Emphysematous pyometra and emphysematous hepatitis caused by Klebsiella pneumoniae infection in a diabetic dog.

A 14-year-old intact female diabetic dog presented with seizures and hyperglycemic hyperosmolar syndrome. Radiographs revealed gas-filled tubular structures in the right and left caudal abdomen, raising concerns of emphysematous pyometra or small intestinal ileus. Ultrasonography played a pivotal role in confirming emphysematous pyometra, a technique previously documented only once in veterinary practice. This report also presents the first documented case of emphysematous pyometra in a diabetic dog attributed to Klebsiella pneumoniae and complicated by emphysematous hepatitis.

Use of radiography, ultrasonography, and computed tomography in the diagnosis of a pyogranulomatous ureteral mass in a cat.

An 8-year-old, spayed female, domestic short haired cat, with diabetes mellitus, was presented to the University of Florida Veterinary Medical Center for an acute onset of vomiting and inappetence. Abdominal radiographs showed mild retroperitoneal effusion and asymmetric left-sided renomegaly. Subsequently, on abdominal ultrasound, a hypoechoic left ureteral mass with left hydronephrosis and hydroureter was identified. An abdominal computed tomography revealed a heterogeneously contrast-enhancing mass circumferentially surrounding the mid to distal left ureter, mild retroperitoneal effusion, left-sided hydronephrosis and hydroureter, and a distally located ureteral calculus at the level of the ureterovesicular junction. The patient was diagnosed with left-sided pyogranulomatous ureteritis via surgical biopsy and histopathology.

Punctate retinal hemorrhage and its relation to ocular and systemic disease in dogs: 83 cases.

OBJECTIVE: To describe clinical aspects of dogs with punctate retinal hemorrhage (PRH). ANIMALS STUDIED: 83 dogs (119 eyes) with PRH. PROCEDURES: Medical records of dogs evaluated by the Cornell University ophthalmology service with a clinical diagnosis of PRH between 2006 and 2015 were reviewed. For this study, PRH was defined as retinal hemorrhages ≤ 1 optic disk diameter in size and dogs with other posterior segment ocular diseases were excluded. Signalment and clinical features of the dogs were recorded, including concurrent ocular and systemic diseases. RESULTS: Punctate retinal hemorrhage was identified in 119 eyes of 83 dogs. The mean (±standard deviation) age of dogs was 10.0 (±3.8) years. Mixed-breed dogs, Golden Retrievers, Jack Russell Terriers, and English Springer Spaniels were statistically overrepresented relative to the ophthalmology service canine referral population during the same period. Hemorrhages were found in all retinal locations and varied in number. Concurrent ocular disease was present in 78 eyes (66%) including keratoconjunctivitis sicca, uveitis, and cataracts. Fifty dogs (60%) suffered from concurrent systemic disease and diabetes mellitus, multiple myeloma, and systemic hypertension were statistically overrepresented in the PRH population. Less frequently, other serious systemic diseases were present in dogs with PRH including immune-mediated thrombocytopenia, leptospirosis, metastatic neoplasia, and thromboembolic disease. CONCLUSIONS: The risk of PRH in dogs may be increased by certain ocular and systemic diseases. As the presence of PRH can be associated with underlying systemic disease in dogs, it may prompt further clinical investigation and diagnostics.

Epidemiology and clinical presentation of canine cataracts in France: a retrospective study of 404 cases.

