Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment

BACKGROUND

Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature.

METHODS

Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied.

RESULTS

There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine--required for decubital necrosis from the gallstone--was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities.

CONCLUSION

Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.

Effect of the administration of flunixin meglumine on pregnancy rates in Holstein heifers

Fifty-two 15-month-old Holstein heifers were synchronised with single or double injections of prostaglandin F(2alpha), followed by an injection of gonadotrophin-releasing hormone (gnrh) 48 hours later, and inseminated 12 to 14 hours after the injection of gnrh (day 0). Half of them were then injected twice intramuscularly with 1.1 mg/kg flunixin meglumine 12 hours apart, on the evening of day 15 and the morning of day 16, and the other 26 were not treated. Pregnancy was diagnosed by ultrasound 29 and 65 days after they were inseminated. On day 29, 20 of the treated heifers were pregnant compared with 13 of the control heifers (P<0.05); on day 65, 18 of the treated heifers were still pregnant compared with 12 of the control heifers (P<0.10).

160 DETERMINATION OF THE INCIDENCE OF EMBRYONIC MORTALITY IN SYNCHRONIZED EWES DURING THE BREEDING SEASON

The aim of the present study was to evaluate the incidence of embryonic mortality in synchronized Konya Merino ewes (2–4 years of age) during the the breeding season. The flushing procedure started in 126 ewes, beginning 1 week before the breeding period until mating. The ewes were synchronized using progesterone : PMSG; a sponge containing 40 mg florogestone acetate was placed into vagina for 12 days. PMSG (500 IU) was given intramuscularly at the time of sponge removal and ewes were allowed to mate 48-60 hours (Day 0) after PMSG injection. The first pregnancy diagnosis was done transrectally 18 days after mating by using B-mode, linear array, 5 MHz real-time ultrasonography, and it was repeated again on Days 22, 26, 30, and 34. One hundred eleven ewes were pregnant on Day 18, and 191 embryos were detected in 111 pregnant ewes. There were 44 single, 54 twin, and 13 triple pregnancies. Embryonic death was determined in 39 out of 111 ewes (35.1%), and 45 embryos out of the total of 191 were lost (23.6%). Among the ewes which experienced embryonic death, 28 ewes maintained pregnancy while 11 ewes (9 single, 1 twin, and 1 triple pregnancy) did not. Among the embryos that were dead, 9 (20%), 20 (44.4%), and 16 (35.6%) were from single, twin, and triple pregnancies, respectively. Rates of embryonic death in the total number of embryos according to type pregnancy were 20% (9/45), 18.5% (20/108), and 41% (16/39). Incidence of embryonic deaths were 22.2% (10/45), 51.1% (23/45), 22.2% (10/45), and 4.5% (2/45) for Days 22, 26, 30, and 34, respectively. The majority of embryonic deaths were observed by Day 22 in single pregnancies and by Day 26 in multiple pregnancies. Incidence of termination of pregnancy in single pregnancies was significantly higher than for twin pregnancies (P &lt; 0.01). The rate of embryonic mortality between single and twin pregnancies was not significant, whereas it was significant among single and triple and among twin and triple pregnancies (P &lt; 0.05 and P &lt; 0.01, respectively). In conclusion, incidence of embryonic death was similar between single and twin pregnancies but the majority of pregnancy losses were observed in single pregnancies. Although embryonic deaths are observed, maintenance of pregnancy conceals the problem of embryonic mortality in multiple pregnancies. Therefore, applications to improve the survival of embryos during the first month after mating could yield higher numbers of lambs.

