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The aim of this study was to evaluate the use of cathepsin-activated intraoperative near-infrared (NIR) imaging to detect insulinomas in dogs, a spontaneous large animal model for human disease. A prospective, pilot clinical trial was performed on dogs with naturally occurring insulinomas undergoing exploratory laparotomy. Each dog underwent routine preoperative diagnostic assessment, and a cathepsin-activated fluorophore (VGT-309) was administered intravenously 1-2 days preoperatively. All intraoperative findings with visible light and NIR imaging were recorded and mean NIR fluorescence intensity of tumors and grossly normal pancreas were quantified. Excision of any identified primary tumor and suspected metastatic lesions was performed. All excised tissues underwent histologic evaluation and immunohistochemistry (IHC) for cathepsin B expression. Descriptive statistics were calculated, and differential fluorescence intensity and cathepsin B expression between the pancreatic mass and adjacent grossly normal pancreatic tissue were assessed for statistical significance via paired t tests with p < 0.05 used for significance. Six dogs were enrolled. No adverse events occurred secondary to administration of the imaging agent. In situ, insulinomas had significantly greater mean fluorescence intensities than the surrounding pancreas, and the median tumor to background ratio was 1.906 (range 1.286-2.556). One dog had an occult pancreatic mass that was identified intraoperatively with NIR guidance. Background fluorescence of liver and lymph nodes was observed in all cases, and one dog was diagnosed with nodal and hepatic metastasis. Histologic tumor margins correlated with margins of NIR fluorescence. Cathepsin B expression was determined to be significantly greater in the pancreatic tumor compared to adjacent non-neoplastic pancreas via IHC, and there was no overlap in the range of median IHC-positive proportion values for these tissues. However, there was overlap in the range of IHC-positive proportion values for neoplastic pancreatic samples and lymph node and liver tissues. The findings of this pilot study support further investigation of cathepsin-activated NIR imaging to enhance intraoperative canine insulinoma localization and margin evaluation. Future studies are needed to further characterize and optimize the utility of targeted NIR imaging, particularly to identify metastatic lesions, for canine insulinoma, which may serve as an effective translational model for humans with pancreatic neuroendocrine tumors.

Case summary A 2-year-old female spayed domestic shorthair cat was presented for evaluation of severe thickening of the proximal duodenum identified on abdominal ultrasound after a 1-year history of vomiting. At surgery, a proximal duodenal mass encompassed the areas of the major and minor duodenal papillae. A gastrojejunostomy was performed to bypass the proximal duodenum and maintain the integrity of the major duodenal papilla. Histopathology revealed changes consistent with feline eosinophilic sclerosing fibroplasia. The cat was treated with prednisolone and survived for 2.5 years. It was euthanized for bronchopneumonia. Relevance and novel information This case report describes a surgical approach for cats with lesions involving the pylorus and proximal duodenum. Gastrojejunostomy provided a therapeutic option that preserved exocrine pancreatic and biliary secretion in this cat.

Abstract Background Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited. Objectives To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats. Animals Thirty-one client-owned cats with HH. Methods Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long-term follow-up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis. Results Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty-one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left-sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow-up was 959 days (range, 3-4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow-up of 2559 and 771 days, respectively. Conclusions and Clinical Importance Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.

Intraoperative optical cancer imaging is an emerging technology in which surgeons employ fluorophores to visualize tumors, identify tumor-positive margins and lymph nodes containing metastases. This study compares instrumentation to measure tumor fluorescence. Three imaging systems (Spectropen, Glomax, Flocam) measured and quantified fluorescent signal-to-background ratios (SBR) in vitro , murine xenografts, tissue phantoms and clinically. Evaluation criteria included the detection of small changes in fluorescence, sensitivity of signal detection at increasing depths and practicality of use. In vitro , spectroscopy was superior in detecting incremental differences in fluorescence than luminescence and digital imaging (Ln[SBR] = 6.8 ± 0.6, 2.4 ± 0.3, 2.6 ± 0.1, p = 0.0001). In fluorescent tumor cells, digital imaging measured higher SBRs than luminescence (6.1 ± 0.2 vs. 4.3 ± 0.4, p = 0.001). Spectroscopy was more sensitive than luminometry and digital imaging in identifying murine tumor fluorescence (SBR = 41.7 ± 11.5, 5.1 ± 1.8, 4.1 ± 0.9, p = 0.0001) and more sensitive than digital imaging at detecting fluorescence at increasing depths (SBR = 7.0 ± 3.4 vs. 2.4 ± 0.5, p = 0.03). Lastly, digital imaging was the most practical and least time-consuming. All methods detected incremental differences in fluorescence. Spectroscopy was the most sensitive for small changes in fluorescence. Digital imaging was the most practical considering its wide field of view, background noise filtering capability and sensitivity to increasing depth.

This retrospective study describes the clinical course, treatment, and outcome of 21 dogs with gastric adenocarcinomas (n=19) and leiomyosarcomas (n=2). Medical records from 1986 to 1999 were reviewed for signalment, weight, diagnosis, tumor location, clinical signs, radiographic imaging procedures, surgical procedures, chemotherapy, duration of follow-up monitoring, outcome, cause of death, metastatic rate, metastatic sites, and method of detection of metastasis. Fourteen of 19 (74%) dogs with gastric adenocarcinomas had metastasis. Metastatic sites included gastric lymph nodes, omentum, liver, duodenum, pancreas, spleen, esophagus, adrenal glands, and lungs. Both cases of a gastric leiomyosarcoma had metastatic disease involving the liver (n=2) and duodenum (n=1). Surgery, consisting of either a Billroth I or a gastrojejunostomy, provided immediate relief of the gastric outflow obstruction and clinical improvement in the early postoperative period. The beneficial effects of chemotherapy alone or adjuvant chemotherapy are still unknown. Recurrence of clinical signs 3 days to 10 months after surgery caused all owners to elect euthanasia. The long-term prognosis for most cases of gastric adenocarcinomas and leiomyosarcomas is poor because of the presence of advanced disease. Surgical resection, however, does alleviate gastric outflow obstruction in the immediate postoperative period.

True emergencies involving the anus and rectum are associated with either perforation and potential sepsis or rectal prolapse. Rectal perforation and leakage of fecal material into the peritoneal or retroperitoneal spaces can quickly lead to life‐threatening septic shock. Rectal prolapse can result in necrosis of the rectum, requiring extensive surgical resection and repair. This chapter will focus on these two conditions but will also outline other anorectal diseases, including anal sac abscesses, anal sac neoplasia, rectal neoplasia, and perianal fistulae that can present to the emergency room clinician.