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2013年9月24日星期二

September | 2010 | Locust Valley Veterinary Clinic


This is a condition frequently seen in dogs and cats and in both males and females. Stones can develop anywhere in the urinary tract: the ureters ( 2 small tubes that carry urine from the kidneys to the bladder), the bladder which stores the urine, and the urethra which takes the urine  from the bladder to outside the body. Over 85% of the times,  stones develop in the bladder. (Very rarely do stones develop in the kidney in dogs and cats, called renal calculi.  Humans get renal calculi and not bladder stones.) In dogs and cats, certain minerals can precipitate out of the urine and become a sandy particle,  more can develop and when they cling to each other a calculus (urolith, stone) develops. They can become 3-4” in diameter and can take up to 99% of a bladder. The largest one I every removed was the size of a goose egg and it took up the majority of the bladder. It was in a female standard poodle. Most stones develop as the result of a bladder infection known as cystitis. Diet is involved as the diet influences the ph (level of acidity) and the mineral content of the urine. Water is involved because if the urine is very concentrated from lack of water consumption, more precipitates occur.  And the breed is involved because certain breeds are predisposed to calculi development. These breeds include: Schnauzers, Lhasas, Yorkies, Bichons, Shihtsus, and mini Poodles.  In male dogs and cats, the urethra is long and narrows at the penis where stones can get stuck and cause a complete obstruction. This obstruction must be relieved, urine must flow, or else it can become fatal. The stones can get stuck near the neck of the bladder, or by the prostate as it narrows going through,   midway down the urethra where it curves, or just behind the penis, (dogs have a bone in the penis known as the os penis, and the urethra is very small there). Early signs of bladder stones are the same as cystitis: frequent urination of small quantities, blood in the urine, urinary accidents, and apparent straining to urinate. The worse sign is attempting to urine but nothing comes out.  Occasionally the bladder stones can be felt with gentle palpation of the lower abdomen, and often a urinalysis shows crystals in the urine which are the precursors of calculi, but usually x-rays are taken to confirm the diagnosis.  If  crystals show up in the urinalysis, and even if very small calculi are present, surgery is sometimes avoided by just changing the diet, especially in females. Small stones in males are the most dangerous ones because of the obstruction possibility.




It is generally believed that dry pet food rather than canned is better for your pet for several reasons: teeth stay stronger and gums stay healthy because they have to break up the food with their teeth. Usually the dry food is eaten more slowly and mixes better with saliva, so the digestive tract functions more efficiently. Some canned foods are up to 75% moisture (water), which is much less expensive from the tap. Also, dry food is more stable during temperature changes which may occur during shipping from the manufacturer to the store and then to your home. Making a meal from your food is just fine, if the balance of all the essential ingredients are correct, but again it is usually soft. Adding table food to just “flavor” a commercially prepared food is okay, but too much table food again creates an imbalance in the diet which defeats the purpose of feeding a nutritionally completely balanced meal. When changing the diet, always do it slowly. Introduce something new gradually, over a period of 5-7 days, so that the digestive tract adjusts to the change. Dogs and cats have very simple digestive tracts, and they will have much less gastro-intestinal upsets if fed the same food consistently every day. Do not feed your dog bones of any kind, including steak bones as they break off pieces with sharp edges. I have had to operate many times to remove pieces of bones from a dog’s intestine. Cats should not be fed fish with bones because they can perforate the intestines. The amount of food to feed your dog or cat depends on a number of factors; the genetic makeup of your pet and its metabolism, the amount of exercise it receives, the amount of calories being consumed and the quality of the food. The less expensive the pet food, the cheaper the quality of ingredients, the less efficiently it is digested and more waste is produced, and thus the more you have to feed to maintain the proper weight and survive. We all want our pets to thrive, not just survive, and be healthy and happy companions. For more articles, check out my web site at http://www.locustvalleyvet.com




