The power of local therapy in superficial bacterial infections- part 2

67668506_2745972975432468_1475995593221341184_nDr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

 

Sandra is a French bulldog whose case I have been following  for 2 years.

Sandra is regularly vaccinated and with regular tick and flea treatmen and dewormig as well .

 

When we first met, Sandra  was prescribed 2 mg of Prednisolone per kg in the morning and evening.

There were already 2-3 diets with hypoallergenic food with no results .

When the dog is on Prednisolone is very good, with no symptoms.

 

Sandra has been on immunotherapy for two years and during this time there are a total of 3-4 exacerbated periods with superficial bacterial infection.86731524_2593062557606841_6481170903102128128_n 86796564_540897716551707_1088806477625294848_n

To control these infections we tried various antibacterial shampoos and the ONLY systemic antibiotic we used was amoxicillin with clavulonic acid (at least one month ingestion)86654192_3849015221805694_8360675259283668992_n 86671200_2685748064865626_3817080252207726592_n 86696362_2218223128473460_5054249941212332032_n 86697202_485388832135765_3554367668330954752_n

86648294_214183006375305_3623894315450761216_nDuring immunotherapy, Sandra takes 1/4 of Prednisolone at 5 mg every 36 hours (Sandra weights about 15 kg throughout the therapy).

For two years, Sandra was very good, and controlling the pyoderma was relatively easy without changing the doses of immunotherapy and without changing the dose of Prednisolone.

The last case of bacterial infection was the beginning of November 2019.86696316_183578386233461_4810920583397113856_n 86702696_191563688606644_4592023430513033216_n

We began the scheme with Chloroxiderm and Amoxicillin with clavulonic acid.

10 days later, it had no effect, even the opposite.

Sandra’s skin was flushed with pustules, color and intense itching.

 

We did cytology, bacteriology and antibiogram.

The results (Staph. intermedius ) were completely resistant to 15 types of antibiotic from different groups.

The only antibiotic that worked was Rifampim, which is a strategic antibiotic in human medicine and we decided not to use.

Sandra’s improvement has been much slower and in the last few months we have changed several different regimens of local therapy.

Peptive Shampoo & Foam, Duoxo tampons & duoxo spo on  (First Month Every Day)

Omega 3 and 6 fatty acids, Chloroxiderm shampoo, Duxo pyo shampoo and foam (second month every day)

Since the beginning of January, Sandra has been on Peptive again with a bath twice a week and a hermitra spray.

The itching has decreased to normal, there are no new pustules and the hair is gradually recovering.

In conclusion, every time we use an antibiotic for systemic therapy or topical therapy, we should think very carefully about all the possible options because resistance is one of the greatest problems of our future.

Diagnosis :

Atopic dermatitis

Superfitial pyodermia

The power of local therapy in superficial bacterial infections- part 1

67668506_2745972975432468_1475995593221341184_nDr Spas Spasov

Veterinary center Dr Antonov

Varna, Bulgaria

 

 

A topic not only for dermatologists.

“Recent high-profile reports warn of the dangers of not taking action. A bleak report by economist Jim O’Neill, commissioned by the British government and released in May, estimates that 700 000 deaths globally could be attributed to AMR this year and that the annual toll would climb to 10 million deaths in the next 35 years. The report projects US$ 100 trillion in losses by 2050 if nothing is done to reverse the trend.”

Aa quote from the World Health Association website.

1.Clinical case of Azar .86809005_225664251788761_2987290882698379264_n

*HISTORY

 

Azar is a 3 years old cane corso dog.

There is a regular   vaccination  and tick and flea teratments  with tablets (isoxazolines).

Case history .

A month and a half ago, the owner has taken Azar to another clinic because of the many  pustules on the dog’s chin.

Clinical symptoms include itching in the facial area, redness, and many of about 0.5 cm pustules all over the chin.86720876_1100028783670155_9119763329592590336_n
Systemic antibiotic therapy and topical once-daily chloroxidine therapy were prescribed for Azar.

Two weeks later there was no change in the condition  of the dog.

Bacteriology and antibiogram were performed( Staph. Aureus ) , a second systemic antibiotic was added after the result (the first antibiotic was discontinued).

Staphyococcus aureus is extracted from the antibiogram.

Both antibiotics show the sensitivity of the causative agent.

Two weeks after the second antibiotic, there was no change in Azar’s condition.

  1. Clinical presentation

At the initial examination, Azar was in good general condition, but there were numerous pimples throughout the chin area, which were very easily bleeding and pussing.

In addition, Azar defecates 3-5 times a day and most times the stools are not well formed.

