Bronchoscopic findings in dogs with bronchial vegetal foreign bodies: 84 cases (2010-2020).

OBJECTIVES: To describe endoscopic findings, foreign body location, success rate of removal and complications in dogs with bronchial vegetal foreign bodies. MATERIALS AND METHODS: The current study retrospectively evaluated the case records of dogs diagnosed with bronchial vegetal foreign bodies at a veterinary hospital centre between January 2010 and April 2020. Information retrieved included breed, sex, age, bodyweight, the season of presentation, presentation and duration of clinical signs, previous removal attempts performed by the referring veterinarian, foreign body location and endoscopic and imaging findings. RESULTS: Eighty-four cases were included. Fifty-nine dogs (70%) presented during spring and summer. Cough (77 of 84; 92%) and fever (15 of 84; 18%) were the main clinical signs. One to 10 bronchial vegetal foreign bodies were removed from each dog. Purulent exudate was observed in the ventral larynx, trachea and bronchi in 49 (65%), 61 (81%) and 71 (95%) dogs, respectively. In most cases, only the barbules of the vegetal foreign bodies were initially observed during endoscopy. The presence of large bronchial nodules or an irregular mucosal surface was a frequent finding (62 of 75; 83%). Mild bleeding was the main complication (58 of 75; 77%) of endoscopic removal, which was successful in 67 of the 84 (80%) cases. CLINICAL SIGNIFICANCE: Mucosal nodules associated with purulent material within the airways are frequent endoscopic findings in dogs with bronchial vegetal foreign bodies. Bronchoscopy is a relatively safe and useful technique for diagnosis and treatment of bronchial vegetal foreign bodies in dogs.

Extended palatoplasty as surgical treatment for nasopharyngeal stenosis in six cats.

OBJECTIVE: To describe the use of extended palatoplasty as treatment of caudal nasopharyngeal stenosis in cats. MATERIALS AND METHODS: CT was used to confirm the diagnosis in cats with clinical signs consistent with nasopharyngeal stenosis. Extended palatoplasty rostral to the tonsils using monopolar electrocautery allowed simultaneous removal of the caudal soft palate together with the stenotic area. Cats were re-evaluated 2 weeks postoperatively. Telephone interview was used to obtain long-term follow-up. RESULTS: Six domestic shorthair cats were diagnosed with nasopharyngeal stenosis, with clinical signs of snoring (n=4), stertor (n=4), nasal discharge (n=3) and sneezing (n=1). CT scan identified a soft-tissue stricture at the level of the caudal nasopharynx in all cats. Other abnormalities included bilateral rhinitis (n=3), retropharyngeal adenomegaly (n=2), unilateral sinusitis (n=1) and bilateral otitis externa with unilateral otitis media (n=1). Excision of the caudal soft palate and the entire stenotic soft-tissue membrane was successful in all six cats. No pre-, intra- or postoperative complications were observed. Short-term outcome revealed clinical improvement in all cases. Long-term outcome revealed no recurrence of clinical signs in four cats. In one cat, occasional sneezing was reported. One cat died 1 month postoperatively for reasons unrelated to the respiratory condition. CLINICAL SIGNIFICANCE: Extended palatoplasty was an effective technique to treat caudal nasopharyngeal stenosis and provide improvement of clinical signs without postoperative complications in all cases.

Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma.

BACKGROUND: According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. OBJECTIVES: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. MATERIALS AND METHODS: We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. RESULTS: During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5years (95% CI=72.6-78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0±4.6 vs. 4.1±3.0, p=0.002) and lower hemoglobin (8.1±1.8 vs. 11.9±2.2, p<0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding. CONCLUSION: We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.

Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals.

OBJECTIVES: To describe the location, retrieval, frequency of surgery and complications associated with fishhook foreign bodies. MATERIALS AND METHODS: Retrospective evaluation of the medical records of cats and dogs admitted between 2010 and 2016 after fishhook ingestion. RESULTS: A total of 33 cases (2 cats and 31 dogs) were included. The most common locations were the proximal oesophagus [12/33 (36%)] and stomach [11/33 (33%)]. Endoscopic retrieval was successful in 27 of 33 cases (82%); oesophageal perforation was the only recorded complication, occurring in six of 33 (18%) cases. Surgery was performed in six cases (18%), and no early complications were recorded. The survival rate was 100%. CLINICAL SIGNIFICANCE: The endoscopic removal of ingested fishhooks is highly successful. In the present study, survival to discharge was 100%, even in cases of oesophageal perforation or in cases requiring surgery.

Risk factors for falling in community-dwelling older adults: which of them are associated with the recurrence of falls?

BACKGROUND: The aim of the study was to determine which risk factors were associated with the recurrence of falls among community-dwelling older adults. METHODS: Based on a cross-sectional design, 1066 community-dwelling volunteers aged 65 and older were recruited. The use of psychoactive drugs, the number of drugs taken per day, the basic mobility assessed with the Timed Up & Go test (TUG), the maximal isometric voluntary contraction strength of hand, the lower limb proprioception, the distance binocular vision, the fear of falling and the history of falls during the past year were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and ≥ 2 falls. RESULTS: Among the 395 (37.1%) fallers, 291 (27.3%) were single fallers and 104 (9.8%) were recurrent fallers (i.e., > 2 falls). The numbers of falls increased significantly with age (Incident Rate Ratio (IRR)=1.03, p < 0.001), female gender (IRR=1.95, p < 0.001), institutionalization (IRR=1.66, p=0.002), number of drugs taken per day (IRR=1.05, p < 0.001), use of psychoactive drugs (IRR=1.29, p=0.009), increased time of TUG Test (IRR=1.02, p < 0.001), use of a walking aid (IRR=1.59, p=0.002), and fear of falling (IRR=3.08, p < 0.001). In addition, a high score at the handgrip test (IRR=0.97, p < 0.001) and distance binocular vision (IRR=0.92, p < 0.001) were associated with a decreased number of falls. After adjustment for potential confounders, only female gender (IRR=1.44, p < 0.001), vision (IRR=0.95, p=0.006) and lower limb proprioception (IRR=0.95, p=0.046), and fear of falling (IRR=2.68, p < 0.001) were still significantly associated with the number of falls. CONCLUSION. The current study shows that female gender, poor vision and lower limb proprioception, and fear of falling were associated with the recurrence of falls.

