Definitive-intent uniform megavoltage fractioned radiotherapy protocol for presumed canine intracranial gliomas: retrospective analysis of survival and prognostic factors in 38 cases (2013-2019).

BACKGROUND: Radiotherapy (RT) is currently considered the treatment of choice for presumed canine intracranial gliomas. However, variable therapeutic responses are described, due to heterogeneous populations and different radiation methods or protocols. Only one study dedicated to intracranial suspected glioma highlighted prognostic criteria. Determination or confirmation of specific clinical and imaging prognostic factors may guide the therapeutic management of these tumours. The objectives were to provide data on long-term clinical outcome (including quality of life, QoL) and to determine specific prognostic factors associated with survival time. We report a single-institution retrospective study, including all dogs with suspected symptomatic primary solitary intracranial glioma, treated with a complete uniform fractionated megavoltage radiation protocol of 15x3Gy over 5 weeks, between January 2013 and February 2019. Thirty-eight client-owned dogs were included. Medical records were retrospectively evaluated for median overall survival time (MST), clinical and imaging responses. Prognostic factors on survival were researched in terms of signalment, clinical presentation, tumour imaging characteristics and response following RT. Finally, the RT's impact on the dogs' clinical signs and Qol were evaluated by the owners. RESULTS: The disease-specific MST was 698 days (95% CI: 598-1135). Survival at 1 and 2 years were respectively 74.2 ± 7.4% and 49.0 ± 9.8%. Initial clinical signs were related to survival, as well as tumour characteristics such as cystic-pattern, mass effect and Tumour/Brain volume ratio. No significant adverse effect or radiotoxicity was observed. CONCLUSIONS: RT appears as a safe and effective treatment for canine intracranial gliomas, allowing long-term tumour control, improvement of life's quality and management of associated clinical signs. The initial clinical signs and MRI characteristics (Tumour/Brain volume ratio, cyst-like lesion and mass effect) may help predict the prognosis.

Corpus callosotomy for control of intractable epilepsy in children.

Cerebral commissurotomy has often been reported to control seizures in patients suffering from intractable epilepsy. However, in adults, division of the corpus callosum alone has been shown to be equally effective while considerably reducing the surgical morbidity. The present study of nine epileptic callosotomized patients suggests that callosal section can also be performed successfully and safely in children. Neurologic and concomitant psychological improvements are described.

Bordetella holmesii isolated from a patient with sickle cell anemia: analysis and comparison with other Bordetella holmesii isolates.

OBJECTIVES: To analyze a Bordetella holmesii isolate from a patient with sickle cell anemia and to compare it with other B. holmesii strains and isolates and with strains of B. pertussis and B. bronchiseptica, two well-characterized species of the Bordetella genus. METHODS: The bacteriological characteristics and proteins produced by the B. holmesii isolate and the reference strain (ATCC 51541) were analyzed and compared with those of B. pertussis and B. bronchiseptica using sera from patients infected with B. pertussis, B. bronchiseptica or B. holmesii. RESULTS: The bacteriological characteristics of the B. holmesii isolate studied here were similar to those of the B. holmesii reference strain and other isolates. Some of the proteins produced by B. holmesii isolates were similar to those produced by B. pertussis and B. bronchiseptica, but none of these proteins was similar to the toxins and adhesins involved in the pathogenicity of B. pertussis and B. bronchiseptica. The phenotypic diversity of the proteins produced by B. holmesii isolates and the reference strain was striking. CONCLUSIONS: Our results suggest that either, the expression of B. holmesii proteins is regulated as in B. pertussis and B. bronchiseptica, with the B. holmesii strain exhibiting different phases, or the proteins produced in B. holmesii are different.

Kinetics of elimination and acute consequences of cerebral air embolism.

