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Jeong E, Chung JY, Ahn JO, Choi H, Lee Y, Lee K, Choi S. Computed tomographic evaluation of portal vein indices in cats with the extrahepatic portosystemic shunts. J Vet Sci 2024; 25:e37. [PMID: 38834507 DOI: 10.4142/jvs.24038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 06/06/2024] Open
Abstract
IMPORTANCE The portal vein to aorta (PV/Ao) ratio is used to assess the clinical significance of extrahepatic portosystemic shunt (EHPSS). Previous studies using computed tomography (CT) were conducted in dogs but not in cats. OBJECTIVE This study aimed to establish normal reference values for PV indices (PV/Ao ratio and PV diameter) in cats and determine the usefulness of these for predicting symptomatic EHPSS. METHODS This study included 95 dogs and 114 cats that underwent abdominal CT. The canine normal (CN) group included dogs without EHPSS. The cats were classified into feline normal (FN, 88/114), feline asymptomatic (FA, 16/114), and feline symptomatic (FS, 10/114) groups. The PV and Ao diameters were measured in axial cross-sections. RESULTS The group FN had a higher PV/Ao ratio than the group CN (p < 0.001). Within the feline groups, the PV indices were in the order FN > FA > FS (both p < 0.001). The mean PV diameter and PV/Ao ratio for group FN were 5.23 ± 0.77 mm and 1.46 ± 0.19, respectively. The cutoff values between groups FN and FS were 4.115 mm for PV diameter (sensitivity, 100%; specificity, 97.7%) and 1.170 for PV/Ao ratio (90%, 92.1%). The cutoff values between group FA and FS were 3.835 mm (90%, 93.8%) and 1.010 (70%, 100%), respectively. CONCLUSIONS AND RELEVANCE The results demonstrated significant differences in PV indices between dogs and cats. In cats, the PV/Ao ratio demonstrated high diagnostic performance for symptomatic EHPSS. The PV diameter also performed well, in contrast to dogs.
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Affiliation(s)
- Eunji Jeong
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea
| | - Jin-Young Chung
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea
| | - Jin-Ok Ahn
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea
| | - Hojung Choi
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Youngwon Lee
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Kija Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Sooyoung Choi
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea.
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Farhoodimoghadam M, Reagan KL, Zwingenberger AL. Diagnosis and classification of portosystemic shunts: a machine learning retrospective case-control study. Front Vet Sci 2024; 11:1291318. [PMID: 38638645 PMCID: PMC11024426 DOI: 10.3389/fvets.2024.1291318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
Diagnosis of portosystemic shunts (PSS) in dogs often requires multiple diagnostic tests, and available clinicopathologic tests have limitations in sensitivity and specificity. The objective of this study was to train and validate a machine learning model (MLM) that can accurately predict the presence of a PSS utilizing routinely collected demographic data and clinicopathologic features. Dogs diagnosed with PSS or control dogs tested for PSS but had the condition ruled out (non-PSS) were identified. Dogs were included if a complete blood count and serum chemistry panel were available from PSS diagnostic testing. Dogs with a PSS were subcategorized as having a single intrahepatic PSS, a single extrahepatic PSS, or multiple extrahepatic PSS. An extreme gradient boosting (XGboost) MLM was trained with data from 70% of the cases, and MLM performance was determined on the test set, comprising the remaining 30% of the case data. Two MLMs were created. The first was designed to predict the presence of any PSS (PSS MLM), and the second to predict the PSS subcategory (PSS SubCat MLM). The trained PSS MLM had a sensitivity of 94.3% (95% CI 90.1-96.8%) and specificity of 90.5% (95% CI 85.32-94.0%) for dogs in the test set. The area under the receiver operator characteristic curve (AUC) was 0.976 (95% CI; 0.964-0.989). The mean corpuscular hemoglobin, lymphocyte count, and serum globulin concentration were most important in prediction classification. The PSS SubCat MLM had an accuracy of 85.7% in determining the subtype of PSS of dogs in the test set, with variable sensitivity and specificity depending on PSS subtype. These MLMs have a high accuracy for diagnosing PSS; however, the prediction of PSS subclassification is less accurate. The MLMs can be used as a screening tool to increase or decrease the index of suspicion for PSS before confirmatory diagnostics such as advanced imaging are pursued.
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Affiliation(s)
- Makan Farhoodimoghadam
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Krystle L. Reagan
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Allison L. Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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3
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Spies K, Ogden J, Sterman A, Davidson J, Scharf V, Reyes B, Luther JK, Martin L, Kudej R, Stockman T, Gallaher HMJ, Buote NJ, Smith M, Ciepluch B, Amore R, Sherman AH, Wallace ML. Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts. Vet Surg 2024; 53:277-286. [PMID: 37846027 DOI: 10.1111/vsu.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery. STUDY DESIGN Multicenter retrospective (10 university hospitals, one private referral institution). ANIMALS Dogs ≥15 kg (n = 63). METHODS Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed. RESULTS Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens. CONCLUSIONS Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs. CLINICAL SIGNIFICANCE Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.
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Affiliation(s)
- Kate Spies
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Jessica Ogden
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Allyson Sterman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Jackie Davidson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Valery Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Bianca Reyes
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Jill Kristine Luther
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Libby Martin
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Raymond Kudej
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Tiffany Stockman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Hayley Maloof-Jones Gallaher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nicole J Buote
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Meghan Smith
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Brittany Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Riley Amore
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Alec H Sherman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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4
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Visser J, Schoemaker NJ, van Zeeland YRA, Veraa S, Kik MJL, Fieten H, Kummeling A. Diagnosis and treatment of a congenital portosystemic shunt in a ferret (Mustela putorius furo). J Small Anim Pract 2024; 65:75-78. [PMID: 37560781 DOI: 10.1111/jsap.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 08/11/2023]
Abstract
A 3-year-old female neutered ferret presented with progressive weight loss was diagnosed with portosystemic shunting based on increased fasting bile acids, rectal ammonia tolerance testing and advanced imaging. Ammonia reference values were determined in 16 healthy ferrets. A congenital extrahepatic spleno-caval shunt was visualised with ultrasonography and CT angiography of the abdomen. Complete surgical shunt closure by suture ligation was performed, without clinical improvement after surgery. Euthanasia was elected 4 months postoperatively because the clinical condition deteriorated. This is a case report of advanced diagnostics and surgical treatment of a congenital extrahepatic portosystemic shunt in a ferret, demonstrating rectal ammonia tolerance testing and imaging as feasible techniques for the diagnosis.
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Affiliation(s)
- J Visser
- Animal Referral Centre, Auckland, New Zealand
| | - N J Schoemaker
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Y R A van Zeeland
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Veraa
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - M J L Kik
- Department Biomolecular Health Sciences - Pathology Division, Utrecht University, Utrecht, The Netherlands
| | - H Fieten
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Kummeling
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
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Lipscomb V, Cassie C, Ritchie B, Greenhalgh S, Tivers M. Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs. Vet Sci 2023; 10:480. [PMID: 37505884 PMCID: PMC10383284 DOI: 10.3390/vetsci10070480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a 'complete ligation where possible' philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this.
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Affiliation(s)
- Victoria Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Chloe Cassie
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Ben Ritchie
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Stephen Greenhalgh
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
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MacEwan I, Thompson D. Intramural esophageal location of a portosystemic shunt in a dog with two congenital portosystemic shunts on CT angiography. Vet Radiol Ultrasound 2023. [PMID: 37332158 DOI: 10.1111/vru.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/06/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
A 5-year-old male neutered pug with hematuria was presented to a referral hospital after identification of an extrahepatic portosystemic shunt (EHPSS) during abdominal ultrasonography. Computed tomographic-angiography revealed two anomalous blood vessels (left gastroazygous and left gastrophrenic). The left gastroazygous vessel followed an atypical path within the dorsolateral esophageal wall before entering the azygous vein. The morphology of this highly unusual vessel has not, based on the authors' review of the literature, been previously reported. In combination with a second anomalous vessel, this resulted in a unique presentation of an EHPSS. Computed tomography-angiography was essential for diagnosis and surgical planning in this case.
