RESUMO
Direct-acting antivirals are the gold-standard treatment for chronic HCV infections, but few studies have investigated their use on kidney and liver transplant recipients. We conducted a real-world study to evaluate the rates of sustained virological response with direct-acting antivirals in kidney and liver transplant recipients. Moreover, it also aimed to evaluate direct-acting antivirals (DAAs) interference with immunosuppressant levels and to describe the frequency of adverse events. As part of this retrospective observational cohort, we included adult patients that had undergone a kidney transplant (KT) or liver transplant (LT) at our center, had a chronic HCV infection, and were treated with DAAs from June 2016 to December 2021. A total of 165 patients were included in the analysis, divided in 108 KT and 57 LT recipients. HCV genotype 1 was more frequent in KT (58.4%), and genotype 3 was more prevalent in LT (57.9%) patients. Sustained virological response was achieved in 89.6% of patients. Adverse effects were reported by 36% of patients. There were significant interactions with immunosuppressants requiring dose adjustments. A total of three episodes of rejection were reported in KT recipients. In conclusion, DAA treatment resulted in high rates of SVR and was well tolerated in both kidney and liver transplant patients. Adverse events were frequent but not severe in most patients, with low treatment drop-out rates. Interactions with immunosuppressants need monitoring since dose adjustments may be required. Reporting real-life experiences is important to help build evidence for patient management in non-controlled environments.
Assuntos
Hepatite C Crônica , Hepatite C , Transplante de Fígado , Adulto , Humanos , Antivirais/efeitos adversos , Hepacivirus/genética , Estudos Retrospectivos , Brasil , Hepatite C Crônica/tratamento farmacológico , Imunossupressores/efeitos adversos , Rim , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the effect of tibial compression on radiographic cranial tibial translation measurements in healthy dogs and those with cranial cruciate ligament (CCL) rupture and establish specific criteria for the radiographic diagnosis of CCL rupture. ANIMALS: 60 dogs. PROCEDURES: Dogs were divided into 3 groups with 20 dogs each: group 1, healthy adult dogs; group 2, adult dogs with CCL rupture; and group 3, healthy young dogs. For each dog, 2 images of the stifle joint in mediolateral projection were taken, of which 1 was conventional and 1 was under tibial compression. Variables were measured in each radiographic projection: the patellar ligament angle, the patellar ligament insertion angle, the angle of tibial translation measured by 2 different methods, and the linear distance between the points of CCL origin and insertion (DPOI). Additionally, a novel variable, DPOI ratio, was evaluated. RESULTS: Regarding radiographic positioning, tibial compression significantly changed most of the variables in the within-group comparison. The variable DPOI were not different with and without tibial compression in the group of healthy adult dogs but were different for dogs with CCL rupture. Thus, these are important parameters in the diagnosis of CCL rupture. In the analysis of a novel variable, DPOI ratio, dogs with CCL rupture could be distinguished from healthy dogs at a high level of specificity and sensitivity. CLINICAL RELEVANCE: DPOI ratio values above 1.18 were consistently indicative of CCL rupture, thus allowing for a precise radiographic diagnosis of the condition.
Assuntos
Lesões do Ligamento Cruzado Anterior , Doenças do Cão , Cães , Animais , Ligamento Cruzado Anterior/diagnóstico por imagem , Ruptura/diagnóstico por imagem , Ruptura/veterinária , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/veterinária , Tíbia/diagnóstico por imagem , Radiografia , Joelho de Quadrúpedes/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagemRESUMO
ABSTRACT Direct-acting antivirals are the gold-standard treatment for chronic HCV infections, but few studies have investigated their use on kidney and liver transplant recipients. We conducted a real-world study to evaluate the rates of sustained virological response with direct-acting antivirals in kidney and liver transplant recipients. Moreover, it also aimed to evaluate direct-acting antivirals (DAAs) interference with immunosuppressant levels and to describe the frequency of adverse events. As part of this retrospective observational cohort, we included adult patients that had undergone a kidney transplant (KT) or liver transplant (LT) at our center, had a chronic HCV infection, and were treated with DAAs from June 2016 to December 2021. A total of 165 patients were included in the analysis, divided in 108 KT and 57 LT recipients. HCV genotype 1 was more frequent in KT (58.4%), and genotype 3 was more prevalent in LT (57.9%) patients. Sustained virological response was achieved in 89.6% of patients. Adverse effects were reported by 36% of patients. There were significant interactions with immunosuppressants requiring dose adjustments. A total of three episodes of rejection were reported in KT recipients. In conclusion, DAA treatment resulted in high rates of SVR and was well tolerated in both kidney and liver transplant patients. Adverse events were frequent but not severe in most patients, with low treatment drop-out rates. Interactions with immunosuppressants need monitoring since dose adjustments may be required. Reporting real-life experiences is important to help build evidence for patient management in non-controlled environments.
