Kinds Of Lesions Research Articles

Individual Management of Recurrent Intracranial Aneurysms: The Wuxi Experience

Recurrent intracranial aneurysms can occur after either surgical clipping or endovascular therapy. In this article, we present a consecutive series of 18 patients who underwent individual treatment for recurrent aneurysms after primary coil embolization or surgical clipping. During an 8-year period between May 1997 and December 2005, 18 patients underwent individual treatment for recurrent aneurysms. Clinical data and imaging studies of the patients were analyzed retrospectively. Out of the 18 patients, 13 had recurrent aneurysms located in the anterior circulation, and 5 had aneurysms of the posterior circulation. Treatment consisted of coiling in 16 patients and clipping in two patients. Of the 18 patients, 15 achieved a good or excellent recovery, two were paralyzed, and one died post-treatment. Both the surgical clipping and endovascular embolization for the treatment of recurrent intracranial aneurysms can achieve very good radiological results with low mortality rates. One of the key points for the successful treatment of this kind of lesions is the proper, individual, and interdisciplinary patient selection.

Breast Fibromatosis after Hydrophilic Polyacrylamide Gel Injection for Breast Augmentation: a Case Report and Review of the Literature

REAST fibromatosis is a rare kind of lesion. The average incidence is about 2-4 per million every year. So far there have been about 100 cases reported altogether. In this report, we describe a case of breast fibromatosis developed after hydrophilic polyacrylamide gel (HPG) injection for breast augmentation. By reviewing the literature, the possible pathogenesis of this case and the proper treatment strategy are investigated.

Differential diagnosis of cystic lesions in different cervical regions on multiple-slice spiral CT

Objective To evaluate the value of MSCT in differentiate cystic lesions in different cervical region. Methods Forty cases with cyst lesions in the neck which was confirmed by pathology were collected in our study. The following diseases were excluded: cystic lesions from thyroid gland and thymus or bronchus, cystic changes of solid lesions ( necrotic lymph node) and cystic or solid lesions in the parotid gland. All patients underwent MSCT scan on GE Lightspeed 16. The parameters were following: 120 kV,260 mA, thickness 5 mm, pitch 1. 375. The delay time for contrast enhanced CT was 25 seconds for arterial phase and 60 seconds for vein phase. Results Lesions were analyzed in 4 different cervical regions including parotid gland, midline, lateral cervix and posterior cervix. Among the lesions in parotid area,2 were first brachial cyst and the other 2 were epidermoid cyst. First brachial cyst occurred intraparotid gland and epidermoid cyst occurred intraparotid or extraparotid gland. Among the lesions in midline area, 17 cases were thyroglossal cysts,81.0% were in the level hyoid bone, 12 cases of thyroglossal cysts protruded at the preepiglottic space or oral base. Another kind of lesions in midline included 3 cases of epiglottic cysts and 1 epidermoid cyst in the lower level of the neck which involved infrasternal level. The 12 cases of second brachial cysts occurred in the lateral neck. Ten cases were in the left side. Type Ⅱ was the most common type and account for 5 cases among all of second brachial cysts. Type Ⅰ and type Ⅱ were running up,accounting 3 cases respectively. Type Ⅳ account for 1 case. Two cases with lymphangioma and 1 case with third brachial cyst located at the posterior neck. Conclusion According to the location and typical imaging appearance, MSCT can do the differentiation of different cystic lesions in the different area of neck. Key words: Cysts; Head and neck neoplasms; Tomography,X-ray computed

Quiste aracnoideo espinal epidural postraumático: presentación de un caso

Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases. The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma. Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.

Couverture de pertes de substance du tibia distal par lambeau pédiculé perforant en hélice : deux cas cliniques

Distal lower leg soft tissue defect is frequently a challenge to repair, particularly on the tibial crest. The coverage of this kind of lesion has some limitations because of regional minimal blood supply and paucity of local soft-tissue flaps. The perforator pedicled propeller (PPP) method tries to find a new place in lower leg reconstruction in bringing similar tissues at the recipient site and avoiding long and difficult free flap transfer or muscular sacrifice. The authors report on the use of PPP method for a tibial crest exposure after trauma and for a soft tissue defect with osteomyelitis on the tibial crest.