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Affiliation(s)
- Isobel MacEwan
- Department of Diagnostic Imaging, Veterinary Specialists Aotearoa, Auckland, New Zealand
| | - Devon Thompson
- Department of Diagnostic Imaging, Veterinary Specialists Aotearoa, Auckland, New Zealand
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Konstantinidis AO, Adamama-Moraitou KK, Patsikas MN, Papazoglou LG. Congenital Portosystemic Shunts in Dogs and Cats: Treatment, Complications and Prognosis. Vet Sci 2023; 10:vetsci10050346. [PMID: 37235429 DOI: 10.3390/vetsci10050346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are a common vascular anomaly of the liver in dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise the clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests and diagnostic imaging. The aim of this article is to review the management, both medical and surgical, complications, and prognosis of CPSS in dogs and cats. Attenuation of the CPSS is the treatment of choice and may be performed by open surgical intervention using ameroid ring constrictors, thin film banding, and partial or complete suture ligation or by percutaneous transvenous coil embolization. There is no strong evidence to recommend one surgical technique over another. Medical treatment strategies include administration of non-absorbable disaccharides (i.e., lactulose), antibiotics, and dietary changes, and are indicated for pre-surgical stabilization or when surgical intervention is not feasible. After CPSS attenuation, short- and long-term post-surgical complications may be seen, such as post-operative seizures and recurrence of clinical signs, respectively. Prognosis after surgical attenuation of CPSS is generally favorable for dogs and fair for cats.
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Affiliation(s)
- Alexandros O Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Michail N Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Konstantinidis AO, Patsikas MN, Papazoglou LG, Adamama-Moraitou KK. Congenital Portosystemic Shunts in Dogs and Cats: Classification, Pathophysiology, Clinical Presentation and Diagnosis. Vet Sci 2023; 10:vetsci10020160. [PMID: 36851464 PMCID: PMC9961057 DOI: 10.3390/vetsci10020160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are abnormal vascular communications between the portal and the systemic circulation, bypassing the hepatic parenchyma and resulting in liver hypoplasia and hepatic insufficiency. Such connections develop in utero and persist postnatally. CPSS are among the two most common congenital vascular anomalies of the liver in small animals, along with primary hypoplasia of the portal vein without portal hypertension (PHPV without PH). CPSS can be extrahepatic (ECPSS), most commonly diagnosed in small and toy breed dogs and cats, or intrahepatic (ICPSS), most commonly seen in large breed dogs. Single ECPSS is the most common type encountered in both dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests, such as determination of fasting plasma ammonia (FA) levels, and pre- and postprandial serum bile acids concentrations, and diagnostic imaging. The purpose of this article is to review the definition, classification, pathogenesis, clinical presentation, and diagnosis of CPSS in dogs and cats, highlighted by the authors' clinical experience.
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Affiliation(s)
- Alexandros O. Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
- Correspondence:
| | - Michail N. Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K. Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Radiologic Evaluation of Portosystemic Shunts in Humans and Small Animals: Review of the Literature with Clinical Case Reports. Diagnostics (Basel) 2023; 13:diagnostics13030482. [PMID: 36766586 PMCID: PMC9914644 DOI: 10.3390/diagnostics13030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The portal venous system is a network of vessels that carry blood from the capillary beds of the major abdominal organs to the liver. During embryology, the portal venous system can develop aberrantly, leading to vascular connections between the portal and systemic venous circulation known as portosystemic shunts. The purpose of this comparative review with a few short representative case reports was to present the similarities and differences in portosystemic shunts in humans and small animals and their radiologic evaluation. Aberrant vascular connections between the portal and systemic venous circulation enable portal blood to bypass metabolism and detoxification in the liver, leading to significant clinical implications. Portosystemic shunts are very rare in humans, but these connections are much more common in small animals, affecting up to 0.6% of small animals. Portosystemic shunts can be congenital or acquired and are divided into intrahepatic and extrahepatic types. Because of its ability to accurately assess abdominal structures, large vessels, and their flow dynamics without anesthesia, ultrasonography has become the first imaging modality employed for the diagnostic evaluation of portosystemic shunts in both humans and small animals. This is usually followed by contrast-enhanced computed tomographic angiography in order to better define the exact shunt anatomy and to plan treatment. It is important to understand the embryology, anatomy, pathology, and pathophysiology of portosystemic shunts in order to understand the findings of radiologic imaging and to initiate appropriate treatment.
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Schikowski L, Schaub S, Thalmeier S, Schneider M. Imaging findings in a minipig with congenital portosystemic shunt. TIERÄRZTLICHE PRAXIS AUSGABE K: KLEINTIERE / HEIMTIERE 2022; 50:370-375. [DOI: 10.1055/a-1913-2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractA 15-month-old, male minipig was presented with a clinical history of seizure activity for one year. The minipig was the smallest among the littermates and was referred due to an elevated blood ammonia level with suspected portosystemic shunt (PSS). Ultrasound and CT angiography were consistent with a congenital extrahepatic PSS. To the author’s knowledge, this is the first description of a congenital extrahepatic PSS diagnosed by ultrasound and contrast-enhanced computed tomography in a minipig (pig). Partial shunt closure was performed by interventional stent application.
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Affiliation(s)
- Lisa Schikowski
- Small Animal Clinic, Surgery, Justus-Liebig-University Giessen
| | | | - Sabine Thalmeier
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University Giessen
| | - Matthias Schneider
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University Giessen
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11
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Bondel M, Morvan V, Moissonnier P. Treatment of an extrahepatic portosystemic shunt by placement of a hydraulic occluder followed by a thin film band in a dog: An eventful story. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Margaux Bondel
- Université de Toulouse, ENVT Toulouse France
- Campus vétérinaire de Lyon, VetAgro Sup, Marcy l'Etoile Lyon France
| | - Victor Morvan
- Campus vétérinaire de Lyon, VetAgro Sup, Marcy l'Etoile Lyon France
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12
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Poggi E, Rubio DG, Pérez Duarte FJ, Del Sol JG, Borghetti L, Izzo F, Cinti F. Laparoscopic portosystemic shunt attenuation in 20 dogs (2018-2021). Vet Surg 2022; 51 Suppl 1:O138-O149. [PMID: 35194798 DOI: 10.1111/vsu.13785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the technique, complications, and outcome of laparoscopic portosystemic shunt attenuation (LPSSA) in dogs. STUDY DESIGN Retrospective study. ANIMALS Twenty client-owned dogs. METHODS Medical records were searched for dogs with a single congenital extrahepatic portosystemic shunt (CEPSS) that was treated with LPSSA. Signalment, clinical signs, CEPSS location, diagnostic imaging, laparoscopic approach, operative technique, complications, and clinical outcome were reviewed. RESULTS Fourteen dogs with CEPSS located in the epiploic foramen had a right (13/14) or left (1/14) paramedian approach. In 6 dogs a CEPSS was not located in the epiploic foramen, and a left paramedian approach was used. A 3 or 4-port technique was used in 7 and 13 dogs, respectively. A thin film band was used for CEPSS attenuation in all dogs. The median operating time for LPSSA was 62 min (range 27-98 min). Intraoperative complications requiring conversion to an open technique occurred in 5 dogs. Mild perioperative self-limiting portal hypertension occurred in 3 dogs, while severe portal hypertension with surgical revision occurred in 1 case. The complications were resolved, and all dogs had a good outcome. CONCLUSION Laparoscopic portosystemic shunt attenuation can be performed in dogs, in particular for a CEPSS located in the epiploic foramen using a right paramedian approach. For CEPSS not located in the epiploic foramen, a left paramedian approach is recommended. Conversion to open celiotomy was required in around a third of cases. CLINICAL SIGNIFICANCE Laparoscopic attenuation of CEPSSs can be performed in dogs and has a good clinical outcome, particularly for CEPSS located in the epiploic foramen.
