Ovarian ectopic pregnancy: aetiology, diagnosis, and challenges in surgical management

Primary ovarian ectopic pregnancy (OEP) remains a rare but important type of ectopic pregnancy which is normally diagnosed at surgery. The aetiology is unknown. We have found fertility treatments (18.1%) and intrauterine contraceptive devices (19.3%) remain important associated risk factors. We undertook a world literature review of all cases since 1995. We found that 52% of cases were managed laparoscopically, which is less than the reported UK rate of all ectopics, of 85.9%. Over that time period, eight patients were treated medically with a success rate of 50%. While the original 1878 Spiegelberg's criterion still holds for the diagnosis, the addition of modern ultrasound scanning has made a radiological diagnosis possible. In a few cases, the management of OEP remains similar to that of a tubal ectopic pregnancy with the same challenges. Laparoscopy with ovarian sparing in the stable woman is today the surgical treatment of choice.

The neurocognitive connection between physical activity and eating behaviour

As obesity rates increase worldwide, healthcare providers require methods to instill the lifestyle behaviours necessary for sustainable weight loss. Designing effective weight-loss interventions requires an understanding of how these behaviours are elicited, how they relate to each other and whether they are supported by common neurocognitive mechanisms. This may provide valuable insights to optimize existing interventions and develop novel approaches to weight control. Researchers have begun to investigate the neurocognitive underpinnings of eating behaviour and the impact of physical activity on cognition and the brain. This review attempts to bring these somewhat disparate, yet interrelated lines of literature together in order to examine a hypothesis that eating behaviour and physical activity share a common neurocognitive link. The link pertains to executive functions, which rely on brain circuits located in the prefrontal cortex. These advanced cognitive processes are of limited capacity and undergo relentless strain in the current obesogenic environment. The increased demand on these neurocognitive resources as well as their overuse and/or impairment may facilitate impulses to over-eat, contributing to weight gain and obesity. This impulsive eating drive may be counteracted by physical activity due to its enhancement of neurocognitive resources for executive functions and goal-oriented behaviour. By enhancing the resources that facilitate 'top-down' inhibitory control, increased physical activity may help compensate and suppress the hedonic drive to over-eat. Understanding how physical activity and eating behaviours interact on a neurocognitive level may help to maintain a healthy lifestyle in an obesogenic environment.

Autologous blood collection and transfusion in cats undergoing partial craniectomy

OBJECTIVE

To describe the procedure for autologous blood donation and associated complications in cats undergoing partial craniectomy for mass removal.

DESIGN

Prospective case series.

ANIMALS

15 cats with intracranial mass confirmed by computed tomographic scan, no evidence of renal failure, and PCV > or = 22%.

PROCEDURE

One unit (60 ml) of blood was collected and stored 7 to 17 days before surgery and transfused during the perioperative period if needed. The PCV was measured before donation, before surgery, during surgery, and after surgery to assess effect of donation on PCV before surgery and effect of transfusion on PCV after surgery. Cats were evaluated for donation complications, iatrogenic anemia, and adverse reactions associated with administration of autologous blood.

RESULTS

Complications associated with phlebotomy were not detected. Fifteen cats underwent partial craniectomy 7 to 17 days after blood donation; all had histologic confirmation of meningioma by examination of tissue obtained at surgery. Eleven cats received autologous blood transfusions. None of the cats received allogeneic blood transfusions. Transfusion reactions were not observed. Subclinical iatrogenic anemia was detected in 3 cats. Two cats were considered to have received excessive transfusion, and 3 cats received inadequate transfusion. All cats undergoing partial craniectomy were discharged from the hospital and were alive > 6 months after surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Autologous blood donation before surgery was considered safe for cats undergoing partial craniectomy for resection of meningioma. The only complication observed was iatrogenic anemia. The procedure contributed to blood conservation in our hospital.

Epidemiology of HIV and AIDS. A retrospective look

This retrospective look at literature and information regarding the epidemiology of HIV and its progression to AIDS is based on many worldwide sources to determine with some certainty the true severity of the epidemic. The purpose of this article is to permit the reader to become more informed concerning the epidemic, based on a global outlook.

Results of craniotomy for the treatment of cerebral meningioma in 42 cats

Forty-two cats underwent craniotomy for removal of a meningioma between 1985 and 1991. Median duration of clinical signs before examination was 1.25 months. All cats had inappropriate demeanor: 48% were dull and 38% were lethargic. Neurological deficits included impaired vision in 93%, paresis in 83%, and seizures in 19%. Computed tomography (CT) showed solitary masses in 86% and multiple masses in 14%. Intraoperative complications included hemorrhage and difficulty excising deep or adherent masses. Anemia in 13 of 42 cats was the most common immediate postoperative complication. Ten of 42 cats had no improvement or a more severe neurological status after surgery. Eight of 42 cats died immediately after surgery; 6 of these were anemic. Of the cats that survived the immediate postoperative period, evaluation 10 to 14 days after surgery showed that 97% (33 of 34) were alert and 79% (27 of 34) had returned to normal behavior. Neurological deficits, except for vision impairment, had resolved in most cats. The duration of follow-up varied from 1.3 months to 55.1 months. Ten cats developed neurological abnormalities from 1 month to 44.2 months after surgery; of these, 6 had tumor recurrence or new growth confirmed by CT scan or necropsy. Overall survival was 71% at 6 months, 66% at 1 year, and 50% at 2 years. Age of cat and location of tumor did not significantly affect survival (P = .1034 and .1851, respectively). There were too few precise measurements of tumor size to make a valid statistical comparison of the effect of size on survival. Location or presence of multiple tumors did not affect final outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Postnatal cerebellar cortical degeneration in Labrador Retriever puppies

