Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Síndrome da feminização em cão com sertolioma / Feminization syndrome in a dog with Sertoli cell tumor

Background: The uncontrolled multiplication of Sertoli cells causes Sertoli cell tumor or Sertolioma. Because of this, the level of estrogen in the bloodstream increases rapidly and approximately 25% of dogs with this tumor develop feminization syndrome. Testicular neoplasms are more common in dogs than cats, and are often found in elderly patients. This work aims to describe the clinical signs of the feminization syndrome and the treatment instituted in a canine diagnosed with sertolioma. Case: A 18-year-old male canine, 19.5 kg of body mass, with an increase in testicular volume for about 2 years, was treated at the University Veterinary Hospital. On clinical examination, a matte and brittle coat, alopecia on the hind limbs and gynecomastia were observed. Also noted, non-harmonious aspect of the scrotum, pendular foreskin, atrophied right testicle and hyperplastic left, scrotal hyperthermia and absence of pain. In addition, as a result of the hyperestrogenism resulting from the neoplasm, the paraneoplastic syndrome of feminization, the patient also presented galactorrhea, pendular foreskin, atrophy of the penis and the contralateral testicle, dermatopathies, such as bilateral symmetrical alopecia of the flanks, easily removable hair and variable hyperpigmentation. Rectal body temperature of 38.6°C, clear lung auscultation and muffled cardiac auscultation. The results of laboratory tests showed changes such as thrombocytopenia, platelet counts below the reference levels, platelet count of 163,000/uL. There were no alterations that represented metastases in the imaging exams, such as in the chest X-ray in three incidences and in the abdominal ultrasonography. Then, we opted for the surgical procedure of orchiectomy, with the traditional technique of three clamps, associated with total ablation of the scrotum. Samples were sent to the histopathology laboratory and the diagnosis of sertolioma was confirmed. At 10, 30 and 90 days after the operation, the patient was reassessed for possible recurrences or alterations, but there were no complications or recurrence after the procedure. Discussion: Neoplasms of the male reproductive system are common in dogs. Sertolioma is considered one of the most frequent neoplasms in elderly dogs and that results in systemic clinical signs. This is in line with the 18-year-old dog described in the present report. In addition, it may result in clinical signs resulting from hyperestrogenism resulting from the neoplasm that is called paraneoplastic feminization syndrome. The characteristics of this syndrome are: gynecomastia, galactorrhea, pendular foreskin, atrophy of the penis and contralateral testicle, associated with dermatopathies, such as symmetrical bilateral alopecia. All these clinical signs were present. The diagnosis is made through complete anamnesis, complete clinical examination and complementary examination such as ultrasound help in the presumptive diagnosis, but only with histopathology can it be confirmed. In the clinical approach, histopathology was performed to close the diagnosis. Treatment is behind orchiectomy and total ablation of the scrotum, which was performed in the reported case. The treatment of choice was easy to apply, in addition to improving the patient's quality of life, promoting rapid post-surgical healing and an early return to normal life. However, for the effectiveness of the technique, the early diagnosis and collaboration of tutors is fundamental.

Hérnia diafragmática peritôniopericárdica congênita em uma gata / Congenital peritoniopericardial diaphragmatic hernia in a female kitten

Background: Peritoneopericardial diaphragmatic hernia is a rare pathogenesis of congenital origin, which occurs due to a failure in the communication between the diaphragm and the pericardium during embryogenesis. Symptoms may be non-existent or non-specific, depending on the herniated organ involved and, in most cases, the diagnosis is incidental. Regarding the most indicated treatment, there are still divergences in the literature concerning the indication of conservative or surgical treatment. This study reports the case of a feline peritoneopericardial hernia, for which surgical correction was the treatment of choice. Case: A 3-month-old female kitten, no defined racial pattern, was referred to the Veterinary Hospital of the Federal Rural University of Pernambuco for treatment of a peritoneopericardial diaphragmatic hernia. This condition was diagnosed through radiographic examination after the patient having been submitted to pediatric castration and presented anesthetic complications in the transsurgery. Blood count, biochemical profile and Doppler echocardiogram were performed, which showed no significant changes. To obtain a better study and surgical planning, computed tomography was performed to observe the heart located cranially in the pericardial cavity. Caudally to the heart, hepatic parenchyma located in the pericardial cavity was observed; and hepatic vessels presenting slightly enlarged dimensions. These tomographic findings suggested peritoneopericardial diaphragmatic hernia; being the liver present in the pericardial cavity and signs of congestion in the hepatic parenchyma. Due to the likelihood of future worsening of the hernia, surgical correction was performed, with an abdominal midline incision in the preumbilical region to reposition the liver to its normal anatomy, followed by diaphragm reconstitution through a herniorrhaphy. After the surgical procedure, the patient was referred for observation in internment and, after 15 days, the skin sutures were removed. Complete correction of the hernial defect was observed on radiography performed 30 days after the surgical procedure. However, the examination showed the presence of deviation/ deformity in the topography of the sternum and costal cartilages, with slight cardiac displacement to the right hemithorax, suggesting the presence of pectus excavatum. Discussion: Peritoneopericardial diaphragmatic hernia is considered rare and, despite being one of the most common causes of congenital pericardial anomaly in felines, it has a low prevalence ranging from 0.06% to 1.45%. They are usually diagnosed from two years of age, with prevalence for older animals. However, due to having presented anesthetic changes, the patient of this case report could be diagnosed early. Among the most common organs that migrate to the thoracic cavity, the liver is the most commonly observed, which is also the hernia content of the present report. Peritoneopericardial hernia is often diagnosed through radiography and ultrasound, and these imaging tests proved to be sufficient for the diagnosis in this report. However, computed tomography was important for providing a better study of case and for the adoption of median celiotomy as a treatment. Associations with other malformations are described in the literature, with pectus excavatum being the most common and also observed in this report. Peritoneopericardial diaphragmatic hernia is a rare anomaly, rarely reported in the literature and with divergences regarding its treatment. The adoption of early surgical treatment performed in this report showed satisfactory evolution and the possibility of a favorable prognosis.

