Disseminated Intravascular Coagulation in Dogs: Review of the Literature

Diagnosis of Disseminated Intravascular coagulation (DIC) is controversial in both human and veterinary medicine. This article reviews the available literature in human and veterinary medicine regarding the etiology, pathophysiology, and diagnosis of DIC with emphasis on the diagnosis of DIC in dogs. Controversy surrounding the diagnosis of DIC arises from the complex nature of the disease itself, in addition to the absence of a consensus strategy for laboratory testing. The available literature indicates that dogs diagnosed with DIC possessed various hemostatic function testing abnormalities, typically possessed an underlying disease that predisposed to DIC, but may or may not have had clinically identifiable hemorrhage or thrombosis. Additionally, the hemostatic function testing utilized in diagnosis is not uniform. Generalizations about the usefulness of individual assays or diagnostic strategies cannot be formulated because of the marked diversity of the types of cases studied, as well as the small number of cases reported in the literature. (Vet Emerg & Crit Care, 1998; 8: 29–45)     

Disseminated intravascular coagulation in cats

The purpose of this study was to describe the clinical characteristics of cats with disseminated intravascular coagulation (DIC), including associated diseases and hemostatic abnormalities, and to identify risk factors for death and treatments that potentially altered outcome. Medical records for cats with DIC from 1990-2004 were evaluated retrospectively. Inclusion criteria were the presence of an underlying disorder associated with DIC and either postmortem examination findings of intravascular fibrin deposition or thrombosis, or both of 2 or more organs or coagulation profiles that meet 3 of 5 criteria: prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), presence of fibrin degradation products (FDP), low plasma fibrinogen (FIB) concentration, and thrombocytopenia (<160,000 platelets/microL). Signalment, historical data, clinical findings, clinicopathologic data, underlying disorders, management, and outcome were recorded. Forty-six cats fulfilled the criteria for DIC. Cats ranged in age from 7 weeks to 17 years (median, 9 years). Hemorrhage was noted in 7 of 46 cats (15%). Three of 46 cats (7%) survived, whereas 43 of 46 (93%) died or were euthanized. The most common underlying disorders were lymphoma, other forms of neoplasia, pancreatitis, and sepsis. There was no association detected between outcome and signalment; underlying disease; hemorrhage; abnormalities in aPTT, FIB, FDPs, platelet count; transfusion of blood products; and heparin therapy. However, the median PT of nonsurvivors was more prolonged than in survivors (P < .005). DIC in cats can result from a variety of neoplastic, infectious, and inflammatory disorders, and is associated with a high case fatality rate.     

SARS,possible zoonosis in the area of conflict of pathogenic coronaviruses of animals

Severe acute respiratory syndrome (SARS) is an emerging disease, which was first recognized in Guangdong Province, China, in November 2002. In the meantime, SARS has been recognized in patients on all five continents. A novel coronavirus, which is not related to the hitherto known coronaviruses, has been proven to be associated with the disease. Our genomic analyses strongly suggest that the new SARS-coronavirus did not emerge through mutation or recombination and that it has probably been transmitted from a so far not identified animal species to humans. Therefore, it is most likely that SARS virus is a zoonotic agent. A broad body of knowledge originating from research in veterinary medicine indicates that development of vaccines against the SARS-coronavirus may be problematic. The potential danger of such vaccines should not be neglected during the process of vaccine development.     

Nosocomial infections.

Nosocomial infections and antimicrobial resistance are topics that have been intensely studied in human medicine because of their significant impact on human health. In recent years, concerns have been raised that the use of antibiotics in veterinary medicine, animal husbandry, and agriculture may be contributing to the development of resistance in common bacterial species affecting human beings. Although there is inadequate proof at this time that the resistance is transmitted from animals to people, if antibiotics continue to be used indiscriminately in veterinary medicine, veterinarians may find themselves facing regulations restricting the use of some antibiotics. Nosocomial infections have been reported in veterinary medicine and are likely to increase in prevalence with the increase in intensive care practices in many hospitals. Prolonged hospitalization and the use of invasive devices and procedures increase the risk of nosocomial disease. As in human medicine, organisms isolated in the nosocomial infections reported in veterinary patients have an increasingly broad spectrum of antimicrobial resistance. Despite these findings, the use of empiric and prophylactic antibiotic therapy is still widespread in veterinary medicine. Nosocomial infections and antimicrobial resistance may have a serious impact on the future of [table: see text] veterinary medicine, because the cost and ability to treat our patients may be affected by the loss of access to or effectiveness of antimicrobial drugs. Despite the millions of dollars spent on research to reduce the incidence of nosocomial infections in human patients, the strategies that have consistently proven successful are simple and inexpensive to implement. The most important factor in preventing nosocomial infections is improving the hygiene practices of health care providers. Hand-washing or the use of disposable gloves can dramatically reduce the transmission of bacteria between patients. Aseptic technique should be used in the placement and management of all invasive devices. All staff members should be educated on the risks and symptoms associated with nosocomial infections so that cases can be detected early and treated appropriately. We in the veterinary profession have the opportunity to learn from the experiences of the human medical profession and can take steps to prevent the escalation of nosocomial infections and their impact on our profession.     

