Mandibular metastasis of a prostatic carcinoma in a dog.

Skeletal metastasis is a common finding in dogs with prostatic carcinoma and most frequently involves the lumbar vertebrae and pelvis. In the present report, we describe the case of a prostatic carcinoma in a 6-year-old Labrador retriever, who developed apparent oral sensitivity and pain within a week of initial diagnosis. Computed tomography of the skull revealed a mixed osteoproductive and osteolytic mass of the condylar process of the left mandible, and cytologic evaluation of the mass was consistent with metastatic prostatic carcinoma. To our knowledge, this is the first published report of mandibular metastasis of a prostatic carcinoma in a dog.

Precision medicine identifies a pathogenic variant of the ITGA2B gene responsible for Glanzmann's thrombasthenia in a cat.

BACKGROUND: A nonpedigreed male cat presented with epistaxis, severe bladder hemorrhage, and secondary urethral obstruction after cystocentesis. OBJECTIVES: To characterize the phenotype of a cat with bleeding diathesis and use a precision medicine approach to identify the molecular genetic defect by whole genome sequencing. METHODS: Adenosine diphosphate (ADP) and arachidonic acid (AA)-induced whole blood platelet aggregometry was performed in the affected cat and a healthy cat. Platelet activation, measured by P-selectin expression, and surface integrin subunit ß3 expression were evaluated by flow cytometry in the affected cat and healthy control. Total integrin subunit αIIb expression was assessed by western blot. Whole genome sequencing at 30× coverage was used to identify genetic variants that segregated in the affected cat compared to 194 cats from the 99 Lives Sequencing Consortium. RESULTS: Platelet aggregometry identified significant impairment in platelet aggregation in response to ADP and AA compared to the control cat. Targeted protein expression analyses by flow cytometry and immunoblot analysis determined that the surface expression and total expression of the integrin, αIIbß3, was absent. Whole genome sequencing identified a homozygous c.1986delC frameshift variant in the integrin subunit αIIb (ITGA2B) gene that was not detected in the control population. The p.Pro662fs (ITGA2B P662X) variant terminates translation of the protein at the extracellular domain of the integrin prematurely, which is predicted to affect expression of the ß3 unit. CONCLUSIONS AND CLINICAL IMPORTANCE: This novel ITGA2B variant and the associated phenotype closely resemble Glanzmann's thrombasthenia, which has never been reported in cats.

Cadaveric evaluation of fluoroscopy-assisted placement of one-lung ventilation devices for video-assisted thoracoscopic surgery in dogs.

OBJECTIVE: To evaluate the feasibility of fluoroscopy-assisted placement of one-lung ventilation (OLV) devices in dogs. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Canine cadavers (n = 8) weighing between 20.2 and 37.4 kg. METHODS: Thoracoscopic access with a two-port approach was established to evaluate bilateral lung ventilation patterns. Advancement of a left-sided Robertshaw double-lumen endobronchial tube (DLT) and the EZ-blocker (EZ) were evaluated under direct fluoroscopic guidance. Each dog also underwent bronchoscopy-assisted placement of an Arndt endobronchial blocker (EBB). Time to initial placement, success of creating complete OLV (after initial placement attempt and after up to two repositionings), and ease of placement score were recorded. Device position was evaluated bronchoscopically after each fluoroscopy-assisted placement attempt. RESULTS: Time to initial placement was significantly shorter for EZ than for DLT and EBB. The rate of successful placement after up to two repositioning attempts was 87.5%, 87.5%, and 100.0% on the right and 87.5%, 100.0%, 100.0% on the left for DLT, EZ, and EBB, respectively, and was not different between devices. Ease of placement scores were significantly higher for DLT compared with EZ and EBB on both the left and the right sides. CONCLUSION: Fluoroscopy-assisted placement of DLT and EZ appears feasible in canine cadavers. EZ-blocker placement was efficient and technically easier than DLT, but positioning must be adapted for dogs. Bronchoscopy-assisted placement of EBB remains highly successful. CLINICAL SIGNIFICANCE: Fluoroscopy-assisted placement of EZ and DLT is a useful alternative to bronchoscopy-assisted placement of these OLV devices.

Use of video capsule endoscopy to identify gastrointestinal lesions in dogs with microcytosis or gastrointestinal hemorrhage.

