Feline musculoskeletal pain index: responsiveness and testing of criterion validity.

BACKGROUND: Progress in establishing if therapies provide relief to cats with degenerative joint disease (DJD)-associated pain is hampered by a lack of validated owner-administered assessment methods. HYPOTHESIS: That an appropriately developed subjective owner-completed instrument (Feline Musculoskeletal Pain Index-FMPI) to assess DJD-associated impairment would have responsiveness and criterion validity. ANIMALS: Twenty-five client-owned cats with DJD-associated pain. METHODS: FMPI responsiveness (ability to detect the effect of an analgesic treatment) and validity (correlation with an objective measure) were explored through a stratified, randomized, double blinded, placebo-controlled, crossover 10-week clinical study. Meloxicam was administered to effect pain relief. A linear mixed model, backward stepwise regression, and Pearson correlations were used to assess responsiveness and criterion validity with the assumption that the NSAID would increase activity. RESULTS: Positive responses of cats to placebo (P = .0001) and meloxicam treatment (P = .0004) were detected; however, the instrument did not detect any difference between placebo and meloxicam (linear mixed model), even for the high impairment cases. Percent meloxicam target dose administered, temperament, and total baseline FMPI score were covariates that most affected FMPI scores. Controlling for significant covariates, most positive effects were seen for placebo treatment. Positive treatment effects on activity were detected, but only for the cases designated as most highly impaired. CONCLUSIONS AND CLINICAL IMPORTANCE: Neither responsiveness nor criterion validity were detected by the inclusion criteria for cases in this study. The data suggest that further work is indicated to understand factors affecting activity in cats to optimize inclusion criteria.

Reliability and discriminatory testing of a client-based metrology instrument, feline musculoskeletal pain index (FMPI) for the evaluation of degenerative joint disease-associated pain in cats.

The objective of this study was to test the readability, reliability, repeatability and discriminatory ability of an owner-completed instrument to assess feline degenerative joint disease (DJD)-associated pain (feline musculoskeletal pain index, FMPI). Readability was explored using four different formulas (Flesch, Fry, SMOG and FOG) and the final FMPI instrument was produced. To assess the instrument, client-owned cats that were defined as normal (normal group) or as having DJD-associated pain and mobility impairment (pain-DJD group) were recruited. A total of 32 client-owned cats were enrolled in the study (normal, n=13; pain-DJD, n=19). Owners completed the FMPI on two occasions, 14days apart. Internal consistency (reliability) and repeatability (test-retest) were explored using Cronbach's α and weighted κ statistic, respectively. Data from the two groups were compared using analysis of covariance (controlling for age) to evaluate discriminatory ability. The FMPI was constructed with 21 questions covering activity, pain intensity and overall quality of life. It had a 6th grade readability score. Reliability of the FMPI was excellent (Cronbach's α>0.8 for all groupings of questions in normal and pain-DJD cats) and repeatability was good (weighted κ statistic >0.74) for normal and pain-DJD cats. All components of the FMPI were able to distinguish between normal cats and cats with DJD (P<0.001 for all components). This initial evaluation of the FMPI suggests that this instrument is worthy of continued investigation.

Nontraumatic rupture of an adrenal gland tumor causing intra-abdominal or retroperitoneal hemorrhage in four dogs.

Diagnosis and surgical management of intra-abdominal or retroperitoneal hemorrhage in 4 dogs with rupture of an adrenal gland tumor were determined. All 4 dogs were lethargic and weak with pale mucous membranes on initial examination. Three dogs did not have any history of clinical signs of hyperadrenocorticism or pheochromocytoma prior to examination. In 3 of the dogs, a mass in the area of the adrenal gland was identified with ultrasonography prior to surgery. All dogs developed ventricular premature contractions before or during anesthesia. Three dogs survived adrenalectomy; 1 dog was euthanatized during surgery because of an inability to achieve adequate hemostasis. The remaining 3 dogs all survived more than 5 months after surgery; 1 was euthanatized 9 months after surgery because of rupture of a hepatic mass. On the basis of these results, we suggest that hemodynamic stabilization followed by adrenalectomy is the treatment of choice for dogs with nontraumatic rupture of an adrenal gland tumor and resulting life-threatening hemorrhage.

Hepatitis B among homeless and other impoverished US military veterans in residential care in Los Angeles.

