Left Displacement Research Articles

Reoccurring Neck Injury in a College Football Player

HISTORY: A 20-year-old male community college football defensive end developed left shoulder paresthesia during a game. He was tackling an opponent and his head was forced into a left lateral rotation. After this, he developed immediate paresthesia in the left upper trapezius and upper deltoid. He was evaluated on the side line by medical staff and removed from the remainder of game. Symptoms resolved within the next two days, and he returned to competition. Two weeks later, he again had his head forced into a left lateral rotation during a tackle. Paresthesia immediately returned in the left upper trapezius and upper deltoid. However, this time pain was increased and had onset of a burning sensation. After sideline evaluation, he was removed from competition. Following the game, he continued to have severe burning pain. He was sent to a local emergency department and ultimately released home. Paresthesia resolved over the next five days, but he was not cleared to return to competition. PHYSICAL EXAMINATION: There was no deformity to the neck or upper extremity. No cervical or left shoulder tenderness to palpation. His range of motion in the left glenohumeral joint was full. Strength was full throughout the entire left upper extremity. Sensation to light touch was diminished in the left upper trapezius and upper deltoid, but normal throughout the remainder of the upper extremity. Deep tendon reflexes were 2+ in bilateral biceps, brachioradialis, and triceps. Spurling’s test was positive on the left. DIFFERENTIAL DIAGNOSIS: 1.Upper trunk brachial plexopathy 2.Cervical radiculopathy 3.Cervical stenosis TEST AND RESULTS: 1.Cervical spine anterior-posterior, lateral and flexion-extension radiographs: No fracture or destructive change, disc spaces preserved, no pathologic movement 2. Cervical Magnetic Resonance Imaging: Left paramedian/foraminal disc protrusion at C3-4 resulting in moderate left foraminal stenosis and displacement of left C4 nerve root. No spinal canal stenosis or ligamentous injury. FINAL WORKING DIAGNOSIS: Left C4 radiculopathy TREATMENT AND OUTCOMES: 1. Orthopaedic spine referral determined to treat with non-operative management 2. Physical therapy for cervical strengthening, flexibility, and traction 3. Currently being withheld from competition with undetermined return to play date

Changes of hematological and biochemical parameters and levels of pepsinogen, histamine and prostaglandins in dairy cows affected with left displacement of the abomasum.

The aims of this study were to determine the serum levels of pepsinogen, histamine, and prostaglandins F2α and E2 in lactating dairy cows affected with left displacement of the abomasum (LDA). In addition, the hematological and serum biochemical parameters were also determined in cows affected with LDA. A total of 52 adult lactating Holstein-Friesian cows affected with LDA and 30 normal cows (control) were used. In LDA cows, the average age, BCS and body weight were 4.9 ± 1.2 years, 2.5 ± 0.75, and 525 ± 150kg respectively. The average days-in-milk (DIM) in affected cows was 14 ± 6 with a range between 7 to 45 days. There were no significant differences in values of rectal temperature, heart rate and respiration rate between LDA cows and control. Rumen motility was significantly (p≤0.05) decreased in LDA cows. Cows affected with LDA had significantly (p≤0.05) increased glucose levels, and decreased levels of calcium and magnesium. There were significantly (p≤0.05) increased serum levels of pepsinogen and histamine in LDA cows while levels of prostaglandin E2 were significantly decreased in comparison to those in control cows. There were no significant changes in serum levels of prostaglandin F2α. In the hematology analyses, there were no significant changes in cows with LDA when compared to those in control cows. This study provides evidence of a possible role for pepsinogen, histamine and prostaglandin E2 in the etiopathophysiology of LDA in dairy cows.

Does Density Ratio Significantly Affect Turbulent Flame Speed?

