Diffuse Pulmonary Adenocarcinoma with Micropapillary Growth Pattern in a Cat.

A 12-year-old female European shorthair cat was presented with severe dyspnoea. Echocardiography revealed hypertrophic cardiomyopathy and pleural effusion. The cat died from acute decompensated left heart failure. At necropsy examination, the lungs were diffusely congested and firm, with multifocal grey areas and sparse haemorrhages. No solid masses were detected. Histopathology revealed a diffuse neoplastic proliferation characterized by irregular growth along alveolar walls with a micropapillary pattern. Tumour cells were large, highly pleomorphic and intensely positive for pan-cytokeratin and CAM 5.2. Tumour growth was obscured by simultaneous lesions related to chronic pulmonary congestion and interstitial lung disease. Histological features were consistent with a diffuse invasive pulmonary adenocarcinoma with a micropapillary pattern of tumour growth. Differential diagnosis included large cell carcinoma, which is usually characterized by rosettes or solid clusters of cells occupying alveolar lumen. Extensive cytokeratin immunolabelling was helpful in the differentiation from histiocytic proliferative disease.

Evaluation of clinicopathological features in cats with chronic gastrointestinal signs.

Food-responsive enteropathy (FRE), idiopathic inflammatory bowel disease (IBD), and alimentary tract lymphoma (AL) are often the remaining differentials for cats presenting with chronic gastrointestinal (GI) signs. Differential diagnosis is further complicated by overlapping clinicopathological features and histopathological changes, however. In this study we describe the clinical presentation of cats with chronic GI signs secondary to FRE, IBD, and AL, and evaluate possible associations between clinical, clinicopathological, ultrasonographic findings and diagnosis. The medical records of client-owned cats with chronic GI signs secondary to FRE, IBD, and AL were reviewed. Univariate and multivariate logistic regression models and receiver-operating characteristic curve (ROC) analysis were used for testing the data. Of the 56 cats included in the study, 22 were diagnosed with FRE (mean age, 70 months ± 49), 17 with IBD (mean age, 101 months ± 40), and 17 with AL (mean age, 122 months ± 45). Cats with FRE were younger and presented more often with diarrhea and less frequently with muscle wasting than cats with IBD or AL. In cats with AL, serum cobalamin levels were lower than in those with FRE or IBD (239 ± 190 ng/L vs. 762 ± 408 ng/L and 625 ± 443 ng/L, respectively) and folate levels were higher than in cats with IBD (18.2 ± 4.2 µg/L vs. 9.1 ± 4.7 µg/L, respectively). Multivariate/ROC curve analysis showed increased values of BUN (sensitivity 100, specificity 29.4, criterion >37 mg/dl) and serum folate (sensitivity 80, specificity 100, criterion >15.6 µg/L) and reduced values of cobalamin (sensitivity 100, specificity 62.5, criterion ≤540 ng/L), which suggested a diagnosis of AL versus IBD. Some clinicopathological features evaluated at diagnosis might suggest AL; however, because differentiating AL from IBD is often difficult, definitive diagnosis should be based on invasive diagnostic workup.

Prognostic factors for survival in dogs with pituitary-dependent hypercortisolism treated with trilostane.

Pituitary-dependent hypercortisolism (PDH) is one of the most frequent endocrinopathies in dogs, but prognostic factors are largely unknown. The aim of this retrospective case series study was to determine the prognostic value of different clinical and clinicopathological variables evaluated in dogs newly diagnosed with PDH that were subsequently treated with trilostane. Medical records from one referral centre were evaluated. Eighty-five dogs with PDH were included. The median survival time was 852 days (range 2-3210 days); 60/85 (70 per cent) and 25/85 (29 per cent) dogs survived more than one and three years, respectively. In multivariable model analysis the length of survival of older dogs (HR 1.24, 95% CI 1.09 to 1.40) and dogs with higher serum phosphate concentrations (HR 1.35, 95% CI 1.01 to 1.81) was shorter. Serum phosphate concentrations were above the reference range in 37/85 (44 per cent) of animals. Clinical signs, liver enzymes, serum cortisol concentrations of the endocrine tests, proteinuria, systolic hypertension, the presence of concomitant disorders, and the frequency of trilostane administration were not associated with survival time. Hyperphosphataemia is a common finding in dogs with newly diagnosed PDH and represents a negative prognostic factor.

