The objectives of this project were: 1) to determine if live animal lung biopsy could be used to characterize early pathologic changes in the bovine lung associated with bovine respiratory disease (BRD), 2) determine if specific infectious respiratory pathogens can be identified in association with early pathological changes, and 3) determine whether pulmonary pathology characterized by live animal lung biopsy at arrival and at the time of initial BRD diagnosis was associated with health and production outcomes of feedlot steers in a commercial feedlot.<p> A live animal percutaneous lung biopsy technique was developed to obtain a lung sample from the right middle lung lobe in intercostal space (ICS) 4 using a Bard® Magnum® reusable biopsy instrument and a modified 4-mm (8g) biopsy needle. The lung biopsy procedure was limited to 2 attempts per biopsy time. In the technique development, 34 animals chronically affected with BRD were utilized, 20 animals in the preliminary development followed by 14 additional animals in a commercial feedlot setting. The technique resulted in 1 fatality of 34 steers (2.9%) and lung parenchyma was harvested in 19 of 34 steers (55.9%) chronically affected with BRD. In addition, in the commercial feedlot setting this procedure was determined to take about 20 minutes per animal.<p> The final study was performed on one hundred feedlot steers considered at high risk of developing BRD from twenty pens within a commercial feedlot. Study animals were enrolled in three different groups: sick on arrival (ARR-SA) consisting of 27 study animals and 13 matched control animals; pen pulls with no fever (PP-NF) consisting of 14 study animals and matched 7 controls; and pen pulls with an undifferentiated fever (PP-UF) consisting of 26 study animals and 13 matched controls. Live animal percutaneous lung biopsies were collected from the right middle lung lobe at 3 different times within the first 30 days of the feeding period, about 2 weeks apart. All samples were histopathologically evaluated and were assessed for the presence of <i>Mycoplasma bovis</i>, <i>Mannheimia haemolytica</i>, Histophilus somni and bovine viral diarrhea virus with immunohistochemistry.<p> A total of 295 lung biopsies were performed yielding 210 (71.2%) lung samples that were sufficient for histopathological evaluation. A histopathology score was awarded to each biopsy based on certain histopathological lesions being present. Only 20 lung biopsy samples from 19 animals received a histopathology score (ie, pulmonary lesions were present) with the most common score being a 1 (maximum score is 20). There were too few lung biopsy samples with a histopathology score to reveal any association with subsequent health events.<p> Immunohistochemistry (IHC) was performed on all lung biopsies recovered yielding one lung sample to be positive for both <i>Mannheimia haemolytica</i> and <i>Mycoplasma bovis</i> from the PP-UF group. There were too few positive samples to reveal any association between IHC and histopathology score.<p> A post mortem evaluation was performed by a study veterinarian on all study animals who died or were humanely euthanized due to poor treatment response. In this study only 4 steers died or were euthanized due to poor treatment response and 3 control steers were humanely euthanized. There were too few animals to reveal any association between histopathology score and post mortem diagnosis.<p> On entry into the feedlot, weights between ARR-SA and the PP-UF and PP-NF groups were significantly different (p<0.05). This is likely an effect of the different processing groups of cattle. At study allocation, the body weights of ARR-SA and PP-UF, PP-UF and their matched controls, and PP-NF and their matched controls were also significantly different (p<0.05). This is likely due to the PP-UF and PP-NF groups experiencing illness for a longer period of time resulting in greater weight loss than the ARR-SA animals as well as the control animals, who were not clinically sick.<p> The live lung biopsy procedure utilized in this study did not appear to cause any long lasting adverse effects as the BRD case fatality rates from the study animals were comparable to the overall case fatality rates reported by the feedlot for fall placed calves. In fact, the study animals experienced a decreased fatality rate compared to the feedlots overall fatality rate. This may be due to the study animals inadvertently being monitored more closely as the pen checkers were aware of and participating in the study. On post mortem evaluation there was no evidence of adhesions at the biopsy site. This procedure was performed on 134 feedlot steers resulting in only 2 acute deaths as a direct result of the live animal percutaneous lung biopsy procedure.<p> The results of this study indicate that live animal, percutaneous lung biopsy can be performed safely on feedlot steers in a commercial feedlot with few clinical side effects. In this study there were only 2 fatalities in 134 steers (1.5%) due to the biopsy procedure or 2 fatalities per 349 sampling times (0.6%) This technique did not prove useful either as a diagnostic tool for the determination of early lung pathology in BRD or as prognostic indicator for health and production outcomes. However, this lung biopsy technique may be a useful diagnostic tool for chronic pneumonia assessment.

