A controlled trial on the effect of feeding dietary chestnut extract and glycerol monolaurate on liver function in newborn calves

Beginning in the fall of 2010, an increasing and alarming number of cases of calves suffering from liver dystrophy were reported in the south of Germany. An epidemiological investigation was carried out by the authors between November 2010 and July 2011, leading to the implication of a commercial dietary supplement as the potential cause for this outbreak. The components of this product were first tested in a cell culture model and two of them (dietary chestnut extract and glycerol monolaurate) showed a cytotoxic effect. The objective of this study was therefore to evaluate the effect of supplemental feeding of both components alone or in combination on liver function in newborn calves on a commercial dairy farm. Ten calves were enrolled in each of the three treatment groups and the control group (group O) following a blocked design. Treatment consisted of supplementation with chestnut extract at 0.02% of birth body mass (BM) (group C), supplementation with glycerol monolaurate at 0.006% of BM (group G) or a combined treatment (group CG) for five consecutive days. The effect of treatments on liver function was evaluated clinically and by measurement of glutamate dehydrogenase (GLDH) and aspartate aminotransferase (AST) activities as well as the determination of the concentrations of glucose, L‐lactate and total bilirubin in serum. There was a significant increase in GLDH and AST activities and a significant decrease in glucose concentration in treatment groups C and CG compared with the control group (p ≤ 0.035), whereas no difference was shown for group G. Survival was significantly decreased in groups C (p = 0.029) and CG (p = 0.001) compared with both group G and the control group. These results suggest that dietary chestnut extract in an amount of 0.02% of BM alone or in combination has a toxic effect on liver function in newborn calves.

Balling gun-induced trauma in cattle: clinical presentation, diagnosis and prevention

Pharyngeal trauma in cattle can occur during the administration of oral medication using a balling gun. The number of cases of severe complications due to bolus application that have been referred to our hospital has increased from nil between 1996 and 2008 to three or four per year. In our experience, reports by bovine veterinarians of patients with severe and often fatal pharyngeal trauma, which were not referred to the clinic, have become more common in recent years as well. The incidence of this complication is likely to be higher than this number of referrals suggests. Diagnosis without the help of imaging techniques, such as radiography and endoscopy, may be difficult, especially in cases where exploration of the pharynx cannot be carried out, or is unable to confirm the absence or presence of a lesion. Prognosis is often poor in cases where perforation has been confirmed. Boluses are increasingly administered by the owners or farm personnel without the supervision of a veterinarian. In order to prevent losses due to balling gun-induced injuries, the veterinarian plays a crucial role in giving advice to his clients. Five cases of cattle suffering from varying degrees of balling gun-induced trauma are presented, and consideration is given to incorrect application techniques.

[High incidence of jaundice in young calves in Southern Germany]

OBJECTIVE

Between September, 2010, and August, 2011, a series of cases of jaundice of unknown origin in young calves was detected in a number of farms in Southern Germany. This paper describes the syndrome on the basis of 57 cases, and the approach taken to discover the cause.

MATERIAL AND METHODS

The clinical course of the disease is described in 19 patients. Using a case definition (calves aged 1-3 weeks, total serum bilirubin > 20 µmol/l and/or serum glutamate dehydrogenase [GLDH] activity >50U/l and/or autopsy findings with striking liver pathology [jaundice, liver dystrophy, cirrhosis]), 36 farms were included in an epidemiological survey. In a feeding trial, two batches of a dietary supplement feed, previously used in diseased calves on farms, were fed at the dosage recommendations of the manufacturer to four clinically healthy calves over 5days. Four other calves served as controls. The calves were clinically monitored daily, and blood samples were investigated using clinical chemistry and haematology.

RESULTS

Clinical examination revealed behavioural alterations (weakness, tonic-clonic seizures and bawling just before death), recumbency, jaundice and discolouration of faeces. In less severe cases without clinical signs, there was an increase in serum bilirubin concentration and/or GLDH activity. In the epidemiological survey of affected farms, the feeding of a diet supplement feed was registered in 54 of 57 cases. The feeding of two batches of that diet supplement feed to four clinically healthy calves resulted in a significant (p<0.05) increase in bilirubin and lactate concentrations, as well as the GLDH activity in serum, but without serious impairment of the general condition, whereas in control calves, no comparable changes were observed.

CONCLUSION

The results of the epidemiological survey and the feeding trial suggest a causal involvement of a dietary supplement feed. The toxic principle is unknown.

