Diagnostic benefits of platelet-to-lymphocyte, neutrophil-to-lymphocyte, and albumin-to-globulin ratios in dogs with nasal cavity diseases.

BACKGROUND: A multimodal approach for diagnostic tests under anesthesia is required to diagnose nasal cavity pathology (NP) reliably in dogs. Blood test results may provide clues to the suspected NP. METHODS: This prospective blinded study assessed 72 dogs with chronic nasal discharge due to NPs, and 10 healthy dogs as the control group (CG). NPs were diagnosed using whole-body computed tomography (CT), upper airway endoscopy, examination of nasal mucosal swabs by bacterial and fungal culture, and histopathological examination of nasal mucosa biopsies. The exclusion criteria were the presence of any additional diseases or corticosteroid pre-treatment. In consideration of these exclusion criteria, 55 dogs entered the study. Dogs were classified into benign (benign tumors, idiopathic rhinitis (IR), and others) and malignant (carcinomas and sarcomas) NP groups. Blood count and blood chemistry tests were performed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin-to-globulin ratio (AGR) were calculated and compared. RESULTS: 25 dogs with malignant NP (13 and 12 with carcinomas and sarcomas, respectively) and 30 dogs with benign NP (seven with benign tumors,13 with IR, and 10 others) were included. In general, in dogs with NP there were only slight abnormalities in complete blood count. However, PLR was significantly higher in dogs with malignant NP (carcinoma and sarcoma) than in those with benign NP and in the CG. Compared with the CG, the NLR was significantly increased in all dogs with NP, and the AGR was mild but significantly lower, except in dogs with sarcomas and benign tumors. CONCLUSIONS: In dogs with nasal disease alone, there are usually no marked abnormalities in blood count. However, while mildly increased NLR and decreased AGR can be observed in almost all NPs, an increased PLR may indicate a malignant NP and can be used as an additional screening tool in dogs with nasal discharge due to nasal cavity pathology.

A Novel Approach to Brachycephalic Syndrome. 1. Evaluation of Anatomical Intranasal Airway Obstruction.

OBJECTIVE: To evaluate airway obstruction due to abnormal intranasal anatomy in 3 brachycephalic dog breeds using computed tomography and rhinoscopy. STUDY DESIGN: Prospective clinical study. ANIMALS: A total of 132 brachycephalic dogs (66 Pugs, 55 French Bulldogs, and 11 English Bulldogs) with severe respiratory distress due to brachycephalic syndrome. METHODS: Computed tomography and anterior and posterior rhinoscopy were performed to evaluate endonasal obstruction. RESULTS: All dogs had abnormal conchal growth that obstructed the intranasal airways. Rostral aberrant turbinates (RAT) were common in Pugs (90.9%) but less frequent in French (56.4%) and English (36.4%) Bulldogs. Caudal aberrant turbinates (CAT) obstructing the nasopharyngeal meatus were commonly found in all breeds (66.7%). Deviation of the nasal septum was an almost consistent finding in Pugs (98.5%) but was less common in bulldogs. Obstructing turbinates had multiple points of mucosal contact responsible for obstruction of the intranasal airway. Interconchal and intraconchal mucosal contacts were evident in 91.7% of dogs. CONCLUSION: Selective breeding for short head conformation reduces the size of the nasal cavities to such an extent that intranasal structures grow aberrantly and malformed, leading to obstructed air conducting spaces. Intranasal airway obstruction of brachycephalic dogs may contribute to their exercise and heat intolerance because of impaired pulmonary ventilation and compromised thermoregulatory functions of the canine nose. Failure to address intranasal obstruction might be an explanation for lack of therapeutic success after conventional surgery for brachycephalic syndrome. Future consideration should be given to the diagnosis, management, and treatment of this newly described aspect of airway obstruction.

Development and Evaluation of Two Canine Low-Fidelity Simulation Models.

