Focal Hemorrhage Research Articles

Hidden Hematologic Disease in Trauma Patients: A Report of Two Cases

In trauma patients, coagulopathy and abnormal increases or decreases in cell counts are frequently observed, and are associated with high mortality and morbidity in the acute phase of trauma. Because major trauma is often life-threatening, and hematologic abnormalities are multi-factorial and transient, major blood loss is usually suspected to be the primary cause of these abnormalities, and much time and cost may be spent attempting to identify a focus of hemorrhage that might or might not actually exist. Persistent abnormalities in the complete blood count, however, require clinical suspicion of other hematologic diseases to minimize improper transfusions and to improve outcomes, including mortality. Physicians at trauma centers should be familiar with the clinical characteristics of hematologic diseases and should consider these diseases in trauma patients. In this report, we present cases of two hematologic disorders found in trauma patients: autoimmune hemolytic anemia induced by systemic lupus erythematosus and myelodysplastic syndrome. Keywords: Trauma centers; Hemorrhage; Hematologic diseases

Death following ingestion of wild mushroom: An autopsy-based study

Poisoning by consumption of wild mushroom is a medical emergency. Incidences of such fatal poisoning have been reported daily from different geographical locations. It has been noted among communities with the habit of hunting and cooking the wild variety. Amongst all mushroom species, poisoning caused by Amanita Phalloides is considered to be the fatal one because of its hepato-renal toxicity. Moreover, the toxic principle i.e. amatoxin cannot be destroyed by cooking or freezing. Symptoms usually appear after 6–8 hours of consumption and by the time patient is brought to the emergency, fulminant hepatic failure starts. The study is a retrospective one and was conducted for a period of five years to find out the incidence of mushroom related deaths in and around Dibrugarh district of Assam. The results showed that the incidence of such fatality during the 5 years period to be 1.61%. Victims were mostly female (62.37%) and most common age group was 31–40 years (39.78%). Most of the incidences occurred during rainy season (80.65%). Most common presenting symptom was nausea and vomiting seen in 87.10% cases, following 6–8 hours (88.17%). Autopsy revealed multiple haemorrhagic foci in different internal organs. Histopathological changes were also significant with respect to liver and kidney.

Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications.

Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.

Fibrosarcoma in Rottweiler dog: case report

The present study aims to report a case of fibrosarcoma in an elderly canine patient who underwent necroscopic examination in June 2018 after natural death. Macroscopic and microscopic analyzes of the pathological findings were performed by organ visualization and histopathological processing of the collected samples. Macroscopically, a pelvic tumor mass of approximately 15 cm, cardiac hypertrophy with parasites in the ventricular lumen, congested and nodular lungs, hepatomegaly and renal atrophy were observed. Histological analysis of the primary tumor mass was compatible with a fibrosarcoma, with most cells of fusiform morphology, with foci of hemorrhage and necrosis in the center of the tumor, alternating with regions of desmoplastic reaction, nuclear atypia and prominent nucleoli. Also, microscopy revealed swollen pulmonary parenchyma with diffuse hemorrhage, vascular congestion, thickening of the alveolar septa and pulmonary nodules suggestive of metastatic lesions, as well as liver with congested sinus capillaries and diffuse hemorrhage in the hepatic parenchyma with foci of coagulation necrosis. Fibrosarcoma is a tumor of mesenchymal origin, composed of transformed fibroblasts, in a collagen background. It occurs in all species, but is more common in dogs and cats. In dogs, it usually manifests in solitary form and in older individuals, with a mean age of 9.7 years. Most pathologists describe the histological picture of fibrosarcoma as a fishbone pattern. It is usually a very invasive tumor, making surgical treatment difficult because it does not allow a wide margin of excision, and its clinic manifests itself late, making diagnosis and treatment even more difficult, as in the case reported here, in which the patient suddenly died. Thus, histopathological and cytopathological analysis remain the gold standard among the initial diagnostic methods to confirm the presence of the tumor, highlighting the importance of applying these study methods in determining the morphological characteristics of different types of lesions, as well as their forms, whose diagnosis can be confirmed with other diagnostic methods.

Autonomic and cardiovascular consequences resulting from experimental hemorrhagic stroke in the left or right intermediate insular cortex in rats.