RESUMO
Background: Radius curvus is a clinical manifestation of the premature closure of the distal ulnar physis and the mostcommon physeal disease in dogs, representing 63% of all physeal injuries. There are few reports indicating the techniqueof stapling for treatment of radius curvus in squeletically immature dogs. The aim of this study is to report a case of radiuscurvus in a young dog successfully treated with a combination of 3 surgical tecniques: 1- Stapling the medial and cranialportions of the distal radial physis; 2- Oblique osteotomy of the proximal ulna and ostectomy of the distal ulna, and 3-Dynamic external skeletal fixation in the elbow joint.Case: A 5-month-old female dog was referred to the University Veterinary Hospital with a history of left thoracic limb deformity for 2 months. There was a history of possible traumatic event on the front limb, in addition to providing nutritionalsupplements daily. In the radiographic evaluation the changes were identified in the left thoracic limb: shortening of theulna, procurvatum and medial angulation of the distal radius, increased joint space and articular incongruity of the elbowjoint. The dog was subjected to surgical treatment by the combination of three main surgical techniques. For the staplingof the distal radial physis the surgical approach on the cranial-medial surface of the distal radius was made. Two surgicalstaples were positioned in the distal radial physis. Thereafter a caudal approach was made to the distal region of the ulnardiaphysis for the distal ostectomy of the ulna. A bone segment of 1 cm in length of the distal ulnar diaphysis was removed.Another caudal approach was made to the proximal region of the ulnar diaphysis and a proximal oblique osteotomy of theulna was performed. For the dynamic external skeletal fixation in the elbow joint two Steinmann pins were inserted. Thefirst pin was proximal to the supracondilar...(AU)
Assuntos
Animais , Feminino , Cães , Cães/anormalidades , Rádio (Anatomia)/anormalidades , Osteotomia/veterinária , Ulna , Grampeamento Cirúrgico/veterinária , Fixadores Externos/veterinária , Ortopedia/veterináriaRESUMO
Background: Radius curvus is a clinical manifestation of the premature closure of the distal ulnar physis and the mostcommon physeal disease in dogs, representing 63% of all physeal injuries. There are few reports indicating the techniqueof stapling for treatment of radius curvus in squeletically immature dogs. The aim of this study is to report a case of radiuscurvus in a young dog successfully treated with a combination of 3 surgical tecniques: 1- Stapling the medial and cranialportions of the distal radial physis; 2- Oblique osteotomy of the proximal ulna and ostectomy of the distal ulna, and 3-Dynamic external skeletal fixation in the elbow joint.Case: A 5-month-old female dog was referred to the University Veterinary Hospital with a history of left thoracic limb deformity for 2 months. There was a history of possible traumatic event on the front limb, in addition to providing nutritionalsupplements daily. In the radiographic evaluation the changes were identified in the left thoracic limb: shortening of theulna, procurvatum and medial angulation of the distal radius, increased joint space and articular incongruity of the elbowjoint. The dog was subjected to surgical treatment by the combination of three main surgical techniques. For the staplingof the distal radial physis the surgical approach on the cranial-medial surface of the distal radius was made. Two surgicalstaples were positioned in the distal radial physis. Thereafter a caudal approach was made to the distal region of the ulnardiaphysis for the distal ostectomy of the ulna. A bone segment of 1 cm in length of the distal ulnar diaphysis was removed.Another caudal approach was made to the proximal region of the ulnar diaphysis and a proximal oblique osteotomy of theulna was performed. For the dynamic external skeletal fixation in the elbow joint two Steinmann pins were inserted. Thefirst pin was proximal to the supracondilar...
