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Complicazioni della chirurgia ortopedica nel gatto politraumatizzato
No full textComplicazioni della chirurgia ortopedica nel gatto politraumatizzato
Del Magno S, Foglia A, Cola V, Pinna S, Valentini S, Giunti M, Pisoni L.
Scopo del lavoro
Il presente lavoro mira a valutare la frequenza e il tipo di complicazioni in seguito a chirurgie ortopediche in corso di politrauma nel gatto.
Materiali e metodi
Gatti politraumatizzati in cui è stata eseguita almeno una chirurgia ortopedica dal 2012 al 2016 sono stati inclusi e classificati in base a sede e tipo di lesione, tipo di trattamento chirurgico e medico e tipo di complicazioni riscontrate.
Ai pazienti è stato attribuito uno score clinico, come precedentemente riportato (Vnuk et al, 2004).
L’analisi statistica delle variabili oggetto di studio è stata condotta mediante l’utilizzo di test per dati non parametrici. La significatività dei test è stata considerata per un valore di p< 0,05.
Risultati
Sono stati inclusi 42 gatti europei, 19 femmine e 23 maschi. L’età mediana era di 24 mesi (range 7 mesi-18 anni), il peso mediano era di 4 kg (range 2,2-6,6).
I traumi ortopedici localizzati allo scheletro appendicolare sono risultati i più frequenti (62%), seguiti dai traumi del bacino (33%), del distretto maxillo-facciale (29%) e della colonna vertebrale (12%).
In 31 gatti erano presenti lesioni in altre sedi anatomiche con un coinvolgimento significativamente più frequente dei distretti toracico e cranico.
Il valore mediano dello score attribuito alle lesioni traumatiche riportate è risultato essere pari a 6 (range 2-12). Tale punteggio è risultato essere positivamente correlato al numero di distretti interessati dal trauma.
Nel 57% dei casi era presente uno stato di shock all’ammissione, che è risultato essere significativamente più frequente nei soggetti con lesioni traumatiche localizzate a più di due distretti corporei.
Nel periodo post-operatorio le complicazioni verificatesi più frequentemente sono state: anemia grave (17%, 7/42 pazienti), parziale fallimento dell’intervento (12%, 5/42), peggioramento dei deficit neurologici secondari ad osteosintesi del bacino (7%, 3/42) e infezioni del sito operatorio (14%, 6/42). Le infezioni erano associate a batteri multiresistenti (5/6), necrosi tissutale estesa (3/6) ed esposizione degli impianti di osteosintesi (2/6).
L’anemia si è sviluppata più frequentemente nei gatti che presentavano infezioni nel periodo post operatorio.
Una terapia antibatterica empirica è stata somministrata in tutti i pazienti come monoterapia (30/42 casi) o terapia combinata (12/42) a discrezione del medico curante. Lo sviluppo delle infezioni nel periodo post-operatorio è risultato significativamente più frequente in soggetti trattati con terapia combinata.
Il tempo intercorso tra l’ammissione e il primo intervento chirurgico (mediana 1 giorno, 0-4) e/o il primo intervento ortopedico (mediana 2 giorni, 0-11) non sono risultati correlati all’insorgenza di complicazioni.
Un solo paziente con trauma facciale e trauma cranico è deceduto nel periodo post-operatorio.
La durata del ricovero (mediana 10 giorni) è risultato significativamente maggiore in caso d’infezione post-operatoria.
Discussione
Un paziente politraumatizzato risulta essere spesso un paziente critico e al momento non sono presenti linee guida sul tipo di approccio chirurgico e il tempo in cui intervenire (Peterson et al, 2015).
L’anemia è una complicazione frequente nel periodo post-operatorio, di solito di natura multifattoriale. La risposta infiammatoria sistemica secondaria alla presenza di infezione sembra contribuire ad aggravare lo stato di anemia nel periodo post-operatorio in questa popolazione.