In order to experimentally study whether or not the density ratio σ substantially affects flame displacement speed at low and moderate turbulent intensities, two stoichiometric methane/oxygen/nitrogen mixtures characterized by the same laminar flame speed SL = 0.36 m/s, but substantially different σ were designed using (i) preheating from Tu = 298 to 423 K in order to increase SL, but to decrease σ, and (ii) dilution with nitrogen in order to further decrease σ and to reduce SL back to the initial value. As a result, the density ratio was reduced from 7.52 to 4.95. In both reference and preheated/diluted cases, direct images of statistically spherical laminar and turbulent flames that expanded after spark ignition in the center of a large 3D cruciform burner were recorded and processed in order to evaluate the mean flame radius bar {R}_{f}left (t right ) and flame displacement speed S_{t}=sigma ^{-1}{dbar {R}_{f}} left / right . {dt} with respect to unburned gas. The use of two counter-rotating fans and perforated plates for near-isotropic turbulence generation allowed us to vary the rms turbulent velocity u^{prime } by changing the fan frequency. In this study, u^{prime } was varied from 0.14 to 1.39 m/s. For each set of initial conditions (two different mixture compositions, two different temperatures Tu, and six different u^{prime }), five (respectively, three) statistically equivalent runs were performed in turbulent (respectively, laminar) environment. The obtained experimental data do not show any significant effect of the density ratio on St. Moreover, the flame displacement speeds measured at u′/SL = 0.4 are close to the laminar flame speeds in all investigated cases. These results imply, in particular, a minor effect of the density ratio on flame displacement speed in spark ignition engines and support simulations of the engine combustion using models that (i) do not allow for effects of the density ratio on St and (ii) have been validated against experimental data obtained under the room conditions, i.e. at higher σ.

Prophylactic crystalloids or prophylactic crystalloids with ephedrine: Comparison of hemodynamic effects during caesarean section under spinal anaesthesia using 0.5% bupivacaine

Background: Spinal anaesthesia is usually chosen for caesarean section not only because of its faster onset and reliability but also because general anaesthesia is associated with more complications. However, hypotension is one of the most common complications of spinal anaesthesia in obstetric patients. Several measures have been devised to prevent hypotension, which include left uterine displacement, infusion of crystalloids before giving spinal anaesthesia (preloading) and administration of a prophylactic vasopressor. This study compared the hemodynamic effects of preloading crystalloids or crystalloids with ephedrine for caesarean section under spinal anaesthesia using 0.5% bupivacaine. Materials and Method: In this randomized, single blind, comparative clinical study, 80 parturients (American Society of Anesthesiologists grade 1) presenting for elective caesarean section under spinal anaesthesia were allocated to one of the two groups; group I received crystalloid preload and group II received crystalloid with ephedrine before spinal block. After institution of spinal anaesthesia in the lateral position with 2.0 ml (10 mg) of bupivacaine, 0.5% (heavy) using 25 G Quincke type spinal needle, parturients were made to assume a supine position with left lateral tilt. Heart rate, systolic blood pressure and diastolic blood pressure were monitored intraoperatively every 2 minutes till delivery and every 5 minutes after delivery. The amount of ephedrine used intraoperatively was also noted and compared among different groups. Results: Incidence of hypotension was 70% in the crystalloid group and 5% in the crystalloid with ephedrine group. This difference between the two groups was statistically significant (P < 0.001). The number of patients receiving rescue bolus of ephedrine was higher in the crystalloid group (40% before delivery and 30% after delivery) compared to crystalloid with ephedrine group (5% before delivery and none after delivery); the difference was statistically significant (P < 0.001). Sixteen patients (40%) in the crystalloid group experienced nausea compared to 6 patients (15%) in the crystalloid with ephedrine group; the difference was statistically significant with a P value of 0.012. Conclusion: This study demonstrates that prophylactic ephedrine given by infusion along with crystalloids is not only a simple and effective method for prevention of hypotension during spinal anaesthesia during elective caesarean section in ASA Grade I patients but also contributes to less incidence of intraoperative nausea and vomiting.

Particular cause of obstructive dyspnea in children

Dyspnea in infants and small children is a common symptom of addressability to a medical service. For a doctor, setting a diagnosis is challenging, because dyspnea can be a symptom in multiple conditions. The first step in establishing the diagnosis of dyspnea in children is explaining the mechanism (obstructive dyspnea, nonobstructive or “sine materia”). In the presence of an obstructive dyspnea, besides common causes (laryngitis, bronchiolitis, bronchial asthma, aspiration of foreign bodies), some mediastinal disorders should be evoked. We present the case of a one year and two month old male patient, presented for cough, expiratory dyspnea and wheezing, the presumed clinical diagnosis being acute bronchitis. Given that dyspnea was enhanced under treatment, a chest radiograph was performed, which revealed a homogeneous oval opacity occupying almost the entire right thorax. Thoracic CT revealed in the right lateromediastinal part a tumor with an apparently cystic form, with inner calcifications, with left displacement of the mediastinal structures. Thoracotomy with tumor excretion was performed, macroscopically seemed to be teratoma, microscopically confirmed. The child has undergone subsequent chemotherapy treatment with favorable evolution.

