Renal dysplasi hos hund

Renal dysplasia is a developmental anomaly of the kidneys which is considered to be the primary lesion in juvenile progressive nephropathy, a condition leading to chronic renal failure in young dogs. It is defined as disorganised development of the renal parenchyma due to abnormal differentiation, and pathological lesions include persistent foetal structures, dysplastic tubules and cartilaginous and osseus metaplasia. The aetiology of renal dysplasia in dogs is still unknown, but possible causes are infection with canine herpesvirus, teratogenic substances or intrauterine ureteral obstruction. In some breeds renal dysplasia is a familial or inherited disease. Clinical signs of chronic renal failure, such as polyuria, polydipsia, vomiting, weight loss, anorexia, lethargy and anemia, usually appear before the age of 2 years. The purpose of this study was to obtain more knowledge about epidemiology, breed predisposition and morphology of renal dysplasia. In the epidemiological part of the study the prevalence of renal dyplasia in nine different breeds during the time period 1981-2001 was investigated. In the histopathological part the presence of dysplastic changes in the kidneys was examined in 57 cases of renal dysplasia in Tibetan Spaniel and Flat-coated Retriever. The highest prevalences for the whole time period were noted for Shih Tzu (0,57%), Tibetan Terrier (0,56%), Lhasa Apso(0,48%) and Tibetan Spaniel (0,42%). For the breeds Irish Soft-coated Wheaten Terrier, Cairn Terrier and Flat-coated Retriever the prevalence was a little bit lower (0,29%, 0,26% and 0,20%, respectively) and for English Cocker Spaniel and Cavalier King Charles Spaniel the prevalence was very low (0,09% and 0,08%, respectively). For Shih Tzu and Tibetan Terrier, but not for the other breeds, the prevalence decreased during the latter part of the time period. More than half (64,2 %) of the dogs in this study were < 2 years of age at the time of diagnos/euthanasia, and the highest proportion of dogs < 2 years of age was noted for Cairn Terriers, Tibetan Terriers and Lhasa Apsos (80,0%, 80,0% and 75,0%, respectively). A sex predisposition for renal dysplasia was detected for Flat-coated Retrievers and Cavalier King Charles Spaniels, in which females represented 87,5% and 85,0 %, respectively, of the cases. In the morphological study, the most commonly detected signs of renal dysplasia were foetal glomeruli, dysplastic tubules and persistent metanephric ducts in both the Tibetan Spaniel and the Flat-coated Retriever. These lesions were found at a frequency of 89%, 22% and 18% in the Tibetan Spaniel and 80%, 53% and 7% in the Flat-coated Retriever, respectively. The observed difference between the two breeds regarding dysplastic tubules was statistically significant (p=0,016). The mean age at the time of diagnosis was 16 months for Tibetan Spaniel and 15 months for Flat-coated Retriever. The morphological changes observed in the Tibetan Spaniel were similar to those reported in the Shih Tzu and Lhasa Apso, whereas the lesions of the Flat-coated Retriever resemble descriptions of familial renal disease in the Soft-coated Wheaten Terrier. In conclusion, the present study showed that most of the cases of renal dysplasia in the nine breeds examined were diagnosed before the age of two years. The reduced prevalence of renal dysplasia observed for the breeds Shih Tzu and *Tibetan Spaniel for the latter part of the investigated time period suggests that the introduced control programs have been effective. For the breeds Flat-coated Retriever and Cavalier King Charles Spaniel, the results indicate a sex predisposition for renal dysplasia, with females clearly over-represented. This study also indicates a breed-related difference between Flat-coated Retrievers and Tibetan Spaniels regarding the histopathological changes occurring in renal dysplasia. * CORRECTION: Tibetan Terrier - not Tibetan SpanielRenal dysplasi är en utvecklingsrubbning i njurarna