Iatrogenic sciatic nerve injury in eighteen dogs and nine cats (1997-2006)

Objective— To report clinical features associated with iatrogenic peripheral nerve injury in dogs and cats admitted (1997–2006) to a referral teaching hospital.
Study Design— Retrospective study.
Animals— Dogs (n=18), 9 cats.
Methods— Patients had acute signs of monoparesis attributable to sciatic nerve dysfunction that developed after treatment. Neurologic examination and electrodiagnostic testing were performed. Surgical therapy was used for nerve entrapment and delayed reconstructive surgery used in other cases.
Results— Of 27 nerve injuries, 25 resulted from surgery (18 with treatment of pelvic injuries). Iliosacral luxation repair resulted in tibial (4 cats) and peroneal (3 dogs) nerve dysfunction. Other causes were intramedullary pinning of femoral fractures (3), other orthopedic surgery (cemented hip prosthesis [2] and tibial plateau-leveling osteotomy [1]), and perineal herniorrhaphy [1]. Nerve injury occurred after intramuscular injection (1 cat, 1 dog). Immediate surgical treatment was removal of intramedullary nails, extruded cement, or entrapping suture. Delayed nerve transplantation was performed in 2 dogs. Within 1 year, 13 patients recovered completely, clinical improvement occurred in 7, and there was no improvement in 7. Five of the 7 dogs that did not recover had acetabular or ilium fracture.
Conclusion— Iatrogenic sciatic nerve injury occurred most commonly during treatment of pelvic orthopedic diseases and had a poor prognosis. Clinical variation in sciatic nerve dysfunction in dogs and cats can be explained by species anatomic differences.
Clinical Relevance— Iatrogenic sciatic nerve injury leads to severely debilitating locomotor dysfunction with an uncertain prognosis for full-functional recovery.     

Atypical Reaction to Acetaminophen Intoxication in a Dog

Objective: To report an unusual manifestation of acetaminophen intoxication in a dog.
Case Summary: A Miniature Pinscher was presented for evaluation of lethargy and facial swelling after ingestion of 500–750 mg/kg of acetaminophen. Laboratory testing revealed eccentrocytes, Heinz bodies, hemoglobinemia, and a declining packed red cell volume consistent with oxidative damage to the erythrocytes. Hepatocellular damage, as monitored by serum alanine aminotransferase, was not documented. The dog responded well to therapeutic intervention, and was discharged from the hospital. The dog returned to the hospital 2 days later with clinical signs and diagnostic tests consistent with acute keratoconjunctivitis sicca, which was assumed to be due to a toxic etiology. The dog responded well to therapy, regaining normal levels of tear production within six weeks.
New or Unique Information Provided: Acetaminophen intoxication may be associated with severe erythrocytic oxidative damage in the absence of detectable hepatic injury in dogs. Acetaminophen intoxication may have the potential to cause acute keratoconjunctivitis sicca in dogs. ( J Vet Emerg Crit Care 2001; 11(2): 123–126 )     

Critical illness-related corticosteroid insufficiency in a dog with septic shock

Objective – To describe a case of hydrocortisone-responsive hypotension and critical illness-related corticosteroid insufficiency (CIRCI) in a dog with septic shock.
Case Summary – A dog with aspiration pneumonia developed septic shock with pressor-refractory hypotension. A standard ACTH stimulation test was performed that showed a blunted cortisol response consistent with CIRCI. Reversal of shock was achieved within 2 hours of hydrocortisone administration, and complete weaning from pressors was accomplished over the subsequent 8 hours. The patient recovered and was discharged from the hospital. An ACTH stimulation test performed 1 month after hospital discharge showed normal adrenal responsiveness consistent with resolution of CIRCI.
New or Unique Information Provided – This case is the first published report of hydrocortisone-responsive hypotension and transient CIRCI associated with naturally occurring septic shock in a dog.     

