Objective—To characterize serologic and clinical features
and outcome of dogs with leptospirosis that
were treated conservatively (ie, medical management
alone) or with hemodialysis.
Animals—36 dogs with leptospirosis.
Procedure—History; results of physical examinations,
ultrasonography, and serologic, hematologic,
and serum biochemical analyses; time to resolution of
azotemia; and outcome were obtained from medical
records. Dogs were treated conservatively (n = 22) or
with hemodialysis (14).
Results—Between 1990 and 1998, amount of rainfall
was positively correlated with number of cases of leptospirosis
identified per year. Serum antibodies
against 6 Leptospira serovars were measured, and
titers were highest to Leptospira pomonain 16 (44%)
dogs, L bratislava in 9 (25%) dogs, and L hardjo in 1
(3%) dog. Eight (22%) dogs had equally high titers to
L pomona and L bratislava, 1 (3%) had equally high
titers to L grippotyphosa and L canicola, and 1 (3%)
had high titers to L grippotyphosa, L pomona, L canicola,
and L bratislava. During initial evaluation, all dogs
were azotemic. Thirty (83%) dogs survived, including
12 of 14 (86%) dogs treated with hemodialysis and 18
of 22 (82%) treated conservatively. Serum creatinine
concentration was similar in both groups after resolution
of clinical signs.
Conclusion and Clinical Relevance—Infection with
L pomona and L bratislava was recognized as a cause
of leptospirosis in dogs, and resulted in development
of acute renal failure with various degrees of
azotemia. Prognosis for dogs with mild to moderate
azotemia was good with conservative treatment,
whereas treatment with hemodialysis appeared to
improve prognosis for dogs with severe azotemia. (J
Am Vet Med Assoc 2000;216:371–375)
Case Description—A 6-month-old female domestic shorthair cat was admitted for evaluation of intermittent clinical signs of hematuria and inappropriate urination for the past 2 months.
Clinical Findings—Transabdominal ultrasonography revealed a multilayered mass in the urinary bladder apex consistent with full-thickness invagination of the bladder wall.
Treatment and Outcome—Exploratory surgery was performed, and partial inversion of the urinary bladder was confirmed. The invaginated bladder apex was manually reduced, and partial cystectomy was performed to remove the invaginated section of bladder wall. Histologic findings were consistent with vascular congestion and edema secondary to partial invagination. Bacterial culture of a section of the bladder mucosa demonstrated concurrent bacterial urinary tract infection. Clinical signs resolved following surgical resection of the bladder apex and antimicrobial treatment for the concurrent urinary tract infection.
Clinical Relevance—Partial invagination of the urinary bladder should be considered in the differential diagnosis for cats with clinical signs of hematuria, stranguria, and inappropriate urination. A diagnosis may be made on the basis of detection of invaginated tissue in the bladder apex during abdominal ultrasonography.
Objective—To evaluate manufacturing variability, diffusion of filling solutions, and maintenance of occlusion over time in 3 sizes of silicone hydraulic occluders (HOs).
Sample Population—2-, 5-, and 20-mm HOs (HO2, HO5, and HO20, respectively).
Procedures—Manufacturing variability was analyzed by comparing variation in internal luminal areas and filling volumes within each size group. Occluders were filled to 100% occlusion with air (n = 4), saline (0.9% NaCl) solution (4), or sodium hyaluronate (4) and submerged in simulated body fluid. Changes in luminal area and weight were recorded for 133 days to evaluate maintenance of occlusion.
Results—Considerable variability in uninflated luminal area and fill volumes was observed among the 3 sizes of HOs. Loss of occlusion developed in the first 12 hours in all air-filled HOs. Fluid-filled occluders were reliable in maintenance of occlusion after 133 days (99.99% for HO20, 99.59% for HO5, and 90.40% for HO2), although diffusion of saline solution and hyaluronate from all HOs was confirmed by detection of significant decreases in weight over time. There was no significant difference in weight loss between HOs filled with saline solution and HOs filled with sodium hyaluronate.
Conclusions and Clinical Relevance—Saline solution or sodium hyaluronate may be used as a filling solution in the HOs tested. Maintenance of occlusion was best in the larger sizes. Saline solution or sodium hyaluronate should be used in future clinical investigations of HOs. Retrograde filling to remove air should be used when filling HOs with fluid.
Objective—To evaluate efficacy of a hydraulic occluder (HO) used for treatment of dogs with an intrahepatic portosystemic shunt (IHPSS).
Animals—10 dogs with an IHPSS.
Procedures—Serum biochemical and postprandial bile acids (PPBA) analyses and transcolonic scintigraphy were performed before surgery. Laparotomy was performed, and an uninflated HO was placed around the portal vein branch leading to the IHPSS. After surgery, 0.9% NaCl solution was injected into subcutaneous injection ports at 2, 4, 6, and 8 weeks to achieve staged occlusion of the HO. Serum biochemical analyses, PPBA analysis, and scintigraphy were performed 2 weeks after occlusion. Serum biochemical analyses were repeated 1 year after surgery.
Results—Implant revision was required in 3 dogs because of rupture of the HO (n = 2) or detachment of the actuating tubing (1). Serum biochemical values and clinical signs improved in all dogs after surgery. Six of 10 dogs had PPBA concentration within reference range 2 weeks after occlusion, and 2 additional dogs had concentrations within reference range at 1 year. Only 5 of 10 dogs had complete resolution of portosystemic shunting 2 weeks after occlusion. Two dogs were lost to follow-up, and 8 dogs remained alive with no recurrence of clinical signs at a median of 22 months after surgery.
