After A Year of Follow Up Non-Cirrhotic Portal Hypertension Patient with Partial Spleen Embolization (PSE) Management

Non-cirrhotic portal hypertension (NCPH) is a heterogeneous group of liver disorders leading to portal hypertension. There are multiple approaches to managing portal hypertension' clinical complications to treat/prevent spontaneous hemorrhage by mitigating thrombocytopenia. Portal hypertension complications have been traditionally managed with serial endoscopic variceal ligation (EVL) or with invasive open surgical procedures such as orthotopic liver transplantation (OLT) or portosystemic shunting, splenectomy.6–9 There are several risks associated with splenectomies, such as hemorrhagic complications or intraoperative blood loss.5,6,14 Partial Spleen Embolization (PSE) ‎may overcome the limitations of splenectomy and provide patients with an alternative treatment. An eighteen-year-old male has a splenomegaly history since he was 12 years old and has recurring hematemesis and melena. After performing abdominal computed tomography, laboratory studies, and several endoscopies, the results indicated secondary hypersplenism due to non-cirrhotic portal hypertension. The patient had 13 endoscopies and 2 EVL in 5 years. Despite adequate treatment, the patients developed recurrent variceal bleeding and no improvement in blood function. The patient underwent PSE at Integrated Cardiovascular Center in Dr. Cipto Mangunkusumo, General Hospital, Jakarta, Indonesia. It was performed through the femoral access with a PVA (polyvinyl alcohol) embolus. The procedure went successful, and there was no major complication with the patient. Twenty days after the patient had an abdominal CT scan, it showed no abscess, and the spleen volume was reduced by 20%. Long-term results over a year after the procedure are presented. PSE is a safe, effective, semi-invasive alternative to splenectomy in non-cirrhotic portal hypertension because it preserves functional spleen mass and avoids postprocedure accelerated liver disease or encephalopathy.

Ultrasonic characteristics of immune bodies in children with infectious mononucleosis

Diagnostic morphometric criteria for splenomegaly in children with infectious mononucleosis are established using ultrasound. The study included 29 children with infectious mononucleosis. The average age is 11.7 ± 3.5 years. A morphometric measurement of the length, width and thickness of the spleen, elastometry (EM), and lymph nodes were evaluated. The spleen mass was determined by method of O.V. Vozgoment, coefficients: the ratio of spleen mass to body mass (KMS, Km), body length (KI), body surface area (Ks). The average CCM value was 6,47 ± 2,8, the absolute value of the indicator varied from 1,9 to 14,2. According to the CCM, patients are divided into 3 groups: group A – 6 (20,7%), group B – 11 (38%), group C – 12 (41,3%). The average mass of the spleen was 332,5 ± 119.6 g, the CMS – from 7,7 to 14,2, the average value of the indicator – 8,6 ± 1,9. In group B the mass of the spleen, compared with group C is 1,2 times less. In group C the spleen mass is statistically significantly greater compared with groups A and B. In group C, spleen rigidity was increased in 42,9% of cases. The average EM value is 15,8 ± 4,8 kPa. A negative correlation between the average strength between EM and age (r = – 0,65, p = 0,01) was revealed. A direct relationship was found between the mass of the spleen and the CMS, and lymphadenopathy of various localization, often periportal lymph nodes.

