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1.
Objective— To evaluate trans-splenic portal scintigraphy (TSPS) and per-rectal portal scintigraphy (PRPS) for diagnosis of congenital portosystemic shunts (CPSS) in dogs, and compare these results with surgical findings.
Study Design— Prospective, randomized cross over clinical trial.
Animals— Dogs (n=42) with suspected CPSS.
Methods— Dogs had TSPS and PRPS 48 hours apart; quantity of radionuclide administered was recorded. Three independent, blinded reviewers evaluated each scintigraphic study for study quality, shunt presence, number, and location of shunt termination (caudal vena cava, azygos vein). All dogs had exploratory celiotomy. Negative scintigraphic findings were confirmed with intraoperative mesenteric portography. Ameroid constrictors were placed on all extrahepatic CPSS, and hepatic biopsies were obtained.
Results— TSPS was 100% sensitive and specific for diagnosis of CPSS and significantly ( P <.05) more likely than PRPS to detect shunt number and termination. Interpretation was consistent between observers, and TSPS required significantly less radionuclide than PRPS.
Conclusion— TSPS was as sensitive as PRPS for detection of shunting vessels, and consistently yielded studies of higher quality, allowing detection of shunt number and location with consistent interpretation among radiologists.
Clinical Relevance— TSPS provides information about shunt number and location, which allows improved surgical planning. Because it requires significantly less radionuclide, TSPS improves safety, allows for more comprehensive patient care, and earlier surgical intervention.  相似文献   

2.
OBJECTIVE: To evaluate the efficacy of cellophane banding of single congenital extrahepatic portosystemic shunts in dogs using transcolonic portal scintigraphy. To investigate the portal circulation of those dogs with elevated postoperative shunt fractions to determine the cause of the persistent shunting. Further, to evaluate whether presenting signs, clinical pathology findings and liver histopathology are predictive of outcome. DESIGN: Prospective study of 16 dogs presenting with single congenital extrahepatic portosystemic shunts. PROCEDURE: Dogs with single extrahepatic portosystemic shunts attenuated by cellophane banding underwent portal scintigraphy and bile acids tolerance testing pre- and post-operatively. Dogs identified with elevated shunt fractions at 10 weeks post-operatively underwent mesenteric portovenography. Qualitative hepatic histopathology from all dogs was reviewed by a veterinary pathologist and assigned a semi-quantitative score to identify any abnormalities that may predict surgical outcome. RESULTS: At 10 weeks post cellophane banding, 10 of 16 cases (63%) had normal shunt fractions, whilst six dogs (37%) had increased shunt fractions and seven dogs (44%) had increased serum bile acids. Of these dogs, mesenteric portovenography revealed incomplete closure of the shunt in three dogs (18.6%) and multiple acquired shunts in three dogs (18.6%). Liver histopathology findings were similar for all dogs, regardless of outcome. CONCLUSIONS: Cellophane banding is an efficacious method for complete gradual occlusion of single extrahepatic shunts when the shunt vessel is attenuated to < or = 3 mm. Transcolonic portal scintigraphy is a reliable method for assessment of shunt attenuation and, unlike serum bile acids, is not influenced by other causes of liver dysfunction.  相似文献   

3.
OBJECTIVE: To determine whether hepatic portal vascularity, as assessed by intraoperative mesenteric portovenography (IMP), is related to outcome in dogs undergoing attenuation of single congenital portosystemic shunts (CPSSs). DESIGN: Retrospective case series. ANIMALS: 45 dogs, each with a single CPSS, in which IMP was performed before and after temporary complete occlusion of the shunting vessel and that underwent complete (17 dogs) or partial (28 dogs) CPSS attenuation (surgery 1). PROCEDURES: Medical records were reviewed for signalment, clinical history, and bile acids stimulation test results. Intrahepatic portal vessel (IPV) opacification in pre- and postocclusion portovenograms was graded to determine whether the degree of opacification was correlated with the degree of shunt attenuation, clinical or biochemical factors, or long-term clinical outcome. In 17 of 28 dogs that had partial CPSS attenuation, these procedures were subsequently repeated (surgery 2) to achieve complete (14 dogs) or further partial (3 dogs) CPSS attenuation. RESULTS: Compared with preattenuation findings, IPV opacification increased significantly after partial or complete CPSS attenuation. The degree of IPV opacification before and after CPSS occlusion (surgery 1) was greater in dogs that tolerated complete versus partial CPSS attenuation and was correlated positively with age. The degree of IPV opacification following CPSS occlusion (surgery 1) was maximal in all dogs without encephalopathy and was correlated negatively with follow-up preprandial serum bile acids concentrations and positively with clinical improvement. CONCLUSIONS AND CLINICAL RELEVANCE: Data suggest that IMP can be used to assess changes in IPV blood flow and help predict outcome following attenuation of single CPSSs in dogs.  相似文献   

