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BACKGROUND: The use of anabolic androgenic steroids (AAS) among athletes has been linked to pathological structural and functional cardiac changes. However, the studies are small, and the results are inconsistent. METHODS: We conducted a systematic review and meta-analysis of echocardiographic outcomes comparing athletes with prolonged use of AAS (at least 2 years of use) versus sex and age- matched athletes who were did not use AAS. PubMed, Cochrane, and embase were searched. A random-effects model was used to calculate mean differences (MDs), with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1. RESULTS: We included 17 studies comprising 1,023 athletes, of whom 543 (53%) were AAS users. The mean age ranged to 24.2 to 43 years. Compared with non-AAS users, athletes who used AAS exhibited a significant increase in interventricular septal wall thickness (MD 1.33 mm; 95% CI [0.8,1.89], p<0.001), a reduction in left ventricular ejection fraction (MD 2.77 %; 95% CI [-4.2,-1.34], p<0.001;Figure 1B) , and worsening of global longitudinal strain (MD 3.39%; 95% CI [2.88,3.91], p<0.001;Figure 1B). Additionally, there was a significant reduction in the E/A ratio (MD -0.21; 95% CI [-0.35,-0.07], p=0.003) and an increase in the E/e' ratio (MD 1.71; 95% CI [0.96,2.46], p<0.001). CONCLUSION: Our findings suggest that prolonged use of AAS in athletes is associated with increased left ventricular wall thickness and worsening of systolic and diastolic parameters.

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INTRODUÇÃO: A intolerância aos esforços é achado relevante dentre as queixas semióticas. Quando ocorre em crianças uma análise mais acurada é necessária para esclarecer os mecanismos da limitação ao esforço. Mesmo uma boa história clínica e um bom exame físico podem não ser suficientes. Assim, exames complementares guiarão para o diagnóstico mais preciso e uma conduta mais assertiva. CASO CLÍNICO: Masculino 10 anos, com dispneia aos esforços e asma desde a primeira infância e pouca resposta ao tratamento específico. Realizada investigação com Ressonância magnética que evidenciou duplo brônquio fonte a direita (acessório). Tal achado mostrou possível mecanismo de obstrução extrínseca para justificar o cansaço desproporcional em relação às demais crianças. Para melhor entendimento do quadro clínico e possíveis mecanismos limitantes à continuidade dos esforços foi realizado o teste cardiopulmonar de exercício (TCPE). O TCPE é o método ouro para investigar a dispneia aos esforços. Desse modo é possível identificar componentes cardiovascular, ventilatório, muscular periférico ou de troca-gasosa. Durante o esforço realizou-se manobras fluxo-volumétricas evidenciando redução de 390 ml da capacidade inspiratória (CI), queda de 15% em relação ao basal, além do deslocamento da alça fluxo-volume para esquerda, definindo critério de hiperinsuflação ou aprisionamento aéreo dinâmico. CONCLUSÃO: O relato revelou a importância do TCPE que através de abordagens de averiguação dos componentes diversos e possíveis limitantes, mostrou condicionamento físico aeróbico reduzido do paciente e foi decisivo no esclarecimento do predomínio do distúrbio ventilatório configurando um padrão compatível com broncoespasmo induzido pelo esforço (possivelmente atípico por ser de grandes vias aéreas).

RESUMO

OBJECTIVES: This study aimed to evaluate the effect of 0.15% sodium hyaluronate (SH) on tear film breakup time (TFBT) in healthy anesthetized cats. PROCEDURES: Forty cats undergoing elective surgery were enrolled. TFBT was assessed before anesthesia to obtain baseline values. As a preanesthetic medication, cats received midazolam, tramadol, and cetamine combined in the same syringe. For anesthetic induction and maintenance, propofol and isoflurane were used. After a 15 min stabilization period to achieve the surgical anesthetic plane, one eye was treated with one drop of SH, while the other eye received saline and served as a control. TFBT was measured at the end of the general anesthesia (T40) and 35 (T75) and 80 min (T120) after the termination of the anesthesia. TFBT values were compared between the control and SH-treated eyes; both values were also compared with the baseline values (p < .05). RESULTS: In the control eyes, TFBT significantly decreased from baseline at all time points (p < .001), while in SH-treated eyes, TFBT significantly increased from baseline only at T40 (p < .0001). In SH-treated eyes, TFBT was significantly higher than that in the control eyes at all time points (p < .001). CONCLUSIONS: In healthy cats, TFBT decreases significantly after 40 min of general anesthesia, and one drop of 0.15% sodium hyaluronate was able to maintain the stability of the tear film for up to 75 min in treated eyes. However, the isolated effect of each drug used in our anesthetic protocol on TFBT should be executed in further studies.

