Laboratory diagnosis and characterization of renal disease in horses

Laboratory evaluation of renal function in horses has advanced dramatically in the last 10 years largely as a result of the interest generated by the creative approach to diagnostic indices taken by Brobst, Traver, Coffman, and others. Some methods of assessing renal function discussed here are clearly outside the scope of a practice environment but are available in referral hospitals for use in difficult or unusual cases. Other methods described, such as calculation of fractional excretions and urine to serum creatinine ratios, are accessible and readily interpreted by the veterinary practitioner. These diagnostic methods should help in the early identification of renal disease in horses and therefore should allow veterinarians the option to treat renal disease before renal failure is advanced. In addition, practitioners may be able to offer more informed prognoses after a more complete evaluation of renal function.     

Musculoskeletal imaging in the cat: what's normal? What's abnormal?

PRACTICAL RELEVANCE: Despite the increasing availability of ultrasonography, computed tomography and magnetic resonance imaging (MRI), radiography remains the primary imaging modality for the assessment of feline musculoskeletal disease in practice. In many respects, having a more feline-focused approach to radiography will reward the clinician with better quality images and, hence, a greater likelihood of a correct diagnosis. CLINICAL CHALLENGES: Correct interpretation of radiographic films requires familiarity with some of the unique aspects of normal feline skeletal anatomy. For optimal patient management, the clinician also needs an appreciation of the distinct advantages of advanced imaging modalities in certain circumstances, in particular for head trauma patients. EQUIPMENT: When considering what equipment is most suitable for musculoskeletal imaging, the small size of our feline patients means that image resolution is of primary importance. Choosing an x-ray system (film-screen or digital) that offers more detail, and selecting ultrasound probes of a higher frequency than would be used on larger canine patients, will go some way to improving the diagnostic yield of any feline imaging study. If there is the option of referral for MRI, and a choice between high-field and low-field MRI systems for the feline patient, a high-field system will always provide more detail. AUDIENCE: This review, drawing on the author's experience and established imaging and anatomical principles, aims to assist general veterinary practitioners in their approach to feline musculoskeletal imaging. It provides an overview of the imaging choices and techniques for different regions of the body, and gives examples of normal anatomy that is peculiar to the cat.     

Ophthalmic imaging.

The availability of advanced imaging modalities in veterinary medicine has greatly widened the diagnostic imaging capabilities possible.Ultrasonography provides a rapid noninvasive modality that provides detailed examination and resolution of the intraocular structures and soft tissues surrounding the orbit of opaque eyes.Ultrasonography is cost-effective and widely available to practitioners,referral centers, and academic institutions. In many areas,mobile specialist ultrasonographers are available to supplement the equipment and skills of the practitioner. The added strengths of CT and MRI lie in their cross-sectional capability and better image quality. Unfortunately, the cost of CT and MRI currently limits their availability to referral centers and academic institutions.Primarily because of financial considerations, CT is currently more widely available for evaluation of equine disorders than MRI. A thorough evaluation of the multiple images and an understanding of normal anatomy and abnormal tissue patterns are indicated to maximize the use of each modality. Unlike ultrasonography, which can be performed in awake horses, the costs and contraindications of general anesthesia in some critical patients should also be considered when using CT and MRI. Finally, imaging artifacts are frequently encountered with each of these modalities. Thus, a thorough understanding of the various types of artifacts that occur is important so as to avoid interpretation pitfalls.     

Employer and new graduate satisfaction with new graduate performance in the workplace within the first year following convocation from the Ontario Veterinary College

Mailed questionnaires administered to employers of graduates and to graduates of the Ontario Veterinary College in 2000 and 2001, 7 to 10 months after convocation, surveyed new graduate performance in the workplace. Proficiency at 9 species-specific (in 4 practice contexts) and 7 nonspecies-specific clinical activities were rated as "high," "some," or "low." Fifteen nonvocation-specific attributes, reflecting interpersonal, communication, and business skills, and the new graduate's competence to do his/her job were rated as "very good," "good," or "poor." Ninety or more percent of employers reported "high" to "some" proficiency in 8/9, 5/9, 3/9, and 1/9 activities relative to small animal, food animal, equine, and exotic animal practice, respectively, and in 5/7 nonspecies-specific clinical activities. Ninety or more percent of employers assessed workplace proficiency as "very good" to "good" in 13/15 nonvocation-specific work skills and overall competence to do the job for which the new graduate had been hired.     

