Publications by authors named "Sabine Kramer"

20 Publications

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Challenging diagnostic work-up of a massive fluid-filled structure in the cranial abdomen of a cat.

Tierarztl Prax Ausg K Kleintiere Heimtiere 2021 Oct 12. Epub 2021 Oct 12.

Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation.

A 9-year-old female, neutered European shorthair cat was presented with acute vomiting, obvious jaundice and painful enlargement of the abdomen. Icteric skin and mucous membranes in addition to severe bilirubinaemia (mainly direct bilirubin) and a large increase in liver enzyme activities were the main findings at the initial examination. Radio- and ultrasonographic evaluation revealed a massive fluid-filled structure caudal to the liver displacing abdominal organs, in particular the stomach. As this structure with a diameter of 8-10 cm occupied considerable space in the cranioventral abdomen, a detailed ultrasonographic examination of the liver and the gallbladder, and determination of the structure's association with a particular abdominal organ was initially impossible. Via ultrasound-assisted puncture under general anaesthesia 300 ml of an almost clear fluid could be aspirated. Cytological examination revealed a cyst content-like fluid with cell detritus.Further ultrasonographic and computed tomographic diagnostics followed by abdominal laparotomy finally enabled diagnosis of a cystic dilatation of the entire common bile duct and accumulation of white bile. Histopathological examination after euthanasia (requested by the owner) identified lymphoplasmacytic cholangitis and necrosis of the duodenal papilla. The massive dilatation of the common bile duct complicated its definite diagnosis by diagnostic imaging methods. It was most likely caused by a longer-standing obstruction of the bile flow by lymphoplasmacytic cholangitis with necrosis and granulation tissue formation in the area of the duodenal papilla. An interesting but initially misleading feature was the presence of white bile. The etiology of this extremely rare condition remains obscure but in the described case a manifestation of impaired hepatocyte function secondary to biliary stasis is suspected to be the cause.
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http://dx.doi.org/10.1055/a-1518-6202DOI Listing
October 2021

Evaluation of Antimicrobial Usage in Dogs and Cats at a Veterinary Teaching Hospital in Germany in 2017 and 2018.

Front Vet Sci 2021 23;8:689018. Epub 2021 Jun 23.

Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany.

In contrast to food-producing animals, where the documentation of the usage of antimicrobials is regulated by law, antimicrobial usage (AMU) in dogs and cats is only sparsely monitored. We collected data generated by an electronic practice management software (EPMS) between January 1, 2017 and December 31, 2018 to investigate AMU. All information was obtained from clinical routine data from the Department of Small Animal Medicine and Surgery (DSAM), University of Veterinary Medicine Hannover (TiHo). In 2017, 78,076 drug administrations were documented for 5,471 dogs and cats, of which 14,020 (17.96%) were antimicrobial drugs (AMs) specifically documented in 2,910 (51.31%) dogs and cats. In 2018, 104,481 drug administrations were documented for 5,939 dogs and cats. Of these drug administrations, 18,170 (17.39%) AM administrations were documented for 3,176 (53.48%) dogs and cats. Despite the increasing documentation of AM administrations, differences between 2017 and 2018 were not statistically significant [odds ratio (OR), 1.01; 95% confidence interval (CI), 0.98-1.03]. Prescription diversity (PD) in 2017 for dogs was 0.92 and for cats 0.89. In 2018, PD for dogs was 0.93 and for cats 0.88. As well as the documented number of AM administrations, the documented amount of active ingredients administered in 2018 (total: 17.06 kg; dogs: 16.11 kg, cats: 0.96 kg) increased compared with 2017 (total: 15.60 kg; dogs: 14.80 kg, cats: 0.80 kg). In 2017 and 2018, the most commonly administered antimicrobial groups were penicillins, nitroimidazoles, and quinolones for dogs and cats, respectively. While the in-house point-of-care administration accounts for the largest share of the documented amount of AMs administered, the highest number of documented AM administrations was assigned to inpatient care in 2017 and 2018, respectively. However, AM administration in outpatient care remained the lowest in both years. Since no statistically significant difference in AM administrations was observed between 2017 and 2018 and the most commonly used AMs at the DSAM were ranked, data can be used as a baseline to evaluate how changes in in-house guidelines and future legal requirements affect the prescribing culture. Data generated within the DSAM should be evaluated annually.
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http://dx.doi.org/10.3389/fvets.2021.689018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260837PMC
June 2021

[Post-operative prevalence of dysphagia in head-and-neck cancer patients in the acute care units].

