DOCSLIB.ORG

Characterization, Prevalence, and Risk Factors of Spontaneous And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Characterization, Prevalence, and Risk Factors of Spontaneous And Louisiana State University LSU Digital Commons LSU Doctoral Dissertations Graduate School 2013 Characterization, prevalence, and risk factors of spontaneous and experimental atherosclerosis and vascular imaging in psittaciformes Hugues Beaufrère Louisiana State University and Agricultural and Mechanical College, [email protected] Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_dissertations Part of the Veterinary Medicine Commons Recommended Citation Beaufrère, Hugues, "Characterization, prevalence, and risk factors of spontaneous and experimental atherosclerosis and vascular imaging in psittaciformes" (2013). LSU Doctoral Dissertations. 1598. https://digitalcommons.lsu.edu/gradschool_dissertations/1598 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Doctoral Dissertations by an authorized graduate school editor of LSU Digital Commons. For more information, please [email protected]. CHARACTERIZATION, PREVALENCE, AND RISK FACTORS OF SPONTANEOUS AND EXPERIMENTAL ATHEROSCLEROSIS AND VASCULAR IMAGING IN PSITTACIFORMES A Dissertation Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Doctor of Philosophy in The Department of Veterinary Clinical Sciences by Hugues Beaufrère Dr.Med.Vet., University of Lyon, France, 2006 Diplomate ABVP – Avian Practice, 2012 Diplomate ECZM (Avian), 2012 May 2013 A Mélanie, qui élève mon cœur. ii ACKNOWLEDGEMENTS First and foremost, I would like to express my thanks to my mentors, Drs. Thomas Tully and Javier Nevarez. Their help, guidance, and trust were instrumental in the completion of my program and these research projects. They promoted unique opportunities at LSU that were far beyond what was just required to succeed in this program. My time within the Zoological Medicine Service will always be remembered as a pivotal point in all my accomplishments. I would like to express my deepest gratitude to Dr. Tully who believed in me from early on when I was just a veterinary student. Dr. Tully consistently demonstrated that science was about sharing and collaborating and this, in combination with his continuous support and mentorship, shaped my vision of learning and teaching avian medicine. I would like to recognize Dr. Nevarez for his constant assistance and for putting me back on the right track when I was “slightly” diverging from initial plans. He managed somehow to insufflate the rigor and meticulousness necessary to all scientific work into my innate sense of chaos. My sincere appreciations also go to the other members of my committee. Dr. Romain Pariaut who was always ready for a new avian cardiologic adventure and whom I consider not only as the transesophageal ultrasound probe bearer, but also as a friend. We are grateful to Dr. Nobuko Wakamatsu who assisted in histopathological interpretation and who was always available when needed. It was a pleasure to work with her. I would like to thank Dr. Heatley for sharing research resources and findings with me and participating in this committee. I would also like to acknowledge the help and teaching of Dr. Brian Marx who contributed to anchoring in me a strong interest in applied biostatistics, a valuable skill that served me well during my studies even if I could never be confident to be right 95% of the time. Furthermore, I would like to acknowledge the help of all my other co-authors, Dr. Daniel Rodriguez for having performed close to 1700 imaging measurements for my studies, Dr. Lorrie Gaschen for her trust in my CT project and for her assistance, Dr. Drury Reavill for having sent me a countless number of pathology slides in a timely fashion, Dr. Michael Garner for having received me in his house and given me access to his histopathology slides database, Dr. Carolyn Cray for having provided clinical pathology support, Dr. Susan Clubb for having supplied the Quaker parrots, Dr. Kali Holder for her assistance in the atherosclerosis classification study, and Dr. Mélanie Ammersbach, my wife, who managed somehow to squeeze her name in one of my PhD publications and actually gave me the idea for my epidemiological study. In addition, I would like to thank our funding sources without which none of this research would have been possible. The Department of Veterinary Clinical Sciences funded the largest part of these studies and we are thankful to all its members for supporting psittacine cardiovascular research and graduate students at LSU. We are also extremely grateful to the Kaytee Avian Foundation, Mr. Rich Bonkowski, and Dr. Randal Brue for their invaluable help with the dietary aspect of our atherosclerosis model study and for supporting the LSU Hispaniolan Amazon parrot colony. We recognize the financial support of the South Alabama Bird Club that provided funds necessary to the completion of our CT study. Finally, I would like to thank my family and particularly my parents who supported me unconditionally throughout my veterinary studies and post-graduate training. Without them, I would be like a bird without wings. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ...................................................................................................... iii ABSTRACT ............................................................................................................................. vii INTRODUCTION ......................................................................................................................1 LITERATURE REVIEW............................................................................................................3 I. Avian cardiology ..................................................................................................................3 A. Anatomy and physiology of the avian cardiovascular system ........................................3 B. Diagnostic techniques .....................................................................................................7 C. Cardiovascular diseases of birds (other than atherosclerosis) ......................................22 II. Atherosclerosis in mammals .............................................................................................38 A. Pathogenesis..................................................................................................................38 B. Atherosclerotic lesions ..................................................................................................44 C. Risk factors for atherosclerotic vascular disease ..........................................................47 D. Diagnostic techniques ...................................................................................................51 E. Medical management and treatment .............................................................................53 F. Mammal models of atherosclerosis ...............................................................................56 III. Avian atherosclerosis .......................................................................................................60 A. Peculiarities of avian lipoprotein metabolism ..............................................................60 B. Avian models of atherosclerosis ...................................................................................61 C. Psittacine atherosclerosis ..............................................................................................63 D. Atherosclerosis in non-domestic avian species ............................................................73 CHAPTER I: CHARACTERIZATION AND CLASSIFICATION OF PSITTACINE ATHEROSCLEROTIC LESIONS BY HISTOPATHOLOGY, DIGITAL IMAGE ANALYSIS, TRANSMISSION AND SCANNING ELECTRON MICROSCOPY ............76 I. Introduction ........................................................................................................................76 II. Materials and methods ......................................................................................................78 A. Sample collection ..........................................................................................................78 B. Histopathology ..............................................................................................................78 C. Digital image analysis ...................................................................................................79 D. Transmission and scanning electron microscopy .........................................................80 E. Classification of atherosclerotic lesions ........................................................................81 F. Statistical analysis .........................................................................................................81 III. Results .............................................................................................................................81 A. The normal intima and arterial wall ..............................................................................85 B. Type I lesions ................................................................................................................86 C. Type II lesions ...............................................................................................................86 D. Type III lesions .............................................................................................................87
Load more

Recommended publications
  • Differentiating Between Anxiety, Syncope & Anaphylaxis
