Aldosterone receptor antagonists--how cardiovascular actions may explain their beneficial effects in heart failure.

Historically, aldosterone receptor antagonists (ARA) have been classified as 'potassium sparing diuretics'. However, the positive effect of spironolactone, the most extensively studied ARA, on morbidity and mortality observed in humans suffering cardiac insufficiency could not be explained by the renal effect of the drug alone, and a pivotal clinical study has led to extensive research. Many experimental studies have demonstrated that ARA have previously unexpected beneficial effects on the cardiovascular system including reduction in remodelling of the vascular smooth muscle cells and myocytes and improvement of endothelial cell dysfunction in heart failure. These effects improve vascular compliance and slow down the progression of left ventricular dysfunction and end-organ damage. Furthermore, aldosterone receptor blockade also restores the baroreceptor reflex, improving heart rate variability in heart failure in humans. Some of these effects have been demonstrated in dog models of cardiac disease and so justified further investigation of the potential benefit of ARA in dogs with congestive heart failure (CHF). Positive effects of spironolactone on morbidity and mortality appear to have been seen in studies conducted in dogs suffering from naturally occurring CHF. In addition, eplerenone has been shown to have benefits in canine models of heart failure. The precise mechanisms by which ARA produce these beneficial effects in dogs remain to be determined but this group of drugs clearly provide therapeutic actions out-with their diuretic effects.

Efficacy of spironolactone on survival in dogs with naturally occurring mitral regurgitation caused by myxomatous mitral valve disease.

BACKGROUND: Spironolactone, an aldosterone antagonist, has been demonstrated to decrease mortality in human patients when added to other cardiac therapies. HYPOTHESIS: Spironolactone in addition to conventional therapy increases survival compared with conventional therapy in dogs with naturally occurring myxomatous mitral valve disease (MMVD). ANIMALS: Between February 2003 and March 2005, 221 dogs were recruited in Europe. Nine dogs were excluded from analysis, leaving 212 dogs with moderate to severe mitral regurgitation (MR) caused by MMVD (International Small Animal Cardiac Health Council classification classes II [n = 190] and III [n = 21]). METHODS: Double-blinded, field study conducted with dogs randomized to receive either spironolactone (2 mg/kg once a day) or placebo in addition to conventional therapy (angiotensin converting enzyme inhibitor, plus furosemide and digoxin if needed). Primary endpoint was a composite of cardiac-related death, euthanasia, or severe worsening of MR. RESULTS: Primary endpoint reached by 11/102 dogs (10.8%) in the spironolactone group (6 deaths, 5 worsening) versus 28/110 (25.5%) in control group (14 deaths, 8 euthanasia, 6 worsening). Risk of reaching the composite endpoint significantly decreased by 55% (hazard ratio [HR] = 0.45; 95% confidence limits [CL], 0.22-0.90; log rank test, P = .017). Risk of cardiac-related death or euthanasia significantly reduced by 69% (HR = 0.31; 95% CL, 0.13-0.76; P = .0071). Number of dogs not completing the study for cardiac and other miscellaneous reasons similar in spironolactone (67/102) and control groups (66/110). CONCLUSION AND CLINICAL IMPORTANCE: Spironolactone added to conventional cardiac therapy decreases the risk of reaching the primary endpoint (ie, cardiac-related death, euthanasia, or severe worsening) in dogs with moderate to severe MR caused by MMVD.

The efficacy of an oral treatment with paromomycin against an experimental infection with Giardia in calves.

A controlled and blinded study was conducted to evaluate the efficacy and safety of a treatment with paromomycin sulphate against an experimental Giardia infection in calves. Animals were infected with 10(5)Giardia cysts of cattle origin and were either treated 11 days later with 25, 50 or 75 mg paromomycin/(kg body weight per day) during 5 consecutive days or not treated (control group). Efficacy was evaluated based on reduction in cyst excretion. Furthermore weight gain and diarrhea scores were monitored. In the group treated with 75 mg/kg per day there was a 100% reduction in cyst excretion until 9 days after the start of the treatment (D9) and a very high reduction (> or =98%) until D13. There was a high reduction (> or =93%) until D9 and D13 in the groups treated with 25 and 50 mg/kg, respectively. The cumulative cyst excretion on D13 was significantly (P<0.05) lower in the groups treated with 75 and 50 mg/kg compared to the control group. Although there was a trend towards higher weight gain and less diarrhea in the treated groups, differences between groups were not significant. No adverse reactions to the paromomycin treatment were recorded. Furthermore, the need for reliable parameters for evaluation of treatments against protozoal infections is emphasised.

