Combination of CT-Guided Microwave Ablation and Cementoplasty as a Minimally Invasive Limb-Sparing Approach in a Dog with Appendicular Osteosarcoma.

Image-guided microwave ablation and cementoplasty are minimally invasive techniques that have been used as part of a limb-sparing approach in the treatment of appendicular bone tumors in humans. The objective of this case report was to describe the feasibility and result of microwave ablation (MWA) and cementoplasty in a dog with stage-1 osteoblastic appendicular osteosarcoma of the right distal radius. A microwave antenna was inserted in the osteolytic area using computed tomography (CT) guidance. Three ablation cycles of 5 min at 60 watts were performed. Immediately after the MWA procedure, a tricalcium phosphate-based cement was injected through the bone trocar to consolidate the ablated zone. Adjuvant chemotherapy with six sessions of carboplatin was performed, without major complication. Response to the treatment was evaluated according to RECIST criteria every 6 weeks. Twenty-four hours after MWA, the dog was pain-free and had excellent mobility. Based on CT measurements, a reduction of the size of the lytic area was observed at the 2-month and at the 7-month follow-up (from 13% to 25% of the longest diameter), classified as stable disease according to RECIST criteria. The dog died 18 months after the initial diagnosis due to distant metastases.

Cervical tracheal rupture with persistence of a pseudotrachea in a dog.

A dog was examined because of acute onset of respiratory distress following a cervical dog bite. Physical examination revealed a deep ventral cervical bite wound associated with localized mild subcutaneous emphysema. Thoracic radiographs showed moderate pneumomediastinum. Medical management consisting of oxygen therapy, antibiotics, and anti-inflammatories was initiated. After 2 days, respiratory distress suddenly worsened. Tracheoscopy showed a discontinuity between the tracheal rings of the cervical trachea; however, the inner tracheal wall appeared intact. Computed tomography scan revealed a ~3-cm complete rupture of all layers of the trachea. Surgical resection and anastomosis of the trachea were performed successfully. Follow-up 15 days after surgery showed complete resolution of respiratory signs, as well as subcutaneous emphysema. A mild ventral angulation of the trachea at the surgical site was noticed on thoracic radiographs. This is the first case report of a pseudotrachea in a dog. Persistence of a pseudotrachea may initially result in only minor clinical signs responsive to medical therapy despite tracheal rupture. In the presence of a pseudotrachea, tracheal rupture may be difficult to identify with tracheoscopy alone. Therefore, CT scan should be proposed in every patient with suspected tracheal trauma. Key clinical message: This case report highlights the importance of including a tracheal rupture in the differential diagnosis of cervical subcutaneous emphysema, even if the amount is small and not associated with significant respiratory signs. The presence of a pseudotrachea may result in less severe clinical signs than expected based on the actual degree of tracheal injury; however, the clinical status may rapidly deteriorate and become life-threatening. This case report also underlines the importance of a CT scan as a complement to tracheoscopy, which may not be sufficient to identify a tracheal rupture in the presence of a pseudotrachea.

Rupture trachéale cervicale avec persistance d'une pseudotrachée chez un chien. Un chien a été présenté pour une dyspnée aiguë modérée consécutive à des morsures cervicales par un autre chien. L'examen clinique révéla une plaie cervicale ventrale profonde associée à un emphysème sous-cutané localisé léger. Les radiographies thoraciques ont montré un pneumomédiastin modéré. Un traitement médical consistant en une oxygénothérapie, des antibiotiques et des anti-inflammatoires a été initié. Après deux jours, la dyspnée s'aggrava brutalement. Une trachéoscopie révéla une discontinuité entre les anneaux trachéaux malgré la persistance d'une paroi trachéale interne intègre. L'examen par tomodensitométrie montra une rupture trachéale cervicale complète dans toute son épaisseur, sur 3 cm de long. Une chirurgie de résection-anastomose de la trachée a été réalisée avec succès.Il s'agit de la première description de pseudotrachée chez un chien. La persistance d'une pseudotrachée peut initialement ne provoquer que des signes cliniques mineurs, notamment un emphysème sous-cutané léger et une dyspnée répondant au traitement médical, malgré une lésion trachéale en réalité importante. Par conséquent, un examen par tomodensitométrie de la trachée doit être envisagé chez tous les patients pour lesquels un traumatisme trachéal est suspecté.Message clinique clé :Ce cas souligne l'importance d'inclure une rupture trachéale dans le diagnostic différentiel de l'emphysème souscutané cervical, et cela même s'il n'est présent qu'en petite quantité et associé à faibles signes cliniques respiratoires. La persistance d'une pseudotrachée peut entraîner des signes cliniques moins importants qu'une rupture trachéale complète, cependant l'état respiratoire de l'animal peut rapidement s'aggraver et devenir une urgence vitale.Ce cas souligne de plus l'importance de l'examen par tomodensitométrie en complément de la trachéoscopie, qui peut parfois s'avérer insuffisante pour le diagnostic des ruptures trachéales, en particulier en présence d'une pseudotrachée.(Traduit par les auteurs).

