Reliability of the bicaudate parameter in the revealing of the enlarged lateral Ventricles in schizophrenia patients.

INTRODUCTION: In schizophrenia patients the lateral ventricle enlargement has mostly been reported in relationship with smaller cortical and/or subcortical brain volumes; and it has been observed that ventricular system growth may be a consequence of the smaller caudate nucleus volume. Bicaudate parameters have been used in the Alzheimer dementia and Huntington's chorea diagnosing in order to evaluate brain changes and the enlargement of the lateral ventricles. SUBJECTS AND METHODS: This study has been carried out on 140 patients out of which 70 patients (30 men and 40 women) who met the ICD 10 criteria for schizophrenia and 70 healthy controls (30 men and 40 women) matched on sex and age with the studied group. All of them underwent direct caudatometry and volume computation based on MRI scans. RESULTS: Except for the bicorporal line, for all the parameters were obtained the statistically highly significant differences between the examined and control groups. Significant correlation was established for the majority of bicaudate parameters and volumes of the caudate nuclei and lateral ventricles. DISCUSSION: Enlargement of the lateral ventricles is one of the most frequent MRI finding in schizophrenia patients. Ventricles are enlarging gradually and frontal horns are more affected than other parts. The increased volumes of the caudate nuclei signalized that ventricular enlargement is not the consequence of the caudate atrophy. CONCLUSION: Bicaudate parameters are reliable parameters for the quick orientation in order to assess the enlarged ventricles in schizophrenia patients.

Clinical Significance of the Cerebral Perforating Arteries.

There is scarce data in the contemporary literature regarding the correlation of the microanatomy of the perforating arteries, their atherosclerosis, and the ischemia in their territory. In order to examine, at least partially, those parameters, the perforating arteries of 12 brains were microdissected or their vascular casts were obtained. In addition, 30 specimens of the perforators were used for a histological and immunohistochemical study. Finally, radiological images of 14 patients with deep cerebral infarcts were examined following a selection among 62 subjects. It was found out that certain groups of the perforators ranged in number between 0 to 11 (1.1-8.4 on average). In addition to the origin from the parent vessels, some of the perforators also arose from the leptomeningeal branches. Occlusion of such a branch may result in both a superficial and a deep ischemic lesion. Besides, the common stems of certain perforators supplied both right and left portions of the corresponding brain regions. Occlusion of such a common trunk leads to bilateral infarction. The atherosclerosis of the perforating vessels, which was found in one third of the specimens, is the basis for the ischemic lesions development on their territory. Among the 62 patients with ischemic lesions, 14 had a deep cerebral infarcts, most often within the thalamus, as well as on the territory of the middle cerebral and the anterior choroidal artery perforators of the hemispheres. Our study showed that a strong correlation exists between certain microanatomical features, atherosclerosis, and region of supply of the perforating arteries, on the one hand, and location of the ischemic lesions on the other hand.

Long-term Effects of Maternal Deprivation on the Volume, Number and Size of Neurons in the Amygdala and Nucleus Accumbens of Rats.

BACKGROUND: Maternal deprivation (MD) in rodents is an important neurodevelopmental model for studying a variety of behavioral changes which closely resemble the symptoms of schizophrenia in humans. SUBJECTS AND METHODS: To determine whether early-life stress leads to changes in the limbic system structures: the amygdala and the nucleus accumbens, 9-day-old Wistar rats were exposed to 24 hour MD. On P60 the rats were sacrificed for morphometric analysis and their brains were compared to the control group. RESULTS: Results show that MD affected important limbic system structures: the amygdala and the nucleus accumbens, whose volume was decreased (17% of the control value for the amygdala and 9% of the control value for the nucleus accumbens ), as well as the number of neurons (41% of the control value for the amygdala and 43% of the control value for the nucleus accumbens ) and the size of their cells soma (12% of the control value for the amygdala and 33% of the control value for the nucleus accumbens ). CONCLUSION: This study indicates that early stress in life leads to changes in the morphology of the limbic areas of the brain, most probably due to the loss of neurons during postnatal development, and it further contributes to our understanding of the effects of maternal deprivation on brain development.

Alternative method for direct measurement of tibial slope.

BACKGROUND/AIM: The tibial slope is one of the most frequently cited anatomical causes of anterior cruciate ligament trauma. The aim of this study was to determine the possibility of direct measuring of the tibial slope of the knee without prior soft tissue dissection in cadavers. METHODS: Measurement was performed on the two groups of samples: osteological and cadaveric. The osteological group consisted of 102 matured tibiae and measurement was performed: indirectly by sagittal photographing of the tibia, and directly by a set of parallel bars. The cadaveric group consisted of 50 cadaveric knees and measurement was performed directly by a set of parallel bars. The difference and correlation between indirect and the direct measurements were observed, which included also measuring of the difference and correlation of the tibial slope on the medial and lateral condyles. RESULTS: A statistically significant difference between the direct and indirect method of measuring (p < 0.01) of 1 degree was found for the tibial slope on the medial condyle, which is of no practical importance. Direct measurement of the osteological and cadaveric groups of samples did not show a statistically significant difference regarding the values of the tibial slope on the lateral condyle (p > 0.05). However, the slope on the medial condyle, as well as indirect measurement showed a statistically significant difference (p < 0.01). CONCLUSION: By the use of a set of parallel bars it is possible to measure the tibial slope directly without removal of the soft tissue. The results of indirect, photographic measurement did not statistically differ from the results of direct measurement of the tibial slope.