We all have Mast cells circulating through out our circulatory system. Mast cells are produced in the bone marrow and are part of the immune system. They release histamine in response to allergens, parasites, stress, and trauma. These cells are essential for life, but for some unknown reasons they can change and become cancerous. While other tumors can frequently be identified by appearance and location, these cannot. These tumors are devious—they vary in size, shape, color, location and texture. Their size and shape can even change on a daily basis. It is impossible to predict their course as they can spread  to other areas of the skin and occasionally even internally to the spleen, liver and bone marrow. They can cause internal bleeding, gastric ulcers, allergic reactions, or remain the same and do nothing. It is for these reasons they are called The Great Impostors of the tumor world. Only a biopsy will give a definitive diagnosis and sometimes even a prognosis.  It is estimated that 25% of all dogs will die of some form of cancer,  30%+ of all tumors in dogs are skin tumors, and Mast cell tumors account for approximately 20% of  those skin tumors. Mast cell tumors rarely occur in cats and even less so in humans. Most researchers believe there is a genetic involvement as they are more frequently seen in beagles, Boston terriers, boxers, labs, golden retrievers, bulldogs, and bull mastiffs. But, they can and do occur in other breeds. There is no way to prevent them from   developing, but an early diagnosis by needle biopsy, surgical excision, and complete biopsy is a must. The pathologists can then determine the degree of malignancy and what stage the tumor is at.  Based on this information the veterinarian will have a course of therapy to follow and hopefully slow down any possible re-occurrence or spread. Prednisone and antihistamines have been used in the past, but now there is a new chemotherapy drug known as Palladia, that is very promising. Any suspicious skin lesion should be examined by your veterinarian immediately to determine what should be done, if anything. For additional articles, go to my website at http://www.locustvalleyvet.com




This is the medical term used for a form of dermatitis in which the outer layer of the skin (epidermis) and the oil secreting glands known as sebaceous glands, and part of the hair follicles are over productive. The result is excessive very dry flaky skin (dandruff), or the reverse, a greasy smelly skin caused by the excessive production of a fatty lubricating substance known as sebum. These two forms of the disease are known as: Seborrhea oleosa (greasy) and Seborrhea sicca (dry). They occur more frequently in Westies, Cockers, Springers, Bassets, Dachshunds, Dobermans, German Shepherds and Labradors, but can occur in any breed. When either form occurs in very young dogs under 18 months of age, it is considered to be a Primary seborrhea, an inherited trait. Occasionally, both forms occur in the same dog. When either the sicca or oleosa form occurs later in life, it is considered Secondary to other dermatological disorders. Some of these other diseases can be mange, mites, flea allergy, food allergy, hypothyroidism, and even deficiencies in the diet. Many times a smelly greasy discharge from the ears also show up. Usually an experienced veterinarian can differentiate the causes, but sometimes various tests must be utilized such as blood tests, skin scrapings, skin cultures and even skin biopsies. Both the sicca and oleosa forms are upsetting to the dog owner and are very uncomfortable for the dog. Sometimes intense scratching ensues which often lead to the secondary skin infections and ear infections. These infections are usually caused either by the bacterium known as Staphylococci or a yeast known as Malassezia. The infections are curable but unfortunately the Seborrhea is not. It becomes a chronic treatable condition. Just as in people with dandruff, frequent bathing with the proper shampoo is a must. Skin infections and ear infections are treated with the appropriate antibiotics and scratching must be controlled to prevent secondary infections and self inflicted wounds. Human shampoos must not be used as often the pH or level of acidity is incorrect, which will make the condition worse. Catch it early and seek your veterinarians help.


2013年9月21日星期六

September | 2008 | Breastfeeding Insights in the Philippines

Archive for September, 2008



Lethal bacteria also found in tainted milk





Pathogen in some Sanlu formulas can cause meningitis or gut infections


Reuters, Associated Press


In another blow to China’s food safety record, the Gansu authorities revealed that a pathogenic bacteria has been found in Sanlu’s milk powder that was also contaminated with melamine, the Lanzhou Morning Post reported.


This latest revelation came as China said yesterday that the melamine-tainted milk scandal had been brought under control and recently tested liquid milk samples showed no traces of the toxic chemical.