Feline hyperthyroidism: spectrum of clinical presentions and response to carbimazole therapy

OBJECTIVE: To determine the spectrum of clinical presentations of hyperthyroidism in cats and response to carbimazole therapy by analysis of historical, clinical and laboratory data. DESIGN: A prospective clinical study involving client-owned cats presenting to a private veterinary practice in Australia. PROCEDURE: Twenty-five cats diagnosed as hyperthyroid during a 23-month period participated in the study with owner consent. Therapy with carbimazole was instituted and revisits were scheduled 2, 6 and 13 weeks after diagnosis. The cats were physically examined and underwent haematological and serum biochemical testing at each revisit. Owners were also asked to assess clinical signs in their cats in the periods between veterinary examinations. Cats with underlying renal disease were managed by alterations or cessation of carbimazole therapy. RESULTS: A high prevalence of lethargic or inappetent cats without detectable underlying nonthyroidal illness was found. There was also a high prevalence of cats less than 10-years-old and cats in good body condition. Fourteen cats treated with carbimazole and monitored for 13 weeks responded favourably to therapy. Side-effects were minor and uncommon. Cats with underlying renal disease that became apparent during the study, responded well to alterations or cessation of carbimazole therapy. CONCLUSION: The trend towards more subtle clinical presentations of hyperthyroid cats reported previously continued in this study. The findings of the current study do not appear to support the traditional view of hyperthyroid cats as being old, hyperactive, hungry and thin. Carbimazole therapy was found to decrease the prevalence of almost all clinical abnormalities in 14 cats and side-effects were minor and uncommon. This study demonstrates the usefulness of medical management of hyperthyroidism in the cat when radioiodine therapy is not possible due to renal compromise or other factors.     

Management of anorexia in the cat.

One of the most frequent motivations for seeking veterinary attention for a cat is when the owner recognises a loss of normal appetite in his pet. The medical term for a lack of appetite for food is 'anorexia', and it may be partial or complete. While anorexia is a common manifestation of disease, the mechanisms underlying decreased food intake are complex and not completely understood. The regulation of appetite involves interaction of external stimuli with signals from the gastrointestinal tract and central nervous system. Aberrations in any of the internal control systems for hunger and satiety, or changes in external factors such as diet or feeding environment, can result in partial or total anorexia. The challenge for the practitioner is not only to diagnose and treat the underlying condition, but to recognise at what point inadequate food intake has or will impinge on the patient's nutritional status to the extent that it might deleteriously affect clinical outcome. It is also important to bear in mind the significance that the patient's appetite and food intake has for the cat owner in his overall perception of his pet's condition and quality of life.     

Paradigms for pharmacologic use as a treatment component in feline behavioral medicine

Veterinary behavioral medicine remains an under-supported, under-appreciated, and under-taught specialty within veterinary medicine. Neuropsychopharmacology is the aspect that has provided the field with the most scientific legitimacy, but is also one of the most hotly debated. Paradigms for use of pharmacologic intervention include firstly ruling out any underlying medical cause. If a behavioral diagnosis can be made, treatment with psychotropic medication may be considered, although their use is most effective as part of an integrated treatment program that includes behavior modification. Used without an understanding of the mechanism of action, pharmacologic intervention may only blunt or mask behavior without altering processes or environments that produced the behavior. This paper reviews specific drugs, mechanism of action of those drugs, and relevant uses are reviewed for cats. Future advances in treatment in veterinary behavioral medicine will be pharmacological and neurophysiological. As the field of veterinary behavioral medicine expands, its paradigm will enlarge to include routine combination therapy and the implementation of neuropharmacological intervention as a diagnostic tool.     

Management of atrial fibrillation.

