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

Objective: To provide a video tutorial on how to perform a temporary palatopexy in an anesthetized brachycephalic dog.

Animals: Brachycephalic dogs.

Methods: To perform a temporary palatopexy, needle drivers, forceps, intubation equipment, and absorbable suture material are needed. In an anesthetized and ideally intubated patient, buried sutures are placed, tacking the free edge of the soft palate to the junction of the hard and soft palate.

Results: Temporary palatopexy pulls the soft palate out of the airway to improve airflow and manage brachycephalic upper airway crises.

Clinical relevance: Temporary palatopexy can be used for brachycephalic obstructive airway crises in an attempt to avoid prolonged intubation, temporary tracheostomy, emergent palatoplasty, euthanasia, or death. This is not intended to replace permanent palatoplasty but to allow time for stabilization/transfer or delay palatoplasty due to the higher complication rate of emergent palatoplasty.

Objective: To demonstrate an underutilized, reliable, and technically simple anuran venipuncture technique by use of the popliteal sinus.

Animals: Medium to large (> 30 g) anuran species.

Methods: The animal is manually restrained using an encircling grip around the pelvic girdle. With the ventrum facing the phlebotomist, the phlebotomist grasps the distal hind limb and gently extends it. If necessary, the medial stifle can be rinsed with sterile water or saline to remove gross debris. Using a caudomedial approach, a 25- to 27-G, 0.5-inch (1.27-cm) needle and attached syringe is advanced toward the stifle at an approximately 45° angle while maintaining negative pressure. If lymphatic fluid or a visibly lymphatic fluid-contaminated blood sample is obtained, the sample is discarded and the attempt is repeated with a new needle and syringe. Collection volume should not exceed 1% of body weight in systemically healthy animals. In compromised animals, a reduction in collection volume should be considered (eg, ≤ 0.5% of body weight). While the phlebotomist may have an ergonomic preference, either hind limb can be used for blood collection.

Results: Popliteal sinus venipuncture in anurans can be safely and easily performed with only manual restraint.

Clinical relevance: Commonly utilized anuran blood collection techniques include venipuncture of the ventral abdominal vein and lingual venous plexus and cardiocentesis. These techniques can be technically difficult and may pose risks to the patient, particularly if attempted without chemical restraint. Popliteal sinus venipuncture is a reliable, technically simple alternative blood collection technique that can be safely performed in anurans with only manual restraint.

Objective: The primary aims were to provide descriptive data on systemic and ocular complications associated with the treatment of equine keratomycosis. The secondary aims were to determine if complication rates differ between treatment types or are related to surgical and anesthetic factors.

Methods: The study was a retrospective evaluation of 126 cases between 2004 and 2020 with confirmed fungal infection and recorded incidence of complications during hospitalization and surgical intervention if pursued. Additional information recorded included the size of the donor graft if utilized, time under general anesthesia, and prescribed medications. Fisher exact and χ2 tests were used to evaluate complication frequency differences. Logistic regression models determined the effects of donor graft size, anesthesia time, and duration of hospitalization on complication rates.

Results: Hypercreatininemia followed by colic were the most frequent systemic complications in the medical treatment group. Colic and conjunctival graft dehiscence were the most frequent systemic and ocular complications in all surgery treatment groups, respectively. The frequency of systemic complications did not vary between treatment groups, although colic rates were significantly higher following general anesthesia. All colic cases were resolved with supportive care. Donor graft size, anesthesia time, and duration of hospitalization did not impact complication frequency. The mainstays of medical therapy included topical fluoroquinolones, topical voriconazole, topical atropine, oral NSAIDS, and oral gastroprotectants.

Conclusion: Treatment of keratomycosis is associated with a range of complications. Colic remains a significant risk, with increased frequency reported following general anesthesia.

Clinical relevance: Reporting common complications associated with treatment aids in decision-making for equine clinicians and owners.

Objective: To determine clients' preferences for veterinarians' communication during decision-making in relation to 3 clinical contexts: preventive care, general problem (eg, illness or injury), and urgent appointments.

Methods: A cross-sectional online questionnaire was distributed by use of snowball sampling to veterinary clients owning a pet. Demographic information was collected, and participants were then randomly assigned to a scenario reflecting one of the following clinical contexts (appointment types): preventive, general problem, or urgent. Discrete choice exercises were used to solicit client preferences for 5 aspects of veterinarians' communication approach to decision-making with clients in clinical contexts: amount of information, presentation of plan (options or a recommendation), communication of value, nature of client involvement, and communication of financial cost. Relative-preference scores were calculated using hierarchical bayesian modeling.

Results: Responses for 1,614 participants were included in the final analysis. The majority were female, lived in Canada, and were financially stable. Across clinical decision-making contexts, participants preferred to collaborate with the veterinarian, be offered options with a clear recommendation, be informed of present and future costs, and have benefits of any action regarding their pet's health explained to them. For the general-problem context, participants preferred veterinarians' communication to focus solely on concerns; in contrast, in preventive care and urgent contexts, participants preferred that communication include both normal findings and concerns.