Assuntos
Feminino , Animais , Cães , Cães/anormalidades , Osteotomia/veterinária , Rádio (Anatomia)/anormalidades , Fixadores Externos/veterinária , Grampeamento Cirúrgico/veterinária , Ortopedia/veterinária , UlnaRESUMO
Background: Hip dysplasia (HD) is the most common non-traumatic orthopedic disease in large breed dogs. Treatment is chosen according to the severity of the condition, the age of the dog and the involvement of osteoarthritis (OA). For puppies up to 20-weeks-old, surgical treatment by the juvenile pubic symphysiodesis (JPS) technique can be performed. This procedure promotes the ventrolateral rotation of the acetabulum over the femoral head, which improves hip joint congruence and stability. The objective of this study is to report the case of a young dog with HD treated with JPS and pectineus myectomy. Clinical and radiographic outcomes were assessed for up to one year after surgery. Case: A 17-week-old Saint Bernard puppy was attended at the University Veterinary Hospital showing abnormal weight bearing and lameness in pelvic limbs, without history of previous trauma. On orthopedic examination, there was a marked hypotrophy of the pelvic limb muscles, severe pain and laxity in the hip joints, and positive feature in the Ortolani test. The hip joint subluxation angle (SA) and reduction angle (RA) were measured. A radiographic study was carried out to evaluate the hip joints and measure the Norberg angle (NA), distraction index (DI), acetabular angle (AA) and dorsal acetabular rim angle (DARA). The 20-week-old dog underwent surgical treatment by JPS technique. A ventral surgical approach to the pubis was performed and the pubic symphysis was cauterized with electrocautery. Partial pectineus myectomy technique was also performed. Drug therapy and restriction of physical activities were indicated in the early postoperative. The dog was evaluated by clinical and radiographic examinations at 4 months and 1 year after the surgical procedure. In the reassessment after 4 months of surgical treatment, the patient showed improvement in clinical signs, with mild lameness and absence of painful sensitivity in the movement of the hip joints. Radiographically, hip joint incongruity was observed, but with progressive improvement in the values of the measured variables. In the clinical examination 1 year after the procedure, the dog showed satisfactory weight bearing with slight lameness in pelvic limbs in the running gait. There was improvement in the thigh muscles and no painful signs were observed in the hip joints, but a positive result was detected in the Ortolani test. In the radiographic examination, bilateral articular incongruity was still observed, however, there was a mild improvement in the coverage of the acetabulum over the femoral head. The measured angles and indices showed favorable results regarding the recovery of hip joint stability and proper development. Discussion: Studies evaluating the JPS technique for the treatment of HD have shown to be a relatively simple and effective procedure, which allows altering the acetabular coverage, reducing the development of HD and the progression of OA. The need for an early diagnosis of this condition is essential, so that the JPS technique can be used in young dogs and offer effective results. In the present report, in the late postoperative period, the dog showed improvement in clinical signs, with favorable weight bearing and ambulation in pelvic limbs, recovery of limb muscles, absence of pain in the hip joints and decrease in RA and SA. Radiographically, the reduction in joint subluxation, improvement in acetabular coverage over femoral heads, increase in NA and AA, reduction in DI and DARA are evidence of the favorable outcome of ventrolateral rotation of the acetabulum after surgical treatment. The surgical technique used was effective, which enabled the dog to recover the functional use of the pelvic limbs and improve the quality of life.