    Differentiating between anxiety, syncope & anaphylaxis Dr. Réka Gustafson Medical Health Officer Vancouver Coastal Health Introduction Anaphylaxis is a rare but much feared side-effect of vaccination. Most vaccine providers will never see a case of true anaphylaxis due to vaccination, but need to be prepared to diagnose and respond to this medical emergency. Since anaphylaxis is so rare, most of us rely on guidelines to assist us in assessment and response. Due to the highly variable presentation, and absence of clinical trials, guidelines are by necessity often vague and very conservative. Guidelines are no substitute for good clinical judgment. Anaphylaxis Guidelines • “Anaphylaxis is a potentially life-threatening IgE mediated allergic reaction” – How many people die or have died from anaphylaxis after immunization? Can we predict who is likely to die from anaphylaxis? • “Anaphylaxis is one of the rarer events reported in the post-marketing surveillance” – How rare? Will I or my colleagues ever see a case? • “Changes develop over several minutes” – What is “several”? 1, 2, 10, 20 minutes? • “Even when there are mild symptoms initially, there is a potential for progression to a severe and even irreversible outcome” – Do I park my clinical judgment at the door? What do I look for in my clinical assessment? • “Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe cardiac and respiratory complications. “ – What is delayed? How much time do I have? What is anaphylaxis? •an acute, potentially
    [Show full text]
  • CIRCULATORY COLLAPSE - EMERGENCY (ISS MED/3A - ALL/FIN) Page 1 of 2 Pages
    SHOCK - CIRCULATORY COLLAPSE - EMERGENCY (ISS MED/3A - ALL/FIN) Page 1 of 2 pages NOTE The most critical step is identifying and treating the underlying cause. Basic causes of shock are: Anaphylaxis - severe allergic reaction Heart attack Loss of circulating blood volume (bleeding, burns, dehydration) Decompression sickness Venous dilation (allergy, pain, drugs, heat stroke, infection) High or low body temperature SIGNS Pulse - rapid, weak, thready Respiration - shallow, irregular, labored Blood Pressure - low, falling Mental State - confused, sluggish, anxious Eyes - pupils may be dilated Skin - cold, clammy, sweating If no pulse or respiration, perform {CARDIOPULMONARY RESUSCITATION: CPR - EMERGENCY} (SODF: ISS MED: EMERGENCY). 1. Evaluate vital signs and record every 5 minutes every 5 minutes. Time (minutes) 0 5 10 15 20 25 30 ALSP Blood Presssure (ALSP-4) Pulse Respiratory Rate ALSP Temperature (Assessment-4) ALSP Pulse Oximeter (Assessment-3) 2. Unstow and don Non-Sterile Gloves (ALSP Airway-4,5,6). If bleeding, control by applying direct pressure using Gauze Pads (Airway-11). 3. Prevent loss of body heat with clothing, sleeping bag, warm environment. 24 AUG 00 4044.shock.circ.collapse.em.doc SHOCK - CIRCULATORY COLLAPSE - EMERGENCY (ISS MED/3A - ALL/FIN) Page 2 of 2 pages 4. Attach ECG leads. Refer to {CARDIOPULMONARY RESUSCITATION: CPR - ECG DATA STORAGE - EMERGENCY} (SODF: ISS MED: EMERGENCY). 5. Contact Surgeon. 6. If no immediate ground communication available, start IV with 1L bag Normal Saline. Fully open roller clamp assembly to allow maximum flow. Refer to {INJECTIONS - NONPOWERED INTRAVENOUS FLUID INFUSION} (SODF: ISS MED: INJECTIONS/IV). 24 AUG 00 4044.shock.circ.collapse.em.doc.
    [Show full text]
  • Management of Racing Pigeons
    37_Racing Pigeons.qxd 8/24/2005 9:46 AM Page 849 CHAPTER 37 Management of Racing Pigeons JAN HOOIMEIJER, DVM Open flock management, which is used in racing pigeon medicine, assumes the individual pigeon is less impor- tant than the flock as a whole, even if that individual is monetarily very valuable. The goal when dealing with rac- ing pigeons is to create an overall healthy flock com- posed of viable individuals. This maximizes performance and profit. Under ideal circumstances, problems are pre- vented and infectious diseases are controlled. In contrast, poultry and (parrot) aviculture medicine is based on the principles of the closed flock concept. With this concept, prevention of disease relies on testing, vaccinating and a strict quarantine protocol — measures that are not inte- gral to racing pigeon management. This difference is due to the very nature of the sport of pigeon racing; contact among different pigeon lofts (pigeon houses) constantly occurs. Every week during the racing season, pigeons travel — confined with thou- sands of other pigeons in special trucks — to the release site. Pigeons from different lofts are put together in bas- kets. Confused pigeons frequently enter a strange loft. In addition, training birds may come into contact with wild birds during daily flight sessions. Thus, there is no way to prevent exposure to contagious diseases within the pop- ulation or to maintain a closed flock. The pigeon fancier also must be aware that once a disease is symptomatic, the contagious peak has often already occurred, so pre- ventive treatment is too late. Treatment at this point may be limited to minimizing morbidity and mortality.