Use of Angle-Independent M-Mode Sonography for Assessment of Diaphragm Displacement.

Sonographic assessment of diaphragm displacement has conventionally been conducted with M-mode sonography via an anterior subcostal approach. This method is subject to measurement errors when diaphragm displacement is not in line with the M-mode plane. We aimed to compare measurements obtained by offline angle-independent (anatomic) M-mode sonography with conventional M-mode sonography. Fifty healthy adults were imaged with conventional and angle-independent M-mode sonography of the bilateral hemidiaphragms at 60% maximal inspiratory capacity using an inspiratory spirometer. Left hemidiaphragm displacement was successfully imaged by conventional M-mode sonography in only 70% (n = 35), as lung expansion obscured imaging, whereas 92% (n = 46) were assessable by angle-independent M-mode sonography. All right hemidiaphragm displacement could be assessed. Conventional M-mode results were higher than angle-independent M-mode results on the right (mean ± SD, 4.9 ± 1.4 versus 4.6 ± 1.2 cm, respectively; P= .003) and left (5.4 ± 1.3 versus 4.6 ± 1.0 cm; P < .001). Displacement values were different for right versus left hemidiaphragms on conventional M-mode sonography (mean difference, 0.6 ± 0.2 cm; P = .005), with only mild agreement (R2 = 0.35; P < .001). There was no laterality seen in the diaphragm displacement on angle-independent M-mode sonography (mean difference, 0.1 ± 0.1 cm; P = .47), with good agreement (R2 = 0.76; P < .001). Angle-independent M-mode sonography leads to better visualization and assessment of the left hemidiaphragm. It records lower displacement than conventional M-mode sonography in the bilateral diaphragms, likely because of fewer orientation and translation errors. Future study is indicated to assess the clinical utility of angle-independent M-mode sonography in a population with diaphragm dysfunction.

Effects of erythromycin on milk yield, rumen contraction rate and blood beta-hydroxybutyrate concentration in dairy cows after laparoscopic reposition of the left displaced abomasum

The objective of this study was to evaluate the beneficial effects of erythromycin (Emy), a prokinetic drug active at the level of the abomasum, duodenum and proximal duodenum, in dairy cows undergoing a laparoscopic repositioning of left abomasal displacement (LAD). A total of 71 German Holstein cows were randomly assigned into three groups. Cows of the group Emy1 received erythromycin once preoperatively (10 mg/kg; intramuscularly). Animals of the group Emy3 were additionally treated twice after surgery at intervals of 24 h each (10 mg/kg; intramuscularly), while cows in the control group did not receive erythromycin. The milk yield of the patients was documented on Days 0, 1, 2, 3, 6 and 10 and the rumen contraction rate (RCR) was determined on Days 1 and 3. Additionally, the measurement of the concentration of beta-hydroxybutyrate (BHB) in whole blood samples was performed on Days 0, 1 and 3. Significant differences between the study groups regarding the cure rates, milk yield (in relation to Day 0); BHB concentrations and RCR could not be determined on the observation dates. With respect to a prudent use of antibiotics in livestock, the application of erythromycin as a prokinetic drug cannot be recommended for the present in cows undergoing a laparoscopic correction of LAD.

Aortic Arch and Thoracic Aorta Curvature Remodeling after Thoracic Endovascular Aortic Repair