Damage to the insular cortex (IC) results in serious cardiovascular consequences and evidence indicates that the characteristics are lateralized. However, a study comparing the effects of focal experimental hemorrhage between IC sides was never performed. We compared the cardiovascular, autonomic and cardiac changes produced by focal experimental hemorrhage (ICH) into the left (L) or right (R) IC. Wistar rats were submitted to microinjection of autologous blood (ICH) or saline (n=6 each side/group) into the R or L IC. Blood pressure (BP), heart rate (HR) and renal sympathetic activity (RSNA) were recorded. Measurements of calcium transient and sarcoplasmic Ca2+ ATPase expression in cardiomyocytes were performed. ICH increased baseline HR (Δ:L-ICH 452±13 vs saline 407±11bpm; R-ICH 450±7 vs saline 406±8bpm, P<0.05) without changing BP. HR was restored to baseline levels after i.v. atenolol. Strikingly, ICH rats presented a reduced baseline RSNA (Δ:L-ICH 122±4 vs saline 148±11spikes/s; R-ICH 112±5 vs saline 148±7spikes/s, P<0.05). After 24h of ICH we observed a marked increase in cardiac ectopies and this number was greater after ICH R-IC. Heart weight, calcium amplitude and SERCA expression were reduced only in ICH R-IC. Focal stroke into IC can alter the cardiac and renal autonomic control. Damage to the R-IC produces a greater number of arrhythmias and changes in calcium dynamics in cardiac cells indicating that the cardiovascular consequences are hemisphere-dependent. These findings confirm asymmetry for cardiac autonomic control at the IC and help to understand the cardiac and renal implications observed after specific side cortical damage.

Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey.

ObjectiveCurrent evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage (aSAH) focus primarily on timing, modality and technique of aneurysm occlusion, and on prevention and treatment of delayed cerebral ischemia. Significant aspects of management in the intensive care unit (ICU) during the later course of aSAH such as ventilation and sedation (VST) remain unaddressed. aSAH patients present unique challenges not accounted for in general ICU recommendations and guidelines, which is why we attempted to further characterize ICU practices in aSAH patients in Germany.MethodsWe conducted a nationwide survey on ICU practices in aSAH in Germany. Secondarily, we assessed the existence of and compliance with current guidelines regarding ICU practices. The questionnaire was designed in interdisciplinary fashion and distributed online through the kwiksurvey® platform (Bristol, UK).ResultsA total of 50 responses were received, accounting for a response rate of 49%. Twenty-one were university hospitals (UH), 23 high-volume centers (HVC), 6 low-volume centers (LVC). Half of the participating centers do not take into consideration WFNS at presentation to indicate ventilation. While 42% of centers rely on the P/F ratio to indicate ventilation, 62% of them have a cutoff value of < 200, and 38% of < 100. While most UH and HVC used propofol for the first phase of sedation (95%), LVC employed benzodiazepines (100%). Sedation deepening was done with ketamine in UH (75%) and HVC (60%), whereas LVC used predominantly clonidine (100%).ConclusionsOur study clearly demonstrates that attitudes and practices pertaining to ICU management in aSAH are enormously heterogeneous, reflecting the lack of good quality evidence and differing interpretations thereof.Electronic supplementary materialThe online version of this article (10.1007/s12028-020-01029-8) contains supplementary material, which is available to authorized users.

Is There a Relationship Between Epitaxis and Anatomical Variations?

The aim of our study is to introduce the relationship between epistaxis and anatomical variations and present the current treatment approach. Forty-five patients (28 males and 17 females) that presented to otorhinolaryngology clinics at Mengucek Gazi Training and Research Hospital with pre-diagnosed epistaxis between October 2018 and April 2019 were included in the study. Age, sex and structural causes and anatomical localization of epistaxis in patients were analysed. The median age of the patients was 42, ranging from 20 to 60 years. Focus of bleeding was observed on the right in 16 cases (35.5%), left in 14 cases (31.1%) and bilateral in nasal cavity in 15 cases (33.3%). Bleeding was from the anterior septum in front of the maxillary ostium line. Anatomical variations were seen in 31 patients (68.8%) (septal deviation in 12, septal perforation in two, and concha hypertrophy in 17). Epistaxis is one of the most common ear, nose, and throat emergencies. Etiological reasons must be analysed for the treatment to be effective.

