Determination of the reference interval for urine kidney injury molecule-1 in 50 healthy cats.

OBJECTIVES: The aim of the present study was to establish a reference interval (RI) for urine kidney injury molecule-1 (KIM-1) in healthy cats. METHODS: History, physical examination, blood pressure, and feline immunodeficiency virus and feline leukemia virus serology status were determined. A complete blood cell count, serum biochemical profile, urinalysis and kidney ultrasound were performed, and N-terminal pro-brain natriuretic peptide, total thyroxine (TT4) and urine KIM-1 were measured. An RI was calculated and the effect of age, sex, body condition score (BCS), blood pressure, symmetric dimethylarginine (SDMA), serum creatinine concentration (SCr), phosphorus, TT4, urine specific gravity (USG) and mid-sagittal kidney length on urine KIM-1 was evaluated using a general linear model. RESULTS: Of 69 recruited cats, 50 met the inclusion criteria. There were 35 male cats and 15 female cats, with a median age of 4.3 years (range 1.0-12.3), median weight of 5.11 kg (range 2.52-8.45) and median BCS of 6/9 (range 3-8). The median serum concentrations were SDMA 11.0 µg/dl (range 2-14), SCr 88.5 µmol/l (range 47-136), phosphorus 1.41 mmol/l (range 0.8-2.2) and TT4 32.0 nmol/l (range 17-51). Median USG was 1.057 (range 1.035-1.076), mid-sagittal left kidney length was 3.50 cm (range 2.94-4.45) and mid-sagittal right kidney length was 3.70 cm (range 3.06-4.55). The derived RI for urine KIM-1 was 0.02-0.68. USG was a significant (P <0.001) predictor of urine KIM-1. Individually, age, sex, blood pressure, BCS, SDMA, SCr, phosphorus, TT4 and mid-sagittal kidney length were not significant predictors of urine KIM-1. In a multivariate model, if combined with USG, SDMA concentration was predictive (P = 0.030) of urine KIM-1. CONCLUSIONS AND RELEVANCE: Urine concentration was significantly correlated with urine KIM-1, which will be an important consideration when interpreting findings in cats with potential kidney injury.

Classification of the quality of canine and feline ventrodorsal and dorsoventral thoracic radiographs through machine learning.

Thoracic radiographs are an essential diagnostic tool in companion animal medicine and are frequently used as a part of routine workups in patients presenting for coughing, respiratory distress, cardiovascular diseases, and for staging of neoplasia. Quality control is a critical aspect of radiology practice in preventing misdiagnosis and ensuring consistent, accurate, and reliable diagnostic imaging. Implementing an effective quality control procedure in radiology can impact patient outcomes, facilitate clinical decision-making, and decrease healthcare costs. In this study, a machine learning-based quality classification model is suggested for canine and feline thoracic radiographs captured in both ventrodorsal and dorsoventral positions. The problem of quality classification was divided into collimation, positioning, and exposure, and then an automatic classification method was proposed for each based on deep learning and machine learning. We utilized a dataset of 899 radiographs of dogs and cats. Evaluations using fivefold cross-validation resulted in an F1 score and AUC score of 91.33 (95% CI: 88.37-94.29) and 91.10 (95% CI: 88.16-94.03), respectively. Results indicated that the proposed automatic quality classification has the potential to be implemented in radiology clinics to improve radiograph quality and reduce nondiagnostic images.

Laparoscopic surgical treatment for sliding hiatal hernia is associated with an owner-perceived improvement in clinical outcome in dogs.