OBJECTIVE: To determine the epidemiology and the clinical presentation of cataracts in a population of dogs in France. PROCEDURES: Records of dogs affected by a cataract presented at the Ophthalmology Unit of Alfort Veterinary School during 2009-2012 were reviewed. The etiology was determined for each dog. The signalment of affected dogs, their medical history, age of onset, stage of progression, location of opacities, and ocular lesions associated were evaluated for each etiology. RESULTS: A total of 2739 dogs were presented at the Ophthalmology Unit from 2009 to 2012. Four hundred and four dogs (14.7%) (716 eyes) were diagnosed with a cataract. The population included 218 males (54%) and 185 females (46%). The gender was not recorded for one dog. The mean age (±SD) of all dogs affected by a cataract was 9 years (±3.9 years). Fifty-four breeds were represented. The Yorkshire Terrier was the only breed significantly overrepresented. The causes of cataracts observed were breed predisposition (28%), aging (22.8%), progressive retinal atrophy (12.4%), congenital cataract (5%), diabetes mellitus (4.7%), trauma (3.7%), uveitis (3%), and hypocalcemia (0.2%). In 20.3% of the cases, the etiology could not be determined. Ocular lesions associated with cataracts reported were lens luxation or subluxation (11.1%), glaucoma (3.7%), and retinal detachment (4.2%). CONCLUSIONS: In a French population of referred dogs, 14.7% were affected by a cataract. The main causes identified were breed predisposition, aging, and progressive retinal atrophy. A breed predisposition for the Yorkshire Terrier was recorded.

Diabetes mellitus does not affect the neuromuscular blocking action of atracurium in dogs.

OBJECTIVE: To compare the duration of action of atracurium in diabetic and nondiabetic dogs. STUDY DESIGN: Prospective, blinded, clinical study. ANIMALS: A total of 26 diabetic and 29 nondiabetic dogs. METHODS: Following preanaesthetic medication and intravenous (IV) propofol induction, anaesthesia was maintained with isoflurane in oxygen. Atracurium 0.2 mg kg-1 IV was administered to provide neuromuscular blockade (NMB) and the responses (twitches; T) to train-of-four nerve stimulation were recorded by palpation and electromyography (EMG). Time to onset of NMB (from atracurium administration to loss of T4 by EMG), duration of NMB (to return of T1 by EMG) and also times to loss and return of T2-T4 were recorded. Heart rate (HR), mean arterial pressure, end-tidal isoflurane (Fe'Iso), end-tidal CO2 concentrations and oesophageal temperature were recorded at onset of NMB and when T1EMG returned. Groups were compared using t tests and Mann-Whitney U tests (p<0.05). RESULTS: Diabetic dogs were older (9.9±0.3 compared with 6.8±0.7 years, p=0.0003). Group parameters were similar at onset and offset of NMB apart from HR at offset, which was higher for diabetics compared to nondiabetics (114±4 compared with 100±3 beats minute-1, respectively, p=0.004), Fe'Iso was higher in the diabetic group at onset (1.3±0.03% compared with 1.2±0.04%, p=0.026) and offset (1.4±0.03% compared with 1.3±0.03%, p=0.007), and temperature was higher for diabetics at onset (37.5±0.1 °C compared with 37.0±0.2 °C, p=0.012) and offset (37.5±0.1 °C compared with 36.9±0.2 °C, p=0.004). The duration of action of atracurium(tactile) and atracurium(EMG) were similar for both groups. CONCLUSIONS AND CLINICAL RELEVANCE: The duration of action of atracurium was similar in diabetic and nondiabetic dogs as indicated by tactile and EMG monitoring.

Emphysematous pyelitis and cystitis associated with vesicoureteral reflux in a diabetic dog.

A 12-year-old female dog with a 3-month history of poor response to diabetes treatment had an acute worsening of symptoms, including weakness and blindness. The dog had elevated blood glucose, alkaline phosphatase and urea concentration, hyposthenuria, glycosuria, hematuria, and pyuria. Escherichia coli was isolated from the urine. Radiographs and ultrasound examination showed that the dog had unilateral emphysematous pyelitis and concurrent cystitis associated with vesicoureteral reflux.

Pyélite emphysémateuse et cystite associées au reflux vésico-urétéral chez une chienne diabétique. Une chienne âgée de 12 ans avec une anamnèse de 3 mois de mauvaise réponse au traitement du diabète a présenté un aggravement aigu des symptômes, y compris de la faiblesse et de la cécité. La chienne avait une glycémie élevée, ainsi que des concentrations sériques élevées de la phosphatase alcaline et d'urée, de l'hyposthénurie, de la glycosurie, de l'hématurie et de la pyurie. Escherichia coli a été isolé de l'urine. Des radiographies et des échographies ont montré que la chienne était atteinte de pyélite emphysémateuse unilatérale et de cystite concomitante associées au reflux vésico-urétéral.(Traduit par Isabelle Vallières).

