Cavernous Spaces Research Articles

Scholars and learners: a case study of new library spaces at Indiana University

Purpose – This case study aims to describe the renovations and intended functions for rooms; explain the different design approaches implemented for the different end-user populations; provide an overview of traditional, new and non-library services for which spaces were designed; briefly explain training and planning; and describe the spaces and services that function well and those that do not. Indiana University Libraries completed two significant renovations in late 2014. They renovated the Learning Commons, which is a 27,000 square feet (SQF) facility designed to meet the needs of undergraduate students, and they created the Scholars’ Commons, which is a 15,000 SQF facility supporting graduate student and faculty research. Design/methodology/approach – Both spaces were thoughtfully designed to support new and traditional library services, as well as services supported by non-library units. Staff training and service planning took place during the construction process, with the goal of having outstanding services operating on opening day. Findings – The goal of creating flexible space was achieved, but it presents organizational and staffing challenges. Libraries seeking to create multifunctional environments must consider the practical implications of daily operation and use of such spaces. Research limitations/implications – This case study describes two library environments that are in their first year of operation and the assessment of the use and impact is underway. The stage of the work limits the research to be reported upon. Practical implications – The spaces described provide very practical information for other academic libraries that seek to renovate spaces and provide innovative services. Originality/value – Academic libraries that are in the planning stage of a learning space should take note of the variety of spaces, strategies for working with cavernous spaces, use of natural light and “bring-your-own-device” interior designs. In addition, the service hub model implemented in the Scholars’ Commons is a unique approach for digital scholarship centers.

MP52-17 EXPRESSION AND DISTRIBUTION OF THE TRANSIENT RECEPTOR POTENTIAL CATIONIC CHANNEL A1 (TRPA1) IN HUMAN PENILE ERECTILE TISSUE AND THE SEMINAL VESICLES

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2015MP52-17 EXPRESSION AND DISTRIBUTION OF THE TRANSIENT RECEPTOR POTENTIAL CATIONIC CHANNEL A1 (TRPA1) IN HUMAN PENILE ERECTILE TISSUE AND THE SEMINAL VESICLES Stefan Ückert, Andreas Bannowsky, Markus Kuczyk, and Petter Hedlund Stefan ÜckertStefan Ückert More articles by this author , Andreas BannowskyAndreas Bannowsky More articles by this author , Markus KuczykMarkus Kuczyk More articles by this author , and Petter HedlundPetter Hedlund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1734AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The transient receptor potential cationic channel A1 (TRPA1) has been suggested to be involved in mechano-afferent/efferent signaling in the bladder, prostate, and urethra. Up until today, no study has addressed the expression of this receptor in male genital and reproductive tissues. Thus, it was the aim of the present study to evaluate in human penile erectile tissue (corpus cavernosum penis) and the seminal vesicles (SV) by means of molecular biology and immunohistochemistry the expression and localization of TRPA/TRPA1. METHODS Human penile erectile tissue was obtained from 5 subjects who underwent reassignment surgery. SV tissue was excised from 5 male patients during pelvic surgery due to malignancies of the prostate or urinary bladder. Using immunohistochemical methods (double-labelling technique, laser fluorescence microscopy), the distribution of TRPA1 in relation to neuronal nitric oxide synthase (nNOS), the neuropeptide vasoactive intestinal polypeptide (VIP), and vesicular acetylcholine transporter protein (VAChT) was examined in sections of the CC, while, in sections of the SV, the distribution of TRPA1 was investigated in relation to eNOS, nNOS, VIP and CGRP. RESULTS In the CC, immunoreactivity for TRPA1 was located in nerves transversing the cavernous sinusoidal space. These nerves also displayed the expression of VAChT. Signals specific for TRPA1 were also observed in meshworks of nerve fibers running alongside the walls of cavernous arteries. Varicose nerves containing nNOS or VIP were not immunoreactive for TRPA1. In the SV, TRPA1 was seen expressed in nerves running through the smooth muscle portion. Here, the protein was in part colocalized with nNOS and CGRP, whereas no colocalization with VIP was observed. Dot-like signals specific for TRPA1 were observed in the cytoplasm of epithelial cells lining the lacunar lumen of glandular spaces. The epithelial layer also presented staining for eNOS. Both the vascular and non-vascular smooth muscle of CC and SV appeared free of immunosignals related to TRPA1. CONCLUSIONS The distribution of TRPA1 and VAChT receptors in penile erectile tissue suggests a role for TRPA1 in the mechanism of cholinergic signaling in the human penis while, in the SV, TRPA1 might be involved in the control of secretory function (mediated by cyclic GMP). © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e633 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefan Ückert More articles by this author Andreas Bannowsky More articles by this author Markus Kuczyk More articles by this author Petter Hedlund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification.

