[Assessing the Correlation between the Radiological, Macroscopic and Histological Examination of Degenerative Changes of Articular Surfaces in Knee Osteoarthritis with Varus Deformity]. / Hodnocení korelace mezi rentgenologickým, makroskopickým a histologickým hodnocením degenerativních zmen kloubních ploch u gonartrózy s varózní deformitou.

PURPOSE OF THE STUDY: Our study aims to compare the results of preoperative radiography and intraoperative visual assessment of the cartilage with histological assessment of joint surfaces of the medial and lateral compartments resected in patients during the total knee replacement. MATERIAL AND METHODS: The cohort included 20 patients (9 men and 11 women) with the mean age of 66.6 (±7.0) years who met the inclusion criteria of the study. Degenerative changes of the knee joint seen on a preoperative weight-bearing anteroposterior X-ray were evaluated according to the Kellgren-Lawrence grading system separately for the medial and lateral compartment. Based on the visual appearance, the condition of articular surfaces was assessed using the International Cartilage Repair Society Score (ICRS Grade). The histological assessment of degenerative changes was conducted by a pathologist with the use of the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment System based on six grades of articular cartilage degeneration. RESULTS: The mean degree of degenerative changes based on the radiological classification was assessed as 3.5 (±0.6) for the medial compartment and 2.1 (±0.4) for the lateral compartment. The visually assessed chondropathy according to the ICRS Grade was 3.7 (±0.6) for the medial femoral condyle and 1.8 (±1.0) for the lateral femoral condyle. The histological score obtained using the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment was 4.9 (±1.1) for the medial femoral condyle and 2.4 (±0.7) for the lateral femoral condyle. In respect of the medial compartment, there was no statistically significant parametric correlation between the intraoperative visual assessment of the cartilage degeneration and the preoperative radiological grade r = 0.45. The histological assessment showed a statistically significant concordance both with the degree of chondropathy r = 0.76 and the radiological grade r = 0.64. In the lateral compartment, the parametric test showed a statistically significant concordance only between the radiological grade and the histological score r = 0.72. The correlation between the visual assessment of chondropathy and the radiological grade r = 0.27 as well as the histological score r = 0.24 was very low. DISCUSSION: In our cohort assessing the early degenerative changes of the lateral compartment as well as the more advanced degenerative changes of the medial compartment, the correlation between the intraoperative assessment of cartilage degeneration as a diagnostic method to examine the lateral compartment and the preoperative radiological grade was not confirmed. Our results failed to confirm a better reporting value of the visual cartilage degeneration assessment of the lateral compartment as against the preoperative X-ray. The space width without narrowing on an X-ray has no reporting value for this compartment in case of varus deformity. CONCLUSIONS: The results clearly indicate that the assessment of macroscopic appearance of the cartilage degeneration during arthroscopy does not necessarily guarantee good long-term clinical outcomes after high tibial osteotomy. The respective degrees of cartilage degeneration identified during the intraoperative visual assessment and the radiological grading of osteoarthritic changes did not correlate in either compartment. In the lateral compartment, the initial radiological and histological findings preceded the visually detectable cartilage changes. KEY WORDS: knee, cartilage, osteoarthritis, radiology, histology, arthroscopy, osteotomy.

Marginal ice zone dynamics: future research perspectives and pathways.

Perspectives are discussed on future directions for the field of marginal ice zone (MIZ) dynamics, based on the extraordinary progress made over the past decade in its theory, modelling and observations. Research themes are proposed that would shift the field's focus towards the broader implications of MIZ dynamics in the climate system. In particular, pathways are recommended for research that highlights the impacts of trends in the MIZ on the responses of Arctic and Antarctic sea ice to climate change. This article is part of the theme issue 'Theory, modelling and observations of marginal ice zone dynamics: multidisciplinary perspectives and outlooks'.

Stem cells regenerative properties on new rat spinal fusion model.

