Evaluation of endoscopic-assisted feline lateral bulla osteotomy: a cadaveric study.

OBJECTIVES: The aims of the study were to investigate if feline middle ear anatomy can be visualized using endoscopy via a lateral bulla approach and to determine if scope-assistance increases rates of successful entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy (TECA-LBO). METHODS: A total of 13 feline cadaver heads underwent CT to confirm the absence of pre-existing middle ear disease. For each head, an electronic coin toss was used to determine which ear would undergo endoscope-assisted TECA-LBO; a traditional TECA-LBO without the use of the scope was performed on the contralateral side. In endoscope-assisted procedures, a 1.9 mm scope was intermittently inserted into the tympanic bulla via a lateral bulla approach and used to identify middle ear structures, visualize the bony septum and confirm entry into the hypotympanum. After the bilateral TECA-LBO, the cadaver heads were imaged again and assessed for evidence of entry through the septum. RESULTS: Soft tissue and osseus structures of the middle ear were readily visualized with a 1.9 mm scope. Success rates for entry into the hypotympanum were high between both endoscope-assisted and traditional procedures, with entry confirmed for 12/13 ears in each group. CONCLUSIONS AND RELEVANCE: Endoscope assistance can facilitate the identification and examination of middle ear structures but does not appear to increase the success rate of entry into the hypotympanum during feline TECA-LBO, as entry through the bony septum was consistently accomplished even without scope-assisted visualization. Alternative benefits to scope assistance may exist, and future studies to elucidate its impact on rates of intraoperative trauma to middle ear structures are indicated.

A Pandora's box in feline medicine: presenting signs and surgical outcomes in 58 previously hoarded cats with chronic otitis media-interna.

OBJECTIVES: The aim of the present study was to report clinical findings, surgical complications and outcomes for previously hoarded cats treated surgically for otitis media-interna (OMI) and to investigate the risk factors for complications and poor outcomes. METHODS: A retrospective study was conducted of 58 cats from an institutional hoarding environment that underwent ventral bulla osteotomy (VBO). RESULTS: Inappetence was uncommon at presentation (9/58, 16%) compared with pruritus/alopecia (50%), nasopharyngeal signs (45%), otitis externa (OE) (79%) and otitis interna (OI) (ataxia ± head tilt/head excursions) in 40%. Purulent aural discharge occurred in 36% and polyps in 26%. The tympanic bulla wall was moderately or severely thickened radiographically in 38/108 (35%) ears. Cultures were positive for Streptococcus equi subspecies zooepidemicus in 26/48 (54%) cats. Of the 58 cats, 40 (69%) had complications after the first VBO and 19/30 (63%) after the second. Of 101 complications, 56 (55%), from 27/88 (31%) surgeries, were considered serious, including life-threatening perioperative complications in seven, OI in eight, prolonged anorexia in six and worsening of pruritus/alopecia in nine cases. Three cats developed xerostomia (dry mouth) after the second VBO. Pruritus/alopecia, nasopharyngeal signs, OE and purulent aural discharge resolved in a statistically significant proportion of cats but persisted in some. Full resolution of OI was uncommon. OI preoperatively, and surgery performed by a generalist (vs specialist) surgeon, were risk factors for OE at recheck (OI: odds ratio [OR] 4.35; 95% confidence interval [CI] 1.21-15.70; P = 0.02; surgery: OR 3.64; 95% CI 1.03-12.87; P = 0.045). No other prognostic indicators were identified. No variables tested were significantly associated with risk of serious complications or euthanasia. CONCLUSIONS AND RELEVANCE: Surgical management of chronic OMI was successful in most cases but was not benign and not always beneficial. The analysis was unable to identify clinically helpful outcome predictors. Optimal management of chronic feline OMI remains a challenge, particularly for animal shelters. Less invasive approaches and chronic medical management require further investigation.

Refractory otitis media and otitis externa in a koala (Phascolarctos cinereus) treated with total ear canal ablation and lateral bulla osteotomy.

BACKGROUND: To the authors' knowledge, this is the first report fully describing the surgical and medical management of otitis media and otitis externa in the koala (Phascolarctos cinereus) treated by total ear canal ablation and lateral bulla osteotomy. CASE REPORT: An adult male koala captured as part of a monitoring project in South East Queensland was diagnosed with chlamydial cystitis. Purulent discharge from the right ear was also observed; diagnostic imaging was consistent with otitis media and otitis externa. Yokenella regensburgei was repeatedly cultured from the site. Clinical signs resolved with topical antibiotic therapy; however, recrudesced following cessation of antibiotics. A total ear canal ablation and lateral bulla osteotomy was performed, followed by an extended period of systemic antibiotic therapy. Mild facial nerve paresis was observed for 4 weeks postoperatively and resolved spontaneously. The koala remained clinically healthy for the 6 months it was monitored following release. CONCLUSION: Total ear canal ablation combined with lateral bulla osteotomy appears to be an appropriate surgical intervention for otitis media combined with otitis externa refractory to medical management in the koala. Transient postoperative facial nerve paresis is a possible complication, as documented in other species. To the authors' knowledge this is the first case of Yokenella regensburgei infection outside of humans and American alligators (Alligator mississippiensis); the clinical significance of this pathogen in the koala remains unknown.

