RESUMEN
BACKGROUND: Blood pressure monitoring is crucial during neuroendovascular procedures. Intraoperative hemodynamic instability is associated with complications, which underscores the importance of continuous monitoring. Although direct measurement with an intra-arterial catheter is the gold standard for determining arterial pressure, it is costly, time-consuming, and associated with complications. The novel ClearSight system offers a noninvasive technique for monitoring arterial pressure via a finger cuff. This study compared noninvasive arterial pressure measurements with the gold standard method. METHODS: Simultaneous recording of noninvasive and invasive arterial pressure was performed in patients undergoing neuroendovascular interventions. Both techniques were compared employing linear regression, Lin's correlation coefficient, Bland-Altman, and error grid analysis. RESULTS: The study enrolled 24 consecutive patients. The concordance correlation coefficient between both methods was 0.3526 (95% confidence interval [0.3134, 0.3906]) for mean arterial pressure and 0.4680 (95% confidence interval [0.4353, 0.4995]) and for systolic arterial pressure. The mean (SD) of the differences was 0.81 (17.86) mm Hg (95% limits of agreement [-52.52, 54.14]) for mean arterial pressure and 5.38 (14.64) mm Hg (95% limits of agreement [-45.12, 56.08]) for systolic arterial pressure. Error grid analysis demonstrated that the majority of measurements lie in regions with no or low risk for patients (mean arterial pressure, 71.0% and 24.4%; systolic arterial pressure, 59.2% and 25.8%). CONCLUSIONS: The ClearSight system provided accurate measurements of arterial blood pressure compared with invasive methods and within safe clinical parameters. This method may serve as a safe and reliable alternative for invasive blood pressure monitoring during neuroendovascular procedures.
Asunto(s)
Presión Arterial , Monitores de Presión Sanguínea , Procedimientos Endovasculares , Monitorización Hemodinámica/métodos , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Dedos , Monitorización Hemodinámica/instrumentación , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Adulto JovenRESUMEN
Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1-7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a patient was under general anesthesia, the patient was able to tolerate the second awake stage and was able to begin stimulation therapy within 48 hours of the second stage.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Enfermedad de Parkinson/terapia , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
Babesiosis, caused by the virulent haemoprotozoan parasite Babesia canis rossi, is an important disease of dogs in South Africa. The nitric oxide metabolites, nitrate and nitrite (collectively termed reactive nitrogen intermediates or RNIs) were measured in admission sera from dogs in a babesiosis-endemic area. Five groups were prospectively studied: mild uncomplicated (n=9), severe uncomplicated (severe anaemia) (n=10) and complicated babesiosis (n=11); and two groups of healthy aparasitaemic dogs: endemic controls from the study area (n=10) and experimental dogs kept in tick-free conditions (n=10). Four measures of RNI production were studied: (i) serum RNI; (ii) serum RNI/creatinine ratio; (iii) fractional clearance of RNI (FC(RNI)); (iv) fractional excretion of RNI (FE(RNI)). Marked elevations of serum RNI occurred in only two dogs, both in the severe uncomplicated group. The highest concentration (log value 5.29 micromol/l) was in a dog that died, but concentrations in the other four dogs that died were unremarkable (0, 0.34, 1.66 and 2.64 micromol/l). Age, appetite and free serum haemoglobin were significant covariates for measures of RNI production. There were no significant differences among the babesiosis groups for serum RNI. Adjustment for creatinine had minor effects on the results. All babesiosis groups had significantly higher serum RNI and RNI/creatinine than the tick-free control group, but did not differ from the endemic controls except for the severe uncomplicated group, which had higher RNI/creatinine. The complicated group had significantly lower FC(RNI) and FE(RNI) than all other groups, except for the tick-free control group, which had similar FE(RNI). The results indicate that, in an endemic area, measures of RNI production are unlikely to be useful indicators of severity or outcome in canine babesiosis.
