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Advances in Minimally Invasive Procedures of the Thoracic Cavity
Significant advances in veterinary minimally invasive surgeries and procedures have occurred in the past 10 years. These advances have been allowed due to continual research into optimizing working space through one-lung ventilation techniques and carbon ... moreSignificant advances in veterinary minimally invasive surgeries and procedures have occurred in the past 10 years. These advances have been allowed due to continual research into optimizing working space through one-lung ventilation techniques and carbon dioxide insufflation. Additionally, minimally invasive surgery enthusiasts have joined forces with interventionalists and, in many cases, physicians to push the boundaries, minimize pain, suffering, and time away from owners with advances in a variety of procedures. Several larger multi-institutional retrospective studies on various disease processes allow veterinarians and owners to understand that minimally invasive approaches allow for outcomes comparable to traditional open surgery and, in some cases, may now be considered the standard of care in canine and feline patients. less
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Looking to the Future; Veterinary Robotic Surgery
This article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Spec... moreThis article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Specific attention is given to the articulated instrumentation, which affords psychomotor benefits not only for surgical precision but also for surgeon ergonomics. A discussion of the possible indications and current use of robotics in veterinary medicine and the challenges to integrating robotics is also provided. less
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Laser-Assisted Turbinectomy in Dogs
This article discusses the laser-assisted turbinectomy (LATE) procedure and indications for its performance in dogs suffering from brachycephalic obstructive airway syndrome (BOAS). The article summarizes landmark works that reported, for the first time, ... moreThis article discusses the laser-assisted turbinectomy (LATE) procedure and indications for its performance in dogs suffering from brachycephalic obstructive airway syndrome (BOAS). The article summarizes landmark works that reported, for the first time, endoscopic-assisted identification and treatment of structures within the brachycephalic nose that contribute to intranasal obstruction and resistance to breathing, specifically hypertrophic and aberrant nasal turbinates. Brachycephaly is discussed in the context of how these aberrations form and how definitive treatments such as LATE and adjunctive treatments such as ala vestibuloplasty, folded flap palatoplasty, and others may ameliorate the negative effects and improve patient outcomes associated with aberrant intranasal conchal configurations. less
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Near-infrared-guided Thoracoscopic Surgery and Future Near-infrared Targets
Intraoperative near-infrared fluorescence imaging allows for real time, noninvasive visualization of anatomic structures (blood vessels, lymphatic vessels) or diseased states (cancer, inflammation). This technique is easily adapted to thoracoscopy and has... moreIntraoperative near-infrared fluorescence imaging allows for real time, noninvasive visualization of anatomic structures (blood vessels, lymphatic vessels) or diseased states (cancer, inflammation). This technique is easily adapted to thoracoscopy and has allowed for improved detection of lung tumors and other various cancers, thoracic lymphatics, and cardiothoracic vasculature.
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Augmenting Veterinary Minimally Invasive Surgery
Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to... moreVeterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed. less
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Augmenting Laparoscopic Surgery with Fluorescence Imaging
Minimally invasive endoscopic surgery is growing in veterinary medicine, in large part, due to the advantages associated with reduced pain, potential for decreased complications, and increased visualization of structures through magnification and illumina... moreMinimally invasive endoscopic surgery is growing in veterinary medicine, in large part, due to the advantages associated with reduced pain, potential for decreased complications, and increased visualization of structures through magnification and illumination. With advancing technologies, we can now improve upon natural “white light” endoscopy with fluorescence-guided imaging. Near-infrared (NIR) cameras allow for real-time, high-definition visualization of vessels, anatomic structures, and perfusion. New uses of NIR technologies during laparoscopy are continuing to grow for vascular, lymphatic, and oncologic-related techniques. Limitations exist, and future efforts need to determine optimal dosing, tissue-specific fluorophores, and veterinary-specific techniques. less
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Laparoscopic Treatment of Peritoneal-Pericardial Diaphragmatic Hernia
Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopi... moreLaparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopic peritoneal-pericardial diaphragmatic hernia repair.
