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Birkbeck R, Chan DL, McBride D, Cortellini S. Prospective evaluation of platelet function and fibrinolysis in 20 dogs with trauma. J Vet Emerg Crit Care (San Antonio) 2024; 34:40-48. [PMID: 38055340 DOI: 10.1111/vec.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/26/2022] [Accepted: 09/24/2022] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To determine platelet function and assess fibrinolysis in dogs following trauma using multiple electrical impedance aggregometry and a modified thromboelastographic (TEG) technique. To determine if the severity of trauma, as assessed by the Animal Trauma Triage (ATT) score and clinicopathological markers of shock, is associated with a greater degree of platelet dysfunction and fibrinolysis. SETTING University teaching hospital. ANIMALS Twenty client-owned dogs with trauma (occurring <24 h prior to admission and blood sampling) and ATT score of >4 were prospectively recruited. A control group of 10 healthy dogs was included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Platelet function was measured using multiple electrode platelet aggregometry (MEPA) utilizing arachidonic acid, ADP, and collagen agonists. Fibrinolysis was assessed in citrated whole blood with the addition of tissue plasminogen activator (tPA; 50 U/mL) using kaolin-activated TEG. Conventional statistical analysis was performed to compare coagulation parameters between the groups and assess linear correlations. Median (interquartile range) ATT score was 5 (5-7), and 65% (n = 13) of dogs suffered polytrauma. Mean (± SD) time from trauma to blood sampling was 9 hours (± 6). Median (interquartile range) shock index and plasma lactate concentration were 1.1 (0.7-2.0, n = 16) and 2.9 mmol/L (0.9-16.0, n = 18), respectively. Four dogs did not survive to discharge (20%). There were no differences between the trauma and control group coagulation variables. A moderate negative correlation between ATT score and area under the curve for ADP was found (P = 0.043, r2 = -0.496). CONCLUSIONS Preliminary evaluation of platelet function measured by MEPA, and fibrinolysis measured by tPA-modified TEG, is not significantly different in this population of dogs with traumatic injury compared to healthy dogs.
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Affiliation(s)
- Rachael Birkbeck
- The Ralph Veterinary Referral Centre, Fourth Avenue Globe Business Park, Marlow, UK
| | - Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - Duana McBride
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK
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Chan DL, Talbot ML. Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment. J Vis Exp 2023. [PMID: 38145373 DOI: 10.3791/65303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Hereditary diffuse gastric cancer (HDGC) caused by the CDH1 gene mutation is an inherited cancer syndrome that increases the risk of diffuse gastric cancer and is nearly impossible to detect by screening gastroscopy. The recommended preventative treatment is a total gastrectomy. Robotic surgery facilitates the use of minimally invasive surgical (MIS) techniques for anastomoses and posterior vagus preservation to potentially reduce adverse functional outcomes. An asymptomatic 24 year old male with the CDH1 gene mutation proven by genetic testing and a family history of a brother having a total gastrectomy for HDGC was treated with this technique. This video case report demonstrates the techniques and pitfalls of robotic surgery in terms of the patient positioning and port placement, posterior vagus-preserving dissection, sutured esophagojejunostomy, jejunal pouch formation, and Roux-en-Y reconstruction with a staple-stapled jejunojejunostomy. While these techniques are demonstrated in the case of prophylactic gastrectomy, many of them can be applied to other benign and bariatric foregut and general surgery types.Robotic surgery can facilitate the foregut MIS technique, as described in this case of a vagus-sparing total gastrectomy.
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Affiliation(s)
- Daniel L Chan
- Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales;
| | - Michael L Talbot
- Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales
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Tan CQY, Ho A, Robinson HA, Huang L, Ravindran P, Chan DL, Alzahrani N, Morris DL. A Systematic Review of Microwave Ablation for Colorectal Pulmonary Metastases. Anticancer Res 2023; 43:2899-2907. [PMID: 37351979 DOI: 10.21873/anticanres.16461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM Pulmonary metastases are the second most common site of metastasis in colorectal cancer after the liver, and microwave ablation (MWA) for its treatment has grown in popularity in patients who are not suitable for pulmonary metastatectomy. However, its long-term efficacy remains unknown. MATERIALS AND METHODS A systematic review was conducted in July 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, using PubMed, EMBASE, Scopus, and Cochrane databases. Studies adopting MWA for colorectal cancer pulmonary metastases were included. RESULTS A total of 488 lesions were ablated in 230 patients across eight studies. The median duration of ablation was 10 minutes. The mean length of stay in hospital was 2.3 days. Complications included pneumothorax in 128 (52%) patients; pneumonia, which occurred in 4 (1.7%) patients, and pulmonary haemorrhage in 23 (10.0%) patients. Complete remission was achieved in 85 (37.0%) patients, local control was achieved in 103 (44.8%) patients, and residual or progressive disease remained in 85 (37.0%). Survival post ablation at 1 year was 89.2% and at 3 years was 40.3%. Post-ablation disease-free survival was 43.2% at 3 years. CONCLUSION MWA is an alternative treatment for pulmonary metastases of colorectal cancer. It has competitive theoretical properties and local recurrence rate compared to radiofrequency ablation.
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Affiliation(s)
- Charis Q Y Tan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia;
- Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Andy Ho
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
| | - Hayden A Robinson
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
| | - Linna Huang
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Praveen Ravindran
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Nayef Alzahrani
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia
| | - David L Morris
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
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Huang BW, Shahul SS, Ong MKH, Fisher OM, Chan DL, Talbot ML. Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study. Obes Surg 2023; 33:2005-2015. [PMID: 37212965 PMCID: PMC10289990 DOI: 10.1007/s11695-023-06629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Revision bariatric surgery may be undertaken after weight loss failure and/or complications following primary bariatric surgery. This study aims to compare the efficacy and safety of revision laparoscopic sleeve gastrectomy (RLSG) after gastric banding (GB) to those of primary laparoscopic sleeve gastrectomy (PLSG). MATERIALS AND METHODS A retrospective, propensity-score matched study was conducted to compare between PLSG (control) patients and RLSG after GB (treatment) patients. Patients were matched using 2:1 nearest neighbor propensity score matching without replacement. Patients were compared on weight loss outcomes and postoperative complications for up to five years. RESULTS 144 PLSG patients were compared against 72 RLSG patients. At 36 months, PLSG patients had significantly higher mean %TWL than RLSG patients (27.4 ± 8.6 [9.3-48.9]% vs. 17.9 ± 10.2 [1.7-36.3]%, p < 0.01). At 60 months, both groups had similar mean %TWL (16.6 ± 8.1 [4.6-31.3]% vs. 16.2 ± 6.0 [8.8-22.4)]%, p > 0.05). Early functional complication rates were slightly higher with PLSG (13.9% vs. 9.7%), but late functional complication rates were comparatively higher with RLSG (50.0% vs. 37.5%). The differences were not statistically significant (p > 0.05). Both early (0.7% vs 4.2%) and late (3.5% vs 8.3%) surgical complication rates were lower in PLSG patients compared to RLSG patients but did not reach statistical significance (p > 0.05). CONCLUSION RLSG after GB has poorer weight loss outcomes than PLSG in the short-term. Although RLSG may carry higher risks of functional complications, the safety of RLSG and PLSG are overall comparable.
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Affiliation(s)
- Brenda W Huang
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia.
| | - Sarfraz S Shahul
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Marcus K H Ong
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Oliver M Fisher
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
| | - Daniel L Chan
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, Western Sydney University, Narellan Rd & Gilchrist Dr, Campbelltown, NSW, 2560, Australia
| | - Michael L Talbot
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
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Tsang CF, Davis B, Chan DL, Yeo D. A rare case of benign pneumatosis intestinalis in Sjogren's syndrome. J Surg Case Rep 2023; 2023:rjad346. [PMID: 37337533 PMCID: PMC10276977 DOI: 10.1093/jscr/rjad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
Pneumatosis intestinalis (PI)-the presence of intramural bowel gas-is an uncommon radiological finding, the severity of which depends on the underlying pathological process, ranging from benign disease to life-threatening ischaemia and intra-abdominal sepsis. PI has been described in systemic sclerosis and mixed connective tissue disease; however, few cases have been reported in Sjogren's syndrome (SjS). The exact pathogenesis of PI in systemic connective tissue disorders is not fully understood and likely multifactorial. We have described a unique case of PI without evidence of peritonitis in a stable patient with long-standing SjS managed non-operatively. An awareness of such benign PI, particularly amongst patients with systemic connective tissue disease, is crucial for diagnostic accuracy and safe patient care, particularly in preventing unnecessary surgical intervention.
