Showing papers in "Journal of Veterinary Internal Medicine in 2007"

Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

Abstract: Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide veterinarians with guidelines regarding the pathophysiology, diagnosis, or treatment of animal diseases. The foundation of the Consensus Statement is evidence-based medicine, but if such evidence is conflicting or lacking, the panel provides interpretive recommendations on the basis of their collective expertise. The Consensus Statement is intended to be a guide for veterinarians, but it is not a statement of standard of care or a substitute for clinical judgment. Topics of statements and panel members to draft the statements are selected by the Board of Regents with input from the general membership. A draft prepared and input from Diplomates is solicited at the ACVIM Forum and via the ACVIM Web site and incorporated in a final version. This Consensus Statement was approved by the Board of Regents of the ACVIM before publication.

Chronic enteropathies in dogs: evaluation of risk factors for negative outcome.

Abstract: Hypothesis: Certain variables that are routinely measured during the diagnostic evaluation of dogs with chronic enteropathies will be predictive for outcome and a new clinical disease activity index incorporating these variables can be applied to predict outcome of disease. Animals: Seventy dogs were entered into a sequential treatment trial with elimination diet (FR, food-responsive group) followed by immunosuppressive treatment with steroids if no response was seen with the dietary trial alone (ST, steroidtreatment group). A 3rd group consisted of dogs with panhypoproteinemia and ascites (PLE, protein-losing enteropathy) that were treated with immunosuppressive doses of steroids. Methods: Three years of follow-up information was available for all dogs. Clinicopathologic variables were tested for their ability to predict negative outcome, defined as euthanasia due to refractoriness to treatment. Different scoring systems including different combinations of these variables were evaluated using receiver operating characteristic (ROC) curves. Results: Thirteen of 70 (18%) dogs were euthanized because of intractable disease. Univariate analysis identified a high clinical activity index, high endoscopic score in the duodenum, hypocobalaminemia (<200 ng/L) and hypoalbuminemia (<20 g/L) as risk factors for negative outcome. Conclusions and Clinical Importance: Based on the factors identified by logistic regression and ROC curve analysis, a new clinical scoring index (CCECAI) was defined that predicts negative outcome in dogs suffering from chronic enteropathies.

Inflammatory airway disease of horses.

Abstract: The purpose of this consensus statement is to provide a review of current knowledge and opinions concerning inflammatory airway disease (IAD) and to help practitioners differentiate IAD from heaves (or recurrent airway obstruction; RAO) and other inflammatory respiratory diseases of horses.

Outbreak of neurologic disease caused by equine herpesvirus-1 at a university equestrian center.

Abstract: Background: Equine herpesvirus type 1 (EHV-1) infection causes neurologic disease in horses. However, risk factors for the disease and long-term prognosis are poorly characterized. Hypothesis: There are identifiable risk factors for equine herpes-1 myeloencephalopathy. Animals: The entire population of 135 horses housed within the equestrian facility. Methods: A descriptive study investigated the clinical, serologic, virologic, and management aspects of an outbreak of EHV-1 myeloencephalopathy. Results: Out of 135 horses at the facility, 117 displayed signs of EHV-1 infection. Forty-six horses developed neurologic deficits characterized by symmetrical hind limb ataxia and weakness. Twelve horses that developed neurologic deficits became recumbent and did not survive. The development of severe neurologic deficits during the outbreak was associated with the presence of residual deficits at the 6-month examination. Within 1 year of the outbreak onset, all horses that survived had returned to an exercise level comparable to that experienced before the outbreak. Factors associated with the development of neurologic disease included age of > 5 years, location in the south or arena stall areas, and highest rectal temperature on day 3 or later of the febrile period. Conclusions and clinical importance: Being > 5 years of age, having had a rectal temperature of > 103.5°F, and highest rectal temperature occurring on or after the 3rd day of the febrile period were the factors most predictive of the development of neurologic disease and death. Data obtained during this outbreak substantiate previous findings relating to clinical aspects and diagnosis of EHV-1 myeloencephalopathy. The prophylactic and therapeutic use of acyclovir during this outbreak is described.

Prognostic Factors in Cats with Chronic Kidney Disease

Abstract: Background: Chronic kidney disease (CKD) is a common cause of morbidity and mortality in cats. Hypothesis: Some baseline variables are associated with shorter survival times in cats with CKD. Animals: Client-owned cats. Methods: Cats with CKD with initial plasma creatinine concentration ≤2.0 mg/dL and urine specific gravity (USG) ≤1.025 were recruited into a prospective clinical trial that compared benazepril with a placebo. We describe baseline variables in 190 cats and their influence on renal survival time in the placebo group (95 cats), which was followed for up to 1,097 days. Renal survival time was defined as the time from initiation of therapy to the need for parenteral fluid therapy, euthanasia, or death related to renal failure. Results: Of the 95 cats treated with a placebo, 58 were censored and 37 reached the renal survival end point (died, n = 0; euthanized, n = 17; parenteral fluids, n = 12; parenteral fluids followed by euthanasia, n = 8). Increased plasma creatinine concentration, increased urine protein-to-creatinine ratio (UPC), and increased blood leukocyte count were significantly (P < .01) associated with a shorter renal survival time and were independent risk factors. Increased concentrations of plasma phosphate or urea, and lower blood hemoglobin concentration or hematocrit were significantly (P < .01) associated with a shorter renal survival time and were dependent risk factors, because they also were significantly (P < .01) correlated with plasma creatinine concentration at baseline. Clinical Importance: Several variables were significantly associated with a shorter renal survival time in cats with CKD.

Diabetes mellitus in a population of 180,000 insured dogs: incidence, survival, and breed distribution.

