Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

A negative energy balance during the peri-implantational period reduces dam IGF-1 but does not alter progesterone or pregnancy-specific protein B (PSPB) or fertility in suckled cows.

The aim of this study was to evaluate the effect of a negative energy balance during the first third of gestation on metabolic, endocrine, and pregnancy recognition parameters in 2 beef cattle breeds adapted to semiextensive conditions. Seventy-five lactating Parda de Montaña and 40 Pirenaica multiparous cows rearing calves were synchronized and timed artificial inseminated (TAI) on day 76 postpartum. Cows were assigned to one of 2 diets (CONTROL or SUBNUT; 100% or 65% of their requirements supplied) until day 82 of gestation. Pregnancy was diagnosed 37 d post-TAI using ultrasound. Blood samples were obtained to determine metabolic (glucose, NEFA, ß-hydroxybutyrate, cholesterol, and urea) and endocrine (IGF-1) status throughout the first third of gestation and to determine the concentrations of progesterone and pregnancy-specific protein B (PSPB) in the peri-implantational period. Undernutrition affected both cow and calf performance. The CONTROL cows maintained BCS and BW, whereas SUBNUT cows had negative daily gains. The CONTROL lactating calves had higher BW gains than SUBNUT. These negative effects were more evident in the Pirenaica breed, which was more sensitive to undernutrition. The negative energy balance was reflected in the cows' metabolic profiles, with higher NEFA values and lower IGF-1 concentrations in SUBNUT cows. However, undernutrition did not affect dam pregnancy/TAI or pregnancy recognition and maintenance, confirming that during periods of undernourishment pregnant dams prioritize the allocation of dietary energy toward reproductive functions. Progesterone concentration on day 21 post-TAI (with a 4.8 ng/mL cut-off value) and PSPB on day 26 post-TAI (with a 0.57 ng/mL cut-off value) were determined as the earliest indicators to accurately establish dam pregnancy status, regardless of breed or nutrition treatment. In summary, early undernutrition affected cow performance and metabolic profiles and impaired lactating calf growth, but did not affect progesterone or PSPB concentrations or the pregnancy/TAI rate in suckled cows.

Influence of postweaning feeding management of beef heifers on performance and physiological profiles through rearing and first lactation.

The aim of this study was to examine the effects of 2 postweaning feeding management approaches (FEED: 0.8 [HIGH] vs 0.6 [MOD] kg/d target ADG) on the performance of heifers of 2 beef breeds (BREED: Parda de Montaña [PA] vs Pirenaica) calving at 2 yr. Twenty-five heifers previously creep fed before weaning (6 mo) were assigned to 2 planes of nutrition from 6 to 15 mo of age. At 15 mo, they were inseminated, and then received similar diets until weaning of their first calf (4 mo postcalving). Several parameters were measured to analyze growth and development (BW; ADG; size measures at 6 mo, 15 mo, calving, and weaning), performance at puberty and first breeding, and dam and calf performance in the first lactation (calving traits, ADG, milk yield). Metabolic (glucose, cholesterol, NEFA, ß-hydroxybutyrate, and urea) and endocrine status (IGF-I and leptin) were assessed in plasma samples collected every 3 mo from 6 mo to calving and monthly during lactation. No interaction between BREED and FEED was observed. Heifers from the HIGH feeding treatment had higher postweaning ADG than those on the LOW diet. At 15 mo, they had greater BW, heart girth, and external pelvic area, but they did not differ thereafter. All heifers reached puberty at similar BW (55% mature BW) but different ages. Heifers from the HIGH treatment tended (P < 0.09) to be pubertal earlier, and PA heifers were 1.6 mo younger than Pirenaica heifers (P < 0.05) at puberty. At the time of conception (452 ± 59 kg) and calving (471 ± 51 kg), BW was above common recommendations in all groups. Calving traits and performance in lactation did not differ between feeding treatments. BREED only influenced birth weight; PA calves being heavier (P < 0.05), which resulted in a larger calf/cow BW ratio, but no effect on calving difficulty or subsequent performance. Metabolic substrates and hormones depended mostly on sampling date, which was related to current energy and protein intake. Glucose (P < 0.001), cholesterol (P < 0.001), and IGF-I (P < 0.05) were greater during the postweaning phase in heifers on the HIGH diet, and persistent physiological effects were observed during lactation. Age at puberty was negatively related with IGF-I (r = -0.43, P < 0.001), but not with leptin concentrations. In conclusion, regardless of breed, a moderate growth rate ensured adequate heifer development and performance until the first lactation, whereas no advantage was gained from enhanced postweaning gains.

