Heidi Phillips

Treatment of Severe Adverse Cutaneous Drug Reactions With Human Intravenous Immunoglobulin in Two Dogs

Severe adverse cutaneous reactions were documented in two dogs with acute skin lesions and systemic signs after exposure to several oral and injectable drugs. Because of the high morbidity and mortality rates of many severe cutaneous drug reactions and a poor response to supportive care, wound management, and conventional immunosuppressive therapy, human intravenous immunoglobulin (IVIG) was infused on 2 consecutive days (1 g/kg per day) after informed consent was received. Human IVIG, with supportive care, resulted in rapid resolution of dermatological and systemic signs in both dogs; this treatment may be considered in other cases of severe cutaneous drug reactions.

Surgical Revision of the Urethral Stoma Following Perineal Urethrostomy in 11 Cats: (1998-2004)

Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.

Retroperitoneal fibrosis in feline renal transplant recipients: 29 cases (1998-2011)

OBJECTIVE To evaluate features, treatment, and prognosis associated with retroperitoneal fibrosis that developed after renal transplantation in cats. DESIGN Retrospective case series. ANIMALS 29 cats. PROCEDURES Medical records of cats that developed retroperitoneal fibrosis after renal transplantation at the College of Veterinary Medicine, University of Pennsylvania, between 1998 and 2011 were reviewed for signalment, date of transplantation, age, results of urine and blood analyses, blood pressure at the time of diagnosis, infectious disease and medication anamneses, anesthetic protocols, and intraoperative complications. RESULTS Of 138 transplant recipients, 29 (21%) developed clinically important retroperitoneal fibrosis. Nineteen (66%) were male, and median age at the time of renal transplantation was 8 years (range, 4 to 13 years). Median number of days after transplantation to diagnosis of retroperitoneal fibrosis was 62 (range, 4 to 730 days; mean, 125 days). The most common clinical signs were lethargy and anorexia. All affected cats were azotemic (BUN concentration > 32 mg/dL; creatinine concentration > 2.0 mg/dL) and anemic (PCV < 35%) at the time of retroperitoneal fibrosis diagnosis, although cats were nonazotemic at the time of discharge following transplantation, and anemia was less pronounced. Twenty-five cats successfully underwent surgical ureterolysis in which scar tissue was dissected away from the allograft ureter to relieve extraluminal compression. Retroperitoneal fibrosis recurred in 6 (22%) cats a median of 180 days (range, 8 to 343 days) following the original diagnosis and was treated successfully by repeated ureterolysis. CONCLUSIONS AND CLINICAL RELEVANCE Retroperitoneal fibrosis occurred in a substantial percentage of feline renal transplant recipients and should be considered a differential diagnosis in any feline renal transplant recipient with clinicopathologic findings, imaging abnormalities, or signs suggestive of obstructive uropathy.

Use of end-to-side arterial and venous anastomosis techniques for renal transplantation in two dogs

CASE DESCRIPTION A sexually intact male Old English Sheepdog and a sexually intact female Bull Terrier were evaluated for renal dysplasia and chronic renal failure, respectively. CLINICAL FINDINGS Both dogs were anemic and had high serum concentrations of urea nitrogen and creatinine. Electrolyte abnormalities (calcium and phosphorus) were also evident. The decision was made to pursue renal transplantation, and donor dogs were identified. TREATMENT AND OUTCOME End-to-side anastomosis of the renal artery and vein of each donors left kidney to the recipients ipsilateral external iliac artery and vein, respectively, was performed. The left caudal abdominal musculature was scarified by making an incision, and nephropexy to that musculature was performed with a simple interrupted pattern of polypropylene sutures. No intraoperative or postoperative complications associated with the vascular anastomoses were encountered. Azotemia, anemia, and electrolyte imbalances resolved after transplantation. CLINICAL RELEVANCE The end-to-side anastomosis technique described here, which is a preferred method in human medicine, was successful, providing an alternative to other renal transplantation techniques in dogs. Additional studies are needed to determine whether any vascular anastomosis technique is preferable for use in dogs requiring renal transplantation.

