Ultrasonography criteria for differentiating ACTH dependency from ACTH independency in 47 dogs with hyperadrenocorticism and equivocal adrenal asymmetry.

BACKGROUND: Adrenal ultrasonography (US) in dogs with hyperadrenocorticism (HAC) is commonly used to distinguish adrenocorticotropic hormone (ACTH)-independent (AIHAC) and ACTH-dependent hyperadrenocorticism (ADHAC). To date, no cut-off values for defining adrenal atrophy in cases of adrenal asymmetry have been determined. Given that asymmetrical hyperplasia is sometimes observed in ADHAC, adrenal asymmetry without ultrasonographic proof of adrenocortical tumor such as vascular invasion or metastasis can be equivocal. OBJECTIVE: The purpose of this study was to compare adrenal US findings between cases of ADHAC and AIHAC in dogs with equivocal adrenal asymmetry (EAA), and to identify useful criteria for their distinction. ANIMALS: Forty dogs with EAA were included. METHODS: Ultrasound reports of HAC dogs with adrenal asymmetry without obvious vascular invasion or metastases were reviewed. Dogs were classified as cases of ADHAC (n = 28) or AIHAC (n = 19), determined by plasma ACTH concentration. The thickness, shape, and echogenicity of both adrenal glands and presence of adjacent vascular compression were compared between AIHAC and ADHAC groups. RESULTS: The maximal dorsoventral thickness of the smaller gland (SDV) ranged from 2.0 to 5.0 mm in AIHAC and from 5.0 to 15.0 mm in ADHAC. The 95% confidence intervals for estimated sensitivity and specificity of a SDV cut-off set at 5.0 mm in the diagnosis of AIHAC were 82-100 and 82-99%, respectively. Other tested US criteria were found to overlap extensively between the 2 groups, precluding their usefulness for distinction. CONCLUSION AND CLINICAL IMPORTANCE: In EAA cases, an SDV ≤5.0 mm is an appropriate cut-off for AIHAC ultrasonographic diagnosis.

Passive liver congestion associated with caudal vena caval compression due to oesophageal leiomyoma.

A large caudodorsal mediastinal mass was identified in a dog which had been presented for vomiting and anorexia. A few weeks later, the dog developed ascites and hindlimb oedema. Radiography showed that the caudodorsal mediastinal mass was compressing the caudal vena cava, probably inducing passive congestion of the liver. At postmortem examination, the mass was diagnosed as a large oesophageal leiomyoma. To the authors' knowledge, an oesophageal tumour leading to compression of the caudal vena cava associated with passive congestion of the liver has not been described previously in dogs. Secondary signs relating to the oesophageal mass appeared to be more prominent than the digestive signs. Causes of passive congestion of the liver and the differential diagnoses for a caudodorsal mediastinal mass are discussed.

Emphysematous pyometra in a dog.

An 8-year-old intact female West Highland White Terrier was examined for anorexia, vomiting, abdominal distension, and mild purulent vulvar discharge. The results of physical examination, laboratory testing, and radiography are presented. Emphysematous pyometra was suspected and confirmed at surgery. Clostridium perfringens was isolated from the uterine lumen. A brief discussion of emphysematous pyometra is presented.

Pericardial effusion and pericardiocentesis in a guinea pig (Cavia porcellus).

A three-year-old, female guinea pig (Cavia porcellus) presented for acute dyspnea and weakness. Radiographs and echocardiography were consistent with a diagnosis of pericardial effusion and heart failure secondary to cardiac tamponade. Ultrasound-guided pericardiocentesis was performed, and clinical signs rapidly improved. Serial echocardiography and radiographs demonstrated normalization of cardiac function over the subsequent six months.

Retrospective review of the ultrasonographic features of adrenal lesions in 21 ferrets.