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Idiopathic hypoparathyroidism in five cats

Idiopathic hypoparathyroidism was diagnosed in five young to middle-aged cats of mixed breeding. Three of the cats were male and two were female. Historic signs included lethargy (n = 5), anorexia (n = 5), muscle tremors (n = 4), weakness (n = 4), generalized seizures (n = 3), ataxia (n = 3), mental dullness or disorientation (n = 3), panting (n = 2), pruritus (n = 1), ptyalism (n = 1) and dysphagia (n = 1). Weakness (n = 4), dehydration (n = 2), cataracts (n = 2), hypothermia (n = 1), and bradycardia (n = 1) were found on physical examination. Results of electrocardiography revealed a prolonged Q-T interval in two cats. Results of initial laboratory tests revealed profound hypocalcemia and severe hyperphosphatemia with normal renal function. The diagnosis of hypoparathyroidism was made on the basis of the history, clinical signs, and results serum biochemical testing (i.e., severe hypocalcemia and hyperphosphatemia); in two cats, the diagnosis was also confirmed by histologic examination of parathyroid glands. Initial treatment included intravenous administration of 10% calcium gluconate and oral administration of large loading doses of calcium and vitamin D (dihydrotachysterol). Successful long-term management with dihydrotachysterol and calcium was achieved in all cats. The final dosage of dihydrotachysterol required to maintain normocalcemia in the five cats ranged from 0.004 to 0.04 mg/kg/day (mean = 0.015 mg/kg/day). Long-term calcium supplementation was given to three of the cats in dosages ranging from 29 to 53 mg/kg/day (mean = 42 mg/kg/day) of elemental calcium. One cat died after 28 months of therapy from widely metastatic hemangiosarcoma; the other three cats are still alive and well after 5 to 37 months of treatment.

The differential diagnosis of disc disease

The differentiation of disc disease from other diseases that result in signs related to varying degrees of proprioceptive ataxia, paresis to paralysis, digital hypesthesia to anesthesia, and spinal hyperpathia is a common problem facing the veterinarian. Classification of the differential diagnoses of disc disease based on neuroanatomic localization facilitates diagnosis because each category shares historical, clinical, and neurologic examination features. These features, as well as the distinguishing ones used in the differential diagnosis of disc disease, will be reviewed.

Myasthenia gravis in the cat

Myasthenia gravis (MG) was diagnosed in four cats--one had an apparently congenital form and three had the acquired autoimmune form. All four cats were examined because of episodes of weakness including gait abnormalities, voice change, neck ventroflexion, and regurgitation. Palpebral reflexes were absent in all cats. Administration of edrophonium chloride resulted in transient resolution of clinical signs in all four cats. Three cats were tested for the presence of serum autoantibodies against acetylcholine receptor (AChR) by radioimmunoassay. Two cats with acquired MG had anti-AChR antibody titers of 10.5 and 96.8 nmol/l (normal, less than or equal to 0.03 nmol/l). Antibodies were not detected in the cat with presumptive congenital MG. All four cats were treated with pyridostigmine bromide. Two cats with acquired MG were euthanatized because of clinical deterioration. The third cat with acquired MG has been asymptomatic since 2 months after diagnosis. The cat with presumed congenital MG is alive 3 years after diagnosis.

Evaluation of two reagent strips and three reflectance meters for rapid determination of blood glucose concentrations

We evaluated three reflectance meters (Accu-Chek II, Glucometer II, and Glucoscan 2000) and two reagent strips (Chemstrip bG and Glucostix) for accuracy and precision in determining blood glucose concentrations in the dog. To evaluate accuracy, we compared results of blood glucose determinations performed on 95 samples using the various strips and meters vs. the glucose concentrations obtained using the glucose-oxidase method on a Beckman Glucose Analyzer. Accuracy was evaluated statistically using least squares regression analysis. To evaluate precision, samples in various ranges of blood glucose concentration were tested repeatedly (20 times within a 1-hour period) on the same reflectance meter. Coefficient of variation (CV) was determined to evaluate reproducibility of results. Overall, there were significant correlations (P less than 0.001) between the laboratory glucose values and the blood glucose concentrations obtained with Chemstrip bG (r = 0.976), Glucostix (r = 0.904), Accu-Chek II (r = 0.986), Glucometer II (r = 0.911) and Glucoscan 2000 (r = 0.944). In the precision study, all three meters had excellent CVs in the normal range (3.6% to 4.9%). However, Accu-Chek II was found to be more precise in the hypoglycemic and hyperglycemic ranges (3.6% and 2.6%, respectively) than either Glucometer II (8.8% and 5.4%) or Glucoscan 2000 (7.8% and 8.2%). The results of this study indicate that all of the meters and reagent strips tested are highly accurate in determining blood glucose concentrations in the dog. However, both in terms of accuracy and reproducibility of results, Accu-Chek II and Chemstrip bG, gave the highest correlation coefficients and, as such, are probably of the greatest clinical value.