Preemptive treatment of type II endoleak for abdominal aortic aneurysm with renal fusion (horseshoe kidney).

OBJECTIVE: To assess viability and safety of preemptive treatment of type II endoleak for abdominal aortic aneurysm (AAA) repairs. METHODS: A 69-year-old man with renal fusion (horseshoe kidney) was referred for treatment of a 5.5 cm AAA. His anatomy was suitable for endovascular repair. The risk for type II endoleak was increased because of multiple infrarenal arterial orifices originating within the aneurysm sac. These included an accessory renal artery that supplied the renal isthmus, a patent inferior mesenteric artery, and a pair of large lumbar arteries originating from a single orifice (8 mm) at L3 spinal level. The lumbar orifice was selectively cannulated and occluded with thrombogenic coils 1 week prior to his endovascular aneurysm repair. RESULTS: Aneurysm repair was uneventful with no signs of early or delayed endoleak and long-term follow-up of 5 years. CONCLUSIONS: Preemptive coil embolization of perianeurysmal arteries may be considered as a safe and effective strategy for management of potential type II endoleak.

Outcome measurement in functional neurological disorder: a systematic review and recommendations.

OBJECTIVES: We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS: A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS: Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS: There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.

Lamotrigine Toxicosis Treated with Intravenous Lipid Emulsion Therapy in a Dog.

A female spayed dachshund/mixed-breed dog was evaluated following ingestion of lamotrigine tablets with subsequent rapid onset of vomiting, diarrhea, and generalized tremoring. On initial examination, the dog was moderately obtunded and nonambulatory with intermittent myoclonus and hyperesthesia. Electrocardiogram revealed sinus tachycardia with prolongation of the QT interval. Intravenous lipid emulsion (ILE) infusion was initiated, with reduction in tremoring and improved patient mentation being noted after ∼20 min of therapy. An elevated cardiac troponin I value measured at 1.02 ng/mL the day after presentation. Serum toxicological assay revealed marked reduction in serum lamotrigine levels following ILE and continued reduction during hospitalization. The dog's clinical signs resolved, corrected QT interval returned to normal, and the patient was discharged 38 hr after presentation. Individual cases of lamotrigine toxicosis have not been fully reported in veterinary literature. This case report documents the rapid onset of clinical signs including neurologic dysfunction, cardiac arrhythmias, and transient corrected QT prolongation. Serial serum concentrations of lamotrigine showed a rapid reduction with ILE therapy and corresponded with clinical recovery, suggesting efficacy of ILE treatment in this case.

Consultation-Liaison Psychiatry vs Psychosomatic Medicine: What's in a name?

BACKGROUND: In November of 2017, The Academy of the Psychosomatic Medicine voted to change its name to the Academy of Consultation-Liaison Psychiatry. It followed a similar change in which the American Board of Medical Specialties voted to change the name of the field to Consultation-Liaison Psychiatry. OBJECTIVE: The authors, all instrumental in bringing about this change, discuss the history and rationale for this name change.

Anatomic site and etiology of hemorrhage in small versus large dogs with spontaneous hemoperitoneum.

OBJECTIVE: To compare anatomic sources and underlying etiology of hemorrhage in small vs large dogs with spontaneous hemoperitoneum (SH). STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Client-owned dogs with SH at 2 academic institutions. METHODS: Medical records were reviewed for age, breed, sex, weight, and results of imaging, surgery, necropsy, cytology, and histopathology. Dogs were divided according to body weight (≤ 20 kg = small, > 20 kg = large). Confidence intervals were calculated to estimate rates of splenic and hepatic hemorrhage in small and large dog SH populations. Multivariable regression was used to compare prevalence of anatomic sources of hemorrhage and etiology in small vs large dogs. RESULTS: We identified 742 dogs with SH, including 637 in which the anatomic site of hemorrhage was investigated. Splenic hemorrhage was diagnosed in 43.2% (95% CI, 34.3-52.4) of small dogs and 61.3% (95% CI, 57.0-65.6) of large dogs. Small dogs had lower prevalence of splenic hemorrhage (prevalence ratio, 0.70; 95% CI, 0.58-0.87; P < .001) and higher prevalence of hemorrhage from liver (prevalence ratio, 1.72; 95% CI, 1.20-2.47; P = .003) or from another location such as retroperitoneal mass, kidney, or adrenal (prevalence ratio, 2.73; 95% CI, 1.66-4.47; P < .001) vs large dogs. Hemangiosarcoma was associated with splenic hemorrhage and occurred more frequently in large vs small dogs (P = .011). CONCLUSION: Small dogs had a lower rate of splenic hemorrhage and higher rates of hemorrhage from liver and other sites compared to large dogs. Etiologies other than splenic hemangiosarcoma were common, particularly among dogs weighing ≤ 20 kg. CLINICAL SIGNIFICANCE: Clinicians should perform diagnostics and consider body size before making presumptive diagnoses in dogs with SH.

