Priapism in a Thoroughbred gelding associated with metastatic S. equi infection

This was such a unique case study, we just had to give it an award.

Kristina Simmons Baltutis - NC State

V51 I1 Cases/Abstracts Honorable Mention

Priapism in a Thoroughbred gelding associated with metastatic S. equi infection

K. Simmons, E.A. Coffman, T.M. Beachler, K. McKelvey, B. Breuhaus, C.S. Bailey

Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

A 12-year-old Thoroughbred gelding presented to the NC State College of Veterinary Medicine for acute priapism and weight loss.  A physical exam was unremarkable except for poor body condition (BCS 2/9) and complete protrusion of the erect penis. The penis was reduced into the prepuce following irrigation of the corpus cavernosum with heparinized saline, injection of 10 mg of phenylephrine into the corpus cavernosum, and manual massage using nitrofurazone and DMSO ointment.  A purse string suture and penile sling were placed to assist in penile retention and support.  The erection recurred approximately 8 hours after the procedure, and treatment was repeated. The purse-string was removed after 48 hours due to superficial trauma. The penis remained moderately erect throughout hospitalization and was treated conservatively with a sling to prevent edema, application of tetracycline wound ointment, and hydrotherapy.  Diagnostic procedures to pursue the weight loss included thoracic and abdominal ultrasound, complete blood count and chemistry, urinalysis, urine culture, rectal biopsy, andStreptococcus equi ELISA. Urinalysis revealed 2+ hematuria and pyuria, likely due to preputial inflammation. The serum ELISA assay for S. equi returned strongly positive (1:25,600), consistent with metastatic strangles abscesses. Treatment with trimethoprim sulfamethoxazole (TMS, 30 mg/kg PO BID) and rifampin (5 mg/kg PO BID) was instituted for 8 weeks based on evidence that rifampin may prevent resistance and improve efficacy of the TMS against Streptococcus spp. sequestered in abscesses. At recheck examination seventeen weeks after discharge, the gelding’s BCS was 5/9 and his priapism had improved, although the penis still protruded from the prepuce two inches at most times. Thirty weeks after discharge the animal had returned to a normal weight and the priapism was completely resolved.  Priapism is rare is horses, especially geldings, and there are no reports of priapism secondary to metastatic strangles.

Relay Barbiturate Toxicity Case Report

Hayley Rasmussen - Washington State

In February of 2015 veterinarians were called on emergency to a wild animal sanctuary in Reno, Nevada. The emergency consisted of one wolf found dead, one tiger found unresponsive, and a cheetah found alive but unresponsive. Jamar, a 9-year-old male, castrated cheetah had been at the same sanctuary since April of 2006. When the veterinarian arrived, Jamar was unconscious, hypothermic (not registering by rectal thermometer), tachycardic (180-200 beats per minute), and bradypneic (8-10 breaths per minute).  Mucous membrane color was pink, and capillary refill time was less than two seconds. His eyes were rolled ventral with a very sluggish palpebral response.

Initial treatment was symptomatic and involved warming the patient with appropriate placement of warm fluid bags and blankets, intravenous fluid therapy (emergency replacement at 60 mL/kg for one hour, followed by maintenance level) and dextrose supplementation. At the time of initial treatment, there was a large differential list, including mostly toxic events because of the multiple animal involvement where there was a history of the patients eating a shared meat source.

Blood was drawn to run a complete blood count and serum chemistry panel, while urine was obtained by manual expression so a urinalysis could be performed. The blood work results were unremarkable except for a very mild lymphopenia, hypoproteinemia, and hypernatremia. Urinalysis results were unremarkable as well. An over the counter barbiturate dip-stick test of the urine was positive. A positive OTC urine barbiturate test is not definitive for barbiturate toxicity; however, with the case history and clinical signs this was highly suggestive of relay toxicity in Jamar.

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Necropsy Report

Caitlyn Lennon - Western

V:50 I:4 Cases/Abstracts 1st Place

NECROPSY REPORT

Pet’s Name:        Patient X

Sex:                    Castrated male

Age:                    14 years

Species:              Canine

Weight:               26 lbs       

HISTORY 

Patient presented for evaluation after sliding down the stairs. A grade III/IV heart murmur, laxity of left stifle, moderate obesity, and significant periodontal disease was appreciated. Radiographs revealed mild cardiomegaly, mild left atrial enlargement, an otherwise unremarkable geriatric thorax (mild bronchointerstitial pattern), joint effusion in the left stifle, and mild DJD of the left tarsus. Pre-operative bloodwork revealed mild hyperalbuminemia, elevated ALP, and thrombocytosis. A lateral suture repair was performed the next day. Patient became hypotensive during surgery, but an increase in the fluid rate improved it slightly. At 11:20am the day after surgery the patient had a temperature of 104.5, was panting, had tacky mucous membranes, and was 6-7% dehydrated. His temperature decreased to 101.7 at 1pm after therapy initiated. By 8pm the temperature had increased to 103.1. The next day the patient was found deceased in his cage at 6:45am and his body was placed in the freezer at 12pm.

