Demographic and clinical characteristics of geriatric horses: 467 cases (1989-1999)

OBJECTIVE: To describe the demographic and clinical characteristics of a population of geriatric horses. DESIGN: Retrospective study. ANIMALS: 467 horses that were > or = 20 years of age. PROCEDURE: Medical records of 539 geriatric horses that were evaluated at a university large animal hospital between 1989 and 1999 were reviewed. Data collected included signalment, reason for evaluation, specific diagnoses, surgical procedures, inpatient or outpatient care, duration of hospitalization, and outcome. RESULTS: 467 horses met the criteria for inclusion in the study. Horses that were > or = 20 years of age comprised 2.2 and 12.5% of horses evaluated during 1989 and 1999, respectively. Pony breeds were significantly overrepresented in the > or = 30-years-of-age group. Gastrointestinal tract, musculoskeletal, and respiratory tract problems were most frequently reported. Colic was the most common clinical sign, followed by lameness. Diagnoses made most frequently included pituitary dysfunction, strangulating lipoma of the small intestine, laminitis, heaves, large colon impaction, and gastric ulcers. Pituitary dysfunction was significantly more prevalent in horses that were > 30 years of age. Laminitis was significantly associated with the presence of pituitary dysfunction. CONCLUSIONS AND CLINICAL RELEVANCE: It was difficult to assess association of age with illnesses identified in these horses. Demographic data and information regarding common diseases of horses that are > or = 20 years of age are limited but will become increasingly important as this geriatric population increases.     

5-Hydroxytryptophan toxicosis in dogs: 21 cases (1989-1999)

OBJECTIVE: To determine epidemiologic characteristics, clinical findings, and treatment outcome of 5-hydroxytryptophan (5-HTP) toxicosis in dogs. DESIGN: Retrospective study. ANIMALS: 21 dogs with evidence of accidental 5-HTP ingestion. PROCEDURE: Information was retrieved from the National Animal Poison Control Center database. Records of dogs ingesting 5-HTP between January 1989 and February 1999 were reviewed for information on signalment, dose ingested, clinical signs (onset, severity, duration), treatments administered, and outcome. RESULTS: Clinical signs of toxicosis developed in 19 of 21 (90%) dogs. Neurologic signs included seizures (9 dogs), depression (6), tremors (5), hyperesthesia (5), and ataxia (4). Gastrointestinal tract signs included vomiting or diarrhea (12 dogs), signs of abdominal pain (3), and hypersalivation (2). Other clinical signs were hyperthermia (7 dogs) and transient blindness (3). Three dogs died. No important clinical laboratory or necropsy findings were reported. The doses of 5-HTP ingested ranged from 2.5 to 573 mg/kg (1.1 to 260 mg/lb) of body weight; the minimum toxic dose reported in our study was 23.6 mg/kg (10.7 mg/lb), and the minimum lethal dose was 128 mg/kg (58.1 mg/lb). Onset of signs ranged from 10 minutes to 4 hours after ingestion, and signs lasted up to 36 hours. Of 17 dogs with clinical signs of toxicosis that received treatment, 16 recovered; treatment consisted of decontamination, seizure control, thermoregulation, fluid therapy, and supportive care. CONCLUSIONS AND CLINICAL RELEVANCE: Ingestion of 5-HTP in dogs can result in a potentially life-threatening syndrome resembling serotonin syndrome in humans, which requires prompt and aggressive care.     

Characteristics of Salmonella isolated from animals at a veterinary medical teaching hospital

Salmonella belonging to 47 serotypes was isolated from animals at the University of California Veterinary Medical Teaching Hospital during the years 1974 to 1983. Salmonella belonging to 12 serotypes accounted for 89% of the 725 isolates. Salmonella typhimurium (including var copenhagen) was the most commonly isolated serotype, but during 1981 to 1983, S krefeld and S saint-paul were predominant. Certain serotypes seemed to be isolated more frequently from extraintestinal sources (S typhi-suis, S dublin). Although resistance to ampicillin, kanamycin, neomycin, streptomycin, and sulfonamides was common (greater than 60% of the isolates were resistant), resistance to chloramphenicol, gentamicin, and trimethoprim-sulfonamides was infrequent, except for isolates of S krefeld and S saint-paul.     

