Segmental Necrosis Research Articles

3D Approaches to Culturing Bovine Skin: Explant Culture versus Organotypic Skin Model

Introduction: Digital dermatitis (DD) in cattle appears with high prevalence; nevertheless, the knowledge on its pathogenesis is still limited. In this context, in vitro skin models represent a valuable tool to facilitate the study of DD. Methods: Two in vitro skin models were established using bovine distal limb skin: a skin explant model and an organotypic skin model. For the skin explant model, skin samples were cultured with an air-liquid interface for up to 7 days. Besides routine histopathological examination, readout parameters were Ki-67 and cleaved Caspase-3 stainings. For the organotypic model, primary keratinocytes were layered on top of a dermal equivalent containing mainly mitotically inactive fibroblasts and maintained for up to 21 days. At regular intervals (days 7, 14, and 21), cultured skin samples were taken for (immuno)histological analysis. Results: Both cultures could be maintained for the entire duration of the intended culture period. In the histopathological assessment, explant skin cultures showed ballooning degeneration of keratinocytes and segmental necrosis starting at day 5 of culturing. Initially, basal keratinocytes in the organotypic model differentiated as demonstrated by positive Keratin 14, Desmoglein-1, Loricrin, and Involucrin immunofluorescent stainings. Ki-67 was observed occasionally and suprabasally still after 21 days of culture. Conclusion: Both in vitro models proved dependable and constitute a viable option for replacing experiments on live animals, each with its own benefits. Whereas skin explants include all cell types available in vivo and can therefore reflect realistic cell-cell interactions and signaling pathways, the organotypic model offers a higher standardization and reproducibility. Depending on the focus of future studies, both models can be used for specific experimental purposes of bovine dermatological research in general or specialized questions concerning (infectious) claw diseases as, e.g., DD.

Mitochondrial modulation of amplified preconditioning influences of remote ischemia plus erythropoietin against skeletal muscle ischemia/reperfusion injury in rats

AimsSkeletal muscle ischemia and reperfusion (S-I/R) injury is relieved by interventions like remote ischemic preconditioning (RIPC). Here, we tested the hypothesis that simultaneous exposure to a minimal dose of erythropoietin (EPO) boosts the protection conferred by RIPC against S-I/R injury and concomitant mitochondrial oxidative and apoptotic defects. Main methodsS-I/R injury was induced in rats by 3-h right hindlimb ischemia followed by 3-h of reperfusion, whereas RIPC involved 3 brief consecutive I/R cycles of the contralateral hindlimb. Key findingsS-I/R injury caused (i) rises in serum lactate dehydrogenase and creatine kinase and falls in serum pyruvate, (ii) structural deformities like sarcoplasm vacuolations, segmental necrosis, and inflammatory cells infiltration, and (iii) decreased amplitude and increased duration of electromyography action potentials. These defects were partially ameliorated by RIPC and dose-dependently by EPO (500 or 5000 IU/kg). Further, greater repairs of S-I/R-evoked damages were seen after prior exposure to the combined RIPC/EPO-500 intervention. The latter also caused more effective (i) preservation of mitochondrial number (confocal microscopy assessed Mitotracker red staining) and function (citrate synthase activity), (ii) suppression of mitochondrial DNA damage and indices of oxidative stress and apoptosis (succinate dehydrogenase, myeloperoxidase, cardiolipin, and cytochrome c), (iii) preventing calcium and nitric oxide metabolites (NOx) accumulation and glycogen consumption, and (iv) upregulating EPO receptors (EPO-R) gene expression. Significancedual RIPC/EPO conditioning exceptionally mends structural, functional, and neuronal deficits caused by I/R injury and interrelated mitochondrial oxidative and apoptotic damage. Clinically, the utilization of relatively low EPO doses could minimize the hormone-related adverse effects.