The pathophysiology of arterial air embolism inducing brain injuries remains unclear. Previous experiments demonstrated the usefulness of computed tomography (CT) in the detection of air emboli in canine brain. This canine study investigates CT's ability to detect small air bubbles and to determine the kinetics of air elimination from cerebral arteries and its relationship with clinical, electroencephalographic (EEG), and histological manifestations. CT detects small air embolism, and intracerebral air volume strongly correlates with injected air dose (r2 = 0.86, p = 2 x 10(-3)). Air clearance time significantly depends on intracerebral air volume (r2 = 0.86, p = 0.04) and on the number of bubbles (r2 = 0.71, p = 0.03), whereas half-life of air elimination does not. No relationship was found between injected air dose, air clearance time, intracerebral volume of air, and clinical, EEG, and histological findings. The data indicate that CT accurately detects small air bubbles in the early course of cerebral air embolism, that air elimination from cerebral arteries follows a first-order compartment model, and that early CT findings do not correlate with clinical, EEG, and histological manifestations.

Accuracy testing of a new stereotactic CT -guided brain biopsy device in the dog.

The accuracy testing of a new CT -guided stereotactic device was undertaken via an experimental study. Ten dog cadaver heads were submitted to a CT examination and a brain target was determined (coordinates: x1, y1, z1). 0.3 ml of a radiopaque paste was injected in this chosen point. The head was analysed twice by CT and the centre of the injection (x2, y2, z2) was measured on slices. Tridimensional statistical analysis of the variance of the two points was carried out. The procedure always led to the injection of the radiopaque paste and created an intracerebral mass which gave a measurable image on CT examination. The distance between the original target and the centre of the injection was 2.9 +/- 1.08 mm. It is concluded that this new device allows the opportunity to perform stereotactic CT -guided brain biopsy for all unknown brain lesions exceeding 6 mm in diameter in the dog.

Cranioplasty after en bloc resection of calvarial chondroma rodens in two dogs.

The clinical features of chondroma rodens in two dogs and the treatment using radiation therapy, en bloc resection of the tumours and cranioplasties with a bone allograft (case 1) and a polymethylmethacrylate implant (case 2) are described. The dogs were still alive with no local recurrence of the tumours 30 and 18 months, respectively, after surgery. En bloc resection and calvarial reconstruction in the treatment of chondroma rodens are discussed.

Diagnosis of pulmonary thromboembolism in a cat using echocardiography and pulmonary scintigraphy.

A 10-year-old male cat was presented with sudden onset of respiratory difficulties. Clinical examination revealed an acute dyspnoea with cyanosis associated with a left systolic heart murmur. Standard thoracic radiographs excluded pulmonary oedema and showed very few pulmonary changes given the intensity of the respiratory compromise. Echocardiographic examination revealed hypertrophic cardiomyopathy and a thrombus in the right pulmonary artery. Pulmonary scintigraphy confirmed a pulmonary thromboembolism with hypovascularisation of the left cranial lobe and of the ventral segment of the right lobe. Conservative treatment was instituted using an antibiotic (doxycycline), anticoagulants (heparin, coumadine) and a calcium inhibitor (diltiazem). The cat was given absolute rest. The general condition of the animal improved.

Stereotactic CT-guided brain biopsy in the dog.

This study evaluated the accuracy of a new stereotactic CT-guided brain biopsy (SCTGBB) device on 23 client-owned dogs which presented with a brain lesion. Biopsy of the lesion was achieved in 95 per cent of cases. The target tissue was not sampled in one dog. Complications were observed in six dogs. Two dogs with highly vascularised brainstem tumours died after SCTGBB. Minor complications (slight variation in the neurological status) were observed in a further four cases. A diagnosis was reached in 16 dogs after cytological examination and in 21 dogs after histological evaluation. SCTGBB is an accurate diagnostic method for the diagnosis of brain lesions.

[Pulmonary and cerebral nocardiosis in a patient infected with HIV]. / Nocardiose pulmonaire et cérébrale chez un patient infecté par le VIH.

We report a case of pulmonary and cerebral nocardiosis in a patient infected with HIV. On the basis of this observation, the authors review the frequency of nocardiosis during the course of an HIV infection and the diagnostic problems proposed, and finally the therapeutic difficulties encountered.

Use of preoperative computed tomography for surgical treatment of recurrent draining tracts.

