Hematuria and transitional cell papilloma of the renal pelvis treated via unilateral nephrectomy in an alpaca

CASE DESCRIPTION: An 11-year-old 72-kg (158-lb) sexually intact female alpaca was examined for diagnosis and treatment of hematuria of 4 months' duration. CLINICAL FINDINGS: Pigmenturia was detected by the owner when the alpaca was 8 months pregnant. Radiographic, ultrasonographic, vaginal speculum, and cystoscopic evaluation of the urinary tract revealed normal vaginal and urethral epithelia and increased bladder vessel tortuosity, with pulses of hemorrhage from the left ureter. Regenerative anemia and mild leukopenia were detected and serum urea nitrogen and creatinine concentrations were within reference ranges. TREATMENT AND OUTCOME: Chronic hematuria resolved after unilateral nephrectomy of the left kidney, and no dysfunction was detected in the remaining kidney. Histologic evaluation of the kidney revealed a transitional cell tumor in the renal pelvis. CLINICAL RELEVANCE: Although anemia is common in South American camelids, hematuria is an uncommon sign of this condition. Chronic urinary tract infection, toxin ingestion, and neoplasia causing hematuria or hemoglobinuria should be considered in South American camelids with pigmenturia. Thorough and systematic evaluation of the urinary tract should be performed to locate the site of hemorrhage to treat hematuria appropriately.     

Evaluation of a bladder tumor antigen test for the diagnosis of lower urinary tract malignancies in dogs

OBJECTIVE: To evaluate the use of a human bladder tumor antigen test for diagnosis of lower urinary tract malignancies in dogs. SAMPLE POPULATION: Urine samples from dogs without urinary tract abnormalities (n = 18) and from dogs with lower urinary tract neoplasia (20) or nonmalignant urinary tract disease (16). PROCEDURE: Test results were compared among groups and among 3 observers. The effects of urine pH and specific gravity, degree of hematuria, and storage temperature and time of urine samples on test results were also assessed. RESULTS: Test sensitivity and specificity were 90 and 94.4%, respectively, for differentiating dogs with lower urinary tract neoplasia from dogs without abnormalities. However, specificity decreased to 35% for differentiating dogs with neoplasia from dogs with nonmalignant urinary tract disease. In dogs with neoplasia, results were significantly affected by degree of hematuria. However, addition of blood to urine from dogs without hematuria had no significant effect on test results. Although intraobserver variation was significant, urine pH, specific gravity, or storage time or temperature had no significant effect on results. CONCLUSIONS AND CLINICAL RELEVANCE: Although this bladder tumor antigen test was sensitive for differentiating dogs with malignancies of the lower urinary tract from dogs without urinary tract disease, it was not specific for differentiating dogs with neoplasia from dogs with other lower urinary tract abnormalities. It cannot, therefore, be recommended as a definitive diagnostic aid for the detection of lower urinary tract malignancies in dogs.     

Surgery of the prepuce and penis.

Diseases involving the reproductive tract of bulls are a significant cause of economic and genetic loss to beef (eg, cow-calf units) and dairy (eg, bull studs) cattle producers. Injury or infectious disease may cause these abnormalities. Some injuries are amenable to surgical treatment. Surgical restoration of breeding bulls allows preservation of genetics and economic productivity for the owner of affected bulls. Accurate selection of surgical candidates is necessary to optimize prognosis.     

Association of microalbuminuria and the urine albumin-to-creatinine ratio with systemic disease in cats

OBJECTIVE: To determine the diagnostic usefulness of semiquantitative and quantitative microalbuminuria assays and urine albumin-to-creatinine (UAC) ratio for detecting disease in cats. DESIGN: Prospective study. ANIMALS: 441 cats evaluated at a veterinary teaching hospital. PROCEDURES: Urine samples from cats for which a complete medical record was available were included. Urine dipstick results, urine protein-to-creatinine ratios (cutoffs, 0.1 and 0.4), semiquantitative and quantitative microalbuminuria assay results (cutoff, 1 mg/dL), and UAC ratio values (cutoffs, 100 and 200 mg/g) were determined. Clinical diagnoses determined within 3 months of enrollment were recorded. Sensitivity and specificity were determined with disease status used as the standard. The influences of clinical diagnosis, sex, age, serum urea nitrogen and creatinine concentrations, blood pressure, bacterial urine culture results, rectal temperature, pyuria, hematuria, and bacteriuria were evaluated by means of logistic regression. RESULTS: Of 441 cats that were eligible for inclusion, 40 were healthy and 401 had > or = 1 disease. Results of logistic regression indicated that significant associations existed for age, presence of disease, presence of urinary tract disease, azotemia, hematuria, and pyuria and results of 1 or both of the microalbuminuria assays. CONCLUSIONS and CLINICAL RELEVANCE: Microalbuminuria was associated with underlying disease. Sensitivity and specificity of the microalbuminuria assays for detection of systemic disease were superior to those of other tests. Microalbuminuria testing in conjunction with other screening procedures may increase identification of occult disease. A prospective study evaluating the predictive values of screening tests with and without microalbuminuria determination is needed to validate this recommendation.     

