Paraneoplastic hypercalcemia in a canine patient with a mandibular salivary carcinoma.

OBJECTIVE: To describe a novel presentation of paraneoplastic hypercalcemia caused by a canine salivary carcinoma. ANIMAL: A 6-year-old intact male Husky with hypercalcemia and a spontaneous salivary carcinoma, stage III. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The dog presented with polyuria, polydipsia, and hypercalcemia. Physical examination revealed a 37 X 43-mm firm mass in the ventrolateral aspect of the right-hand side of the neck, caudal to the temporomandibular joint. Incisional biopsy was suspicious of metastatic carcinoma to the mandibular lymph node. A full-body CT scan found a large, heterogenous, contrast-enhancing mass on the right ventrolateral neck that appeared to be originating from either the mandibular lymph node or right mandibular salivary gland. Parathyroid hormone-related protein was considered within normal reference intervals, and both parathyroid glands appeared ultrasonographically normal. TREATMENT AND OUTCOME: The patient was treated with a marginal surgical excision of the mass, without immediate complications. Histopathology confirmed the presence of a salivary carcinoma with narrow margins of excision and invasion of the mandibular lymph node. Twenty-four hours after surgery, ionized calcium returned to normal reference values and clinical signs completely resolved. CLINICAL RELEVANCE: Hypercalcemia is an urgent pathology with important systemic implications requiring prompt diagnosis and intervention. In this case report, we identify the first salivary carcinoma associated with a paraneoplastic hypercalcemia, including this pathology as a new differential diagnosis. The hypercalcemia resolved with marginal surgical excision, but interestingly the parathyroid hormone-related protein was not overexpressed, meaning that this neoplasia could mediate hypercalcemia by another pathophysiological mechanism.

Successful surgical management of an Escherichia coli epidural-subdural abscess secondary to sino-rhinotomy.

OBJECTIVE: To describe a case of successful management of epidural-subdural abscess and severe meningitis with secondary brain herniation in a dog. CASE SUMMARY: A rhino-sinusotomy was performed in a 3-year-old mixed-breed dog for management of refractory sinonasal aspergillosis. Initial recovery was good, but the dog became acutely stuporous 36 hours after surgery. Evidence of increased intracranial pressure with brain herniation and midline shift secondary to an epidural abscess was observed on magnetic resonance imaging. Decompressive craniectomy and drainage of the abscess was performed. Intensive nursing care and physiologic support was performed with consciousness returning 7 days after initial stupor. The dog was discharged 14 days after craniectomy and was ambulatory with support. NEW/UNIQUE INFORMATION PROVIDED: Intracranial abscesses are rarely described in dogs and few had a successful outcome reported. All previous reports have been of brain abscesses or empyema, rather than a combination of epidural and subdural abscessation. Additionally, the process of sino-rhinotomy for management of aspergillosis has not been previously linked to intracranial abscess formation. To the authors' knowledge, this is the first report of successful management of an epidural-subdural abscess and suggests that even with cases with low modified Glasgow Coma Scale scores outcome may be positive.

Disagreement and aggression in the operating theatre.

AIM: This paper is a report of a study to determine the national spread of incidents of disagreement within and between professional groups in operating departments and the frequency of perceived aggressive behaviour demonstrated by operating department personnel. BACKGROUND: There is both anecdotal and empirical evidence supporting the idea of the operating team as the ultimate example of teamworking in health care. At the same time, international concern is expressed over the level of interprofessional conflict and aggression reported in operating departments. Such reports do not sit well with notions of excellence in teamwork as conceptualized by theorists. METHOD: A questionnaire survey was designed, and sent to a random sample of National Health Service operating departments in England (n = 62) in 2002. Usable survey questionnaires were returned from 37 departments (response rate 59.6) and yielded 391 individual responses. Respondents included nurses (58%, n = 227), surgeons (9.7%, n = 38), anaesthetists (14.32%, n = 56) and operating department practitioners (17.9%, n = 70) of all grades. FINDINGS: Half of the respondents reported experiencing aggressive behaviour from consultant surgeons (53.4%, n = 209). Daily disagreements between nurses and consultants about list management were reported. Perceptions of lack of understanding of roles and shared goals for patient care between the professional groups were also reported. Similar reports were received from all geographical locations in the sample. CONCLUSION: Further research is needed to conceptualize the complex nature of interprofessional working in operating theatres before steps can be taken to develop a less stressful and more efficient working environment.

Assessment of the influence of surgical technique on postoperative pain and wound tenderness in cats following ovariohysterectomy.