Biceps Brachii and Brachialis Tendon of Insertion Injuries in Eleven Racing Greyhounds

Objective— To report injuries of the biceps brachii (BTI) or brachialis (BrTI) tendons of insertion in 11 racing Greyhounds.
Study Design— Case series.
Animals— Greyhounds (n=11).
Methods— Medical records (1990–2006) of racing Greyhound dogs with BTI injuries were reviewed. Preinjury, injury, and posttreatment information was obtained via trainer telephone questionnaire and individual greyhound race data. Outcomes between surgical and conservative management were compared.
Results— Dogs had elbow hyperextension, positive biceps test, and forelimb circumduction and 82% were male, whereas Queensland's male to female ratio of racing Greyhounds was almost equal. Eight dogs had right BTI injuries. Nine dogs had surgically confirmed tendon injuries: 5 combined BTI and BrTI, 2 mid-body BTI, 1 musculotendinous BTI, and 1 ulnar tuberosity avulsion fracture. Seven dogs were treated surgically (3 loop pulley sutures, single radial screw and washer, suture screws or fracture fixation in lag fashion), 2 dogs were euthanatized at surgery, 2 were rehomed and hence managed conservatively. All surgically treated dogs returned to near preinjury performance; 6 returned to racing and at least 4 won races in the same or higher grade. One conservatively managed dog returned to "pet" function. No dog reinjured its BTI or BrTI.
Conclusion— BTI and BrTI avulsions are rare acute traumatic performance injuries of racing Greyhounds.
Clinical Relevance— Preinjury racing performance can be achieved with early surgical repair of BTI and BrTI and optimal postoperative management.     

Closed fluoroscopic-assisted spinal arch external skeletal fixation for the stabilization of vertebral column injuries in five dogs

Objective— To evaluate outcome after closed fluoroscopic-assisted application of spinal arch external skeletal fixators in dogs with vertebral column injuries.
Study Design— Retrospective case series.
Animals— Dogs with traumatic vertebral column injuries (n=5).
Methods— Medical records of dogs with vertebral column fractures and/or luxations stabilized with spinal arch external skeletal fixator frames applied using a closed fluoroscopic-assisted technique were reviewed. Owners were contacted to obtain long-term clinical outcomes.
Results— Five dogs (age range, 6–72 months; weight, 10–54 kg) had traumatic vertebral column injuries stabilized with spinal arch external skeletal fixators applied in closed fashion. Injuries involved vertebral segments of the thoracolumbar junction, lumbar spine, and lumbosacral junction. Immediately postoperatively, 4 dogs had anatomic alignment of their vertebral fracture/luxation; 1 dog had 1 mm of vertebral canal height compromise. Time to fixator removal ranged from 65 to 282 days (141±87 days). All dogs had regained satisfactory neurologic function by 3 months. At long-term follow-up (range, 282–780 days; mean 445±190 days) all dogs were judged to have good to excellent return of function by their owners.
Conclusion— Successful closed fluoroscopic-assisted application of external skeletal fixators using spinal arches provided satisfactory reduction with few complications in 5 dogs. Return to function was judged to be good to excellent in all dogs at long-term evaluation.
Clinical Relevance— Closed fluoroscopic-assisted application of ESF using spinal arches provided satisfactory reduction and effective stabilization of spinal fractures with few complications and should be considered as a treatment approach.     

Pneumothorax secondary to pulmonary thromboembolism in a dog

Objective – To describe a case of spontaneous pneumothorax secondary to pulmonary thromboembolism possibly associated with pituitary dependent hyperadrenocorticism.
Case Summary – A 7-year-old spayed female Collie weighing 26 kg was referred for evaluation of spontaneous pneumothorax. An exploratory thoracotomy was performed and revealed 2 lung lobes to be diffusely hemorrhagic and they were resected. Histologic examination of multiple sections documented diffuse thromboembolism. A 2–3 cm thrombus was visualized distal to the bifurcation of the pulmonary artery during an echocardiographic examination postoperatively. The dog was discharged to the owner after recovery from surgery. The thrombus had resolved at the 4-week recheck examination. Diagnosis of pituitary dependent hyperadrenocorticism was confirmed based on follow-up endocrine testing.
New or Unique Information Provided – This is the first report of pulmonary thromboembolism causing spontaneous pneumothorax in the dog.     

Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma

Objective – Evaluate an abdominal fluid scoring (AFS) system using an abdominal focused assessment with sonography for trauma (AFAST) protocol.
Design – Prospective study.
Setting – Private veterinary emergency center.
Animals – One hundred and one client-owned dogs with motor vehicle trauma.
Interventions – AFAST performed on admission and 4 hours post-admission.
Measurements and Main Results – An AFS was assigned to each dog based on the number of AFAST fluid-positive quadrants identified using a 4-point scale: AFS 0 (negative for fluid in all quadrants) to AFS 4 (positive for fluid in all quadrants). Free abdominal fluid was identified in 27 of 101 dogs (27%). Dogs with AFS scores of 3 or 4 (14/27 [52%] AFS-positive dogs) experienced more marked decreases in packed cell volume and total plasma protein, increases in alanine aminotransferase, and needed more blood transfusions than dogs with lower AFS scores and AFS-negative dogs. Serial AFAST was performed in 71% of dogs (71/101); 17% (12/71) of these cases changed AFS score, and 75% (9/12) of the changes were higher (worsened) AFS, correlating with increasing amounts of free abdominal fluid. Ninety-eight percent of the study population was a primary presentation. Overall, median time from trauma to initial AFAST was 60 minutes, and median AFAST examination time was 3 minutes.
Conclusions – Initial and serial AFAST with applied AFS allowed rapid, semiquantitative measure of free abdominal fluid in traumatized patients, was clinically associated with severity of injury, and reliably guided clinical management. Where possible, AFAST and AFS should be applied to the management of blunt trauma cases.     

The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs

Objective— To evaluate clinical outcome after vacuum-assisted closure (VAC) therapy in dogs with traumatic wounds located in the distal extremities and report our early experience with VAC.
Study Design— Retrospective study.
Animals— Dogs (n=15) with traumatic distal extremity wounds.
Methods— Medical records (1999–2003) of dogs with traumatic injuries to the distal extremities managed by VAC were evaluated. Data included signalment, location of wound, time until surgical intervention, wound reconstruction methods, orthopedic procedures, outcome, complications associated with VAC, and length of hospitalization.
Results— The mean number of days until reconstruction was 4.6 days (range, 2–7 days). Reconstructive surgery was successful in all cases. Mean hospitalization was 9.7 days (range, 6–16 days). Complications included dermatitis at the wound margin and loss of vacuum causing wound desiccation.
Conclusion— VAC therapy can be used to achieve adequate management of traumatic distal extremity wounds. VAC provides an effective method of securing skin grafts over the wound bed.
Clinical Relevance— VAC therapy can be used as an ancillary treatment for distal extremity wounds in dogs before surgical repair as well as a method for securing skin grafts to the wound bed.     

Clinical management of canine babesiosis

Objective – To review and summarize current information regarding epidemiology, pathogenesis, and pathophysiology leading to the various clinical syndromes associated with canine babesiosis. Diagnosis, treatment, preventative strategies, and zoonotic implications are discussed.
Etiology – Babesiosis is caused by hemoprotozoa of the genus Babesia . Numerous species of Babesia exist worldwide. An increased incidence of babesiosis is described, especially in North America. The babesial organism spends the majority of its life cycle within the erythrocyte of the definitive host, resulting in hemolysis, with or without systemic complications.
Diagnosis – Definitive diagnosis depends on direct visualization of the organism on blood smear or polymerase chain reaction. A positive serologic antibody test indicates exposure with or without active infection.
Therapy – Antiprotozoal drugs, antimicrobials, and supportive care are the mainstays of babesiosis therapy.
Prognosis – Prognosis depends on the severity of disease, which in turn depends on both organism and host factors. Clinical syndromes associated with a poorer prognosis include red biliary syndrome, acute renal failure, acute respiratory distress syndrome, neurologic dysfunction, acute pancreatitis, cardiac dysfunction, and hypoglycemia.     

