Gastrinoma and Zollinger-Ellison Syndrome in Canids: A Literature Review and a Case in a Mexican Gray Wolf

Gastrinoma, an infrequent diagnosis in middle-aged dogs, occurs with nonspecific gastrointestinal morbidity. Laboratory tests can yield a presumptive diagnosis, but definitive diagnosis depends on histopathology and immunohistochemistry. We describe a malignant pancreatic gastrinoma with lymph node metastases and corresponding Zollinger–Ellison syndrome in a Mexican gray wolf (Canis lupus baileyi) and review this endocrine neoplasm in domestic dogs. A 12-y-old, captive, male Mexican gray wolf developed inappetence and weight loss. Abdominal ultrasonography revealed a thickened duodenum and peritoneal effusion. Two duodenal perforations were noted on exploratory celiotomy and were repaired. Persisting clinical signs led to a second celiotomy that revealed a mesenteric mass, which was diagnosed histologically as a neuroendocrine carcinoma. During the following 16 mo, the wolf received a combination of H2-receptor antagonists, proton-pump inhibitors, gastroprotectants, and anti-emetics, but had recurrent episodes of anorexia, nausea, acid reflux, and remained underweight. Worsening clinical signs and weakness prompted euthanasia. The antemortem serum gastrin concentration of 414 ng/L (reference interval: 10–40 ng/L) corroborated hypergastrinemia. Autopsy revealed a mass expanding the right pancreatic limb; 3 parapancreatic mesenteric masses; duodenal ulcers; focal duodenal perforation with septic fibrinosuppurative peritonitis; chronic-active ulcerative esophagitis; and poor body condition. The pancreatic mass was diagnosed histologically as a neuroendocrine carcinoma and the parapancreatic masses as lymph node metastases. Immunohistochemistry of the pancreatic mass was positive for gastrin and negative for glucagon, insulin, pancreatic polypeptide, serotonin, somatostatin, and vasoactive intestinal peptide

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Enhancement of muscle and locomotor performance by a series compliance: A mechanistic simulation study

<div><p>The objective was to better understand how a series compliance alters contraction kinetics and power output of muscle to enhance the work done on a load. A mathematical model was created in which a gravitational point load was connected via a linear spring to a muscle (based on the contractile properties of the <i>sartorius</i> of leopard frogs, <i>Rana pipiens</i>). The model explored the effects of load mass, tendon compliance, and delay between onset of contraction and release of the load (catch) on lift height and power output as measures of performance. Series compliance resulted in increased lift height over a relatively narrow range of compliances, and the effect was quite modest without an imposed catch mechanism unless the load was unrealistically small. Peak power of the muscle-tendon complex could be augmented up to four times that produced with a muscle alone, however, lift height was not predicted by peak power. Rather, lift height was improved as a result of the compliance synchronizing the time courses of muscle force and shortening velocity, in particular by stabilizing shortening velocity such that muscle power was sustained rather than rising and immediately falling. With a catch mechanism, enhanced performance resulted largely from energy storage in the compliance during the period of catch, rather than increased time for muscle activation before movement commenced. However, series compliance introduced a trade-off between work done before versus after release of the catch. Thus, the ability of tendons to enhance locomotor performance (i.e. increase the work done by muscle) appears dependent not only on their established role in storing energy and increasing power, but also on their ability to modulate the kinetics of muscle contraction such that power is sustained over more of the contraction, and maximizing the balance of work done before versus after release of a catch.</p></div

Relative muscle force (solid, black), muscle shortening velocity (short dash, green), and power (long dash, red) with a 100ms catch delay.

<p>Panel A had a compliant tendon (<i>E</i> = 0.0159 GPa) and panel B had a functionally rigid tendon (<i>E</i> = 5 GPa). Load mass 100 g, and initial tendon length 2 cm. Data are normalized to the maximal values obtained with a rigid tendon (Panel B).</p

Maximal load height attained (cyan) and associated maximal MTC power (red).