4.
Objective- The purpose of this study was to determine whether an endogenous benzodiazepine receptor ligand (EBZ) was present in the arterial and portal blood of dogs with congenital portosystemic shunts (CPSS).
Study Design- The presence or absence of an EBZ was determined by the collection of systemic and portal blood from dogs with CPSS.
Animals- Fifteen client-owned dogs with a confirmed CPSS. All dogs had historical signs compatible with hepatic encephalopathy. Eight healthy dogs were used as controls.
Methods- In all dogs, systemic blood samples were collected after they were anesthetized. Portal blood samples were collected intraoperatively. EBZ was measured by radioreceptor assay.
Results- In 10 of 15 dogs, the portal blood concentration of EBZ was significantly elevated compared with normal dogs (mean, 13.2 ±18.55 ng/mL). Five dogs had elevated systemic blood EBZ levels (mean, 8.2 ±16.08 ng/mL). Eleven of 15 dogs had a higher portal than systemic blood concentration of EBZ. In contrast, control dogs had extremely low EBZ concentrations detected in their portal blood (mean, 0.16 ±0.3 ng/mL) and systemic blood (0 ng/mL). The mean portal and systemic blood concentrations in dogs with CPSS were significantly greater than in control dogs ( P <.05).
Conclusions- Elevated blood levels of EBZ were found in dogs with CPSS. The portosystemic gradient noted in 11 dogs suggests the gastrointestinal tract as a possible source for the endogenous ligand.
Clinical Relevance- Generalized motor seizures have been reported in dogs after surgical correction of CPSS. If the presence of a CPSS results in stimulation of brain receptors for benzodiazepines, post-CPSS ligation seizures may result from a withdrawal of EBZ after ligation of the portosystemic shunt.  相似文献   

5.
Extrahepatic‐congenital portosystemic shunt is a vascular anomaly that connects the portal vein to the systemic circulation and leads to a change in hepatic microvascular perfusion. However, an assessment of hepatic microvascular perfusion is limited by conventional diagnostic modalities. The aim of this prospective, exploratory study was to assess hepatic microvascular perfusion in dogs with extrahepatic‐congenital portosystemic shunt using contrast‐enhanced ultrasonography (CEUS) using perfluorobutane (Sonazoid®). A total of 17 dogs were included, eight healthy dogs and nine with extrahepatic‐congenital portosystemic shunt. The time‐to‐peak (TTP), rising time (RT), and rising rate (RR) in the hepatic artery, portal vein, and hepatic parenchyma, as well as the portal vein‐to‐hepatic parenchyma transit time (ΔHP‐PV) measured from time‐intensity curve on CEUS were compared between healthy and extrahepatic‐congenital portosystemic shunt dogs. The RT of the hepatic artery in extrahepatic‐congenital portosystemic shunt dogs was significantly earlier than in healthy dogs (P = 0.0153). The TTP and RT of the hepatic parenchyma were significantly earlier in extrahepatic‐congenital portosystemic shunt dogs than in healthy dogs (P = 0.0018 and P = 0.0024, respectively). ΔHP–PV was significantly shorter in extrahepatic‐congenital portosystemic shunt dogs than in healthy dogs (P = 0.0018). CEUS effectively revealed changes in hepatic microvascular perfusion including hepatic artery, portal vein, and hepatic parenchyma simultaneously in extrahepatic‐congenital portosystemic shunt dogs. Rapid hepatic artery and hepatic parenchyma enhancements may reflect a compensatory increase in hepatic artery blood flow (arterialization) caused by a decrease in portal vein blood flow and may be used as an additional diagnostic test to distinguish extrahepatic‐congenital portosystemic shunt dogs from healthy dogs.  相似文献   