Laryngorhinootologie 2021 Jun 29. Epub 2021 Jun 29.

Abt. für Phoniatrie und Pädaudiologie, KHNO,Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Deutschland.

Objective:  Dysphagia constitutes a frequent post-operative functional impairment in head-and-neck cancer patients. This impairment can result in aspiration/penetration and limitations of oral intake. Therefore, often it requires a therapeutic intervention. In this study, prevalence of post-operative dysphagia and its associations with the tumour stage, localisation, patients' age, and biological sex were analysed for the inpatient treatment setting.

Material And Methods:  A total of 201 adult head-and-neck cancer patients (mean age 63 years) were analysed prospectively by FEES in two university hospitals in regard to their penetration/aspiration, limitations of oral intake, and need for therapeutic interventions directly after the operative tumour treatment. Additionally, the influence of the same patients' characteristics on these three parameters were analysed by means of univariate and multivariate statistical methods.

Results:  Out of 201 patients, 66.7 % needed a therapeutic intervention because of their dysphagia, 57.2 % needed a nasogastral or PEG tube due to limitations of oral intake, 45.3 % had an aspiration. In the latter subgroup, 38.5 % had a silent aspiration. Higher tumour stage, patients' higher age and male sex were shown to be significant influence factors for dysphagia, tumour localisation showed only a marginally significant result.

Conclusions:  The study demonstrated a clinical importance and relevance of the consequent and systematic treatment of post-operative dysphagia in head-and-neck cancer patients in the acute care units as a constituent of a modern oncological therapy.
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http://dx.doi.org/10.1055/a-1528-7584DOI Listing
June 2021

Magnetic Resonance Imaging in Patients With Hearing Implants - Follow-up on Prevalence and Complications.

Otol Neurotol 2021 10;42(9):1334-1341

Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main.

Objective: To examine the number of magnetic resonance imaging (MRI) examinations performed in patients with hearing implants and to quantify side effects or complications related to this procedure.

Study Design: Questionnaire.

Setting: Tertiary referral center, academic hospital.

Patients: One thousand four hundred sixty-onepatients with an implanted hearing system.

Intervention: Patients were asked to complete a questionnaire either during a visit to the clinic (304) or by mail contact (1,157) between February 2018 and March 2019.

Main Outcome Measures: Number of examinations by means of MRI per patient and number of side effects or complications.

Results: A total of 711 questionnaires were returned. After excluding nonvalid information on the questionnaire, 12.8% of patients were identified who had undergone an MRI after having received their hearing implant. Within this group of 91 patients, the most common precaution undertaken was a head bandage (69%). Side effects were mainly pain (37%), followed by anxiety (15%) and tinnitus (9%). The MRI had to be aborted in 14% and dislocation of the magnet occurred in 7% of examinations.

Conclusions: Our data indicate that patients undergoing hearing implant surgery need better information about the limitations and requirements of MRI. The occurrence of side effects is likely as only half of the patients in our study group were completely free of symptoms. Dislocation of the implant magnet was observed in several cases, hence patients and physicians need to be educated about this potential complication.
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http://dx.doi.org/10.1097/MAO.0000000000003249DOI Listing
October 2021

[Effectiveness of Inpatient Psychosomatic Treatment: Short and Medium-Term Clinical and Care-Related Effects].

Psychother Psychosom Med Psychol 2020 Dec 27;70(12):509-518. Epub 2020 Apr 27.

Klinik für Psychosomatik, Neurologie und Psychiatrie, Zentrum für Psychiatrie Südwürttemberg, Ravensburg.

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http://dx.doi.org/10.1055/a-1147-9292DOI Listing
December 2020

A new adhesive bone conduction hearing system as a treatment option for transient hearing loss after middle ear surgery.

Eur Arch Otorhinolaryngol 2020 Mar 20;277(3):751-759. Epub 2019 Dec 20.

Department of Phoniatrics and Pediatric Audiology, Universitätsklinikum Frankfurt (UKF), J.W. Goethe-Universität Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.

Objective: The objective of this prospective, single-subject, repeated measures study was to evaluate the audiological benefit and patient satisfaction with an adhesive, pressure-free bone conduction hearing system (ADHEAR; MED-EL, Innsbruck, Austria) in patients who underwent middle ear surgery with transient hearing loss due to auditory canal tamponade.

