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Introduction Heart failure (HF) is a risk factor for postoperative mortality in major non–cardiac surgery. Collaboration between the Multimodal Preoperative Prehabilitation unit (MPP) and Heart Failure Clinic (HFC) could allow optimization of heart failure therapy and negative prognostic factors such as reduced functional capacity (FC), malnutrition, and sarcopenia to improve the prognosis of these patients. Case report: Mrs. C.M. is a 58–year–old patient who presents to the MPP unit in anticipation of total colectomy for drug–refractory ulcerative colitis. Mrs. C.M. has a past medical history significant for heart failure with reduced ejection fraction (EF 25%) of presumably valvular–arrhythmic etiology. She underwent tricuspid annuloplasty and mitral replacement surgery some years ago and is affected by atrial fibrillation. At the MPP unit, Mrs. C.M. had a reduced FC and was malnourished and sarcopenic. Blood tests showed iron deficiency anemia. Heart failure therapy (NYHA II) was not optimized according to guidelines. Therefore, the patient started multimodal prehabilitation consisting of aerobic and resistance exercise, nutritional intervention, intravenous iron infusion, and optimization of HF therapy. After the patient was evaluated at the HFC, she started empagliflozin, sacubitril/valsartan, and ranolazine; intermittent levosimendan therapy was also performed. She also underwent cardiac NMR, which showed non–ischemic fibrosis, and coronary angiography, which was negative. Finally, she underwent PM–ICD implantation. After six months of multimodal prehabilitation, there was an increase in EF (38% vs. 25%), a reduction in NT–proBNP (700 vs 4988 pg/mL), and mitigation of HF symptoms. There was also a marked improvement in FC (383 vs 269 meters at 6–minute walking test), nutritional status (stage B vs stage C at PG–SGA test), and muscle strength (handgrip strength test 14.6 vs 8.5 kg). Considering the excellent preoperative optimization response, it was decided to proceed with surgery after a collegial discussion (anesthetist, heart failure cardiologist, surgeon, and patient). Conclusions Multimodal preoperative prehabilitation, based on the collaboration between the Multimodal Preoperative Prehabilitation Unit and Heart Failure Clinic, can effectively improve the preoperative functional capacity of HF patients.

The use of deslorelin implants to control reproduction in cats is increasing but because of its prolonged duration, cat breeders often request implant removal before the end of the treatment. Assaying Anti Mullerian Hormone (AMH) concentrations might be useful to predict time of resumption of ovarian activity in deslorelin-treated queens following implant removal. In queens a minimum of 3 weeks during increasing photoperiod after implant removal has been described for resumption of ovarian activity but no information about AMH concentrations were observed for determining ovarian activity.Sixteen queens in which deslorelin implants were surgically removed after 3, 6 or 9 months (n = 6, 4 and 6 queens, respectively) were used in this study.A general and reproductive health check with a GnRH stimulation test were performed before the treatment. After implant removal queens were checked every 1-2 weeks with reproductive ultrasonography, a vaginal smear and blood collection to assay AMH concentrations.AMH concentrations decreased significantly at the end of the treatment to ≤ 2.5 + 0.6 ng/ml (p ≤ 0.05) and reached a nadir at 1.9 ± 0.9 (p 0.05) one-week post-removal. Following implant removal AMH concentrations started to rise reaching a value of 3.9 ± 0.7 ng/ml on the third week and were not different from pre-treatment levels on week 6 post-removal (5.8 ng/ml + 0.9, p ≥ 0.05). AMH values did not differ depending on duration of deslorelin treatment but were lower in adult queens (p 0.05).AMH assay can be a useful tool to follow resumption of feline ovarian function following a deslorelin treatment.

