Diagnosis challenge of atypical spindle cells neoplasm of the spermatic cord. / Reto diagnóstico de neoplasia de células fusiformes atípicas del cordón espermático.

OBJECTIVE: To report an unusual case of softtissue neoplasm and to review the literature on this type of tumour. METHODS: We report an accidentally found tumour closely related to the spermatic cord that was diagnosed in a 70 year-old man when he was being operated on for an inguinal hernia repair. RESULTS: After thorough analysis by experienced pathologists it was not possible to determine the nature of the tumour that was removed at surgery. CONCLUSIONS: Soft tissues neoplasms of the spermatic cord may occur in an unusual way and they may be a real challenge to diagnose.

Mental Disorders in Chronic Liver Diseases with Viral Etiology.

The study of chronic viral hepatitis represents a real challenge for modern medicine. If we also analyze this illness from the point of the mental changes involved, the complexity of the study increases. To the etiological, symptomatological polymorphism, alongside the paraclinical and conduct diagnosis, there may be easily added the multitude of mental disorders. The authors have tried, through this paper, to draw the attention upon the importance of studying certain mental disorders connected to a somatic disease, each and every representing a distinct entity, but which together may reach a remarkable complexity.

Cerebral microvascular changes induced by rich cholesterol and saturated fatty acid diet in Wistar rats.

UNLABELLED: The impact of an excess of fatty acids in the diet on cardiovascular diseases has been studied and discussed both in human and animal studies. Generally, excessive saturated fats increase the risk, while unsaturated fats are considered less harmful. Our aim was to perform an experimental study in order to analyze how fatty diet quality (unsaturated vs. saturated fatty acids) influences atherogenesis. MATERIALS AND METHODS: In our experimental study, 18 adult Wistar rats were randomly divided into two equal groups. One group was subjected to a rich unsaturated fatty acid diet (untar) and the other group to a rich saturated one (palm oil). Three animals from each group were sacrificed after 12, 18, and 48 weeks. The brain was removed and microscopically examined after Hematoxylin-Eosin, Orcein and Masson's trichrome classical staining, and after immunohistochemical marking using the anti-alpha smooth muscle actin antibody. RESULTS: Rats sacrificed after 12 weeks revealed modicum lesions, as intimal vacuoles or minute intraluminal thrombosis, and cerebral parenchymal edema. After 18 weeks, some of rats subjected to a rich saturated fatty acid diet presented vacuoles found in all arteriolar wall layers, and a tendency towards parietal thrombosis. In rats subjected to a rich unsaturated fatty acid diet, the subintimal arteriolar vacuolization was associated with an intramural and adventitial fibrosis. In rats sacrificed after 48 weeks, lesional polymorphism was pronounced, but in rats subjected to a rich unsaturated fatty acid diet complete luminal thrombosis was followed by a an organized thrombus with multiple capillary channels. Although in Wistar rats atherosclerosis appeared only after intensive changes in diet, different experimental studies showed that, in transgenic rats, rich saturated fatty acid diet induced progressive atherosclerotic lesions, resembling those observed by us, but also some aspects described in human pathology. CONCLUSIONS: Our experimental study reveals differences in atherogenesis under saturated vs. unsaturated fatty diet.

Lability of potentially toxic elements in soils affected by smelting activities.

Determination of total concentration of potentially toxic elements (PTEs) in soil is not a reliable tool for evaluating potential exposure risk for humans. PTE lability (EDTA, SBET and solution extraction) and chemical speciation (BCR sequential extraction) were investigated for Pb, Cd, Cu, and Zn, as well as how these could be affected by flooding in soils polluted by smelting activities. The flooding experiment was performed in pots from which soil solution was extracted at different time intervals using Rhizon Moisture Samplers. After experiments, the soil was again subjected to the previous extractions (EDTA, SBET, and BCR) in order to reveal the changes which occurred during anoxia. From the results we can conclude that PTE lability is very high and flooding caused the increase in their mobility up to 100% (for bioaccessible Pb). The experiment demonstrated that temporary reducing conditions can increase the risk of contaminants passing to other environmental compartments and the food chain.

