A scoping review of the economic impact of family oral health: Implications for public health, research, and policy

OBJECTIVES

To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice.

METHODS

Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

Of 2758 unduplicated records identified, 52 met inclusion criteria. Study outcomes included indicators of employment/employability (n = 9), earnings/earnings potential (n = 26), parent missed work and family financial impacts of child oral health (n = 19), and financial loss (n = 3). Dental caries-related variables were the most common predictors of poorer economic outcomes. Other oral health problems, such as poorer dental functioning or poorer self-reported oral health status, also were associated with adverse economic outcomes. Significant associations with employment were found among studies that assessed interventions designed to improve oral health. Only one study estimated the impact of oral health on earnings. One-third of studies conducted multivariable analyses, and 14% incorporated race and ethnicity variables.

CONCLUSIONS

Although existing evidence suggests associations between oral health problems and poorer economic outcomes, there is a substantial need for more rigorous research to better understand the extent of economic impact of oral health problems and which populations are most affected. Additional high-quality research is needed to inform which interventions are most likely to improve oral health, reduce adverse economic impacts, and promote health and economic equity.

Urinary tract infections in dogs with spontaneous hypercortisolism - frequency, symptoms and involved pathogens

INTRODUCTION

Dogs with hypercortisolism are predisposed to developing bacteriuria associated either with clinical signs of cystitis or without clinical signs (subclinical bacteriuria). Based on current guidelines, dogs with subclinical bacteriuria should not be treated with antibiotics because there is no evidence that treatment improves outcome and because unnecessary treatments should be avoided. Before these guidelines were published in 2019, dogs with hypercortisolism and bacteriuria were commonly treated with antibiotics irrespective of clinical signs. Comprehensive data on the frequency of bacterial cystitis, subclinical bacteriuria and the outcome of antimicrobial treatment in dogs with hypercortisolism is sparse. The aims of this study were to investigate dogs with hypercortisolism for the presence of bacterial cystitis and subclinical bacteriuria, to address the pathogens involved, and to assess the outcome of antibiotic treatment. Dogs newly diagnosed with hypercortisolism between 2005 and 2015 from which a urine bacterial culture was available were included. Statistical analysis was performed with non-parametric tests. Of the 161 client-owned dogs included, 29 (18%) showed bacteriuria, which was subclinical in 24 (83%) cases. Escherichia coli was the most commonly isolated pathogen (58%). Bacteriuria was not associated with sex or neutering status. In 14 dogs, follow-up data was available, of which 13 (93%) were treated with antimicrobials for 14 to 28 days. Follow-up bacterial culture (1 to 118 days after cessation of therapy) was negative in 10 (77%) treated dogs; a negative follow-up culture was not associated with gender, age or duration of treatment. Bacteriuria persisted in three treated dogs and the one untreated dog. The prevalence of positive bacterial urinary culture in dogs with hypercortisolism was lower than previously reported. In the majority of dogs, bacteriuria was subclinical. Most dogs had a negative bacterial culture result after antimicrobial treatment; however, more resistant bacteria were detected in persistently positive urine.

Systematic study of liposomes composition towards efficient delivery of plasmid DNA as potential application of dermal fibroblasts targeting

The use of non-viral DNA vectors to topically treat skin diseases has demonstrated a high potential. However, vectors applied on the skin face extracellular barriers including the stratum corneum and intracellular barriers such as the endosomal escape and the nuclear targeting of the plasmid DNA. The aim of this study was to develop a formulation suitable for dermal application and effective for delivering plasmid DNA into cells. Different formulations were prepared using different cationic lipids (DOTAP, DC-Chol, DOTMA) and co-lipids (DOPE, DSPE). Lipoplexes were produced by complexing liposomes with plasmid DNA at different pDNA/CL (w/w) ratios. Our results showed that appropriate pDNA/CL ratios allowing total complexation of plasmid DNA differed depending on the structure of the lipid used. The transfection rates showed that (i) higher rates were obtained with DOTMA lipoplexes, (ii) DC-Chol lipoplexes provided a transfection twice as important as DOTAP lipoplexes and (iii) when DSPE was added, the cytotoxicity decreased while transfection rates were similar. We found that formulations composed of DC-Chol:DOPE:DSPE or DOTMA:DOPE were appropriate to complex plasmid DNA and to transfect human primary dermal fibroblasts with efficacy and limited cytotoxicity. Therefore, these formulations are highly promising in the context of gene therapy to treat skin diseases.

Children's dental service use reflects their parents' dental service experience and insurance

BACKGROUND

Decisions about children's oral health care are made by parents. Parents' dental insurance, dental service use, and perceived affordability all influence their children's oral health care.

METHODS

Using data from the 2016 National Health Interview Survey, the authors constructed a database of 4,396 nationally representative US children and their linked household adults. The authors assessed the relationship between children's and parents' use of dental services, private and public dental insurance, and deferral of oral health care owing to cost. To adjust for factors that may influence outcomes independently, the authors performed multivariate analyses to consider child, parent, and household characteristics.

RESULTS

Children have 2 times the risk of lacking a dental visit in a year if the parent has none, 7 times the risk of reportedly lacking dental coverage if the parent has none, and nearly 10 times the risk of having care deferred owing to cost if the parent finds oral health care unaffordable. Affordability risk factors for children include older age and minority race, whereas protective factors include public insurance, parents with higher educational attainment, and female-led households. Increased oral health care use by children was associated with states that provide more extensive adult Medicaid dental benefits.

CONCLUSIONS

Greater parental dental service use, dental coverage, and ability to afford care benefit their children's use of oral health care.

PRACTICE IMPLICATIONS

Policies by employers and government that expand quality private and public coverage for adults hold strong promise to improve oral health care for both parents and their children.

Income-Based Disparities in a Yearly Dental Visit in United States Adults and Children: Trend Analysis 1997 to 2016

OBJECTIVE

To determine how income-based disparities in a yearly dental visit (the Healthy People 2020 Leading Health Indicator for Oral Health) changed since legislation to expand dental coverage and to compare disparity trends in children and adults.

