Pelvic exenteration in advanced and recurrent cervical cancer

Pelvic exenteration consists in a radical surgical procedure for patients with advanced and recurrent cervical cancer and it offers the chance for cure. Surgical techniques have been developed for reducing morbidity and mortality. From July 2005 to September 2009, Pelvic Exenteration was performed for 20 patients with primary advanced cancer cervix and 10 patients with recurrent cervical carcinoma. Full data about the surgery [type of exenteration, type of feacal and urinary diversion, lymph node dissection, and operative morbidity] was recorded. No operation-related mortality, the complications rate was 23.3% and the overall mean survival was 34.7 months [95% CI=28.0-41.5]. Multiple factors were analyzed [univariate analysis] to determine their association with long-term survival. Mean survival was 37.2 months [95% CI 29.7-44.7] in the primary group and was 21.6 months [95% CI=12.8-30.4] in the recurrent group [p=0.033 by Cox regression]. An important prognostic factor was the margin status. Mean survival was 39.2 months [95% CI<=33.0-45.4] for patients with tumor-free resection margins and was 6.4 months [95% CI=3.3-9.5] for those with positive margins [p<0.001 by Cox regression]. In patients with primary advanced cervical cancer, exenteration is a valid alternative to primary chemoradiation. In patients with recurrent tumor limited to the pelvis, secondary exenteration should be offered without post operative mortality although the morbidity rate is still high. Univariate analysis showed that margin status is important prognostic factor for survival

Age related ultrastructural changes in albino rat sciatic nerve and the effect of antioxidants

The present study was performed to clarify the age related ultrastuctural changes of the myelinated fibres in the sciatic nerve of albino rats and to elucidate the effects of receiving antioxidants on such age alterations. Thirty male albino rats were used in this investigation; 10 were adult [3- month- Old], ten were aged [24- month -old] and the last ten were aged but received vitamins C and E for 4 weeks. Then, all rats were decapitated and their sciatic nerves were rapidly dissected and toluidine blue- stained semithin sections were prepared for light microscopic examination. Ultrathin sections were processed for transmission electron microscope examination. Compared to the adults, the sciatic nerves of the aged rats possessed thinner perineurium. The endoneurium was collagen filled and contained many fibrocytes. The myelin sheath showed thickening, invagination, evagination, heterogeneity, splitting and myelin bubbles. The cytoplasm of Schwann cells housed rough endoplasmic reticulum, mitochondria and many electron dense bodies. The axoplasm was compressed in some areas and occasionally housed membrane bound vesicles containing heterogenous granular material and low electron dense vacuoles containing myelin figures. The unmyelinated axons were present in groups burned in deep recesses on the surface of Schwann cells. The sciatic nerves of rats received vitamins C and E showed minute splitting, infolding and outfolding of the myelin sheath. In some situations, fibrocytes extended their processes and encircled the nerve fibres, despite the improvement of the condition of the myelin. The axoplasm exhibited sequestration of the degenerated parts that contained membrane bound vesicles of low electron density. Based on the previous data, it may be concluded that, age affected the myelinated fibres of the sciatic nerve and the intake of vitamins C and E lessened such influences

Effect of methylene blue on intra-abdominal adhesion formation in rats

Adhesion formation represents an important clinical challenge in gastro-intestinal surgery. In the late era, methylene blue [MB] has been claimed to play a helping role in combating such a problem. In the present study, we investigated the effects of MB administered intraperitoneally on the surgically-induced adhesions in rats and tried to clarify whether its impact is concentration-dependent. Seventy adult male Wistar rats were used. They were allocated into seven groups, ten rats each: one control two sham - operated and four experimental ones. Peritoneal adhesions were evoked by scraping the cecal serosa in the four experimental groups which were given different concentrations of MB, intraperitoneally. The animals of the control group were similarly dealt but were given saline. The rats of the sham-operated groups were given either MB or saline but without any serosal damage. After the elapse of two weeks, the resulting adhesions, inflammation and fibrosis were evaluated. In the rats treated with MB 1%, adhesions, inflammatory process and fibrosis scores were similar to those in the sham-operated rats and were significantly lower than those in all other groups. It could be concluded that MB, 1%, had the best anti-adhesion potential

light and scanning electron microscope study of the albino rat ileum after its partial obstruction

