Thumb basal joint arthroplasty using abductor pollicis longus tendon: an average 5.5-year follow-up.

PURPOSE: The goal of this study was to evaluate the 4-year minimum (5.5-y average) results of trapeziectomy and ligament reconstruction using a modified Thompson technique with the abductor pollicis longus tendon for the primary treatment of advanced-stage basal joint arthritis (Eaton stages III and IV). METHODS: We evaluated 25 thumbs in 18 patients after ligament reconstruction arthroplasty for surgical treatment of advanced thumb basal joint arthritis. Treatment consisted of piecemeal excision of the entire trapezium, ligament reconstruction and interposition using the abductor pollicis longus tendon, and 8 weeks of K-wire immobilization of the thumb metacarpal. We evaluated range of motion, lateral pinch, tip pinch, grip strength, and outcomes questionnaires including the Arthritis Impact Measurement Scales 2 Short Form before and at an average of 5.5 years after surgery. RESULTS: Seventeen of 18 patients reported excellent or good relief of pain and were satisfied with their operation, and all of the patients would have the operation again. Of the 25 thumbs, 24 adducted fully into the plane of the palm and opposed to the fifth metacarpal head. Preoperative and postoperative strength comparisons demonstrated an average increase in grip, key pinch, and tip pinch strength of 14%, 12%, and 6%, respectively. The outcomes data demonstrated noteworthy improvement in writing, buttoning a shirt, turning a key/lock, and arthritis pain categories. CONCLUSIONS: This technique restored a stable, pain-free thumb that yielded excellent strength and motion at an average of 5.5 years after the procedure. Compared with published reports of techniques that use hematoma distraction or harvest of all or part of the flexor carpi radialis tendon, this modified Thompson technique has similar pain relief, satisfaction, and motion but had less improvement in strength, which might have resulted from differences in the studied samples.

Diabetes Drugs: List Price Increases Were Not Always Reflected In Net Price; Impact Of Brand Competition Unclear.

List prices for brand-name drugs have risen steeply, often despite the introduction of competition from other brand-name drugs in the same therapeutic class. List prices, however, do not reflect any rebates that manufacturers provide payers. To understand how net prices (after rebates and other discounts) respond to competition, we compared changes in inflation-adjusted, revenue-weighted mean list and net prices of a one-month supply of three classes of diabetes drugs: glucagon-like peptide 1 (GLP1) agonists, dipeptidyl peptidase 4 (DPP4) inhibitors, and sodium glucose cotransporter 2 (SGLT2) inhibitors. These drug classes each had several brand-name products enter the market between 2005 and 2017. The annualized change in list price over this period was $75 (15 percent) for GLP1 agonists, $22 (8 percent) for DPP4 inhibitors, and $41 (11 percent) for SGLT2 inhibitors. In contrast, the annualized change in net price was $38 (10 percent) for GLP1 agonists, -$3 (-2 percent) for DPP4 inhibitors, and -$17 (-9 percent) for SGLT2 inhibitors, suggesting a variable impact of brand-name competition on net prices.

[Long-term results of midtarsal arthrodesis for flatfoot in adults]. / Résultats à long terme du traitement du pied plat valgus de l'adulte par arthrodèse médiotarsienne.

