Spontaneous and experimental poisoning by nitroxinil at 34% in goats / Intoxicação espontânea e experimental por nitroxinil na concentração de 34% em caprinos

This study describes the epidemiological, clinical, and pathological aspects of spontaneous and experimental poisoning by nitroxinil at 34% concentration in goats. The outbreak occurred on a farm in the municipality of Prata, Paraíba state. Nitroxinil was administered to a herd of 120 goats, of which 18 presented with anorexia, vocalization, abdominal distension, weakness, staggering, and falls. Necropsy of three goats revealed that the main lesion was acute liver injury. Histologically the liver showed centrilobular necrosis associated with hemorrhage and hepatocyte degeneration. In the kidneys, tubular nephrosis with granular cylinder formations was observed. The lungs showed multifocal to coalescent areas of moderate interalveolar edema and vascular congestion. Experimental poisoning was carried out in two goats, with the same medication and doses administered on the farm. The experimental goats showed clinical signs and macroscopic and histological changes similar to the spontaneously poisoned goats. The diagnosis of nitroxinil poisoning was made based on epidemiological, clinical, and pathological data, and confirmed by experimental poisoning. The administration of nitroxinil in high doses, associated with high ambient temperature and physical exercises, can cause poisoning with high lethality in goats.(AU)

Este estudo descreve os aspectos epidemiológicos, clínicos e patológicos da intoxicação espontânea e experimental por nitroxinil na concentração de 34% em caprinos. O surto ocorreu em uma fazenda no município de Prata, Paraíba. Nitroxinil foi administrado a um rebanho de 120 cabras, das quais 18 apresentavam anorexia, vocalização, distensão abdominal, fraqueza, cambaleando e quedas. A necropsia de três cabras revelou que a lesão principal era uma lesão hepática aguda. Histologicamente, o fígado apresentava necrose centrolobular associada a hemorragia e degeneração de hepatócitos. Nos rins, nefrose tubular com formações de cilindro granular foi observada. Os pulmões apresentavam áreas multifocais a coalescentes de edema interalveolar moderado e congestão vascular. A intoxicação experimental foi realizada em duas cabras, com a mesma medicação e doses administradas na fazenda. As cabras experimentais apresentaram sinais clínicos e alterações macroscópicas e histológicas semelhantes às cabras intoxicadas espontaneamente. O diagnóstico de intoxicação por nitroxinil foi feito com base em dados epidemiológicos, clínicos e patológicos, e confirmado por intoxicação experimental. A administração de nitroxinil em altas doses, associada à alta temperatura ambiente e exercícios físicos, pode causar intoxicação com alta letalidade em caprinos.(AU)

Spontaneous and experimental poisoning by nitroxinil at 34% in goats

ABSTRACT: This study describes the epidemiological, clinical, and pathological aspects of spontaneous and experimental poisoning by nitroxinil at 34% concentration in goats. The outbreak occurred on a farm in the municipality of Prata, Paraíba state. Nitroxinil was administered to a herd of 120 goats, of which 18 presented with anorexia, vocalization, abdominal distension, weakness, staggering, and falls. Necropsy of three goats revealed that the main lesion was acute liver injury. Histologically the liver showed centrilobular necrosis associated with hemorrhage and hepatocyte degeneration. In the kidneys, tubular nephrosis with granular cylinder formations was observed. The lungs showed multifocal to coalescent areas of moderate interalveolar edema and vascular congestion. Experimental poisoning was carried out in two goats, with the same medication and doses administered on the farm. The experimental goats showed clinical signs and macroscopic and histological changes similar to the spontaneously poisoned goats. The diagnosis of nitroxinil poisoning was made based on epidemiological, clinical, and pathological data, and confirmed by experimental poisoning. The administration of nitroxinil in high doses, associated with high ambient temperature and physical exercises, can cause poisoning with high lethality in goats.

RESUMO: Este estudo descreve os aspectos epidemiológicos, clínicos e patológicos da intoxicação espontânea e experimental por nitroxinil na concentração de 34% em caprinos. O surto ocorreu em uma fazenda no município de Prata, Paraíba. Nitroxinil foi administrado a um rebanho de 120 cabras, das quais 18 apresentavam anorexia, vocalização, distensão abdominal, fraqueza, cambaleando e quedas. A necropsia de três cabras revelou que a lesão principal era uma lesão hepática aguda. Histologicamente, o fígado apresentava necrose centrolobular associada a hemorragia e degeneração de hepatócitos. Nos rins, nefrose tubular com formações de cilindro granular foi observada. Os pulmões apresentavam áreas multifocais a coalescentes de edema interalveolar moderado e congestão vascular. A intoxicação experimental foi realizada em duas cabras, com a mesma medicação e doses administradas na fazenda. As cabras experimentais apresentaram sinais clínicos e alterações macroscópicas e histológicas semelhantes às cabras intoxicadas espontaneamente. O diagnóstico de intoxicação por nitroxinil foi feito com base em dados epidemiológicos, clínicos e patológicos, e confirmado por intoxicação experimental. A administração de nitroxinil em altas doses, associada à alta temperatura ambiente e exercícios físicos, pode causar intoxicação com alta letalidade em caprinos.

