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Recurrent bilateral exophthalmos associated with metastatic thymic carcinoma in a pet rabbit.

A five-year-old, castrated, male chinchilla rabbit was presented for evaluation of recurrent bilateral exophthalmos. Besides a transient and stress-related exophthalmos with protrusion of both third eyelids, the ophthalmological examination was unremarkable. Plain radiography of the thorax revealed a large precardial mass of soft tissue density. Cytological preparations from the thoracic mass were dominated by small, mature lymphocytes with approximately 10 to 20 per cent lymphoblasts. Computed tomography of the head showed a symmetrical laterodorsal deviation of both eyes without evidence of retrobulbar masses. On necropsy a large cystic mass was present in the cranial thorax associated with severe hydrothorax, hydropericardium and ascites. Histology identified the precardial mass as thymic carcinoma with metastases in the kidneys. This case illustrates the difficulty of diagnosing thymic tumours based on cytological or histological features of the primary tumour alone. To the authors' knowledge, this is the first case of recurrent bilateral exophthalmos associated with a metastatic thymic carcinoma in a pet rabbit.

Animals↗

The pathology and haematological changes in experimental Pimelea spp. poisoning in cattle ("St. George disease").

Six young cattle were intoxicated with either stem or extracts of stem of Pimelea trichostachya or P. continua. Oral dosage with whole plant or alcoholic extracts was shown to reproduce all the clinical and pathological features of the various field syndromes known collectively as "St. George disease". Subacute intoxication resulted from relatively high oral dose rates, of the order of 60 mg of whole stem/kg body weight/day, maintained for about 2 weeks. Diarrhoea, weakness and anaemia were the predominant features of this sundrome. Lower dose rates, regulated according to the severity of diarrhoea, eventually produced signs of circulatory failure (subcutaneous oedema, hydrothorax and cardiac dilatation) in addition to anaemia and diarrhoea. It did not prove easier to produce circulatory failure by intranasal insufflation of powdered plant. Although the bone marrow of most affected calves did not react to the anaemia there was some evidence that erythropoietic tissue was not directly damaged during the intoxication.

Animals↗

Perinatal lamb mortality in Western Australia. 6. Listeric infection.

Listeric abortion was diagnosed in sheep on 14 occasions between 1963-65, and 4 of these were associated with other major abortion pathogens. Except for infection in one district, the outbreaks were scattered sporadically over the southern agricultural area. The diagnosis in 1963 was the first time listeriosis had been found in animals or man in Western Australia. L. monocytogenes was readily recovered in pure culture from all organs and sites cultured. All the strains were serotype 5 Ivanov, with a distinctive double zone of haemolysis. The time-of-death of the 40 infected lambs was: ante-parturient death 50%, parturient death 10% and post-parturient death 40%. Three-quarters of the lambs had gross lesions, the most consistent being small necrotic foci in the liver. Typically, lambs with congenital listeriosis had subcutaneous oedema, hydrothorax, hydroperitoneum, distended abdomen, enlarged pale bronze-red friable livers with small necrotic foci, small abomasal erosions, increased yellow-orange mucoid meconium and enlarged mesenteric lymph nodes. The finding of small yellowish, necrotic foci in the liver, small abomasal erosions and yellow-orange meconium in an aborted lamb was considered to be almost pathognomonic for listeriosis. The origin of these outbreaks was unknown. No evidence of Listeria was found in 61 specimens from 7 species of native fauna caught in the infected areas. Epizootiological observations are reported. No cases of neuro-listeriosis were observed.

Abortion, Veterinary↗

Suspected monensin toxicosis in feedlot cattle.

Suspected monensin toxicosis was seen in feedlot cattle aged 6 to 9 months. Twenty cattle died following inclusion of monensin in the feed at 400g/tonne, which was 13 times the recommended level. The deaths occurred over 2 weeks. Clinical signs were inappetance, respiratory distress and sudden death. Post-mortem features were those of right-sided heart failure and included dependent subcutaneous oedema, ascites, hydrothorax, and periancinar hepatocyte congestion and necrosis. However, in contrast to previous reports no myocardial necrosis was found, but focal skeletal muscle necrosis was observed. Additional findings were marked pulmonary oedema accompanied by fibrin and erythrocyte exudation into alveoli and interlobular lymphatics. From these findings it appears that monensin, as well as affecting both cardiac and skeletal muscle, has a primary effect on lung vasculature.

