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Abstract
Case Description—A 12-year-old Miniature Dachshund with a history of permanent endocardial pacemaker implantation performed 7 weeks previously was admitted for routine dental prophylaxis.
Clinical Findings—Preanesthetic ECG revealed normal ventricular capture. Thoracic radiographic findings included caudomedial displacement of the endocardial pacemaker lead. Echocardiography revealed moderate chronic degenerative valve disease with moderate left atrial and ventricular dilation. After induction of anesthesia, loss of ventricular capture was detected. The dog recovered from anesthesia and had improved ventricular capture. The following day, surgical exposure of the cardiac apex revealed perforation of the right ventricular apex by the passive-fixation pacemaker lead.
Treatment and Outcome—A permanent epicardial pacemaker was implanted through a transxiphoid approach. Appropriate ventricular capture and sensing were achieved. The dog recovered without complications. Approximately 2 months later, the dog developed sudden respiratory distress at home and was euthanized.
Clinical Relevance—In dogs with permanent pacemakers and loss of ventricular capture, differential diagnoses should include cardiac perforation. If evidence of perforation of the pacemaker lead is found, replacement of the endocardial pacemaker lead with an epicardial pacemaker lead is warranted.
Abstract
OBJECTIVE To determine accuracy for a technique of needle redirection at a single craniolateral site for injection of 3 compartments of the equine stifle joint, describe the external needle position, and identify the location of the needle tip within each joint compartment.
SAMPLE 24 equine cadaver stifle joints.
PROCEDURES Stifle joints were placed in a customized stand. After the needle was placed, external needle position was measured and recorded. Each joint compartment (medial and lateral compartments of the femorotibial joint and the femoropatellar joint) was injected with a solution containing iodinated contrast medium, water, and dye. Radiography, assessment of intra-articular location of the needle tip, and gross dissection were performed to determine success of entering each joint compartment. Student t tests and an ANOVA were used to compare mean values.
RESULTS Overall accuracy was 19 of 24 (79.1%), and accuracy for individual joint compartments was at least 21 of 24 (87.5%). Mean depth of needle insertion to access each compartment of the stifle joint was 5.71 cm. Mean angle of insertion (relative to the long axis of the tibia) was 82.1°, 80.3°, and 18.5° for the medial compartment of the femorotibial joint, lateral compartment of the femorotibial joint, and femoropatellar joint, respectively, and 28° medial, 7.3° lateral, and 1.3° lateral for the medial compartment of the femorotibial joint, lateral compartment of the femorotibial joint, and femoropatellar joint, respectively.
CONCLUSIONS AND CLINICAL RELEVANCE Results supported that this was an accurate technique for successful injection of the 3 equine stifle joint compartments.
Objective
To evaluate use of an assay for measuring serum concentration of canine thyroid-stimulating hormone (cTSH) as an aid for diagnosing thyroid disease in a population of dogs suspected of having hypothyroidism.
Design
Case-cohort study.
Animals
62 healthy dogs and 49 dogs with clinical signs consistent with hypothyroidism (16 were hypothyroid and 33 were euthyroid with concurrent disease).
Procedure
Samples from healthy dogs were used to establish a reference range for serum cTSH concentration. The 49 dogs were categorized as hypothyroid or euthyroid with concurrent disease on the basis of clinical signs, results of additional diagnostic and thyroid-stimulating hormone (TSH) response tests, and response to administration of levothyroxine sodium. Function of the thyroid gland was considered normal when serum total thyroxine (T4) concentration 6 hours after TSH administration was > 2.5 µg/dl. Hypothyroidism was diagnosed when serum T4 concentration after TSH administration was ≤ 1.5 µg/dl.
Results
Serum cTSH concentration differed significantly among all 3 groups. Four of 33 (12%) euthyroid dogs had cTSH concentrations that were greater than the reference range, whereas 6 of 16 (38%) hypothyroid dogs had cTSH concentrations within the reference range. Specificity for serum cTSH concentration was 0.88 and sensitivity was 0.63. When interpreted in combination with serum T4 concentration, specificity increased to 1.0.
Clinical Implications
cTSH assay had good specificity for use in the diagnosis of hypothyroidism in dogs. Because this assay had low sensitivity, a diagnosis of hypothyroidism could not be excluded on the basis of a serum cTSH concentration that was within the reference range. (J Am Vet Med Assoc 1998; 212:387-391)
Abstract
Case Description—A 3-year-old sexually intact male Standard Poodle was admitted to the veterinary teaching hospital for transcatheter closure of a large atrial septal defect (ASD).
Clinical Findings—The dog had exercise intolerance and was thin. Findings on physical examination were within normal limits with the exception of a left base systolic heart murmur (grade 5/6). The dog was not receiving any medications. Echocardiography and thoracic radiography confirmed the diagnosis of ASD and revealed compensatory changes consistent with a large left to right shunting ASD. Results of serum biochemical analysis and CBC were within reference range limits.
Treatment and Outcome—Transcatheter ASD closure with an atrial septal occluder (ASO) was performed and failed. An open heart surgical approach under cardiopulmonary bypass was declined by the dog's owners. The dog underwent a novel hybrid approach involving active device fixation under temporary inflow occlusion after transatrial device deployment. The dog recovered with some manageable postoperative complications. As of the last follow-up examination, the dog had 10 months of event-free survival.
Clinical Relevance—Transcatheter closure by use of an ASO and open heart patch repair with cardiopulmonary bypass to surgically treat dogs with ASD has been reported. Transcatheter closure is not possible in dogs with large ASD. The novel hybrid procedure reported herein represented a viable alternative to euthanasia.
