High-resolution ultrasound approach to quadrangular joint in carpal boss: Everything musculoskeletal sonographer should know.

At the quadrangular joint (QAJ) of the carpus, a rare bony protuberance called carpal boss (CB) may occur. This bone abnormality may be due to osteophytes development or os styloideum. Symptomatic patients may complain pain, swelling, and restrictions in hand motion. These symptoms result from joint degenerative-inflammatory changes, development of ganglion cyst/bursitis, or tendons pathology. Correct diagnosis and appropriate management can be achieved through high-resolution ultrasonography (HR-US). The purpose of this review is to define the pathology spectrum around and within the QAJ in CB. The role of HR-US is highlighted and the standard technique for the QAJ assessment is described.

Survival outcomes of laparoscopic versus open radical hysterectomy in early cervical cancer with incidentally identified high-risk factors.

OBJECTIVE: Previously, we suggested that patients with cervical cancer (CC) with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aim to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors; lymph node metastasis (LNM) or parametrial invasion (PMI). METHODS: We identified patients with 2009 FIGO stage IB1 CC who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2000 and 2019. Those with a tumor ≤2 cm on preoperative MRI who were not suspicious of LNM or PMI preoperatively were included, while those who were indicated to receive adjuvant treatment but did not actually receive it were excluded. Survival outcomes were compared between the LRH and ORH groups in the overall population, then narrowed down to those with LNM, and then to those with PMI. RESULTS: In total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The LRH and ORH groups showed similar 3-year progression-free survival (PFS) (94.0% vs. 93.6%; P = 0.615) and 5-year overall survival (OS) rates (97.2% vs. 96.8%; P = 0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the LRH and ORH groups (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P = 0.893). CONCLUSIONS: LRH might not deteriorate recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.

Placental Pathologic Changes Associated with Fetal Growth Restriction and Consequent Neonatal Outcomes.

OBJECTIVE: To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outcomes. Study design: This retrospective case-control study included 120 singleton pregnancies with FGR as well as 120 gestational age-matched controls. We compared the placental pathological findings and neonatal outcomes according to the presence of placental malperfusion. Results: The FGR group demonstrated lower placental weight (350.8 ± 118.8 vs. 436.1 ± 109.7g, P < .0001), smaller chorionic plate area (157.7 ± 48.0 vs. 201.5 ± 53.4 cm2, P < .0001), and higher rate of villous change lesions (84.2% vs. 52.5%, P < .0001) than the control group. FGR neonates with placental malperfusion had a higher rate of adverse neonatal outcomes (87.1% vs. 63.2%, P = .0175). Conclusion: Small placentas and placental malperfusion reflected in villous changes are associated with FGR. FGR neonates with placental malperfusion are more susceptible to adverse neonatal outcomes.

Bovine Babesiosis Diagnosed in Formalin-Fixed, Paraffin-Embedded Tissues by Using In Situ Hybridization.

Bovine babesiosis, caused by Babesia divergens, is in general a rare disease in Europe. Nonetheless, local outbreaks can cause severe economic damage, and postmortem identification represents a diagnostic challenge. During a recent outbreak in May 2018 in northern Germany, 21 animals of a herd of 150 cattle died within 40 days having had clinical signs of fever and hemoglobinuria. Gross examination of 4 of the 21 deceased animals revealed a tick infestation, jaundice, and dark brown staining of urine and kidneys. Histologically, there were iron-positive deposits, hyperplasia of the red pulp of the spleen, and centrilobular necrosis of hepatocytes. In several locations, small basophilic granules suggestive of intraerythrocytic parasites were visible in hematoxylin-eosin- and Giemsa-stained sections. Peripheral blood smears from a living cow from the herd and polymerase chain reaction (PCR) of feeding ticks revealed B. divergens infection. In situ hybridization (ISH) was applied on formalin-fixed, paraffin-embedded (FFPE) tissue of the necropsied cattle to confirm babesiosis in these animals postmortem. Digoxigenin-labeled DNA probes were generated based on a specific nucleotide sequence for B. divergens, obtained by PCR and sequencing of DNA isolates from infected Ixodes ricinus ticks from deceased cattle. ISH using these probes allowed postmortem diagnosis of B. divergens infection in routinely fixed FFPE tissues.

