Evaluation of the use of a heparin dose-response test in dogs to determine the optimal heparin dose during intravascular procedures and assessment of the in vitro heparin response in healthy dogs

BACKGROUND

No guidelines for administering and monitoring anticoagulants intraprocedurally are currently available in dogs, despite the prevalence of procedures necessitating systemic anticoagulation with heparin.

OBJECTIVES

To evaluate an activated clotting time (ACT)-based heparin dose-response (HDR) test to predict the individual required heparin dose in dogs during intravascular procedures, and to investigate both the in vitro heparin - ACT and in vitro heparin - factor anti-Xa activity (anti-Xa) relationships in dogs.

METHODS

Blood was collected from eight healthy beagles undergoing a cardiac procedure and utilised to establish baseline ACT and for in vitro evaluation. Subsequently, 100 IU/kg heparin was administered intravenously (IV) and ACT was remeasured (HDR test). The required heparin dose for an ACT target response ≥300 s was calculated for each individual and ACT was remeasured after administration of this dose. For in vitro testing, a serial heparin blood dilution (0-0.5-1-2-4 international unit (IU)/mL) was prepared and ACT and anti-Xa were determined using whole blood and frozen plasma, respectively.

RESULTS

The HDR test overestimated the required heparin dose in 3/7 dogs. In vitro, ACT and anti-Xa increased significantly with increasing blood heparin concentration. Heparin - ACT was nonlinear in 4/8 dogs at heparin concentrations >2 IU/mL, whereas heparin - anti-Xa remained linear throughout the tested range.

CONCLUSIONS

The HDR test poorly estimated the required heparin dose in dogs. This is most likely attributed to a nonlinear heparin - ACT relationship, as observed in vitro. Anti-Xa is a promising alternative for ACT; however, unavailability as a point-of-care test and lack of in vivo target values restrict its current use.

Regional cerebral blood flow in dogs with congenital extrahepatic portosystemic shunts before surgery and six months after successful closure

Previous studies both in humans and dogs with chronic liver diseases have shown that regional cerebral brain flow (rCBF) is altered. The current study aimed to assess abnormalities in rCBF in dogs with congenital extrahepatic portosystemic shunts (cEHPSS), both at diagnosis and after successful surgical attenuation. Furthermore, the influence of age at diagnosis, severity of hepatic encephalopathy (HE) and type of cEHPSS on rCBF were explored as a base for future research. Single photon emission computed tomography (SPECT) with 99mtechnetium-hexamethylpropylene amine oxime tracer was performed before surgical attenuation and six months postoperatively. Twenty-four dogs with cEHPSS had SPECT at time of diagnosis and 13 dogs with a confirmed closed cEHPSS had a second SPECT six months postoperatively. At diagnosis, dogs with cEHPSS had an altered rCBF distribution compared to healthy dogs. This altered rCBF distribution seemed to be most apparent in dogs ≥ one year and in dogs with overt HE at diagnosis. Six months postoperatively, only the rCBF distribution in the subcortical region decreased compared to pre-operatively. In conclusion, all dogs with cEHPSS had altered rCBF which did not seem to normalize completely six months after successful surgical attenuation. Dogs diagnosed at an older age seemed to have more distinct abnormalities in rCBF compared to younger dogs.

Xenogeneic equine stem cells activate anti-tumor adaptive immunity in a 4T1-based intraductal mouse model for triple-negative breast cancer: proof-of-principle

Triple-negative breast cancer (TNBC) remains difficult to treat, especially due to ineffective immune responses. Current treatments mainly aim at a cytotoxic effect, whereas (stem) cell therapies are being investigated for their immune stimulatory capacities to initiate the anti-tumor immunity. Here, a thoroughly characterized, homogenous and non-tumorigenic mixture of equine mesenchymal stem cells (eMSCs) harvested from horse peripheral blood as innovative xenogeneic immunomodulators were tested in a 4T1-based intraductal mouse model for TNBC. The eMSCs significantly reduced 4T1 progression upon systemic injection, with induction of inflammatory mediators and T-cell influx in primary tumors, already after a single dose. These xenogeneic anti-cancer effects were not restricted to MSCs as systemic treatment with alternative equine epithelial stem cells (eEpSCs) mimicked the reported disease reduction. Mechanistically, effective eMSC treatment did not rely on the spleen as systemic entrapment site, whereas CD4+ and CD8α+ T-cell infiltration and activation were critical. These results show that eMSCs and potentially also other equine stem cell types can be a valuable TNBC treatment strategy for further (pre)clinical evaluation.

Surgical correction of an infundibular pulmonic stenosis and ventricular septal defect in a Shetland Sheepdog

A four-month-old male Shetland Sheepdog presented with exercise intolerance. Physical examination revealed an IV/VI left cranial systolic heart murmur. Echocardiography showed a severe infundibular pulmonic stenosis and a concomitant restrictive ventricular septal defect. As clinical signs of congestive right-sided heart failure worsened and were refractory to medical treatment, surgical correction was advised. Via sternotomy, with cardiopulmonary bypass and cardioplegic cardiac arrest, ventricular septal defect closure and resection of the stenotic infundibular band were performed through right ventriculotomy, followed by patch enlargement. Postoperative recovery was uneventful and echocardiography showed complete resolution of the stenosis and successful closure of the ventricular septal defect. Follow-up echocardiography revealed restenosis after seven weeks and recurrence of right-sided heart failure three months postoperatively. Stenting of the restenosis was attempted via a hybrid procedure with sternotomy and direct transventricular approach. The dog developed fatal ventricular fibrillation during stent deployment. This is the first dog in which surgical right ventricular patch enlargement under cardiopulmonary bypass is reported for the treatment of a primary infundibular pulmonic stenosis.

Dogs with congenital extrahepatic portosystemic shunts that have persistent shunting after surgery have a higher prevalence of urolithiasis

OBJECTIVE

To report the presence of urolithiasis in dogs long-term after gradual attenuation of congenital extrahepatic portosystemic shunts (cEHPSS).

ANIMALS

25 client-owned dogs that underwent gradual attenuation of a cEHPSS, of which 19 had a closed cEHPSS and 6 developed multiple acquired portosystemic shunts (MAPSS) following surgery.

PROCEDURES

A retrospective study with prospective follow-up was performed. Dogs that underwent cEHPSS surgery and had their postoperative cEHPSS status determined by transsplenic portal scintigraphy or CT angiography 3 months postoperatively were prospectively contacted and invited for a long-term follow-up visit (a minimum of 6 months postoperatively). Retrospective data were collected, and during the prospective follow-up visit a thorough history, blood tests and urinalysis, and ultrasonography of the urinary tract were performed to assess the presence of urinary signs and urolithiasis.

