Large bladder stones in an augmented bladder - An open approach to a big problem.

Bladder augmentation can be a valuable life-changing operation for patients with bladder dysfunction, however, are associated with several complications that require long-term management. One of the most common complications seen in these patients are bladder calculi. If bladder stones are left untreated, they can become extremely large and cause pain, urinary tract infections, or difficulty emptying the bladder. We present the case of a patient with an augmented bladder who had numerous large bladder stones and his management.

Prognostic indicators in dogs with intra-hepatic portal hypertension.

Objectives: The primary goals of this retrospective study were to describe a population of dogs with portal hypertension secondary to liver disease, and to assess whether prognosis could be inferred from historical, clinical, and clinicopathological data. Animals and procedures: Dogs (N = 76) diagnosed with intrahepatic portal hypertension between 2011 and 2020 were included; dogs with known congenital hepatic anomalies were excluded. Effect on survival was assessed using univariable and multivariable Cox proportional hazards models for historical, clinical, and clinicopathological variables. Results: Dogs survived for a median of 14 d (range: 0 to 2028 d), with 31.6% being euthanized within 2 d of diagnosis and 23.7% surviving longer than 2 mo. Presence of jaundice and duration of clinical signs, expressed in days, were significantly associated with outcome in the univariable analysis (HR = 1.846, 95% CI: 1.094 to 3.117, P = 0.02; HR = 0.995, 95% CI: 0.990 to 1.000, P = 0.033, respectively). However, only presence of jaundice was significantly associated with increased hazard of death in the multivariable analysis. Conclusion: Results of this study show that portal hypertension is associated with a poor prognosis; however, some dogs can show prolonged survival. Clinical relevance: Clinical data can guide decision-making for clinicians and owners.

Indicateurs pronostiques chez les chiens atteints d'hypertension portale intra-hépatique. Objectifs: Les principaux objectifs de cette étude rétrospective étaient de décrire une population de chiens souffrant d'hypertension portale secondaire à une maladie hépatique et d'évaluer si le pronostic pouvait être déduit à partir de données historiques, cliniques et clinicopathologiques. Animaux et procédures: Les chiens (N = 76) diagnostiqués avec une hypertension portale intrahépatique entre 2011 et 2020 ont été inclus; les chiens présentant des anomalies hépatiques congénitales connues ont été exclus. L'effet sur la survie a été évalué à l'aide de modèles de risques proportionnels de Cox univariés et multivariés pour les variables historiques, cliniques et clinicopathologiques. Résultats: Les chiens ont survécu pendant une durée médiane de 14 jours (intervalle : 0 à 2028 jours), 31,6 % ayant été euthanasiés dans les 2 jours suivant le diagnostic et 23,7 % ayant survécu plus de 2 mois. La présence d'ictère et la durée des signes cliniques, exprimées en jours, étaient significativement associées au résultat de l'analyse univariée (HR = 1,846, IC à 95 % : 1,094 à 3,117, P = 0,02; HR = 0,995, IC à 95 % : 0,990 à 1,000, P = 0,033, respectivement). Cependant, seule la présence d'ictère était significativement associée à un risque accru de décès dans l'analyse multivariée. Conclusion: Les résultats de cette étude montrent que l'hypertension portale est associée à un mauvais pronostic; cependant, certains chiens peuvent montrer une survie prolongée. Pertinence clinique: Les données cliniques peuvent guider la prise de décision des cliniciens et des propriétaires.(Traduit par Dr Serge Messier).

Testicular Surveillance Post-Orchidopexy and its Impact on Early Diagnosis of Testicular Cancer.

