Prevalence and clinical features of thoracolumbar intervertebral disc‐associated epidural hemorrhage in dogs

BackgroundIntervertebral disc‐associated epidural hemorrhage (EH) in dogs is a poorly understood neurological condition.ObjectiveTo compare the clinical presentation, magnetic resonance imaging (MRI) changes, and clinical outcome of dogs with acute thoracolumbar intervertebral disc herniation (TL‐IVDH) with and without EH.AnimalsOne hundred sixty client‐owned dogs that underwent MRI and hemilaminectomy for acute TL‐IVDH at a private practice in Colorado, including 63 dogs with EH and 97 dogs without EH.MethodsRetrospective review of medical record data from 160 dogs presenting sequentially to a single practice with acute TL‐IVDH that underwent MRI and hemilaminectomy surgery.ResultsSixty‐three of 160 (39%) dogs had confirmed EH. French Bulldogs were significantly overrepresented (23/63; odds ratio [OR]: 4.1; 95% confidence interval [CI]: 1.8‐9.0; P < .001) of the EH cases. Dogs with EH were more likely to present with clinical signs less than 48 hours than were dogs without EH (24‐48 vs 48‐72 hours; OR: 2.4; 95% CI: 1.2‐4.6; P = .02) and were more likely to be nonambulatory on presentation (OR: 2.1; 95% CI: 1.0‐4.1; P = .04). Dogs with EH were more likely to have <50% cross‐sectional spinal cord compression than dogs without EH (OR: 2.3 vs. 0.4; 95% CI: 1.2‐4.4 and 0.2‐0.9, respectively), longer longitudinal spinal cord compression (3 spaces vs 1 space, P < .001), and greater intrinsic spinal cord change (grade 3/severe vs grade 1/mild; P < .001) based on MRI. The location of the intervertebral disc herniation in French Bulldogs with EH was more likely to be thoracolumbar (OR: 10.8; 95% CI: 2.1‐55.7; P = .03).Conclusions and Clinical ImportanceFrench Bulldogs have a high prevalence of intervertebral disc‐associated EH. Dogs with EH have a shorter clinical course and are more likely to be nonambulatory on initial presentation.     

Evaluation of a long‐acting injectable formulation of omeprazole in healthy dogs

BackgroundTo evaluate the efficacy of a single intramuscular adminsitration of long‐acting omeprazole (LA‐OMEP) in increasing gastric pH in dogs.HypothesisWe hypothesized that LA‐OMEP would meet in healthy dogs the clinical goals defined for human patients for treatment of gastroduodenal ulceration.AnimalsNine healthy research dogs.MethodsProspective experimental study. Dogs were given a 4 mg/kg intramuscular injection of LA‐OMEP. Intragastric pH was continuously recorded on treatment days 0 to 7. Daily mean pH and mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were determined.ResultsThe mean onset of action for the LA‐OMEP was 98.11 min (SD 46.39). The mean number of days the dogs'' pH met established goals for MPT pH ≥3 was 5.5 days (range, 3‐7) and 5.25 days for MPT pH ≥4 (range, 3‐7). Long‐acting omeprazole met the human clinical goals pH ≥3 for 72 hours in 8/8 of the dogs and MPT pH ≥4 for 96 hours in 7/8 of dogs.Conclusions and Clinical ImportanceThe LA‐OMEP formulation produced gastric acid suppression in healthy dogs for an average of 5 days and up to 7 days, after a single intramuscular injection. No major adverse effects were observed.     

Comparison of lung ultrasound,chest radiographs,C‐reactive protein,and clinical findings in dogs treated for aspiration pneumonia

BackgroundComparison of clinical findings, chest radiographs (CXR), lung ultrasound (LUS) findings, and C‐reactive protein (CRP) concentrations at admission and serial follow‐up in dogs with aspiration pneumonia (AP) is lacking.HypothesisLung ultrasound lesions in dogs with AP are similar to those described in humans with community‐acquired pneumonia (comAP); the severity of CXR and LUS lesions are similar; normalization of CRP concentration precedes resolution of imaging abnormalities and more closely reflects the clinical improvement of dogs.AnimalsSeventeen dogs with AP.MethodsProspective observational study. Clinical examination, CXR, LUS, and CRP measurements performed at admission (n = 17), 2 weeks (n = 13), and 1 month after diagnosis (n = 6). All dogs received antimicrobial therapy. Lung ultrasound and CXR canine aspiration scoring systems used to compare abnormalities.ResultsB‐lines and shred signs with or without bronchograms were identified on LUS in 14 of 17 and 16 of 17, at admission. Chest radiographs and LUS scores differed significantly using both canine AP scoring systems at each time point (18 regions per dog, P < .001). Clinical and CRP normalization occurred in all dogs during follow up. Shred signs disappeared on LUS in all but 1 of 6 dogs at 1 month follow‐up, while B‐lines and CXR abnormalities persisted in 4 of 6 and all dogs, respectively.Conclusion and Clinical ImportanceLung ultrasound findings resemble those of humans with comAP and differ from CXR findings. Shred signs and high CRP concentrations better reflect clinical findings during serial evaluation of dogs.     

