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Journal articles on the topic 'Intra vitam Diagnostik'
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1
Ellenberger, Christin, A. Uhlig, G. F. Schusser, and Astrid Grosche. "Spezielle Diagnostik bei einem Pferd mit Cushing-Syndrom und Krankheitsverlauf während der Therapie mit Pergolid." Tierärztliche Praxis Ausgabe G: Großtiere / Nutztiere 33, no. 02 (2005): 114–21. http://dx.doi.org/10.1055/s-0038-1624094.
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Zusammenfassung Ziel: In vorliegendem Fallbericht werden spezielle diagnostische Möglichkeiten beim equinen Cushing-Syndrom (ECS) und der Verlauf einer Langzeitbehandlung mit Pergolid diskutiert. Material und Methoden: Zur Vorstellung gelangte eine 13-jährige Quarter-Horse-Stute mit Konjunktivitis, Hyperhidrosis, Polydipsie und Polyurie. Blut (inklusive ACTH-Konzentration) sowie Harn wurden untersucht und der Dexamethason-Suppressionstest durchgeführt. Zudem wurden MRT-Aufnahmen von der Hypophyse des Pferdes angefertigt. Die Bestimmung spezifischer pharmakokinetischer Parameter erfolgte nach oraler Gabe von Pergolidmesilat. Ergebnisse: Die Stute wies eine Neutrophilie, Lymphopenie, Hyperglykämie und Glukosurie auf. Die ACTH-Konzentration war auf 138,6 pg/ml erhöht. Der Dexamethason-Suppressionstest ergab eine gestörte Kortisolregulation. Die Hypophyse stellte sich im MRT kugelig vergrößert dar. Eine orale Behandlung mit 2 μg Pergolid/kg KM/d führte zur Symptomfreiheit. Die Halbwertszeit für Pergolid lag hier bei 6,8 Stunden. Innerhalb eines Jahres entwickelte die Stute ein gesteigertes Allgemeinverhalten mit rosseähnlichen Symptomen, sodass die Behandlung abgebrochen wurde. Zwei Monate später trat ein durch Hyperkortisolämie bedingter Schock auf, der zum Tod der Stute führte. Die Obduktion ergab ein Adenom des Hypophysenzwischenlappens. Klinische Relevanz und Schlussfolgerung: Der Dexamethason-Suppressionstest und die Bestimmung der ACTH-Konzentration stellten für die Diagnose des ECS hilfreiche Methoden dar. Mit dem MRT war der Hypophysentumor intra vitam hervorragend darstellbar. Allerdings eignet sich dieses Verfahren nicht für Routineuntersuchungen. Die orale Gabe von Pergolid erwies sich als eine wirksame Therapieform des ECS. Bei Langzeitanwendung ist jedoch mit Nebenwirkungen zu rechnen. Zur Reduktion der Nebenwirkungen könnte eine Gabe des Medikaments auf zwei Dosen pro Tag verteilt beitragen.
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Nicke, M., G. F. Schusser, and S. Recknagel. "Diagnostische Aussagekraft der Zytologie von Bauchpunktaten bei abdominalen Tumoren des Pferdes." Tierärztliche Praxis Ausgabe G: Großtiere / Nutztiere 40, no. 02 (2012): 85–93. http://dx.doi.org/10.1055/s-0038-1623102.
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Zusammenfassung Gegenstand und Ziel: Retrospektive Analyse zur Aussagekraft der Zytologie von Bauchpunktaten (BP) hinsichtlich der Intra-vitam-Diagnostik abdominaler Neoplasien. Material und Methoden: Vorgestellt werden 10 Pferde mit histopathologisch bestätigter abdominaler Tumormanifestation, bei denen ante mortem eine Abdominozentese mit Punktatuntersuchung stattfand. Im Bauchpunktat (BP) wurden die Gesamteiweißkonzentration und die Zellzahl bestimmt. Die zytologische Beurteilung erfolgte hinsichtlich der Malignitätswahrscheinlichkeit anhand definierter Malignitätskriterien. Ergebnisse: Bei fünf der 10 Pferde konnte anhand der Zytologie des BP eine Neoplasie bestätigt werden. Das maligne Lymphom war der am häufigsten (2/3 BP) diagnostizierte Tumor. Bei 1/2 Pferden mit multiplem Myelom ergab sich ebenfalls ein positiver Befund des BP. Das maligne Melanom (2/10) wurde in einem Fall über das BP diagnostiziert. Der positive Nachweis gelang ferner bei einem Pferd mit Plattenepithelkarzinom des Magens, wobei die Tumorzellmorphologie hier keine spezifische Tumordiagnose ergab, sodass eine solche nur bei 4/5 Neoplasien möglich war. Ein Adenokarzinom und ein Hämangiosarkom konnten nicht erfasst werden. Der Punktatcharakter erlaubte keinen Rückschluss auf die Tumorart. Das Vorliegen abnormer Mitosen hatte einen größeren diagnostischen Wert als die Mitoserate. Schlussfolgerung: Die Anwendung nukleärer Malignitätskriterien ermöglicht eine akzeptable Identifizierung von Tumorzellen bei Kenntnis der morphologischen Variabilität von Mesothelzellen. Das Fehlen maligner Zellen schließt jedoch eine Neoplasie nicht aus. Klinische Relevanz: Die zytologische Untersuchung des BP ist wertvoller Bestandteil des diagnostischen Vorgehens bei Verdacht auf eine abdominale Tumorose.
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Klein, D., H. Prosl, D. Thaller, and M. Floeck. " Diagnosis of a Dicrocoelium dendriticum infection in New World Camelids: a case report." Veterinární Medicína 57, No. 3 (April 4, 2012): 154–62. http://dx.doi.org/10.17221/5856-vetmed.
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Dicrocoelium dendriticum plays an important role in New World Camelids as infected animals may suffer from severe clinical symptoms even leading to death of the animals. Intra vitam diagnosis may be difficult as clinical signs are atypical and Dicrocoelium eggs are shed only intermittently in faeces. The aim of this paper is to present four clinical cases of dicrocoeliosis in lamas as well as three asymptomatic infected animals to support the veterinarian in practice to diagnose infections. Furthermore, it is the first time that ultrasonographic examinations are described in this context. All seven lamas had been admitted to the Clinic for Ruminants at the University for Veterinary Medicine in Vienna. None of the animals had a history of D. dendriticum infection. The ultrasonographic examination of the liver revealed in all diseased animals as well as in two asymptomatic lamas hyperechoic areas representing calcified bile ducts typical for an infection with liver flukes. These findings together with blood examination of liver enzymes and parasitological examination may lead to the intra vitam diagnosis of dicrocoeliosis in lamas and alpacas. With an early diagnosis, the therapy of Dicrocoelium spp. could become more effective and the number of animals rescued may be increased.
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Wernike, Kerstin, Andrea Aebischer, Franziska Sick, Kevin P. Szillat, and Martin Beer. "Differentiation of Antibodies against Selected Simbu Serogroup Viruses by a Glycoprotein Gc-Based Triplex ELISA." Veterinary Sciences 8, no. 1 (January 18, 2021): 12. http://dx.doi.org/10.3390/vetsci8010012.
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The Simbu serogroup of orthobunyaviruses includes several pathogens of veterinary importance, among them Schmallenberg virus (SBV), Akabane virus (AKAV) and Shuni virus (SHUV). They infect predominantly ruminants and induce severe congenital malformation. In adult animals, the intra vitam diagnostics by direct virus detection is limited to only a few days due to a short-lived viremia. For surveillance purposes the testing for specific antibodies is a superior approach. However, the serological differentiation is hampered by a considerable extent of cross-reactivity, as viruses were assigned into this serogroup based on antigenic relatedness. Here, we established a glycoprotein Gc-based triplex enzyme-linked immunosorbent assay (ELISA) for the detection and differentiation of antibodies against SBV, AKAV, and SHUV. A total of 477 negative samples of various ruminant species, 238 samples positive for SBV-antibodies, 36 positive for AKAV-antibodies and 53 SHUV antibody-positive samples were tested in comparison to neutralization tests. For the newly developed ELISA, overall diagnostic specificities of 84.56%, 94.68% and 89.39% and sensitivities of 89.08%, 69.44% and 84.91% were calculated for SBV, AKAV and SHUV, respectively, with only slight effects of serological cross-reactivity on the diagnostic specificity. Thus, this test system could be used for serological screening in suspected populations or as additional tool during outbreak investigations.
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Hameed, B. M. Zeeshan, Milap Shah, Nithesh Naik, Sufyan Ibrahim, Bhaskar Somani, Patrick Rice, Naeem Soomro, and Bhavan Prasad Rai. "Contemporary application of artificial intelligence in prostate cancer: an i-TRUE study." Therapeutic Advances in Urology 13 (January 2021): 175628722098664. http://dx.doi.org/10.1177/1756287220986640.
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Artificial intelligence (AI) involves technology that is able to emulate tasks previously carried out by humans. The growing incidence, novel diagnostic strategies and newer available therapeutic options have had resource and economic impacts on the healthcare organizations providing prostate cancer care. AI has the potential to be an adjunct to and, in certain cases, a replacement for human input in prostate cancer care delivery. Automation can also address issues such as inter- and intra-observer variability and has the ability to deliver analysis of large volume datasets quickly and accurately. The continuous training and testing of AI algorithms will facilitate development of futuristic AI models that will have integral roles to play in diagnostics, enhanced training and surgical outcomes and developments of prostate cancer predictive tools. These AI related innovations will enable clinicians to provide individualized care. Despite its potential benefits, it is vital that governance with AI related care is maintained and responsible adoption is achieved.
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Mali, Md Hamed Altaf, Anita A. M, Meenakshi Meenakshi, and Anuradha G. Patil. "Evaluation of Cell Block Diagnostics in Intra-Abdominal Lesions with Radiological and Clinical Correlation in a Tertiary Centre in North Karnataka Region." Journal of Evidence Based Medicine and Healthcare 8, no. 19 (May 10, 2021): 1397–402. http://dx.doi.org/10.18410/jebmh/2021/266.
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BACKGROUND Cytological examination of intra-abdominal lesions is crucial in diagnosis, staging, and prognosis of suspected malignancies. Fine needle aspiration cytology (FNAC) is a routine diagnostic modality for diagnosis. FNAC is a reliable, rapid, cost effective procedure and plays an important role particularly in low resource centres. FNAC along with cell block has shown remarkable result in diagnosis of malignant lesions and its sub-classification using various antibody markers. METHODS A total of 102 cases of intra-abdominal lesions were studied over a period of one year in this descriptive study. Ultrasound sonography (USG) guided FNACs were done in 89 cases and ascetic / peritoneal fluid analysis in 13 cases. Cell blocks were made in 95 cases and immunohistochemistry (IHCs) were done in 69 cases of suspected / malignant intra-abdominal lesions to confirm the diagnosis. RESULTS Out of 102 cases, cytological smears in 89, fluid smears in 13 and cell blocks in 95 cases were available respectively. Most common intra-abdominal organ involved was liver (21.56 %) followed by retroperitoneum (17.65 %) and lymph nodes (14.70 %). The intra-abdominal lesions were classified into non - neoplastic (16.67 %) and neoplastic lesions (83.33 %). Neoplastic lesions (83.33 %) were further sub classified into benign (15.68 %) and malignant (67.65 %). IHC was done in all malignant lesions for confirmation of primary and / or metastasis. Complete concordance between cell blocks and smears was observed in 95 / 102 cases (93.14 %), while discordances were noted in 05 out of 102 cases (06.86 %). CONCLUSIONS Cell blocks play a vital role in cytopathology and as an adjunct to the routine cytology smears and body fluids. Cell buttons are cost effective and simple to make without involving much higher technicality. Cell block sections offer advantages with respect to cellular architecture, archival storage and application of IHCs which help in pin-pointing the diagnosis. Hence, cell blocks must be considered to increase the diagnostic yield and efficacy. KEYWORDS Cytopathology, Malignant Lesions, Immuno - Histochemistry, Diagnostic Utility
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Bonelli, Piero, Federica Loi, Maria Giovanna Cancedda, Angela Peruzzu, Elisabetta Antuofermo, Elisabetta Pintore, Toni Piseddu, Giovanni Garippa, and Giovanna Masala. "Bayesian Analysis of Three Methods for Diagnosis of Cystic Echinococcosis in Sheep." Pathogens 9, no. 10 (September 27, 2020): 796. http://dx.doi.org/10.3390/pathogens9100796.
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Diagnosis of cystic echinococcosis (CE) in sheep is essentially based on necropsy findings. Clinical symptoms can be easily overlooked, while the use of immunological tests is still not recommended for an intra vitam diagnosis. This study assessed the performances of three post-mortem laboratory methods in the diagnosis of ovine CE. In the absence of a single and accurate test as a gold standard, the results of multiple analytical tests can be combined to estimate diagnostic performance based on a Bayesian statistical approach. For this purpose, livers (n = 77), and lungs (n = 79) were sampled from adult sheep and examined using gross pathology, histopathology and molecular analyses. Data from the three diagnostic methods were analyzed using a Bayesian latent class analysis model to evaluate their diagnostic accuracy in terms of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). The gross pathology examination revealed excellent diagnostic capabilities in diagnosing ovine CE with an Se of 99.7 (96.7–99.8), Sp of 97.5 (90.3–99.8), PPV of 97.6 (90.5–100), and NPV of 99.7 (96.5–100). The experimental design used in this work could be implemented as a validation protocol in a quality assurance system.
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Eisenberg, Tobias, Ahmad Fawzy, Ute Kaim, Anne Nesseler, Karin Riße, Iris Völker, Silke Hechinger, et al. "Chronic wasting associated with Chlamydia pneumoniae in three ex situ breeding facilities for tropical frogs." Antonie van Leeuwenhoek 113, no. 12 (November 5, 2020): 2139–54. http://dx.doi.org/10.1007/s10482-020-01483-6.
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AbstractA number of different Chlamydia spp. have been detected in the class Amphibia with C. pneumoniae being the predominant species involved. Chlamydiae have been linked to mass mortality events, thereby representing significant pathogens that deserve attention with respect to worldwide amphibian decline. We here present six cases of chlamydiosis and asymptomatic chlamydial infections in different frog species from three ex situ amphibian conservation facilities. Clinical signs predominantly characterised by regurgitation, chronic wasting, lethargy and suspended breeding were associated with C. pneumoniae infection. Despite various treatment regimens, it was not possible to clear infections. However, intra vitam diagnostics succeeded from skin, faeces and urine for the first time.
