Quiz Question
In Chen 2024 et al., on pressure-measurement tools, why is high precision potentially more critical than accuracy when monitoring portal pressures during PSS ligation?
🔍 Key Findings
- WMg (water manometer with gauge) was the most accurate and precise pressure measurement device.
- APT (arterial pressure transducer) was less accurate than WMg but still precise; it differed significantly from the gold standard (WMr).
- CCT (Compass CT) was the least accurate and precise and differed significantly from the set pressure.
- Mean differences from set pressure were smallest for WMg (−0.020 cm H2O), moderate for APT (−0.390 cm H2O), and largest for CCT (−1.267 cm H2O).
- All devices showed excellent interobserver (ICC = 1.000) and intraobserver agreement (ICC range 0.985–0.998).
- Even though the CCT performed least well, all devices had mean errors ≤1.3 cm H2O, indicating potential clinical utility.
- WMg or WMr should be preferred in surgical settings due to superior accuracy and precision.
- Measurement precision is more critical than accuracy during PSS surgery, as a 1 mm Hg (~1.3 cm H2O) increase in portal pressure raises odds of poor outcomes by 9%.
Veterinary Surgery
4
2024
Accuracy, precision, and interobserver and intraobserver agreements related to pressure-measurement devices
2024-4-VS-chen-3
In Zann 2023 et al., In Long-term outcomes after proximal humeral OC debridement in dogs, what functional outcome was most frequently reported by owners at long-term follow-up?
🔍 Key Findings
- 20 dogs (26 shoulders) evaluated at mean 3.5 years post-surgery after arthroscopic or open debridement.
- Ipsilateral muscle atrophy and decreased range of motion (↓ extension, ↓ flexion) in affected limbs compared to contralateral healthy shoulders.
- All treated shoulders developed osteoarthritis, confirmed radiographically, by CT, and arthroscopically.
- Moderate to severe synovitis was present in all shoulders; lesions showed patchy, incomplete cartilage infilling even up to 8.9 years post-op.
- Kinetic gait analysis showed no significant differences in PVF/VI between affected and unaffected limbs, despite mild lameness clinically.
- Owners reported good to very good mobility (median LOAD = 6), often underestimating clinical lameness.
- CT detected larger lesion dimensions than radiographs (wider, deeper defects).
- Despite progression of OA, surgical debridement was associated with satisfactory long-term function, though not prevention of degenerative changes.
Veterinary Surgery
7
2023
Long-term outcome of dogs treated by surgical debridement of proximal humeral osteochondrosis
2023-7-VS-zann-3
In Alvarez-Sanchez 2023 et al., on SLN mapping in canine MCT, what was the histologic metastasis rate (HN2 or HN3) in excised lymph nodes?
🔍 Key Findings
- Combined ICTL and NIRF detected the same SLN in 80% of cases; each method alone missed sentinel lymph nodes in some dogs.
- ICLT failed in 5% of dogs, while NIRF failed in 20%; combined use resulted in only 5% failure in SLN detection.
- Metastatic lymph nodes were detected in 95% of dogs, despite most tumors being low or intermediate grade (95%).
- 27 of 41 nodes (65.8%) were histologically metastatic (HN2 or HN3), many of which would have been missed using ALN alone.
- ALN matched the SLN in only 45% of cases with ICTL and 30% with NIRF, supporting the need for SLN mapping.
- ICLT and NIRF were complementary, often identifying different SLN, with some only fluorescent or enhanced in one modality.
- Subcutaneous MCT had higher metastatic rates (7/8 dogs) than previously reported, challenging older assumptions about benign behavior.
- Removing both ALN and SLN (from both methods) improved detection of metastasis to 85–95%, reducing risk of understaging.
Veterinary Surgery
3
2023
Comparison of indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping for integumentary canine mast cell tumors
2023-3-VS-alvarez-sanchez-4
In Cortez 2024 et al., on feline ectopic ureters, what was the most common postoperative complication following surgical correction of ectopic ureters?
🔍 Key Findings
- Ectopic ureters in cats are rare, but most are extramural and bilateral.
