Acute Necrosis Research Articles

A Case of Acute Pancreatic Necrosis in a Japanese Black Feedlot Cattle during Meat Inspection

と畜場に搬入された27カ月齢の黒毛和種雌牛において，病理組織学的検査の結果，急性膵壊死と診断した症例に遭遇した．病歴書によると，と畜場搬入7日前から食欲不振及び腹部皮膚の振戦が認められ，生体検査でも腹部皮膚の持続的振戦が確認された．解体後検査では，膵臓は軽度に腫大，表面に線維素が少量付着し，割面では白色〜黄色の斑状病巣がび漫性に認められた．膵臓周囲脂肪組織は肥厚し水腫様で，内部に不整形〜帯状の脂肪壊死が散見された．病理組織学的検査では，膵臓に広範な脂肪浸潤及び脂肪壊死がみられ，脂肪壊死に隣接した膵実質組織に限局して腺房細胞の変性・壊死及び好中球・マクロファージ主体の炎症細胞浸潤が認められ，急性膵壊死の病理組織学的特徴と多くの点で一致した．なお，原因の特定には至らなかった．

Pigeon adenovirus and pigeon torque teno virus associated with acute multifocal hepatic necrosis in pigeons in Queensland, Australia.

In 2018, an outbreak resulting in deaths of 28 breeding pigeons was reported north of Brisbane, Australia. The affected birds had runny nasal discharge and poor body condition. Two birds were submitted to Biosecurity Sciences Laboratory, Brisbane, for investigation. A range of diagnostic tests excluded a number of known pathogens, and no virus was isolated in cell culture. Histopathological examination revealed severe acute multifocal necrosis in the liver with eosinophilic intranuclear inclusions in hepatocytes and Kupffer cells. High-throughput sequencing (HTS) revealed full-length sequences for pigeon adenovirus 1 (PiAd-A) and pigeon torque teno virus (PTTV). This report indicates concomitant PiAd-1and PTTV infections in Australian pigeons.

Acute Tubular Necrosis Associated with Autoimmune Hemolytic Anemia due to Acute Gastroenteritis

Abstract
 Autoimmune hemolytic anemia (AIHA) is a rare disease with a rate of 1-3 in 100,000 in adults. AIHA are defined as primary (idiopathic) or secondary depending on the presence or absence of accompanying disease. Secondary causes include drugs, immunodeficiencies, infections, other autoimmune diseases, or malignancies. Here, we report an 42-year-old female presented to us with diarrhea, nausea-vomiting, fever, chills and jaundice for two days. Hematological investigations revealed hemolytic anemia. Direct Coombs test was positive. The patient was diagnosed acute tubuler necrosis with autoimmune hemolytic anemia. Methylprednisolone 40 mg/day was started considering autoimmune hemolytic anemia. She was on hemodialysis at regular intervals. After 4 weeks, the patient was symptomatically improved with remission of acute tubuler necrosis and hemolytic anemia. In our case, the association of AIHA due to acute gastroenteritis and acute tubular insufficiency was considered suitable for the presentation because of its rare occurrence.

Spotty liver disease in Jordan: An emerging disease

Spotty liver disease is an acute bacterial disease that affects the poultry industry throughout the world. In this report, we discuss the first documented outbreak of the recently emerging disease, spotty liver disease, in a poultry flock in Jordan. The clinical history, pathological and molecular findings are described. The outbreak was characterised by recurrent mortalities that subsided with antibiotic treatments. Grossly, there were multiple pinpoint white foci distributed throughout the enlarged liver and less frequently throughout the spleen too. Histologically, the white foci represented areas of acute hepatocellular lytic necrosis and degeneration that were consistent with those of spotty liver disease. An end point polymerase chain reaction (PCR) assay targeting the glycerol kinase gene, coupled with sequencing, confirmed the pathological diagnosis. Continuous surveillance is needed to estimate the prevalence of this disease in Jordanian poultry flocks.

