Journal of Small Animal Practice最新文献

Objectives: To describe thoracic and abdominal imaging findings in dogs with immune-mediated polyarthritis and to evaluate their impact on the decision to commence immunosuppressive therapy.

Materials and methods: Retrospective case series describing imaging findings in dogs with immune-mediated polyarthritis across modalities, including thoracic radiographs, abdominal ultrasound, computed tomography, and where available, echocardiography. Additionally, two internal medicine clinicians reviewed the signalment, clinical signs, clinicopathological findings and diagnostic imaging results on two separate occasions, reaching a consensus for each dog on whether immunosuppression would be their treatment of choice or whether their recommendations would be altered by the results of diagnostic imaging.

Results: Seventy-one dogs met the inclusion criteria. Abnormal diagnostic imaging findings were identified in 25.4% (18/71) of dogs. Thoracic radiography did not identify significant imaging findings in any of the dogs. Lymphadenomegaly was the most commonly reported finding on computed tomography (32/40) and abdominal ultrasound (13/34). Neoplasia was identified in three dogs (3/71). Four (4/13) dogs had echocardiography findings consistent with endocarditis. Immunosuppression without performing diagnostic imaging would have been considered in 41 of 71 (57.7%) dogs, based on the signalment, presenting signs, results of physical examination and clinicopathological testing. Of these, 10 dogs (24.3%) had diagnostic imaging findings suggestive of an underlying trigger, therefore changing the clinician's decision to proceed with immunosuppression.

Clinical significance: Abdominal imaging and echocardiography should be prioritised over thoracic radiography, in dogs with immune-mediated polyarthritis. Signalment, presenting complaint, physical examination findings and clinicopathological results are not reliable predictors of abnormal diagnostic imaging findings in dogs with immune-mediated polyarthritis.

Objectives: To evaluate the utility of 10% buffered formalin in preserving canine cerebrospinal fluid samples when analysis was delayed.

Methods: Inclusion criteria were dogs >10 kg having cerebrospinal fluid analysis performed as part of investigations at a referral hospital. Samples were submitted to an external laboratory in tubes containing Ethylenediaminetetraacetic acid (ETDA) as paired 0.5 mL samples; one with the addition of 0.05 mL of 10% buffered formalin and the other without. The samples were reviewed by a single pathologist who was blinded as to which sample contained formalin. Nucleated cell preservation was graded by the pathologist from 1 to 4 (1 being poor and 4 being excellent). Total protein was measured in both samples.

Results: Forty-five paired samples were included. There was no significant difference in detectability of nucleated cells between plain and formalin samples. Grade 3 was taken as the cut off for acceptable cell preservation. Based on all available samples and assessing the preservation of both nucleated cells and red blood cells, samples containing formalin were significantly more likely to be acceptably preserved. This preservation analysis was repeated on the 17 samples with at least one nucleated cell in both formalin and plain samples and was not statistically significant.

Clinical significance: The addition of formalin did not significantly improve the preservation of cerebrospinal fluid samples when analysis was delayed; however, concerns raised by previous authors regarding reduced cell preservation with addition of formalin were also not confirmed. Further large-scale studies are required to investigate the effect on nucleated cell preservation.

Objectives: The UK dog population is living longer, raising concerns about their welfare as a result of ageing-related diseases. Our primary objective was to determine when dogs enter the "old age" life stage based on free-text clinical narratives in veterinary electronic health records. In addition, to identify common conditions documented during consultations with old dogs.

Materials and methods: Regular expressions were developed for: ageing, elderly, geriatric, senior and old. These were used to search the veterinary clinical narratives within a large database of veterinary electronic health records. A sample of 1000 consultations were then read, and those confirmed as being old age classified according to a modified scheme based on the World Health Organization International Classification of Disease 10th Revision.

Results: A total of 832 old age dogs were identified. The age at which veterinary professionals considered dogs to be in old age was over 7.25 years in 95% of patients (median age 12.5 years). This age varied among the most common breeds, with cocker spaniels being younger (median 11.7 years) compared with Jack Russell terriers (14.1 years). Weight-related (289/832 consultations, 35%), musculoskeletal (278, 33%), dental (254, 31%), integumentary (235, 28%) and digestive (187, 22%) conditions were most common. The odds of a dental condition were greater (odds ratio: 2.71, 95% confidence interval: 1.38 to 5.31) and musculoskeletal condition less (odds ratio: 0.36, 95% confidence interval: 0.17 to 0.81) in cocker spaniels than in a mixed breeds reference.