Assuntos
Animais , Cães , Sínfise Pubiana/cirurgia , Osteoartrite do Quadril/veterinária , Displasia Pélvica Canina/cirurgia , Mioma/cirurgia , Procedimentos Cirúrgicos Operatórios/veterináriaRESUMO
Abstract Introduction: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing cardiac surgery and 2.3% requires renal replacement therapy (RRT). The current diagnostic criteria for AKI by increased serum creatinine levels have limitations and new biomarkers are being tested. Urine sediment may be considered a biomarker and it can help to differentiate pre-renal (functional) from renal (intrinsic) AKI. Aims: To investigate the microscopic urinalysis in the AKI diagnosis in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24 h after the surgery. We looked for renal tubular epithelial cells (RTEC) and granular casts (GC) and associated the results with AKI development as defined by KDIGO criteria. Results: Twenty three patients (20.17 %) developed AKI according to the serum creatinine criterion and 76 (66.67 %) by the urine output criterion. Four patients required RRT. Mortality was 3.51 %. The use of urine creatinine criterion to predict AKI showed a sensitivity of 34.78 % and specificity of 86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of 0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI: 0.465-0.680). Conclusion: RTEC and GC in urine sample detected by microscopy is a highly specific biomarker for early AKI diagnosis after cardiac surgery.
Resumo Introdução: Lesão renal aguda (LRA) ocorre em cerca de 22% dos pacientes submetidos a cirurgia cardíaca e 2,3% necessitam de terapia renal substitutiva (TRS). Os atuais critérios diagnósticos para LRA fundamentados no aumento dos níveis de creatinina sérica apresentam limitações e novos biomarcadores estão sendo testados. O sedimento urinário é um biomarcador que pode ajudar a diferenciar a LRA pré-renal (funcional) da LRA renal (intrínseca). Objetivos: Investigar a urinálise microscópica no diagnóstico de LRA em pacientes submetidos a cirurgia cardíaca com circulação extracorpórea. Métodos: Um total de 114 pacientes com idade média de 62,3 anos, 67,5% do sexo masculino e níveis médios de creatinina de 0,91 mg/dL (DP 0,22) tiveram amostras de urina examinadas nas primeiras 24 horas após a cirurgia. A identificação de células epiteliais tubulares renais (CETR) e cilindros granulares (CG) foi associada a desfechos de desenvolvimento de LRA conforme os critérios do KDIGO. Resultados: Vinte e três pacientes (20,17%) desenvolveram LRA pelo critério de creatinina sérica e 76 (66,67%) pelo critério de diurese. Quatro pacientes necessitaram de TRS. A mortalidade foi de 3,51%. O uso da creatinina urinária como critério preditivo para LRA mostrou sensibilidade de 34,78% e especificidade de 86,81%; razão de verossimilhança positiva de 2,64 e razão de verossimilhança negativa de 0,75; e ASC-COR de 0,584 (IC 95%: 0,445-0,723). Para o critério de diurese, a sensibilidade foi de 23,68% e a especificidade 92,11%; a ASC-COR foi 0,573 (IC 95%: 0,465-0,680). Conclusão: A identificação de CETR e CG em amostras de urina por microscopia representa um biomarcador altamente específico para o diagnóstico precoce de LRA após cirurgia cardíaca.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ponte Cardiopulmonar/efeitos adversos , Células Epiteliais/patologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Túbulos Renais/patologia , Portugal/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/urina , Biomarcadores/urina , Estudos Prospectivos , Microscopia de Contraste de Fase/métodos , Creatinina/urina , Creatinina/sangue , Diagnóstico Precoce , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodosRESUMO
Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb. Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley
Assuntos
Animais , Cães , Ferimentos e Lesões/veterinária , Luxações Articulares/veterinária , Ossos Pélvicos/lesões , Tíbia/anormalidades , Osteotomia/veterináriaRESUMO
Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb. Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley (AU)
Assuntos
Animais , Cães , Tíbia/anormalidades , Ferimentos e Lesões/veterinária , Luxações Articulares/veterinária , Ossos Pélvicos/lesões , Osteotomia/veterináriaRESUMO
INTRODUCTION: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing cardiac surgery and 2.3% requires renal replacement therapy (RRT). The current diagnostic criteria for AKI by increased serum creatinine levels have limitations and new biomarkers are being tested. Urine sediment may be considered a biomarker and it can help to differentiate pre-renal (functional) from renal (intrinsic) AKI. AIMS: To investigate the microscopic urinalysis in the AKI diagnosis in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24 h after the surgery. We looked for renal tubular epithelial cells (RTEC) and granular casts (GC) and associated the results with AKI development as defined by KDIGO criteria. RESULTS: Twenty three patients (20.17 %) developed AKI according to the serum creatinine criterion and 76 (66.67 %) by the urine output criterion. Four patients required RRT. Mortality was 3.51 %. The use of urine creatinine criterion to predict AKI showed a sensitivity of 34.78 % and specificity of 86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of 0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI: 0.465-0.680). CONCLUSION: RTEC and GC in urine sample detected by microscopy is a highly specific biomarker for early AKI diagnosis after cardiac surgery.
Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Células Epiteliais/patologia , Túbulos Renais/patologia , Complicações Pós-Operatórias/urina , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Idoso , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/métodos , Creatinina/sangue , Creatinina/urina , Diagnóstico Precoce , Feminino , Humanos , Testes de Função Renal , Masculino , Microscopia de Contraste de Fase/métodos , Pessoa de Meia-Idade , Portugal/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Estudos ProspectivosRESUMO
Background: Shearing wounds on the limbs of dogs usually affect the regions distally from the radiocarpal joint at thethoracic limb and from the tibiotarsal joint at the pelvic limb. The tissue coverage and re-epithelialization of the injuredregion are important factors that should be considered in the definitive surgical treatment. The hydrocolloid membranepromotes selective autolytic debridement and accelerates the formation of granulation tissue and epithelialization. Thepresent study aims to describe the treatment with hydrocolloid membrane dressing of three cases of shearing wounds withconcomitant orthopedic injuries in the pelvic limbs of dogs.Case: Three dogs with pelvic limb injuries after vehicular trauma were selected for treatment. Two patients had shearinglesions on the medial aspect of the pelvic limb with exposure of the tibia and fibula, the talus and the tibiotarsal joint,associated with bone loss on the medial surface of the limb and rupture of the medial collateral ligament of the tarsus.Another patient had a shearing wound on the dorsal surface of the distal region of the pelvic limb, with injury of the digitalextensor tendons and bone exposure of the second and third metatarsals. Initially, the surgical debridement of the lesionwas performed and during the first five days after trauma the wound was cleansed with chlorhexidine solution and topicalapplication of crystallized sugar daily. In this initial period a dry adherent dressing was used on the lesions, without bandagesfor immobilization of the pelvic limb. In all dogs, the hydrocolloid membrane was applied from the sixth day after initialwound management. Immediately after the application of the hydrocolloid membrane, temporary immobilization of theaffected pelvic limb with a padded Robert Jones bandage was performed. The first changes of the hydrocolloid membraneswere performed after five days of their use. Subsequently, the membranes changes...(AU)
Assuntos
Animais , Cães , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/veterinária , Curativos Hidrocoloides/veterinária , Pelve/lesões , Pelve/cirurgia , Cicatrização , Ligamento Colateral UlnarRESUMO
Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...(AU)
Assuntos
Animais , Cães , Osteotomia/veterinária , Tíbia/cirurgia , Luxação Patelar/cirurgia , Luxação Patelar/veterinária , Articulação do Joelho , Ligamentos Articulares/lesõesRESUMO
Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...