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Affiliation(s)
- Chi F Tsang
- Correspondence address. P.O. Box 21502, World Square, Sydney, NSW 2002, Australia. E-mail:
| | - Brandon Davis
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
| | - Daniel L Chan
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - David Yeo
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
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Glanemann B, Humm K, Pegram C, Chan DL. An investigation into an outbreak of pancytopenia in cats in the United Kingdom. J Vet Intern Med 2023; 37:117-125. [PMID: 36610017 PMCID: PMC9889669 DOI: 10.1111/jvim.16615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In spring 2021 increasing numbers of cats presenting with severe pancytopenia were noted in United Kingdom (UK). OBJECTIVE To describe process and outcome of the investigation performed into the outbreak of pancytopenia in cats. ANIMALS Five hundred and eighty client owned cats that presented with severe bi- or pancytopenia of unknown cause. METHODS Real-time data collection was performed by an online registration forum available to all veterinary surgeons in UK. Data collected included demographics, clinicopathological findings, diagnostic testing, dietary and drug history, outcome and COVID household status. Mycotoxicological feed analysis was performed on feed samples of 3 diets frequently mentioned in the database and 3 control diets. RESULTS Five hundred and eighty cats presented to 378 veterinary practices were included for analysis. Case fatality rate was 63.3%. Dietary history was available for 544 (93.8%) cats, of which 500 (86%) were fed 1 of 3 diets (which were recalled midinvestigation). 54 (9.3%) cats were not fed a recalled product, with diet information unknown in 26 (4.5%) cats. Analysis of feed samples revealed concentrations of hematotoxic trichothecene T-2/HT-2 mycotoxins greater than recommended by the European Commission in 5/7 recalled diet samples but in none of control diet samples. The trichothecene mycotoxin diacetoxyscirpenol (DAS) was detectable in all recalled diet samples but not in any of control samples. CONCLUSION AND CLINICAL IMPORTANCE Contaminated-feed induced trichothecene mycotoxicosis should be considered as a differential diagnosis for pancytopenia in cats.
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Affiliation(s)
- Barbara Glanemann
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Karen Humm
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Camilla Pegram
- Department of Pathobiology and Population SciencesRoyal Veterinary CollegeHatfieldUK
| | - Daniel L. Chan
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
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Indja B, Chan DL, Talbot ML. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:347. [PMID: 36131312 PMCID: PMC9490990 DOI: 10.1186/s12893-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.
Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.
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Affiliation(s)
- Ben Indja
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Surgery, St George Hospital, Sydney, NSW, Australia. .,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia.
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia
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Sharp CR, Blais MC, Boyd CJ, Brainard BM, Chan DL, de Laforcade A, Goggs R, Guillaumin J, Lynch A, Mays E, McBride D, Rosati T, Rozanski EA. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 6: Defining rational use of thrombolytics. J Vet Emerg Crit Care (San Antonio) 2022; 32:446-470. [PMID: 35881647 PMCID: PMC9544803 DOI: 10.1111/vec.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To systematically review available evidence and establish guidelines related to the use of thrombolytics for the management of small animals with suspected or confirmed thrombosis. DESIGN PICO (Population, Intervention, Control, and Outcome) questions were formulated, and worksheets completed as part of a standardized and systematic literature evaluation. The population of interest included dogs and cats (considered separately) and arterial and venous thrombosis. The interventions assessed were the use of thrombolytics, compared to no thrombolytics, with or without anticoagulants or antiplatelet agents. Specific protocols for recombinant tissue plasminogen activator were also evaluated. Outcomes assessed included efficacy and safety. Relevant articles were categorized according to level of evidence, quality, and as to whether they supported, were neutral to, or opposed the PICO questions. Conclusions from the PICO worksheets were used to draft guidelines, which were subsequently refined via Delphi surveys undertaken by the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) working group. RESULTS Fourteen PICO questions were developed, generating 14 guidelines. The majority of the literature addressing the PICO questions in dogs is experimental studies (level of evidence 3), thus providing insufficient evidence to determine if thrombolysis improves patient-centered outcomes. In cats, literature was more limited and often neutral to the PICO questions, precluding strong evidence-based recommendations for thrombolytic use. Rather, for both species, suggestions are made regarding considerations for when thrombolytic drugs may be considered, the combination of thrombolytics with anticoagulant or antiplatelet drugs, and the choice of thrombolytic agent. CONCLUSIONS Substantial additional research is needed to address the role of thrombolytics for the treatment of arterial and venous thrombosis in dogs and cats. Clinical trials with patient-centered outcomes will be most valuable for addressing knowledge gaps in the field.
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Affiliation(s)
- Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Marie-Claude Blais
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Corrin J Boyd
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Armelle de Laforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Julien Guillaumin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Alex Lynch
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Erin Mays
- Veterinary Specialty Services, St. Louis, Missouri, USA
| | | | - Tommaso Rosati
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
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Taylor S, Chan DL, Villaverde C, Ryan L, Peron F, Quimby J, O'Brien C, Chalhoub S. 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat. J Feline Med Surg 2022; 24:614-640. [PMID: 35775307 DOI: 10.1177/1098612x221106353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PRACTICAL RELEVANCE Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Delayed intervention may result in the cat's deterioration; hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome. CLINICAL CHALLENGES Cats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake; previous negative experiences may compound the problem. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits. EVIDENCE BASE The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Information is based on the available literature, expert opinion and the panel members' experience.
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Affiliation(s)
- Samantha Taylor
- International Society of Feline Medicine, Tisbury, Wiltshire, UK
| | - Daniel L Chan
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, UK
| | | | - Linda Ryan
- Inspiring Pet Teaching, Fordingbridge, Hampshire, UK
| | | | - Jessica Quimby
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH, USA
| | - Carolyn O'Brien
- Melbourne Cat Vets, 157 Westgarth Street, Fitzroy, Australia
| | - Serge Chalhoub
- Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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Cheah S, Gao Y, Mo S, Rigas G, Fisher O, Chan DL, Chapman MG, Talbot ML. Fertility, pregnancy and post partum management after bariatric surgery: a narrative review. Med J Aust 2022; 216:96-102. [PMID: 35034365 PMCID: PMC9306879 DOI: 10.5694/mja2.51373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications. Bariatric surgery improves fertility and some pregnancy‐related outcomes. Following bariatric surgery, pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss. Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy. After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies. Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.
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Affiliation(s)
| | | | | | | | - Oliver Fisher
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | - Daniel L Chan
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | | | - Michael L Talbot
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
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Radulescu SM, Skulberg R, McDonald C, Chan DL, Humm K. Randomized double-blinded clinical trial on acute transfusion reactions in dogs receiving leukoreduced versus nonleukoreduced packed red blood cells. J Vet Intern Med 2021; 35:1325-1332. [PMID: 33960540 PMCID: PMC8162603 DOI: 10.1111/jvim.16138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Leukoreduction of blood products is commonly performed in human medicine, but its effect on outcome or incidence of transfusion reactions (TRs) in dogs is unknown. Objectives To prospectively evaluate the incidence of acute TRs in, and the outcome of, dogs receiving either leukoreduced (LR) or nonleukoreduced (N‐LR) packed red blood cells (PRBC). Animals Dogs (n = 194) administered PRBC between August 2017 and June 2020. Methods Prospective randomized double‐blinded clinical trial. Dogs were randomized to receive either LR or N‐LR PRBC and clinicians, nurses and investigators were blinded to the group allocations. The incidence of TRs, change in PCV, hospitalization duration, and survival to discharge were recorded. Results Out of the 194 dogs, 96 received LR and 98 received N‐LR PRBCs. The mean 12‐hour change in PCV value was +9.22% (SD 5.27%) for dogs that received N‐LR and +10.69% (SD 6.44%) for dogs that received LR PRBC (effect size 0.26, 95% confidence interval [CI] −0.02 to 0.55), which was not significantly different (P = .08). TRs were documented in 16/194 (8.24%) dogs, with 1/194 (0.51%) being a mild allergic reaction, while 15/194 (7.73%) had suspected febrile nonhemolytic TRs (FNHTRs). FNHTR incidence was not significantly different between the LR (6/96, 6.25%, 95% CI 2.8‐13.56) and N‐LR (9/98, 9.18%, 95% CI 4.92‐17.11) groups (P = .81). Of the 156 dogs that survived to discharge, 80/156 received N‐LR PRBC and 76/156 received LR PRBC which was not significantly different (P = .66). Conclusions and Clinical Importance A clinical advantage of using LR over N‐LR PRBC in terms of TRs and increase in PCV after transfusion was not detected.
