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.     

Prevalence of hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion: 71 cases (2003-2005)

OBJECTIVE: To determine prevalence of splenic hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion and to identify factors that could differentiate between dogs with hemangiosarcoma and dogs with other splenic masses at the time of hospital admission. DESIGN: Retrospective case series. ANIMALS: 71 dogs. PROCEDURES: Medical records, blood bank logs, and histologic reports of dogs with a splenic mass and hemoperitoneum that required a transfusion between 2003 and 2005 were reviewed. Dogs that received a transfusion of packed RBCs, were splenectomized, and had a definitive histologic diagnosis were included. RESULTS: Signalment of dogs was similar to that in other reports. Malignant splenic neoplasia was identified in 54 of 71 (76.1%) dogs, whereas 17 of 71 (23.9%) dogs had a benign splenic lesion. Of 54 dogs with malignant splenic neoplasia, 50 (92.6% [70.4% of all dogs]) had splenic hemangiosarcoma. In addition, dogs with splenic hemangiosarcoma had significantly lower total solids (TS) concentrations and platelet counts at admission. Finally, hemoperitoneum was strongly associated with a diagnosis of splenic hemangiosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE: In this clinical population of dogs, prevalence of hemangiosarcoma was higher than in other studies. Dogs with hemangiosarcoma in this study had significantly lower TS concentrations and platelet counts at the time of admission, compared with values for dogs with other splenic masses. No other markers were useful in differentiating dogs with hemangiosarcoma. It is important to discuss the prevalence of and poor prognosis associated with hemangiosarcoma with owners when they are contemplating whether to proceed with treatment.     

Use of thromboelastography in dogs with immune-mediated hemolytic anemia: 39 cases (2000–2008)

Objective – To analyze thromboelastograms (TEGs) of naturally occurring cases of immune-mediated hemolytic anemia (IMHA) in order to identify whether a hypercoagulable state was present and whether its presence was associated with differences in survival.
Design – Retrospective study spanning January 2000 to June 2008. Medical records of dogs were evaluated. Endpoints were considered death or discharge from the hospital.
Setting – Academic teaching hospital.
Animals – Thirty-nine dogs with a diagnosis of IMHA and at least one TEG performed during hospitalization were included.
Interventions – None.
Measurements and Main Results – Four values were evaluated from the TEG: the R time (R), K time (K), alpha angle (α), and maximum amplitude. From these values, a coagulation index (CI) was calculated to classify patients as normocoagulable, hypercoagulable, or hypocoagulable. Thirty-three of 39 patients were hypercoagulable based on the CI. The 6 remaining dogs were normocoagulable. The patients with a normocoagulable CI had an increased mortality rate (100%) when compared with the hypercoagulable patients using Fisher's exact test ( P =0.02). Additionally, prolongation of partial thromboplastin time did not preclude hypercoagulable TEG values.
Conclusions – The majority of dogs with IMHA were hypercoagulable as measured by TEG. A normal CI was associated with a worse outcome in this patient population. TEG may provide additional and complementary information to prothrombin time and partial thromboplastin time relating to coagulation status in dogs with IMHA and may help predict prognosis and potentially guide clinical decisions to utilize anticoagulant drugs.     

Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999–2003)

Objective: To characterize the presence of esophagitis in dogs after esophagoscopy for diagnosis and treatment of esophageal foreign body and to relate the degree of esophageal injury to clinical signs and outcome. Design: Retrospective study. Animals, intervention, and measurements: Medical records of 60 dogs with esophageal foreign bodies diagnosed between January 1999 and December 2003 were reviewed. Information obtained from the medical records included age, breed, and sex; type and duration of clinical signs; physical examination, radiographic, and esophagoscopy findings; type and location of foreign body; surgical intervention; morbidity, and outcome. Animals were divided into 2 cohorts based upon the degree of esophageal injury detected during esophagoscopy: mild esophagitis or moderate‐to‐severe esophagitis. Data were then compared between the groups. Results: Dogs with moderate‐to‐severe esophagitis had a longer duration of clinical signs, were more likely to present for lethargy and regurgitation/vomiting, and had a longer time to recovery. This cohort had significantly greater morbidity including esophageal stricture, perforation, necrosis, and diverticulum formation, as well as aspiration pneumonia, pneumothorax, severe tracheal compression, and death. Dogs with mild esophagitis were more likely to present to the hospital for gagging. Conclusions: This study demonstrated a wide range of injury associated with esophageal foreign bodies. The degree of esophagitis appears to relate to the duration and severity of some of the clinical signs.     

