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Objective: To characterize clinical features, comorbidities, frequency of bacterial isolation, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS)., Animals: 168 client-owned cats with S-CCHS., Procedures: Data were prospectively (1980 to 2019) collected regarding clinical features, comorbidities, bacterial infection, illness duration, and treatments. Variables were evaluated for associations with survival time., Results: Median age of cats was 10.0 years, with no breed or sex predilection observed. Common clinical features included hyporexia (82%), hyperbilirubinemia (80%), lethargy (80%), vomiting (80%), jaundice (67%), weight loss (54%), and hypoalbuminemia (50%). Comorbidities included extrahepatic bile duct obstruction (53%), cholelithiasis (42%), cholecystitis (40%), and ductal plate malformation (44%) as well as biopsy-confirmed inflammatory bowel disease (60/68 [88%]) and pancreatitis (41/44 [93%]). Bacterial cultures were commonly positive (69%) despite prebiopsy antimicrobial administration in most cats. Of surgically confirmed choleliths, diagnostic imaging identified only 58%. Among 55 cats with "idiopathic pancreatitis," 28 (51%) were documented to have transiting choleliths, and 20 had pancreatic biopsies confirming pancreatitis. Cholelithiasis (with or without bile duct obstruction) and cholecystectomy were associated with survival advantages. Survival disadvantages were found for leukocytosis, ≥ 2-fold increased alkaline phosphatase, and hyperbilirubinemia. Cholecystoenterostomy had no survival impact. Cats with ductal plate malformations were significantly younger at diagnosis and death than other cats. Chronic treatments with antimicrobials, S-adenosylmethionine, and ursodeoxycholic acid were common postbiopsy., Clinical Relevance: S-CCHS in cats was associated with bacterial infection and various comorbidities and may be confused with pancreatitis. Surgically correctable morbidities (ie, cholecystitis, cholecystocholelithiasis) and cholecystectomy provided a significant survival advantage.

Objective: To characterize the association between peritoneopericardial diaphragmatic hernia (PPDH) or congenital central diaphragmatic hernia (CCDH) and ductal plate malformations (DPMs) in dogs and cats., Animals: 18 dogs and 18 cats with PPDH or CCDH and 19 dogs and 18 cats without PPDH or CCDH., Procedures: Evaluation of clinical details verified PPDH or CCDH and survival times. Histologic features of nonherniated liver samples were used to categorize DPM. Immunohistochemical staining for cytokeratin-19 distinguished bile duct profiles per portal tract and for Ki-67-assessed cholangiocyte proliferation. Histologic features of herniated liver samples from PPDH or CCDH were compared with those of pathological controls (traumatic diaphragmatic hernia, n = 6; liver lobe torsion, 6; ischemic hepatopathy, 2)., Results: DPM occurred in 13 of 18 dogs with the proliferative-like phenotype predominating and in 15 of 18 cats with evenly distributed proliferative-like and Caroli phenotypes. Congenital hepatic fibrosis DPM was noted in 3 dogs and 2 cats and renal DPM in 3 dogs and 3 cats. No signalment, clinical signs, or clinicopathologic features discriminated DPM. Kaplan Meier survival curves were similar in dogs and cats. Bile duct profiles per portal tract in dogs (median, 5.0; range, 1.4 to 100.8) and cats (6.6; 1.9 to 11.0) with congenital diaphragmatic hernias significantly exceeded those in healthy dogs (1.4; 1.2 to 1.6) and cats (2.3; 1.7 to 2.6). Animals with DPM lacked active cholangiocyte proliferation. Histologic features characterizing malformative bile duct profiles yet without biliary proliferation were preserved in herniated liver lobes in animals with DPM., Conclusions and Clinical Relevance: DPM was strongly associated with PPDH and CCDH. Because DPM can impact health, awareness of its coexistence with PPDH or CCDH should prompt biopsy of nonherniated liver tissue during surgical correction of PPDH and CCDH.