Assuntos
Animais , Cães , Articulação do Joelho , Luxação Patelar/cirurgia , Luxação Patelar/veterinária , Osteotomia/veterinária , Tíbia/cirurgia , Ligamentos Articulares/lesõesRESUMO
Background: Shearing wounds on the limbs of dogs usually affect the regions distally from the radiocarpal joint at thethoracic limb and from the tibiotarsal joint at the pelvic limb. The tissue coverage and re-epithelialization of the injuredregion are important factors that should be considered in the definitive surgical treatment. The hydrocolloid membranepromotes selective autolytic debridement and accelerates the formation of granulation tissue and epithelialization. Thepresent study aims to describe the treatment with hydrocolloid membrane dressing of three cases of shearing wounds withconcomitant orthopedic injuries in the pelvic limbs of dogs.Case: Three dogs with pelvic limb injuries after vehicular trauma were selected for treatment. Two patients had shearinglesions on the medial aspect of the pelvic limb with exposure of the tibia and fibula, the talus and the tibiotarsal joint,associated with bone loss on the medial surface of the limb and rupture of the medial collateral ligament of the tarsus.Another patient had a shearing wound on the dorsal surface of the distal region of the pelvic limb, with injury of the digitalextensor tendons and bone exposure of the second and third metatarsals. Initially, the surgical debridement of the lesionwas performed and during the first five days after trauma the wound was cleansed with chlorhexidine solution and topicalapplication of crystallized sugar daily. In this initial period a dry adherent dressing was used on the lesions, without bandagesfor immobilization of the pelvic limb. In all dogs, the hydrocolloid membrane was applied from the sixth day after initialwound management. Immediately after the application of the hydrocolloid membrane, temporary immobilization of theaffected pelvic limb with a padded Robert Jones bandage was performed. The first changes of the hydrocolloid membraneswere performed after five days of their use. Subsequently, the membranes changes...
Assuntos
Animais , Cães , Cicatrização , Curativos Hidrocoloides/veterinária , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/veterinária , Pelve/cirurgia , Pelve/lesões , Ligamento Colateral UlnarRESUMO
ABSTRACT Introduction: Currently, there is no specific immunosuppressive protocol for hepatitis C (HCV)-positive renal transplants recipients. Thus, the aim of this study was to evaluate the conversion effect to everolimus (EVR) on HCV in adult kidney recipients. Method: This is an exploratory single-center, prospective, randomized, open label controlled trial with renal allograft recipients with HCV-positive serology. Participants were randomized for conversion to EVR or maintenance of calcineurin inhibitors. Results: Thirty patients were randomized and 28 were followed-up for 12 months (conversion group, Group 1 =15 and control group, Group 2 =13). RT-PCR HCV levels reported in log values were comparable in both groups and among patients in the same group. The statistical analysis showed no interaction effect between time and group (p value G*M= 0.852), overtime intra-groups (p-value M=0.889) and between group (p-value G=0.286). Group 1 showed a higher incidence of dyslipidemia (p=0.03) and proteinuria events (p=0.01), while no difference was observed in the incidence of anemia (p=0.17), new onset of post-transplant diabetes mellitus (p=1.00) or urinary tract infection (p=0.60). The mean eGFR was similar in both groups. Conclusion: Our study did not show viral load decrease after conversion to EVR with maintenance of antiproliferative therapy.
RESUMO Introdução: Atualmente não há um protocolo imunossupressor específico para os receptores de transplantes renais portadores de hepatite C (HCV). Assim, o objetivo deste estudo foi avaliar o efeito da conversão a Everolimo (EVR) na HCV em receptores adultos de transplantes renais. Método: Trata-se de um estudo unicêntrico, prospectivo, randomizado, exploratório, controlado, aberto em receptores de aloenxertos renais com sorologia positiva para HCV. Os participantes foram randomizados para conversão a EVR ou manutenção dos inibidores da calcineurina. Resultados: Trinta pacientes foram randomizados e 28 foram acompanhados por um período de 12 meses (grupo de conversão, Grupo 1 = 15 e grupo controle, Grupo 2 =13). Níveis de RT-PCR HCV descritos em valores logarítmicos foram comparáveis entre os grupos e entre pacientes em um mesmo grupo. A análise estatística não mostrou efeitos de interação entre tempo e grupo (valor p G*M= 0,852), ao longo do tempo em cada grupo (valor p M=0,889) e entre grupos (valor p G=0,286). O Grupo 1 apresentou uma maior incidência de eventos de dislipidemia (p=0,03) e proteinúria (p=0,01); não houve diferença na incidência de anemia (p=0,17), diabetes mellitus de início pós-transplante (p=1,00) ou infecção do trato urinário (p=0,60). A TFGe média foi semelhante nos dois grupos. Conclusão: Nosso estudo não mostrou redução da carga viral após conversão a EVR com manutenção do tratamento antiproliferativo.
