Biochemical factors affecting newborn survival in dogs and cats.

The importance and implications of small animal neonatology were underestimated until recent times. Despite the recent increasing interest for this branch of veterinary medicine, however, perinatal mortality rates in canine and feline species remain high, representing an important challenge for the clinician. In this perspective, the prompt identification of newborns requiring additional and tailored assistance becomes a key to reduce the perinatal losses in small animals. To achieve this goal, clinical and laboratory findings must be carefully evaluated. This paper focuses on biochemical parameters and their reported influence on neonatal survival, guiding through the evaluation of canine and feline newborn laboratory analyses, with a thorough discussion about the use of different biological material in these subjects. Beside blood, other biological material, such as urines and fetal fluids proved to be interesting for the identification of possible prognostic markers, thanks also to their easy and safe collection. However, the correct reading-through the results must consider many variables such as type of delivery, anesthesia protocol in case of Caesarean section, age of the newborn at samples collection, and for blood analysis, also the type of blood, site of collection, modality of collection and storage must be considered. Notwithstanding the recent progress in literature, for most of the parameters more research is needed to define cut-off values with certainty.

One-year conditional survival of dogs and cats with invasive mammary carcinomas: A concept inspired from human breast cancer.

Numerous studies have described the prognostic factors of canine and feline mammary carcinomas (MCs), that is, variables that predict patient survival after diagnosis. But how does survival estimation evolve in patients that escaped early death from their cancer? In human oncology, conditional survival (CS), the probability of surviving X further years when cancer patients have already survived Y years, is used to analyse cancer outcomes in a long-term perspective. In this cohort of 344 dogs and 342 cats with surgically removed stage I to III invasive MCs, with a minimal follow-up of 2 years, we calculated the 1-year CS, that is, the probability for patients that have survived 1 year, to survive or to die from cancer during the subsequent year. The 1-year conditional specific survival probabilities were 59% and 48% at diagnosis of invasive MC respectively in dogs and cats, and 80% and 52% in 1-year surviving dogs and cats respectively, suggesting that 1-year surviving dogs were relatively protected from cancer-related death, whereas feline MCs remained life-threatening cancers for longer periods of time. Among the most significant parameters associated with CS in surviving dogs and cats were the nodal stage and lymphovascular invasion, as well as patient age, cancer stage and margin status in surviving dogs. By comparison, tumour size and the histological grade did not significantly alter CS probabilities in surviving dogs and cats. Conditional survival may be considered a very interesting tool for veterinary practitioners to estimate the likely outcome of cancer survivors.

Supraventricular tachycardia in 23 cats; comparison with 21 cats with atrial fibrillation (2004-2014).

INTRODUCTION: Supraventricular tachycardia (SVT) has not been well described in cats. The aim of this study was to describe the signalment, clinical findings, and outcome for cats with SVT versus cats with atrial fibrillation (AF). ANIMALS: Forty-four client owned cats are included in the study. 23 cats with SVT and 21 with AF. METHODS: This is a retrospective study. Clinical characteristics were compared between groups using a two-sample t-test or Mann-Whitney U test. Kaplan-Meier survival curves were generated to assess for impact of rhythm diagnosis, presence of ventricular arrhythmia, left atrial diameter, heart rate and congestive heart failure (CHF) status on cardiac death. Differences in survival between groups were compared using Mantel-Cox logrank comparison of Kaplan-Meier survival curves. RESULTS: Cats with supraventricular arrhythmias most commonly presented with respiratory distress (10 of 44 cats). Cats with AF had a slower median heart rate (220 [range: 180-260 beats per minute (bpm)] compared with cats with SVT (300 [range: 150-380] bpm, p < 0.001). All cats with AF had structural heart disease, whereas 4 cats with SVT had no structural abnormalities. Left atrial diameter was significantly larger in cats with AF (23.7 (16.2-40.1) mm compared with 19.1 (12.8-31.4) mm in SVT cats; p = 0.02). Median survival was 58 days (1-780) in cats with AF and 259 days (2-2295) in cats with SVT (p = 0.1). Cats with signs of CHF had a shorter survival time (p = 0.001). CONCLUSIONS: Most cats with AF or SVT have advanced structural heart disease. Some cats with SVT had structurally normal hearts, suggesting that SVT in cats is not always a consequence of atrial enlargement.

