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Abstract
OBJECTIVE
To assess the impact of a communication program on a cohort of veterinary students’ knowledge and performance of communication skills.
SAMPLE
Class cohort of veterinary students at Colorado State University.
PROCEDURES
Year 3 students’ knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated.
RESULTS
In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students’ knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing “chunks” of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure.
CLINICAL RELEVANCE
Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.
Abstract
CASE DESCRIPTION
5 dogs with a history of ventriculocordectomy were anesthetized with isoflurane for ovariohysterectomy, dental prophylaxis, or intracapsular lens extraction.
CLINICAL FINDINGS
No remarkable, abnormal clinical signs such as exercise intolerance, respiratory distress, or stridor were found in 4 dogs. However, 1 dog had cough after drinking, which had started after the ventriculocordectomy. During intubation, laryngeal web, suspected to be a complication of ventriculocordectomy, was accidentally discovered.
TREATMENT AND OUTCOME
Laryngeal web was observed during intubation, necessitating the use of a smaller-diameter endotracheal tube (ETT) for intubation. However, the smaller cuff volume of the smaller ETT did not prevent the air leak. Therefore, the ETT with the inflated cuff was pulled cranially until the narrowed laryngeal lumen was plugged with the cuff behind the vocal cords. The ETT was secured to prevent slippage. No air leakage around the ETT cuff or complications related to the ETT placement were observed in the peri-anesthetic period in any dog.
CLINICAL RELEVANCE
Laryngeal web can be found in patients with a history of larynx-related surgeries and may allow only a small-diameter ETT to pass through. The sealing technique used for peri-cuff air leak using a small ETT described here that can pass through a laryngeal web could be useful to seal an air leak around the cuff without complications.
Abstract
OBJECTIVE
To evaluate the pharmacokinetics of acetaminophen (APAP) after single-dose IV and PO in the goose; to quantify APAP and its main metabolites in goose muscle, heart, lung, liver, and kidney; and to perform a histopathologic evaluation of goose stomach, duodenum, liver, and kidney tissues for potential signs of toxicity.
ANIMALS
24 geese.
PROCEDURES
Geese were randomly divided into 3 groups (n = 8). Group I received APAP (10 mg/kg) IV, and groups II and III received the same dose PO. Groups I and II were used for the pharmacokinetic assessment, and group III was used for the residue analysis and histopathologic evaluation. APAP and its metabolites were quantified in plasma and tissues by ultra–high-performance liquid chromatography–tandem mass spectrometry, and the pharmacokinetic analysis was performed using a noncompartmental approach.
RESULTS
APAP plasma concentrations were lower than those of the metabolites in similar selected time points after both treatments. After IV treatment, the APAP area under the curve value was statistically higher than that after PO administration, resulting in an oral bioavailability of 46%. In contrast, the area under the curve of the metabolites following PO administration was statistically higher than those found after IV administration. Tissue residues of APAP were highest in the liver, with an accumulation index > 1. Fatty degeneration of hepatocytes was observed 24 hours after administration of APAP.
CLINICAL RELEVANCE
In geese, treatment by PO administration of APAP shows incomplete absorption and a slight accumulation in lung and liver. Tissue alterations occurred in the liver at 24 hours, while no signs of toxicity were found in the other tested organs.
Abstract
CASE DESCRIPTION
A 2-year-old intact male Mini Lop rabbit (Oryctolagus cuniculus) exhibited acute paraplegia and was suspected of having a traumatic spinal injury after leaping from the owner’s arms.
CLINICAL FINDINGS
In the physical examination, the patient was conscious and responsive and presented a loss of hind-limb motor function. The results of the neurologic examination indicated a T3-L3 spinal cord lesion. Vertebral column radiography and CT showed a fracture of the dorsal arch in the right caudal part of vertebra L1 and a fracture of the caudal end plate of vertebra L1 without displacement.
TREATMENT AND OUTCOME
The vertebral fracture was stabilized by a monolateral external fixator placed percutaneously with fluoroscopy guidance. The rabbit was discharged 48 hours after surgery. Three days later, the rabbit was able to walk with mild paraparesis, and 2 weeks after surgery, the rabbit showed full recovery of neurologic function. The follow-up performed 6 weeks after surgery showed normal gait, good alignment and complete consolidation of the fracture. The external fixator was then removed. The follow-up examination and radiographic findings showed complete recovery at 2 and 6 months after surgery.
CLINICAL RELEVANCE
The most common cause of traumatic posterior paralysis in rabbits is vertebral fracture. This article describes the possibility and successful outcome of stabilizing a vertebral fracture in a rabbit with an external fixator using a minimally invasive fluoroscopic technique. This technique, described to the authors’ knowledge for the first time in a rabbit, allows a fracture to be stabilized accurately without any incisions while minimizing complications and postoperative pain.