Lateral ear canal resection and bulla osteotomy with marsupialization to treat otitis media in rabbits: forty-eight procedures.

OBJECTIVE: Describe lateral ear canal resection and bulla osteotomy with marsupialization (LECARBOM) in rabbits with otitis media (OM), and report outcomes, complications, bacteria cultured from middle ears, and their antimicrobial susceptibility testing (AST) results. STUDY DESIGN: Retrospective clinical case series; single referral hospital. ANIMALS: Forty-two rabbits with naturally occurring OM. METHODS: Medical records (2011-2021) of rabbits with CT-confirmed OM undergoing surgery were reviewed for outcomes, complications, bacteria cultured from middle ears, and AST. RESULTS: Surgery was performed on 48 ears, and outcomes determined 21 days postoperatively. All rabbits survived the procedure. Otitis externa resolved in all lop-eared rabbits. Of 29 ears with OM-associated head tilt, eight (28%) resolved, nine (31%) improved, seven (24%) remained unchanged and five (17%) worsened. Outcome was not associated with head tilt duration nor OM severity. Postoperative complications occurred in 12 (25%) cases, seven of which had wound margin dehiscence that healed by 21 days. The most frequent bacteria isolated were Pasteurella multocida (16%), Bordetella bronchiseptica (14%) and Staphylococcus aureus (14%). Bacteria were sensitive to azithromycin, marbofloxacin or enrofloxacin and resistant to penicillin. CONCLUSION: LECARBOM is a well-tolerated surgical procedure to treat OM. It also improved or stabilized 83% of cases with head tilt and resolved all cases with otitis externa. CLINICAL SIGNIFICANCE: LECARBOM with administration of an AST-sensitive antibiotic, or azithromycin when no AST is performed, should be effective in rabbits with OM. Postsurgically, it resolves or alleviates most secondary conditions such as otitis externa, head tilt and facial nerve paralysis.

Effectiveness of chlorhexidine diacetate and povidone-iodine in antiseptic preparation of the canine external ear canal prior to total ear canal ablation with bulla osteotomy procedure: A preliminary study.

OBJECTIVE: This article is a preliminary study to compare the ability of 0.05% chlorhexidine diacetate (CD) and 1% povidone-iodine (PI) solutions to reduce bacterial contamination on the canine external ear canal during initial patient preparation and comparison of the incidence of immediate tissue reactions. STUDY DESIGN: The study is a multi-institutional, randomised, clinical prospective study. ANIMALS OR SAMPLE POPULATION: Dogs (n = 19) undergoing total ear canal ablation with bulla osteotomy (TECABO). METHODS: The external ear of each dog was cleaned with the assigned antiseptic solution. Culture of the ear was performed by standard techniques to semi-quantitatively evaluate bacterial growth and to identify bacterial organisms pre- and post-antiseptic use. RESULTS: Both antiseptic groups showed a significant reduction in bacterial growth score (BGS) between pre- and post-antiseptic use (CD p = 0.009, PI p = 0.005). There was no difference in the reduction of BGS between CD and PI solutions (p = 0.53). Minor adverse skin reactions occurred in 25% of cases. There was no significant difference in the occurrence of adverse skin reactions between antiseptics (p = 0.63). CONCLUSION: CD and PI were similarly able to decrease the number of bacteria on the external ear following initial preparation. No difference in the incidence of adverse tissue reactions was found. CLINICAL SIGNIFICANCE: Properly diluted aqueous formulations of either antiseptic may be used for safe preparation limited to the external ear canal of dogs. Additional studies evaluating outcomes such as duration of bacterial inhibition and incidence of surgical site infections are needed to fully elucidate differences between CD and PI antiseptics prior to TECABO.

Influence of extreme brachycephalic conformation on perioperative complications associated with total ear canal ablation and lateral bulla osteotomy in 242 dogs (2010-2020).