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Laparoscopic Treatment of Sliding Hiatal Hernia
Hiatal hernias result from a widening of the esophageal hiatus that leads to the displacement of the lower esophageal sphincter and stomach into the thoracic cavity. Clinical signs of regurgitation, gastroesophageal reflux, and esophagitis are managed med... moreHiatal hernias result from a widening of the esophageal hiatus that leads to the displacement of the lower esophageal sphincter and stomach into the thoracic cavity. Clinical signs of regurgitation, gastroesophageal reflux, and esophagitis are managed medically, but surgery is considered in those that fail to respond to medical management. Surgical treatment of hiatal hernia can be performed laparoscopically. Treatment involves plication of the esophageal hiatus, as well as a pexy of the esophagus to the diaphragm and a left sided gastropexy. Outcomes with laparoscopic treatment are comparable to those performed via laparotomy. less
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Advances in the Treatment of Chylothorax
Idiopathic chylothorax is a challenging clinical condition historically associated with poor resolution rates following surgical intervention. Recent advances in imaging and surgical techniques have revolutionized the treatment of this disease process. Co... moreIdiopathic chylothorax is a challenging clinical condition historically associated with poor resolution rates following surgical intervention. Recent advances in imaging and surgical techniques have revolutionized the treatment of this disease process. Computed tomographic lymphangiography has facilitated improved surgical planning and postoperative assessment, while intraoperative use of near-infrared fluorescence imaging aids in highly accurate intraoperative thoracic duct identification. Utilizing these advancements, minimally invasive surgical techniques have been successfully developed and have been associated with considerable improvements in surgical outcomes. less
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New Training Options for Minimally Invasive Surgery Skills
Veterinary minimally invasive surgery (MIS) training options are becoming more available. This article reviews new developments in this area and the current evidence for manual skills and cognitive training of MIS.
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Toxigenic Endophyte–Infected Tall Fescue and Ergot Alkaloids
“Fescue toxicosis” and reproductive ergotism present identical toxidromes in late-gestational mares and, likely, other equids. Both toxic syndromes are caused by ergopeptine alkaloids (EPAs) of fungal origin, and they are collectively referred to as equin... more“Fescue toxicosis” and reproductive ergotism present identical toxidromes in late-gestational mares and, likely, other equids. Both toxic syndromes are caused by ergopeptine alkaloids (EPAs) of fungal origin, and they are collectively referred to as equine ergopeptine alkaloid toxicosis (EEPAT). EPAs are produced by either a toxigenic endophyte (Epichloë coenophiala) in tall fescue and/or a nonendophytic fungus (Claviceps purpurea), infecting small grains and grasses. EEPAT can cause hypoprolactinemia-induced agalactia/dysgalactia, prolonged gestation, dystocia, and other reproductive abnormalities in mares, as well as failure of passive transfer in their frequently dysmature/overmature/postmature foals. Prevention relies on eliminating exposures and/or reversing hypoprolactinemia. less
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“… and Toxic”
Horses and other equids, like any other species, can be exposed to a variety of toxic substances. The true incidence of poisoning is difficult to estimate, and cases are likely underreported because there is no centralized mandatory reporting mechanism fo... moreHorses and other equids, like any other species, can be exposed to a variety of toxic substances. The true incidence of poisoning is difficult to estimate, and cases are likely underreported because there is no centralized mandatory reporting mechanism for poisoning in veterinary species. Such estimates rely on cases reported to poison control centers (eg, Pet Poison Helpline and ASPCA Animal Poison Control Center) or presented to referral hospitals. Underreporting is likely more severe in equines than in small animals, because equine practitioners and owners are less likely to call a poison control center than small animal practitioners and owners. less
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Range and Pasture Plants Likely to Poison Horses
Range and pasture toxic plants can poison horses. Many of these plants are noxious weeds that can dominate plant populations and replace healthy forages. Poisoning is often difficult to diagnose as the resulting plant-induced disease is similar to other i... moreRange and pasture toxic plants can poison horses. Many of these plants are noxious weeds that can dominate plant populations and replace healthy forages. Poisoning is often difficult to diagnose as the resulting plant-induced disease is similar to other infectious, toxic, and nutritional diseases. Identifying potentially problem plants, and observing what plants horses are eating, is essential in determining the risk of poisoning. If the risk is significant, it can drive management to invest in strategies to avoid exposure, animal disease, and suffering. less
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Investigative and Diagnostic Toxicology and Feed-Related Outbreaks