#5132 POST-COVID-19 ANTI-GLOMERULAR BASEMENT MEMBRANE DISEASE: TWO CLINICAL CASES

Abstract Background and Aims Acute kidney injury is a common complication in patients hospitalized with COVID-19, has multiple aetiologies, and is usually multifactorial. We present two cases of anti-glomerular basement membrane (anti-GBM) disease diagnosed after SARS-CoV-2 infection, suggesting a causal correlation. Case Reports A 76-year-old female, with chronic kidney disease (serum creatinine 1.5mg/dL), hypertension, weight loss (16 Kg/6 months) and a pancreatic nodule under surveillance, presented to the emergency department with 1 week of nausea, vomits, diarrhoea and oliguria, as well as a history of mild SARS-CoV-2 infection 2 weeks before presentation. Lab work revealed severe anaemia (7.4 g/dL), inflammatory markers elevation, nephrotic proteinuria (proteinuria/creatininuria ratio 30 g/g), leucoerythrocyturia, serum creatinine of 19.3 mg/dL, hyperkalaemia and metabolic acidosis requiring dialysis induction. Renal ultrasound showed signs of chronicity and several cysts. Aetiological study disclosed positive anti-GBM antibody (1800 U/L) and negative ANCA. Complementary study failed to identify pulmonary involvement or neoplasms. Given the severity of the renal dysfunction along with the absence of alveolar haemorrhage, immunosuppression and plasmapheresis were not initiated. Patient was discharged and remains dialysis dependent. A 65-year-old male smoker with type 2 diabetes and combined pulmonary fibrosis and emphysema, presented in the emergency department with 2 months of asthenia, weight loss and anaemia, in addition to dyspnoea and haemoptysis in the past 3 days. Lab work exposed moderate anaemia (9.7 g/dL), elevated inflammatory markers, serum creatinine of 1.18 mg/dL (previously 0.8 mg/dL), leucoerythrocyturia and positive SARS-CoV-2 test. Angio-Computed Tomography exhibited known pulmonary fibrosis and possible bacterial superinfection. Despite antibiotic therapy (10 days of levofloxacin), haemoptysis remained and kidney function continuously worsened (serum creatinine 2.1 mg/dL). Complementary study showed positive ANCA-MPO (1125.4 U/L) and anti-GBM antibody (460.8U/L). Renal ultrasound was innocent. Kidney biopsy revealed: 6 glomeruli with cellular crescents with segmental necrosis, 3 with focal Bowman's capsule rupture; erythrocyte casts; intimal arterial fibrosis; moderate tubular atrophy; diffuse linear deposits of IgG. Immunosuppression was initiated with prednisolone (1 mg/Kg/day), cyclophosphamide (3x 12.5mg/Kg-750 mg, 2x 500 mg), rituximab (2x 1g), immunoglobulin (1x 2 g/Kg) and plasmapheresis (15 sessions). Kidney function continued to deteriorate (maximum serum urea 306 mg/dL, maximum serum creatinine 6.92 mg/dL) requiring dialysis induction 3 weeks after the beginning of immunosuppression. Even though haemoptysis ceased, the patient remains dialysis dependent 8 months after. Conclusion Literature reports an increase of Anti-GBM disease since the beginning of the pandemic. The presented cases support the apparent correlation, suggesting SARS-CoV-2 as a precipitant of this disease by endothelial injury with basal membrane exposure and autoantibody development. In the second case, the authors assume a subacute ANCA-MPO vasculitis with superimposed anti-GBM (eventually precipitated by COVID-19). Even though the causal association is not established, we highlight the importance of clinical suspicion of this rare aetiology in cases of acute kidney injury after SARS-CoV-2 infection.

