Abdominal Effusion Research Articles

Abdominal fluid score as a predictor of transfusion needs and outcome in cats following trauma.

To assess the value of the abdominal fluid score (AFS) in cats following trauma in determining surgical needs, transfusion needs, and mortality. Multicenter retrospective observational study utilizing data from the Veterinary Committee on Trauma (VetCOT) registry. VetCOT Veterinary Trauma Centers. A total of 2309 cats entered into the VetCOT registry between January 1, 2013, and December 31, 2020, were included. None. Of the included cats, 148 had abdominal effusion on presentation (AFS 1-4, positive AFS [pAFS]). pAFS cats demonstrated a lower total plasma protein (6.2g/dL, range: 2.8-9.2g/dL vs 6.8g/dL, range: 2.6-11g/dL, P<0.001) and a more negative base excess (BE) (-9, range: -23.7 to 10 vs -6.1, range: -31.7 to 1, P=0.001) than cats without abdominal effusion (negative AFS [nAFS]). pAFS cats also had a higher baseline Animal Trauma Triage score (ATTS) than nAFS cats (5, range 0-12vs 3, range 0-17, respectively, P<0.001). pAFS cats were more likely to require blood transfusions (16% [23/148] vs 4% [94/2161], P<0.001) than nAFS cats, but need for surgical intervention did not differ between groups. A pAFS was associated with increased need for hospitalization (62.8% [93/148] vs 47.7% [1030/2160], P<0.001), but length of hospital stay did not differ. Cats with pAFS experienced higher mortality compared to nAFS cats (42.6% [63/148] vs 22.7% [491/2161], P<0.001). The presence of abdominal effusion in cats following trauma was associated with increased morbidity in this study, as demonstrated by greater need for transfusion, increased likelihood of hospitalization, and greater mortality. Cats in the pAFS group had more negative BE and higher ATTS, but need for surgery, length of hospitalization, PCV, and blood glucose, plasma lactate, and ionized calcium concentrations were not different between groups.

Peliosis hepatis and hepatic fibrosis in a dog infected with multiple Bartonella species.

A 13-y-old, spayed female dog had regenerative anemia, lymphopenia, hypoalbuminemia, and elevated hepatic biochemical parameters. Liver biopsy revealed hepatic peliosis (hepatic sinusoidal angiectasis), frequently associated with perisinusoidal fibrosis. The dog was seroreactive to Bartonella antigens by indirect fluorescent antibody assays, and quantitative PCR from blood identified Bartonella vinsonii subsp. berkhoffii genotype II. The dog was euthanized 9 mo later because of acute decompensation. Autopsy revealed icteric adipose tissues, end-stage liver, and abdominal effusion. Microscopically, there was marked mixed-cell chronic hepatitis with hepatocellular loss, nodular hepatocellular regeneration, and capillary proliferation. Retrospective molecular testing documented B. koehlerae and B. rochalimae DNA in the dog's blood at 2 or more times during liver disease progression. B. koehlerae DNA was also amplified and sequenced from the autopsy sample of liver. Our case emphasizes that Bartonella infection may be associated with hepatic peliosis and end-stage liver in dogs and expands the spectrum of Bartonella species that potentially play a role in canine hepatic diseases.

Computed tomographic findings in dogs with ovarian tumors: A tortuous ovarian artery consistently identifies ovarian origin in complex abdominal masses.