Background Multidrug-resistant zoonotic pathogens represent a risk for human health. The irrational use of antibiotics in production animals has contributed to the spread of antibiotic resistance (AMR) also in humans. The search for alternative systems to the use of antibiotics, including the study of ‘animal welfare-friendly' management tools, should be encouraged. The reduction of the use of antibiotics should be a controlled process, as their absence could have a negative impact on animal welfare, if not accompanied by adequate structural and managerial interventions. Methods Welfare Quality® protocol was used to measure the level of welfare in 14 batches of broiler chickens from 6 farms of an integrated poultry company and the results were compared (antibiotic-free vs conventional). The number of animals per batch ranged from 9,000 to 41,700. Assessments were made throughout a 9-month period, from 2018 to 2019, at-farm the day before slaughtering (age from 42 to 48 days old). Results No statistically significant differences between antibiotic-free and conventional in the general ‘welfare score' were reported. Stocking density was higher in antibiotic-free batches, and the ‘good feeding' principle was averagely higher in conventional batches (74.7 vs 63), with statistical significance (t=-2.45; p < 0.05). Other welfare principles (good housing, good health and appropriate behaviour) were slightly higher for antibiotic-free batches, without statistical significance. The absence of antibiotics did not affect the ‘good health' principle, ranging from 24.1 to 44.7, with the minimum in a conventional batch and the maximum detected in an antibiotic-free batch. The highest mortality (3.9%) was found in a conventional batch. Conclusions The absence of antibiotics in broiler farming doesn't affect animal health and welfare if associated with good management practices. Antibiotic-free farming should be standardized in order to protect both animal welfare and consumers' health. Key messages The absence of antibiotic use does not impact on broiler chicken general welfare score. High stocking density due to the high demand of antibiotic-free meat should be avoided and specific guidelines for antibiotic-free farming should be produced.

Coronal alignment in TKA poses two main questions. First, whether the jointline has to be perpendicular to the tibial axis or it should follow the anatomy and consequently be 2–4° oblique in varus. Second, if the final mechanical axis has to be neutral (0°) or follow the anatomy and have a consequent ipocorrection in varus or in valgus, depending on morphotype.

Sixty different types of human papillomavirus (HPVs) have been isolated and characterized by molecular cloning in becteria (1). Animal models and pathological studies suggest an estiological role of HPV infection in the development and etiological role of HPV infection in the development of intraepithelial neoplasia and squamous cell carcinoma, particularly in the anogential tract, in the larynx and in edidermodysplasia verruciformis(2,3,4).

Resume La transplantation d’organes peut occasionner, dans un nombre non negligeable de cas, des troubles psychologiques. Cet article, qui se concentre sur la greffe cardiaque, avance quelques pistes pour interpreter certains de ces troubles relates par la litterature medicale et psychopathologique. Il s’agira ici de mettre en lumiere, grâce a la notion d’image du corps, le reseau de liens qui se tisse entre le vecu corporel et le developpement ou le maintien de l’identite personnelle. Il sera ainsi question des limites anthropologiques et ethiques d’une comprehension exclusivement mecaniste de l’etre humain qui peut affecter aussi bien le patient que l’efficacite therapeutique eu egard notamment a la qualite de vie dans la periode post-greffe.

Acute kidney injury (AKI) represents 18-47% of all causes of hospital-acquired AKI and it is associated with a high incidence of morbidity and mortality especially in patients requiring dialysis. Only recently, with the application of new AKI classifications and guidelines (RIFLE, AKIN and KDIGO), a more accurate evaluation of the real incidence of kidney dysfunction in patients undergoing surgery has been detailed. In patients undergoing non-cardiac, non-vascular and non-thoracic surgery several independent preoperative and intraoperative predictors of AKI have been identified. Nonetheless, no measure for AKI prevention reached a high level of recommendation, although hemodynamic monitoring and goal-directed fluid management may limit perioperative AKI. Cardiac surgery-related AKI and cardiopulmonary bypass-related AKI have been extensively evaluated and several preventive and treatment strategies have been developed. Open and endovascular surgery-related AKI have been compared and hydration is currently the only preventive strategy with a substantial level of efficacy. In addition, AKI in thoracic surgery, overlooked in the past, has been evaluated, showing that it frequently complicates postoperative course of patients undergoing elective lung cancer resection. Multi-hit mechanisms (ischemia, inflammation, toxins) co-act on patients' predisposition (susceptibility). A multi-step approach is probably necessary to limit the incidence and the severity of postsurgery AKI patients, such as careful risk stratification, adoption of preventive measures and goal directed intraoperative algorithms. The present review will summarize the current literature about the epidemiology of postoperative AKI focusing on patient-related and technical-related risk factors, outcome and prevention strategies in different groups of surgeries.