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Haymet, Andrew B., Daniel Lee, Kevin Ho-Shon, and Richard Waugh. "When the Conventional Treatment Fails: A Rare Approach to Superior Mesenteric Arterial Embolization." Vascular and Endovascular Surgery 54, no. 2 (November 12, 2019): 169–71. http://dx.doi.org/10.1177/1538574419886187.
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Retroperitoneal haemorrhage is a rare but potentially life-threatening event. It may occur either spontaneously or secondary to percutaneous vascular access procedures, trauma, or ruptured aortic, iliac, or mesenteric aneurysms. As a result, the clinical presentation is variable. Computed tomography and/or angiography are vital for diagnosis. Management may range from conservative treatment for stable patients to emergency laparotomy or embolization for catastrophic haemorrhage. Direct percutaneous puncture of a deep intra-abdominal pseudoaneurysm is an accepted but infrequently performed technique due to a number of diagnostic and technical challenges. We describe the successful percutaneous transabdominal angioembolization of a superior mesenteric artery rupture in a 77-year-old woman with a large retroperitoneal haematoma. This was performed after a conventional femoral transarterial approach was unsuccessful.
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Jehangir, Aasia, Amber Goraya, and Abid Ali Qureshi. "Positive Predictive Value of MRI in the Diagnosis of Intra-Abdominal Undescended Testes Taking Laparoscopic Findings as Gold Standard." Annals of Punjab Medical College 15, no. 1 (March 31, 2021): 36–39. http://dx.doi.org/10.29054/apmc/2021.762.
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Background: Cryptorchidism also known as undescended testis, is a birth defect in male babies with higher frequency in preterm infants, leading infertility and other genital problems. In its treatment, diagnosis has a vital role. Objective: The objective of this study was to determine the positive predictive value of MRI in the diagnosis of intra-abdominal undescended testes taking laparoscopic findings as gold standard. Study Design: It was a cross-sectional survey. Settings: Research was conducted at Department of Diagnostic Radiology, Children Hospital & Institute of Child Health Lahore Pakistan. Duration: Six months from June 23, 2018 to December 22, 2018. Methodology: This study involved 68 boys aged between 2 to 15 years presenting with undescended testes. Intra-abdominal undescended testes were diagnosed on MRI and was later confirmed on laparoscopic findings which were taken as gold standard and diagnosis of MRI was judged accordingly as true positive or false positive. A written informed consent was obtained from parents of every patient. Results: The age of the children ranged from 2 years to 15 years with a mean of 8.1±3.5 years. Majority (n=53, 77.9%) of the children had right while 15 (22.1%) children had left undescended testes. Diagnosis of intra-abdominal testes was confirmed in 64 (94.1%) patients on laparoscopy. Thus, there were 64 true positive and 4 false positive cases. It yielded a positive predictive value of 94.1% for MRI in predicting intra-abdominal undescended testes taking laparoscopy as gold standard. Similar positive predictive value was noted across various age and anatomical side groups. Conclusion: The positive predictive value of MRI was found to be 94.1% in predicting intra-abdominal undescended testes taking laparoscopic findings as gold standard regardless of patient’s age and anatomical side which along with its non-invasive and radiation free nature advocates its preferred use in future practice.
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Wirastuti Giri, Putu Ayu Winda, Nyoman Srie Laksminingsih, Firman Parulian Sitanggang, I. Gusti Ayu Sri Mahendra Dewi, I. Wayan Juli Sumadi, and Luh Putu Iin Indrayani Maker. "Case Report: Gastric Wall Thickening: Radiological Diagnostic Challenges in Gastric Malignancy." Jurnal Ilmiah Kedokteran Wijaya Kusuma 10, no. 1 (March 25, 2021): 71. http://dx.doi.org/10.30742/jikw.v10i1.983.
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Gastric abnormalities show nonspecific gastrointestinal symptoms and similarly radiological findings. Intra and extra luminal gastric wall thickening are the most common finding in benign and malignant pathologic process. This aim of this case report was to describe several characteristics such as the location and size of the lesion, involvement of the gastric wall and surrounding structures, calcifications, and contrast enhancement pattern which can assist in radiological diagnosis. Several cases at our institution have similar gastrointestinal complaints, however, there were different lesions characteristic found in contrast enhanced abdominal CT scan. The first case 72-years-old man experienced hematemesis with radiologic finding diffuse gastric mucosal thickening as well as homogenous contrast enhancement but without calcification. The second case 37-years-old man complaint dizziness and melena with radiologic finding large tumor more than 10 cm in size, amorph calcification and heterogenous contrast enhancement. The last 60-years-old man case experienced melena and hematemesis, from abdominal CT scan showed irregular gastric mucosal thickening with heterogenous contrast enhancement and fat stranding around the lesion, without calcification. Methods used in these cases were contrast-enhanced abdominal CT scan, esophagogastroduodenoscopy (EGD), and biopsy in order to determine the diagnosis. Contrast-enhanced abdominal CT scan plays a vital role in describing the lesion characteristics which affects the determination of treatment options and future prognosis.
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Gómez, Marcelo, Catalina García, Isabel Maldonado, Nikola Pantchev, Anja Taubert, Carlos Hermosilla, Manuel Moroni, et al. "Intra Vitam Diagnosis of Neglected Gurltia paralysans Infections in Domestic Cats (Felis catus) by a Commercial Serology Test for Canine Angiostrongylosis and Insights into Clinical and Histopathological Findings—Four-Case Report." Pathogens 9, no. 11 (November 6, 2020): 921. http://dx.doi.org/10.3390/pathogens9110921.
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Gurltia paralysans is a metastrongyloid nematode which belongs to the Angiostrongylidae family and presents tropism for veins of the subarachnoid space in vivo of domestic and wild felids causing a progressive and chronic clinical manifestation of paraparesis/paraplegia. The geographic distribution of G. paralysans includes rural and periurban areas of South America and was recently reported in Europe. To date, a definitive diagnosis of feline gurltiosis is still conducted by post-mortem examination of the spinal cord in affected animals. A presumptive diagnosis of feline gurltiosis can also be achieved based on data of compatible clinical signs and associated epidemiological risk factors. The aim of this preliminary study was to evaluate the commercial serological test Angio Detect TM® (IDEXX Laboratories) as a possible diagnostic method of feline gurltiosis in vivo. For the study, 10 domestic felines (Felis catus) which originated from a high endemic area of Southern Chile, were analyzed. All felines presented chronic paraparesis or severe paraplegia. Subsequently, commercial Angio Detect TM® serological tests for the detection of closely related Angiostrongylus vasorum in canids were performed according to manufacturer’s instructions. Conducted serological tests were positive in seven of ten felines showing paraplegia/paraparesis and presumably infected with G. paralysans, and four of them were additionally necropsied, and presented macroscopic findings compatible with feline gurltiosis. Furthermore, the presence of adult female and male G. paralysans specimens at the level of the subarachnoid vasculature in affected spinal cord segments were observed during necropsy. Histopathology demonstrated severe eosinophilic meningomyelitis, coagulopathies with thrombosis in G. paralysans-parasitized leptomeningeal veins. Results of this preliminary study suggest a cross-reaction between A. vasorum-specific antigens, which also parasitize blood vessels in vivo, and G. paralysans when using an Angio Detect TM® test, which suggests its helpful use as a new diagnostic method for feline gurltiosis in live domestic felines. Additional specific antigen research will be required in order to better understand the sensitivity and specificity of A. vasorum antigens used in this test and for existing cross-reactivity with G. paralysans-derived antigens for future a suitable intra vitam immunodiagnosis of neglected feline gurltiosis.
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Caza, Tabita Larisa, Ioana Andreea Dărămuș, B. C. Dumitrescu, V. Ciubotaru, and Ligia Gabriela Tătăranu. "AN UNUSUAL CASE OF CEREBELLAR VENOUS ANGIOMA ASSOCIATED WITH TEMPORAL CAVERNOMA – PATHOPHYSIOLOGICAL, DIAGNOSTIC, AND SURGICAL CONSIDERATIONS." Journal of Surgical Sciences 2, no. 4 (October 1, 2015): 198–203. http://dx.doi.org/10.33695/jss.v2i4.136.
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Cerebral vascular malformations are hamartomas, classified into four distinct groups:arteriovenous malformations, cavernous malformations, capillary telangiectasias, anddevelopmental venous anomalies. These abnormal vascular entities have distinct histopathological, radiological, and clinical features, which make them different from one another. We report a case of a 37-year-old man, who presented with headaches, generalized grand mal seizures, and an episode of loss of consciousness, due to a left temporal cavernoma. Gadolinium-enhanced T1-weighted MR images showed a left temporal “popcorn-like” lesion, with heterogeneousenhancement, measuring 15/17/18 mm, suggestive of a cavernoma (angiographically occultmalformation). The T2-weighted MRI showed a right cerebellar venous plexus, draining into alarger central vein and the angiogram revealed the pathognomonic caput medusae aspect of avenous angioma. Microsurgical resection of the left temporal cavernous malformation wasperformed using a left frontal temporal approach. The venous angioma was spared to avoid venousinfarction and cerebral edema with devastating vital consequences. The intra- and postoperativecourses were uneventful with total recovery. The seizures remitted under anticonvulsant therapy,and the postoperative computer tomography investigation were within normal limits. The venous angioma was situated in the right cerebellar hemisphere, rather than near the cavernoma, its location making this the particular aspect of this case.
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Haritoshkin, Dmitrij V., Alexej A. Yakovlev, Alexandra V. Yakovleva, Tatevik G. Loginova, and Elena E. Sidorova. "Features of interhospital transportation of patients requiring prosthetics of vital functions (on the example of the federal research and clinical center of intensive care medicine and rehabilitology)." Medical and Social Expert Evaluation and Rehabilitation 23, no. 4 (March 22, 2021): 23–27. http://dx.doi.org/10.17816/mser51029.
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One of the important features of patients in chronic critical illness is their need for prosthetics of vital functions. The provision of specialized medical care to all patients in need is impossible without resolving the issues of transportation to a specialized medical center. Inter-hospital transportation of resuscitated patients is one of the tasks of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. The greatest difficulty is the transportation of patients with unstable hemodynamics. The transportation service created in the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology is engaged in the development of issues of safe transport, including this category of patients by attracting organizational resources, forming a specialized team and equipping it. Medical and diagnostic, additional assessment of the patients condition on the spot. This approach makes it possible to increase the efficiency of intensive care during transportation and to eliminate mortality in this category of patients during transportation. Our experience of inter- and intra-hospital transportation of resuscitation patients was widely discussed at conferences, congresses and today is used in the work of mobile resuscitation teams.
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EL Sahili, Nabil, Ibrahim Nasseh, Antoine Berberi, Sandra David-Tchouda, Sophie Thoret, and Thomas Fortin. "Impact of Cone Beam Computed Tomography Dose in Pre-Surgical Implant Analysis." Open Dentistry Journal 12, no. 1 (January 31, 2018): 94–103. http://dx.doi.org/10.2174/1874210601812010094.
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Objectives: Cone-Beam Computed Tomography (CBCT) produces vital information required for the accurate and prudent placement of dental implants. Lack of standardization between CBCT machines may result in unsafe patient exposure to harmful radiation; higher doses are not necessarily associated with improved image quality. Aim: The study aimed to assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning. Methods: Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using a CBCT (Carestream CS 9300). Cross-sectional slices of both image qualities were evaluated by five expert clinicians, for image quality for implant planning and objective bone measurements. Results: There were no significant differences in bone measurements taken on high or low dose images (p > 0.05). In qualitative image assessments, assessment and image quality for almost all observers were independent of each other. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low and high dose images. Conclusion: Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient intra-rater reliability for qualitative assessment; therefore dose reduction can be achieved without compromising diagnostic decision- making.
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Boyko, V. I., and O. I. Butenko. "Fetus arrest of development at prematurely born pregnancy: diagnostics and prophylaxis of perinatal pathology." HEALTH OF WOMAN, no. 1(117) (February 28, 2017): 124–26. http://dx.doi.org/10.15574/hw.2017.117.124.
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The objective: to reduce the frequency of perinatal complications at pregnant women with a fetus arrest of development the pregnant at prematurely born pregnancy by improvement of the main diagnostic and treatment-and-prophylactic actions. Patients and methods. prospective research was conducted, we surveyed 120 patients, among which 90 pregnant women with syndrome of an arrest of development of a fetus who were divided by method of casual choice into two groups. Results. The use of the proposed treatment and preventive methods in pregnant women with premature birth at FGR allowed to significantly reduce the incidence of threatened abortion and placental dysfunction 1.3 times, genital tract disorders microbiocenosis 1.4 times, premature rupture of membranes by 1.4 times, the severity FGR syndrome 1.6 times, fetal distress is 1.3 times, 1.2 times of the COP, severe asphyxia in 3 times, intra-amniotic infection is 1.5 times, to change the structure of preterm birth (to prevent early preterm birth in 22–28 weeks). The overall incidence of infants in the early neonatal period, these pregnant women was significantly reduced by 1.3 times (p<0.05), but there were no perinatal loss. Conclusion. The received results: when using the technique of complex correction developed by us the dizadaptation of disturbances in fetoplacental complex at women who received algorithm offered by us, all structural mechanisms of adaptation of placenta which allow to keep morphometric and diffuse indicators of vorsine tree at level with firmness compensations that is the most important adaptive agent which allows to support vital activity of fetus turn on and to prevent development of serious degree of delay of its development. Key words: fetus arrest of development, prematurely born pregnancy, diagnostics, prophylaxis.
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White, Geoffrey H., Weiyun Yu, James May, Xavier Chaufour, and Michael S. Stephen. "Endoleak as a Complication of Endoluminal Grafting of Abdominal Aortic Aneurysms: Classification, Incidence, Diagnosis, and Management." Journal of Endovascular Therapy 4, no. 2 (May 1997): 152–68. http://dx.doi.org/10.1177/152660289700400207.
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The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon. Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively). Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures. Standardization of the terminology describing this important sequela to endovascular aneurysm exclusion should facilitate uniform reporting of clinical trial data vital to the evaluation of this emerging technique.
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ATHANASIOU (Λ.Β. ΑΘΑΝΑΣΙΟΥ), L. V. "Quality policy in the veterinary diagnostic laboratory; the paradigm of application of Good Laboratory Practice." Journal of the Hellenic Veterinary Medical Society 65, no. 3 (December 21, 2017): 139. http://dx.doi.org/10.12681/jhvms.15528.