150 EFFECT OF TIMELY FLUNIXIN MEGLUMINE TREATMENT ON PREGNANCY RATES IN HOLSTEIN HEIFERS

The objective was to determine if administration of flunixin meglumine (FM) to heifers following insemination would increase pregnancy rate due to its inhibitory effect on prostaglandin F2� (PGF2�) synthesis. Fifty-two 15-month-old Holstein heifers were synchronized with single or double injections of PGF2� followed by an injection of gonadotropin-releasing hormone (GnRH) 48 h later and a timed artificial insemination at 12-14 h after injection of GnRH (Day 0). Heifers randomly assigned to the treatment group (FMG) were injected twice with FM (1.1 mg/kg BW; i.m.), given 12 h apart on the evening of Day 15 and the morning of Day 16. The control group (CG) was not treated. Pregnancy rates were defined as the percentage of heifers diagnosed pregnant by ultrasound at Days 29 and 65 after AI. Effects of treatment on pregnancy rates and pregnancy losses were analyzed by chi-square test and logistic regression analysis. Pregnancy rates in the heifers treated with FM were higher at Day 29 (76.9%; 20/26 [FMG] vs. 50%; 13/26 [CG]; P < 0.04) and tended to be higher at Day 65 (69.2%; 18/26 [FMG] vs. 46.2%; 12/26 [CG]; P < 0.09). Administration of FM two times at a critical stage leading up to pregnancy recognition, associated with corpus luteum maintenance, increased both early embryo survival and pregnancy rate via an additive antiluteolytic effect due to a delay in the luteolytic secretion of PGF2�; this provided conceptuses extra time to develop the capability to inhibit the luteolytic process.

Effect of seasonal conditions on oestrus occurrence and postpartum period in Anatolian water buffaloes

Oestrus and calving records of Anatolian buffaloes were analyzed to investigate influence of climatic conditions on oestrus occurrence and postpartum period. Oestrus records showed a seasonal pattern concentrated between July and September which is the warmest period of the year. Likewise, more than half (52.7%) of the total calvings occurred between May and August. Month of calving significantly influenced the length of calving to first oestrus interval and open period (P < 0.01). The average length of open period was significantly shorter in autumn and summer calvers compared to those calved in spring and winter (P < 0.05) during long days. The humidity rate was negatively correlated with both calving to first oestrus interval and open period (P < 0.05). In conclusion, exposure to high environmental temperatures around 20 degrees C exerted no suppressive influence on ovarian activity in Anatolian buffaloes. Although humidity rate (P < 0.05) and ambient temperature (P < 0.01) was found to be correlated with the duration of postpartum period, day length might be the main factor regulating reproductive biorhythm and postpartum events in Anatolian buffalo cows.

Testosterone secretion and semen plasma enzyme activity in rams with genital pathology stimulated with GnRH

Testosterone secretion in response to GnRH stimulation and enzymatic activity of semen plasma was evaluated comparatively in rams with or without genital abnormality. Scrota, testes and epididymides of 128 rams between 1.5 and 6 years old from various breeds were examined clinically and ultrasonographically. Bilaterally cryptorchid rams (n = 2), and rams with focal testicular degeneration (n = 3) or unilateral sperm granuloma localized in the caput (n = 3) epididymis or the cauda epididymis (n = 3), diagnosed by either clinical or ultrasonographic examination, were selected for the further investigation of spermatologic parameters, testosterone secretion in response to GnRH stimulation, and enzymatic activity of semen plasma before histopathologic confirmation of lesions. Except for the cryptorchid rams, sperm parameters determined in ejaculates were similar to intact controls (n = 3). GnRH administration increased plasma testosterone levels significantly irrespective of the type of genital pathology (P < 0.01). The testosterone response calculated based on area under the curve following GnRH administration in rams having genital abnormality was not significantly different from the controls. Aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) activity in the semen plasma varied between rams, with the lowest mean values in the bilaterally cryptorchid group (P < 0.05). Spermatic granuloma localized either in the caput or cauda of the epididymis was associated with a significant reduction in the semen plasma AST activity compared to controls (P < 0.01). In conclusion, our results indicated that the ability of testicular tissue to secrete testosterone in response to GnRH stimulation in rams with bilateral cryptorchidism, focal testicular degeneration and unilateral sperm granuloma was similar to that of intact controls, and that reduced semen plasma AST activity may have a diagnostic value in the diagnosis of the epididymal obstruction in rams. Focal testicular degeneration did not influence AST, alkaline phosphatase (ALP) and LDH activity in semen plasma.

