Evaluating preoperative coagulation panels in dogs undergoing liver lobectomy for primary liver tumors: A multi-institutional retrospective study.

BACKGROUND: The objectives of this study were to: (i) Determine whether operable primary liver tumors were associated with prolongations in prothrombin time (PT) and activated partial thromboplastin time (aPTT) and (ii) determine if these secondary hemostatic abnormalities were more prevalent with specific liver tumors. STUDY DESIGN: Multi-institutional retrospective study. ANIMAL POPULATION: Dogs (n = 359) undergoing liver lobectomy for a primary liver tumor with a preoperative coagulation panel. METHODS: Data was identified via electronic medical record review at eight veterinary teaching hospitals. Baseline dog characteristics, coagulation panel values, platelet count, emergency versus non-emergency procedure, whether the dogs received transfusion(s) of a blood product, liver lobe removed, and histopathological diagnosis were extracted from the medical record. Chi-square analysis was used to compare categorical variables between groups. Continuous variables were assessed for normality using the Shapiro-Wilk test. RESULTS: A total of 74 of 359 dogs (20.6%) had a prolongation in either PT or aPTT preoperatively. A total of 20 of 359 dogs (5.6%) were found to have prolongation of both PT and aPTT. Hemangiosarcoma was the only histopathological diagnosis associated with concurrent prolongations of both PT and aPTT (p < .001) in 6/16 (37.5%) dogs. CONCLUSION: Coagulation panels including PT and aPTT are unlikely to detect substantial deficiencies in secondary hemostasis in most dogs with primary liver tumors except in dogs with a histopathological diagnosis of hemangiosarcoma. CLINICAL SIGNIFICANCE: PT and aPTT testing is low yield as an elective preoperative screening test in dogs with primary liver tumors except in dogs where there is a hemoabdomen or high suspicion for hepatic hemangiosarcoma.

Severity of nasopharyngeal collapse before and after corrective upper airway surgery in brachycephalic dogs.

OBJECTIVE: To determine the severity of nasopharyngeal collapse in brachycephalic dogs before and after corrective airway surgery. ANIMALS: Twenty-three brachycephalic dogs (21 with clinical signs referrable to the upper airway) and nine clinically normal nonbrachycephalic dogs (controls). METHODS: Dogs were evaluated with fluoroscopy awake and standing with the head in a neutral position. The magnitude of nasopharyngeal collapse was measured as the maximum reduction in the dorsoventral dimension of the nasopharynx during respiration and expressed as a percentage. Brachycephalic dogs were anesthetized, the airway evaluated, and corrective upper airway surgery (alaplasty, staphylectomy, sacculectomy, tonsillectomy) was performed. A cohort (n = 11) of the surgically treated brachycephalic dogs had fluoroscopy repeated a minimum of 6 weeks after surgery. RESULTS: Median preoperative reduction in the dorsoventral dimensions of the nasopharynx was greater in brachycephalic dogs (65%; range: 8-100%) than in controls (10%; range: 1-24%, p = .0001). Surgery did not improve the reduction in dorsoventral diameter of the nasopharynx during respiration in brachycephalic dogs (n = 11) postoperatively (p = .0505). CONCLUSION AND CLINICAL SIGNIFICANCE: Nasopharyngeal collapse was a common and sometimes severe component of brachycephalic airway obstruction syndrome in the cohort of dogs evaluated. The lack of significant postoperative improvement may represent a type II error, a failure to adequately address anatomical abnormalities that increase resistance to airflow, or inadequate upper airway dilator muscle function in some brachycephalic dogs.

Interobserver reliability of Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) and the relationship between lesion scores and pruritus.

