Tuesday, April 30, 2013

Fatores de risco para vazamento após anastomose intestinal em cães e gatos / Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases

 cover


Abstract
July 1, 2003, Vol. 223, No. 1, Pages 73-77
doi: 10.2460/javma.2003.223.73

Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000)

Dr. S. Christopher RalphsDVM, MS Carl R. JessenDVM, PhD, DACVR Alan J. LipowitzDVM, MS, DACVS
Department of Surgery, College of Veterinary Medicine, University of Minnesota, St Paul, MN 55108. (Ralphs, Jessen, Lipowitz); Present address is Pittsburgh Veterinary Specialists, 882 Butler St, Pittsburgh, PA 15223. (Ralphs)
Objective
To identify factors associated with leakage following intestinal anastomosis in dogs and cats.

Design
Retrospective study.

Animals
90 dogs and 25 cats.

Procedure
Medical records of all dogs and cats that underwent intestinal resection and anastomosis between 1991 and 2000 were reviewed, and information on 27 factors was recorded.

Results
Anastomotic leakage was identified in 13 of the 90 dogs but in none of the 25 cats. Preoperative factors significantly associated with development of anastomotic leakage in dogs included preoperative peritonitis, serum albumin concentration, a left shift, and indication for surgery (dogs with intestinal foreign bodies were more likely to have leakage than dogs that underwent surgery for any other cause). Postoperative and case management factors significantly associated with development of leakage included duration of hospitalization, supplemental alimentation, whether the dog ate the day after surgery, blood product administration, and outcome (died vs survived). Discriminant analysis was performed, and dogs with 2 or more of the following factors were predicted to develop anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration ≤ 2.5 g/dL. The model accurately predicted whether leakage would develop in 67 of 80 (84%) dogs.

Conclusions and Clinical Relevance
Results suggest that a variety of factors may be associated with development of intestinal anastomotic leakage in dogs. In particular, dogs with 2 or more of the following risk factors are predicted to be at high risk for developing anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration ≤ 2.5 g/dL. (J Am Vet Med Assoc 2003; 223:73–77)

Thursday, April 25, 2013

Ocorrência de hipertensão sistêmica em cães com lesão renal aguda e seu tratamento com amlodipina / Occurrence of systemic hypertension in dogs with acute kidney injury and treatment with amlodipine besylate


Occurrence of systemic hypertension in dogs with acute kidney injury and treatment with amlodipine besylate

  1. C. A. Geigy1,†
  2. A. Schweighauser1
  3. M. Doherr2
  4. T. Francey1
Article first published online: 14 JUN 2011
DOI: 10.1111/j.1748-5827.2011.01067.x
Journal of Small Animal Practice

Journal of Small Animal Practice

Volume 52Issue 7pages 340–346July 2011

Objectives: To describe the occurrence of systemic hypertension in dogs with acute kidney injury and the efficacy of amlodipine besylate for its treatment.
Methods: This retrospective study included 52 dogs with acute kidney injury (2007 to 2008) grouped based on the use of amlodipine in their treatment. Systemic blood pressure was measured with an oscillometric device at admission, before, during, and after amlodipine therapy.
Results: Occurrence of systolic systemic hypertension (≥160 mmHg) and severe systolic systemic hypertension (≥180 mmHg) was 37% and 15% at admission and increased with hospitalisation to 81% and 62%, respectively. Twenty-two dogs were treated with amlodipine, at a median daily dosage of 0·38 mg/kg (interquartile range 0·28 to 0·49) divided in one to two applications per day. Amlodipine therapy was associated with a decrease in systolic systemic blood pressure of 24 mmHg (12 to 34) and a correction of severe systemic hypertension in 10 of 11 dogs within 24 hours. Overall, 73% of the dogs survived with a significantly lower proportion of survivors in treated compared to non-treated dogs (59% versus 83%, respectively, P=0·05).
Clinical Significance: Results of this study reveal that systemic hypertension is common in canine acute kidney injury and that treatment with amlodipine is beneficial in reducing systemic hypertension. The potential effect of amlodipine on global outcome requires prospective assessment.