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Congenital third degree block (CHB) is a relative rare disorder. The manifestations of CHB can vary according to many aspects, including ventricular rate of the escape rhythm and ventricular function. The main therapeutic decision is the need for and the ideal timing of permanent pacemaker insertion. Patients with adequate ventricular heart rate increasing appropriately during exertion and no symptoms such as syncope or near syncope and a structurally normal heart and cardiac function can usually be followed without intervention, and therefore, they can selectively participate in competitive sports. Although, this is not a permanent recommendation, and these patients should be followed closely. Case report: 13-year-old asymptomatic male patient, with a previous diagnosis of CHB, who practices competitive soccer, in yearly follow up at the sports cardiology outpatient clinic, who presented a normal echocardiography, without structural alterations, normal Left Ventricle (LV) dimensions, a Left Ventricle End Diastolic Diameter (LVEDD) of 48 mm, and preserved LV function. His exercise test showed an excellent functional capacity (15 METS) despite a chronotropic insufficiency. However, on the 2021 clinical evaluation, he presented a significant worsening of the tests results, although remained asymptomatic. The new echocardiography presented LV dilatation with a LVEDD of 63 mm, but with preserved ejection fraction. The exercise test showed a worse functional capacity of 11 METS and chronotropic deficit. Therefore, it was indicated the insertion of a pacemaker. New tests were performed two months after the procedure. The echocardiography showed normal LV dimensions (LVEDD: 46 mm). At the cardiopulmonary exercise test, the patient reached 103% of the predicted VO2, showing a normal functional capacity. Although all these improvements, the practice of soccer was contraindicated due to the high risk of thoracic trauma. Nevertheless, the patient still may participate of other competitive and high intensity activities with low risk of lead dislocation and thoracic trauma. In CONCLUSION, the CHB is not a prohibitive condition of high intensity sports, as long as the patient remains without structural cardiac alterations, normal LV function, asymptomatic and with a normal functional capacity. However, these conditions can change in a relative short period, so the follow up must be done closely.

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Background: Ocular lymphoma can affect the iris, conjunctiva, choroid, and retina and is mostly associated with multicentric disease. Elastography is an ultrasound technique that provides noninvasive, pain-free assessment of tissue stiffness. It has the ability to assess subtle changes throughout the organ as well as focal lesions. Microbubble contrast ultrasound enables the detection of incipient vascular flows, which are difficult to detect using traditional ultrasound methods. This study aimed to describe acoustic radiation force impulse (ARFI) elastography and microbubble contrast ultrasound findings in the eyes of two dogs diagnosed with intraocular T-cell lymphoma. Cases: Case 1. Physical examination revealed an exophytic mass in the left eye. Schirmer test revealed a secretion of 22 mm/min. Negative threat reflex, glare, direct pupillary light reflex, and consensual response were also noted. Biomicroscopy revealed hyperplasia of the third eyelid, overlapping with the affected eye. When the membrane was removed, moderate conjunctival hyperemia, mucoid secretion, and buphthalmia were observed. In addition, significant corneal edema was present, making it impossible to visualize the anterior chamber and perform fundus examination. The intraocular pressure, as measured with a rebound tonometer, was 39 mmHg. B-mode ultrasonography identified amorphous, hyperechoic, and heterogeneous structures throughout the anterior chamber, iris, and ciliary body. The elastogram showed that the mass had greenish tones and intermediate stiffness, and the mean SWV of the ciliary body and iris was 2 m/s. Contrast-enhanced ultrasound (CEUS) revealed vascularization of the neoformation region, with wash-in, peak, and wash-out values of 9.89 s, 24.56 s, and 107.87 s, respectively. Case 2. On physical examination, a change in the shape of the right pupil was observed. Schirmer test revealed a secretion of 20 mm/min, with negative threat, glare, and pupillary reflexes to direct and consensual light. Biomicroscopy revealed neoformation from 7 am to 11 am in the sclera, retina, and choroid complex, concomitant with dyscoria and conjunctival hyperemia. The intraocular pressure, as measured by rebound tonometry, was 33 mmHg. Fundoscopy revealed a mass in the temporal region and focal retinal detachment. No changes were observed in the contralateral eye. B-mode ultrasound revealed an increase in volume in the temporal region of the iris, ciliary body, and choroid with diffuse heterogeneity and partial retinal detachment. Elastographic examination revealed shades of green and yellow compatible with increased tissue stiffness. On quantitative examination, the mean SWVs of the ciliary body and iris were 3.14 m/s. On CEUS, the neoformation region presented wash-in, peak, and wash-out values of 8.67 s, 22.33 s, and 80.20 s. Discussion: B-mode ultrasonography established the tumor extent and evaluated echogenicity, verifying the involved ocular structures. The examination played an important role in the diagnosis as well as clinical management. ARFI elastography can detect small tissue changes, helping to define nodules and masses more reliably, in addition to allowing the verification of tissue stiffness. In both dogs, it was possible to verify that the masses presented greater rigidity than the adjacent tissues both qualitatively and quantitatively. In previous studies, it was found that cutaneous and breast lymphomas in humans were more rigid than adjacent tissues on elastography. This increase in rigidity and heterogeneity observed on elastograms can be explained by the extramedullary interactions of the matrix in T-cell lymphomas. Tumor growth is dependent on the blood supply, which was evaluated using CEUS in these cases. Furthermore, the ciliary body contrast filling times were longer than those described in normal dogs.

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RELATO DE CASO: Paciente 44 anos, sexo feminino com história de COVID-19 há 4 meses, inicialmente com sintomas leves e sem necessidade de internação hospitalar. Há cerca de 6 semanas após resolução de quadro, apresentou dispneia progressiva a esforços, tendo sido diagnosticada com tromboembolismo pulmonar após angiotomografia de tórax e iniciada anticoagulação. À admissão em Pronto-Socorro de hospital terciário, apresentava-se dispneica, com turgência jugular e hipofonese de bulhas. Ecocardiograma na urgência confirmou a presença de derrame pericárdico importante com comprometimento hemodinâmico, tendo sido corroborado diagnóstico de tamponamento cardíaco. Foi realizada pericardiocentese e estabilização clínica. Após, prosseguida investigação diagnóstica com ressonância magnética (RM) que evidenciou miocardiopatia restritiva com padrão de endomiocardiofibrose. DISCUSSÃO: Ainda que no último ano tenha sido frequente o relato de casos de miopericardite, inclusive com ocorrência de derrame pericárdico, relacionados à infecção pelo Sars-Cov2, é necessário reforçar a importância da perseguição diagnóstica em casos de insuficiência cardíaca e/ou derrames cavitários recém-descobertos. A utilização de adequados métodos complementares, como o ecocardiograma transtorácico e a RM permitem o estabelecimento de diagnóstico etiológico adequado de endomiocardiofibrose, corroborando para seguimento e tratamento dos pacientes portadores desta entidade clínica.

