Case Description—A 7-year-old domestic shorthair cat with a 2-month history of decreased appetite and weight loss was examined because of paraparesis of 1 week's duration that had progressed to paraplegia 3 days earlier.
Clinical Findings—Neurologic examination revealed normo- to hyperreflexia and absence of deep pain sensation in the hind limbs and thoracolumbar spinal hyperesthesia. Neuro-anatomically, the lesion was located within the T3 through L3 spinal cord segments. Biochemical analysis and cytologic examination of CSF revealed no abnormalities. Radiography revealed narrowing of the T11-12 intervertebral disk space and intervertebral foramen suggestive of intervertebral disk disease. Myelography revealed an extradural mass centered at the T12-13 intervertebral disk space with extension over the dorsal surfaces of T11-13 and L1 vertebral bodies.
Treatment and Outcome—A right-sided hemilaminectomy was performed over the T11-12, T12-13, and T13-L1 intervertebral disk spaces, and a space-occupying mass was revealed. Aerobic bacterial culture of samples of the mass yielded growth of a yeast organism after a 10-day incubation period; histologically, Histoplasma capsulatum was identified. Treatment with itraconazole was initiated. Nineteen days after surgery, superficial pain sensation and voluntary motor function were evident in both hind limbs. After approximately 3.5 months, the cat was ambulatory with sling assistance and had regained some ability to urinate voluntarily.
Clinical Relevance—In cats with myelopathies that have no overt evidence of fungal dissemination, differential diagnoses should include CNS histoplasmosis. Although prognosis associated with fungal infections of the CNS is generally guarded, treatment is warranted and may have a positive outcome.
To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol.
105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between January 2019 and March 2020.
Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes.
2 of 105 (1.9%) dogs regurgitated, 1 of 105 (1.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (≥ 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (≥ 4) for both regurgitation and aspiration pneumonia.
CONCLUSIONS AND CLINICAL RELEVANCE
The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks.
Procedure—Complete FHNE was performed on 5 canine femurs. Excision consisting of inadequate removal of the medial distal aspect of the femoral neck was performed on the remaining 5 femurs. Each femur was positioned with predetermined amounts of internal and external rotation about the long axis and radiographed. Investigators evaluated a set of 8 radiographic views of each femur. Sensitivity (SE), specificity (SP), positive predictive value, negative predictive value, and completeness of excision assessment accuracy were estimated for each of the femur positions.
Results—Craniocaudal radiographic views of the femur positioned with external rotation of 15°, 30°, and 45° as a group had the highest SE, SP, and completeness of excision assessment accuracy relative to other radiographic views. The SE, SP, and accuracy of assessment were higher when the degree of external rotation was increased from 15° to 30° or 45°.
Conclusions and Clinical Relevance—Craniocaudal radiographic views of the femur positioned in external rotation (15°, 30°, and 45°) improved the ability to detect adequacy of excision relative to standard craniocaudal and lateromedial radiographic views. Evaluation of craniocaudal radiographic views of the femur positioned in external rotation may increase the ability to assess FHNE adequacy in medium- to large- breed dogs.