Platelet function in dogs with chronic liver disease.

OBJECTIVES: To assess platelet function, buccal mucosal bleeding time and plasma von Willebrand factor concentration in dogs with chronic inflammatory and/or fibrotic liver disease and to compare results with those obtained in healthy dogs. MATERIALS AND METHODS: Preliminary study including 18 dogs with chronic inflammatory and/or fibrotic liver disease undergoing liver biopsy and 18 healthy age-matched control dogs. Platelet function was assessed by measuring closure time with the PFA-100® analyser using adenosine diphosphate (ADP) as an agonist. Buccal mucosal bleeding time, closure time and plasma von Willebrand factor antigen were measured in dogs in both groups. After undergoing ultrasound-guided needle biopsy, dogs were monitored for haemorrhage to determine if there was an association of any measurement with post-biopsy bleeding. RESULTS: The closure time was not different between the liver disease group (median 76.3; range 53 to 118.5 seconds) and control group (72.8; 57 to 89.5 seconds). The buccal mucosal bleeding time was longer in the liver disease group (median 138; range 95 to 229 seconds) than the control group (103; 63 to 200 seconds). The plasma von Willebrand factor antigen concentration was not different between the liver disease group (median 203; range 109 to 351%) and control group (165.5; 63 to 246%). CLINICAL SIGNIFICANCE: In this study, dogs with chronic necroinflammatory and/or fibrotic liver disease did not have overt, clinically relevant derangements in platelet function as assessed by buccal mucosal bleeding time, closure time and von Willebrand factor analysis. In addition, none of the dogs undergoing percutaneous ultrasound-guided biopsy in the study exhibited bleeding complications post-biopsy procedure.

Spontaneous Course of Biliary Sludge Over 12 Months in Dogs with Ultrasonographically Identified Biliary Sludge.

BACKGROUND: Biliary sludge is associated with gallbladder (GB) dysmotility and mucus hypersecretion suggesting a link between biliary sludge and the formation of GB mucoceles (GBM). If biliary sludge progresses to GBM, treatment to reduce the production and progression of sludge is warranted. HYPOTHESIS/OBJECTIVES: The objective of this study was to determine the course of biliary sludge in dogs. ANIMALS: Seventy-seven healthy, client-owned dogs ≥4 years of age screened for biliary sludge; 45 affected dogs identified. METHODS: Prospective, observational design. Serial ultrasound examinations were evaluated at 3, 6, 9, and 12 months to monitor degree of sludge based on proportion of GB filled with sludge (mild [0.01-24.4%], moderate [24.5-49.4%], moderate to severe [49.5-74.4%], severe [74.5-100%]), gravity dependency of sludge, and GB dimensions. RESULTS: After 1 year of follow-up, the degree of sludge was mild (34%), moderate (47%), moderate to severe (13%), severe (3%), or absent (3%). There was no significant difference in median degree of sludge over 1 year (P = .36). There were no significant changes in the gravity dependency of sludge over 1 year. A subset of dogs, 24%, with initial gravity-dependent sludge developed a combination of nondependent and dependent sludge. Dogs had resolved (2%), decreased (19%), static (40%), increased (29%), or recurrent (10%) sludge at the conclusion of the study. CONCLUSIONS AND CLINICAL IMPORTANCE: Biliary sludge was prevalent, affected dogs remained asymptomatic, and it rarely resolves in healthy dogs over a period of 1 year. Some dogs developed nongravity-dependent sludge within 1 year, which might indicate changes in consistency of sludge.

Histopathologic variation between liver lobes in dogs.

