Clinical, serological and molecular investigations of EHV-1 and EHV-4 in 15 unweaned thoroughbred foals.

Fifteen unweaned thoroughbred foals, born on a stud farm to vaccinated mares, were clinically monitored during their first six months of life and repeatedly tested for equine herpesvirus type 1 (EHV-1) and equine herpesvirus type 4 (EHV-4). Nasopharyngeal swabs and blood samples were collected and screened respectively by PCR and seroneutralisation to detect the presence of the virus, explore its role as a possible cause of respiratory disease, and to assess the efficiency of the pcr for the diagnosis of this disease. The foals were divided into three groups on the basis of their clinical signs and whether they had seroconverted to EHV-1 and/or EHV-4: first, foals with no clinical signs of disease that had not seroconverted; secondly, foals with clinical signs that had seroconverted, and thirdly, foals with clinical signs that had not seroconverted. The results indicated that the viruses circulated on the stud farm despite stringent vaccination regimens against them, and confirmed their association with respiratory disease. The absence of significantly different pcr results among the three groups of foals showed that the pcr was effective in confirming the circulation of the viruses on the premises without being particularly helpful as a diagnostic tool.

Deep sequencing and variant analysis of an Italian pathogenic field strain of equine infectious anaemia virus.

Equine infectious anaemia virus (EIAV) is a lentivirus with an almost worldwide distribution that causes persistent infections in equids. Technical limitations have restricted genetic analysis of EIAV field isolates predominantly to gag sequences resulting in very little published information concerning the extent of inter-strain variation in pol, env and the three ancillary open reading frames (ORFs). Here, we describe the use of long-range PCR in conjunction with next-generation sequencing (NGS) for rapid molecular characterization of all viral ORFs and known transcription factor binding motifs within the long terminal repeat of two EIAV isolates from the 2006 Italian outbreak. These isolates were from foals believed to have been exposed to the same source material but with different clinical histories: one died 53 days post-infection (SA) while the other (DE) survived 5 months despite experiencing multiple febrile episodes. Nucleotide sequence identity between the isolates was 99.358% confirming infection with the same EIAV strain with most differences comprising single nucleotide polymorphisms in env and the second exon of rev. Although the synonymous:non-synonymous nucleotide substitution ratio was approximately 2:1 in gag and pol, the situation is reversed in env and ORF3 suggesting these sequences are subjected to host-mediated selective pressure. EIAV proviral quasispecies complexity in vivo has not been extensively investigated; however, analysis suggests it was relatively low in SA at the time of death. These results highlight advantages of NGS for molecular characterization of EIAV namely it avoids potential artefacts generated by traditional composite sequencing strategies and can provide information about viral quasispecies complexity.

Umbilical infections in foals: microbiological investigation and management.

This study aims to investigate the bacteria involved in equine omphalitis and their susceptibility to antimicrobial drugs, and consequently to provide guidelines concerning the most suitable treatment protocol in accordance with the clinical, ultrasound and laboratory findings. Forty foals aged between one and 30 days were evaluated in the course of this investigation. An ultrasound examination of all umbilical remnants was carried out carefully in all foals; umbilical swabs were collected for bacteriological examination, and blood samples were collected for blood culture from 19 foals with fever and abnormal blood values. Bacterial omphalitis was observed in 95 per cent of foals and bacterial septicaemia was diagnosed in 11 cases. Enterobacteria and coccoid Gram-positive bacteria were isolated more frequently than Serratia marcescens, Pantoea agglomerans and Trueperella pyogenes Omphalectomy was performed in 77.5 per cent of the foals examined; the remainder were treated only medically with antimicrobial drugs as recommended by antibiotic susceptibility testing performed for all bacteria isolated. Antibiotic therapy was successful in all foals that only received medical treatment; nevertheless, omphalectomy was performed in most cases particularly in situations of clinical decline despite antibiotic therapy and when involvement of umbilical vein, fever and joint disorders were observed.

Aortic rupture of acute aortic dissection type treated with thoracic endovascular aortic repair (TEVAR).

