Itraconazole for the Treatment of Histoplasmosis in Cats

Eight cats with histoplasmosis were treated with itraconazole at 5 mg/kg per dose PO bid. There were multiple sites of infection, and 2 of the cats had hypercalcemia that was attributed to the histoplasmosis. All 8 cats were eventually cured, but 2 cats experienced recurrences of disease after completion of therapy, requiring 2 to 3 additional months of itraconazole. There were no clinically relevant adverse effects during treatment. Although a limited number of cats were treated, the study suggests that itraconazole is a well-tolerated and effective drug for the treatment of histoplasmosis in the cat.     

Treatment of Blastomycosis With Itraconazole in 112 Dogs

One hundred twelve client-owned dogs with blastomycosis were treated with itraconazole, 5 or 10 mg/kg/d. The first group of 70 dogs treated in 1987 and 1988 received 10 mg/kg/d (group 1), and the second group of 42 dogs treated after October 1988 received 5 mg/kg/d (group 2). Even though the groups were treated at different times, the dogs were similar in age and gender distribution, number of sites involved, and percent and severity of pulmonary involvement. The proportion of dogs cured with a 60–day course of itraconazole was similar for both groups (53.6% versus 54.3%) and for a second historical control group treated with amphotericin B (57%); the recurrence rate was also similar, 20%, 21.4%, and 20%, respectively. Dogs treated with itraconazole had similar mortality rates (25.7% at 5 mg/kg/d; 25% at 10 mg/kg/day) to those treated with amphotericin B (23%). Seventeen of the 23 dogs that died (74%), did so during the first week of treatment; these early deaths were usually attributed to respiratory failure. The only site of infection that was significantly associated with failure (death or recurrence) was the brain. There was a marked difference in survival times between dogs without lung disease or with mild lung disease compared with dogs with moderate or severe lung disease. Serum itraconazole concentrations reached steady state by 14 days of treatment. Dogs receiving 5 mg/kg/d of itraconazole (group 2) had mean serum concentrations of 3.55 ± 2.81 mg/mL (range, 0.67 to 10.8 μg/mL), whereas dogs receiving 10 μg/kg/d (group 1) had mean concentrations of 13.46 ± 8.49 μg/mL (range, 1.8 to 28 μg/mL) (P ≤ .001). There was no association between cure and serum itraconazole concentrations. Dogs in group 1 had significantly more adverse effects than dogs in group 2 (P= .046). Anorexia was the most common adverse effect, occurring in 14.9% of dogs in group 1. Only 8% of dogs in group 2 had adverse effects. Serum concentrations of itraconazole were positively correlated with serum alkaline phosphatase and alanine aminotransferase activities. Our findings indicate that itraconazole administered at a dose of 5 mg/kg/d is the drug of choice for blastomycosis in dogs.     

Results of Craniotomy for the Treatment of Cerebral Meningioma in 42 Cats

Forty-two cats underwent craniotomy for removal of a meningioma between 1985 and 1991. Median duration of clinical signs before examination was 1.25 months. All cats had inappropriate demeanor: 48% were dull and 38% were lethargic. Neurological deficits included impaired vision in 93%, paresis in 83%, and seizures in 19%. Computed tomography (CT) showed solitary masses in 86% and multiple masses in 14%. Intraoperative complications included hemorrhage and difficulty excising deep or adherent masses. Anemia in 13 of 42 cats was the most common immediate postoperative complication. Ten of 42 cats had no improvement or a more severe neurological status after surgery. Eight of 42 cats died immediately after surgery; 6 of these were anemic. Of the cats that survived the immediate postoperative period, evaluation 10 to 14 days after surgery showed that 97% (33 of 34) were alert and 79% (27 of 34) had returned to normal behavior. Neurological deficits, except for vision impairment, had resolved in most cats. The duration of follow-up varied from 1.3 months to 55.1 months. Ten cats developed neurological abnormalities from 1 month to 44.2 months after surgery; of these, 6 had tumor recurrence or new growth confirmed by CT scan or necropsy. Overall survival was 71% at 6 months, 66% at 1 year, and 50% at 2 years. Age of cat and location of tumor did not significantly affect survival ( P = . 1034 and .1851, respectively). There were too few precise measurements of tumor size to make a valid statistical comparison of the effect of size on survival. Location or presence of multiple tumors did not affect final outcome. Results of this study indicate that surgical excision is a beneficial method of treatment of cranial meningioma in cats.     

Arytenoid Lateralization for Treatment of Laryngeal Paralysis in 10 Cats

Objective— To describe the signalment, history, clinical signs, surgical technique, and outcome for cats with laryngeal paralysis that had arytenoid lateralization.
Study Design— Case series.
Animals— Cats with laryngeal paralysis (n=10).
Methods— Medical records (1996–2002) for cats with laryngeal paralysis that had arytenoid lateralization were reviewed for signalment, history, clinical signs, degree of paralysis, cause, concurrent medical conditions, surgical technique, and outcome. Follow-up information was obtained from owners or referring veterinarians.
Results— Of 10 cats, 9 had bilateral and 1 had unilateral laryngeal paralysis. Arytenoid lateralization were unilateral (n=7), bilateral (1), and staged bilateral procedures (2), 10 days and 3 years apart, respectively. Postoperatively, 1 cat had persistent inspiratory noise because of minimal enlargement of the rima glottidis and 2 cats required a temporary tracheostomy for management of laryngeal swelling. Three cats developed aspiration pneumonia and died 4, 7, and 150 days after surgery; all 3 had bilateral (simultaneous or staged) procedures. Of the 7 remaining cats, 4 were alive at follow-up and 3 had died of causes unrelated to arytenoid lateralization. The calculated mean survival time for all 10 cats was 406 days (median, 150 days; range, 4–1825 days).
Conclusions— Arytenoid lateralization was effective at enlarging the rima glottidis and reducing signs of airway obstruction in most cats.
Clinical Relevance— Unilateral arytenoid lateralization is a feasible option for the surgical management of cats with marked clinical signs; however, bilateral procedures should be avoided or at least performed with considerable caution because of the apparent risk for aspiration pneumonia.     

Treatment of Mycotic Rhinitis With Itraconazole in Three Horses

Itraconazole, a third-generation azole, was evaluated for treatment of resistant nasal mycotic infections in horses. Two horses with Aspergillus spp nasal granulomas and 1 horse with Conidiobolus coronatus nasal infection were treated with itraconazole (3 mg/kg PO bid). One of the horses with nasal aspergillosis was also treated by surgical resection of the nasal septum. The treatment time for the horses ranged from 3 to 4.5 months. No adverse effects were noted in any of the horses during the treatment period. Peak and trough serum itraconazole concentrations were < 0.5 μg/mL in all 3 horses. Itraconazole (3 mg/kg PO bid) appears to be effective in the treatment of nasal Aspergillus spp infections in horses because the fungal infection was eliminated in both horses. One horse still had excessive nasal sounds during exercise and was retired from training, whereas the other horse returned to normal. The nasal C. coronatus infection appeared resistant to itraconazole treatment in the affected horse because the granulomas were still present after 4.5 months of treatment.     

Permanent Pacemaker Implantation for Treatment of Symptomatic Bradycardia in Two Cats

Two cats with bradycardia and syncope were treated by permanent pacemaker implantation. Cat 1 had multiple episodes of syncope intermittently over a 10-month period and then multiple episodes within 24 hours; cat 2 had episodes of collapse over a 3-month period. Clinical signs included disorientation, vocalization, and collapse. High-grade second-degree AV block was recorded in both cats, with left and right bundle branch block in cat 1 and right bundle branch block in cat 2. Neither responded to pharmacologic therapy. In cat 1, an epimyocardial electrode was implanted into the left ventricular apex by a ventral abdominal transdiaphragmatic surgical approach. Cat 2 had a permanent smooth endocardial pacing lead introduced into the fight external jugular vein and directed into the right ventricular apex. Both cats were clinically normal within three days after implantation. Complications in cat 2 included failure of pacemaker capture, endocardial lead dislodgement, and pulse generator pocket seroma. Cats with symptomatic bradycardia caused by second-degree and third-degree AV block can be effectively treated by pacemaker implantation by surgical endomyocardial or perivenous endocardial lead placement.     

Enteric Function in Cats after Subtotal Colectomy for Treatment of Megacolon

The enteric function of four cats that had undergone subtotal colectomy for megacolon was compared with that of four normal cats. All cats were fed the same diet before and during the study. History, physical condition, body weight, blood chemistry panel, fasting and postprandial serum bile acids, serum cobalamin concentration, serum folate concentration, fecal weight, fecal water content, fecal fat content, fecal osmolality and electrolyte concentration, quantitative anaerobic fecal bacterial culture, partial thromboplastin time, prothrombin time, breath hydrogen concentration, urinary calcium, phosphorus and electrolyte concentrations, and abdominal radiographic examination with air contrast studies (pneumocolon) were examined. The four cats treated surgically were healthy and thriving and, in general, enteric function was similar to the controls. Bowel movements occurred only slightly more frequently with no significant differences in fecal volume or water content. Serum cobalamin concentrations were significantly higher in cats treated surgically. Fecal sodium concentrations were high and fecal potassium concentrations were low. Results of this study did not show any significant subclinical evidence of abnormal bowel function in cats after subtotal colectomy.     

Subtotal Colectomy for the Treatment of Obstipation Secondary to Pelvic Fracture Malunion in Cats

Eleven cats in which subtotal colectomy with end-to-end jejunocolostomy was performed for the treatment of chronic obstipation secondary to pelvic fracture malunion were followed for at least 18 months. Seven cats had no recurrence of clinical signs and no longterm complications. In two cats, constipation was less severe and occurred less frequently; however, medical treatment was still required. In one cat, watery diarrhea gradually changed to semiformed feces of normal consistency by month 6; the cat was clinically normal at month 18. One cat had recurrence of constipation and was euthanatized after 2 years of medical treatment.     

Methimazole Treatment of 262 Cats With Hyperthyroidism

The efficacy and safety of the antithyroid drug methimazole were evaluated over a 3-year period in 262 cats with hyperthyroidism. In 181 of the cats, methimazole was administered for 7 to 130 days (mean, 27.7 days) as a preoperative preparation for thyroidectomy. The remaining 81 cats were given methimazole for 30 to 1,000 days (mean, 228 days) as sole treatment for the hyperthyroid state. After 2 to 3 weeks of methimazole therapy (10 to 15 mg/d), the mean serum thyroxine (T4) concentration decreased significantly (P less than 0.001) from a pretreatment value of 12.1 micrograms/dl to 2.1 micrograms/dl. The final maintenance dose needed to maintain euthyroidism in the 81 cats that were given methimazole as sole treatment for hyperthyroidism ranged from 2.5 to 20 mg/d (mean, 11.9 mg/d). Clinical side effects developed in 48 (18.3%) cats (usually within the first month of therapy), which included anorexia, vomiting, lethargy, self-induced excoriation of the face and neck, bleeding diathesis, and icterus caused by hepatopathy. Mild hematologic abnormalities developed in 43 (16.4%) cats (usually within the first 2 months of treatment), which included eosinophilia, lymphocytosis, and slight leukopenia. In ten (3.8%) cats, more serious hematologic reactions developed including agranulocytosis and thrombocytopenia (associated with bleeding). These hematologic abnormalities resolved within 1 week after cessation of methimazole treatment. Immunologic abnormalities associated with methimazole treatment included the development of antinuclear antibodies in 52 of 238 (21.8%) cats tested and red cell autoantibodies (as evidenced by positive direct antiglobulin tests) in three of 160 (1.9%) cats tested.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Treatment of Acute Glaucoma in Dogs and Cats

Objective: Glaucoma is an optic nerve disease that may result in rapid loss of vision. Early detection of acute glaucoma and aggressive treatment is important to preserve vision. Continued treatment is indicated in chronic glaucoma to alleviate discomfort associated with chronic elevated intraocular pressure.
Etiology: In primary glaucoma, an abnormal iridocorneal angle results in obstruction to outflow of aqueous humor. In secondary glaucoma, an otherwise normal iridocorneal angle is obstructed by abnormalities such as a luxated lens, neovascular membranes or inflammatory material.
Diagnosis: The diagnosis is made by a combination of clinical signs such as corneal edema, mydriasis, decreased vision, episcleral hyperemia, and confirmed by measuring an elevation in intraocular pressure. Complete ophthalmic examination, knowledge of breed predisposition to various ocular diseases and gonioscopy will aid in distinguishing between primary and secondary glaucoma
Therapy: Aggressive medical management is important in acute glaucoma. Surgical procedures are often indicated after initial emergency medical treatment of acute glaucoma. Chronic, painful blind eyes are best treated with one of various surgical procedures.
Prognosis: The prognosis for maintaining vision or regaining temporarily lost vision in acute glaucoma is related to numerous factors including time between onset of clinical signs and appropriate treatment, etiology of the glaucoma, initial response to therapy and client compliance.     

En Bloc Ovariohysterectomy as a Treatment for Dystocia in Dogs and Cats

En bloc ovariohysterectomy, a technique that involves ovariohysterectomy before hysterotomy and removal of the neonates, was performed on 63 animals (37 dogs and 26 cats). Intraoperative complications were limited to 1 cat that bled excessively during surgery and was later found to have a clotting disorder. Postoperative complications included anemia that required blood transfusion in 3 cats, uroperitoneum in 1 dog, and death in 1 cat. The rate of neonatal survival (75% for dogs and 42% for cats) was similar to that documented by previous studies of medical and surgical management of dystocia. We concluded that en bloc ovariohysterectomy is a safe and effective alternative to cesarean section for surgical treatment of dystocia in dogs and cats.     

猫肝外门静脉分流的诊断与治疗

体重为1.7 kg的4月龄英国短毛公猫,免疫完全,定时体内外驱虫.就诊期间表现为精神沉郁、低烧、流涎的症状,进行保守内科治疗但症状未见明显改善,并进一步出现癫痫、视力障碍等症状.采用血液学检查、影像学检查以及CT血管造影方法进行进一步检查诊断,确诊为猫单一性肝外门静脉分流.实行外科手术放置缩窄环,缓慢封闭分流的血管.术...     

Survival and the Development of Azotemia after Treatment of Hyperthyroid Cats

Background: Hyperthyroidism complicates the diagnosis of chronic kidney disease (CKD) as it increases glomerular filtration rate. No practical and reliable means for identifying those cats that will develop azotemia after treatment for hyperthyroidism has been identified. Hyperthyroidism is associated with proteinuria. Proteinuria has been correlated with decreased survival of cats with CKD and with progression of CKD. Hypothesis: Proteinuria and other clinical parameters measured at diagnosis of hyperthyroidism will be associated with the development of azotemia and survival time. Animals: Three hundred client owned hyperthyroid cats treated in first opinion practice. Methods: Retrospective, cohort study relating clinical parameters in hyperthyroid cats at diagnosis to the development of azotemia within 240 days of diagnosis and survival time (all cause mortality). Multivariable logistic regression analysis was used to identify factors that were predictive of the development of azotemia. Multivariable Cox regression analysis was used to identify factors associated with survival. Results: Three hundred cats were eligible for survival analysis and 216 cats for analysis of factors associated with the development of azotemia. The median survival time was 417 days, and 15.3% (41/268) cats developed azotemia within 240 days of diagnosis of hyperthyroidism. Plasma concentrations of urea and creatinine were positively correlated with the development of azotemia. Plasma globulin concentration was negatively correlated with the development of azotemia. Age, urine protein : creatinine ratio, and the presence of hypertension were significantly correlated with decreased survival time. Urine specific gravity and PCV were significantly correlated with increased survival time. Conclusions and Clinical Importance: The proteinuria associated with hyperthyroidism is not a mediator of progression of CKD; however, it does correlate with all cause mortality.     

Cryptococcosis in a cat

The effectiveness, safety, economics and methodology of selenate prill topdressing in preventing selenium deficiency in grazing stock under various farming conditions on all groups of deficient soil are reviewed. Topdressing at the approved rate of 10 g/ha Se is effective for 12 months, and has a toxicity safety margin of about 20 times. This compares favourably with selenium dosing. However, materials for dosing usually cost less than one-sixth of those for topdressing. Considerations of convenience, correction of soil deficiency, and production profitability make topdressing an alternative for some farmers; particularly with severe deficiency, and a high stocking rate. Topdressing costs are least where one-sixth or less of the farm can be treated and grazed continuously for 2 months or more; as by ewes at mating. At the very small approved rate no adverse effects are foreseen on human or animal health, export sales, or the environment.