[Surgical anatomy of the initial segment of the lateral circumflex femoral artery].

INTRODUCTION: The lateral circumflex femoral artery usually originates from the lateral side of the initial part of the deep femoral artery, or less frequently from the femoral artery. If it is a branch of the femoral artery, it arises directly above the point of origin of the deep femoral artery. The aim of this study was to determine the origin of the lateral circumflex femoral artery, its origin distance from the midpoint of the inguinal ligament and the topographical relations of the origin, which have a great significance in clinical work. MATERIAL AND METHODS: A dissection was performed on the autopsy group of 42 thighs, followed by the analysis of anatomical relationships of the lateral circumflex femoral artery. All data were entered into the custom-made protocol, which contained the case number, age and sex, side, topographical-anatomical relations of the lateral circumflex femoral artery, artery dimensions and variations, and the distance between the place of origin of the lateral circumflex femoral artery and the midpoint of the inguinal ligament. RESULTS: In our study, the lateral circumflex femoral artery most frequently originated from the deep femoral artery, i.e. in 78.6% of cases. In 19.0% of limbs, it originated from the femoral artery, and in one case (2.4%) from a common stem of the deep femoral artery and the lateral circumflex femoral artery, coming from the femoral artery. CONCLUSION: In clinical practice, it is of great importance to know the origin variations of the lateral circumflex femoral artery while planning and performing various surgical and invasive diagnostic procedures in the inguino-femoral region.

Origin of the medial circumflex femoral artery--a cadaver study.

AIM: To determine the pattern of origin of medial circumflex femoral artery (MCFA), its origin distance from the midpoint of the inguinal ligament and the topographical relations of the origin, which have great significance in clinical work. METHODS: Dissections on the autopsy group of 42 thighs were performed, and anatomical relationships of MCFA was analyzed. All data were entered into a scheme of the protocol which was designed for this research containing the case number, age and sex, side, topographical-anatomical relations of MCFA, artery dimensions and variations, and the distance between the place of origin of MCFA and the midpoint of the inguinal ligament. RESULTS: Commonly, in 25 (59.5%) limbs MCFA originated from the deep femoral artery. In 14 (33.3%) limbs MCFA arose from the femoral artery (FA), in one case (2.4%) a common source of deep femoral artery (DFA) and MCFA was identified, and in two limbs MCFA was not noticed. The distance between the level of origin of MCFA and the central point of the inguinal ligament was 44.2 mm, in average, when it was emerging from FA, and 57.9 mm, in average, in cases where MCFA originated from DFA. CONCLUSION: Surgeons and radiologists should be familiar with the variations of clinically important MCFA, which is commonly involved in peripheral occlusive arterial diseases, to improve effectiveness of diagnosis and treatment of various pathological conditions in the femoral region.

[The importance of cytology in diagnosing rare breast carcinoma--two case reports].

INTRODUCTION: This paper presents two cases of very rare tumors of breast: breast sebaceos carcinoma, which has rarely been described in medical literature, and breast carcinosarcoma. Morphological characteristics and biological behavior of sebaceos carcinoma are still rather vague. Carcinosarcoma of the breast is a rare malignancy with distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. CASE REPORT: The first presented case is a 73-year-old female referred to our hospital in January 2008 with tumor of the right breast in the upper outer region of the breast and enlarged lymph nodes in the right axillary region. The second presented case is a 51-year-old female with carcinosarcoma, also a very rare primary breast tumor. She was admitted to our hospital in June 2011 with history of lump in the upper and lower outer quadrant of the left breast. In both cases, biopsy of tumor tissue was carried out with a thin needle, i.e. the aspiration cytology was applied as a diagnostic method, and during the operation the fast diagnostics of frozen sections and cytologic diagnostics were done. Although this methodology is important in diagnosis, in both cases it showed certain limitations in diagnosing such rare tumors. The final diagnosis was made after carefully synthesizing the histological findings and immunohistochemical phenotype. CONCLUSION: An accurate classification of breast tumors on cytological preparations is not possible in case of poorly differentiated and rare tumors. A careful and accurate classification of these tumors is necessary.

[The influence of the morphometric parameters of the intercondylar notch on rupture of the anterior cruciate ligament].