The aim of this retrospective multicentric case series is to describe the CT findings of ovarian neoplasia in dogs. Twenty dogs with pre- and postcontrast CT exams and cytological/histological diagnosis of ovarian neoplasia were included. Five dogs presented with bilateral tumors, for a total of 25 neoplasms: 15 carcinomas (4 bilateral), 4 granulosa cell tumors, 2 poorly differentiated malignant neoplasia (bilateral), 2 luteomas, 1 teratoma, 1 dysgerminoma. In two dogs, the tumor developed from an ovarian remnant. Ovarian tumors showed variable size, lobulated shape, and precontrast heterogenous appearance. Mineral foci and/or fat components were rare, observed in teratoma, granulosa cell tumors (2), and ovarian carcinoma. Tumor type was not found to be associated with any CT features. Larger masses were more likely located in the central abdomen ventral to the ipsilateral kidney, demonstrated signs of tumor rupture, and were associated with abdominal or sternal lymphadenopathy and peritoneal effusion. A tortuous ovarian artery was constantly detectable, associated with an enlarged gonadal vein (12 cases). Related cavitary changes were peritoneal effusion (14 dogs) and sternal lymphadenopathy (7 dogs). Presumed or confirmed metastasis was reported in 9 of 20 cases, with CT evidence of transcoelomic (serosal thickening, peritoneal nodules, omental cake, implant lesions to the liver, spleen, and diaphragm), lymphatic and hematogenous spread (lungs, liver, bone, muscles, and spleen). In conclusion, the present study reports the CT features of different canine ovarian neoplasia. A tortuous ovarian artery may be useful to consistently recognize the ovarian origin of a large abdominal mass.

Evaluation of bile acids and bilirubin in serum and abdominal fluid in dogs with abdominal effusion.

Determine the utility of abdominal fluid bile acids concentration to diagnose biliary tract rupture and the utility of abdominal fluid-to-serum bilirubin ratio as diagnostic tools in dogs. This was a prospective pilot study. Canine serum and abdominal fluid samples were collected and submitted for the determination of bilirubin and bile acids concentrations between 2020 and 2022. Samples were measured at the time of admission from dogs with acute onset of clinical signs and peritoneal fluid. A Mann-Whitney U test and ROC curves were used to compare serum and abdominal fluid bilirubin and bile acids concentration and fluid-to-serum bilirubin and bile acids ratio between patients with biliary tract rupture and non-biliary tract rupture. Ninety-four cases were included, of which seven were diagnosed with biliary tract rupture. Median abdominal fluid bile acids concentration was significantly higher in dogs with biliary tract rupture than non-biliary tract rupture (P-value <0.001). Abdominal fluid bile acids concentration had a sensitivity of 100% and specificity of 99% for the diagnosis of biliary tract rupture. Fluid-to-serum bilirubin ratio was also analysed and no statistically significant difference was seen between groups (P-value 0.925). Although the number of dogs with biliary tract rupture in this study population was small, abdominal fluid bile acids concentration may have a better accuracy than fluid-to-serum bilirubin ratio for the diagnosis of biliary tract rupture. The utility of fluid-to-serum bilirubin ratio for the diagnosis of biliary tract rupture, appears limited. Further studies with a larger number of biliary tract rupture cases are required to support these conclusions.

Clinical features of 50 patients with primary intestinal lymphangiectasia

Objective: To investigate the clinical features of primary intestinal lymphangiectasia (PIL). Methods: This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of (M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tcm-labeled human albumin (99Tcm-HSA) scintigraphy, 99Tcm-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ 2 test. Results: Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tcm-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tcm-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions: The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tcm-HAS scintigraphy, 99Tcm-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Can &lt;i&gt;Talaromyces marneffei&lt;/i&gt; Infection Cause Acute Liver Failure? A Case Report

Introduction: Talaromyces marneffei is a pathogen that causes talaromycosis, a systemic fungal infection. Cases in which hepatic failure is the primary clinical presentation are exceedingly rare. Case Presentation: This report details the case of a 49-year-old male with no prior liver disease, presenting to the hospital with persistent symptoms, including a fever lasting over ten days, abdominal distension for five days, and jaundice for three days. The patient’s history included immune thrombocytopenia and prolonged glucocorticoid therapy. Physical examination revealed yellowing of the skin and sclera, abdominal distension, firmness of the abdominal wall, absence of abdominal tenderness, positive shifting dullness, and pitting edema in the lumbosacral region and bilateral lower extremities. An HIV antibody test was negative. The patient developed hepatic failure and received artificial liver support along with routine therapy. Despite these interventions, the patient was automatically discharged without improvement and subsequently passed away. Post-discharge, cultures from pleural and abdominal effusions identified Talaromyces marneffei. Conclusions: Talaromyces marneffei infection should be considered in the differential diagnosis of immunocompromised patients, particularly those with no history of liver disease but with long-term glucocorticoid or immunosuppressant use who present with acute liver failure. Early and aggressive investigation for the causative pathogen is essential to minimize diagnostic and treatment delays. Given the prolonged incubation period of Talaromyces marneffei, metagenomic next-generation sequencing may offer a more rapid approach for etiological diagnosis.