Induction of some sort of obstruction could be resorted to as a definitive line of management of some cases of short- bowel syndrome [SBS]. The goal of this study was to clarify the histological and morphometric alterations in the albino rat ileum after its surgically induced partial obstruction. Thirty adult male albino rats [240-250 gm] were used in this investigation. They were divided into two equal groups: control and experimental. Small pieces of the ileum of the control and experimental animals were processed for histological and scanning electron microscope study. The ileum of the experimental animals proximal to the site of obstruction showed an apparent enlargement in the Peyer's patches and an increase in the thickness of both the mucosa and muscle layers. The villi showed significant elongation and thickening. Both widening and deepening of the crypts were detected. There were an apparent increment in the goblet cell number and in the lymphocytic infiltration in both the corium and submucosa. Scanning electron microscopic examination, the microvilli showed scattered areas of shortening and irregular orientation. The surface was more frequently broken by goblet cell orifices. It could be concluded that partial ileal obstruction resulted in hypertrophy of the ileal wall with considerable structural alterations oral to the obstruction site. Thus, a procedure apparently increased the absorptive surface area together with slowing the intestinal transit. These effects could support putting forward this technique into consideration as one of the suggested lines of treatment of some cases of short bowel syndrome to eliminate the patients need for the parenteral nutrition and all its associated complications

light and electron microscope study of the effect of sildenafil citrate on the kidney of cyclosporine-treated albino rats

The goal of the current study was to clarify the effects of the phosephodiesterse-5 inhibitor, sildenafil citrate [SC], on the kidney of cyclosporine A [CsA]-treated albino rats. Thirty adult male albino rats [200-250 gm] were used in the present investigation. They were allocated into three equal groups: control CsA- treated and both CsA and SC- treated. The animals were sacrificed after three weeks and blood samples were withdrawn by direct cardiac puncture to determine the levels of urea and creatinine in plasma. Also, small slices of the kidney were processed for histological histochemical and immunohistochemical study. The CsA-treated rats showed a significant increase in both blood urea nitrogen and plasma creatinine. Then, followed a significant decrease in their values in the CsA and SC- treated animals. Histological examination of the kidney of the CsA- treated group exhibited a degeneration in both the tubular epithelium and the glomerulus with a relative widening of the sub-capsular spaces. Areas of interstitial haemorrhage and cellular infiltration were encountered. There was a relative increase in the amount of interstitial fibrosis. Ultrastructurally, the minor foot processes of the podocytes were enlarged and fused around an apparently thickened basement membrane with an apparent reduction in the number of filtration slits. The cells of proximal convoluted tubules showed a marked reduction in their basal infoldings. The nucleus became irregular in outline and the cytoplasm housed degenerated mitochondria. Succinic dehydrogenase reaction got weak while the acid phosphatase one became strong. A moderate to strong immune reaction to caspase- 3 was detected in the renal tubules. On the other hand, albino rats receiving both CsA and SC showed an improvement in the histological architecture and in both the histochemical and immunohistochemical reactions. In conclusion, the present findings lend support to a lessening role of the phosphodiesterase-5 inhibitor, SC, on the CsA- induced renal effects

Light and electron microscope study of the diabetic rat myocardium after trimetazidine [vastarel] treatment

Diabetic patients with ischaemic heart disease have a greater liability of myocardial ischaemia, and an increased incidence of heart failure compared to the non-diabetic ones. The goal of this study was to clarify the effects of trimetazidine on the architecture of the myocardium of diabetic rats. Thirty adult male albino rats [200-250 gm] were used in this investigation. They were divided into three equal groups; control diabetic non treated and diabatic TMZ- treated. At sacrifice, small pieces of the myocardium of left ventricle were processed for histological, histochemical and immunohistochemical study. Myocardium of diabetic rats showed an apparent increase of endomysium.The muscle fibers showed areas of degeneration. Ultrastructurally, the cardiac myocytes of diabetic rats showed distortion of cardiac myofibrils with loss of cross banding in many areas. The nucleus had a corrugated nuclear membrane and the mitochondria were swollen and distorted. Histochemically, myocardium of diabetic rats exhibited a weak succinic dehydrogenase reaction and a strong positive immunoreaction for NK-kappa B and caspase-3 in myocardial sarcoplasm. On the other hand, TMZ- treated diabetic rats showed an improvement in the histological architecture and in both histochemical and immunohistochemical reaction. So, TMZ should always be advised for diabetic patients to alleviate the cardiac hazards

