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before repositioning in dogs with gastric dilatation or gastric dilatation-volvulus.1,2,7-10 |
Figure 1. A gastric foreign body in a dog that ingested a polyurethane adhesive (Gorilla Glue). |
Gastrotomy is a safe and effective way to collect full-thickness gastric biopsy samples of lesions that may be missed or misdiagnosed |
with endoscopic sampling.1,2,11,12 For example, gastrointestinal lymphoma arising from deeper layers of the submucosa can cause many of the same superficial |
inflammatory lesions as lymphocytic-plasmacytic gastroenteritis.11 Phycomycosis can only be definitively diagnosed with organism identification by fungal culture or by special histologic |
stains of fibrotic, firm tissues obtained from surgical incisional biopsy. Full-thickness incisional biopsy is also required |
for histologic examination to definitively diagnose gastric carcinomas.1,11,12 |
Make a ventral midline abdominal incision from the xiphoid to the caudal abdomen. Incisions that are farther cranial may penetrate |
the diaphragm, inadvertently causing a pneumothorax. Retract the abdominal wall with a Balfour retractor to expose the cavity, |
and perform a thorough exploration of the abdominal contents. Visually inspect and palpate the stomach for masses, thickening, |
or foreign bodies, and evaluate the pylorus for abnormalities. |
Figure 2. Isolate the stomach with moistened laparotomy pads, and place stay sutures at either end of the proposed incision |
in the least vascular portion of the gastric body. |
If no gastric wall lesions are present, a gastrotomy is usually performed midway between the lesser and greater curvatures |
of the stomach, where the vasculature is less prominent.1,3,10 Elevate the stomach with full-thickness stay sutures or Babcock forceps at either end of the proposed incision site to improve |
visualization of the surgery site and reduce gastric content spillage (Figure 2). If no assistant is available, drape the hemostats holding the stay sutures over the Balfour retractor to provide retraction |
(Figure 3). Place moistened laparotomy pads around the stomach to limit peritoneal contamination. |
Figure 3. To provide traction, drape the hemostats holding the stay sutures over the Balfour retractor. |
The Companion Animal Parasite Council (CAPC) and the American Heartworm Society (AHS) have released a joint statement prompted |
by concerns of veterinary parasitologists and clinicians over regional reports of lack of efficacy of macrocyclic lactones |
used to prevent heartworm infection in animals. Representatives of both organizations—along with university clinicians with |
particular interest in heartworm disease and experts in pharmacology, parasitology, and resistance research—met to address |
the issues surrounding this lack of efficacy. |
Michael Paul, DVM |
The goal was to take steps to clarify current understanding about resistant populations of heartworms that at this time appear |
to be limited geographically to the upper and lower Mississippi River region. The consensus of the group was that resistance |
has indeed been demonstrated to occur. While such populations have been identified, it was stressed that a lack of dispensing |
consistency and client compliance are major factors that contribute to lack of efficacy. |
The report stresses that macrocyclic lactones are the most important weapon in preventing heartworm infection currently available |
and that they should continue to be prescribed year-round as the need for improved client compliance is emphasized. |
The report also outlines recommendations for testing protocols that take into account some life cycle concerns that are frequently |
misunderstood or neglected. Annual testing is still recommended, with additional testing recommended in some situations such |
as delayed initiation of preventive, which may allow for latent infections, or after a lapse in administration. |
Although the emphasis of the discussions was on canine heartworm disease, effective prevention relies on monthly administration |
of a macrocyclic lactone to all dogs and cats year-round. Additional measures, including screening in kennels when possible, |
confining pets indoors during the heaviest hours of mosquito exposure, and the use of mosquito repellents, can significantly |
reduce exposure to infected mosquitoes. |
Treatment protocols were discussed and agreed to by consensus. One of the most important outcomes was the admonishment not |
to use so-called "slow kill" or "soft kill" treatments. The treatment protocol outlined is the same as that described on the |
CAPC and AHS websites and emphasizes the administration of macrocyclic lactones, doxycycline, and melarsomine injected three |
times in the regimen. |
Several key points from this meeting: |
1. The extent of the lack of efficacy problem is not fully known. As more studies are done, amendments to this statement |
will be necessary. |
2. The single greatest tool we have to prevent heartworm infection remains the macrocyclic lactone group of drugs. |
3. The most basic step we can take to reduce lack of efficacy is to improve compliance, which involves veterinarians recommending |
and clients administering preventives. |
4. The timing and frequency of testing must be linked to an understanding of the life cycle of heartworms. |
5. Treatment is not complete until the patient is free of microfilaria. |
6. Infected dogs should not be transported until proven clear of microfilaria. |
The AHS and CAPC are extremely proud of the fact that this was a joint effort, and we look forward to future collaborations. |
Dr. Paul is the executive director of the Companion Animal Parasite Council and a former president of the American Animal |
Hospital Association. He is retired from practice and lives in Anguilla, British West Indies. |
Water: State, Tribal & Territorial Standards |
Repository of Documents: Puerto Rico |
You will need Adobe Reader to view some of the files on this page. See EPA's PDF page to learn more. |
- Puerto Rico Water Quality Standards Regulation (PDF) (90 pp, 1.8MB) |
- (Effective August 4, 2010) |
- Federal Regulations 40 CFR 131.42 |
- (Effective January 11, 2008) Federal Regulations establishing methods to implement Puerto Rico's antidegradation policy. |
- Federal Regulations, 40 CFR 131.41 |
- (Effective December 16, 2004) Federal regulations establishing bacteria criteria for coastal and Great Lakes waters. This regulation is also known as the Beach Rule. |
- Federal Regulations 40 CFR 131.40 |
- (Effective March 26, 2004) Establishes a primary contact recreation designated use and associated water quality criteria for 6 waterbodies and an area of coastal waters known as the "coastal ring." |
- Federal Regulations, 40 CFR 131.36 |
- (Effective April 12, 2000) Toxics criteria for those states not complying with Clean Water Act section 303(c)(2)(B). This federal regulation establishes water quality criteria for certain toxic pollutants. The regulation is also known as the National Toxics Rule. |
The nice part about science is the ability to retest things as new data and better methods become available. In the case of climate change, new data and updated models are producing increasingly higher warming predictions for the end of this century. MIT joined other entities in retesting their predictions with their I... |
Their new study also includes new predictions of CO2 concentrations over the next 80 years. Their new 5th percentile projection is higher than their 2003 median (50th percentile) at just under 700ppm (current values are 387ppm and increasing). Their new 50th percentile projection is almost as high as their 2003 95th pe... |
Warming in their simulations range from 3.1°C to 7.3°C by 2100. They make sure to note that not one of their 400 simulations resulted in globally averaged temperature increases of less than 2°C. Not one. That’s a very significant result. Why the big change? The authors explain: |
Rather than interacting additively, these different affects appear to interact multiplicatively, with feedbacks among the contributing factors, leading to the surprisingly large increase in the chance of much higher temperatures. |
That mult |
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