding list of disease processes in small animal patients. Reports in the veterinary literature have docume...
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Minimally invasive surgery (MIS) has become increasingly popular in recent years for diagnosis and treatment of an ever-expanding list of disease processes in small animal patients. Reports in the veterinary literature have documented a large number of MIS alternatives to traditional open surgery albeit mostly in small cohorts of patients. Advantages of MIS have been documented by many investigators and include significant decreases in postoperative pain, length of hospital stay, and analgesic requirements, as well as other types of morbidity, with some procedures now being performed on an outpatient basis. However, MIS procedures are not without surgical morbidity and in some cases may be associated with higher levels or different types of complications compared to open surgery.
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Surgery of the upper airway is performed in dogs for the correction of brachycephalic airway syndrome and laryngeal paralysis and for temporary or permanent tracheostomy. Although technically simple to perform, upper airway surger...
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Surgery of the upper airway is performed in dogs for the correction of brachycephalic airway syndrome and laryngeal paralysis and for temporary or permanent tracheostomy. Although technically simple to perform, upper airway surgeries can lead to the development of significant postoperative complications. This article reviews complications associated with common surgical conditions of the upper airway. It involves a discussion of brachycephalic airway syndrome and associated respiratory and gastrointestinal complications. It also covers laryngeal paralysis with a focus on unilateral arytenoid lateralization and the complication of aspiration pneumonia. The condition of acquired laryngeal webbing/stenosis and potential treatment options is also discussed. Finally, tracheostomies and associated complications in dogs and cats are reviewed.
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ObjectiveTo describe the indications for, complications arising from, and outcome of horses that had standing lateral thoracotomy for pleural or pericardial disease.Study DesignCase series.AnimalsHorses (n=16).MethodsMedical recor...
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ObjectiveTo describe the indications for, complications arising from, and outcome of horses that had standing lateral thoracotomy for pleural or pericardial disease.Study DesignCase series.AnimalsHorses (n=16).MethodsMedical records (January 1990-December 2008) of sedated standing horses that had lateral thoracotomy were reviewed. Clinical and surgical findings, perioperative and short-term complications were recorded. Long-term (> 6 months) outcome was determined through telephone conversations with owners and veterinarians.ResultsMean (+/- SD) horse age was 6.6 +/- 5.3 years (range, 1-15 years). Thoracotomy was most commonly for treatment of recurrent or chronic pleural infection (94%). Anaerobic bacteria were frequently isolated from pleural effusion associated with pleuropneumonia (63%). Right lateral intercostal thoracotomy was performed in 13 horses (82%); intercostal muscle myectomy in 5 horses; and rib resection in 1. Perioperative complications were hemipneumothorax (2 horses) and short-term complications included cellulitis and abscessation of the thoracotomy site (6 horses). Fourteen (88%) horses survived to discharge and 46% of horses that survived returned to their previous level of athletic activity.ConclusionsLateral thoracotomy is well tolerated by standing sedated horses with minimal perioperative and short-term complications.Clinical RelevanceStanding lateral thoracotomy should be considered for the treatment of complicated pleuropneumonia in horses.
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ObjectivesTo report use of a shielded hook bistoury developed for correction of epiglottic fold entrapment in standing sedated horses.Study DesignProspective clinical study.AnimalsStandardbreds (n=8), 3-19 years of age.MethodsEpig...
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ObjectivesTo report use of a shielded hook bistoury developed for correction of epiglottic fold entrapment in standing sedated horses.Study DesignProspective clinical study.AnimalsStandardbreds (n=8), 3-19 years of age.MethodsEpiglottic fold entrapment was corrected during standing sedation using a shielded hook bistoury passed nasally into the pharynx. Owners, trainers, and referring veterinarians were contacted by telephone to establish outcome.ResultsAxial division of the entrapping epiglottic fold was successful in all horses. No short- or long-term complications occurred. Axial transection of the entrapping fold was performed rapidly (mean, 83 seconds between advancing the bistoury into the pharynx and transection of the entrapping fold).ConclusionTransnasal axial division of the aryepiglottic fold can be accomplished safely using the shielded hook bistoury. The shield mechanism minimizes the risk of injury from the cutting blade to adjacent structures.
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ObjectiveTo determine the rate of postoperative infection (POI) for internal fixation repaired equine long bone fractures and arthrodeses and identify associated risk factors.Study DesignCase series.AnimalsHorses (n=192) with frac...
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ObjectiveTo determine the rate of postoperative infection (POI) for internal fixation repaired equine long bone fractures and arthrodeses and identify associated risk factors.Study DesignCase series.AnimalsHorses (n=192) with fracture repair of the third metacarpal and metatarsal bones, radius, ulna, humerus, tibia, and femur, or arthrodesis with internal fixation.MethodsMedical records (1990-2006) were reviewed for signalment, anatomic location, fracture classification and method of repair, technique and surgical duration, bacterial species isolated, postoperative care, onset of POI, and outcome.ResultsOf 192 horses (171 [89%] closed, 21 [11%] open fractures), 157 (82%) were discharged from the hospital. Infection occurred in 53 (28% horses), of which 31 (59%) were discharged. Repairs without POI were 7.25 times more likely to be discharged from the hospital. Closed fractures were 4.23 times more likely to remain uninfected and 4.59 times more likely to be discharged from the hospital compared with open fractures. Closed reduction and internal fixation was associated with a 2.5-fold reduction in rate of POI and a 5.9 times greater chance for discharge from the hospital compared with open reduction and internal fixation. Females had a strong trend for increased POI when compared with colts and stallion but not geldings.ConclusionsOverall rate of POI was 28%. Fracture classification, method of repair, gender, and surgical duration were significant risk factors.
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ObjectiveTo describe a novel surgical technique for management of right dorsal colitis in the horse.Study DesignClinical report.Animals14-year-old Warmblood gelding.MethodsThe horse was referred for treatment of a stromal abscess ...
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ObjectiveTo describe a novel surgical technique for management of right dorsal colitis in the horse.Study DesignClinical report.Animals14-year-old Warmblood gelding.MethodsThe horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side-to-side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery.ResultsResection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long-term antimicrobial treatment.ConclusionRight dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity.Clinical RelevanceRDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.
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