Quantitative bidimentional and Doppler ultrasound assessment of the effect of a GnRH antagonist on canine prostatic hyperplasia.

The objectives of this article were: a) To describe the effect of a single administration of the third generation GnRH antagonist, acyline, on canine benign prostatic hyperplasia (BPH) b)To quantitatively compare parenchyma echogenicity, heterogeneity (SD echogenicity) and blood flow in hyperplastic and treated prostate glands. Seven mixed bred dogs, 11.14 ± 0.8 years of age, weighing 8.5 ± 1.4 (3.8-15.6) kg, with BPH were included in this study and administered acyline 330 mg/kg sc (day 0). Then the dogs were examined by B Mode and Doppler ultrasound on days 15, 30 and 60 after treatment. Parenchymal frozen images were digitally analyzed. On day -7, prostatic volume was 1.60-5.36 fold (volume ratio) enlarged in relation to the expected volume. Prostatic volume decreased up to a mean of -38.44% (P < 0.01; range -32.2 to -70.9%) on day 30 to gradually increase towards pretreatment values. A correlation between volume ratio and nadir treatment volume was also found (r = - 0.87; P < 0.05). Mean parenchyma echogenicity (P < 0.01) and heterogeneity (P < 0.01) diminished in all the post treatment evaluations. Pretreatment intraprostatic cysts disappeared at the time point of peak treatment effect. Prostatic arteries RI increased on day 30, being different from day -7 and also from day 60 values (P < 0.05). It was concluded that a single administration of a third generation GnRH antagonist safely decreased prostatic volume and parenchyma and blood flow abnormities associated with canine BPH during 30 days. Monthly administrations of this treatment could represent a rapid, efficient and safe therapeutic option for BPH.

Dioctophyme renale in a domestic cat (Felis catus): Renal location and nephrectomy.

Dioctophymosis is caused by Dioctophyme renale, nematode with indirect life cycle. Its intermediate host is a freshwater oligochaete and its definitive host is a wild or household carnivore. The adult nematode develops in the definite host, generally locating itself in the kidney. This article was meant to describe the first nephrectomy performed in a domestic cat due to renal dioctophymosis in Argentina. The subject showed a non-specific appearance of generally feeling ill, hematuria and mild diarrhea. It was diagnosed through abdominal ultrasound, followed by exploratory celiotomy and nephrectomy. After verifying absence of free specimens, the right kidney was removed. This organ was found to be enlarged in a spheroidal manner in contrast to the left kidney, with significant thickening of the renal capsule, excessive congestion of vessels and adhesions involving the caudal vena cava. An adult nematode was removed from the right kidney and identified as Dioctophyme renale. Reports of feline dioctophymosis are scarce being most of them necropsy findings. In this we are presenting a confirmed case of D. renale removed by surgery from a live cat. The results presented here reinforces the fact that cats are also appropriate definitive hosts for this parasite.

Failure of a single dose of medroxyprogesterone acetate to induce uterine infertility in postnatally treated domestic cats.

In mice and sheep, neonatal administration of progesterone or progestins inhibited development of uterine glands. The aims of the present study were (1) to describe uterine gland development on postnatal Days 6 to 8 and (2) to evaluate the effects of a single postnatal administration of a progestin on reproduction and adult uterine glands morphology and function in domestic cats. Necropsy was performed on three 1-week-old female cats which had died unrelated to this study. Ten female kittens were randomly assigned within the first 24 hours of birth to: medroxyprogesterone acetate 10 mg/animal subcutaneously (MPA; n = 6) or placebo (PLC; n = 4) and followed up until puberty when they were mated. Twenty-four days after the end of estrus, ovulation and pregnancy were diagnosed by serum progesterone measurement and ultrasonography, respectively. Then, all the cats were ovariohysterectomized. After necropsy or surgery, the excised organs were histologically evaluated. Seven queens ovulated (4 of 6 MPA and 3 of 4 PLC; P > 0.1) and were pregnant (P > 0.1). Four MPA cats presented endometrial hyperplasia and one of them developed a pyometra. The 1-week-old females presented uterine glands in the stage of budding and incipient penetration of the glandular epithelium into the underlying stroma. The MPA-treated queens revealed that the area occupied by uterine glands per square-micrometer (0.55 ± 0.2 vs. 0.49 ± 0.2; P > 0.1) and the height of the glandular epithelium (µm; 24.5 ± 6.7 vs. 24.4 ± 7.2; P > 0.1) did not differ from those of the PLC group. Neither significant gross nor microscopical differences were also found for ovaries (P > 0.1). It is concluded that 1-week-old kittens had an incipient stage of uterine gland development and that a single postnatal supraphysiological dose of MPA did not alter uterine adenogenesis in this species. Furthermore, this treatment seemed to predispose to uterine disease without prevention of fertility.

