DEGENERATIVE CARDIAC DISEASE IN TWO SPECIES OF TORTOISE (CHELONOIDIS NIGRA COMPLEX, CENTROCHELYS SULCATA).

Cardiac lesions in tortoises are incompletely described in the literature. This retrospective case series includes 11 cases of degenerative cardiac disease in young tortoises from two species in human care: Galápagos tortoise complex (Chelonoidis nigra complex) (n = 9) and sulcata tortoises (Centrochelys sulcata) (n = 2). Eight tortoises were male, two were female, and sex was undetermined for one individual. The age range at the time of death was 10-32 yr with a mean of 19 yr. The most common clinical signs noted prior to death were peripheral edema, lethargy, and inappetence. Common necropsy findings included generalized edema and pericardial effusion. All cases had ventricular myocardial fibrosis and several cases had epicardial adhesions. Additional common findings included hepatic lesions (hepatic lipidosis, hepatic fibrosis, and hepatitis) and pulmonary lesions (pulmonary edema, pulmonary fibrosis, and pneumocytic hypertrophy). A definitive cause for degenerative cardiac disease was not identified in this case series, but the young age distribution of the tortoises suggests that inappropriate environmental parameters, husbandry, and diet should be investigated as possible underlying contributing factors.

Forehead Movement Discrepancies After Botulinum Toxin Injections: A Review of Etiology, Correction, and Prevention.

BACKGROUND: Forehead rhytides are a popular target for botulinum toxin injections, but neuromodulation of the frontalis can be fraught with complications because of its anatomic complexity and integral role in brow position and expressivity. OBJECTIVE: This article explores common forehead movement discrepancies that can occur after neuromodulation of the frontalis, as well as how to correct and prevent them. METHODS: A review of the literature was conducted and combined with clinical experience to examine underlying forehead anatomy, etiology and correction of forehead movement discrepancies, and important factors to consider before injecting the frontalis with botulinum toxin. RESULTS AND CONCLUSION: Variable anatomy from person to person necessitates an individualized treatment approach to achieve the best cosmetic results and prevent the occurrence of forehead movement discrepancies.

VALIDATION OF CHEMILUMINESCENT ASSAY FOR CANINE THYROID STIMULATING HORMONE IN RED PANDAS (AILURUS FULGENS FULGENS).

Thyroid abnormalities have been anecdotally reported in red pandas (Ailurus fulgens fulgens); however, definitive diagnosis is hampered by a lack of established reference ranges and validated diagnostic tests. The chemiluminescent assay for canine thyroid stimulating hormone (cTSH) has been validated for use in domestic canids and felids. This study aims to validate the cTSH assay for use in red pandas. Validation was performed via serial dilutions of banked serum samples (n = 15) and both inter- and intra-assay testing. High estimated recoveries and low coefficients of variability indicate that the cTSH assay accurately and consistently measures TSH concentrations in red panda serum. Further studies to generate red panda age and sex TSH reference ranges are indicated.

Regional Anesthesia of the Dentition in Bennett's Wallaby (Macropus rufogriseus): Anatomical Landmarks and Approaches Assessed with Computed Tomography and Gross Dissection.

Dental disease is common in captive-managed macropods, including Bennett's wallabies, and is a significant cause of morbidity and mortality. Dental extractions and debridement of diseased tissue is often necessary for those undergoing treatment for severe dental disease. Regional anesthesia of the dentition is considered standard of care for domestic animals undergoing orofacial surgery, however, it is not routinely performed in macropods due to limited information on dental anatomy and block approaches. Regional block descriptions for the infraorbital, maxillary, inferior alveolar, and mental blocks in domestic dogs and cats were evaluated and adapted for use in Bennett's wallabies based on descriptions of their anatomy and examination of 2 skulls. These approaches were then performed on cadaver heads with iohexol and methylene blue dye, and block placement was assessed on computed tomography scans and by gross dissection. All block approaches described in this study resulted in appropriate placement of regional anesthesia of the dentition in Bennett's wallabies. They can thus be used by clinicians to improve the intra and postoperative pain control of patients and provide a high level of veterinary care.

Soft tissue sarcomas in 2 zoo-housed Alaskan moose.