Insights into Chronic Functional Movement Disorders: The Value of Qualitative Psychiatric Interviews.

BACKGROUND: Patients with functional movement disorders (FMDs) are commonly seen by neurologists and psychosomatic medicine psychiatrists. Research literature provides scant information about the subjective experiences of individuals with this often chronic problem. OBJECTIVE: To enhance our understanding of psychologic aspects of FMDs by conducting qualitative interviews of research subjects. METHODS: In total, 36 patients with FMDs were recruited from the Human Motor Control clinic at the National Institutes of Health. Each subject participated in a qualitative psychiatric interview and a structured diagnostic psychiatric interview. RESULTS: Of our 36 subjects, 28 had current or lifetime psychiatric disorders in addition to conversion disorder and 22 had current disorders. Qualitative interviews provided rich information on patients' understanding of their illnesses and impaired cognitive processing of emotions. CONCLUSION: Our study supports the addition of open-ended qualitative interviews to delineate emotional dynamics and conceptual frameworks among such patients. Exploratory interviews generate enhanced understanding of such complex patients, above and beyond that gained by assessing DSM diagnostic comorbidities.

'For men arousal is orientation': Bodily truthing, technosexual scripts, and the materialization of sexualities through the phallometric test.

We trace the history of the phallometric test--which measures erections of men exposed to visual erotic stimuli to characterize sexualities--in order to account for its functioning as a 'truthing technology'. On the basis of a content analysis of 410 key scientific journal article abstracts, we argue that since its invention in Czechoslovakia in the 1950s, phallometry has been employed within three distinct assemblages: as a test of predominance of sexual desire, as a test for therapeutic efficacy, and as a threshold test of sexual risk. Drawing on works of theorists of materialization and proponents of script theory, we argue that within each assemblage phallometric testing materializes male desire and renders it measurable via a 'technosexual script'. We consider the performative effects of phallometry in establishing scientific conceptions of normal and abnormal sexualities. At the same time, through attention to debates among practitioners and broader controversies surrounding the employment of phallometry, we examine the limits of researchers' abilities to establish the broader credibility of the test and capture the phenomenon of sexual desire. This analysis contributes to the study of truthing technologies (or 'truth machines') as a class, while also helping to build bridges between science and technology studies and sexuality studies.

Comparison of Doppler, oscillometric, auricular and carotid arterial blood pressure measurements in isoflurane anesthetized New Zealand white rabbits.

OBJECTIVE: To assess agreement between carotid arterial pressure and auricular arterial, thoracic limb Doppler or thoracic limb oscillometric blood pressure measurements. STUDY DESIGN: Prospective experimental study. ANIMALS: Six adult New Zealand white rabbits. METHODS: Rabbits were anesthetized with isoflurane in oxygen at 1, 1.5 and 2 MAC on two separate occasions. Catheters in the auricular and the contralateral external carotid artery were connected to calibrated pressure transducers via non-compliant tubing. Inflatable cuffs of width equal to approximately 40% of the limb circumference were placed above the carpus on both thoracic limbs with a Doppler transducer placed distal to the cuff on one. Systolic (SAP) and mean (MAP) arterial blood pressure measurements were obtained at each dose, on each occasion. Agreement between measurement techniques was evaluated by repeated measures Bland Altman analysis with carotid pressure as the reference. Variation in bias over the measurement range was evaluated by regression analysis. RESULTS: Carotid MAP and SAP ranged from 20 to 65 mmHg and 37 to 103 mmHg respectively. Bias and 95% limits of agreement for auricular and oscillometric MAP were 7 (0-14) and -5 (-21-11) mmHg, respectively, and for auricular, oscillometric and Doppler SAP were 23 (8-37), -2 (-24-20) and 13 (-14-39) mmHg, respectively. Bias varied significantly over the measurement range (p < 0.001) for all three SAP techniques but not for MAP measurements. CONCLUSIONS AND CLINICAL RELEVANCE: Limits of agreement for all measurements were large but less so for MAP than SAP. Variation in bias with SAP should be considered when using these measurements clinically.

Bronchial artery to pulmonary artery fistula initially misdiagnosed as pulmonary embolism: A case report.