High association of congenital heart disease with indirect inguinal hernia.

We evaluated 103 patients with indirect inguinal hernia (IIH) for the association of congenital heart disease by echocardiography. Congenital cardiac abnormalities were recognized in 32% of patients with inguinal hernia, which is significantly higher than that reported in a population-based study in Turkey and other population-based studies. Ventricular septal defect and valvular anomalies are the most frequently detected malformations. Our findings suggest that screening for congenital hearth disease is necessary in children with indirect inguinal hernia.

Evaluation of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch.

In a multicentre, blinded, placebo-controlled trial, 50 dogs were treated for 28 days with either phenylpropanolamine or a placebo control. Each was given at a dose of one drop per 2 kg orally three times daily, equivalent to 1 mg/kg three times daily of phenylpropanolamine. Dogs that presented with clinical signs consistent with urinary sphincter mechanism incontinence were included in the study. They were examined on three occasions by the investigating veterinary surgeon. The frequency and volume of unconscious urination were scored by veterinary surgeons according to a pre-established scoring system. Phenylpropanolamine proved to be more effective than the placebo in regard to several parameters. At day 28, 85.7 per cent of phenylpropanolamine-treated cases had no episodes of unconscious urination compared with 33.3 per cent of placebo-treated cases. This was statistically significant. Few, mild side effects were seen in either group.

Three-dimensional anatomy of the pelvis in bladder exstrophy: description of bone pathology by using three-dimensional computed tomography and its clinical relevance.

The alterations in pelvic structure that occur in bladder exstrophy were evaluated in six children (one girl and five boys) by using three-dimensional computed tomography (3D-CT). The length and angle of anterior and posterior segments and the slanting angle of iliac wings were measured. 3D-CT scans of the pelvis of four patients with a normal pelvis were obtained to serve as controls. Both anterior and posterior segments were abnormally rotated externally in patients with bladder exstrophy. Whereas the length of the posterior segment is normal, the length of the anterior segment is significantly shorter, and the iliac wings projected more inward than those in the age-matched control subjects.

Pentalogy of Cantrell.

Omphalocele is often associated with various abnormalities. In two patients admitted with omphalocele, we additionally found defects both in the pars stenalis of diaphragm and in the diaphragmatic surface of the pericardium, sternal defect and tetralogy of Fallot. These entities form the components of a syndrome, named pentalogy of Cantrell. It is extremely in the spectrum of midline closure defects that display wide variations and its incidence is very low. Existing cardiac defect is the most important factor influencing morbidity and mortality. Herein we report two cases of pentalogy of Cantrell with the review of the syndrome in the light of literature.

Unilateral inguinal ectopic scrotum and imperforate anus: a case report.

A case of an ectopic scrotum located in the right inguinal area is described. The left hemiscrotum was in normal location, and each hemiscrotum contained testis. The boy also had an infralevator-type anorectal malformation. Initially, anoplasty was performed, and scrotal reconstruction was carried out 1 month later. The authors also reviewed the embryological explanation of ectopic scrotum in the literature.

Postpneumonic empyema in children treated by early decortication.

We performed early decortication in 32 cases of postpneumonic empyema during the period of February 1991 to December 1995. Twenty of them were male and 12 of them were female. We evaluated these cases retrospectively. Decortication was saved for the patients where antimicrobial therapy and closed-tube drainage had failed to achieve a cure and was performed on the 10-15th day after the diagnosis was established. Indications for the decortication were persistent fever (9), pulmonary air leakage (7), localized effusion (7), persistent respiratory distress (5) and pleural thickening without resolution (28). Decortication was performed through the standard posterolateral thoracotomy. Patients were discharged on the 8th postoperative day with minimal morbidity and no mortality. Because of the simplicity of the procedure (short hospitalization periods, low mortality and morbidity rates) good results were achieved with early decortication.

A case of anterior sacral meningocele totally excised using the posterior sagittal approach.

Anterior sacral meningocele is a rare congenital anomaly. The authors present a case of anterior sacral meningocele successfully excised using the posterior sagittal approach. The diagnosis and treatment of this unusual anomaly are discussed.

