Progression of Lactobacillus plantarum prosthetic valve endocarditis followed by transesophageal echocardiogram

Endocarditis due to Lactobacillus species is extremely rare. We report an uncommon case of Lactobacillus plantarum bioprosthetic aortic valve endocarditis, presenting with severe aortic steno-regurgitation, which responded to conventional medical and surgical treatment. This case provides a better understanding of the disease process of L. plantarum and highlights the role of transesophageal echocardiography in following the entire course of endocarditis

Regio- and stereoselective behavior of l-arabinal-derived vinyl epoxide in nucleophilic addition reactions. Comparison with conformationally restricted d-galactal-derived analogs

Abstract The regio- and stereoselectivity of the addition reactions of O-, C-, N-, and S-nucleophiles to l-arabinal-derived vinyl epoxide 2, the simplest non-conformationally restricted glycal-derived vinyl epoxide, has been examined and compared with the corresponding, conformationally restricted d-galactal-derived analogs 1β and 1β-Me. Results indicated that the 1,4-/1,2-regioselectivity ratio and the related syn-1,4-/anti-1,2-stereoselectivity observed in glycal-derived vinyl oxiranes is independent of the presence of substituents on the six-membered unsaturated ring, and the absence of conformational freedom: it depends only on the ability of the nucleophile to give a coordination process with the oxirane oxygen in the form of a hydrogen bond or through a coordinating cation

Endoscopic and Surgical Removal of Gastrointestinal Foreign Bodies in Dogs: An Analysis of 72 Cases

In emergency veterinary practice, gastrointestinal foreign body (GFB) removal is a common procedure that is performed with different techniques, such as endoscopy or surgery. The aims of this retrospective, multicentre, clinical study were to report the common locations and types of objects recovered and to investigate clinical factors and outcomes in dogs after surgical or endoscopic treatment for GFB removal. Records of dogs with a GFB diagnosis referred to the Teaching Veterinary Hospital or treated in three different veterinary hospitals from September 2017 to September 2019 were examined. The data obtained from each case included breed, age, clinical signs at presentation, duration of clinical signs, type and location of the GFB, treatment, length of hospitalisation and outcome. Seventy-two dogs were enrolled in the study. There were 42 males (58%) and 30 females (42%). The median age was 36 months (range: 3 months to 8 years). Endoscopic retrieval was performed in 56% of GFBs (located in the stomach or duodenum), whereas 44% of dogs underwent surgery. The type of FB detected varied greatly: kid toy (14%), metallic object/coin (13%), cloth (13%), sock (8%), ball (8%), plastic material (8%), peach stone (7%), fishhook (6%), sewing needle (4%), hair tie (4%), pacifier (3%), plant materials (3%) and others (9%). Moreover, the FBs were classified as sharp (13%, n = 9), pointed (33%, n = 24), blunt (26%, n = 19), or linear (28%, n = 20). In this study, 68% of FBs were localised in the stomach, 25% in the intestinal tract (50% duodenum, 28% jejunum, and 22% ileum), and 7% in both the stomach and small intestine. The type of GFB was not significantly associated with age, site or breed. There was a significant association between the type of GFB and sex: if the dog was male, there was a 38% probability of ingesting linear GFBs. The dog survival rate was 100% in cases treated by gastric endoscopic or surgical removal, 94% in cases treated with enterotomy and 33% in cases in which enterectomy was necessary. Enterectomy and multiple surgical sites were associated with a poor outcome. The presence of vomiting for more than 24 h was significantly associated with death

Elotuzumab plus pomalidomide and dexamethasone in relapsed/refractory multiple myeloma: a multicenter, retrospective real-world experience with 200 cases outside of controlled clinical trials