Two self-made low-fidelity models for simulation of canine intubation and canine female urinary catheterization were developed and evaluated. We used a study design that compares acquired skills of two intervention groups and one control group in a practical examination. Fifty-eight second-year veterinary medicine students received a theoretical introduction to intubation and were randomly divided into three groups. Group I (high-fidelity) was then trained on a commercially available Intubation Training Manikin (item #2006, Veteffects), group II (low-fidelity) was trained on our low-fidelity model, and group III (text) read a text describing intubation of the dog. Forty-seven fifth-year veterinary medicine students followed the same procedure for training urinary catheterization using the commercially available Female Urinary Catheter Training Manikin (Paws 2 Claws), our self-made model, and text. Outcomes were assessed in a practical examination on a cadaver using an Objective Structured Clinical Examination (OSCE) checklist. Considering a value of p≤.05 significant, intervention groups performed significantly better than the text groups. Group I (high-fidelity) and group II (low-fidelity) showed no significant differences (p≤.684, intubation; p≤.901, urinary catheterization). We thereby conclude that low-fidelity models can be as effective as high-fidelity models for clinical skills training.

Evaluation of the Blood Neutrophil-to-Lymphocyte Ratio (NLR) as a Diagnostic and Prognostic Biomarker in Dogs with Portosystemic Shunt.

The neutrophil-to-lymphocyte ratio (NLR) can help in assessing inflammatory diseases, sepsis, and chronic hepatic conditions in humans. Dogs with congenital portosystemic shunts (PSSs) have signs of generalized inflammation, and the clinical signs can overlap with other conditions, including hypoadrenocorticism (HOC). Thus, the potential diagnostic and prognostic value of leukocyte ratios as surrogate markers was assessed in a retrospective case-control study including 106 dogs diagnosed with PSSs. The disease control groups were dogs with parenchymal hepatopathy (PH; n = 22) or HOC (n = 31). In the PSS dogs, the blood NLRs were associated with the severity of systemic inflammation but not with the shunt type, hepatoencephalopathy, systemic infection, or hypoglycemia. The baseline NLRs did not differ between the three disease groups, between medically and surgically treated PSS dogs, or between those with successful PSS ligation and dogs experiencing peri-/post-surgical complications. However, dogs requiring two consecutive surgical interventions had significantly higher NLRs, and an NLR of <2.53 distinguished dogs with successful shunt ligation in one surgery from those requiring two consecutive surgeries for PSS closure. The blood NLR might be a useful clinicopathologic variable in PSS, but its value in helping differentiate PSS from HOC cases appears low. Integrating the NLR into a diagnostic algorithm may allow for a prediction of the number of surgical interventions required.

Variation of rectal temperature in dogs undergoing 3T-MRI in general anesthesia.

Objectives: Managing body temperature during MRI scanning under general anesthesia poses challenges for both human and veterinary patients, as many temperature monitoring devices and patient warming systems are unsuitable for the use inside an MRI scanner. MRI has the potential to cause tissue and body warming, but this effect may be counteracted by the hypothermia induced by general anesthesia and the low ambient temperature usually encountered in scanner rooms. This study aimed to observe temperature variations in dogs undergoing MRI under general anesthesia. Materials and methods: In this prospective observational study, client-owned dogs scheduled for 3-Tesla MRI under anesthesia between February and October 2020 at a veterinary teaching hospital were eligible for enrollment. Recorded data included breed, body mass, body condition score, age, fur quality, pre- and post-MRI rectal temperatures, time in the MRI room, scan area and coil used, application of contrast medium, choice of anesthetic agents, use of blankets, and infusion therapy. Group comparisons were conducted using the Mann-Whitney U-test or Kruskal-Wallis test, with p < 0.05 considered significant. Results: In total 171 dogs met the inclusion criteria. The median body temperature at admission was 38.4°C (IQR 38.1-38.7°C). The median body temperature before MRI was 38.2°C (IQR 37.8-38.6°C), and the median temperature after the MRI scan was 37.7°C (IQR 37.238.2°C) resulting in a median temperature difference (∆T) before and after MRI of - 0.6°C (IQR -0.8--0.1°C). The median duration of MRI scans was 49 min (IQR 38-63 min). A temperature loss of more than 0.1°C was observed in 121 (70.8%) dogs, 29 (16.9%) dogs maintained their temperature within 0.1°C, and 21 (12.3%) dogs experienced a temperature increase of more than 0.1°C. Factors associated with a higher post-MRI temperature included greater body mass, medium or long fur, and the application of α2- receptor-agonists. Conclusion: Dogs undergoing MRI under general anesthesia are likely to experience temperature loss in the given circumstances. However, in larger dogs and those with much fur, an increase in body temperature is possible and more common than generally anticipated, although clinically insignificant in most cases.