Assessing temperature increase during photodynamic therapy: a simulation model

Photodynamic therapy (PDT) is a non-invasive procedure mainly used for treatment of malignancies. It is based on cytotoxic products generation after the excitation of absorbed photosensitizing drugs by non-ionizing radiation. The wavelength chosen is usually in the 620 - 700 nm region, resulting in limited tissue penetration depth. The relatively low irradiance values and the treatment time that, in most cases, lasts for a few minutes result in limited photothermal effects, which are usually overlooked. Therefore, in this study we computationally assess the temperature distribution during PDT in a cancer bearing mouse model. A user-friendly application is created that could be used in the treatment planning step of PDT. It receives as input various parameters, such as laser power, beam radius, irradiation time, body temperature and returns the maximum tissue temperature and irradiance values. Furthermore, it offers visualization of the generated effects through the spatial distribution of temperature, irradiance, acute necrosis and damaged tissue percentage that are presented in the form of interactive 3D plots. The conducted simulations reveal that 43 °C, which are in the hyperthermia range, are difficult to be excessed in PDT clinical practice, although topical thermal effects are observed.

Bilateral acute renal cortical necrosis after a dog bite: case report

BackgroundCapnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission.Case presentationWe report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs.ConclusionWe present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.

An infant with hypertriglyceridemia presenting as failure to thrive: a case report

Familial hypertriglyceridemia is rare in infancy. Diagnosis in infancy is very difficult and is usually diagnosed when acute pancreatitis sets in. Early diagnosis is important as it can prevent the complications associated with acute pancreatitis and pancreatic necrosis. Here is a case familial hypertriglyceridemia in an infant who presented to us with failure to thrive but was diagnosed early due to presence of highly viscous and milky blood. This holds importance as early treatment can reduce the complications and morbidity associated with familial hypertriglyceridemia.

Suspected sulfasalazine‐induced acute hepatic necrosis in a dog after one year of continuous treatment

AbstractAn 18‐month‐old male entire golden retriever presented with inappetence and a 12‐hour history of episodic vomiting. The dog had been receiving sulfasalazine 15 mg/kg twice daily for one year for the treatment of lymphoplasmacytic colitis, which was well controlled prior to presentation. The dog had no history of other drug or toxin exposure. Investigations initially revealed raised liver enzymes, which increased during hospitalisation along with development of neutropenia and thrombocytopenia. During hospitalisation, acute hepatic necrosis was diagnosed histologically, and the dog recovered completely with supportive treatment and discontinuation of the sulfasalazine. The hepatic necrosis was believed to be associated with a toxic‐metabolite dependent idiosyncrasy due to the long‐term use of sulfasalazine. Unlike other cases previously reported, this dog developed these clinical signs after one year of treatment rather than immediately after therapy initiation. This may raise awareness about possible late‐onset reactions when using long courses of sulfonamides.

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a disease of premature infants characterized by acute intestinal necrosis. Current dogma suggests that NEC develops in response to post-natal dietary and bacterial factors, and so a potential role for in utero factors in NEC remains unexplored. We now show that during pregnancy, administration of a diet rich in the aryl hydrocarbon receptor (AHR) ligand indole-3-carbinole (I3C), or of breast milk, activates AHR and prevents NEC in newborn mice by reducing Toll-like receptor 4 (TLR4) signaling in the newborn gut. Protection from NEC requires activation of AHR in the intestinal epithelium which is reduced in mouse and human NEC, and is independent of leukocyte activation. Finally, we identify an AHR ligand (“A18”) that limits TLR4 signaling in mouse and human intestine, and prevents NEC in mice when administered during pregnancy. In summary, AHR signaling is critical in NEC development, and maternally-delivered, AHR-based therapies may alleviate NEC.