  1. We did cytology and deep scraping of the skin.

Cytology:
Mass neutrophils, macrophages, and cocci bacteria.

84223870_659853468118050_7209325832966242304_n85199680_200298631039436_2333131612209807360_n86702132_1496491853857452_6623962133149253632_n

Skin scraping
No demodex or other parasites of deep skin scraping.

 

Initial therapy:

Local therapy with daily chloroxiderm shampoo, duxo pio tampons and duxo seb spot form and Diprogenta 0.5 mg / 1 mg / g cream

betamethasone / gentamicin for 10 days.

The effect after the first 10 days is significant and more than satisfactory, so the therapy prescribed after day 10 was changed only with shampoo with peptide.

10 days later, there were almost no signs of infection.

10 days later, Azar’s therapy was limited to once daily administration of the duxo self-tampons and once a week the duxo-seb spot form, as well as a curative diet with the Analergenic diet.

86262184_184910839401369_1308086097347084288_n86754901_594896047756071_3207263053011746816_n

There are no signs of bacterial infection now, gastrointestinal symptoms are no longer observed, and therapy is just cleansing with duxo swabs (suitable for daily use).

 

 

Diagnosis:

Chin furunculosis and suspected food allergy.

Tension pneumoperitoneum due to spontaneous gastric perforation in cat

MetodievStoyanovBorislav Metodiev, DVM       Yavor Stoyanov, DVM

Bomed Veternary Clinic, Sofia

Pneumoperitoneum refers to accumulation of gas within abdominal cavity, resulting from a perforated hollow viscus, penetrating wounds or bacterial peritonitis. Emergency condition of massive pneumoperitoneum compromise cardiorespiratory function, known as pneumoperitoneum, has been reported in humans. In veterinary medicine, there are also a few similar cases.

This study reports a case of a cat that developed tension pneumoperitoneum secondary to gastric perforation. The cat was treated with emergency abdominocentesis, followed by laparotomy.Pneumoperitoneum

A 10 years old British shorthair spayed female cat Tara (2.8 kg) was presented with a remarkable abdominal distention. Three months ago, the cat was operated because of suspected alimentary lymphoma. A part of small intestine and caecum was removed. Histology confirmed large cell lymphoma. Tara was started on chlorambucil and prednisolone protocol. Regular control examinations showed only decreased appetite and one or two times weekly vomiting. The last examination was two days before pneumoperitoneum, and ultrasonography was unremarkable.

At the time of admission, the cat was in good condition except respiratory distress, with huge ballooned, tympanic abdomen. Abdominal US showed only gas. Emergency needle abdominocentesis was performed, and about 300 ml air was aspirated. Than was performed X-ray. The abdominal radiograph showed distended by air abdominal wall, compressed viscus, displaced to thoracic cavity diaphragm. There was no evidence for free fluid in abdominal cavity. Subcutaneously was small amount of air, leaked after the needle aspiration. Second abdominocentesis was performed, and about 400 ml air was aspirated. The aspirated gas had no odor or admixtures.

On the next day, the cat was rehydrated, and a laparotomy was performed. Mild peritonitis was found with a small almond of yellowish ascites. The small intestines were empty, in the large intestines there were some faeces. The site of previously enter anastomosis was perfect. There was no evidence of leaking from the gut or any visible evidence of recurrence of lymphoma. A 6-8 mm perforation was found at the gastric fundus. The stomach, liver margin and omentum were mildly adhered. Other portions of stomach wall looked visually and palpably normal. After blunt dissection of the adhered liver and omentum, the gastric perforation was closed with interrupted sutures. Materials from stomach wall for cytology and from free fluid for microbiology were taken. Abdominal cavity was flushed with 0.9% warm saline and closed in a routine manner. Cytology did not show atypical cells, or any suspect for alimentary lymphoma. Microbiology was unremarkable.

Reported common causes for pneumoperitoneum in small animals include abdominal surgery, gastrointestinal perforation and bacterial peritonitis. In cats pneumoperitoneum also has been reported as complication after endoscopic biopsy or gastrostomy tube replacement. Most of these cases have not shown severe abdominal distention, necessitating emergency decompression.

The exact cause of gastric perforation in this cat is unknown. We suspect local weakness of gastric wall due to iatrogenic factors. Chlorambucil or prednisolone, or combination of these two medicaments may cause damage of mucosa and weakness in the walls of GI tract.

Necessity of therapeutic emergency abdominocentesis due to spontaneous pneumoperitoneum in cats has been emphasized only in few previous reports.

