Factors associated with equine shedding of multi-drug-resistant Salmonella enterica and its impact on health outcomes.

BACKGROUND: Salmonella enterica is an important cause of healthcare-associated infections in veterinary hospitals - with outbreaks of multi-drug resistant (MDR) Salmonella among equine cases resulting in high case fatality rates and substantial financial cost. OBJECTIVES: Study objectives were to 1) investigate factors associated with shedding of MDR-Salmonella enterica and 2) evaluate the effect shedding may have on health outcomes of previously hospitalised horses and their stablemates. STUDY DESIGN: Retrospective case-control study with prospective cohort study. METHODS: Analysis of medical records (N = 373; 94 culture positive, 279 culture negative) was undertaken to determine factors associated with shedding of MDR-Salmonella. Additionally, a follow-up study was conducted to assess long-term outcomes associated with shedding among previously hospitalised horses and their stablemates. Data regarding exposures of interest were collected retrospectively from medical records. Information on long-term outcomes was obtained by phone interview of owners. Multivariable regression techniques were used to investigate factors associated with shedding and subsequent health outcomes. RESULTS: Horses experiencing diarrhoea during hospitalisation were more likely to shed Salmonella (OR 1.88; 95% CI 1.02, 3.45) compared with horses without diarrhoea, but isolates tended to be susceptible strains. Antimicrobial therapy during hospitalisation was not associated with shedding or recovery of MDR strains. Shedding did not increase long-term risk for non-survival, colic or abnormal faeces after hospital discharge; nor increase risk for hospitalisation or occurrence of abnormal faeces in stablemates. MAIN LIMITATIONS: Data collection was reliant upon the quality of medical records and owner recall, which may have led to information bias. The study population was derived from central Kentucky and may differ from horse populations in other regions. CONCLUSIONS AND CLINICAL IMPORTANCE: In general, Salmonella shedding was not associated with decreased average survival times or impacts to health of stablemates, perhaps due to owner implemented biosecurity precautions. Regardless, recently hospitalised horses should be segregated after discharge, in addition to employing rigorous hygiene practices. The Summary is available in Spanish - see Supporting Information.

Filiform polyposis of the colon in chronic inflammatory bowel disease (so-called giant inflammatory polyps).

On the basis of 3 of our own cases, we describe unusually intense forms of filiform polyposis and local giant polyposis as a consequence of chronic inflammatory bowel disease. The patients are: A 52-year-old woman who for 7 years has been known to have Crohn's disease (CD); a 55-year-old man who for 14 years has been known to have chronic inflammatory bowel disease, which was first thought to have been ulcerative colitis, but, as a result of the findings on the subtotal colectomy specimen, had to be classified as Crohn's disease or colitis indeterminate; and a 53-year-old woman known to have had ulcerative colitis for 37 years. From the literature on the subject, we drew up a chronological list of a total of 43 cases with similar or completely identical findings. The clinical significance of the findings in their particularly massive intensity results from their necessary differentiation--in the context of differential diagnosis--from a malignant tumor, in particular from a carcinoma in association with chronic inflammatory bowel disease, or from a villous adenoma. The indication of a need to operate results from the impossibility of being able definitely to rule out a malignant degeneration by means of clinical methods. Also, experience shows that with massive findings of the kind described a spontaneous disappearance cannot be expected. Finally, too, the clinical symptoms and the patients subjective complaints necessitate balanced surgical treatment, taking into consideration the site and the extent of the lesion.

[Combined regional chemotherapy and radiotherapy of liver metastases]. / Kombinierte reginale Chemotherapie und Strahlenbehandlung bei Lebermetastasen.

In an attempt to treat patients with non-resectable liver metastases more effectively, hepatic arterial chemotherapy (12 g 5-FU in 3 weeks) was combined with simultaneous whole liver irradiation (8 Gy every week, total dose of 24 Gy). 54 of the 64 patients receiving this treatment had liver metastases from colorectal carcinoma. The objective response rate, judged by CAT scan, was nearly 60%. The median survival of responders was 18 months in contrast to 8 months for nonresponders. There have been 5 lethal complications, 3 of which were related to the combined modality. For safer and better results a more exact selection is needed.

[The esophageal cyst--a rare congenital abnormality]. / Die Osophaguszyste--Eine seltene kongenitale Anomalie.

Esophageal cysts are among the embryonic malformations of the gastrointestinal tract. They develop from persisting diverticulum-like evaginations of the embryonic esophagus. The esophageal cyst is usually asymptomatic and is frequently diagnosed as an incidental finding. Since, however, a clear differentiation from malignancies is not possible with conventional diagnostic procedures. Surgical treatment is advisable in these cases.

