Successful Management of Urinary Bladder Clot with Intravesical Tissue Plasminogen Activator Infusion in a Cat

A 5 yr old male neutered domestic shorthair with intermittent signs of urinary tract obstruction was suspected of having a blood clot in the urinary bladder secondary to trauma. The cat was hospitalized and received standard supportive therapy for urinary tract obstruction with urinary catheterization, with the addition of intravesical saline flushes in an attempt to promote bladder clot lysis. The cat was subsequently discharged after voluntary urination was observed. The cat was represented 28 hr after discharge because of clinical signs consistent with urinary tract obstruction. The cat was hospitalized and intravesical tissue plasminogen activator (tPA) infusions (0.5 mg of tPA in 10 mL of saline with 2 hr dwell time q 8 hr) were administered to break down the bladder clot (2.78 × 4.46 cm). Thirty-two hours after starting tPA, the clot was no longer visible on ultrasound. The cat was discharged with no recurrent symptoms in the subsequent 11 mo. This is the first report of tPA being used for dissolution of bladder clot in a cat. There were no observed complications, suggesting that intravesical instillation of tPA may be a safe and efficacious therapy in cats, similar to the previously reported successes in dogs and humans.

Cataracts and phacoemulsification in the Siberian Husky: A retrospective and multicentric study (2008-2018)

PURPOSE

To compare cataract characteristics and complications related to cataracts and phacoemulsification in the Siberian Husky (Huskies) versus other canine breeds (non-Huskies).

ANIMALS

A total of 50 Huskies (92 eyes) and 96 non-Huskies (182 eyes) were evaluated.

METHODS

Medical records of Huskies (at four university veterinary hospitals, 2008-2018) and non-Huskies (Colorado State University, 2017-2018) diagnosed with cataracts were reviewed. Age of dog, cataract stage at presentation, and pre- and post-operative complications were recorded and analyzed.

RESULTS

Mean (±standard deviation) age at presentation was significantly lower in Huskies (3.5 ± 3.3 years) compared to non-Huskies (9.5 ± 2.9 years) (p < .0001). Huskies more commonly presented with hereditary cataracts than non-Huskies (84% versus 52%) and a significantly higher percentage of non-Huskies presented with diabetic cataracts than Huskies (48% versus 16%; p = .0001). Cataract stage at presentation did not differ between Huskies and non-Huskies. Phacoemulsification was performed in 40% (20 out of 50 dogs, 39 out of 92 eyes) of Huskies and 42% (40 out of 96 dogs, 74 out of 182 eyes) of non-Huskies. Pre-operative and post-operative retinal detachment were more common in Huskies than non-Huskies (13% versus 2% and 10% versus 1%, respectively) but the difference was not significant. Other post-operative complications occurred with similar frequency in both groups (p ≥ .17).

CONCLUSIONS

Huskies evaluated for cataracts were younger and less likely to present with diabetic cataracts than other canine breeds and, although not statistically significant, had a clinically important increased risk of retinal detachment pre- and post-phacoemulsification.

Radiographic diagnoses in 80 cats before and 73 cats after unobstructing the urethra

OBJECTIVE

The aim of this study was to investigate causes for feline urethral obstruction and determine whether the frequency of radiographic diagnoses differs between cats radiographed before or after unobstruction of the urethra.

MATERIALS AND METHODS

A retrospective cross-sectional study of cats with naturally occurring urethral obstruction was performed. Only cats presenting for their first urethral obstruction in which radiography was integrated in the initial evaluation were included. The diagnosis frequency (overall and for each disease type) was compared between cats radiographed before or after unobstruction of the urethra.

RESULTS

Eighty cats (52%) had radiographs obtained before unobstructing the urethra and 73 cats (48%) had radiographs taken after unobstructing the urethra. Cats radiographed before unobstruction had a greater frequency of radiographic diagnoses than those radiographed after unobstruction (61% versus 45%). This difference was largely due to a greater frequency of urethral plugs detected before unobstruction versus after unobstruction (45% versus 5.5%).

CLINICAL SIGNIFICANCE

Radiographs obtained before unobstructing the urethra provided a diagnostic advantage for detecting a cause for urethral obstruction compared to radiographs obtained after unobstructing the urethra. Urethral plugs were the most common diagnosis.

Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016)

OBJECTIVE

To determine the impact of route of nutrition on length of hospitalization and survival to discharge in dogs with septic peritonitis.

DESIGN

Retrospective study from 2007 to 2016.

SETTING

University teaching hospital.

