In This Issue—July 1, 2015

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President's Column

See page 8

JAVMA News

Veterinarians transitioning from clinical practice to other veterinary fields may find help through various resources. In other news, the sole candidate for 2015-2016 AVMA president-elect describes his hopes for the Association and the veterinary profession's future. See page 10

Letters to the Editor

See page 35

What Is Your Diagnosis?

See PAGES 43, 47

Diagnostic Imaging in Veterinary Dental Practice

See page 51

Pathology in Practice

See page 55

COMMENTARY

How wellness plans grow veterinary practice

More and more veterinary hospitals are starting to offer wellness plans. One of the most common questions veterinarians ask when trying to decide whether to start providing wellness plans is what impact these plans will have on their practices.

See page 40

ENHANCING CLINICAL DECISION MAKING

Importance of the role of the scientific literature in clinical decision making

Incorporating information from the scientific literature into clinical decision making is challenging for veterinary practitioners. One of the greatest obstacles is the amount of time required to assess published information. However, a systematic approach to literature review may improve the process.

See page 58

SPECIAL REPORT

A novel fatigue syndrome of finished feedlot cattle following transportation

During the summer of 2013, abattoirs throughout the United States reported concerns about nonambulatory or slow and difficult-to-move cattle and cattle that sloughed hoof walls. Although anecdotal evidence generated concern that cattle fed the β-adrenergic receptor agonist zilpaterol were at increased risk, the condition is likely multifactorial.

See page 66

Detemir insulin for the treatment of diabetes mellitus in dogs

The only insulin preparation currently approved for use in dogs with diabetes mellitus is a porcine insulin zinc suspension, but this product does not always provide for optimal control of the disease. In an open-label, uncontrolled clinical trial involving 10 dogs with naturally occurring diabetes mellitus, treatment with insulin detemir SC every 12 hours for 6 months resulted in significant decreases in blood glucose and serum fructosamine concentrations. Hypoglycemia was identified in 22% (10/45) of the blood glucose concentration curves, and 6 episodes of clinical hypoglycemia in 4 dogs were recorded. Efficacy of insulin detemir at the end of the study was considered good in 5 dogs, moderate in 3, and poor in 2.

See page 73

Association of blood lactate concentration with physical perfusion variables, blood pressure, and outcome for cats treated at an emergency service

Abnormalities in tissue perfusion are common in patients being treated on an emergency basis. Thus, the ability to identify hypoperfusion is fundamental in an emergency setting. In a prospective, observational study of 111 cats examined at an emergency service, blood lactate concentration at the time of initial examination, together with physical examination findings (mucous membrane color, capillary refill time, peripheral pulse quality, heart rate, and rectal temperature) and systolic arterial blood pressure, was found to potentially be a useful tool for identifying abnormalities in tissue oxygen delivery. However, change in lactate concentration during hospitalization (when applicable) was not associated with outcome.

See page 79

Perioperative red blood cell transfusion requirement for various surgical procedures in dogs

Increasingly, veterinarians are performing challenging surgical procedures in dogs. Knowing how often dogs undergoing these types of surgical procedures require perioperative RBC transfusions could be helpful in surgical planning. In a review of medical records of 207 dogs that underwent various surgeries, dogs that underwent splenectomy or liver lobectomy were significantly more likely to receive an RBC transfusion, compared with all other dogs. A significant association was found between body weight and perioperative RBC transfusion, with greater odds of transfusion as body weight increased. Dogs receiving perioperative RBC transfusions were significantly less likely to survive to 2 weeks after surgery.

See page 85

End-to-end ureteral anastomosis and double-pigtail ureteral stent placement for treatment of iatrogenic ureteral trauma in two dogs

A 6-month-old Soft-Coated Wheaten Terrier and 8-month-old Shih Tzu were referred because of inadvertent ureteral ligation and transection during ovariohysterectomy. Abdominal ultrasonography revealed severe unilateral pyelectasia and hydroureter. Ventral cystotomy was performed to allow retrograde placement of a double-pigtail ureteral stent into the affected ureter and renal pelvis. End-to-end ureteral anastomosis was performed over the stent with the aid of an operating microscope. Dogs continued to have intermittent signs of stranguria until stent removal 6 or 7 weeks after surgery. Ultrasonographic examination of the urogenital tract 2 or 4 months after surgery revealed resolution of pyelectasia and hydroureter.

See page 92

Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse

A 4-year-old Arabian-cross mare was examined because of pyrexia, lethargy, and signs of abdominal discomfort. Serial abdominal ultrasonography revealed an irregularly marginated, hyperechoic walled region of heterogenous echogenicity consistent with an encapsulated hepatic abscess. The horse was treated with doxycycline and flunixin meglumine. After 21 days, the horse was reevaluated because of recurrent colic and pyrexia. While the horse was standing and sedated, drainage of an encapsulated intra-abdominal abscess was followed by rib resection and removal of a portion of necrotic left lateral liver lobe. Twelve months later, the horse was clinically normal and had returned to its previous level of performance.

See page 98

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