Newsletter on the conference named Recent advances in dog and cat oncology, 13-14th of April 2018

29663580_408766522919304_655278454_nEsteemed colleagues,

Between the 13th and 14th of April, in Iasi, the Ramada Hotel hosted the conference named Recent advances in dog and cat oncology, organized by the Romanian Association of Veterinary Diagnostic Imaging (ARDIV). ARDIV organized this event in partnership with the Neurovet Association, Altius, Purina, Liamed, Synevovet, MSD Animal Health and Neologis.

The chosen topic was a particular, highly specialized one, and the scientific schedule was concentrated, comprising aspects starting with the clinical and diagnostic ones and ending with aspects related to pathologic anatomy, cytology and histology. Internationally up-to-date information was provided with regard to chemotherapy and radiotherapy. Papers were presented on the technique of tumoral specimen sampling, conditioning and expedition to specialized laboratories, as well as on topics frequently encountered in practice, such as the tumoral prostatic syndrome in dog and the multimodal approach of mammary tumors in the bitch and queen cat.

The two days abounded in scientifically relevant content, benefitting from the high appreciation of the participants towards the connections established by the organizers and speakers with the area of imaging, among others.

National speakers were involved, such as Assoc. Prof. Alexandru Diaconescu (FMV Bucuresti), Lect. Dan Cranganu (FMV Bucuresti), Dr. Claudiu Gal (FMV Bucuresti), and from Spain, Prof. Ana Isabel Raya Bermudez (FMV Cordoba), all of whom have our gratitude for the highly practical presentations and the relevant data.

Participation at the event was rewarded by the College of Romanian Veterinarians with 50 points for participants and 100 points for speakers; at the end of the second day of the event, the participants were awarded the participation diplomas.

The organizing committee considers that the chosen topics were relevant and necessary for the continuing formation of veterinary practitioners, given that the final feedback (provided by survey, with an average score of 4.5 out of 5) was indeed a positive one.

We would also like to point out that this event was the first of its kind (tumoral disease) to take place in Iasi and in the Moldavian region.

The organizing committee has duly noted the ideas of the participants for future application and undertakes it to satisfy these requirements in the future scientific events in the field of veterinary imaging and related areas.

Together on the path of imaging,

ARDIV

The feline nematode parasite Troglostrongylus brevior has been found in cats of Cyprus

17522718_10210771628620689_8401590001954170847_nDr Demetra Sofroniu

Cyprus

 

Cat is one of the most popular pets all over the world with an estimated population number of over 74 millions. In Cyprus, an island of the Mediterrenean Sea, there is a large cat population. Although, for many decades, there is a worldwide intense research activity regarding the parasitesof cats, no research on the parasites of the intestinal and respiratory tract of cats in Cyprus have been conducted until recently.

However, in 2017, a study entitled “Occurrence and zoonotic potential of endoparasites in cats of Cyprus and a new distribution area for Troglostrongylus brevior” has been published in the scientific journal Parasitology Research [Parasitol Res. 2017, 116(12):3429-3435. doi:10.1007/s00436-017-5651-3]

The aim of this study was to investigate the occurrence of pulmonary and intestinal parasites of cats in Cyprus, in order to fill in the gap of relevant information in this area of Europe. A total of 185 cats from 5 districts of Cyprus were included. Individual faecal samples of 48 exclusively indoor living cats and 137 cats with outdoor access were examined by classical parasitological methods. The morphological identification of lungworm larvae was confirmed by PCR.

Parasites were found in 66 cats (35.7%) i.e. Toxocara cati (12%), Cystoisospora rivolta (12%), Joyeuxiella/Diplopylidium spp. (7%), Giardia spp. (6.5%), Troglostrongylus brevior (5%), Cystoisospora felis (2.5%), Aelurostrongylus abstrusus (2%), Taenia spp. (0.5%), Dipylidium caninum (0.5%). Mixed infections were found in 18 cats (9.7%). Parasites were found in 4 of 48 indoor cats and in 61 of 137 cats with outdoor access.Troglo d

This study showed that a high percentage (35.7%) of cats in Cyprus are infected by intestinal or pulmonary parasites, some of which may have an impact on human health (i.e. Toxocara cati, Dipylidium caninum, Giardia spp.). Furthermore, cats who had outdoor access were more likely to be infected, while cats who had received an antiparasitic treatment in the last 6 months were less likely to be infected.