METHODS

We analyzed Medical Expenditure Panel Survey 1997 to 2016 to determine yearly dental visit rates for US children and adults by family income. We determined measures of income disparity, including the Slope Index of Inequality and the Relative Index of Inequality and examined trends in yearly dental visit, Slope Index of Inequality, and Relative Index of Inequality using joinpoint regression.

RESULTS

Income-based disparities, absolute and relative, narrowed over time for children. Steady upward trends in yearly dental visit rates were observed for poor and low-income/poor children and no joinpoint was identified that corresponded to legislation expanding dental care coverage for lower income children. Relative income-based disparities in yearly dental visit rates widened for adults over 20 years. After declining for 14 years, yearly dental visit rate increased for poor adults from 2013 to 2016 suggesting a possible positive effect in adult dental care use trends following enactment of the Affordable Care Act.

CONCLUSIONS

In 1997, US children and adults had similar levels of income-based disparity in yearly dental visits, but by 2016, they differed markedly. Trends in income-based disparities in yearly dental visit rate narrowed for children but widened for adults. There are lessons from the expansion of dental care coverage for children that could be applied to improve access to dental care for adults.

[Acromegaly due to a pituitary tumor in a dog - diagnosis, therapy and long-term follow-up]

INTRODUCTION

Acromegaly due to a pituitary tumor has so far only been described in 3 dogs. The present case report describes a 7-year-old male-castrated Labrador Retriever which was referred because of difficult-to-control diabetes. Physical examination revealed markedly enlarged head, tongue and paws, widened interdental spaces and thickening of the skin in the head and neck area. IGF-1 and GH were increased and the latter continued to be abnormal after somatostatin application. Computed tomography demonstrated a space-occupying lesion in the pituitary gland and the diagnosis of acromegaly due to a GH-producing tumor of the pituitary was made. The dog underwent radiation therapy with a 6MV linear accelerator (3×8Gy) and improved substantially. Two and a half years after radiation therapy the dog developed lethargy and anorexia and was euthanized. Necropsy was not permitted. This case report represents the description of a dog suffering from pituitary-dependent acromegaly which was successfully treated and had a long-term survival.

Infanticide as a male reproductive strategy has a nutritive risk effect in brown bears

Behavioural strategies to reduce predation risk can incur costs, which are often referred to as risk effects. A common strategy to avoid predation is spatio-temporal avoidance of predators, in which prey typically trade optimal resources for safety. Analogous with predator–prey theory, risk effects should also arise in species with sexually selected infanticide (SSI), in which females with dependent offspring avoid infanticidal males. SSI can be common in brown bear (Ursus arctos) populations and explains spatio-temporal segregation among reproductive classes. Here, we show that in a population with SSI, females with cubs-of-the-year had lower quality diets than conspecifics during the SSI high-risk period, the mating season. After the mating season, their diets were of similar quality to diets of their conspecifics. Our results suggest a nutritive risk effect of SSI, in which females with cubs-of-the-year alter their resource selection and trade optimal resources for offspring safety. Such risk effects can add to female costs of reproduction and may be widespread among species with SSI.

[Milbemycinoxime intoxication in a Miniature Australian Shepherd dog]

A 3-year-old female intact Miniature Australian Shepherd presented with convulsive status epilepticus after milbemycinoxime administration in the recommended dosage. In addition to continuous intravenous antiepileptic therapy the dog had to be ventilated for 36 hours due to aspiration pneumonia. After extubation control of intermittent tonic-clonic seizures required a constant-rate-infusion of propofol for another 96 hours, before it could be discontinued on day 5. The patient had fully recovered by day 10. The dog was known to be homozygous for the MDR1-gene mutation. So far milbemycinoxime was regarded a save drug in MDR1-deficient dogs. However, the present case suggests using the lowest possible dosage in MDR1-deficient dogs and pet owners should be advised of potential complications.

Insulin resistance and increased lipolysis in bone marrow derived adipocytes stimulated with agonists of Toll-like receptors

Our objectives were to identify Toll-like receptors (TLRs) in human bone marrow derived adipocytes, to test specific TLR agonists for their ability to induce a proinflammatory response, and to investigate possible metabolic effects after TLR activation, in particular, those associated with insulin resistance and lipolysis. Mesenchymal stem cells were isolated from human bone marrow and differentiated into adipocytes. Total RNA before or after stimulation with agonists specific for TLR was extracted for analysis of expression of TLRs proinflammatory signals and molecules involved in glucose metabolism (IRS-1 and GLUT4). Furthermore, cytokine protein expression was measured from cell lysates. Finally, insulin induced glucose uptake and lipolysis were measured. Human bone marrow-derived adipocytes express TLR1-10. They react to stimulation with specific ligands with expression of inflammatory markers (IL-1beta, IL-6, TNFalpha, IL-8, MCP-1) at the RNA and protein levels. IRS-1 and GLUT4 expression was downregulated after stimulation with the TLR4 and TLR3 specific ligands LPS and poly (I:C), respectively. Insulin-induced glucose uptake was decreased and lipolysis increased. We conclude that adipocytes express TLR 1-10 and react to agonists specific for TLR 1-6. As a consequence proinflammatory cytokine are induced, in particular, IL-6, IL-8, and MCP-1. Since stimulation is followed by decreased insulin-induced glucose uptake and increased lipolysis we conclude that TLRs may be important linking molecules in the generation of insulin resistance in fat tissue.

