Surgical management of intrathoracic wooden skewers migrating from the stomach and duodenum in dogs: 11 cases (2014-2020)

Objectives

To describe the clinical presentation, management and outcome of cases presenting with intrathoracic wooden skewers originating from the abdominal gastrointestinal tract.

Materials and Methods

Clinical records of dogs presented and treated for an intrathoracic wooden skewer were reviewed from June to August 2020. Data included signalment, clinical presentation, duration of clinical signs, haematological and biochemical abnormalities, diagnostic imaging findings, surgical procedure, postoperative complications and outcome.

Results

Eleven dogs were included in the study. In all cases, the foreign body was identified as a wooden skewer. The most common clinical signs were anorexia/hyporexia (n=7), vomiting/regurgitation (n=7), lethargy (n=6), pyrexia (n=4) and gait abnormalities/lameness (n=3). CT correctly identified a wooden skewer in all cases when performed (n=7). A coeliotomy combined with transdiaphragmatic thoracotomy was performed in six of 11 cases (55%), a coeliotomy combined with median sternotomy in four of 11 cases (36%) and a median sternotomy alone was performed in one case. Foreign bodies penetrated from the stomach (n=10) or the duodenum (n=1). Intrathoracic trauma was most commonly identified to the lungs (n=3) and pericardium (n=3). Complications occurred in three of 11 cases (27%), two minor and one resulting in death. Ten of the 11 cases (91%) survived to discharge. Long‐term outcome was available for seven of 11 cases (66%), all of them excellent.

Clinical Significance

Despite the challenges of managing wooden skewers penetrating the thoracic cavity from the abdominal gastrointestinal tract, the majority of the patients are stable to undergo diagnostic procedures, surgical exploration and management with low morbidity and excellent short‐ and long‐term prognosis.

Outcome of caudal superficial epigastric axial pattern flaps in dogs and cats: 70 cases (2007-2020)

OBJECTIVES

To describe the outcome and complications associated with the use of caudal superficial epigastric axial pattern flaps in dogs and cats.

MATERIAL AND METHODS

Multicentre retrospective review and descriptive study of clinical records of dogs and cats having undergone caudal superficial epigastric axial pattern flaps between 2007 and 2020. Data retrieved included signalment, aetiology of surgical defect, tumour type, presence/absence of clean surgical margins, presence/absence of post-operative wound infection, use of peri- and post-operative antibiotics, duration of anaesthesia, duration of surgery, presence and duration of hypothermia, presence and duration of hypotension, presence/absence of post-operative surgical drain and length of caudal superficial epigastric axial pattern flap. The incidence of complications and outcomes were documented.

RESULTS

Seventy cases met the inclusion criteria; 51 dogs and 19 cats. In dogs, 67% of cases developed complications (59% minor, 8% major) and 33% had uneventful wound healing. In cats, 53% of cases developed complications, (47% minor, 5% major) and 47% had uneventful wound healing. In dogs, the percentage of cases experiencing dehiscence, necrosis, seroma, oedema and post-operative infection was 31%, 29%, 26%, 26% and 16% respectively. In cats, this was 26%, 16%, 11%, 0% and 5% respectively. A good overall outcome was seen in 77% of dogs and 79% of cats. A poor overall outcome was seen in 4% of dogs and 0% of cats.

CLINICAL SIGNIFICANCE

Caudal superficial epigastric axial pattern flaps are traditionally thought more robust than other flaps, yet complication rates remain high, despite a high overall success rate.

Can concordance between actual care received and a pathway map be measured on a population level in Ontario? A pilot study

Background

Clinical pathways are associated with improved adherence to clinical guidelines; however, most studies have evaluated pathways for a single intervention at a single institution. The objective of the present study was to develop and evaluate a method of measuring concordance with a population-based clinical pathway map to determine if that method could be feasible for assessing overall health system performance.

Methods

Patients with stage ii or iii colon cancer diagnosed in 2010 were identified, and clinical data were obtained through linkages to administrative databases. Pathway concordance was defined a priori based on receipt of key elements of the Ontario Health (Cancer Care Ontario) colorectal pathway maps. For stages ii and iii colon cancer alike, concordance was reported as the proportion of patients receiving care that followed the predefined key elements of the pathway map. Regression analysis was used to identify predictors of concordant care.

