Cesarean delivery in a parturient with a left ventricular assist device.

Left ventricular assist devices are implanted pumps designed to treat patients with heart failure, and in some cases, to be a bridge to transplantation for patients who qualify. The preconception presence of a left ventricular assist device is a relative contraindication to pregnancy. Few cases have been published regarding the anesthetic management of parturients with left ventricular assist devices. We present the care of a 24-year-old gravida seven, para two woman who presented for induction of labor at gestational age 34 and 6/7 weeks. Her medical history was significant for the presence of a left ventricular assist device, inserted due to heart failure associated with polysubstance abuse. To our knowledge, this is the first description of successful cesarean delivery under neuraxial anesthesia of a parturient with a left ventricular assist device.

Ovine caseous lymphadenitis: disease prevalence, lesion distribution, and thoracic manifestations in a population of mature culled sheep from western United States.

The prevalence, distribution, and severity of caseous lymphadenitis (CLA) lesions in 4,089 mature culled sheep were determined from a sample obtained by random selection of animal lots from a total population of 37,383 animals presented at an abattoir. The animals originated from 5 geographic regions comprising 9 western states. The prevalence rate for all forms of CLA was 42.41%. The prevalence of CLA lesions was significantly different in animals originating from 2 regions than it was in animals from the other 3 regions. The results indicate that CLA is a disease affecting a considerable number of mature culled sheep in different regions of western United States. Lesion distribution was catalogued according to a 4-compartment system: thoracic lymph nodes, lung parenchyma, abdominal tissues, and skeletal tissues including peripheral lymphatic tissues. Prevalence rates were determined for lesions occurring in the thoracic viscera (24.97%), skeletal tissues (23.09%), and abdominal viscera (11.79%). The prevalences of thoracic CLA lesions were significantly different for animals originating from 2 regions than for animals originating from the 3 other regions. Severe or advanced lesions were observed in the thoracic (3.74%) and abdominal viscera (1.27%). Involvements of CLA in the thoracic cavity occurred as abscesses of lung parenchyma, thoracic lymph nodes, or both. The bronchial and mediastinal lymph nodes were the most frequently affected thoracic lymph nodes. The liver was the most frequently affected abdominal organ, with the kidney being the next most commonly affected. The gross and histopathologic characteristics of CLA abscesses and tissues adjacent to the lesions were described.