Influence of sugar supplementation of the extender on motility, viability and acrosomal integrity of dog spermatozoa during freezing

Influence of different sugars supplemented to the extender on the motility, viability and intact acrosome rates of dog spermatozoa during dilution, equilibration and freezing was studied. The ejaculate was divided into 10 aliquots, which were diluted 1:3 with TRIS-citric acid extender containing 240 mMTRIS, 63 mM citric acid, 8% (v/v) glycerol, 20% (v/v) egg yolk and 70 mM sugar, which was either fructose, galactose, glucose, xylose (monosaccharide), lactose, trehalose, maltose, sucrose (disaccharide) or raffinose (trisaccharide). No sugar was added to the extender in the control group. Extended semen samples were cooled to 5 degrees C over 45 min, packaged in 0.25-mL straws, equilibrated for 2 h at 5 degrees C and frozen in liquid nitrogen vapor. Samples were thawed by placing straws into 37 degrees C water for 30 sec. Motility, viable sperm and intact acrosome rates decreased gradually in all groups after equilibration and consecutively freezing (P<0.001). The type of sugar significantly effected motility, viability and acrosomal integrity during equilibration and freezing (P<0.05). Galactose, lactose, trehalose, maltose and sucrose reduced damaged acrosome percentages in equilibrated samples (P<0.05). Sugar supplementation did not enhance motility and viability during equilibration. The disaccharides, except lactose, reduced post-thaw dead sperm and/or damaged acrosome percentages without promoting post-thaw motility (P<0.01), whereas monosaccharides, especially fructose and xylose, improved motility (P<0.05) along with viability and intact acrosome rates (P<0.05). Trehalose, xylose and fructose significantly increased total active sperm rates (motility x live sperm rate x normal acrosome rate) compared to other sugars (P<0.01) and control (P<0.0001) in frozen thawed samples. Therefore, sugar supplementation of the extender influenced post-equilibration and post-thaw sperm quality, and the type or locality of protective impact of the sugar on dog spermatozoa vary according to type of the sugar.

Spermatic granuloma in the ram: diagnosis by ultrasonography and semen characteristics

Ultrasonographic appearance of the testis and epididymis, and seminal characteristics, with regard to localization of spermatic granuloma were studied. In rams with spermatic granuloma (n = 9), diagnosed by clinical or ultrasonographic examinations before histopathological confirmation, localization of each lesion was recorded. Epididymal granulomas, caput and cauda, were seen as anechoic or hyperechoic areas with a distinct margin with or without a hyperechoic capsule. Granulomas in the testis were microscopic and, therefore, could not be detected by ultrasonography. Enlargement in the mediastinum testis was detected in all rams when there were granulomas in the caput. Heterogeneous testis parenchyma invaded by numerous hyperechoic foci, representing testicular degeneration, was associated with granulomas both in the epididymis and testis. Ultrasonographic appearance of the lesions did not differ with regard to season. Seminal characteristics varied between rams. It was concluded that ultrasonographic evaluation may give valuable information in the diagnosis of sperm granuloma in the ram.

Induction of oestrus in Saanen goats at early breeding season by intravaginal progesterone sponges (MAP) or by prostaglandin F(2)alpha injections. Effect on different age groups

Twenty-one maiden and 29 pluriparous milking Ankara Saanen goats received either two i.m. injections of PGF(2)alpha (n=25) or intravaginal MAP sponges (n=25) early in November at the start of the breeding season. About twice as many pluriparous goats as maiden goats exhibited estrus after either treatment (87% vs. 47%). Breeding after this induced estrus caused pregnancies in 62% of the pluriparous goats, but only in 24% of the maiden animals. Maximal concentrations of progesterone were reached 11 days after the start of the MAP treatment. Progesterone declined to basal levels two to four days after sponge withdrawal. A significant slower progesterone increase also resulting in lower maximal concentrations could be observed in maiden goats. Luteolysis was evident in all animals within 24 h after PGF(2)alpha injection. Nine goats (six maiden and three pluriparous) did not exhibit Heat after the second injection and showed only a slow increase of progesterone. It seems that noncyclic animals are less sensitive to MAP treatment than to the first PGF(2)alpha injection. Goats at the beginning of the breeding season may react after a premature interruption of corpus luteum function (after second PGF(2)alpha injection) with delayed or inadequate follicular function.