Cullen's sign and haemoglobinuria as presenting signs of retroperitoneal haemorrhage in a dog

Haemoglobinuria and periumbilical discoloration (also known as Cullen's sign) are clinical signs uncommonly reported in veterinary patients. This report describes a case of retroperitoneal haemorrhage in a dog, associated with haemoglobinuria and Cullen's sign. To the authors' knowledge, these clinical signs have not previously been reported singularly or in combination with retroperitoneal haemorrhage in dogs. A neutered male Shetland sheepdog, which was presented for haematuria, also had an abdominal mass, abdominal pain and a large area of periumbilical discoloration. Laboratory studies determined that haemoglobinuria was the cause of the red-coloured urine. Abdominal radiographs suggested a splenic mass and a coeliotomy was performed. During the induction and throughout the anaesthetic period the dog was hypertensive and a large haematoma originating from the right retroperitoneal space was identified at surgery. The cause of the haemorrhage was uncertain but a ruptured phaeochromocytoma was thought possible on the basis of the persistent hypertension and the location of the haemorrhage.     

Unusually rapid growth and adult stature in an American hairless terrier puppy

A puppy was evaluated for rapid growth and large stature. Extensive diagnostic evaluation suggested a growth hormone independent disorder. As the sole detected abnormality was elevated leptin concentration, an obesity syndrome causing leptin resistance was speculated to explain the puppy's condition but was not confirmed. Except for large body size, the puppy remained clinically normal.     

Assessment of a point‐of‐care cardiac troponin I test to differentiate cardiac from noncardiac causes of respiratory distress in dogs

Objectives – To (1) determine a reference interval for cardiac troponin I (cTnI) using a point‐of‐care device in normal dogs and compare the results with those published by the manufacturer and (2) determine if cTnI differs among dogs with cardiogenic and noncardiogenic respiratory distress. Design – Prospective observational study. Setting – Emergency and referral veterinary hospital. Animals – Twenty‐six clinically normal dogs and 67 dogs in respiratory distress. Interventions – All dogs underwent whole blood sampling for cTnI concentrations. Measurements and Results – Normal dogs had a median cTnI concentration of 0.03 ng/mL (range 0–0.11 ng/mL). Thirty‐six dogs were diagnosed with noncardiogenic respiratory distress with a median cTnI concentration of 0.14 ng/mL (range 0.01–4.31 ng/mL). Thirty‐one dogs were diagnosed with cardiogenic respiratory distress with a median cTnI concentration of 1.74 ng/mL (range 0.05–17.1 ng/mL). A significant difference between cTnI concentrations in normal dogs and dogs with noncardiogenic respiratory distress was not detected. Significant differences in cTnI concentrations were found between normals versus cardiogenic and cardiogenic versus noncardiogenic respiratory distress groups. Significant differences in cTnI concentrations were identified in >10 when compared with the <5 and the 5–10 years of age groups. Receiver operating curve analysis identified cTnI concentrations >1.5 ng/mL as the optimal “cut‐off point” having a sensitivity of 78% and specificity of 51.5%. The area under the receiver operating curve was 0.72. Overall test accuracy was 65%. Conclusions – cTnI concentrations were significantly increased in dogs with cardiogenic respiratory distress versus dogs with noncardiogenic respiratory distress and normal dogs. A significant difference between normal dogs and dogs with noncardiogenic causes of respiratory distress was detected. Although highly sensitive when cTnI concentrations exceed 1.5 ng/mL, the test has low specificity. Assessment of cTnI by the methodology used cannot be recommended as the sole diagnostic modality for evaluating the cause of respiratory distress in dogs.     

Cellular and Molecular Characterization of a Feline Insulinoma

Background: Insulinoma is an autonomous insulin-secreting islet cell neoplasm that is rarely diagnosed in cats. The clinical and pathological aspects of feline insulinoma have been described previously, but the molecular characteristics of these tumors have not been investigated.
Objectives: The study objectives were to characterize peptide hormone production and determine expression of selected genes involved in glucose metabolism and insulin secretion in a feline insulinoma.
Methods: Immunohistochemistry and RT-PCR were used to examine hormone and gene expression, respectively, by insulinoma cells.
Results: Immunohistochemistry examination indicated that the tumor cells expressed insulin, chromogranin A, and somatostatin but not glucagon or pancreatic polypeptide. The tumor expressed several genes characteristic of pancreatic beta cells (β cells) including insulin ( INS ), glucose transporter 2 ( GLUT2 ), and glucokinase ( GCK ). The tumor also expressed hexokinase 1 ( HK1 ), a glycolytic enzyme not normally expressed in β cells. GCK expression was higher in the insulinoma than in normal pancreas from the same cat. The GCK  :  HK1 ratio was >20-fold higher in insulinoma tissue than in normal pancreas.
Conclusions and Clinical Importance: The feline insulinoma produced several peptide hormones and expressed genes consistent with a β-cell phenotype. The pattern of hexokinase gene expression in tumor cells differed from that of normal pancreas. These findings suggest insulinoma cells may have an increased sensitivity to glucose that could contribute to the abnormal insulin secretory response observed at low serum glucose concentrations.     

