Pathology and Advanced Imaging—Characterization of a Congenital Cardiac Defect and Complex Hemodynamics in a Pig: A Case Report

Domestic pigs are widely used in cardiovascular research as the porcine circulatory system bears a remarkable resemblance to that of humans. In order to reduce variability, only clinically healthy animals enter the study as their health status is assessed in entry examination. Like humans, pigs can also suffer from congenital heart disease, such as an atrial septal defect (ASD), which often remains undetected. Due to the malformation of the endocardial cushion during organ development, mitral valve defects (e.g., mitral clefts) are sometimes associated with ASDs, further contributing to hemodynamic instability. In this work, we report an incidental finding of a hemodynamically highly relevant ASD in the presence of incompetent mitral and tricuspid valves, in an asymptomatic, otherwise healthy juvenile pig. In-depth characterization of the cardiac blood flow by four-dimensional (4D) flow magnetic resonance imaging (MRI) revealed a prominent diastolic left-to-right and discrete systolic right-to-left shunt, resulting in a pulmonary-to-systemic flow ratio of 1.8. Severe mitral (15 mL/stroke) and tricuspid (22 mL/stroke) regurgitation further reduced cardiac output. Pathological examination confirmed the presence of an ostium primum ASD and found a serous cyst of lymphatic origin that was filled with clear fluid partially occluding the ASD. A large mitral cleft was identified as the most likely cause of severe regurgitation, and histology showed mild to moderate endocardiosis in the coaptation area of both atrio-ventricular valves. In summary, although not common, congenital heart defects could play a role as a cause of experimental variability or even intra-experimental mortality when working with apparently heathy, juvenile pigs.

P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

Regurgitation under the ERAS Program: A Case Report

Introduction: Enhanced recovery after surgery (ERAS) is an evidence-based concept that reduces the recovery period after major abdominal surgery. Ingestion of carbohydrate solutions up until two hours before elective surgery has shown positive results. The authors present a case of regurgitation in a patient with apparently low risk for delayed gastric emptying who drank a carbohydrate solution two hours before induction of anaesthesia. Case report: An 80-year-old male patient with a relevant history of ischemic heart disease, atrial fibrillation, stage 3 chronic kidney disease and hypertension, was diagnosed with rectal cancer. He was scheduled for an anterior rectal resection hand-assisted laparoscopic surgery under the ERAS program, which included a 200 mL carbohydrate drink the night before and in the morning of the surgery, no less than two hours before the induction of anaesthesia. Immediately after loss of consciousness, there was regurgitation of a significant amount of clear fluid. Discussion: Even though ingestion of oral carbohydrate drinks is considered to be safe up to two hours before anaesthesia, further evaluation (e.g., gastric ultrasonography) may be considered in non-high-risk patients.

A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure

Background Benign Multicystic Peritoneal Mesothelioma (BMPM) is one of the rarest diseases in medicine with only more than 200 cases worldwide. This paper aims to report a case of Benign Multicystic Peritoneal Mesothelioma that strangely arose from the liver and was long treated as Hydatid cyst. The case also had many risk factors including asbestos exposure that had not yet been linked with Benign Multicystic Peritoneal Mesothelioma. Case presentation We report a case of a 62 years old male with a history of a perforated peptic ulcer and a cystic mass in the liver that was misdiagnosed as hydatid cyst 7 years ago. He presented with generalized abdominal pain and bloating. Image studies showed many cystic formations filled with clear fluid. An en bloc surgery was performed and a pathologic study showed a multiloculated mass lined by flat or cuboidal epithelium leading to the diagnosis of BMPM. A follow up was scheduled after 3 months revealed total recurrence. Conclusion BMPM resembles many other cystic lesions in the abdomen and should be taken into consideration when dealing with nontypical cystic formations. Its diagnostic and treatment methods are still hazy making this disease difficult to approach.

