Outcome of superficial brachial axial pattern flaps used to close skin defects in dogs: 16 cases (1996-2019).

OBJECTIVES: To report the complication rate, type of complications and outcome of the superficial brachial axial pattern flap when used for closure of skin defects in dogs. MATERIALS AND METHODS: Medical records of dogs treated with a superficial brachial axial pattern flap for closure of a skin defect were reviewed. Information regarding signalment, reason for axial pattern flap use, skin flap size, flap healing, postoperative complications and need for revision surgery was collected. RESULTS: Sixteen dogs were included in the study. Indications for the superficial brachial axial pattern flap included closure following tumour removal (15/16, 94%) and management of a non-healing wound on the olecranon (1/16, 6%). Postoperative complications occurred in all dogs and included partial dehiscence (7/16, 44%), partial flap necrosis (6/16. 38%), seroma formation (5/16, 31%), flap oedema (3/16, 19%) and complete flap necrosis (2/16, 13%). Eight flaps (50%) healed without open wound management or additional surgery. Five dogs required open wound management without additional surgery, and three dogs (19%) required revision surgery. CLINICAL SIGNIFICANCE: Use of the superficial brachial axial pattern flap was associated with a high rate of complications. Most complications were managed without additional surgery and all wounds eventually healed, in some cases after prolonged open wound management.

Is the caudal auricular axial pattern flap robust? A multi-centre cohort study of 16 dogs and 12 cats (2005 to 2016).

OBJECTIVE: To determine the frequency and type of healing complications arising after the use of the caudal auricular axial pattern flap to close defects on the head in dogs and cats. MATERIAL AND METHODS: Multi-centre retrospective cohort study. Centres were recruited by the Association for Veterinary Soft Tissue Surgery Research Cooperative. Medical records of 11 centres were reviewed, and data from all dogs and cats treated with a caudal auricular axial pattern flap were retrieved. The following data were recorded: signalment, reason for reconstruction, flap dimensions, anatomic landmarks used, histological diagnosis, flap healing and whether revision surgery was required. RESULTS: Twenty-eight cases were included: 16 dogs and 12 cats. Flap length: width ratio was approximately 3:1 and flap length extended to the scapular spine in most cases. Optimal wound healing occurred in five of 16 (31%) dogs and six of 12 (50%) cats. Wound dehiscence without flap necrosis occurred in one of 16 (6%) dogs and one of 12 (8%) cats. Wound dehiscence with flap necrosis occurred in 10 of 16 (63%) dogs and five of 12 (42%) cats. Revision surgery was performed in eight of 16 (50%) dogs and three of 12 (25%) cats. CLINICAL SIGNIFICANCE: The caudal auricular axial pattern flap can provide full thickness skin coverage for large defects on the head in dogs and cats. Partial flap necrosis is a common complication, and revision surgery may be required in order to achieve final wound closure.

Pyometra in a bitch following unusual sterilisation.

A female, stray crossbreed dog, approximately four years old, was presented for routine spaying during a charity neutering programme in Romania. On clinical examination the bitch was lethargic and pyrexic (40.6 degrees C), but no other signs of illness were detected. Laparotomy revealed an enlarged uterus, severed at the cervix, with no communication to the vagina. Abdominal inspection showed an apparently normal, ligated vaginal stump. An ovariohysterectomy was performed and the dog was treated with a seven-day course of netilmicine. It subsequently made a full recovery.

Hemofiltration in diabetic uremic patients.

The increasing number of Diabetic Uremic Patients (DUP) starting the substitutive treatment (ST) constitutes a difficult and often disappointing problem in terms of efforts, clinical results and side-effects. While treatment of these patients by C.A.P.D. is well documented, the adoption of Hemofiltration (HF), has been, up to now scarcely considered. In order to define the potentialities of a HF policy in the treatment of these patients, data from 6 DUP treated with postdilutional HF for a 10.6 months/patient period were collected on a multi-center basis and retrospectively examined. Good results were achieved in terms of vascular stability, control of arterial hypertension and of retinopathy, clinical complications and hospitalization rate. Although C.A.P.D. may represent a first choice treatment for DUP with residual function, satisfactory glicemic control, difficult blood access and a motivation to full autonomization, HF may constitute a logical alternative when C.A.P.D. should be unmanageable (visus impairment, history of repeated peritonitis and dismetabolism, considerable weight gain): an integration of HF and C.A.P.D. can assure PDU with a continuative treatment.

