15 January 2021 – The full programme for the 2021 Virtual Congress of the British Small Animal Veterinary Association (BSAVA) is now live.
This year’s edition of one of the world’s largest event for the small animal veterinary sector will be held from Thursday 25 to Saturday 27 March. It is set to deliver everything people expect of BSAVA Congress – and more:
Excellent International speakers, more than 130 hours of CPD and an extensive range of practice resources to take away.
A new, more interactive formula
With more than 100 speakers and a new format that blends clinical, practical and interactive content across a massive number of topics, Congress is highly relevant for every member of the practice. Shorter sessions and the introduction of new two-speaker sessions on day-to-day topics will focus on the information vets need to know in primary care practice with regular opportunities for delegate engagement and questions.
“Following months of meticulous planning we are thrilled that the programme is now live,” said Professor Ian Ramsey, President of the BSAVA. “The sheer range and high quality of our speakers and content, together with our new, more dynamic format takes webinar learning to a new level.”
Who’s who of the veterinary world
The list of speakers is akin to an international ‘who’s who’ of the veterinary world. As a small taster of what’s in store, Holger Volk (Germany) will present on aspects of neurology on a shoestring, including a case-based panel discussion. Bianca Hettlich (Switzerland/Germany) will present a case-based interactive session to help general practitioners decide if a lameness case is of orthopaedic or neurological origin and will be busting some myths. The USA’s Ernie Ward will be speaking about recruitment and retention.
The speakers – including Mike Willard (USA), Jens Ruhnau (Denmark), Daniel Pang (Canada) and Milinda Lommer (USA) – will give short ‘live’ presentations, often in joint sessions, allowing ample time for discussion allowing a dynamic interaction.
The list of UK speakers includes Rebecca Geddes (kidney medicine and nursing), Nicki Reed (feline nursing), Sarah Heath (behavioural alopecia), Adrian Boswood (asymptomatic cardiac patients), Jane Ladlow (BOAS surgery), Penny Watson (liver biopsies, feline triaditis), Dick White (the surgical team); Tim Nuttall (atopic dermatitis), John Chitty on several rabbits, small furries and exotics topics, and many more.
130 hours of CPD available on the platform for two months
Four simultaneous live streams will deliver 80+ live sessions covering 24 module topics, together with a library of 100 on-demand webinars and other resources for the practice to bring delegates more than 130 hours of CPD. Many modules have relevant presentations woven in to make them suitable for the whole practice team from clinical directors to practice nurses and managers. There will also be a dedicated exhibitor stream every day. BSAVA Congress headline sponsors include Idexx and Hill’s Pet Nutrition.
The live and on-demand content will be available to delegates on the platform for 60 days, and then via the BSAVA Library.
“Delegates will be able to develop their skills and knowledge on topics they see regularly in practice,” said Professor Ramsey. “To make things even easier we will be providing practical resources such as client handouts for delegates to take back to their clinics. This, coupled with many speakers sharing their own notes and practical resources means less note-taking and a quicker and easier way for delegates to share what they have learnt with their colleagues.”
Great value with rates starting at just £99 +VAT
On the social side the focus is on bringing people together on-line to share light-hearted entertainment and laughter. Delegates can throw some shapes with a virtual disco, exercise their bodies as well as their minds with yoga and unwind with some restorative meditation practices.
“This year’s BSAVA Congress is going to be the most innovative ever and deliver like never before,” said Professor Ramsey. There is plenty of relevant and engaging CPD for every practice professional, with all the convenience of a virtual event. If you haven’t already taken a look at the programme and registered, I urge you to do so now. With prices starting at just £99 (approx. €110) +VAT for BSAVA and FECAVA members*, it represents really great value.” The Congress will be held in English.
*As FECAVA member, proof of membership of one of FECAVA’s member associations may be required. To check, please visit https://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.
Called ‘Global Principles of Veterinary Collegiality’, the document springs from discussions held during a VIP Summit at WSAVA World Congress in July 2019. During the meeting, veterinary leaders from around the world expressed concern at the additional stress caused to veterinarians by poor communication and collegiality within teams and among colleagues. They highlighted the additional pressures that this was placing members of a profession already challenged by well-being and mental health issues.