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Affiliation(s)
| | | | | | | | | | | | - Filippo Cinti
- Clinica Veterinaria Apuana AniCura, Carrara, Italy.,Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
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13
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Sunlight C, Weisse C, Berent A, Tozier E. Protein C and comparative biochemical changes in dogs treated with percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts. Vet Surg 2021; 51:125-135. [PMID: 34596252 DOI: 10.1111/vsu.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate protein C (PC) activity after intrahepatic portosystemic shunt (IHPSS) percutaneous transvenous coil embolization (PTCE) in dogs; to identify if PC is associated with clinical status after intervention, and to compare PC with standard biochemical values. STUDY DESIGN Retrospective case series. ANIMALS Forty-seven client-owned dogs with IHPSS undergoing PTCE. METHODS Records were reviewed for preoperative and postoperative PC, hematocrit (HCT), mean corpuscular volume (MCV), albumin (ALB), and blood urea nitrogen (BUN). Ultimate clinical status was classified as excellent, fair, or poor, based on ongoing medical management and the presence of clinical signs. Intrahepatic portosystemic shunt was considered to be completely or incompletely occluded intraoperatively based on angiography. RESULTS Postoperative PC activity increased in 37/47 (78.7%) dogs with a mean increase of 38.7% ± 2.1%. Ultimate postoperative clinical status was excellent in 16/43 (37.2%), fair in 19/43 (44.2%), and poor in 8/43 dogs (18.6%). No association was detected between preoperative PC (46.8% ± 1.8%) and ultimate clinical status but mean postoperative PC (75.7% ± 1.4%), HCT, MCV, ALB, and BUN were higher in dogs with excellent clinical status. Postoperative PC activity was higher when shunts were completely occluded (96.3% ± 10.9%), which was a finding associated with excellent status. CONCLUSION Postoperative, but not preoperative, PC activity was higher in dogs with better ultimate clinical status. Similar trends were noted in standard hematological and biochemical values. Complete occlusion of shunts was associated with a higher postoperative PC and superior ultimate clinical status. CLINICAL SIGNIFICANCE Postoperative PC may provide valuable information about the success of PTCE for IHPSS as it relates to the ultimate status and the need for additional procedures.
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Affiliation(s)
| | | | | | - Eric Tozier
- Lamb Consulting, West Saint Paul, Minnesota, USA
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Mullins RA, Escribano Carrera A, Anderson DM, Billet JP, Brissot H, Broome C, de Rooster H, Kirby BM, Pratschke KM, Tivers MS, White RN, Yool DA, Youmans KR. Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review. Vet Surg 2021; 51:23-33. [PMID: 34585759 DOI: 10.1111/vsu.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.
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Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Cameron Broome
- Veterinary Referral Hospital, Melbourne, Victoria, Australia
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Barbara M Kirby
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | - Kathryn M Pratschke
- Veterinary Clinical Services, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, Midlothian EH25 9RG, UK
| | - Michael S Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, UK
| | - Robert N White
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Donald A Yool
- University of Glasgow, School of Veterinary Medicine, Glasgow, UK
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15
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Werner M, Unterer S. [Use of antimicrobials in acute canine diarrhea - overview of potential risks, indications and alternatives]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2021; 49:110-120. [PMID: 33902119 DOI: 10.1055/a-1395-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In Germany, antibiotics are frequently used in dogs with gastrointestinal disorders such as acute diarrhea. In line with global efforts to limit antibiotic use, this literature review aims to provide a guideline for the rational and judicious use of antibiotics in acute canine diarrhea. Antibiotics can lead to gastrointestinal side effects and may exert a negative influence on the intestinal microbiota in addition to increasing the occurrence of resistant bacteria. There is also evidence that chronic immunological diseases may be triggered by the administration of antibiotics. Therefore, these should not be administered in uncomplicated acute diarrhea without signs of sepsis or systemic inflammatory reaction. In addition, enteropathogenic bacteria usually do not play a role in the etiology of acute diarrhea. For select clinical entities such as acute hemorrhagic diarrhea syndrome, antibiotic therapy should only be recommended in cases displaying signs of bacterial translocation with subsequent sepsis. In the case of parvovirosis, on the other hand, the administration of antibiotics is unavoidable due to the immunological incompetence of the dog caused by the accompanying severe neutropenia.
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Affiliation(s)
- Melanie Werner
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Stefan Unterer
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin, Ludwig-Maximilians-Universität München
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16
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Tinoco-Najera A, Steiner JM, Suchodolski JS, Lidbury JA. Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019). J Small Anim Pract 2021; 62:359-364. [PMID: 33491792 DOI: 10.1111/jsap.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify risk factors for urinary bacterial growth in dogs with confirmed congenital portosystemic shunts on which a quantitative urine culture was performed. MATERIALS AND METHODS Sixty-six dogs were included in this retrospective cross-sectional study. Medical records were reviewed from 1997 through 2019. Variables of interest included age, sex and sexual status, clinical signs for a urinary tract infection, blood urea concentration, urinalysis abnormalities, ultrasound abnormalities of the urinary tract, and previous treatment. Univariable and multivariable analyses were performed. RESULTS The median age of the dogs was one year (range: 0.2-11.0 years). Urinary tract ultrasound abnormalities (cystic calculi and cystic debris) were reported in 50 dogs (75.7%). Abnormalities on urinalysis included pyuria in nine dogs (13.6%), bacteriuria in 13 dogs (19.7%), and haematuria in 26 dogs (39.4%). The median urine specific gravity was 1.021 (range: 1.004-1.052). Sixteen dogs (24.2%) had a positive quantitative urine culture. Based on multivariable analysis, bacteriuria (Odds ratio, 116; 95% CI, 9.6-1393; P = < 0.001) was the only variable significantly associated with a significantly increased odds for a positive quantitative urine culture. CLINICAL SIGNIFICANCE Clinical and subclinical bacteriuria can occur in dogs with congenital portosystemic shunts. In this group of dogs, bacteriuria was a risk factor for urinary bacterial growth.
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Affiliation(s)
- A Tinoco-Najera
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
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17
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Williams A, Gow A, Kilpatrick S, Tivers M, Lipscomb V, Smith K, Day MO, Jeffery N, Mellanby RJ. Astrocyte lesions in cerebral cortex and cerebellum of dogs with congenital ortosystemic shunting. J Vet Sci 2020; 21:e44. [PMID: 32476318 PMCID: PMC7263922 DOI: 10.4142/jvs.2020.21.e44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS. Objectives The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology. Methods Eight dogs with a confirmed cPSS were included in the study. Results Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes. Conclusions This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.
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Affiliation(s)
- Alun Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - Adam Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Scott Kilpatrick
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Mickey Tivers
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Vicky Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Ken Smith
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Michael Oliver Day
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Nick Jeffery
- Department of Small Animal Clinical Studies, Texas A&M University, College Station, TX 77843-4474, USA
| | - Richard John Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom.
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18
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Devriendt N, Serrano G, Paepe D, de Rooster H. Liver function tests in dogs with congenital portosystemic shunts and their potential to determine persistent shunting after surgical attenuation. Vet J 2020; 261:105478. [PMID: 32741493 DOI: 10.1016/j.tvjl.2020.105478] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023]
Abstract
Portosystemic shunts (PSS) are congenital or acquired vascular anomalies that cause blood to bypass the liver. Liver function tests, such as fasting ammonia, ammonia tolerance test, and (paired) serum bile acids, are reliable for the diagnosis of PSS in dogs. Surgical attenuation is a common treatment for congenital PSS. Following surgical attenuation, it is useful to evaluate shunt closure. In this critical review, the ability of liver function tests to determine the presence and degree of residual shunting following surgical attenuation of canine PSS is discussed. Despite the availability of several liver function tests, a single rapid, simple, cost-effective, sensitive and specific test to evaluate surgical attenuation of PSS is not available.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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Kim TY, Kim D, Yoon J, Kim S, Yi SW, Oh WT, Park JY, Kim H, Kang M, Lee JB, Sung H. External Self‐Closing Tube to Occlude a Vessel Gradually as a Therapeutic Means of Portosystemic Shunt. ADVANCED THERAPEUTICS 2020. [DOI: 10.1002/adtp.202000039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Tae Young Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Dae‐Hyun Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Jeong‐Kee Yoon
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Surim Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Se Won Yi
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Won Taek Oh
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Ju Young Park
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Hye‐Seon Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Mi‐Lan Kang
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Jung Bok Lee
- Department of Biological ScienceSookmyung Women's University Seoul 04310 Republic of Korea
| | - Hak‐Joon Sung
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
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M. El-Sebaey A, N. Abramov P, M. Abdelhamid F. Clinical Characteristics, Serum Biochemical Changes, and Expression Profile of Serum Cfa-miRNAs in Dogs Confirmed to Have Congenital Portosystemic Shunts Accompanied by Liver Pathologies. Vet Sci 2020; 7:vetsci7020035. [PMID: 32218339 PMCID: PMC7356535 DOI: 10.3390/vetsci7020035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
Computed tomography angiography (CTA) and biochemical parameters cannot specify liver pathologies in dogs with congenital portosystemic shunts (CPSS) that are easily determined by invasive histopathology. This study aims to assess the possibility of using circulating serum canine familiaris (cfa) microRNAs (miRNAs) as novel non-invasive serum-based fingerprints for liver injuries associated with various morphologies of extrahepatic and intrahepatic portosystemic shunts (EHPSS and IHPSS). Data were obtained from 12 healthy dogs and 84 dogs confirmed to have EHPSS (splenocaval, splenophrenic, splenoazygos, right gastrocaval (RGC), right gastrocaval with caudal loop (RGC-CL)) and IHPSS (right divisional and left divisional) using CTA. Hepatic pathologies were determined by histopathology. Serum expression of miRNAs was assessed by real-time polymerase chain reaction. Based on the nature of liver injuries in each shunt type, cfa-miR-122 was significantly upregulated in all CPSS groups. Meanwhile, serums cfa-miR-34a and 21 were not significantly expressed in splenophrenic or splenoazygos groups, but they were extensively upregulated in splenocaval, RGC, RGC-CL groups and less frequently in right or left divisional groups. Also, serum cfa-miR126 was significantly upregulated in both IHPSS groups but less significantly expressed in RGC, RGC-CL, and splenocaval groups. Overall, estimated cfa-miRNAs could serve as novel biomarkers to mirror the histopathological and molecular events within the liver in each shunt type.
