Secondary aorto-duodenal fistula: a diagnostic challenge in a patient with fever and anemia.

A 69-year-old male, three years post-endovascular exclusion for an abdominal aortic aneurysm, presented with asthenia and fever. An abdominal CT scan showed no gastrointestinal tract communications, abscess, or contrast extravasation. Tc-99m-HMPAO-labeled leukocytes scintigraphy with SPECT/CT revealed increased uptake on the posterior surface of the aortic graft, along with air bubbles in its right iliac limb. Upper gastrointestinal endoscopy was performed, revealing a duodenal ulcer in the transition between the second and third portions. The ulcer exhibited yellow graft tissue at its center. The patient underwent in situ reconstruction, involving the replacement of the infected prosthetic graft, and the duodenal defect was addressed through segmental resection and duodenojejunal anastomosis. Secondary aorto-duodenal fistula (SADF), a rare complication of vascular surgery, may arise from factors such as local infection or graft-bowel contact. SADF, often located in the duodenum, poses a high mortality risk, necessitating early diagnosis. Clinical presentation varies from significant upper gastrointestinal bleeding to obscured bleeding.

Estimate of activity discharged into the sewer network in neuroendocrine treatments with 177Lu-DOTA-TATE.

The urine of patients treated for neuroendocrine tumors with 177Lu is a liquid radioactive waste. The total body activity retained by the patient is quantified with SPECT-CT image 1 day after administration. From the activity of 177Lu in patient after 1 day Apat_Lu177_1d, the activity in urine after 1 day Aurine_Lu177_1d is determined, as well as the activity of 177mLu Aurine_Lu177m_1d that accompanies 177Lu as an impurity. Admitting the patient 24 hours in a dedicated room with storage tanks reduces the discharged activity below the permitted limits.

Canine Dracunculus Nematode Infection, Toledo, Spain.

A fragment of a Dracunculus-like worm was extracted from the hind limb of a 2-year-old dog from Toledo, Spain. Cytochrome oxidase I and rRNA sequences confirmed an autochthonous mammalian Dracunculus worm infection in Europe. Sequence analyses suggest close relation to a parasite obtained from a North American opossum.

Ultrasound-guided excision combined with intraoperative assessment of gross macroscopic margins decreases the rate of reoperations for non-palpable invasive breast cancer.

AIMS: The standard technique for intraoperative tumour localization of clinically occult tumours is wire-guided localization (WGL). This, however, this has several disadvantages. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision, performed by surgeons, combined with intraoperative assessment of macroscopic pathologic and ultrasound margins in non-palpable invasive cancers indicated for conservative breast therapy. PATIENTS AND METHODS: Two-hundred and twenty-five non-palpable invasive breast cancers were subjected to excision with IOUS. The lesion was located in the operating room with a high-frequency ultrasound probe (8-12 MHz), which was then used to guide surgical removal. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. The sensitivity of IOUS and effectiveness in the characterization of the specimen margins were evaluated, assessing the need for reoperation. RESULTS: Pathologic tumour size was 12.0 ± 6.7 mm and 13 lesions (6.4 %) were <5 mm. The sensitivity of IOUS localization was 99.6% (224/225 cases). Only one cancer of less than 5 mm was not localized. The average weight of the specimens was 26.1 g. A second operation was required to remove margins in the 4% of cases (9/225). In 5 cases remains of in situ or invasive carcinoma were found. In two cases, conservative surgery was converted to mastectomy. CONCLUSIONS: IOUS excision combined with the intraoperative assessment of the macroscopic margins of non-palpable breast cancers is a safe, useful, and efficient technique. We obtained an excellent characterization of tumour margins with moderate removal of breast tissue and consequently a lower number of reoperations were required and good cosmetic results were obtained. We believe that use of this technique in conservative breast cancer surgery should be recommended.

Serological study of selected vector-borne diseases in shelter dogs in central Spain using point-of-care assays.

We evaluated the prevalence of selected vector-borne diseases in 131 dogs in an animal shelter in central Spain using point-of-care assays (SNAP 4DX and SNAP Leishmania; IDEXX Laboratories, Westbrook, ME). The SNAP 4DX detects Dirofilaria immitis (Di) antigen and antibodies against Ehrlichia canis (Ec), Borrelia burgdorferi (Bb), and Anaplasma phagocytophylum (Aph); the SNAP Leishmania kit detects antibodies against Leishmania infantum (Li). Dogs were classified as healthy or sick based on physical examination, complete blood counts, and serum chemistry profiles. The prevalence of positive test results was as follows: Ec, 5.3% (n = 7); Aph, 19.0% (n = 25); Bb, 0%; Di, 0%; and Li, 5.3% (n = 7). Four dogs (3%) were coexposed to Ec and Aph, and three dogs (2.3%) were coexposed to Aph and Li. There was no statistically significant correlation between positive serology and clinical status (sick vs. healthy) or hematologic/biochemical abnormalities. The prevalence of Aph was the highest and is in agreement with a recent report in a dog shelter in northwestern Spain. These point-of-care assays may be more valuable as epidemiologic than as clinical tools.

