Infrared Video Thermometry Guidance for Surgical Correction of Chylothorax in Dogs

Background: Macroscopic identification of the extravasation site of chyle in patients with chylothorax is a major challenge. Current forms of identification are invasive and/or expose patients to radiation, as in computerized tomography and radiography. A prototype device that uses infrared video thermometry images to detect temperature increments of 0.1ºC has been developed. This device can process and show real-time images or video on a monitor during surgeries. Therefore, the aim of this work was to report the first successful case in which this innovative device was tested in the transoperative period to identify the thoracic duct and its tributaries in a chylothorax surgery performed in a dog.Case: A 2-year-old male dog of the Shiba Inu breed was presented to the veterinary hospital with exercise intolerance, cough, emaciation, and no history of trauma. Clinical examination was performed along with complete blood count, biochemical analysis, and thoracic radiography. The patient exhibited dyspnea and had diminished breath sounds on chest auscultation. Radiographic images revealed moderate pleural effusion. The dog was anesthetized and submitted to thoracotomy, which enabled visualization of a chylous effusion. A sample of the effusion was collected for cytological and biochemical analyses. Subsequently, pericardiectomy was carried out, and identification of the thoracic duct and its tributaries was guided by an innovative device that generates infrared video thermometry images in real time. The extravasation site of the chylewas visualized on the images shown on a monitor. Consequently, after ligation of the tributary vessel, interruption of chyle overflow could be noticed on the monitor. Thoracotomy was routinely closed, and a drain was placed through an intercostal space after incision. Thirty days after the surgery, the dog exhibited no signs of recurrence. Cytological and biochemical analyses of the effusion revealed an abnormal transudate that had a density of 1,030 g/cm3, alkaline pH, predominance of neutrophils and lymphocytes, and high levels of proteins, triglycerides and cholesterol. These results indicated that the effusion analyzed was chyle.Discussion: Macroscopic aspects of an effusion alone should not be used to make a definitive diagnosis; cytological, physical, and biochemical evaluations are indispensable. The specimen analyzed had a higher concentration of triglycerides than blood, and its cholesterol concentration was lower than that found in blood. Findings like these have already been reported as indicative of chylous effusion. Thoracic duct ligation is the most used technique for correction of chylothorax, and is the technique with better outcomes. Thermometry has already been used for clinical examination in several diseases. However, the innovative device used in this study has the advantage of being noninvasive, and was able to guide the surgeon during the surgery to locate the thoracic duct and precisely identify the tributary lymphatic vessel responsible for the chylous effusion. The physical space occupied by the device did not disturb the surgical team since a small infrared image generator was placed one meter above the patient to take high definition images of the entire animal in the evaluation field. The thermometry device was very useful, non-invasive, and precise to differentiate thoracic structures and to identify the siteof extravasation of chyle. It also allowed a more interactive and precise surgical approach by the surgical team, which was essential to the success of the surgery.Keywords: chyle extravasation, infrared diagnosis, surgery, thorax

Pulmonary Adenocarcinoma in Dogs: Surgical Treatment with Real-Time Video-thermometry

Introdução :  Uma neoplasia pulmonar é uma proliferação anormal de células no tecido pulmonar, podendo ser classificada como primária, secundária ou metastática e multissistêmica. No entanto, uma neoplasia primária é rara em canídeos. Além disso, as neoplasias podem ser classificadas de acordo com seu comportamento biológico como malignas ou benignas. Os tumores malignos são mais prevalentes. O diagnóstico pode ser difícil devido a sintomas inespecíficos, tendo em vista que alguns pacientes afetados não apresentam nenhum sintoma; assim, um real da doença pode permanecer sem diagnóstico em certas ocasiões.Portanto, objetivamos relatar um caso de sucesso inédito de cirurgia de lobectomia pulmonar em cães com auxílio de videotermometria infravermelha, que mostrada como imagens em tempo real durante o procedimento cirúrgico.Caso : Um cão macho de 10 anos, mestiço com Cocker Spaniel, foi atendido com história de letargia, embotamento, perda progressiva de peso, tosse e dificuldade respiratória. Avaliação à gravidade dos sinais clínicos e ao exame clínico fisiológico normal, foram solicitados exames complementares, como radiografia da região cervical e torácica, tomografia computadorizada de sangue e toracoabdominal (TCT). Os resultados dos exames obtiveram a presença de massa nodular no lobo pulmonar direito caudal que ocasionava desvio lateral para hemitórax esquerdo da silhueta cardíaca. A paciente foi submetida a um procedimento cirúrgico com abordagem pela região torácica, na altura do sétimo espaço intercostal, sendo realizada lobectomia total. Durante todo o procedimento cirúrgico,A videotermometria em tempo real por meio da estação MART (Atividade Metabólica em Tempo Real FLIR SC325®) foi utilizada para determinar a viabilidade dos tecidos adjacentes por meio de diferenças de temperatura medidas em graus Celsius. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão.Discussão :Os adenocarcinomas consistem em estruturas glandulares papilares, acinares, sólidas ou mistas. Podem originar-se das vias aéreas, glândulas brônquicas ou região broncoalveolar e, freqüentemente, apresentam crescimento invasivo apresentando formato rudimentar e irregular. Os sinais clínicos são inespecíficos, incluindo intolerância a exercícios, tosse não produtiva, sinais respiratórios crônicos como taquipneia ou dispneia, apetite reduzido, perda de peso, letargia, dor à palpação torácica, hemotórax, pneumotórax e derrame pleural. O diagnóstico é concluído por meio de exames de diagnóstico por imagem, sendo a radiografia de tórax o mais importante, seguida da ressonância magnética e da tomografia computadorizada. Além disso, o exame histopatológico é essencial para determinar um diagnóstico definitivo. O tratamento de escolha para os nódulos de adenocarcinoma é a excisão cirúrgica da massa tumoral. Contudo, o tipo de abordagem cirúrgica é determinado por diferentes fatores, como tamanho, localização e envolvimento de estruturas adjacentes. A ablação de massas pulmonares pode ser realizada por meio de lobectomias parciais ou totais. No entanto, a lobectomia parcial é mais frequentemente realizada em massas não neoplásicas ou para obtenção de material para biópsia, enquanto a lobectomia total é recomendada para a remoção de uma neoplasia maligna.O prognóstico é sempre cauteloso, tendo um desfecho mais favorável nas massas de menor diâmetro sem o envolvimento de estruturas adjacentes

