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1.
Medicine (Baltimore) ; 100(6): e24623, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578574

RESUMO

RATIONALE: Acute esophageal necrosis (AEN) is a rare syndrome with characteristic endoscopic and pathologic findings. It usually results from a combination of tissue hypoperfusion, impaired local defense barriers, and massive reflux of gastric contents. We report a case of AEN after a kidney transplant. PATIENT CONCERNS: A 53-year-old man with hypertension and end-stage renal disease presented with abdominal pain and a single episode of hematemesis 14 days after kidney transplantation. DIAGNOSIS: Upper endoscopy revealed circumferential black coloration in the mid to lower esophageal mucosa. Esophageal biopsy showed ulcer, and immunostains were negative for viral etiology. INTERVENTIONS: Conservative management was done with total parenteral nutrition and proton pump inhibitor. OUTCOMES: The patient experienced no further episodes of hematemesis or abdominal pain and follow-up endoscopy showed remarkable changes from the black mucosa to a red friable mucosa with whitish exudates. LESSONS: In the case, AEN occurred in the setting of normal blood pressure after major surgery despite the absence of preceding factors such as hypotension and infections. The possibility of AEN should be considered in patients with solid organ transplantation who present with abdominal pain, dysphagia, and hematemesis.


Assuntos
Esôfago/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Necrose/diagnóstico , Diagnóstico Diferencial , Esofagoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico
2.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408103

RESUMO

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Assuntos
Dor Abdominal/etiologia , Colecistectomia Laparoscópica , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Anormalidade Torcional/diagnóstico , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Necrose/diagnóstico , Necrose/cirurgia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Ultrassonografia
3.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408110

RESUMO

A 10-year-old boy underwent stem cell transplant for Hodgkin's lymphoma and developed vomiting and seizure in the postoperative period. An ophthalmic referral was made from intensive care unit, to rule out papilledema. On examination, there was no papilledema in both eyes, instead there were areas of retinal necrosis with no haemorrhages or vitritis in right eye. Cerebrospinal fluid serology was negative for herpes but MRI showed hyperintensity in temporal lobe. A clinical diagnosis of progressive outer retinal necrosis (PORN) was made and fundus picture was documented with help of a smartphone and 20D lens. High-dose intravenous injection acyclovir was started and PORN lesion improved on treatment.


Assuntos
Antivirais/administração & dosagem , Transplante de Medula Óssea/efeitos adversos , Infecções por Herpesviridae/diagnóstico , Doença de Hodgkin/terapia , Retina/patologia , Retinite/diagnóstico , Aciclovir/administração & dosagem , Criança , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Infecções por Herpesviridae/tratamento farmacológico , Infecções por Herpesviridae/imunologia , Doença de Hodgkin/imunologia , Humanos , Imunossupressores/efeitos adversos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Necrose/diagnóstico , Necrose/tratamento farmacológico , Necrose/imunologia , Retina/diagnóstico por imagem , Retina/virologia , Síndrome de Necrose Retiniana Aguda/diagnóstico , Retinite/tratamento farmacológico , Retinite/imunologia , Resultado do Tratamento , Ativação Viral/imunologia
4.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334767

RESUMO

An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.


Assuntos
Colecistite Acalculosa/diagnóstico , Escherichia coli/isolamento & purificação , Febre/microbiologia , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Colecistectomia , Quimioterapia Combinada , Febre/sangue , Febre/imunologia , Febre/terapia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/microbiologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Necrose/complicações , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
6.
J Zoo Wildl Med ; 51(2): 407-415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549572

RESUMO

Over a period of 5 mo, seven out of eight American white pelicans (Pelecanus erythrorhynchos) housed on a spring-fed pond at a zoo died or were euthanized. Clinical signs included inability to stand, anorexia, and weight loss. Clinicopathologic findings included heterophilic leukocytosis and elevated creatine kinase and aspartate aminotransferase. Histopathologic findings on all pelicans demonstrated severe, chronic, diffuse rhabdomyofiber degeneration and necrosis, making vitamin E deficiency a differential diagnosis despite routine supplementation. Based on tissue and pond water assays for the cyanobacterial toxin, microcystin, toxicosis is suspected as the inciting cause of death in these cases. We hypothesize that vitamin E exhaustion and resultant rhabdomyodegeneration and cardiomyopathy were sequelae to this toxicosis.