Primary penile adenocarcinoma with concurrent hypercalcaemia of malignancy in a dog.

A 13-year-old male neutered Siberian husky crossbreed dog was presented with a 3-week history of haematuria and penile swelling. Clinical examination and computed tomography demonstrated a soft-tissue mass located at the base of the penis without signs of other primary tumours or metastasis. Clinicopathological findings revealed paraneoplastic hypercalcaemia. Fine-needle aspiration cytology of the mass suggested an epithelial tumour with several criteria of malignancy present. Following surgical excision of the mass, the hypercalcaemia resolved. Histopathology and immunohistochemistry revealed features consistent with an adenocarcinoma. Despite thorough examination, no perineal or anal sac tumour was found. To the authors' knowledge, this is the first reported case of a penile adenocarcinoma with hypercalcaemia of malignancy.

Effect of GnRH analogs in postnatal domestic cats.

The aim of this study was to reproductively assess the clinical and hormonal effects of a GnRH agonist (AG) and an antagonist (AN) administered during the postnatal period in domestic cats. Forty-eight male and female postnatal kittens were randomly assigned to deslorelin acetate 1.6 mg subcutaneous (AG; n = 16), acyline 33 µg/100 g subcutaneous weekly for 3 months (AN; n = 16), or control (CO; n = 16) which remained untreated. The cats were followed up (behavioral observation, physical examination, fecal sexual steroid determinations, mating test, and pregnancy diagnosis) up to puberty. Puberty was delayed (weeks) in the AG animals (62.9 ± 3.5; P < 0.01) but not in the AN (15.5 ± 1.7; P > 0.05) when they were compared with CO kittens (13.4 ± 0.4). Fifteen (15/16) of the AN and CO animals, and only 11 of 16 cats of the AG group were fertile (P > 0.1). No differences were found in body weight (P > 0.1) and measurements (P > 0.1), libido (P > 0.1) and in the appearance of side effects (P > 0.1; except a pyometra in an AG female) among groups. In both AG- and AN-treated males (testosterone; P < 0.01) and females (estradiol-17ß; P < 0.01) fecal hormone concentrations were lower than in CO group during the first five postnatal weeks but not later. It is concluded that the neonatal administration of these AG and AN decreased fecal sexual steroids during the first postnatal weeks causing, the agonists but not the antagonist, a significant, reversible delay in puberty appearance.

Factores de Riesgo para la Diabetes Mellitus en el Profesional de Enfermería / Risk Factors for Diabetes Mellitus in Nursing Professional

Introducción: Los factores de riesgo para la Diabetes Mellitus, son aquellos que aumentan la posibilidad de padecer la enfermedad. Su conocimiento permite ser la base para el desarrollo de actividades preventivas y promotoras de salud. Objetivo: identificar los factores de riesgo para la Diabetes Mellitus en un grupo de enfermeras, mediante los conceptos de la Norma Oficial Mexicana 015 y lo propuesto por la OMS. Metodología: el estudio fue de tipo descriptivo, transversal, se realizó en un grupo de profesionales de Enfermería inscritas en un programa de nivelación académica. A través de un muestreo no probabilístico por conveniencia. La información se obtuvo mediante una cédula de datos personales y el Cuestionario de Factores de Riesgo de la Secretaría de Salud. Resultados: La media para el Cuestionario de Factores de Riesgo para la Diabetes Mellitus de 11.85 (DE=9.06), lo que significa la posibilidad de padecer la enfermedad en el profesional de Enfermería. Discusión y Conclusiones: los hallazgos en este estudio ubican a la población en un riesgo alto para desarrollar Diabetes Mellitus, resultados que coinciden con los obtenidos en otros estudios.

Introduction: risk factors for diabetes mellitus are those that increase the chance of developing the disease. His knowledge, allows it to be the basis for the development of preventive and health promotion. Objective: To identify risk factors for diabetes mellitus in group of nurses, using the concepts of the Norma Official Mexicana 015 and proposed by the WHO. Methodology: The study was descriptive, transversal, was conducted in a group of nursing professionals enrolled in an academic program placement. Through a non-probability convenience sampling. The information was obtained through a certificate of personal data and the Risk Factor Questionnaire of the Ministry of Health. Results: We found an average for the Survey of Risk Factors for Diabetes Mellitus of 11.85 (SD = 9.06), which means the chance of developing the disease in the nursing professional. Discussion and Conclusions: The findings in this study placed the population at high risk for developing diabetes mellitus. Results that agree with those obtained in other studies.