The objectives of this project were: 1) to determine if live animal lung biopsy could be used to characterize early pathologic changes in the bovine lung associated with bovine respiratory disease (BRD), 2) determine if specific infectious respiratory pathogens can be identified in association with early pathological changes, and 3) determine whether pulmonary pathology characterized by live animal lung biopsy at arrival and at the time of initial BRD diagnosis was associated with health and production outcomes of feedlot steers in a commercial feedlot.<p> A live animal percutaneous lung biopsy technique was developed to obtain a lung sample from the right middle lung lobe in intercostal space (ICS) 4 using a Bard® Magnum® reusable biopsy instrument and a modified 4-mm (8g) biopsy needle. The lung biopsy procedure was limited to 2 attempts per biopsy time. In the technique development, 34 animals chronically affected with BRD were utilized, 20 animals in the preliminary development followed by 14 additional animals in a commercial feedlot setting. The technique resulted in 1 fatality of 34 steers (2.9%) and lung parenchyma was harvested in 19 of 34 steers (55.9%) chronically affected with BRD. In addition, in the commercial feedlot setting this procedure was determined to take about 20 minutes per animal.<p> The final study was performed on one hundred feedlot steers considered at high risk of developing BRD from twenty pens within a commercial feedlot. Study animals were enrolled in three different groups: sick on arrival (ARR-SA) consisting of 27 study animals and 13 matched control animals; pen pulls with no fever (PP-NF) consisting of 14 study animals and matched 7 controls; and pen pulls with an undifferentiated fever (PP-UF) consisting of 26 study animals and 13 matched controls. Live animal percutaneous lung biopsies were collected from the right middle lung lobe at 3 different times within the first 30 days of the feeding period, about 2 weeks apart. All samples were histopathologically evaluated and were assessed for the presence of <i>Mycoplasma bovis</i>, <i>Mannheimia haemolytica</i>, Histophilus somni and bovine viral diarrhea virus with immunohistochemistry.<p> A total of 295 lung biopsies were performed yielding 210 (71.2%) lung samples that were sufficient for histopathological evaluation. A histopathology score was awarded to each biopsy based on certain histopathological lesions being present. Only 20 lung biopsy samples from 19 animals received a histopathology score (ie, pulmonary lesions were present) with the most common score being a 1 (maximum score is 20). There were too few lung biopsy samples with a histopathology score to reveal any association with subsequent health events.<p> Immunohistochemistry (IHC) was performed on all lung biopsies recovered yielding one lung sample to be positive for both <i>Mannheimia haemolytica</i> and <i>Mycoplasma bovis</i> from the PP-UF group. There were too few positive samples to reveal any association between IHC and histopathology score.<p> A post mortem evaluation was performed by a study veterinarian on all study animals who died or were humanely euthanized due to poor treatment response. In this study only 4 steers died or were euthanized due to poor treatment response and 3 control steers were humanely euthanized. There were too few animals to reveal any association between histopathology score and post mortem diagnosis.<p> On entry into the feedlot, weights between ARR-SA and the PP-UF and PP-NF groups were significantly different (p<0.05). This is likely an effect of the different processing groups of cattle. At study allocation, the body weights of ARR-SA and PP-UF, PP-UF and their matched controls, and PP-NF and their matched controls were also significantly different (p<0.05). This is likely due to the PP-UF and PP-NF groups experiencing illness for a longer period of time resulting in greater weight loss than the ARR-SA animals as well as the control animals, who were not clinically sick.<p> The live lung biopsy procedure utilized in this study did not appear to cause any long lasting adverse effects as the BRD case fatality rates from the study animals were comparable to the overall case fatality rates reported by the feedlot for fall placed calves. In fact, the study animals experienced a decreased fatality rate compared to the feedlots overall fatality rate. This may be due to the study animals inadvertently being monitored more closely as the pen checkers were aware of and participating in the study. On post mortem evaluation there was no evidence of adhesions at the biopsy site. This procedure was performed on 134 feedlot steers resulting in only 2 acute deaths as a direct result of the live animal percutaneous lung biopsy procedure.