Feline cholecystitis and acute neutrophilic cholangitis: clinical findings, bacterial isolates and response to treatment in six cases

Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.     

Feline chronic renal failure: clinical findings in 80 cases diagnosed between 1992 and 1995

Clinical and laboratory findings at the time of first diagnosis in 80 cats with chronic renal failure (CRF) were examined in a prospective study to determine the survival time of these animals and identify possible factors contributing to the progression of feline CRF. On the basis of clinical presentation, animals were assigned to one of three groups; compensated (n=15), uraemic (n=39) and end-stage (n=26) CRF. Loss of renal concentrating ability was a common finding, even before clinical signs of renal disease were evident. The plasma creatinine concentration at initial presentation was a poor predictor of survival time and the presence of significant anaemia was indicative of a poor prognosis. The study demonstrated the highly variable degree of renal impairment present at the time of diagnosis and the potentially long survival time of many compensated and uraemic cases.     

Feline cerebrovascular disease: clinical and histopathologic findings in 16 cats

Sixteen cats with cerebrovascular disease confirmed via histology to be of nontraumatic and nonneoplastic origins are described. In addition, the anatomy of the arterial supply of the cat's brain is reviewed. It is suggested that this unique arterial design may influence the incidence of cerebrovascular accidents in this species. Of the 16 cats reviewed, seven cats had ischemic infarctions, five had hemorrhagic infarctions, and four were diagnosed with intracranial hemorrhage. The median age was 8 yr and 9.5 yr in cats with infarctions and intracranial hemorrhages, respectively. Clinical signs were severe, acute, consistent with the localization of the cerebrovascular lesion, and influenced by underlying pathology. Four cats with infarction showed lateralized neurologic signs. Four cats with infarctions were diagnosed with pulmonary disease antemortem and three cats had hyperthyroidism. Cerebrospinal fluid analysis and computed tomography scans were available in two cats. None of the infarctions were grossly visible. All cats with hemorrhagic infarcts had severe liver pathology and nephritis was identified in four cats. Hypoxia was a feature in four cats and one cat suffered cardiac failure. In conclusion, the clinical picture is influenced by the type of cerebrovascular disease, the localization of the intracranial lesions, and any underlying pathology.     

Feline hyperthyroidism: spectrum of clinical presentions and response to carbimazole therapy

OBJECTIVE: To determine the spectrum of clinical presentations of hyperthyroidism in cats and response to carbimazole therapy by analysis of historical, clinical and laboratory data. DESIGN: A prospective clinical study involving client-owned cats presenting to a private veterinary practice in Australia. PROCEDURE: Twenty-five cats diagnosed as hyperthyroid during a 23-month period participated in the study with owner consent. Therapy with carbimazole was instituted and revisits were scheduled 2, 6 and 13 weeks after diagnosis. The cats were physically examined and underwent haematological and serum biochemical testing at each revisit. Owners were also asked to assess clinical signs in their cats in the periods between veterinary examinations. Cats with underlying renal disease were managed by alterations or cessation of carbimazole therapy. RESULTS: A high prevalence of lethargic or inappetent cats without detectable underlying nonthyroidal illness was found. There was also a high prevalence of cats less than 10-years-old and cats in good body condition. Fourteen cats treated with carbimazole and monitored for 13 weeks responded favourably to therapy. Side-effects were minor and uncommon. Cats with underlying renal disease that became apparent during the study, responded well to alterations or cessation of carbimazole therapy. CONCLUSION: The trend towards more subtle clinical presentations of hyperthyroid cats reported previously continued in this study. The findings of the current study do not appear to support the traditional view of hyperthyroid cats as being old, hyperactive, hungry and thin. Carbimazole therapy was found to decrease the prevalence of almost all clinical abnormalities in 14 cats and side-effects were minor and uncommon. This study demonstrates the usefulness of medical management of hyperthyroidism in the cat when radioiodine therapy is not possible due to renal compromise or other factors.     

