Sonomorphology of endometriotic cysts

Syndesmotic sutures of the skull are formed by dense connective tissue and called "open"; they are "closed" by formation of a synostosis between adjacent bones. Open sutures are considered as areas of growth and as hinges. The importance of open sutures during the period of skull growth is reflected by pathological situations in which premature closure of the sutures occurs. As alterations of the FGF receptor have been reported in genetical disorders accompanied by premature suture closure (Bellus et al. 1996), the role of fibroblasts and connective tissue in the development of the sagittal suture of mice has been investigated by light and electron microscopy. Morphological changes of the sagittal suture at the following stages are reported: at embryonic day 18, days 1, 5, 9, 14, 20, 26, 28 after birth and in adult mice. Two skulls per stage were investigated. Early osteogenesis appeared in a thin plate, followed by a second plate underneath the first one. Both were separated by blood vessels. In general, vascularization preceded desmoid mineralization; the space around blood vessels was occupied by non-bone-forming cells leaving cavities for the presumptive bone marrow. Mineralization of the collagen-rich osteoid at the mineralizing rim of the bone plates was accompanied by apoptoses and cell disintegration. Newly formed bone was immediately covered by osteoblasts forming a sheet of bone-lining cells. At day 9, the double-layered bone plates of both sides reached the median area of the skull but were separated by non-mineralizing, collagen-rich connective tissue. From day 14 onwards, the bone plates thickened. Bone apposition, recognizable by the formation of collagen-rich osteoid and proceeding from day 14 pp onwards, occurred mainly at the outer and inner surfaces of the calvariae, but neither at bone marrow surfaces nor at the medial edges of the parietal bones. These opposite bone faces showed fewer osteoblasts and bone-lining cells, but an increased number of fibroblasts. Tendon-like collagen bundles connected both bone plates of the open suture of day 26 pp as well as in the adult mice, whereby synostotically closed areas alternated. Formation of an open, syndesmotic suture can, therefore, be described as a transition of bone-forming tissue into a bone-tendon junction. The results indicate the importance of the replacement of osteoblasts by fibroblasts at the sutural front of the bone plates in order to prevent a premature suture closure.     

Management of adrenal cysts

Electrophoretic mobility data of SR vesicles reconstituted with uncharged and two mixtures of charged and uncharged lipids (Brethes, D., Dulon, D., Johannin, G., Arrio, B., Gulik-Krzywicki, T., Chevallier, J. 1986. Study of the electrokinetic properties of reconstituted sarcoplasmic reticulum vesicles. Arch. Biochem. Biophys. 246:355-356) were analyzed in terms of four models of the membrane-water interface: (I) a smooth, negatively charged surface; (II) a negatively charged surface of lipid bilayer covered with an electrically neutral surface frictional layer; (III) an electrically neutral lipid bilayer covered with a neutral frictional layer containing a sheet of negative charge at some distance above the surface of the bilayer; (IV) an electrically neutral lipid bilayer covered with a homogeneously charged frictional layer. The electrophoretic mobility was predicted from the numerical integration of Poisson-Boltzmann and Navier-Stokes equations. Experimental results were consistent only with predictions based on Model-III with charged sheet about 4 nm above the bilayer and frictional layer about 10 nm thick. Assuming that the charge of the SR membrane is solely due to that on Ca++-ATPase pumps, the dominant SR protein, the mobility data of SR and reconstituted SR vesicles are consistent with 12 electron charges/ATPase. This value compares well to the net charge of the cytoplasmic portion of ATPase estimated from the amino acid sequence (-11e). The position of the charged sheet suggests that the charge on the ATPase is concentrated in the middle of the cytoplasmic portion. The frictional layer of SR can be also assigned to the cytoplasmic portion of Ca++-ATPase. The layer has been characterized with hydrodynamic shielding length of 1. 1 nm. Its thickness is comparable to the height of the cytoplasmic portion of Ca++-ATPase.     

Occurrence and epidemiology of Isospora hominis (Railliet and Lucet, 1891) invasion

Authors examine the forensic usefulness and scope of angiometric studies in cases of sudden death that are presumably caused by coronary heart disease (CHD). Hearts of 35 men aged between 40 and 59 years who died of CHD are studied angiographically, morphologically and microscopically. The control group consists of 34 men of the same range of age who died of unnatural causes. Following to a schematic model with special regard to hemodynamic aspects and the degree of the stenosis a stenosis score is made up for each heart and correlated on a diagram with the corresponding heart weight. It appears that the cases of both groups are different areas but are showing a certain degree of overlap. The variation within both groups is discussed. With regard to the CHD group it is presumed that the factors causing death are too variable as to be defined by the deviced methods exclusively. The causal role of factors other than atherosclerosis in the occurrence of CHD is discussed. Authors conclude that the methods examined could be useful in special forensic problems.     