OBJECTIVE: Acute aortic dissection (AAD) is one of the most frequent aortic emergencies, which occurs to the vascular specialist. Endovascular reconstruction of the true lumen using minimally invasive stent grafting or stenting has become increasingly popular and widespread among institutions. The aim of this paper is to report a case series composed by twenty-eight patients, who underwent endovascular intervention for acute type B aortic dissections complicated by rupture using thoracic endovascular aortic repair (TEVAR). PATIENTS AND METHODS: All patients with type B-AAD were admitted to the surgical intensive care unit and initially managed with a standing protocol for medical management of AD and observed for evidence of visceral or extremity malperfusion. RESULTS: No major complications or adverse reactions occurred during the immediate postoperative period. Two patients died in the first three months of the study; both developed a cerebral ischemia. Three patients were lost at follow-up, the remaining twenty-three had a mean follow-up of 41.12±3.55 months (range: 36-58). CT scans were routinely performed at 3 months, 6 months, and yearly after the intervention for all patients. CONCLUSIONS: Endovascular repair is developing as a strong alternative to surgery and may eventually evolve as a superior method for definitive treatment for patients with appropriate indications, such as complicated dissections. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter >4 cm and with a multi-stents placement.

Stored Canine Whole Blood Units: What is the Real Risk of Bacterial Contamination?

BACKGROUND: Bacterial contamination of whole blood (WB) units can result in transfusion-transmitted infection, but the extent of the risk has not been established and may be underestimated in veterinary medicine. OBJECTIVES: To detect, quantify, and identify bacterial microorganisms in 49 canine WB units during their shelf life. ANIMALS: Forty-nine healthy adult dogs. METHODS: Forty-nine WB units were included in the study. Immediately after collection, 8 sterile samples from the tube segment line of each unit were aseptically collected and tested for bacterial contamination on days 0, 1, 7, 14, 21, 28, 35, and 42 of storage. A qPCR assay was performed on days 0, 21, and 35 to identify and quantify any bacterial DNA. RESULTS: On bacterial culture, 47/49 blood units were negative at all time points tested, 1 unit was positive for Enterococcus spp. on days 0 and 1, and 1 was positive for Escherichia coli on day 35. On qPCR assay, 26 of 49 blood units were positive on at least 1 time point and the bacterial loads of the sequences detected (Propionobacterium spp., Corynebacterium spp., Caulobacter spp., Pseudomonas spp., Enterococcus spp., Serratia spp., and Leucobacter spp.) were <80 genome equivalents (GE)/µL. CONCLUSIONS AND CLINICAL IMPORTANCE: Most of the organisms detected were common bacteria, not usually implicated in septic transfusion reactions. The very low number of GE detected constitutes an acceptable risk of bacterial contamination, indicating that WB units have a good sanitary shelf life during commercial storage.

Rhodococcus equi pneumonia in foals: an assessment of the early diagnostic value of serum amyloid A and plasma fibrinogen concentrations in equine clinical practice.

Early diagnosis and prevention of Rhodococcus equi pneumonia in foals represent important goals for equine clinicians. Recent protocols for diagnosis and treatment of Rhodococcosis in foals typically rely on a multimodal approach based on sonographic evidence suggestive of pyogranulomas, sonographic abscess scores and laboratory findings including plasma fibrinogen concentrations, blood biochemistry testing and platelet and leukocyte counts. The aim of this study was to assess the utility of weekly testing of serum amyloid A (SAA) and plasma fibrinogen concentrations in foals to achieve early diagnosis of R. equi pneumonia prior to the onset of clinical signs. This testing was used to simulate a clinically practical screening procedure and compared with thoracic ultrasonography performed in parallel. The present study suggests that SAA does not represent a reliable early marker of Rhodococcosis when plasma concentrations are tested weekly. However, when clinical signs of R. equi pneumonia are present, SAA concentrations may allow clinicians to obtain 'real-time' indications concerning both the progress of infection and the effectiveness of therapy. This study raises the possibility that plasma fibrinogen monitoring starting at 1 week of age and repeated on a weekly basis, could serve as a screening test allowing clinicians to identify foals as suspected of R. equi infection. Future investigations regarding both physiological plasma fibrinogen concentrations in foals as well as fibrinogen kinetics in foals affected with R. equi pneumonia, including the establishment of appropriate reference intervals for the test method employed in this study, will be necessary in order to clarify this possibility.