Elution of Clindamycin and Enrofloxacin From Calcium Sulfate Hemihydrate Beads In Vitro

OBJECTIVE To compare the in vitro elution characteristics of clindamycin and enrofloxacin from calcium sulfate hemihydrate beads containing a single antibiotic, both antibiotics, and each antibiotic incubated in the same eluent well. STUDY DESIGN Experimental in vitro study. METHODS Calcium sulfate hemihydrate beads were formed by mixing with clindamycin and/or enrofloxacin to create 4 study groups: (1) 160 mg clindamycin/10 beads; (2) 160 mg enrofloxacin/10 beads; (3) 160 mg clindamycin + 160 mg enrofloxacin/10 beads; and (4) 160 mg clindamycin/5 beads and 160 mg enrofloxacin/5 beads. Chains of beads were formed in triplicate and placed in 5 mL phosphate buffered saline (PBS; pH 7.4 and room temperature) with constant agitation. Antibiotic-conditioned PBS was sampled at 14 time points from 1 hour to 30 days. Clindamycin and enrofloxacin concentrations in PBS were determined using high-performance liquid chromatography. RESULTS Eluent concentrations from clindamycin-impregnated beads failed to remain sufficiently above minimum inhibitory concentration (MIC) for common infecting bacteria over the study period. Enrofloxacin eluent concentrations remained sufficiently above MIC for common wound pathogens of dogs and cats and demonstrated an atypical biphasic release pattern. No significant differences in elution occurred as a result of copolymerization of the antibiotics into a single bead or from individual beads co-eluting in the same eluent well. CONCLUSION Clindamycin-impregnated beads cannot be recommended for treatment of infection at the studied doses; however, use of enrofloxacin-impregnated beads may be justified when susceptible bacteria are cultured.

Influence of anesthetic variables on short-term and overall survival rates in cats undergoing renal transplantation surgery

OBJECTIVE To identify factors associated with short-term (30-day) and overall survival rates in cats that underwent renal transplantation surgery (RTS). DESIGN Retrospective cohort study. ANIMALS 94 cats that underwent RTS from 1998 through 2010. PROCEDURES Data obtained from the medical records pertinent to RTS included cat signalment; anesthetic agents, techniques, and timings; supportive treatment; perioperative physiologic findings; and surgery and warm ischemia times. Associations with short-term and overall survival rates were investigated. RESULTS Median survival time was 653 days (range, 2 to 4,580 days). Prolonged anesthesia (median, 300 minutes; range, 225 to 445 minutes) reduced overall survival rate but did not influence short-term survival rate. No associations were identified between survival rates and anesthetic agent used, amount and type of fluid administered IV, physiologic abnormalities, and blood product administration. All cats that received μ-opioid receptor antagonists at anesthetic recovery to reverse the effects of μ-opioid receptor agonists survived for at least 30 days. High Hct at the end of anesthesia was also associated with an increase in short-term survival rate. Two cats had an intraoperative hemoglobin oxygen saturation < 90%, and both died within 7 days after surgery. Cats > 12 years old had a lower overall survival rate than did younger cats. CONCLUSIONS AND CLINICAL RELEVANCE Minimization of total anesthesia time, reversal of μ-opioid receptor agonists at the end of anesthesia, and prevention of intraoperative decreases in blood oxygen saturation and postoperative decreases in Hct appeared to help maximize postsurgical survival time in cats undergoing RTS.

Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993–2013)

OBJECTIVE To evaluate perioperative morbidity and outcome in dogs and cats undergoing esophageal surgery. DESIGN Retrospective case series. ANIMALS 63 client-owned dogs and 9 client-owned cats. PROCEDURES Medical records of dogs and cats that underwent esophageal surgery were reviewed for information on signalment, history, results of preoperative diagnostic testing, condition treated, details of surgery, intraoperative complications, and postoperative complications. Long-term follow-up data were obtained via veterinarian and client telephone conversations. The relationship between complications and survival to hospital discharge was evaluated by means of regression analysis. RESULTS The most common indication for surgical intervention was an esophageal foreign body in dogs (50/63 [79%]) and esophageal stricture in cats (3/9). Complications were documented in 54% (34/63) of dogs and 3 of 9 cats. The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat). Partial esophagectomy and resection with anastomosis were significantly associated with the development of immediate postoperative complications in dogs. The most common delayed postoperative complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat). For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed postoperative complications. Six dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were negative prognostic factors for dogs being discharged from the hospital. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that the short-term prognosis for dogs and cats that survive surgery for treatment of esophageal lesions is favorable, with 90% of patients discharged from the hospital (57/63 dogs; 8/9 cats). However, dogs treated for more extensive esophageal lesions as well as those undergoing esophagectomy or resection and anastomosis were more likely to develop postoperative complications.

