The Canadian Veterinary Journal La Revue Vétérinaire Canadienne

January/Janvier 2014 The Canadian Veterinary Journal

La Revue vétérinaire canadienne Vol. 55, No. 01 Vol. 55,

January/Janvier 2014 Volume 55, No. 01

The use of medetomidine-based sedation protocols to perform urohydropropulsion and cystoscopy in the dog

Detection of retinoid receptors in non-neoplastic canine lymph nodes and in lymphoma

Prevalence of feline blood groups in the Montreal area of Quebec, Canada

Scrotal tumors in dogs: A retrospective study of 676 cases (1986–2010)

Extramedullary plasmacytoma in the lung of a Doberman pinscher dog

Long-term outcome of conventional endotracheal tube balloon dilation of tracheal stenosis in a dog

A case of ocular canine transmissible venereal tumor

Preoperative ketoprofen administration to piglets undergoing castration does not affect subsequent growth performance

Intravenous lipid emulsion for treating permethrin toxicosis in a cat

Effect of enteric biopsy closure orientation on enteric circumference and volume of saline needed for leak testing FOR PERSONAL USE ONLY

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JANUARY/JANVIER 2014 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES 1245 A case of ocular canine transmissible 1213 The use of medetomidine-based sedation venereal tumor protocols to perform urohydropropulsion Jewel Milo, Elisabeth Snead and cystoscopy in the dog Jinelle A. Webb, Monica Rosati, BRIEF COMMUNICATION Dinaz Z. Naigamwalla, Alice Defarges COMMUNICATION BRÈVE 1250 Preoperative ketoprofen administration to 1219 Detection of retinoid receptors in piglets undergoing castration does not non-neoplastic canine lymph nodes affect subsequent growth performance and in lymphoma Glen Cassar, Rocio Amezcua, Ryan Tenbergen, Carlos H. de Mello Souza, Victor E.O. Valli, Robert M. Friendship Barbara E. Kitchell

1225 Prevalence of feline blood groups in the STUDENT PAPER Montreal area of Quebec, Canada COMMUNICATION ÉTUDIANTE Fabrice T.J. Fosset, Marie-Claude Blais 1253 Intravenous lipid emulsion for treating 1229 Scrotal tumors in dogs: A retrospective permethrin toxicosis in a cat study of 676 cases (1986–2010) Whitney D. DeGroot Michelle C. Trappler, Cathy A. Popovitch, Michael H. Goldschmidt, Kyle H. Goldschmidt, ARTICLE Rebecca E. Risbon 1255 Effect of enteric biopsy closure orientation on enteric circumference and volume of CASE REPORTS saline needed for leak testing RAPPORTS DE CAS Brad M. Matz, Harry W. Boothe, James C. Wright, 1237 Extramedullary plasmacytoma in the lung Dawn M. Boothe of a Doberman pinscher dog Lauren Adelman, Victoria Larson, 1199 QUIZ CORNER Thomas Sissener, Tim Spotswood TEST ÉCLAIR 1241 Long-term outcome of conventional endotracheal tube balloon dilation of tracheal stenosis in a dog Nili Kahane, Gilad Segev

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JANUARY/JANVIER 2014 Contents Table des matières

FEATURES RUBRIQUES SPÉCIALES

LETTER TO THE EDITOR 1263 DIAGNOSTIC OPHTHALMOLOGY COURRIER DES LECTEURS OPHTALMOLOGIE DIAGNOSTIQUE 1185 Antidote for bromethalin poisoning Lynne S. Sandmeyer, Bianca S. Bauer, Bruce H. Grahn Israel Rubinstein, Guy Weinberg

PRESIDENT’S MESSAGE NOTICES ANNONCES MOT DU PRÉSIDENT 1187 Ethical practice/Pratique éthique 1249 Index of Advertisers Dr. Jim Berry Index des annonceurs

1195 VETERINARY MEDICAL ETHICS 1258 New Products DÉONTOLOGIE VÉTÉRINAIRE Nouveaux produits 1265 Industry News 1201 NEWS Nouvelles de l’industrie NOUVELLES Heather Broughton, Isabelle Vallières 1266 Classifieds Petites annonces COMMENTARY COMMENTAIRE 1234 The “unwanted horse” — A modest proposal Bernard Rollin

VETERINARY PRACTICE MANAGEMENT GESTION D’UNE CLINIQUE VÉTÉRINAIRE 1260 Associate salaries increase ... for half the provinces/Les salaires des vétérinaires augmentent... pour la moitié des provinces Darren Osborne

Contributors

“Instructions for authors” are available online (www.canadianveterinarians.net). Les «Directives à l’intention des auteurs» sont disponibles en ligne (www.veterinairesaucanada.net).

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The Canadian Veterinary Journal Editorial policy: All published articles including editorials and letters reflect the La Revue vétérinaire canadienne opinions of the authors and do not necessarily reflect the opinion of the publisher. Publication of an advertisement does not necessarily imply that the publisher agrees 339 rue Booth Street with or supports the claims therein. Ottawa, Ontario K1R 7K1 Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les Telephone: (613) 236-1162 lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de Fax: (613) 236-9681 l’éditeur. E-mail: [email protected] La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord Website/Site Web: www.canadianveterinarians.net avec son contenu ou qu’il l’appuie. www.veterinairesaucanada.net Editor-in-Chief/Rédacteur en chef © C anadian Veterinary Medical Association 2014 Carlton Gyles, Guelph, Ontario L’Association canadienne des médecins vétérinaires 2014 Associate Editors/Rédacteurs associés Bruce Grahn, Saskatoon, Saskatchewan The Canadian Veterinary Journal is indexed or abstracted in: Dana Allen, Guelph, Ontario La Revue vétérinaire canadienne est indexée ou ses articles sont Feature Editors/Rédacteurs des chroniques résumés dans : Stephen Raverty, Abbotsford, British Columbia AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Tim Blackwell, Fergus, Ontario Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Andrew Allen, Saskatoon, Saskatchewan Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Assistant Editors/Rédacteurs adjoints Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Photo by/Photo de : Elaine Migúe, Laval, Quebec Jacob Thundathil, Calgary, Alberta Ron Johnson, Guelph, Ontario Typesetting/Typographie Richard Kennedy, Pincher Creek, Alberta AN Design Communications Shawn McKenna, Charlottetown, P.E.I. Printed by/Imprimé par Managing Editor/Directrice de la rédaction Dollco a division of The Lowe-Martin Group Heather Broughton, Ottawa, Ontario Ottawa, Ontario Assistant Managing Editor/Directrice adjointe de la rédaction ISSN 0008-5286 Stella Wheatley, Ottawa, Ontario Editorial Coordinator/Coordonnatrice de la rédaction Kelly Gray, Ottawa, Ontario Return undeliverable Canadian addresses to: 339 rue Booth Street Advertising Manager/Gérante de la publicité Ottawa, Ontario K1R 7K1 Laima Laffitte, Wendover, Ontario e-mail: [email protected] Published monthly by/ Subscriptions (2014). Annual: Canada $190 + applicable GST or HST; foreign Publication mensuelle de $195.00 US. Single issue/back issue: $25 each + GST or HST, if applicable. (All prices Canadian Veterinary Medical Association subject to change.) Missing issues will be replaced if the Subscriptions Office is noti- fied within 6 months (for requests within Canada) and 1 year (for requests from abroad) of the issue date. The publisher expects to supply missing issues only when losses have been sustained in transit and when the reserve stock will permit. Telephone (613-236-1162) or (1-800-567-2862) and fax (613-236-9681) orders accepted with a valid Visa or MasterCard number. Please advise the publisher of address changes promptly. Abonnements (2014). Annuel : Canada 190 $ + TPS ou TVH en vigueur; pays étranger 195 $ É-U. Anciens numéros (chacun) : 25 $ + TPS ou TVH en vigueur. Les prix sont sujets à changement sans préavis. Les numéros qui ne sont pas reçus seront remplacés si l’éditeur en est informée dans les 6 mois (pour les demandes venant du Canada) et 1 an (pour les demandes venant de l’étranger) suivant la date de parution. L’éditeur s’engage à remplacer les numéros manquants seulement lorsque les pertes ont été subies en transit et lorsque ses réserves le permettent. On peut payer son abonnement par téléphone (613-236-1162), par télécopieur (613-236-9681) ou par carte de crédit (Visa ou MasterCard). Veuillez aviser le bureau de l’éditeur de tout changement d’adresse.

STUDENT SUBSCRIPTIONS/ABONNEMENTS DES ÉTUDIANTS

The editors and staff of The Canadian Veterinary Journal are pleased to have as readers student veterinarians at Canadian veterinary colleges! The production and distribution of student subscriptions is made possible through the generous sponsorship of Royal Canin Canada, Veterinary Division

Les rédacteurs et le personnel de La Revue vétérinaire canadienne sont heureux de compter les étudiants en médecine vétérinaire des collèges vétérinaires au Canada au nombre de leurs lecteurs. La production et la distribution des abonnements des étudiants ont été rendues possible grâce au généreux soutien de Royal Canin Canada, Veterinary Division

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Immunocidin Ad—D Docket: 2785_BI Publication: Canadian Veterinary Journal Release Date: Oct. 8, 2013 Trim Size: 8.125 x 10.875 Country: Canada FOR PERSONAL USE ONLY Letter to the Editor Courrier des lecteurs

Antidote for bromethalin poisoning Dear Editor, permeability transition pore opening thereby promoting recov- We read with great interest the recent Special Report by ery of veterinary patients (1–3). Finally, we encourage healthcare Dr. Coppock (Can Vet J 2013;54:557–558), on the deadly providers who treat bromethalin-intoxicated veterinary patients consequences of accidental ingestion by veterinary patients of with lipid emulsion to report their experience in the literature. bromethalin rodenticide, a commonly used potent, long-acting (days) neurotoxin for which no known antidote exists (1,2). References However, given the hydrophobic (lipid-soluble) characteristics 1. Coppock R. Advisory: Bromethalin rodenticide — No known antidote. of bromethalin (log P, 6.78), we propose that intravenous or Can Vet J 2013;54:557–558. intraosseous administration of lipid emulsion using a well- 2. Peterson ME. Bromethalin. Top Companion Anim Med 2013;28:21–23. 3. Weinberg GL. Lipid emulsion infusion: Resuscitation for local anesthetic established protocol (aka Lipid Rescue) could be a therapeutic and other drug overdose. Anesthesiology 2012;117:180–187. option for veterinary patients with bromethalin toxicosis and 4. Fernandez AL, Lee JA, Rahilly L, Hovda L, Brutlag AG, Engebretsen should be initiated as soon as possible at point-of-care (3). K. The use of intravenous lipid emulsion as an antidote in veterinary toxicology. J Vet Emerg Crit Care (San Antonio) 2011;21:309–320. Intravenous administration of commercially available lipid emul- 5. Kaplan A, Whelan M. The use of IV lipid emulsion for lipophilic drug sion (e.g., Intralipid® 20%; a parenteral nutritional supplement toxicities. J Am Anim Hosp Assoc 2012;48:221–227. approved worldwide) is a relatively new, safe, and efficacious treatment modality for severe cardiovascular and neurological Israel Rubinstein, MD toxicity provoked by accidental and intentional poisoning with Professor of Medicine lipophilic drugs (3). This emerging intervention is already used Department of Medicine successfully in dogs, cats, and other animals poisoned by iver- University of Illinois at Chicago mectin, moxidectin, permethrin, baclofen, lidocaine, and other College of Medicine and Jesse Brown VA Medical Center lipophilic drugs (4,5). Treated animals often exhibit prompt Chicago, Illinois 60612, USA recovery with no reported acute adverse events nor long-term [email protected] sequelae (4,5). Although the exact mechanism(s) of action underlying the salutary effects of lipid emulsion in the CNS Guy Weinberg, MD of these cases is uncertain (3), it is possible that the circulating Professor of Anesthesiology lipid emulsion entraps bromethalin (viz, the “lipid sink”) and Department of Anesthesiology then shuttle it to other sites for catabolism and excretion from University of Illinois at Chicago the body. At the cellular level, free fatty acids released from College of Medicine and Jesse Brown VA Medical Center lipid emulsion could also rescue mitochondria from the toxic Chicago, Illinois 60612, USA effects of bromethalin in the CNS by inhibiting mitochondrial [email protected]

Constructive and professional comments made in the spirit of intellectual debate are welcomed by the Editor. Writers are expected to be respectful of others and to ensure that letters are considerate and courteous. The Editor reserves the right to remove comments deemed to be inflammatory or disrespectful.

CVJ / VOL 55 / JANUARY 2014 1185 FOR PERSONAL USE ONLY

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Ethical practice Pratique éthique

eterinarians generally enter this profession with a measure es vétérinaires entrent généralement dans cette profession V of compassion, an interest in animals and medicine, con- L avec une dose de compassion, un intérêt envers les animaux cern for animal welfare, and idealism. We are trained to think et la médecine, une préoccupation pour le bien-être des animaux critically, to look at science-based information and evidence- et de l’idéalisme. Nous sommes aussi formés pour penser based medicine. So why are we constantly questioned about de façon critique, pour nous pencher sur de l’information our practice philosophies and decision-making in veterinary scientifique et une médecine factuelle. Donc, pourquoi nos practice? Our professional integrity and ethics are questioned by philosophies d’exercice et les décisions prises en pratique the media, by the public, even our own governments. Have we vétérinaire sont-elles constamment remises en question? missed something in our training? Can veterinarians maintain Notre intégrité professionnelle et notre éthique sont remises their professional ethics and still manage a successful practice? en question par les médias, le public et même nos propres The veterinary oath talks about veterinary medical ethics as gouvernements. Avons-nous oublié quelque chose dans notre well as personal and professional ethical standards. “As a member formation? Les vétérinaires peuvent-ils conserver leur éthique of the veterinary medical profession.....I will practise my profession professionnelle et gérer en même temps une pratique prospère? conscientiously, with dignity, and in keeping with the principles Le serment vétérinaire mentionne l’éthique de la médecine of veterinary medical ethics. I will strive continuously to improve vétérinaire ainsi que les normes d’éthique personnelle et my professional knowledge and competence and to maintain the professionnelle. «En tant que membre de la profession de médecin highest professional and ethical standards for myself and the pro- vétérinaire, (...) j’exercerai ma profession consciencieusement, fession” (1). Yet, where are the principles of veterinary medical avec dignité et conformément aux principes de déontologie de la ethics defined? There is nothing in the CVMA bylaws and codes. médecine vétérinaire. Je m’efforcerai sans cesse d’améliorer mes Some provincial veterinary associations define veterinary eth- connaissances et mes compétences professionnelles et de respecter les ics, while others are silent. There are entire books written on normes professionnelles et déontologiques les plus rigoureuses à mon the subject (2) and The Canadian Veterinary Journal hosts the égard et à celui de la profession.» (1). Pourtant, à quel endroit les “Ethical Question of the Month” to help address real life ethical principes de la déontologie de la médecine vétérinaire sont-ils decision-making. Is that enough to keep veterinarians current? définis? Les règlements administratifs et les codes de l’ACMV To start, we need to be clear on how ethics is defined. Betsy ne donnent aucune indication à cet égard. Certaines associations Saul describes ethics as an issue with no right answer; as an provinciales de médecins vétérinaires définissent la déontologie issue involving wrong versus wrong and right versus right (3). vétérinaire, tandis que d’autres demeurent silencieuses. Il y a In contrast, moral dilemmas center on questions of right versus des livres entiers qui ont été rédigés sur le sujet (2) et La Revue wrong, where a correct answer may be determined through vétérinaire canadienne publie la «Question de déontologie du research (3). Our personal ethics are influenced by our religious mois» pour discuter les décisions éthiques qui se présentent dans belief, the law and political ideology, economics, our educational la vie de tous les jours. Ces outils sont-ils suffisants pour tenir background, the influence of family and peer groups, societal les vétérinaires à jour? norms and personal desires (4). Ethics obviously have numer- Pour commencer, il faut établir une définition claire de la ous underpinnings, but the function is to give us the basis déontologie. Betsy Saul décrit la déontologie comme un enjeu to justify our actions (4). Ethics provide the basis to create a qui ne possède pas de réponse correcte, mais qui examine plutôt socially acceptable action, to help solve moral problems and le mal par rapport au mal et le bien par rapport au bien (3). Par

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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help us understand our own perspectives and those of others contraste, les dilemmes moraux se concentrent sur les questions (4). All veterinarians proceed through their careers with an de bien et de mal, où une réponse correcte peut être déterminée ethical perspective. They also have individual concerns, inter- lors d’une recherche (3). Notre éthique personnelle est influencée ests, biases, and typically a sense of what they wish to achieve par nos croyances religieuses, la loi et l’idéologie politique, les in their respective areas of the profession. This can lead to the questions économiques, nos études, l’influence de la famille et des question of how ethical decision-making co-exists with profes- groupes de pairs, les normes sociétales et les désirs personnels (4). sionalism in practice. La déontologie comporte évidemment de nombreux piliers, mais The role of veterinary medicine is dynamic and as society sa fonction consiste à nous fournir les fondements qui justifient changes, our ethical decision-making must also evolve. It is nos actions (4). La déontologie jette les bases pour créer une becoming more difficult to navigate this role as our obligation action socialement acceptable, faciliter la résolution de problèmes to our patients may conflict with the expectations of our peers, moraux et nous aider à comprendre nos propres points de vue

MOT DU PRÉSIDENTDU MOT clients and society in general (2). Although it is easy to access et ceux des autres (4). Tous les vétérinaires adoptent un point information online, it can be difficult to sort out fact from fic- de vue éthique pour cheminer dans leur carrière. Ils ont aussi tion. It is also a reality that many veterinarians work in private individuellement des préoccupations, des intérêts, des penchants practices and may not have easy access to continuing education et un sentiment général à l’égard de leurs buts dans leurs domaines or reference sources. So, from what sources do we take our cues? respectifs de la profession, et cette situation peut nous inciter à Numerous protocols have been published to help guide veteri- nous interroger sur la façon dont la prise de décisions éthiques et nary decision-making in many aspects of veterinary medicine; leur professionnalisme coexistent dans la pratique. everything from euthanasia, vaccination protocols, heart worm Le rôle de la médecine vétérinaire est dynamique et notre testing, infectious disease testing, weight loss regimens for pets, prise de décision éthique doit aussi évoluer en fonction des and parasite prevention programs. Although many of these changements qui s’opèrent dans la société. Il devient plus protocols contain current information, they may not account difficile de naviguer ce rôle, car notre obligation envers nos for regional and local differences in disease occurrence. In other patients peut entrer en conflit avec les attentes de nos pairs, de words, we may have access to the information, but not be able nos clients et de la société en général (2). Même s’il est facile to adequately determine if there is a strong evidence base for de consulter de l’information qui se trouve en ligne, il peut any recommendations. It is up to the individual veterinarian être difficile de faire la différence entre les faits et la fiction. to sort through the relevance of regional and local variables in Dans la réalité, beaucoup de vétérinaires travaillent dans des decision-making. This may leave some veterinarians in the posi- pratiques privées et n’ont pas facilement accès à de la formation tion of practicing off-label, or not working within the accepted continue ou à des sources de référence. Donc, quelles sources common practice for the profession. Since ethical decisions are devraient orienter nos décisions? Plusieurs protocoles ont été influenced by education, the access to significant amounts of publiés pour guider la prise de décisions dans de nombreux information without the ability to check the underlying assump- aspects de la médecine vétérinaire : l’euthanasie, les protocoles tions and authorship can influence our ethical choices, and de vaccination, le test pour le ver du cœur, les tests pour therefore our practice paradigms. Advocacy and pressure from des maladies infectieuses, les régimes amaigrissants pour les the public can also be a strong driving force in shifting veteri- animaux et les programmes de prévention des parasites. Même nary attitudes, but the general populace is just as susceptible to si beaucoup de ces protocoles contiennent des renseignements following unsubstantiated trends and programs as we are. à jour, ils peuvent ne pas tenir compte des différences régionales So what should veterinarians do? I think the most reason- et locales relativement à la présence de maladies. En d’autres able answer is to question sources of new information that will termes, nous pouvons avoir accès à l’information, mais être impact how we treat our patients or our clients. It is legitimate incapables de déterminer s’il existe des preuves factuelles to ask for the background research from peer-reviewed journals, appuyant des recommandations. Il en revient au vétérinaire it is legitimate to question the significance of diseases and test- individuel d’effectuer un triage pour évaluer la pertinence des ing regimens in your own geographic area, it is legitimate to variables régionales et locales lors de la prise de décisions, ce ask if a new treatment is appropriate in your practice for your qui peut mettre certains vétérinaires dans une position où ils patients. It is legitimate and essential to question and to form exercent en dérogation des directives ou travaillent en dehors your own evidence-based opinions. I believe that the basis of des pratiques communément acceptées pour la profession. Vu ethical decision-making in practice is to remember that our que les décisions éthiques sont influencées par les connaissances, first responsibility is to our animal patients, but our second l’accès à des quantités importantes d’information sans moyens responsibility should be to our clients. If we can do this, our de vérifier les suppositions sous-jacentes et la paternité peut profession will truly be ethical, and can only prosper as a result. influencer nos choix éthiques et, donc, les paradigmes de notre pratique. La défense des intérêts et les pressions exercées par Jim Berry le public peuvent aussi être une force puissante qui influence l’évolution des attitudes vétérinaires, mais la population References en général est tout aussi susceptible que nous de suivre des tendances et des programmes non fondés. 1. CVMA 2004 Veterinarian Oath. Available from: http://www.canadian veterinarians.net/about-veterinary-medicine/oath.aspx Last accessed, Alors que doivent faire les vétérinaires? Je crois que la réponse October 29, 2013. la plus raisonnable consiste à s’interroger sur la source des

1188 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY

D_Lebalab+BLEED.indd 1 13-04-02 10:54 AM FOR PERSONAL USE ONLY

2. Rollin BE. An Introduction to Veterinary Medical Ethics: Theory and Documents/Betsy%20Banks%20Saul%20-%20ethical%20dilemmas%20 Cases, 2nd ed. Ames, Iowa: Blackwell Publishing, 2006. THIS%20IS%20THE%20ONE.pdf Last accessed November 11, 2013. 3. Saul B. Summit of Urban Animal Strategies, “The Pet Dilemma”. Lake 4. Morgan C. CVMA Summit of Veterinary Leaders, “Moral Decision- Louise, Alberta, 2013. Available from: http://www.tsuas.com/Resources/ Making: Ethics and Welfare.” Victoria, British Columbia, 2013. ■

nouveaux renseignements qui auront un impact sur la façon Renvois dont nous traitons nos patients ou nos clients. Il est légitime 1. Serment vétérinaire, ACMV, 2004. Disponible au : http://www. de demander la recherche de fond de la part des revues évaluées veterinairesaucanada.net/about-veterinary-medicine/oath.aspx Dernière par les pairs, il est légitime de s’interroger sur l’importance consultation le 29 octobre 2013. 2. An Introduction to Veterinary Medical Ethics: Theory and Cases, 2e édition.

MOT DU PRÉSIDENTDU MOT des maladies et des régimes de tests dans votre propre secteur ROLLIN, B. E. Ames, Iowa, Blackwell Publishing, 2006. géographique, il est légitime de s’interroger à savoir si un 3. SAUL, Betsy. Summit of Urban Animal Strategies, «The Pet Dilemma». nouveau traitement est approprié dans votre pratique pour Lake Louise, Alberta, 2013. Disponible au : http://www.tsuas.com/ Resources/Documents/Betsy%20Banks%20Saul%20-%20ethical%20 vos patients. Il est légitime et essentiel de poser des questions dilemmas%20THIS%20IS%20THE%20ONE.pdf Dernière consultation et d’adopter nos propres opinions factuelles. Je crois que lors le 11 novembre 2013. de la prise de décisions éthiques en pratique, nos patients 4. MORGAN, Carol. CVMA Summit of Veterinary Leaders, «Moral Decision- Making: Ethics and Welfare», Victoria, Colombie-Britannique, 2013. animaux sont notre première responsabilité, mais que nos clients ■ devraient être notre deuxième responsabilité. Si nous pouvons nous acquitter de cette tâche, notre profession maintiendra une éthique véritable et nous ne pourrons que prospérer.

Jim Berry

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April 25 - 27, 2014 Halifax Marriott Harbourfront Hotel Halifax, NS www.apvc.ca

Veterinarians Dr. Stephen Waisglass Dr. Anthony Fischetti

• A Start to Finish Approach to the Itchy Pet • Radiographic Pearls for the Thorax The CSI Approach-Interviewing Witnesses, Assessing Crime Scene and Gathering Evidence • The Struggle to Diagnose Normal

• Skin Cytology; Latest Trends in Diagnosis and • Barking Up the Wrong Tree Management of Skin Infections; MRSA Where is the Problem? • The Diagnosis of Allergic Dermatitis • Radiology and Ultrasound Food Trials and Intradermal Testing Where Each Fits Best When are Skin Biopsies Needed Diagnostic Otology • Abdominal Radiography ! Making the Call on Small Intestinal Obstructions • Management of the Itchy Pet Latest in the Treatment of Allergic Dermatitis • What’s Your Diagnosis Feline Self Trauma. Case Studies Challenging Case Presentations • Claw and Claw-fold Diseases Dr. Robert Stein • Immune Mediated Diseases • Practical Anesthesia & Periop Pain Mgmt: • Acquired Alopecias of the Dog Foundational Principles and Preanesthetic Meds Dr. Julie Churchill System Selection • Practicing Nutrition in Primary Care Induction, Local Anesthesia and Patient Monitoring It Can be Easier Than You Think Patient Support, Intraop Analgesic Therapy and Postop Outpatient Analgesics • Keeping Current Amidst the Controversy of Feeding Cats • The Nuts & Bolts of Optimal Chronic Pain Mgmt: Carb Free? Canned? Can We Do Better? Foundational Principles and Osteoarthritis Pain • Quagmires and Controversies of “Natural Bone Cancer Pain and Spinal Pain Diets” • The “a b c’s” of Therapeutic Nutrition Using Evidence Based Nutrition to Decide Where to Animal Health Technicians Put Your Efforts David Liss Dr. Susan Little • What to Do in the First 5 Minutes • Cats, Stress and Illness; FIV Update • Critical Care Syndromes • The Amazing Fading Cat • Anesthesia for Critical Patients • Breathing Easy: Diagnosis and Treatment of Feline Asthma • Acute Pancreatitis • Blocked Cats • When Good Bladders Go Bad • Sticking Together - IMHA • Feline Idiopathic Cystitis & Feline Urethral • ER Tips and Tricks Obstruction

Join more than 850 other delegates, exhibiting companies and a world class list of speakers in an environment of true maritime hospitality FOR PERSONAL USE ONLY

A COMPLETE PACKAGE FOR THE ENTIRE VETERINARY TEAM

Animal Health Technicians

Dr. Andrew Roark • The Jedi Mind - How to Get Doctors to Do What You Want

• How to Lead From the Treatment Room

• The Top 3 Ways Doctors Hurt Your Practice

Dr. Robert Stein Support Staff

• Practical Anesthesia & Periop Pain Mgmt: Dr. Julie Churchill Foundational Principles, Preanesthetic Meds and System Selection • Make Nutrition Worth It - Aligning Team Inductions, Locals, Monitoring, Support and Intraop • Petfood Ratings, Ranking and Recalls Analgesic Therapy Dr. Andrew Roark Dr. Julie Churchill • Battle for Sanity - 6 Steps to Manage Angry • Weight Management; If Only They Could Lose, and Complaining Clients Everyone Wins! • Building Client Loyalty • Maximizing Exam Room Productivity • The Nuts and Bolts of a Practical Weight Loss Program David Liss • Emergencies: What to Do and Say • How Important is the First Clinic Contact? Business Management Dr. Susan Little • How to Make Your Clinic Cat Healthy Dr. Andrew Roark • How to Bond Clients in Person and Online Dry Lab • How to Make Facebook Pay • Twitter Basics-Get Up and Going to Drive Veterinarians: 1/2 Day Clients to the Door With Twitter Dr. Anthony Fischetti • Radiology - Interesting Case Studies Dr. Amanda Donnelly • Communicate for Results Fees • Leader of the Pack, Building a Dynamic Team Veterinarians Karn Nichols Full $350 (3 days) Lab $175 or $125 with Full Reg • Designing and Delivering Effective Employee (Radiology) Evaluations AHT’s & Vet’s Assistant’s Full $175 (3 days) Angela Schneider • Discover Todays Best Practices in Inventory Managers Full $275 (3 days) Support Staff Full $125 (2 days) For further information contact:

APVC Committee on Arrangements Email: [email protected] Dr. Ernie Prowse - Chair Tel: (902) 899-2233 106 Maple Blvd Truro, NS B2N 4N3 Register online - www.apvc.ca FOR PERSONAL USE ONLY

“Best Medicine Practices – Timely Topics”

ST. JOHN’S, NEWFOUNDLAND & LAbrADOr • JULY 9–12, 2014

Join us for top-notch Earn CE credits during A social evening to look scientific sessions specialized workshops, forward to — we’ll be addressing companion including a level 2 dental lab “Havin’ a Time in animal, equine and and an orthopedic lab. Newfoundland” as we ruminant medicine, experience the colourful business management culture and world renowned and more. hospitality in St. John’s.

In Collaboration with: The Canadian Association A New Discovery Down Every Lane of Animal Health Technologists and Technicians www.canadianveterinarians.net FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — January 2014 Acquiring funding for research at universities is becoming more difficult. To ensure objectivity and fairness, granting agencies require extensive pre-proposals followed by more demanding final proposals. Many strongly encourage multiple funding partners, which requires more grant writing. The percentage of competitive research grants sought that are successful can be as low as 10% to 20%. As a result, university professors spend much time in unsuccessful efforts to acquire research funding. A solution to this problem comes from the private sector which views university faculty as sources of credible and economical high quality research. If a hypothesis proposed by industry is of questionable scientific value, researchers reply that the work is valued by their “industry partners.” Faculty can now base their careers on non-competitive grants that fund research that tests hypotheses of someone else’s creation. As “negative” findings are seldom published, private industry risks little if their study does not produce the desired positive outcome. Can this trend of faculty acting as contractually limited researchers for private industry create unforeseen problems? Question de déontologie du mois — Janvier 2014 Il devient de plus en plus difficile d’acquérir des fonds pour la recherche dans les universités. Afin d’assurer l’objectivité et l’équité, les organismes subventionnaires exigent des demandes préliminaires suivies de propositions finales plus exigeantes. Beaucoup d’entre eux encouragent des partenaires subventionnaires multiples, ce qui exige plus de rédaction pour les subventions. Le pourcentage de réussite des subventions de recherche concurrentielles peut être aussi bas que de 10 % à 20 %. Par conséquent, les professeurs d’université consacrent beaucoup de temps à travailler à des projets d’acquisition de fonds de recherche qui se soldent par un échec. Une solution à ce problème provient du secteur privé qui envisage les professeurs d’université comme des sources de recherche crédible et économique de grande qualité. Si une hypothèse proposée par l’industrie est d’une valeur scientifique douteuse, les chercheurs répondent que les travaux sont valorisés par leurs «partenaires de l’industrie». Les professeurs peuvent maintenant baser leur carrière sur des subventions non concurrentielles qui financent de la recherche qui vérifie des hypothèses sur la création d’une autre personne. Vu que les résultats «négatifs» sont rarement publiés, il y a peu de risques pour l’industrie privée si leur étude ne produit pas le résultat positif souhaité. Est-ce que cette tendance où les professeurs agissent comme des chercheurs à contrat limité pour l’industrie privée soulève des problèmes imprévus?

Responses to the case presented are welcome. Please limit your Les réponses au cas présenté sont les bienvenues. Veuillez limiter reply to approximately 50 words and forward along with your votre réponse à environ 50 mots et nous la faire parvenir par name and address to: Ethical Choices, c/o Dr. Tim Blackwell, la poste avec vos nom et adresse à l’adresse suivante : Choix Veterinary Science, Ontario Ministry of Agriculture, Food déontologiques, a/s du Dr Tim Blackwell, Science vétérinaire, and Rural Affairs, 6484 Wellington Road 7, Unit 10, ministère de l’Agriculture, de l’Alimentation et des Affaires Elora, Ontario N0B 1S0; telephone: (519) 846-3413; fax: rurales de l’Ontario, 6484, chemin Wellington 7, unité 10, (519) 846-8178; e-mail: [email protected] Elora, (Ontario) N0B 1S0; téléphone : (519) 846-3413; télé Suggested ethical questions of the month are also welcome! All copieur : (519) 846-8178; courriel : [email protected] ethical questions or scenarios in the ethics column are based Les propositions de questions déontologiques sont toujours on actual events, which are changed, including names, loca- bienvenues! Toutes les questions et situations présentées dans tions, species, etc., to protect the confidentiality of the parties cette chronique s’inspirent d’événements réels dont nous involved. modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.

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Ethical question of the month — October 2013 You are an experienced veterinary surgeon who has worked for decades with a number of show breeders who are among your best clients. These breeders strongly believe that the standard elective surgical procedures that are routine in many breeds protect their dogs from infections, hematomas, and allow the dogs to do their intended work more effectively. The Canadian Veterinary Medical Association’s new position statement opposing “purely cosmetic” surgery has forced you to stop performing these procedures. Your clients now go to the United States to have this work done. One of these clients presents you with a 12-week-old puppy with badly infected ears following an ear cropping in the United States. She is distraught regarding the pain the dog is suffering and concerned because this is an outstanding individual from her best line of dogs. The ears are infected, sutures are tearing out, and the quality of the surgery is far below your standards. You are confident you can treat the infection, but some re-trimming is necessary to allow this dog to have any chance of a future on the show circuit. The breeder will euthanize the dog if it cannot be re-trimmed as she does

DÉONTOLOGIEVÉTÉRINAIRE not want the dog in its current state to represent her kennel even as someone’s pet. What should you do? Question de déontologie du mois — Octobre 2013 Vous êtes un chirurgien vétérinaire chevronné qui a travaillé pendant des décennies avec plusieurs éleveurs de chiens de concours qui figurent parmi vos meilleurs clients. Ces éleveurs croient fermement que les interventions chirurgicales non urgentes habituelles qui sont routinières pour beaucoup de races protègent leurs chiens contre des infections, des hématomes et permettent aux chiens de réaliser leurs tâches caractéristiques plus efficacement. Le nouvel énoncé de position de l’Association canadienne des médecins vétérinaires qui s’oppose à la chirurgie «purement esthétique» vous a forcé à cesser ces interventions. Vos clients vont maintenant aux États-Unis pour faire effectuer ces chirurgies. L’un de ces clients vous présente un chiot âgé de 12 semaines qui a des oreilles gravement infectées après une taille des oreilles réalisée aux États-Unis. Elle est désolée de voir la douleur du chien et elle s’inquiète parce qu’il s’agit d’un chien exceptionnel provenant de sa meilleure lignée. Les oreilles sont infectées, les points de suture s’enlèvent et la qualité de la chirurgie est de beaucoup inférieure à vos normes. Vous êtes confiant que vous pouvez traiter l’infection, mais une nouvelle taille est nécessaire pour permettre à ce chien d’avoir une chance dans les concours. L’éleveur fera euthanasier le chien si les oreilles ne peuvent pas être taillées de nouveau, car elle ne veut pas que ce chien, dans son état actuel, représente son chenil, même en tant qu’animal de compagnie de quelqu’un d’autre. Que devriez-vous faire?

Cosmetic surgery dilemma — A comment There are two elements to this scenario. The first — the need for The CVMA encourages all Canadian dog clubs to show the veterinarian to address the medical needs of the puppy — leadership and eliminate the desire for cropped ears (and docked does not involve an ethical dilemma. This would likely involve tails) by revising canine breed standards so that they allow wound debridement, appropriate antimicrobial, and analgesic for natural ears (and tails) and by raising awareness amongst therapy to treat the pinnae infection (i.e., this is not “cosmetic” purebred club members, show judges, and the public about surgery). the unnecessary pain and suffering caused by these procedures. The second element in this scenario is how the veterinarian CVMA position statements are intended to be science-based should approach the client’s desire to have this puppy endure guidance documents and do not “force” Canadian veterinarians not just one cropping procedure, but also a second “retrimming” to stop performing cosmetic or other procedures. The CVMA for show purposes. The CVMA encourages veterinarians to recognizes the positive step that several Canadian provincial educate clients that there is no scientific evidence to support regulatory authorities have taken to pass by-law amendments the practice of ear cropping as a procedure that provides any or codes of practice that prohibit veterinarians from performing health or welfare benefit for the dog. In this case, the veterinar- cosmetic surgery. ian should counsel the client that euthanizing the puppy if the ear trimming procedure cannot be done such that the dog meets Patricia Turner, DVM, Chair, Animal Welfare Committee, the current show standard is not a reasonable course of action. Canadian Veterinary Medical Association

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An ethicist’s commentary on botched ear-cropping Currently, ear-cropping is banned in Australia, Austria, short-lived pain for a potential good life. On the other hand, VETERINARY MEDICAL ETHICS MEDICAL VETERINARY Belgium, Brazil, Croatia, Cyprus, Czech Republic, Denmark, you emphatically do not wish to encourage the breeder to seek England, Estonia, Finland, France, Germany, Greece, Hungary, cropping in the future. Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg, Were I the veterinarian, I would express reluctance at retrim- Netherlands, Norway, Poland, Scotland, Slovakia, South Africa, ming the ears, but would agree to do so and utilize the occasion Sweden, Switzerland, Virgin Islands, and Wales. It has recently as a teachable moment. I would point out that ear cropping and been opposed by the Canadian Veterinary Medical Association. tail docking are nothing short of mutilations, doing no good for The procedure is, except in rare cases, strictly a cosmetic one the animal, and being functionally and morally on a par with based on long-established breed standards. Given that society mutilations that most people deplore when they are performed has ever increasingly moved in the direction of eliminating on farm animals, for example, tail docking in dairy cattle, now unnecessary pain in animal management, ear-cropping was an known scientifically to be highly painful and totally ineffectual extremely plausible procedure to fall victim to this concern. regarding diseases such as mastitis. I would forcefully argue that Other than changing the “look” of the dog, (e.g., making such mutilations are unworthy of those who supply companion Doberman pinschers look more intimidating), cropping has animals to the public, and demean the role of breeders in soci- numerous negative consequences, including significant post- ety. I would ask the breeder to take a strongly proactive role in procedural pain (and even procedural pain when performed changing standards governing the breed. without anesthesia or by breeders); the very real chance of a Such a stance, while morally praiseworthy, is very unlikely to botched job (eminent veterinary surgeon Dr. Harry Gorman be effective. In my view, as attested to by the countries listed, always refused to either perform or teach ear cropping, because only the law is powerful enough to create an effective ban on it too often made a surgeon look bad, in addition to harming such procedures. I would, therefore, expend some energy on the animal); and overtly displaying more concern for fashion banning the selling and/or showing of cropped or docked ani- than for animal well-being. mals. The key to success would be convincing the public of the In the situation confronting us in this case, the breeder has need to eliminate significant unnecessary suffering. While this had the surgery performed in the United States in order to would not come overnight, it is clear from the multiple societal circumvent Canadian regulations. The dog is already experi- examples cited that it could be accomplished. Such an action encing what is known to be a very painful infection, resulting would help catapult the veterinary profession into a strong from poor surgical procedure. Furthermore, the breeder has animal welfare advocacy position recognized by the companion declared that she will euthanize the puppy failing rectification animal owning public and help mitigate the negative image of of the botched surgery. (This response is all too common among veterinarians as colluding with industry on matters of animal breeders, clearly evidencing total disregard for the animal’s welfare. intrinsic value.) Your choice is to either perform the retrimming and save the animal’s life, or allow it to be euthanized. Clearly, the former option is the moral choice, trading some significant Bernard E. Rollin, PhD

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Quiz Corner Test éclair

1. Which agent should not be used to anesthetize 1. Lequel des agents suivants ne doit pas être utilisé pour greyhounds? anesthésier les lévriers? a. propofol a. propofol; b. ketamine b. kétamine; c. isoflurane c. isoflurane; d. thiopental d. thiopental; e. tiletamine-zolazepam e. tilétamine-zolazépam. 2. Thoracocentesis on a dog with pleural effusion yields a 2. La thoracocentèse effectuée chez un chien souffrant modified transudate (protein 30 g/L, 1000 cells/mL, with d’épanchement pleural révèle un transsudat modifié 85% small lymphocytes and 15% nondegenerate neutro- (protéines 30 g/L, 1000 cellules/mL, avec 85 % de petits phils). The cholesterol level in the effusion is lower than in lymphocytes et 15 % de neutrophiles non dégénérés). Le the serum, but the triglyceride level is much higher. What taux de cholestérol de l’épanchement est moins élevé que is the most likely cause of these findings? celui du sérum, mais le taux de triglycéride est beaucoup a. left-sided heart failure plus élevé. Quelle est la cause la plus probable de ces b. lymphosarcoma résultats? c. chylothorax a. insuffisance cardiaque gauche; d. diaphragmatic hernia b. lymphosarcome; e. pyothorax c. chylothorax; d. hernie diaphragmatique; Aside from iatrogenic causes, what is the most common 3. e. pyothorax. cause of hyperadrenocorticism? a. pituitary tumor 3. À part les causes iatrogènes, quelle est la cause la plus b. unilateral adrenal tumor commune de l’hyperadrénocorticisme? c. bilateral adrenal tumor a. tumeur hypophysaire; d. hypothalamic disorder b. tumeur surrénale unitatérale; e. adrenocortical hyperplasia c. tumeur surrénale bilatérale; d. trouble hypothalamique; Which clinicopathologic finding is consistent with feline 4. e. hyperplasie corticosurrénale. infectious peritonitis (FIP)? a. increased serum globulin level 4. Lequel des résultats clinicopathologiques suivants est b. decreased serum globulin level compatible avec la péritonite infectieuse féline? c. monoclonal gammopathy a. augmentation du taux de globuline sérique; d. Bence Jones proteinuria b. diminution du taux de globuline sérique; e. decreased serum albumin level c. gammapathie monoclonale; d. protéine de Ben Jones dans l’urine; e. diminution du taux d’albumine sérique.