[Hemodynamic and inflammatory markers of sleep apnea-hypopnea syndrome and nocturnal hypoxemia: effects of treatment with nasal continuous positive airway pressure]. / Marcadores hemodinámicos e inflamatorios del síndrome de apneas-hipopneas durante el sueño e hipoxemia nocturna. Efectos del tratamiento nasal con presión positiva continua de la vía aérea nasal.

OBJECTIVE: In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers. PATIENTS AND METHODS: Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and (99m)Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment. RESULTS: Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (r=0.37, P=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant. CONCLUSIONS: While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.

Marcadores hemodinámicos e inflamatorios del síndrome de apneas-hipopneas durante el sueño e hipoxemia nocturna. Efectos del tratamiento nasal con presión positiva continua de la vía aérea nasal / Hemodynamic and inflammatory markers of sleep apnea-hypopnea syndrome and nocturnal hypoxemia: effects of treatment with nasal continuous positive airway pressure

OBJETIVO: Investigamos los factores del síndrome de apneas-hipopneas durante el sueño (SAHS) que activan losmecanismos de riesgo cardiovascular, a través del estudio delas concentraciones plasmáticas del fragmento N-terminaldel precursor del péptido natriurético cerebral (NTproBNP)y de la proteína C reactiva de alta sensibilidad (PCRas), asícomo el efecto que sobre ellos tiene el tratamiento con presiónpositiva continua de la vía aérea nasal (CPAPn).PACIENTES Y MÉTODOS: Se estudió a 42 pacientes conSAHS (leve-moderado en 15 casos y grave en 27), comparadoscon 14 personas sin SAHS. No tomaban fármacos nipresentaban diabetes, hipertensión, dislipemia importante oenfermedad cardiovascular, que se descartó tanto clínicamentecomo por ecocardiografía y tomografía computarizadapor emisión de fotón cínico-esfuerzo con 99mTc-tetrofosmina.En los pacientes con SAHS grave se estudiaron losefectos de 6 meses con CPAPn.RESULTADOS: Ajustando por edad, índice de masa corporaly tabaquismo, las medias de los biomarcadores no fueronsignificativamente más altas en los pacientes con SAHS graveque en aquéllos con SAHS leve-moderado o en los controles.Sin embargo, en los pacientes con SAHS el principal factorque influyó en las concentraciones de NTproBNP fue elporcentaje de tiempo con saturación arterial de oxígeno nocturnamenor del 90% (r = 0,37; p = 0,017), sin que se encontraraningún predictor de los valores séricos de la PCRas. Laaplicación de CPAPn hizo descender, pero no significativamente,las concentraciones de los biomarcadores.CONCLUSIONES: Mientras que la hipoxemia nocturna en elSAHS es la responsable de las variaciones en los valores delNTproBNP, derivado de la afectación cardíaca, el SAHS noparece estar asociado con el biomarcador inflamatorioPCRas, cuando se excluye a los pacientes con alteracionescardíacas, factores de riesgo cardiovascular o en tratamiento farmacológico

OBJECTIVE: In this study, we assessed factors associated withcardiovascular risk in patients with sleep apnea-hypopneasyndrome (SAHS) through analysis of plasma concentrationsof N-terminal prohormone brain natriuretic peptide(NTproBNP) and high-sensitivity C-reactive protein (hsCRP).In addition, we analyzed the effect of nasal continuous positiveairway pressure (nCPAP) on these markers.PATIENTS AND METHODS: Forty-two patients with SAHS(mild to moderate in 15 cases and severe in 27) were comparedwith 14 individuals without SAHS. The participants were notreceiving drug treatment and they did not have diabetes,hypertension, marked dyslipidemia, or cardiovascular disease,which was ruled out both clinically and by echocardiographyand 99mTc-tetrofosmin scintigraphy at rest and duringexercise. The effects of nCPAP in patients with severe SAHSwere analyzed after 6 months of treatment.RESULTS: Following adjustment for age, body mass index,and smoking habit, the mean concentrations of markerswere not significantly higher in patients with severe SAHSthan in those with mild-to-moderate SAHS or in controlsubjects. Nevertheless, in patients with SAHS the mainfactor influencing NTproBNP concentrations was thepercentage of time with a nocturnal arterial oxygensaturation of less then 90% (r=0.37, P=.017). No variablespredictive of hsCRP concentration were identified. Theconcentrations of the markers were reduced by nCPAP, butthe differences were not statistically significant.CONCLUSIONS: While nocturnal hypoxemia in SAHS isresponsible for variations in the plasma concentration ofNTproBNP (as a result of cardiovascular changes), SAHSappears not to be associated with the inflammatory markerhsCRP when patients with heart disease, cardiovascularrisk factors, or those receiving pharmacologic treatment are excluded