Scott P. Shaw

Association between outcome and organ system dysfunction in dogs with sepsis: 114 cases (2003-2007)

OBJECTIVE To determine whether multiple organ dysfunction syndrome (MODS) could be identified in dogs with sepsis secondary to gastrointestinal tract leakage, and whether the number of affected organ systems was significantly associated with mortality rate. DESIGN Multicenter retrospective case series. ANIMALS 114 dogs. PROCEDURES Medical records for dogs treated surgically because of sepsis secondary to gastrointestinal tract leakage between 2003 and 2007 were reviewed. Sepsis was diagnosed on the basis of results of bacterial culture of peritoneal fluid, gross evidence of gastrointestinal tract leakage at surgery, or both. Renal dysfunction was defined as a > or = 0.5 mg/dL increase in serum creatinine concentration after surgery. Cardiovascular dysfunction was defined as hypotension requiring vasopressor treatment. Respiratory dysfunction was defined as a need for supplemental oxygen administration or mechanical ventilation. Hepatic dysfunction was defined as a serum bilirubin concentration > 0.5 mg/dL. Dysfunction of coagulation was defined as prolonged prothrombin time, prolonged partial thromboplastin time, or platelet count < or = 100,000/microL. RESULTS 89 (78%) dogs had dysfunction of 1 or more organ systems, and 57 (50%) dogs had MODS. Mortality rate increased as the number of dysfunctional organ systems increased. Mortality rate was 70% (40/57) for dogs with MODS and 25% (14/57) for dogs without. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MODS, defined as dysfunction of at least 2 organ systems, can be identified in dogs with sepsis and that organ system dysfunction increased the odds of death.

Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002-2008).

OBJECTIVE To determine whether changes in presurgical plasma lactate concentration (before and after initial fluid resuscitation and gastric decompression) were associated with short-term outcome for dogs with gastric dilatation-volvulus (GDV). DESIGN Retrospective case series. ANIMALS 64 dogs. PROCEDURES Medical records were reviewed, and signalment, history, resuscitative treatments, serial presurgical lactate concentrations, surgical findings, and short-term outcome were obtained for dogs with confirmed GDV. RESULTS 36 of 40 (90%) dogs with an initial lactate concentration <or= 9.0 mmol/L survived, compared with only 13 of 24 (54%) dogs with a high initial lactate (HIL) concentration (> 9.0 mmol/L). Within HIL dogs, there was no difference in mean +/- SD initial lactate concentration between survivors and nonsurvivors (10.6 +/- 2.3 mmol/L vs 11.2 +/- 2.3 mmol/L, respectively); however, there were significant differences in post-treatment lactate concentration, absolute change in lactate concentration, and percentage change in lactate concentration following resuscitative treatment. By use of optimal cutoff values within HIL dogs, survival rates for dogs with final lactate concentration > 6.4 mmol/L (23%), absolute change in lactate concentration <or= 4 mmol/L (10%), or percentage change in lactate concentration <or= 42.5% (15%) were significantly lower than survival rates for dogs with a final lactate concentration <or= 6.4 mmol/L (91%), absolute change in lactate concentration > 4 mmol/L (86%), or percentage change in lactate concentration > 42.5% (100%). CONCLUSIONS AND CLINICAL RELEVANCE Calculating changes in plasma lactate concentration following initial treatment in dogs with GDV may assist in determining prognosis and identifying patients that require more aggressive treatment.

Use of wound soaker catheters for the administration of local anesthetic for post-operative analgesia: 56 cases

OBJECTIVE To describe the administration of local anesthetic through wound soaker catheters for post-operative veterinary patients and to characterize complications. STUDY DESIGN Retrospective study of hospital records. ANIMALS Records of patients in which a wound soaker catheter was placed post-operatively between November 1, 2004 and July 1, 2006 at a veterinary teaching hospital. Records in which a limb amputation was performed between January 1, 2002 and August 1, 2007 and in which a wound soaker catheter was not placed were reviewed for historic control. RESULTS A total of 56 cases were identified in which a wound soaker catheter was placed post-operatively including 52 dogs, 2 cats, and 2 goats. Twenty canine cases were identified in which limb amputation was performed and no wound soaker catheter was placed. The majority of surgical procedures for which a wound soaker catheter was placed included thoracic limb amputation (46.4%) and pelvic limb amputation (35.7%). Wound soaker catheters remained in place for an average of 1.6 +/- 0.5 days. Feline and caprine patients received intermittent bupivacaine boluses every 6 hours. Canine patients received continuous lidocaine infusions. Complications included disconnection of the catheter from the infusion (7.7%), one seroma, and one suspected lidocaine neurotoxicity. Incisional infections were noted in 3/56 (5.3%) limb amputations with wound soaker catheters placed which was not higher than the incisional infection rate found in the historic control cases 3/20 (15%). CONCLUSION AND CLINICAL RELEVANCE Use of the wound soaker catheter was a viable means of providing local analgesia in post-operative veterinary patients. Studies are needed to evaluate efficacy of pain management, and to further investigate techniques for catheter placement and maintenance which may help to optimize the analgesia achieved using this technique.

