CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

daniDr Daniela Bajenaru

Tazyvet veterinary clinic

Bucharest, Romania

 

Singalment and hystory

 

Bella, presented on 12/13/2016

10 year old, female, Labrador retriever

5 month history of polydipsia, polyuria, polyphagia and pruritus

 

Physical examination

 

Abdominal enlargement

Palpable hepatomegaly

Thin, hypotonic skin, easy bruising

Phlebectasias

Erythema

Calcinosis cutis over the dorsal neck, thorax and rump

Bacterial pyoderma

 

 

 

6 1 unnamed7

 

 

 

8 9 4 10

Investigations

Ultrasound

Urinalysis

Coagulation time

Serum chemistry panel

Trichogram, scoch test

Bacteriological examination

ACTH stimulation test

 

Laboratory results

Ultrasound- hepatomegaly

Urinalysis – low specific gravity (1.005)

Coagulation time – 5’

Serum chemistry panel: GPT -361,  ALP>1980, CHOL- 215, CREA -0,587, UREA -25,2

Trichogram/ scoch test – no significant findings

Bacteriological ex. – Staphylococcus aureus  (++++)

Basal cortisol level  > 10 µg

ACTH stimulation test – cortisol= 29,4 µg/dl

Diagnosis

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

SUSPICION: PITUITARY DEPENDENT

 

Treatment

TRILOSTANE -120 mg once daily

Amoxicillin with clavulanic acid -12,5 mg/kg/12h, 30 days

Probiotics

Topical: – moisturizing and desinfectant shampoo, once weekly

– antiseptic, anti inflammatory and healing gel, once daily

EFA supplements

Diet: low fat

EVOLUTION

After 3 days of topical treatment

15

After 3 days

Basal cortisol level      > 10 µg/dl

13

After first bathing

 

 

Bella1

21

After 7 weeks basal cortisol – 5,3 µg/dl

22

After 7 weeks basal cortisol – 5,3 µg/dl

Bella3

The evolution to be continued ….

How to start up an exotic animal department in your private clinic

ama

Dr Ama Groza Mrcvs

If you have already realised that providing high quality veterinary medicine services to exotic pets can increase your turnover and enhance clientele then let me congratulate you! This article will give you an easy step-by-step guide to follow in order to make the best of your new venture.

Have you wondered why so few vets are seeing exotics? Some frequent explanations include:

  • Most vets get little training in caring for exotic pets and as a consequence they get stressed when having to see an exotic pet. Many clinicians will refuse to see them unless it’s a first aid situation and the ones that do, probably won’t generate sufficient income to cover their time.
  • If surgical intervention is required, the price for the time spent with an exotic animal, a rabbit for example, is almost half that compared with the same time spent caring for a dog or a cat.

It is no surprise that exotic animal medicine is not high on the preference list of any sensible practice owner. But this is because you’ve been doing it all wrong!

These steps will guide you in starting up a successful exotic animal department in your clinic.

 

  1. Don’t cut corners, practice good quality medicine

The slogan “Gold standard practice” is unfortunately overused these days. Many practices advertise gold standard protocols, however these apply to dog and cat patients only. When it comes to seeing an exotic pet, basic investigations like a simple blood sample or a faecal test are often not even offered to owners and this is where the clinic is losing money and clients.

Through having your staff trained and consequently confident in carrying out specific procedures on exotic pets this will not be the case.

Protocols for different alignments should be in place for exotic animals as well as for small mammals to secure the best care for all pets. Having protocols in place will facilitate a fast treatment set-up at the best standard, easily followed even by inexperienced vets when there’s no support around.

There are a wealth of specialised procedures to be carried out on exotics and trained veterinarians and/or nurses will be able to offer all this to customers, generating more income for the practice.

Encouraging best care practice will stimulate your staff to keep up to date with their training; practice high standard procedures and good outcomes will not stay unnoticed for long. As a consequence more owners will register with your practice. Your staff will be delighted to be at the top of their job taking pride in what they do.

 

  1. Train your staff

Having your staff trained into caring for exotic animals their procedures can be fast, successful and stress free. Because major differences exist between exotic and small mammals, one must have specialised training in order to be able to look after exotics.

Knowledge and confidence is what you need in your team. Offering a generous list of fairly priced specialised procedures will generate more work for the practice and can only be an asset comparing with your competitors (I will return to this later in this article).

Naturally, trained staff will exude confidence and gain owners trust. Consequently, owners will be more likely to agree to more high risk or specialised procedures which they might otherwise hesitate upon; again, thus increasing your revenue.

Practices with trained staff to care for exotics are scarce, so letting your customers know what your team can do and what their level of training is, will not only serve to retain existing clients but will also attract new customers to the practice, and these new customers will often have more than one pet. And who doesn’t like a growing client base?!

 

  1. Charge a fair price for your services

Establishing a fair price is the key factor in setting up your business for failure or success.

Firstly, it is important to understand that there is no relation between the purchase price of a pet and the costs for its medical treatment.

Some people will adopt stray dogs and request for expensive laparoscopic rather than traditional neutering. No surgeon would hesitate to give them an accurate estimate. However when contemplating performing a tortoise spay, most surgeons will doubt the owners’ willingness to accept the surgery as a first option because of the costs involved. However, this is only our assumption!

pic 1

I always try and explain before an estimate that the medicines and consumables we use are the same price for all pets. My practice overheads are the same regardless of whether I work with dogs or parrots so why should my work time be priced up differently?

Set your pricing to charge fairly for your time, your assistants’ time, the materials used and not least for your skill.

Pricing all  materials used (like catheters, swabs, gloves etc.) separately will show owners how much the consumables cost, otherwise owners have no idea how much an urinary catheter is and not giving them a detailed bill can lead to confusion. Pricing of the consultation fee should cover time spent with the client and overhead costs such as rent, electricity, water etc. Pricing for the individual procedures carried out (like “placing an IV catheter” or” blood collection”) must cover your salary costs and the cost of ongoing training. The message here is that all costs should be factored in rather than just absorbed.

To your advantage is the fact that few veterinary surgeries offer good quality medicine for unusual pets. If you are clearly the best at it, you have little competition. There is nothing inherently wrong with being expensive but you should not forget that this approach requires continuous training and investment in equipment.

My experience has shown that owners shopping around for price rarely become good, loyal clients. They will always be difficult to convince to agree to investigations and will be likely to complain more if things don’t work out immediately (this is natural, because they can’t afford to spend more money for further tests if needed). The question is not whether you need these clients, but whether you can afford them. Charitable care organisations might be more appropriate for financially challenged clients.

pic 22

This is a baby Russian tortoise (Agrionemys horsfieldii ), has a lifespan of 75 years

Customers shopping for quality and excellence in veterinary care will be yours for life and will pay fairly for your services because they understand and appreciate your approach. Make this group your target clientele and your efforts will pay off.