INTRODUCTION: Bronchopulmonary arterial fistulas have been reported following lung transplant, and in association with COPD, trauma, radiation therapy, and infection. They may also arise congenitally. Embolization is the most frequent treatment. CASE PRESENTATION: We present a case of a 58-year-old male with a prior history of pulmonary tuberculosis who initially presented with minimal hemoptysis for several months. Right upper lobe bronchial artery to pulmonary artery fistulas were discovered by angiography. These were excluded by particle and microcoil embolizations. CLINICAL DISCUSSION: Relatively unopacified blood from bronchial artery enters right pulmonary artery and causes ill-defined hypodensities mixing with opacified blood, especially compared to uniformly, brightly enhancing left pulmonary artery. As a result, interpreters will frequently incorrectly conclude that right pulmonary artery embolism exists rather than a bronchopulmonary arterial fistula. CONCLUSION: In most cases, bronchopulmonary arterial fistulas are treated by bronchial artery embolization; however, direct puncture or stent grafting are alternate considerations depending on the patient's anatomy. In all instances, a multidisciplinary approach is a must.

Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support.

OBJECTIVE: To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time. DESIGN: Experimental study. SETTING: Small animal research facility. ANIMALS: Twenty-four purpose-bred research dogs. INTERVENTIONS: Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T0), at 3 minutes (T3), and at 6 minutes (T6) into BLS. MEASUREMENTS AND MAIN RESULTS: The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao2, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P < 0.03). By T6, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po2, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T0 (P < 0.05). CONCLUSIONS: Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR.

2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations.

OBJECTIVE: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines. DESIGN: This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR. SETTING: Transdisciplinary, international collaboration in academia, referral practice, and general practice. RESULTS: For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science. CONCLUSIONS: Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats.

OBJECTIVE: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

Peripheral stent-graft for the management of an ulnar artery pseudoaneurysm.

Penetrating injury can cause pseudoaneurysm which can then affect nerve compression. Although rare, penetrating injuries leading to ulnar artery pseudoaneurysm (UAP) are implicated slightly more frequently than other upper extremity arterial segments. Manual compression, thrombin injections, and surgical reconstruction are typically chosen to effect repair. Conversely, peripheral stent-graft implantation has rarely been reported as an option to exclude upper extremity pseudoaneurysm. We describe a case of a 25-year-old male who was stabbed, presented with signs of ulnar nerve compression, and in whom UAP was instead discovered and treated by stent-graft deployment.

Iatrogenic subclavian artery rupture: A unique case report on balloon occlusion.

INTRODUCTION: Inadvertent subclavian artery puncture during attempted central venous catheterization can be devastating. Percutaneous stent grafting, closure devices and conventional surgery have been described to effect repair. Balloon occlusion has also been described and often recommended. Numerous publications advise use of balloon expanded to no less than the diameter of the punctured artery. CASE PRESENTATION: We describe the case of a 21 year-old male whose right subclavian artery was inadvertently punctured after central-line removal. Our balloon when expanded was purposely slightly smaller than the inner arterial diameter. Balloon occlusion nevertheless alone sufficed to effect closure and repair. CLINICAL DISCUSSION: When the expanded balloon surpasses the diameter of the subclavian artery, it is expected that blood flow to the upper extremity will be cut off. Presently, there is a lack of definitive data concerning the maximum duration for balloon inflation that could lead to upper extremity ischemia. However, in this particular case, there was a temporary reduction in vertebral artery flow, while the flow in the carotid and axillosubclavian arteries remained rapid and uninterrupted. To our understanding, only one other case documents the use of a balloon shorter than the vessel diameter. CONCLUSION: In specific scenarios, it is advisable to consider the use of smaller balloon diameters to effectively stop extravasation while ensuring adequate perfusion to the brain and hand. While alternative approaches such as open repair, and stent graft procedure have been reported for repairing subclavian artery rupture, balloon tamponade provides interventional radiologists with a distinct technical advantage.

Prevalence of dog erythrocyte antigen 1 in a population of dogs tested in California.

BACKGROUND: Multiple studies have evaluated the breed-specific prevalence of dog erythrocyte antigen (DEA) 1 in various geographic regions. However, few large-scale studies exist that describe breed prevalence of DEA 1 in the United States. KEY FINDINGS: From January 2000 to October 2020, 6469 dogs had their RBC antigen type determined and were included in the study. The overall prevalence of DEA 1 in all dogs was 61.2%. Of 50 breeds with sample sizes ≥20, 8 breeds had a high prevalence (≥90%) of DEA 1-positive blood type: Basset Hound, Bernese Mountain Dog, Brittany, Dachshund, Miniature Pinscher, Miniature Schnauzer, Pug, and Rottweiler. Four breeds had a high prevalence (≥90%) of DEA 1-negative blood type: Boxer, English Bulldog, Flat-Coated Retriever, and French Bulldog. Numerous breeds with a sample size <20 and ≥5 were found to have 100% prevalence of a DEA 1 blood type, although these findings need to be confirmed with a larger sample size. No statistical difference in any breed based on sex was found. The results in this study are consistent with previously reported data in other countries. SIGNIFICANCE: Knowledge of regional breed differences in DEA 1 prevalence can help to improve selection and recruitment of appropriate blood donor dogs.

