Why women with advanced cervical cancer die

According to HoIzbach'y (Zentr. F. Gyn., 1923, No. 50-51), almost every case of this disease that falls on the sectional table indicates a severe lesion of the urinary apparatus, dilatation of the ureters, the disappearance of the renal parenchyma and kidney infection.

Bit-Related Lesions in Event Horses After a Cross-Country Test

Bit-related oral lesions are common and may impair horse welfare. The aim of this study was to investigate the prevalence of oral lesions and their risk factors in a sample of Finnish event horses. The rostral part of the oral cavity (the bit area) of 208 event horses (127 warmbloods, 52 coldbloods, and 29 ponies) was examined in a voluntary inspection after the last competition phase, i.e., the cross-country test. Acute lesions were observed in 52% (109/208) of the horses. The lesion status was graded as no acute lesions for 48% (99/208), mild for 22% (45/208), moderate for 26% (55/208) and severe for 4% (9/208) of the horses. The inner lip commissure was the most common lesion location observed in 39% (81/208) of the horses. A multivariable logistic regression model with data of 174 horses was applied to risk factor analysis. Horses wearing thin (10–13 mm) (OR 3.5, CI 1.4–8.7) or thick (18–22 mm) (OR 3.4, CI 1.4–8.0) bits had a higher risk of moderate/severe lesion status than horses wearing middle-sized (14–17 mm) bits (P = 0.003). Breed was associated with moderate/severe lesion status (P = 0.02). The risk was higher for warmbloods (reference group) and coldbloods (OR 2.0, CI 0.88–4.7) compared with ponies (OR 0.2, CI 0.04–0.87). Mares were at higher risk of moderate/severe lesion status (OR 2.2, CI 1.1–4.5) than geldings (reference group) (P = 0.03). Bar lesions were more common in horses with unjointed bits (40%, 8/20) than with basic double-jointed (10%, 5/52), formed double-jointed (8%, 6/78) or single-jointed bits (5%, 2/40) (Fisher's exact test, P = 0.002). The results of this study suggest that thin and thick bits and mare sex should be considered risk factors for mouth lesions. In addition, in this sample ponies had smaller risk for lesions than other horse breeds. We encourage adopting bit area monitoring as a new routine by horse handlers and as a welfare measure by competition organizers for randomly drawn horses.

Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery

Background: The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency. Methods: Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, n = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, n = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG. Results: There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842–60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453–9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081–0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139–0.812, p = 0.015) were significant protective factors. Conclusions: Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.

Chronic total occlusion (CTO) revascularization a comparison from Japanese and European expert CTO operators registries

Background Development of different strategies and devices improved CTO revascularization. However, technical and procedural success might be influenced by several factors including geographical expertise. Methods A total of 4412 CTO coronary treated lesions (Japan 1531 Europe 2881) (mean age 64.5±10.7, male 85.2%, JCTO score 2.09±1.24) were analyzed in European and Japanese registries during the year 2016. The primary endpoint was to assess technical success rate of CTO-PCI cases and procedural outcomes. Results Primary Antegrade approach and success rate were 71.5% and 90.8% respectively in Japan while 77.0% and 94.1%, respectively in Europe, (p<0001). Primary Retrograde approach and success rate were 28.5% and 84.0% respectively in Japan, while 22.6% and 69.2%, in Europe (p<0001). There were no differences in technical success rate between Japan and Europe (89.9% vs 88.5%, p=0.13). Procedural time was higher in Japan than in Europe 156.3±1.8 vs 107.1±1.3 mins (p<0.001), but contrast media volume resulted the opposite 209.6±3.2 ml vs 267.5±2.4 ml, (p<0.001). Procedural complications were higher in Japan than Europe (death: 0.4% vs 0.07%, p=0.024, myocardial infarction: 1.2% vs 0.57% p=0.045, coronary artery occlusion: 0.26% vs 0.07% p=0.026, coronary perforation: 4.22% vs 3.04% p=0.045). A multivariate analysis showed that independent predictors of failed procedure were both for Japan and Europe unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length>20mm. Conclusions Technical success rate was similar between Japan and Europe, but more retrograde approach was common in Japan. Unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length>20mm were independent predictors of failed procedures for both countries. Procedural complications were higher in Japan probably because of longer procedural time and higher frequency of retrograde approach. Funding Acknowledgement Type of funding source: None

A Large, Severely Obstructive, Calcified Mass in the Midsegment of Aortic Arch

Severe obstructive lesions in the aortic arch are rare. Crossing such lesions poses additional challenges in patients who require cardiac catheterizations. Oftentimes, specialized catheters are required to negotiate the lesion. Herein, we are reporting a series of case images that illustrate a severe lesion in the aortic arch during coronary angiography.

Evaluation of the Efficacy of a Field Isolate of Eimeria Oocysts Immunization in Two Breeds of Chickens - Demystifying use of Coccidiosis Vaccines

Immunization efficacy of a field isolate of unattenuated sporulated Eimeria oocysts in broiler and Nigerian indigenous chickens (NIC) was investigated. Both breeds of birds were grouped and inoculated with varying dose levels (750, 1500 and 3000) of the oocysts per bird.  The immunizing infections were truncated with an anticoccidial drug following detection of patency evident by presence of Eimeria oocysts in the faeces of inoculated birds on day 4 of inoculation.  Immunized birds were then given challenged infections of 10,000 oocysts of the same Eimeria isolate per bird and an additional group that did not receive the immunizing infections was also challenged with 10,000 oocysts to serve as the unimmunized-challenged control while another group remained as uninfected-unchallenged control.  Immunized birds were found to be protected against the challenge infections evident by having significantly less severe gross lesion scores (0 to 1) in contrast to the unimmunized-challenged control birds (which had lesion scores of 2 to 4 and 1 to 2 in broiler and indigenous chickens respectively).  The infection was more severe in broiler chickens in contrast to the indigenous chickens judged by more severe lesion scores and significantly higher oocysts counts in the broilers.  Broilers also had significantly lower PCV (P < 0.05) in comparison to their indigenous counterparts.  Infected birds generally suffered infections more in contrast to the uninfected control birds judged by the significantly higher body weights and PCV of the uninfected birds (P < 0.05).  The results showed that the protection of birds against coccidiosis by immunization with the Eimeria isolate is feasible and this can therefore serve as a premise for the recommendation of immunization against coccidioisis in eastern Nigeria where the practice is extremely low or unknown by poultry farmers and hardly recommended to poultry producers by veterinarians and their allies in spite of the endemicty and severity of the disease in the area.  All the dose levels tried in this study were protective with no obvious differences between the dose levels and we recommended the use of 750 oocysts of such isolates to minimize the risk clinical coccidiosis. Local isolates of Eimeria would also have the added advantage in that they are likely to contain multiple Eimeria species that could provide full protection against the entire spectrum of Eimeria that occur in the area. Â