Learn and Travel……. stories from the vets!

learn and travelLast month started for the first time our project ” LEARN AND TRAVEL WITH VETS ON THE BALKANS”. Dr Andrey Ginchev from Bulgaria, working in Blue Cross veterinary clinic in city of Sofia, and Dr Cristian Badulescu, main vet and owner of Blue Point Vet veterinary clinic in city of Bucharest, Romania have done their externship at Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco. Both of them have stayed 2 weeks. I think is better they to speak about the adveture.

Dr Andrey Ginchev:

I have so many good things to say about this externship. Firstly, it was the best experience of my life! The doctors  are amazing,especially Dr Luca Formaginni and Doctor Luigi Venco –  the best doctors I ‘ve ever seen in my life.17309856_1747923415519034_2303429150324906549_n 17342975_1747923572185685_5866766753935364961_n

The team was very well organized,very welcoming and really friendly with me. I met a lot of people from Italy and had great time with them. I became more flexible to changes, more ambitious and more sociable. My desire to travel is increased. Also this practise  helps me to gain my confidence in my own abilities,so now I am more self – confident in my work.I improved my English language and also I learned a little bit Italian…,Grazie and Thank you!!!I hope to see my  Italian friends again.

17362812_1747331025578273_7316356212028963391_n

Dr Andrey Ginchev with the team of the clinic

I´m so thankful for this experience, Thank you very much for this opportunity that you gave to me!17352518_1843303222609950_1508220180873091218_n


Dr Cristian Badulescu :

17626599_1851345018472437_7398271723240983312_n

Dr Cristian Badulescu with the team of the clinic

Before I go to Lago Maggiore Clinic, I looked on the internet to see what’s going on there. I saw them with equipment high-technology facilities. I saw that they are capable and do surgical maneuvers excellent and it’s a veterinary clinic with a very good reputation. I can therefore expect to find here and a little superciliousness, or even some superiority. But it was not so! I found wonderful people, full of positive energy. Highly trained people who know exactly what they do. But what I liked most is modesty and their openness to sharing information. They do not want to hide anything. If you know what questions to put, you get all the information you need. 17522631_1751933485118027_6444855593354748323_n 17498712_1751933001784742_8726199192797128569_nI had the honor to talk to Luca Formaggini, Luigi Venco and Giorgio Romanelli. They are true celebrities in the world of veterinary medicine in Italy. I talked a lot about a lot. The impression to me of all is that all are governed by modesty and good will. So, I thank you Vets on the Balkans for this oportunity to meet great people! Great job! Bright future!17626459_1751932908451418_3868390825708698876_n 17554387_1751934088451300_4726607108209581561_n

And of course the opinion of Dr Luigi Venco:

It ‘s Always a great experience to meet and work with enthusiastic and motivated people like Dr. Andrey Ginchev and Dr Cristian Badulescu. Exchanging knowledge and experiences and find to be friends at the end. Thanks Andrey and Cristian! Thank you Vet on the Balkans!
 Vets on The Balkans
The team of Vets on The Balkans would like to express their gratitude to ALL THE VETS included in the project! THANK YOU Clinica Veterinara Lago Maggiore – Dr Lugi Venco , Dr Luca Formaggini and Dr Mariangela De Franco for the opportunity! In fact, You are Vets on The Balkans, we are just the technical part.
Thank you as well to our sponsors Pamas Trading SRL , Romania and Bayer , Romania. Because of you Vets on The Balkans is alive.

 

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

index

Dr Adriana Moise

CASE PRESENTATION

  1. MOISE ADRIANA

TAZY-VET, BUCHAREST

 

SIGNALMENT AND HISTORY

  • FEMALE CAT , 2 YEARS OLD WAS PRESENTED FOR A CLINICAL EXAMINATION WITH HYPERSALIVATION , HALITOSIS, LACK OF APPETITE FOR PROCESSED DRY FOOD

CLINICAL FINDINGS

-THE CAT HAD NORMOTHERMIA AND A NORMAL BODY WEIGHT

-AT PHYSICAL EXAMINATION SHE PRESENTED ULCERATIVE LESIONS IN ORAL CAVITY, LOCALISED ON GINGIVAL MUCOSA, INFLAMATION ON PALATOGLOSSAL FOLDS AND PHARYNGEAL WALLS

-EDEMA WAS PRESENTED AND LOCAL LYMPHNODES WERE REACTIVE TOO

der2

photo 1

der3

photo 2

LESIONS WERE PRESENTED BILATERAL ( photo 1,2)