PURPOSE OF THE STUDY: Arthrodesis proposed for the surgical treatment of reducible pes planovalgus (flatfoot) in adults is designed to relieve pain and correct the deformity. The purpose of this work was to present the radiological and clinical results obtained with midtarsal arthrodesis performed in 22 cases of pes planovalgus. MATERIAL AND METHODS: This study concerned 22 cases of reducible flatfoot (Johnson grade 2) in 19 patients (11 males, 8 females, mean age 43 years, age range 15-75 years). Clinical outcome was assessed in terms of pain, function and motion using the AOFAS and Mann classifications. Radiological assessment (loaded anteroposterior and lateral views with Méary cerclage) noted the Djian angle, talometatarsal alignment, talar slope, calcaneal slope, calcaneal valgus, and osteoarthritis stage in adjacent joints. RESULTS: Mean follow-up was 7 years 4 months (range 6 months-20 years 3 months). Two nonunions resolved favorable after cancellous grafting. The Kitaoka score was 73.5/100 points (range 53-94). Pain and function improved from 2.8 to 1.1 points (/4 points) and from 3.45 to 1.6 points (/4) on the Mann scale. Flexion-extension remained unchanged. The foot was aligned correctly in 68% of cases. The mean talar slope and the talocalcaneal divergence were normal at last follow-up but there was a persistent undercorrection of the Djian angle in 68% of the feet and a break in the Méary line in 41%. Calcaneal valgus was reduced 6.6 degrees (16.6 to 10 degrees ) but the podoscope footprint was still the flatfoot type in 86% of the feet. For 50%, the neighboring joints presented progressive osteoarthritic degeneration. Subjectively the patients were very satisfied or satisfied with minor reservations for 73%. None of the patients was disappointed with the results. The objective outcome was excellent or good in 68% of the feet. DISCUSSION AND CONCLUSION: The results in terms of pain relief, function, motion, complications, and rate of satisfaction were comparable with results presented in the literature. Midtarsal arthrodesis provides effective pain relief and satisfactory functional recovery without creating any morbidity greater than simple talonavicular fusion. Nevertheless, it was noted that while correct alignment is achieved in the majority of cases, the clinical and radiological restoration of plantar cavum is limited. Furthermore compensatory hypermobility of the adjacent joints leads to the development of moderate osteoarthritic remodeling which remains asymptomatic more than seven years after the operation.

[Low incidence of hip fractures among the elderly in Guadeloupe: a spared Caribbean island population]. / Faible incidence des fractures de l'extrémité supérieure du fémur chez les patients de plus de 60 ans dans les îles de Guadeloupe.

PURPOSE OF THE STUDY: The purpose of this study was to determine the incidence of hip fractures among the elderly population in Guadeloupe, a French Caribbean archipelago with 440,000 inhabitants who present two rarely associated characteristics: 90% of the population is of African descent and life expectancy is similar to that of European populations. MATERIAL AND METHODS: Using the recent census report, we established that in 2002, 61,000 persons aged 60 years or more (27,000 men and 34,000 women) lived in Guadeloupe. All new cases of hip fracture among the population aged 60 years or more were recorded in 2002, 2003, and 2004 in the seven islands that compose Guadeloupe. For each case, we noted patient age and gender, type of hip fracture, and treatment administered. We excluded open and pathologic fractures. Overall and age-specific incidence of hip fractures were determined and compared with rates reported for other countries. RESULTS: Three hundred and two new cases of hip fracture were recorded from 2002 to 2005 in 211 women (70%) and 91 men (30%). The age of patients was 82 years on average (range 60-102). There were 134 neck fractures and 168 intertrochanteric fractures which were treated by osteosynthesis for 193 and arthroplasty for 108. Only one orthopedic treatment was noted. The incidence of hip fracture for people aged over 60 years was 16.9/10,000; for the population aged 65 years or more, it was 22.2/10,000. DISCUSSION: Osteoporotic fracture is a pandemic problem. Incidence is increasing worldwide. Our findings demonstrate that Guadeloupeans are spared from this pathology. This population offers an interesting field for research into the causal mechanisms of osteoporotic fractures and potential means of prevention or screening. CONCLUSION: The incidence of hip fractures among the elderly population in Guadeloupe is the lowest recorded in the world. We suggest that an environmental and genetic study in this spared population could provide interesting insight into the cause of hip fractures and appropriate means of prevention and screening among the elderly. The geographic and environmental characteristics of Guadeloupe make this area a unique zone of research and should enable new insight into the genetic and environmental factors involved in hip fractures.

[Hydroxyapatite-coated Esop modular femoral stem: three to ten year outcome in 155 cases]. / La prothèse fémorale Esop revêtue d'hydroxyapatite à modularité métaphysodiaphysaire: résultats à 5 ans de recul moyen d'une cohorte de 155 implants.