Falla hepática aguda / Acute liver failure

La falla hepática aguda es la pérdida súbita de la función hepática en un corto plazo en un paciente sin enfermedad hepática previa, que se acompaña de coagulopatía y encefalopatía. Es una entidad rara con una incidencia muy baja que afecta especialmente a personas jóvenes. La principal causa en países desarrollados es la toxicidad por acetaminofén, mientras que en los países subdesarrollados son las hepatitis virales. El curso natural de la enfermedad es la progresión rápida a muerte por falla orgánica multisistémica, sepsis o edema cerebral. Después del diagnóstico, los pacientes deben remitirse tempranamente a la unidad de cuidado intensivo y a centros que ofrezcan trasplante hepático. La supervivencia sin trasplante hepático hasta hace pocos años era menor al 15%; sin embargo, en la actualidad puede ser hasta del 50%, dependiendo de la causa, y está relacionada con tratamientos específicos, la disponibilidad de trasplante hepático y una atención óptima en las unidades de cuidados intensivos. El trasplante hepático se constituye en el tratamiento de elección para los pacientes con falla hepática aguda y criterios de mal pronóstico del King's College.

Acute liver failure is the severe short-term liver function impairment in a patient without previous liver disease, which is accompanied by coagulopathy and encephalopathy. It is a rare condition with a very low incidence that affects young people. The leading cause in developed countries is acetaminophen toxicity, while in developing countries is mainly caused by viral hepatitis. The natural course is characterized by a rapid progression to death due to multisystemic organ failure, sepsis, or cerebral edema. After diagnosis, patients must be transferred to the intensive care unit and liver transplantation centers. Survival without liver transplantation until a few years ago was less than 15%; however, currently it can be up to 50% depending on the cause, and it is related to specific treatments, availability of liver transplantation and optimal care in the intensive care units. Liver transplantation is the treatment of choice for patients with acute liver failure and King's College criteria for poor prognosis.

Aspectos epidemiológicos, clínicos e anatomopatológicos da hepatite infecciosa canina: 15 casos / Epidemiological, clinical and pathological aspects of infectious canine hepatitis: 15 cases

Descrevem-se os principais aspectos epidemiológicos, clínicos e anatomopatológicos de casos de hepatite infecciosa canina diagnosticados no Laboratório de Patologia Animal da Universidade Federal de Campina Grande, durante o período de janeiro de 2003 a dezembro de 2016. Dos 1.640 cães necropsiados, 15 foram diagnosticados como hepatite infecciosa canina (0,91%). Dos cães acometidos nove eram machos e seis fêmeas. As idades variaram de 45 dias a sete anos, sendo a maioria filhotes. Dez animais não apresentavam raça definida, quatro eram Poodles e um Rottweiler. A maioria dos cães não recebeu nenhum tipo de protocolo vacinal. Os cães eram oriundos dos municípios de Patos, São Mamede e Teixeira, pertencentes ao estado da Paraíba, Nordeste do Brasil. A maioria dos cães apresentou curso clínico variando de hiperagudo a agudo. Os principais sinais clínicos foram convulsão, apatia e hiporexia. Na necropsia, as principais alterações foram observadas no fígado que se apresentava de pálido a alaranjado e com áreas irregulares avermelhadas na superfície capsular, além de acentuação do padrão lobular e edema na parede da vesícula biliar. Hemorragias foram observadas em vários órgãos. Na histopatologia havia necrose centrolobular de hepatócitos associada a corpúsculos de inclusão viral intranucleares, hemorragia e infiltrado inflamatório misto. O diagnóstico foi estabelecido com base nas características lesões histopatológicas e foi confirmado por imuno-histoquímica. A hepatite infecciosa canina ocorre ocasionalmente na Paraíba, acometendo particularmente cães jovens e não vacinados.(AU)

We described the main epidemiological, clinical and pathological aspects of canine infectious hepatitis diagnosed in the Laboratory of Animal Pathology of the Federal University of Campina Grande during the period from January 2003 to December 2016. Of the 1,640 necropsied dogs, 15 were diagnosed as infectious canine hepatitis (0.91%). Of the dogs affected nine were males and six females. The ages ranged from 45 days to seven years, being most of them young. Ten animals were mixed breed, four were Poodles and one Rottweiler. Most of the dogs do not received any vaccine protocol. The dogs came from the municipalities of Patos, São Mamede and Teixeira, from Paraiba, northeastern of Brazil. Most of the dogs presented clinical course varying from hyperacute to acute. The main clinical signs were seizure, apathy and hyporexia. At necropsy, the major alterations were observed in the liver, which was pale to orange and with irregular reddish areas on the capsular surface, besides accentuation of the lobular pattern and edema in the wall of the gallbladder. Hemorrhages were observed in several organs. In the histopathology there was centrolobular necrosis of hepatocytes associated with intranuclear viral inclusion bodies, hemorrhages and mixed inflammatory infiltrate. The diagnosis was established based on the characteristic histopathological lesions and was confirmed by immunohistochemistry. Infectious canine hepatitis occurs occasionally in the Paraiba, affecting particularly young and unvaccinated dogs.(AU)

Comparação dos efeitos das folhas de Cestrum axillare Vell. com as saponinas isoladas em caprinos / Comparison of the effects of Cestrum axillare leaves with isolated saponins in goats