The objective of this study was to analyze the original curvature of the aortic arch and thoracic aorta, and how it is modified after the placement of a thoracic endograft. We retrospectively analyzed all patients primarily treated for thoracic aortic aneurysms and blunt traumatic aortic injuries by means of an endograft sealed into the aortic arch (zones, Z1-Z3) in 2 different centers (Vascular Surgery Division, Hospital Clinic, UB; and Vascular and Endovascular Surgery Department, Hospital Vall d'Hebron, UAB; Barcelona, Spain), between 2010 and 2015. The last preoperative and early (1-month) postoperative computed tomography angiography (CTA) was obtained for all cases, and an accurate 3-dimensional (3D) center lumen line was created, from the aortic valve to the renal arteries. Angles in 2-dimensional (2D; XY-plane) and 3D (referred to cranial-caudal Z-axis) were analyzed in: the distal ascending aorta, aortic arch, and thoracic aorta (at 5, 10, 15, and 20cm from the brachiocephalic trunk [BCT]) and celiac trunk (CT). Changes in preoperative-postoperative CTA were compared independently for both diseases. Thirty-six cases were included (20 aneurysms, 16 blunt traumatic injuries; mean age, 69.5 and 42.5years). After placement of an aortic endograft (sealed in Z1-Z2 in 30% of aneurysms and 75% of traumatic injuries; mean endograft length: 22.6cm and 11.3cm, respectively), a global left anterior displacement of the ascending aorta was observed (2D examination: -13.1° and -7.5°, P=0.049 and 0.041, respectively). The 3D examination showed an average increase of the aortic angle at 5 and 10cm from the BCT in the whole sample (+4.0°, +4.9° in reference to the vertical; P=0.017, 0.001), softening the curvature of the proximal descending thoracic aorta. In addition, in traumatic injuries, a decrease in the aortic arch angle was observed (-3.5°, P=0.030). Placement of an endograft into the aortic arch and proximal thoracic aorta engenders a softening of the proximal descending thoracic aorta curvature, increasing its angle from the vertical. In blunt traumatic aortic injuries (with shorter and more proximally sealed endografts), an additional decrease of the aortic arch angle (3.5° more vertical), was observed.

Comparative study of manual uterine displacement and wedge under right hip in prevention of supine hypotension syndrome in caesarean section under spinal anesthesia

Introduction: Supine hypotension syndrome results in signs of shock, by decrease in maternal blood pressure. This may result in life threatening complications in mother and fetus. To reduce the incidence of supine hypotension syndrome, few practices were recommended by authors in maternal positioning during C-section. Here in this study we are comparing hemodynamic stability between manual uterine displacement and wedge under right hip. Materials and Methods: 30 parturients were studied by left ward Manual Uterine Displacement (MUD), assigned as Group MUD. Another 30 parturients were studied by placing a 12 cm wedge under right hip (which gives 150 left lateral tilt), assigned as Group Wedge. Hemodynamic stability was assessed in between MUD and Wedge groups. Results: Systolic blood pressure was lower with wedge under right buttock or hip than Manual Uterine Displacement and it is statistically insignificant. Diastolic Blood pressure fall was almost similar in both the groups. There is a gradual fall in Mean Arterial Pressure in both groups, which is not significant. Heart rate was lower in Wedge Group when compared to MUD group but it was statistically insignificant. Conclusion: There is no much difference in Hemodynamic changes either by Manual uterine displacement or Wedge under right hip. Surgeons and patients feel more comfortable with Manual uterine displacement than Wedge under right hip, but anesthetists feel better with wedge because there is no need to hold the uterus continuously till delivery of the baby, so anesthesiologist can engage in patient monitoring and treatment.

Guttural pouch leiomyosarcoma causing nasopharyngeal compression in a pony

SummaryA 14‐year‐old Connemara cross gelding presented with abnormal respiratory noise and exercise intolerance. Upper airway endoscopy, ultrasonography, radiography and computed tomography revealed a large mass within the left guttural pouch causing marked left dorsal nasopharyngeal collapse and displacement and compression of the right guttural pouch. The horse was subjected to euthanasia and a post‐mortem examination confirmed the above findings. Histological and immunohistochemical examinations of the mass confirmed a diagnosis of guttural pouch leiomyosarcoma, a lesion previously unreported at this site.

Neusbloeden bij een zesjarig paard na fenylefrinebehandeling voor een dorsale colonverplaatsing over de milt-nierband

Een dorsale verplaatsing van het colon over de milt-nierband is een vaak voorkomende oorzaak van koliek bij het paard. Behandeling kan gebeuren door chirurgie, het rollen van het paard onder algemene anesthesie of door toediening van fenylefrine. Een behandeling met fenylefrine, een α1-adrenerge stof, geeft vaak aanleiding tot beven en zweten. Uit de literatuur blijkt dat vooral paarden ouder dan 15 jaar het risico lopen op een fatale bloeding in thorax of abdomen. Uitgaande van de veronderstelling dat het gebruik enkel risicovol is bij paarden ouder dan 15 jaar, wordt het product voornamelijk bij jongere paarden ingezet. In deze casuïstiek wordt echter een ernstige epistaxis bij een zes jaar oude Quarterhorse beschreven na intraveneuze toediening van 22,5 μg/kg LG fenylefrine.

