首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献，搜索用时 46 毫秒
1.
Objective – To review the human and veterinary literature on the pathophysiology of myasthenia gravis (MG) and describe treatment options for clinical use in people and animals. Data Sources – Human and veterinary clinical reports, studies and reviews, textbooks, and recent research findings in MG from 1996 present, with a focus on treatment and patient management. Human Data Synthesis – MG is a well‐described condition in people with new research and treatment options available. Many of the newest therapeutic options available in veterinary medicine for MG are based on current strategies used in people with this condition. Seronegative MG is well described in people and provides insight to clinical cases encountered in veterinary medicine when the index of suspicion is high though serologic tests are negative. Veterinary Data Synthesis – Previous studies in veterinary medicine focused on the use of acetylcholinesterase inhibitors as the main form of treatment in canine MG. Recent studies, mainly case series and case reports, emphasize the use of immunomodulatory treatments as an alternative for long‐term treatment. However, there are no randomized, controlled studies on treatment with immunomodulatory therapy for MG in dogs available to assess the efficacy of this treatment strategy. Conclusions – Although early recognition of clinical signs is most important in the outcome of patients with MG, further understanding the pathophysiology of MG may lead to earlier diagnosis and novel treatment strategies. The discovery of additional autoantibodies against striated muscle proteins in dogs, should enhance our understanding of diseases affecting the neuromuscular junction. In addition, clinical data for canine MG could be applied to other autoimmune disorders.  相似文献   

2.
Although the exact incidence of pulmonary thromboembolism (PTE) in small animals is unknown, it is thought that PTE is a substantial, under-diagnosed complication. The difficulty in diagnosing PTE in small animals is confounded by its subtle symptomatic presentation and a lack of clinical suspicion, coexisting disease states, and lack of noninvasive tests that are sensitive and specific for the diagnosis of PTE. Although numerous laboratory markers of coagulation have been studied, only the D-dimer assay has shown clinical utility in detecting early embolism in humans. This paper examines the use of D-dimer assays and other clinical modalities in the diagnostic approach to thromboembolic disease in small animals.  相似文献   

3.
Background – To review the physics of helium with regard to airway physiology, as well as known human and potential veterinary applications of administration of inhaled helium‐oxygen gas‐carrier mixture (heliox). Data Sources – Human and veterinary studies. Human Data Synthesis – Helium‐oxygen mixtures have been used in human medicine for over 70 years as an adjunct therapy in various upper and lower respiratory disorders. Helium's low density promotes laminar flow through partially obstructed airways, resulting in a decreased work of breathing. Veterinary Data Synthesis – Little to no evidence‐based medicine exists to support or oppose the use of heliox in veterinary species. However, domestic animal species and humans share several common pathophysiologic aspects of various obstructive airway disorders. Thus, veterinary patients may also ultimately and significantly benefit from this novel therapy. Conclusion – Prospective studies are needed in veterinary medicine to determine the utility of heliox in clinical scenarios.  相似文献   

4.
Objective – To review the use of IV lipid emulsion (ILE) for the treatment of toxicities related to fat‐soluble agents; evaluate current human and veterinary literature; and to provide proposed guidelines for the use of this emerging therapy in veterinary medicine and toxicology. Data Sources – Human and veterinary medical literature. Human Data Synthesis – Human data are composed mostly of case reports describing the response to treatment with ILE as variant from mild improvement to complete resolution of clinical signs, which is suspected to be due to the variability of lipid solubility of the drugs. The use of ILE therapy has been advocated as an antidote in cases of local anesthetic and other lipophilic drug toxicoses, particularly in the face of cardiopulmonary arrest and unsuccessful cardiopulmonary cerebral resuscitation. Veterinary Data Synthesis – The use of ILE therapy in veterinary medicine has recently been advocated by animal poison control centers for toxicoses associated with fat‐soluble agents, but there are only few clinical reports documenting successful use of this therapy. Evidence for the use of ILE in both human and veterinary medicine is composed primarily from experimental animal data. Conclusions – The use of ILE appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses. Adverse events associated with ILE in veterinary medicine are rare and anecdotal. Standard resuscitation protocols should be exhausted before considering this therapy and the potential side effects should be evaluated before administration of ILE as a potential antidote in cases of lipophilic drug toxicoses. Further research is waranted.  相似文献   