PURPOSE OF THE STUDY: Primary and secondary stability of the Esop prosthesis depends exclusively on cementless metaphyseal anchoring. This modular implant is composed of an hydroxyapatite-coated metaphysis on which a diaphyseal piece is added intraoperoperatively simply to act as a centering device. The purpose of this retrospective analysis of a consecutive series was to assess primary and secondary stability of the Esop implant by measuring axial migration over time. MATERIAL AND METHODS: Between 1995 and 2001, 172 primary total hip arthroplasties (THAs) were performed with the Esop femoral implant and the Atlas III acetabular implant. Six patients lost to follow-up and eleven patients who died were excluded from the analysis. The review thus concerned 155 THA in 128 patients (66 women and 32 men), mean age 57 years (age range 28-77 years), 53% with an occupational activity at the time of surgery. Degenerative hip disease and aseptic osteonecrosis were present in 87% of patients. Imagika, a dedicated software, was used to measure axial migration and overall offset of the THA at four distinct times: on the immediate pre- and postoperative films, after introduction of weight-bearing, and at last follow-up (mean 61 months, range 35-114 months). Survival and clinical and radiographic outcome were also assessed with the Postel-Merle-d'Aubigné (PMA) score. RESULTS: THA survival was 98%, all causes of failure included. The PMA score showed 97% excellent, very good or good outcome. Axial migration greater than 5 mm was demonstrated in ten hips (6.4%). Among these ten, seven exhibited migration during the first month than did not move further up to last follow-up. Comparison between the pre- and postoperative images revealed a 10 mm reduction in offset in 38% of hips, showing that the hip rotation center was medialized. DISCUSSION: Migration observed in ten implants corresponded to restablization at weight-bearing in seven. There was no correlation with the clinical outcome or poor radiological osteointegration. CONCLUSION: Primary and secondary stabilization of the Esop implant is satisfactory. In this series, the rotation center of the hip was globally medialized so that it would be useful to have available lateralized implants.

An original fibular shortening osteotomy technique in tibiotalar arthrodesis.

Tibiotalar arthrodesis (TTA) is the gold-standard treatment for advanced ankle osteoarthritis. We describe an original fibular shortening osteotomy (FSO) performed during TTA, to allow complete talar ascension and reduce the nonunion rate. Forty-two FSOs were associated to TTA (19 fixed by cross-screwing and 23 by anatomic plates) and assessed clinically and radiographically. At 24.7 months' follow-up, fusion rates were 97.6% for TTA and 100% for FSO, with mean fusion time of 5.2 months. One infection and 1 nonunion (4.7%) required further surgery, with complete resolution. Radiological and clinical outcome in TTA, lack of specific complications of FSO and ease of implementation encourage us to publish the technique.

[Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases]. / Résultats de la ténotomie arthroscopique du chef long du biceps brachial dans les ruptures transfixiantes de la coiffe des rotateurs non réparées: a propos de 40 cas.

PURPOSE OF THE STUDY: Appropriate treatment of irreparable rotator cuff tears in patients without osteoarthritic shoulder joints remains a subject of debate. Medical treatment, a substitution muscle flap, and palliative arthroscopic treatment have been proposed. Arthroscopic tenotomy of the long head of the biceps brachii is warranted because this tendon is often the cause of part or all of the pain. If there is a full thickness tear of the rotator cuff, the exposed tendon of the long head of the biceps brachii can, because of its anterosuperior position, become impinged against the acromial vault during forward flexion. The purpose of this work was to evaluate the mid-term clinical and radiological results of arthroscopic tenotomy of the long head of the biceps brachii during treatment of full thickness tears of the rotator cuff. MATERIAL AND METHODS: The series included 40 shoulders operated on for tenotomy alone (n=32) or in combination with acromioplasty (n=8). The long head of the biceps brachii was in place in 23 shoulders (58%), displaced in seven and subluxed in five. The position was not determined in five. At last follow-up, the mean rough Constant score was 58 points, giving a gain of 20 points. The gain for pain was +7.1 points, +6.4 points for activity, and +6.6 points for motion. After the operation, muscle force for elbow flexion-supination was decreased 40% compared with an age-, sex- and dominance-matched control group. 86% of the patients were satisfied with the outcome and only two patients were disappointed by the asymmetry of arm muscle volume. Radiographically, at last follow-up there were no signs of superior excentration of the humeral head and the subacromial space, which measured 7.38 mm preoperatively was 7.19 mm postoperatively. Likewise only two shoulders progressed to excentered osteoarthritis at 41 and 72 months. DISCUSSION: Mid-term results of arthroscopic tenotomy of the long head of the biceps brachii are satisfactory. The technique is simple and has limited functional consequences. The procedure has an undeniable impact on pain and has allowed a 34 degree gain in anterior flexion of the shoulder. Complementary acromioplasty was not found to provide a supplementary benefit in this series. Nevertheless, the degradation of the result in one female patient at six years suggests we should be prudent concerning the long-term benefit of this procedure which should be reserved for irreparable tears in patients with minimal functional demands.

