Treatment of necrotizing fasciitis using negative pressure wound therapy in a puppy

A two-month-old German shepherd dog was presented with anorexia, lethargy and left hind limb lameness associated with swelling of the thigh. Clinical findings combined with cytology led to the presumptive diagnosis of necrotizing fasciitis (NF). Extensive debridement was performed and silver-foam-based negative pressure wound therapy (NPWT) was applied. During the first 48 hours, a negative pressure of -75 mmHg was used. Evaluation of the wound demonstrated no progression of necrosis and a moderate amount of granulation tissue formation. A new dress- ing was placed and a second 48-hour cycle of NPWT was initiated at -125 mmHg. At removal, a healthy wound bed was observed and surgical closure was performed. The prompt implementation of NPWT following surgical debridement led to accelerated wound healing without progression of necrosis in this case of canine NF. Negative pressure wound therapy could become an integral part of the management strategy of canine NF, improving the prognosis of this life-threatening disease

State of the art: Eye-tracking studies in medical imaging

Eye-tracking – the process of measuring where people look in a visual field – has been widely used to study how humans process visual information. In medical imaging, eye-tracking has become a popular technique in many applications to reveal how visual search and recognition tasks are performed, providing information that can improve human performance. In this paper, we present a comprehensive review of eye-tracking studies conducted with medical images and videos for diverse research purposes, including identification of degree of expertise, development of training, and understanding and modelling of visual search patterns. In addition, we present our recent eye-tracking study that involves a large number of screening mammograms viewed by experienced breast radiologists. Based on the eye-tracking data, we evaluate the plausibility of predicting visual attention by computational models

Two cases of feline pyothorax : medical versus surgical treatment and associated challenges

Pyothorax is a rare disease in cats. Underlying causes and treatment recommendations vary greatly between cases. In this case series, the management of two challenging cases of feline pyothorax is discussed. In the first case, a nine-year-old female spayed European shorthair cat with pyothorax caused by Bacteroides fragilis is described. At the time of presentation, she was diagnosed with feline immunodeficiency virus as well. The pyothorax was succesfully managed medically. Unfortunately, the cat relapsed after three months and the owner elected euthanasia. The second case involved a ten-year-old male castrated British shorthair cat with identification of filamentous bacteria on pleural fluid cytology. This cat underwent surgical intervention because thoracic drainage was very difficult. Eventually, he recovered well and did not relapse up to two months postoperatively. The challenges in the decision process and treatment complications are discussed

Iatrogene trachearuptuur bij een Britse korthaar

Tracheal rupture is an uncommon disease in cats, and is usually iatrogenic. This case report describes a cervical tracheal rupture in a mature male British shorthair. The cat was presented with extreme subcutaneous emphysema and a moderate to severe pneumothorax, pneumomediastinum and pneumoretroperitoneum, but did not show any signs of dyspnea and/or hypoxia. The cat had a recent history of endotracheal intubation. The diagnosis was made with tracheoscopy, and the tracheal rupture was surgically treated. No clinical complications were exhibited by the patient during the hospitalization. After four days, the patient was discharged, and no further complaints were reported during the medical control four months later

Epiglottic retroversion in nine dogs

Epiglottic retroversion (ER) is an uncommon and poorly understood disorder of the upper respiratory tract in small breed dogs. In this retrospective study, perioperative characteristics, surgical technique, outcome, and complications in nine dogs that underwent surgical treatment for ER and/or concurrent upper respiratory tract disorders, were evaluated. The most frequently reported clinical symptoms were chronic intermittent inspiratory stridor (89%), exercise intolerance (78%), and dyspnea (67%). Concurrent respiratory disorders were highly prevalent (78%). Five dogs initially underwent a temporary epiglottopexy and two a permanent epiglottopexy. In two dogs, both suffering from concurrent laryngeal paralysis, only a unilateral cricoarytenoid lateralization was performed. After initial clinical improvement, temporary and permanent epiglottopexy eventually failed in 4/6 dogs (67%) that were available for follow-up, necessitating partial epiglottectomy as revision surgery. This resulted in a successful long-term outcome in 5/6 of these dogs (83%). In the dogs with primary ER or in cases where the presence of secondary ER led to significant respiratory symptoms, partial epiglottectomy as a primary surgical technique appeared to be a more permanent treatment option than epiglottopexy. Both dogs with surgically corrected concurrent laryngeal paralysis without epiglottopexy or epiglottectomy showed clinical improvement. This might indicate that, in case of secondary ER, positive results can be achieved after management of the underlying respiratory disorder

