Pneumothorax secondary to a Pulmonary Bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case.  Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes.Keywords: dyspnea, panting, pulmonary lobectomy, thoracotomy, chest drain.Titulo:  Pneumotórax secundário a bolha pulmonar em cão.Descritores: dispneia, ofegante, lobectomia pulmonar, toracotomia, dreno torácico.

Eventration in Green Iguana (Iguana iguana)

Background: The reptile class could be considered one of the biggest vertebrate groups and are divided in orders and suborders according to their characteristics. These animals’ maintenance in captivity, either at home, captive bred or at zoos, can generate risk to their health, if the required cares are not given for each respective species. The lack of individual cares could lead to bone and muscular diseases and to traumatic lesions in soft tissues, mainly in the coelomic cavity. The report that is being presented aims to describe the case of a green iguana (Iguana iguana) that presented an increase of volume in the coelomic cavity. The animal belongs to the squad of the Zoo “Dr. Fábio de Sá Barreto”.Case: A green iguana arrived at the Zoo in February 2019 coming from another Zoo, with already an increase of volume in the coelomic cavity. The animal was put in quarantine and later on, it was put in display at a terrarium in the Zoo considered adequate to reptiles, with another seven green iguanas along with an argentine tegu (Salvator rufescens). Their feed was offered in the morning and was composed of fruits, vegetables and flowers like hibiscus. In the end of July 2019, it was reported by the attendant that the animal was presented with anorexia and prostration, and these symptoms progressed to neurologic signs, as it walked in circles. So, the animal was evaluated by the Zoo veterinarians and on exam they noticed lethargy, dehydration, absence of reflexes (pupillary, eyelid and painful), locomotion difficulty and when the iguana moves, it walks in circles. The increase in volume had the same size as reported in February and a soft consistency. After that, the animal was interned and treated according to the symptoms and the clinical evolution. Ten days after the hospitalization, the animal was still not eating, and locomotion stopped completely. It was performed in an ultrasonographic exam evaluating all the coelomic cavity, in which a great anechoic area was visualized, and a true hernia was diagnosed. However, the content of the hernia was not identified. In the next day, the animal died, and, in the necropsy, it was possible to verify that the increase in volume was actually a bladder eventration. The eventration occurred due to a laceration in the coelomic cavity musculature that allows the passage of the bladder to the subcutaneous space and its incarceration. So, the elimination of the urine and of nitrogen compounds was difficult and a large accumulation of uric acid from the bladder to the urodeo.Discussion: Iguana iguana is a uricotelic animal, which means that the main nitrogenous waste product is uric acid. Nevertheless, ammonia is also eliminated in less quantity, because of the excess of protein in the diet. These animals eliminate around 98 to 99% of the nitrogen compounds as uric acid and less than 1% as ammonia, which prove that it is possible for the accumulation of ammonia in reptiles, if any obstacle in its elimination exists. The excess of ammonia is extremely toxic to the organism, leading to emesis, irritability, lethargy, anorexia, ataxia, motor difficulties, behavioral and neurological changes, and could progress to coma or even death. The bladder incarceration reported in this case, made it impossible for the excretion of urine, uric acid and ammonia, and these compounds remained accumulated. So, the clinical signs, along with the necropsy findings, were suggestive of intoxication by ammonia accumulation which could be responsible for the signs presented by the animal and the evolution to neurologic symptoms, coma and death.

Mucopolysaccharidosis Type I in a Dog

Background: Mucopolysaccharidoses (MPS) are a group of rare illnesses caused by deficient activity of enzymes required for degradation of glycosaminoglycans (GAGs). Each type of MPS is caused by mutations in one of the genes that encode the 11 acid hydrolases involved in this degradation process, which are present in the lysosomes. Progressive accumulation of GAGs in the lysosomes result in cellular dysfunction and multisystemic clinical signs, with consequent decrease in quality of life and lifespan of the affected patients. The objective of the present work is to report a case of MPS type I in a dog.Case: A mixed-breed male dog of approximately 2-month-old weighing 2.5 kg was referred to Hospital Veterinário de Uberaba with a distended abdomen. At the clinical examination, the patient exhibited a regular nutritional status, pale mucous membranes, 7% dehydration, an arterial pulse rate of 120 beats per minute, a respiratory rate of 40 breaths per minute, and a heart rate of 120 beats per minute. There were increased abdominal volume and tension, and hepatosplenomegaly. The abdominal percussion exam produced a dull tone. Additional findings included muscular atrophy, increased volume in the metaphyseal areas of the thoracic and pelvic limbs, valgus limb deformity in the thoracic limbs, and instability of the hip joint. Radiographic examination revealed a series of bone alterations such as reduced vertebral bodies, a generalized decrease in radiopacity, thin cortical areas in long bones, narrowing of the pelvic canal, and marked deformation and irregularities in acetabular and epiphyseal (both proximal and distal) areas of the femurs and tibias. Ankylosis of the tibiotarsal and tarsometatarsal joints was also observed. There was also loss of trabecular structure and irregularities on the surfaces of all epiphyses of the bones, epiphyseal lines markedly open, and bones that were shorter and thicker than normal. The suspected diagnoses were pseudoachondroplasia and mucopolysaccharidosis. In view of the clinical and radiographic findings, tests were performed to investigate the clinical suspicion of MPS. Consequently, qualitative and quantitative tests of GAGs in the urine, as well as a blood enzymatic essay, were requested; results confirmed the diagnosis of MPS type I. Intensive treatment allowed the patient to reach adulthood. Whenever new clinical signs emerged, they were treated palliatively. As the disease became more severe, the patient died at the age of 3 years.Discussion: Mucopolysaccharidosis type I is a rare disease that exhibits variable clinical signs and for which there is no specific treatment in dogs; these characteristics hinder diagnosis and treatment of patients as the one described in this report. The major clinical signs observed in this case are in agreement with those reported in the literature, according to which the disease can cause severe alterations such as bone defects, increased volume and deformities in the joints of the limbs, corneal opacity, and enlargement of abdominal organs such as the liver and spleen. In considering diagnostic methods for MPS, the main screening test is quantification of GAGs in the urine. The confirmatory test for MPS consists of analysis of the activity of specific lysosomal enzymes in a blood sample; this test allowed the establishment of a diagnosis in this case. Enzyme replacement therapy, in which a recombinant enzyme is used, have yielded good results in humans and dogs. However, this treatment does not cure the disease – it only attenuates the clinical signs and enables the patient to reach adulthood. Access to enzyme replacement therapy was not possible in the present case. As a conclusion, MPS should be included in the differential diagnosis of developmental diseases in puppies. This highlights the importance of further studies and reports on this disease.

Systemic Lupus Erythematosus Associated with Neurological Manifestations in a Border Collie Bitch

Background: Systemic lupus erythematosus (SLE) is an immune-mediated and multisystemic disorder which etiology is believed to be multifactorial. Its clinical signs vary accordingly to affected organs, cutaneous lesions being the most frequently observed. There are few reports of SLE in dogs with neurological manifestations. Therefore, the aim of this report is to describe a case of SLE in a dog with indicative signs of nervous system involvement.Case: A 6-year-old Border Collie bitch was referred to the Veterinary Hospital (HVU) of the University of Uberaba (UNIUBE) with a history of  with cluster seizures, inappetence and urinary incontinence. Erythema and flaking of nasal plan were noted on physical examination, and splenomegaly on abdominal palpation. Thrombocytopenia and slightly increased ALT were found on blood tests. Ehrlichiosis was suspected and doxycycline was prescribed together with phenobarbital for the control of seizures. In the follow-up visit, the dog was still presenting urinary incontinence, thrombocytopenia and splenomegaly. Also, an ulcer on the nasal mucocutaneous junction was observed. The patient went through a neurological examination which indicated thalamocortical lesion. Cerebrospinal fluid samples were obtained for cytology, culture and canine distemper test, and serology tests for leishmaniasis, toxoplasmosis and neosporosis were done. No alterations were found in these exams. The histopathology of the nasal lesion was proceeded and showed results consistent with lupus erythematosus. It was prescribed a 15-day course of prednisolone at immunosuppressive dose. The patient showed clinical improvement with this treatment. Azathioprine was started along with gradual removal of prednisolone. After twenty days of discontinuation of this drug, the dog presented epileptic seizures, urinary incontinence, thrombocytopenia, increased ALT and worsened nasal lesion. Prednisolone at immunosuppressive dose was reintroduced and the dose of azathioprine, increased. One week past this, the patient showed inappetence and an extensive hematoma in the thoracic region. Lab exams confirmed drug-induced acute pancreatitis. All medications were interrupted, the patient was hospitalized, and treatment for pancreatitis was initiated, but the dog passed away.Discussion: For involving multiple body systems and for presenting varied clinical signs, diagnosing SLE can be challenging in clinical routine. The dog from this report was a Border Collie; this breed is considered to be predisposed to this disease. The animal had a history of being exposed to solar radiation for a large part of the day, had dyspigmentation of nasal plan and had no application of sunscreen, predisposing the occurrence of SLE. Neurological signs are uncommon in SLE, but the seizures and the urinary incontinence were the main reasons for the dog’s guardian to look for medical assistance. The suspicion for SLE was raised due to cutaneous manifestations and persistent thrombocytopenia along with splenomegaly. Histopathological findings are essential for diagnosing SLE, as well as antinuclear antibody tests. Nonetheless, due to financial limitations, this last test was not performed. Azathioprine is an immunomodulating drug largely used along with glucocorticoids when treating SLE; however, this medication is prone to induce side effects as the ones presented by the dog from this report. Therefore, it is concluded that SLE should be considered as a differential diagnosis in patients showing cutaneous, hematological, systemic and neurological manifestations, considering the variety of signs caused by this disorder.Keywords: seizures, dog, immune-mediated encephalopathy. Lúpus eritematoso sistêmico associado a manifestações neurológicas em cadela da raça Border CollieDescritores: crises epilépticas, cão, encefalopatia imunomediada.

True Infection by Capillaria hepatica in a Dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepatic disease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of the present report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic. Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds and other wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectal temperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins and a sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patient was treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement. Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed a macrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia. In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP, suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that tested negative. In the ultrasonographic exam it was noticed that the liver had the same alterations and the presence of free fluid in the abdominal cavity. Due to the deterioration of the clinical picture a blood transfusion was necessary, however the patient worsened and presented respiratory difficulty for a bilateral pleural effusion. Then, the fluid was drained and a treatment with S-adenosil metionin, silymarin, ursodesoxicolic acid, doxycycline and prednisolone was started. After 17 days, a hepatic biopsy was performed, but the patient died at the surgery desk. Samples from the liver were collected for histopathologic exam. The diagnosis was confirmed in hepatic capillariosis and periportal chronic hepatitis, with the visualization of numerous parasites structures with bioperculated barrel shape. Discussion: Due to the nonspecific clinical alterations observed in the patient and the low prevalence of C. hepatica in domestic animals, there was a difficulty in the diagnosis which lead to a symptomatic, nonspecific and inefficient treatment that culminate with the death of the patient. The histopathologic exam of the liver is the best manner to find the correct diagnosis of C. hepatica infection, once the parasites eggs remains in the liver parenchyma wrapped by fibrosis and aren´t eliminate in the feces. The eggs elimination in the environment just occur after the death of the animal. Although there didn't exist a consensus about hepatic capillariosis treatment yet, if the diagnosis were done earlier, a specific treatment with better chances of a good result could be performed. We concluded that hepatic capillariosis should be included in differential diagnosis for patients with hepatic syndrome, mainly if the animal had a hunting habit and if it had access to surroundings with high rats’ infestation.

Rhinotheca Prosthesis in a Carcará (Caracara plancus)

Background: The bird’s beak is a structure in constant growth, covered by keratinized epidermal sheaths called rhamphotheca. When subjected to certain degrees of injury, birds can suffer from lesions and fractures in different parts of the body, including the beak. One can treat simple ranch lesions by antisepsis and covering it with resin while the keratin is replaced; yet in complete fractures, with segment avulsion, they need complex prostheses to restore the functions of the nozzle. The main goal of this study was to report a case of a synthetic rhinotheca prosthesis placement in a wild carcará (Caracara plancus). Case: The carcará was referred to the Veterinary Medical Teaching Hospital of the UNIUBE, at the end of May 2018, by Uberaba’s Environmental Police, with a history of having been run over. On the physical examination, the animal showed aggressive behavior, low body weight, increased heart and respiratory rates, mild dehydration and complete fracture of the rhinotheca, with avulsion of the mid-distal portion and presence of necrosis in the remaining proximal remnant, the last one seen after debridement and complete cleansing of the lesion. In the following days, complementary exams were performed aiming a complete evaluation of the animal, these revealed the following: oral cavity swab, positive for Candida sp.; radiography of thoracic and pelvic limbs, without any changes; research of hemoparasites, with a negative result; and complete blood count showing marked leukocytosis. The animal was kept in the hospital’s wild animal ward, with a daily handling of 400 g of chicken neck and heart, processed on a blender and was also supplemented with a variety of minerals. After the wild animal was managed for eleven months, evolving to the ideal weight set for the species, the process for making the prosthesis started. At first, the prosthesis was made manually with epoxy resin and polyamide, being molded on the animal's rhinotheca, before that, the carcará was sedated with intranasal midazolam, and then modeled in the ideal shape for the beak. Then, the definitive prosthesis was made with acrylic resin, using the previous mold as a base. The surgical procedure was performed in April 2019, with an anesthetic protocol composed of midazolam, dexmedetomidine, ketamine and morphine for sedation, and maintenance in sevoflurane. Prosthesis and rhinotheca were both fixated by bilateral perforation with a 1.0 mm drill, and later on 2 titanium screws were inserted for dental use, these measuring 1.5 mm. After being correctly threated, the screws received a thin layer of acrylic resin on top, for better fixation. Immediately after the operation, the animal was able to use the prosthesis to feed itself. After the surgical procedure, the bird was destined for a sanctuary, and months later the prosthesis eventually fell. Since then, the bird has remained without it.Discussion: Because the beak did not grow due to trauma and consequent necrosis, and the animal did not adapt well with the remnant still present, the manufacture of the prosthesis was the solution so that it could return to its natural habits and behaviors. For greater adherence and fixation, we opted for the use of 2 titanium screws for dental use with the deposition of a thin layer of acrylic resin on top of both. Prostheses can be successful in fixing, but there are no studies indicating how long they will remain viable. Therefore, even with the success of the procedure, allowing the bird to return to its natural habits and behaviors, until after the fall of the prosthesis, it is an animal that needs to be kept in captivity suitable for daily observation. Keywords: raptors, wild animals, beak, rhinotheca, prosthesis, synthetic, rehabilitation. Descritores: rapinantes, animais selvagens, bico, rinoteca, prótese, sintética, reabilitação. 

Reactive Seizures Due to Hyperlipidemia in a Maltese Dog

Background: Primary hyperlipidemia is a condition that affects some specific breeds. It has been previously described in Miniature Shnauzer, Beagles, Shetland Shepdog and West Highland White Terrier. There are no reports of primary hyperlipidemia in Maltese dogs. It is a hereditary disorder of lipoprotein metabolism. The etiology is unknown and may be related to a genetic problem in lipoprotein lipase or to the absence of apaprotein CII. Clinical signs include spontaneous arterosclerosis, retinal lipemia, cutaneous xanthomas, abdominal pain, lethargy, vomiting and / or diarrhea. Neurological manifestations such as seizures and behavioral changes may also occur. The aim of this report is to describe a case of reactive seizures due to hyperlipidemia in a dog.Case: A 5-year-old male Maltese dog was admitted with a history of seizures. Hypertension and abdominal distension with large amounts of intestinal gases were found in general physical examination. Neurological examination revealed impaired nasal septum sensory perception, which was slightly bilaterally reduced, and pain on cervical palpation and in the brachial plexus region. Based on history and clinical examination, it was possible to locate the lesion in the thalamocortical region and to suspect idiopathic epilepsy, reactive seizures, and symptomatic epilepsy due to meningoencephalitis of unknown origin. The diagnosis of primary hyperlipidemia was made by exclusion with the aid of laboratory tests and ultrasound. After the establishment of a fat restriction diet, bezafibrate, phenobarbital, and omega-3 supplementation, the animal improved significantly with the reduction of epileptic seizures.Discussion: The initial clinical suspicion was hyperadrenocorticism as the primary cause of hyperlipidemia. This suspicion was based on the presence of polyphagia, polydipsia, polyuria and abdominal distension, together with laboratory results of thrombocytosis, increased ALT and AF, and hyposenuria; but ultrasound images and ACTH stimulation test ruled out this differential diagnosis. Hypothyroidism was also ruled out since LDL values were normal and the animal was extremely active. Regarding nephrotic syndrome, it was also excluded for some alterations would be present, such as severe proteinuria, cholesterol reduction and hypoalbuminemia. As for diabetes mellitus, it was discarded because of the dog’s young age and due to the absence of suggestive clinical signs. The suspicion of primary hyperlipidemia was based on increased levels of triglycerides, and the presumptive diagnosis was of reactive seizures due to hyperlipidemia. It is essential, when treating hyperlipidemia, to readjust to a low-calorie diet with fat concentration below 8% and protein level above 18%. Generally, these restricted diets are for life. Omega-3 supplementation can be performed to help maintain low levels of triglycerides. Drug therapy is usually carried out with bezafibrate, which is used in human medicine as treatment for hypertriglyceridemia, and has showed good results in the control of hypertriglyceridemia and hypercholesterolemia in dogs with primary and secondary hyperlipidemia. Six months after the beginning of the treatment, the animal no longer presented abdominal distension and pain, cholesterol values and its fractions were controlled, as well as triglycerides. Seizures were also under control. Therefore, hyperlipidemia is an important differential diagnosis in cases of patients presenting seizures, especially when dealing with young animals showing signs of metabolic diseases.

Perineal Hernia in Dogs

Background: Perineal hernia is a serious disease characterized by weakening or atrophy and separation of the muscles and fasciae of the perineal musculature, followed by the caudal displacement of pelvic and abdominal organs to the perineum region. Treatment is invariably surgical and several approaches have been proposed, but complication and recurrence rates remain high. This study aimed to evaluate 120 cases of perineal hernia treated at the Veterinary Hospital of Uberaba (HVU) from 2005 to 2020, addressing the clinical and surgical aspects and the postoperative period, seeking to identify the most relevant factors to improve care and treatment of future patients affected by this disease.Materials, Methods & Results: The medical records of dogs with a definitive diagnosis of perineal hernia were collected. The prevalence of perineal hernia was calculated. Data were obtained regarding sex, being castrated or not, age, body mass, race, clinical signs, affected side, possibility of hernia reduction, treatments used, associated pathologies. Of the 120 cases, only 69 underwent surgery at the HVU and from these cases data were obtained regarding hernia content, surgical techniques, surgical wires used, recurrences and postoperative complications. Fisher's exact test was applied to assess the influence of the type of surgical treatment and surgical thread on the occurrence of complications and recurrences. Perineal hernia was the second most frequently observed hernia. Mixed breed, male, non-neutered and geriatric dogs were the most affected. The most frequently observed clinical signs were related to the digestive and urinary tract, consistent with the most commonly found hernia contents (bladder, prostate and rectum). The simple herniorrhaphy technique was the most used and showed a high number of complications. The second most used technique was the elevation of the internal shutter, which proved to be more efficient than the simple technique. Regardless of the technique used, the association of two or more techniques proved to be more efficient to reduce major complications. The use of the vaginal tunic stood out because it proved to be efficient in the treatment of perineal hernias regardless of whether it is associated with simple herniorrhaphy or obturator elevation. The surgical fixations of abdominal organs (Bladder, Ducto deferente and Colon) proved to be effective, since there were no recurrences or major complications associated with their use and the most used threads for herniorrhaphy were polyamide and catgut. Low recurrence rates were found in patients who received synthetic yarns. The most frequent complications were suture dehiscence and serous secretion.Discussion: Perineal hernia is a very important alteration due to difficulties in treatment, high rates of complications and recurrence, in addition to the large number of affected dogs. Several surgical techniques have already been proposed for the treatment of perineal hernia in dogs and are based on the reconstruction of the perineal musculature through sutures, muscle flaps, biological membranes, synthetic mesh and the reduction of pressure on the perineum through the surgical fixation of organs abdominals such as colon, vas deferens and bladder (in the musculature of the abdominal wall). It is concluded that the perineal hernia affects mainly male, non-neutered and geriatric dogs, being rare in females. Regardless of the techniques used, the association of two or more techniques is more efficient to reduce the rate of recurrences and complications. The autogenous vaginal tunic is a good option for muscle strengthening in perineal herniorraphies. The use of synthetic surgical wires leads to better results in the treatment of perineal hernia when compared to biological wires.

Otitis Media and Internal with Brainstem Extension in a French Bulldog

Background: Otitis is a frequent condition in dogs, with a multifactorial etiology covering primary causes, predisposing and perpetuating factors. It is characterized by an inflammatory process of structures that make up the auditory system, with prevalence data ranging from 15 to 20%, which can occur in any age group and without sex predisposition. According to the location, it can be classified as uni or bilateral, affecting the outer, middle and / or inner ear, the latter two being associated with neurological changes such as vestibulopathy, facial nerve paresis and Horner's syndrome. The morbidity and mortality of otitis media and internal may increase with delay in diagnosis, resulting in delay in the correct treatment, and the extension to brainstem is described in felines and considered rare in dogs. The present study aims to report an atypical case of otitis media and internal, with extension to the brain parenchyma in a brachycephalic dog.Case: A 3-year-old bitch French Bulldog canine was seen, weighing 12 kg, with a history of vomiting, apathy, nystagmus, ataxia and acute evolution hemiparesis. As a result of adoption, it was not known about the animal's morbid past. On special physical and clinical examination, depressed mental status, changes in postural reactions, nostril stenosis with unilateral mucopurulent nasal discharge, corneal ulcer, palpebral and labial ptosis, absence of eyelid reflex and spontaneous strabismus were observed, all of these findings observed on the left side of the face. No signs of otitis external to otoscopy were found. The clinical signs found characterize left facial nerve paresis and peripheral and central vestibulopathy. Otitis media / internal and meningoencephalitis were suspected. Hemogram, serum biochemistry (glucose, urea, creatinine, alanine aminotransferase, total proteins, albumin, globulin, alkaline phosphatase, gamma glutamyltransferase, phosphorus, total bilirubin, cholesterol and total calcium), urinalysis, rapid tests for erlichiosis, anaplasms , borreliosis, heartworm, distemper and leishmaniasis, CSF analysis, neurological panel performed by PCR (Polymerase Chain Reaction) that tested the animal for Bartonellosis, Lyme Disease (Borrelia burgdorferi), Blastomyces dermatitidis, Cryptococcus sp., Virus West Nile, Distemper, Toxoplasmosis, Neosporose and Coccidioides sp. using conjunctival swab, whole blood, urine and CSF samples. The samples were negative for all of these tests. As an image exam, brain magnetic resonance was performed. In the latter, otitis media and left internal was observed with extension of the lesion to the brain parenchyma. CSF analysis showed cytological changes compatible with a non-suppurative inflammatory process, mild pleocytosis with predominantly mononuclear leukocyte infiltrate. As a form of treatment, antibiotic therapy and total ablation of the auditory canal with lateral bulectomy were performed, showing good results with reduced clinical symptoms.Discussion: It is concluded that although the diagnosis of otitis media and internal with extension to brainstem is more common in cats, it should be included as a differential for central vestibular disorders in dogs, and that the diagnosis together with early and effective treatment are important, since that the evolution of the infection to the central nervous system represents a risk to the patient.Keywords: vestibulopathy, meningoencephalitis, brachycephalic.Descritores: vestibulopatia, meningoencefalite, braquicefálico.Título: Otite média e interna com extensão para tronco encefálico em cão buldogue francês 

Post-traumatic calcaneal tenorrhaphy associated to plaque and external skeletal fixative in dog: case report

The common calcaneal tendon is one of the most injured tendons in dogs. Regardless the cause, if untreated, the injury may increase permanently compromising the injured limb function. This is a case reported in a seven years old, male, 31.5 Kg, very hecticbehavior, Labrador dog. The dog had been suffered a cut by walking on a wasteland. At the clinical examination, he presented claudication, knee hyperextension and tarsal hyperflexion. At the common calcaneal tendon palpation, a loss of continuity was realized characterizing a rupture. The injury was surgically treated by approximating the tendon ́s stumps. Aiming to reduce the tension over the tendon, a plaque was sutured in the tendon caudal surface and the tarsocrural joint was temporarily immobilized. The calcaneal tenorrhaphy with modified Kessler suture associated to an orthopedical plaque and external skeletal fixative showed to be efficient to promote a dog ́s common calcaneal tendon early repairing. The healing occurred by first intention and the injured limb had a deambulatory restoration even in the first postoperative week. Such conducts have also to be considered in calcaneal tenorrhaphies in active, heavy and/or uncooperative patients.

Cholecystoduodenostomy for Treatment of Biliary Obstruction Secondary to Feline Platinossomosis

Background: Platynosomum spp. it is a trematode that has a predilection for the liver and biliary tissues whose infection is acquired through the ingestion of metacercarian gecko viscera. Felines are the definitive hosts and clinical signs are variable. The diagnosis is through history, hematological and biochemical exams, ultrasound, bile cytology or histopathology. The treatment of choice is cholecystoduodenostomy. This paper aims to report the case of a cat who was treated at the Uberaba Veterinary Hospital with chronic cholangitis secondary to platinosomosis, but there was a transfusion reaction and she died.Case: A 4-year-old, uncastrated SRD cat was treated at the Uberaba Veterinary Hospital complaining of severe episodes of vomiting three days ago, hyporexia and darkened urine. The general clinical examination showed moderate dehydration, jaundice and hepatomegaly. The animal was hospitalized for better investigation of its condition. Increased values of ALT, alkaline phosphatase and all bilirubins were observed. Ultrasound showed liver suggestive of liver disease and steatosis, and gallbladder without alteration. During hospitalization, she remained jaundiced and hypoxic, and the esophageal tube was placed. The initial clinical suspicion was cholangiohepatitis. Liver biopsy and cholecystoduodenostomy were then suggested, with refusal by the tutor. The ultrasound was repeated and showed the same alterations described, besides cholangitis. Stool examination was negative for Platynosomum spp. and positive for Isospora spp. The patient was treated with anthelmintic for three days and received supportive treatment for another week until the tutor authorized cholecystoduodenostomy. During surgery, cholecystocentesis was performed and the parasite Platynosomum spp. in adult form. After four days, a new blood count was done and the animal was still anemic and the blood transfusion was chosen. The patient died within moments of the transfusion procedure.Discussion: Platynosomum spp. it is a trematode whose ultimate host is the domestic felines and inhabits liver, gallbladder and bile ducts causing biliary obstruction and even fibrosis. In the present report, the tutor reports that the cat had several episodes of vomiting and reduced appetite. Feline jaundice is normal in cases where cholestasis causes a two to three-fold increase in bilirubinemia from normal values. The increase was verified in the analyzed feline. Physical examination revealed jaundice and abdominal palpation suggestive of hepatomegaly. Ultrasound suggested cholangiohepatitis. Without improvement, liver biopsy and cholecystoduodenostomy were suggested, with tutor refusal. After repeated ultrasound, the images suggested cholangitis and the stool examination was negative for Platynosomum spp. The definitive diagnosis for this disease is through liver biopsy, visualization of the operated eggs or the adult form of the parasite in feces or bile as suggested in this case. However, in cases where there is total obstruction of the bile ducts, the eggs are not eliminated in the digestive system and the examination may be false negative as in this case. After the exams, the cat was submitted to cholecystoduodenostomy surgery where gallbladder puncture was performed for microscopic evaluation, and the parasite Platynosomum spp. in adult form. Most cats have blood type A, but even when the donor has the same blood type, cross-reaction may occur, so compatibility testing should be performed prior to any transfusion, thus reducing the risk of transfusion reactions. The patient died within moments of the transfusion procedure. 

Inguinal Hernia with Splenic Incarceration in a Male Dog

Background: Hernias are changes with the displacement of organs from their normal anatomical location to a newly formed cavity, which can cause pain and dysfunction of the affected organ. The diagnosis can be obtained by palpation or by ultrasound. The treatment of choice is surgical and vision to promote the return of the organ to its normal anatomical position and the closure of the hernial ring. When affixing the edges of the hernial ring is not possible, alternative techniques such as the use of biological or synthetic membranes should be sought. The aim of the present study is to report an atypical case of inguinal hernia with splenic incarceration, in which splenectomy and herniorrhaphy with a bovine phrenic center were performed.  Case: An 8-year-old large mestizo male dog was referred to the Veterinary Hospital of Uberaba complaining of the appearance of a mass in the inguinal region that increased significantly in the last 15 days. On physical examination, there was an increase in volume in the left inguinal region, irreducible and great pain sensitivity in the region. The hemogram showed normochromic normocytic anemia, hyperproteinemia and thrombocytopenia. No changes were observed in the biochemical analyzes. Urinalysis revealed the presence of protein and traces of occult blood. Ultrasound showed an enlarged spleen inside the hernial sac, closing the diagnosis of inguinal hernia. The animal underwent a herniorrhaphy procedure associated with the use of a biological membrane from a bovine phrenic center and splenectomy. In addition, contralateral inguinal hernia was observed. The animal remained hospitalized and under observation for three days. On return, after five days, the guardian reported that the animal was urinating by dripping and had increased volume in the region of the surgery. Urethral catheterization was performed without difficulty and the region of swelling was punctured, obtaining a serosanguinous liquid. Ten days after surgery, stitches were removed and contralateral herniorrhaphy and orchiectomy were recommended. The animal showed complete healing of the surgical wound, but did not return for treatment of the contralateral inguinal hernia.Discussion: Inguinal hernia is considered rare in male dogs, especially in non-neutered animals, and few cases have been described, most of which are over the age of four years. In the present report, the dog is male, not neutered and is eight years old, in line with the findings of the highest occurrence in this species. Inguinal hernia can be hereditary, congenital or acquired from trauma or hormonal changes, and its etiology is poorly understood. The dog in this report acquired this condition in adulthood, and it was not possible to define the cause of the hernia, however it is believed that there is a possibility of muscle weakness associated with the patient's weight. Inguinal hernia in non-neutered dogs usually progresses to inguino-scrotal hernia, and cases in the Brazilian queue breed have been described. In this work, the herniated content was irreducible contrary to what is generally reported. In inguinal hernia, the most observed content is the intestinal loops, but the bladder and colon have already been seen. In the animal in this report, the spleen appeared as herniated content. The diagnosis can be made by palpation when the hernia is reducible, but it does not allow the definition of the hernia content. In cases of incarcerated hernias, it is necessary to perform an ultrasound which also allows the definition of the hernia content. The recommended treatment is surgical by herniorrhaphy, as was done in this patient. During surgery, muscle atrophy was observed in the inguinal region, but the tutor did not authorize the placement of polypropylene mesh for financial reasons. The alternative used and authorized by the tutor was the use of a biological membrane that achieved a satisfactory result, with few complications in the postoperative period.

Hysteropexy in the Treatment of Total Uterine Prolapse in a Brazilian Molosser Bitch

Background: Uterine prolapse is an obstetric emergency because the exposed tissue can present edema, devitalization or even gangrene, depending on the evolution time and on the severity of circulatory changes. Haemorrhage due to the rupture of ovarian or uterine vessels can evolve rapidly to hypovolemic shock. More rarely, secondary thromboembolism to the uterine strangulation can be developed, complication that can also lead to death. This study reports the case of a Brazilian Molosser bitch treated by reducing total uterine prolapse, complemented with hysteropexy, in order to prevent recurrence and maintain its reproductive ability. Case: A 5-year-old Brazilian Molosser bitch was attended presenting double firm and tubular mass protruding through the vulva. The patient gave birth to five live pups, the last two of which needed to be pulled. Two days after parturition, she had abdominal contraction when a mass protruded from the vagina. A total uterine prolapse was diagnosed, since both uterine horns were found exposed and inverted, with exposition of the endometrium and the areas of placental implantation, together with the body of the uterus. The tissue was apparently edematous and lightly parched, with the presence of strange bodies, but without signals of circulatory complications or lacerations that could turn a possible reduction and maintenance of the uterus unfeasible. Due to interest of the tutor in preserving the reproductive ability, an internal reduction via ventral medial celiotomy and the fixation of the uterus in the lateral abdominal wall (hysteropexy) was chosen in order to diminish the possibility of relapse in future parturition.Discussion: The definitive treatment of the uterine prolapse can be realized through ovariohysterectomy when the exposed uterine tissue is highly compromised or there is vessel rupture or no reproductive purpose for the female. The amputation of everted tissue through the vulva is also an option, but the risk of intracavitary bleeding during tissue resection must be considered when the uterine and ovarian artery and vein escape to the interior of the abdomen without according hemostasis. In cases which there are no complications of the prolapsed tissue and is desired to maintain the reproductive ability of the female, the internal reduction with hysteropexy is recommended. As the etiology of the uterine prolapse is a condition bound to several factors, in between them multiple pregnancies, relaxation of the uterine ligaments and genetic factors, conditions which can be associated to the cause of the prolapse in the mentioned patient, the hysteropexy was preferred as a complementary technique to uterine preservation and prevention of the prolapse relapse in a possible new parturition. In this case, the reduction of prolapse followed by hysteropexy was preferred, because the female dog was apparently well, without signs of complication of the prolapsed tissue and with satisfactory preoperative evaluation. Adding these to the request of the tutor in maintaining the reproductive ability of the female, since the procedure would not pose as a life risk to it. The absence of severe lacerations and circulatory complications in the prolapsed uterus of the bitch under study and the non-detection of toxemia and septicemia corroborated to the reduction and preservation of the uterus. Even though the uterine prolapse is a rare disease, it is necessary to improve surgical techniques that enable the conservation of the female dog in reproduction. In situations of viability of the prolapsed tissue, the technique of hysteropexy in abdominal wall showed itself effective, concluding that hysteropexy is feasible and efficient as a complementary procedure to the reduction of uterine prolapse, having contributed to avoid relapse and maintaining the reproductive of the subject related in this article.

Corticosteroid Responsive Tremor Syndrome Associated with Estrus in a Female Dog

Background: Corticosteroid responsive tremor syndrome is an immune-mediated disorder that primarily affects small dogs aged 1 to 5 years. It is manifested by generalized tremors of high frequency and low amplitude, with involvement of head, trunk and limbs. The diagnosis is based on history, clinical signs and laboratory tests to rule out other conditions, as well as on the response to corticosteroid treatment. The aim of the present study was to report a case of a female dog with corticosteroid responsive tremor syndrome that began after estrus.Case: A 1-year-old, undetermined dog, weighing 4.9 kg, was attended at the Veterinary Hospital of Uberaba, with generalized tremors that impaired her walking and feeding. The picture had an acute onset, there was no history of intoxication, trauma, but the animal had an organophosphate-based collar. The bitch was not castrated and had been in heat for a month. In the clinical evaluation, it was observed that besides the tremors, the dog had hypermetria and hyperthermia. Suspected adverse reaction to organophosphorus or encephalitis. The collar was removed from the animal. Hemogram, serum biochemistry, analysis and culture of cerebrospinal fluid and test for distemper were performed. The hemogram was leukopenia due to lymphopenia. No alterations were observed in serum biochemistry CSF culture and the distemper test were negative. The CSF analyte revealed pleocytosis with predominantly lymphocytes, density and glucose increased slightly. The diagnosis of encephalitis of inflammatory etiology was established. Treatment with prednisone and diazepam was performed. Clinical signs improved after seven days of therapy. Approximately one and a half years after the initial clinical picture, the animal presented recurrence of the tremors associated with estrus again. The same treatment was instituted and the dog underwent ovariohysterectomy. There was no relapse of the clinical picture.Discussion: Syndromes characterized by generalized tremors were initially described in white-coated dogs. Later, they were observed in dogs of other pelts and in cats. It currently receives different nomenclatures such as idiopathic tremor syndrome or corticosteroid responsive tremor syndrome. The animal history of the present case allowed to exclude the main differential diagnoses of tremors caused by medication, intoxication and hypomyelination. The clinical manifestations of hyperthermia, hypermetry and generalized tremors of high frequency and low amplitude were also described by other authors in cases of corticosteroid responsive tremor syndrome. The age and size of the animal is consistent with previous reports that observed a higher frequency in animals from 1 to 5 years of age of small breed. The absence of alterations in the tests that indicated an infectious process allowed the diagnosis of inflammatory disease and the rapid improvement of the clinical signs after treatment with prednisone allowed to establish the diagnosis of the syndrome of the responsive corticosteroid tremor. Recurrence of the clinical picture again after estrus suggests that the variation of the hormones estrogen and progesterone during this phase may influence neuronal excitability as well as stimulate an inflammatory reaction. Further studies are needed to clarify the pathophysiology of corticosteroid responsive tremor syndrome and to investigate this hypothesis of sex hormone involvement in inflammation.

ISOLAMENTO E CULTIVO DE CÉLULAS TRONCO MESENQUIMAIS EXTRAÍDAS DO TECIDO ADIPOSO E DA MEDULA ÓSSEA DE CÃES

Resumo Objetivou-se estabelecer um protocolo para extração, cultivo e expansão de células tronco mesenquimais (CTM), utilizando-se 3,0 mL da medula óssea e 3,0 cm3 de tecido adiposo do subcutâneo de três cães machos com seis meses de idade. As amostras foram processadas e as células extraídas e cultivadas em DMEM. Para comprovação do isolamento de CTM, procedeu-se a caracterização fenotípica e a diferenciação osteogênica, adipogênica e condrogênica. As células isoladas apresentaram morfologia alongada e fusiforme e capacidade de se diferenciar em osteoblastos, adipócitos e condrócitos. A caracterização fenotípica revelou alta expressão de marcadores de CTM CD90 (80,04%) e CD29 (96%) nas células de origem medular e CD90 (60,94%) e CD29 (77,08%) nas de origem adiposa. A expressão de marcadores hematopoiéticos foi baixa tanto nas células de origem medular CD45 (1,45%) e CD34 (1,53%), quanto nas de origem adiposa CD45 (1,45%) e CD34 (1,53%). As modificações e adaptações realizadas nos protocolos clássicos simplificaram o processo e foram eficientes, permitindo o isolamento e cultivo de CTM da medula óssea e do tecido adiposo de cães.

Ischemia-reperfusion model in rat spinal cord: cell viability and apoptosis signaling study

This work aimed at determining the ideal ischemia time in an in vitro ischemia-reperfusion model of spinal cord injury. Rat spinal cord slices were prepared and then exposed or not to oxygen deprivation and low glucose (ODLG) for 30, 45, 60, 75 and 90 minutes. Cell viability was assessed by triphenyltetrazolium (TTC), lactate dehydrogenase (LDH) release, and fluorochrome dyes specific for cell dead (ethidium homodimer) using the apotome system. Glutamate release was enzymatically measured by a fluorescent method. Gene expression of apoptotic factors was assessed by real time RT-PCR. Whereas spinal cord slices exposed to ODLG exhibited mild increase in fluorescence for 30 minutes after the insult, the 45, 60, 75 and 90 minutes caused a 2-fold increase. ODLG exposure for 45, 60, 75 or 90 minutes, glutamate and LDH release were significantly elevated. nNOS mRNA expression was overexpressed for 45 minutes and moderately increased for 60 minutes in ODLG groups. Bax/bcl-xl ratio, caspase 9 and caspase 3 mRNA expressions were significantly increased for 45 minutes of ODLG, but not for 30, 60, 75 and 90 minutes. Results showed that cell viability reduction in the spinal cord was dependent on ischemic time, resulting in glutamate and LDH release. ODLG for 45 minutes was adequate for gene expression evaluation of proteins and proteases involved in apoptosis pathways.

Orthopedic implant of a polyhydroxybutyrate (PHB) and hydroxyapatite composite in cats

The purpose of this study was to evaluate the tissue response to a 70% polyhydroxybutyrate and 30% hydroxyapatite composite in the form of a bone implant, placed intracortically in the distal metaphyseal of the right femur, and subcutaneous implants in cats. Samples of the composite were implanted subcutaneously in the dorsolumbar region and the distal metaphyseal region of the right femur of the animals. The study used 12 neutered adult mixed breed cats, weighing an average of 3.5 kg. The cats were randomly divided into three groups: GI, GII and GIII, according to the length of the assessment period. The assessments of their subcutaneous and bone tissues were performed at 15, 30 and 45 days and at 30, 60 and 90 days, respectively. The subcutaneous and bone reactions to the composites were characterized by granulomatous inflammation with a predominance of macrophages and giant cells. The results showed that the composites triggered a chronic local inflammatory response, despite their clinical acceptance.

Creating a continent tubeless gastrostomy

Standard tube feeding gastrostomy is associated with a myriad of problems among which leakage of gastric contents is the most serious. Over the years many methods of creating tubeless gastrostomy have been unsuccessful because of the extent of surgery required and the persistent leakage of gastric fluids. By using gastrointestinal staplers to create a gastric tube and by incorporating a reverse intussusception valve at its base, we created a continent tubeless feeding gastrostomy in 23 patients aged 10 to 81 years. Eight had head injuries, 12 had cerebrovascular strokes, and 3 had head and neck disorders leading to aphagopraxia. Twelve of the procedures were performed with local anesthesia and the remainder with general anesthesia. The GIA stapler was used to create a 5 cm gastric tube after which circumferential stitches were placed to intussuscept 2 cm of the tube into the stomach to create a valve. A 1 cm stoma was created at skin level. Operative time was 47 to 90 minutes and there were no operative deaths or complications. Stomal necrosis occurred in two patients so they were converted to a standard tube gastrostomy by leaving a Foley catheter in place. After 16 months of follow-up, one stricture developed at 4 months and two were electively closed under local anesthesia. None is incontinent. The tubeless continent feeding gastrostomy is convenient for both patients and nursing staff and should replace the standard feeding gastrostomy when long-term nutritional support is needed.