Feline thyroid carcinoma: diagnosis and response to high-dose radioactive iodine treatment

This study reports the scintigraphy, histopathology, sole treatment with high-dose radioactive iodine and outcome of eight cases of feline thyroid carcinoma. Scintigraphic findings were variable and in 7/8 cases scintigraphic features could not reliably distinguish whether the thyroid tissue was malignant. Histopathology revealed typical criteria of malignancy in all cases, with mitotic activity described most frequently (7/8 cases), followed by infiltration of local tissues (4/8 cases). Cellular pleomorphism was infrequently observed. Single high-dose (1100MBq I(131)) radioiodine therapy was successful in 6/8 cases, with complete resolution of hyperthyroidism, and was associated with prolonged survival times (181-2381 days). Sole treatment with high-dose radioiodine is a safe and effective treatment for functional thyroid carcinoma. The prognosis for feline thyroid carcinoma successfully treated with radioiodine is good, with extended survival times commonly achieved.     

Feline systemic hypertension: Diagnosis and management

PRACTICAL RELEVANCE: the clinical importance of feline hypertension has been recognised for many years and most feline practitioners are quite familiar with this syndrome. Once systemic hypertension is identified, long-term management of the patient is needed to avoid catastrophic (eg, blindness due to retinal detachment) or subtle (eg, accelerated renal damage) target organ damage. PATIENT GROUP: feline systemic hypertension is most commonly a complication of renal disease and hyperthyroidism, both diseases of older feline patients. By 15 years of age, the probability of having at least one of these two diseases is high. As well cared for cats are living longer, optimal long-term management of feline hypertension in patients with concurrent diseases is an issue of clinical importance. CLINICAL CHALLENGES: obtaining accurate blood pressure measurements in patients that are anxious, fractious or just plain uncooperative remains a significant issue in feline medicine, as does confident analysis of results from these patients. DIAGNOSTICS: careful measurement of systolic blood pressure using Doppler or oscillometric techniques in conjunction with evaluation for evidence of hypertensive choroidopathy (funduscopic examination) and hypertensive cardiac changes (thoracic auscultation) are essential to the diagnosis of systemic hypertension in cats. Other diagnostic techniques, including evaluation of renal and thyroid function, are needed to detect the underlying disease condition. EVIDENCE BASE: numerous well-designed clinical studies have greatly advanced our understanding of the most appropriate methods of diagnosis and therapy of feline hypertension.     

Feline systemic hypertension: Classification and pathogenesis

PRACTICAL RELEVANCE: the increased availability of indirect blood pressure monitoring devices in clinical practice over the past decade has highlighted the significance of systemic hypertension in the feline population. Without routine monitoring and appropriate intervention, cats with undiagnosed systemic hypertension may first be presented with sudden-onset blindness as a consequence of either hyphaema or retinal detachment. CLINICAL CHALLENGES: the primary aim in the early diagnosis and treatment of systemic hypertension is prevention of hypertensive target organ damage (with respect to the eye, kidney, cardiovascular and central nervous systems, in particular). A prerequisite is a knowledge of the pathophysiological mechanisms and disease conditions that may contribute to the development of hypertension. This allows the clinician to determine those cases in which blood pressure assessment and longitudinal monitoring is essential and can assist in determining appropriate therapeutic strategies for control of blood pressure. Recent studies have also begun to explore the relationship that systemic hypertension may have with proteinuria and the progression of kidney disease. PATIENT GROUP: the geriatric cat appears most susceptible to the development of systemic hypertension, and monitoring of systolic blood pressure is often advocated as part of a routine health screen in cats over 9-12 years old. Consideration must also be given to cats suspected of having an underlying disease such as chronic kidney disease or hyperthyroidism, or which are receiving therapeutic agents, irrespective of their age. EVIDENCE BASE: much of our understanding of the pathogenesis of feline hypertension is extrapolated from studies performed in experimental animal models or in human patients, and interspecies differences are often poorly understood.     

