Presumed secondary immune-mediated haemolytic anaemia following elapid snake envenomation and its treatment in four dogs.

CASE SERIES: This case series describes secondary immune-mediated haemolytic anaemia (IMHA) in four dogs following elapid snake envenomation and its treatment. All the dogs initially presented with clinical signs commensurate with mainland tiger snake (Notechis scutatus) envenomation. None of the dogs was anaemic at the time of presentation. IMHA was diagnosed 3-9 days following snake envenomation. The trigger for IMHA was unclear in each case and may have been a component of the snake venom, antivenom, fresh frozen plasma, concurrent morbidity, administered drugs or a combination thereof. Three of the four dogs received immunosuppressive therapy comprising corticosteroids with or without azathioprine. Resolution of the IMHA was documented 6 weeks after diagnosis for one dog and 9 months after diagnosis for two dogs, with one dog lost to follow-up. CONCLUSION: IMHA is a potential complicating factor of elapid snake envenomation and its treatment in dogs, and should be considered as a differential diagnosis for a persistent or worsening anaemia. Both the incidence and aetiopathogenesis of IMHA in the context of elapid snake envenomation and its treatment in dogs are unknown and require further examination.

Extramedullary laryngeal plasmacytoma in a dog.

CASE HISTORY: An 8-year-old, female, spayed Border Collie presented with a 3-week history of coughing, choking and haemoptysis. CLINICAL FINDINGS: Inspiratory stridor was evident on clinical examination. Cervical radiographs revealed a round soft-tissue mass on the dorsal aspect of the epiglottis. A laryngeal mass was evident on examination under anaesthesia, and an incisional biopsy was obtained. Histopathology revealed a dense proliferation of neoplastic round cells morphologically consistent with plasma cell origin. Immunohistochemisty results were negative for CD3 (T cell marker) and positive for CD79a (B cell marker), resulting in a diagnosis of extramedullary plasmacytoma. The patient was treated with melphalan and prednisolone; clinical signs resolved within 1 week and the mass was no longer evident on laryngoscopy after 1 month of treatment. After 6 months of chemotherapy, the laryngeal mass recurred and euthanasia was requested. There was no evidence of systemic spread on post-mortem examination. DIAGNOSIS: Solitary extramedullary plasmacytoma of the canine larynx. CLINICAL RELEVANCE: Respiratory extramedullary plasmacytomas are extremely rare with only one laryngeal and two tracheal cases previously reported. This is the first published report of a laryngeal plasmacytoma that recurred despite combination chemotherapy with melphalan and prednisolone.

The effect of upright tilt on the volume of the failing human left ventricle.

The effect of a passive change from supine to 25-degree head-up tilted position on left ventricular volume was studied by echocardiography and other noninvasive techniques in 18 normal subjects, 6 patients with compensated LV volume overloading, and 12 patients with LV failure. In normal subjects and patients with compensated LV volume overloading, 10 minutes of head-up tilt resulted in a significant decrease in the echocardiographic LV internal dimension equivalent to a decrease in the calculated LV end-diastolic volume of 27 and 16 per cent, respectively. In contrast, no change in LV end-diastolic dimension and volume was noted during tilt in the patients with LV failure. The response of heart rate, blood pressure, and LV ejection fraction to this intervention was insignificant in all groups. These data indicate that volume preload is unresponsive to postural changes in patients with LV failure but not in normal subjects or in those with compensated LV volume overloading. It is suggested that the effect of posture on LV volume and output is primarily determined by the absence or presence of LV failure and the consequences of it on the peripheral circulation.

Systolic time intervals by echocardiography.

Technical difficulties in recording phonocardiogram or indirect carotid pulse occasionally preclude determination of the systolic time intervals. Accordingly, an alternative method was tested in 52 patients, using high-speed strip chart recording of the aortic valve echocardiogram. Satisfactory records were obtained in 36. The interval from opening to closing of the aortic valve (ejection time) was subtracted from the interval between the Q wave of the electrocardiogram and the closing of the aortic valve (total electromechanical systole) to provide the pre-ejection period. When these intervals and the pre-ejection period/ejection time ratio were compared to corresponding values obtained by conventional methods from the simultaneously recorded phonocardiograms and indirect carotid pulses, a high degree of correlation (r greater than 0.97) was found. Differences between the two methods for each interval were insignificant, being greatest in the case of the ejection time but never exceeding 16 msec. These findings indicate that the echocardiogram of the aortic valve provides an alternative, noninvasive method for determination of the systolic time intervals whenever the usual methods fail.