Characteristics and outcomes in surgical management of severe acute pancreatitis: 37 dogs (2001–2007)

Objective – Describe clinical characteristics and outcomes associated with canine patients undergoing surgical intervention for treatment of acute pancreatitis.
Design – Retrospective outcome study from 2001 to 2007.
Animals – Thirty-seven dogs.
Interventions – None.
Measurements and Main Results – The following data were collected for dogs who underwent surgical intervention in the course of treatment for severe acute pancreatitis: preoperative clinicopathologic and physical data, ultrasonographic findings, surgical procedure detail, histopathologic findings, and transfusion requirements. The survival rate was 80.8% in dogs with extrahepatic biliary obstruction, 64.3% in dogs undergoing necrosectomy, and 40.6% with pancreatic abscess. Overall survival was 63.6%. Surgical complications included intraoperative and postoperative hemorrhage in 12 dogs, postoperative development of diabetes mellitus in 3 dogs, exocrine pancreatic insufficiency in 1 dog, and bacterial peritonitis in 2 dogs.
Conclusion – Surgical intervention and aggressive postoperative care may be pursued in select dogs with severe acute pancreatitis. In dogs with extrahepatic biliary obstruction secondary to acute pancreatitis, surgical intervention may be associated with a good prognosis whereas dogs with pancreatic abscess formation may have a more guarded prognosis.     

Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbosacral stenosis

Objectives— To describe clinical signs, magnetic resonance imaging (MRI) and surgical findings using a lateral approach to the lumbosacral intervertebral foramen and to evaluate clinical outcomes in dogs with or without concurrent dorsal decompression and annulectomy.
Study Design— Retrospective study.
Animals— Dogs (n=20) with degenerative lumbosacral stenosis (DLSS).
Methods— Medical records (2002–2006) of dogs that had lumbosacral lateral foraminotomy alone or in combination with dorsal decompression were reviewed. Degree of dysfunction was assessed separately for each pelvic limb; dogs with unilateral signs were included in group A, those with bilateral signs in group B. Retrieved data were: signalment, history, neurologic status on admission, 3 days, 6 weeks, and 6 months postoperatively, duration of clinical signs, results of MRI, surgical site(s), intraoperative findings, and outcome.
Results— Based on the clinical and MRI findings unilateral foraminotomy was performed in 8 dogs, bilateral foraminotomy in 1 dog, unilateral foraminotomy with concurrent dorsal decompression in 7 dogs, and bilateral foraminotomy with concomitant dorsal decompression in 4 dogs. Surgery confirmed the presence of foraminal stenosis in all dogs, with osteophyte formation and soft tissue proliferations being the most common lesions. Outcome was good to excellent in 19 dogs and poor in 1 dog. Mean follow-up was 15.2 months (range, 6–42 months).
Conclusion— Lateral foraminotomy addresses compressive lesions within exit and middle zones of the lumbosacral foramen.
Clinical Relevance— Successful surgical management of DLSS is dependent on recognition and correction of each of the compressive lesions within the lumbosacral junction.     

Right ventricular rupture after lateral thoracotomy for removal of rib-associated telangiectatic osteosarcoma in a dog

Objective – To describe a case of a focal right ventricular rupture following removal of a rib-associated telangiectatic osteosarcoma (TOS) in a dog.
Case Summary – A 2-year-old spayed female mixed-breed dog, weighing 20 kg, was presented in compensated hypovolemic shock due to active bleeding into the thoracic cavity. The dog was stabilized with appropriate fluid administration. Subsequent computed tomographic examination revealed a large mineralized mass originating from the body of a rib and displacing the heart. Two days after surgical removal of this mass, focal right ventricular rupture occurred and the dog died. The mass was later identified as a TOS.
New or Unique Information Provided – Although hemothorax secondary to TOS has been described previously, this report describes for the first time, spontaneous focal right ventricular rupture as a rare complication of thoracotomy and rib resection for the removal of a rib-associated, intrathoracic TOS.     

