Conventional and Doppler Abdominal Ultrasonography in Pacas (Cuniculus paca)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mode B ultrasonography and abdominal Doppler in crab-eating-foxes (Cerdocyon thous)

Annually hundreds of crab-eating foxes (Cerdocyon thous) are referred to rehabilitation centers and zoos in Brazil. The ultrasonographic study of wildlife species is an important tool for a non-invasive and accurate anatomical description and provides important information for wildlife veterinary care. The aim of the present study was to determine the characteristics of the main abdominal organs as well as the vascular indexes of the abdominal aorta and renal arteries of crab-eating foxes (Cerdocyon thous) using mode B ultrasonography and Doppler ultrasonography, respectively. Ultrasonographic features of the main abdominal organs were described and slight differences were noticed between ultrasound imaging of abdominal organs of crab-eating foxes and other species. The bladder presented wall thickness of 12 +/- 0.01 mm, with three defined layers. Both, the right and left kidneys presented corticomedullary ratio of 1: 1 and similarly to the adrenals and the liver, they were homogeneous and hypoechoic compared to the spleen. The spleen was homogeneous and hyperechoic compared to the kidneys. The stomach presented 3 to 5 peristaltic movements per minute, wall thickness of 39 +/- 0.05 mm and lumen and mucosa with hyperechoic and hypoechoic features, respectively. Small and large intestines presented 2 to 3 peristaltic movements per minute, wall thickness of 34 +/- 0.03 mm and three defined layers with hyperechogenic (submucosa and serosa) and hypoechogenic (muscular) features. Ovaries of the female crab-eating fox were hypoechoic compared to the spleen and with heterogeneous parenchyma due to the presence of 2x2 mm ovarian follicles. Prostates of the six males were regular and with a well defined boundary, with a homogeneous and hyperechoic parenchyma compared to the spleen. Vascular indexes of the abdominal aorta (PSV: 25.60 +/- 0.32 cm/s; EDV: 6.96 +/- 1.68cm/s; PI: 1.15 +/- 0.07 e RI: 0.73 +/- 0.07) and right (PSV: 23.08 +/- 3.34cm/s; EDV: 9.33 +/- 2.36cm/s; PI: 1.01 +/- 0.65 e RI: 0.65 +/- 0.16) and left renal arteries (PSV: 23.74 +/- 3.94cm/s; EDV: 9.07 +/- 3.02cm/s; PI: 1.04 +/- 0.31 e RI: 0.64 +/- 0.10) were determined. Thus, conventional and Doppler ultrasonographic imaging provides basic information that can be used as reference for the species as well for other wild canids and it is a precise and non-invasive method that can be safely used to evaluate and diagnose abdominal injuries in these patients.

Association between aneurysm shoulder stress and abdominal aortic aneurysm expansion: A longitudinal follow-up study

Background Aneurysm expansion rate is an important indicator of the potential risk of abdominal aortic aneurysm (AAA) rupture. Stress within the AAA wall is also thought to be a trigger for its rupture. However, the association between aneurysm wall stresses and expansion of AAA is unclear. Methods and Results Forty-four patients with AAAs were included in this longitudinal follow-up study. They were assessed by serial abdominal ultrasonography and computed tomography scans if a critical size was reached or a rapid expansion occurred. Patient-specific 3-dimensional AAA geometries were reconstructed from the follow-up computed tomography images. Structural analysis was performed to calculate the wall stresses of the AAA models at both baseline and final visit. A nonlinear large-strain finite element method was used to compute the wall-stress distribution. The relationship between wall stresses and expansion rate was investigated. Slowly and rapidly expanding aneurysms had comparable baseline maximum diameters (median, 4.35 cm [interquartile range, 4.12 to 5.0 cm] versus 4.6 cm [interquartile range, 4.2 to 5.0 cm]; P=0.32). Rapidly expanding AAAs had significantly higher shoulder stresses than slowly expanding AAAs (median, 300 kPa [interquartile range, 280 to 320 kPa] versus 225 kPa [interquartile range, 211 to 249 kPa]; P=0.0001). A good correlation between shoulder stress at baseline and expansion rate was found (r=0.71; P=0.0001). Conclusion A higher shoulder stress was found to have an association with a rapidly expanding AAA. Therefore, it may be useful for estimating the expansion of AAAs and improve risk stratification of patients with AAAs.

Computed wall stress may predict the growth of abdominal aortic aneurysm

Growth rate of abdominal aortic aneurysm (AAA) is thought to be an important indicator of the potential risk of rupture. Wall stress is also thought to be a trigger for its rupture. However, stress change during the expansion of an AAA is unclear. Forty-four patients with AAAs were included in this longitudinal follow-up study. They were assessed by serial abdominal ultrasonography and computerized tomography (CT) scans if a critical size was reached or a rapid expansion occurred. Patient-specific 3-dimensional AAA geometries were reconstructed from the follow-up CT images. Structural analysis was performed to calculate the wall stresses of the AAA models at both baseline and final visit. A non-linear large-strain finite element method was used to compute the wall stress distribution. The average growth rate was 0.66cm/year (range 0-1.32 cm/year). A significantly positive correlation between shoulder tress at baseline and growth rate was found (r=0.342; p=0.02). A higher shoulder stress is associated with a rapidly expanding AAA. Therefore, it may be useful for estimating the growth expansion of AAAs and further risk stratification of patients with AAAs.

Ultrassonografia abdominal de cães e gatos hígidos, adultos e filhotes

Pós-graduação em Medicina Veterinária - FMVZ

Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber) Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions.

Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber) may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12) and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11), for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24-100%, and 86.7-100% respectively). For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9.5-90.6%), with specificity being 100% (95%CI 79.2-100%). For laparoscopy alone sensitivity was 100% (95% CI 34.2-100%), with specificity also being 100% (95% CI 77.2-100%). Further immunoblotting, PCR and histopathological examination revealed one individual positive for E. multilocularis, whilst the other individual was positive for Taenia martis.

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

El impacto que ha generado el trauma en Colombia a lo largo de la historia, nos ha obligado a mejorar y adaptar diferentes tipos de sistemas de atención en trauma, basados en los lineamientos internacionales, los cuales buscan evitar el significativo aumento en las tasas de mortalidad y discapacidad que se obtienen de este, especialmente en los servicios de Emergencias en los cuales se reciben el 100% de estos pacientes con traumatismo múltiple o politraumatismo. Dentro de este grupo de pacientes hay un subgrupo que son las pacientes con trauma de abdomen que cursan con estabilidad hemodinámica y además son clasificados de bajo riesgo, ya sea por índices de trauma o por otros métodos como la medición sérica de lactato, los cuales tienen un papel poco despreciable al momento de ver mortalidad y discapacidad por trauma, ya sea penetrante o cerrado; en este trabajo específicamente nos centramos en las personas que consultan al servicio de Emergencias con trauma cerrado de abdomen los cuales son considerados de bajo riesgo, siendo este subgrupo de pacientes uno de los más difíciles de abordar y enfocar al momento de la valoración inicial, ya que se debe tener la seguridad de que no hay lesiones que comprometen la vida y por consiguiente estos pacientes puedan ser dados de alta.

Évaluation gastro-intestinale chez des chiens présentant un comportement de léchage excessif de surface

L’objectif de cette étude était de démontrer que le léchage excessif de surface (LES) chez le chien représente un signe clinique d’un trouble digestif sous-jacent plutôt qu’un trouble obsessionnel compulsif. Vingt chiens présentés pour LES (groupe L) ont été divisés en 2 sous-groupes de 10 chiens chacun : L0, sans, et LD, avec des signes cliniques digestifs concomitants. Dix chiens en santé ont été assignés à un groupe contrôle (groupe C). Une évaluation comportementale complète, un examen physique et neurologique ont été réalisés avant un bilan diagnostic gastro-intestinal (GI) complet (hématologie, biochimie, analyse urinaire, mesure des acides biliaires pré et post-prandiaux et de l’immunoréactivité spécifique de la lipase pancréatique canine, flottaison fécale au sulfate de zinc, culture de selles, échographie abdominale et endoscopie GI haute avec prise de biopsies). En fonction des résultats, un interniste recommandait un traitement approprié. Les chiens étaient suivis pendant 90 jours durant lesquels le comportement de léchage était enregistré. Des troubles GI ont été identifiés chez 14/20 chiens du groupe L. Ces troubles GI sous-jacents incluaient une infiltration éosinophilique du tractus GI, une infiltration lymphoplasmocytaire du tractus GI, un retard de vidange gastrique, un syndrome du côlon irritable, une pancréatite chronique, un corps étranger gastrique et une giardiose. Une amélioration >50% en fréquence ou en durée par rapport au comportement de léchage initial a été observée chez une majorité de chiens (56%). La moitié des chiens ont complètement cessé le LES. En dehors du LES, il n’y avait pas de différence significative de comportement (p.ex. anxiété), entre les chiens L et les chiens C. Les troubles GI doivent être considérés dans le diagnostic différentiel du LES chez le chien.

Um novo método de avaliação do tempo esofágico com ultra-sonografia por abordagem externa

OBJETIVO: Utilizar a ultra-sonografia como método de avaliação do tempo esofágico e sua capacidade de discriminação entre as substâncias não-sólidas ingeridas (água e iogurte). MATERIAIS E MÉTODOS: Foram estudados 22 adultos jovens, sem queixa gástrica e esofágica, de ambos os sexos. Foi utilizado transdutor de ultra-som de 3,5 MHz, convexo, em modo B, colocado na região epigástrica. O intervalo de tempo esofágico foi determinado utilizando-se um cronômetro que foi acionado no momento da movimentação da glote (início da deglutição) e interrompido ao se visualizar a passagem do conteúdo deglutido no esôfago intra-abdominal. RESULTADOS: O tempo médio de trânsito para a água foi de 6,64 ± 1,83 segundos e para o iogurte foi de 8,59 ± 2,70 segundos. A análise estatística comparativa pelo teste t pareado mostrou que as médias apresentaram diferenças significativas entre as substâncias. CONCLUSÃO: O novo método experimental de avaliar o tempo esofágico com ultra-som é capaz de propiciar diferenças significativas do tempo necessário para um determinado alimento (líquido ou pastoso) percorrer o esôfago, esclarecendo as suspeitas clínicas e possibilitando a indicação mais precisa de exames clínicos mais complexos.

Hepatic bleeding induced by streptokinase and heparin in a patient with acute myocardial infarction

Although rare, major bleeding is the most important side effect of thrombolytic therapy in acute myocardial infarction (AMI) (Levine et al., 1995). Spontaneous hepatic bleeding in normal liver after thrombolytic administration has rarely been reported in literature. To our knowledge, there are only three cases of hepatic bleeding related to thrombolytic therapy in AMI. In these, the used drugs were anisolylated plasminogen streptokinase activator complex (APSAC) (Garcia-Jiménez et al., 1997; Fox et al., 1991) and rt-PA (Garcia-Jiménez et al., 1997). We report a case of hepatic bleeding after streptokinase followed by units over 60 minutes). The next day, the patient developed third-degree atrioventricular block and a temporary pacemaker was inserted. Twenty-seven hours after streptokinase infusion, the patient complained of refractory chest pain that was interpreted as post-myocardial infarction angina; clotting screen was normal and intravenous heparin was started (80 U/kg followed by 18 U/kg/hour). After four hours of heparin administration, the patient presented abdominal pain and distension, and his blood pressure and hematocrit level dropped. Abdominal ultrasonography revealed free fluid in the peritoneal cavity (about 3,000 mL). A laparotomy disclosed blood in the abdominal cavity with bleeding from the right lateral hepatic segment, which was removed. The remaining abdominal viscera were normal and there was no other evidence of hemorrhage. The partial liver resection presented subcapsular hemorrhage with small parenchymal hemorrhage. Histopathological examination also revealed focal areas of ischemic centrilobular necrosis. The patient died of multiple organ system failure 21 days after admission. Copyright © 2002 By PJD Publications Limited.

Características epidemiológicas, clínicas e laboratoriais de gatos com sinais de trato urinário inferior

Pós-graduação em Medicina Veterinária - FCAV

Carcinoma hepatocelular e as infecções pelos vírus das hepatites B e C na Amazônia Oriental: estudo clínico-sorológico e de biologia molecular

Com o objetivo de contribuir para um melhor conhecimento do eventual envolvimento das infecções pelos vírus das hepatites B e C, na etiopatogenia do carcinoma hapatocelular (CHC) na Amazônia Oriental, estudaram-se 36 pacientes internados em três hospitais públicos em Belém (PA), de janeiro de 1992 a março de 1999. Os critérios de inclusão adotados foram: o clínico, associado à imagenologia compatível, níveis séricos de alfafetoproteína (AFP) acima de 400ng/ml e/ou histopatologia compatível. Foram avaliados os aspectos clínicos, exames bioquímicos e hematológicos, imagenologia, histopatologia, níveis séricos de AFP e exames sorológicos das hepatites B e C. A presença dos ácidos nucléicos virais, o HBV-DNA e o HCV-RNA, foi avaliada a partir da detecção no soro pela reação em cadeia da polimerase. Observou-se um predomínio do sexo masculino (p<0.01), com reação M/F de 6,2: 1. Média e medianas gerais de idade foram, respectivamente, 50,8 e 53,0 anos, com amplitude de 6-81 anos. A maioria dos pacientes (52,7%) era procedente da zona rural, sendo a profissão de lavrador a mais freqüente (p<0,01). Etilismo foi encontrado em 33,3% dos casos. Dor abdominal e hepatomegalia, presentes em 94,4% dos casos, foram os sintomas e sinais mais freqüentes. Observou-se a presença de cirrose em 83,3% dos casos, sendo 80% enquadrados nas classes B e C (child-pugh). Cinqüenta por cento apresentaram complicações durante o diagnóstico, sendo as mais freqüentes a encefalopatia hepática e a hemorragia digestiva alta, relacionadas à doença hepática crônica de base. Marcadores sorológicos de infecção pelo HBV e pelo HCV foram encontrados em, respectivamente, 88,9% e 8,3% da casuística. Em 11,1% não se encontrou marcador sorológico. O HbsAg foi encontrado em 58, 3%. Anti-HBc foi encontrado em 86%, estando associado ao anti- HBs em 25%. Entre os HbsAg positivos: o anti- Hbe foi encontrado em 85%; o antiHBc IgM em 57,1%; e o anti-HD não foi detectado. O HBV- DNA foi encontrado em 37,7% do total de casos e em 65% dos HbsAG positivos. O HCV-RNA foi encontrado em 8,5% da amostra estudada e em 100% dos casos anti-HCV positivos. Não foi observada positividade para o HBV-DNA e para o HCV-RNA em soros de pacientes HbsAG ou anti- HCV negativos. A AFP esteve acima da normalidade em 88,9% dos casos, estando acima de 400 ng/ml em 75% e em 27,8% a titulações foi superior a 70.000 ng/ml. A ultrassonografia abdominal mostrou tumores com múltiplos nódulos em 63,9% e, nódulo único em 36,1% dos casos. O tipo histológico predominante foi carcinoma bem diferenciado do tipo trabecular (p<0,05). Os casos HbsAg positivos apresentaram menor média de idade e níveis de AFP mais elevados (p<0,01). A maioria dos pacientes se encontravam em fase avançada de doenças com uma taxa de óbito durante o diagnóstico de 38,9%. Conclui-se que, na Amazônia Oriental, a infecção pelo HBV parece exercer importância na etiologia do CHC, ressaltando-se a necessidade de incrementação de medidas preventivas, como vacinação e programa de detecção precoce do tumor em populações de risco. São necessários estudos adicionais controlados ou direcionados, para os possíveis co-fatores de importância na região, o que pode contribuir para um melhor entendimento dos mecanismos envolvidos na hepatocarcinogênese.

Bilateral hydronephrosis and hydroureter after ovariohysterectomy using nylon cable tie: a case report

A spayed crossbred female dog was presented due to progressive weight loss, emesis and anorexia over the preceding month. A complete blood count, urinalysis, serum biochemical panel, and ultrasound were initially performed. Computed tomography urography was performed as a complementary exam. Based on ultrasound and CT findings an exploratory celiotomy was performed to remove hyperdense structures that could be the cause of the hydronephrosis and hydroureter in both kidneys. An extensive granulomatous reaction was found near the caudal pole to the left kidney. A nylon cable tie adhering firmly to this tissue was removed during surgical excision. On the dorsal surface of the bladder an extensive granulomatous reaction that had entrapped the right ureter was also noted. Another nylon cable tie was removed and the ureter was released. Eight months postoperatively, the dog was in good general physical condition, showing appetite and vigour. Abdominal ultrasonography showed improvement of the hydronephrosis in both kidneys. The urea ratio was normal, but the creatinine level was slightly elevated, suggesting a guarded prognosis. Thus, bilateral hydronephrosis as observed in the present study should be considered as a major complication after elective ovariohysterectomy.

Comparison of imaging methods for diagnosis of renal tumors and their calcifications

Background: To establish the best methodology for diagnosis and management of patients with solid and complex renal masses by comparing the costs and benefits of different imaging methods and to improve differential diagnosis of these benign and malignant lesions, particularly by investigating tumour calcifications. Methods: We performed a prospective study on 31 patients with solid or complex masses by submitting them to Abdominal Ultrasonography (US), Doppler Ultrasonography of the renal mass (US Dop), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). Results: We found 28 patients with malignant and three with benign masses. Of the 28 malignant, 17 showed calcifications at CT; 16 central and one was of the pure peripheral curvilinear type (egg shell). Excretory Urography (IVP) had a significantly lower detection rate for central calcifications than both US and CT. Benign and malignant masses appeared as described in literature, with US, CT and MRI showing high sensitivity and specificity in renal tumor diagnosis. The exception was US Dop where we obtained lower sensitivity for the characterization of malignant tumor flow. Conclusions: In this series we were surprised to find that CT revealed central calcifications in 51.6% of patients, all with malignant lesions, while, literature reports a frequency of calcification in renal cell carcinoma between 8 and 22%, in studies using abdominal films and EU (IVP). This finding is of great importance when we consider that these calcifications occur particularly in malignant neoplasms. As a result of comparing these different imaging methods we have developed a better methodology for renal tumor investigation.

Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome

Objective To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. Design Prospective observational study. Setting ICU of a veterinary university medical center. Animals Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. Measurements and Main Results Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO2), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO2, lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO2 and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis. Conclusion Our study suggests that ScvO2 and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO2 and lower base deficit at admission to the ICU have a lower probability of death.