Milk yield and genomewide expression profiling in the mammary gland of beef primiparous cows in response to the dietary management during the pre- and postweaning periods.

Accelerated growth programs during prepubertal periods have been promoted to advance the first calving of beef heifers. The objectives of the present study were to evaluate nutrition-induced changes on first lactation milk yield and composition and on gene expression of the mammary gland in Parda de Montaña primiparous cows. Female calves ( = 16) were involved in a 2 × 2 factorial experiment. In the preweaning period (PRE-W; 0-6 mo), female calves were either fed a creep feed supplement (Creep) or fed only their dam's milk (Control). In the postweaning period (POST-W; 6-15 mo), heifers received either a high-energy diet (91.7 MJ/d) or a moderate-energy diet (79.3 MJ/d). All the heifers were managed together from breeding (15 mo) to the end of their first lactation (32 mo). Animal performance; milk production and quantity during the first lactation; plasma glucose, IGF-I, and leptin concentrations; and RNA samples from the mammary gland at the end of the first lactation of the primiparous cows (32 mo) were analyzed. The BW and ADG of the primiparous cow during its first lactation were not different among treatments; however, creep feeding during PRE-W reduced milk production ( < 0.01), milk CP, crude fat, lactose, nonfat solids, and casein content throughout lactation and increased somatic cell count in the third ( < 0.05) and fourth month of lactation ( < 0.10). The energy level during the POST-W had no effect on milk production and quality. Gene expression in the mammary gland was affected by the diet in the PRE-W and POST-W, with the PRE-W diet having the greatest impact. During the PRE-W, creep feeding resulted in upregulation of genes related to immune response and chemokine activity, suggesting that these animals might be in a compromised immune status. Therefore, this strategy would not be recommendable; meanwhile, increasing the energy level in the diet during the POST-W would be recommendable, because it had no deleterious effects on milk yield and composition.

Metabolic, endocrine, and reproductive responses of beef heifers submitted to different growth strategies during the lactation and rearing periods.

The effects of different feeding strategies (0.7 kg/d target ADG [LO] and 1.0 kg/d target ADG [HI] during the lactation period (LACT; 0-6 mo) and the rearing period (REAR; 6-15 mo; HI-HI, HI-LO, LO-HI, and LO-LO treatments) on the growth and reproductive parameters of beef heifers bred by fixed-time AI at 15 mo were analyzed. Animal weights were recorded weekly (from birth to 18 mo), and size measures were recorded at 6 and 15 mo. Heifers were bled to determine the onset of puberty and the metabolic and endocrine (IGF-I and leptin) status. During lactation, calves in the high lactation treatment (LactHI) had greater weight ( < 0.001), weight gain ( < 0.001), and body size ( < 0.001) than calves in the low lactation treatment (LactLO). The greater energy balance of LactHI heifers at weaning was reflected in greater concentrations of plasma glucose ( < 0.001), urea ( < 0.001), and IGF-I ( < 0.001); plasma levels of NEFA were lower ( < 0.001). During REAR, LactLO heifers had a greater growth rate than did LactHI heifers ( < 0.001), partially overcoming the lower gains during lactation. The differences in size measurements registered at weaning were also compensated, with the exception of LO-LO heifers. The IGF-I profile was highly correlated with animal performance traits and metabolic profiles, providing a useful indicator of growth, nutritional, and metabolic status at key points in development. By contrast, the function of leptin as an indicator of growth and reproductive development of heifers was less clear. All treatments had similar weights at puberty onset (55.9% mature BW), although LactLO ( < 0.01) and the low rearing treatment (RearLO; < 0.001) heifers were older than the others. The animals with greater glucose and IGF-I levels at weaning and greater cholesterol concentrations during REAR reached puberty earlier. The fertility rate (86%) was similar among treatments. The heifers in the high rearing treatment (RearHI) required more AI services to become pregnant and were older at conception ( < 0.05). The age of conception was positively correlated with glucose ( = 0.57, < 0.01) and cholesterol ( = 0.68, < 0.001) at 9 mo. Our results show that a 0.7 kg/d gain from birth allowed the first breeding at 15 mo, 6 mo earlier than usual for these conditions, without any negative effect on heifer reproductive performance.

The influence of dietary lysine restriction during the finishing period on growth performance and carcass, meat, and fat characteristics of barrows and gilts intended for dry-cured ham production.

