Retrospective evaluation of partial parenteral nutrition in dogs and cats

The purpose of this retrospective study was to evaluate the use of partial parenteral nutrition (PPN) in dogs and cats. The medical records of all dogs and cats receiving PPN between 1994 and 1999 were reviewed to determine signalment, reasons for use of PPN, duration of PPN administration, duration of hospitalization, complications, and mortality. Complications were classified as metabolic, mechanical, or septic. One hundred twenty-seven animals (80 dogs and 47 cats) were included in the study, accounting for 443 patient days of PPN. The most common underlying diseases were pancreatitis (n = 41), gastrointestinal disease (n = 33), and hepatic disease (n = 23). Median time of hospitalization before initiation of PPN was 2.8 days (range, 0.2-10.7 days). Median duration of PPN administration was 3.0 days (range, 0.3-8.8 days). Median duration of hospitalization was 7 days (range, 2-20 days). In the 127 animals receiving PPN, 72 complications occurred. These included metabolic (n = 43), mechanical (n = 25), and septic (n = 4) complications. The most common metabolic complication was hyperglycemia (n = 19), followed by lipemia (n = 17) and hyperbilirubinemia (n = 6). Most complications were mild and did not require discontinuation of PPN. Ninety-three (73.2%) of the 127 patients were discharged. All 4 animals with septic complications were discharged from the hospital. The presence, type, and number of complications did not impact the duration of hospitalization or outcome. However, animals that received supplemental enteral nutrition survived more often than those receiving PPN exclusively. Although PPN seems to be a relatively safe method of providing nutritional support, future studies are warranted to determine its efficacy.     

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.     

Septic osteitis of the distal phalanx in foals: 22 cases (1995-2002)

OBJECTIVE: To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx. DESIGN: Retrospective case series. ANIMALS: 22 foals. PROCEDURES: Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating wounds or subsolar abscessation were excluded. RESULTS: Mean age of foals at initial evaluation was 40.8 days (range, 3 to 122 days). Twenty-one (95%) foals had lameness as the primary complaint. Lesions consistent with septic osteitis of the distal phalanx localized to specific areas of the bone on the basis of radiographic and surgical findings were located on the solar margin or toe (14/22 [64%]), extensor process (5/22 [23%]), and palmar or plantar process (3/22 [13%]). Hind limbs (18/26 [69%] affected limbs) were more frequently affected. Two foals had > 1 affected limb, 2 had additional sites of osteomyelitis, and 4 had concurrent septic arthritis. Surgical debridement and regional antimicrobial perfusion were performed during general anesthesia. Extensor process lesions were not debrided. Nineteen of 22 (86%) foals survived to be discharged from hospital, and 16 horses reached racing age. Eleven of 16 had race starts, of which 8 had official race starts and 3 had unofficial race starts. CONCLUSIONS AND CLINICAL RELEVANCE: Septic osteitis of the distal phalanx should be considered as a source of lameness in foals with signs referable to the foot and does not necessarily preclude a career in racing. Although infection may occur secondary to bacterial penetration of the hoof or sole, the distal phalanx should also be considered as a potential site for hematogenous septic arthritis or osteomyelitis in foals.     

Continuous versus intermittent delivery of nutrition via nasoenteric feeding tubes in hospitalized canine and feline patients: 91 patients (2002–2007)

Objective – To compare continuous to intermittent feeding at delivering prescribed nutrition in hospitalized canine and feline patients. Design – Retrospective clinical study. Setting – University teaching hospital. Animals – Fifty‐four cats and 37 dogs. Measurements and Main Results – Twenty‐four‐hour periods of prescribed and delivered nutrition (kcal) were recorded, and the percentage of prescribed nutrition delivered (PPND) was calculated. If the patient received nasoenteric feeding for >1 day, then the average PPND per day was calculated. Frequency of gastrointestinal complications (vomiting, diarrhea, and regurgitation) was calculated per patient for each group. The PPND was not significantly different between patients fed continuously (99.0%) and patients fed intermittently (92.9%). Vomiting affected 29% of patients (26/91), diarrhea affected 26% of patients (24/91), and regurgitation affected 5% of patients (5/91). There was no significant difference in incidence of gastrointestinal complications between the patients fed continuously and the patients fed intermittently. There was a significantly higher incidence of diarrhea and regurgitation in dogs than in cats. Conclusions – PPND was not significantly different for continuous versus intermittent feeding via nasoenteric tubes. Frequencies of gastrointestinal complications were not significantly different between patients fed continuously and patients fed intermittently. Enterally fed dogs had a significantly higher frequency of regurgitation and diarrhea than enterally fed cats. Prospective studies are warranted to investigate causes for these potential inter‐species differences.     

Humerus fractures in llamas and alpacas: seven cases (1998-2004)

OBJECTIVE: To describe treatment and outcome of humerus fractures in llamas and alpacas. STUDY DESIGN: Retrospective study. ANIMALS: Llamas (n=4) and alpacas (3) with humerus fracture. METHODS: Medical records (January 1, 1998-August 1, 2004) were reviewed for small camelids with a humeral fracture. Retrieved data were signalment, history, physical examination and radiographic findings, surgical and medical treatment, and outcome. RESULTS: Humeral fracture occurred in 7 of 38 (18%) camelids admitted with fractures. Affected animals were aged from 1 month to 3 years old. Fracture configuration included long-oblique (n=4), short-oblique (2), and Salter-Harris Type II fracture of the proximal physis (1). One adult llama was managed by stall confinement and surgical repair was attempted in the other camelids: fixation by screws inserted in lag fashion (n=3), intramedullary pinning and fixation by screws inserted in lag fashion (1), rush pinning (1), and bone plating (1). A Velpeau sling was used for additional support in 3 animals. All fractures healed but temporary radial nerve paresis occurred in 3 animals. Limb shortening and permanent lameness occurred in the llama managed conservatively. CONCLUSIONS: Humerus fractures in small camelids are amenable to surgical repair which may offer better long-term outcome than medical treatment alone. CLINICAL RELEVANCE: Surgical treatment of humerus fractures should have a good prognosis in llamas and alpacas. In select cases, minimally invasive techniques, such as rush pinning or fixation by screws inserted in lag fashion are sufficient for fracture healing.     

Tooth root abscesses in llamas and alpacas: 123 cases (1994-2005)

OBJECTIVE: To determine features, outcome, and complications of surgical treatment of camelid tooth root abscesses. DESIGN: Retrospective case series. ANIMALS: 123 camelids with tooth root abscesses. PROCEDURES: Signalment, history, teeth involved, surgery performed, ancillary diagnostic tests, and short-term complications were recorded from each medical record. An owner questionnaire was used to obtain long-term (> 1 year) follow-up information. RESULTS: The most common surgical treatments included tooth extraction (n = 106) and apicoectomy (13). Owners provided follow-up information on 84 animals. Postoperative complications were reported in 42 of 84 animals. The most common complications included reinfection (n = 15), chronic draining tract (14), and osteomyelitis (14). Significantly more camelids that were in good or obese body condition at the time of surgery were alive at the time of follow-up, compared with those with thin body condition at the time of surgery. Camelids with 2 teeth extracted had significantly more complications than those with 1 tooth extracted. Thirty-four of 47 owners reported that they were completely satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Owners of camelids in poor body condition should be forewarned that such animals are at greater risk for complications following dental surgery. Clinicians should recognize that the number of teeth affected was not associated with a poorer outcome.     

Hemangiosarcoma in cats: 53 cases (1992-2002)

OBJECTIVE: To characterize the biological behavior and prognostic factors associated with hemangiosarcoma in cats. DESIGN: Retrospective case series. ANIMALS: 53 cats with hemangiosarcoma. PROCEDURES: Data were retrieved from a state veterinary diagnostic laboratory, 3 veterinary colleges, and a private practice. RESULTS: Cutaneous and subcutaneous tumor locations were more common than visceral (abdominal and thoracic) and oral locations. Surgical excision was the primary treatment in 47 cats. Tumor-free surgical margins were more likely in cutaneous than subcutaneous lesions and were associated with longer survival times. Local recurrence was observed in 6 of 12 cats with subcutaneous lesions for which follow-up was available. Metastatic disease was detected in 5 of 13 cats with adequate staging at initial diagnosis. A sixth cat had pulmonary metastases at the time of euthanasia. In 4 of 10 cats with visceral hemangiosarcoma, the diagnosis was made at necropsy or they were euthanized at the time of diagnosis. Adjuvant therapy was uncommonly used. Eighteen of the 21 known deaths or euthanasias were tumor-related. Higher mitotic counts (> 3 in 10 hpfs) were associated with shorter survival times. CONCLUSIONS AND CLINICAL RELEVANCE: Subcutaneous hemangiosarcoma was more biologically aggressive than the cutaneous form and was more likely to recur locally and result in euthanasia or death of the cat. Metastatic potential of the cutaneous and subcutaneous forms may be greater than previously reported. Visceral hemangiosarcoma is associated with a grave prognosis.     

Complications after orthopedic surgery in alpacas and llamas: 24 cases (2000-2006)

Objective— To report complications associated with orthopedic surgery in alpacas and llamas.
Study Design— Retrospective study.
Animals— Alpacas (n=18) and llamas (n=6) that orthopedic surgery using internal or external fixation.
Methods— Medical records (January 2000–December 2006) and radiographs were reviewed and owners contacted for follow-up information for alpacas and llamas that had orthopedic surgery involving internal or external fixation. Fourteen camelids had internal fixation, 7 had external fixation, and 3 had a combination of internal and external fixation.
Results— Twenty-two animals (92%) were discharged after surgery (mean hospitalization, 15 days). Of 20 animals with ≥1 year follow-up information, 18 were alive (82%). Postoperative complications related to fracture healing, infection, soft tissue structures, or joints occurred in 21 camelids (87%). Thirteen animals returned to their intended use, 4 animals returned to breeding but not their intended use, 4 were euthanatized, and 3 were only able to be used as pets.
Conclusions— Fixation type (internal, external) did not have any significant effect on complications involving fracture healing, infection, soft tissue structures, or chronic lameness. Camelids with open fractures were more likely to have complications associated with fracture healing, repair, and infection than closed fractures.
Clinical Relevance— Complications after orthopedic surgery in alpacas and llamas are more common than previously reported and may result in chronic lameness or prevent return to their intended use.     

Osteosarcoma in cats: 22 cases (1974-1984)

Osteosarcoma was diagnosed in 22 cats. Diagnosis was based on results of physical, radiographic, and histologic findings. Fifteen tumors arose from the appendicular skeleton, 4 from the skull, 2 from the pelvis, and 1 from a rib. Radiography revealed that in 14 of 15 cats (93%) with appendicular tumors, the lesion was metaphyseal, primarily lytic, with a "moth-eaten" appearance; absence and presence of periosteal new bone formation were associated with the tumors in 12 and 3 cats, respectively. The remaining 7 cats had axial tumors that were characterized by the presence of periosteal new bone formation in addition to bony lysis. Of the 15 cats with appendicular tumors, 12 were treated by amputation and 3 were euthanatized at the time of diagnosis. Of the cats undergoing amputation for treatment of their appendicular tumors, 6 cats were still alive 64 months after surgery (range, 13 to 64 months); the median survival time of the 5 cats (1 cat was lost to follow-up evaluation) that died was 49.2 months (range, 1 to 122 months). Four of 12 cats (33%) survived greater than or equal to 5 years after diagnosis. Of the cats with axial tumors that were not euthanatized at the time of diagnosis (6 of 7), the median survival time was 5.5 months. Based on these findings, we concluded that cats with appendicular osteosarcoma have a better prognosis than those with axial osteosarcoma, and that amputation is a viable treatment for cats with appendicular osteosarcoma.     

Hepatic abscesses in cats: 14 cases (1985-2002)

In this retrospective study, we describe 14 cats diagnosed with hepatic abscesses. The objective of the study was to report the clinical signs, physical examination findings, clinicopathologic findings, and outcomes in affected cats. These findings were then compared with those previously reported in dogs and humans. Clinical signs were vague and included anorexia, lethargy, and weight loss. Only 23% of cats had fever, whereas 31% were hypothermic. Increases in serum activities of alanine aminotransferase and alkaline phosphatase were found in 45 and 18%, respectively, of the 11 cats that had laboratory work performed. Abdominal ultrasound examinations were performed in 7 cats, and abnormalities were found in 71% of them. Four cats had solitary abscesses, all of which were located in the right liver lobes. The other 10 cats had multifocal small abscesses or microabscesses, and all of these cats had clinical signs suggestive of sepsis. Cytologic evaluation of samples obtained by abdominocentesis indicated septic inflammation in 67% of cats in which peritoneal fluid was analyzed. Hepatic abscess cultures yielded polymicrobial growth in 66% of the cats: Escherichia coli was the most commonly cultured organism. Overall mortality rate was 79%. All survivors underwent exploratory laparotomy for partial hepatectomy to resect the abscess followed by medical management. Hepatic abscesses should be considered in cats with signs consistent with sepsis. More routine use of ultrasonography may aid in earlier diagnosis of hepatic abscesses, potentially improving prognosis and outcome.     

Atrial fibrillation in cats: 50 cases (1979-2002)

OBJECTIVE: To determine signalment, clinical signs, diagnostic findings, treatment, and outcome for cats with atrial fibrillation (AF). DESIGN: Retrospective study. ANIMALS: 50 cats. PROCEDURE: Medical records of cats that met criteria for a diagnosis of AF (ECG consisting of at least 2 leads, clear absence of P waves, supraventricular rhythm, and convincingly irregularly irregular rhythm) and had undergone echocardiography were reviewed. RESULTS: There were 41 males (37 castrated) and 9 females (7 spayed). Forty-one were of mixed breeding; 9 were purebred. Mean +/- SD age was 10.2 +/- 3.7 years. The most common chief complaints were dyspnea, aortic thromboembolism, and lethargy. In 11 cats, AF was an incidental finding. Mean +/- SD ventricular rate was 223 +/- 36 beats/min. The most common echocardiographic abnormalities were restrictive or unclassified cardiomyopathy (n = 19), concentric left ventricular hypertrophy (18), and dilated cardiomyopathy (6). Mean +/- SD left atrial-to-aortic diameter ratio (n = 39) was 2.55 +/- 0.80. The most common thoracic radiographic findings were cardiomegaly, pleural effusion, and pulmonary edema. Median survival time (n = 24) was 165 days (range, 0 to 1,095 days). Eight of 24 cats lived for > or = 1 year after a diagnosis of AF was made. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that AF occurs primarily in older adult male cats with structural heart disease severe enough to lead to atrial enlargement. Atrial fibrillation in these cats was most commonly first detected when signs of decompensated cardiac disease were evident, but also was commonly identified as an incidental finding.     

Radiotherapy-induced myelosuppression in dogs: 103 cases (2002-2006)

Definitive radiotherapy refers to delivery of large doses, typically 48-62 Gray, of ionizing radiation over several weeks using a daily or alternate-day fractionation schedule. The impact of definitive radiotherapy alone on haematopoiesis in tumour-bearing dogs is unknown. Medical records from 103 dogs receiving definitive (60) Cobalt teletherapy for cancer over a 5-year period were reviewed for signalment, tumour type and location, total radiotherapy dose and fractionation scheme. Complete blood count data were collected before, halfway through, and at the end of radiation treatment, and analysed for changes associated with patient variables. The results demonstrate significant reductions in haematocrit, total white blood cell count, neutrophils, eosinophils, monocytes, lymphocytes and platelets occurred during definitive radiotherapy but remained within laboratory reference intervals. These data are important for anticipation of toxicity associated with combinations of radiotherapy and chemotherapy in dogs but do not support the routine monitoring of haematology parameters during definitive radiotherapy.     

Gallbladder mucocele in dogs: 30 cases (2000-2002)

OBJECTIVE: To determine long-term outcome of dogs with gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 30 dogs with gallbladder mucocele, including 23 that underwent cholecystectomy. PROCEDURE: Medical records were reviewed for signalment, history, and clinical, ultrasonographic, and surgical findings. Follow-up information was obtained for all dogs that survived the perioperative hospitalization period. RESULTS: 23 dogs had signs of systemic illness; 7 had no clinical signs. Median values for serum activities of alanine aminotransferase and alkaline phosphatase, serum total bilirubin concentration, and total WBC count were significantly higher among dogs with gallbladder rupture than among dogs without rupture. Sensitivity of sonography for detection of rupture was 85.7%. Overall perioperative mortality rate for dogs that underwent cholecystectomy was 21.7%; mortality rate was not significantly greater for dogs with rupture. Aerobic bacteria were isolated from the bile or gallbladder wall in 8.7% of dogs. All 18 dogs discharged from the hospital had complete resolution of clinical signs. In dogs that underwent in-hospital reexamination, serum liver enzyme activities were significantly decreased, compared with preoperative activities. Persistent increases in serum activities of 1 or more liver enzymes were detected in 9 of 12 dogs; 6 of 12 dogs had persistent abnormalities in hepatic echogenicity. Mean follow-up period was 13.9 months. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cholecystectomy is an effective treatment for gallbladder mucocele. Although perioperative mortality rate is high, prognosis after discharge from the hospital is excellent. Rupture of the gallbladder warrants emergency surgical intervention but does not preclude a positive outcome.