 

pic 2

This is a replica cake of a Russian tortoise (Agrionemys horsfieldii ), it survived for 1 day”

  1. Facilities

Working with exotic pets requires that some adjustments to the hospital facilities and dispensary are made. Exotic pets are escape artists, easily stressed and some of them are poikilothermic, will need special hospitalisation facilities like a vivarium or even an incubator. With a modest budget you’ll be able to adjust your clinic to their needs (to keep costs down you can consider buying vivariums, loupes or surgical instruments second hand).

Most medication used is similar to that for small mammals, however, be aware that dosage is not, so be careful and make sure to consult your exotic medicine library.

pic 3

My favourite books which I have always at hand

ARAV.ORG, AAV.ORG  , AEMV.ORG are prestigious, reliable sources of information, so do invest in membership to this organisations. This will give you access to updated care sheets, up to date research data, specific event information and most important, a lot of colleagues to get in touch with in case you need advice on your cases.

 

  1. Advertise

There’s not much gain, except of course personal gain, in being very good at your job if nobody knows about it. In order to keep the business going one should make sure existing and prospective clients know about the range of services the clinic is offering.

You could periodically inform clients about any new equipment purchased and about what training your staff has undertaken. This will not only act as a “refresher” on what your service offering is but will also spread by word of mouth. You may be surprised to find how much impact the users of specialised forums have when a new exotic pet owner is looking for a knowledgeable vet. Make sure your name appears there, next to a good review of course.

Always remember to keep your colleagues informed about your services. Referral cases are a good source of income and a great way of practicing your specialist skills. Organizing open days and continual professional development courses will keep you on the radar of colleagues and clients alike, they should know that you exist and are doing well.

An unusual pet can easily become a news subject and this can get you free advertising. Don’t be shy, let the world know about your successful cases, consider local newspapers, TV and radio as well as social media.

  1. Stay at the top

Don’t ever stop learning.

Exotic animal medicine is developing fast, trends are changing and new protocols are being elaborated at an incredible speed. Refresh your library (very important: change your Carpenter’s Exotic Formulary with any new edition) periodically.

Re-evaluate your protocols every year, attend refresher courses, learn new surgical procedures, and stay updated. When you are the best you can be, you have no competition other than yourself.

Enjoy your success!

16603144_264440650646201_7165809784550866666_n

Next event of Dr Ama Groza, soon in Bucharest, Romania!

 

Resection of a chest wall mass- surgical technique and peri-operative analgesia

12959354_10153530931267960_1853416198_o-200x300

Dr Vladislav Zlatinov

Corresponding authors :

Dr. Vladislav Zlatinov, Dr. Aglika Yordanova (Clinical pathologist), Dr. Nadejda Petrova (Anaesthetist)

 

Central Veterinary Clinic

Chavdar Mutafov str, 25 B, Sofia, Bulgaria

 

Introduction

 

Rib tumors are uncommon in small animals. Osteosarcoma (OSA) is the most common (73%). Other types include chondrosarcoma (CSA), fibrosarcoma (FSA), hemangiosarcoma (HSA).

Rib tumors tend to occur in large breed dogs and the usual location is in the costo-chondral junction. Radiographic changes include lysis, sclerosis, or a mixture of lytic and blastic patterns. Intra-thoracic invasion of adjacent pericardium and lung lobes is relatively common, so CT scans are recommended to determine the location and extent of the tumor, planning of the surgical resection, and clinical staging for pulmonary metastasis1.

 

Chest wall resection is recommended treatment for the rib tumors 2. The surgical approach is the identical to intercostal thoracotomy, but caudal and cranial margins include a minimum of one intercostal space and rib, while ventral and dorsal margins should be a minimum of 2 cm from the tumor.  Because of the large defect present, a need for autogenous and/or prosthetic reconstruction techniques is often necessary. Autogenous reconstruction techniques include the latissimus dorsi and external abdominal oblique muscles, and diaphragmatic advancement following resection of caudal rib tumors 3. Prosthetic reconstruction with non-absorbable polypropylene mesh, alone or in combination with autogenous techniques, is recommended for large defects. Autogenous reconstruction is preferred in humans because of a high complication rate associated with prosthetic mesh, such as infection and herniation. These complications are rarely reported in dogs following chest wall reconstruction with prosthetic mesh. Up to six ribs can be resected without affecting respiratory function in dogs 4.

Thoracic surgery in small animals is considered a painful procedure, resulting in alterations in pulmonary function and respiratory mechanics. Appropriate analgesic protocol may improve outcomes. Systemic administration of opioids and NSAIDs, intercostal and intrapleural blocks, and epidural analgesia are among the most common options for pain management after thoracic surgery in small animals 5.

 

 

Case report

 

A 10 years old male pitbull dog, weighting 24 kg was presented to us. The owners had been to three veterinary consultations before, the chief complaint being lameness at the right front limb. The cause was suggested to be a “lump” on the right thoracic wall. Based on an X- rays study and clinical examination, so far the owners were discouraged to pursue the further surgical treatment, because the procedure was supposed to be too aggressive and painful. The dog was prescribed palliative NSAIDs therapy.

 

 

Clinical examination

 

Fig1

Fig.1

We did a thorough clinical exam, revealing normal behaviour, good over-all body condition; signs of multiple joint arthritic diseases were found- elbows and stifles decreased ROM and capsules thickening. On the right cranio- ventral thoracic wall we found protruding, egg- size oval mass, widely and firmly connected to the rib cage (Fig.1).

 

 

 

Diagnostics

 

Radiograph of the right elbow revealed advanced elbow arthritic changes.

Fig 2

Fig.2

Additionally, orthogonal thoracic radiographs (+ oblique one) were done, demonstrating large infiltrating mass, with heterogenous lytic and proliferative mineralised pattern, originating at the costo-chondral junction of the 4-th rib (Fig.2).

 

 

 

 

 

unnamed

Fig.3

A fine needle aspiration was done and evaluated (Fig.3).

The pathologist remarks:

“Clusters of  fusiform mesenchymal cells, with obvious signs of malignancy- pleomorphism, increased anisokaryosis and anisocytsosis, basophilia, multinucleated cells . Occasional osteoclasts, macrophages and neutrophils were noted. No osteoid/chondroid was found in the examined material. The tumor was classified as malignant mesenchymal– fibrosarcoma, chondrosarcoma or osteosarcoma.”

 

 

Fig4

Fig.4

A computer tomographic study was accomplished and the mass’s margins investigated carefully. A mineralised tumor centre (from the distal third of the 4-th rib) was found; also soft tissue aggressive expansion in the neighbour intercostal spaces -3-th and 5-th. Typically for the chest wall masses, there was an eccentric growth- the 2/3 of the mass volume protruding into the throracic cavity, extruding the pulmonary parenchyma and contacting the heart on the right side. No lung metastases were noticed on the scans (Fig.4, video 1).

 

Complete blood work was done and found normal. Including normal Alkaline Phosphatase level, considered favorable prognostic factor.

 

After a discussion with the owner, a decision for surgical resection was made.

 

 

Anesthetic protocol

 

Premedication with Medetomidine and Butorphanol was used, followed by Propofol induction. The maintenance was sustained by Isoflurane and Ketamin drop in the fluid sack.

