Monthly Archives: December 2015

Crazy Night

by Woodsbum

For some reason I end up being at the wrong place at the right time to end up as a witness to a variety of events. Last Sunday was a crazy night where I ended up witnessing a traffic accident. Because I want to have a record of what I saw, thus I can data dump the majority of the events and fill my head with important information like the exact time the attacks on Pearl Harbor started.

My mother in law and I were headed back from Panda Express and I was in the process of taking her home. We were headed south bound on a main thoroughfare and were watching intently for people driving recklessly. The rain was just pouring and it was at that right temperature where everything kind of turned to a mist.

A sheriff deputy had someone pulled over so I moved to the inside lane, slowed down and prepared to stop for the stale light at the cross street that we were approaching. Once stopped I began my normal scan of our surroundings.

As a reminder, we were facing south and were stopped in the inside lane. No cars were stopped in front of me and I had a clear, unobstructed view of the intersection. There were two vehicles stopped in the east bound turn lane of the cross street waiting for the light to change. From the east and heading west bound there was a four door Honda. For ease I have numbered these cars 1-3 as such:

* Car 1: East bound, 4 door late 1990’s style Honda Civic with 2 younger males in the car.
* Car 2: East bound, 4 door white CRV that seemed to be fairly new and in really nice condition. The driver was a younger girl that appeared to be messing around with her phone.
* Car 3: West bound, 4 door Honda with 4 passengers.

So here is what happened. The east bound vehicles (Cars 1 and 2) were preparing to turn left to head north on the street I was parked on. Their light turned to a flashing yellow arrow and they went ahead and started turning.

Car 3 was headed west bound on the cross street and had a green light. This car had the right of way and had not reached the intersection before it had turned green for them. To rephrase: this car was travelling in a straight line, the light that they were approaching turned green before they reached the intersection, and they had the right of way.

Cars 1 and 2 ignored this oncoming vehicle and Car 1 accelerated to beat Car 3 to the intersection. Again, Car 3 had the right of way and was travelling straight through the intersection. Car 1 slipped by Car 3 by just a slight margin and Car 2 was slowly rolling into the intersection as if they were preparing to turn, but yielding to the oncoming Car 3.

This was not the case for Car 2 turned into the path of Car 3 and thus caused a head on collision where the cars hit almost driver’s side headlight to driver’s side headlight.

The instant I saw the collision I looked to verify the signals since I was witness to the accident. The driver of Car 2 appeared to have been doing something with her cell phone at the time of the collision. When I saw Cars 1 and 2 pull into the intersection I quickly looked at the drivers to see if and what they might be paying attention to. The driver of Car 2 had what appeared to have an object near her head that was lighting up her face.

I also was able to physically watch the air bag in Car 2 deploy into the face of the young girl. I did not see the air bags deploy in Car 3 because my attention had been drawn to the driver of Car 2 when I noticed that she seemed to be operating a cell phone while driving.

Once the cars settled and the light turned green for me I pulled through the intersection, parked and went back to check on the passengers. The driver of Car 2 was getting out of her vehicle crying with a cell phone next to her head in an attempt to talk to someone. The occupants of Car 3 had just exited the vehicle and there was a female adult that was checking the welfare of the younger occupants. When I asked how everyone was the female adult said, “My 9 year old’s stomach hurts.” The sheriff deputy has just pulled up from the traffic stop he had made and took control of the accident scene. He asked me to go sit in my vehicle until he had a chance to come take my statement regarding the accident.

Once I gave my statement I proceeded with taking my mother in law back to her apartment. When I got home I mentioned to my neighbor that I had witnessed the accident and told the story of what had transpired.

