Surgical correction of a splenophrenic shunt in a dog: a case report

A 4.3 kg, nine-year-old, spayed female Shih Tzu was presented for a two-month history of seizures, ataxia, and hyper-salivation. A diagnosis of a splenophrenic shunt was made by use of computed tomography angiography with volume-rendered imaging. A cellophane band was placed around the shunt after its isolation from the central tendon of the diaphragm. Clinical signs continued to wax and wane. Preprandial and postprandial bile acids levels were still elevated 10 months after surgery. An ameroid ring constrictor was placed around the shunt vessel before the vessel entered the diaphragm from its caudal aspect. At three months after the second surgery, the dog was near the normal ranges of preprandial and postprandial bile acids. Although a study of the anatomy of different types of extrahepatic portosystemic shunts has been reported in dogs, to the authors’ knowledge, there is a lack of information on clinical presentation, treatment, and postoperative results in a specific type of extrahepatic portosystemic shunt, such as a splenophrenic shunt. Cellophane banding should be avoided for occlusion of a splenophrenic shunt passing along the central tendon of the diaphragm.  

Download Full-text

Surgical management of choke through oesophagotomy in a buffalo: A case report

THE INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY ◽

10.21887/ijvsbt.v12i3.7098 ◽

2017 ◽

Vol 12 (3) ◽

Author(s):

Devasee Borakhatariya ◽

A. B. Gadara

Keyword(s):

Case Report ◽

Surgical Management ◽

Clinical Presentation ◽

Clinical Signs ◽

Thoracic Inlet ◽

Cervical Oesophagus ◽

Foreign Objects ◽

History Of ◽

Oesophageal Obstruction ◽

Large Animals

Oesophageal disorders are relatively uncommon in large animals. Oesophageal obstruction is the most frequently encountered clinical presentation in bovine and it may be intraluminal or extra luminal (Haven, 1990). Intraluminal obstruction or “choke” is the most common abnormality that usually occurs when foreign objects, large feedstuff, medicated boluses, trichobezoars, or oesophageal granuloma lodge in the lumen of the oesophagus. Oesophageal obstructions in bovine commonly occur at the pharynx, the cranial aspect of the cervical oesophagus, the thoracic inlet, or the base of the heart (Choudhary et al., 2010). Diagnosis of such problem depends on the history of eating particular foodstuff and clinical signs as bloat, tenesmus, retching, and salivation

Download Full-text

Effect of Supplementation of Exogenous Fibrolytic Enzymes in Total Mixed Ration on Rumen Fermentation Pattern in Dairy Cows

THE INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY ◽

10.21887/ijvsbt.v12i3.7106 ◽

2017 ◽

Vol 12 (3) ◽

Author(s):

P. M. Lunagariya ◽

S. V. Shah ◽

R. S. Gupta ◽

Subhash Parnerkar ◽

Hiren Pansuriya ◽

...

Keyword(s):

Dairy Cows ◽

Clinical Presentation ◽

Clinical Signs ◽

Thoracic Inlet ◽

Cervical Oesophagus ◽

Foreign Objects ◽

History Of ◽

Fermentation Pattern ◽

Oesophageal Obstruction ◽

Large Animals

Download Full-text

Case Report: “Incognito” proteus syndrome

F1000Research ◽

10.12688/f1000research.13993.1 ◽

2018 ◽

Vol 7 ◽

pp. 228

Author(s):

Michelangelo Vestita ◽

Angela Filoni ◽

Nicola Arpaia ◽

Grazia Ettorre ◽

Domenico Bonamonte

Keyword(s):