Thymoma geassocieerde exfoliatieve dermatitis bij een kat

A 10-year-old male castrated European Shorthair was presented with signs of scaling, alopecia and pruritus. The dermatopathological examination demonstrated an interface dermatitis with a few apoptotic keratinocytes, a mural lymphocytic folliculitis and the absence of sebaceous glands. These skin changes are compatible with a paraneoplastic syndrome caused by a thymoma. A thoracic radiograph confirmed the presence of a mass in the cranial mediastinum. A sternal thoracotomy was performed. One large tumor and two smaller masses were removed. Histopathological examination of the masses revealed a lymphocyte-rich thymoma. Initially, the skin lesions improved significantly. A few weeks after surgery, there was a relapse of the exfoliative dermatitis, which regressed with a dexamethasone treatment. On the last follow-up consult, 6 months post-operatively, the cat was no longer administered any medication and only showed mild scaling and no pruritus

Alfaxone TIVA bij de chirurgische excisie van een tracheaal adenocarcinoma bij een kat

A ten-year-old European Shorthair cat was presented with complaints of progressively worsening dyspnea with open-mouth breathing and inspiratory and expiratory stridor. Histopathological examination of a biopsy, collected during tracheoscopy, revealed that the mass was an intraluminal tracheal adenocarcinoma. Computed tomography (CT) revealed no metastases and the excision of the tumor was performed during the same anesthesia. Intravenous premedication was not possible due to the behavior of the patient and induction of anesthesia was provided using intramuscular injection of alfaxalone. The maintenance of anesthesia was initially provided by inhalation of isoflurane vaporized in oxygen using a laryngeal mask and a circle rebreathing system, followed by total intravenous anesthesia (TIVA) with alfaxalone during the actual excision of the tumor. By removal of seven tracheal rings, the tumor could be completely removed

Faryngeale sialocele bij een hond

A pharyngeal salivary mucocele was diagnosed in a seven-year-old male Irish softcoated wheaten terrier. The diagnosis was based on history, clinical findings, paracentesis and histopathology. An underlying etiology was not identified. Treatment consisted of the surgical removal of the mandibular and sublingual glands on the affected side and the resection of redundant pharyngeal tissue. Neither postsurgical complications, nor recurrence of the mucocele were observed ten months later

Models of breast lesions based on three-dimensional X-ray breast images

This paper presents a method for creation of computational models of breast lesions with irregular shapes from patient Digital Breast Tomosynthesis (DBT) images or breast cadavers and whole-body Computed Tomography (CT) images. The approach includes six basic steps: (a) normalization of the intensity of the tomographic images; (b) image noise reduction; (c) binarization of the lesion area, (d) application of morphological operations to further decrease the level of artefacts; (e) application of a region growing technique to segment the lesion; and (f) creation of a final 3D lesion model. The algorithm is semi-automatic as the initial selection of the region of the lesion and the seeds for the region growing are done interactively. A software tool, performing all of the required steps, was developed in MATLAB. The method was tested and evaluated by analysing anonymized sets of DBT patient images diagnosed with lesions. Experienced radiologists evaluated the segmentation of the tumours in the slices and the obtained 3D lesion shapes. They concluded for a quite satisfactory delineation of the lesions. In addition, for three DBT cases, a delineation of the tumours was performed independently by the radiologists. In all cases the abnormality volumes segmented by the proposed algorithm were smaller than those outlined by the experts. The calculated Dice similarity coefficients for algorithm-radiologist and radiologist-radiologist showed similar values. Another selected tumour case was introduced into a computational breast model to recursively assess the algorithm. The relative volume difference between the ground-truth tumour volume and the one obtained by applying the algorithm on the synthetic volume from the virtual DBT study is 5% which demonstrates the satisfactory performance of the proposed segmentation algorithm. The software tool we developed was used to create models of different breast abnormalities, which were then stored in a database for use by researchers working in this field