6.
OBJECTIVES: To determine if there were significant changes in prothrombin time (PT), partial thromboplastin time (PTT), and fibrinogen levels in dogs with naturally occurring congenital portosystemic shunts (CPSS) and to determine if there was any association between these values, serum albumin concentration, and the ability to attenuate the shunt vessel. STUDY DESIGN: Retrospective clinical study. ANIMALS: Thirty-nine client-owned dogs. METHODS: Medical records of 60 dogs with confirmed CPSS were retrospectively evaluated. Hemostatic profiles had been performed before surgery in 39 cases. RESULTS: Dogs with CPSS had significantly higher values for PTT (P < .001) when compared with normal dogs. Of the total number of dogs, 64.1% had a PTT greater than 16 seconds (25/39). PTT was prolonged by 25% or more in 51.3% of dogs (20/39). PT tended to be higher in dogs with CPSS (P = .036), although only 7.7% (3/39) of dogs had a PT greater than 12 seconds (the maximum reference value). Dogs with CPSS had significantly lower values for albumin and fibrinogen (P < .001). Platelet numbers were within the normal range in 87.2% of cases (34/39). Of the 5 dogs with platelet numbers outside the normal range, 3 were mildly thrombocytopenic. Fibrin degradation product concentrations were not elevated in any dogs tested (N = 22). There was no significant difference in any of the measured variables between dogs with extrahepatic shunts and those with intrahepatic shunts (P > .1). For PT, PTT, albumin, and fibrinogen, there was no significant difference between dogs that underwent total, partial, or no attenuation (P > .3). CONCLUSIONS: Dogs with CPSS have a tendency to have a prolonged PTT. There was no significant difference in hemostatic profile results between dogs with intrahepatic shunts versus extrahepatic shunts. Preoperative hemostatic profile abnormalities were not useful as predictors of ability to attenuate CPSS. CLINICAL RELEVANCE: Prolonged PTT was not associated with bleeding tendencies in any of the dogs. Assays of individual clotting factors may help to further characterize the abnormalities present in animals with CPSS and may identify specific factor deficiencies. This might enable identification of a noninvasive diagnostic or prognostic indicator.  相似文献   

7.
Objective— To determine the success of medical management of presumptive cervical disk herniation in dogs and variables associated with treatment outcome. Design— Retrospective case series. Animals— Dogs (n=88) with presumptive cervical disk herniation. Methods— Dogs with presumptive cervical and thoracolumbar disk herniation were identified from medical records at 2 clinics and clients were mailed a questionnaire related to the success of therapy, clinical recurrence of signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records. Results— Ninety‐seven percent of dogs (84/87) with complete information were described as ambulatory at initial evaluation. Successful treatment was reported for 48.9% of dogs with 33% having recurrence of clinical signs and 18.1% having therapeutic failure. Bivariable logistic regression showed that non‐steroidal anti‐inflammatory drug (NSAID) administration was associated with success (P=.035; odds ratio [OR]=2.52). Duration of cage rest and glucocorticoid administration were not significantly associated with success or QOL. Dogs with less‐severe neurologic dysfunction were more likely to have a successful outcome (OR=2.56), but this association was not significant (P=.051). Conclusions— Medical management can lead to an acceptable outcome in many dogs with presumptive cervical disk herniation. Based on these data, NSAIDs should be considered as part of the therapeutic regimen. Cage rest duration and glucocorticoid administration do not appear to benefit these dogs, but this should be interpreted cautiously because of the retrospective data collection and use of client self‐administered questionnaire follow‐up. Clinical Relevance— These results provide insight into the success of medical management for presumptive cervical disk herniation in dogs and may allow for refinement of treatment protocols.  相似文献   

