A oxigenoterapia hiperbárica veterinária integrada ao tratamento da necrose tecidual e osteomielite em cão: relato de caso / Veterinary hyperbaric oxygen therapy integrated to the treatment of tissue necrosis and osteomyelitis in a dog: case report

Na rotina veterinária, as lesões nas extremidades dos membros são constantes e representam um desafio especial pelas características anatômicas, susceptibilidade de exposição óssea e limitações de reparos e reconstruções quando comparado a outras regiões do corpo. A osteomielite, decorrente de mordeduras, tem alta prevalência e sua rápida evolução pode levar a medidas drásticas, como a amputação. Neste trabalho, é relatada a utilização da oxigenoterapia hiperbárica como terapia integrativa ao tratamento convencional e a avaliação de seus efeitos durante as 12 sessões realizadas em uma cadela vítima de mordedura, que apresentava necrose e exposição óssea com colonização por Staphylococcus sp e Pasteurella multocida. A avaliação evolutiva do quadro foi elaborada a partir de registro fotográfico da lesão, com escala, a cada três sessões e submetido à análise morfométrica por software analítico. A velocidade da marcha cicatricial revelou que a utilização desta terapia propiciou precocidade e efetiva atuação na cicatrização e no combate à osteomielite, evitando a amputação do restabelecendo as liberdades da paciente, contribuindo ao aprofundamento do emprego da oxigenoterapia hiperbárica na Medicina Veterinária.(AU)

In the veterinary routine, injuries in the extremities of the limbs are constant and represent a special challenge due to the anatomical characteristics, susceptibility of bone exposure and limitations of repairs and reconstructions when compared to other regions of the body. Osteomyelitis resulting from bites is highly prevalent and its rapid evolution can lead to drastic measures such as amputation. This work describes the use of hyperbaric oxygen therapy as an integrative therapy to conventional treatment and the evaluation of its effects during the 12 treatments performed in a female dog victim of a bite, that presented evolution to necrosis and bone exposure with colonization by Staphylococcus sp e Pasteurella multocida. The evolutionary assessment of the condition was elaborated from a photographic record of the lesion, with scale, every three treatments and submitted to morphometric analysis by analytical software. The speed of the healing gait demonstrated, that the use of this therapy proved precocity and effective action in healing and in the fight against osteomyelitis, avoiding the amputation of the limb, restoring the patient's freedoms. Thus contributing to the deepening on the use of hyperbaric oxygen therapy in veterinary medicine.(AU)

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

ABSTRACT: We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 μm diameter), multiple chains of individual conidia or in groups (8-10 μm diameter), and pigmented chlamydoconidia (7.5-15 μm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

RESUMO: Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 μm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 μm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 μm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 µm diameter), multiple chains of individual conidia or in groups (8-10 µm diameter), and pigmented chlamydoconidia (7.5-15 µm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 µm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 µm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 µm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

Staphylococcus aureus-induced pyogranulomatous dermatitis, osteomyelitis, and meningitis with Splendore-Hoeppli reaction in a cat coinfected with the feline leukemia virus and Leishmania sp

This report describes a case of a pyogranulomatous dermatitis, osteomyelitis, and meningitis with Splendore-Hoeppli reaction caused by Staphylococcus aureus in a sheltered female adult cat coinfected with the feline leukemia virus (FeLV) and Leishmania sp. The cat had a mild anemia and marked increased total leukocytes, particularly band and segmented neutrophils. The cat had laboratorial diagnosis of FeLV and Leishmania sp. infections. Clinically, the cat had extensive and multifocal areas of ulceration in cranial region. Due to the progression of cutaneous lesions, progressive weight loss, and the risk for other sheltered animals, the cat was euthanized. Microscopically, there was marked pyogranulomatous ulcerative dermatitis, osteomyelitis and meningitis, with multiple large intralesional colonies of Gram-positive cocci associated with Splendore-Hoeppli reaction. Aerobic bacterial isolates were identified as S. aureus by MALDI-ToF MS. Leishmania sp. DNA sequences were detected in liver and spleen, and amastigotes were demonstrated in skin sections by immunohistochemistry. In conclusion, here we describe a case of S. aureus-induced pyogranulomatous meningitis with SH reaction in a cat naturally coinfected with FeLV and Leishmania sp(AU)

Atypical mandibular osteomyelitis in an ewe caused by coinfection of Pseudomonas aeruginosa and Lactococcus raffinolactis