Resistant starch supplementation alters the gut microbial consortium and attenuates kidney inflammation in an experimental model of autoimmune vasculitis

Abstract Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a rare autoimmune disease with suboptimal treatment options which contribute to morbidity and mortality. The characteristic pathological feature is severe inflammation induced by neutrophils which causes life threatening damage to the small blood vessels of the kidney. Neutrophil activity is influenced by microbial metabolites, including short chain fatty acids (SCFAs), produced from fermentation of non-digestible carbohydrates by gut microbiota. We utilised a well-established mouse model of AAV. Mice were randomised to receive either a control diet or a diet supplemented with 15% resistant starch (RS) (n=8 per group). At day 20, mice were culled and kidneys removed to assess injury. Glomerular neutrophil and macrophage infiltration were assessed by immunohistochemistry. Cecal contents were collected, DNA extracted and the V1-V2 hypervariable region amplified using 27F and 338R universal primers to assess the gut microbiota. The resistant starch intervention significantly reduced segmental necrosis in glomeruli (77.63 ± 7.2 % vs 25.59± 4.5 p/gcs, p < 0.0001) and reduced neutrophil (1.3 ± 0.37per glomerular cross section (p/gcs) vs 0.4 ± 0.3p/gcs, p < 0.0001) and macrophage (1.6± 0.3 p/gcs vs 0.4 ± 0.08 p/gcs, p < 0.0001) infiltration into glomeruli. The resistant starch diet significantly altered the gut microbiota consortium and was associated with a substantial expansion of Bacteroidaceae and Muribaculaceae both SCFA producing bacteria. This is the first report of the therapeutic efficacy of a resistant starch supplemented diet in experimental AAV. This data represents a promising therapeutic avenue to limit autoimmune kidney injury in AAV.

Magnetic resonance imaging in the diagnosis of necrosis of a pulled-through colon segment after abdomino-anal resection of the rectum for cancer

This study presents a case of necrosis of the pulled-through colon after abdomino-anal resection of the rectum, which was diagnosed by magnetic resonance imaging.
 A 47-year-old man underwent laparoscopically assisted abdomino-anal resection of the rectum with reconstruction of a coloplasty pouch and transverse colostomy in the course of combination treatment for locally advanced rectal cancer. The postoperative period was complicated by the development of an inflammatory response syndrome. On postoperative day 3, contrast-enhanced magnetic resonance imaging revealed swelling of the 15-cm segment of pulled-through colon up to the coloanal anastomosis with sharply attenuated contrast enhancement, whereas rectoscopy showed no changes. On postoperative day 6, a magnetic resonance imaging scan revealed a defect in the anterior wall of the coloplasty pouch with a parietal aerocele, and rectoscopy showed signs of necrosis of the bowel wall. On postoperative day 10, the magnetic resonance imaging scan presented no changes. Because of increasing signs of inflammation, relaparotomy with anastomosis disconnection and resection of the necrotized bowel segment were performed.
 Ischemia of the pulled-through colon after rectal surgery is a rare but serious complication. Our clinical case report demonstrates the potential of contrast-enhanced magnetic resonance imaging as a non-invasive method in case follow-up in patients with a complicated postoperative period for early diagnosis of ischemia and bowel wall defects, which helps to make the appropriate patient management plan.

Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS

In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two steps can be divided into different parts and a standardized technique may render the procedure safer and the results will be easier to evaluate. In this paper, we describe a detailed approach to in-situ splitting that allows making both procedures safe, avoids liver necrosis, and is easily reproducible. In the first procedure the portal branches to segments I and IV to VIII are divided, the arterial branches and bile ducts to these segments are preserved and encircled and the parenchyma between segments II/III and IVa/b is divided. This avoids necrosis and bile leaks of segments I and IV and avoids urgent completion operations. In particular, the handling of vital structures close to the dissection line seems important to us. Complete splitting and securing the right and middle hepatic vein will make the second step of this procedure a minimal-risk procedure at a stage where the patient is still recovering from the more demanding first step.

Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis.

Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.