Retrospective study of the prevalence of keratoconjunctivitis sicca in diabetic and nondiabetic dogs after phacoemulsification.

OBJECTIVE: To evaluate the prevalence of keratoconjunctivitis sicca (KCS) in diabetic and nondiabetic dogs following phacoemulsification. PROCEDURES: Medical records were reviewed for signalment, body weight, diabetes status, and STT at the preoperative and all postoperative examinations. A clinical diagnosis of KCS was defined as a STT <15 mm/min with compatible clinical signs. Schirmer tear test values and the prevalence of KCS based on STT <15 mm/min were evaluated at 2-4, 5-8, 9-14, 15-20, and 41-52 weeks postoperatively. Size of dog (large, >10 kg; small, ≤10 kg) and STT ranges (<15 mm/min, 15-22 mm/min and >22 mm/min) were categorized for analysis of effect of body weight and STT on prevalence of KCS. RESULTS: One hundred and seventeen nondiabetic (198 eyes) and 118 diabetic dogs (228 eyes) were evaluated. KCS was diagnosed in nearly twice as many diabetics as nondiabetics (27.4% vs. 15.4%) within 2 weeks postoperatively (P = 0.0088). Percentage of eyes with KCS among all dogs decreased over time and did not differ significantly after the first postoperative visit. Diabetic small dogs were 1.7 times more likely to have KCS than nondiabetic small dogs (P = 0.0052). Preoperative STT was significantly associated with likelihood of postoperative KCS among large (P < 0.0001), but not small dogs (P = 0.0781). Among large dogs, eyes with STTs between 15 and 22 mm/min were approximately 3 times more likely to be diagnosed with KCS after surgery than those with STT >22 mm/min. CONCLUSION: The greatest risk for KCS for all dogs is during the first 2 weeks postoperatively. Populations at greatest risk for postoperative KCS are small dogs, small diabetic dogs, and large dogs with preoperative STT ≤22.

Emphysematous cystitis and pyelonephritis in a nondiabetic dog and a diabetic cat.

Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are the result of infection of the urinary bladder and kidneys by gas-producing microorganisms. Those infections are most often reported in diabetic patients and rarely occur concurrently. This article describes two cases of concurrent EC and EPN, one in a nondiabetic dog and the other in a diabetic cat. The use of diagnostic imaging is necessary in the diagnosis of emphysematous infections. Both radiography and ultrasonography were used in the diagnosis of EC and EPN in the patients described in this report.

A preliminary evaluation of the circulating leptin/adiponectin ratio in dogs with pituitary-dependent hyperadrenocorticism and concurrent diabetes mellitus.

Leptin and adiponectin are thought to modulate insulin sensitivity and pancreatic ß-cell function, but there is limited information regarding the adipokine status of hyperglycemic dogs with hyperadrenocorticism. This study aimed to determine whether alterations in the leptin/adiponectin ratio, insulin sensitivity, and/or pancreatic ß-cell function are associated with diabetes mellitus (DM) in dogs with pituitary-dependent hyperadrenocorticism (PDH). A total of 48 client-owned dogs were included in this prospective observational study: 20 dogs with PDH (10 normoglycemic and 10 with DM), 15 dogs with DM, and 13 healthy dogs. The serum concentrations of leptin, adiponectin, resistin, interleukin (IL)-1ß, IL-6, IL-10, IL-18, and tumor necrosis factor (TNF)-α were measured, and homeostatic model assessment indices (HOMAs) were calculated and compared among the groups. Serum leptin was significantly higher in PDH dogs with and without DM than in healthy and DM dogs, and it was lower in DM dogs than in PDH dogs without DM. Serum adiponectin was significantly lower in PDH dogs with DM than in healthy and PDH dogs, and it was significantly lower in DM dogs than in healthy dogs. Serum IL-10 was significantly higher in PDH dogs with DM than in healthy and PDH dogs without DM. The leptin/adiponectin ratio was significantly higher in PDH dogs with DM than in normoglycemic PDH dogs. Serum IL-6 concentrations were significantly higher in DM dogs than in healthy dogs. Serum IL-1ß concentration was significantly higher in DM dogs than in healthy dogs and PDH dogs with DM and without DM. Serum TNF-α and IL-18 concentrations were not different among groups. The HOMAß-cell function was significantly lower in PDH dogs with DM than in normoglycemic PDH dogs, while HOMAinsulin sensitivity was significantly lower in PDH dogs with DM than in healthy dogs. These results suggest that adipokine dysregulation, a reduction in insulin sensitivity, and a further impairment in pancreatic ß-cell function might predispose PDH dogs to DM. Further longitudinal study will be necessary to confirm this result.

