Focal Hemorrhage Research Articles

Chronic exposure to ammonia induces oxidative stress and enhanced glycolysis in lung of piglets.

Ammonia is one of the major environmental pollutants in the pig industry that seriously affects the airway health of pigs. In this study, we aimed to investigate the metabolic profiling changes of piglets' lung tissue after the exposure of 0 ppm (CG), 20 ppm (LG) and 50 ppm (HG) ammonia for 30 days. Compared with the control group, the obvious lung lesions were observed in HG, including interstitial thickening, inflammatory cell infiltration and focal hemorrhage. The significantly increased content of malondialdehyde in HG, combined with the significantly decreased mRNA expression of antioxidase and inflammatory-regulators in exposure groups, implied that ammonia exposure induced oxidative stress and diminished the anti-inflammatory response in lung tissues. Metabolomic analyses of lung tissues revealed 15 significantly altered metabolites among the three groups including multiple amino acids, carbohydrates and lipids. The accumulation of succinic acid, linoleic acid and phosphorylethanolamine and consumption of glucose, quinolinic acid and aspartic acid in ammonia exposure groups, indicated that energy supply from glucose aerobic oxidation was suppressed and the glycolysis and lipolysis were activated in lung tissues induced by chronic ammonia exposure.

ABDOMINAL ULTRASONOGRAPHY (AUS) AS A MODE OF INVESTIGATION IN THE EARLY EVALUATION OF NECROTIZING ENTEROCOLITIS IN A NEONATAL INTENSIVE CARE UNIT.

INTRODUCTION:Necrotizing enterocolitis (NEC) is the most serious and common gastrointestinal emergency occurring among the neonates. NEC affects 1–5% of all neonates & approximately 7% of preterm infants <1500 grams. The incidence among premature neonates weighing less than 1500 grams is approximately 12% with mortality of 30-35%. NEC is an acute inammatory injury involving the distal small and often proximal large intestine. Segmental coagulative necrosis of the mucosa with focal haemorrhage can be seen histopathologically. The radiological features appear late in the necrotizing enterocolitis. The delay in diagnosis will lead to increased mortality and morbidity. The features of NEC can be detected early in the ultrasonography of the abdomen. AIM: The primary objective as Abdominal Ultrasonography (AUS) being investigation of choice in the early diagnosis of NEC and secondary objective of evaluating the morphological features seen in ultrasound and correlation with clinical, X-ray ndings. MATERIAL AND METHODS: This is a prospective study done from March 2016 to August 2017 at a Tertiary care referral centre. The sample size was calculated as 15, using Snedecor and Cochran formula. All the neonates which fullled the inclusion criteria were included in the study. The neonates with congenital anomalies and hemodynamic instability were excluded. The outcome was based on the AUS ndings. Statistical analysis of data done using the Statistical Package for Social Sciences (SPSS), version 24.0. RESULTS: The neonates included in the study were from 27 weeks to 38 weeks of gestation and mean age of presentation was 4.80±3.50 days, with the male female ratio 2.7:1. 02 (13%) neonates were of 27 weeks gestation, 01 (6.6%) was of 28 weeks of gestation, 02 (13%) were of 29 weeks of gestation, 02 (13%) were of 30 weeks of gestation, 04 (26%) were of 32 weeks of gestation, 01 (6.6%) was of 33 weeks of gestation and 02 (13%) were of 37 weeks of gestation. The mean birth weight±SD (range) in the study was 1447±601 grams. The neonates presented with features of feed intolerance 15 (100%), abdominal distension 8 (53.3%), lethargy 3 (20%). AUS detected abnormal ndings in 10 neonates, in whom there were no radiological abnormalities. There was statistically signicant association between the altered temperature and ultrasound ndings (p value -0.014). CONCLUSIONS: Abdominal ultrasonography is more sensitive to detect NEC at early stage.

