Scapulohumeral subluxation and luxation in five alpacas.

INTRODUCTION: The patient histories, findings from clinical examinations, diagnostic imaging techniques, the surgical procedures, complications, necropsy findings and the outcomes from five male or castrated male alpacas with scapulohumeral sub-/luxation are presented. These alpacas each had a history of severe forelimb lameness for one week (n: 1), four weeks (n: 2) and for two-to-three months (n: 2). Two of the five alpacas were euthanized due to severe osteoarthritic changes that developed during the two-to-three months of scapulohumeral luxation. Three alpacas were treated with open reduction and internal stabilisation by placing tension band sutures between one 4,5 mm cortical screw anchored in the scapular neck and two 4,5 mm cortical screws anchored in the greater humeral tubercle, all of them provided with washers. Post-surgery a carpal flexion sling was applied to avoid postoperative weight-bearing. An exercise programme was started after removal of the carpal sling and continued for 12 weeks. In one of the three alpacas an additional non-displaced fracture of the acromion occurred two weeks after surgery. In conclusion, all three treated alpacas had good-to-excellent long-term outcomes and are still alive 123, 15 and 12 months after surgical repair of the scapulohumeral sub-/luxation. As four weeks, or even up to three months elapsed in four of these five alpacas until a definitive diagnosis was made, more education should be provided to alpaca owners that severely lame animals should be presented to a veterinarian with adequate diagnostic possibilities and expertise as soon as possible in order not to compromise treatment success.

INTRODUCTION: Dans cette étude rétrospective, on présente les antécédents des patients, les résultats des examens cliniques, les techniques d'imagerie diagnostique, les procédures chirurgicales, les complications, les résultats de l'autopsie et les résultats finaux de cinq alpagas mâles ou mâles castrés souffrant d'une subluxation ou luxation scapulo-humérale. Ces alpagas présentaient chacun des antécédents de boiterie sévère des membres antérieurs depuis une semaine (n: 1), quatre semaines (n: 2) et deux à trois mois (n: 2). Deux des cinq alpagas ont été euthanasiés en raison des changements arthrosiques graves qui s'étaient développés au cours des deux à trois mois de luxation scapulo-humérale. Trois alpagas ont été traités par réduction ouverte et stabilisation interne en plaçant des sutures à bande de tension entre une vis corticale de 4,5 mm ancrée dans le col de l'omoplate et deux vis corticales de 4,5 mm ancrées dans le tubercule huméral supérieur, toutes munies de rondelles. Après l'opération, une écharpe de flexion du carpe a été mise en place pour éviter la mise en charge postopératoire. Un programme d'exercices a été mis en place après le retrait de l'écharpe carpienne et a été poursuivi pendant 12 semaines. Chez l'un des trois alpagas, une fracture non déplacée de l'acromion s'est produite deux semaines après l'opération. En conclusion, les trois alpagas traités ont eu des résultats à long terme bons à excellents et sont toujours en vie 123, 15 et 12 mois après la réparation chirurgicale de la subluxation scapulo-humérale. Dans la mesure où il s'est écoulé quatre semaines voire jusqu'à trois mois chez quatre de ces cinq alpagas avant qu'un diagnostic définitif ne soit posé, il convient d'informer davantage les propriétaires d'alpagas que les animaux gravement boiteux doivent être présentés à un vétérinaire disposant des possibilités de diagnostic et de l'expertise adéquates le plus rapidement possible afin de ne pas compromettre le succès du traitement.

Nivolumab for locally advanced and metastatic cutaneous squamous cell carcinoma (NIVOSQUACS study)-Phase II data covering impact of concomitant haematological malignancies.

