Spontaneous Course of Biliary Sludge Over 12 Months in Dogs with Ultrasonographically Identified Biliary Sludge.

BACKGROUND: Biliary sludge is associated with gallbladder (GB) dysmotility and mucus hypersecretion suggesting a link between biliary sludge and the formation of GB mucoceles (GBM). If biliary sludge progresses to GBM, treatment to reduce the production and progression of sludge is warranted. HYPOTHESIS/OBJECTIVES: The objective of this study was to determine the course of biliary sludge in dogs. ANIMALS: Seventy-seven healthy, client-owned dogs ≥4 years of age screened for biliary sludge; 45 affected dogs identified. METHODS: Prospective, observational design. Serial ultrasound examinations were evaluated at 3, 6, 9, and 12 months to monitor degree of sludge based on proportion of GB filled with sludge (mild [0.01-24.4%], moderate [24.5-49.4%], moderate to severe [49.5-74.4%], severe [74.5-100%]), gravity dependency of sludge, and GB dimensions. RESULTS: After 1 year of follow-up, the degree of sludge was mild (34%), moderate (47%), moderate to severe (13%), severe (3%), or absent (3%). There was no significant difference in median degree of sludge over 1 year (P = .36). There were no significant changes in the gravity dependency of sludge over 1 year. A subset of dogs, 24%, with initial gravity-dependent sludge developed a combination of nondependent and dependent sludge. Dogs had resolved (2%), decreased (19%), static (40%), increased (29%), or recurrent (10%) sludge at the conclusion of the study. CONCLUSIONS AND CLINICAL IMPORTANCE: Biliary sludge was prevalent, affected dogs remained asymptomatic, and it rarely resolves in healthy dogs over a period of 1 year. Some dogs developed nongravity-dependent sludge within 1 year, which might indicate changes in consistency of sludge.

Diagnostic utility of abdominal ultrasonography in dogs with chronic diarrhea.

BACKGROUND: Chronic diarrhea is common in dogs and has many causes. Ultrasonographic descriptions of many gastrointestinal diseases have been published, but the diagnostic utility of ultrasonography in dogs with chronic diarrhea has not been investigated. HYPOTHESIS: Diagnostic utility of abdominal ultrasound will be highest in dogs with GI neoplasia and lowest in those with inflammatory disorders. ANIMALS: 87 pet dogs with chronic diarrhea. METHODS: Prospective study in which medical records were reviewed and contribution of abdominal ultrasound toward making diagnosis was scored. RESULTS: In 57/87 (66%) of dogs, the same diagnosis would have been reached without ultrasonography. In 13/87 (15%) of dogs, the ultrasound examination was vital or beneficial to making the diagnosis. Univariable analysis identified that increased diagnostic utility was associated with weight loss (P = .0086), palpation of an abdominal or rectal mass (P = .0031), diseases that commonly have mass lesions visible on ultrasound examination (P < .0001), and a final diagnosis of GI neoplasia. Multivariable regression indicated that utility of abdominal ultrasonography would be 30 times more likely to be high in dogs in which an abdominal or rectal mass was palpated (odds ratio 30.5, 95% CI 5.5-169.6) (P < .0001) versus dogs without a palpable mass. In 15/87 (17%) of dogs, additional benefits of ultrasonography to case management, independent of the contribution to the diagnosis of diarrhea, were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Overall, the diagnostic utility of abdominal ultrasonography was low in dogs with chronic diarrhea. Identification of factors associated with high diagnostic utility is an indication to perform abdominal ultrasonography in dogs with chronic diarrhea.

Comparison of signalment, clinicopathologic findings, histologic diagnosis, and prognosis in dogs with glomerular disease with or without nephrotic syndrome.

BACKGROUND: Nephrotic syndrome (NS) develops most commonly in people with glomerular diseases associated with marked albuminuria. Hypernatremia, hypertension, and progressive renal failure are more prevalent in nephrotic than nonnephrotic human patients. HYPOTHESIS/OBJECTIVES: Dogs with NS have higher serum cholesterol, triglyceride, and sodium concentrations, higher urine protein:creatinine ratios (UPC) and systolic blood pressure, and lower serum albumin concentrations than dogs with nonnephrotic glomerular disease (NNGD). NS is associated with membranous glomerulopathy and amyloidosis. Affected dogs are more likely to be azotemic and have shorter survival times. ANIMALS: Two hundred and thirty-four pet dogs (78 NS dogs, 156 NNGD dogs). METHODS: Multicenter retrospective case-control study comparing time-matched NS and NNGD dogs. NS was defined as the concurrent presence of hypoalbuminemia, hypercholesterolemia, proteinuria, and extravascular fluid accumulation. Signalment, clinicopathologic variables, histopathologic diagnoses, and survival time were compared between groups. RESULTS: Age, serum albumin, chloride, calcium, phosphate, creatinine, and cholesterol concentrations, and UPC differed significantly between NS and NNGD dogs. Both groups were equally likely to be azotemic at time of diagnosis, and NS was not associated with histologic diagnosis. Median survival was significantly shorter for NS (12.5 days) versus NNGD dogs (104.5 days). When subgrouped based on serum creatinine (< or ≥1.5 mg/dL), survival of NS versus NNGD dogs was only significantly different in nonazotemic dogs (51 versus 605 days, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Presence of NS is associated with poorer prognosis in dogs with nonazotemic glomerular disease. Preventing development of NS is warranted; however, specific interventions were not evaluated in this study.