СЛУЧАЙ ЭТАПНОГО ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ТРОМБОЗА ПОРТАЛЬНОЙ И НИЖНЕЙ ПОЛОЙ ВЕНЫ С СЕГМЕНТАРНЫМИ НЕКРОЗАМИ ТОНКОЙ КИШКИ

Acute venous mesenteric thrombosis can be combined with thrombosis of the inferior vena cava, portal vein, or be their result. In this situation, small bowel ischemia manifests itself as segmental necrosis, with the appearance of new foci of necrosis in time. Diagnostics of the prevalence of venous thrombosis and attack control surgery in the background of anticoagulant therapy, described in clinical observation, allowed the determination of the level of damage to the inferior vena cava, control the formation of new necrosis of the intestinal wall, improve blood supply to the remaining parts of the intestine after double resection, and perform delayed distal anastomosis of the proximal small intestine with ileostomy under conditions of confirmed adequate viability of preserved sections of small intestine.

Disconnected pancreatic duct syndrome in patients with necrotizing pancreatitis

In a subset of patients with acute necrotizing pancreatitis, segmental necrosis affecting the main pancreatic duct may result in a discontinuity between the left-sided pancreas and the duodenum. Such an interruption in the setting of a viable upstream portion of the gland can give rise to the disconnected pancreatic duct syndrome (DPDS). By maintaining its secretory function, the disconnected segment may lead to persistent external pancreatic fistulae, recurrent pancreatic fluid collections, and/or obstructive recurrent acute or chronic pancreatitis of the isolated parenchyma. There are currently no universally accepted guidelines for the diagnosis or treatment of DPDS, and because the condition is underrecognized, the diagnosis is often delayed. DPDS is associated with a prolonged disease course and poses a burden on patients' quality of life as well as high health care resource utilization. The aim of our review is to summarize current knowledge, discuss diagnostic approaches, outline management options, and raise awareness of this challenging complication of necrotizing pancreatitis.

Topological approach of liver segmentation based on 3D visualization technology in surgical planning for split liver transplantation.

Split liver transplantation (SLT) is a complex procedure. The left-lateral and right tri-segment splits are the most common surgical approaches and are based on the Couinaud liver segmentation theory. Notably, the liver surface following right tri-segment splits may exhibit different degrees of ischemic changes related to the destruction of the local portal vein blood flow topology. There is currently no consensus on preoperative evaluation and predictive strategy for hepatic segmental necrosis after SLT. To investigate the application of the topological approach in liver segmentation based on 3D visualization technology in the surgical planning of SLT. Clinical data of 10 recipients and 5 donors who underwent SLT at Shenzhen Third People's Hospital from January 2020 to January 2021 were retrospectively analyzed. Before surgery, all the donors were subjected to 3D modeling and evaluation. Based on the 3D-reconstructed models, the liver splitting procedure was simulated using the liver segmentation system described by Couinaud and a blood flow topology liver segmentation (BFTLS) method. In addition, the volume of the liver was also quantified. Statistical indexes mainly included the hepatic vasculature and expected volume of split grafts evaluated by 3D models, the actual liver volume, and the ischemia state of the hepatic segments during the actual surgery. Among the 5 cases of split liver surgery, the liver was split into a left-lateral segment and right tri-segment in 4 cases, while 1 case was split using the left and right half liver splitting. All operations were successfully implemented according to the preoperative plan. According to Couinaud liver segmentation system and BFTLS methods, the volume of the left lateral segment was 359.00 ± 101.57 mL and 367.75 ± 99.73 mL, respectively, while that measured during the actual surgery was 397.50 ± 37.97 mL. The volume of segment IV (the portion of ischemic liver lobes) allocated to the right tri-segment was 136.31 ± 86.10 mL, as determined using the topological approach to liver segmentation. However, during the actual surgical intervention, ischemia of the right tri-segment section was observed in 4 cases, including 1 case of necrosis and bile leakage, with an ischemic liver volume of 238.7 mL. 3D visualization technology can guide the preoperative planning of SLT and improve accuracy during the intervention. The simulated operation based on 3D visualization of blood flow topology may be useful to predict the degree of ischemia in the liver segment and provide a reference for determining whether the ischemic liver tissue should be removed during the surgery.