Paediatric surgeons are expected to counsel patients about the potential risk of cancer post-orchidopexy and the need to self-examine in adulthood. The study objectives were to examine if such advice is being given and identify the stage of cancer at presentation in adult patients with history of orchidopexy. This was a 5-year observational, retrospective collaborative study between a tertiary paediatric surgical unit and its regional adult testicular cancer service, examining the nature of counselling given by paediatric surgeons to orchidopexy patients and their carers and estimating the local incidence of testicular cancer in adults with previous orchidopexy during the same period. Orchidopexy was performed in 228 patients with a mean follow-up of 11.9 months. Twenty-two patients had documented advice to self-examine from puberty onwards. The advice was not influenced whether the surgery was staged or single (p = 0.39). During the 5 years, 133 adults were diagnosed with testicular cancer, 6 (4.5%) were cases of previous cryptorchidism, seminoma (n = 5) and non-seminoma germ cell tumour (n = 1). In our study, the incidence of cryptorchidism in testicular cancer was 4.5%, with all cancer patients presenting with early disease despite documented advice to self-examine being low (9.7%).

Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma.

BACKGROUND: Information regarding outcome of dogs undergoing surgical management for insulinoma is based on studies of a small number of dogs. OBJECTIVES: To report the outcomes of dogs undergoing surgery as treatment for insulinoma, the prevalence of postoperative diabetes mellitus (DM) in this group and to determine if development of DM can be predicted. ANIMALS: Forty-eight client-owned dogs, with a histopathological diagnosis of insulinoma, from three European referral hospitals. METHODS: Retrospective observational study. Dogs were identified from a search of electronic hospital records. Cox's regression was used to determine factors associated with postoperative survival and relapse, and logistic regression was used to determine factors associated with the development of DM. RESULTS: Median survival time (MST) was 372 days (range 1-1680 days), with dogs with stage I disease having the longest survival time. Stage I dogs had MST of 652 days (range 2-1680 days), whereas dogs with either stage II or III disease had MST of 320 days (range 1-1260 days; P = 0.045). Postoperative hyperglycemia was identified in 33% (16/48) of the dogs, of which 9 (19% of the total population) developed persistent DM. No factors that could be used as predictors for development of DM were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Stage of disease and postoperative hypoglycemia were associated with greater odds of relapse and decreased survival time; these could be used when discussing prognosis. In this study, postoperative DM developed more commonly than previously reported, but no factors were identified that might be useful predictors.

Tuberculosis due to Mycobacterium bovis in pet cats associated with feeding a commercial raw food diet.

OBJECTIVES: Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex, can infect cats and has proven zoonotic risks for owners. Infected cats typically present with a history of outdoor lifestyle and hunting behaviour, and cutaneous granulomas are most commonly observed. The aim of this study is to describe an outbreak of tuberculous disease commencing with six young cats, living exclusively indoors in five different households across England, being presented to separate veterinarians across the UK with a variety of clinical signs. METHODS: Investigations into the pyogranulomatous lesions, lymphadenopathy and/or pulmonary disease of these cases consistently identified infection with M bovis. Infection was confirmed by PCR, where possible, or was indicated with a positive interferon-gamma release assay (IGRA), where material for PCR was unavailable. In-contact, cohabiting cats were screened by IGRA and follow-up testing was undertaken/advised where results were positive. A lifestyle investigation was undertaken to identify the source of infection. RESULTS: Six clinically sick cats and seven in-contact cats were identified with evidence of M bovis infection. Five clinical cases were either too sick to treat or deteriorated despite therapy, giving a mortality rate of 83%. Lifestyle investigations revealed the common factors between clusters to be that affected cats had mycobacterial infections speciated to M bovis, were exclusively indoor cats and were fed a commercially available raw food product produced by a single manufacturer. The Food Standards Agency, Animal & Plant Health Agency, Public Health England and the food manufacturer concerned have been notified/informed. Other possible sources of exposure for these cats to M bovis were explored and were excluded, including wildlife contact, access to raw milk, the presence of rodent populations inside the buildings in which the cats lived and exposure to known infectious humans. CONCLUSIONS AND RELEVANCE: Upon investigations, our results provide compelling, if circumstantial, evidence of an association between the commercial raw diet of these cats and their M bovis infections.

Retrospective evaluation of thoracic computed tomography findings in dogs naturally infected by Angiostrongylus vasorum.

