[Lung and pleural lesions before and after implementation of a national eradication program against enzootic pneumonia and actinobacillosis as well as changes of slaughter carcass organs in slaughter pigs in Switzerland]. / Lungen- und Pleuraläsionen vor und nach der Flächensanierung gegen Enzootische Pneumonie und Actinobazillose sowie Organ- und Schlachtkörperveränderungen bei Schlachtschweinen in der Schweiz.

In a representative cross-sectional study during 12 months of the years 2008/2009 in four abattoirs in Switzerland, lung and pleura lesions as well as lesions of slaughter carcasses and organs of 34 706 pigs were studied for frequency and type of macroscopic lesions. Of the 24276 examined pigs, 91.2% of the lungs, 94.4% of the heart and 95.5% of the livers showed no macroscopically visible lesions. Pigs that were produced for a label program had significantly less bronchopneumonia and pneumonia residuals, pleuritis and liver lesions due to echinococcosis. Pigs supervised by the Swiss Pig Health Service (SGD), showed significantly less bronchopneumonia and pneumonia residuals, diffuse pleuritis, pleuritis/pericarditis and milkspots compared to the non-SGD supervised farms. Thanks to the national eradication program for enzootic pneumonia (EP) and actinobacillosis, the health-status of lungs has been considerably improved and the prevalence of pleurisy decreased considerably. The results of this study indicate a good herd health in Swiss pig production.

[Experiences with pain control during piglet castration in Switzerland Part 1: Inhalation anesthesia]. / Erfahrungen zur Schmerzausschaltung bei der Ferkelkastration in der Schweiz Teil 1: Inhalationsanästhesie.

The objectives of this study were a description of the practical implementation of the painless castration under inhalational anaesthesia with an objective assessment of animal welfare, workplace safety and time exposure. 600 questionnaires were sent to farmers all over Switzerland and 100 farms were visited during castration under inhalation anaesthesia. 44 % of the visited farmers administered analgetics during anaesthesia or less than 10 minutes before castration. 14 % of the piglets were insufficiently anaesthetised (moving or vocalising) and 18 % showed stronger bleeding tendency after castration. The mortality rate was less than 0.1 %. 22 % of the swine farmers reported headache or dizziness during or after castration work. The Isoflurane level on 2 farms was above the Swiss safety limits. The time needed for castration was with 4.3 minutes clearly above the time necessary without anaesthesia. The additional financial costs and time are at the moment not adequately compensated to the farmers.

Le but de la présente étude était de décrire la mise en application en Suisse de la castration indolore des porcelets sous anesthésie par inhalation et d'étudier les aspects de protection des animaux, de sécurité à la place de travail ainsi que de l'investissement en temps pour cette castration. On a envoyé 600 questionnaires à des producteurs de porcelets dans toute la Suisse (taux de retour 40.5 %) et 100 exploitations ont été visitées lors de castrations sous anesthésie par inhalation. Sur 44 % des exploitations visitées, un analgésique était appliqué soit pendant l'anesthésie soit moins de 10 minutes avant la castration. 14 % des porcelets montraient des réactions de défense ou des vocalisations causées par la castration et 18% présentaient une tendance augmentée aux saignements après la castration. La mortalité était inférieure à 0.1 %. 22 % des exploitants mentionnaient des céphalées ou des vertiges pendant ou après les castrations. Sur deux exploitations, les concentrations limites d'isoflurane admises en Suisse étaient dépassées. Le temps nécessaire pour une castration, y compris le pré- et le postopératoire, était, avec 4,3 minute, nettement supérieur à celui nécessaire pour une castration sans anesthésie. Les producteurs ne sont actuellement pas correctement indemnisés pour les surcoûts et l'investissement supplémentaire en temps.

[Experiences with pain control during piglet castration in Switzerland Part 2: Injection anesthesia]. / Erfahrungen zur Schmerzausschaltung bei der Ferkelkastration in der Schweiz Teil 2: Injektionsanästhesie.

