Yuki Animal Hospital

ABSTRACTBackgroundPolyarthritis (PA) is an inflammatory joint disease, sometimes with vague clinical signs.Hypothesis/ObjectiveExamine the occurrence of PA in dogs with increased plasma C‐reactive protein (CRP) concentrations, gait‐related clinical signs, or both, and characterize the epidemiological, clinical, and laboratory findings in dogs with PA.AnimalsEighty‐one dogs with increased plasma CRP concentrations, gait‐related clinical signs, or both.MethodsSingle institution, prospective study. The occurrence of PA was examined in dogs with increased plasma CRP concentrations, showing gait‐related clinical signs, or both. Information such as breed, age at diagnosis, sex, body weight, clinical signs, laboratory results, clinical diagnosis, treatment, and therapeutic response was determined for dogs with and without PA.ResultsOf 81 dogs, 20 (25%) were diagnosed with PA, representing 11 breeds. Sex distribution was 10 males and 10 females, with a median body weight of 5.4 kg and a median age of 13.8 years at diagnosis. Half of the cases exhibited gait‐related clinical signs. Thirteen dogs had reactive PA, seven had primary immune‐mediated PA, and none had infectious causes. The PA group had higher serum total calcium concentrations than the non‐PA group, and the recovery rate for PA was 90%.Conclusions and Clinical ImportancePolyarthritis should be included in the differential diagnosis for all dogs with increased CRP concentrations, even those without gait‐related clinical signs. Synovial fluid testing is indicated for dogs with high CRP concentrations, even after treatment for underlying diseases, particularly if they are only displaying vague clinical signs.

Background:Precursor-targeted immune-mediated anemia (PIMA) has been described in dogs presenting with nonregenerative anemia and evidence of ineffective erythropoiesis. Although it has been suggested that its occurrence may be related to the immune targeting of erythroid precursors, this pathogenesis has not been established. PIMA is mainly treated with glucocorticoids, and in cases where glucocorticoids alone are not effective, immunosuppressants are also used as combination therapy. However, not all cases of PIMA go into remission after these treatments.Case Description:Two dogs with severe nonregenerative anemia diagnosed as PIMA based on the results of clinical pathological examinations, including bone marrow examination, were treated with whole-blood transfusion and immunosuppressive doses of prednisolone, mycophenolate mofetil, and cyclosporine. However, these treatments failed to achieve remission of PIMA. Therefore, concomitant administration of oclacitinib, which is a Janus kinase-1 inhibitor that has been applied recently to the treatment of immune-mediated diseases, was performed; this combined regimen improved the anemia and achieved complete remission of PIMA.Conclusion:Oclacitinib may be an option for the treatment of PIMA in dogs failing to achieve remission with conventional immunosuppressive therapy.

To evaluate and compare the clinical usefulness of plasma atrial natriuretic peptide (ANP) and cardiac troponin-I (cTnI) concentrations for assessment of disease severity in dogs with naturally occurring mitral valve disease (MVD). 316 dogs with MVD and 40 healthy control dogs. Each dog underwent a physical examination and echocardiographic and thoracic radiographic assessments. Blood samples were obtained and processed for measurement of plasma ANP and cTnI concentrations. Dogs with MVD were categorized into 3 groups (stages B1 [no clinical signs or evidence of cardiac enlargement], B2 [no clinical signs with evidence of cardiac enlargement], and C [history of congestive heart failure and pulmonary edema]) on the basis of American College of Veterinary Internal Medicine guidelines. Receiver operating characteristic curve analysis was used to evaluate the accuracy of plasma ANP and cTnI concentrations for assessment of MVD severity. Plasma ANP and cTnI concentrations increased as disease severity increased. Median plasma ANP concentrations for all 3 MVD groups and median plasma cTnI concentrations for the stage B2 and C groups were significantly greater than the corresponding concentrations for the control group. Plasma ANP concentration, but not cTnI concentration, appeared to be useful for detection of dogs with subclinical (stages B1 and B2) MVD, whereas both concentrations appeared useful for detection of dogs with stage C MVD. Results indicated that plasma ANP and cTnI concentrations should not be used independently to diagnose MVD but can be used to assess MVD severity and supplement echocardiographic findings.

A 10-year-old spayed female Golden Retriever was examined because of a 3-month history of lethargy, anorexia, and stumbling gait. A splenic mass was identified on abdominal radiography and ultrasonography, and results of clinicopathologic findings indicated nonregenerative anemia, leukocytosis, and high serum C-reactive protein (CRP) concentration. To further investigate the cause of the dog's high serum CRP concentration, radiography and arthrocentesis were performed bilaterally on the carpal and stifle joints. On the basis of results, anemia of chronic disease associated with polyarthritis caused by the localized splenic mass was suspected. After splenectomy, there were improvements in the dog's clinical signs, polyarthritis, nonregenerative anemia, and serum CRP concentration. The splenic mass was histologically diagnosed as a nonneoplastic splenic hyperplastic nodule with evidence of omental adhesion. Findings indicated that nonneoplastic splenic hyperplastic nodules could result in reactive polyarthritis, although such nodules have not to our knowledge been described previously as an underlying cause of polyarthritis. Therefore, veterinarians should investigate for nonneoplastic splenic hyperplastic nodules in addition to other typical underlying causes when treating dogs with polyarthritis.