Methods: Eleven adult subjects suffering from transient conductive hearing loss were enrolled in the study and followed up to 3 weeks after middle ear surgery. Bone and air conduction thresholds were measured pre and postoperatively to evaluate eligibility for enrollment. Postoperative unaided and aided sound-field thresholds, as well as speech tests in quiet and noise were compared to confirm hearing improvement with the hearing system. To determine patient satisfaction, the SSQ12 and a system-specific quality of life questionnaire was administered to all subjects.

Results: Speech perception for monosyllables in quiet improved by 46%, with statistical significance for the ADHEAR system compared to the unaided condition after one week. The functional hearing gain improved by 19 dB. Speech perception in noise with the device was - 6.7 dB SNR on average, with a statistically significant improvement of 2.7 dB SNR. The results of the questionnaire showed a high level of patient satisfaction and subjective hearing improvement. No serious skin reactions or other severe complications occurred.

Conclusion: As long as the auditory canal is blocked due to tamponade, patients benefit from hearing rehabilitation. This adhesive hearing system is a safe and effective device to treat transient conductive hearing loss and may considerably improve treatment for patients even with short-term hearing loss.
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http://dx.doi.org/10.1007/s00405-019-05769-yDOI Listing
March 2020

[Natural history after discharge from a hospital psychosomatic treatment - Results of a one-year follow-up].

Fortschr Neurol Psychiatr 2019 Jun 12;87(6):372-382. Epub 2018 Dec 12.

Zentrum für Psychiatrie Südwürttemberg, Abteilung Psychosomatische Medizin Ravensburg.

The effectiveness of the inpatient psychosomatic treatment has been documented in various settings. The question of the sustainability of the improvement achieved as well as the prognostic factors is of interest for public health.Primary outcome variables reflect the stability or change in the clinical status of patients one year after the discharge from the inpatient psychosomatic treatment. Secondary outcome variables reflect differences in utilization of medical services between the year before and after admission.One-year naturalistic follow-up of a sample consisting of patients treated in a psychosomatic hospital service by means of 9 clinical and 3 variables for measurement of utilization of medical services. Four measuring points were considered: agreeing at admission (N = 262), discharge (N = 249), 6 months (N = 148) and 12 months (N = 114) after discharge. Differences and associations were assessed by means of t tests and multivariate linear as well as logistic regressions.The subsample with adherence to the study is representative for the whole sample since hardly any differences to the drop-out group were found. A year after discharge, all clinical variables showed significant differences (p < 0.001) compared with clinical status at admission and no significant differences compared with status at discharge (p > 0.05). Three quarters of sample reported a subjective improvement one year after discharge, contrary to results of clinical scales. Medical aftercare was ensured principally by psychotherapists (78 %), followed by general practitioners (63 %), and psychiatrists (44 %). Relevant associations were found between psychotherapy appointments and clinical variables in follow-up.The clinical improvement attained through the psychosomatic hospitalization remain on average stable a year after discharge. Subjective global assessment of health status shows an improvement for the majority of the sample, contrary to results of clinical scales; that is the reason why both assessment approaches have to be considered. Psychotherapy in aftercare could play a prominent role for health preservation.
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http://dx.doi.org/10.1055/a-0621-8864DOI Listing
June 2019

The role of diffusion tensor imaging as an objective tool for the assessment of motor function recovery after paraplegia in a naturally-occurring large animal model of spinal cord injury.

J Transl Med 2018 09 17;16(1):258. Epub 2018 Sep 17.

Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Lower Saxony, Germany.

Background: Traumatic spinal cord injury (SCI) results in sensory and motor function impairment and may cause a substantial social and economic burden. For the implementation of novel treatment strategies, parallel development of objective tools evaluating spinal cord (SC) integrity during motor function recovery (MFR) is needed. Diffusion tensor imaging (DTI) enables in vivo microstructural assessment of SCI.

Methods: In the current study, temporal evolvement of DTI metrics during MFR were examined; therefore, values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in a population of 17 paraplegic dogs with naturally-occurring acute SCI showing MFR within 4 weeks after surgical decompression and compared to 6 control dogs. MRI scans were performed preoperatively and 12 weeks after MFR was observed. DTI metrics were obtained at the lesion epicentre and one SC segment cranially and caudally. Variance analyses were performed to compare values between evaluated localizations in affected dogs and controls and between time points. Correlations between DTI metrics and clinical scores at follow-up examinations were assessed.

