Pale Areas Research Articles

Skin and heart histopathology in fatal electrocution with otherwise inconclusive autopsyfindings: A case series

The macroscopic evidence of low voltage electrocution in the skin is seen in the form of a crater with raised areolar edges and a surrounding pale area. This typical picture ofskin is mostly minimal or altogether absent in many cases of electrocution. The issue gets complicated in the absence of any eye witnesses or circumstantial evidences. Under such a scenario, it is advisable to do a histopathological examination of the suspected skin wounds. Since cardiac arrest is the most common mechanism of death following electrocution, heart histopathology may also yield vital evidence. We report three cases of electrocution. In one case, there were eye witnesses to the electrocution incident. In the second case the body was recovered from a swimming pool with no direct eye witness. In the third case the victim suddenly collapsed while welding. All the three cases were received dead in our hospital with inconclusive skin findings during autopsy examination.The histopathological examination of heart along with the skin wounds provides the vital evidence in favor of electrocution. Through these case reports we stress the importance of histopathologically examining the skin and heart in alleged cases of electrocution with inconclusive autopsy findings.

Intoxicación con monensina en un feedlot de búfalos de Argentina

<p>El objetivo de este trabajo fue describir un envenenamiento accidental por monensina en búfalos domésticos (Bubalus bubalis) pertenecientes a un feedlot ubicado en la región nordeste de Argentina. Los signos clínicos incluyeron ansiedad, posición ortopneica con rechinamiento<br />de dientes, diarrea, debilidad muscular, depresión y recumbencia. En los animales expuestos<br />a monensina se observaron aumentos significativos de creatin fosfoquinasa y aspartato aminotransferasa. A la necropsia, los búfalos presentaron áreas pálidas de distribución irregular, hidrotórax, congestión y edema pulmonar. Al examen histológico se observó degeneración y necrosis de músculos cardíaco y esquelético. El análisis del alimento reveló niveles tóxicos de monensina, por lo cual se diagnosticó una toxicosis por ionóforos. A pesar de los efectos positivos de la monensina como fuente de alimento de los animales, se debe requerir un mayor nivel de precaución al alimentar búfalos con ionóforos.</p>

Two independent families with strongly suspected hereditary diffuse gastric cancer based on the probands' endoscopic findings.

Hereditary diffuse gastric cancer (HDGC) is the most famous of hereditary gastric cancer syndromes with an autosomal dominant inheritance pattern, and its diagnosis can be made by identifying a pathogenic germline variant in CDH1. We report two independent families that were strongly suspected of having HDGC based on endoscopic findings (multiple tiny, pale areas) obtained in the probands; the probands were pathologically diagnosed as having signet ring cell carcinoma (SRCC) and were genetically confirmed to have a pathogenic CDH1 germline variant. Although the updated International Gastric Cancer Linkage Consortium (IGCLC)'s clinical guidelines for HDGC (2015) state that screening/surveillance endoscopy should be performed (Cambridge protocol), the endoscopic findings obtained in the two presently reported families suggest that pale areas should be suspected as indicating the presence of SRCCs, and biopsies should be performed in addition to obtaining a precise family history in cases suspected of having HDGC.

An Atypical Presentation of Giant Cell Arteritis with Bilateral Choroidal Ischaemia

