ISFM consensus guidelines on the practical management of diabetes mellitus in cats.

PRACTICAL RELEVANCE: Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats. CLINICAL CHALLENGES: Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently--unless hypoglycaemia is encountered. EVIDENCE BASE: The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.

Hair balls in cats: a normal nuisance or a sign that something is wrong?

PRACTICAL RELEVANCE: Vomiting of hair balls is a common problem in domestic cats, to the extent that it is considered by many owners and veterinarians to be a normal feline behaviour. Whether this is ever the case remains unclear but in most shorthaired cats the frequent elimination of hair balls is an indicator of an underlying chronic disease that is causing increased ingestion of fur or altered gastrointestinal motility. Pruritic skin disease, flea infestation and/or an underlying dietary intolerance are common contributing factors that should not be overlooked. EVIDENCE BASE: Studies concerning this common problem are lacking and there are no previously published data regarding the incidence of hair balls in pet cats or potential predisposing causes. Although a range of commercial hair ball control diets are available there is no objective information in the public domain regarding their efficacy. Similarly, no studies have evaluated the success of other commonly recommended preventive strategies. CLINICAL CHALLENGES: Despite the lack of evidence-based information, veterinarians are faced with the day-to-day challenge of helping owners to limit the extent to which their cats produce hair balls. The problem is at best an unpleasant nuisance for both cat and owner, and at worst may be a cause of significant morbidity and even, in rare cases, mortality.

Comparison of how well conscious cats tolerate blood pressure measurement from the radial and coccygeal arteries.

Hypertension is a common condition of older cats and acquiring clinically relevant and repeatable blood pressure (BP) measurements in conscious cats is important in its diagnosis and management. The most common sites for indirect BP measurement in the cat are the radial artery (RA) and the coccygeal artery (CA) but, to date, there are no published data comparing how conscious cats tolerate BP measurements from these sites. A high-definition oscillometric BP monitor was used to measure BP in 30 cats admitted to a cat-only veterinary clinic for reasons other than hypertension. Systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure (DAP) were measured using the RA and CA, alternating which site was used first. The number of failed attempts and total time to achieve six measurements was recorded. Measurement of BP using the CA was better tolerated than the RA, resulting in fewer failures and shorter total time required. SAP measurements were slightly higher from the CA compared with the RA, irrespective of which site was used first. There were no significant differences in MAP and DAP. The coccygeal artery appears to be the more appropriate site to use when measuring BP in conscious cats using this oscillometric machine. Further studies are required using alternative BP monitors, including Doppler machines, to establish whether this is a consistent finding. When measuring BP in cats the site used should be recorded and the same site used for all subsequent measurements from the same cat.

Evaluation of the repeatability of ultrasound scanning for detection of feline polycystic kidney disease.

Polycystic kidney disease (PKD) is the most prevalent inherited genetic disease in cats with Persian and Persian-related breeds predominantly affected. Diagnosis of PKD relied on ultrasound scanning until the recent development of the PKD gene test. However, gene testing has limitations as it will only identify the autosomal dominant form of PKD and not other forms of cystic kidney disease. Ultrasound scanning also has the advantage of being able to assess the severity and progression of disease in PKD affected cats. The aim of this study was to demonstrate the repeatability of ultrasound scanning in the detection of PKD and to assess progression of the disease over time. This study demonstrated 100% repeatability of ultrasound scanning in the detection of PKD and has also demonstrated progression of disease in 75% of PKD positive cats assessed over a 1-year period.

Cutaneous lesions associated with coronavirus-induced vasculitis in a cat with feline infectious peritonitis and concurrent feline immunodeficiency virus infection.

This report describes a clinical case of feline infectious peritonitis (FIP) with multisystemic involvement, including multiple nodular cutaneous lesions, in a cat that was co-infected with feline coronavirus and feline immunodeficiency virus. The skin lesions were caused by a pyogranulomatous-necrotising dermal phlebitis and periphlebitis. Immunohistology demonstrated the presence of coronavirus antigen in macrophages within these lesions. The pathogenesis of FIP involves a viral associated, disseminated phlebitis and periphlebitis which can arise at many sites. Target organs frequently include the eyes, abdominal organs, pleural and peritoneal membranes, and central nervous tissues, but cutaneous lesions have not previously been reported.

Oesophageal strictures in cats associated with doxycycline therapy.

Four cases of oesophageal stricture subsequent to doxycycline administration are reported. All cases were young to middle age (median age 3 years; range 1-7 years), and either domestic shorthair or domestic longhair breed. In all cases the predominant clinical sign was regurgitation, which developed at variable times after doxycycline administration. In all cases the reason for doxycycline use was treatment or prophylaxis of suspected infections (Mycoplasma haemofelis, Chlamydophila felis or Bordetella bronchiseptica), and the duration of therapy was variable. In one case the stricture was definitively diagnosed at post mortem examination, in the three other cases, definitive diagnosis was by endoscopy. Balloon dilation was successful in the three cases that were treated. This is the largest case series, to date, of oesophageal disease in cats associated with doxycycline administration. Caution should be exercised when administering oral medication to cats, especially doxycycline, and should be accompanied either by a water or food swallow.