Ulcerative neutrophilic dermatitis resembling human bromoderma in a dog

A dog was referred because of the presence of painful ulcers with violaceous borders and multiple dermal and subcutaneous haemorrhagic nodules on the bridge of the nose, on the dorsal aspect of the front paws, and on all four legs. Lesions had not responded to antibacterial and immunomodulatory therapy. Nine months earlier, the dog had been diagnosed with idiopathic epilepsy and treated with potassium bromide ever since. Histopathological examination of lesions revealed an interstitial neutrophilic dermatitis multifocally extending to the subcutaneous tissue. All special stains were negative for infectious agents, and due to the lack of tropism for follicular structures as well as negative bacterial and fungal cultures, a diagnosis of a sterile neutrophilic process similar to pyoderma gangrenosum was made. A cutaneous drug reaction was suspected, potassium bromide was suspended, and after 6 weeks the ulcerative lesions were completely healed. The present report describes a case of an ulcerative neutrophilic dermatitis presumed to be associated with administration of potassium bromide that resembled human bromoderma.

Influence of domperidone supplementation on short-term changes in C-reactive protein and paraoxonase-1 in dogs with leishmaniasis undergoing meglumine antimoniate and allopurinol therapy

BACKGROUND

C-reactive protein (CRP) and paraoxonase 1 (PON1) might increase and decrease in canine leishmaniasis (CanL), , and both can rapidly normalize after therapy. Recently, supplementation of domperidone with conventional therapy , increasing the activity of cells involved in acute phase responses in vitro. This combined therapy has been recommended to treat mild forms of CanL; however, no studies have investigated the effects of domperidone supplementation on early CRP or PON1 changes in dogs with CanL.

OBJECTIVES

The aim of this study was to evaluate whether domperidone, added to conventional treatments, modifies CRP concentration and PON1 activity kinetics in CanL dogs responsive to conventional therapy.

METHODS

Serum CRP concentrations and PON1 activities were measured in dogs with mild CanL before (t-0) and 3 (t-1), 7 (t-2), 14 (t-3), and 21 (t-4) days after treatment with N-methylglucamine antimoniate and allopurinol alone (n = 18) or combined with domperidone (n = 18).

RESULTS

C-reactive protein concentrations increased at t-1 in the domperidone group, especially when the CRP concentration at t-0 was normal. However, the concentrations normalized at t-4 in 18/18 dogs compared with 14/18 dogs not receiving domperidone. The median PON1 activity decreased at t-1 in the domperidone group, and this decrease was more significant in dogs with normal PON1 activity at t-0.

CONCLUSIONS

Based on these results, transient increases in CRP concentrations or decreases in PON1 activities after domperidone administration should not be erroneously interpreted as signs of a worsening disease process.

Use of urinary γ-glutamyl transferase (GGT) to monitor the pattern of proteinuria in dogs with leishmaniasis treated with N-methylglucamine antimoniate

The aim of this study was to assess if the coupled analysis of the urinary protein to creatinine (UPC) ratio and of the GGT/UC ratio (the ratio between urinary γ-glutamyl transferase activity and urinary creatinine) may be used in treated leishmaniotic dogs to differentiate dogs with transient impairment of tubular function from dogs with persistent tubular damage. To this aim, 40 urine from 10 proteinuric and leishmaniotic dogs that at the first visit had high GGT/UC ratio, consistent with tubular damage, were collected and analyzed before treatments and 2, 4 and 6 weeks after treatment with N-methylglucamine antimoniate and allopurinol. Compared with pre-treatment values, at the end of the study period the UPC ratio decreased only in 5/10 dogs, which, however, were still proteinuric or borderline proteinuric. Conversely, the GGT/CU ratio decreased in 8/10 dogs and in 3 of them the values at the end of the study period were below the threshold consistent with tubular proteinuria. The GGT/UC values at 6 weeks was significantly lower than before treatment. However, transient increases were frequent for both the analytes. These results indicate that in most of the dogs that remain proteinuric after treatment, likely due to the persistent glomerular damage, the GGT/UC ratio tends to normalize. This suggests that in these dogs tubular proteinuria at admission depends on functional impairment of tubular cells likely due to the overflow of proteins from damaged glomeruli. However, tubular proteinuria occasionally persists, suggesting that tubulointerstitial damages persist even in dogs responsive to treatments.

Elusive Angiostrongylus vasorum infections

Background

The parasitic nematode Angiostrongylus vasorum causes severe clinical signs in dogs. The disease is often challenging because infected animals are often presented with clinical signs overlapping those of other diseases.

