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J. Thorald, M.A., Ph.D.

Assistant Professor, Philadelphia College of Osteopathic Medicine

These are the result of thromboembolism or acute right-side cardiopulmonary failure. Conference Comment: the contributor provided an excellent overview of feline pulmonary dirofilariasis. Domestic felids, ferrets, and California sea lions are dead-end hosts, and are not a source of transmission due to the absence of microfilaremia. Conference participants felt this was the origin of the deeply eosinophilic conglomerations present in some sections. Other considerations were necrotic nematode debris, as suggested by the contributor, or conglomerations of fibrin and hemoglobin. Conference participants also noticed the presence of hemosiderosis, and attributed this to heart failure. Contributor: University of Connecticut Department of Pathobiology and Veterinary Science 61 N. Signalment: 7-year-old, male, English bull terrier, Canis lupus familiaris, canine. History: the animal was submitted for post mortem examination after being found dead. Gross Pathology: Necropsy was performed approximately 20 hours after estimated time of death. Both kidneys were diffusely pale, showing a dry cut surface with white multifocal pinpoint subcapsular and cortical areas. In the left adrenal gland, severe cortical compression atrophy due to a medullary, pale cream soft mass was seen. Age-related changes, consisting of mild bilateral nodular endocardosis of atrio-ventricular valves, moderate erosive coxarthrosis and mild nodular hepatic and prostatic hyperplasia were present. Amyloid is also seen in renal tubules, within the lumen of a pelvic artery (amyloid cast), and in the renal pelvis. Mild to moderate, multifocal lymphoplasmacytic infiltration (variable within provided slides) and tubular mineralization (calcification) are present. Arteries/arterioles: Moderate to severe deposition of amyloid and fibrosis are also seen in the intima and media of arteries and arterioles in the liver, left ventricle and septum. Left adrenal gland: Adrenal medulla is densely cellular with cells arranged in packets and nests and supported by a moderately fine fibrovascular stroma that occasionally thickens and dissects the parenchyma, leading to a disarranged lobular pattern. The mass is composed of round to polygonal cells exhibiting mild to moderate anisocytosis and anisokaryosis. The cytoplasm of neoplastic cells is finely granular, eosinophilic and most often poorly demarcated. Nuclei are round to oval, hyperchromatic, with finely stippled chromatin and most frequently, no nucleoli. Neoplastic cells are synaptophysin positive (neuroendocrine origin) and are found intravascularly within adjacent mesentery and extending directly from the adrenal gland into an adjacent large artery (phrenicoabdominal artery Occasional vascular degeneration with mineralization (calcification) is seen in the adrenal cortex. Due to the medullary mass, a moderate to severe, diffuse cortical atrophy is present. Transition between adrenal medulla and cortex is multifocally poorly demarcated and in scattered areas a rim of fibrous tissue separates the two regions (pseudocapsule formation). Adrenal gland, dog: the adrenal medulla is expanded by a welldemarcated neoplasm which compresses the overlying cortex. Adrenal gland, dog: Neoplastic cells are arranged in nests and packets and possess moderate amounts of finely granular, eosinophilic to brown cytoplasm. Kidney, dog: Diffusely, glomerular tufts are segmentally to globally expanded by large amounts of amorphous, finely fibrillar to waxy, lightly eosinophilic material (amyloid). Heart, dog: Multifocally, the walls of large- and medium-caliber arteries are expanded by an accumulation of an amorphous eosinophilic proteinaceous material (amyloid). The most frequent secondary changes associated with its presence include pressure atrophy, chronic renal failure and hepatic rupture.

If the two meridians do not lie in the principal planes (that is near to 90 or 180 degrees), but remain at right angles to each other, this type of regular astigmatism is termed as oblique astigmatism. Higher degrees of astigmatism often cause poor visual acuity but vision is not much impaired in mixed astigmatism as the circle of least diffusion falls upon or near the retina. The optic disk appears oval or blurred in one sector in astigmatism on direct ophthalmoscopy. An astigmatic fan, consisting of horizontal and vertical lines may help to detect the regular astigmatism. The patient sees distinct lines of the fan in one direction (vertical or horizontal) and they appear tailed off or blurred in the other direction. Irregular Astigmatism When the curvature and refractive power of the refractive media are markedly irregular causing multiple focal points which produce completely blurred images on the retina such a condition is called irregular astigmatism. The irregular astigmatism is caused by corneal scar, penetrating injuries of the eye, keratoconus, lenticonus and immature cataract. The patient with irregular astigmatism often suffers from distorted vision and headache. Regular Astigmatism Regular astigmatism may be classified into the following types: 1. Simple astigmatism, where one of the principal meridians is emmetropic and the other is either hypermetropic or myopic. The former is known as simple hypermetropic and the latter simple myopic astigmatism. Compound astigmatism, where both the principal meridians are either hypermetropic or myopic, the former is known as compound hypermetropic and the latter compound myopic astigmatism. Mixed astigmatism, where one of the principal meridians is hypermetropic and the other myopic. Treatment A small degree of astigmatic error may not require any optical correction. But in all such cases, if the error causes asthenopic symptoms, a full optical correction by cylindrical lenses should be advised for constant use. All forms of regular astigmatism can be corrected by cylindrical lenses or spherocylindrical combinations. In contrast, irregular astigmatism cannot be corrected by spectacle lenses due to irregularities in curvature of meridians. The visual acuity does not improve in cases of irregular astigmatism with spectacle correction; here toric contact lenses are of immense value. Clinical Features Generally, small astigmatic errors do not give any ocular discomfort. However, severe symptoms are found in cases of hypermetropic astigmatism wherein the accommodation is brought into play Errors of Refraction 33 Soft or rigid gas permeable toric lenses are prescribed. Large degrees of astigmatism following cataract extraction and keratoplasty can be managed by laser in situ keratomileusis or conductive keratoplasty. Astigmatic keratotomy, relaxing incisions in the cornea, or limbal relaxing incision can correct mild astigmatism. In all these techniques the closer the incision to the center of the cornea, the greater its influence on astigmatism. If the eye has become amblyopic, the emmetropic eye is patched and the patient is encouraged to use the ametropic eye with optical correction. Laser in situ keratomileusis has been tried with satisfactory results in cases of anisometropia. Occasionally, the patient complains of throbbing headache often accompanied with nausea. It is significant when the difference between the refraction of the two eyes exceeds 2. A minor difference of refraction between the two eyes is not uncommon and it seldom gives any symptom. Binocular vision is usually maintained if the difference between the two eyes does not exceed 2. In some cases, when one eye is emmetropic or moderately hypermetropic and the other is myopic, the patient falls into the habit of using emmetropic or hypermetropic eye for distant vision and the myopic for near work.

Syndromes

• Medications that are toxic to the liver
• Breathing problems - breathing may stop
• Coarction of the aorta
• Measurements of blood oxygen level
• Older mother
• Colonoscopy
• Swelling of the tissue during the last month of pregnancy