Poroid hidradenoma: a case report.

Poroid hidradenoma is a variant of the eccrine poroma that belongs to the group of poroid neoplasms. It presents architectural features of hidradenoma, with solid and cystic areas and tumour cells restricted to the dermis, and cytological features of poroid neoplasm such as poroid and cuticular cells. Poroid hidradenoma becomes malignant in less than 1% of cases, but its histologic characteristics may resemble those of malignant neoplasms; thus it is easily misdiagnosed. Twenty percent of poroid hidradenomas occur in the extremities. To date, very few cases of this entity have been reported in the literature. We present a case of poroid hidradenoma in a 35-year-old man with a soft-tissue lesion on his right thigh.

Use of an electrothermal bipolar tissue sealing system in lung surgery.

OBJECTIVE: We evaluated the validity of an electrothermal bipolar tissue sealing system (LigaSure, Valleylab Inc., USA) in lung surgery. METHODS: Our study was divided into two phases. EXPERIMENTAL: We performed sutures of pulmonary vessels and bronchi and lung wedge resections by LigaSure in 28 lungs of adult pigs; subsequently, we quantitated the sealing capacity of the system detecting the burst pressure for each anatomical structure. Clinical: LigaSure was used in 36 patients undergoing lung surgery. We performed 23 thoracotomic procedures in 16 patients (19 wedge resections, 2 segmentectomies, and 2 fissure separations), and 20 thoracoscopic procedures (13 wedge resections, 5 bullectomies, and 2 adherence dissections). EXPERIMENTAL: Bronchi and vessels were divided into seven groups (diameter: 1-7 mm); 10 burst pressure measurements for each group were performed. A total of 84 wedge resections were performed; lung specimens were divided into seven groups (weight: 0.2-1.4 g). The percentage of bronchial sutures resistant to the pneumatic critical pressure (60 mmHg) was 100% in the 1-mm and 2-mm groups. No bronchi with 6-mm or 7-mm diameter reached the critical pressure. All pulmonary vessel sutures were resistant to the critical hydrostatic pressure (150 mmHg). The average burst pressure of wedge resection margins was higher than the critical pressure, and the percentage of suture margins resistant to the critical pressure decreased from 95% (0.2-g group) to 68% (1.4-g group). Histology confirmed the sealing of vessels, with a mean depth of thermal injury limited to 1.1mm. Clinical: In all patients, hemostasis obtained by LigaSure was effective, with minimal perioperative bleeding. The mean operating time was 77.2 min (range: 60-97) for thoracotomies and 60.3 min (range: 46-80) for thoracoscopies. The mean drainage duration was 3.1 days (range: 1-8). Two patients had prolonged air leaks (>7 days). The mean postoperative stay was 7.3 days (range: 5-13) for thoracotomies and 4.6 days (range: 1-6) for thoracoscopies. CONCLUSIONS: Use of LigaSure in lung surgery appears feasible and easy. It provides satisfactory hemostasis and air-leak prevention; results are comparable to those of stapling devices, but this system seems to have a better benefit/cost ratio. Larger series are needed to confirm these data.

A giant sarcoma of the parotid gland: a case report and review of the literature.

CASE REPORT: Primary low-grade fibromyxoid sarcoma (LGFMS) is an extremely rare tumour of the salivary glands and arises from undifferentiated pluripotential mesenchymal cells. We report a case of a huge (17 x ll x 10 cm) primary LGFMS of the parotid gland of a 57-year-old woman. Clinically, a 12x8 cm firm, non-tender, left parotid mass was observed, facial nerve function was not impaired and no enlarged lymph nodules were palpated on the neck. A contrast axial CT scan showed intense enhancement of the enlarged left parotid gland. The fine needle aspiration biopsy (FNAB) was compatible with sarcomatous tissue. The tumour was removed en bloc and the facial nerve was sacrificed; surgical margins were free from disease. Microscopically, the tumour consisted of fibrous and myxoid tissue with varying grades of cellularity and gradual transitions between the two. Post-operative radiotherapy was carried out on the left neck region and parotid tumour bed. Thirty-six months after surgery the patient presents good general conditions without any evidence of local or regional disease. CONCLUSION: The largest primary LGFMS of the parotid gland described in the literature is reported and a review of the literature on such neoplasms is also provided.

Expression of angiogenic factors during acute coronary syndromes in human type 2 diabetes.

Inadequate angiogenic response to ischemia in diabetic myocardium could result in poor collateral formation. Because hypoxia-inducible factor (HIF)-1alpha is a transcriptional activator of vascular endothelial growth factor (VEGF) and is critical for initiating angiogenic responses to hypoxia, we investigated the expression of HIF-1alpha and VEGF in specimens of human heart tissue to elucidate the molecular responses to myocardial ischemia in diabetic patients during unstable angina. Moreover, accumulation of a marker of protein nitration nitrotyrosine, as well as the superoxide anion (O(2)(-)) levels and inducible nitric oxide synthase (iNOS), were evaluated. Ventricular biopsy specimens from 15 type 2 diabetic and 14 nondiabetic patients presenting with unstable angina (ischemic group) and from 20 patients (11 type 2 diabetic and 9 nondiabetic patients) who underwent coronary bypass surgery without angina within the preceding 10 days (control group) were collected during coronary bypass surgery. Nondiabetic patients had higher HIF-1alpha and VEGF expressions compared with diabetic patients (P < 0.001). As compared with nondiabetic specimens, diabetic specimens showed higher levels of both iNOS mRNA and protein levels (P < 0.001) associated with the highest tissue levels of nitrotyrosine and O(2)(-) (P < 0.001). Diabetes is associated with increased myocardial tissue levels of iNOS, O(2)(-), and nitrotyrosine and reduced expression of myocardial angiogenesis factors during ischemia.

Cystitis glanduralis complicating an eosinophilic cystitis: a case report.

We report on a rare case of cystitis glandularis complicating an eosinophilic cystitis in an adult. Complaints at presentation included dysuria, haematuria and abdominal pain. Ultrasound and cystoscopy suggested a bladder tumor. Histological analysis of bladder biopsy showed the typical findings of cystitis glandularis associated with eosinophilic cystitis. The patient was treated with transurethral resection of the lesion and a combination of corticosteroids and anthistaminics for three months. He is disease-free at 24 months of follow-up.