內(nèi)容文稿教案esavs cases2譯

ESVSESVS課程3BCasePresentationsinDoulasJ.DeBoerSchoolofVeterinaryMedicineHowmanystudentsareregisteredforthis 3748515672

Howmanypeoplelivein

CasePresentation:3yearoldPersiancat,5kgWhatisyourclinicalFoodallergyFelineacneZincresponsiveDirtyfacedisease

3yearoldPersiancatwith1yearhistoryofseverefacialandventralpruritusandadiagnosisof“DirtyFace”diseaseuIsthistypical“dirtyfaceWhatisdifferentaboutuWhatkindsofdiagnostictestsmightyouuSkin s,hairplucking,fleacombing–u皮膚刮片，拔毛，跳蚤梳uRoutinefleacontrol, uDermatophyteculture–u皮膚真菌培養(yǎng)uCytologyforinfections–manyyeastorganismsandbacteriafoundindebrisaroundfacialfolds uAmoxicillin- or3u阿莫西林-克拉維酸合劑治療3uFluconazolefor3u氟康唑治療3uChlorhexidine-Miconazoleshampootofaceandu氯己定-咪康唑香 uRESULTS:50%decreaseinu結(jié)果：瘙癢減少uWorsenedonceoffuuRe-institutetopicaluHypoallergenicdiet–NOPositiveintradermalteststohousedustandstorageBeginimmunotherapy:Silviais ery

uIs“dirtyface”anunusualmanifestationofADincats?u“臟臉病是”是貓異位性皮炎的不uIsthebenefitoccurringbecauseofnonspecificimmunomodulation?u是由于非特異性的免疫調(diào)節(jié)使得情uAllergyincatscanhaveawidevarietyofpruriticpresentations.1PleasevoteforyourDirtyface 2PleasevoteforyourAnswerAnswerAnswerAnswerAnswer CasePresentation:33montholdmalemixedbreed,4kg Comlaint:3weekhistor roressivel ontrunk Nodulesarenonpruriticand Initialsignsweresomefacialswellingandalarge(~4cm)noduleonthechest Someoldernoduleshaverupturedtothesurface,draininga Concurrent“yeastinfectionin Mostrecently,smallnoduleshavealsoappearedonthemuzzle;sometimesdrain Doghasbeenafebrile,eatinganddrinking AmoxicillinPOfirst10days(noCephalexinPOpast10days(slightAerobiccultureofpustaken5daysago(no 8-10firmsubcutaneousnodulesoverthetrunk from2-8cm. Furunclesonlipsand “BodieInitialDiagnosticsuSkin s:nouuCytologyofpurulentuHowwouldyoudescribetheEosinophilic Pyogranulomatous Pyogenic Granulomatous

uWhatareyourpossiblediagnoses?u你可能的診斷是什么？uWhatdiagnosticprocedureswouldyoumendu Wait24hoursoff Impressionsmearsofbiopsy(cytologywithspecialstainsfororganisms(bacteria,fungi,acid-fast) Surgicalbiopsy:pyogranulomatousinfl extendingdownintothesubcutaneousfat(panniculitis).No Cytology: torycells,noorganisms Culture:nogrowthonallculture CBC:WBC23,000with4% Chemistriesandurinalysis JuvenilecellulitiswithsterilenodularuUnusualvariantof“puppystrangles”u“幼犬腺疫”的不尋常轉(zhuǎn)變uEtiologyunknownuMaybepresentasalitterproblemuTypically:fever,malaise,lymphadenopathy, uNodulesmaydrainan“oily”topurulent3Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

4PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

10yearoldmaleneutered LabradorRetrievercrossbreddog,39kg Comlaint: skinandear Multi-yearhistoryofchronicproliferativeotitisexterna,mostrecentlytreatedwithtwice-weeklyoralenrofloxacin and innaefaceheadfoot non Hadfleasoversummer,treatedwith Recent4kgweightloss,thoughappetite Thick,adherentscaling/crustingonpinnae,face,tail;markedfootpad “Einstein”–Initial Earc :moderatenumbersof Chemistriesandurinalysis:

Lymphnodeaspiration:possible Skin “Einsteinskin WhyaretheresomanyDog’simmunesystemisabnormal犬的免疫系統(tǒng)不正常 roductiveviorousstrainofmite多產(chǎn)的，強(qiáng)壯的螨蟲種屬Doghas Doghascancer

