Objetiva-se relatar a reintervenção cirúrgica para ampliação de margens em um paciente diagnosticado com mastocitoma cutâneo. Um canino, macho, Bulldog Francês, com 7 anos foi atendido com histórico de retirada de nódulo cutâneo em região abdominal há 15 dias, com diagnóstico histopatológico compatível com mastocitoma grau I e margens cirúrgicas comprometidas. Optou-se então pela realização de um segundo procedimento cirúrgico para ampliação das margens de segurança, o qual foi precedido por planejamento de 5 cm de margens cutâneas e uma camada de fáscia e um plano muscular como margem profunda, juntamente com a linfadenectomia inguinal. Durante o procedimento, foi possível a síntese sem a necessidade do uso de técnicas reconstrutivas, a partir da divulsão do subcutâneo e da utilização do padrão Walking Suture. Não houve intercorrências transoperatórias, e a formação de hematoma foi a única complicação pósoperatória observada. O material foi enviado para análise histopatológica, confirmando mastocitoma cutâneo baixo grau/grau I com margens livres, sem evidências de metástase em linfonodo. Dessa forma, não foram instituídas terapias adjuvantes, e após 320 dias pós-operatórios, o paciente apresentava-se em ótimo estado geral, sem evidências de recidiva ou metástases à distância na radiografia torácica e ultrassonografia abdominal. Conclui-se que a reintervenção cirúrgica pode ser uma alternativa para o tratamento do mastocitoma baixo grau/grau I com margens comprometidas, sendo o diagnóstico histopatológico e o planejamento cirúrgico essenciais para redução de complicações trans e pósoperatórias, aumentando as chances de sucesso e cura do paciente.
Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy.Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Klein’s cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart (HR) and respiratory (ƒ) rates, mean arterial pressure (MAP), end-tidal CO2 concentration (EtCO2), expired isoflurane concentration (EtISO), and rectal temperature (RT) were measured. The HR, ƒ, and EtCO2levels did not differ statistically. The mean EtISO presented in M2 (1.16 ± 0.41) was significantly lower than that in M3 (1.39 ± 0.40) and M4 (1.49 ± 0.49).Discussion: In the HR analysis, it was found that during all evaluation moments, the means remained within the reference range for the species. Moreover, the values during the breast pullout (M4) did not exceed 20% of those presented minutes before the beginning of the surgery (M2), which was indicative of analgesic rescue, suggesting that the animals did not experience pain. Hypoventilation resulted in an increase in EtCO2 values. Thus, it can be said that in this study, there was no respiratory depression during the transoperative period, as the values of the variables ƒ and EtCO2 were within the reference for the species. With regard to the EtISO variable, there was no reduction in the MAC of isoflurane with the use of heated tumescence solution, as reported by some authors (EtISO 0.8%). However, the EtISO values presented here are close to those found in the literature during breast pullout (EtISO between 1.3% and 1.52%), with the use of refrigerated tumescence solution. In addition, the values shown in M4 are within the equivalent of 1 MAC (1.41%) of isoflurane, proving that heated tumescent local anesthesia is a safe technique and an excellent adjunct to inhalation anesthesia, as it provides intraoperative analgesia. Therefore, heated tumescence solution is safe and an excellent adjuvant in general inhalational anesthesia for radical unilateral mastectomy as it did not increase inhaled anesthetic consumption during surgery.Keywords: tumescent local anesthesia, lidocaine, dogs, inhalation anesthesia, mammary tumors.
The aim of this study was to evaluate renal hemodynamics, routine clinical and laboratory parameters used to estimate renal function, and clinical evolution during six months in bitches with mammary carcinomas that underwent mastectomy and were treated (TG) or not (CG) with carprofen for three months after surgery. Twenty-six bitches with mammary carcinoma were equally distributed into TG that received carprofen 4.4 mg/kg/day for 90 days and CG that did not receive anti-inflammatory medication. Renal artery Doppler flowmetry, contrast-enhanced ultrasound (CEUS) of renal parenchyma, haematological, biochemical and clinical analyses were obtained once a month. These data were compared between groups and time via analysis of variance (ANOVA) in a completely randomized design with repeated measures (P < 0.05). On B-mode ultrasound, the area of the renal artery was greater (P = 0.0003) in the TG. Regarding laboratory findings, haematocrit and haemoglobin were similar in both groups, showing a significant and gradual increase after three months of treatment; MCV, MHC, and MCHC were increased (P < 0.05) and lymphocyte and band counts decreased (P < 0.05) in the TG. Regarding biochemical tests, ALT was the only parameter with a significant difference, being higher (P = 0.0272) in the treated group. It can be concluded that the use of carprofen for 90 days causes minimal changes in renal perfusion, erythrocyte parameters and ALT activity, and reduces the proportion of blood inflammatory cells. Therefore, use of this medication can be carried out safely in patients who require auxiliary cancer treatment.
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