8.
Objectives— To (1) identify and describe the type and frequency of postoperative complications after pylorectomy and gastroduodenostomy in dogs and (2) identify preoperative and intraoperative risk factors, including the presence of neoplasia, prognostic for patient mortality after surgery. Study Design— Case series. Animals— Dogs (n=24) treated by pylorectomy and gastroduodenostomy. Methods— Medical records (2000–2007) for 2 teaching hospitals of dogs treated that had pylorectomy and gastroduodenostomy were reviewed. Pre‐, intra‐, and postoperative data were obtained from the medical record. Results— Of the 24 dogs, 75% survived 14 days, but 10 (41%) died by 3 months. Overall median survival time (MST) was 578 days. On log‐rank univariate analysis, preoperative weight loss (P=.001) and malignant neoplasia (P=.01) were associated with decreased survival time. Dogs with malignant neoplasia had a MST of 33 days. Common postoperative morbidity included hypoalbuminemia (62.5%) and anemia (58.3%). Conclusions— Pylorectomy with gastroduodenostomy has a good short‐term outcome but long‐term survival time is poor in dogs with malignant neoplasia. Clinical Relevance— Overall, most dogs treated with pylorectomy and gastroduodenostomy survived the postoperative period; however, preoperative weight loss and malignant neoplasia were associated with decreased survival time. Because dogs with malignant neoplasia have markedly shortened survival times, pertinent preoperative, diagnostics steps should be exhausted to identify underlying neoplasia.  相似文献   

9.
Objectives— To compare esophageal function in dogs with idiopathic laryngeal paralysis (ILP) to age and breed matched controls; to determine if dysfunction is associated with aspiration pneumonia over 1 year; and to compare clinical neurologic examination of dogs with ILP at enrollment and at 1 year. Study Design— Prospective controlled cohort study. Animals— Dogs with ILP (n=32) and 34 age and breed matched healthy dogs. Methods— Mean esophageal score was determined for each phase of 3 phase esophagrams, analyzed blindly. After unilateral cricoarytenoid laryngoplasty, dogs with ILP were reexamined (including thoracic radiography) at 1, 3, 6, and 12 months. Neurologic status was recorded at enrollment, 6 and 12 months. Results— Esophagram scores in dogs with ILP were significantly higher in each phase compared with controls, most notably with liquid (P<.0001). Dysfunction was more pronounced in the cervical and cranial thoracic esophagus. Five dogs that had aspiration pneumonia during the study had significantly higher esophagram scores than dogs that did not develop aspiration pneumonia (P<.02). Ten (31%) ILP dogs had generalized neurologic signs on enrollment and all ILP dogs developed neurologic signs by 1 year (P<.0001). Conclusions— Dogs with ILP also have esophageal dysfunction. Postoperative aspiration pneumonia is more likely in dogs with higher esophagram scores. Dogs with ILP will most likely develop generalized neuropathy over the course of 1 year. Clinical Relevance— Esophagrams and neurologic examinations should be performed on all dogs with ILP.  相似文献   

10.
BACKGROUND: Dogs with single congenital portosystemic shunts (CPSS) often develop postoperative hypoglycemia and prolonged anesthetic recovery. These abnormalities could be attributable to inadequate adrenal response. However, adequacy of adrenal response after CPSS surgery is unexplored. HYPOTHESIS: Dogs with CPSS have inadequate postoperative adrenal response. ANIMALS: Eight nonoperated, 8 ovariohysterectomy (OHE), and 16 CPSS dogs. METHODS: Consecutive day ACTH stimulation tests were performed on nonoperated healthy dogs, healthy dogs before and after OHE, and CPSS dogs before and after surgery. Adequate response was defined as >50% or >30 ng/mL increase in cortisol after ACTH administration. Blood glucose (BG) was monitored before and after surgery. Prolonged anesthetic recovery and refractory hypoglycemia episodes were recorded. RESULTS: Results of consecutive day ACTH stimulation tests did not vary in normal dogs. Results of preoperative ACTH stimulation tests of CPSS and OHE dogs were not significantly different. Dogs with CPSS had higher postoperative baseline cortisol concentrations (median, 329 ng/mL) than OHE dogs (median, 153 ng/mL). Postoperative cortisol increase after ACTH in CPSS was < or =50% in 10/16 and < or =30 ng/mL in 6/16. After surgery, BG was < or =60 mg/dL in 7/16 CPSS dogs. Cortisol concentrations were not correlated with BG. Two CPSS dogs had refractory hypoglycemia and 4 had delayed recovery; all improved with dexamethasone administration (0.1-0.2 mg/kg/IV). CONCLUSIONS AND CLINICAL IMPORTANCE: Contrary to previous reports, baseline cortisol concentrations in CPSS and healthy dogs are similar. Many CPSS dogs have postoperative hypercortisolemia. Response to ACTH does not correlate with postoperative hypoglycemia or prolonged anesthetic recovery.  相似文献   

