Marked Irregularity Research Articles

Cytomorphologic analysis of pulmonary neuroendocrine tumors – The physical effect of abrasion and aspiration on cytomorphology

Neuroendocrine tumors of the lung display characteristic cytomorphologic features allowing direct diagnosis. The specificity of these features in distinguishing subtypes of neuroendocrine tumors, and their differences among types of cytologic specimen poses as interpretative potential pitfalls. This study reviewed and compared bronchial, effusion fluid and fine-needle aspiration cytology specimens of neuroendocrine tumors of the lung to address these issues. Histology-proven cytology specimens of neuroendocrine tumors were reviewed for cytomorphological parameters focusing on reported specific neuroendocrine nuclear and background features. Totally, 46 cases (26 bronchial, 11 effusion and 9 aspirate specimens), corresponding to 37 small cell carcinomas, 7 neuroendocrine carcinomas and 2 carcinoids were reviewed. Nuclear moulding (n = 35/37, 95 %), naked nuclei (n = 33/37, 89 %) and marked nuclear irregularity (n = 32/37, 86 %) were the three most common features of small cell carcinoma. The only specific feature for small cell carcinoma was the lack of prominent nucleoli (p = 0.004). For pulmonary carcinoids, in addition to the above features, other features associated with neuroendocrine carcinoma reviewed including crush artifact and necrotic material were absent. Compared to bronchial and aspiration cytology, crush artifact (p < 0.001) and necrotic material (p = 0.014) were absent on effusion fluid specimens and naked nuclei were less frequently seen (p = 0.022), while prominent nucleoli were more often observed (p = 0.005). Nuclear moulding, irregularity and naked nuclei are common but not unique features to small cell carcinomas. Effusion fluid specimens have “cleaner” backgrounds while displaying greater nuclear atypia. The type of cytologic preparation/specimen is an important factor which must be considered during diagnostic interpretation.

A Case Study of a High-Grade Serous Carcinoma of the Fallopian Tube Transformed into Carcinosarcoma at the Site of Peritoneal Dissemination With Immunohistological Evidence of an Epithelial-Mesenchymal Transition.

We report a patient in whom a primary high-grade serous carcinoma (HGSC) of the fallopian tube transformed into a carcinosarcoma at the site of peritoneal dissemination, and immunohistological analysis suggested the involvement of an epithelial-mesenchymal transition (EMT). The patient, a 70-year-old woman, had an abdominal mass palpated on admission, and a laparotomy was performed after a close examination. The resected right fallopian tube was cystically dilated, and a solid mass was observed in its lumen. The histological diagnosis was HGSC of the right fallopian tube with a papillary or complex tubular structure composed of tumor cells with marked nuclear irregularities. p53 was overexpressed, and no mesenchymal tumor component was observed. The resected left-sided abdominal mass of the omentum was a solid with a long diameter of 100 mm. Microscopically, the tumor exhibited a mixture of HGSC and high-grade sarcoma with nonspecific differentiation. Furthermore, a heterologous chondrosarcoma was subsequently observed from the high-grade sarcoma. The HGSC component was E-cadherin positive. The high-grade sarcoma component was positive for EMT-related proteins such as zinc finger E-box-binding homeobox 1 (ZEB1) and twist family bHLH transcription factor 1 (TWIST1). The chondrosarcoma component was ZEB1 positive and TWIST1 negative. p53 overexpression was found in all 3 components. The tumor of the omentum suggested that an EMT phenomenon was involved in the tumorigenesis. In this scenario, the primary HGSC of the fallopian tube with obvious invasion demonstrated that the conversion from carcinoma to sarcoma by EMT occurs only with peritoneal dissemination.