[Analysis of cause of death in the 1st and last periods of the Piedmontese Dialysis and Transplantation Registry]. / Analisi delle cause di morte nel primo e nell'ultimo periodo del Registro Piemontese di Dialisi e Trapianto (RPDT).

The aim of this study is to assess the mortality causes in dialysis in the Piedmont Region, using the data of the Dialysis and Transplantation Register (DTR). Data of a 15-year use of the DTR regarding 5519 hospital dialysis admissions were considered. Mortality seems to be particularly due to cardiac causes analyzing, also the incidence of other causes of death such as: cachexia, sudden death and infection causes.

[Progression of acquired renal cysts in patients undergoing dialysis]. / Evolutività delle cisti renali acquisite nei pazienti in dialisi.

In uremic and dialysed patients, acquired renal cystic disease (ARCD) and its possible neoplastic degeneration are well-known. The aim of the paper is to assess the incidence of this pathology among dialysed patients in our Renal Unit. Final results have been achieved after three years. The evidence is that this pathology increases in older patients with respect to age and/or to long-term dialysis; we confirm neoplastic degeneration in two patients.

[Choice of dialysis methods as initial substitutive treatment: trends in the last 10 years]. / Scelta di metodiche dialitiche quale primo trattamento sostitutivo: evoluzione negli ultimi dieci anni.

The authors report data from the Regional Piedmontese Registry about the evolution of choices concerning dialytic therapy in the 20 regional dialysis Units during the years 1981-1990. They confirm a scale-down of acetate dialysis that is replaced with bicarbonate dialysis; besides a limited use of convective dialysis whereas peritoneal dialysis is steady. At the same time they remark an increase in admittance to dialysis and older patients.

[Anti-HCV antibodies in chronically dialyzed uremic patients. 1-year follow-up study]. / Anticorpi anti-HCV in pazienti uremici cronici dializzati. Studio ad un anno di distanza.

The sera of 109 patients undergoing chronic haemodialysis treatment were reexamined after one year in order to assess changes in the anti-HVC antibody pattern in the intervening period, June 1992-June 1993. Using the ELISA II generation test, positive cases were found to have risen from 57 to 63 (from 52.3% to 57.8%); the Riba II test showed 60 positive cases (previously 52) with 3 undetermined (previously 5). The incidence of biochemical indicators of necrosis and/or cholestasis, negative in HCV patients, also presents a particular positivity (44%) in the presence of four antibody fractions. These data confirm the importance of serial determinations in anti-HCV antibody time, even if they do not correlate directly with the presence of the virus in the circulation and hence with its infecting capacity, the marker for which should be sought in the polymerase chain reaction.

[Role of tumor necrosis factor in hemodiafiltration]. / Ruolo del tumor necrosis factor in emodiafiltrazione.

The Authors review the mechanisms involved in the production of cytokines during substitutive extracorporeal treatment with particular reference to microbial contamination and possibility of backfiltration of bacterial constituents more likely to occur with high permeability membranes. Recent and on-going studies from our laboratory support the contention that patients treated with high permeability membranes may be chronically stimulated. Use of "ultrapure" solution indeed brings about a marked reduction in predialytic plasma levels of tumor necrosis factor (TNF) in regard to what observed when standard solutions are adopted.

[Patients with neoplastic disease or older than 80 years of age: dialysis survival]. / Pazienti con patologia neoplastica o di età superiore ad 80 anni: destino dialitico.

In several European countries, including Italy, the resident population is ageing. This process is at the basis of the progressive increase in incidence of new elderly patients starting dialysis and, to a lesser degree, of patients affected by severe comorbid conditions, such a neoplasia. The aim of the study was an analysis of the situation in Piedmont (Northern Italy, 4,400,000 inhabitants): out of 4483 new entries in 1981-1993, 192 were aged 80 years and 87 were affected by renal neoplasia or by multiple myeloma. Incidence of patients aged 80 increased throughout the period; use of high tolerance techniques increased in the meantime allowing an improvement in survival results. The high incidence of vasculopathic patients and the high rates of death from cachexia pinpoint how much still has to be done in the field of prevention, even before dialysis starts.

[Role of paired filtration dialysis in substitutive treatment]. / Ruolo della paired filtration dialysis nel trattamento sostitutivo.