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Affiliation(s)
- Sinziana Maria Radulescu
- Department of Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Herts, United Kingdom
| | - Ragnhild Skulberg
- Department of Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Herts, United Kingdom.,Small Animal Section, Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Charlotte McDonald
- Department of Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Herts, United Kingdom.,Dick White Referrals, Station Farm, Cambridgeshire, United Kingdom
| | - Daniel L Chan
- Department of Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Herts, United Kingdom
| | - Karen Humm
- Department of Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Herts, United Kingdom
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13
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Chan DL, Chern TY, Iliopoulos J, Hennessy A, Wong SKH, Ng EKW, Talbot ML. Accuracy of High-Resolution Manometry in Hiatal Hernia Diagnosis in Primary and Revision Bariatric Surgery. Obes Surg 2021; 31:2906-2912. [PMID: 33852151 DOI: 10.1007/s11695-021-05335-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is a complex association between obesity, hiatal hernia (HH), and reflux. There is a deficiency of literature on the accuracy of preoperative high-resolution manometry (HRM) in detecting HH before both primary and revision bariatric surgery. MATERIALS AND METHODS A retrospective analysis of a prospective database of all HRM performed before bariatric surgery from 2014 to 2019. An electronic medical records review was conducted. Sensitivity, specificity, and global diagnostic test accuracy were calculated. RESULTS Sixty-seven patients with HRM (mean age of 44.0 ± 11.3 years, body mass index 40.8 ± 6.9 kg/m2) were eligible. Intraoperative diagnosis of HH was made in 37 patients (55.2% prevalence). The HRM sensitivity was 48.7% (95% confidence interval (CI) 31.9-65.6%), specificity 90.0% (95% CI 73.5-97.9%), and accuracy was 67.2% (95% CI 54.6-78.2%). Comparing primary (28) and revision (39) surgery, the sensitivity (37.5% vs 57.1%), specificity (75.0% vs 100%), and diagnostic accuracy (54.3% vs 76.3%) were comparable, with overlapping 95% CI. Endoscopy performed in 30 patients had a sensitivity of 25.5% (95% CI 6.8-49.9%), specificity of 100% (95% CI 75.3-100%), and accuracy of 57.8% (95% CI 38.5-75.5%) and was comparable to HRM. CONCLUSION High-resolution manometry for the detection of HH before bariatric surgery has a high specificity and maintains a high accuracy in both primary and revision bariatric surgery.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia. .,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia. .,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. .,Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Tien Y Chern
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jim Iliopoulos
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Simon K H Wong
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Enders K W Ng
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
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14
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Greensmith TD, Chan DL. Audit of the provision of nutritional support to mechanically ventilated dogs and cats. J Vet Emerg Crit Care (San Antonio) 2021; 31:387-395. [PMID: 33749059 DOI: 10.1111/vec.13060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/03/2020] [Accepted: 02/20/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the use of enteral and parenteral nutrition in a population of mechanically ventilated cats and dogs, identify factors associated with implementation of nutrition, and assess the frequency of nutritional support within 72 hours of absent caloric intake. DESIGN Retrospective, single-center audit from June 2013 to June 2016. SETTING ICU of a veterinary university teaching hospital. ANIMALS Fifty-eight animals (50 dogs, 8 cats) that underwent mechanical ventilation for ≥6 hours with complete medical records. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data collected included nutritional provision, time to initiation of nutrition, period of absent caloric intake, percentage of caloric intake obtained, and possible factors contributing to the delay or failure to implement nutrition. Thirty-one percent of patients (dogs 16/50, 32%; cats 2/8, 25%) received nutritional support during mechanical ventilation with all but 2 dogs receiving parenteral nutrition. Of those patients that did not receive nutrition (dogs 34/50, 68%; cats 6/8, 75%), documented contraindications or notations within the medical record for its omission were present in 16 of 34 dogs (47%) and 4 of 6 cats (66.7%). Thirteen animals (11 dogs, 2 cats) had >72 hours of absent caloric intake with only a small number of these receiving nutrition (dogs 4/11, 36.4%; cats 0/2, 0%). CONCLUSIONS Only 18 of 58 (31%) mechanically ventilated dogs and cats at our institution received nutritional support, and the majority of these were fed parenterally (16/18, 88.9%). For animals that did not receive nutrition, there was no clear reason for its absence in many cases. Animals with absent caloric intake >72 hours had poor implementation of nutritional support in contrast to current guidelines. A repeat audit after implementing changes to institutional protocols for nutritional provision is warranted to assess the impact on morbidity and mortality.
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Affiliation(s)
- Thomas D Greensmith
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Daniel L Chan
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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15
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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16
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Abstract
OBJECTIVES The aim of this study was to describe the clinicopathological findings, management and outcome of cats with refeeding syndrome (RS) following prolonged starvation. METHODS Records from four referral hospitals were searched between May 2013 and November 2019 and retrospectively evaluated. Inclusion criteria were the presence of a risk factor for RS, such as severe weight loss or emaciation following a period of presumed starvation, hypophosphataemia or a delta phosphorous exceeding 30% reduction following refeeding, being treated on the basis of a clinical diagnosis of RS and one or more derangement of hypokalaemia, hypoglycaemia or hyperglycaemia. RESULTS Eleven cats were identified, which had been missing for a median of 6 weeks (range 3-104 weeks). Mean ± SD percentage weight loss was 46% ± 7% (n = 8). Eight of 11 cats developed hypophosphataemia with a mean delta phosphorous of -47% ± 9%. All cats were documented to be hypokalaemic. During hospitalisation, 10/11 cats developed hyperglycaemia and 7/11 cats developed hypoglycaemia. Cardiovascular, gastrointestinal and neurological signs were common. Eight of 11 cats displayed new or progressive neurological deficits after refeeding, including mentation changes and cerebellar dysfunction. All cats became anaemic and seven cats required a blood transfusion. Eight cats survived to discharge after a mean of 14 ± 4 days of hospitalisation. Six cats developed acute kidney injury (AKI; International Renal Interest Society stage 1). The presence of AKI (P = 0.024) was associated with non-survival and maximum bilirubin concentration was significantly higher in non-survivors (P = 0.018). CONCLUSIONS AND RELEVANCE Cats with RS in this cohort had been missing, presumed starved, for more than 3 weeks. In addition to hypophosphataemia and hypokalaemia, altered glucose homeostasis and organ damage involving the liver and kidneys were common. Cats with RS appear to have a good prognosis, but prolonged intensive care is required.