Skin Burn by Termal Mattress - A Therapeutic Approach

Background: Burns are caused by a direct or indirect action of heat on an organism, compromising the functional integrity of the skin. Hypothermia is a common intercurrence in animals during the transoperative period; thermal mattresses are used to maintain the animal’s body temperature, but inappropriate use can cause the patient’s skin to burn. In humans, burns are quite common; however, in veterinary medicine, they are infrequent. The aim of this study was to describe a case of accidental burn in a canine caused by a thermal mattress, emphasizing wound treatment and analgesia used.Case: A 12-year-old male canine without defined breed weighing 15 kg underwent an emergency exploratory laparotomy due to rupture of a spleen mass and presented with intercurrence hypothermia during the anesthesia procedure, which was controlled using a thermal mattress. Ten days after the surgical procedure, he developed a skin lesion with erythema, suffusion, and necrosis, evolving skin displacement along the entire back with a lot of pain which was possibly caused by the use of a thermal mattress in the transoperative procedure. The intuited analgesic treatment involved the use of numerous and different drugs, including Methadone (0.3 mg/kg, QID, SC), Dipyrone (25 mg/kg, TID, IV), and Ketamine (0.5 mg/kg, TID, SC) (during hospitalization), as well as Tramadol (4 mg/kg, TID, PO) and Dipyrone (25 mg/kg, TID, PO) after medical release as support therapy. For the wound treatment, calcium alginate was initially used daily and subsequently changed for daily application of dermisana oil. The patient followed up weekly for approximately two months for wound monitoring as well as adjustments to the drug therapy. The would almost completely healed, but the patient showed a significant worsening in the general clinical condition correlated with the neoplasm that he had, and the owner and clinical staff of the veterinary hospital opted for euthanasia.Discussion: Hypothermia should be avoided as much as possible during anesthesia, as the body’s temperature is very important in homeostasis, in addition to being able to change the pharmacokinetics and pharmacodynamics of some drugs. The use of a thermal mattress to avoid hypothermia during the intraoperative period is a common and useful tool in veterinary routine, but should be used with caution and constant monitoring of the animal under general anesthesia to avoid skin burns which are not immediately noted. When diagnosed, the treatment should aim for wound healing and provide analgesia. Different pharmacological approaches can be used for this purpose, including topical therapies with different products that provide wound healing and regard to analgesia can be used for association of non-steroidal anti-inflammatory drugs such as meloxicam, opioids like morphine and tramadol, and N-Methyl-D-aspartate (NMDA) blockers like ketamine for analgesia. Burn treatment is difficult but can have a favorable prognosis. In the present report, the conservative wound management using sodium alginate and dermisana oil almost completely cured the wound, and the canine responded positively to the analgesic protocol instituted with the association of different drugs. It is still important to highlight the attendance and commitment of the owner in the proposed treatment, as euthanasia, in this case, was due to the comorbidity presented by the patient.

STUDY OF THE CUMULATIVE PROPERTIES OF «INDEZ» ON LABORATORY WHITE RATES

The article presents the results of the study of «Indez» disinfectant. An effective disinfectant for use in animal husbandry should be easy to use, be non-toxic, have broad bactericidal spectrum, be non-carcinogenic, have non-addictive micro-flora and provide a permanent bactericidal effect in the presence of animals, while sanitizing the air environment. «Indez» disinfectant is a small, amorphous grey powder with a specific odour, well sprayed. It is composed of triiodomethane (iodoform), zinc oxide, iron sulphate (II) (iron sulphate), copper sulphate, silicon dioxide, zeolite, active essential oils, a complex of surfactants and pH regulators, auxiliaries. This preparation can be used in the presence of animals; the disinfectant effect is based on the spectrum of antimicrobial action of its constituents. In the experiment of the study of the cumulative properties of «Indez» 80 white rats weighing 180-200 ± 10 g, tested doses of 1/5, 1/10, 1/20, from DL50 were used. To the animals of the experimental group, the suspension of the preparation was administered orally: in the first 4 days - 1/5 of DL50, then 1/10 and 1/20. Animals of the control group were administered saline at a dose of 0.5 ml. Observations on rats were carried out for 22 days. Depending on the dose of the drug, the cumulation coefficient. As a result of the study of the cumulative properties of the drug it is established that the introduction of a total dose of «Indez» 56,8 cm3 per 1 kg body weight does not cause death of white rats. When conducting a total dose of 63,4 cm3 / kg body weight one animal died, representing 5 %. Further administration of the drug lethality was on the 18-th day (total dose 83,13 cm3 / kg) – 15 %, on the 19-th day (total dose 93,0 cm3 / kg) – 20 % and the 20-th day (total dose 102,87 cm3 / kg) – 45 %. With an increase of 9,873 1,5 times (1,8095 cm3 / kg) on the 21-st day, the mortality rate was 80 %, and on the 22-nd day of the studies 90 % of laboratory animals were killed, the total dose was 1032,49 cm3 / kg. Under the study of the cumulative properties of «Indez» disinfectant, it was found that the cumulation coefficient in rats is 2,2 units. This, in turn, indicates that the test agent has moderately pronounced properties for cumulation. In this case, white rats inhibit the hematopoietic function of the bone marrow and reduce the body’s defences, as evidenced by a probable decrease in leukocyte count and a slight decrease in haemoglobin, lymphocyte count, spleen mass factor, and increased segmentation.

