Journal of Feline Medicine and Surgery Open Reports最新文献

Case summary: Acute hepatitis and liver damage are rare adverse effects of clopidogrel in humans. In veterinary medicine, clopidogrel is mainly prescribed in the treatment of feline patients with cardiomyopathies. Little is known regarding the safety and adverse effects of clopidogrel in this group of patients. The limited number of studies scarcely report adverse effects. In this case report, a 6-year-old male castrated crossbred cat with the hypertrophic cardiomyopathy phenotype had signs of acute hepatitis after 5 weeks of clopidogrel treatment.

Relevance and novel information: Evaluation of the case and review of the literature indicate that acute hepatitis might be a potential adverse effect of clopidogrel in feline patients. Therefore, hepatotoxicity should be taken into consideration when a feline patient shows clinical deterioration after the use of clopidogrel.

Case series summary: Described are three cats diagnosed with rhinosinusitis secondary to Mycobacterium bouchedurhonense, Aspergillus species and Alternaria species, respectively. Medical records were retrospectively reviewed to identify cats with decreased nasal airflow and mucopurulent discharge that failed to improve on antibiotic therapy of 3 months or longer duration. Surgical debridement was followed by nasal packing using 5% povidone-iodine saturated umbilical tape, which was replaced at 24 h postoperatively. At 48 h postoperatively, the rhinotomy site was closed. Systemic therapy continued in the postoperative period. All cases were minimally responsive to previous medical management. History, signalment, clinical signs, diagnostic findings, treatment, and short- and long-term outcomes were retrieved. All cats were middle-aged with outdoor access and had clinical signs that commenced during the summer months. CT revealed turbinate destruction and soft tissue densities within the nasal passages. The otic apparatuses and calvaria were intact in all cats before surgery. A repeat CT examination revealed an improvement of the proliferative tissue identified in preoperative imaging in all cases. All cats achieved successful interruption of nasal discharge and restoration of nasal airflow with follow-up times of up to 16 months postoperatively.

Relevance and novel information: To the authors' knowledge, this is the first report of the use of intranasal povidone-iodine packing in cats for the management of infectious rhinosinusitis. Surgical debridement and intranasal packing in addition to systemic therapy were successful in restoring nasal airflow and resolving nasal discharge in all cats with long-term follow-up.

Case summary: An 8-month-old male neutered domestic shorthair cat presented for acute vomiting. Abdominal ultrasound examination revealed a jejunal foreign body, which was removed via enterotomy. Preoperatively, the patient was hypoglycaemic and, intraoperatively, a dopamine infusion was required to maintain a mean arterial pressure >60 mmHg. Despite glucose supplementation, the cat remained severely hypoglycaemic on recovery. Within 24 h postoperatively, despite euglycaemia and normalisation of the cardiovascular status, the patient developed progressive polyuria (up to 14 ml/kg/h). This was associated with neurological signs suggestive of diffuse brain disease, and absence of azotaemia or signs of overhydration. During the first 4 days of hospitalisation, any attempts to decrease intravenous fluid therapy were associated with hypotension, weight loss and clinical dehydration. Urine specific gravity (USG) during this time was in the range of 1.005-1.010 and failed to increase during fluid challenges. A presumptive diagnosis of central diabetes insipidus was made, and desmopressin (1 µg/cat SC) was administered on day 5 of hospitalisation. Consequently, the cat's urinary output decreased and his weight increased within 4 h. The patient required a total of four doses of desmopressin during hospitalisation, but no further doses since discharge. Urinary output on discharge was 3 ml/kg/h. Three months later, the cat's neurological signs and polyuria had completely resolved, and the USG was >1.050.

Relevance and novel information: In this case, a presumptive diagnosis of central diabetes insipidus was supported by clinical progression, neurological signs and the response to desmopressin. To our knowledge, this is the first report of reversible diabetes insipidus after diffuse brain injury secondary to hypotension and hypoglycaemia.

Case summary: A 10-year-old castrated male crossbreed Birman cat was presented for respiratory difficulties, nasal discharge, dysphagia and wheezing. An obstructive nasopharyngeal mass invading the caudoventral nasal cavity and the left sphenoid sinus was observed on a CT scan. Surgical treatment via a ventral rhinotomy and curettage was performed. Histopathology revealed an adenocarcinoma with tubulotrabecular architecture. The cat's clinical signs significantly improved postoperatively. After 10 months, a recurrence was documented and a second surgical procedure was performed that allowed the patient to live an additional 6 months without clinical signs and an overall survival time of 19 months after first presentation.

Relevance and novel information: This case report describes a nasopharyngeal adenocarcinoma treated by ventral rhinotomy in a cat. To our knowledge, there is only one other report describing this surgery on a nasal adenocarcinoma in a cat. The tomodensitometric, endoscopic and unusual histological appearance of the mass are reported. The prognosis after surgical removal of nasal adenocarcinomas in cats is only sparsely documented. This case demonstrates that ventral rhinotomy might be considered if first-line treatment is declined.

Case summary: Persistent and progressive weakness secondary to hypokalaemia, that is, hypokalaemic polymyopathy, is one of the most common clinical signs of primary hyperaldosteronism (PHA). Herein, we report a case of PHA with infraspinatus muscle necrosis. A 5-year-old castrated male domestic shorthair cat presented with a history of polyuria and polydipsia, decreased activity, staggering gait, difficulty in jumping and inward rotation of both forelimbs. Blood examination revealed hypokalaemia, increased serum creatinine kinase activity and high serum aldosterone concentration. Abdominal ultrasonography and CT revealed an enlarged right adrenal gland. Post-contrast thoracic CT showed peripheral contrast enhancement and a non-enhanced centre in the bilateral infraspinatus muscles. From the day of initial presentation, the cat was started on oral potassium replacement therapy. On day 17, the right adrenal gland was surgically resected and the left infraspinatus muscle was biopsied. Histopathological examination confirmed the presence of an adrenocortical adenoma in the right adrenal gland and necrosis of the muscle fibres in the left infraspinatus muscle. On day 29, all clinical signs had disappeared, and the serum potassium concentration, creatinine kinase activity and aldosterone concentration had normalised. On day 57, atrophy of the bilateral infraspinatus muscles was noted, but there was no evidence of any posture or gait abnormalities.

Relevance and novel information: To the authors' knowledge, this is the first report of possible infraspinatus muscle necrosis in a cat with PHA. It is also possible that the infrinatus muscle necrosis with hypokalaemic polymyopathy secondary to PHA was caused by compartment syndrome in the cat described here.

Case series summary: Medical records of two kittens diagnosed with type I phimosis were reviewed. Clinical signs on presentation, investigations, description of the surgical technique, and short- and long-term follow-up were reported. Type I phimosis was diagnosed in both kittens based on the clinical, radiographic and surgical exploration findings. Modified circumferential preputioplasty using 4 and 6 mm Keyes biopsy punches was performed by the same surgeon in each case. The biopsy punch was centred over the existing narrowed preputial orifice and rotated clockwise and anticlockwise to obtain a sharp circumferential cut through the skin and submucosa of predictable diameter. The underlying mucosa was resected with micro curved scissors and mucocutaneous apposition was achieved with simple interrupted sutures placed circumferentially. Minor protrusion of the tip of the penis was recorded in the short-term follow-up (2 weeks) but resolved on the long-term follow-up (10 and 72 months). No evidence of urinary tract infection, strictures or clinical signs associated with phimosis were recorded at long-term follow-up.

Relevance and novel information: This short case series describes the surgical correction of type I phimosis by circumferential preputioplasty implemented using a Keyes biopsy punch in two kittens. The technique described in this case series can be considered alongside other reported surgical techniques, and appears to provide a reliable, rapid and accurate removal of preputial skin in the two reported cases.

Case summary: A 12-year-old castrated male domestic shorthair cat was referred for investigation of lethargy, hindlimb weakness with plantigrade stance and ventroflexion of the neck. The cat was fed a balanced diet and had received methylprednisolone acetate at a dose of 20 mg intramuscularly every 6 months for 6 years. On blood work, severe hypokalaemia and marked elevation of muscle enzymes were noticeable. The findings were suggestive of hypokalaemic myopathy. Urine fractional excretion of potassium (FE_k) was moderately high (9.04%), and serum aldosterone was below the reference interval. An adrenocorticotropic hormone (ACTH) stimulation test was compatible with adrenal suppression. Upon hospitalisation, the patient was given intravenous (IV) Ringer lactate solution supplemented with potassium chloride and oral potassium citrate. The serum potassium concentration normalised by the fifth day of hospitalisation; therefore, IV potassium supplementation was suspended. The cat was discharged with oral potassium and the dose was gradually reduced over time. After 4 months, the cat was clinically normal; the serum potassium concentration remained within the normal range and the adrenal glands showed some response to ACTH stimulation. Potassium supplementation was therefore discontinued. One month later, the serum potassium concentration was still within normal limits and at the time of writing (7 months after presentation), no clinical signs had reoccurred.

Relevance and novel information: This report describes a case of hypokalaemic myopathy associated with iatrogenic hypercorticism in a cat. This condition was successfully treated with supplementation of potassium and a complete clinical remission was achieved within 4 months.

Case summary: An 11-year-old castrated male domestic shorthair cat presented with chronic regurgitation and weight loss. Despite a 2-month history of weight loss, regurgitation intensified over 4 weeks, occurring with every food intake, even on a semi-liquid diet. Physical examination revealed thinness and dehydration, and a focal oval mass was noted in the middle mediastinum on thoracic radiography. Oesophagoscopy identified a 6 cm neoformation almost completely obstructing the oesophageal lumen. Biopsies were taken and histopathology, positivity to melanoma triple cocktail and PNL-2 by immunohistochemistry led to the diagnosis of melanocytic neoplasm. Palliative debulking with argon plasma coagulation (APC) was performed, significantly improving the cat's quality of life for 2 months. The cat survived for 107 days after diagnosis.

Relevance and novel information: This case report describes the first report of melanocytic neoplasia originating from the oesophageal mucosa in a cat. In cats, melanomas outside the eyes are exceedingly rare and oesophageal neoplasms are exceptionally rare in veterinary medicine, particularly melanomas. The diagnosis relied on positive immunohistochemistry markers aligning with previous research. Treatment with APC emerged as a novel, potentially palliative approach, successfully alleviating regurgitation for 3 months. This underscores APC's potential in feline oesophageal neoplasia palliative care, which deserves further investigation in a broader feline cohort to confirm its efficacy. Overall, this report provides valuable insights into the diagnosis and treatment of oesophageal melanoma in cats.

Case summary Two 18-day-old domestic shorthair kittens presented with dyspnoea, mild cyanosis, heart murmur, lung pattern, abnormal crawling and a marked dorsoventral flattening of the thorax. Deformity of the thoracic wall without pectus excavatum was diagnosed. Cardboard corsets tailored to each kitten were applied. This gave immediate respiratory relief, easing distress and pain. After 10 days, clinical and radiographic monitoring revealed normalisation of the shape of the chest wall with an improvement in general condition. At 6 months of age, clinical examination showed normal growth and development of both kittens, with a normal thoracic profile and shape also seen on radiographs. Relevance and novel information Data about flat-chested kitten syndrome and its aetiopathogenesis, treatment and outcome are scarce, but there is significant experience among breeders that is shared through online communities. High mortality rates are reported. The use of a cardboard splint appears to be novel in the published literature; in this case report, it proved to be a rapid and easy solution. For this reason, cardboard splints could be considered as a first approach for the clinical management of flat-chested kitten syndrome.

Case series summary: Two cats were referred to a veterinary teaching hospital with a cotton tip applicator (CTA) tracheobronchial foreign body (FB) after induction of anesthesia for an elective dental cleaning. In both cases, a lidocaine-saturated CTA, utilized to desensitize the larynx before endotracheal (ET) intubation, broke when introduced into the oropharynx and was subsequently aspirated into the tracheobronchial tree. Both CTAs were successfully removed bronchoscopically, and the cats survived with no short- or long-term complications noted.

Relevance and novel information: Utilizing a lidocaine-saturated CTA to facilitate ET intubation in cats is not well described, and information on the relative risks and benefits of this specific method for laryngeal desensitization is lacking. This retrospective case series is the first to describe a complication of this technique and successful treatment. These cases highlight the risk inherent to using a CTA to desensitize the feline larynx.