18F]Fluoromethylcholine PET/CT for CNS lymphoma assessment: a new tool

Background Central nervous system (CNS) lymphomas are a rare subset of lymphoma, which are associated with a poor outcome. The gold standard for CNS imaging is with gadolinium-enhanced magnetic resonance imaging (MRI); however, there are a number of limitations, including some patients with small persistent abnormalities from scarring due to focal haemorrhage or from a previous biopsy, which can be difficult to discern from residual tumour. [18F]Fluoromethylcholine positron emission tomography–computed tomography (FCH-PET/CT) uses an analogue of choline, which due to the upregulation of choline kinase in tumour cells, allows increased uptake of FCH. As there is minimal background grey matter uptake of FCH, FCH-PET/CT can be used in CNS imaging and provide a useful tool for response assessment. Methods This is a cohort study, where we identified 40 patients with a diagnosis of primary or secondary CNS lymphoma between 1st November 2011 and 10th October 2019. Results 26 of the 40 patients (65%) had concordant results. Of the discordant results, 11 out of 14 had partial response (PR) on MRI but showed a metabolic complete response (mCR) on FCH-PET. The overall response rates (ORR) were similar between the two modalities (90% for MRI versus 95% with FCT-PET/CT). Conclusion We conclude that FCH-PET/CT is a reasonable alternative mode of imaging to gadolinium-enhanced MRI brain imaging, providing a new tool for assessment of CNS lymphoma.

Experimental study of fine-grained reticulated titanium nickelide in the near-defective tissues of the palate

Aim. To study the peculiarities of regeneration of fine-gauge reticulated titanium nickelide in near-defective tissues of the palate.Material and methods. The work was carried out on 10 female rabbits of the Shin Shila breed weighing 2,7-3,0 kg; an experimental investigation was carried out in the Central Research Laboratory of the Avicenna Tajik State Medical University. As the implantation material, we used a fine mesh titanium nickelide with a thickness of 40-50 microns threads and the size of 50x50 microns cells.Results and discussion. The morphological study revealed that after the surgery the mucous membrane covering the implant was edematous with foci of hyperemia and hemorrhages. Vessels were dilated and full-blooded, small and medium caliber vessels were constricted. In the zone of anastomosis, there were prevailing changes of inflammatory character with slight activation of local immunity. Fifteen days later the mucous membrane in the anastomosis zone partially recovered. Local immunity activation contributes to the restoration of normal structures in the implant area. Later it was noticed that as soon as blood supply to the implant zone was restored almost immediately from the areas bordering the operation zone the sprouting of the covering epithelium cells began.Conclusion. Regeneration processes in the artificially created defective areas of the palate, at the use of the titanium fine mesh nickelide begin on the border of the implant material contact with the tissues of the peri-defective zone at the expense of the local immune reactions activation with the following gradual transition to the other areas.

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects.

Due to the widespread use of magnetic resonance imaging (MRI) in neurological diagnostics, the number of patients detected as having cerebral microbleeds (CMBs) continues to increase. However, their clinical impact still remains controversial, especially the question of whether CMBs significantly increase the risk of life-threatening intracerebral haemorrhage (ICH) in patients undergoing intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT), or in patients on anticoagulant therapy or statins. The term 'CMB' is a radiological concept that aims to illustrate microscopic pathology of perivascular hemosiderin deposits corresponding most probably to small foci of past bleeding. MRI images in sequence T2*-GRE and susceptibility-weighted imaging (SWI) are used for a diagnosis of a CMB. This review summarises the current knowledge regarding the definition, prevalence, genetics, risk factors, radiological diagnosis and differential diagnosis of a CMB. We discuss its role as an indicator of future ischaemic or haemorrhagic events in high risk patients or those on antiplatelet or anticoagulant therapy, and its prognostic value for reperfusion strategies and for the development of dementia. The place of CMBs in current guidelines is explored herein. It must be emphasised that the recommendations relating to CMBs are expert opinions. Therefore, at the end of this review, we pose a number of questions that future clinical trials should answer.

Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology

Purpose. The experimental study aimed to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Methods. The study comprised 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. A linear accelerator was used for the experiment. Each animal underwent radiation exposure in different areas: 1st animal - AV node (dose 35 Gy), 2nd animal - AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal - pulmonary veins (PV) and left atrium (dose 30 Gy), 4th - AV node and LV free wall (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in three projections: axial, frontal and sagittal. For electrocardiographic control, a loop recorder was implanted in each animal. The average exposure time was 11±7 minutes. After a follow-up period, morphological examination of the autopsy material was performed.Results. The average follow-up period after ablation was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, where AV-node was exposed: 2nd animal - 40 Gy on 108th day of observation and 4th animal - 45 Gy on 21st day of observation. No cardiac tachyarrhythmia was recorded in the animals. The results of myocardium macro- and microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern electrophysiology as an alternative ablation method.

