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

Objective: To investigate the prevalence of acute kidney injury (AKI) and outcome in cats treated for lily exposure as inpatients (IPs) or outpatients (OPs).

Methods: Medical records of cats with lily exposure were retrospectively evaluated; 112 cats were included. Signalment, type of exposure, time from exposure to presentation, decontamination procedures, treatment group (IPs vs OPs), creatinine and International Renal Interest Society AKI grade at specific time points (initial presentation, 0 to 24 hours, 24 to 48 hours, and 48 hours to 2 weeks), whether an AKI developed at any point, whether AKI grade was static or improved when comparing baseline to last documented AKI grade, and outcome (alive or dead/euthanized) were recorded.

Results: There were no significant differences in prevalence of AKI between the IP cats (45 of 96 [46.9%]) and OP cats (7 of 16 [43.8%]). Of the AKI cats, 27 IP cats (60%) and 4 OP cats (57.1%) had a static or improved AKI grade. Inpatient cats had a significantly higher survival compared to OP cats (100% vs 86.5%).

Conclusions: Cats exposed to lilies in both groups had a higher prevalence of AKI than previously reported; however, many cats with AKIs had a static or improved AKI grade by the last documented AKI grade. Although the survival was lower in OP cats compared to IP cats, overall survival was excellent.

Clinical relevance: Results of our study suggested that IP cats have a superior outcome than OP cats; however, cats treated as OPs may still have favorable outcomes.

Objective: To provide a video tutorial on use of the Value Matrix in clinical practice.

Animals: Any animal for which a preference-sensitive decision can be made regarding their care.

Methods: The veterinary professional gathers a comprehensive history from the veterinary client and uses this information, in further discussion with the client, to develop 2 or more evidence-informed options for the veterinary patient's care. With the use of the Value Matrix, options are captured on a whiteboard or piece of paper, and the advantages and disadvantages of each option as well as financial cost are visually presented and discussed.

Results: The Value Matrix is a clinical-communication tool for supporting shared decision-making between veterinary professionals and clients and for delivering the Spectrum of Care.

Clinical relevance: The Value Matrix is a practical tool that can assist veterinary professionals in collaborating with clients on making preference-sensitive decisions, providing contextualized care, and achieving informed-client consent.

Objective: Cruciate ligament rupture (CR) in Labrador Retrievers is a complex polygenic disease with high heritability. The environmental contribution to CR risk remains poorly characterized. An accurate genetic risk test for CR in the Labrador Retriever has been developed. This enables evaluation of environmental risk with knowledge of genetic disease predisposition through study of dogs with phenotypic disease status that is discordant with their genetic risk. The objective of this study was to identify environmental factors that contribute to CR in Labrador Retrievers through evaluation of dogs with clinical phenotypes that are discordantly predicted with the use of genetic markers.

Methods: Dogs were prospectively recruited between January 2013 and December 2022. To study discordant subjects, case dogs with a posterior risk probability value < 0.75 and control dogs with a posterior risk probability of > 0.25, determined with the use of an average of 8 statistical models, were selected. The environmental factors investigated were neuter status, age of neuter, withers height measured at the dorsal-most ridge between the scapulae, weight, body mass index, and athletic activity.

Results: Ninety three dogs were discordant: 58 dogs were discordant CR cases, and 35 dogs were discordant CR controls. Neutering before 12 months of age was a significant risk factor for CR development. Sex, neuter status, or status as an athlete was not associated with CR risk.

Conclusions: Neutering before 12 months of age influences risk of CR in Labrador Retrievers.

Clinical relevance: This information can inform management decisions about Labrador Retrievers regarding age of neutering, body condition, and athletic activity. The primary factor influencing CR development in Labrador Retrievers is polygenic intrinsic genetic risk.

Objective: To evaluate the feasibility and reliability of early ultrasound diagnosis for postsurgical bowel dehiscence and find the most reliable ultrasound criteria for dehiscence identification. Additionally, to determine the impact of early ultrasound detection of leakage in terms of survival and duration of hospitalization. Finally, to assess the need for systematized screening or checkup of the population at risk of dehiscence only.

Animals: 31 cats and 83 dogs.

Methods: A retrospective, records-based study was performed on 83 dogs and 31 cats (114 total) undergoing small intestinal surgery. Epidemiologic data, clinical signs, surgical procedures, pre- and postoperative ultrasound findings at 48 to 96 hours, hospitalization duration, complications, and general outcomes were recorded. Univariate and multivariate analyses were used to identify ultrasound findings associated with dehiscence.

Results: Dehiscence was suspected by ultrasound for 0 of 31 cats and 7 of 83 dogs (2 of 49 for enterotomy and 5 of 34 for enterectomy). Every suspected dehiscence was confirmed during revision surgery except one enterectomy revision, which was declined by the owner. Neither this case nor those without ultrasound evidence of dehiscence developed clinical signs of intestinal leakage. Direct visibility of wall discontinuity, presence of gas bubbles, and liquid in vicinity of the intestinal surgical site were statistically associated with early dehiscence. Survival rate after the second surgery was 83%. Median hospitalization time after the second surgery for dehiscence was 2 days (minimum, 2 days; maximum, 4 days).

Clinical relevance: Postoperative ultrasound examination between 48 and 96 hours after intestinal surgery allows early and sensitive detection of intestinal dehiscence. Survival rate after revision surgery was significantly higher than that associated with septic peritonitis.

Objective: To explore the differences in outcomes between dogs with intrahepatic portosystemic shunts (IHPSSs) partially occluded with a mattress suture with pledgets or attenuated with cellophane banding.