Quality of computerized medical record abstract data at a veterinary teaching hospital

This study was designed to evaluate the quality of data from computerized medical record abstracts at the Veterinary Teaching Hospital, Ontario Veterinary College. Information in the paper medical record (registration, physical exam, daily progress, laboratory, radiology, anaesthesia and surgery forms), the summary sheet, and the computerized record were compared. A random sample of 100 patient visits from a subset of visits that were identified as all possible dog or cat elective-surgery visits in the computerized records from 1983 through 1991 were used. Clinicians were responsible for summarizing the medical record on the summary sheet and health record technicians entered the information from the summary sheet into the computer record. Most of the discrepancies (n = 33) noted for diagnoses, procedures or complications were due to the lack of transfer of information from the paper forms to the summary sheet. Although the medical record technicians detected and entered some of these (n = 10), most were not entered into the computerized records. The next most-common discrepancies (n = 5) were due to the clinician writing a different entry on the summary sheet than was present on the other paper record forms. Only one record had a miscoded diagnosis and three had miscoded procedures. Misfiled forms in the medical record folders of two patients resulted in one incorrect diagnosis and one incorrect procedure recorded in the computer record. When any discrepancy between the paper and computer record for diagnoses, procedures or complications was considered, 41% of the visits had discrepancies (46% dogs; 36% cats). The percentage varied by surgery status: non-elective surgeries 82%, elective surgeries 37% and non-surgical visits 29%. There was no obvious time trend. The completeness and accuracy of information in the database was inadequate for the intended research on post-operative complications following elective surgeries.     

Satellite teaching hospitals and public-private collaborations in veterinary medical clinical education

Veterinary teaching hospitals (VTHs) are facing more and greater challenges than at any time in the past. Changes in demand, expanding information, improving technology, an evolving workforce, declining state support, and an increasingly diverse consumer base have combined to render many traditional VTH modes of operation obsolete. In pursuit of continued success in achieving their academic mission, VTHs are exploring new business models, including innovative collaborations with the private sector. This report provides details on existing models for public-private collaboration at several colleges and schools of veterinary medicine, including those at Kansas State University, Purdue University, the University of Florida, and Tufts University. Although each of these institutions' models is unique, several commonalities exist, related to expansion of the case load available for teaching, the potential positive impact on recruitment and retention of clinical faculty, and the potential for easing financial pressures on the associated VTH. These new models represent innovative approaches that work to meet many of the key emerging challenges facing VTHs today.     

Transmission of opportunistic pathogens in a veterinary teaching hospital

Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium, and Staphylococcus intermedius isolates from infected surgical wounds and other types of infections in a veterinary teaching hospital were typed by pulsed field gel electrophoresis. A first cluster of infections with a multiresistant A. baumannii strain was observed in dogs and cats in 1998-1999. This strain disappeared after cleaning and disinfection of the companion animals intensive care unit. It was followed in 2000 by a second multiresistant strain, which caused another cluster of infections and was also transmitted to a patient in the nearby horse clinic. Transmission of a multiresistant E. faecium strain between two cats with surgical wound infections was also observed during the same period. No multiresistant S. intermedius strain was observed during this time and transmission of this organism between patients did not seem to occur. The present study demonstrates the potential for hospital nosocomial resistance problems in veterinary medicine similar to those encountered in human medicine. The results suggest that the epidemiology of nosocomial infections with A. baumannii and E. faecium may differ from that of S. intermedius infections and that preventive measures may have to be adapted to the problem organism.     

Methicillin-resistant staphylococcal colonization in dogs entering a veterinary teaching hospital

Nasal, axillary and rectal swabs were collected from 193 dogs admitted to the Ontario Veterinary College Veterinary Teaching Hospital. Enrichment culture was performed and coagulase positive staphylococci were identified via standard methods. Methicillin-resistant Staphylococcus pseudintermedius was isolated from 4/193 (2.1%) dogs, and methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus schleiferi subsp. coagulans were each isolated from 1/193 (0.5%) dogs. Methicillin-resistant Staphylococcus intermedius was not identified. All S. pseudintermedius isolates were unrelated on pulsed-field gel electrophoresis. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonization is necessary to understand the apparent emergence of these strains and to develop appropriate control strategies.     