OBJECTIVE: To determine the influence of extreme brachycephalic conformation on presenting signs, imaging findings, intraoperative and perioperative complications following total ear canal ablation and lateral bulla osteotomy (TECA-LBO). STUDY DESIGN: Cross-sectional retrospective study. ANIMALS: A total of 306 (n = 242 dogs) TECA-LBOs (extreme brachycephalic breeds [EBB] = 81, other breeds [OB] = 225). METHODS: Medical records of patients undergoing TECA-LBO at a single referral institution (2010-2022) were evaluated. RESULTS: Extreme brachycephalic breeds most commonly presented acutely, at a younger age with oto-neurological signs (46/81, 56.8%). Chronic otitis externa without neurological signs (171/225, 76.0%) was most common in OBs. Extreme brachycephalic breeds preoperatively presented more frequently with facial nerve paresis (p = .001), vestibular syndrome (p = .001), and Horner's syndrome (p = .002) compared to OBs. On diagnostic imaging, bilateral changes (p = .038), aural masses (p = .045), para-aural abscesses (p = .011), otitis interna (p = .001), and brainstem changes (p = .001) were more common in EBBs. The apparent difference in intraoperative complication rate between EBBs (9/81, 11.1%) and OBs (12/225, 5.3%) did not reach statistical significance (p = .078). Perioperative complications occurred in 85/306 (27.8%) of TECA-LBOs with no difference in perioperative complication rate between EBBs (19/81, 23.5%) and OBs (66/225, 29.3%) (p = .586). CONCLUSION: Extreme brachycephalic breeds are more likely to present for TECA-LBO acutely, with neurological signs and more advanced diagnostic imaging abnormalities. Intra- and perioperative complication rates did not differ between EBBs and OBs. CLINICAL SIGNIFICANCE: Despite being subjectively more technically challenging, TECA-LBO did not result in more surgical complications in EBBs. Reported data are useful for effectively informing clients of the specific risks of TECA-LBO surgery.

Giant and potentially malignant bullae in a dog.

Background: Primary lung neoplasms are, frequently represented by solid, solitary, or multiple formations. However, malignant cavitary lesions may be presented as lung adenocarcinomas. Those malignant lesions differ from benignant bullae by the thickness heterogeneity of its surrounding shape. Case Description: The present clinical case reports a 14-year-old female dog, of mixed breed, with an increase in the coughs frequency, fatigue, and exercise intolerance. A chest X-ray was taken, a large emphysematous cystic area was found, with thickened and irregular walls located in the left caudal pulmonary lobe, which measured 8 × 7.5 × 3 cm, and rejected the bronchial branch corresponding to the left caudal pulmonary lobe, in addition to thickening of the bronchial walls, compatible with bronchopathy. The tomographic examination of the cavity showed an air content structure, oval to round in shape, with irregular thick hyperattenuating walls measuring approximately 0.4 cm in thickness, occupying more than 30% of the left hemithorax, and pulmonary lobectomy was chosen. Histopathology confirmed the diagnosis of bronchoalveolar adenocarcinoma, with the presence of sparse areas of necrosis and dystrophic calcification. Conclusion: The present case successfully diagnosed a malignant bulae, after a surgical remove. The tomographic finds although not confirmatory, suggest a malignant component by the shape and thickness of its wall. The tomographic exam is of great importance, because only through it, it is possible to evaluate if there is lymph node or pleural involvement or the presence of small metastasis foci. There is indication for surgery and histopathological examination of the piece for a definitive diagnosis.

Perioperative complications and outcomes following partial ear canal ablation and lateral bulla osteotomy in pet rabbits: 20 cases (2009-2021).

OBJECTIVE: To investigate the perioperative complications and outcomes of rabbits undergoing partial ear canal ablation and lateral bulla osteotomy for treatment of chronic otitis. MATERIALS AND METHODS: Surgical logbooks were searched to identify rabbits that underwent partial ear canal ablation and lateral bulla osteotomy between December 2009 and September 2021. Data collected included signalment, history, clinical signs, historical and current medical management, physical examination findings, preoperative diagnostic imaging and aural bacterial culture results, surgical procedure information, duration of hospitalisation, complications and final outcome. RESULTS: Twenty rabbits with chronic, medically unresponsive otitis underwent 27 partial ear canal ablation and lateral bulla osteotomies. Ten rabbits had pre-existing neurologic deficits and 17 had an ear base abscess at the time of surgery. A total of 13 (65%) rabbits developed at least one complication, either in the perioperative period or between discharge and recheck. Three of these rabbits (15%) underwent revision surgery for persistent or recurrent ear base abscess. Complete resolution of clinical signs ultimately occurred in 12 (60%) rabbits. Three (15%) rabbits showed improved but not completely resolved clinical signs (three facial asymmetry). Five (25%) rabbits died of causes potentially related to chronic otitis and/or partial ear canal ablation and lateral bulla osteotomy; two of these rabbits had undergone revision surgery. CLINICAL SIGNIFICANCE: Although this study reports a high complication rate (65%), most complications resolved, with 15 (75%) rabbits having a good to excellent final outcome. Since the majority of rabbits in this study had chronic and severe ear disease, further studies are required to determine if surgical intervention earlier in the disease process could result in a lower complication rate.