Intramural mesenteric venulitis. A new cause of intestinal ischaemia.

Venous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel. Extramural mesenteric veins appeared dilated and congested, without evidence of thrombotic occlusion or of inflammatory involvement. The patient, who was not taking any long-term medication and had no clinical evidence of collagen-vascular disease, promptly recovered after surgery. Follow-up for 7 months with no recurrences suggested a self-limited or indolent process. We propose the name 'intramural mesenteric venulitis' for this condition and believe that it could represent one extreme (the microscopic variant or intramural phase) of the spectrum comprising entero-colic phlebitis and mesenteric inflammatory veno-occlusive disease. The immunohistochemical evidence of a marked preponderance of T phenotype in the perivenular lymphocytes suggests lymphocyte-mediated vascular damage as the pathogenesis of the lesion.

Medical subject headings used to search the biomedical literature.

The National Library of Medicine's MEDLINE (MEDLARS Online) database was the first database to be searched nationwide via value-added telecommunication networks. Now available on the World Wide Web free of charge from the National Library of Medicine and from many other sources, it is the world's most heavily used medical database. MEDLINE is unique in that each reference to the medical literature is indexed under a controlled vocabulary called Medical Subject Headings (MeSH). These headings are the keys that unlock the medical literature. MeSH multiplies the usefulness of the MEDLINE database and makes it possible to search the medical literature as we do today. This paper commemorates the 40th anniversary of the introduction of MeSH and salutes some of the farsighted persons who conceived and developed the MEDLINE database.

Atrophy of the primary lymphoid organs of meat pigeons in Italy associated with circoviruslike particles in the bursa of Fabricius.

During a survey effected in a meat pigeon slaughterhouse of central Italy, atrophy of primary lymphoid organs (bursa of Fabricius and thymus) and hypoplasia of bone marrow were observed. Histologic, ultrastructural, and hematologic examinations were performed on a total of 80 randomly selected 30-day-old meat pigeons. By histologic studies, lymphocytic depletion and necrosis with cyst formations in the bursa of Fabricius were detected in all subjects that showed thymus and bursa atrophy at necropsy. Basophilic intranuclear inclusions were also observed in bursal cells. After ultrastructural studies, these inclusions were proved to be viral particles resembling circoviruslike particles in morphology and size. Severe lymphocytic depletion of the bursa was plausibly associated with the presence of the viral particles.

Efficacy and safety of an infectious bursal disease virus intermediate vaccine in ovo.

The study was divided into two experiments. In the first experiment, the efficacy of in ovo intermediate vaccine against infectious bursal disease virus (IBDV) was determined by challenge at 21 days of age with virulent IBDV in specific-pathogen-free (SPF) and commercial chickens. This vaccine was able to induce active immunity and to protect SPF chickens to challenge; protection was not complete in commercial chickens, as testified by bursal lesions, bursal index after challenge, and vaccine immunoresponse. In order to detect field and vaccinal viruses, immunoperoxidase staining, enzyme-linked immunosorbent assay, capture, and reverse transcriptase-polymerase chain reaction (RT-PCR) were tested; the RT-PCR was more effective at detecting both kind of viruses. In the second experiment, the immunosuppressive effect of in ovo vaccination was determined by evaluating the immunoresponse against Newcastle disease virus (NDV) vaccination effected at 10 days in both SPF and commercial chickens vaccinated in ovo. The in ovo vaccine causes a reduction of NDV immunoresponse, as testified by lowest geometric mean titer in group I (SPF chickens vaccinated against IBDV in ovo and against NDV at 11 days). In commercial chickens, immunoresponse to NDV vaccination was not influenced by in ovo vaccination.

Retrospective ultramicroscopic investigation on naturally cryptosporidial-infected commercial turkey poults.

The morphometric characteristics and the ultramicroscopic findings of Cryptosporidium spp. at various stages of their life cycle in the intestinal and bursal epithelial cells of naturally infected 30-day-old commercial turkeys are reported. Small, sporulated oocysts, observed in the small intestinal content after flotation, were identified as Cryptosporidium meleagridis on the basis of morphometric characteristics (round in shape and 4.5-5.0 microm in size) and the small intestinal localization. Light section examinations revealed the presence of the protozoon in multiple organs, but its prevalence was highest in the intestinal and bursal epithelial cells. Ultramicroscopic studies on ileum and bursal samples showed the presence of all the life cycle stages in the microvillar brush epithelial cells in both the organs examined. On the basis of the comparison of the morphology and the sizes of the microorganisms parasitizing the ileum and the bursa, hypotheses are considered on the possible species involved.