location of the mandibular formen and the shape of the lingula in the adult human mandibles

present study was carried out to show the definite position of the mandibular foramen in relation to the surrounding bony landmarks and to detect the variation in the shapes of lingulae in the adult human Egyptian mandibles. 100 dry adult human [90 male, 10 female] mandibles were examined in this study. All measurements were done using a venier caliber and considering the point of reference for the mandibular foramen its lower border where it merges with the lingual. The anteroposterior localization of the mandibular foramen varied according to the definition of the anterior border of the ramus. If the external oblique line is considered as the anterior rameal border, the foramen existed about 5 mm behind the midpoint of the ramus. But when the internal oblique line is taken as the anterior border, the foramen is nearly at the midpoint of the ramus. The mandibular foramen was 1.5 - 2 mm above the midpoint between mandibular notch and the base of the mandible and also was found to lie at the junction between the lower third and the upper two thirds of the line between the angle of the mandible and the tip of the coronoid process. The mandibular foramen, in relation to the occlusal surface of the lower molar teeth was observed mainly below [86%], sometimes level with [13%] and rarely above [1%] that surface. In 88% of the mandibles investigated, the type of lingual was bilateral and only in 12% of mandibles the presentation differed in the two sides. Of the unilateral presentations, 8 were triangular on one side and truncated on the other and also 4 were nolular on one side and incorporated on the other. The incidence of the four types of lingulae i.e. the triangular, the truncated, the nodular and the incorporated lingulae was 67%, 16%, 11% and 6% in succession. The apex of the triangular lingula was found to be directed upward and backward towards the condylar process in most [98] sides [73.1%] and towards the posterior border of the ramus in 36 sides [26.9%]. The upper border of this triangular variety was completely as partially separated from the ramus in 65.7% of sides and was completely attached to the ramus in 34.3% of sides

Morphometric study of the mucous cells in albino rat zymogenic units

The present study was carried out to throw light on the morphometric and ultrastructural changes in the different mucous secreting cells in the rat zymogenic units during cellular migration along the zymogenic units. Twenty adult albino rats [200 -250 gm] were used. The animals were perfused through the left ventricle, under Ketamine hydrochloride anaesthesia [45 mg / kg], with lactated Ringer's solution followed by a mixture of 2.5% gluteraldehyde and 2% paraformaldehyde in 0.1 M cacodylate buffer [pH 7.4]. Fine fragments were taken from the fundus of stomach fixed in the same mixture, post fixed in osmium tetroxide, dehydrated in alcohols and propylene oxide, and embedded in Epon. Semithin sections were cut by a glass knife, stained by toluidine blue and used for morphological study and counting of pit and neck mucous cells. Ultrathin sections were cut also with glass knife, stained with uranyl acetate and lead citrate, examined by JEOL 100S E / M. The pit region was arbitrarily divided into low, mid, high pit as well as pit top segments. The neck was similarly divided into high and low segments. The number of cells in these different pit and neck segments was counted in longitudinal sections of twenty zymogenic units for each animal. The size of secretory granules, and mitochondria were measured in 6 micrographs from different units for each cell type. The data obtained from the pit segments were statistically analyzed for the test of significance as compared to the low pit values, those of low neck region obtained from the high neck ones, in the different pit regions as compared with the low pit segment. The low pit cells showed two rows of ectoplasmic secretory granules with dense cores while their cytoplasm contained supranuclear Golgi apparatus with prospectory vesicles at its trans-face, numerous mitochondria few rER cisternae and many free ribosomes. In the cell of the mid pit there were more raws of secrtory granules with diminution of the free ribosomes. In the high pit cells, the ectoplasm was full of many rows of secretory granules, while the free ribosomes were little in amount. A well developed Golgi apparatus with prosecretory vesicles at its trans face was also evident in these cells. The cells at the pit top had few ectoplasmic secretory granules, rounded pale mitochondria, few rER cisternae. The degenerating pit top cells were characterized by the appearance of several clear spaces in the cytoplasm, their nuclei became condensed and irregular while the ectoplasm housed few, ovoid secretory granules; few of which had dense cores. The remaining cytoplasm contained dilated rER cisternae and pale mitochondria. The completely degenerated pit top cells became separated from the adjacent ones by wide intercellular spaces, their dense cytoplasm contained ghosts of mitochondria, rER and scattered lysosomes. Statistically, there was a significant decrease in the number of cells, a significant increase in the size of secretory granules and a significant decrease in the size of mitochondria in all pit segment cells as compared with the low pit ones. The secretory granules of the high neck cells exhibited irregular cores while the cytoplasm showed long rER cisternae, scattered free ribosomes, Golgi stacks and mitochondria. In the low neck cells the granules possessed cores of variable electron density and the rER cisternae surrounded the nucleus. Statistically there was a significant increase in the number of cells in the low neck segment, as compared with the high neck ones. There was also a significant increase in the sizes of both secretary granules and mitochondria in the low neck cells as compared with those in high neck segment. At the border between neck and base, prezymognic cells containing rounded secretary granules with more electron dense material, were encountered. It could be concluded that the activity of pit cells increased as we go up to its high part and decreased at the pit top where they degenerated and became extruded into the gastric lumen. On the other hand, the neck cells became more active as they descended down to the base to be transformed into zymogenic cells