Evaluation of aural masses submitted as inflammatory polyps in 20 dogs (2000-2020).

BACKGROUND: Canine non-neoplastic aural polypoid masses (APMs) are uncommon, with few published studies. OBJECTIVES: The aim of this retrospective study was to characterise the clinical presentation, diagnostic imaging and histopathological results for APMs submitted as aural inflammatory polyps (AIPs). ANIMALS: Twenty dogs with APMs evaluated at a veterinary teaching hospital. MATERIALS AND METHODS: Cases were selected by searching computerised medical records from 2000 to 2020, using keywords 'canine', 'aural/otic polyp' and 'aural/otic inflammatory mass'. Histological samples and medical records were reviewed. RESULTS: In 14 of 20 dogs, external ear canal masses were characterised by keratinised squamous epithelium with or without adnexa. Tympanic bulla origin was confirmed in four of 20 dogs by the presence of cuboidal to ciliated columnar epithelium, with or without squamous epithelium. The site of origin could not be determined in two dogs. Diagnostic imaging (MRI or CT) confirmed APM presence in 14 of 20 dogs. Otitis media was diagnosed in four of four tympanic bulla APMs and seven of 13 ear canal APMs. In 18 of 20 dogs, debulking, traction avulsion, and total ear canal ablation and bulla osteotomy led to APM resolution in two of eight, four of six and four of four dogs, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Type of epithelium was a key feature in determining the APM origin, and interpretation in conjunction with video otoscopy and diagnostic imaging was crucial. Canine APMs more commonly arose from the ear canal. Tympanic bulla APMs and APMs of undetermined origin were comparable to feline AIPs. Regardless of APM origin site, debulking had the greatest likelihood of recurrence.

A case of cutaneous bullous mastocytosis in a Yorkshire terrier puppy.

BACKGROUND: Cutaneous bullous mastocytosis (CBM) is a rare disease characterised by erythroderma, bullae formation on trunk, scalp and extremities which evolve to erosions. OBJECTIVE: To describe a rare variant of cutaneous mastocytosis and treatment options. ANIMAL: A 7-month-old Yorkshire terrier puppy with erythroderma and bullae formation. METHODS: Clinical examination (including haematological, biochemical and radiographic), skin biopsy, histopathological and immunohistochemical evaluation. CONCLUSION AND CLINICAL RELEVANCE: The case fulfills the criteria of CBM, representing a rare entity that is reported to be associated with spontaneous regression. However, in severe cases treatment with systemic corticosteroids, H1 and H2 antihistamines, and masitinib can be performed.

Contexte - La mastocytose cutanée bulleuse (CBM) est une maladie rare caractérisée par une érythrodermie, la formation de bulles sur le tronc, le cuir chevelu et les extrémités qui évoluent vers des érosions. Objectif - Décrire une variante rare de la mastocytose cutanée et les options de traitement. Animal - Un chiot Yorkshire terrier de 7 mois avec formation d'érythrodermie et de bulles. Méthodes - Examen clinique (y compris hématologique, biochimique et radiographique), biopsie cutanée, évaluation histopathologique et immunohistochimique. Conclusion et pertinence clinique - Le cas remplit les critères de CBM, représentant une entité rare rapportée comme étant associée à une régression spontanée. Cependant, dans les cas graves, un traitement avec des corticostéroïdes systémiques, des antihistaminiques H1 et H2 et du masitinib peut être effectué.

Introducción - la mastocitosis bullosa cutánea (CBM) es una enfermedad rara caracterizada por eritroderma, formación de bullas en el tronco, cabeza y extremidades que evolucionan a erosiones. Objetivo - describir una variante rara de mastocitosis cutánea y opciones de tratamiento. Animal- un cachorro Yorkshire terrier de 7 meses con eritroderma y formación de bullas. Métodos - examen clínico (incluyendo hematológico, bioquímico y radiográfico), biopsia de piel, evaluación histopatológica e inmunohistoquímica. Conclusión y relevancia clínica- el caso descrito cumple con los criterios de CBM, lo que representa una entidad rara que se describe como asociada con regresión espontánea. Sin embargo, en casos graves se puede realizar tratamiento con corticoides sistémicos, antihistamínicos H1 y H2 y masitinib.