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La oftalmología veterinaria cubre el diagnóstico de alteraciones oculares primarias, perioculares y retrobulbares, así como sus manifestaciones sistémicas y secundarias, lo que es posible gracias a la evaluación completa del bulbo ocular, la órbita y las inserciones mediante un examen oftálmico completo y exámenes complementarios. Entre las pruebas de imagen que ayudan en el diagnóstico de patologías oculares, la ecografía se encuentra entre las pruebas de imagen más utilizadas en la rutina veterinaria, ayudando en la observación de anomalías retrobulbares y en la evaluación de estructuras bulbosas en presencia de medios transparentes opacos, por ejemplo. Además de la ecografía, existen otros tipos de exámenes, que incluyen tomografía computarizada, resonancia magnética, angiografía, microscopía especular, angiografía, tomografía de coherencia óptica (OCT) y angiografía por tomografía de coherencia óptica (OCT-A). Debido a los avances tecnológicos en la obtención de imágenes, la evaluación del globo ocular y de las estructuras orbitarias se puede realizar con mayor precisión, lo que favorece el diagnóstico y la elección terapéutica adecuada. El objetivo de esta revisión es enumerar las pruebas disponibles, sus principales indicaciones, así como su aplicabilidad y estudios en animales domésticos.(AU)

Veterinary ophthalmology covers the diagnosis of primary ocular, periocular and retrobulbar alterations, and also their systemic and secondary manifestations. That is possible through the complete clinic avaliation of ocular bulb, orbit and attachments and the use of complementary exams. Among the imaging exams that help in the diagnostics of ocular pathologies, ultrasound is one of the most used exams in the veterinary routine, assisting in the observation of retrobulbar abnormalities and bulbar structures when the transparency of the tissues is committed, for example. There are other modalities of imaging exams like computer tomography, magnetic resonance, angiography, optical coherence tomography (OCT) and angiography optical coherence tomography (OCT-A). Due to technology advances in images, the avaliation of ocular globe and orbital structures is more accurate, allowing accurate diagnosis and adequate treatment. The aim of this literature review is list the available exams and their indications, as well as their applicability and studies in domestic animals.(AU)

A oftalmologia veterinária abrange o diagnóstico das alterações oculares, perioculares e retrobulbares primárias, e também suas manifestações sistêmicas e secundárias, o que se torna possível a partir da avaliação completa do bulbo ocular, órbita e anexos por meio do exame oftálmico completo e de exames complementares. Dentre os exames de imagens que auxiliam no diagnóstico das afecções oculares, a ultrassonografia está entre os exames de imagem mais utilizados na rotina veterinária, auxiliando na observação de anormalidades retrobulbares e na avaliação das estruturas bulbares na presença de opacificação de meios transparentes, por exemplo. Além da ultrassonografia, existem outras modalidades de exames, dentre eles a tomografia computadorizada, ressonância magnética, angiografia, microscopia especular, tomografia de coerência óptica (OCT) e angiografia por tomografia de coerência óptica (OCT-A).  Em virtude dos avanços tecnológicos na obtenção de imagens, a avaliação globo ocular e das estruturas orbitárias pode ser realizada com maior precisão, o que favorece o diagnóstico e a escolha terapêutica adequada. Objetiva-se com esta revisão enumerar os exames disponíveis, suas principais indicações, bem como sua aplicabilidade e estudos em animais domésticos.(AU)

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La oftalmología veterinaria cubre el diagnóstico de alteraciones oculares primarias, perioculares y retrobulbares, así como sus manifestaciones sistémicas y secundarias, lo que es posible gracias a la evaluación completa del bulbo ocular, la órbita y las inserciones mediante un examen oftálmico completo y exámenes complementarios. Entre las pruebas de imagen que ayudan en el diagnóstico de patologías oculares, la ecografía se encuentra entre las pruebas de imagen más utilizadas en la rutina veterinaria, ayudando en la observación de anomalías retrobulbares y en la evaluación de estructuras bulbosas en presencia de medios transparentes opacos, por ejemplo. Además de la ecografía, existen otros tipos de exámenes, que incluyen tomografía computarizada, resonancia magnética, angiografía, microscopía especular, angiografía, tomografía de coherencia óptica (OCT) y angiografía por tomografía de coherencia óptica (OCT-A). Debido a los avances tecnológicos en la obtención de imágenes, la evaluación del globo ocular y de las estructuras orbitarias se puede realizar con mayor precisión, lo que favorece el diagnóstico y la elección terapéutica adecuada. El objetivo de esta revisión es enumerar las pruebas disponibles, sus principales indicaciones, así como su aplicabilidad y estudios en animales domésticos.

Veterinary ophthalmology covers the diagnosis of primary ocular, periocular and retrobulbar alterations, and also their systemic and secondary manifestations. That is possible through the complete clinic avaliation of ocular bulb, orbit and attachments and the use of complementary exams. Among the imaging exams that help in the diagnostics of ocular pathologies, ultrasound is one of the most used exams in the veterinary routine, assisting in the observation of retrobulbar abnormalities and bulbar structures when the transparency of the tissues is committed, for example. There are other modalities of imaging exams like computer tomography, magnetic resonance, angiography, optical coherence tomography (OCT) and angiography optical coherence tomography (OCT-A). Due to technology advances in images, the avaliation of ocular globe and orbital structures is more accurate, allowing accurate diagnosis and adequate treatment. The aim of this literature review is list the available exams and their indications, as well as their applicability and studies in domestic animals.