Abstract: Background: Canine diabetes mellitus (DM) is a common endocrinopathy with an unclear etiology. For a better understanding of the underlying mechanisms, there is a need for comprehensive epidemiologic studies. Earlier studies have shown that the risk of disease is higher in certain dog breeds. Hypothesis: Incidence, age of onset, survival and sex proportion of DM vary by breed. Animals: Data from a cohort of 182,087 insured dogs aged 5–12 years accounting for 652,898 dog-years at risk were studied retrospectively. Methods: Incidence rates by sex, breed, and geography were calculated with exact denominators. Age-specific incidence and survival after 1st DM claim were computed with Cox's regression and Kaplan-Meier survival function. Multivariable survival analysis was performed for the outcome diagnosis of DM with age, sex, and geography tested as fixed effects, previous endocrine or pancreatic diseases tested as time-dependent covariates, and breed tested as a random effect. Results: The mean age at 1st insurance claim for the 860 DM dogs (72% females) was 8.6 years. The incidence of DM was 13 cases per 10,000 dog-years at risk. Australian Terriers, Samoyeds, Swedish Elkhounds, and Swedish Lapphunds were found to have the highest incidence. The proportion of females with DM varied significantly among breeds. Swedish Elkhounds, Beagles, Norwegian Elkhounds, and Border Collies that developed DM were almost exclusively females. The multivariable model showed that breed, previous hyperadrenocorticism, and female sex were risk factors for developing DM. Median survival time was 57 days after 1 st claim. Excluding the 223 dogs that died within 1 day, the median survival time was 2 years after 1st claim of DM. Conclusion: The significant breed-specific sex and age differences shown in this study indicate that genetic variation could make breeds more or less susceptible to different types of DM.

Evaluation of client-specific outcome measures and activity monitoring to measure pain relief in cats with osteoarthritis.

Abstract: Background:There are no validated systems for measuring pain from osteoarthritis in cats. Hypothesis:Owner subjective assessments and an activity monitor (AM) can be used to detect pain in cats with osteoarthritis and to assess efficacy of treatments. Animals:Thirteen cats older than 10 years old, with owner-assessed decreases in activity, painful arthritic joints, and clinically normal blood work were included and evaluated for 3 weeks. Methods:A collar-mounted AM measured activity and a client-specific outcome measure (CSOM) questionnaire characterized the severity of impairment. Overall global quality of life was also evaluated for each treatment. In weeks 2 and 3, meloxicam (0.1 mg/kg, day 1; 0.05 mg/kg, days 2–5) or a placebo was administered in a blinded, randomized, cross-over manner to test the assessment systems. Results:The cats had a median of 4 arthritic appendicular joints. Activity counts for the week when cats (complete data on activity; n = 9) were administered meloxicam were significantly higher than at baseline (P= .02) but not after placebo (P= .06). Baseline activity counts were not significantly different from placebo (P= .6). The CSOM data (n = 13) showed that owners considered their cats to be more active on meloxicam compared with baseline (P= .001) and placebo (P < .004), and more active on placebo than at baseline (P < .01). Global quality of life improved significantly with meloxicam (P < .042). Conclusions and Clinical Importance: Both an AM and a CSOM system can detect behavior associated with pain relief in cats that are arthritic. Objective activity data might allow subjective assessment systems to be validated for use in clinical studies.

Effect of Control of Systolic Blood Pressure on Survival in Cats with Systemic Hypertension

Abstract: Background:Systemic hypertension is a common clinical problem, often occurring in association with renal disease in cats. Limited information is available to assess the effect of blood pressure and the treatment of hypertension on survival. Hypothesis:That adequacy of blood pressure control is associated with the duration of survival in cats with systolic hypertension. Animals:One hundred and forty-one client-owned cats with systolic hypertension. Methods:Hypertensive cats were treated with amlodipine besylate and were followed until death or the study end point. Time-averaged systolic blood pressure (SBPOT) after implementation of antihypertensive medication and stabilization of systolic blood pressure (SBP) was calculated by using the equation (area under the curve/survival [days]). Cats were divided into quartiles based on their SBPOT, representing varying levels of blood pressure control (median [25th, 75th percentile]: Q1 = 137 [132, 141] mm Hg, Q2 = 148 [145, 151] mm Hg, Q3 = 157 [155, 158] mm Hg, Q4 = 170 [164, 175] mm Hg). Survival and clinical variables were compared between the quartiles. Cox proportional hazard regression analysis was used to determine the association of age, renal function, proteinuria, SBPOT, and the presence of hyperthyroidism on survival. Urine protein to creatinine ratio (UP: C) was compared at diagnosis of hypertension and after initiating treatment. Results:Only UP: C and SBP at diagnosis differed significantly between SBPOT quartiles. Proteinuria was the only variable significantly related to survival in hypertensive cats. A significant decline in UP: C was found in cats treated with amlodipine besylate. Conclusions and Clinical Importance: Proteinuria before and after treatment of hypertension is strongly associated with survival in cats with systolic hypertension. Treatment with amlodipine besylate can result in a significant reduction in UP: C.

Continuous low-dose oral chemotherapy for adjuvant therapy of splenic hemangiosarcoma in dogs.

Abstract: Background: Hemangiosarcoma (HSA) is a highly metastatic and often rapidly fatal tumor in dogs. At present, conventional adjuvant chemotherapy provides only a modest survival benefit for treated dogs. Continuous oral administration of low-dose chemotherapy (LDC) has been suggested as an alternative to conventional chemotherapy protocols. Therefore, we evaluated the safety and effectiveness of LDC using a combination of cyclophosphamide, etoposide, and piroxicam as adjuvant therapy for dogs with stage II HSA. Hypothesis: We hypothesized that oral adjuvant therapy with LDC could be safely administered to dogs with HSA and that survival times would be comparable to those attained with conventional doxorubicin (DOX) chemotherapy. Animals: Nine dogs with stage II splenic HSA were enrolled in the LDC study. Treatment outcomes were also evaluated retrospectively for 24 dogs with stage II splenic HSA treated with DOX chemotherapy. Methods: Nine dogs with stage II splenic HSA were treated with LDC over a 6-month period. Adverse effects and treatment outcomes were determined. The pharmacokinetics of orally administered etoposide were determined in 3 dogs. Overall survival times and disease-free intervals were compared between the 9 LDC-treated dogs and 24 DOX-treated dogs. Results: Dogs treated with LDC did not develop severe adverse effects, and long-term treatment over 6 months was well-tolerated. Oral administration of etoposide resulted in detectable plasma concentrations that peaked between 30 and 60 minutes after dosing. Both the median overall survival time and the median disease-free interval in dogs treated with LDC were 178 days. By comparison, the overall survival time and disease-free interval in dogs treated with DOX were 133 and 126 days, respectively. Conclusions: Continuous orally administered LDC may be an effective alternative to conventional high-dose chemotherapy for adjuvant therapy of dogs with HSA.