Background: Osteomyelitis is defined as a bone inflammation involving the cortical and medullary regions, usually caused by the local invasion of opportunistic microorganisms. The inflammatory reaction of bone may extend to the periosteum and soft tissues, compromising adjacent structures far from the initially infected foci. Different classifications of transmission routes, gravity levels, and tissues involved in animal and human osteomyelitis are available. In humans, the infection can reach bone tissue by exogenous or hematogenous pathways. This paper reports an atypical case of mandibular pyogranulomatous osteomyelitis in an ewe caused by concomitant Pseudomonas aeruginosa and Lactococcus raffinolactis infection. Case: The animal presented a 1-month history of progressive mandibular enlargement refractory to conventional therapy. In a physical examination, an increased volume located in the ventrolateral region of the right ramus of the mandible was observed. Fine-needle aspiration of the lesion enabled isolation in bacteriological culture of Pseudomonas aeruginosa and Lactococcus raffinolactis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF MS). Besides support care procedures and antimicrobial treatment approaches for the sheep based on in vitro tests, the animal died due to the severity of the clinical signs and the progressive worsening of the general health status. The radiographic image examination of the mandibular region revealed a severe and infiltrative periodontal reaction, with a predominance of a great number of neutrophils and macrophages, necrotic areas, and bone destruction, characterized histologically as a pyogranulomatous rection. At post mortem examination, a large pyogranuloma was observed in the entire horizontal branch of the mandible as well, showing a dark yellowish content of coarse consistency, caseous appearance, and bone fragmentation. Discussion: Ovine mandibular osteomyelitis is a well-established bone inflammation involving the cortical and medullary regions, characterized clinically by local enlargement, asymmetry, pain sensitivity, edema, hyperthermia, infiltrate caseous or suppurative material, and bone rarefaction. In the current report, 1-month history of progressive enlargement of the mandibular region, prostration, and weight loss in an ewe were referred. Where clinical and epidemiological features, bacteriological, cytological, histological, and mass spectrometry diagnostic approaches were assessed to diagnostic. Most reports involving the etiology of ovine mandibular osteomyelitis have been diagnosed based on classical phenotypic tests. Here, the concomitant identification of P. aeruginosa and L. raffinolactis infection was possible using mass spectrometry (MALDI-TOF), highlighting the importance of molecular methods in the diagnosis of animal diseases. In addition, the differentiation between Lactococcus and Enterococcus species is difficult, which could underestimate the diagnosis of Lactococcus species as a primary pathogen from animal diseases. We report, for the first time, a fatal case of mandibular pyogranulomatous osteomyelitis in a sheep caused by Pseudomonas aeruginosa and Lactococcus raffinolactis coinfection.

Lumbar paravertebral block in a rabbit (Oryctolagus cuniculus) submitted to pelvic limb amputation: case report / Bloqueio paravertebral lombar em coelho (Oryctolagus cuniculus) submetido à amputação de membro pélvico: relato de caso

The concern about pain management in exotic mammals is increasing. However, only a few studies describe locoregional anesthesia techniques in rabbits. Thus, this report aims to describe the lumbar paravertebral block, guided by peripheral nerve stimulation, in a rabbit undergoing mid-femoral amputation. We received a one-year-old rabbit weighing 1.27kg with a history of non-union of the right femur and osteomyelitis. The animal came to us for high pelvic limb amputation. After premedication with ketamine, midazolam, and morphine, the patient was maintained under general anesthesia in a non-rebreathing circuit under spontaneous ventilation with isoflurane vaporized in 0.6 oxygen. Using a peripheral nerve stimulator, we performed the lumbar paravertebral block, positioning the needle between the L5 and L6 vertebrae and injecting 0.2mL/kg bupivacaine. The patient remained stable throughout the procedure, without the need for analgesic rescue with opioids during surgery and postoperatively. The discharge occurred after 24 hours. The lumbar paravertebral block proved efficient for trans and postoperative analgesia for high pelvic limbic amputation in rabbits.

A preocupação quanto ao manejo da dor em mamíferos exóticos é crescente, entretanto existem poucos estudos que descrevem o uso de técnicas de anestesia locorregional em coelhos. Assim, este relato tem por objetivo descrever o bloqueio paravertebral lombar guiado por neurolocalizador em um coelho submetido à amputação mediofemoral. Um coelho de um ano de idade e 1,27kg foi atendido com histórico de não união de fêmur direito e osteomielite, sendo encaminhado para amputação alta do membro pélvico. Após pré-medicação com cetamina, midazolam e morfina, o paciente foi mantido sob anestesia geral em circuito sem reinalação de gases, sob ventilação espontânea com isoflurano vaporizado em 0,6 de oxigênio. O bloqueio do plexo lombar foi realizado pela abordagem paravertebral, com o auxílio de neurolocalizador, sendo a agulha posicionada entre as vértebras L5 e L6 e injeção de 0,2mL/kg de bupivacaína 0,5%. O paciente manteve-se estável durante todo o procedimento, sem a necessidade de resgate analgésico com opioides no trans e no pós-operatório. O paciente recebeu alta médica após 24 horas. O bloqueio lombar paravertebral demonstrou-se eficiente para analgesia trans e pós-operatória no procedimento de amputação alta de membro pélvico de coelho.