Evaluation of chronic oral toxicity and carcinogenic potential of lornoxicam in rats.

As part of the preclinical development program for lornoxicam, a novel non-steroidal anti-inflammatory drug (NSAID), its chronic oral toxicity and carcinogenic potential was assessed in Sprague-Dawley rats. Male and female rats were administered lornoxicam by oral gavage at 0, 0.06, 0.16 or 0.40 mg/kg/day for 12 months or at 0, 0.01 or 0.06 mg/kg/day in a supplementary low-dose study of the same duration (main group: 20/sex/group; 4-wk recovery: five/sex/group; satellites for electrocardiography and toxicokinetics: five/sex/group). Drug-related toxicity mainly comprised mortality, reduced body weight gain, clinico-pathological changes indicative of anaemia resulting from blood loss, and renal damage, renal papillary necrosis and gastrointestinal mucosal lesions. The kidney-associated changes were not completely reversible during the recovery period. Toxicokinetic investigations demonstrated a dose-linear absorption of the drug. In female rats the terminal half-life was about twice that in males which led to a higher exposure of this gender to lornoxicam. A dose of 0.01 mg/kg/day was established as no-observed-effect level. In a 104-wk carcinogenicity study, lornoxicam was administered by oral gavage to male and female rats (50/sex/group) at 0 (control 1), 0 (control 2), 0.0625, 0.125 or 0.250 mg/kg/day. In females only, the high dose was reduced twice during the study due to toxicity observed (0.250 to 0.200 to 0.160 mg/kg/day). Drug-related changes were similar to those in the chronic studies and consistent with the anticipated side-effects of NSAIDs. No carcinogenic potential was revealed.

Subacute and chronic oral toxicity of lornoxicam in cynomolgus monkeys.

Lornoxicam is a novel non-steroidal anti-inflammatory compound in the same chemical class as piroxicam and tenoxicam, with potent anti-inflammatory, antipyretic and analgesic activity. As part of the preclinical safety programme, its toxicity was evaluated in a dose-range-finding and 52-wk toxicity study in cynomolgus monkeys. In the dose-range-finding study, five groups of monkeys (two per sex per group) were dosed orally by gavage for 6 wk with 0, 0.25, 0.5, 1.0 or 2.0 mg lornoxicam/kg/day. Drug-related toxicity was observed in the 1.0 and 2.0 mg/kg/day dose groups only. This included mortality, diarrhoea, prostration, decreased body weight gain and food consumption, faecal occult blood, anaemia, leucocytosis, hypoalbuminaemia, gastrointestinal erosions and ulcerations. On the basis of these results, four groups of monkeys (six per sex per group) were given the compound orally by nasogastric intubation at dose levels of 0, 0.125, 0.25 or 0.5 mg/kg/day for 52 wk. The high-dose level was increased to 0.6 mg/kg/day from wk 39 to wk 52. Treatment was followed by a 4-wk recovery period for two animals per sex per group. Histologically, drug-related changes seen were gastrointestinal erosions, ulcerations and inflammation in males and females at 0.5/0.6 mg/kg/day. Treatment-related clinicopathological findings included decreased haematocrit and hypoproteinaemia (group 0.5/0.6 mg/kg/day males), and hypoalbuminaemia (group 0.5/0.6 mg/kg/day males and females). None of these changes were present after the recovery period, thus indicating reversibility. Plasma concentration of lornoxicam measured 2 hr after dosing increased in a dose proportional manner. The estimated area under the curve (AUC) at steady state increased in a dose-proportional manner and at 0.25 mg/kg was three- to fivefold higher than the human AUC following a 16 mg dose (8 mg b.i.d.). The no-observed-effect level in the chronic toxicity study was 0.25 mg/kg/day.

Body surface Laplacian mapping of bioelectrical activity.

A method is described to process and interpret multi-channel bioelectrical signals. The bioelectrical signals were recorded noninvasively over the body surface of human subjects at 120 sites. The body surface Laplacian maps were then constructed from the multi-channel bioelectrical potential measurement. The method was evaluated by means of computer simulations, and applied to imaging cardiac electrical activity. The present investigation suggests body surface Laplacian mapping provides an important means in interpreting bioelectrical signals.