Assuntos
Doenças das Aves/diagnóstico , Aves , Microcistinas/envenenamento , Necrose/veterinária , Envenenamento/mortalidade , Envenenamento/veterinária , Alabama/epidemiologia , Animais , Doenças das Aves/microbiologia , Doenças das Aves/mortalidade , Diagnóstico Diferencial , Feminino , Masculino , Necrose/diagnóstico , Necrose/microbiologia , Necrose/mortalidade , Envenenamento/complicações , Envenenamento/diagnóstico
10.
Emerg Infect Dis ; 26(8): 1939-1941, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32298228
11.
Clin Exp Metastasis ; 37(3): 425-434, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32185576

RESUMO

To compare the local control and brain radionecrosis in patients with brain metastasis primarily treated by single-fraction radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). Between January 2012 and December 2017, 179 patients with only 1-3 brain metastases (total: 287) primarily treated by SRS (14 Gy) or HFSRT (23.1 Gy in 3 fractions of 7.7 Gy, every other day) were retrospectively analyzed in a single center. Follow-up imaging data were available in 152 patients with 246 lesions. The corresponding Biological Effective Dose (BED) were 33.6 Gy and 40.9 Gy respectively for SRS and HFSRT group, assuming an α/ß of 10 Gy. Local control (LC) and risk of radionecrosis (RN) were calculated by the Kaplan-Meier method. The actuarial local control rates at 6 and 12 months were 94% and 88.1% in SRS group, and 87.6% and 78.4%, in HFSRT group (p = 0.06), respectively. Only the total volume of edema was associated with worse LC (p = 0.01, HR 1.02, 95% CI [1.004-1.03]) in multivariate analysis. Brain radionecrosis occurred in 1 lesion in SRS group and 9 in HFSRT group. Median time to necrosis was 5.5 months (range 1-9). Only the volume of GTV was associated with RN (p = 0.02, HR 1.09, 95% CI [1.01-1.18]) in multivariate analysis. Multi-fraction SRT dose of 23.31 Gy in 3 fractions has similar efficacy to single-fraction SRT dose of 14 Gy in patients with brain metastases. A slightly higher occurrence of radionecrosis appeared in HFSRT group.


Assuntos
Neoplasias Encefálicas/radioterapia , Encéfalo/patologia , Fracionamento da Dose de Radiação , Lesões por Radiação/epidemiologia , Radiocirurgia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/epidemiologia , Necrose/etiologia , Necrose/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Intervalo Livre de Progressão , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral , Adulto Jovem
12.
Parasitol Int ; 76: 102098, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32120051

RESUMO

Sarcocistys -associated menigoencephalitis is virtually an unrecognized cause of neurological disease in chickens. An undescribed species of Sarcocystis cause fatal infection in two backyard chickens in the Midwest of Brazil. Infected chickens presented anorexia, weight loss, incoordination, ataxia and opisthotonos. Yellow necrotic foci in the gray and white matter of the telencephalon were the main gross lesion. Microscopically, necrotizing granulomatous and heterophilic meningoencephalitis with intralesional Sarcocystis -like schizonts and mezoites were observed in the central nervous system. Molecular analysis of frozen brain samples of the two chickens was identical and the protozoan was named Sarcocystis sp. Chicken-2016-DF-BR. Complete nested PCR- sequence of Sarcocystis sp. Chicken-2016-DF-BR was equally similar to Sarcocystis anasi (EU553477) and Sarcocystis albifronsi (EU502868). This is the first report of Sarcocistys -associated meningoencephalitis with molecular characterization in backyard chickens.


Assuntos
Galinhas , Meningoencefalite/veterinária , Doenças das Aves Domésticas/diagnóstico , Sarcocystis/classificação , Animais , Encéfalo/parasitologia , Encéfalo/patologia , Brasil , Feminino , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/parasitologia , Meningoencefalite/patologia , Necrose/diagnóstico , Necrose/parasitologia , Necrose/patologia , Necrose/veterinária , Reação em Cadeia da Polimerase/veterinária , Doenças das Aves Domésticas/parasitologia , Doenças das Aves Domésticas/patologia , Sarcocystis/fisiologia
13.
J Vet Diagn Invest ; 32(2): 230-238, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32081091

