Superficial Part Research Articles

Fibre type-specific expression patterns of myosin heavy chain genes in adult torafugu Takifugu rubripes muscles

Comprehensive in silico studies, based on the total fugu genome database, which was the first to appear in fish, revealed that torafugu Takifugu rubripes contains 20 sarcomeric myosin heavy chain (MYH) genes (MYH genes) (Ikeda et al., 2007). The present study was undertaken to identify MYH genes that would be expressed in adult muscles. In total, seven MYH genes were found by screening cDNA clone libraries constructed from fast, slow and cardiac muscles. Three MYH genes, fast-type MYH(M86-1), slow-type MYH(M8248) and slow/cardiac-type MYH(M880), were cloned exclusively from fast, slow and cardiac muscles, respectively. Northern blot hybridization substantiated their specific expression, with the exception of MYH(M880). In contrast, transcripts of fast-type MYH(M2528-1) and MYH(M1034) were found in both fast and slow muscles as revealed by cDNA clone library and northern blot techniques. This result was supported by in situ hybridization analysis using specific RNA probes, where transcripts of fast-type MYH(M2528-1) were expressed in fast fibres with small diameters as well as in fibres of superficial slow muscle with large diameters adjacent to fast muscle. Transcripts of fast-type MYH(M86-1) were expressed in all fast fibres with different diameters, whereas transcripts of slow-type MYH(M8248) were restricted to fibres with small diameters located in a superficial part of slow muscle. Interestingly, histochemical analyses showed that fast fibres with small diameters and slow fibres with large diameters both contained acid-stable myofibrillar ATPase, suggesting that these fibres have similar functions, possibly in the generation of muscle fibres irrespective of their fibre types.

The human temporalis muscle: Superficial, deep, and zygomatic parts comprise one structural unit

The structure of the temporalis muscle was examined in detail from cadaveric specimens (32 specimens from 16 subjects: 5 males, average age 80.6 years; 11 females, average age 88.6 years) and Computerized Tomography (CT) and T1-weighted Magnetic Resonance (MR) images from normal clinical patients (10 females: average age 45.0 years). Three parts of the muscle were clearly delineated in all cadaveric specimens: (1) the classically recognized superficial part, (2) a zygomatic part, and (3) a complex deep part. In one female specimen, the superficial temporalis demonstrated extensive insertions into the zygomatic process and temporomandibular joint. The zygomatic temporalis originates from the zygomatic arch to insert into the superficial part of the temporalis as it inserts into the lateral surface of the coronoid process. In all specimens, the deep temporalis contained muscle bundles that originated from various crests along the anterior surface of the temporal fossa and inserted into the internal aspect of the coronoid process and retromolar triangle, interdigitating with the buccinator, mylohyoid, and superior constrictor muscles. The confluence of muscle fibers into the buccinator muscle was confirmed in all CT/MRI images. The deep and zygomatic parts described were regarded as accessory muscle bellies previously, but are demonstrably part of the temporalis muscle as a whole.

Correlation between gross anatomical topography, sectional sheet plastination, microscopic anatomy and endoanal sonography of the anal sphincter complex in human males

This study elucidates the structure of the anal sphincter complex (ASC) and correlates the individual layers, namely the external anal sphincter (EAS), conjoint longitudinal muscle (CLM) and internal anal sphincter (IAS), with their ultrasonographic images. Eighteen male cadavers, with an average age of 72 years (range 62-82 years), were used in this study. Multiple methods were used including gross dissection, coronal and axial sheet plastination, different histological staining techniques and endoanal sonography. The EAS was a continuous layer but with different relations, an upper part (corresponding to the deep and superficial parts in the traditional description) and a lower (subcutaneous) part that was located distal to the IAS, and was the only muscle encircling the anal orifice below the IAS. The CLM was a fibro-fatty-muscular layer occupying the intersphincteric space and was continuous superiorly with the longitudinal muscle layer of the rectum. In its middle and lower parts it consisted of collagen and elastic fibres with fatty tissue filling the spaces between the fibrous septa. The IAS was a markedly thickened extension of the terminal circular smooth muscle layer of the rectum and it terminated proximal to the lower part of the EAS. On endoanal sonography, the EAS appeared as an irregular hyperechoic band; CLM was poorly represented by a thin irregular hyperechoic line and IAS was represented by a hypoechoic band. Data on the measurements of the thickness of the ASC layers are presented and vary between dissection and sonographic imaging. The layers of the ASC were precisely identified in situ, in sections, in isolated dissected specimens and the same structures were correlated with their sonographic appearance. The results of the measurements of ASC components in this study on male cadavers were variable, suggesting that these should be used with caution in diagnostic and management settings.

