Alessandro Fruganti

Transthoracic echocardiographically-guided interventional cardiac procedures in the dog

OBJECTIVES Interventional cardiac procedures are traditionally performed using fluoroscopy, or, more recently, transesophageal echocardiography (TEE). Neither modality is widely available to practicing cardiologists worldwide. We examined whether balloon valvuloplasty of pulmonic stenosis (PS) and transarterial occlusion of patent ductus arteriosus (PDA) in dogs could be performed safely with transthoracic echocardiography (TTE). ANIMALS A prospective consecutive case series of 26 client-owned dogs with PS (n = 10) and PDA (n = 16). METHODS The cardiovascular procedures were performed using TTE. Each dog was positioned on a standard echocardiography table in right lateral recumbency (dogs with PS) or left lateral recumbency (dogs with PDA). Guide wires, balloon catheters, Amplatz(®) Canine Ductal Occluder (ACDO) delivery sheaths, and ACDO were imaged by standard echocardiographic views optimized to allow visualization of the defects and devices. RESULTS Procedures were performed successfully without major complications in 20 dogs. In 2 dogs (German shepherds) with Type III PDA, ACDO placement was unsuccessful; 2 other German Shepherds were excluded from the procedure because their ductal diameters, measured echocardiographically, exceeded the limits of the maximal ACDO size. Two dogs weighing ≤3.5 kg had suboptimal echocardiographic visualization of the PDA and were considered too small for safe ACDO deployment. All intravascular devices at the level of the heart and great vessels appeared hyperechoic on TTE image and could be clearly monitored and guided in real-time. CONCLUSIONS We have demonstrated that TTE monitoring can guide each step of pulmonic balloon valvuloplasty and PDA occlusion without fluoroscopy.

Transesophageal Echocardiography as the Sole Guidance for Occlusion of Patent Ductus Arteriosus using a Canine Ductal Occluder in Dogs

Background Transcatheter occlusion of patent ductus arteriosus (PDA) is usually performed by fluoroscopy alone or together with transesophageal echocardiography (TEE). Transthoracic echocardiography (TTE) guidance has been used for deployment of Amplatz Canine Ductal Occluder (ACDO), but sometimes is limited by suboptimal acoustic windows. Transesophageal echocardiography can overcome such issues and provides higher image resolution at the level of the great vessels. Objectives To determine if TEE without fluoroscopy could be used to successfully perform ductal occlusion for the treatment of PDA in dogs. Animals Twenty client‐owned dogs with PDA. Methods A prospective consecutive case series of PDA occlusion was performed using only TEE guidance. Dogs were positioned in right lateral recumbency and the TEE probe was positioned to visualize the descending aorta, PDA, and pulmonary artery. The guide wire, long introducer sheath, and ACDO were imaged by TEE to direct deployment. Results Ductal occlusion was performed successfully without need for fluoroscopy and without complications in 19 dogs. One dog required a second larger ACDO because of embolization of the first device 18 hours after positioning. Conclusions and Clinical Importance We have demonstrated that TEE monitoring without concurrent fluoroscopy can guide each step of transcatheter ACDO embolization thereby providing an alternate method of visualization for this procedure. Use of TEE alone can reduce radiation exposure or is an option when fluoroscopy is not available, and, therefore, should be evaluated in a larger case series to better assess procedural failure rates.

Characteristic clinical, haematological and histopathological findings in feline mastocytoma

M.T. Antognoni1*, A. Spaterna2, E. Lepri3, A. Fruganti2 and F. Laus2 1Department of Clinical Sciences, Section of Internal Medicine, Faculty of Veterinary Medicine, University of Perugia; 2Department of Veterinary Sciences, Clinical Section, Faculty of Veterinary Medicine, University of Camerino; 3Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Perugia, Italy *Correspondence: Department of Clinical Sciences, Section of Internal Medicine, Faculty of Veterinary Medicine, University of Perugia, 06126-Perugia, Italy E-mail: mta@unipg.it

Emphysematous cystitis in two glycosuric dogs.

