Fetal Pulmonary Response After Fetoscopic Tracheal Occlusion for Severe Isolated Congenital Diaphragmatic Hernia

OBJECTIVE: To estimate the response in lung growth and vascularity after fetal endoscopic tracheal occlusion for severe congenital diaphragmatic hernia in the prediction of neonatal survival.METHODS: Between January 2006 and December 2010, fetal lung parameters (observed-to-expected lung-to-head ratio; observed-to-expected lung volume; and contralateral lung vascularization index) were evaluated before fetal tracheal occlusion and were evaluated longitudinally every 2 weeks in 72 fetuses with severe isolated congenital diaphragmatic hernia. Thirty-five fetuses underwent fetal endoscopic tracheal occlusion and 37 cases did not.RESULTS: Survival rate was significantly higher in the fetal endoscopic tracheal occlusion group (54.3%) than in the no fetal endoscopic tracheal occlusion group (5.4%, P<.01). Fetal endoscopic tracheal occlusion resulted in a significant improvement in fetal lung size and pulmonary vascularity when compared with fetuses that did not go to the fetal intervention (increase of the observed-to-expected lung-to-head ratio, observed-to-expected total lung volume, and contralateral pulmonary vascularization index 56.2% compared with 0.3%, 37.9% compared with 0.1%, and 98.6% compared with 0.0%, respectively; P<.01). Receiver operating characteristic curves indicated that the observed-to-expected total fetal lung volume was the single best predictor of neonatal survival before fetal endoscopic tracheal occlusion (cutoff 0.23, area under the curve [AUC] 0.88, relative risk 5.3, 95% confidence interval [CI] 1.4-19.7). However, the contralateral lung vascularization index at 4 weeks after fetal endoscopic tracheal occlusion was more accurate in the prediction of neonatal outcome (cutoff 24.0%, AUC 0.98, relative risk 9.9, 95% CI 1.5-66.9) with the combination of observed-to-expected lung volumes and contralateral lung vascularization index at 4 weeks being the best predictor of outcome (AUC 0.98, relative risk 16.6, 95% CI 2.5-112.3).CONCLUSION: Fetal endoscopic tracheal occlusion improves survival rate by increasing the lung size and pulmonary vascularity in fetuses with severe congenital diaphragmatic hernia. The pulmonary response after fetal endoscopic tracheal occlusion can be used to predict neonatal survival. (Obstet Gynecol 2012; 119: 93-101) DOI: 10.1097/AOG.0b013e31823d3aea

Morphological findings in the tracheal epithelium of dogs exposed to the inhalation of poorly conditioned gases under use of an endotracheal tube or laryngeal mask airway

OBJETIVO: Avaliar as alterações morfológicas no epitélio traqueal de cães expostos à inalação de gases pouco condicionados, sob ventilação com tubo traqueal (TT) ou máscara laríngea (ML). MÉTODOS: Doze cães adultos foram divididos aleatoriamente em dois grupos: grupo TT (n-6) e grupo ML (n-6), submetidos à anestesia venosa e ventilação mecânica, em sistema sem reabsorção de CO2. Foram registrados parâmetros hemodinâmicos e ventilatórios, temperatura timpânica, temperatura, umidade relativa e absoluta do ar ambiente e dos gases inalados durante 3 horas. Ao término do experimento, os animais foram submetidos a eutanásia e realizadas biópsias ao longo do segmento traqueal para estudo morfológico. Três cães saudáveis foram utilizados para controle morfológico. RESULTADOS: A temperatura dos gases inalados manteve-se entre 24ºC e 26ºC, a umidade relativa entre 10% e 12%, e umidade absoluta entre 2 -3 mg H2O.L-1 sem diferença significativa entre os grupos. em ambos os grupos a análise histológica evidenciou processo inflamatório epitelial e congestão no córion, e a microscopia eletrônica de varredura mostrou agrupamento e desorganização ciliar. A microscopia eletrônica de transmissão detectou maiores alterações no grupo TT do que no ML, como alargamento das junções intercelulares, desorientação ciliar, vacuolização citoplasmática, alterações nucleares como pcinose e condensação da cromatina. CONCLUSÃO: A máscara laríngea determinou alterações menos pronunciadas no epitélio traqueal de cães expostos à inalação de gases pouco condicionados.