The aim of this study was to describe the practical implementation of the painless castration under injection anaesthesia in Switzerland. 30 swine farms were visited and 60 farmers answered a questionnaire. 34 % of the piglets showed movements during castration under injection anaesthesia and 17 % had excitations during recovery from anaesthesia. After 48 minutes half of the piglets were in sternal position and after 112 minutes half of them showed coordinated movements. The body temperature decreased by 3.1 °C until 60 minutes after castration, especially small piglets reached critical temperature levels. 38 % of the piglets showed strong bleeding after castration. The healing of the wound was good according to 82 % of the farmers. 83 % of the farmers reported piglet losses, especially at the beginning of the anaesthesia period. The anaesthesia may be improved by using butorphanol in addition to the combination of ketamine and azaperone. The recovery of the piglets should be in a warm place without any risk of injury by obstacles or the sow. Increased bleeding can be controlled by using an emasculator.

Le but de la présente étude était de juger de la mise en application en Suisse de la castration indolore des porcelets au moyen d'une anesthésie par injection. On a visite 30 exploitations choisies au hasard et 60 ont été interrogées par le biais d'un questionnaire. Lors des visites, 34 % des 371 porcelets observés ont présenté de fortes réactions de défense en relation avec la castration et 17 % une importante excitation durant la phase de réveil. Il fallait en moyenne 48 minutes pour que la moitié des animaux soient en position sternale et 112 minutes pour que la moitié puissent à nouveau marcher de façon coordonnée. La température corporelle s'abaissait en moyenne de 3.1 °C 60 minutes apres la castration, les plus petits des porcelets atteignant tout particulièrement des valeurs critiques. 38 % des porcelet saignaient fortement après la castration. La cicatrisation était bonne dans 83% des exploitations questionnées. 83 %. 83 % des exploitants se plaignaient de pertes, survenant en particulier lors de la phase de reveil. L'anesthésie avec de la kératine et de l'azaperon peut être améliorée par l'adjonction de butorphanol. Pour la phase de réveil, les porcelets doivent être placés, séparés de leur mère, dans un environnement chaud. On peut diminuer les saignement postopératoires par l'usage d'un émasculateur.

[Postweaning multisystemic wasting syndrome (PMWS) and porcine dermatitis and nephropathy syndrome (PDNS) in Switzerland in the years 2003 - 2006]. / «Postweaning Multisystemic Wasting Syndrome¼ (PMWS) und «Porcine Dermatitis and Nephropathy Syndrome¼ (PDNS) in der Schweiz in den Jahren 2003 - 2006.

In Switzerland postweaning multisystemic wasting syndrome (PMWS), caused by porcine circovirus type 2, was detected for the first time in 2001. To comprise the PMWS epizooty in 2003 - 2006 retrospectively, individual animals were diagnosed according to internationally accepted criteria and temporal and regional patterns of the epizooty were reconstructed. Occurrence of PMWS was predominantly in regions with a high frequency of swine farms (central and eastern Switzerland). Apparently it was spread to other, less affected regions, through trade of infected fattening pigs. Concurrently, disease was found in different establishments of production. Affected were mainly weaners or fattening pigs. In 40 % of the breeding farms and in 25 % of the fattening farms mortality rate was higher than 5 %. Starting in 2003, also a higher frequency of porcine dermatitis and nephropathy syndrome (PDNS) diseased pigs was diagnosed. In the years 2004 to 2006 they accounted for about 10 % of the diagnosed PCV2-associated diseases. Besides the characteristic skin- and kidney lesions approximately half of the PDNS cases showed wasting and lymphoid lesions with high quantities of PCV2 antigen. We termed these mixed forms PMWS-PDNS-hybrid forms.

Risk factors causing postweaning multisystemic wasting syndrome (PMWS) onset in Swiss pig farms.

Postweaning multisystemic wasting syndrome (PMWS) was epizoozic between 2003 and 2008 in Switzerland. Nevertheless, infectious risk factors including porcine reproductive and respiratory syndrome virus (PRRSV) were missing at all or were seen only sporadically (enzootic pneumonia and actinobazillosis). In a case-control study, 30 farms with PMWS affected pigs were compared to 30 inconspicious farms ("matched pairs"). The case-control allocation was verified by PCV2 DNA measurements of 5 healthy weaned pigs in each control farm, 5 healthy and 5 PMWS affected weaners in each PMWS affected farm. Diseased pigs showed in average 1.8x10(8) DNA templates per ml serum significantly higher than healthy pigs from control farms with 1x10(6) DNA templates per ml serum. Virus load in healthy pigs did not differ between control- and PMWS affected farms. PMWS mainly emerged among affected pigs in the 5th to 8th week of age. In a logistic regression model risk factors were identified such as high occupancy in weaning pens (p = 0.002), large groups in gestation facilities (p = 0.03) as well as reduced birth weight < 1.3 kg (p = 0.04). We suggest these factors might have lead to chronic stress e.g. through influencing negatively social interaction in pigs or disturbances of the maturing immune system. Heavy fly and rodent infestation might not only be viewed as a vector for disease transmission, but, also as a stress factor.