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

2015年９月，大分県内の牧野に放牧中の黒毛和種10歳齢の雌，元気食欲不振を主訴に受診した．症例は可視粘膜蒼白で血液塗沫にてタイレリア原虫が検出されたため，小型ピロプラズマ病と診断された．第１病日赤血球数116×104/μℓ，ヘマトクリット（Ht）値11.2％を呈し，第４病日まで，１日１回ジミナゼン・ジアセチュレート（DDA）１g/頭を投与したが，原虫寄生率，ヘマトクリット（Ht）値に変化がなく，第６病日において臨床症状の改善がみられなかったため，アクリフラビン１％溶液を50 mℓ静脈内投与した．第７病日には食欲は回復し，赤血球数133×104/μℓ，Ht 12.9％と貧血も改善傾向に向かった．アクリフラビンは動物用医薬品として販売されておらず，小型ピロプラズマ病の治療薬としての認識は少ない．今後DDAに反応しない症例においては，その治療選択肢としてアクリフラビンの使用が考慮されるべきと考えられた．

Two dogs were diagnosed with myotonia associated with hyperadrenocorticism and treated with trilostane. One dog showed temporary improvement, but the other dog showed no improvement. The dogs survived 2383 and 1902 days, respectively. Findings suggest that myotonia persists despite treatment, but this condition is not associated with a poor prognosis for survival.

A Bengal tiger was presented for evaluation of weakness, ataxia and inappetance. Computedtomography (CT) and magnetic resonance imaging (MRI) revealed a mass extending from theT7-8 vertebral body to the left rib and compressing the spinal cord. On CT, the bonedestruction and sequestrum were shown. On MRI, the multilobulated mass appeared hypo- toisointense in T1-weighted and hyperintense in T2-weighted images. The tiger died afterimaging, most likely from renal failure. Chordoma without metastasis was diagnosed onnecropsy. The imaging characteristics were similar to those found in chordoma in humans.This report describes the use of CT and MRI in an exotic species.

To the Editor: A seven-month-old male infant who was diagnosed with inguinal hernia at routine medical checkup was admitted to our hospital for surgical repair. Past history and family history were negative for bleeding tendencies, purpura, and hemophilia. Preoperative physical examination and laboratory tests indicated no abnormalities. Coagulation tests were not performed. Hernioplasty was performed with no oozing or complications. The patient was discharged from the operating room at 4 p.m. At 7 a.m. on postoperative day (POD) 1, HR had increased to 132 bpm and BP decreased to 90/40 mmHg. The mother noticed blood contamination of the gauze covering the wound at night, but she did not inform the medical staff. At 9 a.m. on POD1, the attending surgeon noticed the patient to be extremely pale and that the gauze covering the wound was soaked with blood. Blood tests confirmed severe anemia (hemoglobin (Hb) 4.8 g/dl). Emergency hemostasis was performed immediately under general anesthesia. After failure to secure another peripheral venous access, we inserted a central venous catheter in the right internal jugular vein. Preparation of red cell concentrate (RCC) took a long time because blood type screening had not been conducted preoperatively. The coagulation tests showed long APTT (125 s), and thus fresh frozen plasma was transfused. Oozing was observed throughout the surgical field. The blood loss measured intraoperatively was 50 g and laboratory tests at the end of surgery showed Hb 8.9 g/dl, and Ht 26.4% after transfusion of two units of RCC. On POD2, the scrotum began to swell because of oozing which required removal of the stitches to reduce the pressure. On POD6, plasma clotting factor IX was reduced to 8% of the normal value, and he was diagnosed as hemophilia B. Therefore, clotting factor IX was transfused which resulted in complete cessation of oozing on POD11. The patient was discharged on POD26. Routine preoperative management does not include coagulation tests, especially before minor pediatric surgery, for example hernioplasty, for children with no family history of bleeding disorders. Routine use of coagulation tests have been discussed by otorhinolaryngologists who perform elective tonsillectomy and adenoidectomy. Houry et al. [1] and the American Academy of Otolaryngology Head Neck Surgery [2] recommended performing preoperative hemostatic screening tests only for patients with abnormal bleeding history. The reported negative predictive value of normal APTT in the absence of symptoms and M. Sumie (&) T. Yokoo-Matsuoka K. Yamaura Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Maidasi 3-1-1, Higasi-ku, Fukuoka 812-8582, Japan e-mail: sumimako@chorus.ocn.ne.jp

A 2.5 year-old female ferret had a stiff palpable mass arising from the dorsal surface of the thoracic (T) to lumbar (L) vertebrae with paralysis of the hind limbs. By myelography the dorsal and ventral lines of contrast were not observed in the area forwarded of L3. Grossly, the tumor encircled the dorsal vertebrae. Microscopically, tumor cells were proliferated intimately and were attached to the vertebrae surface involving surrounding fatty and connective tissues. The tumor consisted of fibroblastic cells with prominent cellular atypia. The bromodeoxyuridine (BrdU) labeling index to examine cellular kinetics was high (11.8%). Based on macro and micropathological features, the present tumor was diagnosed as periosteal fibrosarcoma arising from perivertebral connective tissue.