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A quality system such as the Good Laboratory Practice (GLP) in a veterinary diagnostic laboratory is concerned with the organizational Nprocess and the conditions under which laboratory work is planned, performed, monitored, recorded, archived and reported. The key persons for applying a quality system are the Management (provides resources), the Director (overall responsibility for the technical conduct of analyses Nand for the interpretation, analysis and reporting of results) and the Quality Assurance Person (inspects operational phases and audits documents for the purpose of assuring management that the facilities, equipment, personnel, methods, practices, records and controls are in conformance not only with applicable rules and regulations but also with Standard Operating Procedures and Laboratory Protocols). Furthermore, the Standard Operating Procedures (SOPs) that govern all aspects of daily activities at the laboratory are an essential foundation for the production of reliable data as they, by definition, describe how to perform certain routine laboratory tests or activities. The standardization of methods used for a series of critical phases, such as storage and processing of samples is required in order to eliminate systematic errors and to improve the precision, specificity and long-range stability of laboratory performance.The correct identification of all samples needs to be systematically checked. For the validation of methods used, particularly in the absence of chemical standards it is helpful to employ inter- and mainly intra laboratory controls. Finally, the disposal of chemical substances and thesafety of the personnel are also of vital interest. All these principles are applicable to a veterinary diagnostic laboratory in order to promote the quality and validity of the data with ultimate goal the contribution to a reliable diagnosis.
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Demaerschalk, Bart, Patrick M. MacLeod, Donald H. Lee, Robert R. Hammond, Peter J. Ainsworth, Sherry K. Musyj, and Vladimir Hachinski. "A Canadian CADASIL Kindred: How sensitive is a skin biopsy?" Stroke 32, suppl_1 (January 2001): 331. http://dx.doi.org/10.1161/str.32.suppl_1.331-c.
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87 Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited arterial disease of mid-adulthood resulting from mutations of the Notch3 gene on chromosome 19. The presence of granular and osmiophilic material surrounding smooth muscle cells visualized under electron microscopy in a skin biopsy allows confirmation of the intra vitam diagnosis. The literature suggests that skin biopsy can establish the diagnosis with high certainty and that it be considered the diagnostic method of first choice. Until the sensitivity and specificity have rigorously been assessed, results from such tests should be interpreted with caution. Objective: To raise some concerns about the possible lack of sensitivity of skin biopsy in the early diagnosis of CADASIL by describing the second large Canadian kindred with this condition. Methods: All siblings of this family in which there was a clinical suspicion of CADASIL underwent neurological evaluation, magnetic resonance imaging (MRI), skin biopsy, and genetic testing. Findings: Nine siblings ranged in age from 40 to 63 years. Two (aged 60 and 62) presented with dementia, strokes, and depression, two (aged 58 and 63) presented with stroke and migraine with aura, three (aged 40, 48, and 51) presented with only migraine with aura, and two (aged 53 and 57) were asymptomatic. Eight consented to diagnostic evaluation. All eight siblings’ DNA-sequence analysis of the Notch3 gene revealed an Arg207Cys mutation in exon 4. All have MRI scans consistent with a diagnosis of CADASIL. Full thickness skin biopsies from all eight were submitted for histopathological and ultrastructural examination. Granular electron dense osmiophilic material was not found in any of the material submitted. Conclusions: In addition to providing an illustrative clinical example of the broad phenotypic variation of CADASIL in a Canadian kindred, this family demonstrates how insensitive the skin biopsy might be. The sensitivity and specificity of various non-genetic diagnostic tests such as skin and muscle biopsy must be rigorously assessed before claiming them as standards for screening or diagnosing CADASIL.
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Boss, Joseph D., Christopher T. Shah, Oladoyin Oluwole, and John N. Sheagren. "TB Peritonitis Mistaken for Ovarian Carcinomatosis Based on an Elevated CA-125." Case Reports in Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/215293.
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Background. In the United States, tuberculosis (TB) is of relatively low prevalence and most newly diagnosed patients are born outside of the United States. In addition, a large percentage (20.6%) of TB cases initially present with extrapulmonary manifestations (CDC, 2010). Cases of TB peritonitis are a diagnostic challenge in women due to the nonspecific clinical features overlapping with signs of ovarian cancer. (Kosseifi et al., 2009; Rashed et al., 2007; and Xi et al., 2010). We present a 27 year-old woman thought to have ovarian carcinomatosis based on elevated levels of CA-125 who was ultimately diagnosed with TB salpingitis, endometritis, and peritonitis.Methods. This brief report is a retrospective case report.Results. This case outlines the unfortunate consequences of the misdiagnosis of what probably was an antibiotic responsive illness, resulting in an unnecessarily aggressive surgical procedure. The delay in the diagnosis of tuberculous pertitonitis resulted in an unnecessary radical resection of the patient’s reproductive organs.Conclusions. Patients with TB peritonitis present with non-specific signs that may be misdiagnoses as ovarian cancer. In differentiating between ovarian carcinomatosis and peritoneal TB, it is vital to consider country of origin, age, CA-125, ascitic fluid analysis, and the use of intra-operative frozen sections.
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Nicholson, Kristina, Kenji Inaba, Dimitra Skiada, Obi Okoye, Lydia Lam, Daniel Grabo, Elizabeth Benjamin, and Demetrios Demetriades. "Management of Patients with Evisceration after Abdominal Stab Wounds." American Surgeon 80, no. 10 (October 2014): 984–88. http://dx.doi.org/10.1177/000313481408001016.
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In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. Demographics, admission vital signs, topography and contents of evisceration, Glasgow Coma Score, indications for exploration, and imaging and operative reports were abstracted. Clinical outcomes measured were: injuries identified on exploration, hospital length of stay, and mortality. Descriptive analysis was performed. Ninety-three patients with evisceration were identified. Ninety-two (98.9%) were male and 60 (64.5%) were Hispanic. Mean age was 31.9 ± 13 years. Forty-seven (50.5%) had evisceration of the omentum, 41 (44.1%) had evisceration of abdominal organs, and two (2.2%) had both. Seventy-four (80.4%) had positive laparotomies. Ten (10.8%) underwent computed tomography (CT) preoperatively. Sixty per cent of CT findings were congruent with operative findings. CT did not impact clinical management. In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients.
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Mathew, Elza Neelima, Miranda N. Hurst, Baolin Wang, Vaibhav Murthy, Yuntao Zhang, and Robert K. DeLong. "Interaction of Ras Binding Domain (RBD) by chemotherapeutic zinc oxide nanoparticles: Progress towards RAS pathway protein interference." PLOS ONE 15, no. 12 (December 16, 2020): e0243802. http://dx.doi.org/10.1371/journal.pone.0243802.
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Zinc oxide (ZnO) NP is considered as a nanoscale chemotherapeutic. Thus, the drug delivery of this inorganic NP is of considerable importance. Ras mutations are common in cancer and the activation of this signaling pathway is a hallmark in carcinoma, melanoma and many other aggressive malignancies. Thus, here we examined the binding and delivery of Ras binding domain (RBD), a model cancer-relevant protein and effector of Ras by ZnO NP. Shifts in zeta potential in water, PBS, DMEM and DMEM supplemented with FBS supported NP interaction to RBD. Fluorescence quenching of the NP was concentration-dependent for RBD, Stern–Volmer analysis of this data was used to estimate binding strength which was significant for ZnO-RBD (Kd < 10−5). ZnO NP interaction to RBD was further confirmed by pull-down assay demonstrated by SDS-PAGE analysis. The ability of ZnO NP to inhibit 3-D tumor spheroid was demonstrated in HeLa cell spheroids—the ZnO NP breaking apart these structures revealing a significant (>50%) zone of killing as shown by light and fluorescence microscopy after intra-vital staining. ZnO 100 nm was superior to ZnO 14 nm in terms of anticancer activity. When bound to ZnO NP, the anticancer activity of RBD was enhanced. These data indicate the potential diagnostic application or therapeutic activity of RBD-NP complexes in vivo which demands further investigation.
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Tambat, Anand R., and Ankita Chauhan. "Relationship of the Findings of Colour Doppler and Non-Stress Test with the Perinatal Outcome among the Cases of Intra-Uterine Growth Restriction." MVP Journal of Medical Sciences 3, no. 2 (November 17, 2016): 115. http://dx.doi.org/10.18311/mvpjms/2016/v3/i2/700.
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<strong>Introduction:</strong> Intrauterine growth restriction is the second most common cause of perinatal mortality and morbidity after prematurity. Etiologies can be maternal, fetal or placental. The correct detection of compromised IUGR fetus to allow timely intervention is a main objective of antenatal care. Many of IUGR patients presents in their third trimester for the first time for antenatal examination. Such patients warrant a highly sensitive and specific diagnostic test which can be noninvasively applied on a large scale. Apart from various other non-invasive tests like USG, NST, Doppler flow studies give us vital information regarding the fetus in utero. Hence the present study is aimed at exploring the association of colour Doppler and non-stress test findings with the perinatal outcome in the fetuses with IUGR. <strong>Aim:</strong> To study relationship of Doppler and NST with perinatal outcome in IUGR cases. <strong>Material and Methods:</strong> A Prospective observational study was conducted on 70 patients of IUGR from August 2013 to November 2015 in Department of Obstetrics and Gynaecology , Dr. Vasantrao Pawar Medical College, Hospital & Research Center. Inclusion criteria: Patients with diagnosed singleton pregnancies with IUGR at gestational age more than 32weeks not in labour. Exclusion criteria: Patients with congenital anomalous fetus, diabetes or acute placental insult. Patients were followed up with serial Umbilical artery Doppler and NST. Perinatal outcome was correlated with the last Doppler and NST within 7days prior to delivery. <strong>Results:</strong> Perinatal outcome is worst in patients with both NST and Doppler are abnormal and best among patients with both normal NST and Doppler. <strong>Conclusion:</strong> Doppler predicts fetal compromise earlier as compared to NST.
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Klevno, V. A., Yu V. Chumakova, O. A. Korotenko, D. I. Sandu, and S. E. Dubrova. "VIRTOPSY FOR STUDYING THE SUDDEN DEATH OF AN ADOLESCENT." Russian Journal of Forensic Medicine 6, no. 1 (March 26, 2020): 41–45. http://dx.doi.org/10.19048/2411-8729-2020-6-1-41-45.
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The article discusses the application of pre-autopsy computed tomography (Virtopsy) for studying the sudden death of an adolescent with undiagnosed Marfan syndrome.Aim. To identify the capabilities of the pre-autopsy computed tomography (CT) in determining the cause of the sudden death of an adolescent, as well as the extent of injuries, if present.Material and methods. A CT scan was obtained at the Department of Diagnostic Radiology of a district hospital using a modern multifunctional CT scanner Siemens SOMATOM Perspective (64-slice configuration, slice width of 1.5 mm).Results. The forensic medical examination revealed the following information about the corpse: asthenic body type, a height of 178 cm, long extremities, thin and long spider-like fingers, pectus excavatum, little fat beneath the skin and poor muscle development; blood in the pericardium, rupture of the dissecting aneurysm of the ascending aorta. The histological examination of the aorta revealed its dramatic thinning, fragmentation of the elastic fibres along with the alteration of the elastic framework, fragmentation and poor development of muscle fibres in the media. A CT scan showed the rupture of the dissecting aneurysm of the ascending thoracic aorta with para-aortic haematoma and cardiac tamponade.Conclusion. The analysis of obtained data allowed us to diagnose a multisystemic disorder of connective tissue (Marfan syndrome) undiagnosed intra vitam. The sudden death was caused by the rupture of the dissecting aneurysm of the ascending aorta which is a complication of the congenital genetic pathology.Intravitam CT or MRI scans of children being at risk of the multisystemic disorder of connective tissue will help detect pathological changes in the aortic wall and perform cardiac surgery promptly which would significantly increase the length of life and improve its quality for such patients.
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Stojsin, Ivana, Ljubomir Petrovic, Igor Stojanac, and Milan Drobac. "Multi-factoriality of dentine hypersensitivity." Medical review 61, no. 7-8 (2008): 359–63. http://dx.doi.org/10.2298/mpns0808359s.
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Introduction. Dentine hypersensitivity has been defined as a sharp, short pain arising from exposed dentin in response to stimuli typically thermal, evaporative tactile, osmoticor, chemical and which cannot be ascribed to any other form of dental defect or pathology. Prevalence. The most affected patients range in age from 20 to 40. The following teeth tend to be most sensitive: cuspids, premolars and incisors, location-concentrated on the facial surface. Morphological bases of dentine hypersensitivity Sensitive teeth have much greater numbers of open tubules per unit area and the average diameter of tubules is almost 2 times greater than tubules in nonsensitive teeth. Mechanisms of dentine hypersensitivity. The most widely accepted theory of how the pain occurs is Brannstroms theory. Etiology Dentine hypersensitivity represents a condition of presumable multifactorial pathology. Two processes are essential for its development: (1) dentin must be exposed through either genetic disturbance, enamel defect (lamellae, tufts and spindles), loss of enamel (erosion, abrasion, attrition, abfraction), gingival recession with rapid loss of cementum and (2) the dentin tubules must be open to both the oral cavity and the pulp. Diagnosis. Diagnostic protocol for this condition consisted of Medical, Dental Dietary, Oral Hygiene History and Intra-oral examinations with air indexing method. Differential Diagnosis: We must take into consideration a number of variables such as: dental caries, cracked tooth, restorative sensitivity, medication sensitivity, bleaching sensitivity and abscessed or non-vital tooth. Conclusion. Dentin hypersensitivity is a problem that bothes many patients. Many conditions share the symptoms of tooth sensitivity so differential diagnosis is essential for suitable treatment or preventive measures.
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Aref, Mohamed, Abou-Bakr Youssef, and Ibrahim El-Sharkawy. "Characterization of Normal and Malignant Breast Tissues utilizing Hyperspectral Images and Associated Differential Spectrum Algorithm." Journal of Biomedical Photonics & Engineering 7, no. 2 (May 6, 2021): 020302. http://dx.doi.org/10.18287/jbpe21.07.020302.
