Cholangiohepatitis and pancreatitis secondary to severe gastroduodenal ulceration in a foal.
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A 2-month-old foal was presented with clinical signs of colic. Gastroduodenal ulceration was suspected. A poor response to medical treatment and signs of gastroduodenal obstruction led to celiotomy and an attempted bypass procedure. The foal was euthanized and postmortem examination revealed gastric ulceration, segmental duodenal stenosis, and severe chronic cholangiohepatitis and pancreatitis. (+info)
A hematogenic pleuropneumonia caused by postoperative septic thrombophlebitis in a Thoroughbred gelding.
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A 7-year-old Thoroughbred gelding was admitted to Equine Hospital, Korea Racing Association for evaluation and treatment of colic. Based on the size and duration of the large colonic and cecal impaction, a routine ventral midline celiotomy and large colon enterotomy were performed to relieve the impaction. Six days following surgery the gelding exhibited signs of lethargy, fever, inappetence and diarrhea. Eleven days following surgery, the jugular veins showed a marked thrombophlebitis. On the sixteenth day of hospitalization the gelding died suddenly. Upon physical examination, the horse was febrile, tachycardic and tachypnoeic. Thoracic excursion appeared to be increased; however, no abnormal lung sounds were detected. No cough or nasal discharge was present. Hematology revealed neutrophilic leukocytosis. Serum biochemistry was normal but plasma fibrinogen increased. In necropsy, fibrinopurulent fluid was present in the thoracic cavity. There were firm adhesions between visceral pleura and thoracic wall. White, mixed and red thrombi were formed in both jugular veins from the insertion point of IV catheter. Histopathological examination showed fibrinopurulent inflammation and vascular thrombosis in the lung. The pleura showed edematous thickening and severe congestion. The clinicopathological and pathological findings suggest that septic thrombi associated with septic thrombophlebitis metastasized into the pulmonary circulation and were entrapped in the pulmonary parenchyma and provoked pleuropneumonia. (+info)
Cholelithiasis associated with recurrent colic in a Thoroughbred mare.
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A 13-year-old Thoroughbred mare, retired from race, was admitted to Equine Hospital, Korea Racing Association with signs of colic. One and a half months following the previous treatment (second time) and 11 days following her previous discharge (third time), the mare repeatedly exhibited signs of colic and finally along with icteric eyes. Routine medical treatment with intravenous fluids, analgesics resulted in resolution of signs of colic in the first and second admission. The condition of the mare did not improve in the third admission despite over one month supportive treatment and she was subject to euthanasia at the request of the owner on the thirtyeighth day of hospitalization (95 days from her first admission). The clinical signs (fever, icterus, mild intermittent colic) in conjunction with clinical laboratory findings (leukocytosis, elevations of serum total bilirubin, direct bilirubin, alkaline phosphatase, aspartate aminotransferase, gamma glutamyl transferase, creatine phosphokinase, lactic dehydrogenase and blood fibrinogen indicative of obstructive biliary disease) in this mare suggested possible chlolelithiasis. However, liver enzymes and bilirubin estimations are often not part of routine screening in emergency colic cases. At necropsy, multiple dark brown choleliths of various sizes obstructing hepatopancreatic ampulla were found in the hepatic duct. The choleliths were found as large as 3-5 cm in diameter, faceted to each other, dark brown in color and showed soap consistency. Histopathologic findings revealed: biliary fibrosis, plugging of the bile canaliculi with bile pigments, cholangiohepatitis and pigmentation of the hepatic lymph node with bile pigment laden macrophages. Although definitive diagnosis of cholelithiasis might be challenging, clinicians should consider this condition in the differential diagnosis of recurrent colic. (+info)
Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic.
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OBJECTIVE: To examine the relative benefits and disadvantages of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for the management of acute renal colic. DATA SOURCES: Cochrane Renal Group's specialised register, Cochrane central register of controlled trials, Medline, Embase, and reference lists of retrieved articles. REVIEW METHODS: Randomised controlled trials comparing any opioid with any NSAID in acute renal colic if they reported any of the following outcomes: patient rated pain, time to pain relief, need for rescue analgesia, rate of recurrence of pain, and adverse events. RESULTS: 20 trials totalling 1613 participants were identified. Both NSAIDs and opioids led to clinically important reductions in patient reported pain scores. Pooled analysis of six trials showed a greater reduction in pain scores for patients treated with NSAIDs than with opioids. Patients treated with NSAIDs were significantly less likely to require rescue analgesia (relative risk 0.75, 95% confidence interval 0.61 to 0.93). Most trials showed a higher incidence of adverse events in patients treated with opioids. Compared with patients treated with opioids, those treated with NSAIDs had significantly less vomiting (0.35, 0.23 to 0.53). Pethidine was associated with a higher rate of vomiting. CONCLUSIONS: Patients receiving NSAIDs achieve greater reductions in pain scores and are less likely to require further analgesia in the short term than those receiving opioids. Opioids, particularly pethidine, are associated with a higher rate of vomiting. (+info)
Therapeutic applications of whey protein.