CCNU for the Treatment of Dogs with Histiocytic Sarcoma

Abstract: Background: Histiocytic sarcoma is an aggressive neoplasm of dendritic cells that carries a grave prognosis. The efficacy of chemotherapy against this disease is unknown. The purpose of this study was to determine the efficacy of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) in dogs with incompletely resected or metastatic histiocytic sarcoma, to describe the clinical characteristics of these dogs, and to identify factors affecting prognosis. Hypothesis: Our hypothesis is that CCNU has activity against canine histiocytic sarcoma and can improve survival in dogs with advanced disease. Animals: Included in analysis are dogs diagnosed with histiocytic sarcoma who had gross measurable or residual microscopic disease and who received CCNU. Methods: A multi-institutional, retrospective, single-arm cohort study was conducted. Available biopsy samples were tested with an antibody against CD18 when possible to confirm the diagnosis of histiocytic sarcoma. Results: Fifty-nine dogs were treated at 8 institutions. Twenty-three tumor specimens were confirmed to be CD18 positive. Treatment with CCNU at 60 to 90 mg/m2 resulted in an overall response rate of 46% in the 56 dogs with gross measurable disease. All 3 dogs with minimal residual disease experienced tumor relapse but lived 433 days or more after starting CCNU. The median survival of all 59 dogs was 106 days. Thrombocytopenia (< 100,000 platelets/μL) and hypoalbuminemia were found to be negatively associated with prognosis and were predictive of < 1 month survival. Conclusions and Clinical Importance: Results suggest that CCNU is active against canine histiocytic sarcoma and may be useful in the treatment of dogs without negative prognostic factors.

Diagnostic value of echo-Doppler and tissue Doppler imaging in dogs with pulmonary arterial hypertension

Abstract: Background: Diagnosis of pulmonary arterial hypertension (PAH) relies on Doppler measurement of pulmonic and tricuspid regurgitation (TR). However, these are not always detectable. Hypothesis: Tissue Doppler imaging (TDI), a novel noninvasive ultrasound technique, provides indirect but sensitive and specific assessment of elevated systolic pulmonary artery pressure (SPAP) in dogs. Animals: One hundred and five dogs with TR. Methods: Prospective observational study. Dogs were categorized as presenting normal (group 1, n = 45), mildly increased (group 2, n = 19), or moderately to severely increased (group 3, n = 41) SPAP, based on TR peak velocities ( 3.0 m/s, respectively). Ten quantitative echo-Doppler- and TDI-derived variables were assessed, including the main pulmonary arterial diameter to aortic diameter ratio, pulmonary flow acceleration time, and acceleration-to-ejection time ratio, the Tei index of right ventricular function, and 6 longitudinal basal right ventricular TDI variables. Results: A significant correlation was observed between SPAP and each of the 10 tested variables (P < .05). Conventional echo-Doppler variables were less discriminating than the TDI for predicting increased SPAP. The combined systolic and diastolic right TDI index had the highest sensitivity and specificity (89% and 93% respectively, for a cutoff of 11.8 cm/s) and could discriminate between dogs in group 1 from dogs in group 2. Conclusions and Clinical Importance: TDI provided effective predictors of systolic PAH and demonstrated that both alterations in right-sided systolic and diastolic myocardial function can occur with mild increases in SPAP.

Dietary energy restriction and successful weight loss in obese client-owned dogs.

Abstract: Background: Obesity is the most common nutritional disease in dogs. Although weight loss by dietary caloric energy restriction is successful in experimental studies, there is limited information on success of such programs in client-owned dogs who are obese. Further, no information currently exists on the changes in body composition during weight loss in clinical cases. Hypothesis: Key determinants of outcome of weight loss, including energy allocation and body composition, are influenced by both individual and weight program factors. Animals: Nineteen client-owned dogs with naturally occurring obesity. Methods: In this prospective clinical study, body composition was quantified by dual-energy X-ray absorptiometry before and after weight loss on an individually tailored program that incorporated a high-protein and moderate-fiber diet. Results: Mean percentage weight loss was 18% (range, 6–29%), and mean rate of weight loss was 0.85% per week (range, 0.35–1.56%). Mean energy allocation required to achieve weight loss was 60% of maintenance energy requirement at target weight (MERTW) (range, 50–82%). Significant dietary noncompliance was reported (mean, 1.0% MERTW; range, 0.0–9.5%). The mean composition of tissue lost was 84:15:1 (fat: lean: bone mineral content [BMC]). Lean tissue loss was positively associated with overall percentage of weight loss (Pearson correlation coefficient [Rp] = 0.591, P= .008), whereas BMC loss was greater in retrievers compared with other breeds (1.9%± 1.16% versus 0.8%± 0.44%; P= .008). Conclusions and Clinical Importance: This clinical study demonstrated body composition changes during weight loss in dogs. Conventional programs produced safe weight loss, but marked energy restriction was required and the rate of loss was slower than in experimental studies.

