Estudo retrospectivo da fenestração toracolombar ventral através de toracotomia intercostal e laparotomia paracostal no cão

The records of 29 dogs, grouped according to breed, sex, age and neurological status, as well as duration of symptoms, T-L disks involved, time elapsed for functional recovery, and success rates were studied. The Dachshund represented 55.18% (n = 16) of the cases, mongrel dogs, 13.8% (n = 4), Poodle, Basset Hound and English Cocker Spaniel, 6.89% each (n = 6) and German Shepherd, Beagle and Pinscher, 3.45% each (n = 3), being 51.72% males and 48.28%, females, with a mean age of 68.03 months. The neurological status corresponded to 13.8% of the dogs belonging to GI (pain), 41.8% to GII (paresis), 27.6% to GIII (paraplegia, with positive deep pain) and 17.2% to GIV (paraplegia with loss of deep pain). Symptoms varied in duration between two and 60 days, corresponding the averages of 18.5 days (GI), 12.3 days (GII), 8.28 days (GIII) and 4.2 days (GIV). Percentage of affected disks was: T10/11 (10.81%), T11/12 (24.33%), T12/13 (40.55%), T13/L1 (16.21%) and L1/2, L2/3 and L3/4, 2.7% each. Mean time of recovery, in days, was: 16 (GI), 19.1 (GII), 20.6 (GIII) and 30.6 (GIV), when 100% of dogs in groups I, II and III recovered both neurological and motor functions. Group IV showed 80% of success. It is concluded that ventral fenestration yields excellent results, although proper case selection must be considered.Foram analisados os resultados da fenestração ventral dos discos toracolombares em 29 cães agrupados segundo a raça, sexo, peso, idade, graus de déficits neurológicos, duração dos sinais, discos intervertebrais envolvidos, tempo para recuperação e porcentagem de sucesso. A raça Dachshund representou 55,18% (n = 16), cães sem raça definida, 13,8% (n = 4), Poodle e Basset Hound e Cocker Spaniel Inglês 6,89% cada (n = 6), e Pastor Alemão, Beagle e Pinscher, 3,45% cada (n = 3), sendo 51,72%, machos e 48,28%, fêmeas, com idade média de 68,03 meses. O grau de déficits neurológicos correspondeu a: 13,8% dos cães pertencentes ao GI (dor), 41,8% ao GII (paresia), 27,6% ao GIII (paraplegia com dor profunda presente) e 17,2% ao GIV (paraplegia com dor profunda ausente). Os sinais clínicos variaram em duração entre 2 e 60 dias, correspondendo às médias de 18,5 (GI), 12,3 (GII), 8,28 (GIII) e 4,2 dias (GIV). A porcentagem de discos intervertebrais acometidos foi: T10/11 (10,81%), T11/12 (24,33%), T12/13 (40,55%), T13/L1 (16,21%) e L1/2, L2/3 e L3/4, 2,7% cada. O tempo médio de recuperação, em dias, foi: 16 (GI), 19,1 (GII), 20,6 (GIII) e 30,6 (GIV), onde 100% dos animais dos grupos I, II e III recuperaram ambas as funções neurológicas e motoras. O grupo IV apresentou 80% de sucesso. Conclui-se que a fenestração ventral produz excelentes resultados pós-operatórios desde que bem selecionados os casos