Fratura exposta do fêmur em preguiça-real (Choloepus didactylus) - tratamento e reabilitação / Open fracture of the femur in a two-toed sloth (Choloepus didactylus) - treatment and rehabilitation

Background: The Choloepus didactylus is characterized by having 2 fingers on the forelimbs and 3 on the hind limbs, being found more frequently in northern South America, in countries such as Venezuela, Guyana, Ecuador, Peru, and Brazil. In Brazil, deforestation of the Amazon rainforest has threatened the survival of C. didactylus. In addition, these animals can be affected by several diseases, being those of the musculoskeletal system with limited reports. Thus, the present report aimed to describe the treatment and evolution of an open fracture of the femur in a free-living Choloepus didactylus, which after rehabilitation was released back to the wild. Case: A free-living female two-toed sloth (Choloepus didactylus), weighing 7.0 kg, was found in Manaus city and referred to the Wild Animal Treatment Center (CETAS - IBAMA-AM) located in Amazonas, Brazil, after initial treatment and osteosynthesis in a private clinic (CVMinasPet). According to history, the animal had suffered electrocution 30 days ago and, as a result, had an extensive wound that resulted in the exposure of the knee joint, distal fracture of the femur, and areas of necrosis in the right pelvic limb. After cleansing of the area and removal of necrotic tissues, the fracture was stabilized with the cross-pinning technique (2 Steinmann pins). Then, the stifle joint was stabilized with external skeletal fixation (Type 1b, unilateral biplanar). The external fixator and cross-pins were removed 2 months after the surgical procedure, being observed bone healing. Next, the animal underwent physical rehabilitation for 30 days. After the rehabilitation period, a microchip and a radio collar were applied, and the sloth was released back to the wild. Discussion: Electrocution has been one of the causes of wildlife rescue, with consequences varying depending on the degree of the burn. Generally, the burn is most severe at the entry and exit sites. Since suspensory quadrupedal locomotion requires that sloths have specialized hands and feet to connect with the supports, probably the animal of the current report touched the right pelvic limb on a high-tension pole. The cross-pinning technique combined with the external fixator was used because the animal had an exposed Salter-Harris type I fracture with soft tissue loss. The younger the animal presents physeal fractures, the greater is the chance of developing growth abnormalities due to growth plate closure caused by fracture type or immobilization method. Since the sloth was a free-living animal, the age was unknown. However, pelvic limb length discrepancy was not observed after removing the implants. Culture and antimicrobial susceptibility test were not done and may be considered a limitation of this report. However, the application of ceftriaxone was adequate to control the infection, since the animal did not show signs of infection or draining sinus tracts. Ceftriaxone is a third-generation antibiotic that can be used in chronic osteomyelitis. In addition, the animal in the present report showed good adaptation to captive conditions that contributed to the clinical management. The longevity of the sloth in captivity can reach more than 30 years, but the goal is always to return the animal to nature after the treatment. Surgical treatment of the fracture and physical therapy after implant removal allowed this action in the current report, confirmed by monitoring with the radio collar.

Anestesia regional intravenosa (bloqueio de Bier) em urubu-de-cabeça-preta (Coragyps atratus) submetido à amputação de dígito / Regional intravenous anaesthesia (Bier's block) in black-headed vulture (Coragyps atratus) submitted to digit amputation

Background: The Coragyps atratus flies long distances in search of food and has a marked behaviour of food competition. Since they are frequently found in areas of recent human occupation, they are subject to trauma, which may require surgical interventions. Locoregional blocks are used as part of a balanced-anaesthesia protocol and are currently being evaluated in birds, with brachial plexus block being the main technique described in the literature. However, to our knowledge, this is the first description of intravenous regional anaesthesia (Bier's block) in a vulture. Thus, we aim to report the use of Bier's block with 1% lidocaine, in a black-headed vulture submitted to digit amputation. Case: A black-headed vulture (Coragyps atratus), weighing 2 kg, was rescued and referred to the Veterinary Hospital due to its inability to fly. Physical examination revealed a swollen digit in the right pelvic limb. Radiographic examination confirmed the intermediate phalanx fracture of the 4th digit of the right pelvic limb with signs suggestive of advanced osteomyelitis. The animal was referred to surgery for amputation of the affected digit. Before surgery, water and food were withdrawn for 12 h. Pre-anaesthetic medication consisted of 1 mg/kg midazolam and 0.5 mg/kg morphine intramuscularly (IM). Anaesthetic induction was performed through face mask with isoflurane, followed by orotracheal intubation with a 3 mm-endotracheal tube. Anaesthesia was maintained with isoflurane through a non-rebreathing circuit in 100% oxygen. Using a multiparametric monitor, heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ), oxyhemoglobin saturation (SpO2 ), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) were evaluated. Antisepsis of the right pelvic limb was performed and an elastic band was applied around the distal region of the affected tibia to serve as a tourniquet. A scalp vein set was used to access the lateral saphenous vein in the region distal to the tourniquet, and 5 mg/ kg lidocaine 1% was injected intravenously. The patient remained stable during the procedure, with no need for analgesic rescue. The tourniquet was gradually released 40 min past its application, being completely removed after 45 min of surgery. The anaesthetic supply was interrupted, with extubation after 4 min; the patient had satisfactory anaesthetic recovery. Discussion: The present report describes the success in using the technique of intravenous regional anaesthesia with 1% lidocaine for digit amputation performed on a specimen of black-headed vulture. The pre-anaesthetic medication provided analgesia, satisfactory sedation for venoclysis, and anaesthetic induction without complications. Anaesthetic induction and maintenance in birds are preferably performed with inhaled anaesthetics, thus the choice of mask induction. Despite the reduction in RR soon after induction, the patient remained on spontaneous ventilation. Bier's block using 5 mg/kg lidocaine showed to be an easy and safe technique in vultures, but doses up to 6 mg/kg lidocaine are not associated with adverse effects in birds. The intravenous regional anaesthesia technique described in this manuscript promoted adequate analgesia for the digit amputation procedure in black-headed vultures and allowed hemodynamic stability without significant anaesthetic complications. Thus, the present report points to the potential use of this locoregional block in other birds.