Stem cells biology is one of the most frequent topic of physiological research of today. Spinal fusion represents common bone biology challenge. It is the indicator of osteoinduction and new bone formation on ectopic model. The purpose of this study was to establish a simple model of spinal fusion based on a rat model including verification of the possible use of titanium microplates with hydroxyapatite scaffold combined with human bone marrow-derived mesenchymal stem cells (MSCs). Spinous processes of two adjacent vertebrae were fixed in 15 Wistar rats. The space between bony vertebral arches and spinous processes was either filled with augmentation material only and covered with a resorbable collagen membrane (Group 1), or filled with augmentation material loaded with 5 × 106 MSCs and covered with a resorbable collagen membrane (Group 2). The rats were sacrificed 8 weeks after the surgery. Histology, histomorphometry and micro-CT were performed. The new model of interspinous fusion was safe, easy, inexpensive, with zero mortality. We did not detect any substantial pathological changes or tumor formation after graft implantation. We observed a nonsignificant effect on the formation of new bone tissue between Group 1 and Group 2. In the group with MSCs (Group 2) we described minor inflamatory response which indicates the imunomodulational and antiinflamatory role of MSCs. In conclusion, this new model proved to be easy to use in small animals like rats.

Storm-induced sea-ice breakup and the implications for ice extent.

The propagation of large, storm-generated waves through sea ice has so far not been measured, limiting our understanding of how ocean waves break sea ice. Without improved knowledge of ice breakup, we are unable to understand recent changes, or predict future changes, in Arctic and Antarctic sea ice. Here we show that storm-generated ocean waves propagating through Antarctic sea ice are able to transport enough energy to break sea ice hundreds of kilometres from the ice edge. Our results, which are based on concurrent observations at multiple locations, establish that large waves break sea ice much farther from the ice edge than would be predicted by the commonly assumed exponential decay. We observed the wave height decay to be almost linear for large waves--those with a significant wave height greater than three metres--and to be exponential only for small waves. This implies a more prominent role for large ocean waves in sea-ice breakup and retreat than previously thought. We examine the wider relevance of this by comparing observed Antarctic sea-ice edge positions with changes in modelled significant wave heights for the Southern Ocean between 1997 and 2009, and find that the retreat and expansion of the sea-ice edge correlate with mean significant wave height increases and decreases, respectively. This includes capturing the spatial variability in sea-ice trends found in the Ross and Amundsen-Bellingshausen seas. Climate models fail to capture recent changes in sea ice in both polar regions. Our results suggest that the incorporation of explicit or parameterized interactions between ocean waves and sea ice may resolve this problem.

[Retrogastric bronchogenic cyst]. / Retrogastrická bronchogenní cysta.

The authors present a case of an incidental finding of an asymptomatic retrogastricaly localized bronchogenic cyst. In a 3.5 year old boy, abdominal US, which was performed because of constipation complains, revealed a cystic mass. MRI study confirmed the presence of a simple cyst, located in the retrogastric region. The patient underwent laparotomy and the cyst, measuring 3 cm in a diameter, was removed from the omental bursa. During the postoperative period, no complications or symptoms were recorded. Histologicaly, the finding was surprisingly identified as a bronchogenic cyst. Occurence of bronchogenic cysts within the abdominal cavity is reported very rarely in the literature.

[Toxoplasmic encephalitis in an HIV patient]. / Toxoplazmová encefalitida u pacienta s HIV infekcí.

Toxoplasmic encephalitis is considered one of the most frequent causes of death in HIV-positive patients. The article presents a case of a 40-year-old HIV-positive male hospitalized for surgical treatment of localized brain tumour verified by CT and MRI. Histopathologically, toxoplasmic aetiology was confirmed. Briefly, tissue toxoplasmosis represents a high risk among HIV-positive patients. Therefore, this disease must be considered in differential diagnosis of localized brain masses in HIV-positive patients.

Autopsy case of Gaucher disease type I in a patient on enzyme replacement therapy. Comments on the dynamics of persistent storage process.

We report a female patient with Gaucher disease (GD) type I on ERT (imiglucerase) for 5 years, which led to a significant general improvement. Aged 59 years she underwent an episode of altitude sickness followed by sepsis, disseminated intravascular coagulation, and multiorgan failure. She succumbed to a cerebral haemorrhage. Autopsy revealed liver cholestatic cirrhosis and multifocal liver carcinoma with immunophenotype compatible with cholangiocarcinoma. Analysis of the storage process revealed its absence or very low levels in the majority of liver and spleen macrophages. Gaucher cells (GCs) were seen only as occasional aggregates of various sizes in these organs. GCs were seen also in the leptomeninx of the cerebellum and as infrequent perivascular clusters in both the grey and white cerebral matters. Bone marrow was heavily infiltrated with GCs, especially in the adipocyte-rich part. GCs in this location displayed varied degrees of cytoplasmic vacuolation unrelated to the lysosomal compartment, caused by droplets of triglyceride, and interpreted as due to resorption of fragments of altered white adipocytes. All these observations point to the relative efficacy of ERT in covering the standard substrate load, which should not be exceeded as it would lead to the evolution of mature GCs. The results are discussed in relation to our recently published hypothesis on GD cell pathology.