Usefulness of magnifying endoscopy with narrow-band imaging for diagnosing primary vascular ectasia in a dog.

A 2-year-old spayed female crossbred dog was presented for profuse, acute, and chronic vaginal hemorrhage. Coagulation disorders were excluded. Conventional diagnostic imaging failed to precisely identify the source of bleeding. After whole-blood transfusion, magnifying endoscopy with narrow-band imaging allowed the visualization of unique vascular patterns within the vaginal wall. Presumptive diagnosis of vaginal vascular ectasia was made and confirmed by histopathological examination. Surgical management with subtotal vaginectomy cured the dog. Key clinical message: Vascular ectasia is rarely reported in veterinary medicine and is challenging to diagnose. This is apparently the first report of the usefulness of magnifying endoscopy with narrow-band imaging as a diagnostic tool for vascular ectasia in a dog.

Apport de la fonction imagerie à bande étroite en endoscopie pour la détection d'une ectasie vasculaire primaire chez un chien. Une chienne femelle stérilisée de race croisée a été présentée pour récidive aiguë et profuse de saignements vaginaux perdurant de façon intermittente depuis l'adoption. Le bilan de coagulation ne présentait pas d'anomalie et les examens d'imagerie conventionnels n'ont pas permis d'identifier avec certitude l'origine de l'hémorragie. Après transfusion, la réalisation d'une endoscopie utilisant un processus informatique de chromoscopie virtuelle par bandes spectrales étroites a permis la visualisation d'un réseau vasculaire anormal sur la paroi vaginale. La présomption d'ectasie vasculaire vaginal a été confirmée par examen histologique. La résolution complète des saignements a été constatée après réalisation d'une vaginectomie subtotale.Message clinique clé:Les ectasies vasculaires (angiodysplasie) sont peu souvent rapportées en médecine vétérinaire et leur diagnostic est difficile à établir. Ce cas relate pour la première fois l'intérêt de la chromoscopie virtuelle par bandes spectrales étroites en endoscopie vétérinaire dans la prise en charge diagnostique d'une ectasie vasculaire vaginale chez un chien.(Traduit par les auteurs).

Acute kidney injury, seizures, and hypertonic hyponatremia secondary to mannitol intoxication in a dog.

OBJECTIVE: To describe a case of mannitol overdose associated with acute kidney injury (AKI), hypertonic hyponatremia, and neurologic abnormalities in a dog. CASE SUMMARY: A 10-year-old intact male Shiba Inu dog was referred to the emergency service of a veterinary teaching hospital for inappetence and acute onset of seizures. The dog had received 2 IV boluses of 3 g/kg of mannitol in less than 24 hours for a glaucoma crisis. Twelve hours after the second injection, the dog became inappetant and developed 2 generalized seizures. Seizure activity was treated with diazepam (0.5 mg/kg IV). Serum biochemistry profile showed severe hyponatremia and hypochloremia, mild hypokalemia, marked increased creatinine (381 µmol/L [44-133 µmol/L]) and moderately increased BUN (13.8 mmol/L [1.6-10.9 mmol/L]). Urinalysis revealed a urine specific gravity of 1.018, glucosuria, proteinuria, pigmenturia and the presence of vacuolized tubular epithelial cells. A presumptive diagnosis of mannitol intoxication was made based on the high dose of mannitol, severe hyponatremia, neurological abnormalities suggestive of intracranial disease, AKI, and urine cytology. Initial calculated plasma osmolality was 263.4 mOsm/kg and measured plasma osmolality was 332 mOsm/kg with an osmolal gap of 68.6 mOsm/kg, confirming the presence of an unmeasured solute attributed to mannitol. Treatment consisted of fluid therapy and supportive care. On day 3, osmolal gap had resolved and serum creatinine concentration returned to normal within 12 days. NEW OR UNIQUE INFORMATION PROVIDED: Mannitol intoxication has been reported in human medicine. This case report is, to our knowledge, the first to describe AKI, hypertonic hyponatremia, and neurological abnormalities secondary to mannitol overdose in a dog.