The Authors have evaluated the possibilities of use of the PFD in the regular dialysis treatment. At first they have studied in 8 patients the advantages offered by this technique in terms of depuration of small molecules and of tolerance in comparison with HD and HDF. Subsequently, they have compared the performances obtained in HF in a second group of 7 patients with the results observed in PFD executed by using 2 dialyzers on line and, in a second phase, in parallel, extending the comparison parameters to a higher molecular weight solute such as the beta 2-M. The results obtained indicate the PFD as a technique which can offer (compared to HD) a better tolerance and higher depurative performances, which on their turn can eventually allow a reduction of the length of the treatment. Moreover the possibility of executing the PFD with 2 polysulfone dialyzers on line and in parallel, increasing the UF to 13.5 and 15 L, renders this technique competitive with the HF also for its capacity of removing the beta 2-M.

[Diabetes mellitus is currently one of the most frequent causes or associated causes of uremia. Data from the Piedmont registry of dialysis and transplantation (update, December 1993)]. / Il diabete mellito rappresenta attualmente una delle cause-concause più frequenti di uremia. Dati del registro piemontese di dialisi e trapianto (aggiornamento al dicembre 1993).

A regular dialytic treatment of diabetic patients is until accepted from about twenty years in many areas. Aim of this work was a retrospective analysis of main clinical and survival data of diabetic patients (diabetic nephropathy or diabetes as comorbidous factor = 659 cases) admitted for dialysis in Piedmont (Northern Italy Region about 4,400,000 inhabitants) in the period 1981-1993 (functional recovery and follow-up < 1 month excluded). A progressive increment in incidence of diabetic patients was seen mostly in the aged. At 12/31/1993, 263 of 2404 patients admitted for dialysis were diabetics (10.9%); the majority of them was treated in Hospital Centers with bicarbonate haemodialysis (54.4%), while a small group was treated with CAPD (12.9%). During the years ¿80 was seen a progressive leaving of CAPD as first choice method in this population and in the last period the orienteering is the utilization of mixed methods (diffusive-convective as first choice). As regards the survival are not prominent significant differences between this cohort and the cohort affected by vasculopathy as comorbidous factor (86.2 and 54.2% in diabetics vs 78.6 and 55.2% in patients affected by vasculopathy at 1 and 3 years--p = 0.3481; patients aged 45-64 years). In conclusion the cohort of diabetic patients represent a good marker of the clinical problems of the elder population with high clinic risk, in progressive increasing in our Region.

[Renal tolerance for aminoglycosides]. / Tollerabilità renale agli aminoglicosidi.

Tissue pharmakinetics, morphology of renal lesions and clinical picture of aminoglycoside-induced tubulopathy are described. Almost completely filtered by the glomerulus, they are eliminated in active form and about a third are reabsorbed along the proximal convoluted tubule, thus reaching maximum concentration in the renal cortex in the sixth hour as the drug disappears from the circulation. They are located inside the lysosomes of the convoluted tubule cells where some typical formations called myeloid bodies are present. Cellular lesions are, however, only produced by high doses after, first, clinical manifestations of tubular disturbance such as polyuria, tubular proteinuria, enzymuria, followed, if the toxic insult persists, by renal insufficiency. This can present clinically as progressive renal function deterioration dependent on the dose-time factor. This deterioration is usually not oliguric and it may also present as a sudden oliguric renal insufficiency. The now fully documented risk factors are discussed as well as the duration of treatment (not more than 11 days), the dosage (3 mg/kg/die), the dosage intervals, the age factor (the elderly being shown to be more highly sensitive to the drug), the association with other aminoglycosides or diuretics or cephalosporin. It is very important to diagnose already existing nephropathies or renal insufficiency, in which case dosages must be appropriately reduced. The nephrological history of the patient and control of urea and creatinine clearances before the start of treatment (in addition, obviously, to functional control of the eighth pair of cranial nerves) are essential for all patients receiving courses of aminoglycoside therapy. It is also necessary to check renal function by daily measurements of creatinaemia and urine. These precautions are valid for all aminoglycosides including those that have come on to the market most recently.

[Hormonal modulation of inflammation]. / Modulazione ormonale dell'infiammazione.

