Javma-journal of The American Veterinary Medical Association最新文献

Objective: The objective of this Case Report was to describe the clinical manifestation and postmortem findings of a horse evaluated for recurrent colic diagnosed with pyloric aplasia and an ectopic duodenal papilla.

Animal: 13-year-old Quarter Horse gelding.

Clinical presentation, progression, and procedures: The horse was presented to a referral center for signs of colic that were unresponsive to management on the farm. No abnormalities were noted on rectal palpation; however, upon passage of a nasogastric tube, 31 L of net gastric reflux was obtained. Gastroscopy noted grade IV squamous ulceration and moderate glandular ulceration, severe gastric dilatation, an abnormally positioned gastric outflow tract, and an ectopic duodenal papilla leaking bile-like fluid directly into the stomach.

Treatment and outcome: The horse was initially treated with gastroprotectants, promotility agents, and dietary modifications. Following treatment failure and repeated episodes of colic with increasing severity, the horse was euthanized and a necropsy performed. At necropsy, it was confirmed that the aboral aspect of the stomach formed a dilated pouch and continued directly into the proximal duodenum with no discernible pyloric sphincter. The area of the pylorus was delineated by a faint indentation. The ectopic duodenal papilla was traced to the liver.

Clinical relevance: Congenital gastric abnormalities, even in adult horses, should be considered as differential diagnoses when investigating horses presenting with a history of chronic colic. Neither pyloric aplasia nor an ectopic duodenal papilla have been described in the equine literature, and this Case Report raises awareness of the presence of such malformations and their manifestations.

Objective: To determine the effect of tranexamic acid (TXA) on clot hyperfibrinolysis (HF), defined as excessive clot lysis at 30 minutes (LY30%), with rapid thromboelastography (rTEG) or rTEG samples spiked with tissue plasminogen activator (tPA-stressed rTEG), in dogs with hemorrhagic shock.

Methods: Prospective blinded clinical trial at 2 teaching hospitals, March 16, 2018, to May 20, 2022. Twenty-five dogs with hemorrhagic shock and HF were treated with standard care plus either TXA (20 mg/kg; TXA group) or saline (SAL group) over 20 minutes followed by an infusion of the same dose over 8 hours. Rapid TEG and tPA-stressed rTEG assays were performed immediately before study drug administration and at 8, 12, and 24 hours afterwards (T0, T8, T12, and T24, respectively).

Results: 4 dogs died or were euthanized before the end of the study period due to disease/injury severity. All survivors had normal rTEG LY30% values after T0; the value for 1 nonsurvivor increased at T8. The tPA-stressed LY30% normalized in all TXA (n = 14) and 8 of 11 SAL dogs at T8; TXA dogs had lower median tPA-stressed rTEG LY30% values at T8 and T12 than SAL dogs (P = .001 and .02, respectively). There was no treatment effect on blood product administration or survival, and no adverse effects were attributed to TXA administration.

Conclusions: Resuscitation with or without TXA reduced HF identified by tPA-stressed rTEG. Hyperfibrinolysis was completely suppressed at the conclusion of the 8-hour TXA infusion.

Clinical relevance: Although TXA treatment stopped HF, there was no effect on survival or transfusion requirements.

Objective: To describe clinical and radiographic outcomes in dogs with uncomplicated pneumonia receiving a shorter (2-week) versus longer (4-week) duration of antimicrobial therapy.

Animals: 30 client-owned dogs with radiographic evidence of pneumonia.

Methods: Dogs were randomly assigned to either a 2-week course of antimicrobials followed by a 2-week course of placebo medication (2-week group) or a 4-week course of antimicrobials (4-week group). All study investigators and owners were masked to the treatment group. Dogs were reevaluated at 12 ± 2 days and again at 28 ± 2 days for a physical examination and thoracic radiography. Standard documentation at visits included owner-reported clinical signs, nurse-acquired history, the clinician's physical examination, the number of affected lung lobe segments, and the global radiographic severity scores assigned. Outcomes investigated included the persistence of clinical and radiographic signs of pneumonia.

Results: 28 dogs (93.3%) experienced complete resolution of clinical signs by the first visit, and no dogs in either group experienced relapse of clinical signs during the study period. Eighteen of 30 dogs (60%) and 25 of 30 dogs (83%) experienced complete resolution of radiographic lesions at the first and second study visits, respectively. The remaining 5 dogs (17%) had either stable (4 dogs) or continued (1 dog) improvement in radiographic lesions.

Clinical relevance: Resolution of clinical and radiographic signs followed similar courses in dogs with uncomplicated pneumonia receiving a 2-week course of antimicrobials compared to a 4-week course. Clinical signs may be more useful for guiding discontinuation of antimicrobial therapy for pneumonia than radiographic signs.

