Carcinoma hepatocelular en el Hospital Nacional Rosales entre los años 2009 y 2014 / Hepatocellular carcinoma at the Rosales National Hospital between 2009 and 2014

El carcinoma hepatocelular (CHC), es el cáncer primario de hígado más frecuente. Entre los factores de riesgo están la infección viral por hepatitis B y C, la cirrosis alcohólica, y la ocasionada por infiltración grasa (Diabetes mellitus). La modalidad de tratamiento depende del tamaño del tumor, el estado basal del hígado y la funcionalidad del paciente. En el Hospital Nacional Rosales recibe a estos pacientes y se desconoce su comportamiento. Se desarrolló un estudio descriptivo, longitudinal de seguimiento de una cohorte basado en datos retrospectivos de los expedientes de pacientes con CHC que consultaron en el Hospital Nacional Rosales con en los años del 2009 al 2014. Se encontró un total de 62 pacientes: 38 mujeres (61.3%) y 24 hombres (38.7%). Edad media de 62.48 años. Entre sus antecedentes: hepatitis 0, alcoholismo 12.90% (8 pacientes), 6 ya con cirrosis, y 1 agregado con diabetes mellitus; Diabetes mellitus en el 19.35%. Tiempo de presentar los síntomas entre 7 y 5 meses. Motivo de consulta: dolor abdominal en un 61.3% de casos, ictericia en un 14.5%. Método diagnóstico: La Tomografía Axial computarizada en 26 pacientes (41.94%), ultrasonografía en 21 pacientes (32.25%). Hubo 21 muertes (33.87%), documentadas y 39 perdidos de vista y 2 vivos y en consulta en el año 2015. Sobre vida global de 8.47 meses desde el diagnóstico. Conclusión: En nuestro hospital, el CHC se presenta más frecuentemente en mujeres, asociado a diabetes mellitus, con síntomas y signos de enfermedad avanzada que no les permite recibir ningún tratamiento y tienen 8.47 meses de sobrevida desde el diagnóstico

Diagnóstico y tratamiento de la hipercolesterolemia familiar en España: documento de consenso / Diagnosis and treatment of familial hypercholesterolemia in Spain: consensus document

La hipercolesterolemia familiar (HF) es un trastorno genético frecuente que se manifiesta desde el nacimiento y que causa un aumento en los niveles plasmáticos de colesterol-LDL (cLDL), xantomas y enfermedad coronaria prematura. Su detección y tratamiento precoz reduce la morbimortalidad coronaria. A pesar de la disponibilidad de un tratamiento eficaz, la HF está poco diagnosticada y tratada. La identificación de los casos índices y la posterior detección en cascada familiar utilizando los niveles de cLDL y la detección genética es la estrategia más coste-efectiva para la detección de nuevos casos. El tratamiento crónico con estatinas ha disminuido el riesgo cardiovascular a los niveles de la población general. Los objetivos en cLDL son < 130 mg/dl en los niños y adultos jóvenes, < 100 mg/dl en los adultos y < 70 mg/dl en los adultos con enfermedad coronaria conocida o diabetes. En la mayoría de los pacientes es difícil conseguir estos objetivos, por lo que puede ser necesario el tratamiento combinado con ezetimiba u otros fármacos. Cuando no se alcanzan los objetivos con el máximo tratamiento farmacológico tolerado, una reducción de cLDL ≥ 50% puede ser aceptable. La LDL-aféresis es útil en los pacientes homocigotos y en los heterocigotos graves resistentes al tratamiento. Este documento proporciona recomendaciones para el diagnóstico, cribado y tratamiento de la HF en niños y adultos, así como consejos específicos para los especialistas clínicos y médicos de atención primaria con el objetivo de mejorar el cuidado de los pacientes y reducir su carga de enfermedad cardiovascular (AU)

Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are < 130 mg/dL for children and young adults, < 100 mg/dL for adults, and < 70 mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥ 50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease (AU)

