Comparação entre duas técnicas de biópsia renal guiadas por laparoscopia em eqüinos

A biópsia renal é técnica de diagnóstico útil para identificação do tipo e severidade e acompanhamento da evolução da doença renal. A alta incidência de lesões renais em eqüinos, geralmente em conseqüência de distúrbios digestivos ou respiratórios, freqüentemente associados a endotoxemia, nos motivou a estudar a técnica de biópsia renal guiada por laparoscopia, comparando o uso de agulha com pinça de biópsia. Foram utilizados 10 eqüinos hígidos, distribuídos aleatoriamente em dois grupos. Em cinco animais foi realizada biópsia renal com agulha descartável do tipo tru-cut e nos outros cinco com pinça de biópsia de 5mm, sendo que o procedimento foi guiado em ambos os grupos com auxílio da laparoscopia. Os animais permaneceram em estação durante a biópsia, que foi realizada mediante sedação e analgesia e bloqueio anestésico local em 2 pontos no flanco esquerdo, sendo um para introdução do trocarte e laparoscópio e outro para introdução da agulha ou pinça. As técnicas foram comparadas quanto à segurança, intensidade do sangramentro, tempo de execução e significância da amostra colhida. Em todos os procedimentos, foi possível a inspeção da cavidade peritoneal e escolha do local de colheita do material, com ausência de acidentes ou complicações o que nos permitiu validar ambas as técnicas. A análise histológica dos fragmentos demonstrou maior porcentagem de biópsias consideradas adequadas no grupo em que foi utilizada pinça laparoscópica o que nos leva a indicar preferencialmente seu uso.Renal biopsy is a useful diagnostic technique for the identification to the type of lesion, severity of the disease and its evolution. The high incidence of renal lesions in horses, which usually are a consequence of digestive and respiratory diseases and are frequently associated with endotoxemia, prompted us to study the laparoscopic technique for renal biopsy compair the use of needle and forceps. For the purpose of this study ten helthy horses were randomly chosen and divided into two grups of five animals each: in one group laparoscopic guided renal biops was performed using tru-cut needles and in the other group using 5mm laparoscopic forceps. Procedures were carried out with the animals in standing position. Animals were given a sedative analgesic combination and local anesthetic was infiltrated in two specific points on the left flank. One point was used to introduce the trocar and laparoscopic, the other was used to introduce the forceps or the needle. The techniques were compared as regards safety, intensity of bleeding, time for execution and significance of the sample obtained. In all of the procedures, were possible to inspect the abdominal cavity, and chose the place to collect samples, without acidents or complications. The histological analysis of the sample showed a higher percentage of adequate biopsies in the group where laparoscopic forceps were used that permit us to viable both of them with preference for the forcps use

Surgical evaluation and laboratory use of homologous pericardium in serous injury by abrasion of large colon (pelvic flexure) of horses

Intra-abdominal adhesions are equine surgery complications, which can result in obstructive processes and jeopardize the survival of these animals. The present study used 10 healthy, male mongrel horses (SRD), with four and 15 years of age and weighing between 300 and 400 kilograms (kg), who underwent laparotomy left station with the aim of inducing adhesions, test intestinal membrane using pericardium as prevention and evaluating the different systemic changes and the abdominal fluid. After sedation and local anesthesia, the surgical approach was used in grade; pelvic flexure was created in an area of abrasion that in Group 1 was covered by homologous pericardium and in Group 2, washed with saline. After repositioning muscle, the skin and subcutaneous tissue were sutured. Postoperative care consisted of clinical evaluation, abdominal fluid cytology, hematology and serum biochemistry in moments M0- preoperative, and M7, M14, M21 and M28 days postoperatively. New laparotomy was performed at 30 days from the surgery to verify adhesion, appearance and intestinal biopsy. The surgical technique allowed less trauma and restricted operative field. The clinical course was satisfactory, and fibrous scar was identified between the muscle planes. Adhesions were not observed. Laboratory evaluations showed increased bilirubin, hematocrit, monocyte, blood urea and protein density and segmented leukocyte peritoneal fluid. The present study concluded that the abrasion was insufficient to promote fibrous adhesions. The implant without proven efficacy is feasible and possible, and does not result in significant differences laboratory or deleterious changes. Aderências intra-abdominais são complicações de cirurgias de equinos que podem resultar em processos obstrutivos e comprometer a sobrevida dos animais. O presente estudo utilizou dez equinos hígidos, machos, sem raça definida (SRD), com quatro a 15 anos de idade e peso vivo situado entre 300 e 400 quilogramas (kg). Os animais foram submetidos à laparotomia esquerda em estação com o objetivo de serem induzidas aderências, testar a utilização intestinal de membrana biológica de pericárdio como prevenção e avaliar as diferentes alterações sistêmicas e do líquido abdominal. Após sedação e analgesia local, foi utilizado o acesso cirúrgico em grade, na flexura pélvica foi criada uma área de abrasão que, no Grupo 1, foi coberta por pericárdio homólogo e no Grupo 2, lavada com solução fisiológica. Após reposicionamento foi realizada a sutura muscular, de subcutâneo e pele. O pós-operatório constou de avaliações clínicas, citologia do líquido abdominal, hematologia e bioquímica sérica nos momentos M0- pré-operatório e M7, M14, M21 e M28 dias de pós-operatório. Nova laparotomia foi realizada aos 30 dias para verificar aderências, aspecto e biópsia intestinal. A técnica cirúrgica possibilitou menor trauma e campo operatório restrito. A evolução clínica foi satisfatória e cicatriz fibrosa foi identificada entre os planos musculares. Aderências não foram observadas. As avaliações laboratoriais demonstraram aumento de bilirrubinas, hematócrito, monócito, ureia sanguíneos e de proteína, densidade e leucócitos segmentados no líquido peritoneal. Conclui-se que a abrasão foi insuficiente para promover aderências fibrosas. O implante, sem comprovada eficácia, é viável e possível, por não resultar em diferenças laboratoriais significativas ou alterações deletérias

Estudo anátomo-cirúrgico do cólon transverso do eqüino por acesso paralombar esquerdo

O cólon transverso é um estreitamento do canal alimentar, sujeito a sofrer processos obstrutivos. A ampliação do conhecimento sobre essa estrutura e adjacentes é de grande importância cirúrgica. Neste estudo foram utilizados 10 cadáveres de eqüinos de diferentes raças, idades e sexos, divididos em dois grupos de cinco. No primeiro grupo foi realizada uma incisão no 16º espaço intercostal esquerdo e posterior ressecção da 16ª costela. No segundo grupo a incisão foi feita sobre a 17ª costela com a remoção da mesma. Todas as estruturas identificadas foram registradas em fichas individuais, assim como a extensão exteriorizada do cólon transverso. Em todas os animais o cólon transverso foi totalmente visualizado e parcialmente exteriorizado, sendo que houve melhor manipulação e exteriorização no segundo grupo, além da maior facilidade no emprego da técnica, com a incisão sobre a costela a ser ressecada. Dessa forma, concluímos que o cólon transverso pode ser acessado pela fossa paralombar esquerda, sendo que a remoção da 17ª costela proporciona o melhor acesso para essa estrutura.The transverse colon is a constriction of the bowel lumen, which can be submitted to obstructive process. The knowledge enlargement about this structure and the adjacent ones has a great surgical importance. For such study, ten anatomic pieces, from equines corpses of different breed, age and sex, were used and divided in two groups. In the first group an incision was made in the left 16 intercostal space and farther resection of the 16 rib. In the second group an incision was made over the 17 rib, before its ressection. All the identified structures were registered into individual files, such as the extension of the exteriorized portion. In all of the studied pieces, the transverse colon was entirely visualized and partially exteriorized. However, we had better handling and exteriorization in the second group, as well as we noticed its technique was of easier execution. In accordance with the results, through this work is possible to conclude that the transverse colon can be approached by the left flank, and that the removal of the 17 rib provides a better access to the transverse colon

Avaliação da composição macroelementar do osso terceiro metacarpiano de equinos

The equine third metacarpal bone has been seen as a region of particular interest due to the large number of injuries to which it is subject. Thus, the detailed study of its anatomical structure, size and elemental composition is justified for the improvement of diagnostic techniques, treatment and prevention of injuries. In this work it has been studied the macro elemental composition of 30 pairs of equine third metacarpal bone and its relation with age, sex, weight, breed, nutrition and activity of animals. The average concentrations of calcium and phosphorus of the samples were 205 ± 62 mg/g and 97 ± 32 mg/g, respectively. The ratio [Ca] / [P] was found to be 2.12 ± 0.13, indicating that the ratio of calcium and phosphorus in bone tissue is constant and approximately equal to the ratio 2:1. The statistical analysis showed normal values for the entire set of measurements. In the evaluation of the animals with intense physical activity, and animals with light physical activity, it was found that the amount of mineralized material for the first and second sets respectively ([Ca] = 222 ± 57 mg/g [Ca] = 179 ± 47 mg/g), showing the existence of statistical correlation between the deposit of mineral material and the function performed by the animals. For the other characteristics were not found statistical evidence of correlations. These findings will be input for further studies of possible correlations with diseases of nutritional origin or physiological outside the series of fractures and other disease common to the equine locomotor system.O terceiro osso metacarpiano equino é uma região de particular interesse devido ao grande número de lesões a que está sujeito. Assim, justifica-se o estudo detalhado da sua estrutura anatômica, dimensões e composição elementar para o aprimoramento de técnicas de diagnóstico, tratamento e prevenção de lesões. Neste trabalho,foi estudada a composição macroelementar óssea de 30 pares de osso terceiro metacarpiano equino e sua relação com a idade, sexo, peso, raça, alimentação e atividade dos animais. As concentrações médias de cálcio e fósforo das amostras foram 205 ± 62 mg/g e 97 ± 32 mg/g, respectivamente. A relação [Ca]/[P] encontrada foi de 2,12 ± 0,13, indicando que a proporção entre o cálcio e fósforo no tecido ósseo é constante e aproximadamente igual à razão 2:1. A análise estatística dos dados mostrou normalidade para todo o conjunto de medidas. A avaliação entre os animais com atividade física intensa e os animais com atividade física leve, em que a quantidade de material mineralizado para o primeiro e segundo conjuntos são, respectivamente, [Ca] = 222 ± 57 mg/g e [Ca] = 179 ± 47 mg/g, evidenciou a existência de correlação estatística entre o depósito de material mineral e a função exercida pelos animais. Para as demais características, não foram verificadas evidências estatísticas de inter-relações. Tais achados serão subsídios para estudos posteriores acerca de possíveis correlações com enfermidades de origem fisiológica ou nutricional frente à casuística de fraturas e outras afecções comuns ao aparelho locomotor equino

Utilização da ultrassonografia Power Doppler no acompanhamento de neovascularização no pós-operatório de ovino submetido a osteossíntese: relato de caso

Sonography is a safe and non-invasive imaging modality, with the added benefit of providing dynamic images. Power Doppler sonography allows blood vessel identification regardless of flow intensity or direction. A one-year-old Ile de France ewe was admitted to the FMVZ-USP Veterinary Hospital with a complete tibial fracture. The animal was submitted to general inhalation anesthesia and fracture repair using a 3.5 mm locking compression plate. Power Doppler sonography was used to assess neovascularization over the course of the bone healing process. Formation of new vessels was noted between postoperative days 14 and 21; new vessels regressed progressively on subsequent assessments (postoperative days 28 and 35). Power Doppler sonography enabled early detection of newly formed blood vessels at the fracture site. The non-invasive nature of this imaging modality prevented patient stress and provided useful information on the progression of bone healing. Early neovascularization was thought to reflect successful postoperative healing of the tibial fracture described.A ultrassonografia é técnica de imagem segura e não invasiva que fornece imagens dinâmicas. O Power Doppler é modalidade ultrassonográfica que permite a visualização de vasos sanguíneos sem depender de intensidade e direção de fluxo. Admitiu-se no Hospital Veterinário da FMVZ-USP um ovino fêmea, de raça Ile de France, com um ano de idade e apresentando fratura completa de tíbia em bisel. O animal foi submetido à anestesia inalatória para a realização de osteossíntese com placa bloqueada de 3,5 mm. Durante o período pós-operatório foram realizadas imagens de ultrassonografia Power Doppler para a avaliação da neovascularização ao longo do processo de regeneração óssea. Entre o 14º e o 21º dia do período pós-operatório, identificou-se a presença de vasos sanguíneos neoformados, que apresentaram sinais de regressão nas avaliações subsequentes (realizadas no 28º e no 35º dia pós-operatório). A ultrassonografia Power Doppler mostrou-se eficiente na detecção precoce de vasos sanguíneos neoformados na região da fratura no período pós-operatório, sendo um exame não invasivo, que não gerou estresse para o animal e que pode estar relacionado ao sucesso no reparo ósseo da tíbia do animal submetido à osteossíntese

A survey on equine neoplasias over a 15-year period in a veterinary hospital

Apesar de vários estudos fornecerem informações sobre a incidência de neoplasias em equinos, há grande variação na distribuição, em decorrência de diferenças regionais, como clima e população racial. Foram analisados 133 casos de neoplasias dentre os 6669 equídeos atendidos no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, durante um período de 15 anos, representando 2% do total de atendimentos. A neoplasia mais frequente foi o carcinoma de células escamosas (45%), diferindo da maioria dos estudos realizados mundialmente. No sistema tegumentar, a neoplasia mais comum foi o melanoma (34,2%); nos sistemas ocular e urogenital, foi o carcinoma de células escamosas (76,9% e 40,9% respectivamente). Em 68% dos casos foi realizado tratamento cirúrgico, em 10%, tratamento clínico e em 22%, nenhum tipo de tratamento, por opção do proprietário ou indicação de eutanásia. Óbitos por causas relacionadas às neoplasias ocorreram em 14% dos casos. Os achados sugerem que o carcinoma de células escamosas ocorre mais frequentemente em nosso atendimento hospitalar. Este fato pode estar relacionado à exposição prolongada à luz ultravioleta, cuja quantidade de radiação em regiões tropicais vem aumentando consideravelmente nas últimas décadas.Although several prior studies have provided information regarding incidence of tumors in horses, there is a wide variation due to regional differences, such as climate and breed population. A number of 133 cases involving tumors was found among the 6669 equides submitted to the Veterinary Hospital (HOVET) of the School of Veterinary Medicine of the University of São Paulo, during a 15 years period, representing 2% of all records. The most commonly found neoplasm was the squamous cells carcinoma (45%), different from most of the studies worldwide. The most common neoplasia in the integument system was melanoma (34,2%) and in the ocular (76,9%) and urogenital systems (40,9%) was squamous cells carcinoma. Surgical intervention was recommended in 68% of the cases, while a clinical approach was chosen in 10% of them. Twenty two percent of the horses were not treated due to of the owner option or euthanasia indication. Death associated with tumors occurred on 14% of the animals during the hospitalization period or treatment. The squamous cell carcinoma occurs more often in our veterinary hospital and may be related to prolonged exposure to ultraviolet radiation, whose amount in the tropics has increased considerably in the last decades

Clinical and Complementary Diagnosis of Sinus Neoplasia in Horses

Background: Sinus neoplasms are reported as low frequency in horses. Its clinical characteristics are often nonspecific, depend on complementary methods for diagnosis, and when diagnosed, generally they are already advanced, limiting therapeutic possibilities. The objective of this case series was to detail clinical aspects and complementary exams for sinus neoplasms for early diagnosis, comparing them with the literature.Cases: Four horses were treated at the College of Veterinary Medicine and Animal Science of the University of São Paulo, with different clinical signs and previous diagnoses, which when evaluated by respiratory endoscopy, radiography, oral cavity evaluation and histopathological exams, revealed the diagnosis of anaplastic carcinoma, poorly differentiated carcinoma, ossifying fibroma and lymphoma. Previous diagnosis, based mainly on clinical signs, were sinusitis secondary to apical infection, ethmoidal hematoma, sinus cyst and sinusitis secondary to periapical disease. The cases of anaplastic carcinoma (case 1) and lymphoma (case 4) presented with an advanced degree of the disease with involvement and destruction of paranasal structures and adjacent tissues, in addition to a poor general condition, which made surgical treatment impossible and led to euthanasia. In these cases, previous treatment was made to apical infection and periodontal disease with secondary sinusitis, but negative evolution led to suspicion of neoplasia, confirmed by histopathological exam of incisional biopsy of the mass in oral cavity. Benign ossifying fibroma (case 3) presented with progressive respiratory difficulty due to occlusion of the lumen of some nasal meatus and radiographic signs of invasion and deformation of the adjacent bones, it was submitted for surgical excision and there was no recurrence until hospital discharge. The poorly differentiated carcinoma (case 2) was a multilobulate neoformation in the ethmoidal region, similar to ethmoid hematoma in endoscopic and radiographic evaluation, it was submitted for excision and two sessions of electrochemotherapy with bleomycin, associated with administration of piroxicam, which obtained a good result until the period of 1 year after discharge.Discussion: It was found that many characteristics are common with these types of neoplasms, and the clinical signs, such as nasal secretions, airway obstruction, increased facial volume, severe alterations in oral cavity, although unspecific, suggest the differential diagnosis for neoplasms. It is important to differentiate from other diseases noting the evolution and growth of these tumors, like in cases 1 and 4, especially the growth to internal tissues, using complementary methods described here, like endoscopic and radiographic examination. Late identification or even manipulation of neoplasms, without proper diagnosis, leads to a few prognoses regarding life. When it is possible to perform surgical excision, complementary methods are important to guide the procedure, and definitive diagnosis is made through histopathologic exam and some need immunohistochemistry analysis. Cases 2 and 3 had surgical access, were submitted to excision and treatment with good results, both with close monitoring in first months and prolonged quality of life. These results highlight the importance of complementary methods for early diagnosis, correct intervention and monitoring of evolution.Keywords: sinus neoplasia, paranasal sinus, tumor, head, horses

Physics behind the implants used for high strain fractures: literature review

Quando fraturas ósseas ocorrem, forças externas produzem movimentação interfragmentária continuamente e um método de estabilização se faz necessário. É sabido que as condições mecânicas no local de fratura influenciam a formação de calo durante o processo de cicatrização óssea e para que cicatrização óssea primária seja obtida é necessária estabilidade absoluta no foco de fratura. O conceito de strain de Perren determina que a deformação relativa no foco de fratura estabilizado depende do tamanho da lacuna de fratura original. Fraturas redutíveis (sem cominuição) são consideradas de alto strain, pois uma pequena força aplicada a linha de fratura resulta em grande movimentação com efeito deletério ao processo de consolidação. O presente trabalho revisa a literatura disponível a respeito de fatores que influenciam a mecânica de fraturas de alto strain em medicina veterinária, seus métodos de tratamento e a física por trás dos implantes disponíveis. Cada configuração de fratura requer atenção especial e cuidado crítico na escolha do método de osteossíntese e no tipo de estabilidade necessária para que a consolidação ocorra no tempo esperado. Conhecimento da teoria do strain é mandatório para a formação de cirurgiões ortopédicos. Whenever bone fractures occur, external forces produce continuous interfragmentary motion and a stabilization method is necessary. It is known that the mechanical conditions at the fracture site influence bone callus formation during healing process. To achieve primary (direct) bone healing, absolute stability at the fracture site is necessary. Perren’s concept of strain determines that relative deformation at the fracture gap depends on the original gap’s conformation. Simple fractures (without comminution) are considered high strain fractures since a small force applied to the fracture site results in great movement with deleterious effects on the healing process. The purpose of this study is to review the available literature regarding factors that influence the mechanics of high strain fractures in veterinary medicine, its treatment methods and implants available. Each fracture configuration requires special attention and critical care in choosing the osteosynthesis method and the type of stability required for consolidation to occur within the expected time. One must know the strain theory to become an orthopedic surgeon

Evaluation of Ventral Laparoscopic Abomasopexy Using Surgical Staples Associated with Suture Material in Dairy Cattle

Background: Displaced Abomasum is known for being on of the main illnesses that affect milking cows. Increase in diagnosis of this illness is due to advancement in diagnosis techniques. Increase in incidence of this illness can be explained by genetic selection of animals with high production, breed systems and changes to the diet with a higher level of protein. For laparoscopic treatment, several surgical changes were performed to optimize the procedure and thus achieve better results. The main purpose of this study was to evaluate applicability of the ventral laparoscopic abomasopexy technique, using surgical clamps attached to the suture thread, to milking cows.Materials, Methods & Results: Six adult cows were placed under anesthesia with isoflurane and placed in dorsal decubitus. Animals were kept with no water for 24 h and no food for 48 h. Four laparoscopic accesses were performed. The first one was created with the intention of inspecting the abdominal cavity and the remaining three for access of surgical instruments. Serous membrane of the abomasum was cauterized, combined with suture threads and placed at the greater abomasal curvature. The free part of suture threads was kept out of the abdominal cavity and after traction of the abomasum against the abdominal wall was tied to the skin. Ultrasound exam was performed for abdominal evaluation after abomasopexy. Anesthesia time and surgery time were recorded and analyzes through average and standard deviation (SD). The average anesthesia time recorded was 94 min (SD 14.63 min) and average surgery time was 51 min (SD 14.71 min). The fasting period was considered adequate, however all animals had to undergo intubation with orogastric tube to drain liquids and gas during the procedure. Four of the six animals had lineal adhesion. Three of the four animals that had adhesion did not keep the abomasum at the retroperitoneal area, however viscera movement was stopped in the abdominal cavity.Discussion: Abomasopexy through laparoscopy is a safe technique, especially when compared with other invasive methods of abomasopexy. However, to perform this type of surgery availability of adequate equipment and a well trained surgical team are required. This study was performed at a surgery room under full anesthesia. In a field situation, the veterinarian can have some difficulties but such adversities must not be considered and impediment for performance of surgery on the field as its performance is possible. Even though surgical clamps were small, they were considered adequate for what was suggested. The applied 0 degree laparoscopic optic presented restrictions for cavity inspection, therefore we believe that an optical lenses with 30 degree angle could facilitate this laparoscopy inspection. To induce greater and more lasting adherence we suggest cauterizing a greater area of the serous membrane of the abomasum. We also suggest not performing this procedure during lactation peak, when fasting and surgery can cause economic losses. Complications associated with this technique could not be avoided. The technique has shown favorable results, but its clinical applicability depends on application on animals subjected to the conditions of a milk production cycle