Freehand diffuse optical spectroscopy imaging for intraoperative identification of major venous and arterial vessels underlying peritoneal fat: an in vivo demonstration in a pig model

Inadvertent injury to important anatomic structures is a significant risk in minimally invasive surgery (MIS) that potentially requires conversion to an open procedure, which results in increased morbidity and mortality. Surgeons operating minimal-invasively currently do not have an easy-to-use, real-time device to aid in intraoperative identification of important anatomic structures that underlie tissue planes. We demonstrate freehand diffuse optical spectroscopy (DOS) imaging for intraoperatively identifying major underlying veins and arteries. An applicator probe that can be affixed to and detached from an 8-mm laparoscopic instrument has been developed. The 10-mm DOS source-detector separation renders sampling of tissue heterogeneities a few millimeters deep. DOS spectra acquired consecutively during freehand movement of the applicator probe on the tissue surface are displayed as a temporal and spectral image to assist in spatially resolved identification of the underlying structures. Open surgery identifications of the vena cava and aorta underlying peritoneal fat of ∼4  mm in thickness using the applicator probe under room light were demonstrated repeatedly in multiple pigs in vivo.

In vivo assessment of diet-induced rat hepatic steatosis development by percutaneous single-fiber spectroscopy detects scattering spectral changes due to fatty infiltration

This study explores percutaneous single-fiber spectroscopy (SfS) of rat livers undergoing fatty infiltration. Eight test rats were fed a methionine-choline-deficient (MCD) diet, and four control rats were fed a normal diet. Two test rats and one control rat were euthanized on days 12, 28, 49, and 77 following initiation of the diet, after percutaneous SfS of the liver under transabdominal ultrasound guidance. Histology of each set of the two euthanized test rats showed mild and mild hepatic lipid accumulations on day 12, moderate and severe on day 28, severe and mild on day 49, and moderate and mild on day 77. Livers with moderate or higher lipid accumulation generally presented higher spectral reflectance intensity when compared to lean livers. Livers of the eight test rats on day 12, two of which had mild lipid accumulation, revealed an average scattering power of 0.37±0.14 in comparison to 0.07±0.14 for the four control rats (p<0.01 ). When livers of the test rats with various levels of fatty infiltration were combined, the average scattering power was 0.36±0.15 0.36±0.15 in comparison to 0.14±0.24 of the control rats (0.05<p<0.1). Increasing lipid accumulation in concentration and size seemed to cause an increase of the scattering power prior to increasing total spectral reflectance.

Percutaneous single-fiber reflectance spectroscopy of canine intervertebral disc: is there a potential for in situ probing of mineral degeneration?

BACKGROUND AND OBJECTIVES

Intervertebral disc herniation is a common disease in chondrodystrophic dogs, and a similar neurologic condition also occurs in humans. Percutaneous laser disc ablation (PLDA) is a minimally invasive procedure used increasingly for prevention of disc herniation. Currently, PLDA is performed on thoracolumbar discs with the same laser energy applied regardless of the differing extent of degeneration among mineralized discs. In a previous study performed on 15 normal and 6 degenerated intervertebral discs in chondrodystrophoid canine species, it was demonstrated that percutaneous single-fiber reflectance spectroscopy (SfRS) detected increased light scattering from mineralized intervertebral discs when comparing to normal discs. The objective of this study is to evaluate how SfRS evaluation of mineralized discs in situ fairs with X-ray radiography and computed tomography (CT) diagnoses and if SfRS sensing of the scattering changes correlates with the level of mineral degeneration in nucleus pulposus.

MATERIALS AND METHODS

Percutaneous SfRS was performed on a total of 28 intervertebral discs of three dogs post-mortem, through a 20 gauge spinal needle standard to PLDA. The raw SfRS measurement was normalized to extract a dimension-less spectral intensity profile, from which the average over 600-900 nm was used as the SfRS intensity index to compare among the measured discs. The discs were imaged prior to percutaneous SfRS by radiography and CT, and harvested after percutaneous SfRS for histopathologic examinations.

RESULTS

Five among 10 discs of dog #1, six among 9 discs of dog #2, and nine out of 9 discs of dog #3 were determined by histopathology to have central focal or multi-focal areas of mineralization occupying 5-75% of the examined area of nucleus pulposus. The overall numbers of discs with detectable and undetectable central mineralization were 20 and 8, respectively. CT resulted in one false positive (FP) and four false negative (FN) diagnoses for dog #1, three FP and zero FN diagnoses for dog #2, and zero FP and one FN diagnosis for dog #3. Of the total 28 discs the CT had an overall positive predictive value (PPV) of 78.8% and an overall negative predictive value (NPV) of 44.4%. X-ray radiography gave five FN diagnoses for dog #1, two FN diagnoses for dog #2, and eight FN diagnoses for dog #3. Of the total 28 discs the radiography had an overall PPV of 100% and an overall NPV of 30.4%. The receiver-operating-characteristic analysis of the SfRS measurement was performed on 24 discs that had a central mineralization not greater than 50%. An area-under-curve of 0.6758 infers that the SfRS intensity weakly indicates the level of mineralization.

CONCLUSIONS

Percutaneous SfRS may be useful as an in situ sensing tool for assessing the level of mineral degeneration in intervertebral discs for the prospect of disc-specific dosage adjustment in PLDA.

Toward transduodenal diffuse optical tomography of proximal pancreas

We demonstrate the feasibility of diffuse optical tomography (DOT) of the proximal pancreas by using optical applicator channels deployed longitudinally along the exterior surface of a duodenoscope. As the duodenum that nearly encircles the proximal pancreas forms a natural "C-loop" that is approximately three-quarters of a circle of 5-6 cm in diameter, a multichannel optical applicator attached to a duodenoscope has the potential to perform transduodenal DOT sampling of the bulk proximal pancreas wherein most cancers and many cystic lesions occur. The feasibility of transduodenal DOT is demonstrated on normal porcine pancreas tissues containing an introduced gelatinous inclusion of approximately 3 cm in diameter, by using nine source channels and six detector channels attached to a duodenoscope. Concurrent ultrasonography of the gelatinous inclusion in the porcine pancreas parenchyma provided a coarse, albeit indispensable, anatomic prior to transduodenal DOT in reconstructing a contrast of optical properties in the pancreas.