11.
Indocyanine green clearance and ammonia tolerance were measured in anesthetized dogs with 60% hepatectomy, 40% hepatectomy, portacaval shunt, and hepatic artery ligation. With a dose of 0.5 mg of indocyanine green/kg of body weight, plasma clearance of the dye was significantly (P less than 0.001) delayed only in dogs with 60% hepatectomy. Ammonia tolerance was abnormal in dogs in this group, because after they were given a gastric challenge load of an ammonium salt, they had a 5-fold increase in plasma ammonia concentration, compared with a 2.5-fold increase in the control group. Before challenge loading, base-line plasma ammonia concentration was significantly (P less than 0.05) increased within 5 minutes after surgical preparation of the portacaval shunt. After challenge loading the stomach with an ammonium salt, dogs with portacaval shunt had increased plasma ammonia concentration, but the amount was not significantly different from postchallenge-loading values in control dogs. Dogs with 40% hepatectomy and with hepatic artery ligation could not be differentiated from control dogs by indocyanine green clearance or by ammonia tolerance testing. Abnormal tolerance to a challenge gastric load of an ammonium salt or delayed clearance of indocyanine green may indicate marked loss of functional hepatic mass, but normal tolerance or normal dye clearance may not exclude liver disease or dysfunction. Seemingly, base-line plasma ammonia concentration was a sensitive indicator of abnormal portal circulation.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

12.
Background: In dogs with congenital portosystemic shunts (CPSS), the ability of the hypoplastic liver to grow is considered important for recovery after surgical shunt attenuation.
Objectives: This study investigated hepatic growth after extrahepatic shunt attenuation in dogs using magnetic resonance imaging (MRI) and computed tomography (CT).
Animals: Ten client-owned dogs with single extrahepatic CPSS.
Methods: Abdominal MRI, CT, or both were performed before and 8 days, 1, and 2 months after shunt attenuation. Liver volumes were calculated from the areas of the MRI or CT images.
Results: Before surgery, median liver volume was 18.2 cm3/kg body weight. Liver volume increased significantly after surgery. Growth was highest between days 0 and 8 and decreased afterward. Median liver volume was 28.8 cm3/kg at 2 months after attenuation. No significant differences in growth were found between dogs with complete or partial shunt closure or between dogs with complete or incomplete metabolic recovery. Volumes measured from consecutively performed MRI and CT images correlated well ( r = 0.980), but volumes from MRI images were significantly larger than volumes from CT images (6.8%; P = .008).
Conclusion and Clinical Importance: After shunt attenuation, rapid normalization of liver size was observed. Hepatic growth was not decreased in dogs after partial closure of CPSS or in dogs with subclinical, persistent shunting 2 months after surgery. CT is the preferred imaging method for volumetric estimation because of speed.  相似文献   

13.
Objective— To describe the clinical features and determine oncologic outcome and prognostic factors for dogs with primary tumors of the osseous chest wall. Study Design— Historical cohort. Animals— Dogs (n=39) with spontaneous tumors involving the chest wall. Methods— Medical records were reviewed for dogs with rib and/or sternal tumors treated by chest wall resection and reconstruction. Signalment, preoperative clinical features, reconstruction technique, and oncologic outcome (local tumor recurrence, metastasis, and survival time) were determined from medical records and by telephone contact with owners and referring veterinarians. Oncologic outcome and prognostic factors were determined using Kaplan–Meier survival analysis and Cox proportional hazards. Logistic regression was used to determine if increased serum alkaline phosphatase (ALP) concentration was associated with tumor type. Results— Of the 39 dogs with tumors arising from the chest wall, 25 had osteosarcoma, 12 had chondrosarcoma, and 2 dogs had hemangiosarcoma. Median survival time (MST) for dogs with rib osteosarcoma was 290 days. Increased activity of total ALP significantly decreased survival in dogs with osteosarcoma (210 days versus 675 days, P=.0035). MST for dogs with rib chondrosarcoma was not reached (mean 1301 days) and survival was significantly greater than all other types of rib tumors (P=.0321). Conclusion— Rib tumors should be resected with wide margins to decrease the risk of incomplete excision, because local tumor recurrence has a significant impact on the survival time. The prognosis for dogs with rib chondrosarcoma is very good, but guarded for other types of tumors. Clinical Relevance— Osteosarcoma and chondrosarcoma are the most common primary tumors of the chest wall. Prognosis for dogs with primary rib chondrosarcoma is very good with surgery alone, but surgery and adjunctive chemotherapy is recommended for dogs with primary rib osteosarcoma and the prognosis remains guarded.  相似文献   

