Objective—To determine the outcome of minimally invasive ureteral stent placement for dogs with malignant ureteral obstructions.
Design—Retrospective case series.
Animals—12 dogs (15 ureters) with ureteral obstruction secondary to a trigonal urothelial carcinoma.
Procedures—In all patients, indwelling, double-pigtail ureteral stents were placed by means of percutaneous antegrade needle and guide wire access under ultrasound and fluoroscopic guidance.
Results—Stents were successfully placed in all patients. In 11 of 12 patients, percutaneous antegrade access was accomplished. One patient required access via laparotomy because percutaneous access could not be achieved. The median survival time from the date of diagnosis was 285 days (range, 10 to 1,571 days), with a median survival time of 57 days (range, 7 to 337 days) from the date of stent placement. Three complications occurred in 1 patient. Seven patients required concurrent urethral stent placement for relief of urethral obstruction. All animals were discharged from the hospital (median hospitalization time after stent placement, 18 hours [range, 4 hours to 7 days]) with an indwelling, double-pigtail ureteral stent (3 bilateral and 9 unilateral) in place. All stents evaluated 0.25 to 11 months after placement were considered patent.
Conclusions and Clinical Relevance—Findings suggested that ureteral stent placement was safe, effective, and well tolerated in patients with malignant ureteral obstructions. Stents could be reliably placed in a minimally invasive manner and remain patent long-term. Ureteral stent placement should be considered as early as possible in patients with neoplasia, prior to the development of permanent renal damage.
Case Description—A 19-year-old neutered male domestic shorthair cat was evaluated because of signs of urinary tract obstruction.
Clinical Findings—Physical examination findings were consistent with urethral obstruction, and a mass could be palpated in the region of the bladder neck. Abdominal ultrasonography and thoracic radiography revealed a mass in the trigone of the urinary bladder and a solitary mass in the left caudal lung lobe. Cytologic examination of the urine sediment, samples obtained by means of traumatic urethral catheterization, and fine-needle aspirates of the bladder mass did not result in a diagnosis.
Treatment and Outcome—A balloon-expandable metallic stent was placed in the proximal portion of the urethra to relieve the malignant obstruction. After stent placement, the cat had signs of urinary incontinence and detrusor atony, both of which resolved with medical treatment. The cat was euthanized 1 month after stent placement because of progressive azotemia. Histologic examination of necropsy samples revealed grade III urothelial carcinoma and papillary pulmonary adenocarcinoma.
Clinical Relevance—Findings suggested that stent placement may be a viable palliative treatment in cats with malignant urinary obstruction.
Objective—To determine clinical characteristics, treatments, and outcome in dogs and cats evaluated after submersion in freshwater.
Design—Retrospective case series.
Animals—25 dogs and 3 cats.
Procedures—Medical records were reviewed for signalment; causes, location, and month of submersion; physical examination findings at admission; results of blood gas analysis; treatments administered; duration of hospitalization; and outcome, including evidence of organ failure or compromise.
Results—All submersions involved bodies of freshwater. Fourteen animals were submerged in man-made water sources, 13 were submerged in natural water sources, and the body of water was not recorded in 1 case. Twenty (71%) submersions occurred from May through September. Cause was identified in 16 animals and included extraordinary circumstances (n = 6), falling into water (5), breaking through ice (3), and intentional submersion (2). Twelve animals were found submerged in water with unclear surrounding circumstances. Treatment included administration of supplemental oxygen, antimicrobials, furosemide, corticosteroids, and aminophylline and assisted ventilation. Respiratory dysfunction was detected in 21 animals. Neurologic dysfunction was detected in 12 animals, hepatocellular compromise was detected in 6 animals, and cardiovascular dysfunction was detected in 4 animals. Three dogs had hematologic dysfunction, and 2 dogs had acute renal dysfunction. Eighteen (64%) animals survived to hospital discharge, but all of the cats died. In 9 of 10 nonsurvivors, respiratory tract failure was the cause of death or reason for euthanasia.
Conclusions and Clinical Relevance—Results suggest that submersion is an uncommon reason for veterinary evaluation but is associated with a good prognosis in dogs in the absence of respiratory tract failure.
Objective—To determine the incidence of and risk
factors for ventilatory failure in dogs undergoing
surgery for treatment of cervical spinal disorders and
to document ventilator management, clinical course,
and long-term outcome of dogs that experienced ventilatory
failure in association with cervical spinal disorders
or their management.