BACKGROUND: Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) are scales used to assess lesion severity in cats with allergic dermatitis. Interobserver reliability has not been assessed for either. HYPOTHESIS AND OBJECTIVES: To determine interobserver reliability for FEDESI and SCORFAD, and the relationship between lesion scores and pruritus. ANIMALS: Thirty-eight cats presenting for pruritus. METHODS AND MATERIALS: Each cat's lesions were scored by two observers at each visit using both FEDESI and SCORFAD (n = 117 paired observations). Spearman's rho was calculated to assess correlation between scales and between each scale and the owner-reported pruritus Visual Analog Scale (pVAS). Concordance correlation coefficients were calculated between observers for each scale, and Bland-Altman plots were used to visually represent the relationship between paired scores. RESULTS: FEDESI and SCORFAD were strongly positively correlated with one another (rho = 0.84, P < 0.001). Each scale showed fair correlation with pVAS (rho = 0.42, P < 0.001; rho = 0.38, P < 0.001, respectively). There was good concordance between observers for both scales, with a correlation coefficient of 0.77 for FEDESI and 0.80 for SCORFAD [intraclass correlation coefficient (ICC) 95%, confidence interval (CI) 0.69-0.83; ICC 95%, CI 0.72-0.86, respectively]. Median lesion score was low (FEDESI 20; SCORFAD 4), which may improve interobserver reliability. CONCLUSIONS AND CLINICAL IMPORTANCE: There is good interobserver reliability for both FEDESI and SCORFAD. FEDESI and SCORFAD are positively correlated with one another and with pVAS. These findings support use of both scales in clinical research and assessment.

Sterile granulomatous dermatitis and lymphadenitis (juvenile cellulitis) in adult dogs: a retrospective analysis of 90 cases (2004-2018).

BACKGROUND: It has long been speculated that sterile granulomatous dermatitis and lymphadenitis (SGDL) occurs in adult dogs. However, only three published case reports exist. HYPOTHESIS/OBJECTIVES: To describe clinical presentation, identify breed predispositions, and assess treatment and outcomes of adult dogs with the histopathological diagnosis of SGDL. ANIMALS: Included are 90 dogs with biopsies submitted to a veterinary teaching hospital with a histopathological diagnosis consistent with SGDL, from 2004 to 2018, of which 35 had medical records available for review. METHODS: Data were analysed retrospectively from histopathology submission forms, medical records, surveys and telephone calls. Scoring systems were created to aid statistical analysis of outcomes. RESULTS: Havanese dog (P < 0.0001), Australian shepherd dog (P < 0.0001), Irish setter (P < 0.0001), Dachshund (P = 0.0002), bichon frise (P = 0.0003) and Maltese dog (P = 0.004) were significantly over-represented breeds. The median age at onset was 1,292 days (3.54 years). Dogs up to five years of age were significantly over-represented (P < 0.01). Of 35 dogs with medical records available for review, the median treatment duration was 60 days and the median time to remission 28 days. Remission status was not established for five dogs but the remaining 30 dogs reached remission. Nineteen dogs remained in complete remission. Recrudescence occurred in 11 dogs (median follow-up 60 days). CONCLUSIONS AND CLINICAL IMPORTANCE: This study shows a close parallel in clinical appearance, histopathological results and clinical behaviour, of both adult and juvenile onset SGDL; therefore, SGDL should be considered as a differential diagnosis for dogs of all ages.

Evaluation of Jackson-Pratt Thoracostomy Drains Compared with Traditional Trocar Type and Guidewire-Inserted Thoracostomy Drains.

A restrospective study was performed to evaluate the efficacy of and complications among Jackson-Pratt (JP) drains placed as thoracostomy drains, traditional trocar type (TRO) thoracostomy drains, and guidewire (GW)-inserted thoracostomy drains that were placed in open fashion during thoracotomy. Medical records of 65 canine and feline patients who underwent thoracic surgery were evaluated. Dogs and cats who underwent thoracotomy and had a chest drain placed intraoperatively were included. Data retrieved from medical records included signalment, body weight, diagnosis, surgical approach, surgical procedure, type of thoracostomy drain, postoperative analgesia, duration of thoracostomy drain, and postoperative complications. The incidence of complications and number of medications used in pain protocols were compared among types of thoracostomy drains. JP (n = 31), TRO (n = 25), and GW (n = 9) thoracostomy drains were placed in 65 patients. Ten minor (15.3%) and four major (6.2%) complications occurred. Cases with JP thoracostomy drains were significantly less likely to have complications (2 minor, 1 major) than cases with TRO thoracostomy drains (8 minor, 3 major, P = .009). There were no differences in the number of major complications when comparing all three drains individually (P = .350). JP drains and GW drains can be considered as an alternative to traditional TRO thoracostomy drains.

