Investigation of serum cortisol concentration as a potential prognostic marker in hospitalized dogs: a prospective observational study in a primary care animal hospital.

BACKGROUND: Dogs with various medical diseases are usually treated at hospitals; however, the prognostic markers in dogs remain unknown. The aim of this study was to investigate the ability of serum cortisol concentration (SCC) to predict the prognosis of dogs with medical diseases. At 0 and 24 h after hospitalization, the neutrophil count, lymphocyte count, blood glucose concentration, and SCC were measured. Survival for 30 days from the time of hospitalization was investigated, and the dogs were divided into a survivor group and a non-survivor group. RESULTS: The neutrophil count at 24 h, SCC at 24 h, increase in SCC from 0 to 24 h (Inc-SCC), and the rate of increase in SCC from 0 to 24 h (R-Inc-SCC) were significantly higher in the non-survivor group than in the survivor group. The area under the receiver operating characteristic (ROC) curve values for the neutrophil count at 24 h, SCC at 24 h, Inc-SCC, and R-Inc-SCC were 0.695, 0.72, 0.63, and 0.66, respectively. Using the highest area under the ROC curve value, the sensitivity and specificity of SCC at a cutoff level of 6.6 µg/dL for predicting mortality were 89.5 and 61.9%, respectively. Moreover, the Kaplan-Meier curves confirmed the significant prognostic influence of SCC at 24 h. CONCLUSIONS: SCC as a marker of stress is a useful biomarker for predicting the prognosis of dogs with medical diseases requiring hospital treatment.

Long-term outcome of myotonia associated with hyperadrenocorticism in 2 dogs.

Two dogs were diagnosed with myotonia associated with hyperadrenocorticism and treated with trilostane. One dog showed temporary improvement, but the other dog showed no improvement. The dogs survived 2383 and 1902 days, respectively. Findings suggest that myotonia persists despite treatment, but this condition is not associated with a poor prognosis for survival.

Résultat à long terme de la myotonie associée à l'hyperadrénocorticisme chez 2 chiens. Deux chiens ont été diagnostiqués avec la myotonie associée à l'hyperadrénocorticisme et traités avec du trilostane. Un chien a manifesté une amélioration temporaire, mais l'autre n'a manifesté aucune amélioration. Les chiens ont survécu 2383 et 1902 jours, respectivement. Les résultats ont suggéré que la myotonie persiste malgré le traitement, mais cette affection n'est pas associée à un pronostic défavorable pour la survie.(Traduit par Isabelle Vallières).

Immune-mediated hemolytic anemia and pure red cell aplasia in a Jack Russell Terrier during treatment for hypoadrenocorticism.

An 11-year-old neutered male Jack Russell Terrier was presented to Yuki Animal Hospital for regenerative anemia during the treatment of hypoadrenocorticism. A blood smear examination showed spherocytes, polychromatic erythrocytes, and erythrocyte ghosts. The direct agglutination test was positive at 37°C. The dog was then diagnosed with immune-mediated hemolytic anemia (IMHA). Although prednisolone and mycophenolate mofetil were administered, the hematocrit and reticulocyte count decreased, and nonregenerative anemia developed. A bone marrow examination was performed to diagnose the cause of the nonregenerative anemia. Histologic and cytologic bone marrow examination revealed a normocellular to hypercellular medulla with severe erythroid hypoplasia. No proliferation of lymphocytes or lymphoblast-appearing cells was observed. This dog was diagnosed with pure red cell aplasia (PRCA). Despite treatment with immunosuppressive agents, the patient died of thrombosis. Although these associations were unclear, this is the first report of PRCA diagnosis following IMHA and while treating hypoadrenocorticism.

Comparison of survival times of cats with hyperthyroidism treated with thyroidectomy or methimazole at a primary care hospital in Japan.