 

Paradoxical Vestibular Syndrome

61902515_2345560455717555_5482604974015774720_o

Dr Svetoslav Penchev

Dr Svetoslav Penchev

United Veterinary Clinic

Varna, Bulgaria

 

 

 

Paradoxical Vestibular Syndrome is a condition that affects flocculonodular lobe or the caudal cerebellar peduncle of the cerebellum and causes vestibular signs. These parts of the cerebellum participate in central components of vestibular apparatus and are responsible for the maintenance of equilibrium and coordination of head and eye movements;
This syndrome is called paradoxical vestibular disease because the head tilt and circling occur contralateral to the lesion. There is usually some evidence of cerebellar disease on neurological examination, such as ipsilateral dysmetria and head tremor.

Signalment: 8 years old, male, not castrated French bulldog

History: The owner noticed that the head of his dog is not in normal position and is tilt to the left. The dog was carried to its personal doctor, and the doctor had doubts that the dog was having problem with the inner ear . The doctor refer the dog to me for computer tomography, and for approval of the diagnosis.

Case presenting signs: Left head tilt, progressive vestibular signs

Clinical examination: Internal body temperature 38,1 ; Respiratory rate: 36 breaths per minute ; Color of mucous membranes – pink; CRT – 1,5 sec.
Puls 110 bpm ; The overall condition of the dog was normal and there was no no signs of pain.

Neurological examination:
Mentation and behavior-normal; Posture – Left head tilt; Gait – Vestibular ataxia, increase muscle tone and dysmetria of right fore and hind limbs The dog react with cranial and spinal normoreflexia. Menace response reaction of right eye was a little bit reduced. There was no change in conscious proprioception and bladder function was normal. The owners report for intention tremor of the head when the dog is waiting to be fed.

Neuroanatomic localisation: Central Vestibular ; Right Cerebellar Flocculonodular lobe; Paradoxical Vestibular Syndrome

Differential diagnosis:

Neoplastic/Degenerative

Case work-up:
CBC and Biochemistry were normal. Magnetic resonance of the head was performed with GE MRI 1.5 Tesla.

1

Image 1

2

Image 2

3

Image 3

4

Image 4

5

Image 5

MRI images : Image 1
Image 2
Image 3 –
Image 4-
Image 5

 

 

 

 

 

 

 

 

 

MRI findings :
A single oval T1-hypo and T2, T2 FLAIR-hyperintensive intra-axial mass is observed, leading out of the cerebellar vermis and affecting the both cerebellar hemispheres. The mass is well circumscribed by the surrounding tissues, with extracapsular expansion and diffuse infiltration into the the gray matter. There is a significant mass effect that reveals compression of the flocculonodular lobe and reveals obstruction to the flow of cerebrospinal fluid with secondary dilatation of the quarter ventricle and central canal with subsequent syringohydromyelia.
Diagnosis: Cerebellar neoplasia
Treatment:
The clinical condition of the dog did improved after i.v
infusion with Mannitol (0.25g/kg bolus 3 times over 20 minutes) , Harmann`s solution 20ml/kg and Prednisolone p.o 0.5mg/kg – 2 times daily – for 3 days . Next 10 days the dog take Prednisolone 0.5 mg/kg 2 times daily at home.
Control visiting on the 14th day -https://www.youtube.com/watch?v=XRyp9sgqCjE

All of previous clinical signs were more severe present. There was no more improvement with this therapy and the owners chose to euthanize the dog.
With both central and peripheral Vestibular syndorme, the head tilt, circling and nystagmus typically occur ipsilateral to the side of the lesion. Less frequently, lesions affecting the caudal cerebellar peduncle, the fastigial nucleus, or the flocculonodular lobes of the cerebellum can cause central Vestibular disease with a resulting paradoxical head tilt. Bilateral Vestibular disease is characterized by head sway from side to side, loss of balance on both sides and symmetrical ataxia with a wide-based stance.  A physiological nystagmus usually cannot be elicited and a head tilt is not observed.

NEW Hill’s ActivBiome+ Technology in Prescription Diet Gastrointestinal Biome Manages Gastrointestinal Health in Cats and Dogs

Clinical Evidence Reporthills

 

The gastrointestinal tract is inhabited by communities of microorganisms essential to host health. These microorganisms, including desirable and undesirable bacteria, are referred to as the micriobiome and the exact population of micoorganisms is unique to each host.

Bacteria in the microbiome are functionally and compositionally diverse, allowing contribution to energy homeostasis, metabolism, gut epithelial cell health, and immunologic activity. This population is not static and can change to due to medications, such as antibiotics, environmental factors, disease states and dietary influences. Additionally, it is common to see dysbiosis (imbalance in the gastrointestinal microbiome) in chronic GI disease in cats and dogs.

