Vets on the Balkans - an online journal for veterinarians from the Balkans

Persistent right aortic arch

July 18, 2019

Tsvetan Ivanov, Dimitar Ivanov, Vladi Kirilov – veterinary clinics “Dobro hrumvane!”- Sofia, Bulgaria

Introduction:

The persistent right aortic arch (PRAA) is vascular ring which is formed by the aortic arch on the right side, with ligamentum arteriosum dorsolaterally, and pulmonary artery on the left and ventrally. This ring compresses the esophagus and trachea, which leads to swallowing difficulty. This malformation is with genetic prevalence and represents error in embryogenesis of the dog. In 95% of the cases of this vascular ring anomaly, a constricting band prevents solid foods from passing to the stomach which prevents the puppy from thriving well. In the remaining 5% of cases, a bizarre anomaly of the vessels is present (double aortic arch and aberrant subclavian artery), which may be difficult to correct and may not have a good prognosis.

Signs of this condition usually become apparent shortly after weaning, when a puppy begins eating semi-solid or solid food. While milk will slide down nicely, bulky foods will “jam up” in the esophagus, leading to a stretched structure and the inability to get food down, hence the symptom known as regurgitation. Regurgitation involves the puppy producing undigested food and mucus through the mouth with no effort; the pup tilts its head down and the food and mucus simply roll out. By contrast, vomiting is an active process, meaning there are abdominal contractions (heaving) and a retching noise when food and mucus are expelled out the mouth.

Often complication of the regurgitation is aspiration pneumonia (AP), which leads to poor prognosis for the patient.

The standart therapy is surgical and is with good prognosis if there is no signs of AP. Before the surgery CBC and blood chemistry is required – WBC is important to rule out infection and the level of blood sugar should be in the reference values. The surgery can be open thoracotomy or thoracoscopy – the goal is to ligate and resect the fibrous annulus.

Patient report

The patient is 2 months old german shepherd dog with history of vomiting after eating, according to the owners, but there is no problems with water drinking. The dog have diarrhea but is in good overall condition. When the dog sleeps there is strange noises from his neck and there is visible peristaltic waves in the level of 1-st rib.

We perform CPV/CCV/Giardia and the result was negative. The CBC and blood chemistry shows no difference from the reference values.

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Then we made x-ray of the chest: pic 2

Because of the typical sign of the chest, we performed and BaSO4 examination, and this was the result:pic 3

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So our diagnosis is PRAA with no signs of AP. We performed surgery on the next day – it was open thoracotomy with ligation of the annulus.

Differentiation of the fibrous ring:

It’s was administrated antibiotics, pain killers, sedatives and assisted feeding. We didn’t use thoracic tube after the surgery.

On the fourth day after the surgery, the dog was discharged. Three months after the surgery the owners still make assisted feeding, but the dog is not vomiting and is in good condition.

Degenerative Mucinotic Mural Folliculitis in cat – first case in Bulgaria

July 14, 2019

Dr. Ivelina Vacheva, DVM

Central Vet Clinic, Sofia, Bulgaria

ESVD member, BAVD bord member

E-mail: ivchopifcho@yahoo.co.uk

Introduction

Degenerative Mucinotic Mural Folliculitis (DMMF) is a rare, poorly understood syndrome in cats, defined as an inflammatory reaction pattern. It is characterized by inflammation of the hair follicle, atrophy degeneration and mucin production. The inflammatory reaction, takes place on the follicle wall, primarily affecting the external sheath of the hair above the follicular isthmus. However it can also affect the infundibulum or the bulbar portion of the hair follicle.
Literature (incl. case studies) regarding feline DMMF is sparse. It can be briefly summarized as follows: All described cases are in middle aged to older cats, the majority of which are male, with no information on breed predisposition. The most characteristic features are: Alopecia of the face, head and neck and in a later stage affecting the body and limbs. Pruritus, if present, is mild to very intense. The diagnosis is confirmed by biopsy and subsequent histopathological examination.

Case Study

Mila is an approximately 1,4 years old spayed female cat. She used to be a stray cat, until a lady, regularly

1_1 Mila before the onset of her skin problem

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1_2 Mila before the onset of her skin problem

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feeding her, noted dramatic changes to the cat’s fur. The lady temporarily adopted the cat and took her to several veterinarians. The lady provided shelter to about 20 other cats. According to the owner all cats were treated monthly with Broadline (Merial).
Picture 1.1, 1.2 Mila before the onset of her skin problem

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2_2 hypotrichosis of the distal parts of the limbs

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First signs were: hypotrichosis of the face (pic. 2.1) and subsequent minor hypotrichosis of the distal parts of the limbs (pic. 2.2)
The cat’s skin condition gradually worsened. She showed progressive hypotrichosis, and alopecia, with severe pruritus. She was seen by a veterinarian and treated with Synulox (Zoetis) orally for 20 days, which reduced the inflammatory signs. Later she was seen by another veterinarian and underwent the following treatments (in a period of 3-4 months):
Pulse therapy (7 days of medication, 7 day break etc.) with oral itraconazole 5mg/kg q24h. Without good response.
Purina Pro Plan veterinary diets HA Hypoallergenic, for two months.
Ivermectin 0.3mg/kg q24h orally for 10 days.
According to the owner, the cat’s skin condition worsened. Described signs included: Pruritus, hypotrichosis, alopecia, skin hyperpigmentation and presence of scales and crusts.
The cat was admitted to our hospital for a second opinion. As as side note: Once admitted to our clinic, the lady signed the cat over to a local charity Redom.
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The cat presented with the following signs:

Symmetrical alopecia of the face and head. The skin had a thickened and swollen appearance.
Severe pruritus (9/10 – 10/10)
Hypotrichosis and alopecia of the entire body.
Hyperpigmentation, scales and crusts covering the dorsum.
Very passive and apathetic.
According to the owner the animal is not feeling well, has an increased water intake and softer stools, with more frequent defecation than usual.

Differential diagnoses (several)
Demodicosis; Notoedrosis
Feline atopic syndrome (allergies)
Feline sebaceous adenitis
Dermatophytosis
Degenerative mucinous mural folliculitis
FIV / FeLV
Thymoma-associated exfoliative dermatitis in cats
Lymphoma

The cat was hospitalized for further diagnostics and treatment was started, while waiting for the results of histopathology.
Results of clincial exam and diagnostic tests:
Skin scrape, hair plaque, tape strip: All negative for Demodex and Notoedres mites.
Tape strip cytology: Epithelial cells, but no neutrophils or Malassezia.
The ears have brown ear wax; Cytology – only epithelial cells, no Malassezia and no Otodectes cynotis.
CBC: WBC HH 58.24×109/L(5-19,5); NEU 25×109/L(2-12,5); LYM 16×109/ L; MONO 7,21 x109/L (0,15-1,7); EOS 8,58×109/L (0,1-0,79); BASO 0,13 x 109/L (0-0,1).
Blood Biochemistry: All parameters within normal range.
TT4= 18 nmol/l (10-80).
Urine: pH 7; PRO 30 mg/dl; GLU, KETO, UBG, BIL and BLOOD negative. No sediment.
Abdominal Ultrasound: Except for slightly enlarged inguinal lymph nodes, the other abdominal organs were unremarkable.
Chest radiographs: Bronchial pattern, possible cause could be lung worms. (Picture 4)
Fecal flotation: Negative
Bearman: Negative
PCR (antigen) Assays: FCoV, FIV, FeLV, Toxoplasma gondii and Giardia ALL negative.
Skin biopsy: Histopathology results below.
Lymph node biopsy: Histopathology results below.

Therapy

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5_1 The cat is licking and biting her legs and tail as well as scratching her neck

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Picture 5 (5.1-5.4): The cat is licking and biting her legs and tail, as well as scratching her neck.

Intravenous fluids: Ringer’s lactate solution 10 ml/h for 5 days. Antibiotics: Ceftriaxone 30 mg/kg IV q12h and Enrofloxacin 5 mg/kg SC q24h for 14days each. Anti-parasitic: Fenbendazole 50 mg/kg PO q24h for 5 days. Antihistamine: Diphenhydramine 1,5 mg/kg SC q24h for 2 weeks. Continuation of Purina Pro Plan veterinary diets HA Hypoallergenic and supplementing this with 4 drops YuMEGA cat (omega-3, -6, -9 fatty acids) once daily. A single application of dexamethasone 0,25 mg/kg SC, resulted in a major reduction of the pruritus!

The CBC was repeated the next day, but did not show significant changes. However the CBC 48h after hospitalization did: WBC HH 44.8×109/L(5-19,5); NEU 19,5 x109/L (2-12,5); LYM 14,12 x109/L; MONO 1,96 x109/L (0,07-1,36); EOS 9,12 x109/L (0,06- 1,93); BASO 0,05 x109/L (0-0,1).
Clinically no evidence of polydipsia!
The charity agreed on taking biopsies (and subsequent histopathology) of the skin, spleen and enlarged lymph node.
Results – Histopathology
Spleen and inguinal lymphnode biopsy
(Dimitra Psalla, DVM, PhD)
Histopathological findings:
Spleen: Multifocally white pulp is composed of atypical round cells with distinct cell borders, scant to moderate amphophilic cytoplasm, round to ovoid nuclei with finely stippled chromatin and one large basophilic nucleolus. There is moderate pleomorphism and mitoses average 1 per HPF. Multifocally red pulp is infiltrated by small numbers of neutrophils.
Inguinal lymphnode: Focal presence of atypical cells similar to those described above. Lymphnode is infiltrated by few neutrophils.
Diagnosis :Spleen and inguinal lymphnode: Infiltration by atypical round cells (accompanied by neutrophilic inflammation)
Comments: The diagnosis of lymphoma cannot be confirmed since the distribution of the atypical cells is limited on the white pulp and the pleomorphism is not high. This population could reflect a hyperplastic conditionas well.

