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