Tumor-like lymphoplasmacytic conjunctivitis in the third eyelid in a dog.

This report aims to describe a case of tumor-like lymphoplasmacytic conjunctivitis in a 7-year-old spayed-female Pomeranian. On complete ophthalmic examination, a mass with papillary projections was noted on the bulbar surface of the right third eyelid. Debulking of the mass was performed while preserving as much of the third eyelid as possible. On the histopathological examination, the mass was diagnosed as lymphoplasmacytic conjunctivitis with mild epithelial hyperplasia. Although a slight regrowth of the mass was noted 3 weeks after surgery, intralesional injection of triamcinolone acetonide led to its disappearance. There was no further recurrence after 5 months.

Percutaneous doxycycline sclerotherapy in a horse with a mandibular aneurysmal bone cyst.

OBJECTIVE: To describe the use and outcome of sclerotherapy with intralesional doxycycline foam in a horse with a mandibular aneurysmal bone cyst. STUDY DESIGN: Case report. ANIMALS: Client-owned 1 year old Standardbred filly. METHODS: The horse presented for progressive mandibular swelling. A 10 mg/mL doxycycline foam was prepared for intralesional injection. Three doses were injected into the lesion under computed tomographic guidance at 6 and 15 weeks after initial treatment. Volume reduction was monitored after each treatment with 3D volumetric rendering and region of interest segmentation using commercially available software. RESULTS: The volume of the lesion decreased from 458.7455 cm3 before treatment, to 363.3101 cm3 at 6 weeks, 273.5855 cm3 at 15 weeks, and 247.2316 cm3 6 months later, resulting in a total reduction of 54% of the initial volume. Bone formation was noted in the lesion. No adverse effects related to doxycycline foam injections were noted. The mandibular swelling was resolved after treatment. CONCLUSION: Intralesional doxycycline sclerotherapy was shown to be efficacious in reducing the volume of the aneurysmal bone cyst in the horse presented in this report. There was complete resolution of mandibular swelling with no side effects related to the intralesional injections.

Intralesional steroid injection after endoluminal esophageal stricture dilatation in a cat.

Background: Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina. Case Description: A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for Mycoplasma spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8-10-12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6-10-12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12-15-16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up. Conclusion: The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.

Recurrence-free interval 12 months after local treatment of mast cell tumors in dogs using intratumoral injection of tigilanol tiglate.

BACKGROUND: Tigilanol tiglate (TT) is a novel small molecule approved by the European Medicines Agency for intratumoral treatment of mast cell tumors (MCTs) in dogs. In a randomized controlled clinical efficacy and safety study in the United States, 85 of 116 dogs that received a single TT injection achieved complete response (CR) of the treated MCT by day 28. OBJECTIVE: To evaluate the durability of the TT treatment response achieved at day 28 in the U.S. study by assessing MCT recurrence at the treatment site 6 and 12 months after TT administration. ANIMALS: Eighty-five dogs previously treated with TT. METHODS: Dogs that achieved CR at day 28 were assessed retrospectively for the presence or absence of MCT at the treatment site using records from clinical visits and telephone interviews with owners. Dogs unavailable at an assessment time were considered lost-to-follow-up and data for their last assessment used in the final analysis. RESULTS: By 12 months after TT treatment, 64 dogs remained evaluable, with 21 unavailable. Of evaluable patients, 57 (89%) remained tumor free at the treatment site and 7 (11%) had developed recurrence. All recurrences occurred within the first 6 months, predominantly (5/7, 71%) within the first 12 weeks. CONCLUSIONS AND CLINICAL IMPORTANCE: Tigilanol tiglate provided a durable long-term local response for the treatment of MCT in dogs.

Intralesional methylprednisolone injection as an adjunct treatment for peri-cloacal pyogranuloma in an African penguin (Spheniscus demersus).

An African penguin (Spheniscus demersus) presented with a large peri-cloacal mass. The mass was diagnosed as a pyogranuloma histologically, with multifocal to coalescing inflammatory responses in the subcutis and keratinized simple stratified squamous epithelium overlying the surface. The patient was prescribed 125 mg/kg oral clavulanic acid/amoxycillin twice a day and 20 mg/kg oral terbinafine once a day for 14 days, but there was no change in the size of the mass 4 days after therapy, so a decision was made to administer 1 mg/kg of intralesional methylprednisolone. Fourteen days later, the mass resolved with no further recurrence. This case demonstrated that intralesional methylprednisolone used with antibiotic and antifungals was effective in resolving a peri-cloacal pyogranuloma and without any side effects.

