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).

Evaluation of benazepril in cats with heart disease in a prospective, randomized, blinded, placebo-controlled clinical trial.

BACKGROUND: Heart disease is an important cause of morbidity and mortality in cats, but there is limited evidence of the benefit of any medication. HYPOTHESIS: The angiotensin-converting enzyme inhibitor benazepril would delay the time to treatment failure in cats with heart disease of various etiologies. ANIMALS: One hundred fifty-one client-owned cats. METHODS: Cats with heart disease, confirmed by echocardiography, with or without clinical signs of congestive heart failure, were recruited between 2002 and 2005 and randomized to benazepril or placebo in a prospective, multicenter, parallel-group, blinded clinical trial. Benazepril (0.5-1.0 mg/kg) or placebo was administered PO once daily for up to 2 years. The primary endpoint was treatment failure. Analyses were conducted separately for all-cause treatment failure (main analysis) and heart disease-related treatment failure (supportive analysis). RESULTS: No benefit of benazepril versus placebo was detected for time to all-cause treatment failure (P = .42) or time to treatment failure related to heart disease (P = .21). Hazard ratios (95% confidence interval [CI]) from multivariate analysis for benazepril compared with placebo were 1.00 (0.57-1.74) for all-cause failure, and 0.99 (0.50-1.94) for forward selection and 0.93 (0.48-1.81) for bidirectional selection models for heart disease-related failure. There were no significant differences between groups over time after administration of the test articles in left atrium diameter, left ventricle wall thickness, quality of life scores, adverse events, or plasma biochemistry or hematology variables. CONCLUSIONS AND CLINICAL RELEVANCE: Benazepril was tolerated well in cats with heart disease, but no evidence of benefit was detected.

Fibrinogen deficiency in a dog - a case report.

BACKGROUND: Among coagulation disorders, primary fibrinogen deficiency is very rare in dogs. It is divided into hypofibrinogenemia, afibrinogenemia and dysfibrinogenemia. Afibrinogenemia has been described in three dogs. There are, however, no published case reports of primary hypofibrinogenemia in dogs. CASE PRESENTATION: A 1.5 year-old male German Pointer dog was evaluated for a locked-jaw syndrome associated with eye protrusion which appeared after a minor head trauma. Three months before the trauma, a persistent increase in coagulation times was detected by the referring veterinarian after a strong suspicion of snake envenomation. Apart for the primary complaint, physical examination was normal. A complete hemostatic profile revealed a moderately increased prothrombin time, activated partial thromboplastin times and a dramatically decreased fibrinogen concentration (0.34 g/L, reference interval [1.3-4.8 g/L]). Platelet count, plasma D-dimers and antithrombin, were all within the reference intervals and not consistent with a disseminated intravascular coagulation. Other possible causes of hypofibrinogenemia such as chronic hemorrhage and liver failure were excluded by laboratory work-up and imaging studies. Finally, antifibrinogen circulating anticoagulants were excluded using a dilution of citrated plasma from the pooled plasma of healthy dogs. These results supported a diagnosis of congenital fibrinogen deficiency and secondary retrobulbar hematoma and/or cellulitis. The dog's condition improved rapidly after symptomatic treatment with corticosteroids and antibiotics. At the 1 year follow-up, the dog was clinically normal but a persistent hypofibrinogenemia (≤ 0.8 g/L) remained. CONCLUSIONS: Various clinical presentations may occur in canine primary hypofibrinogenemia which should be included in the list of coagulation disorders. Diagnosis should include fibrinogen determination by coagulometric and non-coagulometric methods to differentiate from dysfibrinogenemia. There is no specific treatment but care should be taken to prevent bleeding and trauma. Emergency management of bleeding episodes with cryoprecipitate is the treatment of choice.

Chronic intestinal pseudo-obstruction associated with enteric ganglionitis in a Persian cat.

Case summary A 7-year-old neutered male Persian cat was presented for acute vomiting and inappetence. Physical examination revealed severe abdominal distension. Radiographs demonstrated pneumoperitoneum, megaoesophagus and generalised gaseous distension of the digestive tract. Exploratory coeliotomy was performed, revealing markedly distended and thickened small and large intestines with no observable peristalsis. No intestinal perforation was present. Bacteriological and cytological analysis of abdominal fluid revealed a septic peritonitis involving Pasteurella multocida. Full-thickness intestinal biopsies demonstrated lymphocytic ganglioneuritis localised to the enteric nervous system, in association with glandular atrophy and muscular layer hypertrophy. Amoxicillin-clavulanate and analgesics were given. The cat's general condition gradually improved after the addition of pyridostigmine bromide (0.5 mg/kg q12h PO), initiated 3 days postsurgery. Vomiting resolved and did not recur. Follow-up radiographs at 15 days, and 1 and 6 months showed persistent intestinal ileus, milder than on the pretreatment radiographs. Thirty months after presentation the cat is still alive, without clinical signs, and receives 1 mg/kg q12h pyridostigmine. Relevance and novel information To our knowledge, this is the first case of ganglioneuritis of the myenteric plexus described in cats, as well as the first one successfully treated with pyridostigmine. Chronic intestinal pseudo-obstruction is a very rare condition in cats but should be included in the differential diagnosis of generalised gastrointestinal ileus.

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.

Comparison of cytologic and histologic evaluations of the conjunctiva in the normal equine eye.

