Gastrointestinal stromal tumour and hypoglycemia in a Fjord pony: Case report

<p>Abstract</p> <p>Background</p> <p>Neoplasia may cause hypoglycemia in different species including the horse, but hypoglycemia has not previously been reported in the horse associated with gastrointestinal stromal tumours.</p> <p>Case presentation</p> <p>A case of a gastrointestinal stromal tumour in a Fjord pony with severe recurrent hypoglycemia is presented. The mechanism causing the hypoglycemia was not established.</p> <p>Conclusion</p> <p>This case indicates that a gastrointestinal stromal tumour may cause hypoglycemia also in the horse.</p

Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

<p>Abstract</p> <p>Background</p> <p>Unicameral (or simple) bone cysts (UBC) are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC.</p> <p>Methods</p> <p>A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery.</p> <p>Results</p> <p>Forty-six patients (17 female, 29 male) with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%). All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws). Overall recurrence rate after the first surgical treatment was 39% (18/46), second (17.4% of all patients) and third recurrence (4.3%) were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion.</p> <p>Conclusions</p> <p>Our results suggest satisfactory overall long-term outcome for the surgical treatment of UBC, although short-and mid-term observation show a considerable rate of recurrence independent of the surgical technique.</p

Differential Release and Phagocytosis of Tegument Glycoconjugates in Neurocysticercosis: Implications for Immune Evasion Strategies

Neurocysticercosis (NCC) is an infection of the central nervous system (CNS) by the metacestode of the helminth Taenia solium. The severity of the symptoms is associated with the intensity of the immune response. First, there is a long asymptomatic period where host immunity seems incapable of resolving the infection, followed by a chronic hypersensitivity reaction. Since little is known about the initial response to this infection, a murine model using the cestode Mesocestoides corti (syn. Mesocestoides vogae) was employed to analyze morphological changes in the parasite early in the infection. It was found that M. corti material is released from the tegument making close contact with the nervous tissue. These results were confirmed by infecting murine CNS with ex vivo–labeled parasites. Because more than 95% of NCC patients exhibit humoral responses against carbohydrate-based antigens, and the tegument is known to be rich in glycoconjugates (GCs), the expression of these types of molecules was analyzed in human, porcine, and murine NCC specimens. To determine the GCs present in the tegument, fluorochrome-labeled hydrazides as well as fluorochrome-labeled lectins with specificity to different carbohydrates were used. All the lectins utilized labeled the tegument. GCs bound by isolectinB4 were shed in the first days of infection and not resynthesized by the parasite, whereas GCs bound by wheat germ agglutinin and concavalinA were continuously released throughout the infectious process. GCs bound by these three lectins were taken up by host cells. Peanut lectin-binding GCs, in contrast, remained on the parasite and were not detected in host cells. The parasitic origin of the lectin-binding GCs found in host cells was confirmed using antibodies against T. solium and M. corti. We propose that both the rapid and persistent release of tegumental GCs plays a key role in the well-known immunomodulatory effects of helminths, including immune evasion and life-long inflammatory sequelae seen in many NCC patients

2013 WSES guidelines for management of intra-abdominal infections

Peer reviewe

Sources of streptococcal bacteraemia and their implications for the diagnosis of infective endocarditis

Introduction The diagnosis of infective endocarditis (IE) is dependent on the detection of a sustained bacteraemia with multiple positive blood cultures being major criteria in the Duke nosology for IE. The interpretation of a single positive blood culture growing pathogens that could cause IE, but that do not fulfil major Duke criteria, is a common diagnostic difficulty in patients with a febrile illness. This study was designed to examine the clinical outcomes in patients with streptococcal bacteraemias and to determine the proportion of these with a final diagnosis of IE. Methods This was a retrospective descriptive analysis of patients with streptococcal bacteraemias between September-December 2012. IE was confirmed by a Consultant Microbiologist (JS) using the modified Duke criteria. The variables recorded were age, gender, number of blood cultures taken and the final diagnosis stated in the discharge summary. Results 112 episodes were identified in 72 females and 40 males (mean age 40 years, range<1–97). The mean number of blood cultures was 2.57 (range1-12) and 85 (76%) patients had only one blood culture taken. The infections recorded are shown in Figure 1. The cause of the bacteraemia was not stated in 33 (29.5%) cases. Community acquired pneumonia (n=31) was the commonest infection, followed by catheter-related bloodstream infection (n=8) and then IE and soft-tissue infection (both n=7). Details of the streptococcal species are shown in Table 1 and the results have been divided using age less than or greater than 18 years. 50% of bacteraemias were caused by oral streptococci. IE was confirmed in only 7 (1.2%). Conclusions Among all streptococcal bacteraemias, IE is an uncommon cause but is more common when considering oral streptococci in adults (12.5%) compared with those aged less than 18 years (0%). Oral streptococci remain an important cause of IE particularly in adults. This diagnosis should be considered even if only one blood culture is taken and is positive. The high rate of single blood culture sampling (76%) may be an unintended consequence of the Surviving Sepsis campaign and the drive to initiating empirical antibiotic therapy earlier. Under these circumstances the reliability of the Duke criteria will be reduced. Ideally, patients at increased risk of IE require multiple blood cultures if they have a significant pyrexial illness in order to determine if a sustained bacteraemia is present