Effect of an intraoperative infusion of amino acids on body temperature, serum biochemistry, serum insulin and recovery variables in healthy dogs undergoing ovariohysterectomy

Change in body temperature (BT), serum biochemistry and recovery variables were compared after infusion of amino acids (AA) or lactated Ringer’s solution (LRS) in dogs undergoing ovariohysterectomy. Dogs received eight parts 10 per cent AA and two parts LRS (AA, n=10) or only LRS (CG, n=10) at 10 ml/kg/hour during 90 minutes of anaesthesia. BT was measured during anaesthesia and 60 minutes of recovery. Extubation time and shivering were noted. Serum samples were obtained before anaesthesia (T0), end of anaesthesia (T90) and 18 hours after (T18h). Friedman, Mann-Whitney, Kruskal-Wallis or Fisher’s exact tests were used for analysis. A decrease in BT of −2.16 (−1.59 to −3.24)°C for group AA and −2.79 (−1.98 to −4.52)°C for group CG was different (P=0.02). Time to extubation was 5 (3–9) minutes for group AA and 9 (5–15) minutes for group CG and was different (P=0.01). Only 30 per cent of dogs in group AA and 100 per cent of dogs in group CG shivered during recovery (P=0.003). Glucose, insulin and blood urea nitrogen at T90 were higher than T0 and T18h for group AA. Dogs receiving intraoperative infusion of AA had a higher BT, extubated sooner and shivered less than control dogs at recovery from anaesthesia.

Characterization of long-term elution of platinum from carboplatin-impregnated calcium sulfate hemihydrate beads in vitro by two distinct sample collection methods

OBJECTIVE To characterize long-term elution of platinum from carboplatin-impregnated calcium sulfate hemihydrate (CI-CSH) beads in vitro by comparing 2 distinct sample collection methods designed to mimic 2 in vivo environments. SAMPLES 162 CI-CSH beads containing 4.6 mg of carboplatin (2.4 mg of platinum/bead). PROCEDURES For method 1, which mimicked an in vivo environment with rapid and complete fluid exchange, each of 3 plastic 10-mL conical tubes contained 3 CI-CSH beads and 5 mL of PBS solution. Eluent samples were obtained by evacuation of all fluid at 1, 2, 3, 6, 9, and 12 hours and 1, 2, 3, 6, 9, 12, 15, 18, 22, 26, and 30 days. Five milliliters of fresh PBS solution was then added to each tube. For method 2, which mimicked an in vivo environment with no fluid exchange, each of 51 tubes (ie, 3 tubes/17 sample collection times) contained 3 CI-CSH beads and 5 mL of PBS solution. Eluent samples were obtained from the assigned tubes for each time point. All samples were analyzed for platinum content by inductively coupled plasma-mass spectrometry. RESULTS Platinum was released from CI-CSH beads for 22 to 30 days. Significant differences were found in platinum concentration and percentage of platinum eluted from CI-CSH beads over time for each method. Platinum concentrations and elution percentages in method 2 samples were significantly higher than those of method 1 samples, except for the first hour measurements. CONCLUSIONS AND CLINICAL RELEVANCE Sample collection methods 1 and 2 may provide estimates of the minimum and maximum platinum release, respectively, from CI-CSH beads in vivo.

Septicemia and Infection due to ESBL-producing K. pneumoniae Following Feline Renal Allograft Transplantation.

A 12 yr old castrated male domestic longhair underwent renal transplantation for treatment of chronic interstitial nephritis. Full-thickness intestinal biopsies obtained prior to transplantation revealed mild enteritis. Twelve months following transplantation, the patient underwent surgery for resection of a mesenteric mass causing septic peritonitis. The mesenteric mass was resected and an intestinal resection and anastomosis was performed. Extended-spectrum-β-lactamase producing Klebsiella pneumoniae was cultured from the resected tissue and urinary tract. Bacterial rods were noted to be circulating in the bloodstream, causing septicemia. Despite aggressive treatment of the septic peritonitis and septicemia using surgical debridement, drain placement, aggressive antibiotic therapy with IV meropenem, and vasopressor support, the patient succumbed to persistent hypotension and suffered cardiopulmonary arrest. Extended-spectrum-β-lactamase-producing bacteria are of growing concern in human and veterinary medicine, maintaining susceptibility often only to carbapenem and aminoglycoside antibiotics. Resistance to even those antibiotics is emerging. Veterinary patients with a history of antibiotic therapy, central venous or urinary catheterization, immunosuppression, enteric surgery, and an extended stay in the intensive care unit may be predisposed.