 

Peri-operative analgesia, Anesthetists remarks

 

fig 5

Fig.5

fig 6

Fig.6

The thoracic wall resection is considered very painful procedure, so a corresponding analgesic strategy was built and applied. A continuous post operative segmental epidural analgesia application was provided. T13—L1 epidural puncture (by Tuohy needle), was done and an epidural set catheter (B. Braun) was inserted till the 5-th thoracic vertebra(Fig.5-6). The catheter was safely attached and maintained for 48 h post op, during the patient’s stay in the clinic. The agent delivered through, was Levobupivacain (0,5 %), one 1ml every 4 hours, including pre op.

 

 

After the mass removal, a soaker catheter was sutured at the ribs resection edges; another one was applied between the skin and muscle flap, covering the defect. Both catheters were connected to an elastomeric pump (B. Braun), delivering locally 5 ml/h of 1% Lidocain for 96h (including outpatient period) post operatively.

 

The rationale behind additional soaker catheters was to suppress maximally the nociception transfer, including the sensation through the non- blocked cervical spinal nerves. Also we contemplated- removal of epidural catheter at the time of discharge, but leaving the delivery pump, providing residual local analgesia.

 

Cimicoxib (Cimalgex) was prescribed for 10 days post op. No opioids were used in the recovery period.

 

 

 

Surgical protocol (surgeon remarks)

 

Fig7

Fig.7

Fig 8

Fig 8

Fig 9

Fig 9

fig10

Fig10

After macroscopic mapping and drawing, a rectangular shaped, full thickness (skin, muscle, ribs and pleura) en bloc excision was done (Fig.7).  This included partial ostectomy of 3-th, 4-th and 5-th ribs. Caudal intercostal thoracotomy was performed first, permitting evaluation of the intrathoracic extent of the tumor. Special attention was applied at the proximal approach to ligate safely the three intercostal arteries and veins. No visceral lung pleural or pericardium adhesion were noticed. Careful electrocautery haemostasis was done at the muscles’ cut edges.  The removed mass was macroscopically evaluated for “clean” margins, and a reconstruction of the large defect was preceded (Fig.8). A double (folded) polypropylene mesh (SURGIPRO®TYCO) was sutured to the wound edges, using simple interrupted pattern (3-0 PDS material). A latissimus dorsi muscle flap was advanced to cover and “seal” the defect (Fig.9). The air content was evacuated with aspirator on the final closure; no chest drain was left in the thorax. Two soaker catheters were applied in the wound; the skin was closed by double pedicle advanced flap technique and simple interrupted pattern (Fig.10).

 

 

 

 

Post operative care and follow up

 

 

 

Fig 11

Fig. 11

The dog’s chest was loosely bandaged; the elastomeric pump and epidural catheter were securely fixed to the body(Fig.11). I.v. antibiotics and fluid support was continued for 24 hours post op.

Provided very effective local analgesia- the dog revealed excellent comfort immediately after the surgery (video 2,3,4). We paid special attention to any pain signs- excessive vocalization, hyper-excitement, panting, tachycardia, behavior abnormalities, etc. No such were present and the patient started eating the next day after surgery; it was discharged 48 after the procedure. No ambulation deficits were seen with the Levobupivacain application. The elastomeric pump was removed on the 4-th day. Mild to moderate serosanguineous discharges from the wound were present for 10 days after the surgery.

On the 14 days recheck the wound was healed and the sutures were removed; the patient showed excellent clinical recovery (Fig.12).

 

 

 

 

Discussion

 

 

The surgical excision is considered the first treatment of choice for malignant rib tumors, but a question about the long term prognosis and rationale behind an aggressive surgery could be raised. As mentioned above, the most common rib tumors are osteosarcomas (OS)  and chondrosarcomas(CS). They have quite different prognosis- OS is rarely cured, whereas CS could be cured with surgery alone. Dogs with osteosarcoma that have elevation of the Alkaline phosphatase level have a much lower median survival times 6. Chemotherapy significantly increases the survival of dogs with rib OS- from a few months to about 9.5 months. Roughly survival time is increased 4 times with chemotherapy + radical resection, compared to surgery alone. Chondrosarcomas have a very good chance to be cured with surgery alone with median survival times exceeding 3 years. The other common type -fibrosarcoma and hemangiosarcoma have intermediate metastatic potential between the other two. Survival times ranging from 120-450 days with chest wall resection alone 7.

 

Dealing with motivated owners, a patient in good general health, with normal AP, and need for moderately large rib case resection size, we found good indications for tumor removal without preliminary histological verification. We suggested acceptable life expectancy in the worst tumor type scenario (the option for chemotherapy was available). While respecting previous vets’ opinions, we took into consideration the stated in the literature fact that dogs tolerate removal of a large portion of the rib cage very well.

 

Despite all this encouraging decision making facts, we would have fought ethical issues in a scenario we weren’t able to provide sufficient peri-operative analgesia of the patient. Except the ethical side, the pain associated with thoracoectomies may have potentially lethal consequence for the patient cardiopulmonary status after surgery. A thoracoectomy requires a very painful excision, involving multiple muscle layers, rib resection, and continuous motion as the patient breathes. Sub-optimal management of pain has major respiratory consequences. Inspiration is limited by pain, which leads to reflex contraction of expiratory muscles, and consecutively to diaphragmatic dysfunction (decreased functional residual capacity and atelectasis, hypoxemia).Treatment of acute post-thoracotomy pain is particularly important not only to keep the patient comfortable but also to minimize pulmonary complications 8.

 

In the veterinary literature there are suggestion for various types of analgesia provided after thoracotomies-  intercostal blocks, intrapleural lidocaine, incisional pain soaker catheters9; systemic agents as NSAIDs, opioids, NMDA antagonists (ketamine),etc. There is plenty of space for objective evidence based studies, proving the best analgesic protocol, yet.

In the presented case we applied sophisticated but uncommon noxious stimulus blockage strategy. The thoracic epidural catheter insertion is technically demanding procedure but it is very powerful tool for both intra and post operative pain control 10. Even more, it allows even preemptive pain blockage. So-called preemptive analgesia is intended to prevent the establishment of central sensitization caused by surgery induced injuries. Evidence from basic research has indicated that analgesic drugs are more effective if administered before, rather than after, a noxious stimulus.  Human studies report that the area of post-thoracotomy pain is more discrete and largely restricted to the site of surgery. Hence, any benefit of preemptive epidural analgesia is, theoretically, more apparent in thoracic surgery than in abdominal surgery.

 

It is interesting if the present tumor or the arthritic elbow lesions caused the primary clinical sign- front right leg lameness. Lameness of the forelimb had been described with costal tumors, located within the first four ribs 11. Possible mechanism is pain translation to the nerves to the limb, mechanical interference with movement or invasion into the muscles of the forelimb. After the surgical excision the owners reported lameness disappearance, supporting the tumor as the real cause.

