La fibrillazione atriale nel cane: analisi critica e valutazione retrospettiva di alcuni parametri ecocardiografici ed eco-doppler in quattordici casi

RIASSUNTO Gli AA. dopo una breve analisi critica della fibrillazione atriale, ne descrivono alcuni rilievi ecocardiografici ed eco-doppler riscontrati in quattordici cani. L’aritmia è stata riscontrata in presenza di dilatazione di almeno una cavità atriale. La velocità del flusso aortico varia dipendentemente dall’eziologia: è solitamente elevata in corso di stenosi subaortica, mentre tende ad essere leggermente ridotta in presenza di un deficit sistolico. Il flusso transmitralico ad alta velocità è compatibile con le elevate pressioni di riempimento ventricolare sinistre associate all’insufficienza cardiaca. Gli intervalli sistolici variano in maniera prevedibile dipendentemente dall’eziologia, ma non in modo diverso da cani affetti dalla stessa cardiopatia ed in ritmo sinusale. Le alterazioni riscontrate sono probabilmente riconducibili alla cardiopatia primaria ed all’elevata frequenza cardiaca associate all’aritmia piuttosto che alla fibrillazione atriale. SUMMARY The authors, after a concise critical analysis of atrial fibrillation, describe some echocardiographic and echo-doppler findings detected in fourteen affected dogs. The arrythmia was detected in presence of at least monolateral atrial dilation. Maximal aortic velocity varies dependently upon etiology: elevated in case of subaortic stenosis, while is usually reduced if a systolic deficit is present. High velocity transmitral flow is compatible with elevated left ventricular filling pressure associated with heart failure. Systolic time intervals vary in a prevedible manner depending on etiology, but such variations don’t differ from those observed in dogs affected by the same cardiac disease but in sinus rhythm. Observed alterations are probably secondary to the primary disease and elevated heart rate rather than to atrial fibrillation

Rigurgito mitralico e tricuspidale diastolico in due cani con blocco atrioventricolare completo spontaneo

RIASSUNTO Il rigurgito diastolico attraverso entrambe le valvole atrioventricolari è un rilievo ecocardiografico di frequente riscontro in corso di blocco atrioventricolare completo sia nel cane che nell’uomo. L’entità del rigurgito sia mitralico che tricuspidale è lieve e tale da non risultare significativo dal punto di vista emodinamico. La diagnosi può essere emessa sia con l’ausilio del doppler a codice di colore che con il doppler spettrale. Il jet origina dal punto di coaptazione dei lembi valvolari ed è diretto centralmente. Ciononostante, date le piccole dimensioni del jet di rigurgito, l’impiego combinato delle due metodiche può essere di aiuto nel posizionamento del volume campione e nell’allineamento del doppler. L’assenza di contrazione ventricolare a seguito della contrazione atriale comporta un reflusso di sangue all’interno delle cavità atriali presumibilmente come conseguenza di un’inversione del gradiente pressorio intercorrente tra gli atri e i ventricoli nonché della chiusura incompleta delle valvole atrioventricolari. La presenza di insufficienza valvolare e quindi di rigurgito sistolico non è un prerequisito necessario allo sviluppo di reflusso diastolico in corso di blocco atrioventricolare completo. SUMMARY Atrioventricular valvular regurgitation is a common echocardiographic finding in both dogs and humans with complete atrioventricular block. The severity of both mitral and tricuspid regurgitation is mild and hemodynamically non significant. The condition can be easily diagnosed by means of either color-flow doppler and spectral doppler. The jet originates from the site of coaptation of valvular leaflets and is centrally directed. Nevertheless, because of the limited size of the regurgitant jet, the combined use of color-flow and spectral doppler can help in placing the sample gate and align for the doppler study. Lack of ventricular contraction following atrial contraction leads to reflux of blood into the atrial cavities, presumably due to atrioventricular pressure gradient reversal and incomplete closure of the mitral valve. The presence of valvular insufficiency and consequent systolic regurgitation is not a prerequisite for diastolic reflux to occur in case of complete atrioventricular block

Ultrasonographic Diagnosis of Urachal Anomalies in Cats and Dogs: Retrospective Study of 98 Cases (2009–2019)

