Serum antibodies against human albumin in critically ill and healthy dogs

OBJECTIVE: To characterize the magnitude and duration of the antibody response against human albumin (HA) in critically ill and healthy dogs. DESIGN: Cohort and cross-sectional study. ANIMALS: Fourteen critically ill dogs that received 25% HA as part of their treatment protocol, 2 healthy dogs with no known previous exposure to HA that received 2 infusions of 25% HA (positive control dogs), and 47 healthy dogs and 21 critically ill dogs with no known exposure to HA (negative control dogs). PROCEDURES: An ELISA to detect IgG against HA was developed. Serum samples were obtained from the critically ill dogs prior to infusion of HA, at the time of hospital discharge, and 4 to 6 weeks and 6 months after HA administration. Serum samples were obtained at 2- to 4-week intervals from both positive control dogs for 101 weeks. A single serum sample was obtained from each of the negative control dogs. RESULTS: All 14 critically ill dogs developed serum IgG against HA. Peak antibody response was detected 4 to 6 weeks after HA administration. In both positive control dogs, IgG against HA was detected 10 days after HA administration and continued past 97 weeks. The peak antibody response was detected at 3 weeks in 1 dog and at 9 weeks in the other. Five of the 68 (7%) negative control dogs had a positive antibody response. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that dogs developed a pronounced IgG response following exposure to HA and that some dogs with no history of HA administration were positive for anti-HA IgG.     

The therapeutic use of 25% human serum albumin in critically ill dogs and cats.

Twenty-five percent human serum albumin (HSA) is a foreign protein and can potentially cause immune-mediated reactions. For this reason, the author only recommends 25% HSA use after risk analysis shows that the benefits outweigh the potential risks of adverse events. If it is apparent that a critically ill animal may succumb to its illness because of the problems associated with severe hypoalbuminemia, the benefit outweighs the risk. The veterinarian must inform the owner of potential delayed immune-mediated reactions, describe these lesions, and follow the case weekly to ensure that no reaction has occurred. Although there are many positive attributes to the administration of 25% HSA, there seems to be specific situations in which 25% HSA may be indicated and others in which it may not be indicated.     

Use of laser lithotripsy for fragmentation of uroliths in dogs: 73 cases (2005-2006)

OBJECTIVE: To describe use of transurethral cystoscope-guided laser lithotripsy for fragmentation of cystic and urethral uroliths and determine procedure duration and short-term and long-term outcome in dogs. DESIGN: Retrospective case series. ANIMALS: 73 dogs with naturally occurring uroliths in the urinary bladder, urethra, or both. PROCEDURES: Transurethral cystoscope-guided laser lithotripsy was performed in all dogs, and medical records were reviewed for short-term and long-term outcome and complications. RESULTS: Laser lithotripsy resulted in complete fragmentation of all uroliths in all 28 female dogs and a majority of male dogs (39/45 [86.7%]). Dogs with urethroliths had shorter median laser time than dogs with cystic uroliths. Basket extraction and voiding urohydro-propulsion were successful for removal of the urolith fragments following laser lithotripsy. Complications related to cystoscope-guided laser lithotripsy occurred in 5 of 28 (17.9%) female dogs and 6 of 45 (13.3%) male dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Transurethral cystoscope-guided laser lithotripsy was successful in female dogs and most male dogs for fragmentation of cystic and urethral uroliths. Short-term complications were most commonly related to urethral swelling and resolved with placement of an indwelling urinary catheter. There were no long-term complications.     

Bacterial culture of blood from critically ill dogs and cats: 100 cases (1985-1987)

Of 100 critically ill dogs and cats, 49 (39 dogs, 10 cats) had bacteremia. Gram-negative bacilli were the most common isolates from the bloodstream of dogs with bacteremia (46%), and gram-positive cocci and anaerobic bacteria were isolated from 36% and 31% of positive cultures, respectively; 15% of positive cultures were polymicrobial. In cats, gram-negative bacilli (especially Salmonella enteritidis) and anaerobic bacteria were the most common isolates, and 30% of positive cultures were polymicrobial. Gram-positive cocci were not isolated from the blood-stream of cats. Odds ratios, adjusted for the combined effects of disease status (severe vs nonsevere), results of bacterial culture of blood result (positive vs negative), and species (dog vs cat) were calculated for mortality in animals in the study. In animals with bacteremia, severe disease increased the risk of death 11.6-fold, compared with the risk in animals with nonsevere disease. Bacteremia increased mortality 10-fold in animals with severe disease, compared with mortality in animals with severe disease without bacteremia. Animals with severe disease and bacteremia were 15.6 times more likely to die than were those with nonsevere disease and negative culture results. In animals with nonsevere disease, culture results (positive vs negative) were not related significantly to mortality. Disease status (severe vs nonsevere) in animals without bacteremia also was not significantly related to mortality. There was no significant difference in overall mortality in dogs, compared with that in cats.(ABSTRACT TRUNCATED AT 250 WORDS)     