The Gansu Bureau of Quality and Technical Supervision in north-western China issued an emergency notice on Sunday saying that Sanlu’s formulas for older babies contained enterobacter sakazakii as well as the toxic chemical melamine, the newspaper said.


The bacteria, enterobacter sakazakii, can cause meningitis or severe gut infections. It is a new species defined in recent years and recognised by the World Health Organisation as one key pathogen that leads to infant mortality.


This is not the first time that the bacteria is found in powdered infant formula. In September 2002, the Hong Kong Food and Environmental Hygiene Department found enterobacter Sakazakii in a German infant formula Special Batch Milupa HN25.


It is not yet known when, and how the bacteria entered the Sanlu formula, the Lanzhou Morning Post said.


The Gansu authorities have sent the test results to the national-level food quality and safety inspection centre for further action.


Besides affecting premature babies, the bacteria is also harmful to people of all ages, particularly those with weakened immune systems.


So far, there have been no reports of sickness or deaths triggered by enterobacter sakazakii infection involving Sanlu’s products, according to the Post.


In a bid to assure the world that Chinese products are safe, China’s national quality watchdog chief inspection official Xiang Yuzhang told reporters in Beijing: ” There is no problem.”


” It has been brought under control, more or less. There are no more problems in the market. As far as I know, there will be no more bad news.”


China’s quality control agency said on it’s website ( http://www.aqsiq.gov.cn ) that 235 samples of carton milk and drinking yogurts produced since last Sunday and sold across the country had shown no signs of melamine.


Chinese Premier Wen Jiabao told an audience in New York that China would strive to bring its food safety standards up to international levels, describing as a painful lesson the more than 50,000 children sick from drinking chemical-laced milk, which also left four dead.


Speaking to China, where United States and European officials were attending seminars on product safety, Ms Nancy Nord, acting head of the US Consumer Products Safety Commission, said: ” The melamine situation just underscores the message that we are trying to deliver, and that is you have to know what’s coming into your factory and what’s going out of your factory.”


Yesterday, Mr Li Weiyi, a spokesman for the Cabinet-level Taiwan Affairs Officers, issued a public apology to consumers in Taiwan as the authorities there ordered China-made milk products and vegetables-based proteins off store shelves.


Taiwanese officials say at least seven Taiwanese companies have imported contaminated proteins from China. They say the proteins are made from corn or other vegetables but may be mixed with tainted milk products to improve their favour.


Global consumer goods giant Unilever also said it had removed its Lipton green milk tea product from store shelves in Taiwan as it might have used tainted milk from Chinese companies.


Taiwanese President Ma Ying-jeou yesterday called for the creation of a food safety hot-line with China.


Further away, British supermarket chain Tesco removed White Rabbit Creamy Candies from its shelves after tests elsewhere found traces of melamine in the Chinese-made sweets.


From Ivory Coast in West Africa to Tanzania in the east, governments have also joined the list of countries blocking Chinese milk imports over concerns that they could be contaminated.


Sanlu Group, the Hebei-based dairy at the centre of the scandal, will not recover from the damage it has suffered, its New Zealand partner said yesterday.


The Chinese government has now taken control of Sanlu –43 per cent owned by New Zealand’s Fonterra Cooperative –and shut down its operations, Fonterra Chief Executive Andrew Ferrier said at a briefing.


According to the Cabinet probe, Sanlu had received complaints about its infant formula as early as December last year. It discovered melamine in its milk powder in June but did not alert the government officials until Aug 2.


Nitrogen-rich melamine has been added to substandard or watered-down milk to fool quality checks, which often use nitrogen levels to measure the amount of protein in milk.


Reuters, Associated Press




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WHO–Melamine and Cyanuric acid: Toxicity, Preliminary Risk Assessment and Guidance on Levels in Food for everyone




Last reviewed/updated
25 September 2008

Melamine-contamination event, China, September 2008

Melamine and Cyanuric acid: Toxicity, Preliminary Risk Assessment and Guidance on Levels in Food



http://www.who.int/foodsafety/fs_management/Melamine.pdf



25 September 2008



Description of the event


Nearly 40 000 cases of kidney stones in infants with three deaths (and one unconfirmed) related to the consumption of melamine-contaminated powdered infant formula have been reported from across China as of 21 September 2008. Almost 12 900 are currently hospitalized. Kidney stones in infants are very rare.


