Lateral Flank Approach for Ovariohysterectomy in Cats

Vladimir Stojanoski, DVM, Spec. surg. vet.

Irena Mandevska, DVM.

Animal Care Clinic, Clinic for surgery, oftalmology andstomatology, Bitola, Macedonia

ABSTRACT

The ovariohysterectomy is a routine procedure which is recommended primary for control of the population of cats. Until now there are various access techniques that are described in the literature for the ovariohysterectomy(OVH) at cats. In this study of ovariohysterectomy, 500 adult female cats at the age of 6 months to 9 years with bodyweight  of 2,5-5 kg, were covered. In OVH a small lateral accessed cut is made which minimizes the presence of bleeding during incision, easy access and extraction of the ovaries and the horns of the uterus is obtained during the procedure, also minimization of postoperative complication, shorten the time of the surgical procedure (give or take 20 minutes per intervention), also the healing of the wound and the pain threshold postoperative, all this examined by Feline grimace scale fact sheet(Evanelista at all 2019) are significantly smaller. 96% of the clinics in the USA apply the “Flank” lateral access for OVH at cats, but in our region this technique is still not well known though the benefits of it are greater, in contrast to other techniques of OVH at cats.

 

INTRODUCTION

The managing of the population of domestic cats is a global issue which raises the question of the individual wellbeing of the cats (Roberts et all, 2015). OVH is a routine procedure that is recommended as the best method in controlling the population of cats (Levy et all, 2003). Traditionally, OVH is made by medial ventral or lateral “Flank” access which in the world and also our region is still not accepted as a routine everyday technique. Because of the positive feedback, the lateral “Flank” access for OVH at cats is more and more applied in the world.

The left side of incision was preferred in the start of applying the lateral “Flank” access (McGarthet all, 2004) and also many incisions were applied in horizontal and vertical direction of the abdominal oblique muscles in OVH at cats (Hogue, 1991). Generally, at the start of the application of this technique, the length of the incision was 2-3cm м (McGrath et all, 2004; Coe et all, 2006; Rana, 2007; Kiani et all, 2014). In comparative studies Ghanawat and Mantri (1996), Shuttleworth and Smythe (2000), Coe et all, (2006) and Rana (2007) reported significantly smaller incision with the lateral “Flank” access 1-1,5 cm compared to the medial ventral access. Examining the technique and comparing the suturing of the skin with skin and intradermal sutures a conclusion was gained that the healing of the wound with intradermal suture is way quicker and the discomfort of the patient is greatly reduced. Also by applying this technique the time needed for wound healing is shortened, the trauma of the abdominal muscles is way smaller because the incision is lateral, the pressure over the wound and the incision is greatly reduced.

 

MATERIAL AND METHODS

In this study were covered 500 female adult cats, the youngest older than 6 months and the oldest younger than 9 months. All patients undergone: general clinical examination, blood test and ultrasonography for confirmation of pregnancy. Every cat that did not showed deviations in the clinical examination, blood test also were not pregnant was included in this study. Every cat was preoperatively deprived of food 12-24h and water 6h. At all patients a venous path was established, a venous anesthesia was applied, also intubated and a breathing monitoring was used thanks to a Breathe Safe Respiratory Monitor. During the procedure a NaCl0.9% infusion was applied in dose of 20ml/kg/h. The surgical field was shaved by a shaving machine with No. 40F knife, and also disinfected by 4% chlorhexidine. Also the surgical field was covered by surgical covers (sheets) with dimensions of 45-45cm, a surgical knife 10 was used and as a surgical thread we used monofilament Monosyn 3-0. We used the general surgical set for sterilization (with spay hook), sterilized by the method of dry sterilization. Postoperatively as an analgesic a single dose of NSAID – meloxicam 0.2mk/kg i/v was applied.

 

INDICATIONS

One of the most common indication for implementing this access is sterilizing of breastfeeding cats and also sterilizing cats with hyperplasia of the mammary glands. When the OVH is made during lactation it’s a better choice to use the lateral “Flank” access rather than the medial ventral access because the occurrence of dermal and subdermal heamorrhagia is very rare almost unnoticeable, also swelling, infection and discharge of the mammary gland are absent. Besides that, by using the lateral “Flank” access in cats during lactation, there is no disorder in the function of the mammary gland, so these patients can continue the breastfeeding postoperative the next day.

The mammary hyperplasia, also known as fibro adenomatous hyperplasia or mammary hypertrophy -fibroadenomal complex (Dolly Parton Syndrome) – image 1, represents a benign formation during estrous cycle or breastfeeding at cats that characterizes with fast abnormal growth of one or more mammary complexes (Hayden at all, 1981). As a choice of treatment its recommended to use ovariectomy or ovariohysterectomy, that results with regression of the mammary hyperplasia within a time period of 3-4 weeks (Wehrend and all, 2001). The use of this technique during lactation eliminates the occurrence of rupture of the mammary complexes triggered by a wound infection that appears as a complication by using the medial access of OVH.274135312_291687186401383_2989444432093713041_n

ADVANTAGES

The advantages of the lateral “Flank” access to OVH at cats includes the possibility to over watch the surgical wound from distance and reducing the potential to eviscerate due to dehiscence of the wound sutures (Dorn & AS, 1975; Krzaczynski, 1974; Miller &Zawistowski, 2012). These advantages are very important while working with wild, feral and homeless, scared animals or animals whose owner is not always capable to transport the patient back to the clinic/ambulance. The capability for these animals to be brought back for routine control postoperative is very limited, thus very often, observing from distance is necessary.

The lateral “Flank” access allows visual assessment of the wound without manipulating with the patient, which is not the case by using the ventral-medial access.

Evisceration of the abdominal organs or dehiscence of the sutures are very uncommon because the forces of gravity using the lateral “Flank’ access are weaker than using the ventral-medial access (Dorn & AS, 1975; Krzaczynski, 1974; Miller &Zawistowski, 2012; Janssens&Janssens, 1991). In addition, the overlapping of the oblique abdominal muscles helps keeping the integrity of the abdominal wall, which makes the possibility of such complications to occur very small.

With the lateral access, the ipsilateral ovary and the horn of the uterus is spotted right under the incision, which makes them very easy to locate. This shortens the time, normally needed to locate the ovary during the ventral-medial access, thus shortens the time needed for the whole operation.

CONTRAINDICATIONS

Contraindications of the lateral “Flank” access includes: distension of the uterus respectively gravity or pyometra, overweight or patient younger than 12 weeks (Dorn & AS, 1975; Krzaczynski, 1974; Janssens&Janssen,s 1991; Dorn &Swist, 1977). Some authors describe the risk of visual scar or imperfections of the color and fur growth of the operation field (Janssens&Janssens, 1991). At patient that are highly gravid or have a uterine distension/pyometra, the lateral “Flank” access is not recommended because we do not have a clear access to manipulate with the uterus. If the gravity or pyometraare identified by accident, the lateral “Flank” access is extended for relieved extraction of the uterus. However, extending the incision can increase the risk of muscle trauma or potential bleeding, undermining the primary advantages of the lateral “Flank” access during OVH (Salmeri at all, 1991).

 

DISADVANTAGES

The primal disadvantage of the lateral “Flank” access is the limited visual exposure in occurrence of possible complications (Dorn & AS 1975; Krzaczynski, 1974; Janssens&Janssens, 1991; Dorn &Swist, 1977).

The second important concern is that when a cat is brought, but it’s unknown if the same cat has undergone a OVH, the surgical scar is small and the point of incision is not always typical to be made at the same location, even if it’s made on the same side of the previous incision, in contrast to the medial ventral access where the incision is typically spotted on exact location respectively under the umbilicus along the linea alba (Miller &Zawistowski, 2012). This could lead to an unnecessary surgical intervention if the surgeon is not aware of the possibility that the lateral “Flank” access might have been used for OVH. Therefore, when the lateral “Flank” access is used, it is necessary to mark the cat that is operated, like tattooing of the umbilicus or linea alba along the abdomen, or by incising the tip of the left ear at the homeless or feral cats (Miller &Zawistowski, 2012).

SURGICAL INTERVENTION

Anesthesia of the patient

Ovariohysterectomy is a routine surgical procedure by which in this study is used an intravenous anesthesia.

