RESUMO

El síndrome edematoso generalizado o anasarca está presente secundario a un desequilibrio de la homeostasis hídrica, electrolítica y osmolar del organismo, En el adulto el estado de anasarca es más frecuente secundario a insuficiencia cardiaca, en pediatría, el edema que se generaliza está asociado con más frecuencia a bajo aporte proteico, baja síntesis de proteínas o debido a perdida de proteínas de origen gastrointestinal o renal. La disminución de la presión oncótica plasmática genera fuga de líquidos a compartimientos intersticiales de forma generalizada y produce edema. Existen múltiples patologías y mecanismos para la producción del edema generalizado; el conocimiento de la fisiopatología de su desarrollo permite un análisis clínico, de laboratorio y de gabinete que orientan al diagnostico. La infección por citomegalovirus es una causa poco frecuente de edema generalizado, reconocer esta entidad y llegar a un adecuado diagnóstico diferencial es el objetivo de esta revisión.

The generalized edematous syndrome or anasarca is present secondary to an imbalance in the body's water, electrolyte and osmolar homeostasis. In adults, the state of anasarca is more frequent secondary to heart failure; in pediatrics, generalized edema is associated with more frequency due to low protein intake, low protein synthesis or due to protein loss of gastrointestinal or renal origin. The decrease in plasma oncotic pressure generates generalized fluid leakage into interstitial compartments and produces edema. There are multiple pathologies and mechanisms for the production of generalized edema; knowledge of the pathophysiology of its development allows a clinical, laboratory and office analysis that guides the diagnosis. Cytomegalovirus infection is a rare cause of generalized edema; recognizing this entity and reaching an appropriate differential diagnosis is the objective of this review.

RESUMO

A hidropsia fetal é uma anomalia congênita, caracterizada pelo acúmulo excessivo de fluidos no espaço extravascular do feto, sendo denominada anasarca, quando o excesso de fluidos ocorre de forma generalizada, causando edema no tecido subcutâneo. Dessa forma, o aumento exagerado no tamanho do feto é esperado, podendo resultar em uma distocia obstrutiva, durante o parto. Os cães da raça Buldogue são mais susceptíveis a essa enfermidade, devido às características braquicefálicas; portanto, deve-se redobrar os cuidados durante a gestação, como utilizar a ultrassonografia para avaliar periodicamente os fetos, com o objetivo de preservar a saúde, tanto da gestante, quanto dos fetos. Vale evidenciar que, geralmente, essa enfermidade possui prognóstico de reservado a grave. Este presente trabalho relata o parto de uma cadela de 3 anos de idade, da raça Buldogue Inglês, que deu entrada em uma clínica veterinária, na cidade de Ourinhos/SP, com aproximadamente 62 dias de gestação, fruto de inseminação artificial, estando em trabalho de parto há aproximadamente 5 horas. A partir da realização dos exames físico e ultrassonográfico, foi observado que dois dos seis fetos apresentavam edema generalizado, estavam sem reflexos e com batimentos cardíacos diminuídos e abafados. A paciente foi submetida a cesariana de emergência. Os filhotes hidrópicos vieram a óbito, após tentativa de tratamento. Diante do exposto, conclui-se que a utilização da ultrassonografia deve ser priorizada, não apenas para diagnóstico, mas para acompanhamento da evolução da gestação e dos fetos, permitindo a visibilização de possíveis fetos hidrópicos e o agendamento da cesariana, procedimento cirúrgico mais indicado na presença dessa anomalia fetal.

Fetal hydrops is a congenital anomaly characterized by excessive accumulation of fluids in the extravascular space of the fetus, being called anasarca when excess fluid occurs in a generalized way, causing edema in the subcutaneous tissue. Thus, an exaggerated increase in the size of the fetus is expected, which may result in obstructive dystocia during birth. Bulldog dogs are more susceptible to this disease due to their brachycephalic characteristics; therefore, care should be redoubled during pregnancy, such as using ultrasound to periodically evaluate the fetuses to preserve the health of both pregnant and fetuses. It is worth noting that this disease usually has a reserved to severe prognosis. This present work reports the birth of a 3-year-old female English Bulldog that was admitted at a veterinary clinic in the city of Ourinhos/SP, with approximately 62 days of gestation, as a result of artificial insemination, being in labor for approximately 5 hours. From the physical and ultrasound examinations, it was observed that two of the six fetuses had generalized edema, had no reflexes, and presented reduced and muffled heartbeats. The patient underwent an emergency cesarean section. The hydropic puppies s died after an attempted treatment. Thus, it is concluded that the use of ultrasound should be prioritized not only for diagnosis, but for monitoring pregnancy evolution and fetuses, allowing the visualization of possible hydropic fetuses and scheduling of the cesarean section, which is the most indicated surgical procedure in the presence of this fetal anomaly.

