Ninth International Conference on Antimicrobial Agents in Veterinary Medicine (AAVM)

unnamed(1)We are currently preparing the Ninth International Conference on Antimicrobial Agents in Veterinary Medicine (AAVM), to be held in Rome, Italy, October 16-19, 2018. This forthcoming conference follows the success of the past eight AAVM held in Helsinki, Ottawa, Orlando, Prague, Tel Aviv, Washington DC, Berlin and Budapest. This conference has emerged as one of the leading meetings in its field, which provides a very intensive program and encourages communication among the attendees.

Infectious diseases are very common in veterinary medicine and antimicrobial agents have a predominant role in veterinary therapeutics both in farm and companion animals. Antimicrobial use is still under the spotlight for the potential of antimicrobial resistance and human health risks. Valid alternatives to these drugs are still not routinely available and the veterinary medicine has to deal with their use and with a more modern and updated approach in the therapy. These aspects and many others, such as, pharmacokinetics, pharmacodynamics, PK/PD modelling, antimicrobial resistance, residues, clinical trials, new antimicrobial molecules, etc. will stay in the forefront of the topics of the AAVM programs and will be discussed in depth with the participation of speakers of high repute as well as attendees.

Veterinary use of antimicrobials has been increasingly criticized, especially for the potential of resistance transfer from farm animals to humans. Simultaneously, the ever decreasing introduction of new antimicrobial molecules has also limited the number of useful therapeutic agents. Modern approaches for infection reduction in intensive rearing farms are in progress. New ideas of alternatives and “greener” options in the treatment of infectious diseases are under investigation. What the potentials are will also be addressed in the upcoming AAVM meeting.

We look forward to welcoming you to Rome in October.

More info: https://www.aavm2018.com/program-outline

Transplantation of ipsilateral canine ulna as a vascularized bone graft for treatment of distal radial osteosarcoma

12959354_10153530931267960_1853416198_o-200x300

Dr. Vladislav Zlatinov,

Corresponding author :

Dr. Vladislav Zlatinov,

Central Veterinary Clinic

Chavdar Mutafov str, 25 B, Sofia, Bulgaria

E-mail: zlatinov_vet@yahoo.com

 

 

Abstract

 

This case report describes the successful use of a vascularized cortical autograft from the ipsilateral ulna in limb-sparing surgery for the treatment of distal radial osteosarcoma. A pancarpal arthrodesis with two orthogonal plates was performed to stabilize the site. No implant failure and local tumor recurrence were observed in the 6 months post operative period. Excellent limb function was achieved within 6 weeks after surgery; no external support (coaptation) were used during the post operative period. Excellent perceived quality recovery, was reported by the dog’s owners, compared to their preliminary outcome expectations.

 

Introduction

 

Osteosarcoma (OSA) is the most common primary bone tumor in dogs, most commonly affecting the distal radius. Current treatment protocols-Fig.1 are based on a combination of surgery (limb amputation or limb sparing surgery) and adjuvant chemotherapy. Palliative therapies like- Stereotactic radiation or Percutaneous

Fig.1

Fig.1 Osteosracoma treatment algorithm

Cementoplasty therapy are rarely applied with limited success 1,2.

 

 

 

 

 

 

 

 

 

 

 

Recently, numerous publications suggest that the Limb-sparing surgery is a viable alternative to limb amputation in selected cases, especially indicated if there is pre-existing orthopedic or neurological disease or if owners are resistant to limb amputation 3,4,5,6.

 

 

Limb- sparing consists of removing the segment of bone involving the primary tumor and using internal or external fixation to the remaining bones with or without segmental bone replacement, resulting in a salvaged functional limb 7. Limb- salvage procedures

have been described in the distal aspect of the radius, proximal humerus, distal tibia, and proximal femur in dogs with OSA, but the salvage surgery of the distal aspect of the radius has produced the most favorable results. This is mainly because pancarpal arthrodesis is well tolerated by dogs, not like fusion of other joints. Importantly – the prognosis for survival is the same with amputation or limb- sparing, unless an infection is present, in which case the average survival is prolonged.

 

Candidates for limb sparing

 

Good surgical candidates are dogs with OSA confined to the bone, with minimal extension into adjacent soft tis­sue and involving less than 50% of the bone length. The extent of bone involvement is most accurately determined by using computed tomog­raphy and is overestimated by radiography, nuclear scintigraphy, and magnetic resonance imaging 8. Pathologic fracture is a relative contraindication for limb-sparing because of tumor seeding into adjacent soft tissue, although the risk of local tumor recurrence can be re­duced by use of preoperative chemo­therapy or radiation therapy.

 

 

Limb sparing techniques

 

Historically, the most commonly performed limb sparing technique for the distal radial site involved the use of an allograft (donor from an individual of the same species) to replace the bone defect created by segmental bone excision 9- Fig.2. Although the limb function is good to excellent in about 80% of dogs with the allograft technique, the complication rate is substantial. The most common complications include infection, implant related problems, and local recurrence. Infection rate is reported to be up to 60%, implant failure in up to 50% as well. Even more, there are practicality issues for the regular application of the allograft technique- time consuming and costly maintenance of a bone bank. Recently,  there is a new alternative for graft purchasing from a commercial source on a case by case basis.