Pulmonary and vascular effects of acute ozone exposure in diabetic rats fed an atherogenic diet

Air pollutants may increase risk for cardiopulmonary disease, particularly in susceptible populations with metabolic stressors such as diabetes and unhealthy diet. We investigated effects of inhaled ozone exposure and high-cholesterol diet (HCD) in healthy Wistar and Wistar-derived Goto-Kakizaki (GK) rats, a non-obese model of type 2 diabetes. Male rats (4-week old) were fed normal diet (ND) or HCD for 12 weeks and then exposed to filtered air or 1.0 ppm ozone (6 h/day) for 1 or 2 days. We examined pulmonary, vascular, hematology, and inflammatory responses after each exposure plus an 18-h recovery period. In both strains, ozone induced acute bronchiolar epithelial necrosis and inflammation on histopathology and pulmonary protein leakage and neutrophilia; the protein leakage was more rapid and persistent in GK compared to Wistar rats. Ozone also decreased lymphocytes after day 1 in both strains consuming ND (~50%), while HCD increased circulating leukocytes. Ozone increased plasma thrombin/antithrombin complexes and platelet disaggregation in Wistar rats on HCD and exacerbated diet effects on serum IFN-γ, IL-6, KC-GRO, IL-13, and TNF-α, which were higher with HCD (Wistar>GK). Ex vivo aortic contractility to phenylephrine was lower in GK versus Wistar rats at baseline(~30%); ozone enhanced this effect in Wistar rats on ND. GK rats on HCD had higher aortic e-NOS and tPA expression compared to Wistar rats. Ozone increased e-NOS in GK rats on ND (~3-fold) and Wistar rats on HCD (~2-fold). These findings demonstrate ways in which underlying diabetes and HCD may exacerbate pulmonary, systemic, and vascular effects of inhaled pollutants.

Microthrombi as a Major Cause of Cardiac Injury in COVID-19: A Pathologic Study.

Cardiac injury is common in patients who are hospitalized with coronavirus disease 2019 (COVID-19) and portends poorer prognosis. However, the mechanism and the type of myocardial damage associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain uncertain. We conducted a systematic pathological analysis of 40 hearts from hospitalized patients dying of COVID-19 in Bergamo, Italy, to determine the pathological mechanisms of cardiac injury. We divided the hearts according to presence or absence of acute myocyte necrosis and then determined the underlying mechanisms of cardiac injury. Of the 40 hearts examined, 14 (35%) had evidence of myocyte necrosis, predominantly of the left ventricle. Compared with subjects without necrosis, subjects with necrosis tended to be female, have chronic kidney disease, and have shorter symptom onset to admission. The incidence of severe coronary artery disease (ie, >75% cross-sectional narrowing) was not significantly different between those with and without necrosis. Three of 14 (21.4%) subjects with myocyte necrosis showed evidence of acute myocardial infarction, defined as ≥1 cm2 area of necrosis, whereas 11 of 14 (78.6%) showed evidence of focal (>20 necrotic myocytes with an area of ≥0.05 mm2 but <1 cm2) myocyte necrosis. Cardiac thrombi were present in 11 of 14 (78.6%) cases with necrosis, with 2 of 14 (14.2%) having epicardial coronary artery thrombi, whereas 9 of 14 (64.3%) had microthrombi in myocardial capillaries, arterioles, and small muscular arteries. We compared cardiac microthrombi from COVID-19-positive autopsy cases to intramyocardial thromboemboli from COVID-19 cases as well as to aspirated thrombi obtained during primary percutaneous coronary intervention from uninfected and COVID-19-infected patients presenting with ST-segment-elevation myocardial infarction. Microthrombi had significantly greater fibrin and terminal complement C5b-9 immunostaining compared with intramyocardial thromboemboli from COVID-19-negative subjects and with aspirated thrombi. There were no significant differences between the constituents of thrombi aspirated from COVID-19-positive and -negative patients with ST-segment-elevation myocardial infarction. The most common pathological cause of myocyte necrosis was microthrombi. Microthrombi were different in composition from intramyocardial thromboemboli from COVID-19-negative subjects and from coronary thrombi retrieved from COVID-19-positive and -negative patients with ST-segment-elevation myocardial infarction. Tailored antithrombotic strategies may be useful to counteract the cardiac effects of COVID-19 infection.