Cestrum axillare Vell. (formerly Cestrum laevigatum Schltd.), family Solanaceae, is the most important hepatotoxic plant in Brazil that causes acute poisoning. It occurs in the Southeast and Center-West regions and in coastal areas of the Northeast Brazil. Spontaneous poisoning was described in cattle, goats and sheep, with clinical signs evidenced within 24 hours after ingestion of the leaves and death within 48 hours after signs onset. The clinical signs observed in acute poisoning are apathy, anorexia, ruminal arrest, arched back, constipation with feces in small spheres, sometimes covered with mucus and blood streaks, muscle tremors, staggering gait and sometimes sialorrhoea. Neurological signs may be observed, due to interference in the urea cycle due to hepatic insufficiency resulting in hyperammonemia (hepatic encephalopathy). The main pathological finding is centrilobular hepatic necrosis. The toxic principle present in C. axillare was not yet definitively proven, but some authors attribute the toxicity of the plant to the presence of saponins gitogenin and digitogenin. However, it has not been determined whether the saponins present in C. axillare are responsible for the hepatotoxic effect of the plant. Thus, the objective of this work is to determine if the saponins are the compounds responsible for the hepatotoxic effects produced by the ingestion of the leaves of C axillare, using goats as experimental model. For this, the effects of the administration of the leaves were compared with those produced by the saponins isolated from the leaves in goats. Six goats were randomly assigned to three experimental groups that received [1] dry leaves of C. axillare (animals A1 and A2), [2] saponins extract from leaves (animals S1 and S2) or [3] control group (animals C1 and C2). For goats receiving the dry leaves the administered dose of plant was 10g/kg for one animal (A1) and 5g/kg for the other one (A2). For animals receiving the saponins extract, administration was done at a dose equivalent to 20g/kg repeated after 24 hours. The dry leaves administered at a dose of 10g/kg to a goat produced toxic effects, with alterations in biochemistry (indicating hepatic lesion) and histopathology showing centrilobular hepatic necrosis. At the dose of 5 g/kg of dry leaves, clinical signs of poisoning were not observed, but hepatic necrosis was found; after 15 days after the last administration, the hepatic parenchyma of this animal was already normal, with only hemorrhagic areas, demonstrating full regeneration. The administration of extracts of saponins containing gitogenin and digitogenin to goats did not produce significant toxic effects, proving that these compounds are not responsible for intoxication. In addition, goats are a good experimental model for studies of this intoxication.(AU)

Cestrum axillare Vell. (anteriormente C. laevigatum Schltd.), família Solanaceae, é a mais importante planta hepatotóxica do Brasil que causa intoxicação aguda. Tem ocorrência nas regiões Sudeste e Centro-Oeste e em áreas litorâneas do Nordeste. A intoxicação natural foi descrita em bovinos, caprinos e ovinos, com sinais clínicos evidenciados em até 24 horas após a ingestão das folhas e morte em até 48 horas após o início da sintomatologia. Os sinais clínicos observados na intoxicação aguda são apatia, anorexia, parada ruminal, dorso arqueado, constipação com fezes em formas de pequenas esferas, por vezes recobertas com muco e com estrias de sangue, tremores musculares, andar cambaleante e, às vezes, sialorreia. Podem ser observados sinais neurológicos, devido à interferência no ciclo da ureia pela insuficiência hepática resultando em hiperamonemia (encefalopatia hepática). O principal achado patológico é a necrose hepática centrolobular. O princípio tóxico presente no C. axillare ainda não está definitivamente comprovado, mas alguns autores atribuem a toxicidade da planta à presença das saponinas gitogenina e digitogenina. No entanto, ainda não foi determinado se as saponinas presentes em C. axillare são as responsáveis pelo efeito hepatotóxico da planta. Assim, o objetivo deste trabalho é determinar se as saponinas são os compostos responsáveis pelos efeitos hepatotóxicos produzidos pela ingestão das folhas de C. axillare, usando caprinos como modelo experimental. Para isto, foram comparados os efeitos da administração das folhas com os produzidos pelas saponinas isoladas destas folhas em caprinos. Foram utilizados seis caprinos, distribuídos aleatoriamente em três grupos experimentais que receberam [1] folhas secas de C. axillare (Caprinos A1 e A2), [2] extrato de saponinas das folhas (Caprinos S1 e S2), e [3] grupo controle (Caprinos C1 e C2). Para os caprinos que receberam as folhas secas a dose administrada de planta foi de 10g/kg para um animal (A1) e de 5g/kg para outro (A2). Para os animais que receberam o extrato de saponinas, a administração foi feita na dose equivalente a 20g/kg, repetida após 24 horas. Foi verificado que as folhas secas, quando administradas na dose de 10g/kg a um caprino, produziram efeitos tóxicos, com alterações na bioquímica (indicando lesão hepática) e histopatológica apresentando necrose hepática centrolobular. Na dose de 5g/kg de folhas secas, não foi observado sintomatologia clínica da intoxicação, mas houve necrose hepática; 15 dias após a última administração, o parênquima hepático deste animal já se encontrava normal, apenas com áreas hemorrágicas, demonstrando plena regeneração. A administração do extrato de saponinas contendo gitogenina e digitogenina a caprinos não produziu efeitos tóxicos significantes, comprovando não serem estes compostos os responsáveis pela intoxicação. Além disto, a espécie caprina é um bom modelo experimental para estudos desta intoxicação.(AU)

A case of severe corrosive esophagitis, gastritis, and liver necrosis caused by ingestion of methyl ethyl ketone peroxide

The plastic hardener methyl ethyl ketone peroxide is unstable peroxide that releases free oxygen radicals. Ingestion of this compound induces widespread liver necrosis, severe metabolic acidosis, corrosive esophagitis and gastritis, that is often fatal. A 49-year-old man unintentionally ingested approximately 100 mL (55%) of this compound in solution, which was purchased as plastic hardener. Despite resuscitation, he died about 11 hours after admission. We report a patient with poisoning due to methyl ethyl ketone peroxide who presented with corrosive esophagitis and gastritis, gastrointestinal bleeding, and developed ischemia of the bowel and necrosis of the liver and died of severe metabolic acidosis and multiorgan failure.