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5. Which of the following most accurately describes anisog- 5. Lequel des énoncés suivants décrit le plus justement nathism in equids? l’anisognathisme chez les équidés? a. presence of an interdental space a. présence d’un espace interdentaire; b. protrusion of the maxillary incisors rostral to the man- b. protrusion des incisives maxillaires rostralement aux dibular incisors incisives mandibulaires; c. protrusion of the mandibular incisors rostral to the maxil- c. protrusion des incisives mandibulaires rostralement aux lary incisors incisives maxillaires; d. a mandibular arcade that is narrower than the maxillary d. arcade mandibulaire plus étroite que l’arcade maxillaire; arcade e. éruption continue de la couronne dentaire. e. continual eruption of the tooth’s reserve crown

TESTÉCLAIR (See p. 1224 for answers./Voir les réponses à la page 1224.)

Questions and answers were derived from Review Questions and Answers Les questions et les réponses sont extraites de Review Questions and for Veterinary Boards 2nd ed., a 5-volume series including Basic Sciences, Answers for Veterinary Boards 2nd ed., une série de cinq volumes qui Clinical Sciences, Small Animal Medicine and Surgery, Large Animal comprend Basic Sciences, Clinical Sciences, Small Animal Medicine and Medicine and Surgery, and Ancillary Topics, by kind permission of the Surgery, Large Animal Medicine and Surgery, et Ancillary Topics, avec publisher, Mosby–Year Book, Inc., St. Louis, Missouri. l’aimable permission de l’éditeur, Mosby–Year Book, Inc. de St. Louis (Missouri).

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1200 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY News Nouvelles

Strength in Collaboration La collaboration fait la force Your support as a CVMA member is important so that we Votre appui en tant que membre de l’ACMV est important afin may continue to be the influential organization that Canadian que nous puissions continuer de demeurer l’organisation influente veterinarians need as our profession faces many challenges of dont ont besoin les vétérinaires canadiens au moment où notre the changing times. Your membership not only contributes to profession relève de nombreux défis en cette ère de changements. strengthening our collective voice on the national and interna- Votre adhésion contribue non seulement au renforcement de tional scenes, but also ensures the CVMA’s ability to defend the notre voix collective à l’échelle nationale et internationale, profession and advance the interests of all veterinarians. mais elle assure aussi la capacité de l’ACMV à défendre notre A joint Task Force of representatives of the provincial vet- profession et à avancer les intérêts de tous les vétérinaires. erinary regulatory bodies and the CVMA has developed a Un Groupe de travail conjoint composé de représentants collaboration proposal that has been approved in principle by des organismes de réglementation provinciaux et de l’ACMV 7 out of 10 provinces and the CVMA, and is now being further a élaboré une proposition de collaboration qui a été approuvée considered by the registrars. Most of the services CVMA pro- en principe par 7 provinces sur 10 et l’ACMV, et qui fait vides benefit the entire profession and many of them serve the maintenant l’objet d’un examen approfondi par les registraires. public, directly or indirectly. Collaboration among the regulatory La plupart des services que l’ACMV fournit profitent à bodies and with the CVMA creates efficiencies by eliminating l’ensemble de la profession et beaucoup d’entre eux desservent duplication of processes and strengthens the effective flow of le public, soit directement ou indirectement. La collaboration information and knowledge across all provinces. entre les organismes de réglementation et l’ACMV procure des At the national level, the CVMA provides the forum to create gains d’efficacité en éliminant le dédoublement des processus one voice for the profession through seeking input from mem- et elle facilite une circulation efficace de l’information et des bers, veterinary medical associations, species groups, and regula- connaissances entre les provinces. tory bodies. The CVMA represents Canadian veterinarians in À l’échelle nationale, l’ACMV sert de forum pour la création key government discussions on national and international issues d’une voix collective au nom de la profession et elle sollicite to ensure that important decisions that may affect veterinary la rétroaction des membres, des associations de médecins practice will not be made by others without veterinary input. vétérinaires, des groupes des espèces et des organismes de Our profession must be engaged in national and international réglementation. L’ACMV représente les vétérinaires canadiens issues and show leadership in areas such as antimicrobial stew- dans les discussions cruciales avec le gouvernement sur des enjeux ardship, regulation of extra label drug use, use of compounded d’envergure nationale et internationale afin de veiller à ce que drugs and telemedicine. Canadian veterinarians must show les décisions importantes qui pourront influencer la pratique leadership on animal welfare issues such as cosmetic surgery, vétérinaire ne soient pas prises par d’autres intervenants sans une euthanasia, and pain management. The CVMA is participating rétroaction vétérinaire. Notre profession doit participer aux enjeux in the development of food animal codes of practice, and devel- nationaux et internationaux et faire preuve de leadership dans des oping and maintaining the Canadian cattery and kennel codes domaines comme la gestion responsable des antimicrobiens, la of practice. The CVMA’s 2 journals provide the only national réglementation de l’utilisation des médicaments en dérogation des platform for peer-reviewed research. Our work-life balance and directives de l’étiquette, l’utilisation des préparations magistrales et business management services, including the CVMA’s suggested la télémédecine. Les vétérinaires canadiens doivent faire preuve de fee guides and our very competitive insurance program are just leadership à l’égard des enjeux liés au bien-être animal, notamment some of the benefits and services that support the needs of la chirurgie esthétique, l’euthanasie et le contrôle de la douleur. CVMA members. L’ACMV participe à l’élaboration de codes de pratiques pour les We are a small profession, and the proposed collabora- animaux destinés à l’alimentation ainsi qu’à la rédaction et à la tion aims at more equal participation and contribution of all mise à jour des codes de pratiques pour les chatteries et les chenils Canadian veterinarians to outcomes that benefit the entire du Canada. Les deux revues de l’ACMV offrent le seul véhicule profession and the public. national pour la recherche évaluée par les pairs. Nos services de conciliation travail-vie et de gestion commerciale, y compris les guides tarifaires suggérés de l’ACMV et notre programme d’assurance de l’ACMV très concurrentiel, ne représentent que quelques-uns des avantages et des services qui appuient les besoins des membres de l’ACMV. Nous sommes une profession relativement petite et la collaboration proposée vise à assurer une participation et une contribution plus équitables de tous les vétérinaires canadiens aux résultats qui profiteront à la profession dans son ensemble et au public.

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CVMA Releases a Collection of L’ACMV lance une collection de Eco-friendly Resources for Veterinary ressources écoresponsables pour Practices les pratiques vétérinaires The Canadian Veterinary Medical Association’s (CVMA) Le Groupe consultatif environnemental de l’Association canadienne Environmental Advisory Group has just released the new CVMA des médecins vétérinaires (ACMV) vient tout juste de lancer la Green Veterinary Practice initiative, a collection of eco-friendly nouvelle initiative d’une Pratique vétérinaire écoresponsable de resources for veterinary practices. Veterinarians historically have l’ACMV, une collection de ressources écoresponsables à l’intention fostered community health by being stewards of the link between des pratiques vétérinaires. Les vétérinaires ont traditionnellement

NOUVELLES human and animal health. Considerations for the profession’s favorisé la santé communautaire en raison de leur rôle de gardien impact on the environment are part of that concept. It is the du lien entre la santé humaine et animale. L’évaluation de l’impact obligation of veterinarians to minimize the detrimental impact de notre profession sur l’environnement fait partie de ce concept. of veterinary medicine on the environment, and we can all play Nous avons l’obligation, en tant que vétérinaires, de minimiser a part! Through this web-based source of information, discover l’impact néfaste de la médecine vétérinaire sur notre environnement how to improve the environmental impact of your veterinary et nous pouvons tous jouer un rôle! Cette source d’information practice and infrastructure by learning more about concepts sur le Web vous fera découvrir la façon dont vous pouvez atténuer such as: l’impact environnemental de votre pratique et de vos infrastructures • Establishing an environmental policy for your practice vétérinaires en vous communiquant des renseignements sur les • Government funding incentives for going green différents concepts, notamment : • Water and energy efficiency considerations • L’élaboration d’une politique environnementale pour votre • Waste management decisions pratique • Careful selection of chemical and medical products • Les incitatifs financiers du gouvernement en vue de favoriser • Environmentally sustainable building construction and l’écoresponsabilité renovations • L’efficacité énergétique et la conservation de l’eau • Evaluating the eco-responsibility of your suppliers • Les décisions liées à la gestion des déchets Use the CVMA Green Veterinary Practice self-audit tool to • Le choix prudent des produits chimiques et médicaux determine how green your practice really is. Then consider the • Les travaux de construction et de rénovation durables list of top 10 changes you can make to reduce your impact on • L’évaluation de l’écoresponsabilité de vos fournisseurs the environment. Any change, no matter how simple or complex, Servez-vous de l’Outil d’autovérification d’une pratique will make a difference! Visit the Resources section of CVMA’s vétérinaire écoresponsable de l’ACMV pour déterminer le degré website (www.canadianveterinarians.net) and learn more today. d’écoresponsabilité de votre pratique. Puis, considérez la liste des 10 changements les plus importants que vous pouvez apporter pour réduire votre impact sur l’environnement. Tout changement compte, peu importe son ampleur! Visitez la section des Ressources sur site Web de l’ACMV (www.veterinairesaucanada.net) et apprenez-en davantage dès aujourd’hui.

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Preparing for Canada’s Anti-Spam Legislation — Understanding Consent Se préparer à la Loi canadienne anti-pourriel — Comprendre le consentement In July 2013, we provided an overview of the proposed Canadian En juillet 2013, nous avons présenté un survol de la Loi canadienne Anti-Spam Legislation (CASL). To help you understand the anti-pourriel (LCAP). Afin de vous aider à comprendre l’impact impact and begin planning for compliance, the CVMA is pro- de la loi et à commencer à planifier la conformité dès maintenant,

viding a series of information bulletins on the core provisions of l’ACMV fournit une série de bulletins d’information sur les NEWS the regulations. Last month we described Commercial Electronic principales dispositions de la réglementation. Le mois dernier, nous Messages (CEM). This month, we’ll examine Consent. Before avons décrit les messages commerciaux électroniques (MCE). Ce sending a CEM, you must obtain consent from the intended mois-ci, nous examinerons le consentement. Avant d’envoyer un recipient. There are 2 types of consent: implied consent and MCE, vous devez obtenir le consentement du destinataire visé. expressed consent. Consent is valid only for 2 years and it must Il y a deux types de consentement : le consentement implicite et be tracked. Your CEM must identify you as the sender and pro- le consentement exprès. Le consentement est valide seulement vide a way for the recipient to withdraw their consent (i.e., an pendant deux ans et il doit faire l’objet d’un suivi. Votre MCE doit unsubscribe mechanism). vous identifier comme l’expéditeur et fournir une façon dont le destinataire peut retirer son consentement (c.-à-d., des mécanismes What is implied consent? de désabonnement). Implied consent applies to existing business relationships, con- spicuously published e-mail addresses (e.g., recipients’ e-mail En quoi consiste le consentement implicite? address posted publicly on their website), approved existing Le consentement implicite s’applique aux relations d’affaires non-business relationships (e.g., becoming a member of an asso- existantes, aux adresses de courriel qui sont publiques (p. ex., ciation implies that you allow that organization to contact you) l’adresse de courriel des destinataires était affichée publiquement and recipients who have previously given their e-mail address to sur leur site Web), des relations non commerciales existantes the sender, provided that the CEM is relevant to the recipients’ approuvées (p. ex., devenir membre d’une association implique business, role, functions or duties. que vous autorisez cette organisation à vous contacter) et les destinataires qui ont déjà donné leur adresse de courriel à What is expressed consent? l’expéditeur, pourvu que le MCE soit pertinent aux activités, au Expressed consent means that the individual has agreed (orally rôle, aux fonctions ou aux tâches des destinataires. or in writing) to receive CEM from you. En quoi consiste le consentement exprès? Tracking consent Le consentement exprès signifie que la personne a consenti You must be able to store a record of the date, time and manner (oralement ou par écrit) à recevoir un MCE de vous. in which you obtained written consent. Oral consent must be tracked by audio recording or verification by an independent Effectuer un suivi du consentement 3rd party. Vous devez pouvoir stocker un enregistrement de la date, de l’heure et de la manière dont vous avez obtenu le consentement Exemptions écrit. Le consentement oral doit être consigné dans un A number of consent exemptions exist, for example if there is a enregistrement ou une vérification audio par un tiers indépendant. family relationship, or if a requested quote or estimate is being provided. Warranties, product recalls, upgrades, safety and secu- Exemptions rity information are all exempt as well. Plusieurs exemptions existent pour le consentement. Par exemple, s’il y a une relation de parenté, ou si une soumission ou une What you can do in anticipation of CASL? estimation demandée est fournie. Les garanties, les rappels Determine if you need to obtain consent and if so, how you will de produits, les renseignements sur la sécurité sont aussi tous obtain consent. Establish how you will maintain a record of each exemptés. consent you obtain. Que pouvez-vous faire en préparation à la LCAP? Next month’s bulletin: Penalties Déterminez si vous avez besoin d’obtenir le consentement et, Whenever CASL comes into force, almost every business and le cas échéant, comment vous obtiendrez le consentement. organization in Canada will be affected. Questions? Visit Déterminez aussi comment vous tiendrez un registre de chaque www.fightspam.gc.ca or contact CVMA’s Communications team consentement que vous obtenez. at [email protected] or 613-236-1162, ext. 128. Please note: This is intended as a general guide only based on the Bulletin du mois prochain : Sanctions draft regulations and the information available to date. Lorsque la LCAP entrera en vigueur, presque toutes les entreprises et organisations du Canada seront touchées. Vous avez des questions? Visitez www.combattrelepourriel.gc.ca ou contactez l’équipe des communications de l’ACMV à [email protected] ou au 613-236-1162, poste 128. Veuillez noter : la présente note a pour but de servir de guide général uniquement en fonction du projet de règlement et des renseignements disponibles à ce jour.

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CVMA Membership — Return on Your Investment Petro-Canada SuperPassTM Program L’adhésion à l’ACMV — un investissement qui rapporte Programme SuperPassMC de Petro-Canada As a CVMA member, you are provided various benefits, products À titre de membre de l’ACMV, vous avez droit à beaucoup and services that support your personal and business needs. In d’avantages, de produits et de services qui appuient vos besoins many instances, the savings enjoyed more than cover the cost of personnels et professionnels en tant que professionnel vétérinaire. your annual membership fee. Dans beaucoup de cas, les économies dépassent amplement le NOUVELLES Your CVMA membership provides an opportunity for you coût de votre cotisation annuelle. to receive fuel and service discounts through the Petro-Canada Votre adhésion à l’ACMV vous offre l’occasion de recevoir SuperPassTM Program. des rabais sur le carburant et les services dans le cadre du Programme SuperPassMC de Petro-Canada. WHAT is the CVMA Petro-Canada SuperPassTM Program? The CVMA Petro-Canada SuperPassTM is a credit card program EN QUOI CONSISTE le Programme SuperPassMC de providing CVMA members with fuel and services discounts that Petro-Canada de l’ACMV? save you money. The program also provides access to a custom- Le Programme SuperPassMC de Petro-Canada est un programme ized online account management service to help you better de carte de crédit offrant aux membres de l’ACMV des rabais sur manage and control expenses. le carburant et les services afin de vous permettre de réaliser des économies. Le programme permet aussi d’accéder à un service de WHO can benefit from the CVMA Petro-Canada gestion de compte en ligne conçu sur mesure pour vous faciliter SuperPassTM Program? la gestion et le contrôle de vos dépenses. CVMA members with a registered business or company, be it a corporation, individual proprietorship or partnership, can enroll QUI peut profiter du Programme SuperPassMC de in this program. No matter how small or large your business Petro-Canada de l’ACMV? is, or whether you have one vehicle or 5 credit cards issued to Les membres de l’ACMV avec une entreprise enregistrée, qu’il your account, by enrolling and signing up for a Petro-Canada s’agisse d’une société, d’une entreprise à propriétaire unique ou SuperPassTM credit card through the CVMA program, you can d’un partenariat, peuvent s’inscrire à ce programme. Peu importe optimize savings and control expenses. la taille de votre entreprise, ou que vous ayez un véhicule ou cinq Veterinarians operating a mobile practice or performing farm cartes de crédit émises à votre compte, en vous inscrivant pour calls will especially benefit from the fuel and services rebates. As une carte de crédit SuperPassMC de Petro-Canada dans le cadre a business owner/partner, you will appreciate the convenience, du programme de l’ACMV, vous pouvez optimiser les économies control and security the program provides. et contrôler vos dépenses. Les vétérinaires qui exploitent une pratique mobile ou HOW can this service help you? effectuent des visites à la ferme profiteront spécialement des With this program, CVMA members will benefit from: rabais sur le carburant et les services. En tant que propriétaire Significant savings ou associé d’une entreprise, vous apprécierez la commodité, le • Discount of 2.0 cents per litre on purchases of all types of contrôle et la sécurité qu’offre le programme. gasoline and diesel at any Petro-Canada location in Canada, COMMENT ce service peut-il vous être utile? with a minimum purchase of 400 litres/month; Grâce à ce programme, les membres de l’ACMV profiteront des • Discount of 20% on car wash at Petro-Canada retail service avantages suivants : stations. Économies importantes Convenience • Rabais de 2 cents le litre à l’achat de tous les types d’essence • User friendly SuperPassTM Program Online Service gives you et de diesel à toutes les stations Petro-Canada au Canada, avec 24-hour access to complete transaction activity; un achat minimum de 400 litres/mois; • Flexible payment options let you decide how you want to pay • Rabais de 20 % sur le lave-auto dans les stations-service (online, by phone, automatic bank withdrawal, electronic fund Petro-Canada. transfer or by mail); Commodité • Le service en ligne convivial du Programme SuperPassMC vous offre un accès 24 heures par jour pour effectuer vos transactions; • Des options de paiement flexibles vous permettent de décider comment effectuer le paiement (en ligne, par téléphone, retrait bancaire automatique, transfert électronique de fonds ou par courriel);

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• Flexible billing options allow you to choose how you want to • Des options de facturation flexibles vous permettent de choisir receive your statement (by Internet, mail or fax), and when comment vous recevrez votre relevé de compte (par Internet, you want to receive it (weekly or monthly). par la poste ou par télécopieur) et à quel moment vous désirez le recevoir (facture hebdomadaire ou mensuelle). Control and Security • Receive detailed monthly reports with a record of all transac- Contrôle et sécurité tions, purchase locations and dates; • Recevez des rapports mensuels détaillés avec un registre de

• Customize, restrict access, and limit purchases on your cards; toutes vos transactions ainsi que l’emplacement et la date de NEWS • Petro-Canada SuperPassTM Program credit cards are individu- tous les achats; ally numbered with a distinct PIN. • Établissez des paramètres et limitez l’accès et les achats sur vos cartes; WHERE can you access this service? • Les cartes de crédit du Programme Petro-Canada SuperPassMC To request a Petro-Canada SuperPassTM credit card application sont numérotées individuellement avec un NIP distinct. linked to the CVMA member account, or for more information, contact the CVMA Member Services Directorate at OÙ pouvez-vous accéder à ce service? 1-800-567-2862 or at ([email protected]). Pour obtenir un formulaire de demande de carte de crédit Petro-Canada SuperPassMC reliée à votre compte de membre de l’ACMV ou pour en savoir davantage, communiquez avec la Direction des Services aux membres de l’ACMV au 1-800-567-2862 ou à ([email protected]).

2014 CVMA Awards Prix 2014 de l’ACMV Last Call! Nominations Close Dernier avis! Les mises en candidature January 31, 2014 se terminent le 31 janvier 2014 Each year, through CVMA’s national veterinary awards program, Chaque année, dans le cadre du programme des Prix vétérinaires veterinarians are honored for their exceptional contributions to nationaux de l’ACMV, des vétérinaires sont honorés pour leurs veterinary medicine. All CVMA members are encouraged to contributions exceptionnelles à la médecine vétérinaire. Tous les nominate deserving colleagues for their hard work and dedica- membres de l’ACMV sont encouragés à mettre en candidature tion to the profession. des collègues méritants pour leur travail ardu et leur dévouement CVMA Awards will be presented during the CVMA envers la profession. Convention, which takes place in St. John’s, Newfoundland and Les Prix de l’ACMV seront décernés durant le congrès de Labrador, from July 9–12, 2014. Nominations will be accepted l’ACMV, qui se déroulera du 9 au 12 juillet 2014 à St. John’s, until January 31, 2014 for the following awards: à Terre-Neuve-et-Labrador. Des mises en candidature seront CVMA Humane Award (Sponsored by Merck Animal Health) acceptées jusqu’au 31 janvier 2014 pour les prix suivants : Merck Veterinary Award (Sponsored by Merck Animal Health) Prix humanitaire de l’ACMV Small Animal Practitioner Award (Commandité par Merck Santé Animale) (Sponsored by Petsecure Pet Health Insurance) Prix vétérinaire Merck (Commandité par Merck Santé Animale) CVMA Industry Award Prix du praticien des petits animaux CVMA Life Membership (Commandité par Petsecure assurance maladie pour animaux) CVMA Honorary Membership Prix de l’industrie de l’ACMV CVMA Practice of the Year Award Membre à vie de l’ACMV Nomination packages should be submitted by January 31, Membre honoraire de l’ACMV 2014 via e-mail ([email protected]), by fax Prix de la pratique de l’année de l’ACMV (613-236-9681), or by mail to the CVMA office, 339 Booth Les trousses de mise en candidature doivent être soumises d’ici le Street, Ottawa, ON K1R 7K1. Nomination packages must 31 janvier 2014 par courriel à ([email protected]), include a completed nomination form, a written description of par télécopieur (613-236-9681) ou par la poste au Bureau de the nominee’s work and supporting documents. l’ACMV, 339, rue Booth, Ottawa (Ontario) K1R 7K1. Les trousses For additional information, including full descriptions of each de mise en candidature doivent inclure un formulaire de mise en award, nomination forms, and a listing of past award recipients, candidature rempli, une description écrite du travail du candidat please visit the CVMA Awards and Honors section of the CVMA et des documents à l’appui. website (www.canadianveterinarians.net). Pour obtenir des renseignements supplémentaires, y compris des descriptions complètes de chaque prix, des formulaires de mise en candidature et une liste des récipiendaires antérieurs, veuillez visiter la section des Prix et distinctions de l’ACMV sur le site Web de l’ACMV (www.veterinairesaucanada.net).

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Veterinary Practice Team Resources from the Pet Nutrition Alliance Ressources pour l’équipe de la pratique vétérinaire offertes par la Pet Nutrition Alliance As a member of Pet Nutrition Alliance, the Canadian En tant que membre de la Pet Nutrition Alliance, l’Association Veterinary Medical Association is pleased to inform CVMA canadienne des médecins vétérinaires est heureuse d’informer members that you and your clients have access to a num- les membres de l’ACMV que vous et vos clients avez accès ber of free online pet nutrition materials. Visit the website à plusieurs documents sur la nutrition des animaux de (petnutritionalliance.org) to discover the tools and resources compagnie qui sont offerts gratuitement en ligne. Visitez NOUVELLES available for veterinary professionals and pet owners. To help le petnutritionalliance.org pour découvrir les outils et les you navigate through the many tools available, we asked the ressources qui se trouvent à la disposition des professionnels members of the CVMA Communications Advisory Group to vétérinaires et des propriétaires d’animaux. Pour vous aider describe their favorite Veterinary Practice Team Nutrition Tools. à naviguer les nombreux outils offerts, nous avons demandé This month, we’re featuring the top 3 tools selected by Dr. Jayne aux membres du Groupe consultatif des communications Takahashi, vice-president of Communications at Associate de l’ACMV de décrire leurs outils nutritionnels préférés pour Veterinary Clinics: l’équipe de la pratique vétérinaire. Ce mois-ci, nous présentons re Nutrition calculators & charts les trois outils choisis par la D Jayne Takahashi, vice-présidente des communications chez Associate Veterinary Clinics : One of the greatest challenges with nutrition discussions is to provide a thorough review of the pet’s current feeding program Calculatrices et tableaux sur la nutrition and compare this with the optimal plan for the pet in an efficient L’un des plus grands défis des discussions sur la nutrition manner. The “Nutrition Calculators and Charts” provides tools consiste à présenter un examen complet du programme for a quick calculation of daily energy requirements, a detailed d’alimentation actuel de l’animal et à le comparer de manière and unique comparison of pet to human weight equivalents and efficace avec un plan optimal. Les calculatrices et les tableaux a guaranteed analysis converter that allows for accurate com- sur la nutrition (Nutrition Calculators and Charts) fournissent parisons of diets. Together, these resources set the foundation des outils qui permettent d’effectuer rapidement le calcul des for dietary recommendations that are made during a veterinary besoins caloriques quotidiens, une comparaison détaillée et consultation appointment. unique du poids équivalent chez les humains et les animaux et Training for veterinary practice managers un convertisseur d’analyse garanti qui donne une comparaison exacte des diètes. Ensemble, ces ressources servent de fondement This section is filled with practical tips, guidelines and examples aux recommandations alimentaires qui sont présentées durant on how the entire veterinary team can engage clients in effective une consultation vétérinaire. discussions about pet nutrition. Each of the subsections can easily become a continuing education focus for staff meetings Formation pour les gestionnaires de la or become a monthly program for hospital team training. A pratique vétérinaire great place to start would be from the client’s perspective as pre- Cette section contient une foule de conseils pratiques, de sented in the article “What I Wish My Veterinarian Would Have lignes directrices et d’exemples sur la façon dont toute l’équipe Told Me.” Several articles on specific communication skills and vétérinaire peut engager des discussions efficaces avec les clients approaches to dialogue will help one to make specific dietary sur la nutrition des animaux de compagnie. Chacune des sous- recommendations to create a successful nutrition centre. Equally sections peut facilement devenir un sujet de formation continue pour les réunions du personnel ou servir de programme mensuel de formation de l’équipe de la clinique. Pour commencer, le point de vue du client, tel qu’il est présenté dans l’article «What I Wish My Veterinarian Would Have Told Me» («Ce que j’aurais voulu que mon vétérinaire me dise»), représente une excellente introduction. Plusieurs articles sur les compétences particulières en communication et les approches face au dialogue vous aideront à présenter des recommandations alimentaires et à créer un centre de nutrition prospère. Les suggestions sur la

Dr./Dre Jayne Takahashi

1206 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY important are suggestions on how to monitor your efforts and façon de surveiller vos efforts et de faire le suivi de vos progrès track your progress. sont également très utiles. Nutritional needs for specific diseases Besoins nutritionnels pour les maladies For many of our medical cases, dietary modification is a neces- particulières sary element in our treatment plan. This section includes an Pour beaucoup de nos cas médicaux, la modification de la online library of nutritional articles for dogs and cats with medi- diète est un élément nécessaire de notre régime de traitement. cal conditions authored by veterinary nutritionist Dr. Rebecca Cette section comprend une bibliothèque en ligne d’articles NEWS L. Remillard, as well as feeding guides for hospitalized dogs and sur la nutrition des chiens et des chats atteints d’affections cats from The World Small Animal Veterinary Association. For médicales qui ont été rédigés par une nutritionniste vétérinaire, clients who are used to seeking information on “Dr. Google,” la Dre Rebecca L. Remillard, ainsi que des guides d’alimentation an innovative and reliable website on veterinary medical con- pour les chiens et les chats hospitalisés qui ont été préparés par ditions, “Partners in Animal Health” presented by Cornell la WSAVA. Pour les clients qui ont l’habitude de solliciter des University College of Veterinary Medicine, can be viewed in renseignements auprès du «Dr Google», un site Web innovateur this resource section. Client information handouts prepared by et fiable portant sur les affections médicales vétérinaires, the University of California, Davis are also available for your «Partners in Animal Health», qui est présenté par le Collège de practice. médecine vétérinaire de l’Université Cornell, peut être visualisé dans cette section des ressources. Des feuillets d’information à l’intention des clients préparés par l’Université de Californie Davis sont aussi offerts pour votre pratique.

2014 CVMA Convention Congrès 2014 de l’ACMV “A New Discovery Down Every Lane” «Une nouvelle découverte à tous les tournants» The City of Legends, St. John’s, Newfoundland and Labrador, La Ville des légendes, St. John’s, à Terre-Neuve-et-Labrador, vous awaits you on July 9–12, 2014 as the destination for the attend du 9 au 12 juillet 2014 en tant que destination du congrès Canadian Veterinary Medical Association’s (CVMA’s) annual annuel de l’Association canadienne des médecins vétérinaires convention, presented in partnership with the Canadian (ACMV), qui est présenté en partenariat avec l’Association Association of Animal Health Technologists and Technicians canadienne des techniciens et technologues en santé animale (CAAHTT). (ACTTSA). With a combination of big city luxury and small town charm, Alliant le luxe d’une grande ville et le cachet d’un village, St. John’s is North America’s oldest port and has seen over St. John’s est le plus ancien port d’Amérique du Nord qui a 500 years of explorers and pirates. Downtown St. John’s is remi- été, pendant plus de 500 ans, fréquenté par des explorateurs et niscent of San Francisco (minus the cable cars) and is renowned des pirates. Le centre-ville de St. John’s rappelle San Francisco for its brightly colored Victorian townhouses. Because of their (véhicules tractés par câble en moins) et est célèbre pour ses vibrant colors, the houses are known affectionately as “Jellybean maisons en rangée victoriennes aux couleurs vives. Ces maisons Row” and are one of the biggest stars of the hit CBC TV series sont affectueusement connues sous le nom de «Jellybean Row», Republic of Doyle. en raison de leurs couleurs flamboyantes et elles figurent comme Non-Newfoundlanders (known to Newfoundlanders as a vedettes de la série à succès de la CBC «Republic of Doyle». “come from away” or “mainlander”) can get “screeched in,” Les non-Terre-Neuviens (que les Terre-Neuviens appellent des which involves a shot of screech, a short recitation and the kiss- «gens venus d’ailleurs» ou des «gens du continent») peuvent se

2013 convention wet labs were highly rated./Les ateliers de travaux pratiques du congrès 2013 ont été fort appréciés.

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faire assermenter au «screech», ce qui implique boire un coup de screech, lire une courte récitation et baiser une morue. Le quartier des spectacles animé de George Street, le lieu de la soirée sociale 2014, offrira une expérience authentique pour tous les congressistes qui veulent bien participer à cette activité. Terre-Neuve-et-Labrador est une destination qui a beaucoup à offrir — l’observation des baleines et des icebergs à bord d’un kayak de mer, le parcours de la boucle irlandaise à vélo, la randonnée sur les sentiers du littoral ou la détente dans un spa au bord de la mer. NOUVELLES Mais, la plus importante raison de venir à St. John l’été prochain sera de vivre l’expérience d’une formation continue (FC) de calibre supérieur et des occasions de réseautage. Le Comité du perfectionnement professionnel de l’ACMV, sous le leadership de la coordonnatrice scientifique, la Dre Jeanne Lofstedt, travaille diligemment à la planification du programme éducatif enrichissant. La président locale 2014, la Dre Heather Hillier, se réjouit à la perspective d’accueillir les délégués à St. ing of the cod. The lively George Street entertainment district, John’s et de partager avec eux l’expérience d’un party de cuisine the site of the 2014 social evening, will offer this authentic authentique — la représentation typique du style de vie de experience for all willing convention delegates. Terre-Neuve. As a destination, Newfoundland and Labrador has much to Venez faire l’expérience de ce congrès unique de quatre offer — watching whales and icebergs from a sea kayak, biking jours, qui présentera un solide programme scientifique offrant the Irish loop, hiking coastal trails or relaxing at a spa by the sea. 34 conférenciers provenant du Canada et des États-Unis. Avec But the most important reason to be in St. John’s next des séances portant sur la médecine des petits animaux, des summer is to experience the top-notch continuing education équidés, des bovins et des ruminants, en plus de l’examen (CE) and networking opportunities. CVMA’s Professional d’enjeux liés au bien-être animal et à la gestion commerciale, Development Committee, with the leadership of scientific il y aura des sujets qui sauront intéresser tout un chacun. Des coordinator, Dr. Jeanne Lofstedt, has been working diligently crédits additionnels de FC peuvent être accumulés durant les planning an enriching educational program. The 2014 local ateliers spécialisés, incluant un laboratoire dentaire de niveau 2 Chair, Dr. Heather Hillier, is looking forward to welcoming et un laboratoire en orthopédie (frais en sus). delegates to St. John’s and sharing the authentic kitchen party Le Dr Brook Niemiec, de Southern California Veterinary experience — the iconic image of the Newfoundland lifestyle. Dental Specialties à San Diego, et la Dre Sue McTaggart, Experience this unique 4-day convention, which features a fellow de l’Academy of Veterinary Dentistry, présenteront un strong scientific program including 34 speakers from Canada atelier de travaux pratiques sur les soins dentaires de niveau 2 and the United States. With sessions focusing on small animal, le mercredi 9 juillet. Une conférence communiquera des equine, bovine and ruminant medicine, in addition to animal techniques afin de faciliter les extractions dentaires difficiles welfare and business management issues, there is something of chez les chiens et les chats et elle sera suivie d’un laboratoire interest for everyone. Additional CE credits can be earned dur- de travaux pratiques qui permettra aux participants d’exercer ing specialized workshops, including a Level 2 dental lab and an ces techniques. Une deuxième conférence portera sur le orthopedic lab (additional fee will apply). positionnement radiographique et l’interprétation chez les chiens Dr. Brook Niemiec from Southern California Veterinary et les chats, suivie d’un laboratoire pour mettre en pratique les Dental Specialties in San Diego, and Dr. Sue McTaggart, Fellow notions apprises. On présentera et discutera aussi l’affûtage des of the Academy of Veterinary Dentistry, will be presenting a instruments et les instructions d’entretien. La Dre McTaggart a Level 2 Dental Wet Lab on Wednesday, July 9. A lecture will présenté un laboratoire de travaux pratiques semblable durant share techniques for making difficult dental extractions easier in le congrès 2013 de l’ACMV, qui a fait salle comble et a été dogs and cats and will be followed by a wet lab for participants extrêmement apprécié par les participants. to practise these techniques. A 2nd lecture will cover radio- Aussi le 9 juillet, le Dr Thomas Gibson et le Dr Ameet graphic positioning and interpretation in dogs and cats, followed Singh, professeurs adjoints au Département de chirurgie des by a wet lab for hands-on practise. Instrument sharpening and petits animaux de l’Ontario Veterinary College, présenteront un care instruction will also be shown and discussed. Dr. McTaggart laboratoire en orthopédie qui portera sur les «Principes de base presented a similar wet lab during the 2013 CVMA Convention, de la fixation des fractures à l’aide d’os palatins». Ce laboratoire which sold out and was highly rated by participants. d’orthopédie est une introduction à la fixation des fractures Also on July 9, Dr. Thomas Gibson and Dr. Ameet Singh, internes simples à l’aide de plaques et de vis. On présentera une assistant professors in the Department of Small Animal Surgery combinaison de conférences sur la biomécanique des fractures, at the Ontario Veterinary College, will present an orthopedic lab les principes de la réparation des fractures avec des plaques concentrating on the “Basic Fracture Fixation Principals Using et des vis et la prise de décisions ainsi que des laboratoires de

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Palatinate Bones.” This orthopedic lab is an introduction to basic travaux pratiques à l’aide de modèles en plastique pour pratiquer internal fracture fixation using plate and screws. A combination les techniques discutées et se familiariser avec l’équipement of lectures on fracture biomechanics, principles of fracture repair nécessaire pour une réparation réussie des fractures internes. with plate and screws and decision-making, with a hands-on Apprenez-en davantage à propos de ces ateliers et des autres lab experience using plastic models to practise the techniques activités dans le programme provisoire du congrès 2014 de discussed and gain familiarity with the equipment necessary for l’ACMV, qui a été inclus dans votre numéro de décembre successful internal fracture repair. 2013 de La RVC et qui peut aussi être consulté en ligne NEWS Find out more about these sessions and more in the dans la section des Événements du site Web de l’ACMV 2014 CVMA Convention brochure, which was provided (www.veterinairesaucanada.net). L’inscription en ligne pour le with your December 2013 issue of The CVJ and can also congrès 2014 de l’ACMV ouvrira à la mi-février. be viewed online in the Events section of CVMA’s website (www.canadianveterinarians.net). Online registration for the 2014 CVMA Convention opens in mid-February.

Antimicrobial Decision-making App An antimicrobial decision-making tool for urinary tract infections (UTIs) in cats and dogs will soon be available for CVMA members. Developed for use on smartphones and tablets, this app will guide companion animal practitioners through diagnostic steps and appropriate antimicrobial therapy for simple and complicated UTIs. Une application pour le choix des antimicrobiens Un outil de prise de décisions sur le choix des antimicrobiens pour les infections des voies urinaires (IVU) chez les chats et les chiens sera disponible à l’hiver pour les membres de l’ACMV. Développée pour utilisation avec les téléphones intelligents et les tablettes, cette application guidera les praticiens pour animaux de compagnie lors d’un cheminement d’étapes diagnostiques afin de déterminer une thérapie antimicrobienne appropriée pour les IVU simples et compliquées.

Obituary Nécrologie Dr. Bruce Gordon Watson Dr Bruce Gordon Watson August 30, 1931 – November 11, 2013 30 août 1931 – 11 novembre 2013 The Alberta Veterinary Medical Association (ABVMA) regretfully C’est avec regret que l’Alberta Veterinary Medical Association announces the passing of long time ABVMA member Dr. Bruce (ABVMA) annonce le décès du membre de longue date de Watson. Dr. Watson passed away peacefully at the AGAPE l’ABVMA, le Dr Bruce Watson. Le Dr Watson est mort Hospice on Monday, November 11, 2013 at the age of 82 years. paisiblement à l’hospice AGAPE le lundi 11 novembre 2013, Dr. Watson graduated from the Ontario Veterinary College in à l’âge de 82 ans. 1955 and became a registered member of the ABVMA that same Le Dr Watson avait obtenu son diplôme de l’Ontario year. He was a 35-year active registered member of the Association. Veterinary College en 1955 et était devenu un membre en règle de l’ABVMA cette même année. Il était un membre actif de l’Association depuis 35 ans.

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150th Anniversary of the World 150e anniversaire de l’Association Veterinary Association mondiale vétérinaire The 31st World Veterinary Congress (WVC) took place in Le 31e Congrès mondial vétérinaire (CMV) s’est déroulé à Prague Prague (Czech Republic) from 17 to 20 September, 2013. This (République tchèque) du 17 au 20 septembre 2013. Cette année, year, the WVC was marked by the World Veterinary Association’s le CMV a célébré le 150e anniversaire de l’Association mondiale 150 years Anniversary celebrations. Over 1350 delegates from vétérinaire. Plus de 1350 délégués provenant de 75 pays ont 75 countries attended the WVC 2013. assisté au CMV 2013. The scientific program included 11 parallel sessions covering Le programme scientifique incluait 11 ateliers parallèles every veterinary discipline; from companion to exotic animals, portant sur toutes les disciplines vétérinaires : des animaux de NOUVELLES from well-being of animals to well-being of veterinarians. compagnie aux animaux exotiques, en passant par le bien-être A 2-day Global Veterinary Seminar on Animal Welfare des animaux et le bien-être des vétérinaires. brought together specialists from different world regions to dis- Un Colloque vétérinaire mondial de deux jours sur le bien- cuss the different aspects of Animal Welfare. On that occasion, être des animaux a réuni des spécialistes des différentes régions the WVA signed a Memorandum of Understanding with The du monde pour discuter les différents aspects du bien-être World Society for the Protection of Animals (WSPA) to promote des animaux. À cette occasion, le CMV a signé un Protocole animal welfare globally via agreed specific goals and actions. d’entente avec la World Society for the Protection of Animals This year, the WVA-WHO-OIE-FAO 2nd Global Summit (WSPA) afin de promouvoir le bien-être animal à l’échelle focused on strengthening institutional collaboration and coopera- mondiale en mettant en œuvre les buts et les actions spécifiques tion between animal and public health in education and research. faisant l’objet de l’entente. During the WVC 2013, the WVA held its own Presidents’ Cette année, le 2e Sommet mondial CMV-OMS-OIE-FAO a Assembly. The main issue on the agenda was the vote on the porté sur le renforcement de la collaboration et de la coopération proposal to change the WVA Constitution and By-laws with the des institutions de santé animale et de santé publique dans le aim to broaden membership, improve members’ involvement, domaine de l’éducation et de la recherche. and enhance dynamics and decision-making. After in-depth Durant le CMV 2013, l’AMV a tenu sa propre assemblée presentations and discussions on the proposal, it was adopted des présidents. L’enjeu principal au programme était le vote with 100% of the votes in favor. sur la proposition visant à modifier la Constitution et les On the occasion of the WVA 150th Anniversary celebra- règlements administratifs de l’AMV dans le but d’élargir tion, the WVA presented the John Gamgee Award to James l’effectif, d’améliorer la participation des membres et de rehausser Harlan Steele (USA), Milton Thiago de Mello (Brazil) and to la dynamique et la prise de décisions. Après des présentations Bernard Vallat (France) in recognition of their outstanding and et des discussions approfondies sur la proposition, elle a été exemplary services to veterinary science and to the veterinary adoptée à l’unanimité. profession. À l’occasion des célébrations du 150e anniversaire de l’AMV, The WVC 2013 was concluded by a presentation from the l’AMV a décerné le Prix John Gamgee à James Harlan Turkish Veterinary Medical Association, the organizers of the Steele (États-Unis), à Milton Thiago de Mello (Brésil) et à 32nd WVC to take place in September 2015 in Istanbul, Turkey. Bernard Vallat (France) en reconnaissance de leurs services exceptionnels et exemplaires à la science vétérinaire et à la profession vétérinaire. Le CMV 2013 s’est terminé par une présentation de l’Association des médecins vétérinaires de Turquie, les organisateurs du 32e CMV qui se déroulera en septembre 2015 à Istanbul, en Turquie.