Hepatotoxicity in Cattle Associated with Salvia reflexa Diterpenes, including 7-Hydroxyrhyacophiline, a New Seco-Clerodane Diterpene.

A case of baled alfalfa hay contaminated with multiple weeds induced hepatotoxicity and death in cattle. The hepatotoxic compounds were isolated by bioassay-guided fractionation using a mouse model and identified as salviarin, salvianduline D, rhyacophiline, and 7-hydroxyrhyacophiline. The structure of 7-hydroxyrhyacophiline has not been previously reported. All compounds were found to induce severe acute hepatic necrosis within 24-48 h after a single oral dosage (260-280 mg/kg). The identified diterpenes are known to be found among different Salvia species which led to finding dried plant parts of Salvia reflexa within bales of weedy hay and subsequently a population of S. reflexa was found along the field edges and irrigation ditch banks of the alfalfa hay field. It was thus determined that S. reflexa was responsible for the hepatotoxicity observed in cattle fed the contaminated hay.

Waitlist mortality and transplant free survival in Hispanic patients listed for liver transplant using the UNOS database

Introduction and objectivesAfter the implementation of “Share 35”, several concerns arose such as the potential to increase travel distance, costs, and decreased liver availability. These elements could have a negative impact on waitlist outcomes among ethnic minorities. We aimed to determine waitlist survival after the implementation of the Share 35 policy in non-Hispanic white and Hispanic patients. Materials and methodsWe identified non-Hispanic whites and Hispanics who were listed for liver transplantation from June 18th, 2013 to June 18, 2018. We excluded pediatric patients, patients with acute hepatic necrosis, re-transplants, multiorgan transplant, living donor, and exception cases. The primary outcome was death or removal from the waitlist due to clinical deterioration. We used competing risk analysis to compare waitlist survival between the two groups. ResultsThere were 23,340 non-Hispanic whites and 4938 Hispanics listed for transplant. On competing risk analysis, Hispanic patients had a higher risk of being removed from the waitlist for death or clinical deterioration compared to their counterpart (SHR 1.23, 95% CI 1.13–1.34; P < 0.001). ConclusionAfter the implementation of Share 35, disparities are still present and continue to negatively impact outcomes in minority populations especially Hispanic patients.

Restricted Sensitivity of FJ-C Staining to Assess Neuronal Degeneration and Death in Preclinical Mouse Studies.

Fluorescein-derived fluorochromes and anionic dyes such as Fluoro-Jade (FJ) stains have been introduced to facilitate recognition of dying neurons in tissue sections. However, the definition of what is really detected by FJ-based stains and its sensitivity in the detection of neuronal cell death is unclear. In our work, we evaluated the outcome of FJ-C staining in mouse brains from 4 different well-characterized models of neurodegeneration. Neuronal degeneration and loss were highlighted with high sensitivity by FJ-C stain in mice with dysfunctional γ-secretase in the glutamatergic neurons and in mice affected by acute cerebral ischemia. Histopathologically, acute eosinophilic necrosis or "red dead" neurons were associated with FJ-C staining in both settings. Conversely, in mice affected by chronic cerebral microinfarcts due to tumor lysis syndrome as well as in a model of mitochondrial encephalopathy, FJ-C staining failed to detect neuronal death. Histopathologically, these models were characterized by extensive neuronal vacuolation associated with fading neurons ("ghost cells"). Therefore, contrary to the widespread belief that FJ-C stain has high affinity for all degenerating neurons regardless of the underlying cell death mechanism, we observed restricted sensitivity of the technique to specific conditions of neuronal cell death. As such, complementary techniques are essential to evaluate the presence of neurodegeneration in the absence of a positive FJ-C signal.

Boldine treatment protects acetaminophen-induced liver inflammation and acute hepatic necrosis in mice.