Butorphanol in romifidine-tiletamine-zolazepam anesthesia in cats

Visando observar os efeitos do butorfanol (B) na anestesia produzida pela associação de romifidina (R) e tiletamina-zolazepam (TZ), foram utilizados seis gatos adultos, de forma que todos animais receberam a associação de romifidina-tiletamina-zolazepam (grupo RTZ) ou a associação de romifidina-tiletamina-zolazepam-butorfanol (grupo RTZB). Os animais receberam em aplicação única, por via intramuscular, 7mg.kg-1 de tiletamina e 7mg.kg-1 de zolazepam e 40µg.kg-1 de romifidina (grupo RTZ) ou a mesma associação acrescida de 0,2mg.kg-1 de B (grupo RTZB). A freqüência cardíaca, freqüência respiratória, pressão arterial sistólica, diastólica e média por método não-invasivo oscilométrico, saturação de oxihemoglobina e temperatura retal foram avaliadas durante 120 minutos e comparadas aos valores basais. Os efeitos anestésicos foram caracterizados por meio de um sistema de escores. Outros dados como período de latência, período anestésico hábil e período de recuperação foram mensurados para efeito comparativo. Os períodos de latência e anestésico hábil foram significativamente mais prolongados no grupo RTZB. Ocorreu diminuição da freqüência respiratória no grupo RTZB, havendo decréscimo transitório no grupo RTZ. A freqüência cardíaca não variou no grupo RTZ até os 60 minutos e decresceu significativamente no grupo RTZB. Conclui-se que a associação RTZ produz anestesia com mínimos efeitos cardiovasculares e que a adição do butorfanol à associação prolonga o tempo anestésico hábil, além de proporcionar analgesia mais duradoura, mas provoca efeitos colaterais como decréscimo da freqüência cardíaca e da freqüência respiratória em gatos.The effect of butorphanol was investigated in six adult cats anesthetized with romifidine-tiletamine-zolazepam. Cats were given romifidine (40µg.kg-1) tiletamine (7mg.kg-1) and zolazepam (7mg.kg-1) (RTZ) intramuscularly, or RTZ and butorphanol (0.2mg.kg-1) (RTZB). Heart rate, respiratory rate, oscillometric systolic blood pressure, diastolic blood pressure and mean blood pressure, oxihemoglobin saturation and rectal temperature were determined for 120 minutes and compared to baseline values. Anesthetic effects were evaluated using a score system. Time of induction, anesthesia and recovery were also determined for comparison. Induction time and anesthetic time were significantly longer in RTZB. In the RTZB group a significant decrease in respiratory rate was observed while in the RTZ group this was transitory. Heart rate did not change in the RTZ group until 60 minutes and decreased significantly in the RTZB group from the time of injection. It is concluded that RTZ is an effective anesthetic combination with minimal cardiovascular side effects and that addition of butorphanol to this combination prolongs the anesthetic time and induces analgesia for a longer period, but causes a decrease in heart and respiratory rate in cats

Caracterização da doença periodontal em cães com insuficiência renal crônica ou função renal normal

The purpose of this study was to evaluate periodontal disease (PD) in dogs with chronic renal failure (CRF) and to compare it to PD in dogs with normal renal function (NRF). Twelve dogs with CRF and 24 dogs with NRF, all presenting dental pocket formation, were compared. In all dogs, serum creatinine, blood urea nitrogen, urine specific gravity and total red and white blood cells were determined. A complete oral examination was also performed including evaluation of bacterial plaque, gingivitis, gingival recession, pocket, calculus, dental mobility, dental loss, and ulcers. These data were used to calculate plaque index (PI), gingival index (GI) and periodontal destruction index (PDI). PD was graded as mild, moderate or severe based on the results. Mild, moderate or severe PD was observed in dogs with NRF, whereas dogs with CRF presented either mild or severe PD. Dogs with NRF showed higher involvement of the maxillary teeth, whereas dogs with CRF showed a higher involvement of the mandibular teeth. Plaque index was significantly higher in dogs with NRF. It was concluded that lesion distribution and periodontal disease progression may be altered in dogs with CRF, and gingival inflammatory response differs in dogs with NRF and CRF regarding to the stage of periodontal disease.O objetivo deste estudo foi comparar a doença periodontal (DP) em cães com insuficiência renal crônica (IRC) e cães com função renal normal (FRN). Doze animais com IRC e 24 com FRN, apresentando formação de bolsa periodontal foram comparados. Em todos os animais, realizou-se determinação do nível sérico de uréia e creatinina, da densidade urinária e dos valores do hemograma e leucograma. O exame da cavidade oral constou da avaliação do grau de placa bacteriana, gengivite, recessão gengival, bolsa periodontal, cálculo dentário, mobilidade e perda dentária e presença de úlceras. Os dados foram utilizados para determinação do índice de placa dentária (IP), índice gengival (IG) e índice de destruição periodontal (IDP). A DP foi classificada como sendo discreta, moderada ou severa baseada nos achados. Cães com FRN apresentaram DP variando de discreta a severa, enquanto cães com IRC apresentaram DP discreta ou severa. Cães com FRN apresentaram maior envolvimento dos dentes maxilares enquanto animais com IRC apresentaram maior acometimento dos dentes mandibulares. O IP foi significativamente maior em cães com FRN. Concluiu-se que a distribuição e progressão da DP podem apresentar-se de forma alterada em cães com IRC, e que a resposta inflamatória gengival difere em cães com IRC ou FRN, dependendo do grau de DP presente

Isometry of Potential Attachment Sites for the Iliotrochanteric Suture in Dogs: an ex vivo Study

