@article{herrero_iannucci_schreiber_hansen_vigani_2022, title={Acute nephrotic-range glomerular proteinuria following ibuprofen intoxication in two cats}, volume={8}, ISSN={["2055-1169"]}, DOI={10.1177/20551169221104551}, abstractNote={Case series summary In this report we describe the origin of protein loss and development of acute kidney injury after ibuprofen intoxication in two cats. Two 13-month-old neutered male domestic shorthair siblings were presented with acute kidney injury (AKI) and severe glomerular proteinuria following witnessed ibuprofen intoxication 3 days prior. Both cats presented with severe azotaemia (creatinine >900 µmol/l [>10 mg/dl]) and severe proteinuria (urine protein:creatinine [UPC] >20, normal <0.5). Urine protein electrophoresis upon presentation revealed mainly albumin and primary glomerular protein losses. The proteinuria and azotaemia resolved completely within 5 days of hospital treatment (8 days after ingestion). Urine protein electrophoresis, once the azotaemia and proteinuria resolved (UPC 0.11; normal <0.5), had a similar pattern to the one from admission. Both cats made a full recovery with supportive care. Relevance and novel information This is the first clinical report of AKI with nephrotic-range protein losses following ibuprofen intoxication in cats. We propose that this finding is due to idiosyncratic glomerular injury, as described in humans.}, number={1}, journal={JOURNAL OF FELINE MEDICINE AND SURGERY OPEN REPORTS}, author={Herrero, Yaiza and Iannucci, Claudia and Schreiber, Nora and Hansen, Bernard D. and Vigani, Alessio}, year={2022}, month={Mar} }
 @article{culler_vigani_ripoll_gareau_suter_2022, title={Centrifugal therapeutic plasma exchange in dogs with immune-mediated hemolytic anemia (2016-2018): 7 cases}, ISSN={["1476-4431"]}, DOI={10.1111/vec.13196}, abstractNote={OBJECTIVE
To describe the technique of centrifugal therapeutic plasma exchange (cTPE) in dogs diagnosed with immune-mediated hemolytic anemia (IMHA) and summarize the outcome of the procedure.


DESIGN
Retrospective review of cTPE performed at North Carolina State University from 2016 to 2018, through a search of the institutional database for cTPE and IMHA.


SETTING
University teaching hospital.


ANIMALS
Seven dogs with confirmed IMHA were presented to a university teaching hospital ICU for cTPE. Six dogs were not responsive to standard medical management with immunosuppressive agents, while 1 dog presented before immunosuppressive agents were begun.


INTERVENTIONS
All dogs underwent multiple cTPE procedures using 1 of 2 commercially available apheresis systems.


MEASUREMENTS AND MAIN RESULTS
At presentation, the median HCT was 0.15 L/L (15.7%) (range, 0.10-0.19 L/L [10.3%-19%]) and the median total serum bilirubin was 32.5 mmol/L (1.9 mg/dl) (range, 15.4-597 mmol/L [0.9-34.9 mg/dl]). The median number of transfusions before cTPE was 1 (range, 1-4), with a median total of infused RBCs of 12.9 ml/kg (range, 8.8-37 ml/kg). cTPE with an exchange of ≥4 times total plasma volumes was used to decrease the level of circulating autoreactive antibodies. The median total plasma volumes exchanged was 4.5 times (range, 2.5-6.5 times) over 2-4 procedures. Anticoagulation was performed using a combination of systemic heparinization and regional citrate in all dogs. Six of 7 dogs (85.7%) were discharged from the hospital and were alive 90 days after discharge. One dog (14%) did not respond to cTPE (∼6.5 times total plasma volume exchanged) and was euthanized.