Environmental surveillance for Salmonella enterica in a veterinary teaching hospital

OBJECTIVE: To evaluate the extent of environmental contamination with Salmonella enterica in a veterinary teaching hospital. DESIGN: Longitudinal study. SAMPLES: Environmental samples obtained from 69 representative locations within a veterinary teaching hospital by use of a commercially available electrostatic wipe. PROCEDURE: Environmental samples were obtained for bacteriologic culture, and antimicrobial susceptibility testing was performed on each environmental isolate. Environmental isolates were compared with isolates obtained from animals during the same period to investigate potential sources of environmental contamination. RESULTS: 54 S. enterica isolates were recovered from 452 (11.9%) cultured environmental samples. Five different serotypes were recovered; the most common serotypes were S. Newport and S. Agona. Within the 5 serotypes recovered, 10 distinguishable phenotypes were identified by use of serotype and antimicrobial susceptibility patterns. Of the environmental isolates, 41 of 54 (75.9%) could be matched to phenotypes of isolates obtained from animal submissions in the month prior to collection of environmental samples. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that environments in veterinary hospitals can be frequently contaminated with S. enterica near where infected animals are managed and fecal specimens containing S. enterica are processed for culture in a diagnostic laboratory. Bacteriologic culture of environmental samples collected with electrostatic wipes is an effective means of detecting contamination in a veterinary hospital environment and may be beneficial as part of surveillance activities for other veterinary and animal-rearing facilities.     

Meticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital: staff nasal colonisation and incidence of clinical cases

OBJECTIVES: To evaluate staff nasal colonisation with meticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital, and its effect on the occurrence of meticillin-resistant Staphylococcus aureus-associated postoperative wound complications in orthopaedic and spinal surgical patients. METHODS: Nasal bacterial swabs were collected from veterinary staff and environmental surfaces swabbed at six monthly intervals for meticillin-resistant Staphylococcus aureus monitoring over an 18 month period. The incidence of meticillin-resistant Staphylococcus aureus-associated postoperative wound complications of two veterinary orthopaedic surgeons was reviewed for a period when one was positive for nasal meticillin-resistant Staphylococcus aureus. RESULTS: Meticillin-resistant Staphylococcus aureus was isolated from a maximum of two out of 10 staff on each occasion. The persistently infected clinician was primary surgeon in 180 cases, of which four developed meticillin-resistant Staphylococcus aureus-associated wound complications. None of 141 operations led by the other surgeon developed meticillin-resistant Staphylococcus aureus-associated complications. This difference is not statistically significant (P=0.0974). The 95 per cent confidence interval for this odds ratio was 0.83 to 44.0. Meticillin-resistant Staphylococcus aureus resistance patterns of the human nasal isolates and three of four wound-associated isolates were similar. CLINICAL SIGNIFICANCE: Veterinary workers are at increased risk for meticillin-resistant Staphylococcus aureus colonisation, so it is likely that many veterinary patients are treated by meticillin-resistant Staphylococcus aureus-positive staff. Nasal colonisation of veterinary surgeons with meticillin-resistant Staphylococcus aureus appears to present only a small risk to their patients when appropriate infection control procedures are followed.     

Clinical management of flail chest in dogs and cats: a retrospective study of 24 cases (1989-1999)

Cases of flail chest injury for 24 client-owned companion animals following various traumas were evaluated. Concurrently sustained injuries, initial emergency treatments, and definitive treatment and outcome for regimens that utilize stabilization of the flail segment were compared with cases treated with no stabilization. Flail chest was confirmed in 24 animals: 21 dogs and three cats. There was an even division (12 each) of right and left flail segments. The median number of ribs involved was three (range, two to seven). Flail segment stabilization was performed in nine, and 15 were treated with no stabilization. Statistical analysis using multiple data permutations evaluating all combinations failed to reveal a significant difference in outcome between stabilized and unstabilized cases.     