Canine borreliosis: a laboratory diagnostic trial

The aim of this study was to investigate samples from dogs suggestive of active canine borreliosis (group A) by culture and PCR and the detection of antibodies against Borrelia burgdorferi sensu lato in order to confirm a presumptive clinical diagnosis of canine borreliosis by laboratory results. Criteria for such a diagnosis were: history of tick exposure, lameness, neurological signs, nephropathy, lethargy, anorexia, and fever. A total of 302 samples comprising EDTA blood, urine, synovial fluid, cerebrospinal fluid, and tissue (skin, synovial membrane, kidney) from 98 dogs (26 with arthritis, 46 with neurological signs, 21 with nephropathy, 5 with non-specific symptoms) were collected and examined. Moreover, 55 healthy dogs (group B) and 236 dogs with symptoms or injuries unlikely to be associated with borreliosis (group C) were included in this study. Blood serum samples collected from all individuals (n=389) were analysed by ELISA. Twenty-one (21%) out of 98 dogs from group A, 4 (7%) out of 55 from group B and 15 (6%) out of 236 dogs from group C were positive for antibodies against B. burgdorferi sensu lato. The seroprevalences between groups A, B and C differed significantly. None of the corresponding samples investigated by PCR and culture were positive for spirochetal DNA or viable spirochetes. Borrelia afzelii was grown from one EDTA-blood sample but the corresponding blood serum sample remained antibody-negative. Consequently, the etiologic role of B. afzelii in this case is unclear. In approximately 40% of the presumptive canine borreliosis cases, other lesions have been found to be responsible for clinical signs. This study affirms that a definitive diagnosis of canine borreliosis cannot be made by clinical symptoms and serology based on a single consultation. Moreover, this study clearly revealed that the diagnostic sensitivity is enhanced by a thorough consideration and exclusion of other diseases.

[Possibilities of minimal invasive cardiac catheter interventions in the dog]

The therapeutic possibilities in veterinary cardiology have developed rapidly in the past few years. Whereas until recently cardiac intervention in dogs could only be performed by thoracotomy, new minimally invasive techniques are adopted. Procedures like balloondilatation of pulmonic stenosis, coil embolisation of patent ductus arteriosus, pacemaker implantation in symptomatic bradyarrhyhtmia, and palliative balloon pericardiotomy are becoming more and more established. These alternative interventional methods are attractive, because no postsurgical pain and no complications potentially associated with thoracotomy ensue. The knowledge of such new treatment modalities and particularly the indications for an intervention are prerequisites to apply them optimally and broadly.

Recurrent fever as the only or predominant clinical sign in four dogs and one cat with congenital portosystemic vascular anomalies

Fever is not considered a typical clinical sign in animals with portosystemic vascular anomalies (PSVA). In a time period of 8 years, PSVA was diagnosed in 23 cases (20 dogs, 3 cats) at the Animal Hospital of the University of Zurich. Of these, recurrent fever was the only, the predominant or an early sign in 5 animals. Fever and associated unspecific clinical signs like lethargy, inappetence, and reluctance to move were present for weeks to months before the final diagnosis of PSVA was made. It was the lack of typical and well-known signs of PSVA that obscured and delayed the diagnosis. Therefore, PSVA should be included in the differential diagnosis of animals with fever of unknown origin (FUO).

Radiotherapy of pituitary tumours in five cats

Five cats tentatively diagnosed with pituitary adenoma (four cases) or pituitary carcinoma (one case), based on computed tomography (CT) or magnetic resonance imaging, were treated with radiotherapy. Electrons were applied in four cats and electrons and photons in the fifth. Ten to 12 fractions of 3.5 to 4.0 Gy each were delivered on a Monday/Wednesday/Friday schedule. The mean total dose applied was 39 Gy. No severe acute side effects to treatment were seen. Follow-up CT examination was performed in four cats; the mass had disappeared in one cat and remained stable or slightly decreased in size in the other three. The survival times were 5.5, 8.0, 15.0, 18.0 and 20.5 months, with two cats dying of causes unrelated to the tumour. Based on these cases, radiotherapy appears to be a valuable treatment option for feline pituitary tumours.

[Pseudohypoadrenocorticism in two Siberian huskies with gastrointestinal parasitoses]

Two Siberian Huskies were presented because of anorexia, chronic diarrhoea, polydipsia and polyuria. The most significant clinical finding was a severe dehydration. Laboratory results showed severe electrolyte disturbances with sodium: potassium ratios of 13.2 and 15.4, respectively. Hypoadrenocorticism could be excluded in both dogs with an ACTH stimulation test. The plasma aldosterone concentrations before and after stimulation were very high, which might be due to a stimulation by the electrolyte disturbances. The final diagnosis was an infection with the whipworm Trichuris vulpis and secondary pseudohypoadrenocorticism. A life-threatening dehydration syndrome with hyponatremia, hyperkalemia and metabolic acidosis due to intestinal parasitism has been reported in earlier studies. Up till now sodium: potassium ratios less than 14, however, have only been seen in animals with Morbus Addison. The severe hyperkalemia in these dogs might be due to a particular sensitivity in this breed.

[Polycystic kidney disease in a Persian cat]

This case report is about a 9-year-old male castrated Persian cat with chronic renal failure. After physical examination and ultrasonography polycystic kidney disease (PKD) was diagnosed. Various aspects of etiology, pathophysiology and diagnosis of PKD are discussed.

[Ultrasonography of the parathyroid glands in dogs--a review]

The purpose of the study was to give an overview over the usefulness of ultrasonographic examination of parathyroid glands in dogs. By means of a 10 MHz high-resolution linear transducer it was possible to visualize parathyroid glands in healthy dogs. There was a positive correlation between body weight and size of the parathyroid glands, additionally the likelihood to detect 4 glands increased with an increase in body weight. Dogs with chronic renal failure had significantly larger parathyroid glands than healthy dogs and dogs with acute renal failure. In dogs with hypercalcemia of malignancy either none or parathyroids which were small in relation to body weight were detected. In contrast visualisation of parathyroid masses in dogs with primary hyperparathyroidism was easy due to their increased size and anechoic appearance. In dogs with severe azotemia the ultrasonographic examination of the parathyroid glands is helpful to differentiate between acute and chronic renal failure, in dogs with hypercalcemia to differentiate between hypercalcemia of malignancy and hypercalcemia due to primary hyperparathyroidism.