Chemotherapy induced liver abnormalities: an imaging perspective

Treating patients undergoing chemotherapy who display findings of liver toxicity, requires a solid understanding of these medications. It is important for any clinician to have an index of suspicion for liver toxicity and be able to recognize it, even on imaging. Cancer chemotherapy has evolved, and newer medications that target cell biology have a different pattern of liver toxicity and may differ from the more traditional cytotoxic agents. There are several hepatic conditions that can result and keen clinical as well as radiographic recognition are paramount. Conditions such as sinusoidal obstructive syndrome, steatosis, and pseudocirrhosis are more commonly associated with chemotherapy. These conditions can display clinical signs of acute hepatitis, liver cirrhosis, and even liver failure. It is important to anticipate and recognize these adverse reactions and thus appropriate clinical action can be taken. Often times, patients with these liver manifestations can be managed with supportive therapies, and liver toxicity may resolve after discontinuation of chemotherapy.

Novos aspectos sobre a intoxicação por Trema micrantha (Cannabaceae) em equídeos / New aspects of Trema micrantha (Cannabaceae) poisoning in equids

Trema micrantha é uma planta arbórea distribuída amplamente no Brasil. Descrevem-se nesse trabalho novos aspectos epidemiológicos e patológicos relacionados com a intoxicação por essa planta em equídeos. Dois equinos adultos da raça Crioula e dois asininos, de localidades distintas, foram intoxicados naturalmente por Trema micrantha, após consumirem grande quantidade da planta que ficou disponível a eles após uma poda. Além disso, um cavalo adulto, de outra propriedade, que estava passando por restrição alimentar, se intoxicou após consumir as partes baixas de um grande número de árvores jovens de T. micrantha. Clinicamente, em todos os equídeos a doença se caracterizou por alterações neurológicas, que apareceram três a quatro dias após o consumo da planta, com curso clínico de dois a quatro dias (abreviadas por eutanásia). Os principais achados de necropsia foram observados no fígado, que estavam levemente aumentados e com padrão lobular evidente e no sistema nervoso central (SNC), com múltiplas áreas amareladas, focos de malacia e hemorragia, principalmente, no tronco cerebral e cerebelo. Histologicamente, havia necrose hepática aguda, edema acentuado no SNC com degeneração fibrinoide da parede de vasos associada a hemorragia e trombose e, frequentemente, com infiltrado de neutrófilos. Outras alterações observadas nos encéfalos foram: grande quantidade de astrócitos de Alzheimer tipo II na substância cinzenta, acúmulos de células Gitter e degeneração Walleriana próxima a focos de lesões vasculares.

Trema micrantha is a tree widely distributed in Brazil. This paper describes new epidemiological and pathological aspects of this plant poisoning in equids. Two adult horses, Criollo breed and two donkeys from different locations were naturally poisoned by Trema micrantha after consuming large amounts of the plant which was available to them due to pruning. Also an adult horse from another ranch, which was undergoing dietary restriction, was poisoned after consuming the lower parts of a large number of young T. micrantha trees. Clinically, in all cases, the disease was characterized by neurological symptoms that started 3 to 4 days after consumption of the plant, with a clinical course that varied 2 to 4 days (abbreviated by euthanasia). The main gross findings were in the liver, which had slightly increased lobular pattern evident, and in the central nervous system (CNS) with multiple yellowish areas, foci of malacia and hemorrhage, especially in the brainstem and cerebellum. Histologically, there was acute liver necrosis with marked edema of the CNS with fibrinoid vessel wall degeneration, hemorrhage and thrombosis as well as neutrophil infiltration. Other changes in the brain were Alzheimer type II astrocytes in the gray matter, accumulation of Gitter cells and Wallerian degeneration near to vascular lesion foci.

Protective effect of aqueous extract of Feronia elephantum correa leaves on thioacetamide induced liver necrosis in diabetic rats

<p><b>OBJECTIVE</b>To evalueate hepatoprotective effects Feronia elephantum (F. elephantum) correa against thioacetamide (TA) induced liver necrosis in diabetic rats.</p><p><b>METHODS</b>Male wistar rats were made diabetic with alloxan (160 mg/kg) on day 0 of the study. They were intoxicated with hepatotoxicant (thioacetamide, 300 mg/kg, ip) on day 9 of study to produce liver necrosis. Effects of 7 day daily once administration (day 2 to day 9) of EF (400 and 800 mg/kg, po) were evaluated on necorosis of liver in terms of mortality, liver volume, liver weight, serum aspartate aminotransferase (AST) and serum alanine transaminase (ALT), and histopathology of liver sections (for signs of necorosis and inflammation) on day-9 of the study. Separate groups of rats with treated only with alloxan (DA control), thioacetamide (TA control) and both (TA+DA control) were maintained.</p><p><b>RESULTS</b>FE significantly lowered the mortality rate and showed improvement in liver function parameters in TA-induced diabetic rats without change in liver weight, volume and serum glucose levels.</p><p><b>CONCLUSIONS</b>FE showed promising activity against TA-induced liver necorsis in diabetic rats and so might be useful for prevention of liver complications in DM.</p>