Background: Giant cell arteritis is an immune-mediated, medium to large vessel vasculopathy affecting individuals over 50 years of age. It can cause sudden, severe and irreversible loss of vision, most commonly from an arteritic posterior ciliary artery occlusion causing anterior ischaemic optic neuropathy. The optic nerve appearance would typically be swollen and chalky white. Visual reduction secondary to choroidal ischaemia is a much less frequent presentation, the signs of which can be more subtle in appearance, making its early recognition potentially more challenging. Case Presentation: A 51-year-old male presented to eye casualty complaining of a one-week history of neck pain, intermittent headaches and jaw claudication, associated with reduced vision in his right eye. Presenting visual acuity was hand movements and 6/5 in the right and left eyes respectively. On examination, he was noted to have a right relative afferent pupillary defect, a pale macular area in the right eye with a possible cherry red spot. There was no optic disc swelling. ESR was 34 and CRP was 46 and he was wrongly diagnosed with a non-arteritic central retinal artery occlusion. He subsequently re-presented 5 weeks later with vision loss in his left eye. Best corrected visual acuity was now 6/60 and 6/12 in the right and left eyes respectively. Dilated fundoscopy showed multiple yellow-white lesions in the posterior pole of the left eye and a retinal cotton wool spot. The right optic nerve was pale, and left was normal. A fundus fluorescein angiogram showed delayed choroidal filling and the temporal artery biopsy was suggestive of GCA. He was started on 110mgs of oral prednisolone. After 4 weeks of steroids his BCVA was 6/36 and 6/6 in the right and left eyes respectively. His neck pain, headaches and jaw claudication had all resolved and his ESR and CRP had returned to normal levels. Conclusion: Our case highlights the need for increased awareness of this uncommon presentation of this potentially blinding disease, to allow prompt and appropriate treatment. Our case is unusual in that despite a delayed diagnosis of 5 weeks, visual acuity initially improved with treatment.

Infantile Hemangioma: An Updated Review.

Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas. A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.

Immunofluorescent Detection of NET Components in Paraffin-Embedded Tissue.

Neutrophil extracellular traps (NETs) consist of decondensed chromatin fibers studded with granular and cytoplasmic proteins and peptides that are released by stimulated neutrophil granulocytes. If present in abundance (e.g., in large thrombi), NETs are depicted in H&E-stained tissue sections as pale bluish areas. Since no NET-specific antibodies exist, to unambiguously identify even small amounts of NETs in tissue, it is essential to demonstrate colocalization of nuclear and granular/cytoplasmic NET components which in unstimulated neutrophils are clearly separated. This requires good tissue preservation and a very defined immunolocalization, which can be achieved by using 2-3μm thick sections of paraffin-embedded tissue. It provides sufficiently good tissue preservation for subcellular localization of two or more NET components, thereby allow to differentiate stimulated from unstimulated neutrophils and to clearly identify NETs. In this chapter, we will provide protocols for antigen retrieval and immunofluorescent labeling of NET components in paraffin-embedded tissue with commercially available antibodies.

The damselfly genus Mecistogaster (Odonata: Pseudostigmatidae) from the Brazilian Atlantic Forest with a description of three new species and a neotype designation for M. amalia (Burmeister, 1839).

Mecistogaster Rambur, 1842 is a genus of Pseudostigmatidae with five species distributed from Mexico to Argentina. Four of these occur in Brazil, two of which were recorded on the Atlantic Forest, M. amalia (Burmeister, 1839) and M. linearis (Fabricius, 1776). After examining 140 specimens of Mecistogaster amalia it was possible to conclude that it is a complex of species and three new species are described, M. kesselringi sp. nov., M. mielkei sp. nov. and M. nordestina sp. nov. The males differ from each other mainly by the presence or absence of alula, the area occupied by the reddish-brown color of the mesepimeron and penis structure. The females differ mainly by the region occupied for the pale apical area of wing and epiproct shape. The problem of Burmeister's type of M. amalia is discussed and a neotype is erected for it. Distribution and phenology data are provided. A key for males recorded from Brazilian Atlantic Forest is presented.

Increase in morbidity and mortality in a shipment of red-eared slider turtles (Trachemys scripta elegans).

