Liquefactive Necrosis Research Articles

MORPHOLOGICAL CHARACTERISTICS OF THE ENDOCRINE FUNCTION OF THE HEART IN COMORBID PATHOLOGY.

Aim: To study the ultrastructural remodeling of atrial myoendocrine cells (AMC) of the atrial myocardium in streptozotocin-induced diabetes (SID) under chronic immobilization stress (CIS). Materials and methods: 40 sexually mature white male rats (body weight 150-180 g) were included in the study. Four groups were formed: group 1 - animals with comorbid pathology (SID and CIS), group 2 - animals with SID, group 3 - animals with CIS, group 4 - intact animals. Results: On the 14th day of the development of SID and CIS, an increase in the functional activity of AMC is noted, which is confirmed by hyperplasia and hypertrophy of the protein-synthesizing apparatus, an increase in the volume density of secretory granules (SG), especially diffusing ones, and indicates enhanced release of atrial natriuretic peptide (ANP) from cells during the experiment. On the 56th day of the experiment, in groups 1 and 2 of , destructive changes in AMC were noted, such as vacuolar and balloon dystrophy, colliquative and partial necrosis. At the same time, the functional activity of AMC of different regions of the myocardium significantly. In animals with CIS, the volume density of young and diffusing SG in AMC is decreased. Conclusions: Therefore, in the early stages of the development of SID and CIS, an increase in the morpho-functional activity of AMC is noted. The long course of SID and its combination with CIS lead to destructive changes in AMC and to decrease in their secretory activity.

Pancreatic Panniculitis Secondary to Pancreatic Cyst With Lower Extremity Wounds as a Primary Presenting Feature: A Case Report and Literature Review

Introduction. Pancreatic panniculitis is a rare skin manifestation of pancreatic disease. It is characterized by inflammation and liquefactive necrosis of subcutaneous fat. Treatment involves addressing the underlying cause and providing supportive wound care. Case Report. The authors present a case of a 68-year-old man who developed painful, erythematous wounds on his lower extremities that progressed to purple, edematous lesions with purulent drainage. During the progression of his wounds, he developed epigastric pain and acute pancreatitis. Subsequent CT scan showed a pancreatic cyst that had extended into the portal vein. Deep, excisional biopsy of the wounds helped further narrow the differential. Histology indicated “ghost cells,” which are adipocytes with a central clearing and dark basophilic calcium deposits in the cytoplasm. Conclusion. The presence of ghost adipocytes is a rather unique histopathological feature consistent with pancreatic panniculitis and should be considered in combination with the overall clinical picture to determine the underlying etiology. Pancreatic panniculitis can be a primary presenting feature and possible complication of pancreatic disease.

Association between Clinical Symptoms and Histological Features of Molars with Acute Pulpitis.

Diagnosis of dental pulp status on the basis of clinical signs in many cases helps clinicians to better resolve patient problems. Various studies have shown no correlation between clinical and histologic findings. The aim of the present study was to evaluate the associations between clinical findings and histological features in extracted decayed teeth with acute pulpitis. One hundred permanent cavitated human teeth with mature apices and pulpitis, which were extracted for reasons not related to the present study, were evaluated. Demographic, clinical, and radiographic data were collected using pre-designed questionnaires. After tooth extraction, 5 micron-thick slices were prepared for microscopic assessment. General pathologist evaluated reactions to stimuli in all areas of the pulp tissue under a light microscope. When present, inflammation was classified according to the type and spread of cell detected and other histological findings, such as abscess formation, pulp stones, and pulpal fibrosis, were also recorded. We found significant associations between pain characteristics, such as pain type and duration, and histological status. Acute inflammation, severe chronic inflammation, and liquefactive necrosis increased with pain severity. Various histological sections showed the absence of pulpal inflammation. We found a good agreement of patients' pain histories and pain characteristics with histological pulp status. Thus, the use of specified CHARTs and SCALEs that help patients provide the most accurate responses to questions about pain would aid the diagnosis of pulp status. In cases with an accurate pulpal diagnosis, the clinicians can manage pulpal protection when it is possible.