Fig.2

Fig.2 Allograft limbs spring surgery

 

It’s not surprising that alternative limb-sparing methods are being investigated. Reported grafting techniques include pasteurized/ irradiated autografts, endoprosthesis, vascularized ulnar transposition graft (roll-over technqique), free microvascular ulnar autograft.

 

Nevertheless the technical evolution of the available techniques, all of them are still often associated with a high complication rate including infection, construct failure, and tumor recurrence. The longitudinal or transverse bone transport osteogenesis has the advantages to lower the aforementioned complications but still have limitation for routine implementation in the practice 10, 11.

The advantages and disadvantages of the recent innovative techniques are shortly summarized below.

 

Fig.3

Fig.3 Endoprosthesis limb salvage procedure

The most prominent advantage of the endoprosthesis limb salvage (Fig.3) is the simplicity compared to the other grafting techniques; consequently it is time-saving. Decreasing the surgery time may suggest lower infection ration.  Unfortunately this was not proved by the clinical experience with the currently commercially available endoprosthesis.

 

 

A recent study 4, comparing the results of  Cortical Allograft and Endoprosthesis techniques, suggested  surgical infection of 60 and 55% of the cases, respectively. The use of a large volume of implants and foreign material has been proposed as a cause. More over in the same study, long term implant failure occurred in 40% of the treated dogs.

A positive remark in the paper is the good (subjectively) limb function, reported in the stable phases or in non-complicated cases.

 

Fig.4

Fig.4 Ulnar roll-over salvage technique

A more biologic friendly technique- ulnar roll-over – Fig.4 was resently reported with good results, despite limb shortening of up to 24 % 3,12,13. The distal ulna is osteotomized, rolled into the radial defect, and secured with a bone plate and screws. With this technique the preservation of the caudal interosseous artery and vein and a cuff of the deep digital flexor, abductor pollicis longus, and pronator quadratus muscles are important for maintaining viability of the transplanted ulna.

 

 

Theoretically, using a vascularized bone graft could reduce the gross incidence of complications compared to an allografts or endoprothesis. Vascularized bone is more resistant to infections, to the extent that vascularized cortical autografts have been used to treat osteomyelitis. Also the use of a viable graft may preserve biomechanical properties over allografts. Whereas the allograft may resorb and become weaker over time, the ulnar graft may maintain its physical properties or even hypertrophy and healing with the host bones.

However, the statistics reports are controversial, with no clear proof for substantially better outcomes. One study shows no statistically different infection (45%) and implant failure (55%) ratio. Probably the presence of a viable graft does not address all other factors predisposing to infection (poor soft tissue coverage, immunosuppression from neoplasia and chemotherapy, and use of orthopedic implants). The other complication problem- implant failure, sounds as  a surgeon’s skills dependent issue. For example one of the major complication in the mentioned study has been fracture of the remaining radius in cases of great length resection (>57%), which could be just consequence of suboptimal plate length or screws number and distribution.

Importantly, the roll-over technique demands sufficient length of the distal ulna to be preserved, but local recurrence was not increased compared to other limb- sparing techniques.

Microvascular anastomosed bone transfer was used in the presented case. This is a routine procedure in the limb sparing surgeries in human patient, but rarely applied technique in veterinary medicine, nevertheless, the vascular supply of the distal ulna has been , studied, described and successfully used experimentally and clinically 14,15.

In this technique, a more substantial middiaphysis segment of the ipsilateral ulna, with its source artery and vein (the common interosseous) is harvested and transpositioned, with a blood supply restored by vascular anastomosis to a neighboring artery and vein, once the graft is in its new position. The surgical technique is described further in the text. The concept is the same as the ulnar roll-over but, with the advantages of stronger cortical ulnar graft used, more mobile graft and  a chance for full distal ulnar resection. The disadvantages of this procedure are the need for a specially trained and equipped microvascular team and the prolonged surgical time.

Longitudinal bone transport osteogenesis

 

Fig.5

Fig.5 Longitudinal bone transport osteogenesis

This is a specific application of distraction osteogenesis, which has been used successfully in dogs for replacement of large segmental defects of the distal aspect of the radius and tibia after tumor resection. This is a process whereby healthy, detached bone segment is sequentially moved across an adjacent segmental osseous defect forming new regenerate bone in the distraction gap -Fig.5.The regenerate bone is highly vascular and resistant to infection.

The results following the procedure have been very encouraging, with good orthopedic function and no reported infections. Disadvantages of the bone transport osteogenesis procedure is the significant amount of time required to fill the defect after tumor removal (up to 7 months). This often leads to owner compliance issues (distracting the apparatus two to four times per day), also pin-tract drainage and loosening, difficulty in docking the intercalary bone onto the radial carpal bone.

Fig.6

Fig.6 Transverse Ulnar Bone Transport Osteogenesis

A recent modification –Transverse Ulnar Bone Transport Osteogenesis, has been reported 16- Fig.6. The technique substantially decrease distraction times. In one case report,  distraction of the ulnar transport segment across the 84 mm longitudinal segmental radial defect, was completed in 23 days.

 

 

 

Case report

 

 

A 9-year-old female Rottweiler dog (43 kg) was referred to our practice with a 3- weeks history of left forelimb lameness with an gradual onset and an unknown origin. The dog was been previously prescribed NSAIDs with temporary effect. During our examination we found weight-bearing lameness II/V. Physical and orthopedic examination revealed distal radial swelling on the left forelimb, with pain on extension of the carpal joint.