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Around the Provinces Le tour des provinces Nova Scotia Veterinary Medical Association Nova Scotia Veterinary Medical Association

Tandis que je suis assis dans mon salon en considérant le contenu à inclure dans le présent article, les effets de la tempête tropicale Gabrielle se manifestent — et il tombe de 50 à 70 mm de pluie NEWS dans la province. Je sens un orage qui monte en moi en raison de la tempête. Je tente de décider si je devrais consulter mon vieil exemplaire relié de Eats, Shoots and Leaves avant de me lancer dans ce projet. Bien entendu, la raison étant de me rafraîchir la mémoire sur les règles grammaticales avant d’être jugé par mes Dr./Dr Rob Doucette pairs. Eh bien tant pis! Voilà pourquoi nous avons des réviseurs! J’écris le présent article, qui doit être achevé d’ici le 6 octobre As I sit in my living room considering the contents to be aux fins de publication dans le numéro de janvier de La RVC, included in this article the effects of tropical storm Gabrielle are et, entre octobre et décembre, un événement important aura manifesting themselves — 50 to 70 mm of rain is being dumped lieu — notre AGA. across the province. The weather arouses a storm within me. L’Assemblée générale annuelle de la Nova Scotia Veterinary I try to decide whether I should consult my old hardcover copy Medical Association (NSVMA) aura eu lieu le samedi of Eats, Shoots and Leaves before delving into this project. The 23 novembre. Les événements de la journée comprennent un reason of course is to brush up on my grammar before being atelier de formation continue qui présentera deux conférenciers, judged by my peers. Nah — that’s what editors are for! le Dr Terry Whiting et la Dre Carolyn Thomson. Ils discuteront I am writing this article, which is due to be completed by les nombreux défis que doivent relever les vétérinaires (par October 6th for publication in the January issue of The CVJ. exemple, la santé mentale) et le Programme de soutien Between October and December an important event will professionnel (PSP), auquel ont accès les membres de la NSVMA occur — our AGM. et les étudiants de la Nouvelle-Écosse à l’Atlantic Veterinary The Annual General Meeting of the Nova Scotia Veterinary College (AVC). Le PSP procure un soutien confidentiel à ceux Medical Association (NSVMA) will have occurred on Saturday qui vivent des difficultés personnelles et/ou professionnelles. November 23. The events of the day consist of a Continuing Le Conseil rencontrera aussi le doyen Don Reynolds de Education session bringing together 2 speakers, Dr. Terry l’Atlantic Veterinary College (AVC) pour discuter les questions Whiting and Dr. Carolyn Thomson. They will discuss the many d’importance pour les vétérinaires et l’AVC et pour continuer challenges faced by veterinarians (mental health for example) and de miser sur nos relations positives. the Professional Support Program (PSP), to which members of Cette année, nous avons observé le plus grand nombre de the NSVMA and Nova Scotia students at the Atlantic Veterinary nouvelles adhésions de mémoire récente (24) et nous prévoyons College (AVC) have access. The PSP provides confidential sup- que ces nouveaux membres assisteront tous à l’AGA. Une port to those who are facing personal and/or professional dif- nouvelle initiative a été développée pour les nouveaux membres : ficulties. Council will also meet with dean Don Reynolds of the c’est une séance d’orientation qui soulignera les divers aspects Atlantic Veterinary College (AVC) to discuss matters important de l’Association. Les buts consistent à informer les nouveaux to veterinarians and the AVC, and to continue to build upon membres à propos des avantages auxquels ils ont droit, de leur the positive relationships already formed. présenter les divers comités et de les encourager à participer The largest number of new members (24) in recent memory activement à l’Association. Après l’AGA, il y aura un dîner, un has joined the NSVMA this year and all are expected to attend encan de bienfaisance (2700 $ ont été recueillis l’an dernier pour the AGM. A new initiative has been developed for the new mem- la Fondation des maladies du cœur) et un spectacle musical. bers; an orientation session will highlight the different aspects L’AGA de la NSVMA n’est pas seulement un événement of the Association. The goals are to make new members aware important où les enjeux sont discutés et résolus, mais elle réunit of the benefits to which they are entitled, to introduce them aussi tous les vétérinaires des diverses régions de la province pour to the various committees, and to encourage them to become qu’ils apprennent, réseautent et s’amusent ensemble. active within the Association. Following the AGM there will be Un nouveau Comité des prix a été formé. Trois prix seront a dinner, a charity auction ($2700 was raised last year for the désormais décernés annuellement lors de l’AGA afin de Heart and Stroke Foundation), and musical entertainment. The reconnaître les vétérinaires dans les catégories suivantes : NSVMA AGM is not only an important event where issues are 1. Prix du jeune vétérinaire — ce prix sera décerné à un diplômé discussed and resolved but it brings together veterinarians from récent (qui a obtenu son diplôme au cours des dix dernières across the province to learn together, network, and to have a années) qui a apporté des contributions exceptionnelles à la good time. profession vétérinaire et/ou à la collectivité. 2. Prix de mérite — Ce prix sera décerné à un vétérinaire ou à un membre de la collectivité qui a fait des contributions

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A new Awards Committee has been formed. Three awards will importantes à la profession vétérinaire, à la NSVMA et au be given out annually at the AGM in recognition of veterinarians bien-être des animaux. under the following categories: 3. Prix de leadership en médecine vétérinaire — Ce prix sera 1. Young Veterinarian Award — This will be presented to a décerné à un vétérinaire qui a eu une solide carrière sur le recent graduate (graduated within the past 10 years) who has plan des réalisations et du dévouement envers la profession. made outstanding contributions to the veterinary profession Il s’agit du plus grand honneur présenté par la NSVMA. and/or the community. Nous achevons un projet de six ans — le Règlement sur 2. Award of Merit — This will be presented to a veterinarian les technologues vétérinaires. Une fois que le Règlement sur or a member of the community who has made significant les technologues vétérinaires sera en place, les technologues contributions to the veterinary profession, the NSVMA, and vétérinaires autorisés (TVA) seront membres de la NSVMA et NOUVELLES the well-being of animals. recevront tous les privilèges offerts aux membres de la NSVMA. 3. Veterinary Medicine Leadership Award — To be awarded Le règlement décrit les fonctions que peuvent réaliser les TVA to a veterinarian who has a strong career of achievement sous divers niveaux de supervision et les TVA seront désormais and dedication to the profession. This is the highest award responsables de leurs actions. Le règlement protégera aussi le presented by the NSVMA. titre de TVA (RVT). We are close to the completion of a 6-year project — The En réponse à une plainte suscitée par la vente libre de Veterinary Technologists Regulations. Once the Veterinary médicaments sur ordonnance contre les puces et pour Technologists Regulations are in place, Registered Veterinary la vermifugation à un membre du public sans une relation Technologists (RVTs) will be members of the NSVMA and vétérinaire-client-patient valide (RVCP), la NSVMA a adressé will have the privileges that all NSVMA members have. The une lettre à l’ensemble des hôpitaux, des cliniques vétérinaires et regulations describe duties that RVTs can perform under various des vétérinaires leur rappelant qu’une RVCP valide doit exister degrees of supervision and makes RVTs accountable for their afin de vendre des produits sur ordonnance. Cette situation actions. The regulations also give RVTs title protection. a suscité une rétroaction négative de la part du public et de In response to a complaint generated by a veterinary clinic certains vétérinaires. À l’heure actuelle, je crois que la plupart selling prescription flea/deworming medications over the coun- des parties concernées comprennent que les vétérinaires se ter to a member of the public without a valid Veterinary Client trouvent dans une situation unique, car, en tant que membres Patient Relationship (VCPR), the NSVMA produced a reminder d’une profession autoréglementée, nous pouvons diagnostiquer, letter to all veterinary hospitals/clinics and veterinarians that a prescrire et distribuer des médicaments, ce qui représente un valid VCPR must exist in order to sell prescription products. privilège et non un droit. Nous desservons les intérêts du public This generated negative feedback by the public and some ainsi que notre propre intérêt en respectant la loi en vigueur sur veterinarians. At present I believe most parties involved under- la RVCP. stand that veterinarians are unique in that as members of a La NSVMA est fort déçue que l’Agence canadienne self-regulating body, we can diagnose, prescribe and dispense d’inspection des aliments (ACIA) mette fin à son rôle dans la medications. This is a privilege, not a right. We are serving gestion des cas potentiels de la rage, par la quarantaine et des both the interests of the public as well as our own self-interest tests sur les animaux suspects. Cette mesure pourra se traduire by adhering to the VCPR legislation in place. par un nombre accru de vaccins contre la rage de prophylaxie The NSVMA is very disappointed that the Canadian Food post-exposition (PPE) par Santé Canada là où cela sera requis. Inspection Agency (CFIA) is ending its role in dealing with La NSVMA continue de travailler sur des façons de régler ce potential rabies cases, quarantining and testing of suspect ani- problème. Nous évaluons actuellement le niveau d’intérêt des mals. This may result in increased Post Exposure Prophylactic praticiens privés en vue d’assumer ce rôle important. (PEP) rabies vaccines by Health Canada where it may not be Enfin, la NSVMA est encouragée par le haut niveau needed. The NSVMA is continuing to work on how to solve d’entente avec les autres associations de médecins vétérinaires this problem. We are currently assessing the level of interest of (AMV) et le fait qu’une collaboration gérée par l’ACMV sera private practitioners to take on this important role. bénéfique pour toutes les AMV et les vétérinaires à l’échelle Finally, the NSVMA is encouraged by the high level of agree- nationale. La collaboration préviendra le dédoublement du ment by other veterinary medical associations (VMAs) that travail lors de l’élaboration d’énoncés de position et se traduira a collaboration facilitated by the CVMA is beneficial to all par l’établissement d’une voix crédible à l’échelle nationale et VMAs and veterinarians nationwide. Collaboration will prevent internationale, ce qui sera bénéfique pour la profession et le redundancy in the development of position statements and will public. result in the development of one credible voice nationally and (soumis par le Dr Rob Doucette, président, internationally benefitting both the profession and the public. Nova Scotia Veterinary Medical Association) (submitted by Dr. Rob Doucette, President, Nova Scotia Veterinary Medical Association)

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The use of medetomidine-based sedation protocols to perform urohydropropulsion and cystoscopy in the dog

Jinelle A. Webb, Monica Rosati, Dinaz Z. Naigamwalla, Alice Defarges

Abstract — Voiding urohydropropulsion and cystoscopy are routine procedures performed in the dog for diagnostic and therapeutic purposes. These procedures are typically performed under general anesthesia. The purpose of this study was to describe the use of medetomidine-based sedation protocols to perform voiding urohydropropulsion and cystoscopy in cardiovascularly healthy, non-diabetic dogs without evidence of urinary obstruction, renal disease, or hepatic disease. Results of this study revealed significantly shorter procedure times and decreased cost in sedated dogs, with diagnostic and therapeutic outcomes equivalent to those of patients that underwent general anesthesia. Based on the results of this retrospective study, the authors recommend medetomidine-based sedation protocols for voiding urohydropropulsion and cystoscopy in appropriately selected patients.

Résumé — Usage des protocoles de sédation à la médétomidine pour réaliser l’urohydropropulsion et la cystoscopie chez un chien. L’urohydropropulsion permictionnelle et la cystoscopie sont des interventions de routine réalisées chez le chien à des fins diagnostiques et thérapeutiques. Ces interventions sont habituellement réalisées sous anesthésie générale. Le but de cette étude était de décrire l’usage des protocoles de sédation à la médétomidine afin d’effectuer l’urohydropropulsion permictionnelle et la cystoscopie chez des chiens en bonne santé cardiovasculaire et non diabétiques sans signe d’obstruction urinaire, de maladie rénale ni de maladie hépatique. Les résultats de cette étude ont révélé des temps d’intervention significativement réduits et une baisse du coût chez les chiens sous sédation, avec des résultats diagnostiques et thérapeutiques équivalant à ceux de patients qui avaient subi une anesthésie générale. Selon les résultats de cette étude rétrospective, les auteurs recommandent des protocoles de sédation à la médétomidine pour l’urohydropropulsion permictionnelle et la cystoscopie chez les patients choisis selon des critères appropriés. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1213–1218 Introduction dures are typically performed under general anesthesia to allow complete relaxation of the urethra; however, general anesthesia oiding urohydropropulsion is a non-invasive method for results in longer procedure times and in the case of voiding removing small urocystoliths from the dog, most com- V urohydropropulsion, difficult endotracheal tube stabilization monly used in females due to the relatively wider and shorter due to the vertical positioning of animals (Figure 1) (1–4). urethra. Cystoscopy, both rigid and flexible, can be performed in Extra staff members are also required to assist with endotracheal male and female dogs for visualization of the lower urinary tract, tube stabilization for voiding urohydropropulsion. Additional procurement of samples, and removal of material. These proce- disadvantages to general anesthesia include the requirement for a properly set-up anesthetic machine, the use of inhalant anesthe- Department of Internal Medicine and Anesthesiology, sia, the need for a patent airway and associated complications, Mississauga-Oakville Veterinary Emergency Hospital, 2285 an obtunded sympathetic nervous system, marked respiratory Bristol Circle, Oakville, Ontario L6H 6P8 (Webb, Rosati, depression, loss of swallow reflex, increased inhalant required for Naigamwalla); Department of Clinical Studies, Ontario adequate relaxation due to inhalant’s lack of analgesic properties, Veterinary College, Guelph, Ontario N1G 2W1 (Defarges). the production of hazardous exhaled waste gases, and increased Address all correspondence to Dr. Jinelle A. Webb; e-mail: cost to the client compared to sedation protocols (5). Sedation [email protected]. avoids disadvantages specific to general anesthesia; however, Preliminary data from this study were presented at the American the use of a sedation protocol for voiding urohydropropulsion College of Veterinary Internal Medicine Forum, Denver, requires adequate relaxation of the urethra along with immo- Colorado, 2011. bilization of the patient. A protocol that resulted in profound Use of this article is limited to a single copy for personal study. sedation would be required, such as one incorporating medeto- Anyone interested in obtaining reprints should contact the midine. This degree of sedation requires monitoring similar to CVMA office ([email protected]) for additional that for general anesthesia, including continuous electrocardiog- copies or permission to use this material elsewhere. raphy, oscillometric non-inv asive blood pressure measurement,

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Table 1. Summary of data for dogs that had urohydropropulsion performed under medetomidine-based sedation Age Weight Time of procedure Signalment (y) (kg) (min) Standard poodle 2 18.3 8.5 Shih Tzu cross 3 7.0 6.0 Miniature schnauzer 7 10.0 12.5 Shih Tzu 7 9.8 25.0 Bichon frisé 9 7.7 10.0 Average 5.6 10.6 12.4 ARTICLE

cardiovascularly unstable patients, specific endocrinopathies such as diabetes mellitus and hyperthyroidism, geriatric patients due to their lack of cardiovascular reserve, and pediatric patients due to their immature sympathetic nervous system (6,8,10). Adverse effects include baroreceptor-mediated bradycardia, atrioventricular blocks, intermittent hypertension, depressed respiration, hypothermia, increased urination, vomiting, and hyperglycemia due to decreased pancreatic release of insulin; rarely, prolonged sedation, paradoxical excitation, hypersensitivity, apnea, and death due to circulatory failure can occur (6–8,10). The purpose of this study was to determine if medetomidine- based sedation protocols could be used to perform voiding urohydropropulsion and cystoscopy in the dog, with similar success rates in diagnostic and therapeutic goals when compared to anesthetized patients. Materials and methods Criteria for patient selection Dogs that were presented to the Mississauga-Oakville Veterinary Emergency Hospital for voiding urohydropropulsion or cystoscopy were assessed by a board-certified anesthesiologist for suitability to receive medetomidine and for inclusion in this study; an American Society of Anesthesiologists (ASA) class was assigned to each case. Appropriate animals were cardiovascularly Figure 1. A dog positioned for voiding urohydropropulsion healthy, without evidence of renal disease (including urinary under general anesthesia. obstruction), hepatic disease, or diabetes, and were neither less than 12 wk nor considered geriatric for their breed. Cystoscopy and pulse oximetry. As the use of profound sedation can result was performed for several diagnostic and/or therapeutic reasons, in compromised respiratory function, flow-by oxygen supple- including suspicion of ectopic ureters, assessment of lower mentation is recommended, along with intravenous access and urinary tract in cases of chronic urinary tract infection, and immediately available supplies to facilitate rapid intubation in assessment of lower urinary tract masses. Informed consent the event that respiratory compromise occurs and intubation was obtained from pet owners. Initially, a prospective study was is required. planned; however, given the success of the medetomidine-based Medetomidine, an alpha-2 adrenergic agonist, has been sedations protocols, retrospective cases were used for the general used intramuscularly (IM) and intravenously (IV) to provide anesthesia control groups. moderate to profound sedation and analgesia in dogs, typically in combination with other agents such as opioids and ket- Sedation protocol amine (6–8). Common uses include the sedation of patients An intravenous catheter was placed and a combination of for examination and minor procedures, particularly if they are medetomidine (Domitor; Pfizer Canada, Mississauga, Ontario), fractious or aggressive, and as part of a preanesthetic regimen 10 to 15 mg/kg body weight (BW), IV, and hydromorphone due to anesthetic sparing properties (7). Urodynamic testing has (Hydromorphone HP 10; Sandoz Canada, Quebec City, Quebec), indicated that medetomidine causes a decrease in maximal ure- 0.025 to 0.05 mg/kg BW, IV, or butorphanol (Torbugesic; Wyeth thral closure pressure, suggesting a relaxation of the urethra that Animal Health, Guelph, Ontario), 0.2 mg/kg BW, IV, were may facilitate voiding urohydropropulsion and cystoscopy (9). administered, with the addition of ketamine (Ketalean; Bimeda- Contraindications to its use include patients with respiratory MTC Animal Health, Cambridge, Ontario), 2 mg/kg BW, IV, in disease, hepatic and renal disease including urinary obstruction, fractious animals. The choice of sedation protocol was based on

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blood pressure, oxygen saturation (SpO2), and depth of sedation/ anesthesia. The time of administration of sedation or time of induction into general anesthesia was recorded, and the time of administration of reversal agent or time of discontinuation of inhalant anesthesia was recorded; the interval between these times was

considered the “procedure length.” Hospitalization time was ARTICLE recorded for each patient. The cost to the client of each procedure was recorded, including all requirements for sedation or anesthesia; additional costs such as procedural costs, diagnostic testing, and examination fees were excluded. Voiding urohydropropulsion and cystoscopy were performed as previously described (11). There were no alterations in the procedures performed in the sedated versus the anesthetized patients, other than the lack of stabilization of the endotracheal tube required for urohydropropulsion in sedated patients (Figure 2). Procedures were performed by 1 of 2 board-certified internal medicine specialists.

Statistical analysis Statistical analysis was performed to determine significant differences in age, weight, cost of sedation/general anesthesia for procedures (“cost of restraint”), and procedure length between groups receiving general anesthesia and groups receiving sedation. Paired t-tests were employed to compare general anesthesia with sedation groups for both urohydropropulsion and cystoscopy. A P-value of , 0.05 indicated a statistically significant difference between groups. Results Thirteen dogs received medetomidine-based sedation protocols; 5 dogs had urohydropropulsion performed (Table 1, Figure 2), and 8 dogs had cystoscopy performed (Table 2, Figures 2, 3). Thirteen dogs that received general anesthesia were included as a control group; 5 dogs had urohydropropulsion performed (Table 3, Figure 1), and 8 dogs had cystoscopy (Table 4). No anesthetic or procedural complications were noted with any case. Dogs that received medetomidine-based sedation protocols for urohydropropulsion ranged in age from 2 to 9 y (average = 5.6 y), and ranged in weight from 7 to 18.3 kg (average = 10.6 kg). Dogs that received general anesthesia for urohydropropulsion ranged in age from 5 to 10 y (average = 7.2 y), and ranged in weight from 7.1 to 21.2 kg (average = 12.5 kg). Dogs that received medetomidine-based sedation protocols for cystos- Figure 2. A female dog positioned for urohydropropulsion after copy ranged in age from 7 to 11 y (average = 8.4 y), and ranged medetomidine-based sedation. in weight from 9.1 to 40.8 kg (average = 28.2 kg). Dogs that received general anesthesia for cystoscopy ranged in age from assessment of each animal by a board-certified anesthesiologist. 0.5 to 12 y (average = 7.3 y), and ranged in weight from 4.2 to Atipamezole (Antisedan; Pfizer Canada, Mississauga, Ontario) 36.6 kg (average = 20.1 kg). There was no significant difference was administered IM as a reversal agent at a dose of 2 times the in the age or weight between dogs in the treatment and control volume of medetomidine upon completion of the procedure. groups. All animals that received urohydropropulsion, regardless Supplemental flow-by oxygen at a rate of 1 to 2 L/min was proof use of sedation or general anesthesia, were spayed female dogs. vided. Monitoring included electrocardiography, oscillometric Gender of animals that received cystoscopy is listed in Tables 2 non-invasive blood pressure measurement, and pulse oximetry. and 4, and was similar between sedation and general anesthesia. Monitoring was performed and recorded by registered veterinary Procedure length for dogs receiving medetomine-based seda- technicians under the supervision of a board-certified anesthe- tion protocols for urohydropropulsion ranged from 6 to 25 min, siologist, and included heart rate and rhythm, respiratory rate, with an average procedure length of 12.4 min. Procedure length

CVJ / VOL 55 / JANUARY 2014 1215 FOR PERSONAL USE ONLY ARTICLE

Figure 3. A female dog positioned for cystoscopy after medetomidine-based sedation.

Table 2. Summary of data for dogs that had cystoscopy performed under medetomidine-based sedation Duration of Age procedure Signalment Gender (y) Reason for cystoscopy Weight (kg) (min) Outcome Terrier cross MN 1 Mass-like irregular UB wall and uroliths 9.1 40 Cystitis secondary to uroliths Beagle FS 7 Irregular UB wall and chronic UTI 22.8 30 Polypoid cystitis and E. coli infection Collie cross FS 7 Irregular UB wall and chronic UTI 34.7 24 Chronic cystitis and E. coli infection Standard poodle MN 8 Mass in UB 21.4 35 Transitional cell carcinoma Australian shepherd MI 9 Suspected mass in urethra 40.8 45 Transitional cell carcinoma Golden retriever MN 9 Irregular prostate 28.3 11.5 Transitional cell carcinoma Portuguese water dog MN 11 Chronic UTI 40.3 10 Malformed prepuce and penis Wheaton terrier FS 12 Mass in UB 17.4 25 Transitional cell carcinoma Average 8 Average 26.9 27.6

MN — male, neutered; FS — female, spayed; MI — male, intact; UB — urinary bladder; UTI — urinary tract infection.

for dogs receiving general anesthesia for urohydropropulsion Table 3. Summary of data for dogs that had urohydropropulsion ranged from 44 to 78 min, with an average procedure length performed under general anesthesia of 60.4 min. Procedure length for dogs receiving medeto- Age Weight Time of procedure mine-based sedation protocols for cystoscopy ranged from Signalment (y) (kg) (min) 10 to 45 min, with an average procedure length of 27.6 min. Bichon frisé 5 7.1 70 Procedure length for dogs receiving general anesthesia for cys- Bichon frisé 5 12.5 60 Springer spaniel 6 21.2 78 toscopy ranged from 30 to 65 min, with an average procedure Miniature schnauzer 10 11.8 50 length of 49.4 min. There was a statistically significant differ- Miniature schnauzer 10 9.8 44 ence in the procedure length between treatment and control Average 7.2 12.5 60.4 groups, for both urohydropropulsion and cystoscopy. There was no relation between either age of dog or weight of dog and procedure length. All urohydropropulsion procedures were performed by and procurement of tissue for chronic urinary tract infection 1 internal medicine specialist. Of the 13 cystoscopy proce- with supportive histopathology and culture, and visualization dures, 9 were performed by 1 internal medicine specialist and with procurement of diagnostic tissue for histopathology for 4 by the other. There was no relation between the internal urinary system masses (Tables 2, 4). In all dogs in both groups, medicine specialist performing the procedure and the length diagnostic and/or therapeutic goals were considered completely of the procedure. successful. Success of voiding urohydropropulsion was determined by Physiological parameters monitored during sedation were not assessment for residual urocystoliths via ultrasound examina- significantly different from those measured in cases receiving gen- tion and/or cystoscopy. In all dogs in both groups, removal of eral anesthesia, with the exception of heart rate. Medetomidine all urocystoliths was documented and therefore the procedures causes bradycardia with occasional atrioventricular blocking, were considered completely successful. Success of cystoscopy which resulted in heart rates that were significantly lower in was determined by assessment of diagnostic or therapeutic goals, sedated patients compared with those receiving general anes- including visualization of ectopic ureters, assessment of anatomy, thesia. There was no pain response noted in patients receiving

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Table 4. Summary of data for dogs that had cystoscopy performed under general anesthesia Duration of Age Weight procedure Signalment Gender (y) Reason for cystoscopy (kg) (min) Outcome Kuvasz FI 0.5 Urinary incontinence 29.2 55 Ectopic ureters Maltese MN 5 Suspected intraluminal suture material 4.2 30 Confirmed intraluminal suture material Bull terrier FS 6 Chronic UTI 28.0 60 Chronic cystitis and Pseudomonas ARTICLE infection German shepherd dog FS 8 Stranguria 36.6 55 Proliferative urethritis Kerry blue terrier FS 8 Stranguria and hematuria 13.5 50 Proliferative urethritis Wheaton terrier FS 9 Mass in UB 19.4 40 Transitional cell carcinoma Miniature schnauzer MN 10 Irregular UB wall and chronic UTI 6.8 65 Chronic cystitis and E. coli infection Collie MN 12 Mass in UB 23.3 40 Transitional cell carcinoma Average 7.3 Average 20.1 49.4

MN — male, neutered; FS — female, spayed; MI — male, intact; UB — urinary bladder; UTI — urinary tract infection. sedation protocols or general anesthesia protocols; all patients trauma to the trachea and right mainstem bronchi, especially in tolerated the procedure well. larger dogs. Medetomidine-based sedation protocols avoid the Cost of restraint for procedures was determined by including use of an endotracheal tube which, therefore, eliminates this all costs to clients related to sedation/general anesthesia, with risk. Providing flow-by oxygen to a patient in the perpendicular the exclusion of all costs related to performing the procedure orientation required is simple with no risk to the patient. and submission of samples. Costs such as use of the endoscope Procedure length was significantly shorter for sedated dogs and submission costs such as histopathology and bacterial compared with dogs receiving general anesthesia, for dogs culture were excluded. The cost of restraint for dogs receiving undergoing cystoscopy or voiding urohydropropulsion. Upon medetomine-based sedation protocols for urohydropropul- review of the patient files, the increased time could be attrib- sion ranged from $274.70 to $406.20, with an average cost of uted to several factors. There was an increased time for patient $325.48. Cost of restraint for dogs receiving general anesthesia stabilization and adequate depth of anesthesia after induction, for urohydropropulsion ranged from $401.75 to $579.45, with prior to initiation of the procedure. Patient stability and ASA an average cost of $499.72. Cost of restraint for dogs receiving classification may have resulted in longer anesthetic times; it medetomine-based sedation protocols for cystoscopy ranged is theorized by the authors that geriatric patients may take from $130.00 to $372.35, with an average cost of $309.23. longer to achieve acceptable depths of anesthesia and stable Cost of restraint for dogs receiving general anesthesia for cys- vital parameters. However, review of the patients revealed no toscopy ranged from $350.15 to $579.45, with an average of significant difference in age, weight, or ASA classification $487.13. There was a statistically significant difference in the between sedated animals and those receiving general anesthe- cost of restraint between treatment and control groups for both sia. In addition, review of files of patients that received gen- cystoscopy and urohydropropulsion. eral anesthesia revealed that they would have been acceptable candidates to receive medetomidine. There was a much larger Discussion discrepancy between the average procedure lengths for sedated Results of this study support the use of medetomidine-based versus anesthetized dogs that had voiding urohydropropulsion sedation protocols for voiding urohydropropulsion and cystos- performed, compared with those that had cystoscopy. It is the copy. The use of these protocols resulted in a shorter procedure authors’ experience that the care required in endotracheal tube time with decreased cost to the client, avoided the disadvantages stabilization for voiding urohydropropulsion to reduce the risk and complications of general anesthesia, and had equivalent of endotracheal-induced injury results in a much longer time success in diagnostic or therapeutic goals. None of the patients positioning the patient prior to performing voiding urohydro- receiving sedation or general anesthesia experienced any com- propulsion. This extended time required in patient positioning plications, and no patients showed evidence of pain during the is the probable reason for the significant increase in procedure procedure. Patient selection is important, and patients with length for voiding urohydropropulsion for anesthetized patients. cardiovascular instability, hepatic disease, renal disease or urinary Most hospitals have higher fees for anesthetized patients tract obstruction, endocrine diseases such as diabetes mellitus, compared with sedated patients. This is due to the requirement cardiac disease, or geriatric and pediatric patients, should not for premedication and induction agents, the on-going use of receive medetomidine. Alternative forms of sedation and anal- inhalant anesthetic, and additional equipment including an gesia will likely not achieve the level of patient restraint and anesthetic machine and exhaust system. In addition, length of urethral relaxation required for voiding urohydropropulsion and personnel time is increased as the procedure time is increased. cystoscopy, and therefore general anesthesia is recommended for Recovery times are shorter with medetomidine-based sedation cases in which medetomidine is contraindicated. protocols, and therefore personnel time is longer for animals Patient positioning in voiding urohydropropulsion may receiving general anesthesia. All patients in this study were increase the risk of endotracheal tube complications including hospitalized for less than 12 h, and therefore hospitalization

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costs were the same for dogs receiving sedation and dogs receiv- obstruction, renal disease, or hepatic disease for both voiding ing general anesthesia. In addition, monitoring equipment urohydropropulsion and cystoscopy. Use of a medetomidine- used for dogs receiving general anesthesia and dogs receiving based sedation protocol results in shorter procedure times and a medetomidine-based sedation protocols was similar. On aver- decreased cost to the client, and also avoids risks associated with age, the cost associated with general anesthesia compared to the general anesthesia including possible endotracheal tube injury medetomidine-based sedation protocol was 1.6 times higher when positioned for urohydropropulsion. CVJ for cystoscopy, and 1.5 times higher for urohydropropulsion. Limitations to this study include the low numbers of dogs in References each treatment group, and the retrospective nature of the control 1. Adams LG, Syme HM. Canine ureteral and lower urinary tract

ARTICLE data. Urohydropropulsion is not a commonly performed pro- diseases. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, Missouri: Saunders Elsevier, 2010: cedure; therefore, achieving a large number of cases is unlikely. 2086–2115. As all suitable cases that were presented to the Mississauga- 2. Lulich J, Osborne CA. Beyond the stone age: Minimally invasive tech- Oakville Veterinary Emergency Hospital after initiation of the niques. Proc 25th Am Coll Vet Intern Med Forum, Seattle, June 6–9, 2007. study received medetomidine-based sedation, it was necessary 3. Rawlings CA, Berent AC. Cystoscopy. In: Tams TR, ed. Small Animal to use retrospective cases for the control group that received Endoscopy. 3rd ed. St. Louis, Missouri: Saunders Elsevier, 2010: general anesthesia. However, we attempted to closely match the 507–554. 4. Rawlings CA. Diagnostic rigid endoscopy: Otoscopy, rhinoscopy, and control group based on age, weight, and for cystoscopy cases, cystoscopy. Vet Clin North Am Small Anim Pract 2009;39:849–868. disease process. 5. Archer E. Injectable Anaesthesia: Turning Off the Gas. Proc British Small Most of the procedures were performed by a single board- Animal Veterinary Association Congress, Birmingham, UK, April 8–11, 2010. certified internal medicine specialist. Theoretically, the skill to 6. Murrell JC, Hellebrekers LJ. Medetomidine and dexmedetomidine: perform urohydropropulsion and cystoscopy could improve A review of cardiovascular effects and antinociceptive properties in the over time, thereby decreasing procedure length. As control dog. Vet Anaesth Analg 2005;32:17–127. 7. Sinclair MD. A review of the physiological effects of alpha2-agonists cases were obtained retrospectively, it is possible that procedure related to the clinical use of medetomidine in small animal practice. length was shorter in sedation cases as they were performed at Can Vet J 2003;44:885–897. a later date. However, within the groups of dogs there was no 8. Lemke KA. Perioperative use of selective alpha-2 agonists and antago- nists in small animals. Can Vet J 2004;45:475–480. statistically significant difference between procedure length 9. Rawlings CA, Barsanti JA, Chernosky AM, et al. Results of cystometry and the date that the procedures were performed. This would and urethral pressure profilometry in dogs sedated with medetomidine indicate that procedure length did not decrease over time due or xylazine. Am J Vet Res 2001;62:167–170. 10. Plumb DC. Medetomidine HCl. In: Plumb’s Veterinary Drug to an improvement in skill. Handbook. 7th ed. Philadelphila, Pennsylvania: Wiley-Blackwell, 2011: Voiding urohydropropulsion and cystoscopy are typically 630–632. performed under general anesthesia. This study supports the 11. Lulich JP, Osborne CA. Voiding urohydropropulsion: A nonsurgical technique for removal of urocystoliths. In: Bonagura JD, Kirk RW, use of medetomidine-based sedation protocols in cardiovas- eds. Current Veterinary Therapy XII. Philadelphia, Pennsylvania: cularly healthy, non-diabetic dogs without evidence of urinary WB Saunders, 1995:1003–1007.

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1218 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Article

Detection of retinoid receptors in non-neoplastic canine lymph nodes and in lymphoma

Carlos H. de Mello Souza, Victor E.O. Valli, Barbara E. Kitchell

Abstract — This study evaluated the difference in retinoid receptor expression between non-neoplastic lymph nodes and nodal lymphoma in dogs. Retinoid receptor expression was evaluated by immunohistochemistry in 32 canine lymph nodes. The lymph nodes had been previously diagnosed as non-neoplastic (6 normal and 7 hyperplastic lymph nodes) and B- and T-cell lymphoma (19 cases). Immunohistochemistry for retinoic acid receptors and retinoid-X receptors (and their subtypes a, b, and g) was performed in all cases. In addition, immunohistochemistry for CD3 and CD79a was performed in all lymphoma cases. Non-neoplastic lymphocytes were negative for all retinoid receptors. Retinoic acid receptor-g was detected in 100% of B-cell lymphoma and 78% of T-cell lymphoma, while retinoid X receptor-g was positive in 78% of T-cell lymphoma cases. When normal lymph node architecture was still present, a contrast between retinoid-negative benign cells and retinoid-positive malignant cells was clear. Retinoid receptors were expressed in neoplastic, but not in benign lymphocytes, suggesting their value for both diagnosis and treatment of canine lymphoma.