OBJECTIVES: To evaluate a rational decision-making approach based on preoperative computed tomography for surgical planning in dogs and cats with recurrent draining tracts. METHODS: Retrospective evaluation of case records of animals that underwent preoperative computed tomography for surgical treatment of thoracic/abdominal recurrent draining tracts. Cases were classified according to whether a source of inflammation and/or infection, in particular foreign bodies, was identified (group 1), suspected (group 2) or neither identified nor suspected (group 3) at computed tomography. Surgery consisted of removal of the source of inflammation and/or infection (group 1), debridement or abscess drainage (group 2) or en bloc resection of diseased tissues (group 3). Clinical outcome was evaluated at least 12 months after surgery. RESULTS: A source of inflammation and/or infection was found in 100% (8 of 8), 41% (7 of 17) and 25% (3 of 12) of cases in groups 1, 2 and 3, respectively. Recurrent draining tracts resolved in 100% (8 of 8), 94% (16 of 17) and 92% (11 of 12) of cases in groups 1, 2 and 3, respectively. CLINICAL SIGNIFICANCE: The proposed strategy provided a 95% (35 of 37) cure rate, after a single procedure in 81% (30 of 37) of cases. Recovery of a foreign body at surgery was not a prerequisite for the resolution of the recurrent draining tracts.

Use of computed tomography adrenal gland measurement for differentiating ACTH dependence from ACTH independence in 64 dogs with hyperadenocorticism.

BACKGROUND: The measurement of adrenal gland size on computed tomography (CT) scan has been proposed for the etiological diagnosis of hyperadrenocorticism (HAC) in dogs. Symmetric adrenal glands are considered to provide evidence for ACTH-dependent hyperadrenocorticism (ADHAC), whereas asymmetry suggests ACTH-independent hyperadrenocorticism (AIHAC). However, there are currently no validated criteria for such differentiation. OBJECTIVE: The aim of this retrospective study was to compare various adrenal CT scan measurements and the derived ratios in ADHAC and AIHAC cases, and to validate criteria for distinguishing between these conditions in a large cohort of dogs. ANIMALS: Sixty-four dogs with HAC (46 ADHAC, 18 AIHAC). METHODS: Dogs with confirmed HAC and unequivocal characterization of its origin were included. Linear measurements of adrenal glands were made on both cross-sectional and reformatted images. RESULTS: An overlap was systematically observed between the AIHAC and ADHAC groups for all measurements tested. Overlaps also were observed for ratios tested. For the maximum adrenal diameter ratio derived from reformatted images (rADR), only 1/18 AIHAC dogs had a rADR within the range for ADHAC. For a threshold of 2.08, the 95% confidence intervals for estimated sensitivity and specificity extended from 0.815 to 1.000 and from 0.885 to 0.999, respectively, for AIHAC diagnosis. CONCLUSION AND CLINICAL IMPORTANCE: Measurements from cross-sectional or reformatted CT scans are of little use for determining the origin of HAC. However, rADR appears to distinguish accurately between ADHAC and AIHAC, with a rADR > 2.08 highly suggestive of AIHAC.

Chronic traumatic brain injury in a dog.

Chronic traumatic brain injury is rare in man and has not been previously documented in dogs. This report describes a 2-year-old female American Staffordshire bull terrier that was referred with forelimb and hindlimb ataxia, decreased vigilance and disorientation following repeated aggression and physical abuse by its owner. A diffuse cortical lesion was suspected. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and computed tomography showed marked widening of the cerebral sulci with mild bilateral ventriculomegaly. The dog was humanely destroyed in view of the poor prognosis. Necropsy examination revealed narrowing of the cerebral cortical gyri and consequent widening of the sulci without distortion or displacement of the neural parenchyma. These features were consistent with bilateral diffuse cortical atrophy. Microscopically, there were chronic subarachnoid haemorrhages and the cortical subpial layer displayed spongiosis, capillary hyperplasia, astrocytosis, microgliosis and frequent neuronal necrosis occurring in a characteristic laminar pattern. This histopathological pattern of damage was significantly different from that previously described in people suffering from repeated traumatic brain injuries over a long period of time.

Recurrent bacteremia, a complication of cyanoacrylate injection for variceal bleeding: report of two cases and review of the literature.