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Affiliation(s)
- Ahmed M. El-Sebaey
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
- Department of Diagnostics of Diseases, Therapy, Obstetrics and Animal Reproduction, Moscow State Academy of Veterinary Medicine and Biotechnology – MVA named K. I. Skryabin, 109472 Moscow, Russia;
- Correspondence: ; Tel.: +7-966-100-4890
| | - Pavel N. Abramov
- Department of Diagnostics of Diseases, Therapy, Obstetrics and Animal Reproduction, Moscow State Academy of Veterinary Medicine and Biotechnology – MVA named K. I. Skryabin, 109472 Moscow, Russia;
| | - Fatma M. Abdelhamid
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
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21
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Valiente P, Trehy M, White R, Nelissen P, Demetriou J, Stanzani G, de la Puerta B. Complications and outcome of cats with congenital extrahepatic portosystemic shunts treated with thin film: Thirty-four cases (2008-2017). J Vet Intern Med 2019; 34:117-124. [PMID: 31742779 PMCID: PMC6979105 DOI: 10.1111/jvim.15649] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 10/08/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Congenital extrahepatic portosystemic shunts (CEHPSS) are rare in cats. Outcome after attenuation of CEHPSS with thin film has been described in a small number of cases. OBJECTIVES To describe the clinical presentation, postoperative complications, and outcome of cats treated with thin film to attenuate CEHPSS. ANIMALS Thirty-four cats with CEHPSS were identified from the database of 3 institutions over 9 years. METHODS Retrospective study. Medical records were reviewed to identify cats with a diagnosis of a CEHPSS that underwent surgical attenuation. Congenital extrahepatic portosystemic shunts were suspected from clinical signs, clinicopathologic findings, and diagnostic imaging, and confirmed at exploratory laparotomy. Cats treated with thin film band attenuation were included. Postoperative complications and follow-up were recorded. RESULTS Complications were recorded in 11 of 34 cats. Deaths related to CEHPSS occurred in 6 of 34; 4 cats did not survive to discharge. Persistent seizures were the cause of death in 4 cats. Seizures were recorded in 8 of 34 cats after surgery; all these cats received preoperative antiepileptic drugs. Serum bile acid concentrations normalized in 25 of 28 of the cats for which data was available. Three cats had persistently increased serum bile acid concentrations and underwent a second exploratory laparotomy. One had a patent shunt, the other 2 had multiple acquired portosystemic shunts. Median follow-up was 8 months (0.5-84 months). CONCLUSIONS AND CLINICAL IMPORTANCE Congenital extrahepatic portosystemic shunts attenuation using thin film in cats carries a good short- and mid-term prognosis if they survive the postoperative period. Seizures were the most common cause of death.
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Affiliation(s)
| | - Mary Trehy
- North Downs Specialist Referrals, Bletchingley, United Kingdom
| | - Rob White
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, United Kingdom
| | | | | | - Giacomo Stanzani
- Division of Medicine, Bloomsbury Institute for Intensive Care Medicine, University College London, London, United Kingdom
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22
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Vallarino N, Pil S, Devriendt N, Or M, Vandermeulen E, Serrano G, Paepe D, Bosmans T, de Rooster H. Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs. Vet Rec 2019; 187:e48. [PMID: 31662576 DOI: 10.1136/vr.105296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS). METHODS Retrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included. RESULTS None of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67). CONCLUSION Blood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.
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Affiliation(s)
- Nicolas Vallarino
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Steven Pil
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Matan Or
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Gonçalo Serrano
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Tim Bosmans
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
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The effect of neuraxial morphine on postoperative pain in dogs after extrahepatic portosystemic shunt attenuation. Vet Anaesth Analg 2019; 47:111-118. [PMID: 31718938 DOI: 10.1016/j.vaa.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the analgesic effect of epidural morphine after surgical extrahepatic portosystemic shunt (EHPSS) attenuation. STUDY DESIGN Randomized clinical trial. ANIMALS A total of 20 dogs with a congenital EHPSS. METHODS Dogs were randomly allocated to be given either a single epidural dose of 0.2 mg kg-1 preservative-free morphine (group M) or not (group C) before surgery. All dogs were administered 0.3 mg kg-1 methadone intravenously (IV) as preanaesthetic medication. Pain scores were determined every 2 hours for the first 24 hours postoperatively using the short-form Glasgow Composite Measure Pain Scale (GCMPS-SF). Dogs with a GCMPS-SF pain score >4/20 or >5/24 received 0.1 mg kg-1 methadone IV as rescue analgesia and were reassessed 30 minutes later. If more than three doses of methadone were administered in a 2 hour period, alternative pain relief was provided and a treatment failure recorded. The GCMPS-SF pain scores and number of rescue analgesia injections were analysed over 24 hours. The last observation carried forward method was applied in case of treatment failure. Food consumption and time to first urination were recorded. Data were analysed using a Mann-Whitney U test and presented as median (minimum-maximum range), with significance set at p < 0.05. RESULTS Group M showed lower GCMPS-SF pain scores [15 (11-41) versus 31 (11-86); p = 0.023] and lower postoperative methadone requirements [0 (0-0.2) versus 0.25 (0-0.5) mg kg-1; p = 0.029] than group C. There were three treatment failures in group C only. Food consumption and time to first urination did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE Epidural morphine reduced the requirement for postoperative analgesia in this study population.
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Serrano G, Charalambous M, Devriendt N, de Rooster H, Mortier F, Paepe D. Treatment of congenital extrahepatic portosystemic shunts in dogs: A systematic review and meta-analysis. J Vet Intern Med 2019; 33:1865-1879. [PMID: 31471995 PMCID: PMC6766526 DOI: 10.1111/jvim.15607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/20/2019] [Indexed: 11/27/2022] Open
Abstract
Background Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence‐based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs. Objectives To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques. Animals Not used. Methods A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta‐analysis was performed. Results Forty‐eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant. Conclusions and Clinical Importance The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.