Atrial fibrillation (AF) is the most common clinically important arrhythmia in veterinary medicine. Electrical cardioversion of AF to sinus rhythm is feasible, but pharmacologic rate control is an effective and achievable treatment strategy for most veterinary patients. Recent human trials suggest that rate control and rhythm control are almost equally beneficial. Nevertheless, AF can be a challenging arrhythmia to manage, because most affected animal shave numerous other concurring problems associated with the underlying heart disease that dictate or influence the clinician's choice of treatment and monitoring strategy for each patient.     

Causes of respiratory failure.

There are many causes of respiratory failure in veterinary patients. Assessment of oxygenation is imperative for the diagnosis and monitoring of these patients. Oxygen therapy should be instituted when hypoxemia is diagnosed to prevent tissue hypoxia, end-organ damage, and death. Methods of administering oxygen include commercial oxygen cages, mask oxygen, nasal cannulation (for dogs), and intubation. Mechanical ventilation is an option in many referral hospitals for patients who are severely hypoxemic and are not responding to inspired oxygen concentrations achieved with other methods of oxygen administration. One rule of thumb used to assess need for mechanical ventilation is a PaO2 of less than 50 mm Hg despite aggressive oxygen therapy, or a PaCO2 of greater than 50 mm Hg despite treatment for causes of hypoventilation. A mechanical ventilator has the ability to vary the FiO2 by increments of one, from 21% to 100% (0.21-1) oxygen in inspired gas. Positive end-expiratory pressure (PEEP) is also available on most ventilators. PEEP allows the alveoli to remain open on expiration, allowing gas exchange to occur in both inspiration and expiration. PEEP also helps diseased alveoli to inflate, increasing the available surface area for gas exchange and improving arterial blood oxygen tension. Because patients requiring mechanical ventilation have severe respiratory failure that did not respond to conventional oxygen therapy, the prognosis is guarded for most of these patients unless ventilation is instituted due to primary hypoventilation and lung parenchyma is normal. Hypoxemia caused by respiratory failure is a common problem in small animal veterinary patients. Assessment of blood oxygenation and continual monitoring of respiratory rate and effort are essential in management of these patients. Oxygen therapy should be instituted if hypoxemia is diagnosed. The prognosis depends on the underlying disease process and response to treatment with an enriched oxygen environment.     

Plasma D-dimer for the diagnosis of thromboembolic disorders in dogs.

D-dimer is formed during thrombus formation when factor XIIIa crosslinks the terminal D-domains of fibrin. The D-dimer epitope is exposed when the thrombus is lysed by plasmin. Thus, D-dimer represents both thrombin and plasmin activation and is specific for fibrinolysis. D-dimer concentrations are increased in dogs with DIC or other thromboembolic disorders, but because D-dimer is an indicator of physiologic or pathologic fibrinolysis, values are elevated in other conditions associated with fibrinolysis, including orthopedic surgery, neoplasia, and internal hemorrhage. It can be used as an ancillary test for the diagnosis of DIC but is not recommended as a sole test for this purpose. D-dimer has the potential to be a useful laboratory test for the detection of pulmonary thromboembolism in dogs. Further studies are needed to determine the appropriate applications for this test in veterinary patients to aid in clinical decision making, treatment, and patient care.     

Clinical findings and progression of 10 cases of equine ulcerative keratomycosis (2004–2007)

Ulcerative keratomycosis is a serious sight‐threatening disease of horses and the veterinary literature is replete with cases of poor visual outcome following this condition. During a 3 year period, 10 horses were treated for confirmed keratomycosis at the Veterinary Teaching Hospital (VTH) of the University of Cordoba (Spain). Ulcerative keratomycosis accounted for an average of 8.62% of the total equine ophthalmic admissions during this time and an average of 33.3% of horses were diagnosed with infectious keratitis. Fungi were diagnosed using cytology (n = 4) and/or culture (n = 8) and histopathology (n = 1). Aspergillus sp. was the most commonly isolated fungus. Medical therapy alone or combined medical and surgical treatment was utilised for therapy depending on the clinical condition. Miconazole 1% was the most common topical antifungal therapy employed. Median duration of treatment was 73.12 days. Records were evaluated to determine visual outcome and globe survival.     

