A Mucosal Apposition Technique for Ureteroneocystostomy After Renal Transplantation in Cats

Renal transplantation is a successful treatment for terminal renal failure in cats. However, in the initial clinical study, there was a frequent occurrence of obstruction of the implanted ureter at the bladder wall or stoma. This resulted in the use of a modified "drop-in" technique that had proved effective in the prevention of obstruction in five normal cats. When applied to renal transplant recipients, ureteral obstruction was reduced, but continued to occur. The modified "drop-in" technique was abandoned and replaced with a technique that apposed the cut edge of the ureteral mucosa to the torn edge of the bladder mucosa. This technique is recommended as it has prevented ureteral obstruction in six successive cases. Prevention of ureteral obstruction, and the required corrective surgery, markedly reduces patient morbidity and mortality, length of hospitalization, and expense to the client.     

Hypophosphatemia in Cats After Renal Transplantation

Objective— To report the prevalence of hypophosphatemia after renal transplantation in a historical cohort of cats. Design— Case series. Animals— Cats (n=86) that received a renal allograft. Methods— Medical records (January 200–June 2006) were reviewed. Signalment, clinical signs, pre‐ and postoperative diet, pre‐ and postoperative clinicopathologic variables, renal histopathology, and outcome were retrieved. Prevalence, onset, duration, treatment and associated clinical signs of hypophosphatemia were recorded. A χ² test was used to compare hemolysis frequency between cats with normal serum phosphorus concentration or a single spurious low serum phosphorus concentration for <24 hours duration (group 1) and confirmed hypophosphatemia for >24 hours (group 2). A Cox proportional hazards model was used to evaluate the effects of hypophosphatemia on survival while controlling for other potentially confounding variables (age, sex, weight, body condition score, and pre‐ and 24 hours postoperative clinicopathologic variables). Results— Eighty‐six cats (mean age, 7.7 years) were identified. Hypophosphatemia occurred in 32 cats (37%), with a median onset of 2 days and median duration of 4 days. Treatment was initiated in 48 (56%) of hypophosphatemic cats. Survival and hemolysis frequency was not significantly different between groups, and no risk factors were identified. Conclusion— Hypophosphatemia occurs in cats after renal transplantation and does not affect survival. Clinical Relevance— The clinical importance of hypophosphatemia in renal transplant recipients remains unknown.     

Diagnostic Predictors of Complications and Survival after Renal Transplantation in Cats

OBJECTIVE: To identify preoperative diagnostic results that predict postoperative complications and survival in feline renal-transplant recipients. STUDY DESIGN: Retrospective clinical study. ANIMALS: Sixty-one feline renal allograft recipients. METHODS: Medical records for 61 consecutive cats that underwent renal allograft transplantation between January 1, 1996, and December 1, 1999, were reviewed. Age, diagnosis, body weight, body condition score, preoperative medical treatment, systolic blood pressure, packed cell volume, biochemical parameters at admission and at the time of surgery, postoperative complications, and postoperative survival were recorded. Associations of preoperative data with the occurrence of postoperative complications were determined using logistic regression. Postoperative survival was graphed using a Kaplan-Meier cumulative-survival plot. Associations of covariates with postoperative survival were analyzed using Cox proportional hazards analysis. RESULTS: Two parameters were significantly associated with occurrence of postoperative central nervous system (CNS) disorders: blood urea nitrogen concentration (odds ratio = 1.083; 95% CI = 1.018 to 1.148) and serum creatinine concentration (odds ratio = 1.8; 95% CI = 1.413 to 2.187) at the time of surgery. Postoperative survival 6 months after transplantation was 59%, though 3-year survival remained at 42%. Of all covariates investigated, only recipient age (relative hazard = 1.183; 95% CI = 1.039 to 1.334) was significantly associated with survival. CONCLUSION AND CLINICAL RELEVANCE: Standard measures of preoperative renal dysfunction do not predict postoperative survival in cats after renal transplantation, although an increase in the degree of preoperative azotemia is associated with an increased risk of CNS disorders after surgery. Increased recipient age is associated with decreased survival after renal transplantation.     