Objective: To quantify the relative risk of intestinal dehiscence in dogs undergoing intestinal resection and anastomosis (IRA), compared with enterotomy, for surgical management of small intestinal foreign bodies, and to evaluate the association between nasogastric tube placement for early enteral nutrition (EEN) and hospitalization time., Animals: 211 dogs undergoing 227 surgeries for intestinal foreign body removal., Procedures: Medical records were reviewed for dogs undergoing a single-site sutured enterotomy or IRA for foreign body intestinal obstruction between May 2008 and April 2018. Multivariable logistic regression was used to quantify the association between surgical procedure and dehiscence. Multiple linear regression was used to quantify the association of nasogastric tube placement with total hospitalization time., Results: Dehiscence rates were 3.8% (7/183) and 18.2% (8/44) for enterotomy and IRA, respectively. Overall dehiscence rate for all surgeries was 6.6% (15/227). The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy. An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure. Placement of a nasogastric tube was not associated with intestinal dehiscence or decreased total hospitalization time when controlling for the year of surgery., Conclusions and Clinical Relevance: Patients undergoing IRA were at a significantly higher risk of intestinal dehiscence, compared with patients undergoing enterotomy. Although this finding should not be used to recommend enterotomy over IRA, this information may be useful in guiding owner expectations and postoperative monitoring.

Case Description: An 8-year-old male red kangaroo (Macropus rufus) was evaluated with a 2-week history of vomiting and anorexia. Four days prior, the patient became refractory to medical management. The kangaroo was admitted for diagnostic testing and treatment including whole body CT, blood work, and emergency laparotomy., Clinical Findings: CT findings of a severely enlarged stomach, splenic displacement, and a whirl sign were indicative of mesenteric volvulus with gastric dilatation-volvulus (GDV). Contrast enhancement of abdominal viscera suggested intact arterial blood supply; however, compression of the caudal vena cava and portal vein indicated venous obstruction. Results of preoperative blood work suggested biliary stasis without evidence of inflammation. Additionally, a tooth root abscess was diagnosed on the basis of results of CT., Treatment and Outcome: Exploratory laparotomy confirmed the diagnosis of mesenteric volvulus and GDV. The volvuli were corrected by clockwise derotation, and a gastropexy was performed. Tissue samples were obtained from the spleen and liver for evaluation. The kangaroo recovered from surgery, and the abscessed tooth was extracted 6 days later. Eight days after initial evaluation, the kangaroo was discharged., Clinical Relevance: In the present report, the CT whirl sign was used to diagnose volvulus of the abdominal viscera, which suggests that this diagnostic indicator has utility in veterinary patients. Mesenteric volvulus with GDV was successfully treated in a nondomestic species. The tooth root abscess, a common condition in macropods, may explain the historic episodes of anorexia reported by the owner and may have contributed to the development of mesenteric volvulus and GDV in this kangaroo.

Case Description: An 8-year-old castrated male mixed-breed dog (dog 1) and a 13-year-old spayed female mixed-breed dog (dog 2) were evaluated because of spontaneous pneumothorax., Clinical Findings: Both dogs had decreased bronchovesicular sounds with coughing, tachypnea, cyanosis, lethargy, or a combination of these clinical signs. Radiographic examination revealed pneumothorax in both dogs and consolidation of a lung lobe in dog 2. Pneumothorax was alleviated following thoracocentesis in both dogs but recurred., Treatment and Outcome: Dog 1 was initially treated by placement of a thoracostomy tube but underwent thoracotomy when pneumothorax recurred after tube removal; left caudal lung lobectomy was performed because a ruptured bulla was suspected, and a pulmonary bulla was histologically confirmed. Dog 2 underwent thoracotomy with left caudal lung lobectomy and partial removal of the left cranial lung lobe; diffuse pulmonary emphysema was diagnosed. This dog underwent a second surgery for right caudal lung lobectomy because of torsion. When pneumothorax recurred and additional surgery was not considered feasible, pleural access ports were placed in both dogs for repeated removal of air from the thoracic cavity. Ports were used clinically for 17 days in dog 1 and 14 days in dog 2. Dog 1 successfully underwent another surgery when pneumothorax recurred 18 days after port placement but was euthanized 17 months later when dyspnea and tachypnea recurred. Pneumothorax had not recurred further in dog 2 twenty-three months after port placement., Clinical Relevance: Findings suggested that pleural access ports may have a role in the management of spontaneous pneumothorax in dogs.

