Lateral Patellar Luxation and Ehlers Danlos Syndrome (EDS) in a Dog

Background: Ehlers Danlos Syndrome (EDS) is a rare genetic disease characterized by a deficiency in collagen synthesis, which can result in joint laxity. Patellar luxation is one of the main orthopedic conditions that affect the canine knee joint, with limited descriptions of its association with EDS in dogs. The purpose of this report is to describe the surgical management and postoperative evolution of a 1-year-old Chow Chow dog with grade II patellar luxation, tibial valgus and EDS.Case: A 1-year-old Chow Chow dog was referred to the University Veterinary Hospital due to lameness of the left pelvic for 3 months. At the orthopedic examination were verified severe lameness and lateral deviation of the left stifle joint during the ambulation of the animal. Additionally, it was verified bilateral hyperextension of the tibiotarsal joint and grade II patellar luxation of both pelvic limbs with painful hyperextension of the left stifle joint. Radiographic evaluation showed lateral displacement of the patella from both femoral trochlear groove, and a valgus deviation of the proximal left tibial shaft. In addition, it was verified cutaneous hyperextensibility and an extensibility index suggestive of EDS. The animal was submitted to trochlear block resection technique and medial imbrication, followed by corrective tibial osteotomy. Furthermore, skin biopsies of the scapular and lumbar folds were performed during the corrective tibial osteotomy. The samples were sent for histopathological examination, which revealed fragmented and unorganized collagen fibers in the dermis. Histopathological findings were compatible with EDS. The absence of lameness and correct positioning of the patella in the trochlear sulcus were verified in the post-surgical follow-up. Complete bone consolidation of the closing wedge osteotomy to correct the tibial valgus was verified at 90 days postoperatively.Discussion: The clinical signs, cutaneous extensibility index, and histopathological abnormalities in the present case were consistent with EDS. In the present study, this congenital collagen abnormality syndrome may have been a contributing factor of patellar luxation as EDS can result in hypermobility of ligaments and joints, due to metabolic and structural abnormalities of the collagen in connective tissues, and consequently may promote patellar luxation and other orthopedic abnormalities. A variant of EDS in humans has been implicated in the development of skeletal abnormalities such as short stature and bone deformities. This corroborates the possibility that EDS is correlated with valgus angulation of the proximal portion of the tibia in the present case. However, in-depth genetic studies are required to confirm this correlation. Corrective osteotomy in conjunction with block recession sulcoplasty and medial imbrication seem to have enabled patellofemoral stability and alignment of the quadriceps mechanism, ensuring that the patella remained in the trochlear sulcus, even in the presence of EDS. In addition, this syndrome does not seem to affect the surgical outcome of the treatment of patellar luxation associated with closed wedge osteotomy for tibial valgus correction. Medium-term follow-up can be considered excellent in this case report since there was a rapid resolution of lameness and adequate corrective osteotomy healing despite persistent hyperextension of the tibiotarsal joint. Ehlers Danlos Syndrome did not contraindicate the surgical treatment of patellar luxation. However, further studies are needed to assess the influence of the syndrome on long-term patellar luxation. The findings of this case report can help in the diagnosis and treatment of other animals affected by this rare syndrome and associated orthopedic diseases.Keywords: patellar luxation, bone, collagen diseases