A oftalmologia veterinária abrange o diagnóstico das alterações oculares, perioculares e retrobulbares primárias, e também suas manifestações sistêmicas e secundárias, o que se torna possível a partir da avaliação completa do bulbo ocular, órbita e anexos por meio do exame oftálmico completo e de exames complementares. Dentre os exames de imagens que auxiliam no diagnóstico das afecções oculares, a ultrassonografia está entre os exames de imagem mais utilizados na rotina veterinária, auxiliando na observação de anormalidades retrobulbares e na avaliação das estruturas bulbares na presença de opacificação de meios transparentes, por exemplo. Além da ultrassonografia, existem outras modalidades de exames, dentre eles a tomografia computadorizada, ressonância magnética, angiografia, microscopia especular, tomografia de coerência óptica (OCT) e angiografia por tomografia de coerência óptica (OCT-A).  Em virtude dos avanços tecnológicos na obtenção de imagens, a avaliação globo ocular e das estruturas orbitárias pode ser realizada com maior precisão, o que favorece o diagnóstico e a escolha terapêutica adequada. Objetiva-se com esta revisão enumerar os exames disponíveis, suas principais indicações, bem como sua aplicabilidade e estudos em animais domésticos.

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Objective was to evaluate the accuracy of elastography in the differentiation between normal and cataract lenses One hundred forty-five eyes of 98 dogs were divided into groups according to cataract stage. Forty-twoeyes were submitted to phacoemulsification. Biometric parameters, echogenicity and echotexture patterns of the anterior, posterior and vitreous chambers, lens and retina-choroid-sclera complexes were evaluated by ocular ultrasound in modes A and B. Deformability, and color (blue color = indicated less rigid structures, color red = more rigid structures) of the lenses were evaluated by the elastogram. The shear wave velocity (SWV; m/s) was calculated in three regions of the lens, both in the cortex and in the nucleus. The SWV of nucleus was statistically different between the normal lenses and with cataracts, and between the stages of cataract (P<0.001). Healthy lenses and incipient cataracts had a more rigid nucleus. Mature cataracts presented lowest nuclear rigidity (P<0.001). On cortical region the SWV was significantly higher (P<0.01) in intumescent and incipient cataracts. SWV less than 2.67m/s indicates cataract with a sensitivity of 72% and specificity of 94%. Values lower than 2.23m/s suggest mature cataract, with sensitivity of 71% and specificity of 76%. SWV greater than 2.66 m/s are associated with normal lenses or incipient cataract, presenting sensitivity of 94% and specificity of 84%. Qualitative method allowed differentiation between healthy and affected lenses and the classification of evolutionary stages. There was a correlation between the degree of stiffness of lens in cortical and nuclear regions (p=00165, r=0.37) and between the balanced saline solution quantitative and surgical time (P<0.01, r=0.73). Degree of stiffness of lens did not correlate with parameters of phacoemulsification. Elastographic proved feasible for evaluating the lens of dogs, characterizing the types of cataracts, and demonstrating increased stiffness of the diseased lenses.(AU)

O objetivo foi avaliar a precisão da elastografia na diferenciação entre lentes normais e de catarata. Cento e quarenta e cinco olhos de 98 cães foram divididos em grupos de acordo com o estágio de maturação da catarata. Quarenta e dois olhos foram submetidos à facoemulsificação. Parâmetros biométricos, ecogenicidade e padrões de ecotextura das câmaras anterior, posterior e vítrea, lente e complexos retina-coróide-esclera foram avaliados por ultrassonografia ocular nos modos A e B. A deformabilidade e a coloração (cor azul = indicou estruturas menos rígidas, cor vermelha = estruturas mais rígidas) das lentes foram avaliadas pelo elastograma. A velocidade da onda de cisalhamento (SWV; m/s) foi calculada em três regiões da lente, tanto no córtex quanto no núcleo. A SWV do núcleo foi estatisticamente diferente entre as lentes normais e com catarata e entre os estágios da catarata (P<0,001). Lentes saudáveis e cataratas incipientes tinham um núcleo mais rígido. Cataratas maduras apresentaram menor rigidez nuclear (P<0,001). Na região cortical, a SWV foi significativamente maior (P<0,01) nas cataratas intumescentes e incipientes. Uma SWV menor que 2,67m/s indica catarata com sensibilidade de 72% e especificidade de 94%. Valores inferiores a 2,23m/s sugerem catarata madura, com sensibilidade de 71% e especificidade de 76%. Uma SWV superior a 2,66m/s está associada à catarata normal ou incipiente, apresentando sensibilidade de 94% e especificidade de 84%. O método qualitativo permitiu a diferenciação entre lentes normais de olhos saudáveis e afetadas e a classificação dos estágios evolutivos. A elastografia se mostrara uma ferramenta viável para avaliar as lentes de cães, caracterizando os tipos de catarata e demonstrando maior rigidez das lentes doentes.(AU)