OBJECTIVE: To report perioperative complications and client-perceived outcome following laparoscopic surgical treatment for sliding hiatal hernia (SHH) in dogs. ANIMALS: Client-owned dogs (n = 9). METHODS: Medical records were reviewed and perioperative data collected including preoperative diagnostic imaging, operative details, complications, and need for conversion to open celiotomy. A single-incision, multicannulated port was inserted in the subumbilical region followed by placement of an additional 2 or 3 instrument portals. Hiatal plication, esophagopexy, and left-sided gastropexy were performed laparoscopically. Follow-up information was collected with telephone interview with the owners and/or referring veterinarian. A standardized questionnaire was completed by dog owners postoperatively. RESULTS: Intraoperative pneumothorax occurred in 5 of 9 (55.6%) dogs and resulted in conversion to open celiotomy in 2 (22.2%) dogs. In 4 dogs, pneumothorax was suspected to be the result of progressive leakage of capnoperitoneum through the suture bite holes of the esophageal hiatal plication sutures. Hiatal plication was performed using intracorporeal simple interrupted sutures (n = 4) or a simple continuous pattern with barbed suture (4). Esophagopexy was performed using barbed suture in all dogs. Gastropexy was performed using a total laparoscopic technique (n = 4) or laparoscopic-assisted technique (3). Using a standardized questionnaire, dog owners perceived a postoperative improvement in regurgitation after eating and regurgitation after excitement/increased activity. CLINICAL RELEVANCE: Laparoscopic treatment of SHH resulted in owner-perceived improvement in clinical signs. Intraoperative pneumothorax occurred in a high proportion of dogs but did not result in long-term sequelae.

Diagnosis and management of a peripheral T-cell lymphoproliferative disease in an American pine marten (Martes americana).

A 9-year-old neutered male American pine marten (Martes americana) was referred for further evaluation of suspected lymphoproliferative disease. On physical examination, the pine marten was determined to be in an underconditioned state with an enlarged right mandibular lymph node. Hematology revealed a marked leukocytosis characterized by a lymphocytosis. Flow cytometry performed on peripheral blood was suggestive of a CD4+ T-cell lymphoproliferative disease. Whole-body radiographs demonstrated a large cranial mediastinal mass and splenomegaly. These findings were confirmed using ultrasound, which also identified intra-abdominal lymphadenopathy and splenic nodules. Cytologic evaluation of aspirates from the mediastinal mass was interpreted as possible lymphoma. The pine marten was treated with chlorambucil and prednisolone and achieved a durable partial remission. Twelve months after initial diagnosis, progressive disease was noted and treatment with lomustine was initiated as a rescue protocol until euthanasia, which was carried out 15 mo after the initial diagnosis. Based on a literature search, this is the first case report describing the management of peripheral T-cell lymphoproliferative disease, presumably peripheral lymphoma, in a pine marten; this neoplasm should be considered as a differential diagnosis in pine martens that have abnormal complete blood cell count findings and enlarged lymph nodes. Key clinical message: This report describes the diagnosis and management of a peripheral T-cell lymphoproliferative disease, presumably peripheral lymphoma, in an American pine marten (Martes americana). This is the first report of this disease and its successful treatment in a pine marten.

Diagnostic et prise en charge d'une maladie lymphoproliférative à cellules T périphériques chez une martre d'Amérique ( Martes americana ). Une martre d'Amérique (Martes americana) mâle castré âgé de 9 ans a été référée pour une évaluation plus approfondie d'une suspicion de maladie lymphoproliférative. À l'examen physique, il a été déterminé que la martre était dans un état sous-optimal avec un ganglion lymphatique mandibulaire droit élargi. L'hématologie a révélé une hyperleucocytose marquée caractérisée par une lymphocytose. La cytométrie en flux réalisée sur le sang périphérique était évocatrice d'une maladie lymphoproliférative des lymphocytes T CD4+. Les radiographies du corps entier ont montré une importante masse médiastinale crânienne et une splénomégalie. Ces résultats ont été confirmés par échographie, qui a également identifié une lymphadénopathie intra-abdominale et des nodules spléniques. L'évaluation cytologique des aspirations de la masse médiastinale a été interprétée comme un possible lymphome. La martre d'Amérique a été traitée avec du chlorambucil et de la prednisolone et une rémission partielle durable a été obtenue. Douze mois après le diagnostic initial, une progression de la maladie a été notée et un traitement par lomustine a été initié comme protocole de sauvetage jusqu'à l'euthanasie, qui a été réalisée 15 mois après le diagnostic initial. Sur la base d'une recherche documentaire, il s'agit du premier rapport de cas décrivant la prise en charge d'une maladie lymphoproliférative périphérique à cellules T, vraisemblablement un lymphome périphérique, chez une martre d'Amérique; ce néoplasme doit être considéré comme un diagnostic différentiel chez les martres d'Amérique qui présentent des résultats anormaux de numération globulaire complète et des ganglions lymphatiques hypertrophiés.Message clinique clé :Ce rapport décrit le diagnostic et la prise en charge d'une maladie lymphoproliférative à cellules T périphériques, vraisemblablement un lymphome périphérique, chez une martre d'Amérique (Martes americana). Il s'agit du premier signalement de cette maladie et de son traitement réussi chez une martre d'Amérique.(Traduit par Dr Serge Messier).