Biology of Isospora spp. from humans, nonhuman primates, and domestic animals

Coccidial parasites of the genus Isospora cause intestinal disease in several mammalian host species. These protozoal parasites have asexual and sexual stages within intestinal cells of their hosts and produce an environmentally resistant cyst stage, the oocyst. Infections are acquired by the ingestion of infective (sporulated) oocysts in contaminated food or water. Some species of mammalian Isospora have evolved the ability to use paratenic (transport) hosts. In these cases, infections can be acquired by ingestion of an infected paratenic host. Human intestinal isosporiasis is caused by Isospora belli. Symptoms of I. belli infection in immunocompetent patients include diarrhea, steatorrhea, headache, fever, malaise, abdominal pain, vomiting, dehydration, and weight loss, blood is not usually present in the feces. The disease is often chronic, with parasites present in the feces or biopsy specimens for several months to years. Recurrences are common, Symptoms are more severe in AIDS patients, with the diarrhea being more watery. Extraintestinal stages of I. belli have been observed in AIDS patients but not immunocompetent patients. Treatment of I. belli infection with trimethoprim-sulfamethoxazole usually results in a rapid clinical response. Maintenance treatment with trimethoprim-sulfamethoxazole is needed because relapses often occur once treatment is stopped.     

Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature

Hafnia alvei is a gram-negative bacterium that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, meningitis, bacteremia, pneumonia, nosocomial wound infections, endophthalmitis, and a buttock abscess. We studied 80 H. alvei isolates recovered from 61 patients within a period of 30 months. H. alvei was cultured from sites that included the respiratory tract (n = 38), the gastrointestinal tract (n = 16), and the urogenital tract (n = 12); the organism was found in blood cultures (n = 8), on central venous catheters (n = 3), and on the skin (n = 3). Only 25% of H. alvei isolates were recovered in pure cultures. Fifty-seven (93.4%) of the patients had an underlying illness. H. alvei proved to be the etiologic agent in two episodes of septicemia and in one episode of peritonitis and was probably responsible for septicemia in two other patients and pneumonia in one. All six of these patients recovered after receiving antibiotic treatment and/or standard surgical treatment, when needed. Three of these infections were nosocomial, and three were community acquired. Of the strains of H. alvei tested in our study, 100% were susceptible to netilmicin, ciprofloxacin, and imipenem; 92% were susceptible to piperacillin; 90% were susceptible to co-trimoxazole; and 88% were susceptible to ceftriaxone and ceftazidime. In this study, we found H. alvei to be a rare significant etiologic agent of nosocomial and community-acquired infections.     

Parameatal cysts of the penis

We describe a Libyan boy with an unusual phenotype of multiple congenital anomalies, including triophthalmia, dolichocephaly, porencephaly, cleft lip/palate, facial asymmetry, micrognathia, and VSD. The reported phenotype is likely to represent a new entity of non-chromosomal syndromic triophthalmia. Other possibilities are discussed.     

Laparoscopic removal of dermoid cysts

Benign dermoid cysts between 1.5 and 6 cm in diameter were laparoscopically removed in 9 premenopausal women. Cystectomy was performed in eight patients, and unilateral oophorectomy in one. Surgical and postoperative complications were not observed. Chemical peritonitis due to the dermoid contents can be avoided, provided, careful lavage of the peritoneal cavity is performed.     

Endoscopic management of colloid cysts

OBJECTIVE: Several surgical approaches have been proposed for the treatment of colloid cysts, which still remains controversial. The most recent technique used is endoscopy. By its nature, endoscopy cannot offer complete removal, as compared to microsurgical techniques, but can do more than puncture. To evaluate the usefulness of endoscopy for colloid cyst surgery, a series of 15 patients who were operated on for colloid cysts under endoscopic control since 1994 was reviewed. METHODS: The presenting symptoms of our patients (10 men and 5 women) were intermittent headache (10 patients), nausea (3 patients), short-term memory loss (4 patients), coma (2 patients), gait disturbance (3 patients), blurred vision (2 patients), and mental status changes (3 patients). The sizes of the cysts ranged from 4 to 50 mm (median, 22.93 mm). Depending on the radiological appearance, the procedure was performed via a right (10 patients) or left (5 patients) precoronal burr hole. A rigid neuroendoscope was used. Initial stereotactic placement of the neuroendoscope was used in two patients who had moderate hydrocephalus. In the other patients, hand-guided endoscopy was performed using an articulated arm. The cysts were perforated with a needle. The opening was enlarged with microscissors. The cyst material was aspirated, and the remaining capsule was coagulated. RESULTS: The average follow-up was 15.26 months (range, 1-28 mo). Total aspiration of the cysts was achieved in 12 patients, as revealed by normal postoperative magnetic resonance imaging. Control magnetic resonance imaging revealed residual cysts in three patients. One patient presented with an asymptomatic recurrence at 1 year. Resolution of the symptoms was obtained in all patients except for two of the four patients with preoperative memory deficit (improvement without complete recovery). There was no mortality or morbidity. CONCLUSION: These results show that endoscopy is a safe and promising percutaneous technique for the treatment of colloid cysts of the third ventricle. Longer follow-up is, however, still required.     