Diagnóstico y tratamiento de la hipercolesterolemia familiar en España: documento de consenso / Diagnosis and treatment of familial hypercholesterolemia in Spain: Consensus document

La hipercolesterolemia familiar (HF) es un trastorno genético frecuente que se manifiesta desde el nacimiento y que causa un aumento en los niveles plasmáticos de colesterol-LDL (cLDL), xantomas y enfermedad coronaria prematura. Su detección y tratamiento precoz reduce la morbimortalidad coronaria. A pesar de la disponibilidad de un tratamiento eficaz, la HF está poco diagnosticada y tratada. La identificación de los casos índices y la posterior detección en cascada familiar utilizando los niveles de cLDL y la detección genética es la estrategia más coste-efectiva para la detección de nuevos casos. El tratamiento crónico con estatinas ha disminuido el riesgo cardiovascular a los niveles de la población general. Los objetivos en cLDL son < 130 mg/dl en los niños y adultos jóvenes, < 100 mg/dl en los adultos y < 70 mg/dl en los adultos con enfermedad coronaria conocida o diabetes. En la mayoría de los pacientes es difícil conseguir estos objetivos, por lo que puede ser necesario el tratamiento combinado con ezetimiba u otros fármacos. Cuando no se alcanzan los objetivos con el máximo tratamiento farmacológico tolerado, una reducción de cLDL ≥ 50% puede ser aceptable. La LDL-aféresis es útil en los pacientes homocigotos y en los heterocigotos graves resistentes al tratamiento. Este documento proporciona recomendaciones para el diagnóstico, cribado y tratamiento de la HF en niños y adultos, así como consejos específicos para los especialistas clínicos y médicos de atención primaria con el objetivo de mejorar el cuidado de los pacientes y reducir su carga de enfermedad cardiovascular

Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are < 130 mg/dL for children and young adults, < 100 mg/dL for adults, and < 70 mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥ 50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease

[Diagnosis and treatment of familial hypercholesterolemia in Spain: consensus document]. / Diagnóstico y tratamiento de la hipercolesterolemia familiar en España: documento de consenso.

Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are < 130 mg/dL for children and young adults, <100mg/dL for adults, and < 70 mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥ 50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease.

[Diagnosis and treatment of familial hypercholesterolemia in Spain: Consensus document]. / Diagnóstico y tratamiento de la hipercolesterolemia familiar en España: documento de consenso.

Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are <130mg/dL for children and young adults, <100mg/dL for adults, and <70mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease.

Functional characterization of splicing and ligand-binding domain variants in the LDL receptor.

Familial hypercholesterolemia (FH) is an autosomal dominant disorder mostly caused by mutations in the LDLR gene. Although the detection of functional mutations in the LDLR gene provides an unequivocal diagnosis of the FH condition, there are many variants whose pathogenicity is still unknown. The aims of this study were to set up a rapid method to determine the effect of LDLR mutations, thereby providing an accurate diagnosis of FH, and to functionally characterize six LDLR mutations detected at high frequency by the LIPOchip(®) platform (Progenika Biopharma, Spain) in the Spanish population. LDLR expression and activity were analyzed by one-single-step flow cytometry assay and confocal microscopy. Splicing effects were determined by sequencing reverse transcription polymerase chain reaction products. The analysis of three heterozygous variants with a single point mutation within the low-density lipoprotein binding domain allowed us to classify the c.806G>A variant as nonpathogenic, and c.862G>A and c.895G>A variants as causative of FH. The results obtained for three variants affecting donor splice sites of the LDLR mRNA, c.313+2dupT, c.1186+5G>A, and c.1845+1G>C, demonstrated that these mutations are pathogenic. These results expand our knowledge of mutations responsible for FH, providing an accurate diagnosis and leading to early treatment to reduce the risk of premature cardiovascular events.

Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART).

AIM: Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART. METHODS AND RESULTS: A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe. CONCLUSION: Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.