Acute spinal cord injury in the cat: causes, treatment and prognosis

PRACTICAL RELEVANCE: Acute spinal conditions are a common emergency presentation in general veterinary practice and have the potential to cause devastating spinal cord injury (SCI) and consequent severe neurological deficits. SCI can be divided into two subgroups: exogenous SCI (vertebral fracture and/or luxation/subluxation) and endogenous SCI (intervertebral disc extrusion and ischaemic myelopathy). CLINICAL CHALLENGES: The majority of cats with SCI have concurrent injuries. The clinician must perform a thorough physical examination and prioritise and then stabilise the life-threatening problems before focusing on the neurological examination. The possibility of multiple sites of SCI and spinal shock can make interpretation of the neurological examination challenging. While plain radiographs or myelography are usually diagnostic, they do not give direct information about the integrity of the spinal cord parenchyma or the severity of any damage. If facilities or experienced staff capable of performing the necessary surgery are not available, or advanced imaging is indicated, referral to a specialist veterinary institution should be considered. AUDIENCE: This review is aimed at clinicians dealing with feline SCI in the emergency setting or at first-opinion level, and discusses causes, initial management, specific treatment and prognosis. PATIENT GROUP: While any cat may potentially be affected by SCI, there is a tendency for exogenous SCI to be more common in younger individuals and, in the authors' experience, pure-breed cats are very rarely presented. Endogenous SCI can be seen in any breed and is typically a condition of adult cats.     

An overview of canine reproduction services. Getting started.

A veterinarian desiring to increase his or her proficiency in canine reproduction needs to become competent in a variety of reproductive procedures. This article describes commonly performed procedures and gives an overview of how to develop a practice in canine reproduction. Once a veterinarian develops expertise in this area, the base of breeder clients in the practice should rapidly increase.     

Lameness originating from the proximal metacarpus/tarsus: A review of local analgesic techniques and clinical diagnostic findings

Accurate diagnosis of conditions of the equine proximal metacarpus and metatarsus presents a clinical challenge. Diagnostic analgesia of this region is nonspecific, which may lead to incorrect interpretation of blocking patterns, potentiating incorrect diagnoses and treatment. Results of local analgesia should be examined carefully during clinical lameness evaluations due to the possibility of diffusion of local anaesthetic solution and inadvertent intrasynovial injection. Supplementary diagnostic analgesia of surrounding anatomic regions and advanced diagnostic imaging, particularly magnetic resonance imaging, are recommended for most accurate diagnosis of lameness. Failure in response to therapy in cases where supplementary diagnostic analgesia and advanced diagnostic imaging have not been performed should prompt the clinician to broaden the approach to better characterise the site of pain.     

Financial evaluation and decision making in the swine breeding herd.