Investigation of the neuroprotective effect of kefir in experimental spinal cord injury

In this study, the antioxidant, anti-inflammatory, and neuroprotective effects of kefir were investigated in spinal cord injury that was experimentally created on rats with a compression trauma model. A total of 56 Wistar-Albino male rats were used in the study. Daily freshly prepared 18 ml/kg/day of kefir was given by oral gavage to animals 7 days before and during the trauma and during the trauma. Spinal cord injury was created according to the weight drop method. On the 1st and 7th days before euthanasia, intracardiac blood was collected for analysis, and then they were sacrificed. The damaged spinal cord segments were examined biochemically, immunohistochemically, and histopathologically. When compared to the sham groups, kefir had a positive effect in the preconditioning and treatment groups by decreasing spinal cord bleeding, edema, myelin sheath damage, liquefactive necrosis, neuronal necrosis, selectivity of canalis centralis, and gitter cell levels significantly. When compared to the sham groups, kefir was found to have a positive effect in the treatment groups by decreasing the neuron specific enolase (NSE), ionized calcium binding adapter molecule 1 (IBA-1), inducible nitric oxide synthase (INOS), cyclooxygenase 2 (COX-2) and myelin basic protein (MBP) levels significantly on the 1st and 7th days, and by increasing the glial fibrillary acidic protein (GFAP) level significantly. As a result, it was demonstrated that kefir had a protective and therapeutic effect on spinal cord injury.

Exposición de un perro (Cannis familiaris) a un agente cáustico de uso domiciliario Caso clínico

Household cleaning products can cause corrosive or caustic effects on small animals. These products can be classified according to their pH as acidic or alkaline, the former causing a localized coagulative necrotic lesion. In contrast, alkaline products cause liquefactive necrosis immediately upon contact, resulting in deeper and more penetrating lesions. The present work describes the exposure of a dog to a alkaline corrosive agent, caustic soda (NaOH), that presented to the clinic with shortness of breath and anorexia. The owner stated that the animal had fallen into a grease interceptor, where they had placed liquid caustic soda. In the clinical examination, the dog presented inspiratory difficulty, rales, and serous nasal discharge. In addition, moderately congestive and dry ocular mucosa, congestive oral mucosa, inflamed and irritated tongue. The treatment was carried out with physiological saline solution, oxygen therapy, dipyrone, dexamethasone, and antibiotic therapy. Sucralfate (10 %) was orally administered and a wet balanced food diet. The dog was discharged 72 hours when it was able to feed normally. The treatment followed is the recommended one, having been the rapid recovery most likely due to the short period of exposure or low concentration of the caustic. The diagnosis was based on anamnesis and clinical signs observed, while the treatment established was adequate, so that the animal recovered without sequela. This report of caustic soda (NaOH) poisoning in dogs is the first communication in Uruguay.

Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study.

Objectives:Acute gastrointestinal injury (AGI) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a low incidence of complications in patients admitted to the intensive care unit (ICU). Pathophysiological knowledge related to AGI is limited, as few studies have been published on this topic. Therefore, this study was carried out to identify the clinical and histopathological features of patients with SARS-CoV-2 infection and grade IV AGI.Methods:This is a retrospective case study of fifteen patients with SARS-CoV-2 infection and grade IV AGI who underwent emergency surgery.Results:This study revealed a mortality rate of 62.5%. The most frequent gastrointestinal symptoms were abdominal distension (100%) and increased gastric residual volume (93.3%). Distended bowel loops on plain abdominal radiography (90%) and intestinal pneumatosis on computed tomography (50%) were the most frequent imaging findings. Surgical exploration revealed intestinal ischemia (66.6%) and necrosis (46.6%), and histopathology showed ischemic and liquefactive necrosis with mixed inflammatory involvement and absence of thrombosis as the cause of AGI.Conclusions:AGI associated with severe SARS-CoV-2 infection has a high mortality rate and poses a diagnostic challenge in the ICU. The complex pathophysiology and histopathological findings indicate an associated inflammatory phenomenon as the main alteration in the absence of thrombosis, as per the intestinal biopsies of the cases studied. Further clinical studies are required to gain a better understanding of this pathology.

163 Caustic Ingestions: Acids or Bases. Does It Matter?

Caustic ingestions can be classified as either acids or bases. Acidic ingestions can lead to coagulative tissue necrosis; basic ingestions can result in liquefactive tissue necrosis. While the coagulative necrosis is presumed to form an eschar that limits the depth of penetration, significant tissue damage can occur with both types of ingestion. While previous studies involving exploratory ingestions of bases demonstrated asymptomatic patients can be safely observed and discharged without an esophagogastroduodenoscopy (EGD), the safety of this practice in acidic ingestions has been questioned.