Sedation/anesthesia in combination with midazolam:

  • Dexmeditomidin10 µg/kg i/m
  • Midazolam2mg/kg i/v and
  • Ketamine 2mg/kg i/v – slowly applicate till effect is achieved
    • For maintenance of anesthesia if needed Propofol is administered like a bolus of – 0,4mg/kg
    • Intubation and monitoring of breathing with Breathe Safe Respiratory Monitor (image 2).
      Image 2 - Breathe Safe Respiratory Monitor

      Image 2 – Breathe Safe Respiratory Monitor

      Instruments that are used for the procedure

      Standard set for sterilization: surgical gloves, surgical sterile sheet, surgical tweezers – Adison tissue, scalpel – No. 10, needle holder – Mayo Hager, hook (spay hook) for ovariohysterectomy, four surgical forceps – Mosquito forceps, surgical scissors – mayo scissor curved, four Backhaus towel clamps, surgical knife – No. 10, monofilament (Monosyn 3-0) resorptive threat, sterile gauze (image 3).

      Image 3 - Ovariohysterectomy kit

      Image 3 – Ovariohysterectomy kit

      Position of the patient

      By using the lateral “flank” access the patient could be positioned in right or left dorsal recumbence depending of the surgeons opinion. The access at the right side is preferred by some surgeons because it provides better access to more cranially anatomically placed ovary and because the omentum covers the viscera when it’s used a left sided access (Dorn &Swist, 1977). From our experience there aren’t any advantages whether a left or right sided access is used, but the left side is better because the dominant hand is used for easy manipulation with the suspensory ligament. The animal is placed in lateral position by fixing the limbs in their extension (Krzaczynski, 1974) – image 4.

      Image 4 - Lateral position with limbs fixed in extension

      Image 4 – Lateral position with limbs fixed in extension

      Surgical preparation

      The surgical field is being shaved by starting cranially from the last rib all the way down to the iliac bone in cranial-caudal direction and the transversal processes of the lumbar vertebrae, all the way down to the mammary complex in dorsal-ventral projection.

       

      Marking the incision

      The carving of the incision may be placed in dorsal-ventral or cranial-caudal direction, however by our experience we use the technique of cranial-caudal incision by which the incision is placed in one conceived central line, two fingers from the last rib, one finger from the transversal processes and two fingers from the iliac bone in diameter of 1-1,5 cm (image 5) depending on the size of the cat, estrus phase, or the presence of other possible complication factors.

      Image 5 - Ready surgical field and appropriate location of incision for a left lateral access (left dashed line: location of the last rib; right dashed line: location of the iliac crest

      Image 5 – Ready surgical field and appropriate location of incision for a left lateral access (left dashed line: location of the last rib; right dashed line: location of the iliac crest

      Surgical technique

      The incision of the skin for the lateral “Flank” access can made in cranial caudal direction paying attention for avoiding the superficial blood vessels. The subdermal tissue must be cut with separating scissors (image 6). The abdominal muscles should be separated from the subdermal tissue and by using a forceps or scissors an incision must be made separately on every layer of the lateral abdominal muscles. When the abdomen is opened its important to fixate the abdominal muscle with a forceps, or the thumb, to maintain the control over the abdominal wall. The ovary or the uterine horn should be placed right under the incision.

      Image 6 - Subcutaneous separation

      Image 6 – Subcutaneous separation

      The horn is pulled out by using  (image 7 top).

      Image 7 - Spay hook (top) and extraction of the horn of the uterus (bottom)

      Image 7 – Spay hook (top) and extraction of the horn of the uterus (bottom)

      20210528_102125 After the extraction of the horn and sighting the ovary, with the help of a forceps the ovary is fixated with the suspensory ligament (image 7 bottom). At older and obese cats the ovary is surrounded by adipose tissue, which requires prolonging the incision of the abdominal wall to achieve better visibility of the surgical field. After fixating the ovary/ligament the blood vessel is being ligated by placing two ligatures also used at the medial ventral access. The wide ligament (including the surrounding ligament) should be blindly separated parallel to the uterine artery at the level of the bifurcation of the uterus. After that, the uterine horn should be lifted to reveal the bifurcation and the contra lateral  horn of the uterus, after which by using the hook the horn is lifted to a level of visibility of the contra lateral ovary, which is fixated with a forceps to the suspensory ligament. Because this ligament is on the opposite side it is harder to pull it out, and because it is shorter, it should be torn bluntly or be cut by scissors, and the rest of the procedure is the same as the other ovary. Then the both horns are pulled out until the bifurcation is visible. The both horns are being ligated twice near the bifurcation and are cut off 0,5 cm over the second ligature.

      The visualization of the contra lateral ovary and horn of the uterus could be difficult to acquire through the small incision, but because the ipsilateral ovary is spotted right beneath the incision, by pulling out the horn all the way to the bifurcation, the contra lateral horn is pulled out by a hook, so is the contra lateral ovary. For easy visualization of the contra lateral ovary, the duodenum (left lateral “Flank” access) or the descendent colon (right lateral “Flank” access) are used to push dorsally the small intestine with the spay hook, simultaneously we pull the abdominal wall ventrally, and by doing so the visibility of the contra lateral ovary is bigger (image 8).

      Image 8 - Extraction of the ovaries

      Image 8 – Extraction of the ovaries

      Image 8 - Extraction of the ovaries

      To visualize the bifurcation of the uterus, by using the spay hook the small intestine and the bladder should be pulled in cranial and ventral direction simultaneously pulling the abdominal wall caudally, by doing so the uterine body lies dorsally of the bladders neck (image 9).

      The abdominal wall at cats is closed by using a continuous suture, embracing  the three layers of abdominal muscles. The skin is closed with a routine intra dermal suture, and by doing so, the extraction of the suture threads postoperatively is unnecessary (image 10).

      Image 10 - Closing the skin wound by placing an intradermal suture

      Image 10 – Closing the skin wound by placing an intradermal suture

      20210528_103512

      Postoperative care and analgesia

      The postoperative care by using the lateral “Flank” access is nothing special, nor is necessary stationary observing postoperatively, so the patient could be checked out the very same day. The observation is done from distance and there is no need of bringing the patient back for a control. We used a single dose of NSAIL analgesic – meloxicam 0,2 mg/kg i/v.

       

      RESULTS AND DISCUSION

      In this study for ovariohysterectomy were involved 500 adult female cats at the age of 6 months to 9 years, with bodyweight of 2,5-5 kg. (Domestic and feral) which were electively brought to the clinic, which covers all the world known high standards of working in veterinary medicine.

      The owners and volunteers in charge were informed of the whole process both verbally and in writing detailed description of the procedures and in this publication, their personal data isn’t mentioned and they remained completely anonymous.

      The choice of anesthetic protocol and the analgesia in the postoperative period, depends on the procedure and the health status of the patient, including both acute and chronic diseases.

      Even though there is no standard surgical access to ovariohysterectomy at cats, generally the ventral medial access dominates, in contrast to the lateral “Flank” access, which technique is less preferred (Bartels, 1998; Slatter, 2003).

      The complexity to identify the subcutaneous adipose tissue and the internal and external oblique muscle and the peritoneum, during this access did not showed as a problem, so did the identification of the anatomical position of the ovaries and the uterus.

      The risk of remaining ovarian tissue is rather often complication during ovariohysterectomy at cats, so is loosening of the ovarian ligatures during operation, which however doesn’t result with significant loss of blood (James at all, 2021). These intra operational complications didn’t showed as a problem with the application of the “Flank” lateral access in this study, considering the high level of competence and experience of the main surgeon, as is the use of modern materials for ligation and the use of modern surgical techniques as for ligating the ovaries and the

      uterus and as for the fascia of mm. rectus abdominis.

      By choosing the lateral “Flank” access to ovariohysterectomy at cats, there is lower degree of licking the wound, swelling and lower incidence of complications: bleeding of wound 0,5%, dehiscence of the wound 2%, infections of the wound 2,5% in the postoperative period (image 11).

      Even though there is no general opinion for which procedure is better and it’s not used as a routine procedure, the lateral “Flank” access to ovariohysterectomy at cats in this study provede positive effect in veterinary surgeons during the intra and postoperative process, lower costs of material, so is the greater satisfaction of the owners and the comfort of the patients in the healing period.