Evaluation of hair cortisol in the diagnosis of hypercortisolism in dogs.

BACKGROUND: Measurement of hair cortisol is a noninvasive technique used for several purposes in humans and in animals. OBJECTIVES: To measure hair cortisol concentrations (HCC) in dogs with spontaneous hypercortisolism (HC) and determine whether it can represent a useful diagnostic test for this syndrome. ANIMALS: Twenty-two dogs with spontaneous HC before treatment, 28 sick control dogs (SCD), and 40 healthy dogs. METHODS: In this prospective, observational clinical study, the HCC was measured by an RIA assay after extraction in HC dogs, in dogs with other chronic diseases, and in healthy dogs. The diagnostic accuracy of HCC was evaluated by subjecting data from dogs with HC and dogs with other chronic diseases to receiver operating characteristic (ROC) curve analysis. RESULTS: Median (range) cortisol concentration in dogs with HC was 4.53 pg/mg (0.32-74.62 pg/mg) and was significantly higher than in SCD (1.49 pg/mg, 0.13-14.19 pg/mg) and healthy dogs (1.28 pg/mg, 0.34-5.38 pg/mg). Within the 3 groups, there was a large overlap of HCC. The area under the ROC curve was 0.80 (95% CI: 0.67-0.92). A cut-off value of HCC of 1.93 pg/mg revealed 91% sensitivity and 61% specificity to diagnose HC. CONCLUSIONS AND CLINICAL IMPORTANCE: Hair cortisol concentrations are higher in dogs with HC compared to SCD and healthy dogs. It is a noninvasive technique that should be further investigated as a possible diagnostic procedure for the diagnosis of HC in dogs.

Type 1 diabetes mellitus and hyperadrenocorticism in a ferret.

Diabetes mellitus (DM) was diagnosed in a 6-year-old neutered male ferret with polyuria/polydipsia, symmetrical alopecia, and weight loss. Laboratory tests revealed severe hyperglycemia, glucosuria, and increased steroid hormone profile. Abdominal ultrasound revealed a bilateral enlargement of the adrenal glands. Significant clinical improvement was achieved with insulin- and leuprolide acetate-based therapy. After 2 months of therapy, the ferret showed a severe ketoacidosis, and the owner decided to euthanize the animal. Histological findings revealed carcinoma of the left adrenal cortex and cortical hyperplasia of the right adrenal gland. Moderate, chronic, and active pancreatitis with a marked decrease in the number of beta-cells was also present. This is the first reported case of type 1 DM associated with hyperadrenocorticism and chronic pancreatitis in a ferret.

Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis.

BACKGROUND: The diagnosis of canine diabetic ketoacidosis (DKA) usually is based on measurement of urinary acetoacetate (ketonuria). In humans, this test is less sensitive and specific than blood 3-beta-hydroxybutyrate (ketonemia) evaluation. HYPOTHESIS: Ketonemia measurement using a portable meter is more accurate than ketonuria determination with a dipstick to diagnose canine DKA. ANIMALS: Seventy-two client-owned diabetic dogs with ketonemia, ketonuria, or both. METHODS: Prospective observational study. Based on blood bicarbonate concentration and anion gap, dogs were divided into 2 groups: patients with DKA (n= 25); patients with diabetic ketosis (n= 47). Sensitivity, specificity, and positive and negative likelihood ratio (LR) at different cut-off points were determined for both ketonemia and ketonuria. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of each diagnostic test to diagnose DKA. RESULTS: With regard to ketonemia, cut-off values of 2.3 and 4.3 mmol/L revealed 100% sensitivity and 100% specificity, respectively, whereas cut-off values of 2.8 and 3.5 mmol/L showed a -LR of 0.05 and a + LR of 13.16, respectively. With regard to ketonuria, a cut-off value of 1+ revealed 92% sensitivity, 40% specificity, and -LR of 0.20, whereas a cut-off value of 3+ revealed 44% sensitivity, 94% specificity, and +LR of 6.89. The areas under the ROC curves for the ketonemia and ketonuria tests were significantly different (0.97 and 0.81, respectively, P= .003). CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of ketonemia is accurate and more effective than measurement of ketonuria to diagnose canine DKA.

