Search

OBJECTIVE To determine ideal insufflation pressures during transanal minimally invasive surgery (TAMIS) in canine cadavers for rectal submucosal transection and incisional closure. ANIMALS 16 canine cadavers. PROCEDURES Cadavers were placed in lateral recumbency. Urinary catheters were placed to measure intra-abdominal pressure (IAP). A single access port was placed to establish a pneumorectum. Cadavers were placed in insufflation groups of 6 mmHg to 8 mmHg (group 1), 10 mmHg to 12 mmHg (group 2), or 14 mmHg to 16 mmHg (group 3). Defects in the rectal submucosa were created and closed with a unidirectional barbed suture. Duration for each procedure and subjective ease of identifying the transection plane and performing incisional closure were assessed. RESULTS The single access port was successfully placed in dogs weighing 22.7 kg to 48 kg. The ease of each step of the procedure was not influenced by the insufflation pressure. The median surgical duration for group 1 was 740 seconds (range = 564 to 951 seconds), 879 seconds (range = 678 to 991 seconds) for group 2, and 749 seconds (range = 630 to 1,244 seconds) for group 3 (P = .650). The insufflation pressure increased the IAP (P = .007). Perforation of the rectum happened in 2 cadavers in group 3. CLINICAL RELEVANCE The duration of each step of the procedure was not significantly influenced by insufflation pressure. Defining the dissection plane and performing resection was more challenging in the highest-pressure group. Rectal perforation occurred only with the 14 mmHg to 16 mmHg insufflation pressure. Single access port usage with TAMIS may provide a readily available, minimally invasive approach for the resection of rectal tumors in dogs.

The Classical Gold Standard period, with high capital mobility and fixed-exchange rates, is usually seen as the extreme case of international constraints on monetary policy. Contrary to this view, we show how central bank balance sheets offset the effects of international shocks on domestic interest rates. In contrast, in the United States, a gold standard country without a central bank, the reaction of money market rates was two to four times stronger than that of interest rates in countries with a central bank. Our study is based on the monthly balance sheets of all central banks in the world (i.e., 21) from 1891–1913.

This article provides a framework for understanding the economic role of central banks and their democratic legitimacy. I argue that thinking about the democratic challenges of central banking requires considering central banks’ insurance role and how their actions are part of credit policy. The contract between the central bank and the sovereign is incomplete because it cannot integrate all unforeseen contingencies, distributive consequences and interactions with other policies. This opens the door to viewing the legitimacy of central bank decisions through a process of deliberation, coordination and reflexivity, rather than only a delegation of power. I discuss a proposal for a European Credit Council, which would be a deliberative body aimed at strengthening Parliamentary power on monetary and credit policies, the democratic legitimacy of central bank policy in the Euro Area as well as its coordination with other European policies. More coordination, Parliamentary power and deliberation are consistent with central bank independence and aim to delimit more precisely the action of central banks within the macroeconomic and credit policies of the State.

I provide comments and replies to the seven insightful contributions that discussed “The Democratic Challenge of Central Bank Credit Policies” and the proposal for a European Credit Council. I review how interdisciplinary scholarship on the political economy of central banking have shown the limits of simple principal-agent framework applied to central bank power and legitimacy. I emphasize why a change to central bank independence is not necessary for a fundamental change in the financial system and credit policies. I also argue that deliberations can have strong effects on decision-making and that the power of the people is not restricted to the legislative power.

Objective To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs. Study design Ex-vivo study. Animals Colon from 11 canine cadavers. Methods Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site. Results Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at Conclusion End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. Clinical significance These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Objective To describe the treatment of persistent right aortic arch (PRAA) in dogs with combined ligamentum arteriosum (LA) transection and esophageal diverticulum resection. Animals Three client owned dogs. Study design Short case series. Methods Medical records were reviewed for clinical signs, diagnostic procedures, surgical treatment, post-operative therapies including medications and feeding regime, outcomes, and follow-up imaging. Results Esophageal resection was performed using a thoracoabdominal (TA) stapler with suture overlay. All dogs recovered well from surgery and did not experience any peri- or post-operative complications. The last follow-up was performed between 64 and 1004 days post-operatively. In all cases, regurgitation resolved and did not recur in any dogs. No dogs required medical therapy or dietary modifications. In two cases, follow-up imaging was performed that revealed marked improvement of esophageal dilation. Conclusion Resection of esophageal diverticulum secondary to PRAA utilizing a TA stapler with suture overlay was technically feasible and did not seem associated with early or late complications.