CONCLUSIONS
cTPE is a feasible and relatively safe bridging treatment option for the management of canine IMHA.}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Vigani, Alessio and Ripoll, Alexandra Z. and Gareau, Alexandra and Suter, Steven E.}, year={2022}, month={May} }
 @article{chalifoux_butty_mauro_moyle_ehrhardt_robertson_labato_culler_londono_vigani_et al._2022, title={Outcomes of 434 dogs with non-steroidal anti-inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange}, volume={12}, ISSN={["1939-1676"]}, url={http://dx.doi.org/10.1111/jvim.16603}, DOI={10.1111/jvim.16603}, abstractNote={Abstract Background Traditional management of non‐steroidal anti‐inflammatory drug (NSAID) intoxication includes gastrointestinal decontamination, intravenous administration of fluids (IVF), and gastroprotection. Intravenous administration of lipid emulsion (ILE) and therapeutic plasma exchange (TPE) are popular novel therapeutic strategies. Hypothesis Compare outcomes of dogs treated with IVF, ILE, and TPE for NSAID intoxications and evaluate outcome predictors for drug subgroups. Animals Four hundred thirty‐four dogs with NSAID intoxications (2015‐2020). Methods Multicenter retrospective study of ibuprofen, carprofen, and naproxen intoxication. An ordinal outcome was defined as mild gastrointestinal, moderate kidney, or signs of severe central nervous system disease. Results Signs of neurological disease were overrepresented and acute kidney injury underrepresented in the TPE group among dogs exposed to kidney‐ or CNS‐toxic doses (P = .05), though all TPE dogs with signs of neurological disease had evidence of neurotoxicity at presentation. Dogs treated with IVF had a higher maximal creatinine concentration (median, 1.1 mg/dL; range, 0.4‐8.44 mg/dL) compared with IVF + ILE (median, 0.9 mg/dL; range, 0.4‐6.2 mg/dL; P = .01). Increased maximum time to presentation (P < .001), higher baseline creatinine (P < .001) and PCV (P = .007), and absence of induced emesis (P < .001) were associated with greater clinical severity. Ibuprofen toxicosis was associated with more severe clinical signs compared with carprofen (P = .03). Overall survival rate was 99%. Conclusions and Clinical Importance NSAID toxicosis generally carries an excellent prognosis in dogs. Despite similar outcomes of lower incidence of AKI in the TPE group, and slightly lower maximal creatinine concentration in dogs treated with ILE vs IVF alone, ILE and TPE should be considered in the management of severe NSAID toxicosis.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, publisher={Wiley}, author={Chalifoux, Nolan V. and Butty, Emmanuelle M. and Mauro, Katie D. and Moyle, Rachel B. and Ehrhardt, Caryn M. and Robertson, James B. and Labato, Mary A. and Culler, Christine A. and Londono, Leonel A. and Vigani, Alessio and et al.}, year={2022}, month={Dec} }
 @article{butty_suter_chalifoux_lynch_mauro_moyle_ehrhardt_robertson_culler_londono_et al._2022, title={Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs}, volume={8}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.16507}, abstractNote={Abstract Background Therapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti‐inflammatory drug (NSAID) overdose in dogs. Hypothesis/Objectives Describe a population of dogs treated with TPE for NSAID overdose. Animals Sixty‐two dogs with NSAID overdose treated with TPE. Methods Multicenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose. Results The median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36‐4857 mg/kg), 217 mg/kg (range, 88‐625 mg/kg) and 138 mg/kg (range, 26‐3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1‐20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4‐2.2). The median TPE session duration was 2 hours (range, 1‐4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1‐11 days). Sixty‐one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty‐one (91.1%) of the 34 dogs with at least 1 follow‐up visit were not azotemic at the time of reevaluation. Conclusions and Clinical Importance This population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Butty, Emmanuelle M. and Suter, Steven E. and Chalifoux, Nolan V and Lynch, Alex M. and Mauro, Katie D. and Moyle, Rachel B. and Ehrhardt, Caryn M. and Robertson, James B. and Culler, Christine A. and Londono, Leonel A. and et al.}, year={2022}, month={Aug} }
 @article{perry_lynch_caudill_vigani_roberston_vaden_2021, title={Clinical features, outcome, and illness severity scoring in 32 dogs with urosepsis (2017-2018)}, volume={11}, ISSN={["1476-4431"]}, DOI={10.1111/vec.13158}, abstractNote={OBJECTIVE
To describe the clinical features, outcome, and utility of illness severity scoring in dogs diagnosed with urosepsis.