BACKGROUND: Monoclonal antibodies, such as cemiplimab and pembrolizumab, against the programmed death receptor (PD)-1 have become the current standard of care and first-line treatment of advanced cutaneous squamous cell carcinoma (cSCC), proving remarkable clinical benefit and acceptable safety. OBJECTIVES: To assess efficacy and safety of the anti-PD-1 antibody nivolumab in patients with locally advanced and metastatic cSCC. METHODS: Patients received open-label nivolumab 240 mg intravenously every 2 weeks for up to 24 months. Patients with concomitant haematological malignancies (CHMs), either non-progressing or stable under active therapy, were eligible for inclusion. RESULTS: Of 31 patients with a median age of 80 years, 22.6% of patients achieved an investigator assessed complete response, resulting in an objective response rate (ORR) of 61.3% and a disease control rate (DCR) of 64.5%. Progression-free survival (PFS) was 11.1 months, and the median overall survival (OS) was not reached after 24 weeks of therapy. Median follow-up was 23.82 months. Subgroup analysis of the CHM cohort (n = 11; 35%) revealed an ORR of 45.5%, a DCR of 54.5%, a median PFS of 10.9 months, and median OS of 20.7 months. Treatment related adverse events were reported in 58.1% of all patients (19.4% grade 3, the remaining grade 1 or 2). PD-L1 expression and CD-8+ T-cell infiltration did not significantly correlate with clinical response, although a trend towards a shorter PFS of 5.6 months was observed with PD-L1 negativity and low CD8+ intratumoral infiltration. CONCLUSION: This study demonstrated robust clinical efficacy of nivolumab in patients with locally advanced and metastatic cSCCs and a tolerability comparable to data of other anti-PD-1 antibodies. Favourable outcomes were obtained despite involving the oldest hitherto reported study cohort for anti-PD-1 antibodies and a significant proportion of CHM patients prone to high risk tumours and an aggressive course otherwise typically excluded from clinical trials.

Surgical treatment of scapulohumeral subluxation in an alpaca (Vicugna pacos) using osteotomy of the acromion, open reduction and extracapsular tension sutures.

CASE HISTORY AND CLINICAL FINDINGS: A 3.3-year-old male alpaca, weighing 60 kg was referred for investigation of a severe left forelimb lameness of 4 weeks duration. A scapulohumeral subluxation had been diagnosed radiographically by the referring veterinarian. CLINICAL FINDINGS AND DIAGNOSIS: Based on clinical, ultrasonographic and radiographic findings the diagnosis of cranio-lateral subluxation of the left humeral head was confirmed. In addition, a full thickness lesion (approximately 1×1 cm) of the articular cartilage on the caudomedial aspect of the humeral head was diagnosed by arthroscopy. TREATMENT AND OUTCOME: Treatment included open reduction with internal fixation. Severe muscle contraction and local tissue fibrosis around the scapulohumeral joint (SHJ) required osteotomy of the acromion 3 cm proximal to the distal acromial edge, to allow adequate access. Internal stabilisation was achieved by placing tension band sutures between one cortical screw in the scapular neck and two cortical screws, with washers, craniolaterally on the greater tubercle of the humerus. Post-surgery, a carpal flexion sling was applied with the carpus maintained in 70° flexion for 4 weeks to avoid postoperative weight-bearing. An exercise programme was started 8 days after surgery and continued for 12 weeks. The alpaca had an uneventful postsurgical recovery and showed no lameness after 8 weeks. The long-term outcome was excellent; 21 months after surgery the alpaca was sound and the range of movement of the left SHJ was equal to the right SHJ. CLINICAL RELEVANCE: Even in this chronic case of subluxation of the SHJ of 4 weeks duration, surgical treatment using osteotomy of the acromion, open reduction and internal fixation with extracapsular scapulohumeral tension sutures resulted in an excellent long-term outcome in this alpaca, despite the presence of a cartilage lesion.

A simple surgical treatment for bovine digital dermatitis-associated white line lesions and sole ulcers.

Non-healing white line disease (nhWLD) and sole ulcers (nhSU) are seen increasingly in herds endemically affected with bovine digital dermatitis (BDD). In 35 cows with 42 nhWLD or nhSU lesions, the healing process was monitored for up to 28 or 38 days following extensive debridement of loose horn and infected corium under regional anaesthesia, and topical application of tetracycline spray with bandaging. By 28 days, 27/42 (64%) nhWLD and nhSU were completely covered by a new horn layer and this increased to 30/42 (71%) that had healed by 38 days. Lesion sizes on day 0 correlated with clinical healing within the study period. In view of this satisfying therapeutic result, the terms nhWLD and nhSU are proposed for BDD-associated white line disease (BDD-WLD) and BDD-associated sole ulcers (BDD-SU), respectively.

Rare case of a radiographically occult sacral lesion detected on MRI presenting with intractable back pain.