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Affiliation(s)
- Simon Cook
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Emily Whitby
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | | | - Georgina Hall
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
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17
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Chan DL, Cruz JR, Mui WL, Wong SKH, Ng EKW. Outcomes with Intra-gastric Balloon Therapy in BMI < 35 Non-morbid Obesity: 10-Year Follow-Up Study of an RCT. Obes Surg 2020; 31:781-786. [PMID: 33034015 DOI: 10.1007/s11695-020-04986-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Intra-gastric balloon (IGB) therapy is the most established endoscopic treatment of obesity, but there is a paucity of literature on long-term efficacy. This study aims to evaluate the short- and long-term weight loss efficacy of IGB. MATERIALS AND METHODS Double-blinded RCT with 6-month IGB vs with sham endoscopy, in body mass index (BMI) 27-35 patients. Anthropometric, fasting glucose, and lipid profile measurement as early outcomes (up to 2 years) and 10-year follow-up. Primary outcomes were total body weight loss (kg) and BMI. Secondary outcomes were new-onset diabetes mellitus, other new comorbidities, and willingness for further intervention. RESULTS Initial RCT recruited 99 patients (50 IGB vs 49 sibutramine group). Forty-nine patients (26 IGB vs 23 control group) participated in a 10-year review (follow-up rate of 51.6%). Total body weight loss at 6 (9.75 vs 7.48 kg, p = 0.03), 12 (6.52 vs 4.42 kg, p = 0.05), 18 (5.42 vs 3.57, p = 0.32), and 24 months (4.07 vs 2.93 kg, p = 0.56) favored the IGB group. Total weight loss (TWL) at 10 years (0.03 vs - 2.32 kg, p = 0.05) and %TWL (- 0.16 ± 12.8% vs - 2.84 ± 5.6%, p = 0.39) were not significantly different between groups. Follow-up BMI (30.97 ± 1.6 vs 30.38 ± 1.8 kg/m2, p = 1.00) was similar. At 10 years, new-onset diabetes mellitus, sleep apnoea, metabolic syndrome, and arthralgia were not significant (p > 0.05). Twenty-three (81%) IGB group vs 13 (56%) control expressed a willingness for further intervention (p < 0.01). CONCLUSION IGB delivers weight loss to 2 years and is superior to control. However, new comorbidity development is not significantly different at 10 years. Patient that received IGB therapy were subsequently more willing for further bariatric metabolic intervention.
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Affiliation(s)
- Daniel L Chan
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Josil R Cruz
- Department of Surgery, Southern Philippines Medical Center, Davao City, Philippines
| | - Wilfred L Mui
- Hong Kong Bariatric and Metabolic Institute, Hong Kong, Hong Kong
| | - Simon K H Wong
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Enders K W Ng
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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18
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Abstract
Over the past couple of decades, a component of veterinary critical care was simply to ensure that nutritional support formed some part of the treatment plan. Great emphasis was made on early placement of feeding tubes in critically ill veterinary patients to facilitate enteral feeding. Progress has been made on techniques for nutritional provision, establishing feasibility of nutritional interventions in various patient populations and establishing that nutritional support does have an important role in veterinary critical care. Some refinement of appropriate caloric targets in critically ill animals has decreased complications relating to overfeeding, but further work is required to establish optimal feeding regimes.
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Affiliation(s)
- Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, RVC, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK.
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19
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Chan DL, Wong SKH, Lok HT, Iliopoulos J, Talbot ML, Hennessy A, Ng EKW. Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference. JGH Open 2020; 4:1074-1078. [PMID: 33319039 PMCID: PMC7731797 DOI: 10.1002/jgh3.12388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022]
Abstract
Background and Aim Obesity is becoming increasingly prevalent in Asia. Bariatric surgery in the region is growing in popularity to reflect increasing demand. Hiatal hernia (HH) is common among the obese population. There is a lack of evidence comparing preoperative endoscopy against intraoperative findings as a standard of reference for HH diagnosis. Methods This was a retrospective analysis of a bariatric procedure database from a single tertiary teaching hospital and high‐volume endoscopy center. Electronic medical records were reviewed. Endoscopy results were compared to intraoperative findings, and subgroup analysis of >2 cm hernias was performed. Sensitivity, specificity, predictive values, likelihood ratios, and global diagnostic test accuracy were calculated. Results A total of 434 patients were eligible for this study, of which HH was detected in 37 patients (prevalence rate 8.55%). Mean age was 41.51 ± 11.07 years, and body mass index was 39.37 ± 5.67 kg/m2. Endoscopy sensitivity was 75.68% (95% confidence interval, 58.80–88.23%) and specificity 91.44% (88.24–94.00%). Positive likelihood ratio was 8.53 (6.11–12.79) and negative likelihood ratio 0.27 (0.15–0.47). Positive predictive value was 45.16% (36.27–54.38%) and negative predictive value 97.58% (95.80–98.62%). Accuracy of endoscopy for preoperative HH diagnosis was 90.09% (86.89–92.74%). Conclusion Endoscopy can have a high diagnostic accuracy of preoperative HH diagnosis in obese Asian patients using intraoperative diagnosis as the reference standard.
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Affiliation(s)
- Daniel L Chan
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China.,School of Medicine Western Sydney University Sydney New South Wales Australia.,Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
| | - Simon K-H Wong
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
| | - Hon Ting Lok
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
| | - Jim Iliopoulos
- School of Medicine Western Sydney University Sydney New South Wales Australia
| | - Michael L Talbot
- School of Medicine Western Sydney University Sydney New South Wales Australia.,Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
| | - Annemarie Hennessy
- School of Medicine Western Sydney University Sydney New South Wales Australia
| | - Enders K-W Ng
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
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20
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Abstract
Case summary A 3-month-old entire female British Shorthair cat presented for further management of thermal burns after falling into a bath of scalding water. On presentation to the primary care clinician the kitten was obtunded, markedly painful and relatively bradycardic, consistent with a state of shock. The haircoat was wet, with erythematous skin and sloughing from the digital pads and anal mucosa. The primary care clinician administered opioid analgesia, sedation, antibiotics and started intravenous (IV) fluid therapy prior to referral. On arrival to the referral hospital the kitten was obtunded with respiratory and cardiovascular stability but was overtly painful and resistant to handling. The kitten required intensive management with IV and regional analgesia, IV broad-spectrum antibiosis, IV fluid therapy, enteral nutrition and wound management, including surgical debridement and topical antibiotic therapy. Septicaemia developed during the hospitalisation. Multidrug-resistant Escherichia coli and Pseudomonas aeruginosa were cultured, and antibiosis was escalated to IV imipenem. Acute respiratory distress syndrome was suspected following the development of dyspnoea. Early enteral nutrition within 24 h of admission was initiated using an oesophageal feeding tube and a veterinary therapeutic liquid diet. Over the ensuing 72 h the kitten started voluntary intake of food alongside oesophageal tube feeds. The kitten experienced continued weight loss despite the provision of nutritional support to meet, and then later exceed, the estimated resting energy requirements. Caloric intake was gradually increased to a total of 438% of the calculated resting energy requirement using the most recent daily body weight, eventually resulting in stabilisation of weight loss and weight gain. Relevance and novel information There is limited published information on the nutritional management of veterinary patients with thermal burn injury. Hypermetabolic states related to burn injuries are induced and maintained by complex interactions of catecholamines, stress hormones and inflammatory cytokines on proteolysis, lipolysis and glycogenolysis. Secondary infections are common following burn injury and the subsequent proinflammatory state perpetuates hypermetabolism and catabolism. These states present a challenge in both predicting and providing adequate nutrition, particularly in a paediatric septic patient. This subset of patients should be monitored closely during hospitalisation to ensure body weight and condition are maintained (while taking into consideration hydration status), and caloric intake is adjusted accordingly to meet nutritional support goals. Extensive research exists regarding the nutritional requirements and metabolic derangements of people with thermal burns. However, the importance of maintaining body weight and body condition in veterinary burn patients, and the association between nutritional support and reduced morbidity and mortality, has not been investigated and remains to be elucidated.