CLINICAL RELEVANCE

Knowledge of the clinical picture and the probable feed-related context is important to detect this disease early. The suspected dietary supplement feed has been taken off the market, but with other products similar problems may arise.

Häufung von Ikterus bei jungen Kälbern in Süddeutschland

Gegenstand: Zwischen September 2010 und August 2011 traten in süddeutschen Rinderbetrieben mehrere Fälle unklarer Hepatopathien bei jungen Kälbern auf. Beschrieben werden die Kasuistik von 57 Fällen und der beschrittene Weg zur Ursachenklärung. Material und Methoden: Der klinische Verlauf der Erkrankung wird anhand von 19 Patienten dargestellt. Eine epidemiologische Erhebung nach Falldefinition (Alter der Tiere 1–3 Wochen, Gesamtbilirubinkonzentration > 20 μmol/l und/oder Glutamatdehydrogenase-[GLDH-]Aktivität > 50 U/l und/oder auffälliger Leberbefund [Ikterus, Leberdystrophie, Leberzirrhose] in der Sektion) umfasste 36 Betriebe. In einem Fütterungsversuch wurden zwei Chargen eines zuvor in betroffenen Betrieben eingesetzten Diätergänzungsfuttermittels nach Herstellerangabe an vier klinisch gesunde Kälber über 5 Tage verfüttert. Vier weitere Kälber dienten als Kontrollen. Täglich erfolgte eine klinische, klinisch-chemische und hämatologische Untersuchung. Ergebnisse: Bei klinisch manifester Erkrankung treten Verhaltensauffälligkeiten (Mattigkeit, tonisch-klonische Krämpfe, Klagen kurz vor dem Verenden), Festliegen, Ikterus und auffällig heller Kot auf. In weniger stark ausgeprägten Fällen ohne klinische Symptomatik bestehen eine erhöhte Serum-Bilirubinkonzentration und/oder GLDH-Aktivität. Die Befragung in betroffenen Betrieben ergab in 54 von 57 Fällen als Gemeinsamkeit den Einsatz eines Diätergänzungsfuttermittels. Im Fütterungsversuch zeigten Versuchskälber eine signifikante (p < 0,05) Erhöhung von Bilirubin- und L-Laktat-Konzentration sowie GLDH-Aktivität im Serum ohne schwerwiegende Beeinträchtigung des Allgemeinbefindens. Bei den Kontrolltieren fehlten vergleichbare Veränderungen. Schlussfolgerung: Epidemiologische Erhebung und Fütterungsversuch deuten auf eine ursächliche Beteiligung eines Diätergänzungsfuttermittels hin. Das toxische Prinzip ist bisher unbekannt. Klinische Relevanz: Die Kenntnis des klinischen Bildes und der vermutlich fütterungsbedingten Zusammenhänge ist wichtig, um die Krankheit rechtzeitig zu erkennen. Das Diätergänzungsfuttermittel wurde vom Markt genommen, doch könnte die Verfütterung vergleichbar zusammen gesetzter Produkte ähnliche Krankheitserscheinungen hervorrufen.

A human lymphocytotoxic autoantibody is encoded by antibody variable region genes in their germ line configuration

Lymphocytotoxic autoantibodies are commonly found in sera from kidney dialysis patients, where they interfere with interpretation of the crossmatch test. We have produced a monoclonal lymphocytotoxic autoantibody by EBV transformation of PBLs from a dialysis patient, followed by fusion of the transformed cells with a heteromyeloma. The autoantibody derived, called FWE, was IgM kappa class and its pattern of reactivity against T and B lymphocytes, cells from patients with chronic lymphocytic leukemia and K562, was similar to that described for lymphocytotoxic autoantibodies found in sera. It was absorbed by fetal but not adult human erythrocytes, suggesting the antigenic determinant might be the blood group antigen i. cDNA encoding the variable domain of FWE was amplified by polymerase chain reaction, cloned into the vector M13 mp18, and sequenced. The variable region of the kappa light chain (V kappa) was 98.8% identical over a 260-bp stretch with a known germ line sequence and the junctional (J kappa) region was identical over 16 bp with the germ line sequence J kappa 2. The variable region of the heavy chain (VH) was 99.3% identical over a 268-bp overlap with the germ line gene VH4.21, a member of the VHIV family, and the junctional region of the heavy chain (JH) was identical with the germ line JH gene JH5 over 46 bp, with a truncated 5' end. The diversity region was not identified. These data suggest that the genes required to produce human lymphocytotoxic autoantibodies are encoded within the germ line and, therefore, that all dialysis patients may be able to produce them under certain circumstances.