Background: Coxofemoral luxation is the most common traumatic luxation in dogs and the iliotrochanteric suture is one of the surgical treatment options. The orthopedic suture aimed at surgically restoring joint movement should be employed in an isometric manner in order to maintain adequate tension throughout the arc of motion. This study aimed to determine the isometric points for the iliotrochanteric suture in dogs during the joint extension and flexion movements. This evaluation was performed both in the intact hip joint and in the luxation model, establishing the best combination, among the determined points, for the reestablishment of normal joint movement.Materials, Methods & Results: Radiographic analyses of 12 canine cadaveric hips, both intact and in craniodorsal luxation model, were performed in a neutral position, flexion at 50°, and extension at 150°. In the trochanteric segment, two parallel lines were drawn, creating the central vertical axis and the secondary vertical axis. Three points were then determined on each axis, from proximal to distal, corresponding to 25, 50, and 75% of the height of the axis, and were labelled as T1, T2, and T3 and T4, T5, and T6, respectively. In the iliac segment, a line perpendicular to the longitudinal axis of the ilium was drawn, and 25, 50, and 75% of this height corresponded to points I1, I2, and I3, respectively. The lengths between the points were measured, with the objective of evaluating which combination of points presented less variation in the joint positions. The central location of the iliac and trochanteric segments, determined respectively by I2 and T2, provided smaller variations during the maximal movements of hip flexion and extension.Discussion: The surgical techniques of iliotrochanteric suture target to maintain the internal rotation of the femoral head inside the acetabulum and abduction of the femur until the soft tissues have healed. The described techniques for the iliotrochanteric suture present a great anatomical variety in the arrangement of the anchor points of the suture. It is known that if during motion, the attachment sites move closer to one another, the suture will become lax and, if the attachment sites move away from one another, the suture will tighten. Therefore, the implantation in isometric sites assists in reducing the variation of the distance between the points of origin and insertion of the suture during joint movement, keeping the suture tension constant and allowing the functional recovery of the joint. This study demonstrates that there are some locations for the origin and insertion of an iliotrochanteric suture that are associated with less length change than others. I2-T2 combination is the point closest to isometry for the iliotrochanteric suture during hip extension and flexion, so that, T2 is the most central point of the greater trochanter, corresponding to 50% of the height of its central vertical axis, as well as I2, which corresponds to the most central point of the ilium, representing 50% of the height of the most caudal portion of its body. The isometric point found by us details the exact location of perforation in all aspects (height and length), both in the ilium and the trochanter. In addition, it is a personalized point created for each patient from its radiographic examination and taking into consideration its anatomical variations, so that there is no damage to the suture during hip extension and flexion movements

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Discopatia cervical no cão: tratamento cirúrgico através de fenestração ventral. Estudo retrospectivo (1986-1997)

Aproximadamente, 15% das discopatias em cães acometem a região cervical, sendo a dor o principal sinal clínico. Descreve-se a ocorrência de protrusão de disco cervical em 17 cães, agrupados segundo a raça, sexo, peso, idade, assim como a distribuição quanto à duração dos sintomas, acometimento dos discos intervertebrais (DIV), tempo de recuperação e porcentagem de sucesso, em relação à condição neurológica presente antes da cirurgia. A raça Dachshund representou 29,5% (n=5), cães sem raça definida, Poodle e Cocker Spaniel Inglês, 17,6% cada (n=9), Pinscher, 11,8% (n=2) e Dálmata, 5,9% (n=1). Destes, 58,8% eram machos (n=10) e 41,2%, fêmeas (n=7), com peso entre 2 e 29kg, e idade média igual a 5,8 anos. O quadro neurológico desses animais correspondia à dor e ataxia, com exceção de um cão Dálmata, 11 anos de idade, que apresentava tetraparesia. A duração dos sinais variou de 2 a 90 dias. Os DIV mais acometidos foram C2/3 (40%), C3/4 (25%), C4/5 (15%), C5/6 (10%) e C6/7 (10%), sendo que alguns animais apresentavam lesões múltiplas. O procedimento foi padrão para todos os animais, através da fenestração e curetagem de todos os DIV abordados pelo acesso ventral, ou seja, de C2/3 até C6/7, empregando-se para isso instrumental usado para remoção de tártaro dentário (curetas Gracey, curetas McCall, extratores de tártaro S.S.White e McCall). O tempo médio de recuperação foi de 9 a 38 dias, sendo que 100% deles recuperaram totalmente as funções neurológicas. Conclui-se que a fenestração ventral apresenta excelentes resultados no tratamento das discopatias cervicais, desde que bem selecionados os pacientes, inclusive, com respeito aos diagnósticos diferenciais.Approximately 15% of canine disk disease affects the cervical region, with pain being the most significant sign. The authors describe the ocurrence of cervical disk protrusion in 17 dogs, grouped according to the breed, sex, weight, age, duration of symptoms, disk involvement, time elapsed to recuperation after surgery and results. Dachshund represented 29.5% (n=5), mixed-breed dogs, Miniature Poodle and English Cocker Spaniel, 17.6% each (n=9), Miniature Pinscher, 11.8% (n=2) and Dalmatian, 5.9% (n=1). Fifty-eight per cent were males. Weight varied from 2 to 29kg. Mean age at presentation was 5.8 years. All dogs presented neck pain and various degrees of ataxia, exception of one dog that was tetraparetic at time of clinical exam. Duration of clinical signs varied from 2 to 90 days. Intervertebral disks more commonly affected were C2/3 (40%), C3/4 (25%), C4/5 (15%), C5/6 (10%) e C6/7 (10%); some animals presented multifocal involvement. Ventral cervical fenestration was performed in disks C2/3 to C6/7, using tartar scrapers for curetage. Mean time for recuperation was beetwen 9 and 38 days, with 100% of success regarding sensory-motor function. It is concluded that ventral fenestration provides excelent results for the treatment of cervical disk disease, considering case selection

Retrospective study of thoracolumbar ventral fenestration through intercostal thoracotomy and paracostal laparotomy in the dog

Foram analisados os resultados da fenestração ventral dos discos toracolombares em 29 cães agrupados segundo a raça, sexo, peso, idade, graus de déficits neurológicos, duração dos sinais, discos intervertebrais envolvidos, tempo para recuperação e porcentagem de sucesso. A raça Dachshund representou 55,18% (n = 16), cães sem raça definida, 13,8% (n = 4), Poodle e Basset Hound e Cocker Spaniel Inglês 6,89% cada (n = 6), e Pastor Alemão, Beagle e Pinscher, 3,45% cada (n = 3), sendo 51,72%, machos e 48,28%, fêmeas, com idade média de 68,03 meses. O grau de déficits neurológicos correspondeu a: 13,8% dos cães pertencentes ao GI (dor), 41,8% ao GII (paresia), 27,6% ao GIII (paraplegia com dor profunda presente) e 17,2% ao GIV (paraplegia com dor profunda ausente). Os sinais clínicos variaram em duração entre 2 e 60 dias, correspondendo às médias de 18,5 (GI), 12,3 (GII), 8,28 (GIII) e 4,2 dias (GIV). A porcentagem de discos intervertebrais acometidos foi: T10/11 (10,81%), T11/12 (24,33%), T12/13 (40,55%), T13/L1 (16,21%) e L1/2, L2/3 e L3/4, 2,7% cada. O tempo médio de recuperação, em dias, foi: 16 (GI), 19,1 (GII), 20,6 (GIII) e 30,6 (GIV), onde 100% dos animais dos grupos I, II e III recuperaram ambas as funções neurológicas e motoras. O grupo IV apresentou 80% de sucesso. Conclui-se que a fenestração ventral produz excelentes resultados pós-operatórios desde que bem selecionados os casos.The records of 29 dogs, grouped according to breed, sex, age and neurological status, as well as duration of symptoms, T-L disks involved, time elapsed for functional recovery, and success rates were studied. The Dachshund represented 55.18% (n = 16) of the cases, mongrel dogs, 13.8% (n = 4), Poodle, Basset Hound and English Cocker Spaniel, 6.89% each (n = 6) and German Shepherd, Beagle and Pinscher, 3.45% each (n = 3), being 51.72% males and 48.28%, females, with a mean age of 68.03 months. The neurological status corresponded to 13.8% of the dogs belonging to GI (pain), 41.8% to GII (paresis), 27.6% to GIII (paraplegia, with positive deep pain) and 17.2% to GIV (paraplegia with loss of deep pain). Symptoms varied in duration between two and 60 days, corresponding the averages of 18.5 days (GI), 12.3 days (GII), 8.28 days (GIII) and 4.2 days (GIV). Percentage of affected disks was: T10/11 (10.81%), T11/12 (24.33%), T12/13 (40.55%), T13/L1 (16.21%) and L1/2, L2/3 and L3/4, 2.7% each. Mean time of recovery, in days, was: 16 (GI), 19.1 (GII), 20.6 (GIII) and 30.6 (GIV), when 100% of dogs in groups I, II and III recovered both neurological and motor functions. Group IV showed 80% of success. It is concluded that ventral fenestration yields excellent results, although proper case selection must be considered