Problems in Veterinary Medicine

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Abdominal hernias, especially those resulting from trauma, are common in small animals. Little is written regarding prevention and treatment of common problems or complications encountered during or after herniorrhaphy. The purpose of this article is to discuss the numerous potential or documented complications associated with abdominal herniorrhaphy, how to manage them, and, most importantly, how to prevent them.
 
Prostatic abscessation in the dog is a disease process in which diagnostic, therapeutic, and postoperative problems are frequently encountered. Several surgical techniques for the treatment of prostatic abscessation in the dog have been reported. However, few studies have described the indications for use of a particular technique or associated postoperative complications.
 
Urinary diversion techniques to bypass diseased or damaged portions of the urinary tract represent a critical answer to potentially life-threatening conditions. Prepublic urethrostomy in the dog and cat, when used in the appropriate condition, can provide excellent urinary function. Nine animals, two dogs and seven cats, are presented here as a clinical representation of the benefits of prepubic urethrostomy. The surgical technique, clinical case material in the nine animals, and complications associated with the procedure are presented.
 
Echocardiography in veterinary medicine has both enhanced our ability to diagnose and treat cardiac diseases in small animals and added confusion to what we already know. Because we can actually see the heart beating and visualize blood flows within the cardiac chambers as well as measure velocities of blood flows, we have a tool that increases our non-invasive diagnostic abilities. On the other hand, the lines between different heart diseases are not always clear-cut, and the more we learn about heart disease the more we see the shades of distinction between different diseases become blurred. This chapter will look at the main abnormalities we see in veterinary medicine (mitral regurgitation, pericardial disease, and the different feline and canine cardiomyopathies) and will attempt to help the veterinary echocardiographer avoid common problems encountered in acquired heart disease as well as use echocardiographic information to gain a better understanding of the disease process occurring in animals.
 
The concentration of an antimicrobial drug at the site of infection is determined by its relative lipid solubility and the tissue in question. For drugs that are limited by their solubility to the extracellular fluid, the tissue concentrations in bone and soft tissue can be predicted from serum concentrations. Tissues with barriers to antimicrobial penetration include the prostate and central nervous system; there are special considerations when administering antimicrobials to treat infections in these areas or when intracellular drug concentrations are needed. Intermittent tissue concentrations of bactericidal antimicrobials that are 4-8 times the minimum inhibitory concentration (MIC) are usually sufficient for a clinical cure. However, there are situations when higher or more persistent drug concentrations are needed, such as when treating an immunosuppressed patient or when administering bacteriostatic drugs.
 
Acupuncture points are conceived as points on the skin reflecting visceral conditions and the sites for acupuncture treatment. In the skin, acupoints tend to show higher electric conductivity and have higher concentration of neural and vascular elements as well as mast cells. Locations of some acupoints correspond to the motor points, others to the Golgi tendon organs. There is a group of midline acupoints. Most acupoints are associated with meridians and are known as meridian points. The nature of meridians is under scientific scrutiny. For identification of canine acupoints, the human meridian nomenclature was adopted.
 
Acupuncture-produced surgical analgesia has been demonstrated in a wide variety of species under experimental and clinical conditions. Its advantage is that it precludes the need for depressant drugs, which could be especially useful in veterinary practice in very sick patients, geriatric patients, or in patients requiring Cesarean section. Disadvantages are that acupuncture-produced surgical analgesia involves an unfamiliar technique, requires special equipment, has inconsistent effects, and lacks restraint.
 
This chapter introduces veterinarians to Traditional Chinese Medicine (TCM). TCM has its own unique approach to describing medical conditions. The Chinese have been able to describe naturally occurring medical phenomena accurately for thousands of years. Ancient theories and concepts allowed them to treat conditions without the knowledge we currently have of neurophysiology. The terminology used in the study of TCM will help show the difference between TCM and medicine as it is practiced in the west. TCM encompasses Qi and its functions, the Meridians, and the Five Phases. It will be shown how knowledge and application of these concepts can be used to diagnose and treat disease.
 