Patogênese e achados clínicos, hematológicos e anatomopatológicos da infecção por Rangelia vitalii em 35 cães (1985-2009) / Pathogenesis, clinical, hematological, and pathological aspects of Rangelia vitalii infection in 35 dogs (1985-2009)

A patogênese e os achados clínicos, hematológicos e anatomopatológicos da infecção natural pelo protozoário Rangelia vitalii (rangeliose canina) foram estudados em 35 cães que morreram em consequência dessa condição. Os resultados obtidos permitem o seguinte conjunto de conclusões: (1) causa doença hemolítica exclusivamente extravascular e de origem imunomediada; (2) cursa invariavelmente com algum grau de hemorragia à necropsia, mas nem sempre clinicamente perceptível; (3) os principais sinais que devem chamar a atenção para a suspeita clínica são anemia, icterícia e esplenomegalia; (4) o principal achado hematológico e que deve chamar a atenção para a suspeita clínica é a ocorrência de anemia com sinais de intensa regeneração eritroide; (5) os três principais diagnósticos diferenciais são leptospirose, babesiose e erliquiose monocitotrópica aguda; (6) a principal lesão observada é uma associação de hiperplasia linfoide com inflamação mononuclear, predominantemente plasmocitária, mas por vezes granulomatosa; (7) outras lesões frequentes são secundárias à marcada anemia regenerativa; (8) o agente etiológico pode ser facilmente encontrado, pois ocorre em grande quantidade na maioria dos tecidos, principalmente nos linfonodos, no baço, na medula óssea, no coração e nas tonsilas.

The pathogenesis, clinical, hematological and pathological features of the natural infection by the protozoan organism Rangelia vitalii (canine rangeliosis) was studied in 35 dogs that died due this condition. The results allow for the following set of conclusions on canine rangeliosis: (1) causes an exclusively extravascular immune mediated hemolysis; (2) is invariably associated with some degree of hemorrhage observed at necropsy, but no always clinically apparent; (3) the clinical signs that are the hallmark of the disease are anemia, icterus and splenomegaly; (4) the main hematological aspect that establishes a clinical suspect is the development of anemia with signs of intense erythroid regeneration; (5) the three main differential diagnosis are leptospirosis, babesiosis and e acute monocytotropic ehrlichiosis; (6) the main observed histopathological lesion is an association of lymphoid hyperplasia with mononuclear inflammatory reaction, predominantly plasmacytic, but occasionally granulomatous; (7) other frequently found lesions are secondary to a marked regenerative anemia; (8) large numbers of the etiologic agent can be easily demonstrate in most tissues, mainly in lymph nodes, spleen, bone marrow, heart, and tonsils.

Taponamiento cardiaco como manifestación de un carcinoma de pulmón / Cardiac taponade as inicial symptom of lung carcinoma

No disponible

Bloqueo aurículo-ventricular completo por enfermedad de Chagas / Complete atrial-ventricular block as a consequence of Chaga´s disease

No disponible

La prueba de tiroglobulina tras hormona estimulante de la tiroides recombinante modifica la estrategia del seguimiento del cáncer diferenciado de tiroides / The thyroglobulin test after recombinant thyroid-stimulating hormone modifies the follow-up strategy in differentiated thyroid cancer

