Tuesday, June 25, 2013

Avaliação do valores iniciais de lactato como preditor da necrose gástrica e valores subsequentes como preditores de mortalidade em cães com dilatação e vólvulo gástrica / Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003–2007)

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003–2007)

  1. Tiffany I. Green DVM, 
  2. Caroline C. Tonozzi DVM, DACVECC, 
  3. Rebecca Kirby DVM, DACVIM, DACVECC, 
  4. Elke Rudloff DVM, DACVECC
Article first published online: 28 JAN 2011
DOI: 10.1111/j.1476-4431.2010.00599.x
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 21Issue 1pages 36–44February 2011

Abstract

Objective – To test whether an initial plasma lactate≥6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival.
Design – Retrospective study over a 5-year period (2003–2007).
Setting – Urban private referral small animal teaching hospital.
Animals – Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements.
Interventions – None.
Measurements and Main Results – There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate≥6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by≥50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by≥50% from the initial blood lactate.
Conclusion – The results of this study indicate that an initial presenting plasma lactate concentration≥6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations≥50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.


Tuesday, June 18, 2013

Avaliação preliminar da comparação entre a relação SpO2/FIO2 e PaO2/FIO2 em cães / Preliminary evaluation of the utility of comparing SpO2/FiO2 and PaO2/FiO2ratios in dogs

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Preliminary evaluation of the utility of comparing SpO2/FiO2 and PaO2/FiO2ratios in dogs

  1. Janine M. Calabro DVM, DACVECC1,*,
  2. Jennifer E. Prittie DVM, DACVIM, DACVECC1
  3. Douglas A. Palma DVM, DACVIM2
Article first published online: 26 APR 2013
DOI: 10.1111/vec.12050
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 23Issue 3pages 280–285May/June 2013





Keywords:

  • ARDS;
  • ALI;
  • blood gas analysis;
  • noninvasive;
  • pulse oximetry

Abstract

Objective

To determine whether the ratio of pulse oximetry saturation/fraction of inspired oxygen (SpO2/FiO2, [SF]) correlates with the ratio of partial pressure of oxygen in arterial blood/FiO2 (PaO2/FiO2, [PF]) in dogs.

Design

Prospective, observational pilot study.

Setting

Urban tertiary veterinary referral center.

Animals

Thirty-eight client-owned dogs requiring assessment of oxygenation.

Interventions

None.

Measurements and Main Results

Arterial blood gas analysis with co-oximetry was performed on samples obtained from the dorsal pedal artery. Median SpO2 was 91.5% (range 80–97%) and median PaO2 was 70.1 mmHg (range 44.5–103.8 mmHg). Hypoventilation was uncommon and venous admixture was the predominant cause of hypoxemia in this population. Median SF was 435.7 (range 381.0–461.9) and median PF was 334.0 (range 211.9–494.3). Nine dogs (23.6%) had PF <300; no dogs had PF below 200. SF and PF were correlated (ρ = 0.618, P < 0.01).

Conclusions

SF and PF in dogs spontaneously breathing room air have good correlation, suggesting that SF may be a useful, noninvasive surrogate for PF when assessing oxygenation in canine patients. Further studies are warranted to confirm and validate this relationship in spontaneously breathing and mechanically ventilated dogs on varying levels of FiO2 and to assess the ability of SF to predict outcome.


Wednesday, June 12, 2013

Riscos potenciais, indicadores prognosticos, diagnostico e modalidades terapeuticas que afetam a sobrevida de cães com suposta pneumonia aspirativa / Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005–2008)

Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005–2008)

  1. Kelly M. Tart DVM, 
  2. Danielle M. Babski DVM,
  3. Justine A. Lee DVM, DACVECC
Article first published online: 11 MAY 2010
DOI: 10.1111/j.1476-4431.2010.00542.x
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 20Issue 3pages 319–329June 2010