Outcomes and Clinical Characteristics of Intracranial Hemorrhage in Patients with Hematologic Malignancies: A Systematic Literature Review

Many clinical and demographic factors can influence survival of patients with hematologic malignancies who have intracranial hemorrhages (ICHs). Understanding the influence of these factors on patient survival can guide treatment decisions and may inform prognostic discussions. We conducted a systematic literature review to determine survival of patients with intracranial hemorrhages and concomitant hematologic malignancy. A systematic literature review was conducted and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed/MEDLINE, Web of Science, Ovid, SCOPUS, and Embase databases were queried with the following terms: ("intracranial hemorrhages" OR "brain hemorrhage" OR "cerebral hemorrhage" OR "subdural hematoma" OR "epidural hematoma" OR "intraparenchymal hemorrhage") AND ("Hematologic Neoplasms" OR "Myeloproliferative Disorders" OR "Myelofibrosis" OR "Essential thrombocythemia" OR "Leukemia"). Abstracts and articles were screened according to inclusion and exclusion criteria that were determined a priori. Literature review yielded 975 abstracts from which a total of 68 full-text articles were reviewed. Twelve articles capturing 634 unique patients were included in the final qualitative analysis. Median overall survival for all patients ranged from 20 days to 1.5 months while median overall survival for the subset of patients having ICH within 10 days of diagnosis of hematologic malignancy was 5days. Intraparenchymal hemorrhages, multiple foci of hemorrhage, transfusion-resistant low platelet counts, leukocytosis, low Glasgow Coma Scale scores at presentation, and ICH early in treatment course were associated with worse outcomes. Survival for patients with hematologic malignancies and concomitant ICHs remains poor. Early detection, recognition of poor prognostic factors, and correction of hematologic abnormalities essential to prevention and treatment of ICHs in this patient population.

Functions of lactate in the brain of rat with intracerebral hemorrhage evaluated with MRI/MRS and in vitro approaches.

IntroductionLactate accumulation in the brain is caused by the anaerobic metabolism induced by ischemic damages, which always accompanies intracerebral hemorrhages (ICH). Our former findings showed that microglia's movement was always directly toward hemorrhagic center with the highest lactate concentration, and penumbra area has the largest density of compactly arrayed microglia. However, the relationship between microglia and lactate concentration has not been well documented.MethodsCerebral hemorrhage model was successfully achieved by injecting collagenase VII (causing stabile localized bleeding) in CPu (striatum) of SD rats. Emodin was used as a potential therapeutic for ICH. The function of the lactate was examined with in vitro culture studies. Then, the effect of lactate on the proliferation, cell survival, migration, and phagocytosis property of microglia was investigated by in vitro culture studies.ResultsLactate accumulation was observed with in vivo MRS method, and its concentration was monitored during the recovery of ICH and treatment of emodin. Lactate concentration significantly increased in the core and penumbra regions of hemorrhagic foci, and it decreased after the treatment of emodin. The in vitro culture study was verified that lactate was beneficial for the proliferation, cell survival, migration, and phagocytosis property of the microglia.ConclusionResults from in vitro verification study, investigations from the recovery of ICH, and treatment of emodin verify that lactate plays an important role during the recovery of ICH. This could provide a novel therapeutic approach for ICH.

Analysis of correlation between MSCT classification and prognosis of basal ganglia hypertensive intracerebral hemorrhage

