Scrotal granulomatous aspergillosis in a dromedary camel (Camelus dromedarius).

BACKGROUND: This report describes a case of primary subcutaneous aspergillosis in a 7-year-old neutered male dromedary camel (Camelus dromedarius). CASE PRESENTATION: The animal developed a large nodular lesion in the right scrotum two years after surgical intervention for neutering. The mass had a firm consistency and was painful at palpation. Histopathology revealed dermal granulomatous inflammation with a necrotic centre, surrounded by plasma cells, macrophages, neutrophils, and sparse fungal hyphae characterised by parallel cell walls, distinct septa, and dichotomous branching. Fungal culture was not performed, but a panel of mono- and polyclonal antibodies specific for different fungal genera identified the hyphae as Aspergillus sp. CONCLUSIONS: The occurrence of subcutaneous lesions is a rare manifestation of aspergillosis in animals, and this appears to be the first case reported in the dromedary camel.

A simple technique to repair a hand fracture in a captive Siamang.

A 5-year-old female Siamang (Hylobates syndactilus) in captivity sustained a displaced closed fracture of the proximal phalanx of the middle digit, resulting in finger deformity and hand functional disability. Anatomical reduction and stabilization of the fracture were obtained surgically using two multifilament wire sutures. The primate had a successful functional recovery.

[Cardiac troponin-I elevations after thoracic surgery. Incidence and correlations with baseline clinical characteristics, C-reactive protein and perioperative parameters]. / Elevaciones de la troponina I cardiaca tras la cirugía torácica. Incidencia y correlaciones con las características clínicas basales, la proteína C reactiva y los parámetros perioperatorios.

INTRODUCTION AND OBJECTIVES: The exact incidence of cardiac troponin-I elevation after thoracic surgery and its correlation with other clinical parameters have not been fully described. The aims of this study were to determine the frequency of postoperative cardiac troponin-I elevation following lung or pleural surgery for suspected cancer, and to investigate correlations with baseline clinical characteristics, the C-reactive protein level, and perioperative parameters. METHODS: Fifty consecutive patients were enrolled in the study. In each patient, the following parameters were measured: clinical characteristics and C-reactive protein level at baseline, cardiac troponin-I level on postoperative days 1, 3 and 5, and blood pressure, heart rate and ECG parameters every day from the day of the operation until postoperative day 5. RESULTS: The cardiac troponin-I level was elevated postoperatively in 20% of patients. There were significant associations with either a history of coronary artery disease or the presence of more than two coronary risk factors (80% vs. 32.5%; P=.011), a history of chronic antiplatelet therapy (50% vs. 17.5%; P=.046), pneumonectomy compared with less invasive procedures (40% vs. 10%; P=.041), pericardiotomy (30% vs. 2.5%; P=.022), and transient ST-segment alterations on perioperative ECGs (60% vs. 20%; P=.02). No significant correlation was found between cardiac troponin-I elevation and the baseline C-reactive protein level. CONCLUSIONS: Cardiac troponin-I elevation occurs frequently after thoracic surgery and it is associated with clinical markers of coronary artery disease, extensive surgical procedures, and ischemic changes observed on perioperative ECGs.

Elevaciones de la troponina I cardiaca tras la cirugía torácica. Incidencia y correlaciones con las características clínicas basales, la proteína C reactiva y los parámetros perioperatorios / Cardiac troponin-I elevations after thoracic surgery. Incidence and correlations with baseline clinical characteristics, C-reactive protein and perioperative parameters

