Nodules and masses are associated with malignant pleural effusion in dogs and cats but many other intrathoracic CT features are poor predictors of the effusion type

Thoracic CT may be used in the workup of patients with pleural effusion. In humans, certain pleural features on CT aid in diagnosing an underlying cause for pleural effusion, whereas this is not well studied in veterinary medicine. This retrospective cross‐sectional analytical study assessed pleural and other intrathoracic abnormalities on CT in dogs and cats with pleural effusion and explored potential discriminatory features between effusion types. Eighty‐nine dogs and 32 cats with pleural cytology and/or histopathology were categorized into malignant pleural disease (15 dogs and 11 cats), pyothorax (34 dogs and 7 cats), chylothorax (20 dogs and 11 cats), transudative (11 dogs and 2 cats), and hemorrhagic effusion (9 dogs and 1 cat). Multivariable logistic regression analysis comparing malignancy to other effusions found that older patient age (dogs: odds ratio 1.28, P = 0.015; cats: odds ratio 1.53, P = 0.005), nodular diaphragmatic pleural thickening (dogs: odds ratio 7.64, P = 0.021; cats: odds ratio 13.67, P = 0.031), costal pleural masses (dogs: odds ratio 21.50, P = 0.018; cats: odds ratio 32.74, P = 0.019), and pulmonary masses (dogs: odds ratio 44.67, P = 0.002; cats: odds ratio 18.26, P = 0.077) were associated with malignancy. In dogs, any costal pleural abnormality (odds ratio 47.55, P = 0.002) and pulmonary masses (odds ratio 10.05, P = 0.004) were associated with malignancy/pyothorax, whereas any costal pleural abnormality (odds ratio 0.14, P = 0.006) and sternal lymphadenopathy (odds ratio 0.22, P = 0.040) were inversely associated with transudates. There were, however, many overlapping abnormalities between effusion types, so further diagnostic testing remains important for diagnosis.     

Postoperative pulmonary complications in dogs undergoing laparotomy: anesthetic and perioperative factors

Objective: To define the peri‐anesthetic risk factors that are associated with the development of postoperative pulmonary complications (PPCs) in dogs following laparotomy. Study design: Retrospective study. Animals: One hundred and sixty‐two dogs that underwent laparotomy at a veterinary teaching hospital. Methods: Cases were evaluated for factors including signalment, American Society of Anesthesiologists (ASA) physical status (PS) score, duration of fast, duration of anesthesia, anesthetic and analgesic protocols, fluid and blood product therapy, animal positioning, and postoperative temperature. Results: Statistically significant differences between dogs that developed PPCs and those that did not (nPPCs) were identified in the following categories: ASA PS score≥III (P=0.041), emergent surgery (P=0.038), longer duration of anesthesia (P=0.0462), and use of butorphanol or oxymorphone instead of hydromorphone for postoperative medication (P=0.04 and 0.015, respectively). Dogs that received transfusions of stored blood products (fresh frozen plasma or packed red blood cells) during their hospital stay were also more likely to develop PPCs (P=0.035 and 0.005, respectively). Dogs that developed PPCs were also more likely to have received antagonists for potent opiates or benzodiazepines postoperatively and to have recovered in the intensive care unit (ICU) (P=0.03 and 0.009, respectively). Conclusions: Dogs with ASA PS scores≥III, or those requiring longer or emergency anesthesia are at a higher risk of developing PPCs. Additionally, dogs receiving stored blood products in the perioperative period may be at risk for pulmonary complications. Dogs fitting criteria for the above risk factors should be monitored closely postoperatively for development of pulmonary complications.     