Evaluation of thoracic radiographs as a screening test for dogs and cats admitted to a tertiary-care veterinary hospital for noncardiopulmonary disease.

Thoracic radiographs are used as a screening tool for dogs and cats with a variety of disorders that have no clinical signs associated with thoracic structures. However, this practice has never been supported by an evidence-based study. The objective of this retrospective observational study was to determine if certain canine and feline populations have a higher proportion of radiographic abnormalities, and whether any of these abnormalities are associated with patient hospitalization and outcome. Patients were excluded if current or previous examinations revealed evidence of primary respiratory or cardiac disease, malignant neoplasia, or an abnormal breathing pattern consistent with pulmonary pathology. Any notable thoracic change in the radiology report was considered important and evaluated in this study. One hundred and sixty-six of these included patients were dogs and 65 were cats. Of the 166 dog radiographs evaluated, 120 (72.3%) had normal thoracic radiographs, while 46 (27.7%) had radiographic abnormalities. Of the sixty-five cats included, 36 (55.4%) had normal radiographs, while 29 (44.6%) had abnormal radiographs. Canine patients with abnormal radiographs had a significantly higher lactate level (P-value 0.0348) and feline patients with abnormal radiographs had a significantly lower packed cell volume (P-value 0.012). A large proportion of patients that had screening thoracic radiographs (32.5%) had documented abnormalities, but a relatively low percentage (6.5%) of our total population had their clinical plan changed as a consequence of detection of these abnormalities. Findings indicated that abnormal screening thoracic radiographs are more likely in dogs with an elevated lactate and cats with anemia, or a low normal hematocrit.

Cerebrospinal Fluid Calbindin D Concentration as a Biomarker of Cerebellar Disease Progression in Niemann-Pick Type C1 Disease.

Niemann-Pick type C (NPC) 1 disease is a rare, inherited, neurodegenerative disease. Clear evidence of the therapeutic efficacy of 2-hydroxypropyl-ß-cyclodextrin (HPßCD) in animal models resulted in the initiation of a phase I/IIa clinical trial in 2013 and a phase IIb/III trial in 2015. With clinical trials ongoing, validation of a biomarker to track disease progression and serve as a supporting outcome measure of therapeutic efficacy has become compulsory. In this study, we evaluated calcium-binding protein calbindin D-28K (calbindin) concentrations in the cerebrospinal fluid (CSF) as a biomarker of NPC1 disease. In the naturally occurring feline model, CSF calbindin was significantly elevated at 3 weeks of age, prior to the onset of cerebellar dysfunction, and steadily increased to >10-fold over normal at end-stage disease. Biweekly intrathecal administration of HPßCD initiated prior to the onset of neurologic dysfunction completely normalized CSF calbindin in NPC1 cats at all time points analyzed when followed up to 78 weeks of age. Initiation of HPßCD after the onset of clinical signs (16 weeks of age) resulted in a delayed reduction of calbindin levels in the CSF. Evaluation of CSF from patients with NPC1 revealed that calbindin concentrations were significantly elevated compared with CSF samples collected from unaffected patients. Off-label treatment of patients with NPC1 with miglustat, an inhibitor of glycosphingolipid biosynthesis, significantly decreased CSF calbindin compared with pretreatment concentrations. These data suggest that the CSF calbindin concentration is a sensitive biomarker of NPC1 disease that could be instrumental as an outcome measure of therapeutic efficacy in ongoing clinical trials.

Abnormalities detected on digital rectal examinations in dogs are common and influence diagnostic and treatment plans.