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Affiliation(s)
- Rachael Birkbeck
- Rachael Birkbeck DVM, MRCVS, Department of
Clinical Science and Services, The Royal Veterinary College, North Mymms,
Hatfield, Hertfordshire AL9 7TA, UK
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21
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Chen MZ, Chan DL, Alshahrani MS, Altoukhi K, Alzahrani N, Morris DL. Impact of Cytoreductive Surgery and HIPEC on Intraoperative Gastrointestinal Wall Thickness and Patient Outcomes. Anticancer Res 2020; 40:2865-2869. [PMID: 32366436 DOI: 10.21873/anticanres.14262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is associated with significant postoperative ileus (POI). This study examined intraoperative gastrointestinal wall thickness (GWT) and its association with patient outcomes. PATIENTS AND METHODS A prospective study of patients undergoing CRS and HIPEC. Proximal and distal small intestine GWT, before and after HIPEC were recorded. RESULTS Thirty-four patients (mean age=56.1 years, 61.8% female) were recruited. After HIPEC, the mean proximal (4.5 vs. 3.0 mm, p=0.03) and distal (4.3 vs. 3.4 mm, p<0.01) GWT were increased. Increased GWT was associated with prolonged operative time (10 vs. 8.5 h, p=0.03) and total length of stay (35.71 vs. 21.25 days, p=0.02). Postoperative ileus occurred in 23.5% of patients but differences between GWT groups did not reach significance (28.6% vs. 20%, p=0.56). CONCLUSION GWT increased significantly during CRS and HIPEC and is reflective of tissue trauma and oedema. This was associated with prolonged operative time, total length of stay and post-operative ileus.
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Affiliation(s)
- Michelle Zhiyun Chen
- Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Daniel L Chan
- Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - Khaled Altoukhi
- Department of Surgery, St. George Hospital, Kogarah, NSW, Australia
| | - Nayef Alzahrani
- Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
| | - David L Morris
- Department of Surgery, St. George Hospital, Kogarah, NSW, Australia .,Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
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Pereira R, Mimery A, Al-Askari M, De Clercq S, Chan DL. Repair of a paraumbilical hernia containing an incarcerated urachal remnant. ANZ J Surg 2020; 90:E114-E115. [PMID: 32227666 DOI: 10.1111/ans.15880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan Pereira
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
| | - Alexander Mimery
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
| | - Mohammed Al-Askari
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
| | - Stefaan De Clercq
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
| | - Daniel L Chan
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia.,Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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Humm KR, Chan DL. Prospective evaluation of the utility of cross-matching prior to first transfusion in cats: 101 cases. J Small Anim Pract 2020; 61:285-291. [PMID: 32133646 DOI: 10.1111/jsap.13124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To: (1) assess the frequency of crossmatch incompatibility in naïve feline blood transfusion recipients using two crossmatching methods, (2) measure the effect of crossmatch incompatibility on change in packed cell volume following transfusion, (3) assess the frequency of acute transfusion reactions and errors in blood transfusions in cats and (4) assess the impact of crossmatch incompatibility on the likelihood of transfusion reactions. MATERIALS AND METHODS Cats being administered a first AB-matched transfusion in a veterinary teaching hospital were prospectively recruited for this observational study. A slide agglutination method and a commercial test were both used for major and minor crossmatching. We measured increase in packed cell volume at 12 hours after transfusion relative to the mass of red blood cells given per recipient bodyweight and recorded transfusion reactions. RESULTS A total of 101 cats was included. Crossmatch incompatibility was common using the slide agglutination method (27% and 10% major and minor incompatibility, respectively), but less common with the commercial test (major and minor incompatibility both 4%). Crossmatch incompatibility with any method was not associated with less effective transfusion in terms of change in packed cell volume. Transfusion reactions occurred in 20 cats, most commonly febrile non-haemolytic transfusion reactions (n = 9) and haemolytic transfusion reactions (n = 7). The commercial test appeared to be most specific for predicting haemolytic transfusion reactions. CLINICAL SIGNIFICANCE Transfusion reactions were fairly common but not associated with increased mortality. Use of crossmatch-compatible blood did not lead to a greater increase in PCV at 12 hours. The commercial test may predict a haemolytic transfusion reaction.
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Affiliation(s)
- K R Humm
- Department of Clinical Science and Services, The Royal Veterinary College, London, AL97TA, UK
| | - D L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, London, AL97TA, UK
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24
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Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. ANZ J Surg 2019; 90:67-71. [PMID: 31566297 DOI: 10.1111/ans.15438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. METHODS A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. RESULTS Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133 min (range 45-290) and length of hospital stay 3 days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital-acquired pneumonia and pseudomembranous colitis. CONCLUSION Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Howard S Fan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Kristen E Elstner
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Anita S W Jacombs
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nabeel Ibrahim
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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25
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Stavert B, Chan DL, Ozmen J, Loi K. Laparoscopic totally extra-peritoneal groin hernia repair with self-gripping polyester mesh: a series of 780 repairs. ANZ J Surg 2019; 89:1261-1264. [PMID: 31452324 DOI: 10.1111/ans.15378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post-operative pain and infection. Post-operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self-gripping mesh, has a theoretical benefit of avoiding tacks for mesh-fixation. This case series reflects our long-term experience of this technique. METHODS We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re-operation as primary data points. RESULTS A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self-gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo-hernia repairs (0.38%). Post-operative follow-up was up to 4.4 years. CONCLUSIONS Our series of laparoscopic groin hernia repair with self-gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.
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Affiliation(s)
- Bethany Stavert
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - John Ozmen
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
| | - Ken Loi
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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26
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McBride D, Jepson RE, Cortellini S, Chan DL. Primary hemostatic function in dogs with acute kidney injury. J Vet Intern Med 2019; 33:2029-2036. [PMID: 31381195 PMCID: PMC6766483 DOI: 10.1111/jvim.15588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bleeding tendencies can occur with uremia. OBJECTIVES To characterize primary hemostatic function in dogs with acute kidney injury (AKI). ANIMALS Ten dogs with International Renal Interest Society AKI grade III or above and 10 healthy controls. METHODS Prospective study comparing PCV, platelet count, platelet aggregometry (Multiplate), and von Willebrand factor antigen to collagen binding activity ratio (vWF:Ag:vWF:CBA) in 2 groups of dogs (AKI group versus controls). Buccal mucosal bleeding time was measured in the AKI group only. Data are presented as median [25th, 75th percentile] unless otherwise stated. Significance was set at P < .05. RESULTS Mean PCV was significantly lower in the AKI (34.7%; ±SD, 8.8) than in the control (46.1%; ±SD, 3.6; P < .001) group. Platelet count was significantly higher in the AKI (350.5 × 103 /μL [301, 516]) than in the control (241 × 103 /μL [227, 251]; P = .01) group. Collagen-activated platelet aggregometry measured as area under the curve was significantly lower in the AKI (36.9 ± 17.7) than in the control (54.9 ± 11.2; P = .05) group. vWF:Ag:vWF:CBA was significantly higher in the AKI (2.2 [1.9, 2.6]) than in the control (1.1 [1.1, 1.2]; P = .01) group. There was a strong correlation between vWF:Ag:vWF:CBA and creatinine (r = 0.859; P < .001), but no other variables. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with AKI had decreased collagen-activated platelet aggregation and appear to have a type II von Willebrand disease-like phenotype as indicated by the high vWF:Ag:vWF:CBA.
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Affiliation(s)
- Duana McBride
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, London, United Kingdom
| | - Rosanne E Jepson
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, London, United Kingdom
| | - Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, London, United Kingdom
| | - Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, London, United Kingdom
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27
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Goggs R, Blais MC, Brainard BM, Chan DL, deLaforcade AM, Rozanski E, Sharp CR. American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal. J Vet Emerg Crit Care (San Antonio) 2019; 29:12-36. [PMID: 30654421 DOI: 10.1111/vec.12801] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/12/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. DESIGN Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. SETTINGS Academic and referral veterinary medical centers. RESULTS Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. CONCLUSIONS Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Daniel L Chan
- Department Clinical Science and Services, The Royal Veterinary College, London, United Kingdom
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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28
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Sharp CR, Goggs R, Blais MC, Brainard BM, Chan DL, deLaforcade AM, Rozanski E. Clinical application of the American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to small animal cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:121-131. [PMID: 30729652 DOI: 10.1111/vec.12804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case-based approach. ETIOLOGY Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis. DIAGNOSIS Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis. THERAPY Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included. PROGNOSIS In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus-based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.
