Clinical findings, surgical treatment and outcome in dogs with parotid duct ectasia: 14 cases (2010-2023)

OBJECTIVES

To describe the clinical presentation, diagnostic findings, surgical treatment and outcome of dogs diagnosed with parotid duct ectasia.

MATERIALS AND METHODS

Medical records of dogs diagnosed with parotid duct ectasia between 2010 and 2023 at six small animal referral hospitals were retrospectively reviewed. Outcome was assessed by contacting the owners or referring veterinarians.

RESULTS

Fourteen dogs were included. Lateral facial swelling was the most common clinical presentation. CT revealed a tortuous cavitary tubular fluid-filled structure consistent with a dilated parotid duct in all dogs. Surgical treatment included marsupialisation of the parotid duct papilla, surgical exploration of the duct alone, parotid duct marsupialisation with surgical exploration of the duct, parotidectomy or en-bloc parotid duct resection. The aetiology of parotid duct ectasia was not established in 13 of 14 dogs. In one case, a foreign body was retrieved from the duct. No recurrence of clinical signs was noted during the follow-up period (range 21 to 2900 days).

CLINICAL SIGNIFICANCE

Parotid duct ectasia should be considered for dogs with a lateralised fluctuant non-painful tubular facial swelling. Surgical management was associated with a favourable prognosis without evidence of recurrence in all cases reported in the case series.

Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study

INTRODUCTION

Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small.

MATERIAL

We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation.

RESULTS

In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8-1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation.

CONCLUSION

The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.

[Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study

INTRODUCTION

Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small.

MATERIAL

We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation.

RESULTS

In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8 to 1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation.

CONCLUSION

The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.

Major Fusarium species and mycotoxins associated with freshly harvested maize grain in Uruguay

Fusarium species are common fungal pathogens of maize. Fusarium graminearum and Fusarium verticillioides, among others, can cause maize ear rot, and they are also mycotoxin producers. The aims of this work were to determine the frequency and diversity of Fusarium species in Uruguayan maize kernels, evaluate the toxigenic potential of the isolates, determine toxin contamination levels on freshly harvested grain, and assess the sensitivity of main Fusarium species against fungicides. Fusarium verticillioides was the most frequent species isolated, followed by Fusarium graminearum sensu stricto. Of F. verticillioides isolates studied for fumonisin production, 72% produced fumonisin B1 and 32% fumonisin B2. Considering in vitro toxin production by F. graminearum sensu stricto isolates, deoxynivalenol was the main toxin produced, followed by zearalenone and nivalenol. Fumonisins were the most frequently found toxins on freshly harvested maize samples (98% in 2018 and 86% in 2019), and also, fumonisin B1 was the toxin with highest concentration in both years studied (4860 µg/kg in 2018 and 1453 µg/kg in 2019). Deoxynivalenol and zearalenone were also found as contaminants. Metconazole and epoxiconazole were the most effective fungicides tested on F. verticillioides isolates. Fusarium graminearum sensu stricto isolates also were more sensitive to metconazole compared to other fungicides; nevertheless, epoxiconazole was less efficient in controlling this species. This is the first study that reports Fusarium species and mycotoxin contamination levels associated with maize grain in Uruguay. Its detection is the main step to develop management strategies in order to minimize fungal infection in maize crops.

Home-delivered meals for people with dementia: Which model delays nursing home placement? - Protocol for a feasibility pilot

BACKGROUND

Home-delivered meals promote food security, socialization, and independence among homebound older adults. However, it is unclear which of the two predominant modes of meal delivery, daily-delivered vs. drop-shipped, frozen meals, promotes community living for homebound older adults with dementia. Our objective is to present the protocol for a pilot multisite, two-arm, pragmatic feasibility trial comparing the effect of two modes of meal delivery on nursing home placement among people with dementia. We include justifications for individual randomization with different consent processes and waivers for specific elements of the trial.