Résumé — Détection des récepteurs aux rétinoïdes dans les ganglions lymphatiques canins non néoplasiques et dans les lymphomes. Cette étude a évalué la différence dans l’expression des récepteurs de l’acide rétinoïque entre les ganglions lymphatiques non néoplasiques et les lymphomes ganglionnaires chez les chiens. L’expression des récepteurs de l’acide rétinoïde a été évaluée par immunohistochimie dans 32 ganglions lymphatiques canins. Les ganglions lymphatiques avaient été antérieurement diagnostiqués comme étant non néoplasiques (6 ganglions lymphatiques normaux et 7 hyperplasiques) et les lymphomes B et T (19 cas). L’immunohistochimie pour les récepteurs de l’acide rétinoïque et les récepteurs X de rétinoïde (et leurs sous-types a, b et g) a été réalisée dans tous les cas. De plus, l’immunohistochimie pour CD3 et CD79a a été réalisée dans tous les cas de lymphomes. Les lymphocytes non néoplasiques étaient négatifs pour tous les récepteurs de rétinoïde. Le récepteur-g d’acide rétinoïque a été détecté dans 100 % des lymphomes B et dans 78 % des lymphomes T, tandis que le récepteur-g X de rétinoïde était positif dans 78 % des cas de lymphome T. Lorsqu’une architecture normale des ganglions lymphatiques était présente, le contraste entre les cellules bénignes négatives pour la rétinoïde et les cellules malignes positives pour la rétinoïde était clair. Les récepteurs de rétinoïde étaient exprimés dans les lymphocytes néoplasiques, mais non dans les lymphocytes bénins, suggérant leur valeur pour le diagnostic et le traitement des lymphomes canins. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1219–1224

Department of Small Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, Gainesville, Florida 32610-0126, USA (de Mello Souza); VDx Veterinary Diagnostics. 2019 Anderson Road, Suite C, Davis, California 95616, USA (Valli); Center for Comparative Oncology. D208 Veterinary Medicine Center, Michigan State University, College of Veterinary Medicine, East Lansing, Michigan 48824, USA (Kitchell). Address all correspondence to Dr. Carlos H. de Mello Souza; e-mail: [email protected] This project was conducted at The College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 1008 West Hazelwood Drive, Urbana, Illinois, USA. Work was supported by funding provided by Dr. Victor E.O. Valli. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Introduction enhance responses in dogs with LSA. This study was conducted to evaluate the expression of retinoid receptors in lymph nodes ymphoma (LSA) is the most common hematopoietic malig- of dogs. We hypothesized that the expression of retinoid recep- nancy in dogs and the disease most commonly treated by L tors varies from non-neoplastic lymph nodes to lymphoma and chemotherapy (1). Treatment for LSA has been well-documented between B- and T-cell lymphoma. and usually consists of multi-drug chemotherapy regimens. Most dogs with multicentric LSA respond to doxorubicin-based Materials and methods chemotherapy protocols. Remission rates of . 90% and median Formalin-fixed paraffin embedded biopsy specimens from cases survival times ranging from 6 to 17 mo have been reported of lymphoma and lymphoid hyperplasia used in this study were (2,3). Survival for dogs treated with doxorubicin-based protocols ARTICLE consecutive cases retrieved from the archives of the University varies from 25% to 50% (1-year survival), and 13% to 27% of Illinois, College of Veterinary Medicine. Lymph nodes from (2-year survival) (3–5). The common induction of multi-drug cases diagnosed with lymphoid hyperplasia had follow-up of resistance means that most dogs will still die or be euthanized 12 mo. Dr. David M. Vail from the University of Wisconsin- after progression of disease. Long-term chemotherapy does not Madison College of Veterinary Medicine graciously provided prolong survival in humans compared with short-term aggres- the normal lymph nodes. Anti-human antibodies were used sive protocols. The same seems to be true for canine patients for retinoid receptor detection in our study. All antibodies are with 1 major difference being that the induction protocol is indicated by the manufacturer to react against human and mice usually much more aggressive in humans than it is in dogs (2,3). retinoid receptors. Some of them, RARb, RXRb, and RXRg are Chemotherapy treatment intensity may be one of the reasons for described to also react against canine retinoid receptors [Santa the much higher cure rate in humans than dogs (3–7). Clearly, Cruz Biotechnology, Santa Cruz, California, USA, RARa: additional methods of therapy are needed to prolong remission sc-551 and blocking peptide (BP) sc-551P; RARb: sc-552 and times in dogs. One of these emerging approaches is the use of BP sc-552P; RARg: sc-550 and BP sc-550P; RXRa: sc-553 retinoids (8). and BP sc-553P; RXRb: sc-831 and BP sc-831; RXRg: sc-555 Retinoids are natural or synthetic derivatives of vitamin A and BP sc-555P]. These antibodies were chosen based on a study shown to modulate cell growth, differentiation, and apoptosis by Mori et al (21) and a previous study from our laboratory, in vivo and in vitro. Retinoids induce growth inhibition in in which we confirmed that rabbit antibodies against retinoid tumor cells by induction of terminal differentiation, cell cycle receptors cross react with canine tissue (22). In addition, arrest, and apoptosis (8,9). These effects occur through inter- we performed an amino acid homology search [BLAST pro- action with retinoid-specific nuclear receptors which function gram, National Center for Biotechnology Information (NCBI), as ligand-dependent transcription factors; retinoid binding Bethesda, Maryland]. This search revealed a high degree of and activation of the receptor is followed by transcription of homology between all human and canine retinoid receptor pro- responsive genes. Retinoid receptors are divided into 2 classes: teins (RARa 99%, GenBank Accession No. NP-001012663.1; the retinoic acid receptors (RARs); and the retinoid X recep- RARb 92%, XP-862280.1; RARg 94%, XP-849260.1; RXRa tors (RXRs) and their 3 subtypes a, b, and g (8,9). In humans, 89%, XP-548399.2; RXRb 96%, XP-862727.1; and RXRg retinoids are used successfully for the treatment of promyelocytic 97%, XP-536146.2). leukemia, cutaneous lymphoma, lung and thyroid carcinomas, Deparaffinization and antigen retrieval were performed at and glioblastomas (8–14). room temperature as follows. Slides were placed in 3 changes Variation in retinoid receptor expression occurs in cancer of xylene for at least 3 min for each change. This was followed and is associated with aggressiveness, response to treatment, and by 2 changes of 100% ethanol, 2 changes of 95% ethanol, and overall survival (8,10,11). In dogs, retinoids have been used in 1 change of 70% ethanol for at least 2 min per change. Slides dermatology as differentiation agents in actinic keratosis, seba- were placed in running water for at least 1 min and then in 3% ceous adenitis, and benign pilomatrixomas (15–16). Few stud- hydrogen peroxide in methanol for 15 min prior to rinsing in ies have demonstrated the effects of retinoids in canine cancer. Optimax wash buffer (500M Optim; Biogenex, San Ramon, In a study of 14 dogs with cutaneous lymphoma treated with California, USA) for 5 min. Slides were placed in a container retinoids as single agents, a clinical response rate of 42% was of citrated buffer, pH 6, to be microwaved on high power until achieved (17). In addition, research in canine mast cell tumor the buffer boiled. Power was reduced to a level that produced (MCT) cell lines revealed that these cells expressed retinoid intermittent boiling for 10 min. Slides were cooled for 20 min receptors and the level of expression of RARa mRNA corre- and rinsed again in Optimax buffer. lated well with growth inhibition caused by all-trans retinoic Primary antibodies used in the study were: RARa C-20, acid (ATRA) (18,19). Furthermore, concentration-dependent RARb C-19, and RARg C-19 (rabbit polyclonal biotinylated); cell death was achieved at micromolar levels of retinoid-treated RXRa D-20, RXRb C-20, and RXRg Y-20 (rabbit polyclonal MCT cell lines from grade II and III tumors (20). With the biotinylated) (Santa Cruz Biotechnology). For the negative development of synthetic retinoids, specific receptor targeting controls, specific blocking peptides (100 mg/0.5mL) were added has led to superior results in both cancer prevention and treat- to each antibody (25 mL of blocking peptide to 5 mL of anti- ment in human medicine (8,11). The understanding of the body) and incubated for 2 h before dilution. The Supersensitive pattern of retinoid receptor expression in canine lymph nodes kit (streptavidin-biotin system) was used for all antibodies may also lead to the use of specific receptor interacting agents to (Biogenex, San Ramon, California, USA). Immunoreaction

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Table 1. Distribution of retinoid receptor expression among 19 cases of canine nodal lymphoma Retinoid Receptor Subtype LSA phenotype RARa RARb RARg RXRa RXRb RXRg B-cell (10 cases) 4 (40%) 1 (10%) 10 (100%) 0 (0%) 1 (10%) 7 (70%) T-cell (9 cases) 4 (44%) 1 (11%) 7 (78%) 3 (33%) 2 (22%) 2 (22%)

LSA — lymphoma; RAR — retinoic acid receptor; RXR — retinoid X receptor. ARTICLE

was visualized with 3,39-diaminobenzidine substrate. Final dilutions were RARa (1:100), RARb (1:100), RARg (1:75), RXRa (1:100), RXRb (1:100), and RXRg (1:100). Finally, the slides were counterstained with hematoxylin for 1 min, rinsed in water, dehydrated, and mounted. Hematoxylin-eosin stained slides from a total of 32 cases previously diagnosed as normal lymph node (6 cases), lymphoid hyperplasia (7 cases), B-cell LSA (10 cases), and T-cell LSA (9 cases) were reviewed by 1 pathologist (VEOV). For all the lymphoma cases, slides immunophenotyped for CD3 and CD 79a expression by IHC were also re-evaluated (Dako-Cytomation, Carpinteria, California, USA). Formalin-fixed paraffin embedded tissues were used to create 15 sections of 3-mm thickness from each case. Slides were prepared from all blocks for immunostaining using all the markers described. Immunohistochemistry analysis was performed on all lymph nodes at the same time and by Figure 1. RXRb staining in a case of lymphoid hyperplasia using the same biotin-streptavidin-immunoperoxidase ampli- showing numerous RXRb positive macrophages concentrated fied detection system as recently described (22). For retinoid mostly at the nodal sinusoids. receptors, mouse pup eyes were used as positive controls, and blocking peptides were used as negative controls. This decision Discussion was based on our previous study that compared the retinoid Important findings in our study were the absence of retinoid receptor retinal staining patterns of mice and dogs. That study receptor binding in lymphocytes and plasma cells of benign showed that staining of the same retinal structures was similar in canine nodal tissue and a positive pattern present only in mac- mice and dogs. We decided to use mice eyes due to their greater rophages of hyperplastic lymph nodes. In contrast, we detected availability (Figure 1) (22). The immunostaining for retinoid strong retinoid receptor expression in canine lymphomas. In receptors had to be strong in the nucleus of the cell in order for addition, the most common receptor sub-type expressed varied the sample to be considered positive. One pathologist (VEOV) with phenotype. This dramatic difference between retinoid evaluated all the IHC slides. Patterns of staining were recorded receptor expression in non-neoplastic (normal lymph nodes for further analysis. and lymphoid hyperplasia) and lymphoma cases indicates that retinoid receptor expression is associated with the malignant Results phenotype of nodal lymphoma in dogs. A striking finding of Retinoid receptor expression was not detected in any of the our study was the dramatic retinoid receptor staining contrast normal lymph node specimens. In cases of lymphoid hyperpla- of benign versus neoplastic cells. In cases where normal lymph sia, expression of RAR and RXR (a, b, and g) was only pres- node architecture was still present, the interface between the ent in sinus macrophages (Figure 2). Sinusoidal macrophages strong positive neoplastic cells and the negative benign cells are the primary cell on nodal sinus and were identified by cell was very clear after IHC. To our knowledge this fact has not morphology, nuclear size and morphology, and by the com- been reported in the literature. The strong retinoid receptor- mon presence of hemosiderin granules in the cytoplasm. All staining pattern displayed by macrophages within lymph nodes LSA cases expressed at least 2 of the receptor subtypes. In such demonstrating lymphoid hyperplasia was an expected finding. cases, . 95% of the cells were positive. The most commonly It has been previously shown in humans that dendritic cells and expressed receptor was RARg, positive in 17 cases (89% overall; macrophages express retinoid receptors during inflammation 100% in the cases of B-cell LSA), followed by RXRg, positive in and that this expression is associated with cytokine production 9 cases (47% overall; 78% in T-cell LSA specimens) (Figure 3). (23–25). The other subtypes were positive in small percentages of cases The retinoid receptor expression of lymphocytes has been (Table 1). In the LSA cases evaluated, where neoplastic cells had evaluated in neonatal mice and young children. In mice, lym- not effaced the lymph node, normal structures such as mantle phocyte retinoid receptor expression varies throughout the cell cuff and germinal centers, when benign, were uniformly embryonic development of the thymus (25). Both RARa and negative for retinoid receptor expression (Figures 3 and 4). RARg continue to be present in lymphocytes after birth and

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A B ARTICLE

Figure 2. B-cell Marginal zone lymphoma case showing a clear distinction between neoplastic cells (bottom) and benign mantle cuff cells (darker cells on top). Blocking peptide was added (A); same case showing strong staining for RARg that spares the benign mantle cell cuff (B).

A B

Figure 3. Two cases of T-cell lymphoma positive for RARa. The strong staining of neoplastic cells contrasts with the negative benign germinal center.

expression of RARg is particularly strong in both CD41 and assess the value of retinoid receptor expression as a prognostic CD81 mature cells (25,26). Based on studies in mice, retinoid factor. The importance of specific receptor subtype has been receptor activation is important during B- and T-cell activation, underscored by various studies in humans. where it is thought to modulate homing of cells to specific The expression, or sometimes loss of expression, of spe- lymphoid organs and to alter cytokine production (26–29). In cific retinoid receptor subtypes is associated with biologic children, retinoid receptor expression is highest between the behavior and overall prognosis in a variety of carcinomas and ages of 1 and 3 years, decreasing after that. Terminally differen- also in melanomas in humans (31–35) Retinoic acid recep- tiated lymphoid cells do not express or have low-expression of tor and RXR expression in human thyroid carcinomas can retinoid receptors (30). Despite the fact that retinoid receptor predict their response to retinoids and related drugs (35–37). expression was evaluated in a small number of cases of non- Also in humans, the expression of RARb correlates with less neoplastic lymph nodes in this study, this lack of expression aggressive behavior in a variety of malignancies (31,35). In seems to be similar to that in lymph nodes of older children, contrast, loss of RARb has been associated with more aggres- when the immune system is fully developed. An alternative sive behavior and this receptor is now considered to serve a possibility to this negative finding is that retinoid receptor tumor suppressive function, although precise mechanisms expression was present but at levels too low for detection. In for this effect have yet to be elucidated (38). Loss of RARa, contrast, the common expression of some subtypes (RARg and RARg, and RXRb expression also occurs in lung and prostatic RXRg) in LSA cases suggests that retinoid receptor expression cancer in humans (38,39). In addition, recent studies in breast plays a role in this disease, which merits further investigation. cancer cells showed that natural and synthetic retinoids can Due to unavailability of information regarding any treatments, induce expression of RARb and down-regulate levels of Bcl-2 response rates, or survival times of the cases from which lymph and survivin, which in turn leads to an increase in cellular node material was gathered for the study, we were not able to apoptosis (40).

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The pattern of retinoid receptors in adult humans with 12. Wang ZY, Chen Z. Acute promyelocytic leukemia: From highly fatal lymphoma and leukemias, other than promyelocytic leuke- to highly curable. Blood 2009;11:2505–2515. 13. Schmutzler C, Kohrle J. Retinoic acid redifferentiation therapy for mia, is unknown. Only 2 studies correlated the presence of thyroid cancer. Thyroid 2000;10:393–406. retinoid receptors with response to retinoid/rexinoid therapy 14. Coelho SM, Vaisman M, Carvalho DP. Tumor re-differentiation effect in lymphomas and leukemia. In 1 of these studies, response of retinoic acid: A novel therapeutic approach for advanced thyroid cancer. Curr Pharm Des 2005;11:2525–2531. to the RXR selective agent, bexarotene, was associated with 15. White SD, Rosychuck RA, Scott KV, Hargis AM, Jonas L, Trettien A. clinical remission. When relapse occurred despite treatment, Sebaceous adenitis in dogs and results of treatment with isotretinoin ARTICLE evaluation of the resistant cells revealed the RXR-a had been and etretinate: 30 cases (1990–1994). J Am Vet Med Assoc 1995;207: 197–200. down-regulated. As in any immunohistochemistry study, ours 16. Toma S, Noli C. Isotretinoin in the treatment of multiple benign has limitations such as the inability to detect functionality of pilomatrixomas in a mixed-breed dog. Vet Dermatol 2005;16:346–350. the detected proteins. Despite that and a small number of cases, 17. White SD, Rosychuck RAW, Scott KV, et al. Use of isotretinoin and etretinate for the treatment of benign cutaneous neoplasia and cutaneous our findings demonstrate that retinoid receptor expression varies lymphoma in dogs. J Am Vet Med Assoc 1993;202:387–391. markedly between non-neoplastic and neoplastic lymphoid tis- 18. Ohashi M, Miyajima N, Nakagawa T, et al. Retinoids induce growth sue. In addition, the high amino acid homology shared by dogs inhibition and apoptosis in mast cell tumor cell lines. J Vet Med Sci 2006;68:797–802. and humans increases the strength of our results. Correlation of 19. Miyajima N, Watanabe M, Ohashi E, et al. Relationship between reti- retinoid receptor and tumor grade, to extend our findings into noic acid receptor a gene expression and growth-inhibitory effect of the realm of low-grade tumors, might be useful in determining all-trans retinoic acid on canine tumor cells. J Vet Intern Med 2006;20: 348–354. the impact of IHC as a diagnostic modality to differentiate 20. Pinello KC, Nagamine M, Silva TC, et al. In vitro chemosensitivity reactive from neoplastic lymphocyte proliferation. Since the of canine mast cell tumors grades II and III to all-trans-retinoic acid presence or absence of specific retinoid receptors has been asso- (ATRA). Vet Res Comm 2009;33:581–588. 21. Mori M, Ghyselinck NB, Chambon P, Mark M. Systematic immuno- ciated with response to treatment, a study correlating specific localization of retinoid receptors in developing and adult mouse eyes. retinoid receptor isotype to response to treatment, remission Invest Ophthalmol Vis Sci 2001;42:1312–1318. time, and survival is warranted. Furthermore, our results suggest 22. de Mello Souza CH, Valli VEO, Selting KA, Kiupel M, Kitchell BE. that retinoids such as isotretinoin and etretinate (RAR binding Immunohistochemical detection of retinoid receptors in tumors from 30 dogs diagnosed with cutaneous lymphoma. J Vet Intern Med drugs) and bexarotene (RXR binding drug), may prove to be 2010;24:1112–1117. of therapeutic benefit in the treatment of nodal LSA in dogs. 23. Zhelyaznik N, Mey J. Regulation of retinoic acid receptors a, b and retinoid X receptor a after sciatic nerve injury. Neuroscience 2006; Acknowledgments 141:1761–1744. 24. Dzhagalov I, Chambon P, He You-Wen. Regulation of CD81 T lym- We thank Dr. David M. Vail for providing the slides of cases of phocyte effector function and macrophage inflammatory cytokine normal lymph nodes. The authors also thank Mrs. Jane Chladny production by retinoic acid receptor gamma. J Immunol 2007;178: 2113–2121. for preparing the slides for the IHC procedures. CVJ 25. Santhakumar M, Pulendran B. Retinoic acid-dependent regulation of immune responses by dendritic cells and macrophages. Semin Immunol References 2009;21:22–27. 1. Dorn CR, Taylor DON, Schneider R, Hibbard HH, Klauber MR. 26. Dawson HD, Collins G, Pyle R, Key M, Taub DD. The retinoic acid a Survey of animal neoplasms in Alameda and Contra Costa Counties, receptor- mediates human T-cell activation and Th2 cytokine and California. II. Cancer morbidity in dogs and cats from Alameda County. chemokine production. BMC Immunol 2008;9:16. J Natl Cancer Inst 1968;40:307–318. 27. Gordy C, Dzhagalov I, He Y-W. Regulation of CD8 1 T cell functions 2. Fan TM. Lymphoma updates. Vet Clin of North Am Small Animal by RARg. Semin Immunol 2009;21:2–7. Pract 2003;33:455–471. 28. Chen X, Esplin BL, Garrett KP, Welner RS, Webb CF, Kincade PW. 3. Vail DM, Young KM. In: Withrow and MacEwen’s Small Animal Retinoids accelerate B lineage lymphoid differentiation. J Immunol Clinical Oncology. 4th ed., St. Louis, Missouri: Saunders Elsevier, 2007: 2008;180:138–145. 699–733. 29. Hwang SS, Kim YU, Lee W, Lee GR. Differential expression of nuclear 4. Rebhun RB, Lana SE, Ehrhart EJ, Charles JB, Thamm DH. Compara receptors in T helper cells. J Microbiol Biotechnol 2009;19:208–214. tive analysis of survivin expression in untreated and relapsed canine 30. Wei D, Yang Y, Wang W. The expression of retinoic acid receptors in lymphoma. J Vet Intern Med 2008;22:989–995. lymph nodes of young children and the effect of all-trans-retinoic acid 5. Hosoya K, Kisseberth WC, Lord LK, Alvarez FJ, et al. Comparison of on the B cells from lymph nodes. J Clin Immunol 2007;27:88–94. COAP and UW-19 protocols for dogs with multicentric lymphoma. 31. Khuri FR, Latan R, Kemp BL, et al. Retinoic acid receptor-beta as a J Vet Intern Med 2007;21:1355–1363. prognostic indicator in stage I non-small-cell lung cancer. J Clin Oncol 6. Rassnick KM, McEntee WC, Erb HN, et al. Comparison of 3 protocols 2000;18:2798–2804. for treatment after induction of remission in dogs with lymphoma. J Vet 32. Hatoum A, El-Sabban ME, Khoury J, Yuspa SH, Darwiche N. Intern Med 2007;21:1364–1373. Overexpression of retinoic acid receptors alpha and gamma into neo- 7. Simon D, Nolte I, Eberle N, Abbrederis N, Killich M, Hirchberger J. plastic epidermal cells causes retinoic acid-induced growth arrest and Treatment of dogs with lymphoma using a 12-week, maintenance- apoptosis. Carcinogenesis 2001;22:1955–1963. free combination chemotherapy protocol. J Vet Intern Med 2006;20: 33. Gorgun G, Foss F. Immunomodulatory effects of RXR retinoids: 948–954. Modulation of high-affinity IL-2R expression enhances susceptibility 8. Altucci L, Leibowitz MD, Ogilvie KM, de Lera AR, Gronmeyer H. to denileukin diftox. Blood 2002;100:1399–1403. RAR and RXR modulation in cancer and metabolic disease. Nat Rev 34. Chakravarti N, Mathur M, Bahadur S, Shukla NK, Ralhan R. Retinoic Drug Discov 2007;6:793–810. acid receptor-alpha as a prognostic indicator in oral squamous cell 9. Fields AL, Soprano DR, Soprano KJ. Retinoids in biological control carcinoma. Intl J Can 2003;103:544–549. and cancer. J Cell Biochem 2007;102:886–898. 35. Cheung B, Hocker JE, Smith SA, Norris MD, Haber M, Marshall GM. 10. Fontana JA, Rishi AK. Classic and novel retinoids: Their targets in Favorable prognostic significance of high-level retinoic acid receptor b cancer therapy. Leukemia 2002;16:463–472. expression in neuroblastoma mediated by effects on cell cycle regulation. 11. Sun SY, Yue P, Mao L, et al. Identification of receptor-selective retinoids Oncogene 1998;17:751–759. that are potent inhibitors of the growth of human head and neck squa- 36. Haugen BR, Larson LL, Pugazenthi U, et al. Retinoic acid and mous cell carcinoma cells. Clin Can Res 2000;6:1563–1573. retinoid-X receptors are differentially expressed in thyroid cancer cells

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and predict response to treatment with retinoids. J Clin Endocrinol cell lung cancer: Implications for tumor development and prognosis. Metabol 2004;89:272–280. Carcinogenesis 2005;26:525–530. 37. Klopper JP, Hays WR, Sharma V, Baumbusch MA, Hershman JM, 40. Pratt MAC, Niu M, White D. Differential regulation of protein expres- Haugen BR. Retinoid X receptor-g and peroxisome proliferators- sion, growth, and apoptosis by natural and synthetic retinoids. J Cell activated receptor-g expression predicts thyroid carcinoma cell Biochem 2003;90:692–708. response to retinoid and thiazolinedione treatment. Mol Cancer Ther 41. Cheng AL, Chuang SE, Su IJ. Factors associated with the therapeutic 2004;3:1011–1020. efficacy of retinoic acids on malignant lymphoma. Formos Med Assoc 38. Xu XC. Tumor suppressive activity of retinoic acid receptor-b in cancer. 1997;96:525–534. Can Lett 2007;253:14–24. 42. Lin JH, Kim EJ, Bansal A, et al. Clinical and in vitro resistance to 39. Brabender J, Metzger R, Salonga D, et al. Comprehensive expression bexarotene in adult T-cell leukemia: Loss of RXR-a receptor. Blood analysis of retinoic acid receptors and retinoid X receptors in non-small 2008;112:2484–2488. ARTICLE

Answers to Quiz Corner Les réponses du test éclair

1. d) Greyhounds have prolonged and stormy recoveries from 3. a) Pituitary tumor is the most common cause of hyperadre- thiobarbiturate anesthesia. This is a result of altered nocorticism, with resultant hyperplastic adrenal cortices hepatic metabolism, rather than a result of their lean and excessive production of cortisol. body mass and lack of fat for redistribution. Recovery from a) La tumeur de l’hypophyse est la cause la plus commune propofol is smooth, but it takes longer in greyhounds than d’hyperadrénocorticisme et elle provoque des cortex in other dogs. surrénaliens hyperplasiques et une production excessive d) Chez les lévriers, la récupération suite à une anesthésie de cortisol. au thiobarbiturique est prolongée et laborieuse en raison 4. a) Hyperglobulinemia frequently occurs secondary to FIP and d’une altération de leur métabolisme hépatique, plutôt is usually classified as a polyclonal gammopathy. qu’à cause de la forme effilée de leur corps et du manque a) Une hyperglobulinémie se produit fréquemment à la suite de redistribution du gras corporel. La récupération suite de la péritonite infectieuse féline et elle est habituellement à l’anesthésie au propofol est facile, mais prend plus de classée comme une gammapathie polyclonale. temps chez les lévriers que chez les autres races de chien. 5. d) This is the definition of anisognathism. 2. c) The high triglyceride and low cholesterol levels are diag- d) C’est la définition de l’anisognathisme. nostic of a chylous effusion. c) Un taux élevé de triglycéride et un taux faible de cholestérol sont caractéristiques d’un diagnostic d’épanchement de chyle.

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1224 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Article

Prevalence of feline blood groups in the Montreal area of Quebec, Canada

Fabrice T.J. Fosset, Marie-Claude Blais

Abstract — The feline AB blood group system has clinical significance because type B cats have natural alloimmune anti-A antibodies which can cause isoerythrolysis of the newborn and life-threatening transfusion reactions. In the United States, the prevalence of type B blood is estimated to be 1% to 2%. This study determined the prevalence of feline AB blood groups among 207 potential blood donor cats that included 178 domestic cats, in the Montreal area of Quebec, Canada. Blood typing was performed using a standardized tube technique. Blood types AB and B were confirmed using a backtyping technique. The frequency of blood types among the studied population was as follows: 95.2% type A, 4.4% type B, and 0.48% type AB. Among domestic cats, the frequency was 94.4% for type A, 5% for type B, and 0.6% for type AB. The frequency of type B was higher than expected, which reinforces the recommendation to ensure blood compatibility of the recipient and donor before transfusion through typing and possibly cross-matching as well.

Résumé — Prévalence des groupes sanguins félins dans la région de Montréal au Québec, Canada. Le système de groupe sanguin félin AB possède une signification clinique parce que les chats de type B ont des anticorps anti-A allo-immuns qui peuvent causer l’isoérythrolyse du nouveau-né et des réactions potentiellement mortelles lors de transfusions. Aux États-Unis, la prévalence de sang de type B est estimée à 1 % ou 2 %. Cette étude a déterminé la prévalence des groupes sanguins AB félins parmi 207 chats donneurs de sang qui comprenaient 178 chats domestiques, dans la région de Montréal au Québec, Canada. La détermination des groupes sanguins a été réalisée à l’aide d’une technique en tube normalisée. Les types sanguins AB et B ont été confirmés en utilisant une technique de détermination croisée. La fréquence des types sanguins parmi la population étudiée était la suivante : 95,2 % type A, 4,4 % type B et 0,48 % type AB. Parmi les chats domestiques, la fréquence était de 94,4 % pour le type A, de 5 % pour le type B et de 0,6 % pour le type AB. La fréquence du type B était supérieure aux prévisions, ce qui renforce la recommandation afin d’assurer la compatibilité du sang du récipiendaire et du donneur avant la transfusion par la détermination du groupe sanguin et aussi la possibilité d’une épreuve de compatibilité croisée. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1225–1228

Introduction between 85% and 100% in non-pedigree cats. However, some countries, such as Greece and England, have a higher prevalence he AB blood group system includes 3 types: A, B, and of type B among domestic cats (20% and 30%, respectively) AB (1). These blood types are particularly important T (21,22). In any country, the prevalence may also vary by region. because, in contrast to most other species, most cats have natural In Australia, where the prevalence of type B cats is generally alloimmune antibodies against other blood types (2). higher in domestic cats than in other countries, a 10% difference Blood type A has the highest prevalence in the cat population in the distribution of type B was observed between Brisbane worldwide (3–24). In most countries, the prevalence of type A is (26.3%) (1) and the Sydney area (36%) (23) (Table 1). The prevalence of type AB cats is generally very low or even zero; however, some countries have an exceptionally high preva- Médecine interne des animaux de compagnie, Faculté de méde- lence of type AB in non-pedigree cats. For example, in domestic cine vétérinaire, Université de Montréal, 3200, rue Sicotte, cats prevalences of up to 4.1% and 6.3% were found in Grand Saint-Hyacinthe, Québec J2S 2M2. Canary Island (14) and Portugal (17), respectively (Table 1). Address all correspondence to Dr. Fabrice Fosset; e-mail: The prevalence of feline blood types varies depending on [email protected] the breed. Some breeds, such as the Siamese, Tonkinese, and Use of this article is limited to a single copy for personal study. Oriental short hairs, are almost uniformly type A regardless Anyone interested in obtaining reprints should contact the of the country (11,17,19,22,25). Other breeds have a high CVMA office ([email protected]) for additional prevalence of type B, such as the Turkish van in Turkey (57.7% copies or permission to use this material elsewhere. to 60%), Persian (24%), Devon rex (43%), and the British

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Table 1. Blood type frequencies in cats in various countries United States (6,7). The aim of this study, therefore, was to Blood type (%) determine the prevalence of feline blood types in a population of potential blood donor cats in Quebec. Country (reference) N A B AB Blood type frequencies in catsa Materials and methods Canadab 207 95.2 4.4 0.5 USA (7) 3785 98.1 1.7 0.1 This study was approved by the Ethical Committee of the Australia (1) 1895 73.3 26.3 0.4 Faculté de médecine vétérinaire of the Université de Montréal. Australia (23) 187 62.0 36.0 1.6 The sample size was estimated assuming a prevalence of 2% Hungary (15) 73 100.0 0.0 0.0 Scotland (8) 70 97.1 2.9 0.0 of type B cats in the feline population based on results obtained

ARTICLE Scotland (19) 137 87.6 8.0 4.4 in previous North American prevalence studies (6,7). Therefore, UK (22) 105 67.0 31.0 2.0 we aimed to enroll 200 cats [95% confidence interval (CI); 1% Blood type frequencies in domestic cats Canadab 178 94.4 5.0 0.6 margin of error]. The screening process was also conducted to USA (6) 1072 99.7 0.3 0.0 recruit potential feline blood donors. Therefore, only healthy Brazil (9) 172 94.8 2.9 2.3 cats # 8 years old were enrolled from the university com- China (10) 262 88.2 11.4 0.4 Grand Canary Island (14) 97 88.7 7.2 4.1 munity, regional shelters, and a British Shorthair and Scottish Greece (21) 207 78.3 20.3 1.4 Fold breeder. Portugal (17) 147 89.3 4.4 6.3 Ethylenediamine tetra-acetic acid (EDTA) blood samples Portugal (18) 515 97.5 2.1 0.4 Spain (20) 100 94.0 5.0 1.0 (1 to 2 mL) were obtained for blood typing. The blood was Turkey (36) 301 73.1 24.6 2.3 stored at 4°C and typed within 7 days of collection. A red cell UK (22) 105 67.0 31.0 2.0 preservative solution [Teruflex blood bag system CPD/Optisol® N — total number. Red cell Preservative Solution (each 56 mL contains 491 mg a All breeds included, i.e., pedigree and non-pedigree cats. b Data from the current study. NaCl, 504 mg dextrose monohydrate, 294 mg mannitol, and 16.8 mg adenine; Terumo Corporation, Tokyo, Japan)] was added to the sample (1:1 ratio) when blood typing could not be performed within 48 h of collection. shorthair (58.9%) in the United States (6,24–26). Ragdolls The typing was carried out using a standardized tube tech- are known to have a higher prevalence (94%) of type AB, as nique (3,32). Polyclonal antibodies contained in type B cat confirmed in a recent study in Italy (27). The DNA test for serum (diluted 1:3 with 0.9% saline, stored at 224°C) were feline blood typing has not been fully validated in the breed, used as primary reagents for the detection of type A red cell as approximately 3.2% of Ragdoll cats are discordant for blood antigens. Tricitum vulgaris lectin (8 mg/mL, stored at 224°C) group when genotyping is compared to the serological results, was used for the detection of type B red cell antigens (32,33). A necessitating further investigation in this breed (28). 0.9% saline solution was used as a negative control and to test Type B cats, older than 3 mo, all have powerful anti-A anti- for autoagglutination. Blood samples were centrifuged for 5 min bodies mostly of the IgM class. These antibodies are responsible at 1000 3 g to separate red blood cells (RBC) from plasma. for type II hypersensitivity reactions leading to potentially fatal The plasma was stored in a dry tube for possible backtyping. agglutination and intense intravascular hemolysis transfusion Packed RBCs were washed by adding 4 to 5 mL of 0.9% saline. reactions and isoerythrolysis of the newborn. An estimated Following centrifugation (1 min at 1000 3 g), the supernatant 35% to 44% of type A cats have detectable anti-B antibodies was removed and the pellet was suspended in 1.5 to 2 mL of (1,5,7,29,30). These anti-B antibodies (IgM and IgG) have 0.9% saline to obtain a 3% to 5% RBC suspension. much lower agglutinating and hemolytic activity than do anti-A Three tubes were prepared for typing: the anti-A tube con- antibodies. They are responsible for moderate transfusion reac- tained 50 mL of diluted type B serum (0.9% saline 1:3), the tions and early destruction of type B red blood cells adminis- anti-B tube contained 50 mL of the lectin solution (8 mg/mL), tered to a type A cat, thereby reducing the benefit of such a and the control tube contained 50 mL of 0.9% saline. A 25-mL transfusion (31). Type AB cats do not have naturally occurring volume of 3% to 5% RBC solution was added to each tube. The antibodies, as they express both red cell antigens (30,31). tubes were agitated gently and incubated for 15 min at room Transfusion reactions observed during the administration of temperature and then centrifuged for 15 to 20 s at 1000 3 g. type A blood to a type B cat comprise clinical signs such as fever, The results were read while gently shaking the tubes and vomiting, vocalization, lethargy, jaundice, hypotension, and observing for the presence of agglutination. An agglutination- death. Only a few milliliters of type A blood may be sufficient grading chart was used (a large clot without any free cells = to cause the death of a type B recipient (25). 41, a large clot associated with small clots = 31, several In feline transfusion medicine, it is essential to know the medium-sized clots = 21, a few small clots = 11, no clot = 0, blood types of the donor and the recipient. In a specific area, it hemolysis = H). Any agglutination was considered a positive is helpful to know the prevalence of type B cats and to under- result. Agglutination observed in blood typing usually ranges stand the need for a type B cat in a blood bank. from 21 to 41. Since no data have been published on the frequency of feline In addition, backtyping was performed to confirm type AB blood types in Canada, the frequencies are usually extrapolated and B cats (32,33). Type B plasma does not react with type B from studies conducted in North America, especially in the RBCs, but agglutinates very strongly (41) with type A RBCs

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because of the presence of strong anti-A antibodies. The plasma There was no statistical association between the frequency of of type AB cats, which lacks alloantibodies, does not react with blood group and gender (P = 0.16), origin (P = 0.72), and breed type A or type B RBCs. (P = 0.37). However, type A cats were significantly older than Only EDTA-whole blood of less than 24 h was used for type B cats (P = 0.001). backtyping. A 50 mL volume of the plasma to be backtyped was added to each of 3 tubes containing 25 mL of 3% to 5% known Discussion

type A RBC suspension, 25 mL of 3% to 5% known type B Based on previously published North American studies, there ARTICLE RBC suspension, and 25 mL of the individual’s own 3% to 5% was a higher than expected percentage that were type B, notably RBC suspension (auto-control). The tubes were agitated gently, in domestic cats. Previous studies in North America reported incubated at room temperature for 15 min and then centrifuged 0.4% type B for a population of non-pedigree cats. For domestic for 15 to 20 s at 1000 3 g. The results were read according to cats only, there were 0% to 0.4% type B and no type AB (6,7). the same agglutination-grading chart. Our study found that 4.3% were type B (n = 9) cats, all breeds The AB type cat was also confirmed using the Diamed gel included. Among domestic cats only, the frequency of type B column agglutination system [ID Card Anti A 1 B (Cat), was 5% (n = 9), and type AB was 0.6% (n = 1) (Table 1). DiaMed, Bio-Rad Laboratories, Switzerland], which is based on As this is the first prevalence study of feline blood types in monoclonal antibodies; according to the manufacturer’s protocol Quebec, and to our knowledge in Canada, it is impossible to and as previously described (27,34). determine if this variation is geographic or time-related. In fact, the previous studies from the United States (6,7) are 15 years old Statistics and the prevalence may have changed. Factors such as impor- The Chi-squared test was used to evaluate the blood type tation, cross-breeding, and natural selection of type B kittens prevalence according to origin, breed, and gender. The t-test for by the type B female cats (neonatal isoerythrolysis) may have unequal variances was used to test for a link between blood type modified the prevalence of the blood types over time. and age. For both tests, P , 0.05 was considered significant. Although 7 of the 9 type B cats came from the same shelter, they appeared to be unrelated, as they were documented to have Results come from different litters and different geographical areas. Also, Healthy cats (n = 207) were enrolled in the study with an this shelter tends to host young cats, which may account for the average age of 3 y (ranged from 0.25 to 8 y). The popu- age difference between type A and type B cats. lation sample consisted of 76 sterilized females, 16 intact The agglutination reactions when blood typing type A cats females, 100 castrated males, and 15 intact males. Most cats (3 to 41 agglutination reactions in 77% of cats) and when (n = 146) came from the Centre Hospitalier Universitaire backtyping type B cats (41 agglutination reactions in all cats) Vétérinaire (CHUV) of the Université de Montréal, with illustrate the hemagglutination strength of anti-A antibodies 73 cats belonging to staff and students, 57 cats obtained from carried by type B cats. This strong hemagglutination is respon- the CHUV shelter, and 16 cats from the teaching colony. In sible for the life-threatening reaction seen in A-B mismatched addition, 48 cats were recruited from a shelter nearby. Finally, transfusions and for isoerythrolysis of the newborn. 13 cats came from a British shorthair and Scottish fold breeder, Only healthy cats under 8 years of age were recruited. This with the hope of recruiting possible type B cats as blood criterion of selection was dictated by the secondary goal of donors. our study, i.e., to recruit new feline blood donors, including The study group included 178 domestic cats (86%), 8 British type B cats, for the blood bank at the CHUV of the Université shorthair (3.9%), 8 Persian or Persian cross (3.9%), 7 Scottish de Montréal. In order to be able to properly respond to blood fold, Highland fold or Foldex (3.4%), 4 Siamese or Siamese demand, it is pertinent for a blood bank to know the prevalence cross (2%), and 2 Birmans (1%). of type B cats in its area, especially when considering the life- The prevalence rates of feline blood types in the overall threatening consequences of A-B incompatibilities. Therefore, studied population were: 95.2% type A cats (n = 197), 4.3% in the hope of recruiting long-term type B blood donors, kittens type B (n = 9), and 0.5% type AB (n = 1). The prevalence rates were also included in the study. among domestic cats were 94.4% type A (n = 168), 5% type B In our study, no conclusions can be drawn about pedigree (n = 9), and 0.6% type AB (n = 1). All pedigree cats tested cats as the number recruited was too low (n = 29). In order to were type A. Among the type B cats identified, none were increase the chances of finding a type B donor for the blood related. Among type A cats, the blood typing resulted in 3 to bank, we included 13 cats from a British shorthair and Scottish 41 agglutination reactions in 77% of cats (n = 152 cats), and fold breeder and other cats from breeds known to have a higher 21 agglutination reactions in 23% of cats (n = 45 cats). All percentage of type B. However a significant number of breeders, type B cats had 31 agglutination reactions. Finally, the type AB aware of the risks of neonatal isoerythrolysis in specific breeds, cat had a 31 agglutination reaction in the anti-A tube and a tend to exclude all type B individuals from reproduction in order 11 reaction in the anti-B tube. In backtyping, type B cats were to avoid the reproduction of a type B female with a type A male. all 41 in the tube containing the type A RBC. The backtyping Recently, another clinically relevant red cell antigen called of the type AB did not show any hemagglutination. The type AB Mik was identified (35). This blood type was not investigated cat was confirmed with the Diamed gel column agglutination herein since blood typing is not readily available. The recent system (31 positive in A and B columns). discovery of this antigen and its consequences reminds us that

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transfusing blood requires caution. Typing is essential before any 18. Marques C, Ferreira M, Gomes JF. Frequency of blood type A, B and feline transfusion and a cross-match may be advisable (4). This AB in 515 domestic shorthair cats from the Lisbon area. Vet Clin Pathol 2011;40:185–187. study identified a higher than expected prevalence of type B 19. Knottenbelt CM, Addie DD, Day MJ, et al. Determination of the cats, notably among domestic cats, within a sample of cats from prevalence of feline blood types in UK. J Small Anim Pract 1999; Quebec. This finding reinforces the recommendations to always 40:115–118. 20. Ruiz de Gopegui R, Velasquez M, Espada Y. Survey of feline blood types type a cat before giving a transfusion, and even to perform a in the Barcelona area of Spain. Vet Rec 2004;154:794–795. complete cross-match to prevent transfusion reactions. CVJ 21. Mylonakis ME, Koutinas AF, Saridomichelakis M, Leotidis L, Papadogiannakis M, Plevraki K. Determination of the prevalence of blood types in the non-pedigree feline population in Greece. Vet Rec References 2001;149:213–214.

ARTICLE . 1 Auer L, Bell K. The AB blood system of cats. Anim Blood Groups 22. Forcada Y, Guitian J, Gibson G. Frequencies of feline blood types at Biochem Genet 1981;12:287–297. a referral hospital in the south east of England. J Small Anim Pract 2. Holmes R. The occurrence of blood groups in cats. J Exp Biol 1953; 2007;48:570–573. 30:350–357. 23. Malik R, Griffin DL, White JD, et al. The prevalence of feline A/B 3. Griot-Wenk ME, Callan MB, Casal ML, et al. Blood type AB in the blood types in the Sydney region. Aust Vet J 2005;83:38–44. feline AB blood group system. Am J Vet Res 1996;57:1438–1442. 24. Weingart C, Arndt G, Kohn B. Prävalenz der blutgruppen A, B und 4. Knottenbelt CM. The feline AB blood group system and its importance AB bei Haus- und Rassekatzen im Raum Berlin and Brandenburg. in transfusion medicine. J Feline Med Surg 2002;4:69–76. Kleintierpraxis 2006;51:189–197. 5. Giger U, Kilrain CG, Filippich LJ, Bell K. Frequencies of feline blood 25. Giger U, Bücheler J. Transfusion of type-A and type-B blood to cats. groups in the United States. J Am Vet Med Assoc 1989;195:1230–1232. J Am Vet Med Assoc 1991;3:411–418. 6. Giger U, Bucheler J, Patterson DF. Frequency and inheritance of 26. Arikan S, Duru SY, Gurkan M, Agaoglu ZT, Giger U. Blood Type A A and B blood types in feline breeds of the United States. J Hered and B frequencies in Turkish van and angora cats in Turkey. J Vet Med 1991;82:15–20. 2003;50:303–305. 7. Giger U, Griot-Wenk M, Bücheler J. Geographical variation on 27. Proverbio D, Spada E, Baggiani L, Perego R, Milici A, Ferro E. the feline blood type frequencies in the United States. Feline Pract Comparison of gel column agglutination with monoclonal antibodies 1991;19:21–27. and card agglutination methods for assessing the feline AB group system 8. Giger U, Gorman NT, Hubler M, et al. Frequencies of feline A and B and a frequency study of feline bloodtypes in northern Italy. Vet Clin blood types in Europe. Anim Genet 1992;23:17–18. Pathol 2011;40:32–39. 9. Medeiros MA, Soares AM, Alviano R, Ejzemberg R, daSilva MH, 28. Bighignoli B, Owen SD, Froenicke L, Lyons LA. In: August J, ed. Almosny NR. Frequencies of feline blood types in the Rio de Janeiro Consultations in Feline Internal Medicine Vol 6. St. Louis, Missouri; area. Vet Clin Pathol 2008;37:272–276. Saunders Elsevier, 2010:628–638. 10. Zheng L, Zhong Y, Shi Z, Giger U. Frequencies of blood types A,B, 29. Bücheler J, Giger U. Alloantibodies against A and B blood types in cats. and AB in non-pedigree domestic cats in Beijing. Vet Clin Pathol Vet Immunol Immunopathol 1993;38:283–295. 2011;40:513–517. 30. Knottenbelt CM, Day MJ, Cripps PJ, Mackin AJ. Measurement of titres 11. Jensen AL, Olesen AB, Arnbjerg J. Distribution of feline blood of naturally occurring alloantibodies against feline blood group antigens types detected in the Copenhagen area of Denmark. Acta Vet Scand in the UK. J Small Anim Pract 1999;40:365–370. 1994;35:121–124. 31. Wilkersom M, Meyers K, Giger U. Two cat colonies with A and B blood 12. Holmes R. Blood groups in cats. J Physiol 1950;111:61. types and a clinical transfusion reaction. Feline Pract 1991;19:22–26. 13. Eyquem A, Podliachouk, Milot P. Blood groups in chimpanzees, horses, 32. Stieger K, Palos H, Giger U. Comparison of various blood typing meth- sheep, pigs, and other mammals. Ann N Y Acad Sci 1962;97:320–328. ods for the feline AB blood system. Am J Vet Res 2005;66:1393–1399. 14. Silvestre-Ferreira AC, Pastor J, Sousa AP, et al. Blood types in the non- 33. Butler M, Andrews GA, Smith JE. Reactivity of lectins with feline pedigree cat population of Gran Canaria. Vet Rec 2004;155:778–779. erythrocytes. Comp Hematol Int 1991;1:217–219. 15. Bagdi N, Magdus M, Leidinger E, Leidinger J, Vörös K. Frequencies of 34. Seth M, Jackson S, Giger U. Comparison of five blood-typing methods feline blood types in Hungary. Acta Vet Hung 2001;49:369–375. for the feline AB blood group system. Am J Vet Res 2011;72:203–209. 16. Ejima H, Kurokawa K, Ikemoto S. Feline red blood cell groups 35. Weinsten NM, Blais M-C, Harris K, Oakley DA, Aronson LR, Giger detected by naturally occurring isoantibody. Nihon Juigaku Zasshi 1986; U. A newly recognized blood group in domestic shorthair cats: The Mik 48:971–976. red cell antigen. J Vet Intern Med 2007;21:287–292. 17. Silvestre-Ferreira AC, Pastor J, Almeida O, Montoya A. Frequencies 36. Arikan S, Gurkan M, Ozaytekin E, Dodurka T, Giger U. Frequencies of feline blood types in northern Portugal. Vet Clin Pathol 2004;33: of blood type A, B and AB in non-pedigree domestic cats in Turkey. 240–243. J Small Anim Pract 2006;74:10–13.