Paraganglioma-like medullary thyroid carcinoma: fine needle aspiration cytology features with histological correlation.

OBJECTIVES: Two cases of an extremely rare paraganglioma-like variant of medullary thyroid carcinoma (MTC) are reported. METHODS: The patients were a 65-year-old male (case 1) and a 14-year-old female (case 2). Unilateral thyroid nodule and homolateral cervical lymphadenopathy was present in case 1; bilateral thyroid nodules were seen in case 2. Fine needle aspiration cytology (FNAC) was performed from thyroid nodules (in both cases) and from a cervical lymph node (in case 1). RESULTS: The cytological smears contained predominantly ovoid to spindled epithelial cells arranged in cohesive three-dimensional clusters with sharp margins; isolated individual cells were seen only rarely. No colloid or other material was present in the background. The tumour cells showed significant nuclear atypia with occasional bizarre and/or binucleated cells. The nuclear chromatin was coarse and granular, sometimes with grooves and intranuclear inclusions. The cytoplasm was inconspicuous. Polygonal or triangular cells, amyloid and azurophillic cytoplasmic granules were absent in both cases. Calcitonin expression was demonstrated in case 2. Histological examination confirmed the paraganglioma variant of MTC in both cases. Mutation of RET proto-oncogene in exon 16 (Met918Thr) - germline in case 2 and somatic in case 1 was detected by sequencing of DNA in both cases. CONCLUSIONS: This is the first description of cytological findings in the paraganglioma-like variant of MTC. Despite its rarity, it can be reliably diagnosed by FNAC if material for immunocytochemistry is obtained.

[Opacification of hydrophilic acrylic intraocular lenses]. / Opacifikace hydrofilních akrylátových nitroocních cocek.

The authors present results of retrospective study of 10 cases of Aqua-Sense hydrophilic acrylic intraocular lens (IOL) explantation performed during the calendar year 2005 at the Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic. The preoperative visual functions, perioperative findings and postoperative results were evaluated. The best corrected visual acuity (BCVA) before explantation was surprisingly good, even in cases with severe opacification of the lens. There were no serious perioperative complications; in 9 cases, the stable capsular bag enabled us to implant the new IOL in the bag or in the sulcus. In one case, the suction of the secondary cataract was done. In one eye, the zonular dehiscence developed, and the new IOL was placed into the anterior chamber (angle supported AC IOL). We did not see any postoperative complications. The BCVA improved in 3 eyes, in 7 eyes the BCVA remained the same. All patients were satisfied with the postoperative results. Histopathological examinations of the explanted IOLs showed multiple tiny calcium granules concentrated in continuous narrow band closely beneath the anterior surface of the optic part of the IOL. The postoperative calcification of some currently available hydrophilic acrylic IOLs is one of the common reasons for IOL explantation/exchange. Sophisticated surgical techniques greatly improved the postoperative results.

A survey of intraocular lens explantation: a retrospective analysis of 23 IOLs explanted during 2005.

PURPOSE: To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. METHODS: The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. RESULTS: Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562+/-0.279 and 0.627+/-0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). CONCLUSIONS: The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.

Cerebral toxoplasmosis in an allogeneic peripheral stem cell transplant recipient: case report and review of literature.

We present a patient who underwent allogeneic peripheral stem cell transplantation (PSCT) for chronic myelocytic leukemia. Twenty months after the PSCT he experienced status epilepticus. Magnetic resonance imaging (MRI) revealed a focus in the ventral thalamus-hypothalamus region. Using stereotactic biopsy with histology and specific polymerase chain reaction investigation from brain tissue, cerebral toxoplasmosis was diagnosed and treated with antiparasitic therapy. Early recognition of such serious and potentially lethal disease enabled prompt specific treatment. This case report emphasizes the role of stereotactic biopsy in diagnosis of cerebral toxoplasmosis. Other methods such as MRI are non-invasive but not sufficiently specific and sensitive.

[Primitive nonneural granular cell tumor of skin (case report)]. / Primitivní nonneurální nádor kuze z granulárních bunek (kazuistika).