Holmium:YAG laser lithotripsy for urolithiasis in horses.

BACKGROUND: Laser lithotripsy has been used as an alternative to surgical removal of uroliths. OBJECTIVE: To describe the procedure and efficacy of laser lithotripsy for removal of lower urinary tract uroliths in horses. Additionally, the ultrastructure and the differences in mineralogy and microstructure from 1 successful and 1 unsuccessful laser lithotripsy case are described. ANIMALS: Six client-owned horses with 7 episodes of naturally occurring urocystoliths, urethroliths, or both. METHODS: Retrospective study of all horses treated between 2006 and 2008 by laser lithotripsy. All horses were sedated followed by laser lithotripsy. Quantitative urolith analysis was performed in all cases. Ultrastructure and microstructure analyses were performed on uroliths from 2 horses. RESULTS: Procedural success was achieved in 5 of 7 laser lithotripsy procedures. No complications occurred as a result of laser lithotripsy. One horse developed uroabdomen likely as a result of manual lithotrite disruption of the bladder after failure of laser lithotripsy. There were differences in microstructure between 1 urolith that was successfully fragmented by laser lithotripsy and 1 urolith that was resistant to laser fragmentation. CONCLUSIONS AND CLINICAL IMPORTANCE: Laser lithotripsy is an effective procedure for removal of some urocystoliths, urethroliths, or both in horses.

Holmium: YAG laser lithotripsy for urolithiasis in dogs.

BACKGROUND: Laser lithotripsy has been used as an alternative to surgical removal of uroliths in a number of species. OBJECTIVES: To determine the effectiveness of laser lithotripsy for removing urocystoliths, urethroliths, or both in dogs, and to determine the influence of dog (chronological order of lithotripsy, endoscope type, sex, body weight) and urolith (total urolith and urocystolith number, presence or absence of urethroliths, largest urolith dimension, and urolith composition) factors on outcome. ANIMALS: Twenty-five client-owned dogs with urocystoliths, urethroliths, or both were included. Male dogs were required to weigh > or =6.8 kg. METHODS: A single-arm prospective clinical trial. Laser lithotripsy was performed under general anesthesia. Main outcomes included procedure success and lithotripsy time. Predictors of procedure success and lithotripsy time were selected using logistic and linear regression modeling, respectively. RESULTS: The procedure was successful in 21 of 25 dogs. The procedure was successful more often and in less time in female spayed than in male neutered dogs. Sex was identified as a predictor of success. Univariable analysis showed that sex, endoscope type, and chronological order in which the dog received lithotripsy were significantly associated with lithotripsy time. Stepwise linear regression modeling identified sex, body weight, >10 uroliths, and largest urolith dimension as predictors of lithotripsy time. CONCLUSIONS AND CLINICAL IMPORTANCE: Laser lithotripsy is an effective procedure for the removal of urocystoliths, urethroliths, or both with rare important adverse effects and some limitations in male dogs.

Combined hyponatremia and hyperkalemia mimicking acute hypoadrenocorticism in three pregnant dogs.

Differential diagnoses for hyponatremia with concurrent hyperkalemia should include hypoadrenocorticism. Renal failure, chylothorax, and gastrointestinal tract disorders may also cause abnormally low serum sodium:potassium ratios. The ACTH stimulation test is the gold standard for diagnosis of hypoadrenocorticism.

Defunctioning loop ileostomy: a prospective audit.