Skin Biopsies – face, lateral body and dorsum
(Dimitra Psalla, DVM, PhD)
Histopathological findings:
There is moderate irregular acanthosis that extends to follicular infundibula and is accompanied by mild spongiosis. Follicular isthmuses are severely infiltrated by the lymphocytes, histiocytes, neutrophils, and few eosinophils and multinucleated giant cells and the inflammatory infiltration is extending to the infundibulum. Parts of the follicular wall are widened due to accumulation of mucin (clear/basophilic spaces). Follicular atrophy is moderate to severe; normal anagen hair follicles are interspersed, particularly in less inflamed lesions. Moderate numbers of lymphocytes, histiocytes, neutrophils, and plasma cells surround hair follicles and infiltrate the superficial dermis. The histopathological features are similar in all the examined samples.
Diagnosis and Comments : The histopathological findings are compatible with the “Degenerative mucinotic mural folliculitis in cats”.

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Picture 6 (6.1-6.3 pictures) Dimitra Psalla, DVM, PhD
Severely infiltrated Follicular isthmuses by the lymphocytes, histiocytes, neutrophils, and few eosinophils and multinucleated giant cells. Inflammatory infiltration is extending to the infundibulum. Accumulation of mucin. Follicular atrophy is moderate to severe. Moderate numbers of lymphocytes, histiocytes, neutrophils, and plasma cells surround hair follicles and infiltrate the superficial dermis.

Therapy continuation following the histopathology results:

The cat was started on oral prednisolone 3 mg/kg q24.Tapering off the prednisolone after 75% of the skin lesions had resolved and switching to cyclosporine, to avoid longer term adverse effects of corticosteroid treatment.

7_1 One week after the start of prednisolone

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Picture 7(7.1-7.3 pictures) – One week after the start of prednisolone.

Supportive therapy included: Once weekly bathing with Clorexyderm ICF shampoo (4% chlorhexidine); Ectoparasite treatment with Stronghold plus (Zoetis) every 4 weeks; Purina Pro Plan veterinary diets HA Hypoallergenic and supplementing this with 4 drops YuMEGA cat once daily.

To stop the cat from reaching her skin and further self-mutilation, caused by the severe pruritus she was experiencing, she was dressed in a suit. She readily excepted the suit and wore it without any problem.

8_1 Two weeks after the start of prednisolone

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Picture 8(8.1-8.3 pictures) – Two weeks after the start of prednisolone.
Fur started regrowing on her head, body and legs.

There was a significant reduction in skin hyperpigmentation, scaling and crusting on the dorsum.
Gradually the pruritus decreased and the cat became more friendly, more active and was no longer apathetic.

After 3 weeks the prednisolone was tapered off gradually to an anti-inflammatory dose. (The oral prednisolone was decreased with 0.5 mg/kg every 5days, reaching 0,5 mg/kg q24h and finally after 5 days set on 0,5 mg/kg q48h).
Once the prednisolone dosage of 0,5 mg/kg q48h was reached, the cat was started on cyclosporine (suspension) 5mg/kg PO q24h simultaneously, for a duration of 10 days. Then the prednisolone was discontinued and the cyclosporine dosage increased to 7 mg/kg PO q24h.

9-1 Four weeks after the start of prednisolone

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Picture 9(9.1-9.5 pics.)Four weeks after the start of prednisolone.
Mila is much livelier and her fur is regrowing. However there are moments she is intensively licking herself, causing new skin lesions.

10_1 Two weeks after start of cyclosporin

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Picture 10(10.1-10.3 pics.)Two weeks after start of cyclosporin.
Mila while on cyclosporine – visibly improved. No more alopecia, no longer itchy and no new skin lesions.

11 Three weeks after start of cyclosporin-1

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11 Three weeks after start of cyclosporin-2

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11 Three weeks after start of cyclosporin-3

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11 Three weeks after start of cyclosporin-4

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Picture 11(11.1-11.6 pics.)Three weeks after start of cyclosporin.
Mila was feeling much better and was discharged after 12 weeks of inpatient care. She was now being cared for in a single-cat foster home. After discharging Mila she was monitored and followed up closely.
Mila was discharged and after two weeks came for her first check-up.

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Picture 12 (12.1-12.4 pics.) Mila 2 weeks after discharging.

The cat progressed steadily, with normal fur regrowth on head, body, legs and tail. The skin of the dorsum was still very scaly.
The following supportive therapy was continued and slightly modified: Weekly washing with Clorexyderm 4% shampoo (ICF) , directly followed by washing with Allermyl (Virbac) shampoo. Topical treatment with Dermoscent Spot-on once weekly was added to the treatment protocol. Feeding Purina Pro Plan veterinary diets HA Hypoallergenic, but no longer supplementing with YuMEGA cat.

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Picture 13(13.1-13.2 pics.) Mila in her foster home. Mila 8 weeks after discharging

The supportive therapy was continued and oral cyclosporine was reduced to 5 mg/kg q48h for another 2 months.
Her skin and coat were looking great and she was no longer itchy. She became active, friendly and very social.

Case Follow- up
Seven months after her last check-up Mila presented with dyspnoe. Diagnostics showed thoracic effusion and severe anemia. Thoracentesis was performed and she had several blood transfusions. However she didn’t improve. Feline Infectious Peritonitis was suspected. Eventually the decision was made to euthanize her.

