Urinary incontinence in a dog with a duplex renal system and extramural ectopic ureter.

A 1-year-old female spayed French Bulldog was referred to the Interventional Radiology and Endoscopy Service for evaluation of urinary incontinence with partial response to medical management (phenylpropanolamine). Cystourethroscopy and retrograde ureteropyelogram were performed and revealed multiple congenital abnormalities including; a duplex renal system of the left kidney with one normal ureter with an intravesicular ureteral orifice and one extramural ectopic ureter with an associated branching and ureteral diverticulum. A dual vagina was also noted. Left neoureterocystostomy of the extramural ectopic ureter was performed and a temporary ureteral stent was concurrently placed and removed cystoscopically one month later, leaving the patient with two patent left ureters. Thirty-four months later the patient is mildly incontinent with no other comorbidities.

Outcome of SUB placement for the treatment of benign ureteral obstruction in dogs: nine dogs and 12 renal units (2013 to 2017).

OBJECTIVES: To describe a group of dogs with benign ureteral obstruction(s) treated by subcutaneous ureteral bypass and report the intra-operative, peri-operative, short- and long-term outcomes. MATERIALS AND METHODS: Review of medical records of dogs that underwent subcutaneous ureteral bypass. RESULTS: Nine dogs (12 renal units) were included. Causes of obstruction included: ureterolithiasis (n=9) extraluminal compression (n=2), and stricture (n=1). Eleven of 12 ureters had a previously placed stent and required subcutaneous ureteral bypass for: recurrent stricture (n=4), diffuse ureteritis (n=4) or stent migration (n=3). Placement was successful in all renal units and there were no peri-operative or procedure-related deaths. Median hospitalisation time was 3 days. The median creatinine values pre-operatively and 3 month post-operatively were 186 and 106 µmol/L, respectively. No dog had worsening azotaemia in the short-term. The most common long-term complication was mineralisation of six devices, of which four required exchange. All dogs that were infected post-operatively (n=5) had a history of at least one urinary tract infection pre-operatively. One of the nine dogs had a chronic post-operative urinary tract infection and had been chronically infected before placing the bypass. The median survival time was >774 days, with five of nine dogs alive at the time of publication. CLINICAL SIGNIFICANCE: Placement of a subcutaneous ureteral bypass was an effective short-term treatment option for benign ureteral obstructions in dogs but there was a high rate of device mineralisation.

Treatment of pancreatitis-associated extrahepatic biliary tract obstruction by choledochal stenting in seven cats.

OBJECTIVES: To report the clinicopathological findings and outcome in cats with pancreatitis-associated extrahepatic biliary tract obstruction (EHBO) treated by choledochal tube stenting. METHODS: Medical records of cats with EHBO secondary to pancreatitis that underwent choledochal stenting were reviewed. Information on outcome was obtained by re-examination of the cat or by telephone interview with the owners. RESULTS: All cats had pancreatitis confirmed by histopathological examination of biopsy samples (n=6) or suspected based on gross examination at surgery (n=1). In six cats, a section of 3.5 to five French gauge red rubber catheter and in one cat a section of 22 G intravenous catheter were used as a choledochal stent. Two cats developed re-obstruction of the biliary tract within a week of the original surgery. One cat had confirmed episodes of ascending cholangitis postoperatively. Two cats had chronic intermittent vomiting in the postoperative period. Two cats died during the perioperative period. Five cats survived to discharge, three of which died seven to 24 months postoperatively and two of which remain alive to date. CLINICAL SIGNIFICANCE: Choledochal stenting is an alternative to biliary diversion for management of feline pancreatitis-associated EHBO in select cases. However, there may be greater morbidity with this technique in cats compared with dogs.

Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction.

BACKGROUND: Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. OBJECTIVES: To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). ANIMALS: 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). METHODS: Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. INCLUSION CRITERIA: surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. RESULTS: Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE: Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.

Early tumor response to intraarterial or intravenous administration of carboplatin to treat naturally occurring lower urinary tract carcinoma in dogs.

