Veterinary Community

Clinical Studies & Research

Clinical Studies & Research at Friendship Hospital for Animals

OCTOBER 27TH, 2017 – Friendship Surgical Specialists (FSS) Research and Other Academic Projects.

Projects in Process (ongoing case collection or in-process for publication):

  • Incidence of Infections Associated with Wound-Soaker Catheters

Wound-soaker catheters are used to help reduce discomfort after surgery. These catheters are placed into a wound prior to wound closure and a constant amount of a local anesthetic infused into the wound helps to provide a pain-free recovery. While the excellent pain relieve with the use of these catheters has been described, and while we do not believe that there is an increased risk of infection associated with their use, this study is being conducted in an effort to confirm this hypothesis. Friendship Surgical Specialists once more works in cooperation with Texas A&M University on this project.

Currently enrolling cases. 

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  • Hemangiosarcoma (HSA) of the Spleen

Pilot study to help collect tissue samples from dogs with splenic hemangiosarcoma. This study’s aim is to develop a vaccine that may help to extend the life-span of dogs suffering from HSA. This is a nationwide multi-institutional study. At Friendship Hospital for Animals it is performed in cooperation between Friendship Surgical Specialists and General Surgery Departments with the Friendship Oncology Specialists. The study is headed by “The Oncology Service.”

Currently enrolling cases.

  • Percutaneous versus Closed Proximal Tibial Tuberosity Fracture Treatment

A multi-institutional prospective study comparing the traditional surgical method to treat tibial tuberosity avulsion fractures using a pin-and-tension band and a study, published through Friendship Hospital for Animals in 2017, using a minimally invasive, percutaneous method to treat such fractures. Percutaneous means placement of implants directly through the skin, without making a long skin incision. Such technique follows the principles of minimally invasive orthopedics and biologic fracture repair, which have shown significant advantages in regards to healing times, infections, return to function and hospitalization times.

Currently enrolling cases.

  • Prospective Percutaneous Proximal Tibial Tuberosity Fracture Treatment

Prospective collection of case with tibial tuberosity avulsion fractures. This is the continuation of a study, published through Friendship Hospital for Animals in 2017, using a minimally invasive, percutaneous method to treat such fractures. Percutaneous means placement of implants directly through the skin, without making a long skin incision. Such technique follows the principles of minimally invasive orthopedics and biologic fracture repair, which have shown significant advantages in regards to healing times, infections, return to function and hospitalization times.

Currently enrolling cases.

  • Percutaneous Metabone Fracture Repair: a Prospective Study

Animals can break their feet just like humans can. This study focuses on the use of a percutaneous technique (placement of implants directly through the skin, without making a long skin incision) to treat the metacarpal and metatarsal bones in dogs and cats.

Currently enrolling cases.

  • Comparison of Tibial Plateau Leveling Osteotomy (TPLO) With and Without Bone Graft

TPLO is the most commonly used method to stabilize the cranial cruciate deficient stifle in dogs today. In humans, this injury is called “ACL-tear in the knee.” The TPLO surgery stabilizes the knee by changing the biomechanics and includes an osteotomy (bone cut) in the tibia (shin bone). This osteotomy has to heal. The goal of this prospective study is to evaluate if there is better bone healing and thus faster return to function when a bone graft has been applied during surgery.

Case enrollment completed.

  • Minimally Invasive Gastropexy

Gastric dilatation volvulus (GDV) is a condition when a dog’s stomach fills with air and twists around its own axis, resulting in cessation of blood flow and – if not treated – becoming a life-threatening condition. To avoid this problem, a preventative gastropexy can be performed early on in life: the stomach is sutured to the body wall, which avoids the development of GDV. Friendship Hospital for Animals has used a minimally invasive method to conduct this surgery for multiple years and is currently evaluating its long-term outcome. Based on currently available data, this minimally invasive method has consistently avoided GDV later in life and thus is recommended to be applied, for example at the time of spay/neuter etc., early in life.

Case enrollment completed. However, the technique is continuously applied at our hospital.

