Fenestration of the cervical internal carotid artery misdiagnosed as dissection.

Internal carotid artery (ICA) anatomical variations are relatively rare occurrences during diagnostic imaging procedures. Their presence can have important prognostic consequences in the evaluation of vascular neurological diseases. It is therefore important to have a good knowledge about these variations, in order to avoid unwarranted medical interventions. We present the case of a patient harboring a right ICA fenestration in the cervical segment, misdiagnosed as a dissection on computed tomography angiography, admitted in the Department of Neurology and treated accordingly. The possible pathological and embryological origins of arterial fenestrations are discussed, and a brief review of the literature related to ICA fenestrations is presented.

S53P4 bioactive glass and fibrin glue for the treatment of osteochondral lesions of the knee - a preliminary in vivo study in rabbits.

The role of the subchondral bone and the importance of treating both bone and cartilage in cases of chondral and osteochondral lesions of the knee have been highly emphasized. There are no current studies on the experimental use of bioactive glass S53P4 (BonAlive®) as granules in the treatment of osteochondral lesions of the knee. Our preliminary study was designed to establish an experimental model and assesses the effect of glass granules fixed with fibrin compared to fibrin alone as fillers of the osteochondral defects created in the weight-bearing and partial weight-bearing regions of the distal femur in six adult rabbits. We found that the size of the distal femur in adult domestic rabbits allows the creation of 4 mm diameter and 5 mm deep osteochondral defects on both the medial femoral condyle and the trochlea, bilaterally, without significantly affecting the activity level of the animals. Retention of the glass granules in the defects was achieved successfully using a commercially available fibrin sealant. At five weeks post-implantation, we found macroscopic and microscopic differences between the four types of defects. The use of bioactive glass S53P4 for filling condylar osteochondral defects in rabbit femora led to the initiation of an early bone repair process, observed at five weeks after implantation, while the filling of trochlear defects with fibrin glue resulted in the appearance of cartilaginous tissue characteristic of endochondral ossification.

A rare case of concomitant tuberculosis of the nose, paranasal sinuses and larynx: clinical, histological and immunohistochemical aspects. A case report.

Extrapulmonary tuberculosis is a rare condition determined by Mycobacterium tuberculosis. It can affect any organ, and has a higher incidence with the increase of HIV infection, or in countries with high pulmonary tuberculosis. Diagnosis is difficult, mostly because of non-specific symptoms and a low rate of presentation for medical consult when symptoms do occur. Complete diagnosis is usually set by histological, immunohistochemical examinations, and also with Polymerase Chain Reaction (PCR) in selected cases. The authors present a case of concomitant tuberculosis of the nose, paranasal sinuses and subglottic larynx, without primary involvement of the lungs. The diagnosis was imposed by histological examination and immunostaining of probes obtained in surgery. The treatment was surgical debridement followed by specific antituberculosis medication.

Localized laryngeal amyloidosis - a case report.

Amyloidosis encompasses a variety of conditions, caused by extracellular, insoluble protein fibrils that disturb the normal functioning of cells and organs. The disease may be localized or systemic, hereditary or acquired (associated with chronic inflammatory or hematological diseases). We present the case of a 49-year-old woman, with symptoms including dysphagia, dysphonia and dyspnea. After taking the case history and performing clinical examination, we suspected a laryngeal tumor to be the cause of the symptoms. Microlaryngoscopy and biopsy were performed. The histopathological examination result of the biopsy specimen was amyloidosis. Surgical excision of the tumor was performed. Our case presentation describes this rare pathological finding, its clinical manifestations, the histopathological and surgical diagnostic problems, treatment, patient evolution and the difficulties we encountered along the way, through the scope of our personal experience.

A study on the type of lesions achieved by three electrosurgical methods and their way of healing.

The technical progress in the medical sector in the past decades has continuously driven the development of electrosurgical techniques. The controversies surrounding the superiority of a certain technique relative to another - electrocautery, laser and radiofrequency - have determined us to carry out a histopathological design with the aim of comparing the healing sort of the shallow wounds generated by the three types of electrosurgical devices. The experimental study has investigated the healing process inflicted by the electrosurgical devices mentioned beforehand on 12 Wistar albino rats. The wounds were inflicted under intravenous general anesthesia with Xylazine and Ketamine and were performed lateral to the spine region, using laser, radiofrequency and electric cautery. The histological samples harvested at one, three, five, and seven days were sent to pathological examination. We followed by comparison the evolution of the first two phases of the wound healing produced by the three electrosurgical methods analyzed. We described the histopathological changes occurred in the epidermis, dermis and hypodermis and also the subcutaneous soft tissues in all of the three types of lesions. Electrocautery remains the most frequently used electrosurgical device, even if it has unquestionable disadvantages as compared to other modern instruments. Laser-assisted surgery and radiofrequency are refine energy-based instrumentation, being utilized at a multidisciplinary surgical level.

Clinicopathologic and therapeutic aspects of giant parathyroid adenomas - three case reports and short review of the literature.

In the last decade, the clinical picture of primary hyperparathyroidism has changed, with the majority of patients being diagnosed while asymptomatic and the "classical" clinical pattern characterized by bone disease, recurrent nephrolithiasis, peptic ulcer disease, neurological or psychiatric disorders being rarely encountered. In this context, most patients have minimal hypercalcemia and small parathyroid adenomas. Not surprisingly, giant parathyroid adenomas have seldom been described in the literature. We herein report three cases of giant parathyroid adenomas weighing more than 30 g and discuss their clinicopathological and therapeutic particularities. We also review the relevant literature, with the principal aim of outlining the rarity of these giant parathyroid adenomas and the issues concerning their diagnosis and treatment.

Ultrasonographic and histopathological features of cervical lymph node metastases.

OBJECTIVES: Different approaches have been made to differentiate benignant from malignant cervical lymphadenopathy using ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasound in the assessment of malignant cervical lymph nodes using the histological gold standard results. Gray-scale ultrasound assesses the nodal size, shape, border, internal architecture and color Doppler ultrasound evaluate the vascular pattern of lymph nodes. MATERIALS AND METHODS: 158 cervical lymphadenopathies evaluated by ultrasound in 100 patients over a period of 36 months (between January 2010 and December 2012) were evaluated for the presence of intranodal vascular pattern, which was considered benignant when it traversed through the node without disruption. RESULTS: Of the 158 cervical tumors evaluated, 114 (72.2%) were found to be malignant on pathologic review. Malignant vascular markings were present in 133/158 lymph nodes evaluated. The presence of malignant vascular pattern had a sensitivity of 97.37% and a positive predictive value of 82.84%. Malignant gray-scale ultrasound markings had a sensitivity of 23.3% and a positive predictive value of 100%. CONCLUSIONS: The presence of normal intranodal blood flow was associated with a benignant diagnosis in 87.5% of the masses evaluated. The addition of this color Doppler ultrasound finding improves the ability of ultrasound exam to predict the likelihood of malignant involvement.