In both ancient and present-day China, avian acupuncture has been used in domestic fowl kept as food animals only. For the progressive western veterinarian, there is a place for acupuncture as a complement to the practice of conventional avian medicine. The nature and origin of the class Aves render them more responsive than mammals to traditional acupuncture techniques. When acupuncture is appropriately applied, the response is positive and rewarding. A working familiarity with avian anatomy and taxonomy is a prerequisite to location and manipulation of avian points. A descriptive text of currently documented avian acupoints is presented.
 
This chapter offers a brief introduction to the basic principles of acupuncture and a description of its development since its probable origin in China approximately 3,000 years ago. The acupuncture paradigm and its theories of health are compared and contrasted with those of orthodox Euroamerican medicine. Traditional Chinese medicine (TCM) is asserted as distinct in its reliance on astute observations of a patient that tend to be more detailed and subtle than those to which practitioners of orthodox western medicine are accustomed. TCM also tends to adopt a more holistic approach. The historic account of the development of veterinary acupuncture begins with a brief history of human acupuncture followed by a discussion of the history of veterinary acupuncture as it developed in China, and subsequently spread to Korea, Japan, Europe, North America, and elsewhere. The International Veterinary Acupuncture Society is mentioned with regard to its role in promoting and coordinating veterinary activities in countries outside Asia.
 
Experimental studies in animals and clinical studies in humans have demonstrated that acupuncture can exert significant effects on the cardiovascular system and provide effective therapy for a variety of cardiovascular ailments. In veterinary practice, acupuncture should be considered as adjunctive therapy in cases of shock and cardiac arrest. Acupuncture may also be beneficial as adjunctive or sole therapy in the management of congestive heart failure, arrhythmias, and systemic hypertension.
 
Acupuncture activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI-4, LI-11, ST-36, GB-39, SP-6, GV-14, BL-11, BL-20, BL-23, BL-24, BL-25, BL-26, BL-27, BL-28, and CV-12. Some, such as BL-47, are immunosuppressive. Antifebrile points include GV-14 and ST-36. Reactive reflex SHU points, MU points, and earpoints are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of acupuncture include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. Acupuncture therapy may inhibit neoplastic cells. Examples of acupuncture use in immunomediated conditions in small animals are given.
 
The use of acupuncture to treat reproductive disorders can produce excellent results. Two proposed physiologic mechanisms for its effects on the reproductive system include an endorphin-mediated mechanism affecting the hypothalamic-pituitary-gonadal endocrine axis and a direct effect on gonadal paracrine and autocrine control of steroidogenesis. This chapter discusses reproductive disorders from both western and traditional Chinese perspectives, and details the use of acupuncture for the treatment of eight specific categories of reproductive dysfunction.
 
Thoracolumbar disc disease (TLDD) and cervical disc disease (CDD) occur quite regularly in veterinary small animal practice, occurring predominantly in chondrodystrophic breeds and mostly around the age of 5-6 years. CDD is responsible for +/- 15% and TLDD for +/- 85% of disc herniations. Treatments may consist of surgery or medication or both. Acupuncture can also be used as a treatment for TLDD and CDD. With a few exceptions, the results of acupuncture treatment for TLDD and CDD are favorable and comparable to those of surgical treatments. The acupuncture techniques presented here are relatively simple and can be learned in a minimum of time.
 
Research has shown that the benefits of acupuncture are truth, not fiction. Acupuncture effects are due to local effects, stimulation of neuroendocrine systems, and modulation of the body's electromagnetic energy. The exact mechanisms activated depend on point selection, type of stimulation, and probably time of day. The effectiveness of the treatment will depend on the disease entity treated and the skill and knowledge of the acupuncturist. Knowledge should include both the fundamental principles of Chinese medicine and the more recent scientific understanding of acupuncture's physiologic basis.
 
Acupuncture is best known for its application to various musculoskeletal pain-producing diseases. Acupuncture is, however, used for a large variety of internal medical diseases in humans and other animals. This chapter reviews some of the published literature on the use of acupuncture in gastrointestinal (GI) diseases, describes acupuncture points useful for a variety of GI diseases, briefly reviews how traditional Chinese medicine (TCM) treats GI disease, and gives some case examples of how acupuncture can be used in GI diseases.
 