Possible Hemolytic Uremic Syndrome in Three Cats After Renal Transplantation and Cyclosporine Therapy

OBJECTIVE: To describe the clinical history of 3 cats with possible hemolytic uremic syndrome (HUS) after renal transplantation. STUDY DESIGN: This case series documents historical findings, physical examination findings, clinical pathologic features, necropsy and histopathologic findings of 3 cats with possible HUS. RESULTS: Two cats had chronic renal failure; 1 cat had acute renal failure secondary to ethylene glycol toxicity. A renal transplant was performed in each of the 3 cats without obvious problems. Complications that would support a diagnosis of HUS, including anemia, thrombocytopenia, and azotemia occurred within 24 hours in 1 cat, within 8 days in a second cat, and 2 months after transplantation in the third cat. In 2 cats, HUS was likely secondary to cyclosporine immunosuppression. In the third cat, HUS may have been secondary to allograft rejection. Renal biopsies from all 3 cats were suggestive of HUS. CONCLUSION AND CLINICAL RELEVANCE: In human beings, HUS in transplant recipients may occur secondary to immunosuppressive drugs, vascular rejection, or recurrence of original disease. Graft loss occurred in all 3 cats in this study and the mortality rate was 100%. Clinicians caring for these patients need to be aware of this disorder because early recognition and treatment is critical in the management of post-transplant HUS.     

Survival,Complications, and Analysis of Risk Factors after Renal Transplantation in Cats

Objective— To report survival, complications, and analyze risk factors for survival after renal transplantation (RTr) and cyclosporine‐A based immunosuppression in cats. Study Design— Historical cohort. Animals— Cats (n=60). Methods— Data were obtained from medical records of cats that had RTr. Influence of various perioperative factors on survival and complications was evaluated. Occurrence of postoperative hypertension (HT), seizures, infection, acute allograft rejection (AR), congestive heart failure (CHF), and delayed graft function (DGF) was evaluated. Results— Survival to discharge after RTr was 77.5%. Estimated median overall survival time was 613 days; 6 month and 3 year overall survival proportions were 65% and 40%, respectively. Age, weight, and blood pressure influenced overall survival. Increased preoperative creatinine concentration, blood urea nitrogen, postoperative creatinine concentration, left ventricular wall thickness, and reduced creatinine reduction ratio influenced survival until discharge. HT was identified in 9/30 (30%) cats; however, no risk factors were identified, nor was HT related to seizures. AR was identified in 8/62 (13%) grafts. Infection, predominantly bacterial, developed in 22/60 (37%) cats. CHF occurred in 7/60 (12%) cats before discharge. Cats experiencing CHF were younger, had an increased incidence of heart murmurs, and poor initial graft function. DGF was identified in 5 cats and seizures in 2 cats. Conclusions— RTr affords cats with CRF long survival times. Older cats and cats with severe azotemia, HT, and cardiovascular disease may have increased mortality after RTr. Complications after RTr were common. Clinical Relevance— Clinicians should be aware of these risk factors when recommending feline RTr.     

30例猫下泌尿道疾病临床诊断与治疗的分析

猫下泌尿道疾病是对猫泌尿系统发生的一种或多种疾病的综合性描述,是猫最常见的疾病之一,多数情况下不能自愈,一旦发病往往不断加重,不仅累及泌尿系统原发病灶,而且常引起其他组织器官的损害,甚至以死亡归转。通过对30例猫下泌尿道病例诊断和治疗过程的统计整理与分析,系统地梳理了猫下泌尿道疾病的诊断和治疗方法,以期对兽医临床工作者有所帮助。     

Colopexy as a Treatment for Rectal Prolapse in Dogs and Cats: A Retrospective Study of 14 Cases

Colopexy was evaluated as a treatment for recurrent rectal prolapse in eight dogs and six cats. Cases included in the study were from two institutions; the University of Pennsylvania School of Veterinary Medicine and the University of Tennessee College of Veterinary Medicine. Two different colopexy techniques were used: A simple suture technique was used in two cats and four dogs (University of Pennsylvania), and an incisional technique was used in four cats and four dogs (University of Tennessee). Rectal prolapse had not recurred in any of the 14 animals at the time of follow-up. Incisional dehiscence occurred in two animals and in one instance may have been related to the colopexy procedure. Infection at the colopexy site, secondary to suture penetration of the colonic lumen, is a potential complication of this procedure. Colopexy, using either surgical technique described here, was effective in preventing recurrent rectal prolapse.     

