Polar body fragmentation in IVM oocytes is associated with impaired fertilization and embryo development.

PURPOSE: The significance of finding a fragmented first polar body in an oocyte prepared for ICSI is controversial with most recent publications suggesting that it is not prognostic for oocyte fertilization or embryo development. Our purpose was to look at this question in the context of oocytes not stimulated for conventional IVF. METHODS: Oocytes obtained for IVM and obtained from follicles at most 12 mm in diameter were evaluated for their polar body morphology soon after they entered metaphase II when they were denuded in preparation for ICSI. Records were evaluated retrospectively for the fertilization rate and the embryo growth rate (cell number) on each day of development for embryos with normal appearing polar bodies or fragmented polar bodies, but no other cytoplasmic dysmorphisms. RESULTS: Oocytes with fragmented polar bodies were significantly less likely to fertilize than oocytes with normal appearing polar bodies (p < 0.0001). Embryos which developed from oocytes with fragmented polar bodies had significantly impaired growth compared to embryos that developed from oocytes with normal appearing polar bodies (p = 0.0328). CONCLUSIONS: Fragmented polar bodies likely reflect cytoplasmic incompetence.

A comparison of the Cook single lumen immature ovum IVM needle to the Steiner-Tan pseudo double lumen flushing needle for oocyte retrieval for IVM.

PURPOSE: This study compared the impact of using the Steiner-Tan pseudo double lumen needle for antral follicle oocyte retrieval to using a conventional non-flushing needle. The Steiner-Tan needle has a much smaller dead space than the needles commonly used for IVM oocyte retrievals. METHODS: This was a retrospective cohort study. The patient population was determined by the time period in which a patient underwent IVM in a single physician's IVF practice. The following data was abstracted from clinical and embryology records: oocytes retrieved, oocytes matured, early maturing oocytes, oocytes fertilized, embryo quality measures, retrieval time, needle punctures, clot formation, and clinical pregnancy rate. RESULTS: The Steiner-Tan needle did not increase the number of oocytes retrieved. It also did not increase the time required for retrieval. However, flushing of antral follicles significantly decreased clot formation in fluid aspirates. Use of the Steiner-Tan needle also significantly decreased the number of vaginal needle punctures during each case. There was a trend toward improved embryo quality, but statistical power was inadequate to show a difference. CONCLUSIONS: The primary benefit of the Steiner-Tan needle was on the embryological aspects of IVM. Decreased blood and blood clots in the aspirates made an IVM retrieval more like conventional IVF for the embryologist. The patient also experienced less tissue trauma without increasing anesthesia or surgical time. There was no improvement in the number of oocytes retrieved, but based on the results, we hypothesized that oocytes were more commonly retrieved from slightly large follicles than when using a routine needle.

Myocardial stunning. Morphological studies in acute experimental ischemia and intraoperatory myocardial biopsies.

Myocardial stunning represent a consequence of brief ischemia with reversible regional contractile dysfunction dependent persist from minute to days after reperfusion, despite the absence of irreversible damage and restoration of coronary blood flow. The evolution of these new ischemic entity were described by experimental acute ischemia and repeated intraoperatory myocardial biopsies effectuated near 200 patients with heart disease, excluding those with cardiac failure and atrial fibrillation. Using histological histoenzymological and particularly ultrastructural methods, only reversible mitochondrial and sarcoplasmatic reticulum lesions, slight glycogen granules depletions and sporadical dissociation of myofilaments by edema were seen. Major mechanism for the state was suggested: generation of oxygen derived free radicals with consequent oxidative stress and impaired calcium homeostasis. Rare morphological appearance on stunned myocardium was signaled in the references, our collective first made these studies in Romania.

Hibernating myocardium, morphological studies on intraoperatory myocardial biopsies and on chronic ischemia experimental model.

