Mickey Tivers

Gastric dilation‐volvulus syndrome in dogs 1. Pathophysiology, diagnosis and stabilisation

GASTRIC dilation‐volvulus syndrome (GDVs) comprises acute gastric dilation (GD), acute gastric dilation‐volvulus (GDV) and chronic gastric volvulus. This article, the first of two reviewing the management of GDVs in dogs, discusses the pathogenesis, pathophysiology, diagnosis and stabilisation of GDV. An article in the next issue will describe surgical and postoperative

Gastric dilation–volvulus syndrome in dogs: 2. Surgical and postoperative management

GASTRIC dilation–volvulus (GDV) is a challenging but rewarding condition to treat. Appropriate decision making and management can help to achieve a success rate of up to 95 per cent in cases uncomplicated by gastric necrosis. This article, the second of two reviewing the management of canine gastric dilation–volvulus syndrome (GDVs), describes the surgical and postoperative management of GDVs in dogs. An article in the February issue (In Practice, volume 31, pp 66-69) discussed the diagnosis and initial stabilisation of patients with GDVs.

Hepatic Hepcidin Gene Expression in Dogs with a Congenital Portosystemic Shunt

Background Microcytic anemia is common in dogs with a congenital portosystemic shunt (cPSS) and typically resolves after surgical attenuation of the anomalous vessel. However, the pathophysiology of the microcytic anemia remains poorly understood. Hepcidin has been a key role in controlling iron transport in both humans and animals and in mediating anemia of inflammatory disease in humans. The role of hepcidin in the development of microcytic anemia in dogs with a cPSS has not been examined. Hypothesis To determine whether hepatic hepcidin mRNA expression decreases, while red blood cell count (RBC) and mean corpuscular volume (MCV) increase in dogs after surgical attenuation of a cPSS. Animals Eighteen client‐owned dogs with confirmed cPSS undergoing surgical attenuation. Method Prospective study. Red blood cell count (RBC) and mean corpuscular volume (MCV), together with hepatic gene expression of hepcidin, were measured in dogs before and after partial attenuation of a cPSS. Results There was a significant increase in both RBC (median pre 6.17 × 1012/L, median post 7.08 × 1012/L, P < .001) and MCV (median pre 61.5fl, median post 65.5fl, P = .006) after partial surgical attenuation of the cPSS. Despite the increase in both measured red blood cell parameters, hepatic gene expression of hepcidin remained unchanged. Conclusions and Clinical Importance This study found no evidence that dysregulated production of hepcidin was associated with anemia in dogs with a cPSS.

Intrahepatic congenital portosystemic shunts in dogs: short- and long-term outcome of suture attenuation

OBJECTIVESnTo report the short- and long-term outcomes of one- or two-staged suture attenuation for complete closure of intrahepatic congenital portosystemic shunts in dogs.nnnMATERIALS AND METHODSnRetrospective cohort study of dogs surgically treated for intrahepatic congenital portosystemic shunts between February 2000 and March 2015. Long-term follow-up was conducted by telephone conversations with the referring veterinary surgeon, owner, or both.nnnRESULTSnIn total, 55 dogs had suture attenuation of their intrahepatic congenital portosystemic shunt; 10 dogs (18·2%) tolerated complete attenuation, whilst 45 dogs (81·8%) tolerated partial attenuation. Postoperative complications occurred in 24 dogs (43·6%), and six dogs (10·9%) died. Repeat surgery was performed in 33 of 39 dogs (84·6%) that had previously undergone partial attenuation, and 27 of these (84·9%) ultimately achieved complete shunt attenuation. One dog (3·0%) died following second surgery, resulting in an overall postoperative mortality of seven of 55 (12·7%). Detailed follow-up was available for 22 dogs that were still alive at a median of 29u2009months after surgery (7·4 to 103·1) with a subjectively good quality of life. Of 17 dogs (82·4%), 14 with complete attenuation in one or two surgeries had an excellent outcome compared with one of five dogs (20%) with persistent shunting.nnnCLINICAL SIGNIFICANCEnStaged suture ligation resulted in a high proportion of complete attenuation and reduced persistent shunting compared with a single surgery. Repeat surgery was associated with fewer complications than the first surgery. The proportion of dogs with an excellent outcome was greater for those that had complete attenuation in one or two surgeries compared with those with persistent shunting.

Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review: Treatment of intrahepatic CPSS in dogs

The aim of this study was to establish the evidence base for the treatment of intrahepatic congenital portosystemic shunts in dogs through a systematic review of the pertinent literature. Studies were filtered for evidence to answer the question Which of the treatment options for intrahepatic CPSS in dogs offers the best short- and long-term outcome? Studies were assigned a level of evidence based on a system published by the Oxford Centre for Evidence-Based Medicine. Thirty-two studies were included in the review. Twenty-six provided level 4 evidence and six provided level 5 evidence. There were no level 1, 2 or 3 studies. One study compared surgical treatment with medical management and one study compared suture ligation with ameroid constrictor placement. The remaining studies were case series describing the outcome for one treatment method alone. Methods and timings of assessments of short- and long-term outcomes were highly varied, making direct comparisons challenging. The evidence regarding the treatment of intrahepatic congenital portosystemic shunts in dogs is weak, with only two studies directly comparing treatments. There is a lack of evidence regarding short- and long-term outcomes on which to base clinical decisions.

Gall bladder mucoceles in Border terriers

Background Gall bladder mucoceles (GBM) are a leading cause of biliary disease in dogs with several breeds, including the Shetland Sheepdog, American Cocker Spaniel, Chihuahua, Pomeranian, and Miniature Schnauzer apparently predisposed. Objective To determine risk factors, clinical features, and response to treatment of GBM in Border terriers (BT). Animals Medical records of 99 dogs (including 51 BT) with an ultrasonographic (±histopathologic) diagnosis of GBM from three referral centers in the United Kingdom were collected. A control group of 87 similar‐aged BT with no ultrasonographic evidence of gall bladder disease was selected for comparison. Method Retrospective case‐control study. Odds ratios were calculated to establish breed predisposition. Signalment, presence of endocrine disease, clinicopathologic results, and outcome were compared between the BT, other breeds, and control BTs. Results The odds of identifying a GBM in a BT in this hospital population was 85 times that of all other breeds (95% confidence interval 56.9‐126.8). BT had similar clinical signs and clinicopathologic changes to other breeds with GBM. There was no evidence that endocrinopathies were associated with GBM in BT. Clinical Significance A robust breed predisposition to GBM is established for the BT.

Long-term outcome of female dogs treated with static hydraulic urethral sphincter for urethral sphincter mechanism incompetence

The purpose of the study was to report the postoperative outcome, complications, and long-term follow-up of the use of a static hydraulic urethral sphincter for the management of urethral sphincter mechanism incompetence in female dogs. Medical records were reviewed to extract information on long-term (>365 days) outcome data. Telephone owner questionnaire was performed to assess postoperative urinary continence scores (scale 1-10, where 10 is complete continence) and the presence and frequency of complications. Twenty female dogs were included. Mean (±standard deviation) time to follow-up was 1,205.1 (±627.4) days. Median continence score/10 (range) was 3.5 (2-6) preoperatively, and 9.0 (7-10) at the last follow-up. Median continence score was significantly higher at all time points postoperatively compared with before surgery (P < .001). Complete continence was achieved in 90% of bitches. Minor complications occurred in 13 bitches and included dysuria (8), bacterial cystitis (8), longer urination time (10), incisional seroma (5), urinary retention (3), hematuria (2), and pain when urinating (2). Major complications occurred in one dog (static hydraulic urethral sphincter removed 28 mo after placement). Continence scores were sustainably improved in the long-term. Complications were mostly minor. Urinary tract infections were the most common but resolved with conventional antibiotic treatment.

Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review

The aim of this study was to establish the evidence base for the treatment of intrahepatic congenital portosystemic shunts in dogs through a systematic review of the pertinent literature. Studies were filtered for evidence to answer the question Which of the treatment options for intrahepatic CPSS in dogs offers the best short- and long-term outcome? Studies were assigned a level of evidence based on a system published by the Oxford Centre for Evidence-Based Medicine. Thirty-two studies were included in the review. Twenty-six provided level 4 evidence and six provided level 5 evidence. There were no level 1, 2 or 3 studies. One study compared surgical treatment with medical management and one study compared suture ligation with ameroid constrictor placement. The remaining studies were case series describing the outcome for one treatment method alone. Methods and timings of assessments of short- and long-term outcomes were highly varied, making direct comparisons challenging. The evidence regarding the treatment of intrahepatic congenital portosystemic shunts in dogs is weak, with only two studies directly comparing treatments. There is a lack of evidence regarding short- and long-term outcomes on which to base clinical decisions.

The incidence of surgical site dehiscence following full thickness gastrointestinal biopsy in dogs and cats and associated risk factors

OBJECTIVESnThe objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors.nnnMETHODSnData relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14u2009days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon.nnnRESULTSnOf 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors.nnnCLINICAL SIGNIFICANCEnIncidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.