Airway microbial culture and susceptibility patterns in dogs and cats with respiratory disease of varying severity

Objective – To compare airway microbiological culture and susceptibility results in 2 groups of dogs and cats: 1 with respiratory failure requiring positive pressure ventilation (PPV) and 1 with respiratory disease. Design – Retrospective study. Setting – University teaching hospital. Animals – Fifty‐two dogs and cats requiring PPV that had an airway microbiologic culture submitted from October 1, 2003 to October 31, 2008 were included. One hundred and four airway microbiologic cultures from dogs and cats with respiratory disease not requiring PPV were randomly sampled for comparison. Interventions – None. Measurements and Main Results – Patients with respiratory failure were more likely to have a gram‐negative enteric isolate identified (P<0.001), while patients with respiratory disease were more likely to have a gram‐negative nonenteric isolate (P<0.001) or anaerobic isolate (P<0.001) identified. Aerobic bacterial isolates from patients with respiratory failure were less likely to be susceptible to ampicillin (P=0.006), amoxicillin/clavulonate (P<0.001), chloramphenicol (P=0.004), enrofloxacin (P<0.001), ticarcillin/clavulonate (P=0.004), and the combination of ampicillin with enrofloxacin (P<0.001) than were aerobic bacterial isolates from patients with respiratory disease. Conclusions – Canine and feline patients with respiratory failure severe enough to require PPV exhibit a different pattern of bacterial isolates cultured from their airways when compared with isolates from patients with respiratory disease that has not resulted in ventilator dependence. These isolates are more likely to be resistant to commonly used antimicrobials/antimicrobial combinations than patients in the respiratory disease group. These findings suggest that in canine and feline patients with infectious lower respiratory tract disease, consideration of the severity of the pulmonary insult may allow for better prediction of likely isolates and their antimicrobial susceptibilities. Further prospective studies with a standardized collection technique are warranted.     

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.     

Factors associated with adverse outcomes during parenteral nutrition administration in dogs and cats

Background: Parenteral nutrition (PN) is increasingly used to support hospitalized dogs and cats. Published assessments of outcome are limited. Objective: Evaluate type and prevalence of complications and risk factors for death and complications in dogs and cats receiving PN. Animals: Three hundred and nineteen dogs and 112 cats that received PN at a teaching hospital between 2000 and 2008. Methods: Retrospective case review. Diagnosis, duration of PN administration, concurrent enteral feeding, death, and mechanical, septic, and metabolic complications were abstracted from medical records. Association of each parameter with complications and death was analyzed by binary logistic regression. Results: Pancreatitis was the most common diagnosis (109/319 dogs, 34/112 cats), and 137/319 dogs and 51/112 cats died. Dogs and cats received 113 ± 40% and 103 ± 32% of resting energy requirement, respectively. Mechanical (81/319 dogs, 16/112 cats) and septic (20/319 dogs, 6/112 cats) complications were not associated with death (P > .05). Hyperglycemia was the most common metabolic complication (96/158 dogs, 31/37 cats). Hypercreatininemia in dogs (8/79) was the only complication associated with death (P < .01). Chronic kidney disease in dogs, hepatic lipidosis in cats, and longer duration of inadequate caloric intake before PN in both species were negatively associated with survival (P < .05). Factors positively associated with survival included longer duration of PN administration in both species, enteral feeding in cats with any disease, and enteral feeding in dogs with respiratory disease (P < .05). Conclusions and Clinical Importance: PN can be effectively used to provide the energy requirements of most critically ill dogs and cats. Most complications accompanying PN administration do not affect survival.     

The use of 25% human serum albumin: outcome and efficacy in raising serum albumin and systemic blood pressure in critically ill dogs and cats