Objective: To investigate the correlation between MSCT grading and the prognosis of basal ganglia hypertensive intracerebral hemorrhage.Methods: A total of 86 patients with basal ganglia hypertensive cerebral hemorrhage admitted to our hospital from May 2017 to March 2018 were selected. The clinical data and imaging data were collected from 86 patients. The MSCT images were observed and summarized by two radiologists. Based on the morphology of cisterna ambiens and brain stem, the correlation of MSCT grading to Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) grading was analyzed by use of Spearman correlation analysis.Results: Among 86 patients, the number of MSCT grade I, II, III and IV were 29 cases, 38 cases, 9 cases and 10 cases respectively. There was no significant correlation between MSCT grading and age, sex as well as types of combined underlying diseases in the patients with basal ganglia hypertensive intracerebral hemorrhage (p &gt; .05). Spearman correlation analysis showed that there was a positive correlation between MSCT grading and GCS score of basal ganglia hypertensive intracerebral hemorrhage. The higher MSCT grade was, the higher GCS score was (r = .719, p &lt; .001). There was a positive correlation between MSCT grading and GOS grading of basal ganglia hypertensive intracerebral hemorrhage. The higher MSCT grade was, the higher GOS grade was, leading to a poor prognosis (r = .734, p &lt; .001). 86 cases of basal ganglia hypertensive intracerebral hemorrhage showed round or quasi-circular high-density shadows in MSCT images, the CT value ranged from 50 Hu to 80 Hu. Low-density bands surrounded the hematoma in the acute stage, and space-occupying effect could be seen in some patients, which resulted in the compression of ventricular sulcus and cistern and the displacement of midline structure. Subacute basal ganglia hypertensive intracerebral hemorrhage patients showed a relative decrease in the density of hematoma, with the extent of edema gradually reduced, the focus showed a high-density shadow in the center; chronic basal ganglia hypertensive intracerebral hemorrhage focus showed a cystic low-density shadow.Conclusion: MSCT grading of basal ganglia hypertensive intracerebral hemorrhage is positively correlated to GCS and GOS grading. MSCT grading can contribute to the prognostic evaluation to the patients.

COVID-19 in Liver Transplant Recipients: An Initial Experience From the US Epicenter

COVID-19 in Liver Transplant Recipients: An Initial Experience From the US Epicenter

Association between the hydrogenase level and the occurrence of remote diffusion-weighted imaging lesions after spontaneous intracerebral hemorrhage

To explore the influence of serum lactate dehydrogenase (LDH) level on remote diffusion-weighted imaging lesions (rDWILs) after spontaneous intracerebral hemorrhage (ICH). A consecutive cohort of 160 patients with spontaneous ICH who had brain MRI within 4 weeks of ICH onset were collected and analyzed retrospectively. rDWILs showed high signal on diffusion-weighted image (DWI) while low signal on apparent diffusion coefficient (ADC), and at least 20 mm away from the hemorrhage focus. The blood samples were obtained within 24 h after ICH onset from all patients. Lactate dehydrogenase (LDH) levels in blood were collected from serum biochemical tests. We use multivariate logistic regression analyses to investigate the association between serum LDH level and rDWILs after ICH. The average serum LDH level was 186.5 ± 35.6 U/L. And this level was higher in patients who presented rDWILs than in those without rDWILs. With the best cut-off value of 191 by using receiver operating characteristic (ROC) analysis, elevated LDH was associated with the presence of rDWILs independently (OR = 1.024, 95%CI = 1.011–1.037, P < 0.001) in the bivariate logistic regression analysis with adjustment for age, sex, previous ischemic stroke/TIA, smoker, SBP on admission, hematoma volume, and intraventricular hemorrhage (IVH). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of LDH ≥ 191 U/L for rDWILs were 70.4%, 72.2%, 33.9%, 94.2%, respectively. Our study suggests serum LDH level has a significant correlation with rDWILs after spontaneous ICH. Patients with higher serum LDH level in 24 h after ICH onset may be a useful predictor for rDWILs occurrence.

Role of Magnetic Resonance Imaging in Spinal Cord Traumatic Injuries and its outcome according to ASIA Impairment Scale

Background:&nbsp; Spinal trauma is one of common neurosurgical problem and mismanagement can lead to fatal outcome. Objective: To determine the MRI based initial diagnosis of acute spinal injuries and determine its pattern with reference to its neurological outcome. Methodology: Study Design: Prospective cohort study, involving radiographic and clinical review. This study was performed on 69 patients of spinal trauma, January to December, 2018, at Department of Radiology, Gujranwala Medical College and DHQ teaching Hospital, Gujranwala. &nbsp;Male and female of any age were included. After initial neurological examination these patients undergone &nbsp;for &nbsp;Magnetic Resonance Imaging&nbsp; of spine, which &nbsp;were analyzed and correlated with American Spinal Injury Association (ASIA) impairment scale (AIS), then subsequently at sub-acute interval to assess neurological outcome. Data analysis was done on SPSS version 17. Results: The most common MRI findings were spinal cord edema 24 cases (34.7%). Among the other findings were, cord contusion 17 cases (24.6%), spinal cord deformity due to extrinsic compression 14 cases (20.2%), focus of hemorrhage within the cord 9 cases (13%), epidural hematoma 3cases (4.3%) and few cases appeared normal cord 2 cases (2.3%). Most of the MRI findings correlated with clinical presentation of the patient according to American Spinal Injury Association (ASIA) impairment scale. Conclusion: Patients with initial hemorrhagic grade had very poor prognosis, whereas those with focal spinal cord edema had good clinical recovery.