- Surgical techniques used included ureteroneocystostomy (UNC), neoureterostomy (NU), nephroureterectomy, and cystoscopic laser ablation (CLA).
- All cats showed improvement in urinary continence postoperatively, with 11/12 achieving complete resolution.
- Major complications were rare; one cat developed uroabdomen requiring revision surgery.
- Diagnostic imaging was effective, with abdominal ultrasound diagnosing 8/10 and CT 3/3 cases.
- Short- and long-term complications included urethral spasms, UTIs, stranguria, and rectal prolapse; all were manageable.
- CLA was successful in 2 cats and is noted as a first-time described technique in feline ectopic ureter cases.
- Median postoperative follow-up was 340 days, supporting good long-term outcomes.
Veterinary Surgery
6
2024
Presentation, diagnosis, and outcomes of cats undergoing surgical treatment of ectopic ureters
2024-6-VS-cortez-4
In Glenn 2024 et al., on client-based SSI surveillance, what proportion of SSIs were identified *only* via active surveillance?
🔍 Key Findings
- Algorithm 3 had the highest overall accuracy (95.5%) in diagnosing SSIs from client questionnaires.
- Active surveillance identified 19.4% more SSIs compared to passive surveillance alone.
- SSI rate was 8.22% across 754 surgeries; 33.9% of SSIs required revision surgery.
- Client-based responses were 37.9% more frequent than those from referring veterinarians.
- Deep/implant SSIs could be missed if not associated with visible wound healing problems.
- Two late SSIs (after 90 days) occurred, both linked to implant surgeries.
- Algorithm 1 was the most sensitive (87.1%) but less specific; useful for screening.
- Algorithm 2 had the highest specificity (97.9%); useful as a “rule-in” diagnostic method.
Veterinary Surgery
8
2024
Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system
2024-8-VS-glenn-2
In Marchionatti 2022 et al., on antiseptic efficacy comparison, what methodological limitation was common across studies?
🔍 Key Findings
- Chlorhexidine-based asepsis protocols were comparable to povidone-iodine for reducing surgical site infection (SSI) rates in veterinary surgery.
- No significant difference in skin bacterial colonization was observed between the two antiseptics, at both immediate and delayed timepoints.
- Chlorhexidine-alcohol protocols showed a non-significant trend toward improved bacterial reduction in some studies, though inconsistent across all studies.
- Use of neutralizing agents was inconsistent, which may have led to overestimation of antiseptic efficacy in several studies.
- Formulations and concentrations varied widely (e.g., chlorhexidine 0.5–4%, povidone-iodine 0.7–1%), contributing to heterogeneity and limiting definitive conclusions.
- Only a minority of studies reported using CDC criteria for SSI diagnosis, affecting the reliability of infection outcomes.
- Risk of bias was high or unclear in multiple domains across all included studies, limiting overall confidence in conclusions.
- Meta-analysis confirmed no statistically significant superiority of either protocol for SSI prevention or skin bacterial reduction.
Veterinary Surgery
5
2022
Preoperative skin asepsis protocols using chlorhexidine versus povidone‐iodine in veterinary surgery: A systematic review and meta-analysis
2022-5-VS-marchionatti-3
In Veytsman 2023 et al., on feline insulinoma outcomes, which of the following was NOT a negative prognostic factor?
🔍 Key Findings
- Surgical excision of insulinomas resulted in euglycemia or hyperglycemia in 90% of cats immediately post-op.
- 18/20 cats (90%) survived to hospital discharge, with a median survival time of 863 days.
- Younger age, metastasis at surgery, tumor invasion, and lower glucose levels were negative prognostic factors.
- Two cats had stage III disease with metastasis; one lived 413 days post-op, suggesting some benefit to surgery even in advanced disease.
- Postoperative hypoglycemia and seizure activity were associated with poorer outcomes; one cat euthanized due to seizures despite euglycemia.
- Median disease-free interval (DFI) was 1052 days; for cats with metastasis, DFI dropped to 93 days.
