Intoxicação crônica por cobre em ovinos: conduta para o diagnóstico conclusivo / Chronic copper toxicities in sheep: conduct for diagnostic confirmation

Descreveram-se os sinais clínicos e achados anatomopatológicos da intoxicação crônica por cobre em um ovino da raça Texxel e definiu-se a conduta diagnóstica correta para confirmação da enfermidade. Um ovino foi encaminhado ao setor de patologia com histórico de apatia, hemoglobinúria e morte em dois a três dias. No exame necroscópico, observaram-se icterícia e edema subcutâneo, fígado aumentado de volume e amarelado e rins escuros. No exame histológico, observaram-se necrose zonal aleatória e acentuada no fígado, necrose epitelial tubular, gotas hialinas e cilindros marrom-alaranjados em túbulos coletores dos rins. O histórico alimentar, a sensibilidade de espécie/raça, o quadro clínico, as alterações macroscópicas e microscópicas sugeriram o quadro de intoxicação crônica por cobre. A confirmação diagnóstica somente foi possível após a marcação de pigmentos de cobre pela técnica histoquímica de Ulzmann e pela quantificação de cobre em matéria seca de fígado e rins, cujos valores foram mais altos que o normal.

The present work describes the clinical signs and anatomopathological findings of chronic copper toxicities in a Texxel breed sheep and defines the optimal diagnostic procedure for confirmation of the disorder. A sheep was sent to pathology analysis service with a history of apathy, hemoglobinuria and death within two to three days. Necropsy showed jaundice and subcutaneous edema, enlarged yellow liver and dark kidneys. The histologic examination showed random zonal necrosis, marked necrosis in the liver and tubular epithelial and orange-brown spotted hyaline cylinders in the collecting tubules of the kidneys. The dietary history, sensitivity of species/breed, clinical, macroscopic and microscopic alterations suggested the framework of chronic copper poisoning. Diagnostic confirmation was only possible after staining copper pigments trough the Ulzmann technique and quantification of copper in the dry liver and kidney, which were higher than normal levels.

Predicting the outcome of grade II glioma treated with temozolomide using proton magnetic resonance spectroscopy.

BACKGROUND: This study was designed to evaluate proton magnetic resonance spectroscopy ((1)H-MRS) for monitoring the WHO grade II glioma (low-grade glioma (LGG)) treated with temozolomide (TMZ). METHODS: This prospective study included adult patients with progressive LGG that was confirmed by magnetic resonance imaging (MRI). Temozolomide was administered at every 28 days. Response to TMZ was evaluated by monthly MRI examinations that included MRI with volumetric calculations and (1)H-MRS for assessing Cho/Cr and Cho/NAA ratios. Univariate, multivariate and receiver-operating characteristic statistical analyses were performed on the results. RESULTS: A total of 21 LGGs from 31 patients were included in the study, and followed for at least n=14 months during treatment. A total of 18 (86%) patients experienced a decrease in tumour volume with a greater decrease of metabolic ratios. Subsequently, five (28%) of these tumours resumed growth despite the continuation of TMZ administration with an earlier increase of metabolic ratios of 2 months. Three (14%) patients did not show any volume or metabolic change. The evolutions of the metabolic ratios, mean(Cho/Cr)(n) and mean(Cho/NAA)(n), were significantly correlated over time (Spearman ρ=+0.95) and followed a logarithmic regression (P>0.001). The evolutions over time of metabolic ratios, mean(Cho/Cr)(n) and mean(Cho/NAA)(n), were significantly correlated with the evolution of the mean relative decrease of tumour volume, mean(ΔV(n)/V(o)), according to a linear regression (P<0.001) in the 'response/no relapse' patient group, and with the evolution of the mean tumour volume (meanV(n)), according to an exponential regression (P<0.001) in the 'response/relapse' patient group. The mean relative decrease of metabolic ratio, mean(Δ(Cho/Cr)(n)/(Cho/Cr)(o)), at n=3 months was predictive of tumour response over the 14 months of follow-up. The mean relative change between metabolic ratios, mean((Cho/NAA)(n)-(Cho/Cr)(n))/(Cho/NAA)(n), at n=4 months was predictive of tumour relapse with a significant cutoff of 0.046, a sensitivity of 60% and a specificity of 100% (P=0.004). CONCLUSIONS: The (1)H-MRS profile changes more widely and rapidly than tumour volume during the response and relapse phases, and represents an early predictive factor of outcome over 14 months of follow-up. Thus, (1)H-MRS may be a promising, non-invasive tool for predicting and monitoring the clinical response to TMZ.