A low-cost needle-based single-fiber reflectance spectroscopy method to probe scattering changes associated with mineralization in intervertebral discs in chondrodystrophoid canine species – A pilot study

Intervertebral disc herniation is a common disease in chondrodystrophic dogs, and a similar neurologic condition also occurs in humans. Percutaneous laser disc ablation (PLDA) is a minimally invasive procedure used increasingly for prevention of disc herniation. PLDA is performed on thoracolumbar discs to which the same laser energy is applied regardless of their mineral content. Knowledge of individual disc mineral composition would allow laser energy dosage adjustments and more accurate treatment of degenerative discs. Usually, PLDA is guided by radiography/fluoroscopy, which has a limited sensitivity of approximately 60% for identification of mineralized discs. An imaging or sensing technology that provides a more accurate pre-operative

A pilot study was performed on a total of 21 intervertebral discs from two cadaveric dogs (“Dog A” and “Dog B”). The discs were imaged by computed tomography (CT), radiography, and SFR spectroscopy, before histopathologic examination. SFR spectroscopy in the visible/near-infrared band was performed on the nucleus pulposus of the intervertebral disc through a 20-gauge spinal needle placed percutaneously for PLDA. A normalization method was applied to the raw remission spectra to extract a dimension-less and wavelength-dependent intensity profile in the 500–950 nm spectral range.

In total, six discs were determined to be degenerative on histopathology, five discs of “Dog A” and one disc of “Dog B”. CT diagnosed all six degenerated discs, whereas radiography missed two of the five degenerated discs of “Dog A”. The wavelength-dependent mean scattering intensity profiles of the six degenerated discs were noticeably higher than the mean scattering intensity profiles of the 15 “normal” or insignificantly mineralized discs over the entire spectral range. The mean scattering intensities, averaged over each of the entire profiles, were 2.79±0.58 (mean±SD) for the six degenerated discs and 1.48±0.37 for the 15 “normal” or insignificantly mineralized discs. A two-sample

SFR spectroscopy measurements indicate that the increase of light scattering intensity across the entire 500–950 nm spectral range is associated with the mineralization in canine intervertebral discs. However, the scattering characteristics of the nucleus pulposus measured in this study may not necessarily represent the optical properties of the nucleus pulposus at the laser wavelength used for PLDA (2100 nm). More studies on cadaveric and eventually

Comparison of three intraoperative patient warming systems

The purpose of this randomized clinical trial was to compare the efficacy of three patient warming devices (i.e., circulating water blanket, forced-air, and warming panels) used either alone or in combination on patients undergoing surgeries lasting >60 min. In total, 238 dogs were included and divided into either the celiotomy or nonceliotomy group. Dogs in each group were further divided into one of three subgroups. Dogs in subgroup 1 (n=39) were placed on a circulating water blanket with a forced-air warming blanket placed over the trunk. Subgroup 2 dogs (n=40) were placed on a forced-air warming blanket only. Subgroup 3 dogs (n=40) were placed on warming panels. Significant temperature drops occurred from time of induction (38.1°C±0.64°C) to the start of surgical procedures (36.7°C±0.95°C). Although body temperature was maintained once the warming units were started in all groups, there were significant differences in temperatures for the type of surgical procedures (i.e., celiotomies versus nonceliotomies) performed over time except for subgroup 3. The warming panels and forced-air devices were equally effective in preserving body temperature in anesthetized patients.

Transrectal ultrasound-integrated spectral optical tomography of hypoxic progression of a regressing tumor in a canine prostate

The objective of this study was to evaluate if transrectal optical tomography implemented at three wavelength bands for spectral detection could monitor changes of the hemoglobin oxygen saturation (StO2) in addition to those of the total hemoglobin concentration ([HbT]) in lesions of a canine prostate, including an induced tumor modeling canine prostate cancer. Near-infrared (NIR) optical tomography was integrated with ultrasound (US) for transrectal imaging. Multi-spectral detection at 705_nm, 785_nm and 808_nm rendered measurements of [HbT] and StO2. Canine transmissible venereal tumor (TVT) cells were injected into the right lobe of a dog's prostate gland, which had a pre-existing cyst in the left lobe. Longitudinal assessments of the prostate were performed weekly over a 63-day duration by NIR imaging concurrent with grey-scale and Doppler US. Ultrasonography revealed a bi-lobular tumor-mass regressing from day-49 to day-63. At day-49 this tumor-mass developed a hypoxic core that became larger and more intense by day-56 and expanded further by day-63. The tumor-mass presented a strong hyper-[HbT] feature on day-56 that was inconsistent with US-visualized blood flow. Histology confirmed two necrotic TVT foci within this tumor-mass. The cyst appeared to have a large anoxic-like interior that was greater in size than its ultrasonographically delineated lesion, and a weak lesional elevation of [HbT]. On day-56, the cyst presented a strong hyper-[HbT] feature consistent with US-resolved blood flow. Histology revealed acute and chronic hemorrhage in the periphery of the cyst. The NIR imaging features of two other TVT nodules and a metastatic lymph node were evaluated retrospectively. Transrectal US-integrated spectral optical tomography seems to enable longitudinal monitoring of intra-lesional oxygenation dynamics in addition to the hemoglobin content of lesions in the canine prostate.

In vivo trans-rectal ultrasound-coupled optical tomography of a transmissible venereal tumor model in the canine pelvic canal

In vivo trans-rectal near-infrared (NIR) optical tomography was performed concurrently with, albeit reconstructed without spatial a prior of, trans-rectal ultrasound (US) on transmissible venereal tumor (TVT) developed as a model in the canine pelvic canal. Studies were taken longitudinally at prior to, 14 days after, and 35 days after the TVT injection. As the tumor grew, the nodules became increasingly hyperabsorptive and moderately hyperscattering on NIR. The regions of strong NIR contrast, especially on absorption images, correlated well with those of US hypoechoic masses indicative of tumors. Combining the information of trans-rectal NIR and US detected the tumor more accurately than did the US alone at 14 days postinjection.