OBJECTIVE: To determine the frequency of abnormal findings on digital rectal examination (DRE) performed during physical examinations at a tertiary referral veterinary hospital, to establish what abnormal findings are most common and whether they impact diagnostic and treatment plans, and to assess whether patient signalment or admitting service influences the frequency of abnormalities. ANIMALS: Client-owned dogs (n = 440). METHODS: Veterinarians performed DREs on dogs as part of a physical examination. Patient signalment and DRE findings were recorded in a standardized survey. Findings were deemed normal or abnormal and described. Whether the findings changed the diagnostic or treatment plan was also recorded. RESULTS: Abnormalities were detected on DRE in 160 of 440 (36%) dogs. Changes to the diagnostic plan occurred in 41 of 160 (26%) cases when an abnormality was found. Changes to the treatment plan occurred in 20 of 160 (12.5%) cases when an abnormality was found. Age (P = .2), sex (P = .9), and breed (P = 1) did not significantly influence the frequency of abnormal findings. Abnormal findings were significantly more common in dogs presenting to the emergency service than elective services (P = .005). CLINICAL RELEVANCE: Among dogs presenting to a tertiary veterinary hospital, abnormalities found on DRE are common and change the diagnostic plan in 1 out of 4 dogs and treatment plan in 1 out of 8 dogs. This study supports the continued practice of DREs in dogs, especially in emergency settings, regardless of signalment.

Doxorubicin and deracoxib adjuvant therapy for canine splenic hemangiosarcoma: a pilot study.

Canine hemangiosarcoma (HSA) is a highly malignant tumor for which standard chemotherapy has done little to substantially improve survival. Cyclooxygenase-2 (Cox-2) plays a role in the formation, growth, and metastasis of tumors and inhibitors have demonstrated therapeutic benefit with certain canine cancers. In this prospective study, 21 dogs received adjuvant therapy combining the selective Cox-2 inhibitor deracoxib with doxorubicin, following splenectomy for HSA. The combination was well-tolerated with only low-grade gastrointestinal and hematologic toxicities noted. An overall median survival of 150 days (range; 21 to 1506 days) was noted. Although there was no significant difference in survival based upon stage of disease, dogs with stage III HSA (n = 11) had a median survival of 149 days, which appears to be longer than previously reported. Further studies are warranted to evaluate the potential benefit of Cox-2 inhibitors in the treatment of canine HSA.

Traitement adjuvant à la doxorubicine et au déracoxib pour l'angiosarcome splénique canin : étude pilote. L'angiosarcome canin est une tumeur hautement maligne pour laquelle la chimiothérapie standard a peu fait pour améliorer substantiellement la survie. La cyclooxygénase-2 (Cox-2) joue un rôle dans la formation, la croissance et la métastase des tumeurs et des inhibiteurs ont démontré des bienfaits thérapeutiques pour certains cancers canins. Dans cette étude prospective, 21 chiens ont reçu un traitement adjuvant combinant l'inhibiteur de la Cox-2 sélectif déracoxib avec la doxorubicine, après la splénectomie pour l'angiosarcome. La combinaison a été bien tolérée et seulement des toxicités gastro-intestinales et hématologiques de faible intensité ont été signalées. Une survie médiane globale de 150 jours (écart de 21 à 1506 jours) a été signalée. Même s'il n'y a pas eu de différence significative dans la survie si l'on se base sur le stade de la maladie, les chiens avec un angiosarcome de stade III (n = 11) ont eu une survie médiane de 149 jours, ce qui semble plus long que ce qui avait déjà été signalé. De nouvelles études sont justifiées afin d'évaluer le bienfait potentiel des inhibiteurs de la Cox-2 pour le traitement de l'angiosarcome canin.(Traduit par Isabelle Vallières).

Total serum and ionized magnesium concentrations in healthy and hospitalized dogs.

OBJECTIVE: To determine if an association between ionized magnesium (iMg) and total magnesium (tMg) exists in healthy and hospitalized dogs admitted through an emergency service and to assess the associations between iMg and tMg with total protein, albumin, ionized calcium, and total calcium. DESIGN: Prospective cohort study. SETTING: Veterinary teaching hospital. ANIMALS: Sixty-nine dogs were enrolled. The healthy control group (group 1) included 24 dogs, and the hospitalized group (group 2) included 45 dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For both groups, signalment, a venous blood gas, and serum biochemistry were obtained. In addition, the presumptive diagnosis was recorded for group 2. Blood was obtained prior to any therapeutic interventions. Group 1 tMg was within the reference interval (RI), and the values for iMg were used to provide a healthy group range (HGR) of 0.44-0.50 mmol/L. Group 2 tMg was within the RI, but iMg was below the calculated HGR range (group 2 median iMg = 0.4 mmol/L; range = 0.27-0.70). There was a significant positive correlation between iMg and tMg in each group (group 1: r = 0.6713, P = 0.0003; group 2: r = 0.5312, P = 0.0002). Ionized Mg and tMg were not significantly associated with any of the other evaluated variables in either group. CONCLUSIONS: Ionized Mg and tMg were significantly associated in both healthy and hospitalized dogs, but the relationship was weaker in the hospitalized dogs compared with the healthy population. For hospitalized dogs, the relationship was weak enough to question the validity of using iMg and tMg interchangeably to track magnesium status.