A multidisciplinary approach to accidental inhalational ammonia injury: A case report

IntroductionAmmonia is a highly toxic irritant gas, and its toxicity usually occurs from occupational exposure. Most are unintentional toxicity. It causes tissue damage via exothermic reaction with body tissues causing liquefactive necrosis. Presentation depends on the level and duration of exposure. Management is supportive and its antidote is not available yet.Presentation of caseWe report a case of a 22-year-old male with accidental workplace exposure from coolant damage and leakage. He had altered mental status with visible injury to the nasal cavity, and ulcerated laryngeal mucosa with asymmetric vocal cords on bronchoscopy. Computed tomography showed right lower lobe consolidations. A muti-disciplinary approach and prompt management with respiratory support along with inhaled steroids and bronchodilators, antibiotics, electrolyte replacement, analgesics, and supportive eye and oral treatments were initiated. He had to be managed with a high-flow nasal cannula with subsequent tapering of the oxygen supplementation with titration.DiscussionInhalation injury due to ammonia toxicity can have varied presentations from mild to severe life-threatening respiratory distress and neurological deterioration. Complications can range from upper airway edema to pulmonary edema. Most of these are usual findings except for the presence of pneumothorax. It could be due to the pre-existing lung status or oxygen therapy but the literature is inadequate.ConclusionAmmonia inhalational injury may be associated with pneumothorax. It is important to have a multi-disciplinary approach and in-hospital management of ammonia toxicity as well as to raise awareness regarding the work environment and timely recognition of the possible occupational health hazards.

Impact of acute schistosomiasis mansoni and long-term ethanol intake on mouse liver pathology

While the effect of ethanol and schistosomiasis mansoni on liver injury has been well-documented, the influence of comorbidity on liver pathology remains unclear. To address this gap, schistosomiasis-infected mice were given one daily dose of 18% ethanol for 28 consecutive days, from day 35 post-infection. Mice were assigned to four groups: A. control; B. uninfected/ethanol gavage; C. infected; and D. infected/ethanol gavage. At day 64 post-infection, mice were euthanized by CO2 asphyxiation, livers were excised, fixed in 10% buffered formalin, paraffin embedded and cut into 5 μm sections. These were stained with hematoxylin and eosin (HE), Lennert's Giemsa and picrosirius red (for polarization microscopy) to assess histopathological and stereological changes. Group B showed alcoholic liver disease (ALD), including microsteatosis, hepatocyte karyopyknosis, karyorrhexis, karyolysis, increased frequency of Kupffer cells, hydropic degeneration of hepatocyte, thickened plasma membrane and binucleated hepatocytes. Infected mice showed typical exudative and exudative-productive hepatic granulomas, and destruction of the adjacent hepatic parenchyma, resulting in necrotic tissue and periovular leukocyte infiltrate. Group D showed hyperemia (parenchymal panlobular lesions), and liquefactive necrosis in hepatic abscess area. There was also reduced liver collagen deposition (−76%; p = 0.0001) and reduced microsteatosis (−80%, p = 0.0079) compared to group C and group B, respectively. In conclusion, comorbidity exacerbated liver damage.

Dual-layer spectral detector computed tomography parameters can improve diagnostic efficiency of lung adenocarcinoma grading.

BackgroundIt is difficult to distinguish the pathological grade of lung adenocarcinoma (LUAD) with traditional computed tomography (CT). The aim of this study was to assess tumor differentiation by dual-layer spectral detector CT combined with morphological parameters.MethodsIn this prospective study, a total of 67 patients with pathologically diagnosed LUAD were enrolled: 39 patients in the well- and moderately-differentiated group (14 and 25 patients, respectively) and 28 patients in the poorly-differentiated group. Morphological parameters, non-enhanced CT number, double-enhanced CT number, effective atomic number, monoenergetic CT images (40 and 70 keV), iodine density, and thoracic aorta iodine density of tumors were measured. The slope of the spectral curve and normalized iodine density were calculated. The diagnostic efficiency of the spectral parameters alone, and the combined spectral and morphological parameters were obtained by statistical analysis.ResultsThe morphological signs of LUAD (the vessel convergence sign, bronchus encapsulated air sign, and liquefactive necrosis) were higher in the poorly-differentiated group than in the well–moderately-differentiated group (57.1% vs. 30.8%, 40.0%; 60.7% vs. 28.2%, 32.0%; 64.3% vs. 28.2%, 24.0%; all P<0.05). There were significant differences in normalized iodine density (arterial phase: 0.10±0.04 vs. 0.12±0.05, 0.13±0.04; venous phase: 0.31±0.07 vs. 0.39±0.17, 0.40±0.17) among the poorly-differentiated group and moderately-differentiated group as well as the well-differentiated group (all P<0.05). Receiver operating characteristic (ROC) curves of the poorly-differentiated group and well–moderately-differentiated group showed that the normalized iodine density had the best diagnostic efficiency in the arterial phase, with an area under the curve (AUC) of 0.817, sensitivity of 92.9%, and specificity of 82.1% (P<0.001). The AUC increased to 0.916 when the morphological parameters were included, and sensitivity and specificity were 96.4% and 82.1% (P<0.001), respectively.ConclusionsThe parameters of dual-layer spectral detector CT can help discriminate the pathological grade of LUAD. Among the spectral parameters, the normalized iodine density in the arterial phase has the best diagnostic efficiency, and the combination of spectral and morphological parameters improves the pathological grading of LUAD.