Trans-rectal ultrasound-coupled near-infrared optical tomography of the prostate, part II: experimental demonstration

We demonstrate trans-rectal optical tomography of the prostate using an endo-rectal near-infrared (NIR) applicator integrated with a transrectal ultrasound (TRUS) probe. The endo-rectal NIR applicator incorporated a design presented in our previously reported work. A continuous-wave NIR optical tomography system is combined with a commercial US scanner to form the dual-modality imager. Sagittal transrectal imaging is performed concurrently by endo-rectal NIR and TRUS. The TRUS ensures accurate positioning of the NIR applicator as well as guides NIR image reconstruction using the spatial prior of the target. The use of a condom, which is standard for TRUS, is found to have minimal effect on trans-rectal NIR imaging. Tests on avian tissues validates that NIR imaging can recover the absorption contrast of a target, and its accuracy is improved when the TRUS spatial prior is incorporated. Trans-rectal NIR/US imaging of a healthy canine prostate in situ is reported.

Temperature measurement on tissue surface during laser irradiation

Tissue surface temperature distribution on the treatment site can serve as an indicator for the effectiveness of a photothermal therapy. In this study, both infrared thermography and theoretical simulation were used to determine the surface temperature distribution during laser irradiation of both gel phantom and animal tumors. Selective photothermal interaction was attempted by using intratumoral indocyanine green enhancement and irradiation via a near-infrared laser. An immunoadjuvant was also used to enhance immunological responses during tumor treatment. Monte Carlo method for tissue absorption of light and finite difference method for heat diffusion in tissue were used to simulate the temperature distribution during the selective laser photothermal interaction. An infrared camera was used to capture the thermal images during the laser treatment and the surface temperature was determined. Our findings show that the theoretical and experimental results are in good agreement and that the surface temperature of irradiated tissue can be controlled with appropriate dye and adjuvant enhancement. These results can be used to control the laser tumor treatment parameters and to optimize the treatment outcome. More importantly, when used with immunotherapy as a precursor of immunological responses, the selective photothermal treatment can be guided by the tissue temperature profiles both in the tumor and on the surface.

Enhancement of laser cancer treatment by a chitosan-derived immunoadjuvant

A chitosan derivative, glycated chitosan (GC), has been used as an immunostimulant for cancer treatment in laser immunotherapy. The function of GC is to enhance the host immune response after direct cancer cell destruction by a selective laser photothermal interaction. To further test its effects, laser immunotherapy was extended to include several different adjuvants for immunological stimulation and to include photodynamic therapy (PDT) as a different tumor-destruction mechanism. Complete Freund (CF) adjuvant, incomplete Freund (IF) adjuvant and Corynebacterium parvum (CP) were selected for treatment of metastatic mammary tumors in rats, in combination with a selective photothermal interaction. The solution of the immunoadjuvants admixed with indocyanine green (ICG), a light-absorbing dye, was injected directly into the tumors, followed by noninvasive irradiation of an 805 nm laser. Combined with PDT, in the treatment of tumors in mice, GC was administered peritumorally immediately after laser irradiation. The survivals of treated animals were compared with untreated control animals. In the treatment of rat tumors, CF, IF and CP raised the cure rates from 0% to 18%, 7% and 9%, respectively. In comparison, GC resulted in a 29% long-term survival. In the treatment of EMT6 mammary sarcoma in mice, GC of 0.5% and 1.5% concentrations increased the cure rates of Photofrin-based PDT treatment from 38% to 63% and 75%, respectively. In the treatment of Line 1 lung adenocarcinoma in mice, a 1.67% GC solution enabled a noncurative meso-substituted tetra(meta-hydroxy-phenyl)chlorin-based PDT to cure 37% of the tumor-bearing mice. The experimental results of this study confirmed our previous studies, showing that immunoadjuvants played an active role in laser-related cancer treatment and that GC significantly enhanced the efficacy of laser cancer treatment.

Histologic comparison of skin biopsy specimens collected by use of carbon dioxide or 810-nm diode lasers from dogs

OBJECTIVE

To compare histologic artifacts caused by carbon dioxide (CO2) or 810-nm diode surgical lasers used to obtain small biopsy specimens of skin from healthy dogs.

DESIGN

Prospective study.

ANIMALS

4 dogs.

PROCEDURE

21 skin biopsy specimens were collected from each dog. Three biopsy specimens were obtained with a CO2 or an 810-nm diode laser at 3 operating settings each, and 3 biopsy specimens were obtained with a 6-mm biopsy punch instrument (controls). After processing, biopsy specimens were examined for artifacts related to laser-tissue interactions. Microscopically visible char was measured from the lateral edge of each specimen obtained with a laser.

RESULTS

There were no significant differences among mean char distances in biopsy specimens obtained with the CO2 laser at various settings. Mean char distance was significantly greater in all skin biopsy specimens obtained with the diode laser, compared with those obtained with the CO2 laser. Mean char distance was significantly greater in biopsy specimens obtained with the 810-nm diode laser at high power, compared with biopsy specimens obtained with the 810-nm diode laser at low power.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that the CO2 laser caused less thermal injury at margins of skin biopsy specimens; therefore, if a surgical laser is used for removal of cutaneous masses or to obtain skin biopsy specimens, use of the CO2 laser is recommended. Veterinarians performing a biopsy by using a surgical laser should be aware that laser-induced artifacts may render small biopsy specimens useless for providing accurate histologic diagnosis.

Laser Lithotripsy for Treatment of Canine Uroliths

OBJECTIVE

To confirm in vivo optimal laser energy settings previously determined in vitro for lithotripsy, to develop a technique for Ho:YAG laser lithotripsy, and to evaluate acute and chronic tissue effects of laser lithotripsy.

STUDY DESIGN

Prospective, randomized preclinical trial.

ANIMALS OR SAMPLE POPULATION

Nineteen intact, adult male dogs.