Introducción: El seguimiento del carcinoma diferenciado de tiroides (CDT) ha cambiado en los últimos años con la incorporación de la medición de la tiroglobulina (Tg) y de los rastreos corporales isotópicos (RCT) tras la administración de la hormona estimulante de la tiroides (TSH). Pacientes y métodos: En un estudio longitudinal que incluye a 60 pacientes que fueron diagnosticados de CDT, 37 de ellos de bajo riesgo, se ha evaluado la efectividad diagnóstica de la hormona estimulante de la tiroides recombinante humana (TSH-rh). Determinación sérica de Tg y del RCT tras la administración de TSH-rh. Resultados: La sensibilidad de la Tg bajo tratamiento supresor (inferior a 1 ng/ml) es de un 83% para el diagnóstico de recidiva, y su valor predictivo es negativo en un 98%. En el caso de la Tg tras TSH-rh (inferior a 2 ng/ml) esta sensibilidad es del 100%, con una especificidad del 98% y un valor predictivo negativo del 100%. El RCT no aportó ningún dato adicional. Conclusiones: La determinación de Tg tras la administración de TSH-rh es una prueba diagnóstica eficaz en el seguimiento de los pacientes con CDT. La concentración de Tg tras TSH-rh inferior a 2 ng/ml permite identificar con seguridad a los pacientes libres de enfermedad. Este hecho, y el hallazgo de que en nuestra serie el RCT tras TSH-rh no haya mejorado la sensibilidad diagnóstica que la determinación de Tg tras TSH-rh tiene aisladamente, permiten apoyar la aplicación de esta última como método único de seguimiento en pacientes de bajo riesgo

Introduction: Follow-up of patients with differentiated thyroid carcinoma (DTC) has changed in the last few years with thyroglobulin (Tg) measurement and whole-body radioiodine scan (WBS) after recombinant human thyroid-stimulating hormone (rh-TSH) administration. Patients and methods: We performed a longitudinal study of 60 patients with a diagnosis of DTC (37 with a low grade type) to evaluate the diagnostic efectiveness of serum Tg measurement and WBS after rh-TSH administration. Results: The sensitivity of Tg during levothyroxine LT4 suppressive therapy (lower than 1 ng/ml) was found to be 83% in the diagnosis of recurrence with a negative predictive value of 98%. When Tg was measured after rh-TSH administration (lower than 2 ng/ml), sensitivity reached 100% with a specificity of 98% and a negative predictive value of 100%. WBS offered no additional data of value. Conclusions: Measurement of rh-TSH-stimulated serum Tg is a useful diagnostic tool in the follow-up of patients with DTC. Tg levels under 2 ng/ml accurately identify disease-free patients. This finding, along with the finding that WBS after rh-TSH administration did not improve the diagnostic sensitivity of the rh-TSH-stimulated Tg test, support its use as an isolated test in the follow-up of low-risk patients

Adaptaciones cardiovasculares a la permanencia prolongada en agua subterránea / Cardiovascular adjustments prolonged periods of time in underground water

La espeleología obliga a la permanencia prolongada en corrientes de agua subterránea y la modificación de las condiciones ambientales en las que ha de practicarse influye en el desarrollo de la actividad deportiva y puede traducirse en la aparición de "fatiga". Este contacto permanente con el agua subterránea supone la activación de mecanismos de adaptación cuya valoración es preciso contemplar en el momento de programar exploraciones prolongadas. Objetivo: observar el comportamiento de variables cardiovasculares tras la permanencia en agua subterránea en deportistas habituales de esta especialidad y en condiciones de conocimiento previo de la cavidad para intentar minimizar, en lo posible, el impacto de "territorio desconocido" y "exploración de cavidad". Material y métodos: tras un reconocimiento médico inicial y una exploración física detallada se selecciona un conjunto de 24 espeleólogos y se les somete a una prueba real de exploración, sobre cavidad conocida, que obliga a la permanencia en agua subterránea. Entran en la cavidad tras registrar frecuencia cardiaca, tensión arterial, capacidad ventilatoria forzada y oscilometría de flujos arteriales. Tras un periodo globalmente homogéneo de estancia en la misma se procede a una salida programada de la cavidad y se repiten los controles efectuados a la entrada. Resultados: existe tendencia al aumento de la frecuencia cardiaca y de la tensión arterial diastólica. Asimismo, creemos en la posible activación de un mecanismo de adaptación relacionado con la distribución de flujos arteriales en las extremidades inferiores. No hemos hallado variaciones significativas de capacidad ventilatoria forzada o tensión arterial sistólica. Conclusiones: podemos afirmar que la permanencia prolongada en agua subterránea provoca un aumento de la tensión arterial diastólica y un fenómeno de redistribución del flujo arterial caracterizado por la existencia de un aumentó de potencia del flujo sanguíneo, consecuencia de una posible vasoconstricción selectiva y evidenciada en la oscilación provocada por el flujo en el oscilómetro de Reklinghausen, en las arterias principales que se asocia a una relativa centralización de la circulación. Junto a ello podemos concluir que la existencia previa de hipertensión arterial o prehipertensión se traduce en la agravación del cuadro y en la posible aparición de crisis hipertensivas graves (AU)

