Serum insulin concentrations in horses with equine Cushing's syndrome: response to a cortisol inhibitor and prognostic value

REASONS FOR PERFORMING STUDY: Serum insulin concentration and its use as a prognostic indicator in horses with equine Cushing's syndrome (ECS) have been poorly documented. OBJECTIVES: To examine daily insulin variations in horses with ECS and the effect of treatment using trilostane, a competitive inhibitor of 3beta-hydroxysteroid dehydrogenase. Further, we aimed to examine the relationship between baseline serum insulin concentration and survival in horses with ECS. METHODS: Basal serum insulin concentrations were measured in 20 confirmed ECS cases by taking blood at regular 4 h intervals for 24 h (1200, 1600, 2000, 2400, 0400 and 0800 h) before treatment (Day 0) and 10 days, and 30 days and 1-2 years after the onset of trilostane therapy. The temporal pattern of insulin was analysed using a linear mixed model approach, and the prognostic value of measurements on Day 0 assessed using receiver-operating characteristic analysis. RESULTS: Horses with ECS showed a diurnal pattern of serum insulin concentration, highest value at 1200 h, and this pattern was not altered by treatment with trilostane. Furthermore, despite a mild increase of serum insulin concentrations after 10 days of trilostane therapy, insulin concentration was unaffected in the long-term. Low serum insulin concentrations at the beginning of the trial were significantly associated with improved survival to 1-2 years. The 1200 h sampling before treatment had the highest prognostic value for prediction of survival with a sensitivity and specificity of at least 90% for serum insulin at < 62 and > 188 microu/ml to predict survival and nonsurvival, respectively. CONCLUSIONS AND POTENTIAL RELEVANCE: Insulin is a useful prognostic indicator for ECS, but potentially large variations can occur throughout a 24 h period, indicating a single sample may not be representative. Serum insulin concentration did not increase over 1-2 years in horses receiving trilostane therapy.     

Outbreak of Salmonella enterica serotype Newport in a beef cow-calf herd associated with exposure to bovine viral diarrhea virus

CASE DESCRIPTION: Severe disease and death in cows and calves affected 1 of 3 separate groups (A, B, and C) of cattle on a commercial cow-calf operation. CLINICAL FINDINGS: Clinical illness consisting of severe watery and bloody diarrhea, dehydration, weakness, and death affected adult cows and calves in 1 group (group B). Salmonella enterica serotype Newport was recovered from tissues of cows and calves from group B. TREATMENT AND OUTCOME: Despite supportive and antimicrobial treatment of cattle in group B, cow mortality rate attributable to salmonellosis in that group was 7.9% (32/407); calf mortality rate was 14.4% (52/361). None of the cows in Groups A or C died, and the calf mortality rate in those groups was low. Salmonella enterica serotype Newport was recovered from pooled fecal samples subsequently collected from each group of cows. Bovine viral diarrhea virus (BVDV) antigen was identified in an ear notch sample collected from a necropsied calf from group B. Subsequently, ear notch specimens from cattle in all 3 groups were tested for BVDV antigen. A significantly higher proportion of calves persistently infected with BVDV was identified in group B (8/295 [2.7%]), compared with the proportion in groups A and C combined (1/287 [0.3%]). CLINICAL RELEVANCE: Outbreaks of disease attributable to Salmonella Newport infection in beef cattle are unusual. Because of the immunosuppressive nature of BVDV, the possibility of animals persistently infected with BVDV within the herd should be considered during investigation of unusual outbreaks of infectious diseases.     

Low ratios of sodium to potassium in the serum of 238 dogs

Serum sodium:potassium (Na:K) ratios are often reported in biochemical studies of dogs, although their value has not been assessed. The aims of this study were to identify diseases associated with a low Na:K ratio in dogs and to compare their prevalence with the prevalence in dogs from the same referral hospital with normal Na:K ratios. A total of 238 dogs with a Na:K ratio less than 27 were identified from medical records. Sample contamination with edta was suspected in 74 cases (31 per cent) and these and two cases that had been supplemented with potassium were removed from the analysis. The remaining 162 cases and 147 control dogs were divided into five categories depending on the organ system affected. Among the cases there were significantly more in the endocrine category than among the control dogs. Hypoadrenocorticism was the most single common cause of a low Na:K ratio and affected 27 (16.7 per cent) of the cases. Other clinical problems associated with low Na:K ratios included different urogenital, cardiorespiratory and gastrointestinal diseases.     

Nasal oncocytoma in a domestic shorthair cat

An oncocytoma was diagnosed in the nasal cavity of a 12-year-old Domestic Shorthair cat who presented with periocular swelling and sneezing. Histologic examination from biopsy material revealed monomorphic sheets, anastomosing cords, tubules, and acini composed of large polygonal to oval cells that contained abundant finely granular eosinophilic cytoplasm. No vascular or lymphatic invasions were noted. Histochemical stains revealed positive staining of tumor cells with periodic acid-Schiff (PAS) (before and after diastase digestion) and phosphotungstic acid-hematoxylin. Immunohistochemical evaluation of the tumor cells demonstrated positive staining for cytokeratin and negative staining for vimentin, desmin, S-100, glial fibrillar acidic protein, and neuronal specific enolase. Ultrastructurally, the tumor cells contained large numbers of mitochondria within their cytoplasm, which confirmed a diagnosis of oncocytoma.     

Emesis in dogs: a review

Emesis is a common presenting sign in small animal practice. It requires a rational approach to management that is based upon a sound understanding of pathophysiology combined with logical decision making. This review, which assesses the weight of available evidence, outlines the physiology of the vomiting reflex, causes of emesis, the consequences of emesis and the approach to clinical management of the vomiting dog. The applicability of diagnostic testing modalities and the merit of traditional approaches to management, such as dietary changes, are discussed. The role and usefulness of both traditional and novel anti-emetic drugs is examined, including in specific circumstances such as following cytotoxic drug treatment. The review also examines areas in which common clinical practice is not necessarily supported by objective evidence and, as such, highlights questions worthy of further clinical research.     

Intra- and interlaboratory variability of allergen-specific IgE levels in atopic dogs in three different laboratories using the Fc-ɛ receptor testing

The IgE specific Fc-? receptor test is widely used for serological evaluation of allergic canine patients. Aim of the study was to evaluate intra- and interlaboratory variability in three independent laboratories. Duplicate serum aliquots from 15 atopic dogs were submitted simultaneously to 3 laboratories (LA, LB, LC), which subsequently performed the test in a blinded fashion. LA and LC analysed sera for 35 allergens and expressed the results as optical density units (OD), while LB analysed 15 allergens and provided reaction grades (RG). Results were compared with three factorial ANOVA. Intralaboratory variability was evaluated by calculating the dispersion factor for data of LA and LC and standard deviation (SD) for LB. Correlation coefficients (r) were used to evaluate interlaboratory variability. Depending on the allergens, intralaboratory dispersion factor for LA and LC varied from 1.15 to 6.63 and 1.19 to 6.17, respectively. In LB the SD varied between 0 and 0.6 RG. Regarding interlaboratory variability, correlation of OD values between LA and LC was excellent (r > 0.8, p < 0.001) for 13 of 35 allergens. There was a significant difference in OD results for 9 allergens. The results were significantly correlated (r > 0.8, p < 0.001) for all except 3 allergens (Dermatophagoides pteronyssinus, mixed grasses, nettle). As far as negative/positive results were concerned, intralaboratory differences were 3.14% and interlaboratory differences were 4.76%.     

Recurrent single oesophageal stricture treated with a self-expanding stent in a cat

A 1-year-old, female spayed domestic shorthair cat was presented with a 4-week history of dysphagia and regurgitation soon after oral treatment with clindamycin. Fluoroscopic and endoscopic examinations confirmed the presence of a single cervical oesophageal stricture 4 cm caudal to the pharynx. A fluoroscopically and endoscopically guided balloon dilation was performed six times consecutively over a period of 3 weeks as reformation of the stricture appeared within 3-7 days. Feeding via percutaneous endoscopic gastrostomy-tube as long-term management of the condition was declined by the owner. A self-expanding metal oesophageal stent with the following dimension was subsequently implanted: fully open diameter 16 mm, length 30 mm. After stent implantation, the cat was fed on mashed canned food and did not show any clinical signs for 12 months. Twelve months post-implantation the cat was no longer able to eat even liquid food, became lethargic and the owner opted for euthanasia. On post-mortem examination the stent surfaces were overgrown by oesophageal mucosa by approximately 50%. Stent obstruction was detected and caused by swallowed hair which also seemed to have hampered mucosal integration in the distal part of the stent.     

Primary hyperparathyroidism in 29 dogs: diagnosis, treatment, outcome and associated renal failure

OBJECTIVES: To review the records of 29 dogs diagnosed with primary hyperparathyroidism and see if any factors correlate with renal failure. METHODS: Dogs were selected retrospectively from case files from the QVSH and the QMH. RESULTS: The majority of dogs were middle-aged and four were keeshonds. The primary presenting complaints were polyuria and polydipsia. All dogs had an elevated total and ionised plasma calcium concentration. Plasma phosphate concentrations were variable. Ultrasonography of the parathyroid gland revealed nodular enlargement which was found to correlate well with surgical findings. The majority of dogs underwent surgical parathyroidectomy. Five cases were treated by ultrasound-guided chemical ablation of the parathyroid gland, of which only two cases showed a partial response. Three dogs were euthanased within a week of presentation. Seven other dogs had renal failure diagnosed either at presentation or up to six months after parathyroidectomy. The development of renal failure was correlated with total calcium concentration but did not correlate with any other factor, including the calcium phosphate product. Thirteen treated dogs were known to be alive at the time of writing, which was six months to 3.5 years after parathyroidectomy. CLINICAL SIGNIFICANCE: Primary hyperparathyroidism cases with high total calcium were more likely to develop renal failure in this group of dogs; however, the calcium phosphate product did not seem to be a useful predictor. Ultrasound-guided chemical ablation seemed to have limited advantage over surgery.