A. Peli1*, A. Fruganti3, G. Bettini2, G. Aste4 and A. Boari4 1Department of Veterinary Clinical Sciences, Internal Medicine Section; 2Department of Veterinary Public Health and Animal Pathology, Section of General Pathology and Anatomy Pathology, Faculty of Veterinary Medicine, University of Bologna, Bologna; 3Department of Veterinary Sciences, Section of Clinical Medicine, Faculty of Veterinary Medicine, University of Camerino, Camerino; 4Department of Clinic Veterinary Sciences, Internal Medicine Section, Faculty of Veterinary Medicine, University of T eramo, T eramo, Italy *Correspondence: Dipartimento Clinico Veterinario, Sezione di Medicina Interna, Facolta di Medicina Veterinaria, Alma Mater Studiorum, Universita di Bologna, V ia T olara di Sopra 50, 40064 Ozzano dell’Emilia (BO), Italy E-mail: apeli@vet.unibo.it

Clinic and ultrasonographic findings in a cat with Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is a congenital cardiopathy of man and domestic animals. Fallot was a cardiologist in human medicine of the late 19th–early 20th century. This cardiac malformation is characterized by ventricular septal defect, dextroposition of the aorta, pulmonic stenosis and consequent right ventricular hypertrophy. Cardiac morphological alterations in TOF derive from a defective fetal development of both pulmonary and aortic arteries, resulting from troncus arteriosus, and right and left ventricular outflow tracts, resulting from conus arteriosus. There is also an incomplete development of the conotruncal septum which causes a skew between dorsal and apical parts of interventricular septum. As shown by Goodwin and Cooper (1992), pulmonary stenosis causes an increased resistance to blood flow ejected from the right ventricle. This leads to hypertrophy and hypertension of this ventricle, and leads to a right-to-left shunt through interventricular septum defect. The first consequence of the shunt is an inflow in aorta of bad oxygenated blood, that can easily induce hypoxia. Symptoms are failure to grow, exercise intolerance, cyanosis and syncope. Cyanosis depends on the entity of the shunt and it is not always present, but it is typical of most cases. For this reason, in the past the illness was called ‘‘blue disease’’ because of the colour assumed by mucosae. Cyanosis is always present when the subject gets excited or during physical effort, when even asphyxia can occur. TOF is more common for dogs than for cats (Patterson et al., 1993). For this species diagnosis is performed by anatomo-pathological examination or angiography which is an invasive intra vitam examination involving a lot of risks (Eyster et al., 1977). The aim of this report is to furnish a contribution to the study of this pathology in cats, especially for the non-invasive diagnostic methods such as ultrasound.