Bovine beta-lactoglobulin (beta-LG) is a widely studied protein belonging to the lipocalin family, whose structural characterisation has been reported by X-ray crystallography and NMR studies at physiological and acidic pH, respectively. Bovine beta-LG consists of nine antiparallel beta-sheets and a terminal alpha-helix segment. The beta-sheets form a calyx structure with a hydrophobic buried cluster conferring stability to the protein while a hydrophobic surface patch provides stabilising interactions between the barrel and the flanking terminal helix. Here, the stability and the folding properties of bovine beta-LG in the presence of a chemical denaturant is probed. The analysis of the NMR spectra recorded in aqueous solution with increasing amounts of urea revealed that the intensities of the backbone cross-peaks decrease upon increasing urea concentration, while their secondary shifts do not change significantly on going from 0 to 5 M urea, thus suggesting the presence of slow exchange between native and unfolded protein. Hydrogen exchange measurements at different urea concentrations were performed in order to evaluate the exchange rates of individual backbone amide protons. The opening reactions that determine protein exchange can be computed for the most slowly exchanging hydrogen atoms, and the measured exchange rates and the corresponding free energies can be expressed in terms of the equilibrium energetic for the global transition and the local fluctuations. Most of the residues converge to define a common isotherm identifying a unique cooperative folding unit, encompassing all the strands, except strand betaI, and the terminal region of the helix. The amides that do not join the same global unfolding isotherm are characterised by low DeltaGH20op and especially by low m values, indicating that they are already substantially exposed in the native state. A two-state unfolding model N U is therefore proposed for this rather big protein, in agreement with CD data. Renaturation studies show that the unfolding mechanism is reversible up to 6 M urea and suggest a similar unfolding and refolding pathway. Present results are discussed in light of the hypothesis of an alpha-->beta transition proposed for bovine beta-LG refolding.

Summary The results of a two-year treatment with α-dihydroergokryptine mesylate (DEK) carried out in 142 (43 male, 99 female; aged 63–83) demented patients (DAV.I.D.E., DAVERIUM ® Italian Dementia Evaluation), are presented here. The study design included a 1-month run in placebo phase, a 1-year in double-blind condition either with a-dihydroergokryptine or placebo, and a further 1-year (open phase) with DEK. For assessing clinical efficacy the Gottfries-Brne-Steen (GBS) rating scale for dementia (primary variable) and the mental deterioration battery (MDB) (secondary variable) were used. Analysis of variance on efficacy variables and summary measures was performed using age and illness duration as covariates. The safety analysis was carried out monitoring vital signs, adverse events and routine laboratory tests. Seventy out of 142 patients were previously treated with DEK and 72 with placebo; 109 patients completed the study, 33 patients dropped out. The patients previously treated with DEK maintained their clinical conditions observed at the end of the double-blind phase; the patients previously treated with placebo improved the motor (GBS score: −33 %), intellectual (−26 %) and emotional (−24 %) functions, and the neuropsychological performances (MDB scores), the difference between the paired samples being significant. Four patients (2.8%) had adverse events, requiring drug suspension in two cases. The results indicate that DEK treatment might slow down the progression of the disease as documented by both functional and neuropsychological parameters. Safety was very good, indicating that the drug is suitable for long-term treatments.

Three captive female common seals (Phoca vitulina vitulina) were monitored ultrasonographically during five pregnancies. Pregnancy was diagnosed in the third month and fetal monitoring was continued until parturition. The ultrasound measurements were made with the active collaboration of the animals by training them to cooperate with the procedure.

The incidence of gastric metastasis is 2.6%. Although all primary neoplasms can metastasize to the stomach, most originate from melanoma or breast and lung cancer. Their most common endoscopic appearance is a "volcano-like" polypoid mass covered by normal mucosa that may show a central ulceration. Renal cell carcinoma, clear cell type, is known to spread hematogenously, and isolated metastasis to the stomach is a rare event.In this report, we describe a gastric recurrence of RCC, clear-cell type, in a 80-year-old patient who had undergone nephrectomy 20 years before. We also performed a brief review of the literature to update the number of cases described to date.Metastatic involvement of the stomach should be suspected in any patient with a previous history of renal cell carcinoma, clear cell type, presenting with gastrointestinal symptoms, even if many years after nephrectomy. The peculiarity of our case is due to the very late presentation of the gastric metastasis. Only two cases of very late gastric metastases from RCC, clear cell type, have been described in the literature, to date.

Leiomyomatosis peritonealis disseminata (LPD) is a rare smooth muscle tumour characterized by multiple small nodules on the omentum and peritoneal surface, composed of benign smooth muscle cells with minimal mitotic activity, frequently admixed with decidual cells. The possible pathogenetic mechanisms include hormonal dysfunction, differentiation of subperitoneal mesenchymal stem cells, myofibroblastic metaplasia and genetic and iatrogenic causes (resection of myomas during laparoscopic surgery). Diagnosis is easily made on biopsy specimens. Reduction of oestrogen exposure, surgical castration or gonadotrophin releasing hormone agonists are generally sufficient to cause regression of LPD. We report a case of an asymptomatic 36-year-old pregnant woman with long-term use of oral contraceptives, and previous myomectomy, who had a mass of uncertain origin which was, histopathologically, diagnosed as leiomyomatosis peritonealis diffusa with foci of ectopic decidua. Ectopic decidua was also present in a pelvic lymph node. To the best of our knowledge, this is the first case of LPD containing foci of ectopic decidua in a pregnant woman with a past history of myomectomy and use of oral contraception for three years; ectopic decidua was also detected in a pelvic lymph node.