Zinc intoxication in dogs: 19 cases (1991-2003)

OBJECTIVE: To determine physical examination findings, clinicopathologic changes, and prognosis in dogs with zinc toxicosis. DESIGN: Retrospective case series. ANIMALS: 19 dogs with zinc toxicosis. PROCEDURES: Medical records from 1991 through 2003 were searched for animals with a diagnosis of zinc toxicosis. Information concerning signalment, body weight, historical findings, initial owner complaints, physical examination findings, clinicopathologic findings, blood zinc concentrations, source of zinc, treatments given, duration of hospital stay, and outcome was collected. RESULTS: Records of 19 dogs with zinc toxicosis were reviewed.The most common historical findings were vomiting (n = 14) and pigmenturia (12). The most common clinicopathologic findings were anemia (n = 19) and hyperbilirubinemia (12). Median age was 1.3 years, and median weight was 5.6 kg (12.3 lb). The prognosis was favorable, with 17 dogs surviving after a median hospital stay of 2 days. CONCLUSIONS AND CLINICAL RELEVANCE: Hemolytic anemia as a result of zinc toxicosis appeared to affect young small-breed dogs more frequently than older large-breed dogs. The prognosis with treatment is good, and most affected dogs had a short hospital stay.     

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

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

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.     

Relationship between Doppler blood pressure and survival or response to treatment in critically ill cats: 83 cases (2003-2004)

OBJECTIVE: To evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats. DESIGN: Retrospective case series. ANIMALS: 83 cats. PROCEDURES: Medical records from cats admitted to the intensive care unit with at least 2 recorded DBP measurements were included in the study. Hypotension was defined as 1 or more DBP measurements d 90 mm Hg. Change in blood pressure, survival to hospital discharge, heart rate, rectal temperature, PCV, plasma pH, serum ionized calcium concentration, disease process, body weight, age, duration of hospitalization, and catecholamine treatment were also evaluated. RESULTS: 39 cats were included in the hypotensive group, and 44 were consistently normotensive. Overall survival rate was 53% (44/83), with a significantly higher mortality rate in the hypotensive group (64% vs 32%). Among other variables, only low rectal temperature and low PCV were significantly associated with hypotension. Hypotensive cats with an increase in blood pressure of >or=20 mm Hg during hospitalization were more likely to survive to discharge (mortality rate, 69% vs 17%). CONCLUSIONS AND CLINICAL RELEVANCE: Hypotensive cats had increased mortality rate with lower rectal temperatures and lower PCV, compared with normotensive critically ill cats. The implications of these findings with regard to treatment remain to be elucidated, but addressing these abnormalities may be appropriate.     

Evaluation of total and ionized calcium status in dogs with blastomycosis: 38 cases (1997-2006)

OBJECTIVE: To determine blood ionized calcium (iCa) and serum total calcium (tCa) concentrations in dogs with blastomycosis and to evaluate whether serum tCa concentration, albumin-adjusted serum calcium concentration (AdjCa-Alb), and total protein-adjusted serum calcium concentration (AdjCa-TP) accurately predict iCa status. DESIGN: Retrospective case series. ANIMALS: 38 client-owned dogs with a cytologic diagnosis of blastomycosis. PROCEDURES: Dogs were classified as hypocalcemic, normocalcemic, or hypercalcemic on the basis of blood iCa concentration, serum tCa concentration, AdjCa-Alb, and AdjCa-TP; classification on the basis of serum tCa concentration, AdjCa-Alb, and AdjCa-TP was compared with blood iCa concentration. RESULTS: Except for 2 hypercalcemic dogs, all dogs had blood iCa concentrations within the reference interval. Use of serum tCa concentration overestimated hypocalcemia in 57.9% (22/38) of dogs and underestimated hypercalcemia in 1 dog. Use of AdjCa-Alb correctly reclassified all dogs as normocalcemic that were classified as hypocalcemic on the basis of serum tCa concentration, but failed to predict hypercalcemia in 1 dog. Use of AdjCa-TP correctly reclassified all but 2 dogs as normocalcemic that were classified as hypocalcemic on the basis of serum tCa concentration, and failed to predict hypercalcemia in 1 dog. No correlation was found between blood iCa concentration and serum concentrations of tCa, total protein, and albumin; AdjCa-Alb; or AdjCa-TP. CONCLUSIONS AND CLINICAL RELEVANCE: High blood iCa concentration was uncommon in dogs with blastomycosis. Hypoalbuminemia contributed to a low serum tCa concentration despite a blood iCa concentration within reference limits. The use of serum tCa concentration, AdjCa-Alb, and AdjCa-TP may fail to identify a small number of dogs with high blood iCa concentrations.     

Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003)

OBJECTIVES: To describe preoperative, surgical, and postoperative findings and determine prognostic indicators and treatment recommendations in dogs treated surgically for gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURES: Medical records of dogs with gallbladder mucoceles that were treated surgically were reviewed. History, clinical signs, results of selected clinicopathologic analyses and abdominal ultrasonography, surgical procedure performed, results of histologic examination of a liver biopsy specimen, and survival time were recorded. Follow-up information was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs were 7 to 15 years of age and had non-specific clinical signs (vomiting, anorexia, and lethargy). Physical examination findings included icterus, signs of depression, and signs of discomfort on palpation of the abdomen. Sixteen dogs had a definitive diagnosis and 6 dogs were strongly suspected of having a gallbladder mucocele on the basis of results of abdominal ultrasonography. Fifteen dogs survived after surgery; 3 of these dogs had bile-induced peritonitis, and 4 had pancreatitis. One dog was euthanatized as a result of severe pancreatitis, and 1 was euthanatized because of acute renal failure; 5 dogs died as a result of pancreatitis, cholecystitis, or bile-induced peritonitis. Hepatic abnormalities were detected histologically in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: No predictors of survival were identified. No associations between outcome of surgical treatment (survival vs nonsurvival) and preoperative findings, biliary rupture, surgical procedure performed, results of histologic examination of the liver, or development of pancreatitis were found. Cholecystoduodenostomy and cholecystectomy appear to be acceptable treatments for gallbladder mucocele.     

Clinical outcome of nonnasal chondrosarcoma in dogs: thirty-one cases (1986-2003)

OBJECTIVE: To evaluate metastatic rate and survival times of dogs with chondrosarcoma of nonnasal bony sites treated by wide surgical excision. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=31) with chondrosarcoma. METHODS: Medical records were retrospectively reviewed to identify dogs with chondrosarcoma of bone in potentially surgically accessible sites. When complete information was not available in the medical record, owners and referring veterinarians were contacted by telephone to evaluate the course of disease and survival times. When possible, histopathologic diagnosis was confirmed by a single board certified pathologist and tumors were histologically graded. RESULTS: Dogs treated by wide surgical excision (n=18) had a mean survival time of 3097 days and did not reach median survival time. Dogs untreated except for diagnostic biopsy (n =13) had a median survival time of 523 days and a mean survival time of 495 days. Method of treatment and tumor grade predicted survival time (P=.016 and P=.007, respectively). Metastatic rate was 28% for treated dogs and 15% for untreated dogs, with no significant difference between the 2 groups (P=.39). CONCLUSIONS: Wide surgical excision significantly improves survival time for dogs with chondrosarcoma of nonnasal bony sites, but does not affect the likelihood of metastasis. Grade may be prognostic for survival. CLINICAL RELEVANCE: Surgical excision benefits dogs with chondrosarcoma and can result in prolonged survival times. Metastasis still occurs in approximately 1 of 4 dogs even after surgical resection.     

Evaluation of factors associated with survival in dogs with untreated nasal carcinomas: 139 cases (1993-2003)

OBJECTIVE: To evaluate factors associated with survival in dogs with nasal carcinomas that did not receive treatment or received only palliative treatment. DESIGN: Retrospective case series. ANIMALS: 139 dogs with histologically confirmed nasal carcinomas. PROCEDURES: Medical records, computed tomography images, and biopsy specimens of nasal carcinomas were reviewed. Only dogs that were not treated with radiation, surgery, chemotherapy, or immunotherapy and that survived > or = 7 days from the date of diagnosis were included. The Kaplan-Meier method was used to estimate survival time. Factors potentially associated with survival were compared by use of log-rank and Wilcoxon rank sum tests. Multivariable survival analysis was performed by use of the Cox proportional hazards regression model. RESULTS: Overall median survival time was 95 days (95% confidence interval [CI], 73 to 113 days; range, 7 to 1,114 days). In dogs with epistaxis, the hazard of dying was 2.3 times that of dogs that did not have epistaxis. Median survival time of 107 dogs with epistaxis was 88 days (95% CI, 65 to 106 days) and that of 32 dogs without epistaxis was 224 days (95% CI, 54 to 467 days). CONCLUSIONS AND CLINICAL RELEVANCE: The prognosis of dogs with untreated nasal carcinomas is poor. Treatment strategies to improve outcome should be pursued.     