Assessment of five portable blood glucose meters for use in cats

OBJECTIVE

To evaluate the clinical and analytic accuracy of 5 portable blood glucose meters (PBGM) in cats, with emphasis on the detection of potential sources of error.

ANIMALS

200 cats.

PROCEDURE

Venous blood glucose readings from 5 PBGM were compared with the results of a hexokinase reference method. Agreement among methods was determined by error grid analysis and statistical methods.

RESULTS

A total of 2,975 PBGM readings and 513 reference values were analyzed. The accuracy of the PBGM varied in different glycemic ranges. The largest differences between PBGM readings and reference values were in the high glycemic range; 4 PBGM underestimated and 1 PBGM overestimated the reference values in most instances. In the low and reference glycemic ranges, the absolute differences between PBGM readings and reference values were small. Despite the analytic differences in accuracy, 4 PBGM had 100% and 1 PBGM had 98.7% of readings in the clinically acceptable values of the error grid analysis. Within- and between-day precisions were good for all PBGM. Significant differences were not detected between readings of EDTA and lithium-heparinized blood and fresh blood without anticoagulant. Compared with these blood types, 1 PBGM had significantly different readings with fluoride anticoagulated blood. In blood samples with a low Hct, all PBGM overestimated glucose concentrations. Sample volumes < 3 microl resulted in inaccurate measurements in 3 PBGM.

CONCLUSIONS AND CLINICAL RELEVANCE

Performance varied among the 5 PBGM analyzed; however, all PBGM were deemed acceptable for clinical use in cats.

Beta cell and insulin antibodies in treated and untreated diabetic cats

Beta cell and insulin antibodies are involved in the pathogenesis of diabetes in human patients. Beta cell antibodies have also been found in about 50% of newly diagnosed diabetic dogs. This study's objective was to examine these antibodies' role in feline diabetes. The serum of 26 newly diagnosed untreated diabetic cats, 29 cats on insulin therapy, 30 cats with diseases other than diabetes, and 30 healthy cats was examined for beta cell and insulin antibodies. For beta cell antibody testing, purified beta cells from a radiation-induced transplantable rat insulinoma were used. Serum from cats in which anti-beta cell antibodies were induced by injecting a purified beta cell suspension subcutaneously was used as a positive control. Following incubation with test sera, fluorescein-labeled anti-cat immunoglobulins were used to visualize binding between the beta cells and cat gamma globulins. Each serum was tested on two different tumor preparations. For the detection of insulin antibodies, a charcoal separation method was used. It was found that none of the healthy cats, none of the newly diagnosed, untreated diabetic cats and none of the cats with diseases other than diabetes had antibodies against beta cells or against endogenous insulin. Four diabetic cats (14%) that had been treated with different insulin preparations had insulin antibodies. It is concluded that immune-mediated processes are not causing diabetes in the cat. Further studies are needed to evaluate if antibodies directed against exogenous insulin alter the response of diabetic cats to insulin.

[Ehrlichiosis in Switzerland--significance for veterinary medicine]

Ehrlichiosis is a rickettsial disease of animals and humans caused by various species of Ehrlichia. These obligate intracellular microorganisms infect granulocytes or monocytes of mammalian hosts and are transmitted mostly by ticks. The febrile disease is often undiagnosed and characterized by leukopenia, anemia and thrombocytopenia. The diagnosis of ehrlichiosis is based on clinical findings, tick infestation, direct or indirect detection of the agent, and serology. The role of native and imported ehrlichiae of animals in Switzerland is discussed.

Diabetic cataracts: different incidence between dogs and cats

Diabetes mellitus is one of the most common endocrinopathies in the dog and cat. Diabetic cataract primarily affects the canine species and is rarely observed in the cat. It has been proposed that the incidence of cataracts in diabetic dogs is high because many of these patients have significant hyperglycemia despite insulin therapy. Age, gender, levels of serum glucose (before and during insulin therapy) and cataract formation were evaluated, retrospectively, in 23 dogs and 22 cats with diabetes mellitus. In the canine population, the groups with the highest frequency of presentation were females and sexually intact animals. In contrast, males and neutered animals were the most prevalent groups in the feline diabetic population. Over 80% of diabetic cats and dogs were older than 7 years. Our results confirm the almost total lack of cataracts in diabetic cats, while they were present in more than half of the dogs. A relation between the incidence of cataracts and the correspondent level of hyperglycemia in the canine and feline species could not be established. The estimation of the relative risk for the development of cataracts in diabetic dogs shows that some population groups have a higher probability for suffering from this ocular alteration. A relation between relative risk and the correspondent level of hyperglycemia in the various groups was not found. This fact indicates that other factors are involved in the unequal appearance of diabetic cataracts in dogs and cats.

Ultrasonographic examination of the adrenal gland and evaluation of the hypophyseal-adrenal axis in 20 cats

The adrenal glands of 20 healthy, non-sedated cats were examined ultrasonographically; visualisation and assessment was possible in all cases. In comparison with the surrounding tissue, the adrenal glands were hypoechoic and two distinct zones could be differentiated in six of the cats. The length and width of the adrenal glands varied from 0.45 to 1.37 cm and 0.29 to 0.53 cm, respectively, and both dimensions could be reliably reproduced. The adrenal glands did not differ between male and female cats, and, in comparison to dogs, those of cats are more easily visualised ultrasonographically. The basal cortisol value ranged from 2.0 to 79 micrograms/litre. Values 30 and 60 minutes after administration of ACTH (0.125 mg/cat intramuscularly) varied from 36 to 126 micrograms/litre. The basal value of aldosterone ranged from 4 to 618 pg/ml. Values 30 and 60 minutes after administration of ACTH varied from 100 to 832 pg/ml. In all cats, suppression of the cortisol value below the level of detection (< 2.0 micrograms/litre) occurred four and eight hours after the administration of dexamethasone (0.1 mg/kg intravenously).

