Klinische aanpak van hypercalcemie bij de kat

An elevated total calcium concentration is an abnormality on feline blood examinations, and is frequently overlooked. The most important causes of feline hypercalcemia are neoplasia, chronic kidney disease and idiopathic hypercalcemia. In hypercalcemic cats, several diagnostic tests have to be performed in order to find the underlying cause: a thorough physical examination, retroviral testing for feline leukemia virus and feline immunodeficiency virus, complete blood count and serum chemistry profile, the measurement of ionized calcium, urinalysis, thoracic (and abdominal) radiography, abdominal and cervical ultrasonography and the measurement of parathyroid hormone and parathyroid hormone-related protein. A logical and specific work-up is required to obtain a definitive diagnosis. Treatment is mainly focussed on the underlying disease

Treatment of necrotizing fasciitis using negative pressure wound therapy in a puppy

A two-month-old German shepherd dog was presented with anorexia, lethargy and left hind limb lameness associated with swelling of the thigh. Clinical findings combined with cytology led to the presumptive diagnosis of necrotizing fasciitis (NF). Extensive debridement was performed and silver-foam-based negative pressure wound therapy (NPWT) was applied. During the first 48 hours, a negative pressure of -75 mmHg was used. Evaluation of the wound demonstrated no progression of necrosis and a moderate amount of granulation tissue formation. A new dress- ing was placed and a second 48-hour cycle of NPWT was initiated at -125 mmHg. At removal, a healthy wound bed was observed and surgical closure was performed. The prompt implementation of NPWT following surgical debridement led to accelerated wound healing without progression of necrosis in this case of canine NF. Negative pressure wound therapy could become an integral part of the management strategy of canine NF, improving the prognosis of this life-threatening disease

Contrast-enhanced ultrasound examination for the assessment of renal perfusion in cats with chronic kidney disease

Background: Contrast-enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking. Objectives: To evaluate renal perfusion using CEUS in cats with CKD. Animals: Fourteen client-owned cats with CKD and 43 healthy control cats. Methods: Prospective case-controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time-intensity curves were created, and perfusion parameters were calculated using off-line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats. Results: In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla. Conclusions and Clinical Importance: Contrast-enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process

Development of surgical site infections despite perioperative antimicrobial therapy in two dogs

Surgical site infections (SSI) are common complications with a prevalence of 0.8 to 18%. Many risk factors, such as patient, environmental and treatment factors can contribute to the development of SSI. Two dogs that developed a SSI after forelimb amputation are discussed. The first dog was presented with an open comminuted intra-articular fracture of the right elbow. The second dog was diagnosed with a soft-tissue sarcoma at the right elbow. Perioperative cefazolin was administered in both patients. Only in the first patient, antimicrobial therapy was continued in the postoperative period. Both dogs developed an SSI within four to five days postoperatively. Yet, prophylactic antimicrobials can help to prevent SSI, provided that the correct antimicrobial is used at the correct dose, at the right time and given IV. Factors, such as hypothermia, violating the Halsted's principles and the number of people present in the theater may increase the risk of SSI. Besides the meticulous use of antimicrobials, perioperative management is thus also important in SSI prevention

Evaluation of feline renal perfusion with contrast-enhanced ultrasonography and scintigraphy

Contrast-enhanced ultrasound (CEUS) is an emerging technique to evaluate tissue perfusion. Promising results have been obtained in the evaluation of renal perfusion in health and disease, both in human and veterinary medicine. Renal scintigraphy using Tc-99m-Mercaptoacetyltriglycine (MAG(3)) is another non-invasive technique that can be used to evaluate renal perfusion. However, no data are available on the ability of CEUS or Tc-99m-MAG(3) scintigraphy to detect small changes in renal perfusion in cats. Therefore, both techniques were applied in a normal feline population to evaluate detection possibilities of perfusion changes by angiotensin II (AT II). Contrast-enhanced ultrasound using a bolus injection of commercially available contrast agent and renal scintigraphy using Tc-99m-MAG(3) were performed in 11 healthy cats after infusion of 0,9% NaCl (control) and AT II. Angiotensin II induced changes were noticed on several CEUS parameters. Mean peak enhancement, wash-in perfusion index and wash-out rate for the entire kidney decreased significantly after AT II infusion. Moreover, a tendency towards a lower wash-in area-under-the curve was present. Renal scintigraphy could not detect perfusion changes induced by AT II. This study shows that CEUS is able to detect changes in feline renal perfusion induced by AT II infusion

Idiopathische hypercalcemie bij een Perzische kat

This report describes a clinical case of idiopathic hypercalcemia in a cat. A male, castrated Persian cat of seven years old was presented because of partial anorexia that had been present for the past three years.. Blood examination revealed a moderate hypercalcemia with hypofosfatemia. Thorough diagnostic workup revealed polycystic kidney disease and chronic kidney disease (IRIS stage 2). The hypercalcemia was not caused by the renal disease because the parathyroid hormone concentrations were normal, and because the cat had hypofosfatemia and an increased ionized calcium concentration. The cat was diagnosed with feline idiopathic hypercalcemia. The clinical signs disappeared and the calcium concentrations normalized after therapy with glucocorticoids

Intra- and inter-observer variability of computed tomographic measurements of the prostate gland in neutered dogs

The purpose of this study was to evaluate the intra- and inter-observer variability of computed tomographic measurements of linear prostate dimensions in neutered dogs without signs of prostatic disease, to determine potential associations between prostatic parameters and body weight or age and to provide reference ranges. Length, width and height of the prostate gland were measured in 62 neutered dogs with no signs of prostatic disease by three observers with different levels of training. Statistically significant positive associations were found between all prostatic parameters and body weight and between all prostatic parameters and age at castration, but not with age. Formulae allowing the calculation of the expected values for prostatic parameters based on body weight are provided [length = 15.3 + body weight (BW) × 0.3; height = 9.7 + BW × 0.16; width = 9.5 + BW × 0.2]. These may represent a useful tool for computed tomographic evaluation of the size of the prostate in neutered dogs. Subjective evaluations of the morphological appearance of the prostate gland are also provided

Prevalentie van urolithiasis en andere urinaire afwijkingen bij honden met een congenitale extrahepatische portosystemische shunt = Prevalence of urolithiasis and other urinary abnormalities in dogs with a congenital extrahepatic portosystemic shunt

Dogs with a portosystemic shunt (PSS) often have urinary abnormalities. In this retrospective study, the prevalence of urolithiasis and other urinary abnormalities secondary to extrahepatic (EH)PSS was determined from the onset of the clinical signs until the day of surgical correction of the PSS. About 67% of all dogs were presented with urinary complaints that were directly (39%) or probably (28%) related to the EHPSS. Some dogs had surgery for urolithiasis and subsequent quantitative stone analysis revealed ammonium biurate uroliths , suggesting the presence of an underlying PSS. Additionally, 77% of the dogs that did not have any urinary complaints appeared to have urinary abnormalities based on medical imaging and/or urinalysis. Overall, 70.4% of the dogs had urolithiasis. In this study, the importance of performing a complete urinalysis, supplemented with medical imaging of the urinary system in all dogs with an EHPSS is demonstrated. In addition, the importance of quantitative analysis of uroliths is stressed, as the presence of ammonium biurate may be suggestive of a PSS