Evaluation of a Novel Bone Substitute Injection Technique for Potential Treatment of Impact Injury to the Equine Palmar Metacarpal Condyle.

OBJECTIVE: The aim of this study was to evaluate the injection of a bone substitute material (BSM) into an impact lesion in the palmar condyle of the third metacarpal bone. STUDY DESIGN: This was an in vivo controlled study performed on six horses. MATERIALS AND METHODS: Medial metacarpal condyles were exposed via arthrotomy and a compressive lesion created in anaesthetized horses using 80 psi (27.6 MPa) onto the articular surface (n = 12). Paired limbs were randomly selected as a control or for extra-articular injection of BSM towards the subchondral bone near the compressive lesion. Parameters of the surgical techniques and BSM distribution outcomes were evaluated using magnetic resonance imaging analysis, histology and histomorphometry. RESULTS: Injection of the BSM required significant pressure, as well as the use of a pilot hole. The BSM was visible in all magnetic resonance imagings in treatment limbs. Post-impact treatment limbs had greater average grey scale values than controls (p = 0.041), and greater average grey scale values than pre-impact treatment limbs (p = 0.004). Histology demonstrated haemorrhage and microfractures at the site of compression with no evidence of bone disruption from BSM injection. CONCLUSION: Injection of BSM into the dense subchondral bone of the equine palmar condyle could be targeted to a site of injury, distributed subchondrally and without further injury to bone or cartilage. CLINICAL SIGNIFICANCE: This procedure has potential for the treatment of clinical impact injury or osteoarthritis in horses, and long-term studies are warranted.

Oxytetracycline concentrations in interstitial fluid from tissue chambers inoculated with Corynebacterium pseudotuberculosis after intramuscular or intrachamber administration in sheep.

OBJECTIVE: To determine oxytetracycline concentrations in plasma and in fluid from Corynebacterium pseudotuberculosis (CPT)-inoculated tissue chambers (used as experimental abscess models) and uninoculated (control) tissue chambers in sheep after IM or local administration of the drug and to investigate whether CPT growth was reduced or eliminated by these treatments. ANIMALS: 10 clinically normal female sheep. PROCEDURES: Sterile tissue chambers were surgically implanted in both paralumbar fossae of each sheep; ≥ 2 weeks later (day -6), 1 randomly selected chamber was inoculated with CPT, and the opposite chamber was injected with sterile growth medium. Sheep received oxytetracycline IM (n = 5) or by percutaneous injection into CPT-inoculated (4) or uninoculated (1) chambers on day 0. Tissue fluid from each chamber and venous blood samples for plasma collection were obtained at predetermined times over 6 days for bacterial counts (tissue chambers) and analysis of oxytetracycline concentrations (tissue chambers and plasma). Sheep were euthanized on day 6. Regional lymph nodes were collected bilaterally from each sheep for culture. RESULTS: Measurable concentrations of oxytetracycline were present in each chamber throughout the study, regardless of administration route or presence of CPT. No CPT growth was detected after the 48-hour time point in inoculated chambers injected with oxytetracycline; however, CPT was isolated from all inoculated chambers throughout the study after IM drug administration. One regional lymph node (ipsilateral to a CPT-inoculated, oxytetracycline-injected chamber with no CPT growth after 48 hours) was culture positive for CPT. CONCLUSIONS AND CLINICAL RELEVANCE: Intralesional administration of oxytetracycline may eliminate growth of CPT locally, but complete elimination of the organism remains difficult.

Safety and efficacy of intralesional triamcinolone administration for treatment of mast cell tumors in dogs: 23 cases (2005-2011).