Spurious reticulocyte profiles in a dog with babesiosis.

A 9-year-old, female Maltese dog was referred to the Veterinary School of Toulouse with a 2-day history of anorexia and weakness. On clinical examination, the dog had hyperthermia (39.7°C), abdominal discomfort, and polypnea. Significant laboratory findings included pigmenturia, hyperbilirubinemia, hypercreatininemia, hyperfibrinogenemia, abnormal Snap canine pancreas-specific lipase, and pancytopenia with a nonregenerative anemia. A peripheral blood smear revealed numerous intraerythrocytic large Babesia but no polychromasia. There was a discrepancy between the absolute automated reticulocyte count (Sysmex reticulocyte count: 60 × 109 /L; RI 19.4-150.1 × 109 /L) and the manual reticulocyte count (3.6 × 109 /L) as well as the absence of polychromasia. The optical red blood cell scattergram showed an abnormal isolated reticulocyte cluster at the location of low-fluorescence ratio cells. These findings were interpreted as erythrocytes parasitized by large Babesia. The discrepancy between the Sysmex reticulocyte count and the manual reticulocyte count has been reported previously in people with falciparum malaria and numerous intra-erythrocytic Plasmodium falciparum organisms. This spurious reticulocyte profile and reticulocyte count were observed with the Sysmex XT-2000iV and the ProCyte using the same fluorescent dye polymethine but not with the LaserCyte using new methylene blue which does not stain Babesia organisms on a blood smear performed for manual reticulocyte counting.

Manual ventilation therapy and aggressive potassium supplementation in the management of respiratory failure secondary to severe hypokalaemia in a cat with exocrine pancreatic insufficiency.

A domestic shorthair cat was referred for progressive muscle weakness and dyspnoea. The cat had a 2-month history of severe weight loss, small intestinal diarrhoea, polyphagia and polyuria/polydipsia. Biochemical analysis and venous blood gas evaluation revealed severe hypokalaemia [1.7 mmol/l; reference interval (RI): 3.5-5.1 mmol/l] and hypoventilation (partial pressure of carbon dioxide = 68 mmHg; RI: 34-38 mmHg). Aggressive potassium supplementation was initiated. The cat was manually ventilated until serum potassium increased to 3 mmol/l. A diagnosis of exocrine pancreatic insufficiency (EPI) was made based on clinical signs and serum feline trypsin-like immunoreactivity (0.1 µg/l; RI: 12-82 µg/l). Medical management of the EPI resulted in clinical recovery.

Cerebral babesiosis and acute respiratory distress syndrome in a dog.

OBJECTIVE: To describe a case of cerebral babesiosis and acute respiratory distress syndrome (ARDS) in a dog. CASE SUMMARY: A 5-year-old male neutered Scottish Terrier was referred to the emergency department of the Ecole Nationale Vétérinaire de Toulouse for evaluation of progressive dyspnea and clinical signs suggestive of central neurological disease. Thoracic radiographs showed a diffuse and heavy interstitial/alveolar lung pattern. Babesiosis was diagnosed based on blood smear evaluation. The dog died of cardiopulmonary arrest 6 hours after presentation. Cerebral babesiosis and ARDS were confirmed at necropsy. Major pathological findings included erythrocyte aggregation in the lungs, liver, and brain. NEW OR UNIQUE INFORMATION PROVIDED: This case report describes an unusual clinical presentation of Babesia canis canis infection, the most common species associated with babesiosis in Europe. In addition, this is to our knowledge the first case of Babesia-associated ARDS confirmed by histopathology in a dog.

Comparison of the buccal mucosal bleeding time in dogs using 3 different-sized lancet devices.

BACKGROUND: The buccal mucosal bleeding time (BMBT) evaluates primary hemostasis in vivo. Three different-sized lancet devices designed for people, Adult (A), Junior (J), and Newborn (N), can be used to perform the BMBT in dogs. OBJECTIVES: The aim was to compare BMBT using 3 different-sized human lancet devices in dogs with varying platelet counts and hematocrits. METHODS: The BMBT was measured in 46 client-owned dogs (2 healthy, 44 suffering from various disorders) with varying platelet (Plt) counts and hematocrits, using the 3 devices successively in each dog, in a randomly determined order, over a 10- to 30-minute period. Statistical analysis (ANOVA, Mann-Whitney U-test) was performed using commercial software. RESULTS: BMBTs were significantly different between devices (P < .00001), and shorter with devices N and J compared with device A (P < .01). The BMBT was prolonged (> 210 s) in 10 dogs with device A and in 7 dogs each with devices J and N, respectively. Sixteen dogs had a Plt count < 200 × 10(9) /L (Reference interval 200-500 × 10(9) /L). Nine of these dogs had prolonged BMBT with device A, and 6 dogs with device J and device N, respectively. BMBT was longer in thrombocytopenic dogs with devices A and J (P < .016). Anemia without thrombocytopenia did not affect BMBT with any device. CONCLUSIONS: The BMBT is influenced by the size of the used device, with A resulting in the longest BMBT. Therefore, the type of device used to obtain the BMBT has to be specified for standardized results.