OBJECT An important prognostic factor for the surgical outcome and recurrence of a pituitary adenoma is its invasiveness into parasellar tissue, particularly into the space of the cavernous sinus (CS). The aims of this study were to reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. METHODS The authors investigated 137 pituitary macroadenomas classified radiologically at least on one side as Grade 1 or higher (parasellar extension) and correlated the surgical findings using an endoscopic technique, with special reference to the invasiveness of the tumor into the CS. In each case, postoperative MRI was performed to evaluate the gross-total resection (GTR) rate and the rate of endocrinological remission (ER) in functioning adenomas. RESULTS The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. CONCLUSIONS The proposed classification proved that with increasing grades, the likelihood of surgically observed invasion rises and the chance of GTR and ER decreases. The direct endoscopic view confirmed the low rate of invasion of Grade 1 adenomas but showed significantly lower rates of invasion in Grade 2 and 3 adenomas than those previously found using the microscopic technique. In cases in which the intracavernous internal carotid artery was encased (Grade 4), all the adenomas were invasive and the GTR/ER rate was 0%/0%. The authors suggest the addition of Grades 3A and 3B to distinguish the strikingly different outcomes of adenomas invading the superior CS compartments and those invading the inferior CS compartments.

Primary Cavernous Haemangioma of the Frontal Bone: Computed Tomography Features.

Primary Cavernous Haemangioma of the Frontal Bone: Computed Tomography Features.

A rare case of thoracic extradural thrombosed primary cavernous haemangioma in a relatively asymptomatic patient.

Sir, Pure spinal epidural cavernous (haem) angiomas (PSECA) arising without any connection with the vertebrae are rare and few cases have been reported in the literature. They usually grow to a considerable size and are usually symptomatic in form of myelopathy with or without radiculopathy features.[2] We report an interesting case of thrombosed primary cavernous haemangioma located in the extradural space of thoracic region with only intermittent, mild paresthesia in lower limb. A 16 year old girl presented with complaints of intermittent electric shock like sensation in left side lower limb for last 2 to 3 years. There was no history of weakness, numbness, tightness in either lower limb, bladder or bowel disturbances. On examination, there was no sensory deficit with motor power being grade 5/5 (MRCS scale) in all four limbs. All the jerks were well preserved and normal. Plantar was bilaterally downgoing. MRI thoracic region (T1 weighted) showed an elongated, spindle shaped isointense lesion in posterior aspect of spinal canal at T7-T9 level [Figure 1a]. The lesion was hyperintense in T2 image [Figure 1b] with minimal patchy enhancement [Figure 1c]. The lesion was located in extradural space compressing the cord from posterior aspect [Figure ​[Figure2a2a and ​andb].b]. Intra-operatively, after T7-T9 laminectomy, a reddish-brown, soft, well marginated, minimally vascular lesion with bluish black coloured cystic spaces found in extradural space [Figure 3]. The lesion was sessile and was not attached to any nerve roots or bony structures with clear line of cleavage between it and the underlying dura (flimsy adhesions). The lesion was removed in single piece. Histopathology showed the lesion to be packed with large numbers of cavernous spaces lined by thin endothelium [Figure 4a]. Most of the spaces were filled with organised blood clots [Figure 4b]. The final diagnosis was thrombosed cavernous haemangioma. Figure 1 Sagittal image showing the spindle shaped elongated lesion in T1 weighted (a), T2 weighted (b) sequences with minimal patchy enhancement on contrast (c) Figure 2 Extradural location of the lesion with no bony or nerve root connection (a) after contrast administration, (b) T2 weighted image Figure 3 Reddish-brown lesion with bluish black coloured cysts within it Figure 4 (a) Low magnification showing large number of cavernous spaces lined with endothelium and filled with blood along with adipocytes of epidural fat. (b) High magnification showing the typical flattened endothelial cells lining the lumina of cavernous spaces ... Cavernous hemangiomas account for 3 to 16% of spinal vascular anomalies.[6,7] Most of these lesions are extensions from primary vertebral lesions. Extradural primary cavernous haemangioma of spine not arising from bony components are rare and constitute only 4% of all spinal epidural lesions.[4,6] and 12% of spinal cavernous anomalies.[2] Only 80 such cases have been reported in the literature.[8] They are usually located in extradural location (51%)[1] at thoracic region as in our case. They are slow growing and over a period of time attain a considerable size due to repeated micro-haemorrhages thrombosis with recanalisation and organisation of tissue.[3] As they commonly occur in thoracic region where the spinal canal has minimum capacity to accommodate any further in increase in volume due to mass growth, they are usually symptomatic in form of myelopathy features like weakness with spasticity, exaggerated jerks, sensory deficits, bladder, bowel disturbances due to cord compression. But minimal symptoms in our case was quite unusual and can be explained on the basis of widespread thrombosis which would probably had caused the lesion to soften up to exert a less compressive effect on the cord. Cavernous haemangiomas show intense contrast enhancement and resemble meningioma, schwannoma or chordoma. But this was lacking in our case and can be explained by the extensive thrombosis. Pre-operatively such radiological features make such a thrombosed lesion to mimic a more common pathology like schwannoma. Treatment of these cavernous malformations is complete excision. However, highly vascular lesions preventing complete resection can be treated with radiotherapy.[5] Our case was exclusive in that in spite of a sizeable lesion at thoracic location, the patient was having very subtle symptoms with radiological features suggesting a more common nerve sheath tumour. The cavernous haemangiomas of spine, although look benign, have a devastating outcome as these usually present with myelopathy features with bladder, bowel dysfunction and most of these do not completely recover following their excision. Fortunately our case had no preoperative neurological deficits and this could be attributed to the thrombosed nature of the lesion. Such thrombosed haemangiomas should be considered in the differential diagnosis of asymptomatic well-defined extradural lesion in a young patient with long standing symptoms.