The document was launched on Monday January 18, known as ‘Blue Monday’, claimed to be the most depressing day of the year. While some country veterinary associations already have a Code of Conduct, many do not and FECAVA and WSAVA hope that their initiative will help all of their member associations to commit to a common standard of behavior in order to support the profession as it works to achieve the ideals of patient care as set out in the WSAVA Veterinary Oath.
The Global Principles were authored by WSAVA Past Presidents Dr Shane Ryan and Dr Walt Ingwersen, and FECAVA Senior Vice President Dr Wolfgang Dohne. The document sets out the key principles of professional collegiality which they identify as involving equal and reciprocal relationships between veterinary individuals and groups.
Dr Wolfgang Dohne
Commenting, Dr Wolfgang Dohne said: “Poor collegiality and communication add to stress and frustration among veterinary professionals and hold back veterinary teams. Mutual respect, courtesy and support of especially junior team members, together with good communication, results not only in a better working environment, but also in better clinical outcomes. It improves animal welfare and encourages the concept of life-long learning. These goals are at the heart of FECAVA and its national member organizations and we are proud to be co-signatories of this document.”
Dr Shane Ryan
Dr Shane Ryan added: “The mental and emotional well-being of the entire veterinary team and, consequently, our ability to ensure the health and welfare of our animal patients, can only be enhanced by practicing in a harmonious, collegial environment. The principles outlined in the document allow for courteous and respectful interaction with our fellow veterinarians to encourage a more productive and welcoming workplace. Strengthening collegiality is an important element of the WSAVA’s strategy to advocate for the profession globally to bring about positive change.”
The associations plan to follow up the Global Principles with an infographic for practical use in companion animal clinics. It will be unveiled during the joint WSAVA/FECAVA Online Congress which takes place in March 2021. The document and infographics will be translated into multiple languages.
Through its member associations, FECAVA represents more than 25,000 companion animal veterinarians in 39 European countries. FECAVA strives to improve the veterinary care of pets through professional development. It also provides a voice for companion animal issues at European level and works closely with other European veterinary organizations and stakeholders.
The WSAVA aims to advance the health and welfare of companion animals worldwide through creating an educated, committed and collaborative global community of veterinary peers. It currently represents more than 200,000 veterinarians through 110 member associations. Its annual World Congress brings together globally respected experts to offer cutting edge thinking on all aspects of companion animal veterinary care.
The workshops organised by the Romanian Society of Orofacial Surgery and Veterinary Dentistry (RSVD) is becoming a tradition. The tiltle of the workshops that were organized in several cities of Romania was “Treatment options and prophyaxis in periodontal disease” (in dogs and cats, of course). As you already know, periodontal disease is the most common pathology in pets and it can have severe local and systemic complications that affect the quality of life of our beloved cats and dogs. Although it is very common, the disease is mostly treated in very advanced stages when the teeth cannot be saved anymore. The workshops lasted for 2 days. On the first day, the participants, both veterinarians and veterinary students, gained more knowledge regarding conscious oral examination, detailed oral examination under sedation, dental charting, specific instruments, scale and polish and oral homecare.
The second day was dedicated to the more pragmatic treatment option in advanced stages of periodontal disease: the dental extraction. The participants learned a lot regarding indications and contraindications of dental extractions, dental blocks, simple extractions, surgical extractions and possible complications of dental extractions. Both days started with theoretical presentations and ended with the practical part so that the participants could exercise their new dental skills. The founding members of RSVD, Dr. Raluca Zvorasteanu, Dr. Iulia Milin, Dr. Dan Sebastian and Dr. Elena Nenciulescu, were also the speakers of the events. “The main purpose of the Romanian Society of Orofacial Surgery and Veterinary Dentistry is to bring together veterinarians, veterinary nurses and veterinary students to raise awareness of the importance of veterinary dentistry, to increase the professional level of veterinary dentistry in Romania and also to defend the values and interests of the Romanian veterinary community”, said Dr. Raluca Zvorasteanu, President of RSVD. According to Dr. Zvorasteanu, at least 9 out of 10 patients have some sort of dental disease and 100% of patients need oral homecare. “We like to promote prophylaxis as <the best treatment option> ”.