Naturally occurring mucocutaneous histoplasmosis in a rabbit.

Mucocutaneous histoplasmosis was diagnosed in a pet rabbit. A mass protruding through the anal opening was histologically composed of a densely cellular infiltrate of macrophages which expanded the anorectal submucosa. Macrophages contained abundant yeast forms of fungi morphologically consistent with Histoplasma capsulatum. Infection appeared to be localized. Histoplasmosis should be considered in the differential diagnosis of granulomatous inflammatory disease in the rabbit.

Gastrointestinal zygomycosis in suckling pigs.

Gastrointestinal zygomycosis was diagnosed in 3 suckling pigs (10, 14, and 28 days old) with diarrhea that was unresponsive to treatment with broad-spectrum antibiotics. The 3 pigs were from separate farms, and littermates of the 3 pigs with similar clinical signs had died. At necropsy, 2 of the 3 pigs had catarrhal to fibrinonecrotic gastroenteritis, and the third pig had hemorrhagic gastritis without intestinal lesions. Microscopically, transmural necrosis of the stomach and intestines was associated with marked inflammatory cell infiltration and thrombosis and vasculitis of vessels of the lamina propria and submucosa. Numerous broad, irregularly branching, nonseptate, mucoraceous fungi were seen in the lumens of blood vessels and in the necrotic mucosa and submucosa.

Anterior tarsectomy long-term results in adult pes cavus.

PURPOSE OF THE STUDY: Anterior tarsectomy for pes cavus in adults is designed to relieve pain and correct the deformity. The present study reports radiological and clinical results with anterior tarsectomy in 39 cases of pes cavus. MATERIAL AND METHODS: The study concerned 39 cavus feet in 33 patients (22 males, 11 females; mean age: 31 years, range 16-49 years). Clinical outcome was assessed in terms of pain, function and motion, using the AOFAS classification. Radiological assessment (anteroposterior and lateral stress X-ray, views with Méary superficial wire-marking) measured the Djian angle, talometatarsal alignment, talar slope, calcaneal slope, calcaneal valgus, and osteoarthritis stage in adjacent joints. RESULTS: Mean follow-up was 9.8 years (range, 1-25). Mean AOFAS score at follow-up was 69.2/100 points (range, 14-100). Pain decreased considerably in 75% of cases, and 68% of patients recovered normal activity. The foot was aligned correctly in 67% of cases. At last follow-up, pes cavus remained undercorrected in 80% of feet, but mean Djian angle had improved from 100 degrees to 111.3 degrees. Calcaneal valgus improved from 30.8 degrees to 24.8 degrees and the podoscopic footprint was normal in 51% of feet. In 74% of feet, adjacent joints presented progressive osteoarthritic degeneration. Subjectively, 70% of patients were very satisfied or satisfied with minor reservations. Objective outcome was excellent or good in 66% of feet. DISCUSSION AND CONCLUSION: Outcome in terms of function, motion, complications and satisfaction was good, although pain relief results were poor. Anterior tarsectomy is able to correct initial pes cavus deformity and compensate anomalies of the hindfoot, but its correction capacity is limited, and its efficacy in case of clawfoot is poor. Anterior tarsectomy spares the adjacent Chopart complex and Lisfranc joints while inducing hypermobility, and leads to arthritis in 74% of cases. Better results are obtained in cases of reestablishment of the Méary-Tomeno line and of hindfoot valgus, as well as in cases of correction of equinus and clawfoot deformities. Worse results are observed in case of neurological evolutive disease or insufficient correction of the preceding deformities. LEVEL OF EVIDENCE: Level IV. Therapeutic Study.

Flexor tendon problems after volar plate fixation of distal radius fractures.

Four cases of flexor tendon problems which developed after volar plate fixation of distal radius fractures are presented. All cases were associated with close contact of the screws or distal edge of the plate with the flexor tendons. Poor bone stock or multiple bone fragments allowing loosening of the plate or non-locking screws cause the hardware to irritate the flexor tendons and ultimately lead to rupture. The flexor tendons involved include the flexor carpi radialis, flexor pollicis longus and flexor digitorum superficialis, and flexor digitorum profundus to the index and long fingers.

Acellular dermal matrix as an adjunct in treatment of neuropathic pain at the wrist.

