Biomedical subjects
Publications and source records attributed to M P Moore.
Intracranial tumors in dogs are relatively common but are less common in cats. Features of various tumors are described. The antemortem diagnosis is based on demonstrating the mass with advanced imaging. Tumor type, however, can only be diagnosed by histological confirmation. Diagnosis and treatment options are discussed.
Surgical treatments are often used for human epileptics who are refractory to more conventional anticonvulsant therapies. The goals of surgery are to decrease seizure morbidity or, ideally, bring about a cure to the seizure disorder. As a sizable subpopulation of dogs with seizures are also refractory to currently available anticonvulsant therapies, consideration has been given to evaluating alternative treatments for seizures in dogs. This article discusses the adaptability of surgical treatments used in humans for use in seizure control in affected dogs.
Hydrocephalus may be an acquired or congenital condition. Clinical signs often reflect the level of brain involvement. In young dogs, the presence of a dome-shaped head and/or persistent fontanel are suggestive of hydrocephalus. Ventriculoperitoneal shunting is often used for definitive treatment of hydrocephalus.
Defects resulting from resection of advanced breast tumors can be quite large, posing a difficult reconstructive challenge. A significant number of such patients present with local recurrences after receiving external beam radiation and/or chemotherapy treatments. Pectoralis major, latissimus dorsi, rectus abdominis, and omental flaps with split-thickness skin grafts have been recommended for closure of chest-wall defects. What is often excluded from the list of reconstructive options is the external oblique myocutaneous flap. In our series of 20 consecutive patients treated at Memorial Sloan-Kettering Cancer Center, an external oblique myocutaneous flap was used to cover these large chest-wall defects successfully. The median age of our patient population was 54.5 years, and 68 percent of them presented with local recurrence. Fifty percent had external beam radiation, and fifty percent had received chemotherapy. Twenty-five percent of our study group had had both treatments. The mean chest-wall defect measured 326 cm2, corresponding to a 20 x 16 cm area. We believe that the external oblique myocutaneous flap should be considered a safe and reliable option when reconstruction of large chest-wall defects is contemplated.
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OBJECTIVE: To determine the effect of craniectomy and durotomy on intracranial pressure (ICP) in clinically normal dogs. DESIGN: Two-part study (experiments A and B) involving craniectomy and durotomy, with and without treatments to lower ICP. ANIMALS: Six (experiment A) and 7 (experiment B) healthy dogs. PROCEDURE: In experiment A, craniectomy was performed in combination with durotomy, diuretic administration, methylprednisolone sodium succinate administration, and hyperventilation, and effect of these manipulations on ICP was determined. In experiment B, dogs had only craniectomy and durotomy without associated ICP-lowering treatments. During both experiments, ICP was monitored throughout the surgical procedure with a fiber optic ICP monitoring device. RESULTS: Intracranial pressure decreased after the combination of craniectomy, durotomy, and other ICP-lowering treatments in dogs of experiment A. Similar magnitude of decrease in ICP was observed in dogs of experiment B after craniectomy and durotomy. CONCLUSIONS: Comparison of these experiments indicate that surgical removal of overlying skull and incision of the dura mater can significantly decrease ICP in clinically normal dogs. CLINICAL RELEVANCE: Craniectomy and durotomy may be useful as an adjunct treatment for increased ICP.
Axillary dissection for primary operable cancer follows the basic tenets of surgical oncology and achieves the stated goals. Local control is excellent, with failure rates of 0% to 2%. Long-term, disease-free survival is improved with axillary dissection. It is often stated that axillary dissection is not required for the smallest lesions, but the 15% risk of axillary disease with the T1A lesion suggests otherwise. Axillary sampling would not achieve the stated goals because of the high probability of retained, potentially resectable disease in the node-positive group. Axillary recurrence is associated with unacceptably high morbidity and mortality rates. Although the survival is similar in the three treatment groups of NSABP B-04, the inordinately high systemic failure rate with axillary recurrence would suggest that more aggressive local control could prevent many of these failures. After all, long-term survival free of disease is reported in many series, even in patients with multiple involved nodes. Axillary dissection also generates the most accurate prognostic variable on which further therapeutic interventions are predicated. At present, no other diagnostic or therapeutic approach achieves all these goals. The value of the axillary dissection is to provide accurate prognostic information, provide excellent local control, and improve the survival rate in the node-positive group. Perhaps in the future, a diagnostic test such as PET scanning or sentinel node mapping will identify patients with a clear axilla, who therefore do not require an axillary dissection. There has yet to be a primary operable carcinoma that benefits from preservation of potentially fully resectable disease.