Small intestinal intussusception in five dogs with acute renal failure and suspected leptospirosis (L. australis)

Objectives – This case series describes 5 dogs with small intestinal intussusception and acute kidney injury due to infection with Leptospira interrogans serovar Australis.
Case Series Summary – Small intestinal intussusception was observed in 4 dogs diagnosed with acute kidney injury due to leptospirosis presented between 1997 and 2005. Intussusception was diagnosed at initial presentation or later during hospitalization. An additional dog fulfilling our inclusion criteria was presented to a small animal specialty clinic nearby and was included. Upon admission, all dogs were severely azotemic and thrombocytopenic. All 5 dogs showed the strongest microscopic agglutination test serology reaction to L. interrogans serovar Australis. Two dogs survived with no apparent residual renal damage, 1 survived with subsequent mild chronic kidney disease, and 2 dogs were euthanized at the owners' request due to a guarded prognosis.
New or Unique Information Provided – Intussusception can occur or may be seen in dogs with leptospirosis due to L. interrogans serovar Australis and patients should be monitored closely for this potential complication. As all 5 dogs described in this case series showed the highest titer for L. interrogans serovar Australis, these precautions may be especially applied in geographic areas where this particular serovar is seen.     

Factor VIII inhibitors complicating treatment of postoperative bleeding in a dog with hemophilia A

Objective – To describe the clinical course of a dog with hemophilia A and circulating factor VIII inhibitors complicating the treatment of postoperative hemorrhage.
Case Summary – A 7-year-old castrated male Japanese Chin with hemophilia A, weighing 6 kg, was presented for dental cleaning, polishing, and extractions. Despite presurgical administration of cryoprecipitate, continuous oral bleeding occurred. Circulating factor VIII inhibitors were detected, and the postoperative hemorrhage was subsequently managed with extensive and prolonged blood component transfusion. The dog was discharged after a full clinical recovery.
New or Unique Information Provided – This case report describes the clinical consequences and successful treatment of postoperative hemorrhage in a dog with hemophilia A and circulating factor VIII inhibitors. A relevant discussion of the management of human patients with circulating factor VIII inhibitors is included.     

Splenectomy as an adjunctive treatment for dogs with immune-mediated hemolytic anemia: ten cases (2003–2006)

Objective – To describe the patient population, disease severity, and outcome in dogs with immune-mediated hemolytic anemia (IMHA) that underwent splenectomy. To compare presurgical and postsurgical data.
Design – Retrospective case series.
Setting – Emergency clinic/referral hospital.
Animals – Ten dogs diagnosed with IMHA.
Interventions – Splenectomy in addition to standard medical management for IMHA.
Measurements – Medical records of 10 dogs with IMHA, in which a splenectomy was performed were reviewed. The population was analyzed with regards to physical and clinicopathologic data, severity, treatment, and outcome. Outcome was defined as survival at 30 days, percentage of dogs on medications at 30 days, and number of relapses documented by 30 days. The presurgical and postsurgical PCV and transfusion requirements were documented and compared for each dog.
Results – Nine of 10 dogs survived to 30 days. Four of the 9 that survived were not on any immunosuppressive medications. There were no relapses during the 30 days. The 3-day postsplenectomy PCVs were significantly higher than presplenectomy. The number of transfusions administered postsplenectomy was significantly less than those administered presplenectomy.
Conclusion – The use of splenectomy may be associated with an improved outcome in dogs with IMHA.     

Use of the Kishigami Atlantoaxial Tension Band in Eight Toy Breed Dogs with Atlantoaxial Subluxation

Objective— To determine the applicability, complications, and long-term functional outcome of the Kishigami Atlantoaxial Tension Band (Kishigami AATB) for management of congenital and traumatic atlantoaxial (AA) instability in toy breed dogs.
Study Design— Case series.
Animals— Toy breed dogs (n=8) with congenital or traumatic AA instability.
Methods— The AA joint of each dog was surgically stabilized through a dorsal approach using the original or a modified version of the Kishigami AATB. Pre- and postoperative neurologic status, radiographs, and complications were reviewed. Follow-up examination was performed at 1 and 12 months.
Results— Functional improvement occurred in 5 dogs; 1 dog did not improve or worsen and 2 dogs were euthanatized at owner request. Adequate reduction and stabilization was achieved in 7 dogs based on immediate postoperative radiographs; failure of reduction was evident in 1 dog. No relevant complications occurred.
Conclusions— Kishigami AATB may be acceptable as an alternative method for dorsal stabilization of AA subluxation in toy breed dogs in which use of ventral screws or pins is challenging. Experience with this technique in a larger population is necessary to compare our results to those reported by ventral approach.
Clinical Relevance— The surgical technique described is effective, safe, and simple in the surgical treatment of AA subluxation in toy breed dogs.     