 

 

CONCLUSIONS

 

Excision of malignant chest wall masses could be very successful. It is feasible to achieve clean cut margins; large residual wall defects could be managed with combined reconstruction techniques. Never mind the aggressive character of the procedure, an excellent patient comfort should be achieved with a combination of thoracic epidural and local wound nerve nociception blockage, as in this case.

 

 

Comments:

 

Just before the submission of this case report the histopathology result was received. It concluded:

 

Mass, originating from spindeloid to pleomorphic cells, highly cellular. The cells were round, organized in bundles and solid formations. There was moderate to marked anisokaryosis and anisocytsosis; mitotic figures frequently present, multifocally there is osetoid production.

 

Diagnosis: Malignant pleomorphic neoplasia, suspicious for osteosarcoma.

 

Long term prognosis:

 

In the case, no local recurrence is expected because of the wide margins excision. Generally the median survival time (MST) for dogs with rib OSA is 90-120 days with surgery alone and 240-290 days with surgery and adjunctive chemotherapy, and death is caused by distant metastases.  Age, weight, sex, number of ribs resected, tumor volume, and total medication dose do not influence survival disease-free interval 12.

 

A chemotherapy protocol is already being contemplated:

Carboplatin 300mg/sq.m.; 4 treatments q 21 days (Withrow and MacEwen Small Animal Clinical Oncology,2007)

 

 

If available, the long term result and the survival time of the patient will be followed and shared through the journal.

Tibial nerve peripheral nerve sheath tumor in dog

 

 

  1. Loncar, DVM1

    10698593_10203534440535771_1510276061084451082_n-238x300

    Dr Zoran Loncar

  2. Hadzic, DVM2

M.Dragomirov, DVM2

1,2 Department of Orthopedic Surgery and Neurology, Veterinary Clinic Novak, Belgrade, Serbia

 

INTRODUCTION

 

An 8,5 years old miniature schnauzer dog was presented at the clinic with finding of right hind limb monoparesis and grade 1 lameness. CT diagnostic study was done but it was suggested that there was no visible lesions. MRI study shoved a lesion consistent with PNST. The dog was treated surgically and the tumor was excised completely with large margins. The dog recovered completely. The purpose of the article is to suggest that a lesion consisted with PNST distal to the stifle an elbow can be treated with large margins and very good motility of the limb afterwards. This type of pathology can be often missed with orthopedic conditions.

CASE HISTORY

 

A 10 kg BW, 8,5 years old miniature schnauzer was presented at the clinic with owners complain of lameness on right hind limb for last five months.

At previous vet the dog was submitted to complete orthopedic, radiography and CT study with no diagnosis after the diagnostic workout. The dog was treated with 20 days of NSAID therapy (carprofen 2mg/kg BID 10 days and the dosage was reduced by half for the next 10 days). There was no improvement so the dog was treated with prednisolone for 20 days SID with again very little improvement.

The dog doesn’t have any important data in medical history.

At the presentation in our clinic:

During the walk dog showed grade one lameness.

zoran 2

CT STUDY , Fig 1 and 2

At the clinical examination the dog showed normal proprioception but reduced withdraw reflex on right hind limb.  During palpation region of gastrocnemius muscle was markedly painful. The rest of nurology and orthopedic examination was in within normal limits.

CT Study

Figure 1. and 2.

zoran 3

MRI SYUDY Fig 3

zoran 4

MRY STUDY- Fig 4

There is a focal dilation of a vascular structure, presumably a vein, caudal to the medial aspect of the right stifle. The vascular dilation/aneurism has a maximal diameter of 7.7 mm and extends over a distance of approximately 4 cm. Contrast filling of the dilated area is heterogeneous with some areas lacking contrast filling. The affected vessel is an anastomosis/branch between the caudal branches of the saphenous vein and the caudal proximal femoral vein.

MRI study:

Figure 3. T1+contrast: On the right limb at the level of tibial nerve there is a lesion with heterogeneous contrast intake in long contact with blood vessel. The lesion is 3 cm long in diameter.

Figure 4. T1+contrast: Lesion at the level of tibial nerve in close contact with saphenous vein and the caudal proximal femoral vein. Heterogeneous contrast intake.

 

zoran 1

Figure 5. Surgical field

The surgical approach was made from medial side at the level of proximal part of gastrocnemius muscle. The careful identification of blood supplies and nerve structure was needed. The healthy proximal and distal part of the nerve was identified and the excision with 3 cm margins has been done.

The dog was treated post operatively with antibiotics for 7 days (cephalexin 15mg/kg BID), fentanyl patch for 3 days, carprofen 2 mg/kg BID for 7 days, gabapentin since 3th day 20 days 10mg/kg TID.

Neurological exam has been done after 1,3,6 and 12 months. The only abnormal finding 6 and 12 months post op was longer ground phase during walk and reduced withdraw reflex.

 

DISCUSSION:

 

Tibial nerve is in charged for the motor function of caudal aspect of tibia and fibula. Deficit in function shows clinical signs that look similar to orthopedic conditions. Ground phase is longer, calcaneus drops distally more than in contralateral limb. Sometimes we can see plantigrade stance. Orthopedic conditions similar to these in term of signs are pathology of Achill’s tendon and tarsus and metatarsus.

PNST if at the distal part of peripheral nerves can be treated with good outcome. The reasons are fewer functions that lead in less of dysfunction of the limb, and good surgical margins.  If PNST is localized at plexus or nerve root, 78% of dogs are going to be euthanized. The prognosis depends on localization and histopathology grading.

 

CONCLUSION

 

This article shows how close sometimes can be neurology and orthopedic clinical findings. Even if advanced imaging is available the cruciate information is localization of the lesion during the clinical examination. Further a right interpretation of images is necessary to define the lesion. PNST is an important differential diagnosis in investigation of distal extremities dysfunctions.

 

WHO ARE Vets on The Balkans? Veterinarians speak…..

10334323_1650417485231859_7490271749546982451_nLUIGI VENCO, DVM , SCPA, Dipl EVPC, Pavia, Italy

 

It ‘s a wonderful Journal.  Open source. Clinical cases and tips useful for the reader. Not just a display of vanity for the authors. Congratulations to the editors for strong expended effort

 

ROMANIA

 

Dr Constantin Ifteme – Center of Veterinary Endoscopy and Minimum Invasive Surgery

 

Vets on the Balkans it is more than a promoting platform of all successful projects from the veterinary medicine in the Balkans region.  It can be compared with the Olympics of the veterinarians from this geographical area, with major involvement in training and continuous learning of the veterinary community.

 

 

Dr Iuliana Ionascu, DVM , PhD, member ESVO

 

Vets on the Balkans is the meeting point of the specialists, the friends and of the people who have the joy of sharing their experience in areas of interest in veterinary medicine.Vets on the Balkans helped us by placing us in direct contact with specialists and taught us how to work together. The first step is done. The next step is one that I want from the bottom of my heart:  to write therapeutic guides together.So, Vets on the Balkans, my dream has to be your accomplishment in the years to come.I love you for what you created. Good luck on your wonderful journey!