<p> The results of this study indicate that live animal, percutaneous lung biopsy can be performed safely on feedlot steers in a commercial feedlot with few clinical side effects. In this study there were only 2 fatalities in 134 steers (1.5%) due to the biopsy procedure or 2 fatalities per 349 sampling times (0.6%) This technique did not prove useful either as a diagnostic tool for the determination of early lung pathology in BRD or as prognostic indicator for health and production outcomes. However, this lung biopsy technique may be a useful diagnostic tool for chronic pneumonia assessment.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Made available in DSpace on 2014-06-11T19:23:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-19Bitstream added on 2014-06-13T19:09:59Z : No. of bitstreams: 1 silva_aa_me_botfmvz.pdf: 329313 bytes, checksum: acaef38ccfb3815a5cbf93f92e3438da (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliou-se a segurança e a eficácia da técnica de biopsia pulmonar transtorácica percutânea e seus efeitos sobre o metabolismo oxidativo na espécie ovina. Foram utilizados 20 ovinos clinicamente sadios e destinados ao abate. Inicialmente, foram coletadas amostras de sangue da veia jugular em tubos de ensaio contendo heparina. Após a colheita, foi realizado o exame clínico seguido da biopsia pulmonar com agulha semi-automática no 7º espaço intercostal direito cerca de 5 cm acima do olécrano. Avaliou-se o número de tentativas para a realização do procedimento e o tamanho dos fragmentos. As amostras obtidas foram analisadas histologicamente. Uma nova colheita de sangue foi realizada 30 minutos após a biopsia, e as amostras levadas ao laboratório para a detecção indireta dos radicais livres [superóxido dismutase (SOD), glutationa total (GSH-t) e peroxidase (GSH-Px) e substâncias reativas ao ácido tiobarbitúrico (TBARS)]. Após o abate foi realizado o exame pos mortem para avaliação de complicações da técnica e das eventuais lesões provocadas. Entre todos os animais submetidos à biopsia apenas dois demonstraram resistência à técnica, sendo obtidos fragmentos pulmonares que mediram entre 4 mm a 7 mm de comprimento, com média de 1,8 1 tentativas por fragmento. As principais alterações relacionadas à técnica foram: tosse, dispnéia inspiratória, elevação das freqüências cardíaca e respiratória e aumento do ruído broncobronquiolar. Ao exame pos mortem observou-se hemorragia dos músculos intercostais e pleura visceral de tamanho variado em todos os cordeiros, além de feridas lineares de até 14 mm nos dois animais que não reagiram bem ao procedimento. Das 20 tentativas de execução da técnica, 18 obtiveram sucesso, enquanto que em duas o fígado foi equivocadamente puncionado. As amostras de tecido pulmonar foram consideradas representativas... / It was evaluated the safety and effectiveness of the percutaneous transthoracic lung biopsy technique and its effects of the procedure on oxidative metabolism in sheep. It was used 20 clinically healthy sheep. Initially, blood samples were collected from the jugular vein in test tubes containing heparin. After collecting the blood, the clinical examination was carried out followed by lung biopsy with a semi-automatic needle biopsy. The number of attempts and size of the fragments were measured and the samples were analyzed histologically. New blood samples were collected 30 minutes after the biopsy. All blood samples were taken to the laboratory for the indirect detection of free radicals [superoxide dismutase (SOD), total glutathione (GSH-t), glutathione peroxidase (GSH-Px) and thiobarbituric acid reactive substances (TBARS)]. After the slaughter, a post mortem examination assessed the technical complications and possible injuries. Among all animals underwent biopsy only two did not tolerate the technique. It were obtained Lung fragments from 4 mm to 7 mm and it were required on average 1,8 attempts. The main changes related to the procedure were: cough, labored breathing, increased heart and breathing rate and increased broncobronquiolar noise. The post-mortem examination revealed bleeding of the intercostal muscles and visceral pleura of various sizes in all lambs, and a wound up to 14 mm in the lung of two animals that did not tolerate the procedure. From 20 attempts to implement the technique, 18 were successful, while in two of them the liver was mistakenly punctured. Samples of lung tissue were representative. It was possible to visualize intact structures, including bronchioles and alveoli. The activity of SOD and GSH-Px decreased thirty minutes after the biopsy. There were no changes in GSH-t and TBARS concentrations after the procedure. The percutaneous transthoracic lung... (Complete abstract click electronic access below)