Incidence of hepatopathies in dogs administered zonisamide orally: A retrospective study of 384 cases

BackgroundAcute hepatopathy secondary to administration of zonisamide has been reported in 2 dogs, but overall incidence of hepatopathy is unknown.ObjectiveTo characterize the incidence of hepatopathy in dogs administered zonisamide PO.AnimalsThree hundred eighty‐four dogs administered zonisamide PO.MethodsMulticenter retrospective study. Medical records were searched for dogs prescribed zonisamide PO and which had follow‐up for at least 3 months (acute exposure) and >3 months (chronic exposure). Reported clinical signs, physical examination findings, and serum biochemical panels were reviewed for possible hepatotoxicosis. Serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activity and albumin concentration were documented for all available cases.ResultsAcute clinical hepatopathy was found in 2 of 384 treated dogs (0.52%, 95% confidence interval [CI], 0.06‐1.9) after 13‐16 days of zonisamide treatment. One additional dog had elevated serum ALT activity with no clinical signs. Of these 3 dogs, 2 recovered after administration of zonisamide was stopped, and 1 was euthanized because of liver failure. Of the 117 cases chronically administered zonisamide, 10 had an increase in ALP, 6 had an increase in ALT, and 1 had hypoalbuminemia. No clinical signs of liver disease were noted in dogs chronically treated with zonisamide (median, 20 months; range, 5‐94 months).Conclusions and Clinical ImportanceAcute, potentially life‐threatening hepatopathy associated with oral administration of zonisamide to dogs is estimated to occur in less than 1% of dogs and was observed in the first 3 weeks of treatment. Subclinical abnormalities in ALT and ALP activity were noted in <10% of dogs during chronic administration of zonisamide, with no clinical signs of liver disease noted.     

Effect of leukoreduction on inflammation in critically ill dogs receiving red blood cell transfusions: A randomized blinded controlled clinical trial

BackgroundPrestorage leukoreduction of red blood cell (RBC) bags prevents accumulation of pro‐inflammatory mediators and experimentally attenuates post‐transfusion inflammation in healthy dogs. However, the effect of leukoreduction on post‐transfusion inflammation in critically ill dogs is unclear.HypothesisDogs transfused with leukoreduced (LR) RBC will have lower concentrations of leukocytes, interleukin (IL)‐6, IL‐8, monocyte chemoattractant protein‐1 (MCP‐1), and C‐reactive protein (CRP) within 24 hours of post‐transfusion compared to dogs transfused with nonleukoreduced (NLR) RBC.AnimalsSixty‐one RBC‐transfused dogs (LR = 34, NLR = 27).MethodsRandomized, blinded, controlled preliminary clinical trial. Blood bag processing was randomized to create identically appearing LR and NLR bags. Group allocation occurred with transfusion of the oldest compatible RBC bag. Blood samples were collected pretransfusion and at 8 and 24 hours post‐transfusion for leukocyte count, IL‐6, IL‐8, MCP‐1, and CRP. Data were analyzed on an intention‐to‐treat basis using linear mixed effects models. Significance was set at P < .05.ResultsNo significant differences were found between groups in concentrations of leukocytes (P = .93), IL‐6 (P = .99), IL‐8 (P = .75), MCP‐1 (P = .69), or CRP (P = .18) over time. Eleven LR dogs (32%) and 4 NLR dogs (15%) were euthanized in the hospital (P = .14). No natural deaths occurred.Conclusions and Clinical ImportanceNo differences in inflammation biomarker concentrations were detected over time between dogs transfused with LR or NLR RBC, but heterogeneity likely hampered the ability to detect a difference with this sample size. The novel randomization and enrollment protocol was successfully implemented across 2 participating institutions and will be easily scaled up for a future multicenter clinical trial.     