Procedure—Dogs with cervical spinal disorders that
required positive-pressure ventilation (PPV) were
identified, and signalment, concurrent diseases, neurologic
status at initial examination, clinical course,
pulmonary function before, during, and after PPV,
management techniques, complications, and outcome
were recorded. Dogs that underwent surgery
and required PPV were compared with dogs that
underwent cervical spinal surgery during the same
period that did not require PPV.
Results—14 dogs with cervical spinal disorders
required PPV to treat hypoventilation, including 13 of
263 (4.9%) dogs that underwent surgery for cervical
spinal disorders. Lesions between the second and
fourth cervical vertebrae and treatment by means of a
dorsal decompressive laminectomy were associated
with a significantly increased risk of perioperative
hypoventilation. Pulmonary gas exchange function was
normal or nearly normal throughout the course of PPV
in dogs that survived. Ten dogs survived, and 9 of the 10
regained neurologic function. All 9 dogs that regained
neurologic function had deep pain perception on initial
examination at the veterinary teaching hospital.
Conclusions and Clinical Relevance—Results suggest
that a small percentage of dogs with cervical
spinal disorders may require perioperative ventilatory
support. With prolonged PPV and aggressive management,
a good outcome may be achieved in dogs
similar to those described in the present study. (J Am
Vet Med Assoc 2001;218:1598–1602).
Objective—To determine survival times in dogs with
right atrial hemangiosarcoma treated by means of
pericardectomy and tumor resection, with or without
adjuvant chemotherapy, and identify complications
associated with treatment.
Procedure—Dogs were included only if the diagnosis
was confirmed histologically.
Results—The most common initial complaints included
acute collapse (8 [35%] dogs), anorexia or inappetence
(8 [35%]), and lethargy (8 [35%]). The most common
physical examination abnormalities included muffled
heart sounds (12 [52%] dogs), tachycardia (7
[30%]), and weak pulses (7 [30%]). Postoperative complications
developed in 12 (52%) dogs; however, most
complications were minor. Twenty (87%) dogs were
discharged from the hospital. Survival time was significantly
longer in the 8 dogs that received adjuvant
chemotherapy (mean, 164 days; median, 175 days)
than in the 15 dogs that did not receive chemotherapy
(mean, 46 days; median, 42 days). Dogs that received
chemotherapy were significantly younger and had significantly
lower WBC counts than did dogs that did not
Conclusions and Clinical Relevance—Results suggested
that in dogs with right atrial hemangiosarcoma,
surgical resection of the tumor was associated with a
low complication rate and complications that did arise
typically were minor. In addition, use of adjuvant
chemotherapy following resection was associated with
significantly longer survival times, compared with resection
alone. (J Am Vet Med Assoc 2005;226:575–579)
Objective—To determine the prevalence and antimicrobial resistance of enterococci and staphylococci collected from environmental surfaces at a veterinary teaching hospital (VTH).
Sample—Samples collected from surfaces in 5 areas (emergency and critical care, soft tissue and internal medicine, and orthopedic wards; surgery preparation and recovery rooms; and surgery office and operating rooms) of a VTH.
Procedures—Selected surfaces were swabbed every 3 months during the 3-year study period (2007 to 2009). Isolates of enterococci and staphylococci were identified via biochemical tests, and antimicrobial susceptibility was evaluated with a microbroth dilution technique. A subset of isolates was analyzed to assess clonality by use of pulsed-field gel electrophoresis.
Results—430 samples were collected, and isolates of enterococci (n = 75) and staphylococci (110) were identified. Surfaces significantly associated with isolation of Enterococcus spp and Staphylococcus spp included cages and a weight scale. Fourteen Enterococcus spp isolates and 17 Staphylococcus spp isolates were resistant to ≥ 5 antimicrobials. Samples collected from the scale throughout the study suggested an overall increase in antimicrobial resistance of Enterococcus faecium over time. Clonality was detected for E faecium isolates collected from 2 different surfaces on the same day.
Conclusions and Clinical Relevance—Although not surprising, the apparent increase in antimicrobial resistance of E faecium was of concern because of the organism's ability to transmit antimicrobial resistance genes to other pathogens. Results reported here may aid in identification of critical control points to help prevent the spread of pathogens in VTHs.