A cohort of captive-bred red-eared slider turtles, Trachemys scripta, was received from a commercial vendor. Shortly after arrival, several turtles presented as lethargic with subjectively pale skin and multifocal areas of cotton-like tufts in the mouth area and distal extremities. The water was treated with a commercial anti-fungal and anti-bacterial preparation of Victoria Green B and acriflavine. Despite treatment, 10 turtles were euthanized and others demonstrated persistent clinical signs. A live turtle was submitted to a commercial diagnostic laboratory for microbiologic and histologic evaluation. Seven cultures were obtained from this turtle and numerous organisms grew from each culture, including Flavobacterium sp. Blood film analysis demonstrated intracytoplasmic gamonts of Haemogregarina sp. within erythrocytes. On necropsy, internal organs appeared to be slightly more adhered within the coelomic cavity than normal. The urinary bladder was markedly distended with turbid, dark yellow urine. Microscopic evaluation of the tissues revealed significant parasitism with Myxidium sp., Spirorchis sp. and Neopolystoma orbiculare. No fungal organisms were identified on histology or grown in culture. While there are scattered reports of these pathogens in freshwater turtles, none of the cases reported describe such extensive co-infections. It is likely that complicated infection and shipping stress exacerbated clinical signs typically seen with these organisms. Efforts to minimize stress and administration of prophylactic antiparasitic agents during the acclimation period may aid in reducing the consequences of internal parasitism in aquatic turtles.

Pyrimidine Salvage: Physiological Functions and Interaction with Chloroplast Biogenesis.

The synthesis of pyrimidine nucleotides, an essential process in every organism, is accomplished by de novo synthesis or by salvaging pyrimdines from e.g. nucleic acid turnover. Here, we identify two Arabidopsis (Arabidopsis thaliana) uridine/cytidine kinases, UCK1 and UCK2, which are located in the cytosol and are responsible for the majority of pyrimidine salvage activity in vivo. In addition, the chloroplast has an active uracil salvage pathway. Uracil phosphoribosyltransferase (UPP) catalyzes the initial step in this pathway and is required for the establishment of photosynthesis, as revealed by analysis of upp mutants. The upp knockout mutants are unable to grow photoautotrophically, and knockdown mutants exhibit a variegated phenotype, with leaves that have chlorotic pale areas. Moreover, the upp mutants did not show altered expression of chloroplast-encoded genes, but transcript accumulation of the LIGHT HARVESTING COMPLEX B nuclear genes LHCB1.2 and LHCB2.3 was markedly reduced. An active UPP homolog from Escherichia coli failed to complement the upp mutant phenotype when targeted to the chloroplast, suggesting that the catalytic function of UPP is not the important factor for the chloroplast phenotype. Indeed, the expression of catalytically inactive Arabidopsis UPP, generated by introduction of point mutations, did complement the upp chloroplast phenotype. These results suggest that UPP has a vital function in chloroplast biogenesis unrelated to its catalytic activity and driven by a moonlighting function.

Transient Retinal Artery Occlusion After Uncomplicated Rhinoplasty

Loss of vision is an extremely rare and unexpected complication following a routine uncomplicated nasal surgery. In majority of patients, visual loss has attributed to retinal emboli which occur with retrograde flow of the intra-arterially injected agents into the nasal cavity or direct trauma to the optic nerve. In this report, the authors present a patient with unilateral decreased vision due to branch retinal artery occlusion soon after a routine nasal surgery. Clinical report. A 32-year-old female patient admitted to the author' clinic with the complaints of decreased visual acuity in the left eye. She stated that she had undergone rhinoplasty operation 1 week ago and vision loss started immediately after the surgery.In the ophthalmological examination, the best corrected visual acuity with Snellen chart was 1.0 in the right eye and 0.3 in the left eye. In the fundoscopic examination of left eye there was a pale area in the inferior part of the macula. Fundus fluorescein angiography showed no evidence of nonperfusion in the right and left eyes and vascular structure was normal. On the optic coherence tomography, hyperreflectivity and increased thickness were observed in the inner retinal layers of the left eye. In the visual field test, there was a loss of the visual field which corresponds to the pale area on the left eye. Hyperbaric oxygen therapy was recommended. The ophthalmologic examination carried out 2 months later revealed a best corrected visual acuity of the left eye 0.9. In the fundoscopy pale area was regressed in the left eye. Fundus fluorescein angiography showed a good perfusion. There was a little progression in the visual field test. Direct mechanical trauma and vasoplastic/embolic vascular events are thought to be possible mechanisms. The authors think in this case, there was a retrograde flow of agents used during the surgery through ophthalmic artery to retinal arteries and vasospasm by epinephrin worsened the situation. Although rare retinal artery occlusion may develop after rhinoplasty, vision loss as a result of a surgery, if done for aesthetic purposes is not acceptable.