Assuntos
Humanos , Masculino , Feminino , Adulto , Complicações Pós-Operatórias/tratamento farmacológico , Transplante de Rim , Hepatite C Crônica/tratamento farmacológico , Inibidores de Calcineurina/uso terapêutico , Everolimo/uso terapêutico , Imunossupressores/uso terapêutico , Complicações Pós-Operatórias/virologia , Viremia/tratamento farmacológico , Estudos ProspectivosRESUMO
INTRODUCTION: Currently, there is no specific immunosuppressive protocol for hepatitis C (HCV)-positive renal transplants recipients. Thus, the aim of this study was to evaluate the conversion effect to everolimus (EVR) on HCV in adult kidney recipients. METHOD: This is an exploratory single-center, prospective, randomized, open label controlled trial with renal allograft recipients with HCV-positive serology. Participants were randomized for conversion to EVR or maintenance of calcineurin inhibitors. RESULTS: Thirty patients were randomized and 28 were followed-up for 12 months (conversion group, Group 1 =15 and control group, Group 2 =13). RT-PCR HCV levels reported in log values were comparable in both groups and among patients in the same group. The statistical analysis showed no interaction effect between time and group (p value G*M= 0.852), overtime intra-groups (p-value M=0.889) and between group (p-value G=0.286). Group 1 showed a higher incidence of dyslipidemia (p=0.03) and proteinuria events (p=0.01), while no difference was observed in the incidence of anemia (p=0.17), new onset of post-transplant diabetes mellitus (p=1.00) or urinary tract infection (p=0.60). The mean eGFR was similar in both groups. CONCLUSION: Our study did not show viral load decrease after conversion to EVR with maintenance of antiproliferative therapy.
Assuntos
Inibidores de Calcineurina/uso terapêutico , Everolimo/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Imunossupressores/uso terapêutico , Transplante de Rim , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/virologia , Viremia/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Traumatic injuries to the spine and spinal cord occur frequently in veterinary medicine, and motor vehicle trampling is one of the most prevalent causes among dogs. In cases of locomotory disorders, veterinary physiotherapy can be used in conjunction with clinical and surgical treatments. Its main objective is restoring, maintaining and promoting the improvement of the animals physical function and aptitude, welfare, and quality of life, facilitating its fast and even complete recovery. This article is a case report of the physiotherapeutic treatment applied to a dog that presented several complications in pelvic limbs due to spine and spinal cord trauma. It also emphasizes the benefits on rehabilitation associated with clinical and surgical treatments.
Lesões traumáticas em coluna vertebral e medula espinhal ocorrem frequentemente na Medicina Veterinária, e o atropelamento por veículos automotivos é uma das causas mais prevalentes entre os cães. A fisioterapia veterinária, quando relacionada aos distúrbios locomotores e usada em conjunto com os tratamentos clínico e cirúrgico, tem o objetivo de restaurar, manter e promover a melhora da função e aptidão física, o bem-estar e a qualidade de vida do animal, facilitando sua rápida, e até completa, recuperação. Este trabalho relata os resultados do tratamento fisioterápico efetuado em um cão que apresentou diversas complicações em membros pélvicos, decorrentes de traumas na coluna vertebral e na medula espinhal, e destaca os benefícios da associação entre reabilitação e os tratamentos clínico e cirúrgico.