Asunto(s)
Babesia/crecimiento & desarrollo , Babesiosis/veterinaria , Enfermedades de los Perros/parasitología , Óxido Nítrico/metabolismo , Animales , Babesiosis/sangre , Babesiosis/orina , Creatinina/orina , Enfermedades de los Perros/sangre , Enfermedades de los Perros/orina , Perros , Femenino , Masculino , Óxido Nítrico/biosíntesis , Parasitemia/veterinaria , Estudios Prospectivos , Especies de Nitrógeno Reactivo/biosíntesis , SudáfricaRESUMEN
This study was designed to document the systemic inflammatory response syndrome (SIRS) and multiple-organ dysfunction syndrome (MODS) in dogs with complicated babesiosis, and to assess their impact on outcome. Ninety-one cases were evaluated retrospectively for SIRS and 56 for MODS. The liver, kidneys, lungs, central nervous system and musculature were assessed. Eighty-seven percent of cases were SIRS-positive. Fifty-two percent of the cases assessed for organ damage had single-organ damage and 48 % had MODS. Outcome was not significantly affected by either SIRS or MODS, but involvement of specific organs had a profound effect. Central nervous system involvement resulted in a 57 times greater chance of death and renal involvement in a 5-fold increased risk compared to all other complications. Lung involvement could not be statistically evaluated owing to co-linearity with other organs, but was associated with high mortality. Liver and muscle damage were common, but did not significantly affect outcome. There are many similarities between the observations in this study and previous human and animal studies in related fields, lending additional support to the body of evidence for shared underlying pathophysiological mechanisms in systemic inflammatory states.
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Babesiosis/veterinaria , Enfermedades de los Perros/etiología , Insuficiencia Multiorgánica/veterinaria , Síndrome de Respuesta Inflamatoria Sistémica/veterinaria , Animales , Babesiosis/complicaciones , Babesiosis/mortalidad , Enfermedades de los Perros/mortalidad , Enfermedades de los Perros/parasitología , Perros , Femenino , Masculino , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Pronóstico , Estudios Retrospectivos , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/mortalidadRESUMEN
Systemic arterial blood pressures were measured in 30 dogs with acute babesiosis, 10 each with mild uncomplicated, severe uncomplicated and complicated disease. Ten healthy dogs were used as controls. Hypotension was defined as more than 3 standard deviations below the control mean. Normal mean pressures (+/-SD) were: systolic arterial pressure 151 (+/-11) mm Hg, diastolic arterial pressure 89 (+/-8) mm Hg and mean arterial pressure 107 (+/-10) mm Hg. Hypotension was the most frequent abnormality, and increased strikingly in incidence as disease severity increased, with 5/10 dogs in the complicated group being hypotensive for systolic, diastolic and mean arterial pressures, compared with 2/10 in the severe uncomplicated group and 0/10 in the mild uncomplicated group. Systolic, diastolic and mean arterial pressures in the complicated group and severe uncomplicated group, and systolic pressure in the mild uncomplicated group, were significantly lower than in the controls. There were no significant relationships between arterial pressures and age, pulse rate, respiratory rate, temperature, mucous membrane colour or haematocrit. There was a significant negative correlation between arterial pressures and white cell and immature neutrophil counts. Arterial pressures differed significantly between dogs that were clinically collapsed and those that were not, but not between survivors and non-survivors. Pulse pressure (systolic-diastolic) was low in 7/10 complicated, 1/10 mild uncomplicated, and 1/10 severe uncomplicated cases, and differed significantly between the complicated and control groups. The high incidence of hypotension in clinically severe babesiosis has important implications for therapy.