5.
Objective – To review the evolution of and controversies associated with allogenic blood transfusion in critically ill patients. Data sources – Veterinary and human literature review. Human Data Synthesis – RBC transfusion practices for ICU patients have come under scrutiny in the last 2 decades. Human trials have demonstrated relative tolerance to severe, euvolemic anemia and a significant outcome advantage following implementation of more restricted transfusion therapy. Investigators question the ability of RBCs stored longer than 2 weeks to improve tissue oxygenation, and theorize that both age and proinflammatory or immunomodulating effects of transfused cells may limit efficacy and contribute to increased patient morbidity and mortality. Also controversial is the ability of pre‐ and post‐storage leukoreduction of RBCs to mitigate adverse transfusion‐related events. Veterinary Data Synthesis – While there are several studies evaluating the transfusion trigger, the RBC storage lesion and transfusion‐related immunomodulation in experimental animal models, there is little research pertaining to clinical veterinary patients. Conclusions – RBC transfusion is unequivocally indicated for treatment of anemic hypoxia. However, critical hemoglobin or Hct below which all critically ill patients require transfusion has not been established and there are inherent risks associated with allogenic blood transfusion. Clinical trials designed to evaluate the effects of RBC age and leukoreduction on veterinary patient outcome are warranted. Implementation of evidence‐based transfusion guidelines and consideration of alternatives to allogenic blood transfusion are advisable.  相似文献   

6.
Objectives – To introduce the basic equipment necessary to perform interventional radiology (IR) techniques in the veterinary setting, particularly those procedures of interest to the criticalist. Data Sources – Veterinary and human literature as well as author's experience. Human Data Synthesis – Since the 1950s, diagnostic angiography has played an important role in human medicine. However, over the last 2–3 decades, this once purely diagnostic modality has become a subspecialty in human medicine with vast applications throughout the body. These techniques have replaced more invasive surgeries as the standard‐of‐care in many circumstances. Veterinary Data Synthesis – Although comparable data are not available in the veterinary literature, many IR and interventional endoscopy techniques are poised to replace more invasive procedures in veterinary medicine. In addition, these techniques have already been shown to offer treatment options for patients in whom more traditional therapies have failed, have been declined, or are not indicated due to comorbidities or substantial risk to patient health. Conclusions – Like our human medical counterparts, the use of IR techniques will likely play and increasingly important role in the care of veterinary patients. With this in mind, it is important to become familiar with both the equipment used in these techniques as well as their applications both currently in clinical cases and in the near future.  相似文献   

7.
Objective – Review the mechanisms of action and clinical application of hyperbaric oxygen therapy (HBOT) based on human and veterinary clinical and experimental literature. Data Sources – Pubmed and Veterinary Information Network databases were searched for human and veterinary journal articles on hyperbaric therapy in clinically applicable situations. Historical reference searches on several articles in addition to basic physiologic concepts were also reviewed. Human Data Synthesis – HBOT has gained acceptance as an adjunctive treatment in clinical conditions other than diving‐related injuries, such as select problem wounds and central nervous system diseases, in human medicine. Access to hyperbaric therapy has increased and ongoing research has furthered understanding of the mechanisms and potential therapeutic uses of HBOT. Veterinary Data Synthesis – Several animal models have been utilized to examine the effects of HBOT; primarily rodents (mice, rats) and rabbits but also dogs, cats, and pigs. Data related to animal model research as it pertains to clinical application of HBOT is reviewed. Conclusions – There is a substantial body of literature that has examined the adverse and beneficial effects of HBOT in animal models. As technology becomes more readily available to clinical practice and more clinical trials are performed to define its effectiveness, HBOT may be considered as an additional therapeutic option in many conditions including select problem wounds, spinal cord injury, and cerebral ischemic injury. Understanding the mechanisms by which HBOT exerts its effects will help guide research and use of the modality in clinical patients.  相似文献   