Feline cutaneous neuroendocrine carcinoma (Merkel cell tumour): clinical and pathological findings

A case of a feline Merkel cell tumour is described. An 8-year-old, female cat developed a round, alopecic, reddish mass on the nose. Wide excisional surgery was performed with cartilage resection. Histologically the mass was composed of solid islands of mostly basophilic densely packed cells with a scant cytoplasm, which was suggestive of a neuroendocrine origin. Results of immunohistochemical studies using antibodies against neurone-specific enolase, chromogranin, synaptophysin and pan-cytokeratin allowed classification of the lesion as a Merkel cell tumour. Ultrastructurally, dense core granules were identified in the cytoplasm. In a 2-year follow-up no relapses or metastases were observed. The clinical course recorded is in contrast with the malignant nature of a Merkel cell tumour recently described in a cat and of the human Merkel cell tumour, but is similar to the course of the canine Merkel cell tumour which is often benign. Early diagnosis along with the use of wide surgical excision might be considered an important factor in preventing relapse of this tumour.     

Feline inflammatory polyps: historical,clinical, and PCR findings for feline calici virus and feline herpes virus-1 in 28 cases

Inflammatory polyps are associated with significant aural or nasopharyngeal disease in cats. It has been proposed that chronic viral infection may induce the masses. Ventral bulla osteotomy (VBO) is usually recommended for definitive therapy but removal of masses from the nasopharynx or external ear canal by traction/avulsion is also used. A retrospective study of 28 cats with inflammatory polyps was conducted to correlate recurrence with mode of therapy. Tissues from 41 polyps were assayed for feline calicivirus and feline herpesvirus-1 by RT-PCR and PCR, respectively. Of the 14 cats initially treated by traction/avulsion, recurrence was detected in five of nine cats with radiographic evidence of bulla disease but none of the cats with normal bullae. Traction/avulsion is a reasonable treatment for inflammatory polyps if the bullae are radiographically normal. Failure to detect feline calicivirus and feline herpesvirus-1 suggests that tissue persistence of these viruses is not associated with the development of inflammatory polyps.     

Feline perforating dermatitis resembling human reactive perforating collagenosis: clinicopathological findings and outcome in four cases

The clinicopathological findings of perforating dermatitis in two young and two adult cats are described. In all cases, the lesions were characterized by single or multiple papules and plaques, 0.5–3.0 cm in diameter, each containing a central, firm, exophytic, cone-shaped, yellow-orange keratotic plug, tightly adherent to the underlying skin. Removal of the protruding material was associated with bleeding and left the ulcerated surface exposed. In one case, the lesions showed a linear configuration and identical lesions occurred on the suture sites following biopsy. Histopathologically, the diagnosis was straightforward because of the presence of vertically orientated collagen bundles extruded from ulcerated, concave-shaped invaginations of the skin. In two cases, vitamin C administration failed to resolve the disease. In two cases, methyl-prednisolone acetate was used to manage relapsing episodes and vitamin C helped to reduce glucocorticoid requirements. In one case, treatment with methyl-prednisolone acetate only appeared to be curative. The fourth case was lost to follow-up immediately after the diagnosis.     

Feline esophagitis secondary to gastroesophageal reflux disease: clinical signs and radiographic,endoscopic, and histopathological findings

Chronic esophagitis due to gastroesophageal reflux (GER) is rarely reported in the cat. This paper describes the clinical signs and diagnostic findings, including radiographic, endoscopic, and histopathological abnormalities, in three young, purebred, male cats with esophagitis presumed to be secondary to GER. Clinical signs included regurgitation, dysphagia, and weight loss. Contrast radiography revealed GER, esophageal dilatation, and decreased motility. Endoscopy showed hyperemia, increased vascularity, ulcers, erosion, and an abnormal lower esophageal sphincter. Histopathological lesions included squamous hyperplasia and dysplasia, erosions, ulcers, and an inflammatory infiltrate of lymphocytes, plasma cells, and neutrophils. Long-term follow-up demonstrated progression of the disease in two of the cats.     

Feline retinal degeneration: clinical experience and new findings (1994-1997)

A retrospective case series of 26 cats with diffuse retinal degeneration is presented. The most common presenting complaints included bumping into objects, dilated pupils, and reluctance to jump. Ophthalmic examination findings were consistent with those reported in dogs with progressive retinal atrophy. Breed predilection of the Siamese cat was observed. Cats with primary retinal degeneration presented late in the clinical course of their disease, when vision loss was severe. Early symptoms such as night blindness and secondary ocular complications (i.e., cataract and retinal detachment), reported in dogs with progressive retinal degeneration, were not observed in this study. All cats showed excellent adaptive capabilities to blindness.     