The Spaghetti Sign: Nerve Root Redundancy in Lumbar Spinal Stenosis

Redundant nerve roots (RNRs) seen in conjunction with lumbar spinal stenosis (LSS) are well-described radiographic findings. Several studies suggest their presence may be a negative prognostic indicator of postoperative outcome. Our hypothesis was that severe RNR (informally known as the spaghetti sign [SS]) can serve as a reliable marker of LSS that would benefit from surgical decompression. We sought to evaluate a grading scale for RNR, characterize the association with stenosis, and investigate the clinical implications of RNR. We conducted a retrospective chart review of 72 patients who underwent lumbar spine surgery from 2016 to 2018 at 1 institution. Preoperative T2 magnetic resonance imaging scans were graded by 3 reviewers for severity of stenosis (0-4), severity of RNR (0-3), and rostral versus caudal RNR. SS was defined as RNR score ≥2 (clear-cut or marked nerve root irregularity). Preoperative and postoperative Oswestry Disability Index scores were analyzed by stenosis and RNR severity. Seventy-one (98%) patients had severe stenosis (score ≥3) and 25 (35%) had a SS. SS was 100% specific for high-grade stenosis. If patients had a SS, it was more likely rostral (P=0.02). Postoperative Oswestry Disability Index scores improved significantly, but there were no differences related to RNR score, presence of SS, or stenosis severity. The study demonstrated that there is a significant association between SS and severe LSS and that presence of RNR is not a negative prognostic indicator for postoperative outcomes.

Long-term 4-nonylphenol exposure drives cervical cell malignancy through MAPK-mediated ferroptosis inhibition

4-NP (4-nonylphenol), a prevalent environmental endocrine disruptor with estrogenic properties, is commonly detected in drinking water and food sources. It poses a significant risk of endocrine disruption, thereby influencing the onset and progression of diverse diseases, including tumorigenesis. However, its specific impact on cervical cancer remains to be fully elucidated. Our study focused on the biological effects of sustained exposure to low-dose 4-NP on human normal cervical epithelial cells (HcerEpic). After a continuous 30-week exposure to 4-NP, the treated cells exhibited a significant malignant transformation, whereas the solvent control group showed limited malignant phenotypes. Subsequent analyses of the metabolomic profiles of the transformed cells unveiled marked irregularities in glutathione metabolism and unsaturated fatty acid metabolism. Analyses of transcriptomic profiles revealed significant activation of the MAPK signaling pathway and suppression of ferroptosis processes in these cells. Furthermore, the expression of MT2A was significantly upregulated following 4-NP exposure. Knockdown of MT2A restored the aberrant activation of the MAPK signaling pathway, elevated antioxidant capacity, ferroptosis inhibition, and ultimately the development of malignant phenotypes that induced by 4-NP in the transformed cells. Mechanistically, MT2A increased cellular antioxidant capabilities and facilitated the removal of toxic iron ions by enhancing the phosphorylation of ERK1/2 and JNK MAPK pathways. The administration of activators and inhibitors of the MAPK pathway confirmed that the MAPK pathway mediated the 4-NP-induced suppression of ferroptosis and, ultimately, the malignant transformation of cervical epithelial cells. Overall, our findings elucidated a dynamic molecular transformation induced by prolonged exposure to 4-NP, and delineated comprehensive biological perspectives underlying 4-NP-induced cervical carcinogenesis. This offers novel theoretical underpinnings for the assessment of the carcinogenic risks associated with 4-NP.

Suitability of Slaughterhouse-Acquired Pig Eyes as Model Systems for Refractive Ultraviolet and Infrared Femtosecond Laser Research