Capillary blood sampling from the ear of dogs and cats and use of portable meters to measure glucose concentration

Two new methods for collection of capillary blood from the ear of dogs and cats for the measurement of blood glucose concentration using portable blood glucose meters (PBGMs) are described. The first method uses a lancing device after pre-warming the ear, while the second employs a vacuum lancing device. Both methods generated blood drops of adequate size, although the latter method was faster and easier to perform. Accuracy of the two PBGMs was evaluated clinically and statistically. Although assessment of statistical accuracy revealed differences between the PBGMs and the reference method, all of the PBGM readings were within clinically acceptable ranges. Measurement of capillary blood glucose concentration is easy to perform, inexpensive and fast. It may be used by owners to determine blood glucose concentrations at home, and could serve as a new tool for monitoring diabetic dogs and cats.

Evaluation of five portable blood glucose meters for use in dogs

OBJECTIVE

To evaluate clinical and analytical accuracy of 5 portable blood glucose meters (PBGM) used to measure blood glucose concentrations in dogs and to determine potential sources of error.

DESIGN

Prospective study.

ANIMALS

221 dogs.

PROCEDURE

Venous blood samples were obtained, and results of the 5 PBGM were compared with results of a hexokinase reference method. Agreement among methods was determined by use of error grid analysis and statistical methods.

RESULTS

Accuracy of the PBGM varied with glucose concentration of the sample. The largest differences between results of the PBGM and results of the reference method were obtained with samples with high glucose concentrations; 4 PBGM tended to underestimate and 1 PBGM tended to overestimate the true glucose concentration. Absolute differences between results of the PBGM and results of the reference method were small for samples with low glucose concentrations and samples with concentrations in the reference range. None of the PBGM yielded measurements that would result in clinically unacceptable errors. Within-run and between-day precision was good for all PBGM, and results were not affected by use of EDTA or heparin to anticoagulate blood. Readings of the PBGM were significantly higher for blood samples with low Hct than for samples with normal Hct. For 3 PBGM, samples < 3 microliters resulted in inaccurate measurements.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that currently available PBGM are sufficiently accurate for use in clinical practice to determine blood glucose concentrations in dogs.

Nutritional secondary hyperparathyroidism in six cats

Nutritional secondary hyperparathyroidism (NSH) was diagnosed in six cats during a three-year period, based on clinical, radiographic and laboratory findings. Clinical signs were attributable to severe osteopenia (n = 5) and hypocalcaemia (n = 4), which had resulted in spontaneous fractures of long bones, scapulae, pelvis, nasal bones, or spine, and in excitation, muscle twitching or seizures, respectively. Serum parathormone levels were markedly elevated, and 1,25(OH)2-vitamin D3 mildly elevated, whereas 25(OH)-vitamin D3 was mildly decreased compared to age-matched healthy cats. Treatment was limited to short-term parenteral calcium gluconate injections, as clinically indicated, a balanced diet and cage rest, which resulted in quick clinical recovery in four cases. The remaining two cats had to be euthanased because of progressive neurological deficits secondary to spinal fractures. At the time of writing, a multitude of commercial balanced diets is widely available and diseases secondary to dietary deficiencies have become rare. Nevertheless, NSH is still an important clinical entity, and should be considered in growing cats presenting with spontaneous fractures or seizures.

[Case presentation from small animal medicine. Diabetes mellitus in a cat]

This case report is about a 9 year old female spayed domestic shorthair cat with a previously diagnosed diabetes mellitus. After an insulin treatment for a short period of time, the cat was given an oral hypoglycemic agent. Four years after initiating therapy the cat was presented with diabetic ketoacidosis. Various aspects of the etiology, pathophysiology and treatment of diabetic ketoacidosis are discussed.

[Mitotane treatment in a dog with a recurring adrenocortical carcinoma--a case report]

In a 7 year old female poodle an adrenocortical tumor was diagnosed on basis of laboratory and ultrasonographic examinations. One year after adrenalectomy, a relapse was diagnosed, at that time the suspicion of metastases in the liver arose for the first time. By treatment with Mitotane in a dose aiming at completely destroying the adrenal cortex, a complete disappearance of the tumor as well as a dramatic reduction of the size of the metastases could be achieved. 12 months after the begin of the chemotherapy, the dog is in good general condition.

[Effects of mitotane therapy in dogs with pituitary dependent Cushing syndrome on the adrenal gland size--an ultrasonographic study]

The effect of mitotane therapy on adrenal gland size was evaluated in 13 dogs with pituitary dependent hyperadrenocorticism. Ultrasonographic measurements were obtained before and during mitotane therapy. During therapy both adrenal glands were shorter and thinner (median during therapy: left adrenal gland 19.4 mm long, 5.4 mm thick, right adrenal gland 18.1 mm long, 6.1 mm thick) than before mitotane therapy (median before therapy: left adrenal gland 23.6 mm long, 8.3 mm thick, right adrenal gland 21.6 mm long, 8.1 mm thick). Statistical evaluation showed a significant reduction in size. But ultrasonographic measurement of adrenal gland size is not useful in the evaluation of adrenal reserve during mitotane therapy. Inadequate adrenal reserve was not identified and adrenal size measurement by ultrasonography was not helpful to differentiate adequate and inadequate control of adrenal cortisol secretion during mitotane therapy.