    [Show full text]
  • Cardiac Myofibroblasts Enhance Hypertrophy and Systolic Dysfunction, but Not Fibrosis in Experimental Autoimmune Myocarditis
    Cardiac myofibroblasts enhance hypertrophy and systolic dysfunction, but not fibrosis in experimental autoimmune myocarditis P­08.3­45 K. TkaczI, A. Jaźwa­KusiorII, F. RolskiI, E. DziałoI, K. WęglarczykI, M. CzepielI, M. SiedlarI, G. KaniaIII, P. BłyszczukI IJagiellonian University Medical College, Department of Clinical Immunology, Cracow, Poland, IIJagiellonian University, Faculty of Biochemistry, Biophysics and Biotechnology, Department of Medical Biotechnology, Cracow, Poland, IIIUniversity Hospital Zurich, Division of Rheumatology, Zurich, Switzerland Myocarditis is a common cause of dilated cardiomyopathy which is characterized by ventricular stiffening, cardiac fibrosis and heart failure. In experimental autoimmune myocarditis (EAM) susceptible mice are immunized with alpha myosin heavy chain (αMyHC) and complete Freund's adjuvant (CFA). CD4+ T cell­mediated acute cardiac inflammation is followed by fibrosis and systolic dysfunction. The aim was to investigate the role of fibroblasts and myofibroblasts in myocarditis and postinflammatory cardiomyopathy in EAM model. EAM was induced in BALB/c mice by immunization with αMyHC/CFA. We used reporter strains expressing EGFP under the type I collagen promoter and RFP under α­smooth muscle actin (αSMA) promoter and transgenic αSMA­TK mice with ganciclovir­inducible myofibroblasts ablation. Comparing unaffected heart, the number of cardiac fibroblasts (EGFP+) and the subset of myofibroblasts (EGFP+αSMA+) was unchanged at inflammatory (day 21) and fibrotic stages (day 40). EGFP+ fibroblasts were sorted from control and myocarditis­positive hearts (d21) and analyzed for the whole genome transcriptomics by RNA sequencing. Analysis of differentially expressed genes (min. 2x fold change, p value < 0.05) suggested activation of immune processes (mainly chemokine production), response to stress, cytoskeletal and extracellular matrix re­organization in cardiac fibroblasts in response to myocarditis.
    [Show full text]
  • Prognostic Significance of Myocardial Fibrosis Quantification By
    Journal of the American College of Cardiology Vol. 56, No. 4, 2010 © 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.12.074 Cardiac Imaging Prognostic Significance of Myocardial Fibrosis Quantification by Histopathology and Magnetic Resonance Imaging in Patients With Severe Aortic Valve Disease Clerio F. Azevedo, MD, Marcelo Nigri, MD, Maria L. Higuchi, MD, Pablo M. Pomerantzeff, MD, Guilherme S. Spina, MD, Roney O. Sampaio, MD, Fla´vio Tarasoutchi, MD, Max Grinberg, MD, Carlos Eduardo Rochitte, MD São Paulo, Brazil Objectives We sought to determine whether the quantitative assessment of myocardial fibrosis (MF), either by histopathol- ogy or by contrast-enhanced magnetic resonance imaging (ce-MRI), could help predict long-term survival after aortic valve replacement. Background Severe aortic valve disease is characterized by progressive accumulation of interstitial MF. Methods Fifty-four patients scheduled to undergo aortic valve replacement were examined by ce-MRI. Delayed-enhanced images were used for the quantitative assessment of MF. In addition, interstitial MF was quantified by histologi- cal analysis of myocardial samples obtained during open-heart surgery and stained with picrosirius red. The ce- MRI study was repeated 27 Ϯ 22 months after surgery to assess left ventricular functional improvement, and all patients were followed for 52 Ϯ 17 months to evaluate long-term survival. Results There was a good correlation between the amount of MF measured by histopathology and by ce-MRI (r ϭ 0.69, p Ͻ 0.001). In addition, the amount of MF demonstrated a significant inverse correlation with the degree of left ventricular functional improvement after surgery (r ϭϪ0.42, p ϭ 0.04 for histopathology; r ϭϪ0.47, p ϭ 0.02 for ce-MRI).