Shear wave elastography evaluation of cats with chronic kidney disease.

Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of life and financial implications for therapy. Currently staging and identification of CKD is limited by diagnostic testing such as creatinine and urine-specific gravity, which do not change until late in the disease course. Other methods to evaluate CKD would be valuable in the clinical setting. Shear wave elastography is one novel ultrasound method, which has shown promise in identifying increases in tissue stiffness and identifying CKD in people. As CKD is often histologically characterized by tubulointerstitial fibrosis, shear wave elastography has the potential to identify CKD and differentiate between stages of CKD in cats. This prospective observational case-control study with 78 cats found no difference in shear wave velocities between groups (P = 0.33), a contradictory finding to one prior publication. There was no effect of weight (P = 0.65), nor the presence of mineralization (P = 0.31) or infarction (P = 0.52) on cortical shear wave velocities. There was a significant effect of age on shear wave velocity (P = 0.018) where velocities increased with age. The intraclass correlation coefficient was only moderate (0.62). Possible reasons for the difference in results between our work and that published prior, include differences in methodology and differences in instrumentation. Variability in measurements in our population may be due to the effects of respiratory motion or limitations in shear wave elastography software. As such, shear wave elastography is not currently recommended as a tool to evaluate CKD in cats and further work is necessary.

CT features of subcutaneous, intermuscular, and intramuscular mast cell tumors in dogs.

Surgical removal is the treatment of choice for subcutaneous (SC), intermuscular (InterM), and intramuscular (IntraM) mast cell tumors (MCTs). Advanced imaging (CT or MRI) is frequently used for presurgical planning, but InterM and IntraM MCTs can be difficult to identify and delineate on CT. Aims of the current retrospective, diagnostic accuracy, observer agreement study were to describe the imaging features of SC, InterM, and IntraM MCTs on CT and to assess the limitation of CT to identify the full local extent of the MCT. Inclusion criteria for the study were dogs with a cytologically or histologically diagnosed MCTs determined to be SC, InterM, or IntraM MCT based on histology and/or a CT scan performed in the gross disease setting. Two board-certified veterinary radiologists reviewed the CT images and recorded location, contrast enhancement pattern, and delineation between the normal and abnormal tissue. Sensitivity and specificity of CT for determining location (SC/InterM versus IntraM) was 85.71% and 55.56%, respectively, when compared to consensus location based on surgical pathology report/CT/MRI review. There was a low inter-rater agreement for delineation (kappa: 0.150 (-0.070 to 0.370) and measurement had a low/moderate correlation (rho: 0.4667 to 0.5792). Upon review by a surgical oncologist, CT findings were deemed insufficient for curative surgical planning in 13 of 16 due to inadequate definition of tumor depth, compartment boundary (fascial plane) or MCT margins. The use of CT for presurgical planning of SC/InterM/IntraM MCT dogs has limitations, especially when differentiating MCT from the adjacent muscle.

Clinical presentation and treatment of lymphoma in companion rats (Rattus norvegicus; 2008-2020).