Abstract

Objective – To evaluate a clinical population of dogs diagnosed with presumptive aspiration pneumonia (AP) and determine diagnostic and treatment modalities contributing to survival.
Design – Retrospective study.
Setting – A university veterinary teaching hospital in an urban setting.
Animals – One hundred and twenty-five dogs with presumed AP treated from 2005 to 2008.
Interventions – None.
Measurements and Main Results – Dogs with presumptive AP identified by a review of medical records had an overall survival of 81.6% (102/125). Male large-breed dogs (mean 24.9 kg; 82/125) were overrepresented and were more likely to develop AP in this study population. Recent anesthesia had been performed in 16% (20/125), and vomiting was reported in 64% (80/125). The most common radiographic findings were a predominantly alveolar pattern (187/272, [68.8%] total lung lobes) in the right middle lung lobe (80/115, [69.6%]). A mean of 2 lung lobes were involved radiographically, and the relationship between survival and the number of lung lobes affected was statistically significant (P=0.04). Neutrophilia with a left shift was common with no significant change on consecutive daily evaluations. The mean PaO2 was 77.7 mm Hg (SD, 17.5 mm Hg) (range, 40.7–100 mm Hg) with a median alveolar-arterial gradient of 41.1 mm Hg (range, 8.1–81.8 mm Hg). In this study population, 37.6% (47/125) of dogs had microbial cultures performed and of these, 76.6% (36/47) were positive for growth; Escherichia coli (38.8%), Mycoplasma spp. (21.3%), Pasturella spp. (19.1%), and Staphylococcusspp. (17%) were the most common isolates in either single or multiagent infections. No treatment modality was statistically associated with increased survival. Colloid therapy was a negative prognostic indicator.
Conclusions – In this study the overall prognosis for AP was good. Patients with only 1 affected lung lobe appeared more likely to survive. Supportive treatment modalities are warranted for the hospitalized patient, although no individual treatment method was found to be clearly superior to others.
Table 5.   Treatment modalities evaluated between survivors and nonsurvivors
Treatment modalitySurvivors (n=102)Nonsurvivors (n=23)P-values
  • *
    P-value <0.05 was considered statistically significant.
Oxygen45 (44.1%)15 (65.2%)0.08
Ampicllin51 (50%)14 (60.9%)0.34
Ampicillin-sulbactam43 (42.2%)8 (34.8%)0.77
Enrofloxacin66 (64.7%)16 (69.6%)0.67
Cefazolin7 (6.9%)0 (0%)0.44
Colloids8 (7.8%)8 (34.8%)0.001*
Nebulization60 (58.8%)11 (47.8%)0.53
Coupage57 (55.9%)11 (47.8%)0.68
Famotidine54 (52.9%)13 (56.5%)0.84
Sucralfate26 (25.5%)6 (26%)0.89
Metoclopramide28 (27.5%)8 (34.8%)0.62
Dolasetron8 (7.8%)5 (21.7%)0.10
Glucocorticoids14 (13.7%)4 (17.4%)0.92


Table 3.   Relationship between pulmonary infiltrate and survival
 Nonsurvivors with radiographs (n=19)Survivors with radiographs (n=96)P-value
  • *
    P-value <0.05 was considered statistically significant.
1 lobe3 (15.8%)44 (45.8%) 
>1 lobe16 (84.2%)52 (54.2%)0.03*
2 lobes9 (47.4%)31 (32.3%) 
>2 lobes7 (36.8%)21 (21.9%)0.37
Radiograph

Tuesday, June 4, 2013

Manejo e desfecho de gatos com cálculo ureteral / Management and outcome of cats with ureteral calculi

 cover
Abstract
                                               March 15, 2005, Vol. 226, No. 6, Pages 937-944
doi: 10.2460/javma.2005.226.937

Management and outcome of cats with ureteral calculi: 153 cases (1984–2002)

Andrew E. KylesBVMS, PhD, DACVS Elizabeth M. HardieDVM, PhD, DACVS Brent G. WoodenDVM Christopher A. AdinDVM, DACVS Elizabeth A. StoneDVM, MS, DACVS Clare R. GregoryDVM, DACVS Kyle G. MathewsDVM, MS, DACVS Larry D. CowgillDVM, PhD, DACVIM Shelly VadenDVM, PhD, DACVIMThomas G. NylandDVM, DACVR Gerald V. LingDVM

Objective
To determine outcome of medical and surgical treatment in cats with ureteral calculi.

