[Show abstract][Hide abstract] ABSTRACT: The aim is to evaluate the pancreatic vascular-ischemic effects related to double balloon enteroscopy in the porcine model as a possible etiopathogenesis of post-enteroscopic pancreatitis. For this reason we carry out two independent experiments in a porcine animal model. In the first arm protocol (group I), 10 animals underwent 90 minutes of oral enteroscopy with 7 days follow-up.The levels of amylase, lipase and C-reactive protein were measured at T0 basal-T1 -90 min, T2-24, T3-7 days. Also we perform upper gastrointestinal endoscopy in a control group. At 7 days, the animals of experimental protocol-I had their pancreases removed for a pathological and immunohistochemical study to evaluate vascular epithelial growth factor (VEGF) expression.The second experimental protocol in this study aims to evaluate possible changes in vascular topography due to the double balloon enteroscopy (DBE). Group-II (10 animals) underwent oral enteroscopy and selective angiography of the cranial mesenteric artery and celiac trunk. None of the group I or control group animals presented pancreatitis, although the biochemical results for group-I showed increases in the levels of amylase, lipase and C reactive protein at 24 hours. The microscopic study for group-I showed pancreatic necrotic foci and positive VEGF expression, though these changes were not expressed in the control group.These foci were found in 50 % of the group I animals and in relation to the total of the parenchyma were quantified at 6 % of the pancreas. The results for group-II showed that the enteroscopy caused mobilization of the mesenteric vascular axis, with signs of both intestinal and pancreatic hypoperfusion. The conclusions of this study are that, after enteroscopy in the porcine model, pancreatic necrotic foci are produced, in addition to ischemic phenomena causing VEGF expression. This could be related to episodes of visceral hypoperfusion caused by vascular alterations on a topographic level. This can be related to the possible ischemic etiopathogenesis described for post-enteroscopic pancreatitis.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 01/2015; 107(1):17-22. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To (1) assess the canine elbow joint using a high frequency transducer (18 MHz); (2) describe the echogenicity and echo texture of the joint; and (3) correlate the ultrasonographic images with transparent plastinated anatomic sections.DesignDescriptive study.Sample PopulationGerman Shepherd cross-breed dogs (cadavers, n = 10; live dogs, n = 5).Methods
Elbow joints of 10 adult German Shepherd cross-breed dog cadavers were examined by ultrasonography and then 5 cadavers were selected for use in an anatomic study, in which 2 mm thick sections were obtained in the same planes as in the ultrasonographic protocol. Sections were plastinated using the E-12 plastination method and correlated to the corresponding ultrasonographic images. The elbow joints of 5 German Shepherd adult dogs were assessed by ultrasonography for comparison with cadaver images.ResultsGood correspondence of soft tissue and bone structures was obtained between ultrasound images and anatomic sections. There was no difference in the ultrasonographic appearance of elbows of cadavers and live dogs in which the muscular, ligamentous, and bone components of the joints were evaluated.Conclusion
This study presents a descriptive comparison of anatomic and ultrasonographic images, which will offer clinicians a more comprehensive understanding of the anatomic structures of the canine elbow joint and serve as reference for further imaging diagnostic studies because of the precise correspondence between anatomic plastinated sections and ultrasonographic images.
Veterinary Surgery 07/2014; 39(5):S12. DOI:10.1016/j.ultrasmedbio.2013.02.073 · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction/Purpose: Ultrasonographic (US) computed tomographic (CT) and magnetic resonance imaging (MRI) studies of the canine elbow joint have been previously reported separately. The purpose of this study was to assess the canine elbow joint by means of US (high frequency transducer of 18 MHz), CT and MRI and correlating the images with plastinated anatomical sections obtained on the same planes used in the imaging protocols.
