Case Description—A 7-year-old Spaniel-crossbreed dog was evaluated for stertorous breathing and inspiratory stridor.
Clinical Findings—A temporary tracheotomy tube was placed prior to referral. Results of physical examination at our facility, including thoracic auscultation, were unremarkable. Examination of the larynx revealed a 2 × 2-cm nodular mass on the lateral aspect of the epiglottis and left arytenoid cartilage. Cytologic examination of the mass indicated septic suppurative inflammation and intracellular rod-shaped bacteria. During the procedures, decreased air movement through the temporary tracheotomy tube was detected, and the tube was replaced. A thrombus was found on the distal end of the temporary tracheotomy tube; the thrombus obstructed 90% of the tube lumen. Approximately 12 hours later, auscultation revealed decreased sounds in all lung fields. Cervical and thoracic radiography revealed an intraluminal soft tissue opacity distal to the tracheotomy tube. A thrombus that contained hair and plant material was removed from the trachea by use of an embolectomy catheter and videogastroscope. Approximately 30 hours after removal of the initial thrombus, the dog had an episode of respiratory distress. Cervical radiography revealed another intraluminal opacity. It was another thrombus, which also was removed by use of the videogastroscope.
Treatment and Outcome—Tracheoscopy was performed with a videogastroscope in an attempt to remove the thrombi. A Fogarty catheter was used to remove the initial intraluminal thrombus from the trachea.
Clinical Relevance—Airway obstruction resulting from an intraluminal thrombus in the trachea should be considered as a secondary complication after tracheotomy tube placement.
An 8-year-old spayed female domestic shorthair cat was evaluated for increased respiratory effort and inspiratory stridor of 5 months' duration. The cat's appetite, attitude, and activity level were normal, and no coughing or collapsing episodes had been noticed. The cat was housed indoors, and its vaccination status was adequate. An audible, high-pitched inspiratory stridor with a musical quality was detected during auscultation of the thorax. Expiratory wheezes were detected in all lung fields. Abnormalities detected on CBC included mild anemia and mild mature neutrophilia. Radiographs of the thorax were obtained (Figure 1).
To analyze the readability of discharge summaries distributed to owners of pets newly diagnosed with cancer.
118 discharge summaries provided to pet owners following initial consultation.
A database search identified records of new patients that had been presented to the North Carolina State Veterinary Hospital medical oncology service between June 2017 and January 2019. Owner-directed portions of the summaries provided at the time of discharge were copied and pasted into a document and stripped of all identifying information. Readability of summaries was assessed with the use of 2 previously established readability calculators: the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests.
Mean ± SD FKGL was 11.9 ± 1.1 (median, 11.9; range, 8.6 to 15.5; target ≤ 6), and the mean ± SD FRE score was 43 ± 5.9 (median, 42.7; range, 25.5 to 58.1; target ≥ 60). There were no significant differences in FKGL or FRE scores among discharge summaries for patients with the 4 most common tumor types diagnosed or the described treatment options. Ninety-three percent (110/118) of summaries were scored as difficult or very difficult to read.
Owner-directed written information regarding a diagnosis of cancer at a single teaching hospital exceeded readability levels recommended by the American Medical Association and NIH and was above the average reading level of most US adults. Efforts to improve readability are an important component of promoting relationship-centered care and may improve owner compliance and patient outcomes.
Objective—To determine whether thromboelastography is more accurate than conventional methods of evaluating hemostasis for the prediction of clinical bleeding in thrombocytopenic dogs following total body irradiation (TBI) and bone marrow transplantation (BMT).
Animals—10 client-owned thrombocytopenic dogs with multicentric lymphoma.
Procedures—Results of a kaolin-activated thromboelastography assay, platelet count, and buccal mucosal bleeding time were evaluated for correlation to clinical bleeding.
Results—Maximum amplitude, derived via thromboelastography, was the only hemostatic variable with significant correlation to clinical bleeding. Buccal mucosal bleeding time had a high sensitivity but poor specificity for identifying dogs with clinical bleeding.
Conclusions and Clinical Relevance—Compared with buccal mucosal bleeding time and platelet count, thromboelastography was more reliable at identifying thrombocytopenic dogs with a low risk of bleeding and could be considered to help guide the use of transfusion products in dogs undergoing TBI and BMT.
Objective—To determine whether conscious, unsedated
cats will inhale a nebulized material administered
via a facemask and whether this material will
reach the lower airways.
Animals—20 healthy adult cats.
Procedure—Technetium Tc 99m-diaminetriaminopentaacetic
acid (99mTc-DTPA) was nebulized into a spacer
and administered to the cats via a closely fitting facemask.
By use of a gamma camera, images were then
immediately obtained to determine the distribution of
99mTc-DTPA within the lower airways.
Results—Images obtained by use of the gamma
camera revealed that all 20 cats had inhaled 99mTc-DTPA from the facemask. In each cat, deposition of
the radiopharmaceutical agent was evident throughout
the lung fields.
Conclusions and Clinical Relevance—Awake cats
that were not used to the application of a facemask
did inhale substances from such a device.
Aerosolization of medications may be a feasible route
of administration for cats with lower airway disease.
(Am J Vet Res 2004;65:806–809)
Objective—To determine quality and duration of progression-free survival (PFS) time in dogs with unresectable
thyroid carcinomas treated with definitive
megavoltage irradiation and analyze prognostic factors
of PFS and patterns of failure (local recurrence vs
Design—Prospective clinical trial.
Animals—25 dogs with locally advanced thyroid carcinomas
and no evidence of metastasis.
Procedure—Dogs were treated with 48 Gy during 4
weeks on an alternate-day schedule of 4 Gy/fraction.
