Two-stage rumenostomy in buffaloes

Background: Rumenostomy may be performed for therapeutic and digestibility research purposes in bovines, small ruminants and camelids. Several studies requires romenostomy in buffaloes in order to sample ruminal content for laboratorial assays. However, complications and outcome of rumenostomy was poorly studied in buffaloes. Therefore, the aim of the current study was to describe a two-stage rumenostomy technique in buffaloes, focused on intra and post-operative period.Materials, Methods & Results: Nine Murrah buffaloes were submitted to a 36-h and 12-h of food and water fastening. The animals were given acepromazine and maintained in standing position. Flank local anesthesia was carried out. A circular skin incision was carried out in the center of the left flank, followed by divulsion of the external and internal obliques and transversus abdominus muscles, and incision of the peritoneum. Subsequently, a segment of the dorsal aspect of the rumen was grasped and pulled through the flank incision. The rumen was attached to the peritoneum and skin incision margins in four points (dorsal, ventral, cranial and caudal). Additional simple interrupted sutures attaching the rumen serosa to the skin were applied subsequently. Four additional interrupted horizontal mattress sutures were applied equidistantly, taking bites only in the skin and rumen serosa. Following 12 h, the second stage was carried out. The buffaloes were prepared and restrained as performed for the first stage. A circular flap was excised from the exteriorized rumen and the silicone romenostomy cannula was placed. Clinical parameters, postoperative recovery, weight and behavioral pain scale were assessed. Positioning and anesthesia regimen were adequate for the achievement of the procedure. However, two animals fell in the restraint chute during the first surgical stage. Mild ischemia of the exteriorized rumen segment was observed on the second surgical stage, which resulted in less hemorrhage and enhanced cannula positioning. Complete cicatrization and permanent adhesion of the rumen to the skin were achieved. No ruminal leakage to the abdominal cavity occurred. No signs of pain were reported. There were few cases of laxity of the romenostomy opening leading to drop of cannula, myiasis on the margin of the stoma site and few cases of mild ruminal content leakage on the long-term assessment.Discussion: Restraint in standing position was considered adequate, although lateral recumbence constitutes another option. However, higher risk of contamination and technical difficulties in placing the cannulas are expected if lateral recumbence is considered. In other trials using acepromazine, no accidental recumbence occurred. Xylazine was also indicated for chemical restraint of buffaloes. It is known that flexible cannulas provide better anatomic adjustment and adaptation as well as being effective for sampling ruminal content, as seen in the current study. Ruminal leakage is one of the most frequent complications of romenostomy, which may affect animal's welfare. The animals in the current study presented no variations on the body score, even though on those presenting cannula loosening or ruminal content leakage. Moreover, no significant changes of the ruminal content parameters were noticed. Myiasis was also reported following ruminal surgical interventions, which were mainly attributed to extensive breeding. Loss of the cannula, subcutaneous emphysema and suture dehiscence are common complications of romenostomy. Nonetheless, none of those complications were found on the current study. Thus, romenostomy was feasible and efficient for sampling and performing assays of the ruminal content in buffaloes.

Avaliação da eficácia da analgesia com acupuntura pela análise imuno-histoquimica da expressão de proteína C-Fos: estudo em modelo experimental de dor aguda em ratos

The behavior and experience of pain are characterized by alertness and anxiety, which disappear soon after the healing process begins. Based on this area, the present study aimed to quantify the expression of c-fos in segments of the brain of rats after surgical stimulation in one rear hind paw (analgesia), using anesthesia with sodium thiopental and practices of acupuncture pre and post operative. The animals were stimulated with intraperitoneal injections of solution (NaCl) 0.2% (2ml), and divided into three groups, control, preoperative and postoperative. Each treatment was divided in manual acupuncture (AM) and electroacupuncture (EA). The animals were randomly distributed in each group. The c-fos expression was quantitated using immunohistochemistry for all situations. The results showed a great efficiency of all treatment compared to the control group (p <0.001), thus reenforcing data in the literature on the potential of acupuncture analgesia. There were no statistical differences among the different treatments, although there was a trend of EA being more efficient than AM

Nasopalatine duct cyst: a case report within 3 years follow-up

The nasopalatine duct cyst (NPDC) is considered to be the most common non-odontogenic cyst in oral cavity. These cysts are usually asymptomatic; however they can result in swelling, pain and drainage. The radiological analysis can reveal a round, oval or heart shaped well-demarcated image, which can be confounding with inflammatory lesions. The aim of this paper is report a clinical case of NPDC in a patient of 33 years old, occurring near a periapical inflammatory lesion. During clinical examination, it was not possible to detect swelling of the anterior palate and patient didn´t complain painful symptoms. Surgical treatment, enucleation, was performed under local anesthesia and there was no post operative complications. Histological results showed the presence of a cuboidal and respiratory epithelium associated with vessels, nerves and inflammatory cells. The patient’s 3 years follow-up was uneventful with subsequent bone regeneration and no sign of the lesion recurrence.