Clinical significance: This metric applied at scale to identify old patients may provide a novel foundation for timely health interventions targeted to dogs at increased risk of developing various age-related conditions.

Diffuse pachymeningeal contrast enhancement is an uncommon imaging finding in dogs and current understanding of its aetiologies in veterinary medicine is limited. A 2-year-old female neutered Pug presented with chronic progressive vestibular signs, facial nerve paralysis, obtundation and episodic decerebellate rigidity. A magnetic resonance imaging study of the head revealed diffuse pachymeningeal thickening and contrast enhancement involving the caudal fossa and falx cerebri. Cerebrospinal fluid analysis revealed marked neutrophilic pleocytosis. Infectious disease testing was negative and a tentative diagnosis of intracranial idiopathic hypertrophic pachymeningitis was made. Immunosuppressive treatment resulted in a short period of clinical improvement. The patient subsequently suffered multiple relapses which failed to respond to alternative immunosuppressive strategies, necessitating euthanasia. Histopathological findings supported a meningeal null cell lymphoma. While rare, neoplastic causes of diffuse pachymeningeal thickening and contrast enhancement should be considered.

Objectives: To describe the detection frequency, sonoanatomy and reference values of the duodenal papillae and connected anatomical structures in cats, with reference to gross anatomical and histopathological nomenclature.

Materials and methods: A prospective, case-controlled study of sonographic examinations of the duodenal papillae in 50 client-owned cats using an ultrasound device (Logiq E9, GE Healthcare) with a 15 MHz linear transducer.

Results: The major duodenal papilla was found in 100% of cases, the minor duodenal papilla in 10%. The common bile duct and the main pancreatic duct could be traced to the duodenum in all of the cats. After an extramural part, in which the two ducts extend in a parallel fashion, they entered the duodenal wall. The subsequent intramural part was divided into three sections: the portio infundibularis, the portio submucosa and the major duodenal papilla. The 27 clinically healthy cats had a mean portio infundibularis length, width, and height in mm of 3.7, 2.5 and 2.2, respectively. These dimensions were 3.5, 2.1, 2.9 for the portio submucosa and 0.5, 2.1, 2.9 for the major duodenal papilla. Calculi in the major duodenal papilla were found in 12% of the cats. The course of the accessory pancreatic duct from the pancreas through the MIDP into the duodenum was documented.

Clinical significance: The ultrasonographic examination of the duodenal papillae is easy to perform and it can be considered part of the routine examination for feline patients presenting with relevant clinical signs, in some cases to help establish a diagnosis and plan treatment.

Objectives: To describe clinical presentation, diagnostic findings and outcome of presumptive spinal only meningoencephalomyelitis of unknown origin in French bulldogs, and to compare clinical presentation between intervertebral disc herniation and spinal only meningoencephalomyelitis of unknown origin in this breed.

Material and methods: Medical records of French bulldogs diagnosed with presumptive spinal only meningoencephalomyelitis of unknown origin in seven referral centres were reviewed. Clinical presentation was compared to a group of French bulldogs with intervertebral disc herniation.

Results: Fifteen French bulldogs were included. Median age at presentation was 31 months. Most dogs were presented with a chronic onset (54%), and the median duration of clinical signs before diagnosis was 21 days. The most common presentation was ambulatory paresis and proprioceptive ataxia (80%). Spinal pain was uncommon (20%). There was no preferential location between the cervical and thoracolumbar segments. In all but one case, magnetic resonance imaging revealed broad focal or multifocal, poorly defined, intramedullary lesions that typically appeared hyperintense on T2W images and isointense on T1W images with parenchymal and/or meningeal contrast enhancement in 12 dogs (80%). Median total nucleated cell count in cerebrospinal fluid was 15 cells/mm³ with predominance of mononuclear cells in all cases. Follow-up (available for 12 dogs, ranging from 1 month to 1 year) indicated initial positive response to various immunosuppressive treatments in all but one case, with subsequent suspected relapse in three cases. Dogs with spinal only meningoencephalomyelitis of unknown origin had longer clinical sign duration compared to intervertebral disc herniation cases (60 dogs) (21 days compared to 3 days, respectively) and less frequent spinal pain during examination (20% compared to 75%, respectively).

Clinical significance: Spinal only meningoencephalomyelitis of unknown origin is an uncommon cause of myelopathy in French bulldogs that should be particularly considered in young adults with non-acute and non-painful presentation.

Objectives: Determine the utility of abdominal fluid bile acids concentration to diagnose biliary tract rupture and the utility of abdominal fluid-to-serum bilirubin ratio as diagnostic tools in dogs.