A survey of ocular ultrasound abnormalities in horse: 145 cases

PurposeTo describe the association of clinical and ultrasonographic (US) findings in horses affected by visual impairments, to estimate the most frequent ultrasonographic alteration as well importance and limits of US as a part of ophthalmic evaluation in equine patients.MethodsOne-hundred-forty-five horses referred to the Veterinary Teaching Hospitals of the University of Perugia and Camerino for ocular problems were submitted to ophthalmic examination and ocular ultrasound. The following group of abnormalities was established: corneal alteration, cataract, synechiae, iris prolapse, anterior chamber alterations, vitreous opacities, globe reduction, globe enlargement, retinal detachment, lens subluxation/luxation, lens rupture, intraocular masses, retrobulbar masses. Specificity, sensitivity, positive and negative predictive value and related 95% confidence interval were calculated. Kappa value was estimated for concordance evaluation.ResultsA total of 384 clinical alterations were observed during ophthalmological examination, while 357 were found by ultrasound investigation. A very good agreement was found for lens subluxation/luxation, intraocular masses, iris prolapse, globe enlargement, lens rupture, vitreous opacities and cataract. Moderate agreement was found for retinal detachment, anterior chamber alterations and synechiae. Corneal alteration and globe reduction resulted in a fair and poor agreement, respectively.ConclusionsUltrasonography affords the benefit of providing a complete cross-sectional view of the eyeball, facilitating the identification of ocular diseases in cases of loss of transparency of ocular media. It also represents an indispensable aid whenever anterior opacification precludes the use of ophthalmoscopic or biomicroscopic examination techniques.SommarioObiettiviDescrivere l’associazione tra reperti clinici ed ultrasonografici in cavalli affetti da alterazioni della visione, valutare i più frequenti reperti ultrasonografici e l’importanza ed i limiti dell’ultrasonografia come parte della valutazione oftalmologica nel cavallo.MetodiCentoquarantacinque cavalli riferiti all’ospedale Veterinario Didattico dell’Università di Perugia e di Camerino per patologie oculari sono stati sottoposti a valutazione clinica e a ultrasonografia oculare. Le alterazioni sono state suddivise nelle seguenti categorie: lesioni corneali, cataratta, sinechie, prolasso dell’iride, alterazioni della camera anteriore, opacità vitreali, riduzione dimensioni globo, aumento dimensioni globo, distacco retinico, lussazione/sublussazione del cristallino, rottura della lente, masse intraoculari, masse retrobulbari. Sono stati calcolati specificità, sensibilità, valore predittivo positivo (VPP) e negativo (VPN) con i relativi intervalli di confidenza (95%). La concordanza è stata valutata per mezzo del k-value.RisultatiSono state riscontrate un totale di 384 lesioni all’esame clinico e 357 a quello ultrasonografico. Concordanza eccellente è stata riscontrata per lussazione/sublussazione del cristallino, masse intraoculari, prolasso dell’iride, aumento di volume del globo, rottura della lente, opacità vitreali e cataratta. Concordanza moderata per distacco retinico, alterazioni della camera anteriore e sinechie. Le alterazioni corneali e la riduzione delle dimensioni del globo avevano concordanza rispettivamente pari a modesta e scarsa.ConclusioniL’ultrasonografia ha il vantaggio di fornire una visione completa della sezione dell’occhio facilitando l’identificazione di patologie causanti perdita di trasparenza delle strutture oculari. Rappresenta quindi un ausilio indispensabile nel caso di opacizzazione delle strutture anteriori che impediscono l’esecuzione di un corretto esame oftalmoscopico o biomicroscopico.

Bilateral cervical ribs in a mixed breed dog

A 4-year-old intact female, mixed breed dog was presented with a complaint of dyspnea. Clinical examination revealed symptoms related to disease of the upper airways. Radiographic findings were consistent with tracheal collapse associated with anomalies involving the seventh cervical vertebra and the first ribs bilaterally. Radiographs were highly suggestive of cervical ribs; computed tomography and ultrasound examination allowed complete characterization and better localization of the anomalies with relationship to the adjacent muscle and vasculature. Cervical ribs are malformations widely described in human medicine, but only sporadically in dogs. Herein, we discuss etiological, clinical, diagnostic and therapeutic aspects of cervical ribs and possible correlations between the cervical ribs and other anatomical anomalies noted in this dog.