BACKGROUND: Survival times and tumor responses associated with malignant neoplasia of the lower urinary tract are poor despite the vast array of current treatments. Therefore, the evaluation of alternative treatments, such as intraarterial administration of chemotherapy (IAC) should be considered. OBJECTIVE: To describe a technique for superselective catheterization for IAC and to evaluate initial tumor response by ultrasonography after both IAC and intravenous administration of chemotherapy (IVC). ANIMALS: Client-owned dogs with lower urinary tract neoplasia treated with either IVC (n = 15) or IAC (n = 11). METHODS: Retrospective study. An arterial approach via the carotid or femoral artery was utilized to obtain superselective access and administer chemotherapy in the IAC cases. Medical record review was performed, data were recorded, and recorded variables were evaluated statistically. RESULTS: Intraarterial chemotherapy was successfully administered in all cases. There was a significantly greater decrease in longest unidimensional measurement in the IAC group as compared to the IVC group (P = .013). The IAC group was also significantly more likely to have a tumor response as assessed by modified RECIST guidelines (P = .049). Dogs in the IAC group were significantly less likely to develop anemia (P = .001), lethargy (P = .010) and anorexia (P = .024). CONCLUSION AND CLINICAL IMPORTANCE: This study demonstrated the feasibility and efficacy of performing IAC for lower urinary tract neoplasia. Further investigation is necessary as the follow-up time was short and the impact on long-term outcome and survival was not determined.

Depression and immunocompetence: a review of the literature.

Recent evidence suggests that there is a relationship between depression and immunity. On the basis of these studies, it has been argued that depressed mood may increase susceptibility to disease by means of aberrations occurring within the immune system. Empirical research investigating the relationship between depression and immunity is reviewed here. Studies examining both clinical and nonclinical manifestations of depression are discussed and evaluated. This review reveals that indexes of immunocompetence are lower among people exhibiting depressive symptomology and suggests that immune alterations may be more related to dysphoric mood than to specific situations or events. Alternative hypotheses accounting for links between depressed affect and altered immune states are provided, and suggestions for future research are offered.

Chronic stress, leukocyte subpopulations, and humoral response to latent viruses.

Psychological stress has been shown to affect immune system status and function, but most studies of this relationship have focused on acute stress and/or laboratory situations. The present study compared total numbers of leukocytes and lymphocyte subpopulations (determined by flow cytometry) and antibody titers to latent and nonlatent viruses among a group of chronically stressed individuals living near the damaged Three Mile Island (TMI) nuclear power plant with those of a demographically comparable control group. Urinary catecholamine and cortisol levels were also examined. Residents of the TMI area exhibited greater numbers of neutrophils, which were positively correlated with epinephrine levels. The TMI group also exhibited fewer B lymphocytes, T-suppressor/cytotoxic lymphocytes, and natural killer cells. Antibody titers to herpes simplex were significantly different across groups as well, whereas titers to nonlatent rubella virus as well as IgG and IgM levels were comparable.

Increasing short-term fluctuation by increasing the intensity of the fixation aid during perimetry.

An increase in short-term fluctuation is a clinically useful clue in the diagnosis of acquired disorders of the visual pathways. However, short-term fluctuation can also be increased in normal subjects by several factors. We found an increase in short-term fluctuation occurred in normal subjects when the visual field was tested using a bright fixation aid. Eight normal subjects underwent automated perimetry with the Octopus 2000R, in which the dimmest (12.5 candelas/m2) and brightest (435 cd/m2) available fixation aids were used. Mean short-term fluctuation values were 1.63 +/- 0.27 dB with the dimmest aid, and were 2.65 +/- 1.26 dB with the brightest aid. The difference was significant using the paired t-test (P = .037). Moreover, mean sensitivity was reduced from 35.67 +/- 2.26 dB to 33.66 +/- 1.71 dB when the brightest fixation aid was used (P = .004). In six of eight subjects, the relative changes in short-term fluctuation after an increase in brightness of the fixation aid were more pronounced than those in mean sensitivity. An increase in intensity of the fixation aid may cause visual changes in normal subjects that resemble those induced by disorders in the visual pathways. Whenever possible, minimal intensity of the fixation aid should be used to allow for an adequate interpretation of short-term fluctuation values.