Transient clinical diabetes mellitus in cats: 10 cases (1989-1991)

Medical records of 10 cats with transient clinical diabetes mellitus were reviewed. At the time diabetes was diagnosed, clinical signs included polyuria and polydipsia (10 cats), weight loss (8 cats), polyphagia (3 cats), lethargy (2 cats), and inappetence (1 cat). Mean (+/- SD) fasting blood glucose concentration was 454 +/- 121 mg/dL, mean blood glucose concentration during an 8-hour period (MBG/8 hours) was 378 +/- 72 mg/dL, and glycosuria and trace ketonuria were identified in 10 and 5 cats, respectively. Baseline serum insulin concentration was undetectable (6 cats) or within the reference range (4 cats) and serum insulin concentration did not increase after i.v. glucagon administration in any cat. Insulin-antagonistic drugs were being administered to 5 cats and concurrent disorders were identified in all cats. Management of diabetes included administration of glipizide (6 cats), insulin (3 cats), or both (1 cat), discontinuation of insulin-antagonistic drugs, and treatment of concurrent disorders. Insulin and glipizide treatment was discontinued 4-16 weeks (mean, 7 weeks) after the initial diagnosis of diabetes was confirmed. At the time treatment for diabetes was discontinued, clinical signs had resolved, mean fasting blood glucose concentration was 102 +/- 48 mg/dL, MBG/ 8 hours was 96 +/- 32 mg/dL, glycosuria and ketonuria were not identified in any cat, and concurrent disorders (except mild renal insufficiency in 1 cat) had resolved. Significant (P < .05) increases occurred in postglucagon serum insulin concentrations, insulin peak response, and total insulin secretion, compared with values obtained when clinical diabetes was diagnosed. Histologic abnormalities were identified in pancreatic islets of 5 cats in which pancreatic biopsies were obtained and included decreased number of islets (4 cats), islet amyloidosis (3 cats), and vacuolar degeneration of islet cells (3 cats). Mean beta cell density was significantly (P < .001) decreased in diabetic cats compared with control cats (1.4 +/- 0.7 versus 2.6 +/- 0.5%, respectively). Cells within islets stained positive for insulin, however, the number of insulin-staining cells per islet and the intensity of insulin staining were decreased in 5 and 2 cats, respectively. Clinical diabetes had not recurred in 1 cat after 6 years, in 4 cats lost to follow-up after 1.5, 1.5, 2.0, and 2.5 years, and in 2 cats that died 6 months and 5.5 years after clinical diabetes resolved. Clinical diabetes recurred in 3 cats after 6 months, 14 months, and 3.4 years, respectively. These findings suggest that cats with transient clinical diabetes have pancreatic islet pathology, including decreased beta cell density, and that treatment of diabetes and concurrent disorders results in improved beta cell function, reestablishment of euglycemia, and a transition from a clinical to subclinical diabetic state.     

Characterization of the use of antiemetic agents in dogs with parvoviral enteritis treated at a veterinary teaching hospital: 77 cases (1997-2000)

OBJECTIVE: To characterize the use of antiemetic agents in dogs with canine parvovirus (CPV)-associated enteritis in a veterinary teaching hospital. DESIGN: Retrospective case series. ANIMALS: 77 dogs with CPV-associated enteritis. PROCEDURE: Medical records of 560 dogs with confirmed CPV-associated enteritis that were admitted to a veterinary teaching hospital were reviewed. Exclusion criteria included vaccination against CPV infection within the preceding 2 weeks, hospitalization for < 24 hours or removal from the hospital against advice, or an incomplete record. Signalment, duration of hospitalization, and daily antiemetic administrations were assessed; WBC counts and clinical findings were used to classify dogs as having systemic inflammatory response syndrome (SIRS). RESULTS: 77 dogs were included in the study; 55 (71%) received antiemetics (53 received metoclopramide at least once). Seventy-one dogs survived, and 6 dogs died (all 6 received antiemetics). Compared with dogs that did not receive antiemetics, duration of hospitalization was significantly longer for antiemetic-treated dogs. Daily values of rectal temperature and heart and respiratory rates did not predict administration of antiemetics or duration of hospitalization; however, compared with survivors, SIRS developed more frequently among nonsurvivors. Assessment of emetic events recorded hourly for 17 dogs indicated that antiemetic treatment did not control emesis. CONCLUSIONS AND CLINICAL RELEVANCE: Many dogs with CPV-associated enteritis had persistent vomiting despite antiemetic administration. The apparent difference in duration of hospitalization between antiemetic-treated dogs and other dogs may reflect a difference in disease severity between groups, although antiemetic-associated adverse events (e.g., signs of depression, hypotension, and immune modulation) may prolong hospitalization.     