Therapeutic strategy for intrasellar cystic lesions

To make a clear distinction of intrasellar cystic lesions: craniopharyngioma (CR), Rathke's cleft cyst (RCC), cystic pituitary adenoma (PA) and intrasellar arachnoid cyst (AC). A total of 72 adult patients underwent transsphenoidal approach for the removal of intrasellar cystic lesions. The authors conducted a study to (1) investigate preoperative clinical, biochemical and radiographic features of patients with CR, RCC, PA and AC; (2) identify clinicopathological features of independently predicting recurrence in CR, PA and RCC in adults. These adult patients included CR (n = 10), RCC (n = 27), cystic PA (n = 32) and 1 patient with AC (n = 1). The CR patients presented with hypopituitarism in 80% of cases. According to the biochemical criteria, the percentage of patients with a slight prolactin increase happened in PA (55.6%) and RCC (44.4%). Cystic PA had post-contrasting enhancement in cyst wall because of tumor tissue. Calcification detectable on computed tomographic scanning was present in 70% of CR patients. It was a significantly greater proportion compared to other diseases. Typical RCC was located between anterior and posterior pituitary and the contents in RCC were variable. Mass effects vanished post-operatively in all kinds of lesions. Long-term hormone replacement therapy was administered more in CR patients (60%) and diabetes insipidus than other lesions. One PA patient and 2 CR patients had recurrence during a follow-up of 12 - 52 months (mean: 34). RCC and AC had no recurrence. Craniopharyngioma, Rathke's cleft cyst, cystic pituitary adenoma and intrasellar arachnoid cyst are a spectrum of diseases with different therapeutic strategies. An accurate diagnosis of these lesions is essential so as to determine the type of treatment to improve outcome.

Transcription-coupled nucleotide excision repair of a gene transcribed by bacteriophage T7 RNA polymerase in Escherichia coli

Transcription-coupled nucleotide excision repair (TC-NER) removes certain kinds of lesions from the transcribed strand of expressed genes. The signal for TC-NER is thought to be RNA polymerase stalled at a lesion in the DNA template. In Escherichia coli, the stalled polymerase is dissociated from the lesion by the transcription repair coupling factor (Mfd protein), which also recruits excision repair proteins to the site resulting in efficient removal of the lesion. TC-NER has been documented in cells from a variety of organisms ranging from bacteria to humans. In each case, the RNA polymerase involved has been a multimeric protein complex. To ascertain whether a gene transcribed by the monomeric RNA polymerase of bacteriophage T7 could be repaired by TC-NER, we constructed strains of E. coli in which the chromosomal lacZ gene is controlled by a T7 promoter. In the absence of T7 RNA polymerase, little or no β-galactosidase is produced, indicating that the E. coli RNA polymerase does not transcribe lacZ efficiently, if at all, in these strains. By introducing a plasmid (pAR1219) carrying the T7 gene 1 under control of the E. coli lac UV5 promoter into these strains, we obtained derivatives in which the level of T7 RNA polymerase could be regulated. In cultures containing upregulated levels of the polymerase, β-galactosidase was actively produced indicating that the T7 RNA polymerase transcribes the lacZ gene efficiently. Under these conditions, we observed that UV-induced cyclobutane pyrimidine dimers were removed more rapidly from the transcribed strand of lacZ than from the nontranscribed strand, supporting the conclusion that TC-NER occurred in this gene. This response was absent in an mfd-1 mutant, indicating that the underlying mechanism may be similar to that for the bacterial RNA polymerase.