RESULTS

Of 25 included dogs, 1 of 19 (5%) dogs with closed cEHPSS and 4 of 6 (67%) dogs with MAPSS had urolithiasis at long-term follow-up. Three (50%) dogs with MAPSS developed new uroliths. Long-term, dogs with closed cEHPSS that initially presented with and without urolithiasis had significantly less urolithiasis compared to dogs with MAPSS (P = .013 and P = .010, respectively). In the 4 dogs with closed cEHPSS that initially presented with nephrolithiasis, nephroliths became smaller or were no longer visible at the long-term follow-up visit.

CLINICAL RELEVANCE

Dogs that developed MAPSS following cEHPSS surgery are at greater risk of urolithiasis compared to those with closed cEHPSS. Furthermore, ammonium urate uroliths might dissolve if portosystemic shunting ceases to exist.

Repeated specific canine pancreatic lipase measurements do not identify multiple acquired portosystemic shunts in dogs after extrahepatic portosystemic shunt attenuation

BACKGROUND

In dogs with portal hypertension (PH), spec cPL is suggested to be increased despite normal pancreatic histology. After attenuation of congenital extrahepatic portosystemic shunts (cEHPSS), multiple acquired portosystemic shunt (MAPSS) can develop as consequence of sustained PH. Presence of MAPSS affects future therapeutic options and prognosis.

OBJECTIVE

Evaluate if spec cPL concentrations increase postoperatively in dogs that develop MAPSS and can thus serve as an indicator of PH.

ANIMALS

Twenty-four dogs with cEHPSS.

METHODS

Dogs classified according to surgical outcome after cEHPSS attenuation (8 with MAPSS [group M], 9 with closed cEHPSS [group C] and 7 with patent blood flow through the original cEHPSS, without evidence of MAPSS [group P]). Spec cPL was measured in preoperative samples (T0), 4 days (T1) and 1 (T2) and 3- to 6-months (T3) after surgery.

RESULTS

Spec cPL was within reference interval (<200 μg/L) at all timepoints except at T1. At T1, 2 dogs in group M (321 and >2000 μg/L) and also 1 in group C (688 μg/L) and 1 in group P (839 μg/L) had increased spec cPL concentrations. No differences in spec cPL concentrations between groups or changes over time were identified.

CONCLUSIONS AND CLINICAL IMPORTANCE

Spec cPL is not consistently increased in dogs that develop MAPSS after cEHPSS attenuation and has no potential as a biomarker for the identification of MAPSS after cEHPSS attenuation.

Reference interval, longitudinal variability and reliability of activated clotting time in healthy dogs using a point-of-care analyser

BACKGROUND

Activated clotting times (ACTs) are used to screen for coagulopathies and monitor heparin therapy.

OBJECTIVES

To determine a reference interval (RI) for ACT in dogs using a point-of-care analyser, to quantify intra-subject within- and between-day variability, to quantify analyser reliability and inter-analyser agreement and to study the influence of a delay in measurement.

METHODS

Forty-two healthy dogs were included. Measurements were performed on fresh venous blood using the i-STAT 1 analyser. The RI was determined using the Robust method. Intra-subject within-day variability and between-day variability were quantified between baseline and 2 h (n = 8) or 48 h (n = 10) later. Analyser reliability and inter-analyser agreement were studied by duplicate measurements (n = 8) on identical analysers. The influence of measurement delay was studied before and after a delay of one analytical run (n = 6).

RESULTS

Mean, lower and upper reference limits for ACT were 92.9 ± 9.1, 74.4 and 111.2 s, respectively. Coefficients of variation of intra-subject within- and between-day variability were 8.1% and 10.4%, respectively, resulting in a significant between-day measurement difference. Analyser reliability assessed by the intraclass correlation coefficient and coefficient of variation were 0.87% and 3.3%, respectively. Significantly lower ACT values were observed after a measurement delay compared to direct analysis.

CONCLUSIONS

Our study provides an RI for ACT in healthy dogs using the i-STAT 1 and suggests low intra-subject within- and between-day variability. Analyser reliability and inter-analyser agreement were good; however, analysis delay and between-day differences could significantly influence ACT results.

Ultrasound-guided core needle biopsy in dogs with thyroid carcinoma

Currently, a histological diagnosis of highly vascularized canine (c) thyroid carcinoma (TC) is primarily obtained following excisional biopsy (EB) through thyroidectomy. Non-EBs are contraindicated in unresectable invasive cTCs due to their highly vascularized nature, which subsequently, lack histological diagnosis. We hypothesised ultrasound-guided core needle biopsy (UGCNB) to be a safe biopsy technique to obtain an accurate histological diagnosis in unresectable TCs. Nine client-owned dogs with suspected naturally occurring TC, presented for surgical excision, were included. First, a UGCNB was taken from the cervical tumour, followed by EB. Haemorrhage following UGCNB was evaluated preoperatively and once the tumour was surgically exposed by visual inspection and ultrasonography. Histological analysis, including cell organisation, tumour capsular and vascular invasion, and immunohistochemistry were performed and compared between both biopsy specimens (i.e., UGCNB and EB) of the same dog. Pre- and peroperative visual inspection revealed minor, localised haemorrhage, subsequent to the UGCNB, in 7/9 dogs. Histology of the EBs confirmed TC in 8/9 dogs and was inconclusive in 1/9 dogs. Histology of the UGCNBs revealed neoplastic thyroid tissue in 7/9 UGCNBs and was inconclusive in 1/9 UGCNBs. The remaining UGCNB contained no mass related tissue and was, therefore, excluded. Histological parameters (i.e., cell organisation, tumour capsular and vascular invasion) were not concordant between 6/8 included UGCNBs and their respective EB. Immunolabelling for thyroglobulin and calcitonin was concordant between all eight included UGCNBs and their respective EB. The remaining evaluated immunohistochemical markers (i.e., cyclooxygenase-2 [COX-2], P-glycoprotein and vascular endothelial growth factor [VEGF]) were concordant between the included UGCNBs and the EBs in 6/8 dogs. To conclude, UGCNBs can be safely obtained in suspected cTCs and enable a reliable diagnosis of the thyroid origin, thyroid cell origin and potential therapeutic markers such as COX-2, P-glycoprotein and VEGF. Subsequently, UGCNB enables clinicians to establish an individually tailored treatment plan in dogs with unresectable TC.

Intraoral approach for zygomatic sialoadenectomy in dogs: An anatomical study and three clinical cases

OBJECTIVE

To describe an intraoral approach (IOA) for zygomatic sialadenectomy in dogs and to compare this surgical approach to a modified lateral orbitotomy approach (LOA).

STUDY DESIGN

Cadaveric study and short case series.

SAMPLE POPULATION

Ten canine cadavers and three dogs with clinical disease.

METHODS

Bilateral zygomatic sialoadenectomies were performed in six mesocephalic, two brachycephalic and two dolichocephalic cadavers, randomly assigned to IOA on one side and LOA on the contralateral side. Duration of surgery, ease of surgical stage scores (rated on 5-point Likert scale) and completeness of gland removal were recorded. Additionally, IOA was performed in three dogs with zygomatic salivary gland (ZSG) disease.