DIFFERENTIAL DIAGNOSTIC

-FELINE LYMPHOPLASMACYTIC GINGIVITIS-STOMATITIS COMPLEX

-FELINE CALICIVIRUS INFECTION

-FELINE HERPESVIRUS INFECTION

-FeLV-FIV

-FELINE EOSINOFILIC SINDROME

-NEOPLASIA

FURTHER INVESTIGATIONS

-FELINE CALICIVIRUS Ac –NEGATIVE

-FELINE IMMUNODEFICIENCY – FIV Ac-ELISA –NEGATIVE

-FELINE LEUCHEMIA –FELV Ag-ELISA – NEGATIVE

-THE CORONAVIRUS Ac TITRE – INCREASE

-CITOLOGY FROM IMPRESSION SMEAR – INCREASE NUMBER OF BACTERIA AND NUMEROUS ACTIVE INFLAMATORY CELLS

BLOOD TEST (BIOCHEMISTRY)  WAS NORMAL

-HEMATOLOGY REVEALS LYMPHOCYTOSIS

-CYTOLOGY AND HYSTOPATOLOGIC EXAM CONFIRMED THE DIAGNOSTIC – FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

 

DIAGNOSTIC

FELINE LYMPHOPLASMACYTIC GINGIVITIS STOMATITIS COMPLEX

TREATMENT

UNTIL WE GOT THE RESULTS THE OWNER BEGINS TO TREAT THE CAT WITH

-STOMODINE GEL TWISE A DAY, 14 DAYS

-CEFA CURE 20MG/KG/DAY, 10 DAYS

-SYNBIOTIC D-C 1CPS/DAY, 10 DAYS

-K9 IMMUNE SUPPORT CAT

 

-AFTER 10 DAYS OF TREATMENT THE INFLAMATION BEGAN TO REDUCE BUT THE ULCERS DO NOT HAVE THE TENDANCE OF HEALING

AFTER WE GOT THE DIAGNOSTIC THE CAT GETS THE FURTHER TREATMENT

-PREDNISON 2MG/KG/DAY, 5 DAYS; THEN 1MG/KG/DAY , 5 DAYS FOLLOWEDBY EVERY OTHER DAY

-STOMODINE GEL TWICE A DAY LOCAL

-HONNEY WITH PROPOLIS LOCAL

WHEN SHE CAME FOR THE EVALUATION AFTER 5 DAYS OF TREATMENT WE SAW THAT THE LESIONS HAD A TENDANCE TO REDUCE, BUT AFTER ANOTHER 5 DAYS THE LESIONS WERE EXACTLY THE SAME AS THE BEGINNING

-WE DECIDED TO INTRODUCE CYCLOSPORINE IN THE TREATMENT

-CYCLOSPORIN 7MG/KG/DAY

derder1

-THE CAT IS PERMANENTLY MONITORIZED ; HLG IS MADE EVERY 2 WEEKS

-AFTER 2 WEEKS OF TREATMENT THE LOCAL INFLAMATION BEGINS TO REDUCE

-AFTER 1 MONTH OF TREATMENT THE LESIONS FROM ONE SIDE WERE HEALD

-THE CAT IS STILL UNDER TREATMENT

-THERE IS NO SIGN OF SECOND EFFECTS OF CYCLOSPORINE

 

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

daniDr Daniela Bajenaru

Tazyvet veterinary clinic

Bucharest, Romania

 

Singalment and hystory

 

Bella, presented on 12/13/2016

10 year old, female, Labrador retriever

5 month history of polydipsia, polyuria, polyphagia and pruritus

 

Physical examination

 

Abdominal enlargement

Palpable hepatomegaly

Thin, hypotonic skin, easy bruising

Phlebectasias

Erythema

Calcinosis cutis over the dorsal neck, thorax and rump

Bacterial pyoderma

 

 

 

6 1 unnamed7

 

 

 

8 9 4 10

Investigations

Ultrasound

Urinalysis

Coagulation time

Serum chemistry panel

Trichogram, scoch test

Bacteriological examination

ACTH stimulation test

 

Laboratory results

Ultrasound- hepatomegaly

Urinalysis – low specific gravity (1.005)

Coagulation time – 5’

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

Trichogram/ scoch test – no significant findings

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

Basal cortisol level  > 10 µg

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

Diagnosis

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

SUSPICION: PITUITARY DEPENDENT

 

Treatment

TRILOSTANE -120 mg once daily

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

Probiotics

Topical: – moisturizing and desinfectant shampoo, once weekly

– antiseptic, anti inflammatory and healing gel, once daily

EFA supplements

Diet: low fat

EVOLUTION

After 3 days of topical treatment

15

After 3 days

Basal cortisol level      > 10 µg/dl

13

After first bathing

 

 

Bella1

21

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

22

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

Bella3

The evolution to be continued ….

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

12959354_10153530931267960_1853416198_o-200x300

Dr Vladislav Zlatinov

Corresponding authors :

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

 

Central Veterinary Clinic

Chavdar Mutafov str, 25 B, Sofia, Bulgaria

 

Introduction

 

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

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

 

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

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

 

 

Case report

 

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

 

 

Clinical examination

 

Fig1

Fig.1

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

 

 

 

Diagnostics

 

Radiograph of the right elbow revealed advanced elbow arthritic changes.