As afecções pulmonares são muito comuns na rotina clinica de pequenos animais. No entanto, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar garante um diagnóstico especifico da doença. Desse modo a toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. Nesta pesquisa foram avaliadas as técnicas de biópsia pulmonar através da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães da rotina de atendimento do Hospital de Clinicas Veterinárias (HCV) da Faculdade de Veterinária (FAVET) da UFRGS, independente de raça, sexo, idade e peso corporal. Somente animais com nódulos visíveis na radiografia torácica e que apresentaram exames pré-cirúrgicos sem alterações que impediam de serem anestesiados foram incluídos no estudo. Os animais foram posicionados em decúbito dorsal e foram feitos dois acessos à cavidade torácica, um primeiro portal intercostal, para introdução dos dispositivos de biopsia, e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. As amostras foram encaminhadas para exame histopatológico no laboratório de Patologia Veterinária da FAVET/UFRGS. A frequência cardíaca (FC), frequência respiratória (FR), saturação de oxigênio (SpO2) e pressão arterial média (PAM) foram aferidas em seis momentos diferentes do procedimento: após a indução da anestesia (T1), Após o estabelecimento do pneumotórax (T2), após a introdução do primeiro trocarte (T3), após a introdução do segundo trocarte (T4), após a coleta dos fragmentos da biopsia (T5) e após reestabelecer a pressão negativa no tórax (T6). O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, e foram registradas quaisquer complicações cirúrgicas. No pós-operatório os animais foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos animais. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para analise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia principalmente em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemotóraces. / Lung diseases are common in the small animals clinical routine. However, diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides precise diagnosis. Thus, thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared to thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy through the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of UFRGS were assessed. Inclusion criteria was presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of the FAVET / UFRGS. Heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2) and mean arterial pressure (MAP) were measured in six time points during the procedure: after induction of anesthesia (T1); after the establishment of pneumothorax (T2); after introduction of the first trocar (T3); after insertion of the second trocar (T4); after biopsy sampling (T5); and after reestablishment of the thoracic negative pressure (T6). The animals were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedures in any patient. Thoracoscopic-assisted biopsy using both guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However, the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.

Introduction : The lung biopsies guided by computed tomography (CT ) , either by aspiration or removal of tissue fragments , the procedure is routinely performed in developed countries , with proven specificity , accuracy and sensitivity in the diagnosis of pulmonary lesions . In Brazil , there are few published studies reporting the use of image -guided percutaneous biopsy aimed at the diagnosis of lung diseases . Objective: To describe the epidemiology and outcomes of pathological lesions suspected of malignancy in patients undergoing image-guided lung biopsy at the University Hospital of Santa Maria ( HUSM ) . Material and Methods: A descriptive cross-sectional study conducted from January 2007 to January 2012 , the Department of Radiology and Diagnostic Imaging , University Hospital of Santa Maria . Results: We analyzed data from 36 patients undergoing biopsy guided by computed tomography ( CT) or ultrasound (US), 25 men and 11 women , mean age 63 years ( 35-80 years) and history of smoking in 80% of patients . The average lesion size in diameter was 6.3 cm (1.5 to 18.2 cm) and 20% of patients had signs of pulmonary emphysema. In pathology , 53 % showed non-small lung cancer cells , 5.5% of small cell lung cancer , 25 % negative sample , 3 % and 14 % inconclusive other malignancies . As a case complication of pneumothorax was observed (2.8 %). Conclusion : The results suggest that image - guided percutaneous biopsy was performed in most middle-aged adults and elderly , male , smokers and non-small cell bronchial tumor . As it is a minimally invasive procedure with high accuracy in the diagnosis of lung diseases and low rate of complications , it is the indication for suspected lung injury. / Introdução: A realização de biópsias pulmonares guiadas por tomografia computadorizada (TC), seja por aspiração ou por retirada de fragmentos do tecido, é procedimento rotineiramente executado em países desenvolvidos, com comprovada especificidade, acurácia e sensibilidade no diagnóstico de lesões pulmonar. No Brasil, existem poucas pesquisas publicadas relatando o uso de biópsia percutânea guiada por imagem que visavam o diagnóstico de afecções pulmonares. Objetivo: Conhecer o perfil epidemiológico e descrever os resultados anatomopatológicos de lesões suspeitas de neoplasia de pacientes submetidos à biópsia pulmonar guiada por imagem no Hospital Universitário de Santa Maria (HUSM). Material e Métodos: Estudo transversal e descritivo realizado no período de janeiro de 2007 a janeiro de 2012, no Serviço de Radiologia e Diagnóstico por Imagem do Hospital Universitário de Santa Maria. Resultados: Foram analisados dados de 36 pacientes submetidos à biópsia guiada por Tomografia Computadorizada (TC) ou ultrassonografia (US), sendo 25 homens e 11 mulheres, com média de idade de 63 anos (35-80 anos) e história de tabagismo em 80% dos pacientes. A média do tamanho da lesão no seu maior diâmetro foi de 6,3 cm (1,5 a 18,2 cm) e 20% dos pacientes tinham sinais de enfisema pulmonar. No anatomopatológico, 53% evidenciou carcinoma brônquico não de pequenas células, 5,5% carcinoma brônquico de pequenas células, 25% amostra negativa, 3% inconclusivo e 14% outros tumores malignos. Como complicação um caso de pneumotórax foi observado (2,8%). Conclusão: Os resultados permitem concluir que a biópsia percutânea guiada por imagem foi mais realizada em adultos de meia idade e idosos, do sexo masculino, fumantes e com tumor brônquico não de pequenas células. Como é um procedimento minimamente invasivo, com alta acurácia no diagnóstico das afecções pulmonares e com baixa taxa de complicações, cabe à indicação na suspeita de lesão pulmonar.

Resumo: Avaliou-se a segurança e a eficácia da técnica de biopsia pulmonar transtorácica percutânea e seus efeitos sobre o metabolismo oxidativo na espécie ovina. Foram utilizados 20 ovinos clinicamente sadios e destinados ao abate. Inicialmente, foram coletadas amostras de sangue da veia jugular em tubos de ensaio contendo heparina. Após a colheita, foi realizado o exame clínico seguido da biopsia pulmonar com agulha semi-automática no 7º espaço intercostal direito cerca de 5 cm acima do olécrano. Avaliou-se o número de tentativas para a realização do procedimento e o tamanho dos fragmentos. As amostras obtidas foram analisadas histologicamente. Uma nova colheita de sangue foi realizada 30 minutos após a biopsia, e as amostras levadas ao laboratório para a detecção indireta dos radicais livres [superóxido dismutase (SOD), glutationa total (GSH-t) e peroxidase (GSH-Px) e substâncias reativas ao ácido tiobarbitúrico (TBARS)]. Após o abate foi realizado o exame pos mortem para avaliação de complicações da técnica e das eventuais lesões provocadas. Entre todos os animais submetidos à biopsia apenas dois demonstraram resistência à técnica, sendo obtidos fragmentos pulmonares que mediram entre 4 mm a 7 mm de comprimento, com média de 1,8 1 tentativas por fragmento. As principais alterações relacionadas à técnica foram: tosse, dispnéia inspiratória, elevação das freqüências cardíaca e respiratória e aumento do ruído broncobronquiolar. Ao exame pos mortem observou-se hemorragia dos músculos intercostais e pleura visceral de tamanho variado em todos os cordeiros, além de feridas lineares de até 14 mm nos dois animais que não reagiram bem ao procedimento. Das 20 tentativas de execução da técnica, 18 obtiveram sucesso, enquanto que em duas o fígado foi equivocadamente puncionado. As amostras de tecido pulmonar foram consideradas representativas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It was evaluated the safety and effectiveness of the percutaneous transthoracic lung biopsy technique and its effects of the procedure on oxidative metabolism in sheep. It was used 20 clinically healthy sheep. Initially, blood samples were collected from the jugular vein in test tubes containing heparin. After collecting the blood, the clinical examination was carried out followed by lung biopsy with a semi-automatic needle biopsy. The number of attempts and size of the fragments were measured and the