Elevation of albumin synthesis rates in nephrotic patients measured with [1-13C]leucine

Eight patients with a nephrotic syndrome and a histologically-proven kidney disease were compared to age- and sex-matched healthy volunteers. Albumin synthesis rates were measured after injection of 13C-labelled leucine (57 mg/kg body wt, 19.4 atoms%). Plasma volume was determined with 125I-albumin. The fractional synthesis rate of albumin was 7.9 +/- 0.4%/day in control subjects in comparison with a marked elevation to 18.4 +/- 2.0%/day (P less than 0.001) in nephrotic patients. The absolute synthesis rate was 145 +/- 9 mg/kg/day in control subjects compared with 213 +/- 17 mg/kg/day (P = 0.005) in the nephrotic patients. There was a statistically significant correlation between ASR and urinary albumin loss (P = 0.035) and serum cholesterol concentration (P = 0.007). The calculated oncotic pressure was significantly lower in the nephrotic group than in the controls (P less than 0.001), but was without correlation with ASR.

Reduction of sensitization induced by blood transfusion in the rat by monoclonal antibodies

Primary and secondary alloantibody responses were monitored in (AOxPVG)F1 hybrid rats after three transfusions of DA blood; the initial transfusion was either untreated or pretreated with monoclonal antibody directed to class I antigens or other cell surface markers. Mean antibody activity in recipient sera against class I DA antigens was significantly decreased by pretreatment with the monoclonal antibodies. The most marked suppression was associated with pretreatment by antibodies to the four major nonoverlapping epitopes of the RT1Aa antigen. Subsequent transfusions of DA blood failed to stimulate a secondary response. Crossreactivity of the alloantibody reactivity with BDIX antigens was diminished by pretreating the transfusions with rat anti-RT1A antibodies and, to a lesser extent, with a mouse monoclonal antibody (OX-18) to a common class I determinant. Monoclonal antibody pretreatment had no effect on the humoral response to class II DA antigens. These studies indicate that blood transfusions pretreated with monoclonal antibodies induce a less-potent cytotoxic humoral immune response and that reactivity is most effectively suppressed by completely masking the class I antigen. This technique may prove of clinical value in preventing the sensitization caused by blood transfusions in potential transplant recipients.

Effect of cyclosporin A on immunoglobulin class in patients receiving blood transfusions

IgG antibodies detected by flow cytometry in sera from potential renal transplant recipients are associated with an increased number of rejection episodes and impaired graft function. Furthermore, cytotoxic antibodies may develop if pre-transplant blood transfusions are given to such patients. We have investigated the effect of cyclosporin A on the development of IgM and IgG antibodies detected by flow cytometry after blood transfusions in 16 previously untransfused dialysis patients. Eight (group 1) received three to five third-party blood transfusions at two weekly intervals and the remaining eight (group 2) received transfusions with concomitant cyclosporin A therapy (10 mg/kg/day). Sera obtained after each transfusion were tested using flow cytometry against lymphocytes from six normal donors. In all 462 serum/cell combinations were tested. Sera from six out of eight patients in group 1 showed IgG antibody activity following blood transfusions and none developed IgM antibodies alone. In contrast IgG antibody activity was detected in one serum sample from only one of the eight patients in group 2 (P less than 0.02); a further three patients developed IgM but not IgG antibody activity during the transfusion protocol. IgG antibodies were found in 25/228 serum/cell combinations in group 1 but in 1/234 in group 2 (P less than 0.001). The patient in group 2 who developed IgG antibodies in one serum/cell combination was known to have red cell autoantibodies. This IgG activity was removed by red cell absorption, suggesting that the autoreactive red cell antibody cross-reacted with lymphocytes. Cytotoxic antibodies were detected in two serum/cell combinations in group 1 alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical statistics of battlefield casualties

War surgery presents conditions and problems that are radically different from those of peacetime surgery. Categorization of the injured may be necessary (triage), while a short or erratic supply of drugs, materials and personnel may exist. In this study, the hospital mortality following military action was 6.4 per cent. In the group of patients with combined thoracoabdominal injuries mortality was high. However, the inflow of this type of patient was relatively low. In 50 per cent of the cases, ketamine/benzodiazepine anaesthesia without intubation and artificial ventilation was sufficient, with the result that the use of oxygen and nitrous oxide was minimized.