Mary A. McLoughlin

Spontaneous gastroduodenal perforation in 16 dogs and seven cats (1982-1999).

The records of 23 dogs and cats diagnosed with spontaneous gastroduodenal perforation (GDP) were retrospectively reviewed. Survival was 63% in dogs and 14% in cats. Rottweilers <5 years of age were overrepresented. Clinical evidence of gastrointestinal bleeding was common in dogs but not in cats. Shock was an uncommon presenting condition in dogs and was not closely linked to outcome. In fact, progression of an ulcerating lesion to GDP was not associated with marked changes in symptoms exhibited by many patients in this study. Most GDPs were associated with histopathological evidence of subacute or chronic peritoneal reaction at the time of diagnosis. This suggests that diagnostic methods employed lacked sensitivity in identifying early perforating lesions, and that dramatic signs of acute abdomen following gastroduodenal perforation may not be as common as was previously thought.

SURGICAL EMERGENCIES OF THE URINARY TRACT

True emergencies of the urinary tract center on three major issues, including uncontrolled renal hemorrhage, accumulation of urine within the peritoneal cavity or retroperitoneal space, and obstruction to urine outflow. Successful management of urinary tract emergencies in small animal patients is based not only on the severity of the injury or obstruction but on the condition of the patient at the time of diagnosis and the patients response to medical stabilization. When most urinary tract emergencies are initially recognized, patients are metabolically and hemodynamically unstable. Therefore, urinary tract emergencies are first regarded as medical emergencies, and emergency surgical procedures are aimed at patient stabilization and lifesaving measures.

Epsilon aminocaproic acid for the prevention of delayed postoperative bleeding in retired racing greyhounds undergoing gonadectomy.

OBJECTIVE To evaluate the effects of epsilon aminocaproic acid (EACA) on the prevalence of postoperative bleeding in retired racing Greyhounds (RRG), and to assess its effects on selected thrombelastography (TEG) and fibrinolysis variables. STUDY DESIGN Double-blinded, prospective, randomized study. METHODS 100 RRG had elective ovariohysterectomy or orchiectomy and were administered EACA or placebo for 3 days after surgery. TEG variables were analyzed preoperatively and 24, 48, and 72 hours after surgery. RESULTS Thirty percent (15/50) of RRG in the placebo group had delayed postoperative bleeding starting 36-48 hours after surgery compared with 10% (5/50) in the EACA group (P = .012). On the TEG variables, the slopes for R and K time were significantly different between treatment groups (P <.05); the R and K time decreased over time in the EACA group after surgery whereas they increased in the placebo group. The angle, maximal amplitude (MA), and G slopes were also significantly different between treatment groups (P = .001, .001, and .006, respectively). The angle, MA, and G increased postoperatively over time in the EACA group and decreased in the placebo group. All these changes are supportive of hypercoagulability associated with EACA administration. CONCLUSION Postoperative administration of EACA significantly decreased the prevalence of postoperative bleeding in RRG undergoing surgery by increasing the clot strength.

Surgical and nonsurgical treatment of peritoneopericardial diaphragmatic hernia in dogs and cats: 58 cases (1999–2008)

OBJECTIVE To determine clinical findings and outcomes for cats and dogs with peritoneopericardial diaphragmatic hernia (PPDH) treated surgically or nonsurgically. DESIGN Retrospective case series. ANIMALS 28 dogs and 30 cats. PROCEDURES Medical records for cats and dogs evaluated at 1 of 2 veterinary teaching hospitals were reviewed, and data regarding clinical signs, diagnostic and surgical findings, and outcome were evaluated. RESULTS Prevalence of PPDH in the 2 hospitals during the study period was 0.025% (0.062% and 0.015% for cats and dogs, respectively); PPDH was an incidental finding for 13 (46.4%) dogs and 15 (50.0%) cats. Other congenital abnormalities were identified in 16 (571%) dogs and 7 (23.3%) cats (most commonly umbilical hernias, abdominal wall hernias cranial to the umbilicus, or sternal anomalies). Thirty-four (58.6%) animals underwent surgical repair of PPDH; 27 (79.4%) of these animals had a primary diagnosis of PPDH. Detection of clinical signs of PPDH (primary diagnosis) and intestines in the pericardial sac were significantly associated with surgical treatment. Short-term mortality rate for surgically treated animals was 8.8% (3/34). Clinical signs associated with PPDH resolved in 29 (85.3%) of surgically treated animals. No significant differences were detected between dogs and cats or between surgically and nonsurgically treated animals regarding long-term survival rate. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study indicated animals with clinical signs of PPDH were more likely to undergo surgery than were animals without such signs. Herniorrhaphy was typically effective for resolution of clinical signs. Long-term survival rates were similar regardless of treatment method. Surgical or nonsurgical treatment of PPDH may be appropriate for animals with or without clinical signs, respectively.

