Breast cancer remains the most common noncutaneous malignancy of women. Although the incidence of the disease continues to rise, most women now present with early (stage I or II) disease. Breast conservation has been demonstrated to be equal in efficacy to mastectomy in such patients in six modern-day randomized trials. The utilization of breast conservation has been slow throughout the United States. At Memorial Hospital the utilization of breast conservation almost equals that of modified mastectomy in the treatment of 950+ annual primary operable cancers. Excellent local-regional control can be obtained with a defined surgical approach to the primary tumor and axillary nodes, radiotherapy to the breast with a boost to the primary site, and finally patient selection.

Breast Neoplasms↗

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Intraoperative monitoring of ischiatic nerve function with sensory evoked potentials.

Serial recordings of sensory evoked potentials (SEP) generated in response to stimulation of each tibial nerve were obtained from 23 anesthetized dogs. Five dogs were anesthetized for 3 hours to evaluate changes in serial SEP during general anesthesia. Nonsurgical and surgical manipulations were performed on one hind limb of five dogs to determine the effects of limb positioning and nerve retraction on SEP. In 13 dogs, the ischiatic nerve was exposed surgically and retracted until the SEP deteriorated and disappeared, to determine the relationship between amount of tension on the nerve and the time to complete deterioration of the SEP. Sensory evoked potential waveforms, which consisted of two to five peaks, were stable throughout the anesthetic period. The first two peaks were the most stable. Latency of the first two peaks was the easiest and most reliable parameter to evaluate. Although the peak latency in recordings from the superior hind limb was always slightly longer, SEP recordings from the inferior limb were good controls to monitor nerve function. There was considerable variation in sensitivity to nerve retraction. The technique proved to be a reliable way to monitor nerve function in normal anesthetized dogs.

Anesthesia, General↗

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Clinical effects of longitudinal division of the corpus callosum in normal dogs.

Longitudinal division of the corpus callosum was performed in six normal beagles to determine surgical morbidity. The corpus callosum was divided sagittally on the midline and the effect on neurological function was determined. Five of six dogs were clinically normal within 14 days or less after surgery. One dog had persistent but improving clinical signs consistent with a forebrain disturbance at 30 days after surgery. Overall, minimal morbidity and no mortality was associated with this surgical procedure. Further study is indicated to determine the efficacy of this surgical treatment for seizure control in dogs with idiopathic epilepsy.

Animals↗

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The effect of acute, unilateral transverse venous sinus occlusion on intracranial pressure in normal dogs.

Lateral rostrotentorial and caudal suboccipital approaches to the brain were performed on six beagles. Intracranial pressure (ICP) was measured as the two craniectomies were connected by removing the bone of the nuchal crest and occluding the transverse venous sinus. Intracranial pressure remained constant after acute occlusion of the sinus with bone wax and there was no gross evidence of brain edema. All six dogs survived the surgery and five dogs survived for a minimum of 3 months. One dog died acutely during the postoperative period. The exact cause of the cerebellar hemorrhage and infarction found at necropsy in the latter dog was not evident. Anemia occurred in three of the six dogs as a result of intraoperative hemorrhage. All dogs surviving the perioperative period had mild, transient hypermetria and conscious proprioceptive deficits, but were neurologically normal 72 hours after surgery. Results of this study indicate that acute, unilateral transverse sinus occlusion is possible without an increase in ICP. The ability to do this allows access to the rostral aspect of the ipsilateral cerebellum and brain stem.

Animals↗

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Acute, unilateral transverse sinus occlusion during craniectomy in seven dogs with space-occupying intracranial disease.

OBJECTIVE: The purpose of this study was to determine the effect of acute, unilateral transverse sinus occlusion on intracranial pressure (ICP) and postoperative mortality in dogs with structural intracranial disease. STUDY DESIGN: Affected dogs had a single transverse sinus occluded during craniectomy for intracranial mass biopsy or removal. ANIMALS: Seven dogs with space-occupying intracranial disease in the cerebellopontine angle area. METHODS: The ipsilateral transverse sinus was permanently occluded during the surgical approach to the intracranial lesion to increase surgical exposure by allowing a caudal lateral rostrotentorial craniectomy to be combined with a suboccipital craniectomy. In five dogs, intracranial pressure was monitored during surgery using a fiberoptic intracranial pressure monitoring device. RESULTS: Initial ICP varied among dogs, ranging from 7 to 21 mm Hg. Intracranial pressure, however, decreased in all dogs after craniectomy and durotomy (P < .05). No increase in intracranial pressure occurred after transverse sinus occlusion (P = .42). All dogs survived the surgical procedure. CONCLUSIONS: Acute, unilateral transverse sinus occlusion during craniectomy in dogs with space-occupying intracranial lesions did not result in significant increases in ICP or intraoperative mortality. CLINICAL RELEVANCE: Acute, unilateral transverse sinus occlusion during craniectomy can be used to increased surgical exposure to the caudal fossa of the brain without increased risk of increasing ICP.

Animals↗

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Radiographic diagnosis--engorged ticks appearing as distinct radiographic opacities.

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Animals↗

PubMedDate not supplied

Idiopathic polyneuropathy in Alaskan malamutes.

Clinical and morphologic features of a progressive polyneuropathy in young mature Alaskan Malamutes are described. Clinical signs included progressive paraparesis, synchronous pelvic limb gait, exercise intolerance, hyperesthesia, hyporeflexia, muscle atrophy, and tetraplegia. Electromyographic testing revealed diffuse fibrillation potentials and positive sharp waves in limb muscles, especially in muscles below the elbow and stifle. Pathologic findings in skeletal muscles and peripheral nerves included neurogenic muscle atrophy, focal or diffuse loss of myelinated nerve fibers, myelinoaxonal necrosis, and variable demyelination or remyelination. Ultrastructural changes included axonal degeneration, presence of numerous Büngner bands, and denervated Schwann cell subunits. The nature and distribution of abnormal electrophysiologic and pathologic findings were suggestive of a distal sensorimotor polyneuropathy, which we have termed idiopathic polyneuropathy of Alaskan Malamutes to distinguish this condition from hereditary polyneuropathy of Norwegian Alaskan Malamutes, last described in 1982.

Animals↗

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The surgical management of primary invasive breast cancer.

The treatment of operable primary breast cancer has evolved dramatically in the past few decades. The standard operative procedure has changed from the radical mastectomy to the modified radical mastectomy, and the use of breast-conserving treatment is increasing. This article reviews trends in treatment of early-stage breast cancer, factors associated with increased risk for local recurrence after breast-conserving treatment, and the use of axillary lymph node dissection.

Adult↗