Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial.

BACKGROUND: The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. METHODS: Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. RESULTS: 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23-0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. CONCLUSIONS: Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036255.

Corneal epithelial inclusion cysts in 12 dogs (13 eyes) from 2010 to 2019: A multicentric retrospective study.

OBJECTIVE: The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered corneal epithelial inclusion cysts (CEIC). Animals studied Thirteen eyes from 12 dogs from multiple private practices in France and Belgium, with a strong clinical of CEIC were included in the study. RESULTS: The mean age of affected dogs was 9 years. There were 9 females and 3 males. Two out of 12 dogs were Shih Tzus. Where identified, etiology was traumatic. Eleven dogs were affected unilaterally, 1 bilaterally. The cysts were single, bi-lobulated, or tri-lobulate, and cyst size ranged from 1 to 6 mm in diameter. Keratectomy alone was performed in seven cases, in conjunction with a conjunctival graft in three cases, a porcine small intestine mucosa graft in two cases, or an amniotic membrane graft in one case. Histopathologic findings were consistent in all eyes with a cyst located in the corneal stroma, composed of a nonkeratinized squamous epithelium delineating a lumen filled with neutrophils and desquamated epithelial cells. Surgery was curative in all cases but one, where the removal was incomplete and recurrence occurred several weeks after the surgery. CONCLUSION: Corneal epithelial inclusion cysts is a rare condition, secondary to corneal trauma, which can be treated successfully with conventional keratectomy alone or in conjunction with graft procedures.

An evidence-based medicine approach to small animal anaesthetic mortality in a referral practice: the influence of initiating three recommendations on subsequent anaesthetic deaths.

OBJECTIVE: To evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice. STUDY DESIGN: Observational cohort study. ANIMALS: All cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2). METHODS: Death occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods. RESULTS: Six thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0-1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6-1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5-6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3-3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk. CONCLUSION AND CLINICAL RELEVANCE: Following evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.

Risk of anaesthetic mortality in dogs and cats: an observational cohort study of 3546 cases.

OBJECTIVE: To evaluate the anaesthetic death risk for dogs and cats in a French private practice. STUDY DESIGN: Observational cohort study. ANIMAL POPULATION: All small animals anesthetized at the Centre Hospitalier Vétérinaire des Cordeliers between April 15th, 2008 and April 15th, 2010. METHODS: General anaesthesia was defined as a drug-induced unconsciousness characterised by a controlled and reversible depression of the central nervous system and analgesia, sufficient to allow endotracheal intubation. Patient outcome (alive or dead) was assessed at the end of anaesthesia defined as the meeting point of the return of consciousness, rectal temperature >36 °C and ability to maintain sternal recumbency. Death occurring during anaesthesia was recorded. Relationship between anaesthetic death and ASA status, species, age, nature of the procedure, anaesthetic protocol and occurrence of epidural administration of a combination of morphine and bupivacaine were analysed. RESULTS: During the study period 3546 animals underwent general anaesthesia. The overall death rate in the present study was 1.35% (48 in 3546, 95% CI 0.96-1.75). The death rate of healthy animals (ASA 1 and 2) was 0.12% (3 in 2602 95% CI 0.02-0.34). For sick animals (ASA status 3 and over), the overall death rate was 4.77% (45 in 944 95% CI 3.36-6.18). The death rates in the ASA 3, 4 and 5 categories were 2.90%, 7.58% and 17.33%, respectively. The main factor associated with increased odds of anaesthetic death in ASA categories 3 and over was poor health status (ASA physical status classification). The nature of the procedure the patient underwent and epidural administration of a combination of morphine and bupivacaine were not correlated with the occurrence of death during anaesthesia. Neither species nor age effects were detected. CONCLUSION AND CLINICAL RELEVANCE: Specific factors were associated with increased odds of anaesthetic death, especially poor health status. Efforts must be directed towards thorough preoperative patient evaluation and improvement of clinical conditions if possible. Identification of risk factors before anaesthesia should lead to increased surveillance by trained staff. This could result in better outcomes.

ERG findings in three hypothyroid adult dogs with and without levothyroxine treatment.

PURPOSE: To evaluate the effects of levothyroxine (LTh) on the electroretinogram (ERG) of adult dogs. MATERIAL AND METHODS: Binocular, full field photopic and scotopic ERGs were recorded from an anesthetized Maltese Bichon cross (MB), a Yorkshire Terrier (YT) and a Shetland Sheepdog (SS) affected with hypothyroidism and treated with a daily dose of LTh at 20 microg/kg. The photopic ERGs were evoked to 12 different intensities ranging from 0.81 to -2.19 log cd.s/m(2) and presented under photopic conditions in order to assess (from the derived luminance-response curves) Vmax and b : a amplitude ratio parameters. Photopic flicker ERGs were obtained at 30 Hz. The scotopic ERGs (intensity: -3.09 log cd.s/m(2)) were recorded while the retina was dark-adapting and after 32 min of dark adaptation. This procedure was performed on two separate sessions: following a 3-day interruption of LTh treatment (S1) and following 30 days without interruption of LTh treatment (S2). RESULTS: The mean photopic a-wave peak times were 9.8 ms at S1 and 5.0 ms at S2, respectively. The mean photopic b-wave peak times were 23.3 ms at S1 and 11.5 ms at S2, respectively, and the mean scotopic b-wave peak times (after 32 min of dark adaptation) were 45.2 ms at S1 and 26.0 ms at S2, respectively. No other significant ERG changes were observed. CONCLUSION: Our results indicate that a dose of 20 microg/kg of LTh given to adult dogs was accompanied by a marked peak time shortening of both photopic and scotopic ERGs, without affecting other ERG parameters.