Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes

First-line therapy for cats with pyothorax consists of intravenous antibiotics, drainage of the septic pleural effusion and closed-chest lavage. Large-bore thoracostomy tubes are traditionally used for drainage, but case series indicate a comparable efficacy using small-bore tubes. In this retrospective study, we describe a new technique of sheath-guided small-bore (6 F) thoracostomy tubes in cats with pyothorax and evaluate their efficacy and complications. Additionally, we compare outcomes between two treatment groups. Placement and use of the small-bore thoracostomy tubes described here has a low complication rate of 4% (3/67 tubes), and 53% (24/45) of the cats could be treated with thoracostomy tubes and closed-chest lavage according to the protocol. The success rate is reduced by 18% (8/45) due to deaths caused mainly by sepsis, 16% (7/45) due to structural diseases requiring surgery and a further 14% (6/43) due to lavage failures that could only be cured after additive therapy (thoracotomy or fibrinolysis). The long-term prognosis was very good, with a survival rate one year after discharge of 94% (30/32). We detected no effect on survival by early placement of bilateral thoracostomy tubes or closed-chest lavage with a heparinised solution. In conclusion, therapy of pyothorax with small-bore thoracostomy tubes is as successful as therapy with large- or medium-bore tubes.

PREDICTIVE DEFINITION OF THE SEVERITY OF CLOSED CHEST AND ABDOMINAL TRAUMA CAUSED BY SHOTS FROM 12-GAUGE "FORT-500" RIFLES WITH SHOCK-TRAUMATIC BULLETS OF "TEREN-12P" CARTRIDGES

Objective – the predictive definition of the severity of closed chest and abdominal traumaaccording to the reduced AIS injury scale when firing at various distances from "Fort-500" rifles with shock-traumatic bullets of "Teren-12P" cartridges, depending on theirballistic and energetic characteristics in contact with the human body.Material and methods. To establish the speed of bullets of cartridges "Teren-12P" atvarious distances of the shot in the conditions of KhNSC «Hon. Prof. M. S. BokariusForensic Science Institute» experimental shots from the "Fort-500A" and "Fort-500M1"pump-action guns were conducted. In total, two series of 25 shots were fired from eachgun. The values of the velocities of the bullets at the moment of the firing were measuredusing optoelectronic complexes. The determination of the parameters of the trajectory ofthe flight of bullets was carried out by a combined method by means of calculations basedon the results of experimental shots. The obtained data were processed using licensedMicrosoft Excel spreadsheets.Results. According to the research results, it has been found that the ballistic coefficient of the bullet of the "Teren-12P" cartridge is 47.3 kg/m2. This made it possible to determinethe ranges of minimum and maximum speeds of bullets at different shooting distances.Analysis of the data showed that in some cases the speed of bullets at a distance of 3.5m significantly exceeded the speed range declared by the manufacturer of the cartridges.According to the calculated values, according to the literature data, the graphs of thedistribution of the BC blunt injury criterion and the reduced AIS damage scale wereplotted depending on the distance of the shot for the minimum and maximum bullet speedsof the "Teren-12P" cartridges. According to the graphs, when the "Teren-12P" bulletsare fired at their maximum speeds, there is a 50% risk of a closed chest and abdominalinjury according to AIS -2 – AIS-3 at all distances up to 50 m. Even at minimum bulletspeeds cartridges "Teren-12P" there is a 50% risk of formation of a closed abdominaltrauma according to AIS-2 – AIS-3 with shots from a distance of up to 40 m, and chestinjuries – up to 30 m. Closed trauma to these areas of the body according to AIS-4 can bepredictably caused by shots from a distance of up to 10 m.Conclusions. A significant range of variability in the initial speeds of elastic bullets canlead to an incorrect expert estimate of the firing distance due to the fact that similargunshot wounds can be caused by both a bullet with a high initial speed from a longrange of a shot and a bullet with a low initial speed from a close firing distance. Whenthe "Teren-12P" bullets are fired from "Fort-500" rifles, there is a 50 % risk of a closedchest and abdominal injury according to AIS -2 – AIS-3 at all shooting distances up to50 m. Chest and abdominal injuries according to AIS -4 can be predictably caused whenfired from distances up to 10 m. The results obtained can be used in carrying out complexforensic examinations in cases of the use of "Teren-12P" cartridges.