[Feed-related selenium poisoning in swine]. / Fütterungsbedingte Selen-Vergiftung beim Schwein.

The following case report describes a selenium toxicosis in a pig-fattening farm of two finisher groups. The diseased animals partly showed ataxia and paresis or intense lameness in connection with band-like ablation of the epidermis at the coronary band. Some of them suffered from alopecia. Foot-and-mouth disease and swine vesicular disease were excluded by serological tests. Dissection revealed a multifocal bilateral symmetric poliomyelomalacia. Histological changes in the claws ranged from severe cell-decay in the germinative layer to distinctive decay of the stratum corneum. Due to damage of the claw epidermis the corium was partly exposed. Feed analysis revealed 100-fold increased selenium content in the finishing premix from the feed mill and as a result 20- to 60-fold increased selenium values in feed samples from the farm-made finisher mixture. Selenium concentration in the blood of diseased animals was 4- to 10-fold higher than normal values, which confirmed the tentative diagnosis of a selenium toxicosis.

Refined localization of the Escherichia coli F4ab/F4ac receptor locus on pig chromosome 13.

Diarrhoea in newborn and weaned pigs caused by enterotoxigenic Escherichia coli (ETEC) expressing F4 fimbriae leads to considerable losses in pig production. In this study, we refined the mapping of the receptor locus for ETEC F4ab/F4ac adhesion (F4bcR) by joint analysis of Nordic and Swiss data. A total of 236 pigs from a Nordic experimental herd, 331 pigs from a Swiss experimental herd and 143 pigs from the Swiss performing station were used for linkage analysis. Genotyping data of six known microsatellite markers, two newly developed markers (MUC4gt and HSA125gt) and an intronic SNP in MUC4 (MUC4-8227) were used to create the linkage map. The region for F4bcR was refined to the interval SW207-S0075 on pig chromosome 13. The most probable position of F4bcR was in the SW207-MUC4 region. The order of six markers was supported by physical mapping on the BAC fingerprint contig from the Wellcome Trust Sanger Institute. Thus, the region for F4bcR could be reduced from 26 to 14 Mb.

Antimicrobial resistance in Escherichia coli strains isolated from Swiss weaned pigs and sows.

Based on Directive (EC) No 99/2003, monitoring programs on the development of antimicrobial resistance in bacteria from livestock are implemented in many European countries. The aim of the present study was (i) to establish comprehensive baseline data on the antimicrobial resistance situation in Escherichia coli isolates obtained from healthy pigs (pooled fecal samples) originating from 60 Swiss pig-breeding farms, and (ii) to analyze differences in the resistance frequency between Escherichia coli isolates from weaned pigs and sows. Susceptibility testing (disc diffusion method) was performed on 429 isolates from weaned pigs and 431 isolates from sows. Overall, 17.7% of the isolates from weaned pigs and 22.5% of the Escherichia coli isolates from sows were susceptible to all antibiotics tested. Low resistance prevalence was found for amoxicillin, amoxicillin/clavulanic acid, ampicillin, cefquinome, ciprofloxacin, colistin, florfenicol, and gentamicin. The most frequently found resistances were against streptomycin (60.6% of the isolates from weaners and 64.3% of the isolates from sows), sulfonamide (51.5% and 26.9%), tetracycline (35.2% and 22.0%), and trimethoprim (27.5% and 11.1%). With exception of colistin, most resistances were found for those antibiotics commonly used on the farms. Except for ciprofloxacin and streptomycin, isolates from weaned pigs showed higher resistance prevalence than those from sows. This difference was significant for cefquinome, florfenicol, sulfonamide, tetracycline, and trimethoprim (p<0.05).

Capillary haemangiomas of the scrotum and testicle in boars.