Case Description: An 8-year-old castrated male Boxer and a 10-year-old spayed female Yorkshire Terrier were evaluated because of dyspnea. In both dogs, the dyspnea persisted after elongated soft palate resection., Clinical Findings: Laryngoscopic examination revealed caudal displacement of the epiglottis into the rima glottidis in both dogs. Excessive mobility of the epiglottis during respiration with episodic obstruction of the rima glottidis by the epiglottis was observed during fluoroscopic examination., Treatment and Outcome: The epiglottis of both dogs was fixed in a horizontal plane by resection of a band of oral mucosa at the base of the epiglottis and closure of the mucosal defect with sutures. Fixation of the epiglottis resolved the dyspnea in both dogs., Clinical Relevance: Excessive mobility of the epiglottis can predispose to glottic obstruction and cause dyspnea in dogs. Fixation of the epiglottis in a horizontal plane may resolve dyspnea caused by epiglottic retroversion in dogs.

Objective: To evaluate long-term function of vascular access ports (VAPs) implanted in the femoral vein of dogs and cats undergoing cancer treatment., Design: Prospective clinical study., Animals: 3 dogs and 6 cats treated via chemotherapy or radiation., Procedures: VAPs were surgically implanted in the left femoral vein of 3 dogs and 6 cats over a 1-year period. Injection port location was alternated to either a caudal thoracic or ilial location in each patient. Duration of VAP function, ease of infusion, and ease of aspiration through the VAPs were recorded, and associated complications were assessed at each VAP use. Client satisfaction with VAP placement was evaluated by use of a questionnaire., Results: Primary uses of the VAPs included blood sampling and delivering sedative or chemotherapeutic drugs. Median duration of successful infusion was 147 days (range, 60 to 370 days), and median duration of successful aspiration was 117 days (range, 10 to 271 days). The frequency of signs of VAP-related discomfort was low (7% of patient observations). Clients were satisfied with their decision to use VAPs. Complications included partial (n = 7) or complete (2) VAP occlusion, port migration (1), and presumptive infection (1)., Conclusions and Clinical Relevance: Results suggested that VAP implantation into the femoral vein provides an acceptable means of chronic venous access in dogs and cats undergoing cancer treatment.

Case Description: 3 dogs (9 to 12 years old) were evaluated because of recurrent pleural effusion that was refractory to treatment of the underlying cause., Clinical Findings: Dogs were evaluated because of cough, dyspnea, tachypnea, or lethargy or a combination of these clinical signs. Radiography, ultrasonography, or thoracocentesis were used to confirm the presence of pleural fluid in each dog. A neoplastic cause of pleural effusion was confirmed in 2 dogs. In 1 dog, fasciitis of the mediastinum and the left parietal pleura was diagnosed, with no evidence of neoplasia., Treatment and Outcome: Each dog was anesthestized, and thoracotomy was performed with manual perforation of the mediastinum. Permanent, subcutaneously placed vascular access ports were attached to intrathoracic, Jackson-Pratt drain tubing for repeated drainage of pleural fluid. Drains were used successfully in the 3 dogs for periods of 6 weeks, 11 weeks, and > 3 years., Clinical Relevance: Findings suggest that subcutaneous vascular access ports attached to intrathoracic drain tubing may be an effective way to remove recurrent pleural effusion in dogs.

Objective: To compare the incidence of behavior problems following tendonectomy or onychectomy in cats, as well as attitudes of owners following these procedures., Design: Nonrandomized clinical trial., Animals: 18 cats that underwent tendonectomy and 39 cats that underwent onychectomy., Procedure: Owners of cats that underwent tendonectomy or onychectomy between February 1993 and May 1998 were contacted by telephone and asked several questions regarding reasons for surgery as well as complications and behavioral changes in cats following surgery., Results: The most common reason for considering tendonectomy or onychectomy was to avoid damage caused by the cat scratching household materials. Avoidance of injury to humans or animals was chosen more often by owners whose cats underwent onychectomy than those that underwent tendonectomy. Tendonectomy was more likely to have been recommended by veterinarians than onychectomy. Significantly more cats that underwent tendonectomy (67%) than onychectomy (44%) returned to normal activity within 3 days after surgery. Significant differences were not detected regarding behavior problems after surgery., Conclusions and Clinical Relevance: Although tendonectomy and onychectomy involved some medical complications and behavior changes following surgery, owners had positive attitudes regarding both surgeries after the immediate postoperative period. Tendonectomy may be a humane alternative to onychectomy, although owners need to be advised that nail trimming is still necessary in cats after surgery.