Over the past several years, Hill’s has focused heavily on studying the microbiome, characterising bacterial populations of the gastrointestinal tract of cats and dogs. Most critically, Hill’s has performed analyses to understand the functions of those bacteria in the gastrointestinal tract.

 

 

Hill’s has found that a pet’s gastrointestinal health can be impacted by ActivBiome+ Technology, a blend of synergistic prebiotic fibres that works with with each pet’s unique gastrointestinal microbiome.

 

 

1WHAT IS ACTIVBIOME+ TECHNOLOGY?

Hill’s Prescription Diet Gastrointestinal Biome contains ActivBiome+ Technology. This is a proprietary blend of synergistic prebiotic fibres that works with, and is utilised by, each pet’s unique bacteria in the large intestine allowing the beneficial bacteria to flourish and produce postbiotics (metabolic products of microbial metabolism) to help the host. By promoting the growth of desirable bacteria, it also helps to reduce the growth of potentially undesirable bacteria and their metabolites. The fibre sources in ActivBiome+ Technology were selected because they have multiple functions and have fibre bound polyphenols. The bacteria ferment the fibres and produce gut-nourishing compounds, as well as release and activate antioxidant and anti-inflammatory polyphenols. These postbiotics benefit the gut, as well as other organs and tissues.

How does ActivBiome+ Technology improve Gastrointestinal Health?

A series of studies at Hill’s Pet Nutrition Center (PNC) were conducted demonstrating how ActivBiome+ Technology works and clinically showed improvements when this synergistic blend of prebiotic fibres was added to certain foods. Both dogs and cats showed improvements in markers of gastrointestinal microbiome health. Dogs also showed improvements in stool quality.1,2

One canine feeding study evaluated the benefits of the ActivBiome+ Technology in healthy dogs (n=16) and in dogs with chronic, recurrent enteritis or gastroenteritis (n=16) in a randomised, cross-over design study. ActivBiome+ Technology was added to either a hydrolysed meat food (Food A, Fig 1) or grain-rich food (Food B, Fig 2) and fed over a 56 day period. All dogs had significant improvements in stool quality, including those with chronic enteritis/gastroenteritis, when given food that included the ActivBiome+ Technology fibre blend.2 ™

Shemi 1

Active Biome+ Technology Improved Stool Quality in All Dogs

 

Figures 1 and 2 illustrate the changes in stool quality among all dogs consuming this fibre blend. By the end of 4 weeks, the stool quality score of the dogs with chronic enteritis/ gastroenteritis had improved to the point that they were no longer significantly different from the healthy dogs.

Additionally, a significant increase in beneficial bacteria taxa (e.g. Lachnospira sp, Fig 3) and a decrease in harmful bacteria taxa (e.g. Desulfovibrio sp.) was observed. This positive change in the microbiome also leads to an increase in the production of helpful postbiotics. ActivBiome+ Technology significantly increased faecal levels of certain polyphenols and short-chain fatty acids (SCFA’s, Fig 4). The SCFA’s help reduce faecal pH, creating an environment that favours the growth of beneficial bacteria in the host. Potentially harmful postbiotics (faecal polyamines such as putrescine, spermidine) were also measured and were reduced by the addition of ActivBiome+ Technology2.

Shemi 2

 

Similar to studies performed with dogs, the feline research done at the PNC on 28 healthy cats showed that ActivBiome+ Technology helped create a more positive gastrointestinal microbiome environment. There was a significant increase in beneficial bacteria. There was also a significant increase in key postbiotics, such as SCFA’s (acetic & propionic acids) from fibre fermentation and a decrease in fatty acids (isobutyric, 2-methylbutyric, & isovaleric acids) from protein breakdown. Increased stool moisture and decreased pH were also achieved whilst maintaining acceptable stool scores1.

 

NEW ActivBiome+ Technology has been proven to provide

numerous benefits in cats and dogs.

