Evidence of Pneumopericardium after Elective Ovariectomy in a Peritoneopericardial Diaphragmatic Hernia-Affected Dog: A Case Report.

Peritoneopericardial diaphragmatic hernia (PPDH) is an opening between the pericardial sac and the pleuroperitoneal membrane. Pneumopericardium is an infrequent complication of PPDH. This condition is a serious circumstance in which free gas accumulates in the pericardial sac. The present report describes the occurrence of pneumopericardium and pericardial effusion after elective ovariectomy in a dog affected by PPDH. The presence of an umbilical and diaphragmatic hernia was highlighted during ovariectomy, and a pneumopericardium was seen during an X-ray exam. At the time of admission to the hospital, the dog was asymptomatic. The diagnosis was performed by X-ray and ultrasonographic exams. Computed tomography examination confirmed the diagnosis and directed for a surgical approach of the congenital defect. Surgery resulted in resolution of PPDH and of pneumopericardium.

Brain Linac-Based Radiation Therapy: "Test Drive" of New Immobilization Solution and Surface Guided Radiation Therapy.

AIM: To test inter-fraction reproducibility, intrafraction stability, technician aspects, and patient/physician's comfort of a dedicated immobilization solution for Brain Linac-based radiation therapy (RT). METHODS: A pitch-enabled head positioner with an open-face mask were used and, to evaluate inter- and intrafraction variations, 1-3 Cone-Beam Computed Tomography (CBCT) were performed. Surface Guided Radiation Therapy (SGRT) was used to evaluate intrafraction variations at 3 time points: initial (i), final (f), and monitoring (m) (before, end, and during RT). Data regarding technician mask aspect were collected. RESULTS: Between October 2019 and April 2020, 69 patients with brain disease were treated: 45 received stereotactic RT and 24 conventional RT; 556 treatment sessions and 863 CBCT's were performed. Inter-fraction CBCT mean values were longitudinally 0.9 mm, laterally 0.8 mm, vertically 1.1 mm, roll 0.58°, pitch 0.59°, yaw 0.67°. Intrafraction CBCT mean values were longitudinally 0.3 mm, laterally 0.3 mm, vertically 0.4 mm, roll 0.22°, pitch 0.33°, yaw 0.24°. SGRT intrafraction mean values were: i_, m_, f_ longitudinally 0.09 mm, 0.45 mm, 0.31 mm; i_, m_, f_ laterally 0.07 mm, 0.36 mm, 0.20 mm; i_, m_, f_ vertically 0.06 mm, 0.31 mm, 0.22 mm; i_, m_, f_ roll 0.025°, 0.208°, 0.118°; i_, m_, f_ pitch 0.036°, 0.307°, 0.194°; i_, m_, f_ yaw 0.039°, 0.274°, 0.189°. CONCLUSIONS: This immobilization solution is reproducible and stable. Combining CBCT and SGRT data confirm that 1 mm CTV-PTV margin for Linac-based SRT was adequate. Using open-face mask and SGRT, for conventional RT, radiological imaging could be omitted.