Para-Axillary Subcutaneous Endoscopic Approach in Torticollis: Tips and Tricks in the Surgical Technique

An obvious scar on the neck may appear following the open surgery for congenital muscular torticollis (CMT). The cosmetic result may displease the patient and the family. In this study, we describe a minimally invasive technique, para-axillary subcutaneous endoscopic approach (PASEA) in CMT. A total of 11 children (seven girls and four boys with the age range between 1 and 15 years) were operated for torticollis by PASEA. All patients had facial asymmetry and head and neck postural abnormality. Following an incision at the ipsilateral para-axillary region, a subcutaneous cavernous working space is formed toward sternocleidomastoid (SCM) muscle. The muscle and fascia are cut by cautery under endoscopic vision. The patients had postoperative 2nd-week and 3rd-month visits. The incision scar, inspection, and palpation findings of the region, head posture, and shoulder position of the affected side were considered in evaluation of the cosmetic outcome. Preoperative and postoperative range of motion of the head and neck were compared for functional outcome. We preferred single incision surgery in our last two patients; the rest had double para-axillary incision for port insertion. Incomplete transection of the muscle was not observed. There was no serious complication. Postoperatively, head posture and shoulder elevation were corrected significantly. Range of motion of the head was improved. Postoperatively, all the patients had rotation capacity with more than 30 degrees. The range of postoperative flexion and extension movements was between 45 and 60 degrees. The open surgery techniques of CMT causes visible lifelong incision scar on the neck. PASEA leaves a cosmetically hidden scar in the axillary region. A single incision surgery is also possible. A well-formed cavernous working space is needed. External manual palpation, delicate dissection, and cutting of SCM muscle with cautery are the important components of the procedure. Surgeons having experience in pediatric minimal invasive surgery may consider PASEA as an alternative to the open approach in CMT. The surgeon should be familiar with surgical anatomy of the neck and must be highly competent in management of possible complications in the region.

비중격에 발생한 혈관평활근종 1예

Leiomyoma is a benign myogenic tumor which can occur wherever smooth muscle is present. It is common in the female genital tract, skin, gastrointestinal tract, but rare in the nasal cavity or paranasal sinus. Angioleiomyoma is a histologic subtype of leiomyoma, which contains capillary, cavernous or venous vascular spaces, with the smooth muscle cells being associated with the vessel walls . We present an unusual case of an angioleiomyoma arising from nasal septum, which was incidentally detected during routine nasal examination. (J Clinical Otolaryngol 2013;24:247-250)

Complete Resection and Immediate Reconstruction With Costochondral Graft for Recurrent Aneurysmal Bone Cyst of the Mandibular Condyle

Aneurysmal bone cyst is a non-neoplastic expansile lesion characterized by replacement with fibro-osseous tissue and blood-filled cavernous spaces. Involvement of the condyle is rare, and only 11 cases have been reported in English-language literature to date. Its common treatment modalities are lesion excision or condylar resection, but recurrence is high in patients treated with the former. The authors reported a 19-year-old female patient with swelling of the right preauricular region, who had a surgical curettage history in another hospital. The lesion was completely resected and the jaw was immediately reconstructed with costochondral graft with the help of SurgiCase software. The patient has been symptom-free for 6 months postoperatively.