The Significance of a Pale Area Via Flexible Spectral Imaging Color Enhancement in the Diagnosis of Esophageal Precancerous Lesions and Early-stage Squamous Cancer.

Goals:The main aim of this study was to investigate the significance of a pale area via flexible spectral imaging color enhancement (FICE) in the diagnosis of esophageal dysplasia and cancer.Background:The early diagnosis of esophageal squamous cancer is challenging, and the indication of Lugol’s chromoendoscopy has not yet been well established.Study:The esophageal mucosa of patients at our endoscopic center were sequentially evaluated with white-light endoscopy and FICE during insertion of the endoscope, followed by staining with Lugol’s solution during withdrawal. Patients were divided into 2 groups depending on whether esophageal leukoplakia was detected by white-light endoscopy and 2 groups depending on whether a pale area was detected by FICE. We compared cases of patients with abnormal iodine staining, and cases of dysplasia or cancer in esophageal leukoplakia—or pale area—positive and negative groups.Results:Cases of abnormal staining in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000). Cases of esophageal dysplasia and cancer in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000).Conclusions:Iodine staining should be performed in patients with esophageal leukoplakia or pale areas. Esophageal dysplasia and early-stage cancer were more easily detected in those with esophageal leukoplakia or pale areas.

Wooden-Breast, White Striping, and Spaghetti Meat: Causes, Consequences and Consumer Perception of Emerging Broiler Meat Abnormalities.

Ten years ago, the occurrence of macroscopic defects in breasts muscles from fast-growing broilers challenged producers and animal scientists to label and characterize myopathies wholly unknown. The distinctive white striations in breasts affected by white striping disorder, the presence of out-bulging and pale areas of hardened consistency in the so-called wooden breast, and the separation of the fiber bundles in breasts labelled as spaghetti meat, made these myopathies easily identified in chicken carcasses. Yet, the high incidence of these myopathies and the increasing concern by producers and retailers led to an unprecedented flood of questions on the causes and consequences of these abnormal chicken breasts. This review comprehensively collects the most relevant information from studies aimed to understand the pathological mechanisms of these myopathies, their physicochemical and histological characterization and their impact on meat quality and consumer's preferences. Today, it is known that the occurrence is linked to fast-growth rates of the birds and their large breast muscles. The muscle hypertrophy along with an unbalanced growth of supportive connective tissue leads to a compromised blood supply and hypoxia. The occurrence of oxidative stress and mitochondrial dysfunction leads to lipidosis, fibrosis, and overall myodegeneration. Along with the altered appearance, breast muscles affected by the myopathies display poor technological properties, impaired texture properties, and reduced nutritional value. As consumer's awareness on the occurrence of these abnormalities and the concerns on animal welfare arise, efforts are made to inhibit the onset of the myopathies or alleviate the severity of the symptoms. The lack of fully effective dietary strategies leads scientists to propose whether "slow" production systems may alternatively provide with poultry meat free of these myopathies.

Colopexy dehiscence preceding an episode of large colon volvulus, followed by repeat colopexy, in three Thoroughbred broodmares

SummaryThree Thoroughbred mares that had undergone previous colopexy following surgical correction of a large colon volvulus presented for colic signs unresponsive to medical management. Exploratory laparotomy was elected and a midline celiotomy was performed in the caudal aspect of the ventral abdomen in each mare. Examination of the cranial abdomen revealed the large colon was not adhered to the ventral body wall, indicating dehiscence of the previous colopexy. Further examination of the abdomen in each mare revealed a 360‐degree large colon volvulus. The previous colopexy site appeared as a linear haemorrhagic area of fibrosis in one mare and a pale area of fibrosis in two mares. The large colon volvulus was corrected and a second colopexy was then performed using the same technique as the first colopexy – by incorporating 10–12 cm of the lateral free band of the left ventral colon into the midline linea alba closure using number 3 polyglactin 910 (Vicryl®). The mares each recovered uneventfully from anaesthesia and were discharged 2–10 days later. Two of the mares are still alive at the time of manuscript submission, 475 and 789 days post‐operatively. The third mare survived 4 years post‐operatively, following which she was lost to follow‐up. Data available from our clinic indicate an incidence rate of 0.79% for colopexy dehiscence followed by a repeat episode of large colon volvulus. This phenomenon should be considered as a differential diagnosis when a mare that previously underwent a colopexy presents with severe signs of colic.