Feline extranodal lymphoma: response to chemotherapy and survival in 110 cats

O bjective : To determine response to treatment, survival and prognostic factors for feline extranodal lymphoma in the UK.
M ethods : Records of cats diagnosed with lymphoma of extranodal sites at seven referral centres were reviewed and information on signalment, tumour location, prior treatment and chemotherapy protocol recorded. Factors influencing response to treatment and survival were assessed.
R esults : One hundred and forty-nine cases met inclusion criteria. Sixty-nine cats had nasal lymphoma, 35 renal, 15 central nervous system, 11 laryngeal and 19 miscellaneous locations. Sixty-six cats received cyclophosphamide, vincristine, prednisolone, 25 Wisconsin-Madison doxorubicin-containing multi-agent protocol, 10 prednisolone alone and nine other combinations. The response rate for the 110 treated cats was 85·5 per cent. Of cyclophosphamide, vincristine, prednisolone treated cats 72·7 per cent achieved complete remission, median survival 239 days. Sixty-four per cent of Wisconsin-Madison treated cats achieved complete remission, median survival 563 days. Cats with nasal lymphoma achieving complete remission had the longest survival (749 days) and cats with central nervous system lymphoma the shortest (70 days). If complete remission was achieved, prior treatment with corticosteroids significantly reduced survival time.
C linical S ignificance : Cats with extranodal lymphoma respond to chemotherapy and achieve survival times comparable to other locations. Corticosteroid pretreatment reduced survival time in cats achieving complete remission.     

Cutaneous adverse reaction to furosemide treatment: new clinical findings

A poodle was admitted for investigation of pruritus and a lesional pattern of erythema and alopecia located in the dorsolumbar area. After differential diagnosis ruling out several processes a rare side effect to furosemide, not yet described in canine medicine was confirmed as the possible causative agent.     

Feline uveitis: diagnosis and treatment

Uveitis is the inflammation of any or all parts of the vascular tunic of the eye; the vascular tunic includes the iris, the ciliary body, and choroid. A good knowledge base, up-to-date reference materials, and good instruments will improve the diagnosis of uveitis. Feline uveitis can be caused by numerous infectious agents in addition to neoplasia and less likely trauma. The infectious causes most commonly associated with feline uveitis include feline leukemia virus, feline immunodeficiency virus, feline infectious peritonitis, systemic fungal infections, toxoplasmosis, and bartonellosis. Neoplastic causes of uveitis can be primary or secondary. Iris melanoma is the most common primary uveal neoplasia and trauma-associated sarcoma is the second most common primary uveal neoplasia. Treatment for the clinical signs of anterior uveitis include topical steroidal or non-steroidal anti-inflammatory agents, parasympatholytic agents for ciliary spasm, to keep the pupil dilated, and to prevent posterior synechia. Posterior uveitis should be treated with systemic medications that will address the underlying cause. Enucleation of blind, painful eyes not responsive to medications is a means to alleviate the animal's discomfort and to further diagnose the underlying cause.     

Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)

Clinical and diagnostic parameters, and response to topical mupirocin in 25 cats with feline acne are described. The chin was the most common area affected, but the lower lip, upper lip and the commissure of the lips also frequently had lesions. The most common clinical sign was the presence of crusts, followed by comedones, erythema, alopecia, pruritus and nodules/fistulas. Deep skin scrapings for ectoparasites, cytological examination of superficial skin scrapings, and fungal cultures from the chin were performed on all cats. Dermatophytes were cultured from two cats and Malassezia pachydermatis was cultured ( n  = 2), seen on cytology smears ( n  = 1), or noted on histopathology ( n  = 1). Skin biopsies were obtained from three of the cats and most commonly showed dilatation of sebaceous gland ducts, neutrophilic or pyogranulomatous infiltration of the sebaceous glands, and pyogranulomatous inflammation of the dermis.
All cats were treated with topical 2% mupirocin ointment twice daily for 3 weeks as the sole treatment. Treatment response was excellent in 15 cats and good in nine cats. One cat had a contact reaction to the mupirocin, necessitating stopping treatment. The response to treatment of the six cats with dermatophyte or years involvement was good ( n  = 3) or excellent ( n  = 3).