Challenging diagnostic work-up of a massive fluid-filled structure in the cranial abdomen of a cat

A 9-year-old female, neutered European shorthair cat was presented with acute vomiting, obvious jaundice and painful enlargement of the abdomen. Icteric skin and mucous membranes in addition to severe bilirubinaemia (mainly direct bilirubin) and a large increase in liver enzyme activities were the main findings at the initial examination. Radio- and ultrasonographic evaluation revealed a massive fluid-filled structure caudal to the liver displacing abdominal organs, in particular the stomach. As this structure with a diameter of 8–10 cm occupied considerable space in the cranioventral abdomen, a detailed ultrasonographic examination of the liver and the gallbladder, and determination of the structure’s association with a particular abdominal organ was initially impossible. Via ultrasound-assisted puncture under general anaesthesia 300 ml of an almost clear fluid could be aspirated. Cytological examination revealed a cyst content-like fluid with cell detritus.Further ultrasonographic and computed tomographic diagnostics followed by abdominal laparotomy finally enabled diagnosis of a cystic dilatation of the entire common bile duct and accumulation of white bile. Histopathological examination after euthanasia (requested by the owner) identified lymphoplasmacytic cholangitis and necrosis of the duodenal papilla. The massive dilatation of the common bile duct complicated its definite diagnosis by diagnostic imaging methods. It was most likely caused by a longer-standing obstruction of the bile flow by lymphoplasmacytic cholangitis with necrosis and granulation tissue formation in the area of the duodenal papilla. An interesting but initially misleading feature was the presence of white bile. The etiology of this extremely rare condition remains obscure but in the described case a manifestation of impaired hepatocyte function secondary to biliary stasis is suspected to be the cause.

Bullous Pemphigoid- A Rare Case report

Introduction: The most severe autoimmune subepidermal blistering condition of the skin and mucous membranes is bullous pemphigoid (BP). In Europe, it is estimated to affect 1 in every 4,000 people. Currently incidence range between 2-22/1,000,000 worldwide. It primarily affects the elderly and is diagnosed using clinical, histologic, and immunologic criteria. Clinically, it appears as diffuse eczematous, pruritic, urticaria-like lesions with the later emergence of tense bullae or blistering lesions filled with clear fluid. Case Presentation: Here, we report a case of a 50- years old female patient with a complaint of itchy lesions with wounds all over the body present with an 8-month of history. A subepidermal blister with eosinophils and neutrophils infiltration was discovered on histopathological evaluation. Salt-split indirect immunofluorescence revealed linear deposition of IgG at the dermo-epidermal junction. On further investigation, using diagnostic and Interventional aids a final diagnosis of Bullous pemphigoid.

Thermosolutal natural convection in a partly porous cavity with sinusoidal wall heating and cooling

Purpose This paper aims to consider numerical analysis of laminar double-diffusive natural convection inside a non-homogeneous closed medium composed of a saturated porous matrix and a clear binary fluid under spatial sinusoidal heating/cooling on one side wall and uniform salting. Design/methodology/approach The domain of interest is a partially square porous enclosure with sinusoidal wall heating and cooling. The fluid flow, heat and mass transfer dimensionless governing equations associated with the corresponding boundary conditions are discretized using the finite volume method. The resulting algebraic equations are solved by an in-house FORTRAN code and the SIMPLE algorithm to handle the non-linear character of conservation equations. The validity of the in-house FORTRAN code is checked by comparing the current results with previously published experimental and numerical works. The effect of the porous layer thickness, the spatial frequency of heating and cooling, the Darcy number, the Rayleigh number and the porous to fluid thermal conductivity ratio is analyzed. Findings The results demonstrate that for high values of the spatial frequency of heating and cooling (f = 7), temperature contours show periodic variations with positive and negative values providing higher temperature gradient near the thermally active wall. In this case, the temperature variation is mainly in the porous layer, while the temperature of the clear fluid region is practically the same as that imposed on the left vertical wall. This aspect can have a beneficial impact on thermal insulation. Besides, the porous to fluid thermal conductivity ratio, Rk, has practically no effect on Shhot wall, contrary to Nuinterface where a strong increase is observed as Rk is increased from 0.1 to 100, and much heat transfer from the hot wall to the clear fluid via the porous media is obtained. Practical implications The findings are useful for devices working on double-diffusive natural convection inside non-homogenous cavities. Originality/value The authors believe that the presented results are original and have not been published elsewhere.