Liver and Pancreas of Mizo Local Pig (Zovawk): A Histomorphological and Histochemical Analysis

The present study was conducted on liver and pancreas of six (6) apparently healthy zovawk animal of either sex to elucidate its histological nature.Tissue samples were collected as such and were preserved in 10% NBF and Bouin’s solution for light microscopic examination.Zovawk liver was characterized by the thick Glisson’s capsule and thick connective tissue septa which divide liver into hexagonal hepatic lobules. Numerous hepatocytes with centrally placed large, rounded nucleus were presents inside the hepatic lobules. The sinusoids were formed between the hepatic cell cords and separated from the hepatocytes by a perisinusoidal space. Sinusoids were lined by stellate shaped Kupffer’s cells. Histologically, in zovawk pancreas, exocrine and endocrine portion was visualized. The exocrine portion of the pancreas was made up of secretory units and duct system. The secretory units were tubulo-alveolar with more acinar portion. The islets of Langerhans which represented the endocrine portion of the zovawk pancreas appeared as pale areas among the acini. The cells of the islets were arranged as irregular cords surrounding the blood capillaries. Mainly two types of prominent cells were found in the pancreatic islets, i.e. A cells or alpha cells and B cells or beta cells. B cells were more numerous than the A cells in the islets of Langerhans which was characterized by the spherical nucleus and located almost all over the islets. Whereas A cells were characterized by the oval nucleus and distributed mainly in the center of the islets.

Optimal Imaging Method for Late Gadolinium-enhanced Cardiovascular Magnetic Resonance in Arrhythmic Cases

We determined the procedure to reduce arrhythmia-related ghosting artifacts in the late gadolinium enhancement (LGE) imaging of cardiovascular magnetic resonance (CMR) in patients with arrhythmia by examining the causing factors using phantoms. Inversion recovery gradient echo and phase-sensitive inversion recovery (PSIR) sequences were compared under normal sinus rhythm and premature ventricular contraction (PVC) conditions. Under the PVC condition, trigger interval irregularly performed induced ghosting artifacts. A phase-corrected real image in PSIR, however; demonstrated an accurately positive contrast of pale LGE area indicative of mild fibrosis with minimal ghosting artifacts. The study results indicate that PSIR has an advantage for LGE CMR in patients with arrhythmia. Even without having PSIR method, the 2R-R method ensures consistency of contrast and enables reduction of ghost artifacts.

Red Blood Cell Analysis by Hyperspectral Imaging

Hyperspectral imaging is a new technology that aims to use the spectral information of each pixel in different spectral bands to find, identify and classify objects in an image. The hyperspectral imaging system, which is frequently used in the field of remote sensing, is becoming a new imaging model for medical applications and non-invasive disease diagnosis. In this study, a hyperspectral microscope system capable of capturing images of biological samples at different range of spectral wavelengths was developed. With this system, red blood cells in the blood sample were analyzed at various wavelengths and image classification was performed to determine the locations of red blood cells (erythrocytes). Subsequently, the detection of cytoplasm, cell edge, extracellular fluid, and pale area in the cell center of each erythrocyte was successfully performed.