Prospective clinical evaluation of serum cardiac troponin T in dogs admitted to a veterinary teaching hospital

The purpose of this study was to measure serum cardiac troponin T (cTnT) with a commercially available human enzyme-linked immunoassay (ELISA) test in various groups of dogs, including those undergoing doxorubicin chemotherapy. Serum samples were obtained from 6 groups of dogs: (1) normal adult dogs (n = 15); (2) dogs with asymptomatic dilated cardiomyopathy (n = 5); (3) dogs with congestive heart failure (n = 10); (4) dogs with untreated neoplasia (n = 20); (5) dogs with skeletal muscle trauma (n = 10); and (6) dogs with neoplasia receiving doxorubicin chemotherapy (n = 4). One serum sample was obtained from each of the normal dogs, those with asymptomatic cardiomyopathy, those with congestive heart failure, and those with untreated neoplasia. Serum samples were obtained serially from the dogs that were undergoing doxorubicin chemotherapy; samples were collected before doxorubicin (30 mg/m2) administration and then 1, 5, 7, and 14 days after administration throughout 6 cycles for a cumulative total dose of 180 mg/m2. All normal dogs, dogs with untreated neoplasia, and dogs with asymptomatic dilated cardiomyopathy had cTnT concentrations below the lower limits of detection for the assay used (<0.05 ng/mL). Detectable concentrations of cTnT were found in 3 dogs with congestive heart failure and in 2 dogs with skeletal muscle trauma. Detectable concentrations also were found in both dogs that had received 180 mg/m2 of doxorubicin. We conclude that dogs with congestive heart failure and those with skeletal muscle trauma and dogs with neoplasia receiving high-dose doxorubicin chemotherapy may have increased serum cTnT concentration, which may be suggestive of myocardial damage.     

Clinical, radiographic, and pathologic features of bronchiectasis in cats: 12 cases (1987-1999)

OBJECTIVE: To determine clinical, radiographic, and pathologic features of bronchiectasis in cats. DESIGN: Retrospective study. ANIMALS: 12 cats with histologic evidence of bronchiectasis. PROCEDURE: Information on signalment, body weight, clinical signs of respiratory disease, concurrent diseases, method by which lung tissue specimens were obtained (surgical biopsy or necropsy), and histopathologic findings was obtained by reviewing medical records from January 1987 to June 1999 for cats with confirmation of bronchiectasis by histologic examination. Available thoracic radiographs were reviewed by a board-certified radiologist. RESULTS: Bronchiectasis was most commonly identified in older male cats. Clinical signs referable to the lower portion of the respiratory tract were detected in only 5 cats but, when evident, were usually chronic (duration > 1 year). Radiographic pattern of bronchiectasis was cylindrical in 4 cats, and in 1 of these cats, a saccular pattern was also identified. For most cats, bronchiectasis was detected in a single lung lobe. Radiographic evidence of bronchiectasis was not detected in 2 cats. Concurrent respiratory diseases included chronic bronchitis and bronchiolitis, neoplasia, bronchopneumonia, endogenous lipid pneumonia, and emphysema. CONCLUSIONS AND CLINICAL RELEVANCE: Bronchiectasis appears to be an uncommon respiratory tract disorder that predominantly affects older male cats. Thoracic radiography may not be sensitive for the diagnosis of bronchiectasis in cats. Bronchiectasis in cats appears to be a sequela of chronic inflammatory bronchopulmonary diseases, especially chronic bronchitis, neoplasia, and bronchopneumonia.