Abstract
CASE DESCRIPTION
A male Major Mitchell’s cockatoo (Lophochroa leadbeateri) of unknown age presented with an ulcerated mass on the ventral tail caudodorsal to the cloaca.
CLINICAL FINDINGS
An impression smear of the mass showed spindle cell atypia. Multiple biopsies were submitted for histopathology with inconclusive results. A CT scan revealed a soft tissue mass causing compression of the cloacal lumen. The patient underwent surgical debulking, and a core of the mass was submitted again for histopathology, which reported it as fibrosarcoma.
TREATMENT AND OUTCOME
Under repeated general isoflurane gas anesthesia, the patient received a course of definitive radiation therapy totaling 60 Gy and divided in 3 Gy X 20 fractions. By treatment completion, the lesion had decreased in size with necrotic debris on the surface. Surrounding tissues appeared healthy and no adverse effects were observed. As of 1.5 years post-treatment, the mass appears completely healed with no signs of reoccurrence.
CLINICAL RELEVANCE
This case suggests that radiation therapy with this protocol could be an effective treatment option for fibrosarcoma in avian species.
Abstract
CASE DESCRIPTION
A 19-year-old male bottlenose dolphin (Tursiops truncatus) presented with inappetence and avoidant behavior.
CLINICAL FINDINGS
Ultrasound revealed a large-volume left-sided pleural effusion, which was consistent with chronic nonchylous lymphatic effusion and mild chronic hemorrhage by cytology. Computed tomography identified ipsilateral rib fractures, atelectasis, nodular pleuritis, marginal lymph node enlargement, and suspected dilation of the thoracic duct and internal thoracic veins. Fifteen lipids were significantly higher in serum of the dolphin as compared with controls (n = 3) using nontargeted lipidomics.
TREATMENT AND OUTCOME
A series of thoracentesis procedures were performed. Follow-up CT demonstrated marked reduction in pleural effusion with persistence of thoracic duct dilation and mass-like areas of pleural thickening. Ultrasonographic resolution of pleural effusion occurred 14 months after presentation; however, recrudescence was noted 5 months later. Over a total of 24 months, 21.52 L of pleural effusion was removed. Despite the presence of pleural effusion, the patient was clinically stable during this time and quality of life was considered good on the basis of continuous animal welfare evaluations. Humane euthanasia was elected following acute clinical decline 27 months after initial diagnosis. Necropsy confirmed severe pleural effusion, chronic severe pleural fibrosis with chronic hemorrhage, and mediastinal fibrosis with entrapped lymph nodes and thymic tissue.
CLINICAL RELEVANCE
Pleuritis and effusion were suspected sequelae of previous rib fractures. To our knowledge, this is the first report of nonchylous lymphatic pleural effusion with repeated pleural drainage and diagnostic imaging for clinical management in a bottlenose dolphin.
Abstract
CASE DESCRIPTION
A 12-year-old sexually intact male zoo-managed Sumatran tiger (Panthera tigris sumatrae) was evaluated for a 3-day history of vomiting, hyporexia, and lethargy. Radiographs were supportive of gastrointestinal obstruction, and an exploratory laparotomy was performed.
CLINICAL FINDINGS
Diffuse tan foci were present on the liver parenchyma, and the tiger became icteric throughout the procedure. Hepatic histopathology and immunohistochemistry resulted in a diagnosis of leptospirosis. Serum microagglutination testing for Leptospira spp antibody titers were positive for L kirschneri serovar Grippotyphosa, rising from 1:400 to 1:3,200 in 2 days.
TREATMENT AND OUTCOME
The tiger was treated with antimicrobials, ursodiol, and mirtazapine, and increased biosecurity measures were instituted. Free-ranging wildlife on grounds were trapped, euthanized, and submitted for necropsy to screen for disease vectors. The tiger’s urine was intermittently opportunistically collected from the enclosure and remained PCR assay negative for Leptospira spp until being positive once again on day 595. Although the tiger was without clinical signs at that time, antimicrobial therapy and increased biosecurity protocols were instituted a second time until urinary Leptospira shedding was confirmed to have stopped. By 1,071 days after initial presentation, the tiger remained nonclinical, with no additional urinary shedding episodes.
CLINICAL RELEVANCE
While domestic and nondomestic free-ranging felids have been reported as subclinical Leptospira spp carriers, this report indicates the clinical importance of leptospirosis when a tiger presents with generalized gastrointestinal signs and icterus. Due to the zoonotic potential, biosecurity measures are necessary. This patient had a clinically successful outcome with antimicrobial therapy and supportive care.
Abstract
OBJECTIVE
To assess proportionate mortality from all causes for male and female US veterinarians during 1979 through 2015.
SAMPLE
Death records for 11,620 veterinarians.