Pharmacokinetics and pharmacodynamics of intranasal and intramuscular administration of naloxone in working dogs administered fentanyl.

BACKGROUND: Working dogs exposed to narcotics might require reversal in the field. OBJECTIVE: To explore the pharmacokinetic and pharmacodynamic effects of naloxone administered intramuscularly (IM) or intranasally (IN) to reverse fentanyl sedation in working dogs. ANIMALS: Ten healthy, working dogs aged 1.7 ± 1 year and weighing 26 ± 3 kg. METHODS: In this randomized, controlled cross-over study dogs received either 4 mg of naloxone IN or IM 10 minutes after fentanyl (0.3 mg IV) administration. Sedation was assessed at baseline and 5 minutes after fentanyl administration, then at 5, 10, 15, 20, 25, 30, 60 and 120 minutes after reversal with naloxone. Blood samples for naloxone detection were obtained at 0, 5, 10, 30, 60 and 120 minutes. Pharmacokinetic parameters and sedation scores were compared between IM and IN naloxone groups. RESULTS: There was a significant increase in sedation score from baseline (0.25 [-4 to 1] IM; 0 [-2 to 1] IN) after fentanyl administration (11 [5-12] IM; 9.25 [4-11] IN), followed by a significant reduction at 5 (0.5 [-0.5 to 1.5] IM; 1.25 [-1.5 to 4.5] IN) through 120 minutes (-0.5 [-2 to 1] IM; 0 [-4.5 to 1] IN) after reversal with naloxone. Route of administration had no significant effect on sedation score. Maximum plasma concentration was significantly lower after IN administration (11.7 [2.8-18.8] ng/mL IN, 36.7 [22.1-56.4] ng/mL IM, P < .001) but time to reach maximum plasma concentration was not significantly different from IM administration. CONCLUSION AND CLINICAL IMPORTANCE: Although IM administration resulted in higher naloxone plasma concentrations compared to IN, reversal of sedation was achieved via both routes after administration of therapeutic doses of fentanyl.

Body condition and hair coat length impact weight estimation in dogs and cats presented to an emergency department.

OBJECTIVE: To examine weight estimations by veterinarians, veterinary nurses, and veterinary students to determine the accuracy of weight estimation in a veterinary emergency department. Secondary objectives included an initial evaluation of how body condition score (BCS), hair coat length, and hospital position of the estimator impacted accuracy of weight estimation. ANIMALS: 101 dogs and 28 cats that presented to the emergency department from October 17, 2017, to September 3, 2019. PROCEDURES: A written form was prospectively distributed to veterinarians, veterinary nurses, and veterinary students asking them to estimate a patient weight. Additional information about the patient, including estimated hair length and BCS, was recorded. RESULTS: As dogs' weights increased, all estimators underestimated the patients' weight. As BCS increased, dogs' weights were underestimated by veterinary students. Longer hair coat statistically significantly impacted accurate weight estimation in dogs. In cats, as BCS increased, veterinarians and veterinary nurses overestimated patient weight. Only 32% (32/101) and 20% (6/28) of weight estimations in dogs and cats, respectively, were within 10% of the patient's actual weight. CLINICAL RELEVANCE: Veterinarians, veterinary nurses, and veterinary students may not be reliable estimators of patient weight in the emergency department, especially with overweight animals. Prompt measurement of weight, if possible, is important for appropriate patient care.

Retrospective evaluation of gastrointestinal foreign bodies and presurgical predictors for enterectomy versus enterotomy in dogs (2013-2016): 82 cases.

