Radioiodoterapia com protocolo de dose individualizada em paciente felino com hipertireoidismo

O hipertireoidismo é a endocrinopatia mais prevalente na espécie felina e ocorre principalmente em gatos idosos. Consiste em uma condição multissistêmica decorrente da maior produção dos hormônios T3 e T4 pela glândula tireoide. A etiologia da doença é, na maior parte dos casos, devido à hiperplasia adenomatosa ou adenoma glandular que leva ao aumento da produção hormonal. A patogenia e os fatores de risco da doença ainda não estão bem definidos. Fatores como o consumo de disruptores endócrinos já foram associadas à doença. As manifestações clínicas mais comuns são polifagia associada à perda de peso, vômito e diarreia, poliúria, polidipsia, hiperatividade e nódulo palpável em topografia de tireoide. O diagnóstico é feito a partir da anamnese, manifestações clínicas, resultados de exames laboratoriais e de imagem, principalmente a cintilografia, e dosagem de hormônios tireoidianos (T4 total) e hipofisário (TSH). Existem diversos protocolos terapêuticos como uso de fármacos orais, cirurgia, dieta com restrição de iodo e radioiodoterapia. Este relato teve como objetivo descrever o caso de um felino, fêmea, sem raça definida (SRD), 11 anos de idade, com histórico de discreta perda de peso e episódios esporádicos de êmese. Com base no histórico e anamnese, avaliação física e achados de exames laboratoriais e da cintilografia da tireoide, foi realizado o diagnóstico de hipertireoidismo. O tratamento realizado foi a aplicação de iodo radioativo com dose individualizada. Após três meses do procedimento, os valores das dosagens hormonais (T4 total e TSH) encontravam-se dentro do intervalo de referência e, atualmente, o paciente se encontra em estado de eutireoidismo

Pituitary Carcinoma in a Bitch: Clinical, Tomographic, Histopathological and Immunohistochemistry Findings

Background: Primary pituitary carcinoma is rarely reported in dogs and only few reports describe its malignancy. In veterinary literature, primary pituitary carcinomas correspond up to 2.4% to 3.4% of intracranial neoplasms found in dogs and information regarding its biological behavior is quite limited.  In humans, primary pituitary carcinomas represent less than 1.0% of all tumors found in the pituitary gland. The proposed classification for pituitary carcinoma in humans and dogs determines that the tumor must have its origin in adenohypophyseal region and disseminated metastasis by cerebrospinal fluid or systemically to other organs must be observed. In dogs, a few reports have described primary pituitary carcinoma. The goal of this report was to describe clinical, tomographic, histopathological and immunohistochemistry features of a dog with primary pituitary carcinoma with adjacent invasion. Case: A 7-year-old female spayed Golden Retriever dog was assessed by general practice due progressive weight loss, muscular atrophy, lethargy, blindness, head pressing, and hyporexia for 21 days. Computed tomography (CT) showed a cerebral parenchyma with expansive extra-axial base formation, originating from sella turcica topography, measuring about 2.0 centimeter dorsally, displacing the third ventricle, suggesting the diagnosis of pituitary neoplasia. The hormones thyroid-stimulating hormone (TSH) and total thyroxine (T4) as well as stimulation ACTH test were unremarkable. After 7 days, neurological clinical signs progressed and unfortunately the patient died ten days later after hospitalization. A necropsy exam revealed pituitary gland with increased dimensions (2.5 x 2.0 cm). Histopathological findings revealed tumor proliferation in pituitary gland. The neoplasm showed invasion to the nervous parenchyma and metastatic foci between the brain lobes. Immunohistochemistry was positive for keratin and neuron-specific enolase and negative for epithelial membrane antigen, S-100 protein, glial fibrillary acidic protein, estrogen receptor, CD34, chromogranin, somatostatin, and ACTH. The clinical, histopathological and immunohistochemistry findings supported the diagnosis of primary pituitary carcinoma. Discussion: There is lack information regarding pituitary carcinoma prevalence in dogs, and little is known about its pathological and clinical features. The patient showed a shorter survival time (30 days after the onset of clinical signs) for a non-hormonally functional tumor that presented with acute onset of neurological signs due to local effect of an expanding mass, also described in others pituitary carcinoma reports. It was observed a metastatic focus of pituitary neoplasia between cerebral hemispheres, leading us to conclude to be a pituitary carcinoma. Adjacent infiltration was noticed by the presence of neoplasm invasion to the synoptic nervous parenchyma and metastatic foci between the brain lobes as well as the presence of a non-delimited nodular area of neoplastic implantation between the cerebral hemispheres, and optic nerve compromised by neoplasm cells. The data reported here showed that a negative ACTH receptor in neoplasm with 10% Ki-67 proliferation index with no history of clinical signs of pituitary-dependent hyperadrenocorticism (PDH). Pituitary adenocarcinomas are thought to be more often non-secretors. CT findings reveled a pituitary mass of 2.5 cm in vertical height suggesting a pituitary macrotumor although there is lack of description for pituitary carcinomas in veterinary literature. The animal had a fast deterioration of his clinical condition and quickly came to death, suggesting poor biological behavior of the tumor. Keywords: adrenocorticotropic hormone, case report, dog, pituitary tumors