    [Show full text]
  • Reversal of Maladaptive Fibrosis and Compromised Ventricular Function In
    Laboratory Investigation (2017) 97, 370–382 © 2017 USCAP, Inc All rights reserved 0023-6837/17 Reversal of maladaptive fibrosis and compromised ventricular function in the pressure overloaded heart by a caveolin-1 surrogate peptide Dorea Pleasant-Jenkins1,3, Charles Reese2,3, Panneerselvem Chinnakkannu1, Harinath Kasiganesan1, Elena Tourkina2, Stanley Hoffman2 and Dhandapani Kuppuswamy1 Chronic ventricular pressure overload (PO) results in congestive heart failure (CHF) in which myocardial fibrosis develops in concert with ventricular dysfunction. Caveolin-1 is important in fibrosis in various tissues due to its decreased expression in fibroblasts and monocytes. The profibrotic effects of low caveolin-1 can be blocked with the caveolin-1 scaffolding domain peptide (CSD, a caveolin-1 surrogate) using both mouse models and human cells. We have studied the beneficial effects of CSD on mice in which PO was induced by trans-aortic constriction (TAC). Beneficial effects observed in TAC mice receiving CSD injections daily included: improved ventricular function (increased ejection fraction, stroke volume, and cardiac output; reduced wall thickness); decreased collagen I, collagen chaperone HSP47, fibronectin, and CTGF levels; decreased activation of non-receptor tyrosine kinases Pyk2 and Src; and decreased activation of eNOS. To determine the source of cells that contribute to fibrosis in CHF, flow cytometric studies were performed that suggested that myofibroblasts in the heart are in large part bone marrow-derived. Two CD45+ cell populations were observed. One (Zone 1) contained CD45+/HSP47 − /macrophage marker+ cells (macrophages). The second (Zone 2) contained CD45moderate/HSP47+/macrophage marker − cells often defined as fibrocytes. TAC increased the number of cells in Zones 1 and 2 and the level of HSP47 in Zone 2.
    [Show full text]
  • Parrot Brochure
    COMMON MEDICAL PROPER HOUSING COMPANION DISEASES PARROTS: 1.) Nutritional deficiencies - A variety of ocular, nasal, respiratory, reproductive LARGE & SMALL and skin disorders caused by chronically improper diets. 2.) Feather picking - A behavioral disorder, sometimes secondary to a primary medical problem, where the bird self-mutilates by picking out its own Maecenas feathers. It is most often due to depression from lack of mental Proper housing for a macaw and other large birds stimulation or companionship and more Finding the right parrot cage for your feathered commonly seen in larger species. friend depends on the size and needs of your Purchasing your pet birds only in pairs bird. For example, while a parakeet needs a can help prevent this disorder smaller cage that can sit on a counter-top or from developing." table; the macaw needs a HUGE cage practically 3.) Bumblefoot - All caged birds are the size of a small room! It is always safest to “go susceptible to developing “bumblefoot" big.” Avoid galvanized metal wiring due to the or pododermatitis. This disease manifests potential for lead poisoning, and clean the itself as blisters and infections of the feet substrate on the bottom of the cage daily to caused by dirty perches or perches that weekly. Birds are messy creatures that love to are all the same size, shape and made of dive into their food bowls! Perches should vary the same material. i.e. smooth wood. in size, shape and material; including various How best to care for these diverse woods, sand paper and cloth. Clean perches and colorful birds and to ensure regularly to prevent diseases of the feet.