DESIGN
Retrospective study (2017-2018).


SETTING
University teaching hospital.


ANIMALS
Thirty-two dogs diagnosed with urosepsis secondary to pyometra, prostatitis, or pyelonephritis.


INTERVENTIONS
 None.


MEASUREMENTS AND MAIN RESULTS
Urosepsis was identified in 32 dogs, consisting of 9 of 32 (28.1%) with pyometra, 7 of 32 (21.8%) with prostatitis, and 16 of 32 (50%) with pyelonephritis. In total, 28 (87.5%) dogs survived to discharge, with the following group-specific survival rates: pyometra, 9 of 9 (100%); prostatitis, 5 of 7 (71.4%); and pyelonephritis, 14 of 16 (87.5%). Positive bacterial cultures were obtained in 27 of 32 (84.1%) dogs. The most commonly implicated pathogens were Escherichia coli (14/37 [37.8%]), Klebsiella pneumoniae (8/37 [21.6%]), and Staphylococcus pseudintermedius (6/37 [16.2%]). Multiple organ dysfunction syndrome (MODS) was identified in 21 of 32 dogs (65.6%). Although the presence of MODS was not different between survivors and nonsurvivors (P = 0.6), nonsurvivors had more dysfunctional organs (P = 0.04). Nonsurvivors also had higher Acute Patient Physiology and Laboratory Evaluation (APPLEFAST ) scores compared to survivors (P = 0.01).


CONCLUSIONS
Survival of dogs with urosepsis was good and may be higher than for other sources of sepsis. Compared to survivors, nonsurvivors had more dysfunctional organs and higher illness severity scores, which may be helpful in the assessment and management of dogs with urosepsis.}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Perry, Kayla M. and Lynch, Alex M. and Caudill, Alexander and Vigani, Alessio and Roberston, James B. and Vaden, Shelly}, year={2021}, month={Nov} }
 @article{wolf_early_pozzi_vigani_2021, title={Ultrasound-guided paravertebral perineural glucocorticoid injection for signs of refractory cervical pain associated with foraminal intervertebral disk protrusion in four dogs}, volume={258}, ISSN={["1943-569X"]}, DOI={10.2460/javma.258.9.999}, abstractNote={CASE DESCRIPTION
4 dogs, 7.5 to 10 years of age, were presented for evaluation of signs of chronic cervical pain and forelimb lameness secondary to cervical foraminal intervertebral disk protrusion (IVDP). All dogs were refractory to ≥ 2 weeks of conservative management including strict rest and pain management with anti-inflammatory drugs, methocarbamol, and gabapentin.


CLINICAL FINDINGS
The MRI findings included left foraminal IVDP at C2-3 causing mild C3 nerve root compression (dog 1), multifocal degenerative disk disease with mild focal left-sided disk protrusion at C6-7 without associated spinal cord or nerve root compression (dog 2), left foraminal C6-7 IVDP with suspected focal spinal cord atrophy or mild compression (dog 3), and right foraminal C6-7 IVDP and multifocal cervical intervertebral disk degeneration with annulus fibrosus protrusion (dog 4).


TREATMENT AND OUTCOME
Ultrasound-guided paravertebral perineural injections with methylprednisolone acetate (1 mg/kg [0.45 mg/lb]) at the C3 nerve root in dog 1 and at the C7 nerve root in the other 3 dogs were performed. Injections were repeated at intervals of 4 weeks to 3 months on the basis of clinical response. None of the dogs had any complications from the procedures. For dogs 1 and 4, there was complete resolution of lameness and signs of cervical pain following perineural injections, and for dog 3, there was complete resolution of lameness and only minimal residual cervical pain. Dog 2 did not have long-lasting improvement.