Findings are presented for a cross-sectional study of serological markers of hepatitis B virus (HBV) infection in an underserved population-impoverished veterans of the US armed forces in a Veterans Administration (VA) residential program in the US. We examine the demographic, background, and risk factors associated with HBV infection in this high-risk population. This paper presents a secondary analysis of cross-sectional survey and clinical data for 370 male veterans who were residents of a domiciliary care program for homeless veterans in Los Angeles, using chi(2), Fisher's Exact, and logistic regression analysis. About one-third (30.8%) of the sample tested positive for current or past HBV infection (ie, seropositive for either the HBV core antibody or surface antigen). After multivariate analysis, rates of HBV were significantly higher among veterans who were older, non-white, or who had a history of regular heroin use (a proxy measure for injection drug use), drug overdose, or drug detoxification treatment. The rate of current or past HBV infection among veterans in this sample (30.8%) was high compared to an estimated 5% to 8% of the general US population. Also, 3% of the sample were currently infected with HBV. Strategies for intervention include broader screening, immunization, and treatment interventions with this high-risk group.

Comparison of pharmacokinetics of fentanyl after intravenous and transdermal administration in cats.

OBJECTIVE: To compare pharmacokinetic and pharmacodynamic characteristics of fentanyl citrate after IV or transdermal administration in cats. ANIMALS: 6 healthy adult cats with a mean weight of 3.78 kg. PROCEDURE: Each cat was given fentanyl IV (25 mg/cat; mean +/- SD dosage, 7.19 +/- 1.17 mg/kg of body weight) and via a transdermal patch (25 microg of fentanyl/h). Plasma concentrations of fentanyl were measured by use of radioimmunoassay. Pharmacokinetic analyses of plasma drug concentrations were conducted, using an automated curve-stripping process followed by nonlinear, least-squares regression. Transdermal delivery of drug was calculated by use of IV pharmacokinetic data. RESULTS: Plasma concentrations of fentanyl given IV decreased rapidly (mean elimination half-life, 2.35 +/- 0.57 hours). Mean +/- SEM calculated rate of transdermal delivery of fentanyl was 8.48 +/- 1.7 mg/h (< 36% of the theoretical 25 mg/h). Median steady-state concentration of fentanyl 12 to 100 hours after application of the transdermal patch was 1.58 ng/ml. Plasma concentrations of fentanyl < 1.0 ng/ml were detected in 4 of 6 cats 12 hours after patch application, 5 of 6 cats 18 and 24 hours after application, and 6 of 6 cats 36 hours after application. CONCLUSIONS AND CLINICAL RELEVANCE: In cats, transdermal administration provides sustained plasma concentrations of fentanyl citrate throughout a 5-day period. Variation of plasma drug concentrations with transdermal absorption for each cat was pronounced. Transdermal administration of fentanyl has potential for use in cats for long-term control of pain after surgery or chronic pain associated with cancer.

Tracheal rupture in cats: 16 cases (1983-1998).

OBJECTIVE: To determine causes of tracheal rupture in cats and the mechanism of injury. DESIGN: A retrospective study was conducted to identify cats with tracheal rupture. A second study was conducted to establish mechanism of injury, and a third study was conducted to determine volume of air needed to obtain an airtight seal when inflating the cuff of an endotracheal tube in a cat. ANIMALS: 16 cats with clinical signs of tracheal rupture, 10 cat cadavers, and 20 clinically normal cats that were undergoing anesthesia. PROCEDURES: Details were extracted from medical records of 16 cats with tracheal rupture (9 treated surgically and 7 treated conservatively). For the cadaver study, the trachea of each cat cadaver was intubated and observed during overinflation of the endotracheal tube cuff. For clinically normal cats, volume of air needed to obtain an airtight seal for the endotracheal tube was recorded. RESULTS: Most ruptures were associated with cats anesthetized for dental procedures. Clinical signs associated with tracheal rupture included subcutaneous emphysema, coughing, gagging, dyspnea, anorexia, and fever. Tracheoscopy was the method of choice for documenting tracheal rupture. Surgical and conservative management were successfully used, unless the injury extended to the carina. In the cadaver study, overinflation of the endotracheal tube cuff with > 6 ml of air resulted in tracheal rupture in 7 of 10 cadavers. For clinically normal cats, the volume of air (mean +/- SD) needed to obtain an airtight seal was 1.6 +/- 0.7 ml. CLINICAL IMPLICATIONS: Overinflation of an endotracheal tube cuff may result in tracheal rupture in cats.

Abnormalities of the thoracic bellows: stress fractures of the ribs and hiatal hernia.

The thoracic bellows mechanism consists of the rib cage and the diaphragm. The purpose of this study was to determine if nontraumatically acquired lesions of the bellows were secondary to underlying disease. Abnormalities of the bellows, specifically stress fractures of the ribs and hiatal hernia, were found in 21 dogs and cats with underlying cardiopulmonary disease, neuromuscular disease, or metabolic disease. A case-control study of Bulldogs demonstrated that hiatal hernia was associated with the more severe manifestations of brachycephalic syndrome. Stress fractures occurred mostly in females and in cats, and involved multiple ribs. Fractures were usually related to severe respiratory effort, but also occurred in association with metabolic disease. Hiatal hernia was also associated with severe respiratory effort, but may be exacerbated if a neuromuscular disorder affecting the diaphragm is present. Abnormalities of the thoracic bellows, such as rib stress fractures and hiatal hernia, may be signs of underlying disease, rather than being primary causes of disease.