BACKGROUND: Biopsy of the liver evaluates a small portion of tissue, with inferences made to the entire organ. The method and number of biopsies obtained are tempered by consideration of the risks and benefits. Recommendations often include biopsy of more than one liver lobe, although the consistency of histopathology among lobes in dogs is unknown. HYPOTHESIS/OBJECTIVES: To describe the distribution of histopathologic abnormalities between liver lobes. We hypothesized that discordant results would be evenly distributed among all liver lobes. ANIMALS: Seventy dogs undergoing necropsy. METHODS: Prospective study. Liver samples were obtained from all lobes. A primary diagnosis was assigned to each liver sample based on the predominant histopathologic abnormality. RESULTS: In this population of dogs, biopsy of at least 2 liver lobes identified the predominant histologic abnormality in 98.6% of the cases. Ten (14%) of the dogs had ≤ 3 lobes in agreement and could not be assigned a predominant diagnosis. The same diagnosis was present in 6/6 lobes in 39 (56.5%) dogs, 5/6 lobes in 10 (14.5%) dogs, 4/6 lobes in 10 (14.5%) dogs, 3/6 lobes in 7 (10.1%) dogs, and 2/6 in 3 (4.3%) dogs. The number of discordant results did not differ between the liver lobes. CONCLUSION AND CLINICAL IMPORTANCE: The likelihood of obtaining a sample that is reflective of the predominant histologic abnormality in the liver is increased when multiple liver lobes are biopsied.

A comparison of liver sampling techniques in dogs.

BACKGROUND: The liver sampling technique in dogs that consistently provides samples adequate for accurate histopathologic interpretation is not known. HYPOTHESIS/OBJECTIVES: To compare histopathologic results of liver samples obtained by punch, cup, and 14 gauge needle to large wedge samples collected at necropsy. ANIMALS: Seventy dogs undergoing necropsy. METHODS: Prospective study. Liver specimens were obtained from the left lateral liver lobe with an 8 mm punch, a 5 mm cup, and a 14 gauge needle. After sample acquisition, two larger tissue samples were collected near the center of the left lateral lobe to be used as a histologic standard for comparison. Histopathologic features and numbers of portal triads in each sample were recorded. RESULTS: The mean number of portal triads obtained by each sampling method were 2.9 in needle samples, 3.4 in cup samples, 12 in punch samples, and 30.7 in the necropsy samples. The diagnoses in 66% of needle samples, 60% of cup samples, and 69% of punch samples were in agreement with the necropsy samples, and these proportions were not significantly different from each other. The corresponding kappa coefficients were 0.59 for needle biopsies, 0.52 for cup biopsies, and 0.62 for punch biopsies. CONCLUSION AND CLINICAL IMPORTANCE: The histopathologic interpretation of a liver sample in the dog is unlikely to vary if the liver biopsy specimen contains at least 3-12 portal triads. However, in comparison large necropsy samples, the accuracy of all tested methods was relatively low.

Photon blockade in the ultrastrong coupling regime.

We explore photon coincidence counting statistics in the ultrastrong coupling regime, where the atom-cavity coupling rate becomes comparable to the cavity resonance frequency. In this regime, usual normal order correlation functions fail to describe the output photon statistics. By expressing the electric-field operator in the cavity-emitter dressed basis, we are able to propose correlation functions that are valid for arbitrary degrees of light-matter interaction. Our results show that the standard photon blockade scenario is significantly modified for ultrastrong coupling. We observe parametric processes even for two-level emitters and temporal oscillations of intensity correlation functions at a frequency given by the ultrastrong photon emitter coupling. These effects can be traced back to the presence of two-photon cascade decays induced by counterrotating interaction terms.

Diagnostic utility of abdominal ultrasonography in dogs with chronic diarrhea.

BACKGROUND: Chronic diarrhea is common in dogs and has many causes. Ultrasonographic descriptions of many gastrointestinal diseases have been published, but the diagnostic utility of ultrasonography in dogs with chronic diarrhea has not been investigated. HYPOTHESIS: Diagnostic utility of abdominal ultrasound will be highest in dogs with GI neoplasia and lowest in those with inflammatory disorders. ANIMALS: 87 pet dogs with chronic diarrhea. METHODS: Prospective study in which medical records were reviewed and contribution of abdominal ultrasound toward making diagnosis was scored. RESULTS: In 57/87 (66%) of dogs, the same diagnosis would have been reached without ultrasonography. In 13/87 (15%) of dogs, the ultrasound examination was vital or beneficial to making the diagnosis. Univariable analysis identified that increased diagnostic utility was associated with weight loss (P = .0086), palpation of an abdominal or rectal mass (P = .0031), diseases that commonly have mass lesions visible on ultrasound examination (P < .0001), and a final diagnosis of GI neoplasia. Multivariable regression indicated that utility of abdominal ultrasonography would be 30 times more likely to be high in dogs in which an abdominal or rectal mass was palpated (odds ratio 30.5, 95% CI 5.5-169.6) (P < .0001) versus dogs without a palpable mass. In 15/87 (17%) of dogs, additional benefits of ultrasonography to case management, independent of the contribution to the diagnosis of diarrhea, were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Overall, the diagnostic utility of abdominal ultrasonography was low in dogs with chronic diarrhea. Identification of factors associated with high diagnostic utility is an indication to perform abdominal ultrasonography in dogs with chronic diarrhea.