We report the first description of recurrent bacteremia in two patients after cyanoacrylate injection for gastric varices bleeding treated with antibiotics alone. Adapted and prolonged antibiotic treatment allowed a complete resolution of the infection with no relapse after more than 6 months. According to recent data, prophylactic antibiotics should be further investigated for patients with bleeding varices undergoing cyanoacrylate injection.

Effect of contrast medium dose and image acquisition timing on ureteral opacification in the normal dog as assessed by computed tomography.

Computed tomography (CT) excretory urography was performed in five adult female dogs after intravenous injection of a bolus of four different doses of water-soluble iodinated contrast medium (100, 200, 400, and 800 mgI/kg). CT images centered over the urinary bladder were performed before injection and 1, 3, 5, 7, 9, 11, 15, 20, 25, 30, 40, 50, and 60 minutes after injection. Opacification of both ureters was evaluated by measuring maximum CT number of individual ureters at each time. Time opacification curves were generated for each dose. Best opacification of the ureters was obtained with 400 and 800 mgI/kg, with a constant peak at 3 minutes and durable opacification for 1 hour. Insufficient opacification was obtained with lower dose of 100 and 200 mgI/kg.

Nocardia infection of a joint prosthesis complicating systemic lupus erythematosus.

The authors report the case of a 43-year-old woman suffering from severe systemic lupus erythematosus treated with long-term prednisone, who developed Nocardia nova infection on a hip prosthesis. Sepsis occurred about two years after an episode of pulmonary nocardiosis with the same Nocardia species, that was successfully treated by 12 months of antibiotics. A good outcome of the joint infection was observed in response to antibiotics and removal of the prosthesis. Nocardiosis is a rare infection, acting as an opportunistic infection, facilitated in the present case by systemic lupus erythematosus and chronic corticosteroid therapy. Nocardia infections mainly affect the lungs, skin and central nervous system; these last two sites are mostly due to haematogenous spread, a frequent event. Treatment is based on antibiotics, usually continued for 3-12 months, especially because of the risk of relapse. The imipenem-amikacin combination appears to be more effective than trimethoprim sulfamethoxazole. To our knowledge, this is the first case report of Nocardia nova joint prosthesis infection also presenting as late septic spread of pulmonary nocardiosis, complicating corticosteroid-treated systemic lupus erythematosus.

Killing kinetics of meropenem against penicillin-resistant pneumococci.

The killing kinetics of meropenem against sixteen clinical isolates of pneumococci (12 penicillin-resistant, three penicillin-intermediate and one penicillin-sensitive) were studied. Meropenem was tested at 1x, 2x and 4x the MIC for each individual isolate. The results showed a good bactericidal activity with rapid killing of pneumococci (killing > 3 log10 cfu/mL was obtained for nine strains). This strategy needs clinical assessment and might prove to be a suitable alternative to penicillin and cephalosporins for the treatment of mixed infections involving multiresistant pneumococci.

Comparison of two techniques for measurement of in vitro killing kinetics of five antibiotics against Pseudomonas aeruginosa.

The in vitro activity of ticarcillin, imipenem, gentamicin, amikacin and ciprofloxacin against six Pseudomonas aeruginosa isolates was evaluated by two time-killing curve methods: the conventional broth technique, and another method previously described which employs a transfer filter membrane. The patterns of the killing curves obtained over a 5 h period with the two techniques were similar. In contrast to the results obtained for beta-lactam agents, the reduction of inoculum was great and increased with the concentration for aminoglycosides and ciprofloxacin. After 5 h, regrowth of the six strains tested was observed in broth with all antibiotics, whereas a bactericidal effect was observed over 24 h with the filter membrane method. Further studies are warranted to determine the reasons for this difference.

Killing kinetics of RP 59500 and pristinamycin against penicillin-resistant pneumococci.

The killing kinetics of two streptogramins, RP 59500 and pristinamycin against seventeen isolates of penicillin-susceptible and resistant pneumococci were studied. The antibiotics were tested at 1x, 2x and 4x the MIC for each individual isolate. The results showed a very good and rapid bactericidal activity within 1 hour for concentrations equal or greater to the MIC. These antibiotics are very promising agents for the treatment of infections due to multiresistant pneumococci.