samples were analyzed histologically. New blood samples were collected 30 minutes after the biopsy. All blood samples were taken to the laboratory for the indirect detection of free radicals [superoxide dismutase (SOD), total glutathione (GSH-t), glutathione peroxidase (GSH-Px) and thiobarbituric acid reactive substances (TBARS)]. After the slaughter, a post mortem examination assessed the technical complications and possible injuries. Among all animals underwent biopsy only two did not tolerate the technique. It were obtained Lung fragments from 4 mm to 7 mm and it were required on average 1,8 attempts. The main changes related to the procedure were: cough, labored breathing, increased heart and breathing rate and increased broncobronquiolar noise. The post-mortem examination revealed bleeding of the intercostal muscles and visceral pleura of various sizes in all lambs, and a wound up to 14 mm in the lung of two animals that did not tolerate the procedure. From 20 attempts to implement the technique, 18 were successful, while in two of them the liver was mistakenly punctured. Samples of lung tissue were representative. It was possible to visualize intact structures, including bronchioles and alveoli. The activity of SOD and GSH-Px decreased thirty minutes after the biopsy. There were no changes in GSH-t and TBARS concentrations after the procedure. The percutaneous transthoracic lung... (Complete abstract click electronic access below) / Orientador: Roberto Calderon Gonçalves / Coorientador: Débora Cristina Damasceno / Banca: Simone Biaggio Chiacchio / Banca: Fernando José Benesi / Mestre

As afecções pulmonares são muito comuns na rotina clinica de pequenos animais. No entanto, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar garante um diagnóstico especifico da doença. Desse modo a toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. Nesta pesquisa foram avaliadas as técnicas de biópsia pulmonar através da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães da rotina de atendimento do Hospital de Clinicas Veterinárias (HCV) da Faculdade de Veterinária (FAVET) da UFRGS, independente de raça, sexo, idade e peso corporal. Somente animais com nódulos visíveis na radiografia torácica e que apresentaram exames pré-cirúrgicos sem alterações que impediam de serem anestesiados foram incluídos no estudo. Os animais foram posicionados em decúbito dorsal e foram feitos dois acessos à cavidade torácica, um primeiro portal intercostal, para introdução dos dispositivos de biopsia, e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. As amostras foram encaminhadas para exame histopatológico no laboratório de Patologia Veterinária da FAVET/UFRGS. A frequência cardíaca (FC), frequência respiratória (FR), saturação de oxigênio (SpO2) e pressão arterial média (PAM) foram aferidas em seis momentos diferentes do procedimento: após a indução da anestesia (T1), Após o estabelecimento do pneumotórax (T2), após a introdução do primeiro trocarte (T3), após a introdução do segundo trocarte (T4), após a coleta dos fragmentos da biopsia (T5) e após reestabelecer a pressão negativa no tórax (T6). O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, e foram registradas quaisquer complicações cirúrgicas. No pós-operatório os animais foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos animais. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para analise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia principalmente em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemotóraces. / Lung diseases are common in the small animals clinical routine. However, diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides precise diagnosis. Thus, thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared to thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy through the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of UFRGS were assessed. Inclusion criteria was presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of the FAVET / UFRGS. Heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2) and mean arterial pressure (MAP) were measured in six time points during the procedure: after induction of anesthesia (T1); after the establishment of pneumothorax (T2); after introduction of the first trocar (T3); after insertion of the second trocar (T4); after biopsy sampling (T5); and after reestablishment of the thoracic negative pressure (T6). The animals were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedures in any patient. Thoracoscopic-assisted biopsy using both guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However, the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.