    [Show full text]
  • Nest Density and Success of Columbids in Puerto Rico ’
    The Condor98:1OC-113 0 The CooperOrnithological Society 1996 NEST DENSITY AND SUCCESS OF COLUMBIDS IN PUERTO RICO ’ FRANK F. RIVERA-MILAN~ Department ofNatural Resources,Scientific Research Area, TerrestrialEcology Section, Stop 3 Puerta. de Tierra, 00906, Puerto Rico Abstract. A total of 868 active nests of eight speciesof pigeonsand doves (columbids) were found in 210 0.1 ha strip-transectssampled in the three major life zones of Puerto Rico from February 1987 to June 1992. The columbids had a peak in nest density in May and June, with a decline during the July to October flocking period, and an increasefrom November to April. Predation accountedfor 8 1% of the nest lossesobserved from 1989 to 1992. Nest cover was the most important microhabitat variable accountingfor nest failure or successaccording to univariate and multivariate comparisons. The daily survival rate estimates of nests constructed on epiphytes were significantly higher than those of nests constructedon the bare branchesof trees. Rainfall of the first six months of the year during the study accounted for 67% and 71% of the variability associatedwith the nest density estimatesof the columbids during the reproductivepeak in the xerophytic forest of Gulnica and dry coastal forest of Cabo Rojo, but only 9% of the variability of the nest density estimatesof the columbids in the moist montane second-growthforest patchesof Cidra. In 1988, the abundance of fruits of key tree species(nine speciescombined) was positively correlatedwith the seasonalchanges in nest density of the columbids in the strip-transects of Cayey and Cidra. Pairwise density correlationsamong the columbids suggestedparallel responsesof nestingpopulations to similar or covarying resourcesin the life zones of Puerto Rico.
    [Show full text]
  • Commercial Members
    Commercial Members ABC Pets, Humble, TX, www.abcbirds.com Graham, Jan, El Paso, TX, [email protected] Adventures In Birds & Pets Inc, Houston,TX, [email protected] Great Companions Bird Supplies, Warren, MN, American Racing Pigeon Union, Oklahoma City, OK www.greatcompanions.com Angelwood Nursery, Woodburn, OR, [email protected] Hawkins, Connie, Larwill, IN, [email protected] Animal Adventure Inc, Greendale, WI, www.animaladventurepets.com Hidden Forest Art Gallery, Fallbrook, CA, www.gaminiratnavira.com Animal Genetics Inc./Avian Biotech, Tallahassee, FL, Hill Country Aviaries, LLC, Dripping Springs, TX, [email protected] www.hillcountryaviaries.com Avey Incubator, Llc, Evergreen, CO, [email protected] Hobo’s Parrot-Dise, Clarence, NY, [email protected] Avian Adventures Aviary, Novato, CA, Hopper, Verleen, Spring, TX, [email protected] www.avianadventuresaviary.com Innovative Inclosures, Fallbrook, CA Avian Resources, San Dimas, CA Intl Fed Of Homing Pigeon Fanciers, Hicksville, NY, www.ifpigeon.com Avianelites, New Holland, IL, [email protected] Jewelry & Gifts, Antioch, CA, [email protected] Aviary Of Naples & Zoological Park, Naples, FL, [email protected] Jo’s Exotic Birds, Ltd., Kenosha, WI, www.jos-exoticbirds.com Bailey, Laura Santa Ana, CA, [email protected] Johnson, Cynthia, Mehama, OR, [email protected] Beach, Steve, Camp Verde, AZ, [email protected] Jungle Talk And Eight In One, Moorpark, CA, Bell’s Exotics, Inc, Wrightsville, GA, www.bellsexotics.com [email protected] Berkshire Aviary,
    [Show full text]
  • Cardiac Fibrosis in Patients with Atrial Fibrillation: Mechanisms and Clinical Implications У
    Author's Accepted Manuscript У Cardiac fibrosis in patients with atrial М fibrillation: Mechanisms and clinical Г implications р Г Mikhail S. Dzeshka, MD, Gregory Y.H. Lip, MD, Viktor Snezhitskiy, PhD, Eduard Shantsila, PhD Journal of the American College of Cardiology й Volume 66, Issue 8, August 2015, P. 943-959 DOI: 10.1016/j.jacc.2015.06.1313 и р о т и з о п е Р STATE OF THE ART REVIEW Cardiac fibrosis in patients with atrial fibrillation: Mechanisms and clinical implications У Mikhail S. Dzeshka MD1,2 М Gregory Y.H. Lip MD1,3 Viktor Snezhitskiy PhD2 Г Eduard Shantsila PhD1 р Г 1University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, United Kingdom; 2Grodno State Medical University,й Grodno, Belarus; and 3Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. и р Total word count (including references,о figures legends, excluding tables and title page): 9,293 т Brief title: Cardiac fibrosis in иpatients with atrial fibrillation з Corresponding author:о Dr Eduard Shantsilaп , Tel: +44 121 507 5080, Fax: +44 121 554 4083, Email: [email protected] е Р 1 Competing interests G.Y.H.L. has served as a consultant for Bayer, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo and has been on the speakers bureau for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, У Microlife and Daiichi-Sankyo. M.S.D., V.S. and E.S. – none declared.М Г р Г й и р о т и з о п е Р 2 Abstract Atrial fibrillation (AF) is associated with structural, electrical and contractile remodeling of the atria.
