Hérnia diafragmática peritoneopericárdica assintomática em cão

Peritoneopericardial diaphragmatic hernia (PPDH) is a communication between the abdomen and the pericardial sac generated by congenital anomalies triggered during diaphragmatic and pericardial development. This report aimed to present the case of an adult, mixed-breed cat, affected by PPDH, focusing on the period from diagnosis to successful surgical correction. The patient had a capricious appetite and weight loss for about four months and started, at the end of this period, a state of apathy. On abdominal ultrasound, the gallbladder (GB) was close to the heart, suggesting diaphragmatic discontinuity. On thoracic radiography, there were changes suggestive of PPDH, pericardial efusion or cardiomegaly with probable dilated cardiomyopathy. Based on these findings, an echocardiogram was performed, highlighting the hepatic lobe and GB internally to the pericardium, causing cardiac compression, although without severe cardiac changes. During surgery, a diaphragmatic defect of 4 cm in diameter was observed with the congested right medial hepatic lobe and hyperemic GB in the pericardial sac. The defect was sutured using the sultan pattern in separate stitches and polyamide threads. The feline returned to feeding with greater interest soon after the surgery, and after 15 days it was fed with dry food and had normal behavior. PPDH can be diagnosed in healthy adult cats, even if there are no apparent respiratory, gastrointestinal, or cardiac signs. The echocardiogram is relevant in the definitive diagnosis, in addition to excluding differential diagnoses, and simple surgical treatment with polyamide thread and sultan suture is successful.

To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). Retrospective study. One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia was diagnosed in an 11-year-old, desexed female Persian cat. The cat was initially referred for investigation of tachypnoea and dyspnoea. Peritoneopericardial diaphragmatic hernia is a common incidental finding in cats and is usually asymptomatic. Myelolipoma is an extremely rare benign tumour, composed of extramedullary haematopoietic cells and adipose tissue. Myelolipomas are hypothesised to result from metaplastic alteration, rather than a neoplastic process, although this theory cannot be substantiated. The present case is only the fourth report of such an unusual occurrence in cats and displays significant differences to previous reports. Hepatic entrapment and burgeoning of the mass within the pericardial sac resulted in cardiac tamponade and overt signs of right-sided cardiac failure. Surgical intervention was successful and despite concerns regarding the cat's clinical presentation and the gross appearance of the lesion(s), a good long-term outcome is anticipated.

A 2-year-old spayed female British Shorthair cat presented with an increased frequency and duration of cough since infant period. Based on radiographic, ultrasonographic, and computed tomography findings, peritoneopericardial diaphragmatic hernia was considered so that repair surgery was planned. During celiotomy, lax diaphragm was identified instead of defect. Transabdominal diaphragmatic plication was performed to resolve lax diaphragm and to prevent recurrence by overlapping relatively normal part of diaphragm. Diagnosed with diaphragmatic eventration postoperatively, the cat showed improvement in clinical signs and imaging results. Transabdominal diaphragmatic plication is a suitable treatment; the patient maintained normally during a 14-month follow-up period.

Peritoneopericardial diaphragmatic hernia (PPDH) is a congenital defect allowing communication between the peritoneal cavity and the pericardial sac, through which abdominal organs may herniate into the pericardial space. The condition can be asymptomatic or symptomatic, and if symptomatic, accompanied mostly with non‐specific gastrointestinal or respiratory clinical signs. A 2‐year‐old, male, neutered mixed breed dog was referred due to fever, lethargy and decreased food intake over the last 2 weeks. Abdominal ultrasound was performed and a transposition of abdominal organs into the thoracic cavity was suspected. Further diagnostic imaging confirmed PPDH with herniation of the gall bladder and spleen into the pericardial sac. The dog underwent surgery for hernia repair. Severe pneumopericardium subsequently complicated by pericardial effusion developed postoperatively. Both complications resolved without intervention. The dog never showed signs of haemodynamic instability or cardiac tamponade.

