Fístula salpingofaríngea por vídeo cirurgia para tratamento de empiemas guturais crônicos em equinos

Orientador: Prof. Dr. Peterson Triches DornbushDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 08/03/2019Inclui referências: p.45-50Resumo: As doenças das bolsas guturais são frequentes na rotina em equinos de esporte, sendo o distúrbio mais comum o empiema, que se caracteriza por um acúmulo de exsudato na bolsa gutural. Nos casos crônicos, pode haver a formação de condroides, que dificultam o tratamento clínico, podendo a cirurgia ser indicada. Com a evolução da vídeo cirurgia e o desenvolvimento de instrumentais as técnicas de abordagem das bolsas guturais tem sido modificadas. Este trabalho tem por objetivo determinar o acesso as bolsas guturais pela faringe, por via endoscópica, além de desenvolver um dispositivo que facilite o procedimento cirúrgico. Foram utilizados cinco equinos, sem raça definida, com idade entre 03 a 15 anos, sem alterações clínicas ou das vias aéreas detectadas ao exame endoscópico. Os animais foram sedados e permaneceram em estação contidos no tronco. Foi realizada a sondagem e coleta de material das bolsas guturais. Com o auxílio de um dispositivo de cauterização monopolar desenhado para este procedimento realizou a fenestração entre o recesso faríngeo e à laringe. As fístulas formadas tiveram inicialmente formato de elipse e foram acompanhadas semanalmente até completar 35 dias de pós-operatório. Os resultados mostraram que quanto mais dorsal a fístula melhor a perviedade da mesma. O dispositivo desenvolvido permitiu um procedimento rápido e de fácil execução com o equino em estação, além de um baixo custo, podendo ser acoplado a qualquer cautério monopolar. Os exames microbiológicos mostraram total alteração de flora bacteriana da bolsa gutural em todos os animais. Portanto sugerimos novos estudos em animais acometidos de empiemas crônicos e recidivantes das bolsas guturais, para verificar a eficácia clinica desta técnica de faringosalpingostomia. Palavras chave: endoscopia, cavalos, faringe, afecções, divertículos.Abstract: The guttural pouch diseases are frequent in the routine of the athletic horses, with the empyema being the most common disturb, that is characterized by the exudate accumulation at the guttural pouch. In the chronic cases, the formation of chondroids can happen, making the clinical treatment difficult, and surgery may be indicated. With the evolution of the video surgery and the development of instrumental the techniques of approach of the guttural pouch is being modified. This study has the objective to determinate if the access to the guttural pouch through the pharynx, by endoscopic approach. It was used five horses, mixed breed, with age between 03 to 15 years, without clinical or airway changes detected on endoscopic examination. The animals were sedated and remained in station contained in the trunk. The guttural pouch was probed and material was collected. With the aid of a monopolar cauterization device, designed for this procedure, the fenestration was performed between the pharyngeal recess and the larynx. The formed fistulas had an ellipse format initially and were monitored weekly until completing 35 postoperative days. The results showed that the more dorsal the fistulas was better was the patency of the same. The developed device allowed a fast and easy procedure with the equine in station, besides it low cost, being able to be coupled to any monopolar cautery. Microbiological tests showed total alteration of bacterial flora of the guttural pouch in all animals. Therefore, we suggest new studies in animals affected by chronic empyema and recurrent guttural pouch to verify the clinical efficacy of this pharyngoalpingostomy technique. Keywords: endoscopy, horse, pharynx, affections, diverticula

Behavior of Cellulose Biosynthetic Membrane as a Peritendinous Implant in Foals

Background: Tendon injuries are common in horses and are commonly associated with lameness and athletic career disruption. Adhesions formed between the tendons and the surrounding tissues compromise the sliding and movement of the structures, compromising their functionality. Therefore, the control of adhesion formation is critical to restore the structural integrity of the tendon, as well as its biomechanical function. The aim of this study was to evaluate the behavior of the biosynthetic cellulose membrane implanted in foals with surgically induced tendinitis of the superficial digital flexor.Materials, Methods & Results: Six healthy foals were used, which underwent tendinitis induction in the superficial digital flexor of the right and left forelimbs. The lesions was induced by local ischemia by crushing the tendon with hemostatic forceps. The biosynthetic cellulose membranewas implanted only in the right forelimb, involving the superficial digital flexor tendon in the region of the ischemia and the left forelimb was used as control. After surgery, both forelimb were immobilized with synthetic plaster cast for 15 days. Ultrasonography was performed in six foals immediately before (M0), at 15° (M1) at and 30° (M2) day, and three were evaluate at 45° (M3) and 60° (M4) day after surgery. Incisional biopsies were performed in three animals on the 30° day and in three animals on the 60° day after surgery. Histopathological examination involved the analysis of tissue disorganization, presence and type of inflammatory infiltrate and neovascularization, according to the score of 0 to 3. Ultrasonography allowed visualization of the membrane, which was characterized as a continuous hyperechoic line at the edges of the tendon at 15 days (M1). In addition, at 30 and 45 days after surgery, interruption of the hyperechoic line and reduction of echogenicity were observed, and no echogenic lines were observed at 60 days after surgery. During the biopsies, the fragments obtained from the treated limb were presented with easily detachable layers and separate layers of tissue during histological cutting and the slides preparations. There was no significant difference in relation to the histopathological scores between the treated and control member. The inflammatory infiltrate was predominantly of mononuclear cells and fibroblasts, with identification of giant cell in a foal at 30 days. Neovascularization was observed in all limbs, treated and controls at 30 days and in two treated limbs and three control at 60 days. It was possible to identify the synthetic cellulose membrane by histopathology in only two limbs treated at 30 days and in no limb at 60 days.Discussion: The degree of tendonitis induced in the present study was considered mild according to ultrasonographic analysis at 15 days after surgery. This fact limited the evaluation of the biosynthetic cellulose membrane in the prevention of adhesions, since they were not observed in both groups. However, the ability of the membrane to minimize adhesion formation can be suggest by the macroscopically observed individualization of the tissue layers during histological sections and slides preparation. Ultrasonographic analysis allowed the visualization of the membrane, as well as its positioning and the absorption process. Therefore, ultrasonography can be used in post-implantation monitoring of the membrane. The comparison of the histopathological scores demonstrates the biocompatibility of the biosynthetic cellulose membrane when implanted in foals submitted to surgically induced tendinitis, since there was no difference when compared to treated and control limbs. Therefore, it can be used safely in the treatment of tendon injuries in horses

Acrochordonous plaque in a Doberman Pinscher dog

An eight-yr old, neutered female Doberman Pinscher was presented for dermatological evaluation due to numerous pruritic, non-pigmented nodules that created a plaque in the lumbo-sacral region. This report is the first published photographic record of an acrochordonous plaque in a dolichocephalic dog and is the first reported case in Brazil

Use of Monopolar Cauterization for Ectopic Intramural Ureter Correction by Cystoscopy in Bitch

Background: The ectopic ureter (EU) is considered a congenital anomaly in which the ureteral aperture opens in a position other than the bladder neck. The diagnosis involves the use of different methods or combination of image exams, including excretory urography, pneumocystography, ultrasonography, cystoscopy and computed tomography. The technics for surgical repair should be considered evaluating the number and functionality of the EU, the location of the ureteral opening, functional condition of ipsilateral kidney and the presence of other abnormalities. The case reports aims to show the surgical repair of an intramural EU in an English Bulldog bitch by cystoscopy-guides monopolar cautery.Case: A 1-year-old English Bulldog bitch received medical care due to a history of urinary incontinence since a few months of life. The animal had laboratory abnormalities compatible with lower urinary tract infection, followed by a profound growth of Klebsiella sp in urine culture, and received antibiotic treatment for 21 days based on antibiogram results. Due to a suspect EU, a urinary tract tomography was performed and indicated a congenital kidney malformation (renal dysplasia), enlargement and distal insertion of the left ureter (in comparison with the contralateral one), rising suspiciously of its intramural progression. We choose to proceed to cystoscopy examination, in which both right and left ureteral ostium could be seen in the urethral region. A guide of a pigtail catheter was inserted through both ureteral ostia in order to orient the ureteral incision. The monopolar cautery was inserted in cystoscopy working channel to section the mucosa of EU channel on urethra region, separating the lumen of EU from the urethra and extending the incision cranially inside the urinary bladder lumen. After a complete section of the ectopic tissue, a pigtail urinary catheter was correctly placed in both ureters. After bilateral repair of EU, the bitch showed a significative decrease of urinary incontinence, although completer resolution could not be obtained.Discussion:Studies showing the treatment of EU using the ablation of the tissue separating the ureteral and urethral or bladder lumen using cystoscopy-guided laser showed lower post-operative pain and hospitalization time, besides being a minimally invasive technique in comparison with traditional surgery. The limiting factor is the specialized equipment required for the procedure. In our surgical routine, there is a cystoscope, however, we do not own a diode laser or radiofrequency equipment. The adaptation of a monopolar cautery with the objective of correct an intramural EU proved to be feasible in practice since we achieved satisfactory recovery of the patient, similar than what is seen with lasers. Even after surgical repair of both EU, the patient sustained urinary incontinence, although lesser than before surgery. The remaining of the clinical sign, in this case, is compatible with the low rate of postoperative urinary continence in bitches, irrespective of the surgical technique, varying between 25% and 58% with or without medical treatment. To our knowledge, there was no published report on the use of monopolar cautery to treat EU. The monopolar cautery can be used as a less invasive and alternative technique to traditional surgery in the treatment of intramural EU through cystoscopy in bitches