Mastectomia a campo em ruminantes - aspectos cirúrgicos e clínico-patológicos / Field mastectomy in ruminants - surgical and clinicopathological aspects

Background: We report the case of 3 cows, 1 ewe, and 1 doe, with chronic mastitis and which underwent a mastectomy. All animals had a history of mastitis, edema with purulent secretion in the udder region, areas of abscess formation, fibrosis, hypogalactia, and agalactia. The animals had already been treated with systemic antibiotic therapy and anti-inflammatory drugs without response. The objective of this work is to describe the surgical and clinicopathological aspects of performing a radical mastectomy in the field in 3 cows and 1 ewe, and a partial mastectomy in a doe, with both procedures performed successfully and considered efficient to maintain the survival of the affected animals, in addition to being economically viable. Cases: In all animals reported in the study, a general and a specific clinical examination were performed, where on palpation of the udder were observed an increase in the region of the mammary apparatus, fluid fluctuation, areas of fibrosis with increased stiffness, and loss of udder functionality. In the case of the doe, there was a functional teat, which was preserved during the surgical procedure. Radical mastectomy was performed in 3 cows and 1 ewe, and the doe underwent a partial mastectomy, with preservation of the functional teat. All animals have fasted for food and water for 48 h. In cows, the anesthetic protocol consisted of 2% xylazine hydrochloride [0.15 mg/kg, intramuscularly (IM)], followed by an epidural block in the lumbosacral region with 2% lidocaine hydrochloride [10 mL]. The midazolam hydrochloride [0.1 mg/kg, intravenously (IV)] and 2% xylazine hydrochloride [0.05 mg/kg, IM] were administered to the ewe and the doe, also associated with lumbosacral epidural anesthesia with 2% lidocaine hydrochloride [5 mL]. The animals were positioned in the right lateral decubitus position and the entire abdominal and udder region were shaved and sanitized for the surgical procedures of radical mastectomy and partial mastectomy, with the use of degerming and topical povidone-iodine. The postoperative period consisted of penicillin-based antibiotic therapy associated with streptomycin [24,000 IU/kg, IM, 10 consecutive days] and flunixin meglumine [2 mg/kg, IM, 3 consecutive days] in cows; enrofloxacin [2.5 mg/kg, IM, 7 consecutive days] and flunixin meglumine [0.5 mg/kg, IM, 5 consecutive days] in the ewe; oxytetracycline [10 mg/kg, IM, 5 applications on alternate days] and flunixin meglumine [0.5 mg/kg, IM, 3 consecutive days] in the doe. In all animals, the cleaning of the surgical wound was performed daily with 10% topical Povidone-iodine and Permethrin ointment, for 14 days, when the stitches were removed. Discussion: The choice of the surgical procedure resulted in improvement of the clinical conditions and increased survival of all animals, and in the case of the doe, partial mastectomy contributed to the preservation of the functional teat, preserving its productive capacity. All anesthetic protocols used and the anatomical positioning of the animals were satisfactory for performing the procedures. Although they are techniques described in the literature with great blood loss, especially in cows, blood transfusion was not required in any of the animals. The stitches were removed 14 days after the surgical procedures, and the surgical wound was completely healed.

Doxorubicin nephrotoxicity in cats (Felis catus) with malignant mammary neoplasms / Nefrotoxicidade da doxorrubicina em gatas (Felis catus) com neoplasias mamárias malignas

The aim of the study was to investigate the nephrotoxicity of doxorubicin in cats with malignant neoplasms of the mammary gland. All selected cats did not present comorbidities such as nephropathies and/or cardiomyopathies, confirmed by physical and laboratory tests, underwent radical mastectomy associated with regional lymph node excision and were treated with a protocol based on doxorubicin. Renal markers of urea, creatinine, symmetrical dimethylarginine were evaluated during all the treatment, and two months after the end. Abdominal ultrasound, urinalysis and biochemical analysis of protein, urinary creatinine and urinary GGT were performed in the beginning and two months after the end of the treatment, to evaluate possible renal alterations. Six cats did not present renal alterations in any exams performed during the study. Two cats presented azotemia during this study, and one of them stopped the treatment early, because of the intense azotemia. Clinical imaging and laboratory monitoring of patients throughout the treatment is essential, including the measurement of analytes that detect kidney changes early. Thus, it is emphasized that doxorubicin is a safe drug for use in non-nephropathic cats.

O objetivo do estudo foi investigar a nefrotoxicidade da doxorrubicina em gatas com neoplasias malignas da glândula mamária. Todas as gatas selecionadas não apresentaram comorbidades como nefropatias e/ou cardiomiopatias, comprovadas por exames físicos e laboratoriais, foram submetidas à mastectomia radical associada à exérese de linfonodos regionais e tratadas com protocolo baseado em doxorrubicina. Os marcadores renais ureia, creatinina, dimetilarginina simétrica foram avaliados durante todo o tratamento e dois meses após o término. Ultrassonografia abdominal, urinálise e análise bioquímica de proteínas, creatinina urinária e GGT urinária foram realizadas no início e dois meses após o término do tratamento, para avaliar possíveis alterações renais. Seis gatas não apresentaram alterações renais em nenhum dos exames realizados durante o estudo. Duas gatas apresentaram azotemia durante este estudo, e uma delas interrompeu o tratamento precocemente, devido à intensa azotemia. A individualidade de cada paciente deve ser sempre considerada, pois são muitas as variáveis. O monitoramento clínico, com exames complementares, tais como bioquímicos séricos e de imagem dos pacientes durante todo o tratamento, é essencial, especialmente a mensuração de analitos que detectam alterações renais precocemente. Diante disso, ressalta-se que a doxorrubicina é um medicamento seguro para utilização em gatas não nefropatas.