Esophageal Squamous Cell Carcinoma in Cats

Background: Esophageal neoplasms are rarely reported in cats. The frequency rate is less than 0.5% and those neoplasms are usually malignant. Esophageal squamous cell carcinoma (SCC) is an idiopathic epithelial neoplasm, invasive and metastatic that can induce partial or complete obstruction of the esophageal lumen. There is no breed or sex predisposition, and it is more common in cats over 8-years-old. Esophageal SCC is more frequent in the middle third of the esophagus. The prognosis is poor, as the cats are usually diagnosed at an advanced stage. This report aims to describe clinical, endoscopic, radiographic, and pathological features of two cases of esophageal squamous cell carcinoma in cats.Cases: A 11-year-old neutered male cat presenting regurgitation, weight loss, anorexia and dyspnea was referred to veterinary internal medicine care. Simple and contrast-enhanced radiographic images of the cervical and thoracic regions showed an alveolar pattern in the cranial lung lobes and signs of esophageal lumen irregularity and dilatation in the mediastinum topography. The upper digestive endoscopy showed a dilated esophageal lumen, and an irregular mass was observed in the thoracic esophagus involving the entire esophageal circumference. Biopsy fragments were collected, and the histopathological result was compatible with squamous cell carcinoma. The second case was a 10-year-old neutered male cat presenting hyporexia, regurgitation, dyspnea, tachypnea, and abnormal breath sounds. The ultrasound of the chest showed 3 amorphous hypoechogenic and heterogeneous areas in the right and left hemithorax between parietal and visceral pleura. The cytological examination was compatible with a malignant epithelial tumor. The patient died 3 months after the onset of clinical signs. At gross exam, it was observed a friable, irregular, and ulcerated mass of 5.0 x 3.0 cm in the middle third of the esophagus. Metastatic foci in the lungs and liver were also observed. The histopathological diagnosis was esophageal squamous cell carcinoma, with metastases to liver and lungs. Microscopically, in both cases, were seen aproliferation of polyhedral epithelial cells in the mucosa, arranged in nests or trabeculae with central keratinization. These cells presented oval to rounded nuclei, loose chromatin, prominent nucleolus, and abundant eosinophilic cytoplasm, with marked anisocytosis and anisokaryosis, supported by a thin fibrovascular stroma. In the second cat the neoplastic cells infiltrated the esophageal submucosa, including lymphatic vessels and muscle layer. Lung and liver metastases from theSCC had a cellular pattern similar to the primary neoplasm.Discussion: Esophageal squamous cell carcinoma is extremely rare in cats. The SCC begins in the squamous layer of the mucosa and can infiltrate the muscular layer or protrude into the esophageal lumen, leading to clinical signs, as seen in these 2 cats. The differential diagnoses for esophageal SCC include foreign bodies, esophageal strictures, and infiltrative or compressive non-esophageal tumors. Although uncommon, esophageal tumors should be considered when evaluatingelderly cats with regurgitation and weight loss. The diagnosis of esophageal SCC was confirmed by histopathological findings collected endoscopically or during necropsy. As noted in both cases, the prognosis of SCC is generally unfavorable, usually due to the difficulty in treatment and diagnosis in a late stage of the disease.Keywords: feline, esophagus, neoplasms, metastasis, cancer