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RESUMO

The popularity of brachycephalic dogs has increased in recent years due to their docile temperament and peculiar features. The historical inbreeding and consequent lack of genetic diversity involved in the development of these breeds led to an increase in the manifestation of deleterious genes that may lead to malformations. In addition, there are serious health issues intrinsic to the conformation, mainly attributed to these extreme characteristics. Therefore, this retrospective study aimed to observe the frequency of malformations in brachycephalic dogs compared to the pure and mixed breeds (MB). The medical records of pregnant bitches admitted at the Service of Obstetrics and Animal Reproduction (SORA) from January 2017 to December 2021 were retrieved from the hospital's computer system and analyzed one by one. Seven hundred sixty-eight neonates born from 168 litters were included in this study. Of these litters, 72.6% (122/168) were brachycephalic. Malformations were found in 52 puppies, with an incidence of 6.77% (52/768). Of the 32 litters that produced malformed puppies, 28 were brachycephalic (87.5%). In total, 23 types of malformations were registered, the most common being cleft palate (1.30%) and anasarca (1.17%). Ten of the puppies (10/52; 19.23%) presented two or more associated malformations. Bitches above 7 years were more prone to present malformed puppies in their litters. Brachycephalic breeds were 3.03 times more likely to present malformed neonates when compared to other breeds; the odds ratio increased to 5.07 when modern brachycephalic was compared to ancestral brachycephalic. Regarding the mode of delivery, elective cesarean sections accounted for 66.6% of births while 19.64% were eutocic vaginal deliveries, and 13.69% were dystocic. The presence of malformed puppies in a litter causes suffering for the owner, the bitch and for the puppy itself, therefore, the veterinarian plays a key role in this scenario. Knowledge about congenital abnormalities, their causes, diagnosis, and approach is essential to reduce the incidence of malformations and improve the quality of life of these animals.

RESUMO

The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values ​​for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.

RESUMO

The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values ​​for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.(AU)

Assuntos

RESUMO

Abstract The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values ​​for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.

RESUMO

Resumen La enfermedad de Ménétrier es una entidad clínica rara, de etiología no clara, caracterizada por hiperplasia foveolar gástrica asociada con pérdida secundaria de proteínas. En niños se presenta con edema, que puede ser generalizado, sin compromiso renal ni hepático y difiere de la forma adulta por la persistencia del edema y la remisión espontánea. En la mayoría de casos publicados, se relaciona con infecciones, usualmente por cytomegalovirus y Helicobacter pylori. Aquí se presenta el caso de un niño de 9 años, que consulta por un mes de evolución de edema y dolor abdominal. Al examen físico se documenta anasarca, y estudios de laboratorio revelaron hipoalbuminemia sin proteinuria.

Abstract Ménétrier disease is a rare disorder characterized by gastric foveolar hyperplasia associated with secondary protein loss. In children, this condition presents as an edematous syndrome without renal or hepatic impairment and differs from the adult form by the constant presence of edema and spontaneous remission. It has been related to infections in most published cases, especially to cytomegalovirus and Helicobacter pylori. Here we analyze the case of a 9 year old boy, complaining of one month of edema and abdominal pain. Physical exam revealed a patient with anasarca and laboratory results documented hypoalbumenemia without proteinuria.

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RESUMO

A hidropsia fetal é uma afecção que comumente leva à obstrução do canal do parto e à morte do feto acometido. Ela se caracteriza por um acúmulo anormal de líquido no espaço extravascular, edema subcutâneo generalizado e nas cavidades peritoneal, pleural e pericárdica. Este trabalho objetiva relatar uma hidropsia fetal canina do tipo anasarca, diagnosticada por exame ultrassonográfico, em modo bidimensional. A cadela Fox Paulistinha de 2 anos, estava em trabalho de parto há 12 horas e havia expulsado três filhotes, sendo um natimorto. À palpação foi detectado um filhote no canal do parto e solicitou-se exame ultrassonográfico para avaliação da viabilidade fetal e possível encaminhamento cirúrgico. A ultrassonografia revelou persistência de fetos: um ausente de batimentos cardíacos e obstruindo o canal do parto e outros dois em sofrimento fetal. O feto morto apresentava-se aumentado de tamanho e com edema subcutâneo ao longo de toda a extensão do tronco. Foram observados cistos cervicais bilateralmente, além de efusão pleural e abdominal. A idade gestacional por morfogênese e diâmetro biparietal foi de 68 dias e a placenta encontrava-se aumentada, medindo 0,83cm. A paciente foi submetida a cesariana de emergência. Ambos os filhotes em sofrimento foram retirados, já sem batimentos e o filhote malformado foi necropsiado. Adicionalmente, foi constatada congestão no coração, pulmões, fígado, intestino e peritônio. O filhote hidrópico não afetou a expulsão anterior dos que se posicionaram mais próximos ao canal do parto; contudo, obstruiu a passagem dos que se posicionavam cranialmente a ele, levando ao sofrimento e consequente morte fetal de dois filhotes.(AU)