Retrospective evaluation of the effectiveness of epsilon aminocaproic acid for the prevention of postamputation bleeding in retired racing Greyhounds with appendicular bone tumors: 46 cases (2003–2008)

OBJECTIVES To determine the frequency of delayed postoperative bleeding in retired racing Greyhounds with appendicular bone tumors undergoing limb amputations. To identify if administration of epsilon-aminocaproic acid (EACA) was effective on the prevention of postoperative bleeding. DESIGN Retrospective study from December 2003 to December 2008. SETTING Veterinary university teaching hospital. ANIMALS Forty-six retired racing Greyhounds (RRGs) diagnosed with primary appendicular bone tumors that underwent limb amputation were included in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirteen of 46 RRGs (28%) included in the study had delayed postoperative bleeding starting 48-72 h after surgery. Bleeding episodes included cutaneous, subcutaneous, and external bleeding that extended from the area of the surgical site that became widespread within hours, and that required administration of blood components. A paired t-test suggests that there was a significant decrease in PCV postoperatively for both dogs that bled and dogs that did not bleed (P < 0.0001). Forty of 46 RRGs (86%) received either fresh frozen plasma (FFP) or EACA or both, for the prevention of postoperative bleeding. A logistic regression model determined that dogs that did not receive EACA were 5.7 times more likely to bleed than dogs that did receive EACA, when controlling for whether or not they received FFP (95% CI: 1.02-32.15, P = 0.047). CONCLUSION This retrospective study suggests that preemptive postoperative administration of EACA appears to be efficacious in decreasing the frequency of bleeding in RRGs undergoing limb amputation; however, a prospective study is warranted to corroborate its effectiveness.

Uroendoscopy. Evaluation of the lower urinary tract.

Recent advances in uroendoscopy have allowed diagnostic evaluation of the lower urinary tract in most of our canine and feline patients. By providing a magnified view of the luminal surfaces of the lower urinary tract, uroendoscopy provides useful diagnostic information that is not readily available even by more invasive techniques.

Outcome after Placement of an Artificial Urethral Sphincter in 27 Dogs

Objective To evaluate the safety and efficacy of an adjustable artificial urethral sphincter (AUS) in a population of dogs with acquired or congenital urinary incontinence. Study Design Case series. Animals Dogs (n = 27) with naturally occurring urinary incontinence. Methods Medical records (January 2009–July 2011) of dogs that had AUS implantation for treatment of urinary incontinence were reviewed and owners were interviewed by telephone to assess outcome. Continence was scored using a previously established analogue scale, with 1 representing constant leakage and 10 representing complete continence. Results Twenty-four female and 3 male dogs had AUS implantation. Causes of incontinence included urethral sphincter mechanism incompetence (n = 18), continued incontinence after ectopic ureter repair (6), and pelvic bladder (3). Medical therapy was unsuccessful in 25 dogs before AUS implantation. Surgery was performed without major complications in 25 dogs; 2 developed partial urethral obstruction after 5 and 9 months. Median (interquartile range) follow-up for the other 25 dogs was 12.5 (6–19) months. Continence scores were significantly improved (P < .0001) between the preoperative period (2 [1–4]) and last follow-up (9 [8–10]). Overall, 22 owners described themselves as very satisfied, 2 as satisfied, and 3 as unsatisfied. Conclusions AUS implantation was successful in restoring continence in male and female dogs with both congenital and acquired urinary incontinence. Dogs that develop partial urethral obstruction may require AUS removal.OBJECTIVE To evaluate the safety and efficacy of an adjustable artificial urethral sphincter (AUS) in a population of dogs with acquired or congenital urinary incontinence. STUDY DESIGN Case series. ANIMALS Dogs (n = 27) with naturally occurring urinary incontinence. METHODS Medical records (January 2009-July 2011) of dogs that had AUS implantation for treatment of urinary incontinence were reviewed and owners were interviewed by telephone to assess outcome. Continence was scored using a previously established analogue scale, with 1 representing constant leakage and 10 representing complete continence. RESULTS Twenty-four female and 3 male dogs had AUS implantation. Causes of incontinence included urethral sphincter mechanism incompetence (n = 18), continued incontinence after ectopic ureter repair (6), and pelvic bladder (3). Medical therapy was unsuccessful in 25 dogs before AUS implantation. Surgery was performed without major complications in 25 dogs; 2 developed partial urethral obstruction after 5 and 9 months. Median (interquartile range) follow-up for the other 25 dogs was 12.5 (6-19) months. Continence scores were significantly improved (P < .0001) between the preoperative period (2 [1-4]) and last follow-up (9 [8-10]). Overall, 22 owners described themselves as very satisfied, 2 as satisfied, and 3 as unsatisfied. CONCLUSIONS AUS implantation was successful in restoring continence in male and female dogs with both congenital and acquired urinary incontinence. Dogs that develop partial urethral obstruction may require AUS removal.