OBJECTIVE: To evaluate preoperative diagnostics in dogs with gastrointestinal foreign body (GIFB) obstruction and to identify clinical variables associated with the performance of simple enterotomy (EO) versus enterectomy (EC). DESIGN: Retrospective case control study from October 2013 to January 2016. SETTING: Veterinary Teaching Hospital. ANIMALS: Eighty-two client-owned dogs diagnosed at the time of surgery with GIFB obstruction. MEASUREMENTS AND MAIN RESULTS: Data were collected from medical records regarding history, initial physical examination, clinicopathologic testing, diagnostic imaging, and surgical reports. Based on univariate analysis, dogs that required EC were ill (P < 0.0001) and anorexic (P = 0.0007) for a longer duration; had a higher vomiting severity score (P = 0.005); and had worse perfusion parameters (mucous membrane color [P = 0.028] and quality [P = 0.032], poorer pulse quality [P = 0.0015], relatively lower blood pressure [P = 0.0328], greater heart rates [P = 0.0011]). Dogs undergoing EC were more likely to have altered peritoneal detail on radiographs (P = 0.0014; odds ratio [OR] = 25.5; 95% confidence interval [CI]: 2.4, 275.7) and echogenic peritoneal effusion on ultrasound (P = 0.0101; OR = 12.5; 95% CI: 1.3, 120.9), compared to the EO group. Heart rate (adjusted P = 0.028; OR = 1.07; 95% CI: 1.0, 1.1) and vomiting severity score (adjusted P = 0.028; OR = 5.6; 95% CI: 1.2, 26.1) maintained significance after multiple logistic regression. CONCLUSIONS: Multiple factors in the preoperative clinical evaluation were different between dogs undergoing EO versus EC for GIFB obstruction. However, many of these variables become insignificant with multiple logistic regression. The presence of an increased heart rate or increased vomiting severity score at presentation was independently associated with undergoing enterectomy. Prospective studies with greater number of animals are warranted to validate these results.

Effect of cyclosporine, dexamethasone, and human CTLA4-Ig on production of cytokines in lymphocytes of clinically normal cats and cats undergoing renal transplantation.

OBJECTIVE: To evaluate effects of cyclosporine, dexamethasone, and the immunosuppressive agent human CTLA4-Ig on cytokine production by feline lymphocytes in vitro and to assess patterns of cytokine production for 5 immunosuppressed renal transplant recipient cats. ANIMALS: 21 clinically normal cats and 5 immunosupressed renal transplant recipient cats. PROCEDURES: Peripheral blood mononuclear cells were isolated from clinically normal cats and stimulated with concanavalin A (Con A; 10 µg/mL) alone or Con A with cyclosporine (0.05 µg/mL), dexamethasone (1 × 10(-7)M), a combination of cyclosporine-dexamethasone, or human CTLA4-Ig (10 g/mL). Cells from transplant recipients were stimulated with Con A alone. An ELISA was performed to measure production of interferon (IFN)-γ, granulocyte macrophage-colony stimulating factor (GM-CSF), interleukin (IL)-2, IL-4, and IL-10. Proliferation of CD4+ and CD8+T cells from immunosuppressed cats were also evaluated. Pairwise comparisons were performed via a Wilcoxon signed rank test or Wilcoxon rank sum test. RESULTS: Cyclosporine, dexamethasone, cyclosporine-dexamethasone combination, and CTLA4-Ig caused a significant decrease in IL-2, IFN-γ, and GM-CSF production. Cyclosporine and cyclosporine-dexamethasone, but not human CTLA4-Ig, caused a significant decrease in IL-10 production. High basal concentrations of IL-2 and IL-10 were identified in transplant recipients, and IL-10 was significantly increased in stimulated cultures. In immunosuppressed cats, there was a decrease in frequency of responders and proliferative capacity of CD4+ and CD8+T cells. CONCLUSIONS AND CLINICAL RELEVANCE: CTLA4-Ig successfully inhibited proinflammatory cytokines while sparing cytokines critical for allograft tolerance. These data may be useful for developing better strategies to prevent rejection while sparing other immune functions.

Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications.