ANIMALS

Sixty-eight dogs with septic peritonitis that survived ≥48 hours.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Nutritional strategy was categorized into 1 of 4 groups: voluntary, feeding tube, parenteral (PN), and combined feeding tube and PN. Body weight, body condition score, time without caloric intake before and during hospitalization, length of hospitalization, and percentage of resting energy requirements provided during the first 3 days of nutritional support were recorded. Overall, 54/68 dogs survived (79%). Survival Prediction Index 2 scores were not significantly different between groups. Dogs receiving PN only were less likely to survive than those receiving any enteral nutrition (OR 9.7; 95CI 1.84-58.75). Compared to dogs not receiving PN, dogs receiving any PN were significantly less likely to survive (OR 9.66; 95% CI 1.7-105.8), and were in hospital significantly longer (P = 0.025). Metabolic complications associated with PN were frequent but not associated with increased length of hospitalization or survival to discharge.

CONCLUSIONS

Dogs with septic peritonitis that received any PN were in hospital longer and less likely to survive but may have been sicker than those receiving other forms of nutritional support. Further studies are warranted to evaluate reasons for worse outcomes in dogs with septic peritonitis receiving PN.

Retrospective characterization of canine coagulopathies using the turbidimetric ACL-TOP 300 analyzer (2014-2015): Forty-seven dogs

OBJECTIVE

To characterize disseminated intravascular coagulation (DIC), liver failure (LF), post-hepatic cholestasis (PHC), and anticoagulant rodenticide intoxication (ROD) in dogs using an immunoturbidimetric coagulation analyzer and to characterize the relationship between clinical bleeding and bleeding parameters.

DESIGN

Retrospective study (August 2014-July 2015).

SETTING

University teaching hospital.

ANIMALS

Forty-seven client-owned dogs diagnosed with DIC (n = 24), LF (n = 9), PHC (n = 5), or ROD (n = 9) based on history, clinical pathology, cytology, histopathology. or exploratory surgery.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Median prothrombin time (PT), activated partial thromboplastin time (aPTT), and quantitative fribrinogen assay (QFA) were above the reference interval for DIC, LF, PHC and ROD with the exception of a normal QFA for LF. Clot curve analysis for DIC was characterized by elevated PT Delta, PT first derivative, and aPTT Delta, and normal for aPTT second derivative; all LF parameters were within the RI; all PHC parameters were above the RI; and ROD had elevated aPTT delta, but low aPTT second derivative. Coagulopathic bleeding recognized within the DIC group was characterized by median PT delta in mABS (milliabsorbance), first derivative and aPTT delta values in mABS within the RI at 35.0, 55.5 and 38, respectively. The nonbleeding DIC group median values of these same parameters were 189.5, 586.5 and 288, respectively.

CONCLUSIONS

The classically utilized indicators of secondary hemostasis, PT and aPTT, were prolonged within all 4 groups; DIC, LF, PHC and ROD as expected. Fibrinogen concentration was increased in both PHC and ROD, decreased in LF and increased but with a bimodal distribution in DIC that correlated with clinical bleeding. The degree of PT and aPTT prolongation did not correlate with clinical bleeding in the DIC group, however clot curve analysis, did reveal an association.

Retrospective comparison of standard clotting tests and novel clot waveform parameters in dogs using the turbidimetric ACL-TOP CTS 300 coagulation analyzer

Clot waveforms are generated by coagulation analyzers, such as the ACL-TOP, that utilize photo-optical turbidimetric methods to measure prothrombin time (PT) and activated partial thromboplastin time (aPTT), which are standard clotting tests (SCTs). Additional quantitative clot waveform analysis (CWA) parameters include maximum velocity of the PT curve (PT1d), maximum acceleration of the aPTT curve (aPTT2d), and their change in optical density (ODdelta). We explored the potential for CWA to contribute unique information compared to SCTs and quantitative fibrinogen assay (QFA) in dogs with clinical indications for laboratory evaluation of coagulation. We retrospectively evaluated the frequency and agreement between normal, high, and low values of CWA and SCTs for 203 dogs relative to reference intervals (RIs). Most dogs had SCTs within RIs, but most CWA values were high regardless of whether SCT values were within, below, or above the RI. Agreement between SCTs and CWA was slight (kappa <30%). Clinically significant bleeding was noted in 28 of 203 (14%) dogs. SCTs were not different between bleeders and non-bleeders. Median QFA, PT1d, aPTTdelta, and aPTT2d values were statistically significantly higher than RIs in non-bleeders compared to bleeders, whose median values were not below RI. Compared with SCTs, CWA identified differences between the 2 groups. However, wide overlap between the 2 groups limits the use of CWA to clinically discriminate between bleeders and non-bleeders in a heterogeneous population of dogs. Further studies on the diagnostic utility of CWA in coagulopathic dogs are needed.

