3rd Rib Research Articles

Thermal Ablation and Intralesional Cisplatin Injection as Adjunct to Systemic Chemotherapy in Managing Malignant Central Airway Obstruction: A Case Report

Endobronchialultrasound (EBUS)-guidedintralesional chemotherapy and thermal ablation using cryotherapy and electrocautery can be used for the management of malignant central airway obstruction (CAO). This is a case of a 62-year-old male presenting with cough, hoarseness, and shortness of breath. He was diagnosed with squamous cell carcinoma stage IVA (T4N2M1a), causing malignant CAO that progressed to impending respiratory failure (ECOG PS 4). Chest CT scan findings included a left main bronchus mass measuring 3.7 x 5.8 x 5.9 cm causing complete atelectasis, a right pleural-based mass, and osteolytic destruction of the 3rd lateral ribs. Bronchoscopy showed a fungating, friable mass in the carina extending to the orifice of the right and left mainstem bronchus with 70% and 100% occlusion, respectively. A multimodality treatment approach was taken with tumor debulking by thermal ablation with cryotherapy and electrocautery, EBUS-guided intralesional cisplatin, and systemic chemotherapy. Subsequently, there was an interval decrease in the size of the tumor in multiple areas, with left lung re-expansion. The clinical symptoms of the patient significantly improved and ECOG status increased to 1. No adverse effects were noted post procedure. Intralesional cisplatin can be an effective and safe adjunct treatment in malignant CAO, alongside thermal ablation and systemic chemotherapy.

Evaluation of echocardiography and computed tomography characteristics related to aortic valve replacement technique through the right anterior thoracotomy at the 2nd intercostal space

Objective: evaluate echocardiographic and computed tomography characteristics related to minimally invasive aortic valve replacement technique through the right anterior thoracotomy at the 2nd intercostal space. Methods: study on 74 patients undergoing aortic valve replacement surgery through the right anterior thoracotomy at the 2nd intercostal space at Hanoi Heart Hospital and 108 Military Central Hospital, from October 2019 to December 2022. Patients underwent preoperative echocardiography and multiple slices computed tomography to assess the lessons of aortic valve, valve annulus diameter, and intercostal space width. Results: The ratio of aortic valve stenosis is 55.4%, stenosis combined with regurgitation is 31.1%, and aortic regurgitation is 13.5%. The average valve annulus diameter on computed tomography scans is 26.5 ± 3.1 mm (smallest 20; largest 36); average 2nd intercostal space width 18.1 ± 3.1 mm (smallest 11; largest 25). Valve annulus diameter measured by computed tomography correlates closely with actual prosthetic valve size (r = 0.54, p < 0.001); measured by echocardiography had a weak correlation and not statistically significant. The prosthetic valve size to be replaced is smaller than the valve annulus diameter measured on computed tomography, with an average of 4.8 ± 2.7 mm in aortic valve stenosis, 5.7 ± 2.0 mm in combined stenosis and regurgitation, and 7.2 ± 2.9 mm in aortic regurgitation, in which the difference between valve stenosis and regurgitation is statistically significant (p = 0.01). Conclusions: Minimally invasive aortic valve replacement technique through the 2nd intercostal space right thoracotomy, with cutting the 3rd rib, is suitable for Vietnamese anatomy. Valve annulus diameter measured by computed tomography has a good linear correlation and can be a predictor for prosthetic valve size before surgery.

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report.