Intoxicação aguda com sementes de Crotalaria spectabilis (Leg. Papilionoideae) em suínos / Acute poisoning with Crotalaria spectabilis (Leg. Papilionoideae) seeds in pigs

Relata-se necrose hepatocelular em suínos após consumo de ração que continha grãos de sorgo-granífero (Sorghum bicolor) acidentalmente contaminado com sementes de Crotalaria spectabilis. Morreram 76 suínos em quatro propriedades no município de Juscimeira, MT. Os sinais clínicos iniciaram-se 24-48 horas após o consumo da ração contaminada e foram caracterizados por depressão, letargia, apatia, inapetência, vômito, mucosas ictéricas ou pálidas, ascite, decúbito esternal, decúbito lateral com movimentos de pedalagem e convulsões, a evolução clínica foi de 48-60 horas seguida de morte. As Principais alterações macroscópicas foram fígado aumentado de tamanho com evidenciação do padrão lobular, ascite e hidrotórax com líquido de coloração amarelo avermelhado contendo filamentos com aspecto de fibrina, linfonodos aumentados e edema pulmonar interlobular. A doença foi reproduzida utilizando-se 16 suínos divididos em seis grupos que receberam sementes de C. spectabilis em diferentes doses. Necrose hepatocelular ocorreu em sete suínos, sendo dois que receberam doses diárias 2,5g/kg e cinco que receberam doses únicas de 5,0 e 9,5g/kg. Dez doses diárias de 0,5 e 1,25g/kg causaram fibrose hepática.

Hepatocellular necrosis are reported in swine after consumption of diets containing grains of "sorgo-granífero" (Sorghum bicolor) accidentally contaminated with Crotalaria spectabilis seeds in the municipality of Juscimeira, MT. Clinical signs began 24-48 hours after consumption of contaminated ration and were characterized by depression, lethargy, apathy, loss of appetite, vomiting, pale or jaundiced mucous membranes, ascites, lateral recumbency, the lateral position with paddling and convulsions, clinical outcome was 48-60 hours followed by death. 76 pigs died in four properties. The main gross lesions were liver increased in size and lobular illustration with red-brown central areas interspersed with yellowish areas, ascites and hydrothorax with reddish-yellow liquid containing filaments with aspect of fibrin, enlarged lymph nodes and interlobular pulmonary edema. The disease was experimentally reproduced with 16 pigs divided into six groups that received seeds of C. spectabilis in different doses. Hepatocellular necrosis occurred in seven pigs, two of which received daily doses of 2.5g/kg and five who received single doses of 5 and 9.5g/ kg. Ten daily doses of 0.5 and 1.25g/kg caused liver fibrosis.

Transcriptome Analysis of the Effects of Gomisin A on the Recovery of Carbon Tetrachloride-Induced Damage in Rat Liver / 한국실험동물학회지

Gomisin A possesses a hepatic function-facilitating property in liver-injured rats. Its preventive action on carbon tetrachloride-induced cholestasis is due to maintenance of the function of the bile acids-independent fraction. To investigate alterations in gene expression after gomisin A treatment on injured rat liver, DNA microarray analyses were performed on a Rat 44K 4-Plex Gene Expression platform with duplicated reactions after gomisin A treatment. We identified 255 up-regulated and 230 down-regulated genes due to the effects of gomisin A on recovery of carbon tetrachloride-induced rat liver damage. For functional characterization of these genes, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes biochemical pathways analyses were performed. Many up-regulated or down-regulated genes were related to cell cycle or focal adhesion and cell death genes, respectively. Our microarray experiment indicated that the liver repair mechanism induced by gomisin A was strongly associated with increased gene expressions related to cell cycle and suppression of the gene expression related in cell death.

Síndrome HELLP com necrose hepática maciça: relato de caso / HELLP syndrome with massive hepatic necrosis: case report

Essa síndrome pode ocorrer em diferentes fases da gestação e no pós-parto, sendo mais comum no segundo ou terceiro trimestre. É caracterizada por hemólise, aumento das aminotransferases e plaquetopenia (HELLP: HEmolysis, Liver Ezimes, Low Platelets)1 .Representa alteração microangiopática no fígado, que ocorre na pré-eclâmpsia grave e na eclâmpsia com frequência de 2 a 12%. Seu risco está aumentado em pacientes com múltiplas gestações, associado à idade maior de 25 anos.1 A suspensão da gravidez interrompe o curso desse distúrbio e outras gestações podem novamente desencadeá-lo.2 A sintomatologia inicial caracteriza-se por: dor no andar superior do abdômen, especialmente no hipocôndrio direito, náuseas e vômitos.1 Pode evoluir com convulsões, sangramento gengival e hematúria.1,3 A abordagem ao paciente inclui internação em Centro de Terapia Intensiva para monitorização adequada; interrupção da gravidez, na possibilidade de viabilidade do feto; e cirurgia de urgência em caso de hemorragia intraperitoneal.2(AU)