  • Nourishes the pet’s individual gut microbiome and promotes beneficial bacteria
  • Activates the microbiome to release and convert fibre bound polyphenols into more potent anti-inflammatory and antioxidant postbiotics
  • Increases short-chain fatty acid production to nourish colon cells
  • Promotes healthy stool quality in healthy dogs and dogs with enteritis2

MODIFIED PANCARPAL ARTHRODESIS “Dobro hrumvane” – new extreme challenge, new success

logoThis year the created 5 years ago by our team new orthopedic technique for cases with radial nerve palsy in cats (see article http://balkanvets.com/index.php/2019/03/09/main-topic-a-new-approach-to-radial-nerve-palsy-in-cats-clinical-case-series-report/) met its biggest possibe challenge and led the case to unexpected 100 % success:

Cat, M, approx 3 years old, Otelo.  The cat has survived after severe trauma which forced colleagues to amputate one front limb and to try saving the other one using standard surgical procedure.  Weeks later the cat came to us for euthanasia: lethargic, anorhexic, with decubital wounds and with very deep and extremely inflammated and painful exhoriation at the chest area due to body dragging on the floors. The not amputated leg wasn’t functional. It was swallowed, with severe purulent inflammation and permanent fistula, with evaluating maluinon (high degree rotation and mild varus) and with radial nerve paralysis, the antebrachial bones showed all radiographic signes of osteomyelitis.  The patient showed all clinical and paraclinical signs of evaluating sepsis. Additionally Otelo had also severe lungs problem. We took the risk to prepare the cat for the DH arthrodesis surgery and to test our technique in these extremest possible conditions.

Otelo’s condition 1st day in clinic:pic 1

 

It took almost 3 weeks to prepare Otelo fur surgery, lungs multimodal treatment including Opti-Airwei, treatment against the systemic and local infections and lesions, chronic pain and exhaustion.

We used the technique on its standard way, we just decreased the rerotation angle from 90-95 degrees to 80-82 degrees, because cats with only one front limb move the existing one to the median body line which leads to natural 10-12 degrees carpal rerotation.

 

Otelo 5 min post-op X-ray: pic 2

Pre- and intra-operatively we took material for bacterial identification and antibiogram. Of course we counted as usual on VetDiaLab with their unique system for automathic identification even to subtype and for authomatic machine antibiograms. The VetDiaLab fantastic work was the key for complete solving of the chronic multi-infection.

Thanks to the precise lab results, the reliable technique and the amazing post-op care of our team (even including adoption of the patient by “fallen in love” with him team member) Otelo overcame the victim pose, the decubital wounds, the chest deep exhoriation and uses its leg with full geometrical functionality. The deep antebrachial bone infection was 100 % overcome only after removing one of the screws which kept infection – after this manipulation the operative suture finally healed 100 % and we removed the collar on Christmas!

 

Otelo Christmas video:

ABCD & Boehringer Ingelheim invite applications for the 2020 Young Scientist Award

ABCDThe European Advisory Board on Cat Diseases (ABCD) invites applications for the 2020 ABCD & Boehringer Ingelheim Award, which aims to reward innovative and outstanding work by promising young professionals in the field of feline infectious diseases and/or applied immunology.

 

Candidates should have made an original contribution to the field of feline infectious diseases and/or immunology, which has been published or accepted for publication in a referenced journal or accepted by another assessing body in 2018 or later.

 

Candidates should be based in Europe, have completed a veterinary or biomedical curriculum, and ideally be under 35 years of age at the time of application.

 

Applications should be made in English in an electronic format and include a short abstract (max. 500 words) of the work the applicant wishes to submit, as well as a short curriculum vitae and two personal references. Any relevant publications and/or dissertation on the topic should be included. The deadline for submission is 15 April 2020.

 

The 2020 award (1000€) is funded by Boehringer Ingelheim and will be presented by the ABCD at the congress of the International Society of Feline Medicine, to be held from 10 to 14 June 2020 in Rhodes, Greece. The award winner will receive a complimentary registration to this congress. Return travel expenses and accommodation will also be covered to allow the laureate to attend the event. The winner is expected to give a short presentation or present a poster of his/her findings at this event.

 

The Young Scientist Award was created in 2008 jointly by Boehringer Ingelheim (then Merial) and the ABCD.

 

The 2019 recipient of the Award was Rosina Ehmann (Germany).

 

Application forms and detailed rules can be downloaded from the ABCD web site (www.abcdcatsvets.org)

For further information, please contact Karin de Lange, ABCD secretary, kdelange@invivo.edu

Achieving primary closure on the proximal third of the tail after 4 cm mass removal in a dog

51559132_952390804967417_8511078558653743104_nFlorin Cristian Delureanu    

DVM, MRCVS

December 2019

Abstract

Defects located on the tail are challenging due to lack of skin. Second intention healing, skin grafts or random local flaps can be used as a treatment in this particular area. Primary closure can be used when small defects are present but risk of dehiscence and vascular compromise is very increased due to tension and tourniquet effect. In cats was described a perineal axial pattern flap used for covering a defect located on the proximal third of the tail. Also a “spiral closure technique” can be used to close small to medium size defects on the tail. The use of the advancement flap is usually the first choice in approaching the closure of defects if they can not be closed by undermining and suturing. This article illustrates the usage of advancement flap from the base of the tail for closing the surgical defect left after excision of a tumor located on the dorsal proximal third of the tail in a dog. No complications were noted after surgery and the tail maintained the normal function.