Unique maternal immune and functional microbial profiles during prenatal stress

Maternal stress during pregnancy is widespread and stress-induced fetal neuroinflammation is thought to derive from a disruption in intrauterine immune homeostasis, though the exact origins are incompletely defined. We aimed to identify divergent immune and microbial metagenome profiles of stressed gestating mice that may underlie detrimental inflammatory signaling at the maternal-fetal interface. In response to stress, maternal glucocorticoid circuit activation corresponded with diminished spleen mass and IL-1β production, reflecting systemic immunosuppression. At the maternal-fetal interface, density of placental mononuclear leukocytes decreased with stress. Yet maternal whole blood leukocyte analysis indicated monocytosis and classical M1 phenotypic shifts. Genome-resolved microbial metagenomic analyses revealed reductions in genes, microbial strains, and metabolic pathways in stressed dams that are primarily associated with pro-inflammatory function. Overall, these data indicate that stress disrupts maternal immunological and microbial regulation during pregnancy, characterized by concurrent anti- and pro-inflammatory signatures, which may displace immune equilibrium at the maternal-fetal interface.

Synergistic effect of a combination of granulocyte macrophage colony-stimulating factor and thymosin α1 on Lewis lung cancer transplanted tumor in mice

Purpose: To study the synergistic effect of a combination of granulocyte-macrophage colonystimulating factor and thymosin-α1 on the treatment of Lewis lung cancer transplanted tumor.Methods: C57BL/6 mice were used. A mouse model of Lewis lung cancer was established using Lewis lung cancer cell lines. The mice were randomly divided into blank control group, polyene taxol (DTX) group, DTX thymosin α1 (Tα-1) group, and DTX granulocyte-macrophage colony-stimulating factor (GM-CSF) group, with 8 mice per group. The degree of tumor inhibition, thymus mass, thymus index, spleen mass, spleen index, IL-6, TNF-1, IFN-1, CD4+, CD8+ T cells and the ratio of CD4+/CD8+ were determined by ELISA and flow cytometry.Results: Body mass, thymus mass, thymus index, spleen mass, spleen index, IL-6, TNF-1, IFN-1, CD4+, CD8+ T cells and the ratio of CD4+/CD8+ in DTX + Tα-1 group, DTX + GM-CSF group and DTX + Tα-1 + GM-CSF group were significantly elevated (p < 0.05), relative to the corresponding levels in DTXmice (p < 0.05). Body mass, degree of tumor inhibition, thymus mass, thymus index, spleen mass, spleen index, IL-6, TNF-1, IFN-1, CD4, CD8 T cells and CD4+/CD8+ ratio in DTX + Tα-1 + GM-CSF mice were significantly elevated, relative to the DTX + Tα-1 and DTX + GM-CSF groups (p < 0.05). Thestate of the tumor was significantly improved in the DTX + Tα-1 and DTX + GM-CSF mice.Conclusion: A combination treatment of GM-CSF, Tα-1 and DEX effectively enhances the resistance of mice and suppresses chemotherapy-induced decrease in body weight. This finding may be of clinical significance. Keywords: Granulocyte macrophage, Colony-stimulating factor, Thymosin, Docetaxel, Lewis lung cancer, Transplanted tumor

Potency of Curcuma aeruginosa as A Chemopreventive Candidate Agent on 7,12-Dimethylbenz[a]anthracene (DMBA)-Induced Rat Spleen

Present investigation shows that the extract of C. aeruginosa attenuates DMBA-induced spleen carcinogenesis in Wistar rats. Three-week female Wistar rats were treated with three different C. aeruginosa extract doses (CA1: 40 mg/200 g body weight, BW; CA2: 80 mg/200 g BW; CA3: 160 mg/200 g BW) and were induced with DMBA after one-week administration of these doses. A commercial immunostimulant, and DMBA only were also given to each group as positive and negative control, respectively. The development of tumors was evaluated by investigating the incidence of tumor and tumor multiplicity during the experiment. Spleen mass index and histological parameters such as white pulp, centrum germinativum, and marginalis zone were also examined. Based on our study, the administration of C. aeruginosa extract during and after carcinogen induction gave several impacts on rat carcinogenesis. At the extract dose of 80 mg/200 g BW, tumor incidence of animals were least (P<0.05). However, all doses did not show any effect to the spleen mass index, though the highest dose (160 mg/200 g BW) was found to cause changes in white pulp and marginalis zone boards. This trend indicates that it takes higher dose to cause an immune response effect reaching the organs.