  • Ultrasonography of Shoulders in Dropped Iditarod Sled Dogs:

As previously described by Dr. Dirsko von Pfeil (specialty surgeon at Friendship Hospital for Animals), the shoulder is the most commonly injured joint in marathon sled dogs. The recently completed study on ultrasonographic examination of shoulders in these canine athletes will help to enhance preventative and treatment options also in other fields of canine sports medicine. This was a collaborative study with the University of Georgia Athens, generously funded by the Army Research Office and Defense Advanced Research Projects Agency (U.S. Dept. of Defense).

Case enrollment completed. Publication in process.

  • Survey of Veterinary Orthopedic Society Members on the Preferred Method to Treat Cranial Cruciate Ligament Rupture in Dogs Weighing More than 15kg.

Cranial cruciate ligament rupture (CCLR) with subsequent joint instability is the most common pathological condition affecting the canine stifle joint. While surgical stabilization is recommended, the surgical method with best long-term outcome is disputed. This survey among members of the Veterinary Orthopedic Society (an international organization consisting mainly of surgeons dedicated to orthopedic surgery) was undertaken in cooperation with Michigan State University and Tufts University.

Case enrollment completed. Publication in process.

 

Completed Publications

  • Von Pfeil DJF. Achilles tendon injuries in dogs. Virginia-Maryland Dog Magazine. Fall 2017. Achilles tendon injuries can become devastating injuries. If treated early on and when using the appropriate technique, the outcome for canine Achilles injuries is typically very good. Available for free online.
  • Von Pfeil DJF. Mending Dogs’ Broken Bones Has Come a Long Way. How Surgical Procedures Known as Minimally Invasive Osteosynthesis and Fluoroscopically Guided Fracture Repair Have Helped Heal Dogs. Virginia-Maryland Dog Magazine. Summer  2017. Minimally invasive osteosynthesis is considered the Gold Standard in human fracture repair. The author has been involved in the use of this technique over the last 16 years and has contributed to numerous surgical implants and techniques supporting the use of minimally invasive surgery. The article gives an overview on MIO, which – when properly performed – carries an excellent prognosis.  Available for free online.
  • Von Pfeil DJF, Glassman M, Ropski M. Percutaneous Pinning of Tibial Physeal Fractures: Technique and 17 Cases. Vet Comp Orth Traumat Jul 20;30(4):279-287. Minimally invasive osteosynthesis is considered the Gold Standard in human fracture repair. The first author has been involved in the use of this technique over the last 16 years and has contributed to numerous surgical implants and techniques supporting the use of minimally invasive surgery. This study specifically describes treatment of growth plate fractures by placement of implants through the skin, without making a long skin incision, and a technique developed by Dr. Mathieu Glassman called “Spiking” to treat tibial tuberosity avulsion fractures. This study is published and was presented at the Annual Symposium of the American College of Veterinary Surgeons in Indianapolis 2017 and at the Annual Meeting of the European College of Veterinary Surgeons. At the latter, it was elected as one of the four best presentations of the entire conference.
  • Simon BT, Scallan EM, von Pfeil DJF, Boruta DT, Wall R, Nibblett BD, O O, Beauchamp G, Steagall PV. Perceptions and Opinions of Pet Owners in the United Sates About Surgery, Pain Management, and Anesthesia in Dogs and Cats. Accepted: Veterinary Surgery, 2017. Pain management is a cornerstone to provide best recovery and comfort to our surgical patients. Friendship Hospital for Animals  is proud to be the only veterinary clinic in the DC metropolitan area to have a board-certified anesthesiologist on staff, who is also certified in pain management and acupuncture. This study, performed in cooperation with several specialty hospitals and with Texas A&M University, revealed the importance of education and owners perception on pain management for our patients. This study was presented at the Annual Conference of the American College of Anesthesiologists in 2017.
  • Von Pfeil DJF, Zellner E, Langohr I, Fritz M, Griffith C, Hauptman JG, Stanley BJ. Congenital Laryngeal Paralysis in the Alaskan Husky. Accepted: JAVMA April 2017. This publication is the result of a 10-year-long study aiming to describe a devastating condition called congenital laryngeal paralysis (CLP) in Alaskan huskies (AKH). While most dogs with laryngeal paralysis are older and are most often Labradors, AKH with CLP present with a “wheezing” noise rather than the typical stridor seen in older dogs. This study is the first to describe the phenotype, treatment and outcome, as well as histopathological and pedigree analysis results in the AKH. Outcome with surgery (using either a traditional or less-invasive surgery [previously described by the first author]), these patients can resume a normal life, whereas without treatment they are at risk to die from asphyxiation. This study was conducted in cooperation with Michigan State and Louisiana State University, Veterinary Specialists of Alaska and The Travelling Vet in Colorado and presented at multiple national and international conferences.