Purpose To elucidate whether it is feasible to use porcine eyes from scalded, abattoir-acquired animals for refractive femtosecond laser research. Methods An infrared laser (FS 200) and an ultraviolet laser (prototype version) were tested for their applicability on scalded pig eyes. Fifty porcine eyes were divided into two equally-sized groups and assigned to either the infrared or the ultraviolet laser. Both laser groups were comprised of five subgroups of n = 5 eyes each. Group A: non-scalded eyes (negative control); group B: eyes taken from tunnel-scalded animals; group C1: eyes taken from tank-scalded animals without opaque corneal lesion; group C2: eyes taken from animals with opaque corneal lesion; group D: eyes scalded in toto in the laboratory (positive control). In each group the lasers were employed to create a stromal flap. The quality of the laser cuts and the resulting flap beds, as well as of the porcine corneas themselves, was examined by anterior segment optical coherence tomography and scanning electron microscopy. Results All scalded specimens exhibited substantial corneal swelling, most pronounced in group C2. After ultraviolet laser application, the tank- and tunnel-scalded samples displayed marked irregularities and an increased degree of surface roughness in the flap beds. After infrared laser application, this was only the case in the tank-scalded specimens. Conclusion It is not recommended to use eyes taken from scalded pigs for ultraviolet femtosecond laser experiments. For infrared femtosecond lasers, eyes taken from tunnel-scalded animals may represent an acceptable alternative, if non-scalded eyes are not available.

Liposarcoma Involving Serous Fluid Cavities-A Case Series Illustrating Clinical Implications and the Diagnostic Role of Exfoliative Cytology.

Introduction: Cytological diagnosis of sarcomas requires detailed cytomorphological assessment and integration of immunocytochemistry and/or molecular testing. The role of exfoliative cytology, as compared to aspiration cytology, is less understood. This case series describes well-differentiated/dedifferentiated liposarcomas in effusions, with cytomorphological features, ancillary test results and clinical outcomes detailed. Methods: A computerized search of the department pathology archives was performed for sarcomatous effusions with histological diagnosis or clinical history of well-differentiated/dedifferentiated liposarcoma. Clinical progress, cytology slides, immunocytochemistry and molecular test results were reviewed. Results: Six patients were identified. In 5 patients with clinical follow up, 4 (80%) were deceased within 5 months of malignant effusion. One patient was alive with 12 years disease-free survival after radical resection with adjuvant radiotherapy. Three patients showed dedifferentiation on histology, and high-grade (dedifferentiated) tumor cells were present in effusion cytology of 2 patients. Two showed well-differentiated components only on biopsy, but high-grade (dedifferentiated) tumor cells were identified in cytology. The high-grade tumor cells displayed marked nuclear irregularity, enlargement, size variation, with macronucleoli and multinucleation. Well-differentiated lipomatous components were demonstrated in 4 patients (66.7%), comprising of multivacuolated lipoblasts and atypical lipocytes. CDK4 and MDM2 immunoreactivity in all 3 cases with cell blocks, and CDK4 and MDM2 amplification in one were successfully demonstrated. Conclusion: Lipomatous and dedifferentiated components can be sampled and cytomorphologically identified on effusion fluids of liposarcomas, with sufficient cellularity for immunocytochemistry and molecular testing. Although generally associated with poor prognosis, long disease-free survival with sarcomatous effusion is possible with radical surgery and adjuvant treatment.

Nuclear membrane irregularity in high-grade urothelial carcinoma cells can be measured by using circularity and solidity as morphometric shape definitions in digital image analysis of urinary tract cytology specimens.