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RESUMO

ABSTRACT: Objective was to evaluate the accuracy of elastography in the differentiation between normal and cataract lenses One hundred forty-five eyes of 98 dogs were divided into groups according to cataract stage. Forty-twoeyes were submitted to phacoemulsification. Biometric parameters, echogenicity and echotexture patterns of the anterior, posterior and vitreous chambers, lens and retina-choroid-sclera complexes were evaluated by ocular ultrasound in modes A and B. Deformability, and color (blue color = indicated less rigid structures, color red = more rigid structures) of the lenses were evaluated by the elastogram. The shear wave velocity (SWV; m/s) was calculated in three regions of the lens, both in the cortex and in the nucleus. The SWV of nucleus was statistically different between the normal lenses and with cataracts, and between the stages of cataract (P 0.001). Healthy lenses and incipient cataracts had a more rigid nucleus. Mature cataracts presented lowest nuclear rigidity (P 0.001). On cortical region the SWV was significantly higher (P 0.01) in intumescent and incipient cataracts. SWV less than 2.67m/s indicates cataract with a sensitivity of 72% and specificity of 94%. Values lower than 2.23m/s suggest mature cataract, with sensitivity of 71% and specificity of 76%. SWV greater than 2.66 m/s are associated with normal lenses or incipient cataract, presenting sensitivity of 94% and specificity of 84%. Qualitative method allowed differentiation between healthy and affected lenses and the classification of evolutionary stages. There was a correlation between the degree of stiffness of lens in cortical and nuclear regions (p=00165, r=0.37) and between the balanced saline solution quantitative and surgical time (P 0.01, r=0.73). Degree of stiffness of lens did not correlate with parameters of phacoemulsification. Elastographic proved feasible for evaluating the lens of dogs, characterizing the types of cataracts, and demonstrating increased stiffness of the diseased lenses.

RESUMO: O objetivo foi avaliar a precisão da elastografia na diferenciação entre lentes normais e de catarata. Cento e quarenta e cinco olhos de 98 cães foram divididos em grupos de acordo com o estágio de maturação da catarata. Quarenta e dois olhos foram submetidos à facoemulsificação. Parâmetros biométricos, ecogenicidade e padrões de ecotextura das câmaras anterior, posterior e vítrea, lente e complexos retina-coróide-esclera foram avaliados por ultrassonografia ocular nos modos A e B. A deformabilidade e a coloração (cor azul = indicou estruturas menos rígidas, cor vermelha = estruturas mais rígidas) das lentes foram avaliadas pelo elastograma. A velocidade da onda de cisalhamento (SWV; m/s) foi calculada em três regiões da lente, tanto no córtex quanto no núcleo. A SWV do núcleo foi estatisticamente diferente entre as lentes normais e com catarata e entre os estágios da catarata (P 0,001). Lentes saudáveis e cataratas incipientes tinham um núcleo mais rígido. Cataratas maduras apresentaram menor rigidez nuclear (P 0,001). Na região cortical, a SWV foi significativamente maior (P 0,01) nas cataratas intumescentes e incipientes. Uma SWV menor que 2,67m/s indica catarata com sensibilidade de 72% e especificidade de 94%. Valores inferiores a 2,23m/s sugerem catarata madura, com sensibilidade de 71% e especificidade de 76%. Uma SWV superior a 2,66m/s está associada à catarata normal ou incipiente, apresentando sensibilidade de 94% e especificidade de 84%. O método qualitativo permitiu a diferenciação entre lentes normais de olhos saudáveis e afetadas e a classificação dos estágios evolutivos. A elastografia se mostrara uma ferramenta viável para avaliar as lentes de cães, caracterizando os tipos de catarata e demonstrando maior rigidez das lentes doentes.

RESUMO

Objective was to evaluate the accuracy of elastography in the differentiation between normal and cataract lenses One hundred forty-five eyes of 98 dogs were divided into groups according to cataract stage. Forty-twoeyes were submitted to phacoemulsification. Biometric parameters, echogenicity and echotexture patterns of the anterior, posterior and vitreous chambers, lens and retina-choroid-sclera complexes were evaluated by ocular ultrasound in modes A and B. Deformability, and color (blue color = indicated less rigid structures, color red = more rigid structures) of the lenses were evaluated by the elastogram. The shear wave velocity (SWV; m/s) was calculated in three regions of the lens, both in the cortex and in the nucleus. The SWV of nucleus was statistically different between the normal lenses and with cataracts, and between the stages of cataract (P<0.001). Healthy lenses and incipient cataracts had a more rigid nucleus. Mature cataracts presented lowest nuclear rigidity (P<0.001). On cortical region the SWV was significantly higher (P<0.01) in intumescent and incipient cataracts. SWV less than 2.67m/s indicates cataract with a sensitivity of 72% and specificity of 94%. Values lower than 2.23m/s suggest mature cataract, with sensitivity of 71% and specificity of 76%. SWV greater than 2.66 m/s are associated with normal lenses or incipient cataract, presenting sensitivity of 94% and specificity of 84%. Qualitative method allowed differentiation between healthy and affected lenses and the classification of evolutionary stages. There was a correlation between the degree of stiffness of lens in cortical and nuclear regions (p=00165, r=0.37) and between the balanced saline solution quantitative and surgical time (P<0.01, r=0.73). Degree of stiffness of lens did not correlate with parameters of phacoemulsification. Elastographic proved feasible for evaluating the lens of dogs, characterizing the types of cataracts, and demonstrating increased stiffness of the diseased lenses.(AU)