Radiation therapy and surgery for fibrosarcoma in 33 cats.

Thirty-three cats with histologically confirmed fibrosarcomas were treated with radiation therapy followed by surgery. The median (95% confidence interval) disease free interval and overall survival were 398 (261,924) and 600 (lower limit 515) days, respectively. There were 19 treatment failures; 11 cats had only local recurrence, 4 cats developed metastatic disease, 3 cats had local recurrence followed by metastasis, and 1 cat developed simultaneous local and distant disease. Twelve cats are alive and disease free. Two cats died without evidence of treatment failure. The presence of tumor cells at the margin of resected tissue after radiation was the only variable which influenced treatment success. The median (95% confidence interval) disease free interval in 5 cats with tumor cells at the margin of the resected specimen was 112 (94,150) days versus 700 (lower limit 328) days for 26 cats with negative tumor margins, p < 0.0001. We did not identify a relationship between tumor volume, number of prior tumor excisions, concomitant use of chemotherapy or various descriptors of the radiation therapy technique and disease free interval.

Comparison of transdermal fentanyl and intramuscular oxymorphone on post-operative behaviour after ovariohysterectomy in dogs.

The effects of transdermal fentanyl and i.m. oxymorphone on behavioural and physiological responses, after ovariohysterectomy in dogs, were investigated. The study involved three groups of 10 dogs: fentanyl/surgery (FS), oxymorphone/surgery (OS), fentanyl/control (FC). A transdermal fentanyl delivery system (50 microg hour(-1)) (FS and FC) was applied 20 hours before surgery, or i.m. oxymorphone (OS) was administered. After ovariohysterectomy (FS and OS) or anaesthesia alone (FC), dogs were continuously videotaped for 24 hours and a standardised hourly interaction with a handler performed. The videotapes were analysed, and interactive and non-interactive behaviours evaluated. In addition, pain and sedation scores, pulse and respiratory rates, rectal temperature, arterial blood pressure, plasma cortisol and plasma fentanyl concentrations were measured. This study showed that transdermal fentanyl and i.m. oxymorphone (0.05 mg kg(-1)) produced comparable analgesic effects over a 24 hour recording period. I.m. oxymorphone produced significantly more sedation and lower rectal temperatures than transdermal fentanyl. There were no significant differences between groups in respiratory and heart rates, and arterial blood pressures.

Use of colostomy to manage rectal disease in dogs.

OBJECTIVE: The purpose of this study was to develop a diverting colostomy technique for use in dogs. STUDY DESIGN: Clinical case series. ANIMALS: Five client-owned dogs presented for diseases requiring diverting colostomy during treatment. METHODS: Diverting colostomy was performed in five dogs. A ventral approach was used in the first dog and the colon was exteriorized adjacent to the linea alba. The technique used in the next four dogs involved creation of a left flank rod-supported loop colostomy in which the colon was exteriorized through a muscle-separating flank approach to the abdomen. RESULTS: Peritoneal leakage of fecal material resulted in the perioperative death of the first dog. The flank colostomies were maintained for times ranging form 3.5 weeks to 7 months. No major complications were observed, but skin excoriation occurred occasionally around the stoma sites in all dogs. CONCLUSION: Diverting colostomy is a technique that is suitable for use in treatment of dogs with obstruction or leakage involving the distal colon or rectum.

Management of osteoarthritis in cats.

OA is a disease of the geriatric cat. Clinical signs include weight loss, anorexia, depression, urinating outside the litter box, poor grooming, and lameness. Radiographs, synovial fluid analysis, and synovial biopsy are used to distinguish this disease from the various forms of inflammatory arthritis that affect the cat. Management consists mainly of environmental manipulation. Aspirin, butorphanol, corticosteroids, and nutritional supplements are used for chronic treatment of painful OA in cats.

Vestibulovaginal stenosis in dogs: 18 cases (1987-1995).

