Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review.

BACKGROUND: Necrotizing colitis (NC) is a rare complication of the obstructive cancer of the left colon and it is the result of intramural ischemia due to impairment of blood supply secondary to increased endoluminal pressure. CASE PRESENTATION: A 70 years old patient with significant comorbidities (ASA 4) was admitted for intestinal obstruction.The extensive necrosis of the entire proximal colon secondary to an obstructive sigmoid colon cancer has been diagnosed intraoperatively. Total colectomy and terminal ileostomy have been performed. The postoperative course was uneventful and the ileostomy closure with ileo-rectal anastomosis was performed 7 months later. A review of the literature discussing the epidemiology, pathogenesis, diagnosis and therapeutic approach of this type of colitis, was performed. CONCLUSIONS: NC implies diagnosis and therapeutic difficulties,especially from point of view of surgical strategy. We advocate of large colic resections, beyond the macroscopic limits of the necrosis in order to avoid the postoperative complications. We also consider seriate surgical procedures as a good choice for the high risk patients.

[Right colon cancer--clinicopathological findings]. / Cancerul colonului drept--particularitati anatomo-clinice.

BACKGROUND: The right colon cancer (RCC) has some particularities from point of view of epidemiology, clinical aspects, therapy and prognosis. MATERIAL AND METHODS: We retrospectively analyzed the patients operated in the First Surgical Unit Iasi during 2004 until 2009, for right colon cancer. The patients' data from the medical files were digitally encoded and included into a MS Access database, and statistically analyzed. RESULTS: 219 cases were included into the analysis, which represents 24.17% from all the patients with colorectal cancer. The median age was 66 years old. A palpable mass into the right abdominal quadrant was founded in 41.5% and anemia in 65.3%. Abdominal ultrasound exam has been performed in all the patients, with 71.3% sensitivity for primary tumor positive diagnosis. Resectability was 89.5% but without multivisceral resections. The intraoperative complication rate was 6.8%; postoperative morbidity was 19.4% with an incidence of anastomotic leak of 1.38%. The postoperative mortality rate was 2.77%. The mean overall survival was 40.13 +/- 1.93 months (median: 49.26). The prognosis factors for the survival rate were: histologic type of the tumor, stage and tumor grading, vascular and perineural invasion. The presence of metastasis in more than 3 lymphnodes as well as resection of fewer than 11 lymphnodes were found as negative prognosis factors for the survival rate. CONCLUSIONS: RCC has an increasing incidence and it is associated especially with elderly patients. The RCC resectability is about 90% with acceptable rates of morbidity and mortality. Perineural and vascular invasion as well as rate of positive lymphnodes and count of resected lymphnodes are prognosis factor for overall survival rate.

Telocytes form networks in normal cardiac tissues.

Telocytes (TC) are a class of interstitial cells present in heart. Their characteristic feature is the presence of extremely long and thin prolongations (called telopodes). Therefore, we were interested to see whether or not TCs form networks in normal cardiac tissues, as previously suggested. Autopsy samples of cardiac tissues were obtained from 13 young human cadavers, without identifiable cardiac pathology and with a negative personal history of cardiovascular disease. Immunohistochemistry on formalin-fixed paraffin-embedded tissues was performed using monoclonal antibodies for CD117/c-kit. Additionally, ventricular samples from 5 Sprague-Dawley rats were ultrastructurally evaluated under transmission electron microscopy. We found c-kit positive cells with TC features in subepicardium, as well in subepicardial arteries and in subepicardial fat. TCs were also present in the subendocardium. Light and electron microscopy revealed the existence of intramyocardial networks built up by bipolar TCs. Larger c-kit positive multipolar TCs were found between cardiac muscle bundles. Our results support the existence of a cardiac network of telocytes.

Extrahepatic and intrahepatic human portal interstitial Cajal cells.

Portal interstitial cells of Cajal (PICCs), acting as vascular pacemakers, were previously only identified in nonhumans. Moreover, there is no evidence available about the presence of such cells within the liver. The objective of the study is to evaluate whether or not PICCs are identifiable in humans and, if they are, whether or not they are following the scaffold of portal vein (PV) branches within the liver. We obtained extrahepatic PVs and liver samples from six adult human cadavers, negative for liver disease, in accordance with ethical rules. They were stained with hematoxylin-eosin (HE) and Giemsa, and then we performed immunohistochemistry on formalin-fixed paraffin-embedded specimens for CD117/c-kit, a marker of the Cajal's cells. Immune labeling was also performed for S-100 protein, desmin, glial fibrillary acidic protein (GFAP), neurofilaments, α-smooth muscle actin (α-SMA), and CD34. c-kit-Positive PICCs were identified within the extrahepatic PV, in portal spaces, and septa. On adjacent sections, these PICCs were negative for all the other antibodies used. In conclusion, our study confirms the presence of extrahepatic PICCs on humans, which may act as a possible intrinsic pacemaker in the human PV. However, the intrahepatic PICCs, which were evidenced here for the first time, are in need for further experimental studies to evaluate their functional role. A promising further direction of the study is the PICCs role in the idiopathic portal hypertension.