Refractory pyothorax caused by methicillin-resistant Staphylococcus aureus (MRSA) is a challenging clinical condition; complications such as bronchopleural fistulae can further hinder its treatment. To avoid a fatal state caused by aspirating pneumonia, open window thoracotomy is not only sometimes performed, but subsequent closure of the window can also be difficult. In this report, we describe the case of a patient with MRSA pyothorax with bronchopleural fistula in whom a successful closure of window thoracostomy was achieved by utilizing Endobronchial Watanabe Spigot (EWS; Novatech, La Ciotat, France) bronchial occlusion and a modified extraperiosteal air plombage technique. A 66-year-old man underwent an open window thoracotomy for pyothorax with bronchopleural fistula with MRSA infection at the age of 59. After 7 years, he was referred to our department for the closure of the window. Initially, we occluded the right B6a + b by EWS under bronchoscopy. Subsequently, we dissected the intercostal muscles between the 3rd, 4th, 5th, and 6th ribs to collapse the pyothorax cavity and ensure the coverage of the fistula of lung including the hypertrophied parietal pleura and soft tissues of the chest wall. We filled the extrapleosteal space with a pedicled anterior serratus muscle flap to compress the parietal pleura. Postoperatively, lung expansion was satisfactory, and there has been no recurrence for 6 years since the window closure surgery. We were able to achieve closure and healing in a patient who underwent open window thoracostomy for MRSA bronchopleural fistula by applying EWS and modified extraperiosteal air plombage technique.

Determination of normal radiographic indices of heart size in pigeon

Respiratory and cardiovascular diseases are the most common health problems in pigeons which usually change cardiac size. The purpose of this study was to establish a normal radiographic reference value for cardiac size in pigeon. After clinical and radiographic (lateral and ventrodorsal views) evaluations of 27 adult pigeons, the indices below were measured; the cardiac and thoracic widths, the space between 3rd and 4th ribs on the left and right sides, the synsacrum width, the coracoids width on both sides and the distance between both femoral heads and clavicles distance. The ratio between cardiac width and the mentioned indices had been calculated. The correlation of anatomical indices with cardiac width was evaluated by linear regression test. The results indicated that there was a significant positive correlation of cardiac width with thoracic width, with the distance between femoral head, with synsacrum width and with the distance between clavicles. In regression models which showed a significant association between thoracic and synsacrum width with cardiac width, sex and weight factors were not correlated with cardiac width and therefore were removed from the models. However, in regression models where there was a significant correlation between the distance of both femoral heads and the distance between clavicles with cardiac width, sex factor was correlated with dependent variable and was not omitted from regression models. The results and values thus obtained from this study can be used as a normal cardiac size of pigeon in radiology for diagnosis of the cardiomegaly in this bird.

Chemotherapy with inclusion of doxorubicin, ifosfamide for common malignant glomus tumor of soft tissues of forearm (clinical case and literature review)

Malignant glomus tumor is an extremely rare, aggressive neoplasm, which is contain from modified glomus body’s cells. The correct morphological diagnosis is difficult, and requires careful differential diagnosis between neuroendocrine tumors, pericytic tumors, smooth muscle neoplasms. The literature describes only sporadic clinical observations, a series of cases and the results of a small number of retrospective studies. Due to the rarity of nosology, the optimal treatment strategy for this disease has not been developed. Most cases, surgical treatment is used in a locally common process. Cases of metastasis of a malignant glomus tumor are extremely rare. There is no consensus on the tactics of systemic treatment to date. In this article, we present a clinical case of achieving stabilization of the tumor process after 5 courses of chemotherapy with doxorubicin, ifosfamide in a 49-year-old patient with a malignant glomus tumor of the soft tissues of the left forearm with metastatic lesion of the tissues of the anterior chest wall on the left with spread to the left small pectoral muscle, 3rd rib and pleural cavity, with metastatic lesion lung parenchyma.

225 The Effect of Different Analytical Methods on Assessment of Bone Mineralization of Various Rib Bones in Response to Dietary P, Phytase, and Vitamin D in Nursery Pigs