Quantitative evaluation of coronary artery occlusion by 3D coronary volume reconstruction in a large animal model of acute myocardial infarction

Background Large animal models of acute myocardial infarction (MI) offer an important platform to test novel therapies. Consistency of infarct size between animals is critical to ensure an accurate assessment of therapies against control. However, anatomical variation challenges the ability to achieve a consistent infarct size and care must be taken to respect the principles of the 3Rs through minimisation of interventional fatalities. Purpose To standardise the approach of a closed chest model of balloon occlusion-facilitated MI. Novel 3-dimensional quantitative coronary angiography (3DQCA) software has been used retrospectively to identify a correlation between coronary volume occlusion and the extension of the myocardial scar. Methods Twenty-four Yorkshire pigs (mean weight 63.1±3 kg) underwent a closed chest MI model via percutaneous occlusion of the mid portion of the left anterior descending artery (LAD) for 60 minutes. The evaluation of the myocardial damage was obtained via cardiac magnetic resonance imaging (CMR) between 24 and 48 hours after the MI model (Acute) and at 4–5 weeks after MI (Chronic). Troponin I was also measured at multiple timepoints. 3DQCA reconstruction (QAngio XA 3D, Medis medical imaging systems NL) was generated from 2 angiographic projections with segmental analysis of all 3 major epicardial vessels including lumen volume, reference diameters, and segment length. The occlusive volume and vessel length was identified through co-registration of balloon position. Results At the short term timepoint, a significant correlation was found between the LAD volume occluded and the scar size as percentage of the LV mass (Spearman correlation 0.72, p value <0.01, Fig. 1). Using Youden index analysis we identified a cut-off point of 32.8% of the LAD volume to determine a scar volume >20% (Fig. 2). At chronic phase the correlation between these two variables was not significant, although there was a trend towards significance (p value = 0.06, Cor = 0.54). No significant correlation was found with serum Troponin I. Conclusions There is a significant correlation between the LAD volume occluded and the overall scar size in the acute phase and at least 32.8% of the LAD volume should be occluded to determine a scar volume >20% of the entire LV. This indicates that a prospective measure of occluded LAD volume might minimise the intra-experimental variability in studies aiming to reduce infarct size and acute myocardial injury. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): This research work was supported by grants awarded to Professor Ascione: the British Heart Foundation (BHF) (BHF IG/14/2/30991, BHF RM/13/2/30158), and the Medical Research Council (MRC) (MRC MR/L012723/1).

Experimental parameters and infarct size in closed chest pig LAD ischemia reperfusion models; lessons learned

Background Preclinical models that resemble the clinical setting as closely as possible are essential in translating promising therapies for the treatment of acute myocardial infarction. Closed chest pig left anterior descending coronary artery (LAD) ischemia reperfusion (I/R) models are valuable and clinically relevant. Knowledge on the influence of experimental design on infarct size (IS) in these models is a prerequisite for suitable models. To this end, we investigated the impact of several experimental features (occlusion and follow-up time and influence of area at risk (AAR)) on IS. Methods A total of fifty-one female Landrace pigs were subjected to closed chest LAD balloon occlusion and evaluated in three substudies with varying protocols. To assess the relationship between time of occlusion and the IS, 18 pigs were subjected to 60-, 75- and 90 min of occlusion and terminated after 24 h of follow-up. Influence of prolonged follow-up on IS was studied in 18 pigs after 75 min of occlusion that were terminated at 1, 3 and 7 days. The relation between AAR and IS was studied in 28 pigs after 60 min of occlusion and 24 h of follow-up. The relation between VF, number of shocks and IS was studied in the same 28 pigs after 60 min of occlusion. Results Increasing occlusion time resulted in an increased IS as a ratio of the AAR (IS/AAR). This ranged from 53 ± 23% after 60 min of occlusion to 88 ± 2.2% after 90 min (P = 0.01). Increasing follow-up, from 1 to 3 or 7 days after 75 min of occlusion did not effect IS/AAR. Increasing AAR led to a larger IS/AAR (r2 = 0.34, P = 0.002), earlier VF (r2 = 0.32, P = 0.027) and a higher number of shocks (r2 = 0.29, P = 0.004) in pigs subjected to 60 min of occlusion. Conclusions These experiments describe the association of occlusion time, follow-up duration, AAR and VF with IS in closed chest pig LAD I/R models. These results have important implications for future I/R studies in pigs and can serve as a guideline for the selection of appropriate parameters and the optimal experimental design.

Dynamics of the complicated post-traumatic period in combined closed chest injury: a clinical case

Оn the example of clinical observation, the possibilities of radiographic methods (x-ray, ultrasound, and CT) in the diagnosis and prognosis of the course of the post-traumatic period are shown.

Open window thoracostomy for a chronic calcified pleural empyema in the setting of a closed chest trauma

This case report is a chronic calcified pleural empyema in a patient who suffered a closed chest trauma 30 years ago. The first goal is to demonstrate how the closed chest trauma caused a bronchopleural fistula of the calcified pleural empyema, since the patient began to report continued purulent sputum after his trauma with weight loss and the appearance of an air-fluid level in the chest CT scan (no pleurocutaneous fistula in the clinical examination). The second goal is to reveal the rule and the interest of an open window thoracostomy in the management of chronic calcified pleural empyema, since a decortication remains difficult to perform in cases like this one.