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Breast malignancy is the most pervasive disease and a significant reason for death in women around the world. Recently, Photonic technologies play a vital role in medical applications. This study presents an outline of recent outcomes on the magnitude of breast tissue optical properties. We established an optical system setup utilizing a hyperspectral (HS) camera with poly-chromatic source lights with wavelength (380~1050 nm) for this investigation. Measuring the diffuse reflection (Ŗd) of the investigated ex vivo breast sample to select the optimum spectral image to differentiate between the normal and tumor in the near infra-red and visible (NIR–VIS) spectrum. Finally, applying the custom algorithm to increase the image contrast and applying contour delineation of the malignant regions. The experimental analysis indicates key spectroscopic variations between normal tissue and malignant region in range (550~650 nm). Although, after data normalization, there was noticeable variation at three ranges (630–680 nm), (720–770 nm), and (830–880 nm). The calculated standard deviation (Şd) between the normal and cancer tissue to validate the selective ranges shows that the highest contrast at wavelength 680 nm. However, the histogram analysis illustrates that the spectral image at 600 nm was higher contrast and wavelength 400 nm was the lowest contrast from the select seven-spectral images (400, 500, 600, 700, 800, 900, 1000 nm) to avoid the processing time of the captured HS 128-frames. The proposed potential method could provide promising results on the investigated breast sample optical properties in the diagnostic applications to assist the pathologist and the surgeon. Where the optimum wavelength at 680 nm for diagnostic applications and the ideal spectral image at 600 nm discriminate between the normal and malignant tissue.
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Loh, Hui Wen, Chui Ping Ooi, Jahmunah Vicnesh, Shu Lih Oh, Oliver Faust, Arkadiusz Gertych, and U. Rajendra Acharya. "Automated Detection of Sleep Stages Using Deep Learning Techniques: A Systematic Review of the Last Decade (2010–2020)." Applied Sciences 10, no. 24 (December 15, 2020): 8963. http://dx.doi.org/10.3390/app10248963.
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Sleep is vital for one’s general well-being, but it is often neglected, which has led to an increase in sleep disorders worldwide. Indicators of sleep disorders, such as sleep interruptions, extreme daytime drowsiness, or snoring, can be detected with sleep analysis. However, sleep analysis relies on visuals conducted by experts, and is susceptible to inter- and intra-observer variabilities. One way to overcome these limitations is to support experts with a programmed diagnostic tool (PDT) based on artificial intelligence for timely detection of sleep disturbances. Artificial intelligence technology, such as deep learning (DL), ensures that data are fully utilized with low to no information loss during training. This paper provides a comprehensive review of 36 studies, published between March 2013 and August 2020, which employed DL models to analyze overnight polysomnogram (PSG) recordings for the classification of sleep stages. Our analysis shows that more than half of the studies employed convolutional neural networks (CNNs) on electroencephalography (EEG) recordings for sleep stage classification and achieved high performance. Our study also underscores that CNN models, particularly one-dimensional CNN models, are advantageous in yielding higher accuracies for classification. More importantly, we noticed that EEG alone is not sufficient to achieve robust classification results. Future automated detection systems should consider other PSG recordings, such as electroencephalogram (EEG), electrooculogram (EOG), and electromyogram (EMG) signals, along with input from human experts, to achieve the required sleep stage classification robustness. Hence, for DL methods to be fully realized as a practical PDT for sleep stage scoring in clinical applications, inclusion of other PSG recordings, besides EEG recordings, is necessary. In this respect, our report includes methods published in the last decade, underscoring the use of DL models with other PSG recordings, for scoring of sleep stages.
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Pavlik, I., F. Bures, P. Janovsky, P. Pecinka, M. Bartos, L. Dvorska, L. Matlova, K. Kremer, and D. Van Soolingen. "The last outbreak of bovine tuberculosis in cattle in the CzechRepublic in 1995 was caused by Mycobacterium bovis subspecies caprae." Veterinární Medicína 47, No. 9 (March 30, 2012): 251–63. http://dx.doi.org/10.17221/5832-vetmed.
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The last outbreak of bovine tuberculosis in cattle in the CzechRepublic was detected in 1995. Signs of diarrhoea, weight loss and occasional coughing appeared in one 14-year-old cow after giving birth for the thirteenth time. Two months after these symptoms had been observed, it had to be slaughtered and numerous tuberculous lesions were found in its lung tissue, including the pleura. Within three months after the confirmation of the infection and consecutive intra-vitam and post-mortem diagnostics, all 28 remaining head of cattle from the herd (nine cows, seven bulls, six heifers and six calves) and five pigs were slaughtered. Patho-anatomical lesions were detected in all animals indicative of tuberculosis, from which Mycobacterium bovis was cultured and identified on the basis of biochemical tests and virulence test in a guinea-pig. The culture of 33 samples of other biological material than tissues (milk and urine of cows, feeding water, scrapings from the shed, fodder and others) resulted in M. bovis being detected in three samples (scrapings from shed walls). By the spoligotyping method M. bovis subsp. caprae was found in six selected isolates originating from two cows, two heifers and two bulls. It may therefore be assumed that there was one source of infection in the herd, which was the first infected old cow. In comparison with 3 176 spoligotypes in the existing database RIVM (National Institute of Public Health and the Environment, Bilthoven, The Netherlands) and literary data it was found that this spoligotype was also found in Sweden, Belgium, Great Britain, Spain, Poland, Germany and the CzechRepublic. It was impossible to determine the source of M. bovis subsp. caprae of the first infected cow on the basis of results from database and from anamnestic data. Green fodder coming from the farmer’s pastures near a forest could be considered as a possible source of M. bovis from wild ruminants like red deer (Cervus elaphus), which was found infected with bovine tuberculosis in another district of the CzechRepublic in 1991.
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Berezowska, Sabina, Andreas Schmid, Tereza Losmanová, Mafalda Trippel, Annika Blank, Yara Banz, Stephan M. Jakob, and Rupert Langer. "Frequency and Significance of Pathologic Pulmonary Findings in Postmortem Examinations—A Single Center Experience before COVID-19." Diagnostics 11, no. 5 (May 18, 2021): 894. http://dx.doi.org/10.3390/diagnostics11050894.
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Coronavirus disease 2019 (COVID-19) has shown the importance of postmortem investigation of deceased patients. For a correct interpretation of the pulmonary findings in this new era, it is, however, crucial to be familiar with pathologic pulmonary conditions observed in postmortem investigations in general. Adequate postmortem histopathological evaluation of the lungs may be affected by suboptimal gross work up, autolysis or poor fixation. Using a standardized preparation approach which consisted in instillation of 4% buffered formaldehyde through the large bronchi for proper fixation and preparing large frontal tissue sections of 1–2 cm thickness after at least 24 h fixation, we comprehensively analyzed postmortem pulmonary findings from consecutive adult autopsies of a two-year period before the occurrence of COVID-19 (2016–2017). In total, significant pathological findings were observed in 97/189 patients (51%), with 28 patients showing more than one pathologic condition. Acute pneumonia was diagnosed 33/128 times (26%), embolism 24 times (19%), primary pulmonary neoplasms 18 times (14%), organizing pneumonia and other fibrosing conditions 14 times (11%), pulmonary metastases 13 times (10%), diffuse alveolar damage 12 times (9%), severe emphysema 9 times (7%) and other pathologies, e.g., amyloidosis 5/128 times (4%). Pulmonary/cardiopulmonary disease was the cause of death in 60 patients (32%). Clinical and pathological diagnoses regarding lung findings correlated completely in 75 patients (40%). Autopsy led to confirmation of a clinically suspected pulmonary diagnosis in 57 patients (39%) and clarification of an unclear clinical lung finding in 16 patients (8%). Major discrepant findings regarding the lungs (N = 31.16%) comprised cases with clinical suspicions that could not be confirmed or new findings not diagnosed intra vitam. A significant proportion of acute pneumonias (N = 8; 24% of all cases with this diagnosis; p = 0.011) was not diagnosed clinically. We confirmed the frequent occurrence of pulmonary pathologies in autopsies, including inflammatory and neoplastic lesions as the most frequent pathological findings. Acute pneumonia was an important cause for discrepancy between clinical and postmortem diagnostics
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Abd El Baky, Hend, Richard D. Thomas, Joseph Kuechle, and Rabheh Abdul-Aziz. "Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis." Case Reports in Rheumatology 2020 (August 28, 2020): 1–4. http://dx.doi.org/10.1155/2020/8810735.
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Osteoid osteoma (OO) is a benign bone tumor that usually presents between 10 and 35 years of age. The metaphysis and diaphysis of the femur and tibia are the typical locations. The diagnosis is usually straightforward when images reveal a radiolucent nidus surrounded by reactive sclerosis. However, the diagnosis is more difficult when it occurs at atypical locations with nonspecific and misleading appearance on images. OO may mimic juvenile idiopathic arthritis (JIA), bone infection, or malignancy. We present a 14-year-old male with a 4-month history of left hip pain. His pain was worse with playing hockey and lacrosse and in the morning and sometimes woke him up at night. His examination was significant for pain with flexion and external rotation of the left hip and for mild limitation of full external rotation. Blood work revealed normal complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Left hip X-ray was unremarkable. Left hip MR arthrogram showed marked edema of the medial and posterior walls of the left acetabulum. CT-guided biopsy of the left acetabulum showed unremarkable flow cytometry and chronic inflammatory component raising concern about chronic recurrent multifocal osteomyelitis (CRMO). Bone scan revealed focal increased uptake in the left acetabulum and no additional abnormality. Repeat MRI with intravenous contrast showed a left hip effusion, focal synovial enhancement in the medial left hip, and acetabula edema. The patient failed treatment for presumed JIA and CRMO with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate, and adalimumab. CT scan of the left hip was performed for further evaluation of the bone and showed 11 × 6 mm low attenuation focus with subtle internal nidus in the posteromedial aspect of the acetabular rim, suggestive of intra-articular OO. Radiofrequency ablation was performed with no complications, and the left hip pain improved. The atypical location resulted in delay of diagnosis for 12 months after presentation. We highlight the diagnostic pitfalls observed in atypical OO locations and the difficulties this creates with making the diagnosis. OO mimicking JIA has previously been described. We submit CRMO as another differential diagnosis which may be mimicked and demonstrate the vital role of CT scan in the diagnosis.
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Zabotti, A., I. Giovannini, S. Z. Callegher, V. Manfrè, M. Lorenzon, E. Pegolo, C. A. Scott, et al. "POS0735 ULTRASOUND-GUIDED CORE NEEDLE BIOPSY FOR SALIVARY GLAND ENLARGEMENT IN SJÖGREN’S SYNDROME: PROCEDURE SAFETY AND PATIENT TOLERANCE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 618–19. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1804.
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Background:Persistent enlargement of major salivary glands (SGs) is one of the main risk factors for B-cell lymphoma in primary Sjögren’s syndrome (pSS). The Ultrasound-guided Core Needle Biopsy (US-guided CNB) could be a novel technique for the management of SGs enlargement in pSS (1).Objectives:To evaluate the procedure safety and the patient tolerance of US-guided CNB in pSS patients with major SGs enlargement.Methods:Consecutive patients, with either definite or clinically suspected pSS, and with clinical indication for SGs biopsy due to persistent glandular enlargement were screened for US-guided CNB from September 2019 to December 2020. All patients were evaluated clinically between 1 and 2 weeks and 12 weeks following US-guided CNB. All patients were asked to complete a questionnaire to report post-procedural complications (Figure 1, English version) and intra- and post-procedural pain Visual Analogue Scale (VAS). The complications were classified as transient (<12 weeks) or persistent (≥12 weeks).Results:US-guided CNB was performed in 21 glands (12 parotid and 9 submandibular glands) in 20 pSS patients. 16/20 (80%) patients fulfilled the ACR-EULAR classification criteria for pSS (2). The mean age at the time of biopsy was 62.1 (±11.7) years. US-guided CNB was well tolerated, no long-term complications were reported in the follow-up period (mean 9.5 ±5.7 months). Only transient complications were noticed in 11 patients (55%). In particular, two cases of local swelling at the biopsy site lasting no more than 6 days, one case of local bleeding and subsequently hematoma of the submandibular area, one case of transient facial paresis (lasting less than one hour), seven cases of post-procedural mild local pain, that resolved within 10 days without the need of analgesics (Table 1). The procedure was well tolerated, with a very low reported intra-operative pain (mean VAS 1.74 ±2.49) and a mean post-operative pain VAS of 1.39 (±2.33). The biopsy sampling was diagnostic in 19/20 patients (95%).Conclusion:US-guided CNB represents a novel approach for the management of pSS patients with SGs enlargement. This procedure shows a remarkable patient safety and tolerance, allowing an adequate glandular sampling and definite diagnosis in almost all the studied patients.References:[1]Zabotti A, Zandonella Callegher S, Lorenzon M, Pegolo E, Scott CA, Tel A, et al. Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome? Rheumatology (Oxford) 2020.[2]Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X; International Sjögren’s Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017 Jan;69(1):35-45. doi: 10.1002/art.39859. Epub 2016 Oct 26. PMID: 27785888; PMCID: PMC5650478.Table 1.Description of complicationsComplications of US-guided CNBPatients presenting complications, n/N (%)11/20 (55%)Description of transient complicationsSwelling at biopsy site, n2Bleeding, n1Hematoma, n1Local Pain, n7Local infection, n0Sialocele or fistula, n0Anaesthesia/paraesthesia, n0Transient facial palsy (< 1 hour), n1No persistent complications reportedAll the above specified complications were transient (< 12 weeks). No persistent complications were reported in the follow up.Figure 1.Post-biopsy complication QuestionnaireDisclosure of Interests:Alen Zabotti Speakers bureau: UCB, Novartis, Janssen, Paid instructor for: Amgen, Consultant of: Janssen, Ivan Giovannini: None declared, Sara Zandonella Callegher: None declared, Valeria Manfrè: None declared, Michele Lorenzon Consultant of: not relevant for this study, Enrico Pegolo: None declared, Cathryn Ann Scott: None declared, Alessandro Tel: None declared, Massimo Robiony Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Chiara Zuiani Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Salvatore De Vita Consultant of: GSK, Roche, Grant/research support from: not relevant for this study
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Chaudhry, Muhammad M., Tokir Mujtaba, Zeyar Thet, and Frank W. DiPillo. "Agressive Lymphoma without Lymphadenopathy." Blood 112, no. 11 (November 16, 2008): 5291. http://dx.doi.org/10.1182/blood.v112.11.5291.5291.
