Pulmonary artery pseudoaneurysms: endovascular management after adequate imaging diagnosis.

Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities mostly due to infections and trauma, although other conditions such as vasculitis, neoplasms, or inflammatory lung diseases can also predispose to this entity. Endovascular techniques such as embolization or covered stent placement have mostly substituted surgical approaches, for their lower invasiveness and greater security, mainly in patients with life-threatening hemoptysis. The purpose of this manuscript is to describe the imaging findings of pulmonary artery pseudoaneurysms and their endovascular management including tips to help interventional radiologists. PAP should be diagnosed as accurately and early as possible in order to prompt endovascular management of further life-threatening hemoptysis. KEY POINTS: • Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities that may represent a life-threatening condition, mainly due to Staphylococcus, Streptococcus, or Mycobacterium tuberculosis. • Radiologists should know the imaging findings of PAP in order to make an accurate and early diagnosis to prompt endovascular management of further life-threatening hemoptysis.

Changes in gene expression in the rumen and colon epithelia during the dry period through lactation of dairy cows and effects of live yeast supplementation.

The objectives of this study were (1) to use endoscopy to collect biopsies from the rumen and colon epithelia to describe changes in gene expression in these 2 tissues as cows move from a dry to a lactation ration and (2) to evaluate the potential influence that supplementation of live yeast could exert on these 2 epithelia. Twenty-one Holstein cows were split into 2 treatments and received either 300 g/d of corn containing 1 × 1010 cfu/d of live yeast (LY; n = 10) or 300 g/d of corn with no supplementation (control; n = 11) starting 21 ± 2.6 d (average ± SD) before until 21 d after calving. At 14 ± 2.6 d before the expected calving date, and exactly at 7 and 21 d after calving, rumen and colon biopsies were obtained from each cow using an endoscope. Total RNA was extracted from rumen and colon tissues, and the expression of IL10, TNFA, TLR4, IL1B, PCNA, MKI67, SGLT1, BAX, CASP3, OCLN, CLDN4, HSPA1A, HSPB1, DEFB1, and MCT1 (the latter only in rumen samples) was quantified by quantitative PCR. Overall, fluctuations in expression of the selected genes in the colon between the 2 stages of production and the 2 treatments were smaller than those found in the rumen. In the rumen epithelium, expression of TLR4 and DEFB1 was greatest before calving, with LY cows having a greater expression of TLR4 than control cows. Similarly, expression of IL10 was greatest in LY cows before calving. Expression of TNFA in the rumen epithelium of control cows was lowest at 21 DIM but in LY cows was kept steady among production stages. The expression of PCNA and MKI67 in the rumen epithelium was greatest at 7 DIM, indicating a high proliferation rate of this epithelium after calving. In the colon mucosa, expression of TLR4 and DEFB1 was greater than in the rumen, and DEFB1 expression was greater in LY cows than in control cows. The use of an endoscope allowed us to study the dynamics of rumen epithelium adaptation to increased supply of concentrate after calving, consisting of increased epithelia remodeling, reduction of the TLR4, and increased IL10 expression. Furthermore, the rumen epithelium of dry cows responded rapidly to live yeast, with changes in the expression of genes involved in the immune response becoming evident after 7 d of exposure to yeast. The expression of genes related to the immune response (mainly TLR4 and DEFB1) in the colon mucosa was greater than in the rumen, and the expression of DEFB1 was further stimulated by live yeast. It is concluded that the use of an endoscope allows the study of gene expression patterns in the rumen and hindgut epithelia. We report marked changes in the rumen wall and more modest changes in the colon when transitioning from a dry to a lactation ration. Furthermore, supplementation of live yeast fostered and increased expression of genes regulating inflammation and epithelial barrier in the rumen, and in the colon it increased the expression of DFEB1 coding for an antimicrobial peptide.

Short communication: lying behavior of lactating dairy cows is influenced by lameness especially around feeding time.

Lameness is considered one of the most common welfare and productive problems in dairy cattle. The objective of this study was to evaluate differences in lying behavior between moderately lame and nonlame lactating cows under commercial conditions. Data were collected from 10 free-stall commercial herds, which were feeding on exactly the same ration once daily. All lactating cows were scored for lameness according to a 1 to 5 locomotion scoring system. Only cows with a lameness score between 1 and 4 were considered in the study. In each herd, between 10 and 15 lame cows (scored as 3 or 4) were chosen, and for each lame cow, a nonlame cow (scored as 1) within the same parity and similar days in milk was also selected. Pendant data loggers were then placed on the right hind leg of each cow for 10 d to record lying behavior at 1-min intervals. In addition, the time of feed delivery was recorded in each herd on a daily basis. Total daily lying time, daily number of lying bouts, lying bout duration, laterality (side of recumbence), and lying behavior around feed delivery time were evaluated using a mixed-effects model that accounted for the fixed effects of lameness, days in milk, parity, and the interaction between parity and lameness, plus the random effects of herd. Total daily lying time (721±24.2 min/d) tended to increase with days in milk, but it was not affected by lameness or parity. Likewise, no differences were found in the number of lying bouts (9.6±0.49/d) or laterality (47±2.6% of time lying on the right side). However, the mean bout duration was longer in lame (89.3±3.89 min) compared with nonlame (80.7±3.90 min) cows. It is interesting that lame cows stood up 13 min later than nonlame cows relative to the time when the ration was delivered. In addition, lame cows lay down 19 min earlier than nonlame ones after the feed was delivered, which implies that nonlame cows spent more time standing, and probably eating, than did lame cows. It was concluded that lame cows have longer lying bouts than nonlame animals, and that lying behavior around feed delivery time may be an effective proxy to identify moderately lame cows.

