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Timisoara -Romania, and Sofia-Bulgaria
Hematuria describes a condition in which is observed presence of blood in the urine. It could be a result of diseases of the urinary tract – kidney, ureter, urinary bladder, urethra; or by diseases of the genital tract – prostate, penis, prepuce, uterus, vagina, vestibule. It can be classified as: macroscopic (visible to the naked eye), or microscopic (increased number of RBC in the urine, observed during microscopic examination). In general, hematuria can be a result of multiple reasons, as follows :
- Urinary tract origin
- Inflammations (UTI, etc.)
- Parasites (Dioctophyma renale)
- Coagulopathy (Warfarin intoxications, etc.)
- Renal infarction
- Renal pelvic hematoma
- Vascular malformations
- Kidney polycystic disease
- Genital tract origin
- Trauma, Neoplastic or Inflammatory diseases of the genital tract
- Subinvolution of placental sites
For Idiopathic Renal Hematuria, we speak when the origin of RBC in the urine cannot be associated with any of the above-enumerated reasons and is of a renal origin. It is a very rare condition, which occurs in middle and big-sized young dogs (younger than 5 years of age), occasionally has been observed in older dogs and cats. Microscopic IRH is found by incidence during urine microscopic exams when macroscopic one is observed by the owners and described as unusual darker coloration of the urine. The condition is mostly unilateral and can be periodic – with a period of no bleeding. Since there is a release of RBC into the urine, anemia can be present in ranges from none to severe. Further, we will take a look and discuss the available treatment options.
The dog was brought to me by his owner, who observed “Cola-like” coloration of the urine in the last 2-3 days. According to the owner’s description, there are no changes of the dog’s behavior and, according to him, the micturition is normal and does not cause discomfort.
- 3-year-old male mongrel dog
- 25 kg BW, normal body score
- Neutered when he was 8 months of age
- Vaccinations up to date and according to the protocol
- Living indoors
- No data for traumas
- No medications or treatments in the last 6 months
During the physical examination, no abnormalities were observed, body temperature, heart and respiratory rate, and blood pressure were in the normal ranges. No any tegument abnormalities or signs of traumas. Dog temperament was relaxed and friendly.
Clinical diagnostic tests
The CBC was normal, with an RBC count near the left border reference value. Tests for Babesiosis and Lyme disease were negative. A sterile probe of urine was collected by US-guided cystocentesis and examined. Urine-specific gravity was slightly elevated, presence of erythrocyte was confirmed by microscopic examination, microbiological culture was negative. Pigmenturia was excluded after centrifugation of the urine sample, which resulted in a clear separation between RBC (collected at the bottom of the test tube) and urine (supernatant).
The performed x-ray did not reveal any abnormalities (uroliths, tumors). The ultrasound examination did not result in any abnormalities in the urogenital tract – renal parenchyma was with normal structure.
Idiopathic Renal Hematuria was diagnosed by exclusion as a result of performed test procedures and obtained results.
Additional information about the diagnostic approaches for hematuria in dogs and cats can be found in 
For treating Idiopathic Renal Hematuria we have few options available, we could differentiate as:
- Invasive. Surgical cauterization of both ureters before the urinary bladder, and observing which kidney is the bleeding one, sclerotization of the kidney with povidone-iodine and silver nitrate  . This method can be used and for bilateral hematuria. For cases with unilateral bleeding leading to severe anemia, ureteronephrectomy is recommended 
Since the dog doesn’t present anemia and invasive methods are more complex for performance and maintenance, I have directed my decision towards a non-invasive treatment option.
- Non-invasive. It was described that IRH results from elevated blood pressure inside the glomerular arterioles leading to their higher permeability for RBC. This was observed by multiple studies and reports and the effect of ACE2 inhibitors, especially Benazepril, over the arterioles in the renal glomerulus was demonstrated   . In addition, during my studies in FMV-Timisoara, I had the opportunity to observe the treatment of a hunting dog with IRH, using Benazepril with good results (Dr. Doru Morar, FMV-Timisoara).
The dog was treated with Benazepril in dose 0.40mg/kg per os every 24h. In the following days was observed visible reduction of the hematuria – by the owner’s account, urine coloration became normal. Repeated urinalysis revealed the persistent microscopic presence of RBC with a tendency of reduction during the time. Blood pressure was normal and without indications for hypotension during treatment.
Dogs diagnosed with IRH with absent to mild anemia can profit from treatment plan with ACE2 inhibitors – surgical methods are not widely available, are expensive, require hospitalization of the animals, and nephrectomy deteriorates the quality of life for young animals (in cases the IRH becomes bilateral this can lead to a negative outcome for the patient).