METHODS

236 individuals with dementia on waiting lists at three Meals on Wheels programs' in Florida and Texas will be randomized to receive either: 1) meals delivered multiple times per week by a Meals on Wheels volunteer or paid driver who may socialize with and provide an informal wellness check or 2) frozen meals that are mailed to participants' homes every two weeks. We will evaluate and refine processes for recruitment and randomization; assess adherence to the intervention; identify common themes in participant experience; and test processes for linking participant data with Medicare records and nursing home assessment data. We will conduct exploratory analyses examining time to nursing home placement, the primary outcome for the larger trial.

CONCLUSION

This pilot will inform the follow-on large-scale, definitive pragmatic trial. In addition, the justifications for individual randomization with differing consent procedures for elements of a pragmatic trial provide a model for future trialists looking to develop ethical and feasible pragmatic studies enrolling people with dementia.

'Aorta code' implementation and preliminary results of a multidisciplinary protocol for patients with acute aortic syndrome

Background

Expediting life-saving care for patients with acute aortic syndrome (AAS) through multi-disciplinary code protocols is a potential method to improve outcomes. Other code protocols for cardiovascular emergencies, such as ST-elevation myocardial infarction and stroke have shown excellent results.

Aim

To examine the implementation and preliminary results of a code protocol “Aorta Code” for patients with AAS in a healthcare framework of a 4-hospital network in our city by reviewing the number of patients detected, patient's transference time, aortic surgery and patient's outcome during a trial period of 10 months (April 2019-January 2020). A comparison with a previous 2-year period with standard of care management of AAS was performed.

Methods

“Aorta Code” uses a specific diagnostic algorithm to improve detection of patients with AAS at the emergency room, facilitates their quick transfer to the referral hospital by activating a paging system, and places acute cardiovascular care unit, operating room and surgeons specialized in aortic pathology on standby.

Results

Compared to a previous 2-year period (2017–2018) (group I), the current implementation of “Aorta Code” in a period of 10 months (group II) in our 4-hospital network involving the healthcare of 1.100000 inhabitants resulted in the detection of more patients with AAS (group-I: n=18 patients (0.8 patients/month), group-II: n=19 patients (1.9 patients/month); p=0.013). AAS detection in secondary hospitals importantly increased (33.3% vs 63.8%, p=0.07). The “Aorta Code” achieved a significant decrease in patient's transference time to referral hospital (group-I: median 259 min (IQR 150–1911), group-II: median 129 min (IQR 95.5–167.25); p=0.035). There was a marked reduction in the number of surgeons involved in the “Aorta Code” (group-I= 7 cardiac, 6 vascular, group-II= 2 cardiac, 2 vascular). Thirty-day mortality was lower in group-II in the whole AAS cohort (group-I= 22.2%, group-II= 12.5%; p=0.660) and in type A AAS (28.6% vs 18.2%, p=0.661). Misdiagnosis rate (false-calls): 11 patients (7 of them with non-acute aortic disease).

Conclusion

“Aorta Code” facilitates detecting patients with AAS at the emergency room, speeds them to the referral hospital center, allows patients to be treated by surgeons specialized in aortic surgery and improves patient's outcome. Further prospective studies examining the utility of “Aorta Code” are warranted.

Funding Acknowledgement

Type of funding source: None

Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

BACKGROUND

Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) causes swelling in the skin and upper airways and pain in the abdomen because of mucosal swelling. C1-INH-HAE is frequently misdiagnosed, leading to delays in diagnosis, inadequate treatment, and unnecessary procedures.

OBJECTIVE

To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS).

METHODS

The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before being diagnosed as having C1-INH-HAE.