Material and Methods: Ultrasonographic study: 10 elbow joints from 5 adult German Shepherd-crossed breed dogs were ultrasonographically evaluated using an 18 MHz linear array transducer through an ultrasonographic protocol established in a previous study. Tomographic study: 6 elbow joints from 3 adult German Shepherd-crossed breed dogs were evaluated and reformatted images were obtained on the same planes of the ultrasonographic study. Magnetic resonance study: 6 elbows joints from 3 adult German Shepherd-crossed breed dogs were evaluated on the sagittal, axial and dorsal planes using T1 and T2 weighted protocols. Anatomical study: 10 forelimbs frozen at -70ºC obtained from 5 adult German Shepherd-crossed breed dog cadavers were used to obtain transparent sections (2mm thick) on the same planes of the imaging studies; anatomical sections were preserved using the E12 plastination technique. Correlations between ultrasonographic, computed tomography, magnetic resonance and anatomic images were made.
Results: High frequency ultrasonographic study assessed on the medial aspect of the joint the insertion tendons of brachialis and biceps brachii muscles, the medial collateral ligament and the medial coronoid process. On the caudal aspect evaluated structures were the tendon of insertion of the triceps brachii muscle and the anconeal process. On the lateral aspect observed structures included the lateral collateral ligament and the lateral coronoid process. Computed tomography was used to evaluate cortical and subchondral bone of the medial coronoid process, the trochlear notch of the ulna, the radial incisures of the ulna, the anconeal process and the humeral condyles of the elbow joint. Magnetic resonance imaging was used to assess soft tissue structures such as the flexor muscles and their tendons of origin, collateral ligaments, and insertion tendons of brachialis and biceps brachii muscles and articular cartilage of the canine elbow joint. T1 and T2 imaging protocols (FAT SAT, GRE, FSE, STIR) were used to this purpose. There was a good correlation between the images from diagnostic imaging techniques and the transparent anatomical sections.
Our results agree with those obtained in previous studies in which the canine elbow joint has been evaluated by one imaging technique at a time (1, 2, 3). This is the first work that combines three diagnostic imaging techniques at once. On the other hand it was possible to obtain a better ultrasonographic resolution of soft tissue structures by means of a high frequency transducer (18 MHz). In particular, on the medial aspect, the insertion of the tendons of biceps brachii and brachialis muscles on the ulnar tuberosity was observed in this study, which has been reported in a previous publication (4). Ultrasonographic and magnetic resonance studies showed to be more suitable for soft tissue structures such as the flexor muscles and their tendons of origin; and computed tomography was the appropriate technique to assess the bone structures of the canine elbow joint. Correlation of plastinated anatomic sections and images of three different diagnostic imaging techniques all together leads to a more comprehensive understanding of the canine elbow joint.
(1) Lamb et al. 2005 Ultrasonographic Anatomy of the Canine Elbow Vet Radiol Ultrasound 4, 319-25
(2) De Rycke et al. 2002 Computed tomography of the elbow joint in clinically normal dogs AJVR 63,1400-07
(3) Baeumlin et al. 2010 Magnetic resonance imaging of the canine elbow: an anatomic study Vet surg 39, 566-73
(4) EVDI Conference 2011, Anatomic and ultrasonographic study of the canine elbow
[Show abstract][Hide abstract] ABSTRACT: Retrograde (anal) exploration of the canine small intestine by conventional endoscopy is restricted to the ileum, but double balloon endoscopy (DBE) has recently been validated using the oral approach. In this study, anal DBE was performed on nine healthy dogs to characterize the efficiency, exploration dynamics and safety of the technique. DBE was successful in all dogs; the average estimated insertion depth of the endoscope was about 2m and took approximately 1h to achieve. No complications or related adverse clinical effects were observed, and pancreatitis did not occur following the procedure. Anal DBE is viable and safe in the dog within the limits of the study, and has the potential to facilitate the diagnosis and treatment of gastrointestinal diseases, not only in portions of the colon and ileum, but also in portions of the distal jejunum.