OBJECTIVE To evaluate the safety and efficacy of intralesional triamcinolone administration, as a sole or adjuvant treatment, in dogs with mast cell tumors. DESIGN Retrospective case series ANIMALS 23 dogs with mast cell tumors. PROCEDURES Medical records of dogs treated for a confirmed diagnosis of a mast cell tumor between 2005 and 2011 were reviewed. Patients with a confirmed diagnosis and measurable disease (tumor longest dimension ≥ 0.5 cm) that had received ≥ 1 intralesional treatment with triamcinolone, regardless of prior, concurrent, or adjuvant treatments, were eligible for inclusion. Data collected included patient characteristics, results of cytologic and histologic testing and tumor staging, triamcinolone dosage, treatment response, and adverse events. RESULTS 23 dogs with 24 tumors were included. Tumors were treated by means of intralesional triamcinolone administration alone (n = 5), intralesional triamcinolone administration with concurrent oral administration of glucocorticoids (6), and intralesional triamcinolone administration with concurrent cytotoxic chemotherapy, with or without oral administration of corticosteroids and radiation therapy (13). Of 5 dogs treated with intralesional triamcinolone administration alone, 1 achieved a complete response, 3 achieved a partial response, and 1 maintained stable disease. The response rate for all 24 tumors (23 dogs) was 67% (16/24), including 4 with a complete response and 12 with a partial response. The median time to progression was 63 days (range, 6 to 447 days). Three dogs experienced adverse events (local hemorrhage [n = 1]; suspected gastrointestinal ulceration [2]). CONCLUSIONS AND CLINICAL RELEVANCE Intralesional triamcinolone administration may be well tolerated and effective for treatment of nonresectable mast cell tumors in dogs.

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies - a randomized prospective controlled clinical trial.

BACKGROUND: Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry. RESULTS: Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively. CONCLUSIONS: A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

Effect of autologous platelet-rich plasma application on cutaneous wound healing in dogs.

This study was conducted to identify the effectiveness of platelet-rich plasma (PRP) and efficacy of intralesional injection as a method of application to acute cutaneous wounds in dogs. Healthy adult beagles (n = 3) were used in this study. Autologous PRP was separated from anticoagulant treated whole blood in three dogs. Cutaneous wounds were created and then treated by intralesional injection of PRP in the experimental group, while they were treated with saline in the control group on days 0, 2 and 4. The healing process was evaluated by gross examination throughout the experimental period and histologic examination on day 7, 14 and 21. In PRP treated wounds, the mean diameter was smaller and the wound closure rate was higher than in the control. Histological study revealed that PRP treated wounds showed more granulation formation and angiogenesis on day 7, and faster epithelialization, more granulation formation and collagen deposition were observed on day 14 than in control wounds. On day 21, collagen deposition and epithelialization were enhanced in PRP treated groups. Overall, PRP application showed beneficial effects in wound healing, and intralesional injection was useful for application of PRP and could be a good therapeutic option for wound management in dogs.

Use of botulinum toxin type A for the treatment of radiation therapy-induced myokymia and neuromyotonia in a dog.

CASE DESCRIPTION A 5-year-old castrated male Maltese was evaluated for intermittent clinical signs of muscle cramping and abnormal movements of the skin of the right pelvic limb at the site where an infiltrative lipoma had twice been resected. After the second surgery, the surgical field was treated with radiation therapy (RT). The clinical signs developed approximately 14 months after completion of RT. CLINICAL FINDINGS When clinical signs were present, the right biceps femoris and semitendinosus muscles in the area that received RT were firm and had frequently visible contractions, and the skin overlying those muscles had episodic vermiform movements. Electromyography of those muscles revealed abnormal spontaneous activity with characteristics consistent with myokymic discharges and neuromyotonia. Magnetic resonance imaging of the affected leg revealed no evidence of tumor regrowth. The myokymia and neuromyotonia were considered secondary to RT. TREATMENT AND OUTCOME 4 U of Clostridium botulinum toxin type A (BoNT-A) neurotoxin complex was injected into the affected muscles at each of 6 sites twice during a 24-hour period (ie, 48 U of BoNT-A were administered). The clinical signs were completely resolved 10 days after BoNT-A treatment and were controlled by repeated BoNT-A treatment every 3 to 4 months for > 1 year. CLINICAL RELEVANCE To our knowledge, this is the first report of myokymia and neuromyotonia secondary to RT in a dog. For the dog of this report, injection of BoNT-A into the affected muscles was safe, effective, and easy to perform.

