Suspected Compartment Syndrome, Consumptive Thrombocytopenia, and Anemia Secondary to a Ruptured Arterial Aneurysm or Pseudoaneurysm Following Multiple Stifle Surgeries

2019 ◽  
Vol 55 (2) ◽  
Author(s):  
Michael Levenson ◽  
Janine M. Calabro ◽  
Jason R. Crawford ◽  
Samantha K. Hart
Keyword(s):  
Compartment Syndrome ◽  
Tibial Plateau ◽  
Clinical Signs ◽  
Arterial Aneurysm ◽  
Vascular Abnormalities ◽  
Neurologic Impairment ◽  
Immune Mediated ◽  
Peripheral Arterial ◽  
Large Aneurysm ◽  
Hemostatic Disorder

ABSTRACT A 12 yr old male neutered beagle was presented on transfer to the intensive care unit with severe anemia, thrombocytopenia, and bruising detected 1 day after undergoing tibial plateau leveling osteotomy surgery. The patient had undergone extra-capsular stifle stabilization surgery 14 wk prior to treat ligament disease in the same knee. Laboratory testing and treatment for anemia, presumptive immune-mediated thrombocytopenia, and possible hemostatic disorder was initiated. A persistent anemia, progressive thrombocytopenia, and the development of a firm swelling and neurologic impairment in the limb raised concerns for compartment syndrome (CS). A musculoskeletal ultrasound revealed a large aneurysm in the caudal thigh surrounded by abnormal muscle tissue. The patient underwent amputation of the limb and recovered without further complication. Pathology findings were consistent with the development of femoral CS secondary to a ruptured peripheral arterial aneurysm or a pseudoaneurysm. A consumptive thrombocytopenia and regenerative anemia were attributed to periodic or progressive thrombosis of the vessel and regional hemorrhage. Postoperative CS can develop in combination with peripheral arterial aneurysm or pseudoaneurysm, and screening for vascular abnormalities as well as CS should be considered in complicated recovery from orthopedic surgery with compatible clinical signs including progressive soft tissue swelling, persistent anemia, and thrombocytopenia.

Acquired muscle contractures in the dog and cat. A review of the literature and case report

2007 ◽  
Vol 02 (02) ◽  
pp. 79-85 ◽  
Author(s):  
C. H. Tangner ◽  
J. Taylor
Keyword(s):  
Case Report ◽  
Infectious Diseases ◽  
Range Of Motion ◽  
Compartment Syndrome ◽  
Clinical Signs ◽  
Predisposing Factors ◽  
Review Of The Literature ◽  
Muscle Contracture ◽  
Immune Mediated

SummaryCanine and feline muscle contracture is reported to affect several different muscles, is associated with a number of predisposing factors, and a varying prognosis depending upon which muscle is affected. Most patients suffer some form of trauma weeks to months before the contracture is present. The clinical signs include: lameness, pain, weakness, decreased range of motion, a firmness noted throughout the entire muscle, and usually a characteristic gait. Pre-disposing factors for muscle contracture include: compartment syndrome, infection, trauma, repetitive strains, fractures, infectious diseases, immune-mediated diseases, neoplasia, and ischaemia . There does appear to be some breed and age predilection, however, the sex of the animal does not have an appreciable influence. In general, muscle contractures of the forelimb respond better to treatment and carry a better prognosis than muscle contractures of the hindlimb.

Immune-Mediated Neutropenia in a Miniature Poodle

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Benjamin Brunson
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Clinical Signs ◽  
Response To Therapy ◽  
Tertiary Referral Center ◽  
Immune Mediated ◽  
Specialized Equipment ◽  
History Of ◽  
Light Sedation ◽  
The Right

ABSTRACT A 10 yr old spayed female toy poodle was presented to a tertiary referral center for a 10 day history of waxing and waning lethargy, vomiting, diarrhea, and anorexia. An immune-mediated neutropenia (IMN) was suspected to be the underlying cause of her clinical signs. A bone marrow aspirate was obtained from the chostochondral junction of the 11th and 12th ribs on the right side and provided a definitive diagnosis of IMN. A positive response to therapy and repeat blood work further confirmed the diagnosis. Obtaining bone marrow aspirates from the chostochondral junction is a safe, cheap, and reliable method of diagnosing IMN and can be performed in the private practice setting with light sedation and minimal need for specialized equipment.

scholarly journals Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

2019 ◽  
Vol 2 (1) ◽  
pp. 35-40
Author(s):  
Daniel Ion ◽  
Dan Nicolae Păduraru ◽  
Florentina Mușat ◽  
Octavian Andronic ◽  
Alexandra Bolocan
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Management Plan ◽  
Intraabdominal Pressure ◽  
Mortality And Morbidity ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