Laryngeal chondrosarcomas are rare tumours that account for less than 1% of all sarcomas and originate principally from the crycoid cartilage. We report two cases: the former arising from thyroid cartilage in an 85-year-old male presenting with a palpable neck mass and hoarseness, dyspnoea and dysphagia; the other in a 54-year-old male with a mass growing from crycoid cartilage, who underwent biopsy followed by total laryngectomy. We discuss the peculiarity of the site of origin and the role of biopsy, the clinical presentation of the former case and the diagnostic and therapeutic procedures of the latter. Since it is a rare form of sarcoma arising in the larynx, we discuss the role of biopsy as a crucial although still controversial diagnostic tool.

The authors investigated by PCR 138 infiltrating cervical adenocarcinoma (27 grade 1, 76 grade 2, and 35 grade 3) for the presence of human papillomavirus (HPV) 16 and 18 infection. They included 95 (68.8%) mucinous and 43(31.2%) non-mucinous tumors. The overall prevalence of HPV infection was 84.8%; 28.3% of the cases were positive for HPV 16, 29.7% for HPV 18, and 26.8% for both HPVs. Amplification of HPV 16 and 18 negative cases with consensus primers MY09/MY11 failed to yield any additional tumors with HPV DNA sequences. Patients with HPV infection were younger than the patients who were HPV-negative (P = .001). The type of HPV was unrelated to age. Human papillomavirus infection was found in 95.8% mucinous and in 60.5% non-mucinous tumors (P < .001), with even distribution among grade 1, 2 and 3 adenocarcinoma. Our findings confirm the key role of HPV 16 and 18 in the development of cervical adenocarcinoma, particularly in mucinous histotypes. The absence of HPV infection, the old age of patients and the non-mucinous differentiation may identify a subset of cervical adenocarcinoma with different etiopathogenesis.

During the past few years, it has become evident that metabolic control is a major determinant of postoperative outcomes, not only for diabetic patients but for all patients undergoing surgery. In cardiac and vascular surgery, myocardial ischemia is a common challenge and the management of hyperglycemia should be part of the strategy aimed at optimizing cardiac protection during these types of surgery, since performed in high risk patients. Little informations are available on the relation between glucose substrate and the type of anesthesia and few studies have been performed on glucose metabolism in the perioperative risk assessment as well as on intraoperative and post surgical management of hyperglycemia in patients submitted to cardiac and vascular surgery. Evidence exists that even slight increased in glycemia are detrimental for patients (diabetic and non) elective for cardiac and vascular surgery, though the precise details of the timing of insulin therapy, the desired target serum glucose level, and the duration of therapy are so far to be completely elucidated. Anesthestiologists can therefore affect outcome by simply preserving a normal blood glucose concentration initiating in the operating room. The challenge to optimize glucose control should begin during preoperative evaluation.

Experimental models indicate that activated ras genes and HPV oncogenic sequences may cooperate in inducing a completely transformed phenotype in epithelial cells. We searched for K-ras gene mutations and HPV type-16 and -18 sequences in 67 primary adenocarcinomas of the uterine cervix by analyzing DNAs from formalin-fixed, paraffin-embedded tissue samples. Target sequences were amplified by PCR and analyzed by denaturing gradient gel electrophoresis (DGGE) and sequencing for the detection of K-ras gene mutations and by Southern blotting for the detection of HPV infection. We found 16 mutations in 15 cases; 14 were at codon 12 and 2 at codon 13; 11 were base transitions and 5 were transversions. Mutations were more frequent in mucin-secreting than in non-mucinous tumors. HPV oncogenic sequences were detected in 58 cases with no significant difference between K-ras-mutated and wild-type tumors. HPV oncogenic sequences were also more frequent in mucin-secreting than in non-mucinous tumors. Both molecular events were present simultaneously in 13 out of 58 cases, all of which had histologically grade-2 and grade-3 tumors. Clinico-pathological parameters of the disease and the overall survival, however, were independent of K-ras mutations and of HPV-16 and -18 infection, as shown by univariate and multivariate analysis. In contrast, stage of disease, lymph-node metastases, deep infiltration, clear-cell histology and low grade of differentiation were risk factors for tumor-related death. © 1995 Wiley-Liss, Inc.