Esophageal ulcer related to zinc deficiency following a total gastrectomy.

A 76-y-old Japanese man who had undergone gastrectomy 4.5 y earlier experienced 2 wk of sore throat, heartburn, and difficulty swallowing. Endoscopy showed deep, craterlike, longitudinal ulcers in the lower and middle esophagus. Immunohistochemistry and blood tests were negative for herpes simplex virus and cytomegalovirus infections. The patient reported no other symptoms affecting the gastrointestinal tract. Although his symptoms ameliorated after initial hospitalization and treatment, they re-emerged a few days after being discharged. Fifty-one days after being first admitted, he complained of glossalgia. The serum zinc level was found to be 38 µg/dL, which was below the reference range; the patient was diagnosed with zinc deficiency. After oral zinc administration, the patient was relieved of the symptoms, and his pain was alleviated. Upper gastrointestinal endoscopy after symptom relief showed improvement in the esophageal ulcers. He has continued taking zinc supplementations, and has not developed similar symptoms in the 5 y since being treated. To the best of our knowledge, this is the first case report of esophageal ulcers related to zinc deficiency.

Incidental Pathologic Findings from Orthodontic Pretreatment Panoramic Radiographs.

Panoramic radiography is frequently performed for new patients, follow-ups and treatment in progress. This enables dental clinicians to detect pathology, view important structures, and assess developing teeth. The objective of the study was to determine prevalence of incidental pathologic findings (IPFs) from orthodontic pretreatment panoramic radiographs at a university dental hospital. A retrospective cross-sectional review was conducted of pretreatment panoramic radiographs, using data collection sheets with predefined criteria. Demographic data and abnormalities (impacted teeth, widening of periodontal ligament, pulp stones, rotated teeth, missing teeth, unerupted teeth, crowding, spacing, supernumerary teeth, and retained deciduous teeth) were reviewed. SPSS 28.0 was used to analyze data with statistical tests set at a 5% significance level. Results: One hundred panoramic radiographs were analyzed with an age range of 7 to 57 years. The prevalence of IPFs was 38%. A total of 47 IPFs were detected with altered tooth morphology predominantly (n = 17). Most IPFs occurred in males (55.3%), with 44.7% in females. A total of 49.2% were in the maxilla and 50.8% in the mandible. This difference was statistically significant (p < 0.0475). Other abnormalities were detected in 76% of panoramic radiographs; 33 with IPFs and 43 without. A total of 134 other abnormalities detected showed predominantly impacted teeth (n = 49). Most of these abnormalities were in females (n = 77). Conclusions: The prevalence of IPFs was 38%, predominated by altered tooth morphology, idiopathic osteosclerosis, and periapical inflammatory lesions. Detection of IPFs from panoramic radiographs underscored the importance for clinicians to examine them for comprehensive diagnosis and treatment planning, especially in orthodontics.

Accidental Pathological Findings in Asymptomatic Maxillary Sinuses in Patients Referred for Head and Neck Cone-Beam Computed Tomography: A Cross-sectional Study Analysis.

Background: The aim of the present study was to detect the prevalence of accidental pathological findings in asymptomatic maxillary sinuses in patients referred for head and neck cone-beam computed tomography (CBCT) examination for varied reasons. Methods: The present cross-sectional study included a detailed analysis of CBCT scans of 150 patients aged between 18 and 70 years reporting for varied dental complaints for detecting accidental pathological findings in maxillary sinuses while the patients did not have any complaint pertaining to sinuses. Results: The findings of the present study revealed 58% patients to have pathological findings in maxillary sinuses while they were asymptomatic for sinuses. Furthermore, the prevalence of mucosal thickening was found in 29.3% of the patients while 36.7% patients presented with polypoidal mucosal thickening. Conclusion: Higher prevalence of pathologies in asymptomatic maxillary sinuses found in the present study emphasized significance of a thorough examination of routine dental patients by dento-maxillofacial radiologists with necessary investigations to be advised in the form of higher imaging modalities like CBCT, if necessary.