Ultrasonographic evaluation of the adrenal glands in six dogs with hypoadrenocorticism

The purpose of this study was to determine the value of ultrasonographic characterization of the adrenal glands in dogs with hypoadrenocorticism. Measurements of adrenal glands were obtained in six dogs with hypoadrenocorticism. The adrenal glands on both sides were shorter (range: left adrenal gland length, 10.0 to 19.7 mm; right adrenal gland length, 9.5 to 18.8 mm) and thinner (range: left adrenal gland thickness, 2.2 to 3.0 mm; right adrenal gland thickness, 2.2 to 3.4 mm) than in normal dogs (range: left adrenal gland length, 13.2 to 26.3 mm; right adrenal gland length, 12.4 to 22.6 mm; left adrenal gland thickness, 3.0 to 5.2 mm; right adrenal gland thickness, 3.1 to 6.0 mm). Statistical analysis revealed a significant reduction in size of the left adrenal gland (p less than 0.05) in dogs with hypoadrenocorticism compared to the left adrenal gland in normal dogs. The results of this study show that atrophy of the adrenal glands in dogs with hypoadrenocorticism seems to lead to an ultrasonographic-measurable reduction in size of the adrenal glands.

Ultrasonographic characteristics of both adrenal glands in 15 dogs with functional adrenocortical tumors

Ultrasonographic examination of both adrenal glands was performed in 15 dogs with functional adrenocortical tumors (FAT). Bilateral adrenal tumors were diagnosed in three of 15 dogs, and unilateral tumors were diagnosed in 12 of 15 dogs. Adrenal tumors were characterized by adrenal gland enlargement with loss of the normal shape and parenchymal structure. The contralateral adrenal gland could be imaged in all dogs with unilateral tumors. Based on size, shape, and parenchymal structure, the contralateral adrenal gland was similar to adrenal glands of normal dogs. The results of this study show that: 1) both adrenal glands should be imaged routinely in dogs with hyperadrenocorticism; 2) bilateral adrenocortical tumors seem to be more frequent than previously assumed; 3) one normal adrenal gland does not exclude the existence of a contralateral FAT; and 4) the functional atrophy of the contralateral adrenal gland in dogs with FAT may not be apparent ultrasonographically.

Seroprevalence of Ehrlichia canis and of canine granulocytic Ehrlichia infection in dogs in Switzerland

Serum samples from 996 dogs in Switzerland were examined for antibodies to Ehrlichia canis and to the agent causing canine granulocytic ehrlichiosis (CGE). Ehrlichiosis, borreliosis, and systemic illness not associated with ticks were suspected in 75, 122, and 157 of these dogs, respectively. The remainder of the serum samples were obtained from clinically healthy dogs which resided north (n = 235) or south (n = 407) of the Alps. The serum samples were tested by an indirect immunofluorescence technique for antibodies to the two agents incriminated, E. canis and Ehrlichia phagocytophila, a surrogate marker of the agent of CGE. Twenty-two of 996 (2.2%) serum samples had antibodies to E. canis and were distributed as follows: 20 of 75 (26.7%) samples from dogs suspected of having ehrlichiosis, 1 of 122 (0.8%) from dogs suspected of having borreliosis, and 1 of 407 (0.2%) from healthy dogs which resided south of the Alps. Of the 75 (7.5%) serum samples that had antibodies to E. phagocytophila, significantly more samples were from ill dogs than from healthy dogs. Among the sera from healthy dogs, antibodies to E. phagocytophila were significantly more prevalent in the north. Because seropositive dogs had a history of travel outside Switzerland and because Rhipicephalus sanguineus is found exclusively south of the Alps, it was presumed that, in contrast to the agent of CGE, E. canis is not indigenous to Switzerland.

[Case presentation in small animal medicine]

A 11 year old female spayed Jack Russel Terrier was diagnosed with diabetes mellitus and ketoacidosis. After successful initial treatment metabolic control deteriorated although insulin dosage was increased. Cushing's syndrome was diagnosed and treatment with Lysodren was started. As a result blood glucose concentrations decreased. The difficulty to diagnose Cushing's syndrome in some diabetic dogs is discussed.

[Differential diagnosis of hypercalcemia--a retrospective study of 46 dogs]

The case records of 46 dogs with hypercalcemia were studied retrospectively. The most common cause of hypercalcemia was malignancy, of which the majority were diagnosed as having lymphosarcoma (LSA, n = 23). Interestingly only 15 had palpable lymphadenopathy. Other neoplasia were apocrine adenocarcinoma of the anal sac (n = 4), mammary adenocarcinoma (n = 2), anaplastic carcinoma (n = 1), and malignant histiocytosis (n = 1). Non-neoplastic reasons for hypercalcemia were hypoadrenocorticism (n = 5), acute renal failure (n = 2), chronic renal failure (n = 2), hypervitaminosis D (n = 1), and primary hyperparathyroidism (n = 1). In 4 cases no definitive diagnosis could be obtained. Moderate to marked hyperphosphatemia and azotemia was found in all dogs with primary renal failure and in 4 of 5 dogs with hypoadrenocorticism. In contrast only 4 of 31 dogs with neoplasia showed (mild) hyperphosphatemia and 20 showed mild to moderate azotemia. Elevated PTH levels were found in dogs with primary chronic renal failure and with primary hyperparathyroidism, but also in one dog with neoplasia. Low PTH concentrations were measured in the dog with hypervitaminosis D and in 8 cases with neoplasia. Additional three cases with neoplasia had values in the reference range.

CONCLUSIONS

1. The most common cause of hypercalcemia is LSA. Absence of palpable lymphadenopathy does not exclude LSA and further diagnostic steps may be necessary 2. The combination of moderate to marked hyperphosphatemia suggests primary renal failure or hypoadrenocorticism. 3. An elevated PTH level is consistent with primary hyperparathyroidism, but does not exclude other causes of hypercalcemia.

Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 dogs: a retrospective study

Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n = 13) or an Eld gastrostomy tube applicator (n = 28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n = 2), peristomal abscess (n = 2) and pyloric outflow obstruction by a migrated tube (n = 1). Complications associated with the feeding procedure, nausea and vomiting (n = 3), led to aspiration pneumonia in one case.

