No abstract

Background & AimsIn acute liver failure, severity of liver injury and clinical progression of disease are in part consequent upon activation of the innate immune system. Endotoxaemia contributes to innate immune system activation and the detoxifying function of albumin, critical to recovery from liver injury, is irreversibly destroyed in acute liver failure. University College London-Liver Dialysis Device is a novel artificial extracorporeal liver assist device, which is used with albumin infusion, to achieve removal and replacement of dysfunctional albumin and reduction in endotoxaemia. We aimed to test the effect of this device on survival in a pig model of acetaminophen-induced acute liver failure.MethodsPigs were randomised to three groups: Acetaminophen plus University College London-Liver Dialysis Device (n = 9); Acetaminophen plus Control Device (n = 7); and Control plus Control Device (n = 4). Device treatment was initiated two h after onset of irreversible acute liver failure.ResultsThe Liver Dialysis Device resulted in 67% reduced risk of death in acetaminophen-induced acute liver failure compared to Control Device (hazard ratio = 0.33, p = 0.0439). This was associated with 27% decrease in circulating irreversibly oxidised human non-mercaptalbumin-2 throughout treatment (p = 0.046); 54% reduction in overall severity of endotoxaemia (p = 0.024); delay in development of vasoplegia and acute lung injury; and delay in systemic activation of the TLR4 signalling pathway. Liver Dialysis Device-associated adverse clinical effects were not seen.ConclusionsThe survival benefit and lack of adverse effects would support clinical trials of University College London-Liver Dialysis Device in acute liver failure patients.

Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.

PULMONIC stenosis (PS) is a common congenital cardiac defect in dogs (Buchanan 1992). Depending on the type of stenosis and its severity, surgical management is required. Balloon valvuloplasty (BV) is a non-invasive surgical technique that has become commonly performed in veterinary medicine (Bussadori and others 2001).Several protocols to anaesthetise patients undergoing this procedure have been described. However, only one retrospective study (Ramos and others 2014) assessing and reporting the perioperative complications during BV has been published recently.The aim of this study was to describe the anaesthetic management used over the past years in a large referring European veterinary institution and to explore which major factors are associated with complications in dogs undergoing BV.Forty-six dogs in which PS was managed with BV were included in this study. Parameters included in the analysis were breed, age, sex, weight, American Society of Anesthesiologists (ASA) status, severity of the stenosis, systolic pressure gradient, heart remodelling, presence of heart failure, patient medication, concurrent problems, use of NSAIDs, drugs used for premedication, induction and maintenance of anaesthesia, use of intermittent positive pressure ventilation (IPPV), use of other drugs, hypotension (mean arterial blood pressure <60 mmHg for at least five minutes), bradycardia (heart rate <50 beats per minute (bpm)), tachycardia (heart rate >140 bpm), systemic hypertension (systolic arterial blood pressure >160 mmHg for at least five minutes), arrhythmias, treatment of complications, temperature at the end of procedure, length of procedure, drugs used during recovery, morbidity (appearance of any complication during the procedure) and mortality within 48 hours.Statistical analysis was performed using statistical software (IBM SPSS Statistics V.20.0.0). Normality of data was assessed with histograms and the Kolmogorov-Smirnov and Shapiro-Wilk tests. Data were described with mean and sd, median and range or frequency ( per cent) as appropriate. Chi-squared, Fisher's exact or Mann-Whitney U test was used to analyse the data. A P<0.05 was considered as significant.The most commonly represented breed was the cocker spaniel (eight patients, 17 per cent), followed by the boxer and Cavalier King Charles (three patients, 6 per cent each of them). The median age was 11.5 months (range 2-85 months) and median weight was 10.3 kg (range 2.5-65.5 kg).PS without other cardiac diseases was the most frequently diagnosis (30 patients, 65 per cent). The severity of stenosis, according to Bussadori's classification (Bussadori and others 2000), was severe ( peak gradient above 80 mm Hg corresponding to velocity over 4.5 m/s) in 39 patients (85 per cent) and moderate ( peak gradient from 50 to 80 mmHg corresponding to a velocity between 3.5 and 4.5 m/s) in the other seven patients (15 per cent). Forty patients (87 per cent) showed some degree of heart remodelling although only five patients had developed heart failure before the procedure. S...