Utilización de las zonas de entrada seguras para el abordaje de lesiones intrínsecas de tronco cerebral en adultos / Use of safe entry zones for the approach of intrinsic brainstem lesions in adults

Introducción: Las "zonas de entrada seguras" (ZES) al tronco cerebral describen accesos destinados a preservar estructuras críticas. La mayoría de las publicaciones son descripciones anatómicas; existiendo pocas sobre su aplicación. En este escenario, nuestro trabajo puede sumar información para el manejo quirúrgico en casos seleccionados. Material y Métodos: De una serie de 13 pacientes, se presentan 9 que no eran candidatos para biopsia estereotáctica y recibieron microcirugía. Las localizaciones fueron: mesencéfalo (3), tectum (1), protuberancia (2) y bulbo (3). Cinco pacientes tuvieron KPS => 70; y 4, KPS <70. Diferentes ZES fueron utilizadas según la topografía lesional. El grado de resección se basó en la biopsia intraoperatoria y el monitoreo neurofisiológico. Resultados: Los hallazgos patológicos fueron: astrocitoma pilocítico (1), glioma de bajo grado (1), hemangioblastoma (1), subependimoma (1), disgerminoma (1), y lesiones pseudotumorales (3 cavernomas y 1 pseudotumor inflamatorio). El grado de resección fue completo (4), subtotal (3), y biopsia fue considerada suficiente en (2). Un paciente falleció en el postoperatorio. Discusión: Las lesiones del tronco cerebral son infrecuentes en adultos. Las controversias surgen cuando se balancean los beneficios de obtener diagnóstico histopatológico y los riesgos potenciales de procedimientos invasivos. La amplia variedad de hallazgos en esta localización exige una precisa definición histopatológica, que no solamente determinará la terapéutica adecuada, sino que advierte sobre las consecuencias potencialmente catastróficas de los tratamientos empíricos. Las ZES ofrecen un acceso posible y seguro, aunque es más realista considerarlas como áreas para abordar lesiones intrínsecas con baja morbilidad más que como zonas completamente seguras

Introduction: The "safe entry zones" (SEZ) to the brainstem are special entrances described to preserve critical structures. Most publications correspond to anatomic research; few papers report their application in surgery. In this scenario, our report could add information to the surgical management in selected cases. Material and Methods: Out of a series of 13 patients, 9 were non-candidates for stereotactic biopsy and received microsurgery. Localizations of the lesions were: mesencephalus (3), tectal plate (1), pons (2) and medulla oblongata (3). Five patients had KPS => 70; 4, KPS <70. Different SEZ were used according to lesional topography. The extent of resection were based on the frozen pathology findings and neurophysiological monitoring. Results: A variety of pathological findings were found: low-grade glioma (1); pilocytic astrocytoma (1); hemangioblastoma (1); subependimoma (1); disgerminoma (1); pseudotumoral lesions (cavernomas 3 and inflammatory pseudotumor 1). The extent of resection was complete (4), subtotal (3), and biopsy was considered sufficient in 2 cases. One patient died 96-hours-postoperative due to brainstem edema. Discussion: Brainstem structural lesions are uncommon in adults. Controversies arise regarding the need of histologic diagnosis, weighing benefits of a reliable diagnosis and the potential disadvantages of the invasive procedures. The accurate histopathological definition could not only determine an adequate therapy, but also can prevent the disastrous consequences of empiric treatments. The SEZ provides a feasible and safe access, although it is more realistic to consider them as areas to approach intrinsec lesions with less morbidity than to consider them as completely safe entrances

Coinfecções por Leishmania infantum, Neospora caninum e Toxoplasma gondii em cães necropsiados da região central do Rio Grande do Sul, Brasil / Coinfections by Leishmania infantum, Neospora caninum and Toxoplasma gondii in necropsied dogs from the central region of Rio Grande do Sul, Brazil