Results—Irradiation was safe and effective for treatment
of large unresectable thyroid carcinomas.
Progression-free survival rates were 80% at 1 year
and 72% at 3 years. Time to maximum tumor size
reduction ranged from 8 to 22 months. Factors affecting
PFS were not found. Twenty-eight percent (7/25)
of dogs developed metastasis. Dogs with bilateral
tumors had 16 times the risk of developing metastases,
compared with dogs with a single tumor. Dogs
with no evidence of tumor progression had 15 times
less risk of developing metastases. Radiation-induced
hypothyroidism was suspected in 2 dogs 13 and 29
months after irradiation.
Conclusions and Clinical Relevance—Irradiation is
effective for local control of thyroid tumors, despite
their slow regression rate. Results provided evidence
that local tumor control affects metastatic
outcome in dogs with thyroid carcinomas and is a
strong basis for the development of new approaches
that include irradiation in the management of
dogs with advanced thyroid carcinomas. Improvements
in local tumor control alone may be
insufficient to improve survival times because of the
high risk of metastatic spread before an initial diagnosis
is made, which warrants initiation of early systemic
treatment. (J Am Vet Med Assoc 2000;216:
Abnormal body temperature is a major indicator of disease; infrared thermography (IRT) can assess changes in body surface temperature quickly and remotely. This technology can be applied to a myriad of diseases of various etiologies across a wide range of host species in veterinary medicine. It is used to monitor the physiologic status of individual animals, such as measuring feed efficiency or diagnosing pregnancy. Infrared thermography has applications in the assessment of animal welfare, and has been used to detect soring in horses and monitor stress responses. This review addresses the variety of uses for IRT in veterinary medicine, including disease detection, physiologic monitoring, welfare assessment, and potential future applications.
Rapid advances in critical care techniques and life-sustaining measures in the late 20th century led many large human hospitals to encounter ethical dilemmas regarding end-of-life issues, decision-making capacity, clinical futility, and responsible use of resources. Human hospitals are now required to have an established protocol for addressing these ethical dilemmas, and the vast majority have created clinical ethics committees that are available to provide ethics consultations on request. Recent medical advances available at veterinary specialty hospitals have given rise to similar ethical dilemmas in the care of both small and large animal species, and such dilemmas are a major source
Case Description—A healthy 6-year-old 28.5-kg (62.7-lb) spayed female Boxer undergoing surgical repair of a ruptured cranial cruciate ligament was inadvertently administered an overdose of morphine (1.3 mg/kg [0.59 mg/lb]) via subarachnoid injection.
Clinical Findings—50 minutes after administration of the overdose, mild multifocal myoclonic contractions became apparent at the level of the tail; the contractions migrated cranially and progressively increased in intensity and frequency during completion of the surgery.
Treatment and Outcome—The myoclonic contractions were refractory to treatment with midazolam, naloxone, phenobarbital, and pentobarbital; only atracurium (0.1 mg/kg [0.045 mg/lb], IV) was effective in controlling the movements. The dog developed hypertension, dysphoria, hyperthermia, and hypercapnia. The dog remained anesthetized and ventilated mechanically; treatments included continuous rate IV infusions of propofol (1 mg/kg/h [0.45 mg/lb/h]), diazepam (0.25 mg/kg/h [0.11 mg/lb/h]), atracurium (0.1 to 0.3 mg/kg/h [0.045 to 0.14 mg/lb/h]), and naloxone (0.02 mg/kg/h [0.009 mg/lb/h]). Twenty-two hours after the overdose, the myoclonus was no longer present, and the dog was able to ventilate without mechanical assistance. The dog remained sedated until 60 hours after the overdose, at which time its mentation improved, including recognition of caregivers and response to voice commands. No neurologic abnormalities were detectable at discharge (approx 68 hours after the overdose) or at a recheck evaluation 1 week later.
Clinical Relevance—Although intrathecal administration of an overdose of morphine can be associated with major and potentially fatal complications, it is possible that affected dogs can completely recover with immediate treatment and extensive supportive care.
Objective—To characterize rib, intrathoracic, and concurrent
orthopedic injuries, and prognosis associated
with traumatic rib fracture in cats.
Procedure—Medical records from January 1980 to
August 1998 were examined for cats with traumatic
rib fracture. Signalment, cause of trauma, interval
from trauma to evaluation at a veterinary teaching
hospital, referral status and date, method of diagnosis,
duration of hospitalization, number and location of
rib fractures, presence of flail chest, costal cartilage
involvement, intrathoracic and concurrent orthopedic
injury, and clinical outcome were reviewed.
Results—Median age was 3 years. Twenty-five
(58%) cats with reported cause of trauma were
injured by interaction with another animal. Fortyseven
(78%) cats that were treated survived. Cats
that died had a median duration of hospitalization of
< 1 day. Ten (13%) cats had flail chest. Sixty-five
(87%) cats had intrathoracic injury (median, 2
injuries). Nine (100%) cats without detected intrathoracic
injury that were treated survived. Thirty-five
(47%) cats had concurrent orthopedic injury. Cats
with flail chest, pleural effusion, or diaphragmatic
hernia were significantly more likely to die than cats
without each injury.
Conclusions and Clinical Relevance—Traumatic rib
fracture in cats is associated with intrathoracic and
concurrent orthopedic injury. Aggressive treatment of
cats with traumatic rib fracture is warranted, because
the prognosis is generally favorable. Diagnosis and
treatment of intrathoracic injury associated with traumatic
rib fracture in cats should precede management
of concurrent orthopedic injury. ( J Am Vet Med