Methods

The present article describes six angiostrongylosis cases (Cases 1-6) that represent key examples of how canine angiostrongylosis may be extremely confounding. The six animals presented clinical signs compatible with canine angiostrongylosis but they were subjected to clinical examinations for other diseases (e.g. dirofilariosis or immune-mediated disorders) before achieving a correct diagnosis.

Results

In Case 1 clinical, radiographic and ultrasound examinations' results resembled a lung neoplasia. Case 2 was a dog with a mixed infection caused by A. vasorum and Dirofilaria immitis. Case 3 was a critically ill dog presented in emergency for an acute onset of dyspnoea caused by lungworm infection. The dog died a few hours after presentation despite support and etiologic therapy. Case 4 was a dog presented for chronic hemorrhages and ecchymoses caused by thrombocytopenia of unknown origin, thought to have an inherited, immune-mediated or infective cause. Case 5 was referred for neurological signs due to a suspected discospondylitis. Case 6 was erroneously diagnosed infected only with D. immitis although the dog was infected only with A. vasorum. A timely administration of an anthelmintic (mostly moxidectin) showed to be effective in treating the infection in those dogs (i.e. Cases 1,2, 4 and 5) that did not suffer with severe lung haemorrhages yet.

Conclusions

Dogs 1-5 were referred in two regions of Italy that are considered non-endemic for A. vasorum. These findings indicate that veterinarians should include angiostrongylosis in the differential diagnosis of cardio-respiratory distress also in non-endemic regions and should perform appropriate diagnostics in the presence of compatible signs even if the clinical picture is atypical.

Effects of the olive oil phenol metabolite 3,4-DHPEA-EDAH2on human erythrocyte oxidative damage

The olive oil polyphenol HT-EDA metabolite, HT-EDAH₂, protects human erythrocytes from induced oxidative damage.

Gastric cylicospirurosis in a domestic cat from Italy

A gastric nodule was found in a cat examined following a car accident. Cytological examination showed a mixed, mainly eosinophilic, inflammation with reactive fibroblasts and ovoidal elements resembling nematode eggs. The cat was euthanased because of rapid worsening of clinical signs due to secondary injuries, and the gastric nodule was excised for examination. The intramural mass was smooth and spherical, with an intact mucosal surface and a little opening from which several reddish worms were extruding. Histopathological examination confirmed severe reactive fibroplasia and inflammation, surrounding sections of a nematode worm. The latter was then identified with polymerase chain reaction as belonging to the Cylicospirura genus. Cylicospirura species worms should be considered in the differential diagnosis of gastric nodules in the cat.

Haematological and biochemical reference intervals of four feline breeds

Many feline breeds have been generated from a small number of ancestors. Thus, breed-specific peculiarities can be expected, which could include haematological and biochemical measurements. Despite this, there are only a few reports on breed-specific reference intervals (RI). This information is essential in routine practice where results from individual patients are usually compared with an RI. The aim was to compare haematological and biochemical data from clinically healthy Abyssinian, Holy Birman, Norwegian Forest and Siberian cats with published RIs to assess whether the published RIs are acceptable in these breeds. Comparison with established RIs using guidelines from the National Committee for Clinical Laboratory Standards and the American Society of Veterinary Clinical Pathology, revealed a number of breed-related clinicopathological differences. New RIs were established, but in most cases the new RIs overlapped with published RIs, and the use of the breed-specific data would minimally affect the clinical interpretation of laboratory results. Important differences that could result in misinterpretation of laboratory results were as follows: microcytosis and high α2-globulin concentrations in Abyssinian cats; high serum creatinine, α2-globulin and glucose concentrations in Holy Birman cats; high serum alkaline phosphatase activity and calcium and phosphate concentration in Norwegian Forest cats; low β2-globulin and γ-globulin concentrations in Norwegian Forest and Siberian cats. Breed-specific RIs should be used for these analytes. In addition, care should be taken in interpreting clinicopathological data in purebred cats for which specific RIs have not been established.

[Intramural hematoma of the duodenum. Diagnosis and therapy]

Two cases of intramural haematoma of the duodenum caused by injury are examined. The clinical signs were non-specific: vomiting and epigastric pain. The salient features of laboratory tests were leucocytosis and hyperamylasaemia. Radiography of the digestive tract revealed classic bunching of the mucous plicae in the second section of the duodenum in one case and a mark on the gastric antrum together with a clear stretch in the third duodenal section in the other. Surgical examination and drainage of the haematoma was performed in one case while the other was given conservative treatment. Both patients were clinically cured on release from hospital.