14.
Objective— To characterize biologic behavior, clinical outcome, and effect of histologic grade on prognosis for dogs with appendicular chondrosarcoma treated by amputation alone. Study Design— Case series. Animals— Dogs (n=25) with appendicular chondrosarcoma. Methods— Medical records were searched to identify dogs with appendicular chondrosarcoma treated by limb amputation alone. Information recorded included signalment, anatomic location, radiographic appearance, and development of metastasis. Histopathologic diagnosis was confirmed and graded (1, 2, or 3). Survival curves were generated by the Kaplan–Meier method and the association between covariates (gender, age, weight, and tumor grade) and survival were evaluated using the univariate proportional hazards model. Results— Histopathology slides were available for 25 dogs. Rates of pulmonary metastasis were as follows: grade 1–0%, grade 2–31%, and grade 3–50%. Overall median survival time (MST) was 979 days. Age, weight, and sex were not significantly associated with survival (P=.16; .33; and .31, respectively). Survival was significantly associated with tumor grade (P=.008), with dogs with tumor grade of 1, 2, and 3 having MSTs of 6, 2.7, and 0.9 years, respectively. Conclusion— Canine appendicular chondrosarcoma can be treated effectively with amputation alone. Low to intermediate grade chondrosarcoma has a good prognosis, whereas high‐grade tumors appear to behave aggressively. Clinical Relevance— The overall prognosis for appendicular chondrosarcoma is better than that of appendicular osteosarcoma treated by amputation alone or in combination with chemotherapy.  相似文献   

15.
Background: Underlying conditions in dogs admitted to an intensive care unit (ICU) can cause hemostatic dysfunction. Thrombelastography (TEG) may be useful in detecting hemostatic alterations as compared with standard coagulation tests. Objectives: The purpose of this study was to compare TEG results and those of standard coagulation tests in identifying hemostatic dysfunction in dogs admitted to an ICU and to investigate associations among the variables measured. Methods: Tissue factor‐activated TEG analysis, d ‐dimer and fibrinogen concentrations, antithrombin (AT) activity, prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count were measured using standard techniques on 27 dogs admitted to ICU with a disease known to be associated with hemostatic dysfunction and in 31 clinically healthy control dogs. Results were compared between groups using nonparametric tests and κ analysis; principal component analysis (PCA) and Spearman rank correlation were used to measure associations among variables. Results: Fourteen of 27 ICU dogs had abnormal TEG tracings, which were used to classify the dogs as hypercoagulable (n=11), hypocoagulable (n=3), or normocoagulable (n=13). Hypercoagulable dogs had significantly increased d ‐dimer (P=.03) and fibrinogen (P=.01) concentrations compared with normocoagulable dogs. In ICU dogs, positive associations were identified between maximum amplitude (MA), α‐angle, fibrinogen concentration, and platelet count, and between PT, aPTT, and reaction time (R). Significant correlations were found between MA and fibrinogen (rs=.76, P<.001) and between reaction time (R) and PT (rs=.51, P=.003). Conclusions: TEG was useful in detecting hemostatic dysfunction in dogs in an ICU. Positive associations among variables may provide insight as to how overall coagulation status reflects alterations in clot strength and coagulation time. Dogs with TEG tracings indicative of hypercoagulability are likely in procoagulant states. Future studies of the incidence of thrombotic complications in dogs with hypercoagulable TEG tracings are warranted.  相似文献   