Saline-Linked Surface Radiofrequency Ablation

To determine the safety and efficacy of saline-linked surface radiofrequency ablation (SLSRFA) in a clinical setting. We have previously identified safe and effective parameters for use of SLSRFA in a porcine model. An initial study was conducted to determine if parameters defined in the porcine model were safe and effective in human livers. In 16 patients undergoing liver resection, normal areas of liver were treated with SLSRFA using various power/diameter combinations (10 W/1 cm; 15 W/2 cm; 45 W/4 cm) for 9 minutes with and without inflow occlusion. In a second study, superficial hepatic colorectal cancer (CRC) metastases were treated at 45 W/4 cm for 9 minutes without inflow occlusion in 11 patients. Ablation depth was measured and samples were examined for cell viability by nicotine adenine dinucleotide stain. This study was registered in the ClinicalTrials.gov database and has the following ID number, NCT00869843. Ablation depth in normal liver varied from 3 to 20 mm. Depth was significantly dependent on power, lesion size, and inflow occlusion. Nicotine adenine dinucleotide stains showed total cell necrosis to the full depth of ablation. In the second study, large hepatic CRC metastases showed total cell necrosis to a mean depth of 12 mm. Two tumors less than 7 mm in depth showed complete necrosis. Metastases were more susceptible to SLSRFA than normal liver. SLSRFA completely and safely ablates normal liver to a depth of at least 4 mm at 45 W/4 cm treatment parameters. Remarkably, it is even more effective in ablating metastatic CRC. SLSRFA is an effective tool for extending resection margins and for ablating superficial small tumors or superficial parts of large tumors.

Extraneural versus Intraneural Stimulation Thresholds during Ultrasound-guided Supraclavicular Block

A stimulation current of no more than 0.5 mA is regarded as safe in avoiding nerve injury and delivering adequate stimulus to provoke a motor response. However, there is no consistent level of stimulating threshold that reliably indicates intraneural placement of the needle. The authors determined the minimally required stimulation threshold to elicit a motor response outside and inside the most superficial part of the brachial plexus during high-resolution, ultrasound-guided, supraclavicular block. After institutional review board approval, ultrasound-guided, supraclavicular block was performed on 55 patients. Patients with neurologic dysfunction were excluded. Criteria for extraneural and intraneural stimulation were defined and assessed by independent experts. To determine success rate and any residual neurologic deficit, qualitative sensory and motor examinations were performed before and after block placement. At 6 month follow-up, the patients were examined for any neurologic deficit. Thirty-nine patients met all set stimulation criteria. Median +/- SD (interquartile range) minimum stimulation threshold outside was 0.60 +/- 0.37 mA (0.40, 1.0) and inside 0.30 +/- 0.19 mA (0.20, 0.40). The difference of 0.30 mA was statistically significant (P < 0.0001). Stimulation currents of 0.2 mA or less were not observed outside the trunk in any patient. Significantly higher thresholds were observed in diabetic patients. Success rate was 100% after 20 min. Thirty-four patients had normal sensory and motor examination at 6 months. Five patients were lost to follow-up. Within the limitations of this study and the use of ultrasound, a stimulation current of 0.2 mA or less is reliable to detect intraneural placement of the needle. Furthermore, stimulation currents of more than 0.2 and no more than 0.5 mA could not rule out intraneural position.