19 Feasibility of native high-resolution 3D SSFP MR angiography for assessment of the thoracic aorta in pregnant subjects with familial aortopathies

<h3>Introduction</h3> Native magnetic resonance angiography (MRA) is recommended to assess the thoracic aorta during pregnancy, avoiding the risks of ionising radiation and contrast agent administration. This guidance is however, based only on consensus opinion supported by limited case reports (level of evidence C). <h3>Aim</h3> To evaluate the feasibility of performing native 3D steady-state free-precession (SSFP) MRA in pregnant subjects with inherited aortopathy to guide timing and mode of delivery. <h3>Methods</h3> Prospective patients (n = 15) with known thoracic aortic disease underwent native 3D-SSFP MRA at 1.5T (Avanto, Siemens) with high isotropic spatial resolution (1.3×1.3×1.3mm³) using a modified ECG-triggered sequence orientated in a sagittal-oblique plane, aligned along the aortic arch, with a respiratory navigator at the diaphragmatic level (slice thickness 2.00mm; TR/TE: 274/1.5ms). Subjects were imaged during “free breathing” adopting a “left uterine displacement” position, with a wedge under the right buttock, offloading the gravid uterus from the inferior vena cava. Aortic dimensions were measured at 7 levels by two independent blinded observers after an assessment of image quality (score 0–3: 0=poor, 3=excellent). <h3>Results</h3> Native 3D-MRA was successfully acquired in all subjects during the mid-trimester (20.6 ± 4.9wk). Subject characteristics and pregnancy outcomes are available in Table 1. Image quality was deemed excellent in 87% after a mean acquisition time of 3.1 ± 1.5min. Figure 1 provides a typical example of a 3D-MRA image. There was a high level of agreement for aortic measurements, with low intra- and inter-observer variability (ICC ranges; 0.95–0.99 and 0.92–0.96, respectively). All pregnancies reached term (≥37/40) with a mean gestation at delivery of 38.0 ± 0.5wk. Imaging surveillance in combination with satisfactory haemodynamic status permitted vaginal delivery in 60%. <h3>Conclusion</h3> Native SSFP MRA provides a robust and safe method to accurately measure the thoracic aorta in pregnant subjects with aortopathy, helping to inform decisions regarding the timing and mode of delivery.

Reducing the within-patient variability of breathing for radiotherapy delivery in conscious, unsedated cancer patients using a mechanical ventilator

Objective:Variability in the breathing pattern of patients with cancer during radiotherapy requires mitigation, including enlargement of the planned treatment field, treatment gating and breathing guidance interventions. Here, we provide the first demonstration of how easy it is to mechanically ventilate patients with breast cancer while fully conscious and without sedation, and we quantify the resulting reduction in the variability of breathing.Methods:15 patients were trained for mechanical ventilation. Breathing was measured and the left breast anteroposterior displacement was measured using an Osiris surface-image mapping system (Qados Ltd, Sandhurst, UK).Results:Mechanical ventilation significantly reduced the within-breath variability of breathing frequency by 85% (p < 0.0001) and that of inflation volume by 29% (p < 0.006) when compared with their spontaneous breathing pattern. During mechanical ventilation, the mean amplitude of the left breast marker displacement was 5 ± 1 mm, the mean variability in its peak inflation position was 0.5 ± 0.1 mm and that in its trough inflation position was 0.4 ± 0.0 mm. Their mean drifts were not significantly different from 0 mm min−1 (peak drift was −0.1 ± 0.2 mm min−1 and trough drift was −0.3 ± 0.2 mm min−1). Patients had a normal resting mean systolic blood pressure (131 ± 5 mmHg) and mean heart rate [75 ± 2 beats per minute (bpm)] before mechanical ventilation. During mechanical ventilation, the mean blood pressure did not change significantly, mean heart rate fell by 2 bpm (p < 0.05) with pre-oxygenation and rose by only 4 bpm (p < 0.05) during pre-oxygenation with hypocapnia. No patients reported discomfort and all 15 patients were always willing to return to the laboratory on multiple occasions to continue the study.Conclusion:This simple technique for regularizing breathing may have important applications in radiotherapy.Advances in knowledge:Variations in the breathing pattern introduce major problems in imaging and radiotherapy planning and delivery and are currently addressed to only a limited extent by asking patients to breathe to auditory or visual guidelines. We provide the first demonstration that a completely different technique, of using a mechanical ventilator to take over the patients' breathing for them, is easy for patients who are conscious and unsedated and reduces the within-patient variability of breathing. This technique has potential advantages in radiotherapy over currently used breathing guidance interventions because it does not require any active participation from or feedback to the patient and is therefore worthy of further clinical evaluation.