      Also the tress hold of pain during the lateral “Flank” access is very low, examined by Feline grimace scale fact sheet (Evanelista at all, 2019) by which a single dose of NSAID – meloxicam 0,2 mg/kg i/v is enough.

      CONCLUSION

      The lateral access in this study showed as better by the personnel that took place in the operations and the owners/fosters of patients because of the shorter operation time (

      generally the difference is 10-15 minutes quicker), smaller surgical incision (1-1,5 cm), eased anatomical locating of the ovaries and uterus, quicker healing of the wound (2-4 days), smaller degree of wound opening (2%), together with the better response of the patient during awakening from anesthesia and in the postoperative period.

      Saving the amount of time for the procedure (around 20 minutes per procedure), the minimal incision for performing the procedure, the shortened time for wound healing in contrast to the standard medial ovariohysterectomy, the tress hold of pain postoperatively is way lower in contrast to the standard medial technique, the postoperative complications are very rare (infection of the wound, dehiscence of the sutures, postoperative bleeding and pain at the animal itself.

       

If you are ucranian vet you can be supported by vets from whole Europe!

Please check here: https://vetsforukraine.com/?fbclid=IwAR1xVUFbh_0AR9c548ZbJwgWUFlkNtY-PanSj3BoqOxKLsJ1qq0J_uOw2tA

First list:

Here we are with the opportunities for Ukrainian vets
1. Hemodiavet and Dr Vitalaru Bogdan Alexandru-6 persons, Bucharest, Romania
2. Alessia Matia-2 persons,Milan, Italy
3. Linda Werme-1 person, Sweden, lwerme88@gmail.com
4. Larisa Fedotova- 2 persons ,Darlington,UK
5. Natalie Franiek-Krijt-1-2 persons, Austria , vet-vertretung@gmx.at
6. Federica Fogli -1 person, UK , fefy25@gmail.com
7. Aleksandra Pikarevska- 2 persons, Brighton,UK, apikarevska@gmail.com
8. Calorina Delabre- vet family and work for them, North France
9. Elisabeth Buchinger -2-6 persons, Lower Austria
10. Karena Bonte- a family, Belgium 003292537063
11. Julieta Pedernera-1 person, Frankfurt,Germany
12. Lisa Beffort -live in Germany next to Limburg 65558. We can help organizing train tickets.Phone 0049 176 96 15 46 24
13. Diana Lehner-2 persons, South Germany, about an hour south of Stuttgart
WhatsApp is the best way +436509800071
14. Nadia Kostadinova- a family and job for them in the clinic. Plovdiv,Bulgaria, +359887775165
15. Elisabeth Muller-4 persons , +491714265645 for contact
16. Cristian Cristea-4-6 persons, Bucharest, Romania +40723683806 whatsapp or sms and will call you back.
17. Bojana Mircheva- a family, Gorna Oryahovitsa, Bulgaria, also a job for them , +359885468665
Boryana Vankova- a family and work for veterinarian. Troyan, Bulgaria,email boby_van@abv.bg
Phone +359888578783
18. Mila Bobadova- a family, and work for vets,Sofia, Bulgaria , +359888359102
19. Karen Welkenhuyesen- 1 person with kids, Belgium (Diepenbeek)
20. Dr. Michael Greshake-3 persons, Grevener Damm 184, 48282 Emsdetten,
21. Dany Holmes- help in Ireland , holmes veterinary@gmail.com
22. Ann Criel –help in Belgium ann.criel@gmail.com
23. Veerle Guffens- 3 persons, Hoogstaten,Belgium –veerle.guffens@telenet.be
24. Sofia Matias 2 persons , Walton,Uk, sofia.matias@gmail.com
25. Kristein Henckaerts-1 person, Hasselt,Belgium, kristeinhenckaerts@hotmail.com
Second list:
1. Charlotte McGivney
We have a single bedroom available near Newcastle in the UK. Lottieherdan@gmail.com
2. Regina Sassenrath
We are a small animal practice in Ober Olm 12km from Mainz, close to Frankfurt. We can offer a job as vetetinarian and help with accommodation. Please contact us.
Kontakt@tierarztpraxis-ober-olm.de or use messenger.
3.Petra Geisser
Hello from Bavaria,
We could accommodate 1-2 persons. Children and pets are also welcome. Please contact me by Messenger or Mail
petra.geisser@tierarzt-immenstadt.de
4. Ana Cardoso
Hello from Portugal, I can acomodate how much will be needed in one room, and arrange a way for pets if needed, and can help with a job. Please send email for cvet.anaeosbichos@gmail.com
5. Laura Thirtle Mills
Family home in Cornwall, UK, two spare bedrooms available for small family. Please message if we can help.
6. Emma Morris
copthorne vets in the uk, shrewsbury can host a vet and their family and employ one vet www.shrewsburyvets.com do get in touch
7. Annie Koldeweij
Annie et Ben Koldeweij, center of France 58, can host a family of four, lend a vehicle and eventually employ one vet . acaskol@hotmail.com for more details
8. Naas Anastasia
We are small animal practice Dyreklinikk Mo AS in Nittedal 25km from Oslo, Norway. We can hire 1 Ukrainian small/equine veterinarian as veterinary assistant and help with local accommodation in our beautiful area:) help with every tasks to introduce our new colleague to Norwegian life and regulation system. http://www.modyreklinikk.no/ . We will assist with language course as well. Please, contact us post@modyreklinikk.no
9. Maria Ledunger Thulin
Hello from Stockholm Sweden
We can offer a position at our clinics Sollentuna Djurklinik and Vallentuna Djurklinik. For 2-3 ukrainian vets and nurses. Housing can also be solved for up to three adults with 1-2 children, also pets.
maria.ledunger.thulin@sollentunadjurklinik.se
10. Bambi Be
Hy I am from Vienna, we can host one person with a child, pm me for details please!
11. Patrick Govart
I can offer accomodaton for up to 2 persons(couple) with young kids and pet in a studio. We are in paris suburb. Contact us via messenger.
12. Riëtte Kok
Assen, the Netherlands, AniCura Dierenkliniek Assen, can host 1 family. We are a small animal practise (mostly cats and dogs).
13. Emily Thomas
Hello from Cambridgeshire in the UK. I am so very sorry that our government is being unhelpful with visas. Please know that many people here are lobbying them to change this. But if you can get to the UK, I can host 1-2 people +/- a child. ek_thomas@hotmail.com
14. Nathalie Axelsson
Hi, from Sweden (southern part, close to malmö)
We can host 1-2 (+/- a Child) people and pets are welcome.
Nathalie.axelsson@gmail.com
15. Holger Volk
If you are small animal vet or a scientist, we at the vet school in Hannover want to help. Need a place to work in a small animal clinic and potentially live close by, please write an email to Kleintierklinik@tiho-hannover.de. On a personal note, we can host at our own home one Ukrainian vet +/- partner +/- kid +/- dog.
16. Zsolt Szeghő
We are a small equine clinic at northeast Hungary, about 200 km from the ukrainian border. We can offer accomodation and hosting for a vet or a vet student evacuated from Ukraine. We can speak hungarian, english, slovak and romanian language.
Contact email: logyogyasz@logyogyasz.hu
17. Susanna Käppeli
Hello from Interlaken, Switzerland! we can host 1 person (vet or vet student) in a shared Apartement and help in our small animal clinic. please contact me per messenger or +41 33 822 21 41. we help if possible with the travel. info@tierklinik-interlaken.ch
18. Amélie Desvars
Hi from Austria, we have a room for 1 person with 1 kid. Cats welcome. amel.desvars@gmail.com
19. Flamme Martine
Hi, in Belgium (Chimay), we have a place for 2 adults and a young kid, and of course animals.
20. Caro Stolpe
C.Stolpe, Hessen, Germany.
4-6 people, dogs and cats welcome
Contact by FB-Messenger
21. Christiana Ober
We would be happy to have a family (and pets) or anyone in need. Wiltshire, UK christianaober@gmail.com. Please feel free to get in touch
22. Svein Henriksen
Hello from south west Sweden., We can host one family and pets in apartment on our small farm. We also need help in our small animal clinic. Please contact me boigetinge@gmail.com
23. Berit Blomstrand
Hi, I can house 1-2 families in need, animals welcome (Mid-Norway). beritblomstrand@gmail.com, +4797535891
24. Veterinary practice Kay offers accommodation and a job for Ukrainian veterinarians. We are a family business and treat small animals and horses. The practice is located between Stuttgart and Munich. Gladly WhatsApp +49 151 22672554
25.Eleonora Piseddu
Hi, I am italian vet located in Bergamo. I got two rooms (one double and one single) available for Ukraine colleagues and their animals. My email is eleonora-piseddu@idexx.com. Best regards, Eleonora
26.Stephanie Sanderson
We would be happy to host a 3 people ( 1-2 adults +1-2 kids) in north west UK (near liverpool).
steph.sandesron@gmail.com
27.Ledewij Wiersma
Hi there, Great initiative to host Ukranian vets! My husband and I, our 3 year old, our soon to be born second son and our 6 animals have an independent house that can host up to 4 people comfortably, more if needed. We live in the countryside north of Rome. Children and animals welcome. No veterinary jobs but always enough to do around the property (compensated). I prefer not to share
my phone number and email address directly on the facebook site but for your records: lidewij_w@hotmail.com 00393899481311
languages: english, french, italian, spanish, dutch and a little german
28. It is an independent studio, for a couple with a young child, and dogs or cats.
You can reach Martine Flamme with the e-mail in copy of this email: mflamme01@gmail.com.
Hope this will help.
We stand with you.
Martine Martin
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ABCD & Boehringer Ingelheim invite applications for the 2022 Young Scientist Award