Ligation of the mesovarium in dogs with a self-locking implant of a resorbable polyglycolic based co-polymer: a study of feasibility and comparison to suture ligation

Background Ligation of the mesovarium in female dogs may be cumbersome with risk of complications and is associated with intense noxious stimuli. A resorbable implant, a self-locking loop designed for surgery, was developed as an alternative to traditional ligation. The study aimed to test the feasibility of ligating the canine ovarian pedicle with the implant and to compare its performance to traditional suture ligation. Results In total 45 intact female dogs destined for elective ovariohysterectomy and adoption were included. In 21 dogs the new resorbable implant was used to ligate the mesovarium, and in 24 control dogs traditional suture was used with one encircling ligature. Mean weight of implant dogs was 10.7±5.6kg (range 3.5–22.0), and mean weight of control dogs was 12.8±6.4kg, (range 4.1–27.0). The body weight of dogs did not differ between groups (P=0.25). In total, 42 ovarian pedicles were successfully ligated with the implant. In one control dog, intraoperative haemorrhage from the left ovarian pedicle was diagnosed. The mesovarium was re-ligated and haemostasis was confirmed. All dogs recovered uneventfully. The ligation time of the mesovarium was significantly shortened (P=0.02) by using the self-locking implant versus a single ligature (3′28′′±1′05′′ and 5′29′′±3′54′′, respectively). Total duration of surgery differed between the groups (P=0.02) with a shortened duration of surgery when using the self-locking implant (15′56′′±2′47′′ and 20′39′′±8′58′′, study group versus control group, respectively). In both groups, duration of surgery and time required to ligate the ovarian pedicle were longer in larger dogs than smaller dogs. Conclusion The results of this feasibility study suggested the implant can be used to ligate the canine mesovarium. Compared with traditional suture ligation, the results suggested that time to ligate the ovarian pedicle and duration of surgery were significantly reduced with the implant. More time was required to perform surgeries in larger dogs