Case Report ◽

Clinical Presentation ◽

Clinical Signs ◽

Advanced Melanoma ◽

Lateral Margin ◽

Proteus Syndrome ◽

Positive History ◽

Rare Association ◽

History Of ◽

Mosaic Distribution

Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It is clinically diagnosed according to the criteria reported by Biesecker et al. We describe the case of a 49-year-old woman who presented with a 10-year history of pauci-symptomatic infiltrating plaque lesions on the sole and lateral margin of the left foot, which had been diagnosed as a keloid. The patient had a positive history for advanced melanoma and a series of subtle clinical signs, such as asymmetric face, scoliosis, multiple lipomas on the trunk, linear verrucous epidermal nevi, and hyperpigmented macules with a mosaic distribution. Even if the clinical presentation was elusive, she had enough criteria to be diagnosed with PS. This case describes the first evidence, to the best of our knowledge, of pauci-symptomatic PS in adulthood, reports its rare association with advanced melanoma, and illustrates the importance of even minor cutaneous clinical signs, especially when atypical, in formulating the diagnosis of a complex cutaneous condition such as this.

Download Full-text

Adenocarcinoma Arising from Perianal Fistulizing Crohn’s Disease

Case Reports in Gastroenterology ◽

10.1159/000490659 ◽

2018 ◽

Vol 12 (2) ◽

pp. 390-395 ◽

Cited By ~ 1

Author(s):

Rosario Fornaro ◽

Marco Frascio ◽

Michela Caratto ◽

Elisa Caratto ◽

Rita Bianchi ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Poor Prognosis ◽

Perianal Fistula ◽

Lack Of Information ◽

Different Types ◽

History Of ◽

Duration Of Disease ◽

Colon And Rectum

Perianal fistula is a very debilitating event and a cause of morbidity in patients with Crohn’s disease (CD). Its malignant transformation is very rare with an incidence of around 0.004–0.7%. Presence of disease in the colon and rectum is the major risk factor for the development of a perianal fistula. In this report we show a case of adenocarcinoma arising from a perianal fistulizing CD. This type of tumor is highly aggressive, difficult to diagnose, and has a rather poor prognosis. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to date well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula. Due to the rarity of cases, we tried to identify the most frequent and important risk factors: sex, duration of disease, age at diagnosis, and the history of the fistula.

Download Full-text

Adrenal gland tumours. Different clinical presentations in three dogs: a case report

Veterinární Medicína ◽

10.17221/6919-vetmed ◽

2013 ◽

Vol 58 (No. 7) ◽

pp. 377-384

Author(s):

A. Loste ◽

M. Borobia ◽

D. Lacasta ◽

M. Carbonell ◽

...

Keyword(s):

Adrenal Gland ◽

Clinical Presentation ◽

Imaging Techniques ◽

Clinical Signs ◽

Metastatic Lesion ◽

Adrenocortical Adenoma ◽

Imaging Studies ◽

Clinical Presentations ◽

Different Types ◽

Diagnostic Imaging Techniques

Three dogs were evaluated due to the presence of unilateral adrenal gland masses with or without clinical signs. Case 1 showed a unilateral non-functional adrenocortical adenoma, discovered accidentally while Case 2 presented a unilateral cortisol-secreting adrenocortical adenoma; a pheochromocytoma was accidentally discovered in Case 3. The adrenalectomy was the treatment of choice in all cases. The development of diagnostic imaging techniques, mainly ultrasonography, and its application to routine abdominal examinations, have allowed the detection of adrenal gland masses more frequently. However, there is no pattern of echogenicity or architecture which would help in the differentiation in a functional tumour from a non-functional tumour, a pheochromocytoma, a metastatic lesion to the adrenal or a granuloma. A complete description of history, clinical signs, laboratory analysis and imaging studies is included. Moreover, a revision of the different types of adrenal gland tumours, with their clinical presentation, a standardised diagnosis protocol and options for treatment are discussed.  

