Humerus Fracture in a Buff-necked Ibis (Theristicus caudatus) - Anesthesia and Surgical Procedures

Background: The medical science of birds, with the exception of aviculture, has a very short history compared to other subdisciplines of veterinary medicine. With this in mind, the current work aims to report the case of a buff-necked ibis with an open fracture of the left humerus, presenting the surgical treatment and anesthetic protocol used, in order to contribute to the avian medical literature.Case: An adult buff-necked ibis (Theristicus caudatus) was referred to the University Veterinary Hospital with an open fracture of the left humeral shaft, 7 days after rescue. During the physical examination, a skin lesion was identified in the fracture area, with signs of low vascularization, devitalization, necrotic tissues, and purulent secretions being noted. On radiographic examination, the fracture was classified as comminuted, with exposure of the left humeral shaft. After evaluatingthe limb, it was decided to amputate the wing, and 24 h later, the patient was referred to the operating room after fasting for 4 h. As pre-anesthetic medication, ketamine (20 mg/kg) and midazolam (1 mg/kg) were administered, both intramuscularly. Orotracheal intubation was performed, after which the tracheal tube was connected to a Baraka-type gas-free system andthe supply of isoflurane was started through a universal vaporizer, diluted in 100% oxygen. For transoperative analgesia, brachial plexus block was performed using 2% lidocaine (2 mg/kg). During the surgical procedure, an incision was made in the skin and subcutaneous tissue in the middle third of the left humerus, and detachment of the greater deltoid muscle was performed with a periosteal elevator, followed by excision of the tensor propatagialis. In the ventrodorsal region, circular ligation of the brachial vein, ulnar vein and artery, and median-ulnar nerve was carried out, and disarticulation of the scapulacoracoid-humeral region. Subsequently, abolition of dead space and a myorrhaphy were performed, followed by demorrhaphy. In the immediate post-operative period, morphine (5 mg/kg), meloxicam (0.1 mg/kg), and enrofloxacin (10 mg/kg) were administered intramuscularly. The patient was discharged from the hospital 6 h after the end of the surgical procedure.Discussion: Interest in the conservation of wild birds is one of the causes of the increased demand for anesthetic and surgical procedures in these species. However, it is a challenge for professionals in the field. The use of analgesics is recommended for reasons of well-being, but also because of the possibility of reducing the concentration of inhalational anesthetics in surgical procedures. Ketamine associated with midazolam promotes sufficient sedation and muscle relaxation in the patient, enabling safe preoperative management, in addition to reducing the amount of inhaled anesthetics used during the transoperative period. Isofluorane promotes safe general anesthesia for birds and has an advantage over injectable drugs, as it provides better dynamic control of anesthetic depth in these species. The brachial plexus block performed is a simple procedure that promotes quality anesthesia and analgesia in the perioperative period. The choice for amputation was due to the absence of musculature for closure, severe skin, muscle, and bone devitalization, and the infectious process in the region, factors that would prevent osteosynthesis. Although amputation through the bone is preferable, the disarticulation technique was used due to the absence of a healthy proximal humeral fragment. The patient’s death can be explained by the poor nutritional status the bird was in, as it presented an open fracture with severe contamination, a concomitant injury that occurred during the possible trauma, and the excessive time between the day of the trauma and the day of medical attendance. However, the surgical and anesthetic procedures were adequate and satisfactory for the patient. The importance of identifying and treating diseases secondary to contaminated fractures in these species is emphasized. Keywords: bird, avian medicine, fauna, lesions, recovery. Título: Fratura de úmero em uma curicaca (Theristicus caudatus) - manejo anestésico e cirúrgico Descritores: aves, medicina aviária, fauna, lesões, recuperação