Objective: To report on the use of 25% human serum albumin (25% HSA) (Plasbumin®), associated outcome, and efficacy in raising serum albumin and systemic blood pressure (BP) in critically ill dogs and cats. Design: Retrospective clinical study. Animals: Client‐owned cats and dogs. Interventions: Administration of 25% HSA. Measurements and main results: The medical records of 66 animals (64 dogs, 2 cats) at the Ontario Veterinary College, which received 25% HSA (Plasbumin®) from June 1997 to December 2001 were reviewed for age, body weight, clinical problems, albumin and globulin (g/L) levels pre‐ and within 18‐hour post‐transfusion and upon discharge from hospital, total solids (TS), systolic and diastolic BP pre‐ and post‐transfusion total volume administered, adverse reactions, blood products and synthetic colloids used, and outcome. Twenty‐five percent HSA was prescribed for a range of clinical problems, which were grouped into 6 categories for analysis. The age range was 4 months–12 years and body weight range 1.4–65 kg. The maximum volume administered to any dog was 25 mL/kg, mean volume administered was 5 mL/kg, maximum volume given as a slow push or bolus was 4 mL/kg with a mean of 2 mL/kg volume. The range for a constant rate infusion (CRI) was 0.1–1.7 mL/kg/hr over 4–72 hours. Forty‐seven (71%) animals survived to discharge; 11(16%) were euthanized, and 8 (12%) died. Serum albumin and TS increased significantly (P<0.0001) above pre‐transfusion levels as did systolic BP (P<0.01). Conclusions: Twenty‐five percent HSA can be safely administered to critically ill animals, and an increase in albumin levels and systemic BP can be expected.     

Contrast‐enhanced ultrasonography characteristics of intrathoracic mass lesions in 36 dogs and 24 cats

Contrast‐enhanced ultrasonography (CEUS) is increasingly available for veterinary patients, however limited studies describe the use of this method for characterizing intrathoracic mass lesions. The aim of this prospective, observational study was to describe CEUS enhancement patterns for intrathoracic mass lesions in a sample of cats and dogs. Sixty patients (36 dogs, 24 cats) were included. Standardized CEUS examinations were performed for 41 pulmonary masses (68%) and 19 mediastinal masses (32%). Final diagnosis was based on cytology and/or histopathology. Absolute time to enhancement (TTE) values were recorded for the intrathoracic mass lesions and spleen. The spleen was used as a reference parenchymal organ to calculate relative TTE (rTTE) values. Absolute TTE of the spleen and intrathoracic mass lesions differed for dogs and cats (P = 0.001). The rTTE values significantly differed between lesions of neoplastic versus non‐neoplastic origin (P = 0.004). The majority of neoplastic pulmonary masses were supplied by bronchial arteries (63%), while most nonneoplastic pulmonary masses were supplied by pulmonary arteries (78%). The sensitivity and specificity for detecting pulmonary neoplastic masses with rTTE were 63% and 78%, respectively. Enhancement patterns for mediastinal thymomas and lymphomas significantly differed (P = 0.002). Thymomas enhanced heterogeneously in a centripetal pattern (86%), whereas lymphomas typically enhanced uniformly in a centrifugal pattern (75%). Findings indicated that CEUS is a feasible method for characterizing intrathoracic mass lesions in dogs and cats, however, the diagnostic sensitivity for detecting neoplastic pulmonary masses was low.     

Isolation of Campylobacter spp. from Client‐Owned Dogs and Cats,and Retail Raw Meat Pet Food in the Manawatu,New Zealand

Campylobacter causes acute gastroenteritis in people worldwide and is frequently isolated from food, animals and the environment. The disease is predominately food‐borne but many routes of transmission and sources of infection have been described, including contact with pets. The prevalence of Campylobacter spp. in dogs and cats varies widely, and data on New Zealand pets are limited. This study aimed to investigate the prevalence of Campylobacter spp. in dogs, cats and retail raw meat pet food products in New Zealand and to characterize Campylobacter jejuni isolates using multilocus sequence typing (MLST). Ninety dogs and 110 cats examined at the Massey University Veterinary Teaching Hospital for elective procedures, and fifty locally purchased retail raw meat pet diets were sampled. Two culture protocols combining Bolton broth enrichment and mCCDA and CAT agars in a microaerobic atmosphere at 42°C and 37°C with species identification using PCR were performed. The prevalence of Campylobacter spp., C. jejuni, Campylobacter upsaliensis and Campylobacter helveticus was 36%, 13%, 23% and 1% in dogs and 16%, 5%, 5% and 7% in cats, respectively. One dog had Campylobacter lari confirmed, and three dogs and one cat had multiple Campylobacter spp. detected. Significantly more animals tested positive using CAT than mCCDA agar (P < 0.001). Being neutered, vaccinated for Bordetella bronchiseptica, fed dry diets and brought in for neutering were protective factors for dogs, whereas attendance for dental treatment was a risk factor for cats. Campylobacter spp. were isolated from 28%, C. jejuni 22%, C. lari 6% and Campylobacter coli 6% of food samples. Six isolates positive by Campylobacter genus PCR were identified as Arcobacter butzleri. Poultry meat was more likely to be positive than non‐poultry meat (P = 0.006). Of the 13 C. jejuni pet isolates with full MLST profiles, eight were of different sequence types (ST) and all nine food isolates were of different STs.     

