Journal of the American Animal Hospital Association最新文献

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.

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.

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.