<p>Data are from simulations with a 485 g load mass and a tendon with a compliance that maximized lift height. <i>R</i>–muscle connected to load with a functionally rigid tendon (<i>E</i> = 5 GPa). <i>C</i>–muscle connected to load with a compliant tendon (<i>E</i> = 0.0159 GPa). <i>C/D</i>–muscle connected to load with a compliant tendon (<i>E</i> = 0.0167 GPa) and 500 ms catch delay. <i>C/S</i>–muscle connected to load with a compliant tendon (<i>E</i> = 0.00505 GPa) and initial muscle length 120% <i>L</i>_<i>0</i>. <i>C/D/S</i>–muscle connected to load with a compliant tendon (<i>E</i> = 0.00909 GPa), 500 ms catch delay, and initial muscle length 120% <i>L</i>_<i>0</i>. Initial tendon length was 2 cm for all simulations.</p

Lift height (A) and maximal MTC power (B) versus tendon area and Young’s modulus.

<p>Initial tendon length 2 cm, load mass 485 g, and no catch delay.</p

Relative muscle force (solid, black), muscle shortening velocity (short dash, green), and power (long dash, red) with tendons of different compliance.

<p>Tendon A was excessively compliant, tendon B was ideally compliant for maximizing work, and tendon C was insufficiently compliant (i.e. rigid). All data are normalized to the maximal values obtained with a functionally rigid tendon (Panel C). Upper pane shows the load lift heights associated with Tendons A, B and C. Tendon A <i>E</i> = 0.00968 GPa; Tendon B <i>E</i> = 0.0159 GPa; Tendon C <i>E</i> = 0.538 GPa. Initial tendon length 2 cm; load mass 485 g, no catch delay.</p

Lift height attained across a range of tendon Young’s moduli with different simulation parameters.

<p><i>T</i>–tendon, no catch delay, initial muscle length 100% <i>L</i>_<i>0</i>; <i>TD</i>–tendon, 500 ms catch delay, initial muscle length 100% <i>L</i>_<i>0</i>; <i>TS</i>–tendon, no catch delay, initial muscle length stretched to 120% <i>L</i>_<i>o</i>; <i>TDS</i>–tendon, 500 ms catch delay, initial muscle length stretched to 120% <i>L</i>_<i>0</i>. For all simulations, initial tendon length, 2 cm; load mass, 485 g.</p

Coccidioides posadasii in a Dog with Cervical Dissemination Complicated by Esophageal Fistula

A 5-year-old male, neutered mixed breed dog with a history of a mass with an associated draining tract on the ventral cervical region was diagnosed with an esophageal fistula. The dog exhibited serosanguinous discharge from the draining tract, with enlarged left superficial cervical and mandibular lymph nodes, and was reported to have difficulty with deglutition of solid foods. Computed tomography revealed a communication of the draining tract with the esophagus along with enlargement of the left lateral retropharyngeal, left medial retropharyngeal, and mandibular lymph nodes. This prompted surgical exploration and debridement of the site, with closure of the esophageal fistula. Histopathology of thyroid gland, skeletal muscle, and adipose tissue obtained during surgical exploration showed spherules consistent with Coccidioides spp. infection. Antibody titers performed post-operatively were consistent with an active Coccidioides spp. Infection. By fungal culture and subsequent PCR and DNA sequencing, C. posadasii was identified as the species infecting the dog. Over the course of 85 days of antifungal therapy, discharge from the draining tract, lymphadenomegaly, and cutaneous and subcutaneous nodules resolved. In conclusion, this is the first reported case of disseminated coccidioidomycosis to the cervical region of a dog with involvement of the thyroid gland, skeletal muscle, adipose tissue, connective tissue, and secondary esophageal fistula. Coccidioides spp. infections should be considered a differential diagnosis in unusual cases for dogs that live in or have traveled to endemic areas.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]