Consolidation of Tibia Fractures in Rabbits

Background: Disorders of the locomotor system are among the main treatments for this species, among the main causes are falls from a cage, arms or stairs and aggression by animals, such as dogs and cats. Biological osteosynthesis promotes early formation of secondary bone callus and allows a less accurate reconstruction of difficult interfragmentary apposition of 100% of the fragments. The objective of this work is to report the method of external immobilization with an aluminum channel aiming at the use of bone biology for the healing of unexposed tibial fractures in 3 rabbits (Oryctolagus cuniculus). Cases: Between 2020 and 2021, 3 cases of rabbits with unexposed tibial fractures were treated at the Veterinary Hospital. The 3 patients were diagnosed through physical examination and radiographic examination. All patients underwent anesthesia, underwent external immobilization with an aluminum channel, received analgesics and anti-inflammatory drugs, and recommended rest and care with the maintenance of external immobilization. Approximately at 30 days of rigid immobilization, all cases were evaluated by means of radiographic examination revealing the formation of bone callus at different post-immobilization times in the case 1 - 30 days, case 2 - 23 days and case 3 - 37 days. Discussion: Some surgical principles in rabbits must be followed, such as preserving vascularity if the open technique is decided, providing adequate diet, controlling edema, promoting analgesia and deciding on closed reduction if the fracture is recent and stable. The external coaptation method is a non-invasive method for the treatment of fractures and is also indicated with a high success rate for fractures of metacarpal, metatarsal and phalange bones in rabbits. The patient's age contributed to the early healing, which corroborates with case 1 (3-month-old), case 2 (6-month-old) and a little later the healing in case 3 (24-month-old), allowing unrestricted use of the member. It is worth reinforcing the point of view which defends that "biological osteosynthesis" promotes a favorable environment, especially in the preservation of the vascular supply of the periosteum when compared to traditional open surgical approaches. In this species, the surgical approach is a challenge due to the fact that the bones break or crack very easily, because the bones have a low density and higher mineral composition. Together, the skeleton represents 7% of the body weight, lower when compared to dogs and cats, which is 12%. In addition to these factors, rabbits are prone to secondary fractures, postoperative infections and rapid development of osteomyelitis, which significantly worsens the prognosis. The aluminum used in the manufacture of the aluminum channel has properties that offer resistance, lightness and radio transparency radiographic examination without removal of the channel, avoiding excessive micro-movement of the focus of the fracture due to lack of stabilization and possible refracture of the tibia. Rigid external immobilization with an aluminum channel was satisfactory in the 3 patients evaluated and preserved bone biology and anatomical axis. The treatment of choice was easy to apply, in addition to enabling better radiographic follow-up, promoting rapid bone healing for patients and early use of limbs without restrictions. However, for the effectiveness of the technique, the collaboration of tutors is essential. Keywords: biological, fracture, immobilization, osteosynthesis, orthopedics. Título: Consolidação de fraturas de tíbia em coelhos Descritores:  biológica, fratura, imobilização, osteossíntese, ortopedia

Humerus Fracture in a Buff-necked Ibis (Theristicus caudatus) - Anesthesia and Surgical Procedures