Hiperplasia fibroepitelial mamária em um gato macho: relato de caso / Mammary fibroepithelial hyperplasia in a male cat: case report

As neoplasias mamárias representam a terceira neoplasia mais comum em gatas, enquanto nos machos a incidência é rara. Esse trabalho relata o caso de um gato macho, não castrado, atendido no Hospital Veterinário da Universidade Estadual do Ceará, com uma neoformação mamária. O diagnóstico inicial, obtido por meio de punção aspirativa por agulha fina, sugeriu a presença de carcinoma mamário. Exames de imagem como a radiografia torácica e a ultrassonografia abdominal não evidenciaram a presença de metástase no parênquima pulmonar e nos órgãos abdominais, respectivamente. O tratamento instituído foi a remoção cirúrgica da neoformação, pela técnica de mastectomia parcial bilateral. O exame histopatológico da massa evidenciou uma hiperplasia fibroepitelial. Diante disso, conclui-se que, apesar de raras, as neoformações mamárias em gatos do sexo masculino podem ocorrer, devendo, dessa forma, compor parte da lista de diagnósticos diferenciais para aumentos de volume na região ventral desses animais.(AU)

Mammary neoplasms represent the third most common neoplasm in queens, while in tomcats the incidence is rare. This study reports the case of a tomcat, not neutered, treated at the Veterinary Hospital of the State University of Ceará, with a mammary neoformation. The initial diagnosis, obtained through aspiration cytology, suggested the presence of mammary carcinoma. Imaging tests such as thoracic radiography and abdominal ultrasound, did not show the presence of metastasis in the lung parenchyma and abdominal organs, respectively. The chosen treatment was the surgical removal of the neoformation, using the bilateral partial mastectomy technique. Histopathological examination of the mass showed a mammary fibroepithelial hyperplasia. Therefore, it is concluded that, although rare, mammary neoformations in male cats can occur, thus, it should be part of the list of differential diagnoses for increases in volume in the ventral region of these animals.(AU)

Bloqueio do plano serrátil associado ao transverso do abdômen na mastectomia total unilateral em cadela / Blocking of the Serratus Plan associated with the Transverse Abdominis in a total unilateral mastectomy in bitch

A anestesia locorregional, em pequenos animais, está em crescente utilização como forma de promover analgesia para procedimentos cirúrgicos, através do bloqueio reversível da condução do impulso nervoso. Assim, o objetivo deste trabalho foi relatar o uso do bloqueio locorregional do plano serrátil (SP block) associado ao bloqueio locorregional do plano transverso do abdômen (TAP block) em uma cadela da raça Lhasa Apso. A associação de tais bloqueios visou à insensibilização da musculatura na região da cadeia mamária para um procedimento cirúrgico de mastectomia unilateral total. A cadela castrada, foi encaminhada para a mastectomia unilateral total direita, apresentando nódulos nas glândulas mamárias torácica caudal e inguinal. Os bloqueios foram realizados com a paciente em decúbito dorsal, utilizando-se bupivacaína a 0,25%. Em seguida, a paciente foi liberada para o procedimento, o qual foi monitorado. Os parâmetros de eletrocardiografia, frequência respiratória, frequência cardíaca, oximetria de pulso, pressão arterial oscilométrica (composta por pressão arterial sistólica, pressão arterial diastólica e pressão arterial média), capnografia e temperatura esofágica foram anotados a cada dez minutos em uma ficha de avaliação anestésica. Durante a recuperação pós-operatória, foi realizada a avaliação de dor aguda por meio da escala de dor da Universidade de Melbourne. Os resultados demonstram que a associação do TAP block com o SP block foi eficiente em promover analgesia para uma mastectomia total unilateral de cadela.

Locoregional anesthesia in small animals is increasingly used as a way to promote analgesia for surgical procedures, through a reversible block of nerve impulse conduction. Thus, the objective of this study was to report the use of locoregional block of the serratus plane (SP block) associated with the locoregional block of the transverse abdominis plane (TAP block) in a bitch of the Lhasa Apso breed. The association of such blocks aimed to desensitize the musculature in the region of the mammary chain for a surgical procedure of total unilateral mastectomy. The castrated bitch was referred for total right unilateral mastectomy, showing nodules in the caudal thoracic and inguinal mammary glands. The blocks were performed with the patient in dorsal decubitus, using 0.25% bupivacaine. Then, the patient was released for the procedure, which was monitored. The parameters of electrocardiography, respiratory rate, heart rate, pulse oximetry, oscillometric blood pressure (composed of systolic blood pressure, diastolic blood pressure, and mean blood pressure), capnography, and esophageal temperature were recorded every 10 minutes in an anesthetic evaluation form. During the postoperative recovery, acute pain was evaluated using the pain scale of the University of Melbourne. The results demonstrate that the association of TAP block with SP block was efficient in promoting analgesia for a total unilateral mastectomy in a bitch.

