3135. INTERN, EOSINOPHILIC GRANULOMA COMPLEX. A very old cat has eosinophilic granuloma complex ? Evidence needed.

Sep 12, 2017. At Toa Payoh Vets, big bleeding granuloma now seen.

Thin. Gums are cyanotic and possibly anaemic. No mouth or gum ulcerations.
Only a large granuloma, 1.5 cm x 2 cm x 1.0 cm below the chin.
No heart disease. No blood test, so not possible to assess liver and kidney functions.

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Owner had handphone pictures. Asked to be sent to me.

Need dental scaling. Cat has periodontal disease.
No blood test to screen health. Heart and lung and abdomen OK. .

biopsy of granuloma - advised
Fine Needle Aspiration. Impression smear of granuloma - advised. See lots of eosinophils in the smear or biopsy
Check for FIV/Feline Leukaemia needed.

Megestrol acetate given instead of corticosteroid in this case. 5 mg/day for 7 days and then alternate days. Cat's granuloma no longer bleeds so much, according to the owner when phoned 8 days after treatment. See images.

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WHAT IS EGC?  3 presentations






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OTHER SUSPECTED CASES OF EGC BELOW:

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Diagnosis

DIAGNOSIS is best confirmed by a biopsy or fine needle aspirate of the eosinophilic plaque but the owner wanted to save money and permitted FIV and blood tests only as she has other stray cats to pay for expenses. In this case, the blood test show a higher % of eosinophils at 6% and the clinical signs of oral ulcers, plaques and an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal 3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated --- clindamycin >15-20 days and other antibiotics and powders could affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800). Large platelets present --- toxic products from medications affecting the platelets?  

RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64%   8.69
L 24%   3.19
M 6%    0.77
E 6%     0.81
B 0.3%  0.04
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3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis). Salivation and ulcers are signs.

Eosinophilic Granuloma Complex (EGC)
Three distinct but related clinical syndromes comprise the granuloma complex:

3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in the mouth but usually affects the upper lips. The lesions are well-demarcated ulcers.

3.2 Eosinophilic Plaque. These are raised, moist, red eroded or ulcerated areas with a well demarcated border. Pruritus is usually severe. Lesions usually occur on the underside of the cat (abdomen, brisket or inside the thighs).

3.3 Linear Granulomata. These can occur at most sites, especially behind the hind legs and within the mouth. They are well-demarcated lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name *linear* granuloma.

Treatment:
1. Allergy to fleas, mites, parasites, environmental,
Steroid, ivomectin inj.

2. Allergy to dry cat food.
    If food allergy, hypo-allergenic canned food 6 weeks

3134. INTERN_VIDEO. Rabbit eye disease - corneal dystrophy or kerattitis?

2 month-old female rabbit purchased.  Left eye cloudy.


Article
http://www.medirabbit.com/EN/Eye_diseases/Disorder/Lipid/Lipid_en.htm

Corneal lipidosis - also called corneal dystrophy or lipid keratopathy - is a condition where excess lipids (usually cholesterol esters) or minerals (calcium) are deposited under the surface of the cornea. The infiltration usually starts at the edge of the cornea and can be observed in the anterior stroma, the epithelial basement membrane and the epithelium.

Corneal lipidosis is not associated to a disease; it is not breed or gender dependent.

Etiology

A lipid rich diet and/or trauma are the main causes for lipid deposits into the cornea. Congenital factors cannot be ruled out.

Clinical signs and diagnosis

It is based on a complete ophthalmic examination and a discussion with the owner about the food fed to the rabbit.

Both eyes are usually affected (bilateral) but not necessarily to the same degree. Unilateral lipidosis has rarely been reported. The fat deposits, which usually start near the third eyelid, can be opaque, raised, subtle and pale, bright white, silver or grey colored areas. Vascularization is observed in the affected part of the cornea. While the cornea is mainly affected, fat deposits have also been noted in the lens, iris and ciliary body of a Dutch rabbit. Often it is accompanied by macrophage invasion. An inflammatory process has been observed, but does not always seem to be present.

Unlike in dogs, corneal lipidosis is associated to gradual loss of vision in rabbits. If the deposit is severe, it can lead to ulceration of the cornea.