Acute haemorrhagic leukoencephalitis (AHLE) – our experience and a short review

BackgroundAcute haemorrhagic leukoencephalitis (AHLE), a rare variant of acute disseminated encephalomyelitis (ADEM), often presents differently from classical ADEM, thereby posing a diagnostic challenge to the clinician. AimTo report AHLE, its clinic-radiological manifestations, process of diagnosis and prognosis. Method and resultsEight patients presented with altered sensorium, acute focal deficits with or without seizures. Initial workup showed evidence of haemorrhagic lobar or thalamic lesions in seven patients. All patients underwent extensive evaluation for collagen vascular disease and vasculitis profile, autoimmune encephalitis panel and aquaporin-4 antibody, which were found to be normal. Cerebrospinal fluid (CSF) biochemistry and microscopy was non-contributory and CSF viral PCRs, toxoplasma antibodies, cryptococcal antigen were also negative. All patients had progressively worsening sensorium and neurological deficits. Repeat MRIs showed increase in oedema in the lesions and appearance/expansion of haemorrhage in the thalamic/hemispherical lesions. All patients received intravenous methylprednisolone (IVMP) without any benefit. Four patients underwent plasmapheresis (PLEX), one received intravenous immunoglobulin (IVIG) and one received both second line immunotherapies, without significant improvement. Brain biopsy (performed in three patients) showed inflammatory demyelination and areas of haemorrhage, thus confirming the diagnosis. Six patients succumbed in 7–30 days of the illness, despite aggressive treatment and only two survived, albeit with a significant disability. ConclusionAHLE is a rare, yet very severe variant of ADEM. MRI shows lesions with haemorrhages, oedema and mass effect and histology findings reveal inflammatory infiltrates, haemorrhagic foci and fibrinoid necrosis of vessel walls. Prognosis is worse as compared to the classic ADEM, with a high mortality rate. To the best of our knowledge, this is one of the largest series of AHLE to have been reported anywhere in the world. KeymessageAcute encephalopathy, multifocal deficits accompanied by haemorrhagic CNS demyelinating lesions with oedema and mass effect are the key features of AHLE. It is a rare, yet very severe form of ADEM with very high morbidity and mortality.

Effect of Acupuncture on the Expression of Heme Oxygenase 1 and Inflammatory Factors in Rats with Intracerebral Hemorrhage