Results

Our study identified 816 patients with stage ii and 800 patients with stage iii colon cancer. Of the patients with stage ii disease, 70% (n = 571) received concordant care. Of the patients with stage iii disease, results showed high concordance for all key elements except receipt of chemotherapy, leading to an overall concordance rate of 39% for that cohort.

Conclusions

Our method of measuring concordance was feasible on a population-based level, but future studies to validate it and to develop more sophisticated methods to measure concordance in larger cohorts and various disease sites are necessary. Measurement of clinical pathway concordance on a population-based level has the potential to be a useful tool for assessing system performance.

Abstract P3-12-11: Prophylactic application of SkinSafe film strips to the inframammary fold prevents moist desquamation during irradiation for breast cancer in a prospective trial

Purpose: To investigate the effect of prophylactic use of SafeSkin films strips applied to the inframammary fold during whole breast or reconstructed breast irradiation to avoid moist desquamation to the inframammary fold.

Materials and Methods: Between November 15, 2016 and April 17, 2018, a total of 30 patients were recruited, with 29 patients contributing to analysis, and one patient with bilateral breast cancer. Areas of the breast treatment field not covered by the film were treated with physician's choice of cream, (80% Jean's Cream, 13% Aquafor, and 7% with no topical therapy). The treatment field was photographed weekly. SkinSafe strips were reapplied as needed, but were not applied if erythema was already observed in the inframammary fold. Severity of skin reaction was assessed using the RTOG scale.

Results: There was only one treatment interruption, against medical advice, due to axillary discomfort. One patient refused further trial participation after the first day. No short or long term side effects of film use were noted. Inframammary desquamation developed in only one patient, who tried to replicate the increased comfort of her inframammary tape with adhesive bandages when her tape came off. There was no moist desquamation under the SkinSafe film in the inframammary field in any patient. Axillary moist desquamation, where no film, but rather physician's choice of topical cream was applied, remained at 35%. Areas of skin adjacent to the SkinSafe film showed desquamation in 9.7% of patients, 0.5-1 cm in maximal diameter, all of which had resolved at time of completion.

Conclusions: Prophylactic use of SkinSafe film strips applied to the inframammary fold substantially reduces or eliminates the risk of inframammary desquamation during breast radiation.

Citation Format: Garren D, Le B, Vasireddy R, Flynn L, Forster K, Malina L, Dorfman Y. Prophylactic application of SkinSafe film strips to the inframammary fold prevents moist desquamation during irradiation for breast cancer in a prospective trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-11.

Swift and NuSTAR observations of GW170817: Detection of a blue kilonova

With the first direct detection of merging black holes in 2015, the era of gravitational wave (GW) astrophysics began. A complete picture of compact object mergers, however, requires the detection of an electromagnetic (EM) counterpart. We report ultraviolet (UV) and x-ray observations by Swift and the Nuclear Spectroscopic Telescope Array of the EM counterpart of the binary neutron star merger GW170817. The bright, rapidly fading UV emission indicates a high mass (≈0.03 solar masses) wind-driven outflow with moderate electron fraction (Y_e ≈ 0.27). Combined with the x-ray limits, we favor an observer viewing angle of ≈30° away from the orbital rotation axis, which avoids both obscuration from the heaviest elements in the orbital plane and a direct view of any ultrarelativistic, highly collimated ejecta (a γ-ray burst afterglow).

Asymmetries in core-collapse supernovae from maps of radioactive 44Ti in Cassiopeia A

Asymmetry is required by most numerical simulations of stellar core-collapse explosions, but the form it takes differs significantly among models. The spatial distribution of radioactive (44)Ti, synthesized in an exploding star near the boundary between material falling back onto the collapsing core and that ejected into the surrounding medium, directly probes the explosion asymmetries. Cassiopeia A is a young, nearby, core-collapse remnant from which (44)Ti emission has previously been detected but not imaged. Asymmetries in the explosion have been indirectly inferred from a high ratio of observed (44)Ti emission to estimated (56)Ni emission, from optical light echoes, and from jet-like features seen in the X-ray and optical ejecta. Here we report spatial maps and spectral properties of the (44)Ti in Cassiopeia A. This may explain the unexpected lack of correlation between the (44)Ti and iron X-ray emission, the latter being visible only in shock-heated material. The observed spatial distribution rules out symmetric explosions even with a high level of convective mixing, as well as highly asymmetric bipolar explosions resulting from a fast-rotating progenitor. Instead, these observations provide strong evidence for the development of low-mode convective instabilities in core-collapse supernovae.