- Partial pancreatectomy was performed in 11 cats, nodulectomy in 10, and enucleation in 1; method of resection not linked to outcome.
- Postoperative complications occurred in 25% of cats; most were manageable with supportive care.
Veterinary Surgery
1
2023
Retrospective study of 20 cats surgically treated for insulinoma
2023-1-VS-veytsman-2
In Kang 2022 et al., on 3D scaffold reconstruction, what was the primary diagnosis confirmed after tumor excision?
🔍 Key Findings
- Patient-specific 3D-printed PCL/β-TCP scaffold enabled successful zygomatic arch reconstruction in a dog.
- Complete surgical resection of a zygomatic parosteal osteosarcoma was achieved, with a 0.3 mm histologically clean margin.
- Post-op imaging showed progressive tissue ingrowth into the scaffold, with Hounsfield Units increasing from 20.4 to 97.8 over 10 months.
- No complications (e.g., infection, displacement) or tumor recurrence were noted at 16-month follow-up.
- Use of a patient-specific osteotomy guide improved anatomical fit and facilitated precise excision and implant placement.
- Facial symmetry and orbital stability were maintained throughout follow-up.
- The scaffold remained structurally stable despite limited bone regeneration, suggesting connective tissue filled the defect.
- Topical mitomycin C was applied intraoperatively for possible anti-neoplastic effect, but efficacy remains unclear.
Veterinary Surgery
8
2022
Zygomatic arch reconstruction with a patient-specific polycaprolactone beta-tricalcium phosphate scaffold after parosteal osteosarcoma resection in a dog
2022-8-VS-kang-2
In Dobberstein 2022 et al., on NSAID ulcer repair, what clinical parameter was associated with a trend toward increased risk of death?
🔍 Key Findings
- Primary repair of NSAID-associated full-thickness gastroduodenal ulcers was successful in 73% (8/11) of cases.
- NSAID overdose, concurrent corticosteroid use, or extended duration were identified in 9/11 dogs and were major contributors to ulceration.
- All perforations were in the pylorus or proximal duodenum, locations suitable for primary closure.
- No significant association between ulcer size or location and postoperative survival.
- Preoperative hyperlactatemia trended toward increased mortality (P = .0544; OR 2.045).
- Postoperative vasopressor use was linked with a 9-fold increased risk of mortality (P = .0545).
- Dehiscence was rare, suspected in only 1 of 11 cases, indicating that primary repair is structurally sound in selected cases.
- Median follow-up of 444 days showed long-term survival was achievable post-primary repair.
Veterinary Surgery
7
2022
Primary repair of nonsteroidal anti‐inflammatory drug‐associated full thickness gastrointestinal ulcers in 11 dogs
2022-7-VS-dobberstein-5
In Zann 2023 et al., on proximal humeral OC, what conclusion was drawn about the progression of osteoarthritis (OA)?
🔍 Key Findings
- All dogs developed progressive osteoarthritis (OA) after surgical debridement of proximal humeral OC.
- Ipsilateral muscle atrophy and reduced shoulder range of motion were common, particularly in unilaterally affected dogs.
- Arthroscopically, lesions showed incomplete cartilage infilling even years after surgery, averaging only ~37% infilling.
- Synovitis was present in all joints, with moderate-to-severe hypertrophy and vascularity scores.
- CT identified OC lesions as deeper and wider than radiography, and all affected joints had more advanced OA than contralateral limbs (P = .001 radiograph, P = .005 CT).
- Kinetic gait analysis showed no significant differences in peak vertical force or impulse, but a subtle 4.4% asymmetric load reduction on the operated limb.
- Median LOAD score was 6, indicating mild owner-perceived disability despite measurable clinical and imaging abnormalities.
- Cartilage infilling was incomplete in all cases, with no lesion exceeding 60% restoration, raising questions about the healing potential of debridement alone.
Veterinary Surgery
6
2023
Long-term outcome of dogs treated by surgical debridement of proximal humeral osteochondrosis
2023-6-VS-zann-5-f2454
Quiz Results
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Key Findings