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Whey, a protein complex derived from milk, is being touted as a functional food with a number of health benefits. The biological components of whey, including lactoferrin, beta-lactoglobulin, alpha-lactalbumin, glycomacropeptide, and immunoglobulins, demonstrate a range of immune-enhancing properties. In addition, whey has the ability to act as an antioxidant, antihypertensive, antitumor, hypolipidemic, antiviral, antibacterial, and chelating agent. The primary mechanism by which whey is thought to exert its effects is by intracellular conversion of the amino acid cysteine to glutathione, a potent intracellular antioxidant. A number of clinical trials have successfully been performed using whey in the treatment of cancer, HIV, hepatitis B, cardiovascular disease, osteoporosis, and as an antimicrobial agent. Whey protein has also exhibited benefit in the arena of exercise performance and enhancement. (+info)
Incidence of and risk factors for adverse drug reactions in a prospective cohort of HIV-infected adults initiating protease inhibitor-containing therapy.
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Risk factors associated with the occurrence of protease inhibitor (PI)-related severe and serious adverse drug reactions (SADRs) were analyzed in a prospective cohort of 1155 patients who initiated PI-containing therapy. During a total follow-up of 2037 patient-years, 169 SADRs were reported, yielding a rate of 8 incidents per 100 patient-years (95% confidence interval [CI], 6.8-8.6). The most frequent SADRs were elevated transaminase levels (in 49 events); renal colic (27); abnormal hematological findings (23); and metabolic (18), neuromuscular (7), pancreatic (6), cutaneous (6), cardiovascular (5), and psychiatric disorders (5). Among baseline characteristics, plasma human immunodeficiency virus RNA levels of >or=5 log(10) copies/mL (hazard ratio [HR], 1.5; 95% CI, 1.1-2.2), elevated aspartate aminotransferase levels (HR, 1.1 for each 20 IU of elevation; 95% CI, 1.1-1.2), creatinine clearance levels of <70 mL/min (HR, 2.1; 95% CI, 1.2-3.7), test results positive for hepatitis C virus antibodies or hepatitis B surface antigenemia (HR, 2.6; 95% CI, 1.8-3.7), and receipt of indinavir (HR, 1.7; 95% CI, 1.2-2.4) were independently predictive of a SADR. SADRs were frequent in the first 4 months after initiation of highly active antiretroviral therapy but continued to occur after that time period. (+info)
Infantile colic.
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Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the "rule of three": crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the crying, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already. (+info)
Infant colic and feeding difficulties.
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AIMS: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. METHODS: Forty three infants (and their mothers) were enrolled between 6 and 8 weeks of age. Infants were divided into two groups, colic (n = 19) and comparison (n = 24), based on a modified Wessel rule of three criteria for colic. Families were assessed at two visits; one occurred in the laboratory and one occurred in a paediatric radiology office. Outcome measures included the clinical assessment of infant oral motor skills, behavioural observation of mother-infant feeding interactions, maternal questionnaires on infant crying, sleeping and feeding behaviours, and the occurrence of gastro-oesophageal reflux (GOR) in the infants using abdominal ultrasound. RESULTS: Infants in the colic group displayed more difficulties with feeding; including disorganised feeding behaviours, less rhythmic nutritive and non-nutritive sucking, more discomfort following feedings, and lower responsiveness during feeding interactions. Infants in the colic group also had more evidence of GOR based on the number of reflux episodes on abdominal ultrasound as well as maternal report of reflux. Mothers in the colic group reported higher levels of parenting stress. CONCLUSIONS: Results provide the first systematic evidence of feeding problems in a subgroup of infants with colic. Data also illustrate the impact of these difficulties on parental and infant functioning. The association between feeding difficulties and colic suggests the potential for ongoing regulatory problems in infants presenting with clinically significant colic symptoms. (+info)