 

 Dr Alexandru Diaconescu, DVM, PhD, Senior Lecturer

 

I think it’s a great idea! All the vets in the Balkans area can learn from each other’s experience, we can share opinions, interesting clinical cases, etc.

I wish you good luck!

 

Dr Rares Capitan , DVM, resident ECVD

I think is a good interesting idea. I really hope that this project will  continue for a long time and collect many vets as want to share their experience. So the whole community from the Balkans will progress in a good way.

 

Dr Ana Maria Boncea, DVM, resident ECVD

“Vets on the Balkans” is like a fresh air for all the vet’s from every place…Is an open door for sharing your experience, upgrading your knowledge and enjoy the vet’s life spectaculy. Let’s share together all beautiful insides of our job!

 BULGARIA

Dr Vladislav Zlatinov – Central Vet Clinic in Sofia, Bulgaria

 It is so great to have such a professional forum, connecting Balkans (and not only) vets! I literally see people from different countries in the region, getting to know each other because of your journal.  The “Vets on The Balkans” deserve all the compliments for your great positive initiative and work!

 

Dr Stefan Savov- Ditton  Reach Veterinary Surgery, England

 The journal is a really brilliant idea. I read all the articles. I find some really good examples there. It has proved that veterinarians on Balkans are no worse than the colleagues in the western countries. I wish you more and more interesting cases shared on the pages of the journal and lots of luck.

 

 

Dr Mila Bobadova ( Veterinary Clinic “ Dobro Hrumvane”  in Sofia, Bulgaria)

 We needed that kind of journal at Balkans, a connection spot and an open source. It brings veterinary medicine to a new level, but most of all it helps all the vets from Balkans to get to know each other. For that I am very thankful and I am sure it will make a difference.

 

Dr Svetlina Aleksandrova ( Veterinary Clinic “Light Vet” in Sandanski, Bulgaria)

 Vets on the Balkans is great new way for communication and learning. The reality is that we can not know everything for any condition. The learning process continue until the end of our lives. I love the case reports – a lot of photos and good explications. The Learn and Travel initiative will make a lot of collegues better in their prefered section of veterinary medecine. Please, dr Gancheva, continue to do what you do in the best way – connect!

 

Dr Liliya Mihailova ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

 According to me ” Vets on the Balkans “o is one of the greatest way for many veterinarians to communicate and share knowledge and experience. Because is a new and modern way to connect veterinarians not only from countries of Balkan peninsula but also from countries all over the world. Moreover It provides the latest scientific information about news in veterinary medicine and useful personal professional experience.

 

Dr Spas Spasov  ( Veterinary Clinic “ United Veterinary Clinic “ in Varna, Bulgaria )

 I want to extend my greetings to the great work you do with the magazine. It is very interesting and useful. I wish to become more known. I wish to be ever visited. I think the idea to united vets on the Balkans is realized.

 

 

Dr Vanya Stoyanova – Veterinary Clinic Provet in Plovdiv, Bulgaria

 Useful  veterinary journal,creative realized idea.
Like to read the letters ,interesting posts ,new information for me and classified my level where I am on the market with the Balkan colleagues .Receive information for future symposiums,Conferences and Webinars. Thank You  Luba Gancheva & Co
Wish you continue enjoying with your fantastic work!!!

 

 Dr Dimitar Djambazov Veterinary Clinic Sofia in Sofia, Bulgaria

 Vets on the Balkans is a unique in its respective category as a journal who strives to connect the countries on the Balkans- a highly diverse and interesting set of countries.

The journal provides easy-to-reach and concise practical knowledge as well as the opportunity for interviews, presentations and step-by-step guidelines for management of specific problems.

From where I stand as a practitioner the case reports are by far my favorite method of acquiring new information in the veterinary field. That is of course after one has a strong basic knowledge on a given subject.

And here’s where the next indispensible role of “Vets on the Balkans” becomes evident. The journal not only acts as a mean of learning and developing oneself as a veterinary professional with blog posts but also serves as a connecting point between the countries and veterinarians in the region, as to promote and organize practical sessions, continuing education projects and various externships. This is indispensible help, strongly appreciated by many and luckily gaining more and more popularity among animal caregivers on the Balkans.
The effort invested in the journal by its creator and her collaborators is immense and undoubtedly greatly acknowledged as we all know how hard it can be to sustain such a project, be a practicing veterinarian at the same time and have a life from time to time as well.

As a young and still lacking a certain amount of experience, vet, I appreciate the Vets on the Balkans journal as a source of CPD, but also as a opportunity to reach and connect to our neighbors on the Balkans.

 

 

CROATIA
 Dr Emil Ofner – Veterinary Clinic More in Sibenik, Croatia

 Task for every journal is to have a good impact factor on its readers. Vets on the Balkans journal doesn’t do just that, but it also successfully ties up vets from different Balkan countries and others. It is the first of its kind in the Balkans and for sure it will facilitate further development of the veterinary profession. Hopefully it will become a great online tool for improvements of veterinary skills and knowledge.

 Dr Mario Kreszinger – Veterinary Clinic Kreszinger in Zagreb, Croatia

 It very useful easy approachable source of informations we need in everyday Jobs routine.

 

Dr Nikola Bunevski– Veterinary Clinic Kreszinger in Zagreb, Croatia

 Sharing is caring. Every information is priceless. We are working near each other we have similar problems and questions, it will be better for each of us if we share those questions and problems to one another, we will come to answers faster and painless. Vets on the Balkans can serve that purpose.Thank you for having me.

 

 

SERBIA

 Dr Zoran Loncar- Veterinary Clinic Novak in Belgrade, Serbia

 Vets on the Balkan is refreshment and result of people with good energy and wish to improve our region. We live in small countries and if we cooperate together we have better chance to improve ourselves.

 

Dr Nikoleta Novak- Veterinary Clinic Novak in Belgrade, Serbia

I read the interview you had with our colleague Nikola Bunevski, and I think he said it perfectly; “Sharing is caring. Vets on the Balkans can serve that purpose””Vets on Balkans” is really a great idea and I do wish you all the best on this exciting and high-minded mission.

 

SLOVENIA

 Dr Marko Novak- Klinika Loka in the city Škofja Loka in Slovenia

 I came across VTB when I was scrolling down the facebook and I saw these interesting articles from guys doing great job. I think it is one of those starters that help people to become better at what they do.

 

TURKEY

 Banu Dokuzeylul, DVM, PhD ,Department of Internal Medicine

Faculty of Veterinary Medicine

Istanbul University, Istanbul, Turkey

 I like reading. One day I found myself reading a case from Vets on The Balkans Online Journal. This subject was one of my interesting areas in veterinary medicine. With this article, I couldn’t imagine a good collaboration and friendship start. With Dr. Luba Gancheva’s support, I was invited to seminar in Bucharest. As I see until today, the journal improves day by day. Instead of giving important information, this journal combines the colleagues on the Balkans. If you want to be a part of a great friendship and have a vulnerable data, you must start to read the journal as fast as you can.10334323_1650417485231859_7490271749546982451_n

 

 

The nasopharyngeal polyp in cats. Do pictures help?