[Indirect blood pressure measurement in cats with diabetes mellitus, chronic nephropathy and hypertrophic cardiomyopathy]

In the present study blood pressure was measured in cats comparing two indirect methods (oscillometric versus Doppler-sonographic) over a wide pressure range. It was shown, that at the lower pressures Doppler and oscillometric measurements were basically equivalent. However for higher pressures oscillometric measurements were consistently lower than Doppler measurements. This difference became greater as blood pressure increased. The determination of blood pressure by the Doppler-sonographic method was always possible, whereas the measurement by the oscillometric method was often not possible, especially at higher blood pressure levels. In a second step, the frequency of hypertension was determined in cats with diabetes mellitus, chronic renal failure and hypertrophic cardiomyopathy. Eight cats with diabetes mellitus had oszillometric blood pressure values of 101-155 mmHg systolic, 42-105 mmHg diastolic and 65-125 mmHg mean arterial pressure determined at the front leg and 110-167 mmHg systolic, 44-98 mmHg diastolic, and 61-125 mean arterial pressure determined at the tail. The Doppler-sonographic values were 120-180 mmHg. Only the oscillometric measurement (at the tail) of the systolic pressure was significantly higher than that of normal cats. In 11 cats with chronic renal failure the following values were determined by the oszillometric method: at the front leg 137-182 mmHg systolic, 74-138 mmHg diastolic, 100-162 mmHg mean arterial pressure and at the tail 134-189 mmHg systolic, 53-109 mmHg diastolic, 80-135 mmHg mean arterial pressure. With the Doppler-sonographic technique the blood pressure was between 120 and 280 mmHg. All blood pressure measurements were significantly higher than those of healthy cats, except the oscillometric measurements of diastolic blood pressure. In 12 cats with hypertrophic cardiomyopathy systolic pressure was 108-179 mmHg, diastolic pressure was 64-135 mmHg, and mean arterial pressure was 89-154 mmHg at the front leg using the oscillometric method. At the tail results were as follows: 121-201 mmHg systolic, 61-141 mmHg diastolic, and 85-160 mmHg mean arterial pressure. By the Doppler-sonographic technique determined blood pressure was 110-260 mmHg. All oscillometric measurements except the diastolic pressure determined at the front leg were significantly higher than in normal cats. Four cats with chronic renal failure and five cats with hypertrophic cardiomyopathy showed retinal hemorrhages and/or detachments. Eight of this nine cats had blood pressure measurements above the normal range. We conclude that hypertension can be detected in cats with several diseases. In most cases reliable measurements can only be obtained by Doppler-sonographic methods.

[Glycosylated hemoglobin in the cat: affinity chromatography determination in healty, permanent diabetes mellitus and transient hyperglycemic cats]

The affinity method has proved to be the first technique that succeeded in measuring feline GHb as it is not affected by structural differences of haemoglobin as traditional proceedings are. By its help the reference interval for feline GHb was established from blood samples of 62 healthy cats. It ranged between 0.31 to 1.58% with a median of 0.92%. 21 newly diagnosed diabetic cats were reliably determined to be diabetic, because the GHb exceeded significantly the upper limit of the reference interval of 1.30%. The statistical difference between diabetic and healthy cats was highly significant (p < 0.00001). It was confirmed that the GHb value helps to distinguish diabetic from transient hyperglycemic cats. Newly presented hyperglycemic cats suffer from diabetes mellitus, if their GHb values are increased (p < 0.00001).

[Vogt-Koyanagi-Harada syndrome in an Akita-Inu dog. A case report]

An 18 months old Akita-Inu was presented with granulomatous panuveitis, ulcerative blepharitis and dermal depigmentation, ulceration and crusting, involving lips, nasal planum, prepuce, scrotum and perineum. Histologic examination of the affected skin demonstrated lichenoid dermatitis with infiltration of histiocytes and neutrophils. The diagnosis is based on the typical clinical and histological lesions.

Familial nephropathy in Bernese mountain dogs

Between January 1988 and March 1992 nephropathies were frequently diagnosed in Bernese Mountain Dogs. During this period, 20 animals (16 females, four males), ages 2-5 years (average age at time of diagnosis = 3.3 years) presented with clinically renal insufficiency. Morphologic diagnosis of the renal lesions was identical in all cases, i.e., membranoproliferative glomerulonephritis (MPGN) with concomitant interstitial nephritis. Deposits of immunoglobulin-M (IgM) and of the third complement component were regularly demonstrated immunohistochemically in the glomeruli; deposits of immunoglobulin-A (IgA) and immunoglobulin-G (IgG) were found only in isolated cases. Reduplication of glomerular basement membranes, mesangial interposition, and subendothelial deposits of the immunocomplex type were also detected by electron microscopy. A pedigree analysis indicated that the MPGN in these 20 Bernese Mountain Dogs of approximately the same age was of hereditary genesis. Thus, MPGN should be allocated to the group of familial nephropathies. Serologically, high IgG titers against Borrelia burgdorferi were found in 17 dogs. These findings are discussed in relation to familial nephropathies in humans.

A new familial glomerulonephropathy in Bernese mountain dogs

Between 1989 and 1992, 22 Bernese mountain dogs (18 females and four males) aged between two and seven years, which had been suffering for some weeks from weight loss, anorexia, apathy, vomiting, polydipsia and polyuria, were examined. All of them had high blood urea nitrogen and serum creatinine concentrations, and many had hyperphosphataemia, hypercholesterolaemia, hypoproteinaemia and nonregenerative anaemia. All the dogs had very high protein: creatinine ratios in the urine, and macroproteinuria was identified by sodium dodecyl sulphate gel electrophoresis. The immunofluorescent titres against Borrelia burgdorferi, measured in 19 of the dogs, ranged between 256 and 32,768. In all cases, membrano-proliferative glomerulonephritis with concomitant interstitial nephritis was diagnosed. From an analysis of the dogs' pedigree it was concluded that the glomerulonephritis of these Bernese mountain dogs was inherited as an autosomal recessive trait and that its expression was influenced by a second gene locus with a sex-linked dominance exchange.