SAT-199 Diagnostic Dilemma: An Adrenal Incidentaloma in a Young Adult

Introduction:In an adult endocrine clinic, the majority of patients referred for evaluation of an adrenal incidentaloma are older than 30 years of age. It is important to be reminded that a patient may be diagnosed with an adrenal mass at any age but the etiology may vary depending on the age at presentation.Clinical case:An 18 year-old African American female with no significant past medical problems presented with a 2 month history of flank and abdominal pain associated with nausea and vomiting. An abdominal CT scan and a dedicated adrenal CT showed a right adrenal mass measuring 2.2 x 2.6 cm. The noncontrast Hounsfield units were 23, enhanced Hounsfield units 210, and delayed Hounsfield units 72. The calculated washout was 44%, not consistent with an adrenal adenoma. An MRI of the abdomen showed a 2.5 cm right adrenal nodule. The lesion did not demonstrate significant loss of signal between in and out of phase imaging, therefore the characteristics were not consistent with a lipid rich adenoma. Laboratory tests included an ACTH of 31 pg/mL (6-48 pg/mL), cortisol 8.7 ug/mL at 10:57 am (7-9 am 5.27-22.45 ug/mL), aldosterone 10.1 ng/dL (6-48 ng/dL), renin 2.2 ng/mL/hr (upright 0.5-4.0 ng/mL/hr), DHEA-sulfate 129 ug/dL (44-248 ug/dL), plasma free metanephrine 0.10 nmol/L (0.00-0.49 nmol/L), and plasma free normetaneprhine 0.41 nmol/L (0.00-0.89 nmol/L). The 24-hour urine norepinephrine, epinephrine, and metanephrine were all normal, however the 24-hour urine dopamine was elevated, 824 ug/24 hrs (52-480 ug/24 hrs). Subsequently, plasma dopamine, norepinephrine, and epinephrine were all within the reference range. The patient had a robotic-assisted right adrenalectomy removing a 5.7 x 3.5 x 1.7 cm gland, weighing 16.3 grams. The pathology demonstrated a ganglioneuroma within the right adrenal gland measuring 2.2 x 2.0 x 2.7 cm, negative for neuroblastoma or blastic components. Focal hemorrhage was noted, there was no tumor necrosis, and no mitotic figures were present. The tumor appeared to be encapsulated in the adrenal gland and the Ki-67 stain was negative in ganglioneuroma cells.Conclusion:Adrenal adenomas that appear as incidentalomas in young adulthood are extremely rare. Evaluating younger versus older adults found to harbor an adrenal “incidentaloma“ requires a unique approach for each age group, as the differential diagnosis varies widely. In our patient, the imaging was extremely concerning and diagnostic considerations included neuroblastoma, adrenocortical malignancy, pheochromocytoma, or ganglioneuroma. Adrenal ganglioneuromas are most frequently diagnosed in fourth and fifth decades of life. In younger adults ganglioneuromas are usually found in the retroperitoneum and posterior mediastinum. For our patient, surgical resection of the adrenal mass confirmed the pathologic diagnosis and provided definitive cure.

SAT-LB47 Tension Pneumothorax Following Cabergoline Initiation for Macroprolactinoma

