Linear-Accelerator-Based Modified Radiosurgical Treatment of Pituitary Tumors in Cats: 11 Cases (1997–2008)

Objective: Determine the efficacy and safety of a linear-accelerator-based single fraction radiosurgical approach to the treatment of pituitary tumors in cats.
Design: Retrospective study.
Animals: Eleven client-owned cats referred for treatment of pituitary tumors causing neurological signs, or poorly controlled diabetes mellitus (DM) secondary either to acromegaly or pituitary-dependent hyperadrenocortism.
Procedures: Cats underwent magnetic resonance imaging (MRI) of the brain to manually plan radiation therapy. After MRI, modified radiosurgery was performed by delivering a single large dose (15 or 20 Gy) of radiation while arcing a linear-accelerator-generated radiation beam around the cat's head with the pituitary mass at the center of the beam. Eight cats were treated once, 2 cats were treated twice, and 1 cat received 3 treatments. Treated cats were evaluated for improvement in endocrine function or resolution of neurological disease by review of medical records or contact with referring veterinarians and owners.
Results: Improvement in clinical signs occurred in 7/11 (63.6%) of treated cats. Five of 9 cats with poorly regulated DM had improved insulin responses, and 2/2 cats with neurological signs had clinical improvement. There were no confirmed acute or late adverse radiation effects. The overall median survival was 25 months (range, 1–60), and 3 cats were still alive.
Conclusions and Clinical Importance: Single fraction modified radiosurgery is a safe and effective approach to the treatment of pituitary tumors in cats.     

Urinary Catecholamine and Metanephrine to Creatinine Ratios in Dogs with Hyperadrenocorticism or Pheochromocytoma,and in Healthy Dogs

Background: Urinary catecholamines and metanephrines are used for the diagnosis of pheochromocytoma (PHEO) in dogs. Hyperadrenocorticism (HAC) is an important differential diagnosis for PHEO. Objectives: To measure urinary catecholamines and metanephrines in dogs with HAC. Animals: Fourteen dogs with HAC, 7 dogs with PHEO, and 10 healthy dogs. Methods: Prospective clinical trial. Urine was collected during initial work‐up in the hospital; in dogs with HAC an additional sample was taken at home 1 week after discharge. Parameters were measured using high‐pressure liquid chromatography and expressed as ratios to urinary creatinine concentration. Results: Dogs with HAC had significantly higher urinary epinephrine, norepinephrine and normetanephrine to creatinine ratios than healthy dogs. Urinary epinephrine, norepinephrine, and metanephrine to creatinine ratios did not differ between dogs with HAC and dogs with PHEO, whereas the urinary normetanephrine to creatinine ratio was significantly higher (P= .011) in dogs with PHEO (414, 157.0–925.0, median, range versus (117.5, 53.0–323.0). Using a cut‐off ratio of 4 times the highest normetanephrine to creatinine ratio measured in controls, there was no overlap between dogs with HAC and dogs with PHEO. The variables determined in urine samples collected at home did not differ from those collected in the hospital. Conclusion and Clinical Importance: Dogs with HAC might have increased concentrations of urinary catecholamines and normetanephrine. A high concentration of urinary normetanephrine (4 times normal), is highly suggestive of PHEO.     

Cryptococcal Infection in Cats: Factors Influencing Treatment Outcome, and Results of Sequential Serum Antigen Titers in 35 Cats