RESULTS

Removal of the ZSG was complete in 8/10 and 10/10 dogs using the IOA and LOA, respectively. Surgery was faster with IOA (42.0 min; 33.5-49.6 min) than LOA (65.7 min; 54.9-76.4 min, p = .005). Ease of removal did not differ between approaches (p = .091). Diseased ZSGs were successfully removed in three dogs without intra- or short-term postoperative complications.

CONCLUSIONS

The intraoral approach described here was technically equally challenging but faster than the LOA. Its clinical use led to an uneventful surgery with excellent short-term outcome in three dogs.

CLINICAL RELEVANCE

The IOA provides an alternative approach for zygomatic sialoadenectomy in dogs with ZSG disease.

Comparison of urethral length and orifice diameter in cats undergoing transpelvic or subpubic urethrostomy for perineal urethrostomy revision (cadaveric study)

OBJECTIVES

Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques for failed perineal urethrostomies. The first objective was to evaluate the feasibility of performing a transpelvic urethrostomy (TPU) after a previous, correctly performed PU in male cats. The second objective was to determine the residual urethral length, orifice diameter, and the position of the orifice relative to the pubic brim and anus after PU, TPU and subpubic urethrostomy (SPU).

METHODS

Twenty male cat cadavers were randomly divided into two groups: TPU and SPU. In group TPU, PU was followed by TPU; in group SPU, PU was followed by SPU. After each procedure, the urethral orifice cross-section size was estimated by inserting the largest possible urinary catheter without resistance. Residual urethral length was measured both on contrast radiographs and after anatomical dissection.

RESULTS

In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer residual urethral length than SPU, based on contrast radiographs (P = 0.001) and confirmed by anatomical dissection (P <0.001). Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%, respectively. The urethral orifice diameter after TPU did not differ from SPU (P = 1.000), and it was not statistically significantly different between TPU and PU (P = 0.317) or between SPU and PU (P = 0.655). The urethral orifice was located further away from the pubis (P <0.001) and closer to the anus (P <0.001) after TPU than after SPU.

CONCLUSIONS AND RELEVANCE

Both TPU and SPU are possible revision surgeries following PU. As TPU preserves a significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary dermatitis and urinary incontinence might be less following TPU than SPU.

Shear wave elastography measurements in dogs treated surgically for congenital extrahepatic portosystemic shunts

Assessing the postoperative surgical success of congenital extrahepatic portosystemic shunt (EHPSS) attenuation can be challenging and involve invasive imaging methods. Elastography is an ultrasound technique that allows qualitative and quantitative estimation of tissue stiffness and has extensively been used in people with liver disease. In recent years, increased interest in this technique has developed in veterinary medicine due to its non-invasive nature, availability, and low cost. The objective of this study was to compare liver stiffness values between dogs with closed EHPSS and those with multiple acquired portosystemic shunts (MAPSS) after gradual surgical attenuation and to assess whether shear wave elastography could be used to determine EHPSS closure. As a secondary objective, measurements obtained from both intercostal and subxiphoidal views were compared. Mean values for the average, median, and maximum two-dimensional shear wave velocities (2D SWV) for the closed EHPSS were 2.88 +/−0.11 m/s; 2.83 +/−0.11 m/s; and 3.75 +/−0.16 m/s, respectively. In the MAPSS dogs, mean values for the average, median, and maximum 2D SWV were 2.77 +/– 0.17 m/s; 2.71 +/– 0.17 m/s; and 3.66 +/−0.24 m/s, respectively. No significant differences in 2D SWV were present between dogs with closed EHPSS and those with MAPSS (P = 0.33; P = 0.33; P = 0.42, respectively). When assessing potential differences between intercostal and subxiphoidal 2D SWV measurements, no effect was observed for the average and median 2D SWV (P = 0.06; P = 0.07, respectively). Yet, a significant difference was identified for the maximum 2D SWV between intercostal 4.00 +/−0.20 m/s and subxiphoidal 3.41 +/−0.17 m/s measurements (P = 0.02). The relevance of this finding is uncertain as many other studies about liver elastography only report mean and not maximum values.

Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment

OBJECTIVE

To determine the sensitivity and specificity of different individual and combined blood tests to assess extrahepatic portosystemic shunt (EHPSS) closure after gradual attenuation of EHPSS in dogs.

STUDY DESIGN

Clinical prospective study.

ANIMALS

Twenty client-owned dogs with EHPSS.

METHODS

Fasting ammonia (FA), preprandial, postprandial, and paired serum bile acids (SBA), the lidocaine/monoethylglycylxylidide (L/MEGX) test, and serum hyaluronic acid (SHA) were performed at diagnosis, and 1, 3, and 6 months postoperatively. Transsplenic portal scintigraphy was performed to determine EHPSS closure 3 months postoperatively. Their sensitivity and specificity in determining shunt closure postoperatively were calculated.

RESULTS

When assessing a single blood parameter, FA had the highest specificity (100%), whereas SHA and MEGX measured 15 min after lidocaine administration (T15) had the highest sensitivity (96.9% and 96.2%, respectively) for determining shunt closure postoperatively. The most promising blood test combinations were SHA (sensitivity 96.9%, specificity 81.8%), combined with the L/MEGX test (MEGX at T15: sensitivity 100%, specificity 72.4%) or the L/MEGX test (MEGX at T15) combined with either FA (sensitivity 100%, specificity 82.8%) or postprandial SBA (sensitivity 100%, specificity 81.5%).

CONCLUSION

Both SHA and the L/MEGX test were sensitive tests for determining shunt closure after gradual attenuation of EHPSS. Test performances could even be improved by combining these tests with each other or with traditional tests such as FA or postprandial SBA.

CLINICAL SIGNIFICANCE

Although SHA and the L/MEGX test are sensitive blood tests for determining EHPSS closure, especially when combined with traditional blood tests, imaging is still needed to confirm EHPSS closure.

Comparison of diet, lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts

BACKGROUND

Hepatic supportive diet (HSD), lactulose, and antimicrobials are medical treatments for dogs with congenital extrahepatic portosystemic shunts (cEHPSS). The relative contribution of these treatment components is currently unknown.

OBJECTIVES

To determine which treatment combinations are most efficacious in pre-surgical control of clinical signs of cEHPSS in dogs.

ANIMALS

Thirty-six dogs with untreated cEHPSS.

METHODS

Three-arm randomized clinical trial. At inclusion (T0), dogs were divided into 3 groups: HSD (n = 12), HSD + lactulose (n = 12), or HSD + metronidazole (n = 12) and received the randomized treatment for 4 weeks (T1) followed by combined treatment of HSD + lactulose + metronidazole for 2 weeks or until cEHPSS attenuation (T2). Clinical score as well as fasting ammonia (FA) and C-reactive protein (CRP) concentrations were compared among groups and time points.

