The impact of implantation site on procedure success in patients with unresolved facial palsy treated with upper-eyelid gold weight loading.

Loading of the upper eyelid is a well-established procedure for the correction of incomplete eyelid closure due to unresolved facial palsy. Some incurable complications are attributed to type IV hypersensivity reaction, but there is no confirmation of this hypothesis. The aim of the study was to show the impact of gold weights on eyelid tissues depending on the implantation site. Out of 94 total patients (aged 53 ± 17 years) treated from July 2009-2021, since 2014 thirty consecutive patients were randomised into one of 3 groups: the GLE group (gold weight fixed 2 mm above the eyelash line), the GUE group (gold weight fixed at the border of the tarsus and the levator aponeurosis), and the PUE group (platinum chain fixed in the same way as in the GUE group). In the cases of complications, the explanted weights were evaluated histopathologically. The outcomes were compared between groups. Incomplete eyelid closure was corrected in all patients. Serious complications were noted in 100% of patients in the GLE group and 20% in the GUE group (p < 0.0001). A slight lymphocytic reaction was observed in the GUE group. A moderate to significant lymphocytic reaction was observed in the GLE group (p < 0.001). Adverse reactions of the upper eyelid microenvironment resulting from gold weights seem to be dependent on mechanical damage to the eyelid structures, rather than on implants themselves. The site of placement of the weight in the upper eyelid may be critical for procedure success.

[New view on macroscopic criteria for determining the age of subdural hematomas]. / Nowe spojrzenie na ocene wieku krwiaków podtwardówkowych na podstawie ich wygladu makroskopowego.

The objective of the study was to assess the usefulness of macroscopic criteria for determining the age of subdural hematoma (SDH) and, additionally, the effect of other than time-related factors on the evolution of SDH in a prospective study. The analysis included the results of forensic autopsies' performed in the Chair and Department of Forensic Medicine of Warsaw Medical University (Warsaw, Poland) in 76 cases with SDH after a head injury inflicted at a known time. The following parameters of SDH were analyzed: location, diameter, color and consistence. In every case, additional information regarding sex, age, the type of injury, trauma degree (AIS and ISS) was collected and included in the analysis. The results suggest that macroscopic hematoma evaluation is a useful method of dating the age of SDHs. In addition, the results of the study suggest that factors other than time had an effect on hematoma evolution, and the severity of head injury should be considered one of the factors involved.

[Usefulness of selected microscopic morphological changes in determining the age of subdural hematomas]. / Wybrane cechy budowy mikroskopowej jako element dodatkowy w ocenie wieku krwiaków podtwardówkowych.

The objective of the study was to assess the usefulness of selected microscopic changes for determining the age of subdural hematoma (SDH). The research was based on microscopic examination of histopathological preparations representing SDHs collected in the course of 76 forensic autopsies performed in the Chair and Department of Forensic Medicine, Warsaw Medical University, Poland. The deceased had SDH after head injuries and the time of injury was known. H.E. and Masson's staining was employed for qualitative and quantitative determinations. The presence of hematoma capsules, as well as hematoidin and hemosiderine deposits were analyzed. The results suggest that microscopic SDH examinations based on the afore-said features is a helpful method for determining the age of SDHs. Additionally, the results of this study indicate that qualitative techniques of SDHs dating are more accurate than quantitative ones.

Small extracellular vesicles containing arginase-1 suppress T-cell responses and promote tumor growth in ovarian carcinoma.

Tumor-driven immune suppression is a major barrier to successful immunotherapy in ovarian carcinomas (OvCa). Among various mechanisms responsible for immune suppression, arginase-1 (ARG1)-carrying small extracellular vesicles (EVs) emerge as important contributors to tumor growth and tumor escape from the host immune system. Here, we report that small EVs found in the ascites and plasma of OvCa patients contain ARG1. EVs suppress proliferation of CD4+ and CD8+ T-cells in vitro and in vivo in OvCa mouse models. In mice, ARG1-containing EVs are transported to draining lymph nodes, taken up by dendritic cells and inhibit antigen-specific T-cell proliferation. Increased expression of ARG1 in mouse OvCa cells is associated with accelerated tumor progression that can be blocked by an arginase inhibitor. Altogether, our studies show that tumor cells use EVs as vehicles to carry over long distances and deliver to immune cells a metabolic checkpoint molecule - ARG1, mitigating anti-tumor immune responses.