Consolidação de fraturas de tíbia em coelhos / Consolidation of tibia fractures in rabbits

Background: Disorders of the locomotor system are among the main treatments for this species, among the main causes are falls from a cage, arms or stairs and aggression by animals, such as dogs and cats. Biological osteosynthesis promotes early formation of secondary bone callus and allows a less accurate reconstruction of difficult interfragmentary apposition of 100% of the fragments. The objective of this work is to report the method of external immobilization with an aluminum channel aiming at the use of bone biology for the healing of unexposed tibial fractures in 3 rabbits (Oryctolagus cuniculus). Cases: Between 2020 and 2021, 3 cases of rabbits with unexposed tibial fractures were treated at the Veterinary Hospital. The 3 patients were diagnosed through physical examination and radiographic examination. All patients underwent anesthesia, underwent external immobilization with an aluminum channel, received analgesics and anti-inflammatory drugs, and recommended rest and care with the maintenance of external immobilization. Approximately at 30 days of rigid immobilization, all cases were evaluated by means of radiographic examination revealing the formation of bone callus at different post-immobilization times in the case 1 - 30 days, case 2 - 23 days and case 3 - 37 days. Discussion: Some surgical principles in rabbits must be followed, such as preserving vascularity if the open technique is decided, providing adequate diet, controlling edema, promoting analgesia and deciding on closed reduction if the fracture is recent and stable. The external coaptation method is a non-invasive method for the treatment of fractures and is also indicated with a high success rate for fractures of metacarpal, metatarsal and phalange bones in rabbits. The patient's age contributed to the early healing, which corroborates with case 1 (3-month-old), case 2 (6-month-old) and a little later the healing in case 3 (24-month-old), allowing unrestricted use of the member. It is worth reinforcing the point of view which defends that "biological osteosynthesis" promotes a favorable environment, especially in the preservation of the vascular supply of the periosteum when compared to traditional open surgical approaches. In this species, the surgical approach is a challenge due to the fact that the bones break or crack very easily, because the bones have a low density and higher mineral composition. Together, the skeleton represents 7% of the body weight, lower when compared to dogs and cats, which is 12%. In addition to these factors, rabbits are prone to secondary fractures, postoperative infections and rapid development of osteomyelitis, which significantly worsens the prognosis. The aluminum used in the manufacture of the aluminum channel has properties that offer resistance, lightness and radio transparency radiographic examination without removal of the channel, avoiding excessive micro-movement of the focus of the fracture due to lack of stabilization and possible refracture of the tibia. Rigid external immobilization with an aluminum channel was satisfactory in the 3 patients evaluated and preserved bone biology and anatomical axis. The treatment of choice was easy to apply, in addition to enabling better radiographic follow-up, promoting rapid bone healing for patients and early use of limbs without restrictions. However, for the effectiveness of the technique, the collaboration of tutors is essential.

Mandibulectomia em felino com osteomielite fibrosante bacteriana / Mandibulectomy in feline with bacterial fibrosing osteomyelitis

Background: Fibrosing osteomyelitis is a chronic inflammatory process caused by infectious agents that lead to the destructionand replacement of bone tissue by fibroblasts. The diagnosis is based especially on histopathological and bacterial culture. Incases where extensive and irreversible injuries are observed, surgical treatment may be indicated. The objective of this work isto report the clinical, radiographic, histopathological, and microbiological aspects of a cat presenting fibrosing osteomyelitis.Case: A 10-year-old male feline, no defined breed, weighing 3.9 kg was referred to one Private Veterinary Clinic of Fortaleza,CE, Brazil with a history of left mandibular enlargement, presenting dysphagia, sialorrhea, an increase in firm consistencyalong of the left mandibular body, temporomandibular arthralgia and decreased joint motion range. On cranium radiograph,signs of proliferative osteopathy of irregular contours were observed in the branch and body of the left mandible and extending to the rostral region of the right mandible, suggesting a neoplastic process. After anesthesia, for better assessment ofthe oral cavity, a sample was collected by incisional biopsy, however, the histopathological result was nonspecific. In viewof the inconclusive condition, it was decided to perform left hemimandibulectomy combined with right partial mandibulectomy. Tissue samples were obtained and sent for microbiological and histopathological analyses. The last test revealedan inflammatory reaction consisting of neutrophils and plasma cells, associated with a large amount of fibrous connectivetissue, multifocal bacterial aggregates, necrosis and bone resorption. Based on the findings, the diagnosis of chronic bacterial osteomyelitis was concluded. The microbiological culture demonstrated the growth of the bacterium Pseudomonasaeruginosa, with sensitivity to cefovecin, which was administered to the treatment in....