[Segmental portal hypertension caused by splenic vein thrombosis]

Seventeen cases of segmental portal hypertension due to splenic vein thrombosis are reported. This syndrome may be asymptomatic for a long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of gastric fundus varices as a result of hypertrophied submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or splenic artery angiography with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epiploic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Curative treatment of choice is splenectomy.

[Long-term results of gastric resection with reconstruction, using the Billroth I method]

Clinical, radiological and endoscopic results at follow-up about 1-5 yr after surgery in a series of 62 patients subjected to Billroth I resection are compared with those in the literature. Recurrence of ulcers was observed in 8% (as opposed to 5% with the Billroth II). In addition, there was a marked reduction in the incidence of post-resection diseases, with less serious forms of dumping, sounder digestion, and smaller weight losses.

[Problems in the emergency surgical treatment of bleeding esophageal varices]

An examination is made of a series of emergency operations carried out in the period 1974-78 to arrest haemorrhage due to the rupture of oesophageal varices. An account is given of the personal criteria employed in the choice of candidates and the type of surgical management. Stress is laid on the need for greater aggressivity. In addition, support is expressed for the porto-systemic shunts, especially shunts of the porto-cava and meso-cava type. These are superior to other forms on account of their easy and rapid execution.

[Pancreaticogastrostomy in duodenocephalopancreatectomy. Operative technical note]

The technique used to carry out pancreaticogastrostomy after duodenocephalopancreatectomy in 4 cases is described. The technique is better than pancreaticojejunostomy, which is associated with a high incidence of postoperative complications, such as abscesses, fistulae, haemorrhage, and autodigestion at the site of anastomosis.

[Problems in emergency surgery: rupture of the spleen in 2 stages. Apropos of 4 cases]

Six cases of delayed rupture of the spleen in two stages are described. One case of occult rupture is also presented. A picture of acute anaemia was observed in the five two-stage cases, whereas the occult rupture was diagnosed as organised splenic haematoma following computerised scintiscanning, arteriography and tomography. Splenectomy was performed in all cases, under emergency conditions in the first five, and of choice in the sixth. No post-operative complications were noted.

[Intestinal occlusion caused by endometriosis]

Three cases of intestinal occlusion due to endometriosis, presenting as surgical emergencies, are reported. After a review of the literature on the incidence of endometriosis, the mechanisms underlying the occlusive process and the various anatomopathological pictures are presented. The reasons why no correct preoperative diagnosis was possible and the problems encountered in differential diagnosis, particularly with respect to carcinoma of the colon and the sigma-rectum, are discussed. It is considered that correct preoperative diagnosis is very important to avoid subjecting the non-cancer patient to destructive surgery. The therapy recommended for intestinal occlusion due to suspected endometriosis is presented.

[Problems in emergency surgery: segmental portal hypertension]

Three typical cases of segmental portal hypertension due to occlusion of the splenic vein are reported. This syndrome may be asymptomatic for a very long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of the varices of the fundus of the stomach as a result of hypertrophized submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or superselective arteriography of the splenic artery with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epipolic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Resolutive treatment of choice is splenectomy.

[Esophagogastroplasty in upper esophageal lesions. Apropos of 4 cases]

Oesophagogastroplasty has been performed in 4 patients in the Turin Department of Emergency Surgery. Three of them presented high neoplastic lesion of the oesophagus, while the fourth was suffering from mediastinic compression due to sclerosing mediastinitis. The technique and results are reported in detail. Indications for surgery for both malignant and benign lesions are presented. The real advantages of the operation with respect to stomach to chest transposition and oesophagocolonplasty which have in the personal series created considerable inconvenience, are discussed. The reasons making it necessary to carry out the operation in two stages, with different modalities, are also discussed. Complications are indicated and postoperative treatment discussed. This plays a notable part in the success of the operation, as does correct technique.

[Intraoperative choledochoscopy]

Intraoperative choledochoscopy is examined and the instruments mostly employed for this purpose are described, with particular reference to the Olympus CHF B2, and personal modifications to the same, as used in the present study. The indications for the examination and the technique required are explained. It is especially useful in diseases of the bile ducts, and superior to cholangiography, which often fails to diagnose intrahepatic calculosis and small, multicentered tumours. A series of images relating to calculosis of the bile ducts, biliary neoplasia, the choledochus in lesions of the head of the pancreas, and the normal appearance of the bile ducts is presented.