AbstractThe clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study

2021 ◽  
Vol 67 (7) ◽  
pp. 22-30
Author(s):  
Natasha Chaudhary ◽  
Farhanul Huda ◽  
Ravi Roshan ◽  
Somprakas Basu ◽  
Deepak Rajput ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Foot Ulcer ◽  
Arterial Disease ◽  
Major Amputation ◽  
Lower Extremity Amputation ◽  
Patients With Diabetes ◽  
Peripheral Arterial ◽  
Extremity Amputation

BACKGROUND: Lower extremity amputation is a serious complication of diabetes mellitus and occurs most commonly in persons who have a foot ulcer. PURPOSE: To examine variables that affect the rate of lower extremity amputation in patients with diabetes and infected foot ulcers. METHODS: A prospective observational study was performed including all consecutive patients who were 18 to 65 years, had a diagnosis of diabetes, and a foot ulcer showing clinical signs of infection. Patients were followed for 6 months or until ulcer healing, minor, or major amputation. A total of 81 persons were enrolled. Demographic variables were obtained, and clinical assessments, blood tests, and radiological investigations were performed. Ulcers were categorized using the Perfusion, Extent, Depth, Infection and Sensation classification system. Differences between variables and outcomes were assessed using the Wilcoxon test, Fisher’s exact test, Chi-square test, and t-test. RESULTS: Mean patient age was 54.58 ± 9.04 years, and the majority (61, 75%) were male. After 6 months, 33 (41%) were healed, 2 patients died, and 17 (21%) underwent major and 24 (30%) minor amputations. Major amputation rates were significantly higher in patients with a high Perfusion, Extent, Depth, Infection and Sensation score (6.92 ± 1.36; P = .005), elevated HbA1c (%) (9.43 ± 2.19; P = .049), presence of growth on wound culture (41 [64.1%]; P = .016), culture sensitivity to beta lactam (20 [31.2%]; P = .012), and presence of peripheral arterial disease seen on arterial Doppler ultrasound (P < .001). Minor amputation rates were higher in men (P = .02) and in the presence of peripheral arterial disease (P = .01). CONCLUSION: The presence of the above factors in persons with diabetes and foot ulcer with clinical signs of infection should alert the clinician to the need for focused and individualized treatment to attempt to prevent amputation.

Toxoplasma gondii-associated cholecystitis in a cat receiving immunosuppressive treatment

2019 ◽  
Vol 47 (06) ◽  
pp. 453-457 ◽  
Author(s):  
Francesco Lo Piccolo ◽  
Kathrin Busch ◽  
Jelena Palić ◽  
Vera Geisen ◽  
Katrin Hartmann ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Immunosuppressive Treatment ◽  
Clinical Signs ◽  
Abdominal Ultrasound ◽  
Predisposing Factor ◽  
Bile Duct Wall ◽  
Immune Mediated ◽  
Bile Fluid ◽  
Bile Cytology ◽  
Toxoplasma Gondii Infection

AbstractA 9-year-old female neutered domestic shorthair cat diagnosed with immune-mediated thrombocytopenia that was treated with prednisolone and cyclosporine, was presented for anorexia, vomiting, increased liver enzymes, and hyperbilirubinemia. Abdominal ultrasound revealed a markedly thickened gallbladder and common bile duct wall. Bile cytology detected severe neutrophilic inflammation and protozoal zoites. Suspected Toxoplasma gondii infection was confirmed by real-time PCR of bile. The cat was treated with clindamycin and ursodeoxycholic acid for 6 weeks, recovered and remained stable for 2 years despite ongoing immunosuppressive treatment. Thereafter, the cat was presented with suspicion of intestinal lymphoma, and recurrence of toxoplasmosis was diagnosed. Following treatment with clindamycin and prednisolone over 4 weeks the cat was euthanized. This is the first report of Toxoplasma gondii zoites detected in bile fluid from a cat with cholecystitis. Pathogenesis of toxoplasmosis in cats is still not fully understood. Although immunosuppression can represent a relevant predisposing factor, other factors, such as virulence of the parasite and genetic polymorphism of the host, can also play an important role. Toxoplasmosis should be included as a differential diagnosis in cats developing clinical signs of an inflammatory disease while receiving immunosuppressive treatment.

scholarly journals Peripheral vascular disease – a new vascular disease associated with normal tension glaucoma: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Ali Nowrouzi ◽  
Javier Benitez-del-Castillo ◽  
Sepideh Kafi-abasabadi ◽  
Mario Rodriguez-Calzadilla ◽  
Antonio Diaz-Ramos ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Vascular Disease ◽  
Normal Tension Glaucoma ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Vascular Abnormality ◽  
Vascular Abnormalities ◽  
Peripheral Arterial ◽  
The Right ◽  
First Time