Histopathological and histochemical study of mastitis in sheep

Ovine mastitis is considered one of the problems that cause economic losses through its impact on milk production, which is unfit for human consumption. The current study aimed to shed light on mastitis in sheep in different areas of Mosul city. The results of the recent study showed the presence of mammary macroscopic and microscopic changes. Macroscopic changes were represented by the large size of the udder and changes in the color and texture, as well as clarity of sloughing and desquamation of the skin with clear exudation, especially in advanced cases. On the other hand, other samples showed the presence of hard nodules on the udders. In contrast, the histological changes represented by degenerative and necrotic changes 3.5%, and 21.4% of the sample appeared to suffer from liquefactive necrosis and abscesses infiltrated with inflammatory cells, 25% of the samples infected with granulomatous mastitis (nodular mastitis), other models showed that the udder infected with atrophy and metaplasia in the rate of 21%, thickening of the blood vessel wall with clot represented 14.2% and the deposition of calcium salt was 14.2%. The current study concludes that mastitis in sheep is widespread in sheep raised in different areas of Mosul city.

Anlotinib combined with induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: A phase II study.

e18071 Background: Necrotic lesion is a negative prognostic factor for nasopharyngeal carcinoma (NPC) while there are few treatment options for it. This study investigated the efficacy and safety of anlotinib (a multi-target tyrosine kinase inhibitor) in combination with induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in treatment of liquefactive necrosis of NPC. Methods: This is an open-label, single-arm, phase II trial (NCT05232552). Patients with histologically confirmed stage T3-4N2/T1-4N3M0 NPC (AJCC 8th) who had measurable lesions per RECISTv1.1 and received no previous treatment for cancer were enrolled. Other inclusion criteria included 18-70 years old and ZPS 0-2. All patients received docetaxel (75 mg/m², iv, d1), cisplatin (75 mg/m², iv, d1) and anlotinib (12mg, oral, qd, d1-14) every 3 weeks for 3 cycles before CCRT. Chemoradiotherapy was 2 cycles of cisplatin (100 mg/m², iv, d1) and anlotinib (12mg, oral, qd, d1-14) every 3 weeks, concurrently with intensity-modulated radiotherapy (GTV &gt; 66Gy). The primary endpoint was progression-free survival rate at 3 years. Here we report the results of a preliminary analysis. Results: Between January 2021 and September 2021, 34 patients (28 males and 6 females) were enrolled, and the median age was 54 years old. At the data cutoff date on January 24, 2022, all patients were eligible for the evaluation of tumor response with primary and lymph node lesions. 79.4% of the patients (27 of 34) had a response each for primary and lymph node lesions after IC, while 70.6% (20 of 34) achieved complete response in lymph node lesions compared with 29.4% (10 of 34) in primary lesions. At 6 weeks after CCRT, 100.0% of the patients (34 of 34) had a response in primary lesions and 97.1% (33 of 34) in lymph node lesions. The incidence of liquefactive necrosis was 58.8% (20 of 34) and there were 51 necrotic lesions in all. Among those necrotic lesions, 56.9% (29 of 51) and 80.4% (41 of 51) had complete response after IC and CCRT. The average area shrinkage of necrotic lesion after IC and CCRT was 84.5%±0.25, 97.7%±0.06, respectively. The most common adverse events of grade 3 was leucopenia (17.6%) and mucositis (17.6%), and there was 1 patient (2.9%) occurred neutropenia of grade 4. Conclusions: This preliminary analysis indicated that anlotinib combined with IC and CCRT had promising efficacy and favorable tolerance as treatment of liquefactive necrosis of locoregionally advanced NPC.