1228 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Article

Scrotal tumors in dogs: A retrospective study of 676 cases (1986–2010)

Michelle C. Trappler, Cathy A. Popovitch, Michael H. Goldschmidt, Kyle H. Goldschmidt, Rebecca E. Risbon

Abstract — The objective of this study was to determine common tumor types that occur on the canine scrotum in relation to other cutaneous locations and to identify potential risk factors for specific scrotal tumor development. A retrospective study was conducted and the database of pathology reports from the Surgical Pathology Service of the Department of Pathology and Toxicology, School of Veterinary Medicine, University of Pennsylvania from 1986 to 2010 was searched for canine neoplastic scrotal and non-scrotal cutaneous lesions. Neoplastic lesions were evaluated based on diagnosis, breed, age, and number and location of tumors (scrotal versus non-scrotal cutaneous). Mast cell tumor, melanocytoma, malignant melanoma, vascular hamartoma, hemangiosarcoma, hemangioma, and cutaneous histiocytoma were the most common tumor types identified on the canine scrotum. Breed predispositions and mean age at diagnosis were identified for each tumor type and should be considered when planning surgical excision of a canine scrotal tumor.

Résumé — Tumeurs scrotales chez les chiens : étude rétrospective de 676 cas (1986–2010). Cette étude avait pour objectif de déterminer les types communs de tumeurs qui se produisent sur le scrotum canin par rapport à d’autres endroits cutanés et d’identifier les facteurs de risque potentiels pour le développement de tumeurs scrotales spécifiques. Une étude rétrospective a été réalisée et une recherche a été effectuée dans la base de données des rapports de pathologie du Service de pathologie chirurgicale du Département de pathologie et de toxicologie de l’École de médecine vétérinaire de l’Université de la Pennsylvanie de 1986 à 2010 pour les lésions scrotales néoplasiques et les lésions cutanées non scrotales canines. Les lésions néoplasiques ont été évaluées en fonction du diagnostic, de la race, de l’âge ainsi que du nombre et de l’emplacement des tumeurs (scrotales par opposition à cutanées non scrotales). Les tumeurs à mastocytes, les mélanocytomes, les mélanomes malins, les hamartomes vasculaires, les hémangiosarcomes, les hémangiomes et les histiocytomes cutanés étaient les types les plus communs de tumeurs identifiées sur le scrotum canin. Les prédispositions des races et l’âge moyen lors du diagnostic ont été identifiés pour chaque type de tumeur et devraient être considérés lors de la planification de l’excision chirurgicale d’une tumeur scrotale canine. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1229–1233 Introduction The skin of the scrotum is thinner than other skin, is typically pigmented, and may contain fine hairs on the surface pecialized areas of skin can be found on the nose, digital (2). The scrotum is also unique in that it is glabrous skin. The pads, external auditory meatus, mucocutaneous junctions, S dermal layer contains well-developed sebaceous and apocrine and the scrotum (1). Regional variation of the skin with regards glands (1,2). The dartos muscle lies below the scrotal skin, and to type and amount of hair present, distribution and type of is composed of smooth muscle and a mixture of collagen and glands, and skin thickness allows the animal to develop func- elastic fibers (1,2). A well-developed counter-current vascular tional adaptations to its environment and may alter the pattern heat exchanger is present below the dartos and may influence of disease that arises in specialized skin areas. development of vascular hamartomas in the scrotal region. These progressive vascular malformations have been reported, and are Veterinary Specialty and Emergency Center (VSEC) — typically seen in older dogs with pigmented scrotal skin (3–5). Surgery (Trappler, Popovitch), Oncology (Risbon), Levittown, Arterial supply to the scrotum is directly from the scrotal arter- Pennsylvania, USA; University of Pennsylvania — Pathology and ies and indirectly from the perineal arteries, both of which are Toxicology, Philadelphia, Pennsylvania, USA (M. Goldschmidt); branches of the external pudenal. Hemorrhage from a vascular Pennsylvania State University, State College, Pennsylvania, USA lesion in the scrotum can be significant, and there are reports (K. Goldschmidt). of exsanguination (5,6). Venous drainage is accomplished by Address all correspondence to Dr. Michelle Trappler; e-mail: satellite branches of the arterial supply (2). Lymphatics drain [email protected] to the superficial inguinal lymph nodes (2). Use of this article is limited to a single copy for personal study. There have been many studies of canine skin tumors, but Anyone interested in obtaining reprints should contact the no studies have specifically evaluated tumors that arise in the CVMA office ([email protected]) for additional scrotum (3,7–15). A review of cutaneous scrotal lesions in copies or permission to use this material elsewhere. dogs briefly described scrotal neoplasms and their histologic

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Table 1. Scrotal tumors (n = 676) from 655 dogs Table 2. Percent of specific cutaneous tumors located on the scrotum Diagnosis Total % Diagnosis % on scrotum Round cell neoplasms 396 58.6 Mesenchymal neoplasms 92 13.6 Vascular hamartoma 36.2 Melanocytic 80 11.8 Melanocytoma 1.0 Hamartomas 52 7.7 Malignant melanoma 2.9 Epithelial 29 4.3 Histiocytoma 0.1 Cysts and tumor-like lesions 27 4.0 Hemangioma 0.7 Hemangiosarcoma 1.9 Mast cell tumor, low-grade 1.6 Mast cell tumor, high-grade 3.6 ARTICLE appearance, but did not elaborate on prevalence and potential risk factors in these patients (4). Mast cell tumors have been documented as the most common scrotal neoplasm in the dog; however, there is a paucity of information on other tumor scrotal tumors, so that scrotal neoplastic lesions represented types (2,14,16,17). The aim of this study was to identify those 0.4% of all neoplasms. Twenty-one dogs had a second scrotal tumors that arise most commonly on the canine scrotum and tumor in the sample submitted. Thus, a total of 676 scrotal their prevalence compared with other cutaneous locations, and masses met the inclusion criteria. Castration status prior to to determine if any predisposing factors exist in dogs. surgical biopsy could not be definitively determined from the records examined. Materials and methods Round cell neoplasms were the most prevalent, representing Study design 396/676 tumors (58.6%). Mesenchymal neoplasms were diag- Histopathology reports from cases submitted to the Surgical nosed in 92 cases (13.6%), melanocytic neoplasms in 80 cases Pathology Service of the Department of Pathology and (11.8%), hamartomas in 52 cases (7.7%), epithelial neoplasms Toxicology, School of Veterinary Medicine, University of in 29 cases (4.3%), and cysts and tumor-like lesions in 27 cases Pennsylvania from 1986 to 2010 were searched for canine (4.0%) (Table 1). Percentages of the specific tumors on the scrotal and cutaneous non-scrotal lesions. Information obtained scrotum are presented in Table 2. Odds ratios (OR), 95% CI, from the database included age, breed, diagnosis, number and and P-values for all identified tumors are reported in Table 3. location (scrotal versus non-scrotal) of all cutaneous tumors diagnosed over the same period, and presence of additional Mast cell tumor scrotal tumors. Any sample that was diagnosed solely with a Mast cell tumors comprised 54.6% (369/676) of scrotal tumors non-neoplastic lesion was excluded. Data on tumor type were diagnosed during the study period. Low-grade tumors were reported as absolute number and as a percentage of the total 44.2% (299/676) of tumors, and high-grade tumors were 10.4% number of masses included in data analysis. Age at diagnosis (70/676). The mean age at diagnosis was 9.3 y (1/2 2.9 y) and was reported as a mean. 10.1 y (1/2 2.7 years) for low- and high-grade scrotal mast cell Mast cell tumors were re-classified as low grade and high tumors, respectively. Boxers, Boston terriers, and American grade in an attempt to correlate with the recently published pit bull terriers were predisposed to scrotal and non-scrotal mast cell tumor grading scheme (18). For the purposes of this cutaneous low-grade and high-grade mast cell tumors. Vizslas study, previously reported grade 1 and 2 mast cell tumors were were predisposed to development of scrotal low-grade mast cell reclassified as low-grade and previously reported grade 3 were tumors and beagles were predisposed to development of scrotal reclassified as high-grade mast cell tumors (19). high-grade mast cell tumors.

Statistical analysis Melanocytoma The SAS/STAT (R) 9.2 program was used to run statistical Melanocytomas comprised 7.1% (48/676) of scrotal tumors and analysis. Cochran-Mantel-Haenszel statistics were used to cal- scrotal melanocytomas were 0.9% (48/5090) of all cutaneous culate the logit common odds ratio. Confidence intervals (95% melanocytomas diagnosed during the study period. The mean CI) were determined using Greenland and Robins variance age at diagnosis of scrotal melanocytoma was 9.4 y (1/2 2.3 y). estimate. P-values were calculated using the Breslow-Day test for Golden retrievers were predisposed to development of scrotal homogeneity of the odds ratio, which can be approximated by and non-scrotal melanocytomas compared with other breeds. a Pearson chi-squared distribution with q-1 degrees of freedom. Malignant melanoma Case selection Malignant melanomas comprised 4.7% (32/676) of scrotal There were 676 scrotal tumors among the 337 762 cases in the tumors and scrotal malignant melanomas were 3.1% of all cuta- database submitted between January 1, 1986 and December 31, neous malignant melanomas diagnosed during the study period. 2010. All inflammatory lesions of the scrotum were excluded. The mean age at diagnosis of scrotal malignant melanoma was 9.7 y (1/2 2.9 y). Standard schnauzers and miniature schnauzers Results were predisposed to development of scrotal and non-scrotal A total of 165 054 cutaneous neoplasms were submitted during malignant melanoma. Giant schnauzers were predisposed to the study period. Of these, 655 patients were diagnosed with development of non-scrotal cutaneous malignant melanomas.

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Table 3. Breed predispositions for scrotal and non-scrotal cutaneous tumors Breed Tumor type OR 95% CI P-value American pit bull terrier Low-grade mast cell tumor-scrotal 7.50 4.53–12.43 P , 0.005 Low-grade mast cell tumor-non-scrotal 2.80 2.51–5.16 P , 0.005 High-grade mast cell tumor-scrotal 15.00 6.90–32.80 P , 0.005 High-grade mast cell tumor- non-scrotal 2.50 1.80–3.50 P , 0.005 Vascular hamartoma-scrotal 3.20 1.00–10.1 P = 0.035 ARTICLE Vascular hamartoma-non-scrotal 6.16 1.49–25.40 P , 0.005 Bassett hound Vascular hamartoma-scrotal 4.70 1.10–19.40 P = 0.018 Beagle High-grade mast cell tumor-non-scrotal 2.80 1.00–7.70 P = 0.036 Histiocytoma-scrotal 4.35 1.01–18.55 P = 0.030 Histiocytoma-non-scrotal 1.20 1.10–1.30 P , 0.005 Boston terrier Low-grade mast cell tumor-scrotal 7.78 4.54–13.23 P , 0.005 Low-grade mast cell tumor- non-scrotal 4.37 3.92–4.86 P , 0.005 High-grade mast cell tumor-scrotal 4.70 1.20–19.30 P , 0.005 High-grade mast cell tumor-non-scrotal 3.40 2.50–4.70 P , 0.005 Boxer Low-grade mast cell tumor-scrotal 7.60 5.74–10.05 P , 0.005 Low-grade mast cell tumor-non-scrotal 5.13 4.88–5.38 P = 0 High-grade mast cell tumor-scrotal 3.80 1.80–8.00 P , 0.005 High-grade mast cell tumor-non-scrotal 2.20 1.80–2.60 P , 0.005 Vascular hamartoma-scrotal 4.80 2.90–7.90 P , 0.005 Vascular hamartoma-non-scrotal 3.60 1.40–9.20 P , 0.005 Hemangioma-scrotal 5.81 2.22–15.18 P , 0.005 Hemangioma-non-scrotal 3.20 2.80–3.50 P , 0.005 Histiocytoma-scrotal 4.36 1.29–14.66 P = 0.009 Histiocytoma-non-scrotal 4.60 4.40–4.90 P = 0.005 Golden retriever Melanocytoma-scrotal 2.57 1.20–5.50 P = 0.011 Melanocytoma-non-scrotal 2.10 1.90–2.20 P , 0.005 Hemangiosarcoma-scrotal 6.15 2.99–12.61 P , 0.005 Hemangiosarcoma-non-scrotal 2.20 1.90–2.50 P , 0.005 Schnauzer-giant Malignant melanoma-non-scrotal 4.60 2.10–10.40 P , 0.005 Schnauzer-miniature Malignant melanoma-scrotal 17.30 7.11–42.30 P , 0.005 Malignant melanoma-non-scrotal 5.00 3.90–6.40 P , 0.005 Schnauzer-standard Malignant melanoma-scrotal 23.30 8.15–66.70 P , 0.005 Malignant melanoma-non-scrotal 6.40 4.60–8.70 P , 0.005 Viszla Low-grade mast cell tumor-scrotal 3.51 1.12–10.95 P = 0.02

OR — odds ration; CI — confidence interval.

Vascular hamartoma ous hemangiomas diagnosed during the study period. The mean Vascular hamartomas comprised 6.8% (46/676) of scrotal age at diagnosis of scrotal hemangioma was 8.3 y (1/2 2.9 y). tumors, but the scrotum accounted for 36.2% (46/127) of all Boxers were predisposed to development of cutaneous scrotal cutaneous vascular hamartomas diagnosed during the study and non-scrotal hemangiomas compared with other breeds. period. The mean age at diagnosis of scrotal vascular hamartomas was 5.9 y (1/2 2.7 y). Boxers and American pit bull terriers Histiocytoma were predisposed to developing scrotal vascular hamartomas; Histiocytomas comprised 3.4% (23/676) of scrotal tumors. these 2 breeds and the basset hound also had a predilection for Histiocytomas of the scrotum comprised less than 0.1% non-scrotal cutaneous hamartomas. (23/16,744) of all cutaneous histiocytomas diagnosed during the study period. The mean age at diagnosis of scrotal histiocy- Hemangiosarcoma toma was 2.8 y (1/2 2.6 y). Boxers and beagles were predisposed Hemangiosarcoma comprised 5.0% (34/676) of scrotal tumors for development of scrotal histiocytomas. Both breeds were and scrotal hemangiosarcoma comprised 1.9% (34/1802) also predisposed to development of cutaneous histiocytomas of cutaneous hemangiosarcomas diagnosed during the study on non-scrotal skin. Four additional round cell tumors were period. The mean age at diagnosis of scrotal hemangiosarcoma reported on the scrotum: 1 each of a histiocytic sarcoma, a was 8.2 y (1/2 3.0 y). Golden retrievers were predisposed to lymphohistiocytic sarcoma, and 2 round cell tumors that were development of scrotal hemangiosarcoma and cutaneous non- not further classified. scrotal hemangiosarcoma. Discussion Hemangioma Mast cell tumors account for 16% to 21% of cutaneous tumors Hemangiomas comprised 4.6% (31/676) of scrotal tumors. in the dog (7,8,15,20,21). They seem to have a predilection for Scrotal hemangiomas comprised 0.7% (31/4313) of all cutane- the caudal half of dogs and occur more commonly on the rear

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limbs, abdomen, perineum, and scrotum (7,14). It has been study, we reported 0.7% of all cutaneous hemangiosarcoma in reported that mast cell tumors of the preputial, inguinal, and a scrotal location. The lower percentage of lesions on the scro- subungual regions and other mucocutaneous sites tend toward tum may reflect an increased prevalence of neutered male dogs more aggressive behavior (22,23). More recent reports indicate at the current time compared to when the study was published. that tumors in scrotal and inguinal areas behave similarly to However, since castration status could not be determined, we tumors in other cutaneous locations, although, when the data were unable to test this theory. The previous report also identi- are critically evaluated, there is a trend towards more aggressive fied an increased odds of cutaneous hemangiosarcoma in several behavior (23–26). The reported median disease-free interval for breeds, with the highest odds in Italian greyhounds (OR = 23.6), dogs with mast cell tumors in the inguinal or perineal region whippets (OR = 13.7), and Irish wolfhounds (OR = 13.1) (7).

ARTICLE was 9.6 mo, compared with 33.9 mo for dogs with these tumors In that report, golden retrievers had an odds ratio of 1.7 (95% in other cutaneous sites. When dogs with preputial and scrotal CI: 1.1 to 2.5, P = 0.01) for development of cutaneous heman- mast cell tumors were specifically separated out, there was a giosarcoma. Our data support the notion that golden retrievers significant difference in disease-free interval (median of 4.2 mo are at a higher risk of developing scrotal hemangiosarcoma compared with 33.9 mo, respectively) when dogs with preputial compared with other cutaneous locations. mast cell tumors were compared with dogs with scrotal mast cell Hemangiosarcomas were more prevalent than hemangio- tumors (24). However, with aggressive treatment (clean surgical mas in the scrotum, whereas hemangiomas were much more excision with or without definitive radiation therapy), perianal common than hemangiosarcoma in non-scrotal skin. Boxers and preputial mast cell tumors have a similar biological behavior appeared to be predisposed to the development of scrotal to mast cell tumors at other sites (23–26). Additional studies and non-scrotal cutaneous hemangiomas, whereas golden on biologic behavior and prognosis of mast cell tumors in the retrievers appeared to be predisposed to the development of inguinal and preputial areas are warranted. scrotal and non-scrotal cutaneous hemangiosarcomas. It is If a diagnosis of suspected mast cell tumor is made based on unknown whether any of the vascular neoplasms are associ- fine-needle aspiration, a scrotal ablation should be performed at ated with excessive ultraviolet light exposure or whether there the time of surgery (14). The increased proportion of high-grade is malignant transformation of vascular endothelium; how- tumors in the scrotum and improved prognosis with aggressive ever, future biopsy samples should be evaluated for evidence local control warrants scrotal ablation. Furthermore, evaluation of solar elastosis, which is a hallmark of UV-light induced of the inguinal lymph nodes should be undertaken at the time hemangiosarcoma (33). of surgery to exclude metastatic disease and better determine Scrotal hemangiomas comprise 1.1% of all cutaneous hem- prognosis (21). angiomas (7). In this study, scrotal hemangiomas accounted for Melanocytomas and malignant melanomas comprised 4.59% of scrotal tumors and 0.7% of cutaneous hemangiomas. approximately 12% of the scrotal tumors and only 1.3% of There is an increased probability of development of cutaneous all cutaneous tumors in this study, which is lower than previ- hemangiomas in several breeds, with Airedale terriers, Gordon ously published data in which 3% to 7% of canine skin tumors setters, boxers, soft-coated Wheaton terriers, and wire-haired were melanocytic neoplasms (8,10,26–30). Although a previ- fox terriers having the highest odds ratios (7). The previously ous study on the biological behavior of melanomas reported reported odds ratio for boxers and development of cutaneous that greater than 75% of melanocytic tumors in doberman hemangioma was 3.1 (95% CI: 2.5 to 3.9, P , 0.005). Our pinschers and schnauzers were behaviorally benign (31), we results agree with these data. did not find an increased risk for these breeds to develop Histiocytomas are benign tumors of Langerhans cells that are scrotal melanocytomas. In the scrotum there was an increased typically found in dogs less than 3 to 4 years old and occur pre- incidence of melanocytomas (60%) compared with malignant dominantly on the head and neck (11,34). They comprise 5.5% melanoma (40%); however, the percentage of malignancy was to 7.5% of canine cutaneous tumors (12,13,30). Consistent still high. Therefore, any suspected melanocytic neoplasm of with previous reports, our mean age at diagnosis for scrotal the scrotum should be considered more likely to be malignant histiocytomas was 2.8 y (1/2 2.6 y). Scrotal histiocytomas than those arising from non-scrotal haired skin and a more accounted for only 3.4% of all scrotal tumors, but less than radical surgical approach may be appropriate. Mitotic index and 0.01% of all cutaneous histiocytomas arose on the scrotum. pleomorphism are prognostically significant (32). These data These tumors tend to regress spontaneously so it is likely that are not available for this study, but would be of value in future these numbers under-represent the true incidence, as the lesions studies. may regress preventing surgical removal and biopsy (11,34). Cutaneous vascular hamartomas were first described in 1954 Based on our data, boxers and beagles appear to be at increased (5) and are relatively uncommon in dogs (0.4% of all hamarto- risk for developing cutaneous histiocytomas at both scrotal and mas); however, their predilection for the scrotum is noteworthy. non-scrotal sites. Because they are arteriovenous malformations there may be Only 4.2% of scrotal neoplasms were of epithelial origin. significant blood loss from these lesions (5,6). The increased The most common epithelial neoplasm was squamous cell incidence of these lesions on the scrotum is most likely associ- carcinoma. Low incidence of this neoplasm on skin that is ated with the unique vascular and thermoregulatory function exposed to ultraviolet light radiation may be due to the amount of the scrotum. A prior report identified 2.6% of all cutaneous of melanin pigment that is present within the epidermis of the hemangiosarcomas in a scrotal location (7). In the current scrotum. However, the geographic location from which the

1232 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY biopsy samples were obtained may also have influenced the low 8. Bostock DE. Neoplasms of the skin and subcutaneous tissues in dogs incidence of this neoplasm. and cats. Br Vet J 1986;142:1–19. 9. MacNeill AL. Cytology of canine and feline cutaneous and subcutaneous As we have demonstrated, certain dog breeds are predisposed lesions and lymph nodes. Top Companion Anim Med 2011;26:62–76. to development of specific tumor types on the scrotal skin. This 10. Brodey RS. Canine and feline neoplasia. Adv Vet Sci Comp Med may be due to the unique anatomy of the canine scrotum and 1970;14:309–354. 11. Nimwegen S, Kirpensteijn J. Specific disorders. In: Tobias K, Johnston specialized adaptations in this region. Knowledge of the most S, ed. Veterinary Surgery Small Animal. 1st ed. Canada: Elsevier, 2012. common tumors types on the canine scrotum will aid the sur- 1303–1339. ARTICLE geon in decision-making and surgical planning. The ability to 12. Pakhrin B, Kang MS, Bae IH, et al. Retrospective study of canine cutaneous tumors in Korea. J Vet Sci 2007;8:229–236. perform a scrotal ablation may aid in obtaining clean margins 13. Rostami M, Tateyama S, Uchida K, et al. Tumors in domestic ani- at the time of surgery. Conversely, the anatomic location of the mals examined during a ten-year period (1980 to 1989) at Miyazaki scrotum in the inguinal area, where skin is otherwise limited University. J Vet Med Sci 1994;56:403–405. 14. Clinkenbeard KD. Diagnostic cytology: Mast cell tumors. Comp Cont and motion is a significant factor, may deter the surgeon from Ed Pract Vet 1991;13:1697–1704. being aggressive on a first attempt at excision in this region. 15. Carpenter JL, Andrews LK, Holzworth J. Tumors and tumor-like lesions. In: Holzworth J, editor: Diseases of the cat: medicine and Identification of the common tumor types in this area should surgery. Philadelphia, Pennsylvania: WB Saunders, 1987:569–579. guide the surgeon when deciding between an incisional biopsy 16. McEntee K. Scrotum, spermatic cord, and testis: Proliferative lesions. In: or a wide excision. This may be especially important in valuable Reproductive Pathology of Domestic Mammals. San Diego, California: Academic Press, 1990:279–306. breeding dogs and for owners who prefer to leave their dogs 17. Bastianello SS. A survey on neoplasia in domestic species over a 40-year sexually intact. period from 1935 to 1974 in the Republic of South Africa. VI. Tumours Because of the retrospective nature of this study, we were occurring in dogs. Onderstepoort J Vet Res 1983;50:199–220. 18. Kiupel M, Webster JD, Bailey KL, et al. Proposal of a 2-tier histologic unable to determine prognostic data for scrotal tumors. Another grading system for canine cutaneous mast cell tumors to more accurately limitation of this study is that castration status prior to surgical predict biological behavior. Vet Pathol 2011;48:147–155. biopsy could not be definitively determined from the records 19. Patnaik AK, Ehler WJ, MacEwen EG. Canine cutaneous mast cell tumor: Morphologic grading and survival time in 83 dogs, Vet Pathol examined. Further studies are warranted to determine if repro- 1984;21:469–474. ductive status influences scrotal tumor development and biologi- 20. Finnie JW, Bostock DE. Skin neoplasia in dogs. Aust Vet J 1979;55: cal behavior. Cases were evaluated by several pathologists and 602–604. 21. Tams TR, Macy DW. Canine mast cell tumors. Comp Cont Ed Pract were classified based on their diagnosis, with the exception of Vet 1981;27:259–263. mast cell tumors as previously stated. Classification and diagnos- 22. Thamm DH, Vail DM. Mast cell tumors. In: Withrow SJ, Vail DM, tic criteria may have changed over the study period, and these ed. Withrow & MacEwen’s Small Animal Clinical Oncology. 4th ed. St. Louis, Missouri: Saunders, 2007. changes were not accounted for in our data analysis. Also, this 23. Sfiligoi G, Rassnick KM, Scarlett JM, et al. Outcome of dogs with mast study did not evaluate change of tumor prevalence over time. It cell tumors in the inguinal or perineal region versus other cutaneous may be of value to determine if changes in prevalence occurred locations: 124 cases (1990–2001). J Am Vet Med Assoc 2005;226: 1368–1374. with changes in environment, husbandry, and other external 24. Bulakowski EJ, Philibert JC, Siegel S, et al. Evaluation of outcome asso- factors in the life of domestic dogs. ciated with subcutaneous and intramuscular hemangiosarcoma treated Despite study limitations, our data found that mast cell with adjuvant doxorubicin in dogs: 21 cases (2001–2006). J Am Vet Med Assoc 2008;233:122–128. tumors accounted for more than 50% of the cases and that 25. Cahalane AK, Payne S, Barber LG, et al. Prognostic factors for survival certain breeds are predisposed to development of specific of dogs with inguinal and perineal mast cell tumors treated surgically tumor types in a scrotal location. These predispositions should with or without adjunctive treatment: 68 cases (1994–2002). J Am Vet Med Assoc 2004;225:401–408. be considered prior to surgical removal of a scrotal mass. Pre- 26. Rothwell TLW, Howlett CR, Middleton DJ, et al. Skin neoplasms of operative staging, local tumor control, and the need for adjuvant dogs in Sydney. Aust Vet J 1987;64:161–164. chemotherapy following surgical excision may all be influenced 27. Smith SH, Goldschmidt MH, McManus PM. A comparative review of melanocytic neoplasms. Vet Pathol 2002;39:651–678. by the knowledge of common tumor types and breed predisposi- 28. Finnie JW, Bostock DE. Skin neoplasia in dogs. Aust Vet J 1979;55: tions for scrotal masses. Further investigation into the biological 602–604. behavior and prognosis of scrotal tumors is warranted. CVJ 29. Vail DM, Withrow SJ. Tumors of the skin and subcutaneous tissues. In: Withrow SJ, Vail DM, eds. Withrow & MacEwen’s Small Animal Clinical Oncology. 4th ed. St. Louis, Missouri: Saunders, 2007. References 30. Gross TL, Ihrke PJ, Walder EJ, et al. Skin diseases of the dog and cat: 1. Banks WJ. Applied Veterinary Histology. 3rd ed. Baltimore, Maryland: Clinical and histopathologic diagnosis. 2nd ed. Oxford, England: Williams & Wilkins, 1993. Blackwell Science, 2005. 2. Yager JA,Wilcock BP. Color Atlas and Text of Surgical Pathology of 31. Bolon B, Calderwood Mays MB, Hall BJ. Characteristics of canine the Dog and Cat. Dermatopathology and Skin Tumours. London, melanomas and comparison of histology and DNA ploidy to their England: Wolfe, 1994. biologic effect. Vet Pathol 1990;27:96–102. 3. Goldschmidt MH, Hendrick MJ. Tumors of the skin and soft tissues. 32. Laprie C, Abadie J, Amardeilh MF, et al. MIB-1 immunoreactivity In: Meuten DJ, ed. Tumors in Domestic Animals. 4th ed. Ames, Iowa: correlates with biologic behaviour in canine cutaneous melanoma. Vet Blackwell 2002:45–118. Dermatol 2001;12:139–147. 4. Cerundolo R, Maiolino P. Review: Cutaneous lesions of the canine 33. Schultheiss PC. A retrospective study of visceral and nonvisceral scrotum. Vet Dermatol 2002;13:63–76. hemangiosarcoma and hemangiomas in domestic animals. J Vet Diagn 5. Weipers WL, Jarret WFH. Haemangioma of the scrotum of dogs. Invest 2004;16:522–526. Veterinary Record 1954;66:106–108. 34. Moore PF, Affolter VK. Canine and feline histiocytic diseases. In: 6. Thornburg LP, Breitchwerdt EB. Canine hemangioma of the scrotum Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. with fatal bleeding: A case report. JAAHA 1976;12:797–799. St. Louis, Missouri: Elsevier Saunders, 2005. 7. Goldschmidt MH, Shofer FS. Skin tumors of the dog & cat. Oxford, England: Pergamon Press, 1992.

CVJ / VOL 55 / JANUARY 2014 1233 FOR PERSONAL USE ONLY Commentary Commentaire

The “unwanted horse” — A modest proposal

Bernard Rollin

he power of words to mislead is well known to philoso- In particular, being unwanted grows out of blatant abrogation T phers, but perhaps not as well known to others. An extreme of a human being’s responsibility voluntarily assumed. In my philosophical example comes from the work of the 19th cen- view, when one acquires an animal, be it a dog or cat or horse, tury philosopher Alexius Von Meinong. Meinong argued that one implicitly makes a lifelong commitment to that animal to proper nouns named real entities, and he asked what proper care for and be responsible for its life and well-being. This is true nouns like Superman or Thor or Mickey Mouse named. In his whether the animal is a companion or a working animal. (This view, such fictitious names did not refer to nothing. After all, is why the racing industry has been forced to develop retirement while Superman refers to a baby from Krypton who grew up farms for racehorses which can no longer run and were callously in Smallville and hid his true identity as “mild-mannered Clark auctioned for slaughter, even though owned by millionaires.) Kent,” Thor denotes the Thunder God who resides in Valhalla Whenever I hear people defending horse slaughter as a way among the Norse pantheon. Clearly, those names represent an owner can realize some monetary value from the horse, different individuals. Although those individuals do not exist which is now unwanted due to its owner irresponsibility, I grow in our world, they must have some existent status in order for extremely angry. Why do such people deserve to benefit from us to talk about them. Meinong concluded that anything we their blatant violation of trust presuppositional to adoption can talk about has some kind of existence, and not just as an and their dishonorable attempt to worm their way out of what idea, because Thor differs from “the idea of Thor.” As a result, should be a permanent contract? To be sure, there are cases, Meinong’s world was vastly overpopulated. very few, where the owner dies or becomes chronically ill or Just as Meinong was misled by language, so may the rest of incapacitated, and is no longer physically capable of caring for us be. Consider the concept of “the unwanted horse.” Talking the animal. In many such cases, the burden should fall upon about “unwanted horses” suggests that we are talking about a the owner’s estate, with owners making provision for care of the certain natural kind of horse, like a draft horse, Morgan horse, animal well in advance of a crisis. Thoroughbred horse, white horse. Yet, although grammatically In my view, the responsibility incumbent upon acquiring “unwanted horse” looks identical to “white horse,” conceptu- an animal should not be easily shrugged off. I have often been ally it is very different. Whiteness is an absolute property of accused of “elitism” or, were there such a word, “wealthism” the horse in question. “Unwantedness,” however, is a relational for daring to suggest that one demonstrate the possession of property of the horse relative to some human. In other words, resources sufficient to care for the animal, come what may. horses do not come naturally as unwanted — that property “You are saying,” whines the chorus, “that only the rich should arises in relation to human beings. have horses. That is not fa, a, a a, a,i r.” In fact, to quote Pres. That linguistic legerdemain is reminiscent of the same sort of Jack Kennedy, “life is unfair!” Wealthy people get to vacation linguistic obfuscation some confinement agriculturalists engage on the Riviera, own multiple homes, drive hundred thousand in when they refer to aberrant animal behavior under extreme, dollar cars. What I am saying is very simple — society should unnatural confinement conditions as “vices,” as when sows kept not allow people to take responsibility for an animal’s life if the in tiny cages where they cannot stand up or turn around — or person in question lacks the resources to fulfill that responsibil- even lie down fully extended — compulsively chew the bars. ity! And why should slaughter in Canada serve as an easy answer As if the animal is somehow bad or blameworthy for behaving to United States irresponsibility? that way! How might reliance on slaughter be fixed? Fairly easily. In order to be allowed to get a horse, one should be able to prove to an agency that one has sufficient disposable income to care for the animal under the normal vicissitudes of the economy, say Departments of Philosophy, Animal Science, and Biomedical by posting a bond when purchasing an animal. Is this a drastic Science, Colorado State University. Fort Collins, Colorado, USA. and draconian policy? For sure! But the current situation of Address all correspondence to Prof. Bernard Rollin; e-mail: acquiring the horse as an impulse item has led to a very sorry [email protected] and morally unacceptable state of affairs. The same logic should Use of this article is limited to a single copy for personal study. be applied to other animals, such as dogs and cats, which are vic- Anyone interested in obtaining reprints should contact the tims of human irresponsibility; society destroys millions of these CVMA office ([email protected]) for additional animals each year. Perhaps because we have become accustomed copies or permission to use this material elsewhere. to pet euthanasia and wrongly see “spay neuter” as the solution,

1234 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY it shocks us less than the fate of the horses. (Though spay and in the future can be irresponsible without suffering negative neuter is part of the solution, it does not touch the part of the consequences. If people in fact lack the money to care for the problem growing out of callous human irresponsibility.) In any animal, it would be possible to allow them to do public work case, just because animals are legally property, does not mean to pay the state for assuming the care burden. we can use or dispose of them as we see fit — think of medical For many years, some of my work focused on the fact that waste, batteries, or other property that can harm others. shelters and humane societies were not sheltering, but instead COMMENTARY The market for such animals is already supersaturated. My doing society’s dirty work and killing animals because of human friends who rodeo have told me of driving their own horses to irresponsibility in breeding, or because animal owners felt no a rodeo or fair and leaving their horse trailer in the parking lot. compunctions about surrendering animals for the most trivial Upon returning to the trailer, they found two horses within, and and frivolous reasons — “the dog no longer matches my color a note reading “please give us a good home.” scheme since I redecorated,” “the dog is no longer a puppy,” Why, then, do we fail to place responsibility for the lives and “it is cheaper to get a new dog than to board this one while I go well-being of the “unwanted horse” upon those who freely and on vacation.” As I discovered at the time, not only were innocent voluntarily undertook the acquisition of the animal? Why do we animals victims of this sort of unspeakable irresponsibility, so in the United States bemoan the closing of slaughter houses that too were innocent humans. Humane society workers, pound provided an easy, but immoral, way out for those who abrogate workers, animal control officers, and veterinarians all felt as if responsibility? I am deeply disappointed in those veterinarians they were complicit in an endless assembly-line of unnecessary who declare that the protein shortage across the world militates killing, generating in these people large amounts of “moral in favor of horse slaughter. As I once told a veterinarian making stress,” the stress growing out of their moral commitment to this case, why was he not arguing for the same disposition of the helping animals clashing horribly with what they were in fact estimated 4 million dogs and cats trashed by our irresponsibility doing — killing them. I became aware that as a result of this as a society. After all, there are places across the world where stress, countless numbers of dedicated people were becom- people eat dogs and cats! Also, in my experience, the vast major- ing alcohol and drug abusers, undergoing divorce, and living ity of veterinarians will affirm that their primary obligation is unhappy lives. to the animal, not to the owner, to relieve or prevent suffering. On one occasion, while I was lecturing at a large shelter, an Plato makes an oft-forgotten distinction that applies to our employee told me of a woman who had come in to surrender question. When one is a craftsman, be it a goldsmith, a carpen- a blind Labrador. The dog had lived with her since puppy- ter, a stonemason or any other artisan, one must conceptually hood, but now was “too much trouble to manage.” The owner distinguish between the artisan aspect of that work, and one’s instructed the shelter worker to “adopt the dog out to a home conceptually separable role as a wage-earner. Qua craftsman, with a lake.” I asked the employee how she responded: “As I one’s sole job is to improve, make better, or increase the value am ordered to by management — I said I would try my best.” of that upon which one exercises one’s craft. Thus, creating a Then she started to sob. “Why didn’t you tell her the truth, to necklace out of raw gold adds value to the gold, making it worth come back in a week and watch the dog being killed,” I said, more than the simple raw material. The same model applies “It is not your job to be a sin eater for the guilty and irrespon- to health professionals, be they physicians or veterinarians. sible.” Countless numbers of such employees carried the bur- Qua veterinarian, one’s role is to restore health to an animal, den of others’ irresponsibility, and labored in constant misery, thereby increasing its functional value. Whatever one earns further punished by the fact that the unwanted animals kept doing so, is conceptually separable from what Plato considers the coming. primary goal of restoring or improving an animal’s health and St. Thomas Aquinas argued that although in Catholic theol- well-being. Thus the primary moral obligation of a veterinarian is ogy animals enjoy no moral status, it was wrong to visit cruelty to the entity upon which he or she practices their art — the animal. upon them, because people who do so would “graduate” to the The entire project of realizing profit from irresponsibility, abuse of people. That has been empirically confirmed in the rather than punishment, bears a considerable resemblance past 50 years. I would argue analogously that those who are to Jonathan Swift’s infamous satirical pamphlet in which he irresponsible towards their animals are very likely to graduate suggests raising poor and unwanted children to a year of age, to mistreating people. After all, if we cavalierly kill old animal and then selling them as food to wealthy gourmets. The obvi- friends, because they are old and too much trouble to care for, ous reply, of course, is that horses are not children. I am well isn’t it possible that the same mindset can extend to family? aware of that. But the point is that the logic of the two cases is It is unquestionable that shipping horses for slaughter, one remarkably parallel. In both cases, horse or child, the creature commonly cited “solution” to unwanted horses, results in sig- is paradigmatically innocent. Parent and horse owner have both nificant stress, distress, fear, pain, and suffering for the animals, voluntarily decided to take responsibility for a life. If a parent ranging from improper transport to nightmarish methods of abrogates that responsibility, we punish them. And society slaughter in Mexico. If society insists on killing them, the pro- takes responsibility for the human life in question. Should we cess should be genuine euthanasia. Fortunately, a well-placed allow irresponsible animal owners to abrogate responsibility, bullet of the proper caliber is quick and painless and inexpen- and in essence punish the victim? Allowing people to discard sive. But this raises an ancillary question: — can an animal responsibility without sanction fails to discourage such behavior value life per se? To answer this question we must consider some in the future. On the contrary, it sends the message that others conceptual differences between animal and human cognition.