The purpose of the study was to determine the effect of suture pattern and repair length on the load to failure in an ex vivo canine gingival model. Healthy mandibular gingiva and mucosa were harvested from fresh cadavers euthanized for purposes unrelated to the study. Samples were randomly assigned by length and pattern. Lingual and buccal free gingival margins were apposed using a simple interrupted (SI), cruciate (XT), simple continuous (SC), or unidirectional knotless continuous barbed suture (SF) closure technique with USP 4-0 poliglecaprone 25i, ii applied over 2 lengths (3 cm and 6 cm). A custom template was used to ensure uniform suture bite application. Surgical time was recorded. Using a soft tissue mechanical testing frame, samples were tensioned to failure. Testing was video recorded and reviewed in conjunction with the tension trace data for tension at initial failure (Tfail) and maximum tension sustained (Tmax). Two factor ANOVA by length and pattern was performed followed by individual one way T-tests. Statistically significant findings were XT-SC-SF patterns were quicker to perform than SI. SF was more likely to fail by suture breakage than tissue tearing, and SF withstood less tension at the 3 cm length than SI-XT-SC. No significant difference was detected in Tmax or Tfail between SI and SC or XT. The study demonstrates that SC and XT are comparable to SI in tension resistance and faster to perform suggesting that SC and XT could replace SI for extraction site closure although further in vivo testing is required.

Objective To describe a novel laparoscopic technique to treat sliding hiatal hernia in dogs. Study design Retrospective case series. Animals Eight dogs with sliding hiatal hernia treated with laparoscopy. Methods Surgery reports were reviewed for technique description and animal outcomes. Results Six dogs were brachycephalic. Dogs were placed in right lateral oblique recumbency. Four dogs were placed in a reverse Trendelenburg position to visualize the esophageal hiatus. A single port was placed 2 cm caudal to the last rib on the left side. An extra cannula was added in four dogs. A large-bore orogastric tube was introduced in five dogs and used in four dogs to reduce the hernia. A unidirectional nonabsorbable barbed suture was used for the closure of the esophageal hiatus and the esophagopexy. A left-sided gastropexy was performed for all the cases. The gastropexy was performed with a gastrostomy tube to bypass the esophagus in four dogs. Intraoperative complications included pneumothorax in three dogs. Conversion was elective in three cases and emergent in one case. Clinical signs were recorded as improved in each dog. The median follow-up time was 16.5 days (range, 9-264). Conclusion Hiatal hernia repair was performed laparoscopically in this population. Repair included a combination of esophageal plication, esophagopexy, and left-sided gastropexy. Reverse Trendelenburg animal positioning and orogastric tube placement facilitated the reduction of the hernia. Clinical significance Laparoscopy is an option for the treatment of sliding hiatal hernia in dogs.

Objective To report complications and long-term outcomes of cats with benign ureteral obstruction treated with ureteroneocystostomy and to determine the effects of double pigtail catheter (DPT) placement on postoperative outcomes. Study design Retrospective study. Animals Twelve client-owned cats with ureteral urolithiasis treated with ureteroneocystostomy. Methods Records were reviewed for signalment, location of the obstruction, diagnostic tests, surgical technique, perioperative complications, long-term measurements of kidney function, and survival. Cats were divided into two groups; in one group, a DPT was placed at the time of ureteroneocystostomy, and, in the other group, a DPT was not placed at the time of ureteroneocystostomy (NDPT). Results A DPT was placed in six of 12 cats. The NDPT group included four cats with temporary catheters and two cats with no catheter. Median creatinine concentration decreased from 10.4 mg/dL (range, 1.6-20.3) to 2.2 mg/dL (range, 1.1-3.6) at the time of discharge (P = .015) in all cats. Two cats in the NDPT group required revision surgery for uroabdomen. Eleven cats were discharged from the hospital. Long-term complications (hematuria, pollakiuria, urinary tract infections) were more common in the DPT group (P = .047). Seven cats were alive a median of 329 days (range, 8-1772) after surgery. Median creatinine concentration was 2.0 mg/dL (range, 0.6-6.4) at a median of 157 days (range, 43-1772) after surgery. Conclusion Ureteroneocystostomy resulted in acceptable long-term outcomes in 11 of 12 cats. The placement of a DPT did not influence the long-term outcome in this small population. Clinical significance Ureteroneocystostomy with or without intraoperative placement of a DPT should be considered to relieve benign ureteral obstructions in cats.

Background Right ventricle failure (RVF) is associated with serious cardiac and pulmonary diseases that contribute significantly to the morbidity and mortality of patients. Currently, the mechanisms of RVF are not fully understood and it is partly due to the lack of large animal models in adult RVF. In this study, we aim to establish a model of RVF in adult ovine and examine the structure and function relations in the RV. Methods RV pressure overload was induced in adult male sheep by revised pulmonary artery constriction (PAC). Briefly, an adjustable hydraulic occluder was placed around the main pulmonary artery trunk. Then, repeated saline injection was performed at weeks 0, 1, and 4, where the amount of saline was determined in an animal‐specific manner. Healthy, age‐matched male sheep were used as additional controls. Echocardiography was performed bi‐weekly and on week 11 post‐PAC, hemodynamic and biological measurements were obtained. Results This PAC methodology resulted in a marked increase in RV systolic pressure and decreases in stroke volume and tricuspid annular plane systolic excursion, indicating signs of RVF. Significant increases in RV chamber size, wall thickness, and Fulton's index were observed. Cardiomyocyte hypertrophy and collagen accumulation (particularly type III collagen) were evident, and these structural changes were correlated with RV dysfunction. Conclusion In summary, the animal‐specific, repeated PAC provided a robust approach to induce adult RVF, and this ovine model will offer a useful tool to study the progression and treatment of adult RVF that is translatable to human diseases.