Comparison of the histology and immunohistochemistry of vaccination-site and non-vaccination-site sarcomas from cats in New Zealand

AIMS

To compare the histology and immunohistochemistry of vaccination-site sarcomas (VSSs) with non-vaccination-site sarcomas (NVSSs) in cats in New Zealand. To determine whether VSSs in cats in New Zealand have similar histological and immunohistochemical features to those previously described in feline vaccine-associated sarcomas (VASs) in North American studies.

METHODS

A retrospective survey of skin biopsies submitted between 2004 and 2006 was performed to identify cutaneous sarcomas from both vaccination and non-vaccination sites in cats. Vaccination sites included the interscapular, shoulder, or dorsal or lateral cervical and thoracic regions. All sarcomas were examined histologically, and smooth muscle actin and desmin were assessed immunohistochemically. Features previously described in VASs were assessed and compared.

RESULTS

Sarcomas from 34 cats were identified, 10 of which occurred at vaccination sites. Compared with NVSSs, VSSs were more likely to be located in the hypodermis and have greater cellular pleomorphism, higher mitotic rates, more frequent peripheral lymphocytic aggregates and multinucleated giant cells. VSSs were also more likely than NVSSs to show partial myofibroblastic differentiation, demonstrable using immunohistochemistry. The histological and immunohistochemical features of VSSs in cats in New Zealand are consistent with those previously described in VASs in cats in North America.

CONCLUSIONS

The results of this study suggest that VASs occur in cats in New Zealand.

CLINICAL RELEVANCE

The occurrence of VASs in cats in New Zealand would provide further support for restriction of the vaccination of cats to the minimum necessary to protect health, and adoption of the New Zealand Veterinary Association guidelines on vaccination.

A possible predisposition to dilated cardiomyopathy in Huntaway dogs

AIM

To compare the prevalence of dilated cardiomyopathy (DCM) in New Zealand Huntaway dogs with the prevalence of DCM in other breeds of dog.

METHODS

The necropsy database at Massey University was used to identify cases of DCM diagnosed between January 1999 and March 2006. Dogs were considered to have DCM if echocardiographic, gross necropsy, or histological findings were consistent with this diagnosis. The prevalence in Huntaways was then compared with the prevalence observed in all breeds of dog, as well as the prevalence observed in large breeds of dog.

RESULTS

Twelve dogs were identified with DCM. One was diagnosed using echocardiography, while the other 11 were diagnosed by gross necropsy examination. The gross diagnosis of DCM was confirmed histologically in 6/11 dogs. The prevalence of DCM in Huntaways was significantly higher than the prevalence seen in all breeds of dog (p=0.008), and the prevalence in large breeds of dog (p=0.025). All four Huntaways diagnosed with DCM were male, and had an average age of 4 years. Three dogs presented with symptoms attributable to impaired heart function while one presented with symptoms of chronic renal failure. The duration of clinical symptoms prior to presentation ranged between 1 day and 3 weeks.

CONCLUSIONS

The results of this study suggest that Huntaways may be predisposed to the development of DCM. Although the increased prevalence in this breed was significant, only small numbers of affected Huntaways were identified, and additional cases are required to confirm these preliminary findings.

CLINICAL RELEVANCE

Huntaways are the most common working dog in New Zealand. The premature loss of a working dog is expected to have a significant economic impact on farmers. Further investigation of DCM in Huntaways may allow measures to reduce the prevalence in this breed.

The high prevalence of depression and dementia in elder abuse or neglect

BACKGROUND

The risk factors for mistreatment of older people include age, race, low income, functional or cognitive impairment, a history of violence, and recent stressful events. There is little information in the literature concerning the clinical profile of mistreated older people.

OBJECTIVES

To describe the characteristics of abused or neglected patients and to compare the prevalence of depression and dementia in neglected patients with that of patients referred for other reasons.

DESIGN

A case control study.

SETTING

Baylor College of Medicine Geriatrics Clinic at the Harris County Hospital District (Houston, Texas).

PATIENTS

Forty-seven older persons referred for neglect and 97 referred for other reasons.

INTERVENTION

Comprehensive geriatric assessment.

MEASUREMENTS

Standard geriatric assessment tools.

RESULTS

There was a statistically significant higher prevalence of depression (62% vs 12%) and dementia (51% vs 30%) in victims of self-neglect compared to patients referred for other reasons.

CONCLUSIONS

This is the first primary data study that highlights a high prevalence of depression as well as dementia in mistreated older people. Geriatric clinicians should rule out elder neglect or abuse in their depressed or demented patients.

Treating elder neglect: collaboration between a geriatrics assessment team and adult protective services

Neglect is the most common type of elder maltreatment in the United States. Currently, the only formal intervention available is provided by each state's adult protective service agency (APS). Elder neglect involves a complicated relationship among an indvidual's medical problems, social situation, and ability to function in the environment. Geriatric assessment teams are facile at dealing with such complex cases while APS caseworkers are expert in their ability to identify and confirm neglect. Forming a geriatric team that includes APS caseworkers is a logical and innovative approach to the growing problem of elder neglect.

The oldest reported patient with fibromuscular dysplasia of the renal artery

An 80-year-old woman was brought to the emergency department with accelerated hypertension. Multiple medical regimens failed, including an angiotensin-converting enzyme inhibitor, which caused acute renal failure. Results of a renal scan for captopril were negative; renal arteriogram revealed fibromuscular dysplasia of the right renal artery. Percutaneous transluminal angioplasty was successful in dilating the renal artery and making blood pressure easier to control. Although more common in younger people, fibromuscular dysplasia should be considered in patients who are elderly and have hypertension that is difficult to control. Transluminal angioplasty should be attempted to preserve renal function and control blood pressure.

Postoperative delirium. A review of 80 primary data-collection studies

We conducted an on-line search and manual searches for 1966 through 1992 to determine the incidence, diagnosis, risk factors, and treatment of postoperative delirium. Of the 374 citations found, 277 articles were excluded after criteria of relevance were applied. After methodologic criteria for validity were applied to the remaining 80 articles, 26 studies were retained for the final information synthesis. The incidence of postoperative delirium was 36.8% (range, 0% to 73.5%). Primary reasons for this disparity were insufficient sample size and inconsistent application of numerous diagnostic tools. One study provided statistically significant data that demonstrated that postoperative delirium is underdiagnosed by physicians and nurses. Four of the articles that met the established criteria provided risk factor data. Although age, preoperative cognitive impairment, and the use of anticholinergic drugs were significantly associated with postoperative delirium, gender, type and route of anesthesia, and sleep deprivation were not. Two studies demonstrated a decreased incidence of postoperative delirium when patients underwent preoperative psychiatric counseling or participated in a structured perioperative program. These findings indicate a need for (1) accurate incidence data with further definition of risk factors and (2) studies that address the diagnosis and treatment of this common postoperative problem.