25 – Tumors of the Endocrine System

In cats, hyperthyroidism can be treated in 4 ways: medical management with methimazole or carbimazole, nutritional management (low-iodine diet), surgical thyroidectomy, and radioactive iodine (131I). Each form of treatment has advantages and disadvantages that should be considered when formulating a treatment plan for the individual hyperthyroid cat. Medical and nutritional managements are considered "reversible" or palliative treatments, whereas surgical thyroidectomy and 131I are "permanent" or curative treatments. The author discusses how each treatment modality could be the optimal choice for a specific cat-owner combination and reviews the advantages and disadvantages of each treatment option.

Hyperthyroidism in Cats: Considering the Impact of Treatment Modality on Quality of Life for Cats and Their Owners.

Abstract Local recurrence after surgical excision of canine massive hepatocellular carcinoma (HCC) has been poorly studied in veterinary medicine with scant information published regarding risk factors for and outcome following recurrence. The aim of this case–control study was to describe the time to recurrence, evaluate potential risk factors for recurrence, and report the outcome in dogs with massive HCC. Medical records for 75 dogs who developed recurrence and 113 dogs who did not develop recurrence were reviewed. Statistical analyses were performed to determine risk factors for recurrence as well as the median time to develop recurrence and overall survival time (OS). None of the risk factors evaluated were significant for the development of recurrence. The median time to develop recurrence was 367 days (range 32–2096 days). There was no significant difference in median OS for dogs who developed recurrence vs. those who did not (851 vs. 970 days). For dogs with recurrent HCC, treatment at recurrence trended toward prolonged OS but was not significantly different from dogs not undergoing treatment at recurrence. There was no significant difference in median OS for dogs with histologically complete vs. incomplete tumour excision (990 vs. 903 days). Although specific risk factors for recurrence were not identified, elevations in liver values were noted in patients with recurrent disease and could act as a noninvasive surveillance tool. Recurrence was noted earlier in dogs who had routine post‐operative surveillance (228 vs. 367 days). Routine surveillance for recurrence is recommended especially in dogs where further intervention is possible and should extend beyond 1 year. Patients with massive HCC have a good long‐term prognosis regardless of incomplete excision, pulmonary metastasis, or recurrent local disease.

/pdf/risk-factors-and-outcome-in-dogs-with-recurrent-massive-3mpkep4z.pdf

Risk factors and outcome in dogs with recurrent massive hepatocellular carcinoma: A Veterinary Society of Surgical Oncology case–control study

The democratization of ultrasound imaging refers to the process of making ultrasound technology more accessible. Traditionally, ultrasound imaging has been predominately used in specialized medical facilities by trained professionals. Advancements in technology and changes in the health-care landscape have inspired efforts to broaden the availability of ultrasound imaging to various settings such as remote and resource-limited areas. In this review, we highlight several key factors that have contributed to the ongoing democratization of ultrasound imaging, including portable and handheld devices, recent advancements in technology, and training and education. Examples of diagnostic point-of-care ultrasound (POCUS) imaging used in emergency and critical care, gastroenterology, musculoskeletal applications, and other practices are provided for both human and veterinary medicine. Open challenges and the future of POCUS imaging are presented, including the emerging role of artificial intelligence in technology development. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 26 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Critical Advances for Democratizing Ultrasound Diagnostics in Human and Veterinary Medicine.

ObjectivesThe study aimed to document the incidence of erythrocyte microcytosis in a population of hyperthyroid cats referred for radioiodine (RAI) treatment. Microcytosis has been observed but not...

https://journals.sagepub.com/doi/pdf/10.1177/1098612X20983973

Incidence of microcytosis in hyperthyroid cats referred for radioiodine treatment.

Background

The prevalence of concurrent disease in hyperthyroid cats is unknown.



Objectives

To identify the prevalence of concurrent intra-abdominal disease using abdominal ultrasound examination (AUS) in hyperthyroid cats referred for radioactive iodine treatment (RIT) and to determine whether the requirement for pretreatment AUS is justified.



Animals

Five hundred and thirty-four client-owned cats diagnosed with hyperthyroidism and referred for RIT.



Methods

Retrospective study. Age, breed, sex, body weight, clinical signs, total serum T4 concentration, blood urea nitrogen (BUN) concentration, serum creatinine concentration, urine specific gravity (USG), AUS results, and biopsy or cytology results, or both (if obtained) were collected from the medical records.



Results

The prevalence of concurrent disease identified using AUS in hyperthyroid cats referred for RIT was 36.1%; 22.8% of the cats in the study had renal disease and 2.4% had confirmed neoplasia. Significant differences in median USG (P value 0.032) and median BUN (P value 0.028) were found between cats that had abnormal kidneys on AUS compared to those with normal-appearing kidneys. Only 2.2% of the cats were not treated with RIT as a result of changes identified on AUS and subsequently obtained cytology or biopsy results.



Conclusions and Clinical Importance

The results indicate that pretreatment AUS in hyperthyroid cats referred for RIT is unnecessary in most patients.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvim.13369

Abdominal Ultrasound Examination Findings in 534 Hyperthyroid Cats Referred for Radioiodine Treatment Between 2007–2010

OBJECTIVE
To determine ideal insufflation pressures during transanal minimally invasive surgery (TAMIS) in canine cadavers for rectal submucosal transection and incisional closure.


ANIMALS
16 canine cadavers.


PROCEDURES
Cadavers were placed in lateral recumbency. Urinary catheters were placed to measure intra-abdominal pressure (IAP). A single access port was placed to establish a pneumorectum. Cadavers were placed in insufflation groups of 6 mmHg to 8 mmHg (group 1), 10 mmHg to 12 mmHg (group 2), or 14 mmHg to 16 mmHg (group 3). Defects in the rectal submucosa were created and closed with a unidirectional barbed suture. Duration for each procedure and subjective ease of identifying the transection plane and performing incisional closure were assessed.


RESULTS
The single access port was successfully placed in dogs weighing 22.7 kg to 48 kg. The ease of each step of the procedure was not influenced by the insufflation pressure. The median surgical duration for group 1 was 740 seconds (range = 564 to 951 seconds), 879 seconds (range = 678 to 991 seconds) for group 2, and 749 seconds (range = 630 to 1,244 seconds) for group 3 (P = .650). The insufflation pressure increased the IAP (P = .007). Perforation of the rectum happened in 2 cadavers in group 3.


CLINICAL RELEVANCE
The duration of each step of the procedure was not significantly influenced by insufflation pressure. Defining the dissection plane and performing resection was more challenging in the highest-pressure group. Rectal perforation occurred only with the 14 mmHg to 16 mmHg insufflation pressure. Single access port usage with TAMIS may provide a readily available, minimally invasive approach for the resection of rectal tumors in dogs.

https://avmajournals.avma.org/downloadpdf/journals/ajvr/aop/ajvr.23.02.0033/ajvr.23.02.0033.pdf

Effect of insufflation pressure during transanal minimally invasive surgery on surgical complications with dissection of the rectal submucosa in canine cadavers.

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Papers

Risk factors and outcome in dogs with recurrent massive hepatocellular carcinoma: A Veterinary Society of Surgical Oncology case–control study

Abdominal Ultrasound Examination Findings in 534 Hyperthyroid Cats Referred for Radioiodine Treatment Between 2007–2010

Effect of insufflation pressure during transanal minimally invasive surgery on surgical complications with dissection of the rectal submucosa in canine cadavers.