Elective ovariohysterectomy was performed on 66 cats. Surgical approach was flank (group F) or midline (group M) allocated by block randomisation. Pre-anaesthetic medication was acepromazine (0.1 mg/kg) via intramuscular injection. Anaesthesia was induced with intravenous thiopentone, and maintained with halothane in 100% oxygen. Carprofen (4 mg/kg) was administered by the subcutaneous route immediately after induction of anaesthesia. Postoperative pain and wound tenderness were assessed at 1, 3, 6, 9, 11-12 and 20-24h after the end of surgery, and the assessment outcome marked on visual analogue scales (VAS). Intervention analgesia (if pain VAS was >40 mm) was pethidine 4 mg/kg via intramuscular injection. Area under the curve (AUC) for VAS for pain and VAS for wound tenderness for each cat were calculated. AUC for wound tenderness was significantly greater for group F (P = 0.007). There was no significant difference for AUC for pain between the groups. In conclusion, wounds after flank ovariohysterectomy are significantly more tender than after midline ovariohysterectomy in the cat. This indicates that interactive methods, including wound palpation, must be used to assess postoperative pain and the findings should be appropriately weighted in the overall assessment.

Acid-base and electrolyte abnormalities in dogs with gastrointestinal foreign bodies.

Gastrointestinal foreign bodies occur commonly in dogs. The objective of the study was to describe the acid-base and electrolyte abnormalities identified in dogs with gastrointestinal foreign bodies and determine if these abnormalities are related to the site or type of foreign body present. Medical records of 138 dogs were reviewed, and information on signalment, initial venous electrolyte and acid-base values, surgical findings, relevant historical information, imaging modalities used, cost of hospital visit, intra- or postoperative complications, and survival was obtained. The site of the foreign body was recorded in 94.9% of cases and the most common site was the stomach (50%), followed by the jejunum (27.5%). The foreign bodies were linear in 36.2% of cases. The most common electrolyte and acid-base abnormalities regardless of the site or type of foreign body were hypochloremia (51.2%), metabolic alkalosis (45.2%), hypokalemia (25%), and hyponatremia (20.5%). No significant association was found between electrolyte or acid-base abnormalities and the site of foreign body. Linear, as opposed to discrete, foreign bodies were more likely to be associated with a low serum sodium concentration (odds ratio, 0.85; 95% confidence interval, 0.75-0.95). Hyperlactatemia (> 2.4 mmol/L) was seen in 40.5% of dogs. A wide variety of electrolyte and acid-base derangements are found in dogs with gastrointestinal foreign bodies. Hypochloremia and metabolic alkalosis are common in these dogs. Hypochloremic, hypokalemic metabolic alkalosis is seen with both proximal and distal gastrointestinal foreign bodies.

Host-specific cues cause differential attractiveness of Kenyan men to the African malaria vector Anopheles gambiae.

BACKGROUND: Many studies have suggested that variability in the attractiveness of humans to host-seeking mosquitoes is caused by differences in the make-up of body emanations, and olfactory signals in particular. Most investigations have either been laboratory-based, utilising odour obtained from sections of the body, or have been done in the field with sampling methods that do not discriminate between visual, physical and chemical cues of the host. Accordingly, evidence for differential attractiveness based on body emanations remains sparse in spite of the far-reaching epidemiological implications of this phenomenon. METHODS: A new three-port olfactometer that accommodates complete human beings as sources of host-seeking stimuli was used to study behavioural responses of Anopheles gambiae Giles sensu stricto (hereafter An. gambiae) under semi-field conditions in western Kenya. Differential attractiveness of nine male Kenyans was assessed by simultaneously exposing the mosquitoes to (a mixture of) total body emanations of 3 people occupying separate tents. Controls (empty tents) were included and the effect of residual odours following tent occupation was also examined. RESULTS: Trap catches increased significantly (P < 0.001) when a tent was occupied. Based on 'competition' experiments, the nine persons were classified into least, medium and most attractive groups. There was no significant interaction between person and trap (P = 0.302) or person and test period (P = 0.223). Presence (P < 0.001) or absence (P = 0.949) of significant differences in the number of mosquitoes caught per trap when tents were simultaneously occupied by one person in each or left empty, respectively, demonstrated that residual odours following tent occupation did not affect behavioural responses of the mosquitoes. CONCLUSION: We provide evidence that in the vicinity of humans, when exposed to a blend of physical and olfactory signals from more than one host, An. gambiae can effectively and consistently express host-selection behaviour that results in non-random biting.