 

Case report

 

A 5 years old female neutered cross breed dog was admitted for assessment of a lump located on the tail. The owner was not sure for how long time the lump was in that place and how fast developed, was just recently observed on the tail.

On general examination no abnormalities were detected. A 4 cm mass was identified on the dorsal aspect of the mid proximal third of the tail. The mass had round shape, located under the skin and well attached to the coccygeus muscle. On palpation, local temperature was normal, elastic-firm consistency, without local pain. No other abnormalities were detected. Fine needle aspirate was recommended and performed before surgery.

Cytologic interpretation: marked pyogranulomatous inflammation, epithelial proliferation, neoplasia probable and evidence of mineralization.

 

 

 

Surgical approach and suture technique

 

Surgical site was aseptically prepared and the patient was placed on the table in ventral recumbency. Before starting the procedure, another evaluation of the mass in relation to the skin located on sacro-coccygeal area but also with the skin which surrounds the mass was done. Before incision, the skin mobility was checked. In physiological position a small skin fold was observed cranially to the lump (Fig.1).

78346759_2393783297549969_4542870446093107200_n

Figure 1. Preoperative appearance of the sacrococcygeal area after surgical site preparation. The tumor have a spheric shape, is located in the proximal third area of the tail-dorsal aspect and have a wide base of implantation. At the base of the tail a small fold can be observed

A circular incision was performed 3mm distance from the mass. No.10 scalpel blade was used to create the skin incision and the dissection until the muscle was done with Metzenbaum scissors.

 

A thin capsule that surrounds the mass was discovered at the junction between it and the coccygeal muscle. At that point the dissection was performed with the scalpel blade until the end. Care was taken to avoid the major vassels of the tail( Fig 2, Aand B)

Figure 2. Intraoperative view of the tail. (A) Right lateral side before tumor excision and (B) left lateral side after full excision hightlights the intact lateral coccygeal veins (yellow and black arrows).

 

 

78561561_811151145981832_8931977240468520960_n

Fig 2

78657130_445332022812163_8031162679685021696_n

Fig 2

 

 

 

78752190_487893868488710_7100718041469550592_n

Figure 3. Transverse section at the level of caudal vertebrae illustrates distribution of the muscles

The tail movements are coordinated by 6 pairs of muscles (12 muscles in total) that are distributed concentrically over the coccygeal vertebrae (Fig.3).

 

 

 

The vascular supply of the tail is composed by 2 lateral caudal veins and arteries located

on lateral sides and the median caudal artery and vein. In this case both caudal lateral veins were preserved. Minimal bleeding was present and the small blood vassels were ligated with 3/0 PGA. Two parallel lines extended from the proximal border of

the defect to the base of the tail were  made in the skin deep to the muscle. Meticulous dissection of the skin was performed with Metzenbaum scissors until the fold located at the base of the tail. The flap was elevated and advanced distally to cover the defect

(Fig.4 A). The flap managed to cover ¾ of the defect without tension. Undermining of the skin  located on the distal border was attempted to obtain the mobility that can help to cover the ¼ of the defect but faild. To obtain the maximum coverage, walking sutures were used to further advance the flap. The first bite went deep into the dermis and the second bite in the tendinous portion of the m.  sacrocaudalis dorsalis  lateralis (sacrococcygeus dorsalis lateralis).Few walking sutures were placed so that the tension is equally distributed (Fig. 4B).

Figure 4. Undermining and elevation of the skin flap. (A) Stay sutured were placed on the flap corners (yellow arrows) to manipulate the skin; (B) Closer wiev of the first walking suture. First bite (blue arrow) is inserted deep in the dermis and the second bite is inserted in the tendons of m. sacrocaudalis dorsalis lateralis (black arrow).

78594361_612991579480291_9147111151597780992_n

Fig 4

78549079_616311509109836_2261091335480016896_n

Fig 4

 

 

 

 

 

 

 

 

 

 

 

 

Nor following this procedure the primary defect has not been fully covered. In the end, horizontal mattres pattern (“U” shape) was used on the edge of the flap and full coverage was achieved under moderate tension (Fig.5).