Background Pneumocephalus is a rare and life-threatening complication of dopamine agonists (DA) for the treatment of invasive giant prolactinomas. Here we present a catastrophic case of pneumocephalus following cabergoline therapy for invasive macroprolactinoma. Clinical Case A 49-year-old man presented with transient left-sided facial weakness for one day. MRI Brain showed no acute infarcts but revealed a 3.7cm pituitary macroadenoma extending into the sphenoid sinus and left cavernous sinus, encasing the left internal carotid artery with scattered hemorrhagic foci. He was discharged on cabergoline 0.25mg twice weekly for hyperprolactinemia of 7640 ng/mL (N 2.64-13.13 ng/mL). Four weeks later, he was readmitted for altered sensorium, clear rhinorrhea and positional headache. Work-up showed a prolactin of 204 ng/mL confirmed on dilution testing, and a random cortisol of 8.3 mcg/dL. MRI Brain revealed mass involution measuring 2.8cm with the central component replaced by air, and extensive pneumocephalus overlying bilateral cerebral hemispheres, within lateral ventricles and basal cisterns. Further DA therapy was held, and the patient was started on stress dose steroids. He underwent emergent surgical repair of the CSF leak, partial tumor resection and lumbar drain placement. Pathology confirmed pituitary adenoma staining positive for prolactin. Two weeks later, prolactin was 7157 ng/mL. Subsequent attempts to restart DA therapy was complicated by recurrent CSF leaks requiring two additional surgical repairs. After a complicated hospital course requiring prolonged intubation, tracheostomy and PEG tube placement, he was discharged to an acute rehabilitation center on low dose bromocriptine 2.5mg daily as well as maintenance hydrocortisone 10mg twice daily. Discussion CSF leak with pneumocephalus is a rare complication of DA therapy for invasive macroprolactinomas. It occurs due to disruption of the dura with an osseous defect of the skull base. Rapid volume reduction by DA leads to exposure of previously created pathologic opening in the skull base originally plugged by tumor itself until then. Out of 60 patients from 1980 to 2017 who developed DA therapy-induced CSF leak, more than half (57%) were on bromocriptine. Median initial prolactin was 5460 ng/ml and median time from therapy initiation to presence of rhinorrhea was 6 weeks, although it can occur as late as 2 years. The recommended definitive management of DA-induced rhinorrhea is surgical repair. Subsequently, there is no consensus on how to restart DA post-repair. Conclusion This case illustrates the importance of watchful monitoring of response after DA therapy initiation in invasive macroprolactinomas. Although data is sparse, there may be benefit in lower and less frequent dosing initially. Patient education regarding the risk of complications and signs/symptoms to watch out for with DA therapy is also crucial.

Three Patterns of Cutaneous Involvement in Granulomatosis with Polyangiitis

BackgroundSkin involvement in granulomatosis with polyangiitis (GPA) is common and can appear as an initial presentation of the disease or more commonly through its course. Case presentationWe report a case of a 24-year-old male patient, previously diagnosed as having GPA, admitted with fever, hemoptysis, generalized hemorrhagic blisters associated with arthralgia, fatigue, myalgia, nasal crusting, and vertigo. Three weeks prior to admission, he developed erythematous papules on both elbows, and purpuric papules on both lower limbs. Histopathological examination revealed: interstitial granulomatous dermatitis (elbows) and foci of dermal hemorrhage, foci of interstitial histiocytes and zones of altered necrobiotic collagen (lower limbs) consistent with cutaneous lesions of GPA. Two weeks later, his rash progressed to widespread purpura associated with hemorrhagic blisters. Another biopsy revealed leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls associated with perivascular infiltrate of neutrophils, nuclear dust and extravasated erythrocytes without an associated granulomatous inflammation or necrobiosis. The constellation of the results of the three biopsies together with clinical correlation pointed to a flare of GPA. ConclusionSkin involvement in GPA is quite common, and it can manifest in different forms in the same patient. Our patient developed three different skin pathologies within a short period of time.

İnternet Üzerinden Alınan Potasyum Siyanür İle İntihar: Olgu Sunumu

Siyanür bilinen en toksik maddelerden birisidir. Akut zehirlenmelerine sık rastlanmamakla birlikte siyanürle intiharlar sıklıkla ölümle sonuçlanır. Bu çalışmada; internet aracılığı ile alınan potasyum siyanür ile intihar eden 27 yaşındaki bir erkek olgu sunulmuştur. Olay yerinde bulunan beyaz renkli madde ile bulaşıklı bir adet su bardağı ve internet üzerinden kimyasal malzemeler satan bir firmadan 1 kg potasyum siyanür satın aldığını belgeleyen fatura ve kredi kartı ödeme fişi bulunmuştur. Otopside özefagusta submukozal konjesyon ve fokal taze kanama alanları, diğer dokularda ağır hiperemi gibi nonspesifik bulgular olduğu görülmüş ve toksikolojik incelemede ağız yoluyla alınan akut siyanür zehirlenmesi nedeniyle öldüğü saptanmıştır. Bu olgu, bilinen en toksik madde olan siyanürün internet üzerinden kolaylıkla alınabilmesine dikkat çekmek ve bu maddelere erişimin sıkı bir şekilde denetlenmesi gerektiğini vurgulamak amacıyla sunulmuştur.