Laparoscopic treatment of liver cysts

Symptomatic simple liver cysts should be treated. In this report we describe the results of a straightforward, well-tolerated laparoscopic operation for this condition. Between 1990 and 1996 we performed 19 laparoscopic liver cyst excisions. The exposed portion of the cyst wall was excised and a piece of omentum was secured into the remaining cyst cavity to prevent recurrence. The average age of the patients was 65 years (range 30 to 81 years). Eight patients (42%) had single simple cysts, nine patients (47%) had multiple simple cysts, and two patients (11%) had polycystic liver disease. Fifty-three percent of the patients had previous abdominal operations, 47% had undergone previous needle aspirations, and one had previously undergone unsuccessful laparoscopic cyst decompression elsewhere. The indications for surgery included abdominal pain, mass, early satiety, malaise, bloating, and shortness of breath. Two patients underwent concurrent cholecystectomies, and one patient underwent concurrent laparoscopic Nissen fundoplication. Follow-up, which averaged 32 months (range 3 to 68 months), is complete in all patients. There was one treatment failure among the patients with simple cysts. Both patients with polycystic liver disease have had recurrent symptoms. The laparoscopic approach to simple liver cysts is relatively straightforward, and if certain technical principles are adhered to, the success rate is very high.     

Oncocytic cysts of the larynx

Oncocytic cysts make up a pathologically well-defined sub-group of cystic lesions in the larynx. As a rule they originate from the ventricle and occur in middle-aged or elderly persons. Clinically these tumours are uncharacteristic. Such oncocytic cysts are interpretable as retention cysts rather than actual new growths. The question concerning their rare occurrence is discussed on the basis of 5 cases diagnosed within a period of 2 months.     

Surgical treatment of parasitic cysts

An interesting case with both antegrade and retrograde intussusception in an infant is reported. There was no apparent predisposing cause.     

Immunolocalization of interstitial collagenase (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in radicular cysts

To investigate the mechanisms involved in expansion of radicular cysts, monoclonal antibodies against interstitial collagenase (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were used to localize the sites of MMP-1 and TIMP-1 expression in 30 radicular cysts. Positive MMP-1 staining was detected in the lining epithelium and subepithelial fibroblasts, macrophages, endothelial cells and osteoblasts/osteocytes in all specimens. Positive TIMP-1 staining was identified in osteoblasts/osteocytes and endothelial cells of all specimens, and in the lining epithelium and subepithelial fibrous connective tissue wall of five radicular cysts with an intense inflammatory cell infiltrate. The number and distribution of positive cells for MMP-1 or TIMP-1 varied widely among individual specimens, but strong immunostaining was constantly detected at sites with prominent subepithelial inflammation. Results here support the hypothesis that MMP-1 may play an important role in the expansion of radicular cysts. The absence of TIMP-1 expression in lining epithelium and subepithelial fibroblasts and macrophages in most cases studied indicated that an imbalance between MMP-1 and TIMP-1 production may lead to radicular cyst expansion.     

Reappraisal of lateral cervical cysts in neonates: pyriform sinus cysts as an anatomy-based nomenclature

Anticoccidial drugs undergo a vigorous series of test during development in order to demonstrate their efficacy and safety. Evaluation of efficacy may also be necessary after a drug is utilised in the field in order to establish whether resistance has developed. The principles and procedures used to evaluate anticoccidial efficacy were reviewed in a series of papers presented at a symposium held at the University of Georgia in May 1969. It is a testimony to the quality of this symposium that much of the information presented remains valid today. In the USA, general procedures that should be followed in new drug investigations are given in various guidelines and memoranda issued by the Food and Drug Administration. Specific guidelines relate to anticoccidial investigations. Although not a legal requirement, they provide a standard for those investigators seeking approval of a new anticoccidial drug. These guidelines are periodically revised, and investigators should consult the FDA for advice on specific protocols. Many of these procedures are also appropriate for the determination of drug resistance.     

Diagnosis and treatment of breast cysts

Streptomyces brunneofungs 118 and S.griseolus 224 were isolated from natural objects and shown to synthesize ammonium specific products belonging to macrotetrolide compounds. Gradient extraction was applied to the mycelium and it was demonstrated that the compounds were rather labile both in the native cells and on synthetic carriers and could be hydrolyzed by aqueous solutions of acetone and ethanol to various linear oligomers of narctinic acids. Acetone mainly stabilized the monomer and dimer fragments whereas in the ethanol extracts a complete set of the oligomers (from the monomer to the tetramer) was detectable. Graident extract of suspension of the microbial intact cells is useful in the study of some properties and the primary identification of biologically active hydrophobic products even at the early stages of their isolation.     

Sonographic diagnosis of peritoneal inclusion cysts

Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.