Agenesia unilateral de corno uterino em cadela: relato de caso / Unilateral uterine horn agenesis in a bitch: a case report

Relata-se o caso de uma cadela, Poodle, dois anos de idade, que foi encaminhada para ovario-histerectomia por conveniência. O animal apresentava cios regulares e era nulípara. Durante a abordagem da cavidade abdominal constatou-se a ausência de um dos cornos uterinos. O exame histopatológico confirmou agenesia unilateral de corno uterino com ovários funcionais

Intoxicaçäo por Cassia occidentalis (Leg. Caes) em bovinos / Cassia occidentalis (Leg. Caes) poisoning in cattle

Säo descritos um surto espontâneo da intoxicaçäo por Cassia occidentalis em bovinos e a reproduçäo experimental da doença nessa espécie. No surto espontâneo, 37 bovinos de quatro estabelecimentos rurais no Rio Grande do Sul morreram vários dias após terem sido introduzidos numa dieta que incluia gräos de sorgo contaminados por 10% de sementes de C. occidentalis. Os animais afetados apresentaram uma doença afebril caracterizada por diarréia e fraqueza muscular. A doença foi reproduzida experimentalmente em quatro terneiros. As sementes contaminantes de C. occidentalis presentes no sorgo foram, moídas, misturadas em água e administradas oralmente através de garrafa aos terneiros 1 e 2, num total de 10g/kg cada terneiro. O terneiro 1 recebeu a planta em duas administraçöes (8g/kg e 2g/kg), com intervalo de dois dias entre as administraçöes e o terneiro 2 recebeu cinco administraçöes diárias consecutivas de 2g/kg. Os terneiros 3 e 4 receberam o sorgo contaminado com as sementes de C. occidentalis, na mesma maneira em que era administrado nos quatro estabelecimentos onde o surto espontâneo ocorreu. Um bovino controle recebeu apenas o sorgo após terem sido retiradas as sementes de C. occidentalis. Os terneiros 1 e 2 morreram respectivamente 5 e 6 dias após a primeira administraçäo da planta, o terneiro 3 após 12 dias do início da alimentaçäo com sorgo contaminado por sementes de C. occidentalis e o terneiro 4 foi sacrificado após 15 dias do início da alimentaçäo com o mesmo sorgo contaminado e após estar apresentado sinais clínicos evidentes da intoxicaçäo. A doença clínica nesses quatro animais foi muito semelhante a doença espontânea. Observaram-se diarréia, tremores musculares, andar incoordenado, relutância em mover-se, decúbito esternal, decúbito lateral e morte. Aumento da freqüência dos movimentos respiratórios e dos batimentos cardíacos e uma acentuada elevaçäo nos níveis séricos de CPK foram observados nas fases finais da doença. A necrópsia, áreas pálidas foram observadas nos músculos esqueléticos, principalmente no músculos dos membros posteriores. Areas pálidas, quase imperceptíveis, foram vistas também no miocárdio. Os fígados dos terneiros 1 e 2 estavam tumefeitos, marrom-claros e com moderado aspecto de noz-moscada a superfície de corte. A microscopia óptica as lesöes mais evidentes estavam presentes nos músculos esqueléticos e se caracterizavam por edema intersticial, tumefaçäo de fibras e degeneraçäo flocular e hialina com ruptura de fibras. As