BACKGROUND: Defunctioning loop ileostomies are uncommonly used forms of fecal diversion. The aim of this study was to determine the morbidity associated with both construction and reversal of loop ileostomies. STUDY DESIGN: An analysis was performed of all patients who underwent loop ileostomy construction or reversal between 1990 and 1997, with data being collected prospectively. RESULTS: One-hundred-two patients, (43 male, 59 female) with a mean age of 38 years (range 13 to 81 years) had loop ileostomies constructed. Indications for ileostomy construction included inflammatory bowel disease (76 patients), ultralow anterior resection for carcinoma (16 patients), or miscellaneous reasons (10 patients). Nine patients (9%) had complications arising from ileostomy construction including 4 parastomal infections, 3 high output ileostomies, 1 small-bowel obstruction, and 1 ileostomy stenosis in the early postoperative period. Only the stricture required surgical intervention. All other complications improved with conservative management. Mean time to ileostomy reversal was 120 days. Three patients (4%) had complications associated with reversal. All of these complications required surgical intervention, 2 for small bowel obstruction, and 1 for small bowel perforation. Currently 84 patients have had their ileostomy reversed, and 12 patients have had their loop ileostomy converted to a permanent stoma for reasons not related to the loop ileostomy itself. CONCLUSIONS: Defunctioning loop ileostomy is associated with low morbidity. We recommend a defunctioning ileostomy as the procedure of choice for temporary fecal diversion.

Diagnosis and serious mental illness.

We examine some limitations of the psychiatric diagnosis, particularly in the assessment of the seriousness of a patient's mental illness. The bureaucratic or technocratic use of the concept "serious mental illness' is contrasted with the perspective of the clinician who provides ongoing patient care. A decline in the clinical skills of psychiatrists is likely if proposed mental health reforms regulate psychiatric practice according to bureaucratic and technocratic definitions of serious mental illness rather than the realities of the clinical encounter between patient and doctor.

Recent developments in diagnostic radiology of primary and recurrent gastric cancer.

To summarize the imaging work-up of gastric carcinoma, the patient should be initially evaluated with a double-contrast UGI series and correlated with endoscopy. Some authors feel that the primary role of UGI is to provide a guide to the endoscopist. The area in question should be biopsied. The role of CT is controversial due to limitations in staging. Some feel that it is an ancillary procedure, as are ultrasound, MRI, and angiography. Exploratory laparotomy is recommended as the diagnostic and therapeutic evaluation of choice. However, CT may prevent surgery in the nonsymptomatic patient with diffuse metastatic disease.

Sonography in transitional cell carcinoma of the renal pelvis.

Real-time ultrasound examination of the kidneys was performed in 11 patients with transitional cell carcinoma of the renal collecting system. Each sonogram revealed a zone in the renal sinus which was less echogenic than the normal sinus and which corresponded to the extent of the tumor. Although the specificity and sensitivity of this finding are not yet known, this appearance should suggest the diagnosis of transitional cell carcinoma.

Prediction of fetal lung maturity: inaccuracy of study using conventional ultrasound instruments.

The ability of three ultrasound (US) parameters--echogenicity, texture, and through transmission--to predict fetal lung maturity was tested in 59 patients using currently available clinical US equipment. The chi square test was used to determine whether there was an association between any single parameter and a "mature" lecithin/sphingomyelin (LS) ratio or specific phosphatidycholine (SPC). Multiple linear regression analysis was used to assess the combined ability of these three parameters and gestational age to predict LS ratio and SPC. There was no correlation between fetal lung maturity, as determined by mature LS and SPC indices, and the US parameters tested using unmodified clinical equipment.

Computed tomography of malignant pleural mesothelioma.

We tabulated the computed tomographic (CT) findings in 14 consecutive patients who had proven malignant pleural mesotheliomas and were studied over a 3-year period. We also staged the disease in these patients, all of whom were men, aged 40-75 years (mean, 59), and had been exposed to asbestos at work. Common presenting symptoms were shortness of breath or chest pain. Pleural thickening was found on the side of the tumor in all of the patients, characterized as nodular and circumferential (6/14 cases), plaque-like (4/14), or strictly nodular (4/14) in appearance. In addition, 86% of the patients demonstrated contralateral pleural thickening, but these lesions did not prove to be tumor deposits. Other common CT findings in the involved hemithorax included: pleural effusions (79% of cases), lung parenchymal disease (79%), decreased hemithorax size (62%), and pleural calcification (50%). Before the chest scans were performed, 13 patients were felt to have Stage I disease and one to have Stage IV. The CT information revised these opinions: four of the Stage I patients were assigned to Stage II (on the basis of chest wall involvement or enlarged hilar/mediastinal lymph nodes). Therapy was altered in these four cases. In two patients pericardial thickening was seen, but it was not possible to determine if this was due to tumor involvement. We conclude that CT can identify several abnormalities that are commonly associated with mesotheliomas. By demonstrating lesions not detectable on conventional imaging studies, CT may alter staging and therapy in many patients with this disease.