Abstract Pigs (n = 350; initial body weight = 11.9 ± 0.56 kg) were used to evaluate the effects of different bones and analytical methods on the assessment of rib bone mineralization response to dietary P and vitamin D in nursery pigs. Currently, there is little information available describing the effect of rib location (2nd through 10th) on measures of bone mineralization including density and ash. Pens of pigs (5 pigs/pen) were randomized to 6 dietary treatments in a randomized complete block design with 10 pens/treatment. Pens of pigs were assigned dietary treatments consisting of: 1) P at 0.19% STTD P (deficient); 2) P at 0.33% STTD P (NRC requirement) using monocalcium phosphate; 3) P at 0.33% STTD P using monocalcium phosphate and phytase; 4) P at 0.44% STTD P (industry level) using monocalcium phosphate, phytase, no vitamin D; 5) diet 4 with vitamin D (1,653 IU/kg), and 6) diet 5 with additional 2,000 IU/kg 25(OH)D3 (HyD). After feeding diets for 28-days, eight pigs/treatment were harvested for bone analysis. The 2nd, 3rd, 5th, 7th, and 10th ribs were collected from each pig and analyzed for bone density and non-defatted bone ash. All bones were cleaned of tissue and then dried at 105°C for 7 d and then ashed in a muffle furnace at 600°C for 24 h. Bone density was measured on each bone based on Archimedes principle. There was no interaction between bone and dietary treatment for bone density and non-defatted bone ash (P > 0.05; Table). Therefore, interpretation of results will focus on the effect of bone and treatment on measures of mineralization. Pigs fed deficient P (0.19%) had less bone density and ash percent compared with treatments fed NRC and industry levels of P. For bone density, there was a significant main effect of bone (P = 0.001), with the 10th rib having greater bone density than all other treatments and the 3rd rib having greater bone density than the 5th rib. Bone density of the 2nd and 7th ribs did not differ (P >0.05) from either the 3rd or 5th ribs. For non-defat bone ash, 10th rib had the greatest (P < 0.05) bone ash, followed by the 2nd rib which was greater (P < 0.05) than the 3rd rib, with the 5th and 7th ribs having the least non-defat bone ash percent. In summary, bone density and ash responses varied depending on the bone being measured. When measuring all of the bones, the 10th rib has the greatest value for bone density and bone ash percent, while the 5th rib has the least value for both bone density and bone ash percent compared with the rest of the bones analyzed. These results can help guide diagnostic investigations and aid in comparing results across different bones used to measure bone mineralization.

Radiographic determination of the tracheal indices at caudal cervical, thoracic-inlet, and intra-thoracic trachea in non-bulldog brachycephalic breeds without evidence of cardiorespiratory disease

BackgroundCongenital tracheal hypoplasia is a component of airway syndrome affecting a wide variety of brachycephalic dog breeds. Several radiographic procedures were utilized to assess vertical tracheal diameter (VTD) in dogs. The objective of this study was to calculate the tracheal indices at the caudal cervical, thoracic-inlet, and intra-thoracic tracheal regions on the right lateral thoracic radiograph to further establish a screening protocol for diagnosis of tracheal hypoplasia in non-bulldog brachycephalic breeds. Dogs without clinical or radiographic evidence of tracheal, respiratory, or cardiovascular abnormalities were investigated. The absolute and average VTDs were normalized by manubrium length (ML), thoracic-inlet distance (Ti-D), and proximal 3rd rib width (PR3-W). Manubrium-tracheal index (M-TI), thoracic inlet-tracheal index (Ti-TI), and proximal R3-tracheal score (PR3-TS) were calculated. Correlations between averaged VTD and each of the normalizing parameters (ML, Ti-D, and PR3-W), and between M-TI and each of the previously established procedures (Ti-TI and PR3-TS) were determined.ResultsEighty healthy subjects met the inclusion criteria for the study. There were significant differences (P ≤ 0.0001) among the means of absolute and normalized VTDs at the 3 tracheal levels. The smallest VTD was identified at the thoracic inlet. The average tracheal diameter showed a better correlation with ML (rs=0.81, P < 0.0001) compared to Ti-D and PR3-W. There was a strong correlation (rs=0.83, P < 0.0001) between the averaged M-TI and Ti-TI.ConclusionRadiographic M-TI could be an alternative to traditional procedures to assess the tracheal lumen in non-bulldog brachycephalic dogs. M-TI < 0.39, < 0.30, or < 0.34 at caudal cervical, thoracic inlet, or intrathoracic trachea, respectively, may indicate tracheal hypoplasia in non-bulldog brachycephalic breeds. Screening of tracheal diameter using M-TI should be recommended. However, further investigation of non-bulldog brachycephalic breeds with cardiac and/or respiratory disease is indicated.

