A transmandibular lateral transsphenoidal navigated surgical approach to access a pituitary macroadenoma in a warmblood mare.

A 16-year-old warmblood mare was referred with a progressive history of behavioral changes and left-sided blindness. Following neuroanatomical localization to the forebrain, magnetic resonance imaging of the head revealed a well-delineated, 4.5 cm in diameter, round pituitary mass causing marked compression of the midbrain and optic chiasm. Euthanasia was recommended but declined by the owners. Veterinary specialists and a human neurosurgeon collaboratively prepared for surgical case management. A novel navigated transmandibular lateral transsphenoidal approach was developed to access the region of the sella turcica and practiced on cadaver specimens. The horse was anesthetized and placed in sternal recumbency with the head above the heart line. Using a cone beam computed tomography (CBCT)-coupled navigation system, a navigated pin traversing the vertical ramus of the mandible and the lateral pterygoid muscle was placed in a direct trajectory to the predetermined osteotomy site of the basisphenoid bone. A safe corridor to the osteotomy site was established using sequential tubular dilators bypassing the guttural pouch, internal and external carotid arteries. Despite the use of microsurgical techniques, visualization of critical structures was limited by the long and narrow working channel. Whilst partial resection of the mass was achieved, iatrogenic trauma to the normal brain parenchyma was identified by intraoperative imaging. With consent of the owner the mare was euthanized under the same general anesthesia. Post-mortem magnetic resonance imaging and gross anatomical examination confirmed partial removal of a pituitary adenoma, but also iatrogenic damage to the surrounding brain parenchyma, including the thalamus.

Seizures in 3 juvenile dogs after intravenous anesthetic drug withdrawal during weaning from mechanical ventilation suspected to be a sign of iatrogenic withdrawal syndrome.

OBJECTIVE: To describe seizure activity in juvenile dogs successfully weaned from long-term mechanical ventilation. CASE SERIES SUMMARY: Three juvenile dogs (all approximately 3 months old) underwent long-term mechanical ventilation with IV anesthesia for suspected noncardiogenic pulmonary edema. Within 24 hours of extubation and within 10 hours of discontinuing midazolam continuous infusions, all dogs experienced seizures, which is 1 sign of iatrogenic withdrawal syndrome. Each dog was treated with an anticonvulsant protocol, and none experienced seizures after being discharged. NEW OR UNIQUE INFORMATION PROVIDED: Each dog received IV anesthesia, including fentanyl, dexmedetomidine, midazolam, and propofol, during mechanical ventilation and subsequently experienced seizures after successful weaning from mechanical ventilation. Juvenile dogs may be at risk for seizures after weaning from mechanical ventilation and IV anesthesia. Neurological monitoring and further research into an appropriate weaning protocol may prove beneficial in juvenile dogs requiring prolonged anesthesia.

Iatrogenic gas embolism in a juvenile loggerhead sea turtle (Caretta caretta).

A mild pneumocoelom was diagnosed by computed tomography in a stranded juvenile loggerhead sea turtle (Caretta caretta). After gas extraction by ultrasound-guided puncture, the animal did not improve and was subjected to hyperbaric oxygen therapy (HBOT). After HBOT, the turtle developed marked subcutaneous emphysema and was found dead the following morning. Gross lesions included a distended right atrium with numerous gas bubbles within the epicardium, gas bubbles in the hepatic, gastric and mesenteric veins, a small gas-filled bulla in the left lung and diffuse haemorrhages in the encephalon. Histological lesions included gas-like emboli in the lumen of the right atrium with myocardial necrosis, gas-like emboli in the lumina of intestinal, pulmonary and renal blood vessels and severe meningeal haemorrhages. From a forensic pathology perspective, the subcutaneous emphysema of immediate onset after HBOT and the greater severity of the histological lesions in blood vessels, heart, lung and brain differentiate this case from other cases of gas embolism in turtles due to incidental capture. Two factors contributed to this outcome: the existence of a probably unresolved pneumocoelom and the application of HBOT without an initial diagnosis that accurately indicated its use. Therefore, as in human medicine, the use of HBOT in sea turtles with lung lesions and pneumocoelom is discouraged. This is the first description of an iatrogenic gas embolism in a sea turtle.