Electron microscope study of the parietal cells in mice stomach

The intent of this study was to clarify the ultrastructural and morphometric changes in mice parietal cells during different stages of differentiation and alteration. Fifteen adult mice were anaesthetized intraperitonealy with sodium pentabarbital [35 mg / kg] and perfused through the left ventricle with a mixture of 2.5% glutaraldehyde and 2% paraformaldhyde in cacodylate buffer at pH 7.4. The stomach was dissected out and small fragments from the fundus were processed to obtain semithin sections stained with toluidine blue as well as ultrathin sections for E / M study. The fine structure of different forms of pre-parietal and parietal cells at different segments of zymogenic units was examianed. Also the mean surface area of both the clearly outlined mitochondria, and nucleoli were determined, the data were statistically analyzed for the test of significance as compared to the least differentiated pre-partial cells. The isthmus of the zymogenic units contained immature parietal cells identified as pre-parietal ones. Stage 1 pre-parietal cells had primitive small intracellular canaliculi while their cytoplasm housed numerous small mitochondria. Stage 2 pre-parietal cells exhibited small intracellular canaliculi with long microvilli. They contained tubulovesicles and numerous mitochondria. In stage 3, the cells showed deep intracellular canaliculi with excess microvilli, their cytoplasm housed numerous mitochondria and tubulovesicles. The mature parietal cells, in the neck and upper base, showed deep intracellular canaliculi swarmed with long microvilli. They contained rounded or oval mitochondria with closely packed cristae as well as extensive tubulovesicular system. There were a significant decline in the nucleolar size and an increase in the mitochondrial width as the cells proceeded from the immature to the fully differentiated forms. As the mature cells migrated downward to the base and upward to the pit of zymogenic units, their fine structure was altered. The signs of alteration were manifested by the appearance of clear spaces and lysosomal bodies in the cytoplasm. There were also disruption of tubulovesicular system and pleomorphism and distortion of mitochondria. As alteration progressed, there were more larger clear spaces in the cytoplasm, more disruption of the intracellular canaliculi and tubulovesicular system. The mitochondria exhibited abnormal shapes, disrupted cristae and clear matrices while lysosomal bodies and some autophagic vacuoles scattered in the cytoplasm. Parietal cells in advanced stages of alteration exhibited widely disteneded canaliculi, closely packed destroyed mitochondria, indistinct tubulovesicular system as well as lysosomal bodies. Necrosis of parietal cells was manifested by destroyed mitochondria while the remnants of the intracellular canaliculi appeared as wide spaces with destroyed microvilli. The completely degenerated parietal cells were seen protruding into the gastric lumen in their way for extrusion. These observations indicated that the parietal cells might have a cycle starting by differentiation, alteration and ending ultimately by death and extrusion