Download Full-text

Discoid lateral meniscus instability in children. Part I - Clinical presentation of instability combined with MRI and arthroscopic findings

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00014 ◽

2021 ◽

Vol 9 (2_suppl) ◽

pp. 2325967121S0001

Author(s):

Simon Vandergugten ◽

Paul-Henri Bauwens ◽

Charles Fiquet ◽

Sebastien Raux ◽

Franck Chotel

Keyword(s):

Natural History ◽

Children And Adolescents ◽

Clinical Presentation ◽

Lateral Meniscus ◽

Discoid Lateral Meniscus ◽

Arthroscopic Findings ◽

Different Types ◽

History Of ◽

Meniscocapsular Separation ◽

Clinical Mri

Objectives: The initial clinical presentation of the discoid lateral meniscus (DLM) in children is highly variable and can be difficult to assess. The aim of this study was to focus on the meniscal instability associated with DLM and to correlate clinical, MRI and arthroscopic data. Methods: Between 2008 and 2018, 93 children and adolescents with 114 DLMs who underwent surgery in a referral center were included. Based on the anamnesis and clinical data, three types of meniscal instability of increasing severity were defined: occasional ("lock"), regular ("clock") and permanent ("block") instability. These findings were correlated with preoperative MRI data and arthroscopic findings according to Ahn’s classification, and as a result we were able to propose a DLM classification based on clinical or MRI data or both combined. Results: A wide variety of presentations was noted with 18 different types when clinical, MRI and arthroscopic characteristics were combined. 94% of the symptomatic DLMs for which surgery was performed showed instability due to meniscocapsular separation. Clinically, there were "lock", "clock" and "block" instability in 2%, 50% and 31% of DLMs respectively. Preoperative MRI indicated no meniscal shift and an anterocentral, posterocentral or central shift in 41%, 9%, 22% and 28% of the DLMs, respectively. Arthroscopic findings indicated no lesions, or an MC-A, MC-P or PLC type lesion in 6%, 46%, 15% and 33% of DLMs respectively. The most frequent presentations were “clocked” knees with MC-A lesions and “blocked” knees with PLC lesions. Only in 60% of the cases was a good level of correspondence noted between the different data. Conclusion: The association of meniscal instability and symptomatic DLM in children should be accepted as a certainty. “Locked”, “clocked” and “blocked” knees could represent different stages of increasing severity in the natural history of DLM instability.

Download Full-text

Peripartum clinical manifestations of a mesentericorenocaval shunt in a Burmese cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116920961369 ◽

2020 ◽

Vol 6 (2) ◽

pp. 205511692096136

Author(s):

QiCai J Hoon ◽

Jia Wen Siow ◽

Elizabeth Jenkins ◽

Wilson So ◽

Mark Krockenberger ◽

...

Keyword(s):

Bile Acids ◽

Clinical Signs ◽

Clinical Manifestations ◽

Reference Interval ◽

Portosystemic Shunt ◽

Lactation Period ◽

Serum Bile Acids ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Mild Anaemia

Case summary A 3-year-old entire female Burmese cat was presented for investigation of intermittent lethargy during gestation followed by persistent hypersalivation and ataxia postpartum. The cat had queened three litters in total, with clinical signs worsening during the most recent lactation period. Mild anaemia (26%), hypoglycaemia (2.4 mmol/l; reference interval [RI] 3.9–8.3 mmol/l) and increased postprandial serum bile acids (74 µmol/l; RI <25 µmol/l) were identified on initial bloodwork. Multiphase contrast-enhanced CT identified a mesentericorenocaval portosystemic shunt; this was attenuated surgically with an ameroid constrictor. Clinical signs resolved after surgery. Follow-up 3 months postoperatively revealed normal pre- and postprandial serum bile acids (2 µmol/l and 3 µmol/l, respectively) with repeat CT identifying evidence of shunt attenuation. The cat continued to be healthy and free of clinical signs 12 months postoperatively. Relevance and novel information Mesentericorenocaval portosystemic shunt morphology has not been previously reported in the cat and should be considered as a differential diagnosis for cats presenting with peripartum onset of malaise, ptyalism or ataxia.