Segmental necrosis of the outlet of the stomach and duodenum in a premature newborn baby

Introduction. Gastric perforation in newborns is a polyetiological, severe disease that combines a number of destructive conditions, such as: isolated pinpoint perforations, wall necrosis and gastric rupture. The first description of this pathology in a premature infant was made by Siebold in 1825, and only in 1968, G. Reams reported a case of successful diagnosis and surgical correction of this disease. Currently, the frequency of gastric perforation occurs from 1 to 6 cases per 30 thousand live births, and the mortality rate is within 40–70%.In all infants, disorders in the integrity of stomach wall can be divided into iatrogenic and “idiopathic” which are caused, in most cases, by intrauterine hypoxia. Therefore, while examining such patients, differential diagnostics between gastric perforation and necrotizing enterocolitis is often made.Clinical case. The authors present their experience in diagnosing and treating segmental necrosis of the stomach and duodenum outlet in a child with an extremely low body weight of 800 gr. Predisposing factors in the antenatal period were considered to be manifestations of hereditary thrombophilia, severe preeclampsia, placental insufficiency, and intrauterine growth retardation. As far as the discussed pathology had a subacute course, clinical changes were registered only on the 21st day of infant’s life, when pneumoperitoneum was detected at the plain X-ray image. When the patient’s condition was stabilized, median laparotomy was performed, at which radial necrosis with detachment in the gastroduodenal junction was seen. An end-to-end gastroduodenoanastomosis was put at the defect zone. In the postoperative period, the course was complicated with bronchopulmonary dysplasia, oblique femoral fracture with angular fragment displacement because of premature osteopenia as well as cholestatic hepatitis. The patient was discharged from the hospital in satisfactory condition in 80 days.Conclusions. Thus, better understanding of specific features in the clinical picture of the discussed pathology and of the mechanisms of perforation development in hollow organs of the abdominal cavity will reduce the number of complications and adverse outcomes in patients with extremely low body weight.

Severe small intestinal bacterial overgrowth syndrome after jejunal feeding requiring surgical intervention: a case report and review of the literature

BackgroundSmall intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention.Case presentationA 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition. Imaging revealed diffuse pneumatosis and portal venous gas. Surgical exploration confirmed segmental bowel necrosis requiring resection. Histologic findings were consistent with SIBO.ConclusionsPresentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality.

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China.

PurposeTo report the demographic, clinical, and laboratory characteristics of ocular syphilis based on a 6-year case series study from an eye center in East-China.MethodsA total of 131 cases (191 eyes) of ocular syphilis and the annual number of total syphilis cases from January 2016 to December 2021, were included in this study. Detailed medical records including systemic and ophthalmic medical history, a complete ophthalmic examination, color fundus photography, B-type ultrasound, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), laboratory tests of the serum and cerebrospinal fluid (CSF) samples, as well as visual field test and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy, were collected and analyzed. Pearson Chi-square or Fisher’s exact tests was used for statistics analysis.ResultsOf the 131 cases with ocular syphilis, 86 cases were in men and 6 cases had a past medical history or systemic manifestation of syphilis. HIV was found in only 2 of 70 cases undergoing serum HIV test. The average age was 54.0 years, ranging from 26–85 years. The average percentage of ocular syphilis out from the total syphilis cases was 5.1%, the average titer of serum rapid plasma regain (RPR) at presentation was 1:32, ranging from 1:1–1:512. The most predominant manifestation of ocular syphilis was posterior uveitis, followed by optic neuritis, optic atrophy, panuveitis, retinal vasculitis, and retinitis. The median of BCVA of all 191 eyes was 20/200 (ranging from no light perception to 20/20), and 20/40 (ranging from no light perception to 20/20) at presentation and final follow-up, respectively. Ocular syphilis with active inflammation responded well to penicillin therapy, no matter the initial visual acuity, ocular disease type, or RPR titers, as long as it was diagnosed early and treated properly and promptly. However, cases with optic atrophy, acute retinal necrosis, late diagnosis, permanent disruption, or loss of outer segment of photoreceptors of macular retina on SD-OCT showed poor visual improvement after therapy.ConclusionsEarly diagnosis of ocular syphilis is still challenging in clinical practice and syphilis tests should be routinely performed in patients with uveitis, retinitis, optic neuritis, and optic atrophy.