"BLeishmaniosis are anthropozoonosis caused by protozoa of the genus Leishmania, representing a complex of diseases with significant diversity epidemiological and clinical spectrum and can affect 40% of the canine population. Infected dogs may be asymptomatic or may develop canine leishmaniasis (CL), a severe and progressive disease associated with the appearance of clinical signs. Serological tests are frequently used for screening of dogs, however, these techniques present limitations in terms of reproducibility and specificity. In this way, information on the geographical distribution and prevalence of CL is essential to the implementation of appropriate control measures. Therefore, the aim of this study was to determine geographical variations in clinical signs and prevalence of Leishmania sp. infections from dogs in Fortaleza, Ceará state, Brazil. Materials, Methods &amp; Results: Bone marrow samples of 2829 domestic dogs were collected by puncture for parasitological diagnosis of canine leishmaniasis (CL), being considered positive by the presence of Leishmania sp. All dogs were examined and clinical signs were classified as score 0: no clinical signs, score 1: skin lesions, score 2: visceral signs and score 3: skin lesions + visceral signs. Kruskal-Wallis (P &lt;0.05) was used to compare the scores and parasitological diagnosis among the seven regions of Fortaleza. So, it was observed that 72% of dogs were positive and the regions I and V had the highest prevalence (78.3% and 80% respectively), no significant differences among the seven regions. Asymptomatic dogs represented 55% of infected dogs, and the main clinical sign, among symptomatic dogs (45%), was skin lesion, visualized in 43% of dogs. Furthermore, 70% of all dogs had ectoparasites. Discussion: These results show that, despite of the campaign against the disease, there is no great progress in the control of visceral leishmaniasis in the urban areas like Fortaleza, which present an easy access in the fight against the disease. The diagnostic in dogs based in the Indirect Fluorescent Antibody Test (IFAT) associated to others factors, like irregular serological inquiry and no-treated performer personal, perhaps made possible the permanence of susceptibility animals in this area, beyond of the high number of asymptomatic and no-identified dogs. In this study, it was observed that 55% of dogs were asymptomatic, without showing evidence of risk of transmission to human population, escaping from controlling methods. From this we can imply that most of these dogs to LC are asymptomatic and the prevalence did not differ significantly in different regions of Fortaleza, requiring equal attention throughout the city. Moreover, our results demonstrate that Fortaleza city has favorable areas for the maintenance of the parasite cycle, with a high risk of transmission to human and canine population, and it requires special attention because of the large number of asymptomatic cases. Therefore, it is ne"

Senile male, physically ft at usual, he died suddenly without any clinical symptoms. By autopsy dissection, it was found that large amount of bleeding was presented in pericardial cavity, the abdominal cavity and thoracic cavity had a small amount of hemorrhage, partial pancrea tissue had coagulation necrosis accompanied with infltration of neutrophile granulocyte and degeneration and necrosis of liver cell accompanied with acute or chronic inflammation cell infltration. Laboratory examination of the patient when he was alive suggested that liver function and coagulation function had obstacles, there was not any timely clinical process, and he died suddenly. Autopsy examination results suggested that acute pancreatitis caused a large quantity of bleeding in pericardial cavity, which led to cardiac tamponade and it cause acute circulation failure, which initiated cardiac arrest and then death. Coronary heart disease may exert certain facilitation effect in the death process. Patients with pancreatitis, especially the senile and pancreatitis patients with coronary artery disease, should be evaluated and prevented ahead of schedule, for those patients who had coma suddenly, it should be thought that it had possibility of combining with hemorrhage in the interior of pericardial cavity, the patient's doctor should try his or her best to reduce death rate.

ABSTRACTSymmorphosis is a concept of economy of biological design, whereby structural properties are matched to functional demands. According to symmorphosis, biological structures are never over designed to exceed functional demands. Based on this concept, the evolution of the diaphragm muscle (DIAm) in mammals is a tale of two structures, a membrane that separates and partitions the primitive coelomic cavity into separate abdominal and thoracic cavities and a muscle that serves as a pump to generate intra‐abdominal (Pab) and intrathoracic (Pth) pressures. The DIAm partition evolved in reptiles from folds of the pleural and peritoneal membranes that was driven by the biological advantage of separating organs in the larger coelomic cavity into separate thoracic and abdominal cavities, especially with the evolution of aspiration breathing. The DIAm pump evolved from the advantage afforded by more effective generation of both a negative Pth for ventilation of the lungs and a positive Pab for venous return of blood to the heart and expulsive behaviors such as airway clearance, defecation, micturition, and child birth. © 2019 American Physiological Society. Compr Physiol 9:715‐766, 2019.

