[A woman with a sclerotic plaque and a bulla]. / Een vrouw met een sclerotische plaque en een bulla.

A 63-year-old woman had a sclerotic plaque with a bulla under her left breast. Histopathological examination of a biopsy confirmed the diagnosis of bullous morphea. Bullae are rarely seen in morphea. The patient was successfully treated with mometasone ointment 0.1%. To our knowledge, the pathogenesis of bullous morphea is still under debate.

Bladder polyps following Avaulta anterior mesh vaginal wall repair.

We present the case of a postmenopausal woman who developed bladder polyps leading to serious abdominal pain, dysuria with mucus and blood, and urinary incontinence after anterior vaginal wall repair using Avaulta anterior mesh (Bard). All of these symptoms resolved after mesh removal. This case emphasizes that not all complications of mesh are known.

Parotid metastasis from a gastroesophageal carcinoma: report of a case.

Carcinomas of the lower esophagus, gastroesophageal junction or stomach rarely metastasize to the cervical lymph nodes. Furthermore, the parotid gland is an even more unusual site of metastasis from a carcinoma located at these sites. We describe the case of a 45-year-old male patient who was diagnosed 2 months after transhiatal gastroesophagectomy for a primary gastric adenocarcinoma with metastasis in the left parotid gland. In the literature we have only found one other case report.

Carcinoma of the sigmoid presenting as a right inguinal hernia.

We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.

Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI?

BACKGROUND: We compared high-resolution magnetic resonance imaging (MRI) with computed tomography (CT) in the assessment of tumor infiltration in surrounding structures for locally advanced primary and recurrent rectal cancer. METHODS: Twenty-six patients with operable, locally advanced rectal cancer (15 recurrent and 11 primary) were evaluated with conventional pelvic CT and 1.5-T high-resolution MRI with a quadrature phased-array coil. The images were scored for invasion of nine neighboring pelvic structures, and the results were compared with surgical and histologic findings. RESULTS: A total of 234 structures in 26 patients was evaluated for tumor invasion. For MRI the, sensitivity was 97% and the specificity 98%; for CT, the sensitivity was 70% and the specificity was 85%. The difference in performance was statistically significant (p<0.001). The failure most frequently made on CT was the false-positive prediction of pelvic floor and piriform muscle invasion (14), whereas MRI showed only four false-positive predictions. MRI correctly predicted all four cases of sacral bone invasion, three of which were missed by CT. MRI was accurate in 20 patients (80%) and CT in only five patients (19%). CONCLUSION: High-resolution MRI using a quadrature phased-array coil is highly accurate and superior to CT in predicting tumor infiltration in surrounding structures for locally advanced primary or recurrent rectal cancer and is recommended in the preoperative work-up of these tumors.

Topography of cerebellar nuclear projections to the brain stem in the rat.

