ABSTRACTS
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MINIMALLY INVASIVE FRACTURE REPAIR
Daniel D. Lewis, DVM, DACVS
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Numerous advancements have been made with respect to fracture management over the past four decades and recognition of the advantages of limiting manipulation of periosseous soft tissues led surgeons to rely increasingly on indirect and limited open or closed reduction techniques during fracture stabilization as we entered the new millennium. The availability of fluoroscopy and the development of new bone plate systems yielded techniques which allows a plate to be applied through small plate insertion incisions, made remote to the fracture site. This technique epitomizes the philosophies of biological osteosynthesis since the fracture site is not directly exposed and only minimally disturbed. Applications of this percutaneous plating technique, commonly referred to as minimally invasive plate osteosynthesis (MIPO), in dogs and cats will be discussed in this session.
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UNCOMMON CAUSES OF LAMENESS IN DOGS AND CATS
Daniel D Lewis, DVM, DACVS
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This lecture will present some atypical or uncommon causes of fore- and hind limb lameness in dogs and cats. The typical signalment [if any], etiology, presenting clinical and radiographic abnormalities as well as treatment options and prognosis will be described for each to the conditions discussed. The lectures will utilize a “what is your diagnosis?” approach to each condition, so attendees are encourage not to read the proceeding notes until after they have attended the presentation.
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MANAGEMENT OF CRANIAL CRUCIATE LIGAMENT INSUFFICIENCY IN DOGS
Daniel D. Lewis, DVM, DACVS
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This session will briefly review the etiopathogenesis of cranial cruciate ligament disease in dogs. A through review of current surgical and non-surgical options for managing dogs with cruciate insufficiency will ensue. An emphasis will be placed on results of biomechanical and kinematic studies performed at the University of Florida as well as results of other recent reported studies. Inclusion of observations our clinical experiences will supplement the evidence-based material presented in this lecture.
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USE OF HYBRID CONSTRUCTS IN DOGS AND CATS
Daniel D. Lewis, DVM, DACVS
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Hybrid external fixator constructs employ a ring component which can be used to and linear components [hybrid connecting rods and half- or full-fixation pins] which can be used to stabilize fractures, arthrodeses or corrective osteotomies. The ring component of these hybrid constructs are particularly well-suited for stabilizing short juxta-articular osseous segments, while employing linear components circumvents much of the post-operative morbidity typically associated with traditional circular external fixator constructs. Hybrid constructs can also be applied with a “linear mentality” and require much less training and experience to develop proficiency compared to traditional circular constructs. This session will focus on clinical applications of hybrid constructs in small animal practice.
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Plenary Session: The Future of Small Animal Orthopedics
Daniel D. Lewis, DVM, DACVS
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The discipline of small animal orthopedics is rapidly evolving and we commonly preform procedures today that could not have been attempted even a decade ago. Instrumentation and implants are being developed and marketed at an amazing rate, enabling surgeons to expand their capabilities and improve outcomes. The advent of sub-specialization will surely facilitate us in pushing the envelope ever further in our discipline.
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BRAIN TUMORS IN DOGS: UPDATE ON DIAGNOSTIC AND THERAPEUTIC OPTIONS
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Richard A. LeCouteur, BVSc, PhD, DACVIM, (Neurology), DECVN
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Primary brain tumors are a significant cause of morbidity and mortality in small animal companion animals, particularly in dogs. With more widespread availability of advanced imaging techniques, the number of animals being diagnosed with intracranial mass lesions has increased significantly. The most commonly diagnosed tumors are meningioma, followed by glial tumors (astrocytoma, oligodendroglioma) and choroid plexus tumors. Information relating to imaging characteristics of specific tumor types has been published, however imaging can never provide a specific diagnosis. As with neoplastic disease affecting any other organ system in the body, definitive diagnosis has been historically confirmed primarily based on the results of biopsy, histopathology and immunohistochemistry. Biopsy of primary brain tumors presents a number of location specific problems, primarily involving the relative inaccessibility of lesions, together with the significant risks associated with surgical biopsy in many cases. Although limited in availability at this time, recent advances in the development of stereotactic CT guided biopsy of tumors has done much to improve the likelihood of obtaining an accurate ante mortem diagnosis, allowing for a more appropriate and informed approach to therapeutic planning. It is not uncommon for lesions to be diagnosed by biopsy as something very different from the suspected diagnosis based on MRI. In some instances even the category of disease may change (e.g., inflammatory disease being misdiagnosed as neoplastic disease). This can have dramatic consequences on appropriate therapeutic planning, when the expense and potential adverse effects of treatments such as radiation therapy, or surgery are considered. This session will summarize aspects of diagnosis and therapy of brain tumors in dogs.