16.
The medical records of 65 dogs that underwent complete or partial ligation of a single congenital portosystemic shunt (CPSS) were reviewed to determine the long-term clinical results. Information retrieved from the records included age at surgery, preligation (baseline) portal pressure, postligation portal pressure, change in portal pressure from baseline, complete or partial occlusion of the shunting vessel and fasting, and 2-hour postprandial bile acids from the preoperative, early postoperative (PO), and greater than 1 year PO time periods. A clinical rating score derived from a follow-up examination greater than 1 year PO was assigned to each dog. Of the 56 dogs that survived the perioperative period, 29 (52%) had complete and 27 (48%) had partial ligations. Age at surgery, pre- and postligation portal pressure, change in portal pressure from baseline and serum bile acid concentrations were not related to long-term clinical outcome. Clinical rating scores were significantly greater for dogs with partial CPSS ligations compared with dogs with complete ligations, indicating a less favorable clinical outcome for partial ligations. Fasting and 2-hour postprandial bile acid values at both PO time intervals were significantly greater in partial versus complete ligation groups. Follow-up information for more than 1 year was available on 18 of 29 dogs (62%) with complete ligations. All were clinically normal. Of 27 dogs with partial ligations, 11 dogs (41%) developed recurrence of clinical signs resulting in presentation to the university or referring veterinarian for additional surgery, medical management, or euthanasia. Only three dogs with partial CPSS ligation (11%) were clinically normal. Another nine dogs (33%) were operated on again before the possible development of clinical signs and four dogs (15%) were unavailable for follow-up. It was concluded that partial ligation of CPSS is associated with a greater recurrance of clinical signs and patient morbidity than complete ligation.  相似文献   

17.
Objective— To compare short‐ and long‐term outcome and complications of chest wall reconstruction in dogs using autogenous, prosthetic, and composite autogenous–prosthetic techniques. Study Design— Historical cohort. Animals— Dogs (n=44) with spontaneous tumors arising from or involving the chest wall. Methods— Medical records were reviewed for dogs with rib and/or sternal tumors treated by chest wall resection and reconstruction. Signalment, preoperative clinical features, intraoperative findings and complications, reconstruction technique (autogenous muscle flap, prosthetic mesh, or composite autogenous–prosthetic technique), and short‐ (≤14 days) and long‐term (>14 days) postoperative complications were determined from the medical records and telephone contact with owners and referring veterinarians. Associations between chest wall reconstruction technique and postoperative complications were tested with Cox proportional hazards. Results— Chest wall defects were reconstructed with autogenous muscle flaps (29 dogs), prosthetic mesh (3), and a composite technique of prosthetic mesh and either autogenous muscle or omental pedicle flap (12). Early postoperative complications were recorded in 8 dogs (18.2%) and included seroma (5) and pleural effusion and peripheral edema (3). One dog had a late complication (2.3%) with a mesh‐related infection 767 days postoperatively. Overall, complications occurred in 10.3% of autogenous, 25.0% of composite, and 66.7% of prosthetic reconstructions. Chest wall reconstruction with Marlex mesh alone was associated with a significantly increased risk of postoperative complications compared with autogenous reconstruction (P=.027). Reconstruction of sternal defects (3), 2 of which were performed with Marlex mesh alone, was associated with a significantly increased risk of complications compared with lateral chest wall reconstructions (P=.037). Conclusions— Large chest wall defects can be reconstructed with autogenous and composite techniques, but prosthetic mesh should be covered with well‐vascularized autogenous muscle or omentum to decrease the risk of postoperative complications. Sternal defects should be reconstructed with rigid techniques. Clinical Relevance— Chest wall reconstruction with autogenous muscle flaps or a combination of autogenous techniques with prosthetic mesh is associated with a low rate of infection and other complications.  相似文献   