[Villose polyps of the duodenum]

A case of villous polyps of the duodenum is reported, world-wide series also being considered. The various symptomatologies and percentages of malignant transformation and localization are described and stress laid on the superiority of endoscopy to radiography owing to the fact that it gave: 1) exact site and nature diagnosis of the lesion during the haemorrhagic phase; 2) exact histological and topographical diagnosis, following the haemorrhage, paving the way to the subsequent surgery.

[Problems in emergency surgery: acute mesenteric vascular occlusion]

Twenty-one cases of acute mesenteric occlusion are presented. Stress is laid on the difficulty of reaching a diagnosis in time to enable disobstruction to be carried out. In the reported series, diagnosis was established 1-8 days after the onset of symptoms. When radical surgery was performed (extensive resection occasionally coupled with right hemicolectomy), postoperative mortality was high and transit and nutritional problems brought about by the shortness of the residual gut were encountered.

[Emergency surgery problems: selective decompression of esophagogastric varices]

The physiopathological premisses of portosystemic anastomosis and the modern approach to this question are explained. Stress is laid on the general and haemodynamic advantages offered by selective shunts and 6 cases (4 distal splenorenal and 2 coronarocava shunts) are presented. As yet the postoperative period is not long enough to enable a final judgement to be formed. However, it can be stated that the success of this form of management is primarily determined by the proper choice of candidates, i.e. patients with non-decompensated initial cirrhosis and unimpaired portal hepatic flow.

[Use of transhepatic drainage in neoplastic stenosis of the upper biliary tract]

Rodney-Smith's technique (transtumoral transhepatic drainage) was used palliatively in 6 patients with cancer of the upper biliary tracts. Diagnosis from the symptomatology (essentially obstructive icterus) was not easy, though the picture can almost always be clarified by endovenous and endoscopic retrograde cholangiography and, more particularly, by preoperative and intrahepatic intraoperative cholangiography and choledochoscopy in connection with laparatomy. Two patients survived for 9 months and 2 yr respectively, whereas the remainder died within 30 days of surgery. Despite this high mortality, primarily due to very poor general condition, this type of palliative operation is still the best form of management.

[Acute renal failure and acute abdomen]

A series of patients with acute renal failure (ARF) and acute abdomen collected by the St. John the Baptist Hospital's Nephrology and Dialysis Division over the period 1970-75 is examined. A high rate of mortality was noted, due to causes that were mostly independent of ARF Death was often related to failure to resolve acute abdomen. The progression of ARF appeared to be related to that of the abdominal affection with prompt resolution of the latter. These findings suggest that constriction of the afferent arteriole may offer a partial, functional basis for ARF with the corollary that it has a good chance of being reversed, even after protracted periods of anuria. Renal complications associated with disseminated or localised intravascular coagulation appear to be rare. Treatment was best directed to early and frequent dialysis, with surgical resolution whenever indicated, irrespective of the presence of ARF.

[Acute esophagitis and gastritis caused by caustic acids]

9 cases of caustic ingestion are reported and the diagnostic and therapeutic problems of the consequent gastritis and oesophagitis conditions discussed. In the case of small quantities of acids at low concentrations, the immediate steps are largely medical and conservative, their purpose being to monitor complications. In cases of massive ingestion, surgery should be as early as possible to avoid secondary lesions to the surrounding viscera and serious electrolytic imbalances; the limit for action with a relatively favourable prognosis is within 5 hours and removal of the damaged segments must be radical and extensive.

[Problems in emergency surgery: ligation of the hepatic artery]

Reference is made to the literature data and a personal series for the proposal of ligation of hepatic artery as a useful means of controlling: 1) massive haemorrhage following certain forms of liver trauma; 2) haemorrhage following lobectomy or atypical subtotal resection; 3) post-traumatic haemobilia. It is a valuable alternative to lobar resection which, in spite of its over 50% mortality, is still the treatment of choice in serious lesions, especially if these are associated with lesions of the suprahepatic veins or cava, or massive crushing of the parenchima. Haemorrhagic shock following liver damage is usually met by reduced portal and increased hepatic artery flow. It is obvious that ligation of the hepatic artery leads to considerable ischaemia and hypoxia. This disadvantage can only be offset by massive replacement transfusions, protracted parenteral feeding (fasting leads to maximum oxygenation of the portal blood), and intravenous glucagone, to improve the overall liver blood flow and the oxygen saturation of the portal blood.