Prospective Evaluation of Low-Fat Diet Monotherapy in Dogs with Presumptive Protein-Losing Enteropathy.

For dogs with protein-losing enteropathy (PLE) and evidence of lymphangiectasia, the efficacy of low-fat diet as monotherapy or combined with prednisone remains poorly characterized. In this prospective, observational cohort study of 14 dogs with presumptive PLE and ultrasonographic evidence of lymphangiectasia, subjects were placed on various low-fat diets as monotherapy and prednisone was added if response was deemed inadequate. Dogs were assessed and scored at four recheck examinations across a 6 mo study period, including a final recheck ultrasound. Clinical and clinicopathologic variables were collected and dogs were divided into three outcome groups: clinical remission on dietary monotherapy (LOF); clinical remission on dietary therapy plus immunosuppressive prednisone (LOP); and treatment failure (TXF). Eleven of 14 dogs were in clinical remission at the study end date (6 mo after enrollment): 6 LOF dogs and 5 LOP dogs. LOF dogs achieved a significant reduction in Canine Chronic Enteropathy Clinical Activity Index score and a significant increase in serum albumin within 2 wk of beginning dietary monotherapy. Four of 11 dogs in remission also had ultrasonographic evidence of resolution of linear striations. Low-fat diet appears to be an effective monotherapy in some dogs with presumptive PLE and ultrasonographic evidence of lymphangiectasia.

Presumptive non-cirrhotic bleeding esophageal varices in a dog.

An 8-year-old male American Staffordshire terrier was admitted for evaluation of chronic episodes of ptyalism and hematemesis after exercise. Abnormalities were not detected on routine clinicopathological tests, thoracic radiography, and abdominal ultrasonography. Endoscopic examination revealed a labyrinthine network of severely distended, hemorrhagic esophageal blood vessels. Computed tomography angiography demonstrated a network of para-esophageal vessels that communicated with the celiac artery caudally and the brachiocephalic trunk cranially, consistent with a diagnosis of non-cirrhotic esophageal varices. This is a report of exercise, ptyalism, and hematemesis secondary to presumptive, non-cirrhotic, bleeding esophageal varices in a dog.

Chloride:Sodium Ratio May Accurately Predict Corrected Chloride Disorders and the Presence of Unmeasured Anions in Dogs and Cats.

Disorders of chloride and mixed acid-base disturbances are common in veterinary emergency medicine. Rapid identification of these alterations and the presence of unmeasured anions aid prompt patient assessment and management. This study aimed to determine in dogs and cats if site-specific reference values for [Cl-]:[Na+] ratio and [Na+] - [Cl-] difference accurately identify corrected chloride abnormalities and to evaluate the predictive ability of the [Cl-]:[Na+] ratio for the identification of unmeasured anions. A database containing 33,117 canine, and 7,604 feline blood gas and electrolyte profiles was generated. Institution reference intervals were used to calculate site-specific reference values for the [Cl-]:[Na+] ratio and the [Na+] - [Cl-] difference. Contingency tables were used to assess the ability of these values to correctly identify corrected chloride disorders. Unmeasured anions were estimated by calculating strong ion gap (SIG). Continuous variables were compared using the Mann-Whitney U test. Correlations between continuous variables were assessed using Spearman's rho (rs). In dogs, site-specific reference values for the [Cl-]:[Na+] ratio correctly identified 94.6% of profiles as hyper-, normo-, or hypochloremic. For dogs with normal sodium concentrations, site-specific reference values for the [Na+] - [Cl-] difference correctly identified 97.0% of profiles. In dogs with metabolic acidosis (base deficit > 4.0), [Cl-]:[Na+] ratio and SIG were moderately but significantly negatively correlated (rs -0.592, P < 0.0001). SIG was significantly greater in dogs with metabolic acidosis and hypochloremia compared to those without hypochloremia (P < 0.0001). In cats, site-specific reference values for the [Cl-]:[Na+] ratio correctly identified 93.3% of profiles as hyper-, normo-, or hypochloremic, while site-specific reference values for [Na+] - [Cl-] difference correctly identified 95.1% of profiles. In cats with metabolic acidosis [Cl-]:[Na+] ratio and SIG were moderately significantly negatively correlated (rs -0.730, P < 0.0001). SIG was significantly greater in cats with metabolic acidosis and hypochloremia compared to those without hypochloremia (P < 0.0001). Site-specific values for [Cl-]:[Na+] ratio and [Na+] - [Cl-] difference accurately identify corrected chloride disorders in both dogs and cats and may aid identification of the presence of unmeasured anions.

Influence of Salmonella status on the long-term outcome of horses after colic surgery.