Comparison of diet,lactulose, and metronidazole combinations in the control of pre‐surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts

BackgroundHepatic supportive diet (HSD), lactulose, and antimicrobials are medical treatments for dogs with congenital extrahepatic portosystemic shunts (cEHPSS). The relative contribution of these treatment components is currently unknown.ObjectivesTo determine which treatment combinations are most efficacious in pre‐surgical control of clinical signs of cEHPSS in dogs.AnimalsThirty‐six dogs with untreated cEHPSS.MethodsThree‐arm randomized clinical trial. At inclusion (T0), dogs were divided into 3 groups: HSD (n = 12), HSD + lactulose (n = 12), or HSD + metronidazole (n = 12) and received the randomized treatment for 4 weeks (T1) followed by combined treatment of HSD + lactulose + metronidazole for 2 weeks or until cEHPSS attenuation (T2). Clinical score as well as fasting ammonia (FA) and C‐reactive protein (CRP) concentrations were compared among groups and time points.ResultsThirty‐four dogs were evaluated. Thirty‐four dogs reached T1 and 29 dogs T2. At T1, clinical scores decreased in the HSD + lactulose (n = 11; P = .001), but not in the HSD (n = 8; P = .96) and HSD + metronidazole (n = 10; P = .06) groups. Adding metronidazole to HSD + lactulose (n = 11) did not result in further clinical score improvement (T2; P = 1.000). Moderate and weak correlation between clinical score and FA and clinical score and CRP was present (ρ = .35, P < .001; ρ = .27, P = .01, respectively) with FA decreasing over time on medical treatment (P = .001).Conclusions and Clinical ImportanceCombined HSD + lactulose seems sufficient for pre‐surgical cEHPSS stabilization unlike sole HSD or HSD + metronidazole. Medical treatment of cEHPSS clinical signs decreases FA.     

Etiology and outcome of extreme neutrophilic leukocytosis: A multi‐institutional retrospective study of 269 dogs

BackgroundThe magnitude of diagnostic abnormalities can influence the perception of clinical outcome. Extreme neutrophilic leukocytosis (ENL) is an uncommon finding caused by markedly increased granulopoiesis. A lack of recent, large‐scale studies limits our understanding of the importance, causation, and prognosis associated with ENL in dogs.Hypothesis/ObjectivesDescribe disease categories (DC) identified in dogs with ENL and identify variables associated with survival. We hypothesized that factors including fever, segmented and band neutrophil counts, and DC would be negatively associated with survival.AnimalsTwo‐hundred sixty‐nine dogs with ENL (segmented neutrophils ≥50 × 10³ cells/μL) presented to the veterinary teaching hospitals at Auburn University (n = 164), the University of Missouri (n = 81), and Oklahoma State University (n = 24) between January 1, 2009 and December 31, 2019.MethodsRetrospective study. Demographic data and outcome variables including temperature, CBC findings, DC, duration of hospitalization (DOH) and outcome were acquired from the medical record. Statistical analyses included chi‐squared and Kruskal‐Wallis tests, and Pearson product moment correlations with a P < .05 significance level.ResultsMortality was 41%. Survival differed with DC (P = .002). Mortality was higher (P < .05) in dogs with neoplasia (56.2%) vs immune‐mediated disease (20.5%) or tissue damage/necrosis (19%). Weight (P = .001, r = −0.14) and total neutrophil count (P = .04, r = −0.02) were weakly negatively associated with survival whereas DOH was weakly positively associated with survival (P = .03, r = 0.14).Conclusions and Clinical ImportanceMortality in dogs with ENL is high but differed according to DC. Only weak correlations between clinical or clinicopathologic variables and mortality were identified. Extreme neutrophilic leukocytosis should be interpreted in conjunction with the underlying disease process, and not broadly used to predict clinical outcome.     

Expression of adipokines and adipocytokines by epidural adipose tissue in cauda equina syndrome in dogs

BackgroundCompression of epidural adipose tissue (EAT) within the scope of cauda equina syndrome (CES) could lead to an enhanced expression of inflammatory mediators, possibly contributing to pain amplification in dogs.ObjectivesTo analyze expression of inflammatory adipo(‐cyto)kines within the EAT of dogs with CES.AnimalsClient‐owned dogs: 15 dogs with CES and 9 dogs euthanized for unrelated medical reasons (controls).MethodsProspective, experimental study. Epidural adipose tissue and subcutaneous adipose tissue were collected during dorsal laminectomy and used for real‐time quantitative polymerase chain reaction. Tissue explants were cultured for measurements of inflammation‐induced release of cytokines.ResultsResults show a CES‐associated upregulation of the cytokines tumor necrosis factor alpha (TNFα: mean ± SD: 18.88 ± 11.87, 95% CI: 10.90‐26.86 vs 9.66 ± 5.22, 95% CI: 5.29‐14.02, *: P = .04) and interleukin‐ (IL‐) 10 (20.1 ± 9.15, 95% CI: 14.82‐25.39 vs 11.52 ± 6.82, 95% CI: 5.82‐17.22, *: P = .03), whereas the expression of the adipokine leptin was attenuated in EAT of dogs with CES (3.07 ± 2.29, 95% CI: 1.80‐3.34 vs 9.83 ± 8.42, 95% CI: 3.36‐16.30, **: P = .007). Inflammatory stimulation of EAT explant cultures resulted in an enhanced release of IL‐6 (LPS: 5491.55 ± 4438, 95% CI: 833.7‐10 149; HMGB1: 1001.78 ± 522.2, 95% CI: 518.8‐1485; PBS: 310.9 ± 98.57, 95% CI: 228.5‐393.3, ***: P < .001).Conclusion and Clinical ImportanceExpression profile of inflammatory adipo(‐cyto)kines by EAT is influenced from compressive forces acting in dogs with CES and might contribute to amplification of pain.     

