Case Summary (case + summary)

Distribution by Scientific Domains


Selected Abstracts


Serotonin syndrome caused by interaction between citalopram and fentanyl

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2007
S. Ailawadhi MD
Summary Objective:, To report a case of serotonin syndrome associated with interaction between fentanyl and citalopram, as evidenced by medication history, clinical features and reversal following discontinuation of fentanyl. Case Summary:, A 65-year-old patient chronically treated with the selective serotonin reuptake inhibitor (SSRI) citalopram developed confusion, agitation, tachycardia, tremors, myoclonic jerks and unsteady gait, consistent with serotonin syndrome, following initiation of fentanyl, and all symptoms and signs resolved following discontinuation of fentanyl. Based on the Naranjo probability scale, serotonin syndrome was a probable adverse reaction associated with co-administration of citalopram and fentanyl. Discussion:, Serotonin syndrome is a potentially lethal pharmacodynamic interaction between medications that increase serotonergic transmission at the synaptic junction. The development of new pharmacological agents with varied properties and actions has increased the risk of serotonin syndrome as a clinical diagnosis. SSRIs and fentanyl are commonly co-administered, especially in the setting of chronic or malignant pain, as underlying depression may contribute to the pathogenesis of pain. Conclusion:, Healthcare professionals should be aware of the possible development of serotonin syndrome as a complication of initiation of fentanyl and other phenylpiperidine opioids in patients treated with SSRIs. [source]


Use of a point-of-care urine drug test in a dog to assist in diagnosing barbiturate toxicosis secondary to ingestion of a euthanized carcass

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2009
DACVA, DACVECC, Vicki L. Campbell DVM
Abstract Objective , To describe a case of barbiturate toxicosis in a dog secondary to ingestion of a previously buried euthanized goat carcass and to discuss the utility of urine drug testing in diagnosing barbiturate toxicosis. Case Summary , A 6-year-old neutered male Border Collie was presented to a university veterinary teaching hospital for evaluation of ataxia and acute collapse. Past pertinent history included Addison's disease that had been managed for 1 year. A companion dog was seen 12 hours earlier chewing on the partially decomposed head of a goat that had been euthanized 47 days previously and buried on the owner's property. The dog was laterally recumbent, unresponsive to stimuli, and hypothermic on physical examination. Initial blood work revealed hyponatremia and hyperkalemia, with a Na/K ratio of 18.5. The dog was volume resuscitated and received an injection of dexamethasone sodium phosphate due to a suspected Addisonian crisis. Despite this treatment, the dog remained laterally recumbent and unresponsive to stimuli. A urine drug screen was performed and was positive for barbiturates. A diagnosis of barbiturate toxicosis secondary to ingestion of a euthanized goat carcass was made. The dog was treated supportively over 12 hours with IV fluids and activated charcoal. The dog was able to walk 11 hours after presentation and was subsequently discharged from the hospital. New or Unique Information Provided , Urine drug testing is a fast, easy, and point-of-care test that may be useful in dogs to assist in the diagnosis of barbiturate intoxication. Proper disposal of euthanized animals is necessary to prevent toxicosis and possible death of companion animals and wildlife. [source]


Disseminated candidiasis secondary to fungal and bacterial peritonitis in a young dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2009
Catherine L. Rogers DVM, DACVECC
Abstract Objective , To describe a severe case of bacterial sepsis and disseminated candidiasis in a previously healthy dog. Case Summary , Fungal sepsis was identified in a 2-year-old dog following intestinal dehiscence 4 days after abdominal surgery. Septic peritonitis was identified at admission and evidence of dehiscence at the previous enterotomy site was found during an exploratory laparotomy. Both gram-positive cocci and Candida albicans were cultured from the abdominal cavity. Candida sp. was also subsequently cultured from a central venous catheter. Euthanasia was performed due to failure to respond to therapy. Fungal organisms, morphologically consistent with Candida spp., were found in the lungs and kidney on postmortem histopathologic examination indicating disseminated candidiasis. New or Unique Information Provided , Candida peritonitis is a well-recognized entity in humans and contributes to morbidity and mortality in critically ill patients. Abdominal surgery, intestinal perforation, presence of central venous catheters, and administration of broad-spectrum antibiotics are all considered to be suspected risk factors. This report describes the first known case of systemic candidiasis occurring secondary to Candida peritonitis and bacterial sepsis in a critically ill dog. [source]


Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture, diaphragmatic tear, and rupture of the spleen in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008
Gordon D. Peddle VMD
Abstract Objective, To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary, A 1-year-old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco- and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided, Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen. [source]


Medical and surgical management of severe barium aspiration in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008
Stacy D. Meola DVM
Abstract Objective, To describe the medical and surgical management of a unique case of barium sulfate aspiration pneumonia in a dog. Case Summary, A 5-year-old spayed female black Labrador Retriever weighing 33 kg was presented for evaluation of barium aspiration pneumonia. Approximately 200 mL of barium had been instilled into the caudal lung lobes via an improperly placed orogastric tube. Right caudal, right middle, and accessory lung lobectomies were performed, and the dog was managed intensively for 19 days in the hospital. New or Unique Information Provided, This is the first report of a complete diagnostic work-up including bronchoscopy, bronchoalveolar lavage, culture, thoracotomy, and pulmonary histopathology for severe barium sulfate aspiration in a dog with an excellent outcome. [source]


Successful use of short-term mechanical ventilation to manage respiratory failure secondary to profound hypokalemia in a cat with hyperaldosteronism

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008
Tara N. Hammond DVM
Abstract Objective , To report successful management of respiratory failure due to severe hypokalemia in a cat with hyperaldosteronism, including short-term mechanical ventilation strategies and aspects of medical and surgical treatment. Case Summary , A cat presented with bilateral pelvic limb weakness that rapidly progressed to tetraparesis and respiratory muscle failure. Point-of-care testing revealed severe hypokalemia (1.9 mmol/L) and mild azotemia. Initial management included endotracheal intubation, mechanical ventilation, and aggressive potassium supplementation. Spironolactone was started due to a high index of suspicion for hyperaldosteronism. A right adrenal mass visualized during abdominal ultrasonographic examination and a serum aldosterone level greater than 3329 pmol/L confirmed the diagnosis. The cat made a full recovery following surgical removal of a right adrenal adenoma. New or Unique Information Provided , We report successful management of respiratory failure in a cat with hyperaldosteronism using short-term mechanical ventilation. Respiratory failure due to severe hypokalemia should be considered a complication of hyperaldosteronism in cats and may require mechanical ventilation. However, full recovery is possible. [source]


Canine leishmaniasis with nephrotic syndrome and aortic and caudal vena cava thromboembolism

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008
Nuno Félix DVM
Abstract Objective , To describe a case of leishmaniasis associated with nephrotic syndrome and aortic and caudal vena cava thrombosis in a dog. Case Summary , A 3-year-old male Boxer was referred to the Faculty of Veterinary Medicine, Lisbon, with vomiting, polyuria, polydipsia, lethargy, anorexia, and weight loss. On admission, the dog was thin, quiet, and dehydrated. Initial laboratory abnormalities were compatible with a diagnosis of leishmaniasis (confirmed by serology and bone marrow aspirate), and nephrotic syndrome. Three days later, the animal developed lumbar pain, paraparesis, and absent femoral pulses. Coagulation tests showed a marked reduction in antithrombin (AT) and a mild increase in serum fibrinogen concentration. A diagnosis of thromboembolism was made. In spite of treatment aimed at controlling the primary condition and decreasing further thrombus formation, necrosis developed in the distal right pelvic limb and the nail beds of the left pelvic limb. Against medical advice, medication was stopped and, 15 days later, the dog returned to the hospital, showing extensive necrosis of both pelvic limb extremities. Euthanasia was performed at the owner's request. Necropsy showed a thrombus localized at the distal aorta and extending into the right iliac artery, and an additional thrombus extending from both femoral veins onto the caudal vena cava. New or Unique Information Provided , Thromboembolic disease is rare in dogs with leishmaniasis with nephrotic syndrome. This case suggests that a marked decrease in AT and a mild increase in serum fibrinogen may elicit a hypercoagulable state in these patients. [source]