Yordan Yordanov, DVM
Bomed Veterinary Clinic – Sofia
Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats. Ekstrand and Linde-Forsberg reported it as accounting for 0.6% of the maternal causes of dystocia. The etiology of uterine prolapse is unknown in queens. The prolapse can be complete, with both horns protruding from the vulva, or limited to the uterine body and one horn. Uterine prolapse requires immediate attention. It is an obstetric emergency.
A 1-year-old female European Shorthair outdoor cat weighing 2.5 kg was presented to our clinic with 96h after parturition. Two days before presentation his caretaker saw “something like placenta to hanging behind the cat”.
On physical examination, the animal was alert, 38.3 °C and slightly dehydrated. The pulse and respiratory rate were both within normal ranges. The prolapse of the uterus was complete, with both horns protruding from the vulva. The exposed tissue was congested and slightly edematous with a few small areas of necrosis, and was covered with debris.
The exposed uterus was palpated to rule out the possible presence within it of any abdominal organs such as the urinary bladder.
Tips & Tricks. Ultrasound examination of the abdomen and the uterine prolapse can be performed to reveal the position of the urinary bladder and the intestine.
Tips & Tricks. Topical application of Manitol 10% can be performed to reduce the oedema in prolapsed tissue.
CBC and biochemical analysis were performed. CBC showed WBC 38.8 x109/l, HGB 89 g/l, HCT 0.265 l/l. Other parameters of the biochemical analysis and packed cell volume were all normal in range.
After premedication with domitor/buprenorphine/ketamine, anesthesia was induced with propofol after preoxygenation. An endotracheal tube was inserted and anesthesia was maintained with isoflurane. Preoperative antibiotics: Cefazoline i.v. and enrofloxacine s.c.
Tips & Tricks. If the prolapsed organ is in very good condition and the cat is a valuable breeding animal you can try conservative treatment. Replacement, following by medical treatment Oxitocin (0.5-1.0 UI) and antibiotics. Complications may develop from minor laceration of the uterus to septicemia or uterine rupture.
Tips & Tricks. Do OHE! It is the safest option in this situation.
Tips & Tricks. OHE can be performed before reduction if the uterus is too contaminated or necrotic or ruptured.
In this reported case the uterus looked in good condition.
Gross debris was removed gently from the prolapsed organ by irrigation with hypertonic solution.
Then the uterus was reponeted carefully, starting from tip of the horns, one by one.
Tips & Tricks. Use some type of lubricant, like Vaseline.
Tips & Tricks. Oxytocin 0.5 IU can be administered directly in prolapsed tissue to facilitate uterine involution prior to replacement. Attention! Oxitocin make uterine tissue fragile.
Tips & Tricks. An episiotomy may be performed to assist uterine replacement.
Tips & Tricks. Cystocentesis may be performed before attempting to reposition the uterus.
Tips & Tricks. Use monofilament suture material, like PDS 2-0 for cervix ligatures. Polyfilament suture can cut the weakened uterine tissues like saw.
Apposition of vulvar lips was performed with a horizontal mattress pattern without tightening to allow vulvar discharge and normal urination.
This suture was removed after 24 h.
The queen recovered well. Postoperative treatment included the use of an Elizabethan collar and intravenous fluid therapy.
The day after surgery, the cat was alert, urinated normally and there was mild discharge from the vulva.
Antibiotic treatment for 5d amoxicillin/clavulanic acid -Synulox and Enrofloxacin.
Tips & Tricks. Postoperatively, urination should be monitored as swelling and pain can lead to urethral obstruction.
Although rare, uterine prolapse should be managed as an emergency. The treatment for uterine prolapse depends upon the severity of damage to the uterus. The prognosis following treatment for a uterine prolapse is guarded to good, depending on the timing of veterinary intervention.
Blue Cross Veterinary clinic Blagoevgrad- Bulgaria
Canine transmissible venereal tumor(CTVT),also known as transmissible venereal tumor (TVT) or Stickers’s sarcoma, is a transmissible cancer, that affects dogs. CTVT is spread by the transfer of living cancer cells between dogs, usually during mating. It’s normally localized at the external genitalia of male and female dogs, also at the oral and nasal cavities. Immuno-compromised and generally unhealthy dogs are predispose of leishmaniasis associated to genital TVT, and especially in a dogs living in Mediterranean region. CTVT may also be transferred by licking, sniffing or parturition. Clinically, CTVT lesions are red to tan, friable, verrucous to multilobulated masses, predominantly affecting genital organs, and are usually ulcerated and inflamed. Metastasis is uncommon ,but is usually seen in regional lymphnodes. Other reported sites of metastasis include skin, subcutaneous, brain, eyes, spleen ,liver, musculature, lungs, anus, bones, kidneys ,testicles and mammary glands. Leishmaniasis is a vector-borne diseases with wide geographic distribution affecting humans, dogs and several wildlife species. Depending on the infecting Leishmania species and the immunocompetence of the host, the infection can result in visceral (CanVL), cutaneous or mucocutaneous disease. CTVT and CanVL can overlap epidemiologically particularly in regard to their geographical distribution. In recent study was found that Leishmania sp. has tropism for the canine male genital tract. CanVL has been previously identified concurrently with canine transmissible venereal tumor as well as Leishmania amastigotes within CTVT neoplastic cells.
