Mast cells?

Re: Mast cells?

James Laidlaw — Sat, 02 Jun 2012 10:37:17 GMT

Thanks Richard. It's on the flank, so good location for wide margins and total excision (hopefully)

Re: Mast cells?

Richard Fox — Sat, 02 Jun 2012 10:13:05 GMT

Late to the discussion +1 for MCT :) Bx for grading if poss unless you can achieve good margins - up to you if its incisional for grading then excision or go fro broke and do it in 1 go :)

Re: Mast cells?

James Laidlaw — Sat, 02 Jun 2012 09:02:30 GMT

[quote user="Michael Woodhouse"]

The last SPVS fee survey quoted 50% of vets using prophylactic antibiotics for routine surgery, so there are a lot of vets using them.

[/quote]

In my opinion - they need to stop doing this. There's no justification for it if surgery is done competently in a sterile environment.

I apologise for my somewhat grouchy posts previously - having a slightly rough week!

I'm not captain red star by the way...

Re: Mast cells?

David Mills — Sat, 02 Jun 2012 00:59:10 GMT

[quote user="Chris Barker"]

The most recent review of outcomes for MCT shows that the 'old' idea of two centimetre margins is no more than received wisdom which does not stand up to scrutiny. Regularly incompletely resected MCT regress and resolve with no need for further surgery The review suggested that 1cm margins (and once fascial plane deep) should suffice in the majority of cases IMO the best plan is to remove the mass ASAP rather than agonise over a surgical plan

[/quote]

One hopes, Mr Barker, that in your new role amongst our regulators that you take a rather more fulsome analysis of the evidence available, and do not resort to misrepresentation ('agonise' as opposed to careful planning) quick so zealously.

The study to which you refer, I assume:

http://www.ncbi.nlm.nih.gov/pubmed/21627510

was, I'm sure you are aware, not a review, but a retrospective study which comprised a histopath laboraoiry/correspondence-based various-centre study where actual margins were assessed on formalin-fixed samples fixed for varying periods about which - the authors admit - no sure - other than 'it probably was...' expert opinion - conclusion can actually be made about tumour margin at removal. Given that this forms the basis for their summation that 1cm is OK, I'm quite frankly astounded that the authors feel this methodology reasonable.

For myself, I far prefer the prospective study wherein the tumour margins were marked on the skin pre-removal and then submitted:

http://www.ncbi.nlm.nih.gov/pubmed/14736068

This shows that at 1cm 25% were incompletely excised. 2cm margins were associated with 100% removal both in this study and another prospective one:

http://www.ncbi.nlm.nih.gov/pubmed/16426187

Incomplete excision (25% on your scheme) is associated with a high rate of recurrence (another prospective study):

http://www.ncbi.nlm.nih.gov/pubmed/22559107

So. No agonising. Just careful planning, based on the best available evidence. Which isn't the review you quoted.

Re: Mast cells?

James Laidlaw — Fri, 01 Jun 2012 23:05:59 GMT

If you really want to discuss antibiotics - start a new thread.

Re: Mast cells?

Michael Woodhouse — Fri, 01 Jun 2012 21:41:05 GMT

[quote user="Mark Holmes"]Must appologise the question was not borne out out an intention to be critical. To be honest it probably wasn't even fair given your circumstances but I was interested how many observe this rule and how strictly.[/quote]

I have no problem mixing clean and dirty procedures under the same GA. Never had a problem.

The last SPVS fee survey quoted 50% of vets using prophylactic antibiotics for routine surgery, so there are a lot of vets using them. In human surgery intravenous cephlasporins are common and a dose of long acting amoxycillin at the time of pre-med should give me tissue concentration when I cut. I wouldn't dare do large animal surgery without and that is where I spend 80% of my time, so I carry it over to the smallies. Red star me by all means.

Re: Mast cells?

Chris Barker — Fri, 01 Jun 2012 21:33:41 GMT

[quote user="David Mills"] An MCT removal requires careful planning margins etc[/quote]

Re: Mast cells?

Mark Holmes — Fri, 01 Jun 2012 20:51:33 GMT

Must appologise the question was not borne out out an intention to be critical. To be honest it probably wasn't even fair given your circumstances but I was interested how many observe this rule and how strictly. There has been many an occasion when I have seen a dental turned down because of surgery when I would have just got on with it. Often knowing the client and being aware that this is the only opportunity to address some pretty bad teeth. At what point does fixing some bad teeth when you get a chance become worth the risk of a post op infection. Particularly if abs are used rightly or wrongly. I can think of several instances when I have struggled to get owners to accept a dental and find they will book the dog in for surgery if the need should crop up. Strict adherence to the rule does assume everybody is willing to book in for 2 anaesthetics and thats without considering how stressed some dogs become by a clinic visit and ga.