Erythema ab igne

An 86-year-old woman was referred to our Clinic because of a new onset of anaemia. She was under treatment with warfarin for chronic atrial fibrillation. The INR at admission was 4.1. Her caregiver excluded hematemesis or melena, and assured no NSAID had been taken. She appeared pale and was haemodynamically stable. A wellmarked, reddish-brown, netlike discoloration of the skin, with clear-cut margins was present on the anterior and medial surfaces of both thighs (Fig. 1). This kind of lesion was not present in any other body areas. Physical examination was otherwise normal. Routine blood examination revealed the presence of a microcytic anaemia (haemoglobin 7.8 g/dL; mean corpuscular volume 60.8 fL) with iron deficiency (serum iron 20 lg/ dL; serum ferritin 30 lg/L). The erythrocyte sedimentation rate appeared high (75 mm/h). Lupus anticoagulant panel, antinuclear antibodies, Coombs tests, cryoglobulins and antiHCV antibodies were normal. Haptoglobin levels were normal. Esophagogastroduodenoscopy showed a sliding hiatal hernia with erosive esophagitis. The patient reported that the skin discoloration had appeared on her thighs many years before, and was chronic and stable. She added she would usually keep a hot water bottle on her thighs. It is to be noted that the extension of the lesion corresponded to the surface of the water bottle. Therefore, the skin discoloration and anaemia likely had no relationship. In fact, the anaemia was secondary to erosive esophagitis, and was treated with iron supplementation and proton pump inhibitors.

Atypical dento-alveolar fracture fixed with screws: a technical note

Dento-alveolar process fracture is an important and common event in the dental office practice usually managed under the well-established protocols, but sometimes this kind of lesion is evaluated in the hospital emergency rooms without attention to the dental injuries. In this type of trauma, the time between the injury and the definitive resolution is essential for the treatment success, usually 1 h in cases of dento-alveolar fractures (tooth and alveolar bone). This paper describes the management of a patient with unusual dento-alveolar fracture caused by gunshot and treated using screw fixation.

Gingival Mucinous Adenocarcinoma of a Minor Salivary Gland

A 47-year-old male non-smoker with a history of psoriasis sought a consultation because of a painless, hard-on-palpation, 1-cm exophytic lesion with a smooth and speckled surface located on the hard palate adjacent to tooth #12. The radiologic examination revealed no bone destruction. The lesion was clinically diagnosed as a fibrous hyperplasia or chronic pyogenic granuloma. The lesion was surgically removed, fixed in 10% neutral buffered formalin for 24 hours, and, following common practice, embedded in paraffin. Sections, 4 mum thick, were stained with hematoxylin and eosin, periodic acid-Schiff, and alcian blue, pH 2.5. An immunohistochemical study was also performed. A definitive diagnosis of a mucinous adenocarcinoma (MAC), a very rare, high-grade malignancy tumor that more frequently appears in the elderly, was made. With the definitive diagnosis of an MAC of the palate, the upper-left premolars were extracted using a box osteotomy, and the surgical wound was reconstructed with a Bichat fat-pad flap. After a 6-month follow-up, no recurrence or cervical metastases were identified. An MAC of a minor salivary gland may arise as a gingival exophytic lesion with a clinical appearance similar to a pyogenic granuloma. The existence of a light speckled pattern on the surface of the lesion indicates that an incisional biopsy is needed before surgical treatment to make possible a definitive diagnosis. To avoid delays in diagnosis and erroneous clinical approaches to exophytic gingival lesions, periodontists and practitioners should routinely perform a pathologic analysis to confirm the diagnosis when dealing with these kinds of lesions.

The evaluation of psychiatric drug therapy on oral lichen planus patients with psychiatric disorders

