Presenting signs and clinical outcome in dogs with metaphyseal osteopathy: 39 cases (2009-2018).

OBJECTIVE: To describe the presenting signs, concurrent conditions, treatment and outcome of dogs with metaphyseal osteopathy. MATERIALS AND METHODS: Multi-centre retrospective review of medical records from January 2009 to September 2018 at four referral centres to identify dogs with a radiographic diagnosis of metaphyseal osteopathy. RESULTS: Thirty-nine dogs were identified. The median age at onset was 14 weeks old (range, 8 to 32 weeks old). There was a higher proportion of male dogs (29 of 39 male entire, nine of 39 female entire, one of 39 female neutered and no male neutered dogs). Where information was available, median time from the most recent vaccination was 20 days (range, 2 to 144 days). The most commonly recorded clinical signs were pyrexia (34 of 39), lethargy (32 of 39), pain (30 of 39), and being non-ambulatory (17 of 39). Thirty-five dogs required hospitalisation for analgesia and supportive care, 19 of 39 were discharged on prednisolone (median dose 2.0 mg/kg/day; range, 0.9 to 2.6 mg/kg/day), 18 of 39 were discharged on non-steroidal anti-inflammatories, two of 39 did not receive NSAIDs or prednisolone at any time point. The median duration of hospitalisation for those admitted was 5 days (range, 1 to 21 days). Where follow-up was available, relapse occurred in eight of 25 cases before reaching skeletal maturity. At the time of metaphyseal osteopathy diagnosis, five of 39 cases had concurrent conditions. Where follow-up was available, four of 25 developed future immune-mediated conditions. CLINICAL SIGNIFICANCE: Metaphyseal osteopathy should be considered in non-ambulatory painful young dogs. Some dogs developed future immune-mediated conditions, which may support the hypothesis that metaphyseal osteopathy is an autoinflammatory bone disorder. Further studies with a larger cohort are required to determine the clinical significance of this.

Point prevalence and clinical course of proteinuria in dogs with idiopathic non-erosive immune-mediated polyarthritis.

OBJECTIVES: To describe the point prevalence and clinical course of proteinuria in dogs diagnosed with idiopathic non-erosive immune-mediated polyarthritis. MATERIALS AND METHODS: Cases presenting to a single referral centre with a diagnosis of idiopathic non-erosive immune-mediated polyarthritis were retrospectively recruited from January 2009 to August 2018. Data including signalment, urinalysis, clinicopathological results, cytology from arthrocentesis, treatment and long-term follow-up were analysed. Dogs were defined as: non-proteinuric (UPC <0.2), borderline proteinuric (UPC 0.2-0.5) or overtly proteinuric (UPC >0.5). RESULTS: Fifty-eight dogs met the inclusion criteria. Twenty-two dogs were overtly proteinuric (38%), eight dogs were borderline proteinuric (14%) and 28 dogs were non-proteinuric (48%). Repeated urinalysis was performed in nine of 12 dogs with UPC greater than 2.0. The UPC decreased in all nine dogs, with the UPC decreasing to less than 0.5 in 44% of dogs. A greater than 50% decrease in UPC was noted in 44% of dogs, despite seven of nine (77%) receiving prednisolone as either monotherapy or in conjunction with an adjunctive immunosuppressive medication. CLINICAL SIGNIFICANCE: Proteinuria was common in this cohort of dogs diagnosed with primary idiopathic non-erosive immune-mediated polyarthritis. The use of prednisolone does not appear to be contraindicated in proteinuric dogs with idiopathic non-erosive immune-mediated polyarthritis.

Diagnostic utility of canine cerebrospinal fluid preserved by 10% buffered formalin.