Myocardial perforation by a stick foreign body in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2008
Augusta Pelosi DVM, DACVS
Abstract Objective: To report a case of myocardial perforation by a stick foreign body in a dog. Case Summary: A 3-year-old castrated male Labrador Retriever was examined because of a puncture wound seen after an unsupervised run in the woods. The wound was suspected to penetrate into the thoracic cavity on the basis of physical exam and radiographs. Uniform ventricular premature complexes (VPCs) and junctional beats were noted on electrocardiogram (ECG). Thoracotomy was performed and a 6-cm wooden stick was seen protruding from the right ventricle through the pericardium toward the sternum. The stick was removed while purse string sutures were tied around the resultant myocardial defect. Follow-up echocardiography revealed intact intracardiac structures. VPCs were treated with lidocaine and resolved completely within 24 hours of presentation. New or Unique Information Provided: Thoracic trauma can result in myocardial injury; penetration into the myocardium represents a life-threatening situation for the emergency clinician. Cardiac injury should be included in the differential diagnoses of penetrating thoracic foreign bodies. [source]


Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine,zinc): a case of decompensated liver cirrhosis in Wilson's disease

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2007
C. C. Ping MPharm
Summary Objectives:, To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. Case summary:, A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. Discussion:, Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20,30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. Conclusion:, In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs in clinical practice is certainly a subject of serious concern. Systems for better management of patients with rare diseases need to be instituted by all the institutions concerned. [source]


Successful treatment of a leg ulcer occurring in a rheumatoid arthritis patient under leflunomide therapy

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2005
J Knab
ABSTRACT Objective, We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful treatment. Case summary, A 68-year-old woman with a 12-year history of RA developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic factors were ruled out. There were some clinical hints for rheumatoid vasculitis. The ulcer was resistant to ambulant conservative phase adapted wound bed preparation and a split skin transplantation failed. After omission of leflunomide and washout procedure with cholestyramine a second split skin transplantation resulted in complete healing. Discussion, Leflunomide inhibits the division of activated T cells and thus inhibits among others the production of proinflammatory cytokines and the adhesion of cells to the endothelium. These mechanisms may partly explain the possible influence of leflunomide on the perpetuation of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been described in one case each for the novel immunomodulator leflunomide. No successful treatment of a leg ulcer under leflunomide has been described yet. Omission of leflunomide and a washout treatment in our case led to a complete healing. This may indicate a critical role of leflunomide in the maintenance of this slow healing ulcer. Conclusions, An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered. [source]


Coma and respiratory failure due to moxidectin intoxication in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2008
Alexander E. Gallagher DVM
Abstract Objective: To describe the clinical consequences following ingestion by a dog of a moxidectin-containing equine deworming product. Few reports exist concerning the treatment and outcome of severe moxidectin toxicity. Treatment, known factors influencing intoxication, and prognosis are reviewed. Case summary: A 10-month-old female Border Collie ingested an unknown quantity of a moxidectin-containing equine deworming product several hours before presentation. Severe neurological signs subsequently developed and included: ataxia, seizures, coma, and respiratory failure. The dog was treated with supportive care including intravenous fluids, activated charcoal, and positive pressure ventilation. Normal spontaneous respiration returned in 34 hours and the patient was discharged 58 hours after ingestion. Full recovery occurred within 1 week of intoxication. New information provided: This report describes moxidectin intoxication and associated respiratory failure in a dog that required mechanical ventilation. The dog's recovery was rapid. Despite severity of signs, the prognosis for patients with moxidectin intoxication is good with appropriate supportive care. [source]