Portosystemic shunts are anomalies that allow blood returning from the gastrointestinal systems to bypass the liver and pass directly into the systemic circulation. When this occurs, toxins from gastrointestinal tract that are normally cleared by the liver are shunted directly into the systemic circulation. This build-up of these toxins in the bloodstream leads to the clinical signs commonly seen in animals with these shunts. Three categories of clinical signs commonly are associated with the presence of these shunts: neurological, gastrointestinal and urinary. Neurological signs include seizures, head pressing, circling, lethargy and blindness among others- hepatic encephalopathy. Gastrointestinal signs include vomiting, anorexia, weight loss and a reduced rate of growth. Urinary tract signs, including stranguria, pollakiuria and hematuria are generally related to the development of urate cystoliths secondary to the presence of ammonium biurate crystals in the urine.
Contrast CT study with 64 slice scanner was performed with i.v administration of iopamidol solution 370g/ml (contrast agent) in dosage 1ml/kg.
CT findings: There is a abnormal communication between the portal vein and the caudal vena cava using the splenic vein. The portal vein decreases in diameter cranial to the shunt exit and splienic vein is enlarged. The both kidneys are too big and liver is too small.
Congenital extrahepatic splienocaval-caval shunt
The treatment consisted of medical and surgical approach. Ten days before the surgery the condition was managed with amoxicillin 12,5 mg/kg p.o q12h for 15, Lactose oral solution 67g/ 100ml in dosage 1ml/kg p.o q12h and hydrolyzed protein food.
The surgery was planned in great teamwork with d-r Kaloyan Voichev in Multidisciplinary Veterinary Clinic Bulgaria. The operation was performed with the kind assistance of the whole team. The operational approach consisted of midline celiotomy and isolation of the shunt from surrounding structures and placement of thin cellophane band surround the vessel.
Max recovered well from the anesthesia and was discharged after 48 hours with amoxicillin 12,5 mg/kg p.o q12h for 10days, Lactose oral solution 67g/100ml in dosage 1ml/kg p.o q12h for 15 days and hydrolyzed protein food. In postoperative period Max was vomiting sporadic within one week, but with good appetite. The vomiting was stopped with maropitant 1mg/kg s.c q 24h for 3 days.
One month after the surgery Max doesn’t show any clinical signs.
United Veterinary Clinic, 34 Tzarevetz street, Varna, Bulgaria
The aim of this case report is to describe the technique and clinical outcome of limb salvage procedure in a cat with а distal segmental femoral bone deficit due to bone nonunion using customised expandable stifle arthrodesis plate.
3.5 years old female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. The current condition of the cat was as follow: Gustilo-Anderson type 3b open intercondylar and distal diaphyseal femoral fracture, fracture of the femoral head, fracture of the greater trochanter, patella ligament rupture and extensive skin and soft tissue loss in the right stifle region (1). The aim of the treatment was anatomical reconstruction of the femoral fractures, temporary transarticular fixation and soft tissue reconstruction using ipsilateral mammary chain (caudal superficial epigastric axial pattern flap) with a future plan of performing stifle arthrodesis due to a non repairable patella tendon rupture (2). Surgical goal was achieved, but sequestration of the whole distal femoral segment was confirmed radiographically two and a half months after the revision surgery. As the owner declined amputation and insisted for limb salvage procedure, personalised 3D expandable arthrodesis plate was designed, fabricated and used for achieving stifle arthrodesis.
Picture 1-Gustilo-Anderson Grade 3b open distal femur fracture
Picture 2-Shirley, soon after the first surgery when reconstruction of the femur and closure of the soft tissues were performed using caudal superficial epigastric axial pattern flap
Two radiographic examinations immediately postoperatively and five months after surgery were performed. Four months follow up x-rays showed no signs of periprosthetic bone resorption which seems to be in the main concern in this clinical case and whether the porous spacer will be integrated to both the femur and the tibia.
Designing and fabrication of the customised implant is a complex, time consuming and cost depending process, but 3D printed expandable stifle arthrodesis plate could be a realistic option for hind limb preservation in cats. Further cases and long term follow up are required to determine the success and complication risk of the procedure.