Treatment and predictors of outcome in dogs with immune-mediated thrombocytopenia

OBJECTIVE To characterize the clinical course of disease and identify prognostic indicators for immune-mediated thrombocytopenia in dogs. DESIGN Retrospective cohort study. ANIMALS 73 dogs treated for immune-mediated thrombocytopenia at the Foster Hospital for Small Animals at the Tufts Cummings School of Veterinary Medicine and the Tufts Veterinary Emergency Treatment and Specialties Hospital. PROCEDURES Medical records from the period of January 2002 through June 2008 were reviewed to identify dogs with a diagnosis of immune-mediated thrombocytopenia. Data collected included signalment, clinical signs, results of initial diagnostic tests, treatment, complications, and survival duration. RESULTS Dog ages ranged from 5 months to 15 years (median, 8.1 years). Cocker Spaniels were overrepresented, compared with their distribution in the entire hospital population during the same period. Sixty-one of the 73 (84%) dogs survived to discharge. Seven (11 %) of those dogs were lost to follow-up. Five of the remaining 54 (9%) dogs had a relapse of the disease. The presence of melena or high BUN concentration at admission to the hospital was significantly correlated with a decreased probability of survival. CONCLUSIONS AND CLINICAL RELEVANCE Immune-mediated thrombocytopenia is a serious yet treatable disease, which may have a lower rate of recurrence than previously reported. The presence of melena or high BUN concentration in the study suggested a poor prognosis for affected dogs.

Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs

OBJECTIVE To describe the use of IV and oral mycophenolate mofetil (MMF) as adjunctive therapy in 3 dogs with severe generalized myasthenia gravis. CASE SERIES SUMMARY Three dogs suffering from severe generalized myasthenia gravis as confirmed by acetylcholine antibody titers were treated with MMF as part of their treatment regimens. All 3 dogs had radiographic evidence of megaesophagus and suffered from severe regurgitation. Each dog was initially treated with pyridostigmine and supportive agents. When clinical remission was not achieved, IV MMF was administered to all dogs. Signs of clinical remission were apparent within 48 hours and all dogs were later maintained on oral MMF following resolution of regurgitation. NEW OR UNIQUE INFORMATION PROVIDED This is the first report of the use of IV MMF as adjunctive treatment in dogs with severe generalized myasthenia gravis. Outcome was favorable in all 3 dogs and no adverse effects were noted from the MMF.

Coagulation in hepatobiliary disease

OBJECTIVE To review the pathogenesis and clinical consequences of coagulation abnormalities accompanying hepatobiliary disorders and to highlight the need for further studies to characterize these derangements and their treatment options in small animal patients. DATA SOURCES Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent texts. SUMMARY The liver plays an important role in the production and clearance of many components of coagulation. A wide range of hemostatic derangements can occur in patients with hepatobiliary disease including alterations in platelet number and function, coagulation factor levels, anticoagulants, vascular endothelial function, and fibrinolysis. As these hemostatic alterations include both pro- and anticoagulation pathways, the net result is often a rebalanced hemostatic system that can be easily disrupted by concurrent conditions resulting in either clinical bleeding or thrombosis. Conventional coagulation tests are inadequate at identifying the spectrum of coagulation alterations occurring in patients with hepatobiliary disease, but their evaluation is necessary to assess bleeding risk and provide prognostic information. A paucity of information exists regarding the treatment of the coagulation derangements in small animals with hepatobiliary disease. Extrapolation from human studies provides some information about potential treatment options, but further studies are warranted in this area to elucidate the best management for coagulation abnormalities in dogs and cats with hepatobiliary disease. CONCLUSION Hepatobiliary disease can have profound effects on coagulation function leading to hypercoagulable or hypocoagulable states. Overall coagulation status with hepatobiliary disease depends on both the type and severity of disease and the presence of associated complications.

