Cryptococcal nasopharyngeal polypoid mass in a cat

Case summary

An indoor 9-year-old castrated male domestic cat was referred with a 4 month history of increased upper airway noise. Computed tomography revealed a nasopharyngeal polypoid mass, which was removed endoscopically with basket forceps. Histopathology was compatible with a polypoid granulomatous pharyngitis with Cryptococcus-like organisms. This was supported by a positive serum latex cryptococcal antigen agglutination test (LCAT). Minimal inflammation of the nasal tissue was noted on histopathology, with no evidence of fungus. Following endoscopic removal of the mass, the patient was treated with systemic antifungal medication (itraconazole). One year after diagnosis, the LCAT titer was negative and the cat remained free of clinical signs.

Relevance and novel information

This case report emphasizes the importance of considering Cryptococcus species as a potential etiology in cats presented with signs of nasopharyngeal obstruction with an isolated nasopharyngeal polypoid mass, even if kept indoors.

Effects of endothelin on cultured human and rat glomerular mesangial cells

Figure 5 summarizes our results and the data in the literature with regard to both short-term signalling and long-term signalling induced by endothelin. Short-term signalling, which induces vasoconstriction, is undoubtedly mediated by multiple signals including increments of cytosolic calcium, stimulation of protein kinase C and alkalinization of the cytosol. Endothelin also activates negative feedback pathways including arachidonate release with the synthesis of vasorelaxant prostaglandins and potentiation, in a prostaglandin-dependent manner, of beta-adrenergic-stimulated adenylate cyclase. Long-term signalling is less well understood and may depend not only on phospholipase activation with subsequent changes of calcium and protein kinase C but also stimulation of other protein kinases which phosphorylate key intermediates. Endothelin stimulates the transient appearance of protooncogenes that might play a role in the induction of cellular proliferation.

Personal health records for patients with chronic disease: a major opportunity

BACKGROUND

Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease.

OBJECTIVES

To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations.

METHODS

A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations.

RESULTS

Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged.

CONCLUSION

This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.

The neurology of autism: many unanswered questions

Autism is a behaviorally defined developmental disorder of the brain almost always presenting in infancy or the preschool years. Its symptoms persist life-long, although partial compensation is possible through targeted special education that addresses children's deficits in sociability, verbal and non-verbal communication, and atypical range of interests, activities, and cognitive skills. Although a majority of autistic individuals are mentally deficient, IQ is not a defining feature and verbal autistic persons of normal intelligence are increasingly being identified, referred to as Asperger syndrome. Meager neuropathologic data have disclosed subtle prenatal cellular limbic and cerebellar abnormalities. Autism is associated with a variety of defined genetic and acquired conditions, with multifactorial genetic traits, alone or interacting with environmental events, presumably responsible for most unexplained cases. Autistic regression is frequent and poorly understood and may be associated with clinical or subclinical epilepsy. Unravelling the neurobiologic basis of a disorder that may affect 1-2 in 1000 children will require a concerted multidisciplinary attack.

Sarcoidosis, alveolar β-actin and pulmonary fibrosis

BACKGROUND

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Proteins present within the alveolar space early in sarcoidosis disease may provide an insight into novel mechanisms for the development of fibrotic disease and in particular pulmonary fibrosis.

METHODS

A modified two-dimensional difference gel electrophoresis protocol was applied to the human bronchoalveolar lavage fluid (hBALF) of four patients with non-persistent pulmonary interstitial disease at 4-year follow-up (defined as mild disease) and four patients who developed pulmonary interstitial disease at 4-year follow-up (defined as severe disease). The protein β-actin was identified by LC-MS/MS from a preparative gel and found to be significantly elevated in early lavages from the severe disease group. To look at the potential pro-fibrotic effects of this protein, primary human pulmonary fibroblasts (CCD-19Lu) were treated with recombinant β-actin following which qPCR and ELISA assays were used to measure any effects.

RESULTS

We found that β-actin levels were significantly elevated in early hBALF samples in patients who subsequently developed severe disease when compared to the mild group. Treating primary human pulmonary fibroblasts with recombinant β-actin led to enhanced gene expression of the pro-fibrotic markers alpha smooth muscle actin and collagen 1 as well as the increased secretion of interleukin-13 and metalloproteinases 3 and 9.

CONCLUSION

Free β-actin within the lungs of sarcoidosis patients potentially may contribute to disease pathogenesis particularly in the context of abnormal remodelling and the development of pulmonary fibrosis.