UNLABELLED: Hibernating myocardium represent a prolonged but potentially reversible myocardial contractile dysfunction, an incomplete adaptation caused by chronic myocardial ischemia and persisting at least until blood flow restored. The purpose of this study was to investigate the morphological changes and weather relations exist among function, metabolism and structure in left ventricular hibernating myocardium. Material and methods. Experimental study is making on 12 dogs incomplete coronary obstruction during six weeks for morphologic studies of ischemic zones. On 48 patients with coronary stenosis myocardial biopsies was effectuated during aorto-coronarian bypass graft. On 60 patients with valvular disease associated with segmental coronary atherosclerotic obstructions during surgical interventions on a effectuated repeatedly biopsies from ischemic zones. Dyskinetic ischemic areas was identified by angiography, scintigraphy, low dose dobutamine echography to identify the cells viability. On myocardial biopsies various histological, histoenzymological, immunohistochemical and ultrastructural methods were performed. RESULTS: The morphological cardiomyocytic changes can summarized: loss of myofilaments, accumulation of glycogen, small mitochondria with reversible lesions, decrease of smooth reticulum, absence of T tubules, depression of titin in puncted pattern, loss of cardiotonin, disorganization of cytoskeleton, dispersed nuclear heterochromatin, embryofetal dedifferentiation, and persistence of viability. Extracellular matrix is enlarged with early matrix protein such fibronectin, tenascin, fibroblasts. In experimental material the morphological changes present similarities with the human biopsies, but intermixed with postinfarction scar tissue. Redifferentiation of hibernanting cells end remodeling of extracellular matrix is possible after quigle revascularization through aorto-coronary bypass grafts.

A comparison of the use of clomiphene citrate and letrozole in patients undergoing IVF with the objective of producing only one or two embryos.

AIM: The objective of this study was to compare the use of clomiphene citrate and letrozole in an IVF setting in which the objective was to produce only one or two embryos. Either clomiphene citrate or letrozole was used in conjunction with gonadotropins without the use of GnRH antagonists. METHODS: Sixty-two patients received either clomiphene citrate or letrozole with low dose gonadotropins in 128 non-randomized treatment cycles. HCG was given when one follicle was at least 17 mm. Oocyte retrieval was done 34 hours later and fertilization was performed using ICSI. RESULTS: There were no statistically significant differences in the number of large follicles produced, oocytes fertilized, endometrial thickness, clinical pregnancy rates, or delivery rates in patients taking letrozole compared to clomiphene citrate. More mature oocytes were retrieved after clomiphene citrate, but a subset analysis of patients undergoing both treatments did not support this difference. The only statistically different finding in both analyses was the peak estradiol levels during treatment, which averaged 516 pg/ml with letrozole and 797 pg/ml with clomiphene citrate (p = 0.005). Overall, the cancellation rate due to a premature LH surge was 5%. An average of 2.8 mature oocytes were recovered, 2.1 oocytes fertilized and 1.6 embryos were transferred. The overall clinical pregnancy rate per transfer was 25% (95% confidence interval 17.7% to 33.3%) and the overall live birth rate per transfer was 19.2% (95% confidence interval of 11.6% to 26.8%). CONCLUSIONS: Other than peak estradiol levels, there were no clinically significant differences when letrozole or clomiphene citrate was used for mild ovarian stimulation for IVF. There were only rare cancellations because of premature LH surges.

Gastric liposarcoma. A case report.

Gastric localization of a liposarcoma is exceptional. A 67 year old patient with repeated hematemesis was found to have an ulcer on the dorsal wall of the antrum on radiology. Surgery revealed an ulcerated tumour, 5 X 2 X 1.5 cm, involving the tunica muscularis up to the serosa. Histologic examination showed a liposarcoma with intricate myxomatous zones, round cells, pleomorphous clearly differentiated lipoblastic aspects, and haemorrhagic areas.

An uncommon gastric tumour: leiomyoma associated with osteochondroma.

The case of a 65-year-old man having a large gastric tumor for about 6 years, revealed echographically, is reported. A well delimited consistent white-grey tumor of 8 x 6 x 2.5 cm occurring in the anterior wall of the stomach that extended to the peritoneal cavity was surgically found. Histologically it showed leiomyomatous zones with fascicular spindle cells and sometimes with perinuclear vacuolizations, which were actin-reaction positive but S-100 protein negative. These zones alternated with large compact benign osteochondromatous zone. The uncertain origin of this uncommon tumor was discussed. We have not found any references to such gastric tumors.

Immunomorphological lymph node processes in some cirrhogenic liver diseases.

Dynamics of the lymph node modifications as well as hepatic and immunoserological in various cirrhogenic hepatopathies have been studied on human and experimental material. Lymph nodes showed early and progressively immunomorphological reactions with maximum intensity in evolutive stages of certain cirrhoses. Such reactions as well as in other areas of reticulo-endothelial system are decreasing during the immunosuppressive treatment and in advanced stages of cirrhosis. The lymph nodes participation in the pathogenic mechanism of some cirrhogenic hepatopathies has been very little studied, whereas that of the liver and of the spleen has been more approached. Our previous investigations (1) have disclosed the existence of some chronic lymphadenites as well as reactional reticuloses on necroptic material from young cirrhotics. Equally, during some preliminary experimental studies (7) We remarked intense lymph node reactions even in incipient phases of cirrhoses, which fact stirred us up to examine them thoroughly.