 

Fig.7

Fig.7 Orthogonal limb radiograph

Orthogonal radiographs were achieved, revealing vast osteolytic (relatively smooth margins) area in the  distal radius, with no apparent lesions in the distal ulna- Fig.7

 

 

Based on the history, signalment, lesion location, and radiographic findings, a primary bone tumor was suspected.

Fig.8

Fig.8 Thoracic X ray

No abnormalities were detected on preoperative 3-view thoracic radiographs, abdominal ultrasound, echocardiography, and blood tests- Fig.8. The Alkaline Phosphatase (AP) value was 195 U/L- in the upper limit but still within the reference range for the breed.

Treatment options were discussed with the owners:

 

-conservative palliative treatment

-amputation and chemotherapy

-limb-sparing surgery in conjunction with chemotherapy;

 

The owners chose the last  course of treatment but insisted on preoperative histologic confirmation of the suspected diagnosis.

 

Fig.9

Fig.9 Pathological fracture of the cranio-distal cortex

After short anesthesia and minimal invasive approach, tissue biopsy sample was retrieved and send for analysis. Ten day later the the suspicious of osteosarcoma neoplasia was confirmed. The histologist comments were: moderately aggressive OSA with low mitotic figures. Meanwhile the dog showed acute lameness deterioration, related to a pathological fracture of the cranio-distal cortex of the radius, following the biopsy procedure- Fig.9.

 

A limb sparing procedure (roll-over vs. free vascularized) grafting was planned.

 

Twenty minutes before the skin incision high segmental epidural analgesia wad accomplished at the level of T11, infusing 2 ml of 0,25 % Levobupivacian solution and positioning the patient in left lateral recumbency for 10 minutes- Fig. 10.

 

 

Fig.10

Fig.10 Segmental epidural analgesia

Fig.11

Fig.11 Sternal recumbency

 

 

 

 

 

 

 

For the surgical intervention, the dog was positioned in sternal recumbency- Fig 11. , facilitating  a dorsal approach to the radius and carpus. Careful tissue examination was done during the sharp dissection of  the distal soft tissues. Caudally, the tumor was closely attached to the distal ulna. Thus, the tumor was not dissected caudally to avoid contamination. A decision for a more extending distal ulnar resection was made. This prevented the option for roll-over technique more advanced free vascularized transfer was prepared.

The extensor carpi radialis muscle was transected proximal and distal to the tumor; the common and lateral digital extensor tendons were spared. An oscillating saw was used in both radial and ulnar osteotomies. The level of the transverse osteotomy of the radius, 2 cm proximal to the tumor, was determined on radiographs and confirmed appropriately intraoperatively. The ulna was osteotomized at lower level, just over the overlapping zone with the radius. The radius was disarticulated at the antebrachiocarpal joint and the tumor removed en bloc with the distal ulna. The length of the resected radial segment was 10 cm, including the 2-cm free margins (this represented 45% of the total radial length). The whole radio-ulnar segment was stored in 10 % formalin solution for later histologic analysis-Fig.12 and 13

 

Fig.12

Fig.12

Fig.13

Fig.13

 

 

 

 

 

After tumor removal the limb sparing was continued with cartilage debridement from the carpal and metacarpal bones , accomplished by using a speed burr drill; several penetrating drill holes were created in dorsal surface of the radial carpal bone.

The resected radial bone segment was measured and a second ulnar osteotomy performed proximally using a separate blade to match the length of removed radial bone minus 1,5 cm. The proximal ulnar osteotomy was performed above the level of the radial osteotomy while identifying and carefully dissecting the caudal interosseous artery and vein.The last were a-traumatically clamped and transected as proximal as possible, preserving as much as possible of the vessel length.The muscle attachments of the abductor pollicis longus, ulnar head of the deep digital flexor, and pronator quadratus were kept intact onto the periosteum of the distal aspect of the ulna.

The ulnar graft was transposed into the radial defect and the proximal end of the common interosseal artery (<2  mm) was anastomosed to a distal branch of the median artery. The anastomosis was accomplished with the use of magnification (10x) with surgical microscope and fine jewelers forceps- Fig.14 and 15. General principles of end-to-end vascular anastomosis were followed- atraumatic handling, distance of 0,5- 1 mm from the vascular wound’s edge, the regular suture distance, etc. Five interrupted sutures (8-0 nylon) were used to seal the anastomosis. The total ischemic time of the bone graft was about 60 minutes.

Fig.14

Fig.14 Microscope- assisted arterial anastomosis

Fig.15

Fig.15

 

 

 

 

 

 

 

 

The microanastomosis success was confirmed by identification of a active blood flow present in the graft’s tissues and the distal end of the interosseal artery (video 1 ).  The corresponding vein was not anastomosed, but its end was left free in the surrounding soft tissues. The distal artery ending was ligated.

 

 

After the anastomosis, the procedure was finished by stabilization of the bone graft by long plate, engaging from the distal metacarpal bones to the proximal radius, on the cranio-dorsal surface. We used hybrid 4,5 mm plate (Mikromed, human series) allowing fixation with 4,5 mm screw proximally, 3,5 mm in the middle area (free graft) and divergent 2,7 mm screws in the III and IV metacarpal bones. A second orthogonal plate 3,5 mm reconstructive locking (Mikromed) was applied laterally, fixating the proximal radius to the fifth metacarpal bone- Fig.16 and 17. Copious cancellous bone graft (from proximal humerus) was retrieved and stacked at the level of all osteotomy gaps.