BACKGROUND: Video capsule endoscopy (VCE) is a noninvasive imaging modality that can identify mucosal lesions not detected with traditional endoscopy or abdominal sonography. In people, VCE is used in diagnostic and management protocols of various gastrointestinal (GI) disorders, particularly in GI bleeding of obscure origin or unexplained iron deficiency anemia (IDA). OBJECTIVE: To evaluate the utility of VCE in the identification of mucosal lesions in dogs with evidence of GI hemorrhage. ANIMALS: Sixteen client-owned dogs that underwent VCE. METHODS: Retrospective case-control study. Medical records were reviewed to include dogs with microcytosis, low normal mean corpuscular volume, or clinical GI bleeding that received VCE. RESULTS: Median age of dogs was 8.7 years (range, 8 months to 15 years) with a median weight of 21.7 kg (range, 6.9-62.5 kg). Abdominal ultrasound (16), abdominal radiography (4), and abdominal CT (1) did not identify a cause for GI blood loss. Gastric mucosal lesions were identified by VCE in 15 of 16 dogs and small intestinal lesions in 12 of 14 dogs, with 2 capsules remaining in the stomach. Endoscopy was performed in 2 dogs before VCE; 1 dog had additional small intestinal lesions identified through the use of VCE. CONCLUSIONS AND CLINICAL IMPORTANCE: Video capsule endoscopy is a minimally invasive diagnostic tool that can identify GI lesions in dogs presenting with microcytosis with or without GI hemorrhage when ultrasonography is inconclusive; however, the majority of lesions identified would have been apparent with conventional endoscopy.

Factors associated with postobstructive diuresis following decompressive surgery with placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats: 37 cases (2010-2014).

OBJECTIVE: To describe postobstructive diuresis (POD) in cats undergoing surgical placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats and to identify factors associated with duration and maximum severity of POD. DESIGN: Retrospective case series. ANIMALS: 37 client-owned cats with ureteral obstruction treated between August 2010 and December 2014. PROCEDURES: Medical records were reviewed, and data extracted included signalment, history, results from physical examinations and clinical laboratory analyses, treatment, urine output, and outcome. Data were evaluated to identify factors associated with POD duration and maximum severity, alone or in combination. RESULTS: Serum concentrations of creatinine, potassium, phosphorus, and BUN before surgery positively correlated with duration and maximum severity of POD. Absolute changes in serum concentrations of creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration. Cats with anuria before surgery had longer POD than did other cats; however, there was no difference in POD duration or maximum severity with unilateral versus bilateral ureteral obstruction. Thirty-four of 37 (92%) cats survived to hospital discharge, which was not associated with whether ureteral obstruction was unilateral or bilateral. Azotemia resolved in 17 of the 34 (50%) cats that survived to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study indicated that several factors were associated with POD duration and maximum severity, alone or in combination, and that with intensive management of fluid and electrolyte derangements, regardless of the extent of the original azotemia, a high percentage of cats survived to hospital discharge.

Multiple gastric erosions diagnosed by means of capsule endoscopy in a dog.

CASE DESCRIPTION A 6-year-old spayed female Golden Retriever was evaluated for a 2-week history of progressive hyporexia, signs of abdominal pain, and weight loss. CLINICAL FINDINGS Physical examination findings included mild signs of pain on palpation of the cranial part of the abdomen and a body condition score of 4 (scale, 1 to 9). A CBC revealed mild microcytosis and hypochromasia; results of serum biochemical analysis were within the respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Capsule endoscopy was performed, and numerous gastric erosions and hemorrhages were detected, with rare dilated lacteals in the proximal aspect of the small intestine. TREATMENT AND OUTCOME Treatment was initiated with omeprazole and sucralfate for 6 weeks, and the dog was transitioned to a novel protein diet. Capsule endoscopy was repeated at the end of the initial treatment course and revealed overall improvement, with a few small erosions remaining; medical treatment was continued for an additional 2 weeks. At last follow-up 9 months after treatment ended, the dog was clinically normal. CLINICAL RELEVANCE Capsule endoscopy was useful for initial detection and subsequent reevaluation of gastrointestinal lesions in this patient without a need for sedation or anesthesia. Information obtained in the follow-up evaluation was valuable in identifying a need to extend the duration of medical treatment.

Assessment of shock index in healthy dogs and dogs in hemorrhagic shock.