Conclusions: Irrespective of clinical decision-making context, participants preferred collaborative decision-making with a veterinarian.

Clinical relevance: Veterinary professionals should consider, when possible, communication that supports a collaborative approach to decision-making with clients.

Objective: To evaluate the clinical utility of 3 in-house tests to screen for bacteriuria in dogs with urinary conditions: a computerized urine sediment analyzer (SediVue), a rapid immunoassay (RapidBac), and in-house urine culture. Accuracy of culture and antimicrobial susceptibility (C&S) results from submission of the positive in-house culture plate and a 24- to 48-hour refrigerated urine sample was also assessed.

Methods: Sterile urine samples from 101 client-owned dogs were used to evaluate sensitivity, specificity, positive predictive value, and negative predictive value of 3 in-house diagnostic tests to detect bacteriuria using C&S testing at a reference laboratory as the reference standard. For positive in-house culture plates, the plate and a 24- to 48-hour refrigerated urine sample were submitted to the reference laboratory for C&S testing and compared to the reference standard.

Results: The reference standard C&S was positive in 25 of 101 cases (25%). All 3 in-house diagnostic tests had high negative predictive values: SediVue was 89% (95% CI, 81% to 96%), RapidBac was 93% (95% CI, 88% to 99%), and in-house culture was 99% (95% CI, 96% to 100%). Positive predictive values were 89% (95% CI, 74% to 100%) for SediVue, 77% (95% CI, 61% to 93%) for RapidBac, and 86% (95% CI, 73% to 99%) for in-house culture. Culture and antimicrobial susceptibility results from submission of the positive in-house plates and refrigerated urine samples approximated the reference standard.

Conclusions: SediVue, RapidBac, and in-house cultures performed well to rule out canine bacteriuria.

Clinical relevance: Inexpensive in-house diagnostic tests can be used to screen for bacteriuria prior to submission of C&S testing, which promotes antimicrobial stewardship, responsible use of client resources, and access to veterinary care.

Objective: The purpose of this study was to compare a cohort of dogs with serious or life-threatening complications following cryptorchid castration to dogs without complications to identify potential contributing factors to the development of these complications.

Methods: Dogs that had a cryptorchid castration between 2018 and 2022 in 2 hospital networks were retrospectively reviewed in a case-control manner for reported complications. Inclusion criteria for cases and controls consisted of dogs with documented surgical procedures to address a retained testicle within the abdomen and an in-person follow-up visit at least 2 weeks postoperatively. Exclusion criteria consisted of felines, procedures limited to inguinal cryptorchid castrations, if the retained testicle had undergone malignant transformation, and medical records lacking essential patient or procedure information.

Results: 202 dogs were included in the study, with 38 dogs with reported complications and 164 controls. The most reported serious complication was trauma to the prostate, followed by gastrointestinal signs and urinary tract trauma. A complication was more likely if a paramedian skin incision was performed (OR, 4.01; 95% CI, 1.45 to 11.1) compared to a parapreputial incision, as well as if a paramedian abdominal incision was performed compared to a ventral midline incision (OR, 3.4; 95% CI, 1.5 to 7.4).

Conclusions: The most common complication found in this case-control study was prostatic trauma and was likely associated with inadequate exposure based on the incision location.

Clinical relevance: Parapreputial skin incision and ventral midline abdominal incision increase exposure and visualization of organs, decreasing the risk of serious complications associated with cryptorchid castration.

Objective: To evaluate the radiation dose to personnel locations during simulated head and limb scans with a novel equine standing CT (sCT) system.

Methods: Measurements were made with the use of a helical fan beam sCT system (Equina; Asto CT Inc). Scatter radiation was measured in different positions in the sCT room to mimic the location of the control operator, horse handler, and lead rope handler during simulated equine head and limb imaging. Operator/handler dose was quantified at each location using entrance air kerma measured with a spherical ionization chamber and electrometer.

Results: Radiation dose to the control operator, horse handler, and lead rope handler locations wearing a lead apron during simulated head imaging was 13.3, 3.5, and 6.8 µGy, respectively. Radiation dose to the control operator location wearing a lead apron was 1.3 µGy, and dose to the lead rope handler location wearing a lead apron was 0.2 and 5.4 µGy during simulated pelvic limb and thoracic limb imaging, respectively.

Conclusions: With the more widespread clinical use of equine sCT units in clinical practice, there is concern for increased risk of radiation exposure to personnel who stay in the sCT room during scanning. The control operator location had the highest dose during simulated head imaging, and the lead rope handler location in thoracic limb sCT had the highest dose during simulated limb imaging. Limiting the number of personnel in the sCT room, rotating personnel between handler positions, increasing operator distance from the scanner, and using lead shields and eyeglasses are recommended.

Clinical relevance: Our findings suggest that scanning large numbers of horses per year with the Asto CT Equina would not lead to occupational radiation exposure above the recommended safe threshold for handlers using lead shields and eyeglasses.