Xylitol intoxication associated with fulminant hepatic failure in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2007
Jeffrey M. Todd DVM
Abstract Objective: To describe a case of xylitol intoxication causing fulminant hepatic failure in a dog. Case summary: A 2.5-year-old castrated male English Springer Spaniel weighing 26 kg, was presented after ingestion of half of a loaf of bread containing the sweetener xylitol. Toxic effects of the xylitol in this dog included vomiting, mild hypoglycemia and fulminant hepatic failure. Clinical management of acute hepatic failure and subsequent coagulopathy with supportive care and fresh frozen plasma is described. The dog was discharged 3 days after admission after a full clinical recovery. New or unique information provided: This paper describes the clinical consequence and successful treatment of fulminant hepatic failure in a dog following ingestion of xylitol. [source]


Paintball intoxication in a pug

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2007
Jason B. King DVM
Abstract Objective: To describe a case of toxicity caused by oral ingestion of paintballs by a dog and how it was initially misdiagnosed as ethylene glycol intoxication due to similar clinical signs and a positive ethylene glycol blood test. Case summary: A 7 year-old, 8.3 kg, female spayed Pug was referred for treatment of ethylene glycol (EG) toxicity. The patient was ataxic, disoriented, polyuric, polydipsic, and had a positive EG blood test. The patient was started on fomepizole therapy and intravenous fluids. Biochemical assays of the serum showed abnormalities that were not typical of EG toxicity. The following morning the patient defecated bright pink feces. The owner revealed that bright pink paint balls were present in the household when questioned. The patient completed fomepizole therapy and was discharged 40 hours after presentation with no clinical signs. Follow-up telephone conversations found the pet to be clinically normal 2 months after discharge. New or unique information provided: This is the first known case report of paint ball intoxication in a dog that resulted in a positive EG blood test and clinical signs similar to ethylene glycol toxicity. [source]


Budd,Chiari-like syndrome in a dog with a chondrosarcoma of the thoracic wall

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2007
Megan F. Whelan DVM
Abstract Objective: To describe a dog with Budd,Chiari-like syndrome secondary to caudal vena cava compression from a thoracic wall chondrosarcoma. Case summary: A 9-year-old spayed female Shetland Sheepdog cross with a recent history of non-productive cough developed severe abdominal distension and dyspnea. Marked ascites and enlarged hepatic veins were identified with ultrasonography. At surgery, a right thoracic wall mass was found to be compressing the caudal vena cava. Fluid analysis of the ascites revealed a modified transudate with elevated protein concentration, consistent with Budd,Chiari-like syndrome. Clinical signs resolved following thoracotomy and complete resection of the mass. New or unique information provided: Obstruction of venous blood flow can result from compression exerted by a space-occupying thoracic wall mass on the caudal vena cava. Clinical resolution can be achieved with return of adequate venous circulation by removal of the mass and alleviation of the external pressure. [source]


Mechanical ventilation of a cloned calf in respiratory failure

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2007
DACVIM, Sébastien Buczinski Dr. Vet
Abstract Objective: To report the use of mechanical ventilation in a calf suffering from respiratory failure. Case summary: A full-term clone calf born by cesarean section showed signs of respiratory failure that did not respond to intranasal oxygen therapy. Thoracic radiographs were compatible with a diffuse interstitial and alveolar pattern. The calf was successfully managed with 3 days of mechanical ventilation and was eventually discharged from the hospital following further therapy for sepsis. Unique information provided: This is the first description of mechanical ventilation in a calf suffering from hypercapnic respiratory failure. Mechanical ventilation may be useful in the treatment of high pedigree merit calves. The procedure was well tolerated and the calf was able to drink easily during nasotracheal ventilation. [source]