Fig 2

Fig.2

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

 

 

 

 

 

unnamed

Fig.3

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

The pathologist remarks:

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

 

 

Fig4

Fig.4

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

 

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

 

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

 

 

Anesthetic protocol

 

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

 

Peri-operative analgesia, Anesthetists remarks

 

fig 5

Fig.5

fig 6

Fig.6

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

 

 

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

 

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

 

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

 

 

 

Surgical protocol (surgeon remarks)

 

Fig7

Fig.7

Fig 8

Fig 8

Fig 9

Fig 9

fig10

Fig10

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

 

 

 

 

Post operative care and follow up

 

 

 

Fig 11

Fig. 11

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

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

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

 

 

 

 

Discussion

 

 

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

 

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

 

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

 

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

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

 

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

 

 

CONCLUSIONS

 

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

 

 

Comments:

 

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

 

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

 

Diagnosis: Malignant pleomorphic neoplasia, suspicious for osteosarcoma.

 

Long term prognosis:

 

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

 

A chemotherapy protocol is already being contemplated:

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

 

 

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

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

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

 

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

 

ROMANIA

 

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

 

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

 

 

Dr Iuliana Ionascu, DVM , PhD, member ESVO

 

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

 

 Dr Alexandru Diaconescu, DVM, PhD, Senior Lecturer

 

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

I wish you good luck!

 

Dr Rares Capitan , DVM, resident ECVD

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

 

Dr Ana Maria Boncea, DVM, resident ECVD

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

 BULGARIA

Dr Vladislav Zlatinov – Central Vet Clinic in Sofia, Bulgaria

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

 

Dr Stefan Savov- Ditton  Reach Veterinary Surgery, England

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

 

 

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

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

 

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

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

 

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

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

 

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

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

 

 

Dr Vanya Stoyanova – Veterinary Clinic Provet in Plovdiv, Bulgaria

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

 

 Dr Dimitar Djambazov Veterinary Clinic Sofia in Sofia, Bulgaria

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

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

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

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

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

 

 

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

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

 Dr Mario Kreszinger – Veterinary Clinic Kreszinger in Zagreb, Croatia

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

 

Dr Nikola Bunevski– Veterinary Clinic Kreszinger in Zagreb, Croatia

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

 

 

SERBIA

 Dr Zoran Loncar- Veterinary Clinic Novak in Belgrade, Serbia

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

 

Dr Nikoleta Novak- Veterinary Clinic Novak in Belgrade, Serbia

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

 

SLOVENIA

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

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

 

TURKEY

 Banu Dokuzeylul, DVM, PhD ,Department of Internal Medicine

Faculty of Veterinary Medicine

Istanbul University, Istanbul, Turkey

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

 

 

LEARN AND TRAVEL with Vets on The Balkans

learn and travelIdea

 

The project intends to assist and support the veterinarians from The Balkans in their desire to upgrade their knowledge and experience in veterinary medicine. They will visit different clinics which are included in the project. The idea is to go directly into practice, to upgrade their own knowledge and experience, to advance their level of practice and generally the veterinary practice on the Balkans.

Goals

 

  1. Rise the level of veterinary service on The Balkans;
  2. Improve health status of the animals and stop transmitting of some diseases;
  3. Improve the financial status of veterinarians by learning different opportunities of management of veterinary clinic and acquiring new skills;
  4. Better understanding of the meaning of the words “hand by hand we all will be better”;
  5. Create contacts and future collaborations.

 

 

Methods to achieve the goals

 

We have agreements with different clinics and they will be involved to provide good environment for education and practice:

 

  1. Central Vet Clinic –  Dr Ranko Georgiev-Sofia, Bulgaria
  2. Nova Veterinary Clinic – Dr Maria Savova-Sofia, Bulgaria
  3. Petcode Veterinary Clinic – Dr Ates Barut-Ankara, Turkey
  4. Regatul Animalelor ( Dermatology Clinic -Rares Capitan – DVM resident ECVD )  – Bucharest, Romania
  5. Vet Derm Therapy – Dr Ana Maria Boncea DVM resident ECVD- Bucharest, Romania
  6. Blue Vets – Dr Constantin Ifteme-Bucharest, Romania
  7. Center Endoscopy and Minimally Invasive Surgery Veterinary- Dr Constantin Ifteme-Bucharest, Romania
  8. Clinica Veterinara Lago Maggiore – Dr Lugi Venco and Dr Luca Formaggini – Italy
  9. Veterinary Clinic Kreszinger – Zagreb, Croatia
  10. Veterinary Clinic More – Sibenik , Croatia
  11.  Dierenartsen praktijk – Dr Ann Criel- Kermt –Belgium
  12. Patisev Veterinary Clinic – Dr Gizem Taktak – Istanbul, Turkey

 

 How can you participate in the project?

 

The vets can submit their applications (they will receive and fill in a questionnaire).

To receive your questionnaire, send an email to gancheva.vet@gmail.com.