Evaluation of Clinical, Serum Biochemical and Oxidant-antioxidant Profiles in Dairy Cows with Left Abomasal Displacement

Evaluation of Clinical, Serum Biochemical and Oxidant-antioxidant Profiles in Dairy Cows with Left Abomasal Displacement

Associations between pregnancy-associated glycoproteins and pregnancy outcomes, milk yield, parity, and clinical diseases in high-producing dairy cows

Pregnancy-associated glycoproteins (PAG) are produced by the ruminant placenta and secreted into the maternal circulation throughout pregnancy. The extent to which circulating PAG concentrations predict pregnancy outcomes was examined herein. Also, associations between circulating PAG concentrations and various production parameters and clinical diseases were evaluated. Lactating primiparous and multiparous Holstein cows (n=345) were bred via timed artificial insemination using a standard Ovsynch protocol. Pregnancy was diagnosed by transrectal ultrasonography at d 32, 46, and 74 of gestation. Blood was harvested at d 32 to determine plasma concentrations of PAG and progesterone. Cows pregnant at d 32 that subsequently lost their pregnancy at d 46 and 74 had reduced PAG concentrations. Both artificial insemination service number and parity were associated with plasma PAG concentrations. Concentration of PAG in plasma was greater for cows pregnant from their second or later breeding than those pregnant from the first breeding postpartum, and was increased for primiparous compared with multiparous. In addition, cows with greater milk yield had increased plasma PAG concentrations. No association was detected between body condition score and plasma PAG concentrations. Cows that experienced clinical metritis, metabolic problems, or left displacement abomasum in the early postpartum period preceding breeding had greater plasma PAG concentrations than cows not experiencing these clinical diseases. Also, cows with multiple clinical diseases had increased odds of pregnancy loss when compared with cows not experiencing clinical diseases. Odds ratio testing detected a tendency in the relationship between reduced milk yield and increased pregnancy loss. Collectively, these associations illustrate one feature of the early developing placenta that may predict pregnancy outcomes in dairy cattle. It is unclear if plasma PAG are actively involved with mediating pregnancy outcomes, but modifications in circulating PAG concentrations due to pregnancy loss, milk yield, parity, and clinical disease implicate placental PAG production or PAG release as being responsive to various physiological stimuli.

How to Manage Allergic Reactions to Contrast Agent in Pregnant Patients.

This article reviews optimal treatment of allergic reactions to iodinated contrast material in pregnant patients. Initial evaluation and treatment of a pregnant patient is similar to that for a nonpregnant patient. However, additional steps, including assessment for uterine cramping, using left uterine displacement to improve venous return, and maintaining blood pressure to ensure placental perfusion, may be required. Adequate preparation and a team approach will provide optimal care for a pregnant patient who has an allergic reaction to a contrast agent.

Hematological and Biochemical Evaluation in Holstein-Friesian Cows Before and After Surgical Correction of Left Abomasal Displacement on-Filed Condition