Pectus excavatum ­ Correção cirúrgica utilizando tala externa de poliuretano fabricada com tecnologia de impressão 3D / Pectus excavatum ­ Surgical correction, using polyurethane external splint made with 3D printing technology

Objetivou-se relatar o emprego de uma tala externa confeccionada com material de poliuretano e cobertura interna de neopreme na reparação cirúrgica do pectus excavatum em um felino jovem. O felino apresentava deformidade anatômica congênita na região do externo e sinais clínicos respiratórios. Imagens avançadas de tomografia foram utilizadas para moldar a tala impressa com tecnologia tridimensional. Esta alternativa possibilitou melhor planejamento cirúrgico e, com isso, conforto para o paciente, além da qualidade própria do material de poliuretano que é levemente maleável, o que permitiu melhor moldagem e expansão torácica durante a respiração. A tala se provou resistente o suficiente para suportar a tração ocasionada pelos fios de sutura e possibilitou o reposicionamento adequado do osso esterno ao mesmo tempo que se mostrou confortável e acarretou mínimas lesões ao paciente.

The aim of this paper was to report the use of an external splint made of polyurethane material and internal neopreme covering in the surgical repair of a pectus excavatum in a young feline. The feline exhibited a congenital anatomical deformity in the external region and clinical respiratory signs. Advanced CT images were used to shape the 3D-printed splint. This alternative allowed better surgical planning and, therefore, comfort for the patient, this because to the quality of the polyurethane material, which is slightly malleable, and allowed for better molding and chest expansion during breathing. The splint proved to be strong enough to withstand the traction caused by the suture threads and allowed the proper repositioning of the sternum, at the same time it was comfortable and caused minimal injuries to the patient.

Development and validation of a simulator for teaching minimally invasive thoracic surgery in Brazil

ABSTRACT Purpose To develop and validate a chest cavity simulator for teaching video-assited thoracic surgery (VATS). Methods The first phase of the study consisted of developing a chest cavity simulator. A quasi-experimental study was performed in the second phase, and 25 surgeons and residents participated in a three-stage pulmonary suture experiment. The videos were recorded and timed. Generalized linear regression models for repeated measures were used to analyze the outcome change over time. Results The chest cavity simulator consists of a console simulating the left hemithorax. Among the participants, 96% rated the design, visual aspect, positioning ergonomics, and triangulation of the portals as very good or excellent (face validity). There was a decrease in suturing time in step 1 from 435.7 ± 105 to 355.6 ± 76.8 seconds compared to step 3 (p = 0.001). The evaluation of the simulation effectiveness and performance (content validity) was rated as very good or excellent by 96% ofparticipants. The most experienced surgeon showed significant reduction in procedure time (p = 0.021) (construct validity). Conclusions The thoracic cavity simulator is realistic, showing content and construct validity, and can be used in VATS training. The simulation model allowed skill gain in the endoscopic suture.

Efeitos da PEEP na ventilação controlada a volume sobre parâmetros hemodinâmicos em suínos submetidos ao pneumoperitônio associado ao cefalodeclive / Effects of PEEP on hemodynamic variables in pigs submitted to volume-controlled ventilation under pneumoperitoneum associated to cephalodeclive