While the exact onset date of illness resulting from contamination and the beginning of the contamination itself remain unknown, a manufacturer (Sanlu) received a complaint of illness in March 2008.


Chinese media reported at the beginning of September that Sanlu brand infant formula produced by Hebei-based Sanlu Group was contaminated with melamine. Sanlu’s powdered infant formula is widely consumed by infants across China because the product is relatively affordable compared to others.


Following inspections conducted by China’s national inspection agency, at least 22 dairy manufacturers across the country were found to have melamine in some of their products.


Two companies, Guangdong Yashili and Qingdao Suokang, exported their products to Bangladesh, Burundi, Myanmar, Gabon and Yemen. While contamination in those exported products remains unconfirmed, a recall has been ordered from China.


Other countries, however, have also reported finding melamine in dairy products manufactured in China.


So far, contamination has also been found in liquid milk, frozen yogurt dessert and in coffee drink. All these products were most probably manufactured using ingredients made from melamine contaminated milk.


In 2007, melamine was found in pet feed manufactured in China and exported to the United States of America, and caused the death of a large number of dogs and cats due to kidney failure.



Melamine contamination




Presentation of melamine


Melamine is a chemical compound that has a number of industrial uses, including the production of laminates, glues, dinnerware, adhesives, molding compounds, coatings and flame retardants. Melamine is a name used both for the chemical and for the plastic made from it. In this event, all references are to the chemical. There are no approved direct food uses for melamine, nor are there any recommendations in the Codex Alimentarius. Melamine is illegally added to inflate the apparent protein content of food products. Because it is high in nitrogen, the addition of melamine to a food artificially increases the apparent protein content as measured with standard tests.



Source of the contamination


In this event, contamination appears to have happened as fraudulent contamination in primary production. Chinese government officials have pinpointed milk collecting stations as the sites where the melamine was added. According to Sanlu, contaminated milk was used in the manufacture of powdered infant formula processed before 6 August 2008 and the tainted milk powder has also been used in the manufacture of a number of other products.



Contamination levels


There are a total of 175 infant formula manufacturers across China, of which 66 have halted production and the remaining 109 manufacturers have undergone inspection due to the current events of melamine contamination. The inspections’ results presented by the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) show evidence of the presence of melamine. Out of 491 batches tested, 69 of them, produced by 22 companies, tested positive for Melamine.


According to the State Council of China, the levels found in the batches ranged between 0.09 mg/kg and 619 mg/kg. Batches from the company Shijiangzhuang Sanlu Co. contained the highest levels, up to 2563 mg/kg.



Toxicology of melamine


Based on the previous incidents of melamine contaminated pet food and the development of kidney stones and subsequent acute kidney failure in cats and dogs, it appears that melamine and its structural analogues, such as cyanuric acid, may act together to form crystals. This crystal formation occurs at very high-dose levels and is a threshold and concentration dependent phenomenon, which would not be relevant at low levels of exposure (US FDA/CFSAN Interim Melamine and Analogues safety/risk assessment http://www.cfsan.fda.gov/~dms/melamra.html).




Exposure


Consumer exposure to melamine is considered to be low, but may occur through the extraction of melamine from compression moulds by acidic foods, such as lemon or orange juice or curdled milk, at high temperature. Taking into account these sources the estimated oral uptake of melamine is around 0.007 mg melamine/kg/day (OECD 1998).



Toxicity of melamine


Melamine is not metabolized and is rapidly eliminated in the urine. No human data could be found on the oral toxicity of melamine but there are data from animal studies. These show the compound to have a low acute toxicity, with an oral LD50 in the rat of 3161 mg/kg body weight. In animal feeding studies, high doses of melamine have an effect on the urinary bladder, in particular causing inflammation, the formation of bladder stones and crystals in the urine. Analysis of the bladder stones has shown that these are a mixture of melamine, protein, uric acid and phosphate. Animal studies have generally not shown any renal toxicity or the formation of kidney stones.