Image processing methods for the structural detection and gradation of placental villi.

The context-based examination of stained tissue specimens is one of the most important procedures in histopathological practice. The development of image processing methods allows for the automation of this process. We propose a method of automatic segmentation of placental structures and assessment of edema present in placental structures from a spontaneous miscarriage. The presented method is based on texture analysis, mathematical morphology, and region growing operations that are applicable to the heterogeneous microscopic images representing histological slides of the placenta. The results presented in this study were obtained using a set of 50 images of single villi originating from 13 histological slides and was compared with the manual evaluation of the pathologist. In the presented experiments, various structures, such as villi, villous mesenchyme, trophoblast, collagen, and vessels have been recognized. Moreover, the gradation of villous edema for three classes (no villous edema, moderate villous edema, and massive villous edema) has been conducted. Villi images were correctly identified in 98.21%, villous mesenchyme was correctly identified in 83.95%, and the villi evaluation was correct in 74% for the edema degree and 86% for the number of vessels. The presented segmentation method may serve as a support for current manual diagnosis methods and reduce the bias related to individual, subjective assessment of experts.

Role of WNT/ß-Catenin Pathway as Potential Prognostic and Predictive Factors in Renal Cell Cancer Patients Treated With Everolimus in the Second and Subsequent Lines.

BACKGROUND: The aim of the present study was to search for predictive and prognostic factors in patients with metastatic renal cell carcinoma (mRCC) treated with everolimus among the components of the WNT/ß-catenin pathway. PATIENTS AND METHODS: In a prospective, single-arm, phase II study, patients with mRCC received everolimus (10 mg/d) in a 30-day cycle. We performed a prospectively planned evaluation of the potential biomarkers of the WNT/ß-catenin pathway. RESULTS: The serum level of soluble E-cadherin (sE-cadherin) in patients with RCC was significantly greater than that in the controls (71.62 ± 22.28 pg/mL vs. 54.26 ± 10.317 pg/mL; P = .0069). After 2 cycles of everolimus therapy, we observed a significance increase in sE-cadherin (from 71.81 ± 21.18 pg/mL to 77.50 ± 28.212 pg/mL; P = .0151). The Dickkopf-1 protein levels in the study and control groups were not significantly different (P = .2135). The favorable independent predictors for everolimus therapy were normal lactate dehydrogenase level before treatment (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28-0.98; P = .0443) and low sE-cadherin level (HR, 0.54; 95% CI, 0.29-0.98; P = .0422). On multivariate analysis, we observed that worse overall survival was seen in patients with a lower regression coefficient of sE-cadherin after 2 cycles of treatment (HR, 2.60; 95% CI, 1.23-5.52; P = .0128), an increased corrected calcium level (HR, 3.09; 95% CI, 1.21-7.88; P = .0180), and an increased lactate dehydrogenase level before treatment (HR, 1.98; 95% CI, 1.02-3.83; P = .0426). CONCLUSION: WNT/ß-catenin component expression in patients with mRCC had no effect on progression-free survival or overall survival. However, we found that the sE-cadherin level might interact with response to everolimus therapy, although confirmation in future studies is needed.

Serum matrix metalloproteinases MMP-2 and MMP-9 and metalloproteinase tissue inhibitors TIMP-1 and TIMP-2 in diabetic nephropathy.

BACKGROUND: The regulation of mesangial extracellular matrix (ECM) turnover engages a number of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). High glucose concentration affects ECM degradation and the activities of MMPs and TIMPs. ECM accumulation is involved in the pathogenesis of diabetic nephropathy. METHODS: Serum MMP-9, MMP-2, TIMP-2 and TIMP-1 were measured with ELISA in patients with either chronic renal failure (CRF, n=20), type 2 diabetes mellitus (DM2, n=16) or diabetic nephropathy (DM2+CRF, n=14), and healthy controls (n=20). RESULTS: Diabetic nephropathy was related with profound decrease of serum TIMP-2 (122.2 +/- 47.2 vs. 263.0 +/- 89.2 ng/mL), TIMP-1 (242.5 +/- 96.9 vs. 347.4 +/- 87.2 ng/mL) and MMP-2 (385.4 +/- 42.6 vs. 517.2 +/- 75.4 ng/mL) (p<0.001). Both TIMP-1 and TIMP-2 were reduced in diabetic nephropathy in comparison with either diabetes alone (p<0.01 and p<0.001; respectively) or CRF alone (p<0.001 for both). An approximately 2-fold increase of MMP-9/TIMP-1 and MMP-2/TIMP-2 ratio was found in diabetic nephropathy when compared with diabetes with normal renal function (p<0.01). Further, in DM2 patients, TIMP-2 was decreased when compared with CRF alone (219.2 +/- 71.8 vs. 296.8 +/- 58.4 ng/mL). MMP-2 was lowered in both groups of DM2 and CRF patients (413.8 +/- 59.0 ng/mL and 409.7 +/- 93.1 ng/mL, vs. normal control value of 517.2 +/- 75.4 ng/mL; p<0.001). CONCLUSIONS: These data indicate that circulating TIMP-1, TIMP-2 and MMP-2 are decreased in patients with diabetic nephropathy when compared with either CRF or diabetes.