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Abstract Hepatosplenic T cell lymphomas are among a rare breed of aggressive non Hodgkin tumors that usually comprise of immature cytotoxic T cells. They most commonly involve young adults who generally present with constitutional symptoms of fever, weight loss and night sweats. Diagnosis can be challenging in the absence of lymphadenopathy and paucity of bone marrow findings. The discovery of neoplastic cells in peripheral blood is often a finding late in the clinical course. Demonstation of sinusoidal infiltration of T cells on either liver or splenic biopsy is ususally diagnostic. These cells are positive for clonal rearrangement of the γ gene of the T cell receptor which is a hallmark of this disease. Prognosis remains poor and most patients die within two years of diagnosis. We report a case of a patient who presented with unexplained fever and hepatosplenomegaly and after extensive workup was diagnosed with hepatosplenic T cell lymphoma. A 42 year old male with no significant past medical history presented with complains of abdominal pain, fever, malaise and 30lb weight loss over a period of six weeks. Pain was described as intermittent episodes of bilateral flank fullness associated with nausea and vomiting. He had traveled to Mexico 8 weeks earlier and according to him his symptoms began soon after his trip. He denied any headaches, cough, shortness of breath,. No dysuria, and no diarrhea. No smoking alcoholism or illicit drug use was reported. No sick or new sexual contacts. Family history was noncontributory. Vital signs were significant for temperature of 101 F. Physical examination revealed presence of marked hepatosplenomegaly. There was no lympadenopathy as well as no murmurs or rubs. Labs showed pancytopenia with blood counts of 2.7, 9.8 and 101 for WBC, Hb and platelets respectively. Additionally, alkaline phosphatase was elevated while rest of the liver functions was normal. Preliminary diagnosis of infectious versus malignant etiology was made. Peripheral smear did not show any malignant cells. Infectious workup returned negative for HIV, hepatitis, histoplasma, brucella, leptospira, coccidioidomycosis, syphilis, leishmaniasis as well as malaria and dengue fever. A bone marrow biopsy was performed for further evaluation and showed moderately hypercellular bone marrow with erythroid and megakaryocytic hyperplasia but no evidence of malignancy or granulomatous process. Meanwhile patient remained persistently febrile without any growth on blood cultues. An echo was normal with no evidence of endocarditis. Tuberculin test was non reactive. Given the results of the bone marrow biopsy and hepatosplenomegaly without any lymphadenopathy it was thought that a localized infiltrative process of he liver or spleen was likely. Patient thus underwent a liver biopsy disclosing intra sinusoidal collections of atypical CD3, CD7, TIA-1 and CD56 positive lymphocytes also bearing T cell receptor clonal rearrangement consistent with a diagnosis of hepatosplenic T-cell lymphoma which was further classified as gammadelta type.. He was subsequently started on ECHOP regimen and is currently in remission on a three month followup Hepatosplenic lymphoma, though is a rare tumor, should be considered in patients with unexplained hepatosplenomegaly without lymphadenopathy and normal peripheral smear. Liver biopsy is diagnostic most of the time.
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Sharma, Sunny, Pankaj K. Singh, Nikita Raman, Vaibhav K. Singh, Saifullah Akhtar, and Prabhat Mishra. "Cone-beam Computed Tomographic Evaluation of the Anatomical Changes of Temporomandibular Joint Use of Pre-post Dentures: A Time-control Study." Journal of Contemporary Dental Practice 21, no. 12 (2020): 1354–60. http://dx.doi.org/10.5005/jp-journals-10024-2987.
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ABSTRACT Aim and objective The growth of the temporomandibular joint (TMJ) gets affected by multiple factors like aging, occlusion state, and by the movement of the jaw while masticating and swallowing. Radiographic imaging is often utilized as a vital diagnostic adjunct in the evaluation of certain examinations of the TMJ. Materials and methods In this in vivo study, 30 male participants with mean age 55 years, having edentulous maxillary and mandibular arches from the Outpatient Department of Prosthodontics, were randomly selected. Group I (n = 30) patients who were edentulous for the last 4–5 years but without wearing dentures. Whereas group II (n = 30) patients who were edentulous for the last 4–5 years but were wearing dentures for this period. Maxillary and mandibular dentures were fabricated and delivered to subjects. Subjects were subjected to the TMJ analysis with the help of CBCT. Radiological images of dentomaxillofacial structures were analyzed by a specialist with a dual monitor inside a darkened silent room. On the monitor, three times measurements were recorded followed by calculation of mean value. The recordings were taken on both sides and thus, 210 sites were analyzed altogether, followed by the statistical analysis using SPSS software version 15.0. Results The mean ages of group I and II were 59.00 ± 6.74 and 58.27 ± 6.75 years, respectively. The intra- and intergroup comparisons were done using a one-sample t-test. Differences in mean intercondylar width in groups I and II were not found to be statistically significant. The difference in mean length of glenoid fossa was not statistically significant at any of the above observation periods. A continuous decline in mean length of glenoid fossa was observed with time in both groups. The range of change in articular eminence length was found to be statistically significant for both the groups (p < 0.05). Conclusion This study shows that the articular eminence flattening is correlated with age; on the other hand, the rate of deformation was found significantly more in total edentulous subjects as compared to subjects having normally maintained occlusion. The anatomical changes inside the TMJ have been much greater expressed within the completely edentulous subjects in whom the angle of sagittal condyle path declines and so does the articular eminence height. Clinical significance It is essential to provide the edentulous patient with early prosthetic and occlusal rehabilitation after extractions to prevent the anatomical changes in TMJ. How to cite this article Singh PK, Raman N, Singh VK, et al. Cone-beam Computed Tomographic Evaluation of the Anatomical Changes of Temporomandibular Joint Use of Pre-post Dentures: A Time-control Study. J Contemp Dent Pract 2020;21(12):1354–1360.
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Elmaaz, Ahmed, Alberto Antonio Franco Akel, and Regina Belokovskaya. "Bilateral Adrenal Adenomas Attributed to Extrapulmonary Mycobacterium Tuberculosis." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A118—A119. http://dx.doi.org/10.1210/jendso/bvab048.238.
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Abstract Introduction: Adrenal infections are rare, with the Mycobacterium tuberculosis (MTB) being the most common causative agent in the developing world. MTB usually spreads to the adrenal glands hematogenously where it may be clinically manifested years after systemic infection. Here, we present a case of bilateral adrenal MTB infection associated with MTB peritonitis. Case Presentation: A 46-year-old male, from Ecuador, without significant medical history and no medical follow-up presented to the emergency room with a two-week history of abdominal pain, nausea, diarrhea, and significant weight loss. He denied fever, cough, or night sweats. No smoking, alcohol, or illicit drug use. He works as a construction worker without a history of sick contacts. Vital signs were stable, with abdominal distension and fluid shifting dullness on exam. Blood work revealed leucocyte count of 5.58K (4-11K), INR 1.2 (0.9–1.1), Sodium 132 mEq/L (136–145 mEq/L) with albumin 3.3 mg/dL (3.5–5.2 mg/dL), total bilirubin level, 1.3 mg/dL (0–1.2 mg/dL), and AST and alkaline phosphatase levels, 73 U/L (0–40 U/L) and 186 U/L (40–129 U/L) respectively. Computerized tomography (CT) of the abdomen showed large ascites, omental nodularity, calcified gall bladder, bilateral adrenal nodules, and multiple abdominal lymphadenopathies. Chest CT revealed right apical reticulonodular densities. A diagnostic paracentesis revealed an exudative effusion with serum ascites albumin gradient of 0.7, and negative acid fast bacilli (AFB) and adenosine deaminase enzyme. Ascitic cellular analysis was negative for malignant cells. AFB blood and sputum cultures were negative, though Quantiferon gold test was positive and a skin tuberculin test was 13x13mm. Tumor markers CA19-9, CEA, and alpha-fetoprotein came back negative. Additionally, serum aldosterone, plasma metanephrines, DHEA-S, AM Testosterone, ACTH, and morning cortisol levels were normal. The patient had a negative 1-mg dexamethasone suppression test. Positron emission tomography (PET) scan showed a hypermetabolic left adrenal mass (4.9x3.2 cm) and nodular peritoneum with no fluorodeoxyglucose (FDG) uptake in the enlarged abdominal lymph nodes. Peritoneal biopsy analysis revealed non-caseating granuloma positive for MTB. The adrenal biopsy was not performed given the extensive intra-abdominal disease. The patient was started on anti-MTB treatment (Isoniazid, rifampicin, pyrazinamide, and ethambutol) with significant clinical improvement and a slight decrease in the adrenal masses following abdominal imaging. Conclusion: Extrapulmonary MTB should be part of a differential diagnosis for bilateral adrenal masses. Adrenal glands could be infected by a variety of pathogenic microorganisms either by direct contact or hematogenous dissemination. A high index of suspicion is required for the diagnosis of MTB in patients with atypical presentation.
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al Saleh, Mahasen, Tarek Owaidah, Abdulrahman Al Musa, Hazzaa Al-Zahrani, Suleman Al-Sweedan, Nicy Joseph, Rubina Malik, Khawar Siddiqui, Sohaib Zulfiqar, and Rafat Jafri. "Rare Inherited Clotting Factor Deficiencies in Paediatric Population Single Tertiary Centre Experience in Saudi Arabia." Blood 124, no. 21 (December 6, 2014): 5064. http://dx.doi.org/10.1182/blood.v124.21.5064.5064.
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Abstract BACKGROUND The rare coagulation disorders are heritable abnormalities of hemostasis that may present significant difficulties in diagnosis and management to hemophilia center clinicians. The common feature shared by these disorders is that their overall population frequency is low (with the exception of factor XI deficiency). Consequently, diagnosis and monitoring of affected individuals may require specialist phenotypic and molecular investigations that are not widely available. There may be considerable inter-individual variation in bleeding phenotype amongst affected individuals resulting at least in part from the molecular heterogeneity of the rare coagulation disorders. The bleeding risks in affected individuals may therefore be difficult to assess. Coagulation factor support may require the prescription of unlicensed treatment products that are not readily available. Although the rare coagulation disorders are uncommon, most hemophilia centers will have a handful of individuals with one or more disorders. Some centers may have significant number of affected individuals because of the prevalence of these disorders in populations in which consanguineous marriage is common. AIMS To determine the prevalence, clinical profile and treatment outcome of Rare Bleeding Disorders (RBD) in pediatric patients seen at King Faisal Specialist Hospital and Research Centre, Saudi Arabia from 2005-2014 METHODS We are presenting results of a descriptive study where we retrospectively reviewed the charts of the pediatric patients with RBD treated at our facility from 2005 to June 2014. RESULTS Of 39 pediatric (≤14 years) patients profiles reviewed, 54%(21) were females. Median age at diagnosis was 5 years (0.1-14). 78.4% (29/37) had a positive family history of RBD and 96% (24/25) parents with consanguineous marriages. Family history of RBD was most common in Factor XIII deficiency (31%) followed by Factor II (24.1%). Factor XIII deficiency was seen in 15 cases (38.5%), followed by Factor II Deficiency in 7 (17.9%) and Factor VII in 6 (15.4%). 4% (1/25) were found to be HBsAg positive. Hepatitis C screening was done in 66.7%, all (26) were negative. Umbilical cord bleeding was the most common bleeding (8/14, 57%) followed by circumcision bleeding (7/18, 38.9%) seen in patients at their first visit to the physician. 47.4% (9/19) had post-trauma bleeding with 42.1%(8/19) as spontaneous. While on follow-up, 12.8% (5/39) needed at least one blood transfusion and 5.1% (2/39) received at least one platelets transfusion. 47.4% (9/19) had episode of ecchymosis, while one had muscle bleed and two intra-cranial hemorrhage. Six (6) ICU admissions were recorded. Developmental delay was seen in 2 cases. Treatment modality included FFP (64.7%), tranexamic acid (44.4%) and iron supplementation (25.7%). One received hormonal contraceptives. One female patient with FVII died of abdominal hemorrhage four years after the diagnosis. All remaining patients in the cohort were alive at the time of last update to the data set. CONCLUSION In Saudi Arabia, the RBDs are uncommon coagulation problems probably due to under diagnosis of the patients living in remote areas. However in our cohort of pediatric patients, FXIII was the most common RBD presenting with serious bleeding manifestations. Precise knowledge about RBDs, their clinical presentation, diagnostic work-up and treatment options is vital to accurately diagnosing these patients and providing optimal treatment in pediatric patient population. Disclosures No relevant conflicts of interest to declare.
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Onofre, Rubiliza DC, and Rene Louie C. Gutierrez. "Orbital Floor Fracture Reconstruction Using Conchal Auricular Cartilage Graft." Philippine Journal of Otolaryngology-Head and Neck Surgery 25, no. 2 (December 3, 2010): 42–45. http://dx.doi.org/10.32412/pjohns.v25i2.635.
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Orbital wall fractures result from external impact injuries which cause an abrupt increase in intraorbital pressure.1 Patients usually present to the emergency room with periorbital swelling and limited eye movements, with or without changes in vision. Relatively common in the Philippines, these fractures are frequently caused by violent assault followed by vehicular accidents involving motorcycles.2 Among 119 maxillofacial trauma cases seen and treated by the Department of Otorhinolaryngology of the East Avenue Medical Center from 2008-2009, 42 were diagnosed as cases of orbital fractures with 36% having concomitant involvement of the orbital floor. Various techniques in diagnosis and treatment developed in the past 20 years, each having its own strengths and weaknesses. The challenge of choosing which among these methods will best achieve the goals of function and aesthetics always confronts surgeons, particularly in a developing country setting.
We present a case of bilateral orbital floor fractures with diplopia repaired with conchal auricular cartilage graft in a 22 year old female.
CASE REPORT
A 22 year old female was immediately brought to our emergency room following a head-on collision with an Asian utility vehicle while driving a motorcycle without a helmet. She was conscious and coherent with stable vital signs.
On examination, contusion hematomas were noted over both periorbital areas. Visual acuity was 20/30 OD and 20/40 OS with bilateral limitations of extraocular muscle movement. Bilateral ocular pressures were measured at 14.6 mmHg. Craniofacial CT Scans revealed linear frontal bone fractures with subdural hemorrhages and pneumocephalus in the frontal area, fractures of the calvarial bones, lateral orbital walls, inferior orbital rims and orbital floors (Figure 1). A mannitol drip was started for the hemorrhage.
She developed a persistent headache and binocular vertical diplopia with monocular diplopia, OS on the left gaze accompanied by pain on lateral left duction. Visual acuity was 20/25 OU. On the 17th hospital day, she underwent open reduction and internal fixation of multiple facial fractures using titanium plates and screws with reconstruction of both orbital floors using conchal cartilage autografts. The right eye diplopia resolved on the third postoperative day while the diplopia on left lateral downward gaze in the left eye resolved from the ninth postoperative day until the day of discharge.
There was complete resolution of diplopia and improvement in visual acuity to 20/20 OD and 20/25 OS on follow up at one year.