Locoregional anesthesia due to tumescence in bilateral total mastectomy of goats

Background: Mastitis is an inflammation of the mammary gland or udder, regardless of its origin, severity, or evolution. Bilateral total mastectomy is indicated in cases of chronic suppurative mastitis, gangrenous mastitis, udder neoplasm or hyperplasia. For mastectomy, the supine position is recommended and, as it is a long-term procedure, general anesthesia was chosen together with the tumescence technique with the objective of transanesthetic and postoperative analgesia. The present report aims to report the general anesthesia protocol used for 2 goats submitted to bilateral total mastectomy associated with a locoregional block by tumescence, a technique not described in the goat species. Cases: Two female goats, mixed breed, approximately 3 years old, were admitted to the Hospital Veterinário de Grandes Animais (HVGA) of the Universidade Federal Rural do Rio de Janeiro (UFRRJ), with a history of recurrent mastitis. There was an increase in udder volume and the presence of purulent secretion during milking. One of the animals had given birth about 20 days ago. Surgical treatment through bilateral total mastectomy was recommended for both animals, as they did not present a satisfactory response to antimicrobial therapy, excessive enlargement and functional loss of the mammary system. For the procedure, food fasting for 48 h and water fasting for 24 h was established. The anesthetic protocols used consisted of previous sedation with xylazine1 [Xilazin® - 0.05 mg/kg, IM] anesthetic induction with ketamine2 [Ketalex® - 10 mg/kg, IV] and midazolam3 [Dormire® - 0.1 mg/kg, IV]. Orotracheal intubation and connection to the anesthetic circuit were performed for maintenance through inhalation anesthesia with isoflurane4 (Forane®) and oxygen therapy. Then, in bottle of lactated ringer's solution5 [Linhamax® - 500 mL], lidocaine 2%6 without vasoconstrictor [Lidovet® - 40 mL] and adrenaline7 [Adren® - 25 mg/mL, 0.5 mL] were added, 10 mL/kg of the solution were injected into the subcutaneous tissue of the region of the mammary chains utilizing a Klein cannula after local antisepsis. After the administration of the tumescent solution, it was observed that the area involved is presented with the formation of a gel and there is minimal bleeding, compared to the conventional technique. The animals were monitored for the degree of analgesia, recording vital signs every 15 min at the end of the surgery, dipyrone9 [D-500® - 25 mg/kg, IV], morphine7 [Sulfato de Morfina® - 0.1 mg/kg, SC], and meloxicam10 [Maxican® 0.5 mg/kg, IM, 3 consecutive days] for postoperative analgesia. Additionally, tetanus serum1 [Vencosat® - 50,000 IU, single dose] and of oxytetracycline¹ [Oxitetraciclina LA® - 10 mg/kg, IM, 5 applications on alternate days)]. In the following 24 h, no signs of pain were observed on palpation of the surgical wound in the animals, but goat 1 was apathetic and inappetent, with improvement in the clinical picture only 48 h after surgery. Discussion: The choice of the surgical procedure resulted in an improvement in the clinical conditions of the animals and the anesthetic protocol using inhalation anesthesia and locoregional block (tumescence) proved to be efficient to perform in goats, contributing to transanesthetic and postoperative analgesia, being easily applied to ruminants that need surgical interventions in the region of mammary chains.

Effects of heated tumescence solution in bitches after unilateral mastectomy

Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy. Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Klein’s cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart...

Effects of heated tumescence solution in bitches after unilateral mastectomy

Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy. Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Kleins cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart...(AU)

Associação do bloqueio do plano transverso e serrátil em gata submetida à mastectomia / Association of transversus and serratus plane block in cat submitted to mastectomy

Os bloqueios locorregionais são considerados padrão-ouro para a analgesia perioperatória. Sendo assim, este trabalho apresenta o efeito da associação do bloqueio do plano transverso do abdome com o bloqueio do plano serrátil em um felino de 11 anos, fêmea, que foi submetido à mastectomia unilateral. Foi utilizada a metadona 0,3 mg/kg via intramuscular (IM) na medicação pré-anestésica e propofol dose-efeito via intravenosa (IV) para indução, enquanto a manutenção foi feita com isoflurano. O TAP Block e o SP-Block foram realizados unilateralmente utilizando a associação de bupivacaína 0,3mL/kg, em cada ponto, diluída a 0,25% com solução fisiológica. A frequência cardíaca (FC), a frequência respiratória (f), a pressão arterial não invasiva (Método Doppler), a temperatura esofágica (oC), a saturação de oxigênio (SpO2), a capnografia (EtCO2) e o eletrocardiograma foram monitorados continuamente e registrados a cada dez minutos. A paciente foi monitorada por cinco horas, após a extubação, quanto à dor, sendo utilizada, para isso, a Escala Multidimensional de Dor Aguda (UNESP-Botucatu). A recuperação anestésica da paciente foi rápida e sem complicações. Durante a avaliação de dor, o animal apresentou escore zero, não manifestando qualquer desconforto pós-operatório. A associação das técnicas foi eficaz no bloqueio anestésico das paredes torácica e abdominal, sugerindo a inclusão destas nos protocolos de analgesia multimodal para esse tipo de cirurgia.

Locoregional blocks are considered the gold standard for perioperative analgesia. Thus, this paper presents the effect of the association of transverse abdominal plane block with serratus plane block in an 11-year-old female feline submitted to unilateral mastectomy. Methadone 0.3 mg/kg via intramuscular (IM) was used as pre anesthetic medication and dose-effect propofol via intravenous (IV) was used for induction, while the maintenance was done with isofluorane. TAP Block and SP-Block were performed unilaterally using an association of Bupivacaine 0.3 ml/kg at each point, diluted to 0.25% with saline solution. Heart rate (HR), respiratory rate (f), non-invasive blood pressure (Doppler method), esophageal temperature (oC), oxygen saturation (SpO2), capnography (EtCO2), and electrocardiogram were monitored continuously and recorded every 10 minutes. The patient was monitored for pain during five hours after extubation using the Multidimensional Scale of UNESP-Botucatu. The anesthetic recovery of the patient was fast and without complications. During pain assessment, the animal presented a score of zero and did not present any postoperative discomfort. The association of techniques was effective in the anesthetic blockade of the thoracic and abdominal walls, suggesting their inclusion in multimodal analgesia protocols for this type of surgery.