Now let’s fast forward a day to Monday night. While watching a DVR’ed episode of Blue Bloods I received a call from a guy I know that lives in my neighborhood. Come to find out, the occupants of Car 3 were actually his wife and children. Due to the nasty weather, darkness and no real point of reference I had not recognized them when I stopped to check if everyone was okay. Interestingly enough he said that the sheriff was less than cordial to his wife during the “investigation” even though I had already given my statement, he repeated and confirmed understanding that the drivers of both Cars 1 and 2 had not yielded right of way to the oncoming vehicle. He also asked me to explain why I thought the driver of Car 2 had been on a cell phone.

I guess things do happen for a reason. My neighbor is a hard working, roofer and his wife works while trying to complete her degree. They have several kids and truly live paycheck to paycheck. The total loss of this vehicle and any possible loss of work really will hurt them particularly right before the holidays. If my witnessing this accident helps this family through the insurance headache to come, I will be happy.

The fact that the carelessness of this over privileged (kid was driving a very new Rav4), young driver can possibly make this a very lean Christmas for these young children really upsets me a bit. My fingers are crossed that insurance will fix everything in a timely manner and get this hard working family back on their feet before their Christmas is as totalled as their Honda.

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Echinococcosis Hydatid Cyst

by Woodsbum

Seeing as how it is still elk season and I just ran across this, I felt compelled to include this article as today’s post.

Echinococcosis hydatid cyst or cystic echninococcosis (CE) is a condition where a small tapeworm actually grows in the lungs, thus causing a cyst. The following article really explains it quite well, but the important point is that any time you run across these cysts in an animal’s lungs you should be extremely careful and assume that the meat is NOT fit for consumption.

Here is the article:

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Background

Cystic echinococcosis (CE) is the larval cystic stage (called echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally. Ultrasonographic appearance of echinococcal cysts is seen in the image below.

WHO Informal Working Group on Echinococcosis stand WHO Informal Working Group on Echinococcosis standardized ultrasound classification of echinococcal cysts. Image courtesy of World Health Organization (WHO).

Three other species are recognized within the genus Echinococcus, and they may also develop in the human host and cause various forms of echinococcosis (hydatidosis). E granulosus is discussed separately from the other 3 species, notably Echinococcus multilocularis, which causes alveolar echinococcosis, because of marked differences in epidemiology, clinical features, diagnosis, and treatment.

In the normal life cycle of Echinococcus species, adult tapeworms (3-6 mm long) inhabit the small intestine of carnivorous definitive hosts, such as dogs, coyotes, or wolves, and echinococcal cyst stages occur in herbivorous intermediate hosts, such as sheep, cattle, and goats. A number of other suitable intermediate hosts, such as camels, pigs, and horses, are involved in the life cycle in many parts of the world.

In the typical dog-sheep cycle, tapeworm eggs are passed in the feces of an infected dog and may subsequently be ingested by grazing sheep; they hatch into embryos in the intestine, penetrate the intestinal lining, and are then picked up and carried by blood throughout the body to major filtering organs (mainly liver and/or lungs). After the developing embryos localize in a specific organ or site, they transform and develop into larval echinococcal cysts in which numerous tiny tapeworm heads (called protoscolices) are produced via asexual reproduction.

These protoscolices are infective to dogs that may ingest viscera containing echinococcal cysts (with protoscolices inside), mainly because of the habit in endemic countries of feeding dogs viscera of home-slaughtered sheep or other livestock. Protoscolices attach to the dog’s intestinal lining and, in approximately 40-50 days, grow and develop into mature adult tapeworms, once again capable of producing infective eggs to be passed to the outside environment with the dog’s feces.

Because humans play the same role of intermediate hosts in the tapeworm life cycle as sheep, humans also become infected by ingesting tapeworm eggs passed from an infected carnivore. This occurs most frequently when individuals handle or contact infected dogs or other infected carnivores or inadvertently ingest food or drink contaminated with fecal material containing tapeworm eggs.

Pathophysiology

In primary echinococcosis, metacestodes develop from oncospheres after peroral infection with E granulosus eggs. In secondary echinococcosis, larval tissue proliferates after being spread from the primary site of the metacestode. This can occur by spontaneous trauma such as induced rupture or during medical interventions.