Animals↗

Experimental acute yellow-wood (Terminalia oblongata) intoxication in sheep.

An aqueous suspension of air-dried, hammer-milled leaf of Terminalia oblongata (yellow-wood) was administered to sheep by gavage, as a single dose of 5 to 20 g (dry weight)/kg body weight. Doses of 15 g/kg, or more, caused depression, inappetence, abdominal pain and reduced ruminal movements within 24 to 48 h and some sheep also showed dyspnoea, opisthotonus and champing of the jaws. Haematology and blood gas and acid-base measurements were unaffected. In sheep given a dose of 12.5 g/kg, or more, plasma osmolality, aspartate aminotransferase activity and potassium and bilirubin concentrations increased while plasma total protein markedly decreased and plasma sodium concentration and alkaline phosphatase activity remained normal. Most sheep were necropsied 48 h after dosing. The liver showed zonal hepatocellular necrosis, the pattern of which varied with the dose given. No renal lesions were observed, although one sheep given a very high dose became azotaemic and hyperkalaemic. Hydrothorax, hydropericardium and ascites developed in sheep given doses of 15 or 20 g/kg.

Animals↗

Cisplatin toxicity in cats.

Cisplatin (cis-diamminedichloroplatinum; Platinol, Bristol, Syracuse, NY) was administered to 11 cats, divided into three groups of experimental and clinical patients. In group 1, cisplatin was administered at a dose of 60 mg/m2 to four cats. In an attempt to avoid renal toxicity, saline diuresis was induced by administering 0.9% saline solution intravenously at a rate of 20 ml/kg/hr for 4 hours before and 2 hours after cisplatin administration. All four cats became dyspneic and died 48-96 hours after cisplatin administration. Postmortem findings included severe hydrothorax, pulmonary edema, and mediastinal edema. In group 2, four experimental cats entered a trial comparing the effects of saline diuresis and cisplatin (60 mg/m2) with the effects of saline diuresis and placebo (0.9% saline solution). The cats in the saline control group remained completely normal, while the cats that received cisplatin developed clinical signs and gross postmortem pulmonary changes identical to those in the first group of cats. Histopathologic examination showed that the alveolar septa were thickened and congested, and contained macrophages, occasional neutrophils, thrombi, and small foci of necrosis and fibrin. Microangiopathic changes were seen in the alveolar capillaries. In the third group, three additional cats were treated with a lower dose of cisplatin. Two cats that received 40 mg/m2 of cisplatin developed pulmonary changes similar to, but less severe than, those seen in the cats that received the higher dose of cisplatin. One cat treated with 20 mg/m2 of cisplatin showed no pulmonary changes ante mortem or post mortem. This series of 11 clinical and experimental cases identifies an apparent species-specific, dose-related, primary pulmonary toxicity of cisplatin in cats.

Animals↗

[A case report of tuberculous pleuritis diagnosed by thoracoscopy using fiberoptic bronchoscope].

A 27-year-old male visited the outpatient clinic of our hospital with the chief complaints of fever, right chest pain and shortness of breath. He was admitted to our hospital for detailed examination of the right hydrothorax. The pleural effusion obtained by thoracocentesis was exudative and negative for Mycobacterium tuberculosis. Since the titer of adenosine deaminase in the pleural effusion was abnormally high, antitubercular therapy was started under suspicion of tuberculous pleuritis. Thereafter, the patient's subjective symptoms and blood parameters improved. Necrotic tissues were obtained by pleural biopsy using the Cope needle. In order to make a definitive diagnosis, pleural biopsy was performed thoracoscopically. White tubercular lesions with a smooth surface were sparsely distributed on the pleura. Histopathologically, these lesions were characterized by central areas of caseous necrosis surrounded by epithelial cells and Langhans' giant cells. Therefore, they were considered to be granulomatous lesions. The patient was given a diagnosis of idiopathic tuberculous pleuritis, and was treated with four antitubercular drugs in combination. His clinical signs subsided, and he was discharged. This case indicates that the examination of the inside of the pleural cavity with a flexible bronchoscope, instead of thoracoscope, under local anesthesia is useful to diagnose patients having tuberculous pleuritis.

Adult↗

Unilateral pleural effusion complicating central venous catheterisation.