In addition, this study revealed that T. brevior, a respiratory nematode of felids, is presenting on the island. Until recently, T. brevior was considered a parasite of wild felids. However, in recent years, it has been found that domestic cat is also a host for this parasite in some areas. More precisely, T. brevior has been found before in Italy, Spain, Greece and Bulgaria. This study render Cyprus the easternmost distribution border of this parasite in Europe to date. As infection of this parasite in young cats are more likely to be severe and life threatening, there is an acute scientific interest for T. brevior.

More research on T.brevior is expected the next years. Interestingly, the life cycle is not fully described and there is evidence of vertical transmission that needs further confirmation and clarification. It is thus important, thet the veterinary practinioners keep a vigilant eye on the correct and timely diagnosis of troglostrongylosis.IMG_1961 IMG_2006

Brachycephalics-Anaesthesia and Intensive Care particularities

 

10455370_1662135347386201_2573188422215976094_nDr Ruxandra Costea, PhD

Bucharest, Romania

 

 

Brachycephalics are patients that are prone to the increase in the superior airways’ resistance, with the decrease of the airflow at the level of the nose or mouth, which implies higher risks and complications associated with anaesthesia.

The acute obstruction of the superior airways can manifest itself consequently to the overheating syndrome (excessive heat, excessive humidity, after physical effort, hyperthermia), post-detubation or as the worsening of a chronic obstruction.Presentation5

The overheating syndrome is represented by the the body’s incapacity to dissipate the accumulated heat and can manifest clinically through hyperthermia (> 41° C), dysfunctions of the central nervous system, the activation of the inflammatory mechanisms, hemostasis disorders and initiation of the systemic inflammatory response syndrome (SIRS). The physiopathological cascade can evolve through multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), disseminated intravascular coagulation (DIC).

The risk factors for the triggering of the overheating syndrome are represented by any anterior episodes, obesity, breed (brachycephalics, Golden Retriever, Labrador), elevated ambiental temperatures and humidity,  poor acclimatization, low resistance to physical effort.29425659_10211461064425220_967441903115042816_o

Hyperthermia can generate cerebral hypoperfusion, neuronal necrosis, vascular lesions, cerebral edema, haemorrhages, multifocal vascular thromboses. The clinical signs can be spontaneous haemorrhages (petechiae, hematemesis, hematochezia).DIC can appear anytime during the first 24 hours after the incident (close monitoring). Hyperthermia can trigger oxidative stress mechanisms, which can act at gastrointestinal level through intestinal ischemia, cytoskeleton relaxation, increase in intestinal permeability and finally, bacterial translocation. Temperature control is essential for the limitation of clinical manifestations (tachypnea, tachycardia, vasodilation, massive haemorrhagic diarrhea and hematemesis coagulopathies, miocardial hypoperfusion, lactic acidosis, electrolitic disturbances, cardiac arrhythmias, stupor, convulsions, exitus). The patient will have to be cooled simultaneously with the administration of  fluids for the control of tissular perfusion and hydroelectrolytic disorders. Crystalloid isotonic fluids will be administered, supplementing, if needed, with colloid boluses, depending on the hydration state, cardiovascular potential and the electrolytic status of the patient. The therapy will continue without interruptions until the patient is stable. In severe cases, it is necessary to start the antimicrobial therapy for restricting the endotoxemia and preventing sepsis ( broad-spectrum antibiotics). The therapy will be completed with gastrointestinal protectors, H2 antagonists (famotidine) and proton pump inhibitors (pantoprazole). Continuous monitoring throughout the therapy is mandatory, because the patients need re-evaluation and consequent adaptation of the therapy.