DICUSSION
Orbital floor fractures are relatively common midfacial injuries encountered in urban areas2 and were first described by Smith and Regan in 1957.1 Since then, many articles have been written about their diagnosis and treatment, including indications and optimal time for surgery as well as optimal surgical methods.1 Epidemiological studies reveal that despite different settings, the majority of cases involve the young male population with violent assault as the most prominent etiology accounting for 37.8% of orbital blowout fractures; motor vehicle accidents came in at second with 17.6%.; with the remaining fractures resulting from athletics (14.1%).2 To our knowledge, local reports have not been published but similarities in profile can be deduced.
Orbital floor fractures, also known as blowout fractures, imply that the orbital rims have remained intact, whereas one or more walls of the orbit, typically the floor has fractured.3 Orbital floor fractures can be classified into pure and impure according to extent of bone involvement (Table 1). Pure blowout fractures are fractures of the floor not involving the rim while impure blowout fractures have rim extension.3 Pure orbital floor fractures are further classified as trapdoor or non-trapdoor. Trapdoor fractures are those in which either edge of the inferior orbital wall is attached to its original position, while non-trapdoor fractures are those in which the inferior orbital wall is completely separated from its original position and the periorbital tissue has prolapsed into the maxillary sinus1 (Figure 2). These fractures can be also be classified by location: anterior, posterior and anteroposterior1,4 (Figure 3). Our patient presented with non trapdoor type orbital floor fractures measuring 10 x 4 mm on the right and 10 x 5mm on the left.
Patients with orbital floor fractures often complain of blurred vision and pain on eye movement. Physical examination also elicits diplopia, accompanying limitation of eye movement and enophthalmos on the affected side. These signs and symptoms are due to (1) herniation of orbital contents with concomitant partial atrophy of extraocular muscles and to (2) an increase in the volume of the orbital cavity with possible compression of the optic nerve.4 Because of these features, orbital floor fractures are classified as both Otorhinolaryngologic and Ophthalmologic emergencies that warrant immediate surgical treatment especially if the patient presents with blurred vision.3,5
Confirmatory imaging studies help locate and assess the extent of orbital floor injury. These include radiographs and computed tomography of the facial bones. The commonly used radiograph is the chin-to-nose or Water’s view. This gives a view of the whole orbital area and may reveal a pathognomonic “tear drop” sign, seen as an elliptical opacity underneath the inferior orbital rim, that represents orbital contents, usually orbital fat, that herniated through the fracture.1,3 However, facial computed tomography is still the most useful imaging tool in assessing orbital floor fractures.1,2,3,4 It is usually requested without contrast using 3 different cuts: coronal, axial and sagittal. Coronal cuts reveal discontinuity of the inferior orbital rims with concomitant soft tissue sublaxation; axial cuts present the extent of areas involved while sagittal cuts help locate if the fracture is anterior, posterior or anteroposterior.1,4
The goal of surgical repair in orbital floor fractures is two-fold: to reposition herniated orbital fat and tissue back in the orbit; and to reconstruct the traumatic defect.4 Approaches are via open surgery (subciliary or transconjunctival) or endoscopic (transantral), (Table 2). The open transorbital approach is currently regarded as the mainstream method for reduction of blowout fractures of the inferior orbital wall. It is useful for releasing incarcerated soft tissue, as dissecting all soft tissue around the fracture area is necessary.1 Post operative complications include ectropion and unsightly scars, but these rarely occur in the hands of experienced surgeons.5 Endoscopic repair, usually via a transantral approach, can provide surgeons with several advantages over conventional external repair. These include excellent visualization of the medial and inferior walls of the orbit; easy access to maxillary bone (avoiding or minimizing use of intraocular alloplastic implants); virtual elimination of significantly visible facial scarring and eyelid complications; and performing the procedure under local anesthesia, making intra-operative evaluation of ocular movements and diplopia possible.5,6 A transorbital approach has the advantage of releasing incarcerated orbital tissue, while, in contrast, simply lifting the orbital tissue upward in a transantral approach may aggravate the incarceration1 (Table 2). In this patient, the open approach was used because a mid-facial de-gloving was necessary to access other fractures.
The repair of orbital floor fractures involves many techniques, and adequate knowledge and skill is needed to perform any of these techniques employing careful judgment and analysis in formulating a plan that will fit the patient’s needs. As a general principle, the orbital complex is reconstructed by aligning its fractured parts with adjacent stabilized or intact structures.10 Familiarity with the complex shape of the orbital walls is important in repair. In the case of the orbital floor, it gently concaves inferolaterally, turning convex medially to posteriorly, assuming an S-shape configuration. 1,3 The posterior part of the floor is farthest from the inferior orbital rim with the infraorbital nerve coursing thru it makes it vulnerable and weak to the extensive forces absorbed when applied into the orbital area.1,3,10 This explains why posterior orbital floor fractures occur as non-trapdoor types and are difficult to expose. The orbital contents are positioned accurately and precisely into the orbit making any change in volume affect eye function. It is important to assess eye function first as it may give the examiner an idea of the extent of injury to the orbital floor. Indications for repair include diplopia, nonresolving oculocardiac reflex with entrapment (bradycardia, heartblock vomiting, nausea and syncope), fracture involving >50% of the orbital floor, and early enophthalmos or hypoglobus causing facial asymmetry.11 These signs and symptoms elicited during physical examination with documentation of the location of fracture through diagnostic imaging warrant early repair since herniated soft orbital tissue can atrophy within 2-3 weeks post trauma.4
The types of grafts/implants used to span the defects of orbital floor fractures are divided into alloplastic and autogenous implants7 (Table 3). Autogenous grafts include bone, cartilage, and fascia. Alloplastic implants can be divided into nonabsorbable types, such as those made of silicone, polytef, hydroxyapatite, tantalum mesh, or titanium, and absorbable types, including those made of polyglactin or gel film. Repair of the orbital floor defect is mandatory if the defect measures at least 50% of the size of the orbital floor bone. The ideal implant must be nonreactive, provide good structural support, be easily positioned, and be readily available.1,2,3,4 In this case the surgeon utilized conchal cartilage grafts. This graft can be used in repairing defects as large as 2 x 2mm. It advantages over other autogenous grafts include having a shape similar to the orbital floor, ease of harvest, malleability and limited morbidity at the donor site.4
Autogenous tissue grafts, i.e. bone or cartilage, are preferred over alloplastic grafts in the repair of isolated orbital fractures similar to this case.10 Grafts (especially bone) should be secured to avoid displacement or migration and improve graft survival. Complete dissection of the fracture is necessary to identity the intact bone on all side of the fracture since these will be used as alignments when placing the graft. In the case of an orbital floor fracture, the posterior portion of the intact bone will serve as a guide to internal orbital reconstruction. The graft should be placed in inclined position just behind the inferior orbital rim to reach the intact posterior bone.3,10 Placing the graft based on correct anatomic position during reconstruction is of more significance rather than using the globe position as basis in volume restoration.10 It is a must to perform duction tests following graft placements and compare these to baseline duction test prior to surgery.9,10 This will help the surgeon distinguish if the stiff duction test is caused by edema from impingement of the musculofibrous ligament system by the graft material.10
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Acknowledgement
The authors would like to thank Dr Natividad Almazan and Dr. Felix Nolasco for their encouragement and support; and the resident doctors of the Department of ORL-HNS for their help in making this paper.
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Ippolito, Dorotea, Michele Fiasconaro, Flavia Pruiti Ciarello, Antonino Aliberti, Maria Vitale, Benedetta Amato, Paolo Pasquali, and Vincenzo Di Marco Lo Presti. "Intra-vitam Diagnosis of Tuberculosis in Pigs: Concordance Between Interferon-Gamma Release Assay and Comparative Tuberculin Skin Test." Frontiers in Veterinary Science 7 (December 18, 2020). http://dx.doi.org/10.3389/fvets.2020.591444.
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The role of pigs in the maintenance of bovine tuberculosis caused by Mycobacterium bovis has been demonstrated in many settings; however, the current control programs usually do not state any intra-vitam diagnostic procedure in this species, as for the cattle. Carcass inspection has shown to be insufficient to detect infection in swine; thus, the assessment of intradermal tuberculin test and interferon-gamma release assay (IGRA) in this species is mandatory. The current study compares the performances of the single intradermal comparative cervical tuberculin (SICCT) test and IGRA. A total of 628 Nebrodi Black pigs raised in free-roaming farms were subjected to the two tests simultaneously. Besides, 124 animals underwent postmortem examination for the detection of tuberculous lesions and isolation of mycobacteria from target organs. The two tests showed a concordance of 94.42% with a Cohen's k coefficient of 0.786 and McNemar chi-square of 4.83 (P = 0.03). Slightly lower levels of concordance (90.32%) between SICCT and IGRA were obtained in the group of 124 animals, with a Cohen's k = 0.797 and McNemar chi-squared value of 0.69 with a non-significant P = 0.41. Moreover, the results showed how IGRA tends to result positive in higher rates, mostly when non-tuberculous mycobacteria (NTM) were isolated, suggesting a possible impairment of specificity in the event of coinfections in the swine. In conclusion, the results obtained support the possibility of the strategic use of IGRA or SICCT in combination or alternatively one to the other, particularly IGRA which showed lower specificity but has evident advantages over SICCT.
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Nuzzi, Raffaele, and Alessandro Rossi. "Diagnostic imaging versus surgical procedure: intra- and postoperative OCT evaluation of sutureless scleral-fixated intraocular lens implantation and possible related complications." Graefe's Archive for Clinical and Experimental Ophthalmology, March 12, 2021. http://dx.doi.org/10.1007/s00417-021-05087-2.
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AbstractBecause the popularity of corneal refractive surgery has been increasing throughout the last 25 years, many authors have thought to apply optical coherence tomography (OCT) to the anterior segment (AS-OCT); by revising the instrumentation needed and slightly improve the technique, it has become an element of vital importance in order to ensure a complete and exhaustive pre- and postsurgical evaluation. Many applications of OCT have been recently developed—mostly in cataract surgery due to the increasing numbers—such as chamber biometry, which is used in a preoperative stage to determine the details of IOL implantation, and lens evaluation. The aim of this review is to assess the applications of anterior segment OCT in dislocated IOL and/or capsular bag exchange surgery with scleral sutureless fixated intraocular lens and monitoring of possible postoperative complications.
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Shah, M., G. Jenda, H. Nsona, E. Gigi, P. Dadlani, and E. Swedberg. "An automated diagnostic device for children under 5 years of age: A proof-of-concept study in Malawi." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.129.
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Abstract Background Automated diagnostic device to measure child’s vital sign is a global unmet demand. Having separate diagnostic devices to measure multiple vital signs is more expensive, and can be complex for health workers. An automated “all-in-one” device would help avoiding extra costs as well as maintenance challenges associated with multiple devices. In addition to improve classifying childhood illness, such an automated device would also increase adherence to guidelines, optimal use of antibiotics, and a reduction of unnecessary referrals. Methods We studied an automated device in Malawi, which was designed to measure multiple key vital signs (SPO2, respiratory rate, temperature) among newborn, infant and children <5 years. The device collected photoplethysmogram (PPG) signals for SpO2 via a universal pediatric sensor, placed on child’s finger. Temperature was measured via infra-red signal from child’s forehead. Accelerometry measures respiratory rate, by placing the device around the child’s belly. The CO2 sensor data together with video recordings of child’s respiration offered the reference for child’s respiration count. Results Preliminary analyses of valid PPG signals, video annotated respiratory count and CO2 sensor data revealed the following key results: - For SPO2, the performance of the target probe among 170 subjects appears extremely well with even the smallest and largest children. - Among 145 subjects with valid CO2 data, 93 subjects were fully calm and had a regular breathing pattern. Comparing accelerometry measurements from 93 calm subjects with the reference data, the root of mean square error (RMSE) was only 1.18 respiration per minute (RPM). Excluding four outlier measurements from 145 subjects’ dataset, the RMSE for the remaining 141 subjects was 1.76 RPM. Conclusions This study results demonstrated the proof of concept that the device measures key vital signs among newborn, infants and children <5 years, using a reusable single-based probe. Key messages Automated diagnostic device measures key multiple key vital signs (SPO2, respiratory rate, temperature) among newborn, infant and children <5 years. Such an automated device may have potential to ensure accuracy in diagnosis, increasing adherence to recommended guidelines, optimizing use of antibiotics, and reducing unnecessary referrals.
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Funke, Katalina, Faisal Aljehani, and Aundrea Loftley. "SAT-469 Vitals for the Prompt Recognition of Myxedema Crisis in a Critically Ill Patient." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.1171.
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Abstract Myxedema coma is a rare but life-threatening condition if not treated promptly. The time from initial presentation to diagnosis may be prolonged in patients with severe illness whose presenting features are common to myxedema crisis. A 94-year-old male admitted to the neuroscience intensive care unit for acute stroke monitoring after intra arterial thrombolysis was treated for myxedema three days after initial labs revealed severe hypothyroidism and a myxedema score greater than 60. A diagnostic scoring system for the diagnosis of myxedema coma gives points for the following to easily identify patients with high likelihood of decompensated state of extreme hypothyroidism. Given the potential for under recognition of myxedema crisis in severe illness the clinician must pay close attention to vital signs and have a high level of suspicion for myxedema crisis and low threshold for treatment if myxedema score indicates high likelihood despite concomitant critical illness
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Sanders, João Victor Souza, Jonathan Barros Cavalcante, Jalles Dantas de Lucena, Osvaldo Pereira da Costa Sobrinho, Israel Rodrigues Pereira, Hudson Martins de Brito, Roberta Silva Pessoa, et al. "Clinical And Surgical Anatomy Of Lumbar Hernia: A Review." International Archives of Medicine 10 (October 11, 2017). http://dx.doi.org/10.3823/2525.
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Lumbar hernia is defined as the presence of failure in the transverse fascia or in the aponeurosis of the transverse abdominal muscle that results in the extrusion of intra or extra peritoneal organs through the discontinuity of the postero lateral abdominal wall. The aim of this study was to conduct a methodical review of the anatomy of the hernia form grynfelt dated from 2006 to 2017. For this, we performed a bibliographic review by means of electronic databases like SciELO, PubMed, Science Direct, LILACS and Bireme to get better approach to the subject. It has been found that the lumbar hernia is a disease little known by doctors whose diagnostics are often performed in the wrong way and for surgical correction needs a good anatomical knowledge. Lumbar hernias, although rare, must be taken into account, since ischemia of herniated intestinal segments can lead to the death of the patient, especially in the elderly. Knowledge about the anatomy of the lumbar region is of vital importance because it makes surgery safe and reduces risks of complications and recidivating of the hernia.
