Diagnosis of Congenital Portosystemic Shunt in Miniature Schnauzers 7 Years of Age or Older (1997–2006)

2010 ◽  
Vol 46 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Michelle Mertens ◽  
Theresa W. Fossum ◽  
Michael D. Willard ◽  
Geoffrey T. Fosgate ◽  
Angel Garcia de la Paz ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hepatic Encephalopathy ◽  
Confidence Interval ◽  
Clinical Signs ◽  
Prevalence Ratio ◽  
Portosystemic Shunt ◽  
Older Age ◽  
Congenital Portosystemic Shunt ◽  
Relative Prevalence ◽  
Exploratory Surgery

Dogs with congenital portosystemic shunt (PSS) are typically diagnosed before 2 years of age. The objective of this study was to determine if miniature schnauzers are more likely to be diagnosed with congenital PSS at an older age than are other breeds. This retrospective study examined the case records of 171 dogs diagnosed with congenital PSS; dogs were included if they were definitively diagnosed as having congenital PSS by nuclear scintigraphy, contrast portography, and/or exploratory surgery. Seven (23%) of 31 miniature schnauzers diagnosed with congenital PSS were 7 years of age or older at the time of diagnosis, compared to 3.4% for all other breeds. Miniature schnauzers had a relative prevalence ratio of 6.3 (95% confidence interval 2.2 to 18.6; P=0.001) for being diagnosed at or after 7 years of age when compared to all other breeds of dogs. Clinical signs of congenital PSS may not manifest sufficiently to cause an owner to seek veterinary care for some dogs until they are older. Congenital PSS should be considered in mature dogs, particularly miniature schnauzers, that are presented with signs potentially consistent with hepatic encephalopathy.

Hepatic microvascular dysplasia in dogs: a retrospective study of 24 cases (1987-1995)

2000 ◽  
Vol 36 (5) ◽  
pp. 385-389 ◽  
Author(s):  
JS Christiansen ◽  
HA Hottinger ◽  
L Allen ◽  
L Phillips ◽  
LR Aronson
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Clinical Signs ◽  
Portosystemic Shunt ◽  
Surgical Exploration ◽  
Long Term Prognosis ◽  
Criteria For Diagnosis ◽  
Histopathological Evidence ◽  
Rule Out

Hepatic microvascular dysplasia (HMD) is a disease involving a microscopic shunting of blood through the liver without the presence of a macroscopic portosystemic shunt (PSS). Data was collected from medical records and telephone conversations with referring veterinarians and owners of 24 dogs diagnosed with HMD. Criteria for diagnosis included histopathological evidence of microvascular dysplasia on hepatic biopsy as well as surgical exploration and a normal mesenteric portogram to rule out a macroscopic PSS. Dogs with HMD frequently have less severe clinical signs and a better long-term prognosis than do those with a PSS that are managed medically.

MRI findings in two West Highland White Terrier dogs with hepatic encephalopathy secondary to portosystemic shunt

2019 ◽  
Vol 7 (3) ◽  
pp. e000814 ◽  
Author(s):  
Ricardo Fernandes ◽  
Colin Driver ◽  
J H Rose ◽  
Clare Rusbridge
Keyword(s):  
Hepatic Encephalopathy ◽  
Vascular System ◽  
Clinical Signs ◽  
Systemic Circulation ◽  
Brain Parenchyma ◽  
Portosystemic Shunt ◽  
Medial Longitudinal Fasciculus ◽  
Mri Findings ◽  
Weighted Sequences ◽  
The Brain

A portosystemic shunt is an abnormal communication between the portal vascular system and the systemic circulation. A significant number of clinical signs associated with portosystemic shunting result from hepatic encephalopathy (HE); a syndrome encompassing neurological signs such as including changes in behaviour, ataxia, unresponsiveness, pacing, circling, blindness, seizures, coma and death. We present two West Highland White Terrier dogs diagnosed with HE based on clinical signs, bile acid stimulation test and imaging of the abnormal vessel communicating the portal and the systemic circulation. Magnetic resonance sequences of the brain revealed a poorly marginated and diffuse, bilateral and symmetric hyperintense lesions on T2-weighted, fluid attenuation inversion recovery and diffusion-weighted sequences relative to the brain parenchyma including the medial longitudinal fasciculus and reticular formation in the brainstem. No abnormalities were detected on T1-weighted sequences.

scholarly journals Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat

2018 ◽  
Vol 4 (2) ◽  
pp. 205511691879571
Author(s):  
James Crowley ◽  
Timothy Foo ◽  
Lara Boland ◽  
Laurencie Brunel
Keyword(s):  
Hepatic Encephalopathy ◽  
Bile Acids ◽  
Clinical Signs ◽  
Reference Interval ◽  
Portosystemic Shunt ◽  
Liver Size ◽  
Long Term Follow Up ◽  
Stimulation Tests ◽  
Congenital Extrahepatic Portosystemic Shunt ◽  
Liver Changes

Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

scholarly journals Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Lutfor Rahman ◽  
C Nunes ◽  
P Aguiar
Keyword(s):  
Retrospective Study ◽  
Severe Disease ◽  
Diagnostic Delay ◽  
Control Programme ◽  
Alcohol Addiction ◽  
Older Age ◽  
Rank Test ◽  
Female Patients ◽  
Median Delay ◽  
Cox's Regression

Abstract Background Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections. Methods A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data. Results The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays. Conclusions It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays. Key messages To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.

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