[Complications and emergencies in the recovery room]. / Komplikationen und Notfälle im Aufwachraum.

The recovery room as a central monitoring unit plays a crucial role in the perioperative care of patients. Here, the patient is monitored until the subsequent transfer to a further care ward; however, due to the previous anesthesia and surgery the recovery room also provides a high risk for (the development of) complications. The present article provides an overview of the most frequent complications to be expected in the recovery room (in adults), the diagnostics and the acute treatment.

[Anesthesia in patients with dopa-responsive dystonia (Segawa syndrome) : Presentation of the pathophysiology, clinical picture and approach based on two case reports]. / Anästhesieführung bei Patienten mit Dopa-responsiver Dystonie (Segawa-Syndrom) : Darstellung der Pathophysiologie, Klinik und Vorgehensweise anhand zweier Fallberichte.

Segawa syndrome (dopa-responsive dystonia [DRD]) is a rare neurometabolic disorder characterized by progressive dystonia, diurnal variation and tremors. It is caused by an enzymatic defect (a mutation of the GTPCH1 gene located on chromosome 14q) in the synthesis of tetrahydrobiopterin, an important substrate for dopamine synthesis. In the case of early correct diagnosis, clinical symptoms are well-controlled by levodopa therapy. The disease has several features which may lead to organ dysfunctions (e.g. torticollis, scoliosis, dysphagia and immobilization), which may be of concern for the anesthesiologist. Presenting two case reports of female patients undergoing elective cesarean section and breast cancer surgery, the main principles of perioperative management are discussed. Either techniques of regional or general anesthesia can be performed safely. Preoperative medication with levodopa should not be interrupted. Pharmacological agents with an antidopaminergic mode of action have to be avoided as well as significant pain and emotional stress situations in the perioperative period. Surgery in an ambulatory setting may not be recommended.

Post-traumatic Intraocular Leiomyosarcoma in a Domestic Bovine Calf (Bos primigenius taurus).

The present report describes a case of a post-traumatic ocular leiomyosarcoma in a calf (Bos primigenius taurus) including clinical, histopathological and immunohistochemical features. Following a traumatic episode, the animal developed opacification of the lens and shrinkage of the eye. Subsequently, the ocular lesion increased in size over a period of 6 weeks and reached up to 16 cm in diameter with infiltration into the cranium. At necropsy examination, the kidneys, liver and spleen exhibited multiple firm white metastases up to 2 cm in diameter. The mass was composed of closely-packed streams and bundles of neoplastic cells, which immunohistochemically expressed vimentin and alpha smooth muscle actin. Based on the anamnestic data, morphological appearance, distribution and immunohistochemical results, a diagnosis of a post-traumatic intraocular leiomyosarcoma was made. The tumour may have originated from cells lining the pectinate ligament of the ciliary body.

Immunohistochemical and morphometric analysis of intestinal full-thickness biopsy samples from cats with lymphoplasmacytic inflammatory bowel disease.

The distribution and numbers of CD3(+) T lymphocytes, immunoglobulin(+) plasma cells and calprotectin (L1)(+) macrophages was analyzed in full-thickness, formalin-fixed biopsy samples from the small intestine (duodenum, jejunum and ileum) and from the colon from nine cats with clinical signs of inflammatory bowel disease (IBD). All animals had lymphoplasmacytic enteritis or lymphoplasmacytic enterocolitis. Equivalent samples from the same intestinal regions from 12 healthy pet cats served as controls. Labelled cells in the lamina propria were counted by computer-aided morphometry. The different cell types were similarly distributed in both groups, but there were differences in their numbers. There were more CD3(+) T cells in the duodenum and jejunum of cats with IBD; however, the difference was only significant for the duodenum. There were significantly more IgA(+) cells in the duodenal crypt region. There were significantly more IgG(+) cells in the lower jejunal crypt region. Plasma cells expressing IgM were decreased in cats with IBD, but the difference was not significant. L1(+) macrophages were significantly decreased in the lower crypt area of the colon in cats with IBD and there was a trend to decreased L1(+) cells in the upper crypt area of the duodenum and jejunum. Comparison of the results of this study with previous findings on endoscopically-obtained duodenal biopsy samples from cats with IBD revealed some differences. These discrepancies might relate to differences between control cat populations, types of biopsy samples, methodological factors such as different counting techniques and the activity of the disease at the time of sampling.

[Antimicrobial treatment in burn injury patients]. / Antimikrobielle Therapie bei Patienten nach Verbrennungstrauma.

Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.

Central nervous system neuroblastoma in a wild deer (Capreolus capreolus).

