Ureterocolonic Anastomosis in a Dog with Transitional Cell Carcinoma in the Vesical Trigone

Background: Primary bladder tumors are rare in dogs, in spite of that, the transitional cell carcinoma (TCC) is the malignant tumor that most affects dogs. The TCC usually begins in the vesical trigone and extends into the bladder, and may cause partial or complete obstruction of the urinary flow. The treatment with cystectomy and urinary diversion in veterinary medicine is not usual probably because the partial cystectomy has low success and ureterocolonic anastomosis can cause pyelonephritis and/ or urinary incontinence. This paper describes the cystectomy surgery and ureterocolonic anastomosis in a dog with TCC in the bladder and bilateral hydronephrosis. Case: A 8-year-old, male, not castrated, Pitbull was referred to the Veterinary Clinic Hospital - UFRGS. The patient had progressive weight loss, low appetite, dysuria, and hematuria. Abdominal ultrasound showed bilaterally hydronephrosis, kidney pelvis and ureter dilatation. The mesogastric region presented a mass measuring about 14 cm. An exploratory laparotomy was request by the responsible veterinarian. A mass, measuring about 20 cm was observed in the spleen and a splenectomy was requested. An increased of the kidney’s volume and an expansion of the renal pelvis and ureter were observed. The bladder wall had thickened and presented a firm consistency, an ureterocolonic anastomosis was requested by the responsible veterinarian. Total cystectomy was performed in a second surgical procedure. Six days after the second surgery the patient condition got worse. The dog presented abdominal pain signals and pale mucous membranes. The hematological and biochemistry analysis findings were, severe anemia, and elevated serum creatinine (6.12 mg/dL) and urea (263 mg/dL) levels. Based on severity of clinical signs and unfavorable prognosis the owners elected for euthanasia. Necropsy revealed a viscous material into the left ureter and in left renal pelvis, and papillary necrosis in the right kidney. The histologic assessment revealed tumor cells in regional lymph nodes and lungs. Discussion: The urinary diversion when consist of total cystectomy and ureteral transplantation to the gastrointestinal tract can be considered a therapeutic option in cases where the trigone is affected. In this study an ureterocolonic anastomosis was requested due to bilateral ureteral obstruction caused by TCC involving the trigone. Neurological and gastrointestinal signs, elevated serum creatinine levels and pyelonephritis may occur after surgery. Neurological signs were not observed. The dog, in the present case report, had already azotemia in pre-surgical examinations, probably caused by bilateral ureteral obstruction. One of the reasons for the increase in postoperative serum creatinine levels is chronic renal failure caused by ascending infection or post-renal obstruction. Another reason could also be reabsorption of the metabolite through the colon. Necropsy findings were ascending infection and pyelonephritis. Dilation of ureter at the time of surgery may have predisposed to the ascending infection. In previous studies aggressive surgical therapy did not result in a significant increase in survival time in dogs when compared to chemotherapy. Most dogs presented metastases, observed most frequently in lymph nodes and lungs. In this report the surgery was performed in an attempt to improve kidney function and life quality of the patient during hospitalization. The prognosis was considered unfavorable because of the advanced stage of the disease and kidney failure. The absence of an early diagnosis and inability to start early chemotherapy may result in a reduced in the survival time of these patients. Keywords: vesical neoplasm, hydronephrosis, urinary diversion, dogs

Simulación clínica para desarrollar competencias en enfermería de la resucitación cardiopulmonar: revisión sistemática