Mandibulectomia em felino com osteomielite fibrosante bacteriana / Mandibulectomy in feline with bacterial fibrosing osteomyelitis

Background: Fibrosing osteomyelitis is a chronic inflammatory process caused by infectious agents that lead to the destructionand replacement of bone tissue by fibroblasts. The diagnosis is based especially on histopathological and bacterial culture. Incases where extensive and irreversible injuries are observed, surgical treatment may be indicated. The objective of this work isto report the clinical, radiographic, histopathological, and microbiological aspects of a cat presenting fibrosing osteomyelitis.Case: A 10-year-old male feline, no defined breed, weighing 3.9 kg was referred to one Private Veterinary Clinic of Fortaleza,CE, Brazil with a history of left mandibular enlargement, presenting dysphagia, sialorrhea, an increase in firm consistencyalong of the left mandibular body, temporomandibular arthralgia and decreased joint motion range. On cranium radiograph,signs of proliferative osteopathy of irregular contours were observed in the branch and body of the left mandible and extending to the rostral region of the right mandible, suggesting a neoplastic process. After anesthesia, for better assessment ofthe oral cavity, a sample was collected by incisional biopsy, however, the histopathological result was nonspecific. In viewof the inconclusive condition, it was decided to perform left hemimandibulectomy combined with right partial mandibulectomy. Tissue samples were obtained and sent for microbiological and histopathological analyses. The last test revealedan inflammatory reaction consisting of neutrophils and plasma cells, associated with a large amount of fibrous connectivetissue, multifocal bacterial aggregates, necrosis and bone resorption. Based on the findings, the diagnosis of chronic bacterial osteomyelitis was concluded. The microbiological culture demonstrated the growth of the bacterium Pseudomonasaeruginosa, with sensitivity to cefovecin, which was administered to the treatment in....(AU)

Suppurative meningoencephalitis secondary to a Trueperella pyogenes-induced mandibular abscess in a free-ranging gray brocket deer (Mazama gouazoubira)

Trueperella pyogenes é um patógeno oportunista, afetando mais comumente ruminantes e porcos. Uma fêmea de veado-mato-cinzento ( Mazama gouazoubira ) teve um abscesso no músculo masseter associado a uma osteólise e osteomielite na mandíbula direita adjacente, com um trato fistuloso até a órbita e através do forame óptico no crânio, causando uma supuração meningite. Histologicamente, o abscesso foi caracterizado por um infiltrado inflamatório neutrofílico e histiocítico com uma miríade de bactérias Gram-positivas em forma de bastonete e uma leptomeningite supurativa e histiocítica focalmente extensa das porções ventrais do cérebro. A cultura microbiológica aeróbia, MALDI-ToF e PCR identificaram T. pyogenes.

Suppurative meningoencephalitis secondary to a Trueperella pyogenes-induced mandibular abscess in a free-ranging gray brocket deer (Mazama gouazoubira)

Trueperella pyogenes é um patógeno oportunista, afetando mais comumente ruminantes e porcos. Uma fêmea de veado-mato-cinzento ( Mazama gouazoubira ) teve um abscesso no músculo masseter associado a uma osteólise e osteomielite na mandíbula direita adjacente, com um trato fistuloso até a órbita e através do forame óptico no crânio, causando uma supuração meningite. Histologicamente, o abscesso foi caracterizado por um infiltrado inflamatório neutrofílico e histiocítico com uma miríade de bactérias Gram-positivas em forma de bastonete e uma leptomeningite supurativa e histiocítica focalmente extensa das porções ventrais do cérebro. A cultura microbiológica aeróbia, MALDI-ToF e PCR identificaram T. pyogenes.(AU)

Estudo ex vivo do uso do ultrassom fisioterapêutico em pérolas de polimetilmetacrilato dopadas com azul de metileno como carreador de antibiótico / Ex vivo study of use of physiotherapy ultrasound in polymethylmethacrylate beads doped with methylene blue as an antibiotic carrier