COMPARISON OF DIGITAL RADIOGRAPHY,ULTRASONOGRAPHY, AND POSITIVE CONTRAST VAGINOURETHROGRAPHY FOR DETERMINING REPRODUCTIVE STATUS OF FEMALE CATS

It is not always possible to identify female cats that have undergone previous ovariohysterectomy based on physical examination alone. An easy, cost‐effective method for screening female cats for reproductive status would be helpful for avoiding unnecessary exploratory laparotomies. The purpose of this prospective study was to compare diagnostic sensitivities of digital radiography, ultrasonography, and positive contrast vaginourethrography for determining reproductive status in female cats. Sixty‐seven recently euthanized female cats of unknown medical history and reproductive status were randomly selected and included in the study. Digital abdominal radiography, digital abdominal radiography with compression, abdominal ultrasonography, and positive contrast vaginourethrography were performed in sequence by a board‐certified veterinary radiologist and a second‐year radiology resident. Immediately following diagnostic imaging procedures, necropsy was performed. Ultrasonography of the uterus had the highest sensitivity (86%) for determining reproductive status of all the imaging modalities tested. The specificity was 88%, and the positive predictive value and negative predictive value were 96% and 68%, respectively. The calculated sensitivities and specificities of other modalities were as follows: digital radiographs (28%, 100%), digital compression radiographs (58%, 100%), and vaginourethrography (32%, 100%). Based on McNemar's test statistic, there was a significant difference in the sensitivity of ultrasound compared to digital radiographs (P ≤ 0.05), compression radiographs (P ≤ 0.05), and vaginourethrogram (P ≤ 0.05). Findings from the current study indicated that ultrasonography is a sensitive diagnostic test for determining reproductive status in female cats. Although more readily available in private practice and shelters, digital radiography and vaginourethrography are not reliable predictors of reproductive status.     

Serial abdominal radiographs do not significantly increase accuracy of diagnosis of gastrointestinal mechanical obstruction due to occult foreign bodies in dogs and cats

Abdominal radiographs are commonly used in dogs and cats that present with gastrointestinal signs. When initial abdominal radiographs are equivocal for the presence or absence of gastrointestinal mechanical obstruction, follow‐up abdominal radiographs may be recommended. Based on our review of the literature, no published study has been performed to evaluate the clinical utility of serial abdominal radiographs in such cases. The purpose of this study is to determine whether follow‐up abdominal radiographs increase diagnostic accuracy for mechanical obstruction. A prospective cohort study was performed on client‐owned dogs and cats with clinical concern for gastrointestinal mechanical obstruction and initial abdominal radiographs inconclusive for the presence of obstruction. Follow‐up abdominal radiographs were performed between 7 and 28 h of the initial radiographs; an abdominal ultrasound performed within 3 h of the follow‐up study served as the gold standard. A total of 57 patients (40 dogs and 17 cats) were recruited; 19 of 57 cases (11 dogs; 8 cats) were mechanically obstructed, all with nonradiopaque foreign bodies. Four blinded reviewers (2 radiologists, 1 radiology resident, 1 criticalist) separately assessed the initial and the combined initial/follow‐up radiographic studies for diagnosis of mechanical obstruction; for each observer, there was no significant change in accuracy (P = .058‐.87) for the diagnosis of mechanical obstruction. Given the lack of significant increase in diagnostic accuracy using follow‐up radiographs in cases of occult gastrointestinal mechanical obstruction, other diagnostic options (eg, abdominal ultrasonography) could be considered when survey abdominal radiographs are inconclusive for the diagnosis of mechanical obstruction in dogs and cats.     

