BackgroundCavalier King Charles spaniels (CKCSs) are predisposed to degenerative mitral valve disease (DMVD) and studies have indicated a genetic cause.AnimalsA total of 8,860 CKCSs were examined at shows or private clinics from 1991 to 2010.ObjectivesTo analyze the effects of a breed scheme for CKCS on the age at which a murmur consistent with DMVD was first detected.MethodsThe presence or absence of a murmur consistent with mitral regurgitation was noted and age a murmur was first detected recorded.ResultsA total of 16,887 examinations were performed on 8,860 dogs. The median age dogs developed a murmur were slightly younger in male than female dogs (7.8 versus 8.3 years, 95% confidence interval [CI] 7.4–8.1 versus 8.0–8.4, P < .001) and cardiologists detected murmurs in younger dogs than did general practitioner (GP) veterinary surgeons (7.2 versus 8.6 years, 95% CI 7.0–7.4 versus 8.3–8.7 P < .001). In bitches examined by GP vets during the study, there was a significantly increased age of detection of murmurs over time (8.6–9.2 years, 95% CI 8.3–9.1 and 8.5–10.9, P = .001) but not for male dogs examined by GP vets or dogs of either sex examined by cardiologists.Conclusions and Clinical ImportanceThis study suggests that the age incidence of murmurs associated with DMVD might be increased by application of breeding guidelines based on auscultation alone. This benefit was only seen in a subgroup and compliance of breeders with this voluntary scheme was poor.

Appendico-cutaneous fistulas not related to acute appendicitis or cancer are rare and show spontaneous resolution after conservative treatment, mainly when they show low output, absence of obstruction or sepsis and in patients with good nutritional status. We found no report in the literature on appendico-cutaneous fistula after hysterectomy. The evolution of this case shows that this type of fistula can have low, but persistent debt, requiring definitive surgery.

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INTRODUÇÃOO câncer colorretal (CCR) é a terceira causa mais comum de mortes por câncer 1,2 . A hereditariedade é responsável por 3 a 5% dos casos de câncer colo-retal.2,3. A Síndrome de Lynch, também conhecida como HNPCC (câncer colorretal hereditário não polipóide), representa modelo importante deste mecanismo. Nestes casos, observa-se o surgimento da neoplasia em idades mais precoces, em média aos 45 anos, e predileção pelo cólon direito . 2,4,5,6 .A história familial e a faixa etária abaixo de 50 anos podem fornecer dados importantes para a presença da síndrome de Lynch. No entanto, o número reduzido e de registro adequado das famílias atuais, pode dificultar o diagnóstico, baseando-se apenas na história

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