Can subclinical hypothyroidism explain some sudden deaths due to pulmonary embolism without evident risk factors?

Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people, and usually, when this is the case, is associated with acute changes of thyroid hormone blood levels. Three main thyroid causes of sudden death are known and used in tanathologic chains: thyrotoxicosis, myxedematous coma and, as of recently, lymphocytic thyroid infiltration. Coagulation disorders associated with thyroid disease are usually mild and not associated with sudden death. There are some studies showing an increased risk for unprovoked deep venous thrombosis in patients with hypothyroidism but there is none, to our knowledge, showing a correlation between hypothyroidism, deep venous thrombosis and sudden death. Our article suggests that subclinical hypothyroidism can lead to coagulation disorders and deep venous thrombosis which can explain some cases of sudden death associated with pulmonary embolism without other significant risk factors.

Morphological changes associated with hemodynamically significant myocardial bridges in sudden cardiac death.

UNLABELLED: Although myocardial bridging (MB) is a common coronary anomaly, its cardiovascular consequences are still disputed. A positive link between sudden cardiac death (SCD) and myocardial bridging has not yet been definitively proved, even though many case reports and small scale studies support this association. For myocardial bridging to be associated with sudden cardiac death it must exhibit certain specific characteristics involving coronary or myocardial changes sufficient to explain a terminal cardiac event. In this study we aimed to analyze the morphological changes (both myocardial and coronary) associated with hemodynamically significant myocardial bridging and the morphological differences between hemodynamically significant MB and MB considered to be non-hemodynamically significant. MATERIAL AND METHOD: We analyzed 53 cases of sudden cardiac death, of which 21 cases had hemodynamically significant myocardial bridging, 14 had non-hemodynamically significant myocardial bridging and 20 cases suffered sudden cardiac death without myocardial bridging, using a morphological score with seven histological parameters. RESULTS: Myocardial fibrosis and interstitial edema were found to be highly correlated with hemodynamically significant myocardial bridging (HSMB), as were interstitial edema and interstitial fibrosis. CONCLUSIONS: Hemodynamically significant myocardial bridging can be discovered during heart dissection by analyzing a series of morphological markers (width, distribution of atherosclerosis, distal hypoplasia). Our study showed that MB was associated with increased myocardial fibrosis and edema, both of which have an increased risk of electrical instability. Compared to non-hemodynamically significant myocardial bridging, HSMB shows a distinct histological pattern, with increased myocardial fibrosis and edema. The main cause of SCD in association with HSMB seems to be electrical due to increased electrical myocardial heterogeneity, but large scale studies are needed to test this.

Anatomical and immunohistochemical considerations on the microinnervation of trachea in humans.

The anatomy of the tracheal microinnervation is understudied in humans; the purpose of our study was to fill this gap by working on human adult tracheas, to compare the results with those obtained from animal studies, and to checking whether or not these studies are suitable to be translated from comparative to the human anatomy. The study was designed as a qualitative one. The present work was performed on human adult tracheas dissected out in 15 human adult cadavers. Microdissections were performed in eight tracheas and revealed the outer peritracheal plexus, segmentally supplied and distributed to trachea and esophagus, with longitudinal intersegmentary anastomoses but also with bilateral interrecurrential anastomoses previously undescribed in anatomy. Seven different tracheas were transversally cut and paraffin embedded. Histological stains (HE, toluidine blue, luxol fast blue, Giemsa on tissues and trichrome Gieson) and immunohistochemistry using primary antibodies for nNOS, neurofilament, SMA and the cocktail of citokeratines CK AE1-AE3+8/18 were done. According to the histological individual variation, the neural layers of the posterior wall of the human trachea could be considered as it follows: (a) an outer neural layer, ganglionated, associated with the connective covering layers, adventitia and the posterior fibroelastic membrane (external elastic lamina); (b) a submucosal ganglionated neural layer, mainly with juxtaglandular microganglia that may expand, as glands do, through the outer covering layers; (c) intrinsic nerves of the transverse trachealis muscle; (d) the neural layer intrinsic to the longitudinal elastic band (internal elastic lamina) and supplied from the inner submucosa; (e) the neural plexus of the lamina propria, with scarcely distributed neurons. We also bring here the first evidences for the in vivo nNOS phenotype of mast cells that were identified, but not exclusively, within the trachealis muscle.

The iliolumbar artery-anatomic considerations and details on the common iliac artery trifurcation.