Retrospective evaluation of the prognostic utility of plasma lactate concentration,base deficit,pH, and anion gap in canine and feline emergency patients

Objective

To determine the association of plasma lactate concentration, pH, base deficit (BD), and anion gap (AG) in dogs and cats on presentation to an emergency room with outcome, and to compare the prognostic significance of hyperlactatemia with a concurrent metabolic acidosis with that of hyperlactatemia and a normal metabolic acid–base balance.

Design

Retrospective study.

Setting

University teaching hospital.

Animals

Five hundred sixty‐six dogs and 185 cats that had venous blood gas analysis performed.

Interventions

None.

Measurements and Main Results

Medical records were reviewed for plasma lactate concentrations, electrolyte concentrations, and acid–base parameters obtained on emergency room admission, clinical diagnosis, and in‐hospital mortality. The primary outcome measure was all‐cause mortality for the hospitalized visit. Median plasma lactate concentration and AG were higher, BD was more negative, and pH was lower, in non‐survivor dogs and cats. The prevalence of hyperlactatemia was 53% in dogs and 30% in cats. Lactic acidosis was present in 42% and 80% of hyperlactatemic dogs and cats, respectively. Multivariate regression analyses revealed that plasma lactate concentration, BD, and pH, but not AG, were independent predictors of mortality in dogs, and that only plasma lactate concentration was an independent predictor of mortality in cats. Mortality was highest for animals with lactic acidosis, at 59.8% in dogs and 49% in cats. Mortality in dogs with lactic acidosis was significantly higher than dogs with hyperlactatemia and a normal acid–base status (P < 0.0001).

Conclusions

The presence and magnitude of hyperlactatemia on presentation to the emergency room may help identify dogs and cats with high likelihood of in‐hospital mortality, and the presence of lactic acidosis specifically may help identify dogs with yet higher risk of in‐hospital mortality.     

COMPARISON OF LUNG ATTENUATION AND HETEROGENEITY BETWEEN CATS WITH EXPERIMENTALLY INDUCED ALLERGIC ASTHMA,NATURALLY OCCURRING ASTHMA AND NORMAL CATS

Airway remodeling is a prominent feature of feline allergic asthma but requires biopsy for characterization. Computed tomography (CT) has appeal as a minimally invasive diagnostic test. The purpose of this prospective case–control study was to compare indices of airway remodeling between cats with experimentally induced, spontaneous asthma and healthy unaffected cats using CT. We hypothesized that experimental and spontaneous feline asthma would have similar CT airway remodeling characteristics and that these would be significantly different in healthy cats. Experimentally induced asthmatic research cats (n = 5), spontaneously asthmatic pet cats (n = 6), and healthy research cats (n = 5) were scanned unrestrained using a 64‐detector row CT scanner. Inspiratory breath‐hold CT scans were also performed in experimentally induced asthmatic and healthy cats. Mean ± extent variation of lung attenuation for each cat was determined using an airway inspector software program and CT images were scored for lung heterogeneity by a board‐certified veterinary radiologist who was unaware of cat group status. Groups were compared using one‐way ANOVA (unrestrained scans) and the Student's t‐test (anesthetized scans) with significance defined as P < 0.10. Experimentally asthmatic and spontaneously asthmatic cats had significantly (P = 0.028 and P = 0.073, respectively) increased lung attenuation compared to healthy cats. Heterogeneity scores were higher in experimentally induced asthmatic cat than in healthy cats. Objective quantification of lung heterogeneity and lung volume did not differ among the three groups (P = 0.311, P = 0.181, respectively). Findings supported our hypothesis. Inspiratory breath‐hold anesthetized CT scans facilitated discrimination between asthmatic and healthy cats in comparison to unrestrained CT scans.     