OBJECTIVE: To compare long-term outcome of Salmonella-positive versus Salmonella-negative horses discharged from hospital after colic surgery. STUDY DESIGN: Retrospective case-control. ANIMALS: Horses discharged from the hospital after colic surgery. For each horse with positive culture for Salmonella enterica (SAL-POS, n = 59), at least 2 horses testing negative for S. enterica (SAL-NEG, n = 119) were enrolled. METHODS: Owners were interviewed via phone at least 12 months after surgery regarding: (1) complications after discharge from the hospital; (2) duration of survival; and (3) return to prior or intended use. Association between immediate postoperative clinical variables such as Salmonella status and long-term measures of outcome was tested via ratios (odds ratio [OR]) and 95% confidence intervals. Data were analyzed for survival using a Cox proportional hazards model and for return to use using multivariable logistic regression. RESULTS: SAL-POS horses had a higher OR of surgical site infection (2.7 [1.1-6.9] P = .027) and weight loss (6.8 [1.8-26.1] P = .002). At the time of follow-up, there were 53/56 (95%) SAL-POS and 99/118 (84%) SAL-NEG horses alive. The final multivariable model for nonsurvival included postoperative colic (hazard ratio 7.6 [2.8-19.2] P = .002) and the interaction between Salmonella status and duration of rectal temperature > 103°F postoperatively (SAL-POS 1.04 [1.01-1.07] and SAL-NEG 1.16 [1.06-1.25], P = .005). The majority of horses returned to their intended use regardless of their SAL-POS (38/50, 76%) or SAL-NEG (77/96, 80%, P = .498) status. CONCLUSION: Salmonella-positive horses that survive to discharge from the hospital after colic surgery have similar risks of long-term complications (colic/diarrhea), survival, and return to function than Salmonella-negative horses.

Intraoperative delivery of the Notch ligand Jagged-1 regenerates appendicular and craniofacial bone defects.

Each year, 33% of US citizens suffer from a musculoskeletal condition that requires medical intervention, with direct medical costs approaching $1 trillion USD per year. Despite the ubiquity of skeletal dysfunction, there are currently limited safe and efficacious bone growth factors in clinical use. Notch is a cell-cell communication pathway that regulates self-renewal and differentiation within the mesenchymal/osteoblast lineage. The principal Notch ligand in bone, Jagged-1, is a potent osteoinductive protein that positively regulates post-traumatic bone healing in animals. This report describes the temporal regulation of Notch during intramembranous bone formation using marrow ablation as a model system and demonstrates decreased bone formation following disruption of Jagged-1 in mesenchymal progenitor cells. Notch gain-of-function using recombinant Jagged-1 protein on collagen scaffolds promotes healing of craniofacial (calvarial) and appendicular (femoral) surgical defects in both mice and rats. Localized delivery of Jagged-1 promotes bone apposition and defect healing, while avoiding the diffuse bone hypertrophy characteristic of the clinically problematic bone morphogenetic proteins. It is concluded that Jagged-1 is a bone-anabolic agent with therapeutic potential for regenerating traumatic or congenital bone defects.

Disruption of thrombospondin-2 accelerates ischemic fracture healing.

Thrombospondin-2 (TSP2) is a matricellular protein that is highly up-regulated during fracture healing. TSP2 negatively regulates vascularity, vascular reperfusion following ischemia, and cutaneous wound healing. As well, TSP2-null mice show increased endocortical bone formation due to an enhanced number of mesenchymal progenitor cells and show increased cortical thickness. Mice deficient in TSP2 (TSP2-null) show an alteration in fracture healing, that is unrelated to their cortical bone phenotype, which is characterized by enhanced vascularization with a shift towards an intramembranous healing phenotype; thus, we hypothesized that there would be enhanced ischemic fracture healing in the absence of TSP2. We investigated whether an absence of TSP2 would enhance ischemic fracture healing utilizing Laser doppler, µCT and histological analysis. Ischemic tibial fractures were created in wildtype (WT) and TSP2-null mice and harvested 10, 20, or 40 days post-fracture. TSP2-null mice show enhanced vascular perfusion following ischemic fracture. At day 10 post-fracture, TSP2-null mice have 115% greater bone volume than WT mice. This is associated with a 122% increase in vessel density, 20% increase in cell proliferation, and 15% decrease in apoptosis compared to WT. At day 20, TSP2-null mice have 34% more bone volume, 51% greater bone volume fraction, and 37% more bone tissue mineral density than WT. By 40 days after fracture the TSP2-null mice have a 24% increase in bone volume fraction, but other parameters show no significant differences. These findings indicate TSP2 is a negative regulator of ischemic fracture healing and that in the absence of TSP2 bone regeneration is enhanced.

Ocular metastasis of cutaneous malignant melanoma.

BACKGROUND: Metastatic melanoma to the eye and orbit are rare. Patients at greatest risk often have disseminated metastases in the setting of advanced disease. Because the prognosis for orbital metastatic disease is poor, emphasis must be placed on early detection and prevention. Although cutaneous malignancies include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma, the majority of cases that result in metastasis, ocular morbidity, and mortality are from sebaceous cell carcinoma and malignant melanoma. CASE REPORT: A 72-year-old white woman presented emergently with a chief complaint of sudden, painless vision loss in her left eye of 2 weeks' duration. Her best-corrected visual acuities measured 20/30 in the right eye and 20/400 in the left eye with no improvement on refraction. Her systemic medical history was significant for the diagnosis of a cutaneous malignant melanoma. Examination of the left eye found grade II disc edema with all other posterior pole and peripheral structures intact and unremarkable. Magnetic resonance imaging confirmed the diagnosis of metastatic lesions involving structures of the left orbit ultimately causing reduced visual ability. The patient opted to avoid aggressive care and "hope for the best." Denying significant medical intervention, the woman lived in hospice where she died 6 months later. CONCLUSION: The primary care optometric setting, by the way a patient's visual symptoms present or the appearance of fundus abnormalities, can offer the capability of first detection and referral for the discovery of metastatic lesions. Although orbital metastasis is considered a terminal finding in these cases, timely diagnosis enables, while limited, the best options for management.