OBJECTIVE: To describe the clinical presentation, treatment, and treatment outcomes for companion rats (Rattus norvegicus) diagnosed with lymphoma. ANIMALS: All rats that presented to the exotics service and underwent postmortem examination during the time period of 2008 through 2020 were evaluated. PROCEDURES: The medical records of 35 rats were evaluated for an ante- or postmortem diagnosis of lymphoma. Cases with a diagnosis of lymphoma were further reviewed for signalment, presenting complaint, clinical signs observed on physical exam, diagnostic testing performed, and treatments administered. Postmortem gross and histologic findings were reviewed. RESULTS: 7 out of 35 rats were diagnosed with lymphoma, either ante-mortem or postmortem. The most common presenting complaint that was present in all rats with lymphoma was respiratory abnormalities. Five out of 7 rats had radiographs performed, all of which had abnormalities noted in the thoracic cavity including pulmonary nodules, cranial mediastinal widening, or alteration to the cardiac silhouette. Diagnosis via cytologic aspirates was performed in 2 cases and each was diagnostic for lymphoma; however, even with treatment, survival time following initiation of chemotherapy was short (less than or equal to 24 days). The definitive diagnosis in the remainder of the cases was via necropsy. CLINICAL RELEVANCE: Results suggest that lymphoma is a common neoplastic disease in rats and a thorough diagnostic work-up is indicated in any rat that presents for general malaise or respiratory signs.

Complications and outcomes associated with laparoscopic-assisted splenectomy in dogs.

OBJECTIVE: To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS). ANIMALS: 136 client-owned dogs. PROCEDURES: Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group - Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines. RESULTS: LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus. CLINICAL RELEVANCE: In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.

The effect of laparoscopy on intracranial pressure as measured by optic nerve sheath diameter: A review.

Laparoscopic surgery has many benefits over open surgery including lower complication rates, and shorter duration and lower cost of hospitalization. However, recent human literature suggests laparoscopy and carbon dioxide insufflation can result in intracranial hypertension. Invasive monitoring of intracranial pressure is not routinely performed in veterinary medicine, and ultrasonographic evaluation of the optic nerve sheath has been employed as an indirect measure of intracranial pressure in many species. The optic nerve sheath is continuous with the meninges of the brain and becomes distended with intracranial hypertension. Optic nerve sheath diameter is a reliable and consistent measure of intracranial pressure and has been utilized in humans to evaluate patients for intracranial hypertension secondary to laparoscopy and capnoperitoneum. No thorough evaluation of the effects of laparoscopy on intracranial pressure has been performed in dogs. Ultrasonographic evaluation of the optic nerve sheath is a safe, non-invasive, and inexpensive procedure that may allow for the evaluation of intracranial pressure without the need for invasive monitoring systems. As laparoscopic procedures are performed increasingly often, this review aims to inform the reader on the effects of capnoperitoneum and to facilitate appropriate patient selection, anesthetic considerations, and surgical planning.

L'effet de la laparoscopie sur la pression intracrânienne mesurée par le diamètre de la gaine du nerf optique : une revue. La chirurgie laparoscopique présente de nombreux avantages par rapport à la chirurgie ouverte, notamment des taux de complications plus faibles, une durée d'hospitalisation plus courte et un coût moindre. Cependant, la littérature humaine récente suggère que la laparoscopie et l'insufflation de dioxyde de carbone peuvent entraîner une hypertension intracrânienne. La surveillance invasive de la pression intracrânienne n'est pas systématiquement effectuée en médecine vétérinaire, et l'évaluation échographique de la gaine du nerf optique a été utilisée comme mesure indirecte de la pression intracrânienne chez de nombreuses espèces. La gaine du nerf optique est continue avec les méninges du cerveau et se distend avec l'hypertension intracrânienne. Le diamètre de la gaine du nerf optique est une mesure fiable et cohérente de la pression intracrânienne et a été utilisé chez l'homme pour évaluer les patients atteints d'hypertension intracrânienne secondaire à la laparoscopie et au capnopéritoine. Aucune évaluation approfondie des effets de la laparoscopie sur la pression intracrânienne n'a été réalisée chez le chien. L'évaluation échographique de la gaine du nerf optique est une procédure sûre, non invasive et peu coûteuse qui peut permettre l'évaluation de la pression intracrânienne sans avoir besoin de systèmes de surveillance invasifs. Les procédures laparoscopiques étant de plus en plus pratiquées, cette revue vise à informer le lecteur sur les effets du pneumopéritoine et à faciliter la sélection appropriée des patients, les considérations anesthésiques et la planification chirurgicale.(Traduit par Dr Serge Messier).

Outcomes after transperitoneal laparoscopic ureteronephrectomy for the treatment of primary renal neoplasia in seven dogs.