Results: Before surgery, FA values at epicentres were higher than caudally (p = 0.0014) and control values (p = 0.0097); ADC values were lower in the epicentre compared to control values (p = 0.0035) and perilesional (p = 0.0448 cranially and p = 0.0433 caudally). In follow-up examinations, no significant differences could be found between DTI values from dogs showing MFR and control dogs. Lower ADC values at epicentres correlated with neurological deficits at follow-up examinations (r = - 0.705; p = 0.0023).

Conclusions: Findings suggest that a tendency to the return of DTI values to the physiological situation after surgical decompression accompanies MFR after SCI in paraplegic dogs. DTI may represent a useful and objective clinical tool for follow-up studies examining in vivo SC recovery in treatment studies.
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http://dx.doi.org/10.1186/s12967-018-1630-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142343PMC
September 2018

Cranial MRI in a young child with cochlear implants after bilateral magnet removal.

Int J Pediatr Otorhinolaryngol 2017 Dec 28;103:1-4. Epub 2017 Sep 28.

Department for Phoniatry and Pedaudiology, University Clinic Frankfurt, Frankfurt am Main, Germany.

A young bilateral cochlear implant (CI) user required magnetic resonance imaging (MRI) to determine the cause of hydrocephalus. The images obtained with the CIs in place were not diagnostically useful due to large artefacts generated by the CI magnets. We obtained useful images by bilaterally explanting the CI-magnets and replacing them with non-magnetic placeholder dummies then conducted the imaging. The artefact in the new images was greatly reduced and the images were diagnostically useful. Lastly, we explanted the dummies and reimplanted the CI-magnets. This procedure should be useful to obtain useful images in CI users.
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http://dx.doi.org/10.1016/j.ijporl.2017.09.028DOI Listing
December 2017

Chronic post-traumatic intramedullary lesions in dogs, a translational model.

PLoS One 2017 22;12(11):e0187746. Epub 2017 Nov 22.

Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.

Objectives: Post-traumatic intramedullary myelopathies and cavitations are well described lesions following spinal cord injury (SCI) in humans and have been described in histopathological evaluations in dogs. Human intramedullary myelopathies/cavitations are associated with severe initial SCI and deterioration of clinical signs. Canine intervertebral disc extrusions share similarities with SCI in humans. In this descriptive study, magnetic resonance imaging (MRI) findings in spinal cords of dogs suffering from chronic post-traumatic myelopathies, including cavitations, are elucidated. An additional aim of the study was to compare diagnostic imaging and histopathological findings and identify similarities between human and canine chronic post-traumatic spinal cord lesions.

Methods: Thirty-seven dogs with thoracolumbar SCI and one or more 3Tesla MRI investigations more than 3 weeks after SCI were included. Extent of intramedullary lesions and particularly cavitations were evaluated and measured in sagittal and transverse MRI planes. These data were compared with clinical data.

Results: A total of 91.9% of study patients developed chronic intramedullary lesions, and 86.5% developed intramedullary cavitations. Paraplegia without deep pain perception at initial examination was significantly associated with longer chronic myelopathies/cavitations (P = 0.002/P = 0.008), and with larger maximal cross-sectional area (mCSA) of the lesions (P = 0.041/0.005). In addition, a non-ambulatory status after decompressive surgery was also associated with the development of longer intramedullary lesions/cavitations (P<0.001) and larger lesion mCSA (P<0.001/P = 0.012). All dogs with negative outcome developed myelopathies/cavitations. In the group of 21 dogs with positive outcome, 3 did not develop any myelopathies, and 5 did not develop cavitations.

Conclusions: Development of chronic intramedullary lesions/cavitations are common findings in canine SCI. Extensive chronic intramedullary lesions/cavitations reflect a severe initial SCI and negative clinical outcome. This supports the hypothesis that chronic spinal cord changes following SCI in humans share similarities with canine chronic spinal cord changes after spontaneous intervertebral disc extrusion.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187746PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699804PMC
December 2017

Evaluation of thoracic limb loads, elbow movement, and morphology in dogs before and after arthroscopic management of unilateral medial coronoid process disease.

Vet Surg 2014 Oct 30;43(7):819-28. Epub 2014 Jul 30.

Small Animal Hospital, University of Veterinary Medicine Hannover, Hannover, Germany; Small Animal Clinic, Faculty of Veterinary Medicine, National University of Colombia, Bogotá, Colombia.

Objective: To (1) evaluate thoracic limb loads and symmetry, and elbow function and morphology, before and after arthroscopic treatment of unilateral medial coronoid process disease (MCPD), and (2) determine if functional variables correlate with morphologic findings.