The relationship between treatment outcome and location of cryptococcal infection, gender, magnitude of pretreatment cryptococcal antigen titers, results of feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) serology, and serial changes in antigen titers during and after treatment were evaluated in a prospective and nonrandomized study of 35 cats with cryptococcosis. A commercial cryptococcal latex agglutination kit (CALAS; Meridian Diagnostic Inc, Cincinnati, OH) was used to detect cryptococcal antigen in sera. All cats were treated with itraconazole (Sporanox; Janssen Pharmaceutica Inc, Titusville, NJ). Pre-treatment mean log titers for serum cryptococcal antigen were not influenced by location of the infection. Treatment outcome was not influenced by gender, location of the infection, or magnitude of pretreatment serum antigen titer. Treatment outcome was influenced by FeLV and FIV status; cats seropositive for FeLV or FIV had a higher likelihood of treatment failure ( P = .008). The cryptococcal antigen titers of cats successfully treated decreased with significant linearity over time during treatment (r = -.64, P < .000001), whereas the corresponding titers for cats not treated successfully did not decrease with significant linearity ( r = -.03, P > .9). For cats in which treatment was successful, antigen titers decreased significantly from pretreatment values by 1.3 orders of magnitude at 2 months after initiation of treatment. By 10 months after initiating treatment, log titers decreased by at least 2 orders of magnitude in all cats successfully treated, and 9 of 16 cats had undetectable titers. In contrast, in 5 of 6 cats in which treatment failed, antigen titers were unchanged or increased in magnitude even after at least 6 months of treatment.     

Ultrasonography Criteria for Differentiating ACTH Dependency from ACTH Independency in 47 Dogs with Hyperadrenocorticism and Equivocal Adrenal Asymmetry

Background: Adrenal ultrasonography (US) in dogs with hyperadrenocorticism (HAC) is commonly used to distinguish adrenocorticotropic hormone (ACTH)‐independent (AIHAC) and ACTH‐dependent hyperadrenocorticism (ADHAC). To date, no cut‐off values for defining adrenal atrophy in cases of adrenal asymmetry have been determined. Given that asymmetrical hyperplasia is sometimes observed in ADHAC, adrenal asymmetry without ultrasonographic proof of adrenocortical tumor such as vascular invasion or metastasis can be equivocal. Objective: The purpose of this study was to compare adrenal US findings between cases of ADHAC and AIHAC in dogs with equivocal adrenal asymmetry (EAA), and to identify useful criteria for their distinction. Animals: Forty dogs with EAA were included. Methods: Ultrasound reports of HAC dogs with adrenal asymmetry without obvious vascular invasion or metastases were reviewed. Dogs were classified as cases of ADHAC (n = 28) or AIHAC (n = 19), determined by plasma ACTH concentration. The thickness, shape, and echogenicity of both adrenal glands and presence of adjacent vascular compression were compared between AIHAC and ADHAC groups. Results: The maximal dorsoventral thickness of the smaller gland (SDV) ranged from 2.0 to 5.0 mm in AIHAC and from 5.0 to 15.0 mm in ADHAC. The 95% confidence intervals for estimated sensitivity and specificity of a SDV cut‐off set at 5.0 mm in the diagnosis of AIHAC were 82–100 and 82–99%, respectively. Other tested US criteria were found to overlap extensively between the 2 groups, precluding their usefulness for distinction. Conclusion and Clinical Importance: In EAA cases, an SDV ≤5.0 mm is an appropriate cut‐off for AIHAC ultrasonographic diagnosis.     

30例猫下泌尿道疾病临床诊断与治疗的分析

猫下泌尿道疾病是对猫泌尿系统发生的一种或多种疾病的综合性描述,是猫最常见的疾病之一,多数情况下不能自愈,一旦发病往往不断加重,不仅累及泌尿系统原发病灶,而且常引起其他组织器官的损害,甚至以死亡归转。通过对30例猫下泌尿道病例诊断和治疗过程的统计整理与分析,系统地梳理了猫下泌尿道疾病的诊断和治疗方法,以期对兽医临床工作者有所帮助。     

Exogenous Insulin Treatment after Hypofractionated Radiotherapy in Cats with Diabetes Mellitus and Acromegaly

Background: The optimal treatment for feline acromegaly has yet to be established. Surgical and medical therapies are minimally effective although radiotherapy might have greater efficacy. The purpose of this study was to review the response and outcome of cats with acromegaly and insulin-resistant diabetes mellitus (DM) to radiotherapy.
Hypotheses: That radiotherapy improves glycemic control in cats with acromegaly and that improved glycemic control is due to remission of clinical acromegaly; demonstrated by a fall in serum insulin-like growth factor-1 (IGF-1) concentrations.
Animals: Fourteen cats with naturally occurring acromegaly.
Methods: Retrospective case review; records of all cats treated for acromegaly with radiotherapy were reviewed from 1997 to 2008. Cats were selected on the basis of compatible clinical signs, laboratory features, and diagnostic imaging findings. Fourteen cats received radiotherapy, delivered in 10 fractions, 3 times a week to a total dose of 3,700 cGy.
Results: Thirteen of 14 cats had improved diabetic control after radiotherapy. These improvements were sustained for up to 60 months. DM progressed in 2 cats and 1 did not respond. Seven cats responded before the final treatment. Ten cats were euthanized, 1 as a consequence of radiotherapy. In 8 cats in which IGF-1 was measured after treatment, changes in its concentration did not reflect the clinical improvement in glycemic control.
Conclusions and Clinical Importance: Radiotherapy represents an effective treatment for cats with insulin-resistant DM resulting from acromegaly. IGF-1 concentration after treatment does not provide a suitable method by which remission from either acromegaly or insulin-resistant DM may be assessed.     

Endoscopic-Assisted Intracranial Tumor Removal in Dogs and Cats: Long-Term Outcome of 39 Cases

Background: The benefits of endoscopic assistance to remove intracranial tumors in small animals are not described.
Objective: To evaluate the effectiveness of endoscopic-assisted intracranial tumor removal in dogs and cats.
Animals: Thirty-three dogs and 6 cats with intracranial tumors.
Methods: Retrospective study. CBC, serum chemistry profile, coagulation testing, blood typing, and systemic tumor staging, which included 3-view thoracic radiographs and abdominal ultrasound examination, were performed to detect other significant underlying disease in preparation of the animal for surgery. Magnetic resonance imaging was used in 37/39 cases to image the brain tumor. Surgical approach was dictated by the location of the tumor. Histopathologic examination of the tumor tissue was performed in all cases. Animals were followed throughout their postoperative course for complications and survival times. Statistical analysis (Kaplan-Meier curves) was performed to obtain median survival times in dogs with meningiomas.
Results: Use of an endoscope resulted in visualization of residual tumor and potentially more complete removal of the brain tumors. There were no clinically important complications associated with the use of the endoscope. Median survival time was 2,104 days for dogs with forebrain meningiomas surgically removed with endoscopic assistance and 702 days for dogs with caudal brain meningiomas.
Conclusions and Clinical Importance: These results demonstrate that the use of an endoscope to assist in brain tumor removal is apparently safe and might result in improved survival times.     

Skin Lesions in Canine Leishmaniasis (Kala-Azar): A Clinical and Histopathological Study on 22 Spontaneous Cases in Greece

Abstract— Skin lesions occurring in 22 dogs with leishmaniasis (Kala-azar) were studied clinically and histopathologically, so as to better characterize the range of abnormalities encountered in this disease. The main clinical dermatological patterns observed were exfoliative dermatitis (90.9 per cent of dogs), ulcerations (63.6 per cent), onychogryposis (54.5 per cent), sterile pustular dermatitis (13.6 per cent), and paronychia (13.6 per cent). Most of the dogs (86.4 per cent) had more than one type of skin lesion. The most commonly seen histopathological patterns were granulomatous perifolliculitis and sebaceous adenitis (68.2 per cent), superficial and deep perivascular dermatitis (54.5 per cent), and interstitial dermatitis (50.0 per cent). Parasites, mostly within macrophages, were detected in the skin biopsies from 50.0 per cent of the dogs. Résumé— Les lesions cutanés de 22 chiens atteints de leishmaniose ont étéétudiées cliniquement et histopathologiquement, afin de mieux caractériser les anomalies observées lors de cette maladie. La principale manifestation dermatologique observée était une dermatitie exfoliative (90,9% des chiens), des ulcérations (63,6%), une onychogriphose (54,5%) une dermite pustuleuse stérile (13,6%) et une paronychie (13,6%). La plupart des chiens (84,6%) avaient plus d'un type de lésion cutanée. Les lesions histopathologiques les plus communes étaient des périfolliculites granulomateuses et des adénites sébacées (68,2%), une dermite superficielle et profonde périvasculire (54,5%), une dermite intersticielle (50%). Les parasites, généraiement dans les macrophages, ont été isolés dans une biopsie sur deux. Zusammenfassung— Hautveränderungen, die bei 22 Hunden mit Leishmaniose (Kala-azar) auftraten, wurden klinisch und histopathologisch untersucht, um die Spannweite der Veränderungen, die bei dieser Krankheit auftreten, besser charakterisieren zu können. Als hauptsächliche klinische dermatologische Symptome wurden exfoliative Dermatitis (90,9% der Hunde), Ulzerationen (63,6%), Onychogrypose (54,5%)), sterile pustulöse Dermatitis (13,6%) und Paronychie (13,6%) beobachtet. Die meisten Hunde (86,4%) wiesen mehr als einen Typ Hautveränderung auf. Die häufigsten histopathologischen Befunde bestanden in granulomatöser Perifollikulitis und Talgdrüsenadenitis (68,2%), oberflächlicher und tiefer perivaskulärer Dermatitis (54,5%) und interstitieller Dermatitis (50,0%). Die Parasiten, die meistens in den Makrophagen liegen, wurden in den Hautbiopsien bei 50,0% der Hunde entdeckt. Resumen Se estudiarion clínica e histopatológicamente las lesiones cutáneas padecidas por 22 perros con leismaniasis (Kala-azar), con el propósito de caracterizar el rango de abnormalidades producidas por la enfermedad. La sprincipales características patológicias observadas fueron: dermatitis exfoliativa (90.9% de los perros), ulceraciones (63.6%), onicogriposis (54.5%), dermatitis postular esteril (13.6%), y paronquia (13.6%). La mayoría de los perros, (86.4%), presentaban más de un tipo de lesion dérmica. Los modelos histopatológicos reconocidos más frequentemente fueron: perifoliculitis granulomatosa y adenitis sebácea (68.2%)), dermatitis perivascular superficial y profunda (54.5%), y dermatitis intersticial (50%). Las biopsias cutáneas detectaron parásitos, la mayoría en los macrófagos, en 50% de los perros.     

Clinical Features and Outcome of Dogs with Epiglottic Retroversion With or Without Surgical Treatment: 24 Cases

Background

Published information describing the clinical features and outcome for dogs with epiglottic retroversion (ER) is limited.

Hypothesis/Objectives

To describe clinical features, comorbidities, outcome of surgical versus medical treatment and long‐term follow‐up for dogs with ER. We hypothesized that dogs with ER would have upper airway comorbidities and that surgical management (epiglottopexy or subtotal epiglottectomy) would improve long‐term outcome compared to medical management alone.

Animals

Twenty‐four client‐owned dogs.

Methods

Retrospective review of medical records to identify dogs with ER that underwent surgical or medical management of ER.

Results

Dogs with ER commonly were middle‐aged to older, small breed, spayed females with body condition score (BCS) ≥6/9. Stridor and dyspnea were the most common presenting signs. Concurrent or historical upper airway disorders were documented in 79.1% of cases. At last evaluation, 52.6% of dogs that underwent surgical management, and 60% of dogs that received medical management alone, had decreased severity of presenting clinical signs. In dogs that underwent surgical management for ER, the incidence of respiratory crisis decreased from 62.5% before surgery to 25% after surgical treatment. The overall calculated Kaplan–Meier median survival time was 875 days.

Conclusion and clinical importance

Our study indicated that a long‐term survival of at least 2 years can be expected in dogs diagnosed with epiglottic retroversion. The necessity of surgical management cannot be determined based on this data, but dogs with no concurrent upper airway disorders may benefit from a permanent epiglottopexy to alleviate negative inspiratory pressures.