Journal of Small Animal Practice最新文献

Objectives: To report clinical findings, management strategies and outcomes in pet rabbits with maxillofacial fractures.

Materials and methods: Medical records of pet rabbits with confirmed maxillofacial fractures from three exotic animal veterinary services between 2008 and 2022 were reviewed.

Results: Forty-five fractured maxillofacial bones were reported in 27 rabbits, including mandibular symphyseal separation in 13 rabbits. Median age was 18 months (interquartile range, 7 to 38 months), and median bodyweight was 1.70 kg (interquartile range, 1.36 to 2.33 kg). The most common aetiology was anthropogenic accidents (16/27). Hyporexia/anorexia was the most frequent presenting complaint (17/27). Common clinical findings included dental malocclusion (12/27), craniofacial pain (9/27), crepitus (9/27) and swelling (7/27). Three (3/27) rabbits were euthanised after diagnosis. Mandibular symphyseal separation in 11 of 12 treated rabbits were addressed using circummandibular cerclage wiring. All remaining fractures were conservatively managed. Twenty-three of 27 rabbits survived to hospital discharge. Median time of return to normal or near-normal eating was 1 day (interquartile range, <1 to 3 days). Median survival time was 859 days (interquartile range, 567 to 1092 days). Dental malocclusion was a reported complication in 12 of 16 rabbits with follow-up data. However, only five of 12 rabbits developed associated clinical signs requiring corrective dentistry.

Clinical significance: Maxillofacial fracture in rabbits may present with similar clinical signs and findings to other conditions such as odontogenic disease. Successful outcomes with infrequent long-term clinical complications are associated with management strategies that emphasise early functional recovery.

Objectives: To describe the use of a three-dimensional-printed patient-specific guide system for the treatment of distal tibial varus deformity in Dachshunds and retrospectively report the clinical and radiographic outcome.

Materials and methods: Pes varus deformity in nine limbs of seven dachshunds was treated with corrective osteotomy using a three-dimensional-printed patient-specific guide system. Data from computed tomography were processed to obtain virtual 3D-models of the tibias, which were used for computer-aided design-based surgical planning, three-dimensional-printed patient-specific guide system design and evaluation of planned versus achieved tibial correction. Clinical outcomes were evaluated by lameness score and post-operative owner-reported questionnaire at a minimum of 15 months.

Results: The gait abnormality resolved in all limbs. The osteotomy healed uneventfully in eight tibiae. Implant failure occurred in one tibia but was successfully revised. There was good correlation between planned and achieved deformity correction, with mean translational error <1 mm in all planes, and mean angulation correction error <2° in all planes.

Clinical significance: A 3D-printed patient-specific osteotomy and reduction guide system facilitates the accurate correction of tibial pes varus deformity with very good clinical outcomes. Opening osteotomy, stabilised with orthogonal locking plates and without the application of bone graft led to satisfactory bone healing in all cases.

Objective: The purposes of this study were to assess the frequency of detection of clinically relevant findings by abdominal radiographs and abdominal ultrasound during restaging of solid, soft tissue tumours in dogs and to determine the cost per clinically relevant finding for both modalities.

Materials and methods: The medical records of 159 dogs which underwent a total of 223 restaging episodes following a diagnosis of a solid, soft tissue tumour within, or with potential for metastasis to, the abdomen were reviewed. Data collected from the sample dogs were reviewed for clinically relevant findings, including local recurrence, lymph node or intra-abdominal metastasis, and other changes that would influence prognosis or management. The clinically relevant findings were compared between abdominal radiographs and abdominal ultrasound. The cost per clinically relevant finding was calculated per modality based on current hospital costs.

Results: Clinically relevant findings were observed in 158 restaging episodes. Ninety-two clinically relevant findings were detected with ultrasound alone, and 65 clinically relevant findings were detected with a combination of both modalities. Only one dog had a clinically relevant finding detected with radiographs alone. Findings were identified significantly more frequently with ultrasound than radiographs. Cost per clinically relevant finding was 495 USD (approx. 373 GBP/448 EUR) for abdominal radiographs and 323 USD (approx. 242 GBP/292 EUR) for abdominal ultrasound.

Clinical significance: Abdominal radiographs were of minimal use beyond abdominal ultrasound for restaging in this study, despite a higher cost per clinically relevant finding than abdominal ultrasound. This study does not support routine use of abdominal radiographs during routine restaging of solid, soft tissue tumours.

An 8-year-old male cross-Labrador retriever was presented for a progressive appearance of folds all over the body of the dog. Scleromyxoedema was diagnosed based on clinical signs and histopathological features. Clinical signs were characterised by a papular and vesicular eruption and severe skin thickening causing exuberant folds along with concurrent severe osteoarthritis of the coxofemoral joints. Thyroid disorders were excluded and the condition was not associated with monoclonal gammopathy. Histopathological features consisted of mucin deposition, fibroblast proliferation and fibrosis. Prednisolone was prescribed to decrease mucin synthesis which allowed a marked clinical improvement. Due to the progressive inability to walk, the dog was euthanased 6 months after the first consultation.

Objectives: To define a reference interval for alanine aminotransferase for the practice laboratory and then identify and longitudinally follow the clinical health and alanine aminotransferase levels in a cohort of clinically healthy dogs with increased alanine aminotransferase levels documented during wellness screening.

Materials and methods: Alanine aminotransferase levels of 125 clinically healthy dogs were used to define a reference interval for the practice laboratory. The electronic records of 315 clinically healthy dogs which had undergone wellness screening including assessment of alanine aminotransferase levels at a first-opinion veterinary hospital in the UK were reviewed between January 2012 and January 2023. Clinically healthy dogs with increased alanine aminotransferase levels relative to the top of the reference interval determined for the practice on at least one test during the study period were identified. These were longitudinally followed through electronic medical records to determine their long-term clinical outcomes over a period of up to 11 years.

Results: The reference interval for alanine aminotransferase in the practice laboratory was calculated as 10.6 to 181.8 U/L. Nineteen clinically healthy dogs were identified as having increased alanine aminotransferase levels. One dog from the group with increased alanine aminotransferase levels was diagnosed with chronic hepatitis and died of liver failure, while the other 18 dogs died of other causes, or were still alive at the end of the study, with no clinical signs associated with liver disease. One dog in the group with consistently normal alanine aminotransferase levels also died from clinical signs attributed to liver disease.

Clinical significance: Only a small proportion of clinically healthy dogs with increased alanine aminotransferase levels documented on wellness screening developed clinically relevant liver dysfunction over long-term follow-up.

Objectives: To assess the diagnostic accuracy of radiographs in identifying humeral intracondylar fissures in dogs.

Materials and methods: Clinical data from dogs undergoing CT and radiographic elbow investigations at a single institution were reviewed. Based on CT diagnosis, radiographs were classified as having fissures and not having fissures. The radiographic images were evaluated by three blinded observers for the presence/absence of a fissure, type (partial or complete), and for secondary signs that could suggest the presence of a fissure in case this was not visible.

Results: A total of 81 radiographs (76 elbows) were reviewed. Based on CT findings, 37 elbows had fissures and 44 did not. Radiographic interpretation demonstrated a sensitivity of 47.7% (confidence interval 95%: 0.40 to 0.59) and specificity of 85.6% (confidence interval 95%: 0.72 to 0.93) in correctly identifying humeral intracondylar fissures. The positive predictive value was 75.5% (confidence interval 95%: 0.64 to 0.84) and the negative predictive value was 66.1% (confidence interval 95%: 0.63 to 0.68). Agreement with CT images was <0.4, and interobserver and intraobserver agreements were <0.8. The radiographic orientation and type of fissure did not significantly affect interpretation outcomes.

Clinical significance: Radiographic imaging alone is insufficient for reliably diagnosing humeral intracondylar fissures in dogs.

Objectives: Cardiopulmonary resuscitation can be a difficult topic to discuss. The barriers surrounding its discussion are well documented in human medicine but have not previously been examined in veterinary medicine. The objectives of this study is to describe the perceptions, practices and preferences of veterinarians and registered veterinary nurses towards discussing cardiopulmonary resuscitation with pet owners.

Materials and methods: An online survey was circulated to veterinarians and registered veterinary nurses in the UK. Open and closed questions were used, with multiple choice and free text answer formats, all of which related to the timing and content, participants' preferences and perceived barriers to cardiopulmonary resuscitation discussions.