Primitive nonneural granular cell tumor was recognized in an 82-year-old man, mimicking a granuloma in the scalp. Despite its disturbing cytomorphology, this histogenetically enigmatic tumor with unusual immunoprophile (NK1-C3, CD 68 and NSE positivity; S-100 protein negativity) behaves indolently.

[Musculoskeletal vascular malformations in children]. / Cévní malformace pohybového systému u detí.

PURPOSE OF THE STUDY: This study on vascular malformations of the musculoskeletal system in children is concerned with the disease diagnosis and evaluation of treatment results in a group of pediatric patients. MATERIAL: Eighteen children with musculoskeletal vascular malformations, treated at the Department of Orthopedics in Hradec Králové, were assessed. The relevant data were obtained from their medical notes and the children were examined at the outpatient department. METHODS: The initial complaints leading to examination at our department, diagnostic methods used and outcomes of vascular malformation treatment were investigated. Special attention was paid to the results of treatment for unequal leg length. RESULTS: The most frequent initial complaint was a painful, growing, hard tissue mass on either an upper or a lower extremity. In addition to clinical and angiographic diagnostic methods, also Doppler sonography and magnetic resonance imaging were used. Therapy by intervention radiology (selective embolization or sclerotherapy) resulted in reduction of the lesion and subsidence of the signs in 76 % of the patients. In the rest (24 %), the clinical findings did not change. It was necessary to repeat these methods twice to four-times. The best results were achieved by combining intervention radiology and a subsequent excision of the malformation. Of the four patients, only one experienced recurrence after 11 years. Four children were successfully treated for unequal leg length by temporary epiphyseodesis of the proximal tibia which, in one, had to be completed with shortening osteotomy of the proximal femur performed after skeletal maturation. DISCUSSION: There is great inconsistency in the classification of vascular malformations as well as in views on their therapy. The increasing role of magnetic resonance imaging for the diagnosis of vascular malformations is apparent, and our results fully support this fact. Intervention radiology techniques still remain the prevailing methods of treatment. In our experience, the best results are achieved by their combination with an excision of the lesion. When unequal leg length is treated, temporary epiphyseodesis is recommended; if this is preceded by treatment of the malformation, the final discrepancy in leg length is smaller. CONCLUSIONS: The correct diagnosis and treatment of vascular malformations and their sequelae are based on inter-disciplinary cooperation. The use of magnetic resonance imaging for diagnosis is recommended. Good results are achieved by a combination of intervention radiology methods with lesion excision. Temporary epiphyseodesis is the method of choice for treatment of unequal leg length.

[Histologic findings in subantral augmentation (sinus lift)]. / Histologické nálezy u subantrální augmentace (sinus lift).

Subantral augmentation (sinus lift) is used to increase alveolar bone mass of lateral maxilla in order to insert dental implants. In addition to the autogenous bone several foreign materials can be used for augmentation and they can replace the autogenous bone to some extent. Histological findings in specimens taken nine months after augmentation with the autogenous bone, deproteinised bovine bone (Bio-Oss) and beta-tricalcium phosphate (Cerasorb) are presented. In all cases a new bone formation around the augmentation material was seen. The new bone was deposited predominantly on its surface. In cases with Cerasorb the new bone formation was observed within the porous granules, too. From the obtained results it can be concluded, that the main osteogenetic mechanism in the examined augmentation materials was osteoconduction. The biocompatibility of the used augmentation materials was evidenced by an absence of giant cell granulomatous reaction and of marked inflammatory infiltrate.

[Nervous component of mature cystic ovarian teratomas]. / Nervová slozka zralých cystických teratomu ovaria.