Surgical repair of a peritoneopericardial diaphragmatic hernia in a pregnant dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2007
Gretchen D. Statz DVM
Abstract Objective: To describe the surgical repair and pre- and postoperative management of a peritoneopericardial diaphragmatic hernia (PPDH) in a pregnant dog. Case summary: A pregnant dog was presented for vomiting, lethargy, and pale mucous membranes. Pulsus paradoxus was noted on physical examination. The dog was diagnosed with a PPDH via thoracic radiographs, abdominal ultrasound, and an echocardiogram. The hernia was surgically repaired and the dog received supportive medical care until the puppies were old enough to be delivered via cesarean section. The mother and all puppies survived. New or unique information provided: This is the first report that describes the surgical repair and postoperative management of a PPDH in a pregnant dog. [source]


Pyometra with inguinal herniation of the left uterine horn and omentum in a Beagle dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2007
Christopher G. Byers DVM
Abstract Objective: To describe a unique case of pyometra with inguinal herniation of the left uterine horn and omentum. Case summary: A 7-year-old, 19 kg, intact female Beagle dog presented for surgical treatment of presumptive pyometra and biopsy of a caudal abdominal mass in the left inguinal mammary gland region. Ventral midline celiotomy was performed, and a distended, fluid-filled uterus with passage of the distal aspect of the left uterine horn through the left vaginal process into the inguinal canal was identified. The patient recovered uneventfully following ovariohysterectomy and left inguinal herniorrhaphy. New or unique information provided: This is the first documented report of inguinal herniation of a uterine horn associated with a pyometra. [source]


Segmental lung lobe torsion in a 7-week-old Pug

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2006
MACVSc, Naomi L. Hansen BVSc
Abstract Case summary: A 7-week-old, intact female Pug was referred with an acute history of expiratory dyspnea, tachypnea, and pyrexia. Radiologic evaluation revealed bilateral pleural effusion and a poorly demarcated area of soft tissue opacity cranial to the heart. The presence of air bronchograms in the cranial lung lobes suggested alveolar parenchymal pathology consistent with pulmonary edema, congestion, or cellular infiltration. Exploratory thoracotomy revealed a segmental torsion of the left cranial lung lobe. The affected lobe was removed and the puppy recovered uneventfully. Unique information: Lung lobe torsion tends to occur more frequently in mature large breed dogs at a mean age of 3 years. The age, breed, and segmental nature of the torsion in the reported case are contrary to most of the previously documented cases of lung lobe torsion. To the authors' knowledge, this is the first report of lung lobe torsion in a 7-week-old dog. [source]


Pseudomonas aeruginosa sepsis in an adult horse with enteric Salmonellosis

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2006
DACVIM, Imogen C. Johns BVSc
Abstract Objective: To report a case of enteric Salmonellosis and Pseudomonas aeruginosa bacteremia in an adult horse. Case summary: A 7-year-old mare presented for signs of acute abdominal pain. Exploratory laparotomy allowed surgical correction of right dorsal displacement of the large colon with a 180° volvulus at the cecocolic ligament. Postoperatively, the mare developed fevers, leukopenia, and diarrhea. Salmonella newport was cultured from the feces and P. aeruginosa from 2 consecutive blood cultures. The mare responded well to intensive medical therapy. New or unique information provided: Bacteremia associated with colitis is unusual in an adult horse, although the percentage of animals that may be bacteremic is unknown. The bacteria isolated, P. aeruginosa, a common pathogen of other sites in the horse, has not, to our knowledge, been previously reported as a cause of bacteremia and septicemia in an adult horse. [source]