The Paris System for Reporting Urine Cytology defines objective (elevated nuclear/cytoplasmic ratio ≥0.7) and subjective (nuclear membrane irregularity, hyperchromicity, and coarse chromatin) cytomorphologic criteria to identify conventional high-grade urothelial carcinoma (HGUC) cells. Digital image analysis allows quantitative and objective measurement of these subjective criteria. In this study, digital image analysis was used to quantitate nuclear membrane irregularity in HGUC cells. Whole-slide images of HGUC urine specimens were acquired, and HGUC nuclei were manually annotated using the open-source bioimage analysis software QuPath. Custom scripts were used to calculate nuclear morphometrics and perform downstream analysis. In total, 1395 HGUC cell nuclei were annotated across 24 HGUC specimens (48.1±6.0 nuclei per case) using both pixel-level and smooth annotation approaches. Nuclear membrane irregularity was estimated by calculating nuclear circularity and solidity. Annotating at pixel-level resolution artifactually increases nuclear membrane perimeter, thus smoothing is necessary to better approximate a pathologist's assessment of nuclear membrane irregularity. After smoothing, nuclear circularity and solidity discriminate between HGUC cell nuclei with visually apparent differences in nuclear membrane irregularity. Nuclear membrane irregularity defined by The Paris System for Reporting Urine Cytology is inherently subjective. This study identifies nuclear morphometrics that visually correlate with nuclear membrane irregularity. HGUC specimens show intercase variation in nuclear morphometrics, with some nuclei appearing remarkably regular while others show marked irregularity. A small population of irregular nuclei generates most of the intracase variation in nuclear morphometrics. These results highlight nuclear membrane irregularity as an important, but not definitive, cytomorphologic criterion in HGUC diagnosis.

Morphologic vascular anomalies detected during migraine surgery.

Although there is increasing evidence of migraine headaches having extracranial origins, the exact mechanisms underlying the pathogenesis of surgically treated migraines continue to be poorly investigated and described. We studied the microscopic and ultrastructural characteristics of superficial temporal artery (STA) and occipital (OA) artery in the auriculotemporal and great occipital trigger points of migraine patients to determine their possible role in migraine etiopathogenesis. Fifteen biopsies, 10 of STA and 5 from OAs, were collected intraoperatively during migraine surgery and immediately processed for optical and ultramicroscopic analysis. We detected the following anomalies in all the specimens: (a) endothelial damage with internal elastic lamina fragmentation and intimal thickening; (b) marked irregularity in the shape and metachromasia of the vascular smooth muscle cells (VSMCs), separation of cells by abundant extracellular matrix and vacuoles. The electron microscopy analysis confirmed that presumed VSMCs infiltrated the intima layer revealing a consistent shift of VSMCs from contractile to synthetically active phenotypes, endosome-like organelles, multilamellar structures, abundant extracellular vacuoles filled with fine granular material and membranes, and extracellular vesicles in the matrix space surrounding synthetically active cells. Our study revealed specific alterations in the vasculature at the neurovascular bundles of the temporal and occipital trigger sites. These findings are indicative of an active involvement of the arteries in the auriculotemporal and great occipital trigger sites in evoking migraine.

Impaired muscle strength is associated with ultrastructure damage in myositis

The muscle fiber ultrastructure in Idiopathic Inflammatory Myopathies (IIM) has been scarcely explored, especially in Inclusion Body Myositis. The aim of this study was to implement the Scanning Electron Microscopy (SEM) in a small cohort of IIM patients, together with the characterization of immunological profile for a better understanding of the pathophysiology. For immunological profile characterization, we identified the presence of autoantibodies (Ro-52, OJ, EJ, PL7, PL12, SRP, Jo-1, PMScl75, PMScl100, Ku, SAE1, NXP2, MDA5, TIF1γ, Mi-2α, Mi-2β) and quantified cytokines (IL-1β, IFN-α2, IFN-γ, TNF-α, IL-6, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33) and chemokines (CCL2, CXCL8). The histological analysis was made by hematoxylin–eosin staining while the muscle fiber ultrastructure was characterized by SEM. We observed changes in the morphology and structure of the muscle fiber according to muscle strength and muscle enzymes. We were able to find and describe muscle fiber ultrastructure with marked irregularities, porosities, disruption in the linearity and integrity of the fascicle, more evident in patients with increased serum levels of muscle enzymes and diminished muscle strength. Despite the scarce reports about the use of SEM as a tool in all clinical phenotypes of IIM, our work provides an excellent opportunity to discuss and reframe the clinical usefulness of SEM in the diagnostic approach of IIM.