Femoral Orthopedic Implants in Dogs with Titanium - Mechanical Evaluation

ABSTRACTBackground: Orthopedic implants are commonly used for different types of surgical procedures to gain optimal function and to provide stability to both bones and tendon structures. When inserting these implants, the characteristics of the material are important for surgical success, and the ideal implant must be biocompatible and nonallergenic. However, when molding an implant to the bone structure, its resistance can change significantly. Implants can be temporary or permanent in the body, and metal possesses properties that make it acceptable for bone repair. In biomedical implants, 2 types are most common, commercially pure (CP)-Ti and Ti-6A1-4V. They both provide stable fixation and low risk of loosening. Implants made with the same material and composition can perform differently if the material has been altered by processing techniques for different scenarios. Stress, strain and elastic modulus are the primary metrics used in the description of implant materials. They can be calculated based on mechanical tests of specimens with defined geometry, most commonly tensile, bending and torsional tests. In order to better evaluate those changes, we compared the mechanical characteristics of titanium bone plates, before and after they were molded to the bone, to verify and quantify the loss of stiffness and resistance after molding the plate.Materials, Methods & Results: The study was prospective. Orthopedic implant made of commercially pure titanium (CP-Ti) were divided into 2 groups, one group without plate molding and the other with plate molding to a dog femora bone. Thirty-six plates of different sizes (5.0, 6.5, 8.0, 9.0, 10.0 and 11.0-mm diameter) were divided into 6 groups containing 6 plates of each size and submitted to the 4-point flexion test of resistance, using a piece of dog femur (weights of 5, 10, 15, 20 and 25 kg) as the bone in which the molding was performed. The evaluations were tabulated and analyzed using the program GraphPad Prism version 5.0. Corrections of the normal distribution curve were made using the Bartlett test. After the corrections, one-way analysis of variance (ANOVA) was performed with P < 0.05. Assessments were made within the group and between groups. Subsequently, the Newman-Keuls test was performed, adopting P < 0.05. For analyses in 2 groups, Student's t-test was performed as a post-test, also with P < 0.05. When the plates were compared between equal sizes of groups 1 and 2, the non-molded plate group (G1) obtained the best results in the flexural stiffness and structural flexion tests. However, in the flexural resistance test, most plates obtained similar results and the plates with diameters of 8 mm, 9 mm and 10 mm of the molded plate group (G2) obtained the best results.Discussion: Our results show that the implants had adequate mechanical characteristics, but the unmolded plates had greater flexural and structural stiffness than the molded plates. This difference was significant, thus demonstrating a large loss of stiffness in relation to the original conformation. However, when we tested the flexural resistance, no significant differences were observed, and although without significant statistical changes, there was an increase in the resistance of the plate with the new conformation obtained by molding. In the results of the mechanical tests, we observed that after the molding, the implants gained greater resistance, although the difference was not statistically significant. This suggests that the architecture of the implants should have slight curvature in the medial direction of the bone, since this would lead to a better adaptation to the anatomy of the bone, and possibly greater resistance, as indicated by the new configuration after molding.Keywords: bone implants, titanium, orthopedic implants, femur, dogs

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications.Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral lesions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy findings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was 1 (good dissection and visualization), with variance of zero for mediastinoscopy and 0.14 for necropsy. In the mediastinoscopy of one CC, the prosthesis crossed the tracheal bifurcation, involving the posterior vessels of this region, which was confirmed by necropsy. However, the dissection showed no vascular lesions. The integrity of the mediastinum was assessed only by mediastinoscopy. There was no impairment caused by any of the procedures performed. This resulted in a median score of 1 (integrity) with zero variance. When the positioning of the prosthesis was evaluated in relation to the tracheal bifurcation, identical values were obtained by both methods. The median score was 1, with variance of 0.62. No statistical differences were found between the two evaluation methods for the analyzed variables. This demonstrates the strong potential of the proposed evaluation techniques.Discussion: Our results show that the execution of the technique is possible, but some complications may occur. Mediastinoscopy as an evaluation procedure can pose some complications, these considerations are important, but by using technique proposed in this study, these factors are minimized due to the ease of technical implantation of the extraluminal tracheal stent, without the need for several instruments competing in the inflated mediastinal space. We concluded that the technique is viable and a safe method with minimal invasion for investigation and treatment of mediastinal diseases, presenting low impairment of the paratracheal structures, and that mediastinoscopy can be used as a transoperative evaluation method to minimize complications

Tabagismo, uma Patologia Corporativa Transmissível pela Indústria do Tabaco. Como os Profissionais de Saúde podem Contribuir para Deter essa Epidemia?

Os avanços nas Políticas de Controle do Tabaco no Brasil são inegáveis e são considerados uma referência global no que concerne à redução do número de fumantes e na redução da morbimortalidade tabaco-relacionada, contudo, o tabagismo ainda é uma importante causa de adoecimento e morte na nossa população.Nesse cenário, considera-se importante discutir as formas que o uso do tabaco é disseminado e apontar como os profissionais de saúde podem contribuir para as Políticas de Controle do Tabaco

Hérnia perineal complicada com envolvimento de intestino e bexiga em cão: Relato de caso

A hérnia perineal resulta do enfraquecimento e separação no diafragma pélvico, promovendo deslocamento de órgãos abdominais ou pélvicos. Essa afecção pode ser influenciada por fatores como sexo, hiperplasia e cistos prostáticos, obstipação crônica, dentre outros fatores. O diagnóstico é feito por anamnese, exame físico, ultrassonografia e radiografia. O objetivo deste trabalho foi relatar o tratamento cirúrgico de hérnia perianal complicada com envolvimento de cólon e bexiga. O conjunto de manobras cirúrgicas mostrou-se uma alternativa para o tratamento de hérnia perianal

Pulmonary Adenocarcinoma in Dogs: Surgical Treatment with Real-Time Video-thermometry

