Safety of percutaneous renal cryoablation: an international multicentre experience from the EuRECA retrospective percutaneous database.

OBJECTIVE: To investigate the safety profile of percutaneous cryoablation of renal tumours < 7 cm, utilising data extracted from an international multicentre registry. MATERIALS AND METHODS: A retrospective review of all immediate and delayed complications from a multicentre database was performed and was categorised according to the Clavien-Dindo classification. Statistical analysis was performed for both overall complications (all Clavien-Dindo) and major complications (Clavien-Dindo 3 to 5). The following criteria were identified as potential predictive factors for complications: centre number, modality of image guidance, tumour size (≤ 4 cm vs. > 4 cm), number of tumours treated in the same session (1 vs. > 1) and tumour histology. RESULTS: A total of 713 renal tumours underwent ablation in 647 individual sessions. In 596 of the cases, one tumour was treated; in the remaining 51 cases, several tumours were treated per session. Mean lesion size was 2.8 cm. Fifty-four complications (Clavien-Dindo 1 to 5) occurred as a result of the 647 procedures, corresponding to an overall complication rate of 8.3%. The most frequent complication was bleeding (3.2%), with 9 cases (1.4%) requiring subsequent treatment. The rate of major complication was 3.4%. The only statistically significant prognostic factor for a major complication was a tumour size > 4 cm. CONCLUSION: Percutaneous renal cryoablation is associated with a low rate of complications. Tumours measuring more than 4 cm are associated with a higher risk of major complications. KEY POINTS: • Percutaneous kidney cryoablation has a low rate of complications. • Bleeding is the most frequent complication. • A tumour size superior to 4 cm is a predictive factor of major complication.

Pulmonary function after hemorrhagic shock and resuscitation in a porcine model.

BACKGROUND: Hemorrhagic shock may trigger an inflammatory response and acute lung injury. The combination adenosine, lidocaine (AL) plus Mg(2+) (ALM) has organ-protective and anti-inflammatory properties with potential benefits in resuscitation.The aims of this study were to investigate: (1) pulmonary function and inflammation after hemorrhagic shock; (2) the effects of ALM/AL on pulmonary function and inflammation. METHODS: Pigs (38 kg) were randomized to: sham + saline (n = 5); sham + ALM/AL (n = 5); hemorrhage control (n = 11); and hemorrhage + ALM/AL (n = 9). Hemorrhage animals bled to a mean arterial pressure (MAP) of 35 mmHg for 90 min, received resuscitation with Ringer's acetate and 20 ml of 7.5% NaCl with ALM to a minimum MAP of 50 mmHg, after 30 min shed blood and 0.9% NaCl with AL were infused. Hemorrhage controls did not receive ALM/AL. Primary endpoints were pulmonary wet/dry ratio, PaO2 /FiO2 ratio (partial pressure of arterial oxygen to the fraction of inspired oxygen), cytokine and protein measurements in bronchoalveolar lavage fluid (BALF) and lung tissue, neutrophil invasion and blood flow in lung tissue. RESULTS: In the hemorrhage groups, wet/dry ratio increased significantly compared with the sham groups. PaO2 /FiO2 ratio decreased during shock but normalized after resuscitation. BALF did not indicate significant pulmonary inflammation, oxidative stress or increased permeability. Intervention with ALM caused a temporary increase in pulmonary vascular resistance and reduced urea diffusion across the alveolar epithelia, but had no effect on wet/dry ratio. CONCLUSION: Hemorrhagic shock and resuscitation did not cause acute lung injury or pulmonary inflammation. The question whether ALM/AL has the potential to attenuate acute lung injury is unanswered.

Brain death increases COX-1 and COX-2 expression in the renal medulla in a pig model.