RESULTS

Thirty-four dogs were evaluated. Thirty-four dogs reached T1 and 29 dogs T2. At T1, clinical scores decreased in the HSD + lactulose (n = 11; P = .001), but not in the HSD (n = 8; P = .96) and HSD + metronidazole (n = 10; P = .06) groups. Adding metronidazole to HSD + lactulose (n = 11) did not result in further clinical score improvement (T2; P = 1.000). Moderate and weak correlation between clinical score and FA and clinical score and CRP was present (ρ = .35, P < .001; ρ = .27, P = .01, respectively) with FA decreasing over time on medical treatment (P = .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Combined HSD + lactulose seems sufficient for pre-surgical cEHPSS stabilization unlike sole HSD or HSD + metronidazole. Medical treatment of cEHPSS clinical signs decreases FA.

Diagnostic value of liver function tests and ultrasonography in dogs with suspected congenital portosystemic shunts

BACKGROUND

Diagnosing a congenital portosystemic shunt (cPSS) in dogs can be challenging. The current study aims to report diagnostic performance of fasting ammonia (FA), preprandial, postprandial and paired serum bile acids (SBA) and abdominal ultrasound (aUS) in dogs suspected of having a cPSS.

METHODS

Medical records of dogs suspected of having a cPSS at initial presentation were retrospectively reviewed.

RESULTS

In total, 192 dogs suspected of cPSS were included: a cPSS was confirmed in 147 dogs and excluded in 45 dogs. FA had the best combined sensitivity and specificity (77.4 and 93.3%, respectively) to diagnose cPSS. The sensitivity and negative predictive value were 100.0% for paired SBA, making paired SBA the best test to exclude cPSS in this population. Sensitivity and specificity of aUS were 80.8 and 90.0%, respectively.

CONCLUSIONS

In dogs with clinical signs compatible with cPSS, elevated FA is suggestive of cPSS, whereas normal paired SBA makes the presence of a cPSS unlikely. Although aUS is a useful tool to diagnose cPSS, additional imaging is required to visualize cPSS in almost 20% of cases. Furthermore, the localisation of cPSS can be misdiagnosed, especially in case of extrahepatic cPSS that do not insert into the prehepatic vena cava.

Persistent hypercobalaminemia three months after successful gradual attenuation of extrahepatic shunts in dogs: a prospective cohort study

Background

Deficiencies in vitamin A and D and disorders in the vitamin B complex are often present in people with chronic liver diseases. So far, the serum concentrations of these vitamins have not yet been studied in dogs with congenital extrahepatic portosystemic shunts (EHPSS), who also have some degree of liver dysfunction. The objective was to assess serum vitamin concentrations in dogs with EHPSS from diagnosis to complete closure. A prospective cohort study was performed using ten client-owned dogs with EHPSS, closed after gradual surgical attenuation. Serum concentrations of vitamin A, 25-hydroxyvitamin D, folic acid, cobalamin and methylmalonic acid (MMA) were measured at diagnosis prior to institution of medical therapy, prior to surgery, and three months after gradual attenuation and complete closure of the EHPSS.

Results

At diagnosis, median serum concentrations of vitamin A, 25-hydroxyvitamin D and folic acid were 18.2 μg/dL (8.8 - 79.5 μg/dL), 51.8 ng/mL (19.4 - 109.0 ng/mL), and 8.1 μg/L (5.2 - 14.5 μg/L), respectively, which increased significantly postoperatively (88.3 μg/dL (51.6 - 182.2 μg/dL, P=0.005), 89.6 ng/mL (49.3 - >150.0 ng/mL, P =0.005), and 14.8 μg/L (11.5 - 17.7 μg/L, P <0.001), respectively). Median serum cobalamin concentrations were 735.5 ng/L (470 - 1388 ng/L) at diagnosis and did not significantly decrease postoperatively (P =0.122). Both at diagnosis and three months postoperatively 7/10 dogs had hypercobalaminemia.

Conclusions

Serum concentrations of vitamin A, 25-hydroxyvitamin D and folic acid significantly increase after surgical attenuation. Nevertheless, persistent hypercobalaminemia is suggestive of ongoing liver dysfunction, despite successful surgery.

Validation of a skin and coat scoring protocol in dogs

Skin and coat scores have been used to assess changes in skin and coat quality in dogs. The aim of this study was to evaluate a skin and coat protocol in dogs of different coat types. Skin and coat of long-haired, short-haired and wire-haired dogs were scored for alopecia, glossiness, greasiness, softness, scaliness and overall skin and coat quality by ten observers. Intraobserver and interobserver agreement was assessed using kappa values. Thirty-six client-owned dogs were included in the study. The overall intraobserver agreement was moderate when assessing greasiness and glossiness and substantial when assessing alopecia, softness, scaliness and overall skin and coat quality. The overall interobserver agreement was only slight to fair for all features assessed. In conclusion, the proposed skin and coat scoring protocol assesses different aspects of the skin and coat quality in dogs and is easy and non-invasive. Scoring skin and coat quality over time is only reliable if performed by the same person.

Is there a rationale to supplement hepatotropic factors to dogs with multiple acquired portosystemic shunts secondary to congenital portosystemic shunt attenuation?

Experimental rat models and clinical trials in human patients with liver cirrhosis show evidence that supplementation with hepatotropic factors provides therapeutic benefits. This form of support has not yet been described in dogs with multiple acquired portosystemic shunts (MAPSS) despite similarities between both pathological conditions. Especially hepatocyte growth factor (HGF) and branched chain amino acids (BCAA) deserve closer attention. High-quality vegetable rather than animal proteins have been suggested to form an excellent dietary source of BCAA, and leucine seems the best candidate for supplementation given its stimulating effects on liver function in general and on HGF secretion specifically. Research on optimal ways of administration of HGF in dogs with MAPSS secondary to congenital portosystemic shunt attenuation is necessary before clinical trials can be initiated.

Influence of age, sex, body condition score, rectal temperature, anatomical location and hair on skin pH in dogs

BACKGROUND

Physiological skin pH levels are well-documented in human medicine, and assessment of variations may be important in assessing the efficacy of wound healing. By contrast, physiological skin pH levels in dogs are sparsely described.

HYPOTHESIS/OBJECTIVES

To determine the pH of intact skin in healthy dogs and to study the influence of different physiological factors on the pH level of canine skin.

ANIMALS

Seventy-seven client-owned dogs of various breeds, age and sex.

METHODS AND MATERIALS

A prospective study was designed and the pH of intact skin was measured at the concave surface of both pinnae, and in both axillary and inguinal regions. For each location, the colour and density of the hairs also was recorded. Each dog's rectal body temperature and body condition scores also were determined.