Expression of HIF-1α and VEGF in feline mammary gland carcinomas: association with pathological characteristics and clinical outcomes.

BACKGROUND: The microenvironment within solid malignant tumors, including feline mammary gland carcinomas (FMGCs), is commonly hypoxic, possibly due to the lack of functional blood vessels in rapidly proliferating neoplastic tissue. Malignant cells can undergo genetic and adaptive changes that prevent them from dying due to oxygen deprivation through expressions of hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF). Therefore, HIF-1α and VEGF are ideal biomarkers for cancer therapy and prognostic evaluation. The aims of this study were to evaluate the expression of HIF-1α and VEGF in feline mammary carcinomas and analyze their correlations with clinical and pathological factors, such as clinical stage, histologic grading, regional metastasis, and overall survival rate. RESULTS: Paraffin-embedded tissue samples collected from 72 cats with FMGCs were retrospectively studied. Histologic pattern and histologic grading (Elston and Ellis grading system) of these FMGCs were determined. Our data indicated that grade II tubulopapillary carcinomas (43/72, 59.7%) prevailed in this study, and most FMCGs showed apparent necrosis, squamous metaplasia, and intratumoral stromal response. According to the results of immunohistochemical (IHC) stainings performed in tissue microarrays (TMAs), HIF-1α and VEGF overexpressions were respectively noted in 69.4% (50/72) and 77.8% (56/72) of FMGC cases. Chi-square test showed no correlation of HIF-1α overexpression with clinical and pathological factors. VEGF overexpression was significantly correlated with histologic pattern (p = 0.021), stromal response (p = 0.048), squamous metaplasia (p = 0.001), and lymphovascular invasion (p = 0.007). However, neither HIF-1α nor VEGF overexpression was correlated with histologic grading and metastasis. Of 38 cats with 1-year follow-up, IHC stainings of HIF-1α and VEGF were performed on whole tissue sections. The results showed that overexpression of HIF-1α was significantly correlated with the overall survival rate (p < 0.05) (log-rank test), whereas there was no significant correlation between VEGF overexpression and overall survival rate. CONCLUSIONS: This study suggests that the overexpression of HIF-1α may indicate poor prognosis/overall survival rate in cats with FMGCs. Developing compounds that inhibit HIF-1α may be a potential approach to FMGC treatment.

Definitive-intent radiotherapy for sinonasal carcinoma in cats: A multicenter retrospective assessment.

Treatment of epithelial sinonasal tumours in cats is not commonly reported. In the newer reports, palliative radiation protocols have been described more often than definitive-intent protocols. In this multi-institutional retrospective study, we included 27 cats treated with single-modality radiotherapy. Cats were irradiated using 10 daily fractions of 4.2 Gy. Three cats (11.1%) experienced a complete clinical response and 17 (63%) had a partial clinical response. Stable clinical disease was noted in three cats (11.1%). Four cats (14.8%) showed progression within 3 months following treatment. The median time to progression for all cases was 269 days (95 % confidence intervals [CI]: 225; 314). The proportion of cats free of progression at 1 and 2 years was 24% (95% CI: 22%; 26%) and 5% (95% CI: 5%; 6%), respectively. None of the prognostic factors evaluated were predictive of outcome (anaemia, tumour volume at the time of staging, modified Adams stage, intracranial involvement, facial deformity, epistaxis, inappetence or weight loss). Median overall survival (OS) for all deaths was 452 days (95% CI: 334; 571). The proportion of cats alive at 1 and 2 years was 57% (95% CI: 37%; 77%) and 27% (95% CI: 25%; 29%), respectively. Surprisingly, cats with epistaxis had a longer median OS of 828 days (95% CI: 356; 1301) compared to 296 days (95% CI: 85; 508) in cats without epistaxis, (P = .04, Breslow). Radiation therapy used as a single modality for the treatment of feline sinonasal carcinoma improved clinical signs and was well tolerated but progression within a year was common.

Analysis of Copy-Number Variations and Feline Mammary Carcinoma Survival.

Feline mammary carcinomas (FMCs) are highly malignant. As the disease-free survival (DFS) and overall survival (OS) are short, prognostication is crucial. Copy-number variations (CNVs) analysis by next-generation sequencing serves to identify critical cancer-related genomic regions. Thirty-three female cats with FMCs were followed during two years after surgery. Tumours represented tubulopapillary and solid carcinomas encompassing six molecular subtypes. Regardless of the histopathological diagnosis, molecular subtypes showed important differences in survival. Luminal A tumours exhibited the highest DFS (p = 0.002) and cancer-specific OS (p = 0.001), and the lowest amount of CNVs (p = 0.0001). In contrast, basal-like triple-negative FMCs had the worst outcome (DFS, p < 0.0001; and OS, p < 0.00001) and were the most aberrant (p = 0.05). In the multivariate analysis, copy-number losses (CNLs) in chromosome B1 (1-23 Mb) harbouring several tumour-repressors (e.g. CSMD1, MTUS1, MSR1, DBC2, and TUSC3) negatively influenced DFS. Whereas, copy-number gains (CNGs) in B4 (1-29 Mb) and F2 (64-82.3 Mb) comprising epithelial to mesenchymal transition genes and metastasis-promoting transcription factors (e.g. GATA3, VIM, ZEB1, and MYC) negatively influenced DFS and cancer-specific OS. These data evidence an association between specific CNVs in chromosomes B1, B4 and F2, and poor prognosis in FMCs.

Recurrence rate and long-term course of cats with feline lower urinary tract disease.

OBJECTIVES: Feline lower urinary tract disease (FLUTD) causes clinical signs such as stranguria, pollakiuria, haematuria, vocalisation and periuria, and is often associated with recurring episodes. The primary objective of this study was to survey the long-term course of cats presenting with FLUTD in terms of recurrence rate and mortality. METHODS: Data from cats that were presented with lower urinary tract signs from 2010 to 2013 were collected by telephone interview with cat owners, using a questionnaire. The observation period ranged from the first presentation due to FLUTD to the telephone interview or the cat's death. Data on diagnoses, recurrence of clinical signs and disease-free intervals, as well as implementation and impact of prophylactic measures (PMs), were collected and compared between groups with different aetiologies. RESULTS: The study included 101 cats. Fifty-two cats were diagnosed with feline idiopathic cystitis, 21 with urolithiasis and 13 with bacterial urinary tract infection; 15 had no definitive diagnosis. Of the 86 cats with a known diagnosis, the recurrence rate was 58.1%, with no significant difference between groups. Twenty-one cats had one relapse, 12 had two relapses, 10 had three and seven had four to eight relapses within a median observation period of 38 months (range 0.5-138 months). Fourteen cats suffered from different causes of FLUTD at different episodes. Mortality due to FLUTD among all 101 cats was 5.0%. The recurrence rate in cats with urolithiasis receiving at least two PMs was significantly lower than the recurrence rate in those without PMs (P = 0.029). CONCLUSIONS AND RELEVANCE: More than half of the cats with FLUTD presented with two or more recurrent episodes irrespective of the identified aetiology. Cats should be thoroughly investigated at each presentation as it cannot be presumed that the cause of FLUTD is the same at different episodes. The mortality due to FLUTD is lower than previously reported.

Thoracic dog bite wounds in cats: a retrospective study of 22 cases (2005-2015).

OBJECTIVES: The aim of this study was to describe a series of cats suffering from thoracic dog bite wounds, in order to detail the clinical, radiographic and surgical findings, and evaluate outcomes and factors associated with mortality. METHODS: The medical records of cats with thoracic dog bite wounds presenting to a single institution between 2005 and 2015 were retrospectively reviewed. Data relating to clinical presentation, wound depth and management, radiographic findings, surgical findings and mortality were collected. Wound depth was defined as no external wound, superficial, deep or penetrating, and wound management was defined as conservative, exploratory or thoracic exploration. Statistical analyses were performed using Fisher's exact test, the Mann-Whitney U-test and the χ2 test. RESULTS: Twenty-two cats were included, of which two were euthanased on presentation. In cats where wound depth could be assessed (21/22), six had no external wounds, four had superficial wounds, three had deep wounds and eight suffered penetrating wounds. Sixteen cats also suffered wounds elsewhere, most commonly to the abdomen. Neither an abdominal wound nor abdominal surgery were associated with mortality. Pneumothorax was the most common radiographic finding (11/18). Individual radiographic lesions were not significantly associated with respiratory pattern, presence of pseudo-flail, need for thoracotomy or lung lobectomy, or survival. The presence of ⩾3 radiographic lesions was associated with the presence of a penetrating wound (P = 0.025) and with having thoracic exploration (P = 0.025). Local exploration was performed in 7/20 cats, while 8/20 underwent thoracic exploration. Wound management type was not significantly associated with mortality. Overall mortality rate was 27%. CONCLUSIONS AND RELEVANCE: Presence of ⩾3 radiographic lesions should raise suspicion of a penetrating injury and may be suggestive of injury requiring a greater level of intervention. The treating veterinarian should have a high index of suspicion for penetrating injury and be prepared in case thoracic exploratory surgery is necessary, particularly in the presence of pseudo-flail chest, pneumothorax or ⩾3 radiographic lesions.

Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014-2018).

OBJECTIVES: The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. METHODS: This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. RESULTS: Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1-3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. CONCLUSIONS AND RELEVANCE: This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk-benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.

Treatment of idiopathic chylothorax in dogs and cats: A systematic review.

OBJECTIVE: To evaluate the evidence published on the treatment of idiopathic chylothorax (IC) in small animals. STUDY DESIGN: Systematic literature review. SAMPLE POPULATION: Dogs and cats with IC. METHODS: A literature search was performed in three bibliographic databases in July 2018 for publications on IC in dogs and cats. Articles meeting criteria for inclusion were evaluated for treatment, survival, outcome data, and level of evidence (LoE) with a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system. RESULTS: Eleven of 313 identified articles met the inclusion criteria. Only one study was identified in dogs as having higher LoE by using the mOLE system, whereas no study was identified as such in either species with the GRADE system. Surgery was the primary treatment in all dogs and in 93% (68/73) of cats. Medical therapy was the primary treatment in 7% (5/73) of cats. The most common surgical treatment combined thoracic duct ligation (TDL) and subtotal pericardiectomy (SP; 40%; 34/84) in dogs and TDL in cats (51% [37/73]). CONCLUSION: The body of literature for IC treatment in small animals was limited to one higher LoE study in dogs and none in cats. No strong conclusion could be drawn regarding the effectiveness of any one surgical method in dogs or cats, and no evidence was found to support medical therapy as a primary treatment. CLINICAL SIGNIFICANCE: The best available evidence regarding the treatment of IC is published in dogs and provides some support for surgical treatment with either TDL + cisterna chyli ablation or TDL + SP. Additional evidence is required to confirm this finding.

Long-term incidence and risk of noncardiovascular and all-cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy.

BACKGROUND: Epidemiologic knowledge regarding noncardiovascular and all-cause mortality in apparently healthy cats (AH) and cats with preclinical hypertrophic cardiomyopathy (pHCM) is limited, hindering development of evidence-based healthcare guidelines. OBJECTIVES: To characterize/compare incidence rates, risk, and survival associated with noncardiovascular and all-cause mortality in AH and pHCM cats. ANIMALS: A total of 1730 client-owned cats (722 AH, 1008 pHCM) from 21 countries. METHODS: Retrospective, multicenter, longitudinal, cohort study. Long-term health data were extracted by medical record review and owner/referring veterinarian interviews. RESULTS: Noncardiovascular death occurred in 534 (30.9%) of 1730 cats observed up to 15.2 years. Proportion of noncardiovascular death did not differ significantly between cats that at study enrollment were AH or had pHCM (P = .48). Cancer, chronic kidney disease, and conditions characterized by chronic weight-loss-vomiting-diarrhea-anorexia were the most frequently recorded noncardiovascular causes of death. Incidence rates/risk of noncardiac death increased with age in AH and pHCM. All-cause death proportions were greater in pHCM than AH (65% versus 40%, respectively; P < .001) because of higher cardiovascular mortality in pHCM cats. Comparing AH with pHCM, median survival (study entry to noncardiovascular death) did not differ (AH, 9.8 years; pHCM, 8.6 years; P = .10), but all-cause survival was significantly shorter in pHCM (P = .0001). CONCLUSIONS AND CLINICAL IMPORTANCE: All-cause mortality was significantly greater in pHCM cats due to disease burden contributed by increased cardiovascular death superimposed upon noncardiovascular death.

Persian cats under first opinion veterinary care in the UK: demography, mortality and disorders.

Persian cats are a popular cat breed worldwide, and especially in the US, Europe and Asia. This study aimed to describe the demography, common disorders and mortality in Persians under general practice veterinary care in 2013 in the UK. The study population of 285,547 cats overall included 3235 (1.1%) Persians. Mean adult Persian bodyweight was 3.9 kg (SD 0.9) and median age was 7.0 years (IQR 3.3-11.6). At least one disorder was recorded in 2099 (64.9%) Persians. The most common specific disorders were haircoat disorders (411, 12.7%), periodontal disease (365, 11.3%), overgrown nails (234, 7.2%), and ocular discharge (188, 5.8%). The most common disorder groups were dermatological (578, 17.9%), ophthalmological (496, 15.3%) and dental (397, 12.3%). Median longevity was 13.5 years (IQR 9.9-16.0). The most common grouped causes of death were renal disease (102, 23.4%), neoplasia (37, 8.5%) and mass-associated disorder (35, 8.0%). This is the first study to use general practice data to examine the overall health of Persian cats. With haircoat, ocular and dental disorders being the predominant disorders identified, this study highlights the need for increased owner awareness to manage and prevent the typical health problems associated with this breed's phenotype.

Severe Fever with Thrombocytopenia Syndrome Phlebovirus causes lethal viral hemorrhagic fever in cats.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever caused by the SFTS phlebovirus (SFTSV). SFTS patients were first reported in China, followed by Japan and South Korea. In 2017, cats were diagnosed with SFTS for the first time, suggesting that these animals are susceptible to SFTSV. To confirm whether or not cats were indeed susceptible to SFTSV, animal subjects were experimentally infected with SFTSV. Four of the six cats infected with the SPL010 strain of SFTSV died, all showing similar or more severe symptoms than human SFTS patients, such as a fever, leukocytopenia, thrombocytopenia, weight loss, anorexia, jaundice and depression. High levels of SFTSV RNA loads were detected in the serum, eye swab, saliva, rectal swab and urine, indicating a risk of direct human infection from SFTS-infected animals. Histopathologically, acute necrotizing lymphadenitis and hemophagocytosis were prominent in the lymph nodes and spleen. Severe hemorrhaging was observed throughout the gastrointestinal tract. B cell lineage cells with MUM-1 and CD20, but not Pax-5 in the lesions were predominantly infected with SFTSV. The present study demonstrated that cats were highly susceptible to SFTSV. The risk of direct infection from SFTS-infected cats to humans should therefore be considered.

Increased p16CDKN2A, but not p53, immunostaining is predictive of longer survival time in cats with oral squamous cell carcinomas.

Although oral squamous cell carcinomas (SCCs) are common in cats there are currently few prognostic markers for these cancers. This study used 52 feline oral SCCs to determine if prognosis can be predicted by the age or sex of the cat, the presence of bone within the diagnostic sample, or the anatomic location of the SCC. Additionally, as p16CDKN2A protein (p16) and p53 are prognostic for human oral SCCs, p16 and p53 immunostaining was evaluated. Only SCC location and p16 immunostaining were prognostic. Cats with oropharyngeal SCCs had an estimated median survival time (MST) of 151 days which was significantly longer than cats with maxillary (51 days P = 0.017), sublingual (33 days P = 0.011) and mandibular (34 days P = 0.029) SCCs. Overall, 19% of oral SCCs were p16-positive with intense nuclear and cytoplasmic immunostaining within most neoplastic cells, 69% had cytoplasmic immunostaining that was confined to the periphery of nests of neoplastic cells, and 12% had no p16 immunostaining. Cats with p16-positive SCCs had a MST of 87 days, which was significantly longer than cats with p16-peripheral SCCs (MST 37 days, P = 0.03), but not longer than cats with p16-negative SCCs (MST 51 days, P = 0.72). No papillomaviral DNA was amplified from the p16-positive SCCs. Twenty (39%) SCCs contained immunostaining for p53, but this was not prognostic (P = 0.31). These results suggest that feline oral SCCs develop by cellular mechanisms that result in one of three patterns of p16 immunostaining. Cancers which develop due to these mechanisms appear to have different clinical behaviors and p16 immunostaining predicts the behavior of these common feline cancers.