Ex-vivo evaluation of a percutaneous looped thread desmotomy of the accessory ligament of the deep digital flexor tendon in horses.

OBJECTIVE: To determine the ability to completely transect the equine accessory ligament of the deep digital flexor tendon (AL-DDFT) via an ultrasonographically-guided, percutaneous looped thread desmotomy using FiberWire suture as a cutting device. STUDY DESIGN: Ex-vivo study. SAMPLE POPULATION: A total of 24 normal equine distal forelimb specimens. METHODS: Under ultrasonographic guidance, a Jamshidi needle was placed between the suspensory ligament and the AL-DDFT, and between the AL-DDFT and the deep digital flexor tendon, through two stab incisions. FiberWire suture was fed through the needle and looped around the AL-DDFT. Using a sawing motion, the ligament was transected, and the suture exited through the lateral incision. Surgical sites were dissected and assessed for completeness of transection, iatrogenic injuries, and suture remnants. Descriptive statistics were reported. RESULTS: The procedure met the successful criteria in 18/24 (75%) of the limbs. The median surgical time was 11 min (range 7-25). No suture failure or suture remnants were noted in any of the specimens. Complications included iatrogenic injury to the medial and lateral neurovascular bundles in 4/24 and 1/24 specimens, respectively. CONCLUSION: Complete transection of the AL-DDFT was achieved in 22/24 (92%) of the specimens; however, the neurovascular bundles were injured in 5/24 (21%) of the specimens. CLINICAL SIGNIFICANCE: A percutaneous looped thread desmotomy of the AL-DDFT can be studied as an alternative technique for use in equine models prior to its clinical use in patients. Additional studies are required to evaluate efficacy and safety in anesthetized or standing horses.

Ex vivo study shows novel, rapid, suture-free tenotomy technique for the equine deep digital flexor tendon.

OBJECTIVE: To describe the feasibility of a novel thread-transecting technique for the tenotomy of the equine deep digital flexor tendon (DDFT). ANIMALS: 39 equine distal limb specimens. METHODS: Under ultrasonographic guidance, a surgical thread was percutaneously placed around the DDFT through 2 needle punctures (lateral and medial) using a Tuohy needle in equine limbs (22 forelimbs, 17 hindlimbs). The DDFT was transected by a back-and-forth motion of the thread until the loop emerged from the entry puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported. RESULTS: Complete DDFT transection was achieved in all 39 limbs, taking an average of 8.6 minutes per procedure. Iatrogenic damage to surrounding structures occurred in 17 (44%) limbs, with 6 (15%) limbs having more than 1 structure damaged. Damage to the communicating branch of the palmar or plantar nerves was the most commonly seen. CLINICAL RELEVANCE: DDFT tenotomy in equine limb specimens was effectively performed using a novel thread-transecting technique. The procedure is quick, and no suturing is needed, but damage to surrounding structures is possible. Further assessment of the procedure and clinical significance of its potential iatrogenic damage in clinical cases is needed.

Urine concentrating ability in cats with hyperthyroidism: Influence of radioiodine treatment, masked azotemia, and iatrogenic hypothyroidism.

BACKGROUND: Hyperthyroid cats often have urine specific gravity (USG) values <1.035. It remains unclear how USG changes after treatment, if USG can be used to predict azotemia after treatment, or how iatrogenic hypothyroidism influences USG values. OBJECTIVES: To determine the proportion of hyperthyroid cats with USG <1.035 vs ≥1.035; if USG changes after treatment; and whether USG <1.035 correlated with unmasking of azotemia or hypothyroidism. ANIMALS: Six hundred fifty-five hyperthyroid cats treated with radioiodine; 190 clinically normal cats. METHODS: Prospective, before-and-after study. Hyperthyroid cats had serum thyroxine, thyroid-stimulating hormone, and creatinine concentrations, and USG measured before and 6 months after successful treatment with radioiodine. RESULTS: Of untreated hyperthyroid cats, USG was ≥1.035 in 346 (52.8%) and <1.035 in 309 (47.2%). After treatment, 279/346 (80.6%) maintained USG ≥1.035, whereas 67/346 (19.4%) became <1.035; 272/309 (88%) maintained USG <1.035, whereas 37/309 (12%) became ≥1.035. Only 22/346 (6.4%) with USG ≥1.035 developed azotemia after treatment, compared with 136/309 (44%) with <1.035 (P < .001). Of cats remaining nonazotemic, 38% had USG <1.035, compared with 20% of normal cats (P < .001). The 137 cats with iatrogenic hypothyroidism had lower USG after treatment than did 508 euthyroid cats (1.024 vs 1.035), but USGs did not change after levothyroxine supplementation. USG <1.035 had high sensitivity (86.1%) but moderate specificity (65.2%) in predicting azotemia after treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: Hyperthyroidism appears not to affect USG in cats. However, cats with evidence of sub-optimal concentrating ability before radioiodine treatment (USG < 1.035) are more likely to develop azotemia and unmask previously occult chronic kidney disease. Iatrogenic hypothyroidism itself did not appear to affect USG values.

Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study.

OBJECTIVE: To evaluate the feasibility of feline diagnostic coxofemoral arthroscopy. STUDY DESIGN: Ex vivo feline cadaveric descriptive study. ANIMALS: Seven feline cadavers (14 hips). METHODS: Gross dissection of two feline hips was performed to evaluate anatomic landmarks, guide arthroscopic portal development, and determine optimal limb positioning. A 1.9 mm, 0° arthroscope, inserted through a supratrochanteric lateral portal, was used to assess intraarticular structures in 12 feline cadaver hips. Arthroscopy was followed by gross dissection of periarticular soft tissues. Relative portal locations and damage to periarticular structures were recorded. Hips were disarticulated, and an India ink assay was performed to assess whether there was iatrogenic cartilage injury (ICI). RESULTS: Scope insertion was achieved in all hips. Articular cartilage of the femoral head and acetabulum, round ligament, joint capsule, transverse acetabular ligament, and dorsal acetabular rim were identified arthroscopically in all hips. Probe insertion and intra-articular structure palpation was achieved in all hips. Scope and instrument portals resulted in minimal periarticular muscle trauma. No sciatic nerve damage was detected. Minor partial thickness ICI was observed in all hips at the site of scope insertion. Focal full thickness ICI was noted in one hip. CONCLUSION: Arthroscopy of the feline coxofemoral joint allowed visual and probe evaluation of intra-articular structures without evidence of major periarticular neurovascular trauma. Iatrogenic cartilage injury occurred in all hips but severity of lesions was considered mild. CLINICAL SIGNIFICANCE: Coxofemoral arthroscopy is feasible in cats and can be utilized as a diagnostic tool for minimally invasive joint evaluation.

Iatrogenic adrenal atrophy following oral corticotherapy is not reliably identified ultrasonographically in cats.

Background: In dogs, corticosteroid administration is known to decrease adrenal gland height when measured ultrasonographically. However, comparable information is lacking in cats. Objectives: i) Validate that the adrenal height of our control population without corticosteroid administration was similar to previous data, ii) determine effects of dose and duration of oral corticosteroid therapy on adrenal height, and iii) determine an adrenal size threshold to differentiate cats receiving corticosteroids or not. Animals and procedures: Adult cats (N = 308) that received abdominal ultrasonographic examination(s) were retrospectively recruited and allocated into 2 groups: those with and without oral corticosteroid use. Cats receiving corticosteroids were subdivided into 6 subgroups by dose (supraphysiologic, anti-inflammatory, or immunosuppressive) and duration of therapy (≤ 1 mo or > 1 mo). Results: Adrenal height in cats without corticosteroid therapy was comparable to previous studies. An anti-inflammatory corticosteroid dose for > 1 mo caused a 21.4% decrease in adrenal height (mean difference of 0.8 mm; P = 0.009). However, no difference in adrenal height was noted in the other subgroups (P > 0.21), and no useful adrenal height threshold was established. Conclusion and clinical relevance: Feline iatrogenic adrenal atrophy may be difficult to establish with ultrasonography, as only cats receiving anti-inflammatory corticosteroid doses for > 1 mo had a modest (< 1 mm) decrease in adrenal height.

