Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation

OBJECTIVES

Proximal duodenal ulceration is often characterised by continuous bleeding, and treatment is challenging. The aims of this study were to investigate the role of vascularisation in proximal duodenal ulceration and describe clinical aspects, endoscopic features and treatment in dogs.

MATERIAL AND METHODS

Polyurethane foam casts of gastroduodenal vessels were obtained from five dogs which had died from disorders unrelated to the digestive system. In addition, 12 dogs having proximal duodenal ulcers diagnosed by endoscopic examination were enrolled in a treatment trial. After the endoscopic diagnosis of a duodenal ulcer, all the dogs were treated medically and, in the absence of resolution, were subsequently treated by endoscopic electrocauterisation or by surgery.

RESULTS

A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum. In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall. The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection of the proximal duodenal portion. All the dogs survived until discharge, and the median survival time following discharge was 107.5 days.

CLINICAL SIGNIFICANCE

Based on the anatomical details highlighted in this study, the continuous bleeding observed in our patients may have been due to the prominent venous plexus evidenced at the level of the proximal duodenum. Surgical and endoscopic treatments in six patients resolved the ulcer bleeding with no recurrences noted during follow-up.

Water immersion vs. air insufflation in canine duodenal endoscopy: is the future underwater?

Endoscopy represents a commonly employed technique for canine enteropathies. Different trials in human intestinal endoscopy have suggested that the introduction of water for luminal distension, in place of air, improves the visualization of the mucosal texture and decreases pain. The aim of the study was to compare water immersion (WI) vs. air insufflation (AI) during duodenoscopy in anesthetized dogs in terms of mucosal visualization and nociception. Twenty-five dogs undergoing duodenoscopy were included. The same image of the descending duodenum was recorded applying WI and AI. Each pair of images was analyzed using morphological skeletonization, an image entropy evaluation, and a subjective blind evaluation by three experienced endoscopists. To evaluate differences in nociception related to the procedure applied, heart rate and arterial blood pressure were measured before, during and after WI/AI. To compare the two methods, a t-test for paired data was applied for the image analysis, Fleiss' Kappa evaluation for the subjective evaluation and a Friedman test for anesthetic parameters. No differences were found between WI and AI using morphological skeletonization and entropy. The subjective evaluation identified the WI images as qualitatively better than the AI images, indicating substantial agreement between the operators. No differences in nociception were found. The results of the study pointed out the absence of changes in pain response between WI and AI, likely due to the sufficient control of nociception by the anesthesia. Based on subjective evaluation, but not confirmed by the image analysis, WI provided better image quality than AI.

First description of Streptococcus lutetiensis from a diseased cat

This paper describes for the first time the isolation of Streptococcus lutetiensis in a cat with intestinal lymphoma. The Streptococcus bovis group has undergone significant taxonomic changes over the past two decades and, in 2002, Poyart et al. described two distinct novel species within the genus Streptococcus: Streptococcus lutetiensis and Streptococcus pasteurianus. The bovis group streptococci include commensal species and subspecies or opportunistic pathogens of humans and animals. The cat was referred to the Veterinary Teaching Hospital, University of Bologna for chronic diarrhoea associated with fresh blood. A diagnosis of intestinal lymphoma was advanced. S. lutetiensis was accidentally isolated from the faeces of the cat and identified through MALDI-TOF and 16s rRNA sequencing. The Kirby-Bauer test revealed that the isolate was resistant to enrofloxacin, erythromycin, clindamycin, marbofloxacin and tetracycline. The detection of S. lutetiensis in cat faeces might suggest that it could be a normal inhabitant of cat intestinal tract or that it could be involved in the manifestation of intestinal diseases. Since bacteria belonging to the S. bovis group are considered emerging pathogens, additional research is required to evaluate the role of S. lutetiensis in cats and its role in the transmission of antimicrobial resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study the isolation of Streptococcus lutetiensis from a cat with intestinal lymphoma was described for the first time. An antimicrobial susceptibility test performed by means of the disc diffusion method revealed that the isolate was resistant to enrofloxacin, erythromycin, clindamycin, marbofloxacin and tetracycline. Nowadays the ecological or pathogenetic role of S. lutetiensis in the gut of animals remains unclear but, even if its role as commensal bacterium was confirmed, the presence of multi-resistant S. lutetiensis in cat gut could favour the transmission of antimicrobial resistance to other bacteria.

