Infiltrative Lipoma - Atypical Presentation in a Bitch

Background: Primary pelvic tumors have a less favorable prognosis when compared to long bone tumors. Infiltrativelipomas are benign neoplasms of mesenchymal origin, but with an invasive nature, in which highly differentiated adipocytes infiltrate tissues such as muscles, connective tissues, bones, peripheral nerves and spinal cord. Reports of infiltrative lipoma causing bone and joint damage are rare, so the objective of this report is to present clinical-surgical aspects and particularities involved in the treatment of a bitch, with an extensive tumoral mass in the left pelvic limb and coxofemoral and femoro-tibio-patellar joint destruction. The treatment used in search of a cure for the patient is highlighted.Case: One bitch, 1 and a half years old, not neutered, Australian Cattle, 13 kg body weight, with a history of increased volume in the left pelvic limb for approximately 1 year, was admitted at the Veterinary Hospital. The radiographic examination showed loss of delimitation of the coxofemoral joint, irregularity, and the presence of a proliferative and lytic process in the femoro-tibio-patellar portion, in addition to an increase in volume in adjacent soft tissue. A thoracic radiographic study was also carried out to search for metastases and cytological examination by fine-needle aspiration in several points of the limb, including the popliteal lymph node. Aggressive surgical treatment was based on evidence of bone destruction and existing damage to the joints. A mid-to-caudal partial hemipelvectomy was chosen, accompanied by limb amputation. To perform the surgery, a tumor-free area was identified and osteotomy was performed at three points, in the body of the proximal ilium, ischium plate, and pubic body. Due to the removal of the limb and the tumor, there was no muscle to close the pelvic wall, requiring the use of polypropylene mesh to correct the defect. The patient was discharged from the hospital after 24 h. The histopathological analysis of the limb revealed that it was an infiltrative lipoma, which showed infiltration of superficial and deep muscle tissue and marked degenerative lesions in the hip and femoro-tibio-patellar joints. In the macroscopy, the extension of the neoplastic mass was evident and when cutting, the loss of bone architecture. Radiographic images were also compatible with invasion and destruction of the bone delimitation. The patient was evaluated 10, 30, and 120 days post-operatively, and the animal presented a quick recovery. However, 161 days after surgery it was necessary to remove the polypropylene mesh due to its contamination. Discussion: Invasion of infiltrative lipoma into bones has been reported in only 3 dogs. Furthermore, due to the difficult macroscopic differentiation between infiltrative lipoma and normal tissue, the reported recurrence rate after surgical resection varies between 36 and 50%. Hemipelvectomy is a radical surgical procedure indicated for the management of tumors and functional abnormalities involving the pelvis or adjacent soft tissue. In canine patients diagnosed with infiltrative lipoma, surgery is reported to increase life expectancy. In studies, median survival time of 4 patients was 940 days and 13 dogs treated with cobalt radiation 60, of which 10 also underwent cytoreductive surgery, survived from 6 to 94 months. The patient in the current report survived for 21 months after the postoperative period, which is in agreement with the researchs. A case of atypical infiltrative lipoma and consequent joint destruction was highlighted in this work. However, partial hemipelvectomy was effective in the treatment, curing the alteration, despite contamination of the mesh which led to the need for surgical intervention.Keywords: surgery, complications, hemipelvectomy, polypropylene mesh