Effect of autologous platelet-rich plasma application on cutaneous wound healing in dogs

This study was conducted to identify the effectiveness of platelet-rich plasma (PRP) and efficacy of intralesional injection as a method of application to acute cutaneous wounds in dogs. Healthy adult beagles (n = 3) were used in this study. Autologous PRP was separated from anticoagulant treated whole blood in three dogs. Cutaneous wounds were created and then treated by intralesional injection of PRP in the experimental group, while they were treated with saline in the control group on days 0, 2 and 4. The healing process was evaluated by gross examination throughout the experimental period and histologic examination on day 7, 14 and 21. In PRP treated wounds, the mean diameter was smaller and the wound closure rate was higher than in the control. Histological study revealed that PRP treated wounds showed more granulation formation and angiogenesis on day 7, and faster epithelialization, more granulation formation and collagen deposition were observed on day 14 than in control wounds. On day 21, collagen deposition and epithelialization were enhanced in PRP treated groups. Overall, PRP application showed beneficial effects in wound healing, and intralesional injection was useful for application of PRP and could be a good therapeutic option for wound management in dogs.

Outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules: 27 cases (2008-2011).

OBJECTIVE: To describe outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules. DESIGN: Retrospective case series. ANIMALS: 24 dogs with primary hyperparathyroidism that underwent 27 ultrasound-guided ethanol ablation procedures of presumed functional parathyroid nodules identified by cervical ultrasonography. PROCEDURES: Dogs were anesthetized for each procedure. For each nodule, 95% ethanol was injected into the center with ultrasound guidance (volume injected calculated on the basis of ultrasonographic measurements). The interval from treatment to resolution of hypercalcemia, complications, and follow-up clinicopathologic data were recorded. RESULTS: 5 procedures involved simultaneous treatment of 2 nodules. Three dogs underwent a second treatment because of initial treatment failure or development of another nodule. Hypercalcemia resolved after 23 of 27 (85%) procedures. In those 23 treatments, 22 (96%) had resolution of hypercalcemia within 72 hours after treatment. Hypocalcemia was detected in 6 different dogs at 2 (1 dog), 7 (3 dogs), 14 (1 dog), and 21 (1 dog) days after treatment; 5 of these dogs had mild transient hypocalcemia and 1 developed clinical signs requiring calcium supplementation. Although there were no periprocedural adverse effects, 2 dogs had delayed adverse effects; the overall rate of complications (including delayed adverse events and clinical hypocalcemia) was 11.1%. Long-term follow-up data indicated sustained normocalcemia in 17 of 19 dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that percutaneous ultrasound-guided ethanol ablation of functional parathyroid nodules may be an effective treatment for primary hyperparathyroidism of dogs, with short duration of anesthesia, minimal complications, and low risk for hypocalcemia.

Use of ultrasound-guided autologous bone marrow transfer for treatment of suspensory ligament desmitis in 30 race horses (2003-2010).

OBJECTIVE: To evaluate the racing performance of horses that underwent ultrasound-guided intralesional injection of autologous bone marrow aspirate for treatment of selected forelimb suspensory ligament (body or branch) core lesions. DESIGN: Retrospective cohort study of 13 Standardbred and 17 Thoroughbred race horses. METHODS: Autologous bone marrow aspirated from the sternebrae was injected, under ultrasound guidance, into suspensory ligament core lesions (body or branch). Racing records were reviewed for a comparison of performance before and after surgery. RESULTS: Of the 13 Standardbreds, 9 (69%) had one or more starts within the follow-up period and 9 (69%) had five or more starts. Of the 17 Thoroughbreds, 15 (88%) had one or more starts within the follow-up period and 12 (71%) had five or more starts. Eight Standardbred horses had at least one start both before and after surgery. Earnings per start did not differ significantly between the three starts immediately after surgery compared with the three starts immediately prior to surgery. Thirteen Thoroughbred horses had at least one start both before and after surgery. Earnings per start were less for the three starts immediately after surgery compared with the three starts immediately prior to surgery. CONCLUSIONS AND CLINICAL RELEVANCE: A horse with a core lesion in the branch or body of the suspensory ligament has a good prognosis for return to racing after treatment with intralesional injection of bone marrow aspirate.

Intralesional vincristine use for treatment of squamous cell carcinoma in a puma (Puma concolor).

A 14-yr-old male puma (Puma concolor) was presented to the veterinary staff of the National Zoo in Malaysia for an auricular mass. Squamous cell carcinoma was diagnosed by histologic examination of a biopsy. Systemic administration of chemotherapy using vincristine (0.5 mg/m2 i.v. q. 7 days for six treatments) and prednisolone (2 mg/kg i.m. q. 72 hr x 7 days) caused side effects of vomiting, weight loss, and alopecia and did not improve the size or appearance of the tumor. Intralesional vincristine injections (0.2 mg q. 7 days for two treatments) and prednisolone (2 mg/kg i.m. q. 72 hr x 15 days) were administered, resulting in complete tumor regression after 14 days of treatment.