Lead dislodgement is one of the most common complications of endocardial pacing lead implantation in dogs. Incidence of lead displacement appears to be higher in large-breed, compared with small-breed, dogs, suggesting that excessive neck movements may be a contributing factor. To avoid introducing pacing leads through a vein in the neck, we developed a technique for implantation of endocardial pacing leads through the right costocervical vein. A right second intercostal space thoracotomy was performed to expose the vein, and the pacing generator was placed in the musculature over the lateral aspect of the thorax. The technique was performed in 6 dogs, 5 of which had had an endocardial pacing lead dislodge. None of the dogs had problems with lead dislodgement during follow-up periods of 15 to 20 months. Implantation of endocardial pacing leads through the costocervical vein should not be considered a replacement for implantation through the jugular vein. However, we believe that this technique is indicated for large dogs in which endocardial pacing leads implanted through the jugular vein have dislodged.

Two months after initiation of chemotherapy, a totally implantable vascular access system was used for the continuing administration of chemotherapeutic agents to a ferret with multicentric lymphoma. The subcutaneously located injection port minimized the need for restraint and facilitated repeated IV administration of drugs. Treatment with a combination of L-asparaginase, vincristine sulfate, doxorubicin, cyclophosphamide, methotrexate, chlorambucil, and prednisone failed to induce complete remission. Survival time (interval from histologic diagnosis to euthanasia) was 10 months. The vascular access system remained patent and did not cause infection in the surrounding subcutaneous tissues during the 5-month period that it was in position.

Adrenocortical tumors were diagnosed in 5 adult spayed ferrets. Four ferrets had bilaterally symmetrical alopecia of the caudal femoral region, abdomen, and tail, and 1 had alopecia of the distal limbs and feet. All 5 ferrets had vulvar swelling. During abdominal ultrasonography, irregular masses, believed to involve the adrenal glands, were seen in all 5 ferrets. Unilateral adrenalectomy was performed successfully in each ferret by use of ventral midline celiotomy. On histologic examination of biopsy samples, 4 ferrets were found to have adrenocortical adenomas, and 1 ferret was found to have an adrenocortical adenocarcinoma. All clinical signs resolved after adrenalectomy, suggesting that the adrenocortical tumors had been secreting adrenocortical hormones.

The relationships between total serum calcium and serum albumin and total serum calcium and serum protein concentrations were examined in 291 cats. There was a significant (P less than 0.001) linear relationship between serum calcium and serum albumin concentrations. Because of extreme variability among the calcium and albumin concentrations (R2 = 0.18), however, a dependable formula to adjust total serum calcium values for albumin or protein binding in the cat could not be constructed. An adjustment formula could not be based on the relationship between calcium and total protein concentrations because of the lack of a significant relationship (P = 0.21). The association between serum calcium and serum albumin or serum calcium and total protein concentrations is weaker in cats than in dogs or man.

Quadriceps contracture associated with a healed malunion fracture of the left femur was diagnosed in a 1-year-old cat. The proximal portion of the distal fracture piece protruded through the skin of the thigh. The protruding bone was removed surgically and the area of ulcerated skin was debrided. Because the fracture was stable and the cat was able to bear weight on the affected limb, surgical correction of the malunion was not performed. Quadriceps contracture is uncommon in the cat.

The Dragstedt modification of the Stamm tube gastrostomy was used in 29 dogs with gastric volvulus. A total of 17 dogs were monitored for 14 to 40 months after surgery. Volvulus recurred in one dog. All dogs with a presumptive diagnosis of gastric volvulus were treated surgically by gastric derotation and gastrostomy on an emergency basis. Mortality during the first week after surgery was 31%.