This report describes a central nervous system (CNS) neuroblastoma in a wild deer (Capreolus capreolus) of approximate age 10 years. The doe was found in a barn with a fractured right forelimb and was shot. The animal was submitted for post-mortem examination in order to exclude rabies. The tumour was located in the midline of the mesencephalon with replacement of thalamus and parts of the hypothalamus and infiltration into the adjacent neuroparenchyma and the right lateral and third ventricles. Microscopically, the neoplastic cells were arranged in sheets and nests forming Homer-Wright- and pseudorosettes. Immunohistochemically, the tumour cells expressed neuron-specific enolase, synaptophysin, doublecortin and neurofilament. This is the first report of an infiltrative CNS neuroblastoma in a wild deer.

Structural and functional components of the feline enteric nervous system.

Neurohistological and immunohistochemical examinations of the feline enteric nervous system (ENS) were performed by using antibodies against neuron-specific enolase (NSE), phosphorylated neurofilaments (PN), non-phosphorylated neurofilaments (NPN) and vasoactive intestinal peptide (VIP), whereas glial cells were investigated by using antibodies against glial fibrillary acidic protein (GFAP). The study included full-thickness biopsies of the stomach, duodenum, jejunum, ileum and colon of 11 healthy cats. In this study, immunohistochemical staining of feline ENS with antibodies to NSE, PN and NPN revealed the presence of different ganglionated and aganglionated plexus. The two ganglionated plexus were arranged in a plexus submucosus internus & externus and a plexus myentericus. Furthermore, plexus mucosus and subserosal plexus represented two aganglionated plexus. GFAP-stained cellular elements were smaller than and in close contact to enteric neurons possibly resembling astrocytes of the central nervous system. VIP is one of the major neurotransmitters of enteric inhibitory neurons, and immunoreactivity was present in all layers of the gut, especially in ganglionated plexus. This is the first report, describing feline ENS by using immunohistochemical methods.

Numbers and distribution of immune cells in the tunica mucosa of the small and large intestine of full-thickness biopsies from healthy pet cats.

In this study, CD3(+) T lymphocytes and IgA(+) , IgG(+) and IgM(+) plasma cells were quantified in the tunica mucosa of the intestinal tract of 12 pet cats without gastrointestinal diseases. The study included full-thickness biopsies of the duodenum, jejunum, ileum and colon. The distribution and quantification of CD3(+) T cells, IgA(+) , IgG(+) and IgM(+) plasma cells within the intestinal tunica mucosa was performed by using immunohistochemical methods and computer-aided morphometry. CD3(+) T cells were significantly prominent in the villi and their numbers increased from duodenum to ileum but decreased towards the colon. The predominant type of plasma cells was IgA(+) cells, followed by IgM(+) cells. The number of IgG(+) cells was generally low compared to the other plasma cell types investigated. The results of the vertical distribution showed that IgA(+) and IgM(+) plasma cells were most numerous in the lower crypt areas, whilst IgG(+) plasma cells accumulated in the upper crypt region with a decline towards the villi and the lower crypt areas of control cats. All types of plasma cells showed a general decline from the duodenum towards the caudal sections of the intestinal tract regarding the horizontal distribution of plasma cells. This study provides a comprehensive overview on the vertical and horizontal distribution and the number of CD3(+) T cells and IgA(+) , IgG(+) and IgM(+) plasma cells in the intestinal tunica mucosa of pet cats.

Impact of platelets and fresh frozen plasma in contrast to red cell concentrate on unstimulated and stimulated cytokine release in an in vitro model of transfusion.

Transfusion of blood may contribute to immunomodulation. Leuco-depleted standard blood products are supposed to result in less immunomodulation compared with whole blood. To determine the influence of leuco-depleted blood products on the cytokine response, red blood cell concentrates (RBC), fresh frozen plasma (FFP) and platelet concentrates (PC) were investigated in an in vitro model of blood transfusion. Leuco-depleted standard blood bank RBC, FFP and PC were mixed in vitro with AB0 compatible venous blood from healthy volunteers in ratios of 3:1, 1:1 and 1:3. Specimens were incubated in presence or absence of lipopolysaccharide, 1 mug/ml. After 24 h of incubation cytokine release of tumour necrosis factor (TNF)-alpha and interleukin-10 (IL-10) was measured in cell culture supernatants by means of enzyme-linked immunsorbent assay. Addition of RBC, FFP and PC to venous blood from healthy volunteers led to a significant and dose-dependent increase in spontaneous TNF-alpha and IL-10 release. After endotoxin stimulation, RBC, FFP and PC significantly suppressed the TNF-alpha response, while the stimulated release of IL-10 tended to increase, reaching significance only after high doses of FFP. Addition of leuco-depleted blood products changed the spontaneous and stimulated cytokine response in an in vitro model of transfusion. These data may suggest a possible contribution of transfused FFP and PC to immunomodulation after transfusion similar to RBC.