Fig.16

Fig.16

Fig.17

Fig.17

 

 

 

 

 

 

 

 

 

 

After copious wound lavage and before closing of the surgical wound, the implants were covered by Gentamycin impreganted bovine collagen sponges (Gentacoll- resorb). The goal of the last was infection prevention. A soaker catheter was also inserted along the full length of the surgical wound. Subcutaneous tissue and skin were closed routinely. After skin suturing, the leg was bandaged  with modified Robert -Jones bandage for the next 12 hours. The soaker catheter was attached to elastomeric pump, delivering 1 % Lidocain solution – 5 ml/h, for the next 3 days.

 

 

Post operative care

 

 

Postoperative analgesia consisted of: local Lidocain flash block delivery by the elastomeric pump (36 h) , Butorphanol  (0.3 mg/kg, every 6 h, i.v.) and meloxicam (0.1 mg/kg /24h ,s.c.).

 

Fig.18

Fig.18

Cryotherapy (frizzed towels compresses) was applied every 4 hours for the  next 48 h- Fig. 18

 

Cephazolin (20 mg/kg/8 h, i.v.) was applied for 3 days post op.

 

 

On the third post operative day -the dog was discharged, with oral Cimalgex (Cimicoxib, 2 mg/kg/day) for 14 days. Oral amoxicilin clavulonic acid  (12,5 mg/kg/12h) was administered for 2 weeks and exercise was restricted to short walks on a leash for 12 weeks. The dog was re-examined regularly- every 14 days, including the visits for the chemotherapy sessions.

 

Chemotherapy protocol

 

Fig.19

Fig.19

The histopathological diagnosis of the excised bone confirmed a grade II fibroblastic osteosarcoma (OSA)– Fig. 19. Surgical resection was considered complete with no evidence of neoplasia at joint compartment.

 

Fig.20

Fig.20 Carboplatin

A single agent protocol -carboplatin (300 mg/m2)- Fig. 20,  was planned and applied every 3 wk for a total of 5 treatments. The first treatment was started 2 weeks after surgery. A CBC was taken 2 weeks after and just before each carboplatin administration; serum biochemistry was performed every 2 months. There was no evidence of gastrointestinal upset, renal failure or  myelosupression after chemotherapy. The AP levels were always in the reference range.

 

 

 

 

Clinical recovery and Follow up

 

 

Lameness progressively improved from toe-touching (one day after surgery) to full weight-bearing with only slightl visible lameness- 6 weeks post op. No external coaptation was applied during the recovery period- Fig.21, Video 2- 3.

 

 

 

Fig.21

Fig.21 Three weeks post op

Fig.22

Fig.22 Six months post op

Fig.23

Fig.23 After lateral plate removal

 

 

 

 

 

 

 

 

 

 

 

 

 

Six months post op the limb function was appreciated as excellent, without any significant changes on limb palpation- Fig.22. Video 4. Orthogonal radiographs were taken, showing proximal bone fusion; distally the bone was superimposed by the lateral plate. No signs of construct failure were observed. A decision for dynamisation was made and the lateral plate was removed, revealing radiographically the bony structure under it. It showed good bone density and excellent graft fusion (primary), proximally and distally. Further segment hypertrophy is expected by the increased load sharing.

 

 

 

 

 

CONCLUSIONS

 

The limb sparing surgery could be a viable option for treating distal radial OSA in properly selected cases. With the innovative alternatives, the widely accepted approach to canine OSA – limb amputation treatment, should not be applied as “default treatment” in each case.  Case to case individual approach may provide the pets and their owners more fare attitude. Excellent functional results of the limb may be achieved by a complex (but single stage) surgical segment resection and appropriate bone reconstruction and rigid fixation. The use of free vascularized bone graft is a manageable option and an alternative to ulnar-roll over in cases of distal ulnar tumor engagement or vast radial segments resection, where solid vascular bone grafting is demanded.IMG_6122

INGHINO-SCROTAL HERNIA/INTESTINAL OCCLUSION, ACUTE ABDOMEN

timisoara

Dr Fodor Lucian

Lazar Laura¹,    Fodor Lucian²,

¹ʼ²ʼDVM, Veterinary clinic, Happy  Pet Timisoara, Romania

 

Key words:   inguinal hernia, intestinal occlusion, acute abdomen, enterectomy

 

 

Introduction:

An inguinal hernia is a condition in which the abdominal contents protrude through the inguinal canal or inguinal ring, an opening which occurs in the muscle wall in the groin area.

In dogs, inguinal hernias may be acquired (not present at birth but developing later in life) or congenital (present at birth). Factors which predispose a dog to develop an inguinal hernia include trauma, obesity, and pregnancy.

Most inguinal hernias are uncomplicated and cause no symptoms other than a swelling in the groin area. However, if contents from the abdominal cavity (such as the bladder, a loop of intestines or the uterus) pass through the opening and become entrapped there, the situation can become life-threatening.(2)1 2 3 4 5 6

 

 

 

 

 

 

 

 

 

Inguinal hernia may evolve to scrotal hernia when herniated viscera pass down the inguinal canal.The internal, or deep, inguinal ring remains patent in intact male animals.(1)

Inguinal hernias can usually be diagnosed by finding the swelling caused by the hernia on a physical examination. However, sometimes contrast radiographs (X-rays) or an abdominal ultrasound are needed to determine which abdominal contents, if any, are entrapped.(2)

 

Case  report:

 

A six year old intact male jack russel terrier,fully vaccinated and dewormed  suffering an episod of  letarghia, voma  and apatia for two days.He followed an symptomathic treatment with painkillers and antispastics from his current veterinarian.