Current treatments of oral lichen planus are palliative, not curative. Because psychiatric disorders significantly influence the development and severity of oral lichen planus, the use of psychiatric drug therapy may be an adjunct in treatment. The purpose of this study was to determine the efficacy of drug therapy of psychiatric disorders in oral lichen planus. Our controlled clinical study consisted of forty-six patients with oral lichen planus and psychiatric disorders who were randomly divided into two groups. Both groups were given topical corticosteroids and the study group received additional psychiatric drug therapy. Patients were monitored for a period of 6 months. Response to treatment was evaluated in each group and was compared with the other group using Mann-Whitney tests. We evaluated the correlation between psychiatric disorders and the recovery of oral lesions using Spearman's correlation coefficient analysis. Decrease in the size of the lesions was significantly greater in the study group after six months, but this difference was not significant in relationship to the pain experienced and the kind of lesion. Spearman's correlation coefficient analysis demonstrated that, in the sixth month, there was a significant and direct relationship between recovery from the psychiatric disorders and response to treatment of OLP lesions, particularly as it pertained to the kind of lesion. The present study indicates that the combination of psychiatric drug therapy and routine treatment methods were effective in reducing the size of the lesions, but did not have any significant effect on the symptoms.

Tuberculosis of the Renal Artery: A Rare Cause of Renovascular Arterial Hypertension

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.

ADEQUAÇÃO NAS MEDIDAS DO CASCO ASSOCIADO AO TRAMENTO CIRÚRGICO E APLICAÇÃO TÓPICA DO EXTRATO DA CASCA DO BARBATIMÃO (Stryphnodendron barbatiman Martius) NA RECUPERAÇÃO DE BOVINOS DA RAÇA NELORE COM DERMATITE DIGITAL

Digital dermatitis is a multifactor disease that has various kinds of lesions, therefore requiring different treatment and control protocols. Clinical injuries of 180 Nelore cattle with digital dermatitis were assessed. Cows were randomly distributed in 6 groups of 30 animals each and submitted to the process of hoof care, in which lesions were surgically removed and then treated with 5% barbatimao extract and 3% copper sulfate solutions. Hoof health management varied across groups: trimming of injured claws only (Groups I and III); trimming of both healthy and injured claws from affected hooves only (Groups III and IV); and trimming of all claws from healthy and affected hooves (Groups V and VI). During the post-surgery period, wounds were treated with a 5% barbatimao extract solution (Groups I, III and V), and 3% copper sulfate pediluvium (Groups GII, GIV and GVI). Data was statistically analyzed through a chi-square test at p<0,05 significance level. Highest recovery rates were observed after therapeutic treatment, which included trimming of healthy and lesioned hooves, surgical treatment of the injuries, and barbatimao extract application.

Congenital lung malformation: Evaluation of prenatal and postnatal radiological findings

This study evaluated the accuracy of prenatal MRI and postnatal CT imaging in the identification of congenital cystic adenomatoid malformation and bronchopulmonary sequestration by comparison with histological analysis. Over a 3-year period, 15 patients with lung malformations diagnosed prenatally by ultrasound were referred for prenatal MRI, and all were investigated postnatally by chest CT. All asymptomatic newborns with unresolved lesions underwent elective surgery by thoracoscopy. All surgical specimens were analysed histologically. Among the 15 patients with an abnormality diagnosed by ultrasound, prenatal MRI findings differed from the final histological diagnosis with respect to extent (n = 3), type of lesion (n = 1) and aberrant vessel identification (n = 4). Postnatal chest CT failed to visualize the aberrant vessel in one patient. Complete regression of the lesion was noted in two patients with bronchopulmonary sequestration, and in one patient with congenital cystic adenomatoid malformation and was confirmed by CT. Elective thoracoscopic lobectomy of the affected lobe was performed for 12 patients. Two conversions to thoracotomy were required. All operated patients had an uneventful hospital course. Prenatal MRI is less accurate than postnatal CT scan, which remains the most reliable diagnostic modality to specify the location and extent and kind of lesions.

Interventional endoscopic ultrasonography

Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.

Common Clinical Manifestations of Human Papilloma Virus (HPV) Infection

The Papillomaviruses are DNA viruses which belong to the Papova family, having a great affinity for epithelial tissue. They can produce proliferative lesions either in the skin or mucosa, either in man or other animals. Various kinds of lesions, mainly benign, are caused by numerous types of human papillomavirus (HPV) involving the well-known verruca vulgaris, respiratory laryngeal papillomatosis, condylomata acuminata and focal epithelial hyperplasia, as well as a possible association with other alterations and lesions.

Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management

The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.

Spontaneous mutagenesis associated with nucleotide excision repair in Escherichia coli

The vast majority of spontaneous mutations occurring in Escherichia coli are thought to be derived from spontaneous DNA lesions, which include oxidative base damage. Systems for removing intrinsic mutagens and repairing DNA lesions contribute to the suppression of spontaneous mutations. Nucleotide excision repair (NER) is a general DNA repair system that eliminates various kinds of lesions from DNA. We therefore predicted that NER might be involved in suppression of spontaneous mutations, and analyzed base substitutions occurring spontaneously within the rpoB gene in NER-proficient (wild-type), -deficient and -overproducing E. coli strains. Surprisingly, the mutation frequency was lower in NER-deficient strains, and higher in NER-overproducing strains, than in the NER-proficient strain. These results suggest, paradoxically, that NER contributes to the generation of spontaneous mutation rather than to its suppression under normal growth conditions, and that transcription-coupled repair also participates in this process. Using E. coli strains that carried an editing exonuclease-deficient polA mutation, we further obtained data suggesting that unnecessary NER might account for these findings, so that errors introduced during repair DNA synthesis by DNA polymerase I would result in unwanted base substitutions. The repair system itself may thus be an important generator of spontaneous mutation.

Impact of Intramural Thrombus in Coronary Arteries on the Accuracy of Tissue Characterization by In Vivo Intravascular Ultrasound Radiofrequency Data Analysis

Virtual Histology (VH) intravascular ultrasound (IVUS) allows differentiation between 4 different tissue phenotypes. However, the current classification tree for analysis cannot differentiate the presence of intramural thrombus. The aim of this study was to evaluate the impact of intramural thrombus for correlative accuracy between in vitro histopathology of coronary atherosclerotic plaque obtained by directional coronary atherectomy and corresponding in vivo tissue characterization obtained by VH IVUS. Coronary IVUS imaging of 30 coronary artery lesions was obtained using a 20-MHz phased-array IVUS catheter with a motorized pull-back system at set 0.5 mm/s. The debulking region of the in vivo histologic image was predicted from comparison between pre- and post-first debulking VH IVUS images. Cross-sectional histologic slices were cut every 0.5 mm starting from the most proximal part of the formalin-fixed debulking tissue. Histologic slices were divided into 2 groups by the presence or absence of pathologic thrombus. A total of 259 in vitro histologic slices were obtained, and pathologic thrombus was detected in 81 slices. Correlation was favorable, with high sensitivity for all plaque components, but specificities for fibrous (thrombus slices vs nonthrombus slices 36% vs 94%) and fibrofatty (9% vs 60%) tissue were lower in thrombus slices. Therefore, predictive accuracies for the 2 plaque components were lower in thrombus slices (fibrous tissue 78% vs 99%, fibrofatty tissue 68% vs 83%, respectively). In conclusion, intramural thrombus was colored as fibrous or fibrofatty by VH IVUS, reducing VH accuracy in these kinds of lesions.

How to Cope with DNA Damage Induced by Ionizing Radiation and Anti-Cancer Drugs?

Ionizing radiation and chemotherapeutic agents induce many types of DNA lesions, of which DNA double-strand breaks (DSBs) are assumed to be the most deleterious. DNA damage response mechanisms encompass pathways of DNA damage signaling, DNA repair, cell cycle checkpoint arrest, and apoptosis. Increasing evidence suggests that these pathways function co-operatively to maintain genomic stability in the face of exogenous and endogenous DNA damage. The relative impact of one mechanism over another probably depends on the kinds of lesions, the cell cycle phase, and the cell or tissue type. The inability to respond properly to or to repair DSBs may lead to hypersensitivity to DNA damaging agents and genomic instability including chromosomal aberrations. Chromosomal instability, a state of continuous accumulation of chromosomal change, is a common feature of many human cancers and of chromosome instability syndromes with increased cancer susceptibility. Here, we review the DNA damage response and the links between deficiencies in response to DSBs and chromosomal instability.