Sterile granulomatous panuveitis in dogs in the United Kingdom: A review of 33 cases.

PURPOSE: To describe the clinical and histopathological features of a sterile granulomatous panuveitis syndrome in 33 dogs that underwent enucleation and ocular histopathology. METHODS: Retrospective review of the medical records and ocular histopathology reports of 33 cases. Inclusion criteria were enucleation in conjunction with characteristic clinical and histopathological features. RESULTS: Thirteen breeds were represented (including crossbreeds). Panuveitis was acute and fulminating, and secondary glaucoma was common (n = 27). Interval from initial presentation to enucleation was 99 days (median 33 days, range 5-605 days). The mean age at enucleation was 6.7 years. Ocular signs were initially unilateral (n = 18) or bilateral (n = 15). The disease became bilateral in 18/25 cases that initially underwent unilateral enucleation, resulting in enucleation or euthanasia in 9/18 (mean interval of 168 days). Seven out of 59 eyes had a good outcome following topical anti-inflammatory and systemic immunosuppressive therapy. None of the dogs had travel history nor relevant systemic signs from presentation to follow-up (mean 619 days, range 16-3012 days). Histopathology revealed histiocytic and lymphoplasmacytic panuveitis with pigment dispersion, and no infectious agents were identified on light microscopy. CONCLUSION: To the authors' knowledge, this is the first report of a sterile granulomatous panuveitis syndrome in dogs in the UK. The clinical signs are severe, with rapid progression, and can result in bilateral enucleation or euthanasia in affected dogs. There does not appear to be an age or breed predisposition, however further research is necessary in this regard. Early and aggressive intervention, with both topical and systemic immunosuppressive therapy, is recommended to reduce the risk of blindness, enucleation, and euthanasia.

Keratomycosis in six horses in the United Kingdom.

Six horses with keratomycosis were examined and three different clinical expressions of the disease were recognised. The diagnostic work-up and response to treatment is described.

Maxillary bone epithelial cyst in a dog.

A swelling ventromedial to the left eye of a one-year-old, neutered male Labrador failed to respond to antibiotic and anti-inflammatory therapy. Plain and contrast radiography revealed a spherical, radiolucent area, 1.5 cm in diameter, dorsomedial to the fourth maxillary premolar and rostral to the ethmoid region. The lesion was thin-walled, with a smooth radiopaque margin, and was clearly demarcated from the surrounding structures. Dacryocystography demonstrated no apparent physical association between the lesion and the nasolacrimal duct, the latter appearing normal. Ultrasonography of the lesion showed a round, anechoic structure consistent with the appearance of a cyst. Prior to surgical excision of the lesion, intralesional fluid was aspirated. Bacteriology of the fluid was negative for both aerobic and anaerobic organisms. Cytological examination of the fluid showed a few macrophages and small lymphocytes; neither significant inflammatory component nor neoplastic cells were found. Histology showed the lesion to be a benign epithelial cyst. The dog recovered uneventfully and there was no clinical evidence of recurrence within a two-year follow-up period.

The use of porcine small intestinal submucosa in ten cases of feline corneal disease.

Porcine small intestinal submucosa (SIS) was used as a novel graft material in the management of 10 cases of feline corneal disease. Five cases had stromal ulceration associated with trauma, ocular foreign body and/or suspected infection and required a grafting procedure. Five cases had feline sequestra that were managed by a keratectomy prior to placement of SIS as a graft material. Eight eyes healed with minimal corneal scarring with a very good cosmetic and visual result. One eye with continued aqueous leakage in the immediate postoperative period required a conjunctival pedicle graft to reinforce the SIS graft site. One eye required enucleation 48 h following grafting due to progressive keratomalacia but the SIS material remained intact.

Pyogranulomatous blepharitis in two dogs.

Two cases of pyogranulomatous blepharitis (inflammation of the lid margins) in the dalmatian are described. The diagnosis was confirmed on biopsy of the lid lesions. Bacteriology performed in one case was negative. Both cases responded to treatment: one responded well to a course of systemic steroids (prednisolone 1 mg/kg at a decreasing dose over three weeks), while the other, which was negative on culture, responded to a six-week course of cephalexin (30 mg/kg twice daily). This second dog also presented with a localised lymphadenopathy; the owner had suffered a similar reaction three years previously as a result of a penetrating injury by a pyracantha thorn.

Self-expanding tracheobronchial stents in the management of major airway problems.

The management of patients with critical major airways obstruction has been made possible by the recent introduction of expandable metal stents as the sole treatment or as an adjunct to other treatment modalities, to alleviate the distressing symptoms from tracheobronchial obstructions Gianturco self-expanding stents were used successfully in the management of 27 patients. The indications were: stenosis from postoperative strictures and recurrent tumours (n = 6), extrinsic compression from metastatic disease (n = 9), inoperable primary tumours of central airways (n = 9), airway collapse from relapsing polychondritis (n = 1), excessive mediastinal shift following right pneumonectomy (n = 1) and endobronchial non-Hodgkin's lymphoma (n = 1). Twenty three patients had immediate relief of stridor and the remaining two patients were successfully weaned from ventilatory support. There were two postoperative deaths. The stents were inserted under general anaesthesia through a rigid bronchoscope under direct vision. The ease of insertion under radiological control, self-expanding nature of the stents and the lack of major complications on follow-up of up to 47 months are particular advantages. The self-expanding tracheobronchial stents are a useful addition to our armamentarium in maintenance of the airways in patients with major airway stenosis and collapse.

Gastric outlet obstruction of intrathoracic stomach.