Design
Retrospective study.

Animals
153 cats.

Procedure
Medical records were reviewed. Owners and referring veterinarians were contacted for follow-up information.

Results
All cats were initially treated medically before a decision was made to perform surgery. Medical treatment included parenteral administration of fluids and diuretics to promote urine production and passage of the ureteral calculus and supportive treatment for renal failure. Ureteral calculi in the proximal portion of the ureter were typically removed by ureterotomy, whereas ureteral calculi in the distal portion of the ureter were more likely to be removed by partial ureterectomy and ureteroneocystostomy. Ureterotomy could be performed without placement of a nephrostomy tube for postoperative urine diversion. Postoperative complication rate and perioperative mortality rate were 31% and 18%, respectively. The most common postoperative complications were urine leakage and persistent ureteral obstruction after surgery. Chronic renal failure was common at the time of diagnosis and continued after treatment, with serum creatinine concentration remaining greater than the upper reference limit in approximately half the cats. Twelve-month survival rates after medical and surgical treatment were 66% and 91%, respectively, with a number of cats dying of causes related to urinary tract disorders, including ureteral calculus recurrence and worsening of chronic renal failure.

Conclusions and Clinical Relevance
Results suggest that medical and surgical management of ureteral calculi in cats are associated with high morbidity and mortality rates. Treatment can stabilize renal function, although many surviving cats will continue to have impaired renal function. (J Am Vet Med Assoc 2005;226:937–944)

----------------------------------------- Surgical treatment
- - - - - - - - - - - - - - - - - - - - Medical tretament

Alterações clinicas, patológicas, radiográficas e ultrassonográficas em gatos com calculo ureteral / Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi: 163 cases (1984–2002)

 cover



Abstract
March 15, 2005, Vol. 226, No. 6, Pages 932-936
doi: 10.2460/javma.2005.226.932

Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi: 163 cases (1984–2002)

Andrew E. KylesBVMS, PhD, DACVS Elizabeth M. HardieDVM, PhD, DACVS Brent G. WoodenDVM Christopher A. AdinDVM, DACVS Elizabeth A. StoneDVM, MS, DACVS Clare R. GregoryDVM, DACVS Kyle G. MathewsDVM, MS, DACVS Larry D. CowgillDVM, PhD, DACVIM Shelly VadenDVM, PhD, DACVIMThomas G. NylandDVM, DACVR Gerald V. LingDVM
Objective
To determine clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi.
Design
Retrospective study.

Animals
163 client-owned cats.

Procedure
Medical records were reviewed, and information on signalment, history, clinical signs, and results of clinicopathologic testing and diagnostic imaging was obtained.
Results—The number of cats in which ureterolithiasis was diagnosed each year increased progressively during the study period. Clinical signs tended to be nonspecific and included inappetence, vomiting, lethargy, and weight loss. A combination of survey radiography and abdominal ultrasonography revealed ureteral calculi in 66 of 73 (90%) cats in which the diagnosis was confirmed at surgery or necropsy. Ultrasonography revealed that ureteral calculi were causing ureteral obstruction in 143 of 155 (92%) cats. One hundred thirty-four of 162 (83%) cats had azotemia, 84 of 156 (54%) had hyperphosphatemia, and 22 of 152 (14%) had hypercalcemia. Urinary tract infection was documented in 10 of 119 (8%). Fifty-eight of 76 (76%) cats with unilateral ureterolithiasis had azotemia and 33 (43%) had hyperphosphatemia, indicating impairment of renal function in the contralateral kidney or prerenal azotemia. Ultrasonographic imaging of the contralateral kidney in cats with unilateral ureteral calculi suggested that preexisting renal parenchymal disease was common in cats with ureterolithiasis. Ninety-one of 93 (98%) ureteral calculi contained calcium oxalate.

