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Compendium December 2008 (Vol 30, No 12)

Abstract Thoughts — Multiple Epiphyseal Dysplasia in Young Dogs

by Joseph Harari, MS, DVM, DACVS

    Multiple Epiphyseal Dysplasia in Young Dogs

    Rørvik AM, Teige J, Ottesen N, Lingaas F. Clinical, radiographic, and pathologic abnormalities in dogs with multiple epiphyseal dysplasia: 19 cases (1991-2005). JAVMA 2008;233:600-606.

    Abstract: In this retrospective case series from the Norwegian School of Veterinary Science, the clinical, radiographic, and pathologic features of multiple epiphyseal dysplasia (MED) in 19 dogs from 10 litters are described. All affected dogs appeared normal at birth. Most dogs were hound breeds from Norway and lame between 5 and 8 months of age. Diagnosis was by radiography, which revealed failure of ossification of the epiphyses, apophyses, and cuboidal bones of the appendicular skeleton and the epiphyses of the vertebrae. The patellae and fabellae were also affected. The metaphyses and diaphyses of the long bones and vertebrae were normal, including length. Ten affected dogs underwent necropsy and histologic examination. Bone specimens revealed abnormally small centers of ossification with poorly developed bone tissue. Overall, disease severity was consistent among littermates but varied among dogs from different litters. The authors suspected an autosomal mode of inheritance.

    Commentary: Although MED has not been extensively documented in the veterinary literature, the information in this report is useful in providing diagnostic information for practitioners. Although most of the dogs were hound breeds from Norway, one was a golden retriever, and one was an English pointer. It is conceivable that more cases could be identified in the United States as the awareness level increases among veterinarians and international travel brings affected animals into the country. It is interesting to note that results of hematologic, serum biochemical, and thyroid function testing were normal in three affected dogs at 5 months of age. Because of the high degree of morbidity (lameness, limb deformations, premature degenerative joint disease) and lack of effective analgesic therapy, euthanasia was recommended by the authors. The fact that no dog survived past 14 months of age portends a poor prognosis.

    Pemphigus Foliaceus in Dogs

    Mueller RS, Krebs I, Power HT, Fieseler KV. Pemphigus foliaceus in 91 dogs. JAAHA 2006;42:189-196.

    To determine whether certain features could help predict outcome in dogs with pemphigus foliaceus, medical records from six facilities for the years 1994 through 2002 were analyzed for clinical signs; rate of disease onset; lesion type; cytology; breed, sex, and age of patient; medications; and duration and outcome of treatment.

    No sex or breed predisposition was identified. The course of disease was rapid in 29 dogs and slow in 22 (not determined in 40). Average age at onset was 6 years. Crusts were the most common lesion (79 dogs); 36 dogs had pustules; 33, alopecia; and 27, scaling. Sixty dogs had generalized disease, with lesions most often on the trunk (53 dogs), inner pinnae (46 dogs), face (37 dogs), and footpads (32 dogs). Acantholytic cells were present in 37 dogs; high neutrophil numbers, 35 dogs; and numerous eosinophils, 8 dogs. The most common treatment involved prednisolone alone (39 dogs) or with azathioprine (33 dogs). Of 88 treated dogs, 46 showed remission, 31 improved greatly, and 11 were euthanized. Combination treatment had more adverse effects than prednisolone alone.

    More than half of the dogs achieved remission; treatment method had no effect on response rate or euthanasia. Localized versus generalized disease and antibiotic use had no predictive value, but early rapid response to treatment may portend a good outcome.

    Magnetic Resonance Imaging and Clinical Associations in Dogs with Suspected Ischemic Myelopathy

    De Risio L, Adams V, Dennis R, et al. Magnetic resonance imaging findings and clinical associations in 52 dogs with suspected ischemic myelopathy. J Vet Intern Med 2007;21:1290-1298.

    Magnetic resonance imaging (MRI) helps with the antemortem diagnosis of ischemic myelopathy; therefore, clarification of the MRI features of this condition would be beneficial. Associations among clinical, diagnostic, and MRI findings in 52 dogs with ischemic myelopathy were identified by retrospective medical record review. The inclusion criteria were acute onset of nonprogressive, nonpainful myelopathy; 1.5-tesla MRI of the spine within 7 days of onset; complete medical records; and follow-up. The MRI variables assessed included presence, site, lateralization, and extent of intramedullary hyperintense lesions on sagittal and transverse T2-weighted images. Lesion extent was indicated by (1) the ratio between the length of the hyperintense area on sagittal T2-weighted images and the length of the body of C6 or L2 and (2) the maximal cross-sectional area of the hyperintense area on transverse T2-weighted images as a percentage of the cross-sectional area of the spinal cord. Neurologic deficits were scored for severity. MRI findings were normal in 11 dogs. Abnormal MRI results and the time between onset of signs and MRI were not associated.