In the ELOQUENT-3 trial, the combination of elotuzumab, pomalidomide and dexamethasone (EloPd) proved a superior clinical benefit over Pd with a manageable toxicity profile, leading to its approval in relapsed/refractory multiple myeloma (RRMM), who had received at least two prior therapies, including lenalidomide and a proteasome inhibitor (PI). We report here a real-world experience of 200 RRMMs treated with EloPd in 35 Italian centers outside of clinical trials. In our dataset, the median number of prior lines of therapy was 2, with 51% of cases undergoing autologous stem cell transplant (ASCT) and 73% exposed to daratumumab. After a median follow-up of 9 months, 126 patients stopped EloPd, most of them (88.9%) because of disease progression. The overall response rate (ORR) was 55.4%, in line with the pivotal trial results. Regarding adverse events, our cohort experienced a toxicity profile similar to the ELOQUENT-3 trial, with no significant differences between younger (<70 years) and older patients. The median progression-free survival (PFS) was 7 months, shorter than that observed in the ELOQUENT-3, probably due to the different clinical characteristics of the two cohorts. Interestingly, the ISS stage III (HR:2.55) was associated with worse PFS. Finally, our series's median overall survival (OS) was shorter than that observed in the ELOQUENT-3 trial (17.5 versus 29.8 months). In conclusion, our real-world study confirms EloPd as a safe and possible therapeutic choice for RRMM who received at least two prior therapies, including lenalidomide and a PI

CONGENITAL FLEXURAL DEFORMITY IN THE FOAL: CASE SERIES

Flexural Deformities (FD) or “contractures” are a common disease in foals. Therapy to correct the defects is normally established in absence of a precise diagnosis and etiopathogenesis is usually unknown. In infants with weakness and/or contractures, a complete diagnostic algorithm is performed to identify the etiology and, afterwards, to begin the most appropriate therapy and a neuromuscular etiology has been supposed. Aims of the study were to describe a case series of congenital FD, to examine the role of the congenital neuromuscular diseases in etiology and pathogenesis of FD, to suggest a diagnostic algorithm and to verify the clinical usefulness of the muscular biopsy in the diagnostic iter . Affected foals were clinically examined. Routine haematological and biochemistry analysis were performed. Muscle biopsies were collected. Administrated therapy was described. Fourteen foals were examined. Clinical symptoms included contractures associated to weakness, torticollis and scoliosis, mandibular prognathism, inferior eyelid entropion. Core like disease (2), Mild unspecific myopathy (5), Mitochondrial myopathy (2), Congenital Fiber Type Disproportion (2), Lipid storage myopathy (1), Lipomatous muscle “dystrophy” (1) Myopathy with inclusion bodies (1), Vacuolar myopathy (1), Neurogenic myopathy (1) were diagnosed. Multiple myopathic lesions were shown in some biopsies. As FD are a symptom, it should be endeavored to apply to each clinical case a complete diagnostic iter. A definite diagnosis would enable an early prognosis and could identify a potential genetic basis of transmission to offspring. Congenital myopathies were demonstrated in muscle biopsies collected from contracted foals. Both isolated and multiple contractures could be found in neuromuscular disorders, that probably produce reduced foetal movements responsible for intrauterine malpositioning. Muscle biopsy was a valuable diagnostic mean in foals affected by FD

In vitro comparison of three suture techniques for anastomosis of small intestine in horse

Anastomosis using a continuous Lembert single layer pattern were faster to perform and resisted higher pressure than the Gambee and the Lembert double layer pattern. The Lembert single layer technique results in a larger stoma and produces fewer adhesions and should be the technique of choice in most cases

In vitro comparison of three suture techniques for anastomosis of the equine small intestine

Reasons for performing study: The equine small intestine can be affected by a variety of disorders that may require some form of bypass or anastomosis. Many suture patterns have been used in equine anastomoses to minimise post operative complications, which include leakage from the anastomosis site, stenosis and adhesions. Because of the critical condition of horses undergoing colic surgery, it is imperative this is performed as quickly as possible. Objectives: To evaluate, in vitro, differences in the time of execution and leakage pressure between the Lembert single layer (Lsl), Gambee and Lembert double layer suture patterns for intestinal anastomosis in the horse and correlate the time taken to complete the anastomosis and hemicircumference of the anastomotic site Methods: Small intestinal loops immersed in polyionic solution were anastomosed with one of the 3 suture patterns. The intestines were insufflated via a flexible rubber hose, connected to a pressure gauge, inserted into the lumen at one end and fixed at 25 cm fromthe anastomosis site with a locking clip and, using a tube fixed in the same manner at the other end connected to a sphygmomanometer bulb, the pressure at which leakage from the anastomosis site was revealed by the presence of bubbles. Results: The time spent in the execution of the Lembert single layer was significantly less than that for both Gambee and Lembert double layer The leakage pressure of Lembert single layer was significantly higher than that recorded for both Gambee and Lembert double layer Conclusions and potential relevance: This study shows that the continuous Lsl pattern takes less time to execute and fails at higher pressures than the Lembert double layer or Gambee patterns