Incidental finding of thymic cyst in a newborn baby.

Thymic hyperplasia is a common finding among newborns, but cyst formation might produce mediastinal symptoms. Lethal outcome is reported when accompanied by massive intrathoracic hemorrhage. The clinical picture in our case was characterized from profuse multiple hemorrhagic foci and respiratory distress syndrome, with an unclear role of the thymic cyst.

Seasonal emergence of benign epidermal tumor in farm-reared adult grass carp (Ctenopharyngodon idella) caused by lymphocystis disease virus at Uttarakhand, India

From 2017‐2019, during the winter months (November–January), epidermal papilloma like benign tumor was observed in farm-reared adult grass carp, Ctenopharyngodon idella at the northern part of India. An investigation was undertaken to establish the causative agent of this epizootiology. Based on the clinical signs and ineffectiveness of antibiotics to control this disease, viral infection was suspected. A primer was designed to PCR amplify the partial DNA polymerase gene of lymphocystis disease virus (LCDV) from the tumor of moribund grass carp, which yielded 460 bp amplicon. After sequencing this 460 bp amplicon, the viral agent from the tumor of grass carp was identified as lymphocystis disease virus and given strain designation LRI-18 (Genbank accession number-MK347473). Phylogenetic analysis based on the nucleotide sequence of DNA polymerase gene of LCDV revealed the close association of LCDV LRI-18 to LCDV strain from Israel with 99.0% and 96.5% nucleotide and amino acid sequence identity, respectively. LCDV LRI-18 form single (type A; 0.5–2.0 μm) or multiple (type B; 0.5–2.0 μm) intracytoplasmic inclusion bodies on lymphocystis and erythrocyte cells of infected grass carp. Transmission Electron Microscopy (TEM) of blood revealed the presence of enveloped icosahedral virions of approximately 280 nm in diameter with electron dense core and an outer capsid. Histopathological study of various organs of LCDV infected grass carp revealed extensive hypertrophy and fusion of secondary gill lamellae, focal hemorrhage in the eye, pyknotic nuclei in the liver, inflammation in the myocardium, fused villi of intestine and degeneration of the glomeruli in the kidney. Experimental infection by a dip to grass carp fingerlings (average body weight 4.4 ± 0.9 g) using 0.45 μm filtered LCDV crude suspension did not reproduce the disease, and also no mortality were observed. This is the first report of the occurrence of lymphocystis disease in grass carp in India.

The Effects of Prolonged Chloramphnicol Administration on Heamatological Parameters and Histophatology of Liver, Kidney and Spleen in Broiler Chicken

Chloramphenicol a broad spectrum antibiotic was tested on broiler birds to evaluate the effect of its prolonged administration on heamatological parameters, identification of histopathological changes on organs (Liver, Spleen and Kidneys) and to determine if prolonged effect has effects on weight gain and mortality rate.&#x0D; One hundred and twenty day old chicks from Kamadex Ibadan were used for the experiment. The birds were assign to two (2) treatments and control group each replicated in a Complete Randomized Design (CRD), birds in treatment one (T1) were administered normal dose of Chloramphenicol (250 mg/Kg), while treatment two (T2) were served with triple dose in medicated water served ad-lib for seven weeks, while the control (T3) were served with un-medicated water ad-lib. Samples (blood, liver, kidney and spleen) were collected and analyzed after 8 weeks of the experiment.&#x0D; Birds showed significant variations in heamatological values across treatments. Lymphocysts count: treatment two (T2) was higher than the treatment one (T1) whereas that of (T3) was found to be less, compared to those of T1 and T2. Heterophils: T3 was higher than the T1 while that of T2 was less as compared to T3 and T1. Basophil: T1 was higher than T3 while that of T2 was less. A lower value was observed in weight gain with birds on T2 as compared to T1 and T3. The liver of birds on T1 and T2 were significantly larger than those on T3. High mortality was recorded in birds on T2 compared to those in T3 and T2.&#x0D; The histopathological pictures of the liver, kidney and the Spleen depict a varying degree of necrosis and hemorrhagic foci on all the organs, the changes were much severe on T2 as compared to those of T1 and T3.