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Compendium November 2008 (Vol 30, No 11)

Abstract Thoughts — Clinical and Imaging Evaluations of Ischemic Myelopathy

by Joseph Harari, MS, DVM, DACVS

    De Risio L, Adams V, Dennis R, et al. Association of clinical and magnetic resonance findings with outcome in dogs suspected to have ischemic myelopathy: 50 cases (2000-2006). JAVMA 2008;233:129-135.

    Abstract: In this retrospective case series of dogs from practice centers in the United Kingdom, the outcome in patients with a presumed diagnosis of ischemic myelopathy was compared with clinical signs or magnetic resonance imaging (MRI) findings. Dogs included in the study had an acute, nonprogressive, nonpainful myelopathy that was characterized as nontraumatic using cerebrospinal fluid (CSF) analysis and MRI. Follow-up (median, 584 days) information was obtained via reexamination and questionnaires completed by owners and referring veterinarians. Most dogs had an asymmetric lesion causing paresis (ambulatory and nonambulatory). The median duration of hospitalization was 4 days, and the median time from onset of signs to unassisted ambulation was 10 days. Forty-two dogs had a successful outcome; the median recovery time to maximal recovery was 3.75 months. Results of MRI were normal in 11 dogs (22%). For dogs with an MRI finding, a smaller lesion was associated with a more successful outcome. No association was found between CSF abnormalities and outcome. There was an association between unsuccessful outcome and a poor clinical neurologic score. There was no significant statistical correlation between neuroanatomic location and outcome, although all dogs with a poor recovery had a lesion in the C6-T2 or L4-S3 spinal cord region.

    Commentary: Fibrocartilagenous embolization of the spinal cord producing ischemic myelopathy is common in canine patients. While the exact causes have never been completely elucidated, affected dogs are usually medium to large in size and have at least one acute, nontraumatic, nonpainful, nonprogessive, asymmetric limb lesion with variable neurologic dysfunction. Regardless of therapy, most patients recover over the course of weeks to months, as this study indicated. However, definitive diagnosis using traditional means (CSF analysis, myelography) can be elusive. The useful and shared clinical data in this paper and another publication by the same authors (J Vet Intern Med 2007;21:1290) suggest that a worsening neurologic score and more severe MRI lesion (length and cross-sectional area) correlate with each other and with a poorer outcome.

    Choosing Between Ovariectomy and Ovariohysterectomy in Dogs

    Van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Vet Surg 2006;35:136-143.

    Medline and PubMed literature for the years 1969 through 2004 was reviewed to compare ovariectomy (OVE) with ovariohysterectomy (OVH) and to determine whether OVE may serve as the preferred procedure for canine gonadectomy in population control. Although OVE is routine and has replaced OVH in certain European countries, it is not generally accepted in the United States. Technique, indications, surgery-related complications, long-term complications, and uterine pathology were evaluated.

    OVE is technically less invasive and less time-consuming than OVH, with OVH likely associated with greater morbidity (longer duration of surgery and anesthesia, larger incision, greater intraoperative trauma). Complications included intraabdominal hemorrhage (OVH had added risk), vaginal bleeding, accidental ureteral ligation (identical risk for proximal ureteral liga­tion, but greater risk with OVH for distal ureteral ligation), ovarian remnant syndrome (mostly after OVH), inflammation and stump granuloma formation (uterine stump granulomas are impossible with OVE), and incidental complications (fewer with OVE). None of the long-term complications—endometritis/pyometra, uterine tumor formation, urinary sphincter mechanism incontinence, and obesity—showed significant differences between techniques.

    Most evidence led to the conclusion that removal of the uterus provided no benefit, so no indication exists for OVH for routine neutering of healthy dogs. OVE should, therefore, be the procedure of choice for canine gonadectomy.

    Low-Grade Lymphocytic Lymphoma: Outcome in Cats

    Kiselow MA, Rassnick KM, McDonough SP, et al. Outcome of cats with low-grade lymphocytic lymphoma: 41 cases (1995-2005). JAVMA 2008;232:405-410.

    Factors related to response to treatment (prednisone and chlorambucil), remission duration, survival, and prognosis were assessed for 41 cats with histologically confirmed, low-grade lymphocytic lymphoma via a retrospective review of medical records. Outcome differences for anatomic location (gastrointestinal disease versus disease affecting other organs) were also evaluated.

    Of 41 cats, 17 were spayed females and 24 were males (1 intact); almost all were domestic shorthairs or longhairs. Common clinical signs at hospital admission were weight loss, vomiting, anorexia, diarrhea, and lethargy. Also common were hypocobalaminemia, high serum folate levels, and increased trypsin-like immunoreactivity. Lymphoma of the gastrointestinal tract occurred in 68% of cats. A response to treatment was achieved in 95% of cats, with a complete response in 56%. No significant differences were found between responders and nonresponders or complete versus partial responders for any of the 13 risk factors evaluated.

    Because of the favorable prognosis for cats with low-grade lymphocytic lymphoma treated with oral prednisone and chlorambucil, study results support the use of this treatment. Anatomic location was not prognostic for response to treatment, response duration, or survival time. Partial response was associated with shorter remission, but no factors (including response to treatment) were significantly related to survival time.

    Clinical Spirocercosis in Dogs: Signs and Clinicopathologic Abnormalities

    Mylonakis ME, Rallis T, Koutinas AF, et al. Clinical signs and clinicopathologic abnormalities in dogs with clinical spirocercosis: 39 cases (1996-2004). JAVMA 2006;228:1063-1067.

    The purposes of this retrospective review of medical records of dogs with diagnosed clinical spirocercosis included determining clinical signs, clinicopathologic abnormalities, nature and prevalence of concurrent diseases, and potential risk factors. Information on signalment; residence (rural versus urban); season of onset; owner complaints; physical examination, clinicopathologic, radiographic, and endoscopic findings; and concurrent diseases was retrieved.

    Clinical spirocercosis occurred in young-adult large-breed dogs, with mixed-breed and Hellenic hounds and dogs with higher mean body weight being overrepresented compared with controls. Year, season of onset of clinical signs, sex, and residence were not related to disease development. The main clinical feature was esophageal dysphagia (mostly odynophagia, regurgitation, excessive salivation); 36% of dogs had concurrent diseases (e.g., leishmaniasis, dirofilariasis, monocytic ehrlichiosis), which may have accounted for some clinical signs. The most common radiographic abnormalities were mediastinal masses and thoracic spondylitis. All dogs had parasitic nodules at esophagoscopy. Normocytic, normochromic, nonregenerative anemia and neutrophilic leukocytosis were more common than in controls, as were hyperproteinemia and high alkaline phosphatase activity.

    This disease occurs more often in young-adult large-breed dogs. Nonregenerative anemia, neutrophilic leukocytosis, and high alkaline phosphatase activity may be useful disease indicators; esophagoscopy had greater diagnostic value than did fecal testing.

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