Studies on pathogenicity of Yersinia enterocolitica in mice with diabetes mellitus.

In this study, we investigated the colonizing ability as well as the association of Yersinia enterocolitica serotype 0:9 to epithelial cells of the intestinal tract, Peyer's patches, mesenteric lymph nodes, liver, spleen and lungs in Alloxan-induced diabetes mellitus in mice and controls. The results showed that: (a) in diabetic mice the Y. enterocolitica colonizing values were in range of 10(6.5)-10(8.25) CFU/g of feces; (b) maximum colonizing values were found in distal ileum and Peyer's patches and lower in colon; (c) the infection was progressive with dissemination of bacteria in the liver, spleen and lung; (d) in control (non-diabetic) mice, the colonizing values were 10-100 times lower than those found in the diabetic batch; (e) the main histopathological changes noticed, namely ileitis, mesenteric lymphadenitis and septicemia, were presumably induced by high bacterial load in the liver, spleen and lung leading to a septic course of infection as well as toxic effects of heat-stable enterotoxins of Y. enterocolitica (Yst). The results were confirmed by electron microscopy observations. Summing up, these results demonstrate that diabetic mice were more susceptible to Y. enterocolitica cells than normal mice.

Mammary carcinosarcoma with osteochondrosarcomatous differentiations.

The case of a 77-year-old woman with a 6/5/4.5 cm, mobile, hard, white-yellowish tumour associated with axillary adenopathy, with a progressive evolution in the upper external frame of the right breast is presented. The histopathological examination, carried out after the radical mammectomy, revealed zones with plates of slightly differentiated carcinomatous cells forming keratose pearls next to dense mixofibrochondrosarcomatous proliferations. The scarcity of these tumors as well as the mammary sarcomas and histogenesis questions are discussed.

Jejunoileal alveolar rhabdomyosarcoma. A case report.

Intestinal localization of rhabdomyosarcoma is exceptional, this case is the first to be published in the world literature. A 35-year-old patient with abdominal pain, fever, was found to have an infiltrative white-grey tumour, involving 20 cm the jejunoileal wall and also the surrounding mesenterium up to the origin of upper mesenterical vessels and lymph nodes. Histologic examination showed an alveolar type of rhabdomyosarcoma intricated with solid undifferentiated tumoral cells. The presence of multinucleated giant cells and the positivity of protein S 100 reaction was important for differential diagnosis, given the alveolar soft part sarcoma, malignant mesothelioma, malignant melanoma or papillary carcinoma.

Leiomyoosteochondroma of the stomach. A case report.

The case of a 65-year-old man with a large 6-year gastric tumour revealed echographically is reported. A well delimited consistent white-grey tumour occurring in the anterior wall of the stomach and projecting from the gastric serosa in the subhepatic region was surgically found. Histologically, it showed leiomyomatous zones with fascicular spindle cells and sometimes with perinuclear vacuolizations that are actin-reaction positive but protein S-100-negative. These zones alternated with large compact benign osteochondromatous ones. The uncertain origin of this uncommon tumour was discussed. We have not found any references to such gastric tumours.

Gastrointestinal stromal tumors--a recently defined entity. Literature data and personal case report.

Stromal tumors of the gastrointestinal tract are controverted tumoral entities which were recently delimited. They were initially identified by immunohistochemical investigation and processing of the gastrointestinal muscular tumors and of the malignant and benign nervous tumors. Those investigations were subsequently amplified by electronmicroscopic studies and observations during the patient's prognostic follow-up. Within these circumstances, monoclonal tumors responsive to smooth muscular antigens (actin, SMA), to polyclonal antigens reacting to S-100, PGP 9.5, NSE and GEAP were identified. Thus, tumors with a nervous origin known as a gastrointestinal nerve tumors or plexosarcomas were differentiated, taking into account the difficulty of their distinguishing from gastrointestinal tumors (GIST) which also shows multinucleated great cells. There were also difficulties in defining bidirectionally differentiated tumors or those nonresponsive to any antigen, all these elements proving their origin from nondifferentiated mesenchymal cells. These data are presented in a personal case report of a 28-year old woman with an acute anteroenteral invagination due to a gastrointestinal stromal tumor, favorably removed by surgery and with a postoperative outcome.

Extensive cutaneous lymphoma.