O cimento ósseo de polimetilmetacrilato é considerado um material padrão como carreador de antibiótico em cirurgias ortopédicas. A energia ultrassônica é um método capaz de gerar efeitos biológicos por mecanismos térmicos e não térmicos. Este estudo teve como objetivo analisar a dispersão de azul de metileno em pérolas de polimetilmetacrilato combinada com a exposição em campo acústico gerado por ultrassom não térmico. Foram utilizados 49 corpos-de-prova, cada um composto por uma pérola de polimetilmetacrilato (0,6 mm de diâmetro) dopada com azul de metileno e depositada em amostra de gelatina. Quarenta espécimes foram divididos em quatro grupos de 10 amostras com base nas intensidades de ultrassom (Grupo 1: 1,0 W/cm2; Grupo 2: 1,5 W/cm2) e profundidade (A - 2 cm; B - 3 cm) dos grânulos de polimetilmetacrilato na amostra de gelatina. Os outros nove espécimes constituíram o grupo controle. O grupo controle diferiu estatisticamente dos outros grupos. Todos os grupos irradiados com ultrassom apresentaram diferenças significativas, exceto os Grupos 2A e 2B. A dispersão de azul de metileno na gelatina entre os grupos foi: 1A> 1B; 2A> 1A; 2B> 1A; 2A> 1B; 2B> 1B. Ultrassom de baixa intensidade permitiu maior dispersão de azul de metileno com polimetilmetacrilato posicionado mais superficialmente, e não ocorreu influência da profundidade da pérola com ultrassom de alta intensidade.

Polymethylmethacrylate bone cement is a standard material used as antibiotic carrier in the orthopedic surgery. The ultrasonic energy method is capable of triggering biological effects based on both thermal and non-thermal mechanisms. The aim of the current study is to analyze methylene blue dispersion in polymethylmethacrylate beads, in association with the acoustic field generated by non-thermal ultrasound. Forty-nine specimens were used, and each specimen comprised one polymethylmethacrylate bead (0.6-mm diameter) doped with methylene blue and deposited in gelatin sample. Forty test specimens were divided into four groups comprising 10 samples, each, based on different ultrasound intensities (Group 1: 1.0 W/cm2; Group 2: 1.5 W/cm2) and polymethylmethacrylate bead depths (A - 2 cm; B - 3 cm) in gelatin sample. The control group comprised other nine specimens and statistically differed from the other groups. All groups irradiated with ultrasound have shown statistically significant differences in methylene blue dispersion, except for Groups 2A and 2B. Methylene blue dispersion in gelatin among groups was 1A> 1B; 2A> 1A; 2B> 1A; 2A> 1B; and 2B> 1B. Low-intensity ultrasound enabled the highest methylene blue dispersion when polymethylmethacrylate bead was positioned superficial; bead depth associated with high-intensity ultrasound did not influence methylene blue dispersion.

Ex vivo study of use of physiotherapy ultrasound in polymethylmethacrylate beads doped with methylene blue as an antibiotic carrier / Estudo ex vivo do uso do ultrassom fisioterapêutico em pérolas de polimetilmetacrilato dopadas com azul de metileno como carreador de antibiótico

Polymethylmethacrylate bone cement is a standard material used as antibiotic carrier in the orthopedic surgery. The ultrasonic energy method is capable of triggering biological effects based on both thermal and non-thermal mechanisms. The aim of the current study is to analyze methylene blue dispersion in polymethylmethacrylate beads, in association with the acoustic field generated by non-thermal ultrasound. Forty-nine specimens were used, and each specimen comprised one polymethylmethacrylate bead (0.6-mm diameter) doped with methylene blue and deposited in gelatin sample. Forty test specimens were divided into four groups comprising 10 samples, each, based on different ultrasound intensities (Group 1: 1.0 W/cm2; Group 2: 1.5 W/cm2) and polymethylmethacrylate bead depths (A - 2 cm; B - 3 cm) in gelatin sample. The control group comprised other nine specimens and statistically differed from the other groups. All groups irradiated with ultrasound have shown statistically significant differences in methylene blue dispersion, except for Groups 2A and 2B. Methylene blue dispersion in gelatin among groups was 1A> 1B; 2A> 1A; 2B> 1A; 2A> 1B; and 2B> 1B. Low-intensity ultrasound enabled the highest methylene blue dispersion when polymethylmethacrylate bead was positioned superficial; bead depth associated with high-intensity ultrasound did not influence methylene blue dispersion.

O cimento ósseo de polimetilmetacrilato é considerado um material padrão como carreador de antibiótico em cirurgias ortopédicas. A energia ultrassônica é um método capaz de gerar efeitos biológicos por mecanismos térmicos e não térmicos. Este estudo teve como objetivo analisar a dispersão de azul de metileno em pérolas de polimetilmetacrilato combinada com a exposição em campo acústico gerado por ultrassom não térmico. Foram utilizados 49 corpos-de-prova, cada um composto por uma pérola de polimetilmetacrilato (0,6 mm de diâmetro) dopada com azul de metileno e depositada em amostra de gelatina. Quarenta espécimes foram divididos em quatro grupos de 10 amostras com base nas intensidades de ultrassom (Grupo 1: 1,0 W/cm2; Grupo 2: 1,5 W/cm2) e profundidade (A - 2 cm; B - 3 cm) dos grânulos de polimetilmetacrilato na amostra de gelatina. Os outros nove espécimes constituíram o grupo controle. O grupo controle diferiu estatisticamente dos outros grupos. Todos os grupos irradiados com ultrassom apresentaram diferenças significativas, exceto os Grupos 2A e 2B. A dispersão de azul de metileno na gelatina entre os grupos foi: 1A> 1B; 2A> 1A; 2B> 1A; 2A> 1B; 2B> 1B. Ultrassom de baixa intensidade permitiu maior dispersão de azul de metileno com polimetilmetacrilato posicionado mais superficialmente, e não ocorreu influência da profundidade da pérola com ultrassom de alta intensidade.