Stereoselective synthesis of beta-phenylselenoglycosides from glycals and rationalization of the selenoglycosylation processes

β-Phenylselenoglycosides have been efficiently and stereoselectively synthesized by direct oxidative glycosylation of benzenselenolate (PhSe-) with glycals. A rationalization of the presently described β-selectivity and the opposite Rselectivity reported by Danishefsky in the ring-opening of epoxy glycals with benzeneselenol (PhSeH) is proposed

Treatment of eyelids and third eyelid tumors in dogs with radiosurgery: a preliminary study

INTRODUCTION: In canine eyelids surgery, intraoperative bleeding may obscure the surgical field and lead to increased swelling, bruising and pain. Therapies for the canine lids and nictitating membrane tumors include surgical excision, cryosurgery, or carbon dioxide laser ablation (Stades and Van der Woerdt, 2013). Potential disadvantages of cryosurgery are severe postoperative swelling, depigmentation and the unwanted loss of normal tissue. Laser requires safety precautions, including wavelength-specific eye wear and the hazard of beam scatter and or reflection. OBJECTIVE:to evaluate the efficacy of high-frequency radiowave surgery in treating tumors of eyelids and third eyelid in dogs. MATERIALS & METHODS: Seven dogs (7 eyes) referred with eyelids tumors and 3 dogs with third eyelid tumors were enrolled in the study over a 12-month period. Ablation was performed using high-frequency radiowave surgical unit (Ellman Surgitron FFPF) at a power setting on 2.5 (4 cases) or 5.0 (6 cases) with “needle electrode” (TA2B, TA3B, TA8B) or “empire microincision electrode (TEE305) in the Cut/Coag mode (5 cases: 2 eyelid papilloma and 3 third eyelid tumors) or cut mode (5 eyelid tumors). RESULTS: In all cases surgery was performed in a very short time with the advantage of an excellent haemostasis and minimum onset of oedema using both modes (cut or cut/coag). Surgical incisions were extremely precise and accurate. Two dogs with papilloma on the upper eyelid, treated with a needle electrode and a power setting on 3.0 2,5 showed dehiscence of the surgical wound one week postoperatively. One dog with melanocitoma of the third eyelid showed transient depigmentation of the inferior eyelid which resolved after two months. In all other cases (2 meibomian gland carcinomas, 2 adenomas and 3 2 epitheliomas) no notable complications were observed and the results of the scar was judged as good by surgeons and dog's owners. Follow-up (up to 1 year) showed no recurrence in any case. DISCUSSION AND CONCLUSION: To the authors’ knowledge, treatment of eyelid and third eyelid tumors with high-frequency radiowave surgery is not wide described in dogs and there are not published clinical studies. Results of this study demonstrated that it may be a simple, safe and effective surgical treatment for eyelids and third eyelids tumors in dogs. Dehiscence of surgical wound after the excision of an eyelid papilloma in two cases could be due to the use of low power setting in cut/coag mode. At this setting, a less precise incision and a slower passage through the tissue were achieved, increasing tissue damage and delaying healing. In the same way, needle electrodes with cut/coag mode, used for third eyelid excision in a dog, could have caused a minimal amounts of lateral heat, responsible of depigmentation of the inferior eyelid margin. The “empire microincision electrodes” produce a high concentration of energy with the least amount of thermal damage to adjacent tissue. Therefore, they are the optimal electrodes for eyelid surgery. This technique offers potential advantages over some others in use, like CO2 laser, including minimal safety precautions, self cleansing and relatively low cost. Choosing optimal power settings and the correct electrode will prevent increased tissue damage