ABCDThe European Advisory Board on Cat Diseases (ABCD) invites applications for the 2022 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 applied 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 or accepted by another assessing body in 2020 or later.

 

Candidates should be based in Europe, 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 April 2022.

 

The 2022 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 30 June to 3 July in Rhodes. 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 Young Scientist Award was created in 2008 jointly by Boehringer Ingelheim (then Merial) and the ABCD.

 

The 2021 recipients of the Award were Julia Klaus (Zurich) and Yasmina Parr (Glasgow)

 

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, kdelange@invivo.edu

 

BSAVA Congress 2022 is going hybrid!

C22-Tickets-On-Sale-1200x630-FB-Tw20 January – Registration for Europe’s largest small animal veterinary event is now open! The British Small Animal Veterinary Association (BSAVA) Congress will be held from 24-26 March in Manchester for an exciting programme packed with 100+ hours of world-class CPD delivered by over 50 world-class speakers from around the globe.

 

Hybrid and virtual possibilities

The live event is due to be held in Manchester, with the opportunity for delegates to attend online through an interactive virtual platform which will run alongside the live event (‘hybrid’ format). This means you can get the chance to catch up with your peers and experience a live event while not missing out on sessions with the option to catch up on demand.

And of course, if you can’t travel to Manchester, you’ll still be able to attend the event, as the congress can also be followed at a distance (‘virtual format’).

 

Long-form lectures are out, immersive experience is in

Last year’s online event proved top CPD can be delivered remotely in a highly interactive and engaging way. Returning to a face-to-face format enables us to take that even further and provide delegates with a truly immersive experience,” says Sarah Fitzpatrick, BSAVA Head of Partnerships and Events.

Many sessions at this year’s event feature two speakers delivering different perspectives on a topic, followed by a Q&A. With just 15-20 minutes to get into the detail, lectures will get straight to the point, be fast-paced and rich in content. “A day in the life of….”, a new feature for the 2022 event, will see actors play out scenarios, with experts and the audience invited to discuss the options before returning to the actors to play out the scene.

 

Meet-the-speakers and free drop-in practicals

Manchester has a proud history in science, as well as politics, music, arts and sports. The Manchester Central convention centre is an award-winning venue in the heart of the city. The size of the iconic building has enabled the organisers to bring the whole of Congress under one roof.

Alongside industry partner stands’, delegates will be able to drop-in to practical sessions and perfect a technique such as undertaking cytological examination, reading radiographs and even performing endoscopy in as little as 15 minutes. For the first time, the practical sessions will be included within the ticket price. There’s also the opportunity to meet the speakers in a dedicated space in the exhibition during lecture breaks.

 

Early bird discounts apply until 17 February

To register, simply go online on www.bsavaevents.com! Early bird rates apply until 17 February. Virtual-only rates are £203 + VAT and Hybrid (in-person & virtual) rates are £405 + VAT for BSAVA* and FECAVA**-members. Reduced rates also apply for WSAVA*** members, veterinary nurses and students.

Accreditations from RACE, the New Zealand Veterinary Association and the Swiss Veterinary Association (GST/SVS) are pending. All participants will have 60 days access to all virtual and on-demand content after the event.

 

* For information on how to become a BSAVA member please visit: www.bsava.com/Membership

** As FECAVA member, proof of membership of one of FECAVA’s member associations may be required. To check, please visit www.fecava.org/associations.

*** Veterinarians who are members of WSAVA through their national organisation can claim a 10% discount on the BSAVA non-member rate.

 

Basic anaesthesia of brachycefalic dog

denicaDr Denica Djodjeva

Blue Cross Veterinary Clinic

Sofia, Bulgaria

 

 

 

Quite often in our practice we have to sedate or keep under anaesthesia brachycephalic dogs and cats. This is associated with some stress for us, given the peculiarities of the breed. In this article I will try to briefly present the main key points in the anesthesia of brachycephalic breeds, which has gained great popularity in recent years. Will pay attention to their anatomical and physiological features, which are a prerequisite for complications during anesthesia, and how to avoid them and reduce the risk.

d2

The main specificity of them is the so-called brachycephalic syndrome ( BOAS). It may include narrowed nostrils, a long soft palate, a hypoplastic trachea, or an inverted laryngeal sac. It can be re-applied and used for prolonged trauma to the pharyngeal soft tissues and trachea, which can cause soft tissue outflow or tracheal collapse. This trauma most often occurs when the animal is intubated. Gastroesophageal reflux should not be forgotten, also high vagal tone.

In severe cases of BOAS, airway obstruction may benefit from the development of pulmonary edema. The pathophysiology of post-obstructive pulmonary edema includes the effect of negative intrathoracic pressure on fluid distribution and subsequent hypoxia. High negative intrathoracic pressure causes an increase in venous return to the right atrium, which increases the pulmonary artery, while left ventricular function is reduced and afterload is increased. The end result is increased hydrostatic pressure, which aids in the movement of fluids from the capillaries in the interstitium and thus causes pulmonary outflow. Rapid recognition of this condition and taking temporary measures, such as maintaining airway patency, adequate oxygen supply and, if necessary, PPV administration. Diuretics may also be used, but it should be anticipated that hypovolaemia and hypoperfusion may occur during anesthesia and clinical delivery should be considered. And because of the risk of soft tisuue and pulmonary oedema, it’s beneficial to add an corticosteroid in low dose, as prevention. Unless there are a serious contraindications. There are different anaesthesia protocols with dexamethason or methylprednisolon, it’s a matter of personal choice.

Deep sedation in these patients is performed with excessive relaxation of the pectoral muscles and aggravation of airway obstruction. Even if the patient is aggressive, it is good to adhere to lower doses of premedication. The most commonly used combination is of a sedative component, for example an alpha-2-agonist and an opioid. A tranquilizer such as acepromazine and benzodiazepines such as diazepam or midazolam may also be used. Accordingly, the doses are at the discretion and according to the desired effect and treatment.  In the table below I quote some of the most commonly used pre- anaesthetic drugs with the value of the dose. There are no restrictions and contraindications to the use of narcotic drugs in this breed. For induction you can use a different combinations, as benzodiazepine+ propofol or benzodiazepine+ ketamine. Your choice mainly depends on what the end result you whant. In brachycefalic breeds it is recommended the induction to be smooth and fast, so the most suitable drug in this case is propofol.

Given the peculiarity of the birth, it is very important to monitor the brachycephalic patient during the pre-aesthetic period, as relaxation of the pectoral muscles further complicates breathing, reduces the number of respiratory movements and the appropriate patient does not fall into hypoxia. It is recommended that the patient be preoxygenated during the pre-anesthetic period. The administration of 100% oxygen before induction of anesthesia prolongs the time to the onset of arterial hypoxemia.

When intubating a brachycephalic patient, prepare several tube sizes, apparently up to two sizes smaller than you think would be appropriate. It will be useful if you use a laryngoscope, especially when your patient has a long soft palate, as it will help ensure good visibility to the airways.