What is a nasopharyngeal polyp?

 

Inflammatory polyps that develop at the level of the nasopharynx and the middle ear are non-neoplastic masses which are thought to originate in the epithelial layer of the timpanic bulla or the Eustachian tube. Polyps can also emerge from the epithelium lining the external ear canal in association with otitis.

The etiology of nasopharyngeal polyps is not very clear and congenital pathologies as well as underlining inflammatory diseaseses such as bacterial or viral infections and cronical inflammations are discussed.

Most affected are the cats younger than 3 years of age, but some studies found the average age of the patients to be arround 6-7 years and up to 17,5 years in some cases. The studies citing such advnaced ages implied that polyps developed at a younger age, but remained undiagnosed for a long period.

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How to diagnose a nasopharyngeal polyp?

 

The diagnosis is made based on patient history and clinical examination and confirmed through diagnostic imaging, endoscopy and histopathology.

The clasical clinical signs associated with nasopharyngeal polyps include sneezing andheavy breathing. When a nasopharyngeal polyp reaches a large size (and is located in the nasopharynx) or there are bilateral polyps (extending into the nasal cavities) they cause reduction of the upper airways and are associated with loud breathing noises, nasal discharge, snorring and even vestibular disorders (head tilt, balance disorders). Sometimes nasopharyngeal polyps can be associated with Horner syndrome. Large polyps can lead to difficulties in the act of swallowing and anorexia. Direct or indirect examination (endoscopy and sample retrieval) can be of great help to the clinician in diagnosing this type of pathology (depending on the size and localisation of the polyp). Radiograps (RX), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are very good diagnostic tools , providing information about the localisation and size of the polyp and have also a high specificity. Diagnostic imaging can also help differentiate between nasopharyngeal polyps and other pathologies that sometimes similar clinical appearance, such as obstructed or stenotic airways, foreign bodies, neoplasia, thickening or osteolysis of the bullae due to infection.  Another advantage when using diagnostic imaging is the ability to assess the regional lymphnodes in order to give a more precise prognosis.

Non-epidermolytic ichthyosis in rabbit- case report

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Dr Spas Spasov

Dr Spas Spasov
United Veterinary Clinic
Bulgaria
Varna.

 

   Case presentation:

Rabbit nine months old , female  entire.She was presented  to the clinic with a history of progressive hair loss over the last two months. The rabbit came as a second opinion from another practice where she was treated for mange mites for a month with Doramectin and  a month treatment for dermatophytes without result of both treatments.
A clinical examination found:
Generalised alopecia, yellow crusty skin,pododermatitis over the pelvic limbs and  abnormal skin elasticity.

 

 Diagnostic approach.

*microscopic examination- Negative for ectoparasites
*Punch biopsy-  There is  diffuse thickening of the  epidermis characterized by laminated stratum corneum with disproportionate  thickness than the underlying nucleated epidermis. Focal parakeratosis is also present. The epidermis is mildly to moderately achantotic. The follicular infundibulum is greatly distended by keratin. The granular layer of the epidermis exhibits different sizes of keratohyalin granules (hypergranulosis). Superficial dermis  lacks  follicular and adnexal structures. Few intact sebaceous glands are present. There is  no evidence of  neoplastic cells, parasitic/mycotic/fungal or bacterial elements in the examinated sections. The histological appearace is consistent with non-epidermolytic ichthyosis.spas-1spas

 

   Treatment:

Treatment was undertaken to support body hydration, using megaderm( omega three  and six fatty acids,linolenic acid,GLA,EPA,DHA )in order to  strengthen the skin structure.  pain medication(meloxicam 0.2mg/kg ), and antibiotic therapy(Procaine penicillin 150,000 IU per mL. Benzathine penicillin 150,000 IU per mL. ) to control the bacterial infection of the feet.
There was an option for treatment microneedle therapy, but the sample for histopathological study did not showed hair follicles.

After one month of therapy the  rabbits skin had  significantly improved.  However pododermatitis had worsened and abscesses had formed  over the limbs.
Due to failure of antibiotic  therapy and deteriorationof pododermatitis, the decision was to euthanase the rabbit.

 

   Discussion

Ichthyosis is a inherited genetic disorder that occurs both in humans and in animals characterized by diffuse  keratinization  of the surface layer of the skin.  The disease develops as a result of gene mutation that is passed from generation to generation.
Ichthyosis studies are more for dogs and cats, and not so much about rabbits. There is not much information regarding the classification of rabbit Ichthyosis and details of treatment or maintenance therapy.
Affected BreedsThe West Highland White Terrier and the Golden Retriever are the breeds most predisposed to this disease

VOG? WHO ARE VOG? Meeting with 4 real orthopedic vets from The Balkans

 

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https://www.vog-vet.org/

Dr Mario Kreszinger, Croatia

Dr Vladislav Zlatinov, Bulgaria

Dr Marko Novak, Slovenia

Dr Zoran Loncar, Serbia

 

  1. Who are you?

 

 Dr Zoran Loncar:

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Dr Zoran Loncar

My name is Zoran Loncar I am a vet who dedicated his professional life to improve the knowledge and to push the borders of veterinary science.

 

 

Dr Vladislav Zlatinov:

I graduated from University of Forestry- Sofia, in 2005. I started externship attendance in a private small animal practice quite early-since my second year. Right now I am one of the chief surgeons in the Central Veterinary Clinic, Sofia- one of the busiest 24/7 practices in the region. Working already 6 years in this sophisticated facility, I had the chance to master skills and advance in the field of small animal surgery, and particularly orthopedics. I am happy to be involved in BAVOT (Bulgarian Association Veterinary Orthopedics and Traumatology)- the very first specialized guild vet organization in BG. We feel proud to be quite active and have organized some really great seminars, already.

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Dr Vladislav Zlatinov

At present, my focused interest is regional implementation of advanced care standards in the veterinary orthopedics- popularizing the routine use of minimally invasive technique (arthroscopy), Canine Total Hip Replacement and one special pioneering project- “Feline amputee prosthesis”.

 

Dr Marko Novak:

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Dr Marko Novak

I am a vet working in a private small animal clinic Klinika Loka in the city Škofja Loka in Slovenia. I graduated in 2006 on School of Veterinary medicine in University of Ljubljana. Since than I finished multiple courses in Orthopedics and Neurology including four years of an ESAVS program, AOVet courses, ESVOT etc. Most of my today’s work are referring patients from other clinics. Concurrently I am a board member of VOG and a treasurer of VOG and active speaker and table instructor on Orthopedic courses.

Dr Mario Kreszinger:

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Dr Mario Kreszinger

Prof. Mario Kreszinger, DMV, MS, PhD
Veterinary Faculty, University of Zagreb

 

 

 

 

 

 

  1. What is VOG? What VOG means to you?

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    VOG

 Dr Zoran Loncar:

VOG is a newborn that was created out of the frustration of the vets that are dealing in every day practice with neurology and orthopedic cases.