The owner became worried because his symptoms got worse, so he was admitted in our clinic as an emergency after the program hours.

 

Clinical evaluation

his symtomps included:

-severe peritoneal response

-apatia, lethargya

-medium dehydration

-the left testicle was increased in volume

An abdominal ultrasound was performed, was noticed a decreased intestinal motility, with gas presence.

Diagnosis:

inghino-scrotal hernia/intestinal occlusion

 

Treatment

The pacient was initially rehydrated, after stabilization of vital functions was put under general anesthesia and intubated.Surgical intervention was performed, starting initially with the opening of the affected testicle who was enlarged, coloured modified  and continuing with medial celiotomy(Fig.1).The terminal part of the small intestine was herniated inside of the spermatic cord (Fig.2).The affected part was aproximatly 10 cm long, with modified tissue and with the rupture of the intestine wall. (Fig 2,3,4) .Following this an enterectomy was performed (fig. 5) with termino-terminal enteroanastomosis.( Fig. 6,).The pacient was also castrated.

 

     After surgery

The patient condition improved very fast within hours he drank water and ate food.He was also very responsive and playful from the first day.He followed five days of treatment with Metronidazol (20 mg/kg/2×1/day).

 

Conclusion:

The inghino-scrotal hernia is a medical emergency and the intervention must be in the shortest time due to life threatening.

 

 

 

Biblioghaphy

 

  1. Jubb, Kennedy and Palmer’s, Pathology of domestic animals, E Book, vol. II, pg.80

Dermatophytosis (Ringworm)

stef artMarina-Ştefania Stroe, DVM

Romania

History

Dog, yorkshire terrier, F, 6 years old, spayed, vaccinated, dewormed and with fleas and ticks treatment done, 2 kg. She has been scratched for 2 weeks. A new cat was brought home three weeks ago. The cat present areas of alopecia on the tail.

 

WhatsApp Image 2017-09-03 at 15.41.53

fig 1

Circumscribed lesions on the shoulder (Fig. 1) and on ventral cervical region (Fig. 3), areas of round shaped alopecia with erythema, scaling.

Remaining hairs may appear broken off.

WhatsApp Image 2017-09-03 at 15.41.44

fig 2

WhatsApp Image 2017-09-03 at 15.41.52

fig 3

Positive Wood’s lamp examination – apple green glow associated with the root of each hair (Fig. 2)

Matt fur examined with Wood’s lamp:

auricular pavilion (Fig. 4) and cervical ventral (Fig. 5) positive, fluorescent hairs.

WhatsApp Image 2017-09-03 at 15.41.49

fig 4

Picture1

fig 5

A true dermatophyte infection reveals an apple green fluorescence on the roots of the hair.

 

Diagnosis

Picture2

Fig. 6: Microscopic examination – hair with modified structure of medulla and cortex.

Dermatophytosis (Ringworm)

Other differentials (ex. demodicosis, superficial pyoderma).

Wood’s lamp examination: typical yellowish-green fluorescent hair shafts that can be given by Microsporum canis strains; only Microsporum canis fluoresces and in only about half of cases. The Wood’s lamp is useful in establishing a tentative diagnosis of dermatophytosis in dogs and cats but false-negative and false-positive results are common. Definitive diagnosis is established by DTM culture.

Trichogram: misshapen hair shafts infiltrated with hyphae and arthrospores.

Deep skin scraped: negative

Treatment

Topical antifungal treatment applied on whole body twice a week, for 6-8 weeks until the result of the DTM culture is negative. Bathing are recommended to be done with shampoo containing chlorhexidine and an antifungal (ex ketoconazole) after the animal has been clipped. Ointment containing clotrimazole applied locally in thin layer, daily.

Environment: Decontamination measures in the house, where the animal stood (changed and washed carpets, bedding, beds, pillows), taking all measures to remove spores.

Supplements based on Omega 3 and Omega 6, which will help reduce pruritus and inflammation.

Prognosis

The prognosis is good. However, it should not be forgotten that dermatophytosis is a contagious disease that can be transmitted to other animals and humans.

Cervical Herniated Disc in dog

timisoaraDR FODOR LUCIAN HAPPY PET, TIMISOARA ROMANIA

Introduction

 

Disc herniation is a neurological disorder that is characterized by slipping nucleus pulposus outside of the space between the bodies of two vertebrae, the clinical appearance of intense pain in the area. Practical part or whole kernel pulposus (soft area of ​​the intervertebral disc) herniates through a weakened area of ​​the intervertebral disc annulus. Disc herniation can occur at any level of the spine, but the two most common sites are the lumbar and cervical. To establish a diagnosis of certainty indicated imaging studies: x-rays, CT, MRI, myelography. Nuclear magnetic resonance (NMR) is much more appropriate than CT in diagnosing pathologies of the spine. The obtained images are three-dimensional and thus very well both visualization column and nerve roots, and can determine the disease itself. Currently, MRI is the imaging method for diagnosing first intention herniated disk and can even be used in patients who have no clinical symptoms.