GROSS EXAMINATION

The animal submitted for necropsy is Patient X, a castrated male terrier mix canine.

Integumentary System:

The carcass has a body condition score of 4/5 with prominent fat stores. An oval mass was found in the right inguinal region, measuring 2.5cm by 1.5cm, and consisted of adipose tissue (lipoma). There was marked hyperemia of the skin in the inguinal region. No other significant lesions were observed in the skin or subcutaneous tissues. 

Musculoskeletal System:

The right hip joint was opened and revealed mild fibrillation, roughening, and erosion of the head of the femur, consistent with mild degenerative joint disease. A 10cm long incision was noted on the lateral aspect of the left stifle region (Figure 3). Staples were removed and sutured layers were incised, revealing strong, nonabsorbable sutures extending from the lateral fabella to the cranial aspect of the tibial crest, extracapsular to the stifle joint (Figure 4). This is consistent with a lateral suture repair technique for a rupture of the cranial cruciate ligament. The stifle joint was opened and no gross lesions were appreciated (Figure 4). The left tarsal joint was also opened and no gross lesions were revealed.

Gross Diagnosis:

1)     Mild degenerative joint disease of the right hip joint

2)     Lateral suture repair surgery of the left stifle

3)     Grossly normal left stifle and tarsal joints

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Canine Exocrine Pancreatic Insufficiency: A Challenging Condition

Introduction

Exocrine pancreatic insufficiency (EPI) is a particularly concerning digestive condition that leads to nutrient deficiencies, weight loss, and death if left untreated (Foster and Smith, 2012). EPI4dogs Foundation defines EPI as “the inability of the pancreas to secrete digestive enzymes: amylase to digest starches, lipases to digest fats, and proteases to digest protein. Without a steady supply of these enzymes to help break down and absorb nutrients, the body starves. When EPI is undiagnosed and left untreated, the entire body is deprived of the nutrients needed for growth, renewal, and maintenance. In time, the body becomes so compromised that the dog either starves to death or dies of organ failure. The Merck Veterinary Manual defines EPI as “a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas”. “Lack of pancreatic digestive enzymes leads to maldigestion and malabsorption” (2011). This condition is certainly nothing to overlook. Many pet owners and veterinarians are unfamiliar with the detrimental condition and the purpose of this case study is to enhance the veterinarian’s and pet owner’s knowledge and awareness of EPI.

Like other canine medical conditions, EPI requires proper diagnosis and management. However, the condition is unique because it also requires a responsible and financially stable dog owner with patience and willingness to learn as much as he or she can about EPI and nutrition. Clinical signs can be misleading, as they are comparable to those of many other conditions. While diagnosis can be simplified when differentials get ruled out, medical bills can add up to an outrageously high expense. Overall management of EPI is best described as nutritionally variable, effective, expensive, and lifelong. The following case report outlines signs, diagnosis, dietary management, and financial aspects of a canine EPI patient. Its purpose is to emphasize requirements of the veterinarian and client in nutritional support for the condition, as well as to highlight the significance of financial requirements. As such, this case can be of interest to a broad readership of veterinary professionals, veterinary science students, and pet owners.

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Stemness and the Post-Injection Response of the Equine Joint to MSC Injection

Jessica Xu, Texas A&M University

Cases/Abstracts, Honorable Mention

Jiajie Jessica Xu, Amanda-Jo Joswig, Ashlee Watts
Comparative Orthopedics and Regenerative Medicine Lab, College of Veterinary Medicine, Texas A&M University
Merial Veterinary Scholars Program and the College of Veterinary Medicine & Biomedical Sciences, Texas A&M University
Link Equine Research Endowment

Stemness and the Post-Injection Response of the Equine Joint to MSC Injection

A mesynchymal stem cell (MSC)’s ability to undergo trilineage differentiation into osteoblasts, adipocytes, and chondroblasts in vitro is one of the defining characteristics of MSC stemness. This quality allows MSCs to be used as a source of cells in tissue engineering and cell therapy. In addition to cellular differentiation, MSCs also play a role in modulating inflammatory responses by releasing anti-inflammatory factors during tissue repair. Though traditional stemness has been associated with effective tissue repair, the relationship between MSC stemness and immunomodulatory function is unknown. To study this, bone marrow derived MSCs were collected from 6 horses, and injected autologously. The same MSCs were also injected allogeneically into 6 separate horses. Joint fluid cytologic analysis was performed on injected joints to assess the inflammatory response. Stem cells from the donor horses were then cultured in vitro and tested for their ability to undergo trilineage differentiation using visual grading systems. By comparing MSC inflammatory response with stemness qualities, this study re-examines the criteria of what it means to be an effective stem cell.