In 30-50 percent of cases mature cystic ovarian teratomas contain a nervous tissue which can be highly differentiated. This study was focused on research of the nervous component of mature cystic ovarian teratomas with generally available methods to pathologists, including impregnation techniques, immunohistochemistry and electron microscopy. From the total number of 212 mature cystic ovarian teratomas, the nervous tissue was found in 72 cases (34%), which corresponds to the literature data. According to its differentiation, it was possible to distinguish five categories of nervous tissue by light microscopy: 0 peripheral nervous tissue only, 1--solid glial nodules, 2--glial cysts, 3--glial tissue with abundant scattered neurons and, finally, 4--organoid nervous tissue similar to certain CNS structures. Apart from the foci similar to grey matter of the spinal cord and cerebral cortex, those of differentiated cerebellar cortex were present as well. Astrocytes mostly predominated in the nervous tissue, and they sometimes showed reactive changes including gemistocytes and formation of Rosenthal fibres. Neuronal elements also showed degenerative changes quite frequently, especially in a less differentiated nervous component. These changes might have developed due to an abnormal location of the nervous tissue or its hypoxia in the teratoma. Contrary to some literature data, oligodendrocytes and myelin were present in the nervous tissue of most of our cases. Ultrastructurally, neurons with fully developed synapses were observed in the nervous component, and dendritic spines were present on dendrites of Purkinje cells of cerebellar cortex. The results obtained from the examination of teratomas in this study confirmed and enriched the literature data concerning the high degree of differentiation of their nervous components. We suggest that the differentiated nervous tissue of teratoma represents a unique natural model suitable for research of some aspects of neurohistology and neuropathology, e.g. synaptogenesis or myelinogenesis.

Differentiated adamantinoma of the fibula: a rhabdoid variant.

A benign- appearing osteolytic lesion surrounded by a sclerotic rim was found in the upper fibula of a 25-year-old man. Based on histological features the definitive diagnosis of osteofibrous dysplasia-differentiated adamantinoma was made. The correct histological diagnosis of differentiated adamantinoma depends on factors such as the uniform predominance of an osteofibrous dysplasia-like pattern, and scattered epithelial elements positive for cytokeratin and vimentin. In this case the scattered epithelial cells had abundant eosinophilic cytoplasm and resembled rhabdoid elements, but immunohistochemistry proved their epithelial origin.

[Spontaneous necrosis of parathyroid adenoma]. / Spontánní nekróza adenomu prístítného telíska.

The authors describe a female patient with large parathyroid gland adenoma presenting with clinical symptoms of primary hyperparathyroidism and severe hypercalcaemia. Before planned surgical treatment the patient spontaneously developed clinical symptoms of tetany. Hypocalcaemia was confirmed by laboratory test. The reason turned out to be spontaneous necrosis of the parathyroid adenoma, resulting in remission of hyperparathyroidism. After stabilization of calcium levels, the necrotic adenoma was removed and histopathological examination revealed necrotic adenoma with only occasional vital adenoma cells. During the next follow-up the patient was without any subjective complaints and her state was stable. This phenomenon, yet described in the literature in past, belongs to unusual findings.

[Pulmonary changes in rheumatoid arthritis]. / Plicní zmeny pri revmatoidní artritide.

A 78-year-old smoker with a medical history of rheumatoid arthritis (RA) diagnosed 23 years before death and treated for 10 years by sulfasalazine followed by 7 years of therapy by purine antimetabolite (AZAMUN, Leiras Co.). Two years before his death chemotherapy was added to treat a low grade malignant lymphoma. Pulmonary changes revealed during autopsy consisted of diffuse interstitial fibrosis, diffuse alveolar damage in its acute to subacute phase, and massive multiple bilateral ossifications. The possible side effect of RA treatment on pulmonary tissue is discussed. Post mortem low-voltage X-ray examination appears as a method which may contribute to the accurate distribution and correct diagnosis of multiple pulmonary ossification.

[Pulmonary "tumorlet" as a neoplastic condition?]. / Plicní tumorlet jako neoplastická afekce?

A 66-year-old woman, non-smoker, with a diffuse bilateral pulmonary interstitial involvement caused by multiple carcinoid tumorlets associated with a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). The process has developed during the last two years of the patient's life. There were no pathologic changes in the remnant pulmonary parenchyma. Moreover, the minute typical carcinoid (5.2 mm) was encountered after extensive pulmonary tissue examination. The spectrum of DIPNECH, multiple tumorlets, and typical carcinoid tumor demonstrates a possible neoplastic character of the pulmonary tumorlet.

Case report. Disseminated infection of Blastoschizomyces capitatus in a patient with acute myelocytic leukaemia.

Blastoschizomyces capitatus infection in a 48-year-old man with acute myelocytic leukaemia is reported. A multiorgan involvement and fulminant course of the fungal infection resulted in the patient's death despite fluconazole prophylaxis, therapy with amphotericin B and administration of granulocyte colony-stimulating factor. Predisposing factors to the infection, clinical relevance of surveillance strains and in vitro antifungal susceptibility testing are discussed.