We report the imaging findings and histopathology of a rare case of sacral hibernoma in a female presenting with right buttock pain while sitting. The lesion was occult on radiographs and CT scan. A small, rounded right S2 lesion was hypointense on T 1 weighted images and hyperintense on short tau inversion-recovery images. It demonstrated homogeneous contrast enhancement. The lesion was biopsied, and histopathology revealed an intraosseous hibernoma composed of brown fat cells. Intraosseous hibernomas are rare and demonstrate non-specific imaging findings requiring biopsy for diagnosis, although most hibernomas are incidental and asymptomatic. Initial treatment with microwave ablation and cementoplasty improved the patient's symptoms temporarily but cementoplasty caused radicular symptoms, and eventually, cement removal, bone curettage, grafting and sacral nerve root decompression were required for symptom remission.

Phenotypic variability in three families with valosin-containing protein mutation.

BACKGROUND AND PURPOSE: The phenotype of IBMPFD [inclusion body myopathy with Paget's disease of the bone and frontotemporal dementia (FTD)] associated with valosin-containing protein (VCP) mutation is described in three families. METHODS: Probands were identified based on a pathological diagnosis of frontotemporal lobar degeneration with TDP-43-positive inclusions type IV. VCP sequencing was carried out. Clinical data on affected family members were reviewed. RESULTS: Ohio family: four subjects presented muscle weakness and wasting. (One subject had both neuropathic and myopathic findings and another subject showed only evidence of myopathy. The etiology of weakness could not be ascertained in the remaining two subjects.) Two individuals also showed Parkinsonism (with associated FTD in one of the two). The proband's brain displayed FTLD-TDP type IV and Braak stage five Parkinson's disease (PD). A VCP R191Q mutation was found. Pennsylvania family: 11 subjects developed IBMPFD. Parkinsonism was noted in two mutation carriers, whilst another subject presented with primary progressive aphasia (PPA). A novel VCP T262A mutation was found. Indiana family: three subjects developed IBMPFD. FTD was diagnosed in two individuals and suspected in the third one who also displayed muscle weakness. A VCP R159C mutation was found. CONCLUSIONS: We identified three families with IBMPFD associated with VCP mutations. Clinical and pathological PD was documented for the first time in members of two families. A novel T262A mutation was found. One individual had PPA: an uncommon presentation of IBMPFD.

[Ultrasonographic examination of the musculoskeletal system in cattle]. / Sonographische Untersuchung des Bewegungsapparats beim Rind.

Ultrasound machines with 7.5 to 5.0MHz linear transducers are well suited for rapid and straightforward differentiation of soft tissue swelling in the musculoskeletal system of cattle; in proximal limb regions 3.5MHz convex scanners allow better imaging. The main indications for ultrasonography of the musculoskeletal system in cattle are suspected arthritis, tenosynovitis, bursitis, abscesses, haematomas, diagnosis of muscle and tendon lesions, and generally the evaluation of soft tissue swellings everywhere that cannot be diagnosed based on clinical examination. The examiner starts by obtaining a general overview of the affected region for orientation purposes. This is achieved by locating and identifying anatomical landmarks, thereafter one can search for pathological changes by examination of the region of interest in longitudinal and transverse planes from all sides. The ultrasonographic investigation should follow a standardised systematic protocol. Normal synovial cavities in cattle are difficult or impossible to visualize via ultrasonography because of the very small physiological amount of synovial fluid. Thus, effusion that is easily visualized usually indicates a pathological process like arthritis, tenosynovitis or bursitis. Ultrasonography provides accurate information about the location and size of lesions or fluid-filled cavities, the nature of the content and an exact measurement of the distance from pathologically altered structures to the skin surface. Targeted centesis of synovial or other cavities can be carried out after a preliminary ultrasonographic inspection. Characterization of the lesions and a thorough preoperative inspection of affected regions are of enormous benefit for planning surgery and treatment.

The calibration of experimental self-developing Gafchromic HXR film for the measurement of radiation dose in computed tomography.

