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

Objective: To describe the treatment of subcutaneous lipomas in the horse.

Animals: 3 horses.

Clinical presentation: The horses were aged 1 to 2 years old, with lipoma of the abdomen, prepuce, and tarsus.

Results: All cases had surgical removal of the masses under general anesthesia. Recurrence of an invasive abdominal lipoma occurred in case 1 at the exit site of a passive drain. The recurrence was treated unsuccessfully with injectable cisplatin, and a second revision surgery with the use of an active drain resulted in resolution. In case 2, complete resection of an encapsulated lipoma of the lateral prepuce was successful with no recurrence. In case 3, incomplete resection of a tarsal lipoma resulted in a sound horse, with no further growth. Histopathologic analysis revealed that all masses were composed of well-differentiated adipocytes with no evidence of malignancy.

Clinical relevance: Subcutaneous lipomas are relatively rare and affect horses primarily ≤ 2 years of age. They are benign, although their presence can be deleterious due to invasion of local structures or the impact on normal locomotion. The margins of invasive tumors are difficult to identify due to their integration with normal tissue. Incomplete removal may allow for mass recurrence. Active suctions drains are beneficial if dead space is a concern.

Equine fungal keratitis represents a substantial portion of keratitis cases in horses, with fungal involvement identified in approximately half of all infectious keratitis cases. Despite its prevalence, more comprehensive retrospective analyses are needed to better understand this condition. Outcomes vary, with approximately two-thirds of cases achieving complete healing with retained vision, although enucleation is often necessary. Predominant pathogens include Aspergillus and Fusarium, with yeast reported in a minority of cases. Resistance to common antifungal agents among filamentous fungi poses a significant challenge. Advances in diagnostics, including repeat culture and antifungal susceptibility testing, as well as the incorporation of PCR technology, hold promise for improving detection and guiding treatment decisions. Newer antifungals, combination therapies, and innovative modalities such as photodynamic therapy offer hope for improved outcomes. Continued research efforts are essential to further elucidate the epidemiology, pathogenesis, and optimal management strategies for this condition.

Objective: To determine the rate of nodal metastasis in dogs with thyroid cancer and evaluate whether immunohistochemistry (IHC) identifies additional metastases beyond evaluation with H&E.

Animals: 70 prospectively enrolled client-owned dogs with thyroid cancer managed with thyroidectomy.

Methods: Dogs underwent thyroidectomy with concurrent elective bilateral medial retropharyngeal (MRP) ± deep cervical lymphadenectomy. Thyroid tumors and associated lymph nodes were reviewed by a single board-certified pathologist. Immunohistochemistry was used for all primary tumors (thyroid transcription factor-1 and calcitonin) to support a diagnosis of follicular or medullary carcinoma. Lymph nodes without evidence of metastasis after H&E review were labeled with the antibody associated with the wider uptake in the primary tumor.

Results: 77 thyroid cancers were resected from the 70 dogs enrolled, including 61 (79.2%) follicular, 8 (10.7%) medullary, and 7 (9.3%) mixed follicular/medullary carcinomas, with 1 (1.3%) carcinosarcoma. Twelve dogs had evidence of nodal metastasis following H&E review. Occult micrometastasis was identified in 1 dog following nodal IHC, resulting in documented metastasis in 13 of 70 (18.6%) dogs. Metastasis was more common with medullary (5/8) and follicular/medullary carcinoma (3/7) than follicular carcinoma (5/61). All MRP metastases were ipsilateral (7/77 [9.1%]), without contralateral MRP metastases (0/62). Fourteen of 41 (34.1%) deep cervical lymph nodes were metastatic.

Clinical relevance: Nodal metastasis was uncommon for follicular carcinoma but was seen in > 50% of dogs with thyroid cancer involving a medullary component. Routine nodal IHC appears to be low yield for thyroid carcinoma. Extirpation of ipsilateral MRP and identifiable deep cervical lymph nodes is recommended with thyroidectomy until detailed preoperative risk stratification becomes available.

Cats with hypertrophic cardiomyopathy (HCM) have a risk of developing aortic thromboembolism (ATE). Clopidogrel reduces the risk of redeveloping ATE and delays recurrence of ATE in cats that have experienced an ATE episode. Consequently, cardiologists have recommended administering clopidogrel to cats as a primary preventative, suggesting that all cats with severe HCM be administered clopidogrel. However, clopidogrel is unpalatable in its manufactured format, making such administration problematic for many clients. Therefore, estimating the potential benefit of administration might help clinicians determine on a case-by-case basis the need to treat cats with clopidogrel. Relatively simple statistical analyses of currently available data, along with certain assumptions and extrapolations, allow such an estimation of benefit in terms of relative and absolute risk reduction conferred by clopidogrel. Using this approach, and provided certain assumptions are true, clopidogrel likely confers a reduction in risk of ATE in cats with moderate to severe HCM of approximately 3% to 4%. Given the difficulty of administering clopidogrel to cats, clinicians should weigh these relatively small potential benefits against the potential harms (difficulty of administration) and not necessarily insist that clients administer clopidogrel.

Objective: To determine the predictive value of corneal ultrasound biomicroscopy (UBM) findings for the outcome of equine corneal disease.

Animals: 46 horses with a clinical diagnosis of either infectious ulcerative keratitis or stromal abscess.

Methods: Corneal UBM (VevoMD; UHF70; VisualSonics) of horses with infectious corneal disease presenting to the North Carolina State University Equine Ophthalmology Service from 2019 to 2023 were evaluated. Size and depth of lesion, presence of Descemet membrane disruption (DMD), corneal thickness, and aqueous humor cell counts (AHCC) were assessed. Comparisons of UBM and clinical exam findings, presence of infectious organisms, and outcome (healed or enucleated) were performed.

Results: The UBMs from 46 horses were evaluated. Increased AHCC was significantly associated with increased size and depth of corneal lesions on UBM but not with DMD. Deep lesions and DMD were significantly associated with an enucleation outcome. Horses treated with systemic antibiotics had significantly lower AHCC on UBM, but there were no differences in AHCC with the use of other systemic or topical medications. There was no significant correlation between infectious disease results, clinical findings (aqueous flare or cells), outcome, and UBM AHCC.

Clinical relevance: Parameters on UBM, such as depth of lesion, DMD, and AHCC, may be useful diagnostic and prognostic tools to augment the ophthalmic exam of horses with corneal disease. The UBM findings of deep corneal lesions and DMD suggest a poor prognosis and warrant aggressive surgical intervention.

Objective: To evaluate the long-term efficacy, prognostic factors, and complications of intravitreal cidofovir injection in dogs with end-stage glaucoma.

Animals: 130 client-owned dogs.

Methods: Medical records of dogs that underwent intravitreal cidofovir injections were reviewed. A minimum follow-up period of 6 months was required as the inclusion criterion. Signalment, type of glaucoma, preinjection intraocular pressure (IOP), types of applied glaucoma eye drop, coexisting ocular diseases, outcomes, and complications were recorded. Success was defined as IOP of ≤ 25 mm Hg at the 2-week recheck that remained to the 6-month recheck.

Results: The overall success rate of intravitreal cidofovir injection was 91.5% (140/153). The success rate of a single injection was 69.3% (106/153), of a second injection was 59.5% (25/42), of a third injection was 42.9% (6/14), of a fourth injection was 33.3% (2/6), and of a fifth injection was 50.0% (1/2). Intraocular pressures at 6 months after injection were relatively higher when the injection was repeated, fewer types of glaucoma eye drop were applied prior to the injection, and cataract stages were advanced at the time of injection (P < .05). The most common complications were phthisis bulbi (42.5%), cataract progression (30.1%), and intraocular hemorrhage (16.3%). Six eyes were enucleated, and 3 were enucleated due to corneal perforation.

Clinical relevance: Intravitreal cidofovir injection had a high long-term success rate in lowering IOP in dogs with end-stage glaucoma.