In boars, scrotal haemangiomas have been described frequently, but intratesticular haemangiomas are rare. Of 12 boars with scrotal haemangiomas, three animals also had testicular tumours, as follow: testicular haemangioma (TH) (n=1); TH with intratubular germ cell tumour (ITGT) (n=1); TH with intratubular germ cell-like tumour (ITGLT) and Sertoli cell tumour (n=1). In the nine remaining boars, no testicular tumours were found. Immunohistochemical examination of scrotal and testicular haemangiomas revealed labelling of endothelial cells for vimentin and factor VIII-related antigen. Labelling of smooth muscle actin was occasionally observed in the walls of neoplastic vessels. In the ITGT, no labelling was produced by any of the antibodies used. The Sertoli cell tumour was strongly positive for S-100. Sperm granulomas and degeneration of seminiferous tubules were also observed.

Lethal Gastric Mucosal Necrosis due to Administration of Oral Ferrous Bisglycinate Chelate to Suckling Piglets.

The oral application of a newly developed ferrous bisglycinate paste for suckling piglets at a dose of 180 mg/kg body weight led to increased death rates in 10% (n = 10) of Swiss test pig breeding farms (n = 100). Necropsy examination of suckling piglets (n = 12), selected randomly from the test farms with increased death rates, demonstrated severe gastric mucosal ulceration and necrosis. Due to the presence of crystalline iron surface coating within the gastric lesions, the iron was considered as the toxic principle and cause of death. To demonstrate the direct toxicity of ferrous bisglycinate, the paste was administered experimentally to a litter of suckling piglets (n = 11). Different time points (24, 48 and 72 h post partum) and doses (180 mg/kg and 360 mg/kg) were investigated. The manufacturer's recommended dose of 180 mg/kg corresponded to approximately 36 mg Fe/kg and to 6.4 % of the acute lethal dose50 of oral iron in rats. In all piglets the lesions were reproduced and most severe at the earliest time point (24 h post partum) and with the highest applied dose (360 mg/kg). The lesions were in accordance with those described from oral iron intoxication in man, suggesting pigs as an ideal animal model for oral iron toxicity studies.

Detection of chlamydiae in boar semen and genital tracts.

Chlamydiae cause abortion and reproductive disorders in sows. Although organisms can infect the male genital tract, little is known about the disease situation in boars. Hence, we examined the prevalence of chlamydial infection in semen and genital tracts of boars. Samples collected from Swiss boars (group A: n=42), and boars from Germany (group B: n=39) were examined by bacteriology, LPS-ELISA, immunohistochemistry (IHC) and polymerase chain reaction (PCR). The latter methodology involved use of three PCR assays including 16Sig rDNA, IGS-S (intergenic spacer 16S/23S-Short) and IGS-L (intergenic spacer 16S/23S-Long) PCR for comparison methods. PCR sensitivity and the presence of potential PCR inhibitors were determined by spiking semen with Chlamydophila (Cp.) abortus DNA. Detection limits of the 16Sig and IGS-S PCR were 10 templates, while the IGS-L PCR was less sensitive (100 templates). Of 25 semen samples that were collected from group A, one semen sample was positive for Cp. psittaci and two were positive for Chlamydia-like organisms by 16Sig PCR. Screening of sera from Swiss boars revealed three animals with positive reactions in the LPS-ELISA, although we failed to detect chlamydiae within organs of these or sera-negative animals by IHC or IGS-S PCR. In group B, 10 ejaculates were positive for Chlamydia (C.) suis and two were positive for Chlamydia-like organisms by 16S PCR. The identification of DNA from Chlamydia-like organisms in semen from both groups of boars was surprising and a role for these bacteria in reproductive diseases requires further assessment. In conclusion, the prevalence of chlamydial infection was low in group A animals indicating that venereal transmission may not be significant for Chlamydia-associated reproductive diseases in pigs, although rare cases may occur.

Colloidal aggregates of insoluble inclusions in human goiters.