[Reactive benign thymus hyperplasia following cytostatic chemotherapy]. / Reaktive benigne Thymushyperplasie nach zytostatischer Chemotherapie.

A space-occupying mediastinal mass was discovered in a 16-year-old boy with metastasizing non-seminomatous testicular tumour six months after successful conclusion of cytostatic chemotherapy. Metastases at other sites were excluded. An enlarged thymus was the only finding at operation. Histological and histochemical examination demonstrated diffuse hyperplasia. The findings demonstrate that reactive benign thymic hyperplasia after cytostatic chemotherapy has to be considered in the differential diagnosis of space-occupying mediastinal lesions. They can also occur in adults. They are benign, explainable as immunological rebound phenomena, and do not require operative intervention. In case of doubt, short-term corticoid administration will diminish the size of the mass and thus confirms the diagnosis.

[Cumulative functional rates of orthoptic dialysis fistulas and interposition grafts]. / Kumulative Funktionsraten von orthotopen Dialysefisteln und Interponaten.

The function of 221 dialysis shunts was investigated retrospectively in 111 patients of an outpatient haemodialysis centre. The mean age of the patients was 58 years. Of 221 recorded shunts, 171 were direct arteriovenous fistulas, while 50 were interposition grafts. The longest observation period was almost 20 years (227 months). The cumulative function rate was evaluated by the life table method; primary patency (until first revision) was differentiated from total function (revisions included). The direct fistulas as compared to the grafts had a significantly (P less than 0.05) higher primary function rate (median 35 vs. 13 months) and after 36 months also a significantly longer total function (median 76 vs. 28 months). Complications were significantly (P less than 0.05) more frequent in grafts than in fistulas (61/50 vs 120/171). Surgical revisions of fistulas failed significantly more often (P less than 0.05) than revisions of grafts (137/171 versus 26/50). Grafts on the forearm had significantly worse results as compared to grafts or fistulas on the upper arm (P = 0.03). In contrast to age, sex and underlying disease of patients a blood pressure less than 130/70 mmHg was a significant risk factor for shunt failure (P = 0.002). Analysis of primary function shows (clearer than the total patency rate) that a direct fistula is a better vascular access in haemodialysis patients than a graft.

[Regeneration of the liver under the influence of E. coli endotoxin]. / Regeneration der Leber unter Einfluss von E.-coli-Endotoxin.

Studies were conducted into regeneration of rat liver exposed to the action of E. coli endotoxin, following two-third resection. No accelerated regeneration was found to take place in the wake of two-third hepatectomy and following postoperative intraperitoneal administration of E. coli endotoxin. However, regeneration was accelerated with significance in response to preoperative administration of 0.1 mg/kg body weight of E. coli endotoxin (B 5:55 DIFCO).

[Cryosurgery of the healthy rat liver]. / Kryochirurgie an der gesunden Rattenleber.

Cryosurgical treatment was applied to normal liver tissue of 13 clinically intact rats, with a view to investigating effects of freezing temperatures upon normal liver tissue. The animals were sacrificed after different intervals from surgery, and their liver tissue was macroscopically and histologically examined. Major postoperative complications were not observed but for one animal which died of wound healing disorder. The method seems to be suitable also for treatment of liver cell carcinoma or liver metastases.

[Animal experiment studies of cryosurgical treatment of DS sarcomas and Morris hepatomas implanted in the liver]. / Tierexperimentelle Untersuchungen über die kryochirurgische Behandlung von in die Leber implantierten DS-Sarkomen und Morris- Hepatomen.

Cryosurgical treatment was applied to solid liver tumours of rats with a view to studying the effects of freezing temperatures upon liver carcinoma. Such treatment was applied to twelve rats to which carcinomas, 0.5 cm to 3.0 cm in size, had been implanted. Cryosurgical treatment was successful in one case. Many of the animals died of complications which resulted from freezing of surrounding organs, such as stomach or greater liver vessels.

[Esophagitis--hiatal hernia--indications and choice of procedure: fundoplication]. / Oesophagitis--Hiatushernie--Indikation und Verfahrenswahl: Fundoplicatio.

The fundoplication, described by Nissen in 1956, is still an excellent and the most frequently applied antireflux operation in cases of refluxesophagitis. Accurate preoperative evaluation and subtile operative technique are imperative, however. Typical postoperative syndromes will be discussed. Details of the results will be given with particular regard to 214 fundoplications carried out on our own patients: mortality rate 0%, recurrence rate 4.7%, content with the result of the operation 88%.

Aneurysm of the right ovarian vein--an unusual cause of pulmonary embolism.