Acknowledgments

I am particularly grateful for the cooperation with Dr. Rania Farmaki, Dp.ECVD, DVM and Dr. Dimitra Psalla, DVM, PhD. They provided me with invaluable advice and supported me throughout this difficult but interesting case. I would also like to thank the local charity Redom for their excellent care, trust and financial support. Finally, I wish to thank all my colleagues from the Central Veterinary Clinic in Sofia (Bulgaria) for their assistance.

REFERENCES:
Degenerative mucinotic mural folliculitis in cats- Gross TL, Olivry T, Vitale CB, Power HT. Vet Dermatol. 2001;12(5):279-8
Lymphocytic mural folliculitis and pancreatic carcinoma in a cat Remo Lobetti (Journal of Feline Medicine and Surgery 2015, 17 (6): 548-50)
Thymoma associated with exfoliative dermatitis in a cat. Jacqueline Vallim Jacobina Cavalcanti1, Mariana Pereira Moura1 and Fabio Oliveira Monteiro2 (Journal of Feline Medicine and Surgery 2014, Vol. 16(12) 1020– 1023)
First Case of Degenerative Mucinotic Mural Folliculitis in Brazil- Reginaldo Pereira de Sousa Filho, Veronica Machado Rolim, Keytyanne de Oliveira Sampaio, David Driemeier, Marina Gabriela Monteiro Carvalho Mori da Cunha, Fernanda Vieira Amorim da Costa
An anatomical classification of folliculitis-Gross LG, Stannard AA, Yager JA. Veterinary Dermatology. 1997;8147-156.

WSAVA and The Webinar Vet Collaboration Offers Free Access to Virtual Congress 2020

July 1, 2019

The World Small Animal Veterinary Association (WSAVA) and The Webinar Vet have joined forces to offer free access to Virtual Congress 2020 to WSAVA members from countries in which companion animal practice is still developing. Discounted registration will also be offered to all other WSAVA members.

The Webinar Vet’s Virtual Congress is the world’s largest online veterinary congress. The 2020 Congress will take place on February 1 and will include webinars from global experts on a comprehensive range of topics, including companion animal medicine and surgery, dermatology, emergency medicine and veterinary wellness.

WSAVA works to enhance the clinical care and welfare of companion animals globally, representing more than 200,000 veterinarians around the world through its 110 member associations. Its core activities include the creation of Global Guidelines that set standards for veterinary care in key areas of practice, including nutrition, pain management and welfare.

Dr Anthony Chadwick

Set up by British veterinarian Anthony Chadwick BVSC Cert VD MRCVS to make continuous education (CE) easier, more accessible and affordable, The Webinar Vet is the largest online veterinary community in Europe and is rapidly extending into the North and South America, Asia and Africa.

Commenting, Dr Chadwick said: “The Webinar Vet aims to help veterinary healthcare team members to become more confident in their practice and to fit their learning into a busy life in the profession without having to take time out of work or to travel.

“Thanks to all the tickets sold to developed countries over the last five years, our 1-4-1 initiative, under which we donate a ticket to one veterinarian in a developing country for every ticket we sell, has already provided free access to Virtual Congress to more than 5,000 veterinarians from developing countries as part of our mission of making CE accessible to all. We hope that by partnering with the WSAVA we can increase this ten-fold and we are delighted to offer all of its members from developing countries free access to the vast array of learning on offer at the event.”

WSAVA President Dr Shane Ryan said: “Increasing access to veterinary CE is the most effective way to advance the skills and knowledge of veterinarians around the world. Online CE can be an affordable and convenient option for our colleagues in those countries where traditional CE access is limited. We anticipate that many of our members will take up the offer of free or discounted access to Virtual Congress 2020 and so take advantage of the great learning on offer.”

Record-breaking VET Festival Champions Wellness

June 17, 2019

Notching up record delegate and exhibitor numbers for 2019, this year’s VET Festival, received an overwhelmingly positive response from delegates for the calibre of speakers and entertainment. The event took place at Loseley Park, Guildford on 7-8 June.

With wellness a strong focus for VET Festival, the Wellness lecture tent was packed for Lara Heimann, an American who has achieved global recognition for her unique vinyasa yoga style and regularly leads international retreats and workshops. Many delegates took their wellness into their own hands by visiting the Wellness Hub for a massage and yoga session while the Family Hub was busy throughout the two days.

Continuing the wellness theme but also embracing eco concerns, event sponsor MWI Animal Health offered delegates the opportunity to use their own energy by cycling on an exercise bike to create a fruit smoothie. On the Friday night, delegates, many in 80s costumes, partied into the night with live music from MadHen.

Clinical speakers received with particular enthusiasm included Dr Ronaldo da Costa, Professor of Neurology and Neurosurgery at Ohio State University, USA, and Laurie Edge Hughes, a veterinary physiotherapist from Canada.