To shed some light on the physicochemical properties of the thyroid follicular colloid, we have screened retrospectively the autoradiographs of 60 human nodular goiters labeled 17 h preoperatively with 100 microCi 125I for evidence of colloid compartmentalization. In 87% (52/60) of all goiters examined, sporadic or multiple colloidal inclusions ('colloid stones') not mixing with newly labeled Tg were detected. The detailed analysis of 17 goiters revealed a mean incidence of 0.09+/-0.11 'colloid stones' of variable size per follicle ranging from 0.02+/-0.01 (10) to 0.43+/-0.09 (5) (mean values +/- S.D., number of sections examined in brackets). In this study we did not find a clear-cut association of incidence of 'colloid stones' with sex, age or nosologic group (hyperthyroid, preclinically hyperthyroid, euthyroid). The existence of different colloidal compartments as demonstrated in this and other studies is of considerable importance for thyroid function, interpretation of iodine kinetics, and studies on the role of iodine on growth and function of the thyrocytes. Different thyroidal iodine compartments could well be of functional relevance, for example in the adaptation of thyroid hormone secretion to antithyroid drugs or in severe and prolonged iodine deficiency, when very slow compartments become an important source of minimal quantities of iodine and thyroid hormone. 'Colloid stones', for example, may well explain the repeatedly observed, surprisingly large total iodine store in human endemic goiters, even in the presence of severe iodine deficiency. It is evident that the existence of multiple iodine compartments and, in particular, of particulate slow-turnover pools complicates the interpretation of total glandular iodine measurements with modern techniques such as X-ray fluorescence and positron emission tomography.

Swiss pilot study of individual seasonal fluctuations of urinary iodine concentration over two years: is age-dependency linked to the major source of dietary iodine?

OBJECTIVE: Because of known significant seasonal fluctuations of iodine concentration in cow's milk (ICM) in Switzerland (winter/summer (w/s) ICM ratio averages 5.6), we looked for seasonal variations and familial aspects in urinary iodine and sodium concentrations (UIC, UNaC). DESIGN: : Prospective sequential cohort investigation. SETTING: University hospital. SUBJECTS: Thirteen children (six girls, seven boys) aged 3-10 y and their parents (n=9) aged 30-47 y. INTERVENTIONS: The volunteers collected 1729 spot urine samples (5.1996-5.1998). UIC data from winter (UIC(w): December-February) and summer seasons (UIC(s): July-September) were compared with UNaC and average milk consumption. Iodine intakes from milk and salt were modelized. RESULTS: Highest seasonal fluctuations of UIC were found in six pre-school children (w/s UIC group average=1.56, significant), followed by seven school children (w/s UIC group average=1.24, N.S.); none existed in adults. UIC/UNaC showed corresponding seasonal fluctuations in children, but not in adults. Winter milk was an important iodine source for children, as proven indirectly by similar seasonal fluctuations of ICM, UIC, UIC/UNaC and an important part within UIC due to milk. CONCLUSIONS: Contribution to UIC from milk intake during winter was high in children (40-50%) and lower in adults (about 20%). Compared with children, dietary habits of adults are more complex and their iodine supply depends mainly on iodized salt and not on milk, so the effect of seasonal ICM variations on UIC is less marked. Because of significant seasonal UIC fluctuations in consumers of fresh milk products in Switzerland, results of future UIC studies conducted during summer and winter seasons should be compared cautiously, especially in young children. Furthermore, consumption of milk is to be promoted, since, besides calcium and vitamins, it is an essential source of iodine. UNaC determination should be included in epidemiologic studies if the dietary source of iodine is questioned.

Patterns of crossfostering and piglet mortality on commercial U.S. and Canadian swine farms.

A data base of 300 farms using computerized records was used to examine the extent and timing of crossfostering being practiced in commercial herds in the Midwestern U.S. and Canada in 1994-1995. Crossfostering was used on 98% of farms. Across all farms, the mean percent of piglets crossfostered was 8.6%. Farms varied greatly in the age at which they moved piglets. The 20 farms that moved piglets the earliest after birth were classified as early-move farms and the 20 that moved the oldest piglets were classified as late-move farms. Early-move and late-move farms did not differ in herd size (P = 0.14), average parity of farrowed sows (P = 0.47) or age at weaning (P = 0.37). There were differences between early-move and late-move farms in percent of piglets fostered (P = 0.0001), pigs born alive/litter (P = 0.04), and pre-weaning mortality (P = 0.0005). A subset of late-move farms that were part of an integrated production group had unique production parameters that suggested inaccurate record-keeping.

Effects of extensive crossfostering on performance of pigs on a farm.