MORPHOLOGICAL AND HISTOLOGICAL STUDIES ON PARATHYROID GLAND OF ADULT MALE GOAT (CAPRA HIRCUS)

The parathyroid glands are essential endocrine glands as they produce hormones that maintain calcium within the normal level in blood through secretion of parathormone. The removal of parathyroid glands leads to fatal levels of hypocalcemia. The number of parathyroid glands is species specific. The current investigation was performed on 20 healthy freshly slaughtered adult male goats. Fifteen specimens were immediately fixed in 10% buffered neutral formalin, then processed for histological and immunohistochemical examination. Other 5 specimens were handled for transmission electron microscope. The present work was conducted to study the morphological and histological characteristics of parathyroid glands of goat. Parathyroid glands comprised of two pairs, each pair formed from external and internal glands. External parathyroid gland was rounded or oval in shape. Its location was varied in the same animal where it may be located cranial to thyroid gland or beside the submandibular salivary gland. Internal parathyroid gland was embedded inside thyroid tissue. It appeared as pale rounded area at the end of cranial part of the right and left thyroid lobe. The histological findings demonstrated that, each parathyroid gland is surrounded by a thin capsule of dense irregular connective tissue. The glandular parenchyma is divided by short thick septa into ill distinct compartments. Each compartment had numerous numbers of chief cells. The active chief cells were polygonal in shape with oval nuclei. Immuno-histochemical findings revealed that they are positively reacted against chromogranin antibody. Electron microscope revealed that the cytoplasm have abundant mitochondria, rough endoplasmic reticulum, evenly distributed golgi apparatus and numerous secretory granules. On the contrary, the inactive chief cells have more vacuolated cytoplasm which contains less cell organelles.

Endocarditis by Staphylococcus sp. in Cow and Sheep Leading to Osteoarthritis and Sepsis as Unusual Outcomes

Background: Endocarditis is one of the most important heart diseases in cattle and a rare disease in sheep. This illness could be caused by any bacteria when related to bacteremia, being Staphylococcus aureus one uncommon cause for this disorder in ruminants. The clinical sings at the early stages are unspecific and many cases are only diagnosed just at thefinal stages of the disease, resulting in heart insufficiency with bad prognosis. The aim of this study is to report two cases of endocarditis caused by Staphylococcus spp. leading to sepsis in a sheep and osteoarthritis in a cow, showing the importance of this bacteria in the pathogenesis of this disease.Cases: Case 1. A 8-month-old sheep, female, Texel showed lameness in the left thoracic limb, and even treated with nonsteroidal anti-inflammatory drug had anorexia, locomotion difficulty and on the day before of death showed neurological sings, with less than one week of total clinical course. At necropsy, in the heart was observed thrombus in the tricuspid,mitral and aortic valves and pale areas in the myocardium. Multiples abscesses were observed in the lungs, liver and kidneys and infarcts in kidneys, spleen and brain. At the histopathology exam was observed in the tricuspid, mitral and aortic valves subacute endocarditis with intralesional coccoids bacteria Gram positives. There were multifocal fibrinonecrotic myocarditis, abscess in lung, liver and kidney with intralesional bacterial myriads. In kidneys, spleen and brain was observedthrombosis associated to multiple infarct areas. Samples of cardiac thrombus, heart, spleen, kidney and meningeal swabs were submitted for bacterial cultivation and was isolated Staphylococcus aureus in all samples, in pure culture.Case 2. A 2-year-old cow, female, mixed breed Angus and Charolais showed a wound in the distal part of the thoracic limb that was done topical treatment. After a month, was noted submandibular and dewlap edema, prostration, lethargy and fever. Antibiotic treatment was performed having remission of edema and fever, however being lethargic yet. Aftera month post antibiotic treatment, the animal showed bilateral increased of joint volume and a new antibiotic treatment was performed. The X-ray and cytology of the synovial fluid presented septic osteoarthritis in both radiocarpal joint. At necropsy was observed a thrombus in the tricuspid valve of approximately 20x4cm ascending to caudal and cranial cavaveins and a pulmonary abscess. In the left carpometacarpal joint, right antebrachiocarpal joint and stifle joint were observed severe purulent exudation and erosions. At histopathology evaluation of the heart was noted subacute septic endocarditis in tricuspid valve and in the joints was observed subacute fibrinopurulent osteoarthritis. In the swabs of joints and thrombus was identified Staphylococcus coagulase positive.Discussion: Despite the fact of to be skin commensal, S. aureus can enter in the bloodstream and to cause endocarditis, sepsis, abscesses and arthritis. Regard to possible entryways, interdigital pododermatitis and skin superficial lesions can be the entrance of the agent. In both cases the animals showed lesions on the limbs, as possible cause. The relationshipbetween endocarditis and osteoarticular infections is not fully known. In cattle with heart disease was noted that lameness is an important clinical sign and osteoarthritis could be related with endocarditis. Staphylococcus aureus rarely is reported in endocarditis cases in ruminants and the outcomes showed here are uncommon and poorly studied.Descritores: estafilococose, doença cardíaca, poliartrite, bacteremia, ruminantes.

