Anaesthetic considerations for high-risk patient kyphoplasty.

Patients with vertebral compression fractures are often indicated for balloon kyphoplasty. Many of them are elderly with severe comorbidities, which puts them at high risk for general anaesthesia. Surgery under infiltration of local anaesthetic with or without mild sedation is therefore the preferred technique used by many surgeons. However, patients reported moderate­to­severe pain during the procedure. A combination of regional anaesthesia with analgo-sedation offers an interesting alternative to general anaesthesia as well as infiltration administered by the surgeon. In this article we present, apart from general anaesthesia, various regional anaesthetic techniques suitable for high-risk patients, including neuraxial anaesthesia, paravertebral block as well as a novel "erector spinae plane block" at the level of the fractured vertebra. We explore their effectiveness and safety profile, as well as advantage of supplementation of adequate analgo-sedation (Ref. 40). Keywords: erector spinae plane block, kyphoplasty, regional anaesthesia, paravertebral block, neuraxial anaesthesia.

Uncertain histological origin of "glia-like" cells in adult human brain tissue cultures.

OBJECTIVES: Most brain cells studies come from cultured rodent brain tissue, so basic questions about the behaviour of cultured adult human glial cells may remain unanswered. BAGROUND: Cells cultured from adult human brain have been poorly defined until now and are often termed "glia-like" based on some morphological similarities with astrocytes. However, the cells in question fail to express glial markers and may be well be of non-glial origin. METHODS: We examined adult human brain and cultures from 10 patients with non-malignant diagnoses. Immunofluorescence methods were used for glial and non-glial cell type identifications. RESULTS: Confluent cultures contained the following: 0.1 % astrocytes, ≤ 0.01 % oligodendrocytes, 2-5 % microglial and 95-98 % "glia-like" cells. Astrocytes tested as followed: GFAP+/Vim+, microglia: Ferr+Vim+, "glia-like" cells: Vim+/Fn+/CK- or CK+. In the brain tissue, astrocytes were GFAP+/Vim+, microglia Ferr+/Vim-, fibronectin expression was restricted to brain vessels. CONCLUSION: This report demonstrates considerable morphological and cytoskelatal dedifferentiation of cultured brain cells. Cytokeratins, specific markers for epithelial cell differentiation, were absent in the brain tissue. However, they were expressed in "glia-like" cells. This finding could be considered glial dedifferentiation given the ectodermal origin of the brain tissue. We suggest that "glia-like" cells come from currently unknown glial progenitor cells scattered through the brain tissue (Tab. 1, Fig. 4, Ref. 19).

Renal cell carcinoma - summarizing overview, biomarkers, metastases and new perspectives.

Kidney carcinoma is currently the tenth most diagnosed tumour in women and the sixth in men. It makes up about 4 % of all malignant tumours. In urology, it is the third most common malignant disease. It is most often diagnosed between the ages of 40 and 60, and its incidence is still rising. Risk factors include: positive family history, high blood pressure, obesity, and smoking. In examining the samples of cancer tissues, histopathological examination methods were used, including biomarkers such as: LRRC3B, TCF21, or cadherins and other markers. The use of imaging methods such as computer tomography and sonography improved the detection ability of an asymptomatic kidney tumour. Due to the expansion of diagnostic methods and the introduction of new techniques in surgical treatment, the paradigm in the surgical treatment of this disease has changed in recent years. In the case of a detailed study of the intracellular structures in the carcinogenic processes, the more profound knowledge about them can lead to the elimination of the need for surgical resection in future (Tab. 7, Fig. 4, Ref. 51). Text in PDF www.elis.sk Keywords: kidney carcinoma, RCC, biomarkers, diagnostics, surgical treatment.

A New Complex Minimally Invasive Thread Lift Method for One-Time Three-Step Fixation of the Face and Neck Soft Tissues.

Background In recent years thread lift has become widespread; however, existing methods need to improve their long-term outcome, which requires considering topographic anatomy of face and neck, especially the ligamentous apparatus. This study aims to assess the effectiveness and safety of an innovative method of one-time three-step thread facelift, which provides an additional support to the ligamentous structures of the upper, middle, and lower thirds of the face and neck. Methods The study included 357 patients aged 32 to 67 years with various morphotypes of aging. The original method of thread lift was applied, and its effectiveness was followed up for to 2 years. The Wrinkle Severity Rating Score (WSRS) and Global Aesthetic Improvement Scale (GAIS) scores were used for assessment by investigators, independent observers, and patients. Statistical significance was determined using paired t -test and chi-square test. Results The mean WSRS score was 3.88 ± 0.88 before the thread lift, 1.93 ± 0.81 one month after the procedure, and 2.36 ± 0.85 after 2 years of follow-up. The mean GAIS was 4.80 ± 0.04 one month after thread lift, and 4.01 ± 0.04 after 2 years, while in the patients' assessment Global Satisfaction Scale was 4.86 ± 0.02 and 4.10 ± 0.02, respectively. There were no clinically significant complications throughout the observation period. Conclusion The new method of one-time three-step thread fixation of the soft tissues of the face and neck demonstrated a high degree of satisfaction by both experts and patients after 2 years of follow-up. It showed high efficacy and safety, including in the group of patients with pronounced age-related changes of the skin of face and neck.