Objective: to identify the effectiveness of clinical simulation for competence development regarding cardiopulmonary resuscitation in comparison with different teaching and learning strategies used in the education of nursing students. Method: systematic review, performed on the databases PubMed®/MEDLINE®, LILACS, Scopus, CINAHL and Web of Science. The Rayyan QCRI application was used to select the studies, in addition to the instruments for assessing the methodological quality of Joanna Briggs Institute and the Medical Education Research Study Quality Instrument. Results: a total of 887 studies were identified, and five we included in the final sample. The included studies had good methodological quality by the assessment instruments. All of them had statistically significant results to develop competence through clinical simulation, when compared to other methods. Conclusion: clinical simulation proved to be effective for the development of clinical competence in cardiopulmonary resuscitation of nursing students.Objetivo: identificar la eficacia de la simulación clínica para desarrollar competencias de la resucitación cardiopulmonar en comparación con diferentes estrategias de enseñanza y aprendizaje que se utilizan en la educación de estudiantes de enfermería. Método: se trata de una revisión sistemática, realizada en las bases PubMed®/MEDLINE®, LILACS, Scopus, CINAHL y Web of Science. Se utilizó la aplicación Rayyan QCRI para seleccionar los estudios, además de los instrumentos de evaluación de la calidad metodológica del Instituto Joanna Briggs y el Medical Education Research Study Quality Instrument. Resultados: se identificaron 887 estudios de los cuales 5 compusieron la muestra final. Los instrumentos de evaluación reconocieron a los estudios incluidos como de buena calidad metodológica. Todos presentaron mejores resultados estadísticamente significativos para desarrollar competencias por medio de la simulación clínica, al ser comparados con otros métodos. Conclusión: la simulación clínica ha resultado eficaz para el desarrollo de competencias clínicas en la resucitación cardiopulmonar de los estudiantes de enfermería.Objetivo: identificar a efetividade da simulação clínica para desenvolvimento de competência quanto à ressuscitação cardiopulmonar em comparação com diferentes estratégias de ensino e aprendizagem utilizadas na educação de graduandos em enfermagem. Método: revisão sistemática, realizada nas bases PubMed®/MEDLINE®, LILACS, Scopus, CINAHL e Web of Science. Utilizou-se o aplicativo Rayyan QCRI para seleção dos estudos, além dos instrumentos de avaliação da qualidade metodológica do Instituto Joanna Briggs e o Medical Education Research Study Quality Instrument. Resultados: identificaram-se 887 estudos, sendo que cinco compuseram a amostra final. Os estudos incluídos foram considerados de boa qualidade metodológica pelos instrumentos de avaliação. Todos apresentaram resultados estatisticamente mais significativos para desenvolver competência por meio da simulação clínica, quando comparados a outros métodos. Conclusão: a simulação clínica mostrou-se efetiva para o desenvolvimento de competência clínica na ressuscitação cardiopulmonar de estudantes em enfermagem

Cold Atmospheric Pressure Plasma Is Effective against P. gingivalis (HW24D-1) Mature Biofilms and Non-Genotoxic to Oral Cells

The effects of helium cold atmospheric pressure plasma (He-CAPP) jet on Porphyromonas gingivalis (HW24D-1) biofilm, on human gingival fibroblasts (HGF) and human gingival keratinocytes (OBA-9) were assessed. Standardized suspension of P. gingivalis was obtained, and biofilms were grown anaerobically for 48 h. After exposition to He-CAPP, the biofilm viability was evaluated by XTT assay. HGF were grown at 37 °C, in an CO2 chamber in DMEM, while OBA-9 cells were cultured in keratinocyte serum-free medium. After 24 h, plates were exposed to He-CAPP for 1 to 7 min. Plasma was generated using a commercial AC power supply with amplitude modulated signal (voltage amplitude of 20 kVp-p, frequency of 31.0 kHz and duty cycle of 22%). The corresponding discharge power was 0.6W at He flow rate of 1 L/min. DNA damage was accessed by static cytometry. Data were analyzed by GraphPad Prism (p < 0.05). Significant reductions in P. gingivalis viability in relation to non-treated groups were detected (p < 0.0001), directly proportional to exposure time. Treated groups were slightly aneuploid after 5- and 7-min treatment in HGF, and for 3 min in OBA-9 cells, with 1.2 DNA index mean. Helium cold atmospheric pressure plasma jet showed inhibitory effect on P. gingivalis mature biofilm and was not genotoxic for epithelial gingival cells and human oral fibroblasts