Premature death, risk factors, and life patterns in dogs with epilepsy

Abstract: analyzed. Results: The median age at death of dogs was 7.0 years. The life span of dogs in which euthanasia or death was directly caused by their epileptic condition was significantly shorter as compared with epileptic dogs that were euthanized because of other causes (P 5 .001). The median number of years that a dog lived with epilepsy was 2.3 years. Females lived longer with epilepsy than males (P 5 .036). Seizure type (primary generalized versus focal seizures) was not significantly associated with survival time. The remission rate of epilepsy (spontaneous remission and remission with treatment) was 15%. Conclusion and Clinical Importance: The diagnosis of epilepsy implies an increased risk of premature death. The prognosis for dogs with epilepsy is dependent on a combination of veterinary expertise, therapeutic success, and the owner’s motivation.

Sildenafil Citrate Therapy in 22 Dogs with Pulmonary Hypertension

Abstract: Background: Pulmonary hypertension (PH) is a disease condition characterized by abnormally increased pulmonary artery pressures and often is associated with a poor prognosis. Sildenafil is a phosphodiesterase inhibitor that causes pulmonary arterial vasodilation and reduction in pulmonary artery pressures. Hypothesis: Treatment with sildenafil will improve echocardiographic determinants of PH in dogs, while also improving quality of life and survival. Animals: Twenty-two dogs with clinical and echocardiographic evidence of pulmonary hypertension. Methods: A retrospective study evaluating the effects of sildenafil on physical examination, ECG and radiographic findings, blood pressure and echocardiographic findings of PH, clinical score, and outcome was completed. PH was defined as a peak tricuspid regurgitation flow velocity ?2.8 m/s or a peak pulmonic insufficiency flow velocity ?2.2 m/s. Results: Sixteen of 22 dogs with PH were elderly females of small body size. Their clinical score was significantly improved (P= .0003) with sildenafil treatment, but physical examination findings remained unchanged. Heart rate, respiratory rate, vertebral heart size, ECG heart rate, and systolic blood pressure did not change significantly with sildenafil treatment (P > .05). Peak tricuspid regurgitation flow velocities did not change significantly with the treatment of sildenafil, but selected systolic time intervals were significantly improved. Survival times for all dogs ranged from 8 to >734 days. Conclusions and Clinical Importance: Sildenafil did not significantly lower the degree of measurable PH in dogs. Clinical improvement and increased quality of life was seen with sildenafil treatment, despite lack of significant change in other variables.

Distinguishing cardiac and noncardiac dyspnea in 48 dogs using plasma atrial natriuretic factor, B-type natriuretic factor, endothelin, and cardiac troponin-I.

Abstract: Background:It is challenging to differentiate congestive heart failure (CHF) from noncardiac cause of dyspnea. Hypothesis:Circulating concentrations of atrial natriuretic peptide (NT-proANP), B-type natriuretic peptide (BNP), endothelin-1 (ET-1), and cardiac troponin-I (cTnl) can be used to help distinguish between cardiac and noncardiac causes of dyspnea in dogs. Animals:Forty-eight client-owned dogs admitted to a veterinary teaching hospital for respiratory distress. Methods:Blood samples from patients were prospectively obtained. The etiology of dyspnea was determined by using physical examination, thoracic radiographs, and echocardiography. Results:CHF was diagnosed in 22 dogs, and dyspnea of noncardiac origin (noHD group) was diagnosed in 26 dogs. Analyses revealed significant difference between groups for NT-proANP (geometric mean, 95% confidence [CI]; no HD: 0.26 nmol/mL, 95% CI 0.17–1.09; CHF: 1.38 nmol/mL, 95% CI 1.09–1.74 nmol/mL; P < .0001), BNP (noHD: 12.18 pg/mL, 95% CI 10.91–16.17 pg/mL; CHF: 34.97 pg/mL, 95% CI 23.51–52.02 pg/mL; P < .0001), and ET-1 (noHD: 0.32 fmol/mL, 95% CI 0.23–0.46 fmol/mL; CHF: 1.26 fmol/mL, 95% CI 0.83–1.91 fmol/mL; P < .0001). Plasma cTnI concentrations were not significantly different between groups (noHD: 0.29 ng/mL, 95% CI 0.12–0.72 ng/mL; CHF: 0.42 ng/mL, 95% CI 0.18–0.97, P= .53). Receiver operating curves indicated areas under the curve for NT-proANP, BNP, and ET-1 of 0.946, 0.886, and 0.849, respectively. Conclusions and Clinical Importance: Plasma NT-proANP, BNP, and ET-1, but not cTnI, appear useful for distinguishing between dogs with cardiac and noncardiac causes of dyspnea, with plasma NT-proANP having the highest sensitivity (95.5%) and specificity (84.6%).

Clinicopathologic Features and Outcome Predictors of Leptospira interrogans Australis Serogroup Infection in Dogs: A Retrospective Study of 20 Cases (2001–2004)

Abstract: Background and Hypothesis: We retrospectively evaluated the Clinicopathologic findings and outcome predictors in dogs with Leptospira interrogans Australis serogroup infections Animals and Methods: The medical records of 159 dogs that had a leptospiral microscopic agglutination test (MAT) performed between 2001 and 2004 were reviewed Results: Twenty dogs met serologic criteria for either symptomatic (16 dogs) or asymptomatic (4 dogs) infection caused by Leptospira interrogans Australis serogroup Seven of 16 symptomatic dogs died or were euthanized and 9/16 recovered Systemic inflammatory response syndrome (SIRS) was observed in 9/16 dogs The presence of SIRS did not affect prognosis (P= 357) C-reactive protein (CRP) and haptoglobin (Hpt) concentrations were altered in all symptomatic dogs, but results did not differ significantly between survivors and nonsurvivors (P= 08 and P= 055, respectively) Conversely, the CRP to Hpt ratio (CRP/Hpt) was significantly increased in nonsurvivors Disseminated intravascular coagulation (DIC) was diagnosed in 7/16 dogs DIC did not significantly affect outcome (P= 126) Multiple organ involvement was present with renal failure in 16/16, liver damage in 12/16, cardiac damage in 11/16, and muscular damage in 8/16 dogs Conclusions and Clinical Importance: Among the evaluated Clinicopathologic biomarkers, serum albumin, cardiac troponin I, CRP/Hpt, urinary albumin, and urinary total protein to creatinine ratio were found to predict outcome and warrant evaluation in larger prospective studies