CASE REPORT- A 10 yrs old mixed-breed female dog Lucky was presented in Blue Cross animal hospital in Blagoevgrad on 01.04.2019 in a state of prostration. The dog had been adopted from the street. On presentation Lucky was in a very bad body condition-cachectic with pale mucosa membranes , muscle atrophy, onychogryphosis and two large cauliflower-like, ulcerated, hemorrhagic vaginal tumor masses. (Figure 1). The skin examination showed generalized alopecia with lice infestation and diffuse seborrhea. There wasn’t any lymphadenomegaly detected. Abdominal ultrasound examination didn’t show abnormalities in the spleen and other organs.
Clinical diagnostic tests:
A complete blood(cell) count (CBC), serum biochemistry profile were performed along with a Snap 4Dx test to screen for vector borne disease agents Dirofilaria immitis (heartworm disease),Erlichia canis (ehrlichiosis) ,Anaplasma phagocytophilium (anaplasmosis) and Borrelia burgdorferi (Lyme disease) and test for Leishmania detecting antibodies. In addition, skin scrape of the few places on the skin and fine needle aspiration cytology of the vaginal mass was done. The CBC revealed anemia, haemoglobinemia, Leukocytosis (lymphocytosis, granulocytosis).The serum biochemistry profile revealed hyperglobulinemia, hypoalbuminemia, low A/G ratio, hypocalcemia. The dog was positive for E.canis, A.phagocytophilium and Leishmania Ab. The skin scrape was negative for demodicosis and scabies. A fine needle aspiration cytology of the vaginal mass revealed a neoplastic round and ovoid cell population with some inflammatory cells. Every cell is containing single ,large and round nuclei. The abundant cytoplasm was delicately granular and optically empty. The cells had an characteristic for transmissible venereal tumor (TVT).(Figure 2)
Treatment with doxycycline 10mg/kg,p.o. q12h for 30 days for ehrlichiosis and anaplasmosis was initiated. In addition Milteforan 2mg/kg,p.o. q24h for 28 days and Allopurinol 20mg/kg,p.o.,q12h for 6 to 9 months was initiated for treatment of Laishmaniasis. The dog get also every day, some supplement for the skin like omega 3 and omega 6 amino acids and every 3th day topical treatment with shampoo with ketoconazole and chlorhexidine. The dog spent 20 days in the clinic, during that time Lucky get really improved (figure 3 ).
For the TVT treatment with vinciristine sulfate 0.6 mg/kg/m2, I.V., q7d for a total 8 treatments was initiated. The dog was monitored with a CBC every week. Photographs of the vaginal tumors were taken at each follow up visit to monitor the progress. After the second vincristine treatment there was visible improvement. The mass had decreased in a size.(fig.4and 5)
By the f ourth week only a small remnant of the mass was visible(fig6).
During the all treatment there was no decreasing of the thrombocytes, CBC was completely normal. There was no side effects of the vincristine treatment.
The patient was fully recovered. The treatment with Allopurinol is stopped. Sixed months after the last vincristine treatment, Lucky was doing great, no TVT recurrence. Neutering of affected dogs can be beneficial to decrease distribution of the vaginal tumors.
2.Case report Leishmania sp. Amastigotes Identification in CTVT
3.Transmissible Cancer Group
Department of Veterinary Medicine
University of Cambridge
The alimentary secondary hyperparathyroidism is not so rare as many specialists think. For period of only 9 months we diagnosed in our clinics 17 cases and had serious observations in other 9 cases (the owners didn’t agree to prove 100 % in Laboklin) in different stages of the problem evaluating. We present below our treatment protocol and two concrete complicated cases – both with healed patients but one not operated – and our consequences experience in cases with or without surgery.
The hyperparathyroidism is primary and secondary. The secondary could be renal – complication of chronic renal insufficiency, it is more often seen even in comparison to the primary – and alimentary: rarest but for sure not exotic. The alimentary variant is seen in young dogs and especially cats fed only or almost only with meat. The low calcium levels and the inadequate calcium/phosphor ratio in meat starts a multi-vector pathological process evaluating for a couple of weeks to following clinical picture: unwilling for moving, lameness, stiff walking, spontaneous fractures, face edemas, easily teeth removing or teeth loosening, spontaneous neurological deficit in different levels. The standard hematological and biochemical blood panels usually do not give any diagnose direction. It is common the right diagnose to be reached with delay because often the colleagues miss during the anamnestic phase to become well informed about the alimentary regime of the patient, X-rays are rarely made in the very beginning and usually the therapy starts with NSAIDS and general strengthening protocol.