There is no pain associated to this condition.

http://circ.ahajournals.org/cgi/reprint/18/4/519 Lipid plaque in hypercholesteremic rabbit cornea occurring at site of vascularity. Cornea had been cauterized several times by heated probe.

http://circ.ahajournals.org/cgi/reprint/18/4/519 Sections of rabbit cornea in region of plaque stained with hematoxylin-Sudan. Noteworthy is abundance of intracellular globular lipid and relatively slight amount of granular sudanophilia.

Treatment

There is no medical therapy available, other than bring modification to the diet. Fatty food and milk-based products (cheese, butter, and yogurt) should be discontinued.

It is not known if superficial keratotomy can help.

Further information

Fallon MT, Reinhard MK, DaRif CA, Schoeb TR. Diagnostic exercise: eye lesions in a rabbit. Lab Anim Sci. 1988; 38:612-3.

Garibaldi BA, Goad ME. Lipid keratopathy in the Watanabe (WHHL) rabbit. Vet Pathol. 1988; 25:173-4.

Gwin RM, Gelatt KN. Bilateral ocular lipidosis in a cottontail rabbit fed an all-milk diet. J Am Vet Med Assoc. 1977; 171:887-9.

Hillyer E.V.,  Quesenberry K.E., Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery, New York: WB Saunders Co., 1997, p. 339-345.

Sebesteny A, Sheraidah GA, Trevan DJ, Alexander RA, Ahmed AI. Lipid keratopathy and atheromatosis in an SPF laboratory rabbit colony attributable to diet. Lab Anim. 1985; 19:180-8.

Stock EL, Mendelsohn AD, Lo GG, Ghosh S, O'Grady RB. Lipid keratopathy in rabbits. An animal model system. Arch Ophthalmol. 1985 May;103(5):726-30.

 

 

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Procedure for corneal ulceration examination

 

1. Schirmer tear test 

2. Assess corneal and palpebral reflex

3. Thorough examination of the eyelid and conjunctival anatomy and function including

the caudal surface of the 3rd eyelid.

4. Microbiological examination if corneal ulcer is believed to be infected.

5.  Fluorescein staining

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video rabbit with corneal ulcer  fluorescein stain test

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DOG  CORNEAL DYSTROPHY

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Normal human eye cornea

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3132. Ear abscesses in hamsters - cases at Toa Payoh Vets

Sep 5, 2017

Hamsters do suffer from ear warts and ear abscesses but few owners know. Below are some images of cases.

1. For ear warts, the only treatment is surgery. No medication will make the wart disappear.
However, some vets may prescribe medication as they do not perform surgery.

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3132. A guinea pig had watery greyish stools for one week.

The guinea pig had a big operation on the left side of the shoulder area. The swelling, bigger than 3 golf balls were blood. Some blackish lumps near the lower shoulder were removed. The owner consented to a histology this time.

Histology shows benign haemangioma. The guinea pig went home after surgery 2 weeks ago. He had poor appetite in the first week. Stools were normal. The owner fed other food like vegetables. Also spray anti-mange and mite from a pet shop, onto the body filled with patches of hair loss. The guinea pig must have licked the spray causing gastroenteritis.  He eats the watery stools as well, causing more watery diarrhoea. 

Hospitalised one day. Stools back to normal as shown. Guinea pigs do eat their stool pellets to redigest the pellets, as part of their nature. Now the stool pellets are normal and so it is OK for him to eat them.

3130. Case studies in Toa Payoh Vets: Images of red-eared sliders and turtles

3128. CASE STUDY. VIDEO SCRIPT. A Syrian Hamster has 2 large tumours below the throat

August 28, 2017

"I note that you can remove a hamster's tumour in 5 minutes," the young lady had decided not to let the first vet operate on her Syrian hamster with 2 large subcutaneous tumours below the neck. The hamster had been scratching the affected neck area bald but her appetite is excellent.

If the tumour can be removed in 5 minutes as contrasted to an hour's operation estimated by the first vet, that means that her hamster would likely not die on the operating table.  The owner had to sign a consent form for anaesthesia and surgery and she was aware of the anaesthetic death risks.

"5 minutes is possible if the tumour is as small as 5 mm across, but your hamster's tumours are over 2 cm across," I said. "It takes much longer than 5 minutes."

The first vet had warned her: "The tumours are near the major blood vessels and nerves of the neck and the hamster may die during excision of the tumours!"

"What the first vet says is correct," I replied. "If you had got the tumours excised by the vet when it is very small, less than 5 mm across, the risk of damaging the blood vessels and nerves are practically nil."