OBJECTIVES: To examine the diagnostic utility of canine cerebrospinal fluid samples collected into tubes containing ethylenediaminetetraacetic acid (EDTA) with and without the addition of 10% buffered formalin analysed within 6 to 20 hours. MATERIALS AND METHODS: Inclusion criteria were dogs presenting to a referral hospital with neurological signs and having cerebrospinal fluid analysis performed. Samples were submitted to an external laboratory in tubes containing ethylenediaminetetraacetic acid as paired-samples; one with the addition of one drop of 10% buffered formalin and the other without formalin. Cytology report, total nucleated cell counts, and protein concentration were reviewed. Three different categories of cell preservation were defined: diagnostic, non-diagnostic and unclassified. Each sample was included in one of these categories depending on cytological features, and the diagnostic quality between samples was compared. Samples were further divided in two groups depending on protein concentration using 50 mg/dL as cut-off value and the diagnostic quality between samples was compared. RESULTS: 254 samples from 127 dogs were included. 47% of samples without formalin were non-diagnostic, 46% diagnostic and 6% unclassified. In the formalin group, 2% samples were non-diagnostic, 92% diagnostic and 6% unclassified. Samples with formalin preservation were statistically more likely to be diagnostic than samples without formalin preservation. In both protein groups (≥50 and <50 mg/dL) formalin samples were statistically more likely to be diagnostic as well. CLINICAL SIGNIFICANCE: The addition of one drop of 10% formalin is a simple, widely available method which can help to improve the accuracy of cytological assessment in canine cerebrospinal fluid by preserving cellular morphology when analysis is performed within 6 to 20 hours.

Imerslund-Grasbeck syndrome in a cross-breed dog.

Imerslund-Gräsbeck syndrome is an autosomal recessive disease reported only in certain pure-breed dogs. An 18-month-old, male neutered beagle cross-breed was presented for evaluation of severe lethargy, progressive weakness and anorexia. Main clinicopathological findings included low body condition score (2.5/9), severe muscle atrophy, several neurological abnormalities, mild normochromic, normocytic, non-regenerative anaemia, severe hypocobalaminemia and mild proteinuria. Extensive diagnostic tests ruled out most of differential diagnoses for the aforementioned clinicopathological abnormalities and genetic evaluation showed that the dog was heterozygous for two previously described mutations affecting the CUBN gene, the beagle and the border collie variants. The dog showed an excellent clinical response to oral cobalamin supplementation with no relapse after 4 months. In conclusion, this case creates awareness that Imerslund-Gräsbeck syndrome should be considered even in mixed-breed dogs with compatible clinical signs and that two different pathogenic CUBN mutations in compound heterozygosity can lead to a typical Imerslund-Gräsbeck syndrome phenotype.

Pyrexia in juvenile dogs: a review of 140 referred cases.

OBJECTIVES: To describe the presentation, influence of previous treatment and diagnosis in juvenile dogs presenting with pyrexia to a UK referral centre. MATERIALS AND METHODS: Clinical records of dogs aged 1 to 18 months presenting with a problem list including pyrexia (≥⃒39∙2°C) that was reproducible during referral hospitalisation were retrospectively reviewed. Signalment, history - including previous treatment, clinical examination findings and diagnosis were recorded. Diagnoses were categorised as non-infectious inflammatory, infectious, congenital, neoplastic and miscellaneous. The influence of previous treatment on the ability to reach a final diagnosis was analysed. RESULTS: A total of 140 cases was identified. Diagnosis was reached in 115 cases. Non-infectious inflammatory disease was identified in 91 cases (79%), infectious disease in 19 cases (17%), a congenital disorder in four dogs (3%) and neoplasia in one dog (1%). Breeds most commonly identified were Border collies (17/140; 12%), beagles (16/140; 11%), Labrador retrievers (11/140; 8%), springer spaniels (9/140; 6%) and cocker spaniels (8/140; 6%). Before presentation, most dogs had received antibiotics (83/140; 59%), non-steroidal anti-inflammatory drugs (84/140; 60%) or steroids (9/140; 6%), either alone or in combination. Neither antibiotics nor non-steroidal anti-inflammatory drugs influenced the ability to reach a diagnosis. Steroid-responsive meningitis-arteritis comprised 55 of 91 (60%) individuals of the non-infectious inflammatory cohort. All four dogs diagnosed with congenital disorders were Border collies. CLINICAL SIGNIFICANCE: Non-infectious inflammatory disease, particularly steroid-responsive meningitis-arteritis, immune-mediated polyarthritis and metaphyseal osteopathy, was commonly diagnosed in this population of pyrexic juvenile dogs.