Cranio-orbital primary intraosseous haemangioma

Primary intraosseous haemangioma (IOH) is a rare benign neoplasm presenting in the fourth and fifth decades of life. The spine and skull are the most commonly involved, orbital involvement is extremely rare. We describe six patients with cranio-orbital IOH, the largest case series to date. Retrospective review of six patients with histologically confirmed primary IOH involving the orbit. Clinical characteristics, imaging features, approach to management, and histopathological findings are described. Five patients were male with a median age of 56. Pain and diplopia were the most common presenting features. A characteristic 'honeycomb' pattern on CT imaging was demonstrated in three of the cases. Complete surgical excision was performed in all cases with presurgical embolisation carried out in one case. In all the cases, histological studies identified cavernous vascular spaces within the bony tissue. These channels were lined by single layer of cytologically normal endothelial cells. IOCH of the cranio-orbital region is rare; in the absence of typical imaging features, the differential diagnosis includes chondroma, chondrosarcoma, bony metastasis, and lymphoma. Surgical excision may be necessary to exclude more sinister pathology. Intraoperative haemorrhage can be severe and may be reduced by preoperative embolisation.

Adult Diffuse Hepatic Hemangiomatosis: A Rare Cause of Dilated Cardiomyopathy and Sudden Cardiac Arrest

A 53-year-old man presented with two months of fatigue and dyspnea on exertion, and was found to have hepatomegaly and hypotension (71/30 mmHg). Initial tests showed lactic acidosis with normal cardiac enzymes. Computed tomography of the abdomen revealed diffuse, hypodense, hepatic lesions without ischemic bowels. Shortly after admission, he developed cardiopulmonary arrest with ventricular fibrillation and expired despite aggressive medical support. Postmortem examination demonstrated dilated cardiomyopathy without coronary artherosclerosis (heart weight 785 g, normal 365 ± 71 g) and hepatomegaly with diffuse hemangiomatosis (liver weight 4,455 g, normal 1,677 ± 396 g, Fig. 1).1 Figure 1. Multiple irregular, well-circumscribed, dark brown lesions (arrow) were seen in the liver parenchyma. The lesions ranged from 0.5-10 cm in greatest dimension. Diffuse hepatic hemangiomatosis is extremely rare.2 The histologic characteristics include dilated vascular channels lined with flat endothelial cells (Fig. 2). The etiologies are poorly understood, though its association with the use of estrogen and metoclopramide has been described.3,4 The two most common causes of death are cardiomyopathy (from massive hepatic arteriovenous shunting) and cirrhosis.5 Surgical resection is an option in selected cases with small lesions without cirrhosis.5,6 Most cases are inoperable because of poor delineation of the tumor border and bleeding risk. Other anecdotal therapies include hepatic artery ligation and radiation.6 Prognosis depends on the area of hepatic involvement and cardiac function. Figure 2. Microscopic examination revealed cavernous vascular spaces (asterisk) separated by thin fibrous septae lined by endothelial cells (arrow). These findings confirmed the diagnosis of hepatic hemangiomatosis.

Primary hepatic angiosarcoma: a clinical and pathological analysis

To investigate the clinicopathological characteristics, differential diagnosis, and prognosis of primary hepatic angiosarcoma, and to review the literature. Twenty cases of primary hepatic angiosarcoma were analyzed by gross examination and light microscopy. Immunostaining was performed to detect the expression of CD34, CD31, FVIIIRAg, CK, GPC-3, Hepatocyte,vimentin, PTEN, desmin, and CD117. The age of the patients ranged from 7 to 86 years. Eleven cases were male, and 9 were female. All cases showed no specific clinical manifestations and imaging results. Macroscopically, the tumors showed diffuse multi-nodular or single nodular patterns with hemorrhage. Microscopically, there were various patterns such as cavernous vascular space and epithelioid hemangioendothelioma-like appearances; however, specific pathological diagnostic features of angiosarcoma still existed in all cases. All of the cases expressed at least one of the three immunohistochemical markers: CD31, CD34 and/or FVIIIRag. Ten cases had PTEN low expression. Ki-67 proliferative index was more than 10% in all cases. None of cases expressed desmin, CD117, GPC-3 or Hepatocyte. Primary hepatic angiosarcoma is a rare malignant tumor. Detailed morphological observation and using various vascular endothelial immunohistochemical markers can help to establish the diagnosis accurately.