Professor Noel Fitzpatrick said: “It is a real joy to see the VET Festival growing and growing, not just in physical size, but from the immense goodwill that radiates from it. The weather didn’t get in the way of the wellness and there was nothing rainy about the atmosphere at VET Festival – in fact I think that the rain brought us closer together.

“I set out to build a community of compassion for our profession and I genuinely felt that there was a tangible sense of togetherness. There were loads of great conversations with each other and with the exhibitors. The educational content really was world class and the tents were packed. I hoped that VET Festival would be a breath of fresh air, where having an education event outdoors – combined with a focus on wellness of body and mind for all of us – could help vet professionals to be the very best that they could be – and so serve our patients better.

“Everyone there was part of something innovative and refreshing I felt – the delegates, the exhibitors, the team who have worked year-round to create the event, and the fantastic speakers. I’m very grateful to all of them and I sincerely hope that this feeling remains strong for each and every one all year round. The resonant theme this year was ‘kindness’ – to ourselves, to each other, to the families of animals and the animals we are lucky enough to take care of. Nobody is a nobody at VET Festival, and never will be. In that field, we’re all equal, no matter what we do in the vet profession – we all matter – we all want the same thing, which is wellness for each other and the animals we serve – and importantly, we’re all in it together for the greater good, rain or shine.”

Nicole Cooper, Managing Director, Events Division, Fitz All Media, said: “We are all delighted by the support of the industry and welcomed over 1,900 delegates, a 12% increase and 60 exhibitors – a 28% increase on 2018. VET Festival continues to grow because its unique format, half top-flight congress, half festival, offers a laid back and fun environment in which delegates can learn, catch up with friends and have fun. We’re delighted with the response to this year’s event and are already planning to make next year’s event even better.”

Dermoid in eye of a dog

June 16, 2019

Dr Ivaylo Antonov

Varna,Bulgaria

This is the story of Josi. She is a female Pomeranian dog. She has a long history of epiphora, blepharospasm and ocular discomfort.

She has gone several treatments before including surgery of the eyelids with mixed success.

Josi is a well monitored patient with all his dewormings and vaccinations on time.

Josi was presented for second opinion for ocular exam and consultation.

On the physical exam I noticed much more pigment on the fur under the right eye.

With the direct ophtalmoscope I saw some hair in the right eye. Near the limbus there was a dermoid mass with very small size and 3 hairs growing on the cornea.

Then I did Jones test of the both eyes with some fluorescin stain and it was negative for more than 60 seconds. The STT time of the left eye was normal 20 mm / min.

Both eyes were negative for ulcers.

So in this case I decided to do keratotomy and to remove the dermoid from the right eye.

Meanwhile I did nasolacrimal flush of the ducts in the both eyes.

The dermoid was removed using Beaver scalpel blade and than on the after exam I noticed second dermoid in the conjunctiva under the upper eyelid.

So the second dermoid was resected and removed with scalpel blade.

Than I did nasolacrimal flush with IV catheter.

So Josi was sent for home management with some local Tobramycin drops and some hyaluronic gel for the cornea to heal fast.

Recheck will be done after 5 days.

Dr Cristian Marinescu- a man, a vet who try to change the management of veterinary clinic in Romania and not only

June 14, 2019

1. Who is Cristian Marinescu?

I am first of all a Vet, a member of this beautyfull community of veterinarians. I graduated Vet school in Bucharest in 2006 and in 2015 the Law school at Romanian-American University. All my carrier I was around sales, communication and people. I have a passion for everything related to business and people management. And not in the end, I am a father and a husband :-).

2. Why you create VBA?

I start to travel from one vet clinic to another since 2012 and I saw that everybody was talking or compleining about issues related to management and miscommunication. Take in consideration my experience I knew that together we can create a community and a network of people interested in this topic. A lot of vet colleagues encourage me to start this project and give support for this. I could say that VBA is a project of veterinary community in Romania. I would like to mention the big support from dr. Nicolae Valentin and especially from Adrian Radulescu.

3.Why veterinarians nowaday need anoher kind of education as business management?

Simply because in our activity 50% is medical knowledge and 50% is something else related to communication , people interactions and management. The Vet school prepare us how the deal with diseases, not with people or how to communicate between us or with pet owners or farms. Noone mentions nothing about business knowledge, and a big % of people after graduate,when they will start their own business. So….the NEED is clear.

4.What are your goals for the future?

First, to make our community to understand that they need also to educated themselves in directions like : communication, people interactions, marketing and finance. This will not only help only their professional goals but will also impact their personal wellbeing. I know this because I experienced it and I know that vetlife is nice easy one. Especially for work&personal life balance.

Second, I would like VBA to become a relevant provider of help and knowhow in this area.

And in the nearest future, we will try also to provide individual support at vet clinic level. We start a pilot project with couple of clinics in Romania and I hope soon we will be able to extend the community.

5.How people from abroad can attend your events?

Invite us in their country to see if we have what to say or give , it will help them or not. I promise it will.

6.What is your oppinion about Vets on The Blakans?

I think is a great ideea that need support. I work also in some projects at european level. And I know that vets from the Balkans have a lot of similarities and we can find projects that can be run in our region ,that will increase the know how and the image of vets from our region all over the world.