Nutritional management of gastrointestinal disease

The gastrointestinal (GI) tract is primarily responsible for acquiring and digesting food, absorbing nutrients and water, and expelling wastes from the body as feces. A proper diet and normally functioning GI tract are integral for the delivery of nutrients, prevention of nutrient deficiencies and malnutrition, repair of damaged intestinal epithelium, restoration of normal luminal bacterial populations, promotion of normal GI motility, and maintenance of normal immune functions (eg, both tolerance and protection from pathogens). The amount of food, its form, the frequency of feeding, and the composition of diet each have important effects on GI function and may be used to help ameliorate signs of GI disease. Although both nutrients and nonnutritional components of a diet are important to GI health, they also may cause or influence the development of GI pathology (eg, antibiotic responsive diarrhea, inflammatory bowel disease, dietary intolerance, or sensitivity and/or allergy). The appropriate diet may have a profound effect on intestinal recovery and successful management of chronic or severe GI disease.     

Hypercalcemia and calcium oxalate urolithiasis in cats: a report of five cases.

Five cats that presented for signs of lower urinary tract disease (i.e., pollakiuria and hematuria) secondary to a calcium oxalate urolithiasis are presented. On evaluation, all five cats had elevations of both serum ionized as well as total serum calcium. The hypercalcemia resolved after discontinuation of urinary acidifying therapy or a dietary change, or both.     

Comparison of results of thoracic radiography, cytologic evaluation of bronchoalveolar lavage fluid, and histologic evaluation of lung specimens in dogs with respiratory tract disease: 16 cases (1996-2000)

OBJECTIVE: To compare results of thoracic radiography, cytologic evaluation of bronchoalveolar lavage (BAL) fluid, and histologic evaluation of biopsy and necropsy specimens in dogs with respiratory tract disease and to determine whether histologic evaluation provides important diagnostic information not attainable by the other methods. DESIGN: Retrospective study. ANIMALS: 16 dogs. PROCEDURE: BAL fluid was classified as normal, neutrophilic, eosinophilic, mononuclear, mixed, neoplastic, or nondiagnostic. Radiographic abnormalities were classified as interstitial, bronchial, bronchointerstitial, or alveolar. Histologic lesions were classified as inflammatory, fibrotic, or neoplastic, and the predominant site of histologic lesions was classified as the alveoli, interstitium, or airway. RESULTS: The predominant radiographic location of lesions correlated with the histologic location in 8 dogs. Of 11 dogs with histologic evidence of inflammatory disease, 8 had inflammatory BAL fluid. Of the 2 dogs with histologic evidence of neoplasia, 1 had BAL fluid suggestive of neoplasia, and the other had BAL fluid consistent with septic purulent inflammation. Two dogs without any histologic abnormalities had mononuclear or nondiagnostic BAL fluid. Two dogs with histologic evidence of fibrosis had mononuclear or mixed inflammatory BAL fluid. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that although thoracic radiography, cytologic evaluation of BAL fluid, and histologic evaluation of lung specimens are complementary, each method has limitations in regard to how well results reflect the underlying disease process in dogs with respiratory tract disease. Lung biopsy should be considered in cases where results of radiography and cytology are nondiagnostic.     

ACVIM consensus statement on the diagnosis of immune‐mediated hemolytic anemia in dogs and cats

Immune‐mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune‐mediated erythrocyte destruction, and adverse consequences of long‐term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence‐based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.     