Study Design: Prospective case series.

Animals: Dogs (n = 14) with thoracic limb lameness.

Methods: Dogs were included when unilateral MCPD was confirmed as the cause of lameness. Kinetic analysis of both thoracic limbs, along with kinematic analysis and goniometry of both elbows were carried out before, and 60, 120, and 180 days after partial coronoidectomy by arthroscopy. Radiography and computed tomography of both elbows were performed before and 180 days after arthroscopy.

Results: A nonsignificant (P = .11) increase in the peak vertical loads (PFz), and a significant (P = .022) increase in the vertical impulse (iFz) applied by the affected limb were seen. Symmetry indices improved, with significant differences between sessions (PFz: P = .019; iFz: P = .003). Kinematic variables showed no significant differences, between sessions or when comparing both elbows within sessions. Goniometry revealed no significant differences between sessions, but some significant differences were identified when comparing both elbows within sessions. Osteophytosis and degree of lameness showed no correlation, before (rs  = -0.077; P = .79) or after arthroscopy (rs  = 0.27; P = .35).

Conclusions: Kinetic variables improved after arthroscopy, without full restoration of function. Kinematic variables did not change significantly. Osteoarthritis and goniometric measurements in the affected joint worsened. Functional variables did not correlate with morphologic findings.
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http://dx.doi.org/10.1111/j.1532-950X.2014.12250.xDOI Listing
October 2014

Contact heat thermal threshold testing in beagle dogs: baseline reproducibility and the effect of acepromazine, levomethadone and fenpipramide.

BMC Vet Res 2012 Oct 30;8:206. Epub 2012 Oct 30.

Department of Small Animal Medicine and Surgery (Hoffmann, Kästner and Kramer), Bünteweg 9, D-30559, Hannover, Germany.

Background: In this methodology article a thermal threshold testing device designed to test nociception in cats was assessed in six dogs. The purpose of this study was to investigate baseline reproducibility of thermal thresholds obtained by the contact heat testing device, to assess the influence of acepromazine and levomethadone and fenpipramide in dogs. The relationship between change in nociceptive thermal threshold and the opioid's plasma concentration was determined. Six adult beagle dogs received levomethadone (0.2 mg/kg), acepromazine (0.02 mg/kg) or saline placebo by intramuscular injection (IM) in a randomized cross-over design. Three baseline nociceptive thermal threshold readings were taken at 15 minutes intervals prior to treatment. Further readings were made at 15, 30, 45, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, 360, 420 and 480 minutes after injection. A sedation score was assigned at every reading. Four saline placebo treatments were performed to assess baseline reproducibility. Levomethadone serum concentrations were measured prior and 0.5, 1, 2, 4, 8, 12 and 24 hours after drug dosing in a separate occasion.

Results: Acepromazine did not seem to increase the thermal threshold at any time. After levomethadone there was a significant rise of the thermal threshold between 15 to 120 minutes at serum concentrations between 22.6-46.3 ng/mL. Baseline reproducibility was stable in adult beagle dogs.

Conclusion: The thermal threshold testing system is a suitable device for nociceptive threshold testing in dogs.
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http://dx.doi.org/10.1186/1746-6148-8-206DOI Listing
October 2012

Diagnostics and epidemiology of alveolar echinococcosis in slaughtered pigs from large-scale husbandries in Germany.

Parasitol Res 2013 Feb 24;112(2):629-36. Epub 2012 Oct 24.

Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 33, 04103 Leipzig, Germany.

By means of the official meat inspection of domestic pigs, exceptionally high proportions of livers affected by encapsulated nodules containing whitish to light yellow, viscous to pasty material ("microabscesses") were detected. The swine had been raised on four different farms, being located in distinct regions of Germany (Brandenburg, Thuringia, Upper Franconia). Macroscopical and histological examination of 77 samples of livers revealed granulomatous to necrotizing hepatitis with attendance of numerous eosinophils. In 61 % (n = 47) of the lesions, eosinophilic, band-like acellular structures resembling the laminated layer of Echinococcus sp. were visible. Moreover, representative samples (n = 11) showed a positive reaction of these structures with Periodic acid-Schiff. Altogether, the findings were consistent with alveolar echinococcosis. Echinococcus multilocularis DNA could be demonstrated in selected samples (n = 7) by polymerase chain reaction. Epidemiological considerations suggest contamination of the forage with fox tapeworm eggs to be the most likely source of infection on two of the farms, as some of the fodder had been stored in the open, being amenable to infected definitive hosts. On the two other farms, mainly straw litter has to be taken into account regarding the transmission route, since carnivores excreting eggs of E. multilocularis could have gained access to the straw storage. The presented cases show that adequate mechanisms of meat inspection may provide important data for the purposes of surveillance and risk assessment of human alveolar echinococcosis.
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http://dx.doi.org/10.1007/s00436-012-3177-2DOI Listing
February 2013

Quantitative magnetic resonance imaging characteristics: evaluation of prognostic value in the dog as a translational model for spinal cord injury.