Video-assisted submandibular resection: two-step technique

The relative delay in the development of endoscopic neck surgery has been attributed to the relatively narrow operative field and to the presence of many vital structures in it. For endoscopic neck surgery to be feasible, it is essential to create a comfortable working space. A method of creating a working space is the gasless skin-lifting technique. To date, there have been only few reports on the transcervical endoscopic approach to the submandibular gland. Assessment of a new modification in the technique of video-assisted submandibular sialadenectomy aiming at improving the visibility and safety of the operation. The study included 12 adult patients indicated for sialadenectomy. Patients having large, hard or fixed submandibular gland were excluded. Laboratory work-up and ultrasound of the neck were obtained in all patients. All patients had video-assisted submandibular sialadenectomy, using a "two-step resection" technique: A 15-20-m skin incision was performed. The superficial part of the submandibular gland down to the plane of the mylohyoid muscle was dissected free and excised, leaving behind a roomy working space and a clearer view to the deeper part (step 1). The remaining deep part of the gland was then dissected and removed (step 2). A gasless skin lifting was adopted using Army-Navy retractors. Dissection was performed using ultrasonic sealing device. Mean operative time was 89.67 ± 37.97 min. Mean blood loss was 45 ± 19.78 ml. There was no permanent nerve injury. The two-step submandibular sialadenectomy using skin-lifting gasless technique offers good visibility and good working space that allow safer dissection.

Neuronal classes in the corticoid complex of the telencephalon of the strawberry finch, Estrilda amandava

The present study, based on neurohistological techniques (Nissl-staining, Golgi-impregnation), focuses on the cytoarchitecture of the corticoid complex in the strawberry finch, Estrilda amandava. This complex in birds occupies the dorsolateral surface of the telencephalic pallium and remains subdivided into an intermediate corticoid area (CI) and a dorsolateral corticoid area (CDL). The CDL in the strawberry finch is a thin superficial part of the caudal pallium adjoining the medially situated hippocampal formation, whereas the CI is demarcated between the CDL and the parahippocampal area of telencephalon. Neurons of the corticoid complex are classified into three main cell groups: predominant projection neurons, local circuit neurons and stellate neurons. The spinous projection neurons send out distant projecting axons that typically extend several varicose collaterals. Most of these collaterals lie parallel to the ventricle. These neurons are subclassified into pyramidal neurons (localized only in the CI) and multipolar neurons (present in both the CI and CDL). The CDL also possesses small and medium-sized horizontal cells, which are bitufted or multipolar with smooth, moderately branching dendrites. The aspinous local circuit neurons extend short axons that ramify locally. Stellate neurons have sparse spinous dendrites and locally arborizing axons. The corticoid complex of birds corresponds to the lateral cerebral cortex of lizards and to the entorhinal cortex of mammals on the basis of neuronal morphology and bidirectional connections between adjacent areas.

A Two-Way Continuous Buried-Suture Approach to the Creation of the Long-Lasting Double Eyelid: Surgical Technique and Long-Term Follow-Up in 51 Patients

Although it is seldom reported in the Western literature, the buried-suture operation to create a double eyelid is very popular in Asia. However, the buried-suture methods are traditionally associated with a high recurrence rate. Corneal damage and exposed conjunctiva suture are also possible. The two-way continuous buried-suture approach was applied in double-eyelid operations. With seven to nine stab skin wounds on the upper eyelids, a continuous single-armed suture is passed through the dermis as well as the superficial part of the tarsus. Then the needle is inserted in the opposite way. Both ends of the suture are tied within the far lateral incision. The operation takes no longer than 20 min. The scars of the stab incision were no longer visible after several months postoperation. From August 2003 to January 2008, 51 patients underwent this technique. All patients have been satisfied with their appearance after their initial surgery except two patients who had minimal associated morbidity. No disappearance of the formed double eyelids or corneal damage occurred. The two-way continuous buried-suture approach is a simple method for establishing a long-lasting double eyelid. The results are durable and the potential for corneal injury is reduced.