It is common practice to maintain the patient under inhalation anesthesia during the operation. Isoflurane is most commonly used for this purpose. It should be borne in mind that, like other inhaled anesthetics, it produces a dose-dependent reduction in myocardial contractility, systemic vascular resistance and cardiac preload, followed by a reduction in mean arterial pressure (MAP) and cardiac output in a dose-dependent manner; therefore, the evaporator settings should be kept as low as possible while maintaining an adequate depth of anesthesia.

In brachycephalic breeds, there is a very strong vasovagal tone, which can cause bradycardia, which in turn can lead to AV block or even cardiac arrest. The most common reason for increased vagal tone is severe pain. Advice on this reason for good pain relief of this breed is extremely important. However, if the patient develops severe bradycardia, a use of anticholinergic in an appropriate emergency dose is indicated.

As mentioned earlier, another common complication is gastroesophageal reflux, which can occur at any stage of anesthesia. This can lead to airway obstruction and aspiration pneumonia. Advice for this reason is recommended in the anesthesia protocol to include antiemetics, unless there are serious contraindications. It is recomended to be applied proton pump inhibitors as omeprasole, 4 hours before the planed anaesthesia.

d1 d3

The recovery period is also not to be underestimated. Here it is important to constantly monitor the patient and be extubated, when we are sure that all reflexes have returned. Especially the swallowing one. The best time to extubate is when our patient has muscle tone in the lower jaw and tries to cough up the endotracheal tubus itself or even better if the patient is tring to chews it. It is important to be positioned in a sternal position with appropriate continuous monitoring.

The anaesthesia of these specific breeds is not so complicated, if know their features and for what to watch out for. With more carefulness and knowinge there is nothing to be afraid of.

JPEG 20210914_133019

Tabl. Most commonly used pre- anaesthetic drugs

Drug Benefit Side effects Peak onset/duration of action IM dose
Dexmedetomidine,

Medetomidine

Profound sedation, reversible, some analgesic properties, drug sparing (reduction in induction drugs needed) Dose dependent bradycardia 5-15 min IM

2- 3 min IV

Dexmedetomidine 5-15 µg/  kg

 

Medetomidine

3- 10 µg/ kg

Butorphanol Mild analgesia, good sedation Poor analgesia and should not be used for surgical patients 10–15min/lasts for 60–90min 0.1–0.4mg/kg
Buprenorphine Moderate analgesia, mild sedation Moderate analgesia 10- 15 min IV

15-30min IM

/can be given q 6–8 h

0.01–0.04mg/kg
Methadone Good analgesia If given too fast, IV can cause bradycardia and respiratory depression 30min/can be given q 4 – 6 h 0.1–0.4mg/kg
Acepromazine Good anxiolytic, sedation improved when administered with an opioid Hypotension, unreliable sedation when used alone, not reversible 35–40min IM

10- 15 IV

/can be given q 4–6h

0.01–0.05mg/kg

 

 

 

 

Diagnosis of multiple myeloma in a Labrador Retriever

florinFlorin Cristian Delureanu

MRCVS, DVM

November 2021

 

History

A 12 years old intact male labrador retriever was presented to the practice in 05.03.2021 with a history of diarrhea and hyporexia. The diarrhea was present for few days and the appetite was decreased for about 2 weeks but there were moments when the patient was eating normally. The patient was up to date with the booster vaccination and was regulary using antyparasitic treatment.

 

Physical examination

At the moment of examination the patient was bright, alert, with normal temperature (38.7 °C), the palpable lymphnodes were normal in size, nothing abnormal detected in the oral cavity and thoracic ascultation unremarkable. A mass of approximate 5cm diameter with soft consistency, mobile, and without local reaction on the surrounding soft tissue was identified in the xiphoid area.

 

Investigations

Initially general blood tests including complete blood count, biochemistry, electrolytes and total T4 were performed as a routine screening in order to identify any abnormalities. The results from the haemoleucogram demonstrate mild microcytic hypochromic non-regenerative/ pre-regenrative anemia, neutropenia, monocytopenia and eosinopenia. On the biochemistry just hyperproteinaemia due to increased globulins was the single abnormality. Also the thyroid hormone was under the normal reference range (picture 1).

fig 1

Coroborating the blood results with the history and the clinical examination the following differential diagnostic list was discussed with the owner: occult chronic blood loss, iron deficiency, inflammatory/infectiouse cause, neoplastic, immune mediated disease, endocrine (anemia secondary to hypothyroidism), gammopathies.

Aditional history: the last time when the patient went to a veterinary practice was 5 months prior for the regular booster vaccination.

Because of no evident clinical symptoms the presumption of chronic blood loss due to diarrhoea or anemia secondary to hypothyroidism was suspected. After discussion with the owner the decision of repeating blood tests in 4 days was taken. The patient was discharged with oral probiotics and was put on gastro intestinal veterinary diet to treat the diarrhoea. At reevaluation blood was collected and was send to the reference laboratory for complete blood count and blood smear interpretation, SDMA, Coomb’s test and C-reactive protein and complete thyroid panel including total T4, freeT4, cTSH, thyroglobulin autoandibody

The SDMA was normal also the thyroid panel was normal and negative on thyroglobulin autoandibody. The C-reactive protein was mildly elevated and the Coomb’s test was negative. On haematology the anemia had the same characteristics but was normocytic the reticulocytes and platelets under the normal limit. There were no modifications on the leucogram compared with the one performed at the first presentation (picture 2).

fig 2

The blood film was evaluated and a mild microcytosis and no increased in polycromasia was noted. Marked rouleaux formation and occasional metarubricyte were present too and leucopenia was confirmed. Estimation of free platelets (3-8 platelets seen per HPF) suggested platelet numbers are mildly/moderately decreased with and very small platelet clumps seen was identified.

 

Based on the second blood tests (pancytopenia is observed but also marked rouleaux and occasional metarubricyte) and hyperglobulinaemia from the initial blood tests a suspicion of neoplastic disease like multiple myeloma or lymphoma less likely non-neoplastic disorders like monoclonal gammopatihes (Erlichiosis or Dirofilariasis) because the patient was regulary using antiparasitic medication and no history of travelling. In the same day results were reported to the owner and additional questions regarding the origin, travel status and lameness episodes were asked to the owner in order to find more informations. There was no history of travelling, the dog origin was United Kingdom and transitory episode of weakness were observed in the past months.

 

Further investigations

To investigate more the suspicion serum and urine protein electrophoresis, urinalysis including urine protein creatinine ratio, radiographs and bone marrow aspiration were recommended. Five days later the patient presented to the practice but the owner accepted initially just the non-invasive investigation and declined the x-rays and bone marrow aspiration. An additional in house haemoleucogram was performed at this stage to monitor the trend of the red and white blood cells (picture 3)

fig 4

 

 

 

 

 

 

 

The urinalysis revealed proteinuria 3+ and a pH of 8 with active sediment and no crystals or casts, the urine beign collected via urethral catheterisation. The urine protein creatinine ratio was marked elevated (picture 4).

 

fig 4-1

 

 

 

 

At serum protein electrophoresis hypoalbuminaemia was present with a mild increase in alpha 1 globulins and marked increase in gamma globulins migrating in a gamma region and a depletion of the globulins thereafter, consistent with a monoclonal band (picture 5)

fig 5

 

 

 

 

 

 

 

 

 

The urine protein electrophoresis showed that majority of the protein was presented in the alpha-beta region and this was interpreted as overflow proteinuria secondary to the marked gammopaty present at the serum protein electrophoresis. No bands consisting with Bence Jones protein were noted but this would be masked by the overflow proteinuria (picture 6).

fig 6

After these last results a highly suspicion of neoplastic disease was made. Radiography and bone marrow aspiration were recommended to confirm the disease. The owners were reluctant to put the dog under sedation because in the past he had general anesthesia and was not stable according to the previouse veterinarian. At this moment the patient was sent to a referral center to have the imagistic investigation.