Leiomyosarcoma of the inferior vena cava: a clinicopathologic review and report of four cases.

AIM: This article describes four cases of leiomyosarcoma treated in the University Hospital of Turin and reviews current understanding of the biological behavior of the tumor, together with essential diagnostic procedures and established approaches to treatment. METHODS: Between February 2004 and December 2005, four patients (two men and two women; mean age 57.5 years) with leiomyosarcoma of the interior vena cava (IVC) were treated at the Vascular Surgery Unit. Resection and excision of the tumor were carried out (4/4 patients), with resection of the IVC above and below the mass (2/4) and reconstruction of the vein with a Dacron prosthesis with termino-lateral reimplantation of the renal vein in one and placement of a polytetrafluorethylene graft in the other. RESULTS: The postoperative course was unremarkable; the patients were discharged between postoperative days VIII and XI. Oral anticoagulant therapy with dicumarol (3/4) was given to maintain venous or prosthesis patency during the follow-up period. The mean length of follow-up was 23 months (range, 16-28). All patients recovered without local recurrence of disease. CONCLUSION: This malignant slow-growing tumor produces late clinical manifestations, making the study of its natural history clinically important. Currently, surgical excision is the only therapy that can alter disease progression and improve survival. The utility of adjuvant chemo- and radiotherapy remains controversial.

[Cannabis and psychosis]. / Cannabis et psychose.

Cannabis is abused by a progressively larger and younger proportion of our population. For the clinician, this can raise the question of what the relationship between cannabis and psychosis is. For the patient who is already psychotic, this relationship is most certainly adverse; cannabis worsens the symptoms and prognosis of a psychosis. What may be of even greater concern is the growing evidence that cannabis may cause psychosis in healthy individuals. Many studies now show a robust and consistent association between cannabis consumption and the ulterior development of psychosis. Furthermore, our better understanding of cannabis biology allows the proposal of a plausible hypothetical model, based notably on possible interactions between cannabis and dopaminergic neurotransmission.

Primary right atrium haemangiosarcoma in a cat.

Primary cardiac neoplasms are rare in animals. Hemangiosarcoma is the most common primary cardiac tumour in the dog, but has not been reported in the cat. We describe the clinical signs, the gross examination, and the morphological and immunohistochemical features of a haemangiosarcoma in the right atrium of a 13-year-old domestic shorthair cat. In addition, a distant metastasis was found in the liver.

[Harvesting vascular segments]. / Prelievo dei segmenti vascolari.

The authors report the importance of the use of vascular homografts in treatment of prosthetic infections. To have good results is very important to obtain vascular segments prelevated and preserved in the best conditions. The importance of the explant is fundamental. The authors report the right sequence of organs' explant and the technique to obtain good vascular segments; for this purpose is important the coordination of the surgical equips taking part in the explant.

Personal experience of the treatment of ruptured aortic aneurysms. The prognostic evaluation of some parameters.

BACKGROUND: The rupture of an aortic aneurysm is the most frequent and most severe complication, with an incidence of approximately 20-40/100,000 persons each year. The aim of this study was to identify the preoperative, intraoperative and postoperative factors that may influence the mortality rate. METHODS: Between January 1996 and December 1999 145 patients underwent emergency abdominal aortic repair surgery. One hundred and twenty-three patients represented a ruptured AAA and 22 a fissured aneurysm. One hundred and thirty-one patients were males and 14 were females; their mean age was 75+/-5.06 years. We selected a number of parameters after a review of the international literature and these were analysed in the two classes of survivors. No statistical analyses were performed on fissured aneurysms owing to the scant number of cases examined. RESULTS: Mortality was 41.4% (44.7% in ruptured aneurysms alone). The following were negative preoperative prognostic factors: old age, hypertension, ASA V, intraoperative anuria and platelet count <100,000. Intraoperative factors included: hypotension, cardiac arrest, onset of anuria, aortic clamping in more than one site, duration of surgery, quantity of RBC and plasma transfused. The main postoperative variables correlated to mortality were: hypotension, hypothermia, onset of anuria, need for further transfusions, high creatinine levels. CONCLUSIONS: Rapid intervention can minimise mortality in structures with expert teams of surgeons and anesthetists experienced in treating this type of pathology.

Mitral valve repair and transesophageal echocardiographic findings in a high-risk subgroup of patients with active, acute infective endocarditis.