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Human cognition is such that we can value long-term future tent is pleasant or unpleasant in all of the modes it is capable goals and endure short-run negative experiences for the sake of of, for example whether they are bored or stimulated, fearful or achieving them. Examples are plentiful. Many of us undergo vol- not fearful, lonely or enjoying companionship, in pain or not, untary food restriction, and the unpleasant experience attendant hungry or not, or thirsty or not. We have no reason to believe in its wake, for the sake of lowering blood pressure or looking that, lacking linguistic tools, an animal can grasp the notion of good in a bathing suit as summer approaches. We memorize life itself, nor can we be said to abort its future plans if we kill it. volumes of boring material for the sake of gaining admission to The evil in euthanizing these animals is more a matter of veterinary or medical school. We endure the excruciating pain what has been called “virtue ethics” than anything else. Do of cosmetic surgery to look better. And we similarly endure we really aspire to be the kind of society that treats animals as chemotherapy, radiation, dialysis, physical therapy, and trans- disposable and that views our implicit commitments to them

COMMENTAIRE plant surgeries to achieve a longer, better quality of life than as revocable for convenience? Do we wish to teach our children we would have without it or, in some cases, merely to prolong that moral obligations last only as long as we feel compelled to life to see our children graduate, to complete an opus, or fulfill honor them, particularly in a society where half of all marriages some other goal. end in divorce? Furthermore, having them euthanized once In the case of animals, however, there is no evidence, either again resurrects the moral stress we recounted that affected empirical or conceptual, that they have the capability to weigh shelter workers. Now that we know these untoward effects, is it future benefits or possibilities against current misery. To enter- morally acceptable to impose this upon a new class of sin eaters? tain the belief that “my current pain and distress, resulting from I do not propose legislation lightly. I very strongly feel that, the nausea of chemotherapy or some highly invasive surgery, will as a society, we are significantly over-legislated, over-regulated, be offset by the possibility of an indefinite amount of future with the government far too intimately involved in our daily time,” is taken to be axiomatic of human thinking. But reflec- lives. Am I therefore contradicting myself? I don’t believe so. tion reveals that such thinking requires some complex cognitive While there may well be too much legislation and regulation machinery. For example, one needs temporal and abstract con- in many significant areas, it emphatically does not follow that cepts, such as possible future times and the ability to compare there is a sufficient amount in other areas. Over the last 50 or them; a concept of death, eloquently defined by Heidegger as so years, society has moved in the direction of strengthening “grasping the possibility of the impossibility of your being;” the and buttressing the moral status of animals. Animals are steadily ability to articulate possible suffering; and so on. This, in turn, being viewed less as objects or things, and more and more as requires the possibility to think in an if-then hypothetical and moral persons. And my argument against seeing horses and counterfactual mode; that is, if I do not do X, then Y will occur. dogs and cats as disposable things fits well with social distaste This mode of thinking, in turn, seems to necessitate or require at the extermination of what once were viewed as vermin, be the ability to process symbols and combine them according to they prairie dogs, starlings, wolves, gophers, crows or in general, rules of syntax in language. “trash” animals. I have argued vigorously elsewhere against the Cartesian idea In exactly the same way that we discussed the allegedly that animals lack thought and are simply robotic machines. It is “unwanted horse” at the beginning of this essay, society ever- also clear that animals have some concept of enduring objects, increasingly realizes that animals need to be defined not merely causality, and limited futural possibilities (probably learned by in relation to how they affect us, and our convenience, but association), or else the dog would not expect to get fed, the cat also — and even more so — in terms of having their own inter- would not await the mouse outside of its mouse hole, and the ests constitutive of what Aristotle and I have called their telos, lion could not intercept the gazelle. Animals also clearly display their biological and psychological natures. Acknowledging our a full range of emotions, as Darwin famously argued. responsibilities to the horse, a North American icon, rather than To treat animals morally and with respect, we need to con- shirking them or bellowing that “horses are livestock,” and try- sider their mentational limits. Paramount in importance is the ing to squeeze every dirty penny out of them, is a good place to extreme unlikelihood that they can understand the concepts of start. While I am not so naïve as to believe that what I propose life and death in themselves rather than the pains and pleasure will occur in the short run, I do believe that articulating it can associated with life or death. To the animal mind, in a real sense serve to get people thinking in a different way. there is only quality of life, that is whether its experiential con-

1236 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Case Report Rapport de cas

Extramedullary plasmacytoma in the lung of a Doberman pinscher dog

Lauren Adelman, Victoria Larson, Thomas Sissener, Tim Spotswood

Abstract — A 7-year-old Doberman pinscher dog was referred for evaluation of a radio-opaque thoracic mass. The left cranial lung lobe and associated mass were surgically resected and histopathology confirmed the presence of an extramedullary plasmacytoma (EMP). This is the first clinical description of an EMP in the lung of a veterinary patient.

Résumé — Plasmocytome extramédullaire dans le poumon d’un chien Doberman pinscher. Un chien Doberman pinscher âgé de 7 ans a été recommandé pour l’évaluation d’une masse thoracique radio-opaque. Le lobe pulmonaire cranial gauche et la masse associée ont été retirés par chirurgie et l’histopathologie a confirmé la présence d’un plasmocytome extramédullaire (PEM). Il s’agit de la première description clinique d’un PEM dans le poumon d’un patient vétérinaire. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1237–1240

7-year-old intact male Doberman pinscher dog was pre- A sented to the Calgary Animal Referral and Emergency (CARE) Centre oncology service in March, 2010 with a recent history of lethargy and exercise intolerance. A radio-opaque mass had been detected by the referring veterinarian in the left cranial lung field on plain radiographs (Figure 1). The patient had a past history of dilated cardiomyopathy and hypothyroid- ism and was being treated for these conditions with sotalol HCl and levothyroxine sodium. Case description On presentation, the patient was bright, alert, and responsive with a body condition score of 6/9. All physical examination parameters were within normal limits. An echocardiogram showed mild bradycardia (heart rate 80 beats/min), reduced fractional shortening (18% to 20%), mild left ventricular eccen- tric hypertrophy, and mild tricuspid and mitral insufficiency. These changes were similar to those seen in a previous echocardiogram in November 2007, and are consistent with mild non- Figure 1. Right lateral recumbent thoracic radiograph showing a well-defined craniodorsal lung mass (black arrowheads). progressive dilated cadiomyopathy. An abdominal ultrasound examination was also performed; this showed mild cystic prosta- tomegaly, consistent with benign prostatic hyperplasia, and mild hydrochloride (KETASET 100 mg/mL; Wyeth Animal Health, hepatomegaly with normal hepatic echotexture. Following the Guelph, Ontario), 5 mg/kg body weight (BW), IV, and valium ultrasound examination, the patient was induced with ketamine (Diazepam; Hospira Healthcare Corporation, Saint-Laurent, Quebec), 0.25 mg/kg BW, IV. Computed tomography (CT) of the thorax was performed (GE HiSpeed CTi, GE Healthcare, Calgary Animal Referral and Emergency Centre, 7140–12th Street Burnaby, British Columbia) under isofluorane anesthesia with SE, Calgary, Alberta T2H 2V4. the dog in dorsal recumbency using helical acquisition of 3-mm Address all correspondence to Dr. Lauren Adelman; e-mail: slice thickness and 2-mm slice intervals. Sagittal and dorsal [email protected] multiplanar reformatting was applied. The CT scan revealed a Use of this article is limited to a single copy for personal study. well-circumscribed, slightly irregularly marginated soft tissue Anyone interested in obtaining reprints should contact the mass of 3.5 cm 3 2 cm 3 2 cm located in the dorsomedial CVMA office ([email protected]) for additional aspect of the left cranial lobe, abutting the esophagus and aortic copies or permission to use this material elsewhere. arch (Figure 2). The rest of the pulmonary field and thorax was

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Figure 3. Left cranial lung lobe and associated mass resected at time of surgery. Pen in photo measures approximately 17 cm.

(Novo-fentanyl; Novopharm, Toronto, Ontario), 5 mg transder- Figure 2. Axial CT image through the cranial thorax mal patch for 5 d, meloxicam (Metacam; Boehringer Ingelheim (4th intercostal space) showing a well-circumscribed soft tissue Canada), 0.2 mg/kg BW, SQ, once, then 0.1 mg/kg BW, SQ, mass in the left cranial lung lobe (white arrows). “E” and “A“ q24h for 3 d], intravenous antibiotics (cefazolin sodium; Sandoz denote esophagus and aorta, respectively. Canada), 22 mg/kg BW, IV, q8h for 2 d, and thoracic drainage every 4 h. The thoracostomy tube was removed the day after unremarkable. Differential diagnoses included a primary pul- surgery and the dog was discharged from the hospital after 2 d. monary mass, a single metastatic mass, pulmonary granuloma, Two tissue samples from the resected lung lobe (Figure 3) and pulmonary cyst. measuring 3 cm 3 9 cm and 1 cm 3 9 cm, representative of Directly after the CT scan, the patient was clipped and asepti- the lung mass, were submitted for histopathology. Margins cally prepared for a left 5th intercostal lateral thoracotomy. A were not evaluated. Results showed polygonal cells arranged buccal mucosal bleeding test performed prior to surgery was in sheets and indistinct packets (Figure 4). Cells had distinct within normal limits. The mass was identified on the medial borders and contained moderate to abundant eosinophilic, aspect of the left cranial lung lobe. Gentle dissection at the finely granular cytoplasm and ovoid nuclei. Multiple nuclei hilus was performed to free up room for a thoracoabdominal were present in many cells. Nucleoli were prominent and (TA) stapler. A TA30 V3 stapler (Tyco Healthcare, Mansfield, contained coarse chromatin with 0-1 mitoses present per high Massachusetts, USA) was applied to the affected lung lobe power field (Figure 5). Marked anisokaryosis and karyomegaly hilus. A transfixing ligature of 2-0 Prolene (Ethicon, Somerville, were also present. Overall, these findings were consistent with a New Jersey, USA) was placed for added security. The lobe was round cell tumor and strongly favored an anaplastic plasma cell resected, removed, and observed for hemorrhage. The lymph tumor. It was determined to be an extramedullary plasmacytoma nodes were not biopsied. A 12-gauge silicone thoracostomy (EMP). The possibility that this tumor represented a part of a tube (Smiths Medical, Dublin, Ohio, USA) was placed through systemic neoplastic process such as multiple myeloma could the skin at the 10th rib and tunnelled subcutaneously to the not be ruled out. 7th rib space before insertion into the thorax. Simple inter- Immunostaining of block 3 for MUM-1 and kappa and rupted sutures of 0 Prolene (Ethicon) were placed around the lambda light chains was performed to aid in identification of ribs and then individually tied with tension on the sutures from the cell type of origin. Only the staining for lambda chains was above. The scalenus and latissimus dorsi muscles were closed positive, further supporting the diagnosis of a plasma cell tumor. with 3-0 PDS (Ethicon). The subcutaneous tissues were closed Further diagnostic tests included serum protein electro- in 2 layers with 3-0 Monocryl (Ethicon) and the skin was phoresis and examination of bone marrow aspirates; survey closed with 3-0 Monosof (Tyco Healthcare). The thoracostomy radiographs (spine and pelvis) were recommended to the owner tube was secured to the skin using a Chinese finger trap suture to rule out multiple myeloma. Serum protein electrophoresis with 3-0 Monosof (Tyco Healthcare). Gentle suction using a showed a mild polyclonal elevation in the beta fraction at large bore syringe was applied to the thoracostomy tube until 14 g/L which was not consistent with multiple myeloma. Urine negative pressure was obtained. After surgery the patient was protein electrophoresis was not performed as the urine protein supported with intravenous fluids, analgesia [fentanyl citrate concentration was too low. Serum and urine electrophoresis were injection (Sandoz Canada), 4 mg/kg BW, IV, fentanyl patch unremarkable. A bone marrow aspirate from the right proximal

1238 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 4. Histopathology section with polygonal cells arranged Figure 5. Histopathology section showing cells with indistinct in sheets and indistinct packets (203 magnification). borders, moderate to abundant eosinophilic, finely granular cytoplasm, and ovoid nuclei. Prominent nucleoli with coarse chromatin and evidence of mitoses as well as multiple nucleoli humerus was obtained under sedation. Hematopoietic precursors are present. There is marked anisokaryosis and karyomegaly were present in low numbers diffusely dispersed throughout the (403 magnification). slides and there was representation of all blood cell lines and stages of maturation. While proportions were difficult to deter- may be focal, spread to regional lymph nodes, or metastasize mine, occasional plasma cells were noted and did not appear in to distant areas (4). In a large veterinary case study (751 cases), significant numbers or of abnormal morphology. A complete the most common EMP location in the dog was cutaneous sites blood (cell) count (CBC) that was done in conjunction with (86%), followed by mucous membranes (9%), and the rectum the bone marrow aspirate revealed no abnormalities. Serum and colon (4%). Other sites, including the stomach, spleen, biochemistry was not done. genitalia, eyes, uterus, and liver made up the remaining 1% Repeat radiographs and blood work (for elevated globulins) of cases (2). Unlike solitary osseous plasmacytoma for which were recommended at 1 mo after surgery and every 3 mo there- most cases eventually progress to systemic multiple myeloma, after. These tests were performed at the referring veterinary EMP characteristically have a more benign course in dogs (1). clinic. In January 2011, the patient was presented to the CARE Cutaneous and oral EMP are typically easily curable with local Centre for acute non-painful nonsymmetrical hind limb paresis, excision and although visceral EMP (esophagus, stomach, intes- suspicious for a fibrocartilagenous embolism, although neoplasia tines, colorectal) may metastasize to associated lymph nodes, could not be ruled out. The dog fully recovered without any spe- bone marrow involvement and monoclonal gammopathies cific therapy. At the time of case report submission, the patient are uncommon (1,5,6). Extramedullary plasmacytomas in the was 8 ½-years-old and continued to do well. trachea, liver, and uterus are also believed to behave as benign tumors following local resection (7–9). To date, there have Discussion been no clinical case reports of EMP in the lung of a veterinary Plasma cell tumors originate from the proliferation of a single patient. cell of the B-lymphocyte plasma cell line that forms a malignant Diagnosis of EMPs usually requires fine-needle aspiration or population of like cells. This population of neoplastic cells is tissue biopsy. Several immunohistochemical studies may be used typically monoclonal in that all immunoglobulin produced on undifferentiated solitary plasmacytic tumors to help differen- is identical (1). However, there are reports of both biclonal tiate them from other round cell tumors (1). Diagnosis of EMP and polyclonal plasma cell tumors (1). Multiple myeloma is has historically been based upon demonstration of clonality for clinically the most important form of plasma cell tumor in the lambda or kappa immunoglobulin light chains (10,11). Mixed canine patient. cell populations would be expected to have both light chains Solitary plasmacytomas are collections of monoclonal plas- while a monoclonal population would have only one of the two. macytic tumors that can form in bone as solitary osseous plas- The immunohistochemical findings in this case are therefore macytomas, or in soft tissues as extramedullary plasmacytomas supportive of the diagnosis of a plasma cell tumor, which is a (1). They are uncommon in the dog and in 1 study made up tumor of monoclonal immunoglobulin-producing cells (12). only 2.4% of all canine tumor submissions (2). The median age Staining for Multiple Myeloma 1/Interferon Regulatory of afflicted dogs is 9 to 10 y (2,3). The English and American Factor 4 (MUM1/IRF-4) can also be useful in detection of cocker spaniel, West Highland white terrier, and possibly also plasmacytomas. MUM1/IRF4 is an interferon regulatory factor Yorkshire terriers, boxers, German shepherds, and Airedale ter- which is involved in lymphoid cell differentiation via its role riers, are at an increased risk (2,3). in light-chain rearrangement at the pre-B stage of lymphocyte Extramedullary plasmacytoma (EMP) refers to tumors occur- maturation (13,14). In 1 study of 109 canine plasmacytomas, ring outside of the bone marrow, in soft tissues or organs that greater than 94% were positive for MUM1/IRF4, demonstrating

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that the antibody Mum-1p is very specific for this tumor (12). This case report suggests that long-term survival is pos- It was also shown to have a higher sensitivity and specificity sible with surgical excision alone for the treatment of EMP in for the detection of canine plasmacytomas when compared to veterinary patients. Further studies into the role of adjuvant CD79a and CD20 (12). In humans, expression of MUM1/ chemotherapy and radiation are necessary to determine optimal IRF4 is associated with decreased survival; however, additional treatment protocols for EMP in both human and veterinary studies are needed to determine its prognostic significance in medicine. CVJ veterinary medicine. References In this case, staining for MUM-1 was negative, which is not 1. Withrow SJ, Vail DM. Withrow & MacEwen’s Small Animal Clinical consistent with previously reported findings. This could be a Oncology. 4th ed. St. Louis, Missouri: Saunders Elsevier, 2001:779–782. spurious finding due to laboratory error in staining (false nega- 2. Kupanoff PA, Popovitch CA, Goldschmidt MH. Colorectal plasmacyto- tive), or it could be that this particular plasmacytoma does not mas: A retrospective study of nine dogs. J Am Anim Hosp Assoc 2006;

RAPPORTCAS DE 42:37–43. stain positive. Re-staining for MUM-1 as well as T- and B-cell 3. Platz SJ, Breuer W, Pfleghaar S, Minkus G, Hermanns W. Prognostic markers was requested, but the tissue block had been discarded value of histopathological grading in canine extramedullary plasmacy- by the laboratory. Therefore, a diagnoses of lymphoma could tomas. Vet Pathol 1999;36:23–27. 4. Montero C, Souto A, Vidal I, Fernandex M, Blanco M, Verea H. not be ruled out. However, based on the location of the tumor Three cases of primary pulmonary plasmacytoma. Arch Bronconeumol (solitary pulmonary mass), breed of the patient, presence of 2009;45:564–566. a monoclonal gammopathy, the remainder of the diagnostic 5. MacEwen EG, Patnaik AK, Hurvitz AI, et al. Nonsecretory multiple myeloma in two dogs. Am Vet Med Assoc 1984;184:1283–1286. findings and the overall clinical picture, the diagnosis of an 6. Meis JM, Butler JJ, Osborne BM, et al. Solitary plasmacytomas of extramedullary plasmacytoma is strongly favored. bone and extramedullary plasmacytomas. Cancer 1987;59:1475–1485. In human medicine, EMP is a rare plasma cell neoplasia 7. Chaffin K, Cross AR, Allen SW, et al. Extramedullary plasmacytoma in the trachea of a dog. J Am Vet Med Assoc 1998;212:1579–1581. and lesions involving the lung are even fewer (4,15,16). In the 8. Choi YK, Lee JY, Park JI, et al. Uterine extramedullary plasmacytoma lung, EMP can be the first indication of multiple myeloma or in a dog. Vet Rec 2004;154:699–700. it may be restricted to the lung with or without spread to local 9. Aoki M, Kim T, Shimada T, et al. A primary hepatic plasma cell tumor in a dog. J Vet Med Sci 2004;66:445–447. lymph nodes (4). The most common site in the respiratory 10. Gross TL, Ihrke PJ, Walder EJ, Affolter VK. Cutaneous plasmacytoma. tract of humans is the submucosa of the upper respiratory tract In: Skin Diseases of the Dog and Cat: Clinical and Histopathologic (15,16). Plasmacytomas occurring in the lower respiratory tract Diagnosis. 2nd ed. Oxford, UK: Blackwell Science, 2005:866–872. 11. Ramos-Vara JA, Miller MA, Pace LW, Linke RP, Common RS, Watson [primary pulmonary plasmacytoma (PPP)], are extremely rare GL. Intestinal multinodular Al-amyloid deposition associated with (14,15). The association between multiple myeloma, EMP, and extramedullary plasmacytoma in three dogs: Clinicopathological and solitary plasmacytomas of bone is not well understood in human immunohistochemica studies. J Comp Path 1998;119:239–249. 12. Ramos-Vara JA, Miller MA, Valli VEO. Immunohistochemical detec- medicine; some authors view these as separate disease entities tion of multiple myeloma 1/interferon regulatory factor 4 (MUM1/ while others interpret them as different manifestations of one IRF-4) in canine plasmacytoma: Comparison with CD79a and CD20. disease spectrum (4). Vet Path 2007;44:875–884. 13. Gaidano G, Carbone A. MUM1: A step ahead toward the understanding Due to the rarity of this disease, standard treatment protocols of lymphoma histogenesis. Leukemia 2000;14:563–566. in human and veterinary medicine have not been established; 14. Lu R, Medina KL, Lancki DW, Singh H. IRF-4,8 orchestrate the pre- however, if surgical resection is complete, it may be considered B-to-B transition in lymphocyte development. Genes Dev 2003;17: 1703–1708. curative (17,18). Surgery and radiation therapy appear to have 15. Wiltshaw E. The natural history of extramedullary plasmacytoma and equivalent efficacy (16) while combinations of surgery, chemo- its relation to solitary myeloma of bone and myelomatosis. Medicine therapy, and radiation have been tried with no difference in 1976;55:217–238. 16. Joseph G, Pandit M, Korfhage L. Primary pulmonary plasmacytoma. survival times noted (4). However, in these studies, follow-up Cancer 1993;71:721–724. was limited (4). The use of adjuvant chemotherapy in the treat- 17. Wang J, Pandha HS, Treleaven J, Powless R. Metastatic extramedullary ment of PPP is an area that requires further investigation. Since plasmacytoma of the lung. Leuk Lymphoma 1999;35:423–425. 18. Hayes-lattin B, Blanke CD, Deloughery T. Pulmonary and intracerebral so few cases have been reported, little information is known on plasmacytomas in a patient without multiple myeloma: A case report. prognosis. However, it is believed that PPP behaves differently Am J Hematology 2003;73:131–134. than multiple myeloma and increased survival rates have been reported (4).

1240 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Case Report Rapport de cas

Long-term outcome of conventional endotracheal tube balloon dilation of tracheal stenosis in a dog

Nili Kahane, Gilad Segev

Abstract — This report describes a successful dilation of tracheal stenosis in a 16-year-old dog using a conventional endotracheal tube balloon. This technique should be considered as palliative treatment when owners decline other therapeutic options.

Résumé — Résultat à long terme de la dilatation du ballonnet-tube trachéal d’une sténose trachéale chez un chien. Ce rapport décrit une dilatation réussie d’une sténose trachéale chez un chien âgé de 16 ans à l’aide d’un ballonnet-tube trachéal conventionnel. Cette technique devrait être considérée comme un traitement palliatif lorsque les propriétaires refusent les autres options thérapeutiques. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1241–1244

cquired tracheal stenosis may result from various disorders (Propofol-Lipuro 1%; B. Braun Melsungen AG, Melsungen, A including neoplasia, inflammation, infection, and trauma Germany) was given IV to effect. Resistance was noted during (1–4). Clinical signs vary from exercise intolerance and mild intubation; however, immediately after placing the endotracheal inspiratory effort to life-threatening respiratory distress and tube, the inspiratory effort dramatically improved. cyanosis (3,4). The 2 most common treatments for tracheal Complete blood cell count and serum creatinine concentra- stenosis are resection and anastomosis and stenting. The former tion were unremarkable. Due to financial reasons and lack of is technically difficult and might be associated with complication owner compliance serum biochemistry was not conducted. and the latter requires special equipment and training (2,5). Arterial blood gas analysis on room air after intubation, but with no oxygen supplementation, revealed a PaO of 83.8 mmHg, Case description 2 a PaCO2 of 42.7 mmHg, and a pH of 7.37 (at sea level). A 16-year-old, neutered female, mixed breed dog, weighing Before intubation, and during extubation, the larynx was 10 kg, was presented with the chief complaint of respiratory evaluated for arytenoid function and for gross lesions; findings distress. The clinical signs were first noted 4 mo prior to arrival were unremarkable. Cervical radiographs (after removal of the and included exercise intolerance and respiratory difficulties endotracheal tube) revealed a marked narrowing of the trachea during excitement. During these 4 mo the dog was treated by approximately 2 cm caudal to the hyoid apparatus (Figure 1). the referral veterinarian with antibiotics with no improvement. The diameter of the narrowing was estimated to be 5 mm, com- Upon arrival, the dog had severe inspiratory effort and pared with a diameter of 12 mm for the normal trachea. At the cyanosis; she was immediately hospitalized in an oxygen cage. end of the procedure the dog received 4 mg of Dexamethasone Due to progressive deterioration in respiratory effort the dog (Dexacort 4 mg/mL; Teva) IV. Following extubation there was underwent general anesthesia using butorphanol (Morphasol a marked improvement in respiratory effort, most likely due to 10 mg/mL; aniMedica GmbH, Baisensell, Germany), 0.2 mg/kg widening of the stenosis following intubation. Tracheoscopy, body weight (BW), SC, for premedication, ketamine (Clorketam which was performed the same day, revealed abnormal tissue at Veterinary 10%; Vétoqinol, Lure, France), 5.0 mg/kg BW, IV, the cranial trachea, 2 to 3 cm long, extending from the larynx and diazepam (Assival 10 mg/2 mL; Teva, Godollo, Hungary), distally and causing severe stenosis (3 to 4 mm in diameter). 0.5 mg/kg BW, IV, for induction. For maintenance, propofol Differential diagnosis included inflammatory process, neoplastic process, or fibrotic tissue. During tracheoscopy, samples were obtained using swabs and touch smears were performed, but Koret School of Veterinary Medicine, the Hebrew University of were non-diagnostic. Jerusalem, Rehovot, Israel. The dog was discharged but the owners were warned that the Address all correspondence to Dr. Nili Kahane; e-mail: relief was expected to be temporary and further diagnostics and [email protected] treatment such as surgery or stenting were recommended. The Use of this article is limited to a single copy for personal study. owners declined any other diagnostic or therapeutic procedure, Anyone interested in obtaining reprints should contact the however, due to financial constraints. CVMA office ([email protected]) for additional Six months later the dog was presented again for a surgical copies or permission to use this material elsewhere. and oncology consultation due to the recurrence of clinical

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Figure 2. Right lateral projection obtained 6 months after initial intubation which widened the stenosis, demonstrating recurrence Figure 1. Right lateral projection obtained at presentation, of the stenosis at the same previous location. demonstrating a severe narrowing of the tracheal lumen with soft tissue opacity approximately 2 cm caudal to the hyoid apparatus. rence. After extubation the dog was monitored for signs of respiratory distress and was discharged when completely recovered signs. During the last 2 mo there had been progressive dete- and breathing normally. Due to the diameter of the stenosis it is rioration in respiratory effort, which was most notable with likely that it was partly dilated by passing the larger endotracheal minimal activity and upon excitement. On presentation, the dog tube and was further dilated by inflation of the endotracheal was tachypneic (respiratory rate: 120 breaths/min), and had a tube balloon at the stenosis site. The assessment was that the marked inspiratory effort. On thoracic and cervical radiography, stenosis rather than the abnormal lung pattern played a larger a severe narrowing was noted approximately 2 cm caudal to the role in the respiratory difficulty, because after the dilation pro- hyoid apparatus, at the same previous location. The diameter of cedure, the dog was breathing normally without effort. Further the stenosis as revealed by radiographs was 5 mm, comparable diagnostics were not conducted at the owner’s request. Biopsies to the previous estimate (Figure 2). Additionally, an alveolar obtained via endoscopy from the abnormal tissue at the stenosis pattern was present at the right middle, left cranial, and caudal site were consistent with neutrophilic tracheitis and fibrosis with lung lobes. Main differential diagnoses for the alveolar pattern no evidence of a neoplastic process. included non-cardiogenic pulmonary edema secondary to the Eleven months later the dog was presented with a complaint upper airway obstruction, or pneumonia. of respiratory distress and hemoptysis. History revealed that the On repeated tracheoscopy, a 3 to 4 mm diameter stenosis dog had been free of clinical signs until 2 mo prior to presenta- was noted, approximately 2 to 3 cm caudal to the larynx. tion, during which the dog suffered from periods of increased The mucosa cranial to the stenosis was thick and edematous. respiratory effort, which had become worse during the last few Resection and anastomosis was considered as the treatment of days. At arrival, tracheoscopy was performed and revealed a choice despite the concern for dehiscence. Due to financial 2 to 3 mm diameter tracheal stenosis at the previous site. It was constraints, the owners declined any surgical option, including decided to balloon dilate the stenosis again using the same tech- stenting across the stenosis; therefore, palliative treatment with nique, as other options were declined by the owners. Following balloon dilation was performed. The balloon size was selected the procedure the diameter of the trachea was 7 to 9 mm and based on the degree of narrowing and the diameter of the nor- the dog was breathing with no respiratory effort. mal cervical trachea. To prevent bleeding into the lungs during A week later the dog was presented with a complaint of the procedure, a 3.5 mm internal diameter endotracheal tube decreased appetite, coughing, and 1 episode of syncope. Chest was initially inserted through the stenosis and the balloon was radiographs revealed a diffuse alveolar pattern, predominantly in fully inflated. A second, 5.5 mm internal diameter endotracheal the cranial lung lobes, likely due to pneumonia, non-cardiogenic tube was then inserted over the small endotracheal tube and its edema, or neoplasia. The diameter of the stenosis was about balloon was positioned at the level of the stenosis under endo- 8 mm, unchanged compared with its diameter following the scopic guidance (Figure 3). After placing both endotracheal last procedure, and the clinical signs were therefore assessed to tubes and before inflating the balloon, the stenosis was inspected be unrelated to the stenosis. On broncho-alveolar lavage, red and the balloon was inflated for 2-minute intervals under endo- blood cells, white blood cells, and a few epithelial cells were scopic guidance to ensure that there was not much damage to seen; however, a cell count was not performed. There was no the mucosa. The amount of bleeding was minimal to moderate evidence of a neoplastic process or pneumonia. Further diagnos- and when the bleeding ceased, the dog was extubated and the tics were declined for financial reasons. At the owners request stenosis site was evaluated. The stenosis was markedly dilated the dog was discharged with treatment which consisted of oral compared with the diameter prior to the procedure (Figure 4). antibiotics; Amoxicillin-clavulanate (Augmentin 250 mg; Smith Following the procedure, dexamethasone (Dexacort 4 mg/mL; Kline Beecham PLC, Brantford, UK), 1/2 a tablet twice a day, Teva), 0.2 mg/kg BW, IM, was administered to minimize recur- Ofloxacin (Oflodex 200; Dexcel, Or-Akiva, Israel), 1 tablet

1242 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 3. Demonstration of the 2 endotracheal tubes used in this procedure. A smaller tube of 3.5 mm internal diameter was inserted first through the stricture and was dilated (smaller/blue balloon) to secure the airways in case of bleeding during stricture dilatation. After balloon inflation of the 3.5 mm endotracheal tube, a 5.5 mm tube (larger/red balloon) was inserted over the smaller endotracheal tube and the balloon was gradually inflated at the stenosis site.

once a day, and a bronchodilator: Theophylline (Theotrim 100; Trima, Maabarot, Israel), 1 tablet twice a day. The dog was presented again 6 d later with neurological signs of head press- ing, bumping into walls, and ataxia. At this point the dog was euthanized at the owner’s request. Discussion Dilation of tracheal stenosis as a palliative measure for segmental tracheal stenosis in a dog using a new technique is described. Tracheal stenosis, although uncommon, may be seen with neoplastic diseases, inflammatory processes, congenital abnormalities, previous tracheal surgery, endotracheal tube pressure necrosis, or scar formation from previous trauma, abscesses, foreign bodies, vascular anomalies, granulomas, and extratra- cheal compression (1–4). Clinical signs commonly consist of stridor, respiratory dis- Figure 4. Bronchoscopic image of the site of the tracheal tress, and subsequent cyanosis. When the stenosis limits luminal stricture prior (A) and immediately after (B) dilatation using the size to approximately 50% to 75% of normal diameter, respi- endotracheal balloon. ratory distress becomes obvious at rest and cyanosis develops with minimal exercise (6). The diagnosis is usually based on ment after the first intubation, most likely due to dilation of radiographs and tracheoscopy (3,4). the stenosis following intubation, the owners requested that Treatment of tracheal stenosis may be either medical or surgi- surgical intervention be postponed until clinical signs recurred. cal. Resection and anastomosis of up to 50% of the trachea in an Tracheal stent placement is becoming more common in adult dog can be performed (6). Surgical resection and anasto- companion animals; however, it has been typically reserved mosis is the treatment of choice for tracheal stenosis, especially for tracheal collapse in dogs. Intraluminal tracheal stent is a when tracheal neoplasia is diagnosed, not only to eliminate the reasonable treatment option for tracheal stenosis (7), but it was obstruction, but also to resect the neoplastic tissue. Resection not performed in the current case due to financial constraints. and anastomosis is a relatively complicated, invasive procedure, Complications associated with intraluminal tracheal stenting and can result in significant morbidity including dehiscence, tra- in dogs include stent migration, collapse, breakage or deforma- cheal stenosis or necrosis, pneumothorax, and laryngeal paralysis tion, abscess formation, excessive granulation tissue formation, (7). In the present case, the risk for dehiscence was considered tracheitis, coughing, pneumomediastinum, pneumonia, and high since the tissue from the stenosis site cranial to the larynx death (7,11). was abnormal and thus less likely to heal well (8,9). Another nonsurgical option is tracheal bougienage, which is A permanent tracheostomy is another surgical option for used with reasonable success in humans as primary therapy for proximal cranial segmental tracheal stenosis, and is indicated stenosis or as an initial therapy to allow urgent relief of airway when upper airway obstruction is prolonged or cannot be obstruction and to make dilation and stent placement simpler relieved. Complications associated with permanent tracheostomy and safer. The bougienage can be done using designated equip- in dogs and cats include infections, stenosis, and obstruction of ment such as an angioplastic balloon catheter, valvuloplasty the stoma with a foreign body, skin folds, or mucous secretions catheters, or a fogarty catheter (3). Alternatively, the stenosis (10). In this case, a permanent tracheostomy was offered to the can be dilated using an endotracheal tube balloon (12) as was owners; however, because of immediate and dramatic improve- done in this case. In both procedures repeated treatments may

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be needed and the treatment may be combined with steroids and and quick (compared with resection and anastomosis), resulting stenting. Nomori et al (12) used a conventional endotracheal in a shorter anesthesia time and decreased risks for anesthetic tube balloon as an initial treatment prior to stent placement complication. It provided immediate respiratory relief with with adequate dilation and without complications. In this case, no complications, and was performed on an outpatient basis. steroids were administered following the first visit and first The procedure was considered successful considering the long balloon dilation procedure in an attempt to decrease the risk intervals between the procedures; although the final outcome for recurrence. The use of steroids has been described follow- was not favorable. ing esophageal stricture dilation (13); however, there is limited In conclusion, this case demonstrates that when resection evidence to support their use in tracheal stricture dilation. and anastomosis or stents cannot be used due to financial We emphasize that the procedure is palliative and that the constraints, technical difficulties, or the animal’s condition, stenosis is likely to recur; therefore, multiple dilations may be the use of endotracheal tube balloon should be considered as a RAPPORTCAS DE required. Retrospectively, the final cost of the 2 balloon dilations palliative treatment for segmental tracheal stenosis. The tech- might approach the cost of surgery. Surgery was presented to nique described herein was successful, with no complications, the owner each time the stenosis recurred but was rejected due and minimized the risk for respiratory system bleeding. It is to the lower cost of balloon dilation, the success of the previ- relatively easy to perform, inexpensive, and provides an effective ous dilation procedure, and that the potential complication of alternative to other methods. CVJ stenosis recurrence in both procedures (7). Once clinical signs recurred in this dog it was decided to References dilate the stenosis again using an endotracheal tube balloon, . 1 Alderson B, Senior JM, Dugdale AH. Tracheal necrosis following tra- considering the dog’s age and the good and relatively long- cheal intubation in a dog. J Small Anim Pract 2006;47:754–756. lasting response to the first intubation that widened the stenosis. 2. Pink JJ. Intramural tracheal haematoma causing acute respiratory obstruction in a dog. J Small Anim Pract 2006;47:161–164. This decision was further supported the second time by the 3. Ettinger SJ, Kantrowitz B. Diseases of the trachea. In: Ettinger SJ, histopathology, which was consistent with an inflammatory Feldman EC, eds. Textbook of Veterinary Internal Medicine. 6th ed. process. St. Louis, Missouri: Elsevier, 2005:1222–1224. 4. Nelson WA. Diseases of the trachea and bronchi. In: Slatter D, ed. One of the risks of any type of dilation is bleeding into the Textbook of Small Animal Surgery. 3rd ed. Philadelphia, Pennsylvania: respiratory system, which, when severe enough, may directly Saunders, 2002:865–870. obstruct the airways and become life-threatening. To prevent 5. Mayse ML, Greenheck J, Friedman M, et al. Successful bronchoscopic balloon dilation of nonmalignant tracheobronchial obstruction without this complication herein, a small endotracheal tube was first fluoroscopy. Chest 2004;126:634–637. inserted caudal to the stenosis, via endoscopic guidance, and 6. Fingland RB, Layton CI, Kennedy GA, et al. A comparison of simple then sufficiently inflated to prevent bleeding into the lungs. continuous versus simple interrupted suture patterns for tracheal anastomosis after large-segment tracheal resection in dogs. Vet Surg Once the airways were secured, a second endotracheal tube was 1995;24:320–330. inserted over the small one and positioned at the stenosis site. 7. Culp WT, Weisse C, Cole SG, et al. Intraluminal tracheal stenting The balloon was then inflated repeatedly, each time to a larger for treatment of tracheal narrowing in three cats. Vet Surg 2007;36: 107–113. diameter. The pressure used to inflate the balloon sufficiently 8. Couraud L, Jougon JB, Velly JF. Surgical treatment of nontumoral was evaluated subjectively, while the mucosa was carefully stenoses of the upper airway. Ann Thorac Surg 1995;60:250–260. inspected via the bronchoscope for any damage. Since the pro- 9. Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: Prognostic factors and management. J Thorac cedure was performed using the cuff of a tracheal tube, it was Cardiovasc Surg 2004;128:731–739. non-obstructive, allowing it to be left in place for a relatively 10. Stepnik MW, Mehl ML, Hardie EM, et al. Outcome of permanent long time, in order to achieve adequate dilation of the stenosis. tracheostomy for treatment of upper airway obstruction in cats: 21 cases (1990–2007). J Am Vet Med Assoc 2009;234:638–643. Balloon dilation may be performed under fluoroscopic or 11. Kim JY, Han HJ, Yun HY, et al. The safety and efficacy of a new self- endoscopic guidance (14,15). Both tracheoscopy and fluoros- expandable intratracheal nitinol stent for the tracheal collapse in dogs. copy require specialized equipment and experienced staff. The J Vet Sci 2008;9:91–93. 12. Nomori H, Horio H, Suemasu K. Bougienage and balloon dilation disadvantage of fluoroscopy is the exposure of the animal and using a conventional tracheal tube for tracheobronchial stenosis before staff to radiation, and its unavailability in many small animal stent placement. Surg Endosc 2000;14:587–591. clinics. 13. Leib MS, Dinnel H, Ward DL, et al. Endoscopic balloon dilation of benign esophageal strictures in dogs and cats. J Vet Intern Med 2001;15: In the present case, the balloon dilation was repeated with 547–552. an interval of 11 mo between treatments. This is a long interval 14. Berent AC, Weisse C, Todd K, et al. Use of a balloon-expandable and was acceptable by the owner and veterinarians, and thus metallic stent for treatment of nasopharyngeal stenosis in dogs and cats: Six cases (2005–2007). J Am Vet Med Assoc 2008;233:1432–1440. should be considered as a treatment option for dogs with tra- 15. Cohen MD, Weber TR, Rao CC. Balloon dilatation of tracheal and cheal stenosis. The procedure is relatively easy, cost-effective, bronchial stenosis. AJR Am J Roentgenol 1984;142:477–478.

1244 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Case Report Rapport de cas

A case of ocular canine transmissible venereal tumor

Jewel Milo, Elisabeth Snead

Abstract — A 1-year-old, intact female mixed-breed dog was presented to St. George’s University Small Animal Clinic in Grenada for a third eyelid mass. The dog was diagnosed with a rare ocular transmissible venereal tumor (TVT) and concurrent anaplasmosis, ehrlichiosis and dirofilariasis. Treatment with vincristine sulfate resulted in complete resolution of the TVT.