[Uric acid analysis in thalassemia trait carriers]. / Analisi dell'acido urico in portatori di trait talassemico.

The results of a uric acid analysis on Beta Thalassaemia Heterozygotes compared with healthy or microcytic non Beta Thalassaemia Heterozygotes are reported. Identical uric acid levels, higher than in the control group, were found in Beta Thalassaemia Heterozygotes: therefore the difference does not appear to be specific for thalassaemic carriers but consequent to increased erythrocytic catabolism in microcytic anemias.

[Prognostic factors and response to chemotherapy in breast cancer. bibliographic review]. / Fattori prognostici e risposta alla chemioterapia nel carcinoma della mammella. Revisione bibliografica.

The recent literature on prognostic factors in breast cancer was examined with regard to: early or delayed diagnosis, age, menopause, tumour site and size, histological type and grading, involvement of lymph nodes, clinical stage, local recurrence, and distant metastasis. With respect to prognostic factors connected with the response to therapy, the following points were considered: menopause, involvement of lymph nodes, dimensions, clinical stage, free interval, performance and loss of weight, particular sites of metastasis, radiotherapy, oestrogen receptors, prior endocrine management, and certain body fluid parameters (haemoglobin, total lymphocytes, platelets, and white cells, albumin, LDH, SGOT, alkaline phosphatase, blood bilirubin and calcium). Radiotherapy appears to make patients less responsive to subsequent antiblastic treatment, whereas premenopausal status, good psychological and physical efficiency, and prior endocrine management seem to play a positive role in the response to chemotherapy.

[Plasma cell leukemia. Bibliographic review and ultrastructural study (by transmission and scanning electron microscopy) in 2 cases]. / La leucemia plasmacellulare. Revisione bibliografica e studio ultrastrutturale (al M.E.T. ed al M.E.S.) in due casi.

After a brief examination of the recent literature on plasma cell leukemia, the Authors describe the clinical features and the ultrastructural findings of the peripheral blood plasma cells, examined with transmission (T.E.M.) and scanning (S.E.M.) electron microscopes, of two patients with acute plasma cell leukemia. Both of them had a previous history of myeloma. T.E.M. confirmed the diagnostic value of the asynchronous plasma cells, and S.E.M. showed the characteristic microvilli and blebs, previously observed.

[Non-secretory plasmacytoma. Bibliographic review and immunohistochemical study of a case]. / Plasmocitoma non secernente. Revisione bibliografica e studio immunoistochimico di un caso.

After a brief examination of the recent literature on non-secretory multiple myeloma, the Authors describe the immunohistologic study (peroxidase-antiperoxidase method) of a case of truly non producing plasmacytoma, interesting because of the presence of a small polyclonal plasma cell population within the neoplastic clone. Several possible explanations are considered.

[Hypocholesterolemia in multiple myeloma. Inverse relation to the component M and the clinical stage]. / Ipocolesterolemia nel mieloma multiplo. Relazione inversa con la componente M e con lo stadio clinico.

The following parameters were studied in 41 Durie & Salmon staged patients with multiple myeloma: M component, bone lesions, marrow plasma cell %, Hb, leukocytes/mm3, lymphocytes/mm3, platelets/mm3, blood calcium, serum albumin, blood creatinine, BUN, total blood cholesterol. Linear correlation was adopted for the relation between two variables, using Pearson's coefficient, and Student's t test for unpaired data for comparison between the means. A significant (slight to excellent) inverse correlation was noted between total blood cholesterol and the M component. There was also a significant difference between the 1st and 2nd stage of the disease in this respect (P less than 0.05), between the 1st and 3rd (P less than 0.01), and between the 1st and the 2nd and 3rd combined (P less than 0.01). Progress of the disease appears to result in a fall in blood cholesterol. This parameter may be of assistance in differentiating slow-progressing forms from the more aggressive forms requiring treatment. The reasons for this change are discussed. Since cholesterol is an essential part of the cell membranes, attention is given to theories postulating a disorder in intracellular membrane metabolism.