As afecções pulmonares são muito comuns na rotina clinica de pequenos animais. No entanto, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar garante um diagnóstico especifico da doença. Desse modo a toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. Nesta pesquisa foram avaliadas as técnicas de biópsia pulmonar através da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães da rotina de atendimento do Hospital de Clinicas Veterinárias (HCV) da Faculdade de Veterinária (FAVET) da UFRGS, independente de raça, sexo, idade e peso corporal. Somente animais com nódulos visíveis na radiografia torácica e que apresentaram exames pré-cirúrgicos sem alterações que impediam de serem anestesiados foram incluídos no estudo. Os animais foram posicionados em decúbito dorsal e foram feitos dois acessos à cavidade torácica, um primeiro portal intercostal, para introdução dos dispositivos de biopsia, e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. As amostras foram encaminhadas para exame histopatológico no laboratório de Patologia Veterinária da FAVET/UFRGS. A frequência cardíaca (FC), frequência respiratória (FR), saturação de oxigênio (SpO2) e pressão arterial média (PAM) foram aferidas em seis momentos diferentes do procedimento: após a indução da anestesia (T1), Após o estabelecimento do pneumotórax (T2), após a introdução do primeiro trocarte (T3), após a introdução do segundo trocarte (T4), após a coleta dos fragmentos da biopsia (T5) e após reestabelecer a pressão negativa no tórax (T6). O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, e foram registradas quaisquer complicações cirúrgicas. No pós-operatório os animais foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos animais. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para analise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia principalmente em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemotóraces. / Lung diseases are common in the small animals clinical routine. However, diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides precise diagnosis. Thus, thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared to thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy through the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of UFRGS were assessed. Inclusion criteria was presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of the FAVET / UFRGS. Heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2) and mean arterial pressure (MAP) were measured in six time points during the procedure: after induction of anesthesia (T1); after the establishment of pneumothorax (T2); after introduction of the first trocar (T3); after insertion of the second trocar (T4); after biopsy sampling (T5); and after reestablishment of the thoracic negative pressure (T6). The animals were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedures in any patient. Thoracoscopic-assisted biopsy using both guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However, the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.

Abstract Interstitial lung diseases (ILD), including interstitial pneumonias (IP), represent disorders with variable degrees of parenchymal inflammation and/or fibrosis offer an ideal model to investigate the histopathological features in relation to the course of these diseases. The most common IP is idiopathic pulmonary fibrosis (IPF) with the histological pattern of usual interstitial pneumonia (UIP) exhibiting the histological hallmark of fibroblast foci (FF). Surgical lung biopsy (SLB) is not usually needed for diagnosis of IPF, but the lung biopsy samples taken by SLB confers the diagnosis in atypical cases. The safety of SLB in IPF/UIP has been a controversial issue. The acute exacerbation occasionally occurs during the course of IPF/UIP, but pathological features related to this event are poorly understood. Recent studies suggest that one important determinant in the pathogenesis of ILDs, as in IPF, is oxidant stress and an imbalance of the redox-state in the lung. Thiol containing redox-regulated proteins which paticipate in the antioxidant defence of the lung include thiorexin (Trx) and gamma-glutamylcysteine synthetase (γGCS), also called glutamate-cysteine ligase (GLCL), the rate-limiting enzyme of glutathione (GSH) synthesis. The goal of this research was to evaluate the safety of SLB and the relationships between the histological findings and the course of IPF/UIP, and to investigate the above mentioned defense mechanisms in a variety of ILDs by means of immmunohistochemical analyses, Western Blotting and immunoelectronmicroscopy. No deaths occurred in the following 30 days after 34 video-assisted thoracoscopic lung biopsy (VATS). The number of FF in the lung sample predicted the survival, but it was not associated with acute exacerbation of IPF/UIP before death. Diffuse alveolar damage was a common feature in autopsy samples. The studied redox regulated defense enzymes were expressed in bronchial epithelium, metaplastic alveolar epithelium and alveolar macrophages, but the fibrotic areas generally showed no expression. In IPF/UIP VATS is a safe diagnostic method and counting the number of FF represents a reproducible and reliable method for predicting patient survival. Alterations in the redox regulated defense enzymes further point to the importance of oxidant burden in the fibrotic lung.