Femtosecond laser‐assisted penetrating re‐keratoplasty

Editor, Penetrating keratoplasty has usually been performed taking a trephine for the sagittal excision of the corneal donor button and for the preparation of the recipient corneal bed. The disadvantages of this sagittal cutting technique are a lack of rotational stability and a lack of sagittal stability. With the introduction of the femtosecond laser into clinical ophthalmology (Jonas & Vossmerbaeumer 2004; Hoffart et al. 2008; Mastropasqua et al. 2008; Por et al. 2008; Price & Price 2008), a new cutting technique has emerged that offers the possibility of creating non-circular and angled incisions. According to preliminary results, this new technique can markedly reduce postoperative keratoplasty and enhance the overall stability of the wound because of the increased and angled surface of the interface between the graft and the host tissue. Because the femtosecond laser is based on an optical principle with the laser beam penetrating the corneal tissue, it necessitates sufficient transparency of the corneal stroma to allow the laser beam to penetrate to the deep corneal layer and Descemet’s membrane. Previous studies have shown that an intrastromal corneal oedema caused by a corneal endothelial insufficiency has not been an obstacle for the femtosecond laser beam (Hoffart et al. 2008; Por et al. 2008; Price & Price 2008). However, so far it has been unclear whether dense intracorneal scars, particularly after previous corneal surgery, may prevent the use of the femtosecond laser for keratoplasty. Therefore, in this article I report on the feasibility of the technique for a patient who underwent femtosecond laser keratoplasty after a previous keratoplasty had failed. A 48-year-old patient had undergone conventional trephine-guided penetrating keratoplasty as treatment of keratoconus in 1991. The diameter of the graft trephined from the endothelial side was 8.0 mm; the diameter of the excised corneal button in the host cornea was 7.8 mm. The graft was centred onto the optical axis. With an initially clear corneal graft, best-corrected visual acuity was 20/20. Seventeen years after the keratoplasty, the graft started to develop intrastromal oedema, particularly in the late afternoon, because of a progressive age-related insufficiency of the corneal endothelium of the graft. Using a commercially available femtosecond laser (Advanced Medical Optics; Intralase, Santa Ana, California, USA), a penetrating rekeratoplasty was carried out. A top-hat cutting configuration (Price & Price 2008) was chosen. The diameters of the superficial and deep parts were 7.0 mm and 8.5 mm, respectively; a lamellar cut was made at a depth of 250 μm. The lamellar overlapped the superficial part and the deep part by 0.3 mm, so that its outer diameter was 8.8 mm and its inner diameter was 6.7 mm. As per the previous corneal graft, the regraft was centred onto the optical axis. Despite the dense corneal opacities in the zone of the interface between the previous graft and the host cornea, the femtosecond laser was able to cut the corneal tissue unremarkably. The central corneal button precut by the laser could be removed without further use of a knife or scissors. The graft was fixated with a double running suture with buried knots in the interface (Fig. 1). Three months after the intervention, visual acuity was 20/20 with a regular corneal astigmatism of 2.0 dioptres (Fig. 1). Clinical photograph showing an eye 3 months after a femtosecond laser-assisted penetrating homologous keratoplasty 17 years after a previous penetrating keratoplasty. The scar of the interface between the former graft and the recipient cornea (remnants of the former scar: arrows) did not impede the femtosecond laser cutting of the cornea. These results suggest that the femtosecond laser is able to perform incisions in the superficial and deep corneal layers including Descemet’s membrane through dense intracorneal opacities such as scars in the interface after a previous penetrating keratoplasty. A previous keratoplasty is not a contradiction against a femtosecond laser-assisted keratoplasty.

Foliar stable carbon and nitrogen isotopes in woody Mediterranean species with different life form and post-fire regeneration

Wildfire is an important ecological disturbance factor in most Mediterranean ecosystems. In the Mediterranean Basin, most shrub species can regenerate after fire by resprouting or seeding. Here, we hypothesize that post-fire regenerative syndromes may potentially co-vary with traits directly related to functional properties involved in resource use. Thus, seeders with a shorter life span and smaller size would have lower water-use efficiency (WUE) than re-sprouting species and would take up nutrients such as nitrogen from more superficial parts of the soil. To test this hypothesis, we compared leaf (13)C and (15)N signatures from 29 co-existing species with different post-fire regeneration strategies. We also considered life form as an additional explanatory variable of the differences between post-fire regenerative groups. Our data support the hypothesis that seeder species (which mostly evolved in the Quaternary under a Mediterranean climate) have lower WUE and less stomatal control than non-seeders (many of which evolved under different climatic conditions in the Tertiary) and consequently greater consumption of water per unit biomass. This would be related to their smaller life forms, which tend to have lower WUE and shorter life and leaf lifespan. Differences in (15)N also support the hypothesis that resprouters have deeper root systems than non-resprouters. The study supports the hypothesis of an overlap between plant functional traits and plant attributes describing post-disturbance resilience.