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Song, Dandan, Sohaib Shujaat, Karla de Faria Vasconcelos, Yan Huang, Constantinus Politis, Ivo Lambrichts, and Reinhilde Jacobs. "Diagnostic accuracy of CBCT versus intraoral imaging for assessment of peri‐implant bone defects." BMC Medical Imaging 21, no. 1 (February 10, 2021). http://dx.doi.org/10.1186/s12880-021-00557-9.
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Abstract Background Early detection of marginal bone loss is vital for treatment planning and prognosis of teeth and implant. This study was conducted to assess diagnostic accuracy of CBCT compared to intra-oral (IO) radiography for detection, classification, and measurement of peri-implant bone defects in an animal model. Methods Fifty-four mandible blocks with implants were harvested from nine male health adult beagle dogs with acquisition of IO, CBCT and micro-CT images from all samples. Peri-implant bone defects from 16 samples were diagnosed using micro-CT and classified into 3 defect categories: dehiscence (n = 5), infrabony defect (n = 3) and crater-like defect (n = 8). Following training and calibration of the observers, they asked to detect location (mesial, distal, buccal, lingual) and shape of the defect (dehiscence, horizontal defect, vertical defect, carter-like defect) utilizing both IO and CBCT images. Both observers assessed defect depth and width on IO, CBCT and micro-CT images at each side of peri-implant bone defect via CT-analyzer software. Data were analyzed using SPSS software and a p value of < 0.05 was considered as statistically significant. Results Overall, there was a high diagnostic accuracy for detection of bone defects with CBCT images (sensitivity: 100%/100%), while IO images showed a reduction in accuracy (sensitivity: 69%/63%). Similarly, diagnostic accuracy for defect classification was significantly higher for CBCT, whereas IO images were unable to correctly identify vestibular dehiscence, with incorrect assessment of half of the infrabony defects. For accuracy of measuring defect depth and width, a higher correlation was observed between CBCT and gold standard micro-CT (r = 0.91, 95% CI 0.86–0.94), whereas a lower correlation was seen for IO images (r = 0.82, 95% CI 0.67–0.91). Conclusions The diagnostic accuracy and reliability of CBCT was found to be superior to IO imaging for the detection, classification, and measurement of peri-implant bone defects. The application of CBCT adds substantial information related to the peri-implant bone defect diagnosis and decision-making which cannot be achieved with conventional IO imaging.
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Chen, Liang, Xuezhi Ming, Rongmin Gu, Xu Wen, Gang Li, Bin Zhou, Wei Wei, and Huanqiu Chen. "Treatment experience of delayed massive gastrointestinal bleeding caused by intra-abdominal arteriointestinal fistula in gastric cancer patients after radical gastrectomy." World Journal of Surgical Oncology 17, no. 1 (November 30, 2019). http://dx.doi.org/10.1186/s12957-019-1751-0.
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Abstract Background Gastric cancer (GC) remains one of the leading causes of cancer-related death. Arteriointestinal fistula is a very rare but lethal postoperative complication in GC patients after gastrectomy. However, very few reports associated with arteriointestinal fistula have been published, and there is no matured diagnosis and treatment consensus for arteriointestinal fistula. Herein, we will investigate the etiology, clinical feature, diagnostic method, treatment, and prognosis by summarizing two patients we treated and consulting related cases reported in recent years. Case presentation A 61-year-old male and 75-year-old female with advanced gastric cancer of gastric antrum underwent radical distal gastrectomy and D2 regional lymphadenectomy. Residual gastrojejunostomies by the Roux-en-Y method were performed. The two patients recovered well after gastrectomy, and they received postoperative adjuvant chemotherapy. However, both of them suffered sudden hematemesis and melena about 2 months after surgery, resulting in unstable vital signs. Emergency exploratory laparotomy and interventional embolotherapy by digital subtraction angiography were immediately respectively performed. During this process, arteriointestinal fistulas were found in both of them. Pseudoaneurysms of gastroduodenal artery and common hepatic artery were respectively ruptured and bleeding into the duodenum. Finally, the male patient recovered, while the female patient died because of rebleeding and hemorrhagic shock. Conclusions Arteriointestinal fistula, with low morbidity but high mortality, is an acute and fatal postoperative complication for GC patients after radical gastrectomy. DSA is the preferred method to diagnose arteriointestinal fistula. Embolotherapy by DSA should be performed immediately once arteriointestinal fistula is confirmed. Emergency laparotomy is another selection if the embolotherapy failed. We should pay more attention to perioperative preventive measures for formation of pseudoaneurysm, which is the leading cause of arteriointestinal fistula.
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Bamouh, Z., F. Fakri, M. Jazouli, N. Safini, K. Omari Tadlaoui, and M. Elharrak. "Peste des petits ruminants pathogenesis on experimental infected goats by the Moroccan 2015 isolate." BMC Veterinary Research 15, no. 1 (December 2019). http://dx.doi.org/10.1186/s12917-019-2164-6.
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Abstract Background Peste des petits ruminants (PPR) is a viral disease of major economic importance on small ruminants. Goats are usually known to be more susceptible to the disease. Infection chronology, virus circulation, and the disease early detection need to be better understood. This study evaluates the tissue tropism and pathogenesis of PPR following experimental infection of goats using a lineage IV virus, the most dominant in the world originated from Asia. PPRV infection was experimentally induced in 4 six-month-old goats by intra-nasal and intravenous route of cell virus suspension and from infectious mashed tissue. The clinical signs were observed and goats were euthanized at predetermined clinical score level for post-mortem examinations and PPRV detection by RT-PCR. Clinical signs of infection were present, pyrexia, serous-mucopurulent nasal discharges, coughing, diarrhea and asthenia, for both cell virus suspension and infectious mashed tissue. PPRV genome was highly detected in swabs and tissues with clinical signs dominated by pulmonary attack and digestive symptoms secondary. Results Results of this study indicates that PPRV is an invasive infection in animals that in a short period, less than 10 days, invade all vital organs. On live animals, early diagnostic may be easily done on lacrimal and rectal swabs. Conclusion The experimental PPRV-infection model using the cell virus suspension is suitable for vaccine evaluation as a standard model.
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Li, Kewei, Yijun Liu, Xiaolong Xie, Rongxing Zhou, and Bo Xiang. "Severe hypernatremia in children after surgical resection of hepatic echinococcosis: a rare and potentially fatal complication." BMC Pediatrics 21, no. 1 (March 24, 2021). http://dx.doi.org/10.1186/s12887-021-02607-1.
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Abstract Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.
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Abibe, Rebeca Bastos, Cláudia Valéria Seullner Brandão, Geovane José Pereira, Luciane Dos Reis Mesquita, and Sheila Canevese Rahal. "Symptomatic Orthotopic Ureterocele in a Dog." Acta Scientiae Veterinariae 48 (December 11, 2020). http://dx.doi.org/10.22456/1679-9216.103405.
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Background: Ureteroceles are cystic dilatations of the terminal ureter and is a rare diagnosed condition in dogs. They can be classified as orthotopic when it is entirely within the bladder and the ureteral orifice emerges normally or ectopic if the ureteral orifice is not in the normal position in the trigone. Orthotopic are usually clinically silent. Ureterocele can contribute to lower urinary tract disease leading to infections and loss of the renal function. As long as this injury can arise slowly, it might be underdiagnosed in companion animals. This case aims to report a case of a bitch with diagnosed symptomatic orthotopic ureterocele efficacious surgical treatment.Case: A 5-month-old female mixed breed was referred to the veterinary hospital, with a major complaint of urinary incontinence since the birth date after the first attendance in a colleague who have suspected of ureterocele considering ultrasound report of a vesicle of 1.4 x 1.5 cm in lefts ureter bladder’s insertion topography with ipsilateral hydroureter and renal dilatation. Beside the urinary dysfunction, the animal presented good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. A new ultrasound exam and Computerized Urotomography with contrast gave the definitive diagnosis of left orthotopic ureterocele with twisted hydroureter (proximal 1.29 cm and distally 0.98 cm) and hydronephrosis (3.32 cm). The marsupialization was chosen scientifically based to correct the ureterocele and the patient presented good general condition since then with prompt improvement of clinical signs. The patient was submitted to serial image exams in six weeks following up to check the consequent urinary tract dilatation from the previous disease regression. After the last follow up animal received hospital discharge and was assessed twice in four months with normal measures of the urinary tract.Discussion: Different from the most common insert point of this injury, this case report presents an orthotopic ureterocele which due to the clinical signals, could be diagnosed differently from the literature who have described most often ectopic or asymptomatic events. Corroborating with usual development of uretero vesical junction obstruction described, this patient also advanced to hydroureter, hydronephrosis and kidney parenchymal loss. Due to being uncommon in small animal routine, diagnosis and therapeutic recommendations are based on few veterinarian and mainly human data. The gold-standard diagnostic method is excretory urethrocystography with an intra-bladder image called “cobra-head” or a contrast cystic fill defect. When ectopic ureterocele is suspected, intra-venous contrast urography or Computerized urotomography are a thrustful choice. Surgical treatment is indicated in symptomatic and obstructive ureterocele. The planning was based in urotomography diagnosis of unilateral orthotopic left ureterocele, marsupialization technique was performed. Two days after the procedure, the patient returned maintaining the total enhancement of incontinence. During the image follow up made after the surgery was observed decrease of the dilatations and improvement of renal medullary cortical ratio. This case report raises the importance of counting uncommon diseases as differential diagnosis in the veterinarian routine. Also, the use of the correct image approach can lead to the definitive diagnosis and treatment.
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AlamdaryBadlou, Bahram. "COVID-19 War, Human Microbiota Function." Journal of Internal Medicine and Emergency Research, May 11, 2020. http://dx.doi.org/10.37191/mapsci-2582-7367-1(2)-011.
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Worldwide all countries are frightening and suffering from the COVID-19 attack with extraordinary death rate, which the exact mechanism is not elucidated yet [1]. The pathogenesis of the COVID-19 virus can be separated in 4 ways: 1) Communication with organs microbiota, 2) Expression of immune-stimulating compounds, 3) Mutations in hosts cells or microbiota genes and 4) Possible dynamic reaction of COVID-19 virus, post treatment action. Human microbiota is internal and external bacteria, fungi (including yeasts), protozoa and viruses, in different anatomical parts of the body. Some of the microbiota produced remains persistent and others are not- persistent that could be produced and/or cleared physiologically.COVID-19 can be entered subject's body via two pathways directly, and indirectly. In a direct pathway it passes through eyes, respiratory system, mucosal membranes using aerosolized particles or droplets. In an indirect pathway it contaminates subject's biggest organ namely skin, inconspicuously. Moreover, COVID-19 might find the opportunity to be present and colonize at subject's tissues and cells, however [1-3]. Normally, the presence of oral, respiratory, and gut commensal bacteria is largely establishing a barrier against different antigens and pathogens. Several human respiratory viruses are neuroinvasive and neurotropic, with potential neuropathological consequences in vulnerable populations. Understanding the supporting mechanisms of neuroinvasion and communication of respiratory viruses including COVID-19 and Human Corona Viruses (HCovs) with the nervous system is also essential to estimate theoretically pathological short- and long-term consequences [4]. Besides, subject's Brain-Gut-Heart axis regulates immunological responses, which also determines microbial hemostasis, and vice versa. Furthermore, microbial combination changes might also affect hormonal and immunological reaction against pathogens like COVID19 and HCovs.After the COVID-19 enters the body, it might change the balance of the microbiota combination, eventually. Changes in microbiota's count and combination could be beneficial or detrimental to subject's Brain-Gut-Heart axis that regulates immune reactions. For example, in one hand, the presence of some Gram-positive bacterial microbiota i.e. staphylococcus aureus has been shown to prevent influenza virus infections [5], and the presence of some Gram-negative bacteria in the lung microbiota, such as Bacteroides fragilis, which plays an important role in reducing lung inflammation, signify beneficial effects. In the other hand, some Gram-negative lung bacterial microbiota i.e. Prevotella and Veillonella spp. are associated with elevation of Th-17 cell-mediated lung inflammation [6], signify detrimental effects. Furthermore, Bacteroides fragilis found the most prevalence Gram-negative microbiota in oral cavity and lung. This typic Gram-negative genus of bacteria presents a huge amount of lipopolysaccharide (LPS), which could be considered as a "clock-bomb" in order to its endotoxin carriage capacity [7]. Unspecific and irrelevant prescriptions against COVID-19 have shown that bactericidal antibiotics such as vancomycin, tavanex (levofloxacin), azithromycin, cefazolin, etc., and Calcium (Ca+2) level enhancers are used in patients in the case of serum Ca+2 levels was decreased. Consequently random shut down of organs is inevitable due to cytokines storms.After clinical symptoms of the COVID-19 patients were (applicably) assessed, One might speculate that (a-)specific antibiotics prescription in one hand, might challenge subject's systemic blood circulation with severe endotoxemia, LPS release, and cytokine storm. Subsequent of bactericidal antibiotics usage to kill Gram-negative microbiota of either oral cavity, lung or gut axial increased explosion of side effects i.e. release of different endotoxins i.e. LPS, LOS. On the other hand, different COVID-19 patient's responses indicated that most of the patients had "negative bacterial cultures" of blood and lung aspirate, whereby the yeast and fungal culture's test were positive. One might speculate that microbiota population changes definitely after a regiment of unspecific bactericidal antibiotic-therapy, which might increase simultaneously antibiotic-resistant condition, and/or an initiation of random shutdown of organs, eventually [7]. Moreover, different laboratorie's results are showing that bacterial cultures of patients are not completely negative, even after COVID-19 positive ICU'spatients, receiving antibiotics in Hospitals, routinely (unpublished data). One might wonder whether bacterial flora of subjects could becoming suppressed after COVID-19 infection and colonization; or prescribed bactericidal antibiotics has direct relationship (cause-effect), which aggravate cytokine storm, and sudden septic onset that in association with calcium-hypertonic auxiliary therapy, is resulting in patient death, via premature apoptotic processes, eventually. In the other hand, might (unsuccessful) cure/cares clearly show a significant negative change in the liver enzyme profile, as well. Besides, when Medici are planning to prevent severe endotoxemia in COVID-19 patients by prescribing (general) (a-)specific antibiotics to manage Gram-negative microbiota, One might recommend to use at least that categories of bacteriostatic antibiotics, where less endotoxins being released, instead of using bactericides administration. Additionally, the use of probiotics to stablish normal balance in lung and gut microflora could be considered in the case of antibiotic sensitivity and resistance susceptibility of subjects [8]. To reduce the risk of mix-infection, One might recommend better to prevent either possible contamination of yeast and fungi; or medicate suitable (multi-)therapeutic administrations against yeast and fungi; or (re-)consider other nosocomial bacteria, as well. Unfortunately, no investigation was published yet to evaluate the probability of viral infection, which investigate fungi or yeast proliferations aiming all changes in human- or environmental microbiota and microflora combination, simultaneously.Another speculative conspiracy theory might consider the possibilities, where the COVID-19 might undergo self-unknown-(epi-)genetic mutations in different subjects, after colonization. In one hand, COVID-19 might trigger different microbiomes to also undergo (un-)known mutations. In the other hand, (un-)known entry pathways can provide a good platform to escape immune system and make (un-)predictable mutations. It is noteworthy that some kind of disruption of the body's natural microbial defense barrier, especially via the lungs, can lead to wrong decisions in the body's vital and defense biosensors, unusually.Action and dynamic reactions of microbiota and their intervention/collaboration with the COVID-19 actions, might provide completely new diagnostic and therapeutic strategies for Medici. How cellular and molecular protein response systems, such as the unfolded proteins response (UPR) system, play a key role in maintaining the life of the body's cells in the face of deadly inflammation caused by released LPS or Ca+2 overload during deadly endotoxemia and cell apoptosis is not elucidated completely [9]. So, One might suggest that Covid19 might change cell's fate by altering the body's natural microbial balance and UPR machinery, whereby toxic substances spread from different cells to each other, which might induce random shut down (un-)intentionally. Further in-details studies needed to confirm how microbiota combination is changing post-Covid19 infection, inter- and intra-personally.