Performance characteristics of the turbidimetric ACL-TOP CTS 300 coagulation analyzer in dogs and cats

OBJECTIVE

To evaluate the technical performance of the turbidimetric ACL-TOP CTS 300 coagulation analyzer (IL) in dogs and cats and to create reference intervals for standard and novel parameters.

DESIGN

Coagulation testing results from dogs and cats generated by the IL were prospectively compared with another mechanical clot detection system. Precision was documented and reference intervals were created for prothrombin time, activated partial thromboplastin time, and Clauss fibrinogen and D-dimer values, as well as for the quantitative clot curve parameters (high and low amplitude, delta, and first and second derivative curves). Clot curve signatures containing common artifacts due to lipemia, hemolysis, or preactivation were demonstrated.

ANIMALS

Residual frozen plasma from 20 dogs and 10 cats was used for method comparison; prospectively recruited healthy dogs (n = 48) and cats (n = 45) were used for reference interval and precision studies.

MEASUREMENTS AND MAIN RESULTS

Bland-Altman analysis showed a proportional positive bias in the IL compared with mechanical clot detection in dogs and a suggestion of a similar pattern in cats. Precision was good and met manufacturer's recommendations for all assays. Reference intervals are reported. Clot curve artifacts were similar in animals to those reported in people.

CONCLUSIONS

The turbidimetric system had a slight high proportional positive bias compared with mechanical clot detection. Thus, new reference intervals were generated including for novel parameters generated by clot curve analysis. Some preanalytical errors can be identified by inspection of clot curves. This robust novel technology compares favorably with mechanical endpoint detection methods and can be used in dogs and cats.

A pilot study evaluating the prognostic utility of platelet indices in dogs with septic peritonitis

OBJECTIVE

To characterize platelet indices at time of diagnosis of septic peritonitis in dogs and to assess the relationship between platelet parameter data and survival to discharge in dogs treated surgically.

DESIGN

Retrospective, observational, descriptive pilot study from 2009 to 2014.

SETTING

University teaching hospital.

ANIMALS

Forty-eight dogs diagnosed with septic peritonitis were included in this study. Thirty-six dogs had surgical source control. Blood samples from 46 healthy control dogs were used for reference interval (RI) generation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) with increased proportions of dogs having values above the RI compared to healthy dogs. A significantly increased proportion of dogs with septic peritonitis had platelet counts above (12.5%) and below (8.3%) the RI, with no significant difference in mean platelet count compared to healthy dogs. No significant differences in the mean platelet count, MPV, PCT, or PDW were found between survivors and nonsurvivors in dogs with surgical source control; however, dogs with MPV values above the RI had significantly increased mortality compared to dogs within the RI (P = 0.025). Values outside the RI for other platelet parameters were not associated with significant differences in mortality.

CONCLUSIONS

Dogs with septic peritonitis have increased frequency of thrombocytosis and thrombocytopenia with increased MPV, PCT, and PDW. An increased MPV may be a useful indicator of increased risk of mortality in dogs treated surgically.

HealthSouth acquisitions throw another log on the burning market for ambulatory centers

In late May and early June, HealthSouth Corp. announced two major purchases of ambulatory surgery centers from Columbia/HCA Healthcare Corp and National Surgery Centers. Joanne Todd profiles HealthSouth's recent $1 billion spending spree and what it tells us about the already booming ambulatory surgery industry.

Relationship between superoxide dismutase and melanin in a pathogenic fungus

Since melanin is considered a virulence factor in Cryptococcus neoformans, its suppression at 37 degrees C has been perplexing. We now show an opposite thermal regulation of superoxide dismutase (SOD), consistent with a compensatory mechanism. Moreover, we demonstrate normal SOD and catalase levels in albino, oxygen-sensitive mutants. These results suggest that melanin is an antioxidant factor comparable in importance to SOD.

Nutrient intakes of women who are breastfeeding

OBJECTIVE

A study was carried out in Dunedin, New Zealand, to assess the adequacy of dietary intakes of a group of healthy women who had been exclusively breast feeding for approximately 3 months.