Septic pericarditis in a Yorkshire Terrier

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2006
Amanda Wagner DVM
Abstract Objective: To describe a novel case management strategy for a small breed dog diagnosed with septic pericarditis. Case summary: An 8-year-old spayed female Yorkshire Terrier presented for evaluation of pericardial effusion and persistent hypoglycemia. The dog had been hospitalized at a primary care facility for acute onset of vomiting, lethargy, inappetance, and painful abdominal distension. Pericardial effusion was detected and upon referral, cytologic examination revealed a suppurative exudate with Gram-positive and Gram-negative bacteria. The dog was treated with pericardiocentesis and placement of an indwelling pericardial catheter. Subtotal pericardiectomy was performed and a thoracotomy tube was utilized postoperatively. A penicillin-susceptible Bacteroides species was cultured from the pericardial fluid and was treated with a 6-week course of antibiotics. The dog was discharged from the hospital and clinical signs have not recurred in over 2 years. New or unique information provided: Septic pericarditis, an uncommon cause of canine pericardial effusion, has been described primarily in large breed dogs and in association with bacterial infection secondary to Hordeum grass (foxtail) awn migration. This case was unique in that the dog was a small breed with no evidence of foreign body penetration or other precipitating cause for the pericarditis. In a novel management plan, an indwelling pericardial catheter was employed to stabilize the dog before subtotal pericardiectomy. [source]


Opioid dysphoria in three dogs

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2006
Erik H. Hofmeister DVM
Abstract Objective: To describe the clinical manifestations and response to management of opioid dysphoria in 3 dogs. Case summary: Three dogs being managed for post-operative pain were evaluated. All 3 dogs had been managed with various opioids including morphine, hydromorphone, and fentanyl following the surgical procedure. The 3 dogs exhibited vocalization that did not respond to interaction and did not change with administration of analgesic and anxiolytic agents. The dogs were treated with naloxone and, within 5 minutes of its administration, ceased vocalizing, and became aware and interactive with their environment. Further pain management consisted of non-steroidal anti-inflammatory medications, alpha-2 (,2) receptor agonists or the partial ,-receptor opioid agonist, buprenorphine. New and unique information provided: Vocalization and lack of response to interaction with humans are clinical signs which can be seen in dogs with opioid dysphoria, and generally are not responsive to analgesics or sedation. Reversal with naloxone results in rapid resolution of vocalization and opioid-induced dysphoria. [source]


A case of fatal anaphylaxis in a dog associated with a dexamethasone suppression test

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2005
DACVECC, DACVIM, Michael Schaer DVM
Abstract Objective: To describe a case of fatal anaphylaxis in a dog associated with a ,routine' dexamethasone suppression test. Case summary: An 8-year-old, spayed female dog, was treated with parenteral dexamethasone for a diagnosis of immune-mediated thrombocytopenia. The dog had responded to treatment, but 9 months later was evaluated for endogenous hyperadrenocorticism, prior to surgery for a ruptured anterior cruciate ligament. A normal ACTH stimulation test was followed by a high-dose dexamethasone suppression test. Immediately following the intravenous injection of dexamethasone, the dog developed severe anaphylactic shock and died. The postmortem examination findings supported the diagnosis of anaphylaxis. New information provided: The anaphylaxis in this dog was fulminating and by-passed the usual early signs of drug hypersensitivity. This is the first case in the veterinary literature reporting on dexamethasone as the cause of this dog's catastrophic event. [source]


Hypocalcemia in a critically ill patient

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2005
Tamara B. Wills DVM
Abstract Objective: To present a case of clinical hypocalcemia in a critically ill septic dog. Case summary: A 12-year old, female spayed English sheepdog presented in septic shock 5 days following hemilaminectomy surgery. Streptococcus canis was cultured from the incision site. Seven days after surgery, muscle tremors were noted and a subsequent low serum ionized calcium level was measured and treated. Intensive monitoring, fluid therapy, and antibiotic treatment were continued because of the sepsis and hypocalcemia, but the dog was euthanized 2 weeks after surgery. New or unique information provided: Low serum ionized calcium levels are a common finding in critically ill human patients, especially in cases of sepsis, pancreatitis, and rhabdomyolysis. In veterinary patients, sepsis or streptococcal infections are not commonly thought of as a contributing factor for hypocalcemia. Potential mechanisms of low serum ionized calcium levels in critically ill patients include intracellular accumulation of calcium ions, altered sensitivity and function of the parathyroid gland, alterations in Vitamin D levels or activity, renal loss of calcium, and severe hypomagnesemia. Pro-inflammatory cytokines and calcitonin have also been proposed to contribute to low ionized calcium in the critically ill. Many veterinarians rely on total calcium levels instead of serum ionized calcium levels to assess critical patients and may be missing the development of hypocalcemia. Serum ionized calcium levels are recommended over total calcium levels to evaluate critically ill veterinary patients. [source]