RESULTS

The skin pH in dogs <12 weeks of age was significantly lower (3.97-5.70) than in older dogs (4.40-8.18) (P < 0.001). In dogs >12 weeks of age, skin pH was significantly lower in the inguinal regions compared to the pinnae (P = 0.008), and female dogs had a significantly lower skin pH in the inguinal regions than male dogs (P = 0.043). Pinnae covered with light-coloured hair had a lower skin pH than those with dark-coloured hair (P = 0.04). No significant differences were found between dogs with different body condition scores, body temperatures or differences in hair density.

CONCLUSIONS AND CLINICAL RELEVANCE

The pH of intact healthy skin is lower in puppies of <12 weeks of age. Regional differences of body location also were seen which were variably affected by hair colour and sex. A baseline assessment of skin pH in healthy dogs is important for future studies of disease and wound healing.

Serum insulin-like growth factor-1 as a marker of improved liver function and surgical outcome in dogs with congenital extrahepatic portosystemic shunts

Serum insulin-like growth factor-1 concentration (sIGF-1c) is reduced in various hepatopathies in humans and dogs. This work aimed to evaluate sIGF-1c in dogs before and after congenital extrahepatic portosystemic shunt (cEHPSS) attenuation, in relation to surgical outcome (closed vs. persistent shunting). Secondarily, it aimed to assess if sIGF-1c can discriminate between cEHPSS and portal vein hypoplasia (PVH) and finally compare sIGF-1c ratio (postoperative/preoperative sIGF-1c) to pre-prandial serum bile acids (preBA), post-prandial bile acids (postBA), bile acid stimulation test (BAST) and fasting ammonia (FA), regarding surgical outcome. Thirty-nine dogs were included: 15 with closed cEHPSS, 15 with persistent shunting and nine with PVH. Transplenic portal scintigraphy was used to classifiy surgical outcome. There was no significant difference in sIGF-1c between dogs with cEHPSS and those with PVH (P > 0.05). Postoperative sIGF-1c increased in all dogs (P < 0.001 and P = 0.023 for closed and persistent shunting, respectively) and the increase was more pronounced in closed cEHPSS than in persistent shunting (P = 0.006). Using an optimal sIGF-1c ratio cut-off of 2.23, the sensitivity was 93.3% and the specificity was 66.7% for differentiation between surgical outcomes. Serum pre-prandial bile acids, postBA BAST and FA had sensitivities of 80%, 86.7%, 86.7%, 60%; and specificities of 100%, 93.3%, 93.3%, 100%, respectively. There was a greater increase in sIGF-1c after shunt closure than during persistent shunting; nevertheless sIGF-1c ratio was inferior to advanced imaging to assess surgical outcome.

Plasma amino acid profiles in dogs with closed extrahepatic portosystemic shunts are only partially improved 3 months after successful gradual attenuation

BACKGROUND

Dogs with portosystemic shunts have an altered blood amino acid profile, with an abnormal branched-chained amino acid (BCAA)-to-aromatic amino acid (AAA) ratio being the most common abnormality. Different liver diseases have distinctive amino acid profiles.

OBJECTIVES

Determine the changes in plasma amino acid profiles in dogs with extrahepatic portosystemic shunts (EHPSS) from diagnosis to complete closure.

ANIMALS

Ten client-owned dogs with EHPSS closed after surgical attenuation.

METHODS

Prospective cohort study. Medical treatment was instituted in dogs diagnosed with EHPSS. At least 4 weeks later, gradual surgical attenuation was performed. Three months postoperatively, EHPSS closure was confirmed by transsplenic portal scintigraphy. Clinical signs were scored and blood was taken before institution of medical treatment, at time of surgery, and 3 months postoperatively. At the end of the study, the plasma amino acid profiles were analyzed in batch.

RESULTS

The median BCAA-to-AAA ratio was extremely low (0.6) at time of diagnosis and remained low (0.5) at time of surgery, despite the fact that median neurological score significantly improved from 22 to 2 after starting medical treatment (P = .04). Three months after surgical attenuation, a significantly higher BCAA-to-AAA ratio (1.5) was observed (P < .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Medical treatment does not improve the BCAA-to-AAA ratio in dogs with EHPSS, despite substantial clinical improvement. Although the ratio significantly increased after EHPSS closure, it was still indicative of moderate to severe hepatic dysfunction in all dogs.

Cytosolic delivery of gadolinium via photoporation enables improved in vivo magnetic resonance imaging of cancer cells

Longitudinal in vivo monitoring of transplanted cells is crucial to perform cancer research or to assess the treatment outcome of cell-based therapies. While several bio-imaging techniques can be used, magnetic resonance imaging (MRI) clearly stands out in terms of high spatial resolution and excellent soft-tissue contrast. However, MRI suffers from low sensitivity, requiring cells to be labeled with high concentrations of contrast agents. An interesting option is to label cells with clinically approved gadolinium chelates which generate a hyperintense MR signal. However, spontaneous uptake of the label via pinocytosis results in its endosomal sequestration, leading to quenching of the T₁-weighted relaxation. To avoid this quenching effect, delivery of gadolinium chelates directly into the cytosol via electroporation or hypotonic cell swelling have been proposed. However, these methods are also accompanied by several drawbacks such as a high cytotoxicity, and changes in gene expression and phenotype. Here, we demonstrate that nanoparticle-sensitized laser induced photoporation forms an attractive alternative to efficiently deliver the contrast agent gadobutrol into the cytosol of both HeLa and SK-OV-3 IP1 cells. After intracellular delivery by photoporation the quenching effect is clearly avoided, leading to a strong increase in the hyperintense T₁-weighted MR signal. Moreover, when compared to nucleofection as a state-of-the-art electroporation platform, photoporation has much less impact on cell viability, which is extremely important for reliable cell tracking studies. Additional experiments confirm that photoporation does not induce any change in the long-term viability or the migratory capacity of the cells. Finally, we show that gadolinium 'labeled' SK-OV-3 IP1 cells can be imaged in vivo by MRI with high soft-tissue contrast and spatial resolution, revealing indications of potential tumor invasion or angiogenesis.

Evaluation of serum lidocaine/monoethylglycylxylidide concentration to assess shunt closure in dogs with extrahepatic portosystemic shunts

BACKGROUND

Liver function tests do not always normalize despite successful attenuation of extrahepatic portosystemic shunts (EHPSS).

OBJECTIVES

Assess the lidocaine/monoethylglycylxylidide (MEGX) test to determine liver perfusion after EHPSS closure.

ANIMALS

Twenty dogs with EHPSS.

METHODS

A prospective cohort study was performed and all dogs were tested at diagnosis, 1, 3, and 6 months postoperatively. After collecting a baseline blood sample (T0), 1 mg/kg body weight of lidocaine was injected intravenously. Fifteen (T15) and 30 minutes (T30) later, blood was collected. Plasma concentrations of lidocaine and its metabolites MEGX and glycylxylidide (GX) were determined, using a high-performance liquid chromatography with electrospray ionization tandem mass spectrometry method. Three months postoperatively, transsplenic portal scintigraphy was performed to determine EHPSS closure.