DESIGN

Demographic data and nutrient intakes as determined by two quantitative 24 h recalls within 2 weeks were collected from each woman. Dietary intakes were compared to Australian recommended nutrient intakes (RNIs) for lactating women.

SUBJECTS

From 93 eligible women who were recruited, 73 completed the study, giving a 78% response rate.

RESULTS

The mean (SD) energy intake of 8411 (2575) kJ (2007 kcal) was much lower than the recommended intake of 10,500 kJ. The majority of the women had intakes below two-thirds of the RNI for zinc, calcium, folate and vitamin A. Maternal age was significantly positively related to energy intakes (R2 = 14.2%), with women over thirty years having significantly higher energy intake (P = 0.01).

CONCLUSIONS

Findings suggest that lactation may be maintained on lower levels of energy intake than currently recommended, although there is concern that zinc and calcium may not be consumed in adequate amounts. Recommended intakes need to be reassessed to determine if they are too high for some nutrients. Maternal age appears to be a significant factor determining energy and nutrient intakes in this population.

A selective procedure for the field isolation of pathogenic Streptococcus spp. of rainbow trout (Salmo gairdneri)

A procedure established for the selective isolation of the species of Streptococcus responsible for rainbow trout streptococcosis in South Africa, consisted of the inoculation of samples into nutrient broth which had been supplemented with 100 micrograms/ml of nalidixic acid, 160 micrograms/ml of oxolinic acid or 200 micrograms/ml of sodium azide. After incubation, the sample was plated onto tetrazolium agar on which the rainbow trout pathogenic Streptococcus species grew as a red colony. The colonies were isolated from the tetrazolium agar and identified as rainbow trout pathogenic isolates by biochemical and serological tests. In the laboratory the selective procedure is capable of detecting about 2 bacteria per ml. This procedure was used in the field and biochemically identical Streptococcus species were found in the mud and a freshwater crab from the water source of a site with a history of streptococcosis.

Evaluation of immunoreactivity with monoclonal antibody NCRC 11 in breast carcinoma

Immunocytochemical staining with monoclonal antibody NCRC 11 of formalin fixed paraffin embedded tumour tissue has been studied in 444 cases of primary breast cancer with a minimum follow period of 6 years. The relationship between extent of staining, assessed on a four point scale, and patient survival has been confirmed. There are significant relationships between staining and both histological grade and oestrogen receptor status. No association has been shown between staining and lymph node stage or tumour size. Simplification of staining assessment by modification to two staining groups still allows significant separation of patients into prognostic groups and incorporation into an existing prognostic index.

The induction of stress-related proteins by lead

Differential inductive effects of lead on protein synthesis in rat fibroblasts and kidney epithelial cells were examined. The lead was administered as lead glutamate, a complex known to introduce lead into cells. Lead exposure induced the synthesis of three proteins which constitute two separate stress protein subgroups. Two of these proteins have been previously identified as the glucose-regulated proteins because their synthesis is induced by reagents which perturb glucose utilization. The third protein is inducible by several sulfhydryl-binding reagents including lead. This third protein has been compared with a protein, p32/6.3, of very similar size and isoelectric point, which has been associated with lead-induced intranuclear inclusion bodies. However, several features, including one-dimensional peptide maps, indicated that the third protein and p32/6.3 are not identical. The three lead-induced proteins are distinguished from the major group of stress proteins by their relative insensitivity to heat stress. Lead glutamate, on the other hand, induces neither the heat shock protein 70 nor metallothionein, both of which are strongly induced by several metals including cadmium, zinc, and mercury.

Evidence that glutathione participates in the induction of a stress protein

A step in the induction of a 30- to 35-kD stress protein may be the reaction of chemical inducers with glutathione. Effective inducers are sulfhydryl reagents. Further, a comparison of three reagents, 1-chloro-2,4-dinitrobenzene, diethylmaleate, and N-ethylmaleimide, indicates that the first two, which have considerable selectivity for glutathione, are strong inducers of the stress protein but the third, which is much more reactive with protein sulfhydryls, is either a poor or ineffective inducer. A decrease in cellular glutathione does not appear to be inductive, however. An increase in modified glutathione remains as a possible signal for the induction of this stress protein.

Stafne's bone cavity: a review of the literature and report of two cases

This paper reports two cases of Stafne's bone cavity, one of which shows apparent regression over a period of 8 years: an unusual feature that has not previously been reported. A comprehensive review of the literature dealing with this well demarcated mandibular radiolucency of unknown aetiology accompanies these two case reports.