In primary echinococcosis, larval cysts may develop in every organ. Most patients (as many as 80%) have single-organ involvement and harbor a solitary cyst. Approximately two thirds of patients experience liver echinococcosis. The second most common organ involved is the lung.

In each anatomic site, cysts are surrounded by the periparasitic host tissue (pericyst), which encompasses the endocyst of larval origin. Inside the laminated layer, or hyaline membrane, the cyst is covered by a multipotential germinal layer, giving rise to the production of brood capsules and protoscolices. The central cavities of cysts of E granulosus are filled with clear fluid, numerous brood capsules, and protoscolices. In addition, daughter cysts of variable size are often detected. The growth rate of cysts is highly variable and may depend on strain differences. Estimates of the average increase of cyst diameter vary (approximately 1-1.5 cm/y).

The clinical features of cystic echinococcosis are highly variable. The spectrum of symptoms depends on the following:

  • Involved organs
  • Size of cysts and their sites within the affected organ or organs
  • Interaction between the expanding cysts and adjacent organ structures, particularly bile ducts and the vascular system of the liver
  • Complications caused by rupture of cysts
  • Bacterial infection of cysts and spread of protoscolices and larval material into bile ducts or blood vessels
  • Immunologic reactions such as asthma, anaphylaxis, or membranous nephropathy secondary to release of antigenic material

Epidemiology

Frequency

United States

Unfortunately, realistic national or international figures do not exist for total numbers of cases of cystic echinococcosis. The problem is that, until recently, the only basis for diagnosis was surgery, and few countries systematically reported cases. When they did report cases, uneven reporting occurred in different regions of countries. The groups most at risk of cystic echinococcosis are usually underserved by medical services.

However, the increasing use of mass screenings with ultrasonography in endemic countries is generating important epidemiological data. As different cyst stages have been classified according to their sonographic appearance, attempts are being made to match the cyst morphology with the natural history of the cyst. This is evident with the World Health Organization (WHO) standardized classification (see Imaging). At a community level, the relative proportions of cyst types can provide epidemiological information on disease transmission and help design effective control programs.[1]

In the United States, transmission of E granulosus in the dog-sheep cycle is known to occur most frequently in several western states, including California, Arizona, New Mexico, and Utah. In Arizona and New Mexico, cystic echinococcosis is known to occur in American Indians belonging to the Zuni, Navajo, and Santo Domingo tribes, whose members live in close proximity to their animals, kill many of their own animals each year, and generally have limited knowledge concerning the life cycle and transmissibility of the parasite. In the United States, Utah has had the highest number of surgical cases of those states involved, with approximately 45 cases from 1944-1994.

International

E granulosus is a cosmopolitan parasite, and endemic regions exist in each continent. Considerable public health problems occur in many areas, including countries of Central America and South America, Western and Southern/Southeastern Europe, the Middle East and North Africa, some sub-Saharan countries, Russia and adjacent countries, and China. Annual incidence rates of diagnosed human cases per 100,000 inhabitants vary widely, from less than 1 case per 100,000 to high levels. For example, rates in the indicated regions are as follows:

  • Greece – 13 cases per 100,000 persons
  • Rural regions of Uruguay – 75 cases per 100,000 persons
  • Rural regions of Argentina – 143 cases per 100,000 persons in Rio Negro province
  • Parts of Xinjiang province of China – 197 cases per 100,000 persons
  • Parts of the Turkana district of Kenya – 220 cases per 100,000 persons

Cystic echinococcosis causes not only illness but also productivity losses in human and agricultural animal population, and it can have large societal impacts on endemic areas. Research is being conducted to evaluate the burden of disease, including nonmonetary costs.