CLINICAL RELEVANCE
Findings indicated that ultrasound-guided paravertebral perineural injection can be an effective treatment of cervical foraminal IVDP for some dogs. Additional studies to determine appropriate case selection and better assess the overall success rate and risks associated with this technique are warranted.}, number={9}, journal={JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Wolf, Johanna K. and Early, Peter J. and Pozzi, Antonio and Vigani, Alessio}, year={2021}, month={May}, pages={999–1006} }
 @article{tracy_lynch_messenger_vaden_vigani_2021, title={Use of extracorporeal therapy in a dog with heatstroke}, volume={12}, ISSN={["1476-4431"]}, DOI={10.1111/vec.13169}, abstractNote={OBJECTIVE
To describe the use of extracorporeal therapy (ECT) in the management of a dog with complications stemming from heatstroke.


CASE REVIEW
A 3-year-old intact male Rhodesian Ridgeback was presented for heat-related illness following strenuous exercise. Despite intensive supportive care, the dog developed progressive and refractory hyperkalemia, hypoglycemia, neurologic dysfunction, acute kidney injury (AKI), and pulmonary dysfunction. Four ECT sessions were performed in this dog, consisting of 4 intermittent hemodialysis (HD) sessions, the first 2 of which concurrently utilized hemoperfusion with a cytokine adsorption filter. Interleukin-6 (IL-6), IL-8, IL-10, and monocyte chemoattractant protein-1 were detected in samples collected during the first ECT session. Despite an initial decrease in their concentration, the concentrations of these cytokines ultimately rose over the course of the ECT session. Rapid and sustained glycemic and electrolyte control were achieved after the first ECT session, although AKI and muscle injury persisted. The dog survived to discharge and was nonazotemic 3 months following initial management.


NEW OR UNIQUE INFORMATION PROVIDED
Heatstroke is a common, potentially catastrophic, occurrence in dogs. To the authors' knowledge, this represents the first clinical use of ECT consisting of HD and cytokine adsorption in the management of severe heat-related illness in a dog. The use of ECT for the management of complications from severe heatstroke in dogs warrants further investigation.}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Tracy, Alyx and Lynch, Alex and Messenger, Kristen and Vaden, Shelly and Vigani, Alessio}, year={2021}, month={Dec} }
 @article{sekiguchi_vigani_ripoll_taylor_culler_suter_2020, title={Clinical Application of Apheresis in Very Small Dogs Weighing < 8 kg to Pediatric Patients}, volume={24}, ISSN={["1744-9987"]}, DOI={10.1111/1744-9987.13432}, abstractNote={Abstract}, number={3}, journal={THERAPEUTIC APHERESIS AND DIALYSIS}, author={Sekiguchi, Tomoko and Vigani, Alessio and Ripoll, Alexandra Z. and Taylor, Scott and Culler, Christine and Suter, Steven E.}, year={2020}, month={Jun}, pages={333–342} }
 @article{fick_messenger_vigani_2020, title={Efficacy of a single session in-series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs}, volume={30}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12931}, abstractNote={OBJECTIVE
To describe the efficacy of in-series hemoperfusion and hemodialysis in 2 dogs with carprofen overdose.


CASE SUMMARY
This report describes the treatment of 2 dogs following accidental carprofen overdoses who underwent a single in-series hemoperfusion and hemodialysis session. Serial serum carprofen concentrations were measured before, during, and after the session. The first patient's session lasted 5 hours, with the largest decrease in serum carprofen concentrations occurring during the first hour of treatment. The carprofen clearance during the following 4 hours of treatment decreased substantially compared to the first hour and was not different from the patient's intrinsic clearance of carprofen after the session was completed. Based on the findings from the first case, the second patient was treated with a 1 hour single hemoperfusion and hemodialysis session. Our results support the hypothesis that carprofen is not effectively removed by conventional hemodialysis and the efficacy of hemoperfusion is short lived due to rapid saturation of the charcoal filter. Once filter saturation occurs, the extracorporeal session is no longer efficacious. Using in-series hemoperfusion and hemodialysis is of benefit to correct the side effects seen with hemoperfusion alone, and hourly charcoal filter replacement may extend the efficacy of treatment in removing carprofen.


