Treatment of Radius Curvus in a Young Dog with Association of Radial Physeal Stapling, Ulnar Ostectomy and Transarticular Dynamic External Fixator Techniques

Background: Radius curvus is a clinical manifestation of the premature closure of the distal ulnar physis and the most common physeal disease in dogs, representing 63% of all physeal injuries. There are few reports indicating the technique of stapling for treatment of radius curvus in squeletically immature dogs. The aim of this study is to report a case of radius curvus in a young dog successfully treated with a combination of 3 surgical tecniques: 1- Stapling the medial and cranial portions of the distal radial physis; 2- Oblique osteotomy of the proximal ulna and ostectomy of the distal ulna, and 3- Dynamic external skeletal fixation in the elbow joint.Case: A 5-month-old female dog was referred to the University Veterinary Hospital with a history of left thoracic limb deformity for 2 weeks. There was a history of possible traumatic event on the front limb, in addition to providing nutritional supplements daily. In the radiographic evaluation the changes were identified in the left thoracic limb: shortening of the ulna, procurvatum and medial angulation of the distal radius, increased joint space and articular incongruity of the elbow joint. The dog was subjected to surgical treatment by the combination of three main surgical techniques. For the stapling of the distal radial physis the surgical approach on the cranial-medial surface of the distal radius was made. Two surgical staples were positioned in the distal radial physis. Thereafter a caudal approach was made to the distal region of the ulnar diaphysis for the distal ostectomy of the ulna. A bone segment of 1 cm in length of the distal ulnar diaphysis was removed. Another caudal approach was made to the proximal region of the ulnar diaphysis and a proximal oblique osteotomy of the ulna was performed. For the dynamic external skeletal fixation in the elbow joint two Steinmann pins were inserted. The first pin was proximal to the supracondilar foramen of the humerus and the second pin was caudal to the trochlear notch of the ulna, both parallel to the joint surface. To create a dynamic system, the pin tips were connected with elastic rubber bands on the medial and lateral sides of the elbow joint. Clinical and radiographic revaluation were made at 15, 30 and 60 days after surgery. Total correction of the limb deviation was achieved at 60 days postoperative. Two years after the surgical procedure, the owner was contacted and reported that the dog was very well and with no change in the operated limb.Discussion: The most common cause of premature closure of the distal ulnar physis is trauma. Due to the proper conical shape of the distal ulnar physis, there is more predisposition to the compression of the germinative cells in traumatic events, leading to radius curvus disease. Another cause of the radius curvus is the nutritional disbalances. In the reported case the patient had both predisponent factors, although unilateral limb involvement suggested trauma with primary causative agent. The treatment included the interruption of the supplementation of the diet associated with surgical techniques. The stapling of the distal radial physis is usually indicated for mild angular valgus deviation. In the current case the technique was applied with success regardless of the higher grade of radial deviation. Generally, the ulnar ostectomy is preferred to the osteotomy, since it reduces the rate of ulnar osteosynthesis, ensuring that the restrictive effect of the ulna upon the radial growth does not restart. In the reported case the ulnar ostectomy was associated with ulnar osteotomy to achieve a more effective result. Furthermore, the proximal ulnar osteotomy is usually indicated when elbow subluxation is present. In the current case the joint congruence was improved with the use of the dynamic external skeletal fixator

Hydrocolloid Membrane Dressing in Shearing Injuries in the Distal Part of the Pelvic Limbs in Dogs