Comparison of first-opinion and second-opinion histopathology from dogs and cats with cancer: 430 cases (2001–2008)

Second-opinion histopathology is intended to detect clinically significant discrepancies that have a direct impact on patient care. We sought to determine if this practice at our institution affected patient management and prognosis. First- and second-opinion histopathology reports from cases were retrospectively reviewed. Reports were considered to be in diagnostic agreement, partial diagnostic disagreement or complete diagnostic disagreement. Four hundred and thirty cases were studied. In 70% of cases there was a diagnostic agreement. In 20% of cases, there was partial diagnostic disagreement, where diagnoses were the same but information such as grade or lymphatic and/or vascular invasion was changed. In 10% of cases, complete diagnostic disagreement resulted from a change in degree of malignancy (malignant to benign, or converse; 7%) or a change in cell type (3%). In 17% of the cases evaluated, the histopathology review prompted a change in treatment or prognosis. These findings support the use of second-opinion histopathology as an important part of patient care.     

Feline entropion: a case series of 50 affected animals (2003–2008)

Aim  To evaluate the signalment, clinical signs, and etiopathogenesis of entropion in 50 cats.
Methods  Signalment and history of 50 cases of entropion in cats presented to a referral ophthalmology clinic. Animals were examined with direct and indirect ophthalmoscopy and slit-lamp biomicroscopy. Animals were treated surgically with a Hotz-Celsus procedure and results of surgery were evaluated between 4 and 22 weeks.
Results  Sixteen cats were young (mean age 4.1 ± 3.6 years) with pre-existing irritative ocular surface conditions such as conjunctivitis, corneal ulceration or sequestrum. Twenty-six cats were relatively older (mean age 11.3 ± 2.2 years) with involutional entropion with or without enophthalmos, presumed to result from a reduction in orbital tissue. Five cats were Persians with entropion associated with brachycephalic facial anatomy, whereas three were entire young adult male Maine Coones with in-turning associated with excessive facial 'jowl' tissue. Surgical treatment was curative in the majority of cases after one surgery although an increased amount of eyelid tissue was required to be removed for correction compared with similar surgery in the dog.
Discussion  This study has shown that entropion in cats may be caused in young animals as a result of continued blepharospasm related to irritative causes such as conjunctivitis or corneal ulceration or in older animals with lid laxity or globe enophthalmos. Lid in-turning was also seen in Persian and Maine Coone breeds.     

Acute blindness in dogs: Sudden acquired retinal degeneration syndrome versus neurological disease (140 cases, 2000–2006)

Objective  To evaluate dogs with amaurosis and compare signalment, history, ophthalmic examination and neurologic abnormalities between dogs diagnosed with sudden acquired retinal degeneration syndrome (SARDS) versus neurological disease (ND). Animals Studied-140 dogs with acute vision loss and ocular abnormalities insufficient to account for visual deficits. An electroretinogram (ERG) was performed on each dog.
Procedures  Medical records were reviewed and information was collected for all dogs meeting the inclusion criteria. Dogs diagnosed with SARDS were compared to those with ND based on signalment, duration of clinical signs, past medical problems, clinicopathologic findings, and ophthalmic and physical examination abnormalities.
Results  120 dogs were diagnosed with SARDS and 20 dogs with ND based on ERG results. Mixed-breed dogs were most commonly diagnosed with SARDS as well as ND. Pure breed dogs frequently diagnosed with SARDS included the Miniature Schnauzer and Dachshund. Dogs with SARDS did not differ significantly from those with ND based on age or sex distribution. Cushing's-like symptoms were reported more frequently in SARDS dogs as well as conjunctival hyperemia and retinal vascular attenuation. Papilledema and asymmetric visual deficits were observed more frequently in dogs with ND. Dogs with ND were no more likely than SARDS dogs to have additional neurological deficits.
Conclusions  Appreciable overlap of clinical signs exists between dogs with SARDS and dogs with ND resulting in acute vision loss. As a significant portion of dogs (14%) in the present study were diagnosed with ND, an ERG to rule out ND is indicated in dogs with amaurosis.     