Anisocoria without extraocular muscle impairment due to moderate traumatic brain injury with midbrain contusion: a case report

BackgroundNew-onset anisocoria is an important clinical clue to life-threatening intracranial injury. Anisocoria alone without impairment of extraocular muscles is a rare presentation of moderate traumatic brain injury (TBI).Case presentationA 79-year-old woman was transported to hospital soon after falling off a bicycle. Glasgow Coma Scale score on arrival was 11 (E3V3M5). On examination at admission, she was found to be drowsy. Bruising was seen around the right eye and pupil diameters differed (right, 4.5 mm; left, 3.0 mm; both reactive to light). Computed tomography of the head revealed hemorrhagic contusion in the left temporal lobe and left pretectal area of the midbrain, right clavicular fracture, and pulmonary contusion with fractures of the 3rd and 4th ribs. Magnetic resonance imaging confirmed hemorrhagic contusion of the midbrain. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 17.ConclusionWe encountered a case of anisocoria without major extraocular muscle impairment due to moderate TBI with midbrain contusion.

Boomerang of bullet from the chest cavity—an autopsy case

BackgroundWhat if you fire a bullet and, like a boomerang, it comes back towards you after hitting the target, leaving no trace in the body.Case presentationA similar case was presented to us for an autopsy at the district mortuary, Aligarh, with a bullet unusually ricocheting within the thoracic cavity and taking almost path of incidence after grazing over the 3rd rib and coming out just closure to the entry wound towards the musketeer. The presence of stippling at both the entrance and exit wounds poses a challenge to interpreting the track of the injury.ConclusionThorough and detailed examination at autopsy and crime-scene investigation revealed a strange ricochet event within the chest cavity.

Hyperspectral imaging and chemometrics assessment of intramuscular fat in pork Longissimus thoracic et lumborum primal cut

To assess the intramuscular fat (IMF) of Longissimus thoracis et lumborum (LTL) primal cut excised from an animal carcass, rib sections are dissected for chemical or subjective evaluation. Dissection destroys the integrity of the LTL. This study examined the feasibility of developing a method based on hyperspectral imaging to predict the IMF of pork LTL using hyperspectral imaging. Spectral information from different tissues was collected at the cranial (Serratus ventralis, Spinalis dorsi, longissimus , backfat), and the caudal ( Gluteus medius, Psoas major ) ends of the LTL. The spectral information and the IMF content chemically extracted from the mid-loin (3rd and 4th last rib of the LTL) were used to develop regression models for the prediction of the IMF content in the 3rd and 4th. The individual results of the analysis from the various tissues at both the cranial and caudal ends show that models exhibited performances for IMF prediction with root-mean-square-error (RMSEP) ranging from 0.36 to 0.92% and coefficient of determination in prediction ranging from 0.43 to 0.81. Gluteus medius showed the highest accuracy. This study has demonstrated that hyperspectral imaging could be used to accurately predict the IMF content in the mid-loin by using spectral data from Gluteus medius . The result could be useful in segregating pork LTL based on IMF content. • Intramuscular fat in whole pork Longissimus thoracic et lumborum was evaluated. • Muscles from the cranial and caudal of the Longissimus thoracic et lumborum were scanned. • PLSR was used to develop models between tissues and intramuscular fat at 3rd/4th last ribs. • The Gluteus medius muscle predicted intramuscular fat accurately.