Carcinogenicity


The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence in experimental animals for the carcinogenicity of melamine under conditions in which it produces bladder stones. There is inadequate evidence for carcinogenicity in humans.



Role of melamine in the formation of kidney stones


Animal data have not shown that melamine alone causes renal failure or the formation of kidney stones. Evidence from an earlier outbreak of acute renal failure in cats and dogs associated with contaminated pet food suggests that a combination of melamine and cyanuric acid does cause renal toxicity. Both of these compounds were found in the pet food together with other triazine compounds. Subsequent experimental studies in animals have shown that when they are fed a mixture of melamine and cyanuric acid this causes the formation of crystals in the tubules of the kidneys, eventually blocking them and causing renal damage and renal failure. The source of the cyanuric acid in the pet food was unknown but it may have been present as a contaminant of the melamine that had been illegally added to wheat gluten used in formulating the petfood. In the current event in China, the presence of cyanuric acid has not yet been confirmed.



Health-based Guidance Values


Following the petfood incident in 2007 described above, several authorities have preformed preliminary risk assessments.


The US FDA has published an interim safety/risk assessment on melamine and structural analogues and has established for melamine a tolerable daily intake TDI of 0.63 mg per kg of body weight per day.


The European Food Safety Authority has published a provisional statement and recommended to apply a TDI of 0.5 mg per kg of body weight per day as tolerable intake value for melamine.



Epidemiology and treatment




Suggested surveillance case definition


Identification of possible cases related to the consumption of melamine-contaminated products from China


Member States should be aware of the possible distribution of the contaminated products either through formal or informal channels, because of the large quantities involved and the seriousness of the public health consequences of this event. The period of production of contaminated product is uncertain and the incriminated raw material and products may have been exported as infant formula or other milk containing products to other Member States. Therefore WHO is suggesting this surveillance case definition to Member States to increase their awareness of signs that their population may be affected.




Clinical description


The following symptoms have been observed in infants affected by the melamine-contaminated infant formula in China:





  • Unexplained crying in infants, especially when urinating, possible vomiting



  • Macroscopic or microscopic haematuria



  • Acute obstructive renal failure: oliguria or anuria



  • Stones discharged while passing urine. For example, a baby boy with urethral obstruction with stones normally has dysuria



  • High blood pressure, edema, painful when knocked on kidney area



WHO experts believe an additional symptom may be unexplained fever arising from urinary tract infections/bacteraemia secondary to urine stasis resulting from obstruction.




Surveillance case definition


A case is defined as an infant with kidney stones or other kidney problems (e.g. anuria, renal failure) having consumed powdered infant formula produced in China before 6 August 2008, and where other potential causes of kidney stones have been excluded by differential diagnosis.




Treatment


The World Health Organization has agreed to circulate the information contained herein regarding the treatment plan that is being implemented in China by the Ministry of Health. The information below does not reflect the rules, regulations, policies and guidelines of the World Health Organization.



The following regimen has been issued by the Ministry of Health, China.




Clinical manifestations





  • Unexplained crying, especially when urinating, possible vomiting



  • Macroscopic or microscopic haematuria



  • Acute obstructive renal failure: oliguria or anuria



  • Stones discharged while passing urine. For example, a baby boy with urethral obstruction with stones normally has dysuria



  • High blood pressure, edema, painful when knocked on kidney area




Key diagnostic criteria





  • Been fed with melamine-contaminated infant milk formula



  • Having one or more of the above clinical manifestations



  • Laboratory test results: routine urine tests with macroscopic or microscopic haematuria; blood biochemistry; liver and kidney function tests; urine calcium/creatinine ratio (usually normal); urinary red blood cell morphology shows normal morphology of red blood cells (not glomerular haematuria); parathyroid hormone test (usually normal).



