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Background: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. Methods: We studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. Results: Of the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output more...

The objective of this study was to evaluate the clinical outcome of ventral slot decompression and rehabilitation therapy in dogs with cervical intervertebral disc herniation (IVDH). Surgical decompression was performed in dogs with IVDH using the ventral slot procedure. After surgery, physiotherapeutic rehabilitation consisted of a combination of electrotherapy, infrared therapy and mechanical massage; treadmill exercise was started when the animal could stand up. A total of 58 dogs were selected from the hospital and included in two groups: rehabilitated group (RG, n = 34) and non-rehabilitated group (NRG, n = 24). Dogs of each group were subdivided into five groups based on a pre-operative clinical grading system. Grade 1 designated spinal pain only, grade 2 designated ambulatory paraparesis, grade 3 designated non-ambulatory paraparesis, grade 4 designated paraplegia with deep-pain perception intact and grade 5 designated paraplegia without deep-pain perception. Post-operative changes of both groups were evaluated and compared, including time until unassisted standing and walking after surgery and the success rate. Overall, 79.41% (27/34) of dogs had a successful neurologic outcome in the RG group, which was significantly (P < 0.05) higher than the NRG group 62.50% (15/24). Interestingly, the success rate differed when the preoperative grading system was considered. The success rates of grades 1, 2, 3, 4 and 5 were 100% (9/9), 100% (7/7), 75% (3/4), 53.85% (7/13) and 100% (1/1), respectively, in the rehabilitated groups, whereas in the non-rehabilitated groups success rates were 100% (5/5), 83.33% (5/6), 60.00% (3/5), 28.57% (2/7) and 0% (0/1), respectively. The differences in success rates between the two groups according to grading were 0, 16.67, 15, 25.57 and 100%, respectively. The proposed rehabilitation therapy after surgical decompression of cervical IVDH can improve the success rate when the preoperative pathological condition is severe. more...

Nocardiosis, a rare infectious disease in dogs and cats, is caused by Gram-positive aerobic actinomycetes of the genus Nocardia. A one-year-old castrated male Great Dane was presented with clinical signs of an ulcerated nodule on the right ear, which was observed after two weeks of treatment with cyclosporine and prednisolone due to idiopathic hepatitis. Cytological examination revealed pyogranulomatous inflammatory cells and blanched filamentous rods. To detect infectious agents, serosanguinous discharge of the nodule was subjected to bacterial and fungal cultures. For phenotyping of the infectious agents, colonies on blood agar culture plates were further analyzed by matrix-assisted laser desorption ionization (MALDI)-time-of-flight (TOF) mass spectrometry (VITEK MS). The MALDI-TOF spectra were identified as N. africana. Thus, the present case was diagnosed as cutaneous nocardiosis. The skin lesions of ulcerated nodules with fistulous tracts were gradually resolved by the administration of meropenem (8 mg/kg TID, IV) and doxycycline (5 mg/kg BID, PO). Although complete resolution of the skin lesions was observed on day 91 after the initial presentation, single administration of doxycycline was continued until day 198 after the initial presentation to prevent recurrence. To the best of our knowledge, this is the first report of Nocardia africana infection in a dog. In addition, our results show that MALDI-TOF mass spectrometry analysis could be a useful tool for the detection of Nocardia. spps. more...

Objective: The aim of this paper is to report surgical correction of ureteric rupture due to stenosis induced secondary to accidental injury by placing nephrovesical subcutaneous ureteric bypass in a dog and postoperative long term outcomes. Materials and methods: Imaging techniques revealed multiple bone fractures as well as left proximal ureter injury. The all bone fractures were corrected using standard techniques while left proximal ureter injury was treated as conservation medical therapy. One month later, contrast media were also found in proximal ureter and abdomen which indicated ureter rupture. This rupture was corrected surgically by nephrovesical subcutaneous ureteric bypass (SUB) under fluoroscopy guidance. Results: First day after accidental injury, the serum BUN and CRE were 10.7 mg/dL and 0.9 mg/dL, respectively which indicated kidney injury but by conservative therapy these parameters were lowered gradually. On the 5th day after considering these parameters, the dog was judged normal. However, on the 31st day BUN and CRE were 14.3 mg/dL and 0.8 mg/Kg, respectively. The Doppler ultrasonography revealed hydroneprosis, proximal ureter stenosis and high resistive index (0.72±0.02) in the renal arcuate artery indicating renal abnormalities due to ureter obstruction. On re-examination by radiography after one month postoperatively, revealed that patency of the device and normal renal function. The dog was clinically normal with normal urination and no complications were found 6 months postoperatively. Conclusion: In view of the above findings, it is suggested that the SUB system can be a better alternative to preserve the kidney in non-reparable traumatic ureteral damage in dogs. [ABSTRACT FROM AUTHOR] more...

Objective: The objective of this retrospective study was to evaluate the preoperative clinical characteristics to predict postoperative neurologic recovery in dogs with intervertebral herniated disk disease (IVDD). Materials and Methods: The dogs were classified according to postoperative neurologic recovery from clinical history of the hospital e-book. Excellent when dogs (n=13) were neurologically normal; good (n=8) when postoperative neurologic grade was improved from preoperative condition had improved sufficiently to require no or minor therapy after discharge; fair (n=4) is considered when postoperative neurologic status was unchanged from preoperative condition and poor (n=5) when major postoperative complication developed as a consequences neurologic grade had worsened at discharge than their preoperative score or the patient died. The evaluated preoperative clinical characteristics in all groups are breed, age, sex, duration of clinical sings appearance (DCSA), preoperative neurologic grading system (PNGS), compression rate (pre and postoperative) in MRI and CT scan, housefield unit (HU), type of IVDD and surgical procedures, and compared with excellent group. Results: no definitive relationship was found between the clinical characteristics and neurologic recovery, except, DCSA and preclinical neurologic pathological condition. The DCSA were 73.54±15.00, 117.63±31.58, 171.25±99.56 and 175.00±94.83 (P<0.05), respectively. The PNGS were 3±0, 3±0, 4±0 and 4±0 (P<0.01), respectively. Conclusion: Finally based on this clinical study, it is recommended that postoperative recovery greatly depends on DCSA and PNGS in IVDD dogs. [ABSTRACT FROM AUTHOR] more...

The aim of this study was to evaluate the short-term therapeutic effects and adverse events (AEs) associated with the use of tissue plasminogen activator (tPA) for the treatment of acute-onset aortic thrombotic disease (ATD) in cat and dogs. The ATD patients (13 cats and 5 dogs) with acute-onset hind limb paresis were categorized for either continuous rate infusion protocol (group A) or accelerated dosing protocol (group B), then divided further into low-dose and high-dose groups. Patients were randomly selected to receive tPA. Limb score and 48-hour survival rate did not differ significantly between groups A and B (p = 0.0584 and 1, respectively). However, regardless of the method of administration, high-dose groups were superior to low-dose groups in regard to limb score reduction and 48-hour survival rate. AEs due to tPA administration occurred in 41.7% of patients who displayed azotemia, bleeding, reperfusion injury, and seizure. Finally, the percentage of patients who survived and were discharged was 12.5% in low-dose groups and 77.8% in high-dose groups. These findings lead us to believe that thrombolysis using tPA may be useful, depending on the treatment protocol. [ABSTRACT FROM AUTHOR] more...