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Current Issue: Issue 39 December 2018
Spontaneous primary hypothyroidism in 7 adult cats
Peterson ME, Carothers MA, Gamble DA, Rishniw M
Journal of Veterinary Internal Medicine, 2018;32:1864–1873.
Veterinary Clinical Digest Summary
Primary hypothyroidism is common in dogs but rare in cats. This prospective case series looked at the signalment, clinical signs, clinical pathology and imaging results associated with this condition, and evaluated response to treatment. Seven cats with suspected hypothyroidism were included in the study. No breed predisposition was seen but six of the cats were male. The age range of the pa-tients was 3.5 to 11 years. Only two of the cats were initially tested for hypothyroidism because of consistent presenting signs such as coat changes, lethargy and obesity. The other cases were identi-fied by routine screening for hyperthyroidism, or to investigate the possibility of hyperthyroidism because of palpable thyroid nodules. All cats had high thyroid stimulating hormone (TSH) levels and six had low thyroxine (T4) and free T4 levels. Four cats were azotaemic. Bilateral thyroid goi-tre was noted by thyroid scintigraphy in 6 out of 7 cats. Levothyroxine improved thyroid parame-ters, normalised creatinine in the azotaemic cats and reduced goitre size.
Hypothyroidism may be more common in adult cats than previously recognised. Most cases will have a goitre. Levothyroxine is a successful treatment.
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Prevalence of naturally occurring non‐AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes
McClosky ME, Cimino Brown D, Weinstein NM, et al.
Journal of Veterinary Internal Medicine, 2018;32:1934–1942.
Veterinary Clinical Digest Summary
Using blood-typing kits to ascertain the AB blood-type group of donor and recipient cats can re-duce the risk of transfusion reactions. However, the AB group is not the only factor in blood type incompatibilities. The Mik antigen has been recognised and anti-Mik antibodies have been implicat-ed in haemolytic transfusion reactions. This retrospective study aimed to assess the prevalance of non-AB blood type incompatibilities in cats and to ascertain the effect of crossmatching when per-forming transfusions. Three hundred cats that received a blood transfusion with or without a major crossmatch were included in the study. In 15% of cats which had not previously been transfused, a major cross match revealed incompatibilities, while in cats that had received a previous transfusion, 27% showed major crossmatch incompatibilities. Elevation in body temperature was noted more often in cats that received non-crossmatched blood. However, 76% of cats that received packed red cell transfusions survived to be disharged from hospital, and whether or not a crossmatch had been performed was not associated with survival. Despite this the authors conclude that the high preva-lence of non-AB incompatibilities justifies a routine recommendation to perform a cross match prior to transfusion.
It is advisable to perform a crossmatch prior to transfusing red blood cells in cats.
Effect of implementation of a surgical safety checklist on perioperative and postoperative com-plications at an academic institution in North America
Cray MT, Selmic LE, McConnell BM, et al.
Veterinary Surgery, 2018;47:1052–1065.
Veterinary Clinical Digest Summary
Surgical safety checklists (SSC) have been shown to greatly reduce complications and adverse events in human medicine, by documenting that vital procedures have been performed at the correct timing. This study aimed to ascertain whether a SSC in veterinary medicine was also beneficia. In a before and after intervention study design 633 dogs and 44 dogs undergoing consecutive surgeries were recruited into the study. In the before phase, 267 surgeries were performed without a check-list, followed by another 75 surgeries without a checklist, but with a trained observer present in the operating theatre, assessing for complications. In the after phase, 58 surgeries were performed with checklist and trained observer, followed by 277 cases with a checklist and no observer. When the observer was present, complications were recorded prospectively, but when the observer was not present, complications were recorded from client phone calls and veterinary records. Perioperative and postoperative complication rates were lower when a SSC was used than when it was not. ASA score, presence of an observer and anaesthetic time were all also associated with complication rates.
A surgical safety checklist can reduce surgical complications in veterinary practice.
Outcome and prognostic factors in medically treated canine prostatic carcinomas: A multi‐institutional study
Ravicini S, Baines SJ, Taylor A, Amores‐Fuster I, Mason SL, Treggiari E
Veterinary and Comparative Oncology, 2018;16:450–458.