Résumé — Cas de tumeur vénérienne canine oculaire transmissible. Une chienne de race croisée intacte âgée de 1 an a été présentée à la clinique pour petits animaux de l’Université St. George de la Grenade pour une masse de la troisième paupière. La chienne a été diagnostiquée avec une rare tumeur vénérienne oculaire transmissible (TVT) et l’anaplasmose, l’ehrlichiose et la dirofilariose concomitantes. Le traitement au sulfate de vincristine a produit une résolution complète de la TVT. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1245–1249

Case description Three days later the dog was re-examined at the SGU SAC. The right third eyelid was noticeably more swollen with punc- 1-year-old, 15-kg, intact, mixed breed, female dog was tate hemorrhages, scalloped edges, and several lobulated masses presented to St. George’s University Small Animal Clinic A evident. Blood-tinged epiphora with moderate brown-black (SGU SAC) for evaluation of a suspected prolapse of her right crusting around the eye was seen (Figure 1). The third eyelid third eyelid and unilateral ocular discharge. The dog had been mass was friable and bled when manipulated with a cotton tip adopted by a veterinary student 3 days earlier after it was found applicator. The left eye was normal. wandering the neighborhood. On presentation the right third A complete blood (cell) count (CBC), serum biochemistry eyelid was prominent, light pink in color with diffuse punctate, profile, and analysis of urine collected by cystocentesis were raised lesions. There was moderate, yellowish-brown crusting performed along with a Snap 4Dx test (IDEXX Laboratories, around the eye. A neuro-ophthalmic examination showed Westbrook, Maine, USA) to screen for vectorborne disease the eyes to be normal bilaterally. Tear production, intraocular agents Dirofilaria immitis (heartworm disease), Ehrlichia canis pressures, and a fundoscopic examination were normal in both (ehrlichiosis), Anaplasma phagocytophilum (anaplasmosis), and eyes. There was no corneal uptake of fluorescein stain bilater- Borrelia burgdorferi (Lyme disease). In addition, impression ally. Clavamox (Pfizer Animal Health, New York, New York, smear cytology of the third eyelid mass was done. The CBC USA) 16 mg/kg body weight (BW) PO, q12h for 14 d, Rimadyl revealed a mild non-regenerative anemia [hematocrit (HCT) (Caplets and Chewables; Pfizer Animal Health) 2.5 mg/kg BW 34%; reference interval (RI): 37% to 55%, reticulocyte count PO, q12h for 5 d, and chloramphenicol ophthalmic ointment 1.5%)] and marked thrombocytopenia (36 3 109/L; RI: 175 to (Vetachloracin Ophthalmic Ointment 1%; Dechra Veterinary 500 3 109/L). The serum biochemistry profile revealed mild Products, Overland Park, Kansas, USA) OD ¼ inch strip hyperphosphatemia (2.45 mmol/L; RI: 0.81 to 2.2 mmol/L), and applied topically q12h for 7 d were prescribed. Despite these moderate hyperproteinemia (93 g/L; RI: 52 to 82 g/L) character- therapies chemosis of the right third eyelid worsened and the ized by a hyperglobulinemia (63 g/L; RI: 25 to 45 g/L). The urine ocular discharge increased. specific gravity was 1.045 and the urine sediment examination was unremarkable. The dog was positive for D. immitis, E. canis, and A. phagocytophilum and negative for B. burgdorferi on the Department of Small Animal Clinical Sciences, Western IDEXX 4Dx Snap test. Impression smear cytology of the right College of Veterinary Medicine, 52 Campus Drive, University third eyelid mass using Giemsa stain revealed a neoplastic round of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4. cell population with some inflammatory cells (75% neutrophils Address all correspondence to Dr. Elisabeth Snead; e-mail: and 25% macrophages). Features of malignancy in the round cell [email protected] population included mild to moderate anisocytosis, anisokaryosis, Use of this article is limited to a single copy for personal study. numerous mitotic figures, and abundant faint basophilic cyto- Anyone interested in obtaining reprints should contact the plasm. The cells had an increased nuclear to cytoplasmic ratio and CVMA office ([email protected]) for additional the cytoplasm contained 3 to 4 distinct vacuoles characteristic for copies or permission to use this material elsewhere. transmissible venereal tumor (TVT) (Figure 2). Given the findings

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Figure 1. Ocular transmissible venereal tumor (TVT) of the right third eyelid and bulbar conjunctival tissue in a dog. Figure 2. Impression smear cytology of the third eyelid consistent with TVT a vaginal examination was performed. No transmissible venereal tumor (TVT) revealing characteristic features of a TVT showing a round cell population with mild vaginal mass was visualized or palpated. to moderate anisocytosis, anisokaryosis, a few mitotic figures Treatment with doxycycline (Westward Pharmaceutical Corp, and abundant faint basophilic cytoplasm with characteristic Edmonton, New Jersey, USA), 10 mg/kg BW, PO q12h for cytoplasmic vacuoles. Image courtesy of Dr. Kumthekar. 30 d, for ehrlichiosis and anaplasmosis was initiated. In addition, Iverhart Max Chewable tablet containing ivermectin after the final treatment (Figure 3b). With resolution of the 136 mg, PO, q30d, pyrantel pamoate 114 mg, and praziquantel ocular TVT, heartworm adulticide treatment was initiated and 114 mg (Virbac Animal Health, Fort Worth, Texas, USA) were was well-tolerated with no complications. Eighteen months prescribed for heartworm and intestinal parasites. For the TVT, after initial presentation, there was no visible recurrence of the treatment with vincristine sulfate (Hospira, Lake Forest, Illinois, dog’s TVT. USA), 0.025 mg/kg BW, IV, q7d for a total of 6 treatments was initiated. Due to financial limitations of the owner the dog was Discussion monitored with a CBC every other week instead of every week. Transmissible venereal tumor (TVT), also referred to as Sticker’s Photographs of the right nictitating membrane lesion were tumor, venereal granuloma, transmissible venereal sarcoma, taken at each follow-up visit to monitor progress (Figures 3a, b). infective venereal tumor, and transplantable lymphosarcoma is After the first vincristine treatment only minimal improvement a tumor that primarily affects the genitalia of sexually mature was noted. A CBC performed prior to the second vincristine dogs. It is a common tumor in tropical and subtropical regions treatment revealed no improvement in the anemia (HCT 34%), where there is a high population of stray, malnourished dogs a persistent but improved thrombocytopenia (162 3 109/L; RI: (1–4). A TVT is unique in its pathogenesis compared with other 175 to 500 3 109/L), and a mild eosinophilia (1.7 3 109/L; neoplasms since it does not arise spontaneously but is transmit- RI: 0.5 to 1.5 3 109/L). ted from one animal to another (2). The transmissible nature By the third week the right third eyelid mass had decreased is suggestive of an infectious etiology; however, no infectious dramatically in size. By the fourth week only a small remnant particles have ever been detected within the tumor cells (2–3). of the mass was visible (Figure 3a) and by week 6, the mass These tumor cells are not the patient’s own cells transformed was no longer evident without exteriorization of the third into cancer cells. The TVT is a tumor that grafts itself from one eyelid. However, marked thrombocytopenia (25 3 109/L) per- dog’s body onto another dog’s body (5). sisted, along with a now regenerative anemia (HCT 35.9%). In male dogs the tumor typically affects the caudal aspect of A manual platelet count with only 1 platelet seen per high the penis (Figure 4) and occasionally the prepuce. Phimosis or power field (hpf) confirmed the thrombocytopenia. Because paraphimosis may occur as a complication (2). In female dogs the thrombocytopenia was attributed to bone marrow suppres- lesions are most common at the posterior part of the vagina, par- sion from the vincristine the sixth, and final vincristine treat- ticularly at the vestibulovaginal junction (2). Due to this deeper ment, was postponed by a week. Prior to the sixth treatment location a visible genital growth may not be evident; however, a recheck CBC revealed normalization of the platelet count in some cases the mass may be large enough to protrude from (200 3 109/L; RI: 175 to 500 3 109/L) and resolution of the the vulva (Figure 5) (2,4). A digital vaginal examination and anemia (HCT 37.5%). At this time the dog was sedated with possibly vaginoscopy should be performed in a female dog with Propofol (PropoFlo; Abbot Laboratories, Abbott Park, Illinois, a confirmed extragenital TVT to look for a primary vaginal USA), 0.2 mg/kg BW, IV and her right third eyelid was everted tumor. Unlike other genital tumors in dogs that tend to occur to permit examination. Only a very small remnant of the mass in older dogs (. 10 y of age), TVT tends to occur in young was still visible. Complete resolution was evident 1 week later dogs, typically 2- to 5-years old (2).

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A B CASE REPORT CASE

Figure 3. A — Partial resolution of the third eyelid transmissible venereal tumor (TVT) in a dog after 3 weekly vincristine sulphate treatments (left), and B — Complete resolution of the third eyelid TVT in a dog after 6 weekly treatments with vincristine sulfate (right).

The TVT is typically transmitted during coitus (2–4). it is speculated that the dog developed this lesion after being Transmission can also occur through dogs’ normal social behav- licked on the face by an affected dog. ior when they lick, sniff, scratch, or bite at their own genitalia Tumors of the third eyelid are rare, seen in older dogs, and are (autoimplantation) or if they lick the genitalia of an affected typically malignant (15). They usually arise from the conjuncti- dog (heteroimplantation) (2,4,5). Early on, the genital tumors val or glandular tissue. Types of tumors include adenocarcinoma appear as small hyperemic papules but with time progress (most common), hemangiosarcoma, mastocytoma, squamous to become nodular, papillary multilobulated, friable masses cell carcinoma, hemangioma, fibrosarcoma, and malignant with cauliflower-like or pedunculated proliferations that can melanoma (15). Transmissible venereal tumors should also measure up to 15 cm in diameter (2). Ulceration of the surface be considered, especially in a young to middle-aged sexually of the tumor with secondary inflammation is common (2,5). intact dog which resides in or has visited a region where TVT is Transmissible venereal tumors also bleed easily and often have a endemic. Importantly, with the exception of TVT, the treatment malodorous serosanguinous discharge especially if they become for other forms of neoplasia of the third eyelid is amputation of secondarily infected (2,4,5–7). The bloody discharge can be the third eyelid and associated gland (15). confused with signs of estrus or cystitis in females or prostatitis A presumptive diagnosis of canine TVT is often made based in male dogs (2,4). on the combination of epidemiological factors (young- to Transmissible venereal tumor can also occur in extragenital middle-aged sexually active dog living in an endemic region) sites, even in the absence of pre-existing genital lesions as in and the location of the tumor (genitalia involvement). Definitive the case described (2,4,8,9–11). This is typically the result of diagnosis of TVT, with differentiation from other round cell primary auto- or hetero-implantation. Much less commonly this tumors, can usually be made from impression smear cytology can result from metastatic spread from a primary genital tumor or fine-needle aspirate cytology (1,2,16). Differential diagnoses via hematogenous or lymphatic routes (2,5,7,12). Metastases include other round-cell tumors such as histiocytomas, lym- occur in less than 5% of cases and most commonly affect phoma, poorly differentiated mast cell tumors and carcinomas, regional lymph nodes. However, metastasis to other internal and amelanotic melanomas (2,7,12,13). Impression smear organs such as the skin and subcutaneous tissue, pharynx, ton- cytology is preferred over biopsy for establishing the diagnosis sils, liver, spleen, kidneys, brain, eyes, and lymph nodes has been of TVT because it is minimally invasive, inexpensive, and highly reported (2,4,6,8). Diagnosis of a TVT at an extragential site sensitive (1,2,16). There is also less cellular distortion with cytol- such as the eye, when there is no concurrent genital tumor, as ogy than with formalin-fixed biopsy samples. Histopathology, in the case described, can be challenging. The clinical signs seen immunohistochemistry, and electron-microscopy can also be with TVT in the eye can range from chemosis to episcleritis, used to establish a diagnosis of TVT (2) and differentiate TVT severe uveitis, corneal edema, and glaucoma (13,14). There are from other round-cell tumors (3,13) if required. For example, only a few reported cases of ocular TVT in the literature. Most canine TVT cells possess 57 to 64 chromosomes (average of 59), cases have involved other structures of the eye (sclera, cornea) in contrast with the normal 78 in canine somatic cells (2,17). and have been clearly the result of metastasis from genital This finding on electron microscopy can be used to help support lesions (5,6,12,13). In this case, the third eyelid TVT tumor the diagnosis of TVT when the diagnosis is questioned. was suspected to be a primary tumor and not to have resulted Vincristine sulfate, as a single agent given IV once weekly is from metastasis since no external lesions were visible or evident the most common treatment protocol for TVT (2,16–19). Four on digital vaginal examination. Given the conjunctival location to 8 doses are usually necessary to effect a cure (17). Complete

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Figure 5. Large cauliflower-like, ulcerated, hemorrhagic vaginal transmissible venereal tumor (TVT) in a dog. Courtesy of Dr. Emma Hage.

or combination chemotherapy protocols (2,17). Surgical excision is also an option, but due to the locally invasive nature of TVTs and the risk of tumor transplantation into surgical wounds from contaminated instruments and gloves, the results are often unrewarding with recurrence being common (2,8,17). Radiation therapy has also resulted in complete remission of TVTs but this requires special equipment and personnel, which would have Figure 4. Multilobulated, ulcerated transmissible venereal tumor (TVT) on the base of the penis in a dog. Courtesy of Dr. Emma been prohibitively expensive in this case (2,17). Hage. The dog herein was also diagnosed with heartworm disease and there was some concern with immunosuppression from regression of the right third eyelid TVT in this dog was seen chemotherapy. However, the recommendations of the American after 6 treatments with vincristine sulfate, with no recurrence or Heartworm Society (AHS) were followed (20). This dog was metastasis. The most common side effects with vincristine are diagnosed with stage 1 (asymptomatic) heartworm disease; the gastrointestinal upset and myelosuppression evident by leuko- initial recommended treatment is to give a heartworm preventa- penia (8,17). In the case described, the dog was already severely tive monthly for 3 mo along with doxycycline at 10 mg/kg BW, thrombocytopenic and slightly anemic when vincristine therapy PO, q12h for 28 d with adulticide treatment being delayed until was initiated. The initial thrombocytopenia was attributed to days 60, 90, and 91 following diagnosis (20). Doxycycline is rec- ehrlichiosis and anaplasmosis. Treatment for these diseases with ommended to reduce the numbers of the rickettsial bacterium, doxycycline resulted in marked improvement in the thrombocyte Wolbachia spp. that works symbiotically with D. immitis in all count; however, there was no improvement in the anemia for stages of heartworm disease (20). Killing the Wolbachia spp. dis- several weeks. This was likely because the pathophysiology of the rupts heartworm transmission and reduces pathology associated anemia was complex and at least in part explained by chronic with adult heartworms (20). Cage rest was also recommended inflammatory disease. After the fifth treatment with vincris- with only short, slow leash walks as needed. This treatment was tine, the dog became markedly thrombocytopenic again. This well-tolerated by the dog. was attributed to myelosuppression from vincristine because The typical presentation for TVT often involves the genitalia; the thrombocytopenia resolved with a short delay of further however, as the present case illustrates primary ocular TVT may vincristine administration. Transmissible venereal tumors have occur. The dog was also diagnosed with 3 concurrent infec- been reported to be immunogenic tumors; therefore, occurrence, tious diseases which may have contributed to the dog’s risk of metastasis, and recurrence can depend on the strength of the developing a TVT tumor. Treatment of all the diseases was initi- dog’s immune system (17). It is possible that being a stray and ated simultaneously and there was complete resolution of the being malnourished, in addition to having 3 concurrent infec- TVT. tious diseases may have predisposed this dog to the development of TVT. The lack of recurrence and metastasis may have also Acknowledgments been attributable to improved nutrition and successful ongoing The authors thank Dr. Sachin Kumthekar, Veterinary Pathology, treatment of the concurrent infections. for his expertise in cytological interpretation of the ocular tumor Medical treatment options for TVT include other chemother- and for providing 1 of the photographs; Dr. Tara Paterson and apy drugs such as monotherapy with doxorubicin or vinblastine Dr. Emma Hage for assistance in management of the case. CVJ

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References 13. Pereira JS, Silva AB, Martins AL, Ferreira AM, Brooks DE. Immuno histochemical characterization of intraocular metastasis of a canine 1. Santos do Amaral A, Bassani-Silva S, Ferreira I, et al. Cytomorphological transmissible venereal tumor. Vet Ophthalmol 2000;3:43–47. characterization of transmissible canine venereal tumor. RPCV 2007; 14. Abbott PK. Venereal transmissible tumour on eyelid of dog. Aust Vet 102:253–260. J 1966;42:29. 2. Das U, Das AK. Review of canine transmissible venereal sarcoma. Vet 15. Aquino SM. Management of eyelid neoplasms in the dog and cat. Clin Res Commun 2000;24:545–556. Tech Small Anim Pract 2007;22:46–54. 3. Ibrahim AM, Porter BF. Pathology in practice. Transmissible venereal 16. Varughese E, Singla V, Ratnakaran U, Gandotra V. Successful manage- REPORT CASE tumor located on the bulbus glandis and body of the penis. J Am Vet ment of metastatic transmissible venereal tumour to skin of mammary Med Assoc 2012;241:707–7099. region. Reprod Domest Anim 2012;47:366–369. 4. Kabuusu RM, Stroup DF, Fernandez C. Risk factors and characteristics 17. Mello Martins MI, Ferreira de Souza F, Gobello C. The canine transmis- of canine transmissible venereal tumors in Grenada, West Indies. Vet Comp sible venereal tumor: etiology, pathology, diagnosis and treatment. In: Oncol 2010;8:50–55. Concannon PW, England G, Verstegen III J, Linde-Forsberg C, eds. 5. Rodrigues GN, Alessi AC, Laus JL. Intraocular transmissible venereal Recent Advances in Small Animal Reproduction. Ithaca, New York: tumor in a dog. Cienc Rural 2001;31:141–143. International Veterinary Information Service, 2005;A1233.0405. 6. Pigatoo JAT, Hunning PS, Bercht BS, de Albuquerque L. Transmissible Available from: http://www.biologia.studies.uj.edu.pl/~joachimiak/ venereal tumor in the palpebral conjunctiva of a dog: Case report. Semina: WWW/Joachimiak/ciekawostki/Canine%20tumor.pdf Last accessed Ciencias Agraias 2011;32:1139–1144. September 16, 2013. 7. Rogers KS, Walker MA, Dillon HB. Transmissible venereal tumor: A ret- 18. Nak D, Nak Y, Cangul IT, Tuna B. A Clinico-pathological study on rospective study of 29 cases. J Am Anim Hosp Assoc 1998;34:463–470. the effect of vincristine on transmissible venereal tumour in dogs. J Vet 8. Oduye OO, Ikede BO, Esuruoso GO, Akpokodje JU. Metastatic trans- Med Series A 2005;52:366–370. missible venereal tumour in dogs. J Small Anim Pract 1973;14:625–637. 19. Scarpelli KC, Valladão ML, Metze K. Predictive factors for the regres- 9. Park MS, Kim Y, Kang MS, et al. Disseminated transmissible venereal sion of canine transmissible venereal tumor during vincristine therapy. tumor in a dog. J Vet Diagn Invest 2006;18:130–133. Vet J 2010;183:362–363. 10. Yang TJ. Metastatic transmissible venereal sarcoma in a dog. J Am Vet 20. American Heartworm Society. Current canine guidelines for the diag- Med Assoc 1987;190:555–556. nosis, prevention and management of heartworm (Dirofilaria immitis) 11. Chikweto A, Kumthekar SM, Bhaiyat MI, Tiwari KP, Larkin H. Genital infection in dogs (revised 2012 January). Available from: http://www. and extragenital canine transmissible venereal tumor (TVT) in Grenada, heartwormsociety.org/veterinary-resources/canine-guidelines.html Last West Indies. Vet Path J Abstracts ACVP 2011;66:146–148. accessed September 16, 2013. 12. Ferreira AJA, Jaggy A, Varejäo AP, et al. Brain and ocular metastases from a transmissible venereal tumor in a dog. J Small Anim Pract 2000; 41:165–168.

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CVJ / VOL 55 / JANUARY 2014 1249 FOR PERSONAL USE ONLY Brief Communication Communication brève

Preoperative ketoprofen administration to piglets undergoing castration does not affect subsequent growth performance

Glen Cassar, Rocio Amezcua, Ryan Tenbergen, Robert M. Friendship

Abstract — The purpose of this study was to determine if treatment of pigs with ketoprofen (3 mg/kg body weight) before castration at 7 days of age would affect subsequent growth during the suckling period. Piglets from 301 litters were treated with ketoprofen or a placebo and weighed at castration and at weaning. There was no difference in growth rate between the 2 groups of pigs.

Résumé — L’administration préopératoire de kétoprofène aux porcelets subissant une castration n’affecte pas la performance de croissance subséquente. Cette étude avait pour but de déterminer si le traitement des porcs avec le kétoprofène (3 mg/kg poids corporel) avant la castration à l’âge de 7 jours affecterait la croissance subséquente durant la période d’allaitement. Les porcelets provenant de 301 portées ont été traités à l’aide du kétoprofène ou d’un placébo et pesé à la castration et au sevrage. Il n’y avait aucune différence au niveau du taux de croissance entre les 2 groupes de porcs. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1250–1252

he issue of pain as it affects animal welfare and performance of animals under controlled conditions to carry out intensive T in swine production has been widely discussed. In addition behavior and physiological studies. to the need for treatment of pain in farmed animals for ethical In order to improve the adoption of analgesia into the stan- and moral reasons, pain management can have economic rami- dard operating procedures of commercial farms it is important fications (1). Pain may be viewed as not being an end point in that producers know whether or not analgesics given at the time itself, but might be considered in the same manner as a “patho- of castration will result in an increased performance in growth gen” (2). Pain may cause discomfort, impaired physiological rate or piglet survival so that they can better determine the eco- functions, suppression of immune responses, negative energy nomic cost. In order to determine the effect on performance, balance, and self-mutilation (3). The report of the Scientific large numbers of animals are required and trials need to be Panel for Animal Health and Welfare (2004) summarized the performed under commercial farming conditions. Ketoprofen, physiological and behavioral signs exhibited by piglets undergo- a non-steroidal anti-inflammatory drug (NSAID), was chosen ing castration based on research studies (4). The procedure is for this study because it is one of the few pain control products generally performed without anesthesia or analgesia, although approved for use in swine in Canada. The primary goal of the it has been demonstrated that it is painful, both during the trial was to determine if preoperative treatment with ketoprofen surgery and for some hours later, and has become a welfare would result in an improvement in suckling pig performance. concern (5–8). Castration results in acute pain, particularly with A field trial was conducted on a commercial 650-sow farrow- the severing of the spermatic cord, but piglets also continue to to-feeder pig operation near Guelph, Ontario. The protocol was experience pain for several hours and possibly days following approved by the Animal Care Committee of the University of castration. Anesthetics can block the acute pain, but are of little Guelph and followed the guidelines of the Canadian Council value in suppressing the chronic pain that occurs in the post- on Animal Care. A total of 1416 7-day-old piglets from surgical period (5,8). Most studies in this field have evaluated 301 litters were alternately assigned to: i) Control — saline the effect of analgesics on controlling pain, using small numbers given by IM injection 30 min before castration (n = 703), or ii) Treatment — ketoprofen (Anafen; 100 mg/mL; Mérial Canada, Baie d’Urfé, Quebec) given by IM injection, 3 mg/kg Department of Population Medicine, University of Guelph, body weight (BW) 30 min before castration (n = 713). The Guelph, Ontario N1G 2W1. first male piglet caught in a litter was randomly assigned (by Address all correspondence to Dr. Glen Cassar; e-mail: coin toss) to control or treatment and subsequent piglets were [email protected] assigned alternately. Placebo and treatment were given in equal Use of this article is limited to a single copy for personal study. volume and researchers were blinded to treatment. All piglets Anyone interested in obtaining reprints should contact the were ear notched for identification within 24 h of birth and CVMA office ([email protected]) for additional individually weighed at the time of castration and at 21 d of age copies or permission to use this material elsewhere. to determine average daily weight gain (ADG).

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Table 1. Growth rate and mortality for piglets treated with standard deviation (SD)] compared to pigs born from parity a ketoprofen or placebo at castration 3 to 6 sows (279 g/d; 6 70 g/d SD). There was a tendency Placebo Ketoprofen for better growth for piglets nursing sows in parity 1 to 2 n = 703 n = 713 P-value

(276 g/d; 6 70 g/d SD) compared to piglets of sows in parities BRIEF COMMUNICATION Litter size at castration 10.16 6 1.62b 10.15 6 1.61 0.9 . 6 (263 g/d; 6 80 g/d SD) (P = 0.08). No significant differ- Weight at castration (kg) 2.78 6 0.61 2.85 6 0.61 0.06 ences in ADG were observed for piglets nursing sows in parity Weight at 21 d (kg) 6.63 6 1.46 6.76 6 1.46 0.11 ADG (7 to 21 d) (g) 271 6 0.70 276 6 0.70 0.08 1 to 2 compared to piglets of sows in parity 3 to 6. Based on Mortality 2.7% 2.5% 0.83 subjective evaluation by an observer who was blinded to treat- a Anafen; 100 mg/mL; Mérial Canada, Baie d’Urfé, Quebec, given by IM injection ment, there was little evidence of behavior suggesting discomfort (3 mg/kg BW) 30 min before castration at 7 days of age. in either treatment or control group for 15 to 20 min after cas- b 6 standard deviation. tration. Plasma cortisol concentrations were significantly higher in the placebo group at 30 min, 60 min, and 90 min following Mortality between the 2 weighing periods was recorded. castration but not at 4 h (Figure 1). Piglets were returned to their litters after castration and observed When an injectable analgesic drug is given 30 min before for approximately 15 to 20 min after castration for signs of castration, piglets need to be handled twice, and the process of discomfort, including isolation or abstention from suckling castration may take twice as long. Because of practical consider- with littermates. In addition, a total of 120 blood samples from ations most pork producers will want to administer an analgesic piglets in 23 litters were collected at 30 min, 60 min, 90 min, at the time of castration in order to minimize time and labor, and 4 h following castration for determination of cortisol con- as well as reduce the stress for the pig of being handled twice. centrations. An individual pig was only bled once, and therefore, Research suggests that analgesia does not reduce the acute pain in general, 4 littermates in the same treatment group were used associated with castration so there may be limited advantage in where possible. The blood samples were centrifuged at 3900 3 g administering ketoprofen 30 min prior to castration. Treatment at 5°C for 20 min, within 1 to 3 h after collection. The plasma at the time of castration should still result in reduced pain over samples were stored in 2-mL polypropylene micro tubes (Sarstedt the next few hours. The cost of drugs, syringes, and needles is Canada, Saint-Léonard, Quebec) at 220°C until they were ana- approximately 15 cents per castrated piglet. The cost of anal- lyzed for cortisol with a solid-phase, competitive chemilumines- gesia is small on a per pig basis, but for a moderate-sized pig cent enzyme immunoassay (Immulite/Immulite Cortisol 1000; operation the cost associated with extra labor and drug costs Siemens Healthcare Diagnostic Products, Los Angeles, California, represents thousands of dollars. In the present study, ketopro- USA). The test had an analytical sensitivity of 5.5 nmol/L with fen administered 30 min before castration did not result in an a calibration range of 28 to 1380 nmol/L. improvement in ADG or survival. Because piglet performance Descriptive statistics and quantitative statistical analysis is not improved there is no obvious economic incentive to help were completed in Statistix (Statistix10, Version 10.1; College encourage producers to implement this practice. Station, Texas, USA). Each continuous variable was plotted An additional reason producers may be hesitant to use an and tested for normality using the Shapiro-Wilk test. The analgesic is that it is difficult to assess pain in piglets, and they correlation among continuous variables was tested using pair- may not be convinced of the need from a welfare standpoint. In wise correlations. The simple association between continuous the present study observations over the first 15 to 20 min post- variables with treatment were evaluated with a 2 sample t-test surgery failed to note a difference in behavior between piglets when continuous variables were normally distributed and with treated with ketoprofen and those receiving the placebo. Other the Wilcoxon rank sum test when variables were not normally studies that have followed pigs for a longer period of time and distributed. The simple association of continuous variables with used more intensive observation methods have noted more iso- categorical variables was analyzed with a one-way analysis of lation behavior and sometimes other changes. Generally, most variance (ANOVA). A Chi-square test was used to determine studies have found that castrated piglets continue to nurse with the simple association between treatment and dichotomous or littermates whether or not they have received analgesia (7,9), categorical variables. and one explanation that has been presented is that the activ- Weight at castration was not normally distributed. Mean ity of suckling provides some analgesia or calming effect (10). ADG, weight at castration, and weight at weaning between Blood cortisol concentrations are often used as an objective treatment and control groups are summarized in Table 1. No indicator of stress and pain in response to painful procedures significant difference was observed for these parameters between such as castration, but handling alone may not result in elevated the 2 groups. Weight at castration, and weight at weaning and blood cortisol (5,11). The present study found that plasma cor- ADG were highly correlated (P , 0.001). Mortality rates were tisol levels were significantly reduced for up to 90 min after cas- similar for pigs in the 2 groups (P = 0.83). A total of 2.7% tration in piglets that received ketoprofen compared with those (19/703) of pigs died in the control group, and 2.5% (18/713) that received the placebo. The rise in cortisol for up to 3 h is of pigs died in the treatment group. No significant differences similar to that reported in other studies (5,12). Other researchers were observed between treatment and control groups among reported that peak values of plasma cortisol were found between parity categories (P = 0.8). However, ADG varied significantly 30 and 60 min after surgical castration, and that the return to among sow parity categories (P = 0.004). Piglets born from the pre-surgery levels occurred within 3 h after the procedure (13). oldest sows (. 6 parity) had lower ADG [263 g/d; 6 80 g/d The difference found in cortisol levels between treatment and

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Ketoprofen seems to be of benefit in the treatment of post- * operative pain associated with surgical castration of male piglets * based on plasma cortisol results. No negative side-effects were * noted in this trial. Overall, the results of this study are supportive of the use of ketoprofen as a practical method of reducing post-operative pain associated with castration. Acknowledgment

This trial was funded by Ontario Pork. CVJ

Figure 1. Average plasma cortisol concentrations (nmol/L) References from male piglets at various times after castration following 1. Anil L, Anil SK, Deen J. Pain detection and amelioration in animals on ketoprofena or placebo treatment. the farm: Issues and options. J Appl Anim Wel Sci 2005;8:261–278. COMMUNICATIONBRÈVE a Anafen; 100 mg/mL, Mérial, Canada, Baie d’Urfé, Quebec, given by 2. Fisher AD. Pain — Its effect on immune function and growth in ani- IM injection (3 mg/kg body weight) 30 min before castration at 7 days mals. Proc NZ Soc Anim Prod 2002;62:363–367. of age. 3. Hellebrekers LJ. Pain in animals. In: Hellebrekers LJ, ed. Animal Pain: * Significantly different at 30, 60, 90 min (P , 0.01). A Practice Oriented Approach to Effective Pain Control in Animals. Utrecht, The Netherlands: (Van Der Wees), 2000:11–16. 4. Mellor DJ, Cook CJ, Stafford KJ. Quantifying some responses controls in the present study is a useful objective indicator that to pain as a stressor. In: Moberg GP, Mench JA, eds. The Biology the castrated pigs did experience pain and that ketoprofen was of Animal Stress — Basic Principles and Implications for Animal Welfare. Wallingford, England: Commonwealth Agricultural Bureau of some benefit in reducing the pain. International 2000:171–198. The impact of surgical castration of male piglets on subse- 5. Moya SL, Boyle LA, Lynch PB, Arkins S. Effect of surgical castration quent weight gain during the suckling period has been previ- on the behavioural and acute phase responses of 5-day-old piglets. Anim Behav Sci 2008;11:133–145. ously studied, but results are mixed (12). Pre-weaning growth 6. European Food Safety Authority. Welfare aspects of the castration of rates and subsequent weaning weights in pigs can be quite piglets. The EFSA Journal 2004;91:1–18. variable depending on a variety of factors, including genetics, 7. Hansson M, Lundeheim N, Nyman G, Johansson G. Effect of local anaesthesia and/or analgesia on pain responses induced by piglet castra- environment, sow health, and nutrition (14). When a field trial tion. Acta Vet Scand 2011;53:34 is conducted on a commercial farm it is difficult to control for 8. Hay M, Vulin A, Génin S, Sales P, Prunier A. Assessment of pain all the factors that may influence piglet growth. In the present induced by castration in piglets: Behavioural and physiological responses over the subsequent 5 days. Appl Anim Behav Sci 2003;82:201–218. study it was shown that parity, litter size, and starting weight 9. Carroll JA, Berg EL, Strauch TA, Roberts MP, Kattesh HG. Hormonal were important factors influencing growth and were controlled profiles, behavioural responses, short-term growth performance after for in the analysis. The present study is in agreement with other castration of pigs at three, six, nine or twelve days of age. J Anim Sci 2006;84:1271–1278. reports, which found no relationship between pain control treat- 10. Anseloni V, Ren K, Dubner R, Ennis M. Ontogeny of analgesia elicited ment at castration and weight gain, using other analgesics, and by non-nutritive suckling in acute and persistent neonatal rat pain in other species (8,12,15). There is limited research on the use models. Pain 2004;109:507–513. 11. Heinritzi K, Zoels S, Ritzmann. Possibilities of pain reduction in of ketoprofen for the treatment of pain associated with routine castration of piglets. Proc 19th Int Pig Vet Soc Cong, Copenhagen. practices such as castration and tail-docking in swine, but 2006;1:289. research in cattle has demonstrated ketoprofen to be effective 12. Keita A, Pagot E, Prunier A, Guidarini C. Pre-emptive meloxicam for postoperative analgesia in piglets undergoing surgical castration. Vet in the treatment of pain in bulls after castration (15). Anaesth Analges 2010;37:637–374. There is growing concern from consumers regarding best 13. Prunier A, Mounier AM, Hay M. Effect of castration, tooth resection, welfare practices including the incorporation of pain control or tail-docking on plasma metabolites and stress hormones in young pigs. J Anim Sci 2005;83:216–222 into routine farm practices (12). This current study illustrates 14. Kielly J, Dewey CE, Cochran M. Castration at age 3 days of age tem- that pigs receiving analgesia grew the same as pigs not receiving porarily slows growth of pigs. Swine Health Prod 1999;7:151–153. pain control and that farmers are unlikely to see an economic 15. Ting STL, Earley B, Crowe M. Effect of repeated ketoprofen administration during surgical castration of bulls on cortisol, immuno- return associated with using analgesia at the time of painful logical function, feed intake, growth, and behaviour. J Anim Sci procedures in order to provide better welfare for their animals. 2003;8:1253–1264.

1252 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Student Paper Communication étudiante

Intravenous lipid emulsion for treating permethrin toxicosis in a cat

Whitney D. DeGroot

Abstract — A 2-year-old cat was presented with acute onset seizures, tremors, and hypersalivation. Permethrin toxicity was diagnosed based on a history of recent flea treatment. Measures were taken to minimize further absorption of permethrin, and methocarbamol and intravenous lipid emulsion were used to control tremors. The cat recovered and was discharged within 42 h.

Résumé — Émulsion lipidique intraveineuse pour traiter une toxicose causée par la perméthrine chez un chat. Un chat âgé de deux ans a été présenté avec des crises d’épilepsie aiguës, des tremblements et de l’hypersalivation. Une toxicité causée par la perméthrine a été diagnostiquée en se fondant sur une anamnèse d’un traitement récent contre les puces. Des mesures ont été prises pour minimiser l’absorption continue de la perméthrine et le méthocarbamol et une émulsion lipidique intraveineuse ont été utilisés pour contrôler les tremblements. Le chat s’est rétabli et a reçu son congé après 42 h. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1253–1254 Case description tered as needed to control body tremors and twitching: after 2 h, 250 mg/kg body weight (BW) had been administered. The 2-year-old spayed domestic shorthair cat was presented as maximum recommended daily dose is 330 mg/kg BW (1). As a an emergency to Van Isle Veterinary Hospital, Courtenay, A means of reducing treatment costs, and keeping tremors under British Columbia, for acute onset of tremors, seizures, and control without exceeding the recommended daily dose of hypersalivation. Upon physical examination, temperature, methocarbamol, intravenous lipid emulsion therapy was started. pulse, and respiration were within normal limits, but the cat A 1.5 mL/kg BW bolus of a 20% fat emulsion (Intralipid was exhibiting seizures, tremors, and hypersalivation. The his- 20%; Fresenius Kabi, Cheshire, United Kingdom) was given tory revealed that the cat had received a flea treatment of Zodiac via a cephalic catheter, followed by a constant rate infusion at PowerSpot for dogs [permethrin 45%, (s)-methoprene 2.9%; 0.25 mL/kg BW per minute for 60 min. The cat exhibited a Wellmark International, Guelph, Ontario] about 2 h earlier. good response and there was marked reduction in the severity The patient was diagnosed with permethrin toxicity. The owner of twitching. Intravenous Normosol-R (Abbott) was continued indicated that treatment would need to be constrained because at 2 mL/kg BW per hour overnight. of financial reasons. The following morning the cat was able to sit up on its own The patient was given a bath with a gentle shampoo for der- but was still exhibiting severe twitching. Temperature, pulse mal decontamination to reduce cutaneous exposure. A 20-mL rate, and respiratory rate were within normal limits. Intralipid volume of 20% activated charcoal suspension (Charcodote; therapy was repeated at 0.25 mL/kg BW per minute for 60 min, Pharmascience, Montreal, Quebec) was administered orally and a marked reduction in tremors was again noted. Intravenous to reduce gastrointestinal absorption in the event of possible Normosol-R (Abbott) was continued at 2 mL/kg BW per hour. oral exposure. An IV catheter was placed and Normosol-R By the evening, the patient looked much better, was bright and (Abbott, Montreal, Quebec) fluid therapy was initiated at alert, eating and drinking on her own, and urinating in the litter maintenance rate. Injectable methocarbamol (Methocarbamol; box. Mild body tremors were still present. Summit Veterinary Pharmacy, Aurora, Ontario) was adminis- The next morning (approximately 36 h after presentation), the only residual effect of the toxicosis was mild facial twitch- Ontario Veterinary College, University of Guelph, Guelph, ing. No additional methocarbamol was required after intralipid Ontario N1G 2W1. therapy was implemented. Intravenous fluids were discontinued Address all correspondence to Whitney DeGroot; e-mail: and the catheter was removed. The patient was discharged [email protected] approximately 42 h after initial presentation for continued Ms. DeGroot will receive 50 copies of her article free of charge monitoring at home. courtesy of The Canadian Veterinary Journal. Use of this article is limited to a single copy for personal study. Discussion Anyone interested in obtaining reprints should contact the Permethrins are a class I pyrethroid insecticide, a synthetic CVMA office ([email protected]) for additional analog of pyrethrins. Pyrethrins are naturally occurring extracts copies or permission to use this material elsewhere. from the flowers of Tanacetum (Chrysanthemum) cinerariifolium.

CVJ / VOL 55 / JANUARY 2014 1253 FOR PERSONAL USE ONLY

Permethrin is a neurotoxicant that acts on gated sodium chan- dose, moxidectin toxicosis in dogs, and lidocaine toxicosis in nels in the cell membranes of muscle and nervous tissue (2,3). cats (4). Permethrins are highly lipophilic molecules, thus there Thus, permethrin toxicosis manifests clinically with tremors, is potential that ILE can be used as adjunct therapy in treating ataxia, hyperesthesia, hypersalivation, hyperthermia and, in toxicities (4). The exact mechanism of ILE is speculative, though severe cases, seizures and death can occur (3,4). Permethrin has the prevailing hypothesis is the “lipid sink” theory. This theory a low toxicity in most mammalian species and is commonly suggests that expanding the lipid compartment in the blood found in spot-on pesticides used for flea control (2). It is not sequesters fat-soluble toxins within the intravascular space and fully understood why cats are particularly sensitive, though it away from target tissues (nervous and muscle tissue, in the case may be related to a deficiency in glucoronyl transferase. This of permethrins) (6). Adverse effects of ILE are uncommon, and deficiency results in slower hepatic metabolism of permethrin most are due to long-term use as parenteral nutrition. These may and increased time for absorption into target tissues (2,4). include hyperlipidemia, icterus, seizures, hemolytic anemia, and Permethrins are reported to be the most common cause of thrombocytopenia (6). poisoning in cats in the USA (5). In the present case, the use of ILE significantly reduced the COMMUNICATIONÉTUDIANTE Cats may be exposed from cutaneous application of topical amount of methocarbamol required to control clinical signs. products, oral ingestion, and direct contact with topically treated Typical therapy is expensive due to hospitalization and drug dogs (6). Many pet products contain permethrins, including costs, so ILE may be a reasonable option to help reduce costs over the counter spot-ons, flea sprays, flea collars, and flea sham- associated with treatment of permethrin toxicosis and reduce poos. Products that contain over 40% permethrin are labeled for the number of cases euthanized due to financial constraints. use in dogs only (6). There has been significant concern in the Before using ILE, owners should be fully informed of its off- veterinary community about the inadequate labeling of these label use and potential for adverse reactions. However, in cases products and lack of control over their sale, which has resulted where clinical signs are difficult to control, conventional therapy in many deaths of feline patients. This could easily be prevented is unavailable, or euthanasia is imminent, ILE appears to be a by having more obvious safety warnings on product labels and relatively safe and inexpensive alternative (4). by improved client education (3,7). Clinical signs following exposure usually appear within a few Acknowledgments hours of application, though they may be delayed up to 72 h. I thank Dr. Bruce Renooy for hosting me at Van Isle Veterinary There does not appear to be any correlation between the amount Hospital for my externship, and Dr. Mireille de Winter for her of permethrin applied and the severity of clinical signs (2). expertise in dealing with this case. CVJ Treatment protocols aim to control the clinical signs while the toxicant is metabolized and excreted (4) and focus on early References seizure control, decontamination, and supportive care (2). 1. Plumb DC. Plumb’s Veterinary Drug Handbook. 7th ed. Ames, Iowa: Wiley-Blackwell, 2011. Control of seizures is often accomplished using either diaz- 2. Boland LA, Angles JM. Feline permethrin toxicity: Retrospective study epam or midazolam. If seizures continue after administration of 42 cases. J Feline Med Surg 2010;12:61–71. of benzodiazepine, propofol or alfaxalone may be considered. 3. Sutton NM, Bates N, Campbell A. Clinical effects and outcome of feline permethrin spot-on poisonings reported to the Veterinary Poisons Methocarbamol is the most commonly used drug to control Information Service (VPIS), London. J Feline Med Surg 2007;9:335–339. muscle fasciculation. Other management includes skin decon- 4. Haworth D, Smart L. Use of intravenous lipid therapy in three cases of tamination, ensuring a patent airway, IV crystalloids, and tem- feline permethrin toxicosis. J Vet Emerg Crit Care 2012;22:697–702. 5. Meyer EK. Toxicosis in cats erroneously treated with 45 to 65% perme- perature monitoring (2). The intravenous route is preferred over thrin products. J Am Vet Med Assoc 1999;215:198–203. the oral route for administration of methocarbamol because of 6. Kuo K, Odunayo A. Adjunctive therapy with intravenous lipid emulsion its rapid onset of action, ability to titrate to effect, and safety and methocarbamol for permethrin toxicity in 2 cats. J Vet Emerg Crit Care 2013;23:436–441. in compromised patients. On average, it takes 2 to 3 days for 7. Sparkes A, Bessant C. Permethrin and cats don’t mix — Call for action. cats to recover, though recovery periods of up to 7 d have been J Feline Med Surg 2010;12:2–3. reported (3). Intravenous lipid emulsion (ILE) has been used in treatment of lipophilic toxicities, such as intravenous local anesthetic over-

1254 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Article

Effect of enteric biopsy closure orientation on enteric circumference and volume of saline needed for leak testing

Brad M. Matz, Harry W. Boothe, James C. Wright, Dawn M. Boothe

Abstract — This study describes the effect of enteric biopsy closure orientation on circumference and volume of saline needed for leak testing. There were significant differences in circumference measurements at baseline, central circumference of longitudinally closed sites, and volume of saline for leak testing.