Ultrastructural studies of photoreceptor cell degeneration with organophosphate and its regeneration in Cyprinus carpio communis L.

Organophosphates are highly neurotoxic to aquatic fauna if they enter the water bodies as runoff, thus affecting the nervous system of the fishes. The present study was undertaken to investigate the vision changes, especially on the photoreceptor layer of the retina, of Cyprinus carpio communis L. when exposed to monocrotophos, an organophosphate. Fish were exposed to three sub-lethal concentrations of LC50, i.e. 0.038 ppm (1/10 LC50), 0.062 ppm (1/6 LC50), and 0.126 ppm (1/3 LC50), to observe the changes in the photoreceptor cells at the behavioral, histopathological and ultrastructural levels. Further, acetylcholinesterase activity was also evaluated. Behavioral changes, such as long resting period, inactivity, increase in air gulps and decrease in opercular and fin movements, were observed. A semi-quantitative analysis of the histological sections showed shrinkage in retinal layers at 0.038 ppm concentration of monocrotophos. At 0.062 ppm, the disappearance of the outer nuclear layer was observed and at the highest concentration of 0.126 ppm, damage in all retinal layers involving necrosis of the outer segment of the photoreceptor cells was observed. Further, at the ultrastructural level, detachment of photoreceptor cells and damage in the inner and outer segments of the photoreceptors were observed in an increasing dose-dependent manner. A reduction in the acetylcholinesterase level was observed in the treated groups. The treated fish were then transferred to toxicant-free water for 60 days to study self-regeneration, but no regeneration was observed in photoreceptor cells of the fish retina. This study shows that exposure to of monocrotophos effectively damages and disturbs the functioning of photoreceptor cells of retina of C. carpio communis L., thus affecting its vision.

Accidental monensin poisoning in buffaloes in Bahia, Brazil

ABSTRACT: Monensin is an ionophore antibiotic (IA) widely used for growth promotion and weight gain in the production of ruminants. However, it has caused intoxication in several species, including buffaloes, mainly because of the ignorance or disrespect of the recommendations for use in each animal species. The objective of this study was to describe, for the first time, clinical-epidemiological and anatomopathological data of an outbreak of accidental poisoning by monensin in buffalos and rediscuss the recommendation of the use of IA in the production of this species. The outbreak affected 21 adult buffaloes after consumption of remains from a feed formulated on the farm and whose constituents were mixed by hand. Clinical and first death signs were observed 24 hours after ingestion of this food. In general, the clinical picture was characterized by muscle weakness, tremors, difficulty in locomotion, and decubitus. Fifteen buffaloes presented clinical signs of poisoning (71.5% morbidity), followed by death (100% lethality), after acute to subacute evolution (<24h to 96h). Laboratory tests indicated elevated serum activity of creatine phosphokinase and aspartate aminotransferase enzymes. Three buffaloes underwent necropsy, and samples from several organs were collected for histopathological examination. The main injuries found were hyaline degeneration and multifocal segmental necrosis in the skeletal and cardiac striated muscles (myopathy and degenerative-necrotic multifocal multifocal-necrotic cardiopathy). The diagnosis was confirmed by the toxicological evaluation of suspected ration remains, which detected 461.67mg/kg of monensin. The death of 71.5% buffaloes in this lot occurred due to a succession of errors, which included faults in the formulation of the ration and, above all, due to the use of monensin in a highly sensitive species. Despite the possible beneficial effects of IA use as a dietary supplement for buffaloes, we are of the opinion that IAs should never be used in bubalinoculture since any increment in production does not compensate for the imminent risk of death due to a small safety margin for this species and the absence of antidotes.