Central venous pressure: principles, measurement, and interpretation.

Central venous pressure (CVP), an estimate of right atrial pressure, has been used to assess cardiac preload and volume status in critically ill patients, assist in the diagnosis of right-sided heart failure, and guide fluid resuscitation. It is determined by the interaction between cardiac function and venous return. CVP measurements are relatively easy to obtain; however, because of the complex relationship between CVP, cardiac output, and the vascular system, they may be difficult to interpret. This article reviews the physiologic principles of CVP, indications for its use, technical aspects and pitfalls of CVP measurements, and interpretation of the information obtained.

Lung lobe torsion.

Lung lobe torsion is a rare pulmonary disorder in small animals and in humans. Torsion occurs when the lung lobe rotates around the bronchus and vascular supply and remains in that position. Lung lobe torsion is a life-threatening condition. The patient may present in an acute, fulminant respiratory crisis; however, more subtle clinical signs have also been reported. Lung lobe torsion may be secondary to an underlying pathology or spontaneous and idiopathic. Surgical resection of the affected lung lobe is the treatment of choice. The prognosis depends on the underlying cause. This article reviews the incidence, pathophysiology, clinical signs, diagnostic approach, and treatment of lung lobe torsion in dogs and cats.

Ventilator waveform interpretation in mechanically ventilated small animals.

OBJECTIVE: To review the topic of ventilator waveforms analysis with emphasis on interpretation of ventilator waveforms and their use in the management and monitoring of mechanically ventilated small animal patients. DATA SOURCES: Human clinical studies, scientific reviews, and textbooks, as well as veterinary textbooks and clinical examples of ventilator waveforms in mechanically ventilated dogs. SUMMARY: Ventilator waveforms are graphic representations of data collected from the ventilator and reflect patient-ventilator interactions. The 4 parameters pressure, volume, flow, and time are most descriptive of mechanical ventilation. Typically, 3 different graphs, also referred to as scalars, consisting of pressure versus time, volume versus time, and flow versus time, with time always plotted on the x-axis, are used. Changes in the ventilator settings as well as in the characteristics of the lungs such as airway resistance (R(aw)) and respiratory system compliance (C(rs)) can be recognized from specific variations in the waveforms. Flow-volume and pressure-volume loops provide additional information about changes in lung function. Patient-ventilator dyssynchrony is a common problem during mechanical ventilation and can lead to patient discomfort and an increased work of breathing. Ventilator waveforms are helpful to identify dyssynchrony, which can be divided into trigger, flow, cycle, and expiratory dyssynchrony. Ventilator waveforms allow the clinician to assess changes in respiratory mechanics, and can be useful in monitoring the progression of disease pathology and response to therapy. Adjustments in ventilator settings based on proper analysis and interpretation of these waveforms can help the clinician to optimize ventilation therapy. CONCLUSIONS: Ventilator waveforms are graphic representations of patient-ventilator interactions. Proper interpretation of ventilator waveforms affords the critical care clinician a better understanding of the patient's respiratory function, response to therapy, and causes for patient-ventilator dyssynchrony. Ventilator waveform interpretation is an important tool in the assessment and management of mechanically ventilated small animal patients.

Xylitol toxicity in dogs.

Xylitol, a sugar substitute used in sugar-free gum, oral care products, and baked goods, is gaining popularity in the United States. Xylitol consumption is considered harmless to people but is known to cause life-threatening toxicoses in dogs. Dogs that ingest doses of >0.1 g/kg of xylitol are at risk for developing hypoglycemia, while dogs that ingest >0.5 g/kg may develop acute liver failure. Treatment includes dextrose supplementation for hypoglycemia and aggressive monitoring, treatment, and supportive care for dogs experiencing hepatotoxicosis. The prognosis for dogs with uncomplicated hypoglycemia is good, whereas the prognosis for dogs that develop severe hepatotoxicosis is guarded to poor.