Clinical Vignette

This 12-month-old, outdoor intact male cat (Fig. 1) was examined because of an untreated draining nasal lesion. The lesion. initially appeared as small punctures, and progressed ovcr 2 months to an ulcerated draining nodule that gradually enlarged to involve the whole muzzle, extending bilaterally to the medial canthi and having multiple drainage points through overlying necrotic skin. Results of serum feline leukemia virus antigen and feline immunodeficiency virus antibody tests were negative.     

Clinical papers

In a commercial swine herd a rise was noted during the summer of 1981 in the number of repeat breeders, mostly four to eight weeks after serving. During the autumn there was a decrease in the litter size at birth and an increase in the number of stillborn and mummified piglets. Several gilts and sows showed a seroconversion against Porcine Parvovirus (PPV), determined by the Haemagglutination Inhibition lest (HI‐test). Characteristic pathological findings were seen in some maturely stillborn and neonatally deceased piglets (up to an age of 28 days); hepatic congestion and necrosis, accummulation of fluid in body cavities, myocarditis, and encephalitis were the most Prominent features. Serological tests for antibodies in blood samples of one sow and body fluids of two stillborn piglets were suggestive of Porcine Parvovirus as the aetiological agent.     

Clinical ketosis

A diagnosis of primary ketosis is based on clinical signs, clinical pathology, and ruling-out disorders that cause secondary ketosis. Various treatments can be used alone or in combination during the management of clinical ketosis. A treatment should be based on drugs with a mechanism of action that will eliminate the pathogenesis of the clinical signs observed.     

Clinical epidemiology

Rational clinical practice requires deductive particularization of diagnostic findings, prognoses, and therapeutic responses from groups of animals (herds) to the individual animal (herd) under consideration This process utilizes concepts, skills, and methods of epidemiology, as they relate to the study of the distribution and determinants of health and disease in populations, and casts them in a clinical perspective.

We briefly outline diagnostic strategies and introduce a measure of agreement, called kappa, between clinical diagnoses. This statistic is useful not only as a measure of diagnostic accuracy, but also as a means of quantifying and understanding disagreement between diagnosticians. It is disconcerting to many, clinicians included, that given a general deficit of data on sensitivity and specificity, the level of agreement between many clinical diagnoses is only moderate at best with kappa values of 0.3 to 0.6.

Sensitivity, specificity, pretest odds, and posttest probability of disease are defined and related to the interpretation of clinical findings and ancillary diagnostic test results. An understanding of these features and how they relate to ruling-in or ruling-out a diagnosis, or minimizzing diagnostic errors will greatly enhance the diagnostic accuracy of the practitioner, and reduce the frequency of clinical disagreement. The approach of running multiple tests on every patient is not only wasteful and expensive, it is unlikely to improve the ability of the clinician to establish the correct diagnosis.

We conclude with a discussion of how to decide on the best therapy, a discussion which centers on, and outlines the key features of, the well designed clinical trial. Like a diagnosis, the results from a clinical trial may not always be definitive, nonetheless it is the best available method of gleaning information about treatment efficacy.