Associations among albuminuria, C-reactive protein concentrations, survival predictor index scores, and survival in 78 critically ill dogs

Background: Microalbuminuria and C‐reactive protein (CRP) are predictors of morbidity and survival in critically ill human patients. Hypothesis/Objectives: To evaluate results of microalbuminuria assays (untimed single‐sample urine albumin concentration [U‐ALB] and the urine albumin : creatinine ratio [UACR]), serum CRP, and survival predictor index (SPI2) scores as predictors of survival in critically ill dogs. Animals: Seventy‐eight dogs admitted to intensive care units at University of Tennessee (UT) and Colorado State University (CSU). Methods: Prospective observational study. Critically ill dogs were eligible for enrollment, unless euthanized because of financial constraints. Samples were collected within 3 hours of admission. Spearman's rank‐correlation coefficients were determined for U‐ALB, UACR, CRP, and SPI2. U‐ALB, UACR, CRP, and SPI2 were assessed for associations with 7‐ and 30‐day survival by Mann‐Whitney U‐tests and receiver operating characteristic (ROC) curves. P‐values < .0125 were considered significant. Results: UT (n = 49) and CSU (n = 29) patients did not differ significantly. Forty percent (31/78) of dogs died. SPI2 was inversely correlated with U‐ALB (r_s=?0.39, P < .001) and UACR (r_s=?0.41, P < .001). CRP was not correlated with SPI2 (P= .019), U‐ALB (P > .1), or UACR (P > .1). U‐ALB and UACR had very high correlation (r_s= 0.95, P < .001). SPI2, U‐ALB, and UACR differed significantly for survivors and nonsurvivors. SPI2, U‐ALB, and UACR had areas under the ROC curve (AUC) from 0.68 to 0.74 for survival prediction. Conclusions and Clinical Importance: Albuminuria and SPI2, but not CRP, are associated with survival in critically ill dogs. Suboptimal AUCs limit the value of microalbuminuria testing for clinical risk assessment. Additional studies are necessary to determine the usefulness of microalbuminuria testing in patient risk stratification for prospective research.     

Electrocardiographic assessment of hyperkalemia in dogs and cats

Objective: To determine if electrocardiogram (ECG) changes induced by hyperkalemia in clinical patients correspond with previously reported changes in experimental animals. Design: Prospective clinical study. Setting: Two private practice 24‐hour emergency and critical care facilities. Animals: Fifteen dogs and 22 cats with serum potassium levels >5.5 mEq/L. Interventions: None. Measurements: The following data were collected when hyperkalemia was documented: ECG (n=37), sodium and chloride (mEq/L) (n=35), total magnesium (mg/dL) (n=18), total calcium (mg/dL) (n=30), and venous pH (n=18). Animals were divided into five groups based on severity of hyperkalemia and ECG interpretation included rate, rhythm and P‐QRS‐T evaluation. Main Results: Twenty‐two of 37 (59%) of the ECGs were normal or revealed abnormalities that have not been previously described in conjunction with hyperkalemia. In dogs, there was no correlation (r=0) between potassium blood levels and heart rate (n=15). There was weak correlation (r=0.40; P=0.06) between potassium blood levels and heart rate in cats (n=22). The correlation was stronger (r=0.64; P<0.05) when data were compared in cats with serum potassium level >8.5 mEq/L (Groups 4 and Group 5; n=11). Conclusions: ECGs obtained from ill dogs and cats with hyperkalemia are inconsistent with ECGs from experimentally induced hyperkalemia. It is difficult to determine the clinical relevance of heart rate differences between cats with serum potassium levels >8.5 mEq/L and animals with experimentally induced hyperkalemia; this may be due to the presence of other biochemical abnormalities in diseased animals.     