Evaluation of clinicopathological features in cats with chronic gastrointestinal signs

Food-responsive enteropathy (FRE), idiopathic inflammatory bowel disease (IBD), and alimentary tract lymphoma (AL) are often the remaining differentials for cats presenting with chronic gastrointestinal (GI) signs. Differential diagnosis is further complicated by overlapping clinicopathological features and histopathological changes, however. In this study we describe the clinical presentation of cats with chronic GI signs secondary to FRE, IBD, and AL, and evaluate possible associations between clinical, clinicopathological, ultrasonographic findings and diagnosis. The medical records of client-owned cats with chronic GI signs secondary to FRE, IBD, and AL were reviewed. Univariate and multivariate logistic regression models and receiver-operating characteristic curve (ROC) analysis were used for testing the data. Of the 56 cats included in the study, 22 were diagnosed with FRE (mean age, 70 months ± 49), 17 with IBD (mean age, 101 months ± 40), and 17 with AL (mean age, 122 months ± 45). Cats with FRE were younger and presented more often with diarrhea and less frequently with muscle wasting than cats with IBD or AL. In cats with AL, serum cobalamin levels were lower than in those with FRE or IBD (239 ± 190 ng/L vs. 762 ± 408 ng/L and 625 ± 443 ng/L, respectively) and folate levels were higher than in cats with IBD (18.2 ± 4.2 μg/L vs. 9.1 ± 4.7 μg/L, respectively). Multivariate/ROC curve analysis showed increased values of BUN (sensitivity 100, specificity 29.4, criterion >37 mg/dl) and serum folate (sensitivity 80, specificity 100, criterion >15.6 μg/L) and reduced values of cobalamin (sensitivity 100, specificity 62.5, criterion ≤540 ng/L), which suggested a diagnosis of AL versus IBD. Some clinicopathological features evaluated at diagnosis might suggest AL; however, because differentiating AL from IBD is often difficult, definitive diagnosis should be based on invasive diagnostic workup.

Clinicopathologic and prognostic factors in short- and long-term surviving dogs with protein-losing enteropathy

INTRODUCTION

The aim of the present study was to investigate the differences in the characteristics of short- and long-term surviving dogs with protein-losing enteropathy (PLE) and to identify factors that predict its outcome. We retrospectively reviewed the medical records of 59 client- owned dogs with PLE diagnosed at three different hospitals between January 2009 and November 2013. The dogs were classified as either short-term (= 6 months; STs) or long-term (> 6 months; LTs) survivors. Clinical and clinicopathological variables were investigated between the groups and receiver operating characteristic (ROC) curve analysis was performed. Nineteen dogs were classified as STs and 40 as LTs. Body weight and blood urea nitrogen concentrations were significantly higher in the STs at diagnosis (P < 0.05). At 1 month after initiation of immunosuppressive therapy (data- driven cut-off, T1), chronic canine enteropathy clinical activity index (CCECAI) scores were higher (P < 0.01) and albumin, serum total protein and total cholesterol concentrations were lower (P < 0.01) in the STs. ROC curve analysis showed that CCECAI > 5 evaluated at T1 was the best predictor of poor outcome. Although the severity of clinical signs and the majority of clinicopathological findings at diagnosis did not influence the outcome, survival time was shorter in the dogs with high CCECAI scores at T1 and which did not respond to therapy.

Acquisition of Involuntary Spinal Locomotion (Spinal Walking) in Dogs with Irreversible Thoracolumbar Spinal Cord Lesion: 81 Dogs

BACKGROUND

Spinal walking (SW) is described as the acquisition of an involuntary motor function in paraplegic dogs and cats without pain perception affected by a thoracolumbar lesion. Whereas spinal locomotion is well described in cats that underwent training trials after experimental spinal cord resection, less consistent information is available for dogs.

HYPOTHESIS

Paraplegic dogs affected by a thoracolumbar complete spinal cord lesion undergoing intensive physical rehabilitation could acquire an autonomous SW gait under field conditions.

ANIMALS

Eighty-one acute paraplegic thoracolumbar dogs without pelvic limb pain perception.