Posterior segment findings by spectral-domain optical coherence tomography and clinical associations in active toxoplasmic retinochoroiditis

Toxoplasmic retinochoroiditis is a common, potentially blinding parasitic infection. We sought to define the spectrum and frequency of signs of active toxoplasmic retinochoroiditis by spectral domain optical coherence tomography (SD-OCT), and to identify clinical associations. Ninety eyes of 90 individuals presenting consecutively to a tertiary referral uveitis service with active toxoplasmic retinochoroiditis and gradable SD-OCT scans were evaluated prospectively. SD-OCT features were collated, and associations with lesion location, primary versus recurrent episode, serological status, human immunodeficiency virus infection and best-corrected Snellen visual acuity were explored. Active toxoplasmic retinochoroiditis presented with thickened (65%) and hyperreflective (61%) retina, choroidal thickening (55%) and hyporeflectivity (61%), hyperreflective vitreous dots (80%) and deposits (36%), and posterior hyaloid thickening (35%) on SD-OCT. Most signs occurred with similar frequency across clinical groups. Retinal hyporeflectivity (17%) was significantly associated with a visual acuity of 20/200 or worse at resolution. Our observations demonstrate that active toxoplasmic retinochoroiditis has diverse SD-OCT signs and that none are universally present. Retinal hyporeflectivity—suggesting liquefactive necrosis—predicts poor visual outcome.

Dynamics of morphological and immunohistochemical changes in myocardium during hypothyroidism modeling in experiment

An experimental model of hypothyroidism was obtained by thyroidectomy. The operation was carried out on 57 sexually mature male rats weighing 250–300 g. The experiment lasted 45 days. Laboratory animals were removed from the experiment on days 7th, 14th, 21st, 28th, 35th and 45th. As a control, 15 rats were used that were not operated on. For histological examination, pieces of rat myocardium were taken from the left and right ventricles. The pieces were fixed in 10% buffered formalin for 10 days. Histological sections were prepared in a standard manner. Sections were stained with hematoxylin and eosin, picrofuchsin according to van Gieson, toluidine blue, according to Mallory. Results of the study: In the myocardium of rats, hemodynamic disorders, edema, hydropic degeneration of cardiomyocytes, myocytolysis, fragmentation of muscle fibers, colliquation necrosis, compression and atrophy of muscle fibers were found. An immunohistochemical study revealed a decrease in the expression of desmin and sarcomeric actin.

Clinical, pathological, and CT scan findings of multiple Coenurus cerebralis cysts in a non-native lamb in Iran

Coenurus cerebralis is the larval stage of Taenia multiceps which involves particularly the central nervous system of humans and ungulates. A six-month-old Charollais lamb was presented with cortical blindness, dullness, convulsion, head deviation, reluctancy to move, drooling of saliva and ataxia. Haematological findings revealed an inflammatory process. CSF analysis showed leukocytosis associated with increased total protein. By CT imaging, nine cysts were detected in the cerebrum and one in the cerebellum. Hounsfield units were below 10 in all these regions. CT images perfectly revealed multiple Coenurus cysts in various parts of the brain, which was confirmed by necropsy. At necropsy, cysts of variable size were noted at different anatomical sites of the brain. In the cerebrum, atrophy, liquefactive necrosis and mild demyelination were presenty adjacent to the cystic structures. Perivascular and perineuronal oedema, neuronal degeneration, hyperaemia and thrombosis were also seen in the cerebrum. The meninges revealed oedema, thrombosis, and mononuclear meningitis. Based on authors’ knowledge, this is the first study in Iran on Coenurus cysts in a lamb brain utilising CT scan

Tailor-made Pulmonary Rehabilitation Program Aiding Return to Preinfection Fitness in Massive Cavitatory Lung Abscess: A Case Report