 

Case report

 

A 4 years old male, boxer weighting 24kg was present to us, after 14 days of tetraplegia; the debut being 6 months ago when it started difficult and heavy lifting from the bottom, neck pain when the steroid anti-inflammatory drug was administrated, the symptoms were resolved;  14 days ago tetraplegia was installed.

 

Clinical Examination

The animal presents a normal body temperature, its respiratory and cardiac frequency is within normal values, biochemical parameters and blood results is not modified. Neurological tests point out the tetraplegia, with persistence of profound sensibility and the absence of superficial sensibility. After neurological examination were also present: abolished patellar reflexes, flexor reflex abolished, tibial reflex abolished, absence correctional reaction, panicular reflex abolished , anal reflex present globe bladder.

 

Additional Examinations

fig 1

fig 1

fig 2

fig 2

An MRI was done at the Telescan, Timisoara, which pointed out a extrusion of the intervertebral C2-C3 (fig. 1/2).

 

 

Diagnosis:

Cervical Herniated Disc C2-C3

 

 

Treatment:

 

  • Surgical Procedure

 

Surgical technique: ventral corpectomy, herniated disc extraction.

The dogs were anesthetized with a mixture of ketamine and xylazine (10 mg/kg and 15 mg/kg i. m.), Propofol (2 mg/kg) and artificially ventilated by a respirator with oxygen and monitored.

fig 3

fig 3

After trimming antisepsis field operator and 10% betadine solution, and took the subconjunctival tissue and skin incision, incision between the vertebrae C1-C4 (fig. 3)

fig 4

fig 4

fig 4

fig 5

fig 7 new

fig 6

After removing sternocephalic muscle, inferior thyroid artery is highlighted, (Fig 4/5) muscle sternohyoid that close side of trachea, esophagus, carotid, highlighting recurrent laryngeal nerve and muscle along the neck (Fig. 6)

The latter is detached the ventral tubercle of the affected disc space, resulting in highlighting the ventral face of the ring disk.

Discuss ring incision rise to the spinal canal, then extract the affected disc (Fig.7)

fig 7

fig 7

fig 8

fig 8

Hemostasis was secured with ultra incision Harmonic Scalpel(Fig.8)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • After surgery

 

Postoperative treatment containing corticotherapy 5 days, antibiotherapy 5 days and a bladder catheter the first 24 hours.

Surgery is commonly recommended on dogs that do not respond to medical treatment, have progressive clinical signs, or have more severe neurological deficits.

The efficacy of medical therapy may only be seen in patients that have minimal neurological deficits.

 

 

 

 

 

Discussion:

 

  • After surgery evolution of the clinical case has been very good.
  • 72 hours postoperative, the patient is able to move without any help. (Video)
  • After two months postoperative the animal is completely healed, and does not manifest any neurological symptoms.
  • The success rate with surgery is generally high provided that the spinal cord hasn’t been compressed for a long time (chronic spinal cord injury). Chronic cord injuries can be treated successfully with surgery, but the outlook is less favorable than it is for short-term (acute) injuries.

ABCD & Boehringer Ingelheim invite applications for the 2018 Young Scientist Award

 

abcdThe European Advisory Board on Cat Diseases (ABCD) invites applications for the 2018 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 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 (PubMed, Web of Science, Web of Knowledge) or accepted by another assessing body (e.g. a Thesis Committee) in 2016 or later.

 

Candidates should be based in Europe (EU or EFTA country), 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 March 2018.

 

The 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 28 June to 1 July 2018 in Sorrento, Italy. 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 recipient of the 2017 Award was Maciej Parys (University of Edinburgh).

 

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, karin.delange@abcd-vets.org

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Porencephaly in a pug dog with seizures – case report

 

 

421347_10151629937179640_1038846606_nDr Miroslav Todorov

Veterinary Clinic Blue Cross

Sofia, Bulgaria

 

Case presentation: a 3 and a half year old female pug dog was presented at the Bluecross Veterinary Clinic in Sofia for additional diagnostics in view of resently started seizure events.

A month ago the dog started having problems with its hind left limb and another vet started him on prednisolone. The limping improved but 20 days later the dog started having seizures.

The patient was examined at the Bluecross Veterinary Clinic in Blagoevgrad within two hours after one of the seizures. At that stage the dog wasn‘t able to see properly and showed a tendency to circle to the left. Blood was taken for Cbc and biochemistry analysis and the results were normal. The patient was started on an antiepileptics drug – Phenobarbital and the steroids were continued (because of the high possibility of an inflammatory process). An examination at the clinic in Sofia and additional advance imaging were scheduled.2 3 4 5 6 7 8 9 10 11 12

Clinical examination:

good general condition, slight difficulties in breathing (because of the brachiocephalic syndrome), normal heart and lung sounds, normal temperature.

Neurological examination: a little overexcited behaviour (but it was impossible to tell if this behaviour was abnormal for the dog or not). Normal cranial nerve reflexes, no nysgmus or circling, normal pupillary light reflexes. There was slight spinal ataxia in all four limbs. The proprioceptive tests were normal on all four. On the hind left limb the dog has pattelar luxation second degree (this explains the limping epizode a month ago). From the video provided by the owner it could be observed that the dog was demonstrating clonic- tonic seizure.