som anses vara den primära skadan vid fall av s.k juvenil progressiv nefropati, en sjukdom som ger upphov till kronisk njursvikt hos framför allt unga hundar. Med renal dysplasi avses patologiska förändringar som tyder på störningar i den normala differentieringen av njurvävnaden, såsom kvarstående fetala strukturer, dysplastiska tubuli samt brosk- och benmetaplasier. Etiologin till renal dysplasi är ej klarlagd, men neonatal infektion med herpesvirus, teratogena substanser eller intrauterin obstruktion i urinvägarna har angivits som möjliga orsaker. Hos vissa hundraser har även en familjär eller ärftlig disposition påvisats. Kliniska symtom på kronisk njursvikt, såsom polyuri, polydipsi, kräkningar, avmagring, inappetens, trötthet och anemi, uppkommer ofta redan före 2 års ålder. Syftet med denna studie var att öka kunskapen om epidemiologi, rasdisposition och morfologi vid renal dysplasi, och den omfattade en epidemiologisk och en histopatologisk del. I den epidemiologiska delen undersöktes prevalensen av renal dysplasi hos nio olika hundraser under åren 1981-2001. I den histopatologiska delen jämfördes förekomsten av dysplastiska förändringar i njurarna hos totalt 57 diagnostiserade fall av renal dysplasi hos raserna tibetansk spaniel och flat-coated retriever. De hundraser som hade högst prevalens för hela tidsperioden var shih tzu (0,57%), tibetansk terrier (0,56%), lhasa apso (0,48%) och tibetansk spaniel (0,42%). För raserna irish soft-coated wheaten terrier, cairn terrier och flat-coated retriever var prevalensen något lägre (0,29%, 0,26% respektive 0,20%) och för raserna engelsk cocker spaniel och cavalier king charles spaniel var den mycket låg (0,09% respektive 0,08%). Under den senare delen av den undersökta tidsperioden sågs en minskad prevalens för renal dysplasi hos shih tzu och tibetansk terrier, medan prevalensen hos flat-coated retriever var relativt oförändrad. För övriga raser var prevalensen mycket varierande under hela tidsperioden och några säkra slutsatser kan därför inte dras avseende eventuella förändringar i förekomsten av renal dysplasi för dessa raser. Över hälften (64,2%) av hundarna i undersökningen var < 2 år vid tidpunkten för diagnos/avlivning, och högst andel hundar < 2 år noterades hos cairn terrier, tibetansk terrier och lhasa apso (80,0%, 80,0% respektive 75,0%). En markant könsskillnad påvisades inom raserna flat-coated retriever och cavalier king charles spaniel, där tikarna utgjorde 87,5% respektive 85,0% av de diagnostiserade fallen. Den morfologiska undersökningen visade att de vanligaste tecknen på renal dysplasi hos både tibetansk spaniel och flat-coated retriever var fetala glomeruli, dysplastiska tubuli och kvarstående metanefriska gångar. Dessa fynd förekom i en frekvens av 89%, 22% respektive 18% hos tibetansk spaniel och 80%, 53% respektive 7% hos flat-coated retriever. Den påvisade rasskillnaden avseende förekomsten av dysplastiska tubuli var statistiskt signifikant (p<0,016). Genomsnittsåldern för diagnos var 16 månader för tibetansk spaniel och 15 månader för flat-coated retriever. De morfologiska förändringarna hos tibetansk spaniel liknar dem som ses hos shih tzu och lhasa apso, medan bilden hos flatcoated retriever påminner om den som finns beskriven vid s.k. familjär nefropati hos soft coated wheaten terrier. Sammanfattningsvis visade studien att de flesta fallen av renal dysplasi hos de nio undersökta raserna diagnostiserades före 2 års ålder. För raserna shih tzu och tibetansk terrier, men inte för flat-coated retriever, verkar de införda bekämpningsprogrammen ha resulterat i en nedgång i prevalensen för sjukdomen under senare delen av den undersökta tidsperioden. För raserna flat-coated retriever och cavalier king charles spaniel indikerar resultaten en könsdisposition för renal dysplasi, med en klar överrepresentation för tikar. Denna studie visar även en rasskillnad mellan flat-coated retriever och tibetansk spaniel avseende den histopatologiska bilden vid renal dysplasi