INTRODUCTION

Hamster tumours usually develop as small lumps in hamsters over one year old. Many young Singapore hamster owners live hectic working and personal lifestyles. Some do not even have time for their retiree parents, let alone the pet at home.

Singapore has so many distractions and entertainment outlets for the young hamster owner and so the hamster's tumour is left to grow. 

VIDEO OF SUNTEC CITY


Many young Singaporeans procrastinate visiting the vet till the tumours are gigantic as in this case and many others seen at Toa Payoh Vets.

(10 images of hamster tumours operated by Toa Payoh Vets over the 10 years). Many vets do not wish to operate on large hamster tumours. Some will advise oral medication and euthanasia when the infected ulcerated tumours are too large causing the hamster poor health.

Surgical excision is the only treatment. Some vets don't perform hamster surgeyr.


DIAGNOSIS AND TREATMENT by electrosurgery 

This Syrian hamster had 2 mobile subcutaneous tumours.  The smaller one of 1-cm across is nearer to the major blood vessel.  The larger one of 2.5 cm across is below the throat. This is not going to be a simple operation as the owner expected the hamster to be alive at the end of the surgery.

Surgical excision is the only option. Zoletil 100 IM is given at 0.01 ml and it was sufficient for me to remove the 2 tumours without the need for topping up with isoflurane gas. I undermine the skin to detach the tumours. Then I clamp the base and excised the tumour using electro-excision to clot the area. For the larger tumour, I ligate the stump of the large tumour to prevent any bleeding. There was no need to ligate the stump of the smaller tumour. There was no bleeding.  3/0 absorbable sutures were used. The skin was closed by continuous sutures.

VIDEO FOOTAGE

POST-OPERATION

The Syrian hamster was all right and went home around one hour later. The owner and her Taiwanese mother were pleased and would give the oral antibiotics and painkillers. It is a joy to see the Syrian hamster alive.

CONCLUSION

Anaesthetic death is possible if large tumours are operated as they take a much longer time.
Do not procrastinate as hamster tumours never disappear but will grow larger daily.
A 5-minute surgery is possible if the tumour is less than 5 mm across and the risk of anaesthetic death is practically zero. In this case, the hamster survived the anaesthesia and lived to an old age.


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OTHER IMAGES NOT FOR THIS VIDEO

3127. INTERN. Single pup syndrome - Expensive Dachshund puppy saved by Caesarean section

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July 18, 2017   Elective Caesarean Section.  Judgment of breeder to save the pup as it is too large to be born naturally.


2064   Breeder worried. No strong uterine contractions. One large pup palpated. Single pup syndrome.   At Toa Payoh Vets now.

2065. Prepare for surgery.
2070  Cone mask. No IV sedatives like propofol. Just isoflurane and oxygen gas only. By cone mask first, then intubate with endotracheal tube and 2-2.5% isoflurane gas for maintenance.

2071. Intubated.
2072. Uterus taken out of the body.
2073. Stiching in 2 rows.  Illustrations shared with the Corgi pup C-section
2074. 2nd row completed.
2075. Dam awake fast. Washed. oxytocin, antibiotic and painkiller injections.
2076.   Footage of normal water bag with clear fluid inside. Placenta is not normal firm and turgid in size but "melting". The C-section was just in time.

2083. single pup alive.


 



FOLLOW UP 3 WEEKS LATER visit to breeder's farm

See footage in Corgi video in the other blog.




FOLLOW UP AT BREEDER'S FARM    3   WEEKS LATER.
PUPS OK.

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2750     Edit  00:00 - 1:26
Footage shows one of 3 Corgis thriving
Footage shows the single pup (Dachshund) thriving under the poodle. Its mother has not sufficient milk. 
The poodle is the surrogate mother of this single pup syndrome Dachshund and one Corgi. The other 2 corgis are nursed by the Corgi dam.

2773     2 Corgi pups
2772  Dachsund single pup syndrome 
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 CONCLUSION
LIFE AND DEATH depend on the judgment and knowledge of the breeder.

Some do wait for the pup to be born naturally. Generally, the single pup syndrome requires an elective Caesarean section as it is too big to be born naturally in small breed dogs. Death of the pup is expected if the breeder waits past 70 days. The suitable time to operate is 63 days when the pup is fully formed.  The general time of birth for dogs is 59-63 days.


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