Association of cerebrospinal fluid analysis findings with clinical signs and outcome in acute nonambulatory thoracolumbar disc disease in dogs.

BACKGROUND: Cerebrospinal fluid (CSF) pleocytosis recently was associated with the severity of neurologic signs in dogs with intervertebral disc disease (IVDD). HYPOTHESIS/OBJECTIVES: To look for an association among CSF cell counts, total protein concentration, and severity of neurologic signs at presentation with outcome in dogs with acute thoracolumbar IVDD. Our hypothesis was that CSF total nucleated cell count (TNCC) and percentage cell types would be associated with the severity of spinal cord damage and therefore with both the presenting clinical signs and the prognosis of affected dogs. ANIMALS: Fifty-four dogs with acute nonambulatory thoracolumbar IVDD were evaluated. METHODS: Retrospective study. Signalment, neurologic grade, CSF TNCC, protein concentration, red blood cells count and differential cell percentages, and short- and long-term outcomes were evaluated. RESULTS: CSF pleocytosis (>5 cells/µL) was present in 54% of dogs and was positively associated with neurologic grade at presentation and with postoperative time to regaining ambulation. Neutrophils were observed most frequently. The percentage of CSF macrophages and macrophage to monocyte ratio were higher (P = .001, for both) in dogs presented without deep pain sensation (DPS) that did not regain ambulation. Receiver operator characteristics curve analysis yielded a cut-off point of 13% macrophages with a sensitivity and specificity of 100 and 83%, respectively, for prediction of a negative outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: CSF pleocytosis is positively associated with the severity of spinal cord damage in dogs with thoracolumbar IVDD. The percentage of CSF macrophages can be used as a prognostic indicator for regaining ambulation in dogs that have lost DPS.

The problem of empyematous pleural effusion in rheumatoid arthritis: report of two cases and review of the literature.

Two patients with rheumatoid arthritis and empyematous pleural effusion were treated with repeated drainage and intrapleural corticosteroids. One patient with active joint disease improved within 3 months without sequelae, probably because of the systemic therapy. The other patient, with non-active joint disease, had persistent pleural effusion which resulted in pleural thickening and symptomatic restrictive disturbance. It appears that early intervention intended to prevent the accumulation of empyematous pleural effusion could also prevent pleural thickening and fibrosis. Therapeutic options are discussed.

High-dose-rate endobronchial brachytherapy in endobronchial metastatic malignant chondroid syringoma.

A 65-year-old man with malignant chondroid syringoma (MCS) was found to have pulmonary metastases in the form of multiple pulmonary nodules 4 years after wide excision and adjuvant radiotherapy of a primary abdominal wall tumor. Atelectasis of the lingula due to obstructive endobronchial metastasis, resistant to combination chemotherapy, led us to perform high-dose rate (HDR) endobronchial brachytherapy for the first time in this rare tumor with a favorable response. This case emphasizes the role of HDR brachytherapy as a palliative procedure in endobronchial tumors not responding to other treatment modalities, even those considered to be radioresistant.

Detection of isolated distant metastasis in soft tissue sarcoma by fluorodeoxyglucose positron emission tomography: case report.

Fluorodeoxyglucose (FDG), labeled with F-18, is a glucose analog that accumulates in cells in proportion to the rate of glucose metabolism, and increased carbohydrate metabolism has been recognized as a feature of malignant cells versus normal cells. In addition, it permits the detection of metastases not discovered by bone scan. Although detection of the primary site of disease is usually accomplished well with conventional techniques, the performance of FDG positron emission tomography (PET) may be useful to determine metastases that are not clinically evident. The authors describe a case of early detection of distant metastases by FDG-PET in a young patient diagnosed with rhabdomyosarcoma of the hand.

Pleural empyema: An unusual presentation of esophageal perforation.

A 67-year-old patient presented with pleural empyema as the sole manifestation of thoracic esophageal perforation, 2 weeks after accidental fish bone ingestion. Nonspecific chest pain and general deterioration, unusual presenting symptoms in themselves, accounted for the extreme delay in the diagnosis. The empyema was treated surgically, and the esophageal perforation conservatively. Despite the poor prognostic factors, the patient recovered completely after 50 days in hospital.

Radiation-induced sarcoma following curative radiotherapy for testicular seminoma: case report and brief review of the literature.

We report a case of radiation-induced retroperitoneal leiomyosarcoma which developed 37 years after the patient received radiation therapy for testicular seminoma. The sarcoma originated within the para-aortic field, extensively involving neighboring organs, soft tissue and muscle tissues, and could be only partially resected. The absolute number of these secondary sarcomas is low, but the risk of developing such neoplasms calls for awareness in the long-term follow-up of cured seminoma patients.

Chemotherapy-induced spontaneous pneumothorax in a patient with bulky mediastinal lymphoma: a rare oncologic emergency.

Chemotherapy-induced spontaneous pneumothorax (SP) has been described sporadically in chemosensitive tumors, particularly sarcoma, with multiple lung metastases. We present a patient who developed SP following rapid regression of bulky mediastinal lymphoma. Immediately on chest tube insertion, the lung recovered and further chemotherapy could be delivered uneventfully. We suggest that (1) chemotherapy-induced SP should be included amongst oncologic emergencies and that (2) a high degree of awareness of this complication is required.