BACKGROUND AND AIM OF THE STUDY: Limited data are available regarding the efficacy of mitral valve repair in patients affected by active, acute infective endocarditis. In addition, the predictivity of transesophageal echocardiography (TEE) for guiding the surgical decision-making process in these patients has not yet been reported. The study aim was to evaluate the long-term results of mitral valve repair and role of TEE in active, acute infective endocarditis. METHODS: The study population consisted of patients affected by infective endocarditis of the mitral valve who underwent surgery. TEE was performed intraoperatively to guide the best surgical approach. All patients were followed up (mean 73+/-8 months) after surgery. RESULTS: Twenty-eight patients underwent surgery for infective endocarditis; of these, 13 had mitral valve repair for active, acute infective endocarditis and formed the basis of the study. Sensitivity, specificity, positive predictive value, negative predictive value of TEE in detecting the mechanism of mitral regurgitation were 87%, 100%, 100% and 92%, respectively. The predictivity test of TEE in guiding surgical strategy was 94%. All patients were alive at the time of follow up; 10 (77%) were in NYHA class I and three in class II (23%). Mitral regurgitation was severe in one patient (8%), moderate in three (23%), mild in four (31%), and absent in five (38%). No relapses of active infective endocarditis were observed during the follow up period. CONCLUSION: Mitral valve repair appears to be an effective treatment for active, acute infective endocarditis with mitral regurgitation and should be considered as a therapeutic strategy when surgery is contemplated. TEE has a fundamental role in the surgical decision-making process in these patients.

Carotid stenosis and brain tumor. Two cases successfully treated.

The authors report two cases of internal carotid artery stenosis associated with brain tumors. After the presentation of the rarity of this combination little described in the literature, they point out their therapeutic behaviour explaining their technical decisions.

Vagal paraganglioma. Report of a case surgically treated and review of the literature.

The authors report the observation of one case of vagal paraganglioma occurred in a young woman. The tumor manifested itself as a left sub-mandibular tumescence; the very first diagnostic approach was achieved through echography, which showed a mass behind the internal carotid artery and compressing the internal jugular vein. The following examinations, represented by neck CT, NMR, angiography and fine needle aspiration initially directed towards the suspicion of chemodectoma. Only at operation, the anatomical situation of the tumor, which encapsulated the vagus nerve and the subsequent results of the hystological examination revealed the correct diagnosis of vagal paraganglioma.

Prospects of prostanoid therapy. Preliminary results.

BACKGROUND: To evaluate the efficacy of treatment with prostaglandins (Iloprost and Alprostadil) in patients with peripheral arterial disease in whom a surgical act or a redo operation is not proposable and to set the role of these drugs in the therapy of arterial diseases. METHODS: We analyzed the results of 96 treatments in patients with peripheral arterial diseases of different etiology, treated in the Day Hospital in the Division of Vascular Surgery from the 1/1/1993 to the 30/6/1998. The efficacy of the treatment has been evaluated on the basis of the clinical picture (healing or reduction of ulcers, reduction of rest-pain, improvement of the ability to walk). RESULTS: We had positive results in 60% of the patients who completed the treatment, a good outcome for patients with particularly severe arterial disease. Interruptions induced by the occurrence of uncontrolled side-effects are a few (6.25%). Better results have been found in a special category of disease (arterial diseases not associated with diabetes, not very advanced clinical picture, female gender). Iloprost proved to be superior to Alprostadil. CONCLUSIONS: Prostaglandins today represent an effective therapeutic solution to be considered. Further studies need to be done to find a category of patients who can have the best benefit from this kind of drug.

Radiographic and ultrasonographic features of retained surgical sponge in eight dogs.

The radiographic and ultrasonographic signs in eight dogs with a surgical or pathologic diagnosis of retained surgical sponge were reviewed. The most frequent previous surgery was ovariohysterectomy, either as an elective procedure or to treat pyometra. The median elapsed time between surgery and diagnosis of retained surgical sponge was 9.5 months (range 4 days to 38 months). Five dogs had a draining sinus; four had a palpable abdominal mass. Radiologic signs included localized, speckled or whirl-like gas lucency, abdominal mass, and non-focal soft tissue swelling. Survey radiography and sinography were considered diagnostic for retained surgical sponge in 4/7 (57%) and 3/5 (60%) dogs, respectively. The combined use of survey radiography and sinography enabled detection of 6/7 (86%) sponges. In each dog that had ultrasonography, a hypoechoic mass was found that had an irregular hyperechoic centre. The possibility of retained surgical sponge should be considered in animals with a history of previous surgery and a sinus or abdominal mass.