Hypoxia induced VEGF synthesis in visceral adipose depots of obese diabetic patients.

VEGF is one the pro-inflammatory adipokines synthesized by the "adipose secretoma" of obese subjects as a response to hypoxic conditions; but the main function of VEGF is angiogenesis, being recognized as the most important factor increasing blood capillaries in the adipose tissue by stimulating endothelial cell growth. In this paper, we propose a comparative study of the vascular response to VEGF synthesis in the subcutaneous and central-peritoneal adipose depots in lean, obese and obese diabetic patients. We used CD31 to label the endothelial cells in order to evaluate the response of the vascular network to VEGF synthesis. Our results showed an increase of VEGF protein synthesis in obese and obese-diabetic patients compared to lean subjects where the protein was absent. The positivity for VEGF in obese diabetic samples was observed in numerous structures from the adipose depots, both in the stromal vascular fraction--blood vessels and stromal cells--as well as in the cytoplasm of adipocytes. Positivity in the vascular wall was observed more frequently in areas of perivascular and intralobular fibrosis. Obese and diabetic patients showed similar incidence of CD31 immunoreactivity with lean subjects in both subcutaneous and peritoneal depots. In conclusion, human adipose depots show a different incidence of VEGF positive cells in relation with their disposal and the metabolic status. VEGF synthesis in visceral adipose tissue is inefficient being not followed by angiogenesis to counterbalance tissue hypoxia. We suggest that may be a pathogenic link between the degrees of intralobular fibrosis in adipose depots and VEGF expression.

Pulmonary venous compartment of the airways circulation.

Bronchial circulation has three components: a systemic arterial component represented by the bronchial arteries; a pulmonary venous component represented by the pulmonary veins; and a systemic venous component represented by the bronchial veins. We have used vascular casting, microscope dissection coupled with tracers and light microscopy to define the detailed anatomy of the pulmonary venous compartment of the bronchial circulation. We have found that the extrapulmonary drainage territory of the pulmonary veins correlate with the forming pattern of the right superior pulmonary vein. In the case of a large apical venous trunk, pulmonary veins drain the venous blood of the main bronchia, terminal portion of the trachea and of the tracheobronchial lymph nodes. In the case of the systemic venous drainage of the extrapulmonary airways, we constantly found a pulmonary component which drains the venous blood from the subcarinal lymph nodes and the medial side of the main bronchia.

The uterine carcinosarcoma - a case report.

The carcinosarcoma is a malignant mixed müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. The presented case refers to a patient in climax with a vaginal bleeding. The Doppler echography highlights a polypoid mass, which prolapses in the cervical channel. The histopathological and immunohistochemical analysis of the surgically resected piece allowed the carcinosarcoma diagnosis. The uterine carcinosarcoma's incidence is rare, that is why this case is interesting taking in consideration the biphasic pattern of the tumor.

False-negative diffusion-weighted MR findings in acute ischemic stroke.