Drug-induced liver injury (DILI) is a frequent cause responsible for acute liver failure (ALF). Acetaminophen (APAP) is a known hepatotoxin predictably causing intrinsic DILI. At high doses, APAP causes acute liver necrosis and responsible for ALF and liver transplant cases in 50% and 20% of patients, respectively, in the United States alone. Oxidative stress and glutathione depletion are implicated in APAP-induced liver necrosis. Boldine, a plant-derived compound is shown to have promising antioxidant potential. Therefore, this study investigates the protective effect of boldine against APAP-induced acute hepatic necrosis in mice. A single toxic dose of APAP (300 mg/kg b.w. p.o.) was administered in overnight-fasted mice to induce acute liver necrosis. Separately, APAP + boldine and APAP + N-acetylcysteine (NAC) simultaneous treatments were also given. Serum transaminases and reduced glutathione, enzymic antioxidants, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and, IL-6 were evaluated in liver tissue. Acute APAP intoxication significantly elevated serum marker enzymes of hepatotoxicity. APAP administration increased lipid peroxidation, TNF-α, IL-1β, and IL-6 protein expressions. The enzymic antioxidants and reduced glutathione levels were decreased in liver tissue of APAP intoxicated mice. Boldine and NAC simultaneous treatments prevented APAP-induced oxidative stress, inflammation, and necrosis. The results of this study suggest the crucial role of boldine to protect against APAP induced hepatotoxicity by virtue of its antioxidant and anti-inflammatory properties.

Sonographic Rim in Acute Renal Cortical Necrosis

Ultrasonography is the first line of investigation requested for patients presenting with a clinical features of acute renal failure. Acute renal Cortical Necrosis (ACN) is an uncommon cause of acute renal failure secondary to reduced perfusion to the renal cortex with relative sparing of the medulla. There is limited literature available on early sonographic features of acute cortical necrosis. Ultrasonography finding of hypoechoic renal cortex is a diagnostic feature of acute cortical necrosis. This appearance can be aptly called "Sonographic hypoechoic cortical rim". Bilateral ACN following pancreatitis is an extremely rare entity. Due to rarity of association between pancreatitis and bilateral renal cortical necrosis, authors reported case of 25-year-old male presented with severe abdominal pain, vomiting, reduced urine output, constipation. Ultrasonography revealed normal size kidneys with diffuse circumferential hypoechoic appearance of cortex on both sides. Laboratory investigations demonstrated elevated white blood cell count, raised serum amylase. Diagnosis of ACN secondary to acute pancreatitis was made.

Presentation of a Rare Case: Acute Kidney Failure Developed Following Complete Urinary Bladder Herniation and Management of Postoperative Voiding Dysfunction

Inguinal bladder herniation is seen in 1% -4% of all inguinal hernia cases; most of them are asymptomatic and come up with swelling in the groin. In symptomatic cases, nonspecific findings such as lower urinary tract symptoms or pain due to strangulation of the hernia sac are seen. Two-stage micturition (manual pressure to the scrotum to empty residual urine) is a pathognomonic sign for the advanced case. Vesicoureteral reflux (VUR), bilateral hydronephrosis, urinary tract infection, acute kidney failure and bladder wall necrosis are complications that may be seen if the problem is not appropriately managed. Preoperative diagnosis rates are low (&lt;7%) and 16% of the cases are diagnosed in the postoperative period, and most cases are detected intraoperatively. Radiologic examination performed for other indications such as non-contrast abdominal computed tomography (CT) may diagnose the bladder herniation. CT, cystography and ultrasonography are the techniques that can be used in the diagnosis and differential diagnosis. Intraoperatively, reduction of the herniated bladder with herniorrhaphy is a routine procedure. Partial cystectomy has to be made in case of bladder wall necrosis, presence of a tumor in the herniated bladder and narrow bladder neck which don"t allow reduction. In this case report, our aim is to explain the management of left inguinoscrotal complete bladder herniation and postoperative voiding problem.