The iliolumbar artery (ILA) of Haller is the largest nutrient pedicle of the ilium and its detailed knowledge is important for various surgical procedures that approach the lumbosacral junction, the L4/L5 disk space, the sacroiliac joint, the iliac and psoas muscles, or the lumbar spine. Also the ILA is relevant for various techniques of embolization. We aimed to evaluate the anatomic and topographic features of the ILA, by dissection on 30 human adult pelvic halves and on 50 angiograms. ILA was a constant presence and it emerged at Level A (from the common iliac artery (CIA), 8.75%), Level B (from the CIA bifurcation, 2.5%), Level C (from the internal iliac artery (IIA), 52.5%), Level D (from the IIA bifurcation, 3.75%), and Level E (from the posterior trunk of the IIA, 32.5%). Level B of origin of the ILA corresponds to a trifurcated CIA (morphology previously unreported), while Level D corresponds to a trifurcated IIA. A higher origin of the ILA corresponds to a more transversal course of it. A descending lumbar branch that leaves the iliac arterial system independently to enter the psoas major muscle, as seen in 48% of cases, may be misdiagnosed as ILA. Surgical interventions in the lumbar, sacral, and pelvic regions must take into account the variable origins of the ILA from the iliac system that can modify the expected topographical relations and may lead to undesired hemorrhagic accidents.

Georges Marinesco and the early research in neuropathology.

OBJECTIVE: To present the scientific contributions of Georges Marinesco (1863-1938) and place his achievements within the context of early neuropathology research. BACKGROUND: Neuropathology is a relatively recent medical field, its origins dating to the late 19th century. RESULTS: One of the most important neuroscientists of that period was the Romanian-born Georges Marinesco. He became a neurologist under Charcot's guidance at the Salpêtrière Hospital, in Paris. In 1892, Paul Blocq and Marinesco gave a first account of senile plaques, having used their pathologic skills in the examination of nine deceased epileptic patients. They did not, however, relate the plaques to dementia. Marinesco made discoveries in neuropathology which he described from a histopathologic perspective, and introduced new medical terms such as neuronophagia, chromatolysis, and medullomyoblastoma. He also drew correlations between clinical neurologic findings and morphology, for example in congenital cerebellar ataxia, syringomyelia, and parkinsonism. From 1899 he used cinematography as a medical research tool. CONCLUSION: Marinesco was a prolific researcher in the field of neuropathology, especially neurodegeneration but also in clinical neurology. He is now considered the founder of the modern Romanian school of neurology.

The pterygopalatine ganglion in humans: a morphological study.

As a rule the pterygopalatine ganglion (PPG) is considered to be a single structure of the parasympathetic nervous system, associated with the maxillary nerve in the pterygopalatine fossa (PPF). A few structural studies in humans are available in the indexed references. We designed the present study of the PPG in order to provide evidence of possible variations in morphological patterns of the PPG. We performed dissections of the PPF on 20 human adult heads, using different approaches. The dissected specimens were stained with hematoxylin-eosin and silver (Bielschowsky) or prepared for immunohistochemistry for synaptophisin and neurofilament. Four morphological types of the PPG were defined macroscopically: A (10%): partitioned PPG, the upper partition receiving the vidian nerve; B (55%): single, the upper part (base) receiving the vidian nerve; C (15%): single, but the vidian nerve reaches the lower part (tip) of the ganglion; D (20%): partitioned, the lower partition receiving the vidian nerve. We propose that it may be inappropriate to invariably regard the PPG as a single morphological structure. From individual to individual the PPG may present either as a single ganglion or as a partitioned one, with distinct superior and inferior components. Nevertheless, the presence of the dispersed pterygopalatine microganglia (DPPG) evidenced by histochemistry and immunohistochemistry serves to complete an individually variable morphological pattern of a structure usually described as single. The individual variation may be the reason for failures in ablation procedures of the PPG; partitions of the PPG and/or the DPPG may functionally correlate with specific territories and targets and further tracing studies may be helpful in validating or invalidating this theory.

Detailed anatomy of a left accessory aberrant colic artery.

In an aged human female cadaver a left accessory aberrant colic artery (LAACA) was observed and studied. It originated from the superior mesenteric artery at 3 cm proximal to the middle colic artery, at the inferior border of pancreas, passing over Treitz's muscle and continued covered by the superior duodenal fold where it crossed the inferior mesenteric vein. Further, it continued with a satellite vein anterior to the left renal vein and the anterior branch of the renal artery. The LAACA divided into an ascending branch and a descending one, anastomosed with the middle colic and proper left colic arteries; between its two primary branches and the splenic flexure of colon, a hypovascular area was observed. The surgical relevance of the LAACA detailed anatomy mainly relates to specific procedures performed in left colectomies and nephrectomies.