Outbreak of Infection by Piscinoodinium pillulare and Trichodina spp. in Tambaquis (Colossoma macropomu), Pirapitingas (Piaractus brachypomus) and Tilapias (Oreochromis niloticus) in the Federal District, Brazil

Background: Piscinoodinium pillulare is a mandatory mastigophore protozoan with no parasitic specificity, and an important ectoparasite of tropical and temperate psiculture. This parasite is responsible for serious health problems in Brazilian native fish. Another important pathogenic protozoan in psciculture belongs to the genus Trichodina spp., which is commonly found on the surface of fish, gills, fins, and integument. The aim of the present study was to describe an outbreak of P. pillulare andTrichodina spp. in three species of fish intensively created, emphasizing the anatomopathological and epidemiological aspects.Cases: Five animals were necropsied, among them three tambaquis (Colossoma macropomu), one pirapitinga (Piaractus brachypomus) and one tilapia (Oreochromis niloticus) from an intensive psciculture in the Federal District. Out of 1500 fishes, 18 (1.2%) became ill and died. It was reported that the animals showed decreased feed intake, discomfort, dyspnea, opercular movements, red skin lesions and consequent death. In the direct examination of scraping of the body surface of a fish, preparedbetween lamina and coverslip, a ciliated ectoparasite, with a circular bell shape, measuring approximately 20-180 μm, adhered, with morphology consistent with Trichodina spp. was evidenced. During necropsy, fragments of different organs were collected and fixed in 10% formalin, routinely processed for histology, embedded in paraffin, cut to five microns thick and stained with hematoxylin and eosin (HE). Macroscopically, there were pale scaly areas in the medial-lateral regions, moderate increase amountof mucus with brown to green lumps on the body surface, partial loss of the fins, swollen gills with whitish mucus and multifocal hemorrhagic areas on the skin and between the scales. Microscopically, moderate multifocal lymphoplasmocytic branchitis was observed with cell hyperplasia and fusion of secondary lamellae associated with trophons (protozoa), consistent with P. pillulare.Discussion: The diagnosis of infection by P. pillulare and Trichodina spp. in this study was based on the epidemiological and clinical-pathological findings. Regarding the first ones, we highlight the variety of fish species affected. P. pillulare is an example of a commensal parasite present on the substrate of culture tanks, and exerts a type of non-obligatory parasitism that uses the fish as a substrate for its fixation under favorable conditions. In this case, only Trichodina spp. was observed during the traditional evaluation of body surface and gills scraping, and histopathology was essential for the verification of the agent P. pillulare. Routine histopathological analysis may also provide a definitive diagnosis, observing the trophons attached to the gill filaments. Atrophy and fusion of secondary lamellae, which promote proliferative lesions in the gills associated with the interlamellar presence of parasites, are responsible for hypoxia, loss of balance and erratic movements. Although they were observed in a small number, Trichodina spp. are believed to be responsible, on a larger scale, for hemorrhagic lesions on the skin and between fish scales. These findings were similar to those of the literature, and the diagnosis of these parasites allows producers and technicians to adopt adequate treatment, as well as prophylactic measures that provide good environmental conditions in order to avoid economic losses.Keywords: fish diseases, protozoa, fish ectoparasites.

Sa1303 IS THERE A PLACE FOR SPYGLASSTM EVALUATION OF POST LIVER TRANSPLANT BILIARY ANASTOMOTIC STRICTURE?