    The severity of clinical signs (especially presenting ambulatory status) was associated with the presence of MRI abnormalities and with lesion extent on sagittal and transverse MR images. A discrepancy between clinical and MRI lesion localizations, found in nine dogs, suggests that MRI may not allow lesion detection in early disease.

    Combination Chemotherapy for Feline Lymphoma

    Simon D, Eberle N, Laacke-Singer L, Nolte I. Combination chemotherapy in feline lymphoma: treatment outcome, tolerability, and duration in 23 cats. J Vet Intern Med 2008;22:394-400.

    This prospective, single-arm clinical trial evaluated the efficacy and toxicity of a continuous, multiagent chemotherapy regimen in 23 cats with lymphoma. The protocol comprised l-asparaginase, vincristine, cyclophosphamide, doxorubicin, methotrexate, and prednisolone. The planned treatment time was 122 weeks.

    Most of the cats were European shorthairs (median age, 9.5 years). Anatomic locations of lymphoma included mediastinal (four cats), gastrointestinal (five cats), multicentric (one cat), and extranodal (13 cats). Lymphoma was stage 1, 2, or 3 in 26%, 26%, and 35% of cats, respectively. Seven cats were FIV positive. Seventeen cats had a complete remission (CR) with a median duration of 264 days and median survival of 296 days; four cats had a partial remission with a median duration of 23 days and median survival of 47 days. Six-month and 1-, 2-, and 3- to 5-year survival rates for CR cats were 82%, 47%, 34%, and 27%, respectively. Actual treatment time for CR cats was 18 weeks. Toxicity (neutropenia, gastrointestinal effects) was mostly low grade and infrequent.

    This protocol was effective and tolerable. Anatomic location was the only variable that significantly influenced CR duration. About one-third of the cats had long-term CR and survived several years. Cats with CR after induction treatment may not need long-term chemotherapy to maintain remission.

    Freshwater Submersion in Small Animals

    Heffner GG, Rozanski EA, Beal MW, et al. Evaluation of freshwater submersion in small animals: 28 cases (1996-2006). JAVMA 2008;232:244-248.

    Retrospective analysis of medical records from five hospitals identified 25 dogs and three cats that had experienced freshwater submersion. The records were reviewed for signalment, cause and location of submersion, month, physical examination results (including blood gas analysis), treatment, hospitalization, and outcome.

    Twelve animals were female; 16 were male. Various breeds were represented. Thirteen animals were submerged in lakes, ponds, or rivers; 12 others in swimming pools. The circumstances of submersion were unclear for 12 animals (including all three cats); reasons varied for the others. Most submersions took place in the months of May through September. Treatments included supplemental oxygen, antimicrobials, furosemide, assisted ventilation, corticosteroids, and aminophylline. Twenty-six animals had organ compromise, with the lungs most affected. Neurologic, hepatocellular, cardiovascular, hematologic, and renal dysfunction was found in 12, 6, 4, 3, and 2 animals, respectively. Eighteen dogs (64%) survived. In nine of the 10 nonsurvivors, respiratory failure caused death or was the reason for euthanasia. No other factor produced significant differences between survivors and nonsurvivors.

    The data indicate that submersion is a relatively uncommon reason for veterinary evaluation. Dogs without respiratory failure had a good prognosis. The authors recommend collecting culture samples before using antimicrobials, avoiding corticosteroids, restricting unsupervised exposure to water, and not using neurologic compromise as a predictor of negative outcome.

    Continuous Multiagent Versus Short-Term Single-Agent Chemotherapy in Dogs with Lymphoma

    Simon D, Naranjo Moreno S, Hirschberger J, et al. Efficacy of a continuous, multiagent chemotherapeutic protocol versus a short-term single-agent protocol in dogs with lymphoma. JAVMA 2008;232:879-885.

    To clarify the type of chemotherapy required for long remission and survival times in dogs with lymphoma, this study compared two protocols: multiagent therapy, including l-asparaginase, vincristine, cyclophosphamide, doxorubicin, methotrexate, and prednisolone (76% of patients), and the single agent doxorubicin given every 3 weeks for five treatments (24%). Dogs (various breeds; median age, 7 years; 54 females, 60 males) were assigned to groups according to owner preference (nonrandomized). Confirmed lymphoma was mostly stages 3, 4, and 5.

    Sex, clinical stage, substage, anatomic classification, and immunophenotype did not differ significantly between treatment groups. Complete and partial remission was achieved for 73% and 17% of patients, respectively, with multiagent therapy and 52% and 22%, respectively, with single-agent therapy—not a significant difference. No significant difference between treatment groups was found for survival time or incidence of toxicoses (although vomiting was less common with doxorubicin alone).

    No significant difference was found for response to treatment or survival in the two different treatment groups. Dogs with substage a disease and dogs with B-cell phenotype had significantly longer survival times. Despite the study's limitations (e.g., unknown immunophenotype, small sample) and results, the authors' preference for multiagent therapy remained, partly because of the 2-year remission and survival probability rate of 21% and 26%, respectively.

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