To determine the prevalence and predictors of adverse postoperative outcomes in older surgical patients undergoing noncardiac surgery. Prospective cohort study of consecutive patients undergoing noncardiac surgery in 1997. A medical school-affiliated teaching community hospital. Patients age 70 and older undergoing noncardiac surgery. Patients presenting for surgery requiring only local anesthesia or monitored anesthesia care were excluded. Potential pre- and intra-operative risk factors were measured and evaluated for their association with the occurrence of predefined in-hospital postoperative adverse outcomes. Univariate predictors of postoperative outcomes were first measured using the chi-square or Fisher's exact tests followed by multivariate logistic regression. Odds ratios (OR) with 95% confidence interval (CI), and two-sided P-values were reported. Five hundred forty-four consecutive patients were studied. Overall, 21% of patients developed one or more postoperative adverse outcomes and 3.7% died during the in-hospital postoperative period. Of all the adverse outcomes, cardiovascular complications (10.3%) were the leading cause of morbidity, followed by neurological (7.7%) and pulmonary complications (5.5%). By multivariate logistic regression analysis, American Society of Anesthesiologists (ASA) classification (OR = 2.7, CI = 1.6-4.4), emergency surgery (OR = 2.0, CI = 1.1-3.4), and intraoperative tachycardia (OR = 3.8, CI = 1.9-7.6) were the most important predictors of postoperative adverse outcomes. Of all the preoperative physical symptoms and signs, decreased functional status (OR = 3.0, CI = 1.4-6.4) and clinical signs of congestive heart failure (OR = 2.1, CI = 1.1-5.1) were the two most important predictors of postoperative adverse neurological and cardiac outcomes, respectively. The median hospital stay was 4 days. The patients who developed postoperative adverse outcomes had significantly longer median hospital stays (9 days) than those without complications (3 days), (P < .0001). Our study demonstrates that the postoperative mortality rate in geriatric surgical patients undergoing noncardiac surgery is low. Despite the prevalence of preoperative chronic medical conditions, most patients do well postoperatively. The ASA classification (a reflection of the severity of preoperative comorbidities), emergency surgery, and intraoperative tachycardia increase the odds of developing any postoperative adverse events. Future studies aimed at modifying some of the potentially reversible risk factors, such as preoperative heart function and intraoperative heart rate are warranted.

To explore the best operation pattern of esophagogastric junction (EGJ) cancer and the regularity of lymph node metastasis in EGJ cancer according to Siewert typing. Twenty-six patients with EGJ cancer received esophagogastrectomy by thoracic-abdominal double incision and two-field lymphadenectomy (12 cases) or by traditional left postero-lateral thoracotomy and lymph node sampling (14 cases). The outcomes were analyzed with SPSS 10.0 software (1) The number of lymph node dissection group of the thoracic-abdominal double incision group was 7.3 lymph node groups, significantly more than that of the traditional left postero-lateral thoracotomy group (3.5 lymph node group, P < 0.001). The number of proved metastatic lymph nodes of the thoracic-abdominal double incision group was 1.9 groups, significantly higher than that of the traditional left postero-lateral thoracotomy group (0.9 group, P = 0.013). The distance between the esophageal incisal edge and the tumor was 5.8 cm in the thoracic-abdominal double incision, longer than that in the traditional left thoracotomy group (5.1 cm). The diaphragm was not damaged in the double-incision group, thus the influence to respiration and circulation was decreased. (2) The abdominal metastasis of Siewert type I cancer was not severe, the cancer of type II might metastasize to abdominal or thoracic cavity, and the main metastatic site of type III cancer was abdominal cavity. Thoracic-abdominal double incision and two-field lymphadenectomy helps increase the radical resection rate of EGJ cancer and study the regularity of lymph node metastasis.