  • Von Pfeil DJF, Albrecht M, Glassman M. Letter to the editor. Traumatic Fracture of the Medial Coronoid Process in 24 Dogs. Vet Comp Orthop Traumatol. LTE. Vet Comp Orthop Traumatol 2016;30 (1):88. A contribution to the discussion on this condition, seen and treated frequently by the use of arthroscopy at our institution.
  • Von Pfeil DJ, Cummings BP, Loftus JP, Levine CB, Mann S, Downey RL, Griffitts C, Wakshlag JJ. Evaluation of Plasma Inflammatory Cytokine Concentrations in Racing Sled Dogs. Can Vet J. 2015 Dec;56(12):1252-6. State of the art in human exercise physiology, the use of inflammatory cytokines in canine sports medicine is still in its infancy. This study, conducted in cooperation with Cornell University, is one of the first using these markers to help assess injuries and possibly plan for improved training and dietary support of canine endurance athletes.
  • Von Pfeil DJF, Sung J, Barry J, Hayashi K, Edwards MR. Effect of Doxycycline on Contralateral Cranial Cruciate Ligament Rupture. Vet Comp Orth Traum 2015;28(6):371-8. Cranial cruciate ligament rupture (CCLR) with subsequent joint instability is the most common pathological condition affecting the canine stifle joint. While surgical stabilization is recommended and numerous publications describe techniques for surgery, there is a lack of studies evaluating the possibility to prevent CCLR from occurring. Based on previous clinical case reports, suggesting a possibly beneficial effect of doxycycline as a means to prevent CCLR, this study was conducted in cooperation between Friendship Hospital for Animals with Cornell University and Veterinary Specialists of Alaska to further assess this possibly preventative effect. Unfortunately, results revealed that long-term, there is no effect preventing contralateral CCLR to occur. Presented at multiple national surgical and orthopedic specialty meetings.
  • Von Pfeil DJF, Edwards M, Nelson S, Krotscheck U. Letter to the editor. Long-Term Functional Outcome of Tibial Plateau Leveling Osteotomy versus Extracapsular Repair in a Heterogeneous Population of Dogs. Veterinary Surgery 2015; 2015 Oct;44(7):920. Cranial cruciate ligament rupture (CCLR) with subsequent joint instability is the most common pathological condition affecting the canine stifle joint. While numerous surgical techniques have been described for treatment, two of the most commonly applied ones include the tibial plateau leveling osteotomy (TPLO) and extracapsular repair (aka “lateral suture”; “modified retinacular imbrication technique”;”Flo-technique”). This publication shows by using dedicated scientific methods that large-breed dogs undergoing TPLO surgery return to better long-term function when compared to the extracapsular repair. The authors support the original study in that these findings mirror what has been seen in our daily clinical life.
  • Von Pfeil DJF, William D. Liska WD, Nelson S Jr, Mann S, Wakshlag J. A Survey on Orthopedic Injuries During a Marathon Sled Dog Race. Vet Med: Research & Reports.2015. Vol6: 329—339. Marathon sled dog racing is – just like human marathon racing – associated with development of certain injuries. In an effort to help specify these injuries more clearly and with the long-term goal of helping to develop injury preventative strategies, this prospective publication summarizes 5.6GB of collected data and provides directions for future research in this area. This work was resented among others at the Bi-annual conference of the International Sled Dog Veterinary Medical Association, the American College of Veterinary Surgeons  and the Annual Meeting of the Veterinary Orthopedic Society, where it was elected in to the final circle of the best presentations of the conference. Available for free online.
  • Mossman H, von Pfeil DJF, Nicholson M. et al. The Accuracy of YThree Pre- and Intraoperative Measurement Techniques for Osteotomy Positioning in the Tibial Plateau Leveling Procedure. Vet Comp Orthop Traumatol 2015; 28: 250–255. Cranial cruciate ligament rupture (CCLR) with subsequent joint instability is the most common pathological condition affecting the canine stifle joint. While numerous surgical techniques have been described for treatment, one of the most commonly applied ones is the tibial plateau leveling osteotomy (TPLO). The surgical technique entails a step in which the tibia (shin bone) is cut (called osteotomy) using a bone saw. For best final clinical outcome, this bone cut needs to be performed with great accuracy. This publication compares three measurement techniques for TPLO osteotomy.