Metabolic effects of Tart Cherries supplementation in an animal model of obesity

Fruits and vegetables contain non-nutritive phytochemicals that may contribute to their health-promoting effects. Anthocyanins are phytochemical flavonoids principally found in fruits and vegetables. Several studies have suggested that anthocyanin-rich plant extracts can modify lipid metabolism in vitro and can reduce hyperlipidemia in vivo. Tart cherries (Prunus cerasus L.) are a rich source of anthocyanins. This study was designed to evaluate the effects of anthocyanin-rich tart cherries extract and seeds powder on Diet-Induced Obesity (DIO) rats, that provide a useful animal model sharing several common features with human obesity. DIO rats were studied for 17 weeks of hypercaloric diet with the supplementation of 0,1 mg/kg of tart cherries seeds powder (DS) and seeds powder plus tart cherries extract, containing 1mg of anthocyanins (DES). DIO rats were compared to the control rats with not fat diet (Chow).To determine the systemic effects of caloric dense expousure we examined food consumption, fat mass content and fasting glycemia, insulin levels, cholesterol and triglycerides. Ultrasonographic (US) and computed tomography (CT) evaluations were performed to detect adipose tissue deposition. In CT, also fat infarction of the liver was investigated followed by histochemical analysis 17 weeks of fat diet, rats increased significantly their body weight in comparison to the control group. Glycaemia and insulin levels were higher in DIO rats. No difference in body weight was found in DS and DES rats compared to age-matched DIO rats. Supplementation of tart cherries in DS and DES induce a decrease of the blood pressure and the glycemia. Furthermore, decreased the serum levels of thiobarbituric reactive substances. The US and CT analysis indicated an increase of deposition of visceral adipose tissue and evidenced a decrease of hepatic attenuation in DIO rats, suggests a moderate hepatic steatosis prevented by tart cherries supplementation in DS and DES rats. The evidence of the CT was confirmed by histological analysis. DIO rats present a distinctive pattern of steatosis with hepatocytic ballooning degeneration at the perivenular areas. The steatosis elements decrease in DS and DES rats. Tart cherries supplementation, although did not reduce the body weight in DIO rats, prevent the development of related risk factors. Further studies are needed to better clarify the benefits of tart cherry supplementation on health and disease prevention.

Obesity-related nervous system injury: preliminary evidences in diet induced obesity (DIO) rats

Increased food intake, reduced physical activity and altered metabolic processes are the variables that affect energy balance inducing obesity. Obesity is now considered an increasingly medical challenge. Actually, the prevalence of obesity has increased dramatically worldwide over the last decades and has now reached epidemic proportions. On the other hand, obesity is associated with the development of chronic diseases such as cerebrovascular disease promoting the cognitive decline. Caloric-dense diet induced obesity (DIO), provides a useful animal model sharing several common features with human obesity. DIO rats of 7 weeks of age are expose to high fat (45 %) diet ad libitum and after 5 weeks the obese phenotype starts to be develop. To clarify the possible relationships between obesity and nervous system changes, DIO rats were studied after 5 weeks and 17 weeks of hypercaloric diet compared to the control rats with not fat diet (Chow). Memory performance were measured using different cognitive tests. Moreover, ultrasonographic (US) and computed tomography (CT) evaluations were performed to detect adipose tissue changes. Magnetic resonance imaging (MRI) to highlight brain morphological alterations was used. Morphological changes of brain areas (frontal cortex, hippocampus) were evaluated by immunohistochemical analysis. The results confirmed the developed of obesity after 5 weeks of fat diet. At long-term (17 weeks) high fat diet exposure, rats increased significantly their body weight in comparison to the control group and the youngest DIO rats. The US and CT analysis indicated an increase of deposition of both visceral and subcutaneous adipose tissue and evidences a decrease of hepatic attenuation in the older DIO rats.MRI images did not show vascular and morphological alterations in brain. Instead, immuhistochemical and immunochemical analysis, revealed an increase expression of glial-fibrillary acidic protein (GFAP) in the older DIO rats compared to the age- matched Chow rats both in frontal cortex and in hippocampus. DIO rats showed a reduction of retention latency time in the emotional learning task. These preliminary findings indicate that the development of obesity, does not determined gross anatomy alteration in brain, but the occurrence of injury characterized by astrogliosis. The identification of neurodegenerative changes in DIO may represent the first insight to better characterize the neuronal involvement in obesity.

Preliminary Evaluation of M-Mode, B-Mode, and X-Strain® Echocardiographic Indices Before and During Therapy in Dogs Affected by Dilated Cardiomyopathy

Clinical examination and m-mode, b-mode, and two-dimensional speckle tracking evaluations with X-Strain® software were carried out in two dogs with dilated cardiomyopathy before and during therapy. During follow-up, the two dogs presented not only in better clinical condition, but also with improvements in m-mode and b-mode indices, as well as increased values of strain and strain rate. Consequently, X-Strain® evaluation should be included in routine echocardiography to better understand the pathogenesis and evolution of disease characterized by reduced myocardial contractility, optimize the therapeutic protocol during follow-up, and contribute to finding the range of normal values for strain and strain rate in the dog.