Microcirurgia para correção de atresia anal em dois cães

Background: Anal atresia is the most common anorectal malformation in dogs. The treatment of choice for this type of deformity is surgical, with the possibility of postoperative complications. Hyperbaric oxygen therapy (HBOT) consists of offering 100% oxygen in pressurized environments. HBOT causes tissue hyperoxygenation, stimulation of fibroblast angiogenesis and tissue proliferation and is recommended for tissue injuries and for cicatrisation. This work describes the surgical correction of cases of anal atresia in 2 young dogs, 1 of which is associated with a rectovaginal fistula, using microsurgical techniques. In addition, it also describes the associated complications, such as rectal stenosis and vaginal prolapse.Cases: Case 1. Describes a 21-day-old, mixed-breed male dog, with no fecal elimination since birth, caused by type III anal atresia. The patient was submitted to the procedure using a surgical microscope with 10x magnification. The skin and subcutaneous tissue were incised over the anal dimple area and the rectum was located and incised up to the lumen. The mucocutaneous suture was performed in a simple isolated pattern with 6-0 polydioxanone, circling the rectal access at 360°. Subsequently, he developed anal stenosis, treated with anal dilation procedures using balloon endotracheal tubesand enemas. The patient died at home, with no possibility of confirming the cause of death. Case 2. Reports the micro-surgical procedure performed on a 60-day-old bitch with type III anal atresia associated with a rectovaginal fistula. The procedure started with episiotomy to identify the presence of communication of the roof of the vagina and the ventral wall of the rectum. The communication was identified with approximately one centimeter of depth. Ligature was performed for occlusion of the rectovaginal communication, with 6-0 polydioxanone. Anal atresia was corrected in a manner similar to that previously described, with a cross cutaneous incision in the anal dimple area. After identification of the rectum, an incision up to the lumen was performed followed by a 360° mucocutaneous suture using 6-0 polydioxanone thread in a simple isolated pattern. The vaginal roof was reconstructed. The patient presented stitches dehiscence treated conservatively and with an association of 2 sessions of hyperbaric oxygen therapy at 2ATA. After 250 days, the patient developed vaginal prolapse type III and was subjected to clinical therapy and ovariectomy. Conservative treatment did not have the expected effect. Therefore, the patient was referred for vaginal ressection with vulvoplasty. The patient is clinically stable 900 days after the last surgical procedure. Discussion: The greatest difficulty is the presence of delicate tissues and impaired visualization due to the location of theblind end of the rectal pouch within the pelvic cavity. The surgeries were considered satisfactory and the postoperative complications were consistent with what was reported in the literature. The use of microsurgery provided excellent visualization of the structures, preservation of the anal sphincter in case 2, and precise mucocutaneous suture. HBOT helped the patient’s healing process. This is the 1 st report of vaginal prolapse in a bitch with anal atresia. It is concluded that the microsurgery is an excellent tool for the treatment of anal atresia in dogs. Keywords: anorectal malformation, surgical microscope, veterinary surgery, vaginal prolapse.Background: A atresia anal é a malformação anorretal mais comum em cães. O tratamento de escolha para esse tipo de deformidade é cirúrgico, com a possibilidade de complicações pós-operatórias. A terapia com oxigênio hiperbárico (HBOT) consiste em oferecer 100% de oxigênio em ambientes pressurizados. O HBOT causa hiperoxigenação dos tecidos, estimula a angiogênese dos fibroblastos e a proliferação tecidual, sendo recomendado para lesões teciduais e cicatrização. Este trabalho descreve a correção cirúrgica de dois casos de atresia anal em dois cães jovens, um dos quais associado a uma fístula reto-vaginal, utilizando técnicas microcirúrgicas. Além disso, descreve as complicações associadas, como estenose retal e prolapso vaginal. Cases: O Caso 1 descreve um cão macho de raça mista, com 21 dias de idade, sem eliminação fecal desde o nascimento, causada pela atresia anal do tipo III. O paciente foi submetido ao procedimento utilizando um microscópio cirúrgico com aumento de 10x. A pele e o tecido subcutâneo foram incisados sobre a área do orifício anal, e o reto foi localizado e incisado até o lúmen. A sutura mucocutânea foi realizada em padrão isolado simples com fio de polidioxanona 6-0, circundando o acesso retal a 360°. Posteriormente, desenvolveu estenose anal, tratada com procedimentos de dilatação anal usando tubos endotraqueais balão e enemas. O paciente faleceu em casa, sem possibilidade de confirmar a causa da morte. O Caso 2 relata o procedimento microcirúrgico realizado em uma cadela de 60 dias com atresia anal do tipo III associada a uma fístula reto-vaginal. O procedimento começou com uma episiotomia para identificar a comunicação entre o teto da vagina e a parede ventral do reto. A comunicação foi identificada com aproximadamente um centímetro de profundidade. Foi realizada ligadura para oclusão da comunicação reto-vaginal, com polidioxanona 6-0. A atresia anal foi corrigida de maneira semelhante ao descrito anteriormente, com uma incisão cutânea cruzada na área do orifício anal. Após a identificação do reto, foi realizada uma incisão até o lúmen, seguida por uma sutura mucocutânea a 360° usando fio de polidioxanona 6-0 em padrão isolado simples. O teto vaginal foi reconstruído. O paciente apresentou deiscência de pontos tratada de forma conservadora e com duas sessões de terapia com oxigênio hiperbárico a 2ATA. Após 250 dias, o paciente desenvolveu prolapso vaginal tipo III e foi submetido a terapia clínica e ovariohisterectomia. O tratamento conservador não teve o efeito esperado. Portanto, o paciente foi encaminhado para ressecção vaginal com vulvoplastia. O paciente está clinicamente estável 900 dias após o último procedimento cirúrgico. Discussion: A maior dificuldade é a presença de tecidos delicados e a visualização prejudicada devido à localização do extremo cego da bolsa retal dentro da cavidade pélvica. As cirurgias foram consideradas satisfatórias, e as complicações pós-operatórias foram consistentes com o que foi relatado na literatura. O uso da microcirurgia proporcionou excelente visualização das estruturas, preservação do esfíncter anal no caso 2 e sutura mucocutânea precisa. O HBOT auxiliou no processo de cicatrização do paciente. Este é o primeiro relato de prolapso vaginal em uma cadela com atresia anal. Conclui-se que a microcirurgia é uma excelente ferramenta para o tratamento da atresia anal em cães

TORACOSCOPIA NO DIAGNÓSTICO E NA LIBERAÇÃO DE ADERÊNCIAS PÓS-TORACOTOMIA E PÓS-CTVA (Cirurgia Torácica Vídeo-Assistida): ESTUDO EXPERIMENTAL EM CÃES

Fourteen adult mongrel dogs were used, 7 males and 7 females, proceeding from the Federal University ofSanta Maria, aiming to study thoracoscopy to evaluate comparatively the presence and attempt to liberatepost thoracotomy adhesions (TI) and post video-assisted thoracic surgery (VATS). The animals were dividedin 2 groups. In the X group, the visibilization and attempt of liberate adhesions after VATS were carriedthrough from 3 to 5 days (B1) and from 9 to 11 days (B3) after thoracotomy. In group Y, the procedures werecarried through from 6 to 8 days post thoracotomy (B2). Blood samples for CK screening were taken beforeTI (A0), after the end of the surgical procedure (A1), and in the next 2 days (A2 and A3). The adhesionsenclose the location of VATS and thoracotomy incisions, and their extension is smaller after VATS, due tosmaller tissue damage extension. It is possible to liberate the adhesions by thoracoscopy in up to 5 daysfrom surgical procedure, using two work ports. The increase of the CK seric levels is proportional to thetissue damage. In conclusion, thoracoscopy can be used to diagnose thoracotomy and VATS adhesions,and liberate the adhesion in up to 5 days after the surgical procedure. High incidence of adhesions in thisstudy may lead to serious surgical risks and requires special care in future reinterventions. The ethiccommission from UFSM approved this study UFSM (012/2005). All animals were adopted.Foram utilizados 14 cães, 7 machos e 7 fêmeas, provenientes do Biotério Central da UFSM, objetivando-seutilizar a toracoscopia para avaliar comparativamente a presença e a possibilidade de liberação deaderências pós-toracotomia e pós-CTVA (Cirurgia Torácica Vídeo-Assistida). Todos os animais foramsubmetidos à toracotomia TI e após, estes foram divididos em 2 grupos. No grupo X, a visibilização, aliberação das aderências e a CTVA foram realizadas entre 3 e 5 dias (B1) e entre 9 e 11 dias (B3) de pósoperatório,e no grupo Y, os procedimentos foram realizados entre 6 e 8 dias após a toracotomia (B2). Foicolhido sangue para dosagem de CK (creatina quinase) em diferentes tempos para avaliar a intensidade detrauma tecidual. As aderências localizaram-se nos locais das incisões de CTVA e de toracotomia,apresentando extensão menor após CTVA, devido a menor extensão de dano tecidual. Foi possível realizara liberação de aderências por toracoscopia em até cinco dias de pós-operatório utilizando dois portais. Nascondições em que este trabalho foi realizado, conclui-se que a toracoscopia mostra-se eficiente paradiagnosticar aderências provenientes de toracotomia e de CTVA e podem-se liberar as aderências até cincodias de pós-operatório. A alta incidência de aderências para os procedimentos testados predispõe a sériosriscos cirúrgicos e requer cuidados especiais em futuras re-intervenções, Este estudo foi aprovado pelacomissão de ética da UFSM (012/2005). Todos os animais foram adotados