Decreased Systolic Function and Inadequate Hypertrophy in Large and Small Breed Dogs with Chronic Mitral Valve Insufficiency

Abstract: Background: Systolic dysfunction associated with chronic mitral valve insufficiency (CMVI) has been demonstrated in experimental animal models and large breed (LB) dogs but has been reported as an uncommon finding in small breed (SB) dogs with naturally occurring disease. It has been suggested the myocardial failure could be, in part, because of an insufficient increase in left ventricular mass. Hypothesis: To test if SB and LB dogs with CMVI and moderate heart failure have systolic dysfunction and if they have adequate eccentric hypertrophy. Animals: Data from 38 SB and 18 LB dogs affected with CMVI were compared retrospectively with results from 2 groups of normal dogs (17 SB and 32 LB) Methods: Systolic function was investigated echocardiographically by using percentage fractional shortening (FS), the ratio between observed and expected end-systolic diameter (ESD/ESDe), and end-systolic volume index (ESVI). Left ventricular hypertrophy was estimated by using the ratio between the thickness of the left ventricular free wall and the radius in diastole (h/R). Results: Both affected SB and LB dogs had a significantly increased FS and ESVI (FS% SB 45.6 + 8.04 versus 40.06 + 8.9, P < .05; FS% LB 33.64 + 8.61 versus 27.3 + 7.3 P < .05; ESVI SB 30.0 ± 2.3 mL/m2 versus 21.18 ± 13.9 mL/m2, P < .05; ESVI LB 83.22 ± 43.84 mL/m2 versus 36.43 ± 13.30 mL/m2 versus P < .001). The h/R in affected animals was decreased (0.53 ± 0.11 versus 0.41 ± 0.12, P < .05 SB; 0.47 ± 0.11 versus 0.38 ± 0.09, P < .05, LB). Conclusions and Clinical Importance: Data from this study indicate that dogs with moderate heart failure caused by CMVI have systolic dysfunction. Inadequate hypertrophy of the left ventricle may be, in part, responsible for this finding.

Evaluation of Clinical, Macroscopic, and Histopathologic Response to Treatment in Nonhypoproteinemic Dogs with Lymphocytic‐Plasmacytic Enteritis

Abstract: Background: Lymphocytic-plasmacytic enteritis (LPE) is a common cause of chronic vomiting and diarrhea in dogs. However, little information is available about endoscopic or histopathologic improvement after therapy in dogs with LPE. Hypothesis: The objective was to study the clinical, endoscopic, and histopathologic evolution of LPE during and after immunosuppressive treatment with prednisone and metronidazole. Most dogs also were treated symptomatically with metoclopramide and cimetidine. Animals: Sixteen dogs with LPE and normal serum protein concentrations diagnosed at the Veterinary Medical Teaching Hospital of the Complutense University of Madrid were monitored during and after drug treatment. The control group consisted of 9 dogs that had no gastrointestinal signs for the preceding 12 months. Methods: In this prospective clinical treatment trial, clinical, endoscopic, and histopathologic scores were evaluated to describe disease evolution during conventional therapy. Dogs with LPE were monitored for 120 days from the start of treatment. Re-evaluation was performed on post-treatment days 30, 60, 90 (end of treatment), and 120. Results: The average disease activity index observed in our study fell progressively from its initial value, and the decrease between consecutive re-evaluations was statistically significant until day 60 (P= .04). Our results indicate that 75% of the animals revealed improvement of endoscopic gastric lesions (defined as a reduction of the endoscopic score) after treatment, and 75% exhibited improvement of endoscopic duodenal lesions. Statistical analysis of the data revealed significant differences between pre- and post-treatment gastric and duodenal macroscopic endoscopic lesions (P < .05). On the other hand, treatment did not lead to any significant changes in the severity of the gastric and duodenal histopathologic lesions of the affected dogs. Conclusions and Clinical Importance: Treatment of nonhypoproteinemic dogs with LPE led to clinical and endoscopic improvement, but histopathologic lesions were unchanged during therapy.

Serum Iron and Plasma Fibrinogen Concentrations as Indicators of Systemic Inflammatory Diseases in Horses

Abstract: Background:Detection of systemic inflammation, which is important for proper diagnosis and prompt treatment, can be challenging. Hypothesis:Measurement of plasma iron concentration is a sensitive method for detecting systemic inflammation in horses compared with measurements of plasma fibrinogen concentration, a traditional marker for inflammation in the horse. Animals:Ninety-seven horses hospitalized with diseases causing systemic inflammation, 22 horses with localized inflammation, and 12 clinically normal horses were included in this study. Methods:A retrospective study was made on hospitalized horses that had both plasma iron and fibrinogen concentrations measured on hospital admission. Results:Plasma iron concentration was lower in horses with systemic inflammation (64 ± 45 μg/dL) than the reference interval minimum (105 μg/dL) and were significantly lower (P= .001) than the value in a group of horses with local inflammation (123 ± 45 μg/dL) and in healthy transported horses (143 ± 29 μg/dL). Low plasma iron and high fibrinogen concentrations were both sensitive indicators of systemic inflammation in horses with sensitivity of 90 and 82%, respectively. There was a similar correlation between either continued decreases in iron concentration (Rsp of 0.239) or increases in fibrinogen concentration (Rsp of 0.280) during hospitalization and a worse prognosis. Conclusions and Clinical Importance: Measurement of plasma iron concentration better reflected acute inflammation than did fibrinogen concentration.

Effects of genetic and environmental factors on chronic lower airway disease in horses.