Enxerto pediculado de omento maior como adjuvante no tratamento de osteomielite de tíbia em cão - relato de caso / [Greater omentum pedicle flap as adjunctive treatment of tibial osteomyelitis in a dog - case report]

A osteomielite é um desafio terapêutico em ortopedia, capaz de retardar ou mesmo impedir a consolidação óssea. O omento, há anos, tem sido empregado como alternativa em diferentes procedimentos cirúrgicos, por sua capacidade, entre outras, de angiogênese, sendo aplicado na ortopedia veterinária quando há o risco de não união óssea. Neste caso, um cão Fila Brasileiro foi submetido à realização de enxerto com retalho pediculado de omento maior, após osteomielite resistente presente em osteossíntese de fratura múltipla de tíbia aberta grau II. Durante 16 dias, manteve-se a comunicação do retalho, mas, diante do risco de peritonite, o pedículo foi seccionado. Numa sequência de intervenções cirúrgicas, após 89 dias, houve cicatrização óssea e remissão da osteomielite, mesmo na presença de bactérias multirresistentes. Neste relato, o omento foi efetivo como terapia adjuvante no tratamento da osteomielite e garantiu o retorno da função do membro.(AU)

Osteomyelitis is a therapeutic challenge in orthopedics, capable of delaying or even preventing bone healing. The omentum has been used in different surgical procedures as an alternative for its capacity, among others, of angiogenesis, being applied in veterinary orthopedics, when there is a risk of non-union of bone. In this case, a Brazilian row dog was submitted to grafting with pedicle flap of greater omentum, after resistant osteomyelitis present in open fracture osteosynthesis of open tibia grade II. For 16 days the communication of the flap was maintained, but at the risk of peritonitis, the pedicle was sectioned. In a sequence of surgical interventions, after 89 days, there was bone healing and remission of osteomyelitis, even in the presence of multi-resistant bacteria. In this report, the omentum was effective as adjuvant therapy in the treatment of osteomyelitis and guaranteed the return of limb function.(AU)

Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report / Tratamento de não união séptica femoral em cão com estabilização com haste intramedular bloqueada associada a autoenxerto de osso corticoesponjoso e retalho do omento maior: relato de caso

Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.(AU)

Não uniões ósseas associadas à osteomielite crônica necessitam de um planejamento terapêutico muito bem realizado, demandando tratamento multimodal para conseguir atingir a consolidação óssea e eliminar a infecção. Relatou-se um caso de sucesso do uso da associação de retalho do omento maior com estabilização cirúrgica com haste intramedular bloqueada para tratamento de uma não união séptica de fêmur em cão. O paciente apresentou retorno funcional parcial do membro com 30 dias após a cirurgia, cultura bacteriana estéril com sinais radiográficos de consolidação óssea e retorno funcional total do membro aos 90 dias de pós-operatório.(AU)

Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report / Tratamento de não união séptica femoral em cão com estabilização com haste intramedular bloqueada associada a autoenxerto de osso corticoesponjoso e retalho do omento maior: relato de caso

Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.(AU)

Não uniões ósseas associadas à osteomielite crônica necessitam de um planejamento terapêutico muito bem realizado, demandando tratamento multimodal para conseguir atingir a consolidação óssea e eliminar a infecção. Relatou-se um caso de sucesso do uso da associação de retalho do omento maior com estabilização cirúrgica com haste intramedular bloqueada para tratamento de uma não união séptica de fêmur em cão. O paciente apresentou retorno funcional parcial do membro com 30 dias após a cirurgia, cultura bacteriana estéril com sinais radiográficos de consolidação óssea e retorno funcional total do membro aos 90 dias de pós-operatório.(AU)

Chronic osteomyelitis in canine penile bone: case report / Osteomielite crônica em osso peniano canino: relato de caso