Materials and methods: This was a prospective pilot study. Canine serum and abdominal fluid samples were collected and submitted for the determination of bilirubin and bile acids concentrations between 2020 and 2022. Samples were measured at the time of admission from dogs with acute onset of clinical signs and peritoneal fluid. A Mann-Whitney U test and ROC curves were used to compare serum and abdominal fluid bilirubin and bile acids concentration and fluid-to-serum bilirubin and bile acids ratio between patients with biliary tract rupture and non-biliary tract rupture.

Results: Ninety-four cases were included, of which seven were diagnosed with biliary tract rupture. Median abdominal fluid bile acids concentration was significantly higher in dogs with biliary tract rupture than non-biliary tract rupture (P-value <0.001). Abdominal fluid bile acids concentration had a sensitivity of 100% and specificity of 99% for the diagnosis of biliary tract rupture. Fluid-to-serum bilirubin ratio was also analysed and no statistically significant difference was seen between groups (P-value 0.925).

Clinical significance: Although the number of dogs with biliary tract rupture in this study population was small, abdominal fluid bile acids concentration may have a better accuracy than fluid-to-serum bilirubin ratio for the diagnosis of biliary tract rupture. The utility of fluid-to-serum bilirubin ratio for the diagnosis of biliary tract rupture, appears limited. Further studies with a larger number of biliary tract rupture cases are required to support these conclusions.

Objectives: To assess the parameters utilised by and the diagnostic performance of two traditional veterinary classification schemes (named A and B) based on ascites total protein and total nucleated cell count, the Boyer's criteria based on ascites lactic dehydrogenase activity, its serum ratio and the serum total protein, a simplified Boyer's criteria based on ascites lactic dehydrogenase activity and serum total protein only, and finally the serum-ascites albumin gradient in discriminate the pathophysiological origin of the ascites formation in dogs.

Materials and methods: Cross-sectional study including 291 client-owned dogs with ascites. Ascites aetiology was used to classify the pathophysiology of its formation. Parameters measured and calculated included ascites total protein, ascites total nucleated cell count, ascites lactic dehydrogenase activity and its serum ratio, serum total protein, and the serum-ascites albumin gradient.

Results: There were 33 transudates due to decreased colloid osmotic pressure, 69 transudates due to increased hydrostatic pressure gradient, and 189 exudates. Simplified Boyer's criteria misclassified 16 of 291 ascites (94.5% accuracy; 95% confidence interval: 91.2 to 96.8) and Boyer's criteria misclassified 21 of 291 ascites (92.8% accuracy; 95% confidence interval: 89.2 to 95.5). The traditional veterinary classification scheme B misclassified 71 of 291 ascites (75.6% accuracy; 95% confidence interval: 70.3 to 80.4) and scheme A 130 of 291 (55.3% accuracy; 95% confidence interval: 49.4 to 61.1). Finally, the serum-ascites albumin gradient misclassified 100 of 291 ascites (65.6% accuracy; 95% confidence interval: 59.9 to 71.1).

Clinical significance: The Boyers' criteria and a simplified Boyer's criteria were highly accurate in discriminating exudates from transudates, while the other classification schemes had significantly less diagnostic value in doing so.

Objectives: Migrating foreign bodies is common in cats and dogs and can be challenging to retrieve. The aim of this study is to describe a minimally invasive ultrasound-guided technique for the removal of migrating foreign bodies.

Materials and methods: Cases were retrospectively recruited from a single referral hospital. Soft tissue swelling with suspected abscessation was identified on CT and the presence of migrating foreign material was confirmed on ultrasound. Foreign body retrieval was performed under ultrasound guidance: a large bore cannula (14G) was placed in direct contact with the foreign body. A pair of 16G flexible grasping forceps was passed through the sheath of the cannula and the foreign material was grasped and removed. Follow-up was obtained via patient records or telephone conversation.

Results: Seven dogs and one cat were included in this series. This technique was successful in removing foreign material from the neck (n = 4) and retro-bulbar area (n = 3). One retro-bulbar foreign body could not be safely removed due to its proximity to the globe. Median procedure duration was 20 minutes (range 5 to 35 minutes). Follow-up was available for seven cases at a median of 6 months (range 0.5 to 6 months). There was no recurrence of clinical signs in six out of seven cases. The swelling recurred at a different location in one case and no further foreign material was identified.

Clinical significance: This technique enabled retrieval of migrating foreign material from the retro-bulbar and cervical regions. This was an efficient and minimally invasive technique that spared the need for surgical exploration.