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Babesiosis/fisiopatología , Presión Sanguínea , Enfermedades de los Perros/fisiopatología , Hipotensión/veterinaria , Animales , Babesiosis/sangre , Babesiosis/complicaciones , Enfermedades de los Perros/sangre , Enfermedades de los Perros/etiología , Perros , Hipotensión/etiología , Índice de Severidad de la EnfermedadRESUMEN
A 1-year-old Irish wolfhound was presented with a history of slowly progressive left pelvic limb paresis. A neurological examination demonstrated bilateral deficits referable to the thoracolumbar spinal cord. Lumbar cerebrospinal fluid contained neoplastic cells. An intradural, extramedullary mass was demonstrated by myelography at the caudal aspect of T13. Surgical excision was abandoned owing to severe macroscopic damage to, and apparent infiltration of, the cord, and the dog was euthanased. The tumour was diagnosed histologically as an extrarenal nephroblastoma. Nephroblastoma should be suspected in young, large-breed dogs with intradural extramedullary masses over spinal segments T10-L2. The prognosis for complete recovery after surgical excision is guarded to poor.
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Enfermedades de los Perros/diagnóstico , Neoplasias de la Médula Espinal/veterinaria , Tumor de Wilms/veterinaria , Animales , Enfermedades de los Perros/patología , Enfermedades de los Perros/cirugía , Perros , Resultado Fatal , Inmunohistoquímica/veterinaria , Masculino , Mielografía/veterinaria , Pronóstico , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Tumor de Wilms/diagnóstico por imagen , Tumor de Wilms/patologíaRESUMEN
Therapeutic drug monitoring is an underutilised resource in the management of canine primary epilepsy. Many of the anti-epileptic drugs, including phenobarbitone, have variable pharmacokinetic profiles in different dogs, with each individual animal showing variable rates of absorption, distribution, metabolism and excretion. This results in variable serum drug concentrations with the same oral dose. Many clinicians interpret this situation as therapeutic failure and classify these patients as refractory to treatment. By measuring blood concentrations of drugs at appropriate times, it is possible to explain the efficacy or failure of treatment, and also to prevent serum concentrations from reaching toxic levels. By analysing paired samples, key pharmacokinetic parameters may be calculated for each patient and a profile for the disposition of the drug obtained. Individual optimal drug dosage can be calculated for each patient at little cost to the pet owner.
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Anticonvulsivantes/uso terapéutico , Bromuros/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Monitoreo de Drogas , Epilepsia/veterinaria , Fenobarbital/uso terapéutico , Compuestos de Potasio/uso terapéutico , Animales , Anticonvulsivantes/farmacocinética , Bromuros/farmacocinética , Enfermedades de los Perros/sangre , Perros , Quimioterapia Combinada , Epilepsia/clasificación , Epilepsia/tratamiento farmacológico , Fenobarbital/farmacocinética , Compuestos de Potasio/farmacocinéticaRESUMEN
Osteoarthritis or degenerative joint disease is a condition characterised by degeneration of articular cartilage often associated with the formation of new bone at joint surfaces on margins. Commonly encountered in dogs, osteoarthritis may have a gradual onset, but may also occur acutely. Osteoarthritis can be a primary disease of joint cartilage, but is more after secondary to abnormal stresses on joints. This article describes the pathogenesis and progression of cartilage degeneration as well as the dietary, lifestyle and pharmacological management of osteoarthritis. Recent pharmacological developments allow the clinician not only to control clinical signs of the disease, but also to slow the progression of cartilage degeneration.
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Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Osteoartritis/veterinaria , Animales , Cartílago Articular/fisiopatología , Terapias Complementarias/veterinaria , Enfermedades de los Perros/fisiopatología , Perros , Terapia por Ejercicio , Glicosaminoglicanos/uso terapéutico , Osteoartritis/tratamiento farmacológico , Osteoartritis/fisiopatología , Esteroides , Pérdida de PesoRESUMEN
This case report describes a young male German Shepherd dog that presented with bleeding from the lip 24 hours after being bitten by a boomslang (Dispholidus typus). Bites from this snake are infrequently encountered in dogs due to the shy habits of the snake. The boomslang venom is a potent procoagulant causing a consumption coagulopathy with resultant profuse haemorrhage. The only effective treatment is the administration of specific antiserum. Antiserum administration in this patient resulted in cessation of bleeding within one hour after administration. The article also discusses treatment options if antiserum is unavailable. This is the first recorded case of boomslang envenomation in the dog.