Metastatic proximal-type epithelioid sarcoma presenting as a chest lesion with a pathological fracture of the humeral neck

Introduction: Proximal-type epithelioid sarcoma is a rare soft tissue neoplasm which occurs mostly in young males and is much rarer than classic distal sub type. A young male, with a known diagnosis of neurofibromatosis type 1 (NF1) presenting with metastatic proximal-type epithelioid sarcoma is reported. Case Report: A 30-year-old male with known NF1, hypothyroidism, epilepsy, presented with a right shoulder pain of two weeks duration. Plain radiographs revealed an expansile lytic lesion, an aggressive periosteal reaction in right humeral head with an underlying pathological fracture. A well-defined extrapulmonary mass with a lobulated margin in upper zone of right hemithorax with inferior rib erosion of 3rd rib and the 3rd intercostal space widening were also observed. Contrast-enhanced computed tomography (CECT) chest and abdomen confirmed peripherally located poorly enhancing soft tissue mass with lobulated margins arising from posterior chest wall along with a subdiaphragmatic deposit. Multiple lytic lesions in right head of humerus with an underlying pathological fracture of surgical neck, T2, T6, and L3 vertebral bodies, and pelvic bones were observed too. Diagnosis of malignant peripheral nerve sheath tumor with metastases was made and ultrasound-guided biopsy of chest wall lesion was performed. Histology and immunohistochemistry (IHC) revealed a proximal type epithelioid sarcoma. The patient was managed with palliative surgery and oncological follow-up. Conclusion: Presentation of proximal-type epithelioid sarcoma with disseminated metastases in a patient with NF1 masquerading malignant peripheral nerve sheath tumor (MPNST) and the challenges of diagnosis on clinical, radiological, and histopathology as well as IHC perspectives of this rare disease entity is highlighted.

Productive performance and in vivo body composition across the growing and finishing period and carcass traits in pigs of four sex types

This study compares performance, body and carcass composition among castrated (CM), immunocastrated (IM) and entire males (EM), and females (FE) at 30, 70, 100 and 120 kg of body weight (total of n = 92; 20–24/sex type). Overall, IM had similar growth and feed intake to CM and greater than EM and FE. At each slaughter stage, IM had a lower killing-out percentage than CM and FE, in line with their heavier liver and kidneys. Flare fat proportion and backfat thickness on the ham and at the last rib level were similar for IM, EM and FE, and these were lower than CM. In EM and FE, backfat between the 3rd and 4th last ribs was lower and carcass lean content was higher than in CM, whereas IM were intermediate and not different to the other sexes. Females showed the largest ham proportion, this cut being leaner and less fatty than in CM. Belly proportion was higher in CM than in EM.

Poland\'s Syndrome with Unusual Hand and Chest Anomalies: A Rare Case Report

Poland's syndrome is a rare congenital anomaly consisting of a unilateral absence of the pectoralis major, ipsilateral muscle, hand anomaly and occasionally associated other malformations of the chest wall and breast. Many structural and functional abnormalities have been described in association with this syndrome. We report an incidentally diagnosed case in a 27-year-old male patient who presented to us with symbrachydactyly. In addition to this, anterior depression of 2nd, 3rd and 4th ribs and bifid (forked) 5th rib was present on radiological investigations. The body of sternum was short and deformed on the right side with absence of xiphoid process. All middle phalanges were absent on righthand. It is a rare variant of Poland's syndrome.