[Inhalation anesthesia in the cat: Development of cuff pressure when using nitrous oxide]. / Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas.

OBJECTIVE: During inhalation anesthesia with nitrous oxide in oxygen the pressure in the cuff of the endotracheal tube may increase due to diffusion of nitrous oxide into the cuff. The aim of the study was to investigate the development of cuff pressure during nitrous oxide anesthesia under clinical conditions in feline patients and to identify possible influencing factors such as tube size and gas flow rate. MATERIAL AND METHODS: The prospective study included cats scheduled for inhalation anesthesia with nitrous oxide for a minimum duration of 60 minutes at the Department for Small Animals of the University of Leipzig. Cuff pressure was adjusted with a cuff manometer and its development was recorded. RESULTS: In total, the cuff pressure values of 24 cats were recorded. Animals were allocated into groups by tube size (ID 4.0 mm and ID 4.5 mm) and by fresh gas flow rate: low flow rate (0.6 l/min) and high flow rate (3 l/min). During anesthesia, cuff pressure increased over time, with statistical significance occurring from 45 minutes onwards in comparison to the initial cuff pressure (p=0.005). After 60 minutes, there was a mean cuff pressure increase of 3 cmH2O. Despite this moderate mean increase, highly variable pressure values up to 48 cmH2O in individual animals were recorded. No cat reached the termination criterion of 60 cmH2O cuff pressure. Effects of tube size (p=0.63) and flow rate (p=0.334) on the cuff pressure were not evident. CONCLUSION: After a period of 45 minutes of nitrous oxide administration, a significant increase in cuff pressure occurs in the cat. However, tube size and total gas flow rate do not seem to influence the cuff pressure development. CLINICAL RELEVANCE: When using nitrous oxide during inhalation anesthesia, regular cuff pressure evaluation and correction are necessary and hence recommended in feline patients. As individual pressure changes may be highly variable, no fixed recommendations for optimal management are possible.

[A multifactorial risk index for evaluation of anesthetic risk in dogs: the LeiV-Risk-Index]. / Bewertung des Anästhesierisikos beim Hund mithilfe eines multifaktoriellen Risikoindex: der LeiV-Risk-Index.

OBJECTIVE: The Leipzig Veterinary Risk-Index - "LeiV-Risk-Index" is a multifactorial risk index developed to enable an improved objective assessment of the anesthetic risk in dogs. The scoring system is based on 10 risk factors affecting perioperative mortality. The aim of this study was to evaluate the applicability of the LeiV-Risk-Index and its risk factors as well as to perform a direct comparison with the ASA-classification. MATERIAL AND METHODS: An online survey was conducted among veterinarians working in small animal medicine throughout Germany. Participants received a questionnaire containing information on 15 selected patients. They were asked to classify the patients according to the LeiV-Risk-Index and ASA-classification and to answer several questions concerning their professional background. The results were statistically analyzed considering the consistency among veterinarians of rating the different patients by using Fleiss'-Kappa. The correlation of LeiV-Risk-Index and ASA-classification was calculated. RESULTS: The consistency of all assigned LeiV-risk classes between participants was moderate (κ = 0.55) and higher than classification by ASA (κ = 0.33). On average, 3 different LeiV-risk classes and 4 different ASA-classes were assigned for one patient. There was a positive correlation between LeiV-risk class and increasing ASA-class. No effect of gender or clinical experience of the veterinarian could be demonstrated on ranking patients. There was also no effect of how confident veterinarians felt in applying the LeiV-Risk-Index. CONCLUSION UND CLINICAL RELEVANCE: The LeiV-Risk-Index is the first index available in veterinary medicine for assessing anesthetic risk that is based on objective risk criteria and whose objectivity exceeds that of the ASA classification. Anesthetic patients can thus be evaluated more consistently in veterinary medicine as well. Utility and practicability were positively received by 95 % of the participants. Further revision of individual risk criteria needs to be reconsidered.

Extrapolation in the analysis of lung aeration by computed tomography: a validation study.