O objetivo foi avaliar a precisão da elastografia na diferenciação entre lentes normais e de catarata. Cento e quarenta e cinco olhos de 98 cães foram divididos em grupos de acordo com o estágio de maturação da catarata. Quarenta e dois olhos foram submetidos à facoemulsificação. Parâmetros biométricos, ecogenicidade e padrões de ecotextura das câmaras anterior, posterior e vítrea, lente e complexos retina-coróide-esclera foram avaliados por ultrassonografia ocular nos modos A e B. A deformabilidade e a coloração (cor azul = indicou estruturas menos rígidas, cor vermelha = estruturas mais rígidas) das lentes foram avaliadas pelo elastograma. A velocidade da onda de cisalhamento (SWV; m/s) foi calculada em três regiões da lente, tanto no córtex quanto no núcleo. A SWV do núcleo foi estatisticamente diferente entre as lentes normais e com catarata e entre os estágios da catarata (P<0,001). Lentes saudáveis e cataratas incipientes tinham um núcleo mais rígido. Cataratas maduras apresentaram menor rigidez nuclear (P<0,001). Na região cortical, a SWV foi significativamente maior (P<0,01) nas cataratas intumescentes e incipientes. Uma SWV menor que 2,67m/s indica catarata com sensibilidade de 72% e especificidade de 94%. Valores inferiores a 2,23m/s sugerem catarata madura, com sensibilidade de 71% e especificidade de 76%. Uma SWV superior a 2,66m/s está associada à catarata normal ou incipiente, apresentando sensibilidade de 94% e especificidade de 84%. O método qualitativo permitiu a diferenciação entre lentes normais de olhos saudáveis e afetadas e a classificação dos estágios evolutivos. A elastografia se mostrara uma ferramenta viável para avaliar as lentes de cães, caracterizando os tipos de catarata e demonstrando maior rigidez das lentes doentes.(AU)

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Cataract is an important disease on veterinary ophthalmology. Different techniques facilitate the classification of the cataracts, adding information obtained by the conventional eye exam. This review discusses different modalities of ultrasonography methods available for diagnosis and surgical planning in dogs with cataracts. A-Mode ultrasound is used to evaluate thickness and length of the lens. B-Mode also has the capacity to evaluate features of echogenicity, echotexture, position of the lens and the identification of retinal and vitreous degenerations. The ultrasonic biomicroscopy is useful in assessing the anterior capsule and the positioning of the lens. The Doppler method it is useful to detection of vascular changes in patients with cataracts. The elastography method however allows measuring the lens rigidity, which is extremely important for planning and surgical prognosis.

A catarata é considerada importante afecção em oftalmologia veterinária. Diferentes técnicas ultrassonográficas auxiliam na sua classificação das cataratas, complementando informações obtidas ao exame oftálmico convencional. Esta revisão descreve diferentes modalidades ultrassonográficas disponíveis para o auxílio diagnóstico e o planejamento cirúrgico em casos de catarata. A ultrassonografia modo A permite avaliar a espessura e o comprimento da lente. A ultrassonografia modo B permite avaliar características de ecogenicidade, ecotextura, bem como a posição da lente, identificação de descolamentos da retina e degenerações vítreas. A biomicroscopia ultrassônica mostra-se útil na avaliação da cápsula anterior e do posicionamento da lente. O método Doppler, na detecção de alterações vasculares em pacientes com catarata. A elastografia permite a avaliação do grau de rigidez de um tecido, condição importante para o planejamento e prognóstico cirúrgicos.

Assuntos

RESUMO

Cataract is an important disease on veterinary ophthalmology. Different techniques facilitate the classification of the cataracts, adding information obtained by the conventional eye exam. This review discusses different modalities of ultrasonography methods available for diagnosis and surgical planning in dogs with cataracts. A-Mode ultrasound is used to evaluate thickness and length of the lens. B-Mode also has the capacity to evaluate features of echogenicity, echotexture, position of the lens and the identification of retinal and vitreous degenerations. The ultrasonic biomicroscopy is useful in assessing the anterior capsule and the positioning of the lens. The Doppler method it is useful to detection of vascular changes in patients with cataracts. The elastography method however allows measuring the lens rigidity, which is extremely important for planning and surgical prognosis.(AU)

A catarata é considerada importante afecção em oftalmologia veterinária. Diferentes técnicas ultrassonográficas auxiliam na sua classificação das cataratas, complementando informações obtidas ao exame oftálmico convencional. Esta revisão descreve diferentes modalidades ultrassonográficas disponíveis para o auxílio diagnóstico e o planejamento cirúrgico em casos de catarata. A ultrassonografia modo A permite avaliar a espessura e o comprimento da lente. A ultrassonografia modo B permite avaliar características de ecogenicidade, ecotextura, bem como a posição da lente, identificação de descolamentos da retina e degenerações vítreas. A biomicroscopia ultrassônica mostra-se útil na avaliação da cápsula anterior e do posicionamento da lente. O método Doppler, na detecção de alterações vasculares em pacientes com catarata. A elastografia permite a avaliação do grau de rigidez de um tecido, condição importante para o planejamento e prognóstico cirúrgicos.(AU)

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Abstract Background: Fibrosis is present in several pathologies associated with mammary carcinogenesis. Objective: To evaluate and quantify the fibrosis present in malignant and benign mammary neoplasms in bitches. Methods: Eighty-three samples were divided according to histopathological diagnosis into benign (n= 21) and malignant (n= 62) neoplasms. Haematoxylin-eosin and Masson's trichrome were used to locate the connective tissue, and the extent of fibrosis was assessed with image software. Results: Benign neoplasms were classified into adenomas (cystic, complex, and tubular), benign mixed tumor, and ductal and lobular hyperplasia. Malignant neoplasms were classified as carcinomas (complex, mixed tumor, in situ tubular, tubulopapillary, and solid). Grade I was the most prevalent histopathological class, followed by grade II and III. Fibrosis was classified as severe, moderate, or discrete. No significant (p >0.05) difference was observed for the percentage of fibrosis between malignant and benign group neoplasms. However, difference (p=0.028) was found for fibrosis percentage between histopathological subtypes of tumors. The benign subtype of lobular hyperplasia presented differences between cystic adenoma and benign mixed tumor. The in situ malignant tubular carcinoma subtype presented differences between solid and tubulopapillary carcinoma. Conclusions: Fibrosis in canine mammary tumors can be estimated with Massons's trichrome staining.