Performing a surgical procedure in weightlessness, also called 0-gravity (0-g), has been shown to be no more difficult than in a 1-g environment if the requirements for the restraint of the patient, operator, surgical hardware, are observed. The performance of laparoscopic and thorascopic procedures in weightlessness, if feasible, would offer several advantages over the performance of an open operation. Concerns about the feasibility of performing minimally invasive procedures in weightlessness have included impaired visualization from the absence of gravitational retraction of the bowel (laparoscopy) or thoracic organs (thoracoscopy) as well as obstruction and interference from floating debris such as blood, pus, and irrigation fluid. The purpose of this study was to determine the feasibility of performing laparoscopic and thorascopic procedures and the degree of impaired surgical endoscopic visualization in weightlessness. From 1993 to 2000, laparoscopic and thorascopic procedures were performed on 10 anesthetized adult pigs weighing approximately 50 kg in the National Aeronautics and Space Administration (NASA) Microgravity Program using a modified KC-135 airplane. The parabolic simulation system for advanced life support was used in this project, and 20 to 40 parabolas were used for laparoscopic or thorascopic investigation, each containing approximately 30 s of 0-g alternating with 2-g pullouts. The animal model was restrained in the supine position on a floor-level Crew Medical Restraint System, and the abdominal cavity was insufflated with carbon dioxide. The intraabdominal and intrathoracic anatomy was visualized in the 1-g, 0-g, and 2-g periods of parabolic flight. Bleeding was created in the animals, and the behavior of the blood in the abdominal and thoracic cavities was observed. In the thoracic cavity, gas insufflation and mechanical retraction was used at times unilaterally to decrease pulmonary ventilation enough to increase the thoracic domain. Visualization was improved in laparoscopy, from tethering of the bowel by the elastic mesentery, and from the strong tendency for debris and blood to adhere to the abdominal wall because of surface tension forces. The lack of adequate thoracic domain made thorascopy more difficult. Fluid in the thoracic cavity did not impair visualization because the fluid at 0-g does not loculate posteriorly, but disperses along the thoracic wall and mediastinal reflections. Performing minimally invasive procedures instead of open surgical procedures in a weightless environment has theoretical advantages, especially in the ability to prevent cabin atmosphere contamination from surgical fluids (blood, pus, irrigation). Visualization will become more important and practical as the endoscopic hardware is miniaturized from its current form, as endoscopic technology becomes more advanced, and as more surgically capable medical crew officers are present in future long-duration space exploration missions.

Leptospirosis is a neglected zoonotic disease that commonly affects cattle, pigs, horses, and dogs in many countries. Infection in dogs is usually subclinical, but acute cases of leptospirosis may occur along with systemic failure, which may become fatal. After recovery from an acute infection, dogs may become asymptomatic carriers and shed pathogenic leptospires through urine for long periods of time. Here, a study of ten different cases of leptospirosis is presented, showing the relevance of dogs as asymptomatic carriers of pathogenic Leptospira. The diagnosis was confirmed via isolation and further serological and genetic identification. Four Leptospira isolates (LOCaS28, 31, 34, and 46) were obtained from the kidneys and urine samples of 58 dogs destined for destruction (6.89%) at a Canine Control Center in Mexico City. No spirochetes were observed in the urine samples of those Leptospira-positive dogs examined under dark-field microscopy, and no clinical signs of disease were observed either. Six additional isolates were obtained: two came from asymptomatic carrier dogs (CEL60 and UADY22); another isolate came from an asymptomatic dog that was a pack companion of a clinically ill dog with fatal leptospirosis (AGFA24); and finally, three isolates were taken from dogs that died of leptospirosis (LOCaS59, Citlalli, and Nayar1). Nine out of the ten isolates were identified as being from the serogroup Canicola via cross-absorption MAT using reference strains and specific antisera, and their identity was genetically confirmed as Canicola ST34 via multi-locus sequencing typing (MLST). In contrast, the isolate Nayar1 was identified as serovar Copenhageni ST2. Interestingly, the asymptomatic dogs from which Leptospira isolates were recovered consistently showed high antibody titers in the microscopic agglutination test (MAT), revealing values of at least 1:3200 against serogroup Canicola and lower titer values against other serogroups. Isolates showed different virulence levels in the hamster model. Taken as a whole, all these findings confirmed that dogs may act as asymptomatic carriers of pathogenic leptospires and possibly spread them out to the environment, thus representing an active public health risk. The results also showed that the Canicola ST34 clone is the most prevalent Leptospira serovar in dogs in Mexico, and finally that the old-fashioned MAT is a good alternative for the detection of presumptive Leptospira asymptomatic carrier dogs.