Tuesday, April 23, 2013

Prognóstico da instalação da insuficiência cardíaca congestiva em cães com degeneração de valva mitral: O estudo PREDICT / Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study



Volume 14, Issue 1, March 2012, Pages 193–202
The Mitral Valve

Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study




Abstract

Objective

To identify risk factors for first-onset congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD).

Animals

Eighty-two dogs with and without CHF secondary to DMVD were retrospectively assigned to a derivation cohort. Sixty-five dogs with asymptomatic DMVD were recruited into a prospective validation cohort.

Methods

Variables associated with risk of CHF in dogs were identified in a derivation cohort and used to construct a predictive model, which was then prospectively tested through longitudinal examination of a validation cohort.

Results

Logistic regression analysis of the derivation cohort yielded a predictive model that included the left atrial to aortic root dimension ratio (LA:Ao) and plasma concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP). When this model was prospectively applied to the validation cohort, it correctly predicted first-onset of CHF in 69.2% of cases. Analysis of the validation cohort revealed that plasma NT-proBNP concentration and indexed left ventricular end-diastolic diameter (LVIDd:Ao) were independent risk factors for development of first-onset CHF in dogs with DMVD (NT-proBNP ≥1500 pmol/L, odds ratio (OR), 5.76, 95% confidence interval (CI), 1.37–24.28, P = 0.017; LVIDd:Ao ≥3, OR, 6.11, 95% CI, 1.09–34.05,P = 0.039).

Conclusions

Measures of left heart size and plasma NT-proBNP concentration independently estimate risk of first-onset of CHF in dogs with DMVD. These parameters can contribute to the management of dogs with DMVD.

Keywords

  • Natriuretic peptide
  • Mitral regurgitation
  • BNP
  • Full-size image (18 K)
  • Monday, April 22, 2013

    Dados ecocardiográficos e sobrevida de cães com insuficiência cardíaca congestiva causada pela doença da valva mitral e tratada com múltiplas drogas / Survival and echocardiographic data in dogs with congestive heart failure caused by mitral valve disease and treated by multiple drugs: A retrospective study of 21 cases

    Logo of canvetj

    Can Vet J. 2011 November; 52(11): 1219–1225.PMCID: PMC3196016

    Survival and echocardiographic data in dogs with congestive heart failure caused by mitral valve disease and treated by multiple drugs: A retrospective study of 21 cases


    Abstract

    This retrospective study reports the survival time [onset of congestive heart failure (CHF) to death from any cause] of 21 dogs with mitral regurgitation (MR) and CHF treated with a combination of furosemide, angiotensin-converting enzyme inhibitor (ACEI, benazepril, or enalapril), pimobendan, spironolactone, and amlodipine. Baseline echocardiographic data: end-systolic and end-diastolic volume indices (ESVI and EDVI), left atrium to aorta ratio (LA/Ao), and regurgitant fraction (RF) are reported. Median survival time (MST) was 430 d. Initial dosage of furosemide (P = 0.0081) and LA/Ao (P = 0.042) were negatively associated with survival. Baseline echocardiographic indices (mean ± standard deviation) were 40.24 ± 16.76 for ESVI, 161.48 ± 44.49 mL/m2 for EDVI, 2.11 ± 0.75 for LA/Ao, and 64.71 ± 16.85% for RF. Combining furosemide, ACEI, pimobendan, spironolactone, and amlodipine may result in long survival times in dogs with MR and CHF. Severity of MR at onset of CHF is at least moderate.
    Table 3
    Figure 2
    Figure 1


    Estudo retrospectivo de 153 casos de colapso, sincope ou intolerância ao exercício não diagnosticados / A retrospective study of 153 cases of undiagnosed collapse, syncope or exercise intolerance


    A retrospective study of 153 cases of undiagnosed collapse, syncope or exercise intolerance: the outcomes

    1. L. Barnett1
    2. M. W. S. Martin2
    3. J. Todd3
    4. S. Smith4
    5. M. Cobb1
    Article first published online: 22 DEC 2010
    DOI: 10.1111/j.1748-5827.2010.01013.x
    Journal of Small Animal Practice