Neutrophil Gelatinase-Associated Lipocalin in Dogs With Sepsis Undergoing Emergency Laparotomy: A Prospective Case-Control Study.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is an early indicator of acute kidney injury (AKI) in dogs and its use has not been evaluated in dogs with sepsis. ANIMALS: Fifteen dogs with sepsis requiring laparotomy (study dogs) and 10 dogs undergoing surgery for intervertebral disc disease (control dogs). OBJECTIVE: To determine whether NGAL increases in dogs with sepsis undergoing emergency laparotomy and whether it is correlated with development of AKI and survival. METHODS: Longitudinal study conducted at a referral teaching hospital. Serum neutrophil gelatinase-associated lipocalin (sNGAL), urinary NGAL normalized to urinary creatinine concentration (UNCR), and serum creatinine concentration were measured at 4 time points (admission, after anesthesia, and 24 and 48 hours postsurgery). Development of AKI (increase in serum creatinine concentration of 0.3 mg/dL) and in-hospital mortality were recorded. Linear mixed-model analysis was employed to assess differences between groups over time. Mann-Whitney U-test was performed for comparison of continuous variables between groups and Chi square or Fisher's exact tests were used to assess correlation between discrete data. RESULTS: Serum NGAL and UNCR were significantly higher in study dogs across all time points (P = .007 and P < .001, respectively) compared with controls. Urinary NGAL normalized to creatinine in the study group was not significantly different between survivors (n = 12) and nonsurvivors (n = 3). Dogs that received hydroxyethyl starch had significantly higher UNCR across all time points (P = .04) than those that did not. DISCUSSION-CONCLUSION: Serum neutrophil gelatinase-associated lipocalin and UNCR are increased in dogs with sepsis requiring emergency laparotomy. Additional studies are needed to evaluate its role as a marker of AKI in this population.

Coagulation status in dogs with naturally occurring Angiostrongylus vasorum infection.

OBJECTIVES: Angiostrongylus vasorum infection is associated with bleeding tendencies in approximately one-third of clinical cases. The cause of the coagulopathy is poorly understood but may be related to disseminated intravascular coagulation. Thromboelastography is a global evaluation of coagulation and has not been described in a cohort of dogs with this disease. MATERIALS AND METHODS: Thromboelastography in association with other measures of coagulation including prothrombin and activated partial thromboplastin times, antithrombin percentage activity and D-dimer and von Willebrand factor concentrations was evaluated in a group of 30 dogs with A. varosum infection. RESULTS: A total of 18 dogs had signs of bleeding on physical examination. Thromboelastography was consistent with hypocoagulation in 17 of these dogs. There was no association between any of the other measures and hypocoagulation on thromboelastography. Abnormal coagulation times were not significantly associated with bleeding. Only fibrinogen concentration was significantly lower in dogs that were bleeding compared with those that were not (P = 0 · 026). D-dimer concentrations were increased in 22/25 cases in the study; however, other coagulation parameters were more variable. CLINICAL SIGNIFICANCE: Although the changes identified in this study were not consistent, there is activation of coagulation within this population, possibly consistent with an intravascular disseminated coagulopathy.

Fatal aortic oesophageal fistula following oesophageal foreign body removal in a dog.

An eight-month-old male Pomeranian was presented with hypovolaemic shock 7 days after successful oesophageal foreign body removal. On presentation the dog was anaemic and no coagulation abnormalities were detected. A fluid-filled oesophagus was visible on thoracic radiography and frank blood was aspirated from the oesophagus following oro-oesophageal intubation. Fluid resuscitation and blood transfusions were administered but attempts at stabilisation were unsuccessful and the dog died. At post-mortem examination, a 2-mm aortic oesophageal fistula was identified on the ventral aspect of the aorta at the level of heart base that communicated with the overlying oesophagus. Aortic oesophageal fistula has been reported in human medicine and occurs secondary to a number of conditions including oesophageal foreign bodies. These prove fatal without rapid stabilisation and surgery.