OBJECTIVE: To compare the shock index (SI) in a population of healthy dogs to a population of dogs with confirmed hemorrhagic shock. DESIGN: Retrospective analysis of data collected prospectively from 2 previous studies. SETTING: University teaching hospital. ANIMALS: Seventy-eight healthy control dogs enrolled in a study to establish a reference interval for a tissue oxygen monitor; 38 dogs with confirmed hemorrhagic shock enrolled in a study to evaluate the tissue oxygen monitor in hemorrhagic shock. The heart rate and systolic blood pressure obtained during the respective studies were used to calculate the SI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Shock index was significantly higher in the hemorrhage group (median 1.37, range 0.78-4.35) than the control group (median 0.91, range 0.57-1.53); 92% of the dogs in hemorrhagic shock had an SI of >0.91. Compared with controls, dogs in hemorrhagic shock had significantly lower body temperatures (median 38.3°C, range 35.6-39.9°C versus median 38.7°C, range 37.5-39.9°C), higher heart rates (median 150/min, range 120-220/min versus median 110/min range 80-150/min), lower systolic blood pressures (mean 112 mm Hg, SD ±35.8 mm Hg versus mean 125 mm Hg, SD ±21.5 mm Hg), higher lactate concentrations (median 0.51 mmol/L, range 0.078-1.41 mmol/L versus median 0.11 mmol/L, range 0.033-0.33 mmol/L), and lower hemoglobin concentrations (median 81 g/L, range 56-183 g/L versus median 162.5 g/L, range 133-198 g/L). CONCLUSIONS: Shock index is a simple and easy calculation that can be used as an additional triage tool and should prompt further investigation for hemorrhage if the values are >0.9.

Vascular anatomy of the proximal ulna.

PURPOSE: To describe the intraosseous arterial anatomy of the proximal ulna. METHODS: We used 9 fresh-frozen, above-elbow amputations to map the intraosseous arterial supply using the Spalteholtz technique. We treated 3 additional above-elbow amputations similarly, and then dissected them to map the extraosseous arterial supply. We recorded the extraosseous arterial patterns and compared them with the intraosseous arterial findings. RESULTS: The intraosseous arterial supply to the proximal ulna is derived primarily from a large nutrient vessel, a branch of the ulna artery, entering the anterior cortex of the ulna distal to the coronoid base, and from 2 medium-sized branches of the posterior and medial arcade entering near the olecranon tip. A watershed area is seen between these 2 vessel groups, halfway between the tips of the olecranon and coronoid. CONCLUSIONS: The arterial supply of the proximal ulna is relatively consistent and flows in opposite directions from the 2 separate areas.

Sleep aid toxicosis in dogs: 317 cases (2004-2010).

OBJECTIVE: To summarize the signalment, clinical signs observed, time to onset of clinical signs, duration of clinical signs, and the outcome in a large case series of nonbenzodiazepine sleep aid ingestions in dogs, including 2 sleep aids that have not been previously described in the veterinary literature. DESIGN: Retrospective study conducted between 2004 and 2010. SETTING: An animal poison control center based out of Bloomington, MN. ANIMALS: During this time frame, 453 cases were identified involving 467 dogs. Of these cases, 150 cases were excluded due to incomplete medical records, multipet households, or the inability to calculate a dose exposure. A total of 317 dogs with presumed sleep aid medication toxicosis were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Records of dogs with sleep aid medication toxicosis identified by a review of an animal poison control center electronic database were evaluated. The most common sleep aid medications ingested were zolpidem (240/317 [75.7%]), eszopiclone (62/317 [19.5%]), and zaleplon (15/317 [4.7%]). Overall, clinical signs developed in 36% of patients (115/317), while 64% (202/317) remained asymptomatic. The most common organ systems affected and clinical signs seen involved the central nervous system (eg, agitation, sedation) and gastrointestinal tract (eg, anorexia, hypersalivation, vomiting). CONCLUSIONS: Overall, the prognosis for dogs with sleep aid medication toxicosis was excellent, and no fatalities were reported in this clinical population. As significant clinical signs can still be seen with ingestion, appropriate decontamination is warranted in asymptomatic patients via emesis or gastric lavage, followed by activated charcoal administration. Symptomatic patients should be hospitalized for monitoring and supportive care for a minimum of 12 hours or until clinical signs resolve.

Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis.

UNLABELLED: Revision total knee arthroplasty in patients with rheumatoid arthritis can be challenging. We asked whether we could confirm previously reported high failure rates following revision total knee arthroplasty in patients with rheumatoid arthritis. We therefore determined the Knee Society knee score and function scores, radiographic evidence of failure, and overall survival of the revision procedure in these patients. We retrospectively reviewed 39 patients with rheumatoid arthritis who underwent 45 TKA revisions from 1994 to 2006. Twenty-seven of the 45 TKA revisions were for mechanical failure of the prosthetic components and 18 for infection. Five of the 27 knees (19%) revised for mechanical failure subsequently failed a second time. Five of the 18 patients who underwent revision for infection died within 6 months and three of the remaining knees failed secondary to reinfection. Excluding the knees that failed, the average Knee Society knee score and function score improved in both subgroups. Two knees had radiographic evidence of nonprogressive tibial radiolucencies. The probability of survival for all knees (revision as the end point) was 76% +/- 9% at 5 years. We confirmed the previously reported high mortality and subsequent failure rates following revision total knee arthroplasty for both mechanical issues and infection in patients with rheumatoid arthritis and emphasize the potential difficulties in treating these patients. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.