    [Show full text]
  • Circulatory Collapse During Wound Closure In
    Zhang et al. BMC Anesthesiology (2021) 21:4 https://doi.org/10.1186/s12871-020-01220-6 CASE REPORT Open Access Circulatory collapse during wound closure in spine surgery with an unknown cause: a possible adverse effect of topical application of vancomycin? Xiaoqing Zhang, Wenwen Zhai, Min Li and Xiangyang Guo* Abstract Background: Vancomycin (VCM) is effective in fighting Gram-positive bacteria related severe infections, and topical application of VCM powder is widely used in orthopedic surgery to prevent wound infection. However, VCM could lead to infusion rate-dependent antibody-and complement-independent anaphylaxis reaction by inducing direct release of histamine. Case presentation: We retrospectively analyzed seven cases of severe hypotension and shock during wound closure or immediately after orthopedic surgery with unidentifiable reasons. We found that these cases were all associated with local application of VCM powder during wound closure process. Two patients experienced sudden cardiac arrest. Most of the cases (6/7) with circulatory collapse were discharged without severe sequelae. While one case with application of 3 g VCM developed cardiac arrest and remained in a coma due to hypoxic-hypoxic encephalopathy. The clinical presentations and the time of the shock onset were considered to be related with a VCM induced anaphylaxis reaction. However, as this was a retrospective study, and there was no laboratory examination performed, the conclusion was made upon differential diagnosis based on clinical manifestations and the timing of the shock. Conclusions: Local application of VCM may not be as safe as was once believed and may lead to a related anaphylaxis. As VCM induced infusion-rate dependent, non-IgE mediated anaphylaxisischaracterizedbydelayed occurrence, severe hypotension and even circulatory collapse, surgeons and anesthesiologists should be extra vigilant during and after VCM application.
    [Show full text]
  • The Puerto Rican Parrot—A Story of an Amazing Rescue
    THE PUERTO RICAN PARROT- A STORY OF AN AMAZING RESCUE By Alan Mowbray1 HISTORY Five hundred and twelve years ago, on his second voyage to the New World, Christopher Columbus dropped anchor off the Caribbean island he named San Juan Bautista. He and his crew of Spanish explorers saw white sand beaches bordered by high mountains covered with lush forests. They were warmly greeted by the native Taino inhabitants who gave them gifts of gold nuggets they had plucked from the island’s rivers. Hundreds of noisy bright-green parrots with beautiful white-ringed eyes swooped overhead. The Taino called these birds “Higuaca.” At the beginning of the sixteenth century, Spanish colonists estimated that there were nearly a million of these beautiful birds living in the island’s forests. Today there are less than thirty Amazona vittata living in the wild on the island we now know as Puerto Rico. Although there are future plans to expand the wild population to other locations on the island, at the moment, the 28, 000 acre (19, 650 hectare) Caribbean National Forest, known locally as El Yunque, is the sole remaining forest habitat where the few surviving wild Puerto Rican parrots find trees with cavities suitable for nesting and seeds and fruits to forage. Amazona vittata’s near disappearance is not unique. Of the three parrot species that inhabited U.S. territory at the turn of the twentieth century, all but one, the Puerto Rican Parrot became extinct by the 1940’s. There are 332 known psittacine (parrot) species. Approximately 31 of them are of the Neotropical Amazona genus that inhabits central and South America and the Caribbean islands.
    [Show full text]