Videolaparoscopic procedures have gained prominence due to their low invasiveness, causing less surgical trauma and better post-surgical recovery. However, the increase in intra-abdominal pressure due to the institution of pneumoperitoneum can alter the patient's homeostasis. Therefore, volume-controlled ventilation, associated with positive end-expiratory pressure (PEEP), improves arterial oxygenation and prevents pulmonary collapse, but it can lead to important hemodynamic changes. The aim of this study was to evaluate, comparatively, the effects of positive end expiratorypressure (PEEP) on hemodynamic variables of pigs submitted to volume-controlled ventilation, during pneumoperitoneum and maintained in head-down tilt and determine which PEEP value promotes greater stability on hemodynamic variables. Twenty-four pigs were used, between 55 and 65-day-old, weighing between 15 and 25 kg, randomly divided into 3 distinct groups differentiated by positive end-expiratory pressure: PEEP 0 (volume-controlled ventilation and PEEP of 0 cmH2O), PEEP 5 (volume-controlled ventilation and PEEP of 5 cmH2O) and PEEP 10 (volume-controlled ventilation and PEEP of 10 cmH2O). Volume-controlled ventilation was adjusted to 8 mL/kg of tidal volume and a respiratory rate of 25 movements per min. Anesthesia was maintained with continuous infusion of propofol (0.2 mg/kg/min) and midazolam (1 mg/kg/h). Pneumoperitoneum was performed with carbon dioxide (CO2), keeping the intraabdominal pressure at 15 mmHg and the animals were positioned on a 30° head-down tilt. The evaluations of hemodynamic variables started 30 min after induction of anesthesia (M0), followed by measurements at 15-min intervals (from M15 to M90), completing a total of 7 evaluations. The variables of interest were collected over 90 min and submitted to analysis of variance followed by Tukey's post-hoc test, with P < 0.05. The PEEP 10 group had higher values of CVP and mCPP, while the PEEP 5 group, mPAP and PVR were higher. The PEEP 0 group, on the other hand, had higher means of CI. Regarding the moments, there were differences in HR, SAP, DAP, MAP, CO, IC and TPR. According to the literature, important hemodynamic effects due to pneumoperitoneum are reported, which can be caused by the pressure used in abdominal insufflation, CO2 accumulation, duration of the surgical procedure, hydration status and patient positioning. Mechanical ventilation associated with PEEP can also cause an increase in intrathoracic pressure and, therefore, reduce cardiac output. Cardiovascular changes are proportional to the PEEP used. Central venous pressure (PVC) measure the patient's preload, and intrathoracic pressure can interfere with this parameter. The peak pressure values in the PEEP 10 group were higher than the other groups, demonstrating that the increase in intrathoracic pressure results in higher PVC values. Regarding PAPm and PCPm, these variables can be influenced according to the PEEP values and the patient's position. In relation to CI, the increase in PEEP may reflect on intrathoracic pressure, resulting in greater compression of the heart, with a consequent reduction in cardiac output and cardiac index. Therefore, it is concluded that the PEEP effects of 0 cmH2O and 5 cmH2O on hemodynamics are discrete, under the proposed conditions.(AU)

Pulmonary adenocarcinoma in dogs: surgical treatment with real-time video-thermometry

Background: Pulmonary neoplasia is an abnormal proliferation of cells at the lung tissue, and may be classified as primary, secondary or metastatic, and multisystemic. However, primary neoplasia is rare in canids. Additionally, neoplasms may be classified according to their biological behavior as either malignant or benign. Malignant tumors are more prevalent. The diagnosis can be difficult due to nonspecific symptoms, taking into account that some affected patients do not have symptoms at all; thus, the real incidence of the disease might remain undiagnosed on certain occasions. Therefore, we aimed to report an unprecedented successful case of lung lobectomy surgery in dogs with the aid of infrared video thermometry, which showed real-time images during the surgical procedure. Case: A 10-year-old male dog, crossbreed with Cocker Spaniel, was attended with a history of lethargy, dullness, progressive weight loss, cough, and difficulty breathing. Due to the chronic severity of the clinical signs and the normal physiological clinical examination, complementary exams were requested, such as radiography of the cervical and thoracic regions, cranial and thoracoabdominal computed tomography (TCT). The results of the exams showed the presence of a nodule mass in the right caudal pulmonary lobe which caused a lateral deviation to the left hemithorax of the cardiac silhouette. The patient underwent a surgical procedure with an approach through the thoracic region, at the height of the seventh intercostal space, and a total lobectomy was performed. Throughout the surgical procedure, video thermometry in real-time through the MART station (Metabolic Activity in Real-Time FLIR SC325®) was used to determine the viability of adjacent tissues through temperature differences measured in degrees Celsius. The surgical fragment containing the direct caudal pulmonary lobe and the mass were sent to the pathology sector for anatomopathological evaluation. An abundant papillary epithelial proliferation was visualized through microscopy, presenting areas of necrosis and inflammatory polymorphonuclear infiltrate. The nodule was diagnosed as lung papillary adenocarcinoma. Discussion: Adenocarcinomas consist of papillary, acinar, solid, or mixed glandular structures. They may originate from the airways, bronchial glands, or bronchoalveolar region, and often show invasive growth presenting a rudimentary and irregular shape. The clinical signs are non-specific, including exercise intolerance, non-productive cough, chronic respiratory signs such as tachypnoea or dyspnea, reduced appetite, weight loss, lethargy, chest palpation pain, hemothorax, pneumothorax, and pleural effusion. The diagnosis is concluded through imaging diagnostic tests, of which chest radiography is the most important, followed by magnetic resonance and computed tomography. Also, histopathological examination is essential to determine a definitive diagnosis. The treatment of choice for adenocarcinoma nodules is a surgical excision of the tumor mass. However, the type of surgical approach is determined by different factors such as size, location, and involvement of adjacent structures. The ablation of pulmonary masses may be performed either via partial or total lobectomies. Nevertheless, partial lobectomy is more often performed on non-neoplastic masses or to obtain material for biopsy, whilst total lobectomy is recommended for a malignant neoplasm removal. The prognosis is always guarded, having a more favorable outcome in masses of the smaller diameter without the involvement of adjacent structures.(AU)