BACKGROUND: Brain death is linked to a systemic inflammatory response that includes prostaglandins and cytokines among its mediators. The levels of cyclooxygenase-1 and cyclooxygenase-2 (COX-1 and COX-2) affect graft survival, but it remains unknown whether these enzymes are modified during brain death. The aims of this study were to investigate the organ expression of COX and to analyse the cytokine response in the plasma, cerebrospinal fluid (CSF), and organs in a porcine model of intracerebral haemorrhage and brain death. METHODS: Twenty pigs were randomly assigned to either a brain death group or a control group. Brain death was induced by an intracerebral injection of blood, and the animals were observed over the next 8 h. Tissue samples were tested for COX-1, COX-2 messenger RNA (mRNA) expression (heart, lung, and kidney), haeme oxygenase-1 (HO-1) (kidney), interleukin-1ß (IL-1ß), IL-6, IL-8, IL-10, and tumour necrosis factor-α. These cytokines were also measured at eight time points in the plasma and CSF. RESULTS: At the organ level, the levels of COX-1 and COX-2 mRNA expression were increased only in the renal medulla (P = 0.03 and P = 0.02, respectively). The cytokine levels in the tissue, plasma, and CSF revealed no differences between the groups. HO-1 expression decreased (P = 0.0088). CONCLUSION: Brain death increases the expression of COX-1 and COX-2 mRNA in the renal medulla. The release of cytokines into the plasma and CSF did not vary between the groups.

Brain death induced by cerebral haemorrhage - a new porcine model evaluated by CT angiography.

BACKGROUND: Brain death and complications to brain death affects the function of organs in the potential donor. Previous animal models of brain death have not been able to fully elucidate the mechanisms behind this organ dysfunction, and none of the available animal models mimic the most common insult prior to brain death: intracerebral haemorrhage. The objective of this study was to develop a large animal model of brain death based on a controlled intracerebral haemorrhage and verified by computerised tomographic angiography (CTA). METHODS: Twenty pigs (range: 26.6-31.2 kg) were randomised to brain death or control. Brain death was induced by infusion of blood through a stereotaxically placed needle in the internal capsule. Brain death was confirmed by the measured intracranial pressure (ICP), lack of corneal and pupillary light reflexes, and atropine test. CTA was performed 120-180 min after brain death. The pigs were observed for 8 h after brain death. RESULTS: Brain death was declared when the ICP exceeded mean arterial pressure after a median of 36 min (range: 28-51 min). Significant increases in heart rate, and mean arterial pressure (MAP) were followed by a steep decrease. With fluid therapy, the animals demonstrated haemodynamic stability. Reflexes disappeared, and atropine did not induce an increase in heart rate in the brain dead animals. CTA confirmed loss of cerebral circulation. CONCLUSION: This study offers a standardised, clinically relevant porcine model of brain death induced by a haemorrhagic attack. Brain death was verified by the disappearance of corneal and pupil reflex, atropine test, and CTA.

The influence of intermittent altitude exposure to 4100 m on exercise capacity and blood variables.

This study was performed to investigate the effects of intermittent hypoxic exposure on blood and exercise parameters. Eight sea level residents were exposed to 2 h daily stimulus to 4100 m altitude in a hypobaric chamber for a total of 14 days. Exercise performance was evaluated at sea level before and after the hypoxic stimulation. Blood samples were obtained before, during, and at time points up to 14 days after the hypoxic exposure. No changes were observed in haemoglobin, haematocrit, reticulocytes, serum transferrin receptors, or EPO levels in the blood. Submaximal cycle (150 W) ergometer exercise corresponded to a oxygen uptake of 1.9+/-0.1 and 1.9+/-0.1 L min(-1) before and after the intermittent altitude exposure, respectively. At maximal exercise the workloads attained were 343+/-17 and 354+/-27 W before and after the exposure, with corresponding oxygen uptakes of 4.0+/-0.2 and 4.2+/-0.2 L min(-1). It is concluded that intermittent hypoxic exposure to 4100 m altitude for 2 h daily and a total of 14 days does not affect exercise capacity.

Survey of laboratory findings in suspected cases of bovine spongiform encephalopathy in Denmark from 1990 to 2000.