METHODS

Via cystotomy, a single urolith was inserted into the urethra to the level of the base of the os penis to simulate obstruction. Uroliths (calcium oxalate, urate, or magnesium ammonium phosphate) were fragmented by Ho:YAG laser, in contact mode through a 320 micro optic fiber, passed through the operating channel of a 2.8 mm flexible endoscope. The time and total energy to fragmentation were recorded. Dogs were euthanatized immediately after lithotripsy (3 dogs) or at 3 days (7 dogs), and urethral lesions and any stone remnants were evaluated. Urethral integrity was also evaluated in 9 other dogs by endoscopy on day 10; these were also monitored clinically for 30 days.

RESULTS

The mean time for adequate fragmentation was 166.7 seconds (range, 47-494.5 seconds). The mean+/-SD energy used was 1418+/-851.2 J. In part 1, 2 dogs were obstructed with urolith fragments at necropsy. Eight dogs had minimal (<30 mg) or no urolith material evident within the urethra. Four dogs had gross focal or circumferential erosion, ulceration, or hemorrhage of the urethral mucosa. Lesions were not associated with the site of laser irradiation in 2 dogs. In dogs observed for 30 days, hematuria, pollakiuria, and stranguria that were observed after lithotripsy, resolved in all affected dogs by day 5. No mucosal lesions were observed by endoscopy and none of the dogs became obstructed.

CONCLUSION

Laser lithotripsy with the Ho:YAG laser in contact mode successfully fragmented obstructive uroliths in male dogs.

CLINICAL RELEVANCE

Laser lithotripsy may be a clinically relevant technique for treatment of urolithiasis in male dogs; clinical studies to evaluate long-term effects on urethral mucosa and the role of repeat treatment for recurrence are indicated.

In vitro effects of pulsed holmium laser energy on canine uroliths and porcine cadaveric urethra

BACKGROUND AND OBJECTIVES

To assess the effect of holmium laser energy on canine uroliths and porcine urethra.

STUDY DESIGN/MATERIALS AND METHODS

Uroliths of known composition and fresh cadaveric urethra were exposed to holmium laser energy. Urolith fragmentation times and depth of urethral lesions were determined.

RESULTS

Overall mean fragmentation time was 11.8 +/- 8.01 seconds. Magnesium ammonium phosphate (MAP) and urate uroliths had significantly shorter fragmentation times compared to other uroliths. Fragmentation time of MAP uroliths irradiated with 1.2 J/pulse was significantly longer than the fragmentation time of MAP uroliths irradiated with 0.3 J/pulse. Overall mean lesion depth for urethral specimens treated with 90 degrees contact mode irradiation was significantly greater than overall mean lesion depth for specimens treated with 30 degrees non-contact mode.

CONCLUSIONS

Holmium laser energy effectively fragmented canine uroliths and caused minimal urethral damage in vitro. Dogs with urolithiasis may represent a useful animal model for developing human lithotripsy procedures.

Outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease: 277 cases (1992-2001)

OBJECTIVE

To determine outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease.

DESIGN

Retrospective study.

ANIMALS

277 dogs.

PROCEDURE

Medical records of dogs with a history of thoracolumbar disk disease in which the 7 intervertebral disks from T10-11 through L3-4 were ablated with a holmium-yttrium-aluminum-garnet laser inserted through percutaneously placed needles were reviewed. Complications and episodes of a recurrence of neurologic signs (eg, paresis or paralysis) were recorded. Owners were contacted by telephone for follow-up information.

RESULTS

Nine of 262 (3.4%) dogs for which follow-up information was available had a recurrence of paresis or paralysis. Follow-up time ranged from 1 to 85 months (mean, 15 months); signs recurred between 3 and 52 months (mean, 15.1 months) after laser disk ablation. Acute complications occurred in 5 dogs and included mild pneumothorax in 1 dog, an abscess at a needle insertion site in 1 dog, and proprioceptive deficits in 3 dogs, 1 of which required hemilaminectomy within 1 week because of progression and severity of neurologic signs. One dog developed diskospondylitis.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that prophylactic percutaneous laser disk ablation is associated with few complications and may reduce the risk of recurrence of signs of intervertebral disk disease in dogs.

Lumbosacral stenosis in 29 military working dogs: epidemiologic findings and outcome after surgical intervention (1990-1999)

OBJECTIVE

To study the outcome of military working dogs (MWDs) diagnosed with degenerative lumbosacral stenosis (DLS) after surgical intervention and to determine what prognostic indicators affected outcome.

STUDY DESIGN

Retrospective study.

ANIMALS

Twenty-nine MWDs with DLS.

METHODS

The medical records of dogs diagnosed and surgically treated for DLS at the Department of Defense Military Working Dog Veterinary Service Hospital were reviewed. Retrieved data were signalment, clinical signs, survey radiograph results, and surgical findings.

RESULTS

Breed and sex were not found to have prognostic significance. Increasing age at surgery correlated with a poor surgical outcome. Twelve dogs (41%) returned to normal function, 11 (38%) improved, and 6 (20%) never returned to active duty. The average age at surgery was 74 months, 93 months, and 112 months for normal, improved, and dogs not returning to duty, respectively. Significant clinical findings associated with a poor prognosis were related to increasing neurologic severity. The only significant radiographic finding indicating a poor prognosis was foraminal narrowing. Surgical findings with negative prognostic significance were hypertrophic articular facets and interarcuate ligament. Recurrence rates were 16.7% and 54.5% for normal and improved dogs, respectively.

CONCLUSIONS

MWDs with DLS have a good prognosis with surgical decompression if they are young dogs with mild clinical signs at the time of diagnosis. As age and severity of clinical signs increase, the prognosis for successful outcome decreases. Recurrence may be seen in some dogs.

CLINICAL RELEVANCE

Information provided by this study should help military veterinarians determine the prognosis for working dogs with DLS after surgical treatment.