O objetivo do presente trabalho foi determinar a presença de anticorpos para Leishmania infantum, Neospora caninum e Toxoplasma gondii, por meio da reação de imunofluorescência indireta (RIFI), em cães (n=78) provenientes da região central do Rio Grande do Sul, necropsiados no Hospital Veterinário da Universidade Federal de Santa Maria (UFSM), bem como avaliar os dados epidemiológicos, sazonais e anátomo-histopatológicos. Do total de animais avaliados, 67,9% (53/78) apresentaram soropositividade para ao menos um agente. A ocorrência de anticorpos para L. infantum, N. caninum e T. gondii foi de 33,3 (26/78), 37,1 (29/78) e 43,5% (34/78), respectivamente. Detectaram-se monoinfecções em 9,4% (5/53) para L. infantum, 18,8% (10/53) para N. caninum e 20,7% (11/53) para T. gondii. As coinfecções foram observadas em 27/53 (50,9%) dos animais. As infecções ocorreram independentemente de idade, sexo, procedência ou raça (P>0,05). Não se verificaram lesões anatomo-histopatológicas relacionadas aos agentes pesquisados, caracterizando-os como animais assintomáticos. Os resultados confirmaram a exposição de cães a esses protozoários na região central do RS e, em especial, demonstraram a circulação do agente causador da leishmaniose em uma área considerada indene para a enfermidade.(AU)

The present paper is aimed to determine the presence of antibodies for Leishmania infantum, Neospora caninum and Toxoplasma gondii by indirect immunofluorescence (IIF) in dogs (n=78) from the central region in the state of Rio Grande do Sul necropsied in the Veterinary Hospital from Universidade Federal de Santa Maria (UFSM). The data was evaluated regarding epidemiological, anatomic, and histopathologic findings. Of the total animals evaluated, 67.9% (53/78) showed seropositivity for at least one agent. The occurrence of antibodies to L. infantum, N. caninum and T. gondii was 33.3% (26/78) 37.1% (29/78) and 43.5% (34/78), respectively. The mono infections were detected in 9.4% (5/53) of L. infantum, 18.8% (10/53) for N. caninum and 20.7% (11/53) T. gondii. The coinfections occurred in 50.9% (27/53) of animals. There were not anatomical and histopathological lesions regarding these surveyed agents, characterizing them as subclinical animals. The results confirmed the exposition of dogs to these protozoa in the central region of the RS, highlighting the circulation of the causer agent of leishmaniasis in an area considered harmless for the disease.(AU)

The Study of Animal Model of Lymphedema Using the Mouse Tail / 고신대학교의과대학학술지

OBJECTIVES: To investigate the time course of the development of acquired and experimental lymphedema. METHODS: We studied an experimental model of acute post - surgical lymphedema in the tails of female hairless mice. The procedures that remove the skin and subcutaneous tissue in tails of the mice (5-10 mm from tail base) were performed, and then the murine has acquired lymphatic insufficiency. We measured volume of the tails in 2 times per week for 5 weeks, histological biopsy, and lymphoscintigraphy to assess lymphatic flow. RESULTS: There was gradually increased volume of the tails and observed twice volume at post - surgical 18 days. In lymphoscintigraphy, we identified decreased lymphatic flow and dermal back flow in the tails. Histological biopsy showed inflammatory response that was edema and increased neutrophils in epidermis and subdermis, and lymphatic microvascular dilatation. CONCLUSIONS: We have a mouse model of acute acquired lymphedema. This post - surgical murine tail model of lymphedema can be used to simulate an attribute of human lymphedema and provides knowledge about functional and structural alterations of lymphedema.

La ultrasonografía en el estudio de síndrome de hombro doloroso / Musculoskeletal ultrasound in the evaluation of the painful shoulder

El síndrome de hombro doloroso es una causa frecuente de consulta en la práctica clínica diaria. Su origen puede ser traumático, inflamatorio, degenerativo, infeccioso o tumoral. El abordaje diagnóstico implica un amplio conocimiento de la anatomía regional y la aplicación de maniobras clínicas y técnicas de imagen que conduzcan a un diagnóstico certero para la aplicación de un tratamiento óptimo en cada paciente. En los años recientes, el ultrasonido musculoesquelético ha demostrado ser una herramienta complementaria de altísima utilidad en el examen complementario de los pacientes con hombro doloroso, especialmente en el contexto de la práctica reumatológica. Revisaremos los principales hallazgos patológicos evaluados por esta técnica.

Painful shoulder syndrome is a frequent cause of daily clinical consultation. Its origin can be traumatic, inflammatory, degenerative, infectious or tumor like. The boarding diagnosis implies an ample knowledge of the regional anatomy and the application of clinical and technical maneuvers of image that leads to an accurate diagnosis for the application of an optimal treatment in each patient. In the recent years, the musculoskeletal ultrasound has demonstrated to be a complementary tool of highest utility in the complementary examination of the patients with painful shoulder, especially in the context of the rheumatological practice. We will review the main pathological findings evaluated by this technique.

Preoperative Radiologic and Postoperative Pathologic Risk Factors for Early Intra-Hepatic Recurrence in Hepatocellular Carcinoma Patients Who Underwent Curative Resection

PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.