L’infezione del sito chirurgico è una complicazione grave e rappresenta una spesa notevole per il proprietario vista la maggior durata dell’ospedalizzazione. La maggior incidenza di infezioni in pazienti trattati con una combinazione di antibatterici suggerirebbe di impostare un’iniziale monoterapia, solo se necessaria, da variare sulla base dell’esame colturale. L’esecuzione di esami batteriologici su potenziali siti d’infezione al momento dell’ammissione del paziente ed eventualmente la loro ripetizione durante il decorso è di fondamentale importanza per impostare una terapia antibatterica mirata e prevenire o ridurre lo sviluppo di antibioticoresistenza. Questa strategia terapeutica andrebbe associata ad un ottimale controllo dell’infezione, che includa la rimozione del tessuto necrotico dal sito di lesione.
Il fallimento seppure parziale dell’intervento riscontrato in alcuni pazienti è probabilmente ascrivibile ad una gestione non adeguata del paziente in sede chirurgica e/o post-operatoria.
L’aggravamento delle lesioni neurologiche secondarie ad osteosintesi del bacino risulta spesso temporanee (Meeson, 2015). Nei 3 casi del presente studio interessati da tali alterazioni, si è assistito ad un significativo miglioramento clinico al momento della dimissione.
Vnuk D et al, Feline high-rise syndrome: 119 cases (1998-2001). J Feline Med and Surg, 6:305-312, 2004
Peterson NW et al, The impact of surgical timing and intervention on outcome in traumatized dogs and cats. J Vet Emerg Crit Care, 25:63-75.
Meeson RL, Geddes AT, Management and long-term outcome of pelvic fractures: a retrospective study of 43 cats. J Feline Med Surg, Oct 7, pii:1098612X15606958 2015
Transsphenoidal hypophysectomy as treatment for macro-adenomas in dogs: case series.
No full textTRANSSPHENOIDAL HYPOPHYSECTOMY AS TREATMENT FOR MACRO-ADENOMAS IN THE DOG: CASE SERIES
Pisoni L, Del Magno S, Foglia A, Fracassi F, Corradini S, Joechler M.
Introduction
Pituitary tumors can be classified according to the ratio between the pituitary height and the brain area (P/B value) with a cut-off of 0.31 mm-1 between micro and macroadenomas1.
The aim of the study is to retrospectively review the surgical therapy and the related complications of the cases of transsphenoidal hypophysectomy in dogs with macroadenomas performed at the DIMEVET of the University of Bologna.
Material and methods
In the study dogs with a pituitary adenoma diagnosed by CT or MRI and treated surgically between 2011 and January 2015 were included.
For transsphenoidal hypophysectomy all the dog were sedated with midazolam and fentanyl, the induction was executed with propofol and after oro-tracheal intubation, anesthesia was maintained by propofol in costant rate infusion and isolfuorane. Analgesia was provided by fentanyl.
All the surgical procedures were performed according to the microsurgical technique described by Meij in 19972.
In the post-operative period the dogs were monitored for neurological deterioration, electrolytes and fluid balance. Antibiotics, gastroprotection and opioids were administered. Hormonal supplementation consisted of desmopressin, corticosteroids and thyroxine.
The histological evaluation of the masses removed was carried out.
Results
Seven dogs were included in the study and 8 surgeries were performed. The main represented breed was the Labrador Retriever (2/7 dogs), the median body weight was 34,5 kg, the median age was 7,5 years and 6/7 dogs were male.
Of the 7 dogs included, 4 had pituitary-dependent hypercortisolism. One dog had hypopituitarism and 4 dogs showed severe neurological signs.
All the 7 cases had an enlarged pituitary gland, the median P/B value was 0,8 mm-1 .
In one dog the first surgical approach to the sphenoid bone resulted too caudal, in one dog there was a moderated bleeding during surgery and one dog had septic shock when recovered from anesthesia.