Acute hemorrhage in small animals results from traumatic and non-traumatic causes. This review seeks to describe current understanding of the resuscitation of the acutely hemorrhaging small animal (dog and cat) veterinary patient through evaluation of pre-clinical canine models of hemorrhage and resuscitation, clinical research in dogs and cats, and selected extrapolation from human medicine. The physiologic dose and response to whole blood loss in the canine patient is repeatable both in anesthetized and awake animals and is primarily characterized clinically by increased heart rate, decreased systolic blood pressure, and increased shock index and biochemically by increased lactate and lower base excess. Previously, initial resuscitation in these patients included immediate volume support with crystalloid and/or colloid, regardless of total volume, with a target to replace lost vascular volume and bring blood pressure back to normal. Newer research now supports prioritizing hemorrhage control in conjunction with judicious crystalloid administration followed by early consideration for administration of platelets, plasma and red blood during the resuscitation phase. This approach minimizes blood loss, ameliorates coagulopathy, restores oxygen delivery and correct changes in the glycocalyx. There are many hurdles in the application of this approach in clinical veterinary medicine including the speed with which the bleeding source is controlled and the rapid availability of blood component therapy. Recommendations regarding the clinical approach to volume resuscitation in the acutely hemorrhaging veterinary patient are made based on the canine pre-clinical, veterinary clinical and human literature reviewed.

Evaluation of subcutaneous versus intravenous administration of apomorphine for induction of emesis in dogs.

OBJECTIVE: To prospectively compare the effectiveness and any adverse effects of apomorphine administered SC or IV for induction of emesis in dogs. ANIMALS: 42 client-owned dogs. PROCEDURES: Dogs for which emesis induction was deemed appropriate by the attending clinician were prospectively randomized to receive apomorphine (0.03 mg/kg [0.01 mg/lb]) either SC (n = 20) or IV (22). Data collected included whether emesis was successfully induced, time from drug administration to emesis, number of emetic events, and adverse events (eg, sedation, protracted vomiting, or other). RESULTS: Of the 20 dogs given apomorphine SC, 16 (80%) vomited. Of the 22 dogs given apomorphine IV, 18 (82%) vomited. With regard to route of administration, the number of dogs in which emesis was induced did not differ significantly. Median time to the first emetic event was 13.5 minutes (range, 3 to 32 minutes) in the SC treatment group and 2 minutes (range, 1 to 5 minutes) in the IV treatment group; the difference was significant. There was no significant difference in the number of emetic events or frequency of adverse events between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Apomorphine administered SC or IV reliably induced emesis in dogs. Compared with SC administration of apomorphine, the time from drug administration to emesis associated with IV administration was significantly shorter, a finding that has clinical importance.

Evaluation of coccygeal and radial artery Doppler blood pressure measurements in sick cats with and without abnormalities in tissue perfusion.

OBJECTIVE: To compare systolic blood pressure measured by Doppler (SBP) taken from the coccygeal artery versus common digital branch of the radial artery in cats with normal and poor perfusion parameters. DESIGN: Prospective, observational study. SETTING: University Teaching Hospital. ANIMALS: Eighty-five cats presenting to the emergency service for which prior emergency treatment was not received and a blood pressure was indicated on triage. INTERVENTIONS: Systolic blood pressure was measured by Doppler using the radial and coccygeal arteries. Cats were categorized as having normal or poor tissue perfusion based on physical examination. MEASUREMENTS AND MAIN RESULTS: Agreement was poor between coccygeal and radial SBP overall with absolute and relative bias (95% limits of agreement) of 23 (-51 to 96) mm Hg and 16% (-38% to 69%), respectively. In cats with poor perfusion, the agreement was absolute bias = 28 mm Hg and relative bias = 22% and with normal perfusion absolute bias = 22 mm Hg, and relative bias = 12%. The median (interquartile range) coccygeal SBP was significantly different from the radial SBP 141 (50) mm Hg versus 120 (45) mm Hg, P < 0.001. In multivariate linear regression, heart rate was negatively associated with coccygeal SBP (r2  = 0.088, P = 0.049), and pale mucous membrane color (P = 0.034) and poor pulse quality (P = 0.007) were independently associated with lower radial SBP (r2  = 0.18). CONCLUSIONS: Median coccygeal SBP is significantly greater than radial SBP in sick cats with both normal perfusion and hypoperfusion. Agreement between coccygeal and radial SBP is poor in cats and cannot be used interchangeably. As clinically significant differences exist between sites, the authors recommend obtaining SBP from both sites initially and choosing to monitor and trend changes with the one site that correlates most with physical examination findings.

