Gross and histological findings in the canine placenta and amnion at term: What's normal, abnormal or pathological?

The canine placenta is an underexamined organ. Placental abnormalities can affect foetus development and may be responsible for a low weight of the infant at birth; however, knowledge on their clinical significance in the canine species is limited. We aimed to describe macroscopic and microscopic findings in the canine placenta and amnion at term in clinically uncomplicated pregnancies and to evaluate their relationship with birth weight of healthy puppies. During natural delivery or C-section, the birth weight of 82 puppies was recorded, 72 placentas and 66 amnions were recovered. The foetal and maternal surfaces of the placental girdle, marginal haematoma and amnion were evaluated. Each gross finding was recorded, morphometrically assessed and sampled for histological diagnosis. Furthermore, specimens of placenta and amnion were collected from representative areas and microscopic deviations from normal structure were evaluated in haematoxylin and eosin sections. Gross examination revealed 'abnormalities' in the 75.4% of the collected placentas. Necrosis was the gross change most commonly observed in the placental girdle (72.5%). Congestion (17.4%) and clotted blood/fibrinoid material (2.9%) were also observed. No gross changes of either the marginal haematoma or the amnion were recorded. Histologically, placental girdle showed necrosis (62.3%), mineralization (52.2%), congestion (36.2%) and neutrophilic infiltration (27.5%). Marginal haematoma exhibited mineralization (11.6%) and neutrophils (29%), while necrotic foci were rarely observed (4.3%). In the amnion, the most frequent alteration observed was hypertrophy of the epithelium (35.9%) followed by oedema (31.2%), mineralized foci (28.1%), fibrosis (23.4%), congestion (15.6%) and more rarely neutrophils (12.5%). Puppies' birth weight was not statistically affected by either gross or histological abnormalities. Our study revealed that macroscopic and microscopic 'abnormalities' of the placenta and amnion may be common in uncomplicated pregnancies at term; however, no implications on puppies' birth weight were observed. Deviations from 'normal' morphology of canine foetal adnexa warrant further investigation to assess their clinical implications if present.

Relationship between placental characteristics and puppies' birth weight in toy and small sized dog breeds.

Puppy neonatal mortality may be related to low birth weight, which has been shown in humans to be linked to placental factors. The relation between the newborn puppy and the placental characteristics has been poorly investigated in dogs. Twenty bitches, 9 toy-sized (i.e. < 5 Kg) and 11 small-sized (i.e. 5 to 10 Kg), were included in this study. During natural delivery or c-section, puppies were identified and their order of birth, sex and weight were recorded. Puppy weights were registered at birth and daily until Day 6. Placentas were weighed after removal of extraplacental adnexa, after which a photo was taken and morphometrically assessed. The Total Placental Area (TPA) and the Transfer Zone Area (TZA) were calculated and their surface expressed in mm2. Immunohistochemistry with monoclonal mouse anti CD31 antibody was used to identify fetal and maternal vessels in the placental labyrinth zone. A vascularization index (VI) was determined for each placenta and the Total Vascular Area (TVA) was estimated. Puppies' birth weight correlated positively with placental weight (P < 0.001, r = 0.689). A positive correlation was found between the puppies' birth weight and TPA (P < 0.001, r = 0.786), TZA (P < 0.001, r = 0.772), and TVA (P < 0.001, r = 0.482). A positive correlation was also found between placental weight and TPA (P < 0.001, r = 0.661), TZA (P < 0.001, r = 0.583), and TVA (P < 0.001, r = 0.333). In the small-sized breeds, the placentas of low-weight puppies were lighter and had a smaller TZA and TVA (P < 0.05). The VI was higher in the placentas of the toy-sized compared to small-sized bitches (P < 0.01). No effect of parity, litter size, or sex of the puppy was observed on birth weight or growth rates on Day 6. The growth pattern of low-weight puppies did not differ from that of the other puppies during the first 6 days of life. As in humans, placental weight, the extension of the transfer zone and placental total vascular area correlates closely with the puppies' birth weight in normal pregnancies. Our data could represent reference values for placental weight, TZA, TVA and VI in toy and small-sized dog breeds.

Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: survival rate and prognostic factors.

BACKGROUND: The role of prognostic variables in the treatment of hepatocellular carcinoma (HCC) by transarterial chemoembolisation (TACE) is controversial. AIMS: To evaluate the survival of patients with HCC on cirrhosis treated with TACE and to analyse the prognostic factors affecting survival. METHODS: From 1996 to 2006, 580 consecutive patients with HCC in cirrhosis were observed. Of these 194 patients underwent TACE. The primary end-point was survival. Independent predictors of survival were identified using the Cox model. RESULTS: The cumulative 1-year, 3-year, and 5-year survival rates were 96%, 60%, and 41%, respectively. The multivariate analysis showed significant reduction of survival among patients with serum bilirubin values >2mg/dl compared to patients with values <2mg/dl (Hazard ratio 3.84; CI 95% 1.70-8.66; p-value=0.001). Multivariate analysis performed in the group of patients treated with TACE alone showed that elevated serum bilirubin (Hazard ratio 2.96; CI 95% 1.20-7.3; p-value 0.02) and incomplete tumour response (Hazard ratio 2.88; CI 95% 1.18-7.05; p-value 0.02) are correlated with a worse outcome. CONCLUSIONS: TACE was well tolerated and overall survival rate was 41% after 5 years. Complete tumour response and serum bilirubin <2mg/dl were identified as predictors of survival.