Conclusions and Clinical Relevance—Use of the HO appeared to be an effective method for surgical treatment for dogs with IHPSS, although problems with implant reliability indicate a need for modifications in design and manufacturing.
OBJECTIVE To identify factors affecting the diagnostic quality of core needle renal biopsy specimens from dogs with suspected kidney disease.
DESIGN Cross-sectional study.
ANIMALS 522 client-owned dogs with suspected kidney disease for which core needle renal biopsy specimens (n = 1,089) were submitted to the International Veterinary Renal Pathology Service for evaluation and inclusion in their database.
PROCEDURES Data regarding dog signalment, clinical variables, biopsy method, needle brand and gauge, biopsy results, and other variables were extracted from the database. Variables were tested for association with 3 outcomes of light microscopic evaluation of core specimens: number of glomeruli per core specimen, obtainment of < 10 glomeruli, and presence or absence of renal medullary tissue.
RESULTS Number of glomeruli per core specimen was significantly associated with needle gauge, dog age, serum creatinine concentration, and degree of proteinuria, whereas biopsy method and submitting hospital were significantly associated with the presence of renal medullary tissue in specimens. Mean numbers of glomeruli per core specimen obtained with 14- or 16-gauge needles were similar, but both were significantly greater than the mean number obtained with 18-gauge needles. Needle gauge had a similar association with the likelihood of obtaining < 10 glomeruli in a core specimen. Specimens obtained via laparotomy or laparoscopic approaches more commonly contained medullary tissue than those obtained by ultrasound-guided approaches.
CONCLUSIONS AND CLINICAL RELEVANCE Overall, findings suggested that ultrasound-guided biopsy with a 16-gauge needle should maximize the diagnostic quality of renal biopsy specimens from dogs with suspected kidney disease, while avoiding potential adverse effects caused by larger needles.
Objective—To describe a percutaneously controlled
static hydraulic urethral sphincter (SHUS) and evaluate
urodynamic effects of the SHUS in canine cadavers.
Sample Population—Cadavers of 6 adult female
Procedure—Cadavers were obtained immediately
after dogs were euthanatized. Baseline maximal urethral
closure pressure (MUCP) and cystourethral leak
point pressure (CLPP) were measured by use of a
urethral pressure profilometer. An SHUS system was
constructed by use of a silicone vascular occluder and
subcutaneous infusion port. The SHUS system was
then placed around the pelvic urethra in each cadaver.
Measurements of MUCP and CLPP were repeated
after varying occlusion of the SHUS (0%, 25%, and
50% occlusion). Baseline MUCP and CLPP values
were compared with values obtained at 0%, 25%,
and 50% occlusion of the SHUS by use of repeatedmeasures
Results—Mean ± SD MUCP for canine cadavers was
7 ± 1.3 cm H2O at baseline, which increased to 127 ±
53 cm H2O after 50% occlusion of the SHUS. Mean
CLPP was 11 ± 8.6 cm H2O at baseline, which
increased to 73 ± 38 cm H2O after 50% occlusion of
the SHUS. Mean MUCP and CLPP were significantly
associated with the amount of occlusion.
Conclusions and Clinical Relevance—The SHUS
had positive effects on MUCP and CLPP in canine
cadavers. Therefore, additional evaluation of the
SHUS in live dogs is warranted. ( Am J Vet Res 2004;
Rapid advances in critical care techniques and life-sustaining measures in the late 20th century led many large human hospitals to encounter ethical dilemmas regarding end-of-life issues, decision-making capacity, clinical futility, and responsible use of resources. Human hospitals are now required to have an established protocol for addressing these ethical dilemmas, and the vast majority have created clinical ethics committees that are available to provide ethics consultations on request. Recent medical advances available at veterinary specialty hospitals have given rise to similar ethical dilemmas in the care of both small and large animal species, and such dilemmas are a major source
Objective—To determine sensitivity and specificity of
radiography, ultrasonography, and antegrade pyelography
for detection of ureteral obstructions in cats.
Procedure—Medical records of cats that had radiography,
ultrasonography, and antegrade pyelography
performed for suspected ureteral obstructions were
examined. Ultrasound-guided pyelocentesis and fluoroscopic-
assisted antegrade pyelography were performed
on 18 kidneys in 11 cats. Obstructive ureteral
lesions were confirmed in all cats by surgical or
necropsy examination. Sensitivity and specificity of
survey radiography, ultrasonography, and antegrade
pyelography for identification of ureteral obstructions
were calculated. Surgical or necropsy findings were
used as the standard for comparison.
Results—All cats were azotemic. Mean ± SD serum
creatinine and BUN concentrations were 10.2 ± 6.1
and 149 ± 82 mg/dL, respectively. Fifteen of 18
ureters were found to be obstructed at surgery or
necropsy. Sensitivity and specificity were 60 and
100% for radiography and 100 and 33% for ultrasonography,
respectively, in identification of ureteral
obstructions. Leakage of contrast material developed
in 8 of 18 kidneys during antegrade pyelography and
prevented diagnostic interpretation in 5 of 18 studies.
For the 13 diagnostic studies, specificity and sensitivity
were 100% by use of the antegrade pyelography
technique. Correct identification of the anatomic location
of the ureteral obstruction was obtained in 100%
of diagnostic antegrade pyelography studies and in
60% of radiography or ultrasonography studies.
Conclusions and Clinical Relevance—Antegrade
pyelography can be a useful alternative in the diagnosis
and localization of ureteral obstructions in
azotemic cats, although leakage of contrast material
may prevent interpretation of the study. (J Am Vet
Med Assoc 2003;222:1576–1581)