Left abomasal displacement (LAD) is a major disorder occurring in the postpartum period and causes confusion with metabolic diseases in high producing dairy cattle. Surgical correction of abomasal displacement is the most reliable method of treatment. This study aimed to evaluated some hematological and biochemical parameters before and after right omentopexy correction of LAD as well as evaluation of short and long term outcomes after surgery. The study included 85 lactating dairy cows (Holstein-Friesian) with LAD treated surgically with right omentopexy technique (LAD group) and 20 healthy dairy cows at 2-6 week postpartum (control group). In LAD group, the blood samples were collected before surgery (d0), after 3 days (d3) and 7 days (d7) post-surgery. Each sample was analyzed for complete blood count (CBC), serum total protein (TP), albumin (AL), globulin (GL), triglycerides (TG), cholesterol (CL), hepatic enzymes (AST, ALT, GGT), Alkaline Phosphatase (AP), C-reactive protein (CRP) and serum electrolytes as Na and K using commercial available test kits. There were significant hemoconcentration, anemia, and leukopenia with neutropenia in d0 in comparison to control group. Furthermore, there were hypoalbuminemia, hyperglobulinemia, significant decrease in serum triglycerides and cholesterol concentrations in cows at d0. There was significant increase in ALT, AST, GGT, AP and CRP while there were hypokalemia and hyponatremia in cows with LAD at d0. Hematological, biochemical, hepatic function alterations, and inflammatory reaction in LAD cows were relieved after 3 days of surgical correction indicating that these cows were restoring their baseline physiological status and all cows were cured after one week of operation without any incisional complications (short term outcomes). The long term outcomes was also impressive as 94.1% were still alive in a good health condition without recurrent abomasal displacement, and 60% was confirmed to be pregnant within first three months follow up after surgical correction.

Extreme left diaphragm displacement in the context of a tension pneumothorax after cardiac surgery

Extreme left diaphragm displacement in the context of a tension pneumothorax after cardiac surgery

Late Perimortem Cesarean Delivery: An Ethical Challenge

Systematic review of the cases describing the management of cardiac arrest during advanced pregnancy enhanced our understanding of Cardiopulmonary Resuscitation (CPR) in these women [1]. The application of effective left lateral uterine displacement and incorporating the 4-minute rule to perform Perimortem Cesarean Delivery (PCD) during a CPR has saved the lives of many foetuses and mothers in hospital settings [2]. On the other hand, CPR during outof-hospital cardiac arrest in advanced-pregnancy still poses a major challenge to Emergency Medical Technicians (EMTs) responding to a call. The maternal and fetal outcome is mostly very poor in such cases [3].

Sola Abomasum Deplasmanında Modifiye Perkütan Paramedian Abomasopeksi: Saha Şartlarına Uygun Güvenilir Bir Cerrahi Teknik

Amaç: Perkütan paramedian abomasopeksi işlemi, sola abomasum deplasmanı vakalarının tedavisinde, saha şartlarında sık başvurulan tekniktir. Kör dalış şeklinde gerçekleştirilen bu tekniğin en korkulan komplikasyonu, işlem sırasında bir barsak segmentinin ya da omentumun karın duvarı ile abomasum arasına sıkıştırılması ya da perfore edilmesidir. Bu çalışmada; perkütan paramedian abomasopeksi işleminde, bu komplikasyonları gidermeye yönelik modifikasyonlar kurgulanmış ve bunların ne derece etkili olduğu araştırılmıştır. Gereç ve Yöntemler: Mehmet Akif Ersoy Üniversitesi Veteriner Fakültesi Cerrahi Kliniğinde ?sola abomasum deplasmanı? tanısı konulan 15 Holstein ırkı inek kullanıldı. Cerrahi tedavisinde Grymer ve Sterner tarafından tanımlanan perkütan paramedian abomasopeksi yöntemi modifiye edilerek kullanıldı. Abomasopeksi işleminin ultrasonografik görüntüleme rehberliğinde gerçekleştirilmesi, Grymer ve Sterner?in kullandıkları trokar yerine daha ince çaptaki bir deflasyon kanülünün tercih edilmesi ve abomasopeksinin tek toggle pin ile sağlanması söz konusu modifikasyonları oluşturdu. Vakaların tamamında postoperatif 13. Günde abomasopeksi dikişi uzaklaştırıldı. Bulgular: Yuvarlama sonrasında abomasum ve karın duvarı arasında iki inekte omentumun, 1 inekte ise barsak segmentinin bulunduğu ultrasonografik olarak gözlendi. Bu olgularda yuvarlama işlemi tekrar edilerek ve bölgeye dışarıdan masaj uygulayarak omentumun veya barsak segmentinin bölgeden uzaklaşması sağlandı. Tüm olguların abomasumuna ultrasonografik görüntü rehberliğinde deflasyon kanülü ile girilerek bir adet toggle pini yerleştirildi. Postoperatif 45 günlük izleme süresinde herhangi bir komplikasyon veya nüks ile karşılaşılmadı. Sonuç: Perkütan paramedian abomasopeksi yönteminin, ultrasonografik görüntüleme eşliğinde uygulanması durumunda daha güvenli olabileceği kanısına varıldı.