Acupuncture effectively enhances the treatment of chronic allergic bronchitis and asthma in the cat and dog. According to Traditional Chinese Medicine, chronic respiratory conditions can arise from lung, spleen/pancreas, liver or kidney deficiencies. Proper diagnosis is made from patient history, as well as examination of tongue and pulse. Acupuncture points are chosen according to involved energy pathways (meridians) and classical acupuncture combinations. In most cases, medication can be reduced as the acupuncture takes effect.
 
Acupuncture provides companion animal veterinarians a valid therapeutic alternative to medicine and surgery in a variety of neurologic disorders. The veterinarian must arrive at a lesion localization in the nervous system and determine a presumptive diagnosis before instituting acutherapy. Signalment, type of neurologic disorder, efficacy of conventional treatments versus acupuncture, financial constraints, and ethical issues are useful patient selection criteria. In general, animals experiencing pain respond faster and more completely to acupuncture than those demonstrating neurologic deficits consistent with loss of function. Acupuncture offers clients a noninvasive alternative when medications are contraindicated or surgery is not an option. This chapter serves as an introduction to acupuncture for neurologic disorders in pets. It is hoped that the information here will inspire clinical investigations to evaluate more completely patient selection, patient response, and long-term outcome.
 
Veterinary acupuncture is a useful therapeutic modality for treating dermatologic disease. The principles of TCM diagnosis can be applied to the animal patient, and acupuncture points chosen based on the cause and clinical manifestations of the disease.
 
Successful use of acupuncture in small animal practice on a day-to-day basis depends on an organized approach. The staff must be trained to answer telephone inquiries and client questions and to obtain a good history before appointments are scheduled. Colleagues must be ethically and professionally assured of a veterinarian's acupuncture credentials and capabilities, so that they will become a source of patient referrals. A proper examination must be conducted that incorporates traditional western veterinary practices with acupuncture, and the results must be properly recorded. A diagnosis should be established before therapy is initiated, and a plan of treatment set up. The prognosis, projected costs, length of treatment regimen, other means of treating the condition, and any possible sequelae should be discussed with the client. The patient should be monitored during the course of treatment, and reevaluated to determine whether or not changes in acupuncture prescription or additional modes of therapy or supportive care are needed. Communication with the client and the referring veterinarian should be a priority.
 
There are numerous medical and surgical approaches to canine and feline musculoskeletal disorders. Acupuncture was found to be beneficial in cases in which analgesics and anti-inflammatory medications have been ineffective or have demonstrated side effects, and in cases in which surgery was not recommended. It appears that acupuncture not only provides long-term analgesia but also increases circulation to the affected areas and decreases inflammation. Techniques and selection of appropriate acupuncture points depend on the condition treated.
 
A current review of ultrasonographic adrenal imaging is presented with emphasis on the clinical and problematic aspects of adrenal disease in the dog. Examples are presented to illustrate the usefulness of ultrasonography in distinguishing between canine pituitary- and adrenal-dependent hyperadrenocorticism. Adrenal imaging in the cat and ferret are discussed briefly. When coordination of sonographic findings with clinical and biochemical results is implemented properly, ultrasonography becomes a powerful and specific diagnostic tool for adrenal disease.
 
The most common form of lower airway disease (LAD) in dogs is chronic bronchitis, whereas in cats a syndrome resembling chronic bronchial asthma in humans is commonly reported. In most cases, the cause(s) of LAD remains unproven. The primary symptom of LAD in dogs and cats is chronic cough, although many cats are free of symptoms between episodes of acute, life-threatening bronchoconstriction. Diagnosis is based on a careful history, physical examination, and diagnostic tests designed to rule out other causes of cough and dyspnea such as pneumonia, heartworm infestation, and congestive heart failure. More sophisticated tests, such as bronchoscopy, flow volume loops, and radioisotope ventilation scans are available to define the extent of the disease process better. Glucocorticoids remain the mainstay of chronic therapy for most dogs and cats with LAD. Bronchodilators are indicated for most cats with symptoms of acute bronchoconstriction, whereas a smaller number of dogs may respond to bronchodilator administration and demonstrate an increase in exercise capacity and a decrease in cough frequency. LAD in dogs and cats is a progressive disorder, and prognosis is guarded. Nevertheless, with aggressive medical management many of these animals can live relatively symptom-free lives.
 