    Journal of Small Animal Practice

    Volume 52Issue 1pages 26–31January 2011

    Objectives: To retrospectively assess the long-term outcome for dogs that were presented with collapse, syncope or exercise intolerance for which an underlying cause is not identified.
    Methods: The clinical records of animals presenting to two practices were assessed. Dogs which presented for collapse, syncope or exercise intolerance at least 6 months previously and did not receive a definitive diagnosis despite investigation were included. Follow-up of these cases was carried out by conducting telephone interviews with the owners.
    Results: One hundred and fifty-three cases were successfully followed up. Clinical signs had resolved in 64 cases (42%), 35 dogs (23%) were continuing to exhibit clinical signs, although 22 of these had improved without medical intervention. In 17 cases (11%), a diagnosis had subsequently been made or treatment was being administered and 37 dogs (24%) had died. Of the deaths, 18 (12%) were considered to be related to the original presentation. The overall prevalence of death and deterioration related to the problems investigated was 16·2% of cases. Death in boxers was significantly more common than in other breeds (36%).
    Clinical Significance: Death and deterioration are uncommon outcomes for dogs other than boxers presenting with collapse, syncope and exercise intolerance for which a definitive diagnosis cannot be made.


    Wednesday, April 17, 2013

    Desmame da ventilação mecânica / Weaning from mechanical ventilation



    Volume 15, Issue 3, August 2000, Pages 157–164
    Critical Care

    Weaning from mechanical ventilation

    • From the Veterinary Medical Teaching Hospital, and Department of Surgery and Radiological Sciences, University of California, Davis, Davis, CA, USA

    • Patients that require positive pressure ventilation to maintain sufficient alveolar ventilation or pulmonary gas exchange may eventually reach a point in the course of their care wherein mechanical ventilation is no longer necessary. This process of transferring the work of breathing from the ventilator back to the patient is referred to as ventilator weaning. The term “ventilator weaning” may be used to refer to all methods by which this transfer of workload may be accomplished. In many patients, particularly those with short-lasting or readily correctable causes of respiratory insufficiency (eg, general anesthesia), the discontinuation of positive pressure ventilation may be easily achieved. Indeed, in patients awakening from general anesthesia, the axiom “awake enough to blink, awake enough to breath” may prove to be a sufficient guideline. However, in those patients requiring long-term mechanical ventilatory support, the process can prove to be both frustrating and exceptionally challenging. It is of crucial importance to identify those patients that may be successfully weaned because of both the financial impact of prolonged intensive care unit hospitalization and the risks imposed on the patient by the process of positive pressure ventilation. To be able to predict which patients may be ready to be weaned from the ventilator requires an understanding of the balance between the work of breathing (ventilatory load) and the ability of the patient's respiratory pump to meet those needs (ventilatory capacity). The management of patients experiencing difficulty during the weaning process requires that the clinician recognize imbalances between ventilatory load and capacity and to correct these imbalances once identified.

    Tuesday, April 16, 2013

    Lesões orais associadas a intubação orotraqueal em cães criticamente enfermos submetidos a ventilação mecânica / Oral lesions associated with orotracheal administered mechanical ventilation in critically ill dogs


    Oral Lesions Associated with Orotracheal Administered Mechanical Ventilation in Critically III Dogs

    1. Mack Fudge DVM, MPVM1
    2. Jamie G. Anderson DVM, MS2,†
    3. Janet Aldrich DVM1,
    4. Steve C. Haskins DVM, MS3,*
    Article first published online: 1 JUL 2007
    DOI: 10.1111/j.1476-4431.1997.tb00047.x
    Journal of Veterinary Emergency and Critical Care