METHODS

Retrospective study of medical records of dogs selected for intensive rehabilitation treatment in paraplegic dogs with absence of pain perception on admission and during the whole treatment. Binary regression and multivariate logistic regression were used to analyze potential associations with the development of SW.

RESULTS

Autonomous SW was achieved in 48 dogs (59%). Median time to achieve SW was of 75.5 days (range: 16-350 days). On univariate analysis, SW gait was associated with younger age (P = .002) and early start of physiotherapy (P = .024). Multivariate logistic regression showed that younger age (≤60 months) and lightweight (≤7.8 kg) were positively associated with development of SW (P = .012 and P < .001, respectively). BCS, full-time hospitalization, and type and site of the lesion were not significantly associated with development of SW.

CONCLUSIONS

Dogs with irreversible thoracolumbar lesion undergoing intensive physiotherapic treatment can acquire SW. Younger age and lightweight are positively associated with the development of SW gait.

Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs

Background

A novel flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, UK) was recently developed for humans. It continuously measures the interstitial glucose (IG) concentrations for 14 days.

Objectives

To assess the clinical and analytical accuracy of the FGMS in diabetic dogs.

Animals

Ten client‐owned diabetic dogs on insulin treatment.

Methods

Prospective and observational study. The FGMS was placed on the neck for up to 14 days. During the 1st–2nd, 6–7th, and 13–14th days from application, the IG measurements were compared with the plasma (EDTA) glucose (PG) concentrations analyzed by a reference hexokinase based method.

Results

The application and the use of the FGMS were apparently painless, easy, and well tolerated by all dogs. Mild erythema at the site of the application was found in 5/10 dogs at the end of the wearing period. A good correlation between IG and PG concentrations (rho = 0.94; P < .001) was found. The FGMS was 93, 99, and 99% accurate at low, normal, and high blood glucose concentrations. Mean ± standard deviation difference from the reference method was 2.3 ± 46.8 mg/dL.

Conclusion and clinical importance

The FGMS is easy to use and is accurate for IG glucose measurement in diabetic dogs.

Prognostic factors for survival in dogs with pituitary-dependent hypercortisolism treated with trilostane

Pituitary-dependent hypercortisolism (PDH) is one of the most frequent endocrinopathies in dogs, but prognostic factors are largely unknown. The aim of this retrospective case series study was to determine the prognostic value of different clinical and clinicopathological variables evaluated in dogs newly diagnosed with PDH that were subsequently treated with trilostane. Medical records from one referral centre were evaluated. Eighty-five dogs with PDH were included. The median survival time was 852 days (range 2-3210 days); 60/85 (70 per cent) and 25/85 (29 per cent) dogs survived more than one and three years, respectively. In multivariable model analysis the length of survival of older dogs (HR 1.24, 95% CI 1.09 to 1.40) and dogs with higher serum phosphate concentrations (HR 1.35, 95% CI 1.01 to 1.81) was shorter. Serum phosphate concentrations were above the reference range in 37/85 (44 per cent) of animals. Clinical signs, liver enzymes, serum cortisol concentrations of the endocrine tests, proteinuria, systolic hypertension, the presence of concomitant disorders, and the frequency of trilostane administration were not associated with survival time. Hyperphosphataemia is a common finding in dogs with newly diagnosed PDH and represents a negative prognostic factor.

Clinical and pathological findings of acute zinc intoxication in a puppy

This report describes the clinical and pathological findings in a case of acute zinc poisoning in a young dog. The puppy suffered four days of progressively more severe vomiting and diarrhoea. Jaundice and pale mucous membranes, severe haematemesis and haemoglobinuria were other findings. Despite intensive therapy, the dog died a few hours after hospitalisation. Postmortem examination revealed a metallic foreign body in the stomach, catarrhal gastritis, hepatomegaly and enlarged, dark kidneys. Histology showed hepatic centrilobular vacuolar degeneration, haemoglobinuric nephrosis with early tubular necrosis, haemosiderosis and extramedullary haematopoiesis, as well as neuronal damage. The foreign body was mainly composed of zinc. Plasma zinc values were markedly raised (34.5 microg/ml; normal range 0.8 to 1.0 microg/ml). Pathophysiological mechanisms of zinc poisoning are discussed.