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Affiliation(s)
- Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Femke Mortier
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Matiasovic M, Chanoit GPA, Meakin LB, Tivers MS. Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor. Vet Surg 2019; 49:160-171. [PMID: 31270829 DOI: 10.1111/vsu.13273] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/12/2019] [Accepted: 06/02/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the outcomes of dogs treated at a single institution for single extrahepatic congenital portosystemic shunts (CPSS) by thin film banding (TFB) or by placement of an ameroid constrictor (AC). STUDY DESIGN Retrospective case series. ANIMALS Seventy-six client-owned dogs with CPSS treated with TFB (n = 53) or AC (n = 23). METHODS Records were reviewed for signalment, preoperative, intraoperative, and postoperative management and short-term outcomes. Data on second surgeries were reviewed. Long-term outcomes were obtained via an owner-directed health-related quality of life questionnaire. The rates of complications, mortality, and revision surgery were compared between the treatment groups. RESULTS Postoperative complications occurred in 15 (28%) dogs with TFB (9% mortality, n = 5) and 8 (35%) dogs with an AC (4% mortality, n = 1). Long-term follow-up was available in 41 of 56 dogs at a median of 55 months (range, 15-89). Revision surgery for persistent shunting was performed in 14 (29%) dogs treated initially with TFB and in no dogs treated initially with AC (P = .007). Median long-term outcome scores were good in both groups; nine of 14 revision surgeries led to favorable outcomes. CONCLUSION Persistent shunting requiring revision surgery was more common when CPSS were treated with TFB than with an AC, but both treatments achieved favorable long-term outcomes. CLINICAL SIGNIFICANCE Treatment of CPPS by placement of an AC rather than TFB seems more reliable for shunt attenuation and prevention of revision surgeries.
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Affiliation(s)
- Matt Matiasovic
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
| | | | - Lee B Meakin
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
| | - Mickey S Tivers
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
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26
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Plested MJ, Drees R. Survey of surgical specialists' content preferences in radiology reports for extrahepatic portosystemic shunts. Vet Radiol Ultrasound 2019; 60:316-322. [PMID: 30851002 DOI: 10.1111/vru.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of this prospective, survey study was to assess the opinions of specialist surgeons as to the preferred content, nomenclature, and classification of extrahepatic portosystemic shunts for inclusion in radiology reports. A link to an online survey was sent by email to members of the European College of Veterinary Surgeons and the Association of Veterinary Soft Tissue Surgeons, and was made available on the American College of Veterinary Surgeons web forum and Facebook page. There were 93 respondents (survey sent to over 2500 email addresses and made available in two online locations). Most respondents agreed that they both review the images themselves (87/92, 95%) and read the radiology report (82/92, 89%) prior to surgery. Most respondents believed that the radiology report should contain a detailed anatomic description of the insertion (83/92, 90%), origin (54/91, 59%), and course (70/92, 76%) of the shunt, as well as a measure of the diameter of the shunting vessel at its insertion (54/92, 59%). Most respondents (70/90, 78%) disagreed that a brief description of shunt type, such as portocaval or portophrenic, was sufficient. Respondents were undecided regarding the use of an alphanumeric classification system (36/92, 39% agree; 32/92, 35% disagree). There was agreement that details of the presence or absence of urolithiasis (91/93, 98%), renomegaly (54/93, 58%), and peritoneal fluid (72/92, 78%) should be included in the report. The results of this study will help to guide reporting radiologists in providing descriptions of extrahepatic portosystemic shunts that include information most preferred by the recipient surgeons.
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Affiliation(s)
- Mark J Plested
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, UK
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Tamura M, Ohta H, Nisa K, Osuga T, Sasaki N, Morishita K, Takiguchi M. Contrast‐enhanced ultrasonography is a feasible technique for quantifying hepatic microvascular perfusion in dogs with extrahepatic congenital portosystemic shunts. Vet Radiol Ultrasound 2018; 60:192-200. [DOI: 10.1111/vru.12699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/15/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Masahiro Tamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary MedicineHokkaido University Hokkaido Japan
| | - Hiroshi Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary MedicineHokkaido University Hokkaido Japan
| | - Khoirun Nisa
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary MedicineHokkaido University Hokkaido Japan
| | - Tatsuyuki Osuga
- Veterinary Teaching HospitalGraduate school of Veterinary MedicineHokkaido University Sapporo, Hokkaido Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary MedicineHokkaido University Hokkaido Japan
| | - Keitaro Morishita
- Veterinary Teaching HospitalGraduate school of Veterinary MedicineHokkaido University Sapporo, Hokkaido Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary MedicineHokkaido University Hokkaido Japan
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Bristow P, Lipscomb V, Kummeling A, Packer R, Gerrits H, Homan K, Ortiz V, Newson K, Tivers M. Health-related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls. J Small Anim Pract 2018; 60:21-26. [PMID: 30251431 DOI: 10.1111/jsap.12927] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To design a health-related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort. MATERIALS AND METHODS Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health-related quality of life preoperatively (retrospectively) and at the time of follow-up. Owners of control dogs also completed the questionnaire. RESULTS One hundred and twenty-eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow-up time was 64 months (range 19.7 to 157.2). The median long-term health-related quality of life score was excellent for both intrahepatic and extrahpatic shunt cases and similar to that of control dogs. The long-term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group. CLINICAL SIGNIFICANCE Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-related quality of life score at long-term follow-up.
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Affiliation(s)
- P Bristow
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - V Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - A Kummeling
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - R Packer
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - H Gerrits
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - K Homan
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - V Ortiz
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - K Newson
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - M Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
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Culp WTN, Griffin MA. Interventional Radiology Management of Vascular Malformations: Portosystemic Shunts and Vascular Fistulae/Malformations. Vet Clin North Am Small Anim Pract 2018; 48:781-795. [PMID: 29933944 DOI: 10.1016/j.cvsm.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vascular malformations are abnormal connections between blood vessels that can have various endothelial characteristics. Although uncommon, these malformations can present challenging diagnostic and therapeutic scenarios. The use of interventional radiology techniques in the management of various vascular malformations is an attractive option because of the ability to treat these malformations at the most appropriate anatomic location and in the most effective manner. Techniques such as coil embolization of intrahepatic portosystemic shunts and liquid embolization of arteriovenous fistulae/malformations have shown tremendous potential as treatments for these challenging diseases.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Maureen A Griffin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
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Van den Bossche L, van Steenbeek FG, Weber MF, Spee B, Penning LC, van Sluijs FJ, Zomerdijk F, Groot Koerkamp MJA, Rothuizen J, Burgener IA, Kummeling A. Genome-wide based model predicting recovery from portosystemic shunting after liver shunt attenuation in dogs. J Vet Intern Med 2018; 32:1343-1352. [PMID: 29770973 PMCID: PMC6060332 DOI: 10.1111/jvim.15140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/16/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022] Open
Abstract
Background In dogs with congenital portosystemic shunt (CPSS), recovery after surgical CPSS attenuation is difficult to predict. Objectives Our aim was to build a model with plasma albumin concentration and mRNA expression levels of hepatic gene products as predictors of recovery from portosystemic shunting after surgery. Animals Seventy‐three client‐owned dogs referred for surgical attenuation of CPSS. Methods A prediction model was constructed using 2 case‐control studies of recovered and nonrecovered dogs after surgical CPSS attenuation. In the 1st study, a dog‐specific gene expression microarray analysis was used to compare mRNA expression in intraoperatively collected liver tissue between 23 recovered and 23 nonrecovered dogs. In the 2nd study, preoperative plasma albumin concentration and the expression of microarray‐selected genes were confirmed by RT‐qPCR in intraoperatively collected liver samples of 31 recovered and 31 nonrecovered dogs, including 35 dogs from the 1st study. Results In the 1st study, 43 genes were differently expressed in recovered and nonrecovered dogs. The mean preoperative plasma albumin concentration in recovered dogs was higher compared to nonrecovered dogs (23 and 19 g/L, respectively; P = .004). The best fitting prediction model in the 2nd study included preoperative plasma albumin concentration and intraoperative DHDH, ERLEC1, and LYSMD2 gene expression levels. Conclusion and Clinical Importance A preclinical model was constructed using preoperative plasma albumin concentration and intraoperative hepatic mRNA expression of 3 genes that were unbiasedly selected from the genome to predict recovery from portosystemic shunting after shunt ligation. Further development is essential for clinical application.