A Case of Pancreatic Pseudocyst Infection with Acute Gastric Necrosis Who Was Treated by Two-stage Surgery

A Case of Pancreatic Pseudocyst Infection with Acute Gastric Necrosis Who Was Treated by Two-stage Surgery

Aluminium Induced Neurodegeneration in Rat Cerebrum in Presence of Ethanol Co-exposure

Introduction: Aluminium (AL) exposure leads to neurotoxicity and many problems in the body. AL role in Alzheimer's Disease (AD) is unknown and controversial to the scientists. According to World Health Organisation (WHO) provisional tolerable weekly intake of AL is 2 mg/kg body weight. Moderate intake of alcohol may favour body in coronary heart disease and diabetes mellitus, etc. Aluminium being cheaper along with increased consumption of alcohol, mixed with each other may induce neurotoxicity. Aim: The study was designed to identify the effects of AL in cerebrum of rats in presence of ethanol co-exposure. Materials and Methods: An experimental study was carried out at Dr. RP Government Medical College, Kangra and Government Medical College, Amritsar, India after due approval from the Institute Animal Ethics Committee. Thirty-two wistar rats were divided into one vehicle control and three experimental groups. Group I received the normal saline water as vehicle control group. Group II received AL chloride 4.2 mg/kg body weight as experimental group. Group III received ethanol 1 gm/kg body weight as experimental group. Group IV received both AL chloride 4.2 mg/kg body weight and ethanol 1 gm/kg body weight as experimental group. After treatment, brain cortex was processed for histopathological observation under microscope. Results: Cerebral cortex showed normal architecture of the brain with haematoxylin and eosin staining and cresyl violet staining and modified Bielchowsky silver staining in low and high magnification in vehicle control group. Experimental group treated with AL and ethanol separately showed reduction in the count of pyramidal cells with moderate neuronal degeneration with pyknotic nuclei. Vacuolar changes and pericellular spaces around the necrotic neurons were also seen. Combined AL and ethanol treated group showed acute neurodegeneration and necrosis of cortex indicating chromatolysis and loss of substances and Neurofibrillary Tangle (NFT) and plaque. Conclusion: It has been concluded that the ethanol induced the effects of AL on the cerebrum and plays a significant role in AD pathogenesis.

The step up approach in the management of infected pancreatic necrosis. A case report

Presenter: Maria Liz Sanchez MD | Hospital de Clínicas de Asunción Background: Approximately 15% of patients with acute pancreatitis (AP) develop the severe form. Treatment of infected necrotizing pancreatitis has changed over the past 20 years and continues to evolve with increasing experience, new techniques, and research. Treatment of Infected necrosis by laparotomy is associated with high morbidity and mortality. The “Step Up Approach” consists of the successive placement of drains of progressively greater caliber, it has demonstrated, since the publication of the PANTER study, its superiority over the classical surgical approach in terms of morbidity. In up to 35% of cases, the episode will be resolved only in this way, in the rest of patients, the pancreatic cell will be debrided. Methods: We present the case of a patient with a diagnosis of severe acute pancreatitis and infected pancreatic necrosis who was managed with the now popular “step up” approach Results: Clinical case: 28-year-old male with dyslipidemic origin (AP), with necrosis pancreatic, peripancreatic collections, and gas in retroperitoneum, treated with TPN, pancreatin (CREON) and antibiotic therapy (Imipenem 20 days and then according to antibiogram). He developed infected necrosis that required drainage with two 12 Fr and 14 Fr pigtails (25th day-hospitalization), with ultrasound-guided access in the right flank and left flank. Catheter replacement and progressive increase in diameter were performed, followed by RPVA necrosectomy following the path of the left pigtail (th day-hospitalization). The evolution was favorable, with progressive withdrawal of drains, and discharge without drains on day 65 of hospitalization. Conclusion: The “Step Up Approach” is the current standard in the treatment of infected pancreatic necrosis, it is effective and safe, avoiding the serious complications of open necrosectomy, with a good recovery of the patient.