Veterinary Clinical Digest Summary
Canine prostatic carcinomas are associated with a poor prognosis because of difficulties with surgi-cal treatment and a perceived poor response to chemotherapy. This study aimed to assess outcomes of prostatic carcinomas treated with chemotherapy and/or non-steroidal anti-inflammatory drugs (NSAIDs). 67 dogs with confirmed prostatic carcinoma without bladder involvement were included in the trial. Presenting signs were mainly urinary and gastroinestinal. 33% of cases were found to have a positive urinary bacterial culture. 26 dogs had metastases at the time of diagnosis, mainly to lymph nodes and lungs. 32 cases were treated with chemotherapy and NSAIDs, 31 cases with NSAIDs alone and 4 with chemotherapy alone. Chemotherapy protocols included the use of car-boplatin, mitoxantrone, epirubicin, vinblastine, or cyclophosphamide/chlorambucil as metronomic therapy, or toceranib phosphate as a TKI. Dogs that received NSAID and chemotherapy had a sig-nificantly longer median survival time of 106 days compared to those receiving NSAIDs alone at 51 days. Time to progression was also longer in those cases treated with chemotherapy and NSAIDs. Presence of metastasis and being entire were negative prognostic factors.
The combination of chemotherapy and NSAIDs appears to offer the best outcome with canine pros-tatic disease.
Survival times in dogs with presumptive intracranial gliomas treated with oral lomustine: A com-parative retrospective study (2008‐2017)
Moirano SJ, Dewey CW, Wright KZ, Cohen PW
Veterinary and Comparative Oncology, 2018;16: 459-466.
Veterinary Clinical Digest Summary
Intracranial gliomas are one of the most common types of brain tumours in dogs, and unfortunately the prognosis is considered poor due to local invasiveness and poor response to treatment. This ret-rospective study aimed to assess the survival times of dogs with intracranial gliomas treated with lomustine. 40 dogs with presumed intracranial gliomas were included in the study. Dogs treated with lomustine had a longer median survival time of 138 days, compared to those treated sympto-matically at 35 days. Longer duration of clinical signs was also associated with a longer survival time. Neutropenia, anaemia, thrombocytopenia and raised BUN/creatinine and ALT were all com-mon findings in dogs treated with lomustine. However, side effects were rarely life-threatening and usually did not necessitate cessation of treatment.
Lomustine appears to improve survival times in dogs with intracranial gliomas.
Lung lobe torsion in dogs: 52 cases (2005–2017)
Park KM, Grimes JA, Wallace ML, et al.
Veterinary Surgery, 2018;47:1002–1008.
Veterinary Clinical Digest Summary
Lung lobe torsion occurs when a lung lobe rotates along its long axis causing constriction of the bronchus and vessels. This retrospective study of 50 dogs with lung lobe torsion that were managed surgically aimed to describe the outcomes and prognostic factors associated with the condition. 92% of dogs survived to discharge. Torsion of the right cranial or middle lung lobes was associated with a poorer prognosis than the left cranial lung lobe. Four dogs had more than one episode of lung torsion. The median survival time after discharge was 1369 days.
Surgery for lung lobe torsion gives a high survival rate and excellent long term outcome.
Characterization, distribution, antimicrobial resistance and resistance risk factors in staphylococci isolated from cats from 2001 to 2014
Lane MJ, Roy AF, Kearney MT, Pucheu‐Haston CM
Veterinary Medicine and Science, 2018;4: 315-325.
Veterinary Clinical Digest Summary
Information on antimicrobial resistance patterns is vital in order to guide policies aiming to reduce the spread of resistant organisms. This retrospective study described the characteristics of antimi-crobial resistance profiles of Staphylocci between 2001 and 2014 in a USA laboratory. 519 Staphy-lococci were isolated. Methicillin resistance was found in 57.1% of Staphylococcus aureus isolates and 20.5% of Staphylococcus intermedius group isolates. 54.5% of Staphylococcus aureus isolates and 23.9% of Staphylococcus intermedius group isolates were resistant to three or more antimicro-bial classes, indicating multidrug resistance (MDR). The prevalence of MDR increased over time. Methicillin resistance increased in the Staphylococcus intermedius group over time.
Multidrug resistance and methicillin resistance is increasing in Staphylococci isolates in cats.