REPEATABILITY OF A PLANNING TARGET VOLUME EXPANSION PROTOCOL FOR RADIATION THERAPY OF REGIONAL LYMPH NODES IN CANINE AND FELINE PATIENTS WITH HEAD TUMORS

For canine and feline patients with head tumors, simultaneous irradiation of the primary tumor and mandibular and retropharyngeal lymph nodes (LNs) is often indicated. The purpose of this study was to assess the repeatability of a planning target volume (PTV) expansion protocol for these LNs. Two CT image sets from 44 dogs and 37 cats that underwent radiation therapy for head tumors were compared to determine LN repositioning accuracy and precision; planning‐CT (for radiation therapy planning) and cone‐beam CT (at the time of actual treatment sessions). Eleven percent of dogs and 65% of cats received treatment to their LNs. In dogs, the mandibular LNs were positioned more caudally (P = 0.0002) and the right mandibular and right retropharyngeal LNs were positioned more to the left side of the patient (P = 0.00015 and P = 0.003, respectively). In cats, left mandibular LN was positioned higher (toward roof) than the planning‐CT (P = 0.028). In conclusion, when the patient immobilization devices and bony anatomy matching are used to align the primary head target and these LNs are treated simultaneously, an asymmetrical PTV expansion that ranges 4–9 mm (dogs) and 2–4 mm (cats), depending on the directions of couch movement, should be used to include the LNs within the PTV at least 95% of the time.     

The Effects of Illness on Urinary Catecholamines and their Metabolites in Dogs

Background: Urinary catecholamines and metanephrines have been proposed as a diagnostic tool for identifying canine pheochromocytomas, but the effects of critical illness on urine concentrations of catecholamines and metanephrines currently are unknown. Objectives: To examine the effects of illness on urine concentrations of catecholamines and metanephrines in dogs. Animals: Twenty‐five critically ill dogs and 25 healthy age‐ and sex‐matched control dogs. Methods: Prospective observational study. Urine was collected from healthy and critically ill dogs, and urine concentrations of epinephrine, norepinephrine, metanephrine, and normetanephrine were measured by high‐performance liquid chromatography with electrochemical detection. Urinary catecholamine and metanephrine : creatinine ratios were calculated and compared between groups. Results: Urinary epinephrine, norepinephrine, metanephrine, and normetanephrine : creatinine ratios were higher in critically ill dogs when compared with a healthy control population (P= .0009, P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Conclusions and Clinical Importance: Illness has a significant impact on urinary catecholamines and their metabolites in dogs. Further investigation of catecholamine and metanephrine concentrations in dogs with pheochromocytomas is warranted to fully evaluate this test as a diagnostic tool; however, the findings of this study suggest that the results may be difficult to interpret in dogs with concurrent illness.     

Adjuvant medical therapy provides no therapeutic benefit in the treatment of dogs with low‐grade mast cell tumours and early nodal metastasis undergoing surgery

Lymph node (LN) metastasis is a negative prognostic factor in dogs with cutaneous mast cell tumours (cMCTs). While elective lymphadenectomy of metastatic LNs improves outcome, the benefit of adjuvant medical therapy in dogs with early metastatic (HN2) LNs is debated. The aim of this retrospective multicentre study was to evaluate the therapeutic benefit of adjuvant medical therapy following surgical removal of the primary low‐grade cMCT (Patnaik grade 1‐2 and Kiupel low‐grade) and lymphadenectomy of HN2 LNs by analysing survival rates and patterns of recurrence. Seventy‐three dogs were included: 42 received adjuvant medical treatment (chemotherapy and/or kinase inhibitors), and 31 did not. The median follow‐up time for medically treated dogs was 619 days: two experienced local recurrence, three nodal relapse and four distant relapse. For dogs undergoing surgery only, the median follow‐up time was 545 days. None of them experienced local recurrence, nodal, or distant relapse. Time to progression was significantly shorter in dogs receiving adjuvant medical treatment (P = .021). A similar tendency was observed for overall survival (P = .056). The current study shows that dogs with low‐grade cMCTs, that undergo surgical excision of the primary tumour and elective lymphadenectomy of the HN2 regional LN harbour a good prognosis. The use of adjuvant medical treatment in these dogs does not seem to provide any benefit in terms of progression and survival.     