Clinical signs and follow-up information were recorded. Histopathologic diagnoses were obtained for 25 adrenal glands in 21 ferrets. Adrenal lesions included ten adenocarcinomas, nine adenomas, one hyperplasia and one cortical cyst. Four adrenal glands (all right-sided) were diagnosed as unspecified adrenal tumors but lacked a definite histopathologic diagnosis (adenoma vs. adenocarcinoma) due to incomplete surgical resection and consequent small sample sizes. Bilateral adrenal lesions were identified in 4 ferrets (19%). Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated with ultrasound. Size and shape were variable and not specific to lesion type. Both benign and malignant adrenal tumors (adenomas, adenocarcinomas) appeared most often as masses with increased thickness and a normal length (11/23), less frequently as larger masses with increased thickness and length (4/23) or as nodules focally deforming the normal adrenal shape (6/23). The only cortical cyst appeared as a nodule. Three adrenal glands had a normal size and shape and were diagnosed as adenomas (2) or hyperplasia (1). Therefore treatment may be warranted based solely on clinical signs if adrenal glands are ultrasonographically normal. Vascular invasion was not identified ultrasonographically. However, focal absence of periglandular fat resulting in contact of 8 adrenal glands with either caudal vena cava (6), aorta (1) or liver (1) identified ultrasonographically, correlated with incomplete surgical resectability (6/8) and histopathologic diagnoses of carcinoma (4/8) or unspecified tumors (4/8). Therefore, a focal absence of periglandular fat between the adrenal gland and the large vessels or liver, deviation or compression of the large vessels by the adrenal lesion may indicate malignancy. Adrenal tumors (benign and malignant) were often associated with a prominent uterus, uterine stump or prostate with or without prostatic cysts.

Ultrasonographic appearance and clinical findings in 14 dogs with gallbladder mucocele.

Fourteen dogs with enlarged gallbladders and immobile stellate or finely striated bile patterns on ultrasound are described. Smaller breeds and older dogs were overrepresented, with 4/14 Cocker Spaniels. Most dogs presented for nonspecific clinical signs such as vomiting, anorexia and lethargy. Abdominal pain, icterus and hyperthermia were the most common findings on physical examination. All dogs except one had serum elevation of total bilirubin and/or alkaline phosphatase, alanine aminotransferase and gamma glutamyl transferase. All dogs were diagnosed with a gallbladder mucocele upon histologic and/or macroscopic evaluation. Ultrasonographically, mucoceles are characterized by the appearance of the stellate or finely striated bile patterns and differ from biliary sludge by the absence of gravity dependent bile movement. On ultrasound, gallbladder wall thickness and wall appearance were variable and nonspecific. The cystic or common bile duct were normal sized in 5 dogs although all 5 had evidence of biliary obstruction at surgery or necropsy. Loss of gallbladder wall integrity and/or gallbladder rupture were present in 50% of the dogs, all located in the fundus. Gallbladder wall discontinuity on ultrasound indicated rupture whereas neither bile patterns predicted the likelihood of gallbladder rupture. Pericholecystic hyperechoic fat or fluid were suggestive of but not diagnostic for a gallbladder rupture. Cholecystectomy appears to be an appropriate treatment for mucoceles, if not to treat a gallbladder rupture, at least in most dogs to prevent it since gallbladder wall necrosis was identified by histology in 9 of 10 dogs. Mucosal hyperplasia was present in all gallbladders examined histologically. Positive aerobic bacterial culture was obtained from bile in 6 of 9 dogs. Cholecystitis was diagnosed histologically in 5 dogs and 4 dogs had signs of gallbladder infection solely upon bacterial bile culture. Gallbladder infection was not present with all the mucoceles suggesting that biliary stasis and mucosal hyperplasia may be the primary factors involved in mucocele formation. Based on the results of our study, we suggest two alternate courses of action in the presence of a distended gallbladder with an immobile ultrasonographic stellate or finely striated bile pattern: a cholecystectomy when clinical or biochemical signs of hepatobiliary disease are present or a medical treatment (antibiotics and choleretics) and patient monitoring by follow-up ultrasound examinations when the patient does not have clinical or biochemical abnormalities. An aerobic bile culture should be obtained in all patients, by ultrasound-guided fine needle aspirate or at surgery.

Evaluation of joint stabilization for treatment of shearing injuries of the tarsus in 20 dogs.

Medical records of 20 dogs with 23 shearing injuries of the tarsus leading to joint instability were reviewed. A transarticular external skeletal fixation device or prosthetic ligament was used to stabilize the joints. The most common complications were fixator failure and implant infection. The median times for wound healing and maximal joint function were 10 and 12 weeks, respectively. Clinical outcome was excellent in 22%, good in 56%, and poor in 22%. Comparison of the two stabilization methods showed no statistically significant differences in healing time, time to regain function, or clinical outcome.

Retrospective ultrasonographic evaluation of adrenal lesions in 26 dogs.