OBJECTIVE: We identified the associated factors and compared the survival times of feline hyperthyroidism (FHT) between thyroidectomy and methimazole alone. METHODS: The medical records of 41 cats diagnosed with new-onset hyperthyroidism were retrospectively reviewed. The cats were categorized into the thyroidectomy (n = 15) and methimazole (26) treatment groups. Survival analyses using the Kaplan-Meier method, log-rank test, and Cox proportional hazards models were conducted to compare the time to the selected outcomes. RESULTS: Univariate analysis revealed that survival time was significantly longer with thyroidectomy than with methimazole (P < .001). Multivariate analyses revealed thyroidectomy as an independent prognostic factor for good outcomes (hazard ratio, 0.209; 95% CI, 0.073 to 0.601; P = .004). The recurrence rate was significantly lower in cats that underwent thyroidectomy than in those that received methimazole alone (P = .011). CLINICAL RELEVANCE: Compared with methimazole alone, thyroidectomy was associated with a longer survival time in FHT and can be considered an irreversible treatment modality in settings where radioisotopes are not available.

Comparison of polyclonal and monoclonal antibody assays for serum amyloid A in cats: a study based on an automated turbidimetric immunoassay in a primary care veterinary hospital.

OBJECTIVE: Comparing the utility of the anti-human serum amyloid A (SAA)-specific monoclonal and polyclonal antibodies assays (LZ-SAA) with the pure monoclonal anti-human antibody assays (VET-SAA) during clinical practice in primary care hospital populations by measuring SAA measurement in healthy and diseased domestic cats. ANIMALS: 52 healthy and 185 diseased client-owned cats. METHODS: SAA concentration was measured using different LZ-SAA and VET-SAA measurements for healthy and various diseased cats. Sensitivity, specificity, and accuracy were calculated for each disease. RESULTS: VET-SAA has higher sensitivity than LZ-SAA for the most common diseases presenting to primary care veterinary hospitals, including chronic kidney disease, tumors, and gingivostomatitis. Our results reveal the capability of detecting low SAA concentrations in healthy and diseased cats using VET-SAA in contrast to LZ-SAA, which found elevations of SAA concentrations only in diseased cats. CLINICAL RELEVANCE: Our findings indicate that switching to the new VET-SAA instead of the conventional LZ-SAA will likely enhance the diagnostic performance in primary care veterinary hospitals.

Development of acute pancreatitis after oral administering a praziquantel, pyrantel pamoate, and febantel combination in a dog: A case report.

Oral praziquantel, pyrantel pamoate, and febantel combination (PPFC) is a highly safe anthelmintic treatment commonly administered for the purpose of canine gastrointestinal parasites with mild adverse effects such as anorexia, vomiting, lethargy, or diarrhea. A 12-year-old castrated Chihuahua was brought to our hospital for a periodic health examination. Although his general physical examination showed no abnormalities, blood test results showed increase in the liver enzyme, lipase activity, total bile acid, total cholesterol, and triglyceride concentration. Moreover, the dog had underlying tricuspid regurgitation that was not treated. PPFC was prescribed on the suspicion of gastrointestinal tract parasites. Following the oral administration of PPFC at home, anorexia and lethargy were found, and vomiting and diarrhea were noted after 30 h. The dog was diagnosed with acute pancreatitis based on clinical course of the disease and subsequent pathology results. Although intravenous drip was initiated upon hospitalization, the treatment was discontinued owing to financial reasons. The onset of acute pancreatitis can be considered an adverse effect of PPFC. Although the association between PPFC administration and the onset of acute pancreatitis could not be clarified in this case, the onset of acute pancreatitis may have been associated with a decrease in liver function and/or increase in the false activity of lipase. PPFC has been considered highly safe in dogs, although care should be taken when administering medications to dogs suspected of having an underlying disorder.

Complete remission of two canine cases with precursor-targeted immune-mediated anemia after combination therapy with prednisolone, cyclosporine, and oclacitinib.

Background: Precursor-targeted immune-mediated anemia (PIMA) has been described in dogs presenting with nonregenerative anemia and evidence of ineffective erythropoiesis. Although it has been suggested that its occurrence may be related to the immune targeting of erythroid precursors, this pathogenesis has not been established. PIMA is mainly treated with glucocorticoids, and in cases where glucocorticoids alone are not effective, immunosuppressants are also used as combination therapy. However, not all cases of PIMA go into remission after these treatments. Case Description: Two dogs with severe nonregenerative anemia diagnosed as PIMA based on the results of clinical pathological examinations, including bone marrow examination, were treated with whole-blood transfusion and immunosuppressive doses of prednisolone, mycophenolate mofetil, and cyclosporine. However, these treatments failed to achieve remission of PIMA. Therefore, concomitant administration of oclacitinib, which is a Janus kinase-1 inhibitor that has been applied recently to the treatment of immune-mediated diseases, was performed; this combined regimen improved the anemia and achieved complete remission of PIMA. Conclusion: Oclacitinib may be an option for the treatment of PIMA in dogs failing to achieve remission with conventional immunosuppressive therapy.

Diagnostic utility of measuring lactate dehydrogenase levels and its isoenzyme activities for the evaluation of malignancy in feline pleural effusion and ascitic fluid.

Background: Lactate dehydrogenase (LDH) isoenzymes may be useful in the differential diagnosis of pleural effusion (PE) and ascitic fluid (AF) etiologies in cats since tissue damage induces their release, changing the pattern of their activity. Aim: This study aimed to determine the diagnostic utility of measuring LDH levels and isoenzyme activities in PE or AF in cats with malignancy. Methods: LDH levels and isoenzyme activities in the serum, PE, and AF were compared among cats in the malignant, infectious, and non-malignant, non-infectious groups. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy in diagnosing feline malignancy. Results: Significant differences in LDH level and LDH isoenzyme activities in the PE and AF were observed among the three groups. The combination of LDH level and LDH-1 activity in PE or AF had the highest area under the ROC (AUC) values for discriminating malignant effusion from non-malignant effusion. The AUC of the combination of LDH level and LDH-1 activity in PE or AF was 0.874. The sensitivity and specificity of using the combination of LDH level (cut-off: <2,269 U/l) and LDH-1 activity (cut-off: <4.8%) in PE or AF for predicting malignancy with the highest AUC value were 94.4% and 72.7%, respectively. Conclusion: Our results suggest that the combination of LDH level and LDH-1 activity in PE or AF is a potential factor for diagnosing malignancy. Considering that LDH isoenzymes can be measured inexpensively and easily, LDH tests can be readily accommodated in veterinary clinical practice.

Subclinical wandering spleen in a cat with gastrointestinal lymphoma.

We accidentally detected a subclinical wandering spleen on preoperative ultrasonography in a cat with gastrointestinal lymphoma. If the spleen is not in the normal position, the wandering spleen should be considered.

Prognostic utility of preoperative neutrophil-lymphocyte ratio in cats with malignant mammary tumors.

Although studies have determined the neutrophil-lymphocyte ratio (NLR) to be a useful prognostic predictor in various human cancers, little is known regarding its preoperative prognostic significance in feline mammary tumors (FMTs). Thus, the present study aimed to determine the prognostic utility of preoperative peripheral blood NLR in malignant FMTs. Accordingly, medical records of 34 cats that had undergone mastectomy were searched, after which those histopathologically confirmed to have malignant FMTs were included. Univariate analysis was used to determine the effect of each variable on one-year survival time. Factors determined to be significant during univariate analysis were subsequently included for multivariate analysis. Receiver operating characteristic analysis was used to assess the accuracy of the tests for predicting one-year survival. Univariate analysis showed that a high NLR and large tumor size were significantly associated with shorter survival times (P < 0.01, for both). No significant differences in other factors were observed. Multivariate analysis showed that a high NLR (hazard ratio, 25.03; 95% confidence interval, 2.98-210.40; P < 0.01), but not tumor size and age, was an independent prognostic factor for poor outcomes. The sensitivity and specificity of the NLR (cut-off, 5.67) for predicting one-year survival were 93.8% and 88.9%, respectively. This study suggests that the NLR could potentially be used as a preoperative prognostic factor in FMTs. Preoperative NLR may help to establish therapeutic modalities by allowing prognostic evaluation among cats with mammary tumors.

Obese status is associated with accelerated DNA methylation change in peripheral blood of senior dogs.

Obesity and its associated comorbidities constitute a major and growing health problem worldwide not only involved with people but also dogs and cats. Although few genetic mutations have been associated with obesity in dogs, molecular mechanism remains to be clearly understood. Given the fact that DNA methylation leads to gene expression variability and has plasticity affected by metabolic phenotypes such as obesity in human, the objective of this study is to identify obesity-associated differentially methylated cytosine-phosphate-guanine (CpG) dinucleotide sites in dogs. With genome-wide DNA methylation analysis using next-generation sequencing for blood samples from fourteen Miniature dachshunds with body condition score (BCS) 4-5 and BCS ≥6, over 100,000 sites could be analysed to identify genomic locations of differentially methylated CpG sites. As a result, 191 differentially methylated CpG sites (89 CpG sites were hypermethylated in BCS ≥6 and 102 were hypermethylated in BCS 4-5) were identified. These sites included promoter regions of Kisspeptin receptor (KISS1R) and Calcyphosine 2 (CAPS2) genes which were subsequently validated by bisulfite-pyrosequencing for another set of 157 dog blood samples. KISS1R methylation levels were found to be higher in BCS ≥6 group than BCS 4-5 in senior (>84 months) dogs. Especially male dogs but not female dogs as well as uncastrated male dogs but not castrated male dogs showed this trend. DNA methylation of KISS1R gene will be useful for understanding of comprehensive epigenetic change in obese dogs.

Use of a combination of prednisolone and rosuvastatin for treatment of a pyogranuloma in a dog.

CASE DESCRIPTION: A 6-year-old spayed female Miniature Dachshund was examined because of a 3-day history of anorexia and diarrhea. CLINICAL FINDINGS: A lump was detected during abdominal palpation. Biochemical abnormalities included increases in serum concentrations of total protein, globulin, and C-reactive protein (CRP). Abdominal radiography and abdominal ultrasonography revealed a mass on the caudal aspect of the right kidney. Exploratory laparotomy confimed the mass; however, it could not be excised because it was strongly adhered to surrounding tissues. Histologic examination of a tissue sample from the mass led to a diagnosis of pyogranuloma. TREATMENT AND OUTCOME: The dog was treated with rosuvastatin, but no improvement was evident. Administration of a high dose of prednisolone (1 mg/kg [0.45 mg/lb], PO, q 12 h) was initiated. The CRP concentration returned to within reference limits, and the mass gradually decreased in size. The prednisolone dosage was tapered to 0.14 mg/kg (0.064 mg/lb), PO, every 12 hours. However, once the low dosage of prednisolone was reached, CRP concentration and size of the mass increased. Rosuvastatin was subsequently combined with the low dosage of prednisolone. After 1 week of the combination treatment, the CRP concentration returned to within reference limits, and the mass was reduced in size. The mass eventually could not be detected ultrasonographically. CLINICAL RELEVANCE: A low dose of prednisolone was not effective against the pyogranuloma. However, administration of a low dose of prednisolone in combination with rosuvastatin caused decreases in CRP concentration and size of the pyogranuloma. Thus, statins may act as immunosuppressants.

Primary Adenosquamous Cell Carcinoma of the Ileum in a Dog.

A 9-year-old male, castrated Chihuahua was examined because of a 7-day history of intermittent vomiting. A mass in the small intestine was identified on abdominal radiography and ultrasonography. Laparotomy revealed a mass lesion originating in the ileum, and surgical resection was performed. The mass was histologically diagnosed as adenosquamous cell carcinoma. Chemotherapy with carboplatin was initiated, but the dog was suspected to have experienced recurrence 13 months after surgery and died 3 months later. To our knowledge, this is the first case report to describe the clinical course of adenosquamous cell carcinoma in the small intestine of a dog.

A Clinical Investigation on Serum Amyloid A Concentration in Client-Owned Healthy and Diseased Cats in a Primary Care Animal Hospital.

Although measurement of serum amyloid A (SAA) concentration in client-owned cats has already been shown to be clinically useful, limited data are available on common diseases at primary care hospitals. In this study, we measured the SAA concentration in cats with various diseases and investigated their clinical significance using a primary care hospital as a population. We measured the SAA concentrations in healthy cats (n = 98) and those with various clinical signs (n = 444). The SAA concentrations in healthy cats did not differ significantly by age, breed, sex, and presence/absence of neutering/spaying. The SAA concentrations were significantly higher in the diseased cat group than in the healthy cat group (p < 0.001). We observed significant increases in SAA concentrations in cats with confirmed diagnosis of inflammatory disease such as upper respiratory tract infections (p < 0.001), pneumonia (p < 0.001), pyometra (p = 0.001), and feline infectious peritonitis (p < 0.001), compared with those observed in healthy cats. Conversely, no increase was observed in cardiomyopathy, hyperthyroidism, and diabetes mellitus without systemic inflammation. In univariate analysis, survival at 30 days (p = 0.03) differed significantly between the low and high SAA concentration groups, but not at 180 days. In multivariate analysis, survival at 30 days did not significantly affect SAA concentration. Measurement of SAA concentration is a useful biomarker for detecting the presence or absence of inflammation in diseased cats. However, it may not be useful as a biomarker for determining the prognosis of the disease.

Evaluation of atrial natriuretic peptide and cardiac troponin I concentrations for assessment of disease severity in dogs with naturally occurring mitral valve disease.

OBJECTIVE: To evaluate and compare the clinical usefulness of plasma atrial natriuretic peptide (ANP) and cardiac troponin-I (cTnI) concentrations for assessment of disease severity in dogs with naturally occurring mitral valve disease (MVD). ANIMALS: 316 dogs with MVD and 40 healthy control dogs. PROCEDURES: Each dog underwent a physical examination and echocardiographic and thoracic radiographic assessments. Blood samples were obtained and processed for measurement of plasma ANP and cTnI concentrations. Dogs with MVD were categorized into 3 groups (stages B1 [no clinical signs or evidence of cardiac enlargement], B2 [no clinical signs with evidence of cardiac enlargement], and C [history of congestive heart failure and pulmonary edema]) on the basis of American College of Veterinary Internal Medicine guidelines. Receiver operating characteristic curve analysis was used to evaluate the accuracy of plasma ANP and cTnI concentrations for assessment of MVD severity. RESULTS: Plasma ANP and cTnI concentrations increased as disease severity increased. Median plasma ANP concentrations for all 3 MVD groups and median plasma cTnI concentrations for the stage B2 and C groups were significantly greater than the corresponding concentrations for the control group. Plasma ANP concentration, but not cTnI concentration, appeared to be useful for detection of dogs with subclinical (stages B1 and B2) MVD, whereas both concentrations appeared useful for detection of dogs with stage C MVD. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that plasma ANP and cTnI concentrations should not be used independently to diagnose MVD but can be used to assess MVD severity and supplement echocardiographic findings.

Complete Remission of Associative Immune-Mediated Hemolytic Anemia in a Dog Following Surgical Resection of Intestinal Leiomyosarcoma.

A twelve-year-old male castrated Chihuahua with a severe, microcytic, hypochromic, and nonregenerative direct antiglobulin test positive anemia characterized by marked spherocytosis was referred to the veterinary hospital. Abdominal ultrasound revealed a peritoneal mass of unclear origin. Transfusion, followed by mass resection, rapidly resolved the anemia without further immunosuppressive treatment. Histopathology confirmed extraluminal jejunal leiomyosarcoma. Multiple mechanisms, including immune-mediated destruction, likely contributed to the anemia. To the authors' knowledge, this is the first report that describes the resolution of immune-mediated hemolysis in a dog after the removal of an intestinal neoplasm.

Resolution of reactive arthritis after splenectomy in a dog with a nonneoplastic splenic hyperplastic nodule.

CASE DESCRIPTION: A 10-year-old spayed female Golden Retriever was examined because of a 3-month history of lethargy, anorexia, and stumbling gait. CLINICAL FINDINGS: A splenic mass was identified on abdominal radiography and ultrasonography, and results of clinicopathologic findings indicated nonregenerative anemia, leukocytosis, and high serum C-reactive protein (CRP) concentration. To further investigate the cause of the dog's high serum CRP concentration, radiography and arthrocentesis were performed bilaterally on the carpal and stifle joints. On the basis of results, anemia of chronic disease associated with polyarthritis caused by the localized splenic mass was suspected. TREATMENT AND OUTCOME: After splenectomy, there were improvements in the dog's clinical signs, polyarthritis, nonregenerative anemia, and serum CRP concentration. The splenic mass was histologically diagnosed as a nonneoplastic splenic hyperplastic nodule with evidence of omental adhesion. CLINICAL RELEVANCE: Findings indicated that nonneoplastic splenic hyperplastic nodules could result in reactive polyarthritis, although such nodules have not to our knowledge been described previously as an underlying cause of polyarthritis. Therefore, veterinarians should investigate for nonneoplastic splenic hyperplastic nodules in addition to other typical underlying causes when treating dogs with polyarthritis.

A case of fibrosarcoma on the perivertebral surface of a ferret with hind limb paralysis.

A 2.5 year-old female ferret had a stiff palpable mass arising from the dorsal surface of the thoracic (T) to lumbar (L) vertebrae with paralysis of the hind limbs. By myelography the dorsal and ventral lines of contrast were not observed in the area forwarded of L3. Grossly, the tumor encircled the dorsal vertebrae. Microscopically, tumor cells were proliferated intimately and were attached to the vertebrae surface involving surrounding fatty and connective tissues. The tumor consisted of fibroblastic cells with prominent cellular atypia. The bromodeoxyuridine (BrdU) labeling index to examine cellular kinetics was high (11.8%). Based on macro and micropathological features, the present tumor was diagnosed as periosteal fibrosarcoma arising from perivertebral connective tissue.

Diagnostic utility of cardiac troponin I in cats with hypertrophic cardiomyopathy.

BACKGROUND: Cardiac troponin I (cTnI) is useful for assessing hypertrophic cardiomyopathy (HCM) in cats. OBJECTIVE: To measure plasma cTnI concentrations in healthy cats and evaluate the clinical utility of cTnI in determining the severity of HCM. ANIMALS: Clinically healthy cats (n = 88) and cats with HCM (n = 93). METHODS: Multicenter prospective study. Cats with HCM, including hypertrophic obstructive cardiomyopathy at various stages, were diagnosed using echocardiography. Plasma cTnI concentrations were analyzed by a commercial laboratory. Receiver-operating characteristic curve analysis was used to evaluate the accuracy of plasma cTnI concentrations to detect HCM. RESULTS: The median cTnI concentration was 0.027 ng/mL (interquartile range, 0.012-0.048 ng/mL) in healthy cats. Concentrations were significantly higher in diseased cats than in healthy controls, and concentrations were significantly higher in cats with heart failure than in asymptomatic cats. A plasma cTnI concentration of 0.163 ng/mL had a sensitivity of 62.0% and specificity of 100% when used to distinguish normal cats from asymptomatic HCM cats without left atrial dilatation. A cutoff of 0.234 ng/mL had high sensitivity (95.0%) and specificity (77.8%) for assessing heart failure. The areas under the receiver-operating characteristic curves were 0.85 and 0.93, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Increased cTnI concentrations reflect the severity of HCM. If other causes of cardiac injury are ruled out, plasma cTnI concentration may be useful for predicting the severity of HCM in cats.

Enterolithiasis in a cat.

An 8-year-old female Persian cat was brought in for evaluation of chronic vomiting. The presence of opaque enteric foreign bodies and intestinal obstruction along with azotaemia, hyperphosphataemia, moderate anaemia and peritoneal fluid were revealed following appropriate diagnostic work-up. Exploratory laparotomy confirmed jejunoileal dilation, ileocaecal stenosis, and numerous foreign objects in the jejunoileum. These foreign objects and ileocaecal stenosis were surgically removed, and intestinal resection and anastomosis was performed. The patient recovered favourably. Analysis revealed that the foreign objects were composed of calcium phosphate and calcium carbonate. Intestinal inflammation and stenosis secondary to enterolithiasis may have developed following ingestion of cat litter or a previous unrelated surgical intervention. We were unable to delineate the inciting pathogenesis in this particular case.