So, keep up the good work. You also inspire us to start vetbusinessacademy.

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Learn and travel…a new story from Italy with Dr Marin Buchkov from Bulgaria

June 7, 2019

Dr Marin Buchov, a veterinarian from Bulgaria has done his internship in clinica Lago Maggiore in Italy! We would like to express our gratitude to Dr Luca Formaggini.Dr. Mariangela De Franco and Dr Luigi Venco for making this posssible,as well to our partnern Blue Sky Commerce and Pamas Trading for supporting Learn and Travel with Vets on The Balkans.

Dr Marin Buchkov are talking about his advanture:

In a rainy morning, after a long hours of driving I was welcomed by Dr. Amedeo Loss Pelle. He kindly prepared an Italian style coffee and gave me a tour around the clinic – well equipped and designed to be very practical. A clinic that can cover all the aspects of 21st century veterinary medicine – CT, Endoscopy, Ultrasound, Digital X-Ray, Laboratory and modern surgery rooms…

During the next days I met all the vets – Dr. L.Formagini, Dr. M. De Franco, Dr. S. Manfredini, Dr. M. Silvola. Dr. G. Saggin, Dr. V. Galli, Dr. A. Prolo, Dr. C.Ferrari and Alberto. As expected, Dr. Formagini was the most experienced vet, the leader in the clinic. He always explains to the younger vets what, how and when to do the right thing. Amazing vet and skillful surgeon. I like the way he tries to do his job easy and simply, most of all practically.
Dr. Mariangela De Franco is the leading ultrasonographer. We had the chance to examine some patients together and have a discussion about best possible treatment.
Dr. Manfredini and Dr. Silvola – I believe they’re the energy of the clinic – always running from room to room, smiling and ready to help the patients.
Dr. Saggin – its difficult to say if her heart belongs to the veterinary medicine or climbing mountains, but she’s good in both
Dr. Loss Pelle, Dr. Prolo, Dr. Galli, Alberto – charming young vets, very easy to work with. Thank you for the tips of ‘real Italian pizza’ and ‘how to cook pasta’
Dr. Ferrari – thank you for helping me with accommodation.

I came all the way from Bulgaria mainly to see how Dr Luigi Venco extracts diroffilarias from CHW dogs. His colleagues from the clinic describe him as ‘genius’ and after a week of waiting to perform this surgery with him I can confirm – he is We had three patients from Hungary, all done in one afternoon. Professional job.

Other impressive thing I saw – Cystoscopic‐Guided Laser Ablation of Ectopic Ureters in a young female dog. Together Dr Formagini and his team performed this procedure in the clinic.

A lot of other interesting cases, but my favorite patient was Orazzio – english bulldog that had to say goodbye to what makes him ‘a man’ in order to urinate normally. After two cystotomy surgeries in the past (his bladder is so good in creating different types ot urinary stones..), a scrotal uretrostomy was performed. Even this way Orazzio is still charming and lovely

All-focus

It is for sure useful to see how other vets do their everyday job. One thing (even the most simple one) could be done in many different ways and knowing them is what makes you a good vet. You can say the same for being a good person too… Thank you guys for being so kind to me and speaking English all the time I was there. You’re very good team, don’t forget this. Hope to see you soon somewhere around the world. You’re all welcome to Bulgaria!

Vets on the Balkans is such a good idea! Thank you Luba!

Global Experts to Discuss WSAVA Research into Veterinary Wellness during World Congress 2019

June 6, 2019

Experts from around the world will discuss the implications of research undertaken by the WSAVA’s Professional Wellness Group (PWG) into veterinary wellness in a panel session during WSAVA World Congress. The discussion, called ‘Shaping the Future: Wellness in the Veterinary Profession’, will take place on 17 July, following a presentation of the preliminary results of a study of more than 4,000 veterinary professionals globally. They will be presented by PWG Committee Co-Chair Dr Nienke Endenburg, a human psychologist, who works at the veterinary school at the University of Utrecht, Netherlands.

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Dr Nienke Endenburg

Recognizing increased concern as to the impact on veterinary professionals of their demanding working environment, the PWG set out to assess professional wellness and the key factors which affect it globally when it launched its online survey in September 2018. Dr Endenburg will present the findings before inviting panelists to respond and discuss their perspectives on the issue. The panel members are:

Dr Marie Holowaychuk, a Canadian board-certified small animal emergency and critical care specialist and advocate for veterinary team wellbeing
Dr Jen Brandt, the American Veterinary Medical Association’s Director of Member Wellness and Diversity Initiatives
Dr Derick Chibeu, Co-chair of the PWG and Honorary Secretary of the Kenya Small and Companion Animal Veterinary Association
Dr Vicki Lim, who works in New Zealand and is the founder the Riptide Project, an international veterinary wellbeing initiative
Mr Elwin van Oldenborgh, President-Elect of the International Veterinary Students’ Association.

Commenting, Dr Endenburg said: “Veterinarians care for our animal companions but the question is, who is caring for them? As a global community we wanted to gain a clear understanding of the challenges to their well-being faced by our members around the world and to find out both what they have in common and where their experience differs.

