Treatment of Gastrin-Secreting Tumor With Sustained-Release Octreotide Acetate in a Dog

Sangho Kim, DVM, Kenji Hosoya, DACVR, ACVIM (Oncology), Satoshi Takagi, DVM, PhD,Masahiro Okumura, DVM, PhDAn

8 yr old, intact male Shiba Inu was presented with loose stool, polydipsia, hematuria, vomiting, and anorexia. Onabdominal ultrasonography, numerous nodules were detected in the hepatic parenchyma distributed diffuselythroughout all lobes. Excisional biopsy of one of the nodules was performed via exploratory laparotomy. Ahistopathological diagnosis of the lesion was carcinoid, and the tumor cells stained positive to chromogranin A andgastrin. The serum gastrin level of the dog was 45,613 pg/mL (reference range: 160-284). In addition to medicaltreatment with omeprazolecand famotidinee, suppression of gastrin secretion was attempted with octreotide acetate. Atest dose of octreotide acetate significantly decreased the serum gastrin level to approximately one third of the baselinein 2 hr and the effect lasted approximately for 6 hr. On day 21, treatment with sustained-release formulation of octreotideacetatea(5 mg intramuscular, q4 wk) was initiated. The serum gastrin concentration gradually decreased over 32 daysand then progressively increased in parallel with the progression of the hepatic nodules. The dog gradually developedrecurrence of initial clinical signs, and was lost to follow-up on day 510.

(J Am Anim Hosp Assoc2015; 51:407-412. DOI10.5326/JAAHA-MS-6270)


Association of Vitamin D Status and Clinical Outcome in Dogs with a Chronic Enteropathy

H. Titmarsh, A.G. Gow, S. Kilpatrick, J. Sinclair, T. Hill, E. Milne, A. Philbey, J. Berry, I. Handel, andR.J. Mellanby

Background: Dogs with a chronic enteropathy (CE) have a lower vitamin D status, than do healthy dogs. Vitamin D status has been associated with a negative clinical outcome in humans with inflammatory bowel disease.

Objectives: To examine the relationship between serum 25 hydroxyvitamin D (25(OH)D) concentrations at diagnosis andclinical outcome in dogs with a CE.

Animals: Forty-one dogs diagnosed with CE admitted to the Royal Dick School of Veterinary Studies, Hospital for SmallAnimals between 2007 and 2013.

Methods: Retrospective review. Serum 25(OH)D concentrations were compared between dogs which were alive at followup or had died because of non-CE-related reasons (survivors) and dogs which died or were euthanized due to their CE (nonsurvivors). A binary logistic regression analysis was performed to determine significant predictors of death in dogs with CE.

Results: Serum concentrations of 25(OH)D at the time a CE was diagnosed were significantly lower in nonsurvivors(n =15) (median nonsurvivors 4.36 ng/mL, interquartile range 1.6-17.0 ng/mL), median survivors (n=26) (24.9 ng/mLinterquartile range 15.63-39.45 ng/mL,P<.001). Serum 25(OH)D concentration was a significant predictor of death in dogswith CE (odds ratio 1.08 [95% CI 1.02-1.18)]).

Conclusions: Serum 25(OH)D concentrations at diagnosis are predictive of outcome in dogs with CE. The role of vitaminD in the initiation and outcome of chronic enteropathies in dogs is deserving of further study.

Key words: 25 (OH)D; Prognostic; Inflammatory bowel disease.

(J Vet Intern Med2015;29:1473-1478)


Surgical and Medical Treatment of Pyloric and Duodenal Pythiosis in a Dog

David Lee Dycus, DVM, MS, DACVS-SA, Cory Fisher, DVM, MS, DACVS-SA, Ryan Butler, DVM, MS, DACVS-SAA

5 yr old, male, neutered mixed-breed dog was referred for persistent vomiting 2 wk following a pyloric biopsy for apyloric outflow obstruction. Histopathology at the time of initial surgery was suggestive of pythiosis. Following referral,the dog underwent radical surgical treatment with a Billroth II procedure, partial pancreatectomy, and cholecystoduodenostomy. Histopathology and serology confirmed the diagnosis of pythiosis and medical treatment consisting ofitraconazole and terbinafine was started postoperatively. Serology titers were checked again at 8, 12, and 24 wkpostoperatively revealing a positive response to treatment and no reoccurrence of pythiosis. Since surgery, the patientexperienced waxing and waning elevations of liver values and laparoscopic liver biopsies 10 mo postoperatively revealedhepatic cirrhosis with fibrosis, bile duct hyperplasia, and chronic inflammation. This report documents successfultreatment of pyloric/duodenal pythiosis and the long-term (17 mo) consequences associated with the Billroth II, partialpancreatectomy, and biliary rerouting in the dog.

