Heterotopic pregnancy is defined as intrauterine and extrauterine pregnancy entity coexisting simultaneously and which has been on the rise in recent years with the development of assisted reproductive techniques. We report 4 cases of heterotopic pregnancy, three of them resulting from assisted reproductive technologies and a spontaneous case. We also describe the methods used for diagnosis, therapies and behavior and perinatal outcome.
RESUMO:Substâncias inflamatórias como interleucinas (IL), fator alfa de necrose tumoral (TNF-α) e proteína-C reativa (CRP) desempenham papel importante na progressão da insuficiência cardíaca. Os objetivos desse estudo foram dois: investigar a concentração de citocinas circulantes em cães com doença mixomatosa da valva mitral (DMVM) em diferentes estágios, e acessar a relação entre essas substâncias e a morfologia e função cardíacas. Com esse intuito, doze cães com DMVM (7 em estágio B2; 5 em estágio C) e nove controles saudáveis foram submetidos à ecocardiografia transtorácica e tiveram as concentrações séricas de IL-1β, 4, 6, 10, TNF-α e CRP quantificadas. Os dados foram submetidos ao teste de normalidade de Shapiro-Wilk, os grupos foram comparados por meio da ANOVA ou Kruskal-Wallis de acordo com a distribuição, e os coeficientes de correlação obtidos pelo teste de Spearman. A concentração de IL-1β diferiu (P: 0,0056) entre os grupos. Ademais, houve correlação positiva entre IL-1β e o diâmetro ventricular esquerdo ao final da diástole (R: 0,56), relação átrio esquerdo aorta (R: 0,63) e parâmetros indicadores de congestão. Similarmente, a IL-4 exibiu correlação positiva de média a forte com parâmetros de remodelamento e congestão cardíacos, enquanto a IL-6 apresentou correlação negativa com a fração de encurtamento. Como conclusão principal, o nível de IL-1β aumenta em cães com DMVM e valores ainda maiores são observados nos animais sintomáticos.Palavras chave: inflamação, insuficiência mitral, interleucinas, ecocardiografia, insuficiência cardíaca ABSTRACT: Inflammatory substances such as interleukins (IL), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) have been demonstrated to play a role in heart failure progression. The aims of this study were two-fold: to investigate the concentration of circulating cytokines in dogs with myxomatous mitral valve disease (MMVD) in different stages, and to assess the relationship between these substances and cardiac morphology and function. For this purpose, twelve dogs with MMVD (7 stage-B2; 5 stage-C) and nine healthy controls underwent a transthoracic echocardiogram and had their serum concentrations of IL-1β, 4, 6, 10, TNF-α and CRP assessed. Data was submitted to Shapiro-Wilk normality test, groups were compared with ANOVA or Krukal-Wallis test according to distribution, and correlation coefficients were obtained with Spearman test. The IL-1β levels were different (P: 0.0056) between groups. Also, a positive correlation existed between IL- 1β and left ventricular end-diastolic diameter (R: 0.56), left atrium-to-aorta ratio (R: 0.63) and echocardiography congestion surrogates. Similarly, IL-4 exhibited moderate-to-strong positive correlation with parameters of cardiac remodeling and congestion, while IL-6 was negatively correlated with the shortening fraction (R: -0.49). As the main conclusion, IL-1β levels increases in dogs with MMVD, and even higher levels are observed in overtly symptomatic animals.
RESUMO.-[Determinação do volume atrial esquerdo em cães sadios e portadores da degeneração mixomatosa da válvula mitral.] A mensuração do volume atrial esquerdo (VAE) pode ser obtido pelo método biplanar de Simpson via ecocardiografia. Embora na medicina tal parâmetro venha sendo considerado um marcador prognóstico da sobrecarga atrial esquerda em várias cardiopatias, nos cães com degeneração mixomatosa da válvula mitral (DMVM), valvulopatia caracterizada pela sobrecarga do átrio esquerdo (AE), a avaliação da sobrecarga atrial é realizada rotineiramente apelas pela relação entre o diâmetro do AE e da artéria Aorta (Ao) (AE:Ao). Portanto, procurou-se mensurar os valores do LAV indexados à área de superfície corporal (ASC) em cães sadios e em portadores da DMVM utilizando--se do método biplanar de Simpson. The left atrial volume (LAV) can be obtained using the biplane Simpson's method via echocardiography. Although in medicine this parameter has been considered to be a prognostic marker of left atrial enlargement in several cardiac diseases, in dogs with myxomatous mitral valve degeneration (MMVD), a valvulopathy characterized by left atrial (LA) volume overload, atrial enlargement is usually assessed by the LA-to-Aorta ratio (LA:Ao). Therefore, the body surface area (BSA)-indexed LAV was measured in healthy dogs and in dogs with MMVD using the biplane Simpson's method. For this purpose, a total of 107 healthy dogs (control) and 81 dogs with MMVD in ACVIM stages B1, B2 and C were assessed, with LAV being calculated during atrial diastole (d) and systole (s) through the biplane Simpson's method. Two-dimensional apical four-chamber (4C) and two-chamber (2C) images were obtained in every dog through the left parasternal window. The values obtained from healthy dogs were correlated with body weight using Pearson's test. An analysis of variance (ANOVA) and Tukey's test were used to compare healthy and MMVD dogs, as well as to investigate differences according with MMVD stages. A strong positive correlation was documented between either LAVd (r> 0.77) or LAVs (r> 0.73) and body weight in healthy dogs. The BSA-indexed LAV calculated for MMVD dogs was significantly different (p<0.01) from that obtained for the control group. Also, LAV was significantly different (P<0.05) when stages B2 and C, and B1 and C were compared. In conclusion, this study provided a reference for left atrial volume and the applicability of this technique to assess atrial overload in dogs with varying-stage MMVD.
RESUMO:A presente revisão tem por objetivo descrever as atuais utilizações da ultrassonografia tridimensional (US 3D/4D) em obstetrícia veterinária de pequenos animais. A ultrassonografia tridimensional surgiu na década de 1950 e começou a ter maior aplicabilidade nas áreas de obstetrícia e ginecologia no início dos anos 1980. Essa técnica ultrassonográfica 3D facilita o estudo volumétrico de órgãos e estruturas e por permitir um terceiro plano da imagem (plano coronal) possibilita o cálculo volumétrico mais precisamente, principalmente aqueles órgãos com formato irregular. A modalidade 4D é utilizada na avaliação de estruturas e funções via correlação imagem espaço-temporal. Mesmo sendo uma técnica disponível há mais de 30 anos em medicina humana, na veterinária os estudos são recentes e necessários para demonstrar a especificidade e sensibilidade da técnica ultrassonográfica na rotina da obstetrícia de pequenos animais.Palavras-chave: Pequenos animais. Ultrassonografia volumétrica. Obstetrícia. GESTATIONAL ULTRASONOGRAPHY 3D/4D IN SMALL ANIMALSSUMMARY:This review aims to describe the current use of three-dimensional ultrasonography (U.S. 3D/4D) in small animal veterinary obstetrics. The three-dimensional ultrasonography emerged in the 1950s and started to have wider applicability in the areas of obstetrics and gynecology in early 1980. This technique facilitates volumetric study of organs and structures and allow a third image plane enables volumetric calculation more accurately, especially those irregularly shaped bodies. The 4D method is used to evaluate structures and functions via image correlation temporal space. Even being a technique available for more than 30 years in human medicine, in veterinary studies are needed to demonstrate the specificity and sensitivity of the technique in routine obstetric ultrasound of small animals.
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