[Urine characteristics in dogs with diabetes mellitus. Is there a diabetic nephropathy in the dog?]

Dogs with spontaneous Diabetes mellitus were checked at regular intervals for protein excretion in the urine. A large number of dogs developed a proteinuria, very marked in some cases, with excretion of primarily macroproteins.

[Endothelin-1 and endothelin-3 in the plasma of dogs]

The endothelins represent a family of peptides with potent vasoconstrictory effects indicating a role in the regulation of vascular tone. An involvement of endothelins in the pathogenesis as well as pathophysiology of vascular diseases has been proposed. Therefore, the aim of the presented study was to develop the methodology to measure and characterize endothelin-1 (ET-1) and endothelin-3 (ET-3) in the plasma of dogs. Extraction of acidified plasma samples was performed by use of Sep-Pak C18 cartridges and plasma levels of ET-1- and ET-3-immunoreactivity (ET-1-IR; ET-3-IR) were determined by specific radioimmunoassays. The measured ET-immunoreactivities were verified by separation of plasma using high-pressure liquid chromatography (HPLC).

Atrial natriuretic peptide concentration in dogs with congestive heart failure, chronic renal failure, and hyperadrenocorticism

The function of atrial natriuretic peptide (ANP) is claimed to be control of salt and water homeostasis, and thus, the hormone may be involved in the pathogenesis of certain diseases with impaired volume regulation. We, therefore, studied plasma ANP concentration in dogs with chronic renal failure, congestive heart failure, and hyperadrenocorticism. Dogs with chronic renal failure had twofold higher plasma ANP concentration (16.2 +/- 5.8 fmol/ml), compared with healthy dogs (8.3 +/- 3.5 fmol/ml). An even more distinct increase (sixfold) of plasma ANP concentration was found in dogs with congestive heart failure (52.9 +/- 29.7 fmol/ml). In contrast, dogs with hyperadrenocorticism did not have high ANP plasma concentration (5.5 +/- 2.0 fmol/ml). High-performance liquid chromatographic analysis of plasma from dogs with congestive heart failure indicated that, in addition to the normal circulating form of ANP (99-126), the unprocessed precursor ANP (1-126) is detectable in the circulation. These qualitative and quantitative alterations of plasma ANP concentration in dogs further suggest involvement of this peptide in the development and/or maintenance of diseases associated with impaired volume regulation.

[Indocyanine green test in the dog]

The ICG test is recommended as a replacement for the nowadays rarely performed BSP test. ICG has less side effects, and it has a greater range of use. Extrahepatic influences are of little importance. Disadvantages are the greater cost and extra equipment required, the labile nature of the dye solution and the calculation procedure. Reference ("normal") values of the clearance coefficient are 0.044 to 0.131 min-1 and those for the half life 5.2 to 11.2 min. The test is suitable for information about the secretion of the whole liver and the state of its circulation.

[Pathological changes of the endocrine pancreas in dogs and cats in comparison with clinical data]

In a retrospective study concerning the functional morphology of the endocrine pancreas the files of the Institute for Veterinary Pathology, University of Munich, of the last 12 years were reviewed. Cases of diabetes mellitus as well as developmental disorders and tumors of the endocrine pancreas were examined by routine histological and immunohistological methods. Cases are discussed together with clinical data and the relevant literature. The forms of diabetes mellitus were categorized according to the classification used in human pathology.

[Diagnostic possibilities of ANP blood measurements in dogs]

Atrial natriuretic peptide has been considered to be a major regulator in the body's water and salt homeostasis. Antagonizing those mechanisms leading to volume retention and overload (renin, angiotensin, aldosterone), ANP has been suggested to play a critical role in the pathology of certain diseases like renal failure, congestive heart failure or hypertension. In this regard, we measured ANP plasma concentration in normal healthy dogs and dogs with renal failure, congestive heart failure and Cushing syndrome. ANP levels were slightly decreased in dogs with Cushing disease (n = 9; 5.5 +/- 2 fmol/ml), increased in renal failure (n = 7; 16.2 +/- 5.8 fmol/ml, p less than 0.05) and markedly augmented in dogs with congestive heart failure (n = 14; 52.9 +/- 29.75 fmol/ml, p less than 0.01) as compared to healthy dogs (n = 6; 8.3 +/- 3.5 fmol/ml). Furthermore, characterization of the measured immunoreactivity (IR-ANP) revealed, that up to 50% of the IR-ANP in dogs with congestive heart failure corresponds to the ANP precursor molecule, not found in healthy subjects. This fact might present one possible explanation for the attenuated response to ANP in congestive heart failure. In addition, this finding may also serve a diagnostical purpose.

Enzyme activities of urinary alanine aminopeptidase (AAP) and N-acetyl-beta-D-glucosaminidase (NAG) in healthy dogs

The activity of the urinary enzymes alanine aminopeptidase (AAP; EC 3.4.11.2) and N-acetyl-beta-D-glucosaminidase (NAG; EC 3.2.1.30) was measured after eliminating distorting factors in ten healthy dogs on three consecutive days in order to determine inter- and intra-individual variability. All the animals were being housed and fed in the same way. The urine (2nd morning urine) was collected between 8:30 and 10:00 a.m. by means of ultrasound-controlled cystocentesis. Our comparative measurements of native and gel-filtered urine showed an increase in enzyme activity in all of the samples in the case of AAP and in most of the samples in the case of NAG, thus proving the existence in the dog of AAP and NAG urinary enzyme inhibitors. The large inter- and intra-individual AAP and NAG fluctuation ranges were reduced considerably by relating enzyme activity to urine creatinine concentration. The provisional upper limit of the AAP reference range is 6.3 U/g creatinine (90% percentile), that of NAG 6.2 U/g creatinine (90% percentile). The AAP and NAG enzyme activities remained constant in gel-filtered samples kept at 4 degrees C for at least 5 days, in those kept at -18 degrees C for at least 4 weeks.