CONDITIONS OF CLINICAL SYMPTOMS AND LIFE OF VANAME SHRIMP IN PREVENTION OF Vibrio alginolyticus INFECTION USING MIANA LEAF EXTRACT

This study aims to determine the clinical symptoms and survival of white vaname shrimp in the prevention of Vibrio alginolyticus infection using miana leaf extract. The study consisted of 4 treatments and 3 replications. The treatments in this study were 1 treatment and 3 treatments using different concentrations of bacteria, namely 103 CFU/ml, 105 CFU/ml, and 107 CFU/ml. The research was carried out in June-July 2020 at the Hatchery Laboratory of the Faculty of Marine and Fisheries Sciences, Hasanuddin University. Data analysis used descriptive analysis and analysis of variance (ANOVA). The results showed that A (control) shrimp was under normal conditions, treatment B (103 CFU/ml) was red, treated C (105 CFU/ml) was red and had necrosis of the body, and treatment D (107 CFU/ml) was shrimp. reddening, necrosis of tail and body segments. The results of data analysis showed that the use of miana leaf extract had a significant effect (p<0.05) on the use of live vaname shrimp. The highest vaname shrimp survival was treatment A (control) at 100%, treatment B (103 CFU/ml) at 90%, treatment C (105 CFU/ml) at 63.33% and treatment D (107 CFU/ml) by 40%.

Clinical and pathogenetic aspects of acute pancreatic encephalopathy

Pancreatic encephalopathy is a formidable complication of acute pancreatitis, significantly aggravating the course and increasing the mortality rate in this disease. For pancreatic encephalopathy, an acute onset and fluctuating course with subsequent cyclic progression are typical, and the severity of neurological symptoms may be directly dependent on the activity of the pancreatic process. The risk of having residual symptoms, primarily in the form of cognitive impairment, increases with repeated episodes of acute pancreatic encephalopathy. In the pathogenesis of pancreatic encephalopathy, an important role is played by a combination of enzymatic and hormonal dysfunction of the pancreas, systemic microcirculation disorders due to hypovolemia, typical for acute pancreatitis, and changes in glucose metabolism associated with the effects of secondary hepatocellular insufficiency and pancreonecrosis. Microscopically, gross changes in the vascular link are revealed in the form of plasmorrhages and diapedesic hemorrhages in the Virchow-Robin spaces and the white matter of the brain, desquamation and dystrophy of endothelial cells, swelling of the adventitia membrane, sludge of blood corpuscles, plasma impregnation and segmental necrosis of the vascular wall with predominant involvement and small caliber. The presence of pancreatic encephalopathy should be suspected if neurological symptoms are detected in patients with symptoms of acute pancreatitis, such as psychomotor agitation, visual and auditory hallucinations, delirium, followed by episodes of deafness, adynamia, drowsiness, up to a state of catatonia and coma. In most cases, psychomotor agitation is combined with manifestations of the syndrome of irritation of the meninges. Focal neurological symptoms, myoclonia, hyperkinesis may be associated with mental and general cerebral symptoms. Mortality in acute pancreatic encephalopathy is due to shock, hemorrhagic complications, ketoacidosis, fatty embolism of cerebral vessels or renal failure (bibliography: 35 refs)

ABDOMINAL ULTRASONOGRAPHY (AUS) AS A MODE OF INVESTIGATION IN THE EARLY EVALUATION OF NECROTIZING ENTEROCOLITIS IN A NEONATAL INTENSIVE CARE UNIT.