This is the first report of anthrax being diagnosed in any animal in Taiwan. In November 1999, a thoroughbred horse died at a horseback riding Park in Northern Taiwan. The horse died suddenly without clinical signs being observed. The external abnormalities included dark-brown nasal discharge and extensive edematous swellings on the body surface. Necropsy findings including ecchymoses of heart, liver and spleen which accompanied by unclotted blood. There was a serosanguineous exudate with fibrin within the thoracic and abdominal cavities. Gram positive rods were observed in smears of all tissues examined. Culture and laboratory tests, including fluorescence-labeled antibody (FA) staining, PCR of virulence factor genes and Ascoli precipitin test on tissue specimens, identified the organism as Bacillus anthracis.

Canine visceral leishmaniasis in Iran: A systematic review and meta-analysis

Introduction A search on the word “breathing” yields over 940 million Google results (2021). Nestor's Breath (2020) has garnered mainstream attention and curiosity. We propose that breathing (via intubation) in a layered fresh tissue dissection can create a more three dimensional understanding of breath when linked to experientials in a movement-based anatomy lab. Literature continues to look at the importance of dissection in tactile learning (Granger 2004). Topp (2014), noted a concern in medically oriented labs in that, “pattern and form are not immediately apparent...” Others have commented that the combination of movement and dissection lab helps to reinforce understanding and retention of concepts in medical school students (Vertel et al., 2020). Methods Review of current dissectors included Gray's Clinical Photographic Dissector (Loukas et al., 2018), Netter (2018) Thiele, Stecco (2015) as well as anatomical models, such as those created through plastination. In addition, the authors’ expertise in dissection and movement was the basis for a 2020 dissection with a group of yoga therapists and related movement and medical professionals. Steps for fresh tissue dissection: 1) tracheotomy was performed, tubing inserted, and lungs inflated with body in first preparation with pectoralis major, pectoralis minor and serratus anterior muscles reflected from the midline to lateral 2) ribs were clipped laterally and reflected from the level of clavicles. Lung inflation shown with the pericardial sac and relationship to ribcage and lungs 3) dissection continued in stages to highlight relationship with the diaphragm 4) discussion continued in breathing lab utilizing various props to demonstrate the role of the diaphragm in breathing, and yoga concepts to represent the movement of air into and out of the system. Reinforcing the idea of breath as shape-change in the cavities was emphasized, with the distinction of shape and volume change in the thoracic cavity, and shape but not volume change in the abdominal cavity (Kaminoff, Matthews, 2007). Results Relational movement was demonstrated at every level of dissection, from the lungs inflated pre-rib cutting, to lungs in situ with muscles and ribs reflected to highlight the relationship of the lungs, diaphragm and pericardium. The combination of a layered cadaver dissection of lung inflation with the addition of breath applications through movement lab was found to have a high rate of participant satisfaction in being able to more fully visualize human breathing. Video footage of both was documented for educational purposes. Typical survey reports included comments such as: “the demonstration changed my ideas about breathing. I can now visualize the connections in a way that book learning alone never accomplished.” Conclusion/Significance Creating a demonstration of breathing in situ at different levels of dissection puts this important function of human life in context for students of all levels, and effective learning of breath can be enhanced through applications like yoga breathing. Student learning in dissection lab, whether in person or virtually requires application to the living body. Context matters. Future investigations could test learning outcomes from the video footage (both dissection and movement labs) in this approach in repeated settings.