Ultra‐long‐acting recombinant insulin for the treatment of diabetes mellitus in dogs

BackgroundFor the treatment of diabetes mellitus (DM) in dogs, novel insulins with decreased injection frequency while maintaining safety and efficacy are desirable. Insulin fused with immunoglobulin‐fragment‐crystallizable (Fc) has an ultra‐long plasma half‐life because it recycles through cells, protected from proteolysis.HypothesisGlycemic control can be achieved in diabetic dogs with a recombinant fusion protein of a synthetic insulin and canine Fc (AKS‐218d) administered subcutaneously once‐weekly.AnimalsFive client‐owned dogs with naturally occurring DM.MethodsProspective clinical trial in dogs with DM that were recruited from the UC Davis Veterinary Teaching Hospital and local veterinary clinics. Dogs previously controlled using intermediate‐acting insulin q12h were transitioned to once‐weekly injections of a preliminary construct identified as AKS‐218d. The dose of AKS‐218d was titrated weekly for 8 weeks based on clinical response and continuous interstitial glucose monitoring. Clinical signs, body weight, serum fructosamine concentrations, and mean interstitial glucose concentrations (IG) over the preceding week were compared between baseline (before AKS‐218d) and during the last week of treatment. Data were compared using nonparametric paired tests.ResultsOnce‐weekly AKS‐218d, compared to baseline twice‐daily insulin therapy, resulted in no significant changes in clinical signs, median (range) body weight (+0.4 kg [−0.5‐1.1]; P = .6), fructosamine concentration (−75 mmol/L [−215 to +126]; P = .4), or mean IG (+81 mg/dL [−282 to +144]; P = .8). No adverse reactions were reported.ConclusionControl of clinical signs, body weight, and maintenance of glycemia was achieved with this once‐weekly novel insulin construct in 4 of 5 dogs.     

Evaluation of resting cortisol concentration testing in dogs with chronic gastrointestinal signs

BackgroundResting cortisol concentrations are routinely measured in dogs with chronic gastrointestinal signs to rule out hypoadrenocorticism based on a concentration >2 μg/dL (>55 nmol/L).Hypothesis/ObjectivesTo assess the cross‐sectional prevalence of hypoadrenocorticism in a group of dogs with chronic gastrointestinal signs presented to a referral internal medicine service.AnimalsTwo‐hundred and eighty‐two client‐owned dogs with chronic gastrointestinal signs and with resting cortisol concentration testing performed.MethodsRetrospective review of medical records (final diagnosis, resting cortisol concentration, and adenocorticotropic hormone [ACTH] stimulation test results) of a referral population of dogs between May 2013 and September 2017.ResultsResting cortisol concentration was <2 μg/dL (<55 nmol/L) in 79 patients (28%). Repeated resting cortisol concentration measurements were performed in 28 dogs, and in 8, resting cortisol concentrations remained <2 μg/dL (<55 nmol/L). Post‐ACTH cortisol concentration was <2 μg/dL (<55 nmol/L) in 1 dog, consistent with a diagnosis of hypoadrenocorticism and giving a prevalence estimate of hypoadrenocorticism in this population of dogs of 0.3% (95% confidence interval [95CI], 0.03‐1.5%). In 19 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). Overall, the most common diagnosis was chronic primary inflammatory enteropathy (176/282, 62.4%), followed by extragastrointestinal neoplasia (17/282, 6%), protein‐losing enteropathy, pancreatitis and megaesophagus (10/282, 3.5% each).Conclusions and Clinical ImportanceAlthough dogs with hypoadrenocorticism can present with chronic gastrointestinal signs, it was the final diagnosis in only 1 of 282 dogs presenting to a referral internal medicine service for signs of chronic enteropathy. Repeated resting cortisol concentration may be considered as a test to try and exclude hypoadrenocorticism.     