The organization of the cerebellum is characterized by a number of parallel and parasagittally ordered olivocorticonuclear modules; as such, the cerebellar nuclei basically function as output system of these modules. The present study provides a comprehensive and detailed description of the organization of the connections from the cerebellar nuclei to the brain stem in the rat. Thirteen small injections with the anterograde tracer Phaseolus vulgaris leucoagglutinin or biotinylated dextran amine which were centered on various aspects of the cerebellar nuclear complex are described and are illustrated with serial plots detailing the distribution of labeled varicosities throughout the brain stem. In every case at least 1,000 an up to 36,000 varicosities were plotted. All injections resulted in some or heavy labeling concentrated within specific regions of the contralateral inferior olivary complex and, usually, in some labeling of the contralateral ventrolateral thalamus. However, apart from these two areas it is shown that the cerebellar projections are generally very widespread and may be found throughout the entire brain stem. Below, only a survey of main projection areas will be given. Terminal arborizations originating from the rostral part of the medial cerebellar nucleus are mostly found in the caudal half of the brain stem with emphasis on the vestibular nuclear complex, whereas its caudal part rather connects to midbrain areas. Terminals that originate from the dorsolateral protuberance of the medial cerebellar nucleus are distributed more evenly throughout the brain stem and are mostly confined to reticular areas. The interstitial cell groups, interspersed between the medial and both interposed cerebellar nuclei, provide major projections to the ipsilateral vestibular nuclear complex and contralateral mesodiencephalic regions. However, reticular areas are also targeted over a large rostrocaudal range. The medial part of the posterior interposed nucleus sends most projections to the caudomedial red nucleus, prerubral regions and parvicellular reticular formation, all contralateral to the injection site. Projections that originate from more laterally placed injections are directed, apart from the inferior olivary complex, to the rostral half of the contralateral brain stem, where most labeled varicosities are found in the superior colliculus and zona incerta. The anterior interposed nucleus specifically targets the inferior olive, the red nucleus, the pontine reticulotegmental nucleus, the prectectum and the ventrolateral thalamic nucleus. More laterally placed injections also project to the ipsilateral parvicellular reticular formation and deep layers of the spinal trigeminal complex. The latter areas are more specifically targeted by the dorsolateral hump. In addition, its projections are found in the red nucleus and pretectum but do not seem to reach the ventrolateral thalamus. Projections from the lateral cerebellar nucleus are all characterized by a widespread distribution of terminals. Especially, the caudal aspect of the nucleus sends, apart from projections to the deep mesencephalic nucleus, red nucleus, periaquaductal gray, pretectum, prerubral area, and several thalamic regions, prominent projections to the caudal brain stem which terminate in the inferior olive and gigantocellular reticular formation. Projections from the ventral, parvicellular part of the nucleus are mostly, but not exclusively, directed to the rostral half of the brain stem and mainly terminate in the pararubral area, accessory oculomotor nuclei, pretectal areas, zona incerta, and in the parafascicular and ventrolateral thalamic nuclei. We conclude that the impact of the cerebellar nuclei on the brain stem is widespread; projections from different regions of the same cerebellar nucleus may show important differences in distribution of labeled terminals. On the other hand, injections placed in different cerebellar nuclei may result in a simila

Light microscopic and ultrastructural investigation of the dopaminergic innervation of the ventrolateral outgrowth of the rat inferior olive.

The ventrolateral outgrowth of the inferior olive is involved in the control of compensatory eye movement responses to optokinetic stimuli about the horizontal axis that is perpendicular to the ipsilateral anterior semicircular canal. Combining immunocytochemistry with retrograde tracing of WGA-BSA-gold, we demonstrated in the present study that this olivary subnucleus receives a substantial dopaminergic input, and that the prerubral parafascicular area and its surrounding regions form the sole source of this input. In addition, we investigated the postsynaptic distribution of the dopaminergic terminals in the inferior olive at the ultrastructural level. About a third (32%) of the dopaminergic terminals was found to make synaptic contacts in the olivary neuropil. The majority (81%) of these boutons terminated on cell bodies or extraglomerular dendrites, while the remaining terminals contacted dendritic spines inside glomeruli. In contrast, GABAergic terminals in the inferior olive formed more frequently (66%) synaptic contacts and they terminated more frequently (38%) in glomeruli. Thus, the ventrolateral outgrowth receives a dopaminergic input from the mesodiencephalic junction, and the postsynaptic distribution of this input reveals a characteristic pattern.

Single Purkinje cell can innervate multiple classes of projection neurons in the cerebellar nuclei of the rat: a light microscopic and ultrastructural triple-tracer study in the rat.

Two different populations of projection neurons are intermingled in the cerebellar nuclei. One group consists of small, gamma-aminobutyric acid-containing (GABAergic) neurons that project to the inferior olive, and the other group consists of larger, non-GABAergic neurons that provide an input to one or more, usually premotor, centers in the brainstem, such as the red nucleus, the thalamus, and the superior colliculus. All cerebellar nuclear neurons are innervated by GABAergic Purkinje cells. In this study, we investigated whether individual Purkinje cells of the C1 zone of the paramedian lobe of the rat innervate both groups of projection neurons in the anterior interposed nucleus. Two different, retrogradely transported tracers, either cholera toxin beta subunit (CTb) or wheat germ agglutinin coupled to horseradish peroxidase (WGA-HRP) and a gold lectin tracer were injected into the red nucleus and the inferior olive, respectively, whereas Purkinje cell axons were anterogradely labeled with biotinylated dextran amine (BDA) injected into the paramedian lobule. Cerebellar nuclear sections studied with the light microscope demonstrated a close relation of varicosities from BDA-labeled Purkinje cell axons with both gold lectin- and CTb-labeled neurons. Branches of individual axons could be traced to both retrogradely labeled cell populations. At the ultrastructural level, synapses of labeled Purkinje cell terminals with profiles of WGA-HRP-labeled projection neurons predominated over contacts with gold lectin-containing neurons. Nine out of 367 investigated BDA-labeled terminals were observed to be presynaptic to a WGA-HRP-labeled profile as well as to a gold lectin-labeled profile. This indicates that nuclear cells that project to the inferior olive as well as those that project to premotor centers are under the influence of the same Purkinje cells. Such an arrangement would suggest an in-phase cortical modulation of the activation patterns of the inhibitory cells that project to the inferior olive and excitatory cells that project to premotor nuclei, which could explain why olivary neurons, especially those of the rostral part of the dorsal accessory olive, appear to be unresponsive to stimuli generated during active movement.

