Endoscopic application of fibrin glue may be a feasible method of treatment for postintubation tracheal lacerations in cats.

OBJECTIVE: To determine the feasibility of endoscopic application of fibrin glue for the treatment of experimentally induced postintubation tracheal laceration (PITL) in feline cadavers. The secondary objective was to determine the optimal technique for application of the fibrin glue. ANIMALS: 20 feline cadavers (n = 10 fresh and 10 frozen). PROCEDURES: An experimentally induced tracheal rupture was created via overinflation of an endotracheal tube cuff. After endoscopic identification of the tracheal tear, fibrin glue was instilled into the tracheal defect in either a bridging or filling fashion. Following the procedure, the airway of each cat was examined and leak tested. Length of tear, volume of glue applied, procedural time, and glue efficacy were recorded. RESULTS: Experimentally induced tracheal lacerations were full thickness with a mean length of 3.27 ± 0.96 cm. A complete seal was attained in 6 of the 9 fresh cadavers when filling the defect with fibrin glue. In the remaining 3 fresh cadavers, air leakage was restricted to the dorsal mediastinum. Bridging the defect with fibrin glue did not attain a seal in fresh or frozen cadavers. The median volume of glue used to fill defects in fresh cadavers was 0.5 mL (range, 0.4 to 2 mL). Procedural time for the application of fibrin glue was 10.5 ± 4.1 minutes for bridging the defect and 7.8 ± 1.5 minutes for filling the defect. CLINICAL RELEVANCE: Endoscopic application of fibrin glue may be a feasible method of treatment for PITL in cats.

Gastroduodenal ulceration in dogs with liver disease.

BACKGROUND: Liver disease is frequently cited as a cause of gastroduodenal ulceration (GDU) in dogs but studies regarding GDU and liver disease are limited. OBJECTIVES: To document the presence of GDU in dogs with liver disease. ANIMALS: Forty dogs that underwent liver biopsy, computed tomographic (CT) angiography or both at the University of Florida Small Animal Hospital to diagnose congenital or acquired liver disease. METHODS: Cross-sectional study. Dogs had gastroduodenoscopy performed with photographic and video documentation in a standardized fashion. Lesions (hemorrhage, erosions, ulcers) in the esophagus, stomach, and duodenum were scored based on a grading scale. Presence of esophageal varices was recorded. Dogs were categorized into 4 groups according to cause of liver disease (inflammatory disease, cirrhosis, congenital, other). Presence or absence of ulcers, erosions or both as well as total endoscopic scores were compared among groups. RESULTS: Forty dogs were enrolled with the following distribution: 13 congenital, 13 inflammatory, 3 cirrhosis, and 11 other. Four dogs had GDU (10%; 95% confidence interval [CI], 3%-24%) and 6 dogs had erosions (15%; 95% CI, 6%-30%). No difference was found in total endoscopic score (P = .21) or in the proportion of dogs with ulcers, erosions or both versus those without (P = .25) among the groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Gastroduodenal ulceration was found in 10% of dogs with liver disease in this population. Additional studies are warranted to confirm these findings in larger numbers of dogs with specific disease etiologies.

Survey of Instruments and Techniques for Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs.

Esophageal and gastric foreign bodies (EFB and GFB) are a common occurrence in cats and dogs. The objective of this study is to evaluate the endoscopic instruments and techniques used for foreign body retrieval by internists or criticalists based on type and location of the foreign body. An online, anonymous survey was created using a commercial software. The survey was distributed to diplomates of the ACVIM (SAIM) and ACVECC through each college's listserv. Data obtained included specialty, years in practice, practice type, available instruments, and preferred instrument for various foreign bodies by location and type. Two hundred sixty-eight surveys were completed with 74% from private referral practice and 21% from academic practice. For EFB, laparoscopic or endoscopic grasping forceps were used most commonly. For GFB, grasping forceps or loop snares were used most commonly. Fifty percent of respondents reported attempting duodenal FB removal. In practices with limited financial resources, endoscopic grasping forceps and loop snares may be prioritized for purchase as these instruments may have the most application for foreign body retrieval from the esophagus and stomach.

Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers.

OBJECTIVE: To biomechanically assess outcomes for 2 percutaneous gastropexy techniques and determine the amount of time necessary to perform the techniques for securing percutaneous endoscopic gastrostomy (PEG) tubes in canine cadavers. ANIMALS: 18 canine cadavers. PROCEDURES: 6 cadavers were assigned to each of 3 groups (PEG tube only, PEG tube with T-fastener gastropexy, and PEG tube with U-stitch gastropexy). Time to completion of placement of a PEG tube and gastropexy was recorded. After tubes were placed, the stomach and body wall on the left side of the abdomen were removed and biomechanically tested. Maximum tension at the time of initial failure of the PEG tube or gastropexy was recorded. RESULTS: Significantly more force was required to induce failure for the T-fastener and U-stitch techniques than for the PEG tube only technique. In addition, both the T-fastener and U-stitch techniques required significantly more time for placement than did the PEG tube only technique. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that performing a T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs. However, studies conducted with these techniques in live dogs would be necessary to confirm this hypothesis. The additional amount of time needed to perform the T-fastener or U-stitch gastropexy would likely be clinically unimportant.