Lung abscess is a form of liquefactive necrosis of the lung tissue that causes the formation of cavities (greater than 2 cm) which are filled with necrotic debris and fluid because of microbial infection. Aspiration, which may happen while the patient is not conscious and end in a pus-filled cavity. It is very rare to find out lung abscess with a complicated infection of Streptococcus pneumoniae stereotype 6B. A 42-year-old male patient was referred to a tertiary care hospital with chief complaints of breathlessness of grade II on the Modified Borg Scale, cough with expectoration, and right-sided chest pain. Chest X-ray and High Resolution Computed Tomography (HRCT) High Resolution Computed Tomography (HRCT) scan of the thorax were done and the patient was diagnosed with right lower lobe lung abscess caused by Streptococcus pneumoniae. The patient was managed by bronchoscopy and bronchoalveolar lavage (washing). A complete plan of rehabilitation was designed to meet the patient's objectives, and it was executed and followed for 1 month. The patient showed considerable functional improvement in terms of aerobic capacity, endurance, and exercise tolerance ability. It was concluded that medical care combined with pulmonary rehabilitation, together as a multidisciplinary approach result in improved outcomes related to the quality of life of the patients.

EVIDENCE OF APOPTOSIS IN PARVOCELLULAR NUCLEI OF HYPOTHALAMUS IN DIABETES MELLITUS

Diabetes mellitus (DM) causes great socio-economic damage, which is determined by medical expenses and expenditure on social security to patients due to invalidity and loss of labour capacity. Researchers are studying the role of hypothalamic neuropeptides and their involvement in the regulation of pancreatic islet function. In view of the above, the aim of our study was to establish the features of morphofunctional changes in the arcuate nucleus (AN) and ventromedial nucleus (VN) of the hypothalamus in streptozotocin-induced diabetes mellitus (SIDM).&#x0D; Histological, immunohistochemical, electron-microscopic, biochemical and statistical research methods were used.&#x0D; Polymorphic changes were noted in AN and VN at early stages of development of SIDM (on the 14th day). In AN, the area of neurons and their nuclei became larger, the numerical density of dark functionally more active neurons increased, and dinuclear light neuroendocrine cells (NC) appeared. In light and dark NCs of AN, there was a significant increase in the bulk density of neurosecretory granules – by 2-4 times compared with the control, in VN – by 1.2-2 times.&#x0D; Such morphofunctional changes in parvocellular nuclei of the hypothalamus and the increase in the bulk density of neurosecretory granules in their NCs indicate boosted synthesis of neurohormones which directly affect the adenohypophysis and improving functional activity of NCs in AN and VN.&#x0D; On the 70th day of SIDM in AN and VN of the hypothalamus, there was a decrease in the numerical density of neurons due to light NC and increase in the numerical density of vacuolated, dark pycnomorphic and apoptotic neurons. The apoptotic index in the studied nuclei of the hypothalamus increased by 2-4 times compared with the control. The area of the profile field of NC increased and the area of nuclei decreased, which led to the reduced nuclear-cytoplasmic index and indicated a decrease in their functional activity and was confirmed by a decrease in the bulk density of neurosecretory granules in NC by 1.9-2.1 times in AN and by 2.7-4.7 times in VN. At the ultrastructural level, pronounced destructive processes such as vacuolar dystrophy, development of satelliteosis and neuronophagia were observed in light NCs.&#x0D; Thus, prolonged hyperglycemia in SIDM in parvocellular nuclei of the hypothalamus causes neuronal death to a lesser extent due to apoptosis, and to a greater extentdue due to hydropic dystrophy and colliquative necrosis, especially in the long term of the experiment (on the 70th day), and leads to the development of diabetic neuroendocrinopathy.

Tongue granuloma: An unusual complication of potassium permanganate ingestion

Potassium permanganate (KMnO4 ) is a powerful oxidising agent. In its raw form, it is an odourless, sweet-tasting, dark-purple substance, available in ready-to-use solutions, pellets, tablets, crystals and powder form. In clinical practice historically, it has been used as an antiseptic and antifungal agent. In rural South African communities, however, KMnO4 has many traditional uses, including use as a snake repellent, a treatment for constipation, joint pains, open wounds, urticaria and even for casting out spells. KMnO4 is kept in most households in rural Limpopo Province, and is therefore easily accessible by children, and alluring because of its sweet taste and similarity to candy. The corrosive effects of KMnO4 ingestion on the gastrointestinal tract are secondary to the formation of potassium hydroxide, a strong alkaline corrosive which causes liquefactive necrosis, allowing deep penetration into mucosal tissue as cells are destroyed. The most common adverse effect of KMnO4 ingestion observed in our practice, and reported in this case report, is an oesophageal stricture. This adverse event often results in children dying from severe gastrointestinal bleeds or complications of tracheoesophageal fistula associated with upper airway obstruction.