Feline systemic hypertension: Diagnosis and management

PRACTICAL RELEVANCE: the clinical importance of feline hypertension has been recognised for many years and most feline practitioners are quite familiar with this syndrome. Once systemic hypertension is identified, long-term management of the patient is needed to avoid catastrophic (eg, blindness due to retinal detachment) or subtle (eg, accelerated renal damage) target organ damage. PATIENT GROUP: feline systemic hypertension is most commonly a complication of renal disease and hyperthyroidism, both diseases of older feline patients. By 15 years of age, the probability of having at least one of these two diseases is high. As well cared for cats are living longer, optimal long-term management of feline hypertension in patients with concurrent diseases is an issue of clinical importance. CLINICAL CHALLENGES: obtaining accurate blood pressure measurements in patients that are anxious, fractious or just plain uncooperative remains a significant issue in feline medicine, as does confident analysis of results from these patients. DIAGNOSTICS: careful measurement of systolic blood pressure using Doppler or oscillometric techniques in conjunction with evaluation for evidence of hypertensive choroidopathy (funduscopic examination) and hypertensive cardiac changes (thoracic auscultation) are essential to the diagnosis of systemic hypertension in cats. Other diagnostic techniques, including evaluation of renal and thyroid function, are needed to detect the underlying disease condition. EVIDENCE BASE: numerous well-designed clinical studies have greatly advanced our understanding of the most appropriate methods of diagnosis and therapy of feline hypertension.     

A retrospective study of non-specific rhinitis in 22 cats and the value of nasal cytology and histopathology

Case records from 40 cats subjected to rhinoscopic examination for investigation of chronic nasal disease were reviewed. Cases in which no specific underlying cause (eg neoplasia) was detected were further selected for detailed retrospective study. In these 22 cats (55% of the initial population), a final diagnosis of non-specific chronic nasal disease was made. The radiographic, rhinoscopic, cytological and histopathological findings were reviewed. Mucosal biopsy specimens were obtained in 20 cases. Despite clinical signs of more than 4 weeks duration, histopathology indicated acute inflammation in four cases. Two cases had chronic lymphoplasmacytic inflammation and 14 had mixed (lymphoplasmacytic and neutrophilic) inflammation. Specimens for cytology were obtained from 17 cases by brush sampling. Three of these samples were not diagnostic due to the poor quality of the slides; one showed normal cytology. Acute inflammation was diagnosed by cytology (n=11) more commonly than chronic (n=1) or mixed inflammation (n=1). Concurrent samples, of quality suitable for both histopathological and cytological interpretation, were collected from 12 cases only. Cytological results were in agreement with the histological results in 25% of these cases, the main discrepancy being the nature of the dominant inflammatory cell type. Therefore cytology does not appear to be a reliable means for detection of chronic inflammation. Further studies are needed in order to investigate the correlation between the nature of mucosal inflammation as defined by both histological and cytological evaluation, and the relationship of these test results to prognosis and therapy.     

Concentrations of serum amyloid A and lipopolysaccharide-binding protein in horses with colic

OBJECTIVE: To determine concentrations of 2 acute-phase proteins (serum amyloid A [SAA] and lipopolysaccharide-binding protein [LBP]) in serum samples obtained from horses with colic and identify relationships among these acute-phase proteins and clinical data. ANIMALS: 765 horses with naturally developing gastrointestinal tract diseases characterized by colic (ie, clinical signs indicative of abdominal pain) and 79 healthy control horses; all horses were examined at 2 university teaching hospitals. PROCEDURE: Serum concentrations of SAA and LBP were determined by immunoturbidometric and dot-blot assays, respectively. RESULTS: SAA and LBP concentrations were determined for 718 and 765 horses with colic, respectively. Concentrations of SAA were significantly higher in nonsurvivors than in survivors, and horses with enteritis or colitis and conditions characterized by chronic inflammation (eg, abdominal abscesses, peritonitis, or rectal tears) had SAA concentrations significantly greater than those for horses with other conditions. Serum concentrations of LBP did not correlate with outcome, disease process, or portion of the gastrointestinal tract affected. CONCLUSIONS AND CLINICAL RELEVANCE: Circulating concentrations of SAA were significantly higher at admission in horses with colic attributable to conditions having a primary inflammatory cause (eg, enteritis, colitis, peritonitis, or abdominal abscesses) and were higher in horses that failed to survive the episode of colic, compared with concentrations in horses that survived. Serum concentrations of LBP did not correlate with survival. Analysis of these findings suggests that evaluation of SAA concentrations may be of use in identifying horses with colic attributable to diseases that have inflammation as a primary component of pathogenesis.     