The key points in the therapeutical management of the overheating syndrome are:

  • Oxygen supplementation
  • Sedation, general anaesthesia
  • Temperature control
  • Control of the tissular perfusion and of the acid-base and hydroelectrolytic disorders
  • Correction of homeostasis disorders
  • Maintenance of the renal function
  • Blood glucose monitoring
  • Antimicrobial therapyPurpose:  Presentation4 

    Oxygen supplementation is necessary when the patient first shows up ( starting with the triage phase) in the case of acute respiratory distress syndrome (ARDS), noncardiogenic pulmonary edema or laryngeal edema. Brachycephalics in thermal shock exhibit compensatory hyperventilation or can’t oxygenate themselves enough, consequently to respiratory insufficiency, with high respiratory effort, hyperthermia, muscular exhaustion and, finally, respiratory arrest! The immediate control of hypoxemia initially requires oxygenation through noninvasive methods, followed, if needed, by additional invasive procedures (general anaesthesia with endotracheal intubation, nasal oxygenation catheter, tracheal catheter, tracheotomy/ tracheostomy). High air flow devices can be used for oxygenation (>15l /min.)- oxygen tent/cage, AMBU-bag or low flow devices(<6l/min.)-mask, nasal oxygenation tube, endotracheal probe, tracheal catheter.29388957_10211461064265216_3957696742744391680_n 29425012_10211461064385219_3239167496015577088_n

    Assisted ventilation is recommended either in case of hypercapnia (PaC O2 >60 mmHg) or severe hypoxemia (PaC O2 <80 mmHg or SpO2 <90%) with persistent cyanosis despite having oxygenation levels reaching 100%.Possible complications regarding mechanic ventilation are correlated to the accidental disconnection of the patient, device failures, barotrauma, atelectasis or oxygen toxicity.

    Brachycephalics are NOT the best candidates for „a simple sedation”, requiring, in most cases, general anaesthesia protocols. Given the fact that all anaesthetics affect the respiratory function through central depression or through muscle relaxation, a continuous monitoring is necessary, from premedication to the patient waking up from anaesthesia.Presentation1

    Preanaesthetic evaluation will be cautiosly approached, in order to reduce the perioperative mortality, by tracing and evaluating the risks and by adjusting the perioperative protocols. The patients will be premedicated in order to reduce stress, anxiety, agitation, this also leading to a decrease of the doses that are necessary for maintenance. For critical patients, premedication can be excluded, but analgesia must be maintained! A minimal contention is recommended, without a muzzle! For brachycephalics, preoperative preoxygenation is mandatory. For induction, the lowest propofol doses will be slowly administered intravenously. (1.0 mg/kg slowly injected intravenously for the first 15 seconds, then another 1.5-2 mg/kg until reaching the desired effect). The administration of propofol in rapid bolus causes apnea, bradycardia, hypotension and respiratory depression. Propofol reduces the cerebral metabolism, the cerebral blood flow and the intracranial pressure, also alleviating the effects of the hypoxic lesions, and inhibiting lipid peroxidation, having an antioxidative action.

    The endotracheal intubation of the brachycephalics must be done with care. It is hard to anticipate the dimension of the trachea by the size of the patients, because they often  have hypoplastic tracheas. Anaesthesia is maintained gaseously, ensuring the efficient ventilation of the patient.  For avoiding regurgitation, the patients will be positioned slighly forward, with the anterior extremity lifted at . Inhalation anaesthesia protocols can be carried out, if needed, at the same time with the administration of opioids (bolus or CRI) or with locoregional anaesthesia techniques (blockages, infiltrations, epidural etc.).29496194_10211461064545223_8396511414134505472_n

    Secondary effects can appear at high doses of opioids (dysphoria, bradycardia, respiratory depression). For ensuring the polymodal analgesia, opioids, NSAIDs and local anaesthetics can be administred.

    Managing the hemostasis disturbances implies the stabilization of the coagulation system, the administration of fresh frozen plasma or anticoagulants, for preventing thromboses.

     

    Maintaining the renal function is possible in the case of patients suffering from thermal shock through maintaining the perfusion and oxygenation of the kidney. Hypovolemia and dehydration will determine the arterial tension and the cardiac output to lower, leading to the decrease of the renal perfusion ( renal ischemia). Lowering the oxygenation at renal level will favor the triggering of acute renal insufficiency. Consequent rhabdomyolysis and myoglobulinemia will damage the kidney even more. If the urine output is low (<1ml/kg/h) even after fluidotherapy, furosemide and/or mannitol can be administered. Mannitol (osmotic diuretic) will reduce the water content of the neuronal cells, will increase the reanl perfusion and diuresis. Furosemide can be administered at 15 minutes after the administration of mannitol. An option for hyperhydration, uremia or different electrolytic imbalances is represented by hemodialysis.

     

    Monitoring the glycemia is very important for critical patients, because the ones that are hypoglycemic have a hard time compensating!