The case of a 35-years-old patient with a progressive and densely developed subcutaneous tumour comprising the whole right cervical and subcutaneous region is presented. The tumour was painless of pale brown and light red colour, with no adherence on the epidermis and subjacent muscles. The patient has no pathological symptoms. After the histopathological examination we found the dermal infiltration with small, round or oval hyperchromatic cells and the histoenzymological investigation revealed intense positive markers CLA and MB2 pleading for their leukocytic nature while L26 reaction attested the B-cell nature of these lymphocytes and the diagnosis of polymorphous centroblastic malignant lymphoma (K type Working Classification).

Retroperitoneal extraadrenal paraganglioma report of two cases.

Two cases with retroperitoneal tumours affecting young women who cannot undergo surgery were investigated by biopsy and needle sampling. One of these cases presented a mainly alveolar histologic pattern and was easily diagnosed by immunohistochemical means, as well as a chromaffin paraganglioma. We discussed different diagnoses and approaches in the literature.

Uterine leiomyofibroma associated with mesodermal mixed tumour. Case report.

It was reported a case of a 55-year-old woman with giant uterine polylobated leiomyofibromatosis with an albescent-reddish fluctuating nodule, of a mesodermal heterologous mixed tumour aspect. The origin of these sarcomas from müllerian pluripotent mesenchymal cells is discussed. The particularity of this case is underlined by the association of two distinct types of benign and malignant tumours.

Clear cell sarcoma of tendons and aponeuroses (malignant melanoma of soft tissue). A case report.

A case of a 55 year old patient with a tumour in the inguino-scrotal region infiltrating into the depth of the thigh was reported. The most tumoral cells appeared clear, rich in glycogen and in melanic pigment, with positive reaction for S-100 protein; between tumoral cells fine vasculo-conjunctival axes were observed. Excluding a Grawitz tumour metastasis one made the differential diagnosis with synovial sarcoma, epitheloid form of malignant schwanomas, spindle cell melanomas, liposarcoma, fibrosarcoma, the tumour was included in the distinct oncologic entity described by Enzinger, with neuroectodermal origin. This case is the first published in Romania.

Voluminous solitary non-Hodgkin extraganglionary lymphoma of thigh.

The case of a 36-year-old woman is presented. She had a voluminous tumour inside the 1/3 average part of the right thigh at 12 cm from the inguinal region. Apart from some local pains, she had a normal haematological formula, normal spleen, liver and lymph nodes. As the tumour of 5.5 x 5 x 4.5 cm was well incapsulated between the sartorius muscle and the great adductor tendon it was easily extirpated and presented a whitish-light yellow section. The histological cellular aspect was pleiomorphic with round, ovalar cells; some were big and clear cells of centroblast-type with several mitoses and giant multinucleated cells and collagenic bundles in between. The nodular Hodgkin sclerosis is not confirmed immunohistochemically because of the negative reaction for antigen Kil (CD30) so that the diagnosis was lymphoma with lymphoma with big B cells by CD20 reaction. We also found positive T cells at CD43 that might be reactive lymphocytes. The tumour ranks a rare malignant lymphoma and for the first time, an extraganglionar lymphoma in thigh was found. We have not met such a location in the literature.

Retroperitoneal malignant fibrous histiocytoma without histological atypias.

A case of a 36-year-old woman suspected of hepatic hydatid cyst with dyseptic symptoms, hepatomegalia, profound pains in the right hypochondrium is presented. During the operation a 15/12/17 cm well-incapsulated tumour is extirpated. The tumour stretched from the upper right renal pole behind the right hepatic lobe as far as the diaphragm and while sectioning it was grey and orange. Histopathologically we found a fibrous histiocytoma with zones of storiform fascicular pattern alternating with areas of histocytic cells with vacuolar-foamy cytoplasm, rich in lipids and without atypias or mitoses. We report the frequency, histological aspects of the fibrous histiocytomas as well as some particularities of their retroperitoneal location.

Anatomoclinical and bacteriological study on chronic marginal periodontal disease. Therapy with staphylococcic vaccine.

Histological, histochemical and electronmicroscopic investigations were carried out on gum biopsies taken from cases with chronic marginal periodontal disease before and after the treatment with staphylococcic vaccine, thus, morphopathologically proving the findings of Gafar et al. (1985) and of Georgescu et al. (1973; 1974; 1975; 1979; 1995). Before treatment, gum lesions were severe, consisting in an abundance of polymorphic inflammatory infiltrates in the chorion along with oedema and disorganised connective fibres, atrophies and ulceration of the mucosa, purulent deposits at the surface with bacteria and fungi. After the treatment with the staphylococcic vaccine, an epithelial regeneration was seen together with the absence of the chronic inflammation. The intensely fibroparius granulated tissue was also noted, in all cases observing abundant connective fibres, accounting for good results after treatment, notably the firmness of the tooth fitting.