    Journal of Veterinary Emergency and Critical Care

    Volume 7Issue 2pages 79–87July 1997

    Summary

    The incidence and clinical progression of oral lesions in a cohort of critically ill patients administered mechanical ventilation via orotracheal intubation were observed prospectively in the Intensive Care Unit (ICU) of the University of California, Davis Veterinary Medical Teaching Hospital. Oral cavities of these patients were examined within 24 hours of being placed on the ventilator and at least daily thereafter during ventilator therapy. As part of the study protocol, any lesion noted was treated. Twenty-one critically ill canine patients (median age of 7 yrs; range <1 to 19 yrs) were observed from 1 January 1995 through 31 August 1995. Over ninety percent (90.5%) of the observed patients developed oral lesions subsequent to being mechanically ventilated. Erosive and ulcerative mucosal lesions were the most frequently observed (15/43) with the tongue being the most frequently involved oral structure. Most of the observed soft tissue oral lesions appeared secondary to persistently applied pressure from teeth, mouth gags, endotracheal tubes, and other monitoring devices. Efforts taken to prevent persistently applied trauma, such as periodic positional changes of equipment and padding of susceptible structures, apeared effective in preventing oral lesions. There were indications of gastric reflux in 6 patients (28.6%), as evidenced by secretions in the oral cavity with a pH of <6 and containing digested blood. Ulcerative lesions in the subset of patients with gastric reflux seemed to worsen in severity with exposure to the low pH secretions. Over the course of the study, the ICU nursing staff developed an effective protocol for the care of the oral cavity: treating mucosal erosions and ulcers topically8 with a dilute chlorhexidine solution (0.05%), removing oral secretions via suction as needed, and padding persistently traumatized tissues with glycerin moistened gauze. Oral lesions in orotrachealy intubated and mechanically ventilated patients are predictable, preventable, and treatable. Most lesions are pressure induced, associated with monitoring/therapeutic equipment, and appear to be preventable with appropriate nursing protocls. Most observed oral lesions clinically improved with routine, periodic dilute chlorhexidine rinses and relief of applied pressure.

    Indicações, manejo e desfecho após ventilação por pressão positiva por períodos prolongados em cães em gatos : 148 casos /Indications, management, and outcome of long-term positive-pressure ventilation in dogs and cats: 148 cases


    Journal of the American Veterinary Medical Association cover

    January 1, 2007, Vol. 230, No. 1, Pages 64-75
    doi: 10.2460/javma.230.1.64


    Indications, management, and outcome of long-term positive-pressure ventilation in dogs and cats: 148 cases (1990–2001)

    Kate HopperBVSc, MVS, DACVECCSteve C. HaskinsDVM, DACVA, DACVECCPhilip H. KassDVM, PhD, DACVPMMarlis L. RezendeDVM, PhDJanet Aldrich,DVM, DACVECC
    Address correspondence to Dr. Hopper.
    Objective
    To determine outcome of positive-pressure ventilation (PPV) for 24 hours or longer and identify factors associated with successful weaning from PPV and survival to hospital discharge in dogs and cats.

    Design
    Retrospective case series.

    Animals
    124 dogs and 24 cats that received PPV for 24 hours or longer.

    Procedures
    Medical records were reviewed for signalment, primary diagnosis, reason for initiating PPV, measures of oxygenation and ventilation before and during PPV, ventilator settings, complications, duration of PPV, and outcome. Animals were categorized into 1 of 3 groups on the basis of the reason for PPV.

    Results
    Group 1 patients received PPV for inadequate oxygenation (67 dogs and 6 cats), group 2 for inadequate ventilation (46 dogs and 16 cats), and group 3 for inadequate oxygenation and ventilation (11 dogs and 2 cats). Of the group 1 animals, 36% (26/73) were weaned from PPV and 22% (16/73) survived to hospital discharge. In group 2, 50% (31/62) were weaned from PPV and 39% (24/62) survived to hospital discharge. In group 3, 3 of 13 were weaned from PPV and 1 of 13 survived to hospital discharge. Likelihood of successful weaning and survival to hospital discharge were significantly higher for group 2 animals, and cats had a significantly lower likelihood of successful weaning from PPV, compared with dogs. Median duration of PPV was 48 hours (range, 24 to 356 hours) and was not as-sociated with outcome.

    Conclusions and Clinical Relevance
    Results suggested that long-term PPV is practical and successful in dogs and cats.