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Affiliation(s)
- Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, Australia
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Daniel L Chan
- Department Clinical Science and Services, The Royal Veterinary College, North Mymms, UK
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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29
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Chan DL, Goggs R, Brainard BM, Blais MC, Sharp CR, deLaforcade A, Rozanski E. Safe and effective anticoagulation in small animals - Is that too much to ask? Long-awaited first steps. J Vet Emerg Crit Care (San Antonio) 2019; 29:9-11. [PMID: 30654414 DOI: 10.1111/vec.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 12/22/2019] [Accepted: 12/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, London, United Kingdom
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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30
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Tan CQY, Chan DL, Chu F, Fisher OM. Rare presentation of a Bochdalek hernia in adulthood with incarcerated splenic flexure of the colon mimicking diverticulitis: a report and review. ANZ J Surg 2018; 89:1518-1520. [PMID: 30497098 DOI: 10.1111/ans.14945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Charis Q Y Tan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Francis Chu
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Oliver M Fisher
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, The University of Notre Dame Australia, Sydney, New South Wales, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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31
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Gaszynski R, Lim C, Chan DL, Fisher OM, Das KK, Merrett N, Wilson R, Cosman P. Surgical ultrasonography at the bedside: a comparison of surgical trainees with trained sonographers for symptomatic cholelithiasis – a first Australian experience. ANZ J Surg 2018; 89:492-496. [PMID: 30484941 DOI: 10.1111/ans.14928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 09/30/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rafael Gaszynski
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
- Department of SurgeryCampbelltown Hospital Sydney New South Wales Australia
- Discipline of SurgeryWestern Sydney University Sydney New South Wales Australia
| | - Christopher Lim
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
- Department of SurgeryCampbelltown Hospital Sydney New South Wales Australia
- Discipline of SurgeryWestern Sydney University Sydney New South Wales Australia
| | - Daniel L. Chan
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
| | - Oliver M. Fisher
- Department of Surgery, Faculty of MedicineThe University of New South Wales Sydney New South Wales Australia
| | - Kamala Kanta Das
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
| | - Neil Merrett
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
- Department of SurgeryCampbelltown Hospital Sydney New South Wales Australia
- Discipline of SurgeryWestern Sydney University Sydney New South Wales Australia
| | - Robert Wilson
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
| | - Peter Cosman
- Upper Gastrointestinal Surgery UnitLiverpool Hospital Sydney New South Wales Australia
- Department of Surgery, Faculty of MedicineThe University of New South Wales Sydney New South Wales Australia
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32
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Skulberg R, Cortellini S, Chan DL, Stanzani G, Jepson RE. Description of the Use of Plasma Exchange in Dogs With Cutaneous and Renal Glomerular Vasculopathy. Front Vet Sci 2018; 5:161. [PMID: 30073173 PMCID: PMC6060235 DOI: 10.3389/fvets.2018.00161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/26/2018] [Indexed: 01/26/2023] Open
Abstract
Cutaneous and renal glomerular vasculopathy (CRGV) is a rare disease affecting dogs, with a recent apparent increase in prevalence since 2012 in the UK. This disease is characterized by a vasculopathy affecting small vessels of the kidney and skin, leading to thrombotic microangiopathy. The underlying etiology remains unknown although clinicopathological and histological findings resemble features of certain forms of thrombotic microangiopathy in people, for which plasma exchange (PEX) is considered an important component of therapy. The objective of the present study is to describe the use of PEX as adjunctive treatment in dogs diagnosed with CRGV. A retrospective review of dogs diagnosed with CRGV between 2014 and 2016 treated with PEX was performed. Clinical records were reviewed and data relating to signalment, diagnostic tests and management strategies were summarized. Information and complications relating to PEX were recorded. Six dogs were diagnosed with CRGV (n = 2 ante-mortem, n = 4 post-mortem) and underwent PEX as part of their therapy. All dogs had cutaneous lesions and were azotemic with oliguria or anuria. All dogs underwent at least one PEX cycle; one dog had a single cycle PEX, three dogs two cycles PEX, and two dogs had one cycle PEX and one cycle of prolonged intermittent renal replacement treatment. Complications seen during PEX therapy included hypothermia (n = 4), tachycardia (n = 2), hypotension (n = 2), and hypocalcemia (n = 6). Two dogs survived to discharge, the remaining four dogs were euthanized. The positive outcome in two dogs treated with PEX despite the reported high mortality rate once acute kidney injury with oliguria/anuria occurs does not confirm success of this treatment. However, survival in two dogs that were initially oligoanuric highlights that further consideration and evaluation of PEX for this patient group is warranted for this specific disease. Additional studies are urgently needed to identify the underlying etiology of CRGV before more targeted therapies can be developed. Based on our findings, further evaluation of the role of PEX in this specific disease are warranted.
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Affiliation(s)
- Ragnhild Skulberg
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Stefano Cortellini
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Daniel L Chan
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Giacomo Stanzani
- Division of Medicine, Bloomsbury Institute for Intensive Care Medicine, University College London, London, United Kingdom
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
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33
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Chan DL, Ravindran P, White SI. Anal tone may predict recurrence after botulinum toxin for chronic anal fissure. ANZ J Surg 2018; 88:385-386. [PMID: 29611359 DOI: 10.1111/ans.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,Faculty of Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Stephen I White
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,Faculty of Medicine, Bond University, Gold Coast, Queensland, Australia.,John Flynn Colorectal Centre, Gold Coast, Queensland, Australia
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34
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Chan DL, Thompson R, Lam M, Pavlakis N, Hallet J, Law C, Singh S, Myrehaug S. External Beam Radiotherapy in the Treatment of Gastroenteropancreatic Neuroendocrine Tumours: A Systematic Review. Clin Oncol (R Coll Radiol) 2018; 30:400-408. [PMID: 29615284 DOI: 10.1016/j.clon.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/15/2018] [Accepted: 03/16/2018] [Indexed: 12/16/2022]
Abstract
AIMS External beam radiotherapy (EBRT) is infrequently used to treat gastroenteropancreatic neuroendocrine tumours (GEPNETS), with little published data to date. We carried out a systematic review to assess the activity of EBRT for GEPNETS. MATERIALS AND METHODS Major databases were searched for papers including at least five patients treated with contemporary EBRT techniques. Eligible studies underwent dual independent review. The primary end points were response rate for lesions treated with definitive intent and recurrence-free survival for primary lesions treated with neoadjuvant or adjuvant intent. RESULTS Of 11 included studies (all retrospective), seven investigated pancreatic neuroendocrine tumours (PNETs, 100 patients, 14% grade 3) and four studies investigated extra-pancreatic neuroendocrine tumours (84 patients, 14% grade 3). Trials investigating PNETs administered a median of 50.4 Gy via three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. EBRT was given with neoadjuvant or adjuvant intent in 56 patients, with a recurrence rate of 15%. For the 44 patients not undergoing surgery, the radiological response rate was 46%. Grade 3 + toxicity rates were 11% (acute) and 4% (late). Twelve patients with anorectal neuroendocrine carcinoma received 58 Gy to the primary tumour. Seventy-two patients were treated to sites of metastatic disease (34 bone, 27 brain, 11 soft tissue). Local and distant control were poorly reported. Overall survival ranged from 9 to 19 months. No studies in this group reported toxicity outcomes. CONCLUSIONS There are limited, retrospective data on the overall activity and safety of EBRT in GEPNETS. EBRT generally seems to be well tolerated in selected PNET patients with encouraging activity. Well-designed prospective studies in clearly defined populations are required to clarify the role of EBRT in neuroendocrine tumours.