A prototype, self-developing Gafchromic HXR film has sensitivity an order of magnitude larger than that of the commercially available Gafchromic XR film used in interventional radiological applications. The higher sensitivity of the HXR film allows the possibility of acquisition of high-resolution calibrated dose profiles within the diagnostic range of exposure levels, below 10 R (87.7 mGy). We employed a commercially available, optical flatbed scanner for digitization of the film and image analysis software to determine the response of the HXR films to ionizing radiation. Spatial uniformity and temporal repeatability of the flatbed scanner were determined and used in optimization of the digitization protocol. The HXR film postexposure density growth and sensitivity to ambient light were determined using multiple scans of two simultaneously exposed sheets, one stored in light-tight conditions and the other continuously illuminated with white light. A calibrated step wedge of the HXR film was obtained by simultaneous irradiation of a portion of a film strip and a calibrated ionization chamber using a radiographic x-ray tube with beam characteristics matched to a typical CT scanner (8 mm Al HVL, 120 kVp). Repeated digitization of the calibration film was used to determine the precision of the film response measurements. The precision, as measured by the standard deviation of multiple measurements, was better than 1% over the full dynamic range of film response. This precision was measured using exposures ranging from 0.5 to 12 R (4.4 to 105.3 mGy). This exposure range is highly relevant to x-ray computed tomography. Preliminary radiation dose profiles demonstrate the utility of this technique.

Update on patient radiation doses at a large tertiary care medical center.

Radiation procedures in diagnostic radiology and nuclear medicine examinations, especially at referral centers, contribute a significant proportion to population dose; hence, there is a presumed detriment. Knowledge of the magnitude of dose from each type of exam is helpful in determining where to implement dose reduction efforts. Additionally, new records of dose data facilitate comparisons with past measurements. In this paper, updated patient exam dose data (frequency and effective dose equivalent) are provided for a large, comprehensive, tertiary care medical center that served more than 340,000 patients in 1997. Patient billing code data were used to study 31 different types of diagnostic exams encompassed in five major categories (angiography, fluoroscopy, radiography, nuclear medicine, and computerized tomography). Organ doses for each radiographic and nuclear medicine exam were estimated using published Monte Carlo conversion factors and appropriate exposure values. Estimates of organ doses were utilized to compute effective dose equivalent (EDE) per ICRP 26 and collective effective dose equivalent. Mean effective dose equivalent was also calculated for each exam category. Total collective effective dose equivalent had decreased from 1988 (2,030 person-Sv) to 1997 (1,817 person-Sv). The largest contributors to collective effective dose equivalent were angiography (768 person-Sv), computerized tomography (447 person-Sv), and nuclear medicine (355 person-Sv). Radiography (150 person-Sv) and fluoroscopy (97 person-Sv) contributed the least to collective effective dose equivalent. Mean effective dose equivalent contributions remained the same, with angiography accounting for the highest component, followed by nuclear medicine, computerized tomography, fluoroscopy, and radiography, respectively. Effective dose equivalent, collective effective dose equivalent, and mean effective dose equivalent values were calculated and tabulated in five major categories. These data provide updated information as to trends in exam and; collective dose from 31 common types of radiologic exams performed at a large medical center, which can be used as an up to date baseline for analyses of trends in U.S. radiation doses due to medical imaging procedures. Although minor changes were observed in comparing the mean effective dose equivalent data to those of a previous study, substantial differences were evident in the collective effective dose equivalent data. This was due primarily to variations in the number of patients examined and changes in technology and practice.

Mitochondrial toxin 3-nitropropionic acid induces cardiac and neurotoxicity differentially in mice.

We investigated the effects of 3-nitropropionic acid (3NPA), a previously characterized neurotoxin, in four strains of mice to better understand the molecular basis of variable host responses to this agent. Unexpectedly, we found significant cardiac toxicity that always accompanied the neurotoxicity in all strains of mice in acute and subacute/chronic toxicity testing. Caudate putamen infarction never occurred without cardiac toxicity. All mouse strains tested are sensitive to 3NPA although the C57BL/6 and BALB/c mice require more exposure than 129SVEMS and FVB/n mice. Cardiac toxicity alone was found in 50% of symptomatic mice tested and morphologically, the cardiac toxicity is characterized by diffuse swelling of cardiomyocytes and multifocal coagulative contraction band necrosis. In subacute to chronic exposure, atrial thrombosis, cardiac mineralization, cell loss, and fibrosis are combined with cardiomyocyte swelling and necrosis. Ultrastructurally, mitochondrial swelling occurs initially, followed by disruption of myofilaments. Biochemically, isolated heart mitochondria from the highly sensitive 129SVEMS mice have a significant reduction of succinate dehydrogenase activity, succinate oxygen consumption rates, and heart adenosine triphosphate after 3NPA treatment. The severity of morphological changes parallels the biochemical alterations caused by 3NPA, consistent with cardiac toxicity being a consequence of the effects of 3NPA on succinate dehydrogenase. These experiments show, for the first time, that 3NPA has important cardiotoxic effects as well as neurotoxic effects, and that cardiac toxicity possibly resulting from inhibition of the succinate dehydrogenase in heart mitochondria, contributes to the cause of death in 3NPA poisoning in acute and subacute/chronic studies in mice.