    Monday, April 15, 2013

    O papel das citocinas pro e anti-inflamatórias na patogênese das doenças neurológicas espontâneas em caninos / The role of pro- and anti-inflammatory cytokines in the pathogenesis of spontaneous canine CNS diseases



    Review paper

    The role of pro- and anti-inflammatory cytokines in the pathogenesis of spontaneous canine CNS diseases


        Abstract

        Dogs are comparatively frequently affected by various spontaneously occurring inflammatory and degenerative central nervous system (CNS) conditions, and immunopathological processes are a hallmark of the associated neuropathology. Due to the low regenerative capacity of the CNS a sophisticated understanding of the underlying molecular basis for disease initiation, progression and remission in canine CNS diseases represents a prerequisite for the development of novel therapeutical approaches. In addition, as many spontaneous canine CNS diseases share striking similarities with their human counterpart, knowledge about the immune pathogenesis may in part be translated for a better understanding of certain human diseases. In addition to cytokine-driven differentiation of peripheral leukocytes including different subsets of T cells recent research suggests a pivotal role of these mediators also in phenotype polarization of resident glial cells. Cytokines thus represent the key mediators of the local and systemic immune response in CNS diseases and their orchestration significantly decides on either lesion progression or remission. The aim of the present review is to summarize the growing number of data focusing on the molecular basis of the immune response during spontaneous canine CNS diseases and to detail the effect of cytokines on the immune pathogenesis of selected idiopathic, infectious, and traumatic canine CNS diseases. Steroid-responsive meningitis arteritis (SRMA) represents a unique idiopathic disease of leptomeningeal blood vessels characterized by excessive IgA secretion into the cerebrospinal fluid. Recent reports have given sophisticated insights into the cytokine-driven, immune-mediated pathogenesis of SRMA that is characterized by a biased T helper 2 cell response. Canine distemper associated leukoencephalitis represents an important spontaneously occurring disease that allows investigations on the basic pathogenesis of immune-mediated myelin loss. It is characterized by an early virus-induced up-regulation of pro-inflammatory cytokines with chronic bystander immune-mediated demyelinating processes. Lastly, canine spinal cord injury (SCI) shares many similarities with the human counterpart and most commonly results from intervertebral disk disease. The knowledge of its pathogenesis is largely restricted to experimental studies in rodents, and the impact of immune processes that accompany secondary injury is discussed controversially. Recent investigations on canine SCI highlight the pivotal role of pro-inflammatory cytokine expression that is paralleled by a dominating reaction of microglia/macrophages potentially indicating a polarization of these immune cells into a neurotoxic and harmful phenotype. This report will review the role of cytokines in the immune processes of the mentioned representative canine CNS diseases and highlight the importance of cytokine/cytokine interaction as a useful therapeutic target in canine CNS diseases.
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      Sunday, April 14, 2013

      Avaliação dos fatores que afetam a taxa de filtração glomerular e marcadores indiretos da função renal em cães e gatos / Assessments of factors that affect glomerular filtration rate and indirect markers of renal function in dogs and cats

      jvms


      FULL PAPER

      Assessments of Factors that Affect Glomerular Filtration Rate and Indirect Markers of Renal Function in Dogs and Cats


      Chronic kidney disease is one of the most common disorders in dogs and cats. The plasma urea nitrogen (P-UN) and creatinine (P-Cre) concentrations are not sufficiently sensitive for early diagnosis of renal dysfunction. Although urine and plasma clearance methods allow earlier detection of reductions in the GFR, it is difficult to estimate a mildly reduced GFR from the values obtained by these methods, as they are also affected by physiological factors, such as body weight (BW) and age. The present study is a retrospective survey designed to assess the factors that affect markers of kidney function and to revaluate the clinical utility of the markers, including P-UN, P-Cre and GFR determined by plasma iohexol clearance (PCio) in dogs and cats. The P-UN, P-Cre and PCio values in dogs and the P-Cre and PCio values in cats were significantly correlated with BW (P<0.001). PCio in smaller dogs (≤ 15.0 kg) was significantly and inversely correlated with age. In smaller dogs, increase of P-UN alone might warrant a suspicion of a decreased GFR, but in contrast, P-Cre may be inefficient for detecting renal dysfunction or determining the severity of CKD compared with that in larger dogs (≥ 15.1 kg). P-Cre in larger dogs correlated better with PCio than in smaller dogs, suggesting that P-Cre in larger dogs was a more sensitive marker of reduced GFR.