Clinical and Surgical Management of Dog with Diffuse Cholangiocarcinoma

Background: Cholangiocarcinoma is an epithelial cell malignancy arising at various locations within the biliary tree. Primary liver tumors can be classified morphologically as solid, when a single large tumor involves only one liver lobe; nodular, when multiple tumors are located in different liver lobes; diffuse, when either multifocal nodular changes occur in different liver lobes or when diffuse changes occur throughout the liver. Surgery is the treatment of choice for these tumors because there is no established, effective chemotherapy protocol. This paper reports on the management of a dog with diffuse cholangiocarcinoma.Case: A 13-year-old female, castrated Pinscher, weighting 6 kg, was admitted at the Veterinary Medical Teaching Hospital of the Federal University of Rio Grande do Sul (UFRGS) with clinical signs of abdominal distension and dyspnea that had started one month ago. The patient had been subjected to total unilateral mastectomy to remove an adenocarcinoma. At clinical examination, the animal presented anemia, an area of silence during pulmonary auscultation on the right hemithorax,and hepatomegaly. Because of the chronicity and nonspecific signs, additional tests were requested. Abdominal ultrasound exam showed hepatomegaly with irregular echotexture; cavity areas scattered throughout the organ, especially by the right medial lob; discrete presence of free abdominal fluid. Thoracic radiography showed increased radiopacity in themedial and caudal right hemithorax, suggesting metastasis. Laboratory tests included a complete blood count (normocytic mycrocytic anemia), an albumin count (27.49 g/L), an alanine amino-transferase test (77.40 U/L), an alkaline phosphatase test (284.94 U/L), a creatinine test (0.81 mg/dL), a conjugated bilirubin test (0.1 mg/dL), a not conjugated bilirubin test (0.1mg/dL), and a total bilirubin test (0.2 mg/dL). After blood transfusion, a hepatic lobectomy was performed. An incision was made along the ventral midline. A tumoral mass, approximately 20 cm in diameter, was observed in the right medial lobe, as well as diffuse changes throughout all hepatic lobes. A total lobectomy was performed by applying the mass ligationtechnique by placement of a circumferential ligature around the liver hilus. The abdominal cavity was sutured routinely. Histopathological examination showed primary cholangiocarcinoma. The animal had excellent postoperative recovery after six days. Subsequently, the patient again succumbed to hepatomegaly, ascites, anemia, and lethargy, and the ownerchose to euthanize the patient and did not authorize a necropsy.Discussion: The cholangiocarcinoma was classified as primary and diffuse because of the macroscopic characteristics of the liver, since there were diffuse changes throughout the organ. Surgical excision was the treatment of choice. Although the prognosis was better in the early stages, lobectomy was chosen in order to improve the patient’s respiratory condition and, consequently, improve the quality of life. There were no surgical complications and the patient presented good postoperative recovery. After 60 days of the surgical procedure, clinical signs recurred (anemia, hyporexia and abdominal distension) and euthanasia was performed. Hepatic lobectomy in an animal with advanced stage cholangiocarcinomaprovided good quality of life for a period of 60 days.Keywords: neoplasm, liver, surgery, hepatectomy