Congenital lumbar hernia associated with the lumbocostovertebral syndrome: two cases.

Congenital hernias in the lumbar region are very uncommon. Two cases with congenital lumbar hernia associated with the lumbocostovertebral syndrome are presented. The first case of a 14-month-old girl presented with the type of a superior lumbar triangle hernia. The second case was a 2-year-old girl presenting with diffuse lumbar hernia. The anatomy, embryology and treatment of this congenital abnormality are discussed.

Acute appendicitis: MR imaging and sonographic correlation.

OBJECTIVE: Acute appendicitis is the most common indication for emergency abdominal surgery. To our knowledge, MR imaging has not been compared with sonography for revealing acute appendicitis. Our aim was to assess and compare the accuracy, advantages, and limitations of MR imaging and sonography in revealing appendicitis. SUBJECTS AND METHODS: The study included 60 consecutive patients suspected of having appendicitis who underwent abdominal sonography and MR imaging. Fat-suppressed T2-weighted fast spin-echo and gadolinium-enhanced fat-suppressed T1-weighted spin-echo axial and coronal images were obtained. The initial MR imaging and sonographic studies were later correlated with the surgical-pathologic findings, follow-up evaluations, and diagnosis at the time of discharge. RESULTS: Surgical, histopathologic, and follow-up results revealed that 34 patients had appendicitis. Of the 26 patients without appendicitis, 15 with symptoms of acute appendicitis had no pathologic diagnoses and the remaining 11 had another diagnosis. Comparison of the sensitivity, accuracy, and negative predictive values for MR imaging and sonography was found to be statistically significant (p < .05, chi-square test), indicating that MR imaging was superior to sonography in revealing appendicitis. We found no statistical difference in specificity and positive predictive value for MR imaging and sonography. CONCLUSION: Despite some disadvantages, we found MR imaging to be superior to sonography in revealing suspected acute appendicitis. MR imaging can be used after suboptimal or nondiagnostic sonography in cases of suspected acute appendicitis.

A pseudoexstrophy with penile anomaly.

Although classical exstrophy of the bladder is not a rare anomaly, variants of exstrophy are extremely uncommon. We report a male pseudoexstrophy case with appearance of a low set umbilicus associated with umbilical hernia and penile anomaly. Although this mild exstrophy variant does not normally require surgical management, penile reconstruction was necessary in our patient.

A case of ectopic anus localized on the right gluteus.

A case of a gluteus-localized ectopic anus on the right side is described. A 5-month-old boy had a severe sacral anomaly with atrophy of the right lower extremity and a pes equinus deformity. Transcutaneous muscle stimulation showed a well-developed muscle complex, and parasagittal muscle fibers have been localized obliquely. Although he has severe sacral anomalies, the posterior sagittal anorectoplasty procedure could be performed. This unique case provides a good demonstration of not only the ectopically localized anus but also the ectopically localized muscle complex.

A very rare type of multiple intestinal atresias: "a string of pearls".

Intestinal atresia is the most frequently encountered cause of ileus in the neonate. Of all atresias combination of small and large bowel atresias is extremely rare. In 1973, Guttman presented a case with multiple, widespread atresias of small and large bowel, intraluminal calcifications and a hereditary nature. This paper describes the detailed pathological findings of a similar case of multiple intestinal atresias and discusses for the pathogenesis of this rare condition.

Pelvic ganglioneuroblastoma totally excised using posterior sagittal and abdominal approach.

Neuroblastoma usually presents as an upper abdominal mass arising from the adrenal gland. Recent experience with neuroblastoma of the spermatic cord, bladder, and pelvis demonstrates the propensity of this tumor to arise in unusual areas. A 1-year-old boy was admitted with pollakiuria, acute urinary retention, and chronic constipation. Computed tomographic and ultrasonographic examinations revealed a 5×5.5×4-cm pelvic mass, which was totally excised using a posterior sagittal and abdominal approach. The pathologic diagnosis was ganglioneuroblastoma and 1-year follow-up was uneventful.

Lumbar teratoma with intraspinal extension.

Teratomas are childhood tumours especially notable for their diversity of anatomic locations and biological behaviour. We present an extremely rare occurrence of a lumbar teratoma with intraspinal extension. The importance of thorough preoperative evaluation and magnetic resonance imaging for tumours in this location is also emphasised.