The conducting airways, also commonly referred to as the upper airways, provide for the passage of air to and from the atmosphere and lungs. Anatomical components include the nasal passages, pharynx, larynx, trachea, and mainstem bronchi. Clinical problems involving the conducting airways can be manifested by relatively mild clinical signs of stertorous breathing, by life-threatening dyspnea, or by chronic bouts of inspiratory stridor and cough. Concurrent disease of the lower respiratory system (ie, chronic bronchitis) as well as other organ systems (ie, cardiovascular, nervous, endocrine) may significantly contribute to the etiology and pathophysiology of upper airway disease. Diagnosis of the diseases of the conducting airways is primarily based on history and physical examination. The dynamic nature of some conditions, related to the phases of respiration, can make diagnosis more difficult. In addition to direct visualization, radiographic and endoscopic evaluation are often useful. Many upper airway problems, especially congenital conditions, lend themselves to surgical palliation that should be performed as early in life as possible. Medical management is often directed at treating underlying diseases and the relief of clinical signs. Historically, the use of variety of drugs have been advocated and frequently include decongestants, cough suppressants, bronchodilators, glucocorticoids, and antibiotics. However, their use may be detrimental and contraindicated. In addition, therapy for some conditions (ie, laryngeal paralysis and intrathoracic tracheal collapse) may be better directed at increasing airway muscle tone in order to stabilized airway patency. Therapeutic agents that may be useful include aspirin and digitalis. The overall objective to medical management must be to balance potential therapeutic benefit against untoward effects in order to minimize clinical signs and to improve the animal's quality of life.
 
This is a complex condition, recognized primarily in brachycephalic breeds, that results in varying degrees of upper airway obstruction. The signs consist of respiratory distress, stridor, reduced exercise tolerance, and in more severe cases, cyanosis and collapse. The inherent anatomy of the brachycephalic skull contributes to the development of these signs. Such anatomic features include: a shortened and distorted nasopharynx, stenotic nares, an elongated soft palate, and everted laryngeal saccules. The increased negative pressure created in the pharyngolaryngeal region, as a result of these obstructing structures, ultimately results in distortion and collapse of the arytenoid cartilages of the larynx.
 
Cats with lesions involving either the cerebral cortex or thalamus (forebrain) often have a characteristic group of neurologic deficits. When these deficits, in part or in toto, are recognized, consideration should be given to diseases that preferentially involve this area of the brain. Certain diseases that characteristically affect the forebrain are discussed here. Seizures are discussed as a separate entity at the conclusion of this chapter. Other diseases that also may involve the forebrain, but often cause additional lesions in other areas of the brain, are collectively discussed under the subheading of multifocal neurologic disease in Multiple Neurologic Deficits: Inflammatory Diseases (page 426) and Multiple Neurologic Deficits: Noninfectious Diseases (page 440).
 
Conventional adulticidal therapy may cause acute death due to embolism in major pulmonary arteries resulting in severe infarction of the lung. To avoid this problem removing a significant number of worms with flexible alligator forceps prior to adulticidal therapy is recommended. Before surgery, an accurate diagnosis and critical evaluation of the patient is mandated for proper choice and sequence of treatment.
 
Successful antimicrobial therapy for anaerobic infections is often difficult because selection of the wrong antimicrobial drug, the presence of mixed infections, the effect of environmental conditions on antimicrobial activity, and the development of bacterial resistance contribute to therapeutic failure. Drugs that are used for the treatment of anaerobic infections include the beta-lactam antibiotics (ie, penicillins, the carbampenams, and the cephalosporins), chloramphenicol, clindamycin, metronidazole, and vancomycin. The clinical pharmacology and bacterial resistance patterns of each of these drugs determines which should be used in specific clinical situations. The penicillins remain the drug of choice for most anaerobic infections. Piperacillin, cefoxitin, chloramphenicol, clindamycin, and metronidazole are the most effective antimicrobials for the treatment of resistant Bacteroides spp. Drugs that are effective against both aerobic and anaerobic organisms, and thus are indicated as sole drugs for the treatment of mixed infections, include piperacillin, imipenem, cefoxitin and in selected instances, chloramphenicol. Drugs that may need to be combined with antimicrobials effective against gram-negative aerobes are clindamycin, narrow spectrum penicillins, and metronidazole.
 