Feasibility of automated visual field examination in children between 5 and 8 years of age.

AIMS: To investigate how young children develop the ability to undergo a visual field evaluation using regular automated perimetry. METHODS: The study included 42 normal girls aged 5, 6, 7, and 8 years. Twelve locations in the 15 degrees eccentricity were tested in one eye, using an Octopus 2000R perimeter with a two level strategy. False positive and false negative catch trials were presented. The examination was performed three times in succession. Before the examination procedure, a specially designed programme was conducted for progressive familiarisation. RESULTS: During the familiarisation procedure, it was found that all of the 5-year-old children, seven of the 6-year-old children, and three of the 7-year-old children were unable to perform immediately, and correctly, the instructions given during the familiarisation phase; these children took from 30 seconds to 3 minutes to comply with the examiner's requests. With the exception of one 5-year-old child, all tested subjects completed the planned procedure. The mean proportion of false negative answers in catch trials was 1.6%. The mean proportion of false positive answers was 12.2%. The quadratic dependency on age suggested by the averages was not significant (F(3,116) = 0.88; p = 0.45). Detection stimulus improved with age, as shown by the fact that probability of perceiving dim stimulus increases significantly (F(3,116) = 12.68; p < 0.0001). CONCLUSION: Children did remarkably well regarding both the duration of the examination and the reliability of the answers. A preliminary familiarisation phase with a specially designed adaptation programme was found to be mandatory with children aged 7 or under. To our knowledge, this is the first time that such an investigation has been performed.

Behavioral training and AIDS risk reduction: overcoming barriers to condom use.

To assess the short- and long-term effects of an AIDS-prevention workshop on undergraduates' attitudes about condom use and AIDS, 31 participants and 31 controls were studied immediately after training sessions as well as three months later. The workshop was aimed at reducing embarrassment to purchase condoms, encouraging positive attitudes about condoms, and promoting knowledge about AIDS. To help students overcome their embarrassment over condom purchases, a behavioral intervention was included allowing students to make condom purchases at nearby drug stores. Results revealed that participants reported less embarrassment over condom purchases after training sessions and that this effect became even stronger over time. Knowledge about AIDS and positive attitudes about condoms also increased immediately after the workshop, but these changes did not persist. Results suggest that AIDS prevention workshops may lead to transient changes unless a specific skill (i.e., condom purchasing) is targeted via behavioral training.

PIP: The findings of a case-control study conducted among college students suggest that social learning theory principles can reduce the embarrassment of young adults surrounding condom purchase. Surveyed were 62 male students (mean age, 19.4 years), 31 of whom were randomly assigned to receive the behavioral intervention. The intervention encompassed education on acquired immunodeficiency syndrome (AIDS) prevention, experimentation with proper condom use techniques, and actual condom purchases from off-campus drugstores. Questionnaires concerning sexual practices, knowledge and attitudes about AIDS, and perceptions of condom use were administered to all students both at study entry and three months after study completion. At baseline, 88% of students reported ever-use of condoms and 60% identified condoms as their primary form of contraception; however, only 12.2% were using condoms at every act of intercourse. At the follow-up survey, students exposed to the experimental intervention reported an average of 12.0 condom purchases in the preceding three months compared to 7.8 purchases among controls. Moreover, 66.7% of cases compared to 60% of controls now cited condoms as their contraceptive method of choice. Subjects reported significantly less embarrassment about making condom purchases after the training session, and this effect became stronger with time; controls showed no changes in ratings of embarrassment. Although workshop participants expressed greater intentions to use condoms consistently in the future than controls and a more positive overall attitude toward this method, these changes diminished during the post-intervention period and, by the time of the three-month follow-up, cases and controls were similar on both measures. Similarly, workshop participants were more knowledgeable about AIDS after the intervention, but this change was also subject to erosion. It is concluded that purely educational interventions produce only short-term gains, while behavioral training aimed at imparting a specific skill can result in enduring behavioral change.