Infectious Agents Detected in the Feces of Diarrheic Foals: A Retrospective Study of 233 Cases (2003–2008)

Background: Diarrhea is common in foals but there are no studies investigating the relative prevalence of common infectious agents in a population of hospitalized diarrheic foals.
Objectives: To determine the frequency of detection of infectious agents in a population of hospitalized foals with diarrhea and to determine if detection of specific pathogens is associated with age, outcome, or clinicopathologic data.
Animals: Two hundred and thirty-three foals ≤ 10 months of age with diarrhea examined at a referral institution.
Methods: Retrospective case series. Each foal was examined for Salmonella spp., viruses, Clostridium difficile toxins, Clostridium perfringens culture, C. perfringens enterotoxin, Cryptosporidium spp., and metazoan parasites in feces collected at admission or at the onset of diarrhea.
Results: At least 1 infectious agent was detected in 122 foals (55%). Rotavirus was most frequently detected (20%) followed by C. perfringens (18%), Salmonella spp. (12%), and C. difficile (5%). Foals < 1 month of age were significantly more likely to be positive for C. perfringens (odds ratio [OR] = 15, 95% confidence interval [CI] = 3.5–66) or to have negative fecal diagnostic results (OR = 3.0, 95% CI = 1.7–5.2) than older foals. Foals > 1 month of age were significantly more likely to have Salmonella spp. (OR = 2.6, 95% CI = 1.2–6.0), rotavirus (OR = 13.3, 95% CI = 5.3–33), and parasites (OR = 23, 95% CI = 3.1–185) detected compared with younger foals. Overall 191 of the 223 foals (87%) survived. The type of infectious agent identified in the feces or bacteremia was not significantly associated with survival.
Conclusions and Clinical Importance: In the population studied, foals with diarrhea had a good prognosis regardless of which infectious agent was identified in the feces.     

Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007–2008)

Objective – To characterize the clinical presentation, management, and in‐hospital outcomes of dogs and cats diagnosed with acute congestive heart failure (CHF). Design – Retrospective study of animals seen between January 2007 and May 2008. Setting – Emergency service at a university teaching hospital. Animals – Ninety dogs and 55 cats with CHF. Measurements and Main Results – Patient characteristics, including age, clinical signs, clinicopathologic abnormalities, diagnostic testing, and outcome were recorded. Forty‐eight of the animals already were receiving cardiac medications at the time of presentation. The most common diseases represented were chronic valvular disease and cardiomyopathies. Cats had significantly lower median body temperature at admission compared with dogs (P<0.001). The most common abnormalities were elevated lactate (64%), elevated BUN (52%), hypochloremia (31%), hyperglycemia (27%), and elevated liver enzymes (26%). Many of these became even more prevalent during hospitalization. One hundred and sixteen animals were discharged from the hospital, for a survival rate of 80%. There was no survival difference between dogs and cats (P=0.39). Dogs that developed hypokalemia during hospital stay (P=0.04) were more likely to survive compared with those without hypokalemia and initial body temperature was lower for those cats that did not survive (P=0.02). Of those that did not survive, the majority were euthanized (n=25), while 4 dogs died. Conclusions – Dogs and cats presented to the emergency service with CHF had a high survival rate. In cats, initial body temperature was lower for those cats that did not survive. Although clinicopathologic abnormalities were common in both species, only dogs with hypokalemia had improved survival to hospital discharge.     