Contexto - A mastocitose cutânea bolhosa (MCB) é uma doença rara caracterizada por eritrodermia, formações bolhosas no tronco, cabeça e extremidades que evoluem para erosões. Objetivo - Descrever uma variante rara de mastocitose cutânea e as opções de tratamento. Animal - Um filhote de Yorkshire terrier de sete meses de idade com eritrodermia e formações bolhosas. Métodos - Exame clínico (incluindo avaliação hematológica, bioquímica e radiográfica), biópsia de pele, histopatologia e avaliação imunohistoquímica. Conclusão e relevância clínica - Esse caso preenche os critérios de MCB, representando uma entidade rara em que a regressão espontânea é relatada. Entretanto, em casos graves, tratamento com corticosteroides, anti-histamínicos H1 e H2 e masitinib podem ser realizados.

Topical Imiquimod Therapy for Localized Solar Dermatitis in a Dog.

Chronic sun exposure in dogs can result in clinical changes in the skin referred to as solar or actinic dermatitis. A 5-year-old, neutered male, American Bulldog presented with localized unilateral erythematous macules, plaques, alopecia, comedones and hemorrhagic bullae involving the non-pigmented skin on left lateral ventral flank area. The presence of hyperplastic epidermis with keratinocyte dysplasia, superficial dermal elastosis, and multiple follicular cysts with occasional rupture (furunculosis) on histology, together with history and characteristic skin lesions was consistent solar dermatitis/actinic keratosis. Skin scrapings were negative and treatment for secondary pyoderma was initiated with oral clindamycin for 8 weeks. After 2 months of antibiotic therapy, the hemorrhagic bullae resolved; however, erythematous solar/actinic skin lesions with induration and comedones persisted. Topical application of imiquimod 5% cream 3 times weekly for 8 weeks resulted in the resolution of erythema, but some of the non-inflamed comedones remained. Staining for elastin and Ki67 revealed keratinocyte hyperplasia in hair follicle infundibulums and alterations in the elastic fibers around follicles, which may lead to closure and formation of follicular cysts. Imiquimod has been long suggested as a treatment option for solar dermatitis, but this is the first known case report detailing its efficacy in dogs.

Effect of empirical versus definitive antimicrobial selection on postoperative complications in dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy: 120 cases (2009-2019).

OBJECTIVE: To evaluate dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy (TECA-LBO), document antimicrobial choices, and determine relationships associated with infection-related and neurologic postoperative complications. ANIMALS: 107 client-owned dogs and 13 client-owned cats that underwent TECA-LBO. PROCEDURES: A retrospective analysis of medicals records of dogs and cats with TECA-LBO from 2 veterinary hospitals with postoperative data for at least 6 months was performed. All information associated with the TECA-LBO surgery including follow-up was recorded. Logistic regression analyses were performed and corrected using a false discovery rate to identify significance between antimicrobial administration and other perioperative variables and the outcomes of short- and long-term neurologic and infection-related complications, need for revision surgery, and euthanasia due to recurrence of infection-related signs. RESULTS: Intraoperative cultures were performed in 111 animals, and 95 (85.5%) had bacterial growth, with Staphylococcus spp most commonly isolated. Revision surgeries due to infection-related signs occurred in 13 of 120 (10.8%) patients. If intraoperative bacterial cultures were positive and antimicrobials were administered within 1 month of surgery, patients were 85.8% less likely to exhibit infection-related complications, whereas patients not administered antimicrobials were 10.3 times as likely to require a revision surgery. Longer durations of postoperative antimicrobial administration were associated with revision surgery and euthanasia due to infection-related signs. CLINICAL RELEVANCE: Administration of systemic antimicrobials within the first postoperative month may be necessary to prevent complications when intraoperative cultures exhibit bacterial growth and plays a role in the successful outcome of TECA-LBO.

Bilateral cholesterol granulomas in the middle ear cavities of a cat with sinonasal disease successfully removed via video-otoscopy.

CASE DESCRIPTION: A 9-year-old spayed female Maine Coon cat was presented at the University of Veterinary Medicine Vienna for further investigation of chronic nonpruritic bilateral ear disease and unilateral Horner syndrome. CLINICAL FINDINGS: Physical examination and otoscopy findings included right sided Horner syndrome, a right head tilt of approximately 20° and a small pink nodule in the right and several smaller nodules in the left proximal horizontal external ear canal. Computed tomography and magnetic resonance imaging revealed soft tissue opacity material in both middle ear cavities, the caudal portion of the nasal cavity, the left nasopharyngeal meatus and the right frontal sinus. Via videootoscopy, 2 multilobular and several flat nodules were detected in the proximal right horizontal external ear canal and in the left tympanic bulla, respectively. Histopathological examination confirmed the diagnosis of cholesterol granulomas. TREATMENT AND OUTCOME: All otic cholesterol granulomas (CGs) were removed via video-otoscopy (VO), and topical treatment was initiated in addition to oral prednisolone. After the histopathological confirmation, negative microbial cultures from the middle ear cavities, and the remission of the symptoms by the first recheck, topical, and systemic treatment were discontinued. A follow-up 6 months later, did not reveal any recurrence of the CGs. CLINICAL RELEVANCE: To our knowledge, this is the first case of bilateral CGs diagnosed with a combination of CT, MRI, VO, and histopathology and removed minimal invasively via VO, without a need for ventral bulla osteotomy, which led to complete remission of all signs and no relapse until the follow up 6 months later.