OBJECTIVES: To establish intracranial pressure (ICP) measurements in healthy cats under isoflurane anesthesia, using a fiberoptic monitoring system; to assess brain lesions associated with such monitoring; and to determine whether decompressive intracranial surgery decreases ICP in healthy cats. ANIMALS: 6 healthy cats. PROCEDURE: Craniectomy and durotomy were performed, and the effect of these procedures on ICP was determined. ICP was monitored by use of a fiberoptic monitoring system. Gross and microscopic evaluations of brain tissues were performed after data collection. RESULTS: ICP decreased significantly after craniotomy and durotomy. After wound closure, ICP remained significantly reduced relative to initial pressures. However, postsurgical pressures were significantly increased, compared with those associated with ICP after durotomy. Gross and histologic abnormalities associated with placement of the ICP monitoring cable included mild focal acute hemorrhage and mechanical cortical disruption. CONCLUSIONS: Craniectomy and durotomy significantly decreased ICP in healthy cats. ICP increased after wound closure, but remained significantly lower than initial pressures. CLINICAL RELEVANCE: Craniectomy and durotomy may be used to decrease ICP in cats.
Five dogs with space-occupying intracranial lesions underwent lateral craniectomy. Brain tissue pressures, reflective of intracranial pressure, were monitored during the surgical procedure, using a fiberoptic intracranial pressure monitoring system. The intracranial pressure monitoring cable was placed superficially in brain parenchyma on the side contralateral to the primary lesion. Recordings were made continually throughout the surgical procedure. Each dog was treated preoperatively with mannitol, which caused a decrease in intracranial pressure prior to craniectomy in only those dogs that initially had high intracranial pressure. Complications associated with use of the fiberoptic intracranial monitoring system were not evident. Although absolute values for pressure varied, pressure trends were helpful in determining effects of surgical manipulations on intracranial pressure in these dogs.
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Intracranial pressure and cardiovascular variables after IV administration of medetomidine (0.03 mg/kg of body weight) were evaluated in 6 healthy, mixed-breed dogs anesthetized with 1.3% end-tidal isoflurane concentration and mechanically ventilated to normocapnia (PaCO2, 35 to 45 mm of Hg). Baseline values were determined for intracranial pressure, heart rate, arterial blood pressure, cardiac output, mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, end-tidal CO2 tension and isoflurance concentration, arterial pH and CO2 and O2 tensions, and core body temperature. Cerebral perfusion pressure, cardiac index, systemic and pulmonary vascular resistances, plasma HCO3- concentration, and base excess were calculated. Intracranial pressure was measured, using a calibrated, fiberoptic transducer placed within the brain parenchyma and secured to the calvarium by means of a subarachnoid bolt. Cardiac output was determined by thermodilution. End-tidal CO2 tension and isoflurane concentration were determined, using an infrared gas analyzer. Administration of medetomidine did not change intracranial pressure, but was associated with significant (P < 0.05) decreases in values for heart rate, cardiac index, end-tidal CO2, and HCO3- and with significant increases in systolic, mean, and diastolic pressure; pulmonary artery pressure; systemic vascular resistance; central venous pressure; and pulmonary capillary wedge pressure.
During 2 separate studies, intracranial pressure (ICP) was measured in 13 healthy dogs (group A, n = 7; group B, n = 6), using a fiberoptic monitoring system implanted surgically in the right superficial cerebral cortex. Average ICP was measured for 15 minutes after a 15-minute postimplantation period of equilibration. Intracranial pressure was measured in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations. Mean +/- 1 SD ICP in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations was 11 +/- 2 and 11 +/- 3 mm of Hg, respectively. Dogs of group A were euthanatized immediately after measurements were obtained. Mean ICP +/- 1 SD in group-B dogs was 11 +/- 3 mm of Hg. After monitoring, but prior to euthanasia, group-B dogs underwent callosotomy, and were maintained for 30 days after surgery. The brain was removed from all dogs, formalin fixed, and examined grossly and microscopically for lesions associated with fiberoptic cable implantation. Variable degrees of hemorrhage and mechanical brain damage were seen focally around the catheter site in all brains from group-A dogs, especially when the cable entered through a sulcus. In 1 dog, local vacuolation was seen in the brain immediately adjacent to the tract associated with implantation of the fiberoptic catheter. In all other dogs, the additional cortex was histologically normal. Histologic lesions associated with cable implantation were not observed in group-B dogs.
PURPOSE: To identify and quantitate mammographic characteristics of inflammatory carcinoma (IC). MATERIALS AND METHODS: A retrospective analysis was made of the clinical and mammographic findings in 22 women (aged 31-66 years [mean, 51 years]) with IC, who were seen between 1980 and 1990 at the authors' institution. RESULTS: A palpable mass was present in 17 of the 22 women (77%); skin thickening, axillary adenopathy, nipple inversion, and erythema were common findings. At mammography, the findings in one woman with dense breasts were negative. A primary tumor, evident on the basis of a mass and/or malignant-type calcifications, was seen in all other cases. Skin thickening was present in 15 women, stromal coarsening in 11, diffusely increased breast density in nine, and axillary adenopathy in five. CONCLUSION: IC has a mammographic pattern of inflammatory changes: skin thickening and stromal coarsening and/or diffusely increased breast density, associated with evidence of a primary tumor mass and/or calcifications. In this series, inflammatory changes without an associated mass and/or malignant-type calcifications were not seen in women with IC.