<sec><title>Objective</title> To explore the effects of acupuncture at Baihui through Qubin acupoint on the expression of heme oxygenase 1 （HO-1） and inflammatory factors in rats with acute intracerebral hemorrhage from the levels of behavior, histology and molecular biology, so as to provide an experimental basis for clinical acupuncture in the treatment of intracerebral hemorrhage. </sec><sec><title>Methods</title> A total of 108 Wistar male rats were randomly divided into sham operation group, model group, acupuncture + model group （referred to as acupuncture group）. Each group was divided into 3 subgroups according to 1 d, 3 d and 7 d, with 12 rats in each group. The rat model of intracerebral hemorrhage was established by autologous blood injection. The sham operation group received various surgical operations similar to the model group, but no blood injection was performed; the model group received intracerebral hemorrhage model production without any intervention; the acupuncture group was used to create a intracerebral hemorrhage model, and treatment began 12 hours after the model was created. The Berderson scoring method was used to determine the animal success model, and rats with a score of 1-3 were included in the experiment. The rats with intracerebral hemorrhage in the acupuncture group were treated by acupuncture Baihui through Qubin acupoint. The depth of the needle was 20 mm, and the needle was twirled at 100 r/min with small amplitude. Twist the needle once every 5 minutes, and keep the needle for 30 minutes each time, once a day. Modified Neurological Severity Score （mNSS） was used to evaluate the neurological function of rats after intracerebral hemorrhage on 1 d, 3 d and 7 d. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of brain tissue. The expression of HO-1, nuclear transcription factor-κB （NF-κB）, Interleukin-1β (IL-1β), transforming growth factor-β （TGF-β） protein in hematoma tissue was detected by Western blot method at three time points of 1 d, 3 d and 7 d. </sec><sec><title>Results</title> 1） There were no obvious neurological deficits in the sham operation group at all time points; the rats in the model group showed neurological deficit symptoms on the 1st day, and there were still obvious neurological deficits on the 3rd and 7th days; compared with the model group, the acupuncture group had significantly lower neurological scores at each time point （<italic>P</italic><0.01）. 2） Normal nerve cells and glial cells were seen in the basal ganglia of rats in the sham operation group. Rats in the model group showed hemorrhage foci after the 1st day of modeling; the hemorrhage foci increased on the 3rd day, and the pathological structure of the brain tissue was obviously damaged; the hematoma area decreased on the 7th day. Compared with the model group, the acupuncture group had a lower degree of damage to the pathological structure of the brain tissue at each time point. 3） The sham operation group showed a small amount of HO-1 protein expression. The expression of HO-1 protein in the model group increased at each time point. Compared with the model group, the expression of HO-1 protein in the acupuncture group increased significantly on the 3rd and 7th day （<italic>P</italic><0.05）. 4） In the sham operation group, a small amount of NF-κB, IL-1β, and TGF-β protein expression were seen; the expression of NF-κB, IL-1β, and TGF-β protein in the model group was significantly increased at each time point, and the relative expression was the highest on the third day; compared with the model group, the protein expression of NF-κB, IL-1β, and TGF-β in the acupuncture group was significantly reduced on 1st, 3rd and 7th day （<italic>P</italic><0.05）. </sec><sec><title>Conclusion</title> Acupuncture can reduce the neurological deficit scores in rats with intracerebral hemorrhage, possibly by promoting the expression of HO-1 protein, inhibiting the expression of NF-κB, IL-1β, and TGF-β proteins, reducing inflammatory reactions, and exerting a protective effect on the brain. </sec>

HISTOPATHOLOGY AIDING IN THE DIAGNOSIS OF AN ATYPICAL CASE OF AORTIC DISSECTION

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aortic dissection (AD) often presents as acute severe chest or back pain and hemodynamic compromise[1,2]. Early and accurate diagnosis and treatment are crucial for survival. Multiple imaging modalities can be used to demonstrate the dissection, including Computed Tomographic Angiography (CTA), Magnetic Resonance Angiography (MRA), and Transesophageal Echocardiography (TEE). We present a case where a patient with atypical presentation of AD underwent multiple diagnostic studies with inconsistent results. CASE PRESENTATION: A 47-year-old male with history of hypertension, asthma, and tobacco use presented with sudden onset of left-hand numbness, tingling, and pain with associated changes of color in his hand. Patient had sensory deficits in the left hand and left big toe. A left upper extremity (LUE) venous duplex was unremarkable. CTA of the chest showed a filling defect in the right posterior ascending aorta suggestive of an intimal flap. Esmolol was initiated. TEE did not reveal AD. Heparin was initiated. Arterial Doppler of the LUE was negative for any atherosclerotic or thrombotic diseases or evidence of obstruction. The following day, the patient experienced crushing chest pain radiating to the back. Transthoracic echocardiogram showed filling defect in the ascending aorta. Patient was operated on emergently. Although a frank AD was not observed, a mobile pedunculated mass was reported. The affected segment of the aorta was resected and a graft was used for repair. Histopathology results showed focal adventitial hemorrhage and degenerative medial changes consistent with AD. DISCUSSION: In this case of atypical AD diagnosis was not made early due to atypical symptoms and inconclusive and inconsistent imaging studies. The definitive diagnosis was made through histopathology, as even the inspection at time of surgery was inconclusive for AD, given unusual gross appearance. Painless dissection is encountered only in 6.4% of cases [3]. Conventional CT scanning has a sensitivity of 83-95% but it drops to <80% in the ascending aorta[4-7]. MRA or TEE is typically performed next to confirm the diagnosis. Despite a sensitivity of 98%[8,9], TEE was unremarkable in this case. The features of the AD on histopathology, including the presence of the intimal tear, hemorrhage near the adventitial layer, and medial degeneration confirmed the diagnosis. In a recent large cardiovascular registry, >60% of cases of AD were first identified at autopsy[10,11]. CONCLUSIONS: This case represents a diagnostic challenge and highlights the possibility of uncommon presentation of AD, and the importance of taking the results of multiple imaging modalities into consideration to confirm the diagnosis. In this case, and due to unusual gross appearance during surgery, histopathology was necessary to confirm the diagnosis. It is extraordinarily rare to require histopathology to confirm diagnosis of AD at time of surgery. REFERENCE #1: 1.Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283:897 REFERENCE #2: 2. Evangelista A, Isselbacher EM, Bossone E, et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation 2018; 137:1846. 3. Fatima S, Sharma K. Painless Aortic Dissection-Diagnostic Dilemma With Fatal Outcomes: What Do We Learn?. J Investig Med High Impact Case Rep. 2017;5(3):2324709617721252. 4. Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1. 5. LePage MA, Quint LE, Sonnad SS, et al. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol 2001; 177:207. REFERENCE #3: 6. Shiga T, Wajima Z, Apfel CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 2006; 166:1350. 7. Hayter RG, Rhea JT, Small A, et al. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology 2006; 238:841. 8. Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol 2002; 89:1235. 9. Hartnell G, Costello P. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1637; author reply 1638. 10. Hosoda Y. [Pathology of aortic dissection]. Nihon Geka Gakkai Zasshi. 1996 Oct;97(10):873-8. 11. Huynh N, Thordsen S, Thomas T, Mackey-Bojack SM, Duncanson ER, Nwuado D, Garberich RF, Harris KM. Clinical and pathologic findings of aortic dissection at autopsy: Review of 336 cases over nearly 6 decades. Am Heart J. 2019 Mar;209:108-115. DISCLOSURES: No relevant relationships by Matthew Darrow, source=Web Response No relevant relationships by Muhammad Mufty, source=Web Response No relevant relationships by Pradyumna Tummala, source=Web Response