In the post-operative period, complications were hypernatremia and hypertension (5/8 cases), neurological deterioration (4/8), exophthalmos (2/8), agitation (2/8) and venous thrombus (2/8), one in the splenic vein and one in the cranial vena cava.
Four dogs were discharged, while 1 dog died due to sepsis and 3 dogs were euthanized for deterioration of clinical and neurological conditions. The histological diagnosis was adenoma in all cases.
Discussion and conclusion
Transsphenoidal hypophysectomy represents a solution to decrease the mass effect in enlarged pituitary adenomas, however better results were observed in microadenomas. A surgical learning curve is necessary for the surgeon. Nevertheless the complete removal of the mass is not always possible.
In surgery the main difficulties were the exact locatization of the fossa hypophysalys and to recognize and completely remove the neoplastic tissue.
All the cases presented had macroadenomas, some of them with very enlarged pituitary glands. In these dogs more complications were encountered in the post-operative period.
Surgery represents a curative therapy, in cases of complete removal of the mass, both for the neurological signs and the eventual endocrinological disease.
1. Kooistra et al, J Endocrinol, 1997
2. Meij et al, Vet Surg, 199
Early orthopaedic symptoms in a dog with systemic aspergillosis
Full text linkDel Magno S., Gruarin M., Foglia A., Agnoli C., Dondi F., Pisoni L.
EARLY ORTHOPAEDIC SYMPTOMS IN A DOG WITH SYSTEMIC ASPERGILLOSIS
Introduction Systemic aspergillosis is a rare disease in dogs. The unusual orthopaedic presentation in this case report could be helpful in the timely diagnosis of the pathology.
Case description A female, 1.5 years old, mixed-breed dog, was presented for lameness in the left hindlimb. A periosteal proliferation was present on radiographs on the left ileal wing and gluteal enthesistis was suspected. After therapy with NSAID the clinical condition worsened with generalized enlargement of the lymph nodes, azotemia and pyelonephritis. Fungal hyphae were detected in the urine and in the lymph nodes. MRI of the pelvis reveals a severe lesion involving muscle and the bone of the left ileal wing, resulting in osteolysis. Surgical biopsy demonstrated a mycotic myositis and osteomyelitis. Culture from urine and lymph nodes were indicative of infection by Aspergillus spp, group Aspergillus terreus. The antymycogram showed sensibility to itraconazole, voriconazole and amphotericin B. Itraconazole (10 mg/kg 24q) was started and the clinical situation improved. After 1 month the dog had evidence of discospondylitis of L1-L2 and a worsening of the dilatation of the renal pelvis and of the ureters. The dosage of the itraconazole was elevated to 7 mg/kg 12q. After 16 months the dog was euthanized because of severe osteomyelitis of the left femur .The necropsy confirmed the mycotic osteomyelitis of the left ileal wing, of the femur, discospondylitis and pyelonephritis.
Discussion Systemic mycosis usually are promoted by immunosuppression and the route of entrance for Aspergillus are believed to be either pulmonary or gastroenteric. In the case reported the dog did not have any demonstrated predisposing factor to immunosuppression. A primary local infection of the iliac wing is not probable because no surgery or wound was detected. Systemic infection by Aspergillus has major incidence in young female German Sheperd dogs and the dog of the present case was may have been related to this breed.
MRI was performed because in humans it is considered one of the best advanced diagnostic imaging techniques at detecting the soft tissue involvement in mycotic osteomyelitis. The surgical curettage of mycotic osteomyelitis was not performed because of the generalized nature of the infection, and only a biopsy was performed surgically in the iliac region.
The sensibility shown in vitro by the fungus to itraconazole, was not sufficient in vivo, even at high dosage, to eliminate the infection. Other drugs like voriconzole were not used because of the relatively high costs, while amphotericin B was considered risky in such an azotemic patient. Nevertheless the survival of the dog was of 16 months from diagnosis and can be considered satisfactory in comparison to the outcome reported in literature
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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