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

Pyothorax in cats and dogs

Pyothorax, or thoracic empyema, is an infection of the pleural space, characterized by the accumulation of purulent exudate. It is a life-threatening emergency in dogs as well as in cats, with a guarded prognosis. Dyspnea and/or tachypnea, anorexia and lethargy are the most typical clinical signs. Diagnosis is usually straightforward, based on the clinical symptoms combined with pleural fluid analysis, including cytology and bacterial culture. Most commonly, oropharyngeal flora is isolated in the pleural fluid. Treatment can be medical or surgical, but needs to be immediate and aggressive. In this article, an overview of the various causes of both feline and canine pyothorax with its similarities and differences is provided. Epidemiology, symptoms, diagnosis, treatment and prognosis are discussed

Morbidity After Inguinal Lymph Node Dissections:It Is Time for a Change

Inguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND. A retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (>= 10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed. One or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications. Changes in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND

Prenatal Hyperandrogenization Induces Metabolic and Endocrine Alterations Which Depend on the Levels of Testosterone Exposure

Prenatal hyperandrogenism is able to induce polycystic ovary syndrome (PCOS) in rats. The aim of the present study was to establish if the levels of prenatal testosterone may determine the extent of metabolic and endocrine alterations during the adult life. Pregnant Sprague Dawley rats were prenatally injected with either 2 or 5 mg free testosterone (groups T2 and T5 respectively) from day 16 to day 19 day of gestation. Female offspring from T2 and T5 displayed different phenotype of PCOS during adult life. Offspring from T2 showed hyperandrogenism, ovarian cysts and ovulatory cycles whereas those from T5 displayed hyperandrogenism, ovarian cysts and anovulatory cycles. Both group showed increased circulating glucose levels after the intraperitoneal glucose tolerance test (IPGTT; an evaluation of insulin resistance). IPGTT was higher in T5 rats and directly correlated with body weight at prepubertal age. However, the decrease in the body weight at prepubertal age was compensated during adult life. Although both groups showed enhanced ovarian steroidogenesis, it appears that the molecular mechanisms involved were different. The higher dose of testosterone enhanced the expression of both the protein that regulates cholesterol availability (the steroidogenic acute regulatory protein (StAR)) and the protein expression of the transcriptional factor: peroxisome proliferator-activated receptor gamma (PPAR gamma). Prenatal hyperandrogenization induced an anti-oxidant response that prevented a possible pro-oxidant status. The higher dose of testosterone induced a pro-inflammatory state in ovarian tissue mediated by increased levels of prostaglandin E (PG) and the protein expression of cyclooxygenase 2 (COX2, the limiting enzyme of PGs synthesis). In summary, our data show that the levels of testosterone prenatally injected modulate the uterine environment and that this, in turn, would be responsible for the endocrine and metabolic abnormalities and the phenotype of PCOS during the adult life

Pelvic lymph node dissection in metastatic melanoma to the groin should not be abandoned yet

Background: In recent years there has been a plea to abandon the pelvic lymph node dissection in the treatment of patients with metastatic melanoma to the groin. A trend towards a conservative surgical treatment is already evolving in several European countries. The purpose of this study is to identify factors associated with pelvic nodal involvement, in order to improve selection of patients whom might benefit from a pelvic nodal dissection. Methods: A retrospective analysis was performed on prospectively collected data concerning patients who underwent an inguinal lymph node dissection (ILND) with pelvic lymph node dissection for metastatic melanoma at the University Medical Center Groningen. Multivariable logistic regression analysis was performed to determine factors associated with pelvic nodal involvement. Diagnostic accuracy was calculated for F-18-FDG PET + contrast enhanced CT-scan and F-18-FDG PET + low dose CT-scan. Results: Two-hundred-and-twenty-six ILND's were performed in 223 patients. The most common histologic subtype was superficial spreading melanoma (42.6%). In patients with micrometastatic disease, 15.7% had pelvic nodal involvement vs 28.2% in patients with macrometastatic disease (p: 0.030). None of the characteristics known prior to the ILND, were associated with pelvic nodal involvement. Imaging methods were unable to accurately predict pelvic nodal involvement. Negative predictive value was 78% for F-18-FDG PET + low dose CT-scan and 86% for an F-18-FDG PET + contrast enhanced CT-scan. Conclusion: There are no patient- or tumor characteristics available that can predict pelvic nodal involvement in patients with melanoma metastasis to the groin. As no imaging technique is able to predict pelvic nodal involvement it seems unjust to abandon the pelvic lymph node dissection. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved

A negative sentinel node in melanoma patients; no need to worry?

Background: Since its introduction, the outcome of the SLNB is one of the most important prognostic factors in melanoma patients. A negative sentinel node however, does not guarantee a recurrence-free follow-up. This study was performed to determine risk factors of regional or systemic disease recurrence in node negative melanoma patients. Material and methods: Data concerning patients treated between 1996 and 2014 in the University Medical Center Groningen were prospectively collected. The database contained patient and tumor characteristics, follow-up, recurrence and survival data. Cox regression analyses were used to determine variables associated with systemic first site of recurrence in sentinel node negative patients. Results: A total of 668 SLNB's were performed between 1996 and 2014. The SLNB was positive in 27.8% of the patients and negative in 68.6% of the patients. Recurrence rates were 53.2% in the SLNB positive group and 17.9% in the SLNB negative group. Thirty and a half percent of all patients recurred (204/668), 77% of these patients progressed to stage IV during the course of their disease. Multivariate cox regression analysis of factors associated with immediate stage IV recurrence in sentinel node negative patients revealed melanoma located on the head/neck (HR 3.09, p: 0.035) and the presence of ulceration (HR 2.31, p: 0.035) as significant factors. In sentinel node negative patients with a nodular melanoma the ever recurrence rate was 38/128 (29.7%), if ulceration was present the recurrence rate was 43.1%, the first site of recurrence was systemic in 64% of these patients. Analysis of ever stage IV recurrence in all patients revealed SLNB positive results of strong predictive value (HR 3.00, P