INTRODUCTION: Computed tomography (CT) is considered the gold standard for quantification of global or regional lung aeration and lung mass. Quantitative CT, however, involves the exposure to ionizing radiation and requires manual image processing. We recently evaluated an extrapolation method which calculates quantitative CT parameters characterizing the entire lung from only 10 reference CT-slices thereby reducing radiation exposure and analysis time. We hypothesized that this extrapolation method could be further validated using CT-data from pigs and sheep, which have a different thoracic anatomy. METHODS: We quantified volume and mass of the total lung and differently aerated lung compartments in 168 ovine and 55 porcine whole-lung CTs covering lung conditions from normal to gross deaeration. Extrapolated volume and mass parameters were compared to the respective values obtained by whole-lung analysis. We also tested the accuracy of extrapolation for all possible numbers of CT slices between 15 and 5. Bias and limits of agreement (LOA) were analyzed by the Bland-Altman method. RESULTS: For extrapolation from 10 reference slices, bias (LOA) for the total lung volume and mass of sheep were 18.4 (-57.2 to 94.0) ml and 4.2 (-21.8 to 30.2) grams, respectively. The corresponding bias (LOA) values for pigs were 5.1 (-55.2 to 65.3) ml and 1.6 (-32.9 to 36.2) grams, respectively. All bias values for differently aerated lung compartments were below 1% of the total lung volume or mass and the LOA never exceeded ± 2.5%. Bias values diverged from zero and the LOA became considerably wider when less than 10 reference slices were used. CONCLUSIONS: The extrapolation method appears robust against variations in thoracic anatomy, which further supports its accuracy and potential usefulness for clinical and experimental application of quantitative CT.

[Study on preanesthetic risk evaluation in dogs using the ASA-classification system in Germany]. / Deutschlandweite Studie zur präanästhetischen Risikoeinschätzung mithilfe der ASA-Klassifikation beim Hund.

OBJECTIVE: The aim of this study was to assess the accuracy of anesthetic risk evaluation in dogs by using the ASA-classification system (ASA = American Society of Anesthesiologists). In human medicine, several studies criticize ranking patients prior to anesthesia via the ASA-classification due to its subjectivity and substantial variance. This study intends to detect and analyze possible comparable effects when applying the ASA-classification system to dogs. MATERIAL AND METHODS: An online survey was conducted among small animal practitioners throughout Germany. Participants were asked to answer questions concerning their professional background. In addition, they received a questionnaire containing information on 15 selected patients. This included a brief introduction of the patient, the medical history, findings of the preanesthetic examination, the results of blood analysis and biochemistry as well as the reason for planned general anesthesia. Participants were asked to classify the patients according to the ASA-classification scheme. The results were analyzed using an independent t-test, univariate ANOVA and Fleiss' Kappa (κ). The level of significance was set at 5 %. RESULTS: Overall, only weak consistency of the assigned ASA-classes (κ = 0.33) was evident. Each of the 15 patients was ranked in at least 3 different ASA-classes and 4 patients received assignment to all 5 possible classes. No effect of gender or clinical experience of the veterinarian could be detected on ranking patients correctly. There was also no effect of how confident veterinarians felt in applying the ASA-classification system on the accuracy of evaluating these 15 patients. CONCLUSION AND CLINICAL RELEVANCE: This study provides further evidence for a certain subjectivity as well as considerable variance when applying the ASA-classification system to dogs. The ASA-classification system is a widespread tool for rapid and easy preanesthetic risk classification of a veterinary patient. Nevertheless, the inclusion of criteria of increased objectivity in the preanesthetic evaluation is warranted in order to obtain precise and reproducible data.

[Evaluation of the accuracy of volume navigation of sonography and computed tomography using a phantom]. / Genauigkeitsevaluierung der Volumennavigation von Sonografie und Computertomografie anhand eines Phantoms.