Permanent Pacemaker Implantation for Treatment of Symptomatic Bradycardia in Two Cats

Two cats with bradycardia and syncope were treated by permanent pacemaker implantation. Cat 1 had multiple episodes of syncope intermittently over a 10-month period and then multiple episodes within 24 hours; cat 2 had episodes of collapse over a 3-month period. Clinical signs included disorientation, vocalization, and collapse. High-grade second-degree AV block was recorded in both cats, with left and right bundle branch block in cat 1 and right bundle branch block in cat 2. Neither responded to pharmacologic therapy. In cat 1, an epimyocardial electrode was implanted into the left ventricular apex by a ventral abdominal transdiaphragmatic surgical approach. Cat 2 had a permanent smooth endocardial pacing lead introduced into the fight external jugular vein and directed into the right ventricular apex. Both cats were clinically normal within three days after implantation. Complications in cat 2 included failure of pacemaker capture, endocardial lead dislodgement, and pulse generator pocket seroma. Cats with symptomatic bradycardia caused by second-degree and third-degree AV block can be effectively treated by pacemaker implantation by surgical endomyocardial or perivenous endocardial lead placement.     

Oxalate Nephrosis and Renal Sclerosis After Renal Transplantation in a Cat

A 10-year-old castrated domestic shorthair cat received two renal allografts, 14 days apart, for the treatment of chronic renal failure. Oxalate nephrosis developed in both allografts, and they became nonfunctional. During the transplantation period, the cat was not exposed to exogenous sources of oxalate, and there was no evidence of primary type 2 hyperoxaluria before surgery. Urologic surgery, in particular renal transplantation, has been identified as a factor that can precipitate renal failure in human patients with decompensated renal function and hyperoxaluria. If hyperoxaluria was present before surgery in this cat, it was most likely caused by increased absorption or decreased metabolism of dietary oxalate.     

Ureteral papilla implantation as a technique for neoureterocystostomy in cats

OBJECTIVE: To evaluate ureteral papilla implantation for neoureterocystostomy in cats. STUDY DESIGN: Experimental study. ANIMALS: Five domestic shorthair cats. METHODS: The ureteral papilla was resected and the ureter isolated to the level of the renal hilus. The ureter was reimplanted into the apex of the bladder and the contralateral kidney was removed. Serum creatinine concentrations were measured daily for 7 days, then every other day from days 7-14, then every 3rd day until day 35. Ultrasound examination (once during the first 4 days, then again on day 35) and intravenous pyelography (day 35) were performed to assess ureteral patency. Histologic examination of the anastomosis was performed on day 35. RESULTS: Serum creatinine concentration remained within reference range for all cats except for a transient (<24 hour) increase (2.2, 2.3, and 3.6 mg/dL respectively) in 3 cats. Ultrasound examination and intravenous pyelography revealed no evidence of ureteral obstruction. Histologic examination revealed complete mucosal epithelialization of the anastomosis, moderate inflammation localized to residual suture material, and no evidence of vascular compromise of the ureteral papilla. CONCLUSION: Implantation of the ureteral papilla is a viable technique for neoureterocystostomy in cats. CLINICAL RELEVANCE: Advantages of ureteral papilla neoureterocystostomy include the technical ease of suturing the ureteral papilla, reduced risk of ureteral obstruction because sutures are not placed directly within the ureteral lumen and a more secure anastomosis because a complete 2-layer closure is performed.     

Thrombocytopenia in Cats: A Retrospective Study of 41 Cases

The prevalence of feline thrombocytopenia (<200,000 platelets/L) at North Carolina State University, College of Veterinary Medicine Teaching Hospital, from January 1985 to March 1990, was 1.2% (41/3300). Cats were divided into six categories based on clinical diagnoses: 29% (12/41) had infectious disease, 20% (8/41) had neoplasia, 7% (3/41) had cardiac disease, 2% (1/41) had primary immune-mediated disease, 22% (9/41) had multiple diseases, and 20% (8/41) had disorders of unknown etiology. The mean platelet count for all thrombocytopenic cats was 52,000/μL ± 46,000/μL (1 SD) with a range of 1000–190,000/μL. No significant differences were found between groups with respect to platelet count, packed cell volume, or white blood cell count, though anemia and leukopenia were common among the cats as a whole. Bleeding disorders (hemorrhage or thrombosis) were observed in 29% (12/41) of thrombocytopenic cats and were more likely to be associated with neoplasia, cardiac disease, and platelet counts less than or equal to 30,000/μL. Disseminated intravascular coagulopathy was diagnosed in 12% (5/41) of the cats. Infections and/or neoplasia affecting the bone marrow were the most common diseases associated with thrombocytopenia. Feline leukemia virus and myeloproliferative neoplasia accounted for approximately 44% (18/41) of the specific diagnoses in thrombocytopenic cats. (Journal of Veterinary Internal Medicine 1993; 7:261–265. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Micro Total Hip Replacement for Dogs and Cats: Surgical Technique and Outcomes