Background: The medical science of birds, with the exception of aviculture, has a very short history compared to other subdisciplines of veterinary medicine. With this in mind, the current work aims to report the case of a buff-necked ibis with an open fracture of the left humerus, presenting the surgical treatment and anesthetic protocol used, in order to contribute to the avian medical literature.Case: An adult buff-necked ibis (Theristicus caudatus) was referred to the University Veterinary Hospital with an open fracture of the left humeral shaft, 7 days after rescue. During the physical examination, a skin lesion was identified in the fracture area, with signs of low vascularization, devitalization, necrotic tissues, and purulent secretions being noted. On radiographic examination, the fracture was classified as comminuted, with exposure of the left humeral shaft. After evaluatingthe limb, it was decided to amputate the wing, and 24 h later, the patient was referred to the operating room after fasting for 4 h. As pre-anesthetic medication, ketamine (20 mg/kg) and midazolam (1 mg/kg) were administered, both intramuscularly. Orotracheal intubation was performed, after which the tracheal tube was connected to a Baraka-type gas-free system andthe supply of isoflurane was started through a universal vaporizer, diluted in 100% oxygen. For transoperative analgesia, brachial plexus block was performed using 2% lidocaine (2 mg/kg). During the surgical procedure, an incision was made in the skin and subcutaneous tissue in the middle third of the left humerus, and detachment of the greater deltoid muscle was performed with a periosteal elevator, followed by excision of the tensor propatagialis. In the ventrodorsal region, circular ligation of the brachial vein, ulnar vein and artery, and median-ulnar nerve was carried out, and disarticulation of the scapulacoracoid-humeral region. Subsequently, abolition of dead space and a myorrhaphy were performed, followed by demorrhaphy. In the immediate post-operative period, morphine (5 mg/kg), meloxicam (0.1 mg/kg), and enrofloxacin (10 mg/kg) were administered intramuscularly. The patient was discharged from the hospital 6 h after the end of the surgical procedure.Discussion: Interest in the conservation of wild birds is one of the causes of the increased demand for anesthetic and surgical procedures in these species. However, it is a challenge for professionals in the field. The use of analgesics is recommended for reasons of well-being, but also because of the possibility of reducing the concentration of inhalational anesthetics in surgical procedures. Ketamine associated with midazolam promotes sufficient sedation and muscle relaxation in the patient, enabling safe preoperative management, in addition to reducing the amount of inhaled anesthetics used during the transoperative period. Isofluorane promotes safe general anesthesia for birds and has an advantage over injectable drugs, as it provides better dynamic control of anesthetic depth in these species. The brachial plexus block performed is a simple procedure that promotes quality anesthesia and analgesia in the perioperative period. The choice for amputation was due to the absence of musculature for closure, severe skin, muscle, and bone devitalization, and the infectious process in the region, factors that would prevent osteosynthesis. Although amputation through the bone is preferable, the disarticulation technique was used due to the absence of a healthy proximal humeral fragment. The patient’s death can be explained by the poor nutritional status the bird was in, as it presented an open fracture with severe contamination, a concomitant injury that occurred during the possible trauma, and the excessive time between the day of the trauma and the day of medical attendance. However, the surgical and anesthetic procedures were adequate and satisfactory for the patient. The importance of identifying and treating diseases secondary to contaminated fractures in these species is emphasized. Keywords: bird, avian medicine, fauna, lesions, recovery. Título: Fratura de úmero em uma curicaca (Theristicus caudatus) - manejo anestésico e cirúrgico Descritores: aves, medicina aviária, fauna, lesões, recuperação

Feminization Syndrome in a Dog with Sertoli Cell Tumor

Background: The uncontrolled multiplication of Sertoli cells causes Sertoli cell tumor or Sertolioma. Because of this, the level of estrogen in the bloodstream increases rapidly and approximately 25% of dogs with this tumor develop feminization syndrome. Testicular neoplasms are more common in dogs than cats, and are often found in elderly patients. This work aims to describe the clinical signs of the feminization syndrome and the treatment instituted in a canine diagnosed with sertolioma. Case: A 18-year-old male canine, 19.5 kg of body mass, with an increase in testicular volume for about 2 years, was treated at the University Veterinary Hospital. On clinical examination, a matte and brittle coat, alopecia on the hind limbs and gynecomastia were observed. Also noted, non-harmonious aspect of the scrotum, pendular foreskin, atrophied right testicle and hyperplastic left, scrotal hyperthermia and absence of pain. In addition, as a result of the hyperestrogenism resulting from the neoplasm, the paraneoplastic syndrome of feminization, the patient also presented galactorrhea, pendular foreskin, atrophy of the penis and the contralateral testicle, dermatopathies, such as bilateral symmetrical alopecia of the flanks, easily removable hair and variable hyperpigmentation. Rectal body temperature of 38.6°C, clear lung auscultation and muffled cardiac auscultation. The results of laboratory tests showed changes such as thrombocytopenia, platelet counts below the reference levels, platelet count of 163,000/uL. There were no alterations that represented metastases in the imaging exams, such as in the chest X-ray in three incidences and in the abdominal ultrasonography. Then, we opted for the surgical procedure of orchiectomy, with the traditional technique of three clamps, associated with total ablation of the scrotum. Samples were sent to the histopathology laboratory and the diagnosis of sertolioma was confirmed. At 10, 30 and 90 days after the operation, the patient was reassessed for possible recurrences or alterations, but there were no complications or recurrence after the procedure. Discussion: Neoplasms of the male reproductive system are common in dogs. Sertolioma is considered one of the most frequent neoplasms in elderly dogs and that results in systemic clinical signs. This is in line with the 18-year-old dog described in the present report. In addition, it may result in clinical signs resulting from hyperestrogenism resulting from the neoplasm that is called paraneoplastic feminization syndrome. The characteristics of this syndrome are: gynecomastia, galactorrhea, pendular foreskin, atrophy of the penis and contralateral testicle, associated with dermatopathies, such as symmetrical bilateral alopecia. All these clinical signs were present. The diagnosis is made through complete anamnesis, complete clinical examination and complementary examination such as ultrasound help in the presumptive diagnosis, but only with histopathology can it be confirmed. In the clinical approach, histopathology was performed to close the diagnosis. Treatment is behind orchiectomy and total ablation of the scrotum, which was performed in the reported case. The treatment of choice was easy to apply, in addition to improving the patient's quality of life, promoting rapid post-surgical healing and an early return to normal life. However, for the effectiveness of the technique, the early diagnosis and collaboration of tutors is fundamental. Keywords: canine, surgery, neoplasm, orchiectomy. Título: Síndrome da feminilização em cão com sertolioma. Descritores: cão, cirurgia, neoplasia, orquiectomia.Background: The uncontrolled multiplication of Sertoli cells causes Sertoli cell tumor or Sertolioma. Because of this, the level of estrogen in the bloodstream increases rapidly and approximately 25% of dogs with this tumor develop feminization syndrome. Testicular neoplasms are more common in dogs than cats, and are often found in elderly patients. This work aims to describe the clinical signs of the feminization syndrome and the treatment instituted in a canine diagnosed with sertolioma. Case: A 18-year-old male canine, 19.5 kg of body mass, with an increase in testicular volume for about 2 years, was treated at the University Veterinary Hospital. On clinical examination, a matte and brittle coat, alopecia on the hind limbs and gynecomastia were observed. Also noted, non-harmonious aspect of the scrotum, pendular foreskin, atrophied right testicle and hyperplastic left, scrotal hyperthermia and absence of pain. In addition, as a result of the hyperestrogenism resulting from the neoplasm, the paraneoplastic syndrome of feminization, the patient also presented galactorrhea, pendular foreskin, atrophy of the penis and the contralateral testicle, dermatopathies, such as bilateral symmetrical alopecia of the flanks, easily removable hair and variable hyperpigmentation. Rectal body temperature of 38.6°C, clear lung auscultation and muffled cardiac auscultation. The results of laboratory tests showed changes such as thrombocytopenia, platelet counts below the reference levels, platelet count of 163,000/uL. There were no alterations that represented metastases in the imaging exams, such as in the chest X-ray in three incidences and in the abdominal ultrasonography. Then, we opted for the surgical procedure of orchiectomy, with the traditional technique of three clamps, associated with total ablation of the scrotum. Samples were sent to the histopathology laboratory and the diagnosis of sertolioma was confirmed. At 10, 30 and 90 days after the operation, the patient was reassessed for possible recurrences or alterations, but there were no complications or recurrence after the procedure. Discussion: Neoplasms of the male reproductive system are common in dogs. Sertolioma is considered one of the most frequent neoplasms in elderly dogs and that results in systemic clinical signs. This is in line with the 18-year-old dog described in the present report. In addition, it may result in clinical signs resulting from hyperestrogenism resulting from the neoplasm that is called paraneoplastic feminization syndrome. The characteristics of this syndrome are: gynecomastia, galactorrhea, pendular foreskin, atrophy of the penis and contralateral testicle, associated with dermatopathies, such as symmetrical bilateral alopecia. All these clinical signs were present. The diagnosis is made through complete anamnesis, complete clinical examination and complementary examination such as ultrasound help in the presumptive diagnosis, but only with histopathology can it be confirmed. In the clinical approach, histopathology was performed to close the diagnosis. Treatment is behind orchiectomy and total ablation of the scrotum, which was performed in the reported case. The treatment of choice was easy to apply, in addition to improving the patient's quality of life, promoting rapid post-surgical healing and an early return to normal life. However, for the effectiveness of the technique, the early diagnosis and collaboration of tutors is fundamental. Keywords: canine, surgery, neoplasm, orchiectomy. Título: Síndrome da feminilização em cão com sertolioma. Descritores: cão, cirurgia, neoplasia, orquiectomia

Síndrome da feminização em canino com sertolioma: 1Programa de Residência Uniprofissional em Medicina Veterinária, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.2Programa de Pós-Graduação e Pesquisa em Medicina Veterinária (PPGMV), UFSM, Santa Maria, RS, Brazil. CORRESPONDENCE: L.F.D Corrêa [[email protected]], Hospital Veterinário Universitário, UFSM, CEP 97105-900, Santa Maria, RS, Brazil.

Background: The uncontrolled multiplication of Sertoli cells causes Sertoli cell tumor or Sertolioma. Because of this, the level of estrogen in the bloodstream increases rapidly and approximately 25% of dogs with this tumor develop feminization syndrome. Testicular neoplasms are more common in dogs than cats, and are often found in elderly patients. This work aims to describe the clinical signs of the feminization syndrome and the treatment instituted in a canine diagnosed with sertolioma. Case: A 18-year-old male canine, 19.5 kg of body mass, with an increase in testicular volume for about 2 years, was treated at the University Veterinary Hospital. On clinical examination, a matte and brittle coat, alopecia on the hind limbs and gynecomastia were observed. Also noted, non-harmonious aspect of the scrotum, pendular foreskin, atrophied right testicle and hyperplastic left, scrotal hyperthermia and absence of pain. In addition, as a result of the hyperestrogenism resulting from the neoplasm, the paraneoplastic syndrome of feminization, the patient also presented galactorrhea, pendular foreskin, atrophy of the penis and the contralateral testicle, dermatopathies, such as bilateral symmetrical alopecia of the flanks, easily removable hair and variable hyperpigmentation. Rectal body temperature of 38.6°C, clear lung auscultation and muffled cardiac auscultation. The results of laboratory tests showed changes such as thrombocytopenia, platelet counts below the reference levels, platelet count of 163,000/uL. There were no alterations that represented metastases in the imaging exams, such as in the chest X-ray in three incidences and in the abdominal ultrasonography. Then, we opted for the surgical procedure of orchiectomy, with the traditional technique of three clamps, associated with total ablation of the scrotum. Samples were sent to the histopathology laboratory and the diagnosis of sertolioma was confirmed. At 10, 30 and 90 days after the operation, the patient was reassessed for possible recurrences or alterations, but there were no complications or recurrence after the procedure. Discussion: Neoplasms of the male reproductive system are common in dogs. Sertolioma is considered one of the most frequent neoplasms in elderly dogs and that results in systemic clinical signs. This is in line with the 18-year-old dog described in the present report. In addition, it may result in clinical signs resulting from hyperestrogenism resulting from the neoplasm that is called paraneoplastic feminization syndrome. The characteristics of this syndrome are: gynecomastia, galactorrhea, pendular foreskin, atrophy of the penis and contralateral testicle, associated with dermatopathies, such as symmetrical bilateral alopecia. All these clinical signs were present. The diagnosis is made through complete anamnesis, complete clinical examination and complementary examination such as ultrasound help in the presumptive diagnosis, but only with histopathology can it be confirmed. In the clinical approach, histopathology was performed to close the diagnosis. Treatment is behind orchiectomy and total ablation of the scrotum, which was performed in the reported case. The treatment of choice was easy to apply, in addition to improving the patient's quality of life, promoting rapid post-surgical healing and an early return to normal life. However, for the effectiveness of the technique, the early diagnosis and collaboration of tutors is fundamental. Keywords: canine, surgery, neoplasm, orchiectomy. Título: Síndrome da feminilização em cão com sertolioma. Descritores: cão, cirurgia, neoplasia, orquiectomia.Antecedentes: A multiplicação descontrolada das células de Sertoli causa o tumor de células de Sertoli. Devido a isso, o nível de estrogênio na corrente sanguínea aumenta rapidamente e aproximadamente 25% dos cães com esse tumor desenvolvem síndrome de feminização. Este estudo tem como objetivo descrever os sinais clínicos da síndrome da feminização e o tratamento instituído em um canino diagnosticado com sertolioma.Caso: Um canino macho de 18 anos, 19,5 kg de massa corporal, foi atendido no Hospital Veterinário Universitário, com aumento de volume testicular há cerca de dois anos. Ao exame clínico observou-se pelagem baça e quebradiça, alopecia nos membros pélvicos e ginecomastia. Ao exame físico, observou-se aspecto não harmônico da bolsa escrotal, prepúcio pendular, testículo direito atrofiado e testículo esquerdo hiperplásico, hipertermia escrotal e ausência de dor. Os resultados dos exames laboratoriais mostraram trombocitopenia como alteração. Optou-se então pelo procedimento cirúrgico de orquiectomia associada à ablação da bolsa escrotal. Aos 10, 30 e 90 dias após a cirurgia, o paciente foi reavaliado e não houve complicações ou recidiva neoplásica. Em decorrência do hiperestrogenismo decorrente da neoplasia, a síndrome paraneoplásica da feminização é caracterizada por ginecomastia, galactorreia, prepúcio pendular, atrofia do pênis e testículo contralateral, associada a dermatopatias como alopecia bilateral simétrica, pelos facilmente removíveis e hiperpigmentação variável. Todos esses sinais clínicos estavam presentes no paciente relatado.Discussão: Neoplasias do aparelho reprodutor masculino são comuns em cães e o tumor de células de Sertoli é considerado uma das neoplasias mais frequentes em cães idosos e resulta em sinais clínicos sistêmicos. O diagnóstico precoce aliado a um manejo clínico-cirúrgico adequado para promover uma melhora na qualidade de vida do paciente.Palavras-chave: cirurgia, neoplasia, orquiectomia.Descritores: cirurgia, neoplasia, orquiectomia

Consolidation of Tibia Fractures in Rabbits

Background: Disorders of the locomotor system are among the main treatments for this species, among the main causes are falls from a cage, arms or stairs and aggression by animals, such as dogs and cats. Biological osteosynthesis promotes early formation of secondary bone callus and allows a less accurate reconstruction of difficult interfragmentary apposition of 100% of the fragments. The objective of this work is to report the method of external immobilization with an aluminum channel aiming at the use of bone biology for the healing of unexposed tibial fractures in 3 rabbits (Oryctolagus cuniculus). Cases: Between 2020 and 2021, 3 cases of rabbits with unexposed tibial fractures were treated at the Veterinary Hospital. The 3 patients were diagnosed through physical examination and radiographic examination. All patients underwent anesthesia, underwent external immobilization with an aluminum channel, received analgesics and anti-inflammatory drugs, and recommended rest and care with the maintenance of external immobilization. Approximately at 30 days of rigid immobilization, all cases were evaluated by means of radiographic examination revealing the formation of bone callus at different post-immobilization times in the case 1 - 30 days, case 2 - 23 days and case 3 - 37 days. Discussion: Some surgical principles in rabbits must be followed, such as preserving vascularity if the open technique is decided, providing adequate diet, controlling edema, promoting analgesia and deciding on closed reduction if the fracture is recent and stable. The external coaptation method is a non-invasive method for the treatment of fractures and is also indicated with a high success rate for fractures of metacarpal, metatarsal and phalange bones in rabbits. The patient's age contributed to the early healing, which corroborates with case 1 (3-month-old), case 2 (6-month-old) and a little later the healing in case 3 (24-month-old), allowing unrestricted use of the member. It is worth reinforcing the point of view which defends that "biological osteosynthesis" promotes a favorable environment, especially in the preservation of the vascular supply of the periosteum when compared to traditional open surgical approaches. In this species, the surgical approach is a challenge due to the fact that the bones break or crack very easily, because the bones have a low density and higher mineral composition. Together, the skeleton represents 7% of the body weight, lower when compared to dogs and cats, which is 12%. In addition to these factors, rabbits are prone to secondary fractures, postoperative infections and rapid development of osteomyelitis, which significantly worsens the prognosis. The aluminum used in the manufacture of the aluminum channel has properties that offer resistance, lightness and radio transparency radiographic examination without removal of the channel, avoiding excessive micro-movement of the focus of the fracture due to lack of stabilization and possible refracture of the tibia. Rigid external immobilization with an aluminum channel was satisfactory in the 3 patients evaluated and preserved bone biology and anatomical axis. The treatment of choice was easy to apply, in addition to enabling better radiographic follow-up, promoting rapid bone healing for patients and early use of limbs without restrictions. However, for the effectiveness of the technique, the collaboration of tutors is essential. Keywords: biological, fracture, immobilization, osteosynthesis, orthopedics. Título: Consolidação de fraturas de tíbia em coelhos Descritores:  biológica, fratura, imobilização, osteossíntese, ortopedia