Peripheral nerve tumours

Peripheral nerve tumours can cause pain and neurological dysfunction. As these tumours tend to be slow growing, radiotherapy and chemotherapy have limited efficacy, so limb amputation is often performed.

Van Stee et al¹ performed a retrospective study of the outcome of limb-sparing resection of these tumours.

A total of 16 dogs with peripheral nerve tumours that underwent limb-sparing tumour resection were included in the study. The median survival time was 1,303 days.

Clean margins led to better prognosis, with a median survival time in these cases of 2,227 days, compared to 487 days in dogs with infiltrated margins. The majority of cases had good limb function following the procedure.

The authors concluded compartmental excision in these cases can lead to good limb function and extended survival times comparable to those achieved by limb amputation.

Canine pancreatitis treatment

Traditionally, it has been recommended to treat pancreatitis in dogs by withholding food, sometimes for up to 48 hours.

Harris et al² performed a retrospective study to evaluate the outcome of using early enteral nutrition in dogs with pancreatitis. A total of 34 dogs with acute or acute-on-chronic pancreatitis were included in the study.

Dogs were divided into those fed early and those where feeding was delayed. Dogs that had undergone early feeding were quicker to start feeding voluntarily and return to maximum food intake than dogs that had undergone delayed feeding. More gastrointestinal intolerance was noted in the delayed feeding group. However, time of feeding did not affect length of hospitalisation.

The authors concluded withholding food for prolonged periods in cases of pancreatitis may not be necessary or beneficial.

Escalator injuries in dogs

Many escalators have signs saying “Dogs must be carried on this escalator”, presumably meaning if you don’t have a dog, you have to use the stairs. More seriously, although uncommon, dogs can incur injuries from escalators.

Pearson et al³ performed a retrospective study of 30 dogs that had acquired injuries while on an escalator. All the injuries involved entrapment of one or more paws in the moving parts of the escalator. Around three-quarters of the dogs weighed lighter than 10kg.

A total of 50% of cases required surgery, while the rest were managed conservatively. Around a quarter of all cases required a partial or whole digit amputation. No fatalities were recorded.

The authors suggested ways of preventing these injuries include client education, dog training, modifications to escalators or taking the stairs.

Chronic diarrhoea

Chronic diarrhoea is a common presentation in practice, but epidemiological data is scarce on the disease.

Volkmann et al⁴ performed a retrospective review of 136 dogs with chronic diarrhoea, defined as diarrhoea of three or more weeks’ duration.

Of these cases, 90% had a primary enteropathy, 71% were inflammatory (mainly dietary responsive, with 11% being antibiotic responsive), 13% were infectious and 4% neoplastic.

Of the 10% of dogs with secondary diarrhoea, exocrine pancreatic disease was the most common diagnosis.

A total of 87% of cases went into clinical remission with treatment; the rest did not respond or died.

Anaemia, severe hypoalbuminaemia and severe hypocobalaminaemia were poorer prognostic indicators.

Gastrointestinal obstruction

Gastrointestinal obstruction is a frequently encountered problem in general practice due partly to the propensity of dogs to scavenge. However, diagnosis of mechanical obstruction can, on occasion, be challenging and, sometimes, exploratory laparotomy is required for diagnosis.

Two papers deal with the diagnosis of gastrointestinal obstruction.

Barry et al⁵ performed a controlled trial of 16 dogs to examine the usefulness of laparoscopy for the diagnosis of suspected gastrointestinal obstruction in dogs with consistent physical and radiographic findings.

In each case, a single-incision laparoscopy was performed by a surgeon, in which the gastrointestinal tract was examined inside and outside the abdominal cavity. The patient immediately underwent exploratory laparotomy, performed by a second surgeon. The mean procedure duration was 37 minutes for laparoscopy and 13 minutes for exploratory laparotomy.

Winter et al⁶ performed another study regarding diagnosis of gastrointestinal obstruction, in this case comparing ultrasonography against CT.

A total of 16 dogs with radiographic and physical findings suggestive of gastrointestinal obstruction were included in the trial. In all cases, abdominal ultrasonography, CT and exploratory laparotomy were performed.

The findings of the CT and exploratory surgery were in agreement in all 16 dogs, with 10 dogs having complete obstruction, 3 partial and 3 no obstruction. One case with functional ileus was misdiagnosed by ultrasonography as mechanical obstruction. Time spent imaging was much shorter for CT than ultrasonography.

The authors concluded CT was a rapid and accurate method of diagnosing gastrointestinal obstruction.

Alternative medicines

Alternative medicine is generally considered to be a group of treatments outside mainstream medicine with unproven safety and/or efficacy.

While a large number of studies exist examining the effects of the main alternative medicine modalities, such as homeopathy and acupuncture, a few compare mortality rates in patients treated with alternative compared to conventional medicine.

Johnson et al⁷ performed a study of 281 patients with non-metastatic cancer of the breast, prostate, lung or lower gastrointestinal tract who had chosen alternative medicine instead of conventional cancer treatment, such as chemotherapy, radiotherapy and/or surgery, and compared this with a matched cohort of people using conventional medicine.

Interestingly, alternative medicine use was higher among people of higher socioeconomic status.

Overall, a greater risk of mortality was found in patients choosing alternative medicine, with a hazard ratio of 2.5, while, in the breast cancer group, users of alternative medicine were 5.68 times more likely to die than those using conventional medicine.

While this study alone is not definitive – for a human study this is relatively small – it is consistent with the body of literature regarding the efficacy and safety of alternative medicine, and highlights the dangers of relying on unproven treatments for serious diseases.