Federico Fracassi

Intermittent Gastroesophageal Intussusception in a Dog: Clinical Features, Radiographic and Endoscopic Findings, and Surgical Management

M. Pietra1*, F. Gentilini1, S. Pinna2, F. Fracassi1, A. Venturini2 and M. Cipone1 Department of Veterinary Clinical Science (1Section of Internal Medicine; 2Section of Surgery), Faculty of Veterinary Medicine, University of Bologna, 40064 Ozzano dell’Emilia (BO), Italy *Correspondence: Dipartimento Clinico Veterinario, Universita degli Studi di Bologna, V ia T olara di Sopra 50, 40064, Ozzano dell’Emilia (BO), Italy E-mail: mpietra@vet.unibo.it

Breed distribution of canine diabetes mellitus in Italy.

F. Fracassi1, M. Pietra1, A. Boari2, G. Aste2, M. Giunti1 and P. Famigli-Bergamini1* 1Department of Veterinary Clinical Sciences, Internal Medicine Section, Alma Mater Studiorum-University of Bologna, V ia T olara di Sopra 50, 40064 Ozzano dell’Emilia (Bo), Italy; 2Department of Veterinary Clinical Sciences, Internal Medicine Section, University of T eramo, V.le Crispi 212, 64020 T eramo, Italy; *Correspondence: Dipartimento Clinico Veterinario, Alma Mater Studiorum-University of Bologna, via T olara di Sopra 50, 40064, Ozzano dell’Emilia (Bo), Italy E-mail:FAMIGL I@vet.unibo.it

Plasma concentrations and therapeutic effects of budesonide in dogs with inflammatory bowel disease.

OBJECTIVEnTo evaluate the pharmacokinetics and clinical efficacy of budesonide in dogs with inflammatory bowel disease (IBD).nnnANIMALSn11 dogs (mean ± SD age, 5.7 ± 3.9 years; various breeds and body weights) with moderate or severe IBD.nnnPROCEDURESnEach dog received a controlled-release formulation of budesonide (3 mg/m(2), PO, q 24 h) for 30 days (first day of administration was day 1). The concentration of budesonide and its metabolite (16-α-hydroxyprednisolone) was measured via liquid chromatography-tandem mass spectrometry in plasma and urine samples obtained on days 1 and 8 of treatment. On those days, plasma samples were obtained before the daily budesonide administration and 0.5, 1, 2, 4, and 7 hours after drug administration, whereas urine samples were obtained after collection of the last blood sample. A clinical evaluation was performed on the dogs before onset of drug administration and on days 20 and 30 after start of drug administration.nnnRESULTSnThe highest plasma concentration of budesonide and 16-α-hydroxyprednisolone on day 1 was detected at 1 hour and at 2 hours after drug administration, respectively. After standardization on the basis of specific gravity, the ratio between urinary concentrations of budesonide and 16-α-hydroxyprednisolone was 0.006 and 0.012 on days 1 and 8, respectively. The clinical response was adequate in 8 of 11 dogs.nnnCONCLUSIONS AND CLINICAL RELEVANCEnBudesonide was rapidly absorbed and metabolized in dogs with IBD. The drug gradually accumulated, and there was an adequate therapeutic response and no adverse effects.

Use of insulin glargine in dogs with diabetes mellitus.

The objective of this study was to evaluate the safety and efficacy of insulin glargine in dogs with diabetes mellitus (DM). Twelve client-owned dogs with DM were included. All dogs received insulin glargine every 12 hours for at least six months, re-evaluations were performed after one, two, four, eight, 12 and 24 weeks and included clinical signs, blood glucose curves (BGCs) and measurement of serum fructosamine concentrations. Mean blood glucose concentrations were significantly lower after two weeks of treatment and remained significantly lower for the duration of the study. By week 24, polyuria/polydipsia had improved in 91 per cent of the dogs. No clinical signs that could have been caused by hypoglycaemia were observed. Based on BGCs and remission of the clinical signs for judging the success of the treatment, 58, 33 and 8 per cent of the dogs attained good, moderate and poor glycaemic control by week 24 of the study, respectively. Insulin glargine administered subcutaneously twice daily is a possible and safe method of treatment for dogs with naturally occurring DM. Although only a few studies are available on the use of other types of insulin in dogs, their success rate is somewhat greater than that with insulin glargine.

Plasma ACTH precursors in cats with pituitary-dependent hyperadrenocorticism.