[Left atrial myxoma. Clinical and surgical features in 26 surgically treated cases]. / Mixoma dell'atrio sinistro. Aspetti clinici e chirurgici in 26 casi operati.

BACKGROUND: Left atrial myxomas are the most common benign intracardiac tumors. The aim of this study was to compare our experience with the data reported in the literature. METHODS: Between May 1985 and August 1999, 26 patients (8 males, 18 females) with left atrial myxomas underwent surgical resection of these tumors at the Department of Cardiac Surgery, Ospedali Riuniti of Bergamo (Italy). Symptoms included congestive heart failure, dyspnea, arrhythmias, chest pain and syncope. Diagnosis was established preoperatively in all patients by echocardiography and angiocardiography was performed in 8 cases. All tumors were excised with a wide margin of uninvolved atrial septum. Two patients underwent concomitant coronary artery bypass. RESULTS: There was 1 early death due to irreversible ventricular fibrillation. Follow-up was completed for the 25 late survivals. Three patients died, years after operation, due to extracardiac causes. One patients had recurrence of the tumor, which was successfully removed 4 years after initial operation. All other patients are asymptomatic and free from disease. CONCLUSIONS: Operation for left atrial myxoma can be undertaken solely on the basis of echocardiographic findings, but coronary angiography should be performed in older patients who are at risk for coronary artery disease. Surgical excision of left atrial myxomas must be performed as soon as possible after diagnosis is established because of the high risk of valvular obstruction or systemic embolization. Biatrial approach allows for the inspection of the four cardiac chambers, limits manipulation of the mass, and facilitates the complete excision of the tumor. Thus, surgical intervention can be curative for patients with left atrial myxomas and most of these can expect an excellent outcome. Since late recurrence, although rare, has been reported, especially in familial myxomas, long-term clinical and echocardiographic follow-up is recommended.

Neuroleptic malignant syndrome during low dosed neuroleptic medication in first-episode psychosis: a case report.

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal side-effect of antipsychotic drug therapy, especially of dopamine receptor antagonists. As a dose relationship has been postulated, low dose neuroleptization would be expected to help to avoid this side-effect. In contrast, we report on a 21-year-old female following low dose fluphenazine treatment with 2.5 mg/day. The patient recovered from NMS after 3 days of dantrolene administration. Eventually, remission from psychotic symptoms was achieved with clozapine. At 8-month follow-up, psychopathology remained stable and there were no more signs of NMS.

Surgical and endovascular treatment of stenosis of the innominate artery.

BACKGROUND: Atherosclerotic lesions of the brachiocepfialic trunk are relatively rare compared with other types of vascular diseases. Median sternotomy with direct endothoracic repair is recommended because of good early and long-term results. Nevertheless, this procedure is not without risks such as hemorrhaging, embolism, aortic dissection, infection or death. METHODS: This report therefore, describes our experience in intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk with cerebral protection ensured by common carotid artery clamping. Through an anterolateral cervical approach the right common carotid artery was surgically exposed. After dilating the brachiocephalic trunk and positioning the stent, the vessel was repaired with a continuous suture. RESULTS: In all patients the dilation of the stenosis of the brachiocephalic trunk and the stent placement were successful without any side-effects. No distal embolism with neurologic events, innominate artery dissection, rupture, occlusion or neck hematoma occurred. All patients were discharged three days after the intervention. CONCLUSIONS: This technique offers a safe, effective approach to stenoses of innominate arteries because it is less invasive than conventional transthoracic or extrathoracic surgery and offers excellent early and mid-term results. We believe that this technique is a safe and effective alternative to conventional surgery.

[Deep venous thrombosis in a patient with superficial thrombophlebitis. Apropos of 2 cases]. / Trombosi venosa profonda in paziente con tromboflebite superficiale. A proposito di due casi.

Deep vein thrombosis in patient with superficial thrombophlebitis of the leg. Description of two cases. Two clinical cases already observed at our Department of Vascular Surgery, regarding patients with superficial thrombophlebitis (STF) associated with a deep venous thrombosis (DVT) are presented. The diagnosis of DVT was achieved exclusively on the basis of the duplex scanner because the two patients were completely asymptomatic. The chance that symptoms and clinical signs of STF cover a DVT is a possibility that should always be considered. For this reason every STF should be further investigated with duplex scanner in order to exclude that the deep venous circulation get involved at the same time. The DVT in these cases is generally due to the spreading of the thrombosis process from the perforating branches. The chance of a multiple onset of thrombosis in the superficial and deep circulation represents anyway an hypothesis worth of studying.