Introducción y objetivos. La incidencia real de las elevaciones de la troponina I cardiaca tras la cirugía torácica y su correlación con otros parámetros clínicos no está plenamente definida. El objetivo de este estudio fue evaluar la frecuencia de las elevaciones postoperatorias de la troponina I cardiaca después de cirugía pulmonar o pleural por sospecha de cáncer e investigar las correlaciones con los perfiles clínicos basales, con la proteína C reactiva y los parámetros perioperatorios. Métodos. Se registró a 50 pacientes consecutivos y se midieron los siguientes parámetros en cada paciente: variables clínicas basales y concentración de la proteína C reactiva, concentración de troponina I cardiaca en los días 1, 3 y 5 del postoperatorio, electrocardiograma, presión arterial, y frecuencia cardiaca diarias desde el día de la operación hasta el día 5 del postoperatorio. Resultados. Se produjeron elevaciones postoperatorias de la troponina I cardiaca en el 20% de los pacientes y éstas estaban significativamente asociadas con los antecedentes de coronariopatía o más de 2 factores de riesgo coronario (el 80 frente al 32,5%; p = 0,011), los antecedentes de tratamiento antiagregante plaquetario crónico (el 50 frente al 17,5%; p = 0,046), la neumonectomía comparada con los procedimientos menos invasivos (el 40 frente al 10%; p = 0,041), la pericardiotomía (el 30 frente al 2,5%; p = 0,022) y las modificaciones transitorias del segmento ST en el electrocardiograma perioperatorio (el 60 frente al 20%; p = 0,02). No se observó correlación significativa entre las elevaciones de la troponina I cardiaca y la proteína C reactiva basal. Conclusiones. Las elevaciones de la troponina I cardiaca después de la cirugía torácica son frecuentes y están asociadas con marcadores clínicos de coronariopatía, procedimientos quirúrgicos extensos y cambios isquémicos en el electrocardiograma perioperatorio (AU)

Introduction and objectives. The exact incidence of cardiac troponin-I elevation after thoracic surgery and its correlation with other clinical parameters have not been fully described. The aims of this study were to determine the frequency of postoperative cardiac troponin-I elevation following lung or pleural surgery for suspected cancer, and to investigate correlations with baseline clinical characteristics, the C-reactive protein level, and perioperative parameters. Methods. Fifty consecutive patients were enrolled in the study. In each patient, the following parameters were measured: clinical characteristics and C-reactive protein level at baseline, cardiac troponin-I level on postoperative days 1, 3 and 5, and blood pressure, heart rate and ECG parameters every day from the day of the operation until postoperative day 5. Results. The cardiac troponin-I level was elevated postoperatively in 20% of patients. There were significant associations with either a history of coronary artery disease or the presence of more than two coronary risk factors (80% vs. 32.5%; P=.011), a history of chronic antiplatelet therapy (50% vs. 17.5%; P=.046), pneumonectomy compared with less invasive procedures (40% vs. 10%; P=.041), pericardiotomy (30% vs. 2.5%; P=.022), and transient ST-segment alterations on perioperative ECGs (60% vs. 20%; P=.02). No significant correlation was found between cardiac troponin-I elevation and the baseline C-reactive protein level. Conclusions. Cardiac troponin-I elevation occurs frequently after thoracic surgery and it is associated with clinical markers of coronary artery disease, extensive surgical procedures, and ischemic changes observed on perioperative ECGs (AU)

Personal experience in surgical management of pulmonary pleomorphic carcinoma.

BACKGROUND: Pleomorphic carcinoma is a rare epithelial malignant tumor. Pulmonary pleomorphic carcinoma was introduced by the 1999 World Health Organization classification as a new peculiar type of lung carcinoma showing concurrent malignant epithelial and sarcomatoid spindle cell elements. Few reports describe its clinical behavior. My colleagues and I report a series of patients surgically treated for pulmonary pleomorphic carcinoma to describe our experience with this malignant neoplasm. METHODS: Twenty cases of pleomorphic pulmonary carcinoma were collected and studied clinicopathologically. All patients underwent surgical resection. The cases were as follows: 6 stage I, 12 stage II, and 2 stage IIIA. Histologic diagnosis was established by using light microscopic examination and immunohistochemistry. Survival rates were calculated with the Kaplan-Meier method. RESULTS: We postoperatively diagnosed 20 cases of pleomorphic carcinoma: 14 cases were exclusively spindle and giant-cell carcinomas, 2 cases were spindle and giant-cell carcinoma combined with adenocarcinoma, 2 were combined with squamous cell carcinoma, and 2 were combined with large cell carcinoma. At last follow-up, 4 patients were still alive; they were postoperative T1 N0 and T2 N0. The remaining 16 patients died from early distant metastases. The median duration of disease-free survival was 5 months. The median duration of overall survival was 8 months. CONCLUSIONS: The prognosis of patients with pleomorphic carcinoma was poor, despite surgery and adjuvant chemotherapy, because of early relapse of disease. Nodal involvement was a determinant prognostic variable, because advanced stages were related to worse prognosis. In case of preoperatively proven pulmonary pleomorphic carcinoma, surgery should be recommended to N0 patients.

Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification.

BACKGROUND: Pulmonary carcinoid tumors represent a group of malignant neoplasms comprised of neuroendocrine cells. In 1999, the World Health Organization (W.H.O.) proposed the definitive classification of neuroendocrine tumors based on the criteria from Travis and associates. The W.H.O. described two different groups of carcinoid tumors: typical carcinoids (TC) and atypical carcinoids (AC). Few reports have reviewed their data according to the current classification, and therefore, prognosis and standard therapy for TC and AC are still uncertain. METHODS: From 1980 to 2001, 98 pulmonary resections have been performed for primary bronchial carcinoid tumors in our Thoracic Department of the University of Milan. We reviewed original histology using the current W.H.O. criteria and identified 88 patients with TC and 10 with AC. We reviewed the outcomes in each group. RESULTS: The 5 year-overall survival rate was 91.9% for TC and 71% for AC. The 10-year overall survival rate was 89.7% for TC and 60% for AC. The 5-year TNM-related survival rates in the TC group were: IA-B, 100%; IIA-B, 75%; and IIIA, 50%. At 10 years, they were: IA-B, 100%; IIA-B, 75%; and IIIA, 0%. The 5-year survival rates in the AC group were: IA-B, 100%; IIA-B, 100%; and IIIA, 0%. At 10 years, they were: IA-B, 100%; IIA-B, 66%; and IIIA, 0%. CONCLUSIONS: Prognosis is favorable for both subtypes in the early stage. Advanced stages are related to better prognosis in TC. Recurrences rate is worse in the AC subtype. Our data suggest avoiding limited resections when feasible in AC. Parenchyma-sparing resections should be encouraged in TC.

Surgical experience of 15 solitary benign fibrous tumor of the pleura.

OBJECTIVE: The localized benign fibrous tumor of the pleura represents 8% of all benign pathologies of the chest and 10% of neoplasms of the pleura. The authors review the literature, and report on 15 cases of localized benign fibrous tumors of the pleura surgically treated over a period of 15 years to further knowledge of this pathology, its therapy and prognosis. METHODS: With respect to the well-known diffuse malignant mesothelioma, different etiopathogenesis, prognosis, and therapeutic approaches characterize the localized benign fibrous tumor of the pleura. In our experience, 15 patients underwent thoracotomy with excision of a pathological endothoracic mass, then histologically proved to be a localized benign tumor of the pleura. The whole group underwent pre-operative evaluation and, when clinic suggested, stadiation and post-operative frequent follow-up. RESULTS: The whole group of 15 patients underwent surgical approach well tolerated the surgical treatment with perfect recovery of post-operative respiratory function. There was no relapse of disease in any patients. At the moment all patients are still alive except one dead of heart failure. CONCLUSION: The differential diagnosis of benign fibrous tumor of the pleura and lung and pleural malignancy depends upon immunohistochemistry of the surgical specimen so that prognosis could be formulated only after surgery. We consider surgery as the treatment of choice in this pathology.

Personal experience in lung cancer sleeve lobectomy and sleeve pneumonectomy.

BACKGROUND: Sleeve lobectomy (SL) and tracheal sleeve pneumonectomy (TSP) represent valuable alternative techniques to standard resections in the treatment of benign and malignant conditions of the airway and allow preservation of lung parenchyma. METHODS: Eighty-three sleeve lobectomies and 27 tracheal sleeve pneumonectomies have been performed for nonsmall cell lung cancer in the thoracic department of the University of Milan from 1979 to 1999. There were 46 upper right lobectomies, 11 upper and middle lobectomies, 18 upper left lobectomies, 8 lower left lobectomies, and 27 right pneumonectomies. RESULTS: Mortality rate was 3.6% in SL and 7.4% in TSP. Complications were 10.8% of all SLs and 15% of all TSPs. The overall 5-year survival rate was 43% for SL and 20% for TSP; the 10-year survival rate was 34% and 14%, respectively. There was a highly significant difference in survival between patients with N0 and N1-N2 disease. CONCLUSIONS: Sleeve lobectomy is an appropriate surgical procedure and an alternative to pneumonectomy in patients with limited respiratory reserve whenever the situation permits. Trachael sleeve pneumonectomy is associated with more complications and poor survival.