Is manual dexterity essential in the selection of dental students?

OBJECTIVE: The purpose of this study was to determine whether basic manual dexterity (BMD) could be an important parameter in selecting students for the Degree in Dentistry (CLOPD) and to assess whether initial manual dexterity in students admitted to the CLOPD can improve with training in pre-clinical and clinical practice. DESIGN: Observational study. SETTING: The study was carried out at the Catholic University of Rome, in five consecutive academic years. SUBJECTS AND METHODS: Four hundred and thirty-three subjects (262 males and 171 females) were tested (10 different exercises) in five consecutive years. Two retests were performed after three and five years respectively from the beginning of the experimentation. MAIN OUTCOME MEASURES: The scores of individual exercises were averaged for each candidate, assessing the mean value of basic manual dexterity score (BMDS). RESULTS: It was possible to observe some differences among candidates coming from different types of high schools, since those having a prior university degree or a scientific high school degree proved better than those with classical or vocational high school qualifications (p < 0.05). A statistically significant improvement of BMDS has been observed in students who attended the CLOPD for at least 32 months. CONCLUSIONS: Data obtained revealed that basic manual dexterity is not essential in the selection of dental students. Students who could follow training significantly improved in their manual ability.

Echocardiographic and Doppler echocardiographic findings in 11 wolves (Canis lupus).

Two-dimensional real-time, M-mode and Doppler echocardiographic measurements were made in 11 adult wolves (Canis lupus) anaesthetised with an intramuscular combination of medetomidine, ketamine, butorphanol and acepromazine followed by isoflurane in oxygen. M-mode measurements of the left ventricle, B-mode measurements of the left atrium and aorta, systolic indices, and Doppler measurements of aortic and pulmonary blood outflow, and of mitral and tricuspid blood inflow, were recorded. The values obtained were compared with those reported for dogs of similar bodyweight and body type. The diastolic measurements of the cardiac chambers and walls were similar to those reported for healthy, conscious dogs, but the use of anaesthesia probably resulted in the markedly different systolic cardiac measurements, systolic indices and Doppler blood flow velocities observed in the wolves. Mild mitral regurgitation, probably due to mitral endocardiosis, was observed in one wolf, and trivial functional mitral insufficiency was observed in five others.

Granular cell tumor of the tongue (Abrikossoff's tumor). A case report and review of the literature.

Granular cell tumor (GCT), also known as Abrikossoff's tumor, is a relatively uncommon neoplasm presenting as a benign, single, well-circumscribed nodule, usually arising on the tongue. Histologically, GCT shows numerous strands of large polyhedral granular cells, separated by collagen bundles, with no evidence of encapsulation. Recurrences may occur following inadequate excision. A 32-year-old woman, presenting a non-painful nodule embedded in the chorion of her tongue, underwent a first excisional biopsy which revealed a GCT and the margins of the bioptic sample appeared free. Immunohistochemistry for protein S-100 revealed the tumor cells invading the margins of the sample. A second intervention was made to excise the possible remaining neoplastic tissue. This case, owing to its uncommon clinical appearance, seemed particularly interesting. Immunohistochemical assay for S-100, whenever a CGR is suspected, is always mandatory to discover tumor cells infiltrating the margins of the sample. Furthermore, immunohistochemical assay can make the diagnosis more precise excluding other more serious tumors which could arise in the oral cavity. In any event, the patient should be reassured of the benign nature of the tumor and a careful follow-up is necessary in order to diagnose relapses.

[Clinical observations on the nature of early caries. A study with scanning electron microscopy]. / Osservazioni cliniche sulla natura delle lesioni cariose iniziali. Studio al SEM.