Download Full-text

Clinico- etiological profile of acute poisoning and intoxication in children in western Nepal

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20213723 ◽

2021 ◽

Vol 8 (10) ◽

pp. 1643

Author(s):

Love K. Sah ◽

Munu Mahat ◽

Prince Pareek ◽

Ram P. Pokhrel ◽

Reema Garegrat

Keyword(s):

Clinical Presentation ◽

Signs And Symptoms ◽

Acute Poisoning ◽

Acute Onset ◽

Accidental Poisoning ◽

Emergency Physicians ◽

Medical College ◽

Different Types ◽

Common Clinical Presentation ◽

History Of

Background: Pediatric poisoning is a common emergency. The present study was done to assess the incidence, clinico-etiological profile of acute poisoning and intoxication in children.Methods: This study was conducted in the Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Nepal in which children aged less than 18 years, with history of consumption of poison accompanied or unaccompanied by container or poison or with doubtful history of consumption of poison but with definite signs and symptoms of acute poisoning we included. We also included children with history of bites by poisonous creatures like snakes, scorpions, bees and insects or with doubtful history of bites due to poisonous creatures but with definite acute onset of signs and symptoms locally or systemically.Results: In the present study, during the study duration, 68 children were included. The most common age group of included children was 1 to 5 years (59%). Accidental poisoning was reported in 93% of the cases, while the rest had suicidal poisonings. The most common type of poison used were different types of pesticides (46%). We observed that vomiting was the most common clinical presentation (79%). In our study sample, arrival of 46% of the children was delayed by 30 minutes to 2 hours. Majority of the patients arrived in the afternoon to the hospital (51%).Conclusions: The findings of the present study would enable emergency physicians to identify clinical features of common poisonings among children, which would enable manage the cases better.

Download Full-text

Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116918795717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 205511691879571

Author(s):

James Crowley ◽

Timothy Foo ◽

Lara Boland ◽

Laurencie Brunel

Keyword(s):

Hepatic Encephalopathy ◽

Bile Acids ◽

Clinical Signs ◽

Reference Interval ◽

Portosystemic Shunt ◽

Liver Size ◽

Long Term Follow Up ◽

Stimulation Tests ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Liver Changes

Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.

Download Full-text

Cannabinoid hyperemesis syndrome: A Parisian case series

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1745 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s869-s870

Author(s):

M. Marillier ◽

A. Batisse ◽

C. Chevallier ◽

L. Laviale ◽

S. Djezzar

Keyword(s):

Clinical Presentation ◽

Clinical Signs ◽

Case Series ◽

Psychoactive Substance ◽

Cannabis Consumption ◽

Specific Sign ◽

Cannabinoid Hyperemesis Syndrome ◽

History Of ◽

Competing Interest ◽

Medical Examinations

IntroductionCurrently, cannabis remains the most widely used illicit psychoactive substance in the world. Its main pharmacological properties are known and its use for therapeutic purpose is still expanding. Also, its acute and chronic toxicity become more described, even if some mechanisms of pharmacotoxicology still remain to clarify as the cannabinoid hyperemesis syndrome (CHS).ObjectivesTo describe cases of CHS, to highlight the clinical presentation and all the complexity of the medical exploration for making an accurate diagnosis.MethodWe present a case series of CHS related to cannabis use and notified to the Parisian addictovigilance center.ResultsEight cases were collected between 2011 and 2016. The users are almost exclusively men (7/8), with a median age of 31 years and some of them present a history of psychiatric disorder. All of them report important daily cannabis consumption (up to 15 joints by day) with duration of consumption averaged at 10 years. All patients present recurrences of clinical signs of the syndrome including vomiting (8/8) and abdominal pains (8/8) leading to repeated hospitalizations. Despite the presence of compulsive taking hot showers notion (7/8), specific sign of the CHS, its diagnosis were made by a physician in 5 cases. Carried out medical examinations are often complete, invasive, even going to an explorative laparotomy for one patient.ConclusionThe CHS remains not well known. A better understanding of this syndrome will enable better patient care while avoiding costly spending unnecessary investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text