Shohat type-spondyloepimetaphyseal dysplasia: Further phenotypic delineation

Spondyloepimetaphyseal dysplasia-Shohat type (SEMDSH) is an ultra-rare type of skeletal dysplasia. Only nine patients from six families have been reported and genetically confirmed to have biallelic pathogenic variants in the DDRGK1 gene. We present a patient with typical clinical features of the disorder, including disproportionate short-limbed short stature, short neck, short chest with pectus carinatum, exaggerated lumbar lordosis and marked genu vara. Our patient further showed microcephaly, unilateral choanal atresia and antenatal fractures, features that were not reported before in association with this disorder. Radiological changes over time were presented, including delayed epiphyseal ossification, broad metaphysis with marked irregularities that progressed with age, fibular overgrowth, and characteristic spine changes with early platyspondyly and squaring of vertebral bodies at a later age. Exome sequencing revealed a homozygous pathogenic donor splice site variant in the DDRGK1 gene (NM_023935.3:c.408+1G > A). This mutation was also previously identified in patients from Iraqi descent. Our study expands the phenotypic spectrum of SEMDSH, emphasizes the radiological changes with age in SEMDSH patients, and recommends prolonged follow-up for these cases better to delineate the phenotype and surveillance for possible complications.

Mucopolysaccharidosis Type I in a Dog

Background: Mucopolysaccharidoses (MPS) are a group of rare illnesses caused by deficient activity of enzymes required for degradation of glycosaminoglycans (GAGs). Each type of MPS is caused by mutations in one of the genes that encode the 11 acid hydrolases involved in this degradation process, which are present in the lysosomes. Progressive accumulation of GAGs in the lysosomes result in cellular dysfunction and multisystemic clinical signs, with consequent decrease in quality of life and lifespan of the affected patients. The objective of the present work is to report a case of MPS type I in a dog.Case: A mixed-breed male dog of approximately 2-month-old weighing 2.5 kg was referred to Hospital Veterinário de Uberaba with a distended abdomen. At the clinical examination, the patient exhibited a regular nutritional status, pale mucous membranes, 7% dehydration, an arterial pulse rate of 120 beats per minute, a respiratory rate of 40 breaths per minute, and a heart rate of 120 beats per minute. There were increased abdominal volume and tension, and hepatosplenomegaly. The abdominal percussion exam produced a dull tone. Additional findings included muscular atrophy, increased volume in the metaphyseal areas of the thoracic and pelvic limbs, valgus limb deformity in the thoracic limbs, and instability of the hip joint. Radiographic examination revealed a series of bone alterations such as reduced vertebral bodies, a generalized decrease in radiopacity, thin cortical areas in long bones, narrowing of the pelvic canal, and marked deformation and irregularities in acetabular and epiphyseal (both proximal and distal) areas of the femurs and tibias. Ankylosis of the tibiotarsal and tarsometatarsal joints was also observed. There was also loss of trabecular structure and irregularities on the surfaces of all epiphyses of the bones, epiphyseal lines markedly open, and bones that were shorter and thicker than normal. The suspected diagnoses were pseudoachondroplasia and mucopolysaccharidosis. In view of the clinical and radiographic findings, tests were performed to investigate the clinical suspicion of MPS. Consequently, qualitative and quantitative tests of GAGs in the urine, as well as a blood enzymatic essay, were requested; results confirmed the diagnosis of MPS type I. Intensive treatment allowed the patient to reach adulthood. Whenever new clinical signs emerged, they were treated palliatively. As the disease became more severe, the patient died at the age of 3 years.Discussion: Mucopolysaccharidosis type I is a rare disease that exhibits variable clinical signs and for which there is no specific treatment in dogs; these characteristics hinder diagnosis and treatment of patients as the one described in this report. The major clinical signs observed in this case are in agreement with those reported in the literature, according to which the disease can cause severe alterations such as bone defects, increased volume and deformities in the joints of the limbs, corneal opacity, and enlargement of abdominal organs such as the liver and spleen. In considering diagnostic methods for MPS, the main screening test is quantification of GAGs in the urine. The confirmatory test for MPS consists of analysis of the activity of specific lysosomal enzymes in a blood sample; this test allowed the establishment of a diagnosis in this case. Enzyme replacement therapy, in which a recombinant enzyme is used, have yielded good results in humans and dogs. However, this treatment does not cure the disease – it only attenuates the clinical signs and enables the patient to reach adulthood. Access to enzyme replacement therapy was not possible in the present case. As a conclusion, MPS should be included in the differential diagnosis of developmental diseases in puppies. This highlights the importance of further studies and reports on this disease.