Two rare cases of organic outlet obstruction of intrathoracic stomach following Ivor Lewis oesophagectomy are presented. Aetiology and the management of the same is discussed.

Efficacy of oxfendazole as administered by intraruminal injection to naturally infected calves.

Oxfendazole, formulated into a 22.5% suspension, was administered by intraruminal injection to cattle at the rates of 0, 1.125, 2.25, 4.50, and 6.75 mg/kg of body weight. In total, 50 naturally infected calves were used, with 10 animals being allocated to each of the 5 treatment groups on the basis of pretreatment counts of nematode eggs per gram of feces. All animals were necropsied 7 days after treatment. The trial was done between December 1983 and January 1984, with the animals kept on concrete for a minimum of 35 days immediately before necropsy. For all nematodes and stages combined, efficacies were 97.4%, 98.8%, 99.5%, and 99.8% for oxfendazole at dosages of 1.125, 2.25, 4.50, and 6.75 mg/kg of body weight, respectively. Early 4th-stage larvae of Ostertagia and Nematodirus helvetianus adults were eliminated at rates greater than 93% only at the dosages of 4.50 mg/kg and above. Local or systemic adverse reactions were not observed in any of the animals.

Efficacy of morantel against nematode populations in calves exposed on a pasture stocked for two years with morantel sustained-release bolus-treated calves.

Two groups of 10 parasite-free calves were maintained either for 2 weeks on a pasture grazed by nonmedicated cattle (pasture A) or for 3 weeks on a pasture grazed by morantel sustained-release bolus-treated cattle (pasture B) for the preceding 2 years. After a 4-week holding period to allow for maturation of acquired gastrointestinal nematodes, 5 calves from each group were administered a therapeutic dose (10 mg/kg of body weight) of morantel tartrate. All calves were necropsied 1 week later, and the abomasal and small intestinal nematodes were isolated, identified, and enumerated. A comparison of efficacies between nonmedicated and morantel tartrate-treated calves of each pasture demonstrated that morantel was equally effective against the gastrointestinal nematode infections, regardless of infection source (ie, pasture A vs pasture B). The overall nematode reductions due to morantel tartrate treatment of calves that grazed pastures A and B were 98% and 96%, respectively. It was concluded that the sensitivity of gastrointestinal nematodes to morantel tartrate was not diminished in calves maintained on pasture B, which had been stocked with morantel sustained-release bolus-treated calves for the preceding 2 grazing seasons.

Effect of the morantel sustained-release bolus, used during one grazing season, on the sensitivity of Ostertagia and Cooperia to morantel tartrate in calves.

Infective 3rd-stage larvae of Ostertagia and Cooperia, obtained from the feces of nonmedicated and morantel sustained-release bolus (MSRB)-treated calves, were orally administered to 2 groups of parasite-free calves. After a 42-day maturation period, a therapeutic dose of morantel tartrate was administered to half of the calves from each group. All calves were necropsied 7 days after treatment. After comparing the nematode counts for the nonmedicated and morantel-treated calves of each group, morantel tartrate was demonstrated to be equally effective against the nonmedicated-derived and MSRB-derived nematode populations. The sensitivity of Ostertagia spp and Cooperia spp to morantel tartrate, therefore, was not diminished after use of the MSRB for a single grazing season.

Contrasts in the professional identities of psychiatrists and internists.

Projected manpower shortages in psychiatry have prompted studies identifying factors that influence medical students in career choice. In the present study, the authors compare self-images as individuals with professional images of psychiatrists using subjects from internal medicine as a control group. A total of 353 subjects from two university clinical practices completed questionnaires that utilized the Osgood Semantic Differential to determine attitudes in the areas of evaluation, potency, and activity. The hypothesis that psychiatrists differ significantly in their self-images as individuals and their professional role images was partially confirmed. In the areas of activity and power, significant (p less than .001) differences existed in their attitudes. In the concept of evaluation, the self-images and the professional images were similar. The impact of these discrepancies on students making career choices is discussed.

Diabetic hyperglycemia and glycosuria as a manifestation of bulimia.

This is the first reported case of insulin dose manipulation as a manifestation of bulimia. The patient was diabetic, with fluctuations in control. Despite the guarded prognosis in bulimia, the patient's diabetic control improved with psychotherapy.

Distorted learning from unusual medical anecdotes.

Doctors are encouraged to look upon each patient as a learning experience ( Wyngaarden , 1979). Case-oriented learning begins in the clinical years of medical school and continues throughout the professional career of the doctor. Clinical cases, or anecdotes, have the potential of producing accurate, relevant and meaningful learning for the clinician even though they are uncontrolled in a scientific sense. However, unusual or atypical cases can also result in erroneous learning which can negatively affect patient care. The purpose of this article is to identify difficulties in this form of subjective learning which can lead to suboptimal doctor practice patterns. Six actual clinical cases are briefly described to illustrate how inaccurate learning distorted subsequent clinical problem-solving by doctors. Suggestions are then made for ameliorating this difficulty.

Dementia in elderly outpatients: a prospective study.

We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing features of reversible dementia were shorter duration, use of more prescription drugs, and less severe dementia. Almost half of the patients had other previously unrecognized treatable medical diseases. Most diagnoses were made from patient history and physical and mental status examination. Patients with reversible dementia improved but rarely reverted to normal. Objective improvement occurred in 25 patients after treating unrecognized coexistent medical and psychiatric diseases, or stopping unnecessary medication. Careful clinical observation is the most useful part of the evaluation and extensive testing may not be required for all patients. Overemphasis on distinguishing reversible from irreversible forms of dementia may detract from recognition of commoner, treatable causes of dysfunction and suffering.