Acompanhamento radiográfico e ultrassonográfico de calcificação distrófica no ligamento sesamoideo oblíquo em cavalo de salto. Seguimento durante 20 meses

Mineralization of the anatomical structures involved in the limb movement of horses has been reported to induce lameness and interfere with athletic performance. A 4-year-old jumping horse in sport activity was reported at Veterinary Hospital of University of São Paulo, with mild lameness and a mineralized oblique distal sesamoidean ligament (ODSL) of the left forelimb, revealed by a purchase radiographic and ultrasound examination. Mineralization is more common in tendons than ligaments. This report calls for attention to these structures when performing image exams, even in mild lameness. Long-term favorable follow-up by ultrasonographic and radiographic examination showed that the severe ligament injury in this case did not decrease the athletic activity until the present day. A mineralização de estruturas anatômicas envolvidas na movimentação dos membros predispõe à claudicação e interfere no desempenho atlético. Foi admitido no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da USP-SP um equino macho, da raça Brasileiro de Hipismo, com quatro anos de idade e histórico de claudicação leve e ligamento sesamoideo oblíquo distal mineralizado do membro torácico esquerdo, diagnosticado por exame de compra. A mineralização apresenta alta incidência em tendões, sendo em menor proporção nos ligamentos. Esse relato visa atentar à essas estruturas ao se realizar exames rotineiros de imagem, apesar de claudicação leve. O acompanhamento a longo prazo por ultrassonografia e radiografia mostrou que lesões graves de ligamentos, como no presente caso, não diminuíram a atividade atlética até o momento

Comparative study of equine mesenchymal stem cells from healthy and injured synovial tissues: an in vitro assessment

Abstract\ud \ud Background\ud Bone marrow and adipose tissues are known sources of mesenchymal stem cells (MSCs) in horses; however, synovial tissues might be a promising alternative. The aim of this study was to evaluate phenotypic characteristics and differentiation potential of equine MSCs from synovial fluid (SF) and synovial membrane (SM) of healthy joints (SF-H and SM-H), joints with osteoarthritis (SF-OA and SM-OA) and joints with osteochondritis dissecans (SF-OCD and SM-OCD) to determine the most suitable synovial source for an allogeneic therapy cell bank.\ud \ud \ud Methods\ud Expression of the markers CD90, CD105, CD44, and CD34 in SF-H, SM-H, SF-OA, SM-OA, SF-OCD and SM-OCD was verified by flow cytometry, and expression of cytokeratin, vimentin, PGP 9.5, PCNA, lysozyme, nanog, and Oct4 was verified by immunocytochemistry. MSCs were cultured and evaluated for their chondrogenic, osteogenic and adipogenic differentiation potential. Final quantification of extracellular matrix and mineralized matrix was determined using AxioVision software. A tumorigenicity test was conducted in Balb-Cnu/nu mice to verify the safety of the MSCs from these sources.\ud \ud \ud Results\ud Cultured cells from SF and SM exhibited fibroblastoid morphology and the ability to adhere to plastic. The time elapsed between primary culture and the third passage was approximately 73 days for SF-H, 89 days for SF-OCD, 60 days for SF-OA, 68 days for SM-H, 57 days for SM-OCD and 54 days for SM-OA. The doubling time for SF-OCD was higher than that for other cells at the first passage (P < 0.05). MSCs from synovial tissues showed positive expression of the markers CD90, CD44, lysozyme, PGP 9.5, PCNA and vimentin and were able to differentiate into chondrogenic (21 days) and osteogenic (21 days) lineages, and, although poorly, into adipogenic lineages (14 days). The areas staining positive for extracellular matrix in the SF-H and SM-H groups were larger than those in the SF-OA and SM-OA groups (P < 0.05). The positive mineralized matrix area in the SF-H group was larger than those in all the other groups (P < 0.05). The studied cells exhibited no tumorigenic effects.\ud \ud \ud Conclusions\ud SF and SM are viable sources of equine MSCs. All sources studied provide suitable MSCs for an allogeneic therapy cell bank; nevertheless, MSCs from healthy joints may be preferable for cell banking purposes because they exhibit better chondrogenic differentiation capacity.This research was supported by Fundação Coordenação de Aperfeiçoamento\ud de Pessoal de Nível Superior (CAPES), Brasília, SP, Brazil, and by Fundação de\ud Amparo à Pesquisa do Estado de São Paulo (FAPESP), São Paulo, SP, Brazil.\ud These sponsors did not have any influence on the study design, on the\ud collection, analysis and interpretation of data, or on the writing of the\ud manuscript and decision to submit for publication

Overuse: medical novelty or age-old phenomenon?

INTRODUCTION: Mentions of overuse tend to imply it is a recent phenomenon as if irrationality was brought about by technological advances and the development of new procedures. However, it is possible that physicians have been prone to the same cognitive biases since antiquity, also performing inappropriate and excessive procedures. This raises the question of whether the contemporary issue of overuse is a modern phenomenon or inherited from a multi-millennial medical tradition. OBJECTIVE: To infer an answer to this question by summarizing the medical literature about overuse throughout the history of medicine. METHODS: Medical overuse is defined as futile, low-value procedures characterized by excessive use of methods with a high probability of causing more harm than good to patients. It examines the history of medical literature, with a critical look at procedures that might be characterized as harmful, futile, or with excessive use of diagnostic and therapeutic methods. RESULTS: This analysis revealed evidence that such procedures have been taking place throughout many periods of history. Studies have shown that the current prevalence of inappropriate medical procedures can be as high as 29% in the United States and 80% of cases for some individual services around the world. Lack of reliable data thwarts accurate analysis of the prevalence of overuse before the last decade. CONCLUSIONS: Instead of a recent phenomenon, overuse has permeated medical practice from its beginnings until today, regardless of technological advances, and is possibly inherent to the human species

Compared study on the effects of mechanical controled ventilation (MCV) with or without the use of positive-end-expiratory-pressure (PEEP) on inter-pleural pressure variation in horse anesthesia

One of the main death causes in equines during anesthesia and recovery periods is hipoxemia due to intrapulmonary "shunts". In human beings, hipoxy is treated with the use of Positive-End- Expiratory Pressure (PEEP), that in this species hinders airway closure, increases functional residual capacity and improves arterial oxygenation. We studied the effects of PEEP on inter-pleural pressure and on the cardio-vascular system, comparing Spontaneous Ventilation (SV), with Controlled Mechanical Ventilation (CMV) by itself and with PEEP of 10 cm H2O. We used 12 adult horses, females and males. These animals were submitted to general anesthesia with SV, CMV and CMV with PEEP of 10 cm H2O. The anesthetic procedure was equal for all horses. The hemodynamic, ventilatory and oxygenation parameters were evaluated. The statistical analysis of the results showed that when comparing SV, CMV and CMV with PEEP, there was no significant decrease in arterial blood pressure, nor significant alterations in cardiac and respiratory rate, pH, HCO3, BE and SatHb. When comparing SV, and CMV, an increase in PaO2 was noticed, parallel to a constant increase in PaCO2. No significant alterations in "shunt", alveolar-arterial relation and oxygen contend, were noticed. However during CMV and CMV with PEEP lower "shunt" values were noticed. Inter-pleural pressure showed significant alterations, decreasing during CMV and with CMV with PEEP, in comparison to VE. We concluded that CMV and CMV with PEEP of 10 cm H2O do not harm the cardio-respiratory system.Uma das principais causas de mortalidade em anestesia eqüina é a grave hipoxemia, conseqüência da formação de "shunt" intrapulmonar. Em seres humanos, a hipóxia é tratada com uso de pressão positiva no final da expiração (PEEP), que, nesta espécie, previne o fechamento de vias aéreas, aumenta a capacidade residual funcional e melhora a oxigenação arterial. Estudamos os efeitos de PEEP sobre a variação do deltaPpl e sua repercussão no sistema cardiovascular, comparando ventilação espontânea (VE), à ventilação mecânica controlada (VMC) sem PEEP e com PEEP de 10 cm H2O. Foram utilizados 12 animais adultos de ambos os sexos que foram submetidos a anestesia geral em ventilação espontânea, VMC sem e com PEEP. A técnica anestésica foi padronizada para todos os indivíduos. Os parâmetros hemodinâmicos, ventilatórios e de oxigenação foram mensurados no decorrer do experimento. A análise estatística dos resultados demostra que: não houve queda significativa da PAM entre os diferentes tipos de ventilação, nem alteração significativa das freqüências respiratória e cardíaca, pH, HCO3, BE e SatHb entre os três tipos de ventilação. Notou-se aumento da PaO2 entre VE e VMC paralelo a um aumento constante da PaCO2. Não foram verificadas reduções significativas do gradiente alvéolo-arterial, "shunt" e conteúdo de oxigênio. Durante a VCM e VCM com PEEP, observaram-se os valores mais baixos de "shunt". Houve alterações significativas do deltaPpl, que diminuiu durante a VMC e VMC com PEEP. Concluímos que a VMC e VMC com PEEP de 10 cm H2O não são deletérios ao sistema cardiopulmonar