Incidences of feed contamination are rare even though enormous amounts of animal feed are manufactured. However, there are still some cases of feed–related illness in horses. Veterinarians play a crucial role in recognizing and mitigating these events and... moreIncidences of feed contamination are rare even though enormous amounts of animal feed are manufactured. However, there are still some cases of feed–related illness in horses. Veterinarians play a crucial role in recognizing and mitigating these events and in assessing the severity of risks. Due to these risks, proper reporting and consultation with government and state agencies are crucial. Accurate diagnosis and identification of the source of poisoning are promising when a thorough case workup is performed and agencies such as veterinary diagnostic laboratories and the US Food and Drug Administration Center for Veterinary Medicine are used effectively. less
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Plants Causing Toxic Myopathies
Boxelder and sycamore maple contain hypoglycin A (HGA), the toxic metabolite of which, MCPA-CoA, inhibits fatty acid β-oxidation, causing seasonal pasture myopathy (SPM) or atypical myopathy (AM), respectively. White snakeroot and rayless goldenrod contai... moreBoxelder and sycamore maple contain hypoglycin A (HGA), the toxic metabolite of which, MCPA-CoA, inhibits fatty acid β-oxidation, causing seasonal pasture myopathy (SPM) or atypical myopathy (AM), respectively. White snakeroot and rayless goldenrod contain multiple benzofuran ketones (BFKs). The identity/toxicity of BFKs appear variable, possibly involving interactions between toxins/toxic metabolites, but ultimately inhibit cellular energy metabolism. Unthrifty horses grazing sparse pastures during the fall appear predisposed to these plant-associated, frequently fatal, toxic myopathies. Toxidromes are characterized by varying degrees of rhabdomyolysis and cardiac myonecrosis, with plant toxins remaining toxic in hay and being excreted in milk. less
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Equine Mycotoxins
The main mycotoxins involved in adverse equine health issues are aflatoxins, fumonisins, trichothecenes, and probably ergovaline (fescue grass endophyte toxicosis). Most exposures are through contaminated grains and grain byproducts, although grasses and ... moreThe main mycotoxins involved in adverse equine health issues are aflatoxins, fumonisins, trichothecenes, and probably ergovaline (fescue grass endophyte toxicosis). Most exposures are through contaminated grains and grain byproducts, although grasses and hays can contain mycotoxins. Clinical signs are often nonspecific and include feed refusal, colic, diarrhea, and liver damage but can be dramatic with neurologic signs associated with equine leukoencephalomalacia and tremorgens. Specific antidotes for mycotoxicosis are rare, and treatment involves stopping the use of contaminated feed, switching to a “clean” feed source, and providing supportive care. less
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Plants that Contaminate Feed and Forage and Poison Horses
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Toxic Garden and Landscaping Plants
Many popular ornamental shrubs are not only beautiful but also toxic when ingested in sufficient quantities. Common toxic landscaping shrubs in North America include yew (Taxus spp), oleander (Nerium oleander), and rhododendrons and azaleas (Rhododendron ... moreMany popular ornamental shrubs are not only beautiful but also toxic when ingested in sufficient quantities. Common toxic landscaping shrubs in North America include yew (Taxus spp), oleander (Nerium oleander), and rhododendrons and azaleas (Rhododendron spp). Horses are often exposed when plant trimmings are placed within reach or discarded in pastures. Occasionally clippings or fallen leaves contaminate hay. Some plants are unpalatable unless dried and mixed with hay or lawn clippings but others are ingested more readily. In many cases, disease can be severe and treatment unrewarding; therefore, client education is critical to preventing serious and potentially fatal poisonings. less
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Blue Green Algae
Blue green algae cyanotoxins have become increasingly more prevalent due to environmental, industrial, and agricultural changes that promote their growth into harmful algal blooms. Animals are usually exposed via water used for drinking or bathing, though... moreBlue green algae cyanotoxins have become increasingly more prevalent due to environmental, industrial, and agricultural changes that promote their growth into harmful algal blooms. Animals are usually exposed via water used for drinking or bathing, though specific cases related to equines are very limited. The toxic dose for horses has not been determined, and currently only experimental data in other animals can be relied upon to aid in case interpretation and treatment. Treatment is mostly limited to supportive care, and preventative control methods to limit exposures are more likely to aid in animal health until more research has been performed. less
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Diagnostic Pathology of Equine Toxicoses
This article is intended to highlight toxicosis-associated pathology in horses that might be observed by a clinician in the living animal and at gross necropsy. When the clinician is aware of these pathologic changes (particularly when coupled with a sugg... moreThis article is intended to highlight toxicosis-associated pathology in horses that might be observed by a clinician in the living animal and at gross necropsy. When the clinician is aware of these pathologic changes (particularly when coupled with a suggestive environmental or herd history), then collaboration with a diagnostic laboratory can begin to help identify specific toxicants. Proper sampling and communication with the diagnostic laboratory will vastly improve the likelihood of a specific diagnosis; postmortem sampling and specimen submission are reviewed in the last section of this article. less