RESUMO

The role of type A Clostridium perfringens in canine acute hemorrhagic diarrhea syndrome and foal necrotizing enteritis is poorly characterized. However, a highly significant association between the presence of novel toxigenic C. perfringens and these specific enteric diseases has been described. These novel toxigenic strains produce 3 novel putative toxins, which have been designated NetE, NetF, and NetG. Although not conclusively demonstrated, current evidence suggests that NetF is likely the major virulence factor in strains responsible for canine acute hemorrhagic diarrhea syndrome and foal necrotizing enteritis. NetF is a beta-pore-forming toxin that belongs to the same toxin superfamily as CPB and NetB toxins produced by C. perfringens. The netF gene is encoded on a conjugative plasmid that, in the case of netF, also carries another putative toxin gene, netE. In addition, these strains consistently also carry a cpe tcp-conjugative plasmid, and a proportion also carry a separate netG tcp-conjugative plasmid. The netF and netG genes form part of a locus with all the features of the pathogenicity loci of tcp-conjugative plasmids. The netF-positive isolates are clonal in origin and fall into 2 clades. Disease in dogs or foals can be associated with either clade. Thus, these are strains with unique virulence-associated characteristics associated with serious and sometimes fatal cases of important enteric diseases in 2 animal species.


Assuntos
Infecções por Clostridium/veterinária , Clostridium perfringens/fisiologia , Diarreia/veterinária , Doenças do Cão , Enterite/veterinária , Doenças dos Cavalos , Animais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Diarreia/diagnóstico , Diarreia/microbiologia , Doenças do Cão/diagnóstico , Doenças do Cão/microbiologia , Cães , Enterite/diagnóstico , Enterite/microbiologia , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/microbiologia , Cavalos , Necrose/diagnóstico , Necrose/microbiologia , Necrose/veterinária
14.
J Vet Diagn Invest ; 32(2): 203-212, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31955664

RESUMO

Clostridium perfringens type C causes severe and lethal necrotic enteritis (NE) in newborn piglets. NE is diagnosed through a combination of pathology and bacteriologic investigations. The hallmark lesion of NE is deep, segmental mucosal necrosis with marked hemorrhage of the small intestine. C. perfringens can be isolated from intestinal samples in acute cases but it is more challenging to identify pathogenic strains in subacute-to-chronic cases. Toxinotyping or genotyping is required to differentiate C. perfringens type C from commensal type A strains. Recent research has extended our knowledge about the pathogenesis of the disease, although important aspects remain to be determined. The pathogenesis involves rapid overgrowth of C. perfringens type C in the small intestine, inhibition of beta-toxin (CPB) degradation by trypsin inhibitors in the colostrum of sows, and most likely initial damage to the small intestinal epithelial barrier. CPB itself acts primarily on vascular endothelial cells in the mucosa and can also inhibit platelet function. Prevention of the disease is achieved by immunization of pregnant sows with C. perfringens type C toxoid vaccines, combined with proper sanitation on farms. For the implementation of prevention strategies, it is important to differentiate between disease-free and pathogen-free status of a herd. The latter is more challenging to maintain, given that C. perfringens type C can persist for a long time in the environment and in the intestinal tract of adult animals and thus can be distributed via clinically and bacteriologically inapparent carrier animals.


Assuntos
Infecções por Clostridium/veterinária , Clostridium perfringens/fisiologia , Enterite/veterinária , Doenças dos Suínos , Animais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Enterite/diagnóstico , Enterite/microbiologia , Enterite/prevenção & controle , Necrose/diagnóstico , Necrose/microbiologia , Necrose/prevenção & controle , Necrose/veterinária , Suínos , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/microbiologia , Doenças dos Suínos/prevenção & controle
15.
J Med Case Rep ; 14(1): 17, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31969190

RESUMO

BACKGROUND: Necrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available. CASE PRESENTATION: A 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology. CONCLUSIONS: Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.


