Journal of Feline Medicine and Surgery最新文献

Objectives: The aim of this study was to report the clinical outcomes in a series of traumatic elbow luxations in cats treated with closed reduction and a temporary transarticular type II external skeletal fixator (ESF).

Methods: A retrospective review was conducted of traumatic elbow luxation cases in cats at two referral centres. Data collected included signalment, history, clinical assessment, radiographic findings, surgical procedures and complications. Short-term follow-up was based on clinical evaluations at 2 and 6 weeks postoperatively. Long-term follow-up was based either on a telephone interview with the owner or a clinical evaluation.

Results: Eight cats were included. Five cats experienced lateral elbow luxation, while three cats had medial elbow luxation. All cats with medial elbow luxation exhibited radiographic signs of medial humeral epicondylitis. The median age was 9 years (range 3-15). The elbow luxation was treated by closed reduction and percutaneous placement of a temporary transarticular type II ESF, which was removed 2 weeks postoperatively. Two minor complications were recorded. Elbow reluxation and major complications were not encountered. The 6-week postoperative evaluation and long-term follow-up revealed a lameness of grade 1 in 1/8 cats and 0 in the remainder. Elbow range of motion was normal in all cats.

Conclusions and relevance: None of the cases treated with this protocol experienced recurrence of elbow luxation. All cats demonstrated an excellent outcome based on the lameness score, the low complication rate and the follow-up telephone interview. The technique is minimally invasive and carries a low incidence of complications. Concurrent orthopaedic disease, such as medial humeral epicondylitis, may predispose to medial elbow luxation.

Practical relevance: Addison's disease is a very rare condition in cats, with only approximately 40 cases documented in the past 40 years since it was first described in 1983.

Clinical challenges: While canine hypoadrenocorticism is a well-recognised disorder with clear diagnostic and treatment guidelines, feline hypoadrenocorticism remains a challenge because of its rarity and waxing and waning clinical signs. Furthermore, empirical treatment with corticosteroids, resulting in clinical improvement, contributes to delays in achieving the diagnosis and initiating treatment. Feline hypoadrenocorticism is diagnosed with an adrenocorticotropic hormone (ACTH) stimulation test; a low resting cortisol concentration with an inadequate or absent response to synthetic ACTH is diagnostic. Various ACTH stimulation-testing protocols are reported in published cases, with the majority using three time-limited blood samples. This can be limiting clinically, depending on cats' clinical presentation and behaviour at the veterinary practice and tolerance for procedures. Long-term treatment, similar to canine hypoadrenocorticism, consists of oral corticosteroids, with several formulations licensed in the UK, and mineralocorticoids (desoxycorticosterone pivalate), of which the only available formulation (Zycortal; Dechra) is licensed for dogs and its safety has not been assessed in cats.

Global importance: Feline hypoadrenocorticism occurs worldwide. Although no breed, sex or age association has been reported, cats aged <6 years are overrepresented.

Case series summary: The efficacy of medical treatment associated with single myringotomy in cats with suppurative otitis media (OM) and intact tympanum was retrospectively evaluated. Patients' records were retrieved from cats with suppurative OM. Cats were included in this retrospective study based on fluid content within the tympanic cavity on imaging, intact tympanum on otoendoscopic examination and neutrophils on ear bulla exudate cytological examination. A total of 26 cats with middle ear suppurative otitis were included. Just over half of the cats (54%) presented bilateral involvement. Clinical signs included head tilt (13/26), otalgia (9/26), Horner's syndrome (7/26), external ear discharge (5/26), and nystagmus and facial paralysis (1/26). Cocci were identified on cytological examination in 18/40 samples and rods in 2/40. Bacterial culture results were positive in 15/40 samples, with Pseudomonas species (4/15), Pasteurella multocida (3/15), Staphylococcus felis (3/15), Staphylococcus schleiferi (2/15), Staphylococcus canis (2/15), Escherichia coli (2/15), Staphylococcus pseudintermedius (1/15) and Serratia marcesens (1/15) isolation. After myringotomy and gentle flushing of middle ear bullae (0.5-2 ml saline per ear), all cats were treated with oral corticosteroids and a 1-month course of systemic antibiotics according to sensitivity testing. In total, 19 (73%) cats were clinically healed 60-240 days after treatment. One cat was euthanased because of failure to eradicate a Pseudomonas species infection. Another cat died a few hours after the procedure. The five remaining cats were cured after ventral bulla osteotomy.

Relevance and novel information: OM without an aural polyp is a frequent diagnosis in cats, but data on medical treatment are scarce. This simple therapeutic technique, single myringotomy procedure and mild ear flushing, offers a practical, safe and efficient first-line treatment of suppurative OM with an intact tympanum in cats with or without neurological signs.

Objectives: The aims of the study was to assess the placement of the V-gel Advanced (V-gel-A) and to evaluate tracheal selectivity during controlled mechanical ventilation, using CT.