 

In 09.04.2021 the patient arrived at the referral center for the last investigations. After clinical examination a firm mobile mass was noted in the caudal abdomen. Initially HLG, blood film evaluation, ionised calcium and 4Dx were performed followed by CT scan of the thorax and abdomen and fine needle aspiration of the liver, spleen and abdominal mass ultrasound guided. The ionised calcium was mild elevated (1.95 mmol/L), the 4Dx was negative. The haematology findings consist with normal white blood cell count with a slight improvement from the 5th March and a stable red blood cell count (HCT 31%) – with a mild non-regenerative anaemia. An initial review of the CT scan confirms the presence of a 4.5-5cm encapsulated mass in the caudal abdomen, with no obvious association with the intestinal wall. A small amount of free fluid is present between the liver lobes. After these investigations the patient was sent home with Fortekor as a treatment of proteinuria.

 

Seven days later the full CT report, aspirates results and blood smear interpretation were ready.

 

Cytology interpretation

 

A detailed haematology showed a mild, normocytic normochromic, poorly regenerative anaemia (HCT 36.9%, reticulocyte count 95.05×109/L). His white blood cell and platelet count were low-normal. There was no evidence to support haemolysis and leucocyte morphology was unremarkable.

Aspirates from the liver and spleen identify a population of extremely atypical plasma cells, supportive of multiple myeloma. Prominent extra medullary haematopoiesis is also noted within the spleen.

Aspirates from the caudal abdominal mass show adipocytes and a mixed inflammatory cell population, comprising of neutrophils ageing in situ and undergoing pyknosis. An atypical plasmacytoid population is identified but in low numbers, suggesting infiltration with myeloma.

 

CT findings from the report

 

Musculoskeletal:

There are multifocal osteolytic lesions throughout the entire included portion of the skeleton, including essentially all included vertebrae (thoracic, lumbar, sacral), multiple ribs, the sternebrae, the proximal humeri, the pelvis and the proximal femurs (picture 7).

 

Thorax:

No soft tissue attenuating pulmonary nodules are identified. There are multiple small (<5mm), mineral attenuating, geometrically shaped foci throughout the pulmonary parenchyma (predominately within the periphery), consistent with benign osteomata.

 

Abdomen:

An ovoid, well encapsulated mass is identified within the mesentery of the right caudal abdomen, which measures approximately 4.7cm x 4cm x 5.7cm (height x length x width) (picture 8). The mass is predominately fat attenuating, with a soft tissue attenuating rim and patchy regions of internal soft tissue attenuation (which ranges in appearance from ill-defined to linear).

 

A soft tissue attenuating (isoattenuating to the adjacent renal cortical tissue on pre-contrast), minimally contrast enhancing nodule, measuring approximately 1cm in largest diameter, is present in the right lateral renal cortex (picture 9).

 

The liver and spleen are diffusely mildly enlarged, with rounded margins, however they demonstrate normal attenuation and contrast enhancement. A mildly enlarged splenic lymph node is also present.

fig 7 fig 8 fig 9

 

 

 

Diagnosis: Multiple myeloma – advanced stage

 

Discussion

 

Multiple myeloma is a lymphoproliferative cancer arising from plasma cells and their precursors, characterised by clonal proliferation of plasma cells infiltrating the bone marrow and then affecting other organs such as the spleen. Diagnosis of MM usually follows the demonstration of bone marrow or

visceral organ plasmacytosis, the presence of osteolytic bone lesions and the presence of urine myeloma proteins. Renal disease is present in approximately one-quarter to one half of dogs with MM, and azotemia is observed in 30% to 40% of cats.

Bence Jones proteinuria was not evident in the pacient urine protein electrophoresis due to overflow proteinuria secondary to the marked gammopaty. Bence Jones proteinuria occurs in approximately 25% to 40% and hypercalcemia is reported in 15% to 50% of dogs with multiple myeloma. The clinical signs can vary from lethargy and weakness to inappetence, weight loss, lameness, polyuria/polydipsia, bleeding diathesis and central nervouse system deficits. The patient presented with a history of mild inappetence and isolated episodes of lameness.

Chemotherapy is effective at reducing malignant cell burden and to improve the quality of life of the patient. Variouse alkylating agents such as melphalan, cyclophosphamide, chlorambucil, lomustine can be used together with steroid therapy. The most common protocol is a combination between melphalan and prednisolone. This protocol is usually well tolerated by the vast majority of the dogs, the most clinically significant toxic events beign represented by myelosuppression and delayed thrombocytopenia.

 

After the last investigations performed at the referral center the patient started to deteriorate significantly this manifested by presence of a severe swelling over the left side of the face associated with pain and ptyalis. Two days later, a chemotherapeutic protocol including melphalan, cyclophosphamide orally with intravenous dexamethasone was started. Despite this, the dog developed neutropenia and pyrexia, raising concern for sepsis. As a result, a decision was made to euthanase him one day later.

 

 

 

 

 

 

 

 

 

 

 

Junior Assistant Clinicians (10 Posts),University of Glasgow

university-of-glasgow-twitter-1080x675

University of Glasgow

College of Medical, Veterinary and Life Sciences

School of Veterinary Medicine

 

Junior Assistant Clinicians (10 Posts)

Vacancy Ref:  067987

Salary: Grade, level 6, £29,614 – £33,309, per annum

 

We are looking to appoint a number of Junior Assistant Clinicians to deliver small animal veterinary clinical and care service under the supervision of experienced and fully qualified staff.  You will, on a rotating basis, participate and assist, under supervision in Referral Clinical activities, in the areas such as anaesthesia, emergency medicine, internal medicine, oncology, radiology, neurology, soft tissue surgery and orthopaedics as directed by the Hospital Board. You will also, on a rotating basis, participate, and have direct case responsibility, in a Primary Care Out of Hours service.  In all these activities, you will support student training and receive appropriate training yourself as required.

 

This 1-year position will count as an Internship for future residency applications and successful candidates will receive a certificate of completion of internship.  The posts offer the early stage clinical experience required as vets prepare for further specialist training, for example through residencies and masters formal training programmes.

 

We welcome applications from candidates with a degree that is registerable with the Royal College of Veterinary Surgeons and practical clinical experience and training with companion animals (this may include undergraduate courses with a significant practical component and periods of extra-mural studies)

 

The School of Veterinary Medicine has an excellent international reputation in teaching, clinical services and research and is accredited by the Royal College of Veterinary Surgeons (RCVS), the European Association of Establishments of Veterinary Education (EAEVE) and the American Veterinary Medical Association (AVMA).  Our purpose built hospital is one of the most sophisticated in Europe allowing companion animals from across the United Kingdom to benefit for the most advanced care available 24 hours a day, 7 days a week throughout the year from some of the best specialist vets in the world.

 

The School is located in the picturesque Garscube Estate, 10 minutes drive from the vibrant “West End” of Glasgow, and less than one hour from Loch Lomond. Glasgow is the largest city in Scotland and the third largest in the UK, and has recently been named the top cultural and creative centre in the UK in a European Commission report (https://composite-indicators.jrc.ec.europa.eu/cultural-creative-cities-monitor/).

 

The University of Glasgow has recently been named University of the Year at the Times Higher Education Awards 2020. The University offers a wide range of benefits and discounts https://www.gla.ac.uk/myglasgow/humanresources/new/newstart/workingatglasgow/
Visit our website for further information on The University of Glasgow’s School of Veterinary Medicine: https://www.gla.ac.uk/schools/vet/

Informal Enquiries should be directed to Professor Ian Ramsey, Ian.Ramsey@glasgow.ac.uk

 

Apply online at: https://my.corehr.com/pls/uogrecruit/erq_jobspec_version_4.jobspec?p_id=067987

 

The University of Glasgow is the current Times Higher Education (THE) University of the Year.

 

The School of Veterinary Medicine holds an Athena SWAN Silver departmental award. The award recognises commitment to tackling gender inequality in higher education.

 

It is the University of Glasgow’s mission to foster an inclusive climate, which ensures equality in our working, learning, research and teaching environment.

 

We strongly endorse the principles of Athena SWAN, including a supportive and flexible working environment, with commitment from all levels of the organisation in promoting gender equity.

 

The University of Glasgow, charity number SC004401.

 

Pemphigus foliaceus in a cat

   spasDr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

  1.Case History

The cat is 3 y old ,female non castrated ,regular vaccinated ,tick and flea treatment with advocate .

The problem of the cat begane one year ago in with claw bed problems ( yellow puss from there ) ,the cat have also lesions on its ears and nose .

