Journal of the American Animal Hospital Association最新文献

Across the many types of specialty practitioners and hospitals, the requirements for veterinary patient referrals vary from one-time consultations to long-term case oversight and management. These guidelines propose a structured and technology-based approach to optimize the referral process for patients, clients, and veterinary teams. They emphasize a family-centered health care approach that keeps the focus on patients and clients through consistent collaboration between primary and specialty care teams. Collaboration between primary care teams and specialty care teams requires detailed and timely communication and medical records sharing. Veterinary clients also need content-rich and supportive conversations as they navigate often stressful clinical situations with their pets, including the realities of referral care costs, prognoses, and possible ongoing treatments and/or management of chronic conditions. These guidelines establish the concepts, roles, client communication strategies, and timelines that will promote successful referral relationships. Later sections offer detailed insights into the key responsibilities for the primary and specialty care team, from the initial contact before referral, through the referral itself, and then back to primary care team oversight. The final sections consider strategies to increase access to care using team optimization and telehealth, as well as possible obstacles in the referral process and how to address or avoid them.

A 3 yr old female springer spaniel presented with a 3-day history of pyrexia, lethargy, and a mild cough. A year prior, the dog had undergone surgical removal of a grass seed from her sublumbar muscles. Computed tomography of the thorax revealed the presence of a caudal mediastinal mass closely associated with the esophagus and diaphragm. A median sternotomy was performed, but the mass proved nonresectable. Biopsy results confirmed a chronic granuloma, and the culture isolated Escherichia coli spp. The patient was treated with long-term antibiotics and the response was followed with computed tomography, with the mass completely resolved in 6 mo. Caudal mediastinal masses are a rare entity in veterinary medicine. Most of the masses are abscesses or granulomas caused by migrating foreign bodies. Surgical excision or debridement is considered the preferred treatment. This case report describes the successful long-term management of a nonresectable mediastinal granuloma through medical intervention. Medical management can have successful outcomes when surgical excision is not feasible.

A 5 yr old chihuahua presented to our clinic with a complaint of decreased activity and focal seizures. Based on the findings of MRI and computed tomography, a primary brain tumor originating from the right frontal lobe region was suspected. Surgical resection was performed, and a diagnosis of histiocytic sarcoma was made via histopathological examination and immunohistochemical staining. Low-dose 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) (45 mg/m2 every 4-5 wk) was started postoperatively, and no apparent recurrence was found on two MRI scans until the patient's death on day 359. We hypothesized that long-term survival might be achieved in dogs with solitary histiocytic sarcoma of the central nervous system with no metastatic lesions at diagnosis by combining local treatment with CCNU. We also suggested that CCNU may effectively suppress the recurrence of histiocytic sarcoma, even at low doses.

Although intracranial and spinal cord meningioma prognoses have been reported, few studies have evaluated the outcomes and prognoses of orbital and optic nerve meningiomas in dogs. We aimed to evaluate the outcomes of canine orbital meningiomas. The seven dogs included were cytologically or histopathologically diagnosed with meningiomas. Four underwent first-line surgery; three received postoperative radiation therapy. The remaining three underwent first-line radiation therapy; however, 372 days after radiation therapy, one dog underwent surgery as the lesion progressed in size. Five dogs underwent surgical resection, had incomplete resections, and died during the observation period, with a median survival time of 943 days (range 668-1083 days). The two surviving dogs were followed up for 119 and 1083 days. Local recurrence was detected in three of the five dogs at 478, 660, and 814 days. The median progression-free survival was 569 days (range 262-814 days). Although keratoconjunctivitis (grade 2) was observed in one dog that underwent eye-sparing radiation therapy, no serious side effects were observed in the other dogs. Our results suggest that surgery and radiation therapy may play an important role in the treatment of orbital meningiomas and may offer longer survival than that of brain or spinal cord meningiomas.

Vaccination is a cornerstone of canine preventive healthcare and one of the most cost-effective ways of maintaining a dog's health, longevity, and quality of life. Canine vaccination also serves a public health function by forming a barrier against several zoonotic diseases affecting dogs and humans. Canine vaccines are broadly categorized as containing core and noncore immunizing antigens, with administration recommendations based on assessment of individual patient risk factors. The guidelines include a comprehensive table listing canine core and noncore vaccines and a recommended vaccination and revaccination schedule for each vaccine. The guidelines explain the relevance of different vaccine formulations, including those containing modified-live virus, inactivated, and recombinant immunizing agents. Factors that potentially affect vaccine efficacy are addressed, including the patient's prevaccination immune status and vaccine duration of immunity. Because animal shelters are one of the most challenging environments for prevention and control of infectious diseases, the guidelines also provide recommendations for vaccination of dogs presented at or housed in animal shelters, including the appropriate response to an infectious disease outbreak in the shelter setting. The guidelines explain how practitioners can interpret a patient's serological status, including maternally derived antibody titers, as indicators of immune status and suitability for vaccination. Other topics covered include factors associated with postvaccination adverse events, vaccine storage and handling to preserve product efficacy, interpreting product labeling to ensure proper vaccine use, and using client education and healthcare team training to raise awareness of the importance of vaccinations.

Community care is a creative way of thinking about health care that mobilizes resources within a community and consists of four core principles: recognition of the urgency of access-to-care for the veterinary profession, collaboration within community networks, family-centered health care, and redefining the gold standard of care. The AAHA Community Care Guidelines for Small Animal Practice offer strategies to help busy veterinary practitioners increase access to care within their practice and community by optimizing collaborative networks. While these guidelines do not claim to provide exhaustive solutions to access-to-care issues, they propose a starting point from which private practices can explore and implement workable solutions for their community and their practice. Broadening the scope of care to reach all people with pets requires multimodal, collaborative, and creative solutions both within and outside of the veterinary profession. These solutions can begin with greater communication and collaboration between private veterinary practices and nonprofit veterinary practices, with the goal of keeping pets in their homes with their loving families as much as reasonably possible.

An approximately 3 yr old female Chihuahua was presented for evaluation of polyuria and polydipsia noted by the owner after adoption. Serum biochemistry and urinalysis revealed hyponatremia, hypochloremia, hypo-osmolality, and normal fractional excretion of sodium. Serum antidiuretic hormone concentration was 5.54 pg/mL and serum copeptin concentration was 135.40 pg/mL. The antidiuretic hormone value was above the reported range for healthy dogs and was considered inappropriate in light of serum osmolality. Idiopathic syndrome of inappropriate antidiuretic hormone secretion was considered the most likely diagnosis after excluding other potential causes, such as diuretic use, renal disease, adrenal disease, and thyroid dysfunction. The dog remains clinically well 2 yr after diagnosis without specific treatment other than minimal dietary salt supplementation. This case is unique because of the absence of systemic or neurologic signs, good long-term outcome without treatment, and use of novel diagnostic testing.

Most urinary bladder (UB) tumors are malignant, and transitional cell carcinoma (TCC) is the most common neoplasm affecting the UB in dogs. Sorafenib may be a potential therapeutic agent for canine TCC. A 12 yr old spayed female Maltese dog weighing 3.6 kg and with a history of hematuria was referred for a suspected UB tumor. Abdominal ultrasonography revealed a UB mass attached to the cranioventral wall. The remaining abdominal examinations, including that of the lymph nodes, were unremarkable. Ultrasound-guided traumatic catheterization of the UB mass was performed, and the cytological evaluation of the UB mass indicated TCC. Excision was performed by partial cystectomy, and histopathology confirmed TCC, although the tumor had infiltrated the surgical margins. A chemosensitivity assay was conducted using tissue from the excised tumor. Sorafenib tosylate, a tyrosine kinase inhibitor, showed the greatest effect in the chemosensitivity assay. Therefore, adjuvant chemotherapy with sorafenib tosylate and piroxicam was administered postoperatively. The dog lived without any clinical signs, including hematuria or tumor relapse, for more than 2 yr after the surgery. This is the first report of successful long-term management of TCC with sorafenib tosylate in a dog.

Training and maintaining a service dog requires extensive time and financial resources. The emotional bond between service dogs and their handlers poses unique challenges when dogs develop behavioral issues. We present a case of an otherwise healthy adult service dog exhibiting acute environmental fears, hindering her job performance. The dog's fear responses escalated in various settings, including school and home environments. Diagnostic evaluation ruled out medical pathology, leading to a diagnosis of nonsocial environmental fear and generalized anxiety. A multimodal treatment approach involving environmental management, antidepressant medication (fluoxetine), and behavior modification was implemented. Desensitization and counterconditioning protocols targeted specific triggers, such as shiny floors and elevators. Eight weeks after treatment initiation, the dog showed improvement, enabling a modified behavior treatment plan to be implemented as she gradually returned to work with reduced fear responses. Follow-up revealed sustained progress with additional dosage adjustment of fluoxetine.

Collecting clean-caught voided urine samples is minimally invasive, but contamination occurs when urine passes through the nonsterile urethra and external genitalia. Discarding the initial urine stream may reduce these contaminants. This study hypothesized that using a midstream urine collection device would decrease bacterial and cellular contamination as compared with cleanly caught voided urine. This descriptive cross-sectional study collected urine from dogs using standard clean-caught (SCC), midstream collection device (MCD), and cystocentesis (CYS) techniques. Urinalysis and aerobic urine culture characteristics were recorded with each characteristic's prevalence described using percentages and 95% confidence intervals for each mode of collection. Positive urine culture prevalence did not differ between SCC and MCD (adjusted P value = .099); however, CYS had a lower prevalence compared with SCC and MCD (adjusted P values of <.001 [CYS versus SCC] and 0.009 [CYS versus MCD]). For other variables, there was no difference in prevalence when comparing SCC with MCD. There was no identified advantage to collecting urine using an MCD as compared with the SCC technique. Either option is a suitable alternative when CYS is not practical; however, clinicians need to interpret results cautiously because bacterial contamination is more common as compared with CYS.