SONOGRAPHIC APPEARANCE OF UREMIC GASTROPATHY IN FOUR DOGS

Gastrointestinal signs are common in dogs with uremia. Structural changes in the stomach associated with uremia in dogs include ulceration, edema, necrosis, gastric wall thickening, submucosal arteriopathy, and mineralization of the gastric mucosa and submucosa. Upon ultrasonographic evaluation of the abdomen in four dogs with severe uremia due to chronic renal disease, a thickened gastric wall, thickened rugal folds, and a hyperechoic line at the mucosal-luminal interface due to mineralization of the gastric mucosa were found. Ultrasonography was more sensitive than survey radiography for the identification of gastric lesions associated with uremia in these dogs.     

Gastric mucosal lesions in dogs with acute intervertebral disc disease: characterization and effects of omeprazole or misoprostol

We characterized gastric mucosal lesions in dogs with acute degenerative disc disease treated by surgery and corticosteroid administration. The effect of omeprazole and misoprostol on gastric lesions in these dogs was also evaluated. Dogs were randomly assigned to 1 of 2 treatment groups or to the control group. Treatment consisted of omeprazole at 0.7 mg/kg orally once daily, or misoprostol at 2 microg/kg orally 3 times daily. All 3 groups received dexamethasone at 2 mg/kg on day 0, prednisolone at 2 mg/kg on day 1. prednisolone at 1 mg/kg on day 2, and prednisolone at 0.5 mg/kg on all further days (range, 5-6 days). Endoscopic examination was performed on day 0 and 5-6 days later. Four regions of the stomach were qualitatively scored from 1 to 12 based on the presence of submucosal hemorrhage, erosion, or ulceration, with ulceration receiving the highest numerical score. Nineteen of 25 dogs had gastric mucosal lesions at the beginning of the study. No significant difference was found in the gastric lesion score among the 3 groups at the end of the study. Gastric mucosal lesions were concluded to be common in dogs with acute degenerative disc disease treated with corticosteroids. Neither omeprazole nor misoprostol at the doses used was effective in healing or preventing the further development of gastric mucosal lesions.     

Intraoperative Irradiation of 16 Spontaneously Occurring Canine Neoplasms

Sixteen dogs with malignant neoplasms were treated with intraoperative radiation therapy after surgical debulking. Fractionated external beam radiation therapy was given postoperatively to 11 dogs. Healing of surgical incisions was uncomplicated in 14 dogs. When the ureters or urinary bladder were included in the irradiation field, they became stenotic and fibrotic. Urinary incontinence and secondary renal injury were common. Local tumor control was poor regardless of site or tumor type.     

Intraoperative radiotherapy of carcinoma of the prostate gland in ten dogs

Ten dogs with carcinoma of the prostate gland were treated with intraoperative orthovoltage radiotherapy (radiation therapy to surgically exposed tumors). Seven dogs had tumor growth confined to the prostate gland and urethra, and 3 dogs had carcinoma of the prostate gland and regional lymph node involvement. Total radiation doses delivered to the prostate gland of 9 dogs and the affected regional lymph nodes of 3 dogs, using orthovoltage x-rays, ranged from 20 to 30 Gy. Carcinoma of the prostate gland of one dog was intraoperatively irradiated to 15 Gy and was then given a boost of 40 Gy, using cobalt-60 teletherapy. Survival time ranged from 41 to 750 days after intraoperative radiotherapy. Median and mean survival times for all dogs were 114 and 196 days, respectively. The median survival time for 7 dogs with localized prostatic carcinoma was 180 days, which was longer, but not significantly longer (P = 0.09), than the median survival time of 80 days in 3 dogs having prostatic carcinoma and metastatic disease. Intraoperative radiotherapy was tolerated well and caused complete response in 5 dogs. However, surgical complications in 2 dogs, which had subtotal lymphadenectomy or prostatic biopsy performed concurrently at the time of irradiation, resulted ultimately in their deaths. The 2 other dogs with metastatic disease and 1 dog without metastatic disease also had poor response to treatment. Our results indicated that intraoperative radiotherapy is an effective treatment for localized prostatic carcinoma in the dog.     