The tissue damage during the inflammation is determined by the enzymes and the mediators of anaphylaxis released from polymorphonuclear cells (PMN), platelets, basophils and mastocytes. The control of this release involves the cAMP and cGMP. The cyclic nucleotides independently or synergically regulate the polymerisation of the microtubules and the microfilaments. Drugs increasing the intracellular concentration of cAMP or cGMP inhibit or enhance respectively the enzymatic release from PMN, basophils and mastocytes. In the platelets, cAMP plays a very important role, whereas the cGMP function is controversial.

[Renal tubular damage after rapid intravenous contrast study with iopamidol]. / Il danno tubulare renale dopo contrastografia rapida endovenosa con iopamidolo.

Reference is made to results obtained in 53 nephropathics in the study of urinary elimination of alphaglycosidase and lysozyme before and after rapid contrastography with sodium and meglumine diatrizoate and with iopamidol. A statistically significant difference in alphaglycosidase was evident with both media, whereas no change was noted for lysozyme. As far as the evaluation of alphaglycosidase was concerned, the tubular alteration induced by each medium was the same in terms of statistical comparison of the mean differences before and after urography.

[Use of coil negative pressure in the kidney]. / Utilizzazione della pressione negativa nei reni a rotolo

A sealed compartment recycling system has been created for use with Extracorporeal commercial filters in order to exploit the negative pressure of the dialysate for purposes of ultrafiltration. The results of in vivo and in vitro tests regarding ultrafiltration and dialysates of urea, creatinine, Hipaque I125 and vit. B12 Co57 are reported. The tests highlighted improved dehydration characteristics in the system compared with the traditional coil technique, while the dialysates of small and medium molecules showed no decrease. The system can profitably be used as an alternative to the open compartment coil system and is particularly interesting because it can be combined with monitors which provide exclusively for the use of closed circuit dialysate instruments.

Clinical and therapeutic correlations in consumption coagulopathy of obstetric acute renal failure.

Heparin has been proposed following the supposed role of disseminated intravascular coagulation (DIC) in the pathologies associated with the consumption coagulopathies such as obstetric acute renal failure (ARF), whilst antifibrinolytic agents could be advocated to stop a simultaneous triggered fibrinolysis. Out of 26 obstetric ARF DIC may be demonstrated in 10 and supposed in 6 patients who developed severe post-partum uterine bleeding. Therapeutic schedules employing heparin or antifibrinolytic agents early post-partum do not seem to change either the behaviour of laboratory parameters (showing a DIC partial resolution within 48 hours), or heavy bleeding in respect to the patients treated with supportive therapies alone. Furthermore, heparin administered during the following days does not seem to be a crucial factor in the renal recovery, and is often followed by severe haemorrhagic complications. Fresh frozen plasma after aprotinin is able to stop bleeding in the presence of persisting signs of consumption without damaging renal recovery.

[Acute renal failure and acute abdomen]. / Insufficienza renale acuta ed addome acuto

A series of patients with acute renal failure (ARF) and acute abdomen collected by the St. John the Baptist Hospital's Nephrology and Dialysis Division over the period 1970-75 is examined. A high rate of mortality was noted, due to causes that were mostly independent of ARF Death was often related to failure to resolve acute abdomen. The progression of ARF appeared to be related to that of the abdominal affection with prompt resolution of the latter. These findings suggest that constriction of the afferent arteriole may offer a partial, functional basis for ARF with the corollary that it has a good chance of being reversed, even after protracted periods of anuria. Renal complications associated with disseminated or localised intravascular coagulation appear to be rare. Treatment was best directed to early and frequent dialysis, with surgical resolution whenever indicated, irrespective of the presence of ARF.

[Traumatic dislocation of the knee treated by early surgical repair (author's transl)]. / Luxations traumatiques du genou traitement chirurgical précoce. A propos de 12 cas.

The authors have treated twelve traumatic dislocations of the knee. Three were treated conservatively with one satisfactory result. Nine were treated by early surgical repair with seven satisfactory results. The technique of ligamentous repair is described. The authors emphasise the frequency and severity of associated vessel and nerve damage. They found acute lesions of the popliteal artery in five cases, three of which had to be operated upon immediately with arterial suture or graft. In one case, ischaemia appeared four days after dislocation and the thrombosed artery was repaired by a venous graft. In one case a lesion of the lateral popliteal nerve which did not recover was treated by palliative surgery. In one case, secondary skin necrosis was treated by skin flap transplantation using micro-surgical technique with a satisfactory result. It is concluded that ligamentous and vascular repairs should be undertaken at the same procedure after arteriography.