Predictors of inflammatory lower airway disease in cats presented to the emergency room in respiratory distress: a case-control study.

OBJECTIVES: The objective of the study was to identify whether venous blood gas (VBG) variables may serve as a predictor of inflammatory lower airway disease (ILAD) in cats presenting with respiratory distress. A secondary objective of this study was to compare the diagnostic utility of patient signalment, history and physical examination findings, as compared with VBG variables. METHODS: The medical records of cats presenting with respiratory distress secondary to ILAD (54 cases) and non-ILAD (121 controls) were retrospectively reviewed. RESULTS: No admission VBG variables were predictive of a final diagnosis of ILAD. Comparatively, multivariable analysis identified a history of a cough (P <0.001), increased respiratory rate (P = 0.001), the presence of an abdominal component to respiration (P = 0.007) and the absence of pleural effusion (P <0.01) to be independently associated with a final diagnosis of ILAD. Cats with a history of a cough and an abdominal component to respiration had 7.86 and 5.81 greater odds of being diagnosed with ILAD, respectively. Cats with pleural effusion had 7.43 lower odds of having this final diagnosis. For every 10 breaths/min increase in respiratory rate, cats had 1.48 greater odds of being diagnosed with ILAD. Cats diagnosed with ILAD had a survival rate of 94% (95% CI 84-99%) vs 61% (95% CI 51-70%) for non-ILAD controls (P <0.001). CONCLUSIONS AND RELEVANCE: The results of this study found patient history and physical examination findings to be more useful predictors of a final diagnosis of ILAD in comparison with VBG variables at presentation. A history of a cough, an abdominal component to respiration and a lack of pleural effusion were found to be significant predictors of this diagnosis. Further investigation into the role of respiratory rate in ILAD is warranted.

Multicenter evaluation of decompressive cystocentesis in the treatment of cats with urethral obstruction.

OBJECTIVE: To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO). ANIMALS: 88 male cats with UO. PROCEDURES: Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded. RESULTS: No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5). CONCLUSIONS AND CLINICAL RELEVANCE: DC did not improve time to place the urinary catheter or ease of UC in cats with UO.

Case-control study to evaluate risk factors for the development of sepsis (neutropenia and fever) in dogs receiving chemotherapy.

OBJECTIVE-To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome. DESIGN-Case-control study. ANIMALS-Client-owned dogs with various cancers undergoing standard chemotherapeutic treatment at the University of Pennsylvania veterinary hospital. PROCEDURES-39 dogs with sepsis (cases) were identified through a search of the medical record database. Controls (n = 77) were randomly selected from dogs admitted during the same time period. Variables analyzed included patient demographics, tumor type, stage, remission status, treatment phase, chemotherapeutics used, and outcome. RESULTS-Dogs that weighed less and dogs with lymphoma were significantly more likely to become septic, compared with larger dogs or dogs with solid tumors. Septic dogs were also significantly more likely to have received doxorubicin (odds ratio [OR], 12.5; 95% confidence interval [CI], 2.4 to 66.0) or vincristine (OR, 9.0; 95% CI, 1.6 to 52.0) than controls. Of the 39 cases, 28 (71.8%) were in the induction phase of their protocol, and 19 of 39 (48.7%) became septic after receiving the chemotherapeutic drug for the first time. Median survival time of the cases (253 days) was not significantly different from that of the controls (371 days). CONCLUSIONS AND CLINICAL RELEVANCE-Dogs that weighed less were at increased risk for chemotherapy-induced sepsis. Tumor type and chemotherapeutic drug used were also important risk factors. These results may lead to the implementation of prophylactic measures, especially when doxorubicin or vincristine is used in the induction phase in small dogs with lymphoma.