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Affiliation(s)
- Lindsay Van den Bossche
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank G van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Bart Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Louis C Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Freek J van Sluijs
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Flin Zomerdijk
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marian J A Groot Koerkamp
- Holstege groep, Princess Maxima Center for Pediatric Oncology, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Iwan A Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department für Kleintiere und Pferde, Veterinärmedizinische Universität Wien, Vienna, Austria
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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31
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Devriendt N, Vandermeulen E, Or M, Paepe D, Rooster H. Inaccuracy of serum bile acids to predict closure after surgical attenuation of a portosystemic shunt. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nausikaa Devriendt
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Eva Vandermeulen
- Department of Medical Imaging of Domestic AnimalsUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Matan Or
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Dominique Paepe
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Hilde Rooster
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
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32
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Traverson M, Lussier B, Huneault L, Gatineau M. Comparative outcomes between ameroid ring constrictor and cellophane banding for treatment of single congenital extrahepatic portosystemic shunts in 49 dogs (1998-2012). Vet Surg 2017; 47:179-187. [DOI: 10.1111/vsu.12747] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Traverson
- Département de sciences cliniques; Centre Hospitalier Universitaire Vétérinaire, Faculté de Médecine Vétérinaire de l'Université de Montréal; Saint-Hyacinthe Quebec Canada
- Département de chirurgie; Centre Vétérinaire DMV; Lachine Quebec Canada
| | - Bertrand Lussier
- Département de sciences cliniques; Centre Hospitalier Universitaire Vétérinaire, Faculté de Médecine Vétérinaire de l'Université de Montréal; Saint-Hyacinthe Quebec Canada
| | - Louis Huneault
- Département de chirurgie; Centre Vétérinaire Rive-Sud; Brossard Quebec Canada
| | - Matthieu Gatineau
- Département de chirurgie; Centre Vétérinaire DMV; Lachine Quebec Canada
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33
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Culp WTN, Zwingenberger AL, Giuffrida MA, Wisner ER, Hunt GB, Steffey MA, Mayhew PD, Marks SL. Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization. Vet Surg 2017; 47:74-85. [PMID: 29064581 DOI: 10.1111/vsu.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. METHODS Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. RESULTS All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P = .001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P = .029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. CONCLUSION PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Geraldine B Hunt
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, University of California-Davis, School of Veterinary Medicine, Davis, California
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Van den Bossche L, Schoonenberg VAC, Burgener IA, Penning LC, Schrall IM, Kruitwagen HS, van Wolferen ME, Grinwis GCM, Kummeling A, Rothuizen J, van Velzen JF, Stathonikos N, Molenaar MR, Helms BJ, Brouwers JFHM, Spee B, van Steenbeek FG. Aberrant hepatic lipid storage and metabolism in canine portosystemic shunts. PLoS One 2017; 12:e0186491. [PMID: 29049355 PMCID: PMC5648188 DOI: 10.1371/journal.pone.0186491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a poorly understood multifactorial pandemic disorder. One of the hallmarks of NAFLD, hepatic steatosis, is a common feature in canine congenital portosystemic shunts. The aim of this study was to gain detailed insight into the pathogenesis of steatosis in this large animal model. Hepatic lipid accumulation, gene-expression analysis and HPLC-MS of neutral lipids and phospholipids in extrahepatic (EHPSS) and intrahepatic portosystemic shunts (IHPSS) was compared to healthy control dogs. Liver organoids of diseased dogs and healthy control dogs were incubated with palmitic- and oleic-acid, and lipid accumulation was quantified using LD540. In histological slides of shunt livers, a 12-fold increase of lipid content was detected compared to the control dogs (EHPSS P<0.01; IHPSS P = 0.042). Involvement of lipid-related genes to steatosis in portosystemic shunting was corroborated using gene-expression profiling. Lipid analysis demonstrated different triglyceride composition and a shift towards short chain and omega-3 fatty acids in shunt versus healthy dogs, with no difference in lipid species composition between shunt types. All organoids showed a similar increase in triacylglycerols after free fatty acids enrichment. This study demonstrates that steatosis is probably secondary to canine portosystemic shunts. Unravelling the pathogenesis of this hepatic steatosis might contribute to a better understanding of steatosis in NAFLD.
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Affiliation(s)
- Lindsay Van den Bossche
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Vivien A. C. Schoonenberg
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Iwan A. Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Louis C. Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ingrid M. Schrall
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Hedwig S. Kruitwagen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Monique E. van Wolferen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Guy C. M. Grinwis
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jeroen F. van Velzen
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Martijn R. Molenaar
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Bernd J. Helms
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Jos F. H. M. Brouwers
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Bart Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank G. van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- * E-mail:
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35
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Harris L, Reems M, Dial S. An Unusual Case of Portal Hypertension Secondary to Primary Hypoplasia of the Portal Vein. J Am Anim Hosp Assoc 2017; 53:331-337. [PMID: 28892424 DOI: 10.5326/jaaha-ms-6428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary hypoplasia of the portal vein with secondary portal hypertension and acquired portosystemic collateral circulation is infrequently reported in the veterinary literature. Diagnosis of this condition requires documentation of abnormal hepatocellular function, the lack of intrahepatic or extrahepatic macroscopic congenital portosystemic shunts, and liver histopathology demonstrating portal hypoperfusion in the absence of hepatic inflammation or nodular regeneration. Due to a perceived poor prognosis, many patients with this condition are euthanized; however, those that are spared can be medically managed, in some cases for years. This case report describes the diagnosis and management of a patient with primary hypoplasia of the portal vein and secondary portal hypertension that presented with the severe but typical clinical manifestations of ascites and hepatic encephalopathy, normal liver enzyme concentrations, and normal serum bile acid concentrations.
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Affiliation(s)
- Lauren Harris
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
| | - Miryam Reems
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
| | - Sharon Dial
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
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36
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Tivers MS, Lipscomb VJ, Brockman DJ. Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review. J Small Anim Pract 2017; 58:485-494. [DOI: 10.1111/jsap.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. S. Tivers
- School of Veterinary Sciences; University of Bristol; Bristol BS40 5DU UK
| | - V. J. Lipscomb
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
| | - D. J. Brockman
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
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37
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Bristow P, Tivers M, Packer R, Brockman D, Ortiz V, Newson K, Lipscomb V. Long-term serum bile acid concentrations in 51 dogs after complete extrahepatic congenital portosystemic shunt ligation. J Small Anim Pract 2017; 58:454-460. [DOI: 10.1111/jsap.12685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 01/02/2023]
Affiliation(s)
- P. Bristow
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
| | - M. Tivers
- School of Veterinary Clinical Sciences; University of Bristol; Langford house, Langford, Bristol BS40 5DU UK
| | - R. Packer
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
| | - D. Brockman
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
| | - V. Ortiz
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
| | - K. Newson
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
| | - V. Lipscomb
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms, Hatfield Herts AL9 7TA UK
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38
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Van den Bossche L, van Steenbeek F. Canine congenital portosystemic shunts: Disconnections dissected. Vet J 2016; 211:14-20. [DOI: 10.1016/j.tvjl.2015.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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Teng KT, McGreevy PD, Toribio JALML, Dhand NK. Trends in popularity of some morphological traits of purebred dogs in Australia. Canine Genet Epidemiol 2016; 3:2. [PMID: 27051522 PMCID: PMC4820977 DOI: 10.1186/s40575-016-0032-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/03/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The morphology of dogs can provide information about their predisposition to some disorders. For example, larger breeds are predisposed to hip dysplasia and many neoplastic diseases. Therefore, longitudinal trends in popularity of dog morphology can reveal potential disease pervasiveness in the future. There have been reports on the popularity of particular breeds and behavioural traits but trends in the morphological traits of preferred breeds have not been studied. METHODS This study investigated trends in the height, dog size and head shape (cephalic index) of Australian purebred dogs. One hundred eighty-one breeds derived from Australian National Kennel Council (ANKC) registration statistics from 1986 to 2013 were analysed. Weighted regression analyses were conducted to examine trends in the traits by using them as outcome variables, with year as the explanatory variable and numbers of registered dogs as weights. Linear regression investigated dog height and cephalic index (skull width/skull length), and multinomial logistic regression studied dog size. RESULTS The total number of ANKC registration had decreased gradually from 95,792 in 1986 to 66,902 in 2013. Both weighted minimal height (p = 0.014) and weighted maximal height (p < 0.001) decreased significantly over time, and the weighted cephalic index increased significantly (p < 0.001). The odds of registration of medium and small breeds increased by 5.3 % and 4.2 %, respectively, relative to large breeds (p < 0.001) and by 12.1 % and 11.0 %, respectively, relative to giant breeds (p < 0.001) for each 5-year block of time. CONCLUSIONS Compared to taller and larger breeds, shorter and smaller breeds have become relatively popular over time. Mean cephalic index has increased, which indicates that Australians have gradually favoured breeds with shorter and wider heads (brachycephalic). These significant trends indicate that the dog morphological traits reported here may potentially influence how people select companion dogs in Australia and provide valuable predictive information on the pervasiveness of diseases in dogs.