A total of 120 pigs [Duroc × (Landrace × Large White); initial average BW: 100.3 ± 2.5 kg] were used to investigate the effects of sex (barrows and gilts) and dietary total Lys restriction (7.0, 6.5, and 6.0 g·kg(-1)) on growth performance and carcass, meat, and fat characteristics. Pigs were intended for high-quality dry-cured ham from Spain (called Teruel ham), and a minimum fat thickness at the gluteus medius muscle (GM) is required (16 mm) for carcasses to be acceptable. Animals were slaughtered when they reached 129.0 ± 3.6 kg of BW. There were 6 treatments arranged factorially (2 sexes × 3 dietary Lys concentrations) and 4 replicates of 5 pigs per treatment. Barrows consumed more feed (P = 0.001) and tended to have less G:F (P = 0.06) than gilts. Carcasses from barrows were fatter (P = 0.001) and had heavier main trimmed lean cuts (P = 0.008) than gilts. A greater proportion of final acceptable carcasses for Teruel ham (P = 0.001) was observed in barrows than in gilts because of the greater percentage of carcasses that fulfill the minimum fat depth at GM required (P = 0.001). Meat from barrows had greater content of intramuscular fat (P = 0.02) than meat from gilts. Also, subcutaneous fat from barrows had less proportion of PUFA than fat from gilts (P = 0.02). A reduction in dietary Lys concentration decreased ADG (P = 0.004) and ADFI (P = 0.001) in pigs. In addition, backfat depth (P = 0.007) and fat at GM (P = 0.07) increased as dietary Lys decreased. The proportion of carcasses that fulfilled the minimum fat depth at GM required for Teruel ham increased as dietary Lys decreased in feed, but this effect was greater in gilts than in barrows (sex × Lys, P = 0.02). Meat and fat quality was not influenced by dietary treatment. We conclude that different feeding programs with different dietary Lys concentrations may be needed for barrows and gilts intended for production of dry-cured hams where a minimum carcass fat depth is required.

Performance, residual feed intake, digestibility, carcass traits, and profitability of Angus-Hereford steers housed in individual or group pens.

Even though the concept of residual feed intake (RFI) is well accepted, several questions remain regarding other traits that may be associated with selection for decreased RFI. These include DM digestibility, carcass composition, profitability, and performance. The objective of this study was to investigate the difference in those traits between low- and high-RFI cattle. Sixty Angus x Hereford crossbred steers (296 kg of initial BW) were fed a corn-based finishing ration (1.68 Mcal of NE(m)/kg, 13% CP on a DM basis) during 2 periods of 60 d each. For both phases, the regression equation fitted without the intercept (not statistically significant) was DMI (kg/d) = 0.0701 x BW(0.75) + 2.714 x ADG, r(2) = 0.42. The 15 greatest and least RFI steers were classed as high and low RFI groups. There were no differences between low and high RFI groups for days on feed (162 vs. 168 d), slaughter weight (503 vs. 511 kg), HCW (317 vs. 315 kg), LM area (76.5 vs. 77.1 cm(2)), backfat (1.23 vs. 1.27 cm), KPH (3.1 vs. 3.7%), quality grade (average Choice for both groups), or carcass fat (32.4 vs. 33.1%). Visceral organ masses and abdominal fat were similar for low and high RFI groups (32.25 vs. 31.24 kg and 37.48 vs. 36.95 kg, respectively). These results do not support the existence of major differences in composition and organ mass between low and high RFI steers at slaughter. The RFI grouping had a significant effect on DMI, G:F, and RFI values. Stepwise regression showed that G:F alone or DMI and ADG together explained 98.5% of the variance in cost of BW gain, whereas RFI alone explained only 18%. We conclude that RFI is less useful than G:F as an indicator of feedlot efficiency and profitability.

The influence of age at the beginning of Montanera period on meat characteristics and fat quality of outdoor Iberian pigs.