Destructive Arthropathy of the Femoral Head.

OBJECTIVES: Destructive arthropathy of the hip refers to noninfectious arthropathy causing extensive femoral head bone destruction. It has been described in the surgical literature using a variety of diagnostic criteria, but it remains a poorly defined entity. METHODS: Cases of destructive arthropathy diagnosed at our institution between July 1, 2015, and December 31, 2019, were identified by a free text search of the radiology database. The medical record of each case was reviewed for possible causes of femoral head destruction, clinical presentation, laboratory values, imaging studies, and pathologic diagnoses. Imaging studies and pathology specimens were retrospectively reviewed. RESULTS: Twenty femoral heads were identified in which there was 25% or greater destruction of the femoral head in the absence of infections, congenital disease, or inflammatory arthritis. Destructive arthropathy was characterized pathologically by fibromyxoid change of the marrow, aggregates of necrotic bone fragments, increased numbers of osteoclasts, increased trabecular destruction, and granuloma-like aggregates. CONCLUSIONS: The histologic findings were distinctive. We postulate that a variety of preexisting conditions set in motion a cascade of tissue factors that led to bone destruction.

Pathological findings of central nervous system, two GM1 gangliosidosis autopsy cases.

Özdemir Kara D, Sahpaz A. Pathological findings of central nervous system, two GM1 gangliosidosis autopsy cases. Turk J Pediatr 2019; 61: 953-957. GM1 gangliosidosis is an autosomal recessive lysosomal storage disease which is characterized by the accumulation of GM1 ganglioside, sphingolipids, glycoprotein bound oligosaccharides and keratan sulphate. Three major clinical forms have been identified depending on the enzyme levels, the timing of onset and severity of the manifestations; infantile form being the most severe. We herein present the clinical features and the histopathological findings of the central nervous system of two cases with type I infantile gangliosidosis; the first one had been diagnosed when she was 8 months old and died at the age of 3; the second one had been diagnosed when he was 10 months old and died at the age of 2. Correlations between clinical features and histopathological findings have been discussed. Postmortem examination of both cases revealed a severe cortical thinning of cerebrum and cerebellum, accompanied by ventricular dilatation. Light microscopic evaluation of cerebral, cerebellar and brainstem sections demonstrated a distortion of normal parenchymal structures and presence of cellular aggregates bearing large, foamy and eosinophilic cytoplasm. Clinical records of the cases revealed a history of delayed mental and motor development, and frequently recurring infection episodes for both cases. Postmortem histopathological examination of such cases enables us to thoroughly identify and describe the multisystemic organ pathologies stemming from gangliosidosis. In this report, we aim to put an emphasis on the specific postmortem neuropathological findings in GM1 gangliosidosis. For a definitive diagnosis, documentation of low ß-galactosidase enzyme levels in leucocytes is a must.

Helicobacter Pylori Infection Prevalence and Histopathologic Findings in Laparoscopic Sleeve Gastrectomy.