Soft tissue sarcomas (STSs) are common well-described cutaneous neoplasms in many domestic species. Few cutaneous neoplasms have been reported in cervids, other than papilloma virus-induced benign cutaneous fibromas (BCFs). Two wild-caught Alaskan moose (Alces alces), housed at different North American zoos, were both presented with lameness and a mass. The gross appearance of each mass varied greatly; case 1 had a distinct, exophytic, ulcerated mass near the right carpal joint similar in appearance to a BCF, and case 2 had a pronounced swelling over the left hip. Based on histologic evaluation, both masses were diagnosed as STS. The clinical presentation of these masses included rapid growth and associated lameness; however, gross appearance was markedly different. Histopathology revealed characteristics typical of STS in other species, including spindle-shaped cells arranged in streaming sheets with ovoid nuclei. STS should be included as a differential diagnosis for moose with a cutaneous or subcutaneous soft tissue mass or swelling.

Lip Measurements and Preferences in Asians and Hispanics: A Brief Review.

Objective: Most literature regarding lip augmentation refers to Caucasian anthropometric measurements, but ethnic differences affect facial dimensions and the evaluation of beauty. Specifically with regard to Asians and Hispanics, dermatology does not have much literature on the subject. This review investigates the differences in lip measurements and preferences of Asians and Hispanics compared with those of Caucasians. Design: A literature search of other fields, including plastic surgery, maxillofacial surgery, orthodontics, and forensic anthropology, was conducted, and relevant articles were selected that applied to the discussion of lip measurements and preferences in Asians and Hispanics. Results: Lip measurements do appear to differ between Asians, Hispanics, and Caucasians, and ethnic background appears to influence lip preferences. Conclusions: It is inappropriate to use Caucasian measurements and generalizations in lip preferences when determining what is "ideal" when aesthetically augmenting lips among Asians and Hispanics. Ultimately, it is important to take into account the goals, anatomy, and ethnic background of each individual patient before performing lip augmentation.

Inter-individual Relationships between Sympathetic Arterial Baroreflex Function and Cerebral Perfusion Control in Healthy Males.

Maintenance of adequate cerebral perfusion during normal physiological challenges requires integration between cerebral blood flow (CBF) and systemic blood pressure control mechanisms. Previous studies have shown that cardiac baroreflex sensitivity (BRS) is inversely related to some measures of cerebral autoregulation. However, interactions between the sympathetic arterial baroreflex and cerebral perfusion control mechanisms have not been explored. To determine the nature and magnitude of these interactions we measured R-R interval, blood pressure, CBF velocity, and muscle sympathetic nerve activity (MSNA) in 11 healthy young males. Sympathetic BRS was estimated using modified Oxford method as the relationship between beat-to-beat diastolic blood pressure (DBP) and MSNA. Integrated control of CBF was quantified using transfer function analysis (TFA) metrics derived during rest and Tieck's autoregulatory index following bilateral thigh cuff deflation. Sympathetic BRS during modified Oxford trials was significantly related to autoregulatory index (r = 0.64, p = 0.03). Sympathetic BRS during spontaneous baseline was significantly related to transfer function gain (r = -0.74, p = 0.01). A more negative value for sympathetic BRS indicates more effective arterial baroreflex regulation, and a lower transfer function gain reflects greater cerebral autoregulation. Therefore, these findings indicate that males with attenuated CBF regulation have greater sympathetic BRS (and vice versa), consistent with compensatory interactions between blood pressure and cerebral perfusion control mechanisms.

Increased mortality in women: sex differences in burn outcomes.

BACKGROUND: There is increasing evidence that sex differences may influence responses after thermal injury and affect clinical outcomes. The objective of this study was to evaluate the relationships between sex, thermal injury, body size, and inpatient mortality in burn patients. METHODS: Medical records of adults with >20% total body surface area (TBSA) burn injury admitted to two American Burn Association (ABA)-verified burn centers between 2008 and 2014 were retrospectively reviewed. Injury details and baseline characteristics, including body size as estimated by body surface area (BSA) and body mass index (BMI) were recorded, along with details of the hospital course. The primary outcome of inpatient mortality was compared between sexes. RESULTS: Out of 334 subjects, 60 were women (18%). Median TBSA was 33% (IQR 25-49) in this cohort, with 19% full thickness burns and 30% inhalation injury. Despite no significant difference in age, presence of inhalation injury, TBSA, or depth of burn, women had significantly higher rates of inpatient mortality (45 vs. 29%, P = 0.01). BSA was significantly lower in women vs. men (P < 0.001), but this difference was not more pronounced among non-survivors. There was no difference in BMI between men and women non-survivors. Although not significant (P = 0.28), women succumbed to their injuries sooner than men (day 4 vs. 10 post-injury). CONCLUSIONS: Women are less likely to survive burn injuries and die sooner than men with similar injuries. Body size does not appear to modulate this effect. Burn centers should be aware of the higher mortality risk in women with large burns.