Prostaglandin E(1) does not influence plasmatic coagulation, hepatic synthesis, or postoperative blood loss in patients after coronary-artery bypass grafting.

STUDY OBJECTIVE: To assess whether postoperatively administered prostaglandin E1 (PGE1) might prevent bleeding in patients after coronary artery bypass grafting (CABG). DESIGN: Prospective, randomized, placebo-controlled trial. SETTING: University-affiliated hospital. PATIENTS: 49 patients scheduled for elective CABG surgery. INTERVENTIONS: The PGE1 group received intravenous PGE(1) up to 15 ng/kg/min for 72 hours after surgery, whereas the placebo group received isotonic saline for the same time period. MEASUREMENTS AND MAIN RESULTS: Nine patients (4 in the PGE1 group vs. 5 in the placebo group) had to be excluded because of hemodynamic instability, and 1 in the placebo group because of gastric bleeding. In the remaining 39 patients (20 vs. 19), no significant differences with regard to hemoglobin levels or platelet count could be observed. There was no significant difference between the groups concerning the amount of packed red blood cells, platelet concentrates, or fresh frozen plasma transfused. No significant differences could be observed regarding laboratory markers of coagulation activation or hepatic synthesis either. CONCLUSIONS: PGE1 did not prevent coagulation disturbances and blood loss when administered postoperatively in patients undergoing CABG. The absence of these expected effects might be explained by the concomitant administration of acetylsalicylic acid, whose antiaggregatory acivity seems to exceed the effects of PGE1.

Relation of pro- and anti-inflammatory cytokines and the production of nitric oxide in patients receiving high-dose immunotherapy with interleukin-2.

Immunotherapy with intravenous recombinant human interleukin-2 (rh IL-2) may be accompanied by hypotension and the emergence of capillary leak syndrome. Nitric oxide (NO) is supposed to be responsible for both side effects. The aim of the current investigation was to elucidate the relationship between pro- and anti-inflammatory cytokines and the production of NO in eight tumor patients receiving intravenous rh IL-2 continuously over a time period of 120 hours. Markers of systemic inflammation, as well as nitrate plasma levels, were consecutively determined. Significant changes in the levels of pro-inflammatory cytokines IL-6 and IL-8 were observed (p < 0.05). In contrast to the anti-inflammatory cytokine IL-10, which did not increase significantly, the serum concentrations of the soluble tumor necrosis factor receptors (sTNFr) I and II rose continuously and significantly during the observation period (p < 0.05). In parallel, a significant rise in nitrate plasma levels was observed (p < 0.05). Moreover, there were highly significant correlations between nitrate and IL-6 serum levels (p < 0.05), nitrate and sTNFr-I (p < 0.05), nitrate and sTNFr-II (p < 0.05), and between IL-6 and IL-10 (p < 0.05), respectively. We conclude that immunotherapy with IL-2 promotes a pro-inflammatory state, parallelled by an increased production of nitric oxide. Although anti-inflammatory responses accompany this process, they are not able to diminish the production of nitric oxide.

Comparison of tissue harmonic imaging with conventional US in abdominal disease.

Harmonic waves are generated from nonlinear distortion of an acoustic signal as an ultrasound wave insonates tissues in the body. These beams are integer multiples of a fundamental transmitted frequency. Potential advantages of harmonic imaging include improved axial resolution due to higher frequencies and better lateral resolution due to narrower beams. Decreased noise from side lobes improves signal-to-noise ratios and reduces artifacts. Deleterious effects of the body wall are also reduced. The authors prospectively studied ultrasonographic (US) findings in 100 adult patients with 202 abdominal lesions by comparing harmonic US images with conventional US images. The results were subjected to statistical analysis. Harmonic imaging was superior to conventional US in regard to lesion visibility and diagnostic confidence. Harmonic imaging was particularly useful for depicting cystic lesions and those containing echogenic tissues such as fat, calcium, or air. In patients with a body mass index of 30 or more, harmonic imaging was clearly better for lesion visibility and confidence of diagnosis. The authors recommend routine use of harmonic imaging for abdominal US studies in all adult patients.

Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit.