Effect of Chronic Low-dose Tadalafil on Penile Cavernous Tissues in Diabetic Rats

To assess the effect of chronic low-dose administration of tadalafil (Td) on penile cavernous tissue in induced diabetic rats. The study investigaged 48 adult male albino rats, comprising a control group, sham controls, streptozotocin-induced diabetic rats, and induced diabetic rats that received Td low-dose daily (0.09 mg/200 g weight) for 2 months. The rats were euthanized 1 day after the last dose. Cavernous tissues were subjected to histologic, immunohistochemical, morphometric studies, and measurement of intracavernosal pressure and mean arterial pressure in anesthetized rats. Diabetic rats demonstrated dilated cavernous spaces, smooth muscles with heterochromatic nuclei, degenerated mitochondria, vacuolated cytoplasm, and negative smooth muscle immunoreactivity. Nerve fibers demonstrated a thick myelin sheath and intra-axonal edema, where blood capillaries exhibited thick basement membrane. Diabetic rats on Td showed improved cavernous organization with significant morphometric increases in the area percentage of smooth muscles and elastic tissue and a significant decrease of fibrous tissue. The Td-treated group showed enhanced erectile function (intracavernosal pressure/mean arterial pressure) at 0.3, 0.5, 1, 3, and 5 Hz compared with diabetic group values at the respective frequencies (P<.05) that approached control values. Chronic low-dose administration of Td in diabetic rats is associated with substantial improvement of the structure of penile cavernous tissue, with increased smooth muscles and elastic tissue, decreased fibrous tissue, and functional enhancement of the erectile function. This raises the idea that the change in penile architecture with Td treatment improves erectile function beyond itshalf-life and its direct pharmacologic action on phosphodiesterase type5.

Priapism Associated with Lumbar Stenosis in a Dog

Priapism, a persistent long-lasting involuntary erection of the penis, is uncommon in dogs. In this report, the case of a 13-year-old male Pointer, referred to our services due to persistent exposition of the penis, is described. This condition was consecutive to an intermittent priapism situation lasting for several days, which has been initially attributed to the inflammation and haematoma associated with a perianal bite. The owners became unable to retract the penis into the prepuce. At presentation, the dog was anorectic for 48h, intolerant to manipulation, and showed poor body condition and unsteady locomotion. During physical evaluation, a marked engorgement of the local vessels in the prepuce and penis was found. An abdominal X-ray was asked under the suspicion of a neurogenic origin for the clinical situation, which showed evidences of spondylosis. After discussion of the clinical condition, the owners asked for euthanasia. The necropsy confirmed the engorgement of the regional vessels deriving from the pudendal arteries and blood accumulation within all the cavernous spaces, accompanied by congestion and thrombosis within the erectile structures of the penis. No significant changes were observed in the pelvic organs that could be at the origin of priapism. The lumbar-sacral spinal regions were carefully inspected and evidenced signs of L7-S1 stenosis due to spondylosis. The case presented herein is a rare situation of priapism of neurogenic origin in a dog. Necropsy findings suggest that it was consecutive to cauda equina compression due to lumbar spinal stenosis.

Medial wall of the cavernous sinus: dural or fibrous layer?

To the Editor: I read with great interest the article by Goncalves et al. “Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature” [4], recently published in your journal. As the authors of this article found a variation among several studies without conclusive answer to their research question, I would like to provide some comments on their study and highlight a possible explanation for their results. Goncalves et al. conducted a systematic literature review to find out the microanatomy of the medial wall of the cavernous sinus (CS) and its clinical importance on sellar pathologies. Based on 14 experimental studies, four studies found that the medial wall of the CS is composed of a loose, fibrous structure, and according to ten studies, medial wall is composed of a dural layer that constitutes the lateral wall of the sella. They explain the variation in the results section by lacking in definition standards and methodological criteria. First, I am grateful for the Goncalves et al. methodology in their article as they support and establish a step toward the concept of evidence-based morphology [1, 3]. The articles based on this concept are still rare in neurosurgical literature, yet available data about the anatomy, especially in the terms of variation, can be obtained from this kind of study. It can also highlight a hidden anatomical problem that can be utilized to refine the neurosurgical approaches seen in Goncalves et al. work and in the comments on their paper. With regard to medial wall of the CS, to make it understandable, I believe it should always be divided into two parts; sphenoidal and sellar. Even though, at the sphenoidal part there is one layer of dura (osteoperiosteal dura) that adheres to the bone and forms the inferomedial wall of the cavernous space. At the sellar part or the superior medial wall, I do not believe that there is any dural layer that belongs to the CS itself or to the CS as an anatomical entity. To clarify this point, and to give an explanation to that type of anatomical variation which Goncalves et al. found in several studies, there are two facts we need to keep in mind; first, the CS is an extradural anatomical entity [5, 6]. The hypophysis compartment is isolated from all surrounding structures by what is called the pituitary bag. A detailed description of the pituitary bag was reported by Francois et al. using electron microscopic-based methodology [2]. Having said that, we can make a more useful conclusion with regard to the medial wall of the CS; there is no dural layer for superior medial wall of the CS itself. The dural layer that have been reported belong to the pituitary bag and was misinterpreted as it belongs to the CS itself according to some studies. Furthermore, this explains the presence of easy surgical cleavage plane between the medial wall and the suprasellar dura (diaphragma sellae) that was reported by Professor Kawase in his comment at the end Goncalves et al. paper.