The use of scaning electron microscopy in postvaccinal evaluation of tracheal epithelium of Coturnix coturnix japonica

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

Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: Preliminary results

Objective: To evaluate the effect of early fetoscopictracheal occlusion (FETO) (22–24 weeks’ gestation) onpulmonary response and neonatal survival in cases ofextremely severe isolated congenital diaphragmatic hernia(CDH). Methods: This was a multicenter study involving fetuseswith extremely severe CDH (lung-to-head ratio < 0.70,liver herniation into the thoracic cavity and no otherdetectable anomalies). Between August 2010 and December 2011, eight fetuses underwent early FETO. Datawere compared with nine fetuses that underwent standard FETO and 10 without fetoscopic procedure fromJanuary 2006 to July 2010. FETO was performed undermaternal epidural anesthesia, supplemented with fetalintramuscular anesthesia. Fetal lung size and vascularitywere evaluated by ultrasound before and every 2 weeksafter FETO. Postnatal therapy was equivalent for bothtreated fetuses and controls. Primary outcome was infantsurvival to 180 days and secondary outcome was fetalpulmonary response. Results: Maternal and fetal demographic characteristicsand obstetric complications were similar in the threegroups (P > 0.05). Infant survival rate was significantlyhigher in the early FETO group (62.5%) comparedwith the standard group (11.1%) and with controls(0%) (P < 0.01). Early FETO resulted in a significantimprovement in fetal lung size and pulmonary vascularitywhen compared with standard FETO (P < 0.01). Conclusions: Early FETO may improve infant survival byfurther increases of lung size and pulmonary vascularityin cases with extremely severe pulmonary hypoplasia inisolated CDH. This study supports formal testing of thehypothesis with a randomized controlled trial.

The Lanz® endotracheal tube decreases tracheal injury in dogs

Purpose: To determine, in dogs anesthetized with nitrous oxide (N2O), whether the endotracheal tube (ETT) cuffed with a Lanz® pressure regulating valve decreases the tracheal consequences of tracheal intubation. Methods: Sixteen mixed-breed dogs were allocated to two groups according to the ETT used: Control group (n = 8) - Rüsch ETT, and Lanz group (n = 8) - ETT with Lanz® pressure regulating valve. The ETT cuffs in both groups were inflated with air to an intracuff pressure of 30 cm H2O. Anesthesia was induced and maintained with pentobarbitone and N2O (1.5 L·min-1) and O2 (1 L·min-1). ETT cuff pressures were measured before (control) and 60, 120, and 180 min during N2O administration. The dogs were sacrificed, and biopsy specimens from four predetermined areas of the tracheal mucosa in contact with the ETT were collected for light and scanning electron microscopy (SM) examination. Results: Cuff pressures in the Control group were higher than in the Lanz group at all time points studied (P < 0.001), with an increase over time only in the Control group (P < 0.001). Median neutrophilic inflammatory infiltration values of the epithelial surface, and in the subepithelial layer in contact with the cuff, were higher in the Control group as compared to the Lanz group (3.0 vs 1.0 and 3.0 vs 1.5 respectively) (P < 0.05). On SM examination, median histological grades were higher in the Control group compared to Lanz group (2.9 vs 1.9 respectively), (P < 0.05). Conclusions: The Lanz® ETT decreases tracheal mucosal injury in dogs.

Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq (TM) video laryngoscope in obese patients

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

Effects of isoflurane on echocardiographic parameters in healthy dogs

Obejective To study the echocardiographic effects of isoflurane at an end-tidal concentration approximating 1.0 times the minimum alveolar concentration (MAC) in healthy unpremedicated dogs.Study design Prospective experimental trial.Animals Sixteen mature mongrel dogs of either sex weighing 11.06 +/- 2.72 kg.Methods After performing a baseline echocardiogram in the awake animal, anesthesia was induced with increasing inspired concentrations of isoflurane via a face mask until tracheal intubation was possible. Following intubation, the end-tidal concentration was decreased to 1.4% for the rest of the anesthetic period. Serial echocardiograms were recorded at 25, 40, and 55 minutes after the end-tidal concentration was reached.Results No changes were observed in heart rate. However, significant decreases were seen in left ventricular end-diastolic diameter (Mean maximal change: 13.8%), interventricular septal thickness during systole (15.2%), interventricular septal thickening fraction (72.2%), left ventricular free wall thickening fraction (63.5%), ejection fraction (39.9%), and fractional shortening (46.7%). In addition, peak flow velocities across mitral, pulmonic, and aortic valves were significantly lower than baseline values. Decreases were also observed in end-diastolic left ventricular volume index (approximately 32.1% from the awake value), stroke index (58.2%), and cardiac index (55.3%) when compared with awake measurements.Conclusions Our results indicate that 1 x MAC isoflurane caused significant myocardial depression in healthy dogs. These changes in myocardial function need to be considered carefully when isoflurane is to be used in dogs with poor cardiovascular reserve.

Comportamento da pressão intra-ocular segundo os efeitos cardiorrespiratórios e hemodinâmicos induzidos pela anestesia com desflurano, em cães submetidos à hipovolemia experimental

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

Prevalence of newcastle disease virus in broiler chickens (Gallus gallus) in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Newcastle disease in white Pekin ducks: response to experimental vaccination and challenge

A total of 120 Pekin ducks were distributed at random into four experimental groups, vaccinated or not against Newcastle disease (ND): G1 (Ulster 2C strain), G2 (B1 strain), G3 (LaSota strain), and G4 (nonvaccinated group). At 60 days of age, all groups were challenged with a pathogenic ND virus (NDV) suspension, and a group of specific pathogen free (SPF) chicks (G5) was also inoculated. Cloacal and tracheal swabs from all birds were collected after six, 14, 20, and 30 days post-challenge for virus isolation. NDV was isolated in 100% of SPF chicks. Pekin ducks from all groups, vaccinated or not, did not show any ND clinical signs, demonstrating that these birds are not susceptible to ND clinical disease. In the control group (G4), the virus was isolated 20 to 30 days after challenge, suggesting their possible NDV carrier state. In the vaccinated groups, no virus was isolated. This demonstrates that vaccination of white Pekin ducks against NDV is important to reduce NDV shedding in the field.

Dimorfismo sexual da traquéia e siringe de periquito (Touist sp.)

Investigaram-se as diferenças morfológicas da siringe do periquito Touist sp, cinco machos e cinco fêmeas. A traquéia e a siringe foram dissecadas com o auxílio de uma lupa estereoscópia e avaliaram-se o número de anéis, o comprimento da traquéia e da siringe e o comprimento e espessura do músculo traqueolateral. A traquéia do macho apresentou maior número de anéis e maior comprimento que a das fêmeas. O músculo traqueolateral dos machos é mais vigoroso e origina-se no 43º anel traqueal enquanto o das fêmeas origina-se no 30º anel traqueal e se insere no primeiro anel bronquial. A siringe do piriquito é constituída por anéis craniais, cinco nos machos e três nas fêmeas, anéis intermediários, com formato semelhante a uma bolha sulcada ventralmente, anéis caudais, quatro em ambos os sexos, e pessulo. O dimorfismo sexual está presente na morfometria da musculatura e das cartilagens, o que reflete no canto mais vigoroso dos machos.

Influência do dimorfismo sexual sobre a morfologia da siringe de galinha d'angola (Numida meleagris)

Este estudo teve como objetivo realizar uma descrição morfológica e comparativa da siringe, órgão responsável pelo canto das aves, na espécie Numida meleagris. Para isso foram utilizados cinco machos e cinco fêmeas de galinha d'angola, a fim de verificar a sintopia (traquéia, músculos traqueais) e o dimorfismo sexual da siringe. Verificou-se que a siringe se localiza na bifurcação da traquéia e apresenta maior número de cartilagens nos machos. Nos machos, a inserção do músculo traqueal lateral bem como a origem do músculo esterno traqueal localizam-se mais caudalmente e são mais largos em relação às fêmeas. As diferenças existentes entre machos e fêmeas de galinha d'angola revelam a elevada capacidade das fêmeas em produzir sons semelhantes a tô fraco enquanto que os machos emitem arrulhos e cacarejos.

Parâmetros métricos da traqueia e suas correlações com o perímetro torácico, peso e comprimento corporal de cães sem raça definida (Canis familiaris, Linnaeus, 1758)

The present study aimed to analyze metric data from the trachea of dogs and to correlate them with the thoracic girth, body length and weight. We used 48 dogs of unknown breed, 19 males and 29 females. The animals were weighed and then body length, thoracic girth, length and diameter of the trachea, and the number of tracheal rings were measured. The weight of dogs ranged from 4.2 to 21.5 kg, body length from 40.6 to 81.0 cm and thoracic girth from 36.0 to 63.5 cm. The trachea exhibited a total number of tracheal rings between 32 and 43, length between 13.0 and 23.4 cm, diameter of the cervical portion between 11.0 and 23.5 mm and in the thoracic portion between 8.2 and 20.9 mm. We also evaluated the tracheal termination skeletopy, which maintained relations with the 2nd (2.0%), 3 (6.3%), 4 (20.8%) or 5 (12.5%) intercostal spaces, and with the 3rd (6.3%), 4th (35.4%) or 5th (16.7%) ribs. Strong positive correlations of tracheal length with body weight (rS = 0.756, p <0.001), body length (r = 0.808, p <0.001) and thoracic girth (r = 0.735, p <0.001) were found. Therefore, the anatomical study of the trachea provides morphological subsidies for the realization of clinical and surgical procedures in this organ, being an important tool in veterinary practice.

Chlamydophila psittaci in free-living Blue-fronted Amazon parrots (Amazona aestiva) and Hyacinth macaws (Anodorhynchus hyacinthinus) in the Pantanal of Mato Grosso do Sul, Brazil

Chlamydophila psittaci (C. psittaci) infection was evaluated in 77 free-living nestlings of Blue-fronted Amazon parrots (Amazona aestiva) and Hyacinth macaws (Anodorhynchus hyacinthinus) in the Pantanal of Mato Grosso do Sul, Brazil. Tracheal and cloacal swab samples from 32 wild parrot and 45 macaw nestlings were submitted to semi-nested PCR, while serum samples were submitted to complement fixation test (CFT). Although all 32 Amazon parrot serum samples were negative by CFT, cloacal swabs from two birds were positive for Chlamydophila DNA by semi-nested PCR (6.3%); these positive birds were 32 and 45 days old. In macaws, tracheal and cloacal swabs were positive in 8.9% and 26.7% of the samples, respectively. Complement-fixing antibodies were detected in 4.8% of the macaw nestlings; macaw nestlings with positive findings were between 33 and 88 days old. These results indicate widespread dissemination of this pathogen in the two evaluated psittacine populations. No birds had clinical signs suggestive of chlamydiosis. To the best of our knowledge, this is the first report on C. psittaci in free-living Blue-fronted Amazon parrots and Hyacinth macaws in Brazil. (c) 2006 Elsevier B.V. All rights reserved.

Emprego da microscopia eletrônica na avaliação pós-vacinal de epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle

Avaliou-se o emprego da microscopia eletrônica de varredura no estudo da reação respiratória pós-vacinal em epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle. Foram utilizadas 48 aves, distribuídas em quatro grupos: T1 - grupo de aves-controle (não vacinadas), T2 - grupo de aves vacinadas com a estirpe Ulster 2C, T3 - grupo de aves vacinadas com a estirpe B1 e T4 - grupo de aves vacinadas com a estirpe LaSota. Independente do grupo experimental, as aves não apresentaram sinais clínicos detectáveis de reação respiratória pós-vacinal. Ao microscópio eletrônico de varredura, observou-se que os animais vacinados com as estirpes B1 e LaSota desenvolveram descamação epitelial da traqueia, enquanto os vacinados com a estirpe Ulster 2C não, mostrando um epitélio traqueal íntegro, semelhante ao do grupo-controle. Os patos vacinados com a estirpe B1 mostraram evidências de regeneração epitelial da traqueia decorridos 21 dias pós-vacinação, o que não ocorreu com os vacinados com a amostra LaSota.