Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

Bilateral renal descensus and intravesicular ureteroneocystostomy for treatment of bilateral ureteral ligation and transection that occurred during ovariohysterectomy in two cats

CASE DESCRIPTION 6-month-old and 7-month-old spayed female domestic shorthair cats were referred because of complications associated with inadvertent bilateral ureteral ligation and transection during ovariohysterectomy. CLINICAL FINDINGS Both cats had a 1- to 2-day history of lethargy, inappetence, and vomiting. Initial exam findings included lethargy, signs of abdominal pain, anuria, and dehydration. Clinicopathologic testing revealed azotemia and hyperkalemia. Abdominal ultrasonography revealed peritoneal effusion and bilateral pyelectasia in both cats and retroperitoneal effusion in one. Fluid analysis in both cats supported a diagnosis of uroabdomen. TREATMENT AND OUTCOME Exploratory celiotomy was performed in both cats, and bilateral ureteral ligation and transection was confirmed. Bilateral renal descensus and ureteroneocystostomy with an intravesicular mucosal apposition technique was successfully performed in both cats. Clinicopathologic evaluation performed 1 day after surgery in one cat and 5 days after surgery in the other revealed complete resolution of azotemia. Ultrasonographic examination of the urogenital tract performed approximately 4 months after surgery in the first cat and 1 month after surgery in the second cat revealed complete resolution of renal pelvic dilation bilaterally. CLINICAL RELEVANCE Bilateral intravesicular ureteroneocystostomy in conjunction with bilateral renal descensus was used successfully to treat bilateral ureteral transection that occurred in 2 cats during routine ovariohysterectomy. Limited treatment options currently exist for this serious complication, and euthanasia is often considered. This technique, which relies on the use of the natural surrounding tissues for successful treatment, can offer a potential treatment option to correct this uncommon but devastating complication.

Secondary Intracranial Hypertension After Ciprofloxacin Treatment: A Case Report

A 30-year-old man developed secondary osteomyelitis after a traumatic amputation of his right index finger. The infection was treated with ciprofloxacin. Approximately 4 weeks after starting treatment, he complained of a progressive decrease in visual acuity, retro-ocular pain and bitemporal headache. A diagnosis of intracranial hypertension was established. Blood sample analysis, infectious profile, cerebrospinal fluid analysis, and neuroimaging were normal. Visual acuity and other symptoms progressively improved after stopping drug treatment. There were no complications or sequelae. Intracranial hypertension due to fluoroquinolones is described in the medical literature, its appearance during such treatments, despite being a rare adverse event, should be monitored.

Encapsulated Allogeneic Synovial Membrane Mesenchymal Stem Cells Provide Better Outcomes of Chondral Lesions in Horses

Osteoarthritis is the main cause of equine lameness, and its treatment remains ineffective. Synovial membrane mesenchymal stem cells (SMMSCs) provide satisfactory outcomes in joint injuries, mainly due to their immunomodulatory and reparative properties. This study aimed to evaluate the effect of SMMSCs, either encapsulated in alginate hydrogel or free, in chondral lesions of horses.Methods: Chondral lesions were surgically induced in the medial trochlea of the talus of fifteen horses. Animals were treated with PBS free SMMSCs or encapsulated SMMSCs. Physical evaluations, assignment of lameness scores and synovial fluid analysis were performed (cytological analysis and dosage of IL-1, IL-10, IL-6, INF-Ɣ, TNF 𝛼, P substance, serum amyloid A, TGF-β, IGF and PGE2) for two weeks. Cartilage biopsies were performed 150 days after induction for histological analysis and immunohistochemistry staining.Results: All groups initially presented inflammation. Although free SMMSCs showed moderate tissue repair, encapsulated SMMSCs had a lower grade of inflammation with superior tissue macro- and microscopic aspects at the end, while the control group showed fibrosis and poor cartilage aspect. This study suggests better effectiveness of stem cells in chondral defects when encapsulated MSCs are used.Conclusion: While the absence of treatment perpetuates cartilage degradation, encapsulated SMMSCs respond better to initial inflammation, interacting and modulating the environment through the release of anti-inflammatory cytokines. Better outcomes observed in encapsulated MSCs were related to the immuno- and physical barriers provided by the alginate hydrogel, allowing a longer period of permanence and interaction between MSCs and the environment.

Acute Polyarticular Gout due to Chronic Kidney Disease

Gout is a crystal deposition disorder that typically presents as an acute flare of the first metatarso-phalangeal joint of the great toe. Rarely gout can present as an acute poly-articular disease with involvement of multiple joints. Evaluation of patients with poly-articular arthropathy with appropriate investigations like uric acid levels, renal function tests and synovial fluid analysis helps in the early diagnosis of poly-articular gout. Immediate treatment with urate lowering agents during the acute flare provides immediate pain relief and prevents progression of disease & bone destruction.

Slickline Descaling Technology Delivers Cost Savings Over Coiled Tubing

Al-Khafji Joint Operations (KJO), a joint operation representing both Saudi and Kuwaiti energy interests in the divided zone, recently encountered obstructions in their offshore field. Routine pressure and temperature surveys revealed that an increasing number of wells were developing scale. The operation required an efficient mechanical tool to clean out extensive accumulated scale bridging within a vertical production string and restore full wellbore accessibility. The well had been previously shut down from operations for five years. The operator considered using a coiled tubing (CT) unit or workover rig to clear the scale but sought a more cost-effective solution. The operator chose a slickline wellbore cleanup and debris breaking tool, which is an impact-driven tool designed to break up scale deposits in a cost-effective, efficient manner. It is jarred down mechanically in the well, each jar applying a short-duration torque via the unique, helically split torque sub. The well's accessible tubing inner diameter was reduced from 2.9-in, nominal to 2-in, at the wireline reentry guide depth. To combat this issue, the slickline technology was deployed with subs increasing in outer diameter (OD) from 1.9-in. to 2.5-in. OD tools. The special features of the wellbore cleanup and debris breaking tool made it better adapted to the well environment and greatly increased the descaling efficiency. Thirty runs enabled the team to clear the scale accumulations down to 3,652 ft (1113 m). The operator confirmed integrity of the tubing at the end of the slickline operation, allowing the slickline team to access the wellbore and run a memory pressure temperature survey to check the well deliverability. The implementation of the wellbore cleanup and debris breaking tool enabled the operator to reduce inventory and overall descaling time. Microscopic and Fourier transform infrared analyses of the scale determined it was calcite (CaCO3) with some small hydrocarbon impurities from either oil or diesel. The descaling rate and cost savings achieved using the wellbore cleanup and debris breaking tool has since resulted in the operator adopting this technology and looking into the feasibility of starting a campaign for scale removal in more than 20 wells. The presence of calcite as a scaling agent is potentially due to the carbonate-saturated formation water and the loss of carbon dioxide from this water to the hydrocarbon phase as pressure decreases. Creating a detailed reservoir characterization that defines fracture orientation, relative aperture produced fluid analysis, and rock properties can help minimize the effect of scale at an early stage. Continuous well monitoring can lead to early identification of scale and determine the need for chemical treatment or further mechanical interventions. This case study demonstrates the benefits of using this wellbore cleanup and debris breaking tool as the first method of mechanical descaling.