Results: In total, 290 responses met the inclusion criteria. Almost half of participants [140/290 (48%)] worked in first opinion practice. In total, 100 of 290 (34%) participants were "very likely" to discuss cardiopulmonary resuscitation preferences on admission. However, 244 of 272 (90%) said they would rather discuss cardiopulmonary resuscitation prospectively than at the time of a critical event. Most respondents [174/290 (60%)] stated that their practice does not include resuscitation preferences on admission consent forms despite 163 of 290 (56%) "strongly agreeing" that cardiopulmonary resuscitation preferences should be routinely discussed on admission. Over half [168/290 (58%)] never discussed costs associated with cardiopulmonary resuscitation and 67 of 290 (23%) never discussed likelihood of survival to discharge with the most common reason being "unaware of survival statistics." Barriers to discussion included fear of causing upset, concerns for owner reactions and unrealistic owner expectations.

Clinical significance: Veterinary professionals in the UK face multiple challenges when discussing cardiopulmonary resuscitation with pet owners. Whilst communication skills are an increasing area of focus in veterinary education, specific teaching on the topic of cardiopulmonary resuscitation discussion may be beneficial. Pet owner education may also mitigate some of the challenges to conversation.

Objectives: To describe the techniques for preparation and placement of peripheral intravenous catheters (PIVCs), to describe the complications associated with PIVCs, and to identify factors associated with PIVC complications in small animal practice in the United Kingdom.

Materials and methods: A prospective multicentre observational study was undertaken between January 2022 and January 2023. Data collected included patient information, information regarding the placement and maintenance of PIVCs, and PIVC complications, from privately owned cats and dogs presenting to veterinary institutes in the United Kingdom. Patients required a PIVC to be placed as part of their care and the PIVC was anticipated to be in situ for >24 hours to be eligible for PIVC complication analysis.

Results: A total of 19 institutes recorded data regarding 382 PIVCs, with 325 (85.1%) placed in dogs and 57 (14.9%) in cats. The most common reasons for placement were to administer intravenous fluid therapy (74.3%) and intravenous medications (71.7%). There were 102 of 382 (26.7%) PIVCs associated with a complication, with limb swelling/suspected phlebitis in 44 of 382 (11.5%) and PIVC dislodgement/patient interference in 30 of 382 (7.9%) PIVCs. Factors associated with increased risk of complication were more than 1 attempt to place the PIVC, a second or subsequent PIVC being placed during hospitalisation, flush frequency different than every 1 to 24 hours, and flush solution with compound sodium lactate.

Clinical significance: Veterinary professionals must be vigilant when monitoring a patient with a PIVC in situ, particularly if a PIVC is associated with one of the aforementioned factors of increased likelihood of complication.

Objectives: To describe clinical, ultrasonographic, pathological features and response to medical therapy of four dogs with intestinal lipogranulomatous lymphangitis.

Methods: Retrospective review of medical records of dogs with an ultrasonographic evidence of focal or multifocal intestinal wall thickening and a histological diagnosis of lipogranulomatous lymphangitis. Only dogs that did not undergo surgical resection of the lesions were included. The clinical response to medical treatment, consisting of low-fat or hydrolysed diet along with immunosuppressive agents was assessed; clinicopathological and ultrasonographic abnormalities were re-evaluated over time, with a median follow-up period of 16.5 months.

Results: Four dogs met the inclusion criteria. The main historical complaints were diarrhoea (three of four dogs), vomiting (three of four dogs) and abdominal pain (two of four dogs). Clinicopathological abnormalities comprised hypoproteinaemia, hypoalbuminaemia and mild/moderate increase in C-reactive protein levels (three of four dogs). Abdominal ultrasound revealed focal (two of four dogs) or multifocal (two of four dogs) intestinal wall thickening involving distal jejunum, ileum and ileocolic junction. Histopathology of full thickness intestinal biopsies revealed granulomatous enteritis and lymphangitis with lymphangiectasia. Nutritional and medical treatment allowed complete clinical remission in all four dogs within a month of therapy. Improvement of ultrasound abnormalities was noted in three of the four dogs over a 3- to 12-month period.

Clinical significance: Intestinal lipogranulomatous lymphangitis is a rare form of canine chronic enteropathy characterised by focal or multifocal intestinal lesions due to the presence of transmural intestinal lipogranulomas. This is the first case series describing successful management of intestinal lipogranulomatous lymphangitis through medical treatment alone.