Diffuse intracranial oligodendroglioma in a cow.

This report describes the clinical, morphological and immunohistochemical findings in an adult cow with cerebral oligodendroglioma. The tumour extended from the metencephalon to the telencephalon, with infiltration of the meninges. Immunohistochemically, the tumour cells lacked expression of a specific tumour antigen, were partially positive for S-100 and tau protein, and were negative for a range of antigens including glial fibrillary acid protein, neuron-specific enolase, myelin basic protein and synaptophysin. This is the first report describing a diffuse, cerebral oligodendroglioma in a cow.

Listeria monocytogenes septicaemia and concurrent clostridial infection in an adult alpaca (Lama pacos).

A 10-year-old alpaca with a history of anorexia, weight loss and diarrhoea was humanely destroyed and shown to have a multifocal necrotizing hepatitis, splenitis and colitis, as well as an ulcerative to diphtheroid ileitis. Immunohistochemical examination revealed Listeria monocytogenes antigen in the liver and ileum. In addition, L. monocytogenes and Listeria sp.-specific gene fragments were detected by the polymerase chain reaction. L. monocytogenes was isolated from liver and small intestine and Clostridium perfringens type A with beta(2) toxin was found in the small intestine. It is suggested that the infection with C. perfringens type A facilitated the systemic spread of L. monocytogenes.

[Herbal medications. Possible importance for anaesthesia and intensive care medicine]. / Phytopharmaka. Mögliche Bedeutung für Anästhesie und Intensivmedizin.

There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published.

Confocal laser scanning analysis of an equine oral mast cell tumor with atypical expression of tyrosine kinase receptor C-KIT.

A 20-year-old female horse showed a nodular, firm, focal ulcerated mast cell tumor at the right dorsobuccal face of the tongue. Histologically, the nonencapsulated tumor consisted of dense, infiltrating aggregates of well-differentiated, Cresyl violet-positive mast cells accompanied by numerous eosinophils. Furthermore, they exhibited a strong, diffuse, intracytoplasmatic immunohistochemical signal for tryptase and a faint membrane-associated and perinuclear signal for tyrosine kinase receptor KIT. Confocal laser scanning microscopy confirmed an aberrant spatial colocalization of KIT in the Golgi apparatus, which may be the result of a defective protein processing within the tumor cells. The tumor was not associated with a poor prognosis.

Retrospective study on the diagnostic value of full-thickness biopsies from the stomach and intestines of dogs with chronic gastrointestinal disease symptoms.

An evaluation of histologic findings in full-thickness biopsies from the gastrointestinal tract (GIT) from 64 dogs with chronic GIT disease symptoms was performed. In the majority of cases (38/64; 59%), intestinal lymphangiectasia and mucosal edema of unknown etiology were present. In 10 dogs (16%) an eosinophilic colitis, either alone or together with gastritis and/or enteritis, was found. In 5 dogs (8%) lymphocytic-plasmacytic enteritis or enterocolitis was diagnosed. Five dogs (8%) had an intestinal T-cell lymphoma. Samples from the remaining cases were histologically normal or did not allow for a final diagnosis. In contrast to reports about findings in endoscopic biopsies (which often are of varying quality or inadequate for diagnosis), in the majority of cases of this study, examination of full-thickness biopsies from the GIT allowed us to make a definitive histopathologic diagnosis. Furthermore, the study revealed that transmural biopsies are very helpful for diagnosing lymphoma.

Eosinophilic granulomatous gastroenterocolitis and hepatitis in a 1-year-old male Siberian Husky.

A case of eosinophilic granulomatous gastroenterocolitis and hepatitis in a 1-year-old male Siberian Husky is described. The dog presented with a history of diarrhea, weakness, lethargy, and anorexia of several months' duration. Hematologic and biochemical examinations, abdominal ultrasonography, computer tomography, and exploratory laparotomy were performed. Histopathologic examination of full-thickness biopsies from the gastrointestinal tract and liver revealed the presence of eosinophilic granulomatous lesions in the submucosa and tunica muscularis of stomach, jejunum, ileum, colon, and liver. Infectious agents were not detected by light microscopic and electron microscopic examination or by immunohistochemistry. On the basis of the findings, it is concluded that the disease in this dog represents an unusual manifestation of chronic idiopathic inflammatory bowel disease.