Abstract: BACKGROUND: Environment and genetics influence the manifestation of recurrent airway obstruction (RAO), but the associations of specific factors with mild, moderate, and severe clinical signs are unknown. HYPOTHESIS: We hypothesized that sire, feed, bedding, time outdoors, sex, and age are associated with clinical manifestations of mild, moderate, and severe lower airway disease. ANIMALS: Direct offspring of 2 RAO-affected Warmblood stallions (F1S1, n = 172; F1S2, n = 135); maternal half-siblings of F1S1 (mHSS1, n = 66); and an age-matched, randomly chosen control group (CG, n = 33). METHODS: A standardized questionnaire was used to assess potential risk factors and to establish a horse owner assessed respiratory signs index (HOARSI 1-4, from healthy to severe) according to clinical signs of lower airway disease. RESULTS: More F1S1 and F1S2 horses showed moderate to severe clinical signs (HOARSI 3 and HOARSI 4 combined, 29.6 and 27.3%, respectively) compared with CG and mHSS1 horses (9.1 and 6.2%, respectively; contingency table overall test, P < .001). Sire, hay feeding, and age (in decreasing order of strength) were associated with more severe clinical signs (higher HOARSI), more frequent coughing, and nasal discharge. CONCLUSIONS AND CLINICAL RELEVANCE: There is a genetic predisposition and lesser but also marked effects of hay feeding and age on the manifestation of moderate to severe clinical signs, most markedly on coughing frequency. In contrast, mild clinical signs were not associated with sire or hay feeding in our populations.

A high-protein, high-fiber diet designed for weight loss improves satiety in dogs.

Abstract: Background Weight-loss programs for dogs are often hampered by increased begging and scavenging behavior that ensues when food intake is restricted. Hypothesis A diet formulated to contain a high content of both protein and fiber is more satiating than diets that contain only high fiber or high protein. Animals Six entire female adult dogs (2 Shetland Sheepdogs, 2 Brittany Spaniels, 2 Labrador Retrievers) participated in the satiety studies; 105 adult female dogs of various breeds and ages were used for the palatability studies. Methods Three diets (high protein [103 g/1,000 kcal] high fiber [60 g/1,000 kcal] [HPHF]; high protein [104 g/1,000 kcal] moderate fiber [35 g/1,000 kcal] [HP]; moderate protein [86 g/1,000 kcal] high fiber [87 g/1,000 kcal] [HF]) were tested. Voluntary food intake was measured in 5 sequential crossover studies, and palatability was assessed with food preference tests. Results Protein digestibility was significantly lower for HF (mean +/- SD; 77.7% +/- 2.52%) than for both HPHF (81.1% +/- 0.96%) and HP (81.1% +/- 1.65%) (P Conclusions and clinical importance The HPHF diet had a satiating effect as evidenced by reduced voluntary intake compared with HP and HF diets, and has the potential to lead to greater compliance in weight-loss programs.

Plasma adrenocorticotropin, cortisol, and adrenocorticotropin/cortisol ratios in septic and normal-term foals.

Abstract: Background: Little information exists on the hypothalamic-pituitary-adrenal axis in septic foals. Hypothesis: The plasma concentrations of adrenocorticotropin (ACTH) and cortisol are expected to be higher in septic foals as compared to normal foals. The concentrations of hormones in septic foals also are expected to differ further depending upon survival. Animals: Twenty-eight control foals and 46 septic foals < 14 days of age were included in this study. Methods: Blood was collected in EDTA once from 28 normal foals born in the University of Georgia or Cornell University equine research herds and from 46 septic foals within 12 hours after admission to 1 of the 3 tertiary care referral centers involved in the study. Septic foal selection was based on a sepsis score of >11 or a positive blood culture. The control foals were age matched to the septic foals in the study. ACTH and cortisol concentrations were measured by a chemiluminescent immunoassay system. Results: Cortisol concentrations in control foals did not vary with age. Septic foals had significantly higher mean ACTH, cortisol, and ACTH/cortisol ratios than did normal foals. Within the septic foal group, 28 foals survived to discharge, and 18 were euthanized or died. The mean age was not significantly different between the septic surviving and nonsurviving foals. The mean ACTH/cortisol ratio was significantly higher in the septic nonsurviving foals as compared to the septic surviving foals. Conclusions and Clinical Importance: Septic foals had higher hormone concentrations as compared to normal foals, which is an expected endocrine response to critical illness. The increased ACTH/cortisol ratio in nonsurviving septic foals in comparison to surviving septic foals could indicate hypothalamic-pituitary-adrenal axis dysfunction at the level of the adrenal gland in critically ill septic foals.

A newly recognized blood group in domestic shorthair cats: the Mik red cell antigen.

Abstract: Background Naturally occurring alloantibodies produced against A and B red cell antigens in cats can cause acute hemolytic transfusion reactions. Blood incompatibilities, unrelated to the AB blood group system, have also been suspected after blood transfusions through routine crossmatch testing or as a result of hemolytic transfusion reactions. Hypothesis Incompatible crossmatch results among AB compatible cats signify the presence of a naturally occurring alloantibody against a newly identified blood antigen in a group of previously never transfused blood donor cats. The associated alloantibody is clinically important based upon a hemolytic transfusion reaction after inadvertent transfusion of red cells expressing this red cell antigen in a feline renal transplant recipient that lacks this red cell antigen. Methods Blood donor and nonblood donor cats were evaluated for the presence of auto- and alloantibodies using direct antiglobulin and crossmatch tests, respectively, and were blood typed for AB blood group status. Both standard tube and novel gel column techniques were used. Results Plasma from 3 of 65 cats and 1 feline renal transplant recipient caused incompatible crossmatch test results with AB compatible erythrocytes indicating these cats formed an alloantibody against a red cell antigen they lack, termed Mik. The 3 donors and the renal transplant recipient were crossmatch-compatible with one another. Tube and gel column crossmatch test results were similar. Conclusions and clinical importance The absence of this novel Mik red cell antigen can be associated with naturally occurring anti-Mik alloantibodies and can elicit an acute hemolytic transfusion reaction after an AB-matched blood transfusion.

