Accuracy of US-guided FNA of focal liver lesions in dogs: 140 cases (2005-2008).

Medical records from dogs having abdominal ultrasound (US) performed between March 2005 and October 2008 were reviewed for detection of focal liver lesions (FLL) with both cytologic and histologic sampling. Samples were classified as to either the presence or absence of major categories of pathologic processes, including malignant neoplasia, inflammation, hyperplasia/benign neoplasia, vacuolar change, extramedullary hematopoeisis, cholestasis, necrosis, and no microscopic abnormalities. Evaluation of selection bias was performed by review of the relative distribution of cytologic diagnoses for cases with histology compared with cases excluded from the comparison analysis because histology results were not available. Cytology had the highest sensitivity for vacuolar change (57.9%), followed by neoplasia (52.0%). Cytology had the highest positive predictive value (PPV) for neoplasia (86.7%) followed by vacuolar change (51.6%). Cytology had lower sensitivity and PPVs for inflammation, necrosis, and hyperplasia. The ability of cytology to characterize disease in canine FLL varies by pathologic process. Clinicians can have a high degree of confidence when a cytologic diagnosis of neoplasia is given; however, cytology is less reliable for excluding the potential for neoplasia. Cytology has a low sensitivity and PPV for inflammation and a limited diagnostic performance for the diagnosis of vacuolar change.

Analysis of clinical and ultrasonographic data by use of logistic regression models for prediction of malignant versus benign causes of ultrasonographically detected focal liver lesions in dogs.

OBJECTIVE: To investigate the value of clinical, laboratory, and imaging data for use in predicting malignant or benign histologic results for ultrasonographically detected focal liver lesions in dogs. SAMPLE: Records and archived images of 247 dogs evaluated at the University of Minnesota Veterinary Medical Center from 2005 to 2008 that underwent abdominal ultrasonography and histologic evaluation of the liver. PROCEDURES: Data were analyzed with multivariable logistic regression models. All dogs were classified as having benign or malignant liver disease on the basis of histologic reports. Three multivariable logistic regression models were fit to a development subset of the data by use of combinations of signalment, historical, physical examination, laboratory, and diagnostic imaging (survey radiography and abdominal ultrasonography) data as predictor variables. The resulting models were validated by evaluating predictive performance against a holdout validation subset of the data. RESULTS: Models that included ultrasonographic variables had the highest overall predictive value. In these models, greater lesion size and the presence of peritoneal fluid were the only variables that had a positive association with malignant liver disease. CONCLUSIONS AND CLINICAL RELEVANCE: Large ultrasonographically detected liver lesions and the presence of peritoneal fluid were associated with malignant liver disease in dogs.

[Comparison of intravenous fentanyl analgesia and epidural analgesia for postoperative pain relief].

BACKGROUND: Epidural analgesia is available for postoperative pain relief except for the patients with bleeding tendency or under anticoagulation. Intravenous fentanyl analgesia can be applied for such patients but its effect has not been evaluated enough. We compared these two methods after abdominal surgery. METHODS: In the intravenous fentanyl analgesia group (group iv, n = 15), 0.7 microg x kg(-1) x hr(-1) fentanyl infusion was started during operation and decreased to 0.5 microg x kg(-1) x hr(-1) on the next morning. In the epidural analgesia group (group e, n = 15), 0.4 microg x kg(-1) x hr(-1) fentanyl and 5 ml x hr(-1) 1% mepivacaine infusion was started during operation. The VAS pain score (at rest and at coughing), the level of consciousness, respiratory and cardiovascular depression, nausea and vomiting were evaluated for 3 days. RESULTS: The VAS scores at rest were similar in two groups but the VAS scores at coughing were similar or lower in the group iv. In the group iv, five patients suffered from nausea and one patient had somnolence. In the group e, only one patient had nausea but two patients had hypotension. CONCLUSIONS: Intravenous fentanyl analgesia is safe and possibly more effective than epidural analgesia.

[A case of latex allergy induced by indwelt Foley catheter].

A 7-year-old boy with microtia was scheduled for otoplasty under general anesthesia. A Foley catheter was indwelt very gently following tracheal intubation but his foreskin showed remarkable edema about 15 minutes later. All vital signs were normal. His lungs were ventilated easily and no rash or edema was found except for penis. Operation was completed uneventfully as planned. He recovered from anesthesia smoothly but foreskin edema still remained. Allergic reaction was suspected and scratch test was performed to determine the allergen on the next day. Positive reaction to Foley catheter extracts and high serum latex-specific IgE antibody level proved that latex containing Foley catheter had caused foreskin edema. All anesthesiologists should pay attention to latex allergy and interview all patients in detail in preanesthetic evaluation.

[False decrease in pulse oximetry readings due to patent blue in a patient with breast cancer].

A 61-year-old woman with breast cancer was scheduled for breast preserving therapy under general anesthesia. After the tracheal intubation, 4 ml of 2% patent blue was injected into the skin to determine sentinel lymph node. Thirty seconds after injection, the pulse oximetry reading (SpO2) decreased from 100% to 60% and recovered to 90% over the next 5 minutes. At the time when SpO2 was 88%, arterial blood gas analysis showed PaO2 184.4 mmHg (FIO2 0.45) and all other vital signs were normal. About 120 minutes later, SpO2 rose to 99%. The operation was completed uneventfully and the patient recovered from anesthesia smoothly. After extubation, arterial blood gas analysis was performed again and it showed PaO2 of 82.5 mmHg (FIO2 0.21). We conclude that patent blue injection caused this decrease in SpO2 and recommend to evaluate the oxygen status not only by pulse oximetry but also by blood gas analysis when patent blue is used.