Metformin-induced lactic acidosis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin.</p> <p>Case presentation</p> <p>We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A progressive recovery was observed and he was discharged from the intensive care unit on the seventh day.</p> <p>Conclusion</p> <p>We present two case reports of severe lactic acidosis most probably associated with high doses of metformin in patients with no known contraindications for metformin prescription. In both patients no other condition was identified to cause such severe lactic acidosis. Although controversial, lactic acidosis should be considered in patients taking metformin.</p

Advanced Knowledge Work and Stress-related Symptoms : Epidemiology and Clinical Intervention Studies

Well educated knowledge workers are a growing group of the work force. Little research has been conducted on this group regarding possible work-related health symptoms, as well as interventions in order to reduce work-related stress. This thesis describes the current work-related symptoms and potential risk and salutogenic, i.e. protective factors, associated with these symptoms among software and system designers in a high tech company in Sweden. A stress management intervention program was launched in order to evaluate whether work-related stress might be a risk factors for these symptoms. It was also of interest to study the potential impact of stress management interventions on psychosocial work organizational factors. The thesis is based on cross sectional and longitudinal data. Paper I is focusing on risk factors for musculoskeletal symptoms and headaches, and their possible association with biological markers and self-reported physical and psychosocial work environmental factors. Paper II assessed the association between occupational psychosocial factors and psychosomatic symptoms i.e. mental fatigue, headache, restlessness, irritation, moodiness and difficulty concentrating. Paper III and IV evaluated the effects of a stress management program including three different stress reducing strategies, on musculoskeletal and skin symptoms as well as headaches, and on the perceived psychosocial work environment. The overall results indicate that psychosocial factors via stress sensitive hormones have an impact on employee health in a high technological work environment. Furthermore, stress management interventions, conducted as relaxation and mental training, had short-term favorable effects on some musculoskeletal and skin symptoms. It seems that competence and competence utilization among advanced knowledge workers are psychosocial work environmental factors that need to be take into consideration in future health preventive ventures

Innovative communication strategies and modelling of robust sensor functions

The aim of this thesis was to create a resilient network, capable of handling link failures without affecting the data flow. This was done by using graph theory and three mathematical models. A generic system was created, on which the models were applied on. The mathematical models were path diversity, edge protection and path restoration. These models were tested to evaluate if they could create a robust system. The models were also compared with each other to obtain the best performing one. It was concluded that it was possible to construct a resilient network using these types of mathematical modelling. It was also concluded that the models provided different results in terms of cost and robustness. The report ends with suggestions on future work of how studies can be conducted to create realistic systems

Faktorer som kan förhindra avhopp från gruppträffar vid behandling av övervikt och fetma

To complete an overweight treatment program is associated with better weight loss. Previous studies have in principle focused on drop-out from the entire program, not individual parts of a program. Factors previously shown to influence the patients´ weight loss results are: frequency of individual meetings with a professional, the lack of social support from family or friends, the lack of motivation and in a few studies vacations. In several studies the drop-out patients have stated that their reasons for drop-out were dissatisfaction with the staff and the program design. Drop-out has also been shown to be connected with difficulties in adherence to the diet. If the primary motive to lose weight is appearance-related, the risk of drop-out increases according to previous studies

Faktorer som kan förhindra avhopp från gruppträffar vid behandling av övervikt och fetma

To complete an overweight treatment program is associated with better weight loss. Previous studies have in principle focused on drop-out from the entire program, not individual parts of a program. Factors previously shown to influence the patients´ weight loss results are: frequency of individual meetings with a professional, the lack of social support from family or friends, the lack of motivation and in a few studies vacations. In several studies the drop-out patients have stated that their reasons for drop-out were dissatisfaction with the staff and the program design. Drop-out has also been shown to be connected with difficulties in adherence to the diet. If the primary motive to lose weight is appearance-related, the risk of drop-out increases according to previous studies

Faktorer som kan förhindra avhopp från gruppträffar vid behandling av övervikt och fetma

To complete an overweight treatment program is associated with better weight loss. Previous studies have in principle focused on drop-out from the entire program, not individual parts of a program. Factors previously shown to influence the patients´ weight loss results are: frequency of individual meetings with a professional, the lack of social support from family or friends, the lack of motivation and in a few studies vacations. In several studies the drop-out patients have stated that their reasons for drop-out were dissatisfaction with the staff and the program design. Drop-out has also been shown to be connected with difficulties in adherence to the diet. If the primary motive to lose weight is appearance-related, the risk of drop-out increases according to previous studies