This syndrome may occur at different stages of pregnancy and postpartum being more common in the second or third quarter. HELLP syndrome is characterized by a disorder during pregnancy, attending with hemolysis, increased aminotransferases and thrombocytopenia. Microangiopthy is a change occurs on the liver in pre-eclampsia serious and often eclâmpsia of 2 to 12%. Multiple pregnancies associated with an old age, over 25 years, increase the risk for HELLP syndrome.3 It is the acronym: HEmolysis, liver Ezimes, low platelets.3 Abortion interrupted the course of disease and other pregnancies unleash again syndrome.2 The original symptoms are: pain in the upper floor of the abdomen, especially in the right hypochondrium, nausea and vomiting.3 The symptoms may evolve with convulsions, bleeding edge and hematuria.1,3 The treatment requires monitoring, interruption of pregnancy in the possibility of fetal viability, emergency surgery in case of hospitalization and intraperitoneal hemorrhage in intensive care center.2(AUI)

Massive hepatic necrosis with large regenerative nodules / 대한간학회지

No abstract available.

Achados clínicos e patológicos em cães infectados naturalmente por herpesvírus canino / Clinical and pathological Findings in dogs infected naturally by canine herpes virus

Descrevem-se os achados clínicos e patológicos e os exames laboratoriais de filhotes de cães com diagnóstico post mortem de infecção por herpesvírus canino. Os casos ocorreram em duas propriedades da Cidade de Porto Alegre, Rio Grande do Sul, em abril de 2007 e julho de 2008. Clinicamente, os cães apresentaram anorexia, apatia, choro e dispneia. A morte dos cães ocorreu após 24-72 horas do início dos sinais clínicos. Na necropsia observaram-se hemorragia multifocal renal e hepatomegalia com petéquias e pontos brancos na superfície natural do fígado. Os pulmões se apresentaram não-colapsados e vermelhos. Havia esplenomegalia e, em alguns cães, petéquias na superfície capsular do baço. Aumento dos linfonodos mesentéricos e do timo foi observado. Lesões microscópicas incluíram hemorragia e necrose multifocal em células epiteliais tubulares renais, hepatócitos e tecidos linfoides. Nos pulmões, havia necrose alveolar multifocal acentuada com abundante material fibrinoso e infiltrado inflamatório misto de intensidade variada. Ocasionais corpúsculos de inclusão intranucleares em áreas periféricas à necrose foram identificados em hepatócitos, células epiteliais de túbulos renais e células alveolares. Amostras de fígado, rim e pulmão foram positivas na imunofluorescência direta para herpesvírus canino tipo 1 (CHV-1). O diagnóstico de infecção por herpesvírus foi baseado nos achados de necropsia, histológicos e de imunofluorescência positiva em tecidos usando anticorpo anti-CHV-1. De nosso conhecimento, este é o primeiro relato da identificação do CHV-1 no Brasil, embora achados clínico-patológicos anteriores já sugerissem a presença do agente na população canina do país.

The clinic and pathological findings and laboratorial testing of puppies with postmortem diagnosis of canine herpesvirus infection are described. The cases occurred in two households of Porto Alegre, RS, in April 2007 and July 2008. The puppies presented anorexia, depression, cry and dyspnea, followed by death about 24-72 hours after the onset of clinical signs. At necropsy multifocal pin point hemorrhages were observed in the kidneys. The liver was enlarged with petechiae and white foci on the surface. The lungs were red and did not collapse. The spleen was enlarged and, in some cases, with petechiae on the capsular surface. Mesenteric lymph nodes and thymus were enlarged. Microscopic lesions included hemorrhages and multifocal necrosis of the renal tubular epithelial cells, hepatocytes and lymphoid tissues. In the lungs there was severe multifocal alveolar necrosis with abundant fibrin deposits and a mixed inflammatory infiltrate of variable intensity. Intranuclear inclusion bodies were identified in the periphery of necrotic areas in hepatocytes, renal tubular epithelial cells and alveolar cells. Samples of liver, kidney and lung were positive in the direct immunofluorescence test for canine herpes virus type 1 (CHV-1). The diagnosis was based on epidemiological data, necropsy findings, histological lesions and positive immunofluorescence results using CHV-1 antibody in tissue samples. To our knowledge, this is the first report of the identification of CHV-1 in Brazil, although previous clinic and pathological findings already suggested the presence of the virus in Brazilian canine population.