Cholangioscopy allows bile duct visualization, tissue sampling and therapeutic interventions. The aims of this study were to evaluate the usefulness of SpyGlassTM in post orthotopic liver transplant (OLT) biliary anastomotic strictures (BAS) and eventually identify endoscopic predictors of treatment result. This is a prospective observational cohort study conducted at a tertiary center in Brazil. Institutional review board approval and informed consent were obtained. Consecutive eligible patients with suspected post OLT biliary complications referred to ERCP were considered to SpyGlassTM. Exclusion criteria were previous endoscopic therapy, pregnancy, age under 18 years old, and inability to provide informed consent. Once a stricture was confirmed, patients were submitted to SpyGlassTM cholangioscopy followed by deployment of a fully covered self-expandable metal stent (CSEMS). Stent removal was scheduled at 12 months, when SpyGlassTM evaluation was repeated. Primary outcome measures were cholangioscopy success rate and biliary ductal changes in post-OLT BAS before and after CSEMS treatment. Secondary outcome measure was description of adverse events. Between March/16 and June/17, a total of 42 patients with post-OLT biliary complications were assessed for eligibility, and 20 were enrolled (results are summarized in Table 1). Cholangioscopy was successfully performed in all patients and showed the stricture orifice and a pale scar area in all of them. Remarkable findings were the presence of surgical sutures visualized in 10 and debris in 5 patients. All 20 patients had a previous abdominal ultrasound and stones had been described in 5 (25%). However, only 1 was confirmed by cholangioscopy and the remaining 4 ended up being sutures and debris misinterpreted as stones. Cholangioscopy-assisted guide wire placement was necessary in 5 (25%) patients. Other cholangioscopic findings are in Table 1. Two patients died with the stent in place and were excluded. Five patients still have the stent in place. Acute pancreatitis was the most common procedure complication (6.6%). Distal CSEMS migration occurred in 55.5% (10/18) and proximal in 5.5% (1/18) of patients. CSEMS occlusion was found in 16.6% (3/18). So far, with median follow-up of 412 days, stricture resolution was achieved in 30.8%. In best-case scenario, the success rate reaches 50%. No cholangioscopic finding was statistically related to treatment outcome. There were no recurrences. The most interesting finding of cholangioscopic evaluation after stent removal or migration was sutures’ disappearance. The presence of sutures and debris at the anastomotic site in post-OLT patients was remarkable. SpyGlassTM was useful to transverse the stricture in severe cases. The role of diagnostic cholangioscopy in post-OLT patients remains to be defined.Tabled 1Summary of resultsN20Female : Male9:11Age (years)Average (range)50 (19 – 68)Median (±SD)54 (±14)Time from OLT to ERCP (days)Average (range)411.5 (30 - 2488)Median (±SD)159.5 (±657.2)BAS treatmentSuccess4/18 (22.2%)Failure9/18 (50%)In treatment5/18 (27.8%)Stent treatment duration (days)Average (range)180 (14 – 403)Median (±SD)136 (±156)Adverse eventsAbdominal pain with hospitalization2/33 (6.6%)Acute pancreatitis2/33 (6.6%)Distal migration10/18 (55.5%)Proximal migration1/18 (5.5%)Occlusion3/18 (16.6%) Open table in a new tab Table 2SpyGlassTM evaluation in in post orthotopic liver transplantation (OLT) biliary anastomotic strictures.SpyGlassTM findingsBefore CSEMSAfter CSEMSStricture orifice20 (100%)5 (55.5%)Pale scar area20 (100%)1 (11.1%)Granular surface10 (50%)7 (77.8%)Sutures10 (50%)-Prominent small caliber vessels6 (30%)4 (44.4%)Debris5 (25%)-Convergence of folds4 (20%)-Prominent enlarged vessels3 (15%)1 (11.1%)Ulceration2 (10%)-Friability2 (10%)-Mucosal projections1 (5%)-Necrotic tissue1 (5%)1 (11.1%) Open table in a new tab