Acute respiratory distress developed in two preterm babies because of unilateral hydrothorax secondary to the migration of a central venous catheter into the pulmonary vasculature. Prompt recognition of the problem and rapid treatment are essential and life saving. This complication of intravenous alimentation catheters has not been previously reported in the neonatal age group.

Catheterization, Central Venous↗

Clinical and pathological features of dilated cardiomyopathy in Holstein-Friesian cattle.

Dilated cardiomyopathy is a primary disease of the heart muscle that has been reported in Holstein-Friesian cattle worldwide in the past 20 years. Nine cases of the condition were compared in terms of their clinical and pathological characteristics with nine unaffected animals matched for age, sex and breed. Their clinical signs included right-sided heart failure with severe subcutaneous oedema, ascites and/or hydrothorax and distended jugular veins. There were no characteristic biochemical or haematological changes. Postmortem, the affected hearts were enlarged with all the chambers dilated and walls of variable thickness. In most cases the kidneys were pale with a pitted surface. Histologically there was marked perimysial and endomysial fibrosis, extensive loss of cardiomyocytes by coagulative or colliquative necrosis, increased variation in the cross-sectional area of the myocardial fibres, and multifocal disarray and vacuolation of myocytes. Scanning electron microscopy showed that in all cases there was a mild myocardial inflammatory infiltrate, either diffuse or multifocal, which was identified by immunohistochemical labelling as T cells.

Age Factors↗

Diseases of the hepatopulmonary axis.

Hepatopulmonary syndrome is the most widely recognized of the processes associated with end-stage liver disease. Chronic liver dysfunction is associated with pulmonary manifestations due to alterations in the production or clearance of circulating cytokines and other mediators. Hepatopulmonary syndrome results in hypoxemia due to pulmonary vasodilatation with significant arteriovenous shunting and ventilation-perfusion mismatch. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Rarely, pulmonary hypertension occurs in the setting of portal hypertension. A second group of disorders may primarily affect the lungs and liver (the hepatopulmonary axis). Among these are the congenital conditions alpha(1)-antitrypsin deficiency and cystic fibrosis. Autoimmune liver disease may be associated with lymphocytic interstitial pneumonitis, fibrosing alveolitis, intrapulmonary granulomas, and bronchiolitis obliterans with organizing pneumonia. Sarcoidosis affects the lung and liver in up to 70% of patients. Medications such as amiodarone can result in a characteristic radiologic appearance of pulmonary and hepatic toxic effects. Knowledge of these associations will assist the radiologist in forming a meaningful differential diagnosis and may influence treatment decisions.

Diagnosis, Differential↗

Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation: 3-year experience.

PURPOSE: To prospectively evaluate the use of a recently developed expanded polytetrafluoroethylene (PTFE)-covered nitinol stent-graft in preventing the need for repeated intervention after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Fifty-three consecutive patients underwent TIPS procedures between January 2000 and February 2002. Minimum patient follow-up was 9 months (mean, 16.3 months). Fifty-six stent-grafts were implanted in 53 patients; eight of the devices were 8 mm in diameter and 48 were 10 mm in diameter. The stent length varied from 4 to 7 cm. Indications for the procedure included recurrence of bleeding after sclerotherapy (28 patients with cirrhosis, one patient without), refractory ascites or hydrothorax (21 patients with cirrhosis, one patient without), and Budd-Chiari syndrome (two patients). RESULTS: A technical success rate of 100% was obtained, with an early clinical success rate of 96.2%. During the follow-up period, the recurrence rate was 3.4% (one of 29 patients) for bleeding and 9.0% (two of 22 patients) for ascites. Shunt malfunction occurred in nine of 53 patients (16.9%); in one of these nine patients, shunt occlusion was evident after revision, and a parallel shunt was created. The 1-year primary and secondary patency rates were 83.8% and 98.1%, respectively. In this series, the incidence of encephalopathy (included even as a single short-lived episode) was 47.1% (25 of 53 patients). The 30-day mortality rate was 3.8% (two of 53), and the late mortality rate was 17.3% (eight of 46), excluding seven patients who underwent transplantation. CONCLUSION: The new PTFE-covered nitinol stent-graft used appears to be excellent in preventing the need for repeated interventions. A primary patency rate of 83.8% and a secondary patency rate of 98.1% were achieved.

Adolescent↗

Percutaneous extraction of urinary calculi: use of the intercostal approach.

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.