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UPDATE ON THE DIAGNOSIS AND MANAGEMENT OF IDIOPATHIC EPILEPSY IN DOGS AND CATS: WHAT TO DO WHEN PHENOBARBITONE FAILS?
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Richard A. LeCouteur, BVSc, PhD, DACVIM, (Neurology), DECVN
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The management of phenobarbitone resistant epilepsy poses a significant challenge to practitioners and pet owners. With the approval of several new antiepileptic drugs for the management of human epilepsy, the treatment options available for dogs and cats have increased. This session will discuss treatment options available when phenobarbitone fails.
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WEAKNESS, PARESIS OR LAMENESS? DON'T FORGET NEUROMUSCULAR DISEASES
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Richard A. LeCouteur, BVSc, PhD, DACVIM, (Neurology), DECVN
With advances in the techniques used to pathologically evaluate muscle and peripheral nerve biopsies, the advent of molecular technology, and the knowledge that neuromuscular diseases can involve many disciplines (including internal medicine, oncology, neurology, biochemistry, and genetics), the field of neuromuscular diseases in veterinary medicine is rapidly expanding. This session is designed to update the general practitioner with regard to the classification, clinical signs, diagnosis, and treatment, of neuromuscular diseases of dogs and cats.
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Plenary Session: Are we happy that our grandchildren may never be able to see an elephant except in a picture book?
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Richard A. LeCouteur, BVSc, PhD, DACVIM, (Neurology), DECVN
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The question in the title was posed by Sir. Richard Attenborough, who also stated: “I like animals. I like natural history. The travel bit is not the important bit. The travel bit is what you have to do in order to go and look at the animals”. As the human population increases across the world, the interconnection of people, animals, and the environment, has become extremely important. This is the concept of “One Health” – an integrative effort of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and the environment. The role of veterinarians in One Health is vital. In order to effectively contribute to biodiversity conservation, veterinarians must be able to develop and communicate a global viewpoint and see “the big picture” regarding the role of animals. Again, in Attenborough’s words: “Being in touch with the natural world is crucial”. This plenary session will address the importance of “adventure travel” in making veterinarians aware of their fundamental role in One Health.
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HOW TO SELECT A CASE FOR MITRAL VALVE REPAIR AND EXPECTED RESULTS
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Sabine Bozon
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Mitral valve repair under cardiopulmonary bypass is an innovative procedure invented and developed by Pr Masami Uechi from JASMINE (Veterinary Cardiovascular Medical Center) in Japan. This incredibly complicated surgery has been first published in 2012 (1,2).
Selecting a case is challenging and must take into account several parameters such as the age, the breed, the ACVIM heart failure stage, some specific features on ultrasound and Doppler, and most importantly the owner confidence, compliance and motivation. All these criteria must be put all together and balanced to finally give the best advice to the owner. As soon as the dog is “cardiology-wise” a candidate for mitral valve repair, we must know if it is 100% eligible for the full procedure and mainly the cardio-pulmonary bypass with a reasonable success rate. That’s why we ask for a thorough medical screening few months before the surgery date that includes abdominal ultrasound, extensive specific bloodwork, urine tests, blood typing, etc. The benefits can be observed immediately after the surgery in terms of left atrial dilation, mitral regurgitation, mitral valve leaflets coaptation, number of drugs needed and pulmonary arterial pressure. The success rate is correlated with the initial parameters like age, breed, severity of pre-operative pulmonary hypertension and the ACVIM heart failure staging before surgery. The global success rate to date is of 94%.
How the general practitioner vet and client can be involved in cutting edge brain cancer research?
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Dr Simon Puttick
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The lack of new, effective therapies for cancer is no more prevalent than in glioma. In the past 4 decades, median survival rate has increased from 7 months to just 14 months. The successful outcomes on the preclinical scale are not being translated to the clinic. A major contributing factor is that rodent models of primary brain tumours do not fully recapitulate the human disease. Xenograft models in mice and rats exhibit limited genetic heterogeneity, reduced invasiveness, require immune-deficient animals and do not fully recapitulate the blood-brain-tumour barrier, all of which make meaningful comparison to spontaneous tumours in human patients extremely challenging.
The domestic dog represents a large animal model of glioma that can overcome the many shortfalls of rodent models. Canine brain tumours occur spontaneously in fully immune competent animals with an incidence rate and patient age profile similar to that of human populations. Furthermore, it has been shown that many histological and genomic characteristics are conserved between canine and human gliomas. This has led to the introduction of comparative oncology programs, the study of cancer in companion animals, to fast-track the translation of promising new therapies to the clinic.
In this talk I will discuss our development of EphA2 targeted theranostics for primary brain tumours and our work to investigate these theranostics in domestic dogs with naturally occurring primary brain tumours.