The idea was born after continuing education that we organized all around the world.

What we realized is that probably majority of orthopedics surgeries are done by general practitioners. The problem is that they don’t have guiding and possibility always to improve the skills.

This is what we found as a major frustration not only in east countries but also in developed ones. VOG role is to connect the knowledge, mentorship and to come close to the people who do orthopedics and neurosurgery in the practicesDr Zoran Loncar, Serbia.

Dr Vladislav Zlatinov:

When I joined the Veterinary Orthopedic and Neurology Group (VOG), I felt very thrilled. This newborn professional organization will face a bright future. It could not be different with so great open-minded co-founders, sharing the same sincere intentions.

The cradle of VOG may be Eastern Europe, but it is not confined geographically. It is open for all colleagues, interested in never ending process of learning and sharing. Standing for the evidence based approach, the group will encourage members to involve in clinical researches, too.

Nevertheless, the organization is focused just on veterinary orthopedics and neurology, the topics are still greatly diverse and laborious to explore. Unifying and sharing experience is the “enzyme” that fastens the growth of any vet community knowledge. Initiative like VOG may only make us better professionals and is a great chance for many new friendships to be started.

Dr Marko Novak:

A group of enthusiastic veterinarians who want to broaden the “knowhow” to other enthusiastic veterinarians in the region. By learning we evolve, by learning from those farther ahead and following “lege artis” we prosper as veterinary society.

Dr Mario Kreszinger:

VOG is regional orthopaedic Association established to promote and  organize orthopaedic, neurological and traumatological education with objective to connect the members and provide cooperation among each others. Establishing close contact and thrue friendship is one of main goal.15179126_666002020248637_6675110090243320994_nvog-1

 

  1. What means to be an orthopedic vet nowadays?

 Dr Zoran Loncar:

To be and orthopedic surgeon nowdays means that you learn and improve your knowledge and skills on a daily bases. The orthopedics is a mixture of knowledge and manual skills. That needs every day practice. On the other hand there is always a need to follow the new evidence based data in order to be updated.

Dr Vladislav Zlatinov:

The veterinary orthopedics was and still is tough field to work in, sometimes with quite ungratefully unforgiving obastcles. I have seen these: the vet staff staring at a radiograph with broken plate and shaking their heads meaningfully. Rarely you can see this with soft tissue surgeons’ work J

Indeed, the veterinary orthopedic surgeon is a person with serious proffesional responsibilties. Often, his work is not a matter of death or life. But almost always it affects the animal’s quality of life for many years. The job conatains a lot of not so obvious ethical issues behind many clinical decisions taken.

Speaking about “Nowadays”, there is a burst of companies that produce orthopedic implants and tools. Fortunately most of the products are faboulosly good and gives us a chance to help aniamls with “untreatable” conditions in the past. But for me I this also may raise a danger. Just because of a commercial emphasis, we can start easily implement new products without any evidence based justification. For me, there should be a carefull and responsible approach to the “ Fancies” in the sea of products offered to us.13245311_10206690540562329_7499136046518137278_n11986412_10153245936142960_4086193550529382361_n

Dr Marko Novak:

Well for one thing I am absolutly sure it takes a whole person ready to work, ready to work even more and finally uncompromisingly ready to work some more. :) And after you are finished working there comes a night shift… It takes a very, very loving and understanding wife. 😉
There comes a day when you want to quit but it always comes the next day when you want to get back and help some more. But I assume it is the same in any profession.

Dr Mario Kreszinger:

Being an Orthopaedist is one of the highest step in Veterinary speciality.

 

  1. What do you think about the level of veterinary orthopedic on The Balkans?

 

 Dr Zoran Loncar:

Unfortunately the level of knowledge at Balkan countries is low. The reason is old fashioned veterinary schools, the lack of continuing education at the field.

Dr Vladislav Zlatinov:

Our present status has a lot to do with the historical development of the region. I guess it is right to say that I am part of the “new generation” vets. At least in Bulgaria, this generation inherited the experience of very few small animal practitioners, working in the 90-ies. Unfortunately we cannot say that we have a long medical tradition in small animal care, as most Western Europe countries. But.. one way or another a new era has started. For me in the last ten years, the Balkan veterinarians put a hard work and did a huge development in every aspect of their work. The market was opened for Eastern Europe, the pet owners just demand and receive much better care. This includes also us- the orthopedic fellows in the region. I think that we already do quite a good job, with a real potential to shine for excellence

Dr Marko Novak:

I believe it has tremendously spiked in the last few years. There are still reserves, which is good. But what is most important is that people are more than willing to learn. Big thanks to many “good guys” who started teaching especially great orthopedic specialists like Allesandro Piras and Bruno Pierone, Massimo Petazoni etc.

Dr Mario Kreszinger:

The level is right now in extremely high learning curve, coresponds with highly developed western Countries.

 

  1. Your ” golden rules “to be professional orthoped ?

 

 Dr Zoran Loncar:

Learn, practice, learn, control your ego, learn, think out of the box and at the end, learn.
Dr Vladislav Zlatinov:

To be a good orthopedic, demands a lot. Vast stock of knowedge, skilled hands,  attention to the small details. Usually it takes so many years to develop qualities, a great determination is needed to bare the road. And the learning never stops. But this is the common knowledge. I am a believer that to become an especial orthopedic, you should be able to think “out of the box”. We should follow the great minds’ work, but there is always a place for personal contribution.  We should dare to fight paradigms; this is an essential “fuel” for medical science evolution.

Fianlly, our profession never works “good” without a sincere empathy to animals and fare etthical attitude to them and their owners15181147_10154094081597960_611406697039840077_n15181178_10154094095972960_9093230231692850684_n

Dr Marko Novak:

Be precise, train, learn, ask, always try to find mistakes and be better the next time, be objectively sharp to your work, take time for your family and for yourself. Charge your batteries regularly.

Dr Mario Kreszinger:

Be competely dedicated to your job with all efforts and breit knowledge.15181250_10154094080692960_1411178589932869639_n

 

 

  1. What do you think about  the online journal Vets on The Balkans?

Dr Zoran Loncar:

Vets on the Balkan is refreshment and result of people with good energy and wish to improve our region. We live in small countries and if we cooperate together we have better chance to improve ourselves.

 

Dr Vladislav Zlatinov:

It is so great to have such a professional forum, connecting Balkans (and not only) vets! I literally see people from different countries in the region, getting to know each other because of your journal.  The “Vets on The Balkans” deserve all the compliments for your great positive initiative and work!

Dr Marko Novak:

I came across VTB when I was scrolling down the facebook and I saw these interesting articles from guys doing great job. I think it is one of those starters that help people to become better at what they do.