Abstract Introduction Normal-tension glaucoma is known as a multifactorial optic neuropathy. A number of lines of evidence suggested that vascular factors played a significant role in the development of normal-tension glaucoma. The mechanisms underlying the abnormal ocular blood flow in normal-tension glaucoma are still not clear. Peripheral vascular disease seems to be associated with glaucoma populations independent of other cardiovascular risk factors. We found this presentation, for the first time, to our knowledge, as another probable vascular abnormality related to our patient with normal-tension glaucoma, although it is necessary to confirm its pathological effect in future studies. Case presentation Our patient was a 48-year-old Spanish man without any personal and family history of interest except for circulatory problems of the lower limbs with repetitive ulcers at the frontal and lateral aspects of his legs. His chief complaint was vision loss when he came to consult us. In exploration, his best corrected visual acuity was 20/20 in both eyes; initial intraocular pressure in the right eye was 14–16 mmHg and in the left eye was 16–18 mmHg, with a mild sclerosis of the lens in slit-lamp examination. No inflammation or pigmented lesion was detected in the anterior chamber. Open angle confirmed by Goldman four quadrants gonioscopy. Funduscopic examination revealed a vertical cup disc ratio of 0.6 in the right eye and 0.8 in the left eye. The patient’s neuroretinal rim was normal in the right eye, and superior thinning in the left eye was determined. Examination of the patient’s visual field showed inferior mild probable nasal scotoma in the right eye and an inferior deep arcuate scotoma defect in the left eye. His optical coherence tomography examination revealed thinning of the peripapillary nerve fiber layer thickness in the left eye and superior loss of macular retinal ganglion cells in the left eye. Normal intraocular pressure values were measured on the intraocular pressure curve without treatment (maximum value, 18–20 mmHg), discarding higher intraocular pressures measured out of office. Ultrasonic pachymetry measured 515/520 μm, and normal intraocular pressure measured with a PASCAL tonometer ruled out probable corneal biomechanical underestimations. The patient’s polysomnography study was normal and excluded sleep apnea syndrome. The patient’s serial mean blood pressure was normal, especially in the lower limbs (mean value, 125/70 mmHg), ruling out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities, autoimmune disease, and inflammatory disease were excluded. Normal immunologic study and normal vascular biopsy were observed, as well as normal brain magnetic resonance imaging and a normal carotid vascular study. The primary diagnosis was moderate medium peripheral arterial disease in the lower limbs, which was confirmed by echography after ruling out other probable vascular abnormalities related to normal-tension glaucoma. Conclusion After ruling out other systemic diseases and vascular abnormalities related to normal-tension glaucoma, we found peripheral arterial disease as a probable vascular abnormality related to normal-tension glaucoma in our patient. To our knowledge, this is the first time such a case has been reported. Thus, further research is needed to determine the relevance of these results to the general population.

Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy

2005 ◽  
Vol 18 (04) ◽  
pp. 235-242 ◽  
Author(s):  
S. W. Aiken ◽  
G. R. DiResta ◽  
L. G. Herr ◽  
S. Monette ◽  
K. Carey
Keyword(s):  
Risk Factors ◽  
Patellar Tendon ◽  
Medical Records ◽  
Tibial Plateau ◽  
Conservative Therapy ◽  
Cruciate Ligament ◽  
Clinical Signs ◽  
Cranial Cruciate Ligament ◽  
Tibial Tuberosity Fracture ◽  
Clinical Changes

SummaryPatellar tendon thickening (PTT) and patellar tendinosis (PTS) have been discussed in the veterinary literature as a post-operative complication of tibial plateau leveling osteotomy (TPLO). The purpose of this study was to define radiographic PTT, determine the frequency of and risk factors for PTT and PTS, and describe the clinical and histopathological findings of PTS after TPLO. We hypothesized that the location of the osteotomy alters forces placed on the patellar tendon resulting in PTT or PTS. Radiographs and medical records from 83 dogs undergoing 94 TPLO procedures were retrospectively evaluated. Two months post-operatively, 19 dogs (20.2%) had a normal patellar tendon or mild PTT, 51 (54.3%) had moderate PTT, and 24 (25.5%) had severe PTT. Seven of the 24 dogs (7.4%) with severe PTT had clinical signs consistent with PTS. Only dogs with severe PTT developed PTS (p < 0.0001). The risk factors for the development of PTT include: a cranial osteotomy, a partially intact cranial cruciate ligament (CCL) in conjunction with a cranial osteotomy, and post-operative tibial tuberosity fracture. The only risk factor identified for the development of PTS was a partially intact CCL. Four dogs with PTS improved with conservative therapy and one improved with surgical treatment. Two dogs had tendon biopsies with histopathological review that showed tendon degeneration with lack of inflammation. As only the dogs with severe PTT develop PTS, a caudal osteotomy for the prevention of PTT and subsequent PTS is recommended.

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