Atrial septal defect in five dogs

The clinical, electrocardiographic, radiographic, and two-dimensional, M-mode and Doppler echocardiographic findings of five cases of canine ostium secundum type atrial septal defect (ASD) are described. The atrial septal anomaly was associated with other congenital cardiac abnormalities in two dogs: ventricular septal defect in one case and tricuspid dysplasia in the other. ASD was found in addition to dilated cardiomyopathy and suspected atrial thrombosis in one geriatric dog, but was the only cardiac abnormality detected in the remaining two dogs. Colour Doppler imaging facilitated the diagnosis of ASD in all subjects. The long-term prognosis for dogs with isolated and small-sized ASD is usually good, but can be compromised by the presence of concurrent congenital or acquired cardiac diseases.

Aorticopulmonary septal defect in a German shepherd dog

A 2-year-old, female German shepherd dog was referred with a 2-month history of dyspnea, ascites, and anorexia. On physical examination, an arrhythmia, tachypnea, and a continuous grade V/VI heart murmur were evidenced. Atrial fibrillation and tall R waves were noted on electrocardiography. Survey thoracic radiography revealed generalized cardiomegaly and enlarged pulmonary vessels. Echocardiography demonstrated severe dilatation of the left atrium and ventricle with reduced fractional shortening. Doppler echocardiography showed continuous and turbulent flow in the ascending aorta between the aorta and the pulmonary artery. Necropsy demonstrated an aorticopulmonary septal defect.

In vitro mucolytic activity of recombinant human deoxyribonuclease on equine tracheobronchial mucus

The viscosity of the mucus, its DNA concentration and the size range of the DNA were determined on tracheobronchial samples from 11 horses with lower airway diseases before and after incubation with recombinant human deoxyribonuclease (rhDNase). The horses were divided into two groups on the basis of the cytology of the samples: group A (five horses) with more than 60 per cent neutrophils and group B (six horses) with fewer than 50 per cent neutrophils. The mean mucus viscosity and DNA concentration in the preincubation samples were significantly higher in group A than in group B, and there was a correlation between DNA concentration and mucus viscosity in the preincubation samples from group A. Incubation with rhDNase significantly reduced the viscosity of the samples only in group A.

Influence of left atrial enlargement and body weight on the development of atrial fibrillation: retrospective study on 205 dogs

We studied 205 dogs with cardiac diseases associated with left atrial enlargement (LAE). On the basis of electrocardiogram results, they were divided into: Group A, 50 dogs with atrial fibrillation (AF) and Group B, 155 dogs without AF. Group B was further subdivided in Group BI (123 dogs with sinus rhythm) and Group BII (32 dogs with cardiac arrhythmias other than AF). Bodyweight (BW) and left atrial diameter (LA) of Group A dogs were significantly greater (P< 0.05) than dogs in all other groups. The left atrium/aorta (LA/Ao) ratio of Group A dogs was significantly higher (P< 0.05) than that of dogs of Group B and BI. Using the couple of variables BW and LA, the logistic regression models were able to predict "non-development of AF" (with 92.3% probability) vs. "development of AF" (with 74% probability), and "maintaining sinus rhythm" (with 95.1% probability) vs."development of AF" (with 86% probability).

Left ventricular systolic function in primary aldosteronism and hypertension

OBJECTIVE

This study was designed to investigate whether the excess aldosterone found in primary aldosteronism (PA) influences left-ventricular systolic function (LVSF), through a positive inotropic effect

METHODS

M-mode and two-dimensional echocardiography and transmitral Doppler flow velocity measurements were performed in 82 patients: 44 with confirmed PA (23 male; 21 female; aged 51.8+/-13 years) and 38 essential hypertension patients (16 male; 22 female; aged 48.5+/-12 years) matched for demography and blood pressure (BP) values. We measured left-ventricular (LV) midwall fractional shortening (MwFSho) and LV circumferential end-systolic stress (cESS, calculated according to Reichek's equation) and analysed the relationship between MwFSho and cESS.

RESULTS

These are given as the mean +/- standard deviation. PA patients had significantly higher cardiac index (CI) (3.55+/-0.94 l/m2 vs 2.98+/-0.58, P < 0.005) and lower E wave/A wave time-velocity integral ratio (0.93+/-0.27 vs 1.26+/-0.41, P < 0.001) than EH, whereas mean BP (126+/-12 mmHg vs 128+/-12), MwFSho (17.1+/-2.4% vs 16.3+/-1.9), cESS (118+/-19 Kdynes/cm2 vs 121+/-18) and the relationship between LV MwFSho and LV cESS did not differ between groups.

