Immune-mediated and autoimmune diseases of the skin often present with oral cavity involvement. Autoimmune subepidermal blistering diseases and pemphigus vulgaris are classic examples. While the primary lesions (vesicles and bullae) are relatively specific, these fragile lesions evolve rapidly into erosions and ulcers, which are lesion types that overlap with many diseases. Furthermore, some immune-mediated diseases such as severe adverse drug reactions, lupus diseases, canine uveodermatological syndrome, and vasculitis, may or may not involve the oral cavity, and often nonoral clinical manifestations are more diagnostic. In these situations, disease knowledge combined with signalment, lesion distribution, and history help to narrow the differentials. Surgical biopsy is required for confirmation in most diseases, while immunosuppressive treatments most typically involve glucocorticoids with or without nonsteroidal immunosuppressants.
Objective—To evaluate the effects of fascial abrasion, fasciotomy, and fascial excision on cutaneous wound healing in cats.
Animals—Eight 1- to 3-year-old domestic shorthair cats.
Procedures—8 evenly spaced 4-cm2 skin wounds were created on each cat's dorsum, and the underlying subcutaneous tissue was removed to expose the epaxial muscle fascia. Wounds were randomized to receive 1 of 4 treatments (2 wounds/treatment/cat): fascial abrasion, fasciotomy, fascial excision, or control treatment (muscle fascia not disturbed). Bandages were changed and digital photographs and acetate tracings of the wounds were obtained for planimetry daily for 1 week, every other day for 2 weeks, and then every third day for 3 weeks (ie, 40-day observation period). Digitized images were evaluated for granulation tissue formation, wound contraction (surface area measurements), and area of epithelialization.
Results—The epithelialized area and open and total wound areas did not differ among treatments at any time point. Time to the first appearance of granulation tissue was significantly shorter for all treatment groups, compared with that of the control group. Time to achieve granulation tissue coverage of wound base was significantly shorter following fasciotomy (9.6 days) and fascial excision (9.0 days), compared with that of control treatment (18.5 days) or abrasion (16.7 days). Numbers of wounds that developed exuberant granulation tissue following fascial excision (9/16) and control treatment (3/16) differed significantly.
Conclusions and Clinical Relevance—Fasciotomy and fascial excision facilitated early granulation tissue development in cutaneous wounds in cats. In clinical use, these fascial treatments may expedite secondary wound closure or skin grafting.
Objective—To evaluate the stability and retention of viscous formulations of the antifungal drug clotrimazole in vitro and to evaluate retention times, absorption, and histologic response to these compounds when placed in the frontal sinus of dogs.
Animals—6 male Beagles.
Procedures—1% clotrimazole gels were formulated with hydroxypropyl cellulose, poloxamer, and carboxymethylcellulose sodium bases. Commercially available 1% clotrimazole creams were also evaluated. Each compound was incubated at 37°C in a funnel. Volume retained and clotrimazole stability were evaluated for 4 weeks. Six compounds were then chosen for in vivo evaluation. The frontal sinuses of 6 dogs were filled with 1 of the 6 compounds. Computed tomographic evaluation was performed weekly for up to 4 weeks to evaluate gel retention. Blood samples were collected to evaluate clotrimazole absorption. Following euthanasia, sinuses were examined histologically.
Results—Commercially available clotrimazole creams were not retained in funnels in vitro. In vivo, hydroxypropyl cellulose– and carboxymethylcellulose-based gels resulted in the most severe inflammatory response and were retained the longest. Poloxamer-based gels had a shorter retention time and were associated with less inflammation. Clotrimazole was minimally absorbed. Despite a marked inflammatory response to several of the clotrimazole-containing gels, no notable adverse clinical responses were observed.
Conclusions and Clinical Relevance—Poloxamer gels had the most promise for improving drug contact within the frontal sinus of dogs, while limiting the inflammatory response. Poloxamer gels have the additional benefit of improved handling as a result of reverse gelation (ie, they gel when warmed to 37°C).
Case Description—A 6-year-old Siberian Husky–mix dog was examined for episodes of collapse.
Clinical Findings—Physical examination, echocardiography, abdominal ultrasonography, ECG, and thoracic computed tomography with contrast were performed and revealed a 2.5 × 2.3 × 2.0-cm mass over the pulmonic valve leaflets, resulting in moderate pulmonic stenosis. Other abnormal findings included systemic hypertension, right bundle branch block, proteinuria, and a urinary bladder mass.
Treatment and Outcome—Pulmonary arteriotomy was performed under inflow occlusion, and the mass was resected with transesophageal echocardiographic guidance and direct visualization. Results of histologic examination of the mass revealed a vascular hamartoma. Sequential follow-up examinations and telephone contacts (at 0.5, 5, and 15 months after surgery) revealed that the patient had been free from episodes of collapse since surgery. No regrowth of the mass was noted on follow-up echocardiograms, and the pulmonic stenosis had resolved, although mild to moderate pulmonary insufficiency later developed. The bladder mass was excised 15 months after the first surgery when hematuria developed, and results of histologic examination of this mass revealed a vascular hamartoma. The dog was eventually euthanized 31 months after the initial surgery for reasons that could not be directly linked to any recurrence of the pulmonary artery mass.
Clinical Relevance—Hamartomas are benign tumors that can be located in various tissues, including large arteries. Computed tomography was helpful in predicting the resectability of the intracardiac mass in this dog. Treatment with arteriotomy under inflow occlusion and mild hypothermia resulted in a favorable outcome.