RESULTS

At T15, median MEGX concentrations were higher in dogs with closed EHPSS compared to diagnosis (33.73 ng/mL [21.11-66.44 ng/mL] vs 13.74 ng/mL [7.25-21.93 ng/mL]; P < .001), but were not different (12.28 ng/mL [10.62-23.17 ng/mL] vs 13.74 ng/mL [7.25-21.93 ng/mL]) in dogs with persistent shunting. Sensitivity to determine shunt closure for MEGX at T15 was 96.2% (95% confidence interval [CI]: 78.4-99.8) and specificity 82.8% (95% CI: 63.5-93.5).

CONCLUSIONS AND CLINICAL IMPORTANCE

The lidocaine/MEGX test is a promising, rapid, and noninvasive blood test that seems helpful to differentiate dogs with closed EHPSS and dogs with persistent shunting after gradual attenuation.

Neurological signs and imaging findings in three cats with multiple articular process hypertrophy

An eight-year-old British Shorthair (case 1), an eleven-year-old British Shorthair (case 2) and a six-year-old European Shorthair cat (case 3) showed signs of chronic T3–L3 myelopathy. Computed tomography of the thoracolumbar and lumbosacral region was performed in all three cases and magnetic resonance imaging was only performed in case 2. Cross sectional imaging revealed an enlargement of the articular process joints from T2 to T5 in case 1, from T11 to T13 in case 2 and from T10 to T13 in case 3 causing spinal cord compression. Based on the severity of the spinal cord compression, surgical decompression by hemilaminectomy was performed in case 1. In cases 2 and 3, conservative treatment was instituted, although this condition could have been an incidental finding in these two cases. To the authors’ knowledge, this is the first report describing the neurological signs, imaging findings and short-term outcome in cats with multiple thoracolumbar articular process hypertrophy.

Serum hyaluronic acid, a marker for improved liver perfusion after gradual surgical attenuation of extrahepatic portosystemic shunt closure in dogs

Current liver function tests used in dogs do not consistently normalise after successful surgical attenuation of portosystemic shunts (PSS). Serum hyaluronic acid (sHA) concentrations in dogs with PSS are reported to be higher at diagnosis than in healthy dogs. The objective of this study was to assess sHA as a marker of liver perfusion by measuring sHA concentrations in dogs before and after gradual surgical attenuation of extrahepatic (EH)PSS and by determining whether sHA concentrations could differentiate closed EHPSS from persistent shunting. Specificity of sHA was assessed by comparing sHA concentrations in dogs with EHPSS to those in dogs with other liver diseases. Twenty dogs with EHPSS had sHA concentrations measured at diagnosis, 1, 3, and 6 months postoperatively. In addition, sHA concentrations were determined in 10 dogs with other liver diseases. At EHPSS diagnosis, median sHA concentration was 335.6 ng/mL (43.0-790.7 ng/mL). All dogs had a significant decrease in sHA concentrations from 1 month postoperatively onwards (P < 0.05), regardless of surgical outcome. At all postoperative follow-up visits, there was a significant difference between the median sHA concentration in dogs with closed EHPSS vs. those with persistent shunting (P < 0.05). Median sHA concentration in dogs with other liver diseases was 89.8 ng/mL (22.9-160.0 ng/mL), which was significantly lower than dogs with EHPSS at diagnosis (P < 0.001). In conclusion, sHA is a promising non-invasive biomarker that can help to determine liver perfusion after surgical attenuation of EHPSS. In addition, sHA could potentially be used to differentiate dogs with EHPSS from dogs with other liver diseases.

Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016-2019)

OBJECTIVES

The aim of this study was to document survival, complications and risk factors for the development of complications and mortality prior to discharge after placement of a subcutaneous ureteral bypass (SUB) device in cats.

METHODS

The medical records of cats with SUB placement between January 2016 and August 2019 were retrospectively analysed. The development of complications (overall, intraoperative, perioperative, short- and long-term complications) and risk factors for mortality prior to discharge were statistically assessed with univariate binary logistic regression. All variables with a P value ⩽0.10 in the univariate analysis were assessed in a multivariate model. Variables were significant if P <0.05.

RESULTS

Twenty-four cats were included; 12 (50.0%) received a unilateral SUB, 11 (45.8%) a bilateral nephrostomy tube with single cystostomy catheter and the remaining cat (4.2%) two unilateral SUBs. Nearly 80% of the cats developed complications, ranging from mild to fatal, including (partial) SUB obstruction (33.3% of complications), lower urinary tract infection (20.8%), pyelonephritis (20.8%) and sterile cystitis (12.5%). Five cats (20.8%) died prior to discharge. Six cats (25.0%) underwent revision surgery. The overall median survival time (MST) was 274 days (range 1-311 days). Complications were most common in the long-term period (14/16 cats), followed by the short-term (9/18 cats), perioperative (10/23 cats) and intraoperative (4/24 cats) periods. Older cats had an increased risk for developing perioperative complications (P = 0.045) and were less likely to survive to discharge (P = 0.033). An increased haematocrit at presentation was a risk factor for the occurrence of short-term complications (P = 0.03).

CONCLUSIONS AND RELEVANCE

Although complications similar to those previously described were observed, the complication rate was higher and the MST shorter than previously reported in cats undergoing SUB placement. Despite good short-term survival, the development of complications may necessitate regular and intensive control visits. Owners that consider SUB placement should be informed that follow-up can be strenuous and expensive.

The effect of closed-incision negative pressure wound therapy on clinical and ultrasonographic seroma formation and wound healing following forequarter amputation in large dogs - a randomized pilot trial

This pilot study aimed at evaluating whether closed-incision negative pressure wound therapy (ciNPWT) has an effect on seroma formation and wound healing following forequarter amputation in dogs above 20 kg. Twelve client-owned dogs weighing more than 20 kg, presented for forequarter amputation, were randomly assigned after surgery into two groups (six ciNPWT and six controls with soft-padded bandage, both bandages applied for three days). A clinical and ultrasonographic control (newly developed scoring system) was performed at bandage removal (three days postoperatively) and ten days, postoperatively. A postoperative seroma was present in 4/6 dogs in the ciNPWT group and in 5/6 dogs in the control group. There were no apparent differences in the ultrasonographic scores or subcutis measurements at three versus ten days, postoperatively. The results of this pilot trial do not support expansion to a larger-scale study evaluating ciNPWT after forequarter amputation in dogs.