BACKGROUND AND OBJECTIVE: In case of superimpositions of gas in the gastrointestinal tract or the ribs, tissue changes well detectable on computed tomography (CT) cannot be identified sonographically in a number of cases. Combining ultrasonography and CT provides enhanced information compared to sole sonography and volume navigation may be used as an effective tool. Tissue samples easily and safely obtained under sonographic guidance are often necessary to confirm the diagnosis of a suspicious focus. In these cases, the spatial fusion of CT and sonography may also be employed for improved visualization of foci by eliminating superimposition of sonographic images which is a limitation of ultrasound. This study investigated the potential benefit and improved informative value of the fusion of CT and sonography in case of superimpositions and aimed at determining the registration method with the best accuracy. MATERIALS AND METHODS: Sixteen models (10 models with peas [low contrast], 6 models with wooden spheres [high contrast] as round structures) were created. These models were examined by computed tomography and fused using 3 volume navigation protocols. Subsequently, volume-guided sonography was performed. The deviation of the specimens was measured. RESULTS: In total, 1026 measurements of the pea models and 648 measurements of the wooden sphere models were carried out. A fusion accuracy of 100 % was observed in 9.9 % (102/1026) resp. 9.9 % (64/648) of the models. In 85.4 % (876/1026) resp. 94.1 % (610/648) the deviation was < 5 mm and in 98.1 % (1006/1026) resp. 99.4 % (644/648) it was < 10 mm. The registration protocol in which all reference points were used for spatial fusion proved to be the most accurate CONCLUSION: The registration protocols for volume-guided ultrasound have sufficient biopsy accuracy to merge identical sites and provide the basis for improved volume-navigated biopsy sampling.

[Contrast-enhanced ultrasound at a rare bilateral renal carcinoma with secondary inflammation and necrosis in a cat]. / Kontrastmittelsonografie bei einem seltenen bilateralen renalen Karzinom mit sekundärer Entzündung und Nekrose bei einer Katze.

A 17-year-old male neutered domestic short hair cat was presented because of anorexia. The clinical examination revealed no abnormalities. Using sonography, mainly hypoechoic mass lesions at the level of the cortex and capsule were detected in both kidneys. The severity of the renal lesions could be clearly demonstrated using contrast-enhanced ultrasound and contrast-enhanced computed tomography. Under general anesthesia, fine needle aspirations of the lesions were taken. Part of the lesions were sampled from dorsal, an unusual practice for small animal medicine. Cytology revealed a bilateral renal carcinoma with secondary inflammation and necrosis. The cat improved under medical symptomatic treatment, but was euthanized 2 weeks later.

Continuous lumbar hemilaminectomy for intervertebral disc disease in an Amur tiger (Panthera tigris altaica).

A 13-yr-old Amur tiger (Panthera tigris altaica) was presented for an acute onset of paraplegia. Spinal imaging that included plain radiographs, myelography, and computed tomography performed under general anesthesia revealed lateralized spinal cord compression at the intervertebral disc space L4-5 caused by intervertebral disc extrusion. This extrusion was accompanied by an extensive epidural hemorrhage from L3 to L6. Therefore, a continuous hemilaminectomy from L3 to L6 was performed, resulting in complete decompression of the spinal cord. The tiger was ambulatory again 10 days after the surgery. This case suggests that the potential benefit of complete spinal cord decompression may outweigh the risk of causing clinically significant spinal instability after extensive decompression.

[Complications of ultrasound-guided liver biopsies in dogs and cats]. / Komplikationen sonographisch gestützter Leberbiopsien bei Hund und Katze.

OBJECTIVE: Ultrasound-guided biopsies are obtained generally to reach a sound diagnosis in the case of sonographically detectable hepatic changes. The most common and well-known complication associated with ultrasound-guided biopsies is haemorrhage after sampling, which may lead to the patient's death. The aim of this study was to evaluate a possible association between alterations in the coagulation parameters and sonographically observable haemorrhage following liver biopsies. MATERIALS AND METHODS: Dogs and cats in which an ultrasound-guided biopsy of the liver had been performed were retrospectively enrolled in the study. Inclusion criteria were thoroughly documented sonographic findings and the results of the coagula tion parameter thromboplastin time or a combination of the activated partial thromboplastin time and prothrombin time. The incidence of post-interventional ascites and possible risk factors were evaluated. RESULTS: A total of 105 patients met the inclusion criteria and the data of 94 dogs (89.5 %) and 11 cats (10.5 %) were analysed. Post-interventional complications occurred in 26 of 105 patients (24.8 %), 21.9 % being minor and 2.9 % being major. Free abdominal fluid after intervention was sonographically detected in 22 of 94 dogs (23.4 %) and four of 11 cats (36.4 %). Three of 10 dogs (2.9 %) with a clinically significant prolongated coagulation time of > 25 % had ascites after biopsy. Only a small amount of fluid was detected in two of these three dogs, while a moderate amount of ascites was observed in the third dog. One of two cats with a prolonged coagulation time of > 25 % developed a moderate amount of ascites after the puncture. No statistically significant association was found between the occurrence of post-interventional ascites and a prolongation of the coagulation time. CONCLUSION: According to the study results, there is no obvi ous correlation between alterations in coagulation and haemorrhage after an ultrasound-guided liver biopsy.