This disease not rarely causes hind legs function insufficiency and neurological deficit, paradoxally not corresponding to and many times exceeding the found through imaging diagnostic bone (including vertebral) changes. It is not exotic OCD (even in cats) to be diagnosed later due to cartilage underlying bone and bone vessels malformation.
Most directing is the anamneses especially the alimentary regime of the young patient. Absolutely enough for 90 % sure diagnose is combination of anamneses, estimation of the bone geometry and density due to X-rays covering flat bones, spinal cord, mandibula, maxilla and blood levels of macro elements especially P. For 100 % sure diagnose we send blood hormon sample to Laboklin Germany. The differential diagnoses are not many and include some genetic or metabolic disorders.
Our newest therapeutic protocol, product of enough clinical experience and leading to fastest and completest healing includes:
- Hospitalization of the patient in cage for maximal immobilization aiming to avoid pathological fractures and especially vertebral fractures.
- Diet change to P-poor and Ca-rich: the variants are so many, ii is important the diet to be diverse and with enough vitamins. In most of the cases we start with renal diet combined with additional food components;
- Calo-pet – zero P molecules and very adequate composition for this problem;
- NEO-K9: not only because of the demonstrative bone healing stimulation but also very adequate against all cases of hyperphosphatemia – and in cases of alimentary hyperparathyroidism we have severe hyperphosphatemia as well as serious bone demineralization and decrease of their potential for resistance to physical forces and for healing;
- Ipakitine – because of its ability to chelate and eliminate the phosphor
- HyalOral – because of its adequate to the therapy (especially against intra-joints complications) composition and especially because of the gamma-oryzanol inside
- NSAIDS – against pain and inflammation
- Calciferol (Vitamin D3) in dosage 2 ng/kg/24h– please be very careful when using it because increases the resorption of calcium but also of phosphor. Should be added to the protocol only after the phosphor is already in normal blood levels or very close to them;
- Sometimes after careful individual estimation – oral pure Ca human product for children or even injectable Ca vet product;
- Often repeated biochemical including P and Ca blood monitoring (a big Thank you! to our trusted lab VetDiaLab for the precise and reliable work during the last 15 years), every-day neurological monitoring and checking the ability for urination, every-day check for rib and long bone fractures and regular (minimum every 8-10 days) X-ray follow-up of the geometry and healing of all fissures and fractures;
- Therapy against the complications including the spontaneous fractures, eating difficulties because of jaw problems ets.
This algorithm leads to very fast and demonstrative health status improvement. Of course it is very important to estimate carefully when the patient is ready to get out of the cage. We recommend the bone fissues to be X-ray monitored every 5-10 days and all long-bone fractures to be operated especially those near the knee joints. The reason?: the long-bone fractures caused by SAHPT heal very often with malunion which is being well tolerated by young animals but many of them suffer when achieve adult/mature age. On the other hand we recommend vertebral fractures to be operated only in case of neurological deficit or pain. In all cases of eating difficulties esofageal probe and not manual assisted eating is recommendable.
Case 1: cat Darko, SAHPT complicated with two supracondylar femural fractures, operated with delay. We added Calciferol to the therapy protocol at the 7th day when the blood phosphor decreased to normal levels. The owners asked us not to operate and to wait but as usual despide the cage rest after a couple of days the fragments geometry get worse and the healing would lead to malunion and may be to patellar luxation. The owners agreed to operate, the surgeries with implants of Mikromed were fast and simple (peri-operatively: Clavaseptin) and the case result is 100% healthy and extremely mobil cat:
Case two: cat Pisi, SAHPT complicated with fissure and fracture, not operated. The X-ray fissure (left humerus) follow up showed no need to operate and healed without problems. Unfortunately we didn’t receive permission to operate the fracture and as usual the result is serious malunion:
Conclusion: strict cage rest, strict food and therapeutical protocol, strict clinical and paraclinical monitoring and careful surgery estimation = successful outcome.
This is the story of Josi. She is a female Pomeranian dog. She has a long history of epiphora, blepharospasm and ocular discomfort.
She has gone several treatments before including surgery of the eyelids with mixed success.
Josi is a well monitored patient with all his dewormings and vaccinations on time.
Josi was presented for second opinion for ocular exam and consultation.
With the direct ophtalmoscope I saw some hair in the right eye. Near the limbus there was a dermoid mass with very small size and 3 hairs growing on the cornea.
Then I did Jones test of the both eyes with some fluorescin stain and it was negative for more than 60 seconds. The STT time of the left eye was normal 20 mm / min.
Both eyes were negative for ulcers.
Meanwhile I did nasolacrimal flush of the ducts in the both eyes.
So the second dermoid was resected and removed with scalpel blade.
Than I did nasolacrimal flush with IV catheter.
So Josi was sent for home management with some local Tobramycin drops and some hyaluronic gel for the cornea to heal fast.
Recheck will be done after 5 days.
Bomed Veterinary Clinic, Sofia, Bulgaria
Abstract: Endometrial polyps from a 10 –year-old cat are described.The cat was presented in clinic due to vaginal bleeding. Few polypoid cystic masses pedunculated into the uterus lumen were found at the surgery. Sonographic, X-ray, cytology and histopathological examination revealed uterine polyp consisting mainly of endometrial fibrous tissue stroma and glands without invasive growth or atypical mitotic activity. Keywords: Endometrial polyp cats, Feline uterine polyps, Cystic uterine polyps in cat,Ultrasound endometrial polyps, Histology endometrial polyps, X-ray endometrial polyps
Endometrial polyps in cats are a rare disease condition. Much of the available evidence being anecdotal1. There are only three more detailed reports for this condition in cats. One from the archives of the International Registry of reproductive Pathology at the University of Illinois, US -14 cats1, one from Department of Obstetrics and Gynecology, Faculty of veterinary medicine, Kirikkale university, Kirikkale, Turkey-1 cat2 and one from School of Veterinary medicine, Azabu University, Kanagava, Japan -1 cat3.
A 10-year-old Persian cat was presented to Bomed Veterinary Clinic in Sofia, with history of acute vaginal hemorrhagic discharge. The cat was in good physical condition with normal temperature and behavior. Few bloody drops around the vulva. In middle to caudal abdomen was palpated some firm mases.
Under clinical differentials diagnoses of pyometra, uterine adenocarcinoma or alimentary lymphoma was performed abdominal ultrasound. Sonographic examination showed a few cavernous structures cranial to bladder and caudal to kidneys. The large one was about 4 cm in diameter. Caverns were dispersed in haphazard mosaic pattern. Doppler sonography showed good blood supply of masses. On the base of ultrasonography pyometra was excluded of differentials diagnoses list.
On the base of suspected uterine adenocarcinoma were performed two dimensional chest and abdominal X-ray. Lungs and chest X-ray did not show indication of metastases. Abdominal X-ray confirms sonographic findings about dispositions and dimensions of mases.
CBC and biochemistry was in normal limits. On the base of the clinic and tests an exploratory laparotomy under general anesthesia was performed. During surgery uterus with abnormal asymmetric horns was found. Few mobile firm – elastic mases were palpated in uterine lumen. Two and smaller in the right horn, and a bigger one in the left horn. Ovaries looked normal except one little cyst nearby to right ovary.
After OHE the uterus was dissected. Evidence for an inflammation was not found.
We found in left horn one big elongated egg-like structure pending on short narrow peduncle. It is about 5 cm long and 4 cm in diameter. The smallest one in the right horn was about 1 cm long and 0.6 cm in diameter starting nearby end of horn. The middle one was about 4cm long 2cm in diameter and partially entering in the cervix. Polyps had firmly –elastic consistency, easily bleeding, with small delicate cyst on the surface. Uterus wall had irregular thickening mostly because endometrial hyperplasia. On the luminal surface has similar small delicate cyst also. When we dissected one of the polyps many different sized caverns dispersed in haphazard mosaic pattern were found. They were full with translucent slightly mucinous secret. The stroma was tenacious.
Fig. 3 Morfology of uterine polyps. Polyps pedunculated from uterinw endometrium to uterine lumen. Many fine cysts are visualiseted on the surface of polyps. Uterine walls with irregular hyperplastic patern.
Many prints slides for cytolgy were made. We did not found inflamatory cells, evidance for adenocarcima or any proof for other malignasy. These polyps looked benign.
Fig.4 Cytology from uterine polyp. Left- stroma Ridht- cyst wall
Specimen for hystopatology was prepeared in 10% formalin and send to Pathology laboratory, at the same day.
Fig.5 Histology from uterine polyp. Up- Stroma and cysts. Down- Left -Hyperplastic proliferation of glandular epitelial cysts. Down-right- Atrophyc epitelial wall of large cyst.
Histology report: Protocol 107,108,109,110/05.04.2019
Hystological spesimen representing uterine wall with presence of polypoid tumor formations. Tumor origin is from endometrial surface, representing of stroma, built from mature fibroses tissue with glands structures in thinly pattern within. Many of these glands structures are cystic dilated. They are covered with one row cubic epithelium with primarily basal situated nuclei. No signs for epithelium proliferation activity, atypical mitotic activity or invasive proliferation regarding the stroma. An endometrium and myometrium has typical histological structure.
Histological diagnosis: Atrophic endometrial polypsOn the base of clinical examinations, Ultrasonography, X-ray, morphology, cytology and histology report our diagnosis is as follows: Endometrial Polyps. Discussion
A diagnosis endometrial polyp of this case is according to the nomenclature in the Histological Classification of Tumors of the Genital System of Domestic Animals4. Main differential diagnoses are between endometrial polyps and polypoid form of cystic endometrial hyperplasia. The more exact differences between true endometrial polyps and polypoid endometrial hyperplasia are defined as that endometrial polyp have a vascular connective tissue stalk5 or contain a substantial connective stroma in addition to glands, and are pedunculated6. Histology slides demonstrated changes in the different stages of cysts development. Focal cystic endometrial hyperplasia is the stimulus for formation of polyps. As hyperplasia progresses, out of synchrony with surrounding endometrium, the glands become larger and more numerous. If the cystic endometrial glands have no external opening, they start to accumulate fluid. When the fluid pressure in the cysts increases, the gland cells covering their walls are compressed and start atrophic process.1 On the base of reports no breed, age or other predispositions were found1.No evidence that endometrial polyps are preneoplastic changes of the feline uterus except one a 16-year-old cat with metastatic carcinoma and five endometrial polyps1, 2. This probably reflects the rarity of endometrial neoplasia in cats as compared to women1. On the base of this data prognosis in this concrete case is excellent. ConclusionEndometrial polyps in cats are very rare condition.It is difficult to classify this disease as gynecological, hormonal or oncological. On the base of the case studies OHE is choice of treatment with excellent prognosis.
Fig. 6 The lucky cat Dara.Acknowledgments:
The author would like to thank to team of Bomed Veterinary Clinic, Sofia, Dr. B. Rangelov, DVM for sonographic diagnostics, Dr. M. Lulcheva, DVM for anesthesia and Dr. J. Stojkov DM for histology report.
Hera, a 10 months old female Cane Corso, was presented on the 15th of October 2018 for a dental consultation. She had pink teeth, a strong halitosis, „wasn’t eating like she used to” and showed signs of pain (didn’t let anyone touch her mouth or look at her teeth).
X-rays showed a very large pulp cavity in all teeth, very thin dentin and enamel, crown fracture with pulp exposure in 304 and 404 (Image 2), but also an abnomal density of the cortical bone in the mandible (Image 1) . The owner reported that the deciduous teeth were pink too.
The dog previosly had 2 surgeries in both elbows in another clinic (bilateral elbow dysplasia). Hera is also blind with both eyes (there is no vascularization in the eyes).
Antibiotics (amoxicillin with clavulanic acid 20 mg/kg/12 h) and analgesia (meloxicam 0.1 mg/kg/day) were immediately started and the patient was scheduled for a dental procedure a week later. CBC and routine biochemistry were normal.
The dental examination under aneshesia revealed 6 crown fractures with pulp exposure (109, 110, 209, 210, 304, 404). We extracted these teeth and tried to seal with the remaining ones. The dental extractions were very difficult, but the healing was good (as you can see in the images from the second dental procedure).
At this first dental procedure (Images 4 – 11), we took a blood sample to see what were the vitamine D3, calcium and parathoyroid hormone levels. When results came, we found out that Hera had hypoparathyroidism (PTH level was 1.2 pg/ml, almost 16 times lower then the physiologic range) and recomanded a thyroid ultrasound, which is not availiable unfortunately.
Also Vitamine B12 was low, so the patient recieved treatment for that too.
After the first procedure, the recovery was fast, the dog started to eat the next day, but only very soft food.
The second dental procedure (Images 12 – 16) together with the ovariohysterectomy took place on the 23rd of February 2019, when we performed extractions of 208 and 209 retained roots and full 405 was extracted for histopathological examination (that will be performed at Histovet by Dr. Teodoru Soare). The recovery was even better than the first one. Hera received clindamycin 11 mg/kg/day, 7 days and meloxicam 0.1 mg/kg/day, 4 days. Unfortunatelly, because a second set of radiographs were not available for this dental intervention.
The dental pathology of this patient might be a very rare congenital dental condition called „shell teeth”, in which teeth have large pulp chambers and insufficient coronal dentin. The treatment of this dental disease is full mouth extractions, but given the very high level of difficulty of the extractions, we chose to extract only the fractured teeth. It may be a consequence of a congenital hypoparathyroidism, which would also explain the other pathological signs (blindness, bilateral elbow dysplasia).
Hera is a very interesting case with high didactic value. She remains supervised for evaluation of her clinical evolution.
Both interventions took place at QincyVet and were performed together with Dr. Raluca Zvorasteanu.
Veterinary clinic Bomed
A 6-year-old, neutered male domestic shorthair cat
was presented for dental cleaning due to “bed smell breath”.
No vaccinations history, irregular anthelmintic treatment.
No earlier dental care.
History of cystitis four years ago.
The cat was in good physical condition.
Normal temperature, auscultation, palpation.
Normal facial and eyes symmetry, no nose or eyes discharges.
No compression discomfort, no swollen regions, lymph nodes – normal, lips with black pigmented zones.
Conscious Oral exam:
The cat was cooperative.
Normal maxillomandibular joint mobility, without pain.
Normal buccal mucous membranes. Lingual, sub lingual, caudal mouth space and roof of the mouth was normal.
Moderate gingivitis, gingival recessions, missing all upper right premolars (106,107,108), left upper first premolar (206), first and third left mandibular premolars (307,308).
All canine teeth were with root exposure.
Many mobility teeth: 207,208,308,403, with root exposure and visual
root resorption and attachment loss.
Plaque index 2.
CBC, Biochemistry was in normal limits, except high globulins level.
Dental X-Ray was unavailable.
Oral exam and treatment under general anesthesia:
Missing all upper right premolars (106,107,108), left upper first premolar (206), first and third left mandibular premolars (307,308).
Moderate gingivitis (gingival index 2).
Gingival and alveolar recessions.
No periodontal pockets. Stage 3 furcation (307, 308, 309, 208)
All canine teeth were with root exposure due to tooth extrusion.
Mobility teeth: 207(M3), 208(M2), 308(M3), 303(M3), 309(M3), 403(M3), with root exposure, visual root resorption and attachment loss.
Idiopathic Tooth Resorption
Multi teeth simple extraction
Preoperative analgesia: Rheumocam
Chlorhexidine Rinse 0.12% solution
Simple extraction with elevator and extraction forceps.
Rheumocam 24h/3 days
Stomorgil 24h/8 days
Stomodine 12h/14 days
Dental and oral prophylaxis with Stomodine,
Regular examination every 3 months.
There are many theories about the etiology of Tooth resorption in domestic cats but main cause is still unknown.
Depends of the source, about 25–75% of domestic cats are affected.
There is an increasing prevalence of Tooth resorption as cats get older, with the first teeth becoming affected usually at four to six years of age.
Gender and neutering were not found to affect the prevalence of disease.
Cat owners may report halitosis, ptyalism, head shaking, dropping food
while eating, reluctance to eat hard food, excessive tongue movements,
repetitive lower jaw motions while eating, drinking or grooming,
sneezing, dysphagia, dehydration, anorexia, weight loss, and lethargy.
Clinical findings are various degrees of gingival inflammation, missing
or mobile teeth, gingival hyperplasia or recession, tooth extrusion, tooth
tissue destruction and others.
Earlier and most accurate diagnosis is made by dental X-Ray because
first changes are subgingival.
Depending on changes there are few classification based on severity
(stages 1–5) and radiographic appearance of the resorption (types 1–3).
Tooth resorption can develop with cementation and ankyloses or with
attachment loss and mobility of teeth. In case of attachment loss extraction
Tooth resorption is the most common progressive disease affecting the
dental tissues in domestic cats.
In every regular cat exam (with or without oral or dental abnormality)
Tooth resorption should be routinely suspected.
Choice of treatment – extraction of all affected teeth.
6th year veterinary student from Estonian University of Life Sciences
- Donskoy cat
- 6 years 10 months old
- Weight 3,66kg
Owners came to visit, because of halitosis and cats’ loss of appetite. Cat has also lost some weight in previous months. Cat lives mostly inside and was not vaccinated for any diseases over 2 years.
Gingiva was very red, inflammatory and gums were bleeding when the mouth was opened. Opening a mouth was painful for the cat and ulcers on the tongue were visualised (Figure1). Cat had also a lot of calculus and she was hypersalivating. Due to the fact that cat was not vaccinated, a FeLv/FIV snap test was done, and it was negative. Also hematology and biochemistry were evaluated. In biochemistry liver and kidney values were mostly within normal limits (WNL) Only UREA was a bit low (4,5mmol/L) but it might be due to the starvation. Electrolytes were also controlled and they were WNL. In hematology only mild leukocytosis was seen.
After the first visit, a dental appointment was planned. The cat got one subcutaneous injection of cefovencin (Convenia) 8mg/kg and went home with oral meloxicam 0,05mg/kg for 3 days. She came to tooth removal surgery in seven days. A cat was sedated with dexmedetomidine, butorphanol, and ketamine intramuscularly. TIVA with propofol was used during surgery. Cat got 5ml/kg/h of Ringer-Lactate during the procedure and free flow oxygen was given. Buprenorphine (0,01 mg/kg) intramuscularly and meloxicam (0,3 mg/kg) subcutaneously were given for analgesia and lidocaine was used for nerve blocks. Dental radiographs were made pre-and postoperatively (Figures 2). Figure 3 shows how important are dental radiographs. 301 was broken during the extractions but it was unclear if remnant got out or not. An x-ray was made and the root was visualised. Then the root remnant was removed and a new x-ray was taken.
During the procedure, clinical picture (gingivitis II-III in all dens, 204 had gingival pocket of 2mm. 404 had gingival hyperplasia and also pocket of 2mm) and full mouth radiographs were evaluated. All teeth except canines were extracted. A cat went home with oral meloxicam (0,05 mg/kg) for 5 days. A new checkup was in 7 days. Figure 5 shows that gingiva is not so inflamed anymore. Cat started eating with a good appetite already the next day after the extractions.
Figure 2. (a) 409 has a tooth resorption (TR). (b) 309 is missing. (c) and (d) are made after extractions.
Figure 4. was made right after the extractions.
Feline chronic gingivostomatitis (FCGS) is a common syndrome, but its’ aeitology is unclear. FCGS causes inflammation and proliferation for the gingiva and oral mucosa. Inflammation can be mild to severe and it worsens with time. Mucosal ulcers are commonly seen in cats with FCGS. Ulcers are the most commonly on gingiva, tongue, buccal mucosa, lips, palatoglossal folds, and the lateral pharyngeal walls.
Aetiology is unclear, but it might be due to bacteria (usually from plaque Pasteurella spp↑, Prevotella spp↑), viruses or immune-mediated. Feline calicivirus (FCV), feline herpesvirus (FHV-1), feline immunodeficy virus (FIV), feline leukemia virus (FeLV), feline coronavirus (FeCoV) may cause FCGS.
The most obvious clinical changes are bilateral focal or diffuse chronic gingival and oral mucosal inflammation, ulcers and hyperplasia. Cats with FCGS has halitosis, dysphagia, ptyalism, bloody saliva, anorexia, and bleeding gingiva. Caudal part of the oral cavity is also with lesions. There is no sex, age or breed predilection.
For diagnostics, laboratory examinations are mandatory. Complete blood count (CBC), biochemistry (glucose and kidney values) and serological assays (FeLV/FIV) should be done.
Since the aetiology of the disease is unclear then treatment is empirical. In some cases, conservative treatment may help. Administration of antibiotics (amoxicillin/clavulanate, clindamycin, metronidazole), corticosteroids (not a good choice, because of side effects) , megestrol acetate (was used widely in the past, but now it’s not recommended due to the side effect), sodium salicylate, gold salts, lactoferrin (in mild cases, inflammation and salivation↓), interferon (poor results without extractions), professional tooth cleaning 3-4 times per year, chlorhexidine mouth rinses (usually not tolerated by cats for a long time) and teeth cleaning have been reported. The best cure is still full-mouth extractions.
Holmstrom, S.E. Veterinary Dentistry: A Team Approach, 2nd edition. Elsevier 2012, 10:228- 230
Niemiec, B.A. Small Animal Dental, Oral & Maxillofacial Disease: A Colour Handbook. Manson Publishing 2012. 6:176-181
Correl C., Nind, F. Saunders Solutions in Veterinary Practice: Small Animal Dentistry. Saunders 2008. 12-15:79-97
Gorrel, C. Veterinary Dentistry for the General Practitioner 2nd Edition. Saunders, 2013
Tutt,C., Deeprose, J.& D.A. Crossley. BSAVA Manual of Canine and Feline Dentistry, 3rd edition. BSAVA. 2007.8:137-144
Provet clinic , Plovdiv, Bulgaria
Aprilcho’s story takes place in the centre of Plovdiv, Bulgaria. The kitten is a victim of a car accident. Our colleague
Nina is the only one, who noticed the helpless cat , squirming on the street with painful convulsions. Nina picked him
neurologic symptoms, acute mouth bleeding, and convulsions. It was visible that he had maxillofacial trauma and a
First we did shock therapy so we could stabilize the patient. After we had the shock under control, we performed the oral surgery.
The upper premolars and molars had to be extracted, then alveoloplasty and correction of the symphysiolysis.
We’ve inserted an esophagostomy tube, so we could deliver enteral nutrition during the recovery period.
The recovery was long, due to the vestibular syndrome. He had pus expulsion from the left nostril and forehead
edema. We gave him antibiotics (Synulox) , Nootropil (piracetam) diluted with Glucose per os, and he received for
- 6 weeks enteral feeding with *Recovery* Liquid (Royal Canine).