Limfosarkom tankog crijeva mačke.

We describe a clinical case of a 4-year-old cat suspected to be suffering from a kidney disease, sent to our clinic by a private veterinarian. During the preceding two weeks the cat suffered from anorexia and in the past three days she had vomited food and water. Clinical examination revealed dehydration and abdominal palpation identified two solid, walnut-sized formations in the centre of the cat’s abdominal cavity. A blood sample was taken for biochemical examination and the abdominal cavity was examined by X-ray. On the basis of the results obtained a diagnostic laparotomy was performed, which established the presence of two tumorous formations protruding from jejunum. The affected part of the intestine was resected, intestinal ends were joined by end-to-end everted anastomosis and the laparotomic wound was closed using the common procedure. The cat was treated by infusions and antibiotics. The excised portion of the intestine was sent for histological examination, which identified a lymphosarcoma.Opisana je klinička slika u mačke u dobi 4 godine koja je na kliniku upućena pod sumnjom na bolest bubrega. Dva tjedna prije toga pokazivala je znakove anoreksije, a posljednja tri dana povraćala je hranu i vodu. Mačka je bila izrazito dehidrirana, a palpacijom abdomena ustanovljene su dvije čvrste tvorbe veličine oraha i to u središnjem području trbušne šupljine. Provedena je klinička i biokemijska pretraga krvi i rendgenografija abdomena. Na temelju dobivenih nalaza izvršena je dijagnostička laparotomija kojom su dokazane dvije tumorske tvorbe na taštom crijevu. Promijenjeni dio crijeva je reseciran nakon čega su krajnji dijelovi spojeni anastomozom. Mačka je nakon operacije bila liječena infuzijama i antibioticima. Odstranjen dio crijeva bio je dostavljen na histološku pretragu te je potvrđen limfosarkom

Mezoteliom perikarda u bernskoga planinskoga psa - prikaz slučaja

On the basis of a clinical case we describe the symptoms, development and surgical method used for a six-year-old Bernese mountain dog affected by mesothelioma growing out of the pericardium. We provide an overview of the incidence of the tumor, risk factors, pathogenesis and possibilities of therapy in this canine breed. In our clinical case we did not confifi rm any contact of the dog with asbestos or larger amount of pesticides, which are described as etiological factors of mesothelioma in the literature. The dog’s owner did not visit our clinic due to suspicion of a tumor, but because of the general weakness of the dog accompanied by hematuria. The owner later added that the dog had already been suffering from general weakness and depression for a longer time. The radiological examination showed a non-specific effusion in the thoracic cavity, and the ultrasound examination located the mass in the area of the heart with production of exudate into the thoracic cavity. As a result of cytological and histological examinations, a mesothelioma was detected. During thoracotomy a tumorous mass was diagnosed between the pericardium and the left thoracic wall, located on the right accessory pulmonary lobe. The tumor mass was connected with the diaphragm. Because of the bad prognosis and after consultation with the owner, the dog was euthanized. The incidence of mesothelioma in Bernese mountain dogs is described for the first time.Opisani su znakovi, razvoj i kirurška obrada mezotelioma osrčja u šestogodišnjega bernskoga planinskoga psa. Prikazan je pregled pojave tumora, rizični čimbenici, patogeneza i mogućnosti liječenja u te pasmine pasa. U anamnezi nije potvrđen ikakav dodir psa s azbestom ili većom količinom pesticida što je u literaturi opisano kao etiološki čimbenici mezotelioma. Vlasnik nije psa doveo na klinički pregled zbog sumnje na tumor već zbog opće slabosti praćene hematurijom. Naknadno je dodao da je u psa već duže vrijeme primjećivao opću slabost i potištenost. Radiološkom pretragom nije bio ustanovljen nespecifični izljev u prsnu šupljinu, a ultrazvučnom pretragom bila je ustanovljena masa u području srca s eksudatom u prsnoj šupljini. Mezoteliom je bio dijagnosticiran na osnovi citološke i histološke pretrage. Tijekom torakotomije tumorska je masa bila ustanovljena između perikarda i lijeve torakalne stijenke u području desnoga akcesornoga plućnoga režnja i bila je povezana s ošitom. Zbog loše prognoze te nakon savjetovanja s vlasnikom pas je bio eutanaziran. Ovo je prvi opis pojave mezotelioma u bernskoga planinskoga psa

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201