 

79927998_540517130128091_7459387826895847424_n

Figure 5. Dorsal aspect of the tail after final closure

 

Usually after advancing a flap “dog      ears” will result at the base. In this particular    case minimal “dog ears” were present. For a    cosmetic appearance and to preserve the soft     tissue, central suture technique was performed     on the lateral sides of the skin flap due to crescent    shaped defect. There are many ways to close up a crescent shaped defect but in this particular case central suture technique was chosen to avoid “dog    ears” removal. First simple interrupted suture was placed     in the middle of the defect and after, another  sutures in the middle of the two defects obtained   and so on until complete closure.

 

The central closure technique distributes the “dog ears” all along the sutures line in small increments (Fig.6a, 6b). In the end, the final aspect of the tail in relaxing position was changed due to advancement flap. The tail gain a curved up position (Fig.6).

Figure 6. Central suture technique. (a) Left lateral view of the tail illustrates no “dog ear” present at the base of the flap due to suture technique. The black line show the curved shape of the tail after the final closure. (b) Illustration of closure of crescent shape defect1.

78602084_2532339577037341_5783121099822727168_n

Fig 6

78472698_420094512229176_6802791841071628288_n

Fig 6

 

 

 

 

 

 

 

 

 

 

 

Postoperative care 

 

78494333_842587132825425_8327883441676746752_n

Figure 7. Postoperative view after bandage application

For protection, a soft padded bandage was      used to cover the surgical site, this being made up of  square gauze applied on top, fixed in place with an elastic band; Stirrups were applied over the gauze and  extended proximally to the base of the tail and Vetrap  was used as a last layer (Fig.7).

 

The patient was sent home with booster collar to prevent self trauma and 3 days of robenacoxib, also in the surgery day a NSAID injection was administered with the same nonsteroidal anti-inflammatory drug. Until the first recheck (3 days post surgery) the bandage has fallen due to excessive tail movement in 24 hours but the owner apply another one at home; Four days after surgery the patient present for the first recheck, on inspection the tail was less curved in compare with the day the surgery was performed and no complications were present. The owner reports the patient was comfortable at home after surgery, and did not show any changes in behavior. The same bandage was applied in the same manner and this time did not slip until the second visit.                 The patient has presented for sutures removal in day 10 aftert surgery . No postoperative complications were present and the tail was less curved upwords. One last visit was 34 days after surgery. Due to the weight of the tail, continous tension was applied on the skin over time and the natural position was regain (the processes of mechanical creep and stress relaxation) (Fig.8). The owner reptorts the patient was comfortable in all this period and does not seem to be disturbed by surgery.

Figure 8. Ventral (A) and right lateral (B) aspect of the tail after sutures removal – 10 days post surgery; (C) Dorsal view of the tail 34 days after surgery.

79332501_2589065501380609_2151178324896907264_n

Fig 8

78544522_559002944920035_7174581029305319424_n

Fig 8

78534452_1841938695949689_3873558410725163008_n

Fig 8

 

 

Histopthologic result and prognosis

 

The mass (Fig. 9) was put into a containter with formol and sent to the lab for histopathologic examination. Pilomatricoma partially ruptured and mineralized, associated with moderate granulomatous inflammation. This is a benign tumour of the hair follicle, slow growing, non-invasive, and generally rarely metastasizes (malignant variant exists but is rare). was the diagnosis and clear margins were achieved and the prognosis is was good. Poodles, Schnauzers and Kerry Blue and Bedlington terriers may be predisposed.

 

78526523_712125492614617_692359963749646336_n 79379385_2591131814455479_8179800034531868672_n

Veterinarians speak…..Pamas Trading- our first partner! Thank you for doing it!

 

12814393_1673705086236432_1339900710371625092_n

 

 

Dr Andrei Timen , senior president of AMVAC

 

 

Pamas Trading is one of the best veterinary distribution company in Romania. Their portofolio for small animal consists in pet food , diets and medecines very usefull for clinicians. We have a very good cooperation and every year new products are offered on vet market. I believe in this partnership and hope that our relation will be better every year.

 

 

Dr Raluca Zvorasteanu

 

We have been working with Pamas for many years. The portfolio of products offered by them meets our standards and that of our clients. As professionals we want to offer only what is best to increase the quality of animal life. Together with Pamas we managed to raise the standards, offering treatments with the latest generation products. Collaboration with them is a flexible one, being prompt and attentive to our requirements as veterinarians

 

 

Clinica Veterinara Ortovet

 

During our collaboration, Pamas provided us with a wide range of products, which we have used with good results in the treatment and care of our patients. We enjoy an efficient communication, the Pamas team giving us prompt and appropriate answers to our needs.
Thank you, Pamas!
The Ortovet team

 

Dr Simon Corneliu, Tazyvet Clinic

 

I like the collaboration with the company Pamas because it is a company with good management.
It has good products which then become a brand under their distribution.
Always looking to distribute good and niche products.
They have flexible payment terms and are prompt in delivery.
It encourages and facilitates young doctors in the exchange of experience with other clinics.
I wish them success in what they do and keep it that way.