Quantitative electroencephalography was assessed in 6 dogs anesthetized with 1.8% end-tidal halothane, under conditions of eucapnia, hypocapnia, and hypercapnia. Ventilation was controlled in each condition. Heart rate, arterial blood pressure, core body temperature, arterial pH, blood gas tensions, end-tidal CO2 tension, and end-tidal halothane concentration were monitored throughout the study. A 21-lead linked-ear montage was used for recording the EEG. Quantitative electroencephalographic data were stored on an optical disk for analysis at a later date. Values for absolute power of the EEG were determined for delta, theta, alpha, and beta frequencies. Hypocapnia was achieved by hyperventilation. Hypercapnia was achieved by titration of 5% CO2 to the inspired gas mixture. Hypercapnia was associated with an increase in the absolute power of the delta band. Hypocapnia caused an increase in the absolute power of delta, theta, and alpha frequencies. Quantitative electroencephalographic data appear to be altered by abnormalities in arterial carbon dioxide tension. Respiratory acidosis or alkalosis in halothane-anesthetized dogs may obscure or mimic electroencephalographic abnormalities caused by intracranial disease.
BACKGROUND: This study compared the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) alone or in combination with peripheral blood-derived hematopoietic progenitor cells (PBP) as support for patients receiving high-dose chemotherapy and assessed the adequacy of these strategies as alternatives to autologous bone marrow rescue. METHODS: The authors studied patients with metastatic breast carcinoma who had a major response to conventional chemotherapy or had achieved a complete remission by surgical resection of all known metastases. They were treated with carboplatin 1500 mg/m2, etoposide 1200 mg/m2, and cyclophosphamide 5.0 g/m2. Before this high-dose chemotherapy, the patients had been randomly assigned to one of two hematopoietic support strategies: GM-CSF alone (Group 1) or GM-CSF-primed PBP and GM-CSF (Group 2). Autologous bone marrow was harvested from all patients for use only in the event of persistent pancytopenia with marrow aplasia on day 15. RESULTS: A total of 18 patients were treated. Randomization was halted after the initial 10 patients because of the significant advantages for patients in Group 2 in comparison with those in Group 1 in regard to (1) the median number of days to absolute neutrophil count 0.5 x 10(9)/l (12 versus 21) and platelet count to 50 x 10(9)/l (13 versus 23), (2) platelet transfusions (3 versus 15.5), and (3) episodes of neutropenic sepsis (0 versus 4, respectively). One patient in Group 1 died from treatment-related complications. All patients in Group 1 required bone marrow reinfusion. No patient in Group 2 required bone marrow reinfusion, and no early mortality was observed in this group. Eight subsequent patients were treated with PBP and GM-CSF (Group 3). This group was more heavily pretreated than Groups 1 or 2 and had a slower hematologic recovery than Group 2. However, none of these patients required bone marrow reinfusion. The four patients in Group 1 that did not have early bone marrow rescue all had neutrophil counts of 0.0 on day 15. For Groups 2 and 3, the neutrophil counts on day 15 ranged from 0.3-2.1 x 10(9)/l (median, 1.9) and from 0.2-2.1 x 10(9)/l (median 0.6), respectively. CONCLUSIONS: The use of PBP plus GM-CSF accelerated hematologic recovery after this chemotherapeutic regimen compared with GM-CSF alone; there were reduced morbidity and platelet transfusion requirements. Recovery was sufficiently rapid that PBP were an acceptable alternative to autologous bone marrow transplantation in patients receiving high-dose carboplatin, etoposide, and cyclophosphamide.
Quantitative electroencephalography (QEEG) was assessed in 5 dogs anesthetized with 1.6% end-tidal concentration of isoflurane and after subsequent administration of the benzodiazepine midazolam (0.2 mg/kg of body weight, IV). Ventilation was controlled to maintain normocapnia. Effect of the benzodiazepine antagonist, flumazenil (0.04 mg/kg, IV), on QEEG in midazolam-isoflurane-anesthetized dogs was determined. Heart rate, arterial blood pressure, esophageal temperature, arterial pH and blood gas tensions, end-tidal CO2 concentration, and end-tidal isoflurane concentration were monitored throughout the study. A 21-lead linked-ear montage was used for recording the EEG data. Quantitative EEG data were stored on an optical disk for later analysis. Values for absolute power of EEG were determined for delta-, theta-, alpha-, and beta-frequencies. Cardiovascular variables remained stable throughout the study. Midazolam administration was associated with decreased absolute power in all frequencies of EEG at all electrode sites. Administration of flumazenil antagonized midazolam-induced decreased absolute power of EEG in all frequencies at all electrode sites. We conclude that QEEG provides a noninvasive, objective measure of midazolam- and flumazenil-induced changes in cortical activity during isoflurane anesthesia.
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