A 10-year-old male mixed-breed dog was admitted for recurrent signs of urinary tract infection (UTI). Urinary bladder ultrasonography revealed decreased thickness of its wall with floating hyperopic particles within its lumen. Ultrasonography revealed a structure invading the dorsal wall of the penile urethral lumen, located in a segment distal to the bladder. Radiographies showed bone resorption with proliferation at the caudal aspect of the penile bone, stricture of the final aspect of the penile urethra, and no radiopaque images compatible with a urethrolith. Computed tomography showed bone proliferation causing stricture of the urethral lumen at two different sites. Presumptive diagnosis of penile neoplasia was considered more likely and the dog underwent penectomy along with orchiectomy and scrotal urethrostomy. Enterobacter spp. was cultured from the urine sample and antibiotic sensitivity tests revealed that the bacterium was susceptible to amikacin, imipenem, and meropenem. Histopathology revealed severe suppurative urethritis, bone resorption, and hyperostosis, suggestive of osteomyelitis of the penile bone. Neoplastic cells were not observed at any part of the examined tissue. The findings in the present case suggest that osteomyelitis of the penile bone should be included in differential diagnosis for partial and complete urethral obstruction in dogs with recurrent UTI.(AU)

Um cão mestiço, com 10 anos, foi admitido por sinais recorrentes de infecção do trato urinário (ITU). A ultrassonografia da bexiga urinária revelou diminuição da espessura de sua parede com partículas flutuantes dentro de seu lúmen. A ultrassonografia demonstrou estrutura invadindo a parede dorsal do lúmen da uretra peniana, localizada em segmento distal à bexiga. Radiografias evidenciaram reabsorção óssea com proliferação no aspecto caudal do osso peniano, estenose do aspecto final da uretra peniana e ausência de imagens radiopacas compatíveis com uretrólito. Pela tomografia computadorizada, observou-se proliferação óssea causando estreitamento da luz uretral em dois locais diferentes. Diagnóstico presuntivo de neoplasia peniana foi considerado mais provável e o cão foi submetido à penectomia, juntamente com orquiectomia e uretrostomia escrotal. Enterobacter spp. foi cultivada da amostra de urina e testes de sensibilidade revelaram susceptibilidade ao amicacina, imipenem e ao meropenem. A histopatologia revelou uretrite supurativa grave, reabsorção óssea e hiperostose compatível com osteomielite do osso peniano. Células neoplásicas não foram observadas em nenhuma parte do tecido examinado. Os achados do presente caso sugerem que a osteomielite do osso peniano deve ser incluída no diagnóstico diferencial de obstrução uretral parcial e completa em cães com ITU recorrente.(AU)

Chronic osteomyelitis in canine penile bone: case report / Osteomielite crônica em osso peniano canino: relato de caso

A 10-year-old male mixed-breed dog was admitted for recurrent signs of urinary tract infection (UTI). Urinary bladder ultrasonography revealed decreased thickness of its wall with floating hyperopic particles within its lumen. Ultrasonography revealed a structure invading the dorsal wall of the penile urethral lumen, located in a segment distal to the bladder. Radiographies showed bone resorption with proliferation at the caudal aspect of the penile bone, stricture of the final aspect of the penile urethra, and no radiopaque images compatible with a urethrolith. Computed tomography showed bone proliferation causing stricture of the urethral lumen at two different sites. Presumptive diagnosis of penile neoplasia was considered more likely and the dog underwent penectomy along with orchiectomy and scrotal urethrostomy. Enterobacter spp. was cultured from the urine sample and antibiotic sensitivity tests revealed that the bacterium was susceptible to amikacin, imipenem, and meropenem. Histopathology revealed severe suppurative urethritis, bone resorption, and hyperostosis, suggestive of osteomyelitis of the penile bone. Neoplastic cells were not observed at any part of the examined tissue. The findings in the present case suggest that osteomyelitis of the penile bone should be included in differential diagnosis for partial and complete urethral obstruction in dogs with recurrent UTI.(AU)

Um cão mestiço, com 10 anos, foi admitido por sinais recorrentes de infecção do trato urinário (ITU). A ultrassonografia da bexiga urinária revelou diminuição da espessura de sua parede com partículas flutuantes dentro de seu lúmen. A ultrassonografia demonstrou estrutura invadindo a parede dorsal do lúmen da uretra peniana, localizada em segmento distal à bexiga. Radiografias evidenciaram reabsorção óssea com proliferação no aspecto caudal do osso peniano, estenose do aspecto final da uretra peniana e ausência de imagens radiopacas compatíveis com uretrólito. Pela tomografia computadorizada, observou-se proliferação óssea causando estreitamento da luz uretral em dois locais diferentes. Diagnóstico presuntivo de neoplasia peniana foi considerado mais provável e o cão foi submetido à penectomia, juntamente com orquiectomia e uretrostomia escrotal. Enterobacter spp. foi cultivada da amostra de urina e testes de sensibilidade revelaram susceptibilidade ao amicacina, imipenem e ao meropenem. A histopatologia revelou uretrite supurativa grave, reabsorção óssea e hiperostose compatível com osteomielite do osso peniano. Células neoplásicas não foram observadas em nenhuma parte do tecido examinado. Os achados do presente caso sugerem que a osteomielite do osso peniano deve ser incluída no diagnóstico diferencial de obstrução uretral parcial e completa em cães com ITU recorrente.(AU)