BACKGROUND AND PURPOSE: Lesions associated with acute stroke are often missed by diffusion-weighted imaging (DWI), suggesting that the sensitivity of this technique for detecting acute ischemic stroke may not be as high as initially thought. Our aim was to estimate the rate of false-negative DWI studies in patients with persistent neurologic deficit due to an ischemic stroke and to identify which stroke lesions are most likely to be missed by DWI. METHODS: We reviewed MR images obtained within 48 hours after stroke onset in 139 patients admitted for symptoms consistent with ischemic stroke in whom the deficit lasted more than 24 hours. Cases of negative initial DWI findings with an ischemic lesion visible on follow-up MR studies and a final diagnosis of arterial ischemic stroke were analyzed in terms of delay between onset of symptoms and initial DWI (MR latency), size and vascular distribution of the lesions, and relationship to findings in patients with positive initial DWI results. RESULTS: We found eight cases (5.8%) of false-negative initial DWI studies, of which four were positive on initial fluid-attenuated inversion recovery (FLAIR) imaging. Follow-up FLAIR/DWI showed a hyperintensity matching clinical presentation in all eight patients. The mean size of the lesion was 0.19 +/- 0.16 cm3. False-negative studies occurred more often in cases of stroke in the posterior (19%) than in the anterior (2%) circulation or when DWI was obtained within 24 hours after symptom onset. Of the six false-negative vertebrobasilar stroke lesions, five were located in the brain stem. In all, 31% of patients with vertebrobasilar ischemic stroke had a false-negative initial DWI study during the first 24 hours. CONCLUSION: A false-negative DWI study is not uncommon during the first 24 hours of ischemic stroke. Vertebrobasilar stroke should therefore not be ruled out on the basis of early negative DWI, especially when symptoms persist and are suggestive of this diagnosis.

Colloid cysts of the third ventricle: are MR imaging patterns predictive of difficulty with percutaneous treatment?

BACKGROUND AND PURPOSE: Colloid cysts of the third ventricle are rare benign brain tumors. The purpose of this study was to correlate their patterns on MR images with the probability of success of percutaneous treatment. METHODS: Nineteen patients underwent endoscopic treatment for colloid cysts of the third ventricle. The cases were divided into two groups based on difficulty of the aspiration procedure. We reviewed CT scans and MR images and divided cysts into groups based on their signal intensity on the MR images and their density on CT scans. Intensity and density were correlated with difficulty of aspiration during the endoscopic procedure. RESULTS: The aspiration procedure was difficult in 63% of the cases. Eighty-nine percent of hyperdense cysts on unenhanced axial CT scans were categorized as difficult, and 75% of hypodense cysts were categorized as easy. On T2-weighted MR sequences, 100% of low-signal cyst contents were difficult and nearly 63% of high-signal lesions were easy. There was a significant correlation between the T2-weighted sequences and the CT scans regarding the difficulty of the aspiration procedure. CONCLUSION: T2-weighted MR sequences are useful for predicting difficulty of aspiration during stereotactic or endoscopic procedures. A T2-weighted low-signal cyst is correlated with high-viscosity intracystic contents.

Sources of mathematical thinking: behavioral and brain-imaging evidence.

Does the human capacity for mathematical intuition depend on linguistic competence or on visuo-spatial representations? A series of behavioral and brain-imaging experiments provides evidence for both sources. Exact arithmetic is acquired in a language-specific format, transfers poorly to a different language or to novel facts, and recruits networks involved in word-association processes. In contrast, approximate arithmetic shows language independence, relies on a sense of numerical magnitudes, and recruits bilateral areas of the parietal lobes involved in visuo-spatial processing. Mathematical intuition may emerge from the interplay of these brain systems.

[Diffusion MRI and cerebral ischemia. When to calculate the coefficient of diffusion?]. / IRM de diffusion et ischémie cérébrale. Quand calculer le coefficient de diffusion?