Bloqueio do plano transverso do abdômen em coelha submetida à mastectomia e ovariohisterectomia / Blockade of the transverse plane of the abdomen in a rabbit submitted to mastectomy and ovariohysterectomy

Os bloqueios locorregionais vêm sendo cada vez mais estudados na medicina veterinária, principalmente em pets não-convencionais e animais silvestres. O bloqueio do plano transverso do abdômen (TAP block) é uma técnica de anestesia locorregional capaz de promover anestesia e analgesia em regiões da pele, musculatura e peritônio parietal, as quais fazem parte da estratégia de analgesia multimodal. O objetivo deste trabalho é relatar o bloqueio do plano transverso em um coelho doméstico de quatro anos de idade submetido à mastectomia regional e ovariohisterectomia. Foram realizados dois pontos bilateralmente de bloqueio do espaço TAP guiado por ultrassom com 2mg/kg de bupivacaína a 0,25%, padronizando um volume total injetado de 2,4mL. Foram utilizados dexmedetomidina (5É¥g/kg) e midazolam (0,5mg/kg) por via intramuscular como medicação pré-anestésica, indução com isoflurano na máscara de oxigênio 100% e manutenção por anestesia inalatória com isoflurano. Os parâmetros fisiológicos mantiveram-se estáveis, sem necessidade de resgate analgésico, com extubação rápida e despertar tranquilo. Desta forma, conclui-se que o TAP block foi eficaz na analgesia para mastectomia regional e ovariohisterectomia como protocolo multimodal, aumentando o índice de segurança, além de ser de fácil execução mesmo com transdutores de baixa frequência.

The locoregional blocks have been increasingly studied in veterinary medicine, especially in non-conventional pets and wild animals. The transverse abdominis plane block (TAP block) is a locoregional anesthesia technique capable of promoting anesthesia and analgesia in the skin, muscle, and parietal peritoneum regions, which are is part of the multimodal analgesia strategy. This study aims to report the transverse plane block in a four-year-old domestic rabbit submitted to regional mastectomy and ovariohysterectomy. Two ultrasound-guided TAP space blocks were performed bilaterally with 2mg/kg of bupivacaine 0.25%, standardizing a total injected volume of 2.4mL. Dexmedetomidine (5É¥g/kg) and midazolam (0.5mg/kg) were used intramuscularly as pre-anesthetic medication, induction with isoflurane in a 100% oxygen mask, and maintenance by inhalation anesthesia with isoflurane. Physiological parameters remained stable, with no need for analgesic rescue, rapid extubation, and peaceful awakening. Thus, it is concluded that the TAP block was effective in analgesia for regional mastectomy and ovariohysterectomy as a multimodal protocol, increasing the safety index. Moreover, it is easy to perform even with low-frequency transducers.

Bloqueio do plano transverso do abdômen guiado por ultrassom em felino submetido a mastectomia regional / Blocking of the abdomen transverse plan guided by ultrasound in feline submitted to regional mastectomy

Os bloqueios locorregionais vêm sendo cada vez mais utilizados na medicina veterinária. O bloqueio do plano transverso do abdômen (TAP Block) é uma técnica de anestesia locorregional, faz parte da estratégia de analgesia multimodal, capaz de promover anestesia e analgesia em regiões de pele, musculatura e peritônio parietal. O objetivo deste trabalho é relatar o bloqueio do plano transverso em um felino macho de dois anos de idade submetido a mastectomia regional. Foram feitos dois pontos de bloqueio do espaço TAP guiado por ultrassom, em cada lado do abdômen: um na parte caudal da região abdominal média, cranial a crista ilíaca, e o outro ponto, caudal a última costela, com 0,5mg/kg de bupivacaína a 0,25% em cada ponto, padronizando um volume injetado de 0,6mL. Foi utilizado acepromazina (0,05mg/kg), petidina (3mg/kg), cetamina (2mg/kg) e midazolam (0,3mg/kg) como medicação pré-anestésica, indução com propofol (3mg/kg) e manutenção por anestesia inalatória com isoflurano. Conclui-se que o TAP block foi eficaz para mastectomia regional abdominal, com alto índice de segurança e de fácil execução com treinamento adequado, mesmo com transdutores de baixa frequência.

Locoregional blocks have been increasingly used in veterinary medicine. Blocking the transverse plane of the abdomen (TAP Block) is a technique of locoregional anesthesia, it is part of the multimodal analgesia strategy, capable of promoting anesthesia and analgesia in regions of skin, musculature and parietal peritoneum. The aim of this study is to report the transverse plane block in a two-year-old male cat undergoing regional mastectomy. Two ultrasound-guided TAP space block points were made on each side of the abdomen: one in the caudal part of the middle abodminal region, cranial to the iliac crest, and the other point, caudal to the last rib, with 0.5mg/kg of 0.25% bupivacaine at each point, standardizing an injected volume of 0.6mL. Acepromazine (0.05mg/kg), pethidine (3mg/kg), ketamine (2mg/kg) and midazolam (0.3mg/kg) were used as pre-anesthetic medication, induction with propofol (3mg/kg) and maintenance by inhalation anesthesia with isoflurane. It is concluded that the TAP block was effective for regional abdominal mastectomy, with a high safety index and easy to perform with adequate training, even with less frequent transducers.