Endoscopic-guided laser lithotripsy for removal of an encrusted ureteral stent in a dog.

CASE DESCRIPTION: An 8-year-old spayed female Dalmatian was evaluated because of recurrent urinary tract infections following ureteral stent placement 3 years earlier. CLINICAL FINDINGS: Polyuria, pollakiuria, and hematuria were reported by the owner. Abdominal radiography revealed well-defined, faintly mineralized material superimposed over the distal portion of the previously placed ureteral stent. Abdominal ultrasonography revealed thickening of the bladder wall, right hydroureter, and right pyelectasia; the ureteral stent appeared to extend into a region containing cystic calculi. Cystoscopy revealed small uroliths and mineralized encrustation of the distal portion of the ureteral stent. TREATMENT AND OUTCOME: A holmium:yttrium-aluminum-garnet laser was used to fragment mineralized material from the distal end of the stent and allow endoscopic transurethral removal. Stone analysis revealed ammonium urate as the major component of the mineralized material. The owner was instructed to feed the dog a diet formulated to decrease the likelihood of urate stone recurrence and to administer marbofloxacin for 6 weeks because of suspected pyelonephritis. Follow-up bacterial culture of a urine sample and abdominal ultrasonography revealed resolution of urinary tract infection, pyelectasia, hydroureter, and associated clinical signs. CLINICAL RELEVANCE: Results suggested that endoscopic-guided laser lithotripsy can be used as a minimally invasive alternative to surgery for removal of severely encrusted ureteral stents in dogs.

Biologic variability of N-terminal pro-brain natriuretic peptide in adult healthy cats.

Objectives The biologic variability of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its impact on diagnostic utility is unknown in healthy cats and those with cardiac disease. The purpose of this study was to determine the biologic variation of NT-proBNP within-day and week-to-week in healthy adult cats. Methods Adult cats were prospectively evaluated by complete blood count (CBC), biochemistry, total thyroxine, echocardiography, electrocardiography and blood pressure, to exclude underlying systemic or cardiac disease. Adult healthy cats were enrolled and blood samples were obtained at 11 time points over a 6 week period (0, 2 h, 4 h, 6 h, 8 h, 10 h and at weeks 2, 3, 4, 5 and 6). The intra-individual (coefficient of variation [CVI]) biologic variation along with index of individuality and reference change values (RCVs) were calculated. Univariate models were analyzed and included comparison of the six different time points for both daily and weekly samples. This was followed by a Tukey's post-hoc adjustment, with a P value of <0.05 being significant. Results The median daily and weekly CVI for the population were 13.1% (range 0-28.7%) and 21.2% (range 3.9-68.1%), respectively. The index of individuality was 0.99 and 1 for daily and weekly samples, respectively. The median daily and weekly RCVs for the population were 39.8% (range 17.0-80.5%) and 60.5% (range 20.1-187.8%), respectively. Conclusions and relevance This study demonstrates high individual variability for NT-proBNP concentrations in a population of adult healthy cats. Further research is warranted to evaluate NT-proBNP variability, particularly how serial measurements of NT-proBNP may be used in the diagnosis and management of cats with cardiac disease.

Suspected myelodysplastic/myeloproliferative neoplasm in a feline leukemia virus-negative cat.

A 10-year-old castrated Domestic Short-Haired cat was presented to a primary care veterinarian for a wellness examination and laboratory examination for monitoring of diabetes mellitus. The CBC revealed marked thrombocytosis, leukopenia and macrocytic, normochromic anemia. The cat tested negative for FeLV and feline immunodeficiency virus, but was positive for Mycoplasma haemominutum by PCR. Hematologic abnormalities were not responsive to therapy, so a repeat CBC and a bone marrow aspiration for cytology were performed. Additional blood smear findings included anisocytosis with megaloblastic erythroid precursors, large platelets, eosinophilic myelocytes and metamyelocytes, and rare unidentified blasts. The bone marrow smear was highly cellular, and the cytologic pattern was consistent with myelodysplastic syndrome with an erythroid predominance. At that time, 15% blasts were present. The cat was treated with a vitamin K2 analog, doxycycline, and prednisolone, but without a clinical response. Within 3 months, euthanasia was elected due to declining quality of life, and a necropsy was performed. Postmortem bone marrow smears were highly cellular and dominated by monomorphic blasts of unknown line of origin (52%), persistent marked erythroid and megakaryocytic dysplasia, and ineffective erythropoiesis and granulopoiesis. Immunohistochemical, immunocytochemical, and cytochemical stains resulted in a diagnosis of acute myeloid leukemia of unclassified type. Additional histologic findings included mixed hepatitis with trematode infestation and lymphoplasmacytic interstitial nephritis with fibrosis. The marked thrombocytosis with myelodysplastic syndrome and the FeLV-negative status of this cat were unusual. The difficulty in classifying the myelodysplasia and subsequent leukemia highlights a need for further reporting and characterization of these types of disease.