Comparison of COAP and UW‐19 Protocols for Dogs with Multicentric Lymphoma

Abstract: Background: Various chemotherapy protocols for treating lymphoma in dogs have been published; however, comparison of protocols from different studies is difficult, especially when evaluating survival time and toxicoses. Hypothesis: The choice of COAP (C, cyclophosphamide; O, vincristine; A, cytosine arabinoside; P, prednisone) and a modified University of Wisconsin 19-week (UW-19) induction protocol has no influence on overall survival times in dogs with lymphoma. Animals: One hundred and one dogs with multicentric lymphoma. Methods: Retrospective study (2001–2006). Dogs induced with either an 8-week COP-based protocol (C, cyclophosphamide; O, vincristine; and P, prednisone) with maintenance therapy (COAP group) or a 19-week CHOP (C, cyclophosphamide; H, doxorubicin; O, vincristine; and P, prednisone) based protocol (UW-19 group) were compared in terms of the duration of first remission, survival time, toxicoses, and cost. Results: There were 71 dogs in the COAP group and 30 dogs in the UW-19 group. Various protocols were used after the first relapse. The median duration of the first remission for the COAP and UW-19 groups were 94 days (range, 6–356 days) and 174 days (28–438 days), respectively (P < .01). The median survival times for dogs in the COAP and UW-19 groups were 309 days (6–620 days) and 275 days (70–1102+ days), respectively (P= .09). Dogs in the COAP group had a hazard ratio of 1.9 (95% CI 1.1–3.4) for death relative to the UW-19 group (P= .03), after controlling for the confounders (World Health Organization clinical stage, age, sex, use of doxorubicin during reinduction). The severity of neutropenia and gastrointestinal toxicoses were significantly higher in the UW-19 group than in the COAP group (P= .01 and P < .01, respectively). Conclusion and Clinical Importance: Use of a long-term doxorubicin-containing sequential combination chemotherapy protocol is associated with a decreased risk of relapse and death relative to a non-doxorubicin-containing protocol.

Clinical stage, therapy, and prognosis in canine anal sac gland carcinoma.

Abstract: Background:Reports of canine anal sac gland carcinoma (ASGC) describe varied clinical presentations and management and differing responses to therapy. A unifying approach to clinical stage determination and management of this disease has yet to be presented. Hypothesis:An ordinal clinical staging scheme for canine ASGC can be devised on the basis of responses to therapy for a retrospective cohort of affected dogs. Animals:130 dogs with naturally occurring ASGC. Methods:A simplified clinical stage system and a management algorithm for canine ASGC were derived from retrospective evaluation of a cohort of 80 dogs; applicability of both was then prospectively evaluated in a cohort of 50 dogs. Results:Retrospective evaluation revealed 4 statistically significant negative prognostic indicators for survival: lack of therapy, presence of distant metastases, presence of lymph node metastases, and primary tumor size. Lymph node extirpation was a statistically significant positive prognostic indicator by bivariate analysis. In both retrospective and prospective analyses, the modified clinical stage scheme revealed a significant association with survival time. Conclusions and Clinical Importance: The clinical staging scheme permits differentiation between groups in terms of prognosis and, therefore, decisions on therapy. This will facilitate application of appropriate therapy and enhanced communication and collaboration in further investigations of ASGC.

Doxorubicin and BAY 12–9566 for the Treatment of Osteosarcoma in Dogs: A Randomized, Double‐Blind, Placebo‐Controlled Study

Abstract: Background: This study was designed to assess the efficacy of a matrix metalloproteinase inhibitor in prolonging posttreatment survival for dogs with appendicular osteosarcoma after treatment with amputation and doxorubicin chemotherapy. Hypothesis: Survival will be prolonged in dogs receiving BAY 12–9566. Animals: The study included 303 dogs with appendicular osteosarcoma. Methods: Dogs were treated with doxorubicin (30 mg/m2) every 2 weeks for 5 treatments starting 2 weeks after amputation. Dogs were randomly allocated to receive a novel nonpeptidic biphenyl inhibitor of matrix metalloproteinases (MMPs, BAY 12–9566; 4-[4–4-(chlorophenyl)phenyl]-4-oxo-2S-(phenylthiomethyl) butanoic acid) or placebo after doxorubicin chemotherapy. Results: Median survival for all 303 dogs was 8 months; and 1-year, 2-year, and 3-year survival rates were 35%, 17%, and 9%, respectively. Treatment with BAY 12–9566 did not influence survival. Multivariate analysis revealed that increasing age (P= .004), increasing weight (P= .006), high serum alkaline phosphatase (ALP) (P= .012) and high bone ALP (P < .001) were independently associated with shorter median survival times. Additional analyses on available data indicated that as the number of mitotic figures in the biopsy increased (P= .013), and as plasma active MMP-2 concentrations increased (P= .027), the risk of dying increased. Conclusions and Clinical Importance: Doxorubicin is an effective adjuvant to amputation in prolonging survival for dogs with appendicular osteosarcoma.

Effect of Feline Interferon‐Omega on the Survival Time and Quality of Life of Cats with Feline Infectious Peritonitis

Abstract: Background There is no therapy with proven efficacy to treat cats with feline infectious peritonitis (FIP). Hypothesis Feline interferon-omega (FeIFN-omega) prolongs survival time and increases quality of life in cats with FIP. Animals Thirty-seven privately owned cats were subjects of this study. Methods The study was performed as a placebo-controlled double-blind trial. Feline infectious peritonitis was confirmed by histology or immunostaining of feline coronavirus (FCoV) antigen in effusion or tissue macrophages or both. The cats were randomly selected for treatment with either FeIFN-omega or a placebo. All cats received adjunctive treatment with glucocorticoids and antibiotics and passive immunization with Feliserin. Results There was no statistically significant difference in the survival time of cats treated with FeIFN-omega versus placebo or in any other variable evaluated (with the exception of the lymphocyte count). The cats survived between 3 and 200 days (median, 9 days). There was only 1 long-term survivor (> 3 months), and the cat was in the FeIFN-omega group. Conclusion and clinical relevance No effect of FeIFN-omega on survival time or quality of life could be demonstrated in this study.