Investigation of Lesions In Goat Brain Collected From Abattoirs in Rajshahi Metropolitan Area

Brain lesions are important cause of morbidity and reduced productivity in goats worldwide. Works on brain lesion in goats are extremely rare in Bangladesh and remain to be investigated. We investigated lesions in goat brains collected from abattoirs in Rajshahi Metropolitan area by gross and microscopic examination. Randomly selected 57 goat brains were investigated of which 24.56% brains showed gross and histopathologic lesions. Prevalence of brain lesions were higher in Jamnapari goats (29.41%) compared to in Black Bengal goats (22.50%) and female goats (26.47%) were more affected than male goats (21.74%). Age-wise prevalence were 31.25%, 21.43%, 12.50%, and 40.00% in the age of up to 2 years, 2-3 years, 3-4 years, and above 4 years old goats, respectively. Goats were more affected in the rainy (35.29%) season in contrast to in the winter (23.53%) and in the summer (10.52%) seasons. The brains collected from goats with Gid disease showed uni or multilocular cysts containing clear fluid and multiple scolices, the rest of the brains were apparently healthy by macroscopic examination. Histopathologically, pyogranuloma, perivascular cuffing, gliosis, neuronal degeneration, hemorrhages, congestion and thrombus were evident. J. Bio-Sci. 29(1): 49-58, 2021 (June)

Aspiration Pneumonitis with Nasal Liquorrhea. Literature Review

Damage to the meninges in combination with the presence of a defect in the bone structures of the base of the skull and the formation of communication with the nasal cavity or paranasal sinuses are necessary conditions for nasal liquorrhea. There are a number of complications of nasal liquorrhea of various origins: infectious (meningitis, brain abscess), pneumocephalus, aspiration pneumonitis and gastritis. A review of the literature related to aspiration pneumonitis in nasal liquorrhea has been carried out. 4 articles were selected with descriptions of 9 cases. The analysis of demographic indicators of patients, clinical data, treatment characteristics was carried out. Based on the analysis of the literature, aspiration pneumonitis is a rare complication of nasal liquorrhea. For differential diagnosis with other types of pneumonitis, it is necessary to rely on additional clinical data, such as unilateral discharge of clear fluid from the nose when tilting the head, worsening of the condition and intensification of symptoms in a horizontal position, absence of systemic inflammatory response syndrome, ineffectiveness of antibiotic therapy, recurrent the nature of the flow. Antibiotic therapy does not cure the patient from pneumonitis. For the treatment of this pathology, it is first of all necessary to eliminate the cause of aspiration — to perform plastic surgery of the skull base defect in the absence of contraindications from the side of anesthetic aid.

The Effects of Resuscitative Fluid Therapy on the Endothelial Surface Layer

The goal of resuscitative fluid therapy is to rapidly expand circulating blood volume in order to restore tissue perfusion. Although this therapy often serves to improve macrohemodynamic parameters, it can be associated with adverse effects on the microcirculation and endothelium. The endothelial surface layer (ESL) provides a protective barrier over the endothelium and is important for regulating transvascular fluid movement, vasomotor tone, coagulation, and inflammation. Shedding or thinning of the ESL can promote interstitial edema and inflammation and may cause microcirculatory dysfunction. The pathophysiologic perturbations of critical illness and rapid, large-volume fluid therapy both cause shedding or thinning of the ESL. Research suggests that restricting the volume of crystalloid, or “clear” fluid, may preserve some ESL integrity and improve outcome based on animal experimental models and preliminary clinical trials in people. This narrative review critically evaluates the evidence for the detrimental effects of resuscitative fluid therapy on the ESL and provides suggestions for future research directions in this field.