Epiglottic retroversion in nine dogs

Epiglottic retroversion (ER) is an uncommon and poorly understood disorder of the upper respiratory tract in small breed dogs. In this retrospective study, perioperative characteristics, surgical technique, outcome, and complications in nine dogs that underwent surgical treatment for ER and/or concurrent upper respiratory tract disorders, were evaluated. The most frequently reported clinical symptoms were chronic intermittent inspiratory stridor (89%), exercise intolerance (78%), and dyspnea (67%). Concurrent respiratory disorders were highly prevalent (78%). Five dogs initially underwent a temporary epiglottopexy and two a permanent epiglottopexy. In two dogs, both suffering from concurrent laryngeal paralysis, only a unilateral cricoarytenoid lateralization was performed. After initial clinical improvement, temporary and permanent epiglottopexy eventually failed in 4/6 dogs (67%) that were available for follow-up, necessitating partial epiglottectomy as revision surgery. This resulted in a successful long-term outcome in 5/6 of these dogs (83%). In the dogs with primary ER or in cases where the presence of secondary ER led to significant respiratory symptoms, partial epiglottectomy as a primary surgical technique appeared to be a more permanent treatment option than epiglottopexy. Both dogs with surgically corrected concurrent laryngeal paralysis without epiglottopexy or epiglottectomy showed clinical improvement. This might indicate that, in case of secondary ER, positive results can be achieved after management of the underlying respiratory disorder.

Development of a non-functional pancreatic neuroendocrine tumor and a duodenal ulceration after cholecystoduodenostomy in a cat

A six-year-old Ragdoll with previous extrahepatic biliary tract obstruction due to cholangiohepatitis, treated with cholecystoduodenostomy, was presented for acute vomiting, hyporexia, and weight loss. Abdominal ultrasound examination revealed randomly distributed hepatic nodules and dilated biliary ducts. Gastroduodenoscopy showed a patent cholecystoduodenostoma but disclosed a perforated duodenal ulceration. Conversion to celiotomy revealed extensive liver pathology, a discrete pancreatic nodule, and a duodenal ulcer opposite to the cholecystoduodenostoma. The cat was euthanized intra-operatively and necropsy was performed. The intrahepatic biliary tract of the right liver lobes was obstructed and severely dilated, whereas bile from the left lobes drained through the cholecystoduodenostoma. Histopathologic diagnoses were a primary pancreatic tumor, positive for glucagon on immunohistochemistry, with liver metastases, chronic purulent cholecystitis, and duodenal ulceration. To the authors’ knowledge, this is the first report in which the development of pancreatic neoplasia is described in a cat with a history of biliary tract disease.

First robot-assisted radical prostatectomy in a client-owned Bernese mountain dog with prostatic adenocarcinoma

OBJECTIVE

To describe robot-assisted radical prostatectomy (RARP) and report the short-term outcome of a dog with prostatic cancer treated with RARP.

STUDY DESIGN

Case report ANIMALS: Client-owned 6-year-old male-neutered Bernese mountain dog.

METHODS

Robot-assisted radical prostatectomy was performed with a daVinci Si Surgical System through a transperitoneal approach. An interfascial nerve-sparing approach was used to preserve the neurovascular bundles and increase the likelihood of postoperative urinary continence. Urinary continence was assessed by placing white cloth bedding in the kennel during hospitalization and by owners' observation at home.

RESULTS

The console time was 120 minutes, and the estimated intraoperative blood loss was 30 mL. No intraoperative complications were observed. The urinary catheter was removed after 7 days, at which point the dog urinated normally. Peritoneal carcinomatosis was diagnosed 43 days after surgery, and the dog was euthanized.

CONCLUSION

Robot-assisted radical prostatectomy was successfully completed in a dog with prostatic neoplasia and led to postoperative urinary continence.

CLINICAL SIGNIFICANCE

This single-case report provides evidence to justify further evaluation of RARP in dogs with prostatic neoplasms.

Preliminary safety and imaging efficacy of the near-infrared fluorescent contrast agent DA364 during fluorescence-guided surgery in dogs with spontaneous superficial tumors

Tumor-targeting contrast agents may facilitate resection of solid neoplasms during fluorescence-guided surgery. Preliminary safety and imaging efficacy of the near-infrared fluorescent probe DA364 were evaluated during surgical resection of spontaneous solid tumors in 24 dogs. Intra-operative imaging was performed in situ and on excised specimens to evaluate fluorescence intensities of tumor and adjacent tissues. After standard-of-care tumor resection, the wound bed was imaged again, and additional tissue was excised if residual fluorescence was detected.

DA364 was well tolerated after intravenous administration. The median tumor-to-background ratio in situ for mammary tumors, mast cell tumors and sarcomas was 1.8 (range 1.2–3.9), 2.2 (range 1.0–5.6), and 4.2 (range 2.0–4.3), respectively. Qualitative intra-operative tumor identification was feasible in half of the cases. Remaining fluorescence was detected in four wound beds that contained residual disease, and in11 tumor-free wound beds, confirmed by histopathology.

Overall, DA364 did not raise safety concerns and showed accumulation in different types of spontaneous tumors, showing potential to pinpoint residual disease. Larger clinical trials are necessary to select accurate dosing and imaging protocols for specific indications to evaluate the sensitivity and specificity of the agent.

Liver function tests in dogs with congenital portosystemic shunts and their potential to determine persistent shunting after surgical attenuation

Portosystemic shunts (PSS) are congenital or acquired vascular anomalies that cause blood to bypass the liver. Liver function tests, such as fasting ammonia, ammonia tolerance test, and (paired) serum bile acids, are reliable for the diagnosis of PSS in dogs. Surgical attenuation is a common treatment for congenital PSS. Following surgical attenuation, it is useful to evaluate shunt closure. In this critical review, the ability of liver function tests to determine the presence and degree of residual shunting following surgical attenuation of canine PSS is discussed. Despite the availability of several liver function tests, a single rapid, simple, cost-effective, sensitive and specific test to evaluate surgical attenuation of PSS is not available.

Prevalentie van urolithiasis en andere urinaire afwijkingen bij honden met een congenitale extrahepatische portosystemische shunt

Honden met een portosystemische shunt (PSS) vertonen vaak urinaire afwijkingen. In deze retrospectieve studie werd de prevalentie van urolithiasis en andere urinewegklachten secundair aan extrahepatische (EH)PSS nagegaan vanaf het optreden van de eerste klachten tot en met de dag van de chirurgische correctie van de EHPSS. Enerzijds werd 67% van de onderzochte honden aangeboden met urinewegklachten die rechtstreeks (39%) of waarschijnlijk (28%) verband hielden met EHPSS. Zo werden sommige honden chirurgisch behandeld voor urolithiasis, waarna via kwantitatieve steenanalyse ammoniumbiuraat-urolieten vastgesteld werden, wat de aanwezigheid van een onderliggende PSS deed vermoeden. Anderzijds bleek 77% van de honden zonder urinewegklachten toch abnormaliteiten te vertonen op medische beeldvorming en/ of het urinewegonderzoek. In totaal werden er bij 70,4% van de honden urolieten vastgesteld. In dit onderzoek wordt het belang aangetoond van het uitvoeren van een volledig urineonderzoek aangevuld met medische beeldvorming van het urinaire stelsel bij alle honden met EHPSS. Daarnaast wordt de meerwaarde van een kwantitatieve steenanalyse beklemtoond, opdat bij aanwezigheid van ammoniumbiuraat aan een mogelijke PSS wordt gedacht.

