The prognostic value of the Koret CT score in dogs following traumatic brain injury.

Traumatic brain injury (TBI) is a common condition in veterinary medicine with relatively high mortality rate. Recently, a study that correlated abnormal computed tomography (CT) findings with outcome in dogs with head trauma established a prognostic scoring system termed Koret CT score (KCTS). The purpose of this study was to evaluate the accuracy of the KCTS in making short- and long-term prognosis in dogs presented within 72 h of TBI. Thirty-five dogs that were admitted to a hospital during 2010-2019 with TBI and were CT-scanned within 72 h of injury were included in the study. Retrospectively collected data included signalment, modified Glasgow Coma Scale score (MGCS), CT findings, and outcome, i.e. short-term (defined as 10 days) and long-term (6 months) survival. CT images were reviewed and the KCTS was calculated for all dogs. Association between KCTS and outcome was examined. A significant negative association was found between KCTS and both short- and long-term survival. The area under receiver operating characteristic curve for KCTS for short- and long-term survival was 0.9 and 0.87, respectively. Furthermore, the probability of survival in the short term was predicated by the KCTS in an almost linear fashion and a score of 3 points or less on the KCTS was associated with survival with 85% sensitivity and 100% specificity. These results validate the prognostic value of the KCTS in dogs with TBI and provide a complementary tool for serial clinical and neurological evaluation.

Advantages of the prone Lachman versus the traditional Lachman.

Clinical examination of the knee to determine the presence of ACL injury presents a challenge to many clinicians. The prone Lachman test offers many advantages in enhancing patient relaxation, improving psychomotor proficiency, and improving the clinician's interpretation of the results.

Oral vancomycin-induced rash: case report and review of the literature.

Disseminated rash and pruritus are described in an 82-year-old woman with chronic renal failure following administration of oral vancomycin hydrochloride 125 mg q6h for the treatment of Clostridium difficile colitis. Renal function was estimated to be 0.27 mL/s based on a serum creatinine of 177 mumol/L. After eight days of therapy, she developed a slightly raised maculopapular rash on her legs and torso, which spread to her abdomen and arms with continued treatment. Vancomycin was discontinued and the patient was treated symptomatically. The rash cleared and did not recur. Rechallenge with vancomycin was not initiated. No other changes in medications or initiations of new medications occurred during the time of treatment with vancomycin. The patient denied any previous immunologically mediated reactions to medications. Maculopapular rash is rare secondary to vancomycin administration, particularly after oral administration. Although clinically significant serum concentrations can be obtained in patients treated with oral vancomycin who have concomitant C. difficile colitis and renal failure, there has not been a clear correlation between these concentrations and any reported adverse sequelae. This case supports the possible occurrence of a true allergic reaction secondary to low-dose oral vancomycin administration.

Plasma glucocorticoid and circulating blood leukocyte responses in cattle after sequential intramuscular injections of ACTH.

Nine Holstein-Friesian cows in the same stage of lactation were randomly given IM injections of saline solution, 100 IU of ACTH, or 200 IU of ACTH for a period of 3 days at 0800 and 1600 hours on one day and at 0100 hours the next day. A dose of 100 IU of ACTH represented the amount of ACTH released during physiologic stress and 200 IU of ACTH represented a therapeutic dose. Blood samples were obtained from indwelling jugular catheters for total circulating leukocyte and total plasma corticosteroid determinations at -1, 0, 0.25, 0.50, 1, 1.50, 2, 4, 6, and 8 hours after the 0800-hour ACTH injections. Concentrations of blood leukocytes and total plasma corticosteroids were affected significantly (P < 0.05) by treatment, cow within treatment, day of injection, treatment by day interaction, time, treatment by time interaction, and day by time interaction. Total plasma corticosteroids were 5.6 ng/ml (saline), 38.9 ng/ml (100 IU of ACTH), and 59.8 ng/ml (200 IU of ACTH). Mean corticosteroid concentrations from 0.5 to 8 hours were 29.2 ng/ml on day 1, 42.5 ng/ml on day 2, and 32.7 ng/ml on day 3. Blood leukocytes were 8,545 cells/mm3 (saline, 11,241 cells/mm3 (100 IU of ACTH) and 9,777 cells/mm3 (200 IU of ACTH). When compared with basal circulating leukocyte concentrations (within cow), this represented increases of 20.7% for 100 IU of ACTH and 24.5% for 200 IU. Mean circulating leukocyte concentrations from 0.5 to 8 hours were 8,900 cells/mm3 on day 1, 10,500 cells/mm3 on day 2, and 10,000 cells/mm3 on day 3. These data indicate that the adrenal gland responded less on day 3 and that continuous stimulation of bovine adrenal glands by ACTH at physiologic and therapeutic concentration could lead to reduced synthesis or release of adrenal corticosteroids (or both) with concomitant reduction in the concentration of total circulating leukocytes.