8.
Objective – To review the human and veterinary literature regarding the neurophysiology of dyspnea and to provide evidence for the beneficial effects of several novel therapies aimed at the alleviation of dyspneic sensations. Data Sources – Data sources included scientific reviews, case reports, original research publications, and recent research conference proceedings. Human Data Synthesis – The use of blood oxygenation level‐dependent functional magnetic resonance imaging technology has revealed that the brain regions activated by air hunger in humans are also those activated by fear, pain, and thirst perception. In human subjects, it has been found that agents known to enhance the firing of pulmonary slowly adapting receptors (SARs) can alleviate the sensation of dyspnea without altering central respiratory drive. Several small studies have also shown that nebulized opioids can reduce the sensation of dyspnea apparently via activation of peripheral opioid receptors in the lung. Veterinary Data Synthesis – There are several animal models relevant to both small and large animal clinical patient populations. Treatment of rats with a nebulized SAR sensitizing agent (furosemide) enhances SAR firing in response to lung inflation. Behavioral escape responses to airway occlusion are reduced in lightly anesthetized cats when treated with nebulized furosemide. Opioid agonists have been shown to inhibit the release of acetylcholine and other mediators from the airways of dogs and guinea pigs. Studies using a goat model with bilateral destruction of the pre‐Bötzinger Complex do not support current paradigms of air hunger origination. Conclusions – Veterinary patients may benefit from an approach to dyspnea that incorporates an understanding of the origins of the unpleasant sensations associated with the condition. Several novel therapies have shown promise in alleviating dyspneic sensations without altering respiratory drive. Further study is needed to determine the safety and efficacy of these therapies in veterinary patients.  相似文献   

9.
Pulmonary Thromboembolism in Dogs   总被引：1，自引：1，他引：0  
Pulmonary thromboembolism (PTE) is an infrequently diagnosed complication of many systemic diseases including heartworm disease, glomerulopathy leading to the nephrotic syndrome, immune-mediated hemolytic anemia, hyperadrenocorticism, pancreatitis, neoplasia, and sepsis. Acute, unexplained dyspnea in a patient with minimal abnormalities on thoracic radiographs should prompt consideration of this diagnosis. Confirmation requires ventilation-perfusion radionuclide scanning or selective pulmonary angiography. Treatment includes cage rest, anticoagulant therapy with heparin and warfarin, correction of the underlying disorder, and supportive care. Clinicians should be prepared to treat hemorrhage associated with anticoagulant therapy. Recombinant tissue plasminogen activator may prove useful as a thrombolytic in the treatment of animals suffering massive PTE, but is, at present, expensive.  相似文献   

10.
Objective – To review the human and veterinary literature on histamine physiology and pathophysiology and potential applications for clinical use in veterinary critical care. Data Sources – Human and veterinary clinical studies, reviews, texts, and recent research in histamine receptor and antagonist therapy. Human Data Synthesis – Recent progress in molecular biology has led to a more complete understanding of the enzymes involved in histamine metabolism and histamine receptor physiology. The past decade of research has confirmed the role of histamine in the classical functions (contraction of smooth muscle, increase in vascular permeability, and stimulation of gastric acid secretion) and has also elucidated newer ones that are now under investigation. Data on the roles of histamine in angiogenesis, circadian rhythm, bone marrow regeneration, bacterial eradication, and cancer are emerging in the literature. Newer histamine antagonists are currently in drug trials and are expected to advance the clinical field in treatment of allergic, gastrointestinal, and cognitive disorders. Veterinary Data Synthesis – Veterinary histamine research is directed at identifying the effects of certain pharmacological agents on blood histamine concentrations and establishing the relevance in clinical disease states. Research demonstrates important species differences in regards to histamine receptor physiology and tissue response. Studies in the area of trauma, sepsis, anaphylaxis, allergy, and gastrointestinal disorders have direct applications to clinical veterinary medicine. Conclusions – Histamine plays a key role in the morbidity and mortality associated with allergy, asthma, gastric ulcers, anaphylaxis, sepsis, hemorrhagic shock, anesthesia, surgery, cardiovascular disease, cancer, CNS disorders, and immune‐mediated disease. Histamine antagonism has been in common use to block its adverse effects. With recent advances in the understanding of histamine receptor physiology, pharmaceutical agents targeting these receptors have increased the therapeutic options.  相似文献   

11.
Objective – Review the historical development and physiologic principles of hyperbaric oxygen therapy (HBOT) based on human and veterinary experimental literature and current equipment in use. Data Sources – Review of basic physiologic concepts. Data from human and veterinary journals were reviewed through Pubmed and Veterinary Information Network database searches as well as reference searches on several articles covering hyperbaric therapy in clinically applicable situations. Human Data Synthesis – HBOT has been gaining acceptance as an adjunctive treatment in human medicine. The understanding of the physiology and application of hyperbaric therapy is increasing through ongoing research and greater access to hyperbaric equipment. Veterinary Data Synthesis – Several animal models have been utilized to examine the effects of HBOT. Most models utilize dogs and rats but pigs, cats, and other species have been studied. Conclusions – Hyperbaric therapy utilizes several physiologic principles of how gases respond under pressure and more specifically of how oxygen responds under pressure. The increase in concentration of oxygen in solution, based on its solubility under pressure, increases the diffusion gradient for its delivery deeper into tissues, which is the premise of HBOT. Ultimately the increases in dissolved oxygen generated by hyperbaric therapy have several physiologic effects that can alter tissue responses to disease and injury. As this technology becomes more available to clinical practice, HBOT should be considered as a therapeutic option.  相似文献   