In-plane strength and stiffness of AAC floor without concrete topping in buildings with AAC masonry infill walls - experimental tests and numerical analyses

The diaphragm action of floors strongly influences the local and global seismic response of a masonry building. The American (ASCE 7-16) and European (EC8) Codes provide few and contrasting indications to classify the floor as 'rigid' or 'flexible'. Moreover, there is limited experience regarding the in-plane behaviour of diaphragms made of aerated autoclaved concrete (AAC) panels, and no specific regulations are available for AAC floors. The assessment of in-plane strength and stiffness of AAC floors without a concrete topping is still an open topic. In this work, in-plane diagonal compression tests on AAC precast panels without a collaborating slab are performed to evaluate the behaviour of AAC floors. Panels having a different thickness and depth of the shear key were considered for testing. The experimental results are then applied to two case study buildings to verify through numerical analyses if they behave as 'rigid' or 'flexible'. Numerical results showed an almost 'rigid' behaviour in terms of stiffness, but the in-plane strength is not always assured in conditions of marked irregularities of the building and high seismic-prone areas.

In-plane strength and stiffness of AAC floor without concrete topping in buildings with AAC masonry infill walls - experimental tests and numerical analyses

The diaphragm action of floors strongly influences the local and global seismic response of a masonry building. The American (ASCE 7-16) and European (EC8) Codes provide few and contrasting indications to classify the floor as 'rigid' or 'flexible'. Moreover, there is limited experience regarding the in-plane behaviour of diaphragms made of aerated autoclaved concrete (AAC) panels, and no specific regulations are available for AAC floors. The assessment of in-plane strength and stiffness of AAC floors without a concrete topping is still an open topic. In this work, in-plane diagonal compression tests on AAC precast panels without a collaborating slab are performed to evaluate the behaviour of AAC floors. Panels having a different thickness and depth of the shear key were considered for testing. The experimental results are then applied to two case study buildings to verify through numerical analyses if they behave as 'rigid' or 'flexible'. Numerical results showed an almost 'rigid' behaviour in terms of stiffness, but the in-plane strength is not always assured in conditions of marked irregularities of the building and high seismic-prone areas.

Diffuse Large B-Cell Lymphoma of the Cervix Diagnosed on Cervical Screening Cytology

Abstract Case Presentation Primary lymphoma of the cervix is an uncommon entity and far more rarely diagnosed on routine screening cervical cytology. We present a case of a 38-year-old female with a 1-year history of heavy cyclical menstrual bleeding and interval spotting. She had no other significant past medical or obstetric history. On cervical exam, obscuring blood was noted without distinct abnormalities of the visualized cervix. Pathologic Findings Cervical cytology by ThinPrep (Hologic, Marlborough, MA) liquid-based cytology preparation demonstrated atypical squamous cells of undetermined significance as well as an abundant population of atypical lymphoid-appearing cells. Morphology of this second population was characterized by large cells (2-3 times the size of background inflammatory cells) with high nuclear-to-cytoplasm ratio, vesicular chromatin, occasional nucleoli, marked nuclear membrane irregularities, and scant cytoplasm. A cell block of the specimen was performed and demonstrated a mature but cytologically large and atypical lymphoid population. Immunohistochemistry on the cell block specimen was consistent with a B-cell immunophenotype with strong CD45 and CD20 immunolabeling. Subsequent radiologic workup showed a diffusely enlarged cervix with increased metabolic uptake, as well as bilateral metabolically active pelvic lymph nodes. Conclusion Cervical and endometrial curettings obtained at an outside facility confirmed the diagnosis of lymphoma that was further categorized as diffuse large B-cell lymphoma, germinal center B-cell type. This case highlights an uncommon diagnosis found on screening cervical cytology. It reinforces awareness of the potential for lymphoid neoplasms on cervical cytology and the differential diagnosis associated with such cases.