Clinical presentation,auscultation recordings,ultrasonographic findings and treatment response of 12 adult cattle with chronic suppurative pneumonia: case study

Auscultation is considered the critical component of the veterinary clinical examination for the diagnosis of bovine respiratory disease but the accuracy with which adventitious sounds reflect underlying lung pathology remains largely unproven. Modern portable ultrasound machines provide the veterinary practitioner with an inexpensive, non-invasive tool with which to examine the pleural surfaces and superficial lung parenchyma. Simultaneous recording of sounds overlying normal lung and defined pathology allows critical assessment of auscultated sounds in the same animal removing confounding factors such as respiratory rate and thickness of the chest wall (body condition). Twelve cows, referred to the University of Edinburgh Veterinary School, were diagnosed with chronic suppurative pneumonia and enrolled into this prospective study to record and monitor lung sounds, ultrasonographic findings, and response to a standardised antibiotic treatment regimen.Most cows (8/12) had a normal rectal temperature on presentation but all cows had received antibiotic therapy at some time in the previous two weeks and six animals were receiving antibiotic treatment upon admission. All cattle were tachypnoeic (>40 breaths per minute) with frequent and productive coughing, halitosis, and a purulent nasal discharge most noticeable when the head was lowered. Ultrasonographic examination of the chest readily identified pathological changes consistent with severe lung pathology subsequently confirmed as chronic suppurative pneumonia in four cows at necropsy; eight cows recovered well after antibiotic treatment and were discharged two to six weeks after admission. It proved difficult to differentiate increased audibility of normal lung sounds due to tachypnoea from wheezes; coarse crackles were not commonly heard. In general, sounds were reduced in volume over consolidated lung relative to normal lung tissue situated dorsally. Rumen contraction sounds were commonly transmitted over areas of lung pathology.Trueperella (formerly Arcanobacterium) pyogenes was isolated from three of four lung tissue samples at necrospy. Treatment with procaine penicillin for 42 consecutive days resulted in marked improvement with return to normal appetite and improvement in body condition in 8 of 12 cows (67%) where lesions did not extend more than 10-15 cm above the level of the olecranon on both sides of the chest.     

Delivery of growth factors using gene therapy to enhance bone healing

OBJECTIVE: To review the delivery of growth factors using gene therapy for enhancing long-bone fracture healing. STUDY DESIGN: Literature review. METHODS: MEDLINE and CAB Abstracts literature search (1980-2004). RESULTS: Non-union and infected non-union are relatively common complications of long-bone fractures in human and veterinary patients. Growth factors are cytokines that regulate many cell functions important in fracture healing. Exogenous growth factors can be delivered to the fracture site as recombinant proteins or using gene therapy. Recombinant human bone morphogenetic protein-2 and -7 (rhBMP-2 and -7), in particular, enhance fracture healing in numerous experimental and clinical studies. Some limitations with use of recombinant proteins may be overcome by use of gene therapy. Gene therapy involves delivery of the growth factor gene to cells at the fracture site using a viral or non-viral vector. The gene is then expressed (protein synthesis) by cells at the fracture site. Delivery of the BMP gene to the fracture site using gene therapy has been evaluated in laboratory animal models of non-union, with favorable results and without complications. CONCLUSION: Delivery of growth factors, particularly members of BMP family, to the fracture site using gene therapy may be a method to enhance fracture healing. Use of this technology may improve the prognosis for patients with long-bone fractures. CLINICAL RELEVANCE: Clinical application of gene therapy could improve the prognosis for human and veterinary patients with long-bone fractures, but has not been evaluated clinically.     

Antiviral therapy for ocular viral disease.

Ophthalmic manifestations of viral disease are commonly encountered in veterinary practice. Although the number of antiviral agents is rapidly increasing, the efficacy of many of these drugs against animal viral pathogens may not be known. Furthermore, some of these newer medications may, in fact. be toxic to animal patients. Continued research on the efficacy of these medications in treating viral diseases of veterinary importance is warranted.A thorough review of the ever-growing body of literature is imperative before instituting any new or unknown antiviral therapy.At this time, feline HSV-1 infections remain the most well understood of the ocular viral infections that veterinary practitioners may be called on to treat. Ironically, the number of antiviral agents proven to be effective in naturally occurring clinical cases of FHV-I remains quite limited. With new medications being investigated, this paucity of information on efficacious antiviral therapeutic agents will hopefully improve.     