12.
Objective – To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources – Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis – Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid‐resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion – Vasopressin (0.01–0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2–0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow.  相似文献   

13.
This study was performed to characterize pulmonary embolism with computed tomography pulmonary angiography in experimental pulmonary embolism and heartworm infected dogs. In the experimental group, there were pulmonary changes after pulmonary embolism induction as follows: hypoattenuating round filling defects in pulmonary arteries, arterial dilations with straight and abrupt cut‐off appearances in the pulmonary embolism regions, pulmonary infarctions, a cavity formation and spontaneous pneumothorax, and emboli migration. In the heartworm‐infected group, three out of eight dogs developed pulmonary embolism, especially in the right caudal arteries. Arterial dilations with typical tortuosity were also identified, mainly in the right caudal arteries in five dogs. Computed tomography pulmonary angiography can be an important imaging modality in the diagnosis of pulmonary embolism and the evaluation of pulmonary arterial and parenchymal changes in dogs.  相似文献   

14.
Two domestic shorthair cats, a 6-month-old castrated male and a 7-month-old intact female, were diagnosed with complex congenital heart disease. Transthoracic echocardiography in both cats revealed a dilated arterial trunk overriding the interventricular septum with a large ventricular septal defect. The pulmonary trunk and branch pulmonary arteries were not visible using standard echocardiographic views in either cat. The differential diagnosis for both cats included truncus arteriosus communis vs. pulmonary atresia with ventricular septal defect. Each cat underwent computed tomography angiography to determine the origin and extent of the pulmonary blood supply and to better define extra-cardiac anatomy. Computed tomography angiography led to a diagnosis of truncus arteriosus communis with unrestricted pulmonary blood flow in one cat, whereas the other cat was diagnosed with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals serving as the primary source of pulmonary blood flow. Computed tomography angiography allowed for the ante mortem differentiation of truncus arteriosus communis from pulmonary atresia with ventricular septal defect in these two cats, leading to an accurate diagnosis and providing valuable information to therapeutic decision-making for each case.  相似文献   

15.
Objective – To review the human and veterinary literature on the biology of apoptosis in health and disease. Data Sources – Data were examined from the human and veterinary literature identified through Pubmed and references listed in appropriate articles pertaining to apoptosis. Human Data Synthesis – The role of apoptosis in health and disease is a rapidly growing area of research in human medicine. Apoptosis has been identified as a component of human autoimmune diseases, Alzheimer's disease, cancer, and sepsis. Veterinary Data Synthesis – Research data available from the veterinary literature pertaining to apoptosis and its role in diseases of small animal species is still in its infancy. The majority of veterinary studies focus on oncologic therapy. Most of the basic science and human clinical research studies use human blood and tissue samples and murine models. The results from these studies may be applicable to small animal species. Conclusions – Apoptosis is the complex physiologic process of programmed cell death. The pathophysiology of apoptosis and disease is only now being closely evaluated in human medicine. Knowledge of the physiologic mechanisms by which tissues regulate their size and composition is leading researchers to investigate the role of apoptosis in human diseases such as cancer, autoimmune disease and sepsis. Because it is a multifaceted process, apoptosis is difficult to target or manipulate therapeutically. Future studies may reveal methods to regulate or manipulate apoptosis and improve patient outcome.  相似文献   

16.
Objective – To review the immunomodulatory effects of opioids. Data Sources – Original research publications and review articles using the PubMed search engine with the following keywords – opioids, morphine, immuomodulation, and immunosuppression. Veterinary and Human Data Synthesis – Opioids have been shown to modulate the immune system in animal models by affecting both the acquired and innate arms of the immune system. Natural killer cell activity, T‐cell proliferation, antibody production, phagocytic cell function, and cytokine production have all been shown to be affected by opioids. Many of these effects are reversed by opioid antagonists. Opioids have also been shown to induce sepsis in laboratory animals. Opioid administration alters immune parameters in healthy humans at analgesic doses and may increase the risk of infection in some patient populations. Conclusions – While opioids remain the most powerful and widely used analgesics available, their negative effects on the immune system are well established in the laboratory setting. Thoughtful consideration should be given to the use of certain opioids in critically ill patients, especially those with pre‐existing immunocompromise.  相似文献   