Assessment of the efficacy and potential complications of transjugular liver biopsy in canine cadavers.

BACKGROUND: Transjugular liver biopsy (TJLB) is used in humans at risk of bleeding. There are no reports of its use in veterinary medicine. OBJECTIVE: To assess the efficacy and potential complications of TJLB in canine cadavers, and compare with samples obtained via needle liver biopsy (NLB) and surgical liver biopsy (SLB). ANIMALS: Twenty-five medium and large breed canine cadavers. METHODS: Prospective study. TJLBs were procured through the right jugular vein. After biopsy, intravenous contrast and gross inspection were used to assess the biopsy site. Minor and major complications were recorded. NLBs and SLBs were then obtained. Histopathology was performed, and TJLB and NLB were compared for number of complete portal tracts (CPTs), length, and fragmentation. Pathologic process and autolysis were assessed in all samples. RESULTS: All TJLBs yielded liver tissue. The proportion of minor complications was 12/25 (48%), and major complications 16/25 (64%); 13/16 (81%) of the major complications were liver capsule perforation. In 21/25 (84%), the histopathology in the SLB was reflected in the TJLBs. For cases with minimal autolysis, median number of CPTs in TJLBs was 7.5, compared with 4 in NLBs (P = .018). Median length of TJLB specimen was 28 mm compared to 22 mm in NLBs (P = .007). Fragmentation rate was median of 1.25 for TJLB compared to 1.50 in NLBs (P = .11). CONCLUSIONS AND CLINICAL IMPORTANCE: TJLB is technically feasible and achieves comparable results to NLB and SLB. The number of complications, in particular liver capsule perforation, was greater than expected. Further studies are indicated before clinical use is recommended.

Evaluation of urethral stent placement for benign urethral obstructions in dogs.

BACKGROUND: Benign urethral obstructions (BUO) in dogs result in substantial morbidity because of challenges with conventional therapies. Treatment of malignant urethral obstructions with intraluminal urethral stents is reported to successfully relieve obstructions. HYPOTHESIS/OBJECTIVES: To evaluate the efficacy and outcome of urethral stent placement for treatment of BUO in dogs. ANIMALS: Eleven client-owned animals with urethral stents placed for treatment of BUO. METHODS: Retrospective study in which medical records were reviewed in dogs diagnosed with BUO and treated with a metallic urethral stent. Data collected included signalment, cause of benign obstruction, procedure time, size and type of stent, complications, and short- and long-term outcome. RESULTS: Eleven dogs with 15 urethral stents were included. Intraluminal urethral stent(s) relieved the obstructions in all dogs. Four dogs had 2 stents placed in separate procedures because of incomplete patency after treatment (n = 1), inadvertent compression of the stent (n = 1), or tissue ingrowth through the stent (n = 2). The median continence score after stent placement was 10 of 10 (range 3-10) with 6 dogs being continent, 3 mildly incontinent, and 1 each moderately and severely incontinent. All owners considered their dog to have an excellent long-term clinical outcome with long-term urethral patency. The median follow-up time was 24 months (range 4-48). CONCLUSIONS AND CLINICAL IMPORTANCE: Urethral stents appear to be an effective treatment for benign urinary obstructions. Moderate to severe incontinence developed in a minority (12.5%) of dogs. Stents relieved obstructions in all dogs with an excellent long-term outcome.

Esophageal stenting for treatment of refractory benign esophageal strictures in dogs.