OBJECTIVE: To describe the cells observed in conjunctival brush cytology (CBC) from normal horses and compare these findings with conjunctival structural histology so as to understand which cells are recovered from CBC. METHODS: This study was divided into three parts. (1) Conjunctival brush smears were collected from 20 healthy horses on both eyes and a differential count on 300 cells was carried out on May Grünwald-Giemsa (MGG) smears. (2) A similar protocol was used for whole eyes from five horses obtained rapidly after death from a slaughterhouse. The eyes were then assessed for conjunctival histology. (3) Cytobrush smears were collected from five healthy horses. Smears were examined after MGG or periodic acid Schiff (PAS) staining. RESULTS: The differential cell count showed a majority of deep and intermediate epithelial cells with very few superficial and goblet cells in both eyes. A stratified columnar to cuboidal epithelium was observed on nearly the whole surface of the conjunctiva. A stratified squamous type was observed at the palpebral and bulbar edges. Areas with highest mucus cell indices were found from the nasal to the temporal edge of the equine inferior conjunctiva in the upper palpebral segment near the fornix and in a part of the nasal fornix. In MGG smears no mucus cells were identified; however, they were numerous in PAS smears (22.6% +/- 11) and were mostly cylindrical cells (42.5% +/- 14.4 PAS positive). CONCLUSIONS: Cytobrush smears in the healthy horse are characterized by a majority of polyhedral and cylindrical cells and a few squamous cells. The cylindrical cells may be mucous cells and probably originate from the main stratified columnar to cuboidal epithelium.

Pharmacokinetic/pharmacodynamic modelling of NSAIDs in a model of reversible inflammation in the cat.

1 Data on the relationships between plasma concentration and analgesic and anti-inflammatory effects of NSAIDs are limited because most inflammation models do not permit pharmacokinetic/pharmacodynamic (PK/PD) modelling to be readily performed. 2 In this study, a kaolin-induced inflammation model in the cat was evaluated for pre-clinical characterization of the pharmacodynamic profiles of NSAIDs (determination of efficacy, potency, sensitivity (that is the slope of the concentration-effect relationship) and duration of drug response), using meloxicam as a probe article. 3 Indirect response PK/PD models described the time course and magnitude of responses produced by 0.3 mg kg(-1) meloxicam administered subcutaneously. For endpoints for which spontaneous recovery from inflammation was superimposed on drug response, a PK/PD model with a time-dependent K(in) was used to allow for the spontaneous changes of the inflammation with time. 4 The selected endpoints were suitable for studying simultaneously the analgesic, anti-inflammatory and antipyretic effects of meloxicam, allowing comparison of relative potencies for these effects. Mean+/-s.d. IC(50) or EC(50) values (ng ml(-1)) were 777+/-124 (body temperature), 841+/-187 (locomotion variable), 883+/-215 (pain score), 911+/-189 (lameness score) and 1298+/-449 (skin temperature difference). Corresponding mean times+/-s.d. of peak responses (h) were 5.6+/-1.3, 8.6+/-3.8, 5.2+/-5.0, 5.6+/-3.7 and 4.3+/-2.4, respectively. 5 As the pharmacokinetic profiles of meloxicam in cats and humans are similar, simulations of several dosage regimens in the cat provided a pre-clinical basis, illustrating the value of the cat model for predicting a clinical dose regimen for evaluation in man. The predicted loading doses (mg kg(-1)) of meloxicam in the cat producing 70% of the maximum attainable responses were 0.29 (body temperature), 0.32 (lameness score), 0.33 (overall locomotion variable), 0.36 (pain score) and 0.50 (skin temperature difference). The values are similar to or somewhat greater than the clinically recommended doses both in cats (0.3 mg kg(-1)) and humans (7.5-15 mg, that is, between 0.1 and 0.3 mg kg(-1)). 6 These findings indicate the potential value of the cat as a laboratory model, and of a PK/PD modelling approach in assisting NSAID development programs in animals and humans.

Inaccuracy of routine creatinine measurement in canine urine.

BACKGROUND: Urine creatinine concentration often is used in ratios such as urine protein:creatinine to compensate for dilution or concentration of spot urine samples. OBJECTIVE: The purpose of this study was to compare the accuracy of different techniques of urine creatinine measurement currently available for veterinary practitioners. METHODS: In 104 samples of canine urine diluted 1:20 with distilled water, creatinine concentration was measured using a kinetic Jaffé reaction assay, and an enzymatic technique on an automatic analyzer (Elimat) and 3 benchtop analyzers (Reflovet, Scil; Vitros DT2, Ortho-Clinical Diagnostics; Vettest 8008, IDEXX) used in veterinary practice. RESULTS: The Jaffé and enzymatic techniques on the Elimat were not significantly different, and their inaccuracy tested with human control urines was <5%. The benchtop analyzers underestimated creatinine concentration, especially at concentrations >2000 mg/L. Inaccuracy was higher with multilayer slide technology systems (Vitros and Vettest) than with the Reflovet system. Results were approximately 25% and 2% lower, respectively, than with the Elimat at urine creatinine concentrations about 2000 mg/L. CONCLUSION: Inaccuracy in urine creatinine measurements using benchtop analyzers should be taken into account when defining decision thresholds, which should be corrected according to the method used to avoid misinterpretations.