Frequency and pattern of expression of eight markers of gastric, intestinal, and pancreatobiliary duct epithelial cells have been investigated by histochemical and immunohistochemical techniques in 85 cases of cervical adenocarcinomas. M1, a mucin antigen, and Cathepsin E (CaE), an aspartic proteinase, markers of normal gastric superficial/foveolar epithelial cells, are expressed in 40 and 55 tumors, respectively. Periodic acid-concanavalin A-reactive mucin or Pepsinogen (PG) II, markers of gastric mucus neck and pyloric gland cells, are found in 24 tumors, 13 of which also express M1 and CaE. CAR-5 and M3SI, markers of intestinal mucin, are expressed in 68 and 12 tumors and DU-PAN-2, marker of normal pancreatobiliary duct cells, is found in 46 tumors. All but two tumors express at least one of the eight markers studied, none express PG I, marker of gastric chief cells. The different histologic subtypes of cervical adenocarcinomas expressed to a variable degree both gastrointestinal and pancreatobiliary markers. Only endocervical type tumors, however, showed the full spectrum of mucosal pyloric type differentiation, including the expression of PGII which is not present in any other histotype. A correlation between expression of gastroenteropancreatic markers and tumor grade is not apparent in our series.

A 11-year-old, spayed, female mixed breed-dog was presented with an abdominal mass that was detected 1 month ago. Upon abdominal palpation a large, firm, oval shaped, movable mass was found in the mid-abdominal region. Survey radiograph of the abdomen demonstrated an oval soft tissue dense mass located on the right side of the abdominal cavity. A large, heteregenous and cystic mass with solid components occupying the majority of the abdomen and a small, cystic mass with solid components caudal to the left kidney were identified by transabdominal ultrasonography. Computed tomography scans revealed bilateral ovarian masses, and a small volume of retroperitoneal fluid on the right side. A cystic, but otherwise solid mass located in the right ovary and small retained left ovary encapsulated in the ovarian bursa were excised surgically by midline laparotomy. Histopathological examination of the excised mass from the right side revealed a large cystic structure consistent with an ovarian cyst and multiple corpora lutea and follicles at different maturational stages were detected in the left ovary. The precise origin of the ovarian cyst could not be determined by morphological appearance. Immunohistochemical staining suggested a cyst of surface epithelial origin. At re-examination 6 months after the surgery, the bitch appeared healthy and the clinical findings were all normal. To our knowledge, the cyst described here is the largest reported in an incompletely ovariohysterectomized bitch.

Although, until now, there is no evidence for an improved outcome of critically ill patients by measurement of cardiac output, the estimation of flow, other than pressure, is considered of high importance in the management of patients in the perioperative period and in critical care as it provides valuable insights into systemic oxygen delivery (DO2) and global tissue perfusion that can be used to optimize treatment strategies.

Extracranial meningiomas of the head and neck region are rare neoplasms, the majority being a secondary location of a primary intracranial tumour. We herewith report three rare cases of extracranial meningiomas, located in the temporal muscle, parotid gland and nasal cavity, together with complete pathological, immunohistochemical and ultrastructural studies. Prognosis of this tumour is generally excellent. Surgical excision is the treatment of choice, with no need for further treatment; nevertheless, differential diagnosis must consider other more common tumours of the head and neck and be based on histopathologic examination and relative techniques, including examination of frozen sections. This procedure is particularly useful assessing surgical treatment and should be performed whenever possible to exclude the malignant nature of the lesion and avoid over-treatment. All three patients underwent surgery and are alive and disease-free.RIASSUNTOI meningiomi extracranici della regione testa-collo sono neoplasie rare, dal momento che la maggior parte di esse risulta essere una localizzazione secondaria di un tumore primitivo intracranico. Vengono di seguito descritti tre casi clinici di meningioma extracranico localizzati nel muscolo temporale, nella ghiandola parotide e nella cavità nasale. L'asportazione chirurgica è il trattamento di elezione e la prognosi di questo tipo di neoplasia è generalmente eccellente. Per la diagnosi differenziale istopatologica di queste neoplasie è necessario considerare i tumori più comuni della regione testa-collo. In particolare l'esame istopatologico perioperatorio è molto utile nell'indirizzare il trattamento chirurgico e dovrebbe essere sempre eseguito per escludere la natura maligna della lesione evitando un "over-treatment". I nostri pazienti sono stati sottoposti ad intervento chirurgico e sono attualmente in buono stato di salute dopo il trattamento.