Toxoplasma gondii causes lipofuscinosis, collagenopathy and spleen and white pulp atrophy during the acute phase of infection

ABSTRACT In this study, we evaluated homeostatic and functional disorders of the spleen in mice inoculated with Toxoplasma gondii. The kinetics of megakaryocyte and leukocyte production, body and spleen mass and certain histopathological aspects were analyzed. There was increased (P &lt; 0.05) the accumulation of lipofuscin in the red pulp of the spleen, in the periods of 30 and 60 dpi of the infection, that is, in the chronification stage of the disease and decrease of the white pulp area. In addition, we observed (from 7dpi) a quantitative and qualitative increase (P &lt; 0.05) in the deposition of collagen fibers in the spleen of all infected mice. Since resolution of the inflammatory process resulted in pathophysiological changes, we can suggest that the T. gondii invaded and multiplied in the cells of the white and red pulps of the spleen. Although we did not find the parasite in the spleen, this hypothesis is supported by the presence of diffuse inflammatory infiltrate, which extended through the spleen parenchyma of all inoculated mice. Taken together, our results suggest that T. gondii causes severe homeostatic disorders that have altered spleen physiology, including diffuse parenchymal inflammation, lipofuscinosis in histiocytes, early aging, collagenopathy, systemic sclerosis and spleen and white pulp atrophy.

MORPHOMETRIC CHARACTERISTICS OF THE SPLEEN IN INFECTIOUS MONONUCLEOSIS (ULTRASONIC STUDY)

Summary. The spleen is a secondary immune and the largest organ of the reticulo-endothelial system, actively involved in the process of infectious mononucleosis. At the clinical level, an assessment of the degree of organ involvement in the pathological process is unlikely. As a rule, for the diagnosis of splenomegaly, only palpation and percussion determination of the size of the spleen is used, which is a late and subjective sign of possible splenomegaly. Ultrasound examination provides ample opportunity to study the size of the spleen in infectious mononucleosis. The purpose of this study was to identify morphometric and dopplerographic changes in the spleen in patients with infectious mononucleosis. Materials and methods. The study group consisted of 24 patients with infectious mononucleosis. The control group is represented by 30 healthy students of the medical institute. All participants in the study underwent ultrasound examination of the spleen. Echostructure of the organ, clarity of the contour was evaluated, linear dimensions were measured: length, width, thickness of the spleen. The speed indicators in the splenic artery and vein in the gates of the spleen were measured. The positioning of the elastographic window during fibroelastometry was performed in the standard seroscale examination window. Measurements were taken at 5 or more points of the spleen parenchyma with a distance of at least 4-5 mm from the capsular zone and the zone of large vessels. Based on the obtained morphometric measurements, the mass and spleen mass coefficient (CMS), the ratio of spleen mass and growth and body surface area were calculated. Results. The study found that in patients with infectious mononucleosis, the length, thickness and weight of the spleen are statistically significantly greater than in healthy ones. But the mass of the organ varies widely. Therefore, CMS was calculated, which is an objective criterion for the size of the spleen. It was revealed that with infectious mononucleosis there are three variants of the spleen response: decrease, CMR less than 1.5; normal value, CCM is in the range from 1.5 to 4; splenomegaly, CMS more than 4. Splenomegaly is associated with increased organ stiffness, peak blood flow velocity and pressure in v. Lienalis, as well as periportal lymphadenopathy. Identified changes are characteristic of young patients. Conclusion. Ultrasound examination of the spleen is of high diagnostic value in patients with infectious mononucleosis. Using the method, an accurate assessment of the state of the immune organs in the acute period of the disease is possible. At the preclinical level, gradation of splenomegaly is possible depending on its severity, assessment of hemodynamics and organ stiffness.