Esophageal stenting for treatment of refractory benign esophageal strictures in dogs

BACKGROUND

Benign esophageal strictures can recur despite multiple dilatation procedures and palliative management can be challenging.

OBJECTIVE

To describe the technique and determine the outcome of esophageal stenting for treatment of refractory benign esophageal strictures (RBES) in dogs.

ANIMALS

Nine dogs with RBES.

METHODS

Retrospective review of records for dogs with RBES. Indwelling intraluminal esophageal stents were placed transorally with endoscopy, fluoroscopic guidance, or both. Follow-up information was obtained via medical record or telephone interview.

RESULTS

Nine dogs had 10 stents placed including biodegradable stents (BDS) (6/10), self-expanding metallic stents (SEMS) (3/10), and a self-expanding plastic stent (SEPS) (1/10). All dogs had short-term improved dysphagia. Complications included ptyalism, apparent nausea, gagging, vomiting, or regurgitation (8/9), confirmed recurrence of stricture (6/9), stent migration (3/9), stent shortening (1/9), megaesophagus (1/9), incisional infection (1/9), and tracheal-esophageal fistula (1/9). Eight of 9 dogs required intervention because of the complications of which 4 of 8 dogs were eventually euthanized because of stent-related issues. One dog was lost to follow-up examination.

CONCLUSIONS AND CLINICAL IMPORTANCE

Findings suggest that esophageal stent placement was safe and technically effective, but unpredictably tolerated in dogs with RBES. If a stent is placed, dogs should be monitored carefully for stent migration, dissolution of absorbable stents, and recurrence of strictures.

Feline leptospirosis serosurvey from a Quebec referral hospital

Epidemiologic studies have linked interactions with cats as a risk factor for human leptospirosis, but serosurveys of feline Leptospira spp. infection are scarce in the veterinary literature. The objective of this study was to conduct a serosurvey of Leptospira spp. infection in cats presenting to an eastern Canadian veterinary teaching hospital (VTH). All serum samples collected from cats presented to the VTH were tested by the microscopic agglutination test (MAT) for the Leptospira serovars Canicola, Grippotyphosa, Icterohaemorrhagiae, Bratislava, Pomona, and Autumnalis. Ten of 40 cats [25%; 95% confidence interval (CI): 12.7% to 41.2%] tested had positive antibody titers (≥ 1:100). All 10 cats with positive titers were positive for Bratislava and 2 were also positive for Autumnalis. This high incidence of seropositivity for Leptospira spp. may suggest that the disease could be of more clinical importance than previously recognized.

New alternatives for minimally invasive management of uroliths: ureteroliths

Ureterolithiasis is a serious clinical problem in small animal veterinary medicine, and management can be challenging and frustrating. Various traditional surgical treatment options exist but are associated with significant morbidity and mortality. In humans, minimally invasive treatment options have overtaken traditional surgical removal. This article reviews the current literature on the management of ureteral stone disease, including various types of lithotripsy, and discusses some of the newer minimally invasive options available for small animal veterinary patients. It is important to realize that much of the data in this article is only published in abstract form and is largely one institution's experience with these novel techniques. Articles on minimally invasive management of lower urinary tract uroliths and nephroliths were published in the January 2013 and February 2013 issues, respectively.

Surgical views: Thoracoscopy: common techniques in small animals

Thoracoscopy is gaining popularity in small animal surgery as an alternative to thoracotomy for an increasing variety of cases. This article discusses the details of some of the most frequently performed thoracoscopic procedures in small animal practice: diagnostic biopsy of pleural, mediastinal, pericardial, and lung tissue; thoracoscopic pericardial window creation and subphrenic pericardectomy; lung lobectomy; thoracic duct ligation; and cranial mediastinal mass resection. A companion article that presented the instrumentation, anesthesia challenges, and approaches for thoracoscopic procedures in small animals was published in the January 2013 issue.

New alternatives for minimally invasive management of uroliths: nephroliths

Urolithiasis is a common clinical problem in small animal veterinary patients. Management of upper urinary tract calculi can be particularly challenging in small animals, as traditional surgical removal can be associated with significant morbidity. In humans, minimally invasive treatment options have replaced traditional surgical removal in many cases. This article reviews the current literature on the various types of lithotripsy and some of the newer minimally invasive options available for management of nephrolithiasis in small animal veterinary patients. An article in the January 2013 issue addressed management of lower urinary tract uroliths; a future article will discuss current management strategies for ureteroliths.