Anesthesia in patients for surgery of the head and neck should begin with evaluation of the animal's medical history, laboratory data, and physical examination. This information plus knowledge of the physiologic changes induced by abnormalities and surgery of the head and neck provide the basis for selection of anesthetic regimens and techniques. The regimen should include drugs that produce minimal impact on organ systems, especially those systems lacking physiologic reserve because of disease. Establishment of a patent airway, protection of the airway, and control of ventilation should receive primary attention. Monitoring and support of cardiopulmonary function and maintenance of fluid volume and renal function are essential. The patient should be observed until protective reflexes return and recovery is complete. Postoperative pain should be managed with analgesics.
 
Anesthesia for geriatric dental patients should begin with a preanesthetic evaluation of the animal, consisting of the medical history, a laboratory data survey, and a physical examination. This information plus knowledge of the physiologic changes induced by aging provide the basis for selection of anesthetics. The anesthetic regimen should include drugs that produce minimal impact on organ systems, especially those systems that may lack physiologic reserve in older animals. Protection of the airway and control of ventilation should receive primary attention. Regular monitoring and support of cardiopulmonary function are essential, and fluid volume and renal function should be maintained. The patient should be observed during recovery from anesthesia until protective reflexes return and recovery is complete. Analgesics should be used if postoperative pain is present.
 
Communicating with a client whose animal is afflicted with a chronic, incurable, but not-yet fatal illness is one of the most difficult human relations problems in veterinary medicine. A sudden and marked change occurs in the intensity and quality of the owner/patient bond. This necessitates establishing a new, and almost always less satisfying human/animal equilibrium. The practitioner not only plays a critical role in helping the owner cope with the conflicts of chronicity but must also grapple with his or her own frustrations surrounding the need to treat a known ill-fated patient. Techniques and strategies useful for dealing with all aspects of the management of the chronically ill patient are discussed.
 
Cardiac disease in companion animals constitutes a significant part of veterinary medicine. Because of the nature of the problems encountered, emotional problems in the owners can be expected to arise. The major difficulty in dealing with cardiac problems in small animals arises from the uncertainty of prognosis and the frequency of sudden death. This chapter reviews the most prevalent heart diseases seen in companion animals and offers ways of explaining to clients the disease process, different treatments available (and their side effects), and more importantly, prognosis. Many problems can be avoided if good client communications are established early in the course of therapy.
 
Respiratory dysfunction in a critically ill animal is a life-threatening complication that often presents a challenge to patient management. In the critical care setting, the most severe respiratory complications include nosocomial pneumonia, pulmonary thromboembolism (PTE), and acute respiratory distress syndrome (ARDS). Successful treatment of acute respiratory failure, although difficult, can be enhanced by recognition of predisposing factors, knowledge of underlying pathophysiologic mechanisms, and early prophylactic and therapeutic intervention.
 
Understanding companion animal behavior and treating behavior problems requires an appreciation of both the species-typical and individualistic nature of the behavior of dogs and cats, as well as people. Pet behavior problems are influenced by many factors, including genes, physiological processes and a myriad of environmental influences during the development of the pet throughout its life. Human behavior is influenced greatly by cognitive/linguistic capabilities unavailable to pets. Human anthropomorphism, egocentrism, and our tendency to attribute causality have surprisingly little effect on the development of major pet behavior problems but must be considered factors bearing on the successful treatment of these problems.
 