Angiostrongylus vasorum (A. vasorum) is an important emerging disease of canidae. Cardiorespiratory signs are common in affected dogs, therefore thoracic imaging is critical for diagnosing and monitoring disease. Descriptions of thoracic computed tomography (CT) findings in dogs naturally infected with A. vasorum are currently lacking. Aims of this multicenter, retrospective study were to describe thoracic CT findings in a group of dogs with confirmed disease, determine whether any changes were consistent among dogs, and propose standardized terms for describing thoracic CT findings. Nine UK-based referral centers' clinical and imaging databases were searched for dogs that had a confirmed diagnosis of A. vasorum, and had undergone thoracic CT examination. Eighteen dogs, from seven of the centers, fulfilled the inclusion criteria. The lung lobes were divided into the following three zones and the CT changes described in each: pleural (zone 1), subpleural (zone 2), and peribronchovascular (zone 3). The predominent abnormality was increased lung attenuation due to poorly defined ground-glass opacity or consolidation. There were regions of mosaic attenuation due to peripheral bronchiectasis. Nine/18 (50%) dogs showed hyperattenuating nodules of varying sizes with ill-defined margins. The distribution always affected zones 1 and 2 with varied involvement of zone 3; this resulted in clear delineation between zones 2 and 3. Tracheobronchial lymphadenomegaly was frequently noted. Findings were nonspecific and there was considerable overlap with other pulmonary conditions. However, authors recommend that A. vasorum be considered a likely differential diagnosis for dogs with a predominantly peripheral distribution of lung changes.

Locating the optimal internal jugular target site for central venous line placement.

STUDY OBJECTIVE: Historically, the placement of internal jugular central venous lines has been accomplished by using external landmarks to help identify target-rich locations in order to steer clear of dangerous structures. This paradigm is largely being displaced, as ultrasound has become routine practice, raising new considerations regarding target locations and risk mitigation. Most human anatomy texts depict the internal jugular vein as a straight columnar structure that exits the cranial vault the same size that it enters the thoracic cavity. We dispute the notion that the internal jugulars are cylindrical columns that symmetrically descend into the thoracic cavity, and purport that they are asymmetric conical structures. DESIGN: The primary aim of this study was to evaluate 100 consecutive adult chest and neck computed tomography exams that were imaged at an inpatient hospital. We measured the internal jugular on the left and right sides at three different levels to look for differences in size as the internal jugular descends into the thoracic cavity. MAIN RESULTS: We revealed that as the internal jugular descends into the thorax, the area of the vessel increases and geometrically resembles a conical structure. We also reconfirmed that the left internal jugular is smaller than the right internal jugular. CONCLUSIONS: Understanding that the largest target area for central venous line placement is the lower portion of the right internal jugular vein will help to better target vascular access for central line placement. This is the first study the authors are aware of that depicts the internal jugular as a conical structure as opposed to the commonly depicted symmetrical columnar structure frequently illustrated in anatomy textbooks. This target area does come with additional risk, as the closer you get to the thoracic cavity, the greater the chances for lung injury.

Tumor-to-tumor metastasis: pathology and neuroimaging considerations.

The phenomenon of tumor-to-tumor metastasis has been reported in the literature for over a century. However, it remains fairly uncommon, with fewer than 100 cases being described during that time. Virtually any benign or malignant tumor can be a recipient, but meningiomas have been implicated as the most common intracranial neoplasm to harbor metastasis. The donor neoplasm is most frequently lung or breast carcinoma, while rare cases of metastasis from other primary tumors have been reported. We report here three examples of such rare metastases. This case series reports the first documented instance involving rectal adenocarcinoma. In addition, we report two cases of metastatic prostate adenocarcinoma to a meningioma; to date of which only three cases have been published. The terms "tumor-to-tumor metastasis" and "collision tumor" are addressed, as are details of the pathology. The limitations of standard radiological imaging techniques, such as standard CT and MR, which cannot reliably identify the presence of metastasis within a meningioma are compared with physiology-based neuroimaging methods, such as perfusion MR and MR spectroscopy, which may be more useful in noninvasively differentiating tumor histology.