 

The vets will receive the agreement from us (Vets on The Balkans) and the clinic chosen by the vet to visit. Depending on the interests of the vet we can recommend a clinic where they can achieve their goals.

 

Financial sources

 

The financial sources will be from donations (vets, clinics, companies). We will cover accommodation and trip expenses. The companies can pay directly for a vet (their client), elected by them.

 

All the money, which come as donations for the project will be transparent and public and easy reachable for every vet.

If you would like to support the project, you can do it! Even with a small amount! Because “HAND BY HAND WE ALL WILL BE BETTER”

 

You can give your support here:

 

 

VETS ON THE BALKANS

 

PIRAEUS BANK – City of Ruse, Bulgaria

 

BG44PIRB 8087 1605 7096 72

 

BIC COD: PIRB BG SF

 

Please write that the money transfer is for “Learn and Travel with Vets on The Balkans”

 

 

 

The project gives opportunities for raising your knowledge in Cardiology ( Bulgaria, Italy ), Dermatology ( Romania,  Turkey) , Orthopedic and Neurology ( Turkey, Croatia and Bulgaria), Endoscopy (Turkey, Romania and Croatia), Exotic animals ( Romania), Surgery ( Turkey, Italy, Belgium, Bulgaria, Romania), Imaging ( Romania, Turkey and Bulgaria) , different management ( Italy, Bulgaria, Romania, Italy , Belgium), Ophthalmology ( Bulgaria) and all standard practices.

 

We would like to express our gratitude to all clinicians who are open to share their experience and especially to CSAVS (Croatian Small Animals Section) and TSAVA who gave us FREE TICKET for their annual congresses for the vet who will visit the country with the project!!! This is very kind of them and we appreciate OUR FRIENDS!

 

THANK YOU ALL!

 

Dr Ates Barut

Dr Lea Keszinger

Dr Ann Criel

Dr Constantin Ifteme

Dr Luigi Venco

Dr Luca Formaggini

Dr Rares Capitan

Dr Ranko Georgiev

Dr Ana Maria Boncea

Dr Radu Boncea

Dr Maria Savova

Dr Emil Ofner

Dr Gizem Taktak12745855_10153614352488768_1773045904046497569_n10449520_331653303690149_6301850326184657855_n11081271_887548304621403_4674371800362832817_n24246_103549239687374_288378_n10632803_386951221474358_809805735081418787_n13876274_1572033829758101_6531483327220244503_n12985514_476693252530917_7663830711320340997_n 1606385_529954783784550_836186800_o11046515_911180198937089_2761924638059587412_n12079558_903035003067421_4071890671212270246_n

 

 

 

 

 

We express our gratitude to our partners Bayer Romaina and Pamas Trading who makes our existence possible.

If you have questions and ideas how to raise our project or something else, please be free to get contact in gancheva.vet@gmail.com!

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About the “recipe” to be respected from all vets in Romania and is it hard to be a teacher nowadays ?…Alexandru Diaconescu, DVM, PhD, Senior Lecturer

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Alexandru Diaconescu, DVM, PhD, Senior Lecturer

1.How long  are you working in the Faculty of Veterinary Medicine in Bucharest, Romania? And tell us more about your practice?

I work in the Faculty of Veterinary Medicine in Bucharest since october 1990, at the Clinic of Obstetrics and Gynaecology . Before, I have worked for two years in a dairy cattle farm, near Bucharest.

2.Do you think  is hard to be a teacher nowadays?

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Teacher…

I think that it is very different than 20 years ago, because, on one hand, the acces to information for the students is much easier, so you must pay attention to provide always  the newest things and, on the other hand, besides teaching, every teacher is involved in  research activities, documentation, etc. Supplementary, a teacher like me, who works in the clinical field, must have also hours of clinical activity with the students, on large and small animals.

3.What is the most important thing that you would like your students to learn from you?

That you cannot practice veterinary medicine without passion, without loving  animals, but also the humans.

4.What do you think about the level of veterinary medicine on the Balkans? and in Romania ?

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with students

I think that that the level of veterinary medicine in the Balkan region, also in Romania, grows very fast, esspecialy in the field of companion animals. The demand on the market obliges the vet to learn every day the newest things and procedures, so that he can provide the best care for his clients.

5.Everybody has great opinion about you. Tell us more about your “recipe”?

It is not a recipe. I try to be honest to myself and to the others, and I try to do the best job possible to help the animal. I think that the students appreciate the fact that we can discuss freely on a certatin subject, as well that they can participate in certain surgical procedures, ultrasound exams, etc.

6.What do you think about our veterinary journal Vets on The Balkans?

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Vets on The Balkans

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

I wish you good luck!

We would like to express our gratitude to  Alexandru Diaconescu, DVM, PhD, Senior Lecturer! Or how romanians say ” SARUTMANA” (means ” kiss your hand ” ).

