Margo L. Mehl

Long-term outcome after surgical ameroid ring constrictor placement for treatment of single extrahepatic portosystemic shunts in dogs

OBJECTIVEnTo report long-term clinical outcome in dogs treated for single congenital extrahepatic portosystemic shunt (CEHPSS) with a ameroid ring constrictor (ARC) and to identify perioperative variables associated with outcome.nnnSTUDY DESIGNnRetrospective, multi-institutional study.nnnANIMALSnDogs (nu2009=u2009206) with CEHPSS.nnnMETHODSnMedical records of dogs with CEHPSS treated by ARC were reviewed for perioperative and short-term (<1 month) data. Long-term follow-up information was obtained by telephone interview with referring veterinarians and/or owners. Kaplan-Meier analysis was used to estimate median survival time. Factors associated with short-term survival, outcome grade, and total survival time were identified.nnnRESULTSnFifteen dogs died <1 month after ARC placement. Follow-up data were obtained for 112 of 191 dogs that survived >1 month; median follow was 54 months (range, 1-175 months) and 103 (92%) dogs had no clinical signs. Estimated median survival time was 152 months. Variables significantly associated with short-term survival included being intact and a low total white blood cell (WBC) count. Variables significantly associated with a successful outcome included having surgery later in the study period and negative postoperative nuclear scintigraphy. In the long-term survival analyses, intact dogs and those with higher WBC counts and occlusion pressures and lower bile acid concentrations were more likely to survive.nnnCONCLUSIONSnDogs with CEHPSS treated by ARC generally have a good prognosis and prolonged postoperative survival.

Outcome of permanent tracheostomy for treatment of upper airway obstruction in cats: 21 cases (1990–2007)

OBJECTIVEnTo determine clinical outcome of permanent tracheostomy in cats with upper airway obstruction.nnnDESIGNnRetrospective case series.nnnANIMALSn21 cats.nnnPROCEDURESnMedical records were reviewed for information on history, signalment, clinical signs, results of preoperative clinicopathologic testing, cause of upper airway obstruction, surgical procedure, postoperative complications, and outcome.nnnRESULTSnCauses of upper airway obstruction included neoplasia (squamous cell carcinoma [n = 6] or malignant lymphoma [2]), inflammatory laryngeal disease (5), laryngeal paralysis (4), trauma (3), and a laryngeal mass of unknown cause (1). Fourteen cats had dyspnea in the immediate postoperative period; dyspnea most often resulted from mucous plugs at the stoma or elsewhere in the respiratory tract. Eleven cats died, including 6 cats that died while hospitalized after surgery and 5 cats that died after discharge; 7 cats were euthanatized, most often because of progression of neoplasia; and 2 were still alive at the time of the study. The remaining cat was lost to follow-up after discharge from the hospital. Overall, median survival time for the 20 cats for which information was available was 20.5 days (range, 1 day to 5 years). Cats that underwent permanent tracheostomy because of inflammatory laryngeal disease were 6.61 times as likely to die as cats that underwent permanent tracheostomy for any other reason.nnnCONCLUSIONS AND CLINICAL RELEVANCEnResults indicated that permanent tracheostomy was an uncommon procedure in cats with upper airway obstruction that was associated with high complication and mortality rates.

Outcome after renal transplantation in 26 dogs.

OBJECTIVESnTo evaluate clinical outcome in dogs after renal transplantation and determine predictors of outcome.nnnSTUDY DESIGNnRetrospective case series.nnnANIMALSnDogs (n = 26) that had renal allograft transplantation.nnnMETHODSnMedical records (1994-2006) of 26 consecutive cases of dogs that had kidney transplantation were reviewed. History, signalment, pre- and postoperative clinicopathologic and monitoring variables, postoperative complications, immunosuppressive therapy, and survival were recorded.nnnRESULTSnMedian survival was 24 days (range, 0.5 to 4014 days) with a probability of survival to 15 days of 50% and the 100-day survival probability was 36%. Cause of death was attributed to thromboembolic disease in 8 dogs, infection in 6 dogs, and rejection in 1 dog. The only factor significantly associated with an increased likelihood of death was increasing age at time of surgery (P = .024).nnnCONCLUSIONSnCanine renal transplantation in clinical patients is associated with a high morbidity and mortality and increasing recipient age has a negative association with outcome. Thromboembolic complications are a major cause of death in the immediate postoperative period and effective anticoagulation protocols may greatly improve survival in the future.

Hypophosphatemia in cats after renal transplantation.

OBJECTIVEnTo report the prevalence of hypophosphatemia after renal transplantation in a historical cohort of cats.nnnDESIGNnCase series.nnnANIMALSnCats (n=86) that received a renal allograft.nnnMETHODSnMedical records (January 200-June 2006) were reviewed. Signalment, clinical signs, pre- and postoperative diet, pre- and postoperative clinicopathologic variables, renal histopathology, and outcome were retrieved. Prevalence, onset, duration, treatment and associated clinical signs of hypophosphatemia were recorded. A chi(2) test was used to compare hemolysis frequency between cats with normal serum phosphorus concentration or a single spurious low serum phosphorus concentration for <24 hours duration (group 1) and confirmed hypophosphatemia for >24 hours (group 2). A Cox proportional hazards model was used to evaluate the effects of hypophosphatemia on survival while controlling for other potentially confounding variables (age, sex, weight, body condition score, and pre- and 24 hours postoperative clinicopathologic variables).nnnRESULTSnEighty-six cats (mean age, 7.7 years) were identified. Hypophosphatemia occurred in 32 cats (37%), with a median onset of 2 days and median duration of 4 days. Treatment was initiated in 48 (56%) of hypophosphatemic cats. Survival and hemolysis frequency was not significantly different between groups, and no risk factors were identified.nnnCONCLUSIONnHypophosphatemia occurs in cats after renal transplantation and does not affect survival.nnnCLINICAL RELEVANCEnThe clinical importance of hypophosphatemia in renal transplant recipients remains unknown.