Bullous amyloidosis in a horse: first description in veterinary medicine.

BACKGROUND: Bullous amyloidosis is a rare disease in humans that has not been described in a veterinary species in the peer-reviewed literature. The human disease is characterised by haemorrhagic vesicles and bullae on the skin and mucosae, which form due to amyloid deposition. HYPOTHESIS/OBJECTIVES: To describe the clinical features, laboratory analysis and histopathological features of an unique presentation of bullous disease in a horse. ANIMALS: A 17-year-old thoroughbred mare presented for weight loss and severe oral cavity ulcers. METHODS AND MATERIALS: Investigations involved haematological evaluation, chemistry profiles, gastroscopy and serum protein electrophoresis, and, postmortem, histopathological evaluation, Congo-red staining and transmission electron microscopy (TEM). RESULTS: Haemorrhagic vesicles and bullae occurred on the mucosa of the oral cavity, lips, oesophagus and stomach, and much less the muzzle, face and mucocutaneous areas of the perineum, where scarring was evident. Histopathological evaluation and Congo-red staining confirmed the presence of amyloid deposits in dermis and submucosa, in association with vesicle and bulla formation, consistent with bullous amyloidosis. TEM confirmed amyloid fibril deposition in the dermis and along the basement membrane zone. Clefts occurred in the superficial dermis and submucosa, which explained haemorrhage and scarring. The presence of a polyclonal gammopathy and the rapid abolishment of Congo-red staining with performate pretreatment supported serum amyloid A and secondary amyloidosis. CONCLUSION AND CLINICAL IMPORTANCE: Bullous amyloidosis is a novel disease of the horse and a newly recognised differential for bullous disease, for which the haemorrhagic nature of bullae, scarring and deep secondary ulcers are considered clinical clues to the condition.

Endoscope and image-guided ventral bulla osteotomy in the dog: A cadaveric and patient study.

BACKGROUND: Surgery of the bulla in the dog can be difficult and associated with suboptimal resolution of disease and risk of complications, particularly in treatment of cholesteatoma. We explored use of image guidance and endoscopic assistance in ventral bulla osteotomy (VBO), initially with cadaveric studies and subsequently on dogs with cholesteatoma. METHODS: For surgical approach we used cone beam CT with an optical image navigation system. For endoscopic surgery we used 4 mm and 2.7 mm diameter endoscopes and a camera viewing system, with micro-instruments for dissection. RESULTS: Image guidance allowed us to accurately identify and approach the bulla in cadavers (n = 2) and patients (n = 2). The endoscope enabled us to define detailed endoscopic anatomy in cadaveric canine heads (n = 15), and in patients (n = 5) it enabled reliable and safe removal of pathological tissue. CONCLUSION: Image and endoscopic assistance could be a significant advance to the reliability and safety of VBO. Our techniques may be applicable to other indications and species.

Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy.

OBJECTIVES: The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized. METHODS: Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other's surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon. RESULTS: The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P <0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered. CONCLUSIONS AND RELEVANCE: Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.

Comparison of complications and outcome following unilateral, staged bilateral, and single-stage bilateral ventral bulla osteotomy in cats.

OBJECTIVE: To compare complications and outcome following unilateral, staged bilateral, and single-stage bilateral ventral bulla osteotomy (VBO) in cats. ANIMALS: 282 client-owned cats treated by VBO at 25 veterinary referral and academic hospitals from 2005 through 2016. PROCEDURES: Medical records of cats were reviewed to collect information on signalment, clinical signs, diagnostic test results, surgical and postoperative management details, complications (anesthetic, surgical, and postoperative), and outcome. Associations were evaluated among selected variables. RESULTS: Unilateral, staged bilateral, and single-stage bilateral VBO was performed in 211, 7, and 64 cats, respectively, representing 289 separate procedures. Eighteen (9%), 2 (29%), and 30 (47%) of these cats, respectively, had postoperative respiratory complications. Cats treated with single-stage bilateral VBO were significantly more likely to have severe respiratory complications and surgery-related death than cats treated with other VBO procedures. Overall, 68.2% (n = 197) of the 289 procedures were associated with Horner syndrome (19.4% permanently), 30.1% (87) with head tilt (22.1% permanently), 13.5% (39) with facial nerve paralysis (8.0% permanently), and 6.2% (18) with local disease recurrence. Cats with (vs without) Horner syndrome, head tilt, and facial nerve paralysis before VBO had 2.6, 3.3, and 5.6 times the odds, respectively, of having these conditions permanently. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that staged bilateral VBO should be recommended over single-stage bilateral VBO for cats with bilateral middle ear disease. Cats with Horner syndrome, head tilt, and facial nerve paralysis before surgery were more likely to have these conditions permanently following surgery than were cats without these conditions.