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Affiliation(s)
- D L Chan
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - R Thompson
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Lam
- University of Western Ontario, London, Canada
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - J Hallet
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - C Law
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - S Singh
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - S Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Goggs R, Borrelli A, Brainard BM, Chan DL, de Laforcade A, Goy-Thollot I, Jandrey KE, Kristensen AT, Kutter A, Marschner CB, Rannou B, Sigrist N, Wagg C. Multicenter in vitro thromboelastography and thromboelastometry standardization. J Vet Emerg Crit Care (San Antonio) 2018; 28:201-212. [DOI: 10.1111/vec.12710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/22/2017] [Accepted: 03/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca NY
| | - Antonio Borrelli
- Department of Veterinary Science; University of Turin; Grugliasco Italy
| | | | - Daniel L. Chan
- Department of Clinical Sciences and Services; Royal Veterinary College; London UK
| | | | | | | | | | - Annette Kutter
- Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - Clara B. Marschner
- Department of Veterinary Clinical and Animal Sciences; University of Copenhagen; Denmark
| | - Benoît Rannou
- VetAgro Sup; Campus Vétérinaire de Lyon; Marcy l′Étoile France
| | - Nadja Sigrist
- Vetsuisse Faculty; University of Zurich; Zurich Switzerland
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Cole L, Barfield D, Chan DL, Cortellini S. Use of a modified thromboelastography assay for the detection of hyperfibrinolysis in a dog infected with
Angiostrongylus vasorum. Vet rec case rep 2018. [DOI: 10.1136/vetreccr-2017-000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Laura Cole
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Dominic Barfield
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Daniel L Chan
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesRoyal Veterinary CollegeLondonUK
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Chan DL, Ravindran P, Chua D, Smith JD, Wong KS, Ghusn MA. A case report of gastric lymphocytic phlebitis, a rare mimic for malignancy. Int J Surg Case Rep 2017; 41:269-271. [PMID: 29121583 PMCID: PMC5681333 DOI: 10.1016/j.ijscr.2017.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022] Open
Abstract
Gastric lymphocytic phlebitis is a rare benign venous inflammatory disease. This is the fourth case in the reported literature. Endoscopic and laparoscopic features are often a mimic for gastric malignancy. Given scarcity, surgical resection for histological confirmation is reasonable.
Introduction Lymphocytic phlebitis is a benign condition characterised by inflammation of the veins and rarely affects the gastrointestinal tract. Reported cases present as acute abdomen and involve the colon or small intestine. We report the fourth case of gastric lymphocytic phlebitis in the literature. Presentation of case A 74-year-old female presented with eight weeks of abdominal pain. Findings at endoscopy were suggestive of a malignant ulcer on the greater curvature of antrum, while biopsies showed chronic gastritis without malignancy. Appearance at diagnostic laparoscopy was consistent with a malignant gastric ulcer with serosal changes. Due to persistent pain and the macroscopic appearance, she proceeded to have an open subtotal gastrectomy and D2 lymph node clearance. Despite macroscopic appearance, the microscopic examination demonstrated no malignancy, and was consistent with lymphocytic phlebitis with overlying ulceration. Discussion This case was a mimic for gastric malignancy, with the benign diagnosis only being made after surgical resection. Gastric lymphocytic phlebitis is a rare differential diagnosis for gastric ulcers when biopsies are negative, although preoperative diagnosis is difficult given the lesions do not involve the mucosa. Conclusion If clinical history and endoscopic findings are suspicious for malignancy, despite normal biopsies, an aggressive surgical resection remains reasonable given the rarity gastric lymphocytic phlebitis.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia.
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Dorothy Chua
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Jason D Smith
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia
| | - King S Wong
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Michael A Ghusn
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
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Chan DL, Chua D, Ravindran P, Perez Cerdeira M, Mor I. A case report of endometriosis presenting as an acute small bowel obstruction. Int J Surg Case Rep 2017; 41:17-19. [PMID: 29024840 PMCID: PMC5742011 DOI: 10.1016/j.ijscr.2017.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/28/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Endometriosis is a common and benign condition that causes significant morbidity to women of childbearing age. It uncommonly affects the gastrointestinal tract and rarely manifests as an acute small bowel obstruction. PRESENTATION OF CASE A 46-year old female presented to the emergency department with signs and symptoms consistent with an acute small bowel obstruction. She had a paucity of background surgical history, having only had a laparoscopic cholecystectomy. Her CT demonstrated small bowel obstruction with a transition point in the distal ileum. Given the site of obstruction was remote from previous surgery, a high index of suspicion was maintained and early laparoscopy performed the same day. Operative findings were consistent with an endometrial stricture of the distal ileum and a formal resection was performed. DISCUSSION Endometriosis that affects the gastrointestinal tract often presents with non-specific symptoms. This is a rare case of an acute small bowel obstruction as the index symptom of endometriosis in a peri-menopausal patient. This is the first case in the literature to describe same day laparoscopy and small bowel resection of such a case and a prolonged preoperative period and misdiagnoses previously described were avoided due to clinical suspicion. CONCLUSION Endometriosis as a differential should be considered with a high index of suspicion in pre-menopausal women, particularly in patients with negligible previous surgical history. There should be a low threshold for early laparoscopy and resection of affected bowel in these patients.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; The Faculty of Medicine, University of New South Wales, Australia.
| | - Dorothy Chua
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | | | - Isabella Mor
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
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Doolin KS, Chan DL, Adamantos S, Humm K. Retrospective evaluation of unexpected events during collection of blood donations performed with and without sedation in cats (2010-2013). J Vet Emerg Crit Care (San Antonio) 2017; 27:555-560. [PMID: 28795784 DOI: 10.1111/vec.12643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/09/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Describe unexpected events (UEs) that occurred during blood donation in cats with and without sedation. DESIGN Retrospective observational study (2010-2013). SETTING University teaching hospital. ANIMALS Client-owned healthy cats enrolled in a blood donation program. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood collection for transfusion was performed 115 times from 32 cats. Seventy donation events were in unsedated cats and 45 in sedated cats. For each collection, the anticipated blood volume to be collected, actual blood volume collected, sedation protocol, and any UE in the peridonation period were recorded. There were 6 categories of UEs: movement during donation, donor anxiety, inadequate collected blood volume, jugular vessel related UEs, additional sedation requirement, and cardiorespiratory distress. Fisher's exact test was used to compare the frequency of UEs between sedated and unsedated cats. UEs were recorded in 54 of 115 collections. In the donor population, movement was reported as an UE in 0 cats that donated under sedation and 24/70 (34.3%) cats that donated without sedation (P < 0.001). Donor anxiety occurred in 2/45 (4.4%) cats that donated under sedation and 14/70 (20.0%) cats that donated unsedated (P = 0.014). Unsedated donation did not increase the likelihood of inadequate donation volume, jugular vessel related UEs, or cardiorespiratory distress. Eight of 45 (17.8%) sedated donations required additional sedation. CONCLUSIONS Movement during donation and signs of donor anxiety were more frequent in unsedated cats. These were considered minor issues, expected in unsedated cats being gently restrained. Blood collection from unsedated feline donors is a viable alternative to sedated donation.
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Affiliation(s)
- Kerry S Doolin
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, UK
| | - Daniel L Chan
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, UK
| | - Sophie Adamantos
- Langford Veterinary Services, University of Bristol, Langford, Bristol, UK
| | - Karen Humm
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, UK
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Bull N, Chan DL, Ravindran P, Sano SD, White SI. Gastric outlet obstruction secondary to parastomal hernia: case report and literature review. ANZ J Surg 2017; 89:E96-E97. [PMID: 28608395 DOI: 10.1111/ans.14066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/31/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas Bull
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Suzanne D Sano
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Stephen I White
- Department of Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,John Flynn Colorectal Centre, John Flynn Hospital, Tugun, Queensland, Australia
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Tran S, Choi V, Hepburn K, Hewitt N, Zhou J, Chan DL, Talbot ML. Subspecialty approach for the management of acute cholecystitis: an alternative to acute surgical unit model of care. ANZ J Surg 2017; 87:560-564. [PMID: 28512772 DOI: 10.1111/ans.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional 'generalist' general surgery approach or the ASU model. METHOD A 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy. RESULTS Seven hundred emergency laparoscopic cholecystectomies were performed over this time. A total of 486 patients were available for analysis. The median time to operation was 2 days and median length of operation was 80 min. A total of 86.9% were performed during daylight hours. Eight cases were converted to open surgery (1.6%). Intra-operative cholangiography was performed in 408 patients. The major complication rate was 8.2%, including retained common bile duct stones (2.3%), sepsis (0.2%), post-operative bleeding (0.4%), readmission (0.6%), bile leak (2.1%), AMI (0.4%), unscheduled return to theatre (0.6%) and pneumonia (0.8%). There were no mortalities and no common bile duct injuries. CONCLUSION Over a time period that encompasses the current publications on the ASU model, a subspecialty model of care has shown consistent results that exceed established benchmarks. Subspecialty management of complex elective pathologies has become the norm in general surgery and this study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to ASU. Access block to emergency theatres delays treatment and prolongs hospital stay.