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Burke, Dany, Michael Michael Mayette, and Andre Begin. "Posterior Reversible Encephalopathy Syndrome Due To Carcinoid Crisis Complicating Transarterial Chemoembolization for Metastatic Carcinoid Tumour." Canadian Journal of General Internal Medicine 12, no. 1 (May 9, 2017). http://dx.doi.org/10.22374/cjgim.v12i1.165.
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Introduction: We present a case report of posterior reversible leukoencephalopathy syndrome (PRES) following transarterial chemoembolization (TACE) of liver metastasis of an intestinal neuroendocrine tumour.Case presentation: A 62-year-old female was evaluated for progressive bilateral vision loss following transarterial chemoembolization (TACE) of hepatic metastasis of a midgut carcinoid tumour with cisplatin. Vital signs were remarkable for significant hypertension (170-210/85-110) since having undergone TACE (baseline BP 136/74), despite pre-procedure administration of octreotide. Blood pressure failed to correct with administration of amlodipine, hydralazine, captopril and labetalol infusion but responded promptly to octreotide infusion. Magnetic resonance imaging showed findings compatible with PRES. The patient’s vision gradually corrected to her baseline over 2 days. Conclusion: TACE for neuroendocrine tumours can be complicated by carcinoid crisis despite pre-administration of octreotide. Rarely, this may present as a hypertensive emergency of which PRES is a manifestation. Prompt recognition and treatment with high dose octreotide are important and can avoid permanent neurological injury in patients.RésuméIntroduction : Il s’agit d’une étude de cas de syndrome de leuco encéphalopathie réversible postérieure (SERP) consécutive à la chimioembolisation transartérielle (CETA) d’une métastase hépatique d’une tumeur neuro-endocrinine intestinale.Présentation du dossier: Une femme de 62 ans est évaluée pour une perte de vision bilatérale progressive à la suite de la chimioembolisation transartérielle (CETA) de métastases hépatiques d’une tumeur du tube digestif effectuée au moyen du cisplatine. Les signes vitaux sont remarquables malgré une hypertension importante (170-210/85-110) depuis la CETA (p.a. de base 136/74) et l’administration d’octréotide préalable à l’intervention. La pression artérielle ne s’est pas corrigée avec l’administration d’amlodipine, d’hydralazine, de captopril et de labétalol en perfusion, mais a répondu promptement à l’octréotide en perfusion. Une imagerie par résonnance magnétique a fourni des résultats compatibles avec un diagnostic de SERP. La vision de la patiente s’est graduellement corrigée pour revenir à son état habituel en deux jours.Conclusion : Dans le cas de tumeurs neuro-endocriniennes, la CETA peut être compliquée d’une crise carcinoïde malgré l’administration d’octréotide au préalable. Cette condition peut, quoique rarement, représenter une urgence hypertensive dont le SERP est une manifestation. L’identification rapide de la condition et un traitement à l’aide d’octréotide à dose élevée sont de la plus haute importance et peuvent éviter des dommages neurologiques permanents.Carcinoid syndrome is a syndrome classically consisting of diarrhea, paroxysms of cutaneous flushing with or without hypotension and bronchospasm arising most frequently in the setting of hepatic metastases originating from midgut carcinoid tumours. However, these neuroendocrine tumours can synthesize a wide variety of polypeptides, prostaglandins, and biogenic amines and hence present atypical clinical manifestations such as pellagra, abdominal pain, right-sided heart failure from valvular lesions and paroxysmal hypertension. Tumour manipulation may result in a massive influx of hormones into the systemic vasculature, potentially resulting in life threatening swings in blood pressure, cardiac arrhythmias and bronchoconstriction, even in patients without liver metastases or preoperative carcinoid syndrome.1 We present a case report of hypertensive emergency presenting as posterior reversible leukoencephalopathy syndrome (PRES) after transarterial chemoembolization (TACE) of a hepatic metastasis of carcinoid tumour.Case PresentationA 62-year-old caucasian female was evaluated on the surgical ward for progressive bilateral vision loss about 10 hours following transarterial chemoembolization (TACE) of a hepatic metastasis of a midgut carcinoid tumour (Figure 1, Figure 2) with Lipiodol and cisplatin. Premedication with octreotide 100 mcg subcutaneously and dexamethasone 8 mg IV pre-procedure was given, and post-procedure orders were given for dexamethasone 4 mg bid, ondansetron as needed and D5% NaCl 0.45% at a rate of 150 mL/h. The rest of her past medical history was unremarkable, specifically without history of hypertension, cerebrovascular disease, or clinical manifestations of carcinoid syndrome prior to admission. She had undergone two intra-abdominal surgeries without complication. Her usual medication was limited to inhaled glycopyrronium and indacaterol. Figure 1. Axial computed tomography scan of hepatic metastasis. A mass is visible in hepatic parenchyma corresponding to a metastasis of the midgut carcinoid tumour. Figure 2. Fluroscopic image of transarterial chemoembolization of hepatic metastasis. Upon evaluation, the patient was somnolent but otherwise well oriented. Eye exam confirmed bilateral 0/20 vision though pupils were 4 mm and reactive. On motor exam, the patient had diffuse hyperreflexia with upgoing plantar reflexes but without focal weakness. Chart review was remarkable for blood pressures ranging from 170-210/85-110 since TACE (pre-procedure blood pressure 136/74). A presumptive diagnosis of PRES due to cisplatin was made.Initial cerebral computed tomography scan was suspicious for a right occipital sub-cortical hypodensity of 3 cm, possibly of ischemic nature. IV fluids were discontinued (NaCl 0.9% at a rate of 250 mL/h) and anti-hypertensive agents were begun. After failure of improvement of blood pressure or symptoms despite amlodipine, hydralazine, labetalol, and captopril, a diagnosis of carcinoid crisis was suspected and octreotide 300mcg IV bolus followed by an infusion of 50 mcg/h was started. The suspected diagnosis of carcinoid crisis was later confirmed by 24h urinary 5-HIAA dosing at 141.4 umol/day (normal 0–42, previously within normal limits pre-operatively). Serum chromogranin A was also elevated at 138.2 ug/L (normal 0–82), compatible with a neuroendocrine tumour.Characteristic changes of PRES were seen on cerebral magnetic resonance imaging (MRI) (Figure 3) including predominantly sub-cortical hyperintensities in the bilateral parietal and occipital lobes on T2 and FLAIR sequences which were also hyperintense on diffusion-weighted imaging (DWI), likely from T2 shine through, and apparent diffusion coefficient (ADC) maps without restricted diffusion, hence confirming the finding of vasogenic edema compatible with PRES. Figure 3. FLAIR sequence, axial slice, cerebral magnetic resonance imaging. Subcortical hyperintensies in the bilateral occipital lobes reflecting vasogenic edema of the visual white matter tracts are seen. The patient’s blood pressure and her visual symptoms progressively normalized over 48 hours. On last follow-up 1 month after procedure, vital signs were normal (blood pressure 115/54) and vision was normal.DiscussionCarcinoid tumours are classically described as slow growing, mainly affecting the gastrointestinal (GI) tract. They are known to internists mainly for their capability to produce the carcinoid syndrome. However, only about 25% of carcinoids actually produce the mediators which produce the carcinoid syndrome and less than 10% of patients actually develop the carcinoid syndrome.2 The syndrome usually presents when midgut carcinoids metastasize to the liver, hence bypassing hepatic metabolism. Typical symptoms include secretory diarrhea (80%) and flushing of the head, neck, and upper torso (90%) which may be associated with hypotension and tachycardia. Less frequent manifestations are right heart failure due to carcinoid valve disease (30%), bronchospasm (15%) and pellagra (5%). 3 The classic triad of flushing, diarrhea and wheezing is infrequently found. Foregut (e.g., bronchial) and extra-digestive midgut (e.g., ovarian) bypass the liver and may result carcinoid syndrome without hepatic metastasis, although symptoms are usually atypical in these cases.Perioperative carcinoid crisis occurs in 10–30% of patients undergoing operative resection. Absence of preoperative carcinoid syndrome decreases the risk of carcinoid crisis, however it may still occur.1 This has led to the recommendation by some that patients be premedicated with somatostatin analogues to block bioactive peptide release and action, with or without other hormone antagonists (e.g., anti-histamines).3 However, the benefit of octreotide prophylaxis has been questioned by other studies.1 Once a carcinoid crisis has occurred, bolus doses of 25–500 mcg and intravenous infusions at rates of 50–150 mcg/h have been effective in case reports and case series, with higher doses being potentially required in patients on maintenance octreotide therapy or with carcinoid heart disease.4Despite a lack of data comparing it to surgical management, transarterial chemoembolization (TACE).5 is a frequent management strategy for patients with liver metastases, especially when patients present with hormonal symptoms and multiple metastases preclude resection. Rates of complication from TACE are difficult to estimate ranging from 0 to 100%, likely due to variable definitions and reporting. Only one study reported on the incidence of post embolization carcinoid crisis,6 with 2 of 12 patients developing the complication. Both had a history of carcinoid syndrome and had been premedicated with octreotide 200 mcg SC before procedure and q8h afterward. One group7 did report a patient who developed transient cortical blindness following TACE which possibly could have been due to PRES.PRES is a syndrome of failure of cerebral blood pressure autoregulation with acute onset elevations of blood pressure from baseline and a combination of altered level of consciousness, visual symptoms, headache and seizures.8 Blood pressure is often only moderately elevated, though significantly above the patient’s baseline. Etiologies are varied but include cytotoxic chemotherapy, eclampsia and other causes of hypertensive emergency. It was originally felt that the patient’s PRES was due to the cisplatin received during TACE with contribution from dexamethasone and iatrogenic fluid overload (NaCl 0.9% at 150 mL/h had been running for several hours) as she had no history of carcinoid syndrome, had been premedicated and had no other findings associated with the disease. However, her lack of response to standard anti-hypertensives and prompt response to octreotide suggest carcinoid crisis as the cause.Neuroimaging with MRI confirms the diagnosis. Findings are compatible with symmetrical white matter edema in the posterior cerebral hemispheres, particularly the parieto-occipital regions. The cortex, basal ganglia, brainstem, and cerebellar may also be involved though less so than the subcortical white matter, while anterior cortical involvement is seen only with the most severe cases. Importantly, the distribution is not confined to a single vascular territory. Classically lesions appear as punctate or confluent areas of hyperintensity on T2 and FLAIR sequences.9 DWI usually shows hypo or iso-intense signal (though sometimes mildly hyperintense from T2 shine through) while ADC maps show increased signal, thus distinguishing PRES from ischemic stroke. With prompt recognition and management, full recovery over a period of days to weeks can be expected. ConclusionsCarcinoid crisis is a well-known and dreaded complication of surgical manipulation of carcinoid tumours. Transarterial chemoembolization of these tumours may also result in carcinoid crisis and our report suggests that pre-procedure carcinoid syndrome is not a prerequisite for this. Presentation may be atypical, as it was in our patient, and so clinical suspicion should be high. When suspected, prompt management with octreotide and other supportive therapies should be instituted.Key Points1. Patients undergoing transarterial chemoembolization for carcinoid tumour metastases are at risk for carcinoid crisis, even if they have been premedicated with octreotide and have no history of carcinoid syndrome.2. Carcinoid crisis may present as hypertensive crisis rather than hypotension, and may give rise to PRES.References1. Condron ME, Pommier SJ, Pommier RF. Continuous infusion of octreotide combined with perioperative octreotide bolus does not prevent intraoperative carcinoid crisis. Surgery 2016;159:358–67.2. Van Der Lely AJ, Herder WWd. Carcinoid syndrome: diagnosis and medical management. Arquivos Brasileiros de Endocrinologia & Metabologia 2005;49:850–60.3. Mancuso K, Kaye AD, Boudreaux JP, et al. Carcinoid syndrome and perioperative anesthetic considerations. J Clin Anesth 2011;23:329–41.4. Seymour N, Sawh SC. Mega-dose intravenous octreotide for the treatment of carcinoid crisis: a systematic review. Can J Anesth/J can d'anesthés2013;60:492–9.5. Kennedy A, Bester L, Salem R, Sharma RA, Parks RW, Ruszniewski P. Role of hepatic intra‐arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET‐Liver‐Metastases Consensus Conference. HPB 2015;17:29–37.6. Maire F, Lombard-Bohas C, O’Toole D, et al. Hepatic arterial embolization versus chemoembolization in the treatment of liver metastases from well-differentiated midgut endocrine tumours: a prospective randomized study. Neuroendocrinology 2012;96:294–300.7. Gupta S, Johnson MM, Murthy R, et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumours. Cancer 2005;104:1590–602.8. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494–500.9. Pedraza R, Marik PE, Varon J. Posterior reversible encephalopathy syndrome: a review. Crit Care Shock 2009;12:135–43.