Anestesia geral em jabuti-piranga (Chelonoides carbonaria) para retirada de corpo estranho gástrico / General anesthesia in red-footed tortoise (Chelonoides carbonaria) for gastric foreign body removal

Background: The anatomical, physiological, and pharmacological characteristics of reptiles make anesthesia in chelonians particularly challenging. Specific literature regarding safe anesthetic protocols that provide immobilization, antinociception, amnesia, and unconsciousness are scarce. Thus, this paper aims to report the case of a red-footed tortoise submitted to long-duration general anesthesia to celiotomy for foreign body removal. Case: An adult red-footed tortoise (Chelonoides carbonaria), 5.9 kg, was admitted due to hyporexia after ingesting a metallic fishhook. Serial radiographs confirmed the diagnosis and location of the foreign body in the stomach. The animal was premedicated with 0.03 mg/kg dexmedetomidine, 6 mg/kg ketamine, and 0.4 mg/kg butorphanol intramuscularly. After 90 min we inserted a 22G jugular catheter and proceeded to anesthesia induction with 5 mg/kg propofol. We intubated the animal with a 2.5 mm uncuffed endotracheal and started fluid therapy at a rate of 5 mL/kg/h. Surgical anesthesia was maintained with isoflurane in 0.21 oxygen, in a non-rebreathing circuit (baraka), under spontaneous breathing. Expired isoflurane was maintained between 3 and 4.5%. Due to reduced respiratory rate and hypercapnia, we opted for implementing manually-assisted positive pressure ventilation. Morphine (0.5 mg/kg) was administered at 10 and 87 min after the beginning of the surgery for further analgesia when the isoflurane requirement increased significantly. We did not detect any alterations in heart and body temperature. Surgical anesthesia lasted 6 h. During anesthesia recovery, voluntary head retraction and coordinated movement of the limbs occurred at 240 and 540 min after the extubation, respectively. In 2 days, the patient returned to voluntary feeding, being very active and responsive to stimulus. The post-surgical hematologic evaluation was unremarkable. Discussion: Pre-anesthetic medication aimed to promote sedation and preemptive analgesia. Due to its minimal cardiorespiratory depression, we chose the combination of ketamine, dexmedetomidine, and butorphanol. Dexmedetomidine reduced the ketamine dose and caused sufficient muscle relaxation and immobilization to perform the jugular catheter placement. Butorphanol is an agonist-antagonist opioid; that is why we decided to add it to the protocol for antinociception. However, due to signs of nociceptive response (increased isoflurane requirements and heart rate), and considering the evidence of a predominance of µ receptors in reptiles, we administered low-dose morphine twice during the procedure. Propofol was chosen as an induction agent at a dose sufficient to allow endotracheal intubation. Since reptilians often show apnea in the presence of 100% oxygen, we used a 0.21 oxygen fraction. Despite this, the patient showed respiratory depression. Due to right to left cardiac shunt, sudden changes in the direction of the blood can lead to very rapid changes in the serum concentrations of isoflurane, which leads to frequent oscillations in the anesthetic depth and consequently the need for vaporizer adjustments, which may justify the high expired isoflurane fraction during the procedure. Despite that, physiological parameters were maintained within normal ranges for the species, with slight variations during the surgical procedure. We conclude that the proposed anesthetic protocol is safe for long-duration anesthesia in chelonians, ensuring cardiovascular and respiratory stability. Thus, this report may help veterinarians to perform safe anesthesia in tortoises submitted to invasive surgical procedures.

Concurrent hiatal hernia and megaesophagus secondary to a nasopharyngeal polyp in a 6-month-old cat