“The results of our research provide a unique global view of this important issue and we look forward to discussing these with our expert colleagues and exploring practical solutions that respect the regional, economic and cultural differences of our membership. It will be an important first step towards bringing about positive change and enhancing the wellbeing of veterinarians globally.”

The WSAVA works to enhance the clinical care and welfare of companion animals globally, representing more than 200,000 veterinarians around the world through its 110 member associations. Its core activities include the creation of Global Guidelines which set standards for veterinary care in key areas of practice, including nutrition, pain management and welfare.

WSAVA World Congress takes place in Toronto from 16-19 July. The Professional Wellness presentation and expert panel discussion takes place at 11.40 am on 17 July.

Cerebrovascular accidents in dog

June 1, 2019

Dr Svetoslav Penchev

United Veterinary Clinic

Varna,Bulgaria

Stroke or cerebrovascular accident (CVA) is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic stroke and hemorrhagic stroke. CVA are characterized clinically by a per acute or acute onset of focal, asymmetrical and non-progressive brain dysfunction. Next cases show the both type of CVA in dogs.

1^st case is about 9 years old female boxer. The dog was referring to the clinic with acute onset of seizures. The results of CBC and Biochemistry were normal and MRI was performed.

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MRI findings: Intra-axial right piriform lobe and hippocampus lesion with impression of moderate swelling of these portions is present. The cerebral falx is only mildly displaced to the left. There is corresponding low T1 signal intensity in these sections of the brain suggesting edema. There is no enhancement of the lesion after contrast administration. The findings suggest that there is a non-hemorrhagic cerebrovascular accident in right forebrain of the dog.

The 2^nd case is about a 8 years old male Cane corso. The dog was present in the clinic with unilateral fore brain deficits and history of epileptic seizures. Biochemistry and CBC were normal and MRI was performed.

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MRI findings : There is a well‐delineated T1 iso- to hypointense and T2 hypointense mass lesion with surrounding brain edema in right piriform lobe with a thin peripheral rim of contrast enhancement. There is a mass effect, displacement of the right lateral ventricle and midline shift to the left. This imaging feature is consistent with an acute to subacute intracranial hemorrhage.

Conclusion:

MRI features of Hemorrhagic infarction in dogs may not be distinguishable from hematoma caused by vascular disruption. Imaging characteristics will vary depending on the size, location, and chronicity ofthe hematoma.

Hyperacute – 24 hours T1 isointense ; T2 hyperintense

Acute 1-3 days T1 iso- to hypointense ; T2 hyperintense

Early subacute >3 days T1 hyperintense ; T2 hypointense

Late subacute >7 days T1 hyperintense ; T2 hyperintense

Chronic > 14 days T1 hypointense ; T2 hypointense

Secondary features : mass effect, surrounding edema, midline shift , ventricular displacement and compression .

MRI features of Nonhemorrhagic Infarction in dogs include mildly T1 hypointense and T2 hyperintense lesion with minimal mass effect involving both gray and white matter on unenhanced MR images. These changes seen in ischemic parenchyma rely on an increase in tissue water content. Gradually, during the acute stage, the T2-weighted image becomes more hyperintense in the ischemic region, particularly over the first 24 hours. These signal changes seen in the first 24-hours are best appreciated in grey matter and are well visualized in deep grey matter structures such as the thalamus or basal ganglia, in addition to cortical grey matter. Gadolinium enhances infarcts because of vascular rupture but does not enhance ischemia or edema.

Endometrial Polyps in a cat

May 28, 2019

Dr. Yavor Stoyanov, DVM

Bomed Veterinary Clinic, Sofia, Bulgaria

yavkata.ys@gmail.com

Abstract: Endometrial polyps from a 10 –year-old cat are described.The cat was presented in clinic due to vaginal bleeding. Few polypoid cystic masses pedunculated into the uterus lumen were found at the surgery. Sonographic, X-ray, cytology and histopathological examination revealed uterine polyp consisting mainly of endometrial fibrous tissue stroma and glands without invasive growth or atypical mitotic activity. Keywords: Endometrial polyp cats, Feline uterine polyps, Cystic uterine polyps in cat,Ultrasound endometrial polyps, Histology endometrial polyps, X-ray endometrial polyps

Introduction

Endometrial polyps in cats are a rare disease condition. Much of the available evidence being anecdotal¹. There are only three more detailed reports for this condition in cats. One from the archives of the International Registry of reproductive Pathology at the University of Illinois, US -14 cats¹, one from Department of Obstetrics and Gynecology, Faculty of veterinary medicine, Kirikkale university, Kirikkale, Turkey-1 cat² and one from School of Veterinary medicine, Azabu University, Kanagava, Japan -1 cat³.

Case History

A 10-year-old Persian cat was presented to Bomed Veterinary Clinic in Sofia, with history of acute vaginal hemorrhagic discharge. The cat was in good physical condition with normal temperature and behavior. Few bloody drops around the vulva. In middle to caudal abdomen was palpated some firm mases.