INTRODUCTION:Necrotizing enterocolitis (NEC) is the most serious and common gastrointestinal emergency occurring among the neonates. NEC affects 1–5% of all neonates & approximately 7% of preterm infants <1500 grams. The incidence among premature neonates weighing less than 1500 grams is approximately 12% with mortality of 30-35%. NEC is an acute inammatory injury involving the distal small and often proximal large intestine. Segmental coagulative necrosis of the mucosa with focal haemorrhage can be seen histopathologically. The radiological features appear late in the necrotizing enterocolitis. The delay in diagnosis will lead to increased mortality and morbidity. The features of NEC can be detected early in the ultrasonography of the abdomen. AIM: The primary objective as Abdominal Ultrasonography (AUS) being investigation of choice in the early diagnosis of NEC and secondary objective of evaluating the morphological features seen in ultrasound and correlation with clinical, X-ray ndings. MATERIAL AND METHODS: This is a prospective study done from March 2016 to August 2017 at a Tertiary care referral centre. The sample size was calculated as 15, using Snedecor and Cochran formula. All the neonates which fullled the inclusion criteria were included in the study. The neonates with congenital anomalies and hemodynamic instability were excluded. The outcome was based on the AUS ndings. Statistical analysis of data done using the Statistical Package for Social Sciences (SPSS), version 24.0. RESULTS: The neonates included in the study were from 27 weeks to 38 weeks of gestation and mean age of presentation was 4.80±3.50 days, with the male female ratio 2.7:1. 02 (13%) neonates were of 27 weeks gestation, 01 (6.6%) was of 28 weeks of gestation, 02 (13%) were of 29 weeks of gestation, 02 (13%) were of 30 weeks of gestation, 04 (26%) were of 32 weeks of gestation, 01 (6.6%) was of 33 weeks of gestation and 02 (13%) were of 37 weeks of gestation. The mean birth weight±SD (range) in the study was 1447±601 grams. The neonates presented with features of feed intolerance 15 (100%), abdominal distension 8 (53.3%), lethargy 3 (20%). AUS detected abnormal ndings in 10 neonates, in whom there were no radiological abnormalities. There was statistically signicant association between the altered temperature and ultrasound ndings (p value -0.014). CONCLUSIONS: Abdominal ultrasonography is more sensitive to detect NEC at early stage.

Management of acute sigmoid volvulus in a tertiary hospital north central nigeria: The place of advanced radiodiagnostics

Background: Volvulus involves the twisting of an air-liquid stool-filled thin-walled segment of an intestine around its necessarily narrow mesenterial base, thereby strangulating the blood vessels, which often causes necrosis of this redundant intestinal segment. Intestinal volvulus had always been supposed to be a disease of the blacks from West African and the Bushmen natives of South Africa. The West African subset became the index region. Surgery was the best treatment for the full-blown disease. Conservative methods of management have only just been developed and studied in the Scandinavian countries. Scandinavian early rectosigmoidoscopic reductions of the twisted colonic segment have offered some valuable alternative helps. Methods: We studied the documents of all the 44 patients who had a presumptive diagnosis of acute or subacute colonic volvulus and were admitted to surgical management. Biostatistics, exact history taking of the patients, carefully structured physical examination, and a good digital scout X-ray investigation of the abdomen helped to make a rapid diagnosis. Laparotomies confirmed such a diagnosis. We did not regularly attempt to do recto-sigmoidoscopic untwisting of the volvuli. All had Hartmann’s procedure surgeries with terminal colostomies. Results: Of the 41 patients admitted to surgical management, 31 were males and 10 were females with a ratio of 3:1. The timing of surgery influenced mortalities and morbidities greatly. Conclusion: The diagnosis of acute volvulus was simple. We needed to record the medical history, took the proper physical examination, correctly explained the examination results, and only studied the abdominal X-ray film without resorting to advanced computer tomography.

Intestinal Malrotation, Mesocolic Hernia, and Meckel Diverticulum – Differential Diagnosis of Abdominal Pain in Adults: Case Report and Literature Review

AbstractIntestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923.Intestinal malrotation is a rare condition among adults – prevalent in a mere 0.0001% to 0.19% of the population –, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptoms may appear later in life, making diagnosis in adults difficult on account of non-specific symptoms.In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina.