Disc-associated wobbler syndrome in the Doberman pinscher

Disc-associated wobbler syndrome is a subset of the diverse canine wobbler complex. Disc-associated wobbler disease can occur in many large-breed dogs but the vast majority are middle-aged Doberman Pinschers. Dorsal annulus hypertrophy and protrusion is the hallmark lesion with variable association of dorsal ligamentum flavum hypertrophy and bony malformations. Chronic caudal cervical spinal cord compression results in the clinical signs. Instability, primary disc degeneration, and conformational etiologies have been incriminated. The clinical course usually entails chronic progressive paraparesis to tetraparesis with insidious onset. Acute onset or exacerbations are less common. Diagnosis is based upon history, neurologic examination, and radiography/myelography. Long-term conservative therapy is only palliative and usually leads to the demise of the animal. Surgical therapy offers the potential of a cure but at significant risk of morbidity and mortality. Surgical treatment consists primarily of decompressive techniques with or without stabilization. The numerous surgical techniques utilized highlight the variability of the lesions and the lack of universal acceptance of any one technique. Decompression is accomplished by surgical access to the vertebral canal to physically remove the abnormal ligament and/or bony material. Alternatively, distraction combined with fusion of the vertebrae adjacent to the offending disc may reduce the hypertrophied/prolapsed dorsal annulus. Regardless of the procedure, postoperative management may be fraught with complications that require special considerations.     

Rhinostomy as Surgical Treatment of Odontogenic Rhinitis in Three Pet Rabbits

Disease of the upper airways, specifically chronic rhinitis, is common in pet rabbits and is particularly debilitating in this obligate nasal-breathing species. Cases of chronic rhinitis can be mild to severe (empyema of the nasal cavities). Surgical therapy requires a thorough understanding of upper respiratory anatomy of the rabbit and is an option for chronic rhinitis cases nonresponsive to medical therapy. Diagnostic imaging aids in diagnosing the extent of the disease process and guides the surgical approach. The author reports 3 cases of surgical treatment of rabbit patients diagnosed with chronic rhinitis and empyema of the nasal cavities following advanced or end-stage dental disease.     

Management of traumatic fistulous withers and wounds of the lumbar dorsal spinous processes of horses and donkeys used for pack animals

Over a three year period, eighty-nine (89) traumatically induced wounds on the withers and lumbar area of donkeys and horses were treated by the ambulatory clinic at Universidad Nacional Autónoma de México. The wounds generally resulted from poorly fitting pack equipment. Treatment regimens were divided into two categories: 1) conservative topical therapy plus padding or 2) surgical debridement and primary wound closure. Conservative therapy with topical medications and padding was successful in many cases in spite of the fact that the animals generally continued working. However, recurrence of lesions following conservative therapy was common. Surgical treatment was used primarily in cases refractory to conservative therapy. As a result of surgical intervention, clients tended to comply with recommendations to stop working the animal. The convalescent time was shorter, and the recurrence rate was lower following surgery than for conservative therapy.     

Intralesional 5‐fluorouracil (5‐FU) for the treatment of eyelid squamous cell carcinoma in 5 horses

Eyelid squamous cell carcinoma in equine patients often presents a therapeutic challenge to practitioners due to the generally large area affected upon presentation. Surgical excision can be curative if wide enough margins are achieved, but this is not often attainable without enucleation. Other alternatives have been examined including cryotherapy, radiotherapy, brachytherapy, intralesional chemotherapy and photodynamic therapy. Intralesional chemotherapy using cisplatin, mitomycin‐C and bleomycin have been shown to be successful in treating eyelid squamous cell carcinomas but may be prohibitive to some owners due to the cost of therapy. To the authors' knowledge, this is the first case series to illustrate the effectiveness of intralesional 5‐fluoruracil in treating large equine eyelid squamous cell carcinomas. Macroscopic reduction in the size of the affected areas was noted in each case together with regression of clinical signs associated with the mass. This, coupled with the relative inexpensive nature of the procedure, makes this technique an attractive therapy for either primary treatment of eyelid squamous cell carcinoma or as a cytoreductive technique prior to surgical excision.     

Hiatal hernia controversies--a review of pathophysiology and treatment options

OBJECTIVE: To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. DESIGN: Review article. SUMMARY: Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Approach to the acute abdomen

Acute abdominal pain is a clinical sign associated with several underlying disease processes, many of which can be life threatening. Abdominal pain requires efficient diagnostic evaluation to determine the appropriate course of treatment. Definitive treatment involves medical and/or surgical management. The emergency clinician must be well versed in the diagnostic approach to these patients to facilitate appropriate therapy.     

Surgical management of first caudal nerve root foraminal compression secondary to intervertebral disc disease in a Cocker Spaniel

A nine-year-old spayed female Cocker Spaniel was investigated for an eight week history of licking and rubbing at the tail base, dullness, and signs of pain on manipulation of the tail. Left-sided intraforaminal compression of the first caudal nerve root due to intervertebral disc disease was diagnosed by radiographic, computed tomography, and magnetic resonance imaging examinations. The dog was nonresponsive to conservative medical therapy. A decompressive left-sided first-second caudal (Cd1-Cd2) foraminotomy was performed. Postoperative computed tomography confirmed surgical decompression of the involved nerve root. At the one month follow-up examination there was marked improvement in clinical signs. At two months, clinical signs were completely resolved and there was not any evidence of recurrence twelve months after surgery. Intervertebral disc disease should be considered as a differential diagnosis in dogs with discomfort at the tail base or signs of pain on manipulation of the tail. Surgical decompression may be indicated for management of these cases. This is the first report of diagnosis and surgical management of caudal intervertebral disc disease by foraminotomy in the dog. Surgical decompression by foraminotomy may therefore be a treatment option for this condition.     

Feline Physiotherapy and Rehabilitation: 1. Principles and potential

Practical relevance: Physiotherapy is highly valued within human medicine and relatively well established for canine patients. Despite a popular misconception that feline patients will not cooperate with such treatment, physiotherapy is now increasingly being performed with cats. With cat ownership increasing in many countries, and an emergence of specialist physiotherapy practitioners, there is demand for effective postoperative and post-injury rehabilitation for any cat with compromised physical function due to injury, surgery or disease. Clinical challenges: While physiotherapy and rehabilitation are potentially beneficial for cats, due to their independent nature feline patients certainly present a greater challenge in the pursuit of effective therapy than their canine counterparts. Audience: This two-part review article is directed at the primary care veterinary team. The benefits of physiotherapy and the various treatment modalities available to the qualified veterinary physiotherapist, as well as the non-specialist veterinarian and veterinary nurse or technician, are examined in this first part. Evidence base: The benefits of human physiotherapeutic intervention are well documented, and there is good evidence for the effectiveness of most treatment modalities. Animal studies are still in their infancy, although some preliminary studies in dogs have shown good results.     

Gastric dilatation-volvulus syndrome in dogs.

Gastric dilatation-volvulus is a medical and surgical emergency that principally affects large-breed dogs. Surgical treatment should be undertaken as soon as the patient has been stabilized with fluid therapy and decompression. A gastrectomy might be required if the stomach is becoming necrotic. A gastropexy is required to prevent recurrence.     

Application of Platelet-Rich Gel to Enhance Wound Healing in the Horse: A Case Report

A large torn wound of the dorsal elbow region was observed in a 17-year-old Arabian mare. Surgical reconstruction was performed with the horse in standing sedation, but suture dehiscence occurred 2 days later. Autologous platelet-rich gel (PRG) was then applied to the wound every 3 weeks for a total of 3 administrations to accelerate good-quality healing. The wound had healed rapidly and completely within 5 months of the first PRG treatment, without chronic effects or formation of exuberant tissue granulation and with minimum scarring. This case report suggests that topical treatment with autologous PRG, as additional therapy, might be considered beneficial in the management of large-wound healing in horses, and it can be regarded as safe and inexpensive treatment that can be used in field.     

Surgical considerations of nasal discharge

Surgery of the nasal cavity may be exposed primarily via a dorsal or ventral approach. Surgical treatment of lesions of the nasal cavity usually is limited to benign lesions or in combination with adjunctive therapy such as radiation therapy. Caution must be exercised with a dorsal approach to the nasal cavity to avoid complications of inadvertent penetration of the brain case. Gentle tissue handling and careful closure of the mucoperiosteum must be exercised following a ventral approach to minimize the risk of oronasal fistula formation.     

The diagnostic and therapeutic approach to the patient in acute congestive heart failure

The patient presented in acute congestive heart failure represents a diagnostic challenge. Life-threatening compromise of respiratory or cardiovascular function renders the patient vulnerable to the stresses associated with many diagnostic tests. Before risking any test in this situation, it is important to understand the information that each test will give, and how that will impact the diagnostic and therapeutic approach in this crucial early phase of patient management. This article describes the diagnostic tests commonly used in the evaluation of patients in acute heart failure and the information that each provides, and discusses how this information can be used to guide therapy. Pericardiocentesis is discussed in detail.     

Total Skin Electron Beam Irradiation for Generalized Cutaneous Lymphoma

Introduction:  Generalized cutaneous T‐cell lymphoma (CTCL) in canines has many similarities to CTCL in humans. In humans, early stage mycosis fungoides (MF) patients that do not have lymph node or any systemic involvement can do very well with total skin electron beam irradiation (TSE). In fact, if these early stage patients were treated with 30–35 Gy, the median overall survival was not reached at 15 years. Only one dog with CTCL has been treated with total skin irradiation using orthovoltage irradiation. The patient died the night of the 2nd fraction of RT. Now that more veterinary RT facilities have linear accelerators with electron beam capabilities, it is possible canines with CTCL can be treated with TSE. This paper describes an adaptation of the Modern TSE technique used in human MF patients and its application in canine patients with MF/CTCL.
Methods:  The modified Modern TSE technique and its application for canine MF/CTCL patients involves 20 treatments given M‐F over 4 weeks. The entire skin surface is treated from multiple directions.
Results:  Four canine patients with CTCL have been treated with this TSE technique. All patients responded to the treatment initially with the first patient having tumor control for >20 months. One patient has failed the therapy at this date.
Conclusions:  The TSE technique adapted for use in canines with CTCL was well tolerated with no significant toxicity noted. Development of a collaborative study with other veterinary RT centers having electron beam capabilities is being evaluated through VRTOG.     

Cutaneous blastomycosis in a horse

This report describes the case of a horse presented with cutaneous lesions caused by Blastomyces dermatitidis in the absence of signs of other organ involvement. Diagnosis was achieved through cytology, histopathology and culture. Surgical debulking associated with systemic therapy with oral fluconazole resulted in significant remission; however, recurrence occurred following presumed early cessation of treatment.     

Preoperative immunosuppressive therapy and surgery as a treatment for anal furunculosis

OBJECTIVES: To evaluate the efficacy of combining preoperative immunosuppressive therapy with surgical excision for treatment of anal furunculosis (AF) in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=25) with stages 1-4 AF. METHODS: Preoperative immunosuppressive therapy was either cyclosporine A (CyA) alone or in combination with ketoconazole (Group 1; n=18), or azathioprine combined with prednisolone (Group 2; n=7). Surgical excision of residual draining tracts, cryptectomy, and anal sacculectomy were performed. Only dogs with postoperative clinical follow-up exceeding 9 months were retained for the study. RESULTS: Both immunosuppressive protocols were effective in reducing progression of AF. Subsequent draining tracts excision, cryptectomy, and anal sacculectomy were bilateral (12 dogs) or unilateral (13 dogs of which 4 had bilateral anal sacculectomy). Postoperative recovery was uneventful, except for 2 dogs that had wound breakdown. Recurrence was not observed in any of the dogs that had bilateral surgical excision and or in 9 dogs that had unilateral excision. CONCLUSION: Preoperative immunosuppressive therapy, combined with bilateral surgical resection of affected tissue consistently, resulted in resolution of AF. Four dogs that had recurrence had unilateral excision despite initial bilateral involvement, suggesting that all diseased tissue should be excised. CLINICAL RELEVANCE: These preliminary results suggest that immunosuppressive therapy before surgical excision for AF yields minimizes recurrence in dogs.     

Surgical treatments for intervertebral disc disease.

Surgical treatments for intervertebral disc disease are useful for animals with gradually progressive, severely acute, or recurrent lesions. Surgical patients require a diligent neuroradiographic evaluation to confirm location and severity of the discopathy and rule out conditions unrelated to disc disease. Although controversial, some surgeons advocate fenestration for recurrent pain or mild ataxia associated with a noncompressive lesion. Decompressive procedures are recommended for treatment and prognostication of compressive disc-associated myelopathy. Foraminotomy is reserved for patients with lateralizing extrusions confirmed with myelography or newer imaging modalities (CT, MRI). Future treatments for animals may include chemonucleolysis or various discectomy procedures currently performed in humans with symptomatic disc disease.     

Hiatal hernia controversies - a review of pathophysiology and treatment options

Objective To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments.
Design Review article.
Summary Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment.
Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present.
Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplica-tion in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.     

Surgical techniques for the liver and biliary tract

Surgical treatment of hepatic and biliary disease requires a thorough knowledge of pertinent anatomy and pathophysiology. Proper attention to both preoperative and postoperative care is important. This article describes many of the more common surgical manipulations of the liver and biliary tract, as well as pre- and postoperative considerations.     

Paraneoplastic disorders in dogs with hematopoietic tumors

Often overlooked in the presence of neoplasia, PNDs constitute significant clinical entities in dogs with hematopoietic tumors. They may cause morbidity and mortality in such patients, with effects more severe than those caused by the associated tumor. Accurate clinical evaluation of these disorders is important in differential diagnosis and treatment, for failure to realize that cancer can produce many clinical signs similar to those of other diseases may lead to incorrect diagnosis and delayed therapy. Early recognition of the problem underlying the PND is essential to selecting the proper therapeutic approach and maximizing the patient's chances for remission and survival. The presence of these disorders may complicate or rule out the preferred therapy in some cases of hematopoietic neoplasia, because the addition of cytotoxic drugs may worsen the existing PND, predisposing the dog to a variety of complications. Appropriate management of the PND may be of more immediate importance than treatment of the tumor. The study and recognition of PNDs in dogs with hematopoietic tumors may be valuable for a number of reasons: to facilitate early diagnosis of the tumor, for the observed abnormalities may represent tumor cell markers; to allow assessment of premalignant states; to aid in the search for metastases; to help quantify and monitor response to therapy; to aid in the evaluation of tumor recurrence or progression; to aid in identifying specific pathophysiologic processes by which cancer produces systemic effects; and to provide insight into the study of malignant transformation. Recognition of PNDs is relevant to the diagnosis and treatment of many problems in veterinary cancer medicine. With increasing emphasis on diagnosis and treatment of canine hematopoietic tumors, PNDs will be recognized with greater frequency and will assume greater importance in the therapeutic management of those patients. Research in veterinary and human cancer medicine needs to be directed toward identifying more definitively those substances and pathways that are responsible for PNDs, because therapy directed toward arresting the specific pathophysiologic processes causing the PND may offer the best approach for successful management of cancer.     

Generalised lymphadenomegaly associated with methimazole treatment in a hyperthyroid cat

A nine-year-old, domestic shorthair cat was diagnosed with hyperthyroidism and treated with methimazole, which resulted in lethargy, inappetence and marked generalised lymphadenomegaly within two weeks of initiation of therapy. Cytology, histopathology and immunohistochemistry were suggestive of atypical lymphoid hyperplasia. Cessation of treatment resulted in resolution of all clinical signs and physical abnormalities within two days. Subsequent treatment with radioactive iodine cured this cat of its hyperthyroidism. The lymphadenomegaly did not return at any stage and the cat is currently asymptomatic. Although methimazole administration for feline hyperthyroidism has been associated with many side effects, lymphadenomegaly has, to the authors' knowledge, not been previously reported.