Background: Shearing wounds on the limbs of dogs usually affect the regions distally from the radiocarpal joint at the thoracic limb and from the tibiotarsal joint at the pelvic limb. The tissue coverage and re-epithelialization of the injured region are important factors that should be considered in the definitive surgical treatment. The hydrocolloid membrane promotes selective autolytic debridement and accelerates the formation of granulation tissue and epithelialization. The present study aims to describe the treatment with hydrocolloid membrane dressing of three cases of shearing wounds with concomitant orthopedic injuries in the pelvic limbs of dogs.Case: Three dogs with pelvic limb injuries after vehicular trauma were selected for treatment. Two patients had shearing lesions on the medial aspect of the pelvic limb with exposure of the tibia and fibula, the talus and the tibiotarsal joint, associated with bone loss on the medial surface of the limb and rupture of the medial collateral ligament of the tarsus. Another patient had a shearing wound on the dorsal surface of the distal region of the pelvic limb, with injury of the digital extensor tendons and bone exposure of the second and third metatarsals. Initially, the surgical debridement of the lesion was performed and during the first five days after trauma the wound was cleansed with chlorhexidine solution and topical application of crystallized sugar daily. In this initial period a dry adherent dressing was used on the lesions, without bandages for immobilization of the pelvic limb. In all dogs, the hydrocolloid membrane was applied from the sixth day after initial wound management. Immediately after the application of the hydrocolloid membrane, temporary immobilization of the affected pelvic limb with a padded Robert Jones bandage was performed. The first changes of the hydrocolloid membranes were performed after five days of their use. Subsequently, the membranes changes became more spaced and were performed within a period between 7 to 10 days. After wound repair, in one of the dogs with a shearing injury in the medial surface of the pelvic limb, the rupture of the medial collateral ligament was surgically treated with the use of anchor screws and nylon thread for the ligament reconstruction. The other dog presented with lesion in the medial surface of the pelvic limb and collateral ligament rupture was not submitted to late orthopedic surgical treatment. The latter was clinically managed and developed valgus deviation of the affected pelvic limb, but with functional use of the limb. The dog with a shearing lesion on the dorsal surface of the pelvic limb and injury to the extensor tendons was managed conservatively with use of orthosis and, after 45 days of initial trauma, the dog showed a functional lameness and absence of pain in the affected limb.Discussion: In all animals, the hydrocolloid membrane was applied on the wound from the sixth day after the initial lesion treatment. As the wound was healing the hydrocolloid dressing was changed in a more spaced period and this management allowed the proper tissue healing without complications. The wound treatment with dressing was aided by the application of temporary limb immobilization with padded bandage, until a late orthopedic procedure was performed or a final clinical resolution occurred. In general, the shearing wounds healed in a period ranging from 28 to 38 days. In conclusion, the use of the hydrocolloid membrane dressing associated with limb immobilization was an effective method for treatment of patients with shearing wounds, allowing proper healing of the affected tissues and good recovery of the limb function. The hydrocolloid membrane has the main benefits to allow the spaced changes of the dressings and the ability to stimulate the rapid healing of the wound

Avaliação da técnica de guilhotina modificada para lobectomia hepática completa em gatos

O fígado, o maior tecido glandular do organismo, pode ser acometido por afecções localizadas, como neoplasias, abscessos e torção do lobo, onde é indicada a hepatectomia parcial ou a lobectomia. Nesse experimento, avaliou-se a aplicabilidade e segurança de uma forma modificada da técnica de sutura em guilhotina para a lobectomia hepática completa em gatos. Foram utilizados 13 gatos adultos jovens, sem raça definida, machos e clinicamente saudáveis. Empregou-se a técnica de sutura em guilhotina de forma modificada na base do lobo hepático lateral esquerdo, promovendo a hemostasia do órgão por meio de esmagamento dos tecidos. No período pós-operatório, foram avaliados diversos parâmetros clínicos por 10 dias consecutivos e aos 11 dias após a cirurgia realizou-se avaliação ultrassonográfica. Neste período, os parâmetros clínicos avaliados permaneceram dentro dos limites fisiológicos, demonstrando ausência de complicações importantes decorrentes da cirurgia. Na modificação da técnica de guilhotina utilizada, dividiu-se a base do lobo hepático em três segmentos, permitindo que a sutura promovesse um adequado esmagamento do tecido hepático e ligadura satisfatória dos vasos sanguíneos e ductos biliares, não sendo observada hemorragia ou ascite nos exames clínicos e ultrassonográficos. Aos 11 dias após a lobectomia, os fígados apresentavam-se ultrassonograficamente normais com pequena área de hiperecogenicidade no local da ligadura, sugestiva de tecido cicatricial. A técnica de sutura em guilhotina modificada foi considerada segura e com mínima morbidade para a lobectomia hepática em gatos

Estudo comparativo entre três técnicas abertas de orquiectomia em gatos

Background:  :  :  : Surgical sterilization of male cats is one of the most commonly procedures in the small animals practice, used as a control method against the overpopulation of domestic cats. Orchiectomy also aims to prevent or treat hormone-mediated diseases, disorders of the reproductive organs, such as testicular cancer, orchitis, prostatic diseases, trauma or abscesses. In addition, it may be used to control undesirable changes in behavior in adult cats such as the case of territorial marking and aggression. Several surgical techniques are described for orchiectomy in cats using different methods of hemostasis and/or ligation of the spermatic cord. There is a paucity of scientific studies and comparative data that supports one technique over the other, so this experiment was conducted to compare the three major open surgical techniques of ligation of the spermatic vessels to perform orchiectomy in cats. Materials, Methods & Results: Thirty-nine young entire adult male cats, with an average weight of 2.7 kg, were divided into three groups. In group I, animals underwent orchiectomy using the suture technique to ligation of the spermatic cord. In group II, the spermatic cord was used to perform an “eight-knot” on itself. In group III, the vas deferens and spermatic cord were used together to make “square-knots”. The outcome of surgical procedures was assessed by clinical examination, incidence of complications trans and postoperatively, duration of the procedure and ease of implementation. None of the animals had immediate or delayed bleeding after hemostasis. During surgery, there was no significant difference in procedure duration among the three different techniques. Postoperatively, the overall clinical evaluation was normal and there were no changes in behavior in any animal. It was noted a statistically significant difference in respiratory rate among groups, with the GI animals showing high frequency at the postoperative period when compared to animals from GII and GIII. There were no major complications in any of the techniques used and the parameters showed no significant difference among the groups. Discussion: The three most widely used techniques to perform orchiectomy in cats were evaluated in this study. Even though the respiratory rate has been shown to be statistically different among the groups, it was not a significant factor, because all other parameters were normal. These clinical data reflect the absence of major complications of surgery such as infection, pain, hypotension, hypovolemia or shock. In the current study, only adult cats were used and the structures of the spermatic cord showed strong and efficient ligation of testicular vessels with the techniques used. It was clinically observed that there was more edema in the group whose ligature employed was the suture technique. The catgut acts as a foreign body and interferes with the inflammatory reaction, the time of absorption and wound healing. The “eight-knot” technique is safe and effective, however, requires greater skill of the surgeon when compared to other techniques evaluated. The technique of “square-knot” resulted in less tissue manipulation without damaging the spermatic vessels, demonstrated by the absence of bleeding and minimal inflammatory reaction. This technique was effective, without complications postoperatively and easy to perform. These data suggest that the three techniques are considered easy and efficacious to perform orchiectomy in cats, but the technique of “square-knot” performed seems to be easier

Left Ventricular Myocardial Function in a Cat with Nonspecific Cardiomyopathy Phenotype

Background: Non-specific phenotype feline cardiomyopathy (CFNE) is one that does not fit properly in the other categories, and it is necessary to describe in detail the morphology and cardiac function. The causes of CFNE is not very clear, and it may be due to congenital or acquired disease, or also to primary or secondary myocardial dysfunction associated with other conditions. In symptomatic cases, the clinical signs observed are compatible with left congestive heart failure (ICCE). This study reports a CFNE case in an asymptomatic cat, in order to demonstrate the importance of echocardiographic examination in the early diagnosis of the disease.Case: A 6.5-year-old non-neutered crossbred cat weighing 3.1 kg was seen at the institution's veterinary hospital for routine cardiac evaluation. No clinical signs were reported in the history. On physical examination, the animal presented calm behavior, body score 5/9, heart rate 200 bpm, systolic blood pressure of 102 mmHg, respiratory rate 64 mrp, and other normal parameters. CBC and urinalysis laboratory tests were requested, which were unchanged. The electrocardiogram showed normal patterns. In the conventional echocardiographic examination, a significant increase in the left atrium (LA) was observed, and the LA/Ao ratio was 2.05 and the diastolic function was abnormal. There was no presence of concentric hypertrophy of the left ventricle (LV), the thickness of the ventricular wall measured at different points, in the two-dimensional mode and the M mode, was less than 5 millimeters. Other parameters of conventional echocardiography were within the normal range. Through these echocardiographic findings, the suggestive diagnosis was non-specific phenotype cardiomyopathy, with a significant increase in LA. For the assessment of left ventricular myocardial deformation, the strain (St%) and strain rate (StR 1/s) indexes (which correspond to the percentage and speed at which the myocardial fiber deforms during the cardiac cycle, respectively) were evaluated using two-dimensional feature tracking (2D-FTI), with the aid of Xstrain version 10.1 software, optical flow algorithm (ESAOTE®). This analysis showed a decrease in the overall value of the longitudinal and radial St/StR variables.Discussion: The CFNE echocardiographic examination can demonstrate several structural cardiac changes that are not characterized in any other category of cardiomyopathy. Although the patient is still asymptomatic, the echocardiogram made it possible to identify structural changes compatible with the reported disease (enlargement of the left atrium and left ventricular myocardial deformation). Using the 2D-FTI technique, the vulnerability of the myocardial fibers in the longitudinal and radial directions of the left ventricle was observed, demonstrating that despite the patient still not showing clinical signs, there were already signs of ventricular dysfunction. These changes observed by the 2D-FTI technique, suggest that the patient may develop clinical signs of ICCE, resulting from pleural effusion and/or pulmonary edema, requiring more frequent reassessments. For this reason, animals with CFNE should undergo periodic cardiac evaluation to monitor the evolution of the patient's clinical condition. The use of more specific tools, such as 2D-FTI, allows an earlier assessment of clinical changes, which provides a faster therapeutic intervention when necessary, preventing the patient from abruptly decompressing

Variability Inter-observer between Three Methods of Electrocardiographic (Conventional, Computerized and Computerized Printed) on Healthy Cats

Background: Electrocardiography is an exam widely used in feline medicine. It consists of recording the electrical activity of the heart in waves representing myocardial depolarization and repolarization. Two electrocardiographic evaluation methods are employed in dogs and cats: computerized and conventional. However, possible differences in ECG results performed by the different methods have been reported. This paper aims to evaluate the observer's interference in the interpretation of the electrocardiographic exams and possible differences between the methods: conventional single channel, computerized screen and computerized printed of healthy cats.Materials, Methods & Results: Electrocardiographic tracings were obtained from 58 healthy cats, aged between 1 and 10 years-old, of both sexes, of the Persian and mixed breed and therefore interpreted by four observers with similar degree of experience. The examinations were performed in a sequential manner, the computerized method first, and then the conventional method. The animals were gently contained in the right lateral decubitus position. The tracings obtained by the conventional method were printed on thermally sensitive graph paper. The computerized method was performed in computer by means of specific software (TEB® ECGPC version 6.2), being the waves delimited by the observer. The tracings were also printed by means of a jet printer, and also interpreted. The morphology of P waves, QRS complexes and T waves were analyzed in the derivations: I, II, III, aVR, aVL and aVF. Heart rate, amplitude and duration of the P, QRS and T waves, PR, QT and heart rate (HR) intervals were calculated in derivation II. Mean electric axis was determined in leads I and III. Comparing the methods, there was a difference observed in the values of P and R waves, QRS complex, QT and PR intervals and T wave polarity. The interpretation of the evaluators presented statistical differences in the duration of the P wave, QRS, QT and HR. The three methods used presented differences during the mean of the interpretation of the evaluators.Discussion: Some factors such as the positioning of the animal and the use of chemical containment may influence the electrocardiographic tracings, as well as variations between electrocardiographic devices. In our study, the non-use of sedation and the use of the same equipment in all animals reduced the variability of the results. The interpretation of the computerized method printed and on the screen presented different results which can be explained by the reduced human visual capacity when compared to the computers. It is known that the interpretation of different tracings by the observers might influence the results of the examination. The evaluators of the present study evaluated the same tracings, but there was a difference in the interpretation of the observers. Regarding the methods, there was a difference between the three methods evaluated in relation to the ST segment. The computerized on-screen method demonstrated in its totality isoelectric ST segments that represent normal pattern for the species. The conventional and computerized printed methods presented results of elevation in ST segments that represent alterations in the diagnosis. There was a difference between the measurements performed by different observers, however this fact did not influence the results of the tests, since the parameters remained within the normality standards for species. It can be concluded that the variation between observers and among the three methods evaluated suggests that the ST segment interpretation is subtle and less influenced when performed in the computerized method