Objective: To describe the surgical technique for the micro total hip replacement (Micro THR) system and report clinical outcomes. Study Design: Prospective study. Animals: Dogs (n=49) and cats (n=8) with coxofemoral arthropathy. Methods: Small breed dogs and cats with coxofemoral arthritis were enrolled for Micro THR. Patient data were recorded. Implant positioning and cement mantle quality were evaluated radiographically. Orthopedic examinations and client interviews were used to assess outcome. Results: Micro THR was performed unilaterally (40 dogs, 8 cats) and staged bilaterally (9 dogs) to resolve pain associated with osteoarthritis or trauma. Mean body weight was 7.2 kg. Postoperative complications included prosthesis luxation (9), cup aseptic loosening (1), and sciatic neurapraxia (1). Mean radiographic follow up was 96.1 weeks; 10 joints were followed for ≥3.0 years. Sixty of the 66 (91%) Micro THRs had excellent outcomes. Two dogs (<2.75 kg) were too small for the prosthesis and 4 dogs with unmanageable luxation had explantation. Conclusions: Micro THR is considered a satisfactory procedure for management of small breed dogs and cats with coxofemoral disease unresponsive to medical management. Clinical Relevance: Micro THR is a viable option to treat disabling disorders of the hip. More than 170 cat and small dog breeds, and many mixed breeds, could benefit from Micro THR surgery.     

En Bloc Ovariohysterectomy as a Treatment for Dystocia in Dogs and Cats

En bloc ovariohysterectomy, a technique that involves ovariohysterectomy before hysterotomy and removal of the neonates, was performed on 63 animals (37 dogs and 26 cats). Intraoperative complications were limited to 1 cat that bled excessively during surgery and was later found to have a clotting disorder. Postoperative complications included anemia that required blood transfusion in 3 cats, uroperitoneum in 1 dog, and death in 1 cat. The rate of neonatal survival (75% for dogs and 42% for cats) was similar to that documented by previous studies of medical and surgical management of dystocia. We concluded that en bloc ovariohysterectomy is a safe and effective alternative to cesarean section for surgical treatment of dystocia in dogs and cats.     

Degenerative Left Shift as a Prognostic Tool in Cats

Background

A degenerative left shift (DLS) is reported to be a poor prognostic indicator in dogs and cats. Limited data in dogs and no studies in cats have been published to investigate this claim.

Hypothesis/Objectives

To characterize the feline population affected by DLS and to determine if the presence and severity of DLS are associated with increased risk of euthanasia or death.

Animals

One hundred and eight cats with DLS (cases) and 322 cats without DLS (controls) presented to the University of California, Davis Veterinary Medical Teaching Hospital between April 1, 1995 and April 1, 2010.

Methods

Retrospective case–control study. All cases had a CBC performed within 24 hours of presentation in which immature granulocytic precursors exceeded mature neutrophils. Controls were matched by year of presentation and primary diagnosis. Survival analysis was used to determine risk of death or euthanasia from DLS and other potential predictors of outcome.

Results

Cases were more likely to die or be euthanized in hospital compared to controls (60/108 [56%] versus 107/322 [33%]). DLS was a significant predictor of death or euthanasia in hospitalized cats in both univariate and multivariate analysis (hazard ratio, 1.57; 95% confidence interval, 1.13–2.18). Trend analysis showed an increasing trend in the hazard of euthanasia or death with increasing severity of DLS.

Conclusions and Clinical Importance

Cats with DLS are 1.57 times more likely to die or be euthanized in hospital than cats without DLS. In addition, increasing severity of DLS is associated with increased likelihood of death or euthanasia.     

Endoscopic Aspiration of Intestinal Contents in Dogs and Cats: 394 Cases

Medical records from 394 dogs and cats that had endoscopic aspiration of intestinal contents for identification of Giardia sp. trophozoites were retrospectively reviewed. The most common indications for endoscopy were chronic vomiting (152), chronic diarrhea (108), chronic vomiting and diarrhea (58), and acute vomiting (33). Metronidazole had been previously administered to 111 animals (28.2%), and to 58.6% of those with chronic diarrhea. Six aspirate samples (1.5%) were positive for Giardia sp. In 3 of these cases a single fecal flotation identified Giardia cysts before endoscopy. The authors conclude that intestinal aspiration in animals from a primarily referral population undergoing upper gastrointestinal endoscopy rarely identifies Giardia and should not be routinely performed. However, animals in which zinc sulfate flotation was not performed or those that did not previously receive metronidazole might benefit from intestinal aspiration.