Diagnostic utility of abdominal ultrasonography in dogs with chronic vomiting.

BACKGROUND: Chronic vomiting is a common problem in dogs that has many causes. Ultrasonographic descriptions of many gastrointestinal (GI) diseases have been published. However, diagnostic utility of ultrasonography in dogs with chronic vomiting has not been investigated. HYPOTHESIS: Diagnostic utility of abdominal ultrasound will be highest in dogs with GI neoplasia and lowest in those with inflammatory disorders. ANIMALS: Eighty-nine pet dogs with chronic vomiting. METHODS: Medical records were reviewed and the contribution of abdominal ultrasound to the clinical diagnosis was subjectively scored. RESULTS: In 68.5% of dogs, the reviewers thought that the same diagnosis would have been reached without performing ultrasonography. In 22.5% of dogs, the ultrasound examination was considered to be vital or beneficial to the diagnosis. Univariable analysis identified that increased diagnostic utility was associated with increasing age, a greater number of vomiting episodes per week, presence of weight loss, a greater percentage of lost body weight, and a final diagnosis of GI lymphoma or gastric adenocarcinoma. However, multivariate analysis only identified increasing age and a final diagnosis of gastric adenocarcinoma or GI lymphoma to be associated with increased diagnostic utility. In 12.4% of dogs, additional benefits of ultrasonography to case management, excluding the contribution to the vomiting problem, were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: The diagnostic utility of abdominal ultrasonography was high in 27% of dogs. The presence of factors that are associated with high diagnostic utility is an indication to perform abdominal ultrasonography in dogs with chronic vomiting.

Idiopathic eosinophilic masses of the gastrointestinal tract in dogs.

BACKGROUND: Eosinophilic inflammation of the gastrointestinal tract of dogs occurs in numerous disorders, typically resulting in diffuse intestinal thickening. Rarely, eosinophilic masses have been reported. OBJECTIVE: Describe a series of dogs with 1 or more idiopathic eosinophilic gastrointestinal masses (IEGM) to better characterize the clinical features, treatment, and prognosis. ANIMALS: Seven dogs with 1 or more gastrointestinal masses composed primarily of eosinophilic infiltrates for which no underlying cause was found. METHODS: Retrospective case series. RESULTS: Rottweilers and purebred, large breed dogs predominated. Dogs were middle-aged and typically had chronic signs of upper or lower gastrointestinal disease. Decreased appetite, vomiting, and evidence of gastrointestinal hemorrhage were present in the majority of cases. An abdominal or rectal mass was frequently noted on physical examination. Common laboratory abnormalities included peripheral eosinophilia, mature neutrophilia, hypoproteinemia, and hypocholesterolemia. The masses were histologically composed of moderate to severe eosinophilic infiltrates, which were often transmural and accompanied by fibrosis. All dogs treated with surgery alone died of complications of their disease. Treatment with corticosteroids and ivermectin improved clinical signs, caused resolution of eosinophilic infiltrates, and prolonged survival in most dogs treated medically. CONCLUSIONS AND CLINICAL IMPORTANCE: These findings suggest that the prognosis for dogs with IEGM may be good when recognized and managed appropriately. When surgery is performed, medical treatment should also be added.

Safety and efficacy of oral low-volume sodium phosphate bowel preparation for colonoscopy in dogs.

