Evaluation of coagulation parameters in dogs with gallbladder mucoceles.

BACKGROUND: Gallbladder mucocele (GBM) is a common biliary disorder in dogs. Limited information is available on the coagulation status of dogs with GBM. HYPOTHESIS/OBJECTIVES: To determine patterns of coagulation alterations in dogs with GBM and correlate them with clinicopathologic abnormalities and ultrasonographic findings of disease severity. ANIMALS: Twenty-three dogs with GBM identified on ultrasound examination were prospectively enrolled. METHODS: At the time of GBM identification, blood and urine were collected for CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time (aPTT), factor VIII, protein C (PC), von Willebrand's factor (vWF), antithrombin activity, fibrinogen, D-dimers, and thromboelastrography (TEG). Gallbladder mucoceles were classified into ultrasound types 1 to 5. Medical records were reviewed for clinical presentation, underlying conditions and to determine if systemic inflammatory response syndrome (SIRS) was present. RESULTS: Based on TEG parameters, maximal amplitude, and G, 19/23 (83%) of dogs with GBM had evaluations consistent with hypercoagulability. On plasma-based coagulation testing, dogs with GBM had increased total PC activity (20/23, 87%), fibrinogen (9/23, 39%), platelet count (9/23, 39%), and D-dimers (6/15, 40%) as well as prolongations in aPTT (9/22, 41%) and low vWF activity (5/21, 24%). No correlation was found between TEG G value and any coagulation or clinical pathology variables, ultrasound stage of GBM or disease severity as assessed by the presence of SIRS. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with ultrasonographically identified GBM have changes in whole blood kaolin-activated TEG supporting a hypercoagulable state although traditional plasma-based coagulation testing suggests that a complex state of hemostasis exists.

Complications associated with a flash glucose monitoring system in diabetic cats.

OBJECTIVES: Glucose monitoring is an integral part of diabetes management. Interstitial glucose monitoring systems are increasingly commonly being used for this purpose in dogs and cats, including the use of a flash glucose monitoring system (FGMS). The aim of this study was to describe the incidence and nature of complications associated with the use of an FGMS in diabetic cats. METHODS: The medical records of all cats that had placement of a 14-day FGMS during a 1-year period were retrospectively reviewed. Data retrieved included the number of days the sensor remained attached and functional, location of sensor placement and complications associated with the sensor. Complications were defined as early sensor detachment, sensor failure prior to the end of the 14-day monitoring period and dermatologic changes at the sensor site. Descriptive statistics were used to characterize the data. RESULTS: Twenty cats had a total of 33 FGMSs placed. The majority (30/33 [91%]) of sensors were placed over the dorsolateral aspect of the thorax just caudal to the scapula. Twenty (61%) FGMSs remained attached and functional for the full 14 days. The overall incidence of complications associated with FGMS use was 10/33 (30%). The most frequent complication was early sensor detachment (n = 5/33 [15%]). Mild dermatologic changes (erythema, crusts) were noted with 4/33 (12%) FGMSs. More serious complications (skin erosions, abscess formation) were noted with 2/33 (6%) FGMSs. CONCLUSIONS AND RELEVANCE: The use of the FGMS is relatively safe in cats, although there are potential complications that owners should be made aware of.

Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs.

BACKGROUND: Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE: To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS: One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS: Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS: Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE: Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats.

OBJECTIVES: Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. METHODS: The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. RESULTS: All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. CONCLUSIONS AND RELEVANCE: PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

Quantitative and qualitative assessment of university students' definitions of binge drinking.

This study was designed to assess undergraduates' (N = 424) definitions of binge drinking and to evaluate whether the number of drinks they said comprise a binge varied as a function of beverage type, respondent gender, and respondent binge drinking status. When asked to designate the specific number of drinks that comprise a binge for each of four beverage types, students reported that the number of beers constituting a binge was significantly larger than the number of glasses of wine, shots of hard liquor, and servings of any combination of alcoholic beverage types; men reported that a larger number of drinks constitute a binge than did women; and those who had engaged in 3 or more binges in the past 2 weeks reported that more drinks comprise a binge than those who had binged less often. Responses to an open-ended question asking their definition of a binge revealed that students sometimes characterize a binge in terms of motivations for and unhealthy consequences of drinking, in addition to defining a binge as comprising consumption of a large amount of alcohol in a limited (though often unspecified) time period. Furthermore, students attributed their open-ended definitions of binge drinking to informal sources of information and observation of others' drinking almost as often as they did to school-based or media-based sources. This suggests that educators might look for innovative ways to use both formal and informal social networking, and video illustrations of restrained drinking, as ways to influence young people's views of binge drinking.

Assessing university students' self-efficacy to employ alcohol-related harm reduction strategies.

OBJECTIVE: Develop and evaluate key psychometric properties of a self-report questionnaire specifically designed to assess student drinkers' self-confidence to employ a variety of strategies intended to reduce unhealthy consequences of high-risk drinking. METHODS: Four hundred ninety-eight participants rated their confidence (from "not at all confident" to "completely confident") to employ 17 harm reduction strategies when drinking. RESULTS: Factor analysis and internal consistency reliability analyses indicated that the 17 items constitute a single scale with good test-retest reliability. Consistent with other research examining previous use of such strategies, women in our sample reported significantly higher harm reduction self-efficacy than did men. Harm reduction self-efficacy was also associated with reported number of high-risk drinking episodes in the previous 2 weeks. CONCLUSION: This brief and easily administered questionnaire holds promise as a clinical tool to identify individuals with low harm reduction self-efficacy and as an outcome measure for health promotion and educational interventions.

Measuring university students' self-efficacy to use drinking self-control strategies.

Using a Web-based, self-administered questionnaire, we assessed 498 university-student drinkers' self-efficacy to use 31 different behavioral strategies to reduce excessive drinking in each of three different locations (bar, party, own dorm/apartment). Averaging all 31 items within each drinking situation to create a single scale score revealed high internal consistency reliabilities and moderate inter-item correlations. Testing the association of self-efficacy with drinking location, sex, and frequency of recent binge drinking, we found that respondents reported higher self-efficacy to use these strategies when drinking in their own dorm/apartment than when drinking in bars and at parties; women reported higher mean self-efficacy than men; and drinkers who engaged in 3-or-more binges in the previous 2 weeks reported lower self-efficacy than those who reported either 0 or 1-or-2 binges in the same time period. This questionnaire could be used to identify self-efficacy deficits among clients with drinking problems and as an outcome measure to assess the degree to which interventions influence reported confidence to use specific drinking-reduction strategies in high-risk drinking situations.