Association between quantitative bacterial culture of bronchoalveolar lavage fluid and antibiotic requirement in dogs with lower respiratory tract signs

BackgroundHistorically, positive bacterial cultures from the lower respiratory tract (LRT) have been considered clinically relevant when quantitative bacterial cultures of bronchoalveolar lavage fluid (BALF) were >1700 colony forming units (cfu)/mL. However, this threshold might not accurately predict a requirement for antibiotics.ObjectivesTo study whether quantitative BALF bacterial culture results were predictive of antibiotic requirement in dogs with LRT signs.AnimalsThirty‐three client‐owned dogs.MethodsCross‐sectional study. Dogs with positive quantitative bacterial culture of BALF were included. Dogs were divided into 2 groups, depending on whether they had a LRT infection requiring antibiotics (LRTI‐RA) or LRT disease not requiring antibiotics (LRTD‐NRA), based on thoracic imaging features, presence of intracellular bacteria on BALF cytology, and response to treatment. Predictive effect of cfu/mL and BALF total nucleated cell count (TNCC) on antibiotic requirement, adjusting for ongoing or prior antibiotic therapy and age, were studied using logistic regression.ResultsTwenty‐two and 11 dogs were included in the LRTI‐RA and LRTD‐NRA groups, respectively. The cfu/mL was not significantly predictive of antibiotic requirement, independent of ongoing or prior antibiotic treatment and age (LRTI‐RA: median, 10 000 cfu/mL; range, 10‐3 × 10⁸; LRTD‐NRA: median, 10  000 cfu/mL; range, 250‐1.3 × 10⁹; P = .27). The TNCC was not significantly predictive of antibiotic requirement when only dogs with bronchial disease were considered (LRTI‐RA: median, 470 cells/μL; range, 240‐2260; LRTD‐NRA: median, 455 cells/μL; range, 80‐4990; P = .57).Conclusion and Clinical ImportanceThe cfu/mL is an inappropriate measure for determining whether antibiotics are of benefit in dogs with LRT signs.     

Detection of Escherichia coli and Enterococcus spp. in dogs with polymicrobial urinary tract infections: A 5‐year retrospective study

BackgroundUrinary tract infections (UTI) caused by Escherichia coli and Enterococcus spp., which are frequently coisolated in polymicrobial UTI, cause morbidity among dogs and warrant antimicrobial therapy.ObjectivesTo evaluate clinical features of dogs with polymicrobial E. coli and Enterococcal UTI.AnimalsForty‐four client‐owned dogs with polymicrobial bacteriuria and groups of 100 client‐owned dogs with E. coli and Enterococcal monomicrobial bacteriuria.MethodsRetrospective cohort study of medical records of dogs at a university teaching hospital from 2014 to 2019. Prevalence of recurrent UTI and isolate antimicrobial resistance were determined. Clinical outcomes of dogs with recurrent UTI from groups including cost and hospital visits were compared.ResultsRecurrent UTI was more prevalent (P = .05) in dogs with polymicrobial bacteriuria (57%, 95% confidence interval [95% CI]: 42%‐70%) compared to the Enterococcal monomicrobial group (40%, 95% CI: 31%‐50%). Escherichia coli from polymicrobial bacteriuria were more frequently resistant to doxycycline (P < .01, 43%, 95% CI: 29%‐58%) and gentamicin (P = .03, 17%, 95% CI: 9%‐31%) compared to E. coli from monomicrobial bacteriuria (17% and 5%, 95% CI: 11%‐26% and 2%‐11% for doxycycline and gentamicin, respectively). Dogs with recurrent UTI from the polymicrobial UTI group had significantly (P = .05) more hospital visits (mean = 6 visits, 95% CI: 1.7‐9.8) compared to recurrent monomicrobial UTI dogs (mean = 4 and 3 visits, 95% CI: 1.0 to 4.4 and −0.7 to 7.7 for E. coli and Enterococcal monomicrobial UTI, respectively).Conclusions and Clinical Importance Escherichia coli and Enterococcus spp. polymicrobial UTI had more frequent adverse clinical outcomes for dogs.     

Acute kidney injury in dogs: Etiology,clinical and clinicopathologic findings,prognostic markers,and outcome

BackgroundAcute kidney injury (AKI) is a common, potentially fatal condition.ObjectivesTo characterize the etiologies, clinical and clinicopathologic findings, hospitalization period, and outcome of dogs with AKI and to identify markers of negative prognosis.AnimalsTwo hundred forty‐nine client‐own dogs diagnosed with AKI and hospitalized at a veterinary teaching hospital.MethodsRetrospective study. Search of medical records for dogs with AKI.ResultsCommon clinical signs included lethargy (225/249, 90%), anorexia (206/249, 83%), and vomiting (168/249, 68%). Etiologies included ischemic/inflammatory (144/249, 58%), infectious (19/249, 8%), nephrotoxicosis (14/249, 6%), or other (13/249, 5%). Hospital‐acquired AKI was diagnosed in 9% (23/249) of the dogs. Median presentation and peak serum creatinine (sCr) concentrations were 4 mg/dL (range, 1.1‐37.9) and 4.6 mg/dL (range, 1.1‐43.1), respectively. Dogs were classified to AKI grades as follows: Grade I, 6 (2%), Grade II, 38 (15%), Grade III, 89 (36%), Grade IV, 77 (31%), and Grade V, 39 (16%). One hundred and sixty‐four (66%) dogs survived. There was a positive association between death and AKI grade (P = .009). The case fatality rate was higher among dogs with anuria compared with dogs without anuria (50% vs 28%, respectively; odds ratio [95% confidence interval]: 2.5 [1.39‐4.6]; P = .002). Forty‐seven (18.8%) dogs underwent hemodialysis, of which 60% survived.Conclusion and Clinical ImportanceTwo‐thirds of dogs with AKI survived. Hospital‐acquired AKI was common. The severity of AKI, as reflected by presence of anuria, AKI grade, and other body organs involvement, was associated with the outcome.     

Outcomes of esophageal and gastric bone foreign bodies in dogs

BackgroundBone foreign bodies are commonly encountered in small animal practice. Esophageal bone foreign bodies (E‐bFBs) warrant removal, whereas gastric bone foreign bodies might not.ObjectivesDescribe management and outcomes for dogs with esophageal or gastric bone foreign bodies.AnimalsOne hundred twenty‐nine dogs with esophageal (n = 45) or gastric (n = 84) bone foreign bodies.MethodsRetrospective review of medical records.ResultsDogs with E‐bFBs were younger than dogs with gastric bone foreign bodies (median age esophageal, 4 years [IQR 2‐8]; median age gastric, 6 years [IQR 3‐10]; P = .03), and had a higher bone cross‐sectional area relative to body weight (median esophageal, 98.21 mm²/kg [IQR 48.25‐142.6]; median gastric, 28.6 mm²/kg [IQR 17.25‐64.28]; P < .001). Forty‐two of 45 esophageal foreign bodies were resolved non‐surgically and 3 by esophagotomy. Esophageal erosions were more likely with distal entrapment (OR 12.88, [95% CI 31.95‐129.29], P = .01) and longer duration (OR 18.82 [95% CI 2.22‐273.97], P = .01). Sixty‐two of 84 bone gastric foreign bodies were left in situ. Endoscopic removal was successful in 20 of 22 (91%; 95% CI 70‐99) attempts.Conclusions and Clinical ImportanceWhile all E‐bFBs were dislodged either by advancement into the stomach, endoscopic removal, or esophagotomy, the majority of gastric bone foreign bodies were left in situ for dissolution, with no reported complications. Gastric advancement of E‐bFBs should be considered when oral removal is not feasible, and dissolution can be considered even with large bones.     

Prospective study of dilated cardiomyopathy in dogs eating nontraditional or traditional diets and in dogs with subclinical cardiac abnormalities

BackgroundRecent studies have investigated dogs with presumed diet‐associated dilated cardiomyopathy (daDCM), but prospective studies of multiple breeds are needed.Hypothesis/ObjectivesTo evaluate baseline features and serial changes in echocardiography and cardiac biomarkers in dogs with DCM eating nontraditional diets (NTDs) or traditional diets (TDs), and in dogs with subclinical cardiac abnormalities (SCA) eating NTD.AnimalsSixty dogs with DCM (NTD, n = 51; TDs, n = 9) and 16 dogs with SCA eating NTDs.MethodsEchocardiography, electrocardiography, and measurement of taurine, cardiac troponin I, and N‐terminal pro‐B‐type natriuretic peptide were performed in dogs with DCM or SCA. Diets were changed for all dogs, taurine was supplemented in most, and echocardiography and cardiac biomarkers were reassessed (3, 6, and 9 months).ResultsAt enrollment, there were few differences between dogs with DCM eating NTDs or TDs; none had low plasma or whole blood taurine concentrations. Improvement in fractional shortening over time was significantly associated with previous consumption of a NTD, even after adjustment for other variables (P = .005). Median survival time for dogs with DCM was 611 days (range, 2‐940 days) for the NTD group and 161 days (range, 12‐669 days) for the TD group (P = .21). Sudden death was the most common cause of death in both diet groups. Dogs with SCA also had significant echocardiographic improvements over time.Conclusions and Clinical ImportanceDogs with DCM or SCA previously eating NTDs had small, yet significant improvements in echocardiographic parameters after diet changes.     

Treatment of intracranial neoplasia in dogs using higher doses: A randomized controlled trial comparing a boosted to a conventional radiation protocol

BackgroundLocal progression of intracranial tumors can be the consequence of insufficient radiation dose delivered. Dose increases in the brain must be made carefully so as not to risk debilitating adverse effects such as radiation necrosis.HypothesisA new protocol with 10 × 4 Gy + 11% physical dose increase limited to the macroscopic tumor volume results in a clinically better outcome compared to a 10 × 4 Gy protocol.AnimalsFifty‐seven client‐owned dogs with primary intracranial neoplasia.MethodsRandomized controlled trial. Twenty‐eight dogs were assigned to the control protocol (10 × 4 Gy) and 29 to the simultaneous integrated boost (SIB) protocol with 4.45 Gy dose increase. Treatment groups were compared for outcome and signs of toxicity.ResultsMild, transient acute or early‐delayed adverse radiation effects were observed in 5 dogs. Severe late adverse effects were not seen. Between the protocols, no significant differences were found for outcome (intention‐to‐treat analysis): overall time to progression (TTP) was 708 days (95% confidence interval (95% CI) [545,872]), in the control group it was 828 days (95% CI [401,1256]), and in the SIB group 627 days (95% CI [282,973]; P = .07). Median overall survival (OS) was 684 days (95% CI [516,853]), in the control group it was 724 days (95% CI [623,826]), and in the SIB group 557 days (95% CI [95,1020]; P = .47). None of the tested variables was prognostic in terms of outcome.Conclusion and Clinical ImportanceThe dose escalation used with an 11% physical dose increase did not result in better outcome.     

Ultrasonographic patterns,clinical findings,and prognostic variables in dogs from Asia with gallbladder mucocele

BackgroundGallbladder mucocele (GBM) is a common biliary disorder in dogs that can be categorized into 6 types, but the value of this classification scheme remains unknown. Cholecystectomy is associated with high death rates and warrants additional interrogation.ObjectivesInvestigate the clinical value of ultrasonographic diagnosis of type of GBM and identify prognostic factors in dogs with GBM undergoing cholecystectomy.AnimalsTwo hundred sixteen dogs.MethodsRetrospective cohort study. Dogs with GBM diagnosed from 2014 to 2019 at 6 veterinary referral hospitals in Asia. Ultrasonogram images were reviewed and a GBM type (ie, types I‐VI) assigned.ResultsDogs with GBM type V as compared to I (OR, 8.6; 95% CI, 2.6‐27.8; P < .001) and III (OR, 10.0; 95% CI, 2.5‐40.8; P = .001), and dogs with type VI compared to I (OR, 10.5; 95% CI, 1.8‐61.2; P = .009) and III (OR, 12.3; 95% CI, 1.8‐83.9; P = .01) were more likely to exhibit signs of biliary tract disease. Independent predictors of death after cholecystectomy included age (OR, 2.81; 95% CI, 1.41‐5.59; P = .003) and intraoperative systolic blood pressure (SBP) nadir. There was an interaction between SBP nadir and gallbladder rupture; SBP nadir in dogs with (OR, 0.92; 95% CI, 0.89‐0.94; P < .001) and without (OR, 0.88; 95% CI, 0.82‐0.93; P < .001) gallbladder rupture.Conclusion and Clinical ImportanceIncreasing developmental stage of GBM could be associated with an increased likelihood of biliary tract related clinical signs. Nadir SBP deserves further investigation as a prognostic or potentially modifiable variable, particularly in the presence of gallbladder rupture.     