Appropriate communication with clients is essential when dealing with pets that have conditions associated with loss of autonomic function. These conditions include fecal and urinary incontinence, megaesophagus, and feline constipation. These conditions require a strong commitment to long-term caretaking with frequent frustrations on behalf of the client. Evaluation of the owner's personality types as well as the entire home situation is essential in assisting clients with their decision on how to deal with the problems. Each case should be evaluated based on multiple factors. Ideally, the veterinarian needs to go beyond offering medical advice and should help facilitate the decision-making process based on the ability of the client to deal with the care of a pet with a chronic problem. Different approaches to dealing with these often difficult situations will be discussed.
 
The historical changes in practitioner response to client emotions during a companion animal's illness are outlined. In the not too distant past, veterinarians, frustrated by lack of technical competence, ignored the emotional needs of clients. The 1970s witnessed the development of a concerted interest in resolving the lack of knowledge in the subject. The American Veterinary Medical Association and other professional organizations have disseminated proven insights into client emotions. Client sophistication, increased competition, and the threat of litigation have forced practitioners to understand and appreciate human psychologic needs. Major publishers and institutions have accepted the responsibility of making material available. In the final analysis, establishing rapport with clients will prove gratifying to the practitioner and will gain client loyalty.
 
The practice of veterinary oncology requires that attention be paid to both the medical and emotional needs of patients, clients, and staff members. In order to attend to these needs effectively, practice management goals for diagnosis, treatment, and euthanasia must be clearly established. Common medical and emotional issues pertinent to the practice of veterinary oncology are presented in this chapter. Hands-on information about what to say and what to do while dealing with these issues are detailed. After-care strategies for clients and staff are also included.
 
Clients' decisions are based on the veterinarian's ability to familiarize them with nervous system disease. Unfortunately, the nervous system does not lend itself to complete examination without advanced neurodiagnostic tests. These tests usually require general anesthesia, may be invasive, and often require advanced training. Therefore, a logical and orderly approach to animals with neurologic disease should be mastered. Problems can be avoided by educating the client about the extent of neurologic disease, the working diagnosis, pros and cons of diagnostic and therapeutic options, and a plan of action should unanticipated problems arise.
 
Bacteremias and septicemias are diagnostic and therapeutic challenges. Disseminated bacterial infections may be associated with a number of different conditions and can present with any of a wide variety of clinical signs. Additionally, they are often complicated by the adverse effects of an overzealous immune response in the patient. The most immediately severe and life threatening of these complications is septic shock, a frequent sequela to bacteremia characterized by endotoxin-producing gram-negative microorganisms. Infection with any of a large number of gram-positive or gram-negative aerobes or anaerobes is possible, as is mixed infection. Definitive diagnosis of bacteremia is by repeatable isolation of the pathogen(s) from culture of the patient's blood. Successful therapeutic outcome is dependent on early diagnosis and prompt treatment with a prolonged course of high doses of bactericidal antibiotics, facilitated by in vitro sensitivity testing.
 
An intersex animal is one possessing the characteristics of both sexes. Intersex animals, also called pseudohermaphrodites or hermaphrodites, are classified on the basis of their gonads. Pseudohermaphrodites possess the gonads of one sex but the secondary sex characteristics and external genitalia of the opposite sex. Female pseudohermaphrodites have ovaries but phenotypically have a masculine appearance. Male pseudohermaphrodites possess testes while having mixed or female external genitalia. Less common than pseudohermaphrodism is true hermaphrodism, wherein both testicular and ovarian tissue is present in various combinations. A testis may be found on one side in combination with an ovary on the contralateral side, an ovatestis (both testicular and ovarian tissue found in a single gonad) only may be present, or an ovatestis may be paired with a testis or ovary. Problems associated with intersex animals are not unique to intersexes but can be found in animals with normal chromosomal karyotypes. This chapter will review briefly the etiology of intersexuality and it will discuss the diagnosis and management of those problems associated with the intersex animal.
 
This chapter provides a brief but reasonably detailed group of well-defined but difficult problems (with their potential solutions) that are presented on a regular basis to veterinary practitioners. The author stresses that prior to instituting corrective measures there is a need for client education and communication. The potential for increased costs in meeting the needs of the patient and animal owner must be emphasized.
 