In other clinic in other country my other vet is start with antibiotics and steroid therapy (improvement for few months )

    2.Clinical presentation

spas 1 spas 2 spas 3 spas 4

 

 

Paronychia, crusty  and scaly nose ,crusty and scaly ears, pruritus, painful walking no other skin lesions and symptoms .

   3.Differential diagnoses

Fungal infection

Pemphigus Foliaceus

Demodecosis

Pyodermia

Allergy

    4.Diagnostic approach

CBC and Biochemistry –Unremarkable

DTM – Negative

Skin scrape and scotch tape – Negative

Cytology – Neutrophils ,bacteria ( cocci ) and acantholytic  cells .

Microbiology ( Staff .aureus )spas 5

5.Therapeutic approach

14 days Amoxicillin and clavulanic acid and topical therapy with chlorexiderm 4 % ( almost no improvement)

New cytology – Normal neutrophils and acantholytic cells (no bacteria )

Punch biopsy of nail bed .

Pathohistologi report :

Report – Histopathology release date: 23.02.2021

Description

  • There were examined 5 representative sections (Hematoxylin-Eosin stain) from each sample, showing

similar histopathological appearance:

Epidermis with orthokeratotic hyperkeratosis, spongiosis and crusts (composed of acantholitic cells and

neutrophils). Superfcial and deep dermis show oedema, perivasculary to diffuse infammatory infltrate

with eosinophils, few mast cells, few lymphocytes and plasma cells. The hair follicles are in telogen and

catagen phases. The glands (apocrine and sebaceous glands) are well represented, without any

changes. There is no evidence of neoplasia, parasites or fungi in the examined sections.

  • There were examined 5 representative sections (PAS stain – fungi) from each sample, showing similar

histopathological appearance:

NEGATIVE

Interpretation

The histopathological appearance is consistent with hyperkeratosis, suppurative epidermitis, chronicactive dermatitis with eosinophilic component (allergic component).

Comments

The histopathological aspects are suggestive for pemphigus foliaceus. Suspicion is confirmed.

spas 6 spas 7

 

Therapy :

Prednisolon tablets 2 mg per kg twice a day  for 14 days then slowly reduce dose to a minimum working dosage .

6 moths later the cat was perfect then ,the owners call regular just to tell us that everything is ok .

Diagnose :

Pemphigus foliaceus

CORRECTIVE OSTEOTOMIES OF COMPLICATED BONE MALFORMATIONS, USING RIGID FIXATION WITH MIKROMED IMPLANTS

by the Department for orthopedic diagnostic, surgery and anesthesia in clinics “Dobro hrumvane” – dr. Kirilov, dr. D. Ivanov, dr. Ts. Ivanov, dr. Nikolov, dr. Kotsev, dr. Bochukova, technician Kirilova

logo 

Corrective osteotomies, especially the ones caused by combined and complicated malformations of the antebrachium and the crus are truly challenging surgeries, both for the surgeon, and the implants being used. Except by their design and material (steel/titanium), these implants differ also by their qualities such as elasticity, strength, long term quality of the locking mechanisms. The quality of the surgical titanium or steel, being used, along with their manufacturing technology are significantly important for the overall quality of the manufactured implants. Further below, in this abstract, we present 4 orthopedic cases, which required a maximally rigid fixation to be applied. Working on these cases, allowed us to challenge the strength and locking quality of the Mikromed implants.

Case 1: Male dog, Frodo, mixed breed, aprox. 35 kg

In its early age, the patient suffered a trauma to its elbow and antebrachium, creating a malunion, which in the long term lead to permanent elbow damage, radio-ulnar synostosis and high-grade external torsion and valgus of the distal antebrachium:

Pre-op antebrachial valgus:

Fig1FrodoPre-opValgus

Pre-op antebrachial external torsion:

Fig2Frodo Pre-opExternalTorsio

 

 

 

 

 

 

 

 

 

 

 

 

 

Frodo pre-op video:

A double plating corrective osteotomy was performed, using a 3.5 mm locking DCP Mikromed plate and 3.5 mm locking and non-locking screws (this system also accommodates 2.7 and 4.0 mm screws) and a second, straight, non-loking Mikromed DCP plate with cortical 2.7mm screws. In this kind of surgery, it is crucial to have very strong implants and locking and to do precise calculations for the corrective angles to be achieved. Precise contouring of the medially placed non-locking implant is also very important for the successful outcome.

Post-op X-ray CrCd:

Fig3Frodo5 MinPost-opCRCD

 

 

 

 

 

 

 

 

 

Post-op X-ray LAT:

Fig4Frodo5MinPost-opLAT

 

 

 

 

 

 

 

 

Frodo 18H post-op video:

https://youtu.be/8wVnvzzpb-E

Final result: perfect bone healing and normal leg usage

 

 

Case 2: Male dog, Michail, mixed breed, aprox. 13 kg

 

The patient suffers from congenital bilateral antebtachial deformity – high-grade internal torsion and varus.

 

Pre-op antebrachial varus right leg:

Fig5MihailPre-opVarus

 

 

 

 

 

 

 

Pre-op antebrachial internal torsion right leg:

Fig6MihailPre-opInternalTorsion

 

 

 

 

 

 

 

 

 

 

 

 

Pre-op antebrachial varus left leg:

 

Fig7Pre-opVarus

 

 

 

 

 

 

 

 

 

 

Pre-op antebrachial internal torsion left leg:

Fig8Pre-opInternalTorsio8

 

 

 

 

 

 

 

Video pre-op:

A single plate corrective osteotomy was performed (this was possible due to the low weight of the patient). A straight support 2.4 mm locking Mikromed plate was used, along with 2.7 mm locking and non-locking screws (the system also accommodates 2.4 mm screws). The plates was applied in an oblique fashion, instead of purely cranially, due to the need for excessive contouring, which is a serious challenge for the strength of the plate and the stability of the locking and the whole fixation in the post-op period.

X-ray picture 5 min post-op LAT:

Fig9 5minPost-opLAT

 

 

 

 

 

 

X-ray picture 5 min post-op CrCd:

Fig10 5MinPost-opCRCD

 

 

 

 

 

 

 

 

 

 

Final result: perfect bone healing and normal leg usage

X-ray picture 6 months post-op LAT:

Fig 11 6MonthsPost-opLAT

 

 

 

 

 

 

 

 

Case 3: Male dog, Ares, GSD, aprox. 30 kg

The patient suffered a high-energy trauma to its stifle and curs in its early age, which stopped the development of the proximal portion of the tibial plateau, thus making it “sink” in relation to the tibial crest and leading to a shift of it surface in relation to the femoral condyles. Additionally a synostosis between tibia and fibula was found. The patient demonstrated intensifying lameness and more and more severe pain, especially upon limb extension. In addition, a low-grade lumbo-sacral instability was diagnosed during imaging.

 

Ares X-ray picture pre-op LAT:

Fig 12Pre-op LAT

 

 

 

 

 

 

 

 

 

Ares X-ray piicture pre-op CrCd:

Fig 13Pre-op CRCD

 

 

 

 

 

 

 

 

 

A block resection of the tibial plateau was performed, during which the plateau was elevated and leveled. Ilial bone autografts were used to fill the gap, formed between the two tibial fragments. A straight support locking Mikromed 3.5 mm DCP plate plus 4.0 locking screws were used. The correct and adequate leveling of the tibial plateau was crucial, along with strength of the plate and the reliable locking, which were subjected to serious biological forces. In addition to that, the patient had an energetic temper.

Ares X-ray picture 24H post-op LAT:

14

 

 

 

 

 

 

 

 

Ares X-ray picture 24H post-op CrCd:

15

 

 

 

 

 

 

 

 

Ares X-ray picture 6 months post-op LAT:

16

 

 

 

 

 

 

 

Ares X-ray picture 6 months post-op CrCd:

2

Result: perfect healing and limb use, even years after completion of the surgery.

 

 

 

 

 

 

 

Ares CT 2 y post-op:

1

 

 

 

 

 

 

 

 

Ares video 2 y post-op:

https://youtu.be/cDpzO229GcU

 

 

 

 

 

 

 

Case 4: Male dog, Nuki, mixed breed,aprox 25 kg

 

The patient suffered from a rare congenital elbow deformation: the proximal radius and ulna exhibited “mirror view” morphology in the sagittal plane: the ulnar trochlear notch and its coronoid processes were placed at the opposite site. There was no weight baring on the limb due to this, which lead to maximal muscle atrophy. The carpal joint was in permanent flexion and extension was impossible to achieve. All soft tissues related to the elbow joint exhibited atypical morphology.