In vivo measurement of chloride and water secretion in the jejunum of cystic fibrosis patients.

In the present study, we have investigated the possible consequences of the chloride channel defect in the intestine of cystic fibrosis (CF) patients for electrolyte and water transport in the jejunum in vivo, using a multilumen, double occluding balloon catheter, and an Ag/AgCl intraluminal electrode. During a chloride-free perfusion, to optimize the sensitivity of our measurements, the transmural potential difference (PD) (lumen with reference to serosal side) was found to be significantly higher in the jejunum of CF patients (+8.0 +/- 2.1 mV; n = 5) than in healthy control subjects (-2.2 +/- 2.0 mV; n = 9). The chloride concentration measured in chloride-free jejunal perfusates of CF patients was significantly lower than in controls (10.9 +/- 2.3 and 41.4 +/- 8.2 mM, respectively). Possible differences in net chloride and water secretion did not reach statistical significance (chloride secretion controls: -2.1 +/- 0.9 mmol/10 cm/h; CF: -0.8 +/- 0.2 mmol/10 cm/h; water secretion controls: -0.8 +/- 2.5 mL/10 cm/h; CF: -11.7 +/- 8.9 mL/10 cm/h). In control subjects, intraluminally applied theophylline stimulated the secretion of water (delta 23.4 +/- 4.6 mL/10 cm/h) and chloride (delta 4.1 +/- 1.1 mmol/10 cm/h), but not in CF patients (respectively delta 3.6 +/- 3.3 mL/10 cm/h and delta 1.1 +/- 1.1 mmol/10 cm/h). In controls, theophylline caused a significant increase in lumen negativity (PD -10.2 +/- 2.6 mV), but no change could be seen in CF patient transmural PD. These observations provide in vivo evidence for a decreased chloride permeability in the jejunum in CF, resulting in a significant reduction in net electrolyte and water secretion in the presence, but not in the absence, of an intestinal secretagogue.

A retrograde double-labeling technique for light microscopy. A combination of axonal transport of cholera toxin B-subunit and a gold-lectin conjugate.

A light microscopical, non-fluorescent, retrograde double-labeling technique is described. Cholera toxin B-subunit (CTb) and a conjugate of wheatgerm agglutinin and bovine serum albumin coupled to 10 nm gold particles (gold-lectin) are both excellent retrograde tracers and, when visualized by means of immunohistochemistry and silver intensification, respectively, may be readily identified within the same cell. This light microscopical retrograde double-labeling technique is illustrated in rat with experiments designed to investigate the collateralisation (1) of vestibular neurons to the spinal cord and oculomotor complex, (2) of spinal neurons to the left and right lateral reticular nucleus, and (3) of inferior olivary neurons to the uvula of the cerebellum. Advantages over fluorescent double-labeling experiments are found in the fact that the diaminobenzidine reaction product as well as the silver/gold deposits do not fade and can be examined in counterstained sections. Moreover, the injection sites can be kept quite small and may be guided by electrophysiological recording through the injection pipette.

Cerebellar projections to the red nucleus and inferior olive originate from separate populations of neurons in the rat: a non-fluorescent double labeling study.

In the rat, the extent of collateralization of projections from the cerebellar nuclei to the red nucleus and inferior olive was investigated using a retrograde double labeling technique. The combination of tracers selected, cholera toxin-beta-subunit and WGA-BSA-gold, not only enabled the use of small injection sites but also resulted in clearly distinguishable and permanently stained neurons that could be analyzed in counterstained sections.