PRIMARY STERNAL OSTEOMYELITIS IN A CHILD: A CASE REPORT

TYPE: Case Report TOPIC: Pediatrics INTRODUCTION: Primary sternal osteomyelitis which develop without any contiguous focus of infection is a rare condition, that too in children. MRI and biopsy are required for diagnosis. Rarity of the condition often results in delayed diagnosis and treatment. CASE PRESENTATION: A 9 year old boy , who was otherwise normal, presented with high fever - 9 days, followed by painful limitation of movement of right upper limb.O/E- Sick and toxic child..Tender, firm swelling, 2 x 2cm ,over the sterno-chondral junction of 2nd and 3rd rib with signs of inflammation.Rest of physical examination WNL. Investigation revealed anemia, polymorphonuclear leucocytosis with elevated ESR and CRP. Cultures were sterile. USG revealed collection below Rt sternoclavicular joint which yielded a dry tap . CECT showed non enhancing collection with no cortical defect in sternum. MRI revealed T2 hyperintensity and T1 hypointensity showing diffusion restriction of sternum suggestive of bone marrow edema.CT-guided sternal biopsy confirmed sternal osteomyelitis. Patient responded to Meropenem and Vancomycin after nonresponse to Cloxacillin and cefotaxime.Treatment continued for 4 weeks and patient recovered completely. DISCUSSION: Primary sternal osteomyelitis is diagnosed after exclusion of other sources of infection. Close proximity to vital organs can complicate the condition. Early recognition, identification of the causal organism, and early initiation of culture-driven intravenous antibiotic therapy is crucial in determining outcome. Staphylococcus aureus,coagulase negative staphylococcus, group B streptococcus, and other streptococcus species are most commonly implicated organisms.Nearly half requires surgical debridement and resection. CONCLUSIONS: Early diagnosis and appropriate treatment results in complete recovery of sternal osteomyelitis DISCLOSURE: Nothing to declare. KEYWORD: sternal osteomyelitis

Radiographic vertical tracheal diameter assessment at different levels along the trachea as an alternative method for the evaluation of the tracheal diameter in non-brachycephalic small breed dogs

BackgroundTracheal narrowing due to congenital tracheal hypoplasia, acquired tracheal stenosis and tracheal collapse can lead to life-threatening respiratory distress. Tracheal hypoplasia has been identified in brachycephalic dog breeds, predominantly English Bulldogs, by measuring the tracheal diameter compared to the diameter of the thoracic inlet and creating a ratio. However, reference ranges for tracheal diameter have not been established for non-brachycephalic small breed dogs. It would be advantageous to have established tracheal diameters for non-brachycephalic small breed dogs, as these are the dogs most at risk of tracheal collapse. The main objective, of this study was to radiographically evaluate vertical tracheal diameter (VTD) at three standardized locations along the trachea of non-brachycephalic small breed dogs, in an attempt to further establish a screening diagnostic protocol for canine tracheal hypoplasia. Medical records and thoracic radiographs of non-brachycephalic small breed dogs without respiratory disease were reviewed. Right lateral radiographs were reviewed. The absolute and average VTDs at three locations (location A: caudal cervical VTD; location B thoracic inlet VTD; location C: intrathoracic VTD) were standardized by manubrium length (ML), as well as by the previously utilized thoracic inlet distance (Ti-D) and proximal 3rd rib width (PR3-W) to calculate manubrium-tracheal index (M-TI), thoracic inlet-tracheal index (Ti-TI), and proximal R3-tracheal score (PR3-TS), respectively. Correlations between averaged tracheal diameter and each of the ML, Ti-D, and PR3-W, and between M-TI and each of Ti-TI and PR3-TS were calculated.ResultsEighty-one healthy dogs met the criteria for inclusion. Significant differences (P < 0.0001) were identified among the mean values of the absolute and standardized VTDs at levels A, B, and C. The smallest tracheal diameter was identified at the level of the thoracic inlet (Level B).The average VTD correlated better with ML (rs = 0.82, P < 0.0001) compared to Ti-D and PR3-W. A relatively strong correlation (rs = 0.77, P < 0.0001) was identified between the averaged manubrium tracheal index (M-TI) and thoracic inlet tracheal index (Ti-TI).ConclusionM-TI is an appropriate alternative to Ti-TI and PR3-TS to radiographically evaluate VTD in dogs. M-TI < 0.43, < 0.34, or < 0.38 at level A, B, or C, respectively, may indicate tracheal hypoplasia in non-brachycephalic small breed dogs. Screening of canine VTD could be achieved using M-TI.

Surgical treatment of post-traumatic luxation of rib heads with spinal cord compression in a cat

BackgroundLuxation of the rib head with intrusion into the intervertebral foramen seems to be rare in cats. Only one report has been published describing a cat with non-ambulatory paraparesis, which was managed conservatively. Here we report a case of rib head luxation that was managed surgically.Case presentationA 4-year-old, female domestic shorthair cat with a two-week history of non-ambulatory paraparesis was presented at our clinic. Based on history and neurological examination, a diagnosis of thoracolumbar spinal cord lesion of traumatic origin was made. Computed tomography scanning revealed mild scoliosis, a luxation of the 3rd and 4th right rib heads and penetration into the spinal canal through intervertbral foramina. Surgical management using right dorsal approach to the spine was performed. The spinal cord was decompressed by cutting and removing of proximal ribs’ fragments by rotation and pulling out from the intervertebral foramina. The cat was ambulatory and paraparetic four weeks after surgery. Two years after surgery the cat regained functional gait, but ataxia remained.ConclusionsWe report the first case of a surgical treatment of rib head luxation and intrusion into the spinal canal in a cat. The applied procedure resulted in an improvement of neurological signs.

AB009. Pitfalls in mediastinal masses diagnosis

: Mediastinum is a complex anatomic space in which different malignancies can occur, originating from different cell types, such as epithelial thymic, lymphoid, germinal cell and mesenchimal cell. Their diagnosis requires dedicated knowledge and expertise, due to heterogeneous features. Indeed, there is also a frequent overlap between different histologies leading to uncertainty in the diagnostic process. Here, we present an uncommon mediastinal mass challenging in its characterization. A thirty-year-old woman performed thoracic CT scan for dyspnea and persistent cough. Imaging showed a solid mass of 14×11 cm involving the left thorax with mediastinal deviation to the right side. Patient underwent resection en bloc of left endothoracic mass and segmental resection of the left upper lung lobe, and of the 3rd, 4th and 5th ribs. Initial histological examination was suggestive for B3 thymoma/thymic carcinoma due to the positivity for p63, CD99, CD117 and vimentin. Pathological stage pT1b. Patient was then referred to our rare tumor Reference Center. Histological review showed small-medium sized tumor cells. The immunohistochemical panel showed negativity for cytokeratins (CKMNF116, CKAE1/AE3, CK19), as well as PAX8, CD56 NSE and CD117; while CD99 was positive, excluding the diagnosis of thymic/thymoma neoplasms; c-kit and other thymoma related genes resulted negative for mutations at a next generation sequencing (NGS) analysis. On the other hand, the negativity of different types of cytokeratins and the elevated mitotic index associated with the sporadic positivity for p63 was not specific for an epithelial neoplasm. Morphological pattern and positivity for CD99 led to a diagnosis of undifferentiated sarcoma. A third revision, was performed at the National Sarcoma Center and included the assessment of markers for sarcoma cluster differentiation. Tumor cells were characterized by the positivity for CD99 and NKX2.2 consistent with a diagnosis of Ewing’s sarcoma, despite the negativity for ETV4. The evaluation of expert centers was critical to establish a correct diagnosis in this complex case. Taking into account the time lasting from the diagnosis and the aggressiveness of this kind of neoplasm, the patient was candidate for chemo-radiotherapy after a multidisciplinary discussion.

Pectoralis major muscle quantification by cardiac MRI is a strong predictor of major events in HF.

Clinical overt cardiac cachexia is a late ominous sign in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The main goal of this study was to assess the feasibility and prognostic significance of muscle mass quantification by cardiac magnetic resonance (CMR) in HF with reduced LVEF. HF patients with LVEF < 40% (HFrEF) referred for CMR were retrospectively identified in asingle center. Key exclusion criteria were primary muscle disease, known infiltrative myocardial disease and intracardiac devices. Pectoralis majormuscles were measured on standard axial images at the level of the 3rd rib anteriorly. Time to all-cause death or HF hospitalization was the primary endpoint. A total of 298 HF patients were included (mean age 64 ± 12years; 76% male; mean LVEF 30 ± 8%).During a median follow-up of 22months (IQR: 12-33), 67 (22.5%) patients met the primary endpoint (33 died and 45had at least 1 HF hospitalization). In multivariate analysis, LVEF [Hazard Ratio (HR): 0.950; 95% Confidence Interval (CI): 0.917-0.983; p = 0.003), NYHA class I-II vs III-IV (HR: 0.480; CI: 0.272-0.842; p = 0.010), creatinine (HR: 2.653; CI: 1.548-4.545; p < 0.001) and pectoralis major area (HR: 0.873; 95% CI: 0.821-0.929; p < 0.001) were independent predictors of the primary endpoint, when adjusted for gender and NT-pro-BNP levels. Pectoralis majorsize measured by CMR in HFrEF was independently associated with a higher risk of death or HF hospitalization. Further studies to establish appropriate age and gender-adjusted cut-offs of muscle areas are needed to identify high-risk subgroups.

Hepatic Diseases in Canine and Feline: A Review

Dogs and cats are belonging to canine and feline family respectively. The liver is the largest gland in the body and is located in the cranial abdomen between 3rd and 4th ribs in dogs and cats. This review is mainly focused on: to understand the anatomy and physiology of liver, the liver diseases pathophysiology, to diagnose the liver diseases, managemental and ameliorative methods of liver diseases. The dual blood supply to the liver is hepatic artery and portal vein. The function of liver includes the regulation of digestion and metabolism, the synthesis of hormones and proteins, immune response and filtering of toxins from the blood stream. Any problem that affects the liver is liver disease. Inflammation of liver is hepatitis. Hepatitis caused by infectious, non-infectious, auto-immune and reactive. It can be acute and chronic. The most encountered liver diseases in dogs and cats are hepticlipidosis, cholangiohepatitis, portosystemicshunt, cholelithiasis, choledocholithiasis, cholecystitis, pneumobilia and hepatic neoplsia. The clinical symptoms of liver diseases include jaundice, hepatic encephalopathy, gastro intestinal disorders and nonspecific signs include polyuria/polydipisia. The liver disease diagnosed based on history, liver function tests, medical imaging. The latest imaging procedures are endoscopic retrograde cholagio pancreatography (ERCP) and computed tomography (CT). For confirmatory diagnosis liver biopsy and histopathological interpretation is required. Therefore, based on diagnosis appropriate treatment should be selected: bile stasis is treated urodeoxycholic acid (URDA), fluid therapy include sugar and salt solution for replacement fluid loss, gastrointestinal protectors include ranitidine, cimitidine and lactulose, albumin to treat hypoalbuminimia, antioxidant for scavenging free radicals include vitamin E, Selenium, S-adenosyl-L-methionine (SAMe), diuretic fursimid for treatment of ascites and supplementation low protein diets. This laparoscopic technique for removal of gallstones and endoscopic retrograde cholagiopancreatography (ERCP) to treat gall stones on bile ducts and to widen the slipped ducts and liver transplantation for cirrhotic dogs and cats. Early accurate diagnosis and managing any predisposing factors that affects the health of dogs and cats are important for controlling the liver diseases.

Results of allogeneic hematopoietic stem cell transplantation in a patient with classical Hodgkin's lymphoma

The aim of the study was to study the role of allogeneic transplantation of hematopoietic stem cells in a patient with the classic course of Hodgkin's lymphoma.Materials and methods. The work was carried out on the basis of the analysis of a clinical case of the clinic of occupational pathology and hematology of the University Clinical Hospital No. Professor V.Ya. Shustov. Examinations, a course of chemotherapy in conjunction with surgery and analysis of the results of a patient with a diagnosis of classic Hodgkin's lymphoma were carried out. Results. An unfavorable prognostic effect of a large amount of previous chemotherapy on overall survival after allogeneic HSC transplantation was revealed. According to the results of PET-CT, the patient achieved PETnegative remission of the disease after all the stages of treatment. Compared to the presented PET / CT scan of 02/07/2020, there is a positive trend in the form of the disappearance of metabolic activity in the 3rd rib on the right, the body of Th 11 and the body of the left ilium.Conclusion. The use of high-dose chemotherapy with hematopoietic stem cell transplantation makes it possible to achieve success in the treatment of patients in cases where the results of chemotherapy are unsatisfactory.