Fechamento de defeitos em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína em coelhos (oryctolagus cuniculus)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Análise retrospectiva de casuística de hernioplastia inguinal videolaparoscópica TAPP

Pós-graduação em Bases Gerais da Cirurgia - FMB

Análise retrospectiva de casuística de hernioplastia inguinal videolaparoscópica TAPP

Pós-graduação em Bases Gerais da Cirurgia - FMB

Central pain due to stroke: cognitive representation and coping according to gender

Objective: To identify and compare perceptions of pain and how it is faced between men and women with central post-stroke pain. Methods: The participants were 25 men and 25 women of minimum age 30 years-old and minimum schooling level of four years, presenting central post-stroke pain for at least three months. The instruments used were: Mini-Mental State Examination; structured interview for the Brief Psychiatric Scale; Survey of Sociodemographic and Clinical Data; Visual Analogue Scale (VAS); Ways of Coping with Problems Scale (WCPS) in Scale; Revised Illness Perception Questionnaire (IPQ-R); and Beck Depression Inventory (BD). Results: A significantly greater number of women used the coping strategy "Turn to spiritual and religious activities" in WCPS. They associated their emotional state with the cause of pain in IPQ-R. "Distraction of attention" was the strategy most used by the subjects. Conclusion: Women used spiritual and religious activities more as a coping strategy and perceived their emotional state as the cause of pain.

Assessment of Preemptive Analgesia Efficacy in Surgical Extraction of Third Molars

Background and objectives: Literature on preemptive analgesia is controversial. Reliability of results and difficult reproducibility of research contribute for non-elucidation of the subject. The aim of this study is to test the efficacy of oral ketoprofen (150 mg) preemptively administrated two days before third molar surgery, compared with postoperative administration in the same patient. Methods: Thirteen patients underwent surgical removal of bilateral third molar in two separate procedures. In a random and double blind procedure, oral ketoprofen 150 mg was administered every 12 hours two days before surgery and, after the procedure, the same drug was administered for three days. On the other side, a control (placebo) was used orally every 12 hours two days before surgery and, after the procedure, ketoprofen 150 mg was administered every 12 hours for three days. Postoperative pain was assessed by visual analogue scale, nominal scale, and amount of rescue analgesics consumed. Results: There was no statistically significant difference in postoperative pain between the preemptive treatment and control. Conclusion: In this experimental model, preemptive analgesia was not effective in reducing postoperative pain in surgical extraction of third molar compared with the postoperative administration of the same drug.

Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

Background: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods: CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants. Results: Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores. Conclusions: The presence of MPS is not an exception after stroke and may present in association with CPSP as a common comorbid condition. Further studies are necessary to clarify the role of MPS in CPSP.

Avaliação da eficácia da analgesia preemptiva na cirurgia de extração de terceiros molares inclusos

JUSTIFICATIVA E OBJETIVOS: A literatura sobre analgesia preemptiva é controversa. A confiabilidade dos resultados e a dificuldade de reprodutibilidade das pesquisas contribuem para a não elucidação do tema. O objetivo desse estudo é testar a eficácia da administração preemptiva de Cetoprofeno 150 mg via oral dois dias antes da cirurgia de extração deterceiros molares, comparando no mesmo paciente com a administração pós-operatória. MÉTODO: Treze pacientes foram submetidos à cirurgia de extração bilateral de terceiros molares inferiores inclusos em dois procedimentos distintos. De forma randomizada e duplo cega, em um procedimento foi administrado Cetoprofeno 150 mg via oral a cada 12 horas dois dias antes da cirurgia e, após o procedimento, continuou-se o mesmo medicamento por mais três dias. De outro lado, foi utilizado um controle (placebo) via oral a cada 12 horas dois dias antes da cirurgia e, após o procedimento, continuou-se o Cetoprofeno 150 mg a cada 12 horas por mais três dias. A dor pós-operatória foi avaliada por meio da escala visual analógica, da escala nominal e da quantidade de consumo de analgésicos de resgate. RESULTADOS: Não foi observada diferença estatisticamente significante na dor pós-operatória entre o tratamento preemptivo e o controle. CONCLUSÃO: Neste modelo experimental, a analgesia preemptiva não se mostrou eficaz na redução da dor pós-operatória na cirurgia de extração de terceiros molares inclusos em comparação com a administração pós-operatória do mesmo medicamento.

Gestione pre, intra e post-operatoria del cane sottoposto ad ipofisectomia transfenoidale

L’approccio chirurgico agli adenomi ipofisari ACTH secernenti è la terapia d’elezione nell’uomo. L’ipofisectomia transfenoidale è invece una tecnica poco diffusa in ambito veterinario. La terapia più diffusa nel cane con ipercortisolismo ipofisi dipendente (PDH) è di tipo medico e prevede la somministrazione di farmaci inibitori della sintesi del cortisolo. Gli adenomi ipofisari possono aumentare di volume e determinare una conseguente sintomatologia neurologica; in questi casi le uniche opzioni terapeutiche sono rappresentate dall’asportazione chirurgica della neoplasia e dalla radioterapia. Nella presente tesi vengono descritti 8 interventi di ipofisectomia transfenoidale effettuati su 7 cani con macroadenoma ipofisario presso il Dipartimento di Scienze Mediche Veterinarie dell’Università di Bologna. La difficoltà maggiore per il chirurgo è rappresentata dalla localizzazione della fossa ipofisaria rispetto ai punti di repere visibile in tomografia computerizzata o in risonanza magnetica nucleare, oltre ai problemi di sanguinamento durante la rimozione della neoplasia. Nel periodo post-operatorio maggiori complicazioni si riscontrano in soggetti con adenomi ipofisari di maggiori dimensioni. Al contrario, in presenza di adenomi di dimensioni più contenute, la ripresa post-operatoria risulta più rapida e il tasso di successo maggiore. Al fine di poter eseguire nel cane l’exeresi mirata della sola neoplasia ipofisaria, al pari di quanto avviene nell’uomo, è stato condotto uno studio sulla tomografia computerizzata (TC) in 86 cani con PDH. Il protocollo TC non ha tuttavia permesso di individuare con precisione la posizione della neoplasia per guidare il chirurgo nella sua rimozione. In due casi riportati nel presente lavoro si è verificata una recidiva della neoplasia ipofisaria. In un soggetto si è optato per il reintervento, mentre nell’altro caso per la radioterapia. Entrambe le opzioni hanno garantito una buona qualità di vita per più di un anno dall’intervento terapeutico. Questi casi clinici dimostrano come il reintervento e la radioterapia possano essere considerate valide opzioni in caso di recidiva.

Sciatic-femoral nerve block with bupivacaine in goats undergoing elective stifle arthrotomy

The aim of this study was to describe the sciatic-femoral nerve block (SFNB) in goats and to evaluate the peri-operative analgesia when the goats underwent stifle arthrotomy. The animals were randomly assigned to one of four treatment groups: groups 0.25, 0.5 and 0.75 received 0.25%, 0.5% and 0.75% of bupivacaine, respectively, while group C (control group) received 0.9% NaCl. In all groups, the volume administered was 0.2 mL/kg. Intra-operatively, the proportion of animals receiving rescue propofol was significantly lower in groups 0.5 and 0.75, compared to group C. Post-operatively, the visual analogue scale (VAS) and total pain score were significantly higher in group C than in the other groups. Group 0.75 had the highest percentage of animals showing motor blockade. SFNB performed with bupivacaine resulted in better intra- and post-operative analgesia than SFNB performed with saline. Compared to the other concentrations, 0.5% bupivacaine resulted in satisfactory analgesia with acceptable side effects.

Interrelation of peri-operative morbidity and ASA class assignment in patients undergoing gynaecological surgery

OBJECTIVE: The aim of this study was to estimate intra- and post-operative risk using the American Society of Anaesthesiologists (ASA) classification which is an important predictor of an intervention and of the entire operating programme. STUDY DESIGN: In this retrospective study, 4435 consecutive patients undergoing elective and emergency surgery at the Gynaecological Clinic of the University Hospital of Zurich were included. The ASA classification for pre-operative risk assessment was determined by an anaesthesiologist after a thorough physical examination. We observed several pre-, intra- and post-operative parameters, such as age, body-mass-index, duration of anaesthesia, duration of surgery, blood loss, duration of post-operative stay, complicated post-operative course, morbidity and mortality. The investigation of different risk factors was achieved by a multiple linear regression model for log-transformed duration of hospitalisation. RESULTS: Age and obesity were responsible for a higher ASA classification. ASA grade correlates with the duration of anaesthesia and the duration of the surgery itself. There was a significant difference in blood loss between ASA grades I (113+/-195 ml) and III (222+/-470 ml) and between classes II (176+/-432 ml) and III. The duration of post-operative hospitalisation could also be correlated with ASA class. ASA class I=1.7+/-3.0 days, ASA class II=3.6+/-4.3 days, ASA class III=6.8+/-8.2 days, and ASA class IV=6.2+/-3.9 days. The mean post-operative in-hospital stay was 2.5+/-4.0 days without complications, and 8.7+/-6.7 days with post-operative complications. Multiple linear regression model showed that not only the ASA classification contained an important information for the duration of hospitalisation. Parameters such as age, class of diagnosis, post-operative complications, etc. also have an influence on the duration of hospitalisation. CONCLUSION: This study shows that the ASA classification can be used as a good and early available predictor for the planning of an intervention in gynaecological surgery. The ASA classification helps the surgeon to assess the peri-operative risk profile of which important information can be derived for the planning of the operation programme.

The influence of a continuous rate infusion of dexmedetomidine on the nociceptive withdrawal reflex and temporal summation during isoflurane anaesthesia in dogs

Objective To examine the influence of a low dose dexmedetomidine infusion on the nociceptive withdrawal reflex and temporal summation in dogs during isoflurane anaesthesia. Study design Prospective experimental blinded cross-over study. Animals Eight healthy mixed breed dogs, body weight Mean +/- SD 26.5 +/- 8.4 kg and age 25 +/- 16 months. Methods Anaesthesia was induced with propofol and maintained with isoflurane (Fe'ISO 1.3%) delivered in oxygen and air. After stabilization, baseline recordings (time 0) were obtained, then a dexmedetomidine bolus (1 mug kg(-1) IV) followed by a continuous rate infusion (1 mug kg(-1) hour(-1) ) or saline placebo were administered. At times 10, 30 and 60 minutes after the initial bolus, electrical stimulations of increasing intensity were applied over the lateral plantar digital nerve, and administered both as single and as repeated stimuli. The resulting reflex responses were recorded using electromyography. Data were analysed using a multivariable linear regression model and a Kruskal Wallis test for single stimulation data, and repeated measures anova and paired t-test for repeated stimulation data. Results The AUC for the stimulus-response curves after single stimulation were similar for both treatments at time 0. At times 10, 30 and 60 the AUCs for the stimulus-response curves were significantly lower with dexmedetomidine treatment than with placebo. Temporal summation was evident in both treatments at times 0, 10, 30 and 60 starting from a stimulation intensity of 10 mA. The magnitude of temporal summation was smaller in dexmedetomidine than in placebo treated dogs at time 10, 30 and 60, but not at time 0. Conclusions During isoflurane anaesthesia, low dose dexmedetomidine suppresses the nociceptive reflex responses after single and repeated electrical stimulation. Clinical relevance This experimental study confirms previous reports on its peri-operative efficacy under clinical conditions, and further indicates that dexmedetomidine might reduce the risk of post-operative chronic pain development.

The role of intercostal nerve preservation in pain control after thoracotomy

OBJECTIVES Pain control after thoracotomy is an important issue that affects the outcome in thoracic surgery. Intercostal nerve preservation (ICNP) has increased interest in the outcomes of conventional thoracotomy. The current study critically evaluates the role of preservation of the intercostal nerve in early and late pain control and its benefit in patients undergoing thoracotomy. METHODS Data obtained prospectively between January 2006 and December 2010 by a study colleague at our division of General Thoracic Surgery were retrospectively analysed. There were 491 patients who underwent thoracotomy. Eighty-one patients were excluded from the study due to incompatible data. Patients were divided into two groups according to the intercostal nerve state: Group I consisted of patients with ICNP and Group II consisted of patients with intercostal nerve sacrifice. RESULTS Group I consisted of 288 patients [206 male (71%), P < 0.001, mean age 66 years]. Group II consisted of 122 patients [79 male (64%), P = 0.001, mean age 66 years]. There was less use of opiate in Group I (P = 0.019). Early mobilization of the patients was significantly higher in Group I (P = 0.031). The rate of pneumonia and re-admission to the intensive care unit was higher in Group II (P = 0.017 and 0.023, respectively). The rate of pain-free patients at discharge was significantly higher in Group I (P = 0.028). A 2-week follow-up after hospital discharge showed parasternal hypoesthesia to be more in Group II (P = 0.034). Significant patient contentment in Group I was noticed (P = 0.014). Chronic post-thoracotomy pain (CPTP) was higher in Group II (P = 0.016). CONCLUSIONS ICNP without harvesting an intercostal muscle flap achieves excellent outcomes in controlling acute post-thoracotomy pain and CPTP. ICNP is an effective, simple method to perform, and it should be considered as standard in performing thoracotomy.