The basic chromospheres of skin that might not be differentiated visually: observations on aneurysmal fibrous histiocytomas and malignant melanomas

Aneurysmal fibrous histiocytoma (AFH) is a variant of fibrous histiocytoma, which has a cleft-like cavernous blood-filled space in the tumor. It appears as a single reddish black tumor with variable levels of pain and size from its bleeding. And, it must be differentiated from other similar looking malignant conditions such as malignant melanoma. The visual mimicry of AFH to melanoma was raised by some careful dermatologists, but never be confirmed objectively by colorimetric analysis. MATERIALS, SUBJECTS, AND METHODS: In this study, we simply analyzed conventionally photographed digital images of thirty-seven cases of fibrous histiocytomas, including three AFH cases into colorimetrically useful color space, CIELAB, of which coordinates are L*, a*, and b* representing lightness, red to green, and yellow to blue axis, respectively. In addition, we also analyzed the clinical digital images of seven cases of malignant melanomas. Using statistical package, each coordinates of CIELAB were compared using Wilcoxon rank sum test between AFH and melanomas. The CIELAB coordinates of AFH and non-aneurysmal fibrous histiocytomas were compared statistically as well. Comparing with banal fibrous histiocytomas, the colors of AFH showed significantly smaller a* and b* coordinates (P=0.008, 0.008, respectively), which implies more green and blue hue of AFH lesion. Rather, they were more like melanomas (P=0.2839, 0.2040, respectively). As for L*, there were no significant differences for all comparisons. As a result, more objective analysis of the digital images using colorimetric color space confirmed the visual mimicry of AFH to melanoma.

Childhood and Its Discontents: An Introduction

1/Running with M.E. Figure this: a child looking simultaneously forward and back, oversized ear cocked down and back, oriented to what is clearly in the distance, but too far away for us to see. Out of this child's head grows a house, fully formed, replete with windows and a roof. For clothing, the child sports only underwear; for gender, in effect, androgyny. A trumpet-shaped vessel exudes rays of light or sound that spotlight the child, hailing the house-headed being into its cavernous space. That trumpet-like vessel narrows into something of an umbilical cord, which coils and extends back beyond the vessel, in the opposite direction of the child. Carrying the body of another, smaller child, this child's body moves forward, listens backwards but displays two faces: one peeks over her shoulder, as if following the ear backwards; the other peers fully forward, in profile, looking straight ahead into the rays that envelop the two small bodies in motion. Minneapolis-based artist Amy DiGennaro has figured just such a scene, a sketch whose spatial depth and temporal cruxes invite us to figure it further. This image, suggestively titled Running with M.E., is composed with graphite on paper. But its densely drawn lines and curves offer us an image of childhood that is anything but black and white. We are confronted with a child inhabiting two spaces and times, bearing the weight of a house on her head and the weight of a child in her arms. image is a vision of childhood and its discontents: a moving set of contradictions mobilized through a child looking forward and looking back, while being pulled and propelled into the space emanating from the vessel before her. Her fear is as unmistakable as her tenacity and as palpable as her sense of responsibility. She is at once vulnerable and fierce. I refer to the child here as she, for that is the how she ultimately unfolds in DiGennaro's art. This child-figure in Running with M.E. is an autobiographically inspired human-object form that DiGennaro calls Househead: a femininely-gendered portmanteau of freighted domesticity and psychic space exteriorized. In other incarnations in DiGennaro's art (featured in this issue and on its cover), Househead also straddles not just multiple temporalities but the very different lifeworlds of adulthood and childhood. Running with M.E. is one of many complex images (many of which feature the Househead figure) that grace the border of an enrooted epic world, a large-scale work of art that DiGennaro has called Landscape with the Story of. ... This border is storied by scenes that exist sometimes within, sometimes alongside, Hans-Bols-esque medallions or emblems and embroider the 96 x 120 work, the heart of which is an elaborate map of roots and routes. Collectively, the multiple scenes that comprise Landscape are unsettling, otherworldly (without being utopian) enmeshments of childlife and its big emotional landscape imagined backwards and forward: two-faced. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] Like the authors in this special issue on Childhood and Its Discontents, DiGennaro is interested in depictions of children who are at once of, in, and beyond the worlds they inhabit. Indeed the figure of Househead herself is both of and beyond herself. M.E. may literally be the child in her arms in the image above, but the initials me suggest perhaps that the Househead may also be carrying her own self in those arms, daemon-like (the telltale head of the child being carried is obscured). Househead's nightmarish world, for instance, echoes the Gothic worlds Steven Bruhm discusses in his consideration of The Counterfeit Child. DiGennaro's figure of childhood also dramatizes the kind of unjoinings that resist the full narrative thrust of childhood development in Thurschwell's readings of Sula and Member of the Wedding. Indeed, Househead, in her various incarnations throughout DiGennaro's oeuvre, literalizes the intersecting qualities of adults and children that Sara K. …

Exposure of Neonatal Rats to Anti-Androgens Induces Mal-Development and Fat Accumulation in the Penis.

