Pneumopericardium after peritoneopericardial diaphragmatic hernia repair in a dog.

A one-year-old neutered, Goldendoodle presented for evaluation. One week prior to presentation, the surgical closure of a peritoneopericardial diaphragmatic hernia was performed via ventral midline celiotomy. Since the procedure, the dog had been lethargic and anorexic at home. Thoracic radiographs revealed a pneumopericardium. Pericardiocentesis was performed which evacuated approximately 100 mL of air from the pericardial sac. The dog recovered well and began eating in the hospital and resumed normal activity. This is the first reported case of a pneumopericardium post-peritoneopericardial diaphragmatic hernia repair requiring pericardiocentesis. Clinicians should be aware of this rare complication in patients with post-operative peritoneopericardial diaphragmatic hernia.

A multicenter prospective evaluation of owner medication adherence for feline cardiovascular disease in the referral setting.

OBJECTIVE: The aim of this paper is to evaluate owners' chronic medication adherence for management of feline cardiovascular disease in the small animal referral setting. ANIMALS, MATERIALS AND METHODS: A questionnaire-based study of owners at five multispecialty, small animal referral centers was conducted. Owners completed a written survey evaluating demographics, degree of medication adherence, and difficulties encountered for medication adherence. Owners were free to decline participation in the study. RESULTS: Fifty-four questionnaires were available for review. The most common diagnosis was hypertrophic cardiomyopathy (n = 31, 57.4%). Clopidogrel was the most cited medication that was difficult to administer consistently (n = 13, 24.0%) although twenty owners (37.0%) reported no difficulty consistently administering medications. "Taste of medication" (n = 14, 25.9%) was the most reported reason for difficulty medicating their cat, and most owners (n = 36, 66.7%) stated twice daily was the highest frequency of heart medications they feel they can consistently administer. Fifty owners (92.6%) met the criteria for medication adherence. CONCLUSIONS: Chronic medication adherence in this study population was high. Clopidogrel was the most difficult medication to consistently administer, and twice a day dosing was the highest frequency of medication administration most owners could achieve. Cardiologists should be aware of these factors when determining optimal treatment protocols for the management of cardiovascular disease in cats.

Evaluation of owners' attitudes towards veterinary insurance in a specialty hospital.

OBJECTIVES: The purpose of this study was to investigate the frequency and perception of veterinary insurance among owners' at a small animal specialty hospital around a large urban city. MATERIALS AND METHODS: A questionnaire evaluated the prevalence and perception of insurance among owners at a small animal specialty hospital over a 2 month period. Respondents provided demographic information including age, sex, educational level and household income. Respondents without insurance were asked reasons for not having insurance, approximate cost of insurance per month desired and percentage of coverage of medical expenses they would want insurance to provide. Respondents with insurance were asked how they chose their current plan, how it affects their medical decisions for their pet and their overall satisfaction. RESULTS: Sixty-seven (28.5%) owners reporting having insurance for at least one pet. Owners most commonly selected their current insurance plan based on online research (27, 40.3%). Fifty-two respondents (77.6%) reported being satisfied with their insurance plan and 49 (73.2%) stated that would recommend their current insurance plan to a friend. CLINICAL SIGNIFICANCE: Insurance had a relatively high prevalence in this study group with most owners being satisfied with their current plan and would be likely to recommend it to a friend. The role of insurance in how it affects owner's medical decisions, care for their pet and interactions with veterinarians in companion animal medicine requires further evaluation.

Evaluation of owner medication adherence for canine cardiovascular disease in the referral setting.

OBJECTIVE: To evaluate owners' medication adherence for management of cardiovascular disease in the small animal specialty setting. ANIMALS, MATERIALS, AND METHODS: A questionnaire-based study of owners at a single, multispecialty, small animal referral center was conducted. Owners completed a written survey evaluating demographics, degree of medication adherence, and difficulties encountered for medication adherence. Owners were free to decline participation in the study. RESULTS: Ninety-six questionnaires were completed during the study period. Fifty-four respondents (56.3%) reported treating their pet for over one year for cardiovascular disease, and myxomatous mitral valve disease was the most common diagnosis (76.0%). Twenty-nine (30.2%) respondents felt they could consistently administer a maximum of three medications daily, and 46 (47.9%) respondents reported twice-daily dosing was the highest frequency of administration that could be consistently achieved. Twenty-two respondents (22.9%) reported that their pet required daily medications for at least one other chronic condition besides cardiac disease. Seventeen respondents (17.7%) reported at least occasionally missing medications, although only one (1.0%) reported it was more than 20% of medications per week. CONCLUSIONS: Medication adherence was high in this study population. Almost one-half of owners surveyed reported being unable to consistently administer more than three medications daily, and approximately one-quarter of patients were treated for at least one additional chronic condition requiring daily medications, in addition to cardiac disease. Clinicians should be aware of these factors when determining optimal treatment protocols for the management of cardiovascular disease in dogs.