Résumé — Effet de l’orientation de la fermeture de la biopsie entérique sur la circonférence entérique et le volume de solution saline requis pour l’essai d’étanchéité. Cette étude décrit l’effet de l’orientation de la fermeture de la biopsie entérique sur la circonférence et le volume de solution saline requis pour l’essai d’étanchéité. Il y avait des différences importantes dans les mesures de la circonférence pour les données de référence, la circonférence centrale des sites fermés longitudinalement et le volume de solution saline pour l’essai d’étanchéité. (Traduit par Isabelle Vallières) Can Vet J 2014;55:1255–1257 Introduction intestine be closed transversely to minimize luminal reduction (5,6). To the authors’ knowledge, there is minimal information ntestinal leakage can be a sequel to enteric biopsy, lead to regarding the effect of longitudinal and transverse closure of significant postoperative complications, result in a need for I intestine on lumen size or leakage potential. The purpose of re-operation, and potentially lead to mortality of the patient (1). this paper is to report the effect of longitudinal and transverse Identification of intestinal suture line leaks by use of the leak closure of 6-mm enteric biopsy sites in dogs on enteric circum- test is easily performed with minimal equipment (2). Also, intra- ference, leak frequency, and saline volume needed to achieve operative identification of leaks allows for intervention (e.g., predetermined intraluminal pressures of 20 and 34 cm H O. additional suture placement), potentially reducing postoperative 2 We hypothesized that lower volumes of saline would be needed morbidity and mortality (2). Studies in humans have shown the to reach a pressure of 34 cm H O during intestinal leak testing incidence of postoperative intestinal leakage to be variable, with 2 of longitudinal closures with a significant reduction of enteric up to 30% being reported, although an incidence of 5% to 7% circumference compared to transverse closure and that frequency is more typical (3,4). Such studies have shown that leaks iden- of leaks would be similar between the 2 closure methods. tified at surgery are more effectively managed, compared with those that are detected after the development of septic peritonitis Materials and methods (3,4). Additionally, owner financial constraints may influence The study protocol was approved by the Auburn University the opportunity to manage intestinal incisional leakage in vet- Animal Care and Use Committee. Nineteen dogs were used erinary patients, further illustrating the importance of identifica- for data collection; 37 enteric biopsy sites (n = 19 longitudinal; tion and correction of leaks during the operation. Moreover, it n = 18 transverse) were evaluated. These dogs were anesthetized is recommended that enterotomies in a small-diameter loop of for reasons unrelated to this study. Two sites were identified for biopsy by use of a flexible sterile ruler (Surgical Marking Department of Clinical Sciences (Matz, HW Boothe), Pen; Cardinal Health, Dublin, Ohio, USA) placed level with Department of Pathobiology (Wright), Department of Anatomy, the cecal apex and measuring 10 cm and 25 cm orad. A sterile Physiology and Pharmacology (DM Boothe); College of skin marker was used to identify these sites for biopsy. Prior to Veterinary Medicine, Auburn University, 612 Hoerlein Hall, the incision, baseline undistended enteric circumference was Auburn, Alabama 36849, USA. measured by placing the ruler at the mesenteric border of the Address all correspondence to Dr. Brad Matz; e-mail: intestine and measuring to the other side of the mesentery across [email protected] the antimesenteric border. Method of closure (longitudinal or Funding was provided by the Department of Clinical Sciences, transverse) was randomized to either site. Auburn University. A full-thickness enteric defect centered on the anti-mesenteric Use of this article is limited to a single copy for personal study. border was created using a dermal biopsy punch (6 mm Acu- Anyone interested in obtaining reprints should contact the Punch; Acuderm, Fort Lauderdale, Florida, USA) (7,8). A vari- CVMA office ([email protected]) for additional able number of full-thickness, simple interrupted appositional copies or permission to use this material elsewhere. sutures of 4-0 polydioxanone (PDS II; Ethicon, Somerville,

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Table 1. Mean 6 standard deviation (SD) saline volume, circumference values, and leak data Volume of saline or circumference Baseline Longitudinal closure Transverse closure 6 6 Volume of saline at 20 cm H2O 9.0 3.5 mL 8.4 4.9 mL 6 b 6 b Volume of saline at 34 cm H2O 14.5 5.1 mL 14.2 5.9 mL Circumference — baseline, orad site 3.2 6 0.46 cm Circumference — baseline, aborad site 3.4 6 0.41 cma 6 6 Circumference at 20 cm H2O — adjacent 4.8 0.7 cm 5.0 0.5 cm 6 c Circumference at 20 cm H2O — center 4.0 0.6 cm 6 6 Circumference at 34 cm H2O — adjacent 5.3 0.7 cm 5.5 0.5 cm 6 Circumference at 34 cm H2O — center 4.3 0.7 cm Number of sites that leaked n = 6d n = 3 ARTICLE Pressure at which leak was observed 20 cm H2O (n =3) 20 cm H2O (n = 1) (Number of sites) 34 cm H2O (n = 3) 34 cm H2O (n = 2) a Baseline circumferences were significantly different, P = 0.005. b , Volume of saline to achieve 34 cm H2O pressure was significantly different from that to achieve 20 cm H2O, P 0.001. c Central measurements for longitudinal closures were significantly different from adjacent measurements for both closure orientations, P , 0.001. d No significant differences were observed for frequency of leaks for either closure orientation or pressure at which a leak was detected.

New Jersey, USA) were used for closure. Leak testing was per- taken at the center of longitudinally closed sites versus those formed by isolating a 10-cm segment of intestine containing the taken immediately adjacent to the closure (longitudinal and closed biopsy site using Doyen intestinal forceps closed to the transverse closures). For all comparisons, a P-value of # 0.05 first ratchet. An 18-gauge over-the-needle intravenous catheter was considered evidence of statistical difference. was introduced into the occluded segment and attached to extension tubing connected to a water manometer and 3-way Results stopcock. A 20-mL syringe was attached to the stopcock to Dog breeds were variable, and mean dog weight was incrementally add saline to the occluded segment until the 15.7 6 6.0 kg. Information regarding closure orientation,

predetermined pressures of 20 and 34 cm H2O were reached. number of closures that leaked, and pressure at which a leak Volume of saline to achieve 20 and 34 cm H2O pressure for each occurred is listed in Table 1. Mean dog weight was similar in closure orientation was recorded. Leaks were recorded for each dogs with closures that leaked, 15.9 6 5.7 kg versus those with pressure and corrected by placing 1 or 2 additional suture(s). closures that did not leak, 15.5 6 6.5 kg. Of the initial closures A repeat leak test was performed to ensure leak-free closure. that leaked (24%), 67% were longitudinal closures and 33% Enteric circumference was measured immediately adjacent to were transverse closures. All leaks were resolved by the addition the closed biopsy site for each closure orientation and at the of 1 (n = 7) or 2 (n = 2) sutures. One transverse closure site center of longitudinally closed sites at each pressure. Differences was not included in the study due to the initial placement of between pre- (baseline) and post-closure enteric circumferences excessive sutures. were computed for each closure orientation at each site and Saline volume and circumference data are also reported in pressure. Degree of central enteric circumference reduction for Table 1. There was no correlation between baseline enteric longitudinally closed sites only was determined by computing circumference at either site and dog weight. Circumference the difference between circumferential measurements immedi- measurements at the center of longitudinally closed sites were on ately adjacent to the closed site. Central enteric circumference average 0.8 6 0.7 cm (20%) and 1.0 6 0.7 cm (23%) smaller

was not measured for transversely closed sites due, in part, to than immediately adjacent measurements at 20 and 34 cm H2O, the presence of the sutures. respectively. A significant central reduction was observed in lon- Descriptive and inferential statistics were performed using gitudinally closed sites compared to those measured immediately SAS (SAS Institute; Cary, North Carolina, USA). A gen- adjacent to either longitudinally or transversely closed sites at eral linear model (PROC GLM) was used to compare the each pressure (P , 0.001). pre- (baseline) and post-closure enteric circumference and the difference between pre- and post-closure by site (orad versus Discussion aborad), method (longitudinal versus transverse), and pressure Volume of saline needed to leak test selected small intestinal (20 versus 34 cm water). Least square means were calculated segments in dogs after biopsy has been reported previously (2). for each dependent variable and significant differences were Minimal information is available regarding effect on lumen size detected using Tukey’s test of multiple comparisons. To deter- or leakage of longitudinal or transverse closure of enterotomies, mine whether or not the incidence of leaks was dependent on including biopsy sites. Transverse closure of enterotomies in a site, pressure, or closure orientation, Wald Chi-square analysis small-diameter loop of intestine has been suggested, so as to not was performed (PROC LOGISTIC) with leak reduced to a limit the intestinal diameter at the site (5,6). Transverse closure binomial (yes or no). Finally, linear regression (PROC REG) may be inappropriate in some circumstances, due to potential for was used to explore the relationship between body weight and luminal distortion. Information regarding effect of closure ori- pre- or post-closure enteric circumference, leaks, and volume of entation of enteric biopsy sites on security of closure and enteric saline needed to achieve the target pressure of 20 cm or 34 cm circumference is important, in part, because complications water. Students paired t-test was used to compare measurements associated with enteric biopsy in dogs have been reported (1).

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measurement in transverse closures. The presence of suture material/knots limited the ability to obtain an accurate measurement directly over the transverse closures. Transverse closure did not result in an area of depression, as did longitudinal closure, thus enteric circumference was measured immediately adjacent to the suture line. The finding of baseline differences

in circumference of the 2 sites (aborad jejunum and presumed ARTICLE orad ileum) was unexpected, and it complicated the comparison of post-closure enteric circumference. Healing of the biopsy sites was not assessed due to the acute nature of the study. It is unknown what effect the reduced central circumference of longitudinally closed biopsy sites had on enteric healing and long-term enteric circumference. In conclusion, longitudinally closed enteric biopsy sites had Figure 1. Example of a longitudinal closure. a smaller central circumference compared to measurements immediately adjacent to suture lines in both longitudinal and There was a significant difference in post-closure enteric cir- transverse closures. Closure orientation did not impact the cumference between the central portion of longitudinal closures incidence of leaks. CVJ and those measured immediately adjacent to suture lines in both References longitudinal (Figure 1) and transverse closures. There was also 1. Shales CJ, Warren J, Anderson DM, Baines SJ, White RA. Complications a significant difference in volume of saline needed to achieve following full-thickness small intestinal biopsy in 66 dogs: A retrospective 20 cm and 34 cm H2O, consistent with a previous report (2). study. J Small Anim Pract 2005;46:317–321. The volume of saline needed to reach predetermined pressures 2. Saile K, Boothe HW, Boothe DM. Saline volume necessary to achieve predetermined intraluminal pressures during leak testing of small intes- of 20 cm and 34 cm H2O during leak testing was similar for tinal biopsy sites in the dog. Vet Surg 2010;39:900–903. each closure orientation. The upper pressure measurement was 3. Smith S, McGeehin W, Kozol RA, Giles D. The efficacy of intraoperative chosen because intraluminal pressures in normal dogs have been methylene blue enemas to assess the integrity of a colonic anastomosis. BMC Surg 2007;7:15–19. recorded to be as high as 34 cm H2O (25 mmHg) in the small 4. Wheeler JM, Gilbert JM. Controlled intraoperative water testing of left- intestine during peristalsis (9). The orientation of closure of sided colorectal anastomoses: Are ileostomies avoidable? Ann R Coll Surg a 6-mm intestinal defect did not influence closure security as Engl 1999;81:105–108. 5. Ellison GW. Enterotomy. In: Bojrab MJ, ed. Current Techniques in indicated by leak tests. The “ideal” number of sutures needed to Small Animal Surgery. 4th ed. Philadelphia, Pennsylvania: Williams and close a 6-mm intestinal defect is unknown; clinical experience Wilkins, 1998:245–248. suggests that 3 to 4 sutures should achieve an effective closure 6. Pavletic MM, Berg J. Gastrointestinal surgery. In: Lipowitz AJ, Caywood DD, eds. Complications in Small Animal Surgery: Diagnosis, in most situations and limit the amount of suture material in Management, and Prevention. Baltimore, Maryland: Williams and the wound. In the present study, closure orientation of a 6-mm Wilkins, 1996:381. enteric biopsy site did not significantly influence incidence 7. Keats MM, Weeren R, Greenlee P, Evans KL, Minihan AC. Investigation of Keyes skin biopsy instrument for intestinal biopsy versus a standard of enteric leak during leak testing but did influence enteric biopsy technique. J Am Anim Hosp Assoc 2004;40:405–410. circumference. 8. Brown DC. Small intestine. In: Tobias KM, Johnston SA, eds. Veterinary This study had several limitations. Central circumferential Surgery: Small Animal. St. Louis, Missouri: Elsevier, 2012:1528. 9. Ellison GW. Intestinal obstruction. In: Bojrab MJ, ed. Disease measurements were only obtained for longitudinal closures Mechanisms in Small Animal Surgery. 2nd ed. Philadelphia, Pennsylvania: because of the interference of sutures and knots with a similar Lea & Febiger, 1993:252–257.

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New Products Nouveaux produits

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Introducing the Veterinary Equipment Exchange Network (VEEN) Canmedical is proud to announce a veterinarian to veterinar- a handy shopping cart. Visit www.veencanada.com for more ian equipment exchange network called VEEN (Veterinary details. Equipment Exchange Network). Veterinarians anywhere in North

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CVJ / VOL 55 / JANUARY 2014 1259 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

Associate salaries increase ... for half the provinces Les salaires des vétérinaires augmentent... pour la moitié des provinces

Darren Osborne

midst weak economic numbers coming from veterinary n consultant les données financières qui proviennent des A hospitals around the country, associate salaries beat infla- E cliniques des diverses régions du pays, nous constatons tion in 5 of 10 provinces. Nationally, the average associate que les salaires des vétérinaires étaient supérieurs à l’inflation veterinarian experienced a 3% salary increase; 2% better than dans 5 des 10 provinces. À l’échelle nationale, le vétérinaire inflation which is running uncharacteristically low at 1%. moyen a connu une hausse salariale de 3 %, soit 2 % de plus Inflation, both nationally and provincially, was down from a que l’inflation qui se situe à un faible taux inhabituel de 1 %. high of 3% two years ago; the current rate of 1% nationally and L’inflation, à l’échelle nationale et provinciale, a chuté d’un a range of 0% to 3% provincially provides an opportunity for sommet de 3 % il y a deux ans; le taux actuel de 1 % à staff veterinarians to get real gains in income even with mediocre l’échelle nationale et l’écart de 0 % à 3 % à l’échelle provinciale wage increases. Any wage increase above the rate of inflation is fournissent l’occasion aux vétérinaires salariés d’obtenir des considered to be a “real economic gain” because it provides the gains réels du revenu, et ce, même avec des hausses salariales individual with more purchasing power than before. médiocres. Toute hausse salariale au-dessus du taux d’inflation Figures for average associate salaries come from the 2013 est considérée comme un «gain économique» parce qu’elle Survey of Associate Compensation and Benefits. This survey procure un pouvoir d’achat supérieur. was conducted by the Canadian Veterinary Medical Association Les données sur les salaires moyens des vétérinaires proviennent in conjunction with the provincial associations and corporate du Sondage sur la rémunération et les avantages sociaux 2013. Ce sponsors, PetSecure, Merck Animal Health, Scotiabank, and sondage a été réalisé par l’Association canadienne des médecins Idexx Laboratories. Results are provided for individual provinces vétérinaires en collaboration avec les associations provinciales et (Table 1). les sociétés commanditaires : PetSecure, Merck Santé Animale, The 2013 survey was distributed to all associates across the Banque Scotia et Idexx Laboratories. Les résultats sont fournis country; 1037 surveys were returned for a 26% response rate. pour les provinces individuelles (tableau 1). Figures in the report are generally accurate to 2%, 19 times out Le sondage 2013 a été distribué à tous les vétérinaires salariés of 20. Respondents were asked to provide information related du pays; 1037 sondages ont été retournés pour un taux de réponse to their current salary and benefits from private practice in de 26 %. Les données du rapport sont généralement exactes selon 2013. The survey examined several characteristics such as type un écart de 2 %, 19 fois sur 20. On a demandé aux répondants of practice, seniority, and location, and evaluated the effect the de fournir des renseignements se rapportant à leur salaire et à characteristics had on salary. leurs avantages sociaux actuels en pratique privée en 2013. Le Many trends were inconsistent with half the provinces going sondage a examiné plusieurs caractéristiques, incluant le type de in one direction and half going in the other. Nationally the aver- pratique, l’ancienneté et l’emplacement, et il a évalué l’effet des age increase of 3% was ahead of inflation but only 5 provinces caractéristiques sur le salaire.

This article is provided as part of the CVMA Business Management Program, which is co-sponsored by IDEXX Laboratories, Petsecure Insurance, Merck Animal Health, and Scotiabank. Address all correspondence to the CVMA Business Management Committee; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. Le présent article est rédigé dans le cadre du Programme de gestion commerciale de l’ACMV, qui est cocommandité par IDEXX Laboratories, Petsecure Insurance, Merck Santé Animale et la Banque Scotia. Veuillez adresser toute correspondance au Comité de la gestion commerciale de l’ACMV; courriel : [email protected] L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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Table 1./Tableau 1. Comparison of average associate salaries for 2012 and 2013/Comparaison des salaires moyens des vétérinaires pour 2012 et 2013 PRACTICE MANAGEMENT VETERINARY Number Median salary Median salary 2013–2012 of responses 2013 2012 Change Nombre Salaire médian Salaire médian Changement Inflation Real gain de réponses 2013 2012 2013–2012 Inflation Gain réel NF/T.-N. 13 $85 000 $85 750 21% 2% 0% PEI/Î.-P.-É 5 $57 348 $62 856 29% 2% 0% NB/N.-B. 47 $74 000 $70 000 6% 1% 5% NS/N.-É. 58 $70 000 $70 000 0% 1% 0% QC/QC 216 $70 000 $68 000 3% 1% 2% ON/Ont. 363 $79 662 $77 000 3% 1% 2% MB/Man. 71 $80 000 $77 250 4% 3% 1% SK/Sask. 53 $75 000 $74 500 1% 2% 0% AB/Alb. 158 $87 500 $83 000 5% 1% 4% BC/C.-B. 53 $80 000 $85 000 26% 0% 0% CND/CAN 1037 $77 808 $75 670 3% 1% 2%

AB — Alberta, BC — British Columbia, CND — Canada, MB — Manitoba, NB — New Brunswick, NF — Newfoundland, NS — Nova Scotia, ON — Ontario, PEI — Prince Edward Island, QC — Quebec, SK — Saskatchewan./Alb. — Alberta, C.-B. — Colombie-Britannique, CAN — Canada, Man. — Manitoba, N.-B. — Nouveau-Brunswick, T.-N. — Terre-Neuve, N.-É. — Nouvelle-Écosse, Ont. — Ontario, Î.-P.-É. — Île-du-Prince-Édouard, QC — Québec, Sask. — Saskatchewan. saw average increases that beat inflation. Alberta surged ahead Beaucoup de tendances ne concordaient pas avec les faits for the second year with a 5% gain in average associate salaries indiquant la moitié des provinces allant dans une direction et and with provincial inflation only running at 1%, the real gain l’autre moitié se dirigeant dans l’autre direction. À l’échelle for associates amounted to 4%. Last year, the average associate in nationale, la hausse moyenne de 3 % se situait au-dessus de Alberta experienced a 4% increase in salaries. The other province l’inflation, mais seulement cinq provinces ont observé des with higher than average salary increases was New Brunswick hausses qui ont battu l’inflation. L’Alberta a pris de l’avance with a 6% increase. New Brunswick posted a lower inflation rate pour la deuxième année avec un gain de 5 % des salaires moyens of 1% and veterinarians in that province were able to experi- des vétérinaires et, vu que l’inflation provinciale s’établissait ence an average real gain in salaries of 5%. This was good news à seulement 1%, le gain réel pour les vétérinaires s’élevait à considering that last year there was zero growth in associate 4 %. L’an dernier, le vétérinaire moyen de l’Alberta a connu salaries in New Brunswick. une hausse salariale de 4 %. L’autre province avec des hausses Provinces that experienced decreases in salaries included salariales supérieures à la moyenne était le Nouveau-Brunswick, British Columbia, Newfoundland, and Prince Edward Island. avec une hausse de 6 %. Le Nouveau-Brunswick affichait un taux The decrease in wages for these provinces reflects changes in inférieur d’inflation de 1 % et les vétérinaires de cette province seniority levels in the sample. Consistently, veterinarians with ont pu connaître un gain salarial réel moyen de 5 %. Ce sont de less seniority earn lower salaries and in these 3 provinces, there bonnes nouvelles car, l’an dernier, les salaires des vétérinaires au are smaller samples and more, less-experienced veterinarians Nouveau-Brunswick avaient connu une croissance zéro. reporting than in previous years. It is not expected that indi- Les provinces qui ont connu des baisses des salaires incluaient vidual veterinarians experienced salary cuts. la Colombie-Britannique, Terre-Neuve et l’Île-du-Prince-Édouard. The other 5 provinces experienced real increases in wages La baisse des salaires pour ces provinces reflète un changement des between 0% and 2%. Nationally, the real increase in associate niveaux d’ancienneté dans l’échantillon. Les vétérinaires qui ont salaries was 2%. What is the reason for weak increases? We moins d’ancienneté gagnent généralement des salaires inférieurs know from the 2012 Practice Owners Economic Survey (1) et, dans ces trois provinces, il y avait des échantillons plus petits that veterinary practices across the country are suffering with et, cette année, plus de vétérinaires possédant moins d’expérience declining client numbers and stagnating revenues and under ont répondu au sondage par rapport aux années antérieures. Nous these economic conditions practice owners are less likely to offer ne nous attendons pas à ce que les vétérinaires individuels aient higher increases in salaries for staff veterinarians. subi des réductions de salaire. To counter a weakened market for associate salaries, some Les cinq autres provinces ont connu des hausses salariales associate veterinarians are offering to take on some of the finan- réelles se situant entre 0 % et 2 %. À l’échelle nationale, la cial risk and it is turning into significant increases in wages. The hausse réelle des salaires des vétérinaires a été de 2 %. Quelle est key factors that contribute to increased salaries for associates la raison pour les faibles hausses? En nous basant sur le Sondage include type of practice, location, seniority, and method of économique 2012 auprès des propriétaires de pratique (1), nous payment. In the short run, there is little that can be done to savons que les pratiques vétérinaires du pays souffrent d’une affect demographics or seniority, but associates can change the baisse du nombre de clients et d’une stagnation des revenus et, way they are getting paid. Associates who are paid a commis- en raison de ces conditions économiques, il est moins probable sion based on the gross revenue they bring in earn 23% higher que les propriétaires de pratique offriront des hausses de salaire full-time salaries than the average. supérieures aux vétérinaires. Compensation based on revenue is attractive to the practice Pour compenser un marché affaibli pour les salaires des owner because the associate is shouldering some of the risk that vétérinaires, certains vétérinaires offrent d’assumer une part du

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goes with paying a higher salary. The threat of inconsistent or Associate salaries increased 3% in 2013. The increase was declining revenues stands in the way of most salary increases. If above the rate of inflation nationally but only half the provinces a practice owner was guaranteed that an associate could attain saw increases above the rate of inflation. A weakened veterinary a revenue target, then they could be more forthcoming with economy appears to be what is holding back associate salaries salaries. The problem is what comes first — does the associate and, until the economy turns around, associate veterinarians wait to hit the revenue target before salary goes up or does the wanting to beat the odds will have to look to creative payment practice owner offer the higher salary and hope the associate methods like compensation-based pay. makes the revenue target. With commissioned-based pay you References get the chicken and egg. The owner gets the assurance that the 1. CVMA Practice Owners Economic Survey 2012. Canadian Veterinary higher wage will only get paid if the revenue target is met and Medical Association website. Available from: http://www.canadian the associate is guaranteed to get the higher pay when they hit veterinarians.net Last accessed August 19, 2013. the target. Information on compensation pay rates is available 2. CVMA 2012 Report on Compensation and Benefits for Associate Veterinarians Canadian Veterinary Medical Association website. in the Report on Associate Compensation and Benefits (2) offer Available from: http://www.canadianveterinarians.net Last accessed through the specific provincial veterinary medical associations. August 19, 2013. ■ GESTION D’UNECLINIQUE VÉTÉRINAIRE

risque financier, ce qui produit des hausses salariales importantes. le salaire supérieur ne sera versé que si l’objectif de revenu est Les principaux facteurs qui contribuent aux hausses salariales atteint et le vétérinaire obtient l’assurance qu’il recevra un salaire pour les vétérinaires incluent le type de pratique, l’emplacement, supérieur lorsqu’il atteint l’objectif. Des données sur les taux l’ancienneté et le mode de paiement. À court terme, il y a peu de salariaux sont publiées dans le Rapport sur la rémunération et les mesures qui peuvent influencer les données démographiques ou avantages sociaux des vétérinaires salariés (2) qui est offert par les l’ancienneté, mais les vétérinaires salariées peuvent modifier la associations provinciales de médecins vétérinaires. façon dont ils sont rémunérés. Les vétérinaires qui sont rémunérés Les salaires des vétérinaires ont augmenté de 3 % en 2013. La à la commission en fonction du revenu brut peuvent toucher un hausse se situait au-dessus du taux d’inflation à l’échelle nationale, salaire à temps plein qui est de 23 % supérieur à la moyenne. mais seulement la moitié des provinces ont constaté des hausses Par ailleurs, la rémunération en fonction du revenu est au-dessus du taux d’inflation. Une économie vétérinaire affaiblie attrayante pour le propriétaire de pratique parce que le vétérinaire semble être le facteur qui limite les salaires des vétérinaires et, assume une partie du risque qui se rattache au versement d’un jusqu’à ce que l’économie se rétablisse, les vétérinaires qui veulent salaire supérieur. La menace de recettes instables ou en perte déjouer les cotes devront chercher des modes de paiement créatifs, de vitesse représente un obstacle pour la plupart des hausses y compris le salaire à la commission. salariales. Si le propriétaire de pratique recevait une garantie qu’un vétérinaire pouvait atteindre un objectif de revenu, alors Renvois il pourrait être plus généreux avec les salaires. Le problème 1. Sondage économique 2012 de l’ACMV auprès des propriétaires de pratique. Site Web de l’Association canadienne des médecins vétérinaires. Dispo est de savoir ce qui vient en premier — le vétérinaire doit-il nible au : http://www.veterinairesaucanada.net Dernière consultation le attendre d’atteindre l’objectif de revenu avant d’obtenir une 19 août 2013. hausse de salaire ou est-ce que le propriétaire de pratique doit 2. Rapport de l’ACMV 2012 sur la rémunération et les avantages sociaux des vétérinaires salariés. Site Web de l’Association canadienne des méde offrir un salaire supérieur et espérer que le vétérinaire atteindra cins vétérinaires. Disponible au : http://www.veterinairesaucanada.net l’objectif de revenu. En versant un salaire à la commission, vous Dernière consultation le 19 août 2013. ■ obtenez la poule et l’œuf. Le propriétaire obtient l’assurance que

1262 CVJ / VOL 55 / JANUARY 2014 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Lynne S. Sandmeyer, Bianca S. Bauer, Bruce H. Grahn

History and clinical signs 10-year-old, castrated male Quarter horse was examined A at the ophthalmology service at the Western College of Veterinary Medicine related to a 3-day history of squint- ing, ocular discharge, and a white spot on the cornea of the right eye. The horse was currently being treated with topical BNP ophthalmic ointment, and a systemic non-steroidal anti- inflammatory drug (NSAID), Flunixin meglumine (Flunazin; Vétoquinol Canada, Lavaltrie, Quebec). The menace responses, and palpebral and occulocephalic reflexes were present bilaterally. The direct and consensual pupillary light reflexes were present bilaterally. Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 35 and 20 mm/min in the right and left eye, respectively. The Figure 1. Photograph of the right eye of a 10-year-old Quarter intraocular pressures were estimated with a rebound tonometer horse. (Tonvet; Tiolat, Helsinki, Finland) and were 7 and 17 mmHg in the right and left eye, respectively. Fluorescein staining (Fluorets; which includes those that are infected, melting, and/or deep/ Bausch & Lomb Canada, Markham, Ontario) was positive perforated. Melting is more appropriately referred to as kerato- over a 6-mm oval area in the central right cornea. On direct malacia. Keratomalacia occurs due to enzymatic breakdown of examination there was moderate blepharospasm, conjunctival the cornea (1,2). Microbial enzymes, such as collagenases and hyperemia, and mucopurulent ocular discharge in the right proteinases incite dissolution of the corneal intercellular ground eye. Biomicroscopic examination (Osram 64222; Carl Zeiss substance and collagen lamellae. Neutrophils, attracted by che- Canada, Don Mills, Ontario) of the cornea revealed a diffusely motactic factors invade the corneal stroma, then degranulate edematous, central, 6 mm, oval, gray-white, soft, slighty raised, and release additional degradative proteinases (1,2). Progressive and ulcerated lesion. The right pupil was miotic and moderate stromal necrosis can result in rapid, increasing depth of the aqueous flare was present. The right pupil did not completely stromal lesion. dilate following application of 0.5% tropicamide (Mydriacyl; The clinical manifestations of a melting corneal ulcer include Alcon Canada). Indirect ophthalmoscopic (Heine Omega 200; photophobia, blepharospasm, corneal edema, lacrimation, and Heine Instruments Canada, Kitchener, Ontario) examination often a purulent ocular discharge. There is frequently a yellow/ was normal bilaterally. A photograph of the right eye following white infiltrate of inflammatory cells in the ulcer bed. In addi- mydriasis is provided for your assessment (Figure 1). tion, the corneal stroma becomes opaque, soft, and liquid-like. Melting corneal ulcers, like all complex corneal ulcers, are What are your clinical diagnosis, accompanied by anterior uveitis. Manifestations of anterior uve- differential diagnoses, therapeutic plan, itis include miosis, ciliary spasm causing pain and photophobia, and prognosis? lacrimation, aqueous flare, and a lowered intraocular pressure. Discussion The diagnosis of a melting corneal ulcer is based on clini- Our clinical diagnosis was a melting corneal ulcer and anterior cal manifestations and positive fluorescein staining. Further uveitis in the right eye. A melting ulcer is a form of complex diagnostic testing in all cases of complex corneal ulcers should corneal ulceration. This is a clinical category of corneal ulcers include aerobic and anaerobic bacterial and fungal culture and sensitivities and corneal ulcer cytology. Cultures and scrapings Department of Small Animal Clinical Sciences, Western College for cytology must be taken directly from the corneal ulcer to of Veterinary Medicine, University of Saskatchewan, 52 Campus obtain meaningful results. If surgery is part of the therapeutic Drive, Saskatoon, Saskatchewan S7N 5B4. plan, keratectomy specimens removed at the time of surgery Use of this article is limited to a single copy for personal study. are submitted for histopathology and laboratory analysis for Anyone interested in obtaining reprints should contact the potential microbial colonization of these lesions. CVMA office ([email protected]) for additional Melting ulcers are ocular emergencies as progression copies or permission to use this material elsewhere. may result in loss of the cornea and eye within 24 to 48 h.

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Progression of melting ulcers may result in corneal perforation properties of serum. The deeper layers of the graft provide and development of septic endophthalmitis. Treatment of all immediate fibroblasts and collagen with which to rebuild the complex corneal ulcers requires aggressive medical therapy, corneal stroma (3,4). Medical therapy is initiated to stabilize the often in combination with surgical therapy (3,4). The choice corneal disease prior to surgery to reduce protease digestion of of antimicrobial is most appropriately made based upon the the absorbable sutures that will hold the graft in place (usually results of culture and sensitivity. However, results of cultures 12 to 24 h before surgery) and continued after surgery for 3 to are often not available for 48 to 72 h following submission. 4 wk (3,4). Cytologic examination may aid in identification of bacterial or Treatment of this horse was initiated with topical Tobramycin fungal organisms and may be useful in directing initial therapy 0.3% (Tobrex; Alcon Canada), q4h. Autologous serum was while awaiting culture results. Pseudomonas spp. are the most also applied q4h. A topical NSAID, diclofenac sodium 0.1% notorious organisms associated with melting ulcers. Tobramycin (Voltaren; Novartis, Mississauga, Ontario), q6h and a systemic or amikacin are good antibiotic choices to initially treat a melt- NSAID, Flunixin meglumine (Flunazin; Vétoquinol Canada), ing ulcer due to the susceptibility of most Pseudomonas spp. 1.1 mg/kg body weight (BW), q12h, IV were initiated to reduce (5). Frequency of administration of antimicrobials in complex intraocular inflammation. Topical atropine sulphate 1% (Isopto- OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE ulcers should be every 1 to 4 h with the higher frequencies used atropine; Alcon Canada) was administered q6h. The eye was in severely infected or melting ulcers. treated medically until surgery the following day at which time Anticollagenases are required for treatment of keratoma- the abnormal corneal tissue was removed by lamellar keratec- lacia. There are several different anticollagenases reported tomy. This tissue was submitted for histopathologic examination for use in melting ulcers including autologous serum, 10% for bacterial and fungal organisms. A vascularized conjunctival N-acetylcysteine, 0.05% potassium EDTA, and tetracycline anti- pedicle graft was sutured into the corneal defect. A subpalpebral biotics (2). However, the most commonly used, readily available, lavage system (Mila International, Florence, Kentucky, USA) was and broad-spectrum anticollagenase is autologous serum. Serum placed to facilitate post-operative medical therapy. is obtained from the patient and must be stored and handled in Results of corneal cultures were negative for bacterial and a sterile manner to prevent bacterial growth. It may be kept in fungal organisms in this case. Cytologic and histopathologic the refrigerator and should be replaced with fresh serum at least examinations revealed suppurative keratitis but organisms were every 8 d (1,2). Anticollagenases are most often applied every not identified. Corneal cultures may be negative either due to hour for the first 24 h or until stromal liquefaction is halted, superficial culture collections that miss deeper organisms or and then frequency of administration is tapered. previous use of antimicrobials before cultures are attempted. In addition to antimicrobial and anticollagenase therapy, Topical and systemic medical therapies were continued for control of uveitis is essential. The mainstay of treatment for 3 wk following surgery, after which re-evaluation revealed a uveitis is a combination of anti-inflammatory and anticholin- comfortable and sighted eye. The conjunctival graft was healing ergic therapy. Systemic non-steroidal anti-inflammatory drugs and incorporated into the cornea. The remainder of the ocular (NSAIDs) should be used to reduce pain and inflammation. examination was normal. The subpalpebral lavage system was Topical NSAIDs applied up to 4 times daily are also recom- removed and all ocular medications were discontinued. mended to reduce anterior uveitis in cases of complex corneal The prognosis for any complex corneal ulcer is guarded as ulceration. Topically applied anticholinergics (1% to 2% atro- there is the potential for rapid progression. Early and accurate pine) are useful for 3 reasons: they reduce protein and cellular diagnosis and instituting aggressive medical therapy contribute leakage from inflamed uveal blood vessels, they dilate the pupil greatly to a successful outcome. A combination of medical and which protects the eye from development of posterior synechia, surgical therapy is often required in the management of complex and they relax ciliary muscle spasm, which is a major factor in corneal ulcers. discomfort associated with uveitis (3). References Following initiation of appropriate medical treatment, 1. Brooks DE. Inflammatory stromal keratopathies: Medical management prompt referral to an ophthalmologist for potential surgery of stromal keratomalacia, stromal abscesses, eosinophilic keratitis and is recommended in all cases of complex corneal ulceration. band keratopathy in the horse. Vet Clin North Am Equine Pract 2004; Infected and melting ulcers benefit from a keratectomy to 20:345–360. 2. Brooks DE, Ollivier FJ. Matrix metalloproteinase inhibition in corneal remove infected and necrotic cornea and this is usually fol- ulceration. Vet Clin North Am Small Anim Pract 2004;34:611–622. lowed by placement of a conjunctival or corneal graft (3,4). The 3. Brooks DE, Matthews AG. Equine Ophthalmology. In: Gelatt KN, ed. most commonly performed grafting procedure in these cases Veterinary Ophthalmology. 4th ed. Ames, Iowa: Blackwell Publishing, 2007:1165–1274. is the conjunctival pedicle graft in which the base of the graft 4. McLauglin SA, Gilger BC, Whitley RD. Infectious keratitis in horses: retains a connection to the bulbar conjunctiva. The benefits of Evaluation and management. Compend Contin Edu Pract Vet 1992; the conjunctival pedicle graft include replacement of tissue to 14:372–379. 5. Sweeny CR, Irby NL. Topical treatment of Pseudomonas sp-infected cor- strengthen the corneal defect and the continued presence of a neal ulcers in horses: 70 cases (1977–1994). J Am Vet Med Assoc 1996; blood supply. This is useful to provide the affected cornea with 209:954–957. the antibacterial, antifungal, antiprotease, and anticollagenase

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Industry News Nouvelles de l’industrie

Merck Animal Health is pleased to introduce the following appointments: Daniel Beauchamp, General Manager, Merck Animal Susanne Martin Health Canada Susanne Martin is the new Regional Sales Daniel Beauchamp is the new General Manager for Companion Animals in Manager of its Animal Health division in Eastern Canada. Susanne is a graduate Canada. In this role, Daniel will be respon- from the University of Guelph, with a sible for leading Merck’s Canadian Animal Honours Bachelor degree in Biological Health commercial division with the stra- Sciences and a Master of Science degree in tegic objective of providing integrated Epidemiology. She brings with extensive solutions with innovative animal health experience in the Canadian small animal products and services that meet the evolv- health industry as a territory manager and ing needs of the industry. product manager with Pfizer (now Zoetis). Daniel is a proven leader with more than 25 years of successful industry experience that he brings to Merck Animal Health. Jacki Rocchio He has held senior leadership roles in a number of organizations Jacki Rocchio is the new Regional Sales in the U.S. and Canada. Most recently, he served as Country Manager for Companion Animals in Manager for Vetoquinol USA and Vetoquinol Canada. Daniel Ontario. Jacki is an accomplished pharma- has also worked in sales and marketing at Pfizer Animal Health ceutical executive with extensive sales, mar- in Canada, Intervet in the USA and Hoechst Roussel Vet in keting leadership, and people management Canada. experience in the Canadian industry (both human and animal health pharmaceutical Kevin Ryan industry). She comes from Novartis Kevin Ryan has been appointed to the Animal Health where she held the position of sales District position of Canada Cattle and Equine Manager. Prior, she worked with Janssen Ortho Inc. as a Sales Business Unit Director. Kevin holds a Representative in Animal and Human Health, a Product B.A. Honours in Economics and Political Director, a Product Manager and a Sales Training and Science from the University of Toronto. He Development Manager. has previously held senior sales and mar- Based in Pointe Claire, Quebec, Merck Animal Health is part keting leadership positions with Pfizer of Merck’s global animal health business offering veterinarians, Animal Health, Merial and the Agri-Food farmers, pet owners and governments the widest range of veteri- Division of the Angus Reid Group, based nary pharmaceuticals, vaccines and health management solutions in the United States, Europe and Canada. Kevin is widely rec- and services. It is dedicated to preserving and improving the ognized as an accomplished people manager that is highly com- health, well-being and performance of animals. mitted to developing talent, is highly adept in marketing and market research, and experienced in building longer-term strategic plans in the animal health sector.

Contact: Merck Animal Health, 16750 Trans Canada Hwy, Kirkland, QC H9H 4M7; phone: (514) 426-7300; website: http://www.merck-animal-health.ca

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We specialize in surgical packs: Cruciate, spay, eye, orthopaedic packs and screw-plated sets As well as a full range of flexible and rigid endoscopes CONTACT US FOR NEW CLINIC Special package prices!

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Introducing our new logo!! Same company — New Look Check out our renewed website Still specializing in Autogenous Bacterins and Swine Influenza www.gallantcustomlaboratories.com Vaccines.

Gallant Custom Laboratories Inc., 1425 Bishop St. N Units 10–13 Cambridge, ON N1R 6J9 Toll free: 1 888-838-5223 Fax: 519 620-2489 Contact: Jackie Gallant e mail: [email protected]

Horseback Expeditions Into British Columbia’s Northern Working Wilderness Now Booking, xpeditions & Base Camps (June–September) Veterinary recommended by [email protected] (519) 326-3171 Experience with horses is useful, but not necessary; Fitness however is mandatory…. www.go2mk.ca…[email protected] (http://vimeo.com/user17242253/muskwa-kechika)

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YOU’VE SEEN NOTHING LIKE THIS BALANCING ACT Feline-specific insulin for optimal glycemic control • AAHA recommended • Feline-friendly dose concentration

OPTIMAL GLYCEMIC CONTROL

Relief. Just where it’s needed.

Onsior® is different from other NSAIDs. It’s the ONLY tissue-selective* and COX-2 selective NSAID for dogs and cats.

• With a short blood half-life, Onsior quickly exits the bloodstream, sparing vulnerable organs such as kidneys and the gastrointestinal tract from prolonged exposure to effective drug concentrations.1,2,3 • Onsior is highly protein-bound and mildly acidic, persisting longer and at higher concentrations at the site of inflammation than in blood.1,2 • Available as palatable tablets for dogs and cats. Injectable formulation approved for control of pain and inflammation associated with orthopedic and soft tissue surgery in dogs.

* Clinical significance unknown. 1. Silber H.E. et al. Population Pharmacokinetic Analysis of Blood and Joint Synovial Fluid Concentrations of robenacoxib from healthy dogs and dogs with osteoarthritis Pharm Res. 2010 Dec; 27(12):2633-45. 2. Pelligand L. et al. Pharmacokinetic/pharmacodynamic modeling of robenacoxib in a feline tissue cage model of inflammation. J Vet Pharmacol Ther. 2012 Feb; 35(1):19-32. 3. Brune K, Furst DE., Combining enzyme specificity and tissue selectivity of cyclo-oxygenase inhibitors: towards better tolerability? Rheumatology (Oxford) 2007 Jun; 46(6):911-9.

CLIENT : Novartis DOCKET NUMBER : NV3287 PRODUCER DATE PROOF # PROJECT : NV3287 - Onsior Journal Ad FILE NAME : NV3287 Onsior Journal Ad-Dog_v7 Charlene Leong Oct 7, 2013 FINAL TITLE : Onsior Journal Ad FLAT SIZE : 8.125’’ x 10.875’’ STUDIO DIRECTOR ACCOUNT EXE/SUP ACCOUNT DIRECTOR AD NUMBER : FINAL SIZE : 8.125’’ x 10.875’’ PUBLICATION : BLEED : 8.375’’ x 11.125’’ ART DIRECTOR DESIGNER PROOFREADER PUBLICATION DATE : COLOURS: CMYK Jonathan Todd