The femur is the most commonly fractured bone in cats, accounting for more than 30% of feline fractures (3). Those involving the shaft and the distal femur are most commonly seen. Inadequate fracture fixation leads to poor mechanical stability and further compromise of the biological environment, especially if there are migrating implants. The basic tenets for treatment of joint fractures are reestablishment of articular congruity, joint stability, axial alignment and preservation of joint mobility (4). Patella tendon rupture is unusual condition and it is most commonly due to a sharp trauma (5). In our case, an iatrogenic rupture of the patella tendon was suspected due to migrating implants following surgical stabilisation of the distal femur fracture. Arthrodesis of the stifle joint is a salvage treatment option if joint function cannot be preserved with another methods. Arthrodesis will leave the cat with significant gait alterations, and careful consideration should be made before electing for this option. The angle of fusion is estimated from the standing angle of the contralateral limb, and is around 110°. Strict attention should be paid to surgical technique to avoid complications. These tend to occur because of the long lever arm created, which can result in fracture of the femur or tibia at the implant–bone junction. Implants should end in metaphyseal areas and not over the narrowest part of the diaphysis to avoid this complication (6).
3.5 years spayed female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. After removal of the existing implants, reconstruction of the articular fracture was performed using 2.4mm lag screw and antirotational K-wire. 2.0 mm SOP plate was applied as medial transarticular stabilising implant and for fixation of the supracondylar fracture of the femur. Two K-wires and tension band wire were used for fixation of the greater trochanter. The femoral head seemed already stable and no attempt for surgical stabilisation was performed.
Bacterial culture was done during the first surgery and the results came back as Methicillin-resistant staphylococcus. Based on antibiotic susceptibility testing, Amikacin was used as an appropriate antibiotic for seven days. Unfortunately no signs of fracture healing were noticed in the next 8 weeks and small fistulous tract appeared at the lateral aspect of the stifle joint.
Picture 3-Femur fracture configuration with loosed implants before, and the Picture 3-femur anatomically reconstructed after the revision surgery. At the most right radiograph – signs of osteomyelitis and sequestration of the whole femoral condylar segmen
In a subsequent surgery all implants were removed together with the distal femoral fragment, a transarticular external skeletal fixator was applied and CT was performed immediately after that. Bacterial culture has been obtained and came back again positive for Methicillin-resistant staphilococcus. Chloramphenicol was initiated for 7 days p.o. based on bacterial sensitivity testing.
A further attempt was initiated for designing and producing of expandable stifle arthrodesis plate. The aim of the proposed implant was to provide stifle arthrodesis but at the same time to replace the distal femoral segment for overall limb length preservation. The implant was designed by CABIOMEDE Vet, Poland and consisted of two solid portions with locking screw holes and central porous portion for promoting bone ingrowth. The length of the porous part of the plate was 28mm and was intended to replace the missing distal femoral segment.
Picture 4-Shirley with an applied transarticular ESF, waiting for a stifle arthrodesis surgery
Two DCP holes were designed at both sides of the solid part of the plate in order to provide compression on the osteotomised bone segments against the porous part of the plate. The rest of the plate holes were locking ones and were arranged in such a way so they can engage each bones in a different angle providing some sort of orthogonal fixation and at the same time avoiding the holes form the existing ESF pins. The plate was designed to span almost the entire length of both the femur and the tibia, avoiding possible periprosthetic fracture. Limited contact under-plate surface was designed, reducing the implant footprint on the bone because of the concern of too much implant wrapping and possible implant-associated infection. The customised implant and dedicated cutting guides were printed from Polygon Medical Engineering, Russia.
Picture7-Renderings of the femur, tibia and lower extremity showing the position of the custom plate. The arrows are indicating the position of the two non-locking screws which are going to provide compression of the bone segments against the porous part of the plate.
Picture 8-A cutting guides designed for precise osteotomies of the bone ends and proper fit of the customised plate
Picture 9-The stifle arthrodesis expandable plate is printed from titanium alloy (Ti6Al4V ELI) which is the gold standard for orthopedic implants when osteointegration is required. Figure 9
During the surgery, the patient was positioned in a lateral recumbency with the affected limb upermost and cranial skin incision was performed starting from the most proximal aspect of the femur to the the most distal aspect of the tibia. A standard lateral approach to the femur was made which continued over the cranial aspect of the stifle area and on the craniomedial aspect of the tibia. The cutting guides were secured and the bone ends were osteotomised. The plate was then attached to the cranial aspect of the tibia and the femur using temporary K-wires through dedicated holes. The most distal tibial plate hole and the most proximal femoral one were designed for 2.0mm non locking cortical screw to be inserted in a neutral position and two gliding holes at both sides of the porous part of the plate for 2.4mm cortical screws in a compression mode. Autogenous cancellous bone graft was obtained from the proximal aspect of the contralateral humerus and applied at both sides of the porous part of the plate. All needed 2.4mm locking screws were predetermined and their length marked on the plate for faster and precise application.