Resumen Antecedentes: La fibrosis está presente en diversas patologías asociadas con carcinogénesis mamaria. Objetivo: Analizar si existe una correlación entre fibrosis tisular y malignidad en tumores mamarios caninos. Métodos: 83 muestras de tejido mamario fueron divididas en masas benignas (n=21) y malignas (n=62), de acuerdo con sus características histopatológicas. En estas muestras se utilizaron las coloraciones de hematoxilina-eosina y tricromo de Masson para localizar el tejido conectivo y se analizó la proporción y cuantificación de fibrosis en los mismos con un software de imagen especializado. Resultados: Las masas mamarias benignas se diagnosticaron como adenomas (quístico, complejo y tubular), tumor mixto benigno, e hiperplasia ductal y lobular; las masas malignas, como carcinomas (complejo, tumor mixto, tubular in situ, túbulopapilar y solido). Los tumores grado I fueron los más prevalentes, seguidos por los grados II y III. La fibrosis se clasifico como discreta, moderada o severa. No se observó diferencia (p>0,05) en el porcentaje de fibrosis entre neoplasias benignas y malignas. No obstante, el porcentaje de fibrosis mostro diferencias (p=0,028) entre subtipos tumorales. La hiperplasia lobular fue diferente en relación a los adenomas quísticos y tumor mixto mamario. El subtipo maligno carcinoma tubular in situ fue diferente respecto a los carcinomas complejo, mixto maligno, sólido, y tubulopapilar. Conclusiones: La fibrosis en los tumores mamarios caninos se puede estimar por la tinción con tricromo de Masson.

Resumo Antecedentes: A fibrose participa em diversas patologias e ainda possui função adicional associada à carcinogênese mamária. Objetivo: Objetivou-se avaliar a fibrose e correlacionar com a malignidade nas neoplasias mamárias em cadelas. Métodos: 83 amostras foram divididas em dois grupos baseado no diagnóstico histopatológico: neoplasias benignas (n= 21) e neoplasias malignas (n= 62). Hematoxilina e eosina e Tricômico de Masson foram usadas para vizibilização de tecido conjuntivo e avaliação de fibrose através de programa de imagens. Resultados: As neoplasias benignas foram: adenoma (cístico, complexo e tubular), tumor misto benigno, hiperplasia ductal e lobular. As malignas foram: carcinoma complexo, em tumor misto maligno, tubular in situ, tubulopapilar e sólido. O grau histopatológico prevalente foi grau I, seguido do grau II e III. A fibrose nas neoplasias mamárias malignas foi classificada como severa, moderada e discreta. Não houve diferença significativa (p>0,05) na porcentagem de fibrose entre neoplasias malignas e benignas. A estatística revelou diferença significativa (p=0,028) na porcentagem de fibrose em relação ao diagnóstico histopatológico. O subtipo benigno hiperplasia lobular apresentou diferença entre o adenoma cístico e o tumor misto benigno. O subtipo maligno carcinoma tubular in situ apresentou diferença entre carcinoma complexo, misto maligno, sólido e tubulopapilar. Conclusões: A fibrose nos tumores mamários caninos pode ser estimada através da coloração de tricrômio de Masson.

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Background: Contrast Enchantment Ultrasonography (CEUS) allows for detection of vascular flows that are difficult to detect with traditional methods. There were no reports found in the literature of the use of CEUS to evaluate the vascular pattern of the eye of brachycephalic dogs. The objective of this paper is to describe ultrasound findings observed in the eyes of healthy brachycephalic dogs subjected to CEUS.Materials, Methods & Results: Thirty adult brachycephalic dogs were subjected to physical, laboratorial, and ophthalmic examination. The eye structures were evaluated using CEUS after intravenous administration of Sonovue®. Contrast enhancement was seen in 52 eyes with a homogeneous and centrifugal filling pattern. Structures adequately enhanced consisted of the optic nerve, the retina-choroid-sclera complex (RCSC), and the ciliary body. The optic nerve was hyperenhanced and the other structures were isoenhanced. The wash-in time, peak enhancement time, and wash-out time were similar for both right and left eyes. Mean values and standard deviation were calculated for contrast wash-in time, peak enhancement time, and wash-out time in the optic nerve, RCSC, and ciliary body.Discussion: Ultrasound is an important diagnostic resource for veterinary ophthalmology and provides relevant information for the detection of pathological conditions of the eyes of animals. The contrast-enhanced ultrasound allows evaluation of tissues at the capillary level (macro and microcirculation), complementing the vascular ultrasound scan. This study brings original information on contrast-enhanced ultrasound findings for evaluation of eyes in dogs, creating novel diagnostic possibilities for the use of this imaging technique in veterinary ophthalmology.[...]

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Background: Contrast Enchantment Ultrasonography (CEUS) allows for detection of vascular flows that are difficult to detect with traditional methods. There were no reports found in the literature of the use of CEUS to evaluate the vascular pattern of the eye of brachycephalic dogs. The objective of this paper is to describe ultrasound findings observed in the eyes of healthy brachycephalic dogs subjected to CEUS.Materials, Methods & Results: Thirty adult brachycephalic dogs were subjected to physical, laboratorial, and ophthalmic examination. The eye structures were evaluated using CEUS after intravenous administration of Sonovue®. Contrast enhancement was seen in 52 eyes with a homogeneous and centrifugal filling pattern. Structures adequately enhanced consisted of the optic nerve, the retina-choroid-sclera complex (RCSC), and the ciliary body. The optic nerve was hyperenhanced and the other structures were isoenhanced. The wash-in time, peak enhancement time, and wash-out time were similar for both right and left eyes. Mean values and standard deviation were calculated for contrast wash-in time, peak enhancement time, and wash-out time in the optic nerve, RCSC, and ciliary body.Discussion: Ultrasound is an important diagnostic resource for veterinary ophthalmology and provides relevant information for the detection of pathological conditions of the eyes of animals. The contrast-enhanced ultrasound allows evaluation of tissues at the capillary level (macro and microcirculation), complementing the vascular ultrasound scan. This study brings original information on contrast-enhanced ultrasound findings for evaluation of eyes in dogs, creating novel diagnostic possibilities for the use of this imaging technique in veterinary ophthalmology.[...](AU)