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Affiliation(s)
- Kendy T Teng
- Faculty of Veterinary Science, School of Life and Environmental Sciences, The University of Sydney, JD Stewart Building (B01), Camperdown, NSW 2050 Australia
| | - Paul D McGreevy
- Faculty of Veterinary Science, School of Life and Environmental Sciences, The University of Sydney, R.M.C. Gunn Building (B19), Camperdown, NSW 2050 Australia
| | - Jenny-Ann L M L Toribio
- Faculty of Veterinary Science, School of Life and Environmental Sciences, The University of Sydney, JL Shute Building (C01A), 425 Werombi Road, Camden, NSW 2570 Australia
| | - Navneet K Dhand
- Faculty of Veterinary Science, School of Life and Environmental Sciences, The University of Sydney, JL Shute Building (C01A), 425 Werombi Road, Camden, NSW 2570 Australia
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40
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Behavior of plastic and metal ameroid constrictors during in vitro incubation in physiologic solutions of varying glucose concentration. Res Vet Sci 2016; 105:165-70. [DOI: 10.1016/j.rvsc.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/03/2016] [Accepted: 02/05/2016] [Indexed: 11/21/2022]
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Thieman Mankin KM. Current Concepts in Congenital Portosystemic Shunts. Vet Clin North Am Small Anim Pract 2015; 45:477-87. [DOI: 10.1016/j.cvsm.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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42
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Greenhalgh SN, Reeve JA, Johnstone T, Goodfellow MR, Dunning MD, O'Neill EJ, Hall EJ, Watson PJ, Jeffery ND. Long-term survival and quality of life in dogs with clinical signs associated with a congenital portosystemic shunt after surgical or medical treatment. J Am Vet Med Assoc 2015; 245:527-33. [PMID: 25148094 DOI: 10.2460/javma.245.5.527] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare long-term survival and quality of life data in dogs with clinical signs associated with a congenital portosystemic shunt (CPSS) that underwent medical or surgical treatment. DESIGN Prospective cohort study. ANIMALS 124 client-owned dogs with CPSS. PROCEDURES Dogs received medical or surgical treatment without regard to signalment, clinical signs, or clinicopathologic results. Survival data were analyzed with a Cox regression model. Quality of life information, obtained from owner questionnaires, included frequency of CPSS-associated clinical signs (from which a clinical score was derived), whether owners considered their dog normal, and (for surgically treated dogs) any ongoing medical treatment for CPSS. A Mann-Whitney U test was used to compare mean clinical score data between surgically and medically managed dogs during predetermined follow-up intervals. RESULTS 97 dogs underwent surgical treatment; 27 were managed medically. Median follow-up time for all dogs was 1,936 days. Forty-five dogs (24 medically managed and 21 surgically managed) died or were euthanized during the follow-up period. Survival rate was significantly improved in dogs that underwent surgical treatment (hazard ratio, 8.11; 95% CI, 4.20 to 15.66) than in those treated medically for CPSS. Neither age at diagnosis nor shunt type affected survival rate. Frequency of clinical signs was lower in surgically versus medically managed dogs for all follow-up intervals, with a significant difference between groups at 4 to 7 years after study entry. CONCLUSIONS AND CLINICAL RELEVANCE Surgical treatment of CPSS in dogs resulted in significantly improved survival rate and lower frequency of ongoing clinical signs, compared with medical management. Age at diagnosis did not affect survival rate and should not influence treatment choice.
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Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, England
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43
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Seibert RL, Tobias KM, Reed A, Snyder KR. Evaluation of a semiquantitative SNAP test for measurement of bile acids in dogs. PeerJ 2014; 2:e539. [PMID: 25210659 PMCID: PMC4157295 DOI: 10.7717/peerj.539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Serum bile acids (SBA) are used as a routine screening tool of liver function in dogs. Serum samples are usually shipped to a referral laboratory for quantitative analysis with an enzymatic chemistry analyzer. The canine SNAP Bile Acids Test (SNAP-BAT) provides an immediate, semi-quantitative measurement of bile acid concentrations in-house. With the SNAP-BAT, bile acids concentrations of 5–30 µmol/L are quantified, and results outside of that range are classified as <5 or >30 µmol/L. Agreement of the SNAP-BAT with the enzymatic method has not been extensively investigated. Objectives. The purposes of this prospective clinical study were to assess the precision of the SNAP-BAT and determine agreement of SNAP-BAT with results from an in-house chemistry analyzer. Methods. After verifying intra-assay precision of the SNAP-BAT, a prospective analysis was performed using blood samples collected from 56 dogs suspected to have liver disease. Each sample was analyzed with an enzymatic, in-house chemistry analyzer and the SNAP-BAT. Agreement between the two methods was statistically assessed using the κ index of agreement. Results. Intra-assay variability was minimal. The κ index for agreement between the SNAP-BAT and routine chemistry analyzer was between 0.752 and 0.819, indicating substantial to near perfect agreement. Conclusions. The SNAP-BAT is a highly accurate, semi-quantitative test that yields immediate results, and has very little intra-assay variability, particularly for results >30 µmol/L.
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Affiliation(s)
- Rachel L Seibert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Karen M Tobias
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Ann Reed
- Office of Information Technology, University of Tennessee , Knoxville, TN , USA
| | - Karl R Snyder
- Department of Pathology, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
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Tivers MS, Handel I, Gow AG, Lipscomb VJ, Jalan R, Mellanby RJ. Hyperammonemia and systemic inflammatory response syndrome predicts presence of hepatic encephalopathy in dogs with congenital portosystemic shunts. PLoS One 2014; 9:e82303. [PMID: 24392080 PMCID: PMC3879253 DOI: 10.1371/journal.pone.0082303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/22/2013] [Indexed: 12/29/2022] Open
Abstract
Hepatic encephalopathy (HE) is an important cause of morbidity and mortality in patients with liver disease. The pathogenesis of he is incompletely understood although ammonia and inflammatory cytokines have been implicated as key mediators. To facilitate further mechanistic understanding of the pathogenesis of HE, a large number of animal models have been developed which often involve the surgical creation of an anastomosis between the hepatic portal vein and the caudal vena cava. One of the most common congenital abnormalities in dogs is a congenital portosystemic shunt (cpss), which closely mimics these surgical experimental models of HE. Dogs with a cPSS often have clinical signs which mimic clinical signs observed in humans with HE. Our hypothesis is that the pathogenesis of HE in dogs with a cPSS is similar to humans with HE. The aim of the study was to measure a range of clinical, haematological and biochemical parameters, which have been linked to the development of HE in humans, in dogs with a cPSS and a known HE grade. One hundred and twenty dogs with a cPSS were included in the study and multiple regression analysis of clinical, haematological and biochemical variables revealed that plasma ammonia concentrations and systemic inflammatory response syndrome scores predicted the presence of HE. Our findings further support the notion that the pathogenesis of canine and human HE share many similarities and indicate that dogs with cPSS may be an informative spontaneous model of human HE. Further investigations on dogs with cPSS may allow studies on HE to be undertaken without creating surgical models of HE thereby allowing the number of large animals used in animal experimentation to be reduced.