PROCEDURES
For this proportionate mortality ratio (PMR) study, information for veterinarians who died during 1979 through 2015 was obtained from AVMA obituary and life insurance databases and submitted to a centralized database of US death records to obtain underlying causes of death. Decedent data that met records-matching criteria were imported into a software program for calculation of PMRs for all causes stratified by sex and indirectly standardized for age, race, and 5-year calendar period with 95% CIs.
RESULTS
11,620 decedents consisted of 11,049 (95%) males and 571 (5%) females with a median age at death of 77 years. Proportionate mortality for all veterinarian decedents was higher than expected for melanoma (PMRs, 2.1 and 2.2 for males and females, respectively), suicide (PMRs, 2.1 and 3.5 for males and females, respectively), and transportation injuries (PMRs, 1.7 and 1.6 for males and females, respectively). Proportionate mortality for all decedents was lower than expected for respiratory cancers (PMRs, 0.6 and 0.5 for males and females, respectively), diabetes mellitus (PMRs, 0.7 and 0.4 for males and females, respectively), heart disease (PMRs, 0.9 and 0.6 for males and females, respectively), and respiratory disorders (PMRs, 0.7 and 0.6 for males and females, respectively).
CLINICAL RELEVANCE
Results indicated proportionate mortality from malignant melanoma, transportation injuries, and suicide for male and female veterinarians was higher than the general population. These data may help stakeholders improve veterinarian workplace safety and health guidelines.
Abstract
CASE DESCRIPTION
A 9-year-old spayed female Maine Coon cat was presented at the University of Veterinary Medicine Vienna for further investigation of chronic nonpruritic bilateral ear disease and unilateral Horner syndrome.
CLINICAL FINDINGS
Physical examination and otoscopy findings included right sided Horner syndrome, a right head tilt of approximately 20° and a small pink nodule in the right and several smaller nodules in the left proximal horizontal external ear canal. Computed tomography and magnetic resonance imaging revealed soft tissue opacity material in both middle ear cavities, the caudal portion of the nasal cavity, the left nasopharyngeal meatus and the right frontal sinus. Via videootoscopy, 2 multilobular and several flat nodules were detected in the proximal right horizontal external ear canal and in the left tympanic bulla, respectively. Histopathological examination confirmed the diagnosis of cholesterol granulomas.
TREATMENT AND OUTCOME
All otic cholesterol granulomas (CGs) were removed via video-otoscopy (VO), and topical treatment was initiated in addition to oral prednisolone. After the histopathological confirmation, negative microbial cultures from the middle ear cavities, and the remission of the symptoms by the first recheck, topical, and systemic treatment were discontinued. A follow-up 6 months later, did not reveal any recurrence of the CGs.
CLINICAL RELEVANCE
To our knowledge, this is the first case of bilateral CGs diagnosed with a combination of CT, MRI, VO, and histopathology and removed minimal invasively via VO, without a need for ventral bulla osteotomy, which led to complete remission of all signs and no relapse until the follow up 6 months later.
Abstract
OBJECTIVE
To determine the clinical and pathological findings of rabbits diagnosed with lymphoma.
ANIMALS
16 rabbits.
PROCEDURES
The medical and pathology records database of the Veterinary Medical Teaching Hospital at the University of California, Davis was searched for rabbits diagnosed with lymphoma from 1996 to 2019.
RESULTS
Mean age of the 16 rabbits was 8 years (range, 4.5 to 12 years). Immunophenotyping was performed in 14 cases. Diffuse, large, B-cell lymphoma was most common (n = 7) followed by epitheliotropic, T-cell lymphoma (2); type II enteropathy-associated, T-cell lymphoma (2); marginal-zone, B-cell lymphoma (1); peripheral, T-cell lymphoma not otherwise specified (cutaneous nonepitheliotropic lymphoma; 1); primary, mediastinal (thymic) large B-cell lymphoma (1), and unclassified (cytology only with no immunophenotyping; 2). Multiple chemotherapy protocols were used on the basis of each individual animal’s disease state. Initial clinical improvement was reported for most rabbits receiving chemotherapy (5/6), with diffuse B-cell lymphoma responding most favorably to treatment. The 11 rabbits included in the survival analysis had a median survival time of 60 days (range, 1 to 480 days), and those diagnosed with B- and T-cell lymphoma had a median survival time of 8 and 36 days (range, 1 to 150 and 1 to 90 days), respectively.
CLINICAL RELEVANCE
Rabbits develop a range of lymphoma subtypes and, similar to humans and dogs, diffuse large B-cell lymphoma appears to be the most common. Chemotherapy treatments followed multiple protocols, which were mostly well tolerated and had a highly variable response. Further research into chemotherapy protocols is needed to optimize treatment of lymphoma in rabbits.