Books and Book Chapters

  • Von Pfeil DJF. Updated section on interlocking nails in the chapter on “Internal Fracture Fixation“ of the book “Veterinary Surgery: Small Animal” (2nd ed). Co-Autors: Johnston SA, Dejardin LM, Roe S, Weh M. Editors: Spencer A. Johnston and Karen M. Tobias. Elsevier 2018: 654-690. Interlocking nail placement is state of the art for human long-bone fracture management. Over the last 20 years, this minimally invasive method of fracture repair has become more available also for small animal patients. Based on revolutionary design changes of the locking mechanism, in part developed based on the dissertation work of Dr. von Pfeil, the currently most common used nail type, the I-LOC, has been associated with faster healing times and return to function, when compared to other internal fixation methods. This book chapter provides information not only on the interlocking nail, but also on the other methods of fracture repair, including bone plating, pin placement, use of screws and cerclage.
  • Von Pfeil DJF,  Lee J,  Thompson S, Hinchcliff K. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association, 2015. 278pages. Available through the ISDVMA – http://www.isdvma.org. or the publisher, LuLu Press, Raleigh, NC. Lulu.com. This book provides a comprehensive review of topics of interest for both owners and veterinarians involved in sled dog racing. Editors and authors do not obtain royalties – all earnings go towards the non-profit organization ISDVMA. Worldwide available; print on demand: http://www.lulu.com/content/paperback-book/musher-and-veterinary-handbook/16694584.

 

  • Von Pfeil DJF, Steer Z. Terminology. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW,eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015:11-14. For best communication between dog owners and veterinarians, this chapter provides a list of terms commonly used in the sled dog sport.
  • Von Pfeil DJF, Stanley B. Laryngeal Paralysis in the Alaskan Sled Dog. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015: 32-35. While most dogs with laryngeal paralysis are older and most often Labradors, Alaskan huskies with congenital laryngeal paralysis are younger and present with a “wheezing” noise rather than the typical stridor seen in older dogs. This chapter describes the condition and treatment options.
  • Von Pfeil DJF, Hecker S, Lewis T. Checklist for Trail Veterinarians. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC: 2015: 218-223. Being exposed to temperatures down to -40F, a veterinarian who volunteers to work at a sled dog race needs to come prepared. This chapter provides suggestions on how to plan for long and cold arctic days – which can be enjoyed when bringing the appropriate gear.
  • Von Pfeil DJF, Griffits C, Glick K. Orthopedic Examination Basics for the Sled Dog. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC:2015: 122-145. This chapter helps both mushers and veterinarians to identify specific orthopedic injuries  in the athletic dog.
  • Von Pfeil DJF, Griffits C. Injuries to the Axial Skeleton of Sled Dogs. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW,eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015: 127-145. Common orthopedic injuries encountered by sled dogs and the treatments for these injuries are discussed.
  • Von Pfeil DJF. Basics of Wound Care in the Sled Dog. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015: 120-126. Wounds are frequently obtained by sled dogs and the treatments for these injuries are discussed.
  • Von Pfeil DJF, Liska WD. Overview of a Few Big Sled Dog Races. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015: 242-243. This chapter presents some of the worldwide biggest sled dog races.
  • Von Pfeil DJF. Striving for ERxcellence in Sled Dog Veterinary Medicine. Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC, 2015: 273. This chapter explains that all veterinarians volunteering to work at sled dog races do this to provide the best health and care to these amazing athletes.
  • Von Pfeil DJF. Addendum on Sled Dog Research Updates (2010-2015). Book chapter in: Von Pfeil D, Lee J Thompson S, Hinchcliff KW, eds. Musher and Veterinarian Handbook (3rd Ed.). International Sled Dog Veterinary Medical Association/LuLu Press, Raleigh, NC,2015: 274-276. Research in the field of sled-dog-medicine is evolving and a book can never completely cover all the newest publications. This chapter provides additional summaries on such work.