Use of endoscopic-assisted argon plasma coagulation for the treatment of colonic vascular ectasia (angiodysplasia) in an adult dog.

CASE DESCRIPTION: A 10-year-old neutered male mixed-breed dog was evaluated for a 5-year history of intermittent hematochezia and chronic anemia that were unresponsive to medical treatment. CLINICAL FINDINGS: Colonoscopy revealed multifocal areas of coalescing tortuous mucosal blood vessels throughout the colon and rectum. Colonic vascular ectasia (angiodysplasia) was diagnosed on the basis of the endoscopic appearance of the lesions. TREATMENT AND OUTCOME: The dog failed to respond to traditional medical treatments for colonic vascular ectasia and required multiple plasma and blood transfusions. The dog received 4 endoscopic-assisted argon plasma coagulation treatments, which resulted in long-term resolution of gastrointestinal hemorrhage. Colonic perforation occurred during the third argon plasma coagulation treatment. The perforation was surgically repaired. The dog remained free from clinical signs of colonic vascular ectasia for > 1 year after the third argon plasma coagulation treatment and was euthanized because of clinical deterioration associated with progressive heart disease. CLINICAL RELEVANCE: Endoscopic-assisted argon plasma coagulation treatment is a novel treatment for dogs with colonic vascular ectasia and provided long-term resolution of clinical signs for the dog of this report. In human patients, complications associated with endoscopic-assisted argon plasma coagulation treatment include colonic perforation, which also occurred in the dog of this report.

Efficacy of iopanoic acid for treatment of spontaneous hyperthyroidism in cats.

Iopanoic acid is an iodine containing oral cholecystographic agent that has been used to treat hyperthyroidism in humans and has recently been evaluated in an experimental model of feline hyperthyroidism. The aim of this study was to evaluate the efficacy of iopanoic acid in cats with spontaneous hyperthyroidism. Eleven cats were included in the study. Eight were treated initially with 50mg orally q 12h and three were treated with 100mg orally q 12h. Prior to treatment (baseline) and at 2, 4, and 12 weeks of treatment, owner questionnaires, physical exams, complete blood count, biochemistry analyses, and T(3) and T(4) concentrations were evaluated. The mean serum T(3) concentration decreased with treatment at all time periods compared to baseline. Mean T(4) concentrations were increased at weeks 4 and 12 compared to baseline. Five cats had a partial response during the initial 4 weeks of therapy, but the effects were transient and no significant improvements in clinical signs or physical exam findings were noted at any time period. Results suggest that iopanoic acid may be beneficial for acute management of thyrotoxicosis in some cats, but is not suitable for long-term management.

Effects and safety of iopanoic acid in cats administered levothyroxine.

The purpose of this study was to evaluate the safety and effect of iopanoic acid in 13 cats with hyperthyroidism induced by daily subcutaneous administration of 25microg/kg levothyroxine for a period of 42 days. On day 28 of levothyroxine administration, cats were randomly allocated to receive treatment twice daily with a placebo (control group; n=4), 50mg iopanoic acid (low dose group; n=5), or 100mg iopanoic acid (high dose group; n=4) for 14 days. Compared to the control group, T(3) concentrations were significantly decreased in both the low dose and high dose groups on days 35 and 42. T(3) concentrations in the low dose and high dose groups at days 35 and 42 were not different from day -8. The effect of iopanoic acid on clinical signs of hyperthyroidism was less apparent. Further clinical studies evaluating the long-term effect in cats with spontaneous hyperthyroidism are warranted.

Hyperphosphatasemia in Scottish terriers: 7 cases.

Increased serum alkaline phosphatase (ALKP) activity in dogs is commonly encountered. In the study reported here, 7 Scottish Terriers were identified with hyperphosphatasemia, for which a cause could not be determined. The clinicopathologic findings of the syndrome are described and correlated with hepatic pathologic changes in biopsy specimens and in specimens obtained at postmortem examination. Five of the 7 dogs were related. The ALKP activity ranged from 1.7 to 17 times the reference value at the time of biopsy. Increased ALKP activity was present for >6 months in 2 dogs and >12 months in 5 dogs; activity was > 1,000 U/L for at least 1 measurement in 5 dogs. Results of liver function testing, adrenocortical function testing, and hepatic ultrasonography were reviewed. Results of histological examination were normal in 6 dogs. One dog had regional, chronic cholangitis without evidence of cholestasis. The lesion was judged unlikely to account for the degree of hyperphosphatasemia. This study provides evidence of possible benign hyperphosphatasemia in Scottish Terriers or of another familial disorder causing asymptomatical hyperphosphatasemia without corresponding histopathological abnormalities in the liver. Prospective studies of ALKP isoenzyme characterization, investigation of skeletal integrity, evaluation of additional related dogs to determine prevalence, and longer follow-up evaluation are necessary to better characterize this finding.