18.
Treatment options for dogs with metastatic (stage III) splenic hemangiosarcoma are limited. A doxorubicin‐based chemotherapy regimen is commonly administered; however, there are no published data to support this practice. The aim of this study was to investigate the impact of maximum‐tolerated‐dose chemotherapy (MTD), metronomic chemotherapy (MC) and no adjuvant treatment on outcome in dogs with stage III splenic hemangiosarcoma undergoing splenectomy. Medical records of dogs with stage III splenic hemangiosarcoma that underwent splenectomy followed by MTD chemotherapy, MC or no adjuvant treatment were retrieved. Time to progression (TTP), survival time (ST) and toxicity were evaluated. One hundred three dogs were identified: 23 received adjuvant MTD, 38 MC and 42 were not medically treated. Overall median TTP and ST were 50 (95% confidence interval [CI], 39‐61) and 55 days (95% CI, 43‐66), respectively. Dogs treated with adjuvant MTD had a significantly longer TTP and ST compared with dogs receiving MC (median TTP, 134 vs 52 days, P = .025; median ST, 140 vs 58 days, P = .023, respectively). Dogs treated by splenectomy only had the shortest median TTP (28 days) and ST (40 days). However, treatment‐related adverse events (AEs) were significantly more frequent in the MTD group (P = .017). The outcome for dogs with metastatic splenic hemangiosarcoma is poor. While MTD showed greater efficacy compared to MC, toxicity was higher in this group. Treatment‐related AEs need to be carefully balanced against this modest survival prolongation when offering adjuvant MTD to dogs with advanced stage hemangiosarcoma.  相似文献   

19.
The aim of this retrospective, cross‐sectional, study was to evaluate clinical findings and outcomes for different ultrasonographic patterns of hepatic emphysema in dogs and cats. Dogs and cats with an ultrasonographic diagnosis of hepatic emphysema and a known outcome, from January 2010 to January 2018, were enrolled. The following data were recorded from medical and ultrasonographic records: ultrasonographic patterns of hepatic emphysema (parenchymal, portal venous, biliary), clinical signs, laboratory findings, and outcomes (favorable, poor). A total of 33 dogs and four cats met the inclusion criteria. Among these, 23 cases were classified as hepatic portal venous gas, 10 as parenchymal emphysema, and four as biliary emphysema. Clinical diagnosis categories were as follows: infection/sepsis (9), gastro‐intestinal disease (9), iatrogenic (9), trauma (5), and liver neoplasia (5). An increase in serum liver enzymes was significantly associated with parenchymal emphysema (P = .03). Other clinical and laboratory findings were not associated with the type of hepatic emphysema. Hepatic portal venous gas was mostly transient in patients with ultrasonographic follow‐up. The overall mortality was 40.5%. A significant difference was found between mortality by portal venous gas (21.7%) and mortality by parenchymal emphysema (90%) (P = .003). In conclusion, the ultrasonographic differentiation of hepatic emphysema between hepatic portal venous gas and parenchymal emphysema may be important for the prognosis of hepatic emphysema. The presence of parenchymal emphysema may be a poor prognostic indicator, while hepatic portal venous gas may be more benign. However, ultrasound findings should be carefully evaluated in the context of clinical findings.  相似文献   

20.
Ductus venosus (DV) closure plays a key role in hepatic circulation adaptation to postnatal metabolic function, and DV patency might develop a congenital portosystemic shunt (CPSS). The noninvasive Color Flow Mapping (CFM) examination, a validated method to diagnose CPSS in adult dogs, is routinely performed to assess DV closure after birth in humans. This study aimed to describe the feasibility of the ultrasonographic evaluation of the DV after birth and to determine its closure time in healthy Great Dane neonates. Patency of DV in serial Color Flow Mapping (CFM) examinations and bodyweight (BW) were recorded on Days 0‐3‐6‐9 in 24 neonates that were classified as having patent (PDV) or closed ductusvenosus (CDV) basing on CFM signal presence/absence. Since the 3rd day, DV diameter was recorded. Data were analysed by ANOVA (p < 0.05). All dogs resulted healthy 1 year later. The number of PDV and CDV puppies at birth was not different on Day 3 (24 and 0 vs. 22 and 2, PDV and CDV, respectively), whereas it resulted different on Days 6 (24 and 0 vs. 14 and 10) and 9 (24 and 0 vs. 0 and 24); on Day 3, it was different compared to Days 6 and 9; on Day 6, it was different from Day 9. Reduction of DV diameter resulted positively related to neonatal BW growth. The CFM evaluation of DV closure after birth in Great Dane puppies represents a feasible technique. Present results suggest the time of functional closure in normal neonates within 9 days after birth. Thus, CFM examination, as an early screening test for DV patency evaluation, performed 10 days after birth, may identify suspicious dogs at risk that would require further investigations. Further studies are needed to deepen the role of a delayed closure in low bodyweight and preterm puppies.  相似文献   

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