Fetal hydrops is a condition that commonly leads to obstruction of the birth canal and death of the affected fetus. It is characterized by an abnormal accumulation of fluid in the extravascular space, generalized subcutaneous edema and in the peritoneal, pleural and pericardial cavities. This work aims to report a canine hydropsy of the anasarca type diagnosed by ultrasound examination, in two-dimensional mode. A 2-year-old Brazilian Terrier bitch with a labor enduring 12 hours had successfully expelled three puppies, one of them stillborn. On palpation, a fetus was detected in birth canal and an ultrasound examination was requested to assess fetal viability and possible surgical referral. Ultrasonography revealed the persistence of fetuses: one missing a heartbeat and obstructing the birth canal and two in fetal distress. The dead fetus was enlarged and had subcutaneous edema along the length of the body. Cervical cysts were observed bilaterally in the subcutaneous tissue, besides to pleural and abdominal effusion. Gestational age was 68 days based on morphogenesis and biparietal diameter. Placenta was enlarged, measuring 0.83cm. The patient underwent an emergency cesarean section. Both puppies that were in fetal suffering were removed without heartbeat and the malformed puppy was necropsied. In addition, congestion was found in the heart, lungs, liver, intestine and peritoneum. The hydropic pup did not affected the previous expulsion of those who were closer to the birth canal, however it obstructed the passage of those who positioned themselves cranially to him, leading to the suffering and consequent fetal death of two puppies.(AU)

Assuntos

RESUMO

A hidropsia fetal é uma afecção que comumente leva à obstrução do canal do parto e à morte do feto acometido. Ela se caracteriza por um acúmulo anormal de líquido no espaço extravascular, edema subcutâneo generalizado e nas cavidades peritoneal, pleural e pericárdica. Este trabalho objetiva relatar uma hidropsia fetal canina do tipo anasarca, diagnosticada por exame ultrassonográfico, em modo bidimensional. A cadela Fox Paulistinha de 2 anos, estava em trabalho de parto há 12 horas e havia expulsado três filhotes, sendo um natimorto. À palpação foi detectado um filhote no canal do parto e solicitou-se exame ultrassonográfico para avaliação da viabilidade fetal e possível encaminhamento cirúrgico. A ultrassonografia revelou persistência de fetos: um ausente de batimentos cardíacos e obstruindo o canal do parto e outros dois em sofrimento fetal. O feto morto apresentava-se aumentado de tamanho e com edema subcutâneo ao longo de toda a extensão do tronco. Foram observados cistos cervicais bilateralmente, além de efusão pleural e abdominal. A idade gestacional por morfogênese e diâmetro biparietal foi de 68 dias e a placenta encontrava-se aumentada, medindo 0,83cm. A paciente foi submetida a cesariana de emergência. Ambos os filhotes em sofrimento foram retirados, já sem batimentos e o filhote malformado foi necropsiado. Adicionalmente, foi constatada congestão no coração, pulmões, fígado, intestino e peritônio. O filhote hidrópico não afetou a expulsão anterior dos que se posicionaram mais próximos ao canal do parto; contudo, obstruiu a passagem dos que se posicionavam cranialmente a ele, levando ao sofrimento e consequente morte fetal de dois filhotes.