Efficacy and safety of thoracoscopic cryobiopsy in patients with undiagnosed exudative pleural effusion

Background Pleural effusions are either transudate or exudate according to the biochemical analysis of aspirated pleural fluid. Thoracentesis or blind pleural biopsy may not provide a definitive diagnosis. Cryobiopsy has more successful diagnostic results than forceps biopsies with complications (only hemorrhage) during procedures. Cryobiopsy can obtain more diagnostic biopsies due to the size of the biopsies and best property in expressions of an artifact-free sample area. Results This prospective intervention study was conducted on 51 patients who were divided randomly into two groups according to the biopsy technique: Group I (cryobiopsy group): 26 patients where patients will be subjected to thoracoscopic cryobiopsy. Group II (forceps group): 25 patients where patients will be subjected to thoracoscopic forceps biopsy. To demonstrate the efficacy and safety of taking biopsy specimens from parietal pleura in undiagnosed exudative pleural effusion. In the present study, the most common thoracoscopic finding was pleural nodules in 17 (65.4%) patients of cryobiopsy and 13 (53%) patients of forceps biopsy. The mean size in cryobiopsy was 14±4.2 mm, while in forceps biopsy, it was 5±0.6 mm. The most common pathological type of malignancy was the metastatic adenocarcinoma in 30 (58.8%) patients. The diagnostic yield of rigid medical thoracoscopy was 100% in both groups. Cryobiopsy was easily interpretable in the current study as focal and diffuse hemorrhage and crush artifact/atelectasis is less in biopsy. All procedures were generally well-tolerated by the patients in both groups, cryobiopsy was a painless procedure, while forceps biopsy was registered pain in 12 (48%) patients. Conclusions Cryobiopsies of the pleura using medical rigid thoracoscopy represent a safe and painless method to take biopsy and an effective tool to obtain larger tissue samples with a safe cellular architecture.