Tissue levels, histologic changes and plasma pharmacokinetics of meta-Tetra (hydroxyphenyl) chlorin (mTHPC) in the cat

The biodistribution and pharmacokinetics of meta-tetra(hydroxyphenyl)chlorin (mTHPC)(1) have been documented in humans, rats, dogs and rabbits. It has been demonstrated to be an effective photodynamic therapy agent for treatment of squamous cell carcinoma. Squamous cell carcinoma is a common feline neoplasm, causing significant morbidity and mortality in the feline population. The association between ultraviolet radiation exposure and occurrence of this neoplasm in the cat provides a useful model for the study of human cutaneous squamous cell carcinoma. In this study, we document the biodistribution, pharmacokinetics and toxicity of mTHPC in a group of normal cats. Four groups of cats were given the drug intravenously at dosages of 0, 0.15, 0.30 and 0.60 mg/kg. mTHPC levels were measured in plasma and tissues at 0, 24, 48, 72, 96 and 336 h after drug administration. Additionally, plasma samples were collected at 1 and 6 h post-injection and analysed. Biodistribution and pharmacokinetics of mTHPC in cats mirrors that in other animal species. There were no clinical or pathological changes associated with administration of the drug. The biodistribution and pharmacokinetics of mTHPC in cats mirrors that in other species studied. There were no clinical or pathological changes attributable to administration of the drug at the doses administered. mTHPC may be a useful photodynamic therapy drug in cats.

Use of a neodymium:yttrium-aluminum-garnet laser to remove exuberant granulation tissue from the esophagus of a horse

Use of a neodymium:yttrium-aluminum-garnet laser to remove exuberant granulation tissue from the esophagus of a horse A 4-year-old Quarter Horse mare was evaluated because of recurrent esophageal obstruction. Endoscopic examination revealed a proliferative mass in the esophagus approximately 55 cm aborad to the nares. Histologic examination of biopsy specimens revealed diffuse suppurative esophagitis and granulation tissue with no evidence of neoplasia. The mass was excisedand ablated transendoscopically with a neodymium:yttrium-aluminum-garnet laser. During a follow-up examination 2 weeks after the final laser procedure, the mass was no longer apparent, and the esophagus appeared healed. Six months after the final examination, there had been no recurrence of the mass. In this horse, transendoscopic laser excision was efficacious and avoided problems associated with an esophagotomy.

Effect of different components of laser immunotherapy in treatment of metastatic tumors in rats

Induction of a long-term tumor-specific immunity is the ultimate cure of metastatic cancers. Laser immunotherapy is a novel approach that aims at the tumor-directed stimulation of the immune system of the host. It involves an intratumor administration of a laser-absorbing dye and an immunoadjuvant, followed by noninvasive laser irradiation. Previous studies using glycated chitosan (GC) as immunoadjuvant and indocyanine green (ICG) as laser-absorbing dye have shown positive effects of the treatment on metastatic breast tumors in rats. In vivo experiments showed promising results such as: (a) eradication of treated primary tumors; (b) regression of untreated metastases; (c) induced antitumor immune response; and (d) long-term resistance to tumor rechallenge. In this study, rats bearing metastatic breast tumors and metastatic prostate tumors were treated with various combinations of the three components of laser immunotherapy. The rat survival rates and profiles of primary and metastatic tumors, after treatment by individual components and various combinations of the components, were analyzed. In the treatment of breast tumors, all of the experimental groups without immunoadjuvant showed little or no positive effect. The use of GC, either by itself or in combination with other components, had a noticeable impact on the survival rate of tumor-bearing rats. However, it was the combination of all of the three components that resulted in the highest cure rate. Three different concentrations of GC, 0.5, 1, and 2%, were also used to treat the metastatic breast tumors. The results showed that 1% GC was most effective in laser immunotherapy. In the treatment of metastatic prostate tumors, both the laser-ICG and laser-ICG-GC treatments significantly reduced the growth of primary tumors and lung metastases. Long-term survival of the rats bearing the prostate tumors was also observed after the laser immunotherapy treatment in our preliminary studies. These results revealed the important function of the immunoadjuvant in laser immunotherapy.

Lasers in veterinary medicine--where have we been, and where are we going?

Future use of lasers in medicine depends on the active participation of veterinarians in the inception and development of new devices that meet the needs of the entire medical profession. The sensible clinical approach that must be taken every day in the practice of veterinary medicine equips the veterinarian with a unique ability to understand the practical applications of biomedical lasers. Veterinary medicine can and should be in the forefront during these exciting times, adding an essential dimension to development of this twenty-first century technology.

Selective laser-induced hyperthermia for the treatment of spontaneous tumors in dogs

Indocyanine green (ICG), with spectral absorption at 800-810 nm, is a chromophore that strongly absorbs and converts near-infrared laser energy into thermal energy. By directly injecting ICG into a tumor, selective tumor hyperthermia during laser irradiation occurs. In this study, 4 dogs with spontaneous tumors were injected in situ with a 0.25% wt/vol ICG solution and immediately irradiated with 810 nm laser energy. Thermal data were collected from multiple thermocouples placed within the tumor and tumor response was recorded. Tissue heating to ≥ 42°C was observed in all tumors. One dog had a complete remission, one dog had stable disease for 12 weeks, and the other 2 dogs developed progressive disease shortly after treatment. Results from this study demonstrate that chromophore-enhanced laser-induced hyperthermia can effectively and selectively heat canine tumors. However, tumor size and pigmentation of overlying skin are potentially limiting factors to the success of this novel c ancer treatment.

Failure of holmium:yttrium-aluminum-garnet laser lithotripsy in two horses with calculi in the urinary bladder

Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy was attempted in a mare and a gelding with calculi in the urinary bladder. The procedure was unsuccessful in producing adequate fragmentation of the calculi. In the gelding, pulsed dye laser lithotripsy was subsequently used to fragment the urolith. Manual removal of the urolith via the urethra was performed in the mare.

Evaluation of carbon dioxide laser and conventional incisional techniques for resection of soft palates in brachycephalic dogs

OBJECTIVE

To compare clinical outcome, healing, and effect of tracheostomy in conventional incisional and carbon dioxide (CO2) laser techniques for resection of soft palates in brachycephalic dogs.

DESIGN

Prospective randomized trial.

ANIMALS

20 adult brachycephalic dogs.