As the swine industry continues to evolve and develop a greater business orientation--one that demands justification of costs, benefits, and risk-exposure--the veterinarian will be confronted with the need to develop an economic basis to supplement the biologic. The profession should view such a challenge as an opportunity to broaden its role in serving the businesses that make up the industry. However, to be effective in such an expanded role requires that the veterinarian develop a good working knowledge of risk and risk management as well as the role played by economic evaluation techniques used in financial evaluation in the risk management process. Several potential advantages exist for the veterinarian who determines to expand his or her risk management role by using financial evaluation in the course of day-to-day practice routine: Additional service or consulting income may be generated through evaluating alternatives through decision analysis. Client confidence may be strengthened in the veterinarian and in the recommendations made. The costs of consulting services and health products for the client may be viewed as income-generators instead of being viewed solely as expenses. Referrals of additional progressive clients may be generated by satisfied current clients. The veterinarian may achieve personal satisfaction through substantiating his or her recommendation beyond clinical or experimental judgment. With the capability of using financial evaluation techniques in the evaluation and justification of recommendations comes significant responsibility. Reliance upon financial evaluation techniques as a more objective approach in the management of risk for clients carries with it an inherently greater degree of trust. Such trust must be deserved. The universal adage "garbage in, garbage out" applies directly to financial evaluation. Financial evaluation techniques have the potential to provide the decision-maker with objective and accurate analysis, improving the probability of choosing an optimal course of action for the business. However, the objectivity and accuracy achievable is highly dependent upon the quality and quantity of information used in the analysis. Veterinarians must be cognizant of the increased responsibility demand placed on those using financial evaluation techniques to direct the course of action for their clients. Financial evaluation tools are available to decision-makers that may improve the objectivity of the decision-making process, providing for a greater degree of confidence in the expected outcome. Stated another way, these tools can reduce the number of surprises a decision-maker encounters as a result of the decisions made.(ABSTRACT TRUNCATED AT 400 WORDS)     

Chronic nasal discharge in cats: 75 cases (1993-2004)

OBJECTIVE: To identify the most common etiologic diagnosis and any historical, physical, or other diagnostic variables associated with a definitive etiologic diagnosis for chronic nasal discharge in cats. Design-Retrospective case series. ANIMALS: 75 cats with nasal discharge of >/= 1 month's duration. PROCEDURES: Medical records of affected cats were reviewed for information on signalment, clinical signs, duration and type of nasal discharge, results of clinical examination, laboratory findings, and advanced imaging findings. RESULTS: A specific etiologic diagnosis for nasal discharge was identified in only 36% of cats. Neoplasia (carcinoma or lymphoma) was the most common etiologic diagnosis. Character and location of nasal discharge did not contribute greatly toward a specific etiologic diagnosis. Sneezing and vomiting were the most common concurrent clinical signs. Routine CBC, serum biochemical panel, and urinalysis did not contribute to a specific etiologic diagnosis. An etiologic diagnosis was more likely in older cats and cats that underwent advanced imaging studies and nasal biopsy. CONCLUSIONS AND CLINICAL RELEVANCE: Although advanced diagnostic testing, including imaging studies and biopsy, increases the likelihood of achieving an etiologic diagnosis, the cause of chronic nasal discharge in cats often remains elusive.     

Drug interactions

Drug interactions are often the result of complex biochemical, physical, and kinetic factors and may not often be easily predicted or even recognized. Although this article has attempted to point out the more common mechanisms and results of drug interactions, the few interactions that have been documented in small animals are undoubtedly only the tip of the iceberg. For the safety of patients and for the highest quality of veterinary care, it is essential that the practitioner become thoroughly familiar with the actions and interactions of drugs used in his or her practice and realize the possible consequences of multiple drug therapies before adding another drug to a therapeutic regimen. From a therapeutics standpoint, the temptation to polypharmacy is great, but the adage "an ounce of prevention is worth a pound of cure" is especially appropriate when discussing drug therapy. The rational decision to use as few drugs as possible in any given situation is the route to safe and successful drug therapy.     

Feline gastrointestinal foreign bodies.

The common presentations of gastrointestinal foreign bodies in cats are discussed in this article. The options for diagnostic imaging modalities and other diagnostic tests are detailed. The management of foreign body obstructions at different levels of the gastrointestinal tract is discussed. Particular attention is paid to the management of linear gastrointestinal foreign bodies, morbidity associated with this condition, and treatment. There is also a brief discussion on the types of gastrointestinal foreign bodies presenting to a veterinary teaching hospital at which both referral and primary cases are seen.     

Equine nuclear scintigraphy. Indications, uses, and techniques.