Sedation Effect of Acepromazine and Butorphanol in Dopplervelocimetric Parameters in Great Abdominal Arteries and Femoral Artery in Dogs

Background: Doppler ultrasound is a non-invasive diagnostic imaging technique that allows vascular anatomical and dynamics evaluation. Each artery has flow velocity profiles and different Doppler spectrum. The purpose of this study was to determine if sedation with acepromazine and butorphanol in dogs alters Doppler velocimetric values and diameter from abdominal aorta, celiac, mesenteric cranial, renal, external iliac and femoral arteries of healthy dogs.Materials, Methods & Results: Twenty healthy female dogs, aged 1 to 5 years, with body weight ranging from 10 to 25 kg, were evaluated with Doppler ultrasound in order to obtain: peak systolic velocity, end diastolic velocity, time average medium velocity, time average maximum velocity, resistive index, pulsatility index, and diameter from abdominal aorta, celiac, mesenteric cranial, renal, external iliac and femoral arteries. The same animals were sedated with acepromazine (0.02 mg/kg) and buthorphanol (0.4 mg/kg) and the same parameters were reevaluated. The heart rate was also measured. The study was approved by the Animal Ethics Committee of UFRGS, under the 25552 protocol, and the owners signed an informed consent form. Statistical analysis was performed with pared t test.The heart rate was statistically significant different, 98 ± 20.13 bpm before and 79 ± 17.74 after sedation. The exam was done before and after sedation in all selected vessels, except the celiac and cranial mesenteric artery, which were possible only in 35% and 45% respectively. All measured arteries exhibit difference in at least two of the analyzed parameters, except femoral artery, that only diameter was different.Discussion: Each vessel was selected because of its importance, and each of them has its own characteristic waveform. Changes in patterns of flow velocity of the celiac artery and mesenteric can help to determine the physiological condition of the gastrointestinal tract; in the case of renal arteries are associated with diseases involving parenchyma and; thrombosis in the aorta and the iliac and femoral arteries may be difficult to evaluate without the Doppler image. Examination of the AC and AMC before and after sedation not could be performed in all animals, maybe because the present work was carried out with only fasting requirement, without using dimethicone, and one of the difficulties encountered was the presence of gas in the gastrointestinal tract. Another factor that may have contributed to these findings is that the acute stress of containment and other environmental factors can cause release of vasopressin and leads to vasoconstriction of the splanchnic vascular bed. The dopplervelocimetric data found in celiac, mesenteric cranial, renal and femoral arteries in non-sedated animals was similar to what was described by other authors. Although all dogs demonstrated relaxation during the exam, this sedation protocol alters the values found with Doppler ultrasound in the selected vessels, except femoral artery, which caused only increase of diameter. The Doppler differences found can be a consequence of a decrease in heart rate associated with longer cycle length, and therefore, larger diastolic volume with vessels that stayed with same diameter, or in case of caudal abdominal aorta, that reduced the diameter. This study compared the dopplervelocimetric values to the ones described by other authors in non-sedated animals and demonstrated that although acepromazine and buthorphanol are a good option to sedate dogs to perform ultrasound exam, they alter the Doppler values from aorta abdominal, celiac, cranial mesenteric, renal, external iliac arteries and the femoral artery diameter

Miniplacas de titânio na redução de fraturas mandibulares em cães e gatos: estudo de seis casos

Fraturas de mandíbula e maxila são comuns em cães e gatos, correspondendo a cerca de 3 a 6% de todas as fraturas. Muitos tratamentos são propostos para a correção desse defeito, como o uso de pino intramedular, a fixação esquelética externa, a cerclagem e o uso de acrílicos e placas ósseas. Este estudo teve como objetivo avaliar o uso das mini e microplacas de titânio do sistema 2,0 e 1,5mm no tratamento de fraturas mandibulares, em cães e gatos, respectivamente. Os parafusos e as miniplacas utilizadas são compostos de titânio, e o formato dependeu da localização e do tipo de fratura. No total, foram avaliados seis casos, dos quais quatro apresentaram completa consolidação, sendo as placas utilizadas como método único ou associado com fio de aço ou imobilização com focinheira. As causas de insucesso foram a quebra da placa em um dos casos e a contaminação do enxerto, com posterior osteomielite em decorrência da deiscência dos pontos em outro caso. O emprego das miniplacas de titânio mostrou-se eficaz na maioria dos casos testados, promovendo fixação rígida e retorno funcional adequado, sendo utilizado como método único ou associado com outras técnicas de osteossíntese

Miniplacas de titânio na redução de fraturas mandibulares em cães e gatos: estudo de seis casos Titanium miniplates in mandibular fracture repair in dogs and cats: study of 6 cases

Fraturas de mandíbula e maxila são comuns em cães e gatos, correspondendo a cerca de 3 a 6% de todas as fraturas. Muitos tratamentos são propostos para a correção desse defeito, como o uso de pino intramedular, a fixação esquelética externa, a cerclagem e o uso de acrílicos e placas ósseas. Este estudo teve como objetivo avaliar o uso das mini e microplacas de titânio do sistema 2,0 e 1,5mm no tratamento de fraturas mandibulares, em cães e gatos, respectivamente. Os parafusos e as miniplacas utilizadas são compostos de titânio, e o formato dependeu da localização e do tipo de fratura. No total, foram avaliados seis casos, dos quais quatro apresentaram completa consolidação, sendo as placas utilizadas como método único ou associado com fio de aço ou imobilização com focinheira. As causas de insucesso foram a quebra da placa em um dos casos e a contaminação do enxerto, com posterior osteomielite em decorrência da deiscência dos pontos em outro caso. O emprego das miniplacas de titânio mostrou-se eficaz na maioria dos casos testados, promovendo fixação rígida e retorno funcional adequado, sendo utilizado como método único ou associado com outras técnicas de osteossíntese.Jaw and maxilla fractures are common in dogs and cats, representing 3-6% of all fractures. Numerous techniques are proposed to reduce the defect such as intramedullary pin, percutaneous skeletal fixation, circumferential wiring, acrylic splints and bone plating. This study aimed to evaluate the use of 2.0mm and 1.5mm titanium microplates in the treatment of mandibular fractures in dogs and cats, respectively. The screws and the mini and microplates used were composed of titanium and their format depended on the location and type of fracture. A total of 6 cases were selected and 4 of them had complete consolidation using the mini microplate method alone or associated with steel wire or tie with noseband. In one case the failure occurred due to plate breakage and other implant failed due to dehiscence of the skin suture. The use of mini titanium microplates was effective in most cases, as a single method or combined with other techniques of osteosynthesis, because it promoted rigid fixation and return to the appropriate function

Técnica de debriefing videoassistida para simulação em enfermagem: como proceder?

RESUMOObjetivo: Identificar, na literatura científica, elementos que viabilizam a técnica de debriefing videoassistida no processo de ensino eaprendizagem, na simulação em enfermagem.Métodos: Revisão integrativa da literatura, realizada de maio a julho de 2019. Selecionaram-se estudos primários, sem recortetemporal, em português, inglês ou espanhol, nas bases de dados PubMed®, Scopus®, CINAHL e LILACS, por meio do aplicativoRayyan. Adotou-se a análise qualitativa.Resultados: Identificaram-se, inicialmente, 205 estudos, sendo seis deles selecionados e categorizados em: “Elementos quecompõem a técnica de debriefing videoassistida”; “Benefícios da utilização da técnica de debriefing videoassistida” e “Desafios dautilização da técnica de debriefing videoassistida”.Conclusões: Os elementos que viabilizaram a técnica de debriefing videoassistida, no processo de ensino e aprendizagem emenfermagem, foram: conceito, objetivos, recursos materiais e procedimento. O principal benefício foi o reconhecimento imediato decomportamentos, e o desafio foi o risco de o vídeo tornar o debriefing cansativo e humilhante.Palavras-chave: Estudantes de enfermagem. Gravação em vídeo. Simulação. Aprendizagem