Multidrug-resistant E. coli and enterobacter extraintestinal infection in 37 dogs

BACKGROUND: Extraintestinal infections caused by multidrug-resistant (MDR) Escherichia coli and Enterobacter are becoming more common in veterinary medicine. OBJECTIVE: To generate hypotheses for risk factors for dogs acquiring extraintestinal infection caused by MDR E. coli and Enterobacter, describe antimicrobial resistance profiles and analyze treatment and clinical outcomes. ANIMALS: Thirty-seven dogs diagnosed with extraintestinal infection caused by MDR E. coli and Enterobacter spp. between October 1999 and June 2006. METHODS: Retrospective case series assembled from hospital records data, including clinical history before 1st MDR isolation and treatment outcome. Identity and antimicrobial susceptibility profiles were confirmed by standard microbiological techniques for 57 isolates. RESULTS: Most dogs had an underlying disease condition (97%), received prior antimicrobial treatment (87%), were hospitalized for >or =3 days (82%), and had a surgical intervention (57%). The urinary tract was the most common infection site (62%), and urinary catheterization, bladder stasis, or both were common among dogs (24%). Some dogs were treated with high doses of co-amoxyclavulanate (n = 14) and subsequently recovered even though the isolates showed in vitro resistance to this antimicrobial. Other dogs were successfully treated with chloramphenicol (n = 11) and imipenem (n = 2). CONCLUSION AND CLINICAL IMPORTANCE: Predisposing disease condition, any prior antimicrobial use rather than a specific class of antimicrobial, duration of hospitalization, and type of surgical procedure might be risk factors for acquiring MDR extraintestinal infections. Whereas culture and sensitivity results can indicate use of last-resort antimicrobials such as imipenem for MDR infections, some affected dogs can recover after administration of high doses of co-amoxyclavulanate.     

Conventional versus high-flow oxygen therapy in dogs with lower airway injury

Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause. Conventional “low-flow” systems deliver oxygen with a maximum flow rate of 15 L/minute. Traditionally, when an animal’s respiratory status does not improve with conventional oxygen therapy and treatments for underlying disease, options might be limited to either intubation and mechanical ventilation or humane euthanasia. High-flow oxygen therapy (HFOT) has been gaining popularity in veterinary medicine as an alternative route of oxygen supplementation for animals that require support beyond conventional therapy. High-flow oxygen therapy can supply a mixture of air and oxygen via a heated and humidified circuit. It is user friendly and can be used in an environment in which mechanical ventilation is unavailable.This review article is written for emergency doctors and general practitioners who lack access to mechanical ventilation. This article briefly reviews pertinent respiratory physiology, traditional oxygen supplementation techniques, the physiology of HFOT, and the limited evidence available in veterinary medicine regarding the use of HFOT, its applications, and limitations. Guidelines for the use of HFOT are suggested and HFOT is compared to conventional therapy.     

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.     

Cutaneous paraneoplastic syndromes in dogs and cats: a review of the literature

Cutaneous paraneoplastic syndromes are a group of noncancerous dermatoses associated with internal malignancy. Their recognition can facilitate detection and timely treatment of underlying cancer. More than 30 such disorders have been identified in the human scientific literature, whereas only a few are described in veterinary medicine. This may reflect a lower incidence in animals than in people or may be the result of failure to recognize an association between certain skin lesions and neoplasia. Establishing a relationship between a cutaneous disorder and neoplasia can be difficult unless the skin lesions are rare and almost always associated with a particular tumour type, as is the case for most recognized veterinary paraneoplastic dermatoses. Among these are feline paraneoplastic alopecia, feline thymoma-associated exfoliative dermatitis, nodular dermatofibrosis, feminization syndrome associated with testicular tumours, superficial necrolytic dermatitis and paraneoplastic pemphigus. The aetiology of most cutaneous paraneoplastic syndromes has remained elusive in both people and animals.     

Transfusion issues in the cancer patient

Blood transfusions are a lifesaving but transient therapy used to correct deficiencies of blood cells and coagulation factors that occur in cancer patients. Anemia can occur in cancer patients as a result of hemolysis, blood loss, or bone marrow failure. The blood component most commonly recommended for the treatment of anemia is packed red blood cells. Coagulation disorders are common with hemangiosarcoma and diffuse hepatic tumors. Fresh frozen plasma is used as a source for replacement coagulation factors for the treatment of disseminated intravascular coagulation or other cancer-associated coagulopathies. Although thrombocytopenia and neutropenia can be the result of bone-marrow failure from tumor infiltration, chemotherapy, or radiation therapy, these platelets and neutrophils are rarely transfused to veterinary cancer patients. Pretransufsion testing consists of blood typing in cats, and cross matching in dogs and cats if the dog has previously been transfused. Cancer patients receiving transfusions should be monitored on a continual basis during and immediately following the transfusion to enable early identification of an adverse event, allowing the transfusion to be discontinued.