[The possibilities and barriers in endoscopic examination and treatment of esophagus cancer]. / Mozliwosci endoskopli w rozpoznawaniu i leczeniu nowotworów przelyku.

When it comes to the effective treatment of esophagus tumor is one of the most difficult tumor to treat of all tumors of alimentary tract. It is due to the biological features of this tumor and lack of its early clinical symptoms, which would allow to recognize it in the early stage and to begin with a radical treatment. The main method to recognize the esophagous tumor is the endoscopic treatment with histopathology, and the endosonography is the best method which allows to estimate its local advancement. Endoscopy allows to detect pre-malignant phase and the early stage as well use of the alternative to surgical endoscopic methods of the treatment. Unfortunately, endoscopy made to patients with swallow discordance usually shows the advanced esophagus tumor, which is to be qualified for palliative treatment that include: widening of esophagus, different methods of ablation, endoscopic stenting and implementing alimentary gastrostomy. The choice of the treatment method should be based on the type of the tumor and the advancement stage of disease, but the clinical practice shows that the method of treatment is determined by the availability of the methods and experience. The parallel use of different methods of treatment may give better results, but the wide range of treatment methods shows the lack of optimal way of treatment, on the other hand gives the possibility to chose the individual method of optimal treatment. Surgical treatment is still method of choice in the esophagus tumor, but it is often impossible to perform or is appears to be ineffective and it creates the possibility of use of alternative endoscopic methods. The article shows the possibilities of diagnosing and different endoscopic techniques for radical treatment of earlyphase and palliative treatment of advanced tumor of esophagus.

[Endoscopic polypectomy in colorectal cancer prophylaxis]. / Endoskopowa polipektomia w profilaktyce raka jelita grubego.

The increasing incidence of colorectal cancer force to find new and enhance old methods of diagnostic methods that could allow the pre-magnant or early cancer lesions diagnosing. Those could be more effectively and with less invasive surgical and endoscopic methods cured. The proposed method in prophylaxis is colonoscopy that allow the lesion detection as well as apply curative method what is better for patient and decrease cost of procedure. Diagnostic efficacy is dependant on the experience of the person performing the procedure. Only in some cases applying methods as inking or magnifying increase diagnostic yield. Early lesion detection and treatment of colorectal adenomas that could be protruding, flat or concave lead to significant decrease of colorectal cancer incidence. Implementing the wider array of indications and mucosectomy to clinical practice improve treatment efficacy but require proper preparation and experience as well as qualification for the procedure. Despite the development of new diagnostic methods basis the proper evaluation of mucosal layer during endoscopy and histopatological assessmnet of found lesions. Colonoscopy is also widely accepted method of colorectal cancer surveillance after endoscopic or surgical procedures in colorectal treatment.

[Clinico-pathological cooperation rules in biologic material processing]. / Zasady wspólpracy k iniczno-patomorfologicznej w opracowywaniu materialu biologicznego.

The principles of collaboration between a clinician and a pathomorphologist in diagnosis of the intestinal diseases were presented. The optimal criteria of drawing and fixing cytological and tissue samples were presented. The importance of extensive clinical information for pathomorphological diagnosis was proved. It was indicated that an early collaboration between a clinician and a pathomorphologist in the proccess of clinical diagnostic planning is necessary.

[Histoclinic of "indeterminate colitis"]. / Histoklinika "colitis indeterminata".