Dr Mario Kreszinger:

It very usefull easy approachable source of infos we need in everyday Jobs routine.12072565_1159080807469853_2466737431594238709_n

 

 

 

 

Bronchial foreign body in feline patient – case presentation

emil

Dr Emil Ofner

Authors : Emil Ofner, DVM

                Marina Barižon, DVM

                Small Animal Veterinary Clinic More, Šibenik, Croatia

 

 

Bronchial foreign body in feline patient – case presentation

 

Introduction :

 

Male cat ( 4.5 kg ) with chronic gingivitis-stomatitis-pharyngitis syndrome was admitted to our clinic because of aspiration of loose tooth 15 days ago. At that time, the owner told us that cat first started to cough suddenly and because of coughing he received antibiotics. After a course of antibiotics, cough started to decrease, but didn’t stop completely. Thorax x-rays done on next physical examination revealed tooth inside the lungs.

 

 Case presentation :

 

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At the time of admission cat was stable with no apparent breathing problems. The cat was afebrile and blood work revealed elevation in leukocyte number. On x-rays we could see that the tooth (premolar) was stuck somewhere in the right caudal lung lobe (Picture 1). The x-ray scan also demonstrates a radio opaque area around the tooth, which represents fluid filled dilated bronchi ( Picture 2).

 

 Equipment and Methods :

 

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After initial examination, we decided to do a bronchoscopy to attempt endoscopic tooth removal. After intubation Olympus fiberoptic paediatric bronchoscope (3.6 mm diameter) with 1.2 mm working channel was introduced into the trachea (Picture 3 and 4). In level of segmental bronchi of right caudal ( posterior ) lung lobe we located bronchus plugged with white thick purulent material. In order to liquify this purulent material for aspiration we first lavaged it with warm saline. After successful aspiration of pus tooth was finally revealed. Grasping of the tooth was done with 0.9 mm diameter alligator forceps (Picture 5 and 6). After removal of the tooth rest of the pus was aspirated.

 

Discussion :

 

In cats most aspirated foreign objects will get trapped in the right caudal lung lobe. In our opinion the reasons for that are difference in right and left lung volumes, diameter of principal bronchi and bronchial tree anatomy. In cats average diameter of left principal bronchus is 6.0 mm, while the average diameter of right principal bronchus is 7.34 mm. Also, because of bronchial tree anatomy in the cats bronchial pathway which leads to right caudal lung lobe is more straight in comparison to left lung bronchial tree anatomy.

 

Conclusion

 

Majority lung foreign bodies in cats will be trapped somewhere along the right bronchial three because of anatomical differences of right and left lungs.

 

Cats with chronic gingivitis-stomatitis-pharyngitis syndrome may have an increase chance in aspirating foreign objects. Sudden attack of cough in cats with gingivitis-stomatitis-pharyngitis syndrome maybe can be aspirated foreign object.

 

Chronic lameness in a one and half year old German Boxer

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Dr Marko Novak

Marko Novak, dvm

Department of Orthopedics and Neurology

Klinika Loka, refferal small animal clinic, Škofja Loka, Slovenia

 

Luna is a lively 1,5 year old German Boxer, weighing 28 kg. She was presented to us with chronic intermittent right front leg lameness of grade II lasting for almost a year. Her owners noticed a lump on her medial carpal site. The dog had a history of a car accident when she was only six months old. At that time Luna was treated conservatively with NSAIDs and rest. Luna became worse after time and she was reffered.

 

Anatomy

 

Carpal joint is a hinge joint. It is composed out of six carpal bones that are arranged in a proximal and distal row forming three levels of joint spaces; the antebrachiocarpal where most of the joint motion takes place, the middle and the carpometacarpal space.

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Image 1: Anatomy of carpal joint

Joint`s stability is provided by ligaments of the carpus. Carpal ligaments are very stiff and short mostly crossing only one joint level. (image 1), (1)

 

Clinical exam

 

Luna was afebrile, lame on her right front limb, grade II. Her right front limb was shaking while standing and her carpal joint was slightly flexed. Right carpal joint was obviously swollen on the medial side. Carpal range of motion was mildly decreased in flexion, distinct pain was observed on flexion of the carpal joint and by pressing on the firm medial swelling. No apparent instability could be observed while doing clinical exam but only slight valgus. The rest of physical and neurologic exam was normal.

 

Diagnostics

 

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Image 2 : orhogonal view of carpal joints

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Image 3: orhogonal view of carpal joints

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Image 4: stress view with apparent medial instability

Orthogonal and stress radiograms of both carpal joints were made and beside increased opacity of medial carpal soft tissue, extensive mineralisation near medial carpal compartment was noticed most apparently on the craniocaudal view. Stress radigraphs showed moderate instability on the medial side of all carpal joint levels. (image 2 to 4)

 

Therapy

 

Decision in making the right therapeutic approach was difficult. After taking under consideration all of the data especially chronicity of the problem, we advised the owners do a pancarpal arthrodesis. Chronic instability is by far the most common indication (in 76% of the cases) for (pan)carpal arthrodesis. (2)

We could also try to do a synthetic ligament reconstruction but since the problem was present for almost a year, the instability was present in multiple medial carpal levels and the dog did not improve, arthordesis seemed like a prudent decision.

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Image 5 : postop, with slightly suboptimal compression, but due to hybrid locking plate it healed uneventfully

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Image 6: postop, with slightly suboptimal compression, but due to hybrid locking plate it healed uneventfully

Hybride pancarpal arthodesis locking plate (Veterinary instumentation)  (2,7 – 3,5) was used for the procedure, taking care to cover 75 % of third metacrapal bone, which resulted in a strong stabile environment and rapid healing with quick return to good postoperative function. External coaptation with a splinted bandage added extra support for the first three weeks after procedure. (Image 5 and 6)

Follow up

Luna did have some problems with compensation for the first two weeks after the splint was removed, but than started to improve consistently. Follow up xrays at 4 and 8 weeks were unremarkable.

 

Discussion

 

Luna is a very active young German Boxer who was intermittently but progressively lame for the last year. A chance to reconstruct the torn medial ligaments of carpal joint was probably unknowingly lost when the instability was missed at the first veterinary visit almost a year ago.

Chronic instability is seldom succesfully solved by synthetic reconstruction which purpose is to achieve good and functionally strong stability. Unsatisfactory surgical stability again leads to pain and degenerative joint disease.

Dispite apparent instability prooved on xrays, we were not sure how much it contributed to a development of chronic tenosynoviitis but we presume that the proximity of two structures resulted in abductor pollicis longus tendinopathy as well or differentially looking could also be a sign of an old avulsion fracture.

 

Literature:

1 Fractures and Other Orthopedic Conditions of the Carpus, Metacarpus, and Phalanges, Part II: fractures and orthopedic conditions of forelimb, in BRINKER, PIERMATTEI, AND FLO’S HANDBOOK OF SMALL ANIMAL ORTHOPEDICS AND FRACTURE REPAIR, Fourth Edition, 2006, by Elsevier Inc., page 382, chapter 14

 

2 Pancarpal arthordesis in a dog: a review of forty-five cases, Robert B. Parker, DVM, S. Gary Brown, DVM and Alida P. Wind, DVM in American Collegue Of Veterinary Surgery.