Re: Mast cells?

James Laidlaw — Fri, 01 Jun 2012 19:18:59 GMT

[quote user="Niall Taylor"]

[quote user="James Laidlaw"]I just was looking for a yes or no answer to the OP, not a critique of how I do my job.[/quote]

Touchingly naive

This is vetsurgeon.org after all!

Now, about your grammar...

Niall

[/quote] Long day...! And although I live right next to the o2 I'm missing guns and roses due to my early starts and their notoriously late ones. Apparently they finished at 2.15am in Manchester!!! I think I edited my grammar-is an iPhone an excuse?

Re: Mast cells?

Niall Taylor — Fri, 01 Jun 2012 19:08:35 GMT

[quote user="James Laidlaw"]I just was looking for a yes or no answer to the OP, not a critique of how I do my job.[/quote]

Touchingly naive

This is vetsurgeon.org after all!

Now, about your grammar...

Niall

Re: Mast cells?

James Laidlaw — Fri, 01 Jun 2012 18:25:00 GMT

I must say I was taught in my first jobs to use "prophylactic" antibiotics and it is a habit still all too prevalent in many vet practices. To me the fact that I can't recall seeing any post op infections since changing away from this habit is enough reason to see why this is an outdated and unnecessary action. In light of appropriate antibiotic use concerns I can't see how anyone could justify this for routine ops or dentals without apparent infection. It's irrelevant to this thread too, I just was looking for a yes or no answer to the OP, not a critique of how I do my job.

Re: Mast cells?

Evelyn Barbour-Hill — Fri, 01 Jun 2012 18:16:24 GMT

[quote user="Mark Holmes"]Most of us send dogs home with antibiotics anyway, particularly if teeth are extracted. [/quote]

I hope not.

Re: Mast cells?

Evelyn Barbour-Hill — Fri, 01 Jun 2012 18:14:11 GMT

[quote user="Mark Holmes"]second GA.[/quote]

Why not? (Heresy!)

Re: Mast cells?

David Mills — Fri, 01 Jun 2012 18:13:11 GMT

Yes, a mast cell tumour.

I find the criticism of not taking off at the same time ludicrous. An MCT removal requires careful planning margins etc and there is quite some dissection required to fascial plane and some reconstruction required. The 'its having antibiotics anyway' argument makes me shake my head ruefully: prehistoric. The premise is unsound also - why should most dentals go home with antibiotics?

Re: Mast cells?

James Laidlaw — Fri, 01 Jun 2012 17:23:08 GMT

Equally could say why not a second anaesthetic than risk contaminating a wound with a non-sterile procedure? Didn't get the results of the FNA until after the rest of the work was done as te slides needed time to dry and stain and read, was an incidental finding, not the main reason he came in.

Re: Mast cells?

Mark Holmes — Fri, 01 Jun 2012 16:22:56 GMT

[quote user="Mark Hedberg"]

Possibly the owner wasn't available for consent - it does happen sometimes; you ring the number they leave you and "they're out for the day"!

[/quote]

I understand that, happens all the time, but for me the dental surgery thing is not cast in stone.

Re: Mast cells?

Mark Hedberg — Fri, 01 Jun 2012 16:16:08 GMT

Possibly the owner wasn't available for consent - it does happen sometimes; you ring the number they leave you and "they're out for the day"!

Re: Mast cells?

Mark Holmes — Fri, 01 Jun 2012 15:53:53 GMT

[quote user="James Laidlaw"]Yep, dif-quick. Plan is to cut it out next week (was in for a dental today so not operated on).

[/quote]

Sorry I am going to commit heresay here...why not? ... Most of us send dogs home with antibiotics anyway, particularly if teeth are extracted. Whether we shouldor not is another Q BUT if it is a relatively minor skin surgery, closed and covered before dental done and sent home with abs post op is it really worth a second GA? Really? I wouldn't do boney stuff that involved implants but minor skin surgery... not sure I could justify a second GA.

Re: Mast cells?

James Laidlaw — Fri, 01 Jun 2012 15:33:11 GMT

Yep, dif-quick. Plan is to cut it out next week (was in for a dental today so not operated on).

Re: Mast cells?

Ian Ross — Fri, 01 Jun 2012 15:21:23 GMT

I'm not a cytologists, but yes, I think it is!!

Dense staining purple cytoplasmic granules etc (presume diff quick stain?)

I would wait until a pathologists confirms on here, but that would be my diagnosis.

Ian