Superficial Keratectomy and Conjunctival Advancement Hood Flap (SKCAHF) for the Management of Bullous Keratopathy: Validation in Dogs With Spontaneous Disease.

PURPOSE: To evaluate the efficacy of superficial keratectomy and conjunctival advancement hood flap (SKCAHF) for the treatment of bullous keratopathy in canine patients. METHODS: Nine dogs (12 eyes) diagnosed with progressive corneal edema underwent superficial keratectomy followed by placement of conjunctival advancement hood flaps. The canine patients were examined pre- and postoperatively using in vivo confocal microscopy, ultrasonic pachymetry (USP), and Fourier-domain optical coherence tomography (FD-OCT). All owners responded to a survey regarding treatment outcomes. RESULTS: Mean central corneal thickness (CCT) as measured by FD-OCT was 1163 ± 290 µm preoperatively and significantly decreased postoperatively to 795 ± 197 µm (P = 0.001), 869 ± 190 µm (P = 0.005), and 969 ± 162 µm (P = 0.033) at median postoperative evaluations occurring at 2.2, 6.8, and 12.3 months, respectively. Owners reported significant improvement (P < 0.05) in vision and corneal cloudiness at 6.8 and 12.3 months postoperatively. The percentage of cornea covered by the conjunctival flap was correlated (P = 0.0159) with a reduction in CCT by USP at 12.3 months postoperatively. All canine patients were comfortable pre- and postoperatively. CONCLUSIONS: SKCAHF results in a reduction of corneal thickness in canine patients with bullous keratopathy. The increase in corneal thickness over time, after performing SKCAHF, is likely because of progressive endothelial decompensation. This surgery is a potentially effective intervention for progressive corneal edema in dogs that may have value in treatment of human patients with bullous keratopathy.

Avaliações clínica, ecográfica e anatomofisiológica do alotransplante parcial de vesícula urinária com células-tronco mesenquimais alogênicas derivadas do tecido adiposo em coelhos / Clinical, sonographic, anatomic and physiological assessments of partial allotransplant urinary bladder with allogeneic mesenchymal stem cells derived from adipose tissue in rabbits

Os problemas relacionados ao armazenamento vesical são muitos e relevantes. Eles, além de influírem de forma efetiva na qualidade de vida, podem eventualmente evoluir para falência renal. Existem vários trabalhos, os quais descrevem as propriedades imunomoduladoras e imunossupressoras das células-tronco mesenquimais derivadas do tecido adiposo (ADSCs). Objetiva-se com o presente avaliar clínica, ecográfica e anatomofisiologicamente o alotransplante parcial de bexiga a fresco em coelhos, utilizando como agente imunomodulador ADSCs alogênicas. Para isso foram utilizados 25 coelhos, sendo um deles macho e doador das ADSCs, e os outros 24 eram fêmeas, submetidas a alotransplante parcial de bexiga, sendo tratadas com ciclosporina (GCi) ou células-tronco mesenquimais (GCe). Conclui-se que as ADSCs foram suficientes para evitar sinais clínicos e ecográficos de rejeição ao alotransplante de vesícula urinária, mantendo a estrutura anatomofisiológica vesical por até 30 dias em coelhos.

The problems related to bladder storage are many and significant. In addition to effectively impacting the quality of life, they can eventually progress to kidney failure. There are several studies which describe the immunomodulatory and immunosuppressive properties of ADSCs. The aim of this study is to clinically, through sonography, anatomically and physiologically evaluate fresh partial allograft bladder from rabbits using allogeneic ADSCs as immunomodulator agents. For such, 25 rabbits were used, one being a male ADSCs donor, and the other 24 females who underwent simultaneous partial allograft bladder, being treated with cyclosporine (GCi) or mesenchymal stem cells (GCe). It was concluded that ADSCs were sufficient to prevent clinical and ultrasound signs of allograft rejection of the urinary bladder. These bladders retained the anatomophysiological structure for 30 days in rabbits.