INTRODUCTION: Helicobacter pylori (H. pylori) is a type of bacteria that affects more than half of the world's population and has been associated with gastritis. The relationship between H. pylori and obesity is controversial. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used surgery for morbidly obese patients. The aim of this study was to investigate the rate of H. pylori in patients undergoing LSG. METHODS: Biopsy specimens of 32,743 patients who underwent esophagogastroduodenoscopy (EGD) and resection materials from 1257 patients who underwent LSG were examined histopathologically. The relationships between body mass index (BMI), age, gender, H. pylori infection, and intestinal metaplasia (IM) were investigated in patients with gastritis. RESULTS: In patients undergoing EGD, the association of H. pylori infection was found to be increased in males and the elderly (p < 0.001). The presence of gastritis and IM was significantly higher with H. pylori infection (p < 0.001 and p = 0.001, respectively). H. pylori infection was significantly higher in patients over the age of 41 years (p < 0.001). There was no significant difference between the results of H. pylori before and after LSG surgery (p = 0.923). The presence of H. pylori together with gastritis and IM was found to be significant (p < 0.001). CONCLUSIONS: H. pylori infection increases with age. No significant difference was found in the examination for H. pylori before and after LSG surgery. In addition, no relationship was found between H. pylori and excess weight. However, due to the low average age of patients who underwent LSG, further studies are needed in this area.

CAUSES OF DEATH AND DETECTION OF ANTIBODIES AGAINST JAPANESE ENCEPHALITIS VIRUS IN MISAKI FERAL HORSES (EQUUS CABALLUS) IN SOUTHERN JAPAN, 2015-17.

We performed postmortem examinations on seven Misaki feral horses (Equus caballus) and evaluated Misaki feral horses, Japanese wild boars (Sus scrofa leucomystax), domestic pigs (Sus scrofa), and wild Japanese macaques (Macaca fuscata fuscata) from 2015 to 2017 in Cape Toi, Kushima, Miyazaki Prefecture, southern Japan, for antibodies against Japanese encephalitis virus (JEV). Strongylus vulgaris infection with severe arterial lesions and hemomelasma ilei was present in all necropsied horses. We frequently found intestinal ulcers, perihepatitis filamentosa, and poor body condition. We recorded degenerative arthropathy in metacarpophalangeal joints in two cases and a fracture of the rib with diaphragmatic rupture in one case. A total of 73% (177/242) of horses were seropositive for JEV as tested by hemagglutination inhibition (HI). The HI data also revealed that 74% (59/80) of the wild boars, 67% (60/90) of the pigs, and 29% (22/75) of the wild monkeys were seropositive for JEV. Our findings showed that Strongylus spp. are still a risk to horses in this region, and that environmental factors such as topographic location of the pasture and steep slope may have caused of degenerative arthropathy and bone fracture. Our results showed that JEV is endemic in Japan. The wild boars and pigs were presumed to act as strong amplifiers and sources of infection, with subsequent risk to humans.

Congenital Glioblastoma with Distinct Clinical and Molecular Characteristics: Case Reports and a Literature Review.

BACKGROUND: The molecular diagnosis of brain tumors is important in classifying tumors and determining appropriate treatment. Congenital glioblastoma multiforme (GBM) is a rare tumor that occurs in infants, and the prognosis is poor. Approximately 60 patients diagnosed with congenital GBM have been reported. However, few reports have conducted molecular analyses of congenital GBM. CASE DESCRIPTION: We describe 2 congenital GBM patients treated in our hospital, and report results of immunohistochemistry, fluorescent in situ hybridization (FISH), direct sequencing, and methylation analyses. Surgery was performed on both patients at 2 months old, and the cases were diagnosed as glioblastoma. Immunohistochemical staining, FISH, and direct sequencing were positive for glial fibrillary acidic protein and ATRX, partially positive for p53, showed no alteration of isocitrate dehydrogenase 1 R132H, H3F3A, HIST1H3B, and BRAF, and indicated no codeletion of 1p and 19q. Methylation analysis of 1 patient identified copy number aberrations of 4 genes: deletions of CDK6 and CDKN2A/B, and a fusion of MET. One patient received chemotherapy consisting of ranimustine, interferon-beta, carboplatin, and etoposide, whereas the other patient received chemotherapy with the modified Children's Cancer Group study-9921 protocol. Residual tumors in both patients were decreased, and they achieved 18-year- and 9-month progression-free survival, respectively. In addition, we reviewed 65 previously reported congenital GBM patients, and found they have better prognosis than pediatric and adult GBM, and long-term survival can be expected. CONCLUSIONS: Congenital GBM demonstrates clinical and molecular characteristics that are different from those of pediatric or adult GBM.