RESULTS

In January 2016, a total of 418 of 633 IOS patients with C1-INH-HAE type I or II had provided misdiagnosis data. Of these, 185 of 418 (44.3%) received 1 or more prior misdiagnoses. The most common misdiagnoses were allergic angioedema (103 of 185) and appendicitis (50 of 185). A variety of other misdiagnoses were reported, including a substantial number of gastrointestinal disorders (excluding appendicitis). Misdiagnosis rates were similar between males (41.1%) and females (46.5%) and between C1-INH-HAE type I (43.7%) and type II (51.6%). Patients with family members diagnosed as having C1-INH-HAE were significantly less likely to be misdiagnosed than patients without a family history (140 of 366 [41.7%] vs 38 of 58 [65.5%], respectively; P = .001). Patients with a prior misdiagnosis had longer median delay to C1-INH-HAE diagnosis (13.3 years) than patients without (1.7 years; P < .001).

CONCLUSION

From this large database, approximately 50% of patients with C1-INH-HAE type I or II have previously had their conditions misdiagnosed, most commonly as allergic angioedema or appendicitis. Misdiagnosis results in marked delays in receiving the correct diagnosis, during which time patients cannot access effective, lifesaving treatment.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01034969.

ESTES guidelines: acute mesenteric ischaemia

PURPOSE

Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria.

METHODS

A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group.

RESULTS

The resultant recommendations are presented in this paper.

CONCLUSIONS

The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

Processing of marine foods

For the Norwegian fish industry, it is an objective to increase the production of value added products in order to improve profitability. This paper will briefly present four areas of important research tasks in this field. To aid in the identification of the species present in a product, we have applied the method called Random Amplification of Polymorphic DNA (RAPD). This technique is used to produce a fingerprint of DNA contained in the sample. The application of DNA typing for species identification in fish products is presented. The nutritional aspects of foods are important. Although the low death rate from coronary heart disease among the Eskimos of Greenland has been suggested to stem in large part from their consumption of fish, one should keep in mind that the daily diet of Eskimos living in the traditional way consists of substantial quantities of meat and fat (blubber) from seals and whales. A recent study as to whether seal and whale oils are more effective than cod liver oil in changing biological parameters that might be important in explaining low incidence of coronary heart disease, asthma and psoriasis among Greenland Eskimos will be presented. Commercial processing of fish must take the development of rigor mortis into consideration since it affects yield and fish flesh quality. Influence of early processing (pre-rigor) on fish quality and yield is also discussed. There are significant differences among fish species in gross chemical composition and morphological structure. Depending on the properties of the flesh and the way it is treated, it may gain or lose water. The relationship between structure and liquid-holding properties of cod and salmon muscle as a function of temperature is presented.

Polidocanol foam stability in terms of its association with glycerin

Objectives:

Foam sclerotherapy effectiveness mainly depends on the concentration of the sclerosing agent and foam stability. The objective of this study was to determine if the addition of glycerol at different concentrations contributes to the stability of polidocanol foam.

Materials and methods:

Control Group: 3% polidocanol. Group 1: polidocanol 3% + glycerin 1.66%. Group 2: polidocanol 3% + glycerin 3.3%. Group 3: polidocanol 3% + Glycerin 5%. Tessari standard method. Five recordings were made for each mixture. Early visual liquefaction time and half liquid time decay were recorded in seconds. Microscopic measurement of the foams. Mixtures surface tension measurement (N/m).

Results:

Early visual liquefaction: Control Group: 27 (± 3.11); Group 1: 67.8 (± 6.49); Group 2:48.6 (± 8.2); and Group 3: 35.8 (± 4.49). Half-liquid time: Control: 129.2 (± 11.00); Group 1: 260.4 (±18.99); Group 2: 224.6 (±13.03); and Group 3: 189.2 (±8.52). Bubbles/mm2–diameter–wall thickness: Control: 68–98 μm-7 μm; Group 1: 189–60 μm-9 μm; Group 2: 76–92 μm-12 μm; and Group 3: 49–112 μm-20 μm. Surface tension: Control = 5.54 N/m; Group 1 = 5.45 N/m; Group 2 = 5.35 N/m; and Group 3 = 5.21 N/m.

Conclusions:

Small amounts of glycerin highly increase the stability and quality of polidocanol foam. This simple chemical method is easily reproducible and applicable.