Outbreaks of vesicular disease caused by Vaccinia virus in dairy cattle from Goiás State, Brazil (2010-2012) / Surtos de doença vesicular causados pelo Vaccinia virus em bovinos de leite no Estado de Goiás, Brasil (2010-2012)

Cases of vesicular and exanthematic disease by Vaccinia virus (VACV) have been reported in dairy herds of several Brazilian regions, occasionally also affecting humans. The present article describes eight outbreaks of vesicular disease caused by VACV in dairy herds of six counties of Goiás state, Midwestern Brazil (2010-2012), involving a total of 122 cows, 12 calves and 11 people. Dairy cows (3 to 9 years old) were affected in all cases and calves (2 to 9 months old) were affected in five outbreaks, presenting oral lesions. The morbidity ranged between 8 and 100% in cows, and 1.5 to 31% in calves. In the cows, the clinical signs started with vesicles (2-7mm), painful and coalescent papules (3-8 mm), which resulted in ulcers (5-25mm) and scabs in teats, and, occasionally, in the muzzle. The clinical course lasted from 16 to 26 days. The histopathology of bovine skin samples revealed superficial perivascular inflammatory infiltrate of lymphocytes, plasma cells, neutrophils, macrophages and multifocal areas of acanthosis, spongiosis, hipergranulosis and parakeratotic or orthokeratotic hyperkeratosis with adjacent focally extensive ulcers. Eosinophilic inclusion bodies were noted in the cytoplasm of the keratinocytes. PCR to vgf gene of Orthopoxvirus was positive in samples collected from all outbreaks, and in some cases, genomic VACV sequences were identified by nucleotide sequencing of the PCR amplicons. Infectious virus was isolated in cell culture from scabs from one outbreak. Antibodies to Orthopoxvirus were detected in at least 3 or 4 animals in most outbreaks, by ELISA (outbreaks 1, 2, 3, 4, 5 and 7) or virus-neutralization (outbreak 6). Neutralizing titers ranging from 8 to 64 in outbreak 6. In all outbreaks, VACV infection was suspected based on the clinical and pathological findings and it was confirmed by laboratory tests. Upon the etiological confirmation, other agents associated with vesicular disease were discarded. In all outbreaks, at least one milker who handled the affected cows developed malaise, headache, fever, painful vesico-pustular lesions mainly in the hands, but also in the neck and nose. These results confirm the circulation of VACV in the region and call attention for a correct diagnosis and the adoption of prophylactic and control measures.

Casos de doença vesicular e exantemática associados ao Vaccinia virus (VACV) têm sido descritos em rebanhos leiteiros em diversas regiões do Brasil, ocasionalmente afetando também os ordenhadores. Este artigo descreve oito surtos de doença vesicular associados ao VACV ocorridos em rebanhos leiteiros de seis municípios do estado de Goiás (2010-2012), com o envolvimento de 122 vacas em lactação, de 12 bezerros e de 11 pessoas. Vacas em lactação (3-9 anos de idade) foram afetadas em todos os casos. Em cinco rebanhos, bezerros de 2-9 meses apresentaram lesões orais. A morbidade nos rebanhos variou entre oito e 100% (vacas) e entre 1,5 e 31% (bezerros). As lesões iniciavam como vesículas (2-7mm) ou pápulas doloridas e coalescentes (3-8mm), que progrediam para úlceras (5-25mm) e crostas, localizadas principalmente nas tetas e, eventualmente, no focinho das vacas. O curso clínico variou entre 16 e 26 dias. Histopatologia de amostras de pele coletadas de bovinos revelou dermatite perivascular superficial com infiltrado de linfócitos, neutrófilos, plasmócitos e macrófagos, além de áreas multifocais de acantose, espongiose, hipergranulose e hiperceratose ortoceratótica ou paraceratótica com úlceras focalmente extensas. No citoplasma dos ceratinócitos adjacentes às úlceras, observaram-se numerosos corpúsculos de inclusão eosinofílicos. Em todos os surtos, amostras de lesões cutâneas dos bovinos foram positivas para o gene vgf dos Orthopoxvirus por PCR, e em alguns casos, a identificação do VACV foi confirmada por sequenciamento de nucleotídeos dos amplicons. O vírus foi detectado por isolamento em cultivo celular em um dos surtos e, pelo menos 2 a 3 vacas por rebanho, apresentaram sorologia positiva para Orthopoxvirus pelos testes de ELISA (surtos 1, 2, 3, 4, 5 e 7) e soroneutralização (surto 6). No surto 6, os títulos de anticorpos neutralizantes variaram de 8 a 64. O diagnóstico da infecção pelo VACV, inicialmente suspeito com base nos achados clínicos e patológicos, foi confirmado em todos os surtos por exames laboratoriais. Em todos os surtos, pelo menos um ordenhador que teve contato com os bovinos afetados apresentou mal-estar geral, febre alta, dor de cabeça e lesões vesiculo-pustulosas doloridas, principalmente nas mãos, mas também no pescoço e nariz. Esses resultados confirmam a circulação do VACV no rebanho bovino da região centro-oeste, alertando para necessidade de diagnóstico correto e adoção de medidas profiláticas e de controle.