Successful biphasic transthoracic defibrillation of a dog with prolonged, refractory ventricular fibrillation

Objective – To describe a case of spontaneous ventricular fibrillation in a dog in which biphasic defibrillation was life saving.
Case Summary – Ventricular fibrillation occurred in a 7-year-old female Australian Heeler during recovery from anesthesia following pacemaker implantation. Resuscitative efforts including immediate delivery of transthoracic monophasic defibrillation shocks of escalating energy and administration of vasopressors were unsuccessful. However, a single biphasic shock restored sinus rhythm despite prolonged duration of the arrhythmia.
New or Unique Information Provided – This case suggests greater efficacy of biphasic defibrillation compared with traditional monophasic defibrillation. In this dog the newer, biphasic technology was life saving after monophasic shocks failed repeatedly to terminate ventricular fibrillation.     

Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate, with or without laminectomy, for spinal canal stenosis and vertebral instability caused by congenital thoracic vertebral anomalies

Objective— To describe diagnostic findings, surgical technique, and outcome in dogs with thoracic spinal canal stenosis and vertebral instability secondary to congenital vertebral anomalies.
Study Design— Retrospective clinical study.
Animals— Dogs (n=9) with thoracic spinal canal stenosis.
Methods— Medical records (1995–1996; 2000–2006) of 9 dogs with a myelographic diagnosis of spinal canal stenosis and/or vertebral instability secondary to congenital vertebral anomaly that were surgically managed by vertebral stabilization with or without laminectomy were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes were retrieved. Follow-up evaluations were performed at 1, 2, and 6 months. Long-term outcome was assessed by means of clinical examination or owner telephone interviews.
Results— Spinal cord compression was confirmed by myelography, and in 2 dogs, dynamic compression by stress myelography. Eight dogs regained the ability to ambulate postoperatively. One dog with a partial recovery regained voluntary movement but did not become ambulatory.
Conclusions— Spinal cord injury secondary to congenital vertebral anomaly may have a good outcome when treated by vertebral stabilization with or without laminectomy. Adequate stabilization of the vertebrae and improved neurologic outcome were achieved in most dogs.
Clinical Relevance— Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate with or without laminectomy is an effective treatment for spinal canal stenosis and vertebral instability secondary to congenital thoracic vertebral anomalies.     

Magnetic Resonance Imaging in Dogs with Neurologic Impairment Due to Acute Thoracic and Lumbar Intervertebral Disk Herniation

Background: Magnetic resonance imaging (MRI) is a correlate to physical examination in various myelopathies and a predictor of functional outcome.
Objectives: To describe associations among MRI features, neurological dysfunction before MRI, and functional outcome in dogs with disk herniation.
Animals: One hundred and fifty-nine dogs with acute thoracolumbar disk herniation.
Methods: Retrospective case series. Signalment, initial neurological function as assessed by a modified Frankel score (MFS), and ambulatory outcome at hospital discharge and >3 months (long-term) follow-up were recorded from medical records and telephone interview of owners. Associations were estimated between these parameters and MRI signal and morphometric data.
Results: Dogs with intramedullary T2W hyperintensity had more severe pre-MRI MFS (median 2, range 0–4) and lower ambulatory proportion at long-term follow-up (0.76) than those dogs lacking hyperintensity (median MFS 3, range 0–5; ambulatory proportion, 0.93) ( P =.001 and .013, respectively). Each unit of T2W length ratio was associated with a 1.9 times lower odds of long-term ambulation when adjusted for pre-MRI MFS (95% confidence interval 1.0–3.52, P =.05). Dogs with a compressive length ratio >1.31 (which was the median ratio within this population) had more severe pre-MRI MFS (median 3, range 0–5) compared with those with ratios ≤1.31 (median MFS 3, range 0–4; P =.006).
Conclusions and Clinical Importance: MRI features were associated with initial injury severity in dogs with thoracolumbar disk herniation. Based on results of this study, the T2W length ratio and presence of T2W intramedullary hyperintensity appear to be predictive of long-term ambulatory status.