  • Imaging examination: preferably ultrasound B exam of urinary system. If necessary, abdominal CT scan and intravenous urography (not to be used in case of anuria or renal failure). Kidney radionuclide scans can be used where available to evaluate renal function.



  • Ultrasound examination features:




    • General features: bilateral renal enlargement; increased echo on solid tissue; normal parenchyma thickness; slight pyelectasia and calicectasis; blunt renal calyx. If the obstruction locates in the ureter, then the ureter above the obstruction point dilates. Some cases have edema with perinephric fat and soft tissue around the ureter. As the disease develops, the renal pelvis and ureter wall may have secondary edema. A few cases have ascites.




    • Stone features: most stones affect the collecting system and ureters on both sides. Ureteral stones are mostly at pelviureteral junction, the part where the ureter passes across iliac artery, and ureter-bladder junction. Stones stay collectively, covering massive areas. Lighter echo in the background. Most stones are different from the calcium oxalate stones. Urinary tract is mostly completely obstructed by the stones.






Differential diagnosis





  • Haematuria differentiation: need to rule out glomerular haematuria.



  • Stone differentiation: the stones are normally radiolucent and have a negative image on urinary tract x-ray. This feature differentiates the stones from those of radiopaque stones of calcium oxalate and calcium phosphate.



  • Differentiation of acute renal failure: need to rule out pre-renal and renal failure.




Clinical treatment





  • Immediately stop using melamine-contaminated infant formula milk powder.



  • Medical treatment: use infusion and urine alkalinization to dispel the stones. Correct the water, electrolyte and acid-base imbalance. Closely monitor routine urine tests, blood biochemistry, renal functions, ultrasound findings (with particular attention to the renal pelvis, ureter expansion, and the change of the stones in shape and location). If the stones are loose and sand-like, they are very likely to be passed out with urine.



  • Treatment of complicated acute renal failure: priority should be given to the treatment of life-threatening complications such as hyperkalemia. Measures include the administration of sodium bicarbonate and insulin. If possible, blood dialysis and peritoneal dialysis can be used early. Surgical measures can be taken to remove the obstruction if necessary.



  • Surgical treatment: if medical treatment is not effective, and hydrocele and kidney damage present, or blood dialysis and peritoneal dialysis are not available in case of renal failure, surgical methods can be considered to remove the obstruction. Stones can be removed by different methods including cystoscope retrograde intubation into the ureter, percutaneous kidney drainage, surgical removal and percutaneous kidney stone removal. Extracorporeal shock wave lithotripter (ESWL) is greatly limited in its application, because the stones are loose and mainly composed of urate, and the patients are infants.




Follow-up


Once the urinary obstruction is relieved, and the general condition and renal function and urination are back to normal, the children can be discharged.



Key issues to follow-up


Urine routine tests; ultrasound of urinary system; renal function tests; IVP (intravenous pyelogram) if necessary.



Actions taken by INFOSAN


INFOSAN is working directly with Ministry of Health (MoH), China in collaboration with the WHO Country Office in China. Through the INFOSAN Emergency surveillance system, WHO has learned of the contamination of infant formula with melamine and requested further information about the event on the 11 September 2008. MoH confirmed on 12 September 2008 that incriminated products from the Sanlu Company had not been exported and provided WHO with a description of the development of the event. Through further interaction between INFOSAN and MoH the issue of potential other use of the contaminated milk powder as well as parallel (illegal) distribution of contaminated milk powder was raised. An INFOSAN alert was subsequently distributed to the entire network on the 16 September 2008 alerting members of the event and of the possibility of contaminated products finding their way to other markets.


INFOSAN has several times during the past week, kept the entire network informed of developments in relation to this event as well as additional information on other products being found contaminated, information about the toxicity of the melamine and other information to help Member States better understand and assess the potential risks associated with melamine contaminated products.


The Chinese authorities, in their on-going investigation, discovered that 2 producers found to have products contaminated with melamine had exports going to five countries, INFOSAN informed these five countries of the situation.



http://www.who.int/foodsafety/fs_management/infosan_events/en/print.html



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