A total of 120 Iberian pigs of the Lampiña line that grew under outdoor conditions were used to study the effect of the age at the beginning of Montanera period (AM) on meat characteristics and fatty acid (FA) profile of subcutaneous fat. AM period is a free-range fattening phase from November to February in which pigs ate mainly acorns and grass. There were two treatments with two AM (20 pigs per treatment); 18 (P18) and 12 months (P12). Barrows and gilts were in the same proportion within each treatment. All the animals were slaughtered at the same time (at the end of Montanera period) reaching an average 160 kg of body weight. Meat from P18 had less protein and was more red (a*) (P < 0.05), but tended to show higher intramuscular fat content (P < 0.10) than meat from P12. Loin from P18 had lower thawing (P < 0.001) and cooking losses (P < 0.10) than loin from P12. The fat from P18 had higher monounsaturated FA content than fat from P12 pigs (P < 0.01) due to the higher level of C18:1 (P < 0.01) and C20:1 (P < 0.001). However, fat from P12 had higher polyunsaturated FA content than fat from P18 pigs (P < 0.01) because of the higher level of C18:2 (P < 0.001). It is concluded that both 12 and 18 months are adequate AM for purebred Iberian pigs from the commercial point of view. However, if the aim is to produce high-quality dry-cured Iberian products, the P18 pigs would be more advisable because had better meat and fat characteristics than the P12 pigs.

The effect of seasonality of the growing-finishing period on carcass, meat and fat characteristics of heavy barrows and gilts.

A trial was conducted to study the effect of gender (barrows; gilts) and seasonality of growing-finishing period (S, summer; W, winter) on the carcass and meat characteristics and fatty acid (FA) profile of subcutaneous fat of pigs slaughtered at 131kg of body weight. No significant gender×seasonality interaction was detected and the differences between genders were scarce. The S pigs had a 13.2% thinner fat depth over the Gluteus medius muscle and a higher yield of shoulders and loins by 10.6% and 10.0%, respectively than W pigs. Meat from S pigs had 32.5% lower intramuscular fat content and higher cooking losses (9.1%) and shear force (6.4%) than meat from W pigs. Subcutaneous fat from S pigs had a 7.8% higher percentage of saturated FA and 4.9% lower monounsaturated FA than that from W pigs. It is concluded that in Spanish natural-environment facilities, the seasonality of the growing-finishing period affects the carcass, and meat and fat quality of heavy pigs.

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Pyogenic brain abscesses: experience with 60 consecutive cases]. / Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos.

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.

Brucellar spinal epidural abscesses. Analysis of eleven cases.

Brucellar spinal epidural abscesses (BSEA) are rare and very few series of them have been reported. In order to evaluate the clinical characteristics, management and outcome of this entity, the clinical records and current status of a series of 11 patients have been retrospectively reviewed. A series of 11 patients treated for BSEA in our Service during a period of 12 years (1989-2000) have been retrospectively studied. Spinal epidural abscesses (SEA) were diagnosed by MRI, CT or at surgery. Brucellar aetiology of SEA was considered when seroagglutination tests were positive at a titre of 1/160 or higher, and/or Brucella spp. were isolated in the blood or sample cultures. Ten of the 11 cases were treated with rifampicin plus doxycycline and in the remaining patient streptomycin was added because of a poor initial response. Six patients underwent surgical decompression and debridement of the SEA. Outcome was excellent in nine cases and good in two. There was no mortality and only one patient recovered incompletely from preadmission neurological deficits. Although BSEA is considered to be an unusual complication of spondylitis, our findings show that in some cases it can follow direct haematogenous spread to the extradural space. Surgical treatment must be undertaken when major neurological deficits are present. If antibiotic treatment is chosen as the initial therapy, the possibility of sudden neurological deterioration must be taken into account. Contrary to the high morbi-mortality rates reported in pyogenic or tuberculous SEA, BSEA has a good prognosis with early diagnosis and appropriate management.

[Contralateral mesencephalic injury due to tentorial uncal herniation. Magnetic resonance imaging of the Kernohan's notch]. / Lesión mesencefálica contralateral por hernia cerebral. Imagen en resonancia magnética de la hendidura de Kernohan (Kernohan's notch).

We report a case of a traumatic epidural hematoma with ipsilateral hemiparesis, due to the so-called Kernohan's notch. We document the injury with axial and coronal magnetic resonance imaging.

[Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study]. / Estudio camparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio.

The authors conducted a prospective and randomized study in 44 consecutive patients requiring cervical interbody fusion following anterior cervical discectomy to compare the efficacy of heterologous threaded cylindrical bone (Unilab Surgibone) versus titanium implant (Bak-C; Spine-Tech, Minneapolis ). The patients were evaluated between two and five years postoperatively and the objectives of the study were to assess the potential differences in implant shifting, interespace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. Clinical results were satisfactory with both types of implant. However the threaded cylindrical titanium implant was found to be superior to the heterologous threaded cylindrical bone as an interbody substrate after single -and multiple- level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation and radiographic fusion success rates.

Candida albicans spondylodiscitis.