A flexible multi-scale approach for standardised recording of plant species richness patterns

Abstract A sound monitoring of appropriate biodiversity indicators is necessary in order to assess the progress towards the internationally agreed target of halting the loss of biodiversity by 2010. However, existing monitoring schemes often do not address species richness as a key component of biodiversity directly or do so with insufficient methods. I provide an overview and assessment of the large variety of different sampling approaches for small-scale plant species richness. Major shortcomings of many of these are (i) non-uniform plot sizes or shapes; (ii) analysis of only one spatial scale despite the scale dependence of nearly all biodiversity parameters; (iii) lack of replication of smaller subplots; and (iv) exclusion of bryophytes and lichens despite their often large contribution to total plant diversity. Based on this review, I propose a new standardised sampling approach for plant diversity patterns at small scales that is applicable for a multitude of purposes and in any biome. In its basic variant, species composition is recorded on nested squares of 0.01 m2, 0.1 m2, 1 m2, 10 m2, and 100 m2, with all smaller subplots being replicated at least 3-fold and evenly spaced within the next larger plot. Not only terricolous vascular plants, but also bryophytes, lichens, macro-algae as well as non-terricolous taxa should be recorded with the any-part system, i.e. those plants are counted within a plot whose superficial parts reach over it. This approach can be used to assess plant diversity patterns (i) of individual plots of interest, (ii) along environmental gradients, (iii) within specific vegetation types, or (iv) for landscape sectors. In the latter case, the series of nested plots must be placed randomly or systematically, but irrespective of plot homogeneity. The proposed approach allows the calculation of many meaningful biodiversity indicators, while being well compatible with a range of other sampling schemes, but avoiding their shortcomings. As this approach is not very time-consuming in its basic variant, but can easily be extended for specific purposes, I suggest its use for any kind of biodiversity studies and particularly for monitoring.

Extracapsular dissection of benign parotid tumors using a retroauricular hairline incision approach

Extracapsular dissection has emerged as a more conservative approach to parotid surgery. The parotid surgery commonly begins with a modified Blair or facelift incision. Although minor, the incision scar from these incisions is visible on the face and neck. I initially developed a retroauricular hairline incision (RAHI) for the removal of benign lesions in the upper neck with a more esthetic look. The RAHI approach also may be used for selected patients with benign parotid neoplasms. Mobile benign tumors arising in the inferior superficial part of the parotid gland may be removed by the RAHI approach without compromising surgical visualization. This surgery appears to show excellent cosmetic outcomes in addition to the benefits of extracapsular dissection, lower complication rates, and preservation of secretory function. The RAHI without a preauricular incision is a feasible technique in the surgical management of parotid tumors.

The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis

The palmaris longus (PL) is a muscle of the forearm with a long distal tendon that is continuous with the palmar aponeurosis (PA). It is generally assumed that the muscle lies deep to the antebrachial fascia from origin to termination, but a detailed description is lacking. The relationship of the PL tendon with the antebrachial fascia was studied in 30 dissections. The PL was completely absent in six specimens (20%), whereas the PA was identified in all. Average length of the forearm was 25.5 cm (SD: 2.1 cm, range 22-29 cm), overall length of the PL muscle 26.9 cm (SD: 2.6 cm, range 22.5-31.5 cm), muscular belly 13.8 cm (SD: 3.4 cm, range 9.5-23 cm), tendon 13.1 cm (SD: 3.3 cm, range 8-15.5 cm). Proximally, the PL was situated deep to the antebrachial fascia, then in the lower third of the forearm its tendon perforated the antebrachial fascia (at 4.7 +/- 1.7 cm from the bistyloid line) moving to a suprafascial plane, inserting in the PA. The PA could be divided into two layers: the superficial one formed by longitudinal fibers and adherent to the skin, the deep one formed by transverse fibers continuous laterally with the deep fascia of the hand. The PL tendon was found to be in continuity only with the longitudinal fibers of the PA. Based on the anatomical findings, it may be suggested that the superficial part of the PA is situated in the subcutaneous planes of the palm, and that the muscle should be considered as a tensor of the superficial fascial system of the subcutaneous tissue.

Effects of irrigation temperature on heat control in vitro at different drilling depths

Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling. Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 x 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software. The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1 degrees C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10 degrees C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3 degrees C, respectively. All other measurements with both 25 and 10 degrees C saline were below body temperature. This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.