A survey of the laboratory findings in suspected cases of bovine spongiform encephalopathy (BSE) in Denmark from 1 June 1990 to 31 December 2000 is presented. During this period BSE was a notifiable disease, and the heads of suspected cases were submitted according to the legislation on BSE. A total of 176 submissions were made, mostly from bovines with neurological disorders and mainly during the last 3 years of this period. Lesions or other laboratory findings consistent with severe neurological disorders were found in 115 cases. The most frequent diagnosis was encephalic listeriosis (35.8% of submissions) followed by other forms of inflammatory lesions. A wide range of lesions were diagnosed less prevalent. BSE was diagnosed twice. The first case occurred in an imported cow in 1992, while the second confirmed case was diagnosed in a native cow in February 2000. A marked increase in the number of submissions occurred following the detection of BSE in February 2000.

Surveillance of ruminant diseases in the Nordic countries.

All the Nordic countries have a basis for their surveillance and disease control in ruminants in national legislation and regulations listing notifiable diseases of concern to the countries. The Nordic countries are a disease-free zone comparing to other parts of the world and the aim of the surveillance is to keep that status and be able to document it. Following is a short summary from each country.

Antibody dynamics in BRSV-infected Danish dairy herds as determined by isotype-specific immunoglobulins.

Using specific ELISAs, antibody levels of four different isotypes to bovine respiratory syncytial virus (BRSV) were determined in calves, following experimental BRSV infection. Most calves experienced an increase in the specific IgM and IgG1 titres about 6-10 days after infection with BRSV. The IgM titre was transient showing positive titres for only 5-10 days, while specific IgG1 was present for a longer time. IgA was detected concomitantly with IgM but at a lower level. Production of IgG2 anti-BRSV antibodies was detected from 3 weeks after infection. In two closed herds, repeated blood samplings were performed on young stock to analyse maternal immunity. The passively transferred antibodies were mainly of the IgG1 isotype and the half-life of IgG1 to BRSV was estimated to be 26.6 days. One of the herds had an outbreak of enzootic pneumonia, diagnosed to be caused by BRSV. Furthermore, another herd with acute BRSV was followed by weekly blood samples in six calves; in both herds IgM and IgG1 was detected shortly after the appearance of clinical signs. Serum samples from 50 Danish dairy herds (453 samples) were tested for immunoglobulins of the isotypes IgG1, IgG2 and IgM. The presence of antibodies to BRSV was widespread and more than 54% of the samples had BRSV antibodies of both the IgG1 and IgG2 isotypes indicating a high herd prevalence to BRSV. Test samples from two herds out of 50 were free from all isotypes to BRSV.

Abscess disease, caseous lymphadenitis, and pulmonary adenomatosis in imported sheep.

The occurrence of abscess disease, caseous lymphadenitis, and pulmonary adenomatosis in sheep in Denmark is reported for the first time. Subcutaneous abscesses were observed in imported 4- to 5-month-old lambs of the Lacaune breed 10 days after arrival in Denmark. Abscesses were mostly located in the head, neck and shoulder regions close to the regional lymph nodes. Bacteriological examinations revealed growth of Staphylococcus aureus ssp. anaerobius in all animals with subcutaneously located abscesses containing a viscous white-yellow odourless mass. In addition, Corynebacterium pseudotuberculosis was isolated from abscesses in one animal and lesions consistent with pulmonary adenomatosis were found in four animals.

Seroprevalence of Border Disease in Danish sheep and goat herds.

A study was conducted in 1994-96 with the aim of assessing the serological prevalence of Border Disease (BD) among sheep and goats in Denmark and to investigate possible relations to herd factors. From each of 1000 herds, 2 blood samples were obtained from animals older than 1 year. The examination for antibodies was performed using a blocking ELISA detecting antibodies to pestivirus. Data from 815 herds were analysed statistically by the maximum likelihood method in a multinomial model. The estimated herd prevalence was 0.083 and the estimated individual prevalence within the positive herds was 0.50. There was no difference between the prevalence in sheep and goat herds. Records for well over half of the herds could be combined with data from the Danish Central Husbandry Register. No association between occurrence of BD and herd size was found. Cattle were registered as contemporarily present on 135 out of 521 herds which was shown to be strongly associated to BD. The estimated herd prevalences of BD among farms with and without contemporary cattle were 0.24 and 0.042, respectively.