Candida spondylodiscitis is a rare complication of a haematogenous dissemination of a candida infection, that usually affects immunocompromised patients. We present a case of a Candida albicans spondylodiscitis in a patient in whom a bacterial origin was suspected because of the antecedent of a Staphylococcus aureus bacteriaemia. After unfavourable evolution with initial antibiotic treatment, the correct diagnosis was reached after culture of the material obtained from surgical debridement. The clinical, diagnostic features, and the literature are reviewed.

[Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma]. / Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico.

Isolated oculomotor palsy is an unusual symptom in chronic subdural hematomas and it is very rare as initial manifestation. We report a patient with a chronic subdural hematoma that presented with a complete third nerve palsy and normal consciousness. Complete recovery was achieved after surgical evacuation. Rebleeding within the hematoma cavity, most possibly favored by antiaggregating agents, was considered responsible for this rare presentation. In these cases expeditious surgical evacuation is indicated.

Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico / Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma

La parálisis aislada del nervio motor ocular común es un síntoma raro en los hematomas subdurales crónicos (HSDC) y excepcional si lo consideramos como forma de presentación. Comunicamos el caso de un paciente con HSDC que presentó como comienzo una parálisis completa del tercer par craneal, con nivel de conciencia conservado y recuperación completa de su déficit tras la intervención quirúrgica. Consideramos que el resangrado en el interior de la cavidad del hematoma, favorecido por la toma de antiagregantes plaquetarios, pudo provocar esta sintomatología de herniación uncal. En estos casos está indicada la intervención quirúrgica urgente. (AU)

[Carpal tunnel syndrome? Case report]. / ¿Síndrome del tunel carpiano? Case report.

A patient with an initial misdiagnosis of carpal tunnel syndrome is presented. The clinical manifestations were suggestive of such diagnosis, but there were some anamnesis and exploratory aspects requiring to establish a differential diagnosis. Painful syndrome was caused by a brachial plexus compression at the costoclavicular region due to a subclavicular hematoma in a patient under anticoagulant treatment. Carpal tunnel pathology is a frequent cause of neuropathy, however others diagnosis should be ruled out as shown in the present case.

[Spinal extradural lipomatosis. Revision of 108 cases. Case induced by exogenous contribution of ACTH]. / Lipomatosis estradural espinal. Revisión de 108 casos. Caso inducido por aporte exógeno de ACTH.

Authors present a male patient with Spinal Extradural Lipomatosis, previously treated of a cerebral astrocytoma with surgery and radiotherapy, after which he received ACTH for a long period of time. Clinical manifestations were rachialgia, paraparesia with pain and dysestesias in both lower extremities. Diagnosis was carried out by Magnetic Resonance imaging. After a progressive withdrawal of the treatment with ACTH, the patient achieved a complete recovery and neuroimaging studies showed the dissappearance of the compression caused by the lipomatosis. We carry out a revision of the literature showing data we consider of interest derived from the wide series subjected to study.

Cord compression secondary to cervical disc herniation associated with calcification of the ligamentum flavum: case report.

OBJECTIVE AND IMPORTANCE: Calcification of the ligamentum flavum is a rare disease that occurs almost exclusively in elderly Japanese people. We report the case of a young Caucasian woman who presented with a C5-C6 disc herniation associated with a cervical calcified ligamentum flavum. CLINICAL PRESENTATION: The patient presented with a cord compression syndrome of 76 hours' evolution. At exploration, a Brown-Sequard syndrome at the C6 level was found. Magnetic resonance imaging and computed tomography led to a correct diagnosis and planning for decompression. INTERVENTION: We operated on the patient through a combined anterior and posterior approach. After the patient underwent anterior discectomy with intersomatic arthrodesis, we performed posterior decompression. During the operation, we observed that the dura mater could not be separated from the ligamentum, so an en bloc excision of both structures was performed. Microscopic examination indicated that the excised ligamentum had calcification, and total integration of the dura mater into the structure of the ligamentum was demonstrated. To our knowledge, this circumstance has never been described before. A posterior C3-C7 arthrodesis was performed to prevent postoperative kyphosis. Recovery was successful, with total recovery from neurological deficits 4 months later. CONCLUSION: Calcification of the ligamentum flavum is a progressive disease that starts early in life and becomes symptomatic later in life when spinal stenosis occurs. Magnetic resonance imaging and computed tomography provide adequate diagnosis and allow proper surgical planning for decompression. The presence of hyperintense areas within the spinal cord parenchyma, in the absence of a traumatic antecedent, does not preclude a complete recovery.