 

Dr Nikola Bunevski- macedonain vet in Zagreb, Croatia. Real Balkan story

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Dr Nikola Bunevski

1.How long  you work in Croatia? (tell us more about your internship in the university)?

I’m working in croatia for 2,5 years and 2,5 years on postgraduate studies on the University of Veterinary Medicine in Zagreb Croatia. Postgraduate studies on the University of Veterinary Medicine where on the Department of Surgery Orthopedic Ophthalmology and Anesthesiology -they were excellent ,on the Department of Surgery here in Zagreb  are working excellent veterinarians who are excellent in their surgical skills from which you can learn a lot!!! I’m really grateful that i have a chance to be there and learn so much.

2.Why and how you decided to go in Croatia,not in country of West Europe?

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Veterinary Clinic Kreszinger

I was thinking a lot where to sign up  for Postgraduate studies. I was looking for postgraduate studies in Athens, Sofia, Belgrade, Zagreb and Ljubljana, because they are offering programs that i can afford, and i see the Department of Surgery here in Croatia, and realize that they have new modern clinic and a lot of cases where I can learn a lot.

3.Tell us more about the level of veterinary medicine in Croatia?

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Work…

The level of veterinary medicine in Croatia? I can tell you that the veterinarians are working very hard to push up the level of veterinary medicine to be similar like western european countries. Croatian Small Animal Veterinary Section (CSAVS) are organizing a lot of events workshops educations and a lot of professors and educators are coming from around the world and giving lectures and teaching us how to perform better veterinary medicine. The level is high and is growing rapidly. I’m really feel blessed that i have a chance to meet so good friends/veterinarians here in Croatia.

4.And in Macedonia?

The faculties of veterinary medicine in Macedonia are young. Veterinary medicine is changing especially from the young new veterinarians side. I know a lot of young veterinarians in Macedonia who are working a lot and they are giving best from them self to change the future of vet.med. in Macedonia.I really hope that soon a lot of young veterinarians will come in the clinic where im working so we can exchange knowledge and not just here but around Europe to experience some good veterinary practice . I really believe that those young veterinarians will make changes, I’m in very good contact with a lot of them helping in everyway that I can, and I’m expecting some of them here in Zagreb  to work together for some time, some of them already came. It’s really great when you share knowledge.

5.Future plans?

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Love…

I don’t have plans for future. But i have a dreams-to be a better veterinarian and have a chance to collect some new knowledge, maybe to return and work again in my home country Macedonia, or in some place where I can practice good veterinary practice, places like here in Croatia or somewhere around the world.

6 .What do you think about Vets on The Balkans?

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

The team of Vets on The Balkans :” Thank you very much Dr Nikola Bunevski  for sharing with us ! We are proud of having vet like you on the Balkans!!! “

 

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Dr Nikola Bunevski

Dr Nikola Bunevski

He graduated:

Trakya University

Faculty of Veterinary Medicine – Stara Zagora , R. Bulgaria

major: Veterinary Medicine (September 2001 – February 2008)

Professional title: Doctor of Veterinary Medicine

He got his Master calss :

University of Zagreb

Faculty of Veterinary Medicine-Zagreb Croatia

Department of Surgery,Ortopedics Ophtalmology and Anesteziology.

Profesional title:University Master of Surgery (2010-2012)

Certificates:

 

Member of the Veterinary Chamber of Macedonia

 

Member of  Croatian Small Animal Veterinary Section

Member of the Veterinary Chamber of Croatia.

Member of the Society of Radiology genetically influenced skeletal disorders in small animals eV (GRSK)-Germany.

Participation in WSAVA Continuing Education Course in topic: Oncology and Reconstructive Surgery, Stara Zagora, R. Bulgaria (October 2006)

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2010

Certificate of attendance-17th  FECAVA Eurocongress Istambul-Turkey 2011

Certificate of attendance-Small animal Orthopedics seminar-Belgrade Serbia 2011

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2011

Certificate of attendance-Small animal  Neurology seminar-Belgrade Serbia 2012

Certificate of attendance-Small Animal Veterinary Symposium Belgrade Serbia 2012

Certificate Course Participant- All About the Stifle Joint Course Opatija Croatia 2013

Certificate of attendance-1 Congres of Croatian Small Animal Veterinary Section  Zagreb Croatia2014

Certificate Course Participant-AOVET Course-Principles in Smal Animal Fracture Management  Zagreb Croatia 2014

Certificate of attendance-Belgrade Veterinary Neurology Conference Belgrade Serbia 2014.