Clinical investigation of canine testicular function is complicated by the difficulty in the evaluation of seminiferous tubules. Until recently, testicular biopsy was the only diagnostic option for dogs with persistent oligo/azoospermia. In human andrology, testicular fine needle aspiration (TFNA) is currently considered a useful method in the evaluation of azoospermia and severe oligozoospermia, and has long replaced classical biopsy to evaluate spermatogenesis. In order to verify its diagnostic efficacy for the clinical approach to canine oligo- or azoospermia, TFNA was performed in seven adult (two oligozoospermic and five azoospermic) dogs. After sedation, a fine (21-23 gauge) butterfly needle connected to a 50-ml syringe was inserted into each testicle; strong suction was applied and the aspirated fluid squirted on a glass slide, smeared out, air-dried and stained with a modified May-Grunwald-Giemsa. Under light microscopy, Sertoli cells (all those found in each investigated field) and spermatogenic cells (n = 100) were counted on each smear in order to differentiate spermatogonia, primary spermatocytes, secondary spermatocytes, early spermatids, late spermatids and spermatozoa, and calculate their relative percentages. Cytological analysis showed the following testicular pictures: normal spermatogenesis (compatible with obstruction of the seminal ducts), hypospermatogenesis, maturative disturbances and Sertoli cell-only syndrome. Two dogs with an obstructive lesion were treated with corticosteroids; one of them recovered and sired two litters of puppies.

Locoregional thrombolytic therapy has emerged in the last years as the treatment of choise for iliofemoral deep vein thrombosis, preserving the structural and functional integrity of vein walls. We studied the efficacy and complication rates of direct regional thrombolytic therapy in acute venous thrombosis of lower extremities.Between January 2002 and March 2007, 8 selected patients with acute extensive and symptomatic iliofemoral or femoral-popliteal venous thrombosis were treated with flow-direct regional thrombolytic therapy. We used a direct regional infusion of urokinase into the deep venous system ( 100.000 U al presentation, then 75.000 U/ h) from an ipsilateral dorsal foot vein . Simultaneously the superficial venous system was collapsed with elastic limb compression while administering subtherapeutic heparin doses of 300-400 U/h. All patients underwent routine venous duplex imaging at day 1, 2, 30 and after 3, 6 and 12 months. Data including clinical conditions and laboratory values (fibrinogen, hematocrit, haemoglobin, platlets and prothrombin time) were obtained throughout the infusion time. Results. Procedural success was achieved in all patients (100%). Complete recanalization, patency and continence of venous system documented at the echocolorDoppler control, were obtained in 48 hours, with symptom remission. Mean infusion time was 37.5 hours (28-48 hours). Neither major bleeding complications nor pulmonary embolisms occurred during the treatment. At day 30 venous patency and incontinence and long-term symptom resolution were achieved in all patients, as well as at 3, 6 and 12 months.Loco-regional thrombolytic therapy is safe and effective in selected patients and may become a well-founded alternative in the treatment of acute deep vein thrombosis of lower extremities and in the prevenction of its complications .

Although two studies have shown that Addison's disease (AD) is still a potentially lethal condition for cardiovascular, malignant, and infectious diseases, a recent retrospective study showed a normal overall mortality rate. Differently from secondary hypoadrenalism, scanty data exist on the role of conventional glucocorticoid replacement on metabolic and cardiovascular outcome in AD.In 38 AD under conventional glucocorticoid replacement (hydrocortisone 30 mg/day or cortisone 37.5 mg/day) ACTH, plasma renin activity (PRA), DHEAS, fasting glucose and insulin, 2-h glucose after oral glucose tolerance test, serum lipids, 24-h blood pressure and intima-media thickness (IMT) were evaluated and compared with 38 age-, sex- and body mass index (BMI)-matched controls (CS).AD had ACTH and PRA higher and DHEAS lower (p0.0005) than CS. Mean waist was higher (p0.05) in AD than in CS. Although no differences were found for mean gluco-lipids levels, a higher percentage of AD compared to CS were IGT (8 vs 0%), hypercholesterolemic (18 vs 8%), and hypertriglyceridemic (18 vs 8%); none of the AD and CS showed either HDL40 mg/dl or LDL190 mg/dl. At the multiple regression analysis, in both AD and CS, BMI was the best predictor of 2-h glucose and age of total and LDL cholesterol; in AD, no significant correlation was found between the above mentioned metabolic parameters and either hormone levels or disease duration. In both AD and CS 24-h blood pressure and IMT were normal.Our study shows a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia in AD patients.