METHODS

Dogs were randomly allocated into 4 groups, and 1 of the following was performed: palate resection by use of a CO2 laser; incisional palate resection and closure with suture; and palate resection by use of a C02 laser or incision with tracheostomy. A clinical score for respiratory function was assigned to each dog at 0, 2, 8, 16, and 24 hours. Biopsy specimens of incision sites obtained at days 0, 3, 7, and 14 were examined. Data were analyzed to determine the effects of technique on clinical and histologic outcome.

RESULTS

Mean surgical time for laser (309 seconds) was significantly shorter than for sharp dissection (744 seconds). Surgical technique significantly affected clinical scores at 3 of the 5 postoperative time points, but differences were not clinically apparent. Tracheostomy significantly affected clinical scores at 3 of 5 postoperative time points. After tracheostomy tube removal, clinical scores were similar to those of dogs without tracheostomies. Inflammation, necrosis, and ulceration were evident in all groups at day 3; these lesions had almost resolved by day 14. Most complications were associated with tracheostomy.

CONCLUSIONS AND CLINICAL RELEVANCE

Clinical outcomes appear to be similar with the laser and incisional techniques. Regarding surgical time and ease, laser resection of the soft palate appears advantageous. Tracheostomy is not warranted in dogs that have uncomplicated surgeries and recoveries.

Laser lithotripsy of a urethral calculus via ischial urethrotomy in a steer

A steer examined because of obstructive urolithiasis and urethral rupture underwent laser lithotripsy, using a chromium-thulium-holmium:yttrium-aluminum-garnet (Ho:YAG) laser inserted through an ischial urethrotomy. Procedures were performed with caudal epidural anesthesia. Six months after surgery, the urethra was patent with no clinical evidence of urethral stricture or fistula. Ischial urethrotomy provided rapid access to the bladder for catheterization and to the obstructive urolith for lithotripsy. Laser lithotripsy was a rapid and effective means of urolith removal in this steer.

Urinary bladder transitional cell papilloma in a shorthorn heifer

A 12-month-old shorthorn heifer was presented for pollakiuria of 4 months' duration. Urinary bladder transitional cell papilloma was diagnosed. The heifer had no exposure to bracken fern and no papillomavirus or bacterium was demonstrated. Laser surgery was used in an attempt to debulk the mass.

Comparison of a high power diode laser with the Nd:YAG laser using in situ wound strength analysis of healing cutaneous incisions

BACKGROUND AND OBJECTIVE

The laser-tissue interaction of a high power semiconductor diode laser was compared to the continuous wave neodymium yttrium aluminum garnet (Nd:YAG) laser by evaluating primary wound healing of cutaneous incisions in rats.

STUDY DESIGN/MATERIALS AND METHODS

Full thickness incisions were made in rat skin using a diode laser (805 nm, 10 W, contact mode), an Nd:YAG laser (1,064 nm, 10 W, contact mode), and a stainless steel scalpel blade (control). In situ wound breaking strength measurements were obtained at 7, 14, and 21 days using a specially designed tensiometer. Cross sectional area of non-disrupted wounds was calculated in two groups prior to testing to allow for calculation of tensile strength. Blinded histopathologic analysis was also performed.

RESULTS

Analysis of variance (P < or = 0.05) was used to determine differences in breaking strengths and tensile strengths due to incision method. There was no significant difference in the breaking strengths (group 1) or tensile strengths (groups 2 and 3) of the diode and Nd:YAG laser incisions. As predicted, breaking strengths and tensile strengths of scalpel blade incisions were significantly greater than those of incisions made with laser energy. Histopathologic evaluation revealed that through day 14, the degree of inflammation and collagen production was similar for diode and Nd:YAG laser incisions. Laser incisions had greater inflammation and a lag in fibroblast invasion and collagen production compared with scalpel incisions. By day 21, all incisions were similar in fibroblast population and collagen production, but laser incisions had slightly more inflammation than scalpel incisions.

CONCLUSION

In the primary wound healing model described, the tissue effect, cellular response, and development of wound strength were essentially the same for the high power diode laser at 10 W and the Nd:YAG laser at 10 W.

Use of the holmium yttrium aluminum garnet laser for percutaneous thoracolumbar intervertebral disk ablation in dogs

OBJECTIVE-To evaluate a laser ablation-technique for treatment of thoracolumbar intervertebral disk disease in dogs. DESIGN-Prospective case series. ANIMALS-33 dogs with signs of recurrent back pain associated with intervertebral disk disease after the initial episode had been managed conservatively for a minimum of 2 weeks. PROCEDURE-Spinal needles were placed percutaneously through the annulus fibroses to permit delivery of an optical fiber into the nucleus pulposes of thoracolumbar intervertebral disks T10-11 through L3-4. Fluoroscopy was used to guide needle placement. Holmium yttrium aluminum garnet laser energy then was used to ablate the contents of each selected intervertebral disk. Intervals from time of treatment to time of assessment ranged from 3 to 114 weeks. RESULTS-All dogs recovered without complication. Results of follow-up radiography and histologic evaluation indicated that percutaneous holmium yttrium aluminum garnet laser ablation reduces the volume of nucleus pulposus in treated disks. CLINICAL IMPLICATIONS-Used as a clinical treatment and prophylactically, this minimally invasive procedure should prevent further extrusion of partially herniated disks and should reduce the chances of subsequent herniation of disks at other treatment sites.

Photothermal effects on murine mammary tumors using indocyanine green and an 808-nm diode laser: an in vivo efficacy study

Murine mammary tumors were treated using indocyanine green and an 808 nm diode laser, and the in vivo chromophore-enhanced photothermal effects on the tumor burden and on tumor rat survival were investigated. The power of the laser was selected in the range of 5-10 W, and irradiation duration 3-5 min. One percent aqueous indocyanine green solution in a volume of 100-200 microliters was administered in situ, either acutely or 24 h prior to the treatment. The photothermal interaction was apparent under all our treatment conditions with a well-defined spatial containment in this study and the tumor growth was slowed after treatment. The post-treatment observation showed tumor recurrence and metastasis; no long-term survival was achieved with the single application of laser in conjunction with indocyanine green. Our results pose a question on the efficacy of the photothermal interaction even though tumor cell destruction can be achieved in a large and controlled scale. However, this highly selective photothermal impact on the tumor tissue did suggest that this method be applied repeatedly to be more effective and be used as the precursor of other modalities, such as chemotherapy, radiation therapy, immunotherapy, and surgery.