The Veterinary Journal 06/2013; 197(3). DOI:10.1016/j.tvjl.2013.04.020 · 2.17 Impact Factor
14th World Congress of Ultrasound in Medicine and Biology - WFUMB; 16th Congress of the Latin American Federation of Ultrasound - FLAUS; 43rd Sao Paulo Radiological Meeting – JPR, Sao Paulo, Brazil; 05/2013
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to assess the safety and efficacy of CO(2) during double-balloon enteroscopy (DBE) in an experimental animal model study. In this study, insufflation with room air and with CO(2) was compared.
Twenty healthy swines were used. The animals were randomly allocated to two groups. The room air-DBE group was insufflated with room air, whereas the CO(2) -DBE group was insufflated with CO(2) . Endoscopy duration was 90 min. The following parameters were measured during the study (basal, 30 min, 60 min, 90 min): invasive hemodynamic parameters, ventilatory parameters, arterial blood gases, exploration depth, as well as biochemical tests. Residual gas was evaluated at the end of DBE, at 180 min and 24 h after DBE.
During the endoscopic exploration none of the animals showed hemodynamic, ventilatory or arterial blood gas alterations in the normal reference range for the swine species. The CO(2) group showed statistically significant differences over the room air group with lower post-procedure residual gas and greater depth of the small bowel explored.
The use of CO(2) for insufflation during DBE was safe and no complications associated with CO(2) were observed. In addition, the use of CO(2) offers benefits over the use of room air for insufflation during DBE.
[Show abstract][Hide abstract] ABSTRACT: Forces exerted by fibrous structures on the medial aspect of the canine elbow joint have been reported to be involved in elbow pathology. The purpose of this paper is to assess the relationships of the ligamentous and muscular structures of this region of the canine elbow joint, and how they relate to the medial coronoid process. Six cadavers of adult German shepherd cross-breed dogs were used in this study to make intra-articular and vascular injections of this region. Some joints were dissected and some were frozen to saw sagittal or dorsal cryosections to assess the relationships of the myotendinous structures. The brachialis muscle tendon passed through the division of the bicipital tendon of insertion which formed a fibrous tendon sheath that was reinforced by the oblique ligament. The biceps' brachii's main insertion is the radial tuberosity where it inserts along with the cranial branch of the oblique ligament and the cranial branch of the medial collateral ligament. Rotational and compression forces exerted by the insertion of the biceps brachii-brachialis tendon complex onto the ulna might influence medial coronoid disease. Therefore, sectioning these tendons could be considered as a treatment for medial coronoid disease.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of double-balloon enteroscopy (DBE) on pancreas histology and levels of pancreatic enzymes.
Conventional upper gastrointestinal endoscopy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups (10 pigs each) were defined according to DBE duration: 90 min for Group 1 and 140 min for Group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amylase, lipase and C-reactive protein (CRP) levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of decreased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was performed on day 7.
All animals tolerated DBE without clinical manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic levels had returned to baseline. No differences between Groups 1 and 2 were found for any enzyme and sampling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspection of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from Groups 1 and 2 revealed the existence of focal areas (0.14-0.26 mm(2)) of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe (tail) was always affected. However, this only happened in 83.3% of the samples from the right lobe (head) and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe (tail) and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe (tail). The presence of the lesions was not related to the exploration length.
The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.
World Journal of Gastroenterology 10/2012; 18(37):5181-7. DOI:10.3748/wjg.v18.i37.5181 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The minute anatomy of the temporomandibular joint (TMJ) is of great clinical relevance in cats owing to a high number of lesions involving this articulation. However, the precise anatomy is poorly documented in textbooks and scientific articles. The aim of this study was to describe, in detail, the TMJ anatomy and its relationship with other adjacent anatomical structures in the cat. Different anatomical preparations, including vascular and articular injection, microdissection, cryosection and plastination, were performed in 12 cadaveric cats. All TMJ anatomical structures were identified and described in detail. A thorough understanding of the TMJ anatomy is essential to understand the clinical signs associated with TMJ disorders, to locate lesions precisely and to accurately interpret the results in all diagnostic imaging techniques.