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Affiliation(s)
- Sonia Tran
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Vincent Choi
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Kirsten Hepburn
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Nathan Hewitt
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Joel Zhou
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Affiliation(s)
- Frances Taylor-Brown
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA
| | - Elsa Beltran
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA
| | - Daniel L Chan
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA
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Affiliation(s)
- Daniel L Chan
- Professor of Emergency and Critical Care Medicine and Clinical Nutrition, Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of, London, UK
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Li RHL, Chan DL. Evaluation of platelet function using multiple electrode platelet aggregometry in dogs with septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2016; 26:630-8. [PMID: 27428542 DOI: 10.1111/vec.12508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/18/2015] [Accepted: 12/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess platelet function via multiple electrode platelet aggregometry (MEPA) in dogs with septic peritonitis and in healthy dogs. The secondary aim was to determine if there is prognostic significance to changes in platelet function observed in septic dogs. DESIGN Prospective, observational cohort study conducted from January 2012 to March 2014. SETTING University teaching hospital. ANIMALS Twenty dogs with septic peritonitis and 23 healthy dogs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS MEPA using arachidonic acid, adenosine diphosphate, and collagen (COL) as agonists was measured within 24 hours of diagnosis of sepsis. Compared to healthy dogs, platelet aggregation was reduced in dogs with septic peritonitis for all agonists (P < 0.01). Overall mortality rate was 40%. MEPA in response to COL was significantly reduced in nonsurvivors compared to survivors (P = 0.019). Using receiver-operating characteristic curve statistics, a COL-activated MEPA less than 43.5 aggregation units had a sensitivity and specificity of 85.7% and 90.9%, respectively, for predicting nonsurvival in dogs with septic peritonitis. CONCLUSIONS Circulating platelets from dogs with septic peritonitis have diminished aggregation in response to multiple platelet agonists. MEPA may serve as an assessment tool for illness severity in this patient population.
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Affiliation(s)
- Ronald H L Li
- Section of Emergency and Critical Care, Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK. .,Dr. Li's current address: Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, UC Davis, Davis, CA.
| | - Daniel L Chan
- Section of Emergency and Critical Care, Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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Goggs R, Dennis SG, Di Bella A, Humm KR, McLauchlan G, Mooney C, Ridyard A, Tappin S, Walker D, Warman S, Whitley NT, Brodbelt DC, Chan DL. Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Intern Med 2015; 29:1603-10. [PMID: 26473338 PMCID: PMC4864895 DOI: 10.1111/jvim.13642] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Outcome prediction in dogs with immune‐mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified. Objectives An online case registry was initiated to: prospectively survey canine IMHA presentation and management in the British Isles; evaluate 2 previously reported illness severity scores, Canine Hemolytic Anemia Score (CHAOS) and Tokyo and to identify independent prognostic markers. Animals Data from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012. Methods Outcome prediction by previously reported illness‐severity scores was tested using univariate logistic regression. Independent predictors of death in hospital or by 30‐days after admission were identified using multivariable logistic regression. Results Purebreds represented 89.1% dogs (n = 246). Immunosuppressive medications were administered to 88.4% dogs (n = 244), 76.1% (n = 210) received antithrombotics and 74.3% (n = 205) received packed red blood cells. Seventy‐four per cent of dogs (n = 205) were discharged from hospital and 67.7% (n = 187) were alive 30‐days after admission. Two dogs were lost to follow‐up at 30‐days. In univariate analyses CHAOS was associated with death in hospital and death within 30‐days. Tokyo score was not associated with either outcome measure. A model containing SIRS‐classification, ASA classification, ALT, bilirubin, urea and creatinine predicting outcome at discharge was accurate in 82% of cases. ASA classification, bilirubin, urea and creatinine were independently associated with death in hospital or by 30‐days. Conclusions and clinical importance Markers of kidney function, bilirubin concentration and ASA classification are independently associated with outcome in dogs with IMHA. Validation of this score in an unrelated population is now warranted.
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Affiliation(s)
- R Goggs
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - S G Dennis
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Di Bella
- Vets Now Referrals Kent, Blue Bell Hill, UK
| | - K R Humm
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
| | | | - C Mooney
- University College Dublin, Dublin, Ireland
| | - A Ridyard
- University of Edinburgh, Edinburgh, UK
| | - S Tappin
- Dick White Referrals, Six Mile Bottom, UK
| | - D Walker
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - S Warman
- Companion Animal Studies, University of Bristol, Langford, UK
| | - N T Whitley
- Davies Veterinary Specialists, Higham Gobion, UK
| | - D C Brodbelt
- Production and Population Health, Royal Veterinary College, North Mymms, UK
| | - D L Chan
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
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Affiliation(s)
| | - Daniel L Chan
- Professor of Emergency and Critical Care Medicine and Clinical Nutrition, both at The Royal Veterinary College, North Mymms, Herts AL9 7TA
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Chan DL, Alzahrani NA, Morris DL, Chua TC. Systematic review and meta-analysis of hepatic arterial infusion chemotherapy as bridging therapy for colorectal liver metastases. Surg Oncol 2015; 24:162-71. [PMID: 26133575 DOI: 10.1016/j.suronc.2015.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/17/2015] [Accepted: 06/20/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) has been shown to be beneficial in the management of unresectable colorectal liver metastases (CRLM). This systematic review evaluates the potential role of HAIC as a neoadjuvant downstaging therapy, prior to hepatic resection with curative intent for initially unresectable CRLM. METHODS A literature search was conducted using Pubmed, EMBASE and Medline databases from January 2000 to November 2013. Studies adopting HAIC as a neoadjuvant bridging therapy for hepatic resection for CRLM were included. RESULTS Eleven studies (n = 1514) were included. HAIC response rate was 50% and achieved conversion to surgery rate in 18% of patients. The median overall and 5-year survival for patients who underwent conversion to hepatectomy was 53 months and 49% compared to 16 months and 3% for patients who did not undergo surgery. Meta-analysis demonstrated strong association between hepatectomy and improved 5-year survival (RR 0.56, 95% CI = 0.48-0.65, Z = 7.26, p < 0.00001). CONCLUSION For patients presenting with unresectable CRLM, HAIC in conjunction with current systemic chemotherapy may allow some patients to undergo resection and potentially provide long-term survival.
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Affiliation(s)
- Daniel L Chan
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia
| | - Nayef A Alzahrani
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia
| | - David L Morris
- UNSW Department of Surgery, St George Clinical School, Kogarah, NSW, Australia
| | - Terence C Chua
- Department of Surgery, Ryde Hospital, Northern Sydney Local Health District, Denistone, NSW, Australia; The Systematic Review Unit, The Collaborative Research (CORE) Group, Kogarah, NSW, Australia.
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Chan DL. Listening to the body's response--a dedication to the teachings of Dr. Steve C. Haskins. J Vet Emerg Crit Care (San Antonio) 2015; 24:489-90. [PMID: 25277852 DOI: 10.1111/vec.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamzianpour N, Chan DL. Thromboelastographic assessment of the contribution of platelets and clotting proteases to the hypercoagulable state of dogs with immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio) 2015; 26:295-9. [DOI: 10.1111/vec.12315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Negar Hamzianpour
- Department of Clinical Science and Services, The Royal Veterinary College; University of London; North Mymms Hatfield UK
| | - Daniel L. Chan
- Department of Clinical Science and Services, The Royal Veterinary College; University of London; North Mymms Hatfield UK
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Chan DL. The swinging pendulum between consensus and controversy in veterinary emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2015; 25:1-3. [PMID: 25597283 DOI: 10.1111/vec.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel L Chan
- The Royal Veterinary College, University of London, UK
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