Assuntos
Parede Abdominal/patologia , Inflamação/diagnóstico , Ligamentos/patologia , Necrose/diagnóstico , Ligamentos Redondos/patologia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Diagnóstico Diferencial , Feminino , Vesícula Biliar/patologia , Humanos , Laparoscopia , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Ligamentos Redondos/diagnóstico por imagem , Ligamentos Redondos/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
17.
J Vet Diagn Invest ; 32(2): 246-251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31585515

RESUMO

Gas gangrene occurs in several animal species and is caused by one or more clostridial species. In horses, the disease is most often caused by Clostridium perfringens type A. Although Clostridium sordellii has been associated with gas gangrene in ruminants and humans, cases of the disease associated with this microorganism have not been described in horses, to our knowledge. We report herein 8 cases of gas gangrene caused by C. sordellii in horses. These cases were characterized by myonecrosis and cellulitis, associated with systemic changes suggestive of toxic shock. The diagnosis was confirmed by gross and microscopic changes combined with anaerobic culture, fluorescent antibody test, immunohistochemistry, and/or PCR. The predisposing factor in these cases was an injection or a traumatic skin injury. C. sordellii should be considered as a possible etiologic agent in cases of gas gangrene in horses.


Assuntos
Clostridium sordellii/fisiologia , Gangrena Gasosa/veterinária , Doenças dos Cavalos/diagnóstico , Animais , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/veterinária , Gangrena Gasosa/diagnóstico , Gangrena Gasosa/microbiologia , Doenças dos Cavalos/microbiologia , Cavalos , Humanos , Necrose/diagnóstico , Necrose/microbiologia , Necrose/veterinária , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Choque Séptico/veterinária
18.
J Vet Diagn Invest ; 32(2): 192-202, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31735127

RESUMO

Clostridia can cause hepatic damage in domestic livestock, and wild and laboratory animals. Clostridium novyi type B causes infectious necrotic hepatitis (INH) in sheep and less frequently in other species. Spores of C. novyi type B can be present in soil; after ingestion, they reach the liver via portal circulation where they persist in phagocytic cells. Following liver damage, frequently caused by migrating parasites, local anaerobic conditions allow germination of the clostridial spores and production of toxins. C. novyi type B alpha toxin causes necrotizing hepatitis and extensive edema, congestion, and hemorrhage in multiple organs. Clostridium haemolyticum causes bacillary hemoglobinuria (BH) in cattle, sheep, and rarely, horses. Beta toxin is the main virulence factor of C. haemolyticum, causing hepatic necrosis and hemolysis. Clostridium piliforme, the causal agent of Tyzzer disease (TD), is the only gram-negative and obligate intracellular pathogenic clostridia. TD occurs in multiple species, but it is more frequent in foals, lagomorphs, and laboratory animals. The mode of transmission is fecal-oral, with ingestion of spores from a fecal-contaminated environment. In affected animals, C. piliforme proliferates in the intestinal mucosa, resulting in necrosis, and then disseminates to the liver and other organs. Virulence factors for this microorganism have not been identified, to date. Given the peracute or acute nature of clostridial hepatitis in animals, treatment is rarely effective. However, INH and BH can be prevented, and should be controlled by vaccination and control of liver flukes. To date, no vaccine is available to prevent TD.


Assuntos
Clostridiales/fisiologia , Infecções por Clostridium/veterinária , Clostridium/fisiologia , Hemoglobinúria/veterinária , Hepatite Animal , Animais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Hemoglobinúria/diagnóstico , Hemoglobinúria/microbiologia , Hemoglobinúria/prevenção & controle , Hepatite Animal/diagnóstico , Hepatite Animal/microbiologia , Hepatite Animal/prevenção & controle , Necrose/diagnóstico , Necrose/microbiologia , Necrose/prevenção & controle , Necrose/veterinária
20.
Klin Lab Diagn ; 64(11): 644-648, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31747490

RESUMO

The aim of the study was to assess the information content of volatile fatty acid parameters for the differential diagnosis of infected and sterile pancreatic necrosis. The work is based on the results of examination and treatment of 34 patients with pancreatic necrosis. The analysis of concentrations of volatile fatty acids: acetic, propionic, butyric and isovaleric was carried out on an automated gas chromatograph «Crystallux-4000¼ with a capillary column «HP-FFAP¼ and flame ionization detector. The indicators of acetic, propionic, butyric, isovaleric acid and the sum of volatile fatty acids are statistically significantly higher in patients with infected pancreatic necrosis compared with the indicators of volatile fatty acids in patients with sterile pancreatic necrosis. Volatile fatty acid values can be used for the differential diagnosis of infected and sterile pancreatic necrosis.


Assuntos
Ácidos Graxos Voláteis/análise , Necrose/diagnóstico , Pâncreas/patologia , Cromatografia Gasosa , Diagnóstico Diferencial , Humanos
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