Association of point-of-care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes.

OBJECTIVE: To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium concentration (0.222 [0.071-0.700], P = 0.010), and chloride concentration (0.805 [0.694-0.933], P = 0.004) were associated with survival to hospital discharge. CONCLUSIONS: Biochemical variables such as PvO2 , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR.

Etiology and effusion characteristics in 29 cats and 60 dogs with pyothorax (2010-2020).

BACKGROUND: Pyothorax, an accumulation of inflammatory fluid in the pleural space, is often caused by foreign body inhalation in dogs, whereas the etiology in cats can be more difficult to discern. OBJECTIVE: Compare clinical, microbiologic findings, and etiology in cats and dogs with pyothorax. ANIMALS: Twenty-nine cats and 60 dogs. METHODS: Medical records of cats and dogs diagnosed with pyothorax from 2010 to 2020 were reviewed. Clinical findings, fluid analysis, and microbiologic results were retrieved. RESULTS: Antimicrobials had been administered to equal proportions of cats and dogs before fluid sampling (45% and 47%). Groups did not differ in age or total protein concentration or percentage neutrophils in pleural fluid, but effusion cell count was significantly higher in cats than in dogs (P = .01). Neutrophils containing intracellular bacteria were identified in more cats (27/29, 93%) than dogs (44/60, 73%; P = .05). Penetrating damage to the thorax was implicated as the cause of pyothorax in equal percentages of cats (76%) and dogs (75%). Etiology could not be determined in 2 cats and 1 dog. Cats had higher numbers of bacterial isolates per patient (median, 3) than dogs (median, 1; P = .01) and anaerobes were isolated more often in cats (23/29, 73%) than in dogs (27/60, 45%; P = .003). CONCLUSIONS AND CLINICAL IMPORTANCE: Pyothorax had similar etiologies in cats and dogs. Cats had higher fluid cell counts, higher numbers of bacterial isolates identified per patient, and intracellular bacteria detected more commonly than did dogs.

Retrospective evaluation of noncardiogenic pulmonary edema in dogs and cats (2000-2021): 31 cases.

OBJECTIVE: To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Thirty dogs and 1 cat, all client owned. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03). CONCLUSIONS: NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation.

Antimicrobial susceptibility patterns from urinary isolates obtained from cats (2013-2020).

BACKGROUND: Bacterial urinary tract infections have been associated with comorbidities and increased antimicrobial resistance over time. OBJECTIVE: To identify bacterial species, antimicrobial susceptibility patterns and risk factors associated with antimicrobial resistance. ANIMALS: Three hundred sixty-three positive urine cultures from 308 cats. METHODS: Bacterial species and antimicrobial susceptibility data from positive aerobic bacterial urine cultures from cats with growth of ≥103 colony forming units per milliliter (cfu/ml) were included. Medical records were reviewed, and bacteriuria was classified as sporadic bacterial cystitis, recurrent bacterial cystitis or subclinical bacteriuria (SBU). Multivariable logistic regression analysis was used to evaluate antimicrobial resistance risk factors. RESULTS: A total of 444 bacterial isolates from 363 bacteriuric episodes were identified. Escherichia coli (52%) and SBU (59%) were the most common organism and classification, respectively. When compared to other classifications of bacteriuria, Enterococcus spp. were more likely to be isolated from SBU episodes (P < .001), whereas E. coli was more likely to be isolated from sporadic bacterial cystitis episodes (P < .001). Recurrent bacterial cystitis was associated with an increased risk of antimicrobial resistance to amoxicillin/clavulanic acid (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.3-11.3). The percent susceptibilities of all bacterial isolates to commonly prescribed antimicrobials were amoxicillin/clavulanic acid (72%), cefazolin (49%), enrofloxacin (61%), and trimethoprim/sulfamethoxazole (75%). Multidrug resistance was highest for Enterococcus faecium isolates (65%). CONCLUSIONS AND CLINICAL IMPORTANCE: No antimicrobial achieved >90% susceptible designation to all bacteria isolated highlighting the importance of performing urine culture and susceptibility testing, particularly for cats with recurrent bacterial cystitis.