Increased Liquefactive Necrosis Formation After Transarterial Chemoembolization Combined with Molecular Targeted Agents Plus Immune Checkpoint Inhibitors for Hepatocellular Carcinoma.

PurposeIn clinical practice, we found some of the patients who received transarterial chemoembolization (TACE) with molecular targeted agents (MTGs) plus immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) had obvious liquefactive necrosis formation within the tumor and some even progressed to a liver abscess, which seems more frequent than patients who received other treatments. Thus, we aim to identify this condition and analyze the potential risk factors.Patients and MethodsMedical records of 72 consecutive patients with intermediate (BCLC B) and advanced (BCLC C) HCC who received TACE plus MTGs combined with (n=30) or without (n=42) ICIs were reviewed. Liquefactive necrosis formation was defined as the presence of obvious liquefactive necrosis within the tumor that required intervention.ResultsThe liquefactive necrosis rate was higher in the TACE+MTGs+ICIs group than in the TACE+MTGs group (30% vs 4.8%, P=0.006). Moreover, 18.2% (2/11) of the patients with liquefactive necrosis within the tumor had a bacterial infection. We then take the binary logistic regression analysis model to identify the predictors of liquefactive necrosis formation, and which showed the tumor size (P=0.006, OR=1.355, 95% CI: 1.090–1.684), alpha-fetoprotein level (P=0.036, OR=6.745, 95% CI: 1.130–40.262) and treatment modality (P=0.015, OR=11.717, 95% CI: 1.617–84.887) were the independent risk factor for liquefactive necrosis formation within the tumor.ConclusionPatients with HCC who received TACE combined with MTGs plus ICIs have increased liquefactive necrosis formation, and the larger tumor size and higher alpha-fetoprotein level were associated with more liquefactive necrosis formation within the tumor.

Hematological, biochemical and histopathological studies on selected canine skin diseases

The skin is the largest organ of the body that has many functions. Canine dermatology remain a challenging field that requires a variety of knowledge as dermatological problems are reported to be the most common health problem in small animal practice. Blood, skin and biopsy samples were collected from 50 dogs of different breeds and sexes. The present study is designed for identification of the different etiological agents causing skin diseases in dogs, evaluation of some hematological and biochemical parameters in diseased dogs and histopathological examination of selected cases using skin biopsy. These dogs were grouped into two groups, the first one was the control group (n=10) apparently healthy dogs and the second group (n=40) diseased dogs presented with different skin ailments where 12 out of 40 dogs were suffered from demodicosis, dermatophytosis (6 cases), pyoderma (8 cases) , mixed infection (10 cases) and canine atopic dermatitis (4 cases). Evaluation of the hematological parameters revealed presence of anemia and leukocytosis with apparent neutrophilia in dogs with pyoderma and eosinophilia in the other groups. Biochemical parameters lied within the reference range in all diseased groups. Staphylococcus spp. was the most common bacterial isolate in canine pyoderma. With respect to histopathological picture, results indicated presence of large focal area of epidermal liquefactive necrosis associated with dense neutrophils infiltration. Severe dermatitis, folliculitis, perifollicular and perivascular inflammatory cells infiltration, all these changes associated with cases of pyoderma. Demodicosis cases demonstrated as heavy mite infestation in different developmental stages in the stratum conium of the epidermis and in the follicles. Laminar orthokeratotic hyperkeratosis, vacuolated epidermal prickle cells, acanthosis and vaculation of keratinocytes of the infundibula. Dermatitis characterized by moderate to marked inflammatory infiltration. Necrosis of adnexa, folliculitis and perifollicultis were also recorded in demodecosis infected dogs. Fungal dermatosis showed pronounced laminar orthokeratotic hyperkeratosis and acanthosis. Vacuolar degeneration of keratinocytes and fungal Hyphae were seen in dermatophytosis infected dog. Ulcerative dermatitis in form of focal extensive area of epidermal necrosis and ulceration associated with inflammatory cells infiltration, acanthosis and spongiosis of prickle cell layer were noticed in mixed infection infected dogs. The most common infectious skin problems during our study were pyoderma, red mange and dermatophytosis. The predominant pathogen in pyoderma affected dogs was Staphylococcus spp. Histopathological examination was very useful in our study as they provide accurate diagnosis in a short period of time and help in clear visualization of the clinical picture.