SOMA (carisoprodol) toxicity in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2005
Stephen G. Lane DVM
Abstract Objective: To describe a case of SOMA intoxication in a dog. Case summary: A 13-year-old, 25 kg, female spayed Australian shepherd presented to the emergency service after ingestion of ten to fifteen 350 mg tablets of SOMA (carisoprodol), a muscle relaxant used for back pain in humans. Toxic effects of the drug in this dog included mild sinus tachycardia, respiratory depression, seizures, and ataxia. The dog's mentation progressively deteriorated from depressed to comatose within 1 hour after admission. Treatment on initial presentation consisted of induction of emesis while the dog still had a gag reflex, administration of activated charcoal, oxygen therapy, and supportive care. The dog was discharged to the owner prior to full recovery (4 days later). New or unique information provided: This is the first known report of carisoprodol intoxication in the dog. [source]


Management of femoral artery thrombosis in an immature dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2005
Kathy C. Tater DVM
Abstract Objective: To report a case of femoral artery thrombosis and its medical management in a young dog. Case summary: A 13-week-old, female Boxer puppy presented with hind limb paralysis after an abdominal crush injury. A left femoral artery thrombus was identified on ultrasound. No spinal trauma was visualized in imaging studies. Clinical management of arterial thrombosis in a 13-week-old puppy with streptokinase and dalteparin therapy is described. New or unique information provided: This paper describes an unusual presentation of arterial thrombosis. The medical management with streptokinase and dalteparin is also out of the ordinary. Images that document the development of compensatory circulation around the thrombosed vessel are included. Additionally, this paper also documents the altered development that occurred in this immature dog after the thrombotic event. [source]


Spontaneous resolution of hypothermia-induced atrial fibrillation in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2004
Scott A. Campbell DVM
Abstract Objective: To report a case of spontaneous resolution of atrial fibrillation secondary to hypothermia in a dog without detectable heart disease. Case summary: An 8-year-old female spayed mixed breed dog presented with a history of prolonged exposure to below freezing environmental temperatures. The dog presented hypothermic (<32°C or <90°F) and minimally responsive to stimuli. The heart rate was 80 beats per minute (bpm) and irregular. Atrial fibrillation was diagnosed. The dog had pale mucous membranes, absent femoral pulses, and no obtainable blood pressure via indirect Doppler technique. Resuscitation fluids were administered and active external warming was instituted. Peripheral edema was observed during the rewarming phase and the irregular heart rate was noted to increase. The atrial fibrillation spontaneously resolved with no specific anti-arrhythmic therapy. No underlying myocardial disease was found. The recovery of this dog was complete with a subsequent repeat of the echocardiogram and electrocardiogram (ECG) 8-months later found to be within normal limits. [source]


Later-onset congenital central hypoventilation syndrome due to a heterozygous 24-polyalanine repeat expansion mutation in the PHOX2B gene