Adverse Pathology After Neoadjuvant Chemotherapy and Radical Cystectomy: The Role of Adjuvant Chemotherapy.

BACKGROUND: The current guidelines do not recommend adjuvant chemotherapy (AC) for patients with adverse pathologic findings after neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for bladder cancer. We sought to evaluate the association of AC with overall survival (OS) in these patients. MATERIALS AND METHODS: The National Cancer Database was used to identify patients with adverse pathologic findings (ypT3N0, ypT4N0, or ypTanyN1-N3) after NAC and RC for bladder cancer from 2006 to 2012. The clinicopathologic variables were abstracted, and the patients were stratified according to the receipt of AC. OS was estimated using the Kaplan-Meier method and log-rank test. Associations between AC and OS were evaluated in multivariable Cox proportional hazards regression models among all patients and stratified by pathologic classification. RESULTS: A total of 1361 patients were identified: 444 (32.6%) with ypT3N0, 162 (11.9%) with ypT4N0, and 755 (55.5%) with ypTanyN1-N3. The median OS for the entire cohort was 22.9 months, which differed by pathologic classification: 34.6 months with ypT3N0, 21.4 months with ypT4N0, and 19.3 months with ypTanyN1-N3 (P < .01). AC was used in 328 patients (24.1%), and no difference in OS was observed by receipt of AC (24.6 months with AC vs. 22.0 months without; P = .18). On multivariable analysis, AC was not independently associated with OS (hazard ratio, 0.86; 95% confidence interval, 0.74-1.01; P = .06). CONCLUSION: Patients with adverse pathologic findings at RC after previous NAC have a median OS of approximately 2 years, which was not significantly improved with AC. Clinical trials with newer systemic agents are warranted for patients in this setting to guide future therapy.

Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management.

BACKGROUND: Laparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Before the procedure, patients undergo a rigorous preoperative evaluation including double contrast upper gastrointestinal radiographic series at our institution. Patients undergoing sleeve gastrectomy are presumed to have no significant gastric pathology. OBJECTIVES: To investigate the prevalence of histopathologic findings requiring clinical follow-up in sleeve gastrectomy specimens. SETTING: University Hospital, United States. METHODS: Retrospective review was conducted of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (N = 248). RESULTS: Unanticipated findings warranting clinical follow-up were identified in 8.4% of cases and included cases of H. pylori gastritis, autoimmune gastritis with microcarcinoid formation, necrotizing vasculitis, and intestinal metaplasia. H. pylori was identified in 5.2% of all cases and in 33.3% of cases of gastritis. Neoplasms were identified at laparoscopy in 2 additional cases (0.8%). CONCLUSIONS: Surgeons and pathologists should be aware of the high prevalence of diagnoses requiring clinical follow-up in vertical sleeve gastrectomy specimens.

Thorax: normal and benign pathologic patterns in FDG-PET/CT imaging.

This article describes the normal patterns of thoracic (18)F-fluorodeoxyglucose (FDG) biodistribution, and expands on the role of FDG-PET/computed tomography (CT) for the evaluation of patients suffering from a spectrum of benign pathologic conditions that affect the chest. The discussion addresses the applications of FDG-PET/CT imaging in a wide variety of chest-related disorders. Familiarity with the normal thoracic biodistribution of FDG, coupled with knowledge of the potential nonmalignant causes of increased FDG uptake in the chest, is essential to minimize the incidence of incorrect interpretation of FDG-PET images in daily clinical practice.