Topical KINOSTAT™ ameliorates the clinical development and progression of cataracts in dogs with diabetes mellitus.

OBJECTIVE: To determine whether topical administration of the aldose reductase inhibitor Kinostat™ can ameliorate the onset or progression of cataracts in dogs with naturally occurring diabetes mellitus (DM). MATERIALS AND METHODS: A randomized, prospective, double-masked placebo control pilot study was conducted with 40 dogs newly diagnosed with DM with no or minimal lens changes. Twenty-eight dogs received Kinostat™ and 12 dogs received placebo. PROCEDURES: Owners administered the agent into both eyes three times daily for 1 year and compliance was monitored with log sheets. Complete ophthalmic examinations were performed on dilated eyes at the time of enrollment and 1, 2, 3, 6, and 12 months into treatment. Cataract severity was assessed on a scale of 0-3. At 12 months, full bloodwork, including HbA1C and blood Kinostat™ levels were performed. RESULTS: After 12 months of treatment, the cataract score in the placebo group significantly increased with seven dogs (14 eyes) developing mature cataracts, two dogs (4 eyes) developing cortical opacities, and one dog (2 eyes) developing equatorial vacuoles with mild punctate cortical opacities. In contrast, the cataract score in the Kinostat™ treated dogs was significantly less with seven developing anterior equatorial vacuoles, two developing incipient anterior cortical cataracts, and four developing mature cataracts. In fact, the cataract scores of the Kinostat™ group at 12 months did not significantly increase from the score at the time of enrollment. The HbA1C values between the two groups after 12 months of treatment were similar, and no blood levels of Kinostat™ were found in any enrolled dog. CONCLUSION: The onset and/or progression of cataracts in dogs with DM can be significantly delayed by topical administration of Kinostat™.

Hypophysectomy for a dog with coexisting Cushing's disease and diabetes mellitus.

An 11-year-old male mixed breed dog diagnosed with Cushing's disease and diabetes mellitus was treated by hypophysectomy. After surgery, the hypercortisolemia disappeared and the diabetes status improved. The insulin requirement to control hyperglycemia gradually decreased. At 12 weeks after surgery, there was no requirement for insulin and we suspected the diabetes was completely resolved. In the present case, diabetes mellitus seems to be secondary to Cushing's disease. In conclusion, this mixed breed dog with coexisting Cushing's disease and diabetes mellitus is the first case showing the effectiveness of hypophysectomy to treat diabetes mellitus secondary to Cushing's disease in dogs.

Controlled retrospective study of the effects of eyedrops containing phenylephrine hydrochloride and scopolamine hydrobromide on mean arterial blood pressure in anesthetized dogs.

OBJECTIVE: To determine whether dogs that received eyedrops containing phenylephrine and scopolamine would have a higher mean arterial blood pressure (MAP) when anesthetized than would dogs that did not receive the eyedrops. ANIMALS: 37 nondiabetic and 29 diabetic dogs anesthetized for phacoemulsification and 15 nondiabetic dogs anesthetized for corneal ulcer repair (control dogs). PROCEDURES: Medical records were reviewed to identify study dogs. Dogs undergoing phacoemulsification received 2 types of eyedrops (10% phenylephrine hydrochloride and 0.3% scopolamine hydrobromide) 4 times during a 2-hour period prior to the procedure. Control dogs did not receive these eyedrops. Heart rate and MAP were measured before surgery in all dogs 10 and 5 minutes before, at the time of (t0), and 5 (t5) and 10 (t10) minutes after atracurium administration. RESULTS: MAP was greater in the 2 groups that received the eyedrops than in the control group at t0 and t5; at t10, it was greater only for the nondiabetic dogs that received eyedrops. Nine nondiabetic dogs and 1 diabetic dog anesthetized for phacoemulsification had at least 1 MAP value>131 mm Hg; 73% of MAP values>131 mm Hg were detected within 10 minutes after atracurium administration. At no time did a control dog have an MAP value>131 mm Hg. CONCLUSIONS AND CLINICAL RELEVANCE: Anesthetized dogs pretreated with eyedrops containing phenylephrine and scopolamine had higher MAP values than dogs that did not receive the eyedrops, suggesting the drops caused hypertension. Atracurium may interact with the eyedrops and contribute to the hypertension.

