Journal of the American Animal Hospital Association最新文献

Primary care veterinarians may diagnose, stage, and treat many canine and feline cancers while providing comprehensive patient health care in their practices. Collaboration between general practitioners and veterinary oncologists can optimize patient care and enhance client engagement, and referral is often necessary, especially in complex cases. These guidelines cover key fundamentals of, and new developments in, cancer diagnosis, staging, and treatment in dogs and cats, including patient supportive care and follow-up assessments. Therapy is based on identifying the tumor type, grade, and stage by using cytologic or histologic evaluation or both, combined with staging diagnostic testing such as imaging and lymph node sampling. Therapy is most often multimodal and may include chemotherapy, immunotherapy, radiation therapy, and surgery, along with nutritional support and pain management. Methods to protect patient, team, and client safety as related to handling cytotoxic chemotherapeutics are emphasized. In addition, strengthening the training, education, and responsibilities of veterinary technicians is encouraged to promote team engagement and practice efficiency, which is highly beneficial when managing complex cancer cases. These guidelines also highlight how to achieve successful collaboration between all members of primary care and referral practice teams, cover tools that can aid in referral to or consultation with veterinary oncologists, and describe communication skills that enhance client understanding and compliance.

Boar attack-associated trauma (BAAT) in dogs was reviewed by assessing the injury type (blunt, penetrating, or combined), distribution, Animal Trauma Triage (ATT) score, and prognosis. We conducted a university teaching hospital retrospective study of the hospital medical records from December 2013 to January 2024 of all dogs presented for BAAT. Forty-two cases were identified: 36 (85.7%) had blunt trauma, 13 (30.9%) had penetrating trauma, and 7 (16.7%) had combined trauma. The mean ATT score (± standard deviation [SD]) was significantly higher in penetrating (4.3 ± 1.2) and combined trauma (5.0 ± 1.0) than in blunt (2.5 ± 1.3) trauma. Similarly, the mean ATT score was significantly higher in multiple (4.2 ± 1.4) than in single (2.5 ± 1.4) lesions. The mean ATT score was 3.0 (± 1.6) in survivors and 5.5 (± 0.71) in dogs that died naturally. The number of observations was too low to reach statistical significance. The survival rate was 100% (6/6) with only penetrating, 89.7% (26/29) with only blunt, and 85.7% (6/7) with combined lesions. ATT scores were higher in cases that suffered penetrating or combined and multiple injuries. Blunt trauma affecting a single region was more common than penetrating or multiple injuries. The overall survival rate was 90.5%.

Hyperechoic retroperitoneal fat was identified in a 3 yr old Sphynx cat with systemic coagulopathy. This ultrasonographic finding preceded the development of hematochezia and anemia, and pleural and peritoneal bleeding did not develop. Fine-needle aspirate cytology of the retroperitoneal space showed a predominance of erythrocytes, and rapid clinical recovery was noted following treatment with plasma, a whole blood transfusion, and vitamin K. Systemic coagulopathy should be considered a differential for hyperechoic retroperitoneal fat in cats, even in the absence of other clinical manifestations of hemorrhage.

A 1 yr old female spayed dog presented for evaluation of lethargy, hyporexia, and left hind limb lameness. On presentation, she was tachycardic and febrile. Echocardiogram revealed pericardial effusion and evidence of pericarditis and myocarditis, and electrocardiogram showed underlying sinus rhythm with complex arrhythmias. Cardiac troponin-I level was markedly elevated. The dog was hospitalized for 6 days on IV fluid therapy and treated with ampicillin/sulbactam and enrofloxacin. She was discharged on amoxicillin-clavulanic acid and maropitant citrate. Within 24 hr, the dog returned because of progressive clinical signs. It was revealed that two of her littermates had tested positive for Brucella canis, so antimicrobial therapy was switched to enrofloxacin and doxycycline. Six days later, the dog developed worsening clinical signs and was euthanized. Postmortem examination was performed. Blood cultures and brucellosis testing were positive for B canis. Two other dogs and two humans in the household were ultimately diagnosed with brucellosis. To our knowledge, infection with B canis has not been reported in dogs diagnosed with myocarditis. However, myocarditis is a rare clinical manifestation of brucellosis in humans. Depending on patient history, clinical signs, and diagnostic findings, brucellosis is a zoonotic disease that may be a differential diagnosis in dogs with suspected myocarditis.

An 8 yr old castrated male Cavalier King Charles spaniel dog was presented for an acute onset of an abnormal mentation and ataxia. After vomiting a large volume of material containing paintball shells, the diagnosis of paintball intoxication was made. Despite mild hypernatremia (157 mmol/L) that was unchanged from presentation, the dog developed tonic-clonic seizures 4 hr after admission. Approximately 11 hr after admission, the patient's plasma sodium increased to 170 mmol/L; the dog became comatose and required endotracheal intubation. Gastric lavage was performed to remove a conglomerate of residual paintball material. The dog's free water deficit was corrected to safely reduce plasma sodium to baseline levels over 12 hr. The patient remained comatose for 7 hr following correction of the acute hypernatremia and developed a Cushing reflex that responded to hyperosmolar therapy. With continued intensive care, his neurological status made gradual improvements and he was successfully discharged after 68 hr with a normal neurological examination. Two weeks after discharge, the owners reported that the patient was bright and alert, with no persistent clinical signs and normal blood parameters on recheck blood work. This case report highlights successful treatment of a dog that developed severe neurological signs following "nontoxic" paintball ingestion both before and after the development of acute hypernatremia.

The objective of this study was to determine if the time to any antimicrobial administration, as well as time to appropriate antimicrobial administration, impacted hospitalization time of dogs diagnosed with sepsis. Records from 175 dogs diagnosed with sepsis were included in this single-center retrospective study. Results found a significant, positive correlation between hospitalization time and time to appropriate antimicrobial administration (P = .004). A significant relationship was also found between survival rate and acute patient physiological and laboratory evaluation fast (APPLEfast) score (P = .03), survival rate and source control (P = .05), and source control and time to appropriate antimicrobial administration (P < .01). No significant relationship was found between hospitalization time and time to any antimicrobial administration (P = .11), time to any antimicrobial administration and source control (P = .77), time to any (P = .11) or appropriate (P = .37) antimicrobial administration and survival rate, or APPLEfast score (P = .07). These findings suggest the importance of appropriate antimicrobial choice upon recognition of sepsis in veterinary patients to decrease length of hospitalization. Additional research is required to further investigate the effect of time to antimicrobial administration on the survival rates of dogs with sepsis.

This case report describes partial pancreatectomy in a dog with insulinoma, emphasizing the role of pancreatic ductal anatomy on surgical planning and postoperative management. A 13 yr old castrated male poodle was evaluated for a pancreatic mass with signs indicative of insulinoma. Imaging showed the mass occupying most of the right pancreatic limb, with its cranial margin just adjacent to the minor duodenal papilla. Although intraoperative visualization was limited by duodenal adhesions, postoperative ultrasonography and histopathology supported anatomical preservation of the accessory pancreatic duct. Histopathologic and immunohistochemical analyses confirmed insulinoma with incomplete surgical margins, prompting adjuvant chemotherapy with imatinib. Initial follow-up revealed maintenance of normoglycemia despite development of pancreatitis. Over time, laboratory findings and clinical signs indicated progressive exocrine insufficiency, with diabetes mellitus diagnosed at 8 mo. The patient survived beyond 16 mo postoperatively without tumor recurrence. This case demonstrates that ductal preservation is anatomically feasible when tumor location permits, although functional preservation may not always follow. It highlights the complexity of balancing oncologic control with pancreatic function. Although surgical management of canine insulinoma is well described, few reports examine the impact of ductal anatomy on surgical decisions and long-term outcomes, underscoring the need for further investigation.

Veterinary medicine is centered on the animal patient, and similarly, human medicine is centered on the human patient. Yet animal health, human health, and the environment intersect in myriad ways. Despite this intersection, there are few resources that take a family-centered, collaborative approach to human, animal, and environmental health. To help address this gap, AAHA has brought together a task force of human and veterinary medical professionals with the goal of improving collaboration between professions to facilitate better outcomes for families with pets. These guidelines address common scenarios (e.g., zoonotic disease, disability, intimate partner violence) that intersect with human and animal health and provide strategies for greater communication and collaboration between the professions. The guidelines cover (1) terms and definitions to establish a common language between professions; (2) how to determine if a case requires a One Health approach; (3) how and when to reach out to other professionals for a case (e.g., social worker, physician, other medical professionals); and (4) how and when to follow up and close cases. These guidelines also offer case studies illustrating One Health scenarios that connect with human/family health, with supplemental materials available on the AAHA website at aaha.org/one-health.

Dogs with hyperadrenocorticism (HAC) present to a referral dermatology practice with clinical signs that vary from the traditional HAC signs. This retrospective case series evaluates the presenting complaints, history findings, and physical examination findings in dogs diagnosed with HAC presenting to a referral dermatology practice. Medical records of 30 dogs diagnosed with HAC and evaluated at a private dermatology referral practice were retrospectively reviewed. A history of pruritus was the most prevalent history finding in 26/30 dogs (87%). On physical examination, a superficial bacterial pyoderma was diagnosed in 22/30 dogs (73%) with a supportive cytology followed by alopecia in 16/30 dogs (53%). Alkaline phosphatase was only elevated in 20/30 cases (67%). These results indicate that pruritus was the most commonly documented historic finding and pyoderma was the prevailing physical examination finding. Uncommonly reported findings included otitis externa and pododermatitis for patients with HAC presenting to a referral dermatology practice.

Nasogastric tubes (NGTs) are used in critical care to provide early enteral nutrition to reduce mortality and morbidity. Compared with other feeding tubes, NGTs are inexpensive and easy to place without delaying provision of enteral nutrition. In addition, NGTs are used to monitor gastric motility and reduce the risk of aspiration pneumonia. Despite their versatility, there are complications associated with their use. This report presents three cases of isocalothorax in animals resulting from inadvertent placement of NGTs into the respiratory tract. Two dogs were treated surgically; one survived to discharge and one died. One cat survived to discharge with medical management. Few reports in veterinary literature describe complications of misplaced NGTs. To our knowledge, this is the first case report of successful medical management in a cat with isocalothorax. This report highlights complications of NGT misplacement and offers possible management strategies in cases of isocalothorax.