Aicardi syndrome: a case report.

BACKGROUND: Aicardi Syndrome is an X-linked autosomal recessive neurodegenerative encephalopathy. The diagnostic triad is composed by infantile spasms, agenesis of corpus callosum and chorioretinal lacunae. Additional common findings are: microencephaly, spasticity and severe mental delay. It affects only females because of early embryonic lethality in males. A significant number of females with Aicardi syndrome are of normal birth and develop normally until three months of age when infantile seizures begin. Psychomotor retardation is usually severe, neuromotor retardation is commonly present with lack of motor and language skills. Literature reports only few information about the dentofacial features of the syndrome. CASE REPORT: We present the case of a patient, by describing the dental and facial characteristics with focus on dental prevention in order to avoid dental pain and the risks connected to general anaesthesia, and ultimately for improving the quality of life.

Rapid palatal expansion in patients with craniosynostosis: a case report.

The craniosynostoses represent a group of pathologies characterised by the premature fusion (during prenatal or perinatal stages or early infancy) of one or more of the cranial sutures. Its genetic origins are not completely clear although mutations in the genes that code for fibroblast growth factor receptors have been described; depending upon the gene involved, the type of mutation and the embryological period in which the mutation itself occurs, a type of craniosynostosis arises that may involve one or more cranial sutures. The premature fusion results in a lack of growth in the regions corresponding to the cranial vaults, with compensatory growth occurring in other regions and the consequent deformation of the skull. Here, a case report is presented of a Caucasian male child affected by craniostenosis of the sagittal suture with a orthodontic-orthopedic diagnosed ogival palate and insufficient space for the eruption of the superior canines. The patient was treated by fitting a rapid palatal protractor, an orthopedic device that acts upon the median palatine suture of the palate increasing the transverse diameter of the upper jaw and causes the widening and lowering of the floor of the nasal cavity. The results obtained were equivalent to those obtained in subjects with no past medical history of craniosynostosis. This clinical study demonstrated that the premature fusion of the mid-sagittal suture of the skull, that characterises sagittal craniosynostoses, can occur without the involvement of the median suture of the palate, rendering expansion possible by means of orthopedic treatment.

Dental features in patients with Turner syndrome.

AIM: This was to investigate the dental characteristics (caries sensitivity and tooth crown size of permanent elements) in subjects affected by Turner Syndrome (TS). PATIENTS AND METHODS: A group of 25 patients affected by TS, aged from 4 to 18 years, was selected and the data were compared to those of an age matched control healthy group. The caries index values in TS patients are higher in the permanent (6.4 vs. 3.9), mixed (0.5 vs. 0.75) and primary dentition (0 vs. 1). The mesio-distal diameter in TS patients was significantly reduced for every tooth measured (in particular for the lower first permanent molar). RESULTS AND CONCLUSION: This investigation confirms that numeric aberration of the X chromosome most likely affects the quantitative and qualitative excretion of amelogenin so that teeth often present enamel defects (reduced crown size and enamel hypoplasia). High caries index values (DMFT) highlight the demand of early preventive measures mostly focused on special care patients.

Comparison of histamine release induced by morphine and oxymorphone administration in dogs.

Cardiovascular effects (vasodilatation, hypotension) of morphine administration have been attributed to central actions and peripheral histamine release. In the study reported here, we compared plasma histamine (Hm) concentrations after morphine sulfate and oxymorphone HCl administration in conscious dogs. Five healthy adult dogs (mean body weight, 10.1 kg) were randomly administered morphine (2 mg/kg of body weight, IV) or oxymorphone (0.2 mg/kg, IV) by a 5-second bolus injection at weekly intervals. Venous blood samples (5 ml) were collected from jugular veins before and at 1, 2, 5, 15, 30, and 60 minutes after drug administration. Behavioral changes were recorded. Plasma was analyzed by a radioenzymatic technique, using purified histamine N-methyltransferase as an enzyme catalyst (sensitivity of assay, 40 pg Hm/ml). Mean base-line Hm value for all dogs was 0.55 ng/ml. The mean Hm value was significantly higher (P less than 0.05) than the base-line value at 1, 2, 5, 15, and 60 minutes after morphine administration (531.4, 251.0, 113.0, 31.5, and 1.0 ng of Hm/ml, respectively), but there were no significant increases in histamine values from base-line values at any time after oxymorphone administration. All dogs given morphine and 1 dog given oxymorphone showed excitatory behavior; 2 dogs given morphine and 3 dogs given oxymorphone salivated profusely.

Xylazine hydrochloride-ketamine hydrochloride immobilization of wolves and its antagonism by tolazoline hydrochloride.