(J Am Anim Hosp Assoc2015; 51:385-391. DOI 10.5326/JAAHA-MS-6217)


Seizures Associated With Hypocalcemia in a Yorkshire Terrier With Protein-Losing Enteropathy

Jim Whitehead, DVM*, Jessica Quimby, DVM, PhD, DACVIM, Danielle Bayliss, DVM, MS, DACVIMA

7 yr old, male, castrated, Yorkshire terrier was presented on emergency for an acute onset of seizure activity. Theowner also reported that the dog had previously exhibited other symptoms, including intermittent vomiting, diarrhea,and anorexia for several yr. The initial workup revealed a marked decrease in ionized calcium and total protein. Furtherdiagnostics revealed decreases in magnesium, 25 hydroxyvitamin D, albumin, and globulins, and an increasedparathyroid hormone level. Intestinal biopsies revealed inflammatory bowel disease and lymphangiectasia. The dogreceived intravenous calcium gluconate for treatment of hypocalcemia followed by oral calcium and vitamin Dsupplementation. Seizure activity ceased once calcium levels approached the normal range. Medical and dietarytherapy for lymphangiectasia and inflammatory bowel disease consisted of prednisone, rutin, and a low-fat diet.Decreased serum total ionized calcium levels have been reported previously in dogs with protein-losing enteropathies.Typically, the hypocalcemia is not associated with clinical signs. Severe clinical signs of hypocalcemia are rarelyreported in dogs with protein-losing enteropathy, but seizures, facial twitching, and tremors can occur. When presentedwith a dog with a history of seizure activity, panhypoproteinemia, and hypocalcemia, protein-losing enteropathy shouldbe included on the list of differential diagnoses.

(J Am Anim Hosp Assoc2015; 51:380-384. DOI 10.5326/JAAHA-MS-6205)


Portal vein anatomy in the dog: comparison between computed tomographic angiography (CTA) and intraoperative mesenteric portovenography (IOMP)

A. T. Parry and R. N. White*
Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, North Mymms, Herts AL9 7TA
*Willows Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH

Objectives: To compare and contrast the findings of intra-operative mesenteric portovenography (IOMP) and computed tomography angiography (CTA) for the visualisation and identification of the extrahepatic and intrahepatic portal venous system in the normal dog.

Methods:Retrospective study of dogs with raised post-prandial bile acids concentrations, normal portal venous pressures and grossly normal portal vasculature that had undergone both CTA and IOMP was performed. Images and video were compared with the published anatomic literature.

Results:Ten dogs met the inclusion criteria. CTA documented the portal vein and its tributaries in all 10 dogs. IOMP documented the portal vein and the cranial mesenteric vein in all 10 dogs and the splenic vein in 1 dog but failed to show the caudal mesenteric and gastroduodenal veins in any dog. CTA documented more extrahepatic portal venous tributaries than IOMP. Both techniques documented the intrahepatic portal vasculature completely with equal clarity.

Clinical Significance:There was a large difference between the ability of the two techniques to delineate the normal portal vasculature; CTA consistently visualised the extrahepatic portal vasculature more completely than the IOMP and, as such, might be considered the modality of choice for imaging the normal portal vasculature in the dog.

(Journal of Small Animal Practice(2015) 56, 657-661DOI: 10.1111/jsap.12392)


Association of Gallbladder Mucocele Histologic Diagnosis with Selected Drug Use in Dogs: A Matched Case-Control Study

J.L. Gookin, M.T. Correa, A. Peters, A. Malueg, K.G. Mathews, J. Cullen, and G. Seiler

Background:The cause of gallbladder mucocele (GBM) formation in dogs currently is unknown. Many available drugsrepresent a newer generation of xenobiotics that may predispose dogs to GBM formation.

Objective:To determine if there is an association between the histologic diagnosis of GBM in dogs and administration ofselected drugs.

Animals:Eighty-one dogs with a histologic diagnosis of GBM and 162 breed, age, and admission date-matched controldogs from a single referral institution.

Methods:Medical records of dogs with GBM and control dogs from 2001 to 2011 were reviewed. Owner verification ofdrug history was sought by a standard questionnaire. Reported use of heartworm, flea, and tick preventatives as well as nonsteroidal anti-inflammatory drugs, analgesics, corticosteroids, or medications for treatment of osteoarthritis was recorded.