BACKGROUND: Sodium phosphate (NaP) is a low-volume, hyperosmolar laxative that is an effective bowel-cleansing agent in humans. HYPOTHESIS: NaP will be as safe and efficacious as polyethylene glycol (PEG) bowel preparation for colonoscopy in dogs. ANIMALS: Eight purpose-bred healthy dogs. METHODS: In phase I, standard (NaP and enemas; NaP(1)) and control preparations (PEG and enemas) were compared in a crossover design to determine the safety and efficacy of NaP. Serial clinical and serum analytical evaluations were used to determine the safety of NaP. In phase II, the efficacy of the standard NaP preparation was compared with 3 other NaP variations, which excluded enema or included bisacodyl, with or without enemas in a crossover design. An observer blinded to the bowel preparation assigned a score of 1-4 (1=clean colon; 4=unacceptable colon cleansing preventing adequate endoscopic evaluation) to each of 5 regions of the colon. RESULTS: The mean total colon cleansing score (TCS), defined as the sum of scores from each region, of the control (9.4) was less than NaP(1) (13.6) (P < 0.05). There were no significant differences in regional or TCS for the remaining 4 NaP protocols. NaP(1) resulted in moderate, but clinically occult, hyperphosphatemia and hypocalcemia, which resolved within 24 hours. CONCLUSIONS AND CLINICAL IMPORTANCE: Despite the safety and ease of administration of the NaP preparations, the NaP bowel-cleansing preparations used in this study cannot be recommended for use because of the inadequate quality of bowel preparation compared with the protocol using PEG-containing fluids.

Using the World Wide Web to enhance the problem-solving skills of third-year veterinary students.

A Web site was created for the small animal problem-solving elective at Virginia Tech. In addition to signalment, history, physical examination findings, and results of routine laboratory tests, students were able to view images of cytologic and histologic specimens, radiographs, and endoscopic findings and hear examples of breath and cardiac sounds. Students commented that the availability of Web-based case materials allowed them increased opportunities to practice problem-solving skills.

Endoscopic balloon dilation of benign esophageal strictures in dogs and cats.

Endoscopic balloon dilation of benign esophageal strictures was performed in 18 dogs and 10 cats with a median age of 4 years. Stricture formation was associated with a recent anesthetic episode in 18 patients. Regurgitation was the most common clinical sign and was present a median of 4 weeks before dilation. Most animals had a single stricture; median diameter was 5 mm, and median length was 1 cm. Esophagitis and mucosal fibrosis were detected in 9 patients each. Dilation was performed with progressively increasing diameter balloons, from 6 to 20 mm. After dilation, mucosal hemorrhage was mild to moderate in most patients. Esophageal perforation was the only serious complication and occurred in 1 patient. Postdilation therapy consisted of administration of cimetidine, metoclopramide, sucralfate, and prednisone in most animals. The median number of dilation procedures performed in each animal was 2, with a range of 1-5. The median interval between dilations was 13 days. Stricture diameter markedly increased with subsequent dilations. Median duration of follow-up was 131 weeks. A successful outcome occurred in 88% of patients, with most animals able to eat canned, mashed, or dry food without regurgitation. Mucosal fibrosis was associated with a better clinical response score, while increasing age was weakly associated with fewer dilations. The dilation protocol used in this group of animals was safe and efficacious.

Evaluation of the bromosulfophthalein 30-minute retention test for the diagnosis of hepatic disease in dogs.

The purpose of this study was to evaluate efficacy of bromosulfophthalein (BSP) retention testing in dogs with and without histopathologically confirmed hepatobiliary disease. Medical records of 150 dogs with hepatobiliary disease having both a BSP test and hepatic biopsy were retrieved. Histopathologic slides of liver tissue were reviewed, and dogs were classified according to 1 of 11 histopathologic categories. Twenty-five clinically normal random-source dogs were used as controls for hepatic biopsy and BSP testing. No dogs suffered adverse effects due to BSP administration. BSP retention was significantly (P < .05) higher in hospitalized (13.9%) than control (3.2%) dogs, but the test could not distinguish between hospitalized dogs with different types of hepatobiliary disease. Sensitivity, specificity, and predictive values of BSP retention as a test for hepatic disease were calculated. Using 5.0% as a cutoff for normal BSP retention resulted in a specificity of 88% and a sensitivity of 76%. Using 6.0% as a cutoff for normal BSP retention resulted in a specificity of 100% and a sensitivity of 70%. Dogs of this study having BSP retention of >6% had at least an 86% chance of having an abnormal liver. We concluded that continued use of BSP retention testing is warranted as a noninvasive diagnostic test for liver disease in dogs.