Introdução :  Uma neoplasia pulmonar é uma proliferação anormal de células no tecido pulmonar, podendo ser classificada como primária, secundária ou metastática e multissistêmica. No entanto, uma neoplasia primária é rara em canídeos. Além disso, as neoplasias podem ser classificadas de acordo com seu comportamento biológico como malignas ou benignas. Os tumores malignos são mais prevalentes. O diagnóstico pode ser difícil devido a sintomas inespecíficos, tendo em vista que alguns pacientes afetados não apresentam nenhum sintoma; assim, um real da doença pode permanecer sem diagnóstico em certas ocasiões.Portanto, objetivamos relatar um caso de sucesso inédito de cirurgia de lobectomia pulmonar em cães com auxílio de videotermometria infravermelha, que mostrada como imagens em tempo real durante o procedimento cirúrgico.Caso : Um cão macho de 10 anos, mestiço com Cocker Spaniel, foi atendido com história de letargia, embotamento, perda progressiva de peso, tosse e dificuldade respiratória. Avaliação à gravidade dos sinais clínicos e ao exame clínico fisiológico normal, foram solicitados exames complementares, como radiografia da região cervical e torácica, tomografia computadorizada de sangue e toracoabdominal (TCT). Os resultados dos exames obtiveram a presença de massa nodular no lobo pulmonar direito caudal que ocasionava desvio lateral para hemitórax esquerdo da silhueta cardíaca. A paciente foi submetida a um procedimento cirúrgico com abordagem pela região torácica, na altura do sétimo espaço intercostal, sendo realizada lobectomia total. Durante todo o procedimento cirúrgico,A videotermometria em tempo real por meio da estação MART (Atividade Metabólica em Tempo Real FLIR SC325®) foi utilizada para determinar a viabilidade dos tecidos adjacentes por meio de diferenças de temperatura medidas em graus Celsius. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão. O fragmento cirúrgico contendo o lobo pulmonar caudal direto e a massa foi encaminhado ao setor de patologia para avaliação anatomopatológica. Abundante proliferação epitelial papilar foi visualizada ao microscópio, apresentando áreas de necrose e infiltrado polimorfonuclear inflamatório. O nódulo foi diagnosticado como adenocarcinoma papilar de pulmão.Discussão :Os adenocarcinomas consistem em estruturas glandulares papilares, acinares, sólidas ou mistas. Podem originar-se das vias aéreas, glândulas brônquicas ou região broncoalveolar e, freqüentemente, apresentam crescimento invasivo apresentando formato rudimentar e irregular. Os sinais clínicos são inespecíficos, incluindo intolerância a exercícios, tosse não produtiva, sinais respiratórios crônicos como taquipneia ou dispneia, apetite reduzido, perda de peso, letargia, dor à palpação torácica, hemotórax, pneumotórax e derrame pleural. O diagnóstico é concluído por meio de exames de diagnóstico por imagem, sendo a radiografia de tórax o mais importante, seguida da ressonância magnética e da tomografia computadorizada. Além disso, o exame histopatológico é essencial para determinar um diagnóstico definitivo. O tratamento de escolha para os nódulos de adenocarcinoma é a excisão cirúrgica da massa tumoral. Contudo, o tipo de abordagem cirúrgica é determinado por diferentes fatores, como tamanho, localização e envolvimento de estruturas adjacentes. A ablação de massas pulmonares pode ser realizada por meio de lobectomias parciais ou totais. No entanto, a lobectomia parcial é mais frequentemente realizada em massas não neoplásicas ou para obtenção de material para biópsia, enquanto a lobectomia total é recomendada para a remoção de uma neoplasia maligna.O prognóstico é sempre cauteloso, tendo um desfecho mais favorável nas massas de menor diâmetro sem o envolvimento de estruturas adjacentes

ATIVIDADE DA LACTATO DESIDROGENASE (LDH) SÉRICA EM CÃES SUBMETIDOS À OXIGENAÇÃO EXTRACORPÓREA POR MEMBRANA (ECMO) POR UM PERÍODO DE TRÊS HORAS

The extracorporeal membrane oxygenation (ECMO) is a prolonged cardiopulmonary support technique, which aims to help the lungs and the heart when they do not respond to conventional non-invasive treatments. This research was carried out to determine the behavior oflactate dehydrogenase (LDH) of five mongrel dogs undergoing ECMO for three hours. Under controlled ventilation, positive end-expiratory pressure (PEEP) at 10mmHg and FiO2 at 21%, the animals were submitted to femoral cannulation for ECMO (artery and vein), by the arterial-venous (AV) deviation. The LDH was measured and evaluated every thirty minutes for an uninterrupted period of three hours. The results were tabulated and statistically analyzed with ANOVA and Tukey tests, with p<0.05. The results showed an increase of serum LDH,featuring a muscle injury during the procedure due to a physiological response, similar to that caused by a hypovolemic shock. We concluded that ECMO is a viable technique for prolonged ventilatory support, but it needs some adjustments for clinical use in dogs