Lack of glucokinase regulatory protein expression may contribute to low glucokinase activity in feline liver

In most mammals, glucokinase (GK) acts as a hepatic “glucose sensor” that permits hepatic metabolism to respond appropriately to changes in plasma glucose concentrations. GK activity is potently regulated by the glucokinase regulatory protein (GKRP), which is encoded by the GCKR gene. GKRP binds GK in the nucleus and inhibits its activity. GK becomes active when it is released from GKRP and translocates to the cytosol. Low glucokinase (GK) activity is reported to be a principal feature of feline hepatic carbohydrate metabolism but the molecular pathways that regulate GK activity are not known. This study examined the hypothesis that species-specific differences in GKRP expression parallel the low GK activity observed in feline liver. Hepatic GKRP expression was examined using RT-PCR, immunoblot, and confocal immunomicroscopy. The results show that the GCKR gene is present in the feline genome but GCKR mRNA and the GKRP protein were absent in feline liver. The lack of GKRP expression in feline liver indicates that the low GK activity cannot be the result of GKRP-mediated inhibition of the GK enzyme. However, the absence of the permissive effects of GCKR expression on GK expression and activity may contribute to reduced GK enzyme activity in feline liver. The study results show that the cat is a natural model for GCKR knockout and may be useful to study regulation of GCKR expression and its role in hepatic glucose-sensing and carbohydrate metabolism.     

Serum-effusion albumin gradient in dogs with transudative abdominal effusion

A prospective clinical study in dogs with transudative abdominal effusions examined the clinical usefulness of the serum albumin-effusion albumin (SA-EA) gradient. In humans, the SA-EA gradient facilitates classification of abdominal effusion, with a gradient > or = 1.1 indicating the presence of portal hypertension. Gradient values proved useful for predicting therapeutic response to sodium restriction and diuresis in humans. Of 49 dogs evaluated, 25 had hepatobiliary disease (group 1) and 24 had other nonhepatobiliary conditions (group 2). Portal hypertension was clinically suspected in 24 of 25 dogs in group 1 and in 15 of 24 dogs in group 2. A broad range of SA-EA gradients was found. A gradient > or = 1.1 was found in 22 of 25 (88.0%) dogs with liver disease and in 14 of 24 (58.3%) dogs with other disorders. The median SA-EA gradient was higher in group 1 than in group 2, with values of 1.4 (range, 0.7-3.1) and 1.1 (range, 0.3-2.6), respectively (P < .04). Considerable overlapping of SA-EA gradients occurred between groups and among dogs with diverse conditions such that gradient values could not distinguish dogs with hepatobiliary disease from dogs with other conditions. The overall diagnostic accuracy of the SA-EA gradient in predicting portal hypertension in dogs with and without hepatobiliary disease (69.4%) exceeded that of hypoalbuminemia (57.1%). These findings suggest that portal hypertension is a predominant force in formation of transudative abdominal effusion in dogs with hepatobiliary disease and in dogs with other disorders. Whether the SA-EA gradient can be used to guide therapeutic mobilization of effusion in dogs remains to be proved.     

Monoclonal immunoglobulin G cryoglobulinemia and multiple myeloma in a domestic shorthair cat

A 13-year-old castrated domestic shorthair cat was examined because of fever, anorexia, and dermatologic lesions. Crusting, erythema, and well-demarcated purple discoloration of the foot pads and the tips of the pinnae, nose, and tail were seen. A white flocculent precipitate was detected in cooled serum. This precipitate dissolved upon rewarming, consistent with a cryoglobulin. Hypercalcemia, high alanine and aspartate aminotransferase activities, thrombocytopenia, and a monoclonal IgG gammopathy were found. Numerous hepatic nodules were detected by means of abdominal ultrasonography. Cytologic evaluation of fine-needle aspirates of the liver and spleen revealed numerous plasma cells, and evaluation of a bone marrow aspirate revealed plasmacytosis. A diagnosis of multiple myeloma and monoclonal IgG cryoglobulinemia was made, and the cat was euthanatized.     

Intravesical instillation of dilute formalin for the treatment of severe hemorrhagic emphysematous cystitis in a diabetic dog

Intravesical formalin is a known treatment for control of hemorrhagic cystitis caused by multiple etiologies in humans and dogs. This case report documents the successful use of intravesical formalin for the treatment of severe hemorrhagic cystitis that occurred secondary to emphysematous cystitis in a diabetic dog. In addition, a review of emphysematous cystitis and the use of intravesical formalin in human and veterinary medicine is discussed. Formalin instillation into the urinary bladder is an option for life-threatening, refractory cases of hemorrhagic cystitis; but clinicians must be familiar with the proper technique and be aware of potential complications prior to its use.