 

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SEPTEMBER 27TH, 2017 – A Funded Clinical Trial to Evaluate an Autologous Vaccine Plus Adoptive T-Cell Transfer in the Treatment of Dogs with and Hemangiosarcoma.

Friendship Oncology Specialists is now recruiting patients for a funded clinical trial to evaluate an autologous vaccine plus adoptive T-cell transfer in the treatment of dogs with and hemangiosarcoma.
Trial Specifics:

Animal Clinical Investigations is conducting a clinical trial in dogs with hemangiosarcoma, sponsored by Elias Animal Health, LLC.  ELIAS Cancer Immunotherapy (ECI™) is a personalized T cell-based treatment that triggers the patient’s immune system to eliminate cancer.

This trial is designed to evaluate the safety and efficacy of surgery combined with ECI-VAR-04 as a treatment for newly-diagnosed splenic hemangiosarcoma.  Following surgery, enrolled dogs will receive a series of vaccinations that are customized from the cancer tissue.  Up to 5 customized vaccines will be given over the course of the study.  After the vaccinations, the personalized T cells are collected through apheresis and then activated before being reinfused into the patient. Patients will receive oral chemotherapy prior to T-cell infusions. Following intravenous infusion of activated T cells and additional vaccination visits, enrolled dogs will be followed for up to 11 months.  The follow-up visits will include bloodwork, ultrasound examinations, and thoracic radiographs every 3 months.

Trial Funding:

The owner is responsible for the initial surgery, and the remainder of the trial is fully funded for the full trial duration (11 months), including all visit procedures and treatments.

Trial Eligibility:

Dogs with hemangiosarcoma may be enrolled if they meet the specific criteria:

  • Biopsy confirmation of splenic hemangiosarcoma
  • Splenectomy must be performed at a designated study site for appropriate tissue processing
  • No prior or current anti-cancer treatment other than surgery for hemangiosarcoma
  • No concurrent glucocorticoids or other immunosuppressive chemical agents
  • No second malignancy or other uncontrolled medical condition that may be disruptive to the objectives of the study

Please contact Friendship Oncology Specialists to discuss enrolling your patient in this study.

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AUGUST 9TH, 2017 – Subclinical Bacteriuria in Dogs with CKD

Friendship Internal Medicine is now recruiting patients for a fully funded clinical study of Subclinical Bacteriuria in Dogs with CKD.

How do you approach a positive urine culture in a dog without any clinical signs?
Veterinary infectious disease experts have recommended that these dogs do not require therapy. However, diseases like chronic kidney disease (CKD) may increase the risk of ascending urinary tract infection. Currently, data isn’t available to help guide treatment recommendations. Our goal is to change that.  We are looking to enroll dogs with CKD and a positive urine culture, who lack clinical signs of lower or upper urinary tract infection.

This study is fully funded. All dogs will receive the following at no cost to the owners:

  • Exam by internal medicine specialist
  • Recheck urine culture to confirm bacteriuria
  • Complete blood count
  • Biochemical panel
  • Urinalysis
  • Urine protein:creatinine ratio
  • Urinary tract ultrasound
  • Analysis of serum and urinary renal injury biomarkers
Dogs will not receive antibiotic therapy throughout the duration of the study unless clinical signs of infection develop. Dogs with clinical signs of urinary tract infection at the time of enrollment will be treated with appropriate antimicrobials and not be eligible for enrollment.  All dogs will receive complimentary recheck examinations and free labwork at 1, 3, and 6 months after enrollment.  Please contact Friendship Internal Medicine to discuss enrolling your patient in this study.

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