Developmental delay of infants and young children with and without fetal alcohol spectrum disorder in the Northern Cape Province, South Africa

OBJECTIVE

To describe the extent and nature of developmental delay at different stages in childhood in a community in South Africa, with a known high rate of Fetal Alcohol Spectrum Disorder (FASD).

METHOD

cohort of infants, clinically examined for FASD at two time periods, 7-12 months (N= 392; 45 FASD) and 17-21 months of age (N = 83, 35 FASD) were assessed using the Griffiths Mental Developmental Scales (GMDS).

RESULTS

Infants and children with FASD perform worse than their Non-FASD counterparts over all scales and total developmental quotients. Mean quotients for both groups decline between assessments across subscales with a particularly marked decline in the hearing and language scale at Time 2 (scores dropping from 110.6 to 83.1 in the Non-FASD group and 106.3 to 72.7 in the FASD group; P = 0.004). By early childhood the developmental gap between the groups widens with low maternal education, maternal depression, high parity and previous loss of sibling/s influencing development during early childhood.

CONCLUSION

The FASD group show more evidence of developmental delay over both time points compared to their Non-FASD counterparts. Demographic and socio-economic factors further impact early childhood. These findings are important in setting up primary level psycho-educational and national prevention programmes especially in periurban communities with a focus on early childhood development and FASD.

New alternatives for minimally invasive management of uroliths: lower urinary tract uroliths

In small animals, removal is indicated for lower urinary tract calculi that are not amenable to medical dissolution and are causing, or may cause, urinary tract obstruction, inflammation, or recurrent infection. Surgical removal of lower urinary tract uroliths by cystotomy or urethrotomy has been the traditional method. The current standard of care for human urinary tract stones involves the use of lithotripsy and is minimally invasive. This article reviews the current literature on the various minimally invasive options available for managing lower urinary tract stones in small animal veterinary patients. Options for managing nephroliths and ureteroliths will be presented in forthcoming companion articles.

Enumeration of Microbial Populations in Radioactive Environments by Epifluorescence Microscopy

Epifluorescence microscopy was utilized to enumerate halophilic bacterial populations in two studies involving inoculated, actual radioactive waste/brine mixtures and pure brine solutions. The studies include an initial set of experiments designed to elucidate potential transformations of actinide-containing wastes under salt-repository conditions, including microbially mediated changes.

The first study included periodic enumeration of bacterial populations of a mixed inoculum initially added to a collection of test containers. The contents of the test containers are the different types of actual radioactive waste that could potentially be stored in nuclear waste repositories in a salt environment. The transuranic waste was generated from materials used in actinide laboratory research. The results show that cell numbers decreased with time. Sorption of the bacteria to solid surfaces in the test system is discussed as a possible mechanism for the decrease in cell numbers.

The second study was designed to determine radiological and/or chemical effects of239Pu,243Am,237Np,232Th and238U on the growth of pure and mixed anaerobic, denitrifying bacterial cultures in brine media. Pu, Am, and Np isotopes at concentrations of ≤1×10–5M, ≤5×10–6M and ≤5×10-4M respectively, and Th and U isotopes at concentrations of ≤4×10-3M were tested in these media. The results indicate that high actinide concentrations affected both the bacterial growth rate and morphology. However, relatively minor effects from Am were observed at all tested concentrations with the pure culture.

Gallbladder sludge on ultrasound is predictive of increased liver enzymes and total bilirubin in cats

The purposes of this retrospective study were to assess the prevalence of gallbladder sludge (GBS) in a population of cats presented for abdominal ultrasound in a teaching hospital and to determine its association with increased serum alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB). Gallbladder sludge was detected in 152 (14%) of the cats undergoing abdominal ultrasound between 2004 and 2008. This population was compared to a control group of 32 cats without GBS. Alanine aminotransferase, ALP, and TB mean values were significantly higher in cats with GBS than in controls (P ≤ 0.0005) and odds for increased values in cats with GBS were 4.2 [95% confidence interval (CI): 1.6 to 11.0], 9.5 (95% CI: 2.2 to 41.7), and 4.1 (95% CI: 1.5 to 11.5), respectively (P ≤ 0.007). In conclusion, GBS is an uncommon ultrasonographic finding in cats that is predictive of increased liver enzymes and TB. More studies are needed to establish potential links between GBS and hepatobiliary disease in cats.