Effects of Streptozotocin - Induced Diabetes on the Tongue of Adult Male Albino Rat and the Possible Protective Role of Cod Liver Oil

Introduction: Oral problems are among the common diabetes induced complications. Cod liver oil (CLO) is a rich source of polyunsaturated fatty acids that was found to provide a better control of glucose and lipid metabolism. Aim: to study the histological changes of streptozotocin (STZ) induced diabetes on rat’s tongue and evaluate the possible protective role of CLO. Material and methods: Thirty-six adult male albino rats, aging 4-6 months and weighting 180-200 gm, were used in this study. Animals were divided into three equal groups. Group I: was equally subdivided into three subgroups; subgroup IA: kept as negative control, subgroup IB: received single intraperitoneal injection of citrate buffer and Subgroup IC: received CLO by gastric tube daily for 12 weeks. Group II: received single intraperitoneal injection of STZ to induce diabetes. Group III: diabetes was induced as group II then rats were given CLO daily by gastric tube for 12 weeks. At the end of the experiment for each group, animals were anesthetized and tongues were dissected out and processed for light and scanning electron microscopic examination and immunohistochemical studies. Results: The present study revealed that diabetes induced marked irregularities, flattening and hyperkeratosis of tongue papillae in addition to distortion of the muscle layer. Group III revealed evident improvement of these changes. Conclusion: Obvious diabetes induced changes of tongue histoarchitecture were detected. However, CLO exerted a marked protective role against these changes. Thus, it could be a promising protector against diabetes induced tongue hazards.

How does blood pressure change in hypertensive patients with atrial fibrillation after successful electrical cardioversion?

How does blood pressure change in hypertensive patients with atrial fibrillation after successful electrical cardioversion?

Histological comparison between the anterior capsule integrity in femtosecond laser-assisted capsulotomy and traditional continuous curvilinear capsulotomy in cataract surgeries

Purpose To compare the histological edge structures of anterior lens capsule specimens obtained from laser-assisted cataract surgery capsulotomies using two different laser platforms (LenSx post-soft-fit and Victus II) with that of traditional continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting I-Care Center, Alex Eye Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Design Prospective comparative series. Patients and methods Anterior capsule specimens following CCC (n=15) or femtosecond laser-assisted capsulotomy using two platforms (LenSx, n=15 and Victus, n=15) were studied by SEM. Irregularity of the capsule edge was quantified using two parameters (angular second moment and contrast) using ImageJ software. The clinical features and laser parameters were correlated with angular second moment and contrast. SEM images were analyzed for the coefficient of variation (CoV) of pixilation along the capsule edge and homogeneity using gray-level co-occurrence matrix analysis. Subjective analysis for cut-surface irregularities and assessment for complications and anomalies, such as tags and misdirected laser shots, were also made. Results The femtosecond laser-assisted capsulotomy edge surfaces created by both laser platforms showed marked irregularity compared with the smoother edge of the CCC. The angular second moment and contrast measures for both lasers differed significantly from those obtained for CCC (P Conclusion Laser capsulotomies are approaching the smoothness of manual capsulorhexis. The LenSx post-soft-fit platform shows less anomalies and smaller difference for the CoV and homogeneity metrics compared with the Victus II platform. In the manual group, there is dishomogeneous thickness along the capsulorhexis edge, while in the femtosecond laser samples the cuts are more homogeneous regarding thickness throughout the whole capsulorhexis edge.