Pathologic Findings of Residual Tumor according to the Response Rate after Neoadjuvant Chemotherapy for Breast Cancer

PURPOSE: There are questions about selecting the best postoperative chemotherapeutic regimen for breast cancer patients who have different response rates after neoadjuvant chemotherapy. The aim of this study was to examine the pathologic findings of residual tumors according to the response rate after neoadjuvant chemotherapy for breast cancer. METHODS: We obtained specimens of residual tumors from 43 breast cancer patients who received neoadjuvant chemotherapy followed by curative operation at the Department of Breast and Endocrine Surgery, Sacred Heart Hospital, between Oct. 2002 and Oct. 2006. Four patients received 3 cycles of FAC (5-FU, Adriamycin, Cyclophosphamide) and 39 patients received 3 cycles of AT (Adriamycin, Docetaxel). We analyzed the pathologic characteristics according to the response rate. RESULTS: The clinical response rate for neoadjuvant chemotherapy was 69.8%. There was no significant difference in the response rate for neoadjuvant chemotherapy between the AT and the FAC regimen groups. The tumors of the complete response group showed to be more ER-negative, PR-positive, p53-negative and c-erb-B2-positive and they had a lower Ki-67 staining index than the tumors of the partial response group. Moreover, the tumors of the clinical complete response group showed more triple (ER/PR/c-erb-B2) negative tumor than did the tumors of the partial response group. CONCLUSION: Although the tumor responded to neoadjuvant chemotherapy, the pathologic findings of the residual tumors in the clinical complete response group differed from that of the partial response group. So, this should be considered for the selection of postoperative chemotherapeutic agents.

Clinical Analysis of Cholecystitis: Acalculous Cholecystitis Compared to Calculous Cholecystitis

PURPOSE: The purpose of this study was to analyse the characteristics of acalculous cholecystitis (AC) compared with those of calculous cholecystitis (CC), and also to find the relationship of preoperative radiologic findings to the classification of pathological degree of inflammation of the gallbladder in AC. METHODS: Between March 1996 and June 2000 a total of 163 patients undergoing cholecystectomy for cholecystitis were divided into group AC (21 patients) and group CC (142 patients) and retrospectively studied by analyzing clinical data. RESULTS: The incidence of AC among cholecystitis cases was 12.9%. there was male preponderance in group AC whereas female preponderance in group CC (P<0.036). The pulse rate (P<0.02) and white blood cell count (P<0.003) were significantly elevated in group AC. Possible etiological factors were found in 6 cases (28%) in group AC. The rates of preoperatively observed pericholecystic fluid collection in US (P<0.033) and dilatation of the gallbladder in CT (0.012) were significantly higher in group AC than in group CC. Additionally, the rate of tube drainage during surgery was significantly higher in group AC than group CC (P<0.02). Finally, wall thickness (P<0.05), dilatation (P<0.05) of the gallbladder in CT and the total sum of findings in CT (P<0.01) and US (P<0.05) were strongly related to the degree of inflammation of the gallbladder. CONCLUSION: The majority of AC patients exhibit nonspecific clinical findings, often delaying diagnosis; however, if it develops, AC tends to display more acute and inflammatory characteristics than calculous cholecystitis. laparoscopic surgery cannot be sucessful in cases of delayed diagnosis. US, CT and scintigram are useful diagnostic tools if we interpretate each finding in relation to the severity of inflammation.

Clinical and Pathologic Analysis of Thin Glomerular Basement Membrane Disease in Children

PURPOSE : Clinical manifestations and pathologic findings of thin glomerular basement membrane disease, recognized as a common underlying disease of benign, familiar and asymptomatic hematuria has not been reported systemically in Korea. We analyzed clinical and pathologic findings of patients who were diagnosed as thin glomerular basement membrane disease. METHODS : We analyzed clinical and pathologic findings of twenty-six patients who were diagnosed as thin glomerular basement membrane disease by renal biopsy among who complained asymptomatic hematuria from 1990 to 2000. RESULTS : The subjects were aged 9.4+/-3.2 (3.0-15.8) years-old at onset of hematuria, and 11.1+/-2.2 (4.7-16.3) years-old at renal biopsy. Sexual discrepancy was more common in girls (eight boys and eighteen girls). A family history of hematuria was found in 8 patients(30.7%). Major clinical manifestation on admission was microscopic hematuria according to the findings of 3cases(11.5%) of gross hematuria, 23cases(88.5%9) of microscopic hematuria, and 1case(3.8%) of proteinuria. Microscopic hematuria persisted in all cases. Kidney biopsy showed few changes by light microscopy, but IgM, C3 and fibrinogen deposit in mesangium was found by immunofluorescent microscopy in a few cases. Electron microscopic findings have revealed thinning of the glomerular basement membrane varied from 180.9+/-35.8nm. CONCLUSION : Thin glomerular basement membrane disease might be a common cause of microscopic hematuria of children and family history was revealed in about 30%. Clinical progression was good in majorities.