[Hyperprogesteronism due to bilateral adrenal carcinomas in a cat with diabetes mellitus]. / Hyperprogesteronismus infolge bilateraler Nebennierenrindenkarzinome bei einer Katze mit Diabetes mellitus.

An 8 year old male castrated Russian Blue cat with polyuria, polydipsia, polyphagia, abdominal enlargement, unkempt and easily epilated hair coat and abdominal alopecia is described. As a first step diabetes mellitus was diagnosed. Further work-up by ultrasonography revealed severe bilateral enlargement of the adrenal glands. Hypercortisolism was suspected and therefore ACTH stimulation test and dexamethasone suppression test were performed. In all samples cortisol concentrations were below the detection limit of the assay used. Various precursor hormones were measured and high progesterone concentrations were found. Histologically, the adrenal masses were characterised as bilateral adrenal carcinomas of the adrenal cortex. The case report demonstrates that adrenal gland tumors are also capable to secrete sex hormones instead of cortisol. Clinical signs of hyperprogesteronism are identical to those of hypercortisolism.

Clinical and pathological characteristics of acute myelogenous leukemia in a female koala with diabetes mellitus.

A female koala presented with hyperglycemia related to diabetes mellitus diagnosed at 9 years and treated with insulin. She presented with nasal hemorrhage, anemia, leukocytosis, and tachypnea at 10 years. A blood smear examination revealed scattered, atypical large myeloid cells and a clinical diagnosis of myelogenous leukemia was made. White blood cell count reached a maximum of 295 × 102/µl, with evidence of severe regenerative anemia and thrombocytopenia. Grossly, systemic lymph node enlargement, fragile liver with hemorrhage, and bloody ascites were observed. Histopathologically, atypical myeloid cells, including myelocytic and metamyelocytic cells, were scattered in the vasculature and surrounding tissues throughout the organs. The patient was infected with a koala retrovirus, which might have caused the myelogenous leukemia.

Evaluation of diabetes mellitus regulation in dogs treated with ophthalmic preparations of prednisolone acetate versus diclofenac sodium.

OBJECTIVE: To evaluate and compare regulation of diabetes mellitus (DM) in dogs with cataracts and well-controlled DM that received an ophthalmic preparation of prednisolone acetate versus diclofenac sodium. ANIMALS: 22 client-owned dogs with cataracts and well-controlled DM. PROCEDURES: A prospective, randomized, double-masked, experimental study was conducted. On days 0 and 32, serum fructosamine concentrations (SFCs), clinical scores, and body weights were determined. Dogs were assigned to receive a topically administered ophthalmic preparation of either prednisolone acetate 1% or diclofenac sodium 0.1% in each eye 4 times daily for 28 days. Data analysis was conducted with generalized linear mixed models. RESULTS: Findings indicated no meaningful differences in SFCs, clinical scores, or body weights between the treatment groups on days 0 or 32. Clinical score on day 0 was positively associated with SFC, as indicated by the corresponding rate of change such that each 1 -unit increase in clinical score was associated with an approximately 45.6 ± 9.4 µmol/L increase in SFC. In addition, the least squares mean ± SEM SFC was higher in spayed females (539.20 ± 19.23 µmol/L; n = 12) than in castrated males (458.83 ± 23.70 µmol/L; 8) but did not substantially differ between sexually intact males (446.27 ± 49.72 µmol/L; 2) and spayed females or castrated males regardless of the treatment group assigned. CONCLUSIONS AND CLINICAL RELEVANCE: Findings indicated no evidence for any differential effect on DM regulation (assessed on the basis of SFCs, clinical scores, and body weights) in dogs treated topically with an ophthalmic preparation of prednisolone versus an ophthalmic preparation of diclofenac. Additional research investigating plasma concentrations of topically applied ophthalmic glucocorticoid medications is warranted. (Am J Vet Res 2019;80:1129-1135).