Vertificate of attendance-20th FECAVA Eurocongress Munich Germany 2014

Certificate attended as a Faculty-A Practical Approach to External Skeletal Fixation Opatija Croatia 2014

Certificate of attendance-2 Congres of Croatian Small Animal Veterinary Section  Zagreb Croatia2015

 

 

 

 

Retrobulbar chondrosarcoma in a dog

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Dr Marian Ralic

        Retrobulbar chondrosarcoma in a dog

M. Ralić 1,*, J. Vasić2 , M. Jovanović3 and B. Cameron4

1Veterinary surgeon, Kumanovo, 1300, Republic of Macedonia 2Department of Surgery, Orthopaedics and Ophthalmology, Faculty of Veterinary Medicine, University of Belgrade, 11000 Belgrade, Serbia 3Department of Pathomorphology, Faculty of Veterinary Medicine, University of Belgrade, 11000 Belgrade, Serbia 4Veterinary surgeon, Hague, The Netherlands

Abstract

This paper presents a review of a dog, with a retrobulbar chondrosarcoma, which was admitted for surgery for visible changes in his eye during inspection. Orbital neoplasia in dogs may be primary and secondary. Sixty percent of orbital neoplasia in dogs are primary, ninety percent of which are malignant. Retrobulbar neoplasms are rare and in their early stage represent a diagnostic challenge. Chondrosarcoma of the skull is a slow-progressing malignant disease which occurs locally, aggressive with invasion into the surrounding tissues. Dogs with chondrosarcoma of the skull have life expectancy between 210 and 580 days – in our case it was 180 days – after the first alterations on the eye of the dog occurred.

Keywords: Chondrosarcoma, Computed tomography, Exophthalmos

Introduction

Chondrosarcoma (CS) is a malignant tumour of bones in animals and humans. This neoplasm corresponds to 5 – 10% of all the primary bone tumours in dogs. Primary CS may occur on skeletal system and then it is called central or medular CS. When CS is located on periosteum, it is called peripheral CS (Withrow and Vail, 2007).

Case Details Eight years and seven months old male Cocker Spaniel was admitted to the surgery for presence of a thick mucus discharge and changes on the cornea of his left eye. The dog apparently did not have any other health issues. During the clinical examination, the dog was fit, in a good mood and there were no changes in regional lymph nodes. The changes on the left eye were visible: presence of the dried mucus discharge and clingy hair on the upper eyelid and medial canthus.

Due to protrusion of the eye bulb, a pronounced exophthalmos of the left eye was clearly perceptible. The upper lateral quadrant of the cornea was blurry. There were no visible changes in the right eye. The methods used during the first examination of the eye were: the fluorescein eye stain test, the Schirmer I tear test, measurement of the intraocular pressure and the Jones’ test for patency of nasolacrimal duct. As the process progressed, the tumour was sampled for histopathological examination and computed tomography of the skull was also performed in the follow-up examinations.

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Fig. 1. Dried mucous secretion on the eye lids, hyperaemia, oedema of the conjunctiva with protrusion of the third eye lid and keratitis (one month after the first examination).

The intraocular pressure was measured by the Schiotz method, with prior application of anaesthetic (proparacain) to the eye. The solution of fluorescein was used for staining the cornea and testing the patency of the nasolacrimal duct. The computed tomography of the skull was performed by the thirdgeneration device GE (9800-8800), under sedation using Domitor. The inspection revealed changes on the auxiliary parts of the left eye and presence of dried mucus discharge. Alopecia was not noticed on the lids of the left eye. The third eyelid protruded out of its place covering half of the eye bulb (Fig. 1).

The dog did not react painfully to retropulsion of the eye bulb, which was performed due to its enlargement. There was no counter effect from the bottom of the orbit of the affected eye during the retropulsion. The Schirmer I test results for the right and the left eye were 15 mm and 6 mm, respectively. There was a superficial whitish blur in the upper medial quadrant of the left eye cornea. The fluorescein stain test was positive, which indicated alteration of the superficial layer of the cornea. The Jones’ test was positive for both nasolacrimal ducts. The changes on the iris and on the anterior chamber were not noticed during the ophthalmoscopy. Examination of the posterior segment of the eye and the lens of the left eye was performed after application of the Midriacil 1% drops to the eye. A central Y nuclear sclerosis was noticed in the lens.

There were no anatomic deviations on the fundus, both on the tapetal and non-tapetal part of the retina. A slight swelling of the optic papilla was observable. The mean values of the intraocular pressure of the right eye and the left eye were 22.38 mmHg and 10.24 mmHg, respectively. The findings of the examination, absence of tears, moderate exophthalmos and slight protrusion of the third eye lid were basis for establishing the working diagnosis of keratoconjunctivitis sicca of the left eye, so further regular follow-ups were advised. The therapy for dry eye (artificial tears) and systemic antibiotic therapy (Cephalexin tabl. 15 mg/kg) were administered to the dog.

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Fig. 2. Lateral transposition of the left bulb and impossibility of retropulsion of the left eye to the orbit. Dried secretion on the left nostril.