Urethral and bladder rupture in a neonatal colt with uroperitoneum

This case report documents uroperitoneum due to bladder and pelvic urethral rupture in a 9 h old Standardbred colt born after severe dystocia. Three surgical procedures were required to manage rupture of the urinary bladder, urethral rupture, and ventral abdominal hernia with evisceration of a loop of jejunum. After 40 days of hospitalisation the colt was discharged without any further complication.     

Effects of treatment with omeprazole or ranitidine on gastric squamous ulceration in racing Thoroughbreds

OBJECTIVE: To compare the effects of oral administration of omeprazole and ranitidine on gastric squamous ulceration in Thoroughbreds in race training. DESIGN: Modified crossover study. ANIMALS: 60 Thoroughbreds in race training with gastric squamous mucosal ulceration. PROCEDURE: Horses were randomly allocated into 3 groups. Group 1 received no treatment for 28 days followed by administration of omeprazole (4 mg/kg [1.8 mg/lb], PO, once daily) for 28 days; group 2 received omeprazole (4 mg/kg, PO, once daily) for 28 days followed by no treatment for 28 days; and group 3 received ranitidine (6.6 mg/kg [3.0 mg/lb], PO, q 8 h) for 28 days followed by administration of omeprazole (4 mg/kg, PO, once daily) for 28 days. Ulceration was assessed endoscopically at days 0, 28, 42, and 56. Lesions were scored from 0 (no ulceration) to 3 (severe ulceration). RESULTS: After the initial 28 days of treatment, the decrease in ulcer severity was significantly greater after omeprazole treatment than after ranitidine treatment. Ulcer severity decreased significantly in group 3 horses after 14 days of treatment with omeprazole. Discontinuation of omeprazole resulted in worsening of ulcer scores; however, ulcer scores at completion of the study were less than at day 0. Horses that received omeprazole after 28 days of ranitidine treatment had a further reduction in ulcer severity. CONCLUSIONS AND CLINICAL RELEVANCE: Omeprazole was more effective than ranitidine in healing gastric squamous ulcers in Thoroughbreds in race training. Improvement was detected by 14 days and persisted in most of the group 2 horses for at least 28 days after omeprazole treatment was discontinued.     

Emphysematous gastritis in a horse

A 12-year-old Morgan gelding was examined for colic of 3 days duration. Signs of depression, colic, diarrhea, and endotoxemia persisted despite aggressive medical therapy and surgical exploration. Culture results from gastric fluid and feces yielded many colonies of Clostridium perfringens. This organism also was recovered from peritoneal fluid 10 days after admission; consequently, the horse was euthanized. At necropsy, a localized gas-filled, necrotic stomach wall was found; many mucosal and submucosal gas blebs were visible. Culture of this tissue yielded Clostridium perfringens. Emphysematous gastritis is a fulminant infection of the stomach wall caused by gas-forming organisms that gain access to the submucosa via mucosal defects such as ulcers. This condition has been reported infrequently in people, and the case reported herein represents the first instance of emphysematous gastritis in the horse.     

Ultrastructure of the hydrophobic gastric surfactant barrier in the dog

OBJECTIVES: To confirm the hydrophobicity of the luminal surface of the canine stomach and to elucidate the ultrastructure of the lining imparting that property. DESIGN AND PROCEDURES: Gastric and duodenal mucosal samples from eight dogs were collected immediately after euthanasia and subjected to contact angle measurement using a goniometer. Other samples were examined by electron microscopy following a fixation procedure known to preserve phospholipids and oligolamellar structures. RESULTS: Contact angles for the canine gastric mucosal surface (85.1 +/- 5.5) were significantly greater (P < 0.0001) than for the duodenum (24.0 +/- 1.7). Electron microscopy revealed the existence of surfactant as abundant osmiophilic phospholipid material within the gastric and duodenal mucosae. CONCLUSION: We have confirmed the hydrophobic nature of the canine gastric mucosa whereas the luminal surface of the duodenum is hydrophilic. We propose that the water-repellent nature of the canine gastric lining contributes to the 'gastric mucosal barrier' and is imparted by an oligolamellar layer of surface-active phospholipid ('gastric surfactant') adsorbed to the surface. Both gastric and duodenal mucosae may also utilise phospholipids as an intercellular defense mechanism in the event that tight junctions are breached by acid. It is tempting to speculate that a deficiency of gastric phospholipids may predispose dogs to ulcers. Further, exogenous administration of phospholipids may be useful in preventing gastric ulceration.     