J Spinal Disord Tech 2012 May;25(3):E81-7

Tierarztpraxis Dres. Boettcher, Diekhoff 7, Petershagen, Germany.

Summary Of Background Data: The mechanisms of injury in spinal cord injury in dogs are similar to those in human patients and the dog is considered to be a valuable translational model for new treatment modalities. Studies regarding the quantitative characteristics of magnetic resonance imaging (MRI) findings in spinal cord injury in a uniform cohort of patients are lacking.

Objective And Study Design: The aim of this retrospective study was to evaluate the quantitative MRI signal characteristics of the spinal cord in T2-weighted (T2W) sequences, degree of spinal cord compression, and functional outcome in paraplegic dogs with thoracolumbar disk herniation proving the usefulness of imaging before treatment studies.

Methods: MR images of 63 paraplegic dogs with intact or absent deep pain perception due to thoracolumbar disk herniation examined between January 2005 and June 2009 were reviewed blinded to clinical information. The presence and degree of spinal cord compression, and the presence and length of an intramedullary hyperintensity on T2W images were correlated to clinical signs and outcome.

Results: A statistically significant correlation was seen between the neurological status before surgery and the presence and extent of the intramedullary hyperintensity adjacent to the disk herniation in T2W sequences. In dogs with a longer duration of clinical signs, the degree of spinal cord compression was statistically significantly higher. The extent of hyperintensity and the degree of spinal cord compression presented a positive correlation, whereas improvement in the neurological score for each grade was faster with no or a smaller size of T2W intramedullary hyperintensity.

Conclusions: In conclusion, a direct correlation between neurological status and MRI signal intensity and extent was proven. Moreover, the presence and extent of T2W hyperintensity can help determine the prognosis before surgery and to decide, whether new therapeutical strategies in dogs as a translational model should be evaluated.
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http://dx.doi.org/10.1097/BSD.0b013e31823f2f55DOI Listing
May 2012

Plasma and urine concentrations of marbofloxacin following single subcutaneous administration to cats.

Berl Munch Tierarztl Wochenschr 2011 Jan-Feb;124(1-2):83-8

Institute for Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine, Foundation, Hannover, Germany.

The pharmacokinetic properties of marbofoxacin, a third generation fluoroquinolone, were investigated in 12 healthy adult cats after single subcutaneous (SC) administration of 2 mg/kg BW (Part I, n=8 cats) and 4 mg/kg BW (Part II, n=4 cats). In each part of the study blood and urine samples were collected before treatment and thereafter for 5 days. The plasma and urine concentrations of marbofloxacin were determined by HPLC with UV detection. Pharmacokinetic calculations were performed for each treated animal using an open one-compartment-model with first-order elimination after SC dosing. Marbofloxacin in plasma (means): Maximum concentrations (Cmax) of about 1.2 and 3.0 microg/ml were measured 2.3 and 4 hours (tmax) after dosing of 2 and 4 mg/kg BW, respectively. Elimination from the body was low with a total clearance (Cl/F) of approximately 0.1 l/h/kg for both dosages. The half-life (t 1/2) for this process was calculated with 8-10 hours. AUC increased almost proportional when doubling the dose, i.e., 19.77 +/- 6.25 microg * h/ml (2 mg/kg BW) and 51.26 +/- 11.83 microg * h/ml (4 mg/kg BW). Plasma kinetics measured were in accordance with data from literature. Marbofloxacin in urine (means): Maximum drug concentrations were detected 4 and 8 hours after dosing with 70 microg/ml (2 mg/kg BW) and 160 microg/ml (4 mg/kg BW), respectively. Inhibitory effects of the urinary matrix on the antimicrobial activity of the drug were taken into account when performing PK/PD calculations. However, a concentration-dependent bactericidal activity (Cmax/MIC > 8-10) which is claimed for fluoroquinolones was sufficiently met with focus on Escherichia (E.) coli (MIC90 0.5 microg/ml). In the same matrix a threshold value of 1.0 microg/ml was undercut 82 and 116 hours after SC dosing, respectively. Hence, a time-dependent bacteria killing kinetic (T > MIC) which may be of relevance for some Gram-positive germs like Staphylococcus spp. (MIC90 1.0 microg/ml) should be covered, too.
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April 2011

[Low flow anaesthesia with isoflurane and sevoflurane in the dog].