Conclusions and Clinical Relevance
Results suggest that abdominal imaging should be performed in all cats with chronic nonspecific signs or with acute or chronic renal failure to rule out ureterolithiasis. Preexisting renal disease may be common in cats with ureteral calculi. (J Am Vet Med Assoc 2005;226: 932–936)

Monday, June 3, 2013

Avaliação dos efeito da lavagem peritoneal intraoperatorio sobre a cultura bacteriana em cães com suspeita de peritonite séptica / Evaluating the effect of intraoperative peritoneal lavage on bacterial culture in dogs with suspected septic peritonitis

Logo of canvetj



Can Vet J. 2012 September; 53(9): 971–977.

Evaluating the effect of intraoperative peritoneal lavage on bacterial culture in dogs with suspected septic peritonitis

Abstract


This pilot study describes the effect of intraoperative peritoneal lavage (IOPL) on bacterial counts and outcome in clinical cases of septic peritonitis. Intraoperative samples were cultured before and after IOPL. Thirty-three dogs with presumed septic peritonitis on the basis of cytology were managed surgically during the study period. Positive pre-lavage bacterial cultures were found in 14 cases, 13 of which were a result of intestinal leakage. The post-lavage cultures showed fewer isolates in 9 cases and in 1 case became negative. The number of dogs with a decrease in the concentration of bacteria cultured from pre-lavage to post-lavage samples was not statistically significant. There was no significant effect of the change in pre- to post-lavage culture, single versus multiple types of bacteria, selection of an appropriate empiric antimicrobial on survival or the need for subsequent surgery.



Saturday, June 1, 2013

Mecanismos pro-trombóticos e terapia anticoagulante em cães com anemia hemolitica imunomediada / Prothrombotic mechanisms and anticoagulant therapy in dogs with immune-mediated hemolytic anemia

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Prothrombotic mechanisms and anticoagulant therapy in dogs with immune-mediated hemolytic anemia

  1. Linda Kidd DVM, PhD, DACVIM1,*
  2. Nigel Mackman PhD, FAHA2
Article first published online: 28 JAN 2013
DOI: 10.1111/j.1476-4431.2012.00824.x
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 23Issue 1pages 3–13January/February 2013

Keywords:

  • aspirin;
  • clopidogrel;
  • hemostasis;
  • heparin;
  • microparticle;
  • tissue factor

Abstract

Objective

To review the pathophysiology of thrombosis in hemolytic disease, and the efficacy of thromboprophylaxis in dogs with immune-mediated hemolytic anemia (IMHA).

Data Sources

Computerized searches of Pubmed, INDEX VETERINARIUS, and the journal database of the Veterinary Information Network, and a manual search of bibliographies of published manuscripts.

Human Data Synthesis

Experimental data suggest that hemolysis leads to the induction of the potent procoagulant tissue factor on monocytes and endothelial cells and subsequent activation of coagulation. In addition, damaged red cells, activated platelets, and small cell-derived membrane vesicles called microparticles may contribute to coagulation by providing membrane surfaces containing exposed anionic phospholipids that serve as docking sites for prothrombinase (factor Va-factor Xa) and tenase (factor VIIIa–factor IXa) complexes of the coagulation cascade. Some microparticles also contain tissue factor, further fueling coagulation. Thromboprophylaxis for hemolytic disease in people primarily targets the coagulation cascade rather than platelets, as most thromboemboli are of venous rather than arterial origin. The use of unfractionated heparin is closely monitored to ensure therapeutic levels are reached.

Veterinary Data Synthesis

Thromboembolic disease is a major factor affecting survival in dogs with IMHA. It is likely that hemolysis contributes to the prothrombotic state. Thrombosis occurs in both veins and arteries, with pulmonary thromboembolism (a venous thrombus) occurring very commonly. Evidence suggests that tissue factor mediates the development of the prothrombotic state. Heparin, and the anti-platelet agents aspirin, and clopidogrel have been used for thromboprophylaxis in dogs with IMHA. However, a lack of validated therapeutic endpoints and controlled studies make it difficult to determine if survival is affected or if 1 drug is more effective than another.

Conclusions

Prospective clinical trials comparing individually adjusted heparin or other anti-coagulant drugs to anti-platelet drugs are needed to make evidence-based recommendations for thromboprophylaxis in dogs with IMHA.