Utilización de las zonas de entrada seguras para el abordaje de lesiones intrínsecas de tronco cerebral en adultos / Use of safe entry zones for the approach of intrinsic brainstem lesions in adults

Introducción: Las "zonas de entrada seguras" (ZES) al tronco cerebral describen accesos destinados a preservar estructuras críticas. La mayoría de las publicaciones son descripciones anatómicas; existiendo pocas sobre su aplicación. En este escenario, nuestro trabajo puede sumar información para el manejo quirúrgico en casos seleccionados. Material y Métodos: De una serie de 13 pacientes, se presentan 9 que no eran candidatos para biopsia estereotáctica y recibieron microcirugía. Las localizaciones fueron: mesencéfalo (3), tectum (1), protuberancia (2) y bulbo (3). Cinco pacientes tuvieron KPS => 70; y 4, KPS <70. Diferentes ZES fueron utilizadas según la topografía lesional. El grado de resección se basó en la biopsia intraoperatoria y el monitoreo neurofisiológico. Resultados: Los hallazgos patológicos fueron: astrocitoma pilocítico (1), glioma de bajo grado (1), hemangioblastoma (1), subependimoma (1), disgerminoma (1), y lesiones pseudotumorales (3 cavernomas y 1 pseudotumor inflamatorio). El grado de resección fue completo (4), subtotal (3), y biopsia fue considerada suficiente en (2). Un paciente falleció en el postoperatorio. Discusión: Las lesiones del tronco cerebral son infrecuentes en adultos. Las controversias surgen cuando se balancean los beneficios de obtener diagnóstico histopatológico y los riesgos potenciales de procedimientos invasivos. La amplia variedad de hallazgos en esta localización exige una precisa definición histopatológica, que no solamente determinará la terapéutica adecuada, sino que advierte sobre las consecuencias potencialmente catastróficas de los tratamientos empíricos. Las ZES ofrecen un acceso posible y seguro, aunque es más realista considerarlas como áreas para abordar lesiones intrínsecas con baja morbilidad más que como zonas completamente seguras

Introduction: The "safe entry zones" (SEZ) to the brainstem are special entrances described to preserve critical structures. Most publications correspond to anatomic research; few papers report their application in surgery. In this scenario, our report could add information to the surgical management in selected cases. Material and Methods: Out of a series of 13 patients, 9 were non-candidates for stereotactic biopsy and received microsurgery. Localizations of the lesions were: mesencephalus (3), tectal plate (1), pons (2) and medulla oblongata (3). Five patients had KPS => 70; 4, KPS <70. Different SEZ were used according to lesional topography. The extent of resection were based on the frozen pathology findings and neurophysiological monitoring. Results: A variety of pathological findings were found: low-grade glioma (1); pilocytic astrocytoma (1); hemangioblastoma (1); subependimoma (1); disgerminoma (1); pseudotumoral lesions (cavernomas 3 and inflammatory pseudotumor 1). The extent of resection was complete (4), subtotal (3), and biopsy was considered sufficient in 2 cases. One patient died 96-hours-postoperative due to brainstem edema. Discussion: Brainstem structural lesions are uncommon in adults. Controversies arise regarding the need of histologic diagnosis, weighing benefits of a reliable diagnosis and the potential disadvantages of the invasive procedures. The accurate histopathological definition could not only determine an adequate therapy, but also can prevent the disastrous consequences of empiric treatments. The SEZ provides a feasible and safe access, although it is more realistic to consider them as areas to approach intrinsec lesions with less morbidity than to consider them as completely safe entrances

Coinfecções por Leishmania infantum, Neospora caninum e Toxoplasma gondii em cães necropsiados da região central do Rio Grande do Sul, Brasil / Coinfections by Leishmania infantum, Neospora caninum and Toxoplasma gondii in necropsied dogs from the central region of Rio Grande do Sul, Brazil