Clinical and surgical management of dog with diffuse cholangiocarcinoma

Background: Cholangiocarcinoma is an epithelial cell malignancy arising at various locations within the biliary tree. Primary liver tumors can be classified morphologically as solid, when a single large tumor involves only one liver lobe; nodular, when multiple tumors are located in different liver lobes; diffuse, when either multifocal nodular changes occur in different liver lobes or when diffuse changes occur throughout the liver. Surgery is the treatment of choice for these tumors because there is no established, effective chemotherapy protocol. This paper reports on the management of a dog with diffuse cholangiocarcinoma. Case: A 13-year-old female, castrated Pinscher, weighting 6 kg, was admitted at the Veterinary Medical Teaching Hospital of the Federal University of Rio Grande do Sul (UFRGS) with clinical signs of abdominal distension and dyspnea that had started one month ago. The patient had been subjected to total unilateral mastectomy to remove an adenocarcinoma. At clinical examination, the animal presented anemia, an area of silence during pulmonary auscultation on the right hemithorax, and hepatomegaly. Because of the chronicity and nonspecific signs, additional tests were requested. Abdominal ultrasound exam showed hepatomegaly with irregular echotexture; cavity areas scattered throughout the organ, especially by the right medial lob; discrete presence of free abdominal fluid. Thoracic radiography showed increased radiopacity in the medial and caudal right hemithorax, suggesting metastasis. Laboratory tests included a complete blood count (normocytic mycrocytic anemia), an albumin count (27.49 g/L), an alanine amino-transferase test (77.40 U/L), an alkaline phosphatase test (284.94 U/L), a creatinine test (0.81 mg/dL), a conjugated bilirubin test (0.1 mg/dL), a not conjugated bilirubin test (0.1 mg/dL), and a total bilirubin test (0.2 mg/dL). After blood transfusion, a hepatic lobectomy was performed. An incision was made along the ventral midline. A tumoral mass, approximately 20 cm in diameter, was observed in the right medial lobe, as well as diffuse changes throughout all hepatic lobes. A total lobectomy was performed by applying the mass ligation technique by placement of a circumferential ligature around the liver hilus. The abdominal cavity was sutured routinely. Histopathological examination showed primary cholangiocarcinoma. The animal had excellent postoperative recovery after six days. Subsequently, the patient again succumbed to hepatomegaly, ascites, anemia, and lethargy, and the owner chose to euthanize the patient and did not authorize a necropsy. Discussion: The cholangiocarcinoma was classified as primary and diffuse because of the macroscopic characteristics of the liver, since there were diffuse changes throughout the organ. Surgical excision was the treatment of choice. Although the prognosis was better in the early stages, lobectomy was chosen in order to improve the patient’s respiratory condition and, consequently, improve the quality of life. There were no surgical complications and the patient presented good postoperative recovery. After 60 days of the surgical procedure, clinical signs recurred (anemia, hyporexia and abdominal distension) and euthanasia was performed. Hepatic lobectomy in an animal with advanced stage cholangiocarcinoma provided good quality of life for a period of 60 days

Brazilian consensus for the diagnosis, treatment and prognosis of cutaneous mast cell tumors in dogs

Mast cell tumors represent the most common malignant skin tumor in the dog. This review outlines the incidence, etiology and clinical signs of mast cell tumors. Diagnostic tests, staging and treatments are also discussed. This study was performed by the Veterinary Oncology and Pathology of UNESP, Jaboticabal and the Service of Pathology Veterinary, of UNESP-Botucatu with the support of the Brazilian Association of Veterinary Oncology and the Brazilian Association of Veterinary Pathology

Sustainable Development of Tajikistan: Perspectives for Tajik Aluminum Company (TALCO)

Energy efficiency is one the most pressing objectives of the XXI century. Energy efficiency is an intrinsic part of sustainable development of any country. But it is especially crucial for country like Tajikistan, which has an inefficient energy use pattern as a result of the legacy of Soviet era. Energy resources required for economic development can be obtained not only through increased extraction of raw materials, but also through improved energy efficiency at the demand side. Tajikistan imports about 35 percent of its energy needs, which makes the country extremely energy-dependent. That leads to an obvious inference that for Tajikistan to get on a sustainable development path, it is highly important to improve its energy efficiency and increase its energy security. The biggest energy consumer in Tajikistan is the Tajik Aluminum Company (TALCO). According to the World Bank Energy Audit estimates from 2012, TALCO is the single largest power end-user in the country, which consumes 39 percent of total electricity generated. This research will explore the energy efficiency potential of TALCO. The research will use a core set of Energy Indicators for Sustainable Development (EISD) developed by UNDESA, the IEA, Eurostat and the European Environment Agency (EEA) to measure selected aspects of production and use of energy in TALCO. In particular, the research will focus on two of three dimensions of the EISD: Economic and Environmental dimensions. The objective of the research is to define the progress or the lack of progress towards sustainable development in Tajikistan. The research will provide information on current energy-related trends in the selected country and will attempt to provide a set of recommendation on alternatives and strategies to promote efficient and sustainable energy development

Natural orifices transluminal endoscopic surgery (NOTES) : main access and implications : review

As cirurgias endoscópicas transluminais por orifícios naturais ou NOTES (Natural Orifice Transluminal Endoscopic Surgery) significam um novo conceito de cirurgia, uma vez que são produzidas pela hibridização de endoscopia e laparoscopia, culminando em uma modalidade cirúrgica com ausência de incisões abdominais. Diversas vias de acesso para a NOTES já foram descritas na literatura, entre elas: a via transvaginal, a transgástrica, a transuretral, a transcolônica e a transretal, sendo os acessos transvaginal e transgástrico os mais estudados até o momento. Apesar da NOTES apresentar vantagens como menor dor abdominal, rápida recuperação pós-operatória, menor risco de aderências e herniações, ausência de cicatriz e menor reposta inflamatória sistêmica, a necessidade de um fechamento seguro da víscera de acesso à cavidade abdominal, bem como adequada cicatrização do órgão ainda são desafios desta nova abordagem cirúrgica. Desta maneira, o presente trabalho tem por objetivo trazer uma revisão bibliográfica da cirurgia por orifícios naturais, como também suas implicações clínicas decorrentes dos diferentes acessos à cavidade abdominal.Natural orifices transluminal endoscopic surgery (NOTES) is a new concept in surgery produced from the hybridization of endoscopy and laparoscopy and results in incisionless to the abdominal cavity. Different routes for NOTES have been described in the literature among them, the transvaginal, the transgastric, transurethral, transcolonic and the transretal, but the transvaginal and trangastric access the most studied to date. Present advantages, such as lower abdominal pain, rapid postoperative recovery, less risk of adhesions and hernias, no scar and lower systemic inflammatory response, however the secure closure and cicatrization of the viscera are still challenges of this new surgical approach. This study aims to review of natural orifice surgery, as well as their clinical implications of different access to the abdominal cavity

Immune-Mediated Hemolytic Anemia in a Bitch Triggered by Drugs

Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog.Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCV-UFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued.Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.Título: Anemia hemolítica imunomediada medicamentosa em uma cadelaKeywords: dog, hypochromic macrocytic anemia, erythrocyte, hemoglobin, spherocyte.Descritores: cão, anemia macrocítica hipocrômica, eritrócito, hemoglobina, esferócito.

Síndrome de Caroli em um cão

Caroli syndrome is characterized by a combination of intrahepatic biliary ductal ectasia and congenital ductal fibrosis due to the failure of involution of ductal plates and large intrahepatic ducts. This study aims to report Caroli syndrome in a dog, with emphasis on clinical characteristics, complementary examinations, and diagnostic approach. A 1-year-old mixed-breed intact male dog was presented with a 7-day history of acute vomiting and anorexia. Clinical evaluation revealed severe jaundice, abdominal pain, dehydration, lethargy, and abdominal distension. Ultrasonography revealed hepatic cysts filled with fluid. Exploratory laparotomy was performed to clarify the imaging findings; however, the dog died shortly after surgery. Postmortem examination revealed that the liver was reduced in size and had multiple interconnected and distended saccular dilations. The bile ducts were markedly dilated and replaced a large part of the liver parenchyma. Multiple small cysts were also observed in the kidneys. Microscopically, the hepatic lesions were characterized by extensive bridging fibrosis associated with proliferating and ectatic bile ducts contiguous with the biliary tree. Marked fibrosis and small cysts were observed in the kidneys. Therefore, a final diagnosis of Caroli syndrome was made. While uncommon, this syndrome should be considered as a differential diagnosis for young dogs with biliary cysts and hepatic fibrosis.A síndrome de Caroli é caracterizada pela combinação de ectasia biliar intra-hepática e fibrose ductal congênita, que se devem a falha na involução das placas ductais dos grandes ductos intra-hepáticos. Esse trabalho tem a intenção de reportar um caso de síndrome de Caroli em um canino, com ênfase em suas características clínicas, exames complementares, e abordagem diagnóstica. Um canídeo de um ano de idade, sem raça definida, apresentou um histórico clínico de sete dias de vômito agudo e anorexia. A avaliação clínica revelou severa icterícia, dor abdominal, desidratação, letargia e distensão abdominal. A ultrassonografia foi sugestiva de cistos hepáticos preenchidos por fluido. Uma laparotomia exploratória foi realizada para esclarecer os achados de imagem, porém, o cão morreu logo após a cirurgia. O cão foi submetido a exame de necropsia, onde se observou fígado diminuído em tamanho e com múltiplas dilatações saculares distendidas e interconectadas entre si. Os ductos biliares estavam acentuadamente dilatados e substituíam grande parte do parênquima hepático. Nos rins, múltiplos pequenos cistos eram observados. Microscopicamente as lesões hepáticas eram caracterizadas por extensa fibrose em ponte, associada a ductos biliares ectáticos e proliferados, que eram contíguos a árvore biliar. Nos rins, marcada fibrose e pequenas formações císticas foram observadas. Baseado na associação dos achados clínicos e patológicos, o diagnóstico de síndrome de Caroli foi feito. Mesmo que incomum, essa síndrome deve ser considerada como um diagnóstico diferencial para cães jovens com ductos biliares císticos e fibrose hepática