Carboplatin-gemcitabine treatment of patients with transitional cell carcinoma of the bladder and impaired renal function.

INTRODUCTION: Bladder cancer is a frequently occurring tumour in Spain and usually affects elderly patients with renal impairment. The development of new combination therapies for such patients is thus of vital importance. PATIENTS AND METHODS: Between 1997 and 1998, 17 patients with locally advanced non-surgical or metastatic bladder tumours were treated at our centres. Treatment consisted of 1,000 mg/m(2) of gemcitabine administered on days 1 and 8, and carboplatin (area under the concentration curve = 5) on day 1, every 21 days. RESULTS: The mean age of the patients [4 females (26%) and 13 males] was 69 years (range: 54-78 years). The average Karnofsky performance status was 80% (range: 50-100%). Mean creatinine clearance was 45.4 ml/min (range: 21-55 ml/min). There were 2 complete responses, 7 partial responses (RO: 56%; range 31-81%), 6 patients had stable disease and 1 disease progression. Haematological toxicities were as follows: grade I anaemia in 2 patients, grade III in 3; grade I granulocytopenia in 2 patients, grade III-IV in 4 patients; grade III thrombocytopenia in 3 patients. Toxic death occurred in the course of one grade IV neutropenic event. Non-haematological toxicities were as follows: grade I-II vomiting in 3 patients and grade III in 1. One patient had grade III hepatic toxicity. One patient had grade III renal toxicity, and 3 patients grade II alopecia. CONCLUSIONS: The above-mentioned treatment has low toxicity, is easy to administer and offers promising results in this group of patients.

Randomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancer.

PURPOSE: The efficacy of adjuvant chemotherapy in gastric cancer is controversial. We conducted a phase III, randomized, multicentric clinical trial with the goal of assessing the efficacy of the combination of mitomycin plus tegafur in prolonging the disease-free survival and overall survival of patients with resected stage III gastric cancer. PATIENTS AND METHODS: Patients with resected stage III gastric adenocarcinoma were randomly assigned, using sealed envelopes, to receive either chemotherapy or no further treatment. Chemotherapy was started within 28 days after surgery according to the following schedule: mitomycin 20 mg/m(2) intravenously (bolus) at day 1 of chemotherapy; 30 days later, oral tegafur at 400 mg bid daily for 3 months. Disease-free survival and overall survival were estimated using the Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS: Between January 1988 and September 1994, 148 patients from 10 hospitals in Catalonia, Spain, were included in the study. The median follow-up period was 37 months. The tolerability of the treatment was excellent. The overall survival and disease-free survival were higher in the group of patients treated with chemotherapy (P =.04 for survival and P =.01 for disease-free survival in the log-rank test). The overall 5-year survival rate and the 5-year disease-free survival rate were, respectively, 56% and 51% in the treatment group and 36% and 31% in the control group. CONCLUSION: Our positive results are consistent with the results of recent studies; which conclude that there is a potential benefit from adjuvant chemotherapy in resected gastric cancer.

Phase II study of estramustine and vinorelbine in hormone-refractory prostate carcinoma patients.

The purpose of this study was to evaluate the antitumor activity of vinorelbine and oral estramustine phosphate in patients with metastatic, hormone-refractory prostate cancer. We evaluated the activity of this association using the following schedule: estramustine phosphate 600 mg/m2/day orally days 1-42 and vinorelbine 25 mg/m1 days 1, 8, 22, 29 cycles repeated every 56 days. Twenty-five patients were included in the study, 24 being evaluable for response and 25 for toxicity. Out of 5 patients with measurable disease, none had an objective response. Of the 24 assessable patients with bone metastases, 9 patients had a > or = 65% decline in pretreatment prostate-specific antigen (PSA) level, stable disease was observed in 10 and 5 patients progressed. Toxicities were minimal. Anemia was observed in 5 patients, alopecia in 4 and nausea and vomiting was observed in 6 patients. Anorexia and weight loss of more than 10% were observed in 2 patients. This combination is active and well tolerated in hormone-resistant prostate cancer. These results support the therapeutic strategy of combining agents that impair microtubule function.

Alternating chemotherapy in advanced non-small cell lung cancer: a phase II study.

Fifty-three patients with advanced non-small cell lung cancer (NSCLC) were treated with alternating two-drug schedules cisplatin/vindesine and ifosfamide/mitomycin. Objective response (complete and partial response) was obtained in 31% (confidence limits 18.6-44%) of patients. The median duration of response was 26 weeks. The median survival was 25 weeks, with 24% of patients alive at 1 year. The toxicity was acceptable. The still poor antitumor activity of the chemotherapy schedules used and the lack of non-cross-resistance are factors that could explain the low antitumor activity of alternating chemotherapy.

[Undifferentiated carcinoma of nasopharyngeal type sitting in the hypopharynx]. / Carcinoma indiferenciado tipo nasofaríngeo, localizado en hipofaringe. A propósito de un caso.

Nasopharyngeal-like carcinoma is an extremely rare tumor when localised in the laryngopharyngeal mucosa. Only 10 of such tumors could be found by the AA. in the medical literature. They report this additional case in which the radiotherapy plus the chemotherapy have controlled, till now, the primary disease and its spreading to the cervical lymph nodes.

Case report: CT diagnosis of nonobstructive left paraduodenal hernia.

The preoperative diagnosis of paraduodenal hernias (PH) can only be made radiologically. PH are seldom diagnosed preoperatively unless they cause bowel obstruction. We report an unusual case of a nonobstructive left PH diagnosed preoperatively by computed tomography (CT). The CT findings of internal hernias are discussed.