The need for a veterinary antibiotic policy.

The international recognition of the 'stable to table' approach to food safety emphasises the need for appropriate and safe use of antibiotics in animal production. An appropriate use of antibiotics for food animals will preserve the long-term efficacy of existing antibiotics, support animal health and welfare and limit the risk of transfer of antibiotic resistance to humans. Furthermore, it may promote consumer confidence in the veterinary use of antibiotics. In advancing these arguments, the authors of this article argue that there is a need for a visible and operational policy for veterinary use of antibiotics, paying particular attention to the policies that are being developed in Denmark.

Diagnostic studies of abortion in Danish dairy herds.

Diagnostic findings in 218 aborted bovine foetuses are reported. The materials were examined in a matched case-control study of 69 Danish dairy herds with a sudden increase in the number of abortions and a corresponding 69 control herds. Foetuses aborted during the subsequent 6-month period were examined to identify the cause of abortion if possible. A total of 186 specimens were submitted from case herds and 32 from control herds. A likely cause of abortion was diagnosed in 73 foetuses. The most common cause was bovine viral diarrhoea virus (BVDV: 13%) followed by Neospora caninum infection (10%), mycosis (5%) and Bacillus licheniformis infection (4%). Foetal and/or placental lesions were found in a further 27 cases. Only BVDV infection and neosporosis were diagnosed in more than one foetus per herd and only protozoal associated abortions occurred significantly more frequently in the case, rather than in the control, herds.

Influence of feeding intensity on blood concentrations of glucose, ketone bodies and free fatty acids in nutritionally adapted dairy cows fed 24 times daily.

Concentrations of acetoacetate, D-3-hydroxybutyrate, glucose and free fatty acids were determined in blood from 3 Jersey cows during a 5-months period. The cows were fed an identical complete feed every hour, from ad libitum intake to maintenance level, for 28 days at each of the following levels of intake: 170, 138, 102, 53 and 37 g organic matter per kg bodyweight0.75 (metabolic bodyweight). Throughout the experimental period, the cows were in negative energy balance, which was reflected in an average weight loss of 640 g per day. None of the metabolites differed from reference values for healthy lactating cows. The concentration of D-3-hydroxybutyrate decreased linearly with the level of feeding and reflected a decreased ruminal production of butyrate. The high feeding frequency to lactating cows may be considered an essential factor in the prevention of ketosis.

Mulberry heart disease in young pigs without vitamin E and selenium deficiency.

Mulberry heart disease persists among young pigs in Denmark although abundant supplies of selenium and vitamin E are added to feedstuffs for sows and pigs. The concentrations of selenium and vitamin E in the liver and heart tissues of young pigs which had died suddenly, and had the characteristic lesions of mulberry heart disease post mortem, were not significantly different from the concentrations found in pigs of the same age which had died suddenly for other reasons. The concentrations of selenium and vitamin E in the livers (0.3 mg/kg and 4 mg/kg, respectively) appeared to be satisfactory in all the pigs examined.

Excessive dietary selenium to primiparous sows and their offspring. I. Influence on reproduction and growth.

The effect of high dietary selenium (Se) on the reproductive performance, growth and health in pigs was examined. Addition of 0 to 16 mg Se per kg feed to sows and their piglets up to nine weeks of age did not cause any manifest toxic effect. None of the sows died due to the Se treatment. The piglets were all fullborn and showed no macroscopic abnormalities. The treatment did not influence neither the number of liveborn and stillborn piglets in the litter, nor the survival of the piglets until 9 weeks of age. The weight of the whole litter at birth was unaffected by the Se supplementation, while there was a significant difference in body weight of the piglets at 9 weeks of age. The weaned pigs receiving 8 or 16 mg Se per kg feed had a reduced feed intake. As the feed utilization was unaffected by treatment, these pigs had a significantly lower weight at 9 weeks of age.