Adult↗

Contribution of Starling and lymphatic flows to pleural liquid exchanges in anesthetized rabbits.

We studied the time course of volume and protein reabsorption of a 2-ml hydrothorax using whole (WP) or diluted (DP) homologous plasma injected into the right pleural cavity in anesthetized spontaneously breathing supine rabbits. Animals were killed at 5 (WP, n = 4; DP, n = 3), 36 (WP, n = 3; DP, n = 4), 55 (WP, n = 4), 90 (WP, n = 8; DP, n = 4), and 150 (WP, n = 4; DP, n = 5) min after the injection. The volume and protein content of the pleural liquid in control conditions (n = 12) amounted to 0.35 +/- 0.015 (SE) ml/kg and 1.8 +/- 0.27 g/100 ml, respectively, which are not significantly different at 90 min (n = 7). Pleural liquid volume decreased at a similar rate during WP or DP reabsorption according to the equation V = 0.84 +/- 0.05 X e-0.02t, with net reabsorptive flow expressed as dV/dt. The globulin quantity (Q) of the pleural liquid for WP and DP, respectively, decreased according to the equations Qwp = 1 + 1.5 X e-0.04t and Qdp = 0.7 + 0.6 X e-0.03t. Assuming a major lymphatic globulin clearance and no filtration into the cavity, we obtained lymph flow using the equation VL = dQ/dt X l/C where dQ/dt is calculated from the equations for Qwp and Qdp and C represents globulin concentration. The Starling flow (Vs) was then calculated by the equation Vs = dV/dt-VL. With increasing time, lymph flow was found to decrease progressively and was not significantly different from net flow with DP, which implied a Starling flow value of zero. During WP reabsorption, lymph flow initially exceeded the net flow, with the difference disappearing at approximately 60 min; accordingly, Starling filtration flow decreased progressively, becoming zero at the same time.

Anesthesia↗

Prevention and cure of complications from multiple-electrode radiofrequency treatment of liver tumors.

BACKGROUND/AIMS: To determine the complication rate of multiple-electrode radiofrequency treatment of liver tumors, and their prevention and cure. METHODS: 114 patients with liver tumors were treated 170 times using multiple-electrode radiofrequency. The clinical complications and their prevention and cure were observed. RESULTS: The complication rate was 9.6%. The complications included 1 case of colon perforation, 4 cases of skin burn, 5 cases of hydrothorax, and 1 case subcutaneous hemorrhage, but none of the patient died due to these complications. CONCLUSION: The complication rate of multiple-electrode radiofrequency treatment of liver tumors is low and the complications could be prevented and cured.

Adult↗

Ippolito Albertini and Michael Albertus: disparate old and innovative theories on dropsy and edema.

The concept of edema and dropsy as a part of heart and renal failure developed in the 17th and 18th centuries with the observations of Albertini, who realized that two clinical entities were derived from the blood rather than the tissues. Albertus, who lived in the same period, was the last physician to interpret fluid accumulation according to the old, scholastic and dogmatic procedures of medicine. The fundamental concepts of Albertus held little in addition to the classification and categories of the physicians of the Middle Ages. Bloody congestions were distinguished from stagnation: the former have the purpose of reducing superfluites of blood and occurred in plethoric patients. Plethora in turn is caused by the ancient villain, inculpated since Hippocrates and Galen: suppressed hemorrhoids, suppressed menstrual evacuation and cutaneous eruption driven inward. Because of its suppression, transfer of blood occurs toward the chest, which impedes thoracic expansion and contraction, then asthma and dyspnea occur. On the contrary, Albertini with his clinical and autoptic observations and pronouncements filled in the anatomical and clinical picture of fluid accumulation and created the rudiments of diagnostic criteria. Edema, dropsy, asthma, dyspnea were, according to Albertini, the signs and symptoms of heart and renal failure. Albertini was the first to point out that dyspnea is apt to arise with special rapidity when a lesion occurs in the left atrial chamber and ventricle and by implication the mitral valve. In modern physiopathological terms, he discovered the picture of pulmonary edema. To this important discovery, he added a number of extremely important comments: changes in the respiratory organs are secondary to changes in the cardiovascular system; edema that is accompanied by dyspnea also affects the viscera, most especially the lungs, and finally dropsy of the lungs must be differentiated anatomically and clinically from dropsy of the chest (hydrothorax). In other words, he depicted the anatomical and clinical picture of congestive heart failure in modern terms.