Results:Dogs with GBM were 2.2 times as likely to have had reported use of thyroxine (as a proxy for the diagnosis ofhypothyroidism) as control dogs (95% confidence interval [CI], 0.949-5.051), 3.6 times as likely to have had reported treatment for Cushing's disease (95% CI, 1.228-10.612), and 2.3 times as likely to have had reported use of products containingimidacloprid (95% CI, 1.094-4.723). Analysis of a data subset containing only Shetland sheepdogs (23 GBM and 46 control)indicated that Shetland sheepdogs with GBM formation were 9.3 times as likely to have had reported use of imidacloprid aswere control Shetland sheepdogs (95% CI, 1.103-78.239).

Conclusions and Clinical Importance:This study provides evidence for an association between selected drug use and GBMformation in dogs. A larger epidemiologic study of Shetland sheepdogs with GBM formation and exposure to imidacloprid iswarranted.

Key words:Bile; Canine; Mucus; Xenobiotic.

(J Vet Intern Med2015;29:1464-1472)


Usefulness of whole blood, plasma, peritoneal fluid, and peritoneal fluid supernatant glucose concentrations obtained by a veterinary point-of-care glucometer to identify septic peritonitis in dogs with peritoneal effusion

Amie Koenig, DVM, and Lindsey Lane Verlander, DVM

Objective: To evaluate the usefulness of a veterinary point-of-care glucometer for identification of septic peritonitis in dogs with peritoneal effusion (PE).

Design: Prospective clinical evaluation.

Animals: 39 dogs with PE

Procedures: Blood and peritoneal fluid convenience samples were collected concurrently in all dogs at the time of initial evaluation. A veterinary point-of-care glucometer was used to measure glucose concentration in heparinized whole blood, plasma, peritoneal fluid, and peritoneal fluid supernatant samples. Seventeen dogs had confirmed septic peritonitis, and 22 dogs had nonseptic PE. Sensitivity, specificity, positive and negative predictive values, and accuracy of identification of dogs with septic peritonitis were calculated for glucose concentration differences for whole blood versus peritoneal fluid (WB-PF), plasma versus peritoneal fluid (P-PF), and plasma versus peritoneal fluid supernatant (P-PFS).

Results: With a cutoff of >20 mg/dL, the glucose concentration difference for WB-PF was an insensitive indicator of septic peritonitis (sensitivity, 41.2%; specificity, 100%). In comparison, the glucose concentration differences for P-PF and P-PFS had a higher sensitivity for septic peritonitis (88.2% and 82.4%, respectively) but a lower specificity (80% and 77.8%, respectively). With a glucose concentration difference cutoff of ≥38 mg/dL, specificity, positive predictive value, and accuracy of P-PF and P-PFS improved.

Conclusions and Clinical Relevance: Determination of the glucose concentration difference for WB-PF with the veterinary point-of-care glucometer was not useful in identifying all dogs with septic peritonitis. A glucose concentration difference of ≥38 mg/dL for P-PF or P-PFS, however, supported an accurate diagnosis of septic peritonitis in dogs with PE.

(J Am Vet Med Assoc2015;247:1027-1032)

High Prevalence of Covert Infection With Gastrointestinal Helminths in Cats

Susan Little, DVM, PhD, DACVM-Parasit, Chris Adolph, DVM, MS, Kathryn Downie, DVM,Tim Snider, DVM, PhD, DACVP, Mason Reichard, MS, PhD

Fecal flotation is routinely used to identify feline helminth infections in clinical practice, but it is known to have limitations ofsensitivity, particularly for cestodes. To determine the prevalence of helminths in a contemporary population of cats andevaluate the ability of fecal flotation to detect these infections, helminths were recovered from intestinal tracts removedfrom 116 adult cats humanely euthanized by an animal control shelter in northeastern Oklahoma. Results were comparedto those of fecal flotation performed using both passive and centrifugal techniques. Helminths were identified in 78/116(67.2%) cats, including Toxocara cati(48/116; 41.4%), Ancylostoma tubaeforme(8/116; 6.9%), Dipylidium caninum(40/116; 34.5%), andTaenia taeniaeformis(30/116; 25.9%). Cats with T. catiwere significantly more likely to harborT.taeniaeformis(P¼.001) than cats without ascarids. Centrifugal fecal flotation with sugar solution identified 37/48 (77.1%)T. catiinfections, 8/30 (26.7%) T. taeniaeformisinfections, and no D. caninuminfections. Proglottids were detected onexternal examination in 19.0% (12/63) of cats with cestodes. Cestodes were present in over half of the cats examined inthis study, but the majority of these infections were not evident by the detection of external proglottids or recovery ofcharacteristic stages on fecal flotation.

(J Am Anim Hosp Assoc2015; 51:359-364. DOI 10.5326/JAAHA-MS-6221)