Berl Munch Tierarztl Wochenschr 2008 Jan-Feb;121(1-2):53-65

Klinik für Kleintiere, Stiftung Tierärztliche Hochschule Hannover.

The aim of the present study was to compare the safety and efficacy of sevoflurane and isoflurane during low flow anaesthesia (fresh gas flow (FGF) 14 ml/kg/min) as well as to compare the consumption of both anaesthetics. Data were gathered from 60 dogs assigned for surgery under general anaesthesia with an expected duration of 75 minutes or longer. All dogs were induced with 0.6 mg/kg (maximum 25 mg) l-methadone and 1 mg/kg (maximum 25 mg) diazepam i.v.. Anaesthesia was maintained with isoflurane (group 1) or sevoflurane (group 2) in a mixture with 50% O2 and 50% N2O as carrier gases, under controlled ventilation. Monitoring included electrocardiogram, body temperature, the temperature of in- and exspired gases, arterial oxygen saturation, arterial blood pressure as well as a continuous monitoring of inhaled and exhaled gas concentrations (O2, N2O, CO2, isoflurane, sevoflurane). The consumption of isoflurane and sevoflurane as well as the dogs' recovery times were evaluated for both groups. In all groups the inspired oxygen concentrations ranged above the minimum value of 30 Vol% during low flow anaesthesia, with an arterial oxygen saturation above 97%. End tidal concentration of CO2, heart rate and arterial blood pressure were within the physiological ranges and showed no differences between the two groups. Recovery time was significantly shorter after sevoflurane compared to isoflurane anaesthesia, whilst the consumption of sevoflurane was higher than that of isoflurane. Sevoflurane appears to be as clinically safe as isoflurane in low flow anaesthesia. Even considering that sevoflurane is more expensive than isoflurane, the use of the low flow technique decreases the cost of anaesthesia due to the reduced volatile anaesthetic consumption.
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October 2008

Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair.

Vet Surg 2007 Oct;36(7):623-32

Small Animal Clinic, School of Veterinary Medicine, Bischofsholer Damm 15, Hannover, Germany.

Objective: To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen.

Study Design: Blind, randomized clinical study.

Animals: Dogs with femoral (n=18) or pelvic (27) fractures.

Methods: Dogs were grouped by restricted randomization into 4 groups: group 1 = carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2 = carprofen immediately after extubation, no epidural anesthesia; group 3 = carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4 = mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia.

Results: Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables.

Conclusions: Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen.

Clinical Relevance: Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration of carprofen provides safe and effective pain relieve in canine fracture repair.
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http://dx.doi.org/10.1111/j.1532-950X.2007.00314.xDOI Listing
October 2007

Effects of preoperative administration of carprofen on renal function and hemostasis in dogs undergoing surgery for fracture repair.

Am J Vet Res 2005 Aug;66(8):1356-63

Small Animal Clinic, School of Veterinary Medicine, Bischofsholer Damm 15, D-30173 Hannover, Germany.

Objective: To evaluate effects of preoperative administration of carprofen on renal function and hemostasis in dogs undergoing general anesthesia for fracture repair.

Animals: 26 client-owned dogs.

Procedure: Anesthesia was induced with levomethadone, diazepam, and propofol and maintained by administration of isoflurane in oxygen-nitrous oxide. Carprofen (4 mg/kg, SC) was administered 1 hour before induction to 13 dogs (group 1) and after extubation to the other 13 dogs (group 2). All dogs also received carprofen (4 mg/kg, SC, q 24 h) for the first 4 days after surgery. Renal function (glomerular filtration rate [GFR], urinary protein-to-urinary creatinine ratio [UP:UC], and results of urinalysis and biochemical analysis of plasma), hemostatic variables (bleeding time, platelet aggregation, prothrombin time [PT], activated partial thromboplastin time [APTT], and platelet count), and Hct were assessed before and at various time points after surgery.

Results: Analysis of results for renal function tests, most of the hemostatic and plasma biochemical variables, and Hct did not reveal significant differences between treatment groups. Values for GFR, UP:UC, PT, APTT, and platelet aggregation were outside reference ranges in many dogs before surgery and during the first 6 hours after surgery. In most dogs, these trauma-induced pathologic changes returned to within reference ranges during the 4-day period after surgery.