A cross‐sectional study of show English bulldogs in the United States: evaluating paw lesions, cyto-logical findings, pruritic behaviours and gastrointestinal signs
Webb Milum AN, Griffin CE, Blessing KS
Veterinary Dermatology, 2018;29: 395-e130.
Veterinary Clinical Digest Summary
English bulldogs are known to suffer from respiratory, gastrointestinal and ocular conditions that result from their brachycephalic conformation. This cross-sectional study of show English Bulldogs in the USA aimed to evaluate paw lesions in a cohort of animals considered healthy. 34 English Bulldogs participating in a dog show were included in the study. The dogs were examined and cy-tological samples were collected from the feet. The dogs were also assessed for gastrointestinal signs and pruritus, and the owners completed questionnaires about medical history and pruritus. No dog was considered healthy. All dogs had at least one erythematous paw, all had an abnormal der-matological examination, and 22 of the dogs had recently had drugs administered.
English Bulldogs frequently have pedal dermatological disease, and many receive medications for this.
Multicentre, blinded, randomised clinical trial comparing the use of flunixin meglumine with fi-rocoxib in horses with small intestinal strangulating obstruction
Ziegler AL, Freeman CK, Fogle CA, Burke MJ, Davis JL, Cook VL, Southwood LL, Blikslager AT
Equine Veterinary Journal, 2018; ePub, ahead of print.
Veterinary Clinical Digest Summary
In this blinded, randomised study Amanda Lee Ziegler and colleagues in the USA aimed to deter-mine whether the COX‐2 selective non-steroidal anti-inflammatory drug (NSAID) firocoxib would reduce the signs of endotoxaemia to a greater extent compared to the nonselective COX inhibitor flunixin meglumine in horses with small intestinal strangulating obstructions (SISO).
Fifty-six horses ≥1 year of age that underwent surgical correction of a SISO were randomly allocat-ed to be treated with either flunixin meglumine (1.1 mg/kg IV q12h) or firocoxib (0.3 mg/kg IV loading dose then 0.1 mg/kg IV q24h). Pre- and 12‐, 24‐ and 48‐hour post‐operative plasma sam-ples were assessed for markers of endotoxaemia including tumour necrosis factor alpha (TNF-α), prostaglandin E2 (PGE2) and soluble CD14. COX‐2 selectivity was confirmed by the relative lack of inhibition of the COX‐1 prostanoid thromboxane B2 (TXB2). Pain scores were assigned by per-sonnel blinded to NSAID allocation using a standardised system every 12 hours in the first 3 days post‐operatively, and then every 24 hours for the following 3 days.
There was no significant difference in pain scores, the use of additional analgesia, the incidence of clinical signs attributable to systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), or survival to discharge between groups. There were no significant differences in TNFα and mean sCD14 levels between the two groups at any point; however, at 48 h post‐operatively, 26.9% of horses treated with flunixin meglumine had sCD14 levels exceeding the upper limit of the reference range as compared with 8.33% of horses treated with firocoxib.
Bottom line: Use of firocoxib following surgery for SISO results in similar levels of pain control as compared with horses treated with flunixin meglumine, but firocoxib horses have reduced evidence of endotoxaemia at 48 h post‐operatively as detected by measuring sCD14.
Evaluation of dynamic testing for pituitary pars intermedia dysfunction diagnosis in donkeys
Mejia‐Pereira S, Perez‐Ecija A, Buchanan BR, Toribio RE, Mendoza FJ
Equine Veterinary Journal, 2018; ePub, ahead of print.
Veterinary Clinical Digest Summary
This prospective study by S. Mejia‐Pereira and colleagues in Spain and the USA aimed to evaluate dynamic testing for PPID in donkeys.
Six donkeys with clinical signs consistent with PPID and a basal adrenocorticotropic hormone (ACTH) concentration >50 pg/mL were included in the study. A dexamethasone suppression test (DST), thyrotropin‐releasing hormone (TRH) stimulation test and combined DST-TRH challenge were performed in all animals during the summer months with a 1‐week washout period between tests.
The TRH stimulation test identified all six donkeys as having PPID, whereas the DST and the DST-TRH identified 3/6 and 4/6 donkeys, respectively. Agreement between the DST and the DST-TRH tests was poor.
Bottom line: The TRH stimulation test is recommended as a dynamic test for the diagnosis of PPID in donkeys.
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