The owner was questioned for possible toxins, drugs and plants that could be the reason for the seizures but he said that the dog couldn’t have eaten anything abnormal.

A forebrain lesion was localised but the possibility of a multifocal process was very high.

The blood results were normal; therefore, possible extracranial reasons for the seizures were excluded. Toxin exposure was excluded by the anamnesis.

The list of differential diagnoses was:

  1. Inflammatory process – Necrotizing Meningoencephalitis (NME or Pug encephalitis)
  2. Idiopathic epilepsy
  3. Brain neoplasia
  4. Congenital lesion- hydrocephalus, cysts

To exclude most of the diagnoses from the list, advance imaging was performed – MRI 1,5tesla was used. The test was done with and without contrast material.

On the MRI we discovered a bilateral enlargement at the cranial part of both lateral ventricles within the frontal lobe of the brain. There was a visible communication between the ventricles and the subarachnoid space at the level of the eyes. They looked like cystic lesions filled with CSF. Bilateral loss of brain tissue was observed in both hemispheres. Around the cavities the cerebral cortex was reduced. These bilateral lesions could explain all the clinical signs that this dog was showing – seizures and the ataxia of all four limbs. There are motor cortex within the frontal lobe of the brain. There was no contrast enchantment after injection of contrast material within the brain tissue.

Therapeutic plan: the dog antiepileptic treatment was continued and regular measurements of the level of phenobarbital were scheduled. I added proton pump inhibitor –Esomeprazole (S enantiomer of omeprazole) because the drug has the effect of reducing the cerebrospinal fluid production. The steroids are slowly taped and they will be discontinued after two weeks.

The dog’s condition will be monitored by the owner and the vets at the BlueCross Veterinary Clinic in Blagoevgrad. In case of progression, especially after we stop the steroids, the necessity to take a CSF sample in order to finally exclude an inflammatory process is being discussed with the owner.

Porencephaly is a rare congenital cerebral defect and it is described in several reports in the field of veterinary medicine. It is more commonly seen in ruminants but there are few reports about dogs and cats.

There are few cystic congenital lesions of the brain, including focal lesions (porencephaly), extensive lesions (hydranencephaly) and very rarely schizencephaly (more commonly seen in humans). In porencephaly the defect creates a communication between the lateral ventricles and the subarachoid space. In schizencephaly the defect may be surrounded by a ring of polymicroglia. The schizencephalic defects are lined by gray matter.

The most frequent classification of these lesions based on their pathogenesis divides these defects into two major categories: developmental and encephaloclastic. Developmental porencephaly is due to a focal neuronal migration disorder, leaving a gap in the developing cerebral hemisphere. Encephaliclastic porencephaly includes cerebral cavities that result from tissue breakdown of various etiologies (cerebral ischemia, infection, trauma). In utero infection is the most common reason, especially in ruminants.

The interesting thing is that this type of lesions are congenital in nature but the clinical signs can start after the birth of the animal (which should be expected from the age) or sometimes later in life (after a few years).

According to the few reports about this type of pathology, the progression of the disease is different in every case. Some of those are completely asymptomatic, other cases are well controlled with drugs (antiepileptic drugs) third – their condition worsened, with poor control on drugs and some of those were euthanized. There was one report on a case of hydranencephaly where a ventriculoperitoneal shunt was placed and the dog’s condition slightly improved. Therefore, this is also a therapeutic option in some of those severe cases.

 

References:

  1. Porencephaly and cortical dysplasia as cause of seizures in a dog: Gisele Fabrino, Maria-Gisela Laranjeira, Augusto Schweigert and Guilherme Dias de Melo BMC Veterinary Research 2012
  2. Porencephaly and hydranencephaly in six dogs: Davies ES1, Volk HA, Behr S, Summers B, de Lahunta A, Syme H, Jull P, Garosi L. Vet Rec. 2012 Feb
  3. Porencephaly in dogs and cats: Magnetic resonance imaging findings and clinical signs: Schmidt MJ1, Klumpp S, Amort K, Jawinski S, Kramer M. Vet Radiol Ultrasound. 2012
  4. Porencephaly in dogs and cats: relationships between magnetic resonance imaging (MRI) features and hippocampal atrophy: Ai HORI, Kiwamu HANAZONO, Kenjirou MIYOSHI and Tetsuya NAKADE, J Vet Med Sci. 2015

Our last 12 months…or our 12 people who have changed our journal!!!

Here we would like to share with you our last year, but in a different way. We will present  12 people who made last year amazing, different and really lovely for the journal

  January 

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Luigi Venco

Dr Luigi Venco – I think, he is one of the most popular vet in Europe. Dear Luigi, Thank you so much for your strong support and real and lovely friendship. Proud to know you!Love you!

 

 

 

 

 

  February

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Lea Kreszinger

Dr Lea Kreszinger- I can say a HUGE heart, collecting so much goodness and positive intention. Thank you for all you did for Vets on The Balkans. If you see her one time ,you will remeber her for sure, if she is your friend, she will be in your heart forever.

  

 

 

 

 

 

 

March 

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Mila Bobadova

Dr Mila Bobadova- OMG , she is a real lady. Always say “YES” to Vets on The Balkans, always ready for ideas and  thank you so much that you share with us your power and positive intention. Thank you for having you!