Long-term management and postmortem examination in a diabetic cat with acromegaly treated with two courses of radiation therapy.

A 12-year-old, castrated male cat with diabetes mellitus was diagnosed with acromegaly and examined with magnetic resonance imaging (enlarged pituitary gland, 8 mm); serum hormone concentrations were measured. After the first course of radiation therapy (4 Gy, 12 fractions), insulin administration was not required from day 420 after diagnosis. Enlarged pituitary tumor (8 mm) recurred, and insulin dosage amount of the cat was increased on day 1,065. The second course of radiation therapy (6 Gy, 4 fractions) was performed on day 1,201 and insulin administration was again discontinued. However, the cat died from lymphoma on day 1,397. Postmortem examination revealed pituitary adenoma. Most tumor cells were positive for chromogranin A, synaptophysin, and growth hormone immunohistochemistry. The pancreatic islet cells revealed diffuse hyperplasia. We achieved long-term successful management of an acromegalic cat with two courses of RT. However, a protocol for a second course of RT for feline recurrent pituitary tumor should be further discussed.

Determination of renal vascular resistance in dogs with diabetes mellitus and hyperadrenocorticism.

In dogs, diabetes mellitus and hyperadrenocorticism are causes of hypertension associated with increases in vascular peripheral resistance. In human patients, the renal resistive index (ri) and pulsatility index (pi) are related to hypertension and diabetes and are used as indicators of disease severity. In this study the renal vascular resistance was measured in 12 dogs with hyperadrenocorticism, three with diabetes mellitus and four with both conditions, and the possible relationships between the two indices, blood pressure and biochemical parameters were investigated. Hypertension, defined as a systolic blood pressure more than 150 mmHg, was recorded in two of the dogs with hyperadrenocorticism and three of the dogs with hyperadrenocorticism and diabetes. The overall mean values for ri, pi and systolic blood pressure were higher in the diseased group of dogs than in 27 healthy dogs, and both indices were correlated with blood glucose concentration.

Heart failure is common in diabetic cats: findings from a retrospective case-controlled study in first-opinion practice.

OBJECTIVES: To study the prognosis and cause of death in cats with diabetes mellitus. METHODS: Twenty consecutive cases of feline diabetes mellitus diagnosed in first-opinion practice were followed. Three control cats, without diabetes, were matched to each case of diabetes; these were also followed. RESULTS: One Somali cat with diabetes could not be matched, so complete data analysis considered only 19 diabetics and 57 matched controls. Death occurred in 14 of 20 diabetics and 23 of 57 controls although one control cat was eventually lost to follow-up. Heart disease and heart failure led to death in six diabetic cats. One of these was the non-matched Somali; nevertheless, the death rate from heart disease in the diabetics was five of 19 compared with two of 57 in controls. The relative risk of heart failure in diabetic cats was 10.4 times that of the controls; this difference in rates was statistically significant. Survival amongst diabetics was significantly worse than for controls. For the control cats median survival was 718 days after the index visit, whereas for the diabetic cases median survival was 385 days after diagnosis. CLINICAL SIGNIFICANCE: Heart disease and failure are common in diabetic cats. This observation deserves further attention.

Infectious endocarditis caused by gas-producing Escherichia coli in a diabetic dog.

A 10-year-old, female West Highland white terrier was presented with poorly controlled diabetes mellitus and a previously undetected heart murmur. Emphysematous cystitis, emphysematous peritonitis and infective endocarditis of the tricuspid valve with gas accumulation were diagnosed with radiographs, including non-selective angiocardiography. The diagnoses were confirmed by post-mortem examination and positive cultures for Escherichia coli in blood, urine and tricuspid valve tissue samples.