Decrease in gait variability while counting backward: a marker of "magnet effect"?

Counting backward (CB) and walking are both rhythmic tasks. An improvement of CB performance has been reported while walking, and has been interpreted as a "magnet effect" which is the tendency of biological oscillators to attract each other. The objective of this study was to compare the coefficient of variation (CoV) of stride time (ST) and the number of enumerated figures while single- and dual-tasking between older adults who increased and decreased their CoV of ST while CB. The number of enumerated figures and the CoV of ST under single-task (i.e., CB while sitting or walking alone) and dual-task (i.e., CB while walking) were measured among 100 community-dwelling older subjects (mean, 69.8 ± 0.07 years). Subjects were separated into two groups according to the dual-task-related changes in CoV of ST (i.e., either above or below the mean value of CoV of ST under single-task). Seventeen participants decreased their CoV of ST while CB compared to usual walking (2.6 ± 1.6% vs. 2.0 ± 1.3%, P < 0.001), while 83 increased their CoV of ST (1.7 ± 0.6% vs 3.4 ± 2.3%, P < 0.001). The subjects who decreased their CoV of ST had a tendency to enumerate more figures while walking compared to sitting (20.9 ± 6.3 vs 19.4 ± 4.7, P = 0.046) unlike those who increased their CoV of ST (20.3 ± 5.0 vs 21.8 ± 6.0 while sitting, P = 0.001). We found that most of subjects had worse gait and CB performance while dual-tasking. Conversely, a limited number of subjects improved significantly their gait performance and simultaneously had a tendency to improve their CB performance while walking compared to sitting. This behavior was observed only among subjects with the highest gait variability and could be interpreted as an implicit strategy based on the "magnet effect".

Association of plasma N-terminal pro-B-type natriuretic peptide concentration with mitral regurgitation severity and outcome in dogs with asymptomatic degenerative mitral valve disease.

BACKGROUND: The clinical outcome of dogs affected by degenerative mitral valve disease (MVD) without overt clinical signs is still poorly defined, and criteria for identification of animals that are at a higher risk of early decompensation have not yet been determined. HYPOTHESIS: N-terminal pro-B-type natriuretic peptide plasma concentration (NT-proBNP) is correlated with mitral regurgitation (MR) severity and can predict disease progression in dogs with asymptomatic MVD. ANIMALS: Seventy-two dogs with asymptomatic MVD, with or without heart enlargement (International Small Animal Cardiac Health Council: ISACHC classes 1a and 1b), and a control group of 22 dogs were prospectively recruited. METHODS: Severity of MR was quantitatively assessed from the regurgitation fraction (RF) by the proximal isovelocity surface area method. Consequences of MR were evaluated from measurements of the left atrium/aorta ratio (LA/Ao), fractional shortening (FS), end-diastolic and end-systolic left ventricular volumes indexed to body surface area (EDVI and ESVI). The relevance of these echo-Doppler indices and NT-proBNP for prediction of outcome at 12 months was studied. RESULTS: A significant correlation was found between NT-proBNP and RF, LA/Ao, FS, and EDVI (P < .05). NT-proBNP was higher in dogs with MVD (ISACHC classes 1a and 1b) compared with the control group (P= .025 and < .001, respectively). The difference was not significant when only dogs from ISACHC class 1a with RF < 30% were considered. Lastly, NT-proBNP was higher in dogs that underwent MVD decompensation at 12 months (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE: NT-proBNP is correlated with MVD severity and prognosis in dogs with asymptomatic MVD.

Comparison of 3 ultrasound methods for quantifying left ventricular systolic function: correlation with disease severity and prognostic value in dogs with mitral valve disease.

BACKGROUND: End-systolic volume index (ESVI) is a marker of systolic function, which can be assessed by the geometric (GM, based on Teichholz formula) or 2 planimetric methods (PM, Simpson's derived and length area methods). HYPOTHESIS: Systolic dysfunction (SyD) may be observed in dogs with mitral valve disease (MVD) and is better assessed by PM than GM, which does not take into account the longitudinal left ventricular systolic shortening. ANIMALS: Six healthy dogs were used to determine the variability of the tested variables (Study 1). These variables were then prospectively assessed (Study 2) in 101 small breed dogs: 77 dogs with MVD and 24 healthy controls (CD). METHODS: ESVI was measured by GM and PM in awake dogs. RESULTS: All within- and between-day coefficients of variation were <11% (Study 1). For Study 2, a nonlinear overestimation of ESVI was observed by GM compared with PM. PM-derived ESVI was significantly increased in ISACHC class 3 dogs compared with ISACHC class 1 dogs and exerted a significant influence on cardiac events at 5 months in dogs with MVD from ISACHC classes 2 and 3 (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE: ESVI can be calculated by GM and PM with good repeatability and reproducibility. However, GM overestimates ESVI in a nonlinear way. Therefore, PM-derived ESVI should be preferred for the detection of SyD that is present at the late stages of the disease.