OBJECTIVE: To describe the perioperative characteristics and outcomes in dogs that underwent transperitoneal laparoscopic ureteronephrectomy (TLU) for primary renal neoplasia. STUDY DESIGN: Short case series. ANIMALS: Seven client-owned dogs. METHODS: Medical records were reviewed and data extracted regarding perioperative characteristics and animal outcomes. TLU was performed using a single-port + 1 or multiple port techniques. Hemostatic clips or a vessel-sealing device were used for occlusion of renal hilar vessels. The ureter was occluded and transected close to the ureterovesicular junction and the tumor was placed in a specimen retrieval bag for extraction from the abdomen. RESULTS: Preoperative contrast enhanced computed tomography (CECT) was performed in 6/7 dogs. Median estimated tumor volume measured from abdominal CECT removed by TLU was 32.42 cm3 (interquartile range [IQR] 14.76-94.85). Median surgery time for TLU was 90 minutes (IQR 85-105). In one dog, elective conversion to open laparotomy was performed due to large tumor size. Median time to discharge was 31 hours (IQR 24-48). No major perioperative complications occurred and all dogs survived to discharge. Progression free survival in four dogs was 422 days (IQR 119-784). CONCLUSION: TLU was performed for the extirpation of modest sized primary renal tumors with acceptable perioperative outcomes and a low complication rate. CLINICAL RELEVANCE: TLU may be considered for the treatment of selected cases of primary renal neoplasia in dogs.

Laparoscopic ureteronephrectomy for the treatment of giant kidney worm infection in 2 dogs.

One male and one female dog were presented with giant kidney worm infection in the right kidney. Infection was identified through visualization of intra-renal Dioctophyme renale on abdominal ultrasound. Both dogs underwent right-sided laparoscopic ureteronephrectomy for treatment of the giant kidney worm infection. Additional adult worms were extirpated from the peritoneal cavity of both dogs. Both dogs recovered without complication from anesthesia and surgery and were discharged within 24 hours after surgery. Laparoscopic ureteronephrectomy has not previously been described for the treatment of giant kidney worm infection in North America.

Urétéro-néphrectomie laparoscopique pour le traitement d'une infection par le ver géant du rein chez deux chiens. Un chien mâle et un chien femelle furent présentés avec une infection par le ver géant du rein dans le rein droit. L'infection fut identifiée par visualisation de Dioctophyme renale intra-rénal par échographie abdominale. Les deux chiens furent soumis à une urétéro-néphrectomie laparoscopique pour le traitement de l'infection par le ver géant du rein. Des vers adultes additionnels furent retirés de la cavité péritonéale des deux chiens. Les deux chiens ont récupéré sans complication de l'anesthésie et de la chirurgie et ont obtenu leur congé en moins de 24 h après la chirurgie. L'urétéro-néphrectomie laparoscopique n'avait pas encore été décrite en Amérique du Nord pour le traitement de l'infection par le ver géant du rein.(Traduit par Dr Serge Messier).

INTRAOPERATIVE IMAGE NAVIGATION: EXPERIMENTAL STUDY OF THE FEASIBILITY AND SURGEON PREFERENCE BETWEEN A STERILE ENCASED NINTENDO WIITM REMOTE AND STANDARD WIRELESS COMPUTER MOUSE.

Diagnostic imaging plays an important role in the operating room, providing surgeons with a reference and surgical plan. Surgeon autonomy in the operating room has been suggested to decrease errors that stem from communication mistakes. A standard computer mouse was compared to a wireless remote-control style controller for computer game consoles (Wiimote) for the navigation of diagnostic imaging studies by sterile personnel in this prospective survey study. Participants were recruited from a cohort of residents and faculty that use the surgical suites at our institution. Outcome assessments were based on survey data completed by study participants following each use of either the mouse or Wiimote, and compared using an analysis of variance. The mouse was significantly preferred by the study participants in the categories of handling, accuracy and efficiency, and overall satisfaction (P <0.05). The mouse was preferred to both the Wiimote and to no device, when participants were asked to rank options for image navigation. This indicates the need for the implementation of intraoperative image navigation devices, to increase surgeon autonomy in the operating room.