Journal of the American Animal Hospital Association最新文献

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.

A 10 wk old male shih tzu (1.9 kg) was presented for severe non-weight-bearing lameness of the right thoracic limb. Radiographs revealed luxation of the right humeroulnar joint (type II), with severe external rotation of the proximal ulna. The ulna was manually reduced to achieve articulation with the medial part of the humeral condyle under general anesthesia, which was maintained by two positive-profile threaded pins placed into the lateral part of the humeral condyle in a caudal to cranial direction ("stopper" antiluxation pins). The lameness improved at 5 days postoperatively. One pin appeared loose radiographically and both pins were removed at 30 days postoperatively. The dog showed no lameness with mildly limited range of motion with radiographic findings including the mild residual humeroulnar incongruity and degenerative joint disease at the final follow-up (6.8 yr postoperatively). We propose that this extra-articular method to prevent luxation is advantageous for its minimal adverse effect on elbow range of motion, as compared with the previously described methods including transarticular pinning and external fixators. This case report describes a novel treatment option for congenital humeroulnar luxation in very young dogs that maintains reduction and allows early return to function.

A 1 yr old spayed female Scottish fold cat was referred for further investigation because of loss of appetite and markedly elevated liver enzyme activities. Significant biliary dilatation and positive bile culture were documented, raising suspicion for cholangitis. A strictured/stenotic duodenal papilla was noted on laparotomy, with retrograde cholangiopancreatography documenting the main pancreatic duct joined with the common bile duct outside the duodenal wall. In addition, pancreatic enzyme activity in the bile was high, suggesting that pancreatic juice was flowing back into the biliary tract. These findings are similar to those of pancreaticobiliary maljunction observed in humans. Duodenal papillotomy improved the excretion of bile and pancreatic juice, resolving both the bile duct dilatation and elevated liver enzyme activities. To our knowledge, this is the first report demonstrating the association of pancreaticobiliary maljunction with the development of cholangitis associated with biliary dilatation in cats. In clinical practice, when cholangitis with severe biliary dilatation is observed in a young cat, the association with pancreaticobiliary maljunction should be considered.

Recurrent pericardial effusion (PE) with cardiac tamponade due to a cardiac mass was identified in two dogs. Cytology of the masses was consistent with a malignant epithelial tumor with a neuroendocrine appearance in both cases. Given the location and description, an ectopic thyroid carcinoma was considered the most likely cytological diagnosis. Pericardiectomy and chemotherapy were proposed in both cases, but the owners declined to perform any invasive surgical treatment, and an alternative option was offered to palliate the symptoms associated with PE. Placement of a subcutaneous pleural access port in the pericardial cavity was achieved to drain the PE and avoid the need to perform serial percutaneous pericardiocentesis. The placement of a subcutaneous access port appeared to be safe and well tolerated in two patients for whom more invasive treatment was declined and may be considered for future similar cases.

A 12 yr old, 6.11 kg, neutered male spitz dog was referred for acute hind limb paralysis. The dog had a history of inflammatory bowel disease and hyperadrenocorticism. Abdominal ultrasonography revealed a large thrombus at the aortic trifurcation, involving both iliac arteries. Therefore, the dog underwent mechanical thrombectomy using a stent-retriever thrombectomy device via the carotid artery. The procedure involved three cycles of thrombus retrieval, successfully capturing dark red thromboembolic material in the device. Successful recanalization of the aortic trifurcation and external iliac arteries was confirmed on the angiogram. After the procedure, the dog's neurological deficits resolved, and normal motor function in both hind limbs was maintained during follow-up. This case demonstrates that mechanical thrombectomy using a stent-retriever thrombectomy device is a viable and effective alternative to traditional treatments for dogs in the acute stage of aortic thromboembolism.

A 3 yr old intact male Doberman pinscher was referred with chronic diarrhea, severe polyuria-polydipsia, and behavioral changes for 2 wk. Biochemical abnormalities were consistent with central diabetes insipidus, hypothyroidism, and hypoadrenocorticism. Brain MRI and cerebrospinal fluid analysis raised suspicion for lymphocytic hypophysitis and meningitis, later confirmed histologically. Immunosuppressive steroid therapy and hormonal supplementation were implemented, resulting in a marked clinical improvement. Brain MRI at a 3 mo follow-up showed a resolution of inflammatory lesions along with pituitary atrophy. The patient was euthanized 4.5 mo following diagnosis because of uncontrolled aggressiveness. Lymphocytic hypophysitis (LHP) is a rare autoimmune condition in people and dogs, often accompanied by total or partial pituitary hormonal deficiency. This is the first case of histologically confirmed canine LHP with documented clinical and biochemical response to medical management. As described in people, LHP should be considered as a differential diagnosis for pituitary lesions. Although the overall prognosis of this disease remains guarded to poor, early diagnosis and adequate immunosuppressive treatment might improve the outcome.

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.

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.