“Einstein”–Initial Ivermectin,200u/k,POonce n:reassessin10-14 Lymphnodebiopsy? Bonemarrowcytology?“Einstein”2WeekRecheck2“Einstein”2WeekRecheck2“Einstein”2WeekRecheck2 LNbiopsy,chestfi ,abdominalfi ,abdominalultrasound,bonemarrowcytology,allbloodevaluationsNORMAL uTreatingdemodicosiswith uEars:reallyneedsystemiccorticosteroidsbut…u耳部：需要全身的皮質(zhì)類固醇，但是。。。uOther“immunefunctiontests? u evere and Oftennotpruritic ThousandsofSarcoptesscabieion Mayalsobeconcurrent Ownermayhavescabies **Generallyassociatedwithasevereunderlyingdiseaseand 5Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

6Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

2yearoldmalecastratedPuggle15kguomlaint:5weeksaosuddenonsetofintenselickinandchewingatrightforelimbandscratchingoverrightshoulder uPresentedtoreferringvetwith“swellingandrednessofrightforelimb”withaggressivechewingatskin,bodytemperature104F.u轉(zhuǎn)診到獸醫(yī)的表現(xiàn)為“右前肢腫腫”并咀舔皮膚，體 Treatments:prednisone,hydroxyzine,fattyacidcapsules,selamectin,cephalexin,triamcinolonespray–noeffect —uAlopecia,erythema,thickeningofskin,hyperpigmentation,linearulcerswithscabs,extendingfromtherightshoulderdownovertheliu脫毛，紅斑，皮膚增厚，色素過度沉著，線性的潰瘍uExtremelypruritic;wearsElizabethancollar,socks,andT-shirtconstantlyu嚴(yán)重的瘙癢； uExamotherwiseuuSkin snegativeuCytologyofulceratedareas:neutrophilsandRBC;noorganismsseenuuuSurgicalbiopsy:noevidence toryinfiltrate;noevidencevasculitis;findingsconsistentwithchronicself-trauma.YouropiniononPruritic,allergicAbehavioralAneurologicResistantAgenetic

uNeurologicconsultation: mendbasicbloodwork chestradiora u考慮 uGabapentin,30mgPO ephoneprogresscallin7-10u7-10 uCALL:Within7days,Georgehasalmostcompleystoppedscratch ermovecollar,socks,andT-shirt,withonlyminimalscratching oue ABAthouhmechanismofactionisnot Originallydevelopedfor Usedtotreatpain,especially“neuropathic PaincausedbydysfunctionofnervousBurning,coldness,“pinsandneedles,”numbness, Well-toleratedbydogs;maybemildsedationand Empiricaldose–reporteddose1mg/kgBIDto10mg/kgTIDforatleast2weeks經(jīng)驗(yàn)性劑量 的劑量1mg/kg每天2次到10mg/kg每天3，連用2 Donotusehumanoralliquidformorotherformsthat Discontinueslowly–taperover2-3緩慢的停藥減量通過2-37PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

8PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

10yearsfemalespayedSamoyedDiagnosis=masticatorymusclemyositis,consideredtobeanautoimmunemyositisTreatmentisinprogress(8WhatdrugisKarmatou’sdiseasebeingtreatedwithcurrently?Karmatou’s現(xiàn)在用什么藥物在治療？

WhatisthemajorreasonyouchooseNOTtouseallergen-specificimmunotherapyforadogwithcanineatopicdermatitis?

NotavailableinmyTooexpensiveshatetogiveIdon’tknowenoughaboutthetreatmenttouseitIthinkitdoesnot

Allergen-specificimmunotherapyviaadministrationofextractsintotheoral ,insteadofbyinjectionCommonlyusedandacceptedinEuropefortreatmentofallergicrhinitis在歐洲常用于治療過敏性鼻炎EuropeanextractcompaniesoftenprovideBOTHinjectableandsublingualformulationsintheircatalogues ingreportsof Recently,increasingdatasupportsafetyandefficacyofSLITinhumanallergicdiseaseImmunoloiceffectssimilartoinectionsbutmechanismsmaybedifferentTendogssensitivetomiteonly(DF,DPt,6-monthopentrialofSLITalongwithenoughsteroidtokeepcomfortableClinicalevaluationsat0,2,4,and6Formulatedaccordingtoindividualpatientsensitivities 3-bottle,escalatingdoseset0.1mlBID,everyday,“sublingually”Eachbottleusedfor2Results:Pruritus 3700 6Results:Steroid per250Month MonthResults:OwnerNumberNumberof100 0OverallPercent

