ABSTRACT
The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.
Subject(s)
Epidural Space/pathology , Postoperative Complications/therapy , Spinal Cord Stimulation/methods , Adult , Aged , Cicatrix , Cohort Studies , Epidural Space/diagnostic imaging , Failed Back Surgery Syndrome/complications , Female , Fibrosis/therapy , Humans , Low Back Pain , Lumbosacral Region , Magnetic Resonance Imaging , Male , Middle Aged , Neuralgia/therapy , Pain Measurement , Postoperative Complications/diagnostic imaging , Prospective Studies , Treatment OutcomeABSTRACT
Two cases of atypical decubital fibroplasia (ischemic fasciitis) were presented. Both patients were immunocompromized and their lesions were located in usual decubital places (back shoulder, femorogluteal region). Histology was typical: 1. zone of fibrinoid necrosis, 2. neighbouring cellular parts reminding of proliferative fasciitis. Focal high cellularity with atypical ganglioid fibroblasts and mitotic activity imitated sarcoma. Immunohistochemistry showed expression of vimentin in all cells and of KP1 (CD 68), lysozym as well as F-XIIIa in majority of them. There was not any expression of desmin, actin, S-100 protein, cytokeratin and epithelial membrane antigen. Importance of atypical decubital fibroplasia (ischemic fasciitis) is in its histological similarity to sarcoma-as it was in both the presented cases.
Subject(s)
Fasciitis/pathology , Ischemia/complications , Adult , Aged , Fasciitis/etiology , Female , HumansABSTRACT
A gastric antral tumor histologically classified as a yolk sac carcinoma was studied immunohistochemically. The tumor contained immunoreactive alpha-fetoprotein and gastrin. This is the first yolk sac carcinoma in which neuroendocrine differentiation was demonstrated immunohistochemically.
Subject(s)
Dysgerminoma/metabolism , Gastrins/metabolism , Stomach Neoplasms/metabolism , Aged , Aged, 80 and over , Dysgerminoma/pathology , Humans , Immunohistochemistry , Male , Stomach Neoplasms/pathologyABSTRACT
Cervical carcinoma in a 49-year-old woman was resected and found to spread into parametrium. It consisted of a unique combination of adenoid cystic, squamous and small cell neuroendocrine structures. Small celled part revealed positivity with chromogranin A and neuron-specific enolase, neuroendocrine granules were argyrophilic and about 130 nm in diameter. Adenoid cystic and squamous parts were lacking of unambiguous neuroendocrine or myoepithelial differentiation. The patient died in 27 months due to generalization but only a small cell carcinoma without any heterogeneity was found in autopsy. Small cell and adenoid cystic carcinomas are rare and more malignant than usual cervical carcinomas.
Subject(s)
Carcinoma, Adenoid Cystic/pathology , Carcinoma, Small Cell/pathology , Neoplasms, Multiple Primary/pathology , Uterine Cervical Neoplasms/pathology , Female , Humans , Middle AgedABSTRACT
Another case of a very rare type of carcinoma is presented which was introduced recently as occurring in hypopharynx, larynx and tongue. Macroscopical description of an exophytic tumour of aryepiglottic fold and piriform recess in a 41-year old man is the second one in literature. Main histological feature of the tumour is a biphasic cellular structure with closely related basaloid and squamous components. Immunohistochemical expression of the squamous component concerned carcinoembryonic antigen, whereas S-100 protein, desmin and neuron specific granules. The small group of one own case and of 11 cases from the literature seems to support the idea that the tumour is aggressive, tending to early regional and remote metastases, and with shorter survival than other subtypes of epidermoid carcinoma.
Subject(s)
Carcinoma, Basosquamous/pathology , Hypopharyngeal Neoplasms/pathology , Laryngeal Neoplasms/pathology , Adult , Humans , MaleABSTRACT
A heterogenous mostly neuroendocrine small cell carcinoma was found in a gallbladder resected from a 75-year-old man suffering from CLL. It progressed along bile ducts into choledochus, into omentum and liver. Its histology was characterized by solid alveoli and small cell trabeculae with a high mitotic activity, dissociated infiltration in some parts and desmoplasia. Sometimes a typical adenocarcinomatous differentiation could be found out. Tumour cells produced immunohistological expression of EMA, CEA, NSE and CHG and had Grimelius silver impregnation positivity. Neuroendocrine gallbladder carcinomas used to be more aggressive than carcinomas of another type, can cause an endocrine syndrome and claim a special treatment.
Subject(s)
Carcinoma, Small Cell/pathology , Gallbladder Neoplasms/pathology , Aged , Carcinoma, Small Cell/metabolism , Gallbladder Neoplasms/metabolism , Humans , Immunohistochemistry , Male , Phosphopyruvate Hydratase/metabolismABSTRACT
The model of atherosclerosis was elaborated by administration of cholesterol to rabbits in daily doses of 70 g per animal over a period of 3 months. The model served to study the effect of the calcium entry blocker Verapamil as to its potential capacity of affecting the extent of atherosclerotic changes. The thoracic aorta, the abdominal aorta, the right coronary artery and the apex of the myocardium were removed for histological evaluation. Atherosclerotic changes were assessed by light microscopy using the method of quantifying the thickening of the intima of vessels. The extent of atherosclerotic changes in the coronary arteries and arterioles was evaluated morphometrically. Further the presence and extent of necroses of the myocardium as well as endothelial proliferation in the capillaries of the cardiac muscle were recorded. Evaluation of the obtained results calculated as percentage of the presence of findings demonstrated a significant protective effect of Verapamil on the parameters studied.