A month later, the next examination revealed significant deterioration of the clinical signs on the surface of the cornea and significant enlargement of the eye bulb (Fig. 2).The position of the left eye bulb indicated upward lateral strabismus. The third eye lid was everted and the conjunctiva was swollen. When performed again, the Jones’ test resulted with absence of staining in the left nostril which indicated obstruction of the left nasolacrimal duct. The owner reported that the dog sniffles discharging a thick secretion from the left nostril and has swallowing problems. Computed tomography of the skull with prior application of sedative Domitor followed the examination of the mouth cavity, which revealed an obvious tumoural mass behind the last upper molar on the left side. The scan was performed in dorsolateral position (Fig. 3).

 

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Fig. 3. Computed tomography of the skull. The left eye bulb protrusion, presence of the tumoural mass in the very base of the orbit with osteolysis of the nasal septum and presence of the neoplasm in the left nasal duct.

 

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Fig. 4. Reconsturction: neoplasia the bottom of the orbit.

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Fig. 5. Reconstruction: the neoplasia affects the bottom of the orbit and osteolysis of part of the orbit.

The images clearly showed presence of the neoplasia in the region of the medial orbit, osteolysis of the nasal septum and presence of the tumoural mass in the left nasal duct (Fig. 4 and 5).

 

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Fig. 6. Position of the prominent part of the tumour behind the last molar of the maxilla.

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Fig. 7. The part of the tumour removed for histopathological examination.

The excisional biopsy of the neoplasm in the mouth cavity with prior application of xylocain 2% spray was performed after the scan (Fig. 6).The system therapy including antibiotic and NSAID – antibiotic Cephalexin at a dose of 15 mg/kg p/o and Movalis tablets at a dose of 1.7 mg/kg BW per day – was applied, as the dog obviously suffered from pain. The excised tumour was assessed morphopathologically. The tumoral mass was 3, 4×2, 5×1.8 cm in size and 25g in weight and hard in texture (Fig. 7).

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Fig. 8. Depicted scattered pleomorphic binuclear chondrocytes. Clearly pronounced cytoplasm, due to the larger amount of glycogen. The isles of hyaline cartilage surrounded by non-defined mesenchymal cells (H&E x300)

The preparation for histopathological examination was dyed with hematoxylin and eosin (H&E). Histopathological findings showed presence of pleomorphic cells with vesicular nucleus containing one or more nucleoli. The tumour cells produced the chondroid matrix and they were arranged, by their shape and size, in irregular groups which were separated from the surrounding tissue (Fig. 8).

Such histopathological finding indicated a highly differentiated mesenchymal sarcoma of the left eye with destruction of the nasal septum. Since surgery and radical removal of the neoplasm, as well as application of chemotherapy, were not possible, the dog was given the medication for pain relief and the eye was treated locally with the antibiotic drops (Tobramicin 4×1). Three months after the final diagnosis was established, the dog died.

Discussion

Primary neoplasia of the orbit can arise from any tissue: epithelial, vascular, nervous or connective tissue. Secondary orbital neoplasia arises from the nasal structures, sinuses or cranial cavities of the skull and rarely as distant metastasis. Meningioma, lymphosarcoma, adenocarcinoma, fibrosarcoma, myxoma, glioma, squamous cell carcinoma (SCC) and rabdomyosarcoma are among the numerous neoplasia of the orbit in dogs. In dogs, 90% of orbital tumors are malignant. CS occurs on pelvis, facial bones, ribs, vertebrae and scapula as a non-painful tumoural mass (Bostock and Owen, 1975). The occurrence in trachea, lungs, omentum, mammary gland, heart valves, aorta, tongue, root of the penis and the penile urethra was also reported (Kim et al., 2007). CS is a malignant tumour cells which produce cartilaginous matrix. It develops from the cartilage structures of the bones and can also develop out of the tissues where cartilage normally does not exist. CS of the skull rarely occurs and most often, in 28.8% cases, it can be found in the nasal cavity, 9% of which is on the facial bones (maxilla, mandible and orbit) (Kim et al., 2007). Due to impossibility of the eye closure, the cornea gets dry and keratitis, conjunctivitis, myosis and eccentric pupil can be observed. The eye affected by CS of the orbit is non-functional, and due to destruction of the nasal septum and expansion of the tumor, a thick nasal discharge, difficult breathing and nasal stridor are also present. Besides the clinical signs, ultrasonography of the eye and the orbit, fine-needle aspiration biopsy (FNA), plain radiography of the skull, computed tomography and magnetic resonance imaging (MRI) are also the methods used in diagnosing CS of the orbit. Regarding the differential diagnosis, CS should be distinguished from non-neoplastic inflammatory orbital granuloma, cellulitis and abscesses and from myositis of extraocular muscles and masticatory muscles.