Picture 10-Tibial cutting guide on place and secured with K-wires (on the left). The 3D printed arthrodesis plate fixed to its final position (on the right)
Picture 11-Medio-lateral radiographs immediately after removal of the transarticular ESF and the application of the printed arthrodesis plate
Picture12-Shirley a few days after performing the limb salvage surgery
This case report describes fracture complications in a feline femur multiple fracture and application of customised 3D printed expandable plate for stifle arthrodesis as a limb salvage procedure. The customised plate made of Titanium alloy has the features of the replacement of missing bone, providing initial fixation using screws (both non-locking and locking ones) and long-term bone fixation (bone ingrowth) (7). Our main concern was mainly the long-term bone ingrowth and the bending and shear strength of the plate at the porous/solid part of the implant. Five months after the surgery (at the time of this article has been published) there are positive radiographic signs for osteointegration (no signs of peri-implant bone osteolysis, lack of osteolysis around the screws and progressive bone bridging over the porous part of the plate). In a recent paper (8), porous implants without hydroxyapatite coating showed a consistent bone ingrowth in a canine transcortical model. Despite the concern of poor functional limb after limb sparing/fuse of the stifle joint (4) , our cat was performing extremely well and almost fully weight-bearing on the operated leg about ten days after surgery. Till today she improved her gait a lot and the limb use while she is running and playing with toys.
“Shirley is doing great. She really behaves as a kitten which never had an issue with that leg” – Shirley’s owner, 25.09.2020
Picture 13-Five months follow up radiograph. Close up views to the bone-implant interface
Picture 14-Abnormal sitting “on a side”. Shirley, about five months after stifle arthrodesis
2 weeks after the surgery:
Kim P.H, Leopold S.S. Gustilo-Anderson classification. Clinical Orthopaedics and Related Research 2012, 470:3270-3274
Moors, A. Axial pattern flaps. In: BSAVA Manual of Canine and Feline Wound Management and Reconstruction. BSAVA: 2009; 100 – 111
Hill, F.W.G. A survey of bone fractures in the cat. J.Small Animal Practice 1977, 18, 457-463
DeCamp C.E, Johnston A.Spencer et al. Principles of joint surgery. In: Handbook of small animal orthopedics and fracture repair. Elsevier, Inc. 2016; 211-229
Das S., Langley-Hobbs S., et al. Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases. Journal of Feline Medicine and Surgery 2015, Vol. 17(4) 348-352
Glioblastoma is a malignant tumor of the nervous tissue. This is the fourth degree of astrocytoma. It is more common in the frontal and temporal lobes. Good contrast enhancement in magnetic resonance imaging, edema of the surrounding tissue is often observed. Macroscopically, it has well-defined borders.
Male dog, named Jazz, 9 years old, husky, brought to the clinic on 01.07.2020
There is worsening of the condition since the day before, the animal was no longer interested in food or water, there was lack of coordination. The clinical examination reveals that the animal was obtunded, but still responsive and it was responding to commands, given by the owners, it was also consciously resisting some tests, during the examination, which it doesn’t seem to like. No evidence of seizures. Posture – head turn to the left and tilt to the right. Gait – vestibular ataxia. Cranial nerves – absent menace reaction on the left. Postural reactions – decreased proprioception of the left pelvic limb, decreased hopping reaction of the right thoracic limb. Spinal reflexes – normal. Localization – the decreased proprioception only on the left pelvic limbs cannot definitively determine the localization. Due to the left head turn, the localization is determined in the left forebrain or peripheral vestibular syndrome. Differential diagnoses: ischemia, metabolic disease, neoplasia. MRI is recommended.
On 02.07.2020 blood was taken for CBC – nothing remarkable, Biochemistry – a slight increase in glucose and AST, ALP – 455.99 (10.6-109 U / L). FT4 and TSH are normal.
On 03.07.2020, an MRI was performed. The imagining showed a mass in the left cerebellum, with mass effect on the brainstem and cerebellum, obstruction of the normal outflow of cerebrospinal fluid and for that causing hydrocephalus. Also edema in the surrounding tissue.
Preoperative preparation was started with Mannitol 1.5 g/kg/12h i.v., Methylprednisolon 15.78 mg/12h i.v. Antibiotic therapy – Ceftriaxone – 1 g/12h i.v.