INTRODUCTION: There are two types of diffusion images: so-called "diffusion-weighted" images (DWI) and apparent diffusion coefficient (ADC) images. For certain authors, ADC mapping is crucial for interpreting diffusion images while for others the ADC map adds no further sensitivity or specificity compared with diffusion weighted images. The objective of this work was to determine those situations where ADC mapping modifies image interpretation. MATERIAL AND METHODS: T2-weighted and diffusion-weighted (DIF) MRI sequences were acquired in 197 patients with suspected cerebral ischemia (< or = 48 hr). For each lesion (239 lesions in the 197 patients), we analyzed MRI interpretation with and without ADC mapping and compared the interpretations with the final diagnosis established on clinical data and complementary explorations. RESULTS: We observed 3 groups. In group A (36% of the lesions), ADC mapping did not change image interpretation. This group was subdivided into 3 subgroups. A1: T2 and DIF weighted images are normal: no lesions and normal ACD map (n = 38 patients); A2: High intensity signal on T2 and low intensity signal on DIF: ischemic sequelae, ADC always increased (n = 32 lesions); A3: T2 normal and high intensity signal on DIF: hyper acute ischemia and ADC always decreased (n = 16 patients) In group B (high intensity signal on T2 and DIF, 54.5% of the lesions), ADC mapping changed the MRI interpretation: there was acute ischemia if the ADC was decreased (n = 113) and "pseudo-ischemic" lesions if the ADC was normal or increased (n = 17 patients). Group C was comprised of 23 lesions with a false negative ADC (9.5%). These lesions were always small recent ischemic lesions (< or = 5 mm) with a high intensity signal on DIF and a strictly normal ADC map. CONCLUSION: ADC mapping was found to be useful in 54.5% of the lesions and should not be considered as solely a research tool but also as a useful tool for routine clinical practice.

Abnormal collagen cross-linking in the cartilage of a diastrophic dysplasia patient.

The abnormal organization of the cartilage collagen in diastrophic dysplasia is not generally reflected in the levels of the major stabilizing cross-link, hydroxylysyl-pyridinoline. However, in one case there was a marked decrease in the pyridinoline concomitant with the appearance of two unknown components in the cross-link region of the chromatogram. A decrease in cross-linking of this magnitude could lead to mechanically weakened cartilage. Insufficient material was available to characterize these unknown components. The disorganization of cartilage in some cases of diastrophic dysplasia could therefore be due to post-translational modifications, including defective cross-linking.

Non-collagenous protein screening in the human chondrodysplasias: link proteins, cartilage oligomeric matrix protein (COMP), and fibromodulin.

A gel-electrophoretic screening for link proteins, cartilage oligomeric matrix protein (COMP), and fibromodulin abnormalities was performed in fetuses, newborn infants, and children with various types of chondrodysplasia. Microdissected freeze-dried sections of upper tibial growth cartilage were extracted with 4M guanidinium chloride in the presence of proteolysis inhibitors. After dialysis against 8M urea, the extracts were submitted to stepwise ion-exchange chromatography to separate the large proteoglycans (aggrecans) from the other components. The latter were analyzed by gel electrophoresis, electrotransferred onto nitrocellulose membranes, and reacted with specific antibodies. Control samples from individuals with apparently normal growth were analyzed in the same runs. Two link protein bands with abnormal electrophoretic migration were found in a sporadic case of spondylometaphyseal dysplasia, Kozlowski type. Three link protein bands with the same migration as in the control samples were found in thanatophoric dysplasia, homozygous achondroplasia, achondrogenesis type II, hypochondrogenesis, Goldblatt syndrome, Desbuquois dysplasia, pseudoachondroplasia, and diastrophic dysplasia. In several pathologic cases with normal electrophoretic pattern of the link proteins, small link protein fragments appeared after reduction. The gel electrophoretic pattern of COMP was studied in thanatophoric dysplasia, diastrophic dysplasia, homozygous achondroplasia, fibrochondrogenesis, hypochondrogenesis, Goldblatt syndrome, and Kniest dysplasia. In all these cases the pattern was the same as in the control samples. The main band of fibromodulin had a normal migration rate in fibrochondrogenesis, Desbuquois dysplasia, Kniest dysplasia, and pseudoachondroplasia. It was delayed in diastrophic dysplasia.

Infrared and nuclear magnetic resonance studies of some surface properties of asbestos-albumin interactions.

The interaction capacity of asbestos with albumin was studied. Asbestos fibres were treated with bovine serum albumin and were investigated by Fourier transform infrared (IR) spectrometry, conventional IR spectrometry and wide-line nuclear magnetic resonance spectrometry. In asbestos, the presence of active sites on the surface of the fibres was evidenced through external and internal OH stretching vibrations. It was also demonstrated that in asbestos fibres treated with albumin mixed hydrogen bonds of the type O-H...Nalbumin or O...H-Nalbumin occur. A physical interaction between asbestos fibres and albumin was demonstrated.