Fourteen wolves (Canis lupus L.) were singularly or repeatedly immobilized with 30 mg xylazine hydrochloride (HCl) and 400 mg ketamine HCl. Mean induction time was 5.3 +/- 4.6 min (mean +/- SD). Administration of 8.0 mg/kg tolazoline HCl as an antagonist significantly reduced immobilization times from 148.0 +/- 52.7 to 47.9 +/- 8.9 min (F = 63.69, df = 1,17, P less than 0.05). The average times from injection to ambulation for 2.0, 4.0, and 8.0 mg/kg tolazoline HCl were 35.2 +/- 31.8, 18.5 +/- 11.7, and 10.2 +/- 9.1 min. Tolazoline HCl increased heart rates significantly (P less than 0.001) from 75 +/- 14 to 120 +/- 23 beats/min, reversing a xylazine HCl-induced bradycardia. Respiratory rates also increased significantly (P less than 0.01) after tolazoline HCl injection from 19 +/- 7 to 28 +/- 8 breaths/min. Immobilization resulted in an initial hypertension which was normalized after tolazoline HCl administration. One female wolf had a single sinoatrial block within 1 min of receiving tolazoline HCl. Tolazoline HCl appears to be an effective antagonist for xylazine HCl-ketamine HCl immobilization of wolves.

Cardiovascular and behavioral responses of gray wolves to ketamine-xylazine immobilization and antagonism by yohimbine.

Adult wolves (Canis lupus) were immobilized with 6.6 mg/kg ketamine hydrochloride (KET) and 2.2 mg/kg xylazine hydrochloride (XYL) administered intramuscularly. Induction time was 4.6 +/- 0.3 min (mean +/- SE). Immobilization resulted in significant bradycardia and hypertension (P less than 0.05). Twenty min after induction, the wolves were given 0.05-0.60 mg/kg yohimbine hydrochloride (YOH). Yohimbine given intravenously produced dose-related increases in heart rate (HR) with doses greater than 0.15 mg/kg resulting in extreme tachycardia (greater than 300 bpm). All doses of YOH caused a temporary decrease in mean arterial blood pressure (MABP) with some individual animals manifesting profound hypotension (less than 30 torr) at doses greater than 0.15 mg/kg. Increasing the dose of YOH above 0.15 mg/kg did not significantly decrease either arousal or ambulation times. Administering YOH at 40 or 60 min after induction resulted in decreased arousal and ambulation times. Stimulation by weighing and taking repeated blood samples during anesthesia did not shorten arousal times. We recommend that wolves immobilized with XYL-KET be antagonized with doses of YOH less than 0.15 mg/kg.

Surgical techniques for neutering 6- to 14-week-old kittens.

Ninety-six kittens (48 males and 48 females) between the ages of 6 and 14 weeks were neutered. There were no important anesthetic complications, or complications during or after surgery. Pediatric neutering of kittens is a low-risk procedure when specific guidelines are followed. It is recommended that a complete preanesthetic evaluation be performed, a quiet and warm preoperative and postoperative environment be provided, handling of kittens be minimized, bleeding during surgery be meticulously controlled, fragile pediatric tissues be handled gently, kittens be offered food shortly after standing to prevent hypoglycemia, and dextrose be administered PO or IV if recovery is prolonged.

Anesthetic techniques for neutering 6- to 14-week-old kittens.

Forty-eight male and 48 female 6- to 14-week-old kittens were neutered by use of 4 anesthetic protocols. Preanesthetic disposition, depth of sedation, loss of resistance to handling, induction quality, induction time, sternal and stand times, and recovery quality were evaluated. Analgesia and muscle relaxation without supplemental inhalational anesthetics were evaluated in male kittens, and the time until extubation was recorded in female kittens. Intramuscular administration of tiletamine/zolazepam (TZ), midazolam/ketamine, atropine/midazolam/ketamine/butorphanol (AMKB), and atropine/midazolam/ketamine/oxymorphone (AMKO) produced rapid sedation and smooth induction into anesthesia. In male kittens, there were no significant differences in sedation, relaxation, induction time, or quality. Tiletamine/zolazepam administration induced the best analgesia, and midazolam/ketamine administration induced the least analgesia for castration. The recovery time in male kittens was longest with TZ and shortest with the opioid groups (AMKB, AMKO). In females, TZ produced significantly faster induction times, but the degree of sedation and relaxation after administration of injectable agents was not significantly different among the groups. More females given TZ could be intubated without supplemental inhalational agents than females in other groups. Extubation time was rapid in all groups, but the times until sternal and standing were significantly longer, and recovery quality was significantly poorer in females given TZ. In kittens given opioids, reversal of the opioid did not shorten recovery time or improve recovery quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of anesthetic protocols for neutering 6- to 14-week-old pups.