False Negative of Doppler Ultrasonography During Testis Torsion in Animal Model / 대한비뇨기과학회지

PURPOSE: Our aim is to identify the false negative rate of doppler ultrasonography and to compare color doppler ultrasonography with pathologic findings during testis torsion in animal model. MATERIALS AND METHODS: Seventeen male house rabbits weighted 1.9-2.6kg were examined with doppler ultrasonography as control group and 1 rabbit was orchiectomized as pathologic control group. In 16 rabbits, right spermatic cord was torqued 720o count-clockwise and placed back into the scrotum, and 1, 3, 6, 9, 12, 18, 24, 48 hours after torsion, doppler ultrasonographic and pathologic findings were examined at twisted testicles. RESULTS: In 1 hour and 3 hours group, false negative rate of doppler ultrasonography were 100% and 6 hours after torsion false nagative rate was 63%. Nine hours after torsion false negative rate was 50%, 12 hours after torsion false negative rate was 25%. But after 18 hours group, all had decreased or disappeared blood flow. Before 9 hours after torsion, there was no pathologic changes in seminiferous tubules. In seminiferous tubules, number of spermatid decreased in 12 hours group and spermatid was absent and spermatocyte were markedly degenerated in 18 hours group. In 48 hours group, spermatid and spermatocyte were absent, number of Sertoli cell decreased markedly and diffuse infarction were seen. CONCLUSIONS: As time goes by, false negative rate of doppler ultrasonography was decreased. So if blood flow have been normal when doppler ultrasonography was done before 12 hours after torsion, doppler ultrasonography should be re-examined in suspected testis before 12 hours after torsion because of spermatocytes are degenerated after 12 hours.

2-Bromopropane as a New Etiology of Primary Ovarian Failure / 대한내분비학회지

BACKGROUND: Primary ovarian failure is reportedly increasing in recent years. Environmental factors have been frequently implicated as responsible for this increase, However, only a few of the environmental factors have been proven to cause the ovarian failure in human. METHODS: In June 1995, 24 female laborers, who worked in a factory which used Solvent #5200 (with a main chemical component being 2-bromopropane), developed symptoms of amenorrhea or irregular menstruation. All subjects underwent laboratory tests including measurement of serum LH, FSH, and estradioL Magnetic resonance imaging and ultrasonography of the pelvis were performed in all subjects. Laparoscopic examination was performed in 6 out of 24 patients after obtaining informed consent and 4 of 6 underwent ovarian biopsy. RESULTS: One subject was excluded because she had undergone hysterectomy previously. Among the remaining 23 subjects, 14 and 9 complained of amenorrhea and irregular menstrual periods, respectively. When we defined primary ovarian failure as FSH>30mIU/mL, all of those 14 patients with amenorrhea could be classified as primary ovarian failure. On the other hand, those 9 patients with irregular menstruations had normal FSH levels. Pathologic examination of ovaries showed interstitial fibrosis, loss of primordial follicles, and development arrest of follicles in the group with amenorrhea, similar to what is found in those who received chemotherapy or were exposed to radiation. CONCLUSION: The female laborers who were exposed to the solvent with 2-bromopropane developed primary ovarian failure. This failure was associated with longer duration of exposure. To our knowledge, this is the first report in the world indicating 2-bromopropane as a possible agent for ovarian failure.

Pathologic Findings after Recession and Resection of Extraocular Muscles in Rabbits

A study on the pathologic findings after recession and resection of extraocular muscles in rabbits was performed. Fibrosis of extraocular muscles increased with time, which showed no difference between recessed and resected muscles. Inflammation and foreign body reaction decreased with time, which showed no difference between recessed and resected muscles. Adhesions of extraocular muscles to the sclera were observed from 1 month after operation. The resected muscles showed milder adhesion to the sclera than recessed one. The operated extraoculr muscles showed atrophies at 1 month, which showed no difference between recessed and resected muscles. According to our results, when reoperation is needed, fibrosis of extraocular muscles after recession and resection should be considered in making decision of recession and resection amount of muscles.