The effect of atorvastatin on haemostatic parameters in apparently healthy dogs.

OBJECTIVE: To determine the effect of atorvastatin on haemostatic parameters as measured by prothrombin time, activated partial thromboplastin time and thromboelastography in apparently healthy dogs administered 2 mg/kg orally once daily for 1 week. MATERIALS AND METHODS: Prospective study of 20 apparently healthy client-owned dogs at a small animal specialty hospital. Dogs had a baseline complete blood count, serum chemistry profile, fibrinogen, platelet count, prothrombin time, activated partial thromboplastin time and thromboelastography performed. Each dog was then administered approximately 2 mg/kg of atorvastatin orally once daily for 1 week, and the laboratory tests were repeated. Adverse effects attributed to atorvastatin were recorded. RESULTS: All 20 enrolled dogs completed the study. Dogs received a median dose of 2.06 mg/kg (range 1.94 to 2.44 mg/kg) atorvastatin once daily, which was associated with a significant increase in pulse rate, mean corpuscular haemoglobin concentration, albumin and a significant decrease in mean corpuscular volume, cholesterol and lipase values compared with baseline. On thromboelastography, there was a significant increase in maximum amplitude, G, coagulation index, amplitude at 30 minutes, amplitude at 60 minutes and significant decrease in percentage of clot lysed at 30 minutes and percentage of clot lysed at 60 minutes values compared with baseline. Six dogs had a noticeable increase in appetite. CLINICAL SIGNIFICANCE: The results of this study suggest that atorvastatin may produce a procoagulant effect in dogs, although the clinical significance is unclear. Polyphagia was the most commonly reported adverse effect.

Effect of client complaints on small animal veterinary internists.

OBJECTIVES: To investigate the effect of client complaints on small animal veterinary internists' welfare, job satisfaction and medical practices. MATERIALS AND METHODS: Cross-sectional anonymous survey study. Between February 1 and March 31, 2017, a web-based questionnaire was made available through the American College Veterinary Internal Medicine sub-specialty Small Animal Internal Medicine E-mail List Serve. RESULTS: A total of 92 completed surveys were available for review. Fifty-nine (64∙1%) respondents received a client complaint during the previous 6 months with cost of care the most common reason (53∙3%). Eighty-nine (96∙7%) respondents worry about client complaints being made against them with 33 (35∙8%) stating they worry "most of the time" or "all of the time." Thirty-two (34∙8%) reported being verbally assaulted by a client in the previous 6 months and 27 (29∙4%) reported being threatened with litigation during the previous 6 months. Sixty-six (71∙7%) have reported changing the way they practice medicine to avoid a client complaint and 40 (43∙5%) have considered changing their career because of complaints made against them. CLINICAL RELEVANCE: Client complaints are a frequent problem among small animal veterinary internists that have detrimental effects on job satisfaction, psychological distress and medical practices.

Surgical correction of gastro-oesophageal intussusception with bilateral incisional gastropexy in three dogs.

Three dogs presented for evaluation of acute onset tachypnoea and dyspnoea following episodes of vomiting and/or regurgitation. Thoracic radiographs were suggestive of a gastro-oesophageal intussusception in all three dogs; one dog also showed evidence of aspiration pneumonia. All three dogs underwent surgical correction with a bilateral incisional gastropexy. All dogs recovered from anaesthesia uneventfully and were discharged from the hospital 3 days after presentation. Persistent megaoesophagus was evident in all three dogs, and they are being chronically managed with a strict feeding regime and pro-motility agents.

Effects of gamma-hydroxybutyrate on the performance of monkeys in a Go/No-go visual discrimination task.