We have previously demonstrated that neonatal anti-androgen exposure in rats induced mal-development of the penis and permanent infertility. The objective of this study was to determine if anti-androgen exposure during the neonatal period induces penile deformities that is characterized by fat accumulation in the corpus cavernosa of the penis, and if peroxisome proliferator-activated receptor gamma (Pparg) was a mediator for the results obtained. Male rats were treated from postnatal days 1-6 with GnRH antagonist, antide (15 mg/kg) or antide and dihydrotestosterone (DHT; 20 mg/kg). Testicular samples at day 7 were assayed for intratesticular testosterone and also subjected to microarray analysis. Penile tissues were collected at day 7 for histopathology, immunohistochemistry and to determine the expression of Pparg by quantitative real time-PCR. Antide treatment reduced penile length and weight significantly, and induced fat accumulation in the corpus cavernosa of penis. Intratesticular testosterone was also reduced by 70-95%. Microarray analysis of 7-day antide treated testis showed down regulation of genes that corresponded to the steroidogenic pathway such as Cyp17, Cyp21, Cyp11b1, Cyp11b2 and Hsd17b3. mRNA expression of Pparg showed a 2-fold increase (P<0.01) and protein data followed mRNA results. Antide-induced changes in histopathology, mRNA expression of Pparg and testicular testosterone production was mitigated by the co-administration of DHT. An increase in the adipocyte marker, PPARG, and increased accumulation of fat cells in the corpus cavernosa of the penis provide evidence for the predisposition of stromal cells into adipocytes rather than smooth muscle cells and cavernous spaces, structures needed for erection. The decreased intratesticular testosterone levels and down regulation of steroidogenic pathway genes suggests that the changes in penile development are mediated by decreased levels of testosterone production. The data unequivocally show that reduced testosterone production and/or action in the neonatal period, induces accumulation of fat in the corpus cavernosa and dysmorphogenesis of the penis.

Recountings: On Dickens’s Financial Memory

great house is, therefore, a huge circulating library. Charles Dickens on Bank of England (1850) Without memory, there is no debt Margaret Atwood, Payback: Debt and Shadow Side of Wealth (2008) In a 2006 TLS review article on architectural history of Bank of England, Gillian Darley thus describes vast expansion of Bank's operations in early-nineteenth century: By 1815, more than a thousand were working on Bank site, a factory floor in which time-keeping, discipline and mechanization ordered what may have been largest white-collar work force in world (13). This consummate display of order, precision, and systemization contributed to Bank's increasing figuration as an imposing symbol of nation and authority--an edifice responsible for good governance of, as Darley says, with language of exemplarity that so frequently accompanies its description, the largest white-collar work force in world. The Bank, and larger system it inhabited, was evidently an increasing force to be reckoned with. In recent years, a growing body of critical work has carried out a good deal of this reckoning process, encouraging us to consider degree to which institutionalization of banking system informed cultural experience--and cultural production--of nineteenth-century Britain. (1) Such thinking of course extends well beyond bounds of both that period and those of academic enquiry. I point, for instance, to a recent marketing campaign by direct, which compels us to think in similar terms about bank's construction in our own age. In ING'S 2012 Old Ways television commercial, a central feature of its new Forward Banking campaign, viewer enters a looming, grey cavernous space, a bank, which is emptied of employees and customers and, it seems, of its cultural significance as well. (2) In this fascinating piece of revisionism, bank's conventional iconography--the deposit slip; pen with chain attached; limited banking hours, marked on an archaic sign; water cooler, stale coffee, and free donuts; velvet ropes; and, above all, banker's green lamp--are, literally, obliterated, exploding one by one before our eyes. Endless reams of paper reminiscent of Dickens's Circumlocution Office rain down across this financial sepulchre and are replaced, as we move to next shot and comfortable, easy-chair bank of today, by relaxed coffee-sipping individual, happily reviewing his financials on his smooth functioning iPad at his local ING direct Cafe. In rendering such images and objects of banking realm so viscerally obsolescent, taps into a critical aspect of shared cultural memory: this commercial urgently reminds us of degree to which banking, as a physical experience, had once been bound up with individual and daily life, and perhaps, more importantly, it reminds us of just how much of it we have forgotten. And as if bank's connection to our collective memory were not plain enough from images on screen, nostalgic tones of Edith Piaff are called in to overstate case: It's all paid for, wiped out, and forgotten, she sings in her mournfully defiant Je Ne Regrette Rien. What is doing here is attempting to revise, but not altogether alter, our conception of banking as intensely personal, tactile, and experiential. Such a construction of bank can likewise be found, I would contend, in nineteenth-century British culture. Throughout century, period's fiction charts an increasing--if tentative--acceptance of bank's role as both a financial and interpersonal mediator, one often responsible for authentication of individual identity and a guarantor of social legitimacy. In George Eliot's Middlemarch (1874), for example, narrator identifies relocation of saved money from Old stocking at home to the savings-bank in town as one of a range of changes coming to Old provincial society (88). …