Under clinical differentials diagnoses of pyometra, uterine adenocarcinoma or alimentary lymphoma was performed abdominal ultrasound. Sonographic examination showed a few cavernous structures cranial to bladder and caudal to kidneys. The large one was about 4 cm in diameter. Caverns were dispersed in haphazard mosaic pattern. Doppler sonography showed good blood supply of masses. On the base of ultrasonography pyometra was excluded of differentials diagnoses list.

Fig.1 Sonographic view of uterine polyps

On the base of suspected uterine adenocarcinoma were performed two dimensional chest and abdominal X-ray. Lungs and chest X-ray did not show indication of metastases. Abdominal X-ray confirms sonographic findings about dispositions and dimensions of mases.

Fig.2 X-Ray view of uterine polyps

CBC and biochemistry was in normal limits. On the base of the clinic and tests an exploratory laparotomy under general anesthesia was performed. During surgery uterus with abnormal asymmetric horns was found. Few mobile firm – elastic mases were palpated in uterine lumen. Two and smaller in the right horn, and a bigger one in the left horn. Ovaries looked normal except one little cyst nearby to right ovary.

After OHE the uterus was dissected. Evidence for an inflammation was not found.

We found in left horn one big elongated egg-like structure pending on short narrow peduncle. It is about 5 cm long and 4 cm in diameter. The smallest one in the right horn was about 1 cm long and 0.6 cm in diameter starting nearby end of horn. The middle one was about 4cm long 2cm in diameter and partially entering in the cervix. Polyps had firmly –elastic consistency, easily bleeding, with small delicate cyst on the surface. Uterus wall had irregular thickening mostly because endometrial hyperplasia. On the luminal surface has similar small delicate cyst also. When we dissected one of the polyps many different sized caverns dispersed in haphazard mosaic pattern were found. They were full with translucent slightly mucinous secret. The stroma was tenacious.

Fig. 3 Morfology of uterine polyps. Polyps pedunculated from uterinw endometrium to uterine lumen. Many fine cysts are visualiseted on the surface of polyps. Uterine walls with irregular hyperplastic patern.

Many prints slides for cytolgy were made. We did not found inflamatory cells, evidance for adenocarcima or any proof for other malignasy. These polyps looked benign.

Fig.4 Cytology from uterine polyp. Left- stroma Ridht- cyst wall

Specimen for hystopatology was prepeared in 10% formalin and send to Pathology laboratory, at the same day.

Fig.5 Histology from uterine polyp. Up- Stroma and cysts. Down- Left -Hyperplastic proliferation of glandular epitelial cysts. Down-right- Atrophyc epitelial wall of large cyst.

Histology report: Protocol 107,108,109,110/05.04.2019

Hystological spesimen representing uterine wall with presence of polypoid tumor formations. Tumor origin is from endometrial surface, representing of stroma, built from mature fibroses tissue with glands structures in thinly pattern within. Many of these glands structures are cystic dilated. They are covered with one row cubic epithelium with primarily basal situated nuclei. No signs for epithelium proliferation activity, atypical mitotic activity or invasive proliferation regarding the stroma. An endometrium and myometrium has typical histological structure.

Histological diagnosis: Atrophic endometrial polypsOn the base of clinical examinations, Ultrasonography, X-ray, morphology, cytology and histology report our diagnosis is as follows: Endometrial Polyps. Discussion

A diagnosis endometrial polyp of this case is according to the nomenclature in the Histological Classification of Tumors of the Genital System of Domestic Animals⁴. Main differential diagnoses are between endometrial polyps and polypoid form of cystic endometrial hyperplasia. The more exact differences between true endometrial polyps and polypoid endometrial hyperplasia are defined as that endometrial polyp have a vascular connective tissue stalk⁵ or contain a substantial connective stroma in addition to glands, and are pedunculated⁶. Histology slides demonstrated changes in the different stages of cysts development. Focal cystic endometrial hyperplasia is the stimulus for formation of polyps. As hyperplasia progresses, out of synchrony with surrounding endometrium, the glands become larger and more numerous. If the cystic endometrial glands have no external opening, they start to accumulate fluid. When the fluid pressure in the cysts increases, the gland cells covering their walls are compressed and start atrophic process.¹ On the base of reports no breed, age or other predispositions were found¹.No evidence that endometrial polyps are preneoplastic changes of the feline uterus except one a 16-year-old cat with metastatic carcinoma and five endometrial polyps^{1, 2}. This probably reflects the rarity of endometrial neoplasia in cats as compared to women¹. On the base of this data prognosis in this concrete case is excellent. ConclusionEndometrial polyps in cats are very rare condition.It is difficult to classify this disease as gynecological, hormonal or oncological. On the base of the case studies OHE is choice of treatment with excellent prognosis.

Fig. 6 The lucky cat Dara.Acknowledgments:

The author would like to thank to team of Bomed Veterinary Clinic, Sofia, Dr. B. Rangelov, DVM for sonographic diagnostics, Dr. M. Lulcheva, DVM for anesthesia and Dr. J. Stojkov DM for histology report.