Fetal hydrops is a condition that commonly leads to obstruction of the birth canal and death of the affected fetus. It is characterized by an abnormal accumulation of fluid in the extravascular space, generalized subcutaneous edema and in the peritoneal, pleural and pericardial cavities. This work aims to report a canine hydropsy of the anasarca type diagnosed by ultrasound examination, in two-dimensional mode. A 2-year-old Brazilian Terrier bitch with a labor enduring 12 hours had successfully expelled three puppies, one of them stillborn. On palpation, a fetus was detected in birth canal and an ultrasound examination was requested to assess fetal viability and possible surgical referral. Ultrasonography revealed the persistence of fetuses: one missing a heartbeat and obstructing the birth canal and two in fetal distress. The dead fetus was enlarged and had subcutaneous edema along the length of the body. Cervical cysts were observed bilaterally in the subcutaneous tissue, besides to pleural and abdominal effusion. Gestational age was 68 days based on morphogenesis and biparietal diameter. Placenta was enlarged, measuring 0.83cm. The patient underwent an emergency cesarean section. Both puppies that were in fetal suffering were removed without heartbeat and the malformed puppy was necropsied. In addition, congestion was found in the heart, lungs, liver, intestine and peritoneum. The hydropic pup did not affected the previous expulsion of those who were closer to the birth canal, however it obstructed the passage of those who positioned themselves cranially to him, leading to the suffering and consequent fetal death of two puppies.

Assuntos

RESUMO

A hidropisia fetal é uma doença caracterizada pelo acúmulo anormal de liquido extravascular nos tecidos ou nas cavidades docorpo. Em humanos o diagnóstico é realizado durante o exame ultrassonográfico no pré-natal. Este estudo tem como objetivo reportar o diagnóstico intrauterino de hidropsia fetal em um feto de Poodle num período avançado da gestação, durante um exame ultrassonográfico pré-natal onde foi detectado a presença de efusão pleural e peritoneal. Os achados ultrassonográficos foram confirmados no exame pós-morte do feto.(AU)

The Hydrops fetalis is a disease characterized by abnormal accumulationof extravascular fluid in the tissues or body cavities. In human medicine the diagnosis is usually performed during the prenatal ultrasound examination. This study aims to report the intrauterinediagnosis of fetal hydrops in a fetus of a Poodle dog. In a late prenatal ultrasound the presence of pleural and peritoneal effusion were detected. The ultrasound findings were confirmed in the post-mortem examinations.(AU)

Assuntos

RESUMO

A hidropisia fetal é uma doença caracterizada pelo acúmulo anormal de liquido extravascular nos tecidos ou nas cavidades docorpo. Em humanos o diagnóstico é realizado durante o exame ultrassonográfico no pré-natal. Este estudo tem como objetivo reportar o diagnóstico intrauterino de hidropsia fetal em um feto de Poodle num período avançado da gestação, durante um exame ultrassonográfico pré-natal onde foi detectado a presença de efusão pleural e peritoneal. Os achados ultrassonográficos foram confirmados no exame pós-morte do feto.

The Hydrops fetalis is a disease characterized by abnormal accumulationof extravascular fluid in the tissues or body cavities. In human medicine the diagnosis is usually performed during the prenatal ultrasound examination. This study aims to report the intrauterinediagnosis of fetal hydrops in a fetus of a Poodle dog. In a late prenatal ultrasound the presence of pleural and peritoneal effusion were detected. The ultrasound findings were confirmed in the post-mortem examinations.

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RESUMO

El hidrops es un transtorno caracterizado por una acumulación excesiva de líquido en los compartimientos extravasculares fetales y la cavidad corporal del feto, que dependen de las alteraciones patológicas de los órganos del mismo variando según la gravedad del proceso. Presentando grados variables de anasarca fetal, ascitis, derrame pericardico, edema placentario y polihidramnios. No estando ciertamente comprobado su fisiopatología, actualmente se postula que la eritropoyesis medular, sigue a la anemia fetal, los tejidos erotropoyéticos y fibroblásticos reemplazan el parénquima hepático, provocando hepatomegalia, hipertensión venosa portal, lo que conlleva a la ascitis fetal. La mortalidad es alta dependiendo de la etiología, entre 50-95 por ciento. Hay dos tipos de Hidrops Fetal, Inmune: Rh sensibilizado (eritroblastosis fetal); No Inmune: Talasemia, defecto estructural, arritmia cardíaca. El que se presenta a continuación es el tipo inmune, en una paciente femenina de 17 años de edad quien consulta por presentar contracciones uterinas dolorosas y pérdida de líquido anmiótico, de 6 horas de evolución; su incidencia está condicionada por el paso transplacentario de anticuerpos IgG de origen materno que se unen a los eritrocitos fetales, destruyéndolos; señalándose que el 98 por ciento de la enfermedad hemolitica del neonato guarda relación con incompatibilidad Rh y ABO y el 2 por ciento depende de anticuerpos irregulares; siendo una rareza en los países desarrollados. Por ello, en vista de que esta patología es poco frecuente decidimos presentar este caso y hacer una revisión detallado de la literatura internacional actual.

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