Free skin grafts are a useful adjunct to wound management in small animals. The indications for free skin grafts, the advantages and disadvantages of free skin grafts, and several case examples are presented in this section.
 
Injuries involving full-thickness skin wounds are common in large animals. Skin grafting can shorten the healing time and improve the cosmetic result. Techniques that have been used successfully in the management of full-thickness skin wounds include full-thickness skin grafts, split-thickness skin grafts, tunnel grafts, pinch/punch grafts, and immediate split-thickness skin grafts. The technical aspects of each of these procedures are detailed and representative cases are presented.
 
The objective when treating a patient with refractory epilepsy is to control the seizures without drug toxicity. This is accomplished in a stepwise fashion: 1) use a drug known to be effective in the species being treated, 2) verify that the owner is complying with the prescribed dosage regimen, 3) monitor serum drug levels with samples taken at trough blood concentrations, 4) observe for adverse drug reactions/interactions, and 5) test for metabolic or structural brain injuries that would explain the poor drug response. By following these steps and individualizing the treatment for each patient, you should be able to obtain seizure control in the majority of patients.
 
The pharmacology of anticonvulsant drugs is reviewed with emphasis placed on the treatment of canine and feline epilepsy. Due to pharmacokinetic reasons, only phenobarbital, primidone, and, with certain limitations, the benzodiazepines can be used in dogs. Bromides may be given additionally in cases that cannot be controlled with phenobarbital or promidone therapy. In cats, diazepam has been shown to be very useful because no tolerance develops to the antiepileptic effect in this species.
 
Certain principles and clinical techniques can be applied to antimicrobial therapy, whatever the specific circumstances. This review is intended to consider these general principles in the context of the decisions that must be made in order to apply antimicrobial therapy in veterinary patients. Attention is given to beneficial properties that contribute to action against bacterial infections, in both qualitative and quantitative terms. Selection of an antimicrobial is considered from the perspective of the laboratory test that can be used to support decisions. Finally, a structured and formal method for evaluating the overall decision making process is described.
 
The respiratory tract of small animals is exposed to a large number of potential pathogens. If endogenous defense mechanisms are not able to remove the invading microorganism, infection may result. The veterinarian must then determine if antimicrobial therapy is appropriate and, if so, which drug to use, at which dose, and for how long. This article discusses the therapeutic problems that arise when deciding on antimicrobial therapy in small animal respiratory disease.
 
The usefulness of antimicrobial drugs for prevention of certain infections has been well proven. The use of antibiotics during surgery, in order to prevent increased morbidity and expense associated with surgical infections, is a well accepted part of clinical practice. Experience with various techniques for their administration suggests that refinement in drug selection, dosage, and the timing of administration improves the efficacy of prophylactic antimicrobials. For surgical implants, nontraditional uses of antimicrobial drugs are probably indicated. Urinary tract infections can be postponed beyond the need for continued catheterization in certain patients by judicious application of antimicrobials. The purpose of this review is to summarize the accepted principles of antimicrobial prophylaxis and to examine specific therapeutic regimens used for the prevention of infections in surgical patients, those requiring chronic urinary catheterization, dental patients, and severely ill and immunocompromised patients.
 
Antimicrobials are a common part of a symptomatic approach to the treatment of gastrointestinal disorders. Without an etiologic diagnosis, antimicrobial therapy is likely to be of little value and, in the worst case, may harm the patient either by altering normal gastrointestinal flora or by producing direct toxicity. This review is a systematic appraisal of antimicrobial therapy for gastrointestinal disease, beginning with the oral cavity, proceeding through the gastrointestinal tract and concluding with pancreatic and hepatic disorders. The intent is to highlight specific etiologies which form the basis for rational therapeutic choices. Controversies concerning the need for antimicrobial therapy or therapeutic alternatives are also explored. The review concludes with a discussion of adverse gastrointestinal effects of antimicrobial therapy.
 
Top-cited authors
Luc Janssens
  • Ghent University
Cheryl S Hedlund
  • Iowa State University
Joe N Kornegay
  • Texas A&M University
Urs Giger
  • University of Pennsylvania
Philip Padrid
  • vcaantech