Edema↗

Transjugular intrahepatic portosystemic shunt.

The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 16 years ago, more than 1,000 publications have appeared demonstrating broad acceptance and increasing clinical use. This review summarizes our present knowledge about technical aspects and complications, follow-up of patients and indications. A technical success rate near 100% and a low occurrence of complications clearly depend on the skills of the operator. The follow-up of the TIPS patient has to assess shunt patency, liver function, hepatic encephalopathy and the possible development of hepatocellular carcinoma. Shunt patency can best be monitored by duplex sonography and can avoid routine radiological revision. Short-term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. Stent grafts covered with expanded polytetrafluoroethylene show promising long-term patency comparable with that of surgical shunts. With respect to the indications of TIPS, much is known about treatment of variceal bleeding and refractory ascites. The thirteen randomized studies that are available to date show that survival is comparable in patients receiving TIPS or endoscopic treatment for acute or recurrent variceal bleeding. Another group comprises patients with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications. Five randomized studies comparing TIPS with paracentesis and one study comparing TIPS with the peritoneo-venous shunt showed good response of ascites but controversial results on survival. In addition, TIPS has been successfully applied to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic variceal bleeding.

Ascites↗

Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi.

INTRODUCTION: The treatment of large complete staghorn calculi requires a sandwich combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. Many urologists hesitate to place more than 2-3 tracts during PCNL because of the belief that this may increase complications. We present data to support multi-tract PCNL for large (surface area >3,000 mm(2)) complete staghorn calculi. PATIENTS AND METHODS: From July 1998 to October 2003, 121 renal units (103 patients) with large complete staghorn renal calculi were treated with PCNL. All procedures were performed in the prone position after retrograde ureteral catheterization. Fluoroscopy-guided punctures were made by the urologist followed by track dilation to 34 french. When multiple tracts were anticipated all punctures were usually made at the outset and preplaced wires were put into the collecting system or down the ureter. Stones were fragmented and removed using a combination of pneumatic lithotripsy and suction. Postoperative stone clearance was documented on X-ray KUB. RESULTS: 121 renal units of 103 patients (15 women and 88 men, mean age 43 years) were treated. Six patients had associated bladder calculi that were treated simultaneously. The stone surface area was 3,089-6,012 (mean 4,800) mm(2). 10 patients (9.7%) had renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-5.5) mg/dl. The number of tracts required per patient were 2 tracts in 11, 3 tracts in 68, 4 tracts in 39, and 5 tracts in 3, giving a total of 397 tracts in 121 renal units, over a total of 140 procedures (including second-look procedures in 19 renal units). The points of entry of these tracts were 121 upper calyx (30.4%), 178 middle calyx (44.8%), and 98 lower calyx (24.6%). All 121 units had one upper polar access tract of which 92 (76%) were supracostal. Complications were blood transfusion (n = 18), pseudoaneurysm (n = 2), fever (n = 22), septic shock (n = 1) and hydrothorax (n = 3). PCNL monotherapy achieved an 84% complete clearance rate that improved to 94% with SWL in 8 renal units with small residual fragments. Stone compositions were calcium oxalate (91%), uric acid (2%) and mixed (7%). CONCLUSION: Aggressive PCNL monotherapy using multiple tracts is safe and effective, and should be the first option for massive renal staghorn calculi.

Adult↗

Four cases of absent ductus venosus: three in combination with severe hydrops fetalis.

Ductus venosus links the umbilical vein and the portal vein to the inferior vena cava. It is of great significance for the developing fetus but of minor importance to the growing infant where it normally obliterates and is transformed to the ligamentum venosum. An absent ductus venosus implies that the oxygenated blood from the umbilical vein has to circulate through the liver. We report 4 cases with this malformation. Prenatally, three fetuses had an extreme hydrops, especially hydrothorax. In two fetuses hydrops was severe already in the second trimester of pregnancy. Termination was performed. In the third case, hydrops was first diagnosed in the 36th week of gestation. The fourth case had an ultrasound examination in the 34th week of gestation. There was no hydrops but a disproportion with a very small head and abdominal diameter compared to femur length. Postpartum both these infants died. At autopsy, the only structural malformation in the three hydrops cases was an absent ductus venosus. In the fourth case there were other anomalies.

Adult↗