%150x103 4x103AU18x106 3923x106AUPilotStudyByseveralclinicalcriteria,atopicmite-sensitivedosimrovedwithSLITImprovementgenerallypaniedseroloicchan es,eseciallincreasesinspecific Conclusion1Overall,SLITisasuccessfultreatmentinapproxima ofpatientswhohavenothad Thisapproximatestheresponsetoallergyshots.Conclusion2Allergyshotsareanineffectivetreatmentforsomepatients,duetolackofefficacy,difficultyinadministration,oradverseSLITisaneffectivetreatmentformanypatientswhofailallergyshottreatment.9PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

1.5yearoldmaleneuteredDoberman,34kg Recurrentpyodermasince4monthsofage Pseudomonasotitisexternaat8monthsof Recurrentpapillomatosisbeganat1yearofage Multiplesurgeriestoremovelesions,withnospontaneousregressionobserved WhatdoyouthinkmightbewrongwithMax? tativeserum uCBCchemistries…uSerialvaccination tativeu Widerangeof“normalValuesvaryovertimeinsameValuesvarywithconcurrentuResults“significant”onlyifdramaticallyandconsistentlylowerthan“normal” uFirstserum uVaccinateuSecondserumsample3-6weekslater uTestforneutralizingantibodyagainstcaninedistemper uNormaldog-strongriseintiter(protectivetiteris>1:320) uBloodcountandchemistries=u tativeIgA,IgM=uSerum tativeIgG=230mg/dl(normal,2000mg/dl)u usneutra –Beforevaccination:打–4weeksafterWhichofthefollowingdrugshasbeenshowntotheimmuneresponseto Dihenh Amoxicillin

“Max”Therapymendation?“Max”治療建議？uCimetidinetreatment,30mg/kg/dayappearedtoslowprogressionof aillomas uGeneralizeddemodicosisdeveloedwhichwassuccessfullytreatedwithmilbemycin,butrecurred Cimetidine:uCertainlymphocytesubsets(suppressorT-cells)mayhavesurfaceH2receptorsuBlockingH2receptorspreventsactivationofsuppressorcellsCimetidine:uViralpapillomatosisin Controlledtrials–noeffectinadults,possibleeffectinchildren控制性試驗(yàn)Controlledtrial–bettereffectwhencombinedwithlevamisole!控制性試驗(yàn)Effectiveinrecalcitrantrespiratorypapillomatosisandconjunctivalpapillomatosis Dose30-40mg/kg/day劑量30-40mg/kg/ Proposedforrecurrentpyodermaanddemodicosisindogs,notevaluatedu9montholdneuteredmaleLabradoruOralgrowthsbeganat4monthsofageandhaveuTreatments:partialremoval,crushing,metronidazoleforsecondaryinfection,withnouEvaluationof tativeIg,serumchemistries,CBCallnormal uSurgicaldebulkingwithcarbondioxideuCimetidinenot Toicalimmuneresonsemodifierthatlocall activatesacell-mediatedimmuneresponse Antiviral,antitumor basalcellcarcinomaorpapilloma sonsn Possibleforuseinequinesarcoids,squamouscellcarcinomaofcats,viralpapillomasofdogs 5%cream,apply2xweeklywithglove“Teejay”3month “Teejay”3month “Teejay”3month Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

yearoldmalecastratedBerneseMountainDog,40kg u6monthhistoryofslowlysmmetricalhair rinci overuuu uAppearshealthyotherwise;normalwaterconsumption,appetite,noweightgain,normaluOwnerhasnoticedthatheseemstohavesome“dandruff”(scaling)layaroundtheheadandneckarea. uReferringveterinarianhasdonethefollowingtests,whichareallnormal: Serum Skin WhichwouldbebesttesttoRepeatthyroidsuppressiontest AbdominalSkin Intradermaltestingfor

CutaneousPrimary

breedbutahereditar diseasein Diagnosedonlybyskin Treatment:palliativetreatmentfor CyclosporinAisveryhelpful(5mg/kg/dayofCsAModified)…forlifetimeofpet! /k/每天?Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

yearoldAustralianShepherdneutered2121 u6monthhistoryofgradualonsetofcrustinganddepigmentationonthenasal bridgeofthenose,andperiocularskin.uMildlypruriticuApparently u1otherdogand1catathome;no““ uSkin suSkincytology–liftupacrustonnoseandmakeimpressionsmearfromunderneathu皮膚細(xì)胞學(xué)—揭起鼻部的一個(gè)結(jié)痂，在下面用玻uCBC uUrinalysisuSerum uPunch uDermatophyte PemphigusCutaneousCutaneous