It has been suggested that monkeys, administered gamma-hydroxybutyrate (GHB), manifest a state resembling petit mal status. This implies that an animal would produce erroneous responses immediately prior to, and discontinue behaviors requiring any cognitive effort concurrently with, an episode of GHB-induced generalized 3 cps wave-spike bursts in the EEG. This prediction was not confirmed in the present study. Rhesus macaques (Macaca mulatta) were trained to perform in a visual discrimination Go/No-go test. Thereafter bipolar transcortical electrodes were implanted in the hemisphere contralateral to the preferred hand. All monkeys discontinued to lever-press for water reward when administered GHB (125 or 250 mg/kg, esophageal intubation) and exhibited signs of reduced postural control and somnolence punctuated by episodes of hypermotility about 40-50 min after GHB. However, the monkey's difficulties in completing the program were not associated with the development of generalized hypersynchronous EEG activity. While occasional wave-spike bursts did occur, they were poorly regulated, often 'focal' (i.e. developed only in isolated areas), and had a frequency of 1.5-2 cps. In this state, animals could be easily roused by sensory stimuli. All of them reacted with a characteristic aversive-aggressive display when confronted by a direct gaze. These effects are interpreted to be more consistent with characterization of GHB activity as that of a potent hypnotic rather than a convulsant agent.

Hypnogenic center theory of sleep: no support from metabolic mapping in monkeys.

By comparing rates of glucose utilization in brains of monkeys in non-REM sleep and two types of awake controls, we attempted to reveal cerebral hypnogenic centers that drive organisms to sleep through increases in their neural activity. Instead we found that metabolic activity is reduced in all the putative hypnogenic centers during sleep as compared to wakefulness. The results thus offer no support for the notion of an active center that either maintains or triggers sleep.

A retrospective evaluation of doxorubicin-based chemotherapy for dogs with right atrial masses and pericardial effusion.

OBJECTIVE: To report the outcome of doxorubicin-based chemotherapy as the sole treatment for dogs with echocardiographically identified right atrial masses and pericardial effusion. METHODS: A retrospective study of case records of dogs with right atrial masses treated with doxorubicin. Dogs were excluded from the study if they had any type of surgery performed such as pericardiectomy or right atrial mass resection, or if their chemotherapy protocol did not include doxorubicin. The data collected included signalment, history, physical examination findings, diagnostic test results and long-term survival. RESULTS: Dogs with right atrial masses and pericardial effusion that received doxorubicin-based chemotherapy alone had a median survival of 139 · 5 days (range 2 to 302 days). Chemotherapy side effects were frequent but mild. CLINICAL SIGNIFICANCE: Doxorubicin-based chemotherapy alone appears to be a viable treatment option for dogs with echocardiographically identified right atrial masses and pericardial effusion.

Adult-onset nemaline myopathy in a dog presenting with persistent atrial standstill and primary hypothyroidism.

A nine-year-old neutered female mixed breed dog presented for evaluation following a five-day history of lethargy, inappetence, weakness, abdominal distension and generalised muscle atrophy. Persistent vatrial standstill with a junctional rhythm was identified on electrocardiogram. Echocardiogram identified moderate dilation of all cardiac chambers and mild thickening of the mitral and tricuspid valves. Serology was negative for Neospora caninum and Toxoplasma gondii. Permanent pacemaker implantation was performed in addition to endomyocardial and skeletal muscle biopsies. Cryosections from the biceps femoris muscle showed numerous nemaline rod bodies while endomyocardial biopsies were possibly consistent with end-stage myocarditis. Rod bodies have rarely been reported in the veterinary literature. To the authors' knowledge, this is the first report of adult-onset nemaline rod myopathy and hypothyroidism with concurrent cardiac disease in a dog.

Hand hygiene practices of veterinary support staff in small animal private practice.

OBJECTIVE: To evaluate the hand hygiene (HH) practices among veterinary technicians (VT) and veterinary support staff (VSS) in small animal private practice. METHODS: This was a prospective questionnaire-based study involving 182 VT and VSS from 18 small animal hospitals in the USA. Questions asked included gender, number of animals handled per work shift, frequency of hand washing, reason for not washing more frequently, most common available hand washing agent, education regarding the importance of HH and frequency of ring wearing. RESULTS: Less than half of the respondents [76 of 182 (41·7%)] reported washing their hands regularly between handling patients and 154 of 182 (85·6%) believed they should have washed more frequently. The most commonly employed HH agent was hand soap [154 of 182 (84·6%)] and the most common reason cited for not washing more frequently was being too busy [132 of 182 (72·5%)]. Only 96 of 182 (52·7%) respondents were educated by doctors at their hospital regarding the importance of HH. CLINICAL SIGNIFICANCE: The HH practices among VT and VSS in small animal private practice is poor. Hand soap was the most commonly employed agent among respondents in this study. Education of VT and VSS regarding the importance of HH requires improvement.

A prospective study of clopidogrel therapy in dogs with primary immune-mediated hemolytic anemia.

BACKGROUND: A major cause of death in dogs with primary immune-mediated hemolytic anemia (pIMHA) is thrombotic disease. Ultralow-dose aspirin (ULDA) is commonly used to prevent thrombosis in dogs with pIMHA; however, the efficacy of antiplatelet agents in dogs with pIMHA is unknown. HYPOTHESIS: The use of clopidogrel (CL), alone or in combination with ULDA, would improve survival to discharge and at 90 days without important adverse effects compared with ULDA alone in dogs with pIMHA treated with standard immunosuppressive therapy. ANIMALS: Twenty-four client-owned dogs with pIMHA. METHODS: Prospective, positive-controlled, unmasked clinical trial with dogs randomized in 3 treatment groups to receive PO ULDA or CL or both. RESULTS: There was no identifiable adverse reaction, evidence of hemorrhage, or increase in transfusion requirements associated with CL therapy, either alone or combined with ULDA, compared with ULDA alone. There was no significant difference between treatment groups with respect to survival to discharge and at 90 days. CONCLUSIONS AND CLINICAL IMPORTANCE: This study suggests that CL therapy, alone or in combination with ULDA, was safe and had similar short-term survival compared with ULDA alone in a small group of dogs with pIMHA able to tolerate oral medications and treated with standard immunosuppressive treatment.

Chronic 'blindness' following lesions of nonvisual cortex in the monkey.

Chronic 'blindness' was produced in monkeys by a lesion that combined right optic tract section, forebrain commissurotomy, and a large cortical ablation in the left hemisphere that spared most of the modality specific visual cortex. The finding suggests that, contrary to implications from earlier studies, central visual processes can influence behavior only with the participation of nonvisual cortex.

Attention-related unit activity in the frontal association cortex during a go/no-go visual discrimination task.

Unit activity related to a go/no-go visual discrimination task was studied in four rhesus monkeys. We recorded 272 task-related cells from frontal cortex in a region extending from the midprincipal sulcus to the central sulcus, and medially to the cingulate sulcus. Units located in anterior regions (dorsolateral prefrontal and anterior cingulate cortex) were typically related to both go and no-go trials (designated type II units) and showed similar ("symmetrical") activity in both kinds of trials; some of them also showed prestimulus ("anticipatory") activity. Such units were present but less common in posterior regions (postarcuate and precentral and posterior cingulate cortex). Units in these posterior regions were active predominantly in go trials (designated type I units). Also found posteriorly were "asymmetrical" type II cells whose activity was greater in go trials and occurred later in the trial, around the behavioral response. The anterior symmetrical and anticipatory type II units in the frontal association cortex were similar to such units described earlier in the brain stem reticular formation and may have similar functions in supporting focused and preparatory attention. On the other hand, asymmetrical type II units in the posterior frontal regions may have a role in the initiation of visually guided motor behavior.

Visual responses from cells in striate cortex of monkeys rendered chronically 'blind' by lesions of nonvisual cortex.

Chronic 'blindness' can be produced in monkeys by a large cortical removal that spares modality specific visual cortex (striate, prestriate, and inferior temporal cortex). To understand the reasons for the blindness we compared single unit activity recorded from striate cortex of these monkeys with the activity of units recorded from seeing animals. The results indicate that visual processing in the striate cortex of the blind monkeys, with the exception of changes attributable to a partial disruption of the geniculostriate pathway, is similar to that of the normal monkeys. The chronic blindness is therefore probably due not to dysfunction within striate cortex but rather to a disconnection from critical processing stages within the ablated territory. Feedback from this territory is apparently not necessary for information processing to occur in striate cortex.

A flexible restraint chair for the cynomolgus monkey (Macaca fascicularis).

We have found that commercial restraint chairs suitable for the rhesus monkey (Macaca mulatta) cause severe physical distress to many cynomolgus monkeys (Macaca fascicularis). A new restraint chair has therefore been designed specifically for the cynomolgus. The key features of the chair are an angled neck piece, a large opening to provide free movement for the tail, a soft waist restraint, and a level surface for both the heels and ischial pads. This new chair is not only suitable for the cynomolgus monkey but may also be more comfortable for the rhesus monkey than standard commercial chairs.