Chromophore-enhanced in vivo tumor cell destruction using an 808-nm diode laser

Rat mammary tumors were treated using an 808-nm diode laser in a power range of 3-15 W. Photothermolysis was selectively enhanced by the chromophore indocyanine green (ICG), which has an absorption peak corresponding to the laser wavelength. ICG, injected into neoplastic tissues 24 h before laser exposure, was retained in sufficient quantity to produce a strong photothermal reaction. With appropriate laser power and adequate irradiation duration, laser energy could inflict severe photothermal damage to the entire targeted tumor tissue while leaving the skin and other interdicted tissue undamaged. Higher laser powers (10-15 W) produced more surface damage that limited light transmission and as a result gave rise to reduced regions of thermal destruction. Post-treatment observation revealed the survival of numerous tumor cells. This finding questions the long term efficacy of the photothermal effect of a single treatment using the combination of the ICG and the diode laser, particularly in the absence of other modalities.

Chromophore-enhanced laser-tumor tissue photothermal interaction using an 808-nm diode laser

A diode laser was used to irradiate tumor tissue, with indocyanine green as the chromophore. The 808-nm wavelength radiation falls within the absorption peak of the chromophore (about 780 nm). The preliminary results in this report revealed clear and significant coupling of this laser and indocyanine green in laser-tissue photothermal interaction. The chromophore targeted tissue showed laser damage while peripheral tissues remained intact. Without the chromophore, this laser inflicted no apparent tissue damage in the non-contact mode with irradiance up to 1755 J/cm2.

Mechanisms of biliary stone fragmentation using the Ho:YAG laser

We have investigated the fragmentation of gallstones using the pulsed Ho:YAG laser, comparing it to lithotripsy using the visible pulsed-dye laser. We find that the physical mechanisms of stone fragmentation appear to be quite different in the two cases. Using high-speed photography, measurement of acoustic transients, time-resolved optical emission spectroscopy, and direct microscopic observation, we have analyzed the interaction of the Ho:YAG laser with both water and gallstones. We propose a new model in which fragmentation begins with absorption of the laser light by the stone surface. This is followed by melting and ejection of stone material, which is then swept away by the vapor bubble formed by the absorption of the Ho:YAG laser light by water. This model is in excellent agreement with our experimental observations, and differs substantially from the model developed by Teng et al. for laser lithotripsy using the visible pulsed-dye laser.

Effects of holmium:YAG laser on equine articular cartilage and subchondral bone adjacent to traumatic lesions: a histopathological assessment

This study was performed to investigate the effects of holmium:yttrium-aluminum-garnet (Ho:YAG) laser energy on articular cartilage and subchondral bone adjacent to traumatically created cartilage lesions in a continuous weight-bearing model. The 2.1-microns wavelength was delivered efficiently and precisely in hand-controlled contact and near-contact hard tissue arthroscopic surgery in a saline medium. Bilateral arthroscopy was performed on normal antebrachiocarpal and intercarpal joints of four adult horses. One hundred twenty traumatic lesions were created on three weight-bearing articular surfaces with a knife, curet, or motorized burr. Depths of the lesions were partial and full thickness. Configurations of the lesions were lacerations, scrapes, and craters. Left limbs were used as controls. Right limb lesions were treated with various intensities of laser energy: 0.1. 0.16, and 0.2 J. Animals were killed at intervals of 1, 3, and 8 weeks. Gross microscopic anatomy was documented, and tissue sections were subjected to blind review by a pathologist. Mankin grading for cellularity and proteoglycan content was used to qualitatively evaluate cartilage response. Cartilage adjacent to all lesions exposed to laser energy had better cellularity and proteoglycan content (p < 0.05) than did corresponding controls by Mankin grading. Mankin grades for levels of 0.16 and 0.2 J were lower (p < 0.05) than were those of controls or lesions exposed to 0.1 J. There was loss of cellularity and necrosis in subchondral bone at higher energy levels (0.16 and 0.2 J). This study examined the effects of Ho:YAG laser on articular cartilage and subchondral bone in terms of depth of damage and healing response over time in a weight-bearing model. Additional research to define dose-response curves for Ho:YAG laser treatment of cartilage and subchondral bone are indicated.

Synthesis of potential metabolites of ethyl (E)-4-[2-(3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl)-1-propenyl] benzoate

Potential metabolites of ethyl (E)-4-[2-(3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl)-1-propenyl] benzoate were synthesized. The new compounds include ethyl 3-[3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl]crotonate, 3-[3,4-dihydro-4,4-dimethyl-1H-1-benzopyran-6-yl]crotonic acid, 3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-carboxylic acid, 4-[3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl]delta 2-butenolide, ethyl (E)-4-[3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl)-3-hydroxy-1- propenyl]benzoate, ethyl (E)-4-[2-(3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl)-2-propenal] benzoate, and ethyl (E)-4-[2-(3,4-dihydro-4,4-dimethyl-2H-1-benzopyran-6-yl)-2-propenoic+ ++ acid]benzoate. Stereospecific oxidizing reagents and/or conditions were developed for these sensitive systems and include the use of SeO2, Clorox bleach, activated MnO2, and NaClO2 in the presence of resorcinol as a chlorine scavenger.

A detailed colostomy procedure and its application to quantify water and nitrogen balance and urine contribution to thermobalance in broilers exposed to thermoneutral and heat-distressed environments

A surgical procedure for the separation of avian urinary and fecal excrement, in birds as young as 3.5 wk of age, was developed and used to quantify ambient temperature effects on urine production and composition. The colostomized broilers were used in two experiments to estimate urine production, osmolality, and contribution to water, nitrogen, and thermobalance of birds exposed to thermoneutral (24 C, TN) and heat-distressed (35 C, HD) environments. Urine production averaged over three 12-h periods was greater (P < .05), at 101 versus 51 mL/12 h per kilogram of BW and osmolality lower (P < .05) at 142 versus 220 mOsm/kg urine during HD and TN, respectively, in Experiment 1; and averaged over one 12-h period 82 versus 32 mL/12 h per kilogram of BW and 136 versus 208 mOsm/kg in Experiment 2 for HD and TN, respectively. In Experiment 1, urine production per milliliter of water consumed was increased (P < .05) by HD during Periods 2 and 3 even though in both experiments the values were similar during the first 12 h. Both urinary nitrogen and osmolar losses were increased (P < .05) by 50 and 89.2%, respectively, during HD, but without effect on fecal nitrogen. Evaporative cooling of broilers was increased (P < .05) by 154% during HD. These studies provide a well-defined colostomy procedure and suggest that broiler urine production and composition as well as overall thermobalance, water, and nitrogen balance are strongly impacted by acute HD.