Uso do sulfato de magnésio (mgso4) na anestesia total intravenosa como adjuvante anestésico e analgésico em cadela submetida à mastectomia parcial bilateral – relato de caso / Use of magnesium sulfate (MgSO4) in total intravenous anesthesia as anesthetic and analgesic adjuvant in a dog submitted to bilateral partial mastectomy - Case report

A utilização do sulfato de magnésio (MgSO4) está crescendo gradativamente na Medicina Veterinária, principalmente na anestesiologia, pois é um fármaco que possui propriedades analgésicas e sedativas com potencial para neuro e cardioproteção. Apresenta um grande papel na anestesia e analgesia multimodal, principalmente para controle de dor no trans e pós-operatório, reduzindo a necessidade e a dose de outros fármacos analgésicos, sendo efetivo para o tratamento do controle de dor. Este relato descreve o caso de um cão, fêmea, da raça fox paulistinha, com onze anos de idade, que foi submetido à mastectomia parcial bilateral, tendo sido anestesiada com o emprego da técnica total intravenosa com o Propofol, associada à infusão contínua do sulfato de magnésio com o objetivo de avaliar a eficácia do mesmo em relação à analgesia no transoperatório e pós-operatório, redução na taxa de infusão do fármaco indutor e necessidade de resgate analgésico.

The use of magnesium sulfate (MgSO4) is gradually increasing in Veterinary Medicine, mainly in anesthesiology, as it is a drug that has analgesic and sedative properties with potential for neuro and cardioprotection. It plays a great role in anesthesia and multimodal analgesia, mainly for pain control in the trans and postoperative period, reducing the need and dose of other analgesic drugs, being effective for the treatment of pain control. This report describes the case of a female fox paulistinha dog, 11 years old, who underwent bilateral partial mastectomy where she was anesthetized using the Total Intravenous Technique with Propofol associated with the continuous infusion of magnesium sulphate with objective of evaluating the efficacy of the same in relation to analgesia in the intraoperative and postoperative period, reduction in the rate of infusion of the inducing drug and need for analgesic rescue.

Mammary fibroepithelial hyperplasia in a male cat

Background: Feline mammary hyperplasia (FMH) is a benign disease that commonly affects young females, once it iscaused by the exaggerated stimulation of endogenous or exogenous progestogen. FMH leads to acute edema and inflammation of the mammary glands and frequently evolve to ulcerations, secondary infections, and systemic clinical signs.Even though it is rare in male cats, progesterone therapy or an unknown endogenous source of hormone can cause thedisease. This report aims to describe a case of FMH in a male feline with no history of hormonal treatment and treatedwith radical surgical resection.Case: A 7-month-old intact male domestic shorthair cat was presented due to acute onset of generalized mammary tumorswhich had progressed for 18 days. Tumors size had 5 cm large in diameter, symmetric, bilateral, and affected all mammaryglands. The tissue was firm, hyperemic, and ulcerated. FMH was initially suspected but with a differential diagnosis formammary adenocarcinoma. Except for pain on tumor palpation, there was no other clinical abnormality. Survey thoracicradiographs and abdominal ultrasound did not find signs of metastasis or hermaphroditism. Fine-needle aspirate biopsy andfurther cytological examination were inconclusive. Surgical resection through a single-stage bilateral total mastectomy andreconstruction using a left flank fold flap was elected. There were no intraoperative complications and the cat recoveredwell, with good healing and no clinical signs 21 days after the surgery. Histological examination of the mammary glandsconfirmed the diagnosis of FMH due to the non-neoplastic characteristics and tissue’s benign biological behavior. Elevenmonths after diagnosis, the cat was asymptomatic.Discussion: The FMH frequently affects young females and is associated with gestational periods, the end of the estrouscycle, and, most commonly, hormonal therapy with synthetic progesterone. Male cats are rarely affected with or...

Mammary fibroepithelial hyperplasia in a male cat

Background: Feline mammary hyperplasia (FMH) is a benign disease that commonly affects young females, once it iscaused by the exaggerated stimulation of endogenous or exogenous progestogen. FMH leads to acute edema and inflammation of the mammary glands and frequently evolve to ulcerations, secondary infections, and systemic clinical signs.Even though it is rare in male cats, progesterone therapy or an unknown endogenous source of hormone can cause thedisease. This report aims to describe a case of FMH in a male feline with no history of hormonal treatment and treatedwith radical surgical resection.Case: A 7-month-old intact male domestic shorthair cat was presented due to acute onset of generalized mammary tumorswhich had progressed for 18 days. Tumors size had 5 cm large in diameter, symmetric, bilateral, and affected all mammaryglands. The tissue was firm, hyperemic, and ulcerated. FMH was initially suspected but with a differential diagnosis formammary adenocarcinoma. Except for pain on tumor palpation, there was no other clinical abnormality. Survey thoracicradiographs and abdominal ultrasound did not find signs of metastasis or hermaphroditism. Fine-needle aspirate biopsy andfurther cytological examination were inconclusive. Surgical resection through a single-stage bilateral total mastectomy andreconstruction using a left flank fold flap was elected. There were no intraoperative complications and the cat recoveredwell, with good healing and no clinical signs 21 days after the surgery. Histological examination of the mammary glandsconfirmed the diagnosis of FMH due to the non-neoplastic characteristics and tissues benign biological behavior. Elevenmonths after diagnosis, the cat was asymptomatic.Discussion: The FMH frequently affects young females and is associated with gestational periods, the end of the estrouscycle, and, most commonly, hormonal therapy with synthetic progesterone. Male cats are rarely affected with or...(AU)

Uso do sulfato de magnésio (mgso4) na anestesia total intravenosa como adjuvante anestésico e analgésico em cadela submetida à mastectomia parcial bilateral relato de caso / Use of magnesium sulfate (MgSO4) in total intravenous anesthesia as anesthetic and analgesic adjuvant in a dog submitted to bilateral partial mastectomy - Case report

