内容文稿教案esavs cases2译

ESVSESVS课程3BCasePresentationsinDoulasJ.DeBoerSchoolofVeterinaryMedicineHowmanystudentsareregisteredforthis 3748515672

Howmanypeoplelivein

CasePresentation:3yearoldPersiancat,5kgWhatisyourclinicalFoodallergyFelineacneZincresponsiveDirtyfacedisease

3yearoldPersiancatwith1yearhistoryofseverefacialandventralpruritusandadiagnosisof“DirtyFace”diseaseuIsthistypical“dirtyfaceWhatisdifferentaboutuWhatkindsofdiagnostictestsmightyouuSkin s,hairplucking,fleacombing–u皮肤刮片，拔毛，跳蚤梳uRoutinefleacontrol, uDermatophyteculture–u皮肤真菌培养uCytologyforinfections–manyyeastorganismsandbacteriafoundindebrisaroundfacialfolds uAmoxicillin- or3u阿莫西林-克拉维酸合剂治疗3uFluconazolefor3u氟康唑治疗3uChlorhexidine-Miconazoleshampootofaceandu氯己定-咪康唑香 uRESULTS:50%decreaseinu结果：瘙痒减少uWorsenedonceoffuuRe-institutetopicaluHypoallergenicdiet–NOPositiveintradermalteststohousedustandstorageBeginimmunotherapy:Silviais ery

uIs“dirtyface”anunusualmanifestationofADincats?u“脏脸病是”是猫异位性皮炎的不uIsthebenefitoccurringbecauseofnonspecificimmunomodulation?u是由于非特异性的免疫调节使得情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你可能的诊断是什么？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”的不寻常转变uEtiologyunknownuMaybepresentasalitterproblemuTypically:fever,malaise,lymphadenopathy, uNodulesmaydrainan“oily”topurulent3Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

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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犬的免疫系统不正常 roductiveviorousstrainofmite多产的，强壮的螨虫种属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：需要全身的皮质类固醇，但是。。。uOther“immunefunctiontests? u evere and Oftennotpruritic ThousandsofSarcoptesscabieion Mayalsobeconcurrent Ownermayhavescabies **Generallyassociatedwithasevereunderlyingdiseaseand 5Pleasevoteforyour AnswerAnswerAnswerAnswerAnswer

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2yearoldmalecastratedPuggle15kguomlaint:5weeksaosuddenonsetofintenselickinandchewingatrightforelimbandscratchingoverrightshoulder uPresentedtoreferringvetwith“swellingandrednessofrightforelimb”withaggressivechewingatskin,bodytemperature104F.u转诊到兽医的表现为“右前肢肿肿”并咀舔皮肤，体 Treatments:prednisone,hydroxyzine,fattyacidcapsules,selamectin,cephalexin,triamcinolonespray–noeffect —uAlopecia,erythema,thickeningofskin,hyperpigmentation,linearulcerswithscabs,extendingfromtherightshoulderdownovertheliu脱毛，红斑，皮肤增厚，色素过度沉着，线性的溃疡uExtremelypruritic;wearsElizabethancollar,socks,andT-shirtconstantlyu严重的瘙痒； uExamotherwiseuuSkin snegativeuCytologyofulceratedareas:neutrophilsandRBC;noorganismsseenuuuSurgicalbiopsy:noevidence toryinfiltrate;noevidencevasculitis;findingsconsistentwithchronicself-trauma.YouropiniononPruritic,allergicAbehavioralAneurologicResistantAgenetic

uNeurologicconsultation: mendbasicbloodwork chestradiora u考虑 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经验性剂量 的剂量1mg/kg每天2次到10mg/kg每天3，连用2 Donotusehumanoralliquidformorotherformsthat Discontinueslowly–taperover2-3缓慢的停药减量通过2-37PleasevoteforyourAnswerAnswerAnswerAnswerAnswer

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10yearsfemalespayedSamoyedDiagnosis=masticatorymusclemyositis,consideredtobeanautoimmunemyositisTreatmentisinprogress(8WhatdrugisKarmatou’sdiseasebeingtreatedwithcurrently?Karmatou’s现在用什么药物在治疗？

WhatisthemajorreasonyouchooseNOTtouseallergen-specificimmunotherapyforadogwithcanineatopicdermatitis?

NotavailableinmyTooexpensiveshatetogiveIdon’tknowenoughaboutthetreatmenttouseitIthinkitdoesnot

Allergen-specificimmunotherapyviaadministrationofextractsintotheoral ,insteadofbyinjectionCommonlyusedandacceptedinEuropefortreatmentofallergicrhinitis在欧洲常用于治疗过敏性鼻炎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

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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”治疗建议？uCimetidinetreatment,30mg/kg/dayappearedtoslowprogressionof aillomas uGeneralizeddemodicosisdeveloedwhichwassuccessfullytreatedwithmilbemycin,butrecurred Cimetidine:uCertainlymphocytesubsets(suppressorT-cells)mayhavesurfaceH2receptorsuBlockingH2receptorspreventsactivationofsuppressorcellsCimetidine:uViralpapillomatosisin Controlledtrials–noeffectinadults,possibleeffectinchildren控制性试验Controlledtrial–bettereffectwhencombinedwithlevamisole!控制性试验Effectiveinrecalcitrantrespiratorypapillomatosisandconjunctivalpapillomatosis Dose30-40mg/kg/day剂量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

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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皮肤细胞学—揭起鼻部的一个结痂，在下面用玻uCBC uUrinalysisuSerum uPunch uDermatophyte PemphigusCutaneousCutaneous