Mortality/Morbidity

Cystic echinococcosis is rarely fatal. Occasionally, deaths occur because of anaphylactic shock or cardiac tamponade in heart echinococcosis.[2]

Rare locations of the cyst (muscle, bone, brain, orbit) can cause dramatic and disabling symptoms (blindness, paralysis).[3, 4, 5, 6, 7, 8, 9, 10]

Race

No racial predilection exists.

Sex

In some endemic countries, females are affected more than males because their lifestyle habits and practices bring them into contact with the parasite.

Age

Individuals of all ages are affected. In some endemic countries, children have higher infection rates because they are most likely to play with dogs.

History

Months or years may pass before an individual exhibits any signs or symptoms of infection with the cystic larval stages.

During the natural course of infection, the fate of E granulosus cysts is variable. Some cysts may grow to a certain size and then persist without noticeable change for many years. Other cysts may rupture spontaneously or collapse and completely disappear.

Spontaneous or traumatic cyst rupture and spillage of viable parasitic tissue during interventional procedures may result in secondary echinococcosis. Cysts may rupture into the peritoneal or pleural cavity, the pericardium, the bile ducts, the gastrointestinal tract, or even blood vessels, leading to extraordinary manifestations and severe complications.

Spontaneous cure of cystic echinococcosis is possible.

After a variable incubation period, infections may become symptomatic if cysts are growing and exerting pressure on adjacent tissue and inducing other pathologic findings.

Sudden symptomatology is usually due to spontaneous or traumatic cyst rupture.

Usually, cysts do not induce clinical symptoms before they have reached a size sufficient to exert pressure on adjacent organs.

Physical

The presentation of human echinococcosis is protean. Patients come to the clinician’s attention for different reasons, such as when a large cyst has some mechanical effect on organ function or rupture of a cyst causes acute hypersensitivity reactions. The cyst may also be discovered accidentally during radiographic examination, body scanning, surgery, or for other clinical reasons.[11]

Common chief symptoms are upper abdominal discomfort and pain, poor appetite, and a self-diagnosed mass in the abdomen. Physical findings are hepatomegaly, a palpable mass if on the surface of the liver or other organs, and abdominal distention. If cysts in the lung rupture into the bronchi, intense cough may develop, followed by vomiting of hydatid material and cystic membranes.[12]

Liver findings may include the following:

  • Hepatomegaly
  • Jaundice
  • Biliary colic–like symptoms
  • Cholangitis
  • Pancreatitis
  • Liver abscess
  • Portal hypertension
  • Ascites
  • Inferior vena cava compression or thrombosis
  • Budd-Chiari syndrome
  • Cyst rupture, peritoneal spread, and peritonitis
  • Hemobilia
  • Biliary fistula to skin, bronchial system, or gastrointestinal tract

Lung findings may include the following:

  • Tumor of chest
  • Chest pain
  • Chronic cough, expectoration, and dyspnea
  • Pneumothorax
  • Eosinophilic pneumonitis
  • Pleural effusion
  • Parasitic lung embolism
  • Hemoptysis
  • Biliptysis

Heart findings may include the following:

  • Tumor
  • Pericardial effusion
  • Embolism

Breast masses may be found (must be differentiated from neoplasms).[11]

Spine masses with neurologic symptoms may be found.

Brain masses with neurologic symptoms may be found.

CE

CE

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So there you have it. If you see any animal lungs that have cysts that resemble the picture above you should immediately assume that the meat is tainted and not fit for consumption. Make sure to take a picture of the infected animal’s lungs and you can forward it to any number of organizations that are monitoring this condition.

Again, there is much speculation as to why this is occurring, but much finger pointing is direction towards the wolves that were reintroduced to the Western United States. From what I have read, the current species of wolf that was introduced is actually a different species than what originally lived here. That also accounts for the tremendous increase of wolf numbers over the last several years.

No matter what side of the wolf debate you are on or even if the wolf was the cause of this tapeworm that is infecting the herbivores of the Western States it is 100% fact that this is a problem that needs to be researched.

Be careful out there!!

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