OBJECTIVE: To evaluate vestibulovaginal stenosis in dogs. DESIGN: Retrospective study. ANIMALS: 18 dogs with vestibulovaginal stenosis diagnosed between January 1987 and June 1995. PROCEDURE: Signalment, results of physical examination, and diagnostic testing, treatment, and outcome were analyzed. RESULTS: Mean age at initial examination was 4.6 years. Problems reported by the owners included signs of chronic urinary tract infection (6 dogs), urinary incontinence (4), failure to mate (4), signs of chronic vaginitis (2), and inappropriate urination (1). One dog did not have evidence of a clinical problem. Vestibulovaginal stenosis was detected by means of digital vaginal examination (18/18 dogs), vaginoscopy (17/17 dogs), and positive-contrast vaginography (9/10 dogs). Bacteria were isolated from the urine of 11 of 15 dogs. Twelve of 18 dogs were treated. Manual dilation (4 dogs) and T-shaped vaginoplasty (4) were less successful than vaginectomy (2) or resection of the stenotic area (3). Four of 6 dogs with signs of recurrent urinary tract infection underwent surgical correction, and none of these dogs subsequently had urinary tract infection. Three of 4 dogs with urinary incontinence responded to medical or surgical treatment for sphincter incompetence or for ectopic ureters. CLINICAL IMPLICATIONS: Surgical correction of vestibulovaginal stenosis is indicated in dogs that have mating difficulties or signs of recurrent urinary tract infection or chronic vaginitis, but stenosis is probably an incidental finding in most dogs with urinary incontinence. Vaginectomy and vaginal resection and anastomosis are the preferred surgical options.

Effect of ovariohysterectomy on maintenance energy requirement in cats.

OBJECTIVE: To determine whether maintenance energy requirement (MER) to maintain stable body weight (BW) is substantially lower for spayed female cats than for sexually intact female cats and to assess whether an equation commonly used to estimate MER would accurately predict caloric need in spayed cats. DESIGN: Prospective study. ANIMALS: 10 spayed and 5 sham-operated young adult female cats. PROCEDURE: During an acclimatization period, initial daily food allowance was determined by estimating MER as 1.4 x (30 x BW + 70), then adjusted weekly to maintain BW within 200 g of baseline. Ovariohysterectomy (OHE) or sham laparotomy was performed at week 7, and the study was continued for 15 additional weeks (period 1). To correct for a presumptive effect of continued musculoskeletal growth that resulted in some cats becoming unacceptably thin during period 1, the study was repeated over an additional 10 weeks (period 2), using a new estimate of MER calculated from BW measured after reestablishing normal body condition. RESULTS: Substantial restriction in food allowance was necessary to prevent BW gain in the OHE group during both periods. Caloric intake of spayed cats in dietary balance was significantly lower than that of control cats at the end of each study period. Sexually intact cats appeared to self-regulate food intake, whereas spayed cats tended to eat all food available to them. Significant differences were not detected between OHE and control groups in observations of physical activity before or after surgery. The equation used to predict caloric needs overestimated the apparent MER for spayed and sexually intact cats. CLINICAL IMPLICATIONS: Ad libitum feeding of spayed cats may be inadvisable, and careful monitoring of food allowance, relative to body condition, is suggested to prevent excessive weight gain.

Disposition of transdermally administered fentanyl in dogs.

OBJECTIVE: To evaluate the disposition of fentanyl after i.v. and transdermal administrations. The hypothesis was that transdermal administration of fentanyl would result in a measurable plasma opioid concentration. DESIGN: Each dog received 2 treatments in a randomized, crossover design. ANIMALS: 6 clinically normal Beagles. PROCEDURE: 2 treatments consisting of i.v. fentanyl (50 micrograms/kg of body weight) and transdermal fentanyl (50 micrograms/h) administrations. Plasma fentanyl concentrations were measured at fixed times, and pharmacokinetic values were calculated. RESULTS: Intravenous pharmacokinetics of fentanyl was similar to those previously described in dogs and provided the distribution and clearance data necessary to calculate the rate of absorption of the transdermally administered opioid. The transdermal fentanyl patch produced average steady-state concentrations of 1.6 ng/ml. The actual rate of delivery of transdermal fentanyl was 35.7 (range, 13.7 to 49.8) micrograms/h, which represented 71.48% (range, 27.45 to 99.56%) of the theoretical rate of delivery. The mean elimination half-life of fentanyl after patch removal was 1.39 hours. CONCLUSIONS: Transdermally administered fentanyl resulted in fairly constant plasma concentrations, in the range generally considered to be analgesic, from 24 to 72 hours after application of the patch. The rate of drug delivery was less than expected, and there was substantial individual variation. CLINICAL RELEVANCE: Transdermally administered fentanyl has the potential to be a clinically useful analgesic regimen in dogs, and further evaluation of its analgesic actions and potential side effects warranted

Nonendoscopic antegrade percutaneous gastrostomy: the effect of preplacement gastric insufflation on tube position and intra-abdominal anatomy.

Nonendoscopic tube gastrostomy was performed on 47 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum.