Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)最新文献

Objective: To compare perioperative trends in plasma colloid osmotic pressure (COP) between horses undergoing orthopedic and colic surgery.

Design: Prospective clinical study September 2009-January 2011.

Setting: Veterinary university teaching hospital.

Animals: Thirty-three healthy, client-owned horses presenting for orthopedic surgery (non-GI) and 85 client-owned horses presenting for emergency exploratory celiotomy (GI, gastrointestinal).

Interventions: None.

Measurements: Data relating to the horse's parameters on presentation, surgical lesion, post-operative management and survival were extracted from computerized clinical records. Heparinized blood samples were taken on presentation (PreOp, pre-operative), on recovery from anesthesia (T0), at 12 (T12) and 24 (T24) hours post recovery. COP was measured within 4 hours of collection.

Results: There was no significant difference in PreOp or T0 COP between groups. Both groups had a significant decrease in COP during anesthesia. When compared to their respective pre-operative values, horses in the non-GI group had significantly increased COP at T12, whereas those in the GI group had significantly reduced COP. This trend was continued at T24. Horses in the GI group placed on intravenous crystalloid isotonic fluids post-operatively had a significantly lower COP at T12 and T24. Horses in the GI group that did not survive had significantly lower post-operative COP values at T24.

Conclusions: Horses undergoing exploratory celiotomy had significantly lower COP post-operatively than those horses undergoing orthopedic surgery. This difference was more marked in those horses receiving isotonic crystalloid intravenous fluid therapy post-operatively and in those that did not survive to discharge. In the non-GI group an increase in COP post-operatively was common.

Objective: To assess the utility of population-based reference intervals (PRIs) for interpreting thromboelastography (TEG) variables in horses using biological variation data.

Design: Prospective cohort biologic variation study conducted over a 5-week period.

Setting: Veterinary teaching hospital and research facility.

Animals: Ten clinically healthy horses randomly selected from a veterinary school research and teaching herd.

Interventions: Horse health was determined using physical examination, CBC, and biochemical and coagulation profiles prior to the start of the study. Subsequently, once weekly blood sampling for TEG testing was performed for 5 weeks.

Measurements and main results: The 4 TEG variables reaction time (R), clot formation time (K), angle, and maximum amplitude (MA) were measured, and coefficient of variation representing within- and between-horse biological variation (CVi and CVg , respectively) and coefficient of variation representing analytical variation (CVa ) were calculated using a nested ANOVA after removing outlier data. The CVi , CVg , and CVa for R were 26.8%, 5.2%, and 5.9%; for K were 31.0%, 0.0%, and 5.9%; for angle were 9.4%, 6.2%, and 21.7%; and for MA were 3.4%, 4.1%, and 4.4%, respectively. Index of individuality (IOI) was then calculated for each variable using the formula {( CVi² + CVa²/CVg²)}¹/². IOI for R was 5.3, for angle was 3.8, and for MA was 1.4; IOI was not assessed for K.

Conclusions: PRIs are appropriate for TEG variables, R, angle, and MA when interpreting results from individual horses based on calculated IOI values equal to or greater than 1.4. PRIs are likely appropriate when interpreting K, but IOI could not be calculated for this variable.

Objective: To describe the use and outcome following autologous blood transfusion (ABT) in dogs.

Design: Retrospective study (January 2007-July 2012).

Setting: Private veterinary referral center.

Animals: Twenty-five dogs that underwent ABT secondary to thoracic or abdominal hemorrhage.

Interventions: None.

Measurements and main results: The hospital transaction database was searched using the keyword "autotransfusion" from January 2007 to July 2012. Data collected included signalment, body weight, etiology of hemorrhage, source and method of collection, volumes and method of ABT administration, use of anticoagulant, reported complications, and outcome. Twenty-five dogs were included for a total of 27 ABTs. Causes of hemorrhage included vascular trauma (14/25 dogs, 56%), ruptured tumor (8/25, 32%), and coagulopathy attributed to brodifacoum toxicosis (3/25, 12%). Autologous blood was collected from the abdominal (19/25, 76%), thoracic (5/25, 20%), or abdominal and thoracic cavities (1/25, 4%). Anticoagulant was added to the ABT blood in 13 of 25 (52%) cases. A median ABT volume of 29.3 mL/kg (range 2.9-406.9 mL/kg) was infused through either a 210 μm blood administration filter (21/27, 78%) or an 18 μm hemonate filter (6/27, 22%). Reported complications that may have been associated with ABT included hypocalcemia (4/17, 24%), hemolyzed serum (5/19, 26%), and prolonged coagulation times (4/5, 80%). These complications were considered of minimal clinical significance. Additional blood products were administered in 17 of 25 (68%) dogs. Seventeen (68%) dogs survived to discharge. Cause of death in the remaining cases was euthanasia or cardiac arrest secondary to uncontrollable hemorrhage.

Conclusions: ABT is an adjunct to volume replacement in dogs with thoracic or abdominal hemorrhage secondary to vascular trauma, ruptured tumor, or anticoagulant rodenticide toxicosis. ABT may be used as bridge to definitive hemorrhage control, particularly when other blood products are not available or affordable. Complications may include hypocalcemia, prolonged coagulation times, and hemolysis.

Objective: To describe a case of cardiac malposition in a cat, and the successful management of the anomaly.