Background: Nasopharyngeal polyps are benign and inflammatory masses assumed to arise from the middle ear or the eustachian tube with extension into the pharynx. The most common clinical signs associated with nasopharyngeal polyps include respiratory stertor, dyspnea, and otic discharge. Neurological signs, including head tilt, facial nerve paralysis, and ataxia, might indicate concurrent involvement of the middle or inner ear. The objective of the current report is to describe a case of a feline nasopharyngeal polyp with a concurrent hiatal hernia and megaesophagus, both spontaneously resolved after removal of the polyp. Case: A 6-month-old female intact domestic shorthair cat was presented for evaluation of lethargy, anorexia, and upper respiratory signs, such as stridor, stertor, and dyspnea. A thoracic radiography revealed esophageal dilation caudal to the cardiac silhouette, suggestive of megaesophagus with gaseous filtration. An esophagram confirmed a hiatal hernia and megaesophagus. Computed tomography revealed a nasopharyngeal mass adjacent to the soft palate and a soft-tissue density in the right tympanic bulla. A tentative diagnosis of a nasopharyngeal polyp was made. After the ventral bulla osteotomy, the nasopharyngeal mass was removed by a gentle traction avulsion technique. Six days after the surgery, hiatal hernia and megaesophagus were spontaneously resolved. Based on histopathologic exam, the mass was found to be an inflammatory nasopharyngeal polyp. Two months after surgery, the owner reported that the patient's condition had returned to baseline with a good appetite, and the thoracic radiography was within normal limit. Discussion: For successful treatment of a nasopharyngeal polyp, traction avulsion of the polyp with or without a ventral bulla osteotomy is recommended. However, in patients with otitis media, a ventral bulla osteotomy followed by traction avulsion of the polyp is recommended in order to reduce the rate of polyp recurrence. Common clinical signs of a nasopharyngeal polyp are stertor, stridor, dyspnea, dysphagia, and open-mouth breathing, which are identified in a chronic upper airway obstruction. A hiatal hernia secondary to a nasopharyngeal polyp has not been reported so far. However, a relationship between chronic upper airway obstruction and hiatal hernias has been proposed previously. Moreover, hiatal hernia resolved spontaneously after removal of the nasopharyngeal polyp suggests that the occurrence of the hiatal hernia was secondary to the nasopharyngeal polyp. In addition to the hiatal hernia, megaesophagus was also identified in the present case. Megaesophagus secondary to a chronic upper airway obstruction from a nasopharyngeal obstruction has been reported. However, megaesophagus is also thought to occur secondary to hiatal hernias. Therefore, in the current study, it is unclear whether the megaesophagus was solely a result of the obstructive nature of the nasopharyngeal polyp or a combination of the hiatal hernia and the nasopharyngeal polyp. In conclusion, any cat with clinical signs of an upper airway obstruction and a concurrent hiatal hernia and megaesophagus should be thoroughly investigated for a nasopharyngeal polyp, as well as other gastrointestinal and systemic causes. Furthermore, this case suggests that the prognosis for a concurrent hiatal hernia and megaesophagus is good in cats if the nasopharyngeal polyp is properly removed.

The feasibility and effectiveness of thoracoscopic transdiaphragmatic approach for lung biopsy in rabbits: a randomized study

Purpose To assess the feasibility of thoracoscopic transdiaphragmatic approach for biopsy of all lung lobes and to determine the optimal intercostal space (ICS) for biopsy of each lung lobe. Methods Ten rabbits were positioned in dorsal recumbency. Total thoracoscopy lung biopsy was made combined transdiaphragmatic approach and right ICS approaches. A camera port was made in the transdiaphragmatic approach and the instrument port was made of ICS 7 and ICS 9. A pre tied loop ligature was placed to performed a caudal lung lobe biopsy and to simulate biopsies of the others lung lobes. Results Biopsy of the cranial aspect of the right caudal lung lobe was performed at ICS 9. Simulated biopsy of the accessory lung lobe was performed at ICS 9. Simulated lung biopsy of the right cranial and middle lung lobes was performed at ICS 7. The caudal and dorsal aspect of the right caudal lung lobe was not visualized by telescope at transdiaphragmatic approach, and biopsy was not performed. Conclusions Thoracoscopic transdiaphragmatic approach for lung lobes biopsies was a feasible technique, except for the caudal aspect of the right caudal lung lobe. An ideal intercostal port for biopsy of each right lung lobe was determined.(AU)

Evaluation of echocardiographic variables of morphometry and function in horses submitted to minimally invasive partial pericardiotomy / [Avaliação de variáveis ecocardiográficas morfométricas e funcionais em cavalos submetidos à pericardiotomia parcial minimamente invasiva]

This study aimed to evaluate the impact of minimally invasive partial pericardiotomy on echocardiographic variables of morphometry and function in healthy horses. Minimally invasive pericardiotomy was performed in six healthy horses. Echocardiographic evaluation was executed in different moments: prior to the surgical procedure (M0); 24 hours post procedure (M1); 72 hours post procedure (M2) and 28 days post procedure (M3). The following variables were measured: Right ventricular internal diameter in diastole and systole (RVd and RVs), interventricular septum thickness in diastole and systole (IVSd and IVSs), left ventricular internal diameter in diastole and systole (LVd and LVs), left ventricular free wall thickness in diastole and systole (LVFWd and LVFWs), aortic root diameter (Ao) and left atrial diameter (LA). From this data, the following variables were calculated: fractional shortening (FS%), fractional thickening of the interventricular septum (IVS%), fractional thickening of the left ventricular free wall (LVFW%) and the relationship between left atrial and aortic diameters (LA/Ao). After 28 days, a new thoracoscopy was performed for inspection of the thoracic cavity. In M1 and M2 ECO evaluations, a statistically significant change in LVFW and a decrease in RVd, LVd, LVFWs, LA, LVs, FS% and IVS was documented. Pericardiotomy is a promising technique in horses, with minor postoperative complication. The variations in the echocardiographic parameters were transient and did not cause hemodynamic damage to the animals.(AU)