Blood Glucose in Horses with Acute Abdominal Disease

Abstract: Background: Hyperglycemia in critically ill humans is associated with increased glucose production and insulin resistance and is associated with death. This might also be true in horses presenting with acute abdominal disease. Hypothesis: Throughout hospitalization, hyperglycemia will be common in adult horses presenting with acute abdominal disease. Hyperglycemia will be associated with a worse prognosis for survival to hospital discharge. Animals: Two hundred sixty-nine adult horses with acute abdominal disease. Methods: Observational retrospective study. Records were reviewed for 269 horses that had glucose data analysed and recorded at the time of hospital admission: 154 horses had a first sample after admission; 110 horses at 24 hours after admission; 74 horses at 36 hours after admission; and 49 horses at 48 hours after admission. Logistic regression analyses were performed to investigate the association of glucose concentrations with survival, in addition to the association of glucose concentrations with surgical, small intestinal, strangulating lesions, and lesions requiring a resection. Results: Of 269 horses presenting with acute abdominal disease, 50.2% had blood glucose concentrations greater than the reference range (75.6–131.4 mg/dL); 0.4%, below the reference range; and 49.4%, within the reference range at admission. Of 269 horses, 2.3% had blood glucose concentrations below the reference range at some point during the first 48 hours of hospitalization, all of which had strangulating intestinal lesions. Horses that did not survive to hospital discharge had a higher mean blood glucose concentration at admission; at the first sample after admission; at 24, 36, and 48 hours after admission; and higher maximum and minimum blood glucose concentrations in the first 24 hours after admission. Conclusions and Clinical Importance: Derangements of blood glucose concentration are common in horses with acute abdominal disease. Hyperglycemia is much more common than hypoglycemia in these animals. Hyperglycemia in the first 48 hours of hospitalization is associated with a worse prognosis for survival to hospital discharge.

The effect of hydration status on the echocardiographic measurements of normal cats.

Abstract: Background: Diagnosis of cardiomyopathy of cats is based on 2-dimensional (2D) echocardiography. However, circulatingfluid volume largely determines diastolic cardiac chamber dimensions, and reduced diastolic volume in other species results inwhat has been called ‘‘pseudohypertrophy of the ventricular myocardium.’’Hypothesis: Altered hydration produces changes on 2D echocardiography that may confound the diagnosis or severityassessment of cardiomyopathy of cats.Animals: Ten normal colony-sourced mixed breed cats were included.Methods: Cats were examined by echocardiography at baseline and at completion of 3 protocols (volume depletion andmaintenance-rate and anesthetic-rate IV fluid administration) applied in randomized crossover design with a 6–7 day washoutperiod.Results: Volume depletion increased diastolic left ventricular interventricular septal (IVSd) and free wall diameter (4.5 6 0.4to 5.8 6 0.6 mm; P , .001) with wall thickness exceeding 6 mm in 4 cats. Diastolic left ventricular internal diameter (LVIDd)decreased, and reduction in systolic left ventricular internal diameter (LVIDs) produced end-systolic cavity obliteration in 7cats. Left-atrial-to-aortic-root ratio (LA:Ao, 1.4 6 0.2 to 1.2 6 0.1, P , .05) and left atrial area in diastole (LAAd) decreasedwith volume depletion. Maintenance-rate IV fluid administration increased LAAd and fractional shortening (FS%).Anesthetic-rate IV fluid administration increased LVIDd, FS%, LAAd, and LA:Ao ratios (to 1.7 6 0.1, P , .01), producingan LA:Ao ratio above normal limits in 6 cats. A systolic heart murmur developed with administration of fluid at maintenance(n 5 1) and anesthetic rates (n 5 6).Conclusions: Altered hydration status produces changes in the echocardiographic examination of normal cats that may leadto an erroneous diagnosis of cardiomyopathy or mask its presence. Hydration status should be considered duringechocardiographic examination in cats.Key words: Dehydration; Fluid administration; Heart murmur; Pseudohypertrophy; Volume depletion.

Comparison of direct immunofluorescence, immunoassays, and fecal flotation for detection of Cryptosporidium spp. and Giardia spp. in naturally exposed cats in 4 Northern California animal shelters.

Abstract: Background: Giardia spp. and Cryptosporidium spp. are common intestinal protozoan parasites in domestic cats. Few studies have critically evaluated the performance characteristics of commercially available immunoassays for detection of these organisms in the cat. Hypothesis: Human-based immunoassays are suboptimal for the detection of Giardia spp. and Cryptosporidium spp. in cats. Animals: Three-hundred-and-forty-four cats with diarrheic and nondiarrheic fecal specimens at 4 northern California animal shelters. Methods: A fecal specimen was collected from each cat in a case-controlled fashion. Fecal specimens were tested for Giardia spp. and Cryptosporidium spp. by using centrifugation flotation and 5 commercially available immunoassays (SNAP Giardia, ProSpecT Giardia Microplate Assay, ProSpecT Cryptosporidium Microplate Assay, ImmunoCard STAT!Cryptosporidium/Giardia Rapid Assay, and Xpect Giardia/Cryptosporidium). Results were compared with a reference standard, the MeriFluor direct immunofluorescence assay. Results: Overall prevalences of Giardia spp. and Cryptosporidium spp. were 9.8 and 4.7%, respectively. The ProSpecT Microplate Assay had the highest sensitivities and specificities for Giardia spp. (91.2 and 99.4%) and Cryptosporidum spp. (71.4 and 96.7%), respectively. The SNAP Giardia antigen assay was easier to use and equally sensitive (85.3%) and specific (100%) to fecal flotation. Conclusions and Clinical Importance: Caution should be exercised when using human-based immunoassays for the diagnosis of Giardia and Cryptosporidium spp. in cats. Fecal flotation remains a useful method for detection of Giardia spp., can be used to detect other parasites, and has a sensitivity of 97.8% for detection of Giardia spp. when combined with the SNAP Giardia immunoassay.