The epidermal growth factor-like domain of the large proteoglycans from articular cartilage (aggrecans). Estimate of content at different ages and in osteoarthritis.

Sequencing of cDNA clones has shown that the carboxy terminal domain of the core protein of large proteoglycans (aggrecans) from human cartilage contains an epidermal growth factor-like (EGF-like) domain which is alternatively spliced. In a previous study it was found that the domain of the translated protein can be recognized by polyclonal antibodies to mouse EGF. A competitive enzyme-linked immunoabsorbent (ELISA) assay has been developed to evaluate the EGF-like domain content of aggrecans at various ages and in osteoarthritis. Fetal aggrecans digested with protease free chondroitinase ABC were adsorbed on polyvinyl chloride microtiter plates followed by blocking with bovine serum albumin and goat serum. Mixtures of known amounts of protein of digested aggrecans and constant amounts of anti-mouse EGF antibodies were incubated and added to plates. The second antibody was peroxidase-conjugate F(ab')2. Fetal, newborn and child aggrecan proteins have a higher content of EGF-like domain than aggrecan proteins from cartilage of older humans. Three areas of cartilages from osteoarthritic joints were separated: cartilages with normal macroscopic appearance, erosion border cartilage and osteophytic cartilage. Values derived from these samples were compared with values derived from nonosteoarthritic aged humans. The content of aggrecans from osteoarthritic cartilage with normal macroscopic appearance was similar to or slightly lower than the latter. The aggrecans from osteophytes had a higher EGF-like domain content. The aggrecans from the erosion border had a variable content, close to noneroded cartilages, to osteophytes or in between the values obtained for noneroded cartilages and for osteophytes. Variations in the amount of newly synthesized aggrecans, in the proteolysis of the carboxy terminal domain of aggrecans and in the alternating splicing of the EGF-like domain might explain the results shown here.

Multiple epiphyseal dysplasia, Fairbank type: morphologic and biochemical study of cartilage.

We have performed histochemical, immunohistochemical, electron microscopic, and biochemical studies on the upper tibial cartilage from a case of multiple epiphyseal dysplasia, Fairbank type. Most chondrocytes had intracytoplasmic inclusions which took the stains for proteins and were resistant to microbial collagenase digestion. The electron microscopic study showed that the inclusions are dilatations of the rough endoplasmic reticulum containing a material with alternately wide electron dense and electron lucent layers. Both in optical and in electron microscopy the inclusions fixed antibodies against the core protein of the large cartilage proteoglycans (aggrecans). They didn't stain with antibodies against type II collagen. The gel electrophoretic pattern of the large proteoglycans was different from normal controls. The morphologic and biochemical alterations found in multiple epiphyseal dysplasia are similar to those already described in pseudoachondroplasia (Stanescu et al.: Eur J Pediatr 138:121-225, 1982; Stanescu et al.: J Bone Joint Surg 66A:817-836, 1984). However, the inclusions are smaller and the growth cartilage much less disorganized in multiple epiphyseal dysplasia. The similarity of morphologic and biochemical abnormalities strongly suggests that the two diseases have a similar pathogenesis and belong to the same bone dysplasia family.

Early lesions of the articular surface in a strain of mice with very high incidence of spontaneous osteoarthritic-like lesions.

Our study was designed to see if the lesions of the articular surface represent an early event in the development of some types of articular degeneration. We examined the ultrastructural appearance of the articular surface labelled in vitro with cationized ferritin in several age groups of a substrain of C57BL/6 mice that develop a high incidence of osteoarthritic-like lesions. We found that as early as the age of 2 1/2 months the articular femoral and patellar surfaces presented abnormalities that became more severe with age. Alterations of the articular surface is a precocious event in this type of osteoarthritic-like degeneration.