Natural PGF administered at a dose of at least 250 micrograms/kg twice daily subcutaneously for at least 4 days starting no earlier than day 5 of cytologic diestrus induces luteolysis and pregnancy termination in the mated bitch. The resulting shortening of the luteal phase is associated with a shortening of the interestrous interval from 1 to 4 months. Bitches treated with PGF show emesis, diarrhea, and panting within 5 minutes and transient hypothermia which lasts 2 to 3 hours but generally have no further reaction. Bitches with cardiac or respiratory dysfunctions are not considered safe patients for early pregnancy termination with PGF because of the cardiovascular effects of this drug. Bitches treated with this regime early in diestrus resorb their conceptuses; those treated after days 35 to 40 show clinical abortion of viable fetuses.

Four basic classes of circulatory shock can be clinically defined: hypovolemic, cardiogenic, obstructive, and distributive. Looking at the physiology of cardiac performance, taking a pathophysiologic approach we can distinguish between hypovolemic shock, distributive shock, systolic cardiogenic shock, diastolic cardiogenic shock, or a mix of them. All these types evolve, if not treated early and adequately, towards end-organ failure (dysoxia, microcirculatory failure). Multi-organ dysfunction syndrome (MODS) accounts for most deaths in the intensive care unit (ICU). Disturbances in systemic hemodynamics and organ perfusion resulting in tissue hypoxia appear to play a key role in the onset and maintenance of MODS.

Die Physiologie und Biomechanik des Kniegelenks sind Themen der medizinischen Forschung seit dem fruhen 19. Jahrhundert. Heute ermoglichen uns In-vitro- und In-vivo-Methoden mathematische Modelle zur Auswertung der statischen und dynamischen Kniefunktion zu erstellen (Abb. 1) [1–3, 33].

Die Verwendung jeweils zweier, voneinander unabhangiger Implantate fur Femur und Tibia macht die eigentliche Besonderheit der doppelten unikondylaren Schlittenprothese aus. Hierdurch kann die Interkondylarregion, einschlieslich des vorderen Kreuzbandes erhalten werden. Das Vorgehen ermoglicht ein sehr gutes „Outcome” in Bezug auf Kinematik, Gangbild, Mobilisation und Erhalt der Beinlange. Mit der Implantation einer doppelten Schlittenprothese lassen sich eine physiologische Lastverteilung bei stabiler Gelenksituation, korrekte Rotationsverhaltnisse, die Wiederherstellung der Gelenkachse und des Alignements der Patella in ihrem Gleitlager erreichen. Die Implantationstechnik entspricht derer, welche beim Einbau einer unikompartimentaren Alloarthroplastik verwendet wird. Der Zugang erfolgt entweder uber zwei kurze Hautschnitte medial und lateral oder uber einen minimalinvasiven, medialen, etwa 8-10 cm langen Zugang parapatellar medial. Letzterer ermoglicht auch einen guten Uberblick uber das tibiofemorale Kompartiment. Die Praparation des Knochens erfolgt zunachst tibial im medialen Kompartiment. Lediglich 2-5 mm der Tibiaoberflache und 2-3 mm der Oberflache am korrespondierenden Femurkondylus werden entfernt. Somit kann dieses Implantat als Oberflachenersatzprothese angesehen werden. Die tibialen Schnittflachen mussen senkrecht zur epiphysaren Achse angelegt werden um dem Verlauf der Gelenklinie Rechnung zu tragen und „Releasephanomene” zu vermeiden. Im Bereich der Femurkondylen konnen im medialen und lateralen Kompartiment unterschiedliche Implantate zum Einsatz kommen um den unterschiedlichen Oberflachenradien der medialen, respektive der lateralen Femurkondyle Rechnung zu tragen. Abschliesend muss die ursprungliche Gelenkmorphologie (1-3° varus oder 3-6° valgus) gewahrt bleiben. Werden alle Regeln (Kondylenachse, Gelenklinie, Gelenkspannung) im Rahmen der Implantation beachtet, kann eine maximale Flexion des operierten Kniegelenkes von 135° erreicht werden. Abschliesend werden die Prothesenkomponenten unter strenger Berucksichtigung der Gelenklinie zementiert.