NEW OR UNIQUE INFORMATION PROVIDED
This is the first published report of in-series hemoperfusion and hemodialysis being used to treat carprofen overdose in a dog. In these 2 cases, the intrinsic clearances of the patients were shown to be equivalent to that of standard hemodialysis alone, indicating that hemodialysis does not produce any advantage in carprofen clearance. In this limited report, we suggest that the efficacy of hemoperfusion in removing carprofen is short-lived, and extending the treatment beyond the first hour does not produce any therapeutic benefit. In order to extend the efficacy of hemoperfusion, hourly replacement of the charcoal filter should be considered.}, number={2}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Fick, Meghan E. and Messenger, Kristen M. and Vigani, Alessio}, year={2020}, month={Mar}, pages={226–231} }
 @article{culler_reinhardt_vigani_2020, title={Successful management of clinical signs associated with hepatic encephalopathy with manual therapeutic plasma exchange in a dog}, volume={30}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12940}, abstractNote={OBJECTIVE
To describe the use of manual therapeutic plasma exchange (TPE) to manage hepatic encephalopathy (HE) in a dog.


CASE SUMMARY
A 9-year-old neutered female Dachshund presented for HE secondary to a previously diagnosed portosystemic shunt. The hyperammonemia and severe clinical signs of HE persisted despite extensive medical management. Therapeutic plasma exchange was performed for stabilization prior to surgical shunt ligation. A total of 1 plasma volume was processed during a single manual TPE session. The ammonia immediately prior to TPE was 235 μmol/L (reference interval, 10-30 μmol/L) and decreased to 117 μmol/L by the end of the session. The dog showed significant improvement in clinical signs shortly after the session and remained stable thereafter. Shunt ligation was performed 5 days later with no complications observed with TPE or postoperatively. The dog was discharged 3 days after surgery with no neurological signs and was doing well 100 days after surgery.


NEW OR UNIQUE INFORMATION PROVIDED
To the authors' knowledge, this is the first published report of manual TPE to manage HE in veterinary medicine. Therapeutic plasma exchange should be further investigated as a possible strategy to manage clinical signs of HE in patients that are refractory to medical management. Achieving this with manual TPE may be considered in patients that are too small for conventional TPE due to extracorporeal volume or in situations where conventional TPE is not available.}, number={3}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Reinhardt, Alyx and Vigani, Alessio}, year={2020}, month={May}, pages={312–317} }
 @article{culler_vigani_2019, title={Successful treatment of a severe cannabinoid toxicity using extracorporeal therapy in a dog}, volume={29}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12899}, abstractNote={Abstract}, number={6}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Vigani, Alessio}, year={2019}, month={Nov}, pages={674–679} }
 @article{culler_fick_vigani_2019, title={Ultrasound-guided placement of pigtail cystostomy tubes in dogs with urethral obstruction}, volume={29}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12832}, abstractNote={Abstract}, number={3}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Fick, Meghan and Vigani, Alessio}, year={2019}, pages={331–336} }
 @article{hansen_vigani_2017, title={Maintenance Fluid Therapy Isotonic Versus Hypotonic Solutions}, volume={47}, ISSN={["1878-1306"]}, DOI={10.1016/j.cvsm.2016.10.001}, abstractNote={The goal of maintenance fluid therapy in small animals is to replace normal ongoing losses of water and salts when oral intake is withheld. Hospitalized dogs and cats may have multiple stimuli for antidiuretic hormone release that disrupt normal osmoregulation and predispose to water retention. Severe illness promotes retention of both sodium and water as edema. Commercially available fluids have electrolyte concentrations that are very different from dietary maintenance requirements, and potential consequences include development of hypoosmolality, edema, or both when excesses of water or sodium are administered. Suggestions for tailoring fluid administration toward specific goals are provided.}, number={2}, journal={VETERINARY CLINICS OF NORTH AMERICA-SMALL ANIMAL PRACTICE}, author={Hansen, Bernie and Vigani, Alessio}, year={2017}, month={Mar}, pages={383-+} }
 @article{vigani_culler_2017, title={Systemic and local management of burn wounds}, volume={47}, DOI={10.1016/j.cvsm.2017.06.003}, abstractNote={Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI—including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control—the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.}, number={6}, journal={Veterinary Clinics of North America. Small Animal Practice}, author={Vigani, A. and Culler, C. A.}, year={2017}, pages={1149-} }