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Affiliation(s)
- Mickey S. Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Ian Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Adam G. Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Vicky J. Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Rajiv Jalan
- UCL Institute for Liver and Digestive Health, UCL Medical School, London, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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45
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Falls EL, Milovancev M, Hunt GB, Daniel L, Mehl ML, Schmiedt CW. Long-term outcome after surgical ameroid ring constrictor placement for treatment of single extrahepatic portosystemic shunts in dogs. Vet Surg 2013; 42:951-7. [DOI: 10.1111/j.1532-950x.2013.12072.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 11/01/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Emily L. Falls
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athena Georgia
| | - Milan Milovancev
- Department of Clinical Sciences, College of Veterinary Medicine; Oregon State University; Corvallis Oregon
| | - Geraldine B. Hunt
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis California
| | - Leticia Daniel
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis California
| | - Margo L. Mehl
- VCA-San Francisco Veterinary Specialists; San Francisco California
| | - Chad W. Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athena Georgia
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Leeman JJ, Kim SE, Reese DJ, Risselada M, Ellison GW. Multiple Congenital PSS in a Dog: Case Report and Literature Review. J Am Anim Hosp Assoc 2013; 49:281-5. [DOI: 10.5326/jaaha-ms-5877] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 4 yr old spayed female mixed-breed dog presented with a 2 yr history of recurring increases in liver enzymes. Two congenital portosystemic shunts (PSSs) were identified using computed tomography (CT) angiography, which included a portoazygous and portorenal extrahepatic shunt. Double right renal veins were also identified. The shunts were successfully identified and attenuated with cellophane banding. Multiple congenital PSS is a rare phenomenon, but should be considered during exploratory laparotomy for PSS and in dogs with poor response to surgical attenuation of a single PSS. CT proved to be a crucial part of accurate diagnosis and surgical planning for this dog with multiple congenital PSS.
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Affiliation(s)
- Jessica J. Leeman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Stanley E. Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - David J. Reese
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Marije Risselada
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Gary W. Ellison
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
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47
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Kim SE, Giglio RF, Reese DJ, Reese SL, Bacon NJ, Ellison GW. COMPARISON OF COMPUTED TOMOGRAPHIC ANGIOGRAPHY AND ULTRASONOGRAPHY FOR THE DETECTION AND CHARACTERIZATION OF PORTOSYSTEMIC SHUNTS IN DOGS. Vet Radiol Ultrasound 2013; 54:569-74. [DOI: 10.1111/vru.12059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/04/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Stanley E. Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Robson F. Giglio
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - David J. Reese
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Shona L. Reese
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Nicholas J. Bacon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Gary W. Ellison
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
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48
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Vandermeulen E, Combes A, de Rooster H, Polis I, de Spiegeleer B, Saunders J, Peremans K. Transsplenic portal scintigraphy using 99mTc-pertechnetate for the diagnosis of portosystemic shunts in cats: a retrospective review of 12 patients. J Feline Med Surg 2013; 15:1123-31. [DOI: 10.1177/1098612x13488594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Portosystemic shunts (PSS), congenital or acquired, occur uncommonly in the feline population. The diagnostic approach is similar to one in dogs suspected of a PSS based on the clinical signs and haematological and biochemical changes. Diagnostic imaging, however, is key for the confirmation of a PSS. Although abdominal ultrasound is the first-choice diagnostic imaging modality, the results are not always unequivocal. Transsplenic portal scintigraphy (TSPS) using 99mTc-pertechnetate is a well-established technique in canine medicine, providing relatively fast and easy confirmation of the presence or absence of a PSS. As the prevalence of PSS is much lower in the feline population, this technique has not been widely used in cats. This retrospective study of 12 cases gives an overview of the potential of TSPS in the diagnostic work-up of PSS in cats (2005–2012).
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Affiliation(s)
- Eva Vandermeulen
- Department of Veterinary Diagnostic Imaging and Small Animal Orthopaedics, Ghent University, Belgium
| | - Anaïs Combes
- Department of Veterinary Diagnostic Imaging and Small Animal Orthopaedics, Ghent University, Belgium
| | - Hilde de Rooster
- Department of Medicine and Clinical Biology of Small Animals, Ghent University, Belgium
| | - Ingeborgh Polis
- Department of Medicine and Clinical Biology of Small Animals, Ghent University, Belgium
| | | | - Jimmy Saunders
- Department of Veterinary Diagnostic Imaging and Small Animal Orthopaedics, Ghent University, Belgium
| | - Kathelijne Peremans
- Department of Veterinary Diagnostic Imaging and Small Animal Orthopaedics, Ghent University, Belgium
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49
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van Steenbeek FG, Van den Bossche L, Grinwis GCM, Kummeling A, van Gils IHM, Koerkamp MJAG, van Leenen D, Holstege FCP, Penning LC, Rothuizen J, Leegwater PAJ, Spee B. Aberrant gene expression in dogs with portosystemic shunts. PLoS One 2013; 8:e57662. [PMID: 23451256 PMCID: PMC3581512 DOI: 10.1371/journal.pone.0057662] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/23/2013] [Indexed: 11/24/2022] Open
Abstract
Congenital portosystemic shunts are developmental anomalies of the splanchnic vascular system that cause portal blood to bypass the liver. Large-breed dogs are predisposed for intrahepatic portosystemic shunts (IHPSS) and small-breed dogs for extrahepatic portosystemic shunts (EHPSS). While the phenotype resulting from portal bypass of the liver of the two types of shunt is identical, the genotype and molecular pathways involved are probably different. The aim of this study was to gain insight into the pathways involved in the different types of portosystemic shunting. Microarray analysis of mRNA expression in liver tissue from dogs with EHPSS and IHPSS revealed that the expression of 26 genes was altered in either IHPSS or EHPSS samples compared with that in liver samples from control dogs. Quantitative real-time PCR of these genes in 14 IHPSS, 17 EHPSS, and 8 control liver samples revealed a significant differential expression of ACBP, CCBL1, GPC3, HAMP, PALLD, VCAM1, and WEE1. Immunohistochemistry and Western blotting confirmed an increased expression of VCAM1 in IHPSS but its absence in EHPSS, an increased WEE1 expression in IHPSS but not in EHPSS, and a decreased expression of CCBL1 in both shunt types. Regarding their physiologic functions, these findings may indicate a causative role for VCAM1 in IHPSS and WEE1 for IHPSS. CCBL1 could be an interesting candidate to study not yet elucidated aspects in the pathophysiology of hepatic encephalopathy.
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Affiliation(s)
- Frank G van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Adam FH, German AJ, McConnell JF, Trehy MR, Whitley N, Collings A, Watson PJ, Burrow RD. Clinical and clinicopathologic abnormalities in young dogs with acquired and congenital portosystemic shunts: 93 cases (2003-2008). J Am Vet Med Assoc 2013; 241:760-5. [PMID: 22947159 DOI: 10.2460/javma.241.6.760] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether clinical and clinicopathologic data could assist differentiation of congenital portosystemic shunts (CPSSs) from acquired portosystemic shunts (APSSs) in young dogs. DESIGN Retrospective case series. ANIMALS Dogs < 30 months of age with CPSSs (n = 62) or APSSs (31). PROCEDURES Medical records from 3 referral centers identified 31 dogs with APSSs and 62 dogs with CPSSs diagnosed from July 2003 to July 2008. Signalment, clinical signs, physical examination, and clinicopathological data were recorded, and statistical analyses were performed to determine differences between groups. RESULTS Univariable analysis showed APSS patients were older, heavier, and in poorer body condition, compared with CPSS patients. In CPSS patients, diarrhea was less prevalent, and neurologic signs were more prevalent. Ascites was more prevalent in APSS (Fisher exact test; OR, 50.2; 95% confidence interval [CI], 6.2 to 409.7), with no significant difference in albumin concentration between groups. The logistic regression model used to assess clinicopathological parameters showed lower Hct (OR, 1.42 × 10(-12); 95% CI, 1.42 × 10(-17) to 4.0 × 10(-6)), higher mean corpuscular volume (OR, 1.27; 95% CI, 1.08 to 1.50), and higher alanine aminotransferase concentrations (OR, 1.005; 95% CI, 1.001 to 1.009) were more likely in APSS patients. CONCLUSIONS AND CLINICAL RELEVANCE Several clinicopathologic differences between dogs with congenital and acquired shunts were identified; however, assessed alone, these would be unlikely to enable differentiation between the 2 conditions. Awareness of the rarity of ascites in CPSS cases should prompt recognition of a likely diagnosis of APSS, allowing the veterinarian to target further diagnostics and counsel the owner appropriately.
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Affiliation(s)
- Fiona H Adam
- Small Animal Teaching Hospital, University of Liverpool, Neston, Cheshire, England.
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