BACKGROUND: Traumatic or surgical injury to superficial sensory nerves at the wrist can lead to significant morbidity. Multiple treatment modalities have been proposed, including the use of flap coverage to provide soft-tissue padding and decrease tactile irritation. In this report, acellular dermal matrix (AlloDerm) was used as an alternative to flap coverage, thereby avoiding the need for a donor site. METHODS: Five patients with postsurgical and five patients with posttraumatic neuropathic pain at the wrist underwent neuroma excision and/or neurolysis followed by interposition of acellular dermal matrix allograft between skin and nerve. RESULTS: Patients were followed from 12 to 25 months and demonstrated substantial improvement in pain. Eight previously employed patients returned to their prior occupations. CONCLUSIONS: Dermal matrix allograft may provide cushioning and/or a gliding surface for the nerve and represents a simple alternative to flap coverage in the treatment of neuropathic pain at the wrist.

Emergence of orientation-selective inhibition in the primary visual cortex: a Bayes-Markov computational model.

The recent consensus is that virtually all aspects of response selectivity exhibited by the primary visual cortex are either created or sharpened by cortical inhibitory interneurons. Experimental studies have shown that there are cortical inhibitory cells that are driven by geniculate cells and that, like their cortical excitatory counterparts, are orientation selective, though less sharply tuned. The main goal of this article is to demonstrate how orientation-selective inhibition might be created by the circuitry of the primary visual cortex (striate cortex, V1) from its nonoriented geniculate inputs. To fulfill this goal, first, a Bayes-Markov computational model is developed for the V1 area dedicated to foveal vision. The developed model consists of three parts: (i) a two-layered hierarchical Markov random field that is assumed to generate the activity patterns of the geniculate and cortical inhibitory cells, (ii) a Bayesian computational goal that is formulated based on the maximum a posteriori (MAP) estimation principle, and (iii) an iterative, deterministic, parallel algorithm that leads the cortical circuitry to achieve its assigned computational goal. The developed model is not fully LGN driven and it is not implementable by the neural machinery of V1. The model, then, is transformed into a fully LGN-driven and physiologically plausible form. Computer simulation is used to demonstrate the performance of the developed models.

Mycotoxicoses produced in ducklings and turkeys by dietary and multiple doses of citrinin.

Citrinin was mixed in the diet (100, 250, 500 parts/10(6)) and fed to 1-day-old male White Pekin ducklings (Trial I), or it was dissolved in dimethyl-sulphoxide-70% ethanol (3:1, v/v) and administered by crop gavage to 14-day-old male White Pekin ducklings (Trial II) or 7-day-old male turkey poults (Trial III). Ducklings given 250 or 500 parts/10(6) citrinin diet for 15 days had clinical signs of citrinin toxicity. Body weight gain was significantly decreased by the 500 parts/10(6) diet (P < 0.05). Ducklings fed 250 and 500 parts/10(6) developed nephropathy that was more severe in the 500 parts/10(6) group. The nephropathy was characterised by degeneration, necrosis, mineralisation and regeneration of tubular epithelial cells of both the cortical and medullary regions. Interstitial fibrosis was found in the medullary regions of the 500 parts/10(6) group only and focally was accompanied by interstitial nephritis. Seven daily doses of citrinin equal to a half or three-quarters of the single-dose LD(50) produced no additive toxic effects in either ducklings or turkeys, but body weight gain was significantly decreased in duckling given three-quarters of the single-dose LD(50).

Acute toxicity of citrinin in turkeys and ducklings.

Citrinin, a naturally occurring mycotoxin, was dissolved in dimethyl-sulphoxide - 70% ethanol (3:1, v/v) and administered orally in two trials to 7-day-old male turkey poults and male white Pekin ducklings. The single dose LD50 value in 7-day-old male turkey poults was 56 mg/kg and in 7-day-old male white Pekin ducklings it was 57 mg/kg. The mycotoxin was nephrotoxic in both species, but the renal lesions were more severe in turkeys and were characterised by degeneration and necrosis of renal tubular epithelium. In turkeys, lesions were found in the liver and included hepatic cell necrosis and biliary hyperplasia. Lymphoid necrosis with depletion involved the thymus and cloacal bursa of turkeys and ducklings. These latter lesions were the most prominent histopathological alterations in citrinin-treated ducklings.