Nuclear imaging of the stomach of healthy dogs.

To evaluate the use of technetium pertechnetate (99mTcO4) as a means of estimating gastric mucosal integrity, nuclear images of the empty stomach were obtained from 6 dogs at 20, 40, 60, 120, 180, and 240 minutes after IV administration of the radiopharmaceutical. Blood and gastric secretion samples were collected during the same time intervals. The left lateral-view image of the stomach was used to calculate the relative fraction of the dose in the stomach and the count density ratio. Between 20 and 40 minutes and 40 and 60 minutes, significant differences (P less than 0.001) were apparent in the amount of 99mTcO4 in the stomach. Blood concentration of 99mTcO4 decreased significantly (P less than 0.001), whereas gastric secretion concentration increased significantly (P less than 0.001) over time. Qualitative assessment of the gastric nuclear scans and the statistical analytic results indicated that the optimal time for imaging the canine stomach was between 40 and 60 minutes after radiopharmaceutical administration. In a second study, the same dogs were pretreated with the H2-receptor antagonist cimetidine and the cholinergic antagonist glycopyrrolate to block gastric secretions. Over time, changes in the relative dose fraction in the stomach and the density ratio were the same as values obtained during the experiment performed without use of cimetidine and glycopyrrolate. Results of the study indicate that nuclear imaging with 99mTcO4 outlines normal canine gastric mucosa and that pretreatment with cimetidine and glycopyrrolate has no effect on the quality of the gastric image.     

Megaesophagus and aspiration pneumonia secondary to gastric ulceration in a foal

A 3-month-old foal with a history of persistent fever and leukocytosis was found to have pneumonia, ulceration of the squamous portion of the stomach, and dilatation of the distal portion of the esophagus. The foal was euthanatized and necropsied. The distal portion of the esophagus was severely dilated, and there was severe ulceration and mural thickening of the stomach at the cardia. Because of the severe gastric ulceration and mural thickening, the gastroesophageal junction was fixed in an open position, permitting gastroesophageal reflux. The megaesophagus and pneumonia were considered to have resulted from chronic gastroesophageal reflux.     

Prevalence of gastric ulcers in endurance horses--a preliminary report

Gastric endoscopy was performed at the end of a 50 or 80 km endurance ride. Gastric ulceration was evident in 67% of the horses with ulcers on the squamous region of the stomach found in 57% of the horses and active bleeding of the glandular mucosa in 27%. Three horses (10%) had lesions only on the glandular mucosa. Values of albumin, creatinine and glucose were higher in horses without gastric lesions. We conclude that horses from endurance competitions have a high prevalence of gastric ulceration that is similar to that observed in performance horses. However the severity of ulceration is less severe than has been reported in Thoroughbred race horses in active training. Owners should be aware of the high prevalence of gastric ulceration in horses that perform in endurance competitions. The high incidence of active bleeding from the glandular mucosa of the stomach in these horses requires further investigation.     

Characterization of metastatic intestinal adenocarcinoma with differentiation into multiple morphologic cell types in a Virginia opossum.

A captively maintained mature male opossum (Didelphis virginiana) utilized in a research protocol was presented with clinical signs of chronic diarrhea and severe muscle wasting. At necropsy, there was multifocal mural gastric, intestinal, and urinary bladder thickening, concurrent bilateral hydroureter and hydronephrosis, and extensive fibrous abdominal adhesions. Histologic evaluation revealed intestinal adenocarcinoma with coelomic metastasis to the stomach and urinary bladder. The adenocarcinoma was evaluated using histochemistry and electron microscopy. Paneth, enteroendocrine, and goblet cell differentiation was documented in primary and metastatic sites. This unique presentation of intestinal adenocarcinoma has not previously been reported in the opossum or any other animals. Intestinal neoplasia with Paneth cell differentiation is extremely rare and has been reported in humans with familial adenomatous polyposis.     

Experimental evaluation of urinary bladder marsupialization in male goats

OBJECTIVE: To evaluate the outcome of urinary bladder marsupialization in male goats. STUDY DESIGN: Prospective, experimental study. ANIMALS: Six healthy mixed-breed male goats. METHODS: After experimentally induced urethral obstruction, 6 male goats had urinary bladder marsupialization. Renal ultrasonography, complete blood count, and serum biochemical analysis were evaluated preoperatively (day 0), at 7 postoperative days, and then at 30-day intervals until 180 days. Stomal diameter was recorded immediately postoperatively and at each postoperative interval. Necropsy examination was performed on day 180 or when stomal stricture or death occurred. RESULTS: Stomal stricture occurred in 1 goat at 120 days. Another goat was found dead at 150 days; severe, suppurative cystitis was identified on necropsy. All goats had mild urine scald dermatitis. Serum biochemical values remained within normal limits, but significant decreases in white blood cell count, serum creatinine concentration, and stomal diameter occurred. At necropsy, all bladders were tubular in shape. Histological evidence of chronic suppurative cystitis and chronic, mild lymphoplasmacytic pyelitis occurred in all goats. Bacterial culture of renal tissue yielded growth in 3 goats, and bladder mucosal swabs yielded bacterial growth in all goats. CONCLUSIONS: Although clinical signs of ascending urinary tract infection were not observed in goats with patent stomata, urinary bladder marsupialization may result in ascending urinary tract inflammation or infection. CLINICAL RELEVANCE: Based on our results, urinary bladder marsupialization should be recommended with caution as the primary method for management of urinary tract obstruction in clinical cases.     

Clinical factors determining the efficacy of urinary bladder tumour treatments in dogs: surgery, chemotherapy or both?

In a study of 44 canine patients suffering from histopathologically proven urinary bladder tumour with a high incidence of transitional cell carcinoma (TCC) (n = 35), a close relationship was found either between the disease-free period and the age (r = -0.40) of animals or between the survival times and the age (r = -0.62) of animals after treatment. In addition to the dog breeds known to be prone to have urinary bladder tumour, we found an additional potentially sensitive breed, the Hungarian Vizsla. The median survival times obtained by the applied treatment types were as follow: 'surgery and chemotherapy' (n = 8/44) 475 days, 'surgery alone' (n = 19/44) 240 days, 'chemotherapy alone' (n = 7/44) 31 days, and 'no treatment' (n = 10/44) 7 days (P < 0.001). According to the findings, chemotherapy combined with surgery completed in time is the most effective protocol in the treatment of urinary bladder tumour cases in dogs. A rational and more effective procedure for the assessment and treatment of urinary bladder tumour cases is presented.     

Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus

CASE DESCRIPTION-An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting. CLINICAL FINDINGS-Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct. TREATMENT AND OUTCOME-Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery. CLINICAL RELEVANCE-Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.     

The prevalence of gastric ulceration in racehorses in New Zealand

AIM: To establish the prevalence and factors influencing the prevalence and severity of gastric ulceration in racehorses in New Zealand. METHODS: Horses (n=171) in active training for racing by trainers (n=24) located throughout New Zealand were examined using gastroscopy during 2003 and 2004. Images of the examination were recorded and reviewed, and an ordinal grade based on the severity of gastric ulceration present was assigned, using the grading system proposed by the Equine Gastric Ulcer Council (EGUC). Information about the horses such as age, breed, sex, stabling, time at pasture, pasture quality, and presence of clinical signs consistent with equine gastric ulcer syndrome (EGUS) was recorded. RESULTS: Of the 171 horses in the study, 133 (78%) were Thoroughbreds and 38 (22%) were Standardbreds. Evidence of gastric ulceration was present in 151 (88.3%) of these. Prevalence of ulceration was higher at the lesser curvature (LC) and greater curvature (GC) of the stomach than at the saccus caecus (SC; p<0.01), and ulceration was more severe at the LC than at either the GC (p=0.02) or the SC (p<0.001). The prevalence of ulceration did not differ between the two breeds (p=0.51) or between horses of differing ages (p=0.56). Gastric ulceration was evident in 125/141 (89%) horses kept at pasture for at least 4 h/day, in all 13 (100%) horses kept at pasture full time, and in 16/17 (94%) horses stabled full time. Prevalence and severity of ulceration did not differ between horses stabled full time, kept at pasture for part of the day or kept at pasture full time (p=0.33 and 0.13, respectively), and for horses grazed on pasture severity of ulceration did not vary significantly with the quality of the pasture (p=0.12). Neither prevalence (p=0.26) nor severity (p=0.49) of gastric ulceration varied significantly with duration of training. CONCLUSIONS: The prevalence of gastric ulceration in racehorses in New Zealand is similar to that reported elsewhere for horses in active training for racing. Access to pasture for some or all of the day did not appear to be protective.     

Preclinical evaluation of 5-aminolevulinic acid-based photodynamic therapy for canine transitional cell carcinoma

As a prelude to photodynamic therapy, 5‐aminolevulinic acid (ALA) was given orally to healthy dogs. ALA‐induced protoporphyrin IX (PpIX) fluorescence significantly increased in the mucosa of the urinary bladder in an ALA dose‐dependent fashion. Vomiting occurred after ALA administration in 70% of the dogs but did not affect PpIX fluorescence. ALA‐based photodynamic therapy (PDT) of the urinary bladder in healthy dogs caused only submucosal oedema within the bladder wall. No haematologic or serum biochemistry abnormalities were observed after ALA administration. Microscopic haematuria was observed in all the dogs after PDT but was mild and self limiting. ALA‐based PDT was administered to six dogs with transitional cell carcinoma (TCC) of the lower urinary tract. ALA‐based PDT resulted in tumour progression‐free intervals from 4 to 34 weeks in five dogs; one dog with pre‐existing hydronephrosis died shortly after PDT. Dogs with TCC represent an outbred, spontaneous, tumour model for developing PDT protocols for humans with bladder cancer.     

Laparoscopic repair of ruptured urinary bladder in a stallion

A 12-year-old stallion was evaluated because of pollakiuria; endoscopy of the urinary tract during general anesthesia revealed that the urinary bladder was intact. After recovery, the stallion developed clinical and biochemical signs of bladder rupture, which was confirmed by endoscopy. Cystoplasty in adult stallions represents a unique surgical dilemma; the large distance between the incision site and the bladder necessitates the repair be accomplished under maximum tension with minimal exposure. Because traditional surgical approaches through ventral midline or paramedian incisions provide limited access and viewing, laparoscopy was used to provide a definitive diagnosis, good viewing, easy access, tension-free dissection, and a secure repair. Lack of surgical complications and postoperative discomfort, rapid and uncomplicated healing, and patient-client satisfaction make laparoscopic cystoplasty the preferred method for surgical repair of ruptured urinary bladder in adult stallions.     

Immunohistochemical detection of uroplakin III,cytokeratin 7, and cytokeratin 20 in canine urothelial tumors

Immunohistochemistry for uroplakin III (UP III), cytokeratin 7 (CK 7), and cytokeratin 20 (CK 20) using commercially available antibodies was done in normal canine urinary bladder and 72 canine urinary bladder tumors that had been fixed in formalin and embedded in paraffin. Prolonged fixation (3-28 days) did not significantly alter the immunostaining for UP III. There was moderate reduction in the intensity for CK 7 and CK 20 after 1 week of fixation. UP III was detected in superficial (umbrella) cells and some intermediate cells of the normal urinary bladder, 7 of 7 transitional cell papillomas (TCPs), 50 of 55 transitional cell carcinomas (TCCs), and 4 of 5 metastatic TCCs. Staining was typically outlined in the plasma membrane, but diffuse or focal cytoplasmic staining was also observed. Intracytoplasmic lumina were usually positive for UP III. One squamous cell carcinoma of the bladder, 4 nonepithelial bladder tumors, and 285 nonurothelial tumors from different nonurinary locations were negative for UP III. CK 7 was detected in 7 of 7 TCPs, 53 of 54 TCCs, and 5 of 5 metastatic TCCs. The staining for CK 7 was diffuse cytoplasmic. CK 20 was detected in 1 of 7 TCPs, 37 of 54 TCCs, and 1 of 5 metastatic TCCs. The staining with CK 20 was cytoplasmic and weaker than with antibodies to UP III or CK 7. There was concurrent expression of UP III, CK 7, and CK 20 in 36 of 54 TCCs. UP III is a specific and sensitive marker for canine transitional epithelial (urothelial) neoplasms, detecting 91% of TCCs. Negative results may be observed with anaplastic tumors.