 

 

 

 

 

April

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Katharina Brunner

Dr Katharina Brunner – When she is around you, you recieve all the peace and love from all over the world. If you feel her hugs, you would want to feel this all your life, REAL FRIEND! Thank you for all you did for Vets on The Balkans

 

 

 

 

 

 

 

May

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Ann Criel

Dr Ann Criel- high possition in the veterinary society, but what a feeling to be your friend, so grounded, so funny,so lovely. Always supportive! Thank you for being such a friend!

 

 

 

 

 

 

 

 

June

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Alberto Cordero

Dr Alberto Cordero- What is Mexico in your mind? Sunny, beach, hot, pleasure…yes, What he is? The same feeling when you are his friend, always smile, positive energy and so much friendly support! I am proud to be your friend

 

 

 

 

 

July

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Luca Formaggini

Dr Luca Formaggini – italian energy, aways smiling, with jokes and positive intention, you are BIG Frieand of Vets on The Balkans. Thank you for everthing. Please be the same in 2018 :)

 

 

 

 

 

 

 

August

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Ranko Georgiev

Dr Ranko Georgiev – the best cardiologist in Bulgaria and always open for Vets on The Balkans, and the most important close and real friend. Thank you so much for being you! Keep going!

 

 

 

 

 

September

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Jolle Kripensteijn

Dr Jolle Kripensteijn- Do you know the feeling when you meet someone and you have the feeling that you know that person all your life? It is Jolle. You start speaking with this “foreigner” and you feel so free to speak without thinking what and how to say something, so much freedom, so much understanding and warming. Thank you so much for having you!

 

 

 

 

October

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Elli Klemtzaki

Dr Elli Klemtzaki – a cute lady with HUGE heart, always supportive, always open to us, she is this word “always” . Thank you for all you did!

 

 

 

 

 

 

November 

12814393_1673705086236432_1339900710371625092_nPAMAS TRADING SRL- our super partner, our friend, our BIGGEST SUPPORT! Thank you so much, Vets on The Balkans is avaible because of you!

 

 

 

 

December 

23316272_180060419216123_164154967085808895_nBLUE SKY COMMERCE-  our second partner! Such a pleasure to have you and to work with you!

 

 

 

 

 

 

 

 

WITH ALL MY LOVE

 

Luba Gancheva

Christmas News! Bravo Bulgaria!

25442768_1576961642350193_8145106940698514483_nA FOUR PAWS team together with bulgarian veterinarians were on site to transfer the pregnant lioness Raya and her partner Hector to a safe place. The conditions in Razgrad Zoo aren’t appropriate for a birth, so it is necessary to transfer them now. Good news from the ultrasound: The cub is healthy, expected birth date is in 2-3 weeks.23795031_1553305748049116_1213372497055135105_n 23843082_1553305751382449_2492045853743789465_n 23915484_1553306148049076_3600530369129028540_n 24068161_1554210984625259_354602558747149375_n

Four out of five lions were checked thoroughly. The last male lion was in critical condition and is transported to Sofia for thorough examination.

 

We are pround that this happened on The Balkans  and we are able to be part of the world veterinary journay.

Who is Dr Andrei Timen?

  1. Who is Andrei Timen?

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Dr Andrei Timen

I graduated Faculty of Veterinary Medicine Cluj-Napoca , Romania in 1993. After six months work in large animals I joined Surgery Department In Faculty of Veterinary Medicine Cluj  from 1994 till 2006.

With two colleagues we started also private practice Trivet in 1996 in Cluj-Napoca. In 2002 I graduated the PhD program in orthopaedic surgery. In 2006 I started a new project , Trivet Clinic  with 5 vets  full time employed  where I am practicing now. Cluj-Napoca is the second city in Romania , having more than 500000 habitants and about 60 cabinets and clinics offer veterinary services for pets.15439979_1293073300765382_1452308516314094008_n

  1. Is it hard to be president of Small Animal Association on The Balkans?

I was AMVAC president for 4 years . Now I am Past president since November 2017. AMVAC means more than vets association. It is an honour to be president of Romanian Small Animal Vets Association. The team work is the most important thing and I was lucky to have dedicated colleagues. Every year we try to improve the level of education in our meetings.  In our first conference 12 years ago we had 60 vets and now more than 1100 join every year the congress. During this time we had great support from the veterinary companies and from Romanian Veterinary Chamber. Everybody understood that continuous education will improve the quality of medical acts in all practices.12800187_1033673523372029_6432084009150298114_n

3.How you combine  your professional life and your family life?

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Dr Anderi Timen and his wife

We are a vet family , my wife is also veterinarian so it is very easy to combine those aspects of life. Most of our holidays are linked to veterinary conferences, so the combination is a success one.

4.What do you think about professional level of veterinary medicine on the Balkans?

I am happy to see that the level of veterinary medicine in Balkans is improving day by day. More and more facilities are offered for the pets and the number of vet clinics is bigger every year. It means that we are on a right way and a great benefit will be the insurance program for small animals. I hope that in a few years pet  insurance companies will understand the opportunities to be present in Balkans also.

  1. What are you doing outside of professional life?

I like to practice winter sports, skiing and ice skating. Free time is dedicated to our family members 2 dogs and a cat. Also volunteer projects are taking part of my life.1468572_541932935880810_88657000_n

  1. Your opinion about Vets on The Balkans?

Sharing information between colleagues from this region is very important for the profession.Cooperation between vets from different countries were started and will continue on the benefits of our clients.