Hair bleaching and skin burning

Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.

Retained surgical swabs in 13 dogs

To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats that were referred to four referral centres were reviewed. Cases in which a retained surgical swab was identified during surgery at the referral hospital were selected for further study. The signalment, history, clinical signs, diagnostic and surgical findings and outcome in these cases were reviewed. Thirteen dogs with retained surgical swabs were included in the study. Bodyweight ranged from 9 to 45 kg. The initial surgery was a 'non-routine' abdominal procedure in seven dogs, ovariohysterectomy in five dogs and perineal hernia repair in one dog. Time from initial surgery to presentation at the referral centre ranged from four days to seven years. Treatment involved major surgery in eight of the 13 dogs. Outcome was excellent in 12 of 13 cases, one dog was euthanased.

Evaluation of Fiducial Marker Migration and Respiratory-Induced Motion for Image Guided Radiotherapy in Whole Breast Irradiation

Purpose: Image guided radiation therapy (IGRT) may be beneficial to improve set up accuracy and reduce treatment margins, therefore improving efficacy while decreasing long term toxicity of whole breast irradiation (WBI). In order to assess if intraparenchymal fiducials can facilitate the use of IGRT, this study quantifies fiducial motion over the normal course of whole breast irradiation.Materials and Methods: On a prospective IRB-approved protocol, fiducials were placed in fourteen patients who were then treated with 3D conformal WBI. Three or four intraparenchymal gold fiducial markers were placed in each patient at the periphery of the surgical bed intraoperatively. Free breathing 4D CT image sets were obtained at pre-treatment simulation and then every two weeks over a six week course of treatment. Each fiducial marker was contoured at end-inspiration and end-expiration on all 4D CT image sets. The effects of respiration induced motion were assessed by comparing the positions of the fiducials between inspiration and expiration. Overall fiducial migration was determined by comparing the relative positions of each marker to one another from the pre-treatment and post-treatment 4D CT image sets.Results: The 4D CT image sets were acquired over a period of 55±4 days with a range of 49 to 60 days. The respiration induced fiducial motion, as measured by the average change in the fiducials' center of mass, was 0.8±0.6 mm with a range of 0 to 2.2 mm. The average fiducial displacement over the course of treatment as determined from relative seed position from the image sets was 1.5±1.2 mm with a range of 0.1 to 3.3 mm for all individual fiducials with 71% of the fiducials moving closer to each other and 29% away from each other.Conclusions: The preliminary results of using gold fiducials for breast IGRT are promising. Fiducial position was very stable during treatment, and there was very little respiration induced motion. Using IGRT, there is the potential to improve the accuracy of daily set-up and to reduce margins in WBI. Better tumor bed localization and reduced margin size will decrease the volume of normal tissue treated, which may translate into improved local control by ensuring accurate coverage of the target volumes throughout the treatment course and improvement in cosmesis and other long term toxicities.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4113.

Efficacy of antiviral agents in feline herpetic keratitis: Results of anin vitrostudy

PURPOSE

To determine, by a plaque reduction assay, the in vitro efficacy of novel antiviral agents in the treatment of feline herpes virus 1 (FHV-1) keratitis in the domestic cat (Felis felis).

MATERIALS AND METHODS

A standard plaque reduction assay was performed using a laboratory strain of FHV-1 and embryo-derived feline kidney cells to determine the in vitro efficacy of the antiviral drugs penciclovir (PCV), bromovinyldeoxyuridine (BVdU), and (S)-9-(3-hydroxy-2-phosphonylmethoxypropyl) adenine (HPMPA) and to compare these with the drugs acyclovir (ACV) and trifluorothymidine (TFT). Efficacy was assessed by determining the dose of drug at which 50% plaque reduction was noted (ED(50)).

RESULTS

HPMPA was found to have greatest antiviral activity (ED(50) 0.07 microg/ml). ACV was least active (ED(50) 24 microg/ml), while TFT was active with an ED(50) of 5.7 microg/ml. PCV and BVdU had intermediate activity (ED(50) 1.6 and 1.7 microg/ml, respectively).

CONCLUSIONS

This study suggests that the efficacy of HPMPA, BVdU, and penciclovir in cats with herpesviral keratitis should be determined in vivo as their efficacy in vitro was substantially greater than that of acyclovir, already shown to have demonstrable but limited clinical antiviral activity.