Complications of Lower Urinary Tract Surgery in Small Animals

Surgical procedures of the lower urinary tract are commonly performed in small animal practice. Cystotomy for removal of uroliths and urethrostomy diverting urine outflow due to urethral obstruction are the most commonly performed surgical procedures of the bladder and urethra respectively. Surgical procedures of the lower urinary tract are typically associated with few complications, including leakage of urine, loss of luminal diameter (stricture or stenosis), urine outflow obstruction, tissue devitalization, denervation, urinary incontinence, urinary tract infection, and death. Complications can result from inappropriate or inadequate diagnosis, localization, and surgical planning; failure to respect regional anatomy, and other causes.

Thromboelastographic changes after gonadectomy in retired racing greyhounds

Twenty-one healthy greyhounds with no history or clinical signs of bleeding disorders, and no abnormalities on physical examination, complete blood count, serum biochemistry profiles (in dogs more than five years of age), and SNAP-4DX test for vector borne diseases underwent routine gonadectomies at the Ohio State University Veterinary Teaching Hospital. Blood samples were collected 24 hours before and after surgery by jugular venepuncture for thromboelastography and haemostasis assays (prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen concentration). The magnitude of the bleeding in each patient was estimated using a bleeding scoring system recently validated in greyhounds. Eight dogs were classified as bleeders and 13 as non-bleeders. Thromboelastograph (TEG) tracings in bleeders were different to that of non-bleeders. Neither sex (odds ratio [OR]: 0.148, P=0.05), haematocrit (OR: 0.907, P=0.39), platelet count (OR: 0.996, P=0.65) or age (OR: 0.949, P=0.83) were predictors of the outcome. None of the variables that evaluated clot kinetics, and fibrinolysis (that is, aPTT OR: 0.781, P=0.51; PT OR: 1.337, P=0.63; TEGR OR: 1.269, P=0.06; TEGK OR: 1.696, P=0.05; TEGLY60 OR: 1.028, P=0.81) were able to predict the bleeding episodes. Only the TEG variables that represent the fibrin cross-linking of the clot (TEGangle OR: 0.903, P=0.03); and the strength of the clot (TEGMA OR: 0.833, P=0.03) were considered predictors of the outcome.

Ectopic Ureters in Male Dogs: Review of 16 Clinical Cases (1999–2007)

Ureteral ectopia is a well-described cause of urinary incontinence in female dogs, but this condition has not been completely characterized in male dogs. Sixteen male dogs with ectopic ureters were evaluated between Jan 1999 and Mar 2007. Male dogs were similar to female dogs with ectopic ureters in terms of breed, presenting complaint, age of onset, and bilateral nature of the ectopia. Diagnosis was made by expert interpretation of imaging techniques such as excretory urography and contrast-enhanced computed tomography (CT). Overall, 11 of 13 dogs that had surgical correction of ectopic ureters were incontinent preoperatively. Urinary continence was restored in 82% of those dogs.