Methods: In this prospective clinical study, 20 healthy cats undergoing general anaesthesia for an elective procedure underwent four successive CT scans from the nose to the mid-abdomen: at baseline (no device); after the placement of the V-gel-A, after a controlled mechanical ventilation (CMV) period of 5 mins; and after the placement of an endotracheal tube (ETT). Using both a purpose designed position score and a gas score estimating the quantity of gas in different digestive regions, the position of the V-gel-A and presence of gas in the digestive tract at each step were evaluated. Number of attempts and times required to place the V-gel-A and ETT were recorded and compared.

Results: The V-gel-A was found to be correctly placed, with position scores of 3/5 in six cats, 4/5 in 13 cats and 5/5 in one cat. Imperfect positioning was due to minor axial rotation or incomplete occlusion of the oesophagus by the tip of the device. The gas scores significantly increased after placement of the V-gel-A compared with baseline and after CMV was initiated. Correct positioning of the device was mostly achieved at the first attempt; no significant difference was found in the time required to place V-gel-A vs ETT, nor in the number of attempts (P >0.05).

Conclusions and relevance: The V-gel-A was clinically easy to place and use in both spontaneous and controlled ventilation. The device properly fitted the larynx and was never observed to occlude the airway. However, incomplete occlusion of the oesophagus was frequently observed and may lead to a lack of complete tracheal selectivity.

Objectives: Feline enterectomy is commonly performed in referral and general veterinary practice; however, existing studies in the veterinary literature lack significant case numbers to guide clinical decision-making. In addition, no studies have evaluated the use of surgical staplers in cats for this procedure. This study aimed to compare the use of surgical staplers for functional end-to-end anastomosis (SFEEA) with hand-sewn end-to-end anastomosis (EEA) in cats. Additional aims included investigating the feasibility of surgical staplers in cats as well as assessing short- and long-term complications and outcomes.

Methods: The medical records of four referral hospitals were retrospectively searched for cats that had undergone enterectomy between 2003 and 2022. Preoperative, intraoperative and postoperative data were compared between the SFEEA and EEA groups, with a median long-term follow-up time of 488 days (interquartile range 255-1030).

Results: In total, 54 cats met the inclusion criteria for this study, with 24 undergoing an SFEEA while 30 underwent EEA. There was a significant difference in surgical time between the two groups. The SFEEA group had a mean surgical time 34.3 ± 9.274 mins faster than the EEA group (P <0.001). Unique complications reported for the SFEEA group included haemo abdomen and anastomotic stricture.

Conclusions and relevance: SFEEA should be considered in cats where anaesthetic time should be kept as short as possible, such as patients with American Society of Anesthesiologists scores of 3-4. Stricture at the anastomotic site may be seen in the long term for cats undergoing SFEEA.

Objectives: The aim of the study was to evaluate the perioperative analgesic effect of a quadratus lumborum (QL) block in queens undergoing ovariectomy.

Methods: A total of 37 healthy queens admitted for elective ovariectomy were randomised into two groups: control (CTRL, n = 19) and QL block (QL, n = 18). All cats were premedicated with dexmedetomidine 0.005 mg/kg, alfaxalone 1 mg/kg and methadone 0.1 mg/kg IM. Under general anaesthesia, cats allocated to the QL group received a bilateral ultrasound-guided QL block with 0.4 ml/kg of ropivacaine 0.4% (3.2 mg/kg). No treatment was administered to cats in the CTRL group. Intraoperative rescue fentanyl boluses were administered if haemodynamic and/or respiratory parameters exceeded 30% of the pre-incisional values. Postoperative methadone boluses were administered based on Feline Grimace Scale scores. Demographics, baseline vital parameter values, requirement for rescue analgesia, incidence of hypotension, sialorrhoea, vomiting and dysphoria, and number of cats accepting food at 6 h after extubation were compared between groups.

Results: A higher number of queens required intraoperative fentanyl in the CTRL group (14/18, 77.8%) compared with the QL group (1/19, 5.3%) (P <0.001). The median total fentanyl dose was 4 µg/kg (range 0-4) in the CTRL group and 0 µg/kg (range 0-4) in the QL group (P <0.001). No statistically significant difference was found between groups when comparing the number of animals requiring postoperative methadone, total methadone dose, episodes of hypotension, sialorrhoea, vomiting and dysphoria, and number of queens accepting food at 6 h postoperatively. No adverse effect or complication potentially related to the block was recorded.

Conclusions and relevance: The QL block resulted in a lower intraoperative fentanyl requirement in queens undergoing ovariectomy. Further studies are needed to clarify the postoperative analgesic effect of this technique in cats.

Objectives: The aim of this study was to describe the technical success and outcomes of ureteral and urethral decompression using the subcutaneous ureteral bypass (SUB) device and transurethral self-expanding metallic stents (SEMS) as a palliative treatment option for feline malignant urinary outflow tract obstructions.

