Journal of Feline Medicine and Surgery

Practical relevance Myocardial disease (cardiomyopathy, CM) is the most common cardiac disorder observed in cats. The disease usually leads to the development of congestive heart failure, which is the major cause of cardiac mortality. Arterial thromboembolism is another severe outcome often associated with feline CM.

Patient group The median age of cats when diagnosed with a form of CM is 5.5 years (range 4 months to 16 years). The disease appears to be equally distributed between males and females and among different breeds, although a genetic predisposition of some pedigrees should be taken into consideration (ie, Maine Coons, Ragdolls, Norwegian Forest cats).

Audience General practitioners, as well as specialists in small animal medicine, cardiology and pathology, have to deal with CM on a regular basis.

Clinical challenges The diagnosis and clinical management of myocardial disease in cats represents one of the greatest challenges in veterinary cardiology. Although several attempts have been made to standardise the classification of CM, both in humans and cats, some disagreement still exists among cardiologists. Classification criteria are continuously evolving as the aetiology of myocardial disease becomes better understood. It is now widely appreciated that, for a given aetiology, there may be a spectrum of phenotypes ranging from restrictive to dilated.

Diagnostics The diagnosis and classification of CM is primarily based on echocardiographic criteria. However, phenotypic variability is substantial, even within a single form of CM, and this often causes subjective interpretations of echocardiographic diagnosis, especially by inexperienced echocardiographers. Post-mortem examination is an alternative approach to diagnosis.

Evidence base The clinical management of feline myocardial disease is even more controversial, especially in the light of recent clinical studies. This two-part article reviews the literature to date, discusses various manifestations of the disease in cats and offers a critical, and often controversial, approach to diagnosis and management.

Practical relevance Feline lower urinary tract disease (FLUTD) accounts for up to 8% of cats presenting to veterinary clinics, with urethral obstruction occurring in 18–58% of those case. Though the requirement for surgery has declined with better understanding and management of the underlying causes of FLUTD, surgery does have an important role in intractable cases.

Patient group Male (mostly castrated) mature cats.

Clinical challenges The decision to take a cat to surgery has to be based on the severity and frequency of the clinical signs. The decisionmaking process is relatively straightforward where cystic calculi are present; the challenge is deciding when and which urethrostomy to carry out. This article seeks to give guidance for the practitioner grappling with these issues.

Global importance FLUTD and urethral obstruction Is a well documented problem throughout Europe, and North and South America.

Equipment The basic surgical equipment is readily available; fine-tipped instruments are preferred to allow for atraumatic tissue handling.

Evidence base There is an abundance of literature on FLUTD and urethral obstruction and its surgical management, with surgery for this condition first having been reported back in 1967. Recent studies have investigated both the long and short term outcome following surgical management of the blocked cat. Still, there are no hard and fast rules as to when surgery should be carried out, with the guidelines varying in the literature.

Practical relevance Oral cancers are not the most common tumour in our domestic cats, but the death rate associated with cancer in this location is particularly high. This is largely because the cancer is discovered late in its development and also because of the severe debility it causes when the patient is unable or unwilling to eat and drink.

Audience This review of malignant oral tumours (squamous cell carcinoma, oral sarcoma, oral melanoma and salivary adenocarcinoma) and benign oral tumours that may mimic malignant lesions is directed at all veterinarians that see older cats - both for ‘health and wellness’ as well as for more advanced treatment of already diagnosed neoplasia.

Patient group As it is almost always older cats that are affected, patients will have a strong bond with their owners. These cats also often have unrelated intercurrent disease that may affect treatment choices, the way treatment is administered, and whether the owner chooses aggressive or palliative therapy.

Evidence base While the literature on treatment of oral cancer in dogs is well established, until recently it was less so in cats. As researchers focus on treating cats with curative intent, as well as palliatively and supportively, the material available to guide veterinarians has also increased. This article evaluates the current literature from the author's perspective as an oncologist and a cat owner.

Practical relevance Inflammatory bowel disease (IBD) is a common diagnosis in cats with chronic gastrointestinal signs. Its management presents clinical challenges, not least because rational therapy relies on a definitive diagnosis, and current understanding of the underlying pathogenesis has, to date, limited the development of specific therapies. The mainstays of treatment remain dietary manipulation and immunosuppressive therapy, but treatment failures are not uncommon. A logical clinical approach is important and there are a number of alternative or adjunctive treatments that can prove useful in refractory cases.

Evidence base This article draws on data from clinical trials in humans, in vitro studies, prospective and retrospective studies in cats with naturally occurring IBD, and clinical experience to discuss the work-up and treatment selection for cats with idiopathic IBD.

Patient group IBD affects young adult to geriatric cats of both sexes.

Audience Companion animal and feline practitioners are at the front line when it comes to managing these often challenging cases.

Background Feline herpesvirus 1 (FHV-1) is a common cause of ocular and upper respiratory disease in cats and kittens, and a potential cause of eosinophilic dermatitis.

Hypothesis The systemic anti-herpes drug, famciclovir (Famvir; Novartis), would be effective in the clinical management of disease attributable to FHV-1, including conjunctivitis, keratitis, corneal sequestra, rhinosinusitis and FHV-1 associated dermatitis.

Clinical outcome Oral famciclovir was used to treat signs considered referable to FHV-1 in 10 cats: four had primary ocular disease, two had rhinosinusitis and four had FHV-1 associated dermatitis. Patients treated in Australia (five cats) and Europe (one cat) were given 62.5 mg of famciclovir once or twice daily. Four cats treated in the USA were given 125 mg three times daily. Famciclovir was uniformly well tolerated and, in all cases, had a positive impact on the patient's condition. The apparent improvement in lesions was superior to what had been achieved previously using other therapeutic strategies. One cat with severe destructive rhinosinusitis was significantly improved by a 4-month course of famciclovir in combination with antibacterials. Corneal sequestra detached in two out of three cats treated; cats with ocular signs were qualitatively more comfortable, with reduced clinical signs and an improved appearance of the eyes. Critically, oral famciclovir therapy was considered more convenient than topical ocular therapy. All four cats with FHV-1 associated dermatitis improved substantially, although relapse occurred subsequently in three patients. A further cat with presumptive FHV-1 associated dermatitis responded to topical aciclovir cream before famciclovir could be sourced.

Conclusions Famciclovir appears to be a promising systemic drug for treating diseases associated with FHV-1 infection. More rigorous clinical trials are required to optimise the dosing regimen for safe and effective specific anti-herpes treatment in feline clinical medicine.