L'atrophie iatrogène des surrénales consécutive à une corticothérapie orale n'est pas identifiée de manière fiable par échographie chez le chat. Contexte: Chez le chien, l'administration de corticostéroïdes est connue pour diminuer la taille des glandes surrénales lorsqu'elle est mesurée par échographie. Cependant, des informations comparables manquent chez les chats. Objectifs: i) Valider que la taille des surrénales de notre population témoin sans administration de corticostéroïdes était similaire aux données précédentes, ii) déterminer les effets de la dose et de la durée de la corticothérapie orale sur la taille des surrénales, et iii) déterminer un seuil de taille des surrénales pour différencier les chats recevant des corticostéroïdes ou pas. Animaux et procédures: Des chats adultes (N = 308) qui ont subi un ou plusieurs examens échographiques abdominaux ont été recrutés rétrospectivement et répartis en 2 groupes : ceux avec et sans corticothérapie orale. Les chats recevant des corticostéroïdes ont été subdivisés en 6 sous-groupes selon la dose (supraphysiologique, anti-inflammatoire ou immunosuppresseur) et la durée du traitement (≤ 1 mois ou > 1 mois). Résultats: La taille des surrénales chez les chats sans corticothérapie était comparable à celle des études précédentes. Une dose de corticoïdes anti-inflammatoires pendant > 1 mois a entraîné une diminution de 21,4 % de la taille des surrénales (différence moyenne de 0,8 mm; P = 0,009). Cependant, aucune différence de taille surrénalienne n'a été notée dans les autres sous-groupes (P > 0,21) et aucun seuil de taille surrénalienne utile n'a été établi. Conclusion et pertinence clinique: L'atrophie surrénalienne iatrogène féline peut être difficile à établir par échographie, car seuls les chats recevant des doses de corticostéroïdes anti-inflammatoires pendant > 1 mois ont présenté une diminution modeste (< 1 mm) de la taille des surrénales.(Traduit par Dr Serge Messier).

Outcomes, including death, in dogs with pneumothorax following nasogastric feeding tube misplacement in the tracheobronchial tree: 13 cases (2017-2022).

OBJECTIVE: Complications of feeding tube placement are uncommon, but life-threatening pneumothorax has been reported in human and veterinary patients during feeding tube placement. This article describes the development of pneumothorax and the outcome associated with misplacement of nasogastric (NG) tubes in the tracheobronchial tree in 13 dogs. ANIMALS: 13 dogs being treated for various medical conditions that had NG tubes placed in 4 hospitals. PROCEDURES: A review was carried out of the medical records of 13 dogs that developed pneumothorax after misplacement of NG tubes between 2017 and 2022. RESULTS: 14 dogs out of 4,777 (0.3%) developed pneumothorax as an adverse effect of NG tube misplacement in the tracheobronchial tree. One dog was excluded due to incomplete medical records. The feeding tube size ranged from 5F to 10F, and the most common tubes utilized were polyurethane tubes with flushing stylets. Nine out of 13 dogs developed evidence of respiratory compromise after the NG tube was placed. Eleven dogs required thoracocentesis, and 5 dogs had thoracostomy tubes placed. Five dogs suffered cardiopulmonary arrest after developing pneumothorax, with 3 of 5 undergoing cardiopulmonary resuscitation. Two out of 3 dogs that underwent cardiopulmonary resuscitation were discharged from the hospital. Five of 13 dogs were successfully discharged from the hospital, while 5 dogs died or were euthanized because of the pneumothorax. CLINICAL RELEVANCE: Pneumothorax is a rare but potentially life-threatening complication of NG tube placement in dogs and may lead to death if not immediately addressed. Practitioners should be aware of this complication and be ready to perform thoracocentesis quickly if appropriate.

Treatment and outcome following substantial ketamine overdose in a dog.

A 9-year-old, 3.7 kg (8.14 lb) neutered male Yorkshire terrier mix was treated following a ketamine overdose after subcutaneous ureteral bypass surgery. Due to an error in communication and misinterpretation of an electronic treatment sheet, the dog was inadvertently placed on a continuous rate infusion (CRI) of ketamine at 67.6 mg/kg per hour, rather than the intended 0.2 mg/kg per hour rate. Four hours after initiation of the ketamine CRI, the dog developed signs indicative of a ketamine overdose including tachycardia, hyperthermia, anisocoria, and hypoglycemia. It was determined the dog had received an iatrogenic overdose of ketamine; the infusion had been running at 67.6 mg/kg per hour, resulting in 270 mg/kg of ketamine over 4 h. Aggressive supportive measures were undertaken, and the dog gradually recovered over an 18-hour period, without lasting consequences of the overdose. To the authors' knowledge, there are no current published reports of a ketamine overdose of this magnitude in a dog. This case report documents an iatrogenic 338 times intravenous ketamine overdose in a dog, which was successfully managed with supportive care. In addition, it highlights the importance of doctor-technician communication and the potential errors in using electronic treatment sheets.

Traitement et résultat à la suite d'une surdose importante de kétamine chez un chien. Un Yorkshire terrier mélangé mâle de 9 ans et pesant 3,7 kg (8,14 lb) a été traité à la suite d'une surdose de kétamine après un pontage urétéral sous-cutané. En raison d'une erreur de communication et d'une mauvaise interprétation d'une feuille de traitement électronique, le chien a été placé par inadvertance sous une perfusion à débit continu (IRC) de kétamine à 67,6 mg/kg par heure, au lieu du débit prévu de 0,2 mg/kg par heure. Quatre heures après le début de l'IRC de kétamine, le chien a développé des signes indiquant une surdose de kétamine, notamment de la tachycardie, de l'hyperthermie, de l'anisocorie et de l'hypoglycémie. Il a été déterminé que le chien avait reçu une surdose iatrogène de kétamine; la perfusion fonctionnait à 67,6 mg/kg par heure, entraînant 270 mg/kg de kétamine en 4 h. Des mesures de soutien agressives ont été mises en place et le chien s'est progressivement rétabli sur une période de 18 heures, sans conséquences durables du surdosage.À la connaissance des auteurs, il n'existe actuellement aucun rapport publié sur une surdose de kétamine de cette ampleur chez un chien. Ce rapport de cas documente une surdose iatrogène de kétamine de 338 fois par voie intraveineuse chez un chien, qui a été gérée avec succès avec des soins de soutien. De plus, il met en évidence l'importance de la communication médecin-technicien et les erreurs potentielles dans l'utilisation des fiches de traitement électroniques.(Traduit par Dr Serge Messier).

Arthroscopic-assisted hip toggle stabilization in cats: An ex vivo feasibility study.

OBJECTIVE: To describe arthroscopic-assisted hip toggle stabilization (AA-HTS) in cats, evaluate its feasibility and associated rate of iatrogenic injury, and assess deviations from planned surgical technique. STUDY DESIGN: Ex vivo study. ANIMALS: Skeletally mature cat cadavers (n = 7). METHODS: Preoperative pelvic computed tomography (CT) was performed for surgical planning and to identify the ideal femoral bone tunnel projection. Ultrasound-guided transection of ligament of head of femur was performed. Following exploratory arthroscopy, AA-HTS was performed using a commercially available aiming device. Surgical time, intraoperative complications, and feasibility of technique were recorded. Iatrogenic injury and technique deviations were assessed by postoperative CT and gross dissection. RESULTS: Diagnostic arthroscopy and AA-HTS were successfully performed in all 14 joints. Median (range) surgical time was 46.5 (29-144) min, including 7 (3-12) min for diagnostic arthroscopy and 40 (26-134) min for AA-HTS. Intraoperative complications occurred in 5 hips, related to bone tunnel creation (4) and toggle dislodgment (1). Toggle passage through the femoral tunnel was the most challenging component of technique, recorded as mildly difficult in 6 joints. No damage to periarticular/intrapelvic structures was identified. Minor articular cartilage damage (<10% total cartilage area) was identified in 10 joints. Thirteen deviations (8 major, 5 minor) in surgical technique from preoperative planning were identified in 7 joints. CONCLUSION: In feline cadavers AA-HTS was feasible but was associated with a high rate of minor cartilage injury, intraoperative complications, and technique deviations. CLINICAL SIGNIFICANCE: Hip toggle stabilization using an arthroscopic-assisted approach may be an effective technique for management of coxofemoral luxation in cats.

Ionized hypercalcemia in 238 cats from a referral hospital population (2009-2019).

BACKGROUND: Ionized calcium concentration ([iCa]) is more sensitive for detecting calcium disturbances than serum total calcium concentration but literature on ionized hypercalcemia in cats is limited. Urolithiasis is a possible adverse consequence of hypercalcemia. HYPOTHESIS/OBJECTIVES: To describe clinical details of diagnoses associated with ionized hypercalcemia in cats and association with urolithiasis. ANIMALS: Cats (238) seen between 2009 and 2019 at a referral hospital with [iCa] above the normal reference interval. METHODS: Observational cross-sectional study. Signalment, serum biochemical and imaging findings were reviewed for cats with ionized hypercalcemia considered to be clinically relevant (>1.41 mmol/L). Data were summarized by cause of hypercalcemia (i.e., diagnosis). RESULTS: Diagnoses for the 238 cats with [iCa] >1.41 mmol/L included: acute kidney injury (AKI; 13%), malignancy-associated (10.1%), idiopathic hypercalcemia (IHC; 10.1%), chronic kidney disease/renal diet-associated (8.4%), iatrogenic (5.5%), primary hyperparathyroidism (2.1%), vitamin D toxicity (2.1%) and granulomatous disease (1.7%). In 112 cases (47.1%), no cause for ionized hypercalcemia could be determined (n = 95), hypercalcemia was transient (n = 12), or the cat was juvenile (<1 year; n = 5). Urolithiasis was identified in 83.3% of AKI, 72.7% of iatrogenic, 61.1% of CKD/renal diet-associated and 50% of IHC cases that were imaged (<50% for other diagnoses). Diagnoses with a high proportion of concurrent total hypercalcemia included primary hyperparathyroidism (100%), vitamin D toxicity (100%), malignancy-associated (71.4%), granulomatous disease (66.7%) and IHC (65.2%). CONCLUSIONS AND CLINICAL IMPORTANCE: Ionized hypercalcemia was most commonly associated with kidney diseases, neoplasia or IHC. The proportion of urolithiasis cases varied by diagnosis.

Preliminary report of spinal cord injuries resulting from inappropriate microchip implantation in two puppies.

Since the revised Animal Welfare and Management Law in Japan became effective on June 1st, 2022, it became mandatory for pet dogs and cats to have microchips implanted and registered prior to be sold. Two cases of spinal cord injury as the result of inappropriate microchip implantation in puppies were referred to our facility, of which were diagnosed by cervical spinal radiography and computed tomography (CT). While adverse reactions following microchip implantation are rare, the possibility of iatrogenic spinal cord injury remains a serious complication. This is the first report of adverse reactions following microchip implantation in Japan, and it alerts the possibility of iatrogenic spinal cord injury secondary to inappropriate microchip implantation, where adequate training and extra caution is crucial especially in small light-weight animals.

Determination of the effect of iatrogenic blood contamination on lactate dehydrogenase and creatine kinase activity in canine cerebrospinal fluid.

BACKGROUND: Lactate dehydrogenase (LDH) and creatine kinase (CK) have differential tissue activity and isoenzyme profiles. LDH and CK exist as 5 and 3 isoenzymes, respectively, in both serum and cerebrospinal fluid (CSF). Studies have demonstrated that measuring LDH, CK, and their isoenzymes in CSF has diagnostic and prognostic values for dogs and people with neurologic disorders. OBJECTIVES: Iatrogenic blood contamination can distort the results of CSF analysis. The purpose of this study was to determine allowable thresholds of blood contamination (RBC/µL) for accurate measurement of LDH, CK, and their isoenzymes in canine CSF. METHODS: Venous blood and CSF were collected from healthy dogs. Total LDH and CK activity were measured spectrophotometrically. Isoenzyme profiles were determined using gel electrophoresis and densitometric scanning. All samples were analyzed within 6 hours of collection. A nonlinear mixed effects regression model was used to estimate the allowable thresholds of blood contamination for accurate measurement of LDH, CK, and their isoenzymes in canine CSF. RESULTS: The threshold of iatrogenic blood contamination for total LDH and total CK in healthy dogs are 6696 RBC/µL (95% CI 3879-11 187) and 5961 RBC/µL (95% CI 2939-12 085), respectively. LDH-1 is the most sensitive isoenzyme to iatrogenic blood contamination, while LDH-4 is the least sensitive. CONCLUSIONS: These results are important for the interpretation of LDH, CK, and their isoenzymes in canine CSF. Additionally, our methodology is translatable for determining thresholds of acceptable iatrogenic blood contamination in CSF for other diagnostic and prognostic biomarkers of neurologic disease.

Subcutaneous Implantation of Hepatocellular Carcinoma in a Dog.

A 13-year-old male neutered Cocker Spaniel mixed-breed dog developed a subcutaneous mass 2 years after undergoing surgery to remove a hepatocellular carcinoma. An approximately 4 × 3 cm subcutaneous mass was found on the ventral abdomen at the cranial end of the abdominal incision from the previous surgery. The subcutaneous mass was surgically removed and histopathological examination determined that it was an implantation of the previously excised hepatocellular carcinoma. The diagnosis was confirmed by immunohistochemical labelling with hepatocyte paraffin 1 antibody and pancytokeratin. Based on the location of the subcutaneous mass at the cranial end of the abdominal incision associated with the previous hepatocellular carcinoma resection, it is likely there was iatrogenic metastasis from the primary tumour excision. Subcutaneous iatrogenic metastasis of hepatocellular carcinoma is well recognized in humans but has apparently never been reported in dogs. Clinicians should be aware of this potential surgical complication.

Iatrogenic doramectin overdosing causes toxicity in sheep: A case report.

Macrocyclic lactones are widely used endectocides in ruminants, with a high margin of safety for labeled indications. No previous report of iatrogenic doramectin overdosing has been published. We report an outbreak in a sheep flock in Northeast Patagonia, Argentina. Toxicity signs were observed in more than 10% and 59% of ewes and lambs, respectively, particularly those with low body condition, treated with doramectin 3.5% long-acting injectable formulation, presumably at the indicated dose of 700 µg/kg. Clinical signs included lethargy, mydriasis and coma. Doramectin concentration in blood samples was 826.8 (±119.3) ng/ml. Cerebrospinal fluid (CSF) and liver doramectin concentration in euthanized lambs were 3.26-4.28 ng/ml and 8506-8772 ng/g, respectively. Epidemiological and clinical information, and high doramectin concentration were sufficient to confirm the neurotoxicity. Scarce fat deposition could have altered doramectin pharmacokinetic which may have accounted for the observed neurotoxicity. Special care should be taken when animals under similar nutritional conditions are treated with macrocyclic lactones.

Prevalence of iatrogenic heart murmurs in a population of apparently healthy cats.

OBJECTIVES: To determine the prevalence of iatrogenic heart murmurs in a population of apparently healthy cats and to investigate factors that may predispose cats to iatrogenic murmurs. MATERIALS AND METHODS: Apparently healthy cats presenting for routine examinations were prospectively enrolled. Following a physical examination to confirm there were no abnormalities, a cardiac examination was performed before and during a provocative manoeuvre performed independently by two clinicians. The provocative manoeuvre was performed on the right side of the chest wall by applying gentle pressure with a stethoscope to ascertain whether a murmur became audible, graded using a modified descriptive scale (soft/moderate). The cat's heart rate before and during the provocative manoeuvre and their age, sex, body condition score and bodyweight were recorded. RESULTS: One hundred and six cats were prospectively enrolled. The average prevalence of iatrogenic murmurs was 28.2% with good interobserver agreement recorded on both the presence (kappa 0.67 and 0.62) and grade of the murmur (kappa 0.6 and 0.53). A significant association was noted between age and body condition score, with iatrogenic murmurs more likely in cats with increasing age and decreasing body condition score. There was no association between heart rate and the presence of an iatrogenic murmur. CLINICAL SIGNIFICANCE: Iatrogenic murmurs are a common finding in cats with increasing prevalence noted in older and lean cats. Iatrogenic murmurs should therefore be considered as a differential diagnosis in a cat when an audible soft systolic right-sided murmur occurs with gentle pressure application to the chest wall during auscultation.

Accidental monensin poisoning in buffaloes in Bahia, Brazil / Intoxicação acidental por monensina em búfalos na Bahia, Brasil

Monensin is an ionophore antibiotic (IA) widely used for growth promotion and weight gain in the production of ruminants. However, it has caused intoxication in several species, including buffaloes, mainly because of the ignorance or disrespect of the recommendations for use in each animal species. The objective of this study was to describe, for the first time, clinical-epidemiological and anatomopathological data of an outbreak of accidental poisoning by monensin in buffalos and rediscuss the recommendation of the use of IA in the production of this species. The outbreak affected 21 adult buffaloes after consumption of remains from a feed formulated on the farm and whose constituents were mixed by hand. Clinical and first death signs were observed 24 hours after ingestion of this food. In general, the clinical picture was characterized by muscle weakness, tremors, difficulty in locomotion, and decubitus. Fifteen buffaloes presented clinical signs of poisoning (71.5% morbidity), followed by death (100% lethality), after acute to subacute evolution (<24h to 96h). Laboratory tests indicated elevated serum activity of creatine phosphokinase and aspartate aminotransferase enzymes. Three buffaloes underwent necropsy, and samples from several organs were collected for histopathological examination. The main injuries found were hyaline degeneration and multifocal segmental necrosis in the skeletal and cardiac striated muscles (myopathy and degenerative-necrotic multifocal multifocal-necrotic cardiopathy). The diagnosis was confirmed by the toxicological evaluation of suspected ration remains, which detected 461.67mg/kg of monensin. The death of 71.5% buffaloes in this lot occurred due to a succession of errors, which included faults in the formulation of the ration and, above all, due to the use of monensin in a highly sensitive species. Despite the possible beneficial effects of IA use as a dietary supplement for buffaloes, we are of the opinion that IAs should never be used in bubalinoculture since any increment in production does not compensate for the imminent risk of death due to a small safety margin for this species and the absence of antidotes.(AU)

Monensina é um antibiótico ionóforo (AI) amplamente empregado na produção de ruminantes para promoção de crescimento e ganho de peso, mas que tem causado intoxicação em diversas espécies, incluindo os búfalos, principalmente, pelo desconhecimento ou desrespeito das recomendações de uso e às particularidades de cada espécie animal. Objetivou-se descrever, pela primeira vez na Bahia, dados clínico-epidemiológicos e anatomopatológicos de um surto de intoxicação acidental por monensina em búfalos e rediscutir a recomendação do uso de AI na produção de bubalinos. O surto acometeu um lote de 21 búfalos adultos após consumo de sobras de uma ração para bovinos formulada na fazenda e cujos constituintes eram misturados à mão. Os sinais clínicos e primeiros óbitos foram observados 24 horas após a ingestão dessa ração. O quadro clínico, em geral, se caracterizou por fraqueza muscular, tremores, dificuldade de locomoção e decúbito. Quinze búfalos apresentaram sinais clínicos de intoxicação (morbidade 71,5%), seguido de morte (letalidade 100%), após evolução aguda a subaguda (<24h até 96h). Exames laboratoriais indicaram acentuada elevação na atividade sérica das enzimas CPK e AST. Três búfalos foram necropsiados, sendo coletadas amostras de diversos órgãos para exame histopatológico. A principal lesão encontrada foi degeneração hialina e necrose segmentar multifocal nos músculos estriados esqueléticos e cardíacos (miopatia e cardiopatia degenerativo-necrótica tóxica multifocal polifásica). O diagnóstico foi confirmado pela avaliação toxicológica das sobras da ração suspeita, que detectou 461,67mg/kg de monensina. A morte de 71,5% dos búfalos deste lote ocorreu devido a uma sucessão de erros, que incluíram falhas na formulação da ração e, sobretudo, devido ao uso da monensina em uma espécie altamente sensível. Enfatizamos que, apesar dos possíveis efeitos benéficos do uso AIs como suplemento dietético para bubalinos, somos da opinião que os AIs nunca devem ser empregados na bubalinocultura, uma vez que os eventuais incrementos na produção não compensam o risco iminente de morte, devido a pequena margem de segurança para essa espécie e a inexistência de antídotos.(AU)