Left Ventricle Outflow Obstruction by Reverse-Oriented Tricuspid Semilunar Valve-Like Endocardial Duplicatures.

A 57-year-old female had a history of hypertension disease, and one year before her death, her ECG showed signs of left ventricle hypertrophy. She died with signs of heart failure with pulmonary edema development. At autopsy, there was left ventricle hypertrophy (wall thickness: 21 mm). In the left ventricle outflow channel, 15 mm below the aortic valve on the muscular wall, there were three white 1-1.5 mm thick membranous semilunar valve-like structures with the sizes of 9, 7, and 5 mm, with concavities opened into the left ventricle, reducing the outflow area by 21.5%. These structures were hanging on the regular muscular ventricular wall, without any visible fibrous anchoring structure and without formation of commissures, and were composed of fine collagen and elastic fibers. Gross anatomy as well as histological structure was different from the subaortic membrane. The reported accessory reverse-oriented tricuspid semilunar valve-like structure is an unusual finding of a structure in the left ventricular outflow tract, to which we could not find an analogy in the available literature.

The variable origin of the recurrent artery of Heubner: an anatomical and morphometric study.

The recurrent artery of Heubner (RAH) is the largest vessel of the medial lenticulostriate arteries. It supplies many deep structures, mainly the corpus striatum, the globus pallidus, and the anterior crus of the internal capsule. The aim of the present paper was studying the morphological variations of the RAH and its diameter in relation to different areas of origin. The series contained the records from 183 formalin-fixed adult human brains. The calibrated digital images of the studied brains were evaluated and measured by Image J, which can calculate the number of pixels and convert them to metric measures. The RAH arose most often from the postcommunicating part of the anterior cerebral artery (47.81%). It originated from the precommunicating part of the anterior cerebral artery in 3.55% and at the level of the anterior communicating artery in 43.4% of cases. The RAH was missing in 5.19% and doubled in 6.28% of cases. The mean outer diameter of the RAH was 0.6 mm. The maximal measured diameter was 1.34 mm, and the minimal diameter was 0.19 mm. The awareness of the various anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures to avoid unexpected neurological complications.

The first histological and immunohistochemical examination of thymus in a case of fetus in fetu.

Fetus in fetu (FIF) is a rare condition with less than 150 cases reported in the world to the best of our knowledge. It is a malformed monozygotic twin ("non-dominant twin"), which is found inside the body of a living child or sometimes in an adult ("dominant twin"). Different organs can be seen in these fetuses; vertebral column limbs, central nervous system, gastrointestinal tract, vessels, and genitourinary tract. In the literature, we found only two cases of fetus in fetu with the present thymic tissue. In this paper, the thymus of non-dominant twin exteriorized from the mediastini of dominant twin, was analyzed by histological and imunohistochemical methods. Even though the majority of organs did not develop normally in the mentioned case, thymic tissue was proved to be present in many body parts of the non-dominant twin. In spite of the fact that the cortex and the medulla were not so distinguishable as in the normal thymuses, presence of many basic cell populations was demonstrated: thymic epithelial cells (AE1/AE3 positive cells), T (CD45RO positive) and B (CD20 positive) cells, macrophages (CD68 positive cells), dendritic cells (S100 positive cells) and myoid cells (desmin positive). The Hassall's bodies were localized mostly in the medulla, however in sporadic cases they occurred in the area close to the connective tissue septa. The superficial epithelial cells of the Hassall's corpuscules as well as their internal contents, were markedly stained by alcian blue, and the cystic formations, found inside the Hassall's bodies, contained PAS-positive substance, similar to Hassall's bodies of normal thymuses. This fact indicates that although development of the parasitic twin is incomplete, all three germ layers participate on its development.

Congenital anomalies of the spleen from an embryological point of view.

The spleen is the major accumulation of lymphoid tissue in the human body, an organ which prenatally produces and postnatally controls blood cells. Normally, a developed spleen lies in the upper left quadrant in parallel with the long axis of the 10th rib. It is a mesodermal derivate which first appears as a condensation of mesenchymal cells inside the dorsal mesogastrium at the end of the fourth embryonic week. Some congenital anomalies of the spleen are common, such as splenic lobulation and accessory spleen, while other conditions are rare, such as wandering spleen and polysplenia. Splenogonadal fusion is also a rare developmental anomaly, resulting from abnormal fusion of the splenic and gonadal primordia during prenatal development. The purpose of this article is to describe the normal development of the human spleen, supplemented with our own photomicrographs and a review of congenital anomalies of the spleen with their possible embryonic basis.