Lung lobe torsion in 35 dogs and 4 cats.

The purpose of this study was to assess survival to discharge of animals with surgical or postmortem confirmation of a lung lobe torsion (LLT) as well as to evaluate pre-operative effusion, lung lobe affected, and patient size as prognostic indicators. Medical records search identified 35 dogs and 4 cats with a confirmed diagnosis including 17 small-breed dogs, 18 large-breed dogs, 3 domestic shorthair cats, and 1 minskin cat. Lobes affected included right middle (n = 18), left cranial (n = 18), right cranial (n = 2), left caudal (n = 1), and accessory (n = 1). Two animals died before surgery; the remaining 37 animals underwent thoracotomy. All treated small-breed dogs and cats survived; 12/18 large-breed dogs survived, with an overall survival to discharge of 87%. Pre-operative pleural effusion and affected lung lobe did not affect survival to discharge in this population. Small dogs and cats with LLT appear to have an excellent survival to discharge following thoracotomy and the survival is good in larger dogs.

Torsion de lobe pulmonaire chez 35 chiens et 4 chats. Le but de cette étude est d'évaluer le taux de survie jusqu'à la sortie d'hôpital, chez des animaux ayant eu confirmation chirurgicale ou post-mortem de torsion de lobe pulmonaire (TLP), ainsi que d'évaluer la présence d'épanchement pleural, le lobe pulmonaire affecté et la taille des patients en tant que facteurs pronostics. Les dossiers médicaux de 35 chiens et 4 chats avec un diagnostic de TLP confirmé furent identifiés, comprenant 17 chiens de petite race, 18 chiens de grande race, 3 chats Européens et 1 Minskin. Les lobes pulmonaires affectés étaient le lobe moyen droit (n = 18), le lobe cranial gauche (n = 18), le lobe cranial droit (n = 2), le lobe caudal gauche (n = 1) et le lobe accessoire (n = 1). Deux animaux décédèrent avant chirurgie, et une thoracotomie fut pratiquées chez les 37 animaux restant. Tous les chiens de petites races et les chats survécurent à leur chirurgie; 12/18 des chiens de grande race survécurent, et le taux de survie global était de 87 %. La présence d'épanchement pleural et le lobe pulmonaire affecté n'avaient pas d'influence sur la probabilité de survie dans cette population. Le taux de survie au congé hospitalier semble excellent chez les chiens de petite taille et les chats diagnostiqués avec une torsion de lobe pulmonaire et il est bon pour les chiens de grande taille.(Traduit par les auteurs).

Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication.

OBJECTIVES: The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis. METHODS: Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05. RESULTS: A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. CONCLUSIONS AND RELEVANCE: MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.

External beam radiotherapy for the treatment of feline salivary gland carcinoma: six new cases and a review of the literature.

CASE SERIES SUMMARY: Salivary gland carcinoma is uncommon in cats. We report the outcome of radiation therapy in six cases (four salivary gland adenocarcinomas, one tubulopapillary adenocarcinoma, one carcinoma). Five were treated after surgical excision of the primary tumour, but four had gross disease (primary or metastatic) at the time of starting radiotherapy. Exact progression-free interval from the start of radiotherapy in the two cats where this was known was 120 and 144 days, respectively. One cat was signed off at 766 days with no evidence of recurrence. Another cat was in remission at 202 days (when last seen by the referring practice) but subsequently developed recurrence (date uncertain). Survival time was known for three cats (55 days, 258 days and 570 days from initiation of radiotherapy, respectively). In two cases, locoregional progressive disease (PD) was confirmed, and the other presumed as the cause of death. Two cats, known to have developed PD, were alive at the time of writing (at 206 and 549 days, respectively). No cat died as a result of distant metastatic disease. RELEVANCE AND NOVEL INFORMATION: There is a paucity of information on the treatment of salivary gland tumours. In humans, as in cats, there is no optimised standard of care for malignant tumours. It is accepted that, for surgical candidates (even with large tumours), surgery and radiotherapy is superior to radiotherapy alone. However, the benefits of postoperative radiotherapy compared with surgery alone are only clear in patients with high-risk tumours (ie, those with large and invasive primary tumours, close or incomplete margins, high histopathological grade, histological evidence of neural or vascular invasion, or positive lymph nodes). This population is analogous to the population reported here, and likely to most cats presented in practice. Thus, radiation therapy may help improve locoregional control and survival in cats.