BACKGROUND: Benign esophageal strictures can recur despite multiple dilatation procedures and palliative management can be challenging. OBJECTIVE: To describe the technique and determine the outcome of esophageal stenting for treatment of refractory benign esophageal strictures (RBES) in dogs. ANIMALS: Nine dogs with RBES. METHODS: Retrospective review of records for dogs with RBES. Indwelling intraluminal esophageal stents were placed transorally with endoscopy, fluoroscopic guidance, or both. Follow-up information was obtained via medical record or telephone interview. RESULTS: Nine dogs had 10 stents placed including biodegradable stents (BDS) (6/10), self-expanding metallic stents (SEMS) (3/10), and a self-expanding plastic stent (SEPS) (1/10). All dogs had short-term improved dysphagia. Complications included ptyalism, apparent nausea, gagging, vomiting, or regurgitation (8/9), confirmed recurrence of stricture (6/9), stent migration (3/9), stent shortening (1/9), megaesophagus (1/9), incisional infection (1/9), and tracheal-esophageal fistula (1/9). Eight of 9 dogs required intervention because of the complications of which 4 of 8 dogs were eventually euthanized because of stent-related issues. One dog was lost to follow-up examination. CONCLUSIONS AND CLINICAL IMPORTANCE: Findings suggest that esophageal stent placement was safe and technically effective, but unpredictably tolerated in dogs with RBES. If a stent is placed, dogs should be monitored carefully for stent migration, dissolution of absorbable stents, and recurrence of strictures.

Feline ureteral strictures: 10 cases (2007-2009).

BACKGROUND: Feline ureteral obstructions have emerged as a common problem. Ureteral strictures rarely are reported as a cause and the predisposing factors and clinical course of this condition have not been described. OBJECTIVES: Evaluate cases of feline ureteral strictures and characterize historical features, clinical signs, diagnostic imaging, surgical and endoscopic findings, histopathology, treatment modalities, and short- and long-term outcomes. ANIMALS: Ten cats diagnosed with ureteral strictures based on compatible findings from at least 2 of the following: ultrasonography, ureteropyelography, surgical exploration, or histopathology. METHODS: Retrospective study. RESULTS: Median age, serum creatinine concentration, and size of the renal pelvis were 12 years, 3.7 mg/dL, and 11.75 mm, respectively. Six of 10 cats had hyperechoic periureteral tissue on ultrasound examination at the stricture site. Four cats had evidence of a circumcaval ureter at surgery. Eight cats had an intervention including ureteral stent placement (n = 6) and traditional surgery (n = 2). Seven of 8 cats had decreases in serum creatinine concentration and renal pelvic parameters preceding discharge and 6 had persistently improved results at their last examination. All patients survived to discharge. Median survival time was > 294 days (range, 14 to > 858 days) with 6/10 cats still alive. CONCLUSIONS AND CLINICAL IMPORTANCE: Ureteral strictures may occur in cats secondary to ureteral surgery, inflammation, a circumcaval ureter, impacted ureterolithiasis, or for unknown causes. With appropriate and timely intervention, the prognosis for long-term survival is good. In addition to ureteral reimplantation or ureteronephrectomy, ureteral stenting or SC ureteral bypass may be considered as future therapeutic options.

Cardiac magnetic resonance in the differentiation of neoplastic and nonneoplastic pericardial effusion.