O objetivo do presente estudo foi avaliar o impacto da pericardiotomia parcial minimamente invasiva sobre as variáveis ecocardiográficas morfométricas e funcionais em cavalos, visto que não há nenhum trabalho que tenha avaliado o impacto da pericardiotomia na espécie equina. Foram utilizados seis cavalos hígidos, nos quais se realizou pericardiotomia minimamente invasiva. Em todos eles, foi efetuado exame ecocardiográfico em diferentes momentos: previamente ao procedimento cirúrgico (M0); 24 horas após (M1); 72 horas após (M2) e 28 dias após (M3). Foram mensurados: diâmetro interno do ventrículo direito (VDd e VDs), espessura do septo interventricular (SIVd e SIVs), diâmetro interno do ventrículo esquerdo (VEd e VEs), espessura da parede livre do ventrículo esquerdo (PLVEd e PLVEs), diâmetro interno da aorta (Ao) e diâmetro atrial esquerdo (AE). Foram calculadas as variáveis fração de encurtamento (FEC%), espessamento fracional do septo interventricular (SIV%), espessamento fracional da parede livre do ventrículo esquerdo (PLVE%) e relação entre diâmetro do átrio esquerdo e diâmetro aórtico (AE/Ao). Após 28 dias, realizou-se nova toracoscopia para inspeção da cavidade torácica. Nas avaliações do ECO no M1 e no M2, houve alteração estatisticamente significativa no PLVE em diástole (28±5,5 e 31,7±2, respectivamente) e diminuição dos parâmetros VDd,(30,1±11,6 e 31,7± 10,7) VEd (113,3±21 e 121,7±13,7), PLVEs (42±8,2 e 43,9±2,8), AE (78,5±6,1 e 82,7±4,7), VEs (74,1±16 e 71,5±9,3), FEC (34,4±10,2 e 41,2±5,7) e SIV (27,1±8,7 e 42,3±27,9). A técnica de pericardiotomia empregada mostrou-se promissora em equinos. As variações dos parâmetros ecocardiográficos foram transitórias, não causando prejuízos hemodinâmicos aos animais.(AU)

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se que a disfunção miocárdica é um fator determinante de prognóstico em casos de sepse, o que ressalta a importância de seu diagnóstico e tratamento precoce.

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.

Clinical, laboratorial and image aspects of a perforated pyloric ulcer secondary to nonsteroidal anti-inflammatory use in a cat

Background: Inappropriate use of drugs for veterinary patients represents a common problem at clinical practice. Nonsteroidal anti-inflammatories are one of these misused drugs and may lead to clinical status of challenging diagnosis. Adverseeffects for patients submitted to its incorrect use may include simple cases such as pharmacological gastroenteritis to severeacute renal failure or perforated gastroenteric ulcers with no pathognomonic clinical signs. The objective of this reportwas to describe a case of a perforated pyloric ulcer secondary to prolonged use of meloxicam in a cat with its clinical,laboratorial and image aspects from the moment of suspicion until the diagnosis.Case: An 8-year-old female feline was attended at the Veterinary Hospital of the Dom Bosco Catholic University, withmain complaint being a mammary nodule with recent ulceration. Tumor staging and pre-surgical blood analysis wereperformed previous to total unilateral mastectomy. Eleven days post-surgery the patient was brought for suture removal,but it was observed stupor, moderate dehydration (estimated 10%), 36.7ºC rectal temperature, heart rate at 100 beats/min,respiratory rate at 60 breaths/min, 40 mg/dL blood glucose, icterus and abdominal distension with tympany at percussion(fluid wave test was negative). Anamnesis revealed the possible use of meloxicam for 10 days. The first suspicion wassepsis, with enteric gas secondary to infection. Due to no classical signs of peritoneum effusion and possible severe entericdistension, abdominocentesis was not immediate performed. Complete blood count and serum biochemistry revealed amarked band leukocytosis associated with renal injury, supporting the first sepsis suspicion. Abdominal radiography revealedradiodensity of diffuse aspect at ventral topography but no evidence of marked...