Orbital Glomangioma

Glomangioma is a vascular hamartomatous tumor originating from the glomus body, a specialized thermoregulatory organ localized in the dermis and precoccygeal soft tissue. Glomus tumors are characteristically found in the hands and are very rarely reported in the head region. Here we describe a 29-year-old woman presenting with acute proptosis and pain in the left eye. A computed tomography scan of the orbit revealed a well-defined circumscribed mass, displacing the globe and lateral rectus muscle inferotemporally. The tumour was surgically removed through a lateral Kronlein approach. On histology, the lesion consisted of cavernous vascular spaces, partly filled with blood and thrombotic material, and a mixture of capillary-sized vessels and tumor cells; immunostaining for smooth actin showed a strong positivity in the cytoplasm of tumor cells, consistent with a diagnosis of glomangioma. Our case adds to the very few cases of orbital glomangioma reported in the literature and demonstrates that this tumor can be safely removed.

Philmore Ensemble (review)

This is the debut recording by Philmore Ensemble, group formed at Temple university in 2004 initially by .A.manda Heckman (flute), Duane Large (guitars), and Julia Madden (soprano), later joined by Myanna Harvey (violin. viola). The groups mission, as Large writes in the booklet. is to offer a fresh and engaging look at the works of popular and lesser-known composers, and to bring to life that has fallen into obscurity and shed different light on will-known music. The group plays works ranging from the Renaissance era through the twenty-first century, with special locus on the nineteenth century, and all of these periods are represented in the selections on this disc. Their instrumentation dictates variety of repertoire, with some works played as written, some necessitating the combinations of two or more members, and sonic necessitating the addition of guest artists--special guest pianist Tim Ribchester joins the ensemble for two of the fourteen selections here, both of which are songs. The disc lacks work in which all four primary members perform together, as die title states plainly. The Adagio non molto-Allegro Moderato movement from Wenzeslaus Matiegka's Serenade, op. 26, for guitar, flute, and viola, is one Of two pieces on the disc in which the group's instrumentalists combine forces. Matiegka (1773--18301. Bohemian guitarist and composer active in vienna, is most likely one of the lesser-known composers the ensemble intends to highlight. All of his published works are either for guitar solo or chamber ensembles including guitar. so it seems probable this ensemble will include other Matiegka works in its repertoire. If they were going to dedicate themselves solely to classical music, Matiegka might be good choice for the ensemble's name, but the stated scope of this group is not bound to one side or era--their name is portmanteau of Philadelphia and Baltimore, the cities where the members live. This is not group overly concerned with the strictures of historical performance practice. although Large writes in his notes that with the eighteenth and particularly nineteenth-century music on this disc the ensemble implements the use of the Italian style by employing tempo rubato and extemporizing on the music itself. This approach is audible on the Matiegka recording, on which Large plays period insoninent Francois Rondhloff. ca. 1815, creating bright sound that offsets the flute and viola nicely in the mix. I wish they had included the remaining two movements. but I realize they were by the time constraints of the compact disc format--especially when attempting to include music from live centuries. The ensemble's blend sounds better on this work than it does on many other tracks on this disc, which prompts my primary complaint about this disc: the levels seem bit too hot throughout. diminishing the dynamic range of the playing. I doubt the musicians were playing in range constantly between mezzo forte and forte. Perhaps it is the result of close-microphone placement during recording. or engineering choices made in die mixing and mastering stages, but the instruments sound loud even when playback volume is decreased. Another issue compromising the listening experience is the sense that. different instruments often sound as if they were recorded in disparate locations instead of being in the same room. For example, in the performance of Johann Rudolf Zumsteeg's Monolog der Maria Stuart, arranged for guitar, flute, and soprano by Albert Methfessel, it sounds as if soprano Julia Madden is singing in much more cavernous space than the one in which her instrumental collaborators are playing. …