OBJECTIVE: To compare mortality and growth rates of pigs subjected to continuous or limited crossfostering. DESIGN: Prospective study. ANIMALS: 80 liters containing 879 pigs. PROCEDURE: In half of the litters, crossfostering was limited to the first 2 days of life. In the other litters, pigs were crossfostered throughout the lactation period to maintain uniform body weights within litters. RESULTS: Restricting crossfostering to the first 2 days of life resulted in a 20% increase in body weight at weaning, compared with crossfostering throughout the nursing period. Mortality rates did not differ between the limited and continuous crossfostering groups. CLINICAL IMPLICATIONS: The emphasis placed on reducing variation of body weights within litters is unwarranted and veterinarians should advise limiting crossfostering to the first 2 days of life. Excessive crossfostering late in the nursing period may be identified by low within-litter SD of mean body weight.

[Disease prevention in swine production]. / Krankheitsprophylaxe in der Schweineproduktion.

First, it is mentioned that the health status of the population of Swiss swines is very good in comparison to other nations due to the activity of the pig health service (PHS) and that in many places the conditions for a reduction of the use of antimicrobials are already there. Then, the activity of the PHS is described. Its success is base on the obstinate implementation of the eradication programs which are already widely used at the present time in several regions of Switzerland and which have attracted interested specialized practitioners. How the renouncement of the use of antimicrobial growth promoters will affect PHS and non PHS herds remains to be determined. A special paragraph lists the reasons why practitioners often have only little access to swine herds. One reason is the lack of competence. This problem should be solved by an intensification of the graduate and postgraduate education. Finally, the argument for a valorization of an applied and problem-oriented research at the faculties should be put forward.

[Erysipelas of the skin in fattening swine: assessment from the view of meat hygiene]. / Hautrotlauf beim Mastschwein: Beurteilung aus fleischhygienischer Sicht.

Nine pigs with acute erysipelas in skin manifestation have been subjected in 1998 to a bacteriological examination. Eight animals proved to have Erysipelothrix rhusiopathiae in muscles and/or organs. In the part of the well-defined rhomboid, bluish-red skin lesions, histology showed a disseminated acute vasculitis and a perivascular suppurating dermatitis and panniculitis. The actually valid Swiss Meat Inspection Ordinance which in case of erysipelas in skin manifestation requires only the elimination of the skin and admits the consumption of the meat, is not warrantable from the point of view of meat hygiene.

[Lowering of the incidence of puerperal mastitis in the sow by protection of the mammae from contamination]. / Senkung der Inzidenz von puerperaler Mastitis bei der Sau durch Schutz des Gesäuges vor Verschmutzung.

Twelve sows each farrowed in an experimental pen designed especially for this study or in a crate. Viable counts of enterobacteriaceae were performed in samples taken from the laying area and from the teats. Secretion from every mammary complex was examined repeatedly for bacteria and for somatic cells. The sows in the experimental pen did not lay down in their own faeces. The viable counts in samples from the laying area and the teats were much lower than with the sows kept in farrowing crates. Infection with E. coli was observed in 3 mammary complexes of the sows in the experimental pen as compared to 27 complexes of the sows in the crate. More than half of the infections was detected in the samples taken before farrowing began. In the average the bacteria persisted for 1.3 days. On the first 4 days of life piglets sucking teats with cytologically defined mastitis had an average daily gain of 105 g as compared to 125 g with piglets sucking healthy teats. In conclusion puerperal mastitis is a consequence of faecal contamination of the mammary gland. Soiling of the laying area with faeces and urine can be reduced by improvements in the farrowing accommodations.

[Determination of hematologic and blood chemical reference values in fattening pigs of different ages]. / Bestimmung hämatologischer und blutchemischer Referenzwerte bei Mastschweinen verschiedenen Alters.

In swine medicine, the determination of hematology and blood chemistry parameters is of primary interest in connection with the detection of herd problems. For the evaluation of laboratory results the availability of reference values is a prerequisite. So far, no reference values of fattening pigs have been available in Switzerland. For this reason, in the present study reference values for hematology and blood chemistry were determined for two bodyweight categories, 40-60 kg (group 1) and 85-110 kg (group 2). Hematocrit, hemoglobin and RBC counts were lower in animals in group 1. The number of segmented neutrophils was markedly higher in group 1. Lymphocyte counts exceeded neutrophil values in both groups. Concentrations of total bilirubin, AST, CK and LDH partly reached very high levels due to hemolysis or contamination of the blood samples with muscle tissue.