Relative Factor Analysis of Postoperative Complications in Infants Below 1 Year Undergoing Repair of Ventricular Septal Defect Combined with Other Procedures through a Right Axillary Incision

Background: Compared to the traditional surgical repair of isolated ventricular septal defects, the proportion of complex congenital heart diseases has been increasing due to advancements in diagnostic capabilities and surgical techniques. Concomitant surgeries to correct multiple congenital heart diseases have become the preferred choice. Therefore, the evaluation of the safety of the combined correction of ventricular septal defects with other cardiac anomalies in young children through a right axillary incision and the analysis of related factors of perioperative complications needs to be investigated. Methods: A retrospective study was conducted on a single-center patient sample from January 2018 to December 2022 to compare outcomes between infants undergoing isolated ventricular septal defect (VSD) repair via a right axillary thoracotomy (control group) and those undergoing VSD repair combined with other cardiac procedures (experimental group). Results: A total of 397 eligible infants were included. After baseline data were matched using propensity score matching, the experimental group (n = 181) and the control group (n = 107) showed no significant differences in intraoperative blood loss, postoperative total drainage, length of hospital stay, duration of ICU monitoring, Vasoactive-Inotropic Score (VIS), pre-discharge left ventricular ejection fraction, fractional shortening (FS), postoperative severe pulmonary infection, reoperation, mortality, postoperative atrioventricular block, chylothorax, cardiac arrest, pericardial effusion, pneumothorax, pulmonary atelectasis, tricuspid regurgitation, myocardial injury, abdominal effusion, and metabolic acidosis. However, the control group had shorter surgical time [28.00 (90.00, 196.00) vs. 140.00 (95.00, 658.00) min, p &lt; 0.05], shorter cardiopulmonary bypass time [58.00 (24.00, 114.00) vs. 66.00 (33.00, 422.00) min, p &lt; 0.05], shorter aortic cross-clamp time [32.00 (17.00, 62.00) vs. 37.00 (15.00, 142.00) min, p &lt; 0.05], and shorter postoperative mechanical ventilation time [22.00 (0, 99.00) vs. 23.00 (3.00, 193.00) h, p &lt; 0.05]. The rate of abdominal effusion was lower in the experimental group than in the control group (p = 0.044). In the analysis of postoperative complication-related factors, the preoperative grade of tricuspid regurgitation, postoperative mechanical ventilation time, and VIS were positively correlated with abdominal effusion and satisfied the variable (p &lt; 0.05) in each of three established models. In the single-factor analysis, both VIS and preoperative lymphocyte count were (p &lt; 0.1) related to pericardial effusion; however, in the multi-factor analysis, only VIS met the threshold (p &lt; 0.05). Gender, height, and VIS were each associated with pleural effusion (p &lt; 0.05). Conclusion: The combination of ventricular septal defect repair with other cardiac procedures via a right axillary thoracotomy did not significantly differ from isolated VSD repair in terms of postoperative complications, monitoring, and length of hospital stay. However, increased surgical complexity was associated with longer surgical and mechanical ventilation times. Factors such as tricuspid regurgitation severity, duration of postoperative mechanical ventilation, and VIS were identified as relative factors for postoperative effusion. Additionally, the risk of postoperative pericardial effusion increased with higher VIS, while gender, height, and VIS were identified as relative factors for postoperative chylothorax.

Construction and validation of a prediction model for prolonged hospitalization in patients with severe acute pancreatitis

To construction the risk factors associated with prolonged hospitalization in patients with severe acute pancreatitis (SAP) and develop a prediction model for assessing these risks. SAP patients admitted to the department of emergency of Hebei Province Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to December 2023 were retrospectively selected as the study subjects. The 75% of hospital stay was used as the cut-off point, and the patients were categorized into a normal group and an extended group. Clinical indicators of patients were collected, and independent risk factors for prolonged hospital stay in SAP patients were analyzed using multifactor Logistic regression. A prediction model was established, and a nomogram was created. The efficiency of the prediction model was evaluated using a receiver operator characteristic curve (ROC curve). The accuracy of the model was assessed using Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) was employed to evaluate the clinical applicability of the model. Finally, internal validation of the model was conducted using Bootstrap method. A total of 510 patients with SAP were included, and the length of hospital stay was 18 (6, 44) days, including 400 cases in the normal group (<24 days) and 110 cases in the extended group (≥24 days). Multivariate Logistic regression analysis showed that abdominal effusion [odds ratio (OR) = 4.163, 95% confidence interval (95%CI) was 2.105-8.234], acute physiology and chronic health evaluation II (APACHE II; OR = 1.320, 95%CI was 1.185-1.470), C-reactive protein (CRP; OR = 1.006, 95%CI was 1.002-1.011), modified CT severity index (MCTSI; OR = 1.461, 95%CI was 1.213-1.758), procalcitonin (PCT; OR = 1.303, 95%CI was 1.095-1.550) and albumin (OR = 0.510, 95%CI was 0.419-0.622) were independent risk factors for prolonged hospital stay in SAP patients (all P < 0.01). ROC curve analysis showed that the area under the curve (AUC) of the model was 0.922 (95%CI was 0.896-0.947), the optimal cut-off value was 0.726, the sensitivity was 87.3%, and the specificity was 85.3%. Hosmer-Lemeshow test showed that χ 2 = 5.79, P = 0.671. It showed that the prediction model had good prediction efficiency and fit degree. The DCA curve showed that the prediction probability of the model could bring more clinical benefits to patients at 0.1 to 0.7. Bootstrap internal verification showed that the model had a high consistency (AUC = 0.916). Abdominal effusion, high APACHE II score, high CRP, high MCTSI, high PCT and low albumin level are significantly associated with prolonged hospital stay in SAP patients. The prediction model can help clinicians make more scientific clinical decisions for SAP patients.

Ovarial Torsion in Young Children. Ultrasound Diagnostic

Background. Early adnexal torsion (AT) is extremely rare. It usually involves a torsion of the ovary together with the tube, which cannot be differentiated by transabdominal ultrasound, so the terms "adnexal torsion" and "ovarian torsion" for children are echographically identical.Objective. To study the features of echographic representation of ovarian torsion in infant girls.Materials and Methods. During 2015–2024, adnexal torsion was echographically diagnosed in 6 girls of the first year of life. All patients underwent transabdominal ultrasound in B-mode and color Doppler scanning. All children were operated, and the diagnosis was verified.Results. The frequency of adnexal torsion in children under 1 year of age was 13.3% of all patients (45) with this pathology. The complaints and clinical picture were nonspecific. In all cases, suspicion of adnexal torsion was expressed only when ultrasound was performed. There was an increase in the volume of the affected ovary by 6.91 ± 0.68 times compared to the contralateral ovary and increased echogenicity of the ovarian parenchyma, against which numerous anechogenic follicles were traced. Vascular pattern in the parenchyma of the affected ovary was detected in 2/6 cases (33.33%), uterine appendages were irreversibly changed. Hyperstimulated ovaries were observed in 4 out of 6 cases. The distribution of follicles in the affected ovary was chaotic, there was no "necklace symptom", there was no marked rounding of the ovarian shape, and the amount of stromal component in the tilted ovary was relatively small. In 5/6 (83.3%) girls, no pelvic cavity effusion was noted.ConclusionThere are no specific anamnestic and clinical data suggestive of adnexal torsion in infants, which determines the importance of ultrasound as virtually the only method of emergency diagnosis of this pathology.The peculiarity of ultrasound in the infant should be the maximum expansion of the area of examination with attempts to visualize the pelvic organs regardless of the degree of bladder filling.The basis of echographic diagnosis of adnexal torsion in infants are structural changes of the appendage in B-mode: increase in linear size of 1.5–2 times, volume of 4–10 times and increased echogenicity of the stroma. Rounding of the shape of the affected ovary is insignificant.A feature of twisted appendage in infants is a large number of follicles in the affected ovary (2/3 of observations). The "necklace" symptom is atypical.The presence of abdominal effusion in adnexal torsion in infants is not characteristic.Preservation of the vascular pattern in the ovary does not exclude adnexal torsion, is infrequent (in 1/3 of cases) and does not guarantee preservation of ovarian viability.

Association between different patterns of obesity and the short-term outcomes of gastric cancer surgery.

Previous studies have shown that general and central obesity are each linked to adverse outcomes in gastrointestinal cancers. However, their combined effect on gastrointestinal cancers surgery outcomes were less understood. This study aims to integrate both general and central obesity to examine the outcomes of gastric cancer surgery in different obesity patterns. We retrospectively analyzed 248 patients who underwent gastric cancer surgery between 2021 and 2023 in a single institute. The Inbody720 body composition analyzer measured body composition. We evaluated the relationship between obesity patterns - combining BMI with central obesity measures (waist circumference, waist-to-hip ratio, visceral fat area) - and postoperative complications and 30-day readmission. Central-only obesity were more likely to induce fistula (P = 0.025), while non-obesity was more likely to develop postoperative abdominal effusion (P = 0.049) and bleeding (P = 0.042). Central-only obesity was significantly associated with severe postoperative complications after adjustment for hypertension, diabetes, abdominal surgery history, preoperative albumin levels, age, sex, and surgical types. This remains significant even after adjusting for muscle mass. However, we did not find the same results for significant complications. Regarding 30-day readmission, there are no differences between different patterns of obesity. Central-only obesity is an independent risk factor for severe postoperative complications in gastric cancer, while a high BMI appears to be associated with a lower risk compared to non-obese patients, but not significant postoperative complications. The likelihood of readmission within 30 days post-surgery may not be related to the patient's pattern of obesity.

Activity of the Caged Xanthone Morellic Acid against Vancomycin-Resistant Enterococcus Infection by Targeting the Bacterial Membrane.

Vancomycin-resistant Enterococcus (VRE) is an important nosocomial opportunistic pathogen that is associated with multidrug resistance. Here, we demonstrate that morellic acid inhibits VRE by restoring its sensitivity to vancomycin and ampicillin with low drug resistance and efficient biofilm clearance effects. Morellic acid binds to inner membrane phospholipids, such as phosphatidylethanolamine (PE), phosphatidylglycerol (PG), and cardiolipin (CL) of VRE, such that the fluidity and proton-motive force (PMF) interfere with the damaged inner membrane, causing intracellular reactive oxygen species (ROS) accumulation and bacterial death. Transcriptional analyses supported this effect on inner membrane-related pathways such as fatty acid biosynthesis and glycerophospholipid metabolism. Moreover, morellic acid significantly eliminated residual bacteria in the spleen, liver, kidneys, and abdominal effusion in mice. Our findings indicate the potential applications of morellic acid as an antibacterial agent or adjuvant for treating VRE infections.

Clinical features and genetic analysis of two Chinese pedigrees affected with Lymphedema-Distichiasis syndrome

To explore the prenatal and postnatal features and genetic characteristics of patients with Lymphedema-Distichiasis syndrome (LDS) due to variants of FOXC2 gene. A retrospective analysis was carried out on the phenotypic information, fetal ultrasound image, and genetic testing of two Chinese pedigrees diagnosed at the Third Affiliated Hospital of Zhengzhou University. A literature review was also carried out by searching the China National Knowledge Infrastructure (CNKI), Wanfang Database, and PubMed databases dated from January 2010 to June 2024 using keywords "Lymphedema-Distichiasis syndrome " and "FOXC2 ". This study has been approved by the Medical Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (Ethic No. 2021-046-01). Neither family was found to harbor chromosomal aneuploidy or pathogenic CNVs larger than 100 kb. The fetuses from pedigree 1 and pedigree 2 were respectively found to be heterozygous for a c.361C>T (p.R121C) variant and a c.168C>A (p.Y56*) variant of the FOXC2 gene. Both variants were paternally derived. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variants were classified as pathogenic and likely pathogenic, respectively. Literature search has identified 20 articles, and combined with our cases, a total of 117 patients were identified. Among them, 13 had shown prenatal phenotypes, primarily with increased nuchal translucency (NT) (12/13), urinary abnormalities (5/12), and fetal edema (4/13). Postnatal phenotypes were observed in 110 cases, mainly as distichiasis (87/110) and lymphedema (73/110). Only 6 cases had both prenatal and postnatal phenotypes. A total of 32 genetic variants were identified. The primary prenatal manifestations of LDS include increased NT, fetal edema, pleural and abdominal effusion, and separation of renal collecting system. Postnatal phenotypes are primarily characterized by lymphedema, distichiasis, and spinal extradural arachnoid cysts. Discovery of the c.168C>A variant has expanded the spectrum of FOXC2 gene mutations in China.

A CASE REPORT OF CHRONIC HEPATITIS WITH EFFUSION IN A DOG AND ITS THERAPEUTIC MANAGEMENT

The present study was aimed to know the chronic hepatitis with abdominal effusion in a beagle dog and its therapeutic management. A 2.5 year old male beagle was presented to Madras Veterinary College teaching Hospital, madras veterinary college, Chennai with the history of inappetence, abdominal distension for past 10 days and the clinical signs of inappetence, fever and palpablelymph node and congested mucous membrane. On Physical examination, dog showed respiratory distress and dull. Dog was subjected for radiography examination, haematology, biochemistry parameters and ultrasound examination. On first day of examination, dog was treated with Lasix at the dose rate of 3 mg/kg body weight, antibiotics and Tribivet injection. Hematology and biochemical values revealed neutrophilia, elevated alkaline phosphatase, total bilirubin, direct bilirubin, and decreased total protein and albumin. The lateral view radiography of abdomen revealed fluid shadow and ultrasound examination revealed that chronic hepatitis with moderate abdominal effusion. In case of clinical suspicion of hepatitis an ultrasonographic liver scan can be of diagnostic aid and the finding of an altered structure can be indicative of a liver problem. In many cases of chronic hepatitis may not be associated with ultrasound abnormalities but ascites can be easily identified. Dog was treated with antibiotic cefotaxime at the dose rate of 25 mg/Kg body weight and Lasix at the dose rate of 3 mg/Kg body weight with liver supplement of Lysibin which contain silymarin and supplement with Astymin syrup for 3 weeks. The animal was reviewed after three weeks of treatment which was subjected for haeamtology, biochemistry and ultrasound examination which revealed there was improvement in the blood parameters with decreased total protein and normal level of Alkaline phosphatase and bilirubin level and ultrasound examination revealed normal study of abdominal effusion and liver echogenicity and dog had normal appetite and normal vital parameters. In this case hepatitis may be due to any viral etiology like adenovirus that may cause hepatitis with effusion that may be respond to treatment and diuretics and brought normal parameters of vital in dog. Chronic hepatitis with effusion may be further confirmed by Liver biopsy and molecular diagnosis.

Late-Onset Post-transplant Lymphoproliferative Disorders Presenting with Sudden Massive Abdominal Ascites Effusion: A Case Report

Late-Onset Post-transplant Lymphoproliferative Disorders Presenting with Sudden Massive Abdominal Ascites Effusion: A Case Report

Gadoxetate disodium (Gd-EOB-DTPA) contrast-enhanced magnetic resonance imaging for differentiation between benign and malignant splenic lesions in dogs.

Malignant splenic lesions in dogs are common, with hemangiosarcoma diagnosed most frequently, and there have been no consistent clinicopathologic, gross, or imaging characteristics identified that differentiate malignant from benign splenic lesions. Histopathology is required for definitive diagnosis, and given the poor long-term prognosis of malignant splenic lesions, a noninvasive tool to aid in diagnosis would be valuable. This prospective cohort study utilized gadoxetate disodium, a liver-specific contrast agent (Gd-EOB-DPTA; Eovist), to identify the general lesion and pre- and postcontrast signal characteristics of benign and malignant splenic and hepatic lesions in dogs with naturally occurring disease. Twenty-five dogs were enrolled, Eovist-enhanced MRI was performed, and dogs were taken to surgery for splenectomy and other organ biopsy. All histopathology and MRI studies were evaluated by a single pathologist and a single radiologist, respectively. The associations between the tumor type and numerous variables defined on MRI were evaluated using Fisher's exact tests, and the significance was identified at a P-value of.05. Malignant splenic masses were identified in 11/25 (44%) dogs, and 5/11 malignancies represented hemangiosarcoma. The presence of abdominal effusion (P=.017) and the presence of hepatic nodules on MRI (P=.009) were associated with splenic malignancy. There were no benign T2 hyperintense and no malignant T2 hypointense lesions (P=.021). Utilization of the T2 W MRI sequence may aid in the identification of malignant splenic lesions, particularly when accompanied by abdominal effusion and hepatic lesions.

Abdominocentesis and intra-abdominal pressure measurement in small animals.

To provide a video tutorial detailing how to perform "blind" and ultrasound-guided abdominocentesis for diagnostic and therapeutic guidance, and to provide a brief demonstration of intra-abdominal pressure measurement (IAP). Any cat or dog with suspicion of free abdominal effusion or patients requiring measurement of IAP. Abdominocentesis should be performed when there is high suspicion for peritoneal effusion based on physical exam and/or diagnostic imaging. The 4-quadrant tap uses 20-gauge or larger needles placed blindly in ≥ 1 of the 4 quadrants of the abdomen to collect abdominal fluid. In contrast, ultrasound allows visualization of fluid in the abdomen prior to percutaneous insertion of a needle and syringe to collect fluid. Regardless of collection technique, fluid should have immediate cytologic analysis and later can be submitted for biochemical parameters, additional cellular analysis by a pathologist, and culture and sensitivity (in rare cases if indicated). Intravesicular bladder pressure measurement using a manometer-urinary catheter system approximates the IAP when there is concern for organ hypoperfusion and compartment syndrome. Abdominocentesis can be performed with and without the use of ultrasound guidance. Intravesicular bladder pressure measurement is used to diagnose and trend IAP values before and after treatments are performed. Abdominocentesis is a simple and safe technique that all small animal clinicians should be comfortable performing. Effusion sampling can guide further diagnostics and treatments. Measurement of IAP is simple and requires no specialized equipment.

Efficacy analysis of letrozole combined with gonadotropin-releasing hormone antagonists in patients with high risk of ovarian hyperstimulation syndrome undergoing total embryo freezing

Objective: To investigate the clinical efficacy of letrozole combined with gonadotropin-releasing hormone antagonists (GnRH-ant) in patients at high risk of ovarian hyperstimulation syndrome (OHSS) who underwent total embryo freezing after oocyte retrieval. Methods: A retrospective analysis was conducted on 348 female patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive and Genetic Hospital of the First Affiliated Hospital of Zhengzhou University between January and July 2023. Due to their high risk of OHSS, these patients canceled fresh embryo transfer and opted for total embryo freezing. Based on patients' preferences, those who received GnRH-ant and letrozole after oocyte retrieval were categorized as the intervention group (164 cases), while those who did not receive these medications were categorized as the control group (184 cases). The first luteal phase after oocyte retrieval, OHSS grading, ovarian volume, and estradiol (E2) levels were evaluated in both groups. A multivariate logistic regression model was used to analyze factors related to moderate-to-severe OHSS among patients at high risk of OHSS who underwent total embryo freezing after oocyte retrieval. Results: The age of the intervention and control groups was (29.3±3.8) and (29.4±4.1) years, respectively (P=0.821). The duration of the first luteal phase post-oocyte retrieval was shorter in the intervention group [(7.16±1.39) days] compared to that in the control group [(13.88±2.11) days] (P<0.001). The incidences of mild, moderate, and severe OHSS in the intervention group were 75.0% (123 cases), 23.8% (39 cases), and 1.2% (2 cases), respectively, whereas in the control group they were 12.5% (23 cases), 60.9% (112 cases), and 26.6% (49 cases) (P<0.001). E2 levels on the 2nd and 6th days after oocyte retrieval [M(Q1,Q3)] in the intervention group were 1 520.0 (1 213.8, 1 884.8) and 108.5 (45.6, 218.0) ng/L, respectively, which were statistically significantly lower than those in the control group [1 666.0 (508.8, 1 702.0) ng/L] and [1 761.0 (826.0, 2 546.5) ng/L] (P<0.001). The abdominal cavity effusion in the intervention group [M(Q1,Q3)] were 19.5 (0, 30) and 0 mm, statistically significantly less than those in the control group [46.0 (0, 61.0) mm] and [54.5 (0, 69.5) mm] (P<0.001). On the 6th day after oocyte retrieval, the bilateral ovarian volumes in the intervention group were smaller than those in the control group (P<0.001). Multivariate logistic regression analysis indicated that no combined treatment with letrozole and GnRH-ant was a risk factor of moderate to severe OHSS. The risk of developing moderate to severe OHSS in the control group was 35.312 times higher than that in the intervention group (OR=35.312, 95%CI: 17.488-71.300). Conclusions: The administration of letrozole combined with GnRH-ant post-oocyte retrieval in patients at high risk of OHSS can prevent the occurrence of moderate-to-severe OHSS, shorten the first luteal phase, accelerate the reduction of serum E2 levels, and promote the recovery of ovarian volume and absorption of abdominal fluid.

Cytauxzoon brasiliensis sp. nov. (Apicomplexa: Theileriidae), a new species infecting a little-spotted-cat (Leopardus tigrinus) (Carnivora: Felidae) from Brazil.

Cytauxzoon spp. have been detected in Brazil infecting mainly asymptomatic domestic cats and wild felids. However, the supposed genetic similarity with the pathogenic Cytauxzoon felis is questionable because it is based on analysis of short sequences of the 18S rRNA gene. Herein, we describe a novel Cytauxzoon species infecting an asymptomatic little-spotted-cat (Leopardus tigrinus) based on morphological, histopathological, and molecular analyses. The animal was attended presenting a history of a run-over with multiple traumas. Although the little-spotted-cat was stabilized, he died a few days later. Ring-shaped merozoites within erythrocytes were found on blood smears and in the abdominal effusion. In addition, schizonts were observed in histiocytes in the liver. Phylogenetic analyses based on both near-complete 18S rRNA and cytb genes positioned the obtained sequences in a unique clade, albeit closely related to Cytauxzoon felis from the USA. Genetic divergences ranging from 0.004 and 0.067-0.068 were found between the near-complete 18S rRNA and cytb sequences of Cytauxzoon sp. detected in the little-spotted-cat and C. felis, respectively. This study evidenced the circulation of a novel Cytauxzoon species, herein named Cytauxzoon brasiliensis sp. nov., in an asymptomatic wild felid species from Brazil. Further studies are necessary to identify Cytauxzoon species from domestic and wild felids in the country.

Persistent response to combination treatment of pemigatinib and chemotherapy in a patient with advanced gastric cancer: A case report

AbstractObjectiveThis study aimed to report the treatment and outcomes of a patient with advanced gastric cancer (GC) using a combination of a targeted molecular therapy and chemotherapy.Patients and methodsA 40‐year‐old woman presented with abdominal metastatic nodules and peritoneal effusion. Biopsy and cytology identified signet ring cell carcinoma. Ten months after the onset of initial symptoms, gastroscopy confirmed signet ring cell carcinoma of the gastric body. Genetic testing revealed amplification of the fibroblast growth factor receptor (FGFR) gene. Consequently, the patient received FGFR inhibitor pemigatinib in addition to a chemotherapy regimen of albumin paclitaxel plus 5‐fluorouracil.ResultsDuring the treatment, the patient experienced recurrent liver function abnormalities and intestinal obstruction, which were managed with symptom‐specific medications and supportive therapies. The combined treatment regimen resulted in a progression‐free survival (PFS) period of ten months.ConclusionThe integration of FGFR inhibitor pemigatinib with standard chemotherapy showed promising results in prolonging PFS in a patient with advanced GC characterized by FGFR gene amplification, despite the occurrence of manageable side effects.

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report

BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of &lt; 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture. CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency &gt; 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection. CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.