Morphological preservation of carbonaceous plant fossils in blueschist metamorphic rocks from New Zealand

Morphological and chemical evidence of ancient life is widespread in sedimentary rocks retrieved from shallow depths in the Earth's crust. Metamorphism is highly detrimental to the preservation of biological information in rocks, thus limiting the geological record in which traces of life might be found. Deformation and increasing pressure/temperature during deep burial may alter the morphology as well as the composition and structure of both the organic and mineral constituents of fossils. However, microspore fossils have been previously observed in intensely metamorphosed rocks. It has been suggested that their small size, and/or the nature of the polymer composing their wall, and/or the mineralogy of their surrounding matrix were key parameters explaining their exceptional preservation. Here, we describe the remarkable morphological preservation of plant macrofossils in blueschist metamorphic rocks from New Zealand containing lawsonite. Leaves and stems can be easily identified at the macroscale. At the microscale, polygonal structures with walls mineralized by micas within the leaf midribs and blades may derive from the original cellular ultrastructure or, alternatively, from the shrinkage during burial of the gelified remnants of the leaves in an abiotic process. Processes and important parameters involved in the remarkable preservation of these fossils during metamorphism are discussed. Despite the excellent morphological preservation, the initial biological polymers have been completely transformed to graphitic carbonaceous matter down to the nanometer scale. This occurrence demonstrates that plant macrofossils may experience major geodynamic processes such as metamorphism and exhumation involving deep changes and homogenization of their carbon chemistry and structure but still retain their morphology with remarkable integrity even if they are not shielded by any hard-mineralized concretion.

[Risk factors for recurrent venous thromboembolism]

Recurrent venous thromboembolism (VTE) is frequent and can be fatal. Long-term antithrombotic treatment reduces the risk of recurrent VTE but increases the risk of bleeding and, therefore, cannot be proposed for all patients. Predicting the probability of recurrence in an individual patient is of utmost importance for assessing the risk-benefit ratio of long-term anticoagulation. Multiple clinical risk factors for recurrent VTE have been identified which include: unprovoked first episode, anatomical proximal location, male gender, residual venous thrombosis, cancer and antiphospholipid syndrome. d-dimer level after discontinuation of oral anticoagulation can help to predict the risk of recurrence with a good negative predictive value. Finally, genetic polymorphisms and rare inherited deficiencies of natural anticoagulant proteins do not seem to be strongly associated to recurrence. New antithrombotic drugs may, in the near future, improve the safety and of long-term anticoagulation treatment.

Interoperable and standard e-Health solution over Bluetooth

The new paradigm of e-Health demands open sensors and middleware components that permit transparent integration and end-to-end interoperability of new personal health devices. The use of standards seems to be the internationally adopted way to solve these problems. This paper presents the implementation of an end-to-end standards-based e-Health solution. This includes ISO/IEEE11073 standard for the interoperability of the medical devices in the patient environment and EN13606 standard for the interoperable exchange of the Electronic Healthcare Record. The design strictly fulfills all the technical features of the most recent versions of both standards. The implemented prototype has been tested in a laboratory environment to demonstrate its feasibility for its further transfer to the healthcare system.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

How To Deal with Additional Findings Seen in Pre-Therapeutic Breast MRI and Their Impact on Therapeutic Approach. A Prospective Longitudinal Single-Institutional Study in 465 Patients