Polycythemia in dogs with chronic hypoxic pulmonary disease

BackgroundProlonged tissue hypoxia caused by chronic pulmonary disease is commonly regarded as an important mechanism in the development of secondary polycythemia, but little clinical data are available to support this hypothesis.ObjectiveTo study the prevalence and severity of erythrocytosis accompanying chronic hypoxic pulmonary disease in dogs.AnimalsForty‐seven dogs with hypoxic chronic pulmonary disease, 27 dogs with nonhypoxic chronic pulmonary disease, and 60 healthy controls.MethodsDogs with chronic pulmonary disease and chronic hypoxemia (partial pressure of arterial oxygen [PaO₂] < 80 mm Hg on at least 2 arterial blood gas measurements a minimum of 1 month apart) were identified retrospectively from patient records. Association between arterial oxygen and red blood cell parameters was analyzed using Pearson''s correlation coefficients and multivariable linear regression analysis.ResultsRed blood cell parameters measured at the end of the hypoxemia period were within the laboratory reference range in most dogs. In chronically hypoxemic dogs, hematocrit (Hct) was increased in 4/47 (8.5%; 95% confidence interval [CI], 0‐17) dogs, erythrocyte count (Erytr) was increased in 12/47 (26%; 95%CI, 13‐38) dogs and hemoglobin concentration (Hb) was increased in 3/47 (6.4%; 95%CI, 0‐14) dogs. No marked polycythemia (Hct ≥65%) was noted in any of the dogs. Red blood cell parameters were not associated with the severity of hypoxemia (correlation to PaO₂: Erytr, r = −.14; Hb, r = −.21; Hct, r = −.14; P > .05 for all).Conclusions and Clinical ImportancePolycythemia is uncommon, and usually mild if present, in dogs with chronic hypoxia caused by pulmonary disease.     

Changes in renin‐angiotensin‐aldosterone system during cardiac remodeling after mitral valvuloplasty in dogs

BackgroundInformation regarding changes in renin‐angiotensin‐aldosterone system (RAAS) during cardiac remodeling after mitral valvuloplasty (MVP) in dogs remains lacking.Hypothesis/ObjectivesTo assess the longitudinal effects of MVP on circulating RAAS activity.AnimalsEight client‐owned dogs receiving MVP for myxomatous mitral valve disease (MMVD).MethodsThis is a cohort study. Plasma renin activity (PRA), angiotensin II (AT2), aldosterone (PAC), blood urea nitrogen (BUN), and creatinine concentrations, were measured in these dogs before (baseline) and at 3 consecutive monthly follow‐ups (Post‐1M, Post‐2M, Post‐3M). Echocardiography was concomitantly used to assess the process of cardiac recovery after MVP.ResultsThe echocardiography revealed a significant decrease in LVIDDN, LA/Ao, FS, E velocity, E/A, E′ sep, S′ lat, E′ lat, and A′ lat after MVP compared with baseline (P < .05). There was a significant reduction in the PRA (2.45, 3.05, 2.74 vs 8.8 ng/mL/h; P = .002), AT2 (466, 315, 235 vs 1200 pg/mL; P = .009), and PAC (39.88, 47, 54.62 vs 179.5 pg/mL; P = .01), respectively at Post‐1M, Post‐2M, Post‐3M compared to the baseline. Additionally, BUN and creatinine concentrations decreased from Post‐1M. The RAAS variables showed significant, weak to moderate, relationship with selected echocardiographic variables.Conclusions and Clinical ImportanceMitral valvuloplasty contributes to decreased RAAS activity in MMVD dogs, which paralleled the process of cardiac reverse remodeling up to Post‐3M. This information facilitates formulating strategies to optimize clinical outcomes for dogs after MVP.     

Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence

BackgroundTransvenous electrical cardioversion (TVEC) is 1 of the main treatment options for atrial fibrillation (AF) in horses. Large‐scale studies on factors affecting success and prognosis have primarily been performed in Standardbred populations.Hypothesis/ObjectivesTo determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a predominant Warmblood study sample.AnimalsTVEC records of 199 horses.MethodsRetrospective study of TVEC procedures of horses admitted for AF without severe echocardiographic abnormalities. Horse and procedural factors for success and cumulative amount of energy (≤ 600 J vs > 600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence.ResultsTwo hundred and thirty‐one TVEC procedures were included, with a 94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151, 95% CI 0.032‐0.715, P = .02) and AF cycle length (OR 1.05, 95% CI 1.01‐1.09, P = .02) were independent determinants for success. Catheter type (OR 0.154, 95% CI 0.074‐0.322, P < .001), previous AF episode (OR 3.10, 95% CI 1.20‐8.01, P = .02), tricuspid regurgitation (OR 2.54, 95% CI 1.25‐5.13, P = .01), and body weight (OR 1.009, 95% CI 1.003‐1.015, P = .004) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05, 95% CI 1.34‐6.95, P = .008), mitral regurgitation (HR 1.91, 95% CI 1.08‐3.38, P = .03), and AF duration (HR 1.001, 95% CI 1.0001‐1.0026, P = .04).Conclusions and Clinical ImportanceBoth horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.