The high resolution three-dimensional structure of the newly discovered plant viscotoxin C1, from the Asiatic Viscum album ssp. Coloratum ohwi, has been determined in solution by (1)H NMR spectroscopy at pH 3.6 and 285 K. The viscotoxin C1-fold, consisting of a helix-turn-helix motif and a short stretch of an antiparralel beta-sheet is very similar to that found for the highly similar viscotoxins A2 and A3 and for other related thionins. Different functional properties of members of the thionin family are discussed here in light of the structural and electrostatic properties. Among the very homologous family of alpha- and beta-thionins, known for their antimicrobial activity, the viscotoxin subfamily differs from the other members because of its high toxicity against tumoral cells. Key residues for the modulation of viscotoxin cytotoxicity have been identified on the basis of sequence and structural alignment.

Mules, hybrids resulting from the mating of a horse mare (Equus caballus, 2n = 64) to a Jack donkey (E. asinus, 2n = 62), are generally infertile. Five horse embryos were transferred non-surgically to two cyclic and one acyclic recipient mules. In the mares and cycling mules, oestrus and ovulation were induced with, respectively, d-cloprostenol and human chorionic gonadotrophin (hCG). The acyclic mule, on the other hand, received oestradiol benzoate when the embryo donor was showing oestrus and progesterone after the donor had ovulated and until pregnancy diagnosis. Non-surgical embryo collections were attempted on day 7 after ovulation and recovered embryos were transferred transcervically into the mules' uteri. Mules that became pregnant were blood sampled serially for equine chorion gonadotrophin (eCG), progestagen and total conjugated oestrogen concentrations until around 6 months of gestation. The three embryos transferred to the acyclic mule did not produce any pregnancies whereas both embryos transferred to the cycling mules resulted in the birth of live foals. The peak concentration and duration of secretion of eCG differed markedly between the two pregnant mules, although both animals appeared to develop secondary corpora lutea beyond day 40 of gestation, as in normal intraspecies horse pregnancy. Moreover, the rise in serum oestrogen concentrations from around day 90 was also similar to that seen in normal pregnant mares. Parturition occurred spontaneously on day 348 of gestation in both mules and the resulting colt foals developed normally to weaning. Thus, cycling mules can carry a horse conceptus after non-surgical embryo transfer and give birth to a normal mature foal.

Relapsing spontaneous pneumothorax can be the first manifestation of pulmonary metastases of soft tissues sarcomas. Standard imaging techniques and computed tomography may not be able to detect small malignant cystic lesion or to distinguish between them and benign bollous lesions. We report the case of a 33 year-old male who, in the past, underwent surgical treatment for a synovial sarcoma of the inferior limb. The patient was admitted to our hospital because of right spontaneous pneumothorax; both chest x-ray and CT scan didn't detect any metastatic pulmonary lesion. A few days after the discharge the patient was readmitted because of relapsed pneumothorax; high-definition CT of the chest revealed a pulmonary cystic lesion that was resected thoracoscopically. Histological examination revealed a pulmonary metastases of synovial sarcoma.

Also, the present case did not have notable edema of the throat region, and death was attributed to septicemia and toxemia instead of asphyxia. The circumstances of this case leave several unanswered questions regarding the source of exposure of this dog to anthrax. Exposure was considered unlikely during the 6 days prior to death because the dog was kept at home. albeit unrestrained, in a residential area with no livestock within approximately 0.8 km. No livestock deaths had been reported at this site. Exposure to the dog was presumed to have occurred 6 days prior to initial clinical signs (7 days prior to death) during a dove hunt over a freshly plowed field. One possible source includes carrion ingested in adjacent wooded areas, although a carcass was not found. Ingestion would be the most likely explanation for the gastrointestinal hemorrhage found at necropsy. A second possibility is percutaneous infection, such as a wound or an insect bite. The wound interpreted as a pucture or spider bite may have represented a counterpart to the malignant carbuncle described in human beings.’ Although cutaneous anthrax has not been described in animals, a puncture wound cannot be ruled out. Insect transmission has been demonstrated but is considered an insignificant means of spreading anthrax unless the insect population is very large.’ References

Bovine beta-Lactoglobulin (BLG) has been studied for many decades, but only recently structural data have been obtained, making it possible to simulate its molecular properties. In the present study, electrostatic properties of BLG are investigated theoretically using Poisson-Boltzmann calculations and experimentally following pH titration via NMR. Electrostatic properties are determined for several structural models, including an ensemble of NMR structures obtained at low pH. The changes in electrostatic forces upon changes in ionic strength, solvent dielectric constant, and pH are calculated and compared with experiments. pK(a)s are computed for all titratable sites and compared with NMR titration data. The analysis of theoretical and experimental results suggests that (1) there may be more than one binding sites for negatively charged ligands; (2) at low pH the core of the molecule is more compact than observed in the structures obtained via restrained molecular dynamics from NMR data, but loop and terminal regions must be disordered.