On July 4, 2020, a left suboccipital craniectomy was performed for removing the mass, part of which was sent for histopathology to Laboklin, Germany. Part of the capsule of the tumor has not been removed due to adhesions with the brainstem and the risk of injury during the process of removing it. An artificial dura was placed on the defect to prevent the leakage of cerebrospinal fluid.
After the surgery Jazz was recovering very well. There was a manifestation of vertical nystagmus, which disappeared quickly by itself. Antibiotic therapy was continued, as well as mannitol and methylprednisolone therapy 24 hours after the surgery. Meloxicam was included for pain management 12 hours after the steroids were stopped
The first day after the surgery Jazz was still slightly uncoordinated and his head was still with negligible turn, but he was able to get up and walk on his own.
On July 6, 2020, 48 hours after the surgery, Jazz was more stable, progressively getting better and eating and drinking water.
On July 9, 2020, in the middle of the day Jazz’s condition got worse. He started to turn his head to the left again. On the same day, the histology result was received:
Glioblastoma with high degree of malignancy.
On 10.07.2020, steroid therapy was started, which led to a fast improvement. On the next day Jazz was sent home with home therapy of prednisolone 0.5mg/kg/12h.
Consultation with oncology department for chemotherapy was recommended
On 17.07.20 the sutures were removed from the skin incision, Jazz’s therapy with prednisolone (0.5 mg/kg /12h) was continued. There was a slight incoordination and tilt of the head.
The nerve sheath is a layer of myelin and connective tissue that surrounds and insulates fibers in the peripheral nerves. A nerve sheath tumor is an abnormal growth within the cells of this covering. Nerve sheath tumors include schwannomas, neurilemmomas, and neurofibromas. The trigeminal nerve is the most frequently affected cranial nerve. This results in unilateral atrophy of the temporalis and masseter muscles and facial dysesthesia or anesthesia. Eventually, brain-stem compression can develop.
Signalmen: 12 years old, female, castrated Labrador retriever
History: The owner noticed that dog`s head has not normal shape.
Case presenting signs: Chronic right trigeminal nerve deficit with atrophy of the temporalis and masseter muscles. Reduced facial sensation, absent palpebral reflex with normal menace response reaction and reduced right corneal sensation and enophtalmus.
Clinical examination: The overall condition of the dog was normal with normal appetite, good muscle and body condition except the right temporalis and masseter muscles. Internal body temperature 38,8 ; Normal respiratory and heart rate; Color of mucous membranes – pink; CRT – 1,5 sec.
Mentation and behavior- Normal
Gait – Normal
Cranial nerves – right trigeminal nerve deficit
There was no change in conscious proprioception and bladder function was normal.
Case work-up: CBC – without changes; Biochemistry – Elevation of Liver enzymes (ASAT 69 IU/L; ALAT 90 IU/L)
Contrast MRI study of the head was performed with GE MRI 1.5 Tesla.
There is a large extra-axial T1 hypointense, T2 hyperintense tubular mass that arises at the origin of the right trigeminal nerve and extends rostrally through the trigeminal canal of the temporal bone. The right oval foramen is enlarged because of involving the mandibular branch. Atrophy and denervation of the masticatory muscles (temporalis, masseter and pterygoid muscles) is present with T1-, T2-hyperintesity, reduction of the muscle mass and replacement by fatty tissue. Post contrast images shows marked contrast enhancement of the right trigeminal nerve compared with the left (mild enhancement of the left trigeminal nerve is physiologic).
Right Trigeminal nerve sheath tumor
Intracranial peripheral nerve sheath tumors are relatively uncommon tumors in dogs. Clinically, dogs with intracranial PNST have one or more of the following clinical signs: ipsilateral masticatory muscle atrophy, loss of facial sensation, and Horner’s syndrome. Signs from intracranial brainstem compression can also occur. Radiation therapy is a commonly used modality in the treatment of intracranial PNST. Stereotactic radiation therapy (SRT) is one method used to deliver a curative dose of external beam radiation therapy. This precise and conformal treatment directly targets the radiation at the tumor with rapid dose drop-off, which allows for very high doses of radiation to be administered without increasing toxicity to adjacent normal tissues.
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.
The surgery was performed in two steps: first the replacement of the prolapsed horns and uterus and then ovariohysterectomy.
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.