BACKGROUND: Cardiac magnetic resonance (CMR) is the imaging modality of choice for cardiac tumors in people. Although neoplastic pericardial effusion (PE) carries a poor prognosis, benign idiopathic pericardial effusion does not. Definitive diagnosis is critical for surgical intervention, but currently available diagnostic techniques such as echocardiography and pericardial fluid cytology often are inconclusive. HYPOTHESIS/OBJECTIVE: Describe CMR findings associated with PE and determine whether CMR aids in differentiation of benign and neoplastic causes of PE. ANIMALS: Eight client-owned dogs with PE diagnosed by transthoracic echocardiography (TTE). METHODS: CMR was performed with a 1.5 T, including dark blood, steady-state free procession cine, pre- and postcontrast T1-weighted imaging, and delayed inversion recovery prepped imaging. RESULTS: CMR confirmed a cardiac mass and supported suspected tumor type in 4 dogs with suspected hemangiosarcoma. In 1 equivocal TTE case, CMR did not demonstrate a mass, but neoplasia was later diagnosed. In another equivocal case, CMR did not demonstrate a mass but showed findings consistent with a pericardiocentesis complication. In 1 dog without evidence of cardiac neoplasia, abdominal magnetic resonance imaging identified presumptive hepatic and splenic metastases. On reevaluation of the original CMR study, the 2 equivocal cases that were interpreted as tumor negative were reassessed as tumor positive. CONCLUSIONS AND CLINICAL IMPORTANCE: CMR did not substantially improve diagnosis of cardiac tumors compared with TTE in these 8 cases, but it yielded useful descriptive information regarding extent, anatomic location, and potential tumor type and confirmed that CMR requires extensive additional training for tumor identification.

Diagnosis of arterioportal fistulae in four dogs using computed tomographic angiography.

Arterioportal fistulae are rare congenital anomalies of the hepatic vasculature. Diagnosis is conventionally made by selective angiography or ultrasonography. This report describes use of a dual-phase computed tomographic (CT) angiographic technique to diagnose arterioportal fistulae in four dogs. Advantages of this method include a noninvasive peripheral injection of contrast medium, ability to diagnose multiple acquired extrahepatic shunts, and observation of hemodynamic changes such as hepatofugal blood flow and reduced circulation to the caudal abdomen. The hepatic vasculature including arteries, veins, and portal veins can be completely evaluated. Dual-phase CT angiography is a safe and minimally invasive method of diagnosing arterioportal fistulae in dogs.

Psychological influences on pain perception and non-pharmacologic approaches to the treatment of pain.

Pain is a complex process, in part because it is mediated by so many different variables. However, because pain is the primary reason for seeking medical treatment and often a barrier to compliance, therapists treating painful disorders or injuries need to be familiar with those factors that influence pain perception and treatment approaches. How individuals perceive pain, and hence how clinicians treat it, depends upon a wide variety of psychosocial factors, including mood, age, gender, expectations, social support, and perceptions of control. Even the manner with which therapists interact with patients can minimize the pain experience and ultimately impact compliance and recovery rates. This paper overviews the multifaceted nature of pain by outlining how psychologic variables impact pain experiences. In addition, this article reviews a number of nonpharmacologic techniques and approaches (i.e., distraction, imagery, relaxation, biofeedback) that are available for assisting patients in dealing with pain.

Do gender and race affect decisions about pain management?

OBJECTIVE: To determine if patient gender and race affect decisions about pain management. DESIGN, SETTING, AND PARTICIPANTS: Experimental design using medical vignettes to evaluate treatment decisions. A convenience sample of 111 primary care physicians (61 men, 50 women) in the Northeast was asked to treat 3 hypothetical patients with pain (kidney stone, back pain) or a control condition (sinusitis). Symptom presentation and severity were held constant, but patient gender and race were varied. MEASUREMENTS AND MAIN RESULTS: The maximum permitted doses of narcotic analgesics (hydrocodone) prescribed at initial and return visits were calculated by multiplying mg per pill x number of pills per day x number of days x number of refills. No overall differences with respect to patient gender or race were found in decisions to treat or in the maximum permitted doses. However, for renal colic, male physicians prescribed higher doses of hydrocodone to white patients versus black patients (426 mg vs 238 mg), while female physicians prescribed higher doses to blacks (335 mg vs 161 mg, F1,85 = 9.65, P =.003). This pattern was repeated for persistent kidney stone pain. For persistent back pain, male physicians prescribed higher doses of hydrocodone to males than to females (406 mg vs 201 mg), but female physicians prescribed higher doses to females (327 mg v. 163 mg, F1,28 = 5.50, P =.03). CONCLUSION: When treating pain, gender and racial differences were evident only when the role of physician gender was examined, suggesting that male and female physicians may react differently to gender and/or racial cues.