     

    A particular situation is represented by the acute obstruction of the superior airways after detubation. The muscles of the superior airways, which are relaxed post anaesthesia, can favor the appearance of acute obstructions at brachycephalic breeds, together with the inflammation of the larynx and the pharynx, especially after the specific correctional surgical procedures. That is the reason why it is recommended to postpone these patients’ extubation for as long as possible after anaesthesia and to supplement their oxygenation through noninvasive methods (nasal oxygenation probes, prongs, oxygen cage), until they have completely recovered from it. Since the risk of complications is high, it is good to be prepared for a possible reintubation or even for invasive oxygenation methods (trecheotomy, trecheostomy).

     

SAVAB Congress 2018 and how Balkans were part of it!

congrestasVets on the Balkans has got 2 free registrations with accommodation from SAVAB (Small Animal Veterinary Association of Belgium) this year. It was a huge gesture to our region and our journal. They support the willing and desire of the veterianrians from East Europe to grow and improve their knowledge.

 

 

‘ The CATalogue’ cats, cats and more cats,  in Wemmel ( near to Brussels) was on 9th to 10th of March this year.

They had as speakers: Hans Kooistra, Gerry Polton, Penny Watson, Pascale Smets , Sara Van Cauwelaert .

bdr

bty

 

 

 

 

 

 

 

 

 

One of the vets, Dr Yordan Yordanov, who was able to be there, share with us:

 

 

“I am grateful for the opportunity to visit the Belgian congress for small animals, I am extremely impressed by the high level of lectures, the hospitality of the organizers Anne Kriegel, Bob Prossmasms and Mark Vanghelwell, and the good organization of the event. I’ve made many new acquaintances, and I hope other colleagues like me will discover the benefits of SAVAB.”

 

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After something like this we are strongly believe that hand by hands we all be better and we live in a wonderful world. We would like to express our gratitude to SAVAB for such a great opportunity and you should know that you are big part of our Balkan family!

 

THANK YOU SAVAB and Dr Ann Criel!!!banner catalogue

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

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

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

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

We look forward to welcoming you to Rome in October.

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

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

12959354_10153530931267960_1853416198_o-200x300

Dr. Vladislav Zlatinov,

Corresponding author :

Dr. Vladislav Zlatinov,

Central Veterinary Clinic

Chavdar Mutafov str, 25 B, Sofia, Bulgaria

E-mail: zlatinov_vet@yahoo.com

 

 

Abstract

 

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

 

Introduction

 

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

Fig.1

Fig.1 Osteosracoma treatment algorithm

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

 

 

 

 

 

 

 

 

 

 

 

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

 

 

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

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

 

Candidates for limb sparing

 

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

 

 

Limb sparing techniques

 

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

Fig.2

Fig.2 Allograft limbs spring surgery

 

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

 

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

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

 

Fig.3

Fig.3 Endoprosthesis limb salvage procedure

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

 

 

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

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

 

Fig.4

Fig.4 Ulnar roll-over salvage technique

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

 

 

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

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

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

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

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

Longitudinal bone transport osteogenesis

 

Fig.5

Fig.5 Longitudinal bone transport osteogenesis

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

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

Fig.6

Fig.6 Transverse Ulnar Bone Transport Osteogenesis

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

 

 

 

Case report

 

 

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

 

Fig.7

Fig.7 Orthogonal limb radiograph

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

 

 

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

Fig.8

Fig.8 Thoracic X ray

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

Treatment options were discussed with the owners:

 

-conservative palliative treatment

-amputation and chemotherapy

-limb-sparing surgery in conjunction with chemotherapy;

 

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

 

Fig.9

Fig.9 Pathological fracture of the cranio-distal cortex

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

 

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

 

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

 

 

Fig.10

Fig.10 Segmental epidural analgesia

Fig.11

Fig.11 Sternal recumbency

 

 

 

 

 

 

 

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

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

 

Fig.12

Fig.12

Fig.13

Fig.13

 

 

 

 

 

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

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

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

Fig.14

Fig.14 Microscope- assisted arterial anastomosis

Fig.15

Fig.15

 

 

 

 

 

 

 

 

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

 

 

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

Fig.16

Fig.16

Fig.17

Fig.17

 

 

 

 

 

 

 

 

 

 

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

 