Evaluation of clinical characteristics and bacterial isolates in dogs with bacterial keratitis: 97 cases (1993-2003)

OBJECTIVE: To evaluate clinical characteristics and breeds affected with bacterial keratitis and compare patterns of resistance in bacterial isolates over time in dogs. DESIGN: Retrospective cross-sectional study. ANIMALS: 97 dogs with bacterial keratitis. PROCEDURE: Dogs with bacterial keratitis were identified from teaching hospital medical records at the Universities of Tennessee and Florida during the years 1993 to 2003. Data were collected pertaining to breed, Schirmer tear test results, treatments administered at the time of initial examination, bacterial species isolated, and resistance to selected antimicrobials. RESULTS: 66% of the dogs were brachycephalic, 54% had tear production < 15 mm/min, and 29% were receiving a corticosteroid at the time of initial examination. The most common bacteria isolated were Staphylococcus intermedius (29%), beta-hemolytic Streptococcus spp (17%), and Pseudomonas aeruginosa (21%). Staphylococcus intermedius isolates had limited resistance to certain antimicrobials. More than 80% of beta-hemolytic Streptococcus spp isolates were resistant to neomycin, polymyxin B, and tobramycin. Isolates of P aeruginosa were susceptible to tobramycin and gentamicin and had limited resistance to ciprofloxacin and enrofloxacin. Among bacterial species isolated, there was no evidence of development of antimicrobial resistance over time. CONCLUSIONS AND CLINICAL RELEVANCE: Data suggested that administration of ciprofloxacin or a combination of a first-generation cephalosporin and tobramycin may be used in the treatment of bacterial keratitis while awaiting results of bacterial culture and susceptibility testing. Evidence suggests that current methods of medical management of bacterial keratitis are not associated with increased antimicrobial resistance.     

Radiographic findings in dogs with pulmonary blastomycosis: 125 cases (1989-2006)

OBJECTIVE: To identify radiographic patterns in dogs with pulmonary blastomycosis and radiographic factors associated with outcome. DESIGN: Retrospective case series. ANIMALS: 125 dogs with pulmonary blastomycosis. PROCEDURES: Medical records were reviewed, and for each lung lobe, the primary radiographic pattern and percentage of lobar involvement at the time of initial examination were recorded. RESULTS: 79 dogs survived, 38 died, and 8 were euthanized without treatment. The initial radiographic pattern was variable and not significantly associated with outcome. Mean half-time for radiographic resolution of pulmonary infiltrates was 41.4 days for all patterns except masses, for which mean half-time to resolution was 90.8 days. Transient radiographic worsening was seen in 20 of 87 (23%) dogs but was not associated with a poor prognosis. Pulmonary bullae were seen in 20 (16%) dogs, most often in association with an alveolar pattern. Accuracy of using percentage of right caudal lung lobe involvement ( 20%) to predict outcome was 74.4%; accuracy of using number of affected lobes (< 4 vs >or= 4) to predict outcome was 65.8%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that a nonuniform distribution of pulmonary infiltrates was equally as likely as a diffuse nodular interstitial pattern in dogs with pulmonary blastomycosis. On the basis of half-time for resolution of pulmonary infiltrates, follow-up radiography should be performed no more often than every 4 to 6 weeks in clinically stable patients. Transient radiographic worsening that occurred during the initial weeks of treatment was not associated with a poorer prognosis.     

Computed tomographic appearance of masticatory myositis in dogs: 7 cases (1999-2006)

OBJECTIVE: To document computed tomography (CT) features in dogs with masticatory myositis. DESIGN: Retrospective case series. ANIMALS: 7 dogs with an immunologic diagnosis of masticatory myositis and an absence of clinical abnormalities of any skeletal muscles other than the masticatory muscles. PROCEDURES: History; clinical, hematologic, biochemical, immunologic, cytologic, and histologic findings; and pre- and postcontrast CT imaging features of masticatory muscles and head and neck lymph nodes were extracted from medical records. RESULTS: On CT images, changes in size (atrophy or swelling) were common for all masticatory muscles except the digastricus muscles, which were involved only in 1 dog. Pre-contrast attenuation changes, most often hypoattenuation with varied distribution patterns, were seen in masticatory muscles of 4 dogs. Contrast enhancement with a predominantly inhomogeneous distribution pattern was seen in the temporalis, masseter, and pterygoid muscles of all dogs. Head and neck lymph nodes were enlarged in all but 1 dog and had contrast enhancement with predominantly central or homogeneous distribution patterns. Muscle biopsy was performed in 6 dogs, with biopsy specimens obtained from areas that had the most obvious contrast enhancement on CT images. For all 6 dogs, biopsy specimens had histologic features indicative of masticatory myositis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that CT may be a useful adjunct in the diagnosis of masticatory myositis in dogs, including selection of sites for diagnostic muscle biopsy.