PATHOMORPHOLOGICAL CHANGES IN CATS WITH CHLAMYDIOSIS

In recent years, there is a tendency to increase the incidence of the disease in dogs with signs of diarrhea, not only in Ukraine, but also in Europe. In general, diseases with the manifestation of such specific clinical sign as diarrhea can be caused by viruses, bacteria and helminths. In general pathology of dogs, enterovirus infections of puppies occupy a leading place. The practice of specific prophylaxis suggests that in the etiological aspect diseases emerging with this symptom can be caused not only by parvo-, but also corona- and rotavirus enteritis. These diseases are extremely dangerous for puppies and miniature dogs, due to rapid dehydration, and as a result, death. The article presents the results of a study on histological changes in organs and tissues of dogs with coronavirus infection. A histological study of pathological material sampled from 6 dogs of various breeds and sex, aged from 2 to 6 months, died from diarrheal syndrome was carried out. The presence of the coronavirus was confirmed in fecal samples by polymerase chain reaction. The most expressed injuries and typical changes in all dead dogs we recorded in the small intestine, namely in the jejunum and ileum, regional lymph nodes, and also in the spleen. Morphological manifestations of coronavirus infection in dogs at macroscopic level are the following signs: the presence of exudative inflammation in the small intestine in form of serous-fibrinous jejunoileitis, hyperplasia and serohemorrhagic lymphadenitis of the mesenteric lymph nodes, multiple foci of hemorrhage in the parenchyma of the spleen and serous membrane of the small intestine, passive venous hyperemia of the liver and kidneys, dilatation of the right ventricle of the heart, pulmonary edema, cachexia and dehydration of the body. At the microscopic level we registered the following: serofibrinous jejunoileitis, hyperplasia of the lymphoid nodules of the spleen and lymph nodes, hemorrhagic infarctions in the spleen, hyperplasia of individual and aggregated lymphoid nodules of the mucous membrane in the small intestine, degenerative processes in the parenchyma of the liver and kidneys.

A case of sellar epidermoid tumour with haemorrhage

Introduction: Intracranial epidermoid cysts are congenital inclusion tumours. Cerebellopontine angle and parasellar locations are the common locations. This is a report of an intrasellar epidermoid cyst with haemorrhage, which is rare. Case report: A 70-year-old female presented with bifrontal headache, vertigo, and nasal discharge. Contrast-enhanced Magnetic resonance imaging[MRI] showed heterogeneously enhancing lesion in sella turcica. Internal hemorrhagic foci were seen. Computed tomography[CT] scan showed a slightly hyperdense tumour of sella. Transnasal transsphenoidal excision was done. Hemorrhagic and colloid material came out. Histopathological examination showed cyst lined by stratified squamous epithelium with keratohyalin granules and keratin flakes, suggestive of an epidermoid cyst. Discussion: Usually epidermoid cyst is hypodense in CT scan. But hyperdensity can occur due to calcification of keratinized debris, increased protein content, and recurrent haemorrhage. Enhancement with gadolinium in MRI is mild and in cyst wall. Haemorrhage and enhancement are probably due to foreign body granulation tissue developing from leakage.

Cerebrocortical necrosis causes multiple deaths in Scottish ewes and lambs.

Cerebrocortical necrosis causes multiple deaths in Scottish ewes and lambs.

A Rare Case of Anemia Caused by Retroperitoneal Hematoma

Introduction: Retroperitoneal hemorrhage has been reported with enoxaparin therapy. İn this article, spontaneous retroperitoneal hemorrhage developed in a patient using enoxaparin due to deep vein thrombosis is discussed. Case Report: A seventy-six-year-old male patient was admitted to the emergency department with the complaint of fatigue. On deeper introspection, our patient had, in the recent past, been used enoxaparin for deep vein thrombosis. In the physical examination was natural except subcutaneous minimal hematoma in the upper extremity bilateral enoxaparin area. İn laboratory tests, hemoglobin: 4.6 g / dl, urea: 158 mg / dl and creatinine were determined as 1.86 mg / dl. Abdominopelvic computed tomography imaging were performed and retroperitoneal hemorrhage reaching a depth of 4 cm adjacent to the right psoas muscle was detected. The patient, who did not develop additional complications after FFP and erythrocyte suspension replacement during the intensive care follow-ups and did not need surgical treatment, was discharged on the 17th day of his hospitalization in good health. Conclusion: When patients under enoxoparine treatment present with the complaint of fatigue, major bleeding may be seen when anemia is detected. One should be vigilant in terms of retroperitoneal bleeding as the bleeding focus in these patients.