CONCLUSION

These findings confirm that PA patients exhibit: (1) a modest increase of CI; (2) an LV diastolic filling mainly occurring with the atrial kick. However, they do not lend support to the contention that the excess of plasma aldosterone seen in PA is associated with enhanced LV inotropism under resting conditions.

Left ventricular performance in the early stages of systemic hypertension. HARVEST Study Group. Hypertension and Ambulatory Recording Venetia Study

To investigate whether and how frequently left ventricular (LV) systolic performance assessed with endocardial and midwall measurement is depressed in young subjects with mild systemic hypertension, we studied 722 borderline to mild hypertensive patients (mean age +/- SEM 33 +/- 0.3 years, mean office blood pressure (BP) 146 +/- 0.4/94 +/- 0.2 mm Hg) enrolled in the Hypertension and Ambulatory Recording Venetia Study and 50 normotensive controls with similar age and sex distribution. BP was measured with 24-hour ambulatory monitoring. LV dimensional and functional indexes were assessed by M-mode echocardiography and sympathetic activity from 24-hour urinary catecholamines. In 64 hypertensive subjects (8.9%) the LV midwall shortening-stress relation was < 95% of the confidence interval in 50 normotensive controls. Subjects with depressed LV myocardial function had age, duration of hypertension, and LV mass similar to those of hypertensives with normal performance, and greater relative wall thickness (0.42 vs 0.37, p < 0.001). Stroke volume and cardiac output were lower (p < 0.001) in the former group. Among these 64 subjects, endocardial performance was depressed in 35 (group 1) and normal in 29 (group 2). Group 2 subjects had greater posterior wall (10.0 vs 9.5 mm, p = 0.03), ventricular septum (10.6 vs 10.1 mm, p = 0.05), and relative wall (0.44 vs 0.40, p < 0.001) thicknesses than group 1 subjects. Urinary norepinephrine was 50% higher in group 2 subjects (106 vs 70 g/24 hours, p = 0.03). Stroke volume and cardiac output were similar in both groups. In conclusion, these results show that LV contractility may be depressed in young subjects with borderline to mild hypertension.

Pulsed wave-Doppler ultrasonographic evaluation of the common carotid artery in the resting horse: physiologic data

A pulsed wave-Doppler ultrasonographic evaluation of common carotid arterial blood flow was carried out on 63 healthy Italian Saddlebred horses. Vessel diameter and tracing morphology were evaluated and blood flow parameters (systolic, diastolic and mean velocity, acceleration and deceleration of the systolic wave, carotid pulse volume) were calculated and correlated with class variables (sex, age and body weight). On the basis of the presence of an incisure in the ascending branch of the systolic curve, subjects were divided in two groups: one with a bifid systolic curve and the other with a monophasic aspect. Correlations between: 1) diameter of the vessel and body weight and 2) carotid pulse volume and flow velocity (systolic, diastolic and mean) were found. A greater systolic pulse volume was found in male subjects, in subjects with greater body weight and in those which had a monophasic systolic wave.

[Prospective evaluation of the captopril test in diagnosing renal artery stenosis in hypertensive patients]

In order to verify the utility of the captopril test (CT) in diagnosing renal artery stenosis we performed a prospective study in 94 consecutive patients (40 females, 54 males, mean age 52.4 +/- 12.3 years) suspected of having renovascular hypertension and with a serum level of creatinine < 2 mg/dl. Antihypertensive drugs were withdrawn one week before the CT or, if this was considered unsafe, patients were treated with nifedipine or diltiazem (53 subjects; 56.4%). We used renal angiography and the Muller criteria to interpret the CT. Our results were as follows: sensitivity, 92%; specificity, 96%; positive predictive value, 88%; and negative predictive value, 97%. In our study a simplified criterion for positive CT-postcaptopril plasma renin activity > 10 ng/mL/h-provided a similar diagnostic value. We conclude that the captopril test is a useful screening test for the detection of renal artery stenosis in selected hypertensive patients and that it can also be reliably performed in patients who are taking calcium antagonists.