Hematology and Serum Biochemistry of Feline Immunodeficiency Virus-Infected and Feline Leukemia Virus-Infected Cats

Background: Hematological and biochemical values in cats naturally infected by feline immunodeficiency virus (FIV) or feline leukemia virus (FeLV) are not completely documented. Objective: Report differences in laboratory values between FIV‐ or FeLV‐infected and noninfected and between FIV‐ and FeLV‐infected cats. Animals: Three thousand seven hundred and eighty client‐owned cats tested for FIV and FeLV. Methods: Retrospective study. Evaluation of clinicopathologic changes in cats with defined FIV and FeLV status and for which laboratory data were available. Results: FIV‐infected cats were more likely to be neutropenic (odds ratio [OR]=3.6, 95% confidence interval [95% CI] 2.1–6.2, P < .0001) and had lower serum activities of aspartate aminotransferase and glutamate dehydrogenase than control cats; serum total protein (8.1 ± 1.1 versus 7.6 ± 1.3 g/dL, P < .001) and γ‐globulin concentrations (2.2 ± 1.1 versus 1.7 ± 1.3 g/dL, P < .001) were higher than in uninfected cats. Compared with controls, FeLV‐infected cats had a higher risk of anemia (OR = 3.8, 95% CI 2.4–6.0, P < .0001), thrombocytopenia (OR = 5.0, 95% CI 3.0–8.4, P < .0001), neutropenia (OR = 3.6, 95% CI 2.1–6.1, P < .0001), lymphocytosis (OR = 2.8, 95% CI 1.6–4.8, P= .0002), and lower erythrocyte counts (6.13 ± 2.95 × 10³ versus 8.72 ± 2.18 × 10³/μL, P < .001), thrombocyte counts (253.591 ± 171.841 × 10³ versus 333.506 ± 156.033 × 10³/μL, P < .001), hematocrit (28.72 ± 12.86 versus 37.67 ± 8.90%, P < .001), hemoglobin and creatinine concentration. Conclusions and Clinical Importance: Hematologic abnormalities are common in FeLV‐infected but not in FIV‐infected cats. Clinicopathologic abnormalities are less frequent in FIV‐infected cats and might reflect an unspecific immunologic response.     

The Cardiac Biomarker NT-proBNP Is Increased in Dogs with Azotemia

Background: Amino‐terminal probrain natriuretic peptide (NT‐proBNP) has been proposed as a useful biomarker for heart disease in dogs. In humans, decreased glomerular filtration rate (GFR) increases NT‐proBNP. Objective: To investigate whether decreased GFR as indicated by plasma creatinine concentration is associated with increased NT‐proBNP in dogs without heart disease. Animals: Four groups of dogs: healthy (n= 39), azotemic (n= 36), heart disease (n= 37), and congestive heart failure (CHF) (n= 7) presented to 2 teaching hospitals. Methods: Prospective observational cohort study. Plasma creatinine concentration and NT‐proBNP were measured in every dog. Nonparametric tests were used to compare the differences among groups. The median and actual results for each group were compared with the manufacturer's recommended and previously published suggestions for cut‐off values for diagnosis of heart disease. Results: Median (range) plasma creatinine concentration was 1.47 (1.06–1.70), 4.36 (1.74–15.6), 1.22 (0.69–1.91), and 1.45 (0.63–1.64) mg/dL and median (range) NT‐proBNP was 118 (2–673), 556 (37–1,819), 929 (212–5,658), and 3,144 (432–5,500) pmol/L for the healthy, azotemic, heart disease, and CHF groups, respectively. Pair‐wise comparison indicated a significant difference among all groups for NT‐proBNP (P≤ .049). Plasma creatinine concentration was significantly higher in the azotemic group compared with other groups (P < .001) but there was no significant among other groups. Application of 3 recommended cut‐off values led to misclassification of dogs with azotemia as having heart disease. Conclusions: Azotemia results in NT‐proBNP being increased to concentrations reported as diagnostic of heart disease or heart failure in dogs. Care should be employed when interpreting the results of NT‐proBNP in patients with known or possible increased plasma creatinine concentration.