Objective: To describe CT findings and epidemiologic features of nasal and paranasal disease of rabbits (Oryctolagus cuniculus).

Methods: An electronic search was performed for rabbits that underwent skull CT from 2004 to 2024 and had findings consistent with nasal/paranasal or maxillary dental disease. History, signalment, and physical examination findings were recorded and reevaluated retrospectively for evidence of changes to the nasal passages, paranasal sinuses, and nearby associated anatomy. Data were analyzed with descriptive statistics, ordinal mixed logistic regression, and correlation analysis.

Results: 100 studies from 69 rabbits were reviewed. Lop-eared rabbits represented 30 of 69 cases. Upper respiratory signs (48 of 69 [69.6%]) and dental-related disorders (21 of 69 [31.9%]) were primary complaints. Rhinitis (49 of 69 [71.0%]), sinusitis (50 of 69 [72.5%]), and both (40 of 69 [60.0%]) were most diagnosed, with turbinate destruction (48 of 69 [69.6%]) and alveolar bone loss of adjacent teeth (51 of 69 [73.9%]) being common findings. Sinusitis was most common in the ventral (48 of 50 [96.0%]) and dorsal (33 of 50 [66.0%]) recesses of the maxillary sinus. Multiple CT variables were significantly correlated (P < .05); of those, maxillary alveolar bone loss of the incisor teeth and the second premolar tooth were, respectively, correlated with rhinitis grade and with sinusitis and sinusitis grade within the ventral recess of the maxillary sinus (P < .001).

Conclusions: Computed tomographic evaluation allowed characterization of nasal and paranasal disease in rabbits and the association of rhinitis, sinusitis, and dental disease.

Clinical relevance: The correlation between the maxillary dentition, rhinitis, and sinusitis highlights the need for thorough evaluation in CT of the teeth in rabbits with upper respiratory signs.

Objective: Evaluate the incidence of Borrelia burgdorferi in cases of equine nuchal bursitis (NB) and investigate the relationship between elevated serum outer surface protein A (OspA) antibodies and the molecular identification of B burgdorferi in bursal tissue or synovial fluid. Additionally, describe clinical cases and compare the histologic changes in NB with and without detection of B burgdorferi.

Methods: This was a retrospective multicenter cohort study (2013 to 2022). Medical records from horses with a diagnosis of NB and B burgdorferi PCR testing on NB tissue or synovial fluid were reviewed. The study population included 11 horses with a postmortem diagnosis of NB, 19 horses from the northeastern US with an antemortem diagnosis of B burgdorferi PCR-positive NB, and 15 healthy controls without evidence of NB and unvaccinated for B burgdorferi. Where serum was available, Lyme multiplex assay results were compared with controls and ELISAs targeting individual B burgdorferi antigens were performed. Histologic findings in nuchal bursa tissue were compared between NB cases with and without B burgdorferi PCR detection.

Results: Serum OspA antibody values in B burgdorferi-positive NB cases (n = 13) were significantly elevated (P < .001) compared to controls (15), and OspA was the predominant antigen detected by ELISA (8). Histopathology did not vary between NB cases with (n = 9) and without (6) B burgdorferi PCR detection.

Conclusions: The presence of B burgdorferi in the nuchal bursa of horses is associated with increased serum OspA antibodies.

Clinical relevance: The role of B burgdorferi in equine NB may be underestimated, and targeted therapy requires investigation.

Objective: To evaluate field-applicable cooling methods for treatment of exercise-induced hyperthermia in dogs.

Methods: In this randomized, crossover study from June 27, 2023, to July 24, 2023, 12 working dogs exercised for 10 minutes until core body temperature reached 40.6 °C or above or ≥ 2 signs of heat stress were observed. Four different cooling protocols were evaluated: (1) neck chemical ice packs (2), (2) a wet (22 °C) neck towel, (3) wet (22 °C) axillae towels, or (4) voluntary head immersion ("dunking") into (22 °C) water. After intervention, dogs rested and were monitored for 40 minutes.

Results: The dunking protocol, which included limited water ingestion, produced the lowest mean core temperature in the initial 5 minutes after exercise, in the subsequent 35 minutes during which dogs cooled to baseline temperature and was the only protocol to prevent the initial postexercise temperature rise. All methods resulted in return to baseline temperature.

Conclusions: Trained voluntary head dunk with limited water ingestion results in rapid cooling in field situations of exercise-induced hyperthermia in dogs with normal mental status and ability to pause panting.

Clinical relevance: "Cool first, transport second" reduces morbidity and mortality of acute heat injury. When whole-body water immersion is not an option, the trained voluntary head dunk in mentally appropriate dogs prevents postexercise rise and rapidly reduces core body temperature within the first 5 minutes. Alternatively, allowing the dog to drink controlled amounts of cool water and pouring water on the dog's head may provide some benefit but warrants further study.