Prospective evaluation of complications associated with jugular venous catheter use in a veterinary hospital.

OBJECTIVES: To prospectively investigate the incidence of mechanical and infectious complications associated with the use of jugular catheters and risk factors for these complications. METHODS: Data was collected over a 6-month period and risk factors associated with the occurrence of mechanical or inflammatory complications were investigated. RESULTS: One hundred catheters were placed over a 6-month period, totalling 393 catheter days. Complications were seen in 39% of catheters with a total of 51 complications. Forty-one of these complications were mechanical. A total of 10 inflammatory or infectious complications were identified in eight catheters (a total of 0.03 infectious complications per catheter day). Complications were more likely to occur in patients requiring more than one attempt for placement and patients that were ASA status 3 to 5. Infectious complications were more likely in patients not having general anaesthesia for placement, those having medical rather than surgical disease and those placed out of theatre. No association was found between the skill of the person placing the catheter and risk of complication. CLINICAL SIGNIFICANCE: Mechanical complications are frequently associated with jugular catheter placement. Identification of risk factors for complications is important and warrants further study.

Is evaluation of a faecal smear a useful technique in the diagnosis of canine pulmonary angiostrongylosis?

OBJECTIVES: To describe a method of faecal smear production and to determine the sensitivity and specificity of faecal smear for detection of parasitic larvae using Baermann sedimentation as a gold standard. METHODS: Faecal smears were produced from samples submitted to the Royal Veterinary College Diagnostic Laboratory Service for Baermann sedimentation. An inexperienced and an experienced assessor each examined the smear for larvae for a maximum of five minutes. RESULTS: One hundred and eighty six samples were analysed of which 28 were positive for Angiostrongylus vasorum on Baermann sedimentation. The experienced assessor had a faecal smear sensitivity of 61% and a specificity of 100%. The inexperienced assessor had a faecal smear sensitivity of 54% and a specificity of 95%. CLINICAL SIGNIFICANCE: Faecal smear is an effective and cheap aid to diagnosis of canine angiostrongylosis which can be readily performed in general practice. Its use leads to a rapid detection of infection compared to other available methods. This could lead to swifter treatment of the disease and a decrease in inappropriate diagnostics. A further diagnostic method, such as Baermann sedimentation, is recommended whether the faecal smear result is positive or negative.

Evaluation of small-bore wire-guided chest drains for management of pleural space disease.

OBJECTIVES: To evaluate the efficacy and practicality of a small-bore wire-guided chest drain for management of pleural space disease in dogs and cats. MATERIALS AND METHODS: A 14 gauge chest drain was placed using a modified Seldinger technique in animals requiring ongoing management of pleural space disease. A questionnaire was used immediately after placement to collect data regarding the ease of placement, reliability and function of the drain. RESULTS: Twenty animals were enrolled in which 29 drains were placed. The most common pleural space disease encountered was pyothorax (10 of 20). Sixteen animals required sedation for placement, and 25 of 29 chest drains were inserted at the first attempt. Most drains were placed in less than 10 minutes. The median length of time of catheter use was three days. Few complications were noted during the insertion and throughout the use of the drains. Clinicians rated drain placement as "easy" in 27 of 29 times and the drain function as "good" in 24 of 29 times. CLINICAL SIGNIFICANCE: Small-bore wire-guided chest drains are an effective alternative to larger gauge drains. Only minor complications were seen during insertion of the chest drains, and their performance was deemed satisfactory in most cases.

Thirteen cases of tetanus in dogs.

The records of 13 dogs with tetanus were reviewed, 12 of the dogs survived and were discharged, but the other died as a result of the acute onset of hyperthermia. Long-term follow up was available for 10 of the survivors of which nine were reported to be normal. One case was euthanased after a cervical spine fracture four months after it was discharged. Complications encountered during management included aspiration pneumonia in three cases, urinary tract infection in two cases, and upper respiratory tract obstruction, hiatal hernia, coxofemoral luxation, seizures and respiratory arrest in one case each. None of the dogs required ventilatory support, and the complications were managed successfully. The dogs were nursed intensively and monitored carefully.