Assuntos
Animais , Cães , Cães/anormalidades , Modalidades de Fisioterapia/veterinária , Traumatismos do Sistema Nervoso/diagnóstico , Traumatismos do Sistema Nervoso/veterinária , ArtrodeseRESUMO
Traumatic injuries to the spine and spinal cord occur frequently in veterinary medicine, and motor vehicle trampling is one of the most prevalent causes among dogs. In cases of locomotory disorders, veterinary physiotherapy can be used in conjunction with clinical and surgical treatments. Its main objective is restoring, maintaining and promoting the improvement of the animals physical function and aptitude, welfare, and quality of life, facilitating its fast and even complete recovery. This article is a case report of the physiotherapeutic treatment applied to a dog that presented several complications in pelvic limbs due to spine and spinal cord trauma. It also emphasizes the benefits on rehabilitation associated with clinical and surgical treatments.(AU)
Lesões traumáticas em coluna vertebral e medula espinhal ocorrem frequentemente na Medicina Veterinária, e o atropelamento por veículos automotivos é uma das causas mais prevalentes entre os cães. A fisioterapia veterinária, quando relacionada aos distúrbios locomotores e usada em conjunto com os tratamentos clínico e cirúrgico, tem o objetivo de restaurar, manter e promover a melhora da função e aptidão física, o bem-estar e a qualidade de vida do animal, facilitando sua rápida, e até completa, recuperação. Este trabalho relata os resultados do tratamento fisioterápico efetuado em um cão que apresentou diversas complicações em membros pélvicos, decorrentes de traumas na coluna vertebral e na medula espinhal, e destaca os benefícios da associação entre reabilitação e os tratamentos clínico e cirúrgico.(AU)
Assuntos
Animais , Cães , Cães/anormalidades , Modalidades de Fisioterapia/veterinária , Traumatismos do Sistema Nervoso/diagnóstico , Traumatismos do Sistema Nervoso/veterinária , ArtrodeseRESUMO
ABSTRACT Mesiodens are supernumerary teeth, commonly seen in the maxillary midline. Given their high frequency, dentist should be aware of the signs and symptoms of mesiodens and their appropriate treatment. This case report describes an 8-year-old girl with a radiographic image suggesting two unerupted mesiodens between the central incisors on the palate. The intraoral examination showed swelling in the anterior palatal region with no mucosa alteration. The supernumerary teeth were diagnosed by periapical radiograph and computed tomography. The objective of this study is to present the clinical importance and use of diagnostic images, such as periapical radiograph (Clark technique) or tomography.
RESUMEN. Un mesiodens es un diente supernumerario que comúnmente se presenta en la línea media maxilar. Dada la frecuencia con la que se presenta, el odontólogo general debe estar bien informado acerca de los signos y síntomas del mesiodens y del tratamiento adecuado. Este artículo relata el caso de una paciente de 8 años de edad, en cuyo examen radiográfico se observa una imagen sugestiva de dos mesiodens no erupcionados entre los incisivos centrales superiores. En la valoración intraoral se encontró una inflamación en la región palatina anterior, sin ninguna alteración en la mucosa. Los dientes supernumerarios se diagnostican mediante radiografía y tomografía computarizada. El objetivo de este trabajo es presentar la importancia clínica observada y la utilización de imágenes auxiliares para el diagnóstico, como la radiografía periapical (técnica de Clark) o la tomografía computarizada.
Assuntos
Anormalidades Dentárias , Cirurgia Bucal , Dente Supranumerário , MaxilaRESUMO
The objective of this case report was to describe the oral rehabilitation of a five-year-old boy patient diagnosed with amelogenesis imperfecta (AI) in the primary dentition. AI is a group of hereditary disorders that affects the enamel structure. The patient was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of AI. The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms. The main objectives of the selected treatment were to enhance the esthetics, restore masticatory function, and eliminate the teeth sensitivity. The child was monitored in the pediatric dentistry clinic at four-month intervals until the mixed dentition stage. Treatment not only restored function and esthetic, but also showed a positive psychological impact and thereby improved perceived quality of life. The preventive, psychological, and curative measures of a young child with AI were successful. This result can encourage the clinicians to seek a cost-effective technique such as stainless steel crowns, and resin-filled celluloid forms to reestablish the oral functions and improve the child's psychosocial development.