This retrospective study investigated the prevalence of different urachal anomalies (UA) in cats (n = 60) and dogs (n = 38) and their association with clinical symptoms and urinalysis alterations. Among UA, the vesicourachal diverticulum was the most prevalent UA diagnosed in both cats (96.7%) and dogs (89.5%): the intramural vesicourachal diverticulum was diagnosed in 76.7% of cats and 71.1% of dogs, followed by extramural vesicourachal diverticulum (20.0% and 18.4% respectively). In both cats and dogs, bladder wall diffuse or regional thickening was the most prevalent alteration. The most common alterations of the urinary bladder content were urolithiasis sediment in cats (33.3%) and in dogs (31.6%). Dogs with UA were more often asymptomatic (p = 0.01). No difference was found in cats. Stranguria, hematuria, and urethral obstruction were the most frequently reported clinical signs, while hematuria and leukocyturia were the most prevalent abnormalities at urinalysis. In conclusion, our study confirmed UA as uncommon, and often incidental findings, with a high prevalence of animals without clinical signs

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Low in‑hospital mortality rate in patients with COVID‑19 receiving thromboprophylaxis: data from the multicentre observational START‑COVID Register

Abstract COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease,and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Ectopia ventricolare ipokaliemia-indotta in due cani con insufficienza cardiaca

RIASSUNTO Nel cane l’ipokaliemia è una rara complicazione della terapia diuretica con furosemide. In medicina umana circa il 10% dei pazienti in terapia con diuretici d’ansa ed il 20-30% di quelli in terapia con diuretici tiazidici, sviluppa ipokaliemia. Tale incidenza risulta superiore per i tiazidici (nonostante l’escrezione frazionata del potassio legata alla somministrazione dei diuretici d’ansa sia superiore) in virtù della loro maggiore durata d’azione. Non esistono studi analoghi condotti nel cane, ma si ritiene che l’incidenza sia molto più limitata. È stato inoltre osservato che i diuretici d’ansa, inibendo il riassorbimento del magnesio a livello di ansa di Henle, ne aumentano l’escrezione urinaria e possono, anche se raramente, causare ipomagnesiemia. In due cani (affetti da miocardiopatia dilatativa e malattia valvolare degenerativa mitralica) alla somministrazione di furosemide, pimobendan e, in un caso, spironolattone ha fatto seguito lo sviluppo di un’ectopia ventricolare. In entrambi i casi è stata riscontrata ipokaliemia; l’integrazione orale di potassio ha comportato la normalizzazione della potassiemia e la scomparsa dell’aritmia ventricolare senza che venisse somministrato alcun farmaco antiaritmico. In ogni cane con insufficienza cardiaca ed in terapia con furosemide in cui si verifichi l’improvvisa insorgenza di un’aritmia ventricolare dovrebbero essere valutati i livelli plasmatici del potassio. SUMMARY Both loop and thiazide diuretics administration induces marked kaliuresis that, in people, leads to the development of hypokalemia in a significant percentage of patients. 20-30% of patients receiving standard doses of thiazides and about 10% of patients treated with loop diuretics develop hypokalemia. Viceversa in the dog hypokalemia is a rare complication of diuretic therapy. Hypokalemia may promote, especially if the patient is concurrently receiving digitalis, the appearance of supraventricular and ventricular ectopic rhythms. This arrhythmias may be enhanced by hypokalemia/induced increased automaticity and/or facilitation of re-entry. Potassium repletion is the preferred therapeutical approach in human medicine, but routine oral supplementation is not currently recommended. This report describes two clinical cases of dogs (affected by either dilated cardiomyopathy and degenerative mitral valve disease) in which ventricular ectopy developed following administration of furosemide, pimobendan and, in one case, spironolactone. In the former case ventricular bigeminism leading to syncope was diagnosed; in the latter isolated premature ventricular complexes with two different morphologies were detected. In both cases hypokalemia was detected and subsequent oral potassium supplementation led to normalization of serum potassium levels and ventricular arrhythmia without the need of administering any antiarrhytmic drug. In all dogs with heart failure receiving furosemide, sudden onset of a ventricular arrhythmia should prompt evaluation of serum potassium levels

Doppler pulsato delle arterie arcuate intrarenali nel cane

RIASSUNTO Nel campo della medicina interna dei piccoli animali le patologie renali costituiscono una delle principali cause di mortalità. In medicina umana numerosi lavori hanno dimostrato che lo studio del rene attraverso la metodica doppler ad onda pulsata delle arterie arciformi e la conseguente determinazione dell’indice di resistività consente di ottenere delle informazioni utili per la diagnosi precoce di alcune nefropatie. Nonostante non tutti i processi patologici renali causino un’alterazione delle resistenze vascolari intrarenali o comunque producano un aumento rilevabile dell’indice di resistività, tale indice può risultare utile in corso di patologie renali acute e sindromi ostruttive. L’obiettivo di questo studio è di determinare il normale range di variabilità dell’indice di resistività in cani sani allo scopo di valutarne, in un secondo momento, le modificazioni in presenza di diverse nefropatie. Abbiamo ottenuto un valore medio di 0,61 (deviazione standard pari a 0,049) per il rene destro e di 0,60 per il rene sinistro (deviazione standard pari a 0,046). Non sono state riscontrate differenze significative in misurazioni seriali effettuate nello stesso rene, né tra i due reni di uno stesso soggetto mentre in soggetti diversi, sebbene sani, i valori dell’indice di resistività possono oscillare all’interno di un range piuttosto ampio. Inoltre non è stata riscontrata alcuna correlazione significativa tra l’età o il sesso del soggetto in esame ed il suo indice di resistività. SUMMARY In the field of small animal internal medicine renal diseases are among the most important causes of mortality. In human medicine several studies stated the usefulness of pulsed-wave doppler evaluation of renal arcuate arteries blood flow and subsequent determination of the resistivity index in early diagnosis of some nephropathies. Despite not all kinds of renal conditions alter intrarenal vascular resistance or cause a detectable modification of the resistivity index, such index may be valuable in presence of acute renal diseases or obstructive syndromes. The aim of this study is to determine the normal range of variability of the resistivity index in healthy dogs in order to assess, later, eventual modifications induced by different nephropathies. We obtained a mean resistivity index of 0.61(standard deviation is 0.049) in the right kidney and 0.60 (standard deviation is 0.046) in the left kidney. We did not find any differences among serial determinations of the resistivity index in the same kidney nor between the two kidneys of a given patient while among different patients, although healthy, the normal variability range is quite large. Furthermore we did not get any correlations between the age or sex of the dog and the resistivity index

Utilità dell’esame ecografico addominale nell’iter diagnostico del versamento peritoneale nel cane

RIASSUNTO Il versamento addominale è l’accumulo patologico di liquido libero in cavità peritoneale. L’esame ultrasonografico dell’addome è un test diagnostico comunemente disponibile, non invasivo, né doloroso che consente una completa esplorazione della cavità peritoneale. L’obiettivo di questo studio è di valutare le informazioni ottenibili dall’esame ecografico addominale, in quali scenari clinici questo si riveli più utile ed in quali viceversa il suo valore sia più limitato. In questo studio retrospettivo i rilievi ecografici riscontrati in cani con versamento addominale sono stati confrontati con l’origine e la natura del versamento stesso allo scopo di valutarne la validità diagnostica. L’ecografia addominale è risultata particolarmente utile in caso di lesioni occupanti spazio, che possono essere facilmente evidenziate e studiate. Allo stesso modo, in caso di sospetta insufficienza cardiaca congestizia destra, consente la valutazione delle dimensioni e della vascolarizzazione epatica allo scopo di evidenziare un’eventuale congestione sistemica e quindi confermare l’eziologia del versamento. L’ecografia costituisce anche la metodica di prima scelta in caso di sospetto shunt porto-sistemico. In alcune situazioni cliniche quali epatopatie e nefropatie non neoplastiche, deficit coagulativi, l’ecografia, consentendo solo lo studio morfologico e non funzionale dei diversi organi, può suggerire la presenza di una patologia potenzialmente responsabile del versamento addominale, ma la conferma di tale ipotesi richiede l’esecuzione di ulteriori test diagnostici e/o laboratoristici. In caso di pioperitoneo l’ecografia può essere di scarso ausilio al fine di determinarne l’origine. SUMMARY Abdominal effusion is the pathologic accumulation of free fluid in the peritoneal cavity. Abdominal ultrasonography is a diagnostic test readily available, non invasive neither painful, allowing detailed exploration of the peritoneal cavity. The aim of this study is to evaluate the information that can be obtained with an ultrasonographic study of the abdomen, in which clinical scenarios it is more valuable and in which ones its diagnostic value is more limited. In this retrospective study ultrasonographic findings detected in dogs with peritoneal effusion have been compared with the origin and nature of the effusion in order to assess their diagnostic value. Abdominal ultrasonography proved to be very useful for diagnosing space-occupying lesions that can be easily detected and studied. When right-sided congestive heart failure was suspected, it allows evaluation of liver size and vascularization in order to detect systemic congestion and then confirm the origin of the effusion. Ultrasonography is a very useful test for the diagnosis of porto-systemic shunts. In some instances, such as non-neoplastic hepatopathies or nephropathies and coagulation disorders, ultrasonography, allowing only a morphologic and not a functional assessment of abdominal organs, can suggest the presence of a disease potentially responsible of the abdominal effusion, but to confirm such hypothesis further diagnostic work-up is mandatory. In case of pyoperitoneum abdominal ultrasonography proved to have a limited value in detecting its origin

Fratture pelviche nel cane e nel gatto: classificazione ed esame di 591 casi

RIASSUNTO In questo lavoro è presentato un sistema di classificazione delle fratture pelviche nei piccoli animali, con esame e discussione di 591 casi raccolti presso il Dipartimento di Clinica Veterinaria dell’Università di Pisa dall’anno 1996 all’anno 2006. Il sistema adottato si basa su una modificazione del sistema di classificazione AO/ASIF, utilizzato in medicina umana e in medicina veterinaria dei piccoli animali per la classificazione delle fratture delle ossa lunghe, e già utilizzato e modificato in studi precedenti. Anche nel nostro caso è stato utilizzato un sistema di classificazione basato su codici composti da numeri e lettere che indicano il sito anatomico, la localizzazione, l’implicazione o meno degli elementi di carico e la gravità della frattura pelvica. I casi sono stati valutati in base ad esami radiologici eseguiti nelle due proiezioni standard, LL e VD, prendendo in considerazione solo i radiogrammi di buona e ottima qualità. Lo scopo di questo studio è stato quello di elaborare un metodo di classificazione che ci ha permesso di poter osservare 221 tipi di fratture pelviche diverse, in parte prese in considerazione singolarmente ed in parte associate fra di loro, applicando 113 combinazioni diverse di siti di frattura. Le fratture pelviche riscontrate più frequentemente sono risultate essere quelle a livello del corpo dell’ileo con 157 casi su 591 (26,56%), considerando sia le fratture del corpo dell’ileo semplici che quelle associate a fratture in siti diversi o a lussazione sacro-iliaca, seguite da quelle acetabolari con 135 casi su 591 (22,84%). La combinazione di fratture che è stata osservata più comunemente è quella della frattura del corpo dell’ileo accompagnata dalla frattura della tavola dell’ischio e dell’osso del pube con 40 casi su 69 (57,97%), che presentavano fratture pelviche in siti diversi combinate fra loro. SUMMARY In this article a classification system for pelvic fractures of small animals is presented, based on the analysis of 591 cases observed at the Department of Veterinary Clinic, University of Pisa, from 1996 to 2006. System adopted is a modification of AO/ASIF system, used in human and veterinary medicine to classify long bones fractures, and adopted in other studies successive to our study. The adopted method is based on alphanumeric codes indicating anatomic region, site, involvement of weight-bearing elements and severity of fracture. Cases have been evaluated by standard two-projection radiological examinations LL e VD, including only good and excellent quality radiograms. This detailed classification system enabled us to observe 221 kinds of different pelvic fractures, some observed separately, others in combination, applying 113 associations of different fracture sites. Ilial body simple or together with fractures in different sites or with sacroiliac luxation and, in the second place, acetabulum showed the highest prevalence, respectively 157 cases on 591 (26,56%), and 135 cases on 591(22,84%). The most frequent fractures combination was ilium body together with ischium body and pubic bone con 40 cases on 69 (57,97%)