Fluorescence-guided surgery using indocyanine green in dogs with superficial solid tumours

BACKGROUND

Near-infrared fluorescence (NIRF) imaging is a relatively novel technique that can aid surgeons during intraoperative tumour identification.

METHODS

Nine canine oncology patients (five mammary gland tumours, three mast cell tumours and one melanoma) received intravenous indocyanine green (ICG). After 24 hours, tumours were resected and fluorescence intensities of tumours and surroundings were evaluated. Additional wound bed tissue was resected if residual fluorescence was present after tumour resection. Ex vivo, fluorescence-guided dissection was performed to separate tumour from surrounding tissue.

RESULTS

Intraoperative NIRF-guided tumour delineation was feasible in four out of nine dogs. Wound bed imaging after tumour removal identified nine additional fluorescent lesions, of which four contained tumour tissue. One of these four true positive in vivo lesions was missed by standard-of-care inspection. Ex vivo fluorescence-guided tumour dissection showed a sensitivity of 72 per cent and a specificity of 80 per cent in discriminating between tumour and surrounding tissue.

CONCLUSION

The value of ICG for intraoperative tumour delineation seems more limited than originally thought. Although NIRF imaging using ICG did identify remaining tumour tissue in the wound bed, a high false positive rate was also observed.

Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs

BACKGROUND

The aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS).

METHODS

Retrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included.

RESULTS

None of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67).

CONCLUSION

Blood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.

Comparative accuracy and precision of two commercial laboratory analyzers for the quantification of ammonia in cerebrospinal fluid

BACKGROUND

Hyperammonemia is one of the contributing factors of hepatic encephalopathy (HE). Although blood ammonia concentrations are frequently measured in patients suspected of HE, systemic levels do not necessarily reflect the amount of ammonia in the central nervous system. Measuring ammonia in cerebrospinal fluid (CSF) can help to understand HE better and potentially improve the diagnosis and follow-up of patients with HE.

OBJECTIVES

The objectives of this technical report were to evaluate the accuracy and precision of two commercial blood ammonia analyzers (Catalyst Dx, CatDX and Pocket Chem BA, PocBA) to measure CSF ammonia concentrations.

METHODS

A pool of normal equine CSF was spiked with concentrated ammonia, and a series of six spiked samples were measured in parallel with both CatDx and PocBA.

RESULTS

CatDx and PocBA data correlated excellently with but differed significantly from the spiked ammonia concentrations. These differences were smaller when ammonia CSF concentrations were measured with the PocBA than with the CatDx. In addition, values obtained with the PocBA were more precise than those measured with the CatDx, especially for low ammonia concentrations.

CONCLUSION

This in-house comparative study shows that ammonia concentrations in spiked equine CSF correlate well with those measured by two commercial blood ammonia analyzers. Nevertheless, concentrations obtained with the PocBA are more accurate and more precise than those obtained with the CatDx, making the former device the preferred choice for clinical veterinary applications.

Treatment of congenital extrahepatic portosystemic shunts in dogs: A systematic review and meta-analysis

Background

Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence‐based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs.

Objectives

To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques.

Animals

Not used.

Methods

A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta‐analysis was performed.

Results

Forty‐eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant.

Conclusions and Clinical Importance

The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.

Development of surgical site infections despite perioperative antimicrobial therapy in two dogs

Surgical site infections (SSI) are common complications with a prevalence of 0.8 to 18%. Many risk factors, such as patient, environmental and treatment factors can contribute to the development of SSI. Two dogs that developed a SSI after forelimb amputation are discussed. The first dog was presented with an open comminuted intra-articular fracture of the right elbow. The second dog was diagnosed with a soft-tissue sarcoma at the right elbow. Perioperative cefazolin was administered in both patients. Only in the first patient, antimicrobial therapy was continued in the postoperative period. Both dogs developed an SSI within four to five days postoperatively. Yet, prophylactic antimicrobials can help to prevent SSI, provided that the correct antimicrobial is used at the correct dose, at the right time and given IV. Factors, such as hypothermia, violating the Halsted’s principles and the number of people present in the theater may increase the risk of SSI. Besides the meticulous use of antimicrobials, perioperative management is thus also important in SSI prevention.

Effect of the Bone Morphogenetic Protein-2 Doses on the Osteogenic Potential of Human Multipotent Stromal Cells- Containing Tissue Engineered Constructs

IMPACT STATEMENT

A strategy for improving the efficacy of stem cell-based bone tissue engineering (TE) constructs is to combine bone morphogenetic protein-2 (BMP-2) with multipotent stromal cells (MSC). Previous studies on the potential cooperative effect of BMP-2 with human multipotent stromal cells (hMSCs) on bone formation in vivo have, however, shown contradictory results likely due to the various and/or inappropriate BMP-2 doses. Our results provided evidence that the addition of BMP-2 at low dose only was beneficial to improve the osteogenic potential of hMSCs-containing TE constructs, whereas BMP-2 delivered at high dose overcame the advantage of combining this growth factor with hMSCs. This new knowledge will help in designing improved combination strategies for tissue regeneration with better clinical outcomes.

Closed incision management with negative pressure wound therapy after forelimb amputation in a dog

A four-year-old male castrated German shepherd dog was presented with severe left front leg lameness due to a fibrosarcoma lateral to the elbow. The ill-defined mass was not amendable to wide local excision and a curative-intent limb amputation was performed. Immediately postoperatively, closed incision management with negative pressure wound therapy (NPWT) was applied to minimize the risk of postoperative complications. The incision line was covered with a PrevenaTM dressing attached to a NPWT pump set at a continuous negative pressure of -125 mmHg. The dressing was removed 72 hours later. No wound complications were evident and further healing was unremarkable.

Initial Management of Traumatic Wounds

When traumatic wounds are quickly and accurately treated, morbidity and costs can be significantly decreased. Several factors, such as time delay between injury and treatment, the degree of contamination, extension and depth of the wound, and the mechanism of injury, influence the treatment and prognosis and stress the importance of a patient-specific approach. Although all traumatic wounds are contaminated, antibiotic therapy is seldom required if correct wound management is installed.

Chirurgische behandeling van een sublinguale sialocoele (ranula) bij een kat

In deze casuïstiek wordt een zeven jaar oude, mannelijke, gecastreerde, Europese korthaar met een ranula beschreven. De patiënt werd aangeboden vanwege een sublinguale zwelling aan de rechterkant die chirurgisch werd behandeld door middel van marsupialisatie en excisie van de mandibulaire en sublinguale speekselklieren. Histopathologisch onderzoek van de verwijderde weefsels bevestigde de diagnose van een ranula en toonde de onopzettelijke resectie van de rechter submandibulaire lymfeknopen. Vijf maanden na de ingreep werden er geen complicaties of recidieven vastgesteld.