Canine Bladder and Urethral Tumors: A Retrospective Study of 115 Cases (1980–1985)

One hundred and fifteen dogs with neoplasms of the lower urinary tract (bladder and/or urethra) were retrospectively evaluated at five referral institutions participating in ongoing studies by the Veterinary Cooperative Oncology Group. Most tumors were malignant (97%) and of epithelial origin (97%). Lower urinary tract tumors were more common in older dogs weighing greater than 10 kg. The following significant (P less than 0.05) statistical associations were found using the University of Guelph hospital population as control; there was no sex predisposition although the female:male ratio was 1.95:1. Neutered dogs were predisposed as were Airedale Terriers, Beagles, and Scottish Terriers, whereas German Shepherds were significantly under-represented among dogs with lower urinary tract tumors. These statistical associations should be interpreted cautiously because of possible demographic differences in hospital populations among the University of Guelph and other cooperating institutions. There were no significant correlations between age, gender, weight, breed, response to therapy, and survival time. Clinical signs were indicative of lower urinary tract disease and included hematuria, stranguria, and pollakiuria. The laboratory data were nonspecific except for urinalysis test results. Hematuria and inflammatory urinary sediments were most commonly reported; neoplastic cells were identified in the urine sediment of 30% of dogs with lower urinary tract tumors. Contrast cystography was a useful noninvasive diagnostic method since 96% of the dogs had a mass or filling defect in the lower urinary tract demonstrated by this technique.(ABSTRACT TRUNCATED AT 250 WORDS)     

Randomized controlled trial of the efficacy of short-term amitriptyline administration for treatment of acute,nonobstructive, idiopathic lower urinary tract disease in cats

OBJECTIVE: To determine whether short-term amitriptyline administration would be efficacious in the treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. DESIGN: Randomized controlled trial. ANIMALS: 31 untreated male and female cats with acute, nonobstructive, idiopathic lower urinary tract disease. PROCEDURES: Cats were treated with amitriptyline (5 mg/d; n = 16) or a placebo (15) for 7 days and monitored for pollakiuria, hematuria, and adverse events. Cats were reexamined 1 month after treatment, and owners were interviewed by telephone 6, 12, and 24 months after treatment. RESULTS: 2 amitriptyline-treated cats were excluded from analyses because of acquired urinary tract infection. Clinical signs resolved by day 8 in 8 amitriptyline-treated and 10 control cats. There were no apparent differences in likelihood or rate of recovery from pollakiuria or hematuria between groups. Overall, clinical signs recurred significantly faster and more frequently in amitriptyline-treated than control cats. However, after excluding recurrences within 21 days of treatment, risk of recurrence was similar in both groups. Increasing age was significantly associated with increased likelihood and rate of recovery from hematuria and with decreased risk of recurrence of signs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that short-term amitriptyline treatment has no benefit in terms of resolution of pollakiuria and hematuria in cats with idiopathic lower urinary tract disease and may be associated with an increased risk of recurrence.     

Evaluation of underlying risk as a source of heterogeneity in meta-analyses: a simulation study of Bayesian and frequentist implementations of three models

Evaluation of important causes of heterogeneity among study results is an important component of any meta-analysis. For factors which can be measured (e.g. population characteristics, indicators of study quality), standard methods such as meta-regression can be used for this evaluation. The underlying risk (i.e. risk of outcome in the control population) can be viewed as a summary of the effects of unmeasured population characteristics so it is a logical candidate for evaluation as a source of heterogeneity. Unfortunately, because of its relationship with the study outcome (odds ratio or relative risk), standard methods should not be used for evaluating underlying risk as a cause of heterogeneity. Three models with different sets of underlying assumptions were evaluated in a simulation study to determine how well they performed in assessing the role of underlying risk as a source of heterogeneity. All models were fit using both Bayesian and frequentist (maximum likelihood random slopes models) estimation procedures and the results compared. Two of the models produced good results (i.e. minimal evidence of bias in parameter estimates), while the third clearly produced biased estimates of some parameters. In general, the Bayesian and frequentist approaches produced similar results. In situations in which the number of studies in a meta-analysis is small ( approximately 10), the maximum likelihood (frequentist) approach was preferable. While the bias induced by heterogeneity associated with underlying risk was generally not large, use of one of the approaches described in this paper will produce better estimates of treatment effect in situations where there is substantial heterogeneity between studies. A model based on the assumption that the number of positive events in each of the treatment and control groups are binomially distributed (Model 1) is the recommended approach.     

ACVIM consensus statement guidelines for the diagnosis,classification, treatment,and monitoring of pulmonary hypertension in dogs

Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH-specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.     