A case of feline injection-site sarcoma at the site of cisplatin injections.

A spayed 14-year-old female domestic shorthair cat presented with a squamous cell carcinoma of the nasal planum and was treated with intralesional chemotherapy. During nasal infiltrations with cisplatin mixed with the cat's own serum, a new carcinomatous lesion developed at the medial canthus of the right eye, which was also treated using intralesional chemotherapy. Two months after the treatment course, the cat developed a new mass at the site of the eyelid chemotherapy, which was diagnosed as a soft tissue sarcoma. At the owner's request, the tumour was marginally excised, but it recurred after 10 months. No lung or lymph node metastases were evident at the time of euthanasia. The histotype of the tumour, the coincidence with injections and the histological description make the hypothesis of an injection-site sarcoma likely. To the authors' knowledge, this is the first case of an injection-site sarcoma at the site of a cisplatin injection.

Treatment of refractory feline sporotrichosis with a combination of intralesional amphotericin B and oral itraconazole.

OBJECTIVE To describe the use of intralesional amphotericin B in localised lesions for the treatment of 26 cats from Rio de Janeiro, Brazil, with sporotrichosis refractory to oral itraconazole. DESIGN Uncontrolled intervention study. METHOD The 26 cats in this study were diagnosed with sporotrichosis, confirmed by isolation of Sporothrix schenckii, and presented residual localised skin lesions refractory to treatment with oral itraconazole for a minimum period of 8 weeks. The animals received weekly applications of intralesional amphotericin B in conjunction with oral itraconazole. In cases of owner unavailability, a maximum of 2 weeks between the infiltrations was accepted. RESULTS Twenty-two (84.6%) of the 26 treated cats achieved clinical remission, 16 (72.7%) of which were cured, and in the remaining six (27.3%) the lesions recurred at the same site. Lack of clinical response was observed in one animal and three owners abandoned treatment. CONCLUSION The proposed therapeutic regimen is an adjunctive treatment option for cats with sporotrichosis presenting as residual skin lesions refractory to itraconazole.

Balloon dilation and intralesional steroid for benign rectal stricture management in a cat.

A 4-year-old castrated male domestic shorthair presented for 1 week of constipation and tenesmus. A rectal stricture had been diagnosed 8 months prior at the time of adoption and the cat had been successfully managed with stool softeners until presentation. A complete diagnostic work-up failed to reveal an underlying etiology for the stricture and colonoscopy was performed. Endoscopic biopsies of the stricture revealed benign non-specific inflammatory changes. Balloon dilation of the rectal stricture was performed during the initial colonoscopy and 3 and 9 days later. Triamcinolone acetonide was injected into the stricture site with endoscopic guidance during the third dilation procedure. The patient has been monitored for over 27 months; follow-up indicates no signs of tenesmus and repeated rectal examinations reveal no stricture recurrence. This case report demonstrates that endoscopic balloon dilation with intralesional steroid injection represented a minimally invasive and effective option for the treatment of a benign rectal stricture in this cat, and deserves further prospective investigation.

Acanthomatous ameloblastoma in dogs treated with intralesional bleomycin.

Acanthomatous ameloblastoma (AA) is a benign gingival tumour that often invades bone. This retrospective study evaluated the efficacy of intralesional (IL) bleomycin as a treatment for AA. Six dogs received weekly or bimonthly IL bleomycin injections (dose range, 10-20 U m(-2)). A seventh dog presented with advanced, nonresectable AA was treated palliatively. One to sixteen treatments were administered (median, 5). Six of the seven dogs had a complete response within 4 months from initial IL injection (median, 1.5 months), whereas the palliative case had approximately 25% decrease in tumour volume 14 days from initial injection. Local recurrence was not observed during the study period, with a median follow-up time of 842 days. Adverse effects were limited to wound formation with bone exposure (n = 4), mild tissue reactions (n = 3), local swelling (n = 2) and local infection (n = 1). The conclusions of this study show IL bleomycin is an effective treatment for canines with AA.