Clinical, laboratorial and image aspects of a perforated pyloric ulcer secondary to nonsteroidal anti-inflammatory use in a cat

Background: Inappropriate use of drugs for veterinary patients represents a common problem at clinical practice. Nonsteroidal anti-inflammatories are one of these misused drugs and may lead to clinical status of challenging diagnosis. Adverseeffects for patients submitted to its incorrect use may include simple cases such as pharmacological gastroenteritis to severeacute renal failure or perforated gastroenteric ulcers with no pathognomonic clinical signs. The objective of this reportwas to describe a case of a perforated pyloric ulcer secondary to prolonged use of meloxicam in a cat with its clinical,laboratorial and image aspects from the moment of suspicion until the diagnosis.Case: An 8-year-old female feline was attended at the Veterinary Hospital of the Dom Bosco Catholic University, withmain complaint being a mammary nodule with recent ulceration. Tumor staging and pre-surgical blood analysis wereperformed previous to total unilateral mastectomy. Eleven days post-surgery the patient was brought for suture removal,but it was observed stupor, moderate dehydration (estimated 10%), 36.7ºC rectal temperature, heart rate at 100 beats/min,respiratory rate at 60 breaths/min, 40 mg/dL blood glucose, icterus and abdominal distension with tympany at percussion(fluid wave test was negative). Anamnesis revealed the possible use of meloxicam for 10 days. The first suspicion wassepsis, with enteric gas secondary to infection. Due to no classical signs of peritoneum effusion and possible severe entericdistension, abdominocentesis was not immediate performed. Complete blood count and serum biochemistry revealed amarked band leukocytosis associated with renal injury, supporting the first sepsis suspicion. Abdominal radiography revealedradiodensity of diffuse aspect at ventral topography but no evidence of marked...(AU)

Comparative analysis between patients undergoing gastric bypass and sleeve gastroplasty in a private hospital in Sao Luis-MA

Purpose: To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. Methods: The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. Results: Most patients were female (Bypass 56% and Sleeve 67.4%) and aged between 30 and 39 years old (Bypass 32% and Sleeve 55.8%). Information (Bypass 92% and Sleeve 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass 92% and Sleeve 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. Conclusions: Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.(AU)

Unexpectedly prolonged fasting and its consequences on elderly patients undergoing spinal anesthetics. A prospective observational study

Purpose:To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia.Methods:This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)].Results:Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4 12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes were significantly more frequent in PM group and body temperatures were significantly higher in AM group patients.Conclusion:Our study has shown that fasting times in our population is far longer than recommended and fasting prolonged>15 hours is related to a transiently increased cardiac stress and mild hypothermia.(AU)

Eletrocardiografia em cadelas submetidas à mastectomia unilateral total / Electrocardiogram in bitches submitted to unilateral total mastectomy

Background: The frequency of oncological diseases in companion animals has increased in recent years, mainly due tothe longer longevity of dogs. The neoplasms are not only open by the presence of the tumor and its location, but also byparaneoplastic syndromes, which are disorders that occur due to the production of substances by the tumor that cause.In addition to causing local changes and damages, oncological diseases may also result in injuries at distant sites, suchas paraneoplastic syndromes, which, if untreated, may result in death of animals. The present study aimed to investigatewhether female dogs with mammary tumors demonstrate electrocardiographic changes, and if so, to investigate whetherthese cease after removal of the tumor, and to relate the type of tumor with the occurrence of arrhythmias.Materials, Methods & Results: Eighteen female dogs, aged between 4 and 14 years, underwent electrocardiogram 24 hprior to undergoing a total unilateral mastectomy. After removal of the tumor, electrocardiograms were again performed 24(M24), 48 (M48), and 72 (M72), as well as 14 days (M14d) after surgery. Histological analysis of the neoplasms showedthat 55% of the tumors were benign, with predominance of adenoma (38%), and 45% were malignant, with predominanceof adenocarcinoma (22%). The following rhythms and arrhythmias were observed: normal sinus rhythm (37.2%), sinusarrhythmia (62.8%), wandering pacemaker (26%), 1st degree atrioventricular block (AVB; 5%), premature ventricularcomplex (PVC; 10%), and T-wave > 25% of R-wave (25%); more than one change could occur simultaneously. Out of theevaluated electrocardiographic parameters, a significant difference was observed in the QT interval between the followingtimepoints: M24 (204 ± 18), M48 (204 ± 22), and M72 (203 ± 23), as well as Mbasal (192 ± 15) and M14d (178 ± 43).Discussion: Regarding the observed rhythms, arrhythmias, and changes, respiratory sinus arrhythmia was the normal predominant... (AU)

Eletrocardiografia em cadelas submetidas à mastectomia unilateral total / Electrocardiogram in bitches submitted to unilateral total mastectomy