ACTA PAEDIATRICA, Issue 1 2009
Gabriela M Repetto
Abstract Aim: to describe a family with later onset congenital central hypoventilation syndrome (LO-CCHS) and heterozygosity for a 24-polyalanine repeat expansion mutation in the PHOX2B gene, rendered phenotypically apparent with exposure to anesthetics. Case summary: An otherwise healthy 2.75-year-old boy presented with alveolar hypoventilation after adenoidectomy and tonsillectomy for obstructive sleep apnea, requiring invasive ventilatory support during sleep. He had a heterozygous 24-polyalanine repeat expansion in the PHOX2B gene (20/24 genotype), a genotype that has not been previously described in association with CCHS or LO-CCHS symptoms. Clinical findings in members of the family with the same 20/24 genotype ranged from asymptomatic to prolonged sedation after benzodiazepines. Conclusion: CCHS should be suspected in individuals presenting with unexplained hypoventilation and/or seizures after anesthetics or sedatives. This is the first report of LO-CCHS in a kindred with the PHOX2B 20/24 genotype. The incomplete penetrance observed in this family suggests a gene,environment interaction. [source]


Individual Differences in Attitudes Relevant to Juror Decision Making: Development and Validation of the Pretrial Juror Attitude Questionnaire (PJAQ),

JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2008
Len Lecci
This study involves scale development using theoretically derived items from previous measures and a lay consensual approach for generating new items. Confirmatory factor analysis was used to validate the emergent constructs assessing individual differences in attitudes of prospective jurors. Using case summaries, the Pretrial Juror Attitude Questionnaire (PJAQ) demonstrates superior predictive validity over commonly employed measures of pretrial bias. The PJAQ confirms the importance of theoretically derived constructs assessed by other scales and introduces new constructs to the jury decision-making literature. The attitudes assessed by the PJAQ are conviction proneness, system confidence, cynicism toward the defense, racial bias, social justice, and innate criminality. Implications for assessing such attitudes and for better understanding the decision-making process of jurors are discussed. [source]


Modernising Morning Report: innovation in teaching and learning

THE CLINICAL TEACHER, Issue 2 2010
Kerry Layne
Summary Background:, Over recent years there has been a shift in undergraduate medical education, from predominantly passive, didactic teaching methods to facilitating learning by focusing on the management of common scenarios, through the means of problem- and case-based learning. Context:, Case-based learning and peer-led teaching are often overlooked at postgraduate level, despite the continuing demonstrated success of these methods in fostering independent reasoning and problem-solving skills that are vital for newly qualified doctors to develop. When trying to strike a balance between educational needs and service provision, it is essential to identify and implement efficient, effective approaches to optimise learning opportunities. Innovation:, We have adapted the pre-existing framework of the American ,Morning Report' to suit the needs of today's junior doctors, creating a system of providing case-based learning paired with peer-led teaching. Implications:, We evaluated the educational model through a focus group session, and found that our Morning Report was a unique environment where junior doctors feel comfortable engaging with group case-based teaching, with the support and encouragement of senior consultants, reinforced with online case summaries and blog resources. [source]


The perceived credibility of older adults as witnesses and its relation to ageism,

BEHAVIORAL SCIENCES & THE LAW, Issue 3 2007
Katrin Mueller-Johnson Ph.D.
In experiment 1, 267 undergraduates read a case summary and witness statement. Sex and age of the witness (49, 69, 79 or 89 years) were varied. Participants rated the witness's perceived convincingness, confidence, quality of observation, accuracy, honesty, competence, memory, suggestibility, and cognitive functioning. As well as an age effect for honesty, age by sex interactions were observed for several characteristics, particularly for comparisons of the 79-year-olds versus the 49-year-olds, and 89-year-olds versus the 49-year-olds. In experiment 2, 94 undergraduates read the same testimony given by a 79-year-old male or female witness, and completed the Fraboni Scale of Ageism and the Aging Semantic Differential. Participants who evidenced stronger aging stereotypes on these measures rated the witness less favorably than did participants who were less prejudiced. This experiment is the first to show a link between perceived credibility of older adults and ageist attitudes. Practical applications regarding how older witnesses are viewed by jurors, and the criminal justice system more generally, are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source]