Traumatic Body Wall Herniation in 36 Dogs and Cats

Traumatic body wall hernias (TBWH) are serious sequelae to traumatic injury in dogs and cats. During the study period, 26 dogs and 10 cats with surgically managed TBWH were identified. Five cases (four dogs, one cat) did not have their hernias identified during the first 24 hours of hospitalization. Bite wounds were the most common cause of TBWH, accounting for 54% of canine and 40% of feline hernias. Twelve cases (nine dogs, three cats) had serious intra-abdominal injuries diagnosed in addition to their TBWH. Seventy-three percent of dogs and 80% of cats survived to hospital discharge. In addition, the authors report the occurrence of a unique cause of herniation, termed an autopenetrating hernia.

Retrospective Study of Tetanus in 20 Dogs: 1988–2004

The case records of 20 dogs that were treated for tetanus between 1988 and 2004 were reviewed. Young, large-breed dogs were most commonly affected. Twelve dogs had a likely source of infection identified. All dogs were treated with intravenous antibiotics and supportive care, such as muscle relaxants and sedation for muscle tremors and rigidity. Sixteen dogs received tetanus antitoxin. The mortality rate was 50%. Complete recovery in survivors required approximately 1 month.

Lack of Evidence of Pregnancy‐Induced Alloantibodies in Dogs

BACKGROUND It is controversial whether or not pregnant bitches become sensitized to red blood cell (RBC) antigens. HYPOTHESIS Bitches do not develop alloantibodies to RBC antigens during gestation and can be used safely as blood donors. ANIMALS The study group included 35 healthy female dogs with a prior history of 1 (n = 12), 2 (n = 14), or >or= 3 (n = 9) pregnancies. The control group consisted of 15 healthy female dogs without any history of pregnancy. METHODS All dogs were blood typed for dog erythrocyte antigens (DEA) 1.1, 1.2, 3, 4, 5, and 7 using ethylenediaminetetraacetic acid blood samples and polyclonal antisera. Antibody screening was performed with serum and canine RBC panels of known blood type. An autocontrol and direct antiglobulin test were performed to rule out the presence of autoantibodies. RESULTS The only alloantibodies identified were those against DEA 7 and the prevalence of anti-DEA 7 alloantibodies was similar in dogs with known history of pregnancy (11.4%) and in the control group (13.3%). CONCLUSIONS AND CLINICAL IMPORTANCE These results confirm previous studies and clinical transfusion medicine experience. Naturally occurring anti-DEA 7 alloantibodies have been reported but their clinical relevance has not been shown. Pregnancy does not appear to sensitize dogs to RBC antigens. Consequently, dogs with prior history of pregnancy can be used safely as blood donors. Conversely, no additional pretransfusion compatibility studies would be required should these dogs themselves need to be transfused.

Evaluation of an educational campaign to increase hand hygiene at a small animal veterinary teaching hospital

OBJECTIVE To establish baseline data on rates of hand hygiene behavior, evaluate the effectiveness of an educational intervention aimed at improving hand hygiene, and determine whether methods similar to those applied in human hospitals to improve hand hygiene can be successfully applied in a small animal veterinary hospital. DESIGN Prospective observational study. SAMPLE 568 and 187 observations of interactions between small animal patients and veterinary health-care providers before and after, respectively, educational intervention. PROCEDURES Proper hand hygiene practices were defined as use of antibacterial foam or hand washing before or after physical interactions between health-care providers (veterinary medical faculty members, residents, interns, students, and technicians) and patients or proper use of gloves. Data were collected by anonymous direct observation. After an initial observation period, a multimodal educational campaign promoted proper hand hygiene with specific attention to increasing use of antibacterial foam. Two months later, data on proper hand hygiene practices after intervention were collected. RESULT At baseline, 117 of 568 (20.6%) interactions met criteria for proper hand hygiene practices; after intervention, a significantly greater proportion (78/187 [41.7%]) of interactions met criteria for proper hand hygiene practices. Use of antibacterial foam significantly increased from 34 of 568 (6.0%) to 67 of 187 (35.8%) interactions. Health-care providers were 4.1 times as likely to wash their hands with soap and water or to use antibacterial foam on their hands after the intervention than before the intervention. CONCLUSIONS AND CLINICAL RELEVANCE Initial low rates of proper hand hygiene practices at baseline were improved substantially 2 months after implementing a low-cost multimodal educational campaign.