Ocular injuries in people with multiple trauma.

About 8% of all major trauma patients have eye injuries, which can have serious implications for the patients and their families. This article outlines a practical approach to the recognition, assessment and management in emergency departments of common ocular traumatic injuries. It also provides an overview of the applied anatomy, and discusses common complications.

Serum pancreatic lipase immunoreactivity in sick dogs after chronic administration of supraphysiologic doses of glucocorticoids.

BACKGROUND: Glucocorticoids (GC) are commonly used for a long term to treat a multitude of immune-mediated, inflammatory, and neoplastic diseases in dogs. Conflicting results of published studies on the effects of exogenous and endogenous GCs on serum canine pancreatic lipase immunoreactivity (cPLI) raise the question of whether cPLI concentrations can be reliably interpreted in patients receiving GCs. OBJECTIVE: We sought to determine the effect of long-term GC administration at supraphysiologic doses on serum cPLI concentrations in sick dogs. METHODS: Serum samples were collected from 35 client-owned dogs. Dogs were administered prednisone at a dose of ≥0.5 mg/kg per day for ≥3 weeks. Serum cPLI was measured prior to the initiation and after ≥3 weeks of GC therapy. RESULTS: There was a significant increase in serum cPLI between baseline (median 101 µg/L; range 30-1997 µg/L) and following the administration of ≥0.5 mg/kg/day of prednisone (median 173 µg/L; range 30-2000 µg/L) in dogs (P = 0.025). However, the median change was small (31 µg/L). There was no suspicion of pancreatitis in any of the dogs. Diagnostic interpretation changed in 6/35 dogs, with no apparent dose-response relationship. CONCLUSIONS: There was a statistically significant difference from baseline in serum cPLI measurements in sick dogs receiving long-term prednisone. Although the change was small and often clinically insignificant, it could pose a clinical interpretation dilemma in some dogs. It is unknown whether these observations are coincidental due to subclinical pancreatitis or caused by another effect of GCs on pancreatic acinar cells.

Comprehensive comparison of upper and lower endoscopic small intestinal biopsy in cats with chronic enteropathy.

BACKGROUND: Integrating immunohistochemistry (IHC) and clonality testing with histopathology may improve the ability to differentiate inflammatory bowel disease (IBD) and alimentary small cell lymphoma (LSA) in cats. HYPOTHESIS/OBJECTIVES: To evaluate the utility of histopathology, IHC, and clonality testing to differentiate between IBD and LSA and agreement of diagnostic results for endoscopic biopsy (EB) samples from the upper (USI) and lower small intestine (LSI). ANIMALS: Fifty-seven cats with IBD or LSA. METHODS: All cases were categorized as definitive IBD (DefIBD), possible LSA (PossLSA), probable LSA (ProbLSA), or definitive LSA (DefLSA) based on histopathology alone. Results from IHC and clonality testing were integrated. RESULTS: Based on histopathology alone, 24/57 (42.1%), 15/57 (26.3%), and 18/57 (31.6%) cats were diagnosed with DefIBD, PossLSA or ProbLSA, and DefLSA, respectively. After integrating IHC and clonality testing, 11/24 cases (45.8%) and 15/15 cases (100%) previously categorized as DefIBD and PossLSA or ProbLSA, respectively, were reclassified as LSA. A final diagnosis of IBD and LSA was reported in 13/57 (22.8%) and 44/57 (77.2%) cats, respectively. Agreement between USI and LSI samples was moderate based on histopathology alone (κ = 0.66) and after integrating IHC and clonality testing (κ = 0.70). However, only 1/44 (2.3%) of the LSA cases was diagnosed based on LSI biopsy alone. CONCLUSIONS AND CLINICAL IMPORTANCE: Integrating IHC and clonality testing increased the number of cases diagnosed with LSA, but the consequence for patient outcome is unclear. There was moderate agreement between USI and LSI samples. Samples from the LSI rarely changed the diagnosis.