This case reports a 23-year-old female who experienced a massive bilateral pulmonary embolism. The source of thrombi was found to be in a large saccular aneurysm of the right ovarian vein. The pulmonary emboli were treated by local infusion of streptokinase. The patient was cured after removal of the aneurysm by surgery.

[Is there progress in the operative treatment of sigmoid diverticulitis]. / Gibt es Fortschritte bei der operativen Behandlung der Sigmadiverticulitis?

A high percentage of people in the civilized Western world develops colonic diverticula. Signs of illness are coming from inflammation around the diverticula. Resection therapy is indicated after several inflammation episodes. The operation has often to be performed in case of emergency: Ileus, bleeding, perforation. We recommend the primary resection of the sigmoid colon with an transverse colostomy or the Hartmann operation even in case of perforation or peritonitis. We operated 140 patients. The mortality rate in our hospital was 12% of the elective and 27% of the emergency operations.

[Anastomosis healing in the irradiated colon. III. Microangiographic studies. An animal experiment study]. / Untersuchungen über die Anastomosenheilung am bestrahlten Kolon. III. Mikroangiographische Untersuchungen. Eine tierexperimentelle Untersuchung.

During an experimentation on animals, the vascularization of anastomoses in the recto-sigmoidal region was investigated by microangiographic examinations after an irradiation corresponding to the therapeutic proceeding in man. The anastomoses were performed with and without fibrin coating one day, four weeks, eight weeks and four months following to irradiation. The examinations were performed on the third, seventh, 14th, and 21th postoperative day. The results of microangiography do not show any difference between irradiated and non-irradiated animals.

[Anastomosis healing in the irradiated colon. II. Influence of irradiation on new formation of connective tissue. An animal experiment study]. / Untersuchungen über die Anastomosenheilung am bestrahlten Kolon. II. Der Einfluss der Bestrahlung auf die Bindegewebsneubildung. Eine tierexperimentelle Untersuchung.

With regard to the permanent increase of perioperative irradiations in case of colorectal tumors, the possible influence of irradiation on the healing of anastomoses has been investigated. 230 rats were submitted to an irradiation of the rectosigmoidal region corresponding to the therapeutic method employed in human patients (focal dose of 50 Gy, in fractions of 4 x 2 Gy per week, interval of three weeks without irradiation). Rectosigmoidal anastomoses were performed one day, four weeks, eight weeks, and four months after the irradiation. The increase of connective tissue which is decisive for the stability of the anastomosis and which can be additionally induced by irradiation, was determined 3, 7, 14 and 21 days after the operation by identification of the hydroxyproline concentration within the anastomotic region. A comparison with nonirradiated animals shows that irradiation induces an additional formation of new connective tissue which becomes more intensive as the time interval since the finishing of irradiation is longer.

[Roentgenologic contribution to the diagnosis of gallstone ileus]. / Röntgenologischer Beitrag zur Diagnostik des Gallensteinileus.

Between 1969 and 1982 8 patients of ours were operated on for gallstone ileus. Signs found in the preoperative x-ray examination indicating this condition are analyzed retrospectively. The frequency and specificity of the x-ray signs found in the abdominal survey radiograph are compared with those reported in the literature. The value of oral contrast media administration in the detection of a cholecystointestinal fistula and localization of the obstruction is discussed.

[Study about the healing of anastomoses in the irradiated colon--experimentation on animals (author's transl)]. / Untersuchungen zur Anastomosenheilung am bestrahlten Kolon. Eine tierexperimentelle Studie.

Operations on preirradiated intestinal segments are followed by a high rate of complication. In order to determine the period after which an anastomosis on the clinically/therapeutically irradiated colon involves the greatest risk, 230 rats were submitted to a fractionated X-ray stationary-field irradiation of the colon with 50 Gy. The colon was anastomosed one day, four weeks, eight weeks, and four months respectively after the irradiation. A possible protective influence of fibrin on the healing of anastomoses was examined. The resistance to bursting pressure is taken as a criterion of the security of the anastomosis. It was determined on the third, 7th, 14th, and 21st day after the operation. The irradiation alone produces a markedly higher resistance to bursting pressure in the not operated control animals. After presurgical irradiation, the healing of anastomoses is delayed. There is no dependence on the period of time between irradiation and operation. From the 14th day after surgery, the resistance to bursting pressure is considerably higher than initially. In our experiment, the healing of anastomoses was not improved by an additional fibrin application.

[Primary tumors of the small intestine (author's transl)]. / Primäre Dünndarmtumoren.

From 1969 to 1979, 19 patients were operated for tumors of the small intestine: 8 were benign and 11 malignant. Of the benign, mesenchymal tumors predominated, the malignant tumors were epithelial. The difficulty of diagnostic confirmation and its effect of the prognosis of the disease are discussed with reference to the literature.