BACKGROUND: Early caries lesions present a greater porosity in the deep layers than in the superficial layer of the enamel. The "white spot" lesion is a dynamic lesion which is subjected to the changes occurring in the oral cavity; it can regress, stabilize or progress. The aim of this study is to show if there are considerable morphological differences in the superficial ultrastructural aspect of early caries lesions, active or stabilized, in persons of different age. METHODS: To carry out this SEM observation, 15 patients aged from 12 to 50 presenting early caries lesions have been selected. Some of them had been recently subjected to orthodontic treatment, others several years ago. Five of these patients have been called back to examine again the demineralized area by microscope in the very same place of the first observation. The replica technique was used utilizing a silicon-based impression material, an epoxy resin for replicas casting, little steel nets to fix the silicon material. RESULTS: At the level of white spot lesions it is evident a tissural structure scattered with small overlappings and micropits with a diameter of 0.5-2 mu. The patients who removed orthodontic bands more than 10 years before show a shining white aspect, corresponding to the nearly complete loss of enamel perikymata with well defined abrasions, but without any micropits at SEM examination. CONCLUSIONS: The replica technique has shown to be useful to record the defects of active and stabilized caries lesions. However this technique can't be utilized as a diagnostic instrument because it would be too expensive, but it is certainly a valid support for in vivo research.

[Efficacy of 4 adhesive systems for amalgam. In vitro study]. / Efficacia di 4 sistemi adesivi per amalgama. Studio in vitro.

BACKGROUND: The aim of this research is to study the shear bond strength of 4 adhesive systems of the last generation: All-Bond 2 (AB2), Clearfil Liner Bond 2 (CL), Scotchbond MP plus (SBMP) and High Q Bond plus (HQB). According to the manufacturing company these products are suitable for amalgam adhesion to dentin. METHODS: Forty extracted human third molars have been ground to expose a flat dentin surface. The teeth were randomly assigned to 4 groups, and every group was treated with one of the adhesive system according to the manufacturer's instructions. Samples were then secured in a split Teflon mould, having a 6 mm diameter opening and a spherical amalgam was triturated and condensed onto the treated dentin surfaces. The amalgam cylinders have been exposed to a tensile bond test using a Universal Testing Machine (Instron 4500). ANOVA test has been used to the statistic study among groups. RESULTS: The study of the tensile mean range, showed that dentin shear bond strength values (MPa) for the adhesive systems tested were: 8.13 +/- 1.48 for AB2, 7.06 +/- 1.41 for SBMP, 4.2 +/- 1.06 for HQB, 3.04 +/- 0.68 for CL. The statistic test revealed significant differences among the 4 groups (p < 0.05). CONCLUSIONS: The bond strength mean values of amalgam adhesives are lower than the ones for composite resins, nevertheless dentin-enamel adhesive systems specific for amalgam have to be taken into consideration particularly in case of conservative restorations that need chemical retention as a support, when the mechanical one is not enough.

Bonding of composite resins to dentin: SEM observation of one-component enamel-dentin bonding systems.

AIM: To evaluate in vitro the qualitative characteristics of the surfaces of some enamel-dentin bonding systems. METHODS: Seven different bonding systems were observed first by stereomicroscopy then by scanning electron microscopy, as follows: 49 extracted teeth were abraded to expose a uniform dentin surface. After application of the bonding system, composite resin was placed on the surface and shaped as an inverted truncated cone. The tensile bond test was performed and the specimens observed under SEM; the fracture location was determined and the formation of the hybrid layer evaluated. RESULTS: SEM observation indicated that adhesive, cohesive and mixed fractures had occurred. The abraded dentin surfaces were also observed under SEM before and after etching. The most recent enamel-dentin bonding systems use a conditioning technique that demineralizes the upper dentin surface at and around the tubule entrance. This is known as the total etching technique. A layer is formed in which the demineralized dentin is impregnated with fluid resin: the so-called hybrid layer. CONCLUSIONS: The length of the plugs of adhesive was not found to be determinant. The formation of the hybrid layer appeared to be more important, as it indicated a three-dimensional interaction between the conditioned collagen fibres and the primer that diffuses the adhesive.