Radiation therapy for intracranial tumours in cats with neurological signs.

OBJECTIVES: The aim of this study was to evaluate the outcome of cats with intracranial tumours presenting with neurological signs treated with radiation therapy. METHODS: This study comprised a retrospective multicentre case series. Medical records of a total of 22 cats with intracranial space-occupying lesions, presenting with neurological signs and/or epileptic seizures and treated with external beam radiation therapy, were reviewed. In the treated cats, patient-, tumour- and treatment-related variables were investigated, including age, sex, tumour location, tumour volume, total radiation dose, equivalent dose in 2 Gy fractions (EQD2), corticosteroid dose, overall treatment time and institution for influence on local tumour control and survival. RESULTS: Based on advanced imaging characteristics, the 22 treated cats presented with meningioma (n = 11), pituitary tumour (n = 8), choroid plexus tumour (n = 2) or glioma (n = 1). Allocated to the neuraxis, 11 lesions were extra-axial, three were intra-axial and eight were located in the pituitary region. At diagnosis, 21 cats exhibited altered neurological status. One cat presented with epileptic seizures and another cat had both seizures and altered neurological status. The mean total physical dose of radiation was 41.63 Gy (± 4.33), range 24-45 Gy. In all but one cat (95.5%), neurological signs improved after radiation therapy. The median progression-free survival was 510 days (95% confidence interval [CI]: 51-969). The proportion free of progression at 1 year was 55.7% (95% CI: 33-78). Fourteen cats died (only in five cases was death related to the intracranial tumour) and eight cats were still alive or lost to follow-up. The median overall survival time was 515 days (95% CI: 66-964). None of the tested variables influenced outcome. CONCLUSIONS AND RELEVANCE: Radiation therapy seems to represent a viable treatment option in cats with intracranial tumours, relieving neurological signs and improving local tumour control. Radiation therapy may be considered for cats with tumours in complicated/inoperable localisations or for cases with a high peri- and postoperative risk.

Comparison of medical and/or surgical management of 23 cats with intracranial empyema or abscessation.

OBJECTIVES: Feline intracranial abscessation or empyema is infrequently reported in the veterinary literature. To date, the largest study is based on a population of 19 cats with otogenic infection. The aim of this study was to review a larger population of cats with intracranial empyema from multiple aetiologies and document their signalment, imaging findings, treatment protocols (including medical and/or surgical management) and to compare outcomes. METHODS: Cases presenting to a single referral centre over a 10 year period with compatible history, neurological signs and imaging findings consistent with intracranial abscessation and empyema were reviewed retrospectively. RESULTS: Twenty-three cats met the inclusion criteria. Advanced imaging (CT and/or MRI) was performed in 22/23 cats; one case was diagnosed via ultrasound. Ten cases underwent medical and surgical management combined, 10 underwent solely medical management and three were euthanased at the time of diagnosis. Short-term outcome showed that 90% of surgically managed and 80% of medically managed cats were alive at 48 h post-diagnosis. Long-term survival showed that surgically managed cases and medically managed cases had a median survival time of 730 days (range 1-3802 days) and 183 days (range 1-1216 days), respectively. No statistical significance in short- or long-term survival ( P >0.05) was found between medically and surgically managed groups. CONCLUSIONS AND RELEVANCE: Feline intracranial abscessation and empyema are uncommon conditions that have historically been treated with combined surgical and medical management. This study documents that, in some cases, intracranial abscessation and empyema can also be successfully treated with medical management alone.