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.

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.

Phase II trial of oral etoposide plus cisplatin in extensive stage small cell carcinoma of the lung: an Eastern Cooperative Oncology Group study.

Based upon the schedule specificity of etoposide and the in vitro and clinical synergy observed with cisplatin, the Eastern Cooperative Oncology Group conducted a phase II trial of oral etoposide and cisplatin in newly diagnosed, untreated patients with extensive stage small cell carcinoma of the lung. 35 patients received 100 mg/m2 of cisplatin intravenously on day 1 and 50 mg/m2 of etoposide orally for 21 consecutive days. Cycles were repeated every 28 days. The most common toxicity observed was myelosuppression. Sixty-seven per cent of patients had grade 3 or 4 leukopenia and 34% had grade 3 or 4 thrombocytopenia during cycle one. Of 26 evaluable patients, 4 had a complete response (15%) and 17 had a partial response (65%). The median survival for the group as a whole was 8.5 months. We conclude that this regimen was associated with significant myelosuppression, and offered no therapeutic advantage to other commonly administered chemotherapeutic regimens for small cell carcinoma of the lung.

A comparison of hepatic sonographic features and histopathologic diagnosis in canine liver disease: 138 cases.

BACKGROUND: Ultrasound examination is commonly used in the diagnostic evaluation of liver disease in dogs. HYPOTHESIS/OBJECTIVES: To determine if hepatic sonographic features were predictive of findings on liver histopathology. We hypothesized that there would be a relationship between sonographic features and the category of liver disease based on histologic assessment. ANIMALS: One hundred and thirty-eight dogs in which the liver was evaluated by both abdominal ultrasound examination and histopathologic examination. Twenty-five dogs were included in each of the following categories based on histopathology: normal, degenerative, vascular, inflammatory, and neoplasia. Thirteen dogs had nodular regeneration. METHODS: Retrospective study. Medical records of dogs from 2005 to 2010 were searched for cases in which the liver was evaluated by abdominal ultrasound examination as well as by histopathology. After independent evaluation of ultrasound images, the recorded sonographic features were analyzed to identify abnormalities associated with each histopathologic diagnosis or degree of fibrosis. RESULTS: Sixty-four percent of sonographically unremarkable livers had histologic abnormalities. Both microhepatia and the identification of abnormal vasculature were significantly associated with a histopathologic diagnosis of vascular disease. Hepatic masses were significantly associated with a diagnosis of neoplasia. Dilated common bile duct and thickened gall bladder wall were significantly associated with hepatitis. There were no sonographic findings consistently present with hepatic fibrosis. CONCLUSION AND CLINICAL IMPORTANCE: Although some ultrasonographic findings, including masses, microhepatia, anomalous veins, and biliary changes, are associated with specific histopathologic abnormalities, sonographic findings are inconsistently detected in many disorders. Overall, hepatic ultrasonographic abnormalities have substantial limitations in predicting the underlying disease.

Ultrasonographic findings of the pancreas in cats with elevated serum pancreatic lipase immunoreactivity.

BACKGROUND: Pancreatitis is a common disease in cats that is difficult to diagnose. HYPOTHESIS/OBJECTIVES: To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis. ANIMALS: 35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound. METHODS: Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis. RESULTS: Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44-87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60-97%) and 75% (95% confidence interval = 48-93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis. CONCLUSIONS AND CLINICAL IMPORTANCE: The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.

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.