OBJECTIVE: To assess survival in cancer patients admitted to an intensive care unit (ICU) with respect to the nature of malignancy, cause of ICU admittance, and course during ICU stay as well as to evaluate the prognostic value of the Acute Physiology and Chronic Health Evaluation (APACHE) III score. DESIGN: Retrospective cohort study. SETTING: ICU at a university cancer referral center. PATIENTS: A total of 414 cancer patients admitted to the ICU during a period of 66 months. INTERVENTIONS: None. MEASUREMENTS: Charts of the patients were analyzed with respect to underlying disease, cause of admission, APACHE III score, need and duration of mechanical ventilation, neutropenia and development of septic shock, as well as ICU survival and survival after discharge. Mortality data were compared with two control groups: 1362 patients admitted to our ICU suffering from diseases other than cancer and 2,776 cancer patients not admitted to the ICU. MAIN RESULTS: ICU survival was 53%, and 1-yr survival was 23%. The 1-yr mortality rate was significantly lower in both control groups. Patients admitted after bone marrow transplantation had the highest mortality. In a multivariate analysis, prognosis was negatively influenced by respiratory insufficiency, the need of mechanical ventilation, and development of septic shock during the ICU stay. Admission after cardiopulmonary resuscitation yielded high ICU mortality but a relatively good long-term prognosis. Admission after surgery and as a result of acute hemorrhage was associated with a good prognosis. Age, neutropenia, and underlying disease did not influence outcome significantly. Admission APACHE III scores were significantly higher in nonsurvivors but failed to predict individual outcome satisfactorily. All patients with APACHE III scores of >80 died at the ICU. CONCLUSION: A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU. The APACHE III scoring system alone should not be used to make decisions about therapy prolongation. Admission to the ICU worsens the prognosis of a cancer patient substantially; however, as ICU mortality is 47%, comparable with severely ill noncancer patients, general reluctance to admit cancer patients to an ICU does not seem to be justified.

Activation of endothelium by immunotherapy with interleukin-2 in patients with malignant disorders.

Treatment with intravenous recombinant human interleukin-2 (rh IL-2) is frequently accompanied by the capillary leak syndrome and disturbances of the coagulation system. Although the exact mechanisms are still not fully understood, the involvement of the endothelium is proven. This investigation aimed to elucidate more precisely the role of the endothelium in the generation of IL-2-based side-effects. In nine tumour patients receiving intravenous rh IL-2, parameters characterizing endothelial cell activation as well as activation of the coagulation system were evaluated. A significant increase of the circulating endothelial leucocyte adhesion molecule-1 (cELAM-1) and the vasoconstrictor peptide endothelin-1 (ET-1) was observed (P<0.05), indicating activation of endothelial cells. The simultaneous increase of tissue-plasminogen activator and plasminogen activator inhibitor type-1 during therapy (P<0.05) corroborated this observation. A decrease in platelet count parallelled by an increase of fibrin degradation products, the prolongation of partial thromboplastin time, and the decrease of fibrinogen (P<0.05) suggested the development of disseminated intravascular coagulation (DIC), induced by activated endothelium and intensified by transient hepatic failure. We concluded that activation of the endothelium mediated by IL-2 was accompanied by a loss of endothelial integrity and capillary leak. The activated endothelium can trigger DIC via activation of the coagulation cascade. The increased ET-1 might act as an endogenous counter-regulator of the disadvantageous haemodynamic side-effects induced by IL-2.

Use of abciximab-modified thrombelastography in patients undergoing cardiac surgery.

UNLABELLED: Thrombelastography (TEG) is a reliable coagulation monitoring system that can guide blood product transfusion in cardiac surgery. The maximum amplitude (MA) of TEG measures clot strength, which is dependent on both fibrinogen level and platelet function. Inhibition of platelet function with abciximab-fab is suggested to permit quantitative assessment of the contribution of fibrinogen to clot strength. We hypothesized that abciximab-modified TEG permits prediction of plasma fibrinogen levels and that the difference of standard MA and abciximab-modified MA (deltaMA) is a correlate for platelet function. We correlated abciximab-modified MA with plasma fibrinogen levels and deltaMA with platelet count in patients undergoing coronary revascularization. Correlation between plasma fibrinogen levels and abciximab-modified MA was significant (adjusted r2: 0.8; P < 0.0001). Correlation of deltaMA with platelet count was not significant when calculated in millimeters (adjusted r2: 0.04; P = 0.73). However, when deltaMA was calculated in dynes per square centimeter (deltaGMA), it correlated significantly with platelet count (adjusted r2: 0.51; P < 0.0001). We conclude that abciximab-modified TEG may therefore help to discriminate between hypofibrinogenemia and platelet dysfunction as a cause of decreased MA. IMPLICATIONS: We examined the use of abciximab-modified thrombelastography in patients undergoing cardiac surgery. Modification of thrombelastography with abciximab-fab allows prediction of fibrinogen levels, despite coagulation altered by cardiac surgery. The difference of standard maximum amplitude and abciximab-modified maximum amplitude correlates with platelet function when expressed in dynes per square centimeter.