BACKGROUNDnDiagnosis of pituitary-dependent hyperadrenocorticism (PDH) in cats is challenging because there is no specific diagnostic test.nnnHYPOTHESIS/OBJECTIVEnThe determination of plasma ACTH precursor (POMC and pro-ACTH) concentration might facilitate the diagnosis of PDH in cats. The aim of the study was to evaluate prospectively the plasma concentrations of ACTH precursors in a small cohort of cats with PDH and to estimate the value of this approach for diagnosis.nnnANIMALSnFour groups of cats were included: group 1 (cats with PDH), group 2 (cats with diabetes mellitus but not hyperadrenocorticism (HAC)), group 3 (cats with diabetes mellitus and confirmed acromegaly but not HAC), and group 4 (healthy cats).nnnMETHODSnPDH diagnosis was based on clinical data, low-dose dexamethasone suppression test (LDDST), and adrenal and pituitary gland computed tomography (CT) scan. For groups 2, 3, and 4, hyperadrenocorticism was excluded by LDDST or urine cortisol:creatinine ratio (UCCR). An immunoluminometric assay was used to determine plasma concentrations of ACTH precursors in the 4 groups of cats.nnnRESULTSnGroup 1 contained 9 cats (enlarged pituitary gland in 7/9). Plasma ACTH precursor concentrations ranged from <53 to >1010 pmol/L with 8/9 concentrations ≥ 229 pmol/L. Groups 2, 3, and 4 included 13, 7, and 13 cats, respectively. Plasma ACTH precursor concentrations ranged from <53 to 96 pmol/L in group 2, <53 to 72 pmol/L in group 3, and <53 to 99 pmol/L in group 4.nnnCONCLUSION AND CLINICAL IMPORTANCEnHigh plasma concentration of ACTH precursors in cats (>100 pmol/L) is highly suggestive of PDH.

Use of high-frequency ultrasonography for evaluation of skin thickness in relation to hydration status and fluid distribution at various cutaneous sites in dogs

OBJECTIVEnTo assess the usefulness of high-frequency diagnostic ultrasonography for evaluation of changes of skin thickness in relation to hydration status and fluid distribution at various cutaneous sites in dogs.nnnANIMALSn10 clinically normal adult dogs (6 males and 4 females) of various breeds.nnnPROCEDURESnUltrasonographic examination of the skin was performed before and after hydration via IV administration of an isotonic crystalloid solution (30 mL/kg/h for 30 minutes). A 13-MHz linear-array transducer was used to obtain series of ultrasonographic images at 4 different cutaneous sites (the frontal, sacral, flank, and metatarsal regions). Weight and various clinicopathologic variables (PCV; serum osmolality; and serum total protein, albumin, and sodium concentrations) were determined before and after the infusion. These variables and ultrasonographic measurements of skin thickness before and after hydration were compared.nnnRESULTSnAmong the 10 dogs, mean preinfusion skin thickness ranged from 2,211 microm (metatarsal region) to 3,249 microm (sacral region). Compared with preinfusion values, weight was significantly increased, whereas PCV; serum osmolality; and serum total protein, albumin, and sodium concentrations were significantly decreased after infusion. After infusion, dermal echogenicity decreased and skin thickness increased significantly by 21%, 14%, 15%, and 13% in the frontal, sacral, flank, and metatarsal regions, respectively.nnnCONCLUSIONS AND CLINICAL RELEVANCEnCutaneous site and hydration were correlated with cutaneous characteristics and skin thickness determined by use of high-frequency ultrasonography in dogs. Thus, diagnostic ultrasonography may be a useful tool for the noninvasive evaluation of skin hydration in healthy dogs and in dogs with skin edema.

Evaluation of Hair Cortisol in the Diagnosis of Hypercortisolism in Dogs

BACKGROUNDnMeasurement of hair cortisol is a noninvasive technique used for several purposes in humans and in animals.nnnOBJECTIVESnTo measure hair cortisol concentrations (HCC) in dogs with spontaneous hypercortisolism (HC) and determine whether it can represent a useful diagnostic test for this syndrome.nnnANIMALSnTwenty-two dogs with spontaneous HC before treatment, 28 sick control dogs (SCD), and 40 healthy dogs.nnnMETHODSnIn this prospective, observational clinical study, the HCC was measured by an RIA assay after extraction in HC dogs, in dogs with other chronic diseases, and in healthy dogs. The diagnostic accuracy of HCC was evaluated by subjecting data from dogs with HC and dogs with other chronic diseases to receiver operating characteristic (ROC) curve analysis.nnnRESULTSnMedian (range) cortisol concentration in dogs with HC was 4.53 pg/mg (0.32-74.62 pg/mg) and was significantly higher than in SCD (1.49 pg/mg, 0.13-14.19 pg/mg) and healthy dogs (1.28 pg/mg, 0.34-5.38 pg/mg). Within the 3 groups, there was a large overlap of HCC. The area under the ROC curve was 0.80 (95% CI: 0.67-0.92). A cut-off value of HCC of 1.93 pg/mg revealed 91% sensitivity and 61% specificity to diagnose HC.nnnCONCLUSIONS AND CLINICAL IMPORTANCEnHair cortisol concentrations are higher in dogs with HC compared to SCD and healthy dogs. It is a noninvasive technique that should be further investigated as a possible diagnostic procedure for the diagnosis of HC in dogs.