[Show abstract][Hide abstract] ABSTRACT: Exploration of the canine small intestine using conventional endoscopy is restricted to the duodenum and/or the ileum. Double balloon endoscopy (DBE) is a 'push and pull' technique that has been described in humans and permits a complete exploration of the small intestine. In this study, oral DBE was performed on 12 healthy dogs (10-34kg) to characterize for the first time the efficiency, exploration dynamics and safety of the technique. DBE was successful in 83% of dogs; the average estimated insertion depth of the endoscope was 287±36cm, and the average duration of the exploration was 84±8min. No complications or relevant adverse clinical effects were observed, and there was no indication of post-procedure pancreatitis based on serology of two specific markers of pancreatitis (amylase and lipase) and the immediate nonspecific inflammatory mediator C-reactive protein. The study showed that oral DBE is viable and safe in the dog, allowing for the diagnosis and treatment of gastrointestinal diseases deep in the small intestine to an extent that has not previously been possible using conventional endoscopy.
The Veterinary Journal 07/2012; 195(3). DOI:10.1016/j.tvjl.2012.06.023 · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The histology of the canine intestine has not been accurately defined. To establish the precise thickness of its different layers, whole wall samples of the small intestine were removed from 41 cadavers at five standardised sampling sites (duodenum, proximal jejunum, distal jejunum, proximal ileum and distal ileum). The total thickness was estimated by morphometry, as was the thickness of the mucosa, muscularis mucosae, submucosa and muscularis externa. In addition, the size of the lymphoid aggregates in the submucosa and the thickness of the circular and longitudinal layers within both the muscularis mucosae and the muscularis externa were estimated. The total intestinal thickness depended very much upon the thickness of the mucosa and submucosa. The mucosa decreased progressively from proximal to distal parts of the small intestine (47% reduction). The thickness of the submucosa, however, changed little from the duodenum to the distal jejunum, but increased significantly in the ileum; this change was positively correlated with the amount of lymphoid tissue. Sex influenced the thickness of the intestinal wall, with males displaying higher thickness values along the small intestine. Conversely, no correlation between bodyweight and intestinal thickness was found for any of the five sampling sites. This study gives absolute and relative values for the thickness of the layers of the dog intestine which might help in the diagnosis of small intestinal pathology from postmortem samples and/or endoscopic biopsies.
The Veterinary Journal 11/2011; 192(3):498-502. DOI:10.1016/j.tvjl.2011.06.041 · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our aim was to compare plastinated sections of the canine heart with corresponding two-dimensional (2D) echocardiographic images. Thirteen dog hearts were fixed by dilation and then processed by the S10 silicon plastination method (Biodur). Two dogs without evidence of cardiac disease were imaged using 2D echocardiography so as to obtain a complete series of the standard right and left parasternal images, which were compared with corresponding plastinated slices obtained by knife sectioning of the hearts. The plastinated slices revealed the internal anatomy of the heart with great detail and were particularly useful to display the spatial relationship between complex anatomic structures. The plastinated slices corresponded accurately with the echocardiographic images. Because of the dilation of the right heart during the fixation process, it was not possible to obtain plastinated specimens in ventricular systole. This paper may be a reference atlas for assisting 2D echocardiography interpretation.
[Show abstract][Hide abstract] ABSTRACT: Double balloon endoscopy (DBE) enables the diagnosis and treatment of small intestinal disease. The dog is a potential animal model for DBE training and also a candidate for the clinical application of this technique. However, the anatomy of the canine small intestine may limit the use of DBE by restricting the push-and-pull manoeuvres required for DBE. To establish what these limitations are, the length and width of different portions of the small intestine as well as the mesenteric dependences were measured in 55 dogs. Several external parameters related to body size plus the age, weight, sex and breed were recorded. Potential restriction of the progress of the enteroscope due to narrow intestinal diameter is expected in the jejunum of mid- and small size dogs.
The Veterinary Journal 10/2010; 190(1):113-8. DOI:10.1016/j.tvjl.2010.08.017 · 2.17 Impact Factor