Semiclosed thromboendoarterectomy on femoro-popliteal tract revisited after a fourteen years experience on 595 cases.

In the seventies atherosclerotic femoropopliteal lesions were extensively treated by means of retrograde semiclosed thromboendarterectomy (FP-TEA) an analytic follow-up of cases, until 1980, induced the modification of the indications to FP-TEA. Currently the FP-TEA technique is only employed for patients at the 2nd Fontaine's stage with disabling claudication (generally less than 100 mt) with a good distal run-off (at least 2 tibial vessels patent). The report deals with a series of 595 cases operated in the period January 1971-December 1984. In 45% of cases FP-TEA was associated with a proximal revascularization. In an attempt to focus on the factors that may influence the outcome, the patients operated in 1976, 1980, 1984, were assessed and the results related to clinical stage, angiographic pattern and postoperative treatment.

[Surgical management of trauma: from the "golden hour" to the "Golden Day"]. / La gestione chirurgica del trauma: dalla "golden hour" al "Golden Day".

The treatment of the "trauma" has individualized objective therapeutic to reach in the first phase of clinical management defined by Mattox in the concept of the Golden Hour, that consist to transport the patient to the fittest hospital and to recognize and to treat the priorities "ABCDE", identifies in ATLS Guideline. The evolution of the organization for the treatment of the trauma has developed the concept of Trauma System to whose apex there are of the structures devoted define Trauma Center, with specificity of structures and functions, personal devoted fully grown with a specific run. In the Trauma Center is possible to get a therapeutic planning according to the priorities of the case in few times so that to not only achieve the objective to treat in emergency the vital lesions, but to do the necessary treatments precociously to prevent the compliances of the patient, that is checked in environment then multidisciplinary intensive care. This systematic treatment by objective it allows to identify some Guideline of surgical treatment for priority in once defined Golden Day.

[Abdominal "packing": indications and method]. / Il packing addominale: indicazioni e metodo.

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in damage control surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. Its possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure (hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: These three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 70%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions: in these situations is possible a MOF syndrome due to excessive intra-abdominal pressure (overpacking) or to an Abdominal Compartment Syndrome.

[The role of endoscopy in the hemorrhagic complications of gastroduodenal ulcer]. / Ruolo dell'endoscopia nella complicanza emorragica dell'ulcera gastro-duodenale.

The hemorrhage is a fairly frequent event in the evolution of the gastroduodenal peptic ulcer syndrome. The mortality rate has remained approximately unchanged, in spite of the progress in instrumental diagnosis and medical therapy, in the last decade. The authors examine 163 cases of digestive hemorrhage from gastroduodenal ulcers, observed in the last five years (1984-1988), with particular reference to the medical or surgical treatment undertaken, and to the mortality rate. Gastroduodenal ulcers, in 340 cases of upper digestive hemorrhage, represented nearly half the lesions, registered in the same period. Duodenal ulcers (D.U.), were found in 124 patients (34.4%) and gastric ulcers (G.U.) in 39 patients (11.47%), 113 (91.1%) patients with D.U., and 33 (84.6%) patients with G.U. were treated by medical therapy. The mortality rate in this group was 6.16%. II patients (8.9%) with D.U. and 6 patients (15.3%) with G.U. were operated on. The surgical mortality rate was high at 35.2%. Total mortality rate was 9.2%. The endoscopic exam was useful for diagnostic bleeding investigation and contributed to therapeutic decisions. Active bleeding lesions were found in 38.4% of patients with G.U. and in 32.3% with D.U. In 61.6% of patients with G.U. and in 67.7% with D.U., the lesions had already stopped bleeding; but in both lesions nearly 40% of cases, presented signs of a recent hemorrhage. The prognosis and natural history of the hemorrhage, was not changed by an immediate exam. The clinical reports and the data furnished, especially from continuous bleeding and rebleeding lesions, could be useful in identifying a sub-group of patients who could obtain better results by surgical treatment within a suitable time. The endoscopy, besides selecting and contributing to a better therapeutic strategy, through haemostasis technic, could reduce mortality rate from gastroduodenal ulcer lesions.