A Collapse that Led to Shoulder Pain

HISTORY: A 55 year old female presents for right shoulder pain. She has a history of multiple sclerosis, recent falls complicated by a right 6th rib fracture and a right 4th phalanx fracture, a 35 pack year history of tobacco use, and an unknown fracture of her right shoulder sustained at age 16. Her current shoulder pain began four weeks prior to her visit while reaching behind her back in the shower. She felt like her shoulder popped out of place. She has achy pain, worse when touching her shoulder or using her walker. It improves with lying down and with a sling. Acetaminophen and ibuprofen do not provide relief. Physical therapy as part of her multiple sclerosis treatment has not helped. PHYSICAL EXAMINATION: BP: 122/82, Pulse: 69, Respirations: 16, SpO2: 96%. Shoulder: - No gross abnormality, no step-offs along the clavicle. - Tender over the entire humeral head and anterior shoulder. - No swelling, warmth, or erythema. - ROM: o Right flexion 85 degrees active, 95 degrees passive. o Right abduction 90 degrees active, 100 degrees passive. o Adduction, internal rotation, external rotation and extension were full and equal bilaterally. - 5/5 strength - Special tests: positive empty can, Hawkin’s, O’Brien’s, and Speed’s test. Negative crossed arm adduction, AC compression, and sulcus sign. Unable to perform Neer’s test due to pain. DIFFERENTIAL DIAGNOSIS: Torn rotator cuff Glenohumeral arthritis Humeral head fracture as part of Osteogenesis Imperfecta Avascular necrosis AC joint arthritis Shoulder dislocation/subluxation Elder Abuse TEST AND RESULTS: Shoulder 3 view XR: - Extensive posttraumatic deformity of proximal right humerus with marked irregularity of articular surface. - Possible non-displaced superimposed acute or subacute fracture - Slightly displaced posterolateral right 4th and 5th rib fractures Shoulder MRI: - Marked abnormality of the right humeral head with contour deformity - Progressive collapse of superior articular surface, with focal marrow edema. This may be posttraumatic or relate to avascular necrosis - No rotator cuff tear. FINAL WORKING DIAGNOSIS: Avascular necrosis of the humeral head TREATMENT AND OUTCOMES: - Placed in arm sling for pain control - Referred for surgical replacement of the humeral head - Referred for workup for osteogenesis imperfecta, given multiple fractures

Outcome of Dermal Grafting in the Management of Atrophic Facial Scars.

Background:Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars.Aims and Objectives:This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others.Materials and Methods:Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction.Results:Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing.Conclusion:Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4–5 mm across; linear scars at least 2–3 mm across and 3–4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting.Limitations:Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.

Vitamin C Depletion in Prenatal Guinea Pigs as a Model of Lissencephaly Type II.

Humans and guinea pigs are unable to produce vitamin C, with deficiency resulting in a well-known disorder of collagen synthesis. Pial basement membrane structure preservation is essential in the proper migration of neurons. In our study, intrauterine deprivation of vitamin C in guinea pig fetuses led to a collagen synthesis disorder, weakness, and finally a breach of pial basement membrane. We found excessive migration of the external germinal layer cells into the subarachnoid space of the cerebellum through defects in the pial basement membrane. The changes ranged from focal rupture of pial basement membranes to their complete disintegration. The loss of proper folia formation resulted in macroscopically visible flattening of the cerebellar surface. Different grades of dysplastic changes in the folia of the cerebellar cortex were observed in 2 experimental groups assigned different limits to mark the time of commencement and duration of vitamin C deprivation. The most severe form of dysplastic changes was characterized by marked irregularity of the cerebellar cortex similar to that in lissencephaly type II. Thus, prenatal vitamin C deficiency represents a novel animal model to study the effects of collagen synthesis on development of breaches in the pial basement membrane, disordered migration of neurons, dysplasia of cerebellar cortex, and the pathogenesis of lissencephaly.