Case description: A 2-year-old male neutered male British Shorthair cat weighing 7.58 kg was referred for bicavitary effusion. Ultrasonography and echocardiography demonstrated displacement of the heart into the abdomen through a diaphragmatic defect. Clinical signs of right-sided congestive heart failure were attributed to mechanical restriction of diastolic function by a constrictive segment of fibrous pericardium and to impaired venous return due to a kink in the caudal vena cava. Surgical repositioning of the heart into the thoracic cavity and a subtotal pericardectomy were performed, and the diaphragmatic defect was repaired. The patient recovered well postoperatively.

New or unique information provided: The diagnosis and management of cardiac malposition has not been previously described in cats. With timely diagnosis and surgical intervention, a favorable outcome is possible.

Objective: To compare the influence of the obstetrical condition on neonatal respiratory performance, to estimate surfactant synthesis through lecithin and sphingomyelin ratio (L/S) in amniotic fluid of pregnant bitches and correlate the L/S with the respiratory condition during the first hour of life.

Design: Prospective randomized study.

Setting: University veterinary teaching hospital and private referral centers.

Animals: In accordance to the condition at birth, puppies from 25 healthy bitches aged 2-6 years were allocated into: Eutocia Group--EUT (n = 19 neonates and 14 bitches); Dystocia Group--DYS (n = 8 neonates and 5 bitches) and Elective Cesarean Section Group--CS (n = 12 neonates and 11 bitches).

Interventions: Amniotic fluid was drawn from amniotic sac and lecithin (L) and sphingomyelin (S) were measured by high performance liquid chromatography to obtain the L/S ratio. Neonatal physical examination was performed at 1, 5, and 60 minutes after delivery, and included the assessment of respiratory rate (RR) and respiration effort (RE).

Measurements and main results: CS group had significantly lower amniotic L/S ratio when compared to EUT and DYS. There were no significant differences between vaginal groups (EUT versus DYS) in respect to L/S ratios. RE of eutocic neonates improved promptly, while RE of DYS and CS groups improved only 1 hour following birth. Moreover, amniotic L/S ratio positively correlated with RR after 60 minutes.

Conclusions: We identified a possible influence of the delivery method on the final surfactant maturation process. Thus, neonates born by elective CS prior to the onset of expulsive uterine contractions should have their respiratory parameters carefully monitored. Additionally, we propose that assessment of respiratory parameters 1 hour following birth can serve as a practical means to indirectly estimate pulmonary maturation (ie, surfactant synthesis) in puppies.

Objective: To describe a clinical case of transient central diabetes insipidus (CDI) occurring post cardiopulmonary arrest (CPA) in a dog.

Case summary: An 8-week-old dog presented for intensive care after successful resuscitation following CPA. The patient exhibited neurologic deficits at initial presentation and over the following days developed marked polyuria, isosthenuria, and low urine osmolality. Treatment with synthetic vasopressin resulted in a reduction in urine output, increase in urine specific gravity (>50%), and increase in urine osmolality, suggesting a diagnosis of partial CDI. Clinical signs resolved over the following weeks and treatment was discontinued.

New or unique information provided: CPA has been described as a cause of ischemic injury to the pituitary gland resulting in CDI in people. To the authors' knowledge, this is the first report of a dog developing transient partial CDI following CPA and successful resuscitation.

Objective: To describe the use of contrast-enhanced ultrasonography (CEUS) for the detection of active renal hemorrhage in a dog with spontaneous kidney rupture resulting in hemoperitoneum.

Case summary: A 9-month-old, sexually intact male Boxer dog presented for acute collapse, abdominal pain, and tachycardia. Physical examination findings were consistent with hypovolemia and acute abdomen. B-mode ultrasonography revealed peritoneal effusion and a right kidney mass. Subsequently, a CEUS study was performed on the right kidney, which demonstrated active hemorrhage from that kidney resulting in both hemoretroperitoneum and hemoperitoneum. At exploratory surgery, ultrasonographic findings were confirmed and a right nephrectomy was performed. Histopathology demonstrated severe parenchymal alterations along with the presence of nematode larvae. Fecal and urine testing for the presence of parasitic ova were negative. Identification of the larvae was inconclusive. At 30 days postoperatively, repeat B-mode ultrasound and clinicopathologic testing was unremarkable. The dog was alive at 1 year postsurgery with no ill effects.

New or unique information provided: To the authors' knowledge, this is the first report of CEUS for the detection of active hemorrhage from a kidney resulting in hemoretroperitoneum and hemoperitoneum in a dog. Although rare, the finding of nematode larvae within the renal parenchyma may have been the cause of kidney rupture. Importantly, surgical removal of the kidney was curative. Benign processes causing kidney rupture such as parasitic infestation should be considered in the working diagnosis as related to geographical location.

Objective: To describe a case of myocarditis associated with naturally occurring canine parvovirus type 2 (CPV-2).

Case summary: A 5-week-old male intact Dachshund dog presented for acute respiratory distress. Limited diagnostic tests prior to the dog experiencing cardiopulmonary arrest included a lateral thoracic radiograph, which indicated cardiomegaly and diffuse unstructured pulmonary infiltrate. Necropsy was performed and results identified a lymphoplasmacytic myocarditis with positive CPV-2 immunohistochemistry within the myocardium.

Unique information provided: This report describes the natural occurrence of CPV-2-associated myocarditis. In addition to highlighting this rare form of canine parvovirus, cardiomyopathy in survivors of the acute viral myocarditis phase is reviewed.