Indeterminate colitis is an ill definied, preliminary and temporary descriptive term overused in clinical and morphological practice. The aim of this paper is to offer an opinion, supported by published data, about the appropriate use of this term. There is no generally accepted definition of indeterminate colitis. All current temporary definitions of this term relay on exclusionary criteria and there is no confirmatory diagnostic tests. Nevertheless the diagnosis of indeterminate colitis appears to define subgroup of patients with special phenotype of inflammatory bowel disease. A diagnosis of indeterminate colitis should be reached with description of criteria applied.

[Pathomorphologic diagnostic guidelines for colon polyps]. / Zasady diagnostyki patomorfologicznej polipów jelita gubego.

Among polypoid laesions of the large bowel the great attention should be payed to Adenomas because of they neoplastic transformation capabilities. In this paper a classification of neoplastic adenomas extended with serrated adenoma and hyperplastic polyps with presence of tubular adenoma structures has been presented. The recommended laboratory procedures used in preparing of endoscopy material has been discussed. The role of Pathologists and Gastrologist in proper diagnosis of precancerous and early cancerous changes has been also discussed.

[Endoscopic surgery in treatment of inverted papilloma nose et paranasal sinuses in the older patient]. / Brodawczak odwrócony nosa i zatok przynosowych leczony chirurgia endoskopowa u chorej w wieku podeszlym.

Inverted papilloma is a benign neoplasm of uncertain ethiology. The tumour is considered locally aggressive, its tendency to invade adjacent paranasal structures and high recurrence rate causes. In this work was described one case of 102 year's old patient with unilateral nasal obstruction since 5 month and headache. Endoscopy surgery was applied. Histological examination revealed inverted papilloma.

The case of monochorionic twin gestation complicated by intrauterine demise of one fetus in the first trimester.

The study investigated the clinical and pathomorphological characteristics of monochorionic diamniotic twin gestations complicated by the spontaneous loss of one fetus during the first trimester. Nine monochorionic diamniotic twin gestations were analyzed in which the demise of one fetus occurred during the first trimester. During the course of the study, 178 twin gestations were sonographically identified during the first trimester. Forty-three (24.2%) were complicated by the intrauterine demise of one fetus before the end of the 12th week of pregnancy. Nine cases were monochorionic diamniotic. The gestational age of the demised fetuses ranged between 5 and 11 weeks (mean 7.4 weeks). The prognoses for the surviving fetuses were rather poor with the surviving co-twin dying 1 to 3 weeks after the first twin, with abortion of both fetuses. In only one case was gestation concluded on the 40th week with delivery of a live neonate. No blood coagulation changes were observed in the affected pregnant women, and the one live newborn did not reveal any haematological or neurological abnormalities. A postnatal study provided evidence for the history of monochorionic diamniotic placentation in all of the cases. In two cases, probable causes of fetal death were established (congenital malformation, the presence of anastomoses between blood vessels). The obtained results suggest an extremely high risk of mortality for the surviving twin fetus following the co-twin's death in cases of monochorial placentation. The morphological evaluation of placentas and fetal membranes enables the establishment of the type of placenta and, in certain cases, the probable cause of the intrauterine demise of one twin fetus during the first trimester of monochorionic diamniotic twin gestation.

[Intrauterine death of one fetus during the first trimester of monochorionic diamniotic twin gestation]. / Zgon wewnatrzmaciczny jednego, z plodów w j trymestrze ciazy blizniaczej jednokosmówkowej dwuowodniowej.

OBJECTIVES: The goal of our study was the clinical and pathological characteristics of the monochorionic diamniotic twin gestations complicated by the intrauterine death of one fetus during the first trimester. MATERIAL AND METHODS: This study is a prospective review of 9 monochorionic diamniotic twin gestations involving the intrauterine death of one fetus during the first trimester. RESULTS: During the study period 178 twin gestations were identified sonographically during the first trimester. Forty three of them (24,2%) were complicated by the intrauterine death of one fetus before the end of 12th gestation week. Nine cases were monochorionic diamniotic. Gestational age of one fetus demise ranged from 5 to 11 (mean 7,4) weeks. Prognoses for surviving fetus were adverse. In 8 cases there was a death of a second fetus after the period of 1 to 3 weeks, with abortion of both fetuses. Only in one case, the gestation has finished in 40th week by delivery of liveborn infant. Maternal coagulation changes did not occur in those cases. One liveborn infant was without evidence of hematological and neurological abnormalities. The postdelivery examination allowed to establish a presence of monochorionic diamniotic placentation in all cases. In two of them, the probable causes of death were established (developmental defect, presence of anastomoses between blood vessels). CONCLUSION: These results suggest that the risk of mortality for the living twin is very high, after the death of its sibling, in case of monochorionic placentation. Morphological examination of placenta and fetal membranes lets to establish a type of placenta, and in some cases a probable cause of intrauterine death of one twin during the first trimester of monochorionic diamniotic twin gestation.