BACKGROUND/AIM: Morpohometric parameters of the intercondylar notch of femur present one of the substantial risk factors for rupture of the anterior cruciate ligament (ACL). In morphometric studies of the knee the most often referred indexes are notch width index and notch shape index. The aim of this study was to identificate the morphometric parameters of the intercondylar notch as risk factors for ACL rupture. METHODS: This study included 99 patients divided into two groups: the study group (n=57) composed of patients with chronic instability of the knee because of previos rupture of the ACL, and the control group (n=42) composed of patients with lesion of the knee, but without rupture of the ACL. Measuring the width and height of intercondylar notch and epicondylar width was observed on a horizontal MR section. According to these values notch width and notch shape indexes were calculated. RESULTS: The study group had statistically significantly higher (p < 0.05) intercondylar notch and lesser notch shape index than the control group (p < 0.05). The difference was highly statistically significant (p < 0.01) only in males, but not in females (p > 0.05). Absolute dimensions of the morphometric parameters of the distal part of the femur had highly statatistically significant larger values (p < 0.01) in males than females, exept in case of the intercondilar height in the control group (p > 0.05). CONCLUSION: Enhanced height of the intercondylar notch as well as lesser value of the notch shape index are associated with rupture of the ACL in males but not in females.

The third branch of the main trunk of the left coronary artery in Cercopithecus aethiops sabaeus. Is the nonhuman primate model appropriate?

The aim of this study was to investigate the morphometry of branching patterns of the main trunk of the left coronary artery (MT of LCA) in nonhuman primates, and comment on the current nomenclature. The biometric study was performed using stereomicroscopic dissection of hearts of healthy and fertile nonhuman primates (Cercopithecus aethiops sabaeus) of both sexes. Our results reveal that the MT of LCA terminates in a bifurcation into the anterior interventricular branch (AIB) and the circumflex branch (CB) (74.6%), trifurcation into the AIB, CB, and diagonal branch (DB) (23.6%), or occasionally quadrifurcation into the AIB, CB, and two DBs (1.8%). This is similar to the case in humans. Furthermore, two morphological aspects of the DB spatial distribution, in addition to its branching pattern, resemble the DB in humans. Myocardial bridges observed over the DB in the Cercopithecus aethiops heart further contribute to the similarity with humans. The resemblance of the DB and its branches to their human counterparts make them a suitable model for experimental study on coronary circulation.

[Morphometric characteristics of neuropeptide Y immunoreactive neurons of human cortical amygdaloid nucleus].

INTRODUCTION: Cortical amygdaloid nucleus belongs to the corticomedial part of the amygdaloid complex. In this nucleus there are neurons that produce neuropeptide Y. This peptide has important roles in sleeping, learning, memory, gastrointestinal regulation, anxiety, epilepsy, alcoholism and depression. MATERIAL AND METHODS: We investigated morphometric characteristics (numbers of primary dendrites, longer and shorter diameters of cell bodies and maximal radius of dendritic arborization) of NPY immunoreactive neurons of human cortical amygdaloid nucleus on 6 male adult human brains, aged 46 to 77 years, by immunohistochemical avidin-biotin technique. RESULTS: Our investigation has shown that in this nucleus there is a moderate number of NPY immunoreactive neurons. 67% of found neurons were nonpyramidal, while 33% were pyramidal. Among the nonpyramidal neurons the dominant groups were multipolar neurons (41%--of which 25% were multipolar irregular, and 16% multipolar oval). Among the pyramidal neurons the dominant groups were the neurons with triangular shape of cell body (21%). All found NPY immunoreactive neurons (pyramidal and nonpyramidal altogether) had intervals of values of numbers of primary dendrites 2 to 6, longer diameters of cell bodies 13 to 38 microm, shorter diameters of cell bodies 9 to 20 microm and maximal radius of dendritic arborization 50 to 340 em. More than a half of investigated neurons (57%) had 3 primary dendrites. DISCUSSION AND CONCLUSION: The other researchers did not find such percentage of pyramidal immunoreactive neurons in this amygdaloid nucleus. If we compare our results with the results of the ather researchers we can conclude that all pyramidal NPY immunoreactive neurons found in this human amygdaloid nucleus belong to the class I of neurons, and that all nonpyramidal NPY immunoreactive neurons belong to the class II of neurons described by other researchers. We suppose that all found pyramidal neurons were projectional.

[Breast Paget disease: morphologic substrate and Paget cells characteristics]. / Pagetova bolest dojlke: morfoloski substrat i karakteristike Pagetovih celija.

Authors analyzed 143 cases of breast Paget disease with special emphasis on basic tumor process and on immune histochemical characteristics of tumor cells. Breast Paget disease represent special clinical presentation of the breast tumor. The most often tumor in the breast are ductal carcinoma in situ, ductal carcinoma and in rare instance lobular carcinoma and lobular carcinoma in situ. There are several clinical combinations with or without involvement of axillary's lymph nodes. The best prognosis is in cases with in situ as underlying process. All other combinations have worse prognosis in relation to the combination with in situ lesion. The middle ages of patients with Paget disease is 10 years higher than the ages without areola involvement. Paget cells show the same immune histochemical characteristic as tumor cells. The authors propose mastectomy instead central segmentectomy.