Intoxicação por larvas de Perreyia flavipes em bovinos na região sul do Rio Grande do Sul / Perreyia flavipes larvae poisoning in cattle in southern Rio Grande do Sul, Brazil

Descrevem-se três surtos de intoxicação por larvas de Perreyia flavipes Konow, 1899 (Hymenoptera: Pergidae) ocorridos em bovinos durante os meses de julho e agosto de 2006. A morbidade foi de 0,8 por cento, 6,2 por cento e 33 por cento nos três estabelecimentos, respectivamente. A letalidade foi de 100 por cento. Os sinais clínicos nos três surtos caracterizaram-se por depressão, icterícia, decúbito com movimentos de pedalagem e morte em 24-48 horas. Macroscopicamente o fígado dos animais necropsiados estava aumentado de tamanho e com marcada acentuação do padrão lobular, os linfonodos hepáticos e mesentéricos estavam edemaciados e as placas de Peyer na mucosa do intestino delgado estavam deprimidas. Petequias e equimoses foram observadas no mesentério e abomaso. Histologicamente observou-se degeneração e necrose hemorrágica hepática que variou de centrolobular, se estendendo a região a mediozonal, ou massiva. Havia, ainda, marcada hemossiderose e necrose dos centros germinativos dos linfonodos, da polpa branca do baço e das placas de Peyer no intestino. A intoxicação ocorreu provavelmente em conseqüência da intensa seca observada na região nos meses de outubro a dezembro de 2005, período em que o inseto se encontra na forma de casulo enterrado no solo. A seca proporcionou maior emergência de adultos e conseqüentemente maior quantidade de posturas. A grande quantidade de matéria vegetal em decomposição devido às precipitações próximas do normal no verão proporcionou ambiente ideal para o desenvolvimento das larvas no período de inverno o que provavelmente levou à intoxicação.

Three outbreaks of poisoning by Perreyia flavipes Konow, 1899 (Hymenoptera: Pergidae) in cattle during July and August 2006 in southern Brazil are reported. The morbidity rate was 0.8 percent, 6.2 percent and 33 percent on the 3 farms, respectively. Fatality rate was 100 percent. Clinical signs were depression, jaundice, recumbence, pedaling movements and death in 24-48 hours. The liver was enlarged with increased lobular pattern, the mesenteric lymph nodes were edematous and Peyer patches of the small gut were depressed. Petechial hemorrhages and ecchymosis were observed in the mesentery and abomasum. On histologic examination the liver showed centrolobular or massive necrosis. Hemosiderosis and necrosis of the germinative centers of lymph nodes, white pulp of the spleen and Peyer patches were also observed. The poisoning occurred probably due to an intense drought in October-December 2005, when the insect stayed as a cocoon underground. The dry conditions probably avoided a higher number of adult sawflies to emerge from the cocoons, what resulted in greater egg production. The large amount of decaying grass due to almost normal rain fall during summer seemed to have provided favorable environmental conditions for the development of larvae in winter.

Focal eosinophilic hepatic necrosis / 대한내과학회지

No abstract available.

Necrose isquêmica hepática e diabete melito: relato de caso / Liver ischemic necrosis and diabetes mellitus: case report

JUSTIFICATIVA E OBJETIVOS: O infarto hepático é definido como necrose isquêmica do parênquima hepático envolvendo pelo menos dois ácinos. Trata-se de evento considerado raro devido ao duplo suprimento sangüíneo, arterial e venoso. O objetivo deste estudo foi relatar um caso de paciente não sabidamente diabética que desenvolveu extensas áreas isquêmicas de infarto hepático, após quadro de descompensação aguda da diabete. RELATO DO CASO: Paciente do sexo feminino, 67 anos, hipertensa, procurou o Pronto Socorro com queixas de polidipsia, poliúria, turvação visual, náuseas e vômitos, dificuldade para deambular, havia aproximadamente 10 dias. Ao exame físico foi observado desidratação, palidez cutânea, cianose periférica, hipotermia, taquicardia, hipotensão, dor abdominal leve e difusa. Exames laboratoriais mostraram: leucócitos: 16800, creatinina (Cr): 3,7, uréia (Ur): 167, Na: 133, K: 6.9, glicose: 561; gasometria arterial (cateter de oxigênio: 2 L/min): pH: 6.93, pCO2: 12.1, pO2: 107, BE: -28,8, HCO3: 2,4, Sat 91,3 por cento, lact: 79; urina I: pH: 6,0; leucócitos: 13; densidade: 1015; eritrócitos: 19; proteína: ++; glicose: +++; bilirrubina: negativa; corpos cetônicos: + denotando cetonemia. Eletrocardiograma com onda T apiculada, bloqueio de ramo direito. A paciente foi tratada com insulina, hidratação, bicarbonato de sódio e introduzido antibioticoterapia. Após o tratamento inicial, os exames laboratoriais mostraram: Cr: 2,2, Ur: 122, Na: 162, K: 4,3, Ca: 6,4, glicose: 504, pH: 7,01, HCO3: 7.1, BE: - 22. Um dia após, a paciente apresentou importante dor abdominal acompanhada de irritação peritoneal, além de sonolência e dificuldade para falar; exames laboratoriais mostraram: pH: 7,4, pCO2 : 31, pO2: 68, BE: -4,4, HCO3: 19, Sat.O2: 93,5 por cento; Ur: 95; Cr: 1,4, albumina: 2,4, Ca: 0,95, Na: 166, K:4, bilirrubina: 0,5, bilirrubina D/I: 0,2/0,3, amilase: 1157, Gama-GT: 56, AST 7.210, ALT: 2.470, VHS: 15, lipase: 84. Ultrasonografia abdominal...