Placement of a pulmonary artery catheter via a previously unrecognized persistent left superior vena cava.

This case report describes a patient with persistent left superior vena cava (LSVC) as discovered by difficult placement of a pulmonary artery catheter via the left subclavian vein. After positioning in wedge position, chest x-ray showed a catheter route suggestive of persistent LSVC. Since this abnormality may yield potential clinical complications, this possibility should be considered in every difficult central venous access.

Time course of immunological markers in patients with the systemic inflammatory response syndrome: evaluation of sCD14, sVCAM-1, sELAM-1, MIP-1 alpha and TGF-beta 2.

BACKGROUND: The systemic inflammatory response syndrome (SIRS) is viewed as a system-wide inflammatory response. Up until now, no parameter has been available for predicting the development of septic shock. In the present study, we evaluated the usefulness of serum levels of CD14, vascular cells adhesion molecule-1 (VCAM-1), endothelial leucocyte adhesion molecule-1 (ELAM-1), macrophage inflammatory protein (MIP) 1 alpha and transforming growth factor beta 2 (TGF-beta 2) as early markers of outcome in patients with SIRS. METHODS: A group of 28 SIRS patients (13 survivors/15 non-survivors) was compared with a healthy control group and with patients with local inflammation. Blood samples were analysed on days 0, 4 and 7. Proinflammatory parameters such as sCD14, sVCAM-1, sELAM-1, MIP-1 alpha and anti-inflammatory parameters such as TGF-beta 2 were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: At the beginning, all evaluated proinflammatory immunological parameters with the exception of sVCAM-1 were significantly increased in patients with SIRS compared with the healthy control group. However, no significant difference could be observed for all immunological parameters comparing survivors and non-survivors, with the exception of interleukin (IL) 6 at day 7. CONCLUSION: All evaluated proinflammatory parameters were increased in patients with SIRS during the course of the disease. However, the parameters have no correlation with outcome and prognosis of SIRS patients.

[Squamous cell carcinoma of the claw matrix in a cow]. / Plattenepithelkarzinom der Klauenmatrix eines Rindes.

Clinical, radiographic, gross-pathological and histological findings in a squamous cell carcinoma of the claw matrix in a three-year-old Simmental cow are described. The cow showed severe lameness of the right foreleg. Radiological examination revealed a large osteolytic focus in the medial distal phalanx. The tentative clinical diagnosis of apical pedal bone necrosis was followed by amputation and pathological examination of the claw. The horn capsule showed no lesions. Pathological examination revealed soft consistency of pedal bone and the cut surface showed a yellowish crumbling material, which had replaced most of the pedal bone. Histologically, infiltration and osteolysis of distal pedal bone by a squamous cell carcinoma was ascertained. This claw tumor has not been reported until now. Clinically, it resembles apical pedal bone necrosis and therefore should be included in the differential diagnosis.

Cutaneous, multilocular T-cell lymphosarcoma in a horse--clinical, ultrasonographic and pathological findings.

Clinical, ultrasonographic and pathological findings of a cutaneous, multilocular T-cell lymphosarcoma (malignant lymphoma) in a 13-year-old, brown Austrian warmblood mare are reported. The horse was under clinical observation, and the tumours were sonographically monitored over an 8 month period, revealing worsening of body condition, weight loss, lameness of the left hindlimb and a slight increase in the tumours size. Most of the tumours were covered by normal skin, one showed ulceration. Ultrasonography of the tumours allowed accurate anatomical localization in relation to the adjoining tissue, assessment of their internal structure, of involvement of adjacent muscles and of a regional lymph node, and it facilitated the percutaneous fine-needle aspiration. Necropsy confirmed muscular infiltration in three locations. Light microscopy and immunohistology led to the diagnosis of a T-cell lymphosarcoma.