Histopathological and ultrastructural study of carotid atherosclerotic plaques: a study of four cases

ABSTRACT To clarify the characteristics and origin of the cellular components in atherosclerosis, carotid atherosclerotic plaques (CAPs) of four patients were studied by light microscopy using hematoxylin-eosin, Congo red and alpha-smooth-muscle actin stains, and by transmission electron microscopy of different regions of CAPs. By light microscopy, CAPs were composed of 1) a fibrous cap; 2) an atherosclerotic core presenting focal fibrosis, neovascularization, hemorrhage, necrosis, chondrification and ossification; and 3) a basal band composed of a hyperplasic pseudo-media and affected tunica media. Ultrastructurally, the CAPs contained a diversity of cells including fibroblasts, myofibroblasts, osteochondrocytes, vascular smooth-muscle cells, foam cells and other myoid cells characterized by varied features of the above mentioned cells. The results indicated that CAPs were derived from a proliferation of multipotential mesenchymal stem cells, leading to the presence of degenerated foam cells and lipid-laden cells.

CASE SERIES OF CHORDOMA IN THREE DIFFERENT LOCATIONS: CLIVAL, CERVICAL SPINE, AND SACROCOCCYGEAL

Background: Chordoma is a relatively rare malignant, slow growing, and locally aggressive tumour that arise from embryonic remnants of the primitive notochord. It accounts for 4% of all primary bone tumours. Chordomas can present a diagnostic challenge due to the rare occurrence and a tendency to involve any region within the craniospinal axis. Case Presentation: First case, 25-y-o female with cephalgia. CT scan shows lytic clival bone destruction. MRI show lobulated isointense mass on T1-WI, hyperintense on T2-WI and heterogenous contrast-enhancement. The mass extending to the many structures, destructing the Atlas, infiltrating perivertebral and epidural space. The patient received endoscopic tumour excision and confirmed as chordoma. Second case, 50-y-o male with tetraparesis, urinary and bowel incontinence. CT scan shows destruction of the first and second cervical spine. MRI shows the same characteristics as the first case. The mass compressing spinal cord, infiltrating the right perivertebral and orophrayngeal space. The patient received laminectomy and confirmed as chordoma. Third case, 50-y-o male with large soft tissue bulging at gluteal region. CT scan 3D surface rendering shows destruction of the first sacral spine until coccygeal. MRI shows the same characteristics as the first and second case. The mass infiltrating gluteal and piriform muscles, encasing left internal iliac artery. The mass further pathologically confirmed as chordoma. Conclusion: Patients might experience different symptoms. Imaging studies classically show a destructive bone mass with lobular growth, high water content (high T2 signal intensity), foci of haemorrhage and calci?cation. Differential diagnosis are also depend on the location. Physaliferous cells is the hallmark of chordoma. Surgical intervention is the recommended treatment modality.

Suprachoroidal hemorrhage associated with pars plana vitrectomy

PurposeTo analyze the characteristics, related risk factors, and prognosis of suprachoroidal hemorrhage (SCH) associated with pars plana vitrectomy (PPV).MethodsCases of SCH associated with PPV excluding trauma were retrospectively analyzed in Beijing Tongren Hospital between January 2010 and June 2020. The data collected included general data, myopia status, axial length, state of the crystalline lens, SCH onset time, range, treatment method, visual prognosis, and methods of operation and anesthesia. Patients were divided into those with SCH related to the first PPV (Group 1), and SCH related to second intraocular surgery in the vitrectomized eye (Group 2). Patients were also classified by the SCH onset time into either the expulsive suprachoroidal hemorrhage group (ESCH) and the delayed suprachoroidal hemorrhage group (DSCH). The general data, related risk factors, and the visual prognosis of SCH in the different groups were analyzed.ResultsSCH associated with PPV was studied in 28 cases with an incidence of 0.06 %; 16 males and 12 females. The mean age of the patients was (53.51 ± 10.21) years old, the mean follow-up time was (24.94 ± 14.60) days, and the mean axial length was (28.21 ± 3.14) mm. Of these cases, 21 were classified as high myopia, 25 as aphakia/ pseudophakic, and 7 as focal hemorrhage. Silicone oil removal occurred in 12 cases (43 %). Patients in Group 2 were younger than Group 1 (P = 0.005). In terms of treatment and prognosis, 5 eyes were simply closely observed, 4 were given single suprachoroidal drainage, 15 were given suprachoroidal drainage combined with silicone tamponade, 2 underwent anterior chamber puncture, and 2 gave up treatment. A follow-up vision: NLP ~ 20/30; among them, 2 eyes with NLP (7.14 %), 6 of ≥ 20/200 (21.43 %). The final outcomes presented a significantly positive correlation with baseline vision but no significant correlation with age or axial length.ConclusionsSCH has a higher incidence rate after a second intraocular surgery in a vitrectomized eye which is associated with the lack of vitreous support and easier fluctuation of intraocular pressure. SCH associated with PPV is more localized and has a relatively good prognosis; high myopia and aphakic/ pseudophakic eyes are risk factors. Active treatment can effectively improve visual prognosis.Trial registrationRetrospective case series study, not applicable.