[Nephroblastoma in a 2-year-old female dog]. / Nephroblastom bei einer 2-jährigen Hündin.

An intact female 2-year-old boxer presented with polydipsia, polyuria, and decreased feed intake. Palpation of the abdomen was painful. Sonography revealed an abdominal mass of the left kidney causing displacement of the organs located in the cranial and mid-abdomen. Dimen sion and invasiveness of the process were evaluated both by contrast enhanced ultrasound (CEUS) and contrast-enhanced computed tomography. Histopathological examination of a biopsy sample revealed a nephroblastoma. The case report describes the clinical, sonographic, and computed tomographic results and the outcome in the untreated dog over a period of 5 months.

Vascular surgery of aortic thrombosis in a dog using Fogarty maneuver - technical feasibility.

Aortic thromboembolism is a rare and life-threatening disease in dogs. This report aims to describe the successful surgical treatment by use of a Fogarty Thrombectomy Catheter in an 8-year-old patient. The postsurgical intensive care therapy to prevent ischemia-reperfusion syndrome is specified, despite poor outcome in our case (owner elected euthanasia).

[Multiple choristoma and a myelolipoma in a Sheltie]. / Multiple Choristome und ein Myelolipom bei einem Sheltie.

An 11-year-old female Sheltie was presented with inappetence and a progressive increase in abdominal distention. Abdominal ultrasound revealed a large cystic mass in the midabdomen and cystic lesions in the right liver lobe and in the caudal pole of the left kidney. Histopathologic examination of the resected tissue revealed a myelolipoma of the spleen, dispersed splenic tissue in the liver and dispersed uterine and salpinx tissues in the kidney. This report describes the clinical, ultrasonographic and computed tomographic features and the results of histopathology. In addition to the abnormally large and cystic myelolipoma of the spleen, the great number of choristomas is remarkable, which has not previously been documented in a dog.

[Anaesthesia for canine caesarean section - an evidence-based approach]. / Anästhesie für die Sectio caesarea beim Hund ­ ein evidenzbasierter Ansatz.

In recent years, several new studies on anaesthesia for caesarean section have been published. This paper refers to these and ground-breaking research on risk factors affecting the puppies. Based on the available evidence, a recommendation for an anaesthetic procedure is given and in addition, alternatives are discussed. Induction with propofol or alfaxalone and maintenance by inhalation anaesthesia appears to be the method with the least risk. Intraoperatively, an adequate and low-risk analgesia is achieved by an epidural anaesthesia. Opioids allow an adequate maternal pain management after delivery of the puppies as well as postoperatively. A stabilisation of the dam before induction and an optimised oxygen supply are additional basal requirements.

[Comparison of different applications of the sonographic contrast medium Levovist]. / Verschiedene Applikationsarten des sonografischen Kontrastmittels Levovist im Vergleich.

The influence of the application modes (bolus injection, infusion) of the sonographic signal enhancers Levovist was investigated in a total of 24 dogs. The animals in the bolus group were given 0.2 ml/kg body mass Levovist at a concentration of 300 mg/ml while in the other group the same amount was continuously injected over a time of two minutes. Signal enhancement was measured by an audiodoppler. Contrast duration above six, twelve, 18 and 24 dB and maximum signal enhancement were determined for each application mode. The comparison of these parameters showed that a statistically significant longer contrast duration (significance level p less than 0,05) at 0 and 6 dB can be achieved by continuous injection. Bolus application, on the other hand, resulted in significantly higher maximum contrast enhancement. With time consuming investigations (perfusiondiagnostic, shuntdiagnostic) the contrast effect can be partly extended with continuous injection but the technical requirements are higher and there is the risk that the acoustic properties of the microbubbles are negatively influenced.