Nuky X-ray picture pre-op LAT:

Fig 19 NukyPre-OpLAT

 

 

 

 

 

 

 

 

 

Nuky X-ray piicture pre-op CrCd:

Fig 20 NukyPre-OpCRCD

 

 

 

 

 

 

 

 

In the are moments of leg “usage” Nuky treaded in this way:

Fig 21 NukyPre-OP

 

 

 

 

 

 

 

 

 

 

An elbow arthrodesis along with a minor (around 25 mm) limb shortening was performed. An angle of 110-130 degrees between the humerus and antebrachium was impossible to be achieved, because of the altered soft tissue morphology and due to the risk of worsening the carpal situation. Due to that, a laterally applied curved non-locking DCP Mikromed plate was used, instead of the typical caudally applied straight plate.

Medial application of the plate is usually recommended, but in this case we decided to once again challenge and trust the Mikromed implant, being laterally applied.

 

Nuky video 3 days post-op:

 

Nuky video 1 W post-op:

https://youtu.be/alVKE2AJtF0

Nuky video 2 W post-op:

 

 

 

Result: full bone healing and good limb use. Home carried physiotherapy helped the particular patient overcome the permanent carpal flexion and evaluate shoulder muscles.

 

Nuky X-ray picture 6 months post-op LAT:

Fig22 6MPost-opLAT

 

 

 

 

 

 

 

 

Nuky X-ray picture 6 months post-op CrCd:

Fig 23 6MPost-opCRCD

 

 

 

 

 

 

 

 

Nuky video 10 months post-op:

 

Conclusion: The corrective osteotomies require precise pre-surgical planning, regarding both the osteotomy geometry and the choice of implants to be used. The Mikromed implants possess the required strength and locking quality to withstand even excessive orthopedic challenges, especially in the area of rigid fixation.

 

Vaginal tumor in a dog

Case history and clinical findings

 

mirela miroslavDr. Mirela Marinova DVM, EVSSAR member , MVC Bulgaria

Dr. Miroslav Genov DVM, PhD, EVSSAR member, MVC Bulgaria

 

A 14 kg, 13-year-old female cocker spaniel for truffle hunting was examined for a swelling in the perineal region. As informed by the owner the bitch had given birth once in the past and was in heat two months ago. The swelling appeared one year ago, but had enlarged aggressively the previous month. The dog had been facing difficulty defecating.pic 1 pic 2

Clinical examination revealed palpable little dense masses in the mammary glands. The swelling turned out to be a firm vaginal mass compressing the colon.

CBC and biochemistry profile showed no changes.  An ultrasound showed no accumulation of fluid, the ovaries were normal, the bitch was in anoestrus.

Owner was recommended surgical removal of the mass with episiotomy and castration.

 

The patient was prepared in advance for vaginectomy in case  removal of the mass with episiotomy was impossible.

 

Surgical procedure

Episiotomy was performed for examination of the masses. We started removing them consecutively with an electrosurgical knife. Their location was beneath the mucosa and were removed easily without loss of wall integrity. A part of the vaginal mucosa was hyperplastic so it was also removed. The urethra was unaffected. The vagina was sutured and it’s normal structure was restored.

The second part of the surgery was ovariohysterectomy. No changes in the ovaries and uterine were visualized.

After the castration, careful visual inspection of the uterine stump and the vagina led us to a big mass in the pelvic cavity that compressed the colon.  The abdominal cavity was opened caudally to pecten ossis pubis and the uterine stump was pulled cranially. The mass was localised at pars cervicalis. After it’s removal the vaginal wall was sutured.

pic 4 pic 5 pic 6 pic 7 pic 8

Post-operative period

The recovery was smooth.  Control of the urine bladder was kept and normal defecating restored.

The postoperative edema disappeared in 2 weeks.

 

Diagnosis

A part of the resected mass was send to laboratory for histopathological diagnosis resulting vaginal polyps- benign non-neoplastic proliferations of well differentiated fibrous tissue, covered by regularly structured hyperplastic epithelium.

 

 

Vaginal tumors

Tumors of the female reproductive tract are divided in two categories: arising from the ovaries and those derived from the tubular genitalia.

Genital tract tumours are usually seen in medium-aged (mean age 10 years) non-spayed dogs. Vulvar tumors in dogs are rare- 2,5% of all canine tumors with 70% of them being benign.

 

https://www.youtube.com/watch?v=SHCML_LI2pw

 

https://www.youtube.com/watch?v=Dsg-ClVJPpY

Tumors of mesenchymal origin, leiomyomas, fibroleiomyomas and fibromas occur most commonly. Leiomyosarcomas, lipomas, mastocytomas, adenocarcinomas, squamous cell carcinomas occur much less frequently. Transmissible venereal tumors (that spreads during coitus)  can also appear  in dogs. Transitional cell carcinoma of the urinary tract occasionally extend into the vagina and vestibule. Metastasis to the vagina is extremely rare.

 

Smooth muscle tumors and polyps of the tubular part of the genital system are common in the bitch. The growth of many of these benign tumours is associated with the ovarian secretion of oestrogen. Therefore, unless the bitch is receiving exogenous oestrogens, it is very unusual to find them in an spayed animal. Leiomyomas appear to be steroid-hormone dependent-  around 56% of them have estrogen receptors and 84% express progesterone receptors.  This type of tumor is associated with estrogen secreting tumors or ovarian follicular cysts. Spontaneous regression has been observed after castration or treatment with progesterone receptor antagonist.

About 85% of leiomyomas occurring in the reproductive tract in the bitch arise from the vagina, vestibule and vulva. Boxers are predisposed.

 

Benign vaginal tumours may present as either extraluminal or intraluminal forms. Extraluminal are usually well encapsulated and their growth results in a noticeable perineal swelling. Intraluminal tumours tend to be attached to the wall of the vestibule or vagina. The are often ovoid and firm. Sometimes they can protrude from the vulva. Large intraluminal tumours may become traumatized, oedematous and infected and their appearance may be similar to that of vaginal hyperplasia. Sometimes  with the development of the tumour mammary gland tumours, ovarian cysts and cystic endometrial hyperplasia can be seen simultaneously.

Benign tumours can reach 10-12 cm in diameter. When it’s small the consistency is fleshy, but as it develops it becomes firm and hard  due to increase in connective tissue ( so called “fibroid”). Small vaginal masses are are asymptomatic unless protruded form the vulva and they can only be discovered by coincidence during vaginal inspection.

 

Clinical signs include bulging of the perineum, dysuria, stranguria, haematuria, vulvar bleeding and discharge, faecal tenesmus, constipation. Usually there are no changes in the CBC.  Radiographs of the caudal abdomen may suggest the presence of vaginal tumor but will not be enough for a definitive diagnosis or it’s location. Endoscopy is an excellent way to visualize the vaginal mucosa and the presence of polyps. Histological examination is considered to be the gold standard in determining the type of the tumor. Surgical resection with ovariohysterectomy ( reduces the risk ot recurrence) provide great outcomes for patients. Digital vaginal and rectal examinations are performed monthly to monitor for tumor recurrence.

 

 

References:

  • Jane M. Dobson and B. Duncan X. Lascelles, BSAVA Manual of Canine and Feline Oncology, Third Edition, 17: 257-259
  • David E. Noakes, Timothy J. Parkinson, Gary C.W. England, Arthur’s Veterinary Reproduction and Obstetrics, 9th Edition, 5: 649-651
  • Robert Klopfleisch, Veterinary oncology, 5: 141-143
  • Linda G. Shell, DVM, DACVIM, Tanya Gustafson DVM, Vaginal/Vulvar Neoplasia
  • B. Kand and D.L. Holmberg, Department of veterinary anesthesiology, radiology and surgery, Western College of Veterinary Medicine, Univeristy of Saskatchewan, Case Report: Vaginal leiomyoma in dog
  • Tuli Dey, Bhajan Chandra Das, Syed Imran, Mohammed B. Bostami, Bibek C. Sutradhar, Sonnet Poddar, University ot Veterinary medicine, Bangladesh, Case report: Surgical Management of Canine Vaginal Leiomyoma of a bitch