Background: The frequency of oncological diseases in companion animals has increased in recent years, mainly due tothe longer longevity of dogs. The neoplasms are not only open by the presence of the tumor and its location, but also byparaneoplastic syndromes, which are disorders that occur due to the production of substances by the tumor that cause.In addition to causing local changes and damages, oncological diseases may also result in injuries at distant sites, suchas paraneoplastic syndromes, which, if untreated, may result in death of animals. The present study aimed to investigatewhether female dogs with mammary tumors demonstrate electrocardiographic changes, and if so, to investigate whetherthese cease after removal of the tumor, and to relate the type of tumor with the occurrence of arrhythmias.Materials, Methods & Results: Eighteen female dogs, aged between 4 and 14 years, underwent electrocardiogram 24 hprior to undergoing a total unilateral mastectomy. After removal of the tumor, electrocardiograms were again performed 24(M24), 48 (M48), and 72 (M72), as well as 14 days (M14d) after surgery. Histological analysis of the neoplasms showedthat 55% of the tumors were benign, with predominance of adenoma (38%), and 45% were malignant, with predominanceof adenocarcinoma (22%). The following rhythms and arrhythmias were observed: normal sinus rhythm (37.2%), sinusarrhythmia (62.8%), wandering pacemaker (26%), 1st degree atrioventricular block (AVB; 5%), premature ventricularcomplex (PVC; 10%), and T-wave > 25% of R-wave (25%); more than one change could occur simultaneously. Out of theevaluated electrocardiographic parameters, a significant difference was observed in the QT interval between the followingtimepoints: M24 (204 ± 18), M48 (204 ± 22), and M72 (203 ± 23), as well as Mbasal (192 ± 15) and M14d (178 ± 43).Discussion: Regarding the observed rhythms, arrhythmias, and changes, respiratory sinus arrhythmia was the normal predominant...

Evisceração de lobo pulmonar direito após ferida por mordedura de cão / Evisceration of right pulmonary lobe after dog bite injury

Background: Pneumothorax is the presence of free air in the pleural cavity. Air in the thoracic cavity causes respiratorydiscomfort, severe hypoxemia, decreased venous return, and haemodynamic instability, and it may lead to death. Pneumothorax can be triggered by wounds from firearm projectiles, bladed weapons, or sharp or piercing objects, as well asbites and barotrauma. The diagnosis of open pneumothorax is based on anamnesis, in combination with clinical signsobserved on physical examination. The objective of this report is to discuss the relevance of clinical-surgical managementto adequately treat evisceration of the pulmonary lobe caused by a bite in the thoracic region of a female dog.Case: This report discusses a 15-year-old female canine weighing approximately six kg with a history of wounds in thethoracic region and respiratory difficulty after being bitten by another dog. On clinical examination, she presented with abruised wound in the right thoracic region and another in the scapular region. The examination revealed evisceration of theright cranial lung lobe, which exhibited atelectasis. The animal was immediately referred to the Surgical Center. Anaesthesia was induced using propofol 2.0 mg/kg combined with ketamine hydrochloride 2.0 mg/kg, followed by intubation andmaintenance under inhalation anaesthesia with isoflurane and 100% oxygen and fentanyl 2.5 mcg/kg every 15 min. Thetemperature, non-invasive blood pressure, cardiac and respiratory frequency, pulse oximetry, capnography and electrocardiogram were monitored. Tricotomy and antisepsis of the wound were performed with 0.9% NaCl and 2% chlorhexidine.The eviscerated pulmonary lobe was immersed in saline solution, and positive pressure insufflation was performed in theinhalation circuit to verify the presence of perforation of the eviscerated lung, which was not observed. The lobe was repositioned in the correct anatomical location in the thoracic region...

Evisceração de lobo pulmonar direito após ferida por mordedura de cão / Evisceration of right pulmonary lobe after dog bite injury

Background: Pneumothorax is the presence of free air in the pleural cavity. Air in the thoracic cavity causes respiratorydiscomfort, severe hypoxemia, decreased venous return, and haemodynamic instability, and it may lead to death. Pneumothorax can be triggered by wounds from firearm projectiles, bladed weapons, or sharp or piercing objects, as well asbites and barotrauma. The diagnosis of open pneumothorax is based on anamnesis, in combination with clinical signsobserved on physical examination. The objective of this report is to discuss the relevance of clinical-surgical managementto adequately treat evisceration of the pulmonary lobe caused by a bite in the thoracic region of a female dog.Case: This report discusses a 15-year-old female canine weighing approximately six kg with a history of wounds in thethoracic region and respiratory difficulty after being bitten by another dog. On clinical examination, she presented with abruised wound in the right thoracic region and another in the scapular region. The examination revealed evisceration of theright cranial lung lobe, which exhibited atelectasis. The animal was immediately referred to the Surgical Center. Anaesthesia was induced using propofol 2.0 mg/kg combined with ketamine hydrochloride 2.0 mg/kg, followed by intubation andmaintenance under inhalation anaesthesia with isoflurane and 100% oxygen and fentanyl 2.5 mcg/kg every 15 min. Thetemperature, non-invasive blood pressure, cardiac and respiratory frequency, pulse oximetry, capnography and electrocardiogram were monitored. Tricotomy and antisepsis of the wound were performed with 0.9% NaCl and 2% chlorhexidine.The eviscerated pulmonary lobe was immersed in saline solution, and positive pressure insufflation was performed in theinhalation circuit to verify the presence of perforation of the eviscerated lung, which was not observed. The lobe was repositioned in the correct anatomical location in the thoracic region...(AU)