Dermatomyofibroma: Clinicopathologic and Immunohistochemical Analysis of 56 Cases and Reappraisal of a Rare and Distinct Cutaneous Neoplasm

Dermatomyofibroma represents a rare and distinct benign cutaneous mesenchymal neoplasm of fibroblastic/myofibroblastic differentiation. A series of 56 cases of dermatomyofibroma has been analyzed to further characterize the clinicopathologic spectrum of this entity. Forty patients were female and 8 were male (gender was unknown in 8 cases). Patients' age ranged from 3 to 51 years (mean 30.8 years, median 30 years). Interestingly, 6 patients were younger than 16 years, and in this age group, 3 male and 3 female patients, respectively, were noted. The shoulder (13 cases) was the anatomic site most commonly affected, followed by the upper arm (7 cases), the neck (6 cases), the thigh (6 cases), the chest wall (4 cases), the back (3 cases), the axillary fold (2 cases), the abdominal wall (2 cases), and 1 case each was seen on the forearm, the buttock, and the popliteal fossa (exact anatomic location was unknown in 10 cases). One patient presented with 2 lesions arising simultaneously on both shoulders. Histologically, an ill-defined, plaque-like dermal neoplasm of varying cellularity was seen in all cases, composed of bland spindle-shaped tumor cells often oriented parallel to the overlying epidermis. An infiltration of superficial part of the subcutis was seen in 23 cases, and in 6 cases, deeper parts of the subcutis were involved by often perpendicular growing bands of neoplastic cells. Immunohistochemically, tumor cells in 11 of 48 cases tested stained positively for alpha-smooth muscle actin, and a focal expression of this marker was noted in 20 cases. In addition, a focal expression of CD34 was seen in 10 of 45 cases tested. Follow-up information was available in 38 cases (range from 3 to 156 months, median 34 months), and despite marginal or incomplete excision in 17 cases, none of the cases recurred. Dermatomyofibroma represents a benign fibroblastic/myofibroblastic dermal neoplasm.

In vitro chemosensitivity based on depth of invasion in advanced colorectal cancer using ATP-based chemotherapy response assay (ATP-CRA)

Background Tumors are composed of subpopulations of cells with heterogeneous characteristics that allow for tumor progression and development of treatment resistance. The purpose of this study was to determine if there is heterogeneity in the in vitro chemosensitivity in different invasive sections of a single tumor. Materials and methods Chemosensitivity in advanced colorectal cancer specimens was examined using an ATP-based chemotherapy response assay. Four chemotherapeutic agents (5-fluorouracil (5-FU), oxaliplatin, irinotecan, and mitomycin) were used for chemosensitivity studies. Tumor tissues were obtained from the superficial (mucosa/submucosa) and deep parts (muscle/subserosa/serosa), respectively. Twenty patients who had results for both the superficial and deep parts were evaluated. Results The chemosensitivity study showed variable cell death rates in both parts of the tumor. Regression analysis showed some correlations with 5-FU and irinotecan, but not with oxaliplatin or mitomycin. With the exception of three patients in whom no drug was recommended, at least one chemotherapeutic drug showed some consistency between the superficial and deep parts of the tumor. Mitomycin was the most frequently active agent for the superficial part. In the deep part, oxaliplatin and mitomycin were the most active agents. Conclusions There may be heterogeneity in the responses to anti-chemotherapeutic agents in advanced colorectal cancer, according to the depth of invasion. Therefore, in clinical situations, chemosensitivity test specimens should be mixed with various parts of the whole tumor in order to obtain representative chemosensitivity and chemoresistance profiles.

Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas

Composite glandular/exocrine-endocrine carcinoma of the gastrointestinal tract is a special tumor type composed of common adenocarcinoma and the neuroendocrine component comprising at least one-third of the whole tumor area. These tumors are rare in the stomach and mostly published as case reports. We describe a further case of a 36-year-old man being unique in that it was associated with extensive formation of sarcoid-like granulomas. Tumor consisted of, predominantly poorly differentiated, intestinal-type adenocarcinoma and poorly differentiated neuroendocrine, small cell carcinoma. The adenocarcinomatous and neuroendocrine areas were separated, but closely juxtaposed with focal areas showing gradual transition from one to another. Perigastric lymph node metastases corresponded either to neuroendocrine or adenocarcinomatous component. On immunohistochemistry, the exocrine part was positive for cytokeratin 7, whereas superficial well-differentiated parts showed positivity with cytokeratin 20 as well. The neuroendocrine component was negative with those two types of cytokeratin. Both adenocarcinomatous and neuroendocrine tumor portions showed carcinoembryonic antigen (CEA) immunoexpression. Neuroendocrine markers (chromogranin A, synaptophysin and neuron-specific enolase) were diffusely positive in the neuroendocrine component, and found only in the scattered cells within the neoplastic glands of the adenocarcinoma. Entire gastric mucosa and all perigastric lymph nodes were extensively affected by noncaseating, sarcoid-like granulomas. The absence of any clinical manifestations combined with the negative results of chest radiograph and laboratory test for the serum angiotensin converting enzyme argued against the possibility of systemic sarcoidosis.

Superficial vascular anatomy of the medial prefrontal cortex: an anatomical study

Background Superficial vascular anatomy of the medial prefrontal cortex, which is exposed after craniotomy for the anterior interhemispheric approach, has received little attention in the anatomy literature. This study focuses on the precise vascular anatomy of the medial part of the prefrontal cortex and provides more detailed information for surgery. Methods Five adult cadaveric heads were used in this study. After a bifrontal craniotomy, the dura was opened and the superficial vascular structures of the medial prefrontal cortex were exposed in 10 hemispheres. The CS was used as a landmark, and the location and the course of the medial cortical vessels were recorded. The variations were noted and photographed. Results There are 4 major superficial veins and 3 arteries on the medial prefrontal cortex, which are important during the surgery. Anterior frontal vein, MFV, PFV, and frontopolar veins drain the superficial part of the medial prefrontal cortex to the SSS. The frontomarginal artery and cortical branches of the frontopolar and callosomarginal arteries supply this region. One great BV on each hemisphere poses risk during the opening of the dura of the prefrontal cortex. All of the veins drain to the SSS. Conclusions The surface of the medial prefrontal cortex has a rich and complex vascular network and represents the first obstacle for surgery. The upper part of the medial prefrontal cortex seems safer than the lower part; the CS is a reliable and crucial landmark in planning and performing surgery in this region.

耳下腺上皮筋上皮癌例

Epithelial-myoepithelial carcinoma (EMCa) comprises less than 1% of all salivary gland neoplasms and mainly involves the major salivary glands, especially the parotid gland. We report on a case of an EMCa arising from the parotid gland. An 86-year-old woman visited our hospital with a painless mass in the left subaural region which had been present for two years. Head and neck imagings revealed a 28×30 mm mass in the left parotid gland. There was no apparent facial nerve involvement on clinical evaluation. A pleomorphic adenoma was suspected following cytodiagnosis of a needle biopsy specimen. The tumor was resected with the left superficial part of the parotid gland on November 6, 2006. Histopathological and immunohistochemical examination revealed that the inner cells had differentiated to the ductal epithelium and outer cells to the myoepithelium. Consequently, the final diagnosis was an epithelial-myoepithelial carcinoma. Two years after surgery, the patient’s postoperative course has been uneventful.

Qualitative detection of single submicron and nanoparticles in human skin by scanning transmission x-ray microscopy

First results on single particle detection in human skin samples by x-ray microscopy are reported. 94+/-6 and 161+/-13 nm gold core particles with silica shells and 298+/-11 nm silica particles coated with a gold shell on ultramicrotome sections of human skin were determined. The particles were applied on fresh intact skin samples, which were sectioned prior to imaging. After screening the sections by conventional microscopy techniques, defined areas of interest were qualitatively investigated by scanning transmission x-ray microscopy at the Swiss Light Source. In studies on the percutaneous penetration of 161+/-13 nm particles on human skin samples, x-ray microscopy yielded high-resolution images of single particles spreading on the superficial layer of the stratum corneum and on the epithelium in superficial parts of hair follicles. No deeper penetration was observed. The present work using x-ray microscopy provides the unique opportunity to study qualitative penetration processes and membrane-particle interactions on the level of single particles. This goes beyond present approaches using optical microscopy. Further improvement of this approach will allow one to study particles with different physicochemical properties and surface modifications, including responses of the exposed tissue.