[New method of biopsy of palatine tonsils and its role in the indication for tonsillectomy (preliminary report)]. / Nowa metoda oligobiopsji migdalków podniebiennych i jej znaczenie w kwalifikacji do tonsillektomii (doniesienie wstepne)

In our work we presented a new method of chronic tonsillitis diagnosis and evaluated its usefulness in qualification to tonsillectomy. Oligobiopsies were obtained from right and left palatine tonsils of 36 patients who were qualified to tonsillectomy on the basis of past medical history, otolaryngological examination and laboratory tests findings. Following gauge of biopsy instruments were used: 2 mm, 3 mm, 4 mm. The material obtained at biopsies and tonsillectomies was histopathologically evaluated. Histopathological findings of specimens obtained at oligobiopsies and post tonsillectomies were compared. The presence of interstitial fibrosis, neutrophils infiltrates, hyperplastic changes of lymphoid follicles of palatine tonsils were evaluated in oligobiopsy specimens in comparison to the results of postoperative specimen findings. Full concordance of histopathological findings obtained at oligobiopsy and post tonsillectomy was noted with the use of biopsy instruments of 3 mm and 4 mm gauge. Specimens obtained at oligobiopsies had a great diagnostic value. It was proved that the biopsy performed according to our method has a great diagnostic value and helps surgeon to qualify patient to tonsillectomy.

[Rare case of papillary cystic carcinoma of ectopic thyroid gland in glossothyroid ductus]. / Rzadki przypadek raka brodawczakowato- torbielowatego ektopicznego gruczolu tarczowego przewodu tarczowo-jezykowego.

The neck midline cyst is the most common congenital malformation in the neck area. In described case of 33 years women the diagnosis was established on clinical examination, the results of USG and the aspiration biopsy. The tumor was surgically excited and the microscopy examination revealed papillary cystic carcinoma of ectopic thyroid gland in glossothyroid ductus. In the every case of neck tumor we have to consider neoplastic process.

[Possibilities and limitations of morphological diagnosis in early stages of colitis]. / Mozliwosci i ograniczenia diagnostyki patomorfologicznej we wczesnych fazach zmian zapalnych wjelicie grubym.

In the paper the most frequent difficulties in diagnosis of early stages of colitis has been presented. Also the most frequent sources of errors depending on methods of obtaining and fixing of material as well as diagnostic possibilities of various kinds of obtained biopsy material has been shown. The role of close cooperation between clinician and pathologist in the earliest stages of diagnostic efforts and final diagnosis has been emphasized.

[Ischaemic intestinal disease--still opened diagnostic clinical and pathomorphological problem]. / Choroba niedokrwienna jelita grubego--wciaz otwarty problem diagnostyczny dla klinicysty i patomorfologa.

Contemporary opinions on etiology and pathogenesis of ischaemic colitis have been presented. Diagnostic difficulties in endoscopic and pathologic examination of colonic ischaemic changes have also been discussed. Some aspects of differential diagnosis of ischaemic colitis has been discussed. The literature opinions and authors own experience indicate that ischaemic colitis is still serious histoclinical problem which could be resolved only if close cooperation of gastrologists and pathologists has been applied.

[Histoclinic of nonspecific inflammatory bowel diseases]. / Histoklinika nieswoistych stanów zapalnych jelita grubego.

In the paper pathomorphological indices of changes in inflammatory bowel lesions were presented. Additionally a clinicopathological correlation has been performed. The necessity of collaboration between gastroenterologist and pathomorphologist in diagnostic process of inflammatory bowel lesions has been indicated. The collaboration should mainly result from the lack of repeated morphological changes in most cases of inflammatory bowel lesions, but also from lack of specificity of signs and symptoms in these inflammations.