Ultrasonographic Detection of Interstitial Nephritis in a Canine Fetus

Background: A detailed ultrasound examination of the fetal urinary tract as part of prenatal care is important to detect possible abnormalities. Early diagnosis can prevent more serious damage such as loss of kidney function. Interstitial nephritis can compromise renal functionality. Also, acute interstitial nephritis is a frequent cause of acute kidney injury and can become chronic if not treated. Besides, a renal biopsy can help in the diagnosis and at the staging of the disease. Therefore, this report aims to describe the ultrasonographic findings of the renal tissues in a canine fetus affected by interstitial nephritis.Case: Gestational ultrasound evaluations were performed in a female Pug, at the 25th, 45th, and 58th gestational days. Ultrasound examination was performed with a 9.0 MHz linear transducer and a high-resolution digital transducer with a frequency standardized at 17.0 MHz. During the first evaluation, embryonic vesicles were detected and were compatible with the gestational period. At 45 days of gestation, some abnormalities were observed in the kidneys of one of the fetuses, such as increased cortical echogenicity, cortical thickening, loss of corticomedullary ratio (1:1), renal pelvis and ureter dilatation by echogenic content. Biparietal and abdominal diameters were also lower than that from the other fetuses, which did not show abnormalities, being compatible with the estimated gestational age. However, the heart rate was similar among all fetuses. On the 58th day, we observed in the underdeveloped fetus that both kidneys still presented the abnormalities seen previously, in addition to the presence of a cystic structure in the right kidney, in the cranial topography of the cortex. The other fetuses kept showing normal ultrasonographic findings, normal heartbeat, all of these compatible with the ultrasound gestational age. The delivery occurred without complications and only the underdeveloped fetus stillborn. Then, it was submitted to a necropsy where chronic interstitial nephritis was found in the histopathological analysis.Discussion: Adequate prenatal care is important to detect abnormalities in fetuses, in which ultrasound examination allows to access fetal development. The gestation in the bitch seemed to be occurring without complications, but the B mode and High Definition ultrasound techniques were able to identify abnormal development of the fetus' kidneys. Both techniques showed to be secure to the fetuses and the mother, as they are non-invasive and free of radiation. These findings, different from those described as normal for a fetus, reinforce the warning signal for a possible establishment of anomalies consistent with nephropathy. Still, histopathology is important to exclude other diseases and help to define prognosis. Interstitial nephritis can significantly affect perinatal survey, considering that the fetus was stillborn, confirming that the description of such anomalies can help to prevent disease. Since nephritis can be associate with the use of some medicines, the orientation of the owner regarding drug use during bitch pregnancy is essential.  Therefore, this is the first report describing renal abnormalities in a canine fetus, which highlights the importance of ultrasound examination for disease identification in prenatal care. Lastly, high-resolution ultrasound (HD) could provide detailed information on abnormalities in the fetal kidney

Detection of anti-Toxoplasma gondii antibodies in wild free-living birds and mammals from the northwest region of São Paulo state, Brazil

Toxoplasmosis is a protozoonosis caused by an obligate intracellular parasite named Toxoplasma gondii, which can infect humans and a large number of homeothermic animal species with worldwide distribution. The present study aimed to detect anti T. gondii antibodies from serological samples of free living wild animals from the northwest region of São Paulo state, Brazil. Thirty-two samples (eight from birds and 24 from mammals) were analyzed by the modified agglutination test (MAT) using 5 cut-off points for birds and 25 for mammals. Seropositivity was observed in 25% (2/8) of birds, including the species Rupornis magnirostris (roadside hawk) and Caracara plancus (southern caracara), and 29.2% (7/24) animals were seropositive among mammals, including one hoary fox (Lycalopex vetulus), two maned wolves (Chrysocyon brachyurus), one black howler monkey (Alouatta caraya), two crab-eating foxes (Cerdocyon thous) and one gray brocket deer (Mazama gouazoubira). The results obtained with the present study indicate the exposure to T. gondii of free-living wild animals from the northwest region of São Paulo state and, therefore, that they probably play a role in the transmission and maintenance of T. gondii in the environment they inhabit. Thus, identification of the infection in several animal species in the region indicates the environmental contamination of the area. Studies of this nature may help to understand the importance of the prevention and control of this disease in Brazil.A toxoplasmose é uma protozoonose causada por um parasita intracelular obrigatório denominado Toxoplasma gondii, que pode infectar os humanos e um vasto número de espécies animais homeotérmicas, apresentando distribuição mundial. O presente estudo objetivou a detecção de anticorpos anti-T. gondii a partir de amostras sorológicas de animais silvestres de vida livre da região noroeste do estado de São Paulo. Foram analisadas 32 amostras (oito de aves e 24 de mamíferos) por meio do teste de aglutinação modificado (MAT), utilizando ponto de corte 5 para as aves e 25 para os mamíferos. Soropositividade foi observada em 25% (2/8) das aves, incluindo as espécies Rupornis magnirostris (gavião-carijó) e Caracara plancus (carcará); entre os mamíferos, 29,2% (7/24) foram soropositivos incluindo uma raposa-do-campo (Lycalopex vetulus), dois lobos guará (Chrysocyon brachyurus), um bugio-preto (Alouatta caraya), dois cachorros-do-mato (Cerdocyon thous) e um veado-catingueiro (Mazama gouazoubira). Os resultados obtidos com o presente estudo indicam a exposição dos animais selvagens de vida livre a T. gondii na região noroeste do estado de São Paulo e, portanto, que provavelmente apresentam papel na transmissão e manutenção de T. gondii no meio ambiente em que vivem. Assim, a identificação da infecção em várias espécies de animais na região indica a contaminação ambiental da área. Estudos dessa natureza podem ajudar no entendimento sobre a prevenção e o controle dessa importante doença no Brasil.

High-definition ultrasonography in the evaluation of the reproductive tract of bitches during the follicular phase of the estrous cycle

The aim was to sonographically evaluate the reproductive tract of bitches during the follicular phase of the estrous cycle using High Density (HD) ultrasonic techniques. Females (n = 8) were evaluated at five different times throughout the follicular phase, as determined by vaginal cytology and blood progesterone concentrations. Ultrasonic exams were performed using the ACUSON S2000/SIEMENS device utilizing a multifrequency HD transducer (5.5–18 MHz). Videos of the ovaries were obtained and recordings were evaluated using a DICOM viewer software for counting and measuring the ovarian structures, which were assigned to groups based on diameter in mm: G1: ≤ 1; G2: from 1.01 to 3.5; G3 from 3.51 to 5.5; G4: from 5.51 to 10. There was a greater uterine thickness with the progression of the follicular phase (P < 0.05). Six distinct regions were identified in the uterine wall. The ovarian dimensions increased (P < 0.05) as stage of the follicular phase advanced. There was fluid detected around the ovaries after ovulation. There was a characteristic fat tissue hyperechogenicity around the ovaries at all timepoints. There was a difference in the number of ovarian structures of each dimension group at each time there were assessments (P < 0.05). There was a difference in diameter of the largest ovarian structure and in average value of wall thickness at all timepoints when there were evaluations (P < 0.05). The HD ultrasonography technique provides for excellent image resolution, allowing for a more precise characterization of the bitch's reproductive structures and changes occurring during the follicular phase of the estrous cycle

Lateral Patellar Luxation and Ehlers Danlos Syndrome (EDS) in a Dog

Background: Ehlers Danlos Syndrome (EDS) is a rare genetic disease characterized by a deficiency in collagen synthesis, which can result in joint laxity. Patellar luxation is one of the main orthopedic conditions that affect the canine knee joint, with limited descriptions of its association with EDS in dogs. The purpose of this report is to describe the surgical management and postoperative evolution of a 1-year-old Chow Chow dog with grade II patellar luxation, tibial valgus and EDS.Case: A 1-year-old Chow Chow dog was referred to the University Veterinary Hospital due to lameness of the left pelvic for 3 months. At the orthopedic examination were verified severe lameness and lateral deviation of the left stifle joint during the ambulation of the animal. Additionally, it was verified bilateral hyperextension of the tibiotarsal joint and grade II patellar luxation of both pelvic limbs with painful hyperextension of the left stifle joint. Radiographic evaluation showed lateral displacement of the patella from both femoral trochlear groove, and a valgus deviation of the proximal left tibial shaft. In addition, it was verified cutaneous hyperextensibility and an extensibility index suggestive of EDS. The animal was submitted to trochlear block resection technique and medial imbrication, followed by corrective tibial osteotomy. Furthermore, skin biopsies of the scapular and lumbar folds were performed during the corrective tibial osteotomy. The samples were sent for histopathological examination, which revealed fragmented and unorganized collagen fibers in the dermis. Histopathological findings were compatible with EDS. The absence of lameness and correct positioning of the patella in the trochlear sulcus were verified in the post-surgical follow-up. Complete bone consolidation of the closing wedge osteotomy to correct the tibial valgus was verified at 90 days postoperatively.Discussion: The clinical signs, cutaneous extensibility index, and histopathological abnormalities in the present case were consistent with EDS. In the present study, this congenital collagen abnormality syndrome may have been a contributing factor of patellar luxation as EDS can result in hypermobility of ligaments and joints, due to metabolic and structural abnormalities of the collagen in connective tissues, and consequently may promote patellar luxation and other orthopedic abnormalities. A variant of EDS in humans has been implicated in the development of skeletal abnormalities such as short stature and bone deformities. This corroborates the possibility that EDS is correlated with valgus angulation of the proximal portion of the tibia in the present case. However, in-depth genetic studies are required to confirm this correlation. Corrective osteotomy in conjunction with block recession sulcoplasty and medial imbrication seem to have enabled patellofemoral stability and alignment of the quadriceps mechanism, ensuring that the patella remained in the trochlear sulcus, even in the presence of EDS. In addition, this syndrome does not seem to affect the surgical outcome of the treatment of patellar luxation associated with closed wedge osteotomy for tibial valgus correction. Medium-term follow-up can be considered excellent in this case report since there was a rapid resolution of lameness and adequate corrective osteotomy healing despite persistent hyperextension of the tibiotarsal joint. Ehlers Danlos Syndrome did not contraindicate the surgical treatment of patellar luxation. However, further studies are needed to assess the influence of the syndrome on long-term patellar luxation. The findings of this case report can help in the diagnosis and treatment of other animals affected by this rare syndrome and associated orthopedic diseases.Keywords: patellar luxation, bone, collagen diseases

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit’s model

ABSTRACT Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended

Contrast-enhanced ultrasound evaluation of placental perfusion in brachicephalic bitches

: The present study aimed to investigate placental hemodynamics to determine quantitative and qualitative parameters for pregnant brachycephalic bitches as well as describe placental vascularization and perfusion in females with fetal abnormalities close to delivery. Forty-four healthy fetuses from 22 brachycephalic bitches and 9 fetuses with gestational abnormalities (anasarca and hydrocephalus) from 8 brachycephalic bitches were evaluated. All female dogs were artificially inseminated intravaginally and underwent cesarean section at the end of gestation. Pregnancy diagnosis was made on the 25th day and experimental evaluations were performed on Days 25 (M1), 45 (M2), and 58 (M3) of gestation in normal pregnancies. Fetuses with gestational abnormalities were evaluated at the last time point. Biometric values of the fetuses were determined by B-mode and vascular indices by Doppler fluxometry of the umbilical artery, whereas qualitative assessment of contrast filling and quantitative parameters of placental perfusion were performed using CEUS. Parameter comparisons among the examined fetuses (normal and abnormal) and between the moments (M1, M2, and M3) were performed by Student's t-test and ANOVA tests, and then correlated using the Spearman test. In healthy fetuses, systolic and diastolic velocities as well as the time averages of minimum and maximum velocities increased significantly from M2 to M3 (P  0.05), but CEUS evaluation demonstrated a heterogeneous distribution with lower intensity of placental tissue filling and a delay in perfusion time (P < 0.05) with a diagnostic accuracy of 75%. The association of dopplerfluxometry and CEUS allowed evaluation of qualitative and quantitative parameters of physiological pregnancy hemodynamics in all gestational thirds without evidence of significant changes in the physiology of the maternal-fetal binomial, and CEUS was shown to be applicable in the detection of failures in placental vascular filling (tissue dysfunction) in fetuses with anasarca and hydrocephaly

B-mode ultrasonography and ARFI elastography of articular and peri-articular structures of the hip joint in non-dysplastic and dysplastic dogs as confirmed by radiographic examination

Abstract Background Canine hip dysplasia is a common orthopedic disease in veterinary practice. The diagnosis is made by radiographic examinations that evaluate bone alterations associated with hip dysplasia. Although radiographic examination is the gold standard for diagnosis, it does not allow a detailed evaluation of soft tissues such as the joint capsule and periarticular muscles. This study aimed to evaluate the accuracy of B-mode ultrasonography and acoustic radiation force impulse (ARFI) elastography in assessing the joint capsule and periarticular muscles of dogs using the Orthopedic Foundation of Animals (OFA) classification and the distraction index (DI) in the early and late diagnosis of hip dysplasia. This study sought to propose a protocol for the ultrasonographic evaluation of the structures involved in canine hip dysplasia. Methods Radiographic and ultrasonographic evaluations were performed on 108 hip joints of 54 dogs. Thirty dogs were older than 2 years and 24 were aged between 4 and 10 months. Results It was verified that an increase in pectineus muscle stiffness (cutoff value > 2.77 m/s) by elastography in some dysplastic dogs and an increase in the thickness of the joint capsule (cutoff value > 0.9 mm) in B-mode ultrasonography, were associated with a distraction index > 0.5, with both having a positive correlation. In B-mode ultrasonographic evaluation, the presence of signs of degenerative joint disease, such as irregularities of the cranial edge of the acetabulum and femoral head, were associated with a distraction index > 0.5 in canines, with a specificity of 94%. In adult dogs, the findings of degenerative joint disease on ultrasound were associated with a diseased OFA classification (P  1.10 mm was diagnostic for dysplasia in unhealthy dogs by OFA. Conclusions ARFI elastography has shown that the pectineus muscle may experience changes in stiffness in dysplastic animals. Additionally, changes in joint capsule thickness can be identified in B-mode in young and adult dogs with dysplastic joints, which contributes to the diagnosis of hip dysplasia

Abdominal perfusion in canine patients with pyometra and sepsis evaluated by Doppler and contrast-enhanced ultrasound

Abstract Background Sepsis is a condition characterized by organic dysfunction, leading to hemodynamic instability and high morbidity and mortality rates in humans and animals. Early identification of perfusion changes and appropriate management of sepsis are crucial for improving patient prognosis. Currently, the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely studied for sepsis identification and evaluation of organ dysfunction. However, these scores do not assess gastrointestinal involvement, which is common in this condition. Contrast-enhanced ultrasound (CEUS) and Doppler have been considered promising diagnostic techniques for detecting changes in vascularization and microcirculation in a non-invasive and safe manner, particularly in the gastrointestinal system. This study aimed to evaluate duodenal perfusion using CEUS, as well as abdominal aortic and cranial mesenteric artery blood flow using Doppler ultrasound, and systolic arterial pressure (SAP) in 17 bitches with pyometra and in 10 healthy animals. Results The variables were compared between the pyometra and control groups, as well between patients with and without sepsis determined by the SOFA or SIRS scores. Pyometra was found to cause a reduction in abdominal aortic blood flow volume, aortic peak systolic velocity, and resistivity index as evaluated by Doppler ultrasound. Patients with sepsis according to the SOFA criteria only presented lower SAP. In contrast, sepsis animals identified by the SIRS score exhibited lower SAP, aortic peak systolic velocity, aortic blood flow volume, and aortic resistivity index and additionally, higher peak intensity of contrast in the duodenal wall. Conclusions Pyometra causes a reduction in abdominal aortic blood flow, which is more pronounced in animals with sepsis identified by the SIRS criteria. These animals also exhibited a decrease in systolic blood pressure and an increase in duodenal perfusion, as evident by CEUS. However, these changes were not observed in patients with sepsis identified by the SOFA criteria. The alterations in intestinal perfusion observed in animals with sepsis indicate the presence of inflammation or dysfunction. In this regard, CEUS proves to be a valuable technique for detecting subtle changes in tissue hemodynamics that may not be apparent in conventional exams