Active methodologies and pedagogical aspects in Veterinary Medicine programs

Em 2017, 289 instituições de ensino superior (IES) ofereciam curso de graduação em Medicina Veterinária no Brasil, sendo que a maioria delas utilizava a abordagem tradicional de ensino.Com a instituição das Diretrizes Curriculares Nacionais dos cursos de Medicina Veterinária, em 2003, recomendou-se que as IES deveriam ser capazes de estimular, além das competências técnicas, o desenvolvimento das competências humanísticas nos discentes e, em 2012, o Conselho Federal de Medicina Veterinária propôs a utilização de metodologias ativas de ensino para atingir tal propósito.O objetivo do presente trabalho foi analisar o uso de metodologias ativas em cursos de graduação de Medicina Veterinária. A pesquisa foi conduzidaem duas instituições de ensino superior, uma pública e outra privada, utilizando-se entrevistas semiestruturadas realizadas com docentes de graduação do curso de Medicina Veterinária e análise dos planos de ensino das disciplinas avaliadas. Os depoimentos foram tratados pela análise de conteúdo, sendo determinadas cinco categorias de análise: uso de metodologias ativas e conceitualização do termo; "teorização" da prática; mudanças nas técnicas e ferramentas de ensino utilizadas ao longo da carreira docente e desinteresse geral do estudante. entrevistados; disciplinas Variáveis como número de docentes ministradas; período do curso em que eram ministradas;carga horária total, aulas práticas e, ou, teóricas;número de alunos matriculados; tempo de docência; formação acadêmica e didática; técnicas e ferramentas de ensino utilizadas pelos professoresforam analisadas de forma descritiva. Foram entrevistados 37 docentes, sendo 18 da IES-pública, com média de 23 anos de experiência, e 19 da IES-privada, com média de seis anos de experiência, que ministravam 57 disciplinas. Embora 75,6% dos docentes fossem doutores, nenhum deles apresentou curso de especialização em didática no ensino superior. Os docentes da IES-pública e privada relataram a utilização de 19 e 40 técnicas de ensino diferentes, respectivamente. Todos os entrevistados relataram utilizar pelo menos uma MA de ensino em pelo menos uma aula ministrada. Na IES-pública, mais da metade dos docentes não soube conceituar o termo MA de ensino. Na IES-privada, todos os 19 docentes entrevistados conheciam o termo. Observou-se que as aulas práticas vêm se tornando cada vez mais teóricas, com menor utilização de animais vivos.Com o tempo e a experiência, os docentes diminuíram a quantidade de aulas expositivas tradicionais, substituindo-as por técnicas de ensino mais ativas. Concluiu-se que os docentes das IES estudadas necessitam maior formação técnica nas áreas de didática e andragogia. As MA de ensino vêm sendo utilizadas, mas o ensino oferecido pelas IES avaliadas ainda apresenta características do modelo tradicional. Nas aulas práticas, os docentes entrevistados percebem que o processo ensino-aprendizado ocorre de forma mais eficaz, entretanto estas aulas vêm sendo substituídas por aulas expositivas ou demonstrações.There were 289 institutions offering Veterinary Medicine graduate programs in Brazil in 2017 and most of them were using the traditional teaching approach.The National Curriculum Guidelines for Veterinary Medicine graduate programs was established in 2003 and it was recommended that those institutions not only should stimulate the technical skills of the students, but also develop their humanistic competences.In 2012, the Brazilian Board of Veterinary Medicine proposed the use of active learning methodologies to achieve those educational goals. The objective of the present study was to analyze the use of active learning methodologies in Veterinary Medicine graduate programs in public and private teaching institutions. This research was conducted in one private and one public institution using semi-structured interviews with professors from the Veterinary Medicine graduate programs and analysis of the teaching plans of the disciplines evaluated. The Content Analysis was used to analize the testimonials, and five categories of analysis were determined: use of active methodologies and conceptualization of the term; theorization of the practice; changes in teaching techniques and tools used throughout the teaching career; and general lack of interest of the student. The variables of the research as number of teachers interviewed; disciplines administered; period of the day the classes were given; program length includinghands-on and/or theoretical classes; number of students enrolled; years of teaching experience, academic and didactic training; and techniques and teaching tools used by the professors were analyzed in a descriptive way. A total of 37 professors who taught 57 different subjects were interviewed, 18 from the public and 19 from the privateinstitution, with an average of 23 and six years of teaching experience, respectively. Although 75,6% of the faculty members had a PhD title, none of them presented a post graduation course in didactics for graduate programs.The professors from the public and private institutions reported the use of 19 and 40 different teaching techniques respectively. All interviewed professors reported the use of at least one active methodology in at least one lecture. More than half of the professors from the public institutiondid not know how to conceptualize the term active learning methodologies. On the other hand, all 19 interviewed professors from the private institutionknew the term. It was noticed that the hands-on classes are becoming more theoretical, using less live animals. Over time and experience, the professors have reduced the number of traditional lectures, replacing them by more active teaching techniques. It was concluded that the faculty members of the studied institutions need more technical training in the andragogy and didactic areas. The active learning methodologies have been used, but the education offered by the evaluated institutions still presents the characteristics of the traditional model.Although the interviewed faculty members have noticed that the teaching- learning process is more effective during the hands-on classes, such classes have been substituted by demonstrations or expository classes

Pituitary Carcinoma in a Bitch: Clinical, Tomographic, Histopathological and Immunohistochemistry Findings

Background: Primary pituitary carcinoma is rarely reported in dogs and only few reports describe its malignancy. In veterinary literature, primary pituitary carcinomas correspond up to 2.4% to 3.4% of intracranial neoplasms found in dogs and information regarding its biological behavior is quite limited.  In humans, primary pituitary carcinomas represent less than 1.0% of all tumors found in the pituitary gland. The proposed classification for pituitary carcinoma in humans and dogs determines that the tumor must have its origin in adenohypophyseal region and disseminated metastasis by cerebrospinal fluid or systemically to other organs must be observed. In dogs, a few reports have described primary pituitary carcinoma. The goal of this report was to describe clinical, tomographic, histopathological and immunohistochemistry features of a dog with primary pituitary carcinoma with adjacent invasion. Case: A 7-year-old female spayed Golden Retriever dog was assessed by general practice due progressive weight loss, muscular atrophy, lethargy, blindness, head pressing, and hyporexia for 21 days. Computed tomography (CT) showed a cerebral parenchyma with expansive extra-axial base formation, originating from sella turcica topography, measuring about 2.0 centimeter dorsally, displacing the third ventricle, suggesting the diagnosis of pituitary neoplasia. The hormones thyroid-stimulating hormone (TSH) and total thyroxine (T4) as well as stimulation ACTH test were unremarkable. After 7 days, neurological clinical signs progressed and unfortunately the patient died ten days later after hospitalization. A necropsy exam revealed pituitary gland with increased dimensions (2.5 x 2.0 cm). Histopathological findings revealed tumor proliferation in pituitary gland. The neoplasm showed invasion to the nervous parenchyma and metastatic foci between the brain lobes. Immunohistochemistry was positive for keratin and neuron-specific enolase and negative for epithelial membrane antigen, S-100 protein, glial fibrillary acidic protein, estrogen receptor, CD34, chromogranin, somatostatin, and ACTH. The clinical, histopathological and immunohistochemistry findings supported the diagnosis of primary pituitary carcinoma. Discussion: There is lack information regarding pituitary carcinoma prevalence in dogs, and little is known about its pathological and clinical features. The patient showed a shorter survival time (30 days after the onset of clinical signs) for a non-hormonally functional tumor that presented with acute onset of neurological signs due to local effect of an expanding mass, also described in others pituitary carcinoma reports. It was observed a metastatic focus of pituitary neoplasia between cerebral hemispheres, leading us to conclude to be a pituitary carcinoma. Adjacent infiltration was noticed by the presence of neoplasm invasion to the synoptic nervous parenchyma and metastatic foci between the brain lobes as well as the presence of a non-delimited nodular area of neoplastic implantation between the cerebral hemispheres, and optic nerve compromised by neoplasm cells. The data reported here showed that a negative ACTH receptor in neoplasm with 10% Ki-67 proliferation index with no history of clinical signs of pituitary-dependent hyperadrenocorticism (PDH). Pituitary adenocarcinomas are thought to be more often non-secretors. CT findings reveled a pituitary mass of 2.5 cm in vertical height suggesting a pituitary macrotumor although there is lack of description for pituitary carcinomas in veterinary literature. The animal had a fast deterioration of his clinical condition and quickly came to death, suggesting poor biological behavior of the tumor. Keywords: adrenocorticotropic hormone, case report, dog, pituitary tumors

Esophageal Squamous Cell Carcinoma in Cats

Background: Esophageal neoplasms are rarely reported in cats. The frequency rate is less than 0.5% and those neoplasms are usually malignant. Esophageal squamous cell carcinoma (SCC) is an idiopathic epithelial neoplasm, invasive and metastatic that can induce partial or complete obstruction of the esophageal lumen. There is no breed or sex predisposition, and it is more common in cats over 8-years-old. Esophageal SCC is more frequent in the middle third of the esophagus. The prognosis is poor, as the cats are usually diagnosed at an advanced stage. This report aims to describe clinical, endoscopic, radiographic, and pathological features of two cases of esophageal squamous cell carcinoma in cats.Cases: A 11-year-old neutered male cat presenting regurgitation, weight loss, anorexia and dyspnea was referred to veterinary internal medicine care. Simple and contrast-enhanced radiographic images of the cervical and thoracic regions showed an alveolar pattern in the cranial lung lobes and signs of esophageal lumen irregularity and dilatation in the mediastinum topography. The upper digestive endoscopy showed a dilated esophageal lumen, and an irregular mass was observed in the thoracic esophagus involving the entire esophageal circumference. Biopsy fragments were collected, and the histopathological result was compatible with squamous cell carcinoma. The second case was a 10-year-old neutered male cat presenting hyporexia, regurgitation, dyspnea, tachypnea, and abnormal breath sounds. The ultrasound of the chest showed 3 amorphous hypoechogenic and heterogeneous areas in the right and left hemithorax between parietal and visceral pleura. The cytological examination was compatible with a malignant epithelial tumor. The patient died 3 months after the onset of clinical signs. At gross exam, it was observed a friable, irregular, and ulcerated mass of 5.0 x 3.0 cm in the middle third of the esophagus. Metastatic foci in the lungs and liver were also observed. The histopathological diagnosis was esophageal squamous cell carcinoma, with metastases to liver and lungs. Microscopically, in both cases, were seen aproliferation of polyhedral epithelial cells in the mucosa, arranged in nests or trabeculae with central keratinization. These cells presented oval to rounded nuclei, loose chromatin, prominent nucleolus, and abundant eosinophilic cytoplasm, with marked anisocytosis and anisokaryosis, supported by a thin fibrovascular stroma. In the second cat the neoplastic cells infiltrated the esophageal submucosa, including lymphatic vessels and muscle layer. Lung and liver metastases from theSCC had a cellular pattern similar to the primary neoplasm.Discussion: Esophageal squamous cell carcinoma is extremely rare in cats. The SCC begins in the squamous layer of the mucosa and can infiltrate the muscular layer or protrude into the esophageal lumen, leading to clinical signs, as seen in these 2 cats. The differential diagnoses for esophageal SCC include foreign bodies, esophageal strictures, and infiltrative or compressive non-esophageal tumors. Although uncommon, esophageal tumors should be considered when evaluatingelderly cats with regurgitation and weight loss. The diagnosis of esophageal SCC was confirmed by histopathological findings collected endoscopically or during necropsy. As noted in both cases, the prognosis of SCC is generally unfavorable, usually due to the difficulty in treatment and diagnosis in a late stage of the disease.Keywords: feline, esophagus, neoplasms, metastasis, cancer