Clinical presentation, treatment, and outcome of dacryocystitis in rabbits: a retrospective study of 28 cases (2003–2007)

Objective  To document the clinical presentation, diagnostics, treatment, and clinical outcome of rabbits with dacryocystitis.
Materials and methods  This retrospective study included 28 rabbits diagnosed with dacryocystitis. Available records of clinical and ophthalmological examinations, bacteriological samplings, diagnostic imaging, and treatment were reviewed. A telephone survey of the owners was conducted to evaluate recovery and recurrences.
Results  The mean age of the 28 rabbits presenting with ocular discharge from the nasolacrimal duct was 4.4 years. In 25 rabbits (89%), dacryocystitis was a unilateral finding. No underlying cause could be determined in 10 animals (35%). Dental malocclusion was observed in 14 rabbits (50%) and rhinitis in two animals (7%), with one animal showing both symptoms (4%). One rabbit (4%) presented with panophthalmitis. Most animals (96%) received topical antibiotic treatment. If necessary, additional topical (acetylcysteine, vitamin A ointment, nonsteroidals) or systemic treatment (antibiotics, nonsteroidals, paramunity inducer, and glucocorticoids) was provided. The mean duration of therapy was 5.8 weeks. The nasolacrimal duct was flushed in 27 of 31 affected eyes (87%). Dentistry was performed in 80% of the animals suffering from malocclusion. Regarding the clinical outcome, 12 animals (43%) showed complete recovery, eight rabbits (28%) were euthanized, three (11%) died due to unrelated causes, and three (11%) were lost to follow-up. Two rabbits (7%) continue to display signs of dacryocystitis and are being treated symptomatically by the owners.
Conclusions  This study reports the clinical presentation, treatment, and outcome of dacryocystitis in rabbits and outlines the importance of examination of the oral cavity, diagnostic imaging, and bacteriologic sampling.     

The use of amniotic membrane transplantation for ocular surface reconstruction: a review and series of 58 equine clinical cases (2002–2008)

Amniotic membrane transplantation (AMT) is an effective clinical therapy for reconstruction of the ocular surface in human and veterinary patients. Amnion is avascular and strong, contains antiangiogenic and antiinflammatory properties and growth factors, and has properties that prevent or decrease fibrosis in healing tissue. Indications for its use are steadily growing and include grafting to replace diseased, missing or excised tissue, patching to support diseased tissue during the healing process and as a substrate for the expansion of epithelial cells for transplantation to the cornea. AMT through a combination of mechanical and biologic factors can preserve the integrity of the globe, optimize the visual outcome, and minimize scarring in severely diseased corneas.     

Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003–2007)

Objective – To assess the utility of nasotracheal tubes in postoperative oxygen supplementation in dogs following corrective surgery for brachycephalic syndrome. Design – Retrospective study 2003–2007. Setting – University teaching hospital. Animals – Thirty‐six client‐owned dogs that underwent corrective surgery for brachycephalic syndrome. Interventions – None. Measurements and Main Results – Medical records were reviewed for animals that underwent surgical interventions for brachycephalic syndrome including palatoplasty, ventriculectomy, and rhinoplasty. Data collected included signalment, presenting complaints, analgesic and surgical interventions, type of supplemental oxygen therapy, complications and mortality occurring during hospitalization. A nasotracheal tube (NTT) was placed in 20 dogs at the end of surgery; 16 dogs received other forms of oxygen supplementation (8) or no oxygen supplementation (8) during recovery. The total number of postoperative complications was similar in both groups (8/20 dogs with NTTs and 7/16 in those without NTTs). However, respiratory distress was observed in 5 dogs without NTTs but was not observed in any dog while an NTT was in place. One dog in each group died postoperatively. Conclusion – Placement of an NTT was found to be easy and may offer benefit in dogs with brachycephalic syndrome as a noninvasive means of delivering oxygen. The use of NTT may minimize severe postoperative morbidity, in particular by reducing postoperative respiratory distress.