Cystic endometrial hyperplasia-pyometra complex is the most frequent and important endometrial disorder encountered in bitches. The pathogenesis of the disease is related to the activity of progesterone [Feldman and Nelson, Canine and Feline Endocrinology and Reproduction (1996) W.B. Saunders, Philadelphia]. Cystic endometrial hyperplasia (CEH) is an abnormal response of the bitch's uterus to ovarian hormones [De Bosschere et al. Theriogenology (2001) 55, 1509]. CEH is considered by many authors to be an exaggerated response of the uterus to chronic progestational stimulation during the luteal phase of the oestrous cycle, causing an abnormal accumulation of fluid within the endometrial glands and uterine lumen (De Bosschere et al. 2001). The resulting lesions of pyometra are due to the interaction between bacteria and hormones. The aim of this study was to evaluate if transabdominal uterine ultrasonography can be a useful and reliable diagnostic method to confirm Dow's [Veterinary Record (1958) 70, 1102] and De Bosschere's histopathological classification of CEH-pyometra complex. The study was carried out on 45 bitches with pyometra, 10 purebreds and 35 crossbreeds, 1-15 years old, 20% of which had whelped at least once. None of these animals had received exogenous oestrogen or progesterone treatment. On admission the 45 animals were in the luteal phase of the oestrus cycle. Clinical signs, blood parameters, uterine ultrasonography, bacterial swabs and uterine histopathological results were recorded. Results suggest that ultrasonographic examination is a useful and reliable tool for the diagnosis of cystic endometrial hyperplasia.

No abstract

Abstract. The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those of 54 patients (group 2) retrospectively drawn from patients who underwent aortic replacement for noninflammatory AAAs. A computerassisted matching system was used to match patients according to date of birth, gender, and surgical priority. All patients of both groups were followed by periodic clinical and instrumental examinations. Patients in group 1 complained more frequently of aneurysm-related symptoms (72% vs. 20%; p = 0.0001), and their erythrocyte sedimentation rate was elevated more often (78% vs. 19%; p < 0.0001). Surgical morbidity and mortality rates were not different. The mean lengths of follow-up were 61 ± 47 months (group 1) and 71 ± 38 months (group 2). The 10-year overall survival rates did not differ significantly between the two groups (49.1% ± 16.9% for group 1 vs. 61.6% ± 13.8% for group 2; p = 0.26, log-rank test). In contrast, the free from paraanastomotic aneurysm survival rates were significantly lower in group 1 (57.3% ± 20.2% vs. 97.8% ± 2.5% at 10 years; p = 0.025, log-rank test). Long-term outcomes showed a higher incidence of graft-related complications in group 1. As inflammatory aneurysms might represent a risk factor for the development of paraanastomotic aneurysms, routine imaging surveillance of graft aortic healing after inflammatory AAA repair is warranted.

No abstract

The frequency of trauma and penetrating wounds of the heart and the great intrathoracic vessels is continuously increasing. In peacetime heart wounds constitute about 3% of all penetrating wounds of the chest. About 40% of patients with penetrating wounds of the heart reach hospital alive. If these patients undergo an immediate pericardiocentesis and operation they have an 80-90% chance of survival. In a study of cases of penetrating gunshot wounds of the heart and aorta 31 patients died immediately while five survived for at least 30 minutes (Parmley et al, 1958).We present a case of simultaneous penetrating gunshot wounds of the myocardium and thoracic aorta when the patient survived more than 30 minutes and was successfully treated surgically. Repeated assessment during the four years since the injury has not shown any late complications. Case reportA white 52-year-old man was brought to the emergency room with a gunshot wound. The entry point of the projectile was in the left fourth intercostal space on the midclavicular line. The point of entry into the chest and the severity of the state of haemorrhagic shock led us to suspect a lesion of the heart or the aorta. A preoperative radiographic examination of the chest showed an increased heart shadow and mediastinal widening, a haemothorax, and the presence of a projectile in the left paracardiac region adjacent to the vertebral column. The arterial blood pressure was 60 mmHg during continuous blood transfusion and the central venous pressure 30 cmH2O. An electrocardiogram showed an alteration of ventricular repolarisation with notable raising of the S-T segment, and bradycardia.An emergency thoracotomy was performed through an incision in the fifth left intercostal space. Initial inspection of the thoracic cavity showed a haemothorax, haemomediastinum, and haemopericardium. By opening the pericardium, which contained 400 cc of blood, we could see two lesions of the myocardium -one on the anterior wall of the right ventricle near the anterior descending branch of the left coronary artery and the other a few centimetres from the apex of the left ventricle (fig 1). The greatest loss of blood was from the wound of the right ventricle. Digital Further inspection of the thoracic cavity led to the discovery of a large periaortic haematoma caused by two perforations of the thoracic aorta, one anteriorlI and one posteriorly at the level of the inferior pulmonary vein. Because of the impossibility of performing left heart bypass advantage was taken of the degree of hypothermia (34°C) and hypovolaemic hypotension (60 mmHg) of the patient. The aorta was totally clamped just above the wounds allowing direct 819 on 7 May 2018 by guest. Protected by copyright.