Methods: A retrospective study was conducted of 14 cats with ureteral and/or urethral obstructions secondary to diagnosed or suspected transitional cell carcinoma (TCC). In all cats, a SUB device and/or a SEMS was placed to relieve the obstruction(s). Group 1 consisted of cats with ureteral obstructions, with or without concurrent urethral obstructions, and group 2 consisted of cats with only urethral obstructions.

Results: Eight cats were included in group 1 (seven with concurrent urethral obstructions) and six cats were included in group 2. TCC was confirmed in 8/14 cats. Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device. Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 (mean 92; range 14-349) and 80 days in group 2 (mean 96; range 7-209). The MST from the time of mass identification of the cats that did and did not receive adjunctive therapy was 349 days (mean 358; range 124-602) and 43 days (mean 113; range 14-423), respectively.

Conclusions and relevance: The use of bypass devices for feline malignant urinary outflow tract obstructions is a viable option to provide immediate renal and urinary bladder decompression. TCC in cats is locally aggressive and can result in urethral re-obstruction, prompting consideration for placing a covered urethral stent. The use of adjunctive therapies for malignant neoplasia should be considered to improve overall survival once the obstruction has been relieved.

Objectives: This study aimed to evaluate the performance of a protocol in which topical products (DOUXO S3 CALM Shampoo and Mousse; Ceva Santé Animale) containing Ophytrium were applied to cats to help manage feline atopic syndrome (FAS).

Methods: A total of 23 client-owned cats with a history of FAS and presenting irritated skin and pruritus were recruited for this study. The cats were either shampooed or moussed on day 0 (D0) and then moussed every 48-72 h for 3 weeks. On D0, D7 and D21, clinical signs were assessed using the validated scoring system, Scoring Feline Allergic Dermatitis (SCORFAD). Pruritus was graded by the owner using an adapted dual visual analogue scale (Pruritus Visual Analog Scale for Cats [VAScat]). Veterinarians also assessed pruritus intensity and frequency, and provided a subjective assessment of global skin condition and of improvements in each cat's condition. On D21, all questionnaires were collected from both veterinarians and owners.

Results: Among the 19 cats that completed the study, the SCORFAD and VASmax (maximum value of VAScat, either scratching or licking) scores improved by ⩾50% in 63.2% and 38.9% of animals, respectively. Mean SCORFAD values decreased significantly between D0 and D21 (from 6.2 to 2.8, P <0.05). Similarly, mean VASmax values decreased significantly between D0 and D21 (from 7.4 to 4.3, P <0.05). Overall, veterinarians assessed the improvement as satisfactory, good or excellent in 18/19 (94.7%) cases. The protocol was considered efficient and practical by 18/19 (94.7%) and 19/19 (100%) owners, respectively, and the resulting good condition of skin and coat was emphasised by 15/19 (78.9%) owners.

Conclusions and relevance: This topical protocol with Ophytrium-containing mousse and shampoo was well tolerated. The products were effective in reducing skin irritation and discomfort quickly and significantly in cats with skin irritation and pruritus, yielding high satisfaction levels among both veterinarians and owners.

Objectives: Mammary tumours in cats are biologically aggressive. The standard of care relies upon wide surgical resection. Chemotherapy has been described in the macroscopic disease setting; however, limited efficacy has been shown. The aim of this study was to assess the efficacy of toceranib phosphate in macroscopic feline mammary tumours (FMTs).

Methods: A total of 17 cats with cytologically or histopathologically confirmed mammary adenocarcinoma (gross disease) were prospectively enrolled. Toceranib phosphate was administered at a median dose of 2.77 mg/kg (range 2.3-3.2) PO q48 h. No corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs) were administered. Toxicity was graded according to Veterinary Cooperative Oncology Group-Common Terminology Criteria for Adverse Events (VCOG-CTCAE) v1.1 criteria. The response was assessed after 1 month, following Response Evaluation Criteria In Solid Tumours (RECIST) criteria.

Results: Toxicity was observed in eight cats, with most instances being grade 1 or 2, which were managed with supportive care. Only one cat experienced grade 3 toxicity (anorexia), which resolved after a dose reduction. Clinical benefit was seen in 12 (64.7%) cats and an objective response was seen in six (35.2%) cats. One cat experienced complete response, five had partial response, six had stable disease and five had progressive disease. One cat showed distant progression (malignant pleural effusion) despite continued partial remission of the primary tumour. The median progression-free survival and median overall survival time were 91 days (range 30-158) and 145 days (range 31-234), respectively.

Conclusions and relevance: Toceranib phosphate showed clinical benefit and a good safety profile in advanced or recurrent FMTs, offering a new alternative in the treatment of this disease; however, further prospective and randomised studies are required to further assess its efficacy. Interestingly, one cat developed distant metastases while the primary tumour showed partial response, suggesting that primary tumour and metastatic disease may not sustain the same sensitivity to toceranib.