A utilização do sulfato de magnésio (MgSO4) está crescendo gradativamente na Medicina Veterinária, principalmente na anestesiologia, pois é um fármaco que possui propriedades analgésicas e sedativas com potencial para neuro e cardioproteção. Apresenta um grande papel na anestesia e analgesia multimodal, principalmente para controle de dor no trans e pós-operatório, reduzindo a necessidade e a dose de outros fármacos analgésicos, sendo efetivo para o tratamento do controle de dor. Este relato descreve o caso de um cão, fêmea, da raça fox paulistinha, com onze anos de idade, que foi submetido à mastectomia parcial bilateral, tendo sido anestesiada com o emprego da técnica total intravenosa com o Propofol, associada à infusão contínua do sulfato de magnésio com o objetivo de avaliar a eficácia do mesmo em relação à analgesia no transoperatório e pós-operatório, redução na taxa de infusão do fármaco indutor e necessidade de resgate analgésico.(AU)

The use of magnesium sulfate (MgSO4) is gradually increasing in Veterinary Medicine, mainly in anesthesiology, as it is a drug that has analgesic and sedative properties with potential for neuro and cardioprotection. It plays a great role in anesthesia and multimodal analgesia, mainly for pain control in the trans and postoperative period, reducing the need and dose of other analgesic drugs, being effective for the treatment of pain control. This report describes the case of a female fox paulistinha dog, 11 years old, who underwent bilateral partial mastectomy where she was anesthetized using the Total Intravenous Technique with Propofol associated with the continuous infusion of magnesium sulphate with objective of evaluating the efficacy of the same in relation to analgesia in the intraoperative and postoperative period, reduction in the rate of infusion of the inducing drug and need for analgesic rescue.(AU)

Relationship between PD-L1 expression and tumor-infiltrating lymphocytes in canine mammary tumor

Background: Studies pointed out that the tumor-infiltrating lymphocytes (TILs) have considerable importance in caninemammary tumor (CMT). On the other hand, cancer cells sometimes find ways to use immune checkpoint proteins as ashield to avoid being identified and attacked by the immune system as programmed death 1 ligand 1 (PD-L1). In this study,it was investigated the relationship between PD-L1 expression, stromal tumor-infiltrating lymphocytes (TILs) in caninemammary tumor (CMT), and the association with clinical and pathological characteristics of the tumors.Materials, Methods & Results: PD-L1 expression and TILs were assessed in 23 female dogs with CMT. The tumors weregrouped into simple carcinoma (CA, n = 8) and complex carcinoma (CC, n = 15). Stromal TILs were assessed using twothresholds as TILs-Low representing < 50% of infiltrate within stromal area and TILs-High representing ≥ 50% of stromalarea. Clinicopathological data of CMT was characterized according to key parameters, as well as survival rates. TILs evaluation within tumor stroma revealed that 65.2% (n = 15) of tumors had TILs-Low. PD-L1 expression and stromal TILs weresignificantly associated (P = 0.009). PD-L1 expression was observed in 39% (n = 9) of all tumors of which 17.4% (n = 4)were from CA group and 21.7% (n = 5) were from CC group. PD-L1 expression within TILs was observed in 39% (n =9) of the tumors. PD-L1 in malignant epithelium was present in all lymph node metastasis (n = 5). PD-L1 was associatedwith involvement of regional lymph nodes (P = 0.034). Survival curves demonstrated TILs-Low had higher (P = 0.010)overall survival (OS) compared with TILs-High, and PD-L1+ and PD-L1– (P = 0.06) did not differed. The clinicopathological variables significantly correlated with OS by univariate analysis were the histological grade (P = 0.009), lymphnode involvement (P = 0.004), stromal...

Relationship between PD-L1 expression and tumor-infiltrating lymphocytes in canine mammary tumor

Background: Studies pointed out that the tumor-infiltrating lymphocytes (TILs) have considerable importance in caninemammary tumor (CMT). On the other hand, cancer cells sometimes find ways to use immune checkpoint proteins as ashield to avoid being identified and attacked by the immune system as programmed death 1 ligand 1 (PD-L1). In this study,it was investigated the relationship between PD-L1 expression, stromal tumor-infiltrating lymphocytes (TILs) in caninemammary tumor (CMT), and the association with clinical and pathological characteristics of the tumors.Materials, Methods & Results: PD-L1 expression and TILs were assessed in 23 female dogs with CMT. The tumors weregrouped into simple carcinoma (CA, n = 8) and complex carcinoma (CC, n = 15). Stromal TILs were assessed using twothresholds as TILs-Low representing < 50% of infiltrate within stromal area and TILs-High representing ≥ 50% of stromalarea. Clinicopathological data of CMT was characterized according to key parameters, as well as survival rates. TILs evaluation within tumor stroma revealed that 65.2% (n = 15) of tumors had TILs-Low. PD-L1 expression and stromal TILs weresignificantly associated (P = 0.009). PD-L1 expression was observed in 39% (n = 9) of all tumors of which 17.4% (n = 4)were from CA group and 21.7% (n = 5) were from CC group. PD-L1 expression within TILs was observed in 39% (n =9) of the tumors. PD-L1 in malignant epithelium was present in all lymph node metastasis (n = 5). PD-L1 was associatedwith involvement of regional lymph nodes (P = 0.034). Survival curves demonstrated TILs-Low had higher (P = 0.010)overall survival (OS) compared with TILs-High, and PD-L1+ and PD-L1(P = 0.06) did not differed. The clinicopathological variables significantly correlated with OS by univariate analysis were the histological grade (P = 0.009), lymphnode involvement (P = 0.004), stromal...(AU)