The demand for advanced and correlative imaging methods in equine medicine is growing. Scintigraphy can provide unique information about the physiologic status of an animal that cannot be discerned by other imaging modalities.     

Foot-and-mouth disease. A review for the practitioner.

Foot-and-mouth disease (FMD) is perhaps the most infectious disease known to human and veterinary medicine. This article is written with the practitioner in mind, concentrating on early recognition, epidemiology, occurrence around the world, and sampling and diagnostic methods. The article stresses that there are numerous FMD viruses, and not all behave in a similar fashion. The practitioner must be acute in his or her herd inspection of animals in which vesicular disease is suspected and knowledgeable as to differential diagnosis.     

The integration of radiography and alternative imaging methods in the diagnosis of equine orthopedic disease

There is increasing demand on equine practitioners to provide confirmation of their diagnoses. For obscure lameness and for many of the more difficult locomotory problems presented in referral hospitals, the question to be answered is not only how to make the most accurate diagnosis but also how to document the findings so that there is less doubt in the mind of the client. This article describes a quasi algorithmic approach to choosing the best combinations of the increasingly sophisticated imaging methods available for evaluation of orthopedic disease.     

Abnormal platelet activity in dogs and cats – impact and measurement

Abnormal platelet activity can either lead to bleeding tendencies or inappropriate thrombus formation and can occur secondarily to a wide variety of disease processes, with a range of clinical consequences and severity. This article will discuss the pathophysiology of platelet function abnormalities and consider a logical diagnostic approach applicable to veterinary practice. Recent advances in platelet function testing will then be discussed, with regards to detection of platelet dysfunction and tailoring of pharmacological manipulation. Although many of these tests are still confined to research or academic institutions, techniques for indirectly assessing platelet function are starting to become more widely available. Although we still require further research to develop guidelines for the use of these tests in clinical decision-making, the recent advances in this field are an exciting step forward in being able to detect and manage platelet dysfunction in both primary care and referral practice.     

Orbital penetration associated with tooth extraction

Three cats and 2 dogs were evaluated for ophthalmologic complications associated with tooth extraction procedures. Orbital penetration leading to ocular and, in one case, brain trauma was secondary to iatrogenic injury from a dental elevator. Outcomes included enucleation of the affected eye in 3 cases, and death from brain abscessation in 1 case. Early treatment or, preferably, referral to a veterinary ophthalmology specialist may prevent such outcomes. Awareness of the anatomical proximity of caudal maxillary tooth roots and the orbit, appropriate interpretation of diagnostic intraoral dental radiographs, and technical proficiency in tooth extraction techniques will minimize these complications in veterinary dental practice.     

Respiratory applications for the future: one perspective.

Respiratory diagnostic instruments previously available only to referral centers should be converted into miniature, portable, wireless medical devices for use in practice. Internet and wireless connections of these instruments should expedite the process of seeking second opinions and in general information sharing. We are moving into a world of greater objectivity that should free us from speculation in some areas, yet open new avenues for research and innovation in others.     

IMAGE DISPLAY

Digital imaging systems are imaging chains where the diagnostic utility of the system is limited by its weakest link. Digital image display has had a major impact on the imaging chain. Radiologist performance can be greatly impacted by monitors and software choices. Many factors should be considered when purchasing monitors or an entire workstation and workstation rank or importance is of primary concern. The workstation should be likened to the studio or perhaps more appropriately the surgical suite of the radiologist. It should be comfortable, useful, and enable the radiologist to practice their trade to the best of their ability.     

Advanced diagnostic imaging and surgical treatment of an odontogenic retromasseteric abscess in a guinea pig

A two‐year‐old guinea pig presented for difficulty chewing. Examination and diagnostic imaging, including computed tomography and magnetic resonance, revealed an odontogenic retromasseteric abscess associated with a mandibular cheek tooth. Treatment included removal of the abscess and marsupialisation of the surgical site for repeated debridement and healing by second intention. Unique features of this case included the use of advanced diagnostic imaging and utilisation of marsupialisation for surgical correction.