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Background: Eyelid coloboma or eyelid agenesis is the most common congenital disease in cats. It can affect both the upper and the lower lids and is commonly bilateral. This congenital defect has been reported in several breeds, such as Persian and Domestic Short-Haired Cat. Generally, this defect results in inversion of the colobomatous eyelid, which can cause trichiasis and inflammatory keratitis and corneal ulceration. The only effective treatment is blepharoplasty. This paper describes the clinical and surgical aspects of four patients treated by lip commissure to eyelid transposition for the repair of eyelid coloboma using the technique described in 2010. Results of this procedure have never been reported in Brazil.Cases: Seven eyes of four cats presenting eyelid coloboma affecting up to two thirds of the eyelid were evaluated in this study. Two of the four cats were males and two were females; their average age was 3 years. All patients were admitted at the same institution, and the main issues were purulent discharge and impaired vision. Diagnosis was based on physical and ophthalmic examination. Non-ulcerative keratitis was present in all cases. Corneal ulcer was diagnosed in three patients by the fluorescein dye test. In two cats, a corneo-conjunctival dermoid was found at the temporal-dorsal region of one eye, and measured approximately 0.3 mm; and the other two [...]

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The compartmental syndrome is a condition, which leads to ischemia and necrosis of the tissues involved, causing, if not identified early severe injuries. We report here the case of a 3-year-old mongrel cat, with approximately 3.2 kg treated at a clinic in Cuiabá-MT, with complete fracture of the proximal radius and ulna in the right forelimb. The patient underwent surgery (osteosynthesis radio and ulna), 36 hours after the surgical procedure were observed signs of the syndrome as the decrease of the temperature 3 cm distal to the fracture, cyanosis, absence of pain and proprioception. Confronted with these symptoms fasciotomy was conducted in attempt to recover the blood perfusion. After 7 days of treatment, it was not possible to reverse the syndrome picture, resulting in amputation of the affected limb. So it is a serious condition, underdiagnosed that has no previous descriptions in the national literature, and when neglected leads in amputation.

A síndrome compartimental é uma afecção que leva à isquemia e necrose dos tecidos envolvidos, gerando graves lesões quando não identificada precocemente. Este trabalho relata o caso de uma gata de 3 anos de idade, sem raça definida, com aproximadamente 3,2 kg, atendida em uma clínica na cidade de Cuiabá-MT, com fratura proximal completa de rádio e ulna no membro torácico direito. O paciente foi submetido à cirurgia (osteossíntese de rádio e ulna), 36 horas após o procedimento cirúrgico foram observados sinais da síndrome como diminuição da temperatura do segmento distal 3 cm abaixo da fratura, cianose, ausência de dor e propriocepção. Diante desses sintomas foi realizado fasciotomias na tentativa de recuperar a perfusão sanguínea. Após 7 dias de tratamento, não foi possível reverter o quadro da síndrome, resultando em amputação do membro acometido. Logo, trata-se de uma afecção grave, subdiagnosticada que não apresenta descrições prévias na literatura nacional, e quando negligenciada enseja em amputação.

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RESUMO

The compartmental syndrome is a condition, which leads to ischemia and necrosis of the tissues involved, causing, if not identified early severe injuries. We report here the case of a 3-year-old mongrel cat, with approximately 3.2 kg treated at a clinic in Cuiabá-MT, with complete fracture of the proximal radius and ulna in the right forelimb. The patient underwent surgery (osteosynthesis radio and ulna), 36 hours after the surgical procedure were observed signs of the syndrome as the decrease of the temperature 3 cm distal to the fracture, cyanosis, absence of pain and proprioception. Confronted with these symptoms fasciotomy was conducted in attempt to recover the blood perfusion. After 7 days of treatment, it was not possible to reverse the syndrome picture, resulting in amputation of the affected limb. So it is a serious condition, underdiagnosed that has no previous descriptions in the national literature, and when neglected leads in amputation.(AU)

A síndrome compartimental é uma afecção que leva à isquemia e necrose dos tecidos envolvidos, gerando graves lesões quando não identificada precocemente. Este trabalho relata o caso de uma gata de 3 anos de idade, sem raça definida, com aproximadamente 3,2 kg, atendida em uma clínica na cidade de Cuiabá-MT, com fratura proximal completa de rádio e ulna no membro torácico direito. O paciente foi submetido à cirurgia (osteossíntese de rádio e ulna), 36 horas após o procedimento cirúrgico foram observados sinais da síndrome como diminuição da temperatura do segmento distal 3 cm abaixo da fratura, cianose, ausência de dor e propriocepção. Diante desses sintomas foi realizado fasciotomias na tentativa de recuperar a perfusão sanguínea. Após 7 dias de tratamento, não foi possível reverter o quadro da síndrome, resultando em amputação do membro acometido. Logo, trata-se de uma afecção grave, subdiagnosticada que não apresenta descrições prévias na literatura nacional, e quando negligenciada enseja em amputação.(AU)

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