Severe mammary fibroepithelial hyperplasia due to single injection of medroxyprogesterone acetate in two male cats / Hiperplasia fibroadenomatosa mamária felina secundária à aplicação única de acetato de medroxiprogesterona em dois felinos machos

Thirty and forty days after a 50 mg medroxyprogesterone acetate injection, respectively, two mixed-breed, 7 and 8-month-old entire male cats presented diffuse enlargement of thoracic and abdominal mammary glands, with ulceration, abscessation and necrosis. One patient was treated with 10 mg/kg aglepristone, antibiotic therapy, analgesic and non-steroidal anti-inflammatory compound; however a worse enlargement of mammary glands, necrosis and clinical condition was noted two days after antiprogestin injection. The second patient was submitted to surgical procedure without previous medical treatment. A partial bilateral mastectomy and conventional orchiectomy were performed, and both patients presented no clinical abnormalities 10 days after surgical treatment. In the male cat, the interruption of progesterone associated mammary fibroepithelial hyperplasia cannot be based in gonadectomy, being antiprogestin treatment the primary approach. Mastectomy can be a treatment option in selected cases, such as the two cases presented here, in case of antiprogestin treatment failure or in case of extensive ulceration, necrosis and risk of sepsis.(AU)

Trinta e quarenta dias após aplicação de acetato de medroxiprogesterona, dois gatos SRD machos não castrados, de sete e oito meses respectivamente, apresentaram aumento difuso de volume em glândulas mamárias torácicas e abdominais, com ulceração, abscedação e necrose. Um paciente foi tratado com 10 mg/kg de aglepristone, terapia antimicrobiana, analgésicos e anti-inflamatório não-esteroidal. Entretanto, apresentou piora dos sinais clínicos, da abscedação e necrose dois dias após a aplicação. O outro paciente foi submetido a procedimento cirúrgico sem tratamento clínico prévio. Mastectomia parcial bilateral e orquiectomia convencional foram realizadas e, ambos os pacientes se apresentaram sem alterações clínicas e receberam alta após 10 dias do procedimento cirúrgico. No felino macho, a interrupção da ação da progesterona associada à ocorrência de hiperplasia fibroadenomatosa mamária, não pode ser obtida por meio de gonadectomia, portanto, o tratamento de eleição deve ser realizado com utilização de antiprogestágeno. Em alguns casos, mastectomia parcial ou total é recomendada quando o tratamento clínico com antiprogestágeno falha ou, em casos de sepse, ulceração extensa e necrose, como nos pacientes deste relato.(AU)

Influência do tramadol associado à levobupicavaína epidural sobre a taxa de propofol e variáveis fisiológicas, em cadelas submetidas à mastectomia e à ovário-histerectomia / [Influence of tramadol combined with epidural levobupicavaine, on the propofol infusion rate and physiological variables, in female dogs undergoing mastectomy and ovariohysterectomy]

Objetivou-se avaliar os efeitos fisiológicos e sobre o consumo do propofol, relativos à anestesia epidural com levobupivacaína isolada ou associada a diferentes doses de tramadol. Para tal, 18 cadelas foram pré-tratadas com acepromazina, utilizando-se propofol para indução e manutenção anestésicas. Conforme o protocolo epidural instituído, formaram-se três grupos (n=6) tratados com levobupivacaína isolada (1,5mg/kg) (GL) ou acrescida de 2mg/kg (GLT2) ou 4mg/kg (GLT4) de tramadol, respectivamente. As fêmeas foram submetidas à mastectomia e à ovário-histerectomia (OH), registrando-se as variáveis fisiológicas nos períodos pré (TB e T0) e transanestésicos (T10 a T70), bem como a taxa mínima de propofol necessária. Houve redução da FC para o GL e o GLT4 em relação ao GLT2 (T30 a T70), detectando-se, no GL, redução da PAS e da PAD em relação ao TB. Maiores taxas de infusão do propofol foram necessárias para o GL (0,70±0,12mg/kg/min) em relação ao GLT2 (0,50±0,19mg/kg/min) e ao GLT4 (0,50±0,19mg/kg/min). Conclui-se que o tramadol potencializou o propofol, ao ofertar analgesia, independentemente da dose administrada. Todos os protocolos testados foram seguros e eficazes em cadelas submetidas à mastectomia e à OH.(AU)

The aim of this study was to evaluate the physiological and on propofol-sparing effects related to epidural anesthesia with levobupivacaine alone or combined with different doses of tramadol. For this purpose, 18 female dogs were pretreated with acepromazine, using propofol for induction and maintenance of anesthesia. Based on a previously established epidural (L7-S1) protocol, three groups (n=6) were treated with either levobupivacaine alone (1.5mg.k-1) (GL) or in association with to 2mg.kg-1 (GLT2) or 4mg.kg-1 (GLT4) of tramadol, respectively. These dogs were all undergoing mastectomy and ovariohysterectomy (OH). The physiological data were registered in the pre (TB and T0) and trans-anesthetic periods (T10 - T70), as well as the consumption of propofol. There was a reduction in the HR for GL and GLT4 in relation to GLT2 (T30 - T70) and reductions in SAP and DAP in relation to TB in the GL group. Higher continuous infusion rate of propofol were required for GL (0.70±0.12mg.kg-1.min-1) relative to GLT2 (0.50±0.19mg.kg-1.min-1) and GLT4 (0.50±0.19mg.kg-1.min-1). It was concluded that tramadol potentiated propofol, offering analgesia independently of its administered dose. All protocols tested were safe and effective in female dogs undergoing mastectomy and OH.(AU)