Use of the neodymium:yttrium-aluminum-garnet laser for treatment of squamous cell carcinoma of the nasal planum in a cat

A mature castrated male domestic shorthair cat was referred for treatment of an excoriated, ulcerated area on the nasal planum. Undifferentiated squamous cell carcinoma was diagnosed. Surgical resection of the nasal planum was not an option, so the lesion was treated 4 times with neodymium:yttrium-aluminum-garnet laser. Laser surgery results in uniform photovaporization of large volumes of tissue. Although treatment with laser does not yield tissue specimens suitable for histologic evaluation, it can result in a cosmetically suitable appearance and can extend the predicted life span. A diagnosis of undifferentiated squamous cell carcinoma has a guarded prognosis: however, the cat of this report survived more than 18 months.

Comparison of holmium and flashlamp pumped dye lasers for use in lithotripsy of biliary calculi

The characteristics of laser lithotripsy of biliary calculi are compared for a flashlamp pumped dye laser (lambda = 640 nm) and a Cr:Tm:Ho-YAG laser (lambda = 2.1 microns). Data on fragmentation efficiency with respect to laser power and pulse repetition rate are presented for different types of stones. It is shown that both lasers can produce effective stone fragmentation. The laser power required for efficient fragmentation characteristics is significantly less for the visible wavelength laser. However, the problems associated with damage to the fiber tips of the delivery system during operation were found to be less with the near infrared wavelength. The laser power for efficient fragmentation with the dye laser varies significantly for different types of stones while the power for efficient fragmentation with the holmium laser is the same for all stones.

Corrosion potential of steel bird shot in dogs

Each year many dogs are accidentally or purposely wounded with shotguns. When lead pellets were used exclusively in the past, clinical problems from chronically embedded shot seldom developed except for rare cases of lead toxicosis. However, because expended lead shot ingested unintentionally by waterfowl and other avian species is fatal, the US Fish and Wildlife Service mandated exclusive use of steel shot for waterfowl hunting beginning in 1991. To discover the effects of implanted steel shot in a biological system, in vitro and in vivo studies were performed. Severe surface corrosion was evident when steel shot was placed in physiologic saline solution and sterile canine plasma. Eight laboratory dogs were surgically implanted with sterile steel shot in various superficial locations for intervals of 2 to 26 weeks. Corrosion of implants and tissue inflammation was observed in all biopsy specimens examined. It has been shown that steel shot embedded in tissues will corrode and result in a severe inflammatory response. If the accompanying inflammation is complicated by bacterial contamination, foreign body reactions resulting in infected, draining tracts could develop. Veterinarians and dog owners should be aware that treatment and prognosis for wounds caused by steel shot may differ from those for similar wounds caused by lead shot.

Chronic bile duct cannulation in laboratory rats

To our knowledge this is the first report of rat bile duct cannulations in which the distal cannula is hemisected but extends to the sphincter of Oddi. It is minimally invasive and requires only about 45 minutes preparation time. In contrast to studies described in the literature, enterohepatic recirculation remains intact but bile can always be separated from pancreatic secretions at investigator discretion in the model. In addition, biliary flow and pressure can be measured without compromise. Acute biliary secretory pressure, under anesthesia, was 17 cm water. Bile flow, averaging 9.6 microliters/min/100 g was measured in unanesthetized rats surviving for 2 weeks (60% of animals monitored). Gross necropsy findings indicated that animals dying in less than 7 days usually suffered bile peritonitis subsequent to catheter rupture of the bile duct or loss from the ligature restraint. Deaths after 2 weeks were usually related to cholestasis due to blockage of the catheter with mineral debris and/or duct tissue. A detailed literature review of bile duct cannulation in rats has been made.

Nonunion

The recognition and treatment of delayed union or nonunion of a fracture is an orthopedic salvage procedure that all veterinary surgeons eventually experience. The major factor in determining whether a fracture becomes a nonunion or goes on to unite is the degree of stabilization of the fracture site. Infection (osteomyelitis) also contributes significantly to the formation of a nonunion. Nonunions can usually be classified clinically and radiographically as either vascular (capable of biologic activity) or avascular (incapable of biologic activity). Once this determination has been made, treatment regimens include application of rigid internal fixation (vascular nonunions) and installation of autogenous cancellous bone grafts after decortication (avascular nonunions). With the complication of osteomyelitis, microbiologic evaluation and antibiotic therapy should be considered even though a fracture will heal in the presence of infection if it is stable.

Complications associated with the dorsolateral muscle-separating approach for thoracolumbar disk fenestration in the dog

In a series of over 125 cases, complications associated with the dorsolateral muscle-separating approach for thoracolumbar intervertebral disk fenestration have been pneumothorax, hemorrhage, and neuromuscular deficits. Most of the complications were neuromuscular in origin and of short duration. It was concluded that the approach provides excellent visualization and is rapid, precise, and unlikely to lead to permanent complications.

Surgical implantation of electroencephalographic electrodes in the dog

A simple surgical technique for implanting chronic electroencephalographic electrodes in the skull of the dog was devised to obtain electroencephalograms from nonsedated and nonanesthetized dogs frequently. Orthopedic screws were used as implant electrodes and for securing the recording assembly over the frontal sinus. The electrode assemblies have been tolerated well for as long as 10 months in 17 of 20 dogs and have given reliable and satisfactory electroencephalograms for computer analysis and have been virtually free of all physiologic and motion artifacts in all dogs, with minimal use of physical restraint.