Nutcracker syndrome: a case-based review.

The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome refers to the constellation of clinical symptoms that may arise from the nutcracker phenomenon, typically inclusive of haematuria, flank/pelvic pain, orthostatic proteinuria and (in male patients) varicocele. We provide a short review of the nutcracker syndrome including various diagnostic and therapeutic modalities. We utilise our own experience with a patient as a case study and highlight the modern management option of endovascular stenting.

Retrospective and longitudinal study of salmonellosis in captive wildlife in Trinidad.

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.

Retrospective and longitudinal study of salmonellosis in captive wildlife in Trinidad

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.

A longitudinal study of Escherichia coli strains isolated from captive mammals, birds, and reptiles in Trinidad.

A longitudinal study was conducted of the prevalence and characteristics of Escherichia coli in mammals, birds, and reptiles housed at the Emperor Valley Zoo, Trinidad. During a 6-mo study period, swabs were obtained from fecal samples that were randomly collected from the enclosures of animals from these three taxonomic groups every 3 wk. With snakes, both cloacal and fecal swabs were obtained. Fecal and cloacal swabs were cultured for E. coli on eosin methylene blue agar. The production of mucoid colonies and hemolytic colonies and non-sorbitol fermenter status were identified. The occurrence of O157 strains was determined amongst E. coli isolates that were non-sorbitol fermenters, and the disc diffusion method was used to determine the antibiograms of isolates. The frequency of E. coli isolation was significantly higher in mammals compared with birds and reptiles. Overall, the frequencies of isolation of E. coli from omnivores. herbivores, and carnivores, 87.2%, 70.0%, and 57.3%, respectively, regardless of animal class, were significantly different. Most (99.6%) of the E. coli isolates tested for antibiotic sensitivity exhibited resistance to one or more of the eight antimicrobial agents used. The possession of phenotypic virulence markers by the E. coli isolates studied and the generally high resistance to antimicrobial agents may have health implications for the zoological collection.

Prevalence of Salmonella and Campylobacter species in animals at Emperor Valley Zoo, Trinidad.

The prevalence of Salmonella and thermophilic Campylobacter species in animals kept at the Emperor Valley Zoo, Trinidad, was determined. Of the 433 animals from a total of 30 species sampled, 28 (6.5%) and 11 (2.5%) were positive for Salmonella and Campylobacter, respectively. The difference was statistically significant (P < or = 0.001: chi2). Overall, 12 stereotypes of Salmonella were isolated, with S. miami accounting for eight (25.8%) of 31 isolates. All Campylobacter isolates were C. jejuni, with nine (81.8%) of 11 isolates originating from birds. Reptiles had a high prevalence of Salmonella infection with a high probability for salmonellosis, but the risk of campylobacteriosis appears to be very low.

Some bacterial enteropathogens in wildlife and racing pigeons from Trinidad.

Fecal and cloacal swabs or feces of wild mammalian, avian and reptilian species, either farmed or free-ranging, and of racing pigeons (Columba livia) kept in lofts were cultured for Salmonella spp., Campylobacter spp., and Yersinia spp. Of 291 free-ranging mammals tested, 6 (2%) and 1 (< 1%) yielded positive cultures of Salmonella spp. and Campylobacter spp., respectively. Salmonella newport was the predominant serotype isolated and the opossum (Didelphis marsupialis insularis) had the significantly highest prevalence (29%) of Salmonella spp. infection compared to other species such as deer (Mazama americana trinitatis), lappe (Agouti paca), tattoo (Dasypus novemcinctus), agouti (Dasyprocta leporina), and wild hog (Tayassu tajacu). Among 14 species of farmed wildlife studied, 13 (7%) and 10 (5%) of 184 fecal or cloacal samples tested were positive for Salmonella spp. and Campylobacter spp., respectively. Salmonella javiana accounted for 50% of the Salmonella spp. isolates and C. jejuni represented 90% of the Campylobacter spp. cultured. Only 1 (1%) of 124 cloacal swabs of free-flying avian species yielded Salmonella spp. compared to 21 (17%) samples positive for Campylobacter spp. Of 171 racing pigeons which originated from 8 fanciers, 8 (5%) yielded Salmonella spp. all of which were serotype typhimurium while only 1 (1%) was positive for Campylobacter spp. Seven (88%) of 8 Salmonella spp. isolates were recovered from one fancier. Yersinia spp. was not cultured from any of the above samples. Although the prevalences of Salmonella spp. and Campylobacter spp. in wildlife in Trinidad are low, the practice of wildlife farming and the increased consumption of meat from wildlife may increase the health risk to human consumers.

Some bacterial enteropathogens in wildlife and racing pigeons from Trinidad

Fecal and cloacal swabs or feces of wild mammalian, avian and reptilian species, either farmed or free-ranging, and of racing pigeons (Columba livia) kept in lofts were cultured for Salmonella spp., Campylobacter spp., and Yersinia spp. Of 291 free-ranging mammals tested 6 (2 percent) and 1 (< 1 percent) and 1 (< 1 percent) yielded positive culture of Salmonella spp. and Campylobacter spp., respectively. Salmonella newport was the predominant serotype isolated and the opossum (Didelphis marsupialis insularis) had the significantly highest prevalence (29 percent) of Salmonella spp. infection compared to other species such as deer (Mazama americana trinitatis), lappe (Agouti paca), tattoo (Dasypus novemcinctus), agouti (Dasyprocta leporina), and wild hog (Tayassu tajacu). Among 14 species of farmed wildlife studied, 13 (7 percent) and 10 (5 percent) of 184 fecal or cloacal samples tested were positive for Salmonella spp. and Campylobacter spp., respectively. Salmonella javians accounted for 50 percent of the Salmonella spp. isolates and C. jejuni represented 90 percent of the Campylobacter spp. cultured. Only 1 (1 percent) of 124 cloacal swabs of free-flying avian species yielded Salmonella spp. compared to 21 (17 percent) samples positive for Campylobacter spp. Of 171 racing pigeons which originated from 8 fanciers, 8 (5 percent) yielded Salmonella spp. all of which were serotype typhimurium while only 1 (1 percent) were positive for Campylobacter spp. Seven (88 percent) of 8 Salmonella spp. isolates were recovered from one fancier. Yersina spp. was not cultured from any of the above samples. Although the prevalences of Salmonella spp. and Campylobacter spp. in wildlife in Trinidad are low, the practice of wildlife farming and the increased consumption of meat from wildlife may increase the health risk to human consumers(AU)