Postoperative analgesia time in dogs submitted to mastectomy and anesthetized with tumescent solutions of lidocaine or ropivacaine

Background: Mastectomy, a procedure with high pain stimulation, is the treatment of choice for bitches with breast cancer. Tumescent anaesthesia is widely used for transoperative and postoperative analgesia in bitches submitted to mastectomy, because facilitates tissue divulsion, also contributing significantly for the rapid recovery of patients. Although, there is no consensus as to which local anesthetic to use and at what concentration it should be used. Herein was investigated which local anesthetics, lidocaine or ropivacaine, when used in tumescent solutions, could provide a more lasting analgesic effect in the postoperative period in bitches submitted to radical unilateral mastectomy. Materials, Methods & Results: Sixteen bitches were sedated with chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) followed by anesthesia with propofol and isofluorane. Then, bitches were randomly assigned to two groups (n= 8 each): LG group, infused with 15 mL/kg of tumescence solution containing 0.1% lidocaine; and RG group, infused with 15 mL/kg of tumescence solution with 0.1% ropivacaine. The study was conducted in a double-blind fashion. Control group did not include, because the patients would be submitted to severe or unbearable pain, according to the short-form of the Glasgow pain Scale (CMPS-SF). The heart (HR) and respiratory (ƒ) rates, and systolic blood pressure (SBP) were measured in the pre-operative period and immediately after extubation (Mextub) and at 0.5 h, 1 h, 2 h, 4 h, 8 h, and 12 h after the extubation. Analgesic efficacy was assessed using the CMPS-SF and von Frey filaments. Both groups showed higher means for HR at 0.5 h (167 ± 7 in LG; 170 ± 7 in RG) than at 4 h (117 ± 7 in LG; 120 ± 7 in RG). CMPS-SF revealed higher medians (P = 0.038) at the Mextub and 12 h time points for the LG [5 (3-6) and 1 (0-2)] than for the RG [5 (2-5) and 0 (0-1)]. Discussion: Pain was excluded as a possible explanation...

Tumescent anesthesia or epidural anesthesia combined with intercostal block in bitches submitted to mastectomy / Anestesia local tumescente ou anestesia epidural associada ao bloqueio intercostal em cadelas submetidas à mastectomia

The present study aimed to evaluate the use of tumescent local anesthesia or epidural anesthesia associated with an intercostal nerve block in bitches submitted to mastectomy. Fourteen bitches from the clinical routine of the Veterinary Hospital of the Federal University of Pelotas were premedicated with acepromazine (0.03 mg/kg) and morphine (0.3 mg/kg) intramuscularly, then induced with propofol (2 to 6 mg/kg/IV) and maintained with 1,4V% isoflurane (calibrated vaporizer). The patients were randomly allocated into: GALT Group (n=7), which received tumescent local anesthesia (0.16%) at the dose of 15 mL/kg, and the GEBI Group (n=7) which received epidural anesthesia with lidocaine (5 mg/kg) and morphine (0.1 mg/kg) associated with an intercostal nerve block from the 6th to 12th intercostal space with lidocaine (2 mg/kg). An increase higher than 10% in heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were considered as possible signs of nociception, to which fentanyl was administered intravenously as rescue analgesia. Postoperative analgesia was evaluated by means of the modified Glasgow scale at 30, 60, 120, 240 and 360 minutes. There were no differences in physiological parameters (P>0.05) in the transoperative period intra-group and inter-group the groups. The GEBI Group required more frequent transoperative rescue analgesia (9) in comparison to the GALT Group (5), but with no statistical difference. During the postoperative period, there was no need for rescue analgesia in either group. Results suggest that epidural anesthesia associated with intercostal nerve block can be used as an alternative technique in patients with restrictions against the use of local tumescent anesthesia.

O presente estudo objetivou avaliar o uso da anestesia local tumescente ou da anestesia epidural associada ao bloqueio intercostal em cadelas submetidas à mastectomia. Foram utilizadas 14 cadelas, provenientes da rotina do Hospital de Clínicas Veterinária da Universidade Federal de Pelotas, pré-medicadas com acepromazina (0,03 mg/kg) e morfina (0,3 mg/kg) intramuscular, induzidas com propofol (2 a 6 mg/Kg/IV) e mantidas com isofluorano à 1,4 V% (vaporizador calibrado). Após essa etapa, foram alocadas aleatoriamente em grupo GALT (n=7), que recebeu a anestesia local tumescente 0,16% na dose de 15 mL/Kg e em grupo GEBI (n=7), que recebeu como tratamento a anestesia epidural com lidocaína (5 mg/kg) e morfina (0,1 mg/kg) associada ao bloqueio intercostal, do 6º ao 12º espaço intercostal, com lidocaína (2mg/kg). Os parâmetros avaliados para sinais de nocicepção transcirúrgica e realização de resgates analgésicos com fentanil foram: frequência cardíaca, frequência respiratória, pressão arterial sistólica, pressão arterial diastólica e pressão arterial média. No pós-operatório avaliou-se a analgesia pela escala de Glasgow Modificada aos 30, 60, 120, 240 e 360 minutos. Não houve diferenças entre os parâmetros clínicos (p > 0,05) no período transoperatório entre e dentro dos grupos. O GEBI apresentou maior quantidade de resgates analgésicos transoperatórios (9) em relação a GALT (5), porém sem diferenças estatísticas. No pós-operatório, nenhum animal de ambos os grupos atingiu pontuação máxima para resgate analgésico. Pode-se concluir que a anestesia epidural associada ao bloqueio intercostal é uma técnica alternativa para casos em que se tenham limitações para utilização da anestesia local tumescente.