 

Post operative care

 

 

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

 

Fig.18

Fig.18

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

 

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

 

 

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

 

Chemotherapy protocol

 

Fig.19

Fig.19

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

 

Fig.20

Fig.20 Carboplatin

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

 

 

 

 

Clinical recovery and Follow up

 

 

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

 

 

 

Fig.21

Fig.21 Three weeks post op

Fig.22

Fig.22 Six months post op

Fig.23

Fig.23 After lateral plate removal

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

CONCLUSIONS

 

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

INGHINO-SCROTAL HERNIA/INTESTINAL OCCLUSION, ACUTE ABDOMEN

timisoara

Dr Fodor Lucian

Lazar Laura¹,    Fodor Lucian²,

¹ʼ²ʼDVM, Veterinary clinic, Happy  Pet Timisoara, Romania

 

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

 

 

Introduction:

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

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

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

 

 

 

 

 

 

 

 

 

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

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

 

Case  report:

 

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

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

 

Clinical evaluation

his symtomps included:

-severe peritoneal response

-apatia, lethargya

-medium dehydration

-the left testicle was increased in volume

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

Diagnosis:

inghino-scrotal hernia/intestinal occlusion

 

Treatment

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

 

     After surgery

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

 

Conclusion:

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

 

 

 

Biblioghaphy

 

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

Dermatophytosis (Ringworm)

stef artMarina-Ştefania Stroe, DVM

Romania

History

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

 

WhatsApp Image 2017-09-03 at 15.41.53

fig 1

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

Remaining hairs may appear broken off.

WhatsApp Image 2017-09-03 at 15.41.44

fig 2

WhatsApp Image 2017-09-03 at 15.41.52

fig 3

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

Matt fur examined with Wood’s lamp:

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

WhatsApp Image 2017-09-03 at 15.41.49

fig 4

Picture1

fig 5

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

 

Diagnosis

Picture2

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

Dermatophytosis (Ringworm)

Other differentials (ex. demodicosis, superficial pyoderma).

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

Trichogram: misshapen hair shafts infiltrated with hyphae and arthrospores.

Deep skin scraped: negative

Treatment

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

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

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

Prognosis

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

Cervical Herniated Disc in dog

timisoaraDR FODOR LUCIAN HAPPY PET, TIMISOARA ROMANIA

Introduction

 

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

 

Case report

 

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

 

Clinical Examination

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

 

Additional Examinations

fig 1

fig 1

fig 2

fig 2

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

 

 

Diagnosis:

Cervical Herniated Disc C2-C3

 

 

Treatment:

 

  • Surgical Procedure

 

Surgical technique: ventral corpectomy, herniated disc extraction.

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

fig 3

fig 3

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

fig 4

fig 4

fig 4

fig 5

fig 7 new

fig 6

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

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

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

fig 7

fig 7

fig 8

fig 8

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • After surgery

 

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

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

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

 

 

 

 

 

Discussion:

 

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

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

 

abcdThe European Advisory Board on Cat Diseases (ABCD) invites applications for the 2018 ABCD & Boehringer Ingelheim Award, which aims to reward innovative and outstanding work by promising young professionals in the field of feline infectious diseases and/or immunology.

 

Candidates should have made an original contribution to the field of feline infectious diseases and/or immunology, which has been published or accepted for publication in a referenced journal (PubMed, Web of Science, Web of Knowledge) or accepted by another assessing body (e.g. a Thesis Committee) in 2016 or later.

 

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

 

Applications should be made in English in an electronic format and include a short abstract (max. 500 words) of the work the applicant wishes to submit, as well as a short curriculum vitae and two personal references. Any relevant publications and/or dissertation on the topic should be included. The deadline for submission is 15 March 2018.

 

The award (1000€) is funded by Boehringer Ingelheim and will be presented by the ABCD at the congress of the International Society of Feline Medicine, to be held from 28 June to 1 July 2018 in Sorrento, Italy. The award winner will receive a complimentary registration to this congress. Return travel expenses and accommodation will also be covered to allow the laureate to attend the event. The winner is expected to give a short presentation or present a poster of his/her findings at this event.

 

The recipient of the 2017 Award was Maciej Parys (University of Edinburgh).

 

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

For further information, please contact Karin de Lange, ABCD secretary, karin.delange@abcd-vets.org

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