Background: Accurate assessment of the extent of breast cancer with breast MRI (BMRI) yields additional findings (AF) that must be characterized in order to guide treatment. The aim of our study was to analyze the work-up of AF seen in pre-therapeutic BMRI and their impact on therapeutic approach and re-excision rates.Methods: From 07/2002 to 04/2007 we studied prospectively 465 consecutive patients with a diagnosis of breast cancer that underwent a pre-treatment BMRI to evaluate disease extent. BMRI studies were performed with a 1,0 and a 1,5 T magnet and coronal T2-weighted fast spin-echo and contrast-enchanced T1-weighted 3D gradient-echo sequences were evaluated. Post-processing included parametric, multiplanar reconstructions and maximum intensity projections. Fischer's scale was used to characterize additional lesions (AL). AL &gt;5 mm were classified as: increase in tumor size, multifocal, multicentric and contralateral disease. AF that would potentially change therapeutic approach were re-evaluated with 2nd-look ultrasound (US), biopsied if found and/or marked with clips or with a radioisotope (ROLL). BI-RADS 3 lesions were followed up with BMRI. Gold standards were pathology reports and follow-up &gt;2 years for benign lesions. Therapeutic change based on MRI findings was deemed correct in malignant AF and incorrect if pathology was benign. Re-excision rates and disease-free intervals were calculated.Results. A total of 280 AF were found in 222 (47,7%) patients. US studies were performed in 111 patients, in 99 of which the AL (89,1%) was found. 63 patients underwent biopsies and 48 of them (76,1%) were malignant. ROLL procedures were performed in 32 patients and malignancy rate was 65,6%. Follow-up BMRI studies for BI-RADS 3 lesions were performed in 42 patients (9%). BMRI found index lesions seen by mammography or US in 98,9% of the patients and did not find additional multifocal or multicentric disease in 10 patients, yielding a total negative predictive value of 96,7% for BMRI (6 invasive and 9 intraductal cancers). Therapeutic approach was changed in 107 patients (23%) and considered correct in 92 (86%) representing 19,7% of all patients and incorrect in 15 (14%) corresponding to 3,2% of the total. Re-excision due to positive margins during the first 6 months was performed in 39/323 patients treated with conservative surgery (re-excision rate of 12%). Mean follow-up was 48,4 months (m) (6,7-81,4 m) and mean disease-free interval was 45 m (6,7-81,4 m).Conclusion: Work-up of AF diagnosed in BMRI allows accurate treatment adjusted to disease extent in 96,8% of the patients. Additional work-up using US and close correlation with the rest of conventional modalities is the mandatory behaviour to ensure an integrated evaluation of AF. This policy allows a correct treatment in 86% of the patients with potential therapeutic change. Overtreatment was induced in 14% of these patients. Regarding the overall series of 465 patients submitted to BMRI, the 15 patients who were overtreated represent 3,2% of the total. The precision level of preoperative MRI in this scenario is clearly superior to conventional modalities when combined in an integrated multimodality approach.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4023.

Rectal diversion without colostomy in Fournier's gangrene

Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy.

Human papillomavirus type 16 reduces the expression of microRNA-218 in cervical carcinoma cells

Human papillomaviruses (HPVs) are involved in the pathogenesis of cancer of the cervix (CaCx). MicroRNA (miRNA) expression analysis using Ambion (Austin, TX, USA) arrays showed that three miRNAs were overexpressed and 24 underexpressed in cervical cell lines containing integrated HPV-16 DNA compared to the normal cervix. Furthermore, nine miRNAs were overexpressed and one underexpressed in integrated HPV-16 cell lines compared to the HPV-negative CaCx cell line C-33A. Based on microarray and/or quantitative real-time PCR and northern blot analyses, microRNA-218 (miR-218) was specifically underexpressed in HPV-positive cell lines, cervical lesions and cancer tissues containing HPV-16 DNA compared to both C-33A and the normal cervix. Expression of the E6 oncogene of high-risk HPV-16, but not that of low-risk HPV-6, reduced miR-218 expression, and conversely, RNA interference of E6/E7 oncogenes in an HPV-16-positive cell line increased miR-218 expression. We also demonstrate that the epithelial cell-specific marker LAMB3 is a target of miR-218. We also show that LAMB3 expression is increased in the presence of the HPV-16 E6 oncogene and this effect is mediated through miR-218. These findings may contribute to a better understanding of the molecular mechanisms involved in cervical carcinogenesis.