Renal Crest Proliferative Lesions in Cats with Chronic Kidney Disease

In a histopathological study of the renal crest (RC) of kidneys of cats with chronic kidney disease (CKD), 58/90 (64%) had epithelial proliferation. Of these, 33 cats had hyperplasia of the collecting duct (CD) epithelium (CDH) alone, eight had hyperplasia of the urothelium covering the RC (RCUH), of which one had concurrent abaxial renal pelvic urothelial hyperplasia (UH), and eight had both CDH and RCUH. CDH or RCUH were present in five cats with marked dysplasia of the CD epithelium (CDD) and four cats with invasive carcinomas, which also had epithelial dysplasia. All nine cats with marked dysplasia or neoplasia of the RC also had substantially altered RC contours due to focal haemorrhage, papillary necrosis or fibrosis. Three of the carcinomas had a strong desmoplastic response. In control cats, both urothelial (RC and renal pelvis) and tubular (CD and distal tubular) cells were immunopositive for cytokeratin (CK; AE1/AE3), tubular epithelial cells were positive for vimentin (Vim) and aquaporin 2 (Aq2), while urothelial cells were positive for p63. PAX8 immunolabelling was difficult to validate. CD and UH labelling was similar to control tissue. While urothelial dysplasia had the same immunolabelling pattern as UH and control tissue, CDD was generally immunonegative for Aq2. As immunolabelling of the four carcinomas did not distinguish between tubular and urothelial origin, with three positive for both Vim and p63, all were broadly designated as RC carcinomas. Overall, proliferative epithelial lesions are common in cats with CKD and form a continuum from simple hyperplasia to neoplasia of the urothelium or CD of the RC.

Anatomic Variations of the Hepatic Artery in 5625 Patients.

To analyze the origin and anatomic course of the hepatic arteries by using digital subtraction angiography (DSA) and multidetector CT in a large study sample. This retrospective study included 5625 patients who underwent liver CT and chemoembolization between January 2005 and December 2018 (mean age, 60 years ± 11 [range, 11-99 years]; 4464 males). The CT and DSA images were reviewed to evaluate the visceral arterial anatomy for variations in the celiac axis and hepatic arteries. Aberrant right hepatic arteries (aRHAs) and aberrant left hepatic arteries (aLHAs) were defined on the basis of their origin and anatomic course. Statistical analyses were performed to evaluate the association between aRHAs and aLHAs and the association between variations in the hepatic artery and celiac axis. Right hepatic arteries were categorized as being aRHAs (if originating from the proximal to middle common hepatic artery, gastroduodenal artery, superior mesenteric artery [SMA], celiac axis, aorta, splenic artery, or left gastric artery [LGA]) or as being aLHAs (if arising from the LGA, celiac axis, aorta, or SMA). The prevalence of aRHAs (15.63%; 879 of 5625) and the prevalence aLHAs (16.32%; 918 of 5625) were similar. Patients with an aRHA were more likely to have an aLHA than those without an aRHA (29.01% vs 13.97%; P < .001), and patients with an aLHA were more likely to have an aRHA than those without an aLHA (27.78% vs 13.26%; P < .001). There was no association between the hepatic arterial variations and celiac axis variations. A hypothetical anatomic model summarizing the observed variations was created. A comprehensive list of hepatic arterial variations and a three-dimensional hypothetical model for the observed variations were described.Keywords: CT, Angiography, Liver, Anatomy, Arteries© RSNA, 2021 Supplemental material is available for this article. See also commentary by Sutphin and Kalva in this issue.

Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience.

The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed. The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.