The main symptom in the dogs with inflammatory processes in the region of the orbit is presence of a strong pain during mouth opening. The dogs with inflammatory processes in the region of the orbit feel pain during mouth opening (Withrow and Vail, 2007). The following six parameters are being used in CT scan and in diagnosis of tumours of the nose, the superior sinuses and the orbit:

1. Bilateral expansion of the tumour in basal and paranasal sinuses.

2. Destruction of the nasal bone and finding of tumoural mass on nasal surface and in the facial area.

3. Presence of the tumour in the mouth cavity with hard palate destruction.

4. Presence of the tumour in the orbit and lateral pressure on the bulb.

5. The frontal sinus involvement.

6. The brain involvement and destruction of the cranium, expansion of the tumour into the brain (Kondo et al., 2008)

Radiography reveals presence of the irregular and often blurred areas permeated by calcification. Atypical cartilaginous tissue with metachromatic basal material can be observed in the histopathological finding. Some cells and some groups of cells are binuclear. Especially characteristic are the big atypical cells with large “swollen-plump” nuclei (Zlateva and Milenkov, 1983). All degrees of differentiation occur; benign tumours have an abundant cartilaginous matrix whilst malignant tumours contain closely packed cells with plump, frequently multiple nuclei. Mitotic figures are common in the more malignant tumours (Bostock and Owen, 1975). Sometimes, calcifications and ossifications can be found in the cartilaginous tissue of the tumour. Treatment for CS of the skull is directly dependent on its localization and the degree of invasiveness towards the surrounding tissue. As it is a malignant tumour, the treatment of choice, if it is possible, would be the surgery. Orbitotomy with resection of zygomatic arch is recommended. If the tumoural mass is small, a transconjuctival approach to the tumour is also possible (Maggs et al., 2008). In the case of the surgery, the operation is difficult because differentiation between the normal and the tumoural tissue is not easy.

For this reason, it can happen that the neoplasm is removed incompletely, which causes consequent recurrences (Gelatt and Gelatt, 2011). In the case that the tumour invaded the brain, the mouth cavity, or the orbit, radiotherapy – either as monotherapy or combined with chemotherapy – and sometimes (as it was in our case) even only the antibiotic and NSAID treatment are recommended before the surgical treatment.

Prognosis for the orbital tumours is poor since the surgical treatment does not solve the issue of recurrences. The dogs with orbital osteolysis (as in our case) have even poorer prognosis. In the case of radical surgery (orbitectomy), the owners are reluctant to accept the fact that their pet is going to have the postoperative facial deformity. The studies suggest that surgical treatment of CS and chemotherapy can prolong life of the dog for six months (Gelatt and Gelatt, 2011). The average life expectancy for dogs with CS that also invaded the nasal cavity is between 210 and 580 days, with treatment provided (rhinotomy with radiotherapy) (Withrow and Vail, 2007). The low-grade chodrosarcoma can grow for a long time during several years without showing a tendency to metastasize, while the fast-growing CS metastasizes to lungs, kidneys, liver and heart (Withrow and Vail, 2007).

CS of the orbit is a rare, slow-progressing malignant disease in dogs and is extremely destructive to surrounding tissues. In the cases of clinically diagnosed CS in dogs, the dogs were in the age of about eight years. On the computed tomography scans one can observe a large, irregularly shaped mass with destruction of the orbital bones and mineralisation of the tumoural matrix. There is also compression of the local tissue, the muscles of the eye bulb and dislocation of the eye bulb from the orbit.

Due to the difficult approach to the tumour and the pronounced destruction of the surrounding tissues, it is difficult to perform the surgery. Recurrences are very frequent and the life expectancy in dogs is less than a year after the accurate diagnosis is established. Due to the severe pain, it is necessary to apply the potent NSAID and opioid analgesics as well as the supportive therapy including vitamins and intravenous solutions to bring some relief to the dog.

References

Bostock, D.E. and Owen, L.N. 1975. Veterinary Colour Atlas: Neoplasia in the cat, dog and horse, Chondromasand Chondrocarcomas. pp: 99. Gelatt, K.N. and Gelatt, J.P. 2011. In: Veterinary Ophthalmic Surgery, Surgery of the Orbit. Oxford, Elsevier/Saunders. pp: 59. Kim, H., Nakaichi, M., Itamoto, K. and Taura, Y. 2007. Primary chondrosarcoma in the skull of a dog. J. Vet. Sci. 8(1), 99-101. Kondo, Y., Matsunaga, S., Mochizuki, M., Kadosawa, T., Nakagawa, T., Nishimura, R. and Sasaki, N. 2008. Prognosis of canine Patients with Nasal Tumors According to Modified Clinical Stages Based on Computed Tomography: A Retrospective Study. J. Vet. Med. Sci. 70(3), 207-212. Maggs, D.J., Miller, P.E. and Ofri, R. 2008. Orbit. In: Slatter`s; fundamentals of Veterinary Ophthalmology 4th edition, Neoplasm and SpaceOccupying Lesions. St. Louis: Saunders, Elsevier. pp: 352-373. Withrow, S.J. and Vail, D.M. 2007. In: Small Animal Clnical Oncologz 4th edition, Oculars Tumors, Tumors of the Orbit and Optic Nerve. Zlateva, M. and Milenkov, H.R. 1983. Rakovodstvo za praktičeski upraženia po patologična anatomia, Sofija. pp: 19.