Treatment of chronic idiopathic large-bowel diarrhea in dogs with a highly digestible diet and soluble fiber: a retrospective review of 37 cases.

The medical records of 37 dogs diagnosed with chronic idiopathic large-bowel diarrhea were reviewed. The median age of affected dogs was 6 years. The median body weight was 13.9 kg. The median duration of clinical signs before diagnosis was 32 weeks. Diarrhea usually was intermittent and characterized by increasing frequency, fecal mucus, hematochezia, and tenesmus. Vomiting was common but usually much less frequent and severe than the diarrhea. A variety of stressful factors and abnormal personality traits were identified. CBC and serum biochemistry usually were normal. Fecal examination rarely identified parasites. Rectal cytology specimens were most often normal, but some dogs had increased numbers of neutrophils. The colonic mucosa often was normal during colonoscopy, but decreased numbers of lymphoid follicles were found in some dogs. Histopathologic evaluation found that colonic mucosa was within normal limits. Treatment with soluble fiber (Metamucil) added to a highly digestible diet (Hills i/d) resulted in a very good to excellent response in most dogs. The median initial dosage of Metamucil was 2 tablespoons (2 T) per day. In some dogs, the fiber dosage was reduced or eliminated, or a grocery store brand of dog food was substituted, without causing diarrhea to return.

The gastroduodenal effects of buffered aspirin, carprofen, and etodolac in healthy dogs.

Twenty-four healthy mixed-breed dogs were divided into 4 groups. Group 1 received a placebo p.o. q12h, group 2 received an average of 16.5 (15.1-17.8) mg/kg buffered aspirin p.o. q12h, group 3 received an average of 2.2 (2.0-2.4) mg/kg carprofen p.o. q12h, and group 4 received an average of 12.8 (11.7-13.8) mg/kg etodolac p.o. q24h (with a placebo in the PM). All treatments continued for 28 consecutive days. Gastroduodenal endoscopy was performed on days -9, 0, 5, 14, and 28. Multiple gastric biopsies were obtained endoscopically on day -9 to determine each dog's Helicobacter infection status. Four regions in the stomach and 1 region in the proximal duodenum were evaluated endoscopically, and each was assigned a score from 1 to 11. Scores for each region then were summed to give a total score for each endoscopic evaluation. Erosions and submucosal hemorrhages were seen in all dogs receiving aspirin. Only minor gastric lesions were observed in the carprofen, etodolac, and control groups. No adverse clinical signs were noted in any dog given any treatment. Median total score on days 0, 5, 14, and 28, respectively, were as follows: group 1: 5.0, 5.0, 5.0, 5.0; group 2: 5.0, 27.0, 26.0, 27.5; group 3: 5.0, 5.0, 6.0, 5.0, group 4: 5.0, 7.0, 5.0, 5.0. There was no significant difference among dogs receiving carprofen, etodolac, or placebo. The administration of carprofen, etodolac, or placebo to healthy dogs resulted in significantly less gastroduodenal lesion development than in dogs receiving buffered aspirin.

Endoscopic aspiration of intestinal contents in dogs and cats: 394 cases.

Medical records from 394 dogs and cats that had endoscopic aspiration of intestinal contents for identification of Giardia sp. trophozoites were retrospectively reviewed. The most common indications for endoscopy were chronic vomiting (152), chronic diarrhea (108), chronic vomiting and diarrhea (58), and acute vomiting (33). Metronidazole had been previously administered to 111 animals (28.2%), and to 58.6% of those with chronic diarrhea. Six aspirate samples (1.5%) were positive for Giardia sp. In 3 of these cases a single fecal flotation identified Giardia cysts before endoscopy. The authors conclude that intestinal aspiration in animals from a primarily referral population undergoing upper gastrointestinal endoscopy rarely identifies Giardia and should not be routinely performed. However, animals in which zinc sulfate flotation was not performed or those that did not previously receive metronidazole might benefit from intestinal aspiration.

Rectal ganglioneuroma in a dog.

An 18-month-old, spayed female Australian terrier cross was presented with a 10-month history of chronic large bowel diarrhea. Ulceration and two proliferative masses in the rectum were seen on colonoscopy. Surgical resection was performed to remove the masses, and the dog recovered without complications related to surgery. Histopathology was consistent with the diagnosis of ganglioneuroma. The dog had no clinical signs of disease within three months of surgery and was completely normal 2.5 years after diagnosis. This is the first report providing follow-up and successful outcome of a ganglioneuroma in the gastrointestinal tract of a dog.

Multiple myeloma involving the orbit.

Multiple myeloma is a plasma cell malignancy often associated with destructive skeletal lesions. Orbital involvement in multiple myeloma is rare. Risk factors for orbital involvement have not been established, although risk may vary with immunoglobulin subtype. Early detection of orbital plasmacytoma may affect treatment and clinical course. A case is reported of multiple myeloma without elevated serum immunoglobulins that involves the orbit, and the implications of early detection are discussed. The patient was first examined by an ophthalmologist 13 months after multiple myeloma was diagnosed and 5 months after the external appearance of an orbital tumor. Urine protein electrophoresis demonstrated kappa light chains. Hypergammaglobulinemia was not detected. Plain-film roentgenography showed orbital involvement at the time of initial diagnosis. An impressive clinical response to external beam radiation therapy was seen. Attention to immunoprotein characteristics in multiple myeloma may help to identify risk factors for orbital involvement. Early detection may permit safer and equally effective treatment. All patients with multiple myeloma should undergo thorough ophthalmic examination at the time of initial diagnosis.

Translacrimal transnasal laser-assisted dacryocystorhinostomy.

Chronic dacryocystitis is due to an obstruction in the nasolacrimal duct, with subsequent infection of the lacrimal sac. The goal of surgery is to reestablish intranasal drainage of the lacrimal sac. Classic dacryocystorhinostomy (DCR) requires an external incision and drilling through the lacrimal bone into the middle meatus. In our study a 600-micron neodymium:YAG (Nd:YAG) fiber with a blunt hemispherical tip is inserted via the lacrimal puncta. An intranasal ostium is created with the laser under intranasal endoscopic control. Silicon tubes are then left in place for 6 months. We have performed 49 procedures over the past 2 1/2 years, with a success rate of 85% after one surgical procedure, which is commensurate with standard DCR. This procedure provides a simple, bloodless, incisionless alternative to standard DCR.

Lens epithelial cell apoptosis appears to be a common cellular basis for non-congenital cataract development in humans and animals.

Cataract is a major ocular disease that causes blindness in many developing countries of the world. It is well established that various factors such as oxidative stress, UV, and other toxic agents can induce both in vivo and in vitro cataract formation. However, a common cellular basis for this induction has not been previously recognized. The present study of lens epithelial cell viability suggests such a general mechanism. When lens epithelial cells from a group of 20 cataract patients 12 to 94 years old were analyzed by terminal deoxynucleotidyl transferase (TdT) labeling and DNA fragmentation assays, it was found that all of these patients had apoptotic epithelial cells ranging from 4.4 to 41.8%. By contrast, in eight normal human lenses of comparable age, very few apoptotic epithelial cells were observed. We suggest that cataract patients may have deficient defense systems against factors such as oxidative stress and UV at the onset of the disease. Such stress can trigger lens epithelial cell apoptosis that then may initiate cataract development. To test this hypothesis, it is also demonstrated here that hydrogen peroxide at concentrations previously found in some cataract patients induces both lens epithelial cell apoptosis and cortical opacity. Moreover, the temporal and spatial distribution of induced apoptotic lens epithelial cells precedes development of lens opacification. These results suggest that lens epithelial cell apoptosis may be a common cellular basis for initiation of noncongenital cataract formation.