BACKGROUND AND OBJECTIVES: Hepatic infarction is characterized by parenchyma ischemic necrosis involving at least two acinis. It is extremely uncommon due to the arterial and portal venous blood supply. We report a case of a patient not know to have diabetes who developed massive areas of ischemic infarcts of the liver after episode of acutely diabetes decompensated. CASE REPORT: A 67 year-old hypertensive female who has been presenting, for the last 10 days, polydipsia, high urinary volume, visual and gait impairment, nausea and vomiting was admitted to the emergency room (ER). During the physical examination it was observed dehydration, skin discoloration, peripheral cyanosis, hypothermia, tachycardia, hypotension and mild diffuse abdominal pain. Admissional laboratory exams demonstrated total leukocytes: 16.800, Cr: 3.7, Ur: 167, Na: 133, K: 6.9, glucose: 561; arterial gasometry (O2 catheter: 2 L/min): pH: 6.93, pCO2: 12.1, pO2: 107, B.E.: -28.8, HCO3: 2.4, Sat 91.3 percent, lactato: 79; urinalysis: pH: 6; leukocytes: 13; density: 1015; erythrocytes: 19; protein: ++; glucose: +++; bilirubin: negative; ketonic bodies: + denote ketonemia. EKG: sharp T wave, right branch block. Patient was treated with intravenous insulin, hydration, sodium bicarbonate and ceftriaxone. After initial treatment, the laboratory exams showed Cr: 2.2, Ur: 122, Na: 162, K: 4.3, Ca: 6.4, glucose: 504, pH: 7.01, HCO3: 7.1, B.E.: -22. One day after admission the patient presented with important abdominal pain and peritoneal irritation, followed by difficulty for talking and somnolence; routine laboratory exams showed arterial gasometry: pH: 7.4, pCO2: 31, pO2: 68, BE: -4.4, HCO3: 19, SatO2: 93.5 percent; Ur: 95,Cr: 1.4, albumin: 2.4, Ca: 0.95, Na: 166, K:4, bilirubin: 0.5, bilirubin D/I: 0.2/0.3, Amylase: 1157, Gamma-GT: 56, AST 7.210, ALT: 2.470, SR (sedimentation rate): 15, Lipase: 84. Abdominal ultrasound was unremarkable. Patient respiratory function and conscience...

Clinical usefulness of serum isocitrate dehydrognase as a marker of centrilobular hepatic necrosis in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: The zonal differentiation of hepatic necrosis is important in the aspect of treatment, follow-up and prognosis of patients. The purpose of this study was evaluating the clinical usefulness of serum isocitrate dehydrogenase (ICDH) as a marker of centrilobular hepatic necrosis in patients with hyperthyroidism. METHODS: We determined the serum ICDH and alanine aminotransferase (ALT) activities in 56 patients with hyperthyroidism, 16 patients with chronic viral hepatitis, and 17 normal controls. RESULTS: The activities of serum ICDH were significantly higher in patients with hyperthyroidism than those of patients with chronic viral hepatitis or normal control (p< 0.01), even though those of serum ALT were higher in patients with chronic viral hepatitis (p< 0.01). The ratio of serum ICDH and ALT activities were markedly different between the patients with hyperthyroidism and chronic viral hepatitis (p< 0.001). There was a significant correlation between the serum ICDH and ALT activities in patients with hyperthyroidism as well as in those with chronic viral hepatitis (p< 0.05). In patients with hyperthyroidism, the serum ICDH levels were more significantly correlated with serum triiodothyronine (T3) than thyroxine (T4) levels. In a patients with hyperthyroidism and elevated ALT levels, the serum ICDH activity decreased progressively and was normalized ultimately, as serum ALT level and thyroid function were normalized with antithyroid medication. CONCLUSION: The serum ICDH or ratio of serum ICDH and ALT activities might be useful clinically in differentiating the centrilobular from periportal hepatic necrosis, and following up the degree of hepatic necrosis in patients with hyperthyroidism.

Diffuse hepatic necrosis with enlargement of the liver (acute and subacute yellow atrophy) - report of two fatal cases

Two cases showing extensive hepatic necrosis but with enlargement of the liver are hereby reported2. Both are multiparas and both are in the third decade of life (both 38 years old)3. Both had bleeding as the main complaint although one was having a miscarriage at the time of admission and the other hydatidiform mole which was later found malignant4. Both had clinical and laboratory findings suggestive of urinary tract infection; both had jaundice - one of several months duration and the other only of two weeks. Both had febrile reaction especially towards the latter part of the disease5. Bilirubin I findings were high in both - almost 2 mgs. per 100 c.c. in one and well above I mg. per 100 c.c. in the other - strongly suggesting liver destructive process6. On autopsy both livers failed to show gross evidences of liver destructive processes but histological examinations revealed diffuse necrosis of the liver cells in both organs7. The term "diffuse liver necrosis" appears more appropriate than the term "yellow atrophy" to designate these clinical conditions and pathologic processes since liver necrosis may not always be accompanied by atrophic changes. (Summary and Recommendations)

PRELIMINARY OBSERVATION ON THE EXPERIMENTAL TREATMENT FOR ACUTE HEPATIC NECROSIS WITH GLUCAGON AND INSULIN / 第二军医大学学报

An experiment of treatment for acute hepatic necrosis with glucagon, insulin branched chain aminoacid and scopolamine in rats was reported.Liver specimens were investigated microscpically and a serial changes of 3H-TdR were evaluated.It is suggested that G-I therapy may reduce the hepatic injury and may also accelerate the regeneration of hepatic cells in D-gal-induced hepatic injiury.G-I thfrapy may be effective for prevention of progressing hepatic necrosis and promotion of hepatic regeneration in fulminant hepatic failure.