Methods: 74 dogs with IHPSSs were included in this retrospective study. Medical records between January 2000 and February 2020 were evaluated for information on dogs undergoing laparotomy with cellophane banding (group C) or mattress suture with pledgets (group P) for treatment of IHPSSs, including specific outcomes of survival time, persistence of clinical signs, and necessity of continued medical management. Primary veterinarians and owners were contacted for long-term follow-up.

Results: 51 dogs were entered in group C and 23 in group P. The duration of surgery was 154.6 minutes (136.3 to 170 minutes) for group C and 154.9 minutes (128.9 to 180.9 minutes) for group P. The short-term mortality rate was 2% for group C and 4% for group P. Dogs in group C had a median survival time of 3,537 days, while dogs in group P had a median survival time of 2,141 days. In the long term, dogs in group P received more medications than dogs in group C, but the distribution of the quality-of-life score was not different.

Conclusions: Mattress suture with pledgets can be used as an alternative to cellophane banding.

Clinical relevance: For dogs with IHPSSs where full surgical dissection for placement of cellophane band is not possible, partial occlusion of the shunt with a mattress suture with pledgets is a viable option with acceptable long-term outcomes.

Objective: To describe clinical findings, complications, and short- and long-term outcomes associated with colonic torsion and volvulus in dogs.

Animals: 28 client-owned dogs.

Clinical presentation: Multi-institutional, retrospective study. Medical records were searched for dogs of any age, body weight, sex, and breed that underwent surgery for colonic torsion and volvulus. Collected data included signalment, previous history, preoperative findings, time until surgery, intraoperative findings, postoperative complications, length of hospitalization, survival to discharge, and outcomes.

Results: 28 dogs were included. Thirteen of 28 dogs (46.4%) had preexisting gastrointestinal conditions. Nine of 28 dogs (32.1%) had a gastropexy performed prior to presentation. Ten dogs (35.7%) were found to have a resolution of colonic torsion and volvulus at the time of the surgery. All but 1 dog (27 of 28 [96.4%]) survived to discharge. Two dogs died during the postoperative period, yielding a mortality rate of 7.1%. Postoperative complications were noted in 9 dogs (9 of 28 [32.1%]). Long-term follow-up information was available in 16 of 28 dogs (57%). Among 16 dogs with at least 6 months' follow-up, all dogs (16 of 16 [100%]) were alive at 6 months postoperatively. Two dogs developed mesenteric torsion after the initial surgery.

Clinical relevance: Dogs with colonic torsion and volvulus undergoing surgery can have an excellent survival-to-discharge ratio with a low mortality rate. Surgeons should not be prompted to euthanize or assume a guarded prognosis solely on the basis of the intraoperative appearance of the bowel and should consider all factors prior to making decisions. Owners should be informed of the risk of developing further torsional diseases after surgery.

Objective: To evaluate nonsurgical management outcomes of cleft palate (CP) in dogs and identify any association between cleft size, prevalence of clinical signs, and quality of life (QoL).

Methods: 65 dogs treated conservatively for CP from January 2006 through December 2023 were retrospectively identified. Diet, activity, medical history, and QoL were recorded for dogs that survived to the transition to solid food. Results were compared to those from 24 control dogs. Measurements of cleft area, width, and percentage of the hard palate occupied by the cleft were made with the use of calibrated photographs. Clefts were divided into 3 types: wide throughout, wide rostrally, and slit throughout.

Results: Sneezing was the most frequent clinical sign (43 of 65 over the past month, 34 of 65 when most affected). There was a greater frequency of material lodging in the cleft in the wide-throughout clefts (13 of 16 dogs) compared to the slit-throughout clefts (7 of 19 dogs). Veterinary removal of material was required in 10 of 68 episodes (7 of 31 dogs). There was no correlation between cleft size and prevalence of clinical signs or QoL. Sixty-three percent of dogs had a perfect QoL on a weighted scale, while 83.3% had a perfect score on a visual analog scale. Sixty-four of 65 owners would adopt another dog with a CP.

Conclusions: Measures of QoL were favorable among dogs treated conservatively for CP.

Clinical relevance: Conservative management appears to be a viable option for treatment of CPs in some dogs.

Objective: To describe the CT features of Morel-Lavallée lesions (MLLs) and their association with trauma in cats. This study aimed to investigate whether MLL fluid in cats accumulates between the dermis and deep fascia near superficial trauma, exhibits a vertical attenuation gradient, and shows no or only mild contrast enhancement on CT images.

Animals: 3 young cats: a 1-year-old neutered male domestic shorthair cat, a 2-year-old neutered male domestic shorthair cat, and a 3-year-old neutered female British Shorthair cat.

Clinical presentation: The clinical presentation of the 3 cats in the study involved recurrent swelling and fluid accumulation affecting at least 1 pelvic limb following trauma.

Results: In all cases, there was a fluid-filled space deep to the skin and superficial subcutaneous layer but superficial to the deep fascial plane overlying the muscular component of the pelvic limbs. The MLL fluid had a vertical attenuation gradient and no or only mild contrast enhancement.

Clinical relevance: Morel-Lavallée lesions are often initially overlooked, likely due to distraction by concomitant significant bone injuries, and can be mistaken for hematomas, seromas, subcutaneous edema, contusions, or cellulitis, leading to less aggressive treatment. If left untreated, MLLs present a significant risk of extensive skin necrosis compared to other types of subcutaneous swelling.