17.
A 5‐year‐old spayed female English Bulldog was evaluated for acute anorexia, lethargy, respiratory distress, and syncope. Contrast‐enhanced computed tomography revealed the vascular malformation of azygous continuation of the caudal vena cava with extensive thrombus formation and pulmonary arterial thromboembolic disease. The patient was hospitalized for supportive treatment and was prescribed long‐term clopidogrel therapy. The patient survived to discharge and at last follow‐up remained clinically stable. While this vascular malformation has been reported in canines, to the authors’ knowledge, this is the first reported case of pulmonary thromboembolic disease in a canine concurrent with this condition.  相似文献   

18.
Objective – To describe and review both traditional and newer diagnostic and therapeutic options for canine and feline ureteral obstructions currently being performed clinically in veterinary medicine. Data Sources – A Medline search with no date restrictions was used for this review. Human Data Synthesis – The human literature would support the use of minimally invasive endourological techniques for the treatment of nearly all causes of ureteral obstructions, whenever possible. This typically includes extracorporeal shockwave lithotripsy, intracorporeal lithotripsy via retrograde ureteroscopy or antegrade percutaneous nephroureterolithotomy, ureteral stenting, percutaneous nephrostomy tube placement, and laparoscopic endopyelotomy. Typically open surgery is only suggested in cases of ureteral or gynecological malignancy when en bloc resection is considered a good option, or when various methods of endourological techniques have failed. Veterinary Data Synthesis – The veterinary literature is scarce on the use of interventional endourological techniques for the treatment of ureteral obstructions and has been growing over the last 5 years. The current literature reports the use of extracorporeal shockwave lithotripsy for ureteral stones, as well as the use of ureteral stents for the treatment of trigonal obstructive transitional cell carcinoma, ureterolithiasis, and ureteral strictures. Traditional surgical interventions, like ureterotomy, ureteronephrectomy, and ureteral reimplantation is more vastly reported and accepted. This review will focus on new clinical data using interventional endourological techniques for ureteral obstructions. Conclusions – Various treatment options for ureteral obstructions are now available for veterinary patients, and the trend away from traditional surgical techniques will hopefully be followed now that they are technically and clinically available for dogs and cats.  相似文献   

19.
Objective: To review the thrombolytic agents most commonly used in humans, their mechanisms of action, potential uses, adverse effects, and reports of their use in dogs and cats.
Human data synthesis: Thrombolytic agents avaliable in human medicine include streptokinase, urokinase, tissueplasminogen activator (t-PA), single-chain urokinase plasma activator (scu-PA) and anisoylated plasminogen-strep-tokinase activator complex (APSAC). These agents were originally used for the management of proximal deep vein thrombosis and severe pulmonary embolism but more recently, use of these drugs has been extended to include the treatment of acute peripheral arterial disease, cerebrovascular disease (stroke) and acute coronary thrombosis. The most predictable side effect associated with the use of thrombolytic therapy is hemorrhage.
Veterinary data synthesis: Clinical experience with thrombolytic agents in small animals is limited to streptokinase and t-PA. It is possible, that as in humans, canine and feline patients with PTE and right ventricular dysfunction may benefit from thrombolytic therapy but there are no veterinary studies to support this theory to date. Successful use of streptokinase has been documented in a small number of canine patients with systemic thromboembolism. 63 Thrombolytic therapy is relatively efficacious in cats with aortic thromboemboli but is associated with a high mortality rate. 59,60,64 With regard to use of t-PA in veterinary medicine, the small number of animals treated with varying protocols makes it impossible to provide safe and effective dose recommendations at this time.
Conclusions: Future goals for thrombolytic therapy in veterinary medicine include determination of more specific clinical indications, as well as design of effective protocols that minimize mortality and morbidity.  相似文献   

20.
An eight‐year‐old, neutered, male German short‐haired pointer was presented for a chronic cough and an intrathoracic mass. Computed tomography revealed a mass with low attenuation in the right caudal lung lobe that invaded the principal bronchi. The mass was removed by right caudal and accessory lung lobectomy. The histopathological diagnosis was pulmonary lipoma. The clinical signs resolved following surgery. There was no evidence of recurrence or de novo lesions on computed tomography performed 12 months post‐surgery. To the authors’ knowledge, this is the first report of a pulmonary lipoma in a dog.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号