Conclusions And Clinical Relevance: Carprofen did not cause clinically relevant adverse effects in dogs anesthetized for fracture repair after 5 days of treatment, even when it was administered before surgery or given to patients with trauma-induced alterations in renal function or hemostasis.
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http://dx.doi.org/10.2460/ajvr.2005.66.1356DOI Listing
August 2005

[Low flow anaesthesia with isoflurane in the dog].

Berl Munch Tierarztl Wochenschr 2005 Mar-Apr;118(3-4):164-74

Klinik für kleine Haustiere der Tierärztlichen Hochschule Hannover.

The aim of the present study was to compare the safety of two low flow (LF) regimes [fresh gas flow (FGF) 20 ml/kg/min (group 2) and 14 ml/kg/min (group 3)] with the high flow (HF) technique (FGF 50 ml/kg/min; group 1) of isoflurane anaesthesia. Data were gathered from ninety dogs assigned for surgery under general anaesthesia with an expected duration of 75 minutes or longer. All dogs had an anaesthetic induction with 0,6 mg/kg I-methadone (maximum 25 mg) and 1 mg/kg diazepam (maximum 25 mg) i.v. Anaesthesia was maintained with isoflurane in a mixture of 50% O2 and 50% N2O as carrier gases, with controlled ventilation. The Monitoring included electrocardiogramm, body temperature, the temperature of in- and exspired gases, arterial oxygen saturation, arterial blood pressure as well as a continuous monitoring of inhaled and exhaled gas concentrations (O2, N2O, CO2, isoflurane). The consumption of isoflurane and carrier gases as well as the recovery times were evaluated for the three groups. The inspired oxygen concentrations always ranged above the minimum value of 30 Vol.-% during low flow anaesthesia. The arterial oxygen saturation ranged between 92-98%, the end tidal concentration of CO2 between 35 and 45 mmHg. Heart rate and arterial blood pressure were within normal limits. Recovery time was significantly shorter after LF than after HF anaesthesia. The highest decrease in body temperature occurred in the HF group 1 because of a significantly lower anaesthetic gas temperature. Despite this, LF anaesthesia resulted in a reduced consumption of carrier gases and volatiles. In conclusion, low flow anaesthesia with isoflurane is a safe technique and offers substantial economic advantages over high flow techniques and is moreover better tolerated by the patients.
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June 2005

[Placebo-controlled blinded study of postoperative pain therapy with carprofen and levomethadone in dogs with fractures].

Berl Munch Tierarztl Wochenschr 2005 Mar-Apr;118(3-4):101-12

Klinik für kleine Haustiere,Tierärztliche Hochschule Hannover.

It was the aim of this placebo-controlled study to evaluate the analgesic efficacy of the NASAID carprofen and the pure m-agonist levomthadone over a five-day postoperative evaluation period in dogs with fractures of the humerus or the femur (n = 30). Pain and sedation evaluation was carried out with a visual analogues system (VAS) and with the aid of a numerical estimation scale(NRS). The degree of lameness, the pain treshhold, the glucose and cortisol concentration curves as well as the respiration and heart rate and the systolic blood pressure were used as further pain indicators and to identify drug side effects. The levomethadon group displayed the lowest degree of pain on postoperative examination on the first day. On days 2 to 5, the carprofen group showed the lowest degree of pain in comparison to the placebo group. The levomethadon- and the carprofen group showed no statistically proven differences from day 2 on. Due to great variations in the pain scores and comparatively high median pain score especially on the first day of this study, the efficacy of all analgesics evaluated here must be regarded as insufficient in many cases. Only the parameter nociceptive pain treshhold showed a little, the degree of lameness, the glucose and cortisol levels showed no close correlation to the VAS and NRS pain scores and were therefore of little usefulness as postoperative pain indicators. No relevant clinical side effects caused by the used analgesics were detected in the kidney, the liver, the gastrointestinal tract and the circulatory system in this study. Rather, traumatically induced elevation of enzyme levels improves or normalised until the 5th day of the study. In addition, no negative effect on wound healing was noted, especially for carprofen. Therefore, the evaluated analgesics seems to be adequate for postoperative pain therapy also in fracture patients (trauma patients). However, the efficacy of all analgesics evaluated here must be regarded as insufficient in many cases.
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June 2005
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