Biomedical subjects
Publications and source records attributed to D D Smeak.
Four years after successful implantation of a pleuroperitoneal shunt in a dog with persistent pleural effusion, signs of lethargy and dyspnea reappeared. Although the shunt was still functional, compartmentalization of the right pleural space eventually isolated a pocket of fluid, causing dyspnea. Symptomatic relief was achieved for at least 11 months by contralateral implantation of a second shunt.
Twenty dogs with neoplasms requiring multiple radiation treatments received either percutaneous vascular access catheters (PVACs; Cook, Bloomington, IN) or subcutaneous vascular access ports (SVAPs; Vascular-Access-Ports, Norfolk Medical Products, Inc., Skokie, IL); 10 dogs were entered in each group. All catheters were implanted and removed aseptically and the catheter tips were cultured during implant removal. Complications with PVACs included mild incisional swelling and redness and accidental severance or rupture of the catheter. Complications with SVAPs included incisional or port swelling, bruising or redness, hematoma formation, and pain. Ports in 4 of these dogs could not be used for 1 to 3 days after surgery because of swelling and pain. Surgical wound complications, when pooled for comparison, occurred significantly more frequently with the SVAPs (P = .023). Wound complications associated with both catheters were self-limiting and resolved within 7 days. Bacterial cultures were positive in two PVACs and four SVAP tips, however, none of these dogs had clinical signs of infection or sepsis. Although both types of indwelling catheters were functional in a clinical setting, PVACs were preferred to SVAPs for dogs undergoing radiation therapy because of decreased time for implantation and fewer overall complications.
Forty students were randomly assigned into two study groups (traditional, T; and simulator, S) of 20 students each for a core operative practice laboratory. Students were randomly paired and their group assignment and identity remained anonymous to the evaluators throughout the study. Questionnaires were distributed to students to evaluate prior surgical experience and obtain learning resource use information. Before the evaluation sessions, both groups were given identical learning resource opportunities except students in Group S received hollow organ simulators and practice materials for gastrotomy closure. All students were forewarned that surgical instruction would not be available during the evaluation sessions. In the first live animal evaluation session, all student pairs were videotaped after which stomachs were harvested for gross evaluation of the surgical site. Group T performed an additional gastrotomy for video and gross evaluation 2 weeks later. Questionnaire, and gross and video evaluation results were compared statistically between groups and sessions. The hollow organ model did not suitably simulate live stomach tissue; the material was more fragile and stiff and suture cut-out was a problem even with appropriate suture tension and technique. The model was effective for teaching needle placement, instrument usage, creating proper tissue inversion, and methods to minimize instrument handling of tissue during gastrotomy closure. Prior practice with models did not boost student confidence during their live gastrotomy session. The autotutorials (ATs) were well received by students but did not sufficiently address how to manage mucosal eversion, suture tension, and bleeding encountered during live gastrotomy. AT viewing time positively correlated with mean total video score for Group T during both sessions. None of the students had prior experience performing hollow organ closure and no significant difference in experience level was evident between groups. Mean closure time was not significantly different between groups for session one (Group T, mean, 31.5 minutes, range, 18.4 to 53.4; Group S, mean, 28.2 minutes, range, 16.8 to 36), but was significantly reduced for session two (Group T, mean, 21.3 minutes, range, 13.9 to 31). This AT/simulator program does not significantly influence students' overall gastrotomy closure technique; gross and video evaluation scores were not significantly different between groups. Without instructor supervision, an additional gastrotomy experience did not improve surgical technique appreciably for Group T; however, these students performed the second procedure with more confidence and speed.(ABSTRACT TRUNCATED AT 400 WORDS)
The records of 35 dogs and two cats with Broviac-Cookea catheters implanted during a one-year period at The Ohio State University Veterinary Teaching Hospital (OSU-VTH) were reviewed for complications. In 36 patients, the catheters were used for daily anesthesia associated with cobalt radiotherapy, and in one dog the catheter was used for parenteral hyperalimentation. The catheters were in place for a mean of 16.7 days. Complications occurred in five patients and included infection or sepsis (n = 3), local abscess formation (n = 1), and local induration (n = 1); all the complications resolved with appropriate therapy. Broviac-Cooke catheters should be considered for use in dogs and cats requiring frequent blood sampling, repeated intravenous access, or in those for which routine venous access is difficult or impossible. The complication rate is minimal (13%) and is similar to that reported in studies of humans with indwelling, silastic catheters.
Simple continuous closure of scrotal urethrostomy in 20 dogs is described. Mean duration of postoperative active bleeding and mean duration of bleeding only associated with urination were 0.2 day and 3.1 days, respectively. Long-term complications were minimal; intermittent urine scald (n = 2), recurrent urinary tract infections (n = 2), and recurrent obstruction due to struvite stones (n = 2) developed after surgery. All complications resolved with medical therapy (n = 4) or by cystotomy (n = 2). None of the dogs had complications due to wound dehiscence, stricture, incisional infections, self-mutilation, or incontinence. Follow-up ranged from two to 52 months (mean, 25.2 months). This technique is a viable alternative to previously reported closure methods.
Abdominal hernias, especially those resulting from trauma, are common in small animals. Little is written regarding prevention and treatment of common problems or complications encountered during or after herniorrhaphy. The purpose of this article is to discuss the numerous potential or documented complications associated with abdominal herniorrhaphy, how to manage them, and, most importantly, how to prevent them.