O objetivo do presente trabalho foi determinar a presença de anticorpos para Leishmania infantum, Neospora caninum e Toxoplasma gondii, por meio da reação de imunofluorescência indireta (RIFI), em cães (n=78) provenientes da região central do Rio Grande do Sul, necropsiados no Hospital Veterinário da Universidade Federal de Santa Maria (UFSM), bem como avaliar os dados epidemiológicos, sazonais e anátomo-histopatológicos. Do total de animais avaliados, 67,9% (53/78) apresentaram soropositividade para ao menos um agente. A ocorrência de anticorpos para L. infantum, N. caninum e T. gondii foi de 33,3 (26/78), 37,1 (29/78) e 43,5% (34/78), respectivamente. Detectaram-se monoinfecções em 9,4% (5/53) para L. infantum, 18,8% (10/53) para N. caninum e 20,7% (11/53) para T. gondii. As coinfecções foram observadas em 27/53 (50,9%) dos animais. As infecções ocorreram independentemente de idade, sexo, procedência ou raça (P>0,05). Não se verificaram lesões anatomo-histopatológicas relacionadas aos agentes pesquisados, caracterizando-os como animais assintomáticos. Os resultados confirmaram a exposição de cães a esses protozoários na região central do RS e, em especial, demonstraram a circulação do agente causador da leishmaniose em uma área considerada indene para a enfermidade.(AU)

The present paper is aimed to determine the presence of antibodies for Leishmania infantum, Neospora caninum and Toxoplasma gondii by indirect immunofluorescence (IIF) in dogs (n=78) from the central region in the state of Rio Grande do Sul necropsied in the Veterinary Hospital from Universidade Federal de Santa Maria (UFSM). The data was evaluated regarding epidemiological, anatomic, and histopathologic findings. Of the total animals evaluated, 67.9% (53/78) showed seropositivity for at least one agent. The occurrence of antibodies to L. infantum, N. caninum and T. gondii was 33.3% (26/78) 37.1% (29/78) and 43.5% (34/78), respectively. The mono infections were detected in 9.4% (5/53) of L. infantum, 18.8% (10/53) for N. caninum and 20.7% (11/53) T. gondii. The coinfections occurred in 50.9% (27/53) of animals. There were not anatomical and histopathological lesions regarding these surveyed agents, characterizing them as subclinical animals. The results confirmed the exposition of dogs to these protozoa in the central region of the RS, highlighting the circulation of the causer agent of leishmaniasis in an area considered harmless for the disease.(AU)

Preoperative radiologic and postoperative pathologic risk factors for early intra-hepatic recurrence in hepatocellular carcinoma patients who underwent curative resection.

PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.

La ultrasonografía en el estudio de síndrome de hombro doloroso / Musculoskeletal ultrasound in the evaluation of the painful shoulder

El síndrome de hombro doloroso es una causa frecuente de consulta en la práctica clínica diaria. Su origen puede ser traumático, inflamatorio, degenerativo, infeccioso o tumoral. El abordaje diagnóstico implica un amplio conocimiento de la anatomía regional y la aplicación de maniobras clínicas y técnicas de imagen que conduzcan a un diagnóstico certero para la aplicación de un tratamiento óptimo en cada paciente. En los años recientes, el ultrasonido musculoesquelético ha demostrado ser una herramienta complementaria de altísima utilidad en el examen complementario de los pacientes con hombro doloroso, especialmente en el contexto de la práctica reumatológica. Revisaremos los principales hallazgos patológicos evaluados por esta técnica.

Painful shoulder syndrome is a frequent cause of daily clinical consultation. Its origin can be traumatic, inflammatory, degenerative, infectious or tumor like. The boarding diagnosis implies an ample knowledge of the regional anatomy and the application of clinical and technical maneuvers of image that leads to an accurate diagnosis for the application of an optimal treatment in each patient. In the recent years, the musculoskeletal ultrasound has demonstrated to be a complementary tool of highest utility in the complementary examination of the patients with painful shoulder, especially in the context of the rheumatological practice. We will review the main pathological findings evaluated by this technique.