Use of the Galactose-Based Contrast Agent SHU 508A (Levovist®) in Renal Ultrasonography of the Dog

Contrast enhancement has been routinely applied in order to ameliorate imaging in radiology, scintigraphy, computed tomography and magnetic resonance. Ultrasound contrast agents were introduced into human medicine from 1980 in order to improve the Doppler signal from organs and vessels, and to differentiate between healthy and sick tissue. Contrast agents have acoustic properties that enhance the backscattered signal (Ophir and Parker, 1989). Contrast media are classified in relation to their chemical structure and period of synthesis into first generation (SHU 454 Echovist, SHU 508A Levovist, Albunex), second generation (EchoGen, FSO 69 Optison, AFO 145 Imagent, BR 1 SonoVue) and third generation (MRX 115, BY 963, SHU 563A Sonavist, Quantison, PESDA, Aerosomes). The canine specie has been used as a model for human medicine in order to test new contrast media (Brown et al., 1997; Uchimoto et al., 2000) but few publications about the non-cardiac application of contrast media have been produced for the dog (Valentini et al., 1999; Bahr et al., 2000; Salwei et al., 2003; Ziegler et al., 2003). The aim of the current work was the description of the application of contrast media in the renal ultrasonography of clinical healthy dogs using SHU 508 (Levovist R

Evaluation of clinicopathological features in cats with chronic gastrointestinal signs

Food-responsive enteropathy (FRE), idiopathic inflammatory bowel disease (IBD), and alimentary tract lymphoma (AL) are often the remaining differentials for cats presenting with chronic gastrointestinal (GI) signs. Differential diagnosis is further complicated by overlapping clinicopathological features and histopathological changes, however. In this study we describe the clinical presentation of cats with chronic GI signs secondary to FRE, IBD, and AL, and evaluate possible associations between clinical, clinicopathological, ultrasonographic findings and diagnosis. The medical records of client-owned cats with chronic GI signs secondary to FRE, IBD, and AL were reviewed. Univariate and multivariate logistic regression models and receiver-operating characteristic curve (ROC) analysis were used for testing the data. Of the 56 cats included in the study, 22 were diagnosed with FRE (mean age, 70 months ± 49), 17 with IBD (mean age, 101 months ± 40), and 17 with AL (mean age, 122 months ± 45). Cats with FRE were younger and presented more often with diarrhea and less frequently with muscle wasting than cats with IBD or AL. In cats with AL, serum cobalamin levels were lower than in those with FRE or IBD (239 ± 190 ng/L vs. 762 ± 408 ng/L and 625 ± 443 ng/L, respectively) and folate levels were higher than in cats with IBD (18.2 ± 4.2 μg/L vs. 9.1 ± 4.7 μg/L, respectively). Multivariate/ROC curve analysis showed increased values of BUN (sensitivity 100, specificity 29.4, criterion >37 mg/dl) and serum folate (sensitivity 80, specificity 100, criterion >15.6 μg/L) and reduced values of cobalamin (sensitivity 100, specificity 62.5, criterion ≤540 ng/L), which suggested a diagnosis of AL versus IBD. Some clinicopathological features evaluated at diagnosis might suggest AL; however, because differentiating AL from IBD is often difficult, definitive diagnosis should be based on invasive diagnostic workup.

Altered Serum Thyrotropin Concentrations in Dogs with Primary Hypoadrenocorticism before and during Treatment

Background Thyrotropin (TSH) can be increased in humans with primary hypoadrenocorticism (HA) before glucocorticoid treatment. Increase in TSH is a typical finding of primary hypothyroidism and both diseases can occur concurrently (Schmidts syndrome); therefore, care must be taken in assessing thyroid function in untreated human patients with HA. Objective Evaluate whether alterations in cTSH can be observed in dogs with HA in absence of primary hypothyroidism. Animals Thirty dogs with newly diagnosed HA, and 30 dogs in which HA was suspected but excluded based on a normal ACTH stimulation test (controls) were prospectively enrolled. Methods cTSH and T4 concentrations were determined in all dogs and at selected time points during treatment (prednisolone, fludrocortisone, or DOCP) in dogs with HA. Results cTSH concentrations ranged from 0.01 to 2.6 ng/mL (median 0.29) and were increased in 11/30 dogs with HA; values in controls were all within the reference interval (range: 0.01–0.2 ng/dL; median 0.06). There was no difference in T4 between dogs with increased cTSH (T4 range 1.0‐2.1; median 1.3 μg/dL) compared to those with normal cTSH (T4 range 0.5‐3.4, median 1.4 μg/dL; P=0.69) and controls (T4 range 0.3‐3.8, median 1.8 μg/dL; P=0.35). After starting treatment, cTSH normalized after 2–4 weeks in 9 dogs and after 3 and 4 months in 2 without thyroxine supplementation. Conclusions and Clinical Relevance Evaluation of thyroid function in untreated dogs with HA can lead to misdiagnosis of hypothyroidism; treatment with glucocorticoids for up to 4 months can be necessary to normalize cTSH.