Diagnosis and medical treatment of otitis externa in the dog and cat

Otitis externa is no longer viewed as an isolated disease of the ear canal, but is a syndrome that is often a reflection of underlying dermatological disease. Causes are classified as predisposing (increase the risk of otitis); primary (directly induce otitis), secondary (contribute to otitis only in an abnormal ear or in conjunction with predisposing factors) and perpetuating (result from inflammation and pathology in ear, prevent resolution of otitis). Common primary causes include foreign bodies, hypersensitivity (particularly atopy and food allergy), keratinisation disorders (most commonly primary idiopathic seborrhoea and hypothyroidism) and earmites, particularly in cats. A systematic diagnostic procedure is required to identify causes and contributing factors. This should include history, clinical examination, otoscopy and cytology in all cases and culture and sensitivity as well as otitis media assessment and biopsy in severe and recurrent cases. Ancillary tests may be required depending on the underlying cause. Treatment consists of identifying and addressing predisposing and primary factors; cleaning the ear canal; topical therapy; systemic therapy where necessary; client education; follow-up; and preventive and maintenance therapy as required.     

Clinical signs, underlying cause, and outcome in cats with seizures: 17 cases (1997-2002)

OBJECTIVE: To determine clinical signs, results of diagnostic testing, underlying cause, and outcome in cats with seizures. DESIGN: Retrospective study. ANIMALS: 17 cats with seizures. PROCEDURE: Only those cats in which an underlying metabolic abnormality causing the seizures had been identified, diagnostic imaging of the brain and CSF analysis had been done, or a necropsy had been performed were included. Seizures were classified as being a result of metabolic disease, symptomatic epilepsy (ie, epilepsy resulting from a structural lesion of the brain), or probably symptomatic epilepsy (ie, epilepsy without any extracranial or identifiable intracranial disease that is not suspected to be genetic in origin). RESULTS: 3 cats had seizures associated with an underlying metabolic disease (hepatic encephalopathy), 7 had symptomatic epilepsy (3 with neoplasia and 4 with meningoencephalitis), and 7 had probably symptomatic epilepsy. Six of the 7 cats with symptomatic epilepsy died or were euthanatized within 3 months after the diagnosis was made, whereas 6 of the 7 cats with probably symptomatic epilepsy survived for at least 12 months after the diagnosis was made. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cats with probably symptomatic epilepsy may have a good long-term prognosis.     

Immune-mediated hemolytic anemia in an eclectus parrot

CASE DESCRIPTION: A 2-year-old female Solomon Island eclectus parrot (Eclectus roratus) was evaluated by a veterinarian because of a 4-day history of progressive lethargy, weakness, poor appetite, and inactivity. The bird was referred to a veterinary teaching hospital for further examination. CLINICAL FINDINGS: Clinicopathologic analyses revealed that the parrot had marked regenerative anemia, autoagglutination, and biliverdinuria. Small, rounded RBCs (thought to be spherocytes) were detected in blood smears. The abnormal findings met the diagnostic criteria for dogs with primary immune-mediated hemolytic anemia. However, analyses of blood samples for lead and zinc concentrations and plasma bile acids concentrations; the use of PCR assays for Chlamydophila psittaci, psittacine circovirus 1 (causative agent of beak and feather disease), and polyomavirus; and microbial culture and Gram staining of feces did not reveal a cause for the hemolytic anemia. TREATMENT AND OUTCOME: Although administration of immunosuppressive doses of cyclosporine was initiated, there was a rapid progression of disease, which lead to death of the parrot before this treatment could be continued long-term. Lack of an identifiable underlying disease (confirmed by complete histologic examinations at necropsy) supported the diagnosis of primary immune-mediated hemolytic anemia. CLINICAL RELEVANCE: Primary immune-mediated hemolytic anemia has not been widely reported in psittacine birds. A comprehensive evaluation and complete histologic examination of tissues to rule out underlying disease processes are required to definitively establish a diagnosis of primary immune-mediated hemolytic anemia in parrots. Primary immune-me-diated hemolytic anemia should be considered as a differential diagnosis for regenerative anemia in a parrot.     

Otitis externa. A disease of multifactorial etiology

Dogs and cats with long-standing otitis externa pose a difficult diagnostic challenge for the veterinarian, because chronically affected ears usually have the same appearance regardless of the underlying cause(s). In patients with chronic otitis externa, the disease is often caused by different combinations of primary, predisposing, and perpetuating factors. The unique therapeutic needs of each patient may be determined by careful interpretation of historical and physical findings, which should be supported by ancillary diagnostic tests.