 

Dr Ina Dragomir

In the more than 4 years of collaboration, Pamas has shown me that it is a company I can rely on, with a wide portfolio of products and seriousness in the delivery of orders. Also, the team from which it is formed and that broke my threshold in the cabinet is cooperative, united and very serious. At the same time, all its members proved to be jumping, understanding and always funny. I hug you PAMAS!

 

Dr Matei Alexandru

We have been collaborating with Pamas company for over 7 years. During this time we managed to create a strong connection based on professionalism and mutual trust. All the problems that have appeared over the years have been solved in a professional and equitable manner for both parties. I have recommended and I will continue to recommend my colleagues to collaborate with Pamas Trading for the quality of the products and for the short delivery time.

 

Dr Sonia Pintece

 

The Pamas Trading Company is very professional, they pay attention to our needs, the delivery is fast and they have good prices. Pamas Trading and Dr. Luba Ganceva by ”Learn and Travel” program made possible my externship to Central Vet Clinic – Sofia, Bulgaria and for that I would like to say : ” Thank you!”.

 

 

Dr Mirel Marafet

 

 

I have been working with Pamas for over 5 years, during which time it has proved to me that it is a company I can rely on. I hug you and wish you Happy Holidays PAMAS

Learn and Travel… a new story from Bulgaria and Italy

80573570_576596106473856_4151501502684332032_nDr Plamena Boycheva from Bulgaria attended our program Learn and Trave with Vets on The Balkans in December 2019 with the support of Blue Sky Commerce and Clinica Veterinara Laggo Magiore.

 

Let her tell us more about her adventure:

“We all know that to be good vets and to provide the best possible care for our patients we need to be up to date with the newest, the most modern and well-used techniques in our everyday practice. Is there a better way to achieve that than being part of a Vet on the Balkans. Talking about pursuing that goal, I want to thank the whole team of Blue sky commerce and Vet on the Balkans.

I am thrilled to have had the opportunity to be part of the Lago Maggiore Clinic team, even for a week. After a few emails exchanged, I knew that I was going to the right place. I had no doubts regarding my safe journey and the organization of the trip. Let me tell you how I spent my time there:

In a late and rainy afternoon, I arrived at the airport in Italy, where I was greeted by Dr Sara Manfredini – an incredible person and anesthesiologist, who showed me handy tips in anaesthesia. Furthermore, I find out what a great spirit she has. I can easily say that she is the heart of the clinic; she has never stopped giving her passion for everything she has done. She was very supportive, and on the very same day, she arranged a tour around the clinic. I was impressed with the scale of the clinic. There are digital X-ray, CT, well-equipped laboratory room, endoscapy, ultrasound very well organized stationary. Of course, Dr Sara Manfredini was so kind as to order an Italian pizza for my first dinner there. Immediately I felt a friendly and warm atmosphere. Then I met Dr Jessica; rigorous and dedicated doctor. She was the person who showed the apartment where I would be staying and made my time there very easy; thank you, Jessica, for being so lovely and kind.

My colleagues had thought of everything, and the organization was incredible, like everything else that the team do. I can assure you that the atmosphere of this place is terrific.

The chief doctor at the time that I was there was Dr Mariangela De Franco, who has inspired my work. Also, she gave me essential pieces of advice on the field of echocardiography, in which I am very interested. She is not only a fantastic specialist but also a wonderful person. She has led her team with great love and warmth, which reflected on their overall work and attitude towards patients. A few days later, I had the honour to meet Dr Luigi Venko and Dr Luca Formaggini; Two exceptional people and doctors. With professionalism and humanity Dr Formagini, the head of the clinic is the inspiration of each member of the team. Everyone at the clinic has been dedicated and has taught many tricks in my day-to-day work. Besides the professional experience I had given, I also learned to cook some Italian dishes according to original recipes.12745855_10153614352488768_1773045904046497569_n

Although, I might not mention everyone: thank you, people, for your hospitality, your attitude and your guidance. Thank you for the spirit you carry. I wish I would have the opportunity to meet you again soon.”learn and travel23316272_180060419216123_164154967085808895_n