A review was performed of ultrasonographic findings in 26 dogs with confirmed adrenal lesions. Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated. Histopathologic diagnoses were obtained in all dogs. Adrenal lesions were confirmed as pheochromocytomas (9), adenocarcinomas (6), a poorly differentiated blastoma (1), bilateral adrenal metastases of a carcinoma (1), adenomas--one of which was bilateral--(4) and hyperplasia (6). Size and shape were extremely variable and not specific to lesion type. There was a tendency for pheochromocytomas (7), adenocarcinomas (5) and poorly differentiated blastoma (1) to be rounded masses. Adenomas (4), hyperplasia (7) and adrenal metastases (2) presented predominantly as nodules. No specificity in echogenicity was noted. Mineralization and bilaterality were present in both benign and malignant lesions. Vascular extension or the presence of a thrombus were suggestive but not specific signs of malignancy. Based on our preliminary study, ultrasonography is an effective method for localizing adrenal lesions and is helpful in assessing their extension. However, no definitive differentiation between benign and malignant lesions was possible using ultrasonographic criteria alone.

Imaging of adrenal gland disorders.

In recent years, diagnostic imaging has become an important adjunct to conventional endocrine testing in the evaluation of adrenal gland dysfunction. This article discusses the role of imaging in the diagnostic workup of the following adrenal gland disorders: hypercatacholaminism, hyperaldosteronism, hyperadrenocorticism, and hypoadrenocorticism. The strengths and limitations of radiography, ultrasonography, scintigraphy, CT scanning, and MR imaging are addressed.

Blood volume following diuresis induced by furosemide.

Changes in blood volume were investigated following intravenous injection of a single dose of furosemide in 21 patients with pulmonary edema. In a subset of 10 patients in whom the blood urea nitrogen level was 11.4 +/- 2.2 mg/dl and the serum creatinine level was 1.3 +/- 0.1 mg/dl and in whom total urine output exceeded 1 liter over a four- to six-hour interval ("diuretic" group), no significant change in plasma or total blood volume was observed, nor were there any significant changes in hematocrit. In a "nondiuretic" group of 11 patients who had moderately decreased renal function (blood urea nitrogen level 59.3 +/- 13.0 mg/dl and serum creatinine level 2.3 +/- 0.3 mg/dl) and in whom total urine output was less than 1 liter over the four- to six-hour interval, there was a significant increase in blood volume with a concomitant decrease in hematocrit and hemoglobin levels. Furosemide-induced diuresis therefore did not deplete intravascular volume. To the contrary, actions of furosemide that were independent of its diuretic action were associated with an expansion of plasma volume in the absence of diuresis. This may be related to the venous capacitance effects of furosemide with lowering of venous resistance and, therefore, lowering of the capillary hydrostatic pressure. In addition, there was an increase in colloid osmotic pressure. Both mechanisms increase the effective oncotic pressure gradient, which favors reabsorption of extravascular (edema) fluid. It is concluded that intravascular volume was therefore replenished at a rate equal to or in excess of the volume removed by diuresis.

La presion coloidosmotica. / Colloid osmotic pressure

Se realiza un estudio retrospectivo en 975 historias clínicas de pacientes egresados del Servicio de Cirugía General del I.N.S.N. entre 1979 y 1983 con el diagnóstico de apendicitis aguda, con la finalidad de determinar la incidencia de absceso residual intraabdominal postapendicectomía y algunos factores predisponentes asi como su morbimortalidad. Se encontró una incidencia de 6.1% de A.R.I. postapendicectomía la que aumenta significativamente pasadas las 24 horas de enfermedad y al no invaginar el muñon apendicular. El 94.9% de los casos de A.R.I. presentó perforación del apéndice y el 62% peritonitis generalizada. Su localización mas frecuente fue el fondo de saco de Douglas y sólo tres pacientes no recibieron antibióticos en el postoperatorio. Fallecieron dos pacientes (3.38% )

[Our experience with bronchofibroscopy]. / Notre expérience de la broncho-fibroscopie.

Five hundred and eighty three broncho-fibroscopies were performed by the authors. Tumoural pathology represents 60% of diagnostic indications. Histological samples have a satisfying yield : 72.4% for the whole tumoural pathology, 80% for primitive bronchial tumours. The comparison with the results of sampling done by bronchoscopy is in favour of broncho-fibroscopy, especially for distal localizations (62% of positive results against 47%). In respiratory intensive care, a place of its own should be given to bronchoaspiration, where this technique of tracheo-bronchial clearing seems well adapted.