Ninety-nine 6- to 14-week-old pups were given anesthetic agents according to 10 anesthetic protocols. Mean quality rating scores were determined to compare anesthetic protocols. In male pups, IV administration of propofol (6.5 mg/kg of body weight) 15 minutes after IM administration of atropine (0.04 mg/kg) and oxymorphone (0.22 mg/kg) provided the best quality anesthesia. Intramuscular administration of midazolam (0.22 mg/kg) and butorphanol (0.44 mg/kg) instead of oxymorphone provided little sedation, but induced good analgesia. Atropine/oxymorphone/midazolam/xylazine, atropine/butorphanol/midazolam/xylazine, and tiletamine/zolazepam were unsatisfactory combinations for use in castration of 6- to 14-week-old male pups. In female pups, IV administration of propofol (3.4 mg/kg) 15 minutes after IM administration of atropine (0.04 mg/kg) and oxymorphone (0.11 mg/kg) was the most effective anesthetic protocol. Administration of the drugs according to this protocol enabled a pup to be intubated. Anesthesia was maintained with isoflurane in oxygen. If inhalational induction was preferred, IM administration of 13.2 mg of tiletamine/zolazepam/kg, 0.04 mg of atropine/kg and 0.11 mg of oxymorphone/kg, or 0.22 mg of midazolam/kg and 0.44 mg of butorphanol/kg may be used prior to mask delivery of inhalational anesthetics. In female pups, it was not advantageous to combine midazolam with oxymorphone, and use of high dosages of oxymorphone (0.22 mg/kg) or midazolam/butorphanol provided little sedation. Time of recovery after use of tiletamine/zolazepam was the longest for the combinations used, but did not adversely affect pups. Male pups were castrated via scrotal incisions, using hemostatic clips. Ovariohysterectomies were performed via a ventral abdominal midline approach, using hemostatic clips for ligation, five females developed signs of inflammation at the surgical site within 1 to 2 weeks after surgical, and were treated conservatively with warm compresses.

Hypercalcemia associated with rodenticide poisoning in three cats.

Hypercalcemia (12.0 to 18.3 mg/dl) was detected in 3 cats that had eaten a rodenticide that contained cholecalciferol. Clinical signs included lethargy, anorexia, vomiting, and polydipsia. Treatment with furosemide and fluids administered IV resulted in normalization of the serum calcium concentration and in remission of the clinical signs in 2 cats. One cat with a serum calcium concentration of 18.3 mg/dl did not have clinical signs, was not treated, and was reportedly normal 9 months after initial examination. We attributed the uniformly favorable outcome of exposure to the rodenticide in these cats to the small quantity of the toxin ingested.

Use of orally administered succimer (meso-2,3-dimercaptosuccinic acid) for treatment of lead poisoning in dogs.

OBJECTIVE: To determine whether succimer (meso-2,3-dimercaptosuccinic acid) would be effective in reducing blood lead concentration in dogs with naturally acquired lead poisoning and whether treated dogs would develop clinically important adverse effects. DESIGN: Prospective case series. ANIMALS: 13 dogs with moderate-to-high blood lead concentrations (39 to 120 micrograms/dl) and clinical signs of lead poisoning. PROCEDURE: Dogs were treated with succimer (10 mg/kg of body weight, PO, q 8 h) for 10 days. Blood and urine samples were analyzed for lead concentration before, during, and after treatment with succimer. RESULTS: Mean blood lead concentrations on days 0, 3, 7, and 20 were 70.6, 32.7, 16.8, and 27.6 micrograms/dl, respectively. Mean blood lead concentrations decreased 53.6, 76.2, and 60.9% from pretreatment value on days 3, 7, and 20, respectively. Mean urine lead concentrations on days 0, 3, 7, and 20 were 70.0, 485.4, 254.3, and 28.3 micrograms/dl, respectively. CLINICAL IMPLICATIONS: In dogs with naturally acquired lead poisoning, succimer administered orally for 10 days effectively reduced blood lead concentrations and eliminated clinical signs of lead poisoning.

First aid, transport, and triage.

A favorable outcome for a patient suffering acute trauma or disease is more likely if prehospital first aid can be administered. Veterinary facilities should teach their clients about first aid and transport and be able to give instructions over the telephone. Once a patient arrives at a veterinary facility, the entire staff should be prepared so that triage, the primary survey, resuscitation and stabilization, and the secondary survey may be performed efficiently and effectively.

Anesthetic management of thoracotomy.

Successful anesthesia for thoracic surgery requires an understanding of the clinical disease and the physiologic changes accompanying the disease, as well as anesthetic agents available for use. The authors discuss selection of appropriate anesthetic drugs, perioperative management considerations, pharmacologic support, intraoperative monitoring and postoperative